Advanced COPD Research Articles

Patient perspectives on the Tailored intervention for Anxiety and Depression Management in COPD (TANDEM): a qualitative evaluation

BackgroundChronic obstructive pulmonary disease (COPD) is commonly associated with anxiety/depression which can affect self-management and quality of life. The TANDEM trial evaluated a cognitive behavioural approach intervention targeting COPD-related symptoms of anxiety and/or depression, comprising up to eight one-to-one sessions delivered by respiratory healthcare professionals prior to pulmonary rehabilitation (PR). The intervention showed no improvement in anxiety/depression or uptake/completion of PR. We present patient perspectives of the intervention to help understand these results.MethodSemi-structured individual interviews, using a semi-structured topic guide informed by Sekhon’s Theoretical Framework of Acceptability, were conducted with 19 patients between September 2019 and April 2020. The interviews were audio-recorded, transcribed verbatim and analysed thematically.ResultsThe following could have limited the impact of the intervention: (1) The lives of patients were complex and commonly affected by competing comorbidities or other external stressors which they managed through previously adopted long-standing coping strategies. (2) Some patients were reluctant to talk about their mood despite the Facilitators' training and person centred-skills which aimed to enable patients to talk freely about mood. (3) The intervention handouts and ‘home-practice’ were perceived as helpful for some, but not suitable for all. (4) Many patients perceived improvements in their physical and mental health, but this was not sustained due to a mix of personal and external factors, and some did not perceive any benefits. (5) PR non-attendance/non-completion was a result of personal and PR service-related reasons. (6) Discussing COPD and mental health with the Facilitator was a novel experience. Many patients felt that TANDEM could be of benefit if it was offered earlier on/at different time points in the COPD illness journey.ConclusionWe found the delivery of TANDEM prior to PR was not helpful for patients with advanced COPD often experiencing other comorbidities, and/or difficult personal/external events. These patients already utilised long-standing coping strategies to manage their COPD. Holistic interventions, that address the impact of COPD in relation to wider aspects of a patients’ life, may be more beneficial.Trial registrationISRCTN Registry 59,537,391. Registration date 20 March 2017.

Dyspnea and Palliative Care in Advanced COPD: A Rapid Review.

Dyspnea and Palliative Care in Advanced COPD: A Rapid Review.

Development and application of a deep learning-based comprehensive early diagnostic model for chronic obstructive pulmonary disease

BackgroundChronic obstructive pulmonary disease (COPD) is a frequently diagnosed yet treatable condition, provided it is identified early and managed effectively. This study aims to develop an advanced COPD diagnostic model by integrating deep learning and radiomics features.MethodsWe utilized a dataset comprising CT images from 2,983 participants, of which 2,317 participants also provided epidemiological data through questionnaires. Deep learning features were extracted using a Variational Autoencoder, and radiomics features were obtained using the PyRadiomics package. Multi-Layer Perceptrons were used to construct models based on deep learning and radiomics features independently, as well as a fusion model integrating both. Subsequently, epidemiological questionnaire data were incorporated to establish a more comprehensive model. The diagnostic performance of standalone models, the fusion model and the comprehensive model was evaluated and compared using metrics including accuracy, precision, recall, F1-score, Brier score, receiver operating characteristic curves, and area under the curve (AUC).ResultsThe fusion model exhibited outstanding performance with an AUC of 0.952, surpassing the standalone models based solely on deep learning features (AUC = 0.844) or radiomics features (AUC = 0.944). Notably, the comprehensive model, incorporating deep learning features, radiomics features, and questionnaire variables demonstrated the highest diagnostic performance among all models, yielding an AUC of 0.971.ConclusionWe developed and implemented a data fusion strategy to construct a state-of-the-art COPD diagnostic model integrating deep learning features, radiomics features, and questionnaire variables. Our data fusion strategy proved effective, and the model can be easily deployed in clinical settings.Trial registrationNot applicable. This study is NOT a clinical trial, it does not report the results of a health care intervention on human participants.

Prognostication of co-morbidity clusters on hospitalisation and mortality in advanced COPD

RationaleAs the prevalence of multimorbidity increases, understanding the impact of isolated comorbidities in people COPD becomes increasingly challenging. A simplified model of common comorbidity patterns may improve outcome prediction and allow targeted therapy. ObjectivesTo assess whether comorbidity phenotypes derived from routinely collected clinical data in people with COPD show differences in risk of hospitalisation and mortality. MethodsTwelve clinical measures related to common comorbidities were collected during annual reviews for people with advanced COPD and k-means cluster analysis performed. Cox proportional hazards with adjustment for covariates was used to determine hospitalisation and mortality risk between clusters. Measurements and main resultsIn 203 participants (age 66 ± 9 years, 60 % male, FEV1%predicted 31 ± 10 %) no comorbidity in isolation was predictive of worse admission or mortality risk. Four clusters were described: cluster A (cardiometabolic and anaemia), cluster B (malnourished and low mood), cluster C (obese, metabolic and mood disturbance) and cluster D (less comorbid). FEV1%predicted did not significantly differ between clusters. Mortality risk was higher in cluster A (HR 3.73 [95%CI 1.09–12.82] p = 0.036) and B (HR 3.91 [95%CI 1.17–13.14] p = 0.027) compared to cluster D. Time to admission was highest in cluster A (HR 2.01 [95%CI 1.11–3.63] p = 0.020). Cluster C was not associated with increased risk of mortality or hospitalisation. ConclusionsDespite presence of advanced COPD, we report striking differences in prognosis for both mortality and hospital admissions for different co-morbidity phenotypes. Objectively assessing the multi-system nature of COPD could lead to improved prognostication and targeted therapy for patients.

Chemosensory function and food perception is affected in COPD, but unrelated to sarcopenia risk

Background & AimsPatients with advanced COPD often have difficulty maintaining sufficient dietary intake. Chemosensory function influences food choice and intake but is often overlooked in dietary assessment and intervention strategies. This study aimed to assess differences in chemosensory function and hedonic evaluation of food between patients with COPD and age- and gender-matched healthy controls. Additionally, a possible association between increased risk of sarcopenia or frailty and chemosensory impairments was explored. MethodsWe recruited 53 COPD patients (34 males, mean age 66.6 ±7.6 years) and 53 controls (25 males, mean age 68.4 ±5.7 years). Chemosensory function was assessed using a smell threshold, smell identification (Sniffin’ Sticks, Burghart) and taste recognition test (Taste Strips, Burghart) and through self-report. Sensory properties (appearance, smell, taste, mouthfeel) of four standardized food products were evaluated on 9-point hedonic rating scales. Sarcopenia risk was assessed with the SARC-F. ResultsThe COPD group scored lower on both the smell (p=.026 for threshold, p=.001 for identification) and taste recognition tests (p≤.001) and also reported more smell and taste impairments (p≤.001) compared to controls. Hedonic evaluation of food items’ appearance (p=.009) and smell (p=.033) was lower in COPD patients. Within the COPD group, risk of sarcopenia was not associated with chemosensory function. ConclusionThis study demonstrates that COPD patients have poorer chemosensory function and experience more impairments compared to controls. COPD patients also tend to evaluate foods less positive than do their controls but within COPD patients, sarcopenia risk is not associated with chemosensory function.

Evaluation of Peak Inspiratory Flow Rate in Hospitalized Palliative Care Patients with COPD.

Dry powder inhalers are an effective yet costly COPD medication-delivery device. Patients must possess a minimum peak inspiratory flow rate (PIFR) for inhaled medication to be properly deposited into the lungs. Hospitalized palliative-care patients with diminished lung function due to advanced COPD may not possess the minimum PIFR (30 L/min) for adequate drug delivery. This study aims to quantify PIFR values for hospitalized palliative-care patients with advanced COPD to evaluate whether these patients meet the minimum PIFR requirements. Hospitalized patients ≥18 years old with a palliative-care consultation were eligible if they had a diagnosis of advanced COPD (GOLD C or D). Patients were excluded if they lacked decision-making capacity or had a positive COVID-19 test within the previous 90 days. Three PIFR values were recorded utilizing the In-CheckTM device, with the highest of the three PIFR attempts being utilized for statistical analysis. Eighteen patients were enrolled, and the mean of the highest PIFR readings was 72.5 L/min (±29 L/min). Post hoc analysis indicated 99.9% power when comparing the average best PIFR to the minimum PIFR (30 L/min) but only 51.4% power when compared to the optimal PIFR (60 L/min). This study found that palliative-care patients possess the minimum PIFR for DPI drug delivery.

Meditative movement for breathlessness in advanced COPD or cancer: a systematic review and meta-analysis.

The effect of meditative movement, which includes yoga, tai chi and qi gong, on breathlessness in advanced disease is unknown. This systematic review aims to comprehensively assess the evidence on the effect of meditative movement on breathlessness (primary outcome), health-related quality of life, exercise capacity, functional performance and psychological symptoms (secondary outcomes) in advanced disease. 11 English and Chinese language databases were searched for relevant trials. Risk of bias was assessed using the Cochrane tool. Standardised mean differences (SMDs) with 95% confidence intervals were computed. 17 trials with 1125 participants (n=815 COPD, n=310 cancer), all with unclear or high risk of bias, were included. Pooled estimates (14 studies, n=671) showed no statistically significant difference in breathlessness between meditative movement and control interventions (SMD (95% CI) 0.10 (-0.15-0.34); Chi2=30.11; I2=57%; p=0.45), irrespective of comparator, intervention or disease category. Similar results were observed for health-related quality of life and exercise capacity. It was not possible to perform a meta-analysis for functional performance and psychological symptoms. In conclusion, in people with advanced COPD or cancer, meditative movement does not improve breathlessness, health-related quality of life or exercise capacity. Methodological limitations lead to low levels of certainty in the results.

Circulating Hsp70 Levels and the Immunophenotype of Peripheral Blood Lymphocytes as Potential Biomarkers for Advanced Lung Cancer and Therapy Failure after Surgery.

Lung cancer remains a devastating disease with a poor clinical outcome. A biomarker signature which could distinguish lung cancer from metastatic disease and detect therapeutic failure would significantly improve patient management and allow for individualized, risk-adjusted therapeutic decisions. In this study, circulating Hsp70 levels were measured using ELISA, and the immunophenotype of the peripheral blood lymphocytes were measured using multiparameter flow cytometry, to identify a predictive biomarker signature for lung cancer patients pre- and post-operatively, in patients with lung metastases and in patients with COPD as an inflammatory lung disease. The lowest Hsp70 concentrations were found in the healthy controls followed by the patients with advanced COPD. Hsp70 levels sequentially increased with an advancing tumor stage and metastatic disease. In the early-recurrence patients, Hsp70 levels started to increase within the first three months after surgery, but remained unaltered in the recurrence-free patients. An early recurrence was associated with a significant drop in B cells and an increase in Tregs, whereas the recurrence-free patients had elevated T and NK cell levels. We conclude that circulating Hsp70 concentrations might have the potential to distinguish lung cancer from metastatic disease, and might be able to predict an advanced tumor stage and early recurrence in lung cancer patients. Further studies with larger patient cohorts and longer follow-up periods are needed to validate Hsp70 and immunophenotypic profiles as predictive biomarker signatures.

PANDORA dyadic project: hope, spiritual well-being and quality of life of dyads of patients with chronic obstructive pulmonary disease in Switzerland – a multicentre longitudinal mixed-methods protocol study

IntroductionChronic obstructive pulmonary disease (COPD) is responsible for 2.9 million deaths annually in Europe. Symptom burden and functional decline rise as patients reach advanced stages of the disease enhancing risk...

Supplemental oxygen and noninvasive ventilation.

The respiratory system attempts to maintain normal levels of oxygen and carbon dioxide. However, airflow limitation, parenchymal abnormalities and dysfunction of the respiratory pump may be compromised in individuals with advanced COPD, eventually leading to respiratory failure, with reduced arterial oxygen tension (hypoxaemia) and/or increased arterial carbon dioxide tension (P aCO2 ; hypercapnia). Hypoxaemia may persist in individuals with severe COPD despite smoking cessation and optimisation of pharmacotherapy. Long-term oxygen therapy (LTOT) can improve survival in those with severe daytime hypoxaemia, whereas those with less severe hypoxaemia may only have improved exercise capacity and dyspnoea. Changes in respiratory physiology that occur during sleep further predispose to hypoxaemia, particularly in individuals with COPD. However, the major cause of hypoxaemia is hypoventilation. Noninvasive ventilation (NIV) may reduce mortality and need for intubation in individuals with COPD and acute hypercapnic respiratory failure. However, NIV may also improve survival and quality of life in individuals with stable, chronic hypercapnia and is now suggested for those with prolonged hypercapnia (e.g. P aCO2 >55 mmHg 2-6 weeks after hospital discharge) when clinically stable and after optimisation of medical therapy including LTOT if indicated. Many questions remain about the optimal mode, settings and goal of NIV therapy.

Proteomics and metabolomics profiling reveal panels of circulating diagnostic biomarkers and molecular subtypes in stable COPD

BackgroundChronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease with high morbidity and mortality, especially in advanced patients. We aimed to develop multi-omics panels of biomarkers for the diagnosis and explore its molecular subtypes.MethodsA total of 40 stable patients with advanced COPD and 40 controls were enrolled in the study. Proteomics and metabolomics techniques were applied to identify potential biomarkers. An additional 29 COPD and 31 controls were enrolled for validation of the obtained proteomic signatures. Information on demographic, clinical manifestation, and blood test were collected. The ROC analyses were carried out to evaluate the diagnostic performance, and experimentally validated the final biomarkers on mild-to-moderate COPD. Next, molecular subtyping was performed using proteomics data.ResultsTheophylline, palmitoylethanolamide, hypoxanthine, and cadherin 5 (CDH5) could effectively diagnose advanced COPD with high accuracy (auROC = 0.98, sensitivity of 0.94, and specificity of 0.95). The performance of the diagnostic panel was superior to that of other single/combined results and blood tests. Proteome based stratification of COPD revealed three subtypes (I–III) related to different clinical outcomes and molecular feature: simplex COPD, COPD co-existing with bronchiectasis, and COPD largely co-existing with metabolic syndrome, respectively. Two discriminant models were established using the auROC of 0.96 (Principal Component Analysis, PCA) and 0.95 (the combination of RRM1 + SUPV3L1 + KRT78) in differentiating COPD and COPD with co-morbidities. Theophylline and CDH5 were exclusively elevated in advanced COPD but not in its mild form.ConclusionsThis integrative multi-omics analysis provides a more comprehensive understanding of the molecular landscape of advanced COPD, which may suggest molecular targets for specialized therapy.

Caring for patients with advanced COPD: beyond the inhalers….

To understand the multidisciplinary approach to management of patients with advanced COPD.To recognise the parallel approaches to oxygen, NIV and dyspnoea management with consideration of more interventional options with lung volume reduction therapy or lung transplantation.To understand the high level of symptomatology present in advanced COPD and the relevance of palliative care alongside optimal medical management.

Pulmonary Arterial Hypertension in COPD and its Correlation with Disease Severity

Background: Pulmonary arterial hypertension is a condition that develops in advanced stages of chronic obstructive pulmonary disease. The development of pulmonary arterial hypertension indicate poor prognosis. Objective: To assess the arterial hypertension in COPD and its correlation with disease severity Methodology: This descriptive study was carried out at the Pulmonology department, Fatima Jinnah Institute of Chest Diseases and Sheikh Khalifa Bin Zayyed Al Nahyan Medical Complex Quetta from December 2021 to May 2022. The severity of COPD was measured by FEV1 (spirometry). All the data was collected by using a pre-designed proforma. The data was analyzed via SPSS version 24. Results: In this study, totally 80 patients were enrolled. The male participants in our study were 42 (52.5%) while female participants were 38 (48.5%). The overall frequency of pulmonary arterial hypertension in COPD was 28 (35%). There was a statistically significant positive association between the severity of COPD and presence of pulmonary arterial hypertension (p=0.038). Conclusion: Our study concludes that the most common complication of COPD is pulmonary arterial hypertension and should be investigated particularly in patients with advanced (severe and very severe) COPD in order to reduce the morbidity and mortality. Keywords: Prevalence, Pulmonary arterial Hypertension, Chronic obstructive pneumonic disease

Safety and Considerations of the Anaesthetic Management during Bronchoscopic Lung Volume Reduction Treatments

Background: Different bronchoscopic lung volume reduction approaches are available for a select group of patients with advanced COPD. General anaesthesia is the recommended method of sedation during these procedures. However, this patient population is at an increased risk of anaesthetic complications, and the best approach to general anaesthesia and mechanical ventilation is unknown. Objectives: The aims of this study were to describe the anaesthetic management techniques used during bronchoscopic lung volume reduction procedures and to investigate the number of anaesthesia-related events. Methods: Data were retrospectively collected from all endobronchial valve and lung volume reduction coil procedures performed between January 2018 and March 2020 in our hospital. Primary outcomes measures were anaesthetic technique including airway management; ventilation mode and settings; and the incidence of anaesthesia-related events, classified as catastrophic, severe, significant, or moderate. Results: 202 procedures were included. One procedure was performed under procedural sedation, 198 (98%) under general anaesthesia with endotracheal intubation, and 3 (1.5%) under general anaesthesia with laryngeal mask airway. Volume-controlled ventilation was used in 64% of the procedures and pressure-controlled in 36%. Patients were ventilated with a median respiration rate of 9.9 (IQR: 9.6–10.6) breaths per minute, mean tidal volume of 5.8 ± 1.4 mL/kg, and median inspiratory to expiratory (I:E) ratio of 1:2.8 (IQR: 1:2.1–1:3.2). No catastrophic anaesthesia-related events were observed. Hypotension was the most observed anaesthesia-related event. Conclusions: Despite the presence of advanced COPD, general anaesthesia and mechanical ventilation are well tolerated by patients undergoing endobronchial valve or lung volume reduction coil treatment. This is presumably strongly linked to the strict selection criteria. Other important considerations are using a low respiratory rate, low tidal volume, and high I:E ratio.

Clinical Implications of Low Absolute Blood Eosinophil Count in the SPIROMICS COPD Cohort

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) considers blood eosinophil counts< 100 cells/μL (BEC≤100) in people with COPD to predict poor inhaled corticosteroid (ICS) responsiveness. However, the BEC≤100 phenotype is inadequately characterized, especially in advanced COPD. Are there differences between GOLD group D patients with high BEC and those with low BEC regarding baseline characteristics and longitudinal outcomes? We used multivariable mixed models and logistic regression to contrast clinical characteristics and outcomes of BEC≤100 vsBEC > 100 (BEC100+) in all subjects with COPD (n= 1,414) and GOLD group D subjects (n= 185) not receiving ICS. We identified n= 485 with BEC≤100 (n= 61 GOLD group D) and n= 929 people with BEC100+ (n= 124 GOLD group D). BEC≤100 status was stable at 6weeks and approximately 52weeks (intraclass correlations of 0.78 and 0.71, respectively). Compared with BEC100+, BEC≤100 comprised more women, with greater current smoking, and less frequent childhood asthma. Among all analyzed participants, the two BEC-defined subsets showed similar rates of lung function decline (mean slope, BEC≤100 vsBEC100+, -50 vs-39mL/y; P= .140), exacerbations (0.40 vs0.36/y; P= .098), subsequent ICS initiation (2.5%vs4.4%; P= .071), and mortality (7.8%vs8.4%; P= .715). However, in GOLD group D, people with BEC≤100 showed higher exacerbation rates within 365days of enrollment (0.62 vs0.33/y; P= .002) and total follow-up (1.16 vs0.83/y; P= .014). They also had greater lung function decline (mean slope of -68mL/y vs-23mL/y; P= .036) and had greater emphysema at baseline (voxels< 950 Hounsfield units at total lung capacity of 7.46%vs4.61%; P= .029). In non-ICS-treated GOLD group D COPD, people with BEC≤100 had more baseline emphysema, prospective exacerbations, and lung function decline. Our analysis has identified a particularly vulnerable subpopulation of people with COPD, suggesting the need for studies focused specifically on their therapeutic treatment. ClinicalTrials.gov; No.: NCT01969344; URL: www. gov.

Risk of revision in UKA versus HTO: a nationwide propensity score-matched study.

Our study aims to investigate the incidence rate and risk factors for subsequent revision in patients treated with UKA compared with those treated with HTO. In this retrospective nationwide cohort study, we used data from the Korean National Health Insurance claims database from January 1, 2009 to December 31, 2017. We compared patients who had undergone UKA or HTO as the primary surgical procedure longer than two years prior. We used multivariable logistic regression models to compare risk of revision between the groups after propensity matching with inverse probability of treatment weighting (IPTW). Revision was defined as conversion to total knee arthroplasty (TKA) after primary UKA or HTO. In this study, 73,902 patients with UKA and 72,215 patients with HTO were identified after applying IPTW. The risk of revision during the entire study period was higher for patients with HTO than for patients with UKA (adjusted hazard ratio [HR] = 1.42). Kaplan-Meier 8-years survival was 96.8% in the UKA group and 95.1% in the HTO group. Patients with HTO who were at higher risk of revision had advanced age (60-69years [HR = 2.17, 95% CI 1.76-2.67] and 70-79years [HR = 2.89, 95% CI 1.81-4.62]), female sex (HR = 1.41, 95% CI 1.19-1.66), CHF (HR = 3.12, 95% CI 1.25-7.78), COPD (HR = 1.68, 95% CI 1.34-2.10), PVD (HR = 1.75, 95% CI 1.10-2.78), and CVA or TIA (HR = 1.87, 95% CI 1.13-3.08) compared with those with UKA. Risk of revision was higher for patients with HTO than for patients with UKA. Risk factors for subsequent revision in patients with HTO were advanced age (60-69, 70-79), female sex, and comorbidities such as CHF, COPD, PVD, CVA, or TIA. However, orthopedic surgeons should also consider that TKA conversion from UKA has higher risk of revision than TKA conversion from HTO before choosing between UKA and HTO.

FIRE IN THE HOLE: GIANT BULLOUS LUNG DISEASE IN A VETERAN WITH BURN PIT EXPOSURE AND SMOKING

FIRE IN THE HOLE: GIANT BULLOUS LUNG DISEASE IN A VETERAN WITH BURN PIT EXPOSURE AND SMOKING

Anesthetic considerations in the patients of chronic obstructive pulmonary disease undergoing laparoscopic surgeries

Context: COPD is a progressive, chronic inflammatory disorder that permanently reduces one's ability to breathe out during expiration. "COPD is a preventable and curable illness with some important extrapulmonary consequences that may add to the severity in individual individuals," as stated by the worldwide effort for COPD guideline (GOLD). The pulmonary (airway) restriction often worsens with time and is not completely reversible since it is linked to an inappropriate inflammatory response of the lung to unpleasant particles or gases. This article provides an overview of the different anaesthetic options available for patients with severe COPD undergoing laparoscopic procedures. The above discussion suggests that LC is not only possible under RA, but should be considered as a valid option for the patients who are poor candidates for GA, such as those with advanced COPD, because it reduces the risk of atelectasis, the impact on closing capacity and FRC, the maintenance of pulmonary gas exchange, and the duration of the postoperative recovery period.

Serum Vitamin D Level in Chronic Obstructive Pulmonary Disease and its Relation with Severity

Introduction: The COPD is a serious epidemic-level public health issue. Patients with COPD have been found to have low vitamin D serum levels in a number of studies. Aim: The goal of the study was to determine whether there was a relationship between vitamin D serum levels and the severity of COPD by comparing the levels in COPD patients at stages II, III, and IV to those in the control group. Study Design: A Cross-sectional study Place and Duration: In the Pulmonology department of Lady Reading Hospital, Peshawar and District Headquarter Hospital, Timergara Dir-Lower KPK during the period from January 2022 to June 2022. Methods: The study included 140 participants in total, including 70 COPD patients and 70 controls for comparison. Patients were included from the outpatient department and medical wards. According to GOLD guidelines, advanced COPD staging II, III, and IV were done. In SPSS 21.0, inferential and descriptive statistics were accomplished. Results: COPD was found in 34.3%, 37.1%, and 28.6% of people in stages II, III, and IV, respectively. There was a statistically significant relationship between lower vitamin D levels and advanced COPD patients, with the mean vitamin D serum concentration in COPD patients being 16.01 ng/ml and the vitamin D mean concentration in healthy controls being 35.98 ng/ml. (p&lt;0.0001). The severity of COPD was supposed to be inversely related with vitamin D serum levels. Conclusions: The vitamin D serum levels were found lesser in patients with advanced COPD (stages II, III, and IV) than in the general population correlated with GOLD staging. Keywords: Global initiative for chronic obstructive lung diseases; Chronic obstructive pulmonary disease and Vitamin D levels

Comparison of the Effectiveness of Long Acting Beta 2 Agonist and Long Acting Antimuscuranics with Long Acting Beta 2 Agonist/Long Acting Antimuscuranics Plus Inhaled Corticosteroids in preventing Exacerbations of patients with Chronic Obstructive Pulmonary Disease Targeted by Blood Eosinophils

Objective: To compare the efficacy of long acting beta 2 agonist and long acting antimuscuranics with long acting beta 2 agonist/long acting antimuscuranics plus inhaled corticosteroids in preventing exacerbations of chronic obstructive pulmonary disease and its relationship with increased eosinophils level. Study Design: Randomized control trial Place and Duration Study: Department of Pulmonology, Fauji Foundation Hospital, Rawalpindi from 7th February 2018 to 6th August 2018. Methodology: Seventy patients with chronic obstructive pulmonary disease were enrolled. They were divided in two groups; Group A receiving LABA/LAMA combination and Group B receiving LABA/LAMA plus ICS combination. Both groups treatment efficacy was related with increased eosinophils count. Patients were regularly followed and number of exacerbations in the first three months was noted. At the completion of the study, the rate of exacerbations among the 2 groups was compared. Results: The rate of efficacy in LABA/LAMA and LABA/LAMA plus ICS group was 62.9% and 85.7% respectively. Efficacy was more achieved in LABA/LAMA plus ICS group in patients whose eosinophil count was ≥ 2% up to 90.5% and was 78.6% whose eosinophil count was ≤ 2%. Conclusion: Treatment with long acting beta 2 agonist/long acting antimuscuranic plus inhaled corticosteroids is more effective in preventing exacerbations of patients with advanced COPD than with long acting beta 2 agonist and long acting antimuscuranic. Keywords: Chronic obstructive pulmonary disease, Long acting beta 2 agonist, Long acting antimuscuranics, Inhaled corticosteroids, Efficacy, Eosinophilia