Cause Of Exacerbations Research Articles

Risk Factors for Influenza-Induced Exacerbations and Mortality in Non-Cystic Fibrosis Bronchiectasis.

Influenza infection is a cause of exacerbations in patients with chronic pulmonary diseases. The aim of this study was to investigate the clinical outcomes and identify risk factors associated with hospitalization and mortality following influenza infection in adult patients with bronchiectasis. Using the Chang Gung Research Database, we identified patients with bronchiectasis and influenza-related infection (ICD-9-CM 487 and anti-viral medicine) between 2008 and 2017. The main outcomes were influenza-related hospitalization and in-hospital mortality rate. Eight hundred sixty-five patients with bronchiectasis and influenza infection were identified. Five hundred thirty-six (62%) patients with bronchiectasis were hospitalized for influenza-related infection and 118 (22%) patients had respiratory failure. Compared to the group only seen in clinic, the hospitalization group was older, with more male patients, a lower FEV1, higher bronchiectasis aetiology comorbidity index (BACI), and more acute exacerbations in the previous year. Co-infections were evident in 55.6% of hospitalized patients, mainly caused by Pseudomonas aeruginosa (15%), fungus (7%), and Klebsiella pneumoniae (6%). The respiratory failure group developed acute kidney injury (36% vs. 16%; p < 0.001), and shock (47% vs. 6%; p < 0.001) more often than influenza patients without respiratory failure. The overall mortality rate was 10.8% and the respiratory failure group exhibited significantly higher in-hospital mortality rates (27.1% vs. 6.2%; p < 0.001). Age, BACI, and previous exacerbations were independently associated with influenza-related hospitalization. Age, presence of shock, and low platelet counts were associated with increased hospital mortality. Influenza virus caused severe exacerbation in bronchiectasis, especially in those who were older and who had high BACI scores and previous exacerbations. A high risk of respiratory failure and mortality were observed in influenza-related hospitalization in bronchiectasis. We highlight the importance of preventing or treating influenza infection in bronchiectasis.

Analysis of length of stay and treatment emergent complications in hospitalized myasthenia gravis patients with exacerbation

IntroductionAIMSMyasthenia Gravis (MG) is an autoimmune neuromuscular disease in which patients suffer from recurrent exacerbation. There are insufficient data measuring the effects of the resources employed before and during acute exacerbation on subsequent disease outcomes. This study aims to identify factors which lead to lengthened hospital stay.MethodsThis is a retrospective chart review of acute MG exacerbations requiring hospitalization. Exacerbations were identified using ICD-9/ICD-10 codes and considered the following variables: age and Myasthenia Gravis Foundation of America (MGFA) class at initial MG diagnosis, age and MGFA class at exacerbation, sex, thymectomy, cause of exacerbation, treatment regimen at time of exacerbation, inpatient treatment regimen, length of hospital stay (LOS), intubation, use of noninvasive ventilation, complications, and disposition.ResultsSeventy patients with 141 hospitalizations were identified. Crisis management characterized by intubation and plasmapheresis positively correlated with LOS (both p < .001). Almost 1/5 hospitalizations required intubation. Previous thymectomy negatively correlated with LOS (p < .05). In contrast, male sex correlated with longer LOS (p < .05). One-third of hospital stays were followed by discharge to a post-acute care facility, 7% home with home health, and 1 hospitalization resulted in death.DiscussionPlasmapheresis, intubation, and male sex were associated with increased LOS in acute MG exacerbation. Intubation appears to be the strongest predictor of LOS. Those with previous thymectomy had shorter hospital stays. The role of thymectomy in the acute setting merits further analysis.

Noninvasive ventilation in acute exacerbation of interstitial lung diseases

Introduction Noninvasive ventilation (NIV) has been recognized as a mean to avoid intubation and to reduce the risk of complications. Aims To study the role of NIV in acute respiratory failure in patients with interstitial lung diseases (ILD). Settings and design This was a prospective study. Patients and methods The present study included 30 mechanically ventilated patients through noninvasive masks subjected basically to informed consent, clinical data collection, laboratory investigations, chest radiograph, and arterial blood gas samples. Results A total of 20 patients were found to be survivors, whereas 10 patients were found to be nonsurvivors. The most common type of ILD in our study was hypersensitivity pneumonitis (53.3% of all patients) with fibrosis, and ground glass opacities were the most common radiological findings on high-resolution computed tomography, and moderate restrictive pattern in pulmonary function tests. Infection was the main cause of exacerbation as evidenced by fever, elevated total leukocytic count, staff neutrophilic count, and erythrocyte sedimentation rate. None of our patients developed complications or intolerance to NIV. Conclusion There was improvement in oxygenation parameters, so NIV could be a valuable option for management of acute type I mild to moderate respiratory failure in patients with ILD.

Nothrus mite as a potential cause of exacerbation of pruritus in a cat.

Morphological and molecular approaches were used to identify arthropods associated with feline pruritus. The literature associated with the arthropod genus identified was reviewed. On two occasions (summer 2020 and summer 2021), the owner of a cat with seasonal pruritus (commenced 2020) found the cat's bed was substantially infested with arthropods suspected of being associated with exacerbated pruritus. The pruritus was largely itching and hair loss, particularly on the abdomen, and flaking skin patches. On the second occasion (2021), examples of the arthropods were sent to the parasitology laboratory at the Norwegian University of Life Sciences for identification. They were examined by stereomicroscopy and tentatively identified based on morphology. DNA was extracted, and identification confirmed by PCR and sequencing. The literature was reviewed to determine whether this arthropod genus has previously been considered to be associated with pruritus or the infestation of mammals. Based on morphological characteristics, the arthropods were tentatively identified as Nothrus species mites. This was confirmed by PCR. A literature review found no previous reports of pruritus or other clinical signs associated with Nothrus species mites, and mites were not found on the cat. However, this mite has previously been found on small mammals at densities exceeding that expected of incidental stragglers. The large number of Nothrus species mites could have exacerbated the cat's pruritus. By publishing this study, we hope to alert veterinarians to the possibility that Nothrus species mites may cause or exacerbate pruritus in cats.

The COPD Foundation's COPD360Net Initiative Approach to Patient-Centric Drug Development: A Case Study in Using Patient Surveys to Inform New Treatments for Viral Respiratory Infections.

Patient-centric drug development is crucial to creating treatments that address unmet patient needs but is often ignored. The COPD Foundation's COPD360Net® includes a multistakeholder approach for operationalizing patient-centric development of treatments where patients, caregivers, scientists, and clinicians review opportunities based on scientific merit, potential to address an unmet need, and feasibility of adoption. COPD360Net deploys large-scale online community surveys to review profiles of potential therapies based on those criteria. This approach was implemented to inform the development of an intranasal spray to prevent viral respiratory infections (VRIs), a major cause of exacerbations in people with chronic lung diseases. Insights included: Of the 376 respondents with COPD surveyed, frequent exacerbators reported strong interest in a new type of antiviral nasal spray to prevent VRI.Patient survey and advisory committee insights demonstrated that a pan antiviral nasal spray has potential high value to both clinicians and patients and informed the COPD360Net decision to partner on its development.Including patient perspectives from the outset can be conducted efficiently by mobilizing an engaged online patient community.

A CASE OF NEAR-FATAL ASTHMA EXACERBATION

A CASE OF NEAR-FATAL ASTHMA EXACERBATION

LONG-TERM MORTALITY IN HOSPITALIZED PATIENTS WITH COVID-19 AND PREEXISTING ASTHMA

LONG-TERM MORTALITY IN HOSPITALIZED PATIENTS WITH COVID-19 AND PREEXISTING ASTHMA

Management of patients with allergic diseases in the era of COVID-19.

In the early days of the coronavirus disease 2019 (COVID-19) pandemic, allergic diseases, especially asthma, were considered to be risk factors for severe COVID-19 infection, hospitalization, and death. These concerns stemmed from the idea that individuals with allergic diseases are generally more susceptible to respiratory virus infections, which are major causes of exacerbation of allergic diseases. However, epidemiologic data with mechanistic studies showed that the associations between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and clinical outcomes of allergic diseases are complex and affected by diverse factors such as allergic disease severity, phenotypes, and control status with current medications. In addition, children generally have less severe clinical outcomes of COVID-19 than those of adults, which complicates the association between allergic diseases and COVID-19-related outcomes among them. The present review summarizes the potential association between allergic diseases and COVID-19-related outcomes and discusses the factors requiring consideration. The findings viewed herein will aid the management of allergic diseases in patients with SARS-CoV-2 infection and the establishment of medical polices for managing patients with allergic diseases.

Peculiarities of manifestations of chronic diseases after a COVID-19 coronavirus infection

Introduction.A new coronavirus infection COVID-19 is the cause of exacerbation of chronic diseases, increasing number of referrals for diseases of the digestive and circulatory systems. The urgent task in the post-co-infection period becomes the planning of health care resources and organization of timely accessible medical care, including the rehabilitation of patients after COVID-19.The aim of the workwas to study specific features of manifestations of chronic noninfectious diseases in persons after COVID-19 coronavirus infection to substantiate preventive and rehabilitative measures.Materials and Methods.The retrospective analysis of the outpatient charts (form N 025/u) of patients who underwent COVID-19 was carried out.Results.In the group with mild course of COVID-19 the frequency of cases of digestive organs diseases increased from 13.7 % to 22.7 %. In the group of patients with a moderate course of COVID-19 the share of appeals for circulatory system diseases increased from 14,8 % to 21,6 %, for digestive organs diseases from 16,7 to 21,6 %.Discussion.The peculiarity of the postcoid period is the increase in the incidence of chronic non-infectious diseases of the population. Cardiovascular, pulmonary, gastrointestinal, neurological and psychosocial symptoms of postvoid syndrome are revealed. The high prevalence of disease in the working-age population requires special attention to the organization of primary health care in a prolonged pandemic.Conclusion.In the structure of nosological forms of diseases in the postcoid period in patients with mild COVID-19 the highest frequency of cases is associated with diseases of the digestive organs, their proportion increased almost twofold. In patients with the moderate form of COVID-19 the reason for visiting the polyclinic is diseases of the circulatory system and digestive organs (21,6 %). Peculiarities of manifestations of chronic diseases after COVID-19 coronavirus infection can be taken into account when conducting clinical examination of the population and implementing rehabilitation measures.

Analysis of Time Series Gene Expression and DNA Methylation Reveals the Molecular Features of Myocardial Infarction Progression.

Myocardial infarction (MI) is one of the deadliest diseases in the world, and the changes at the molecular level after MI and the DNA methylation features are not clear. Understanding the molecular characteristics of the early stages of MI is of significance for the treatment of the disease. In this study, RNA-seq and MeDIP-seq were performed on heart tissue from mouse models at multiple time points (0 h, 10 min, 1, 6, 24, and 72 h) to explore genetic and epigenetic features that influence MI progression. Analysis based on a single point in time, the number of differentially expressed genes (DEGs) and differentially methylated regions (DMRs) increased with the time of myocardial infarction, using 0 h as a control group. Moreover, within 10 min of MI onset, the cells are mainly in immune response, and as the duration of MI increases, apoptosis begins to occur. Analysis based on time series data, the expression of 1012 genes was specifically downregulated, and these genes were associated with energy metabolism. The expression of 5806 genes was specifically upregulated, and these genes were associated with immune regulation, inflammation and apoptosis. Fourteen transcription factors were identified in the genes involved in apoptosis and inflammation, which may be potential drug targets. Analysis based on MeDIP-seq combined with RNA-seq methodology, focused on methylation at the promoter region. GO revealed that the downregulated genes with hypermethylation at 72 h were enriched in biological processes such as cardiac muscle contraction. In addition, the upregulated genes with hypomethylation at 72 h were enriched in biological processes, such as cell-cell adhesion, regulation of the apoptotic signaling pathway and regulation of angiogenesis. Among these genes, the Tnni3 gene was also present in the downregulated model. Hypermethylation of Tnni3 at 72 h after MI may be an important cause of exacerbation of MI.

A Survey of Antibiotic Usage Characteristics in Treatment of Acute Exacerbation of COPD Patients in National Hospital 74

Acute exacerbation of COPD (AECOPD) represents a pivotal point in the progression of COPD, which is a major cause of physician visits, hospitalization, and death in COPD patients. Bacterial respiratory infections have long been considered the main cause of exacerbations. This study was conducted with the aim of surveying the antibiotic usage characteristics in AECOPD of hospitalized patients at National Hospital 74. Data were collected from 265 patients hospitalized from January 1st, 2021 to March 31st, 2021. Most of the patients in the study were male (82.3%) and had comorbidities (74.7%). The most isolated bacteria were Haemophilus influenzae, Moraxella catarrhalis, and Pseudomonas aeruginosa. The majority of patients did not change their antibiotic regimen during treatment (61.5%). Alternative regimens in patients having regimen changes tended to be more focused on Pseudomonas aeruginosa than the first regimens. In the antibiotic-containing regimens tested antibiograms of 38 patients with isolated bacteria, most of the regimens had at least 1 antibiotic sensitive to the isolated bacteria (38.5%). The results of this study provide reliable information for making recommendations to contribute to improving the effectiveness of antibiotic usage in the AECOPD treatment at National Hospital 74, reducing the medical burden for patients and society.

Evaluation of respiratory Failure in Patients with Chronic Obstructive Pulmonary disease

Objectives: - The aim of the present study is to evaluate the clinical profile, investigations, treatment protocol and the response to the therapy in patient of COPD presenting with Respiratory failure.&#x0D; Materials and Methods: - All those patient with COPD with respiratory failure admitted in IPD in department of Respiratory Medicine R. D. Gardi Medical College Ujjain included in the study. Patients were evaluated by a detailed history, clinical examination, chest radiograph, arterial blood gas analysis and relevant blood investigation and were put on treatment. All the information was written in a proforma and the results were analysed.&#x0D; Results: - Majority of the patients were males (83.3%) with mean age of 65 years. In our study, the most common risk factor for COPD with respiratory failure was found to be smoking (80%). Nearly 70% cases were having type 2 respiratory failure. The main causes of exacerbations were bronchospasm(88.3%) and secondary infection (68.4%). 65% of the patients were discharged on room air with medical treatment, 23.3% patients were discharge on home oxygen with medical treatment, 3.33% patients discharged on NIV along with medical treatment and 5 patients died during hospitalization.&#x0D; Conclusion: - It is very important to take holistic approach toward COPD patient with respiratory failure. Early diagnosis, prompt treatment, pulmonary rehabilitation and vaccination are mainstay of management modalities and to prevent further exacerbation in patients.&#x0D;

Biomarkers to guide the use of antibiotics for acute exacerbations of COPD (AECOPD): a systematic review and meta-analysis

BackgroundAntibiotics are frequently prescribed for acute exacerbations of COPD (AECOPD) even though most do not have a bacterial aetiology. Biomarkers may help clinicians target antibiotic use by identifying AECOPD caused by bacterial pathogens. We aimed to summarise current evidence on the diagnostic accuracy of biomarkers for detecting bacterial versus non-bacterial AECOPD.MethodsWe searched Embase and Medline using a search strategy including terms for COPD, biomarkers and bacterial infection. Data regarding diagnostic accuracy for each biomarker in predicting bacterial cause of exacerbation were extracted and summarised. We used to QUADAS-2 tool to assess risk of bias.ResultsOf 509 papers identified, 39 papers evaluating 61 biomarkers were eligible for inclusion. Moderate quality evidence was found for associations between serum C-reactive protein (CRP), serum procalcitonin (PCT), sputum interleukin (IL)-8 and sputum tumour necrosis factor alpha (TNF-α), and the presence of bacterial pathogens in the sputum of patients with AECOPD. Having bacterial pathogens was associated with a mean difference (higher) CRP and PCT of 29.44 mg/L and 0.76 ng/mL respectively. There was inconsistent or weak evidence for associations between bacterial AECOPD and higher levels of sputum IL-1β, IL-6, myeloperoxidase (MPO) and neutrophil elastase (NE). We did not find any consistent evidence of diagnostic value for other biomarkers.ConclusionsThere is moderate evidence from heterogeneous studies that serum CRP and PCT are of value in differentiating bacterial from non-bacterial AECOPD, and little evidence for other biomarkers. Further high-quality research on the role of biomarkers in identifying bacterial exacerbations is needed.

An epidermal keratinocyte homogenate induced type 2 and proinflammatory cytokine expression in cultured dermal cells

BackgroundThe “itch-scratch cycle” is a clinically well-known cause of exacerbation of atopic dermatitis (AD), but the underlying molecular mechanisms remain largely unknown. ObjectiveTo test our hypothesis that some molecules released from damaged epidermal keratinocytes by scratching inducetype 2 responses in intact skin dermal cells, leading to exacerbation of AD. MethodsNormal human dermal fibroblasts (NHDF) and human dermal blood microvascular endothelial cells (HMVEC-dBl) were treated with an epidermal keratinocyte homogenate (EKH). We used qPCR and ELISA, respectively, to measure the mRNA expressions and protein concentrations of various cytokines, including IL-6, IL-8, thymic stromal lymphopoietin (TSLP), and IL-33. We analyzed IL-33 protein expression in the nuclear fractions of NHDF by Western blotting. We also investigated the effects of IL-1R1 gene-silencing and several AD therapeutic drugs on EKH induction of cytokine production by the dermal cells. ResultsEKH significantly induced IL-6 and IL-8 in NHDF and HMVEC-dBl. EKH also induced type 2 cytokines, TSLP and IL-33, in NHDF. IL-1R1 gene-silencing in NHDF partially attenuated the induction. Dexamethasone (a corticosteroid) significantly inhibited, while ABT494 (a JAK1 inhibitor) partially inhibited, EKH’s induction of cytokines in fibroblasts. In contrast, ABT494 was more effective than dexamethasone in inhibiting the cytokine induction in HMVEC-dBl. ConclusionThis study showed that a homogenate of epidermal keratinocytes significantly induced AD-related cytokines in cultured dermal cells, and IL-1α, an alarmin, might be involved in that induction. Combined use of corticosteroids and JAK1 inhibitors is likely to block the itch-scratch cycle by targeting different types of dermal cells.

Parvovirus B19-associated transient aplastic crisis following P. falciparum malaria and post-artesunate delayed haemolysis in a returning traveller.

We report a case of parvovirus B19-associated transient aplastic crisis following P. falciparum malaria and post-artesunate delayed haemolysis. Concomitant parvovirus B19 infection is an established cause of exacerbation of malaria-related anaemia in endemic countries, but a rare and potentially life-threatening condition in returning travellers.

Vitamin D resistant genes - promising therapeutic targets of chronic diseases.

Vitamin D is an essential vitamin indispensable for calcium and phosphate metabolism, and its deficiency has been implicated in several extra-skeletal pathologies, including cancer and chronic kidney disease. Synthesized endogenously in the layers of the skin by the action of UV-B radiation, the vitamin maintains the integrity of the bones, teeth, and muscles and is involved in cell proliferation, differentiation, and immunity. The deficiency of Vit-D is increasing at an alarming rate, with nearly 32% of children and adults being either deficient or having insufficient levels. This has been attributed to Vit-D resistant genes that cause a reduction in circulatory Vit-D levels through a set of signaling pathways. CYP24A1, SMRT, and SNAIL are three genes responsible for Vit-D resistance as their activity either lowers the circulatory levels of Vit-D or reduces its availability in target tissues. The hydroxylase CYP24A1 inactivates analogs and prohormonal and/or hormonal forms of calcitriol. Elevation of the expression of CYP24A1 is the major cause of exacerbation of several diseases. CYP24A1 is rate-limiting, and its induction has been correlated with increased prognosis of diseases, while loss of function mutations cause hypersensitivity to Vit-D. The silencing mediator of retinoic acid and thyroid hormone receptor (SMRT) and its corepressor are involved in the transcriptional repression of VDR-target genes. SNAIL1 (SNAIL), SNAIL2 (Slug), and SNAIL3 (Smuc) are involved in transcriptional repression and binding to histone deacetylases and methyltransferases in addition to recruiting polycomb repressive complexes to the target gene promoters. An inverse relationship between the levels of calcitriol and the epithelial-to-mesenchymal transition is reported. Studies have demonstrated a strong association between Vit-D deficiency and chronic diseases, including cardiovascular diseases, diabetes, cancers, autoimmune diseases, infectious diseases, etc. Vit-D resistant genes associated with the aforementioned chronic diseases could serve as potential therapeutic targets. This review focuses on the basic structures and mechanisms of the repression of Vit-D regulated genes and highlights the role of Vit-D resistant genes in chronic diseases.

Study of clinical features of patients with chronic eczema

Objective — s to study the clinical features of chronic eczema (CE) in 96 patients aged 18 to 78 years.&#x0D; Materials and methods. The study was carried out in the city clinical dermatovenerological dispensary No. 5 in Kharkov. All patients gave written informed consent to participate in the study.The majority of them (66.7 %) were between 31 and 50 years old. The duration of dermatosis in 6.3 % of the surveyed persons ranged from 6 months to 1 year, in 33.3 % — from 1 year to 5 years, in 42.7 % — from 5 to 10 years, in 17.7 % — over 10 years. The most frequent causes of exacerbation in 51.1 % were neuropsychiatric trauma and stress, in 15.6 % — dise­ases of internal organs and acute respiratory diseases, in 13.5 % — contact with chemicals. In all patients, dermatosis was recurrent. Most often, the surveyed patients complained of moderate intensity itching (51 %) and severe sleep disturbances (66.7 %). Moderate leukocytosis and accelerated ESR were found in 21.9 % of patients, eosinophilia — in 5.1 %.&#x0D; Results and discussion. 96 patients with chronic eczema aged 18 to 78 years were under observation. The diagnosis of chronic eczema was based on anamnestic data, patients’ complaints of itchy skin of varying intensity, objective examination of the patient, as well as recurrences of dermatosis for more than 1 year. The largest number of patients had dermatosis from 5 to 10 years. Chronic eczema in the observed patients was recurrent. The duration of remission was (4.9 ± 0.2) months. The duration of exacerbation was (6.1 ± 0.2) weeks. To characterize the severity of chronic eczema, a scoring system was used, according to which the average severity was (2.63 ± 0.08) points.According to the degree of skin lesions, the forms of dermatosis were limited and widespread. Patients complained of skin itching of varying intensity: more often itching of moderate intensity, periodic; painful, persistent, with an insurmountable need to scratch; short-term; no itching.Also, patients noted sleep disturbance in the form of difficulty falling asleep, sudden awakening at night and lack of a feeling of rest after waking up in the morning. 39 patients had bad habits (smoking, alcohol abuse).Сlinical analysis of blood revealed moderate leukocytosis, accelerated ESR, eosinophilia, signs of secondary infection.&#x0D; Conclusions. The average age of the patients ranged from 31 to 50 years. All examined patients had recurrent dermatosis. The average degree of its severity was (2.63 ± 0.08) points. Most often, patients complained of moderate intensity itching (51 %) and severe sleep disturbances (66.7 %). In 21.9 % of the examined patients moderate leukocytosis and accelerated ESR were revealed, in 5.1 % — eosinophilia.

Prevalence and predictors of pulmonary embolism in patients with acute exacerbation of chronic obstructive pulmonary disease.

Background:The prevalence of pulmonary embolism (PE) in patients of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) varies over a wide range. Early detection and treatment of PE in AECOPD is a key to improve patient outcome. The purpose of the study was to investigate the prevalence and predictors of PE in patients of AECOPD in a high burden region of North India.Materials and Methods:This prospective study included patients of AECOPD with no obvious cause of exacerbation on initial evaluation. Apart from routine workup, the participants underwent assessment of D-dimer, compression ultrasound and venous Doppler ultrasound of the lower limbs and pelvic veins, and a multidetector computed tomography pulmonary angiography.Results:A total of 100 patients of AECOPD with unknown etiology were included. PE as a possible cause of AE-COPD was observed in 14% of patients. Among the participants with PE, 63% (n = 9) had a concomitant presence of lower extremity deep venous thrombosis. Hemoptysis and chest pain were significantly higher in patients of AECOPD with PE ([35.7% vs. 7%, P = 0.002] and [92.9% vs. 38.4%, P = 0.001]). Likelihood of PE was significantly higher in patients who presented with tachycardia, tachypnea, respiratory alkalosis (PaCO2 <45 mmHg and pH >7.45), and hypotension. No difference was observed between the two groups in terms of in-hospital mortality, age, sex distribution, and risk factors for embolism except for the previous history of venous thromboembolism (35.7% vs. 12.8% P = 0.03).Conclusion:PE was probably responsible for AECOPD in 14% of patients with no obvious cause on initial assessment. Patients who present with chest pain, hemoptysis, tachypnea, tachycardia, and respiratory alkalosis should be particularly screened for PE.

Oral antibiotic treatment of exacerbation of COPD. Beyond COVID-19

RESUMENLa enfermedad pulmonar obstructiva crónica (EPOC) incluye a los pacientes con bronquitis crónica y/o enfisema que tienen en común a presencia de una obstrucción crónica y progresiva al flujo aéreo, con clínica de disnea y cuya historia natural se ve modificada por episodios agudos de exacerbaciones. La exacerbación (EAEPOC) se define como un episodio agudo de inestabilidad clínica caracterizado por un empeoramiento mantenido de síntomas respiratorios. Es necesario distinguir una nueva EAEPOC de un fracaso terapéutico previo o de una recaída. Las EAEPOC se hacen con el tiempo más frecuentes e intensas deteriorando la función pulmonar y la calidad de vida. El diagnóstico de una EAEPOC consta de 3 pasos esenciales: a) diagnóstico diferencial; b) establecer la gravedad, y c) identificar su etiología. La principal causa las agudizaciones es la infección, tanto bacteriana como viral. Los antibióticos están especialmente indicados en las EAEPOC grave y la presencia de esputo purulento. Los betalactámicos (amoxicilina-clavulánico y cefditoreno) y las fluoroquinolonas (levofloxacino) son los antimicrobianos más utilizados. Esta revisión realiza una actualización del problema de la exacerbación aguda con origen infeccioso desde una perspectiva de la etiología, resistencias a los antimicrobianos, estudios microbiológicos, la estratificación del riesgo y el manejo antimicrobiano. Se analiza el riesgo, pronóstico y características de los pacientes con EPOC que desarrollan COVID19.

Oscillococcinum® for upper respiratory tract infections and exacerbations in COPD: an observational, prospective study (OXITUNIS).

BackgroundUpper respiratory tract infections (URTIs) are a major cause of exacerbations in patients with chronic obstructive pulmonary disease (COPD). We assessed the effectiveness of Oscillococcinum® in the protection from URTIs in patients with COPD who had been vaccinated against influenza infection over the 2018–2019 winter season.MethodsPatients (n=106; mean ± standard deviation age: 66.0 ± 10.3 years; 89.6% men) were randomized into two groups: group V received influenza vaccination only and group OV received influenza vaccination plus Oscillococcinum® (one oral dose per week from inclusion in the study until the end of follow-up, with a maximum of 6 months follow-up over the winter season). The primary endpoint was the incidence rate of URTIs (number of URTIs/1000 patient-treatment exposure days) during follow-up compared between the two groups.ResultsThere was no significant difference in any of the demographic characteristics, baseline COPD, or clinical data between the two treatment groups (OV and V). The URTI incidence rate was significantly higher in group V than in group OV (2.9 versus 1.2 episodes/1000 treatment days, difference OV–V = −1.7; p=0.0312). There was a significant delay in occurrence of an URTI episode in the OV group versus the V group (mean ± standard error: 48.7 ± 3.0 versus 67.0 ± 2.8 days, respectively; p=0.0158). Limitations to this study include its small population size and the self-recording by patients of the number and duration of URTIs and exacerbations.ConclusionOscillococcinum may decrease the incidence rate and delay the appearance of URTIs in patients with COPD.