Chronic Obstructive Lung Disease Guidelines Research Articles

Adherence to the GOLD Guideline in COPD Management of South Korea: Findings from KOCOSS Study 2011-2018.

The guidelines for chronic obstructive pulmonary disease (COPD) treatment are important for the management of the disease. However, studies regarding the treatment adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines have been scarce in Korea. Therefore, to examine the adherence to the GOLD guidelines, we examined the patterns of prescribed medication in COPD patients from 2011 to 2018. Patients were classified as having been appropriately and inappropriately treated (overtreatment or undertreatment) for the GOLD group. Appropriate medical therapy was defined as using the first choice or alternative choice drug recommended in the GOLD guidelines. Inappropriate therapy was classified as overtreatment or undertreatment in accordance with the categorization in the GOLD guidelines. According to treatment of 2011 GOLD guidelines, there was inappropriate treatment in 52.3% in group A, 47.3% in group B, 56.3% in group C, and 17.8% in group D. According to treatment of 2017 GOLD guidelines, there was inappropriate treatment in 66.7% in group A, 45.3% in group B, 14.3% in group C, and 24.0% in group D. The common type of inappropriate COPD treatment is overtreatment, with inhaled corticosteroid (ICS) containing regimens. In conclusions, adherence to the GOLD guideline by the pulmonologist in clinical practice is still low in Korea. Therefore, we need better strategies to both optimize the use of the guidelines and adhere to the guidelines as well.

Neural Respiratory Drive Measured Using Surface Electromyography of Diaphragm as a Physiological Biomarker to Predict Hospitalization of Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients.

Background:Neural respiratory drive (NRD) using diaphragm electromyography through an invasive transesophageal multi-electrode catheter can be used as a feasible clinical physiological parameter in patients with chronic obstructive pulmonary disease (COPD) to provide useful information on the treatment response. However, it remains unknown whether the surface diaphragm electromyogram (EMGdi) could be used to identify the deterioration of clinical symptoms and to predict the necessity of hospitalization in acute exacerbation of COPD (AECOPD) patients.Methods:COPD patients visiting the outpatient department due to acute exacerbation were enrolled in this study. All patients who were subjected to EMGdi and classical parameters such as spirometry parameters, arterial blood gas analysis, COPD assessment test (CAT) score, and the modified early warning score (MEWS) in outpatient department, would be treated effectively in the outpatient or inpatient settings according to the Global Initiative for Chronic Obstructive Lung Disease guideline. When the acute exacerbation of the patients was managed, all the examination above would be repeated.Results:We compared the relationships of admission-to-discharge changes (Δ) in the normalized value of the EMGdi, including the change of the percentage of maximal EMGdi (ΔEMGdi%max) and the change of the ratio of minute ventilation to the percentage of maximal EMGdi (ΔVE/EMGdi%max) with the changes of classical parameters. There was a significant positive association between ΔEMGdi%max and ΔCAT, ΔPaCO2, and ΔpH. The change (Δ) of EMGdi%max was negatively correlated with ΔPaO2/FiO2 in the course of the treatment of AECOPD. Compared with the classical parameters including forced expiratory volume in 1 s, MEWS, PaO2/FiO2, the EMGdi%max (odds ratio 1.143, 95% confidence interval 1.004–1.300) has a higher sensitivity when detecting the early exacerbation and enables to predict the admission of hospital in the whole cohort.Conclusions:The changes of surface EMGdi parameters had a direct correlation with classical measures in the whole cohort of AECOPD. The measurement of NRD by surface EMGdi represents a practical physiological biomarker, which may be helpful in detecting patients who should be hospitalized timely.

Endothelial damage and functional state of the vascular wall in chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) creates conditions for endothelial damage with the development of endothelial dysfunction: hypoxia, an increase in biologically active substances, including cytokines, leukotrienes, etc. Previous studies have been conducted in COPD patients with a combination of arterial hypertension and coronary heart disease. The aim of the study was to evaluate the endothelial damage and the vasoregulatory function of the vascular wall in patients with COPD of varying severity. Material and methods. The study included 76patients with COPD (men, mean age 51.14 ± 0.97years). COPD was defined according to the Global Initiative for Chronic Obstructive Lung Disease (2013) guidelines. The patients were divided into two groups according to COPD severity: the 1st group (GOLD I-II) included 27 patients, the 2nd group (GOLD III-IV) included 49 patients. Antithrombogenic, vasoregulatory function of the endothelium, synthesis of nitric oxide (NO) in blood plasma by the level of stable NO metabolites (nitrates and nitrites) was studied. The number of desquamated endotheliocytes, von Willebrand factors in the blood was determined. As a result of the study, a significant damage to the endothelium, an increase in the thickness of the wall of the brachial artery, a decrease in the total plasma concentration of stable NO metabolites, a violation of the antithrombogenic and vasoregulatory activity of the vascular wall in COPD patients compared with healthy people. The most significant changes were found in patients with severe COPD.

QUALITY IMPROVEMENT PROJECT TO REDUCE COPD READMISSION RATE IN MEDICARE PATIENTS USING A MULTIDISCIPLINARY PROTOCOL-BASED CARE PLAN

SESSION TITLE: Electronic Top Posters SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/08/2018 01:15 pm - 02:15 pm PURPOSE: A quality improvement (QI) project was initiated at the Houston Methodist Hospital (HMH) to reduce the readmission rate for acute exacerbation of COPD (AECOPD). Our goal was to reduce the 30-day all cause readmission rate using a multidisciplinary and focused care plan for high-risk patients. METHODS: Beginning in 2016, all patients admitted to HMH with the primary diagnosis of AECOPD had a standardized care plan based on the Global Initiative for Chronic Obstructive Lung Disease guideline implemented prior to hospital discharge. Patients with a concurrent diagnosis of congestive heart failure exacerbation, active lung cancer or history of a lung transplant were excluded. The project involved physicians, nurses, case managers, social workers, respiratory therapists, project coordinators and the Houston Methodist Research Institute. Moreover, in 2017, a multidisciplinary group met weekly to identify high risk patients (having >50% likelihood of readmission based on internally developed software, ReAdmit app) and offered focused care. The interventions included diagnostics, medical treatments, nutrition, teaching, psychosocial assessment, discharge planning and outpatient follow up plans. The utilization of the care plan was at the discretion of the attending physician, and every hospitalist in our hospital was educated and encouraged to follow the plan. The intervention was applied to all patients; this study we focused on Medicare patients. We obtained baseline readmission data (2011–2015) and compared with the intervention period (2016 and 2017). The data was analyzed using Student’s t-test. RESULTS: A total of 994 Medicare patients were admitted for AECOPD from 2011 to 2015 prior to the intervention; 238 patients were readmitted within 30-days after discharge (23.9%, CI: 21.3%-26.5%) (Table 1). The readmission rate was 25.1% (55 out of 219, p-value = 0.270) in 2016, and 17.7% (50 out of 283, p-value = 0.00271) in 2017 (Figure 1). In 2017, there was an absolute risk reduction of 6.2% and 25.9% relative risk reduction of being readmitted. The number-needed-to-treat to avoid readmission was 17. CONCLUSIONS: A multidisciplinary care plan approach for Medicare patients with AECOPD resulted in a statistically significant reduction in the rate of readmission. Due to the nature of a QI project, the care plan was not equally applied to patients, as it was the attending physicians’ discretion to utilize each aspect of the formulated care plan. Nevertheless, this study strongly suggests that a standardized multidisciplinary care plan decreases 30-day readmission for patients admitted for AECOPD. CLINICAL IMPLICATIONS: Based on this model, we plan to modify an AECOPD admission order set in our electronic medical record system to make it easier for physicians to incorporate our standardized plan. We plan to analyze readmission rates for non-Medicare patients to determine if there is a similar effect. DISCLOSURES: No relevant relationships by Aida Coralic, source=Admin input Speaker/Speaker's Bureau relationship with ACTELION PHARMACEUTICALS Please note: $5001 - $20000 Added 01/22/2018 by Adaani Frost, source=Web Response, value=Honoraria ENDPOINT ADJUDICATION COMMITTEE relationship with UNITED THERAPEUTICS Please note: $1001 - $5000 Added 01/22/2018 by Adaani Frost, source=Web Response, value=Honoraria No relevant relationships by Robert Jackson, source=Web Response No relevant relationships by Jared Lee, source=Web Response No relevant relationships by Mamta Puppala, source=Web Response No relevant relationships by Lilianna RajtakMuller, source=Web Response No relevant relationships by Elena Ruocco, source=Admin input No relevant relationships by Lin Wang, source=Web Response No relevant relationships by Stephen Wong, source=Web Response

Systemic Corticosteroid and Antibiotic Use in Hospitalized Patients With Chronic Obstructive Pulmonary Disease Exacerbation.

Effective inpatient chronic obstructive pulmonary disease (COPD) exacerbation management is critical to appropriately manage health care resources. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines provide recommendations on appropriate systemic corticosteroid and antibiotic use, in select patients, for COPD exacerbation. To determine the impact of GOLD guideline-recommended systemic corticosteroid and antibiotic therapy in the hospital setting on clinical outcomes in patients with COPD exacerbation. This was a noninterventional, retrospective, single-center study. Adults admitted to a non-intensive care unit internal medicine service with documented COPD exacerbation were included. Two analyses were conducted evaluating systemic corticosteroid and antibiotic therapy. A total of 220 patients were included in the systemic corticosteroid cohort. No difference in 30-day readmission rates was demonstrated for the standard (⩽200 mg prednisone equivalents [PEs] for exacerbation course) and high-dose groups (>200 mg PEs; 20.5% vs 13.1%, respectively; P = 0.15). Hospital length of stay (LOS) was significantly shorter for patients prescribed standard-dose therapy (3 days [2-4.5] vs 4 days [2-6]; P < 0.001). A total of 174 patients were included in the antibiotic cohort. For the appropriate and inappropriate antibiotic use groups, no significant differences were observed between 30-day readmission rates (15% vs 18.4%, respectively; P = 0.57) and hospital LOS (4 days [2-5] in both groups; P = 0.97). Conclusion and Relevance: Hospital LOS was shorter for patients prescribed standard-dose systemic corticosteroids; however, no differences in other clinical outcomes were found in either cohort. Use of guideline-recommended systemic corticosteroid and antibiotic therapy is recommended for hospitalized patients with COPD exacerbation.

Systematic literature review and meta-analysis of US-approved LAMA/LABA therapies versus tiotropium in moderate-to-severe COPD

Dual bronchodilator maintenance therapy may benefit patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) versus long-acting muscarinic antagonist (LAMA) monotherapy. The efficacy and safety of US-approved LAMA/long-acting beta-agonist (LABA) combinations versus tiotropium (TIO), a LAMA, were assessed. This systematic review and meta-analysis (GSK: 206938), conducted in MEDLINE, MEDLINE In-process, and EMBASE following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, identified randomized clinical trials (>8 weeks) in moderate-to-severe COPD (per Global Initiative for Chronic Obstructive Lung Disease guidelines), receiving LAMA/LABA or TIO. Endpoints: difference in change from baseline in lung function (forced expiratory volume in 1 s [FEV1]; trough, peak, area under the curve 0–3 h post-dose (AUC0–3), St George’s Respiratory Questionnaire (SGRQ) responder rate (≥4-unit improvement), SGRQ total score, and rescue medication use at 12 and 24 weeks. Safety was also assessed. From 5683 citations, the meta-analysis included eight clinical trials. LAMA/LABA significantly improved FEV1 trough (Week 12: 63.0 mL, 95% confidence intervals [CI]: 39.2, 86.8; Week 24: 66.1 mL, 95% CI: 40.0, 92.3), peak (Week 12: 91.5 mL, 95% CI: 70.5, 112.4; Week 24: 92.4 mL, 95% CI: 72.9, 111.9), AUC0–3 (Week 12: 126.8 mL, 95% CI: 108.1, 145.4), SGRQ responder rate at Week 12 (risk ratio: 1.19; 95% CI: 1.09, 1.28), mean SGRQ total score (Week 12: −1.87, 95% CI: −2.72, −1.02; Week 24: −1.05, 95% CI: −2.02, −0.09), and rescue medication use (Week 24: −0.47 puffs/day, 95% CI: −0.64, −0.30) versus TIO (all p ≤ 0.03). The SGRQ responder rate at 24 weeks and adverse events were not significantly different between treatments. US-approved LAMA/LABA therapies improved lung function, SGR,Q and rescue medication use versus TIO, without compromising safety.

Stepping down therapies in COPD

Beverley Bostock-Cox explains why clinicians should regularly review their use of inhaled therapies and in some cases, step down treatment or take people off therapies The National Institute for Health and Care Excellence (NICE) guidelines for chronic obstructive pulmonary disease (COPD) and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines have key differences in treatment. These discrepancies reflect a growing understanding about the risks and benefits of the inhaled therapies on the market, which was not available when NICE published its guidance but which is reflected in the GOLD guidelines. Clinicians should be able to differentiate between different COPD phenotypes based on the history and the GOLD ABCD algorithm, and recognise the different drug classes which are indicated for each category. It is important to regularly review patients' use of inhaled therapies and in some cases, step people with COPD down or off treatment.

Chronic Obstructive Pulmonary Disease in Older Adults: Part I: Case Study.

Chronic obstructive pulmonary disease (COPD) is a distressing respiratory disease that may greatly impact a patient's quality of life. Although many treatment options exist, the Global Initiative for Chronic Obstructive Lung Disease Guidelines outline management strategies based on severity of daily symptoms and exacerbations. Although it is important to weigh the risks and benefits of medication use, involvement of patients in their overall care plan is imperative to optimal outcomes. According to recent studies, the prevalence of COPD in older adults is increasing, along with the complexity of care due to comorbidities, drug interactions, and side effects. A thorough evaluation of a patient case provides insight into the everyday challenges of COPD management. [Journal of Gerontological Nursing, 44(7), 10-14.].

An Update on the Global Initiative for Chronic Obstructive Lung Disease 2017 Guidelines With a Focus on Classification and Management of Stable COPD.

The 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines offer important changes to the assessment and management of stable COPD of importance to practitioners, respiratory therapists, pharmacists, and nurses who care for patients with COPD. Therapies are now chosen based on the burden of symptoms and the history of COPD exacerbations, and inhaler regimens are modifiable based on continual clinical reassessment. Although identifying the degree of airway obstruction remains important for informing the clinical status of the patient with COPD, FEV1 is no longer used to direct the therapeutic approach. Therapies and modes of inhaled medication delivery for each GOLD grouping have been modified and reflect the need for reevaluation of patient symptoms and COPD exacerbation history as an indicator to add or withdraw therapies. As the knowledge of this important disease continues to expand, exacerbation and symptom prevention in patients with stable COPD will remain as an important target of COPD therapies and research. Novel drug combinations and delivery devices are sure to positively affect the practitioner's approach to patients with stable COPD. The new 2017 GOLD guidelines represent a step toward personalized care of the patient with COPD.

Triple Therapy for COPD Patients

Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend stepwise therapy for patients with chronic obstructive pulmonary

Association of Anthropometric Indexes With Disease Severity in Male Patients With Chronic Obstructive Pulmonary Disease in Qazvin, Iran.

Malnutrition is one of the most important factors that lead to lower quality of life in patients suffering from chronic obstructive pulmonary disease (COPD). There are several methods for assessing malnutrition including anthropometric indexes. The aim of this study was to determine the association of anthropometric indexes with disease severity in male patients with COPD in Qazvin, Iran. This cross-sectional study was conducted on 72 male patients with COPD in Qazvin, Iran, from May to December 2014. Spirometry was performed for all participants. Disease severity was determined using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline. Body mass index (BMI), mid-arm muscle circumference (MAMC), and triceps skinfold thickness (TSF) were measured. MAMC and TSF were categorized into three subgroups as <25th P, between 25th P and 75th P, and >75th P (Where P is the abbreviation for percentile.). Data were analyzed using ANOVA and logistic regression analysis. Mean age was 60.23 ± 11.39 years. Mean BMI was 23.23 ± 4.42 Kg/m2, mean MAMC was 28.34 ± 3.72 cm2, and mean TSF was 10.15 ± 6.03 mm. Mean BMI and MAMC in the GOLD stage IV were significantly lower than other stages. Of 72, 18.1% were underweight while 6.9% were obese. The GOLD stage IV was associated with 16 times increased risk of underweight and nine times increased risk of MAMC < 25th P. Disease severity was associated with BMI and MAMC as indexes of malnutrition in patients with COPD in the present study. The GOLD stage IV was associated with increased risk of underweight and low MAMC.

Management of chronic obstructive pulmonary disease exacerbations at the Nasser Medical Complex: a clinical audit

BackgroundThe frequency and severity of chronic obstructive pulmonary disease (COPD) exacerbations are the most important determinants of prognosis in COPD. The aim of this study was to assess the management of patients presenting with COPD exacerbations at the Nasser Medical Complex in the Gaza Strip and to compare the management with the Global Initiative for Chronic Obstructive Lung Disease guidelines (GOLD 2015). MethodsWe reviewed the medical records of all patients admitted to Nasser Medical Complex and diagnosed with COPD exacerbation between Jan 1, 2014, and Dec 31, 2016. Clinical practice was compared with GOLD guidelines. Ethical approval was obtained from the General Directorate of Human Resources. Findings55 patient records were reviewed. The mean age was 66·4 years (SD 8·5), and 54 (98%) patients were male. All patients received inhaled bronchodilators. 36 (65%) patients received short-acting β agonists (SABA), 43 (78%) received short-acting muscarinic agonists (SAMA), 13 (24%) received long-acting muscarinic agonists (LAMA), one (2%) received long-acting beta-agonists (LABA), and 22 (40%) received both SABA and SAMA. 53 (96%) patients received systemic corticosteroids. 43 (78%) patients took more than the recommended 40 mg prednisolone daily. Only 12 (22%) patients received prednisolone as the recommended 5 day treatment course, whereas most patients received a shorter course. Other treatments included oxygen (51 [93%] patients), antibiotics (55 [100%]), antiviral medication (three [6%]), and theophylline (two [4%]). InterpretationOverall adherence to guidelines was moderately good. All patients received antibiotics, and most patients received oxygen, which are both recommended for all patients. Less useful therapies were rarely prescribed. However, more patients received SAMA than SABA, although SABA is more effective and therefore the first-line treatment for COPD exacerbation. The dose of the most prescribed drug (prednisolone) exceeded the recommended dose. Generally, awareness and adherence to clinical guidelines needs to be improved as part of the fostering of evidence-based medicine. Documentation was of a very poor standard and must be improved to develop a meaningful audit culture. FundingNone.

Annexin A1 is elevated in patients with COPD and affects lung fibroblast function.

PurposeFibrosis in peripheral airways is responsible for airflow limitation in chronic obstructive pulmonary disease (COPD). Annexin A1 modulates several key biological events during inflammation. However, little is known about its role in airway fibrosis in COPD. We investigated whether levels of Annexin A1 were upregulated in patients with COPD, and whether it promoted airway fibrosis.MethodsWe quantified serum Annexin A1 levels in never-smokers (n=12), smokers without COPD (n=11), and smokers with COPD (n=22). Correlations between Annexin A1 expression and clinical indicators (eg, lung function) were assessed. In vitro, human bronchial epithelial (HBE) cells were exposed to cigarette smoke extract (CSE) and Annexin A1 expression was assessed. Primary human lung fibroblasts were isolated from patients with COPD and effects of Annexin A1 on fibrotic deposition of lung fibroblasts were evaluated.ResultsSerum Annexin A1 was significantly higher in patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines stage III or IV than in those with GOLD stages I or II (12.8±0.8 ng/mL versus 9.8±0.7 ng/mL; p=0.016). Annexin A1 expression was negatively associated with airflow obstruction (forced expiratory volume in one second % predicted; r=−0.72, p<0.001). In vitro, Annexin A1 was significantly increased in CSE-exposed HBE cells in a time- and concentration-dependent manner. Annexin A1 promoted lung fibroblasts proliferation, migration, differentiation, and collagen deposition via the ERK1/2 and p38 mitogen-activated protein kinase pathways.ConclusionAnnexin A1 expression is upregulated in patients with COPD and affects lung fibroblast function. However, more studies are needed to clarify the role of Annexin A1 in airway fibrosis of COPD.

Transthoracic ultrasonographic evaluation of diaphragmatic excursion in patients with chronic obstructive pulmonary disease

BackgroundChronic obstructive pulmonary disease (COPD) is a multisystem disorder that mainly besides the lungs also affects the muscle mass. The force generated by the respiratory muscles decreases, resulting in a negative effect on ventilation and exercise capacity. Recent studies have reported that M-mode ultrasonography is reliable and relatively easy to use for assessment of diaphragmatic motion.ObjectiveTo evaluate diaphragmatic excursion by M-mode ultrasonography in patients with COPD and to correlate it with different clinical and ventilatory variables.Patients and methodsA total of 40 patients with COPD who attended Chest Diseases Department Al-Azhar University Hospitals from January 2017 to May 2017 were recruited in this study. Informed consent was obtained. Diagnosis and severity of COPD was made according to the Global Initiative for Chronic Obstructive Lung Disease guidelines. All patients in this study were subjected to full medical history, clinical examination, pulmonary function tests, calculation of BMI, arterial blood gases analysis, 6-min walk test, and ultrasound imaging of the diaphragm.ResultsDiaphragmatic excursion during quiet breathing did not differ significantly between the patients and the controls (P=0.085). However, during deep breathing, the degree of diaphragmatic excursion was lower in the patients (P=0.001). Diaphragmatic excursion during deep breathing correlated significantly with disease severity(r=0.86); the percentage of the predicted forced expiratory volume in the first second, forced vital capacity, and forced expiratory volume in the first second/forced vital capacity (r=0.84, 0.72, and 0.80, respectively); and the 6-min walk test (r=0.47). Conclusion M-mode ultrasonography is an easy, noninvasive and inexpensive method for evaluation of diaphragmatic excursion. Patients with COPD had significantly lower diaphragmatic excursion than normal ones.

Correlation of exhaled carbon monoxide level with disease severity in chronic obstruction pulmonary disease.

Introduction:Amplification of airway inflammation and its destruction due to oxidative stress is a major step in the pathogenesis of chronic obstruction pulmonary disease (COPD). Exhaled carbon monoxide (eCO) may be quantified to evaluate the airway inflammation and oxidative stress in such patients.Objectives:To assess the disease severity of COPD and treatment response by measuring eCO as a biomarker.Materials and Methods:COPD patients diagnosed according to the global initiative for chronic obstructive lung disease guidelines and healthy individuals as controls were selected. One hundred and fifty patients with COPD and 125 controls were included in the study. Participants were further subdivided on the basis of their smoking habits. Clinical examinations and spirometry were done to diagnose COPD by following the standard protocol. eCO was measured using a piCO + Smokerlyzer (Breath CO Monitor, Bedfont Scientific Ltd., Kent, UK). It was a single-center cross-sectional study.Results:Mean (± standard error of mean) CO levels in ex-smokers with COPD were higher (5.21 ± 1.546 ppm; P < 0.05) than in nonsmoking controls (1.52 ± 0.571 ppm) but were lower than in current smokers with COPD (12.55 ± 4.514 ppm; P < 0.05). eCO levels were higher in current smokers with COPD (12.55 ± 4.514 ppm; P < 0.05) compared to healthy smokers (9.71 ± 5.649). There was a negative correlation between eCO and forced expiratory volume in 1 s (FEV1) in COPD (r = −0.28; P < 0.05). The mean eCO level was decreased (6.291–4.332; P < 0.001) with improvement in lung function (FEV1 38.75%–50.65%: P < 0.05) after treatment with inhaled steroid.Conclusion:Our study concludes that quantification of eCO level in COPD varies with different grades of airway obstruction and to measure the treatment response. Measuring the level of eCO can be used to assess the indirect assessment of airway inflammation, oxidative stress, and severity of airway obstruction in COPD patients.

Utility of bone marrow mononuclear cells as a novel therapy in chronic obstructive pulmonary diseases

Background Stem cells have undifferentiated cells that have can proliferate to one or more cells. Exogenous stem cells derived from embryonic and adult tissues could be used in the regeneration of diseased organs, including lung and tissue. Chronic obstructive pulmonary disease (COPD) pathogenesis plays a major role in the upregulation of inflammation, making irreversible procedure, like apoptosis of cells, lysis of the components of extracellular matrix in lung. All treatments of COPD to date have involved pharmacological therapy and mainly target the symptoms; hence, there is an urgent need for novel and more effective therapeutic strategies. Mesenchymal stem cells are considered a therapy in COPD more for their immune modulatory effects. Aim This study aimed to evaluate the effect of stem cell therapy on mild-to-moderate COPD patients, either by infusion or by inhalation, on the basis of pulmonary function tests and quality of life. Patients and methods This study was carried out on 30 patients with COPD divided into three groups: 10 patients received COPD medication alone according to the Global Initiative for Chronic Obstructive Lung Disease guidelines (long-acting B2 agonist and inhaled corticosteroids) as a control group, 10 patients received COPD medication plus stem cell infusion, and 10 patients received COPD medication plus stem cell inhalation. Pulmonary functions tests were performed and the quality of life was determined in all patient groups. Results The pulmonary functions tests showed an insignificant increase in mild-to-moderate COPD patients after 1 month of stem cell, both by infusion and by inhalation, but there was a significant increase in the quality of life with the use of both methods of stem cell treatment compared with the control group. Conclusion Stem cell therapy leads to significant improvements in the quality of life of patients with mild-to-moderate COPD.

Adherence to a COPD treatment guideline among patients in Hong Kong.

BackgroundThis study aimed to assess the adherence rate of pharmacological treatment to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline published in 2011 and the prevalence of comorbidities among patients with COPD in Hong Kong (HK).MethodsPatients were recruited from five tertiary respiratory centers and followed up for 12 months. Data on baseline physiological, spirometric parameters, use of COPD medications and coexisting comorbidities were collected. The relationship between guideline adherence rate and subsequent COPD exacerbations was assessed.ResultsAltogether, 450 patients were recruited. The mean age was 73.7±8.5 years, and 92.2% of them were males. Approximately 95% of them were ever-smokers, and the mean post-bronchodilator (BD) forced expiratory volume in 1 second was 50.8%±21.7% predicted. The mean COPD Assessment Test and modified Medical Research Council Dyspnea Scale were 13.2±8.1 and 2.1±1.0, respectively. In all, five (1.1%), 164 (36.4%), eight (1.8%) and 273 (60.7%) patients belonged to COPD groups A, B, C and D, respectively. The guideline adherence rate for pharmacological treatment ranged from 47.7% to 58.1% in the three clinic visits over 12 months, with overprescription of inhaled corticosteroids (ICS) and underutilization of long-acting BDs in group B COPD patients. Guideline nonadherence was not associated with increased risk of exacerbation after adjustment of confounding variables. However, this study was not powered to assess a difference in exacerbations. In all, 80.9% of patients had at least one comorbidity.ConclusionA suboptimal adherence to GOLD guideline 2011, with overprescription of ICS, was identified. The commonly found comorbidities also aligned with the trend observed in other observational cohorts.

Frequency and effect of type 1 hypersensitivity in patients from India with chronic obstructive pulmonary disease and associated upper airways symptoms.

BackgroundChronic obstructive pulmonary disease (COPD) is now recognized as a systemic disorder with many comorbidities. Atopy in patients with COPD and upper airways symptoms has not been characterized.ObjectiveWe investigated the occurrence and impact of aeroallergen sensitisation in patients with COPD and upper airways symptoms.MethodsAll 41 subjects with COPD diagnosed as per Global Initiative for Chronic Obstructive Lung Disease guidelines, underwent spirometry with reversibility, computed tomography of the paranasal sinuses (CT-PNS), skin prick test (SPT) against common aeroallergens and responded to St. George's Respiratory Questionnaire (SGRQ) and Sino Nasal Outcome Test - 22 (SNOT-22) questionnaires. Upper airways symptoms were assessed as per the Allergic Rhinitis and its Impact on Asthma guidelines.ResultsAs documented earlier, 27 of the 41 patients (65.9%) with COPD had upper airways symptoms. Of these 27 patients, 11 had SPT positivity against at least one aeroallergen (group 1). One patient had monosensitisation to pollens of grass Imperata while polysensitisation was seen in 10/11 patients commonly to weeds, trees, and insects. Fungal sensitisation to Aspergillus fumigatus was seen in 3 of 11 patients (27.2%). In group 1, all 11 patients (100%) had radiological sinusitis as compared to 8 of 16 (50%) in group 2. The mean CT-PNS scores were significantly higher in group 1 as compared to group 2. Similarly, the SNOT-22 scores were significantly higher in group 1 as compared to group 2. However, there was no difference in SGRQ scores between the 2 groups. In group 1, there was a significant correlation between CT-PNS and SNOT-22 scores.ConclusionPatients with COPD, associated upper airways symptoms and a positive SPT had a significantly higher frequency of radiological sinusitis on CT-PNS. They even had worse quality of life as compared to those with a negative SPT. The study suggested that atopic patients with COPD and upper airways involvement were more symptomatic. It is therefore possible that upper airways symptoms, if left untreated, would result in less than desirable control of the disease.

Association of Serum Uric Acid Levels and Outcomes of Patients With COPD: A Prospective Cohort Study

SESSION TITLE: COPD 1 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: This study hopes to determine the association between elevated serum uric acid level and outcomes of patients with chronic obstructive pulmonary disease as to mortality within 30 days, length of hospital stay, ICU admission and non-invasive ventilation use. Also, results of this study would help as clinicians on whether high serum uric acid levels should be aggressively treated by pharmacologic means for the prevention of COPD exacerbation. METHODS: All diagnosed COPD in exacerbation who met the selection criteria were included in the study. Serum uric acid level determination was done as part of the routine blood tests obtained during admission. Decisions on treatment and discharge was made by the pulmonology fellow involved in this study, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. The principal investigator recorded the length of hospital stay, length of ICU stay and the need for non-invasive ventilation (NIV). Patient was followed-up until discharge and through a telephone conversation 30 days after discharge to determine mortality. RESULTS: A total of 159 patients were included in the study. Fifty-seven (57%) were males and forty-three (43%) were females. The mean age of the study population was 69 years old. Majority of the patients (91%) were smoker, with mean average pack-year-smoker of 25.57±9.03 pack-year. One hundred forty four patients (91%) has no PTB treatment. Majority of the patients (66%) were hypertensive with GOLD Classification C (55%). Patients with high serum uric acid levels required more prolonged hospitalization with a mean average hospital stay of 16.38±6.58 days and presented higher rates of 30-day mortality which was statistically significant (p value 0.005). Moreover, patients with high serum uric acid levels required non-invasive ventilation (NIV) which were both statistically significant (p value <0.001). CONCLUSIONS: In this study we have shown that serum uric acid levels on admission for COPD in exacerbation are associated with increased 30-day mortality and increased risk of non-invasive ventilation use. CLINICAL IMPLICATIONS: In this study we have shown that serum uric acid levels on admission for COPD in exacerbation were an independent predictor of 30-day mortality. Additionally, patients with increased uric acid levels more often required use of non-invasive ventilation. Morover, serum uric acid levels were higher in patients with more severe airflow limitation (COPD classification D). Our results, combined with the fact that serum uric acid is a widely and rapidly available, easy to interpret, low-cost biomarker, suggests a possible role for serum uric acid in the identification of COPD patients at increased risk of adverse outcomes that may need early intensive management. DISCLOSURE: The following authors have nothing to disclose: John Ray Galamay No Product/Research Disclosure Information

The evaluation of retinal and choroidal structural changes by optical coherence tomography in patients with chronic obstructive pulmonary disease

ABSTRACTPurpose: To evaluate the retinal nerve fiber layer (RNFL) thickness, ganglion cell-inner plexiform layer (GCL+) thickness, and macular choroidal thickness (mCT) in patients with chronic obstructive pulmonary disease (COPD) using spectral domain optical coherence tomography (SD-OCT).Methods: A total of 79 COPD patients and 71 age- and sex-matched healthy individuals were enrolled in this prospective cross-sectional study. The patients were divided into two subgroups (with mild-to-moderate COPD and severe COPD) using spirometric data suggested by the Global Initiative for Chronic Obstructive Lung Disease guideline. The RNFL, GCL+, and mCT were compared between groups.Results: The average and nasal RNFL thicknesses in the COPD group were significantly lower than those in control group (p = 0.023 and 0.027 respectively). Statistically significant reductions in average thickness and in those of all six wedge-shaped GCL+ sectors were evident in the COPD group compared with control group and were more marked in patients with severe COPD. The other RNFL data did not differ significantly between COPD and control groups. The mCT was somewhat thinner at all the measured locations in COPD group compared with control group, but statistically significance was not attained.Conclusions: The study results revealed significant average, nasal RNFL, global GCL+ loss, and a nonsignificant choroidal thinning in patients with COPD compared to healthy subjects. The eye seems to be one of the affected tissues during the natural course of the COPD.