Episodes Of Acute Exacerbation Research Articles

Clinical and economic burden of acute exacerbations of idiopathic pulmonary fibrosis: a prospective observational study in Spain (OASIS study)

BackgroundIdiopathic pulmonary fibrosis (IPF) is a fatal progressive lung disease entailing significant impairment in health-related quality of life (HRQoL) and high socioeconomic burden. The course of IPF includes episodes of acute exacerbations (AE-IPF) leading to poor outcomes. This study aimed to compare management, costs and HRQoL of patients with AE-IPF to patients without AE-IPF during one year in Spain.Materials and methodsIn a 12-month, prospective, observational, multicenter study of IPF patients, healthcare resource use was recorded and costs related to AE-IPF were estimated and compared between patients with and without AE-IPF. HRQoL was measured with the St. George’s Respiratory Questionnaire (SGRQ), EuroQoL 5 dimensions 5 levels questionnaire (EQ-5D-5L), EQ-5D visual analogue scale (EQ-VAS) and the Barthel Index.Results204 IPF patients were included: 22 (10.8%) experienced ≥ 1 acute exacerbation, and 182 (89.2%) did not. Patients with exacerbations required more primary care visits, nursing home visits, emergency visits, hospital admissions, pharmacological treatments and transport use (p < 0.05 for all comparisons). Likewise, patients with exacerbations showed higher annual direct health AE-IPF-related costs. In particular, specialized visits, emergency visits, days of hospitalization, tests, palliative care, transport in ambulance and economic aid (p < 0.05 for all comparisons). Exploratory results showed that patients with AE-IPF reported a non-significant but substantial decline of HRQoL compared with patients without AE-IPF, although causality can be inferred.ConclusionWe observed significantly higher resource use and cost consumption and lower HRQoL among patients suffering exacerbations during the study. Thus, preventing or avoiding AE-IPF is key in IPF management.

Obesity Prevalence and Association with Spirometry Profiles, ICU Admission, and Comorbidities Among Patients with COPD: Retrospective Study in Two Tertiary Centres in Saudi Arabia.

Obesity is common among chronic obstructive pulmonary disease (COPD) patients and is associated with an increase in acute exacerbation episodes. However, data on obesity's impact on and association with clinical outcomes among patients with COPD are limited. This study aimed to determine overweight and obesity prevalence and associations with spirometry profiles, intensive care unit (ICU) admission, and comorbidities in patients with COPD. In this retrospective cohort study, we reviewed the electronic health records of adult individuals diagnosed with COPD who visited the studied pulmonary clinics between 1 January 2018 and 31 December 2022 and then collected key demographic variables and relevant clinical outcomes and comorbidities. A total of 474 patients with COPD were included in the final analysis, of whom 60% were male. The occurrences of overweight and obesity were 32.7% and 38.2%, respectively. The presence of comorbidities was high in obese patients (78.4%), followed by overweight patients (63.8%) with COPD. Obese and overweight patients had the highest ward admission rates (38.3% and 34.2%, respectively). ICU admissions were higher in obese and overweight patients (16% and 12%, respectively) compared with normal-weight patients (9%). Although no significant correlation was found between body mass index and spirometry parameters, comorbidities and ICU admission were linked to overweight and obesity in COPD patients (AOR: 1.82 95% CI: 1.15 to 2.86 and AOR: 3.34 95% CI 1.35 to 8.22, respectively). Our findings imply that obesity in COPD is prevalent and is associated with adverse clinical outcomes including a greater number of comorbidities and higher rates of hospitalization and admission to ICUs although no associations were found between body weight and spirometry parameters. Further studies are needed to assess whether implementing and optimising obesity screening and management at an early stage in COPD can prevent further deterioration.

A Preliminary Study on the Impact of Household Air Pollution on Adult Respiratory Health in Urban and Rural Settings of Jaipur, India.

This study aimed to investigate the association between household air pollution and chronic respiratory illness (CRI) in Jaipur, India. A total of 147 participants over 18 years of age from 45 households were randomly included in the study, and follow-up visits were conducted once every fortnight over a three-month period. Spirometry tests were conducted using a portable hand-held digital spirometer. A self-designed, pretested, semi-structured questionnaire was utilized to collect socio-demographic information from the participants. Statistical tests, such as t-tests were used to analyze the association between household air pollution and CRI. The prevalence of COPD and bronchial asthma was 2% and 4%, respectively. Various risk factors for CRI were identified within households, and only 4 episodes of acute exacerbation of chronic respiratory illness were observed, resulting in no incidence density calculation. The mean values of forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were significantly lower in females (P < 0.001) Also, the mean values of FVC and FEV1 were significantly lower in rural areas (P < 0.005) than urban areas. Our findings highlight the importance of government and stakeholder action to implement clean air policies and protect respiratory health. Further studies are needed to expand on these findings and delve deeper into understanding the complex interactions between various risk factors and respiratory health in this population.

Concurrent features of sarcoidosis and hypersensitivity pneumonitis in two patients exposed to fungal antigens

BackgroundSarcoidosis and hypersensitivity pneumonitis (HP) are two distinct clinical entities that share granulomatous inflammation, although each of them has specific clinical, radiologic and pathologic profiles. Coexistence of the two diseases have been described, suggesting, at least in some cases, a common biologic background.Case presentationWe describe two patients showing the concurrent diagnosis of sarcoidosis and hypersensitivity pneumonitis. Case 1: a 51-year old never smoker man had a history of occupational exposure, episodes of acute exacerbations and positive serum precipitins to Penicillium spp suggestive of HP, while the positivity of serum angiotensin converting enzyme (ACE) favored sarcoidosis. Case 2: a 42-year old non-smoker woman with occasional finding of enlarged mediastinal lymph nodes had a history of domestic exposure to molds and positive serum precipitins to Aspergillus spp suggestive of HP.In both cases high resolution computed tomography (HRCT) together with broncoscopy findings allowed to maintain both the diagnoses: HRCT showed both enlarged hilar/mediastinal limph nodes and intersitial lung involvement typical of HP; bronchoalveolar lavage presented marked lymphocytosis and granulomatous nodal lesions were observed at transbronchial needle aspiration.ConclusionsSarcoidosis and HP share some clinical findings and the differential diagnosis may be difficult. Our cases suggest that a common trait may be responsible for the concurrent diagnosis of sarcoidosis and hypersensitivity pneumonitis in the same patient.

Air Pollution and Meteorological Conditions Significantly Associated With Vernal Keratoconjunctivitis Exacerbations.

Vernal keratoconjunctivitis (VKC) is a severe chronic allergic inflammation of the ocular surface with episodes of acute exacerbations, that primarily affects children and young adults. Although the etiology and pathogenesis of VKC remain unclear, studies have suggested that environmental factors may be involved. This study aims to investigate the association between exposure to meteorological and environmental factors and the incidence of VKC exacerbations. This study was conducted in southern Israel, which is a semi-arid, hot, and dry climate with frequent dust storms. Patients diagnosed with VKC were recruited for the study. VKC exacerbations were identified as the need for medical intervention. Pollutants measured included nitrogen dioxide (NO2), ozone (O3), particulate matter (PM10 and PM2.5), sulfur dioxide (SO2), relative humidity (RH), temperature, and solar radiation (SR). To assess the association between VKC exacerbations and exposure to different pollutants, a case-crossover analysis was conducted. We also stratified the analysis by sex, age, ethnicity, immigration status, and social state score. Our results demonstrated that the pollutants NO2, O3, and PM10 were associated with VKC exacerbations with odds ratio (OR) = 2.17 (95% confidence interval [CI] =1.40 to 3.04), OR = 2.28 (95% CI = 1.30 to 3.39), and OR = 1.89 (95% CI = 1.06 to 2.74). Other pollutants PM2.5, temperature, and solar radiation were also independently associated with incidence of exacerbations with OR = 1.15 (95% CI = 0.87 to 1.50), OR = 1.75 (95% CI = 1.16 to 2.65), and OR = 1.37 (95% CI = 1.01 to 1.63) and had varying effects in different demographic strata. The environmental parameters, NO2, O3, PM10, PM2.5, temperature, and solar radiation were found to be significantly associated with VKC exacerbations, with NO2, O3, and PM10 showing the strongest associations. Our findings suggest that environmental factors should be considered when developing strategies to prevent and manage VKC exacerbations.

Serum Electrolytes in Patients Presenting With Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD) and Their Comparison With Stable COPD Patients.

Introduction Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, which may be further aggravated by episodes of acute exacerbationof COPD (AECOPD). Electrolyte imbalances during these episodes may add to the duration of hospitalization and disease outcome. Aims and objectives This study aims to compare the serum electrolyte levels of patients with AECOPD and stable COPD and correlate them with the severity of exacerbation and disease outcome. Materials and methods The study was conducted as a case-control study between January 2021 and December 2022. Patients with AECOPD and stable COPD were included as "cases" and "controls," respectively. The various serum electrolyte levels were defined as per recent guidelines. Statistical analysis was performed using SPSS 20.0 (IBM Corp., Armonk, NY). Results A total of 75 patients wereincludedwith 41 in the study group and 34 in the control group. The majority of people were between the ages of 61 and 70. The most frequent electrolyte abnormality found was hyponatremia.The mean serum sodium and calcium levels were lower in patients with AECOPD while the mean serum potassium levels were higher. A total of five deaths were recorded in patients with two or more electrolyte imbalances. The latter also had a requirement for home oxygen or non-invasive ventilation at the time of discharge. Conclusion Patients of AECOPD with multiple electrolyte imbalances need scrutinized treatment as they are more prone to develop complications, have poorer outcomes, and prolonged hospital stays.

Adiponectin Increase in Patients Affected by Chronic Obstructive Pulmonary Disease with Overlap of Bronchiectasis

Chronic obstructive pulmonary disease (COPD) is characterized by respiratory symptoms and non-reversible airflow limitation with recurrent episodes of acute exacerbations. The concurrent presence of bronchiectasis in patients with COPD is associated with reduced respiratory function as well as increased exacerbation risk. Adiponectin is a promising biomarker in COPD, as greater high molecular weight (HMW) oligomer levels have been observed among COPD patients. Here, we investigate adiponectin levels in two groups of COPD patients characterized by the presence or absence of bronchiectasis (BCO), comparing both groups to healthy controls. We evaluated serum adiponectin levels in COPD patients, those with BCO, and healthy subjects and characterized the pattern of circulating adiponectin oligomers. We found that forced volume capacity % (FVC%) and forced expiratory volume % (FEV1%) were lower for BCO patients than for COPD patients. COPD patients had higher levels of adiponectin and its HMW oligomers than healthy controls. Interestingly, BCO patients had higher levels of adiponectin than COPD patients. We showed that expression levels of IL-2, -4, and -8, IFN-γ, and GM-CSF were significantly higher in BCO patients than in healthy controls. Conversely, IL-10 expression levels were lower in BCO patients. Our data suggest that the increased levels of adiponectin detected in the cohort of BCO patients compared to those in COPD patients without bronchiectasis might be determined by their worse airway inflammatory state. This hypothesis suggests that adiponectin could be considered as a biomarker to recognize advanced COPD patients with bronchiectasis.

Posterior Reversible Encephalopathy Syndrome (PRES) and its relation with COPD

and importance: PRES is a neurological disorder which is usually seen in adult females with symptoms like headache, altered mental status, seizures, impairment of vision. It is a radiographic diagnosis and can present with complications like status epilepticus, hemorrhagic and ischemic brain strokes.It can be associated with many clinical entities, COPD being one. Treatment is symptomatic. We present a case of a 68 years female, presenting with clinical pictures of PRES in an episode of Acute Exacerbation of COPD, who has been diagnosed with PRES based on her CT head and MRI head findings. Treated by treating the infection and other symptomatic measures. Our case had similar association with COPD as mentioned in few other articles. Although rare, PRES is sometimes associated with exacerbation of COPD, and thus should not be ignored.

Specific circulating neutrophils subsets are present in clinically stable adults with cystic fibrosis and are further modulated by pulmonary exacerbations

The progressive lung destruction in cystic fibrosis (CF) is tightly associated with chronic bacterial infection and neutrophil-dominated airway inflammation. CF pulmonary disease is complicated by episodes of acute exacerbations, contributing to irreversible lung damage. We hypothesized that circulating subsets of neutrophils from clinically stable adults with CF present some phenotypic specificities that could amplify their activation during an infectious episode. The aim of the present study was to examine the different neutrophil subsets in whole blood and in the low density neutrophils (LDN) that co-purify with peripheral blood mononuclear cells (PBMC) in clinically stable adults with CF and in CF adults during pulmonary exacerbations compared to healthy donors. Blood samples were obtained from 22 adults with CF (16 in stable state and 6 during pulmonary exacerbations) and from 20 healthy donors. Flow cytometry analysis of 13 different markers related to lineage (CD45, CD15), maturity (CD16, CD10, and CD33), activation (CD62L, CD11b, CD66b, and CD114), metabolism (GLUT-1, LOX1) and immunosuppression (PD1, PD-L1) was carried out within whole blood and within the LDN fraction. Unsupervised analysis of flow cytometry data was performed using visual t-distributed stochastic neighbor embedding (vi-tSNE). A significant increase in the CD11b expression in neutrophils from CF patients during exacerbations was observed compared to neutrophils from stable CF patients or to healthy donors, indicative of a circulating activation state due to an infectious status. The percentage of LDN was not increased in stable CF patients but increased during exacerbations. Analysis of neutrophil subsets using the double CD16/CD62L labeling revealed a significant increase in the CD16high/CD62Llow subset in all CF patients compared to healthy donors. In contrast, an increase in the CD16low/CD62Lhigh subset was observed only in CF patients during exacerbations. Unsupervised analysis identified a PD-L1high/CD114high population that was present in stable CF patients and as well as in CF patients during exacerbations.

Outcome of Pulmonary Rehabilitation in Patients after Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Pulmonary rehabilitation (PR) is an evidence-based intervention in patients with chronic obstructive pulmonary disease (COPD) which improves the exercise capacity and quality of life (QoL). We studied 60 patients after an episode of acute exacerbation of COPD (AECOPD). They were randomised to receive conventional treatment without pulmonary rehabilitation (CTWPR) (n=30) or, standard treatment plus a 12-week post-exacerbation pulmonary rehabilitation (PEPR) programme in addition. Assessment of exercise capacity by six minute walk test (6MWT) and QoL measured by St George's Respiratory Questionnaire (SGRQ) were carried out initially and at the end of three months. The baseline characteristics of both the groups were found to be similar. There was a statistically significant increase in the six minute walk distance (6MWD) (increase by 37.9 meters, p< 0.001) and a significant decline in the total SGRQ score (by 3.8 units p< 0.001) in the PEPR group compared to CTWPR group. Early pulmonary rehabilitation in patients with an AECOPD has significant benefits on the QoL and exercise capacity.

Coexistent Chronic Obstructive Pulmonary Disease-Heart Failure: Mechanisms, Diagnostic and Therapeutic Dilemmas

Mortality in chronic obstructive pulmonary disease (COPD) is more often due to cardiac rather than respiratory causes. The coexistence of heart failure (HF) and COPD is frequent but remains under-diagnosed. Both conditions share several similarities including the age of the population affected, a common risk factor in smoking and symptoms of exertional dyspnoea. There is also a strong possibility of COPD promoting atherosclerotic vascular disease through systemic inflammation. Both the conditions are punctuated by episodes of acute exacerbations of symptoms from time to time where differentiation between these two can be especially challenging. Although coexistence of the two is common, more often, only one of the two is diagnosed resulting in under-treatment and unsatisfactory response. Awareness of co-occurrence is essential among both pulmonologists and cardiologists and a high index of suspicion should be maintained. The coexistence of the COPD and HF also poses several challenges in management. Active search for the second disease using clinical examination supplemented with specialised investigations including plasma natriuretic peptides, lung function testing and echocardiography should be carried out followed by appropriate management. Issues such as adverse effects of drugs on cardiac or pulmonary function need to be sorted out by studies in coexistent COPD-HF patients. Caution is advised with use of beta2-agonists in COPD when HF is also present, more so in acute exacerbations. On current evidence, the beneficial effects of selective beta1-blockers should not be denied in stable patients who have coexistent COPD-HF. The prognosis of coexistent COPD and HF is poorer than that in either disease alone. A favourable response in the patient with coexistent COPD and HF depends on proper evaluation of the severity of each of the two and appropriate management with judicious use of medication.

Remote Monitoring for Prediction and Management of Acute Exacerbations in Chronic Obstructive Pulmonary Disease (AECOPD).

The progression of chronic obstructive pulmonary disease (COPD) is characterized by episodes of acute exacerbation (AECOPD) of symptoms, decline in respiratory function, and reduction in quality-of-life increasing morbi-mortality and often requiring hospitalization. Exacerbations can be triggered by environmental exposures, changes in lifestyle, and/or physiological and psychological factors to greater or lesser extents depending on the individual’s COPD phenotype. The prediction and early detection of an exacerbation might allow patients and physicians to better manage the acute phase. We summarize the recent scientific data on remote telemonitoring (TM) for the prediction and management of acute exacerbations in COPD patients. We discuss the components of remote monitoring platforms, including the integration of environmental monitoring data; patient reported outcomes collected via interactive Smartphone apps, with data from wearable devices that monitor physical activity, heart rate, etc.; and data from medical devices such as connected non-invasive ventilators. We consider how telemonitoring and the deluge of data it potentially generates could be combined with electronic health records to provide personalized care and multi-disease management for COPD patients.

Liver Cirrhosis in Chronic Hepatitis B: is it due to Hepatic Vena Cava Syndrome: case report

Chronic hepatitis B (CHB) is a common chronic viral infection of man. Hepatitis B Virus is not a cytopathic virus. Extensive intrahepatic viral replication is compatible with normally functioning hepatocytes. Patients with CHB in the West manifest as a ‘healthy carrier’, whereas in Asia and Africa some develop liver cirrhosis and hepatocellular cancer. Liver cirrhosis in CHB is assumed to evolve through chronic hepatitis but its pathogenesis and the geographic difference in the outcome of CHB is not explained adequately. Nepal is a country with low prevalence of CHB, where patients with CHB have hepatic vena cava syndrome (HVCS) as a comorbid condition. HVCS is a bacterial infection induced chronic obstructive disease of inferior vena cava at the site of hepatic vein opening. It is clinically characterized by long asymptomatic courses and occasional episodes of acute exacerbation precipitated by bacterial infection that result in hepatic venous outflow obstruction. Increased frequencies of acute exacerbations led to development of hypersplenism, liver cirrhosis and hepatocellular carcinoma. Long time follow up of patients with CHB in Nepal showed development of cirrhosis in many but it was not related to the severity of viral replication or to the duration of the viral infection. Cirrhosis developed more frequently in patients with hypersplenism and those with severe and recurrent acute exacerbation of HVCS. These observations suggested that the development of cirrhosis in CHB in Afro-Asian countries may be due to the presence of HVCS as a comorbid condition. Reported here are a few cases of CHB that illustrate this point. Pathogenesis of cirrhosis in these patients is discussed.

Arterial blood gas analysis and dyselectrolytemia in acute exacerbation of COPD as a prognostic marker

Background: Chronic obstructive pulmonary disease (COPD) is a disease state characterized by airflow limitation that is not fully reversible. COPD is the umbrella term used to include three different respiratory conditions defined clinically as chronic bronchitis and pathologically as Emphysema and it also includes small airway disease. COPD patients mostly present with the features of acute respiratory infectionsbut there may be a number of metabolic derangements arising out of the disease process or as a consequence of the therapy instituted like hyponatremia, hypokalemia, elevated liver enzymes and blood urea. These abnormalities are very often missed and may contribute to morbidity and mortality, if overlooked. Objectives: To study the levels of hypoxemia and serum electrolytes like sodium and potassium in cases of acute exacerbation of COPD and to assess the significance of dyselectrolytemia, as a prognostic marker in these patients. Materials and methods: The study was undertaken from November 2014 to October 2016 among the patients attending, Victoria hospital and Bowring and Lady Curzon hospital attached to Bangalore Medical College and Research Institute, with acute exacerbation of COPD diagnosed clinically and by the pulmonary function tests. 50 patients with acute exacerbation of COPD and 50 disease free healthy controls were included in the study. The Statistical software SAS 9.2, SPSS 15.0, were used for the analysis of the data and Microsoft word and excel have been used to generate graphs, tables etc. Conclusion: Electrolyte abnormalities are most commonly seen in patients with COPD with acute exacerbation and carry very poor prognosis in this group of patients. Thus, overlooking of coexistant metabolic abnormalities may contribute to a great deal of mortality and morbidity in COPD patients during their acute exacerbation episodes. Keywords: pulmonary disease; COPD; dyselectrolytemia; acute exacerbation

FIZZ2 as a Biomarker for Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Found in inflammatory zone 2 (FIZZ2) is associated with lung inflammation. The aim of the study was to investigate the expression and utility of FIZZ2 as a marker for chronic obstructive pulmonary disease (COPD). Immunohistochemistry was used to detect the expression of FIZZ2 in COPD. The serum concentration of FIZZ2 was measured by enzyme-linked immunosorbent assay and the episodes of acute exacerbations of COPD (AECOPD) in the following year were recorded. FIZZ2 expression was elevated in bronchial epithelial cells (0.217 ± 0.021 vs 0.099 ± 0.010, p < 0.0001) and negatively correlated with the pulmonary function (FEV1/FVC%) (p = 0.0149) and positively correlated with the smoking index (p = 0.0241). Serum level of FIZZ2 in COPD were significantly higher than that in healthy controls (561.6 ± 70.71 vs 52.24 ± 20.52pg/ml, p < 0.0001) and increased with the COPD severity. Serum levels of FIZZ2 negatively correlated with the pulmonary function [Forced Vital Capacity (FVC), Forced Expiratory Volume (FEV1), FEV1%, FEV1/FVC) (r = - 0.3086, - 0.3529, - 0.3343, and - 0.2676, respectively, p = 0.0003, p < 0.0001, p < 0.0001, p = 0.0014). The expression of human serum FIZZ2 was positively correlated with the smoking index (r = 0.2749, p = 0.0015). There was a positive correlation between the FIZZ2 concentration and the frequency of AECOPD episodes in the following year (r = 0.7291, p < 0.0001). FIZZ2 expression was elevated in patients with COPD and its serum concentration might be a potential biomarker for AECOPD.

“RESPIRATORY VIRAL INFECTION: AN UNDERRATED ENTITY THAT NEED TO CONSIDER IN MANAGEMENT OF ACUTE EXACERBATION OF COPD”

BACKGROUND: Acute exacerbation of COPD (AECOPD) is one of the most common cause of hospital admission. It causes signicant morbidity, mortality and inexorable decline in ling function. Many exacerbations are believed to be due to upper and/ lower respiratory tract viral infections, but the incidence of these infections in patients with COPD is still undetermined. Objectives of the study are-(a) To nd out the viral etiology in patients having acute exacerbation of COPD. (b) To correlate the severity of COPD patients having exacerbations with viral etiology. METHODS: This cross-sectional study was carried out on 70 AECOPD patients admitted in department of Respiratory Medicine, Institute of Respiratory Diseases, SMS Medical College, Jaipur during July 2019–June 2020. Demographic and clinical parameters were recorded from each patient during admission. Twin nasopharyngeal/oropharyngeal swabs were collected and are tested for Respiratory viruses via RT-PCR. RESULTS: Respiratory viruses were detected in 15 of 70 (21.42%) patients during exacerbations of COPD. The viruses detected were inuenza (10%), rhinovirus (5.71%), adenovirus (4.29%) and RSV (1.42%). Majority of the patients had exacerbations in severe COPD subgroup, had duration of hospital stay of more than or equal to 5 days, had one episode of acute exacerbation per year and 5, 9, 11 respiratory viruses were detected in this group respectively. CONCLUSION: Viral infections seem to contribute to the exacerbations of COPD in our settings and should be strongly considered in the management of such patients. Considering appropriate antiviral therapy can timely reduce morbidity in an event of an inuenza viral exacerbation.

Caring for patients at home after acute exacerbation of chronic obstructive pulmonary disease: A phenomenological study of family caregivers' experiences.

To understand the experiences and support needs of informal caregivers of patients with chronic obstructive pulmonary diseases chronic obstructive pulmonary disease who return home following an acute exacerbation. The presence of an informal caregiver is important to provide practical and emotional support after an episode of acute exacerbation of chronic obstructive pulmonary disease. However, caregiving in such circumstances can be challenging and stressful. Phenomenology. This is a phenomenological study based on semi-structured interviews with sixteen primary caregivers of chronic obstructive pulmonary disease patients. Interview data were analysed using Colaizzi's descriptive analysis framework, to identify significant themes and sub-themes. Data were collected between April-December 2017 in a Teaching Hospital in Italy. The study was designed and reported following the COREQ guidelines and checklist. Analysis elicited five themes embracing various aspects of the caregivers' lived experiences: (a) a home disrupted, (b) living with constant vigilance and anxiety, (c) feeling the need to escape (d) self-justifications for caregiving role/duty, and (e) feeling abandoned by professionals. Our results show that carers experience a range of difficulties when caring for their relative at home with chronic obstructive pulmonary disease. Some of these are linked to the physical disruption of their home but many are linked to feelings of inability to cope and the psycho-social impact of the caring role. The study also shows how participants felt unsupported by professionals. Focused support for carers is required to enable them to meet these challenges. Healthcare professionals should be trained to provide technical and psychological support to caregivers especially during the phases of disease that may involve episodes of exacerbation. Home care and continuity of care can work if there is excellent communication and collaboration between healthcare professionals and caregivers. Developing appropriate support for family caregivers is essential to address the problems they can face.

Is Blood Eosinophil Count a Biomarker for Chronic Obstructive Pulmonary Disease in a Real-World Clinical Setting? Predictive Property and Longitudinal Stability in Japanese Patients.

The authors examined predictive properties and the longitudinal stability of blood eosinophil count (BEC) or three strata (<100 cells/mm3, 100–299 cells/mm3 and ≥300 cells/mm3) in patients with chronic obstructive pulmonary disease (COPD) for up to six and a half years as part of a hospital-based cohort study. Of the 135 patients enrolled, 21 (15.6%) were confirmed to have died during the follow-up period. Episodes of acute exacerbation of COPD (AECOPD) were identified in 74 out of 130 available patients (56.9%), and admission due to AECOPD in 35 out of 132 (26.5%). Univariate Cox proportional hazards analyses revealed that almost all the age, forced expiratory volume in 1 s (FEV1) and health status measures using St. George’s Respiratory Questionnaire (SGRQ) Total and COPD Assessment Test (CAT) Score were significantly related to these types of events, but the relationship between age and AECOPD did not reach statistical significance (p = 0.05). Neither BEC nor the three different groups stratified by BEC were significant predictors of any subsequent events. There were no significant differences in the BEC between Visits 1–3 (p = 0.127, Friedman test). The ICC value was 0.755 using log-transformed data, indicating excellent repeatability. In the case of assigning to strata, Fleiss’ kappa was calculated to be 0.464, indicating moderate agreement. The predictive properties of BEC may be limited in a real-world Japanese clinical setting. Attention must be paid to the fact that the longitudinal stability of the three strata is regarded as moderate.

Fractional heat shock protein 27 urine excretion as a short-term predictor in acute exacerbation of chronic obstructive pulmonary disease.

BackgroundChronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality and is characterized by episodes of acute exacerbations. Finding a systemic biomarker that reliably predicts outcome after an acute exacerbation remains a major challenge. Heat shock protein 27 (HSP27) has been previously studied in COPD, however, urine excretion trajectory and prognostic value after an exacerbation is unknown.MethodsIn this retrospective post hoc analysis of a prospective study that included 253 COPD patients who were hospitalized for acute exacerbation, 207 patients were analyzed. Urine and serum were sampled at admission, discharge, and 180 days after discharge; urine excretion trajectory was analyzed and correlated with clinicopathological and survival data.ResultsHSP27 urine excretion increased after an exacerbation episode [1.8% admission, 1.8% discharge, 2.3% 180 days after discharge (P=0.091)]. In severely ill patients (GOLD IV) this course was even more distinct [1.6% admission, 2.1% discharge, 2.8% 180 days after discharge (P=0.007)]. Furthermore, fractional HSP27 urine excretion at discharge was increased in GOLD IV patients (P=0.031). In Kaplan-Meier and univariable Cox proportional hazard models patients with HSP27 urine excretion below 0.845% showed significantly worse survival at 30, 90 and 180 days after discharge. In a multivariable Cox proportional hazard model including established COPD outcome parameters fractional HSP27 urine excretion remained a significant predictor of survival at 30 and 90 days after discharge. Comparing this model to our already published model that includes HSP27 serum concentration we could show that fractional HSP27 urine excretion performs better in short-term survival.ConclusionsOur findings provide novel information about fractional HSP27 urine excretion trajectory in acute exacerbation of COPD. Fractional HSP27 urine excretion may be significantly reduced during an episode of acute exacerbation in COPD patients and may be used as a predictor of short-term all-cause mortality.

DSP rs2076295 variants influence nintedanib and pirfenidone outcomes in idiopathic pulmonary fibrosis: a pilot study

The antifibrotic drugs nintedanib and pirfenidone are used for the treatment of idiopathic pulmonary fibrosis (IPF). We analysed the association of common profibrotic polymorphisms in MUC5B (mucin 5B, rs35705950) and DSP (desmoplakin, rs2076295) on antifibrotic treatment outcomes in IPF. MUC5B rs35705950 and DSP rs2076295 were assessed in IPF patients (n = 210, 139 men/71 women) from the Czech EMPIRE registry and age- or sex-matched healthy individuals (n = 205, 125 men/80 women). Genetic data were collated with overall survival (OS), acute exacerbation episodes, worsening lung function and antifibrotic treatment. We confirmed overexpression of the MUC5B rs35705950*T allele (55.2% versus 20.9%, p < 0.001) and the DSP rs2076295*G allele (80.4% versus 68.3%, p < 0.001) in IPF compared with controls. On antifibrotic drugs, lower mortability was observed in IPF patients with DSP G* allele (p = 0.016) and MUC5B T* allele (p = 0.079). Carriers of the DSP rs2076295*G allele benefitted from nintedanib treatment compared with TT genotype by a longer OS [hazard ratio (HR) = 7.99; 95% confidence interval (CI) = 1.56-40.90; p = 0.013] and a slower decline in lung function (HR = 8.51; 95% CI = 1.68-43.14; p = 0.010). Patients with a TT genotype (rs2076295) benefitted from treatment with pirfenidone by prolonged OS (p = 0.040; HR = 0.35; 95% CI = 0.13-0.95) compared with nintedanib treatment. Both associations were confirmed by cross-validation analysis. After stratifying by MUC5B rs35705950*T allele carriage, no difference in treatment outcome was observed for nintedanib or pirfenidone (p = 0.784). In the multivariate model, smoking, age, forced vital capacity (FVC) and DLCO (diffuse lung capacity) at the IPF diagnosis were associated with survival. Our real-world study showed that IPF patients with MUC5B T* allele or DSP G* allele profit from antifibrotic treatment by lower mortability. Moreover, carriers of the DSP rs2076295*G allele benefit from treatment with nintedanib, and TT genotype from treatment with pirfenidone. MUC5B rs35705950 did not impact the outcome of treatment with either nintedanib or pirfenidone. Our single-registry pilot study should be confirmed with an independent patient cohort.