Exacerbations In COPD Patients Research Articles

Predictive Value of CCQ and its Subdomains for Hospitalized Exacerbations in Chronic Obstructive Pulmonary Disease: A 3-Year Observational Prospective Study.

The prediction capacity of the Clinical COPD Questionnaire (CCQ) and its functional, symptom, and mental subdomain for COPD hospitalized exacerbation were rarely studied. To examine the prognostic capacity of the total CCQ and its three subdomains for 3-year COPD hospitalized exacerbations. We analyzed the predictive ability of total CCQ score and its subdomains for hospitalized exacerbations in an observational cohort of 987 subjects with stable COPD from the RealDTC, an ongoing multicenter prospective study. Hospitalized exacerbations were prospectively collected every 6month for a maximum of 3years. The total CCQ and its functional and symptom domain, but not the mental domain, were significantly associated with 3-year hospitalized exacerbations by multivariate Cox regression analysis. The predictive capacity of functional domain was similar to that of the total CCQ, but significantly stronger than the symptom and mental domain by ROC analysis (P < 0.05). ROC curves also showed that the AUC of exacerbation history combined with CCQ functional domain was larger than that of exacerbation history alone (P < 0.0001). Additionally, the predictive value of multivariable models that contains CCQ functional domain was significantly better than the corresponding model without CCQ functional domain (P < 0.05). The total CCQ and its functional and symptom domain were independent risk factors of 3-year hospitalized exacerbations. The prognostic capacity of the functional domain was similar to that of total CCQ, and was significantly stronger than the symptom and mental domain. The CCQ functional domain was able to increase the predictive power of exacerbation history and other multivariable prediction models, indicating it may have an important role in the multivariable prediction tool for hospitalized exacerbation, and its combination with other clinical variables might be used as a low-cost approach for assessments of the disease severity and severe exacerbation in COPD patients in the future.

Associations of the Serum KL-6 with Severity and Prognosis in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

As a biomarker of alveolar-capillary basement membrane injury, Krebs von den Lungen-6 (KL-6) is involved in the occurrence and development of pulmonary diseases. However, the role of the KL-6 in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has yet to be elucidated. This prospective study was designed to clarify the associations of the serum KL-6 with the severity and prognosis in patients with AECOPD. This study enrolled 199 eligible AECOPD patients. Demographic data and clinical characteristics were recorded. Follow-up was tracked to evaluate acute exacerbation and death. The serum KL-6 concentration was measured via an enzyme-linked immunosorbent assay. Serum KL-6 level at admission was higher in AECOPD patients than in control subjects. The serum KL-6 concentration gradually elevated with increasing severity of AECOPD. Pearson and Spearman analyses revealed that the serum KL-6 concentration was positively correlated with the severity score, monocyte count and concentrations of C-reactive protein, interleukin-6, uric acid, and lactate dehydrogenase in AECOPD patients during hospitalization. A statistical analysis of long-term follow-up data showed that elevated KL-6 level at admission was associated with longer hospital stays, an increased risk of future frequent acute exacerbations, and increased severity of exacerbation in COPD patients. Serum KL-6 level at admission is positively correlated with increased disease severity, prolonged hospital stay and increased risk of future acute exacerbations in COPD patients. There are positive dose-response associations of elevated serum KL-6 with severity and poor prognosis in COPD patients. The serum KL-6 concentration could be a novel diagnostic and prognostic biomarker in AECOPD patients.

Early Enteral Nutrition and Clinical Outcomes in COPD Patients Requiring Mechanical Ventilation

Early commencement of enteral nutrition (EEN) in critically ill patients requiring mechanical ventilation may improve outcomes. But there is a lack of enough data regarding EEN effects on COPD exacerbation patients’ outcomes. This retrospective study involved 129 COPD exacerbation patients who received invasive mechanical ventilation in ICU. The clinical outcomes were compared based on the timing of enteral nutrition (&lt;48h vs &gt;48h) during 60 days of ICU stay. We surveyed and analyzed mortality, pleural effusion, ventilator-associated pneumonia, weaning failure, cardiac arrhythmias, GI bleeding, electrolyte imbalances, renal dysfunction and length of ICU stay. All analyses were performed using SPSS software version 22.0. 129 COPD-exacerbated patients (EEN group n=66; DEN group n=63) who met the inclusion criteria were enrolled in the study. EEN group had a lower death rate (39% vs 44.4%) than the DEN group, but no significant difference was found in the overall mortality during the 60-day follow-up (P 0.561). The EEN group also had lower ICU stay and pleural effusion rate than the DEN group (P:0.006 and 0.020 respectively). No significant differences were found in other outcomes. Early enteral nutrition might be associated with shorter ICU stay and lower odd ratio of acquisition of pleural effusion in COPD patients requiring invasive mechanical ventilation. EEN could not decrease mortality rate compared with DEN in the current study.

Dynamic hyperinflation is a risk factor for mortality and severe exacerbations in COPD patients

ObjectiveTo assess if dynamic hyperinflation is an independent risk factor for mortality and severe exacerbations in COPD patients. MethodsA cohort of 141 patients with stable COPD and moderate to very severe airflow limitation, treated according to conventional guidelines, was followed for a median of 9 years. Clinical characteristics were recorded and arterial blood gases, pulmonary function tests, 6-min walk and incremental exercise test with measurement of respiratory pattern and operative lung volumes were performed. Endpoints were all-cause mortality and hospitalization for COPD exacerbation. Results58 patients died during the follow-up period (1228 patients x year). The mortality rate was higher in patients with dynamic hyperinflation (n = 106) than in those without it (n = 35) (14.6; 95% CI, 14.5–14.8 vs. 7.2; 95% CI, 7.1–7.4 per 1000 patients-year). After adjusting for sex, age, body mass index, pack-years and treatment with inhaled corticosteroids, dynamic hyperinflation was associated with a higher mortality risk (adjusted hazard ratio [aHR], 2.725; 95% CI, 1.010–8.161), and in a multivariate model, comorbidity, peak oxygen uptake and dynamic hyperinflation were retained as independent predictors of mortality. The time until first severe exacerbation was shorter for patients with dynamic hyperinflation (aHR, 3.961; 95% CI, 1.385–11.328), and dynamic hyperinflation, FEV1 and diffusing capacity were retained as independent risk factors for severe exacerbation. Moreover, patients with dynamic hyperinflation had a higher hospitalization risk than those without it (adjusted incidence rate ratio, 1.574; 95% CI, 1.087–2.581). ConclusionIn stable COPD patients, dynamic hyperinflation is an independent prognostic factor for mortality and severe exacerbations.

Relationship between airway inflammation, small airway dysfunction, and frequency of acute exacerbations in patients with chronic obstructive pulmonary disease

ContextRecurrent exacerbations in COPD patients are associated with accelerated reduction in lung function. Airway inflammation and small airway dysfunction were recognized for a long time as an essential feature of COPD.AimTo study the relationship between neutrophilic airway inflammation, small airway dysfunction, and frequency of acute exacerbations in COPD patients.Settings and designThis was a cross-sectional study.Patients and methodsThirty COPD patients were enrolled and classified into two groups: infrequent exacerbators (IFE) “who developed ≤ 1 exacerbation per year” and frequent exacerbators (FE) “who developed ≥ 2 exacerbations per year” in the last year prior to this study. All patients included in the study underwent clinical evaluation, and assessment of small airway dysfunction by pulmonary function testing (MEF 25–75, RV/TLC, and DLCO) and paired inspiratory and expiratory HRCT-chest to measure the mean lung density (MLD) as well as assessment of neutrophilic airway inflammation by taking BAL via bronchoscopy and examined for differential cell count.ResultsThe small airway dysfunction is more severe in the case of the FE COPD group as there were statistically significant differences between FE and IFE COPD groups in %MEF 25–75 and RV/TLC (p = 0.038 and p = 0.030, respectively). The mean value of the BAL neutrophil % was higher in FE than in IFE COPD patients but without a significant statistical difference (p = 0.513). There were statistically significant negative correlations between %FEV1 (p = 0.026), %FVC (p = 0.020), and %MEF25–75 (p = 0.005) and MLD(E/I) in all studied COPD patients.ConclusionCOPD patients associated with small airway dysfunction and increased BAL neutrophil cell count are more prone to frequent exacerbations.Trial registrationClinicalTrials.gov NCT06040931. Registered 18 Sept 2023—Retrospectively registered.

Characteristics of Exacerbation and Antibiotic Usage in Treatment for Exacerbation of COPD Patients in National Lung Hospital (2022-2023)

Abstract: Exacerbations of COPD are important events in the progression of the disease, being the leading cause of hospitalization and mortality. Bacterial respiratory infections are one of the main causes of exacerbations. This retrospective study was described characteristics of exacerbation and antibiotic use in COPD exacerbation patients hospitalized at the National Lung Hospital. This study included 200 hospitalized patients from January2022 to June 2023. Many patients in the study sample were male (90%), 76% of patients had two or more exacerbations per year. The most isolated bacteria are Haemophilus influenzae, Pseudomonas aeruginosa, Acinetobacter baumannii. There were 77,5% pneumonia patients had Drug Susceptibility Tests (DST), and 54,7% of patients had antibiotic regimens consistent with the DST. The results of this study provide a reliable basis for selecting and improving the effectiveness of antibiotic use in the treatment of COPD exacerbations, improving outcomes and survival prognosis for patients.&#x0D; Keywords: COPD, exacerbation, bacteria, antibiotics.

Development and Validation of Prediction Models for Exacerbation, Frequent Exacerbations and Severe Exacerbations of Chronic Obstructive Pulmonary Disease: A Registry Study in North China

In COPD patients, exacerbation has a detrimental influence on the quality of life, disease progression and socioeconomic burden. This study aimed to develop and validate models to predict exacerbation, frequent exacerbations and severe exacerbations in COPD patients. We conducted an observational prospective multicenter study. Clinical data of all outpatients with stable COPD were collected from Beijing Chaoyang Hospital and Beijing Renhe Hospital between January 2018 and December 2019. Patients were followed up for 1 year. The data from Chaoyang Hospital was used for modeling dataset, and that of Renhe Hospital was used for external validation dataset. The final dataset included 456 patients, with 326 patients as the model group and 130 patients as the validation group. Using LABA + ICS, frequent exacerbations in the past year and CAT score were independent risk factors for exacerbation in the next year (OR = 2.307, 2.722 and 1.147), and FVC %pred as a protective factor (OR = 0.975). Combined with chronic heart failure, frequent exacerbations in the past year, blood EOS counts and CAT score were independent risk factors for frequent exacerbations in the next year (OR = 4.818, 2.602, 1.015 and 1.342). Using LABA + ICS, combined with chronic heart failure, frequent exacerbations in the past year and CAT score were independent risk factors for severe exacerbations in the next year (OR = 1.950, 3.135, 2.980 and 1.133). Based on these prognostic models, nomograms were generated. The prediction models were simple and useful tools for predicting the risk of exacerbation, frequent exacerbations and severe exacerbations of COPD patients in North China.

Analysis of sputum microbial flora in chronic obstructive pulmonary disease patients with different phenotypes during acute exacerbations

BackgroundIncreasing studies have shown that the imbalance of the respiratory microbial flora is related to the occurrence of COPD, the severity and frequency of exacerbations and mortality.However, it remains unclear how the sputum microbial flora differs during exacerbations in COPD patients manifesting emphysema phenotype, chronic bronchitis with emphysema phenotype and asthma-COPD overlap phenotype. MethodsSputum samples were obtained from 29 COPD patients experiencing acute exacerbations who had not received antibiotics or systemic corticosteroids within the past four weeks.Patients were divided into three groups;emphysema phenotype(E);chronic bronchitis with emphysema phenotype(B+E) and asthma-COPD overlap phenotype(ACO).We utilized metagenomic Next Generation Sequencing (mNGS) technology to analyze the sputum microbial flora in COPD patients with different phenotypes during exacerbations. ResultsThere was no significant difference in alpha diversity and beta diversity among three groups.The microbial flora composition was similar in all three groups during exacerbations except for a significant increase in Streptococcus mitis in ACO.Through network analysis,we found Candidatus Saccharibacteria oral taxon TM7x and Fusobacterium necrophorum were the core nodes of the co-occurrence network in ACO and E respectively.They were positively correlated with some species and play a synergistic role.In B+E,Haemophilus pittmaniae and Klebsiella pneumoniae had a synergistic effect.Besides,some species among the three groups play a synergistic or antagonistic role.Through Spearman analysis,we found the relative abundance of Streptococcus mitis was negatively correlated with the number of hospitalizations in the past year(r = −0.410,P = 0.027).We also observed that the relative abundance of Prevotella and Prevotella melaninogenica was negatively correlated with age(r = −0.534,P = 0.003;r = −0.567,P = 0.001),while the relative abundance of Streptococcus oralis and Actinomyces odontolyticus was positively correlated with age(r = 0.570,P = 0.001;r = 0.480,P = 0.008).In addition,the relative abundance of Prevotella melaninogenica was negatively correlated with peripheral blood neutrophil ratio and neutrophil to lymphocyte ratio(r = −0.479,P = 0.009;r = −0.555,P = 0.002),while the relative abundance of Streptococcus sanguinis was positively correlated with peripheral blood neutrophil ratio and neutrophil to lymphocyte ratio (r = 0.450,P = 0.014;r = 0.501,P = 0.006).There was also a significant positive correlation between Oribacterium and blood eosinophil counts(r = 0.491,P = 0.007). ConclusionOverall,we analyzed the sputum microbiota of COPD patients with different phenotypes and its relationship with clinical indicators, and explored the relationships between microbiota and inflammation in COPD.We hope to alter the prognosis of patients by inhibiting specific bacterial taxa related to inflammation and using guide individualized treatment in the future research.

Risk Factors for Anxiety and its Impacts on Acute Exacerbation in Chronic Obstructive Pulmonary Disease: A Prospective Cohort Study in Elderly COPD Patients in Shanghai

Background: We aimed to explore the relation between anxiety and its associated risk factors in elderly COPD patients in Shanghai and to illuminate the relation between anxiety and the risk of acute exacerbations in 12 months. Methods: 424 patients were included in our analysis. All participants were assessed by comprehensive questionnaires. Hamilton Anxiety Rating Scale (HAM-A) was used to assess all COPD patients. Acute exacerbations including the previous one year and one-year follow-up were recorded. Results: 424 patients including 380 males and 44 females were included in the final analysis. Of the 424 COPD patients, 19.81% (N=84) had anxiety symptoms and 80.19% (N=340) had no anxiety symptoms. There were increased pack-years, more comorbidities, and acute exacerbations in COPD patients with anxiety compared to those without anxiety. Meanwhile, a higher Modified Medical Research Council (mMRC), a higher COPD Assessment Test (CAT) score, and a shorter Six-Minute Walking Distance (6MWD) were found in COPD patients with anxiety. We found that the BODE index, mMRC, CAT score, comorbidities, and exacerbations were independently associated with a significantly higher risk of anxiety. Eventually, COPD patients with anxiety increased the risk of acute exacerbations in 12 months, especially moderate and severe exacerbations as compared with COPD patients without anxiety. Conclusion: Anxiety is a common comorbidity of individuals suffering from COPD, although it is frequently underdiagnosed and consequently undertreated. Physicians should more actively detect and manage anxiety by considering the associated factors. Mental health care should be paid more attention to decrease the risk of acute exacerbation in COPD patients.

Change in physical activity related to admission for exacerbation in COPD patients

IntroductionThe aim of this study was to determine the impact of hospitalizations on levels of physical activity (PA) and whether other factors were associated with subsequent changes in PA. MethodsProspective observational cohort study with a nested case-control study, with follow-up 60 days from the index hospital admission. Nine hospitals participated in the study. Patients were recruited consecutively. Several variables and questionnaires of the clinical baseline status of the patients were recorded including: the COPD Assessment Test (CAT), the Hospital Anxiety-Depression scale (HADS), comorbidities and the Yale Physical Activity Survey. Patients’ data related to admission and up to two months after discharge were also recorded. Results883 patients were studied: 79.7% male; FEV1 48%; Charlson index 2; 28.7% active smokers. The baseline PA level for the total sample was 23 points. A statistically significant difference in PA was found between patients readmitted up to 2 months after the index admission and those not readmitted (17vs. 27, p < 0.0001). Multivariable linear regression analysis identified the following as predictors of the decrease of PA from baseline (index admission) up to 2 months follow-up: admission for COPD exacerbation in the two months prior to the index admission; readmission up to 2 months after the index admission; baseline HAD depressive symptoms, worse CAT score, and patient-reported “need for help”. ConclusionsIn a cohort of admitted COPD patients, we identified a strong relationship between hospitalization for exacerbation and PA. In addition, some other potentially modifiable factors were found associated with the change in PA level after an admission.

The use of high-flow versus conventional oxygen therapy in addition to noninvasive ventilation in exacerbated COPD patients in the ICU: A retrospective cohort study in 351 patients

Background and aimThe optimal treatment strategy for acute exacerbation of COPD in the ICU next to the well-known benefits of noninvasive ventilation (NIPPV) is unknown. We hypothesised that High Flow Nasal Cannula (HFNC) as noninvasive respiratory support plus NIPPV could add additional help compared to conventional oxygen therapy (COT) plus NIPPV. MethodsWe conducted a retrospective analysis. We included 351 patients admitted to ICU with AECOPD and need for NIPPV. Survival was assessed with Kaplan-Meier curves and the Log-rank test. Cox proportional hazard regression models were used to analyse differences in survival between treatment groups. Results126 patients were treated with HFNC plus NIPPV. 225 patients received COT plus NIPPV. Median pH and hypercapnia only showed slight differences on admission. ICU stay was 4 days in both groups. The need for invasive ventilation was alike in both groups (HFNC 18.3% vs COT 17.8%). In a cox regression model for 30-day mortality, patients treated with HFNC showed a 2.17 (0.99–4.78) higher hazard for mortality compared to the COT group (p = 0.054). ConclusionAccording to our data HFNC in combination with noninvasive positive pressure ventilation does not seem to provide additional benefits over COT in combination with noninvasive positive pressure ventilation in terms of 30-day mortality and need for intubation.

Hypercapnic Failure in Acute Exacerbated COPD Patients: Severe Airflow Limitation as an Early Warning Signal

Hypercapnic failure is a severe complication of COPD disease progression, which is associated with a high morbidity and mortality. The aim of this study was to examine the association of comorbidity and clinical risk factors with the development of hypercapnia in acute exacerbated COPD patients. In this retrospective monocentric cohort study, we examined the influence of the clinical parameters and the comorbidity of hospitalized patients with the acute exacerbation of COPD on the development of hypercapnia by performing multivariate logistic regression and a receiver operating characteristic analysis. In total, 275 patient cases with COPD exacerbation were enrolled during the period from January 2011 until March 2015, where 104 patients (37.8%) with hypercapnia were identified. The logistic regression analysis revealed severe airflow limitation (decreased FEV1) as the main factor associated with the development of hypercapnia. In the ROC analysis, we determined an FEV1 of 42.12%, which was predicted with a sensitivity of 82.6% and specificity of 55%, and an absolute value of FEV1 of 0.8 L, with a sensitivity of 0.62 and specificity of 0.79 as the cut off points, respectively. We could not verify an association with the patient's condition or the laboratory surrogate parameters of organ failure. Severe airflow limitation is an important risk factor that is associated with hypercapnic failure in acute exacerbated COPD patients. Validation in prospective cohorts is warranted and should focus on more intensive monitoring of these at-risk patients.

Immunosensors made of polymer-infused porous paper for the non-invasive detection of airways cytokines trapped by porous face masks

The diverse physicochemical properties of polymers make them perfect candidates for developing biosensor elements when combined with porous substrates. For example, microfluidic channels, valves, reservoirs and biorecognition elements have been proposed that rely on filling the cavities of porous cellulose with different polymers. Yet, highly concentrated polymers are often too viscous to dispense them with precision using conventional printing methods. This increases the manufacturing variability, which degrades the performance of the biosensors. Here this issue is solved with a new method for infusing porous materials (filter paper) with concentrated polymers (PSS) that circumvents the dropwise addition of highly viscous reagents. The resulting films contain homogenously distributed polymers, which reduces the intra- and inter-batch variabilities of biosensors based on dispensing nanoparticles from the reservoirs. The proposed method was utilized to develop immunosensors for detecting the cytokines IL-6 and IL-5 in aerosols, which were trapped by the polypropylene layer of a surgical face mask (limit of detection 10−2 pg·mL−1). Using this approach, we were able to detect elevated levels of airways cytokines when exacerbated COPD patients and eosinophilic asthma patients wore the face mask for 30 min. The results shown here pave the way for upscaling the manufacturing of paper-based nanoparticle biosensors, which is a crucial step towards their future commercialization.

What Role Do Immunological and Inflammatory Biomarkers Play on Mortality and Exacerbations in COPD Patients?

Background: COPD phenotypes have been identified according to patient clinical characteristics and, more recently, to their immunological markers. However, the role of these biomarkers in relation to exacerbations in different COPD phenotypes is not yet clear. Thus it is important to continue investigating this topic to plan the most appropriate treatment, to contrast the decline of respiratory function and to reduce subsequent exacerbations in COPD patients. Therefore the aim of this study was to assess whether biomarkers are only predictors of exacerbations and mortality in COPD patients or instead play a causal role in these adverse COPD developments. Methods: COPD phenotypes were identified according to patient clinical characteristics or immunological markers. Immunological and inflammatory biomarkers were identified as predictors of mortality and exacerbations. COPD patients were identified from the hospital discharge register of Pisa (Italy) in 2000-2006, on the basis of diagnoses and a FEV1/FVC &lt; 0.70, and enrolled in 2003-2006 according to a longitudinal approach. They were characterized at enrollment by age, sex, comorbidities, immunological and inflammatory biomarkers. The phenotype was assigned at enrollment as eosinophilic (eosinophils&gt;2%) or neutrophilic (leukocytes&gt;11.0x109/L and/or neutrophils&gt;65%). Mortality and exacerbations registered in the period 2003-2012 were assessed by phenotype and other possible predictors in regression models. Results: Mortality rates reached 43.3% in COPD patients: 69.1% and 36.5% in neutrophilic and eosinophilic, respectively. The exacerbation rate was higher in neutrophilic (54.4%) than in eosinophilic patients (48.4%). Uni-variable regression confirmed that mortality was related to age, Congestive Heart Failure (CHF), Ischemic Heart Disease (IHD), elevated neutrophil count and Neutrophil to Lymphocyte Ratio (NLR). At multivariable analysis only age was associated with mortality, whereas inflammatory biomarkers induced exacerbations. Conclusion: Mortality was influenced by phenotype and age, exacerbations by COPD severity and NLR to suggest that an appropriate treatment and the biomarker’s monitoring might help prevent exacerbations.

Associations of serum sclerostin levels with body composition, pulmonary function, and exacerbations in COPD patients

BackgroundIn COPD, the bronchial epithelium shows a pathologically activated Wnt pathway. Sclerostin (SOST) is a secreted glycoprotein that is associated with bone metabolism and blocks the Wnt pathway. We hypothesized that low sclerostin levels might be associated with lung function and COPD exacerbations in patients. MethodsWe studied 139 outpatients with stable COPD and normal kidney function. We assessed the serum levels of SOST and bone metabolism parameters, body composition, clinical characteristics and lung function at baseline. We followed the patients prospectively for 12 months after enrolment. Moderate exacerbations and hospital admissions were recorded during follow-up. ResultsThe serum SOST levels were 23.98±7.6 pmol/l (men: 25.5±7.7 pmol/l, women: 20.3±5.9 pmol/l (p < 0.001)). SOST showed correlations with age (r = 0.36), FFMI (r = 0.38), FEV1 (r = 0.27), DLCO (r = 0.39), 6MWD (r = 0.19) and CAT (r = -0.24). In multivariate linear regression analysis, only age (beta=0.264) and FFMI (beta=1.241) remained significant. SOST showed a significant negative correlation with serum phosphorus (r = -0.29). Cox proportional risk analysis indicated that patients in the lower tertile of SOST levels were at higher risk of moderate COPD exacerbation (HR 2.015, CI95% 1.136–3.577, p = 0.017) and hospital admission due to COPD (HR 5.142, CI95% 1.380–19.158, p = 0.015) than the rest of the patients. ConclusionsSOST levels are associated with body composition and lung function in patients with COPD. Furthermore, lower SOST levels predict a higher risk of exacerbations and hospitalization.

High-flow nasal cannula versus conventional oxygen therapy in acute COPD exacerbation with mild hypercapnia: a multicenter randomized controlled trial

BackgroundHigh-flow nasal cannula (HFNC) can improve ventilatory function in patients with acute COPD exacerbation. However, its effect on clinical outcomes remains uncertain.MethodsThis randomized controlled trial was conducted from July 2017 to December 2020 in 16 tertiary hospitals in China. Patients with acute COPD exacerbation with mild hypercapnia (pH ≥ 7.35 and arterial partial pressure of carbon dioxide > 45 mmHg) were randomly assigned to either HFNC or conventional oxygen therapy. The primary outcome was the proportion of patients who met the criteria for intubation during hospitalization. Secondary outcomes included treatment failure (intolerance and need for non-invasive or invasive ventilation), length of hospital stay, hospital cost, mortality, and readmission at day 90.ResultsAmong 337 randomized patients (median age, 70.0 years; 280 men [83.1%]; median pH 7.399; arterial partial pressure of carbon dioxide 51 mmHg), 330 completed the trial. 4/158 patients on HFNC and 1/172 patient on conventional oxygen therapy met the criteria for intubation (P = 0.198). Patients progressed to NPPV in both groups were comparable (15 [9.5%] in the HFNC group vs. 22 [12.8%] in the conventional oxygen therapy group; P = 0.343). Compared with conventional oxygen therapy, HFNC yielded a significantly longer median length of hospital stay (9.0 [interquartile range, 7.0–13.0] vs. 8.0 [interquartile range, 7.0–11.0] days) and a higher median hospital cost (approximately $2298 [interquartile range, $1613–$3782] vs. $2005 [interquartile range, $1439–$2968]). There were no significant differences in other secondary outcomes between groups.ConclusionsIn this multi-center randomized controlled study, HFNC compared to conventional oxygen therapy did not reduce need for intubation among acute COPD exacerbation patients with mild hypercapnia. The future studies should focus on patients with acute COPD exacerbation with respiratory acidosis (pH < 7.35). However, because the primary outcome rate was well below expected, the study was underpowered to show a meaningful difference between the two treatment groups.Trial registration: NCT03003559. Registered on December 28, 2016.

Comparison of CRP, Procalcitonin, Neutrophil Counts, Eosinophil Counts, sTREM-1, and OPN between Pneumonic and Nonpneumonic Exacerbations in COPD Patients.

Introduction The patients with community-acquired pneumonia (CAP) and acute exacerbations of COPD (AECOPD) could have a higher risk of acute and severe respiratory illness than those without CAP in AECOPD. Consequently, early identification of pneumonia in AECOPD is quite important. Methods. 52 subjects with AECOPD + CAP and 93 subjects with AECOPD from two clinical centers were enrolled in this prospective observational study. The values of osteopontin (OPN), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), C-reactive protein (CRP), procalcitonin (PCT), eosinophil (EOS) counts, and neutrophil (Neu) counts in blood on the first day of admission and clinical symptoms were compared in AECOPD and AECOPD + CAP. In addition, subgroup analyses of biomarker difference were conducted based on the current use of inhaled glucocorticoids (ICS) or systemic corticosteroids (SCS). Results Patients with AECOPD + CAP had increased sputum volume, sputum purulence, diabetes mellitus, and longer hospital stays than AECOPD patients (p < 0.05). A clinical logistic regression model showed among the common clinical symptoms, purulent sputum can independently predict pneumonia in AECOPD patients after adjusting for a history of diabetes. At day 1, AECOPD + CAP patients had higher values of Neu, CRP, PCT, and OPN, while serum sTREM-1 levels and EOS counts were similar in the two groups. CRP fared best at predicting AECOPD with CAP (p < 0.05 for the test of difference), while OPN had similar accuracy with Neu, PCT, and purulent sputum (p > 0.05 for the test of difference). Multivariate analysis, including clinical symptoms and biomarkers, suggested that CRP ≥15.8 mg/dL at day 1 was a only promising predictor of pneumonia in AECOPD. CRP and OPN were not affected by ICS or SCS. Conclusions CRP ≥15.8 mg/dL is an ideal promising predictor of pneumonia in AECOPD, and its plasma level is not affected by ICS or SCS. The diagnostic performance of CRP is not significantly improved when combined with clinical symptoms or other markers (OPN, PCT, and Neu).

Outpatient pulmonary rehabilitation

HintergrundAmbulante pneumologische Rehabilitation (PR) spielt eine zentrale Rolle in der integrativen Versorgung von Patient:innen mit Lungenerkrankungen.Material und MethodeIn dieser Arbeit wird die rezente Evidenz zu ambulanter PR bei verschiedenen Erkrankungen, in verschiedenen Settings inklusive der Kosteneffektivität dargelegt. Diese basiert auf Literaturrecherche in den Datenbanken PubMed und MEDLINE, aktuellen Expertenmeinungen und klinischen Erfahrungen.ErgebnisseFrühe Rehabilitation nach Exazerbation führt bei COPD(chronisch obstruktive Lungenerkrankung)-Patient:innen zu einer Reduktion der Wiederaufnahme im Spital (Hazard Ratio 0,83) und zu einer Reduktion der Mortalität (Hazard Ratio 0,63) über den Zeitraum von 12 Monaten. Telerehabilitation ist eine vielversprechende Zukunftsperspektive in spezifischen Settings. Rezente Publikationen zu Bronchiektasenerkrankungen, interstitiellen Lungenerkrankungen und pulmonaler Hypertonie konnten die Machbarkeit und Sicherheit der ambulanten PR bestätigen, und die Kosteneffektivität konnte dargestellt werden. Auch zu Post‑/Long-COVID mehrt sich die Evidenz im stationären wie im ambulanten Reha-Setting.SchlussfolgerungenEs besteht zunehmend eine Gleichwertigkeit in Bezug auf die Evidenz der PR – unabhängig davon, ob sie im ambulanten oder stationären Setting erfolgt.

Current Practice of High Flow through Nasal Cannula in Exacerbated COPD Patients.

Acute Exacerbation of Chronic Obstructive Pulmonary Disease is a form of severe Acute Respiratory Failure (ARF) requiring Conventional Oxygen Therapy (COT) in the case of absence of acidosis or the application of Non-Invasive Ventilation (NIV) in case of respiratory acidosis. In the last decade, High Flow through Nasal Cannula (HFNC) has been increasingly used, mainly in patients with hypoxemic ARF. However, some studies were also published in AECOPD patients, and some evidence emerged. In this review, after describing the mechanism underlying potential clinical benefits, we analyzed the possible clinical application of HFNC to AECOPD patients. In the case of respiratory acidosis, the gold-standard treatment remains NIV, supported by strong evidence in favor. However, HFNC may be considered as an alternative to NIV if the latter fails for intolerance. HFNC should also be considered and preferred to COT at NIV breaks and weaning. Finally, HFNC should also be preferred to COT as first-line oxygen treatment in AECOPD patients without respiratory acidosis.

Association of body mass index and COPD exacerbation among patients with chronic bronchitis

Background and objectiveChronic obstructive pulmonary disease (COPD) patients with a body mass index (BMI) < 25 kg/m2 are prone to develop adverse event of pharmacological treatment for frequent exacerbation. As chronic bronchitis (CB) is one of the strong risk factors of exacerbation, we investigated the associations between BMI and COPD exacerbations in patients with CB.MethodsPatients with COPD were included from the Korean COPD Subgroup Study (KOCOSS), a multicenter observational cohort study. CB was defined using the St. George’s Respiratory Questionnaire and the participants were categorized according to BMI cut-off of 25 kg/m2. Exacerbations during a 1-year follow-up were compared among four groups: non-CB with BMI ≥ 25 kg/m2, non-CB with BMI < 25 kg/m2, CB with BMI ≥ 25 kg/m2, and CB with BMI < 25 kg/m2.ResultsAmong the 1264 patients with COPD, 451 (35.7%) had CB and 353 (27.9%) had both CB and BMI < 25 kg/m2. The COPD exacerbation risk increased across the non-CB with BMI < 25 kg/m2, CB with BMI ≥ 25 kg/m2, and CB with BMI < 25 kg/m2 groups (adjusted incidence rate ratio [95% confidence interval] 1.21 [0.89–1.62], 1.20 [0.77–1.88], and 1.41 [1.02–1.91], respectively, compared to the non-CB with BMI ≥ 25 kg/m2 group).ConclusionsCOPD patients having both CB and a BMI < 25 kg/m2 are at higher risk of exacerbations. Considering that a BMI < 25 kg/m2 often limits treatment options preventing exacerbations, modified guidelines might be needed for non-obese CB patients in Asia.