Exacerbation Frequency In Patients Research Articles

Relationship between depression and exacerbations in COPD

Chronic obstructive pulmonary disease is associated with exacerbations. Some patients are prone to frequent exacerbations and these individuals have a worse quality of life, greater limitation of their daily activity and faster disease progression than patients with less frequent exacerbations. A prospective study in a well-characterised cohort was performed and it was assessed whether depression, as determined by the Centre for Epidemiologic Studies Depression Scale, was related to exacerbation frequency, systemic inflammation and various social factors. The associations of any increase in depressive symptoms at exacerbation were also investigated. Frequent exacerbators had a significantly higher median (interquartile range) baseline depression score than infrequent exacerbators (17.0 (7.0-25.0) and 12.0 (6.0-18.0), respectively). Depressed patients spend significantly less time outdoors and had significantly worse quality of life as measured by the St George's Respiratory Questionnaire. Depression increased significantly in patients from baseline to exacerbation (12.5 (5.0-19.0) and 19.5 (12.0-28.0) respectively). The present study is the first to show a relationship between depression and exacerbation frequency in patients with chronic obstructive pulmonary disease. The finding that frequent exacerbators are more depressed than infrequent exacerbators is relevant, as exacerbation frequency is an important outcome measure in chronic obstructive pulmonary disease.

Pharmacology, clinical efficacy and safety of recombinant human DNase in cystic fibrosis

Recombinant human DNase (rhDNase) is a mucolytic agent that is primarily used to improve mucociliary clearance in cystic fibrosis (CF). rhDNase is a recombinant human enzyme that is synthesized in a Chinese hamster ovary cell line. rhDNase enzymatically cleaves extracellular DNA into molecules of shorter length. CF sputum shows high concentrations of DNA released by disintegrating inflammatory cells. Free DNA contributes to the abnormally high viscosity of CF sputum and therefore forms an important target in the treatment of CF lung disease. Clinical studies have shown that daily nebulization of rhDNase is associated with an increase in lung function and a decrease in the frequency of exacerbations in patients with CF.

Medical Therapy for Chronic Obstructive Pulmonary Disease in 2007

Medical treatment for patients with stable chronic obstructive pulmonary disease (COPD) has evolved significantly over the past 2 decades. Current World Health Organization recommendations suggest a stepwise approach to therapy depending upon disease severity. As-needed use of short-acting bronchodilators is recommended for patients with mild disease. Scheduled dosing of bronchodilators is recommended for patients with more advanced disease. Inhaled beta-agonists and anti-cholinergic agents in combination have proved to be more effective than either agent alone. Long-acting preparations are associated with better disease control and have not been associated with tachyphylaxis. Inhaled corticosteroids are useful for reducing the frequency of exacerbations in patients who experience one or more episodes per year. Oxygen therapy is clearly beneficial in patients with advanced COPD and chronic respiratory failure, and its potential benefits in less severe disease are currently being studied. Pulmonary rehabilitation benefits patients with mild-to-severe disease, although the greatest benefits have been demonstrated in those with moderate COPD. New ultra-long-acting inhaled bronchodilators, phosphodiesterase inhibitors, protease inhibitors, and retinoids intended to promote tissue regeneration are currently being evaluated in clinical trials as future therapeutic agents.

Same role and same treatment for airway eosinophilia in asthma and COPD?

Chronic inflammatory diseases of the airway, such as asthma and chronic obstructive pulmonary disease (COPD), are common and represent a substantial amount of the workload of most respiratory physicians. While medications for asthma provide good control of the disease in the majority of cases 1, pharmacotherapy for COPD is less satisfactory since none of the existing drugs has been shown to have a significant effect on the long-term decline in lung function that is the hallmark of this disease 2. It is, however, underlined in the international guidelines that COPD is a treatable disease 2. Current strategy in managing stable COPD includes several individualised interventions directed at different aspects of the disease. Most of these interventions are nonpharmacological, such as smoking cessation to prevent the accelerated loss of lung function, influenza and pneumococcal vaccines to prevent respiratory infections, exercise training to improve exercise tolerance and dyspnoea, nutritional support to avoid weight loss, and long-term administration of oxygen to increase survival in patients with chronic respiratory failure. Pharmacotherapy with long-acting bronchodilators is used to reduce symptoms and exacerbations. The addition of inhaled corticosteroids further reduces the frequency of exacerbations in patients with severe COPD 3, 4. This issue of the European Respiratory Journal features a study by Siva et al. 5, who focused their intervention on an aspect of COPD that has never been considered before. These investigators tested the hypothesis that treatment with corticosteroids aimed at maintaining sputum eosinophils at <3% in COPD patients is associated with a reduction in exacerbations of COPD. A total of 82 patients with moderate-to-very severe COPD were randomised into two groups and the follow-up was extended for 12 months. One group was treated according to conventional British Thoracic Society (BTS) guidelines …

Stress Can Be Bad for Your Bowels

Source: Mawdsley JE, Macey MG, Feakinhs RM, et al. The effect of acute psychologic stress on systemic and rectal mucosal measures of inflammation in ulcerative colitis. Gastroenterology. 2006;110:410–419; doi:10.1053/j.gastro.2006.05.017The results of recent studies suggest that life events and chronic stress increase the risk of relapse in inflammatory bowel disease (IBD).1 The authors from Barts and the London, Queen Mary School of Medicine and Dentistry, Barts and London NHS Trust, and University College London conducted a study to examine the effects of experimentally induced acute psychological stress on a variety of measures of systemic and rectal mucosal inflammatory response in adult patients with inactive ulcerative colitis (UC) and in well controls. A total of 25 patients with inactive UC and 11 healthy volunteers (HV) underwent an experimental stressor involving a need to complete a 60-minute IQ test in 50 minutes while rock music played in one ear and folk music in the other. A separate group of 10 patients with UC and 11 HV underwent a control procedure involving the same 50-minute test, but with their choice of relaxing music playing in their ears. Before and after each procedure, systemic inflammatory response was assessed by measurement of serum inflammatory mediators such as serum interleukins and tumor necrosis factor. In all study patients with UC, sigmoidoscopy was performed before and after the study procedures; rectal mucosal inflammation was assessed by measurement of inflammatory mucosal blood flow (RMBF) and histology.Following the stressor, increased pulse (P<.0001) and systolic blood pressure (P<.0001) were noted in the stressed UC patients and healthy volunteers compared to the unstressed UC and HV participants who underwent the control experience. In both UC patients and HV who were stressed, numerous serum inflammatory mediators significantly increased compared to baseline measurements. However, there were no significant differences in changes between stressed UC and HV participants. There were no significant changes in markers of stress among UC patients or HV in the control group. Among stressed UC patients there was a significant change in RMBF; the changes in control UC patients were not significant. The authors suggest that stress may act as a trigger for exacerbations of UC. However, since stress-induced inflammatory markers also increased in HV, it seems unlikely that an exaggerated autonomic and inflammatory response to stress is a primary etiologic factor in UC.Dr. Nassau has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of a commercial product/device. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Dr. LeLeiko has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of a commercial product/device. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Every day the effect of stress on our young patients is the subject of parental questions. Patients with chronic IBD (or indeed any chronic illness) are no strangers to stress and we always endorse the virtues of trying to lessen what stressors we can and learning to manage those we cannot avoid. The overall paucity of rigorous scientific studies means that we make recommendations based on our experience, which reflects our biases, rather than on data. Although this study was performed in adults, the results are likely applicable to children with IBDs.Results from this study suggest a possible mechanism for how stress might play a role in increased risk of relapse in IBD. There is a growing body of research on the influence of stress on immunity,2 including the influence of stress on the immune system in children and adolescents with chronic medical conditions (eg, asthma).3 The current study adds to this research and reminds us that physicians who care for children with diseases associated with immunological pathophysiology, such as IBD, need to attend to the stress their patients may be experiencing.The authors also raise the interesting point that if stress may enhance the risk of relapse, then perhaps psychological treatments such as stress management training could mitigate these effects. There are data to suggest that psychological interventions can influence immunological parameters.4 The current study underscores the potential utility of psychological intervention in the total care of patients with inflammatory bowel disease.Despite that fact that stressed healthy volunteers or unstressed UC patients and healthy volunteers did not undergo sigmosidoscopy and rectal mucosal study, which would have added to their stress, the notable elevations in serum inflammatory mediators in the UC patients who were stressed are concerning. Designing a study to evaluate the utility of stress reduction in patients with IBD is a daunting challenge. In the absence of such evidence this study gives added weight to the idea that managing stress might reduce the frequency of exacerbations in patients with IBD.

Relationship between airway colonization, inflammation and exacerbation frequency in COPD

To evaluate bacterial colonization and the airway inflammatory response, and its relationship to the frequency of exacerbation in patients with stable chronic obstructive pulmonary disease (COPD). Quantitative bacteriologic cultures, neutrophil elastase, myeloperoxidase (MPO), tumor necrosis factor alpha (TNF-alpha) and interleukin (IL)-8 were measured in bronchoalveoler lavage (BAL) in 39 patients with stable COPD [19 with frequent exacerbation (> or = 3/year), and 20 with infrequent] and in 18 healthy controls (10 smokers and 8 non-smokers). BAL revealed the microorganisms with potential pathogenicity above the established threshold (> or = 10(3)cfu/ml) in 68.4% of patients with frequent exacerbation, 55% of infrequent exacerbation, 40% of smokers and 12.5% of non-smokers controls (P=0.05). BAL MPO, IL-8 and TNF-alpha levels were found to be significantly higher in COPD as compared to controls (P=0.001). However, only IL-8 level was significantly higher in COPD patients with frequent exacerbation as compared to infrequent (P=0.001). Airway bacterial load correlated with levels of airway inflammation markers in COPD (P<0.05). The bacterial load and airway inflammation contributes to each other in stable COPD. However, there is a link only between interleukine (IL)-8 and frequent exacerbations. Clearly, the relationship between bacterial colonization, airway inflammation and frequent exacerbations is of major importance in understanding of the COPD pathogenesis.

Relationship between airway inflammation and the frequency of exacerbations in patients with smoking related COPD

BACKGROUNDPatients with more frequent exacerbations of chronic obstructive pulmonary disease (COPD) may have increased bronchial inflammation. Airway inflammation was measured in patients who had been thoroughly investigated with full pulmonary...

Incidence of exacerbations in the first 90 days of treatment with recombinant human interferon beta-1b in patients with relapsing-remitting multiple sclerosis.

Interferon beta-1b (IFNbeta-1b) is effective in reducing the frequency of exacerbations in patients with relapsing-remitting multiple sclerosis (RRMS). Recently, a study suggested that treatment with IFNbeta-1b may place MS patients at risk of exacerbations by increasing interferon-gamma (IFNgamma)-secreting cells in the blood early after onset of treatment. We conducted a retrospective study in 192 RRMS patients treated with IFNbeta-1b. We did not observe an increase in the frequency of exacerbations early after the onset of treatment and suggest that the IFNgamma-secreting cell surge linked to the onset of treatment with IFNbeta-1b may not be clinically significant.

The effect of film quality on reading radiographs of simple pneumonconiosis in a trial of x-ray sets.

Post-hoc analysis of two phase III clinical studies found that the phosphodiesterase 4 (PDE4) inhibitor, roflumilast, reduced exacerbation frequency in patients with severe chronic obstructive pulmonary disease (COPD) who were taking inhaled corticosteroids (ICS) concomitantly, whereas patients not taking ICS derived no such benefit. In contrast, in two different trials also performed in patients with severe COPD, roflumilast reduced exacerbation rates in the absence of ICS, indicating that PDE4 inhibition alone is sufficient for therapeutic activity to be realized. Given that roflumilast is recommended as an “add-on” medication to patients with severe disease who will inevitably be taking a long-acting <i>β</i>₂-adrenoceptor agonist (LABA)/ICS combination therapy, we tested the hypothesis that roflumilast <i>augments</i> the ability of glucocorticoids to induce genes with anti-inflammatory activity. Using a glucocorticoid response element (GRE) luciferase reporter transfected into human airway epithelial cells [both bronchial epithelium + adenovirus 12 - SV40 hybrid (BEAS-2B) cells and primary cultures], roflumilast enhanced fluticasone propionate–induced GRE-dependent transcription. Roflumilast also produced a sinistral displacement of the concentration-response curves that described the augmentation of GRE-dependent transcription by the LABA formoterol. In BEAS-2B cells and primary airway epithelia, roflumilast interacted with formoterol in a positive cooperative manner to enhance the expression of several glucocorticoid-inducible genes that have anti-inflammatory potential. We suggest that the ability of roflumilast and formoterol to interact in this way supports the concept that these drugs together may impart clinical benefit beyond that achievable by an ICS alone, a PDE4 inhibitor alone, or an ICS/LABA combination therapy. Roflumilast may, therefore, be especially effective in patients with severe COPD.