Exacerbations Requiring Hospital Admission Research Articles

Bisoprolol in Patients With Chronic Obstructive Pulmonary Disease at High Risk of Exacerbation

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Observational studies report that β-blocker use may be associated with reduced risk of COPD exacerbations. However, a recent trial reported that metoprolol did not reduce COPD exacerbations and increased COPD exacerbations requiring hospital admission. To test whether bisoprolol decreased COPD exacerbations in people with COPD at high risk of exacerbations. The Bisoprolol in COPD Study (BICS) was a double-blind placebo-controlled randomized clinical trial conducted in 76 UK sites (45 primary care clinics and 31 secondary clinics). Patients with COPD who had at least moderate airflow obstruction on spirometry (ratio of forced expiratory volume in the first second of expiration [FEV1] to forced vital capacity <0.7; FEV1 <80% predicted) and at least 2 COPD exacerbations treated with oral corticosteroids, antibiotics, or both in the prior 12 months were enrolled from October 17, 2018, to May 31, 2022. Follow-up concluded on April 18, 2023. Patients were randomly assigned to bisoprolol (n = 261) or placebo (n = 258). Bisoprolol was started at 1.25 mg orally daily and was titrated as tolerated during 4 sessions to a maximum dose of 5 mg/d, using a standardized protocol. The primary clinical outcome was the number of patient-reported COPD exacerbations treated with oral corticosteroids, antibiotics, or both during the 1-year treatment period. Safety outcomes included serious adverse events and adverse reactions. Although the trial planned to enroll 1574 patients, recruitment was suspended from March 16, 2020, to July 31, 2021, due to the COVID-19 pandemic. Two patients in each group were excluded postrandomization. Among the 515 patients (mean [SD] age, 68 [7.9] years; 274 men [53%]; mean FEV1, 50.1%), primary outcome data were available for 514 patients (99.8%) and 371 (72.0%) continued taking the study drug. The primary outcome of patient-reported COPD exacerbations treated with oral corticosteroids, antibiotics, or both was 526 in the bisoprolol group, with a mean exacerbation rate of 2.03/y, vs 513 exacerbations in the placebo group, with a mean exacerbation rate of 2.01/y. The adjusted incidence rate ratio was 0.97 (95% CI, 0.84-1.13; P = .72). Serious adverse events occurred in 37 of 255 patients in the bisoprolol group (14.5%) vs 36 of 251 in the placebo group (14.3%; relative risk, 1.01; 95% CI, 0.62-1.66; P = .96). Among people with COPD at high risk of exacerbation, treatment with bisoprolol did not reduce the number of self-reported COPD exacerbations requiring treatment with oral corticosteroids, antibiotics, or both. isrctn.org Identifier: ISRCTN10497306.

Immunomodulators Containing Epicor, Colostrum, Vitamin D, Zinc, Lactobacilli and Bifidobacterium Reduce Respiratory Exacerbations in Children and Adults with Chronic Pulmonary Diseases

(1) Background: A number of studies have demonstrated the connection between developing or exacerbating chronic respiratory diseases in adults and children. However, still, few studies focus on reducing exacerbations via immunomodulation. (2) Methods: In this pilot study, a total of 25 pediatric and adult patients with bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD)/persistent bacterial bronchitis (PBB) were included, administered over-the-counter (OTC) immunomodulators and followed up for 6 or 12 months. (3) Results: We observed a decrease in the frequency of exacerbations with slight improvements in functional respiratory indicators in adults on their second and third visits and a reduced number of exacerbations and improved spirometry indices in children with BA, although exacerbations requiring hospital admission remained at a similar rate. (4) Conclusions: We confirmed that the number of exacerbations of underlying chronic respiratory disease in adults and children could be reduced after the administration of OTC immunomodulators, probably by optimizing the immune resistance to common viral infections.

Burden and treatment of chronic obstructive pulmonary disease among people using illicit opioids: matched cohort study in England

ObjectiveTo understand the burden of chronic obstructive pulmonary disease among people who use illicit opioids such as heroin, and evaluate inequalities in treatment.DesignCohort study.SettingPatients registered at primary care practices in...

A machine learning approach to characterize patients with asthma exacerbation attending an acute care setting

BackgroundOne of the main problems in poorly controlled asthma is the access to the Emergency Department (ED). Using a machine learning (ML) approach, the aim of our study was to identify the main predictors of severe asthma exacerbations requiring hospital admission. MethodsConsecutive patients with asthma exacerbation were screened for inclusion within 48 hours of ED discharge. A k-means clustering algorithm was implemented to evaluate a potential distinction of different phenotypes. K-Nearest Neighbor (KNN) as instance-based algorithm and Random Forest (RF) as tree-based algorithm were implemented in order to classify patients, based on the presence of at least one additional access to the ED in the previous 12 months. ResultsTo train our model, we included 260 patients (31.5% males, mean age 47.6 years). Unsupervised ML identified two groups, based on eosinophil count. A total of 86 patients with eosinophiles ≥370 cells/µL were significantly older, had a longer disease duration, more restrictions to daily activities, and lower rate of treatment compared to 174 patients with eosinophiles <370 cells/μL. In addition, they reported lower values of predicted FEV1 (64.8±12.3% vs. 83.9±17.3%) and FEV1/FVC (71.3±9.3 vs. 78.5±6.8), with a higher amount of exacerbations/year. In supervised ML, KNN achieved the best performance in identifying frequent exacerbators (AUROC: 96.7%), confirming the importance of spirometry parameters and eosinophil count, along with the number of prior exacerbations and other clinical and demographic variables. ConclusionsThis study confirms the key prognostic value of eosinophiles in asthma, suggesting the usefulness of ML in defining biological pathways that can help plan personalized pharmacological and rehabilitation strategies.

Frequent productive cough: Symptom burden and future exacerbation risk among patients with asthma and/or COPD in the NOVELTY study

IntroductionPersistent cough with sputum production is an important clinical trait in chronic obstructive pulmonary disease (COPD). We defined “frequent productive cough” based on 2 questions from the St George's Respiratory Questionnaire (SGRQ) and sought to determine its occurrence and associated outcomes in patients with physician-assigned asthma and/or COPD from the NOVELTY study. MethodsFrequent productive cough was defined as cough and sputum production most or several days/week for the past 3 months (scoring ≥3 for both SGRQ questions). Relationships with baseline disease characteristics and exacerbations over 12 months’ follow-up were examined using logistic regression. ResultsBaseline SGRQ data were available for 7125 patients, of whom 31.3% had frequent productive cough. It was more common in asthma+COPD (38.8%) and COPD (38.1%) than asthma (25.0%), increasing with physician-assessed severity, and in current versus former and never smokers. Patient-reported symptomatic worsening was more common in patients with versus without frequent productive cough. Reduced post-bronchodilator FEV1 (odds ratio [OR] per 10% decrement 1.14 [95% confidence interval 1.11–1.16]) and history of pollutant exposure at home/work (OR 1.50 [1.33–1.69]) were associated with frequent productive cough in all diagnoses. Patients with baseline frequent productive cough were more likely to have ≥1 exacerbation over the subsequent 12 months (OR 1.71 [1.52–1.93]), including exacerbations requiring hospital admission and those treated with oral corticosteroids. ConclusionsFrequent productive cough represents an important indicator of adverse clinical outcomes across asthma and/or COPD. Research into the underlying pathologic mechanisms is required to support targeted therapy development. Clinicaltrials.govNCT02760329.

Relationship between exposure to ozone and exacerbation requiring hospital admission among patients with asthma: a case-control study in central Taiwan

ObjectiveThe convergence of asthma and air pollutants in ageing populations is currently a growing health issue worldwide, and hence there is an essential need to investigate the association between exposure...

Outcomes of Peripheral Blood Eosinophilia in Hospitalized Exacerbations of COPD

Abstract Background The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines define COPD as a disease state characterized by airflow limitation that is not fully reversible, is usually progressive, and is associated with an abnormal inflammatory response of the lungs to inhaled noxious particles or gases. Objective To identify outcomes of patients with eosinophilic COPD exacerbations requiring hospital admission. Patients and Methods This study is a prospective cohort study that was conducted on two groups of total 60 patients recruited from Ain Shams University hospitals between October 2019 and July 2020. Group 1: Eosinophilic COPD exacerbation if the peripheral blood eosinophil on admission is ≥ 200 cells/µL and/or ≥2% of the total leukocyte count Group 2: Non-eosinophilic COPD exacerbation if the peripheral blood eosinophil on admission is &amp;lt; 200 cells/µL and/or &amp;lt; 2% of the total leukocyte count. Results There was significant high diagnostic performance in predicting readmission at 6-month among eosinophilic group. Eosinophils count, percent (%) and NLR cutoff points had high characteristics (highest in NLR ≥3.1 at discharge) in predicting readmission at 6-month among eosinophilic group. Diagnostic performance of Eosinophils count, percent (%) and NLR were assessed. Eosinophils count, percent (%) and NLR had significant high diagnostic performance in predicting readmission at 6-month among eosinophilic group. Eosinophils count, % and NLR cutoff points had high characteristics (highest in NLR ≥2.1 at discharge) in predicting readmission at 6month among non-eosinophilic group. Conclusion Eosinophils can be used as a prognostic marker in non-infective COPD exacerbations. Validity of eosinophil count and percent as a prognostic parameter in COPD exacerbation can be increased by combining with other parameters for example NLR.

Protecting children from tobacco-related harm in private vehicles

Protecting children from tobacco-related harm in private vehicles

Associations between smoke-free vehicle legislation and childhood admissions to hospital for asthma in Scotland: an interrupted time-series analysis of whole-population data

In Scotland, childhood admissions to hospital for asthma fell from March, 2006, after legislation was introduced to prohibit smoking in public places. In December, 2016, new Scottish legislation banned smoking in vehicles containing a child. We aimed to determine whether the introduction of this new legislation produced additional benefits. We obtained data on all asthma emergency admissions to hospitals in Scotland between 2000 and 2018 for individuals younger than 16 years. We used interrupted time-series analyses to study changes in monthly incidence of asthma emergency admissions to hospital per 100 000 children after the introduction of smoke-free vehicle legislation, taking into account previous smoke-free interventions. We did subgroup analyses according to age and area deprivation, using the Scottish Index of Multiple Deprivation, and repeated the analyses for a control condition, gastroenteritis, and other respiratory conditions. Of the 32 342 emergency admissions to hospital for asthma among children younger than 16 years over the 19-year study period (Jan 1, 2000, to Dec 31, 2018), 13 954 (43%) were among children younger than 5 years and 18 388 (57%) were among children aged 5-15 years. After the introduction of smoke-free vehicle legislation, there was a non-significant decline in the slope for monthly emergency admissions to hospital for asthma among children younger than 16 years (-1·21%, 95% CI -2·64 to 0·23) relative to the underlying trend in hospital admissions for childhood asthma. However, children younger than 5 years had a significant decline in the slope for monthly asthma admissions (-1·49%, -2·69 to -0·27) over and above the underlying trend among children in this age group (equivalent to six fewer hospitalisations per year), but no such decline was seen in children aged 5-15 years. Monthly admissions to hospital for asthma fell significantly among children living in the most affluent areas (-2·27%, -4·41 to -0·07) but not among those living in the most deprived areas. We found no change in admissions to hospital for gastroenteritis or other respiratory conditions after the introduction of the smoke-free vehicle legislation. Although legislation banning smoking in vehicles did not affect hospital admissions for severe asthma among children overall or in the older age group, this legislation was associated with a reduction in severe asthma exacerbations requiring hospital admission among preschool children, over and above the underlying trend and previous interventions designed to reduce exposure to second-hand smoke. Similar legislation prohibiting smoking in vehicles that contain children should be adopted in other countries. None.

COVID-19, severe asthma and biologicals targeting type 2 inflammation: results in a third-level hospital in Madrid, Spain.

Our aim was to describe the ratio and severity of COVID-19 infection in patients with severe asthma treated with biologics. A total of 58 patients with severe asthma treated with biologics under follow-up in our Allergy and Pneumology Unit of Hospital Gregorio Marañón were included. Demographic data, clinical characteristics, laboratory and radiological findings, pulmonary function test and changes in clinical control (by ACT), were obtained by reviewing electronic medical record system and telephone interview. The mean age was 52.15 ± 16.3 years, and 72.4% were female. Twenty-five patients (43%) were characterized by allergic (mean total IgE 476 KU/l, eosinophiles 400/microliter), and the rest by eosinophilic non-allergic phenotype of asthma (mean eosinophiles 430/microliter). They received omalizumab (53.4%), mepolizumab (32.7%) and reslizumab (15.5%). COVID-19 was confirmed in one patient (1.7%) by serological test (IgG+). There was a forty-six-year-old man, with severe allergic asthma treated with omalizumab for 38 months, with 1100 eosinophiles/microliter, total IgE 110 KU/l, without comorbidities. In April 2020, he reported fever, cough and dyspnea without hypoxemia, treated with increased dosage of inhaled corticosteroids, with good control and FEV1 preserved, not requiring hospital admission. Seventeen patients (29.3%) were suspected cases, one of them with pneumonia and another one with asthma exacerbation requiring hospital admission, both without infection confirmation neither by SARS-CoV-2 PCR nor serology. The others had mild symptoms, with neither admissions nor changes in treatment. In our patients with severe asthma receiving biologicals, the rate of COVID infection was low (1.7%). None of them had severe COVID-19 infection.

Inhaled tobramycin for chronic infection with pseudomonas aeruginosa in non-cystic fibrosis bronchiectasis: A systematic review and meta-analysis

IntroductionNon-cystic fibrosis bronchiectasis (NCFBE) is a chronic and progressive disease characterized by the permanent destruction of small and mid-sized airways. Many patients are chronically colonized by Pseudomona aueruginosa, for which oral antibiotics are given. Evidence to support the use of inhaled antibiotics is contradictory. ObjectiveTo describe the clinical effects of inhaled Tobramycin in P. aeruginosa density in sputum and eradication, lung function, bacterial resistance, and exacerbations requiring hospital admission, in the context of patients with NCFBE colonized by P. aeruginosa. MethodsWe included RCTs comparing inhaled tobramycin to other antibiotics and placebo in patients with NCFBE. Main findings5 studies with 211 participants were included. 2 studies reported a significant but transitory decrease in P. aeruginosa density in sputum as compared to placebo. There was a small difference in the eradication of P. aeruginosa among groups, although with very wide confidence intervals. Tobramycin reduced the rate of hospital admissions but no frequency of exacerbations. There was no evidence of an increased rate of bacterial resistance but was associated to respiratory adverse effects. ConclusionsEvidence is not robust enough to confirm a benefit of inhaled Tobramycin in reducing P. aeruginosa sputum density or eradication. There was a high attrition rate, in part due to respiratory adverse events after drug administration, which affects interpretation of the data and raises concerns about the tolerability of the drug. Further network meta-analysis should be done to compare the efficacy and safety of different inhaled antibiotics.

Well-Child Care Attendance and Risk of Asthma Exacerbations.

Asthma remains a leading cause of hospitalization in US children. Well-child care (WCC) visits are routinely recommended, but how WCC adherence relates to asthma outcomes is poorly described. We conducted a retrospective longitudinal cohort study using electronic health records among 5 to 17 year old children residing in Durham County with confirmed asthma and receiving primary care within a single health system, to compare the association between asthma exacerbations and previous WCC exposure. Exacerbations included any International Classification of Diseases, Ninth Revision, or International Classification of Diseases, 10th Revision, coded asthma exacerbation encounter with an accompanying systemic glucocorticoid prescription. Exacerbations were grouped by severity: ambulatory encounter only, urgent care, emergency department, hospital encounters <24 hours, and hospital admissions ≥24 hours. In the primary analysis, we assessed time to asthma exacerbation based on the presence or absence of a WCC visit in the preceding year using a time-varying covariate Cox model. A total of 5656 children met eligibility criteria and were included in the primary analysis. Patients with the highest WCC visit attendance tended to be younger, had a higher prevalence of private insurance, had greater asthma medication usage, and were less likely to be obese. The presence of a WCC visit in the previous 12 months was associated with a reduced risk of all-cause exacerbations (hazard ratio: 0.90; 95% confidence interval: 0.83-0.98) and severe exacerbations requiring hospital admission (hazard ratio: 0.53; 95% confidence interval: 0.39-0.71). WCC visits were associated with a lower risk of subsequent severe exacerbations, including asthma-related emergency department visits and hospitalizations. Poor WCC visit adherence predicts pediatric asthma morbidity, especially exacerbations requiring hospitalization.

Safety and efficacy of amantadine, modafinil, and methylphenidate for fatigue in multiple sclerosis: a randomised, placebo-controlled, crossover, double-blind trial

Methylphenidate, modafinil, and amantadine are commonly prescribed medications for alleviating fatigue in multiple sclerosis; however, the evidence supporting their efficacy is sparse and conflicting. Our goal was to compare the efficacy of these three medications with each other and placebo in patients with multiple sclerosis fatigue. In this randomised, placebo-controlled, four-sequence, four-period, crossover, double-blind trial, patients with multiple sclerosis who reported fatigue and had a Modified Fatigue Impact Scale (MFIS) score of more than 33 were recruited at two academic multiple sclerosis centres in the USA. Participants received oral amantadine (up to 100 mg twice daily), modafinil (up to 100 mg twice daily), methylphenidate (up to 10 mg twice daily), or placebo, each given for up to 6 weeks. All patients were intended to receive all four study medications, in turn, in one of four different sequences with 2-week washout periods between medications. A biostatistician prepared a concealed allocation schedule, stratified by site, randomly assigning a sequence of medications in approximately a 1:1:1:1 ratio, in blocks of eight, to a consecutive series of numbers. The statistician and pharmacists had no role in assessing the participants or collecting data, and the participants, caregivers, and assessors were masked to allocation. The primary outcome measure was the MFIS measured while taking the highest tolerated dose at week 5 of each medication period, analysed by use of a linear mixed-effect regression model. This trial is registered with ClinicalTrials.gov, NCT03185065 and is closed. Between Oct 4, 2017, and Feb 27, 2019, of 169 patients screened, 141 patients were enrolled and randomly assigned to one of four medication administration sequences: 35 (25%) patients to the amantadine, placebo, modafinil, and methylphenidate sequence; 34 (24%) patients to the placebo, methylphenidate, amantadine, and modafinil sequence; 35 (25%) patients to the modafinil, amantadine, methylphenidate, and placebo sequence; and 37 (26%) patients to the methylphenidate, modafinil, placebo, and amantadine sequence. Data from 136 participants were available for the intention-to-treat analysis of the primary outcome. The estimated mean values of MFIS total scores at baseline and the maximal tolerated dose were as follows: 51·3 (95% CI 49·0-53·6) at baseline, 40·6 (38·2-43·1) with placebo, 41·3 (38·8-43·7) with amantadine, 39·0 (36·6-41·4) with modafinil, and 38·6 (36·2-41·0) with methylphenidate (p=0·20 for the overall medication effect in the linear mixed-effect regression model). As compared with placebo (38 [31%] of 124 patients), higher proportions of participants reported adverse events while taking amantadine (49 [39%] of 127 patients), modafinil (50 [40%] of 125 patients), and methylphenidate (51 [40%] of 129 patients). Three serious adverse events occurred during the study (pulmonary embolism and myocarditis while taking amantadine, and a multiple sclerosis exacerbation requiring hospital admission while taking modafinil). Amantadine, modafinil, and methylphenidate were not superior to placebo in improving multiple sclerosis fatigue and caused more frequent adverse events. The results of this study do not support an indiscriminate use of amantadine, modafinil, or methylphenidate for the treatment of fatigue in multiple sclerosis. Patient-Centered Outcomes Research Institute.

BAL Inflammatory Markers Can Predict Pulmonary Exacerbations in Children With Cystic Fibrosis

Pulmonary exacerbations in cystic fibrosis are characterized by airway inflammation and may cause irreversible lung damage. Early identification of such exacerbations may facilitate early initiation of treatment, thereby potentially reducing long-term morbidity. Is it possible to predict pulmonary exacerbations in children with cystic fibrosis, using inflammatory markers obtained from BAL fluid? A longitudinal analysis was conducted of children aged 0 to 7 years included in the Australian Respiratory Early Surveillance Team for Cystic Fibrosis (AREST CF) study between 2005 and 2015. The association between inflammatory markers from annual BAL fluid and time to pulmonary exacerbation requiring hospital admission in the 6-month period post-BAL was analyzed using Kaplan-Meier curves and Weibull regression, adjusting for annually repeated measurements. Admissions for Pseudomonas eradication were excluded in the main analysis, because of the standard policy in participating centers to treat Pseudomonas in-hospital. Nine hundred seventy-six BAL samples from 308 children were analyzed. After exclusion of admissions for Pseudomonas eradication (n= 43), there were 145 pulmonary exacerbations recorded within 6months of BAL; median time to exacerbation was 31days (interquartile range, 9-100). In univariate analyses, high IL-8 (hazard ratio [HR], 2.25 for 75th vs 25th percentile; 95%CI, 1.87-2.72), neutrophil elastase (HR, 3.00; 95%CI, 2.03-4.42), and high neutrophil percentage (HR, 1.80 for 75th vs25th percentile; 95%CI, 1.56-2.04) were all significantly associated with risk for a pulmonary exacerbation (P< .001). The inflammatory markers remained significant predictors after adjustment for clinical predictive variables. Inflammatory markers in BAL fluid are significant predictors of pulmonary exacerbations in young children with cystic fibrosis. The development of noninvasive measures of lung inflammation may facilitate routine surveillance of cystic fibrosis.

A service evaluation of the implementation of dedicated chefs on a specialist adult cystic fibrosis unit

In 2014 the Wolfson Cystic Fibrosis Centre (WCFC) opened for admission of adults and young people with Cystic Fibrosis (CF). Prior to this this people with CF were admitted to general respiratory wards and received general hospital food, whilst this is nutritionally adequate it is not always the comforting food people need during regular and repeated hospital admissions(1). The WCFC offers fresh, cooked-to-order, bespoke, flexible meal service which is more appetising and encourages people to complete intravenous antibiotics when needed. People with CF may require up to twice the calories a healthy person may need(2,3), at a time when they may feel up to eating the least. Frequent respiratory exacerbations requiring hospital admission, causing shortness of breath and reduced appetite can impact on oral intake making it difficult to maintain the caloric intake required (CF Trust 2016). The result can be suboptimal nutritional status which may negatively impact on lung function(2,4,5). This service evaluation aimed to compare standard ward (OC) based catering with the implementation of dedicated catering facilities and chefs on a newly built adult CF ward (NC).

Regular follow-up visits reduce the risk for asthma exacerbation requiring admission in Korean adults with asthma

BackgroundAsthma requires regular follow-up visits and sustained medication use. Although several studies have reported the importance of adherence to medication and compliance with the treatment, none to date have reported the importance of regular follow-up visits. We investigated the effects of regular clinical visits on asthma exacerbation.MethodsWe used claims data in the national medical insurance review system provided by the Health Insurance Review and Assessment Service of Korea. We included subjects aged ≥ 15 years with a diagnosis of asthma, and who were prescribed asthma-related medication, from July 2013 to June 2014. Regular visitors (frequent visitors) were defined as subjects who visited the hospital for follow-up of asthma three or more times per year.ResultsAmong 729,343 subjects, 496,560 (68.1%) were classified as regular visitors. Old age, male sex, lack of medical aid insurance, attendance of a tertiary hospital, a high Charlson comorbidity index, and a history of admission for exacerbated asthma in the previous year were significant determining factors for regular visitor status. When we adjusted for all these factors, frequent visitors showed a lower risk of asthma exacerbation requiring general ward admission (odds ratio [OR] 0.48; 95% confidence interval [CI] 0.47–0.50; P < 0.001), emergency room admission (OR 0.83; 95% CI 0.79–0.86; P < 0.001), and intensive care unit admission (OR 0.49; 95% CI 0.44–0.54; P < 0.001) than infrequent visitors.ConclusionsRegular clinical visits are significantly associated with a reduced risk of asthma exacerbation requiring hospital admission in Korean adults with asthma.

The BRICS (Bronchiectasis Radiologically Indexed CT Score): A Multicenter Study Score for Use in Idiopathic and Postinfective Bronchiectasis

The goal of this study was to develop a simplified radiological score that could assess clinical disease severity in bronchiectasis. The Bronchiectasis Radiologically Indexed CT Score (BRICS) was devised based on a multivariable analysis of the Bhalla score and its ability in predicting clinical parameters of severity. The score was then externally validated in six centers in 302 patients. A total of 184 high-resolution CT scans were scored for the validation cohort. In a multiple logistic regression model, disease severity markers significantly associated with the Bhalla score were percent predicted FEV1, sputum purulence, and exacerbations requiring hospital admission. Components of the Bhalla score that were significantly associated with the disease severity markers were bronchial dilatation and number of bronchopulmonary segments with emphysema. The BRICS was developed with these two parameters. The receiver operating-characteristic curve values for BRICS in the derivation cohort were 0.79 for percent predicted FEV1, 0.71 for sputum purulence, and 0.75 for hospital admissions per year; these values were 0.81, 0.70, and 0.70, respectively, in the validation cohort. Sputum free neutrophil elastase activity was significantly elevated in the group with emphysema on CT imaging. A simplified CT scoring system can be used as an adjunct to clinical parameters to predict disease severity in patients with idiopathic and postinfective bronchiectasis.

Vitamin D deficiency during chronic obstructive pulmonary disease exacerbations

BackgroundVitamin D deficiency is widespread and associated with increased risk of chronic diseases. The relation between chronic obstructive pulmonary disease (COPD) and vitamin D is complex owing to comorbidities, which are affected by vitamin D. Patients with low vitamin D showed higher risk for exacerbations.AimThe aim was to study the status of vitamin D in patients during exacerbation of chronic obstructive pulmonary disease (AECOPD).Patients and methodsThe study included 205 patients presented with AECOPD and 150 controls. Patients and controls were subjected to full clinical history and examination, pulmonary function testing, and vitamin D [hydroxyvitamin D, 25(OH)D] examination by Liaison 25 OH Vitamin D assay (direct competitive chemiluminescence immunoassay, DiaSorin Inc, Stillwater, Minnesota, USA) in serum. Symptom scoring was done using modified Medical Research Council (mMRC) and combined assessment of Global Initiative for Chronic Obstructive Lung Disease COPD classification, with division into groups A, B, C, and D. Data related to severity of exacerbation, site of care, and hospital days were gathered.StatisticsPearson’s χ2-test was used to compare the prevalence of categorical variables between patients with COPD and control groups. t-Test was used to compare differences in the levels of continuous variables between the two groups. R2-test was used to measure how close the data are to be fitted in the regression line.Results25(OH)D was significantly lower in patients with AECOPD than control group (mean: 39.5±32.5 vs. 56.3±43.7 nmol/l, P? 0.05). Vitamin D insufficiency (25–75 nmol/l) was significantly higher in patients than controls [115 (56.09%) patients vs. 51 (34%) controls, P<0.05]. Dyspnea score (mMRC) was higher in deficiency group (70.1% having two or more mMRC score) compared in insufficiency and sufficiency groups (51.3 and 51.5%, respectively). Patients with mild and moderate COPD (forced expiratory volume in first second >50%) showed higher 25(OH)D (69.4±23.1) than patients with severe and very severe COPD (forced expiratory volume in first second <50%) (47.4±28.3), with P value less than 0.05. Patients required hospitalization showed lower levels of 25(OH)D compared with patients treated at home (23±14.9 and 52±22.1, respectively), with P value less than 0.05. Hospital days were higher in deficiency group (3.78±3.51 days) compared with insufficiency group (1.68±2.33 days) or sufficiency group (1.3±1.7 days), with P value less than 0.05.ConclusionVitamin D is low in patients with COPD during AECOPD. The relationship is linear with lung function, disease severity groups and with previous exacerbation rate. Severe exacerbations requiring hospital admission and lengthy hospital stay were demonstrated in patients with low vitamin D.

Clinical Utility of Sputum Cultures During Cystic Fibrosis Exacerbation Requiring Hospital Admission

Clinical Utility of Sputum Cultures During Cystic Fibrosis Exacerbation Requiring Hospital Admission

Predictors of Hospitalized Exacerbations and Mortality in Chronic Obstructive Pulmonary Disease.

Background and AimExacerbations of chronic obstructive pulmonary disease (COPD) carry significant consequences for patients and are responsible for considerable health-care costs—particularly if hospitalization is required. Despite the importance of hospitalized exacerbations, relatively little is known about their determinants. This study aimed to analyze predictors of hospitalized exacerbations and mortality in COPD patients.MethodsThis was a retrospective population-based cohort study. We selected 900 patients with confirmed COPD aged ≥35 years by simple random sampling among all COPD patients in Cantabria (northern Spain) on December 31, 2011. We defined moderate exacerbations as events that led a care provider to prescribe antibiotics or corticosteroids and severe exacerbations as exacerbations requiring hospital admission. We observed exacerbation frequency over the previous year (2011) and following year (2012). We categorized patients according to COPD severity based on forced expiratory volume in 1 second (Global Initiative for Chronic Obstructive Lung Disease [GOLD] grades 1–4). We estimated the odds ratios (ORs) by logistic regression, adjusting for age, sex, smoking status, COPD severity, and frequent exacerbator phenotype the previous year.ResultsOf the patients, 16.4% had ≥1 severe exacerbations, varying from 9.3% in mild GOLD grade 1 to 44% in very severe COPD patients. A history of at least two prior severe exacerbations was positively associated with new severe exacerbations (adjusted OR, 6.73; 95% confidence interval [CI], 3.53–12.83) and mortality (adjusted OR, 7.63; 95%CI, 3.41–17.05). Older age and several comorbidities, such as heart failure and diabetes, were similarly associated.ConclusionsHospitalized exacerbations occurred with all grades of airflow limitation. A history of severe exacerbations was associated with new hospitalized exacerbations and mortality.