Exacerbations In Last Year Research Articles

Assessment of frailty and its predictors in chronic obstructive pulmonary disease.

Frailty represents a state of risk in which a relatively small stressor results in a disproportionate decline in health status. This study aims to determine the prevalence of frailty among patients with COPD in the Indian population and its associated risk factors. A descriptive cross-sectional study was conducted in 150 COPD patients. Frailty was assessed using the frailty phenotype method. The mean age (SD) of the study population was 60.59 (5.9) years with 88.67% males and 53.33% ex-smokers. The prevalence of frailty was 51.33% (n = 77). Most of the frail patients belonged to GOLD group D (66.23%) (P < 0.0001). Post-bronchodilator FEV1(%) was lowest in the frail group (40 [36-47]%) (P < 0.0001). Risk of frailty significantly correlated with smoking pack years (1.036; 1.001-1.074), history of 1 exacerbation in last year (6.810; 2.036-22.779), post-bronchodilator FVC(%) (0.955; 0.926-0.985), post-bronchodilator FEV1(%) (0.940; 0.913-0.968), distance covered in 6-minute walk test [0.975; 0.965-0.986] and dyspnoea severity [1.044; 1.024-1.063]. In multivariate regression, 6-minute walk distance and GOLD group B were the independent predictors of frailty in COPD. The prevalence of frailty in Indian patients with COPD was 51.33%. Six-minute walk distance is an important predictor of frailty. Early identification of frailty will lead to prompt intervention and rehabilitation.

Blood and sputum eosinophilia in COPD exacerbation

BackgroundExacerbations in chronic obstructive pulmonary disease (COPD) are major contributors to worsening lung function, impaired quality of life, emergency healthcare use, and COPD-related mortality. COPD exacerbations are heterogeneous in terms of airway inflammation and etiology.ObjectivesTo assess the relation between blood and sputum eosinophils and COPD exacerbation.Subjects and methodsProspective cohort study, conducted on 100 COPD patients presented in outpatient clinic. All patients were subjected to medical history including: occupational history, smoking history, comorbidity, number of exacerbations in last year and their degree, history of admission in the last year and treatment taken for COPD. Modified Medical Research Council scale of dyspnea, peak expiratory flow rate, oxygen saturation using pulse oximetry. Complete blood count with differential eosinophilic count. Sputum sample differential cell count was done.ResultsThe eosinophil level in blood before and after treatment showed a significant positive correlation with the number of hospital admission in the last year (r = 0.29; P = 0.003 and r = 0.3; P = 0.002, respectively). Regarding the eosinophil level either in blood or in sputum, it showed significant statistical elevation in patients not using steroid treatment in comparison to patients who used systemic or inhaled steroid treatments (P < 0.001 and 0.004, respectively).ConclusionBlood eosinophil count can be used as a severity marker of COPD exacerbations. The eosinophil levels, either in blood or sputum, were significantly correlated with the degree of exacerbation. Sputum eosinophilia can also predict the risk of hospitalization. In addition, blood eosinophil count can direct the use of oral corticosteroids in exacerbation.

Transitions between COPD groups: A cross-sectional study in Turkey

Introduction: Since GOLD 2017 separates spirometry results from ‘ABCD’ groups, there have been some changes to the stages of COPD patients. Our aim was to investigate the shifts in COPD groups after GOLD 2017.Methods: COPD patients from outpatient clinics of 3 hospitals in Turkey were stratified into old and new ABCD groups according to exacerbation history, mMRC evaluation and spirometry results for both GOLD 2011 and 2017 assessments. Treatment protocols were also evaluated if they were suitable for both classifications.Results: There were 578 patients (334 men, 244 women) with a mean age of 65.21±10.42. The distribution of patients from group A to D was 28%, 15%, 15%, 42% (GOLD 2011) and 36%, 22%, 7% and 35% (GOLD 2017) respectively. There were shifts from group C to A (53.4%) and D to B (18.4%). The treatment suitability was 66.3% in GOLD 2011 and 60.9% in GOLD 2017. The most common inappropriate treatment protocol was triple therapy. Presence of exacerbations in last year, mMRC score, FEV1 level (p < 0.01 for three parameters) and proportion of males (p = 0.029) were statistically significantly higher in groups C and D of GOLD 2017 compared with new patients in group A and B of GOLD 2017 (shifted from GOLD 2011's C-D groups).Conclusion: There were shifts from group C to A and D to B with GOLD 2017, which means some high-risk COPD patients were reclassified into low-risk groups. Despite guideline updates, there are still many COPD patients with overtreatment. To our knowledge, this is the first study examining transitions between COPD groups after GOLD 2017 in Turkey.

A new predictor to determine the exacerbation and treatment of chronic obstructive pulmonary disease: eosinophil/neutrophil ratio.

COPD is an inflammatory disease characterized by persistent respiratory symptoms and airflow limitation. Currently, it has been demonstrated in some studies that eosinophil and T helper-2 mediated inflammation play a role in the pathophysiology of COPD. It was planned to evaluate eosinophilia, eosinophil/ neutrophil ratio (ENR), distribution of ENR according to GOLD groups, number of exacerbations in last year, relationship between ENR and the rate of ICS use in COPD patients, and the ENR cut-off value that predicts eosinophilic COPD. This study was planned prospectively in stable COPD patients between July 2017 and December 2017. All patients were divided into two groups as eosinophilic and non-eosinophilic group. Eosinophilia was considered to be > 2% of peripheric blood eosinophils. A total of 206 stable COPD patients (127 eosinophilic and 79 noneosinophilic) were included. Age, gender, BMI, smoking history, mMrc score were statistically similar while average pack-year of smoking was significantly higher in eosinophilic group. ENR was significantly higher in eosinophilic group as expected (p<0.001). High positive correlation was found between ENR and eosinophilic COPD (r= 0.8, p<0.001). In Group D, the number of eosinophilic COPD patients is significantly higher than the non-eosinophilic group while the distribution of patients in group A, B, C was similar. Although the PFT findings were similar in both groups, the use of ICS was significantly lower and the number of exacerbations was significantly higher in eosinophilic group. In the ROC analysis, the ENR cut-off value that predicts eosinophilic COPD was found to be 0.32 in all COPD patients (Sens: 93.7%, Specif: 92.4%, AUC= 0.97, p<0.001). Based on these findings, it is considered that more priority should be given to the use of ICS in COPD patients with high ENR and it can be used as a marker for predicting COPD exacerbation as COPD exacerbations are higher in patients with ENR.

PROFILE OF STABLE COPD PATIENTS IN COUNTRIES FROM CENTRAL EASTERN EUROPE: RESULTS FROM A LARGE OBSERVATIONAL STUDY

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: The profile of patients with stable chronic obstructive pulmonary disease (COPD) in countries from Central Eastern Europe (CEE) is not clearly characterized. The population of stable COPD patients from 5 CEE countries participating in a large cross-sectional observational study is described here. METHODS: In a multinational study (NCT03031769), 2162 patients with stable COPD were enrolled from in 11 participating countries. In total, 1422 patients were enrolled from CEE: Romania (RO) n=406, Poland (PL) n=356, Serbia (SB) n=250, Bulgaria (BG) n=210 and Slovakia (SK) n=200. Eligible patients were aged ≥40 years with ≥1 year since COPD diagnosis. All patients were current or former smokers with a smoking history of ≥10 pack-years (PY). Stable disease was defined as no exacerbation history or changes in COPD maintenance treatment in last 2 months before enrolment. Exacerbation was defined as acute worsening of respiratory symptoms resulting in additional therapy. RESULTS: The mean age was 65.9 years in RO, 66.6 in SK, 66.7 in BG, 67.0 in PL and 68.0 in SB. More males were enrolled, from 61.0% in PL to 78.5% in SK and 83.5% in RO. Mean tobacco consumption (PY) for both smokers and non-smokers was 32.2 in BG, 32.5 in SK, 36.4 in PL, 38.1 in RO and 41.9 in SB. Mean post-bronchodilator FEV1 varied from 45.0% in BG and 47.8% in RO to 54.1% in PL, 54.5% in SK and 60.7% in SB. Most patients had moderate to severe airflow obstruction – percentages of patients ranged from 80.0% in SB, 83.7% in RO, 84.3% in BG, 87.7% in PL and 90.0% in SK. Mean number of exacerbations/patient in the last year (mild, moderate and severe) was 0.7 in SK, 1.9 in RO, 3.5 in BG, 4.8 in PL and 6.3 in SB. SB had the highest percentage of patients reporting severe exacerbations in last year (58.8%), while BG had highest percentage of patients with moderate exacerbations in last year (51.4%). Mean number of visits/year to chest specialist was 2.3 in BG, 3.4 in RO, 3.5 in SB, 3.7 in PL and 4.7 in SK. Mean score of COPD Assessment Test (CAT) ranged from 15 in SK and SB to almost 17 in PL, 19 in RO and 19.2 in BG. The distribution of low burden (A/C) vs. high burden (B/D) symptom categories by GOLD 2017 report differed at country level: 27.2% vs. 72.8% in BG, 35.9% vs. 64.1% in PL, 27.6% vs. 72.4% in RO, 32.5% vs. 67.5% in SK and 48.4% vs. 51.6% in SB. CONCLUSIONS: More discrepancies than similarities in characteristics of stable COPD patients were found across CEE countries participating in this study. The cultural, environmental and healthcare system differences may partly explain the results found. CLINICAL IMPLICATIONS: This large study allowed the homogeneous collection of data from 5 CEE countries. The variability of characteristics of stable COPD patients across countries may be explained by personal factors and local treatment and monitoring aspects that require further exploration. DISCLOSURES: Employee relationship with AstraZeneca Please note: $1001 - $5000 Added 03/10/2019 by Silviu Alecu, source=Web Response, value=Salary No relevant relationships by Adam Antczak, source=Web Response Employee relationship with AstraZeneca Please note: $1001 - $5000 Added 03/14/2019 by Yunqin Chen, source=Web Response, value=Salary No relevant relationships by Florin Mihaltan, source=Web Response No relevant relationships by Vesna Radulović, source=Web Response

Chronic obstructive pulmonary disease exacerbations and periodontitis: a possible association

BackgroundThere is an increasing interest concerning the potential link between both chronic obstructive pulmonary disease (COPD) and chronic periodontitis; therefore the association became the research focus.ObjectiveThis study intended to evaluate the potential association between the frequency of COPD exacerbations and chronic periodontitis.Patients and methodsA total of 250 male patients with COPD were included in the study and were categorized into two groups according to the frequency of exacerbations per year: group 1 had patients with frequent exacerbations (having ≥2 exacerbations in last year) and group 2 had patients with infrequent exacerbations (having <2 exacerbations in last year). They were compared regarding age, smoking history, education background, information of their oral hygiene behaviors, calculated modified Medical Research Council dyspnea scale, calculated COPD assessment test, the number of exacerbations and hospitalizations in the past year, prebronchodilator and postbronchodilator spirometry, calculated plaque index, bleeding index, probing pocket depth, clinical attachment level, and measured high-sensitivity C-reactive protein. Correlations between variables were examined. Logistic regression test was performed to explore the concurrent influences of periodontal health variables on the frequency of exacerbations.ResultsThis study evidenced that all periodontal health variables were significantly correlated with smoking status, modified Medical Research Council dyspnea scale, COPD assessment test, number of exacerbations and hospitalizations per year, and C-reactive protein level. Simplified oral hygiene index, plaque index, bleeding index, gingival index, probing pocket depth, and clinical attachment level were significantly correlated with most of the spirometry data.ConclusionPeriodontal health variables were considerably associated with the frequency of COPD exacerbations.

Vitamin D Deficiency and Insufficiency in Hospitalized COPD Patients.

Introduction31–77% of patients with COPD have vitamin D deficiency and insufficiency, with results being highly variable between studies. Vitamin D may also correlate with disease characteristics.AimTo find out the prevalence of vitamin D deficiency and insufficiency in patients with COPD admitted for exacerbation and a risk factors for lower vitamin D levels among comorbidities and COPD characteristics.Methods152 patients were studied for vitamin D serum levels (25(OH)D). All of them were also assessed for diabetes mellitus (DM) and metabolic syndrome (MS). Data were gathered also for smoking status and exacerbations in last year. All patients completed CAT and mMRC questionnaires and underwent spirometry.ResultsA total of 83,6% of patients have reduced levels of vitamin D. 42,8% (65/152) have vitamin D insufficiency (defined as 25–50 nmol/L) and 40,8% (62/152) have vitamin D deficiency (<25 nmol/L). The mean level of 25(OH)D for all patients is 31,97 nmol/L (95%CI 29,12–34,68). Vitamin D deficiency and insufficiency are more prevalent in females vs. males (97,7 vs 77,8%; p = 0.003). The prevalence and severity of vitamin D deficiency and insufficiency in this study is significantly higher when compared to an unselected Bulgarian population (prevalence 75,8%; mean level 38,75 nmol/L). Vitamin D levels correlate with quality of life (measured by the mMRC scale) and lung function (FVC, FEV1, FEV6, FEF2575, FEV3, but not with FEV1/FVC ratio and PEF), it does not correlate with the presence of arterial hypertension, DM, MS and number of moderate, severe and total exacerbations. Vitamin D deficiency is a risk factor for longer hospital stay.ConclusionsThe patients with COPD admitted for exacerbation are a risk group for vitamin D deficiency and insufficiency, which is associated with worse disease characteristics.

THE EFFECT OF DISEASE SEVERITY ON CLINICAL OUTCOME WITH ACUTE EXACERBATION OF CHRONIC BRONCHITIS PATIENTS TREATED WITH GEMIFLOXACIN

PURPOSE: Gemifloxacin is approved to treat acute bacterial exacerbations of chronic bronchitis (AECB). Patients with AECB associated with COPD and a history of recurrent acute episodes can be difficult to treat. Data from 10 AECB clinical trials were analysed for number of exacerbations in last year (NELY), disease duration, history of asthma or chronic bronchitis.

Safety and tolerability of adenosine stress MPI in patients with asthma or chronic obstructive airways disease

Background: Vasodilator stress is traditionally contraindicated in patients with asthma or chronic obstructive airways disease (A/COAD). However, recent evidence suggests that adenosine is safe in well-controlled disease. We conducted a systematic review of the safety and tolerability of adenosine stress in patients with A/COAD. Methods: 124 patients (46% asthma, 54% COAD) were identified from 1261 consecutive subjects referred for myocardial perfusion SPECT imaging. Patients were given adenosine if asthma only mild or moderate, no admission for an exacerbation in last year, no current steroid therapy, documented FEV1 or peak expiratory flow ≥70% predicted, no wheeze on auscultation. An inhaled short-acting beta-2-agonist (salbutamol, 200 mcg) was administered and adenosine titrated starting at 70 mcg/kg/min for 1 minute, increasing to 100 mcg/kg/min for another 1 minute up to the maximal dose of 140 mcg/kg/min for 4 minutes. Radiotracer was injected 2 minutes before termination of the adenosine infusion. Adherence to protocol, patient symptoms and complications were compared with a control group (non-A/COAD) matched for age, sex and clinical indications. Results: Of 124 patients, 72 (58%) were suitable for adenosine stress. Adenosine was combined with exercise in the majority of cases (86.1%). The protocol was completed successfully in a similar proportion of tests (100% control vs. 97.2% A/COAD, p=0.5). Symptoms were mostly minor and well tolerated, with dyspnoea reported more often in the A/COAD group (50% vs. 34% p=0.03). There were 4 cases of bronchospasm in the A/COAD group, all reverted shortly after discontinuation of adenosine (n=2) or administration of inhaled salbutamol. Aminophylline was not required. No other complications were reported. A similar proportion of studies showed reversible perfusion abnormalities in both groups (42% A/COAD vs. 50% control, p=0.3). Conclusion: A titrated adenosine protocol with prophylactic use of an inhaled beta-2-agonist is a safe procedure in patients with history of mild, well-controlled asthma or COAD undergoing stress myocardial perfusion imaging.