GOLD Guidelines Research Articles

Applicability of 2017 Global Initiative for Chronic Obstructive Lung Disease guidelines in diagnosing COPD in a tertiary care hospital

Chronic obstructive pulmonary disease (COPD) is one of the common conditions that physicians frequently diagnose and treat both in the hospital and outpatient setting. Every year, a new report is generated based on an analysis of published studies which attempts to improve the way physicians handle COPD. In 2011 and 2017, the traditional GOLD guidelines were revised, and it included exacerbation history and COPD Assessment Test (CAT) and modified Medical Research Council Dyspnoea Scale (mMRC) in diagnosis of the disease. This study we used patients’ symptoms, risk factors and exacerbation history to diagnose COPD as per 2017 guidelines and checked its accuracy by confirming with spirometry. A prospective study, in which 105 patients with history suggestive of COPD were classified according to ABCD tool, later these patients were subjected to spirometry to confirm the diagnosis of COPD and severity. The results obtained were analysed by statistical software SPSS-V.24. About 79% of the population diagnosed to have COPD by ABCD tool were confirmed using spirometry, the rest 21% either had spirometric post bronchodilator FEV1/FVC >0.7 or significant reversibility. CAT and mMRC test correlate with the spirometric FEV1 predicted percentage.On comparing ABCD and Spirometric grading most of them had severe airway obstruction and these people were mostly distributed in group B and D of ABCD grading. The utility of 2017 GOLD consensus in diagnosing COPD in the Indian scenario was studied. The ABCD tool of GOLD consensus will be helpful in diagnosing COPD in a resource limited setting, primary care centres were spirometry is not available.

FEV1/FEV6 is effective as a surrogate for FEV1/FVC in the diagnosis of chronic obstructive pulmonary disease

Background and objectiveChronic Obstructive Pulmonary Disease (COPD) causes substantial morbidity and mortality across the globe. Diagnosis of COPD requires post-bronchodilator FEV1/FVC <0.70 as per GOLD Guidelines. FVC maneuver requires a minimum of 6 seconds of forceful expiration with no flow for 1 second for an accepted effort, which lacks any fixed cut-off point. This leads to discomfort, especially in advanced COPD and old aged population. We conducted this study to find the utility of FEV1/FEV6 as a surrogate for FEV1/FVC, the correlation between the two ratios, and the fixed cut-off value of FEV1/FEV6 for COPD diagnosis. MethodsThis was a prospective, cross-sectional study approved by the institutional ethics committee conducted from January 2017 to November 2018. Consented patients above 18 years suspected of COPD underwent Spirometry as per ATS guidelines. FEV1, FEV6, FEV1/FEV6 and FEV1/FVC ratios were recorded from the best acceptable maneuver. ResultsOut of 560 screened patients, 122 diagnosed as COPD. The correlation coefficient between the post-bronchodilator FEV1/FVC ratio and FEV1/FEV6 ratio was 0.972 (p < 0.01). The relationship between the post-bronchodilator FEV1/FVC ratio and FEV1/FEV6 ratio (linear regression analysis) was found out as: FEV1/FVC = −1.845 + 1.009(FEV1/FEV6). Using this formula, the post-bronchodilator FEV1/FEV6 value of 71.845 was obtained corresponding to the post-bronchodilator FEV1/FVC value of 70.00. ConclusionWe found a positive correlation coefficient (r = 0.972, p < 0.001) between the FEV1/FEV6 and FEV1/FVC ratios and the cut off value of 71.845 (p < 0.01) for the post-bronchodilator FEV1/FEV6 ratio for the diagnosis of COPD. Thus FEV1/FEV6 should be used as a surrogate for FEV1/FVC for the diagnosis of COPD.

Sex differences in the lung function in chronic obstructive lung disease

For many years, chronic obstructive pulmonary disease has been considered a disease of men, with a higher prevalence in men than in women. Recent data, however, report a significant change in the sexual profile of chronic obstructive pulmonary disease. The influence of the female sex on the development, progression, and outcome of chronic obstructive pulmonary disease is becoming increasingly apparent from the accumulation of data on sex and gender in chronic obstructive pulmonary disease studies. Objective — to evaluate sex differences in lung function, severity, and evolutionary types in chronic obstructive pulmonary disease. Materials and methods. A clinical study was conducted on 236 patients aged 40 to 75 years with exacerbation of COPD GOLD stages II—IV. The patients were examined clinically and paraclinically according to the 2017 GOLD guidelines. The degree of respiratory impairment was assessed using spirometry, and a digital X-ray examination of the chest was performed.Results and discussion. Based on the data of a questionnaire survey of 236 patients with COPD, the following distribution was obtained: women who never smoked — 29.7 %; current smokers among women — 46.9 %; and former smokers among women at the time of the study — 39.1 %. These percentages were generally the same for both sexes, although for subjects aged 40 to 59, smoking was more common in women than in men.Conclusions. Women differ both in terms of clinical manifestations of symptoms, and exacerbations and radiological manifestations. Women with COPD have more dyspnea than men with the same degree of airway obstruction. Smoking is the leading cause of COPD in women, and the risk increases with the number and duration of cigarette use.

Correlation of FEV1/FEV6 with BODE Index, CAT Score and DLCO in COPD Patients

Chronic Obstructive Pulmonary Disease is associated with progressive airflow limitation. Spirometry is one of the most important non-invasive tests that help in diagnosing airway obstruction. A Post bronchodilator FEV1/FVC ratio &lt; 0.7 according to GOLD guidelines is considered to be diagnostic of COPD, wherein FEV1 is the forced expiratory volume in the first second, and FVC is the forced vital capacity which requires complete emptying of lungs that may require longer expiratory time and a more significant expiratory effort. The value of FEV1/FEV6 ratio is similar to the FEV1/FVC rate in diagnosing obstruction. FEV1/FEV6 is one such spirometric measurement which reduces the effort of expiration and helps in detecting the airway obstruction at the end of the sixth second during forceful exhalation thus serving as a natural, cost-effective bedside investigation that can be used in every health care facility for prompt diagnosis and management of the disease. FEV1/FEV6 can also be used to assess the prognosis of patients with COPD. It can even independently predict the reduction of lung function, rate of death and risk of carcinoma. The vitalograph is a smooth handheld device which helps in early detection of COPD in a quick, simple and reproducible manner. It not only displays the FEV1, FEV6 ratio and FEV1 per cent predicted but also provided information regarding the severity of COPD classification and lung age estimation. It can be used as a tool to avoid over diagnosis of COPD, especially in elderly patients. It has the advantage of requiring minimal instruction for use by non-respiratory specialists as well. This work concludes that FEV1/FEV6 can be used as a simple, cost-effective bedside investigation to diagnose COPD as an alternative to the conventional spirometry to detect undiagnosed airway obstruction in individuals with a low expiratory effort, especially in poor resource settings.

Amid COVID-19 pandemic: Challenges with access to care for COPD patients.

Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammation in the lungs that causes obstruction in the airway, poor airflow, and irreversible loss of lung function. In clinical practice, comprehensive care for COPD patients includes the diagnosis using spirometry, clinical examination and comprehensive pharmacological and non-pharmacological management. The diagnosis is based on symptoms, dyspnea and lung function impairment and can be mild to very severe. Symptoms are examined using the COPD assessment test (CAT) score, and dyspnea grade are examined using a modified MRC from GOLD guidelines. When mild, the care includes self-management education, smoking cessation, lifestyle modifications, vaccination, and short-acting bronchodilators. Self-management education involves inhaler device training, breathing technique, early recognition of acute exacerbations and writing action plans. As the disease progresses, other care measures are added. These measures include the addition of long-acting inhaler therapies, pulmonary rehabilitation, oral therapies, oxygen and lung transplantation. During the final stages of COPD, patients receive end-of-life care (Bourbeau et al., 2019).1The novel coronavirus disease (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that is spread through respiratory droplets. This infectious disease has led to a pandemic and is affecting the lives of many around the world, including Canadians. During this pandemic, the non-essential health services, including caring for patients with COPD, have been put on hold to reduce the risk of spread. Other implications of this pandemic for COPD patients include the health risk in case of infection. A meta-analysis including studies from January to March 2020 in Wuhan showed that pre-existing COPD worsens the risk of COVID-19 progression and leads to poorer prognostics. The sub-group analysis showed a significantly higher risk of ICU requirements and death in COPD patients who are infected with the SARS-CoV-2 virus. Studies suggest strong efforts to mitigate the risk of infection in this population (Zhao et al., May 2020).2 This makes caring for this population even more critical during the pandemic.

Can Pulmonary Rehabilitation Affect Mortality After an Acute COPD Exacerbation

Current GOLD guidelines state that pulmonary rehabilitation is associated with fewer chronic obstructive pulmonary disease (COPD) hospitalizations;

Out-of-pocket Healthcare Costs of COPD Exacerbation Episodes: A Hidden Cost and Growing Strain on Family Budgets

Introduction: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) appears to be the main reason for hospitalization among chronic obstructive pulmonary disease (COPD) patients. This study aimed to evaluate the substantial economic burden of COPD in terms of out-of-pocket costs (OOPCs) among COPD patients.&#x0D; Methods: This study consisted of 67 consenting patients with AECOPD. A cross-sectional study was performed via convenience sampling. Data were gathered based on per episode of exacerbation and the calculation of OOPCs was done based on direct and indirect costs.&#x0D; Results: This study showed that the mean length of hospital stay for four severity levels (according to GOLD guidelines) was 3.4, 7.2, 10.3 and 14.1 days, respectively. The mean OOPCs per episode of exacerbation according to the severity level were 139.1, 153.3, 171.4 and 365.8 USD, respectively.&#x0D; Conclusion: Impacts of OOPCs regarding AECOPD episodes on healthcare resources are worthy of attention. Cost estimation from patients’ perspective especially OOPCs estimation is important in decision and policy-making to improve healthcare states of a population.

Assessment of Prescription Pattern Among COPD Patients in Departments of General Medicine Ward and Pulmonology in Tertiary Care Hospitals of Khammam Region

Chronic obstructive pulmonary disease is a common preventable and treatable disease. It has been a leading cause of morbidity and mortality in industrialized and developing countries. Drug utilization research promotes the rational use of drugs and decreases adverse drug reactions in the population. The present study is aimed to analyze and evaluate the trends and patterns of prescribing drugs among COPD patients. A prospective observational study was conducted in 301 patients admitted in the general and pulmonary medicine departments over six months at a tertiary care hospital in Khammam region. Out of the 301 study population, male patients were more (81.39%). The majority of the patients were from the age group of 51-60 years (30.56%). Smoking was found to be more prominent in the study population (63.6%). Bronchodilators (46.90%) were mostly prescribed class of drugs in the management of COPD followed by Systemic Corticosteroids (20.60%), Antibiotics (19.09%) Most common co-morbidity was found to be Hypertension (19.85%). The study concludes that symptomatic treatment was given to COPD patients in the hospital. The prescribing pattern was found to be in concordance with the current GOLD guidelines in the management of COPD patients

Cardiopulmonary Exercise Test in evaluation of Functional Capacity in patients with Chronic Obstructive Pulmonary Disease

Background: Assessment of severity in patients with Chronic Obstructive Pulmonary Disease(COPD) is usually done at rest by spirometry test. But cardiopulmonary exercise test can be a measure to assess the functional capacity more accurately in patients with COPD.&#x0D; Method: Fifty eight patients with stable COPD were included in this study period of one and half years from January 15 to June 2016 and categorise into four groups based on spirometric data following the GOLD guidelines 2018; GOLD 1 mild COPD, GOLD 2 moderate COPD, GOLD 3 severe COPD and GOLD 4 very severe COPD. Symptom limited CPET on treadmill using Bruce protocol using cardiopulmonary exercise machine was done in all fifty eight patient.&#x0D; Results: twenty one patients (36.20%) had moderate COPD; twenty six(44.82%) had severe COPD; eleven(18.96%) had very severe COPD and none found to be categorised as mild COPD. All fifty eight patients attained anaerobic threshold. Majority(34, 58.62%) of patients stopped exercise due to shortness of breath; decreased oxygen saturation was the cause of stopping exercise in eight(13.7%) patients; other causes of exercise limitation were increased heart rate, vertigo, leg fatigue, increased blood pressure, ventricular ectopic and chest tightness. Four patients were found to limit exercise due to combined shortness of breath and leg fatigue. A significant correlation between forced expiratory volume in first second (FEV1, percent predicted) and maximum oxygen uptake(ml/kg/min) was observe. Twenty(46.55%) patients with low(&lt;40%) AT were identified who could be benefited from pulmonary rehabilitation program.&#x0D; Conclusion: CPET can be useful to identifying the COPD patients with functional capacity impairment for pulmonary rehabilitation by assessing exercising capacity and the cause of exercise limitation.&#x0D; J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 23-27

Lung sounds can be used as an indicator for assessing severity of chronic obstructive pulmonary disease at the initial diagnosis

To assess the value of pulmonary auscultation for evaluating the severity of chronic obstructive pulmonary disease (COPD) at the initial diagnosis. The patients with newly diagnosed COPD in our hospital between May, 2016 and May, 2019 were enrolled in this study. According to the findings of pulmonary auscultation, the lung sounds were classified into 5 groups: normal breathing sounds, weakened breathing sounds, weakened breathing sounds with wheezing, obviously weakened breathing sounds, and obviously weakened breathing sounds with wheezing. The pulmonary function of the patients was graded according to GOLD guidelines, and the differential diagnosis of COPD from asthmatic asthma COPD overlap (ACO) was made based on the GOLD guidelines and the European Respiratory Criteria. A total of 1046 newly diagnosed COPD patients were enrolled, including 949 male and 97 female patients with a mean age of 62.6± 8.71. According to the GOLD criteria, 88.1% of the patients were identified to have moderate or above COPD, 50.0% to have severe or above COPD; a further diagnosis of ACO was made in 347 (33.2%) of the patients. ANOVA analysis showed significant differences in disease course, FEV1, FEV1%, FEV1/FVC, FVC, FVC% and mMRC among the 5 auscultation groups (P < 0.001), but FENO did not differ significantly among them (P=0.097). The percentage of patients with wheezing in auscultation was significantly greater in ACO group than in COPD group (P < 0.001). Spearman correlation analysis showed that lung sounds was significantly correlated with disease severity, FEV1, FEV1%, FVC and FVC% of the patients (P < 0.001); Multiple linear regression analysis showed that a longer disease course, a history of smoking and lung sounds were all associated with poorer lung functions and a greater disease severity. Lung sounds can be used as an indicator for assessing the severity of COPD at the initial diagnosis.

To Study the Prevalence of Obstructive Airway Disease in Patients of OSA Diagnosed by Polysomnography

Aim: To study the prevalence of obstructive airway disease in patient of OSA diagnosed by polysomnography. Method: This study is a descriptive cross-sectional and was carried out in patients admitted in the department of Respiratory Medicine who were diagnosed with OSA after polysomnography. Total 41 patients who were diagnosed as cases of obstructive sleep apnea were clinically evaluated and investigated by history taking and final diagnosis were made as either COPD, Asthma on basis of GOLD and GINA guidelines respectively. Results: Mean age of the study participants was 50.95 years. Prevalence of Asthma and COPD among cases with OSA was 58.5% and 14.6%.Mean AHI and ESS score was 42.45 and 16.80 respectively. The most common co-morbid condition was GERD (19.5%). Conclusion: Present study concluded that asthma is more prevalent than COPD in patients of obstructive sleep apnea. The main factors associated with Obstructive lung diseases and its pathogenesis is the obesity, hypertension, smoking habits, adenoids, tonsillitis, musculoskeletal changes, weakness and atrophy of muscles of upper respiratory tract.

Cardiovascular co-morbidity in patients with COPD in Bulgaria

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. It is also associated with significant concomitant diseases which affect the disease progression course, and contribute to the exacerbation of health status and overall mortality rate. The aim of this study was to identify the most frequent Cardio-vascular disease (CVD) comorbidities among patients with COPD in Bulgaria and their effect on the hospitalization rate, hospital stay duration and health status. A retrospective national observational study was conducted among a statistically representative cohort of 426 patients in Bulgaria. Demographic data, smoking, clinical data for COPD severity and co-morbidity were collected. Health status was assessed through the specific COPD assessment test (CAT). CVD co-morbidity was evaluated by type, considering the GOLD guidelines and number. More than 80% of the patients reported two and more CVD co-morbidities and all of them reported more than two exacerbations and more than two hospitalizations over the last year. The most frequently reported CVD co-morbidity was hypertension, which was present in 88% of the men and in 89% of the women. The data showed a positive correlation between the cardiovascular risk and the progression of the disease. Hypertension, ischemic heart disease and heart failure prevailed in the observed population. With the advancement of COPD, the number of CVDs diseases per patient and CAT score, average hospitalization rate and hospital stay increased.

Study of microalbuminuria in chronic obstructive pulmonary disease patients at tertiary care teaching hospital

Background:Hypoxemia-induced endothelial dysfunction leads to microalbuminuria. Microalbuminuria (MAB) has also been used as a parameter to assess the risk of cardiovascular events in an individual. The aim of this study was to observe the relationship of MAB in patients with chronic obstructive pulmonary disease (COPD) and to correlate MAB with different stages of COPD.Materials and Methods:This cross sectional study included 140 patients with COPD selected according to GOLD guidelines based on COPD test assessment score and the number of exacerbations who had smoking pack years of more than 10 years. Urine albumin creatinine ratio (UACR) more than 30 mg/gm represents MAB.Results:The UACR increases as the severity of groups of COPD increases with significant differences in UACR values among different COPD groups. Significant differences were seen among various groups of COPD when compared for different clinical parameters such as SPO2, PaO2, PaCO2, pH, and C-reactive protein (CRP). Pearson correlation analysis revealed that UACR was significantly inversely related with PaO2 (r = -0.514, P < 0.001), SPO2 (r = –0.397, P < 0.001) and FEV1 (r = –0.441, P < 0.001) and it was significantly positively correlated with PaCO2 (r = 0.675, P < 0.001).Conclusion:This study indicates that there is strong relationship of MAB in patients with COPD and the levels of MAB increase as the severity of COPD increases due to hypoxia and endothelial dysfunction. As MAB is a marker for cardiovascular risk, patients with COPD can be routinely evaluated for the urine test of MAB specially who are at increased risk for cardiovascular events.

Fresh air for weakened lungs - pulmonary rehabilitation in Switzerland 2019

Fresh air for weakened lungs - pulmonary rehabilitation in Switzerland 2019 Abstract. Pulmonary rehabilitation traditionally plays an important role in the treatment of chronic pulmonary diseases in Switzerland. There is a good availability of pulmonary rehabilitation with 17 centers offering inpatient pulmonary rehabilitation across the country. There is good evidence that pulmonary rehabilitation is not only effective but also cost-effective, especially for the indication of COPD but also for other chronic pulmonary diseases. According to the GOLD guidelines there is an undersupply of COPD patients with pulmonary rehabilitation in Switzerland. Pulmonary rehabilitation is not only limited to the improvement of physical exercise, but also covers all the important aspects for an individual to function in everyday life. Though the daily costs for pulmonary rehabilitation are only a fourth to a thirth of the costs in a hospital. Offering pulmonary rehabilitation to the patients who also have an indication for it lies in the responsibility of the admitting doctors, the insurances and the patients themselves, who need to bring a basic motivation to participate in pulmonary rehabilitation.

Effects of the Chinese herbal formula San-Huang Gu-Ben Zhi-Ke treatment on stable chronic obstructive pulmonary disease: study protocol of a randomized, double-blind, placebo-controlled trial

BackgroundDue to the large number of patients, high mortality rate as well as high social costs and economic burden, chronic obstructive pulmonary disease (COPD) has become one of the most important health problems around the world, which has attracted people’s attention. Currently, Chinese herbs have been widely used as alternative medicine (CAM) for COPD patients. The Chinese herbal formula San-Huang Gu-Ben Zhi-Ke (SHGBZK) has shown good clinical efficacy in COPD in preclinical studies. Animal experiments have shown that it has mucosal immune barrier function and can maintain airway wall integrity, reduce inflammatory cell infiltration, promote inflammatory damage repair, and relieve narrow airway conditions.Methods/designThis study is a randomized, double-blind, placebo-controlled trial. A total of 100 patients with stable COPD diagnosed with deficiency of lung qi and spleen qi will be recruited and randomly assigned to one of two treatment groups: SHGBZK treatment, N = 50; placebo treatment, N = 50. The two groups will receive basic treatment for COPD according to the 2017 GOLD Guidelines for Chronic Obstructive Pulmonary Disease. Patients will stick to the treatment they used to take as much as possible, and will be given present general treatment when acute exacerbation of COPD occurs during the study. Both groups will receive a 24-week intervention and patient status will be assessed at 24 weeks and then 28 weeks after treatment. After the 24-week treatment, patients will be followed up for another 28 weeks. Outcome measures, including the frequency and duration of acute exacerbation, lung function, traditional Chinese medicine symptom score, exercise capacity, and quality of life will be assessed.DiscussionIt is hypothesized that SHGBZK will have beneficial effects in reducing the frequency and duration of acute exacerbations, improving the exercise capacity function of patients with stable COPD diagnosed with a deficiencies in lung qi and spleen qi. This study may establish a new treatment method for COPD patients, differentiating it from other drugs in clinical use used for similar clinical indications.Trial registrationChinese Clinical Trial Registry, ChiCTR1800016349. Registered on 26 May 2018.

ECHOCARDIOGRAPHIC STUDY OF RIGHT VENTRICLE CHANGES IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) PATIENTS OF DIFFERENT SEVERITY

Chronic obstructive pulmonary disease (COPD) characterized by interminable air flow limitation that is not fully reversible COPD includes chronic bronchitis, emphysema, and chronic asthmatic bronchitis. Chronic obstructive pulmonary disease as a complex disease with various systemic manifestations and one of the co-morbidity linked with COPD is cardiovascular disease. Hypoxic vasoconstriction and alterations in pulmonary microvasculature, which are both observed in COPD patients, leads to an increase in pulmonary vascular resistance. As a result, this increase in right ventricular (RV) after load causes right ventricular remodeling, including chamber dilatation and wall hypertrophy and ultimately to functional deterioration. The aim of this study to evaluate the right ventricular changes that develop secondary to COPD using GOLD guidelines and echocardiographic findings .This cross-sectional study involved 134 patients who presented to the pulmonary disease outpatient clinic with COPD. We assessed the right ventricular changes in COPD patients of different severity using echocardiography .COPD patients shown change in the right ventricular dimensions as the severity of COPD increases and right ventricular function as well. It is also observed that frequency of pulmonary hypertension also increased as the severity of COPD increases. The study shows high prevalence of cardiac co-morbidities such as RV dysfunction and pulmonary hypertension in COPD patients. The severity of complications increases with severity of COPD and makes a linear relation.&#x0D; Keywords: Echocardiography, ECG, COPD

EFFICACY OF NEBULIZED ARFORMOTEROL FOR THE TREATMENT OF PATIENTS WITH COPD: A ROLE FOR LONG-ACTING BRONCHODILATORS IN TREATING LONG-TERM CARE PATIENTS WITH COPD

SESSION TITLE: Monday Electronic Posters 4 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality and increased health care resource utilization in long-term care (LTC) nursing home facilities in the US. Although GOLD guidelines recommend the use of long-acting bronchodilators (LABDs) for the treatment of COPD, as they are more effective and convenient than regular treatment with short-acting bronchodilators (SABDs), a large proportion of nursing home residents with a diagnosis of COPD do not receive any respiratory medication. Arformoterol tartrate (ARF; 15 μg twice daily [BID]) is a nebulized long-acting beta2-agonist (LABA) indicated for the maintenance treatment of bronchoconstriction in patients with COPD; ARF should not be used as rescue medication. In this post-hoc analysis, the efficacy of ARF was assessed in older COPD patients and in patients with very severe COPD. METHODS: Data from two identical, 12-week, multicenter, double-dummy, randomized Phase III trials (NCT00685841 and NCT00064402) evaluating improvement in airway function with ARF treatment in patients with COPD were pooled for analysis. Patients (n=1456; mean predicted forced expiratory volume in 1 second [FEV1]=40.6% [standard deviation: 12.8]) received nebulized ARF 15 μg BID, 25 μg BID, or 50 μg once daily (QD), salmeterol 42 μg BID (via metered dose inhaler), or placebo BID for 12 weeks. In order to assess the efficacy of ARF in patients with COPD representative of an LTC population, an analysis of improvement in airway function (as measured by FEV1) was performed comparing ARF 15 ug BID with placebo (BID) in a subset of patients defined by age (≥75 years; n=160) and baseline COPD disease severity (FEV1 <30% predicted; n=410). RESULTS: In the overall study population, the median % change in FEV1 was 2.05% among patients receiving placebo and 12.72% in patients treated with ARF 15 μg BID. In patients ≥75 years of age, the median % change in FEV1 was −5.22% in patients receiving placebo compared with 18.62% improvement in patients treated with ARF 15 μg BID. In patients with severe COPD disease (<30% FEV1 % predicted), the median % change in FEV1 was 5.13% among patients receiving placebo compared with 22.58% in patients treated with ARF 15 μg BID. CONCLUSIONS: Despite the recommendations for use of LABDs by GOLD guidelines, many LTC nursing home residents with COPD do not receive any respiratory medications. In this post-hoc analysis of patients with COPD representative of nursing facility residents (≥75 years of age; severe baseline disease), treatment with ARF 15 μg BID resulted in greater improvements in lung function when compared with placebo. CLINICAL IMPLICATIONS: LABDs such as ARF should be considered as a treatment option for residents in an LTC setting with a diagnosis of COPD. DISCLOSURES: Employee relationship with Sunovion Pharmaceuticals Please note: >$100000 Added 03/11/2019 by Thomas Goodin, source=Web Response, value=Salary Employee relationship with Sunovion Pharmaceuticals Please note: >$100000 Added 03/12/2019 by Ayca Ozol-Godfrey, source=Admin input, value=Salary Employee relationship with Sunovion Pharmaceuticals Please note: >$100000 Added 03/13/2019 by Barry Price, source=Web Response, value=Salary Employee relationship with Sunovion Pharmaceuticals Inc. Please note: >$100000 Added 03/14/2019 by Shahin Sanjar, source=Web Response, value=Salary Employee relationship with Sunovion Pharmaceuticals Inc. Please note: $20001 - $100000 Added 03/11/2019 by Sanjay Sharma, source=Web Response, value=Salary Removed 03/11/2019 by Sanjay Sharma, source=Web Response Employee relationship with Sunovion Pharmaceuticals, Inc. Please note: >$100000 Added 03/11/2019 by Sanjay Sharma, source=Web Response, value=Salary

Can Eosinophil Levels Be Used to Guide Use of Steroids for COPD Exacerbations

GOLD guidelines recommend use of prednisone (40 mg daily) for 5 days for acute exacerbations of chronic obstructive pulmonary disease (COPD; NEJM JW

Metabolomic signatures of asthma-COPD overlap (ACO) are different from asthma and COPD.

Asthma-chronic obstructive pulmonary disease (COPD) overlap, termed as ACO, is a complex heterogeneous disease without any clear diagnostic or therapeutic guidelines. The pathophysiology of the disease, its characteristic features, and existence as a unique disease entity remains unclear. Individuals with ACO have a faster lung function decline, more frequent exacerbations, and worse quality of life than those with COPD or asthma alone. The present study aims to determine whether ACO has a distinct metabolic profile in comparison to asthma and COPD. Two different groups of patients were recruited as discovery (D) and validation (V) cohorts. Serum samples obtained from moderate and severe asthma patients diagnosed as per GINA guidelines [n = 34(D); n = 32(V)], moderate and severe COPD cases identified by GOLD guidelines [n = 30(D); 32(V)], ACO patients diagnosed by joint GOLD and GINA guidelines [n = 35(D); 40(V)] and healthy controls [n = 33(D)] were characterized using nuclear magnetic resonance (NMR) spectrometry. Multivariate and univariate analysis indicated that 12 metabolites [lipid, isoleucine, N-acetylglycoproteins (NAG), valine, glutamate, citric acid, glucose, L-leucine, lysine, asparagine, phenylalanine and histidine] were dysregulated in ACO patients when compared with both asthma and COPD. These metabolites were further validated in a fresh cohort of patients, which again exhibited a similar expression pattern. Our findings suggest that ACO has an enhanced energy and metabolic burden associated with it as compared to asthma and COPD. It is anticipated that our results will stimulate researchers to further explore ACO and unravel the pathophysiological complexities associated with the disease.

An Argument for Protocolized Diagnosis and Management of COPD by GOLD Guidelines: Needs Modification and More Emphasis to be Given to ICS (Inhaled Corticosteroids) in Indian Subsets of COPD Patients

Indian COPD patients have variable pattern of risk exposure and response to treatment as compared with western patients.Prospective interventional and observational study conducted after IRB approv...