Chronic Obstructive Pulmonary Disease Mortality Research Articles

Time-updated resting heart rate predicts mortality in patients with COPD.

High resting heart rate (RHR) is associated with higher mortality in the general population and in cardiovascular disease. Less is known about the association of RHR with outcome in chronic obstructive pulmonary disease (COPD). In particular, the time-updated RHR (most recent value before the event) appears informative. This is the first study to investigate the association of time-updated RHR with mortality in COPD. We compared the baseline and time-updated RHR related to survival in 2218 COPD patients of the German COSYCONET cohort (COPD and Systemic Consequences-Comorbidities Network). Patients with a baseline RHR > 72 beats per minute (bmp) had a significantly (p = 0.049) higher all-cause mortality risk (adjusted hazard ratio (HR) of 1.37 (1.00-1.87) compared to baseline RHR ≤ 72bpm. The time-updated RHR > 72bpm was markedly superior (HR 1.79, 1.30-2.46, p = 0.001). Both, increased baseline and time-updated RHR, were independently associated with low FEV1, low TLCO, a history of diabetes, and medication with short-acting beta agonists (SABAs). In conclusion, increased time-updated RHR is associated with higher mortality in COPD independent of other predictors and superior to baseline RHR. Increased RHR is linked to lung function, comorbidities and medication. Whether RHR is an effective treatment target in COPD, needs to be proven in controlled trials.

Associations of county-level cumulative environmental quality with mortality of chronic obstructive pulmonary disease and mortality of tracheal, bronchus and lung cancers

Chronic obstructive pulmonary disease (COPD) and tracheal, bronchus, and lung (TBL) cancers are among the leading causes of mortality worldwide. Many environmental factors have been linked to COPD and TBL cancers. This study examined the associations of cumulative environmental quality indices with COPD mortality and TBL cancers mortality, respectively. Environmental Quality Index (EQI) was constructed to represent cumulative environmental quality for the overall environment and 5 major environmental domains (e.g., air, water, built). Associations of each EQI indices with COPD mortality and TBL cancers mortality, across 3109 counties in the 48 contiguous states of the US, were examined using simultaneous autoregressive (SAR) models. Stratified analyses were conducted in females versus males and according to rural-urban continuum codes (RUCC) to assess the heterogeneity across the overall population. Overall poor environmental quality was associated with a percent difference (PD) of 0.75 [95% confidence intervals (95% CI), 0.46, 1.05] in COPD mortality and an PD of 1.22 (95% CI, 0.97, 1.46) in TBL cancers mortality. PDs were higher in females than in males for both COPD and TBL cancers. The built domain had the largest effect on COPD mortality (PD, 0.85; 95% CI, 0.58, 1.12) while the air domain had the largest effect on TBL cancers mortality (PD, 1.54; 95% CI, 1.31, 1.76). The EQI-mortality associations varied among different RUCCs, but no consistent trend was found. This result suggests that poor environmental quality, particularly poor air quality and built environment quality may increase the mortality risk for COPD and that for TBL cancers. Females appear to be more susceptible to the effect of cumulative environmental quality. Our findings highlight the importance of improving overall and domain-specific cumulative environmental quality in reducing COPD and TBL cancer mortalities in the United States.

Chronic obstructive pulmonary disease mortality: The Diesel Exhaust in Miners Study (DEMS)

BackgroundMiners are highly exposed to diesel exhaust emissions from powered equipment. Although biologically plausible, there is little evidence based on quantitative exposure assessment, that long-term diesel exposure increases risk of chronic obstructive pulmonary disease (COPD). To fill this gap, we examined COPD mortality and diesel exhaust exposure in the Diesel Exhaust in Miners Study (DEMS). MethodsWe fit Cox models to estimate hazard ratios (HRs) for COPD mortality and cumulative exposure (μg/m3-years) to respirable elemental carbon (REC), a key metric for diesel exhaust exposure. Separate models were fit for ever-underground and surface-only miners to allow for effect modification. Exposure was lagged by 0, 10 and 15 years. In a secondary analysis, we addressed the healthy worker survivor effect by applying the parametric g-formula to handle time-varying confounding affected by prior exposure among ever-underground workers. ResultsBased on 140 cases, the HRs for COPD mortality increased as categories of lagged REC exposure increased for all workers. Among surface-only workers, those in the middle exposure category (0 lag) had a significantly elevated hazard ratio of 2.34 (95% CI: 1.11–4.61) relative to those in the lowest category. Among the ever-underground, that ratio was 1.35, with wide confidence intervals. Using the g-formula, we estimated that the lifetime cumulative risk of COPD mortality would have been reduced from the observed 5.0%–3.1% under a hypothetical intervention where all ever-underground workers were always unexposed. ConclusionsOur results suggest long term exposure to diesel exhaust may increase risk of COPD in miners, though power was limited.

Short-term associations between size-fractionated particulate air pollution and COPD mortality in Shanghai, China

Particulate air pollution is a continuing challenge in China, and its adverse effects on chronic obstructive pulmonary disease (COPD) have been widely reported. However, epidemiological evidence on the associations between size-fractionated particle number concentrations (PNCs) and COPD mortality is limited. In this study, we utilized a time-series approach to investigate the associations between PNCs of particles at 0.25–10 μm in diameter and COPD mortality in Shanghai, China. Quasi-Poisson regression generalized additive models were applied to evaluate these associations, with adjustment of time trend, day of week, holidays, temperature and relative humidity. Stratification analyses were performed by season and gender. There were a total of 3238 deaths due to COPD during the study period. We found that daily COPD deaths were significantly associated with PNCs of particles <0.5 μm, and the magnitude of associations increased with decreasing particle size. An interquartile range (IQR) increase in PNC0.25—0.28, PNC0.28—0.3, PNC0.3—0.35, PNC0.35—0.4, PNC0.4—0.45 and PNC0.45—-0.5 was associated with increments of 7.51% (95%CI: 2.45%, 12.81%), 7.22% (95%CI: 2.16%, 12.53%), 6.95% (95%CI: 1.81%, 12.35%), 6.26% (95%CI: 1.25%, 11.52%), 5.24% (95%CI: 0.56%, 10.13%) and 4.15% (95%CI: 0.14%, 8.32%), respectively. The associations remained robustness after controlling for the mass concentrations of gaseous air pollutants. In stratification analyses, significant associations between PNCs and COPD mortality were observed in the cold seasons, and in males. Our results suggested that particles <0.5 μm in diameter might be most responsible for the adverse effects of particulate air pollution on COPD mortality, and COPD patients are more susceptible to PM air pollution in the cold seasons, especially for males.

Midlife cardiorespiratory fitness and the long-term risk of chronic obstructive pulmonary disease

BackgroundGood midlife cardiorespiratory fitness (CRF) may reduce the risk of chronic obstructive pulmonary disease (COPD). Reverse causation may play a role if follow-up time is short. We examined the association...

Associations between size-fractionated particle number concentrations and COPD mortality in Shanghai, China

BackgroundFew studies have investigated respiratory effects of particulate matter air pollution using a full range of particle size distribution. ObjectivesTo explore the short-term associations between size-fractionated particle number concentration (PNC) and chronic obstructive pulmonary disease (COPD) mortality. MethodsWe conducted a time-series study to explore the associations between size-fractionated PNC and daily COPD mortality in the Pudong New Area of Shanghai, China, from 2014 to 2016. We evaluated particle size distribution from 0.01 μm to 10 μm, which was segregated into 7 ranges to better explore the size-dependent associations. We used over-dispersed generalized additive models to estimate the associations after controlling for time trends, temperature, humidity, day of the week and holidays. ResultsA total of 5430 deaths due to COPD were identified during the study period. For size ranges from 2.5 – 10 μm, 1–2.5 μm to 0.3–1 μm, there were stronger associations between PNC and COPD mortality, but the associations were statistically insignificant. However, for the smaller size ranges from 0.3 to 0.01 μm, the associations became statistically significant and the magnitude of association remained stable. An interquartile range increase in PNC at lag 0–1 day for size ranges 0.01–0.03 μm, 0.03–0.05 μm, 0.05–0.1 μm and 0.1–0.3 μm was associated with increments of 4.44% (95% CI: 1.16%, 7.73%), 4.31% (95% CI: 1.16%, 7.47%), 4.22% (95% CI: 1.05%, 7.40%), and 4.28% (95% CI: 0.48%, 8.09%) in COPD mortality, respectively. ConclusionThis study suggested that particles below 0.3 μm in diameter might be mainly responsible for the adverse effect of particulate air pollution on CDPD mortality in Shanghai, China.

The effect of low body mass index on the development of chronic obstructive pulmonary disease and mortality.

Sarcopenia may worsen disease progression and lead to poor outcomes in chronic obstructive pulmonary disease (COPD). We aimed to determine the effect of BMI on the development of COPD and mortality. We enrolled 437584 participants registered in the physical health check-up cohort database of the Korean National Health Interview Survey from 2002 to 2003, and we defined COPD diagnosis based on the ICD-10 code and prescribed medication. BMI (kgm-2 ) classified them to five groups (low BMI<18.5, normal BMI 18.5-23, overweight 23-25, obesity 25-30, severe obesity ≥30) at baseline. Participants in the low BMI group had a significantly higher rate of COPD development for 13years (7.6%) than those in other groups (3.4-4.1%, P<0.0001). Amongst never or light smokers, COPD development in the low BMI group (5.6-6.7%) was significantly higher than that in other groups (2.8-4.7%). Similarly, amongst participants with a smoking history of ≥30years, COPD development in the low BMI group (20.1%) was higher than those in other groups (8.4-12.4%). On multivariable analysis, normal or higher than normal body weight was significantly protective against the development of COPD (hazard ratio [HR], 0.609-0.739,) compared to low BMI. COPD-free-survival (HR, 0.491-0.622) and overall survival (HR, 0.440-0.585) were also better in them compared to those with low BMI (all P<0.0001). Low BMI is an important risk factor for COPD development and mortality. Maintaining adequate body weight may reduce the risk for COPD development and mortality.

Survival and Long-Term Cause-Specific Mortality Associated With Stage IA Lung Adenocarcinoma After Wedge Resection vs. Segmentectomy: A Population-Based Propensity Score Matching and Competing Risk Analysis.

Background: Limited resection has been carried out increasingly in early stage NSCLC as an alternative to standard lobectomy. This study aimed to investigate the differences in survival and long-term cause-specific mortality between wedge resection and segmentectomy for treatment of stage IA lung adenocarcinoma.Method: Cases with primary lung adenocarcinoma that received wedge resection and segmentectomy between 2004 and 2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching was performed to balance the baseline covariates. Long-term cause-specific mortality was investigated through competing risk analysis. The overall survival (OS) was estimated with the Kaplan-Meier method with the log-rank test. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify the independent prognostic factors.Results: Of the 3,046 cases included, 2,360 and 686 cases underwent wedge resection and segmentectomy, respectively. After propensity score matching, 686 pairs were selected. Segmentectomy was associated with a significantly better OS in stage IA2, grade I/II, female, and married patients. The segmentectomy group had a higher lung-cancer specific mortality in 65–74 years of age, stage IA1 and IA3, male, and married patients, and a lower chronic obstructive pulmonary disease (COPD) specific mortality in ≤64 and 65–74 years of age, stage IA1, IA2, and IA3, all grade, male, and married patients. The cardiovascular disease (CVD) specific mortality was also lower in the segmentectomy group in ≥75 years of age, stage IA1 and IA3, and grade I/II patients.Conclusion: Wedge resection was inferior to segmentectomy in terms of OS regarding all included parameters. In most cases, the segmentectomy group had higher lung-cancer specific mortality and lower COPD and CVD specific mortality.

Management of patients with obstructive lung disease in South India: a retrospective study of spirometry and bronchodilator use in an urban health centre

Background: Based on the burden of obstructive lung diseases program (BOLD), the global prevalence of chronic obstructive pulmonary disease (COPD) was 11.7% in which 90% of the deaths occur in low- and middle-income countries. India and China are estimated to account for 66% of total global COPD mortality. The Indian Chest Society (ICS) recommends spirometry to document irreversible airflow limitation in patients suspected of having COPD. However, the reported usage of spirometry among primary care physicians in India is only 10-20% as primary health care centers in India are not equipped with spirometry or inhaler devices.Methods: A retrospective study was done on patients treated for respiratory symptoms with bronchodilators at an urban health centre to document the practice pattern of primary care physicians with regards to use of spirometry in patients on bronchodilators.Results: Of the 1196 patients on bronchodilators, spirometry was documented in 15.5%. Patients on inhalers, using more than one therapy and males less than 55 years were more likely to undergo spirometry. About 52.4% of patients who underwent spirometry were found to have post bronchodilator forced expiratory volume at first second (FEV1)/ forced vital capacity (FVC) less than 0.7 of which 43% had severe disease and 44% had poor post-broncho-dilator reversibility.Conclusions: Besides diagnostic spirometry, management guidelines for COPD should be complemented by health education to change patients’ perception of respiratory symptoms, increase awareness of COPD in those with risk factors and change their health seeking behaviour along with continuous professional development activities for primary care physicians.

The relationship between serum levels of surfactant protein D in COPD exacerbation severity and mortality

Background/aim Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. In COPD patients, various inflammatory markers such as cytokines and acute phase proteins, which show systemic inflammation in the circulation, increase during exacerbations. In our study, we aimed to determine the relationship between serum SP-D levels and exacerbation severity, clinical course of the disease, and early mortality after discharge.Materials and methods Fifty hospitalized patients with COPD acute exacerbation (46 male and 4 female) were recruited in this study. Thirty-three of the subjects (31 male and 2 female) were reevaluated after discharge. Venous blood samples were taken from all patients and followed up for exacerbation frequency, hospital admission, and mortality for 12 months.Results Serum SP-D levels in the stable period of the patients were lower than exacerbation (P < 0.001). The median exacerbation period SP-D level of the patients admitted to emergency department in the first month was statistically significantly higher than that of the patients who were not admitted (P < 0.05) after discharge. There was a correlation between the rate of emergency admission and serum SP-D levels during the 12-month period after discharge (P = 0.04 (r = 0.29)).Conclusion Our study showed that serum SP-D was found to be a useful biomarker in predicting emergency admission and predictor of the health status of COPD patients but did not predict early mortality after the exacerbation.

It\u2019s more than low BMI: prevalence of cachexia and associated mortality in COPD

BackgroundCachexia is associated with increased mortality risk among chronic obstructive pulmonary disease (COPD) patients. However, low body mass index (BMI) as opposed to cachexia is often used, particularly when calculating the BODE (BMI, Obstruction, Dyspnea and Exercise) index. For this reason, we examined mortality using a consensus definition and a weight-loss definition of cachexia among COPD cases and compared two new COPD severity indices with BODE.MethodsIn the current report, the consensus definition for cachexia incorporated weight-loss > 5% in 12-months or low BMI in addition to 3/5 of decreased muscle strength, fatigue, anorexia, low FFMI and inflammation. The weight-loss definition incorporated weight-loss > 5% or weight-loss > 2% (if low BMI) in 12-months. The low BMI component in BODE was replaced with the consensus definition to create the CODE (Consensus cachexia, Obstruction, Dyspnea and Exercise) index and the weight-loss definition to create the WODE (Weight loss, Obstruction, Dyspnea and Exercise) index. Mortality was assessed using Kaplan-Meier survival and Cox Regression. Performance of models was compared using C-statistics.ResultsAmong 1483 COPD cases, the prevalences of cachexia by the consensus and weight-loss definitions were 4.7 and 10.4%, respectively. Cachectic patients had a greater than three-fold increased mortality by either the consensus or the weight-loss definition of cachexia independent of BMI and lung function. The CODE index predicted mortality slightly more accurately than the BODE and WODE indices.ConclusionsCachexia is associated with increased mortality among COPD patients. Monitoring cachexia using weight-loss criteria is relatively simple and predictive of mortality among COPD cases who may be missed if only low BMI is used.

Assessing global COPD awareness with Google Trends

Although chronic obstructive pulmonary disease (COPD) prevalence and mortality rates rise continuously, patients often remain undiagnosed, probably due to a lack of disease-related awareness. The aim of this study was to quantify public interest in COPD by analysing the frequency of web queries via Google.Data from 2004 to 2018 were collected using the search engine query data analysis tool Google Trends. The relative search volume of the topic "chronic obstructive pulmonary disease" was compared with the relative search volume of nine topics representing the major causes of death in high-income countries according to the World Health Organization.Our analysis showed highest relative search volumes for the topics "diabetes mellitus", followed by "stroke" and "breast cancer". The topic "chronic obstructive pulmonary disease" ranked eighth and its relative search volume clearly displayed a seasonal variation, with peaks in the first and the fourth quarter of the year.This analysis reveals that COPD is highly under-represented in the public interest, while real-world prevalence constantly rises, indicating that there is still an urgent need to raise the levels of awareness for COPD.

Difference in Long-Term Trends in COPD Mortality between China and the U.S., 1992⁻2017: An Age⁻Period⁻Cohort Analysis.

Complications due to chronic obstructive pulmonary disease (COPD) is a leading cause of death in China and the United States (U.S.). This study aimed to investigate the long-term trends in COPD mortality in China and the U.S. using data from the Global Burden of Disease Study 2017 (GBD 2017) and explore the age, period, and cohort effects independently by sex under the age–period–cohort (APC) framework. Taking the age group 40–44 years old, the period 1992–1996, and the birth cohort 1913–1917 as reference groups, we found that the age relative risks (RRs) of COPD mortality increased exponentially in both China and the U.S., the period RRs increased in the U.S. but decreased in China; and the cohort RRs showed an overall downward trend in both China and the U.S. with the year of birth. From 1992 to 2017, the increased RRs of COPD mortality in the U.S. was mainly attributable to the increased prevalence of smoking before 1965, while the decreased RRs of COPD mortality in China was mainly attributable to reduced air pollution as well as improvements in medical technology and more accessible health services. Reducing tobacco consumption may be the most effective and feasible way to prevent COPD in China. However, we also need to pay more attention to COPD in nonsmokers in the future.

An impact of cardiovascular comorbidity on course and prognosis of chronic obstructive pulmonary disease

Comorbidity of chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) is currently important and not fully investigated. The aim of this study was to analyze clinical signs, lung function, the central and the intracardiac hemodynamics, and predictors of outcome in patients with comorbidity of COPD and CVD. Methods. The study involved 118 patients with stage 3 to 4 COPD (GOLD, 2016) including 111 men and 7 women. The mean age was 59.5 ± 0.63 years, the smoking history was 23.1 ± 0.93 pack-years, and body mass index (BMI) was 27.2 ± 9.06 kg/m2. The patients were allocated into one of three groups: COPD group (n = 37), COPD + coronary heart disease (CHD) group (stable angina functional class (FC) II to III, n = 45), and COPD + hypertension (H) group, n = 36). Results. Patients with COPD and CVD were older, had higher smoking history and higher BMI. Clinical signs of COPD were more prominent and the lung function was lower in COPD patients with CVD comorbidity. Cardiac remodeling and right and left ventricular diastolic dysfunction were more severe in the groups with comorbidity. The 3-year survival in the groups with comorbidity clearly tended to be lower. Age, smoking history, the heart beat rate, the systolic blood pressure, the distance in 6-minute walking test, and the serum C-reactive protein and fibrinogen levels were independent predictors of mortality in both COPD + CHD and COPD + H groups. Conclusion. The comorbidity of COPD + CHD and COPD + H is characterized by more severe clinical signs and symptoms of COPD, and decreased physical tolerance. Hypoxemia, heart remodeling, left and right ventricular diastolic dysfunction, and higher mortality risk were seen in both groups with comorbidity.

Evaluating fluticasone furoate + vilanterol for the treatment of chronic obstructive pulmonary disease (COPD)

ABSTRACTIntroduction: Inhaled corticosteroid/long-acting β-2 agonists (ICS/LABA) combination inhalers have been a lifeline for a generation of chronic obstructive pulmonary disease (COPD) and asthma patients. Fluticasone furoate and Vilanterol (FF/VI) as a once-daily ICS/LABA combination have an extensive clinical trial and real-world data to support its use in COPD patients.Areas covered: The authors provide pharmacological profiles of fluticasone furoate, vilanterol and the FF/VI fixed dose combination. Salient clinical trials evaluating efficacy and safety of the FF/VI combination, and studies demonstrating the impact on COPD exacerbation risk and mortality are also discussed.Expert opinion: ICS/LABA combinations provide bronchodilation and decrease the frequency of COPD exacerbations. Individualizing treatment of each COPD patient based on unique phenotypes will maximize chances of therapeutic responsiveness. Asthma-COPD overlap (ACO), patients with sputum and/or blood eosinophilia, patients with a brisk bronchodilator response, and patients with frequent exacerbations are more likely to show a therapeutic response to ICS than populations who have none of these features. FF/VI will likely remain a popular ICS/LBA combination to treat COPD, as a once-daily inhaled therapy delivered via the Ellipta device popular with COPD patients, with extensive clinical trial and real-world data to support its use.

New frontiers in the treatment of comorbid cardiovascular disease in chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a disease characterised by persistent airflow limitation that is not fully reversible and is currently the fourth leading cause of death globally. It is now well established that cardiovascular-related comorbidities contribute to morbidity and mortality in COPD, with approximately 50% of deaths in COPD patients attributed to a cardiovascular event (e.g. myocardial infarction). Cardiovascular disease (CVD) and COPD share various risk factors including hypertension, sedentarism, smoking and poor diet but the underlying mechanisms have not been fully established. However, there is emerging and compelling experimental and clinical evidence to show that increased oxidative stress causes pulmonary inflammation and that the spill over of pro-inflammatory mediators from the lungs into the systemic circulation drives a persistent systemic inflammatory response that alters blood vessel structure, through vascular remodelling and arterial stiffness resulting in atherosclerosis. In addition, regulation of endothelial-derived vasoactive substances (e.g. nitric oxide (NO)), which control blood vessel tone are altered by oxidative damage of vascular endothelial cells, thus promoting vascular dysfunction, a key driver of CVD. In this review, the detrimental role of oxidative stress in COPD and comorbid CVD are discussed and we propose that targeting oxidant-dependent mechanisms represents a novel strategy in the treatment of COPD-associated CVD.

Type IV collagen turnover is predictive of mortality in COPD: a comparison to fibrinogen in a prospective analysis of the ECLIPSE cohort

BackgroundIdentifying subjects with chronic obstructive pulmonary disease (COPD) at high risk of exacerbation and mortality is key to aid individual management of COPD. The only FDA approved blood-based drug development biomarker for patients at high risk of mortality, is plasma fibrinogen. In this study, we benchmarked two biomarkers of basement membrane remodeling, a characteristic of COPD, against plasma fibrinogen alone and as a combination. The biomarkers of basement membrane remodeling are two neoepitopes from of the alpha 3 chain of type IV collagen (COL4A3).Materials and methodsCOL4A3 degradation was assessed by the biomarkers C4Ma3 and tumstatin (TUM) in year 1 plasma samples in 984 COPD subjects, 95 non-smoking controls and 95 smoking controls from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE) cohort. They were measured by competitive ELISA using monoclonal antibodies recognizing two specific MMP-generated cleavage site within COL4A3. The level of fibrinogen was previously assessed in year 1 plasma.ResultsIn COPD subjects, plasma C4Ma3 levels were significantly correlated with plasma fibrinogen levels (0.389 (P < 0.0001)). Cox proportional-hazards regression adjusted for relevant confounders showed that high levels of plasma C4Ma3, but not TUM, were related to a higher risk of mortality (hazard ratio 5.12 (95% CI 2.28–11.50), P < 0.0001). High levels of plasma fibrinogen were not associated with all-cause mortality in this subpopulation, contradictory to published results. Whereas plasma C4Ma3 multiplied by fibrinogen showed to be related to a higher risk of mortality (hazard ratio 5.74 (95% CI 2.65–12.41), P < 0.0001). Plasma C4Ma3 levels were related to the number of hospitalizations due to COPD exacerbations in the year before study start (P = 0.0375). Fibrinogen levels were related to hospitalized exacerbations prior to study start (P = 0.0058) and were also related to future exacerbations (P < 0.0001).ConclusionWe compared herein fibrinogen, C4Ma3 and TUM as biomarkers for COPD prognosis. Fibrinogen was related to future exacerbation, whereas C4Ma3 and the combination of C4Ma3 with fibrinogen were superior to fibrinogen alone in predicting mortality. This pilot study suggests that the assessment of plasma C4Ma3 could be important for identifying COPD patients with a poor prognosis.Trial registrationNCT00292552, GSK Study No. SCO104960.

The Effect of Nursing Care Protocol on Health Outcomes of Patients with Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is the fourth most common cause of death in the world. COPD prevalence, morbidity, and mortality vary across countries and across different groups within countries. Aim: Examine the effect of nursing care protocol on health outcomes of patients with COPD. Study design: A quasi-experimental design was utilized to conduct this study. Setting: The study was conducted at outpatient clinics at Chest Hospital (AL masah ALbahary) in Port Said city. Subjects: A purposive sample of 45 patients with (COPD) disease was included. Methods: four tools were used as follow (1) Patients’ assessment sheet. (2)The Bristol COPD Knowledge Questionnaire (BCKQ) sheet.(3) Patients’ observational checklists.) (4) Health outcomes assessment sheet. Results: There was improvement in patients' total knowledge scores and all practices post nursing care protocol implementation with highly statistically significance whereas p ? .001,there were statistically significant difference between mean scores of total mood disturbance, sleep quality and fatigue for patients with COPD pre and post implementation of protocol of nursing care, with significant decrease in mean score whereas p ? .001 and there were improvement in level 4 of dyspnea (sever dyspnea) post implementation of nursing care protocol compared to pre nursing care protocol and there was highly statistically significant difference between levels of dyspnea pre and post implementation of nursing care protocol whereas p ? .001. Conclusion: Based on the study findings, it is concluded that, application of nursing care protocol for patients with COPD has positive effect on improving their knowledge about COPD and its management, practices related to pursed lip breathing, diaphragmatic breathing, deep breathing exercise, a metered dose inhaler and dry powder inhaler and improving their health outcomes regarding mood, fatigue, sleep quality and dyspnea. Recommendation: Continuous educational program for patients with chronic obstructive pulmonary disease should be applied periodically in order to improve knowledge, practices and health outcomes for those patients.

Re-evaluation of combination therapy in chronic obstructive pulmonary disease (COPD).

Clinical trials of COPD pharmacotherapy typically involve aging populations with moderate-to-severe COPD, but the latter is often diagnosed by spirometric criteria that are not age-appropriate across the continuum of lung function. We have therefore re-evaluated the clinical effect of combination therapy (salmeterol plus fluticasone) in moderate-to-severe COPD, using more age-appropriate spirometric criteria from the Global Lung Function Initiative (GLI) and trial data from Towards a Revolution in COPD Health (TORCH). Of the 6112 TORCH participants, 5688 (93.1%) had GLI-based moderate-to-severe COPD (mean age 64.8 years). The primary outcome was all-cause mortality and the primary comparison was combination therapy vs. placebo. Secondary outcomes included COPD and cardiovascular (CV) mortality and pneumonia. A modified intention-to-treat analysis evaluated differences in time-to-event over a three-year period, using Cox proportional hazards models with statistical significance at p < 0.010 (acknowledging repeated significance testing). Relative to placebo, combination therapy yielded a statistically non-significant reduction in all-cause mortality-adjusted hazard ratio [adjHR] 0.78 (95% confidence interval [CI]: 0.64, 0.95), p = 0.012. Relative to placebo, combination therapy also yielded statistically non-significant reductions in COPD and CV mortality-adjHR 0.75 (95% CI: 0.55, 1.02), p = 0.068 and adjHR 0.76 (95% CI: 0.53, 1.09), p = 0.135, respectively. In contrast, combination therapy yielded a statistically significant increased risk of pneumonia, relative to placebo-adjHR 1.80 (95% CI: 1.46, 2.21), p < 0.001. In GLI-based moderate-to-severe COPD, combination therapy yields a statistically significant increased risk of pneumonia but the reductions in mortality are not statistically significant, although could potentially be clinically meaningful.

A review on the role of Pidotimod in prevention of acute exacerbations of chronic obstructive pulmonary disease

A review on the role of Pidotimod in prevention of acute exacerbations of chronic obstructive pulmonary disease - IJIRM- Print ISSN No: - 2581-4214 Online ISSN No:- 2581-4222 Article DOI No:- 10.18231/2581-4222.2019.0005, IP Indian Journal of Immunology and Respiratory Medicine-IP Indian J Immunol Respir Med