Number Of Chronic Obstructive Pulmonary Disease Exacerbations Research Articles

Cost-Effectiveness Analysis of Fixed-Dose Tiotropium/Olodaterol versus Tiotropium for COPD Patients in China.

Tiotropium/olodaterol (TIO/OLO) fixed-dose combination (FDC) can improve lung function and quality of life for patients with chronic obstructive pulmonary disease (COPD), and is not inferior to other LAMA/LABAs. The aim of this study was to assess the cost-effectiveness of TIO/OLO FDC in patients with moderate to very severe COPD in China. A Markov model was developed to estimate the cost-effectiveness of TIO/OLO FDC versus TIO in the treatment of COPD from Chinese health system perspective. Four health states were based on 2021 Global Initiative for Chronic Obstructive Lung Disease (GOLD 2021), which included moderate (GOLD II, 50% ≤ FEV1 ≤ 80% of predicted), severe (GOLD III, 30% ≤ FEV1 ≤ 50% of predicted) and very severe (GOLD IV, FEV1 > 30% of predicted) COPD and death. The model simulated in cycles yearly. The indicators of total costs, number of COPD exacerbations, life years (LYs) and quality-adjusted life-years (QALYs) were used as the model output. Costs and outcomes were discounted at a 5% annual rate. A cost-effectiveness analysis was conducted over a 10-year time horizon. The threshold of incremental total cost per unit effectiveness gained (ICER) was 1.5 times of GDP per capita. Uncertainty was assessed by one-way and probabilistic sensitivity analysis. TIO/OLO was 0.007 QALYs more than TIO but 0.012 LYs lower, which increased the total cost by $2268.17 per patient, but the total exacerbations number was less. Incremental cost effectiveness analysis had shown that the ICER exceeded the willingness to pay threshold. Results were robust under most parameter variation, except the parameters of total drug cost of TIO/OLO FDC in univariate sensitivity analyses. Although TIO/OLO FDC could reduce the exacerbation risk, it was not cost-effective, and needed to be repriced.

Relationship Between Chronic Obstructive Pulmonary Disease Exacerbations and Depression

Background and objectivesDepressive episodes are frequent in chronic obstructive pulmonary disease (COPD) patients. These episodes are related to a vast number of clinical and psychosocial variables. Nevertheless, the relationship between the number of COPD exacerbations and depression has not been extensively studied in the Colombian Caribbean. The objective was to determine the relationship between COPD exacerbations and depression in a sample of outpatients in Santa Marta, Colombia. MethodsA cross-sectional analytical study was designed in which COPD adult patients participated. The number of COPD exacerbations (none versus one or more) and the risk of depression were documented. The crude and adjusted association was established by calculating the odds ratios (OR) and 95% confidence interval (95%CI). ResultsThe study included 408 patients aged between 40 and 102 years (mean 72.9±10.2), and 58.8% were male. 105 patients (25.9%) reported one or more exacerbations in COPD, and 114 patients (27.9%) were at risk for depression. The crude relationship between exacerbations and depression was statistically significant (OR=1.80; 95%CI, 1.12-2.89) and after adjusting for sex (OR=1.99; 95%CI, 1.23-3.23). ConclusionsThe number of COPD exacerbations among outpatients in Santa Marta, Colombia is related to depression. Longitudinal studies are needed in Colombia.

Chronic obstructive pulmonary disease: Is serum magnesium level a risk factor for its acute exacerbation?

Background:Determination of modifiable risk factors for treatment and prevention of acute chronic obstructive pulmonary disease (COPD) exacerbation is very crucial. Therefore, the present study determined the role of serum magnesium level in acute COPD exacerbation.Methods:This prospective study involved 100 patients with an exacerbation of COPD. Demographic data were collected for all the patients, and serum magnesium (Mg2+) levels were determined at two different time intervals. These patients were given standard treatment for COPD. All the patients were followed up after one month and later at three-month intervals for one year.Results:Majority (72%) of the patients had serum Mg2+<1.7 mg/dL and the odds of hypomagnesemia was 6.54 times more during exacerbations than when they had stable COPD during follow-up. Patients with serum Mg2+<1.7 mg/dL had 9.34 times higher risk of an increased number of acute exacerbations. A significant difference (p<0.05) was observed in the mean serum Mg2+ levels and number of COPD exacerbations among patients with hypomagnesemia at different stages of COPD.Conclusion:Low serum magnesium level during acute exacerbation is correlated with the increased frequency of acute exacerbation in COPD.

Evaluation of the influence and correction of pneumocystis infection on clinical and laboratory characteristics of chronic obstructive pulmonary disease

Introduction . Chronic obstructive pulmonary disease (COPD) is an actual problem of modern medicine due to the appearance of exacerbations and inevitable progression, but currently known clinical factors cannot fully explain the course of the disease. Aim . To assess the relationship between the presence of Pneumocystis (PC) infection and the clinical characteristics of COPD, as well as the effect of correcting the activity of PC on the course of COPD. Materials and methods . 90 patients with COPD of II, III, IV degrees of severity were examined. Against the background of standard therapy for COPD exacerbation and therapy with trimethoprim/sulfamethoxazole, laboratory and functional research methods were performed, the current of COPD was evaluated by validated questionnaires (CAT, mMRC), the titer of IgM and IgG antibodies to PC in the blood serum was determined, and the number of COPD exacerbations was tracked throughout the year. Results . Markers of active PC infection were detected in 62.2% of patients. PC infection with COPD exacerbation significantly increased the frequency of COPD exacerbations (2.68±0.08 vs. 2.45±0.15; р˂0.05). PC infection was statistically (р˂0.05) more common in individuals with grade II COPD. In the group with PC infection, a significantly higher number of eosinophils was observed than in the group without PC infection in COPD exacerbation of 360.46±15.39 vs. 277.82±13.63 cells/µL (р˂0.01) and remission of 398.87±19.49 vs. 324.21±26.68 cells/µL (р˂0.05). After treatment with trimethoprim /sulfamethoxazole, there was a disappearance of IgM to PC and a decrease in IgG titer, a significant decrease in the level of blood leukocytes (6.08±0.13 vs. 6.91±0.19×10 9 /L; p&lt;0.01), an improvement in the values of FEV 1 (63.59±1.30 vs. 61.06±1.29% pred.; р˂0.01) and FEV 1 /FVC 54.53±1.0 vs. 52.29±1.03%; р˂0.01). There was a significant decrease in COPD activity according to the CAT test, mMRC, and a decrease in the number of exacerbations during the year. Conclusion . Active PC infection in COPD is associated with a high number of eosinophils in the blood and an increased risk of frequent exacerbations of COPD during the year. Treatment of PC infection in COPD with a combination of trimethoprim/sulfamethoxazole leads to a significant improvement in clinical and laboratory parameters and a decrease in the frequency of exacerbations of the disease over the next year

The Relationship Between the "Adherence Starts with Knowledge-20" Questionnaire and Clinical Factors in Patients with COPD: A Multi-Center, Cross-Sectional Study.

PurposeInhaler therapy is the mainstay of chronic obstructive pulmonary disease (COPD) management. Poor adherence causes disease exacerbation and affects patient mortality. Although the Adherence Starts with Knowledge-20 (ASK-20) questionnaire is a reliable tool for assessing medication adherence, the relationship between the ASK-20 and clinical factors in patients with COPD remains unknown. We investigated the relationship between the ASK-20 and clinical factors, and assessed real-world inhaler therapy use.Patients and MethodsA multicenter, cross-sectional study of outpatients with COPD undergoing inhaler treatment who completed the ASK-20 questionnaire was performed. We investigated COPD-related health status using the COPD Assessment Test (CAT), psychological status using the Hospital Anxiety and Depression Scale (HADS-anxiety and HADS-depression), respiratory function, patient satisfaction levels, and real-world inhaler therapy use.ResultsOf the total 319 patients, 87% were male with a median age of 74 years. Most patients had mild or moderate COPD, according to Global Initiative for Chronic Obstructive Lung Disease stage. The total ASK-20 scores correlated significantly with the CAT, HADS-anxiety, and HADS-depression scores (r = 0.27, 0.33, and 0.29, respectively, p < 0.01). Multivariable analysis showed that CAT and HADS-anxiety scores had an independent and significant impact on the ASK-20 scores [β, standardized regression coefficient: 0.18 (95% CI, 0.03–0.35; p = 0.02), and 0.29 (95% CI, 0.17–0.42; p < 0.01), respectively]; however, the ASK-20 scores were not correlated with age, sex, body mass index, cohabitation, modified Medical Research Council Dyspnea Scale score, pulmonary function, disease duration, number of COPD exacerbations per year, comorbidities, inhaler numbers, nor inhaler components.ConclusionThe ASK-20 scores in patients with COPD were significantly associated with CAT and HADS scores. In Japan, Respimat was prescribed to younger patients and patients with lower CAT scores. The ASK-20, a simple evaluation method, is useful for identifying clinical factors affecting adherence in patients with COPD.

High-dose N-acetylcysteine for long-term, regular treatment of early-stage chronic obstructive pulmonary disease (GOLD I\u2013II): study protocol for a multicenter, double-blinded, parallel-group, randomized controlled trial in China

IntroductionThe presence of increased oxidative stress and airway inflammation has been proven in subjects with chronic obstructive pulmonary disease (COPD). Several studies have demonstrated that drugs with antioxidant and anti-inflammatory properties such as N-acetylcysteine (NAC) can reduce the rate of exacerbations in patients with COPD. However, the beneficial effects of NAC in early-stage COPD are minimally discussed. We are investigating whether high-dose NAC has therapeutic effects in Chinese patients with early-stage COPD.Method and analysisA randomized, double-blinded, placebo-controlled, parallel-group, multicenter clinical trial is evaluating the efficacy and safety of NAC for the long-term treatment of patients with early-stage COPD at 24 centers in China. Subjects aged 40–80 years and recruited by physicians or researchers with special training will be randomized to either NAC 600 mg twice daily group or matching placebo group for 2 years. Measurements will include forced expiratory volume in 1 s (FEV1), the number of COPD exacerbations, health-related quality, and pharmacoeconomic analysis.DiscussionCurrently, there are no randomized controlled trials with high-dose N-acetylcysteine (600 mg twice daily) for patients with mild-to-moderate COPD (GOLD I–II). We designed this multicenter randomized controlled trial (RCT) to assess the effectiveness, safety, and cost-effectiveness of long-term treatment with high-dose N-acetylcysteine. The results of this trial may guide clinical practice and change the standard of early COPD management.Trial registrationChinese Clinical Trial Registry ChiCTR-IIR-17012604. Registered on 07 September 2017.

Obesity in patients with chronic obstructive pulmonary disease: prerequisites for the isolation of a separate phenotype

Chronic Obstructive Pulmonary Disease (COPD) is highly lethal and has a pronounced impact on the patient's quality of life (QoL), representing a serious public healthcare problem. According to various studies, the prevalence of obesity in COPD, which can have a significant effect on the course of the disease, reaches 50%. The aim of the study was to assess the disease course characteristics, symptom severity, QoL, concomitant diseases, and lung function in obese COPD patients. Materials. Patients included in the study (n = 176) of COPD patients (GOLD II – IV, group D) were divided into 2 groups: 1 st (n = 88: 71 men, 17 women; mean age 62.40 ± 8.83 years) – normal weight COPD patients; 2 nd (n = 88: 64 men, 24 women; mean age 62.94 ± 5.96 years) – obese COPD patients. The number of COPD exacerbations in the last 12 months has been estimated. Visual analogue scale (VAS) was used to assess the severity of coughing, sputum production, shortness of breath, general weakness. Modified shortness of breath severity scale (Medical Research Council – mMRC), COPD Assessment Test (CAT) and the Chronic obstructive pulmonary disease control Questionnaire (CCQ) were also used, spirometry, 6-minute step test (6-MST) was performed, QoL was assessed using the SF-36 questionnaire, and BODE index was determined. Results. It was shown that the frequency of exacerbations of COPD for the previous year, which did not require hospitalization, and hospitalizations to the inpatient department for exacerbation of COPD, in patients of the 1st group was significantly higher and was 1.21 ± 0.83 and 0.96 ± 0.42 (p = 0.016) and 1.82 ± 0.94 and 1.5 ± 0.81 cases (p = 0.0145) respectively. In patients of the 2 nd group the dyspnea severity, sputum production and general weakness according to VAS and the dyspnea according to mMRC scale were significantly lower. In patients of the 2 nd group reliably higher indices of the forced expiratory volume in the 1 st second (FEV1), forced vital capacity (FVC) and Tiffno index were noted. Patients of the 1 st group also have higher index BODE – 6.23 ± 2.81 and 4.53 ± 2.11 respectively (p = 0.0000). Conclusion . It was found that patients with COPD with obesity have low indices of symptom severity at relatively high values of FEV1, FVC, relatively low risk of acute COPD and hospitalization, and low BODE index at frequent combination with diabetes mellitus and hypertension.

Control of chronic obstructive pulmonary disease exacerbations frequency in association with ENT organs abnormalities

Chronic obstructive pulmonary disease (COPD) is a disease holding a stable position in morbidity and mortality structure in patients aged over 40 years.The aim of the study was to evaluate the condition of otorhinolaryngological (ENT) organs in patients with the COPD at different disease periods with subsequent analysis of COPD exacerbation rate based on the results of therapy regimen change according to the established comorbidity.Materials and Methods. Examination of ENT organs was performed in patients with COPD (n = 99) Patients from group 1 (n = 50) were treated at Pulmonary Department of the Regional State Budgetary Health Institution "Vladivostok Clinical Hospital No.1" for disease exacerbation; outpatients from group 2 (n = 49) had stable COPD course. Control group (n = 50) included patients without history of smoking and without respiratory and hearing disorders. All patients were matched by age and sex. Repeated examination was conducted in patients (n = 72) with stable COPD after 6 months.Results. It was observed that patients from groups 1 and 2 had different severity of disease symptoms, but equally high (&gt; 2) risk of COPD exacerbation within 1 year. 50.0 and 42.9% of patients actively complained about the ENT organ-related conditions during the periods of COPD exacerbation and stable course, respectively. Among ENT organ diseases the most frequent were laryngeal diseases reported in 84.0 and 73.5% of patients with COPD exacerbation and stable course, respectively. The chronic catarrhal rhinitis and pharyngitis were revealed in 26 and 30% of patients with COPD exacerbation (p &lt; 0.01). According to the data of 6-month study, the number of COPD exacerbations in high-risk patients with COPD using personal treatment plan for ENT-organ diseases was reduced by half, which had a positive effect on the condition of ENT-organs.Conclusion. The study showed that patients with COPD often ENT-organ-related complaints – in the exacerbation period about 50% of patients, and at stable course – 43%. Patients most often complain on glottic incompetence with the most pronounced symptoms at COPD exacerbation. Decreased number of COPD exacerbations by 2 times in patients with high risk of their occurrence and improvement of ENT organ condition were noted if ENT diseases were timely treated. ENT specialist consultation should be provided at dispensary observation organization for patients with COPD in order to personalize the treatment plan depending on the clinical situation.

EFFECTIVENESS OF THE PULMONARY REHABILITATION PROGRAMME IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND OBESITY

Aim. To evaluate the effectiveness of pulmonary rehabilitation programme in patients with chronic obstructive pulmonary disease (COPD) and obesity. Materials and methods. The study included two groups of patients. The first group consisted of 44 patients with COPD and obesity (23 men and 21 women; median age — 57.47±0.76 years; average body mass index (BMI) — 34.1±1.24 kg/m2) who were receiving only standard medical treatment for COPD. The second group consisted of 44 patients (22 men, 22 women; median age — 56.07±0.83 years, average BMI — 33.4±1.62 kg/m2) who were undergoing pulmonary rehabilitation along with the standard medical treatment for COPD. Pulmonary rehabilitation programme involved group training of COPD patients including dietary recommendations, graduated exercise, as well as recommendations on smoking cessation. At the initial stage and 12 months after the study, the severity of COPD symptoms was assessed using a visual analogue scale, the frequency of exacerbations and hospitalisations, spirometry parameters, as well as quality of life data obtained via the SF-36 questionnaire. Results. At 12 months into the study, patients from the second group showed a significant decrease in the number of COPD exacerbations and related hospitalisations; a decrease in the shortness of breath, cough, sputum production; as well as an improvement of the SF-36 questionnaire with respect to a number of points. At the same time, spirometry parameters did not improve significantly. Conclusion. Inclusion of pulmonary rehabilitation programmes in the standard treatment of patients with COPD and obesity contributes to providing higher effcacy of medical treatment, decreasing the load of main COPD clinical symptoms, as well as to reducing their impact on the patients’ health status and improving life quality.

Impact of H. Pylori on Severity of Chronic Obstructive Pulmonary Disease

Background and aim of the work: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Many studies reported a high prevalence of Helicobacter pylori (H. pylori) infection in COPD patients and this may have a role on severity of COPD. To estimate impact of H. pylori infection on exacerbation and severity of COPD. Patients and Methods: A prospective observative study was conducted for one year and included 142 well controlled COPD patients. Participants were classified into two groups; group 1 which included 72 COPD patients with +ve H. pylori infection and group 2 which included 70 COPD patients with -ve H. pylori infection. All participants were submitted to full clinical examination, routine laboratory investigations, CXR, arterial blood gases analysis, spirometry, H. pylori serology and stool antigen and COPD assessment test (CAT). Patients were followed monthly for at least three months. Results: High significant statistical differences were found between both groups regarding; FEV1, FVC, PH, PaO2, which were lower in group 1 when compared to group 2. While CRP, CAT score, PCO2, HCO3 were significantly higher in group 1. COPD severity was higher in group 1 when compared to group 2 where the sever and very sever COPD cases were more abundant in group1. Conclusion: H. pylori infection adds an inflammatory burden in the COPD patients by increasing their CAT and number of COPD exacerbations per year.

Beta-blocker Use in Moderate and Severe Chronic Obstructive Pulmonary Disease.

Introduction:The most appropriate choice of pharmacological treatment of heart rhythm disorders occurring in patients with chronic obstructive pulmonary disease (COPD) and cardiovascular comorbidity is often a topic of debate between pulmonologists and cardiologists in clinical practice, although numerous studies and clinical trials have demonstrated evidence to support the use of selective beta-blockers (BBs) in these patients.Aim:To examine the difference in the number of exacerbations in patients treated with a combination of verapamil and digoxin or BB alone in patients with different COPD stages.Patients and methods:The study included 68 patients (n = 68) diagnosed with COPD who were followed-up during a 12-month period, and the number of exacerbations were analyzed. The patients were divided into two groups according to the stage of COPD: GOLD II (moderate), and GOLD III (severe), and in each group a subdivision was established in relation to the use of either a combination of verapamil and digoxin or the use of BBs alone in pharmacological treatment. The inclusion criteria for patients were defined as following: a) established diagnosis of COPD according to present or deteriorated relevant clinical symptoms and signs, b) the ejection fraction (EF) of a left ventricle (LV) >35%, and c) spirometric cut-points classified as GOLD II (FEV1 / FVC <0.7, FEV1 predicted 50-80%), or GOLD III (FEV1/FVC <0.7, FEV1 predicted 30-50%) stage of the COPD. The exclusion criteria were EF of LV <35% and a lethal outcome during a follow-up period (2 patients were encountered). Exacerbation was defined as functional deterioration of the COPD symptoms verified by spirometric functional testing, frequency of hospitalizations according to GOLD stage assignment or verified clinical symptoms deterioration.Results:Regardless the pharmacological treatment, there is a statistically significant increase in the number of COPD exacerbations, in a 12-month period follow-up, in the GOLD III group (severe) compared to the GOLD II group (moderate). In the group of patients taking verapamil and digoxin, a two-tailed t-test was used to analyze the results between the GOLD II and GOLD III stage groups, p = 0.01, and 2. In the group of patients taking BBs, a two-tailed t-test was also used to analyze the results between the GOLD II and GOLD III stage groups, p = 0.003). Within the COPD GOLD II stage group, there appears to be no statistically significant difference in the number of exacerbations between the patients taking verapamil and digoxin (n = 24) and the patients taking BBs alone (n = 15), although, in patients taking BBs alone, there appears to be a trend towards a decrease in the exacerbations compared to the number of exacerbations in patients taking verapamil and digoxin (p = 0.007). Within the COPD GOLD III stage group, there is no difference in the number of exacerbations between the patients taking verapamil and digoxin (n = 20), and the patients taking BBs alone (n = 9), as analyzed by a two-tailed t-test, p = 0.577.Conclusion:Use of selective BBs in the treatment of cardiovascular comorbidity in patients with COPD represents a far better choice of pharmacological approach in the treatment of patients diagnosed with COPD GOLD II (moderate) stage.

Randomized Controlled Trial of Health Coaching for Vulnerable Patients with Chronic Obstructive Pulmonary Disease.

Socioeconomically disadvantaged patients with chronic obstructive pulmonary disease (COPD) often face barriers to evidence-based care that are difficult to address in public care settings with limited resources. To determine the benefit of health coaching for patients with moderate to severe COPD relative to usual care. We conducted a randomized controlled trial of 9 months of health coaching versus usual care for English- or Spanish-speaking patients at least 40 years of age with moderate to severe COPD. Primary outcomes were COPD-related quality of life and the dyspnea subscale of the Chronic Respiratory Disease Questionnaire. Secondary outcomes were self-efficacy for managing COPD, exercise capacity (6-min walk test), and number of COPD exacerbations. Additional outcomes were COPD symptoms, lung function (forced expiratory volume in 1 s percent predicted), smoking status, bed days owing to COPD, quality of care (Patient Assessment of Chronic Illness Care), COPD knowledge, and symptoms of depression (Patient Health Questionnaire). Outpatient visits, emergency department visits, and hospitalizations were assessed by review of medical records. Generalized linear modeling was used to adjust for baseline values and account for clustering by clinic. Of 192 patients enrolled, 158 (82%) completed 9 months of follow-up. There were no significant differences between study arms for the primary or secondary outcomes. At 9 months, patients in the coached group reported better quality of care (mean Patient Assessment of Chronic Illness Care score, 3.30 vs. 3.18; adjusted P = 0.02) and were less likely to report symptoms of moderate to severe depression (Patient Health Questionnaire score, ≥15) than those in the usual care arm (6% vs. 20%; adjusted P = 0.01). During the study, patients in the coaching arm had 48% fewer hospitalizations related to COPD (0.27/patient/yr vs. 0.52/patient/yr), but this difference was not significant in the adjusted analysis. These results help inform expectations regarding the limitations and benefits of health coaching for patients with COPD. They may be useful to health policy experts in assessing the potential value of reimbursement and incentives for health coaching-type activities for patients with chronic disease. Clinical trial registered with www.clinicaltrials.gov (NCT02234284).

The clinical research on long-term low-dose omeprazole treatment of chronic obstructive pulmonary disease in acute attack

Objective To explore the clinical efficacy of the long-term low-dose application of omeprazole for the treatment of chronic obstructive pulmonary disease (COPD) with stability stage, and observe its safety. Methods From July 2013 to August 2014, 126 stabilization patients in Dajiang East Hospital of Hangzhou with COPD were selected, and they were randomly divided into Proton pump inhibitor (PPI) therapy group and the control group by random number table method, with 63 cases in each group.The control group patients were given routine therapy, PPI treatment group treated with omeprazole 20mg, one time/day, oral, treatment for 9 months, based on the control group. Frequency of upper respiratory tract infection and the number of COPD exacerbations of the two groups during and after one year treatment were mainly observed, and the adverse reaction of the two groups during the treatment were also observed. Results The frequency of upper respiratory tract infection and the number of COPD exacerbations results of the PPI treatment group during and after one year treatment were (2.04±0.33)times, (2.31±0.50)times and (0.98±0.39)times, (2.26±0.42)times, respectively, which were lower than those of the control group[(2.90±0.31)times, (3.24±0.47)times and (2.41±0.34)times and (3.19±0.38)times], the differences were statistically significant (t=9.33, 9.68, 10.41, 9.19, all P 0.05). Conclusion The low-dose omeprazole treatment of chronic obstructive pulmonary disease patients can significantly reduce the frequency of upper respiratory tract infection, COPD exacerbations times and the hospital time, and has good security, which has good security. Key words: Pulmonary disease, chronic obstructive; Omeprazole; Comparative study

Telemonitoring and home hospitalization in patients with chronic obstructive pulmonary disease: study TELEPOC

ABSTRACTBackground: Chronic obstructive pulmonary disease (COPD) is a major consumer of healthcare resources, with most costs related to disease exacerbations. Telemonitoring of patients with COPD may help to reduce the number of exacerbations and/or the related costs. On the other hand, home hospitalization is a cost-saving alternative to inpatient hospitalization associated with increased comfort for patients. The results are reported regarding using telemonitoring and home hospitalization for the management of patients with COPD.Methods: Twenty-eight patients monitored their health parameters at home for six months. A nurse remotely revised the collected parameters and followed the patients as programmed. A home care unit was dispatched to the patients’ home if an alarm signal was detected. The outcomes were compared to historical data from the same patients.Results: The number of COPD exacerbations during the study period did not reduce but the number of hospital admissions decreased by 60% and the number of emergency room visits by 38%. On average, costs related to utilization of healthcare resources were reduced by €1,860.80 per patient per year.Conclusions: Telemonitoring of patients with COPD combined with home hospitalization may allow for a reduction in healthcare costs, although its usefulness in preventing exacerbations is still unclear.

Efficacy of Vaccine Prophylaxis for Pneumococcal Infection in Patients with Chronic Obstructive Pulmonary Disease with Various Comorbidity Indix

Actuality. Modern medicine shows a sharp growth of patients with comorbid and concurrent chronic diseases, involving not only the mature and older persons but also the young people. Combined diseases of the circulatory and respiratory systems are the main cause of death, disability of the population and major labor losses. The aim of this work was to study the vaccine prophylaxis effectiveness for chronic obstructive pulmonary disease (COPD) patients having the different Charlson comorbidity index. Material and methods: This study covered 174 patients with COPD and IHD. All patients were subject to the complex clinical research, including the medical assessment, patient complaints, medical history, physical and instrumental examinations and pathology tests Assessment of respiratory function and general Body plethysmography were performed Degree of dyspnea was assessed using a scale provided by Medical Research Center. Number of COPD exacerbations, hospitalizations and pneumonia development cases were analyzed. Modified Charlson comorbidity index was calculated for all patients Results and conclusions: Among the patients with comorbidity the severe manifestations of chronic obstructive pulmonary disease correspond to the more pronounced functional classes of angina pectoris. With the comorbidity index growth the number of exacerbations, hospitalizations and pneumonia cases were increasing. Vaccine prophylaxis is the most effective for the patients having the lower comorbidity indices and shows a tendency to stabilize these indicators for the patients having the moderate & high levels of comorbidity, and therefore, are to be recommended for all COPD and CVD patients. Changes in clinical and functional parameters of respiratory function for COPD patients are statistical-significantly different for the patients having the low and high levels of comorbidity.

Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease.

Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease.

Impact of vaccination on the course of bronchial and systemic inflammation in patients with COPD and CHD

To investigate the effect of 13-valent pneumococcal conjugate vaccine (PCV-13) on the clinical and functional manifestations of systemic inflammation in patients with chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD). The protocol included 36 patients with COPD and 36 patients with COPD concurrent with CHD. The number of COPD exacerbations, hospital admissions, pneumonia cases, degree of dyspnea, and functional indicators were analyzed. The levels of markers for inflammation, such as C-reactive protein (CRP), fibrinogen, and procalcitonin (PCT), were investigated. A year after vaccination, the COPD group showed decreases in the level of CRP, fibrinogen, and PCT by 11, 6, and 2%, respectively; the COPD + CHD group did by 12, 24, and 19%. PCT levels demonstrated the closest correlation with clinical and functional parameters; the other indicators showed moderate (CRP) and low (fibrinogen) correlations. PCV-13 vaccination can reduce systemic inflammation just a year later.

Does gastroesophageal reflux increase chronic obstructive pulmonary disease exacerbations?

BackgroundThe relationship between chronic obstructive pulmonary disease (COPD) exacerbations and gastroesophageal reflux (GER) has been investigated less than asthma-GER. We aimed to evaluate the presence of GER in patients with COPD and its impact on exacerbations. MethodsWe included 24 patients with stable mild-moderate stage COPD and 19 volunteers as the control group. We conducted a gastroesophageal reflux disease (GERD) symptom questionnaire, gastroscopy, manometry, and an ambulatory 24-h pH-impedance study. ResultsAccording to the GERD questionnaire, only 5 (20.8%) patients with COPD had typical GER symptoms. According to the 24-h pH-impedance study, the mean DeMeester score (DMS) was 38.1 ± 34.6 in the COPD group and 13.3 ± 16.8 in the control group (p = 0.01). The acid reflux (DMS > 14.7) rate was higher in patients with COPD than in controls (73.9% vs 26.3%, p = 0.01). The symptom association probability positivity rate was 17.4% (n = 4) in the COPD group, which was similar to the controls (p = 0.11). The mean proximal extension rate of reflux (Z 17 cm) was 26.4 ± 12.9% in the COPD group. The proximal extent of reflux was positively correlated with the number of COPD exacerbations per year (p = 0.03, r = 0.448). In the motility results, only 2 (20%) patients in the control group had a minor motility disorder. Seventeen (70.8%) patients in the COPD group had a minor motility disorder, and 4 (16.7%) had major motility disorders (p < 0.001). ConclusionIn our study, gastroesophageal reflux was frequent in patients with COPD, but only a quarter had typical reflux symptoms. The proximal extent of reflux may trigger frequent exacerbations of COPD.

Tiotropium and Salmeterol in COPD Patients at Risk of Exacerbations: A Post Hoc Analysis from POET-COPD®

IntroductionAmong patients with chronic obstructive pulmonary disease (COPD), the frequency and severity of past exacerbations potentiates future events. The impact of current therapies on exacerbation frequency and severity in patients with different exacerbation risks is not well known.MethodsA post hoc analysis of patients at low (≤1 exacerbation [oral steroids/antibiotics requirement] and no COPD-related hospitalization in the year preceding trial entry) or high (≥2 exacerbations [oral steroids/antibiotics requirement] or ≥1 COPD-related hospitalization[s] in the year preceding trial entry) exacerbation risk, from the Prevention of Exacerbations with Tiotropium in Chronic Obstructive Pulmonary Disease (POET-COPD®) database.ResultsCompared with salmeterol, tiotropium significantly increased time to first COPD exacerbation (hazard ratio 0.84; 95% confidence interval [CI] 0.76–0.92; p = 0.0002) and reduced the number of COPD exacerbations (rate ratio 0.90; 95% CI 0.81–0.99; p = 0.0383) in patients at high exacerbation risk. With treatment, the risk of remaining in the high-risk exacerbator subgroup was statistically lower with tiotropium versus salmeterol (risk ratio [RR] 0.89; 95% CI 0.80–1.00; p = 0.0478). For low-risk patients, time to first COPD exacerbation and number of COPD exacerbations were numerically lower with tiotropium versus salmeterol. With treatment, the risk of transitioning from a low to a high exacerbation risk was lower with tiotropium versus salmeterol (RR 0.87; 95% CI 0.71–1.07; p = 0.1968).DiscussionThis analysis confirms the higher efficacy of tiotropium versus salmeterol in prolonging time to first COPD exacerbation and reducing number of exacerbations in patients both at low and high exacerbation risk.FundingBoehringer Ingelheim and Pfizer.Clinical trial registration number: ClinicalTrials.gov NCT00563381.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-015-0216-2) contains supplementary material, which is available to authorized users.

Сlinical efficacy of pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease and metabolic syndrome

Comorbidity of chronic obstructive pulmonary disease (COPD) and metabolic syndrome (MS) creates the need of comprehensive approach to treatment, and prevention and rehabilitation of the patients. The aim . The objective of this study was to evaluate clinical efficacy of a comprehensive pulmonary rehabilitation program in patients with COPD and MS. This program was based on patient education, smoking cessation, physicaltraining, and nutritional correction in addition to the standard treatment of COPD. Methods. The study involved 70 patients (27 women (38.6%) and 43 men (61.4%) with stable moderate COPD and MS aged 18 to 60 years (mean age, 48.31±0.64 years). The patients were randomly divided into two groups: 35 patients were involved in a pulmonary rehabilitation program in addition to the standard therapy of COPD; other 35 patients were treated with the standard therapy. Clinical and laboratory parameters were assessed at baseline and in 12 months. Results . To the end of the study the groups differed significant in number of COPD exacerbations, emergency calls, hospitalizations, clinical symptoms of COPD and impact of the disease on physical activity and health status of the patients, quality of life (QOL), and physical tolerance. Conclusions: Management of patients with comorbid COPD and MS should include specific educational programs and physical training in order to improve treatment efficacy and quality of life of the patients.