Treatment Of COPD Exacerbations Research Articles

Characteristics of Exacerbation and Antibiotic Usage in Treatment for Exacerbation of COPD Patients in National Lung Hospital (2022-2023)

Abstract: Exacerbations of COPD are important events in the progression of the disease, being the leading cause of hospitalization and mortality. Bacterial respiratory infections are one of the main causes of exacerbations. This retrospective study was described characteristics of exacerbation and antibiotic use in COPD exacerbation patients hospitalized at the National Lung Hospital. This study included 200 hospitalized patients from January2022 to June 2023. Many patients in the study sample were male (90%), 76% of patients had two or more exacerbations per year. The most isolated bacteria are Haemophilus influenzae, Pseudomonas aeruginosa, Acinetobacter baumannii. There were 77,5% pneumonia patients had Drug Susceptibility Tests (DST), and 54,7% of patients had antibiotic regimens consistent with the DST. The results of this study provide a reliable basis for selecting and improving the effectiveness of antibiotic use in the treatment of COPD exacerbations, improving outcomes and survival prognosis for patients.
 Keywords: COPD, exacerbation, bacteria, antibiotics.

Response to Bronchodilators Administered via Different Nebulizers in Patients With COPD Exacerbation.

The recommended treatment of COPD exacerbations includes administration of short-acting bronchodilators that act to reverse bronchoconstriction, restore lung volumes, and relieve breathlessness. In vitro studies demonstrate vibrating mesh nebulizers (VMNs) provide greater drug delivery to the airway compared to standard small-volume nebulizers (SVNs). We examined whether the physiological and symptom response to nebulized bronchodilators during a COPD exacerbation differed between these 2 modes of bronchodilator delivery. Subjects hospitalized with a COPD exacerbation participated in a comparative clinical effectiveness study of 2 methods of nebulization. Using block randomization, 32 participants in this open-label trial were administered salbutamol 2.5 mg/ipratropium bromide 0.5 mg via vibrating mesh (VMN group, n = 16) or small-volume jet nebulizer (SVN group, n = 16) on one occasion. Spirometry, body plethysmography, and impulse oscillometry were performed and Borg breathlessness scores recorded pre bronchodilator and at 1 h post bronchodilator. Baseline demographics were comparable between groups. Mean FEV1 was 48% predicted. Significant changes in lung volumes and airway impedance were seen in both groups. Inspiratory capacity (IC) increased by 0.27 ± 0.20 L and 0.21 ± 0.20 L in the VMN and SVN group, respectively, between group difference P = .40. FVC increased in the VMN group by 0.41 ± 0.40 L compared to 0.19 ± 0.20 L with SVN, between group difference P = .053; and residual volume (RV) decreased by 0.36 ± 0.80 L and 0.16 ± 0.50 L in the VMN and SVN group, respectively, between group difference P = .41. The VMN group had a significant reduction in Borg breathlessness score, P = .034. Greater improvement in symptoms, and larger absolute change in FVC, was observed in response to equivalent doses of standard bronchodilators administered by VMN, compared to SVN, but no substantial difference in change in IC.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND COMORBIDITIES: MANAGEMENT OF SOMATOFORM DISORDERS

The aim: To perform a comprehensive evaluation of the effect of paroxetine on the degree of somatoform disorders in exacerbation of severe COPD in women. Materials and methods: The study involved 53 female patients with severe COPD (Group D), confirmed by instrumental methods of study. At hospitalization, patients were divided into 2 groups. Patients of Group 1 (n = 21; aged 52.5 ± 0.8 years old) underwent basic exacerbation therapy. Patients of Group 2 (n = 22; aged 57.9 ± 0.4 years old) underwent basic exacerbation therapy supplemented with paroxetine for 14 days, 1 tablet (0.20 g) once a day. Results: The basic therapy for treatment of COPD exacerbations, supplemented with paroxetine, led to a positive clinical effect, confirmed by increase in skeletal and respiratory muscular system, increased parameters of pulmonary ventilation, increased tolerance to physical load, increased oxygen saturation, decreased heart rate and breathing rate. Conclusions: The strategy for choosing an antidepressant to provide multidisciplinary care for somatoform disorders in women with exacerbation of severe COPD (group D) should take into account the efficacy and favorable safety profile and personalization of the drug. In exacerbation of severe COPD, the degree of somatoform disorders in patients correlates with the severity of the main criteria: FVC1, the distance walked during the 6-minute step test, oxygen saturation after the 6-minute step test, end-expiratory pressure in the oral cavity.

Does levofloxacin result in better outcomes than other antibiotics in treatment of COPD exacerbations?

Breen, James MD; Cáceres, Christie MD; Pizzutto, Tatianna MD; Spradling, Tyler DO; Wong, Renee MD Author Information

Hospital at home versus hospital treatment of COPD exacerbations

Hospital at home versus hospital treatment of COPD exacerbations

Eosinophil-guided treatment of COPD exacerbations: unfinished business

Eosinophil-guided treatment of COPD exacerbations: unfinished business

Nebulized Corticosteroids in the Treatment of COPD Exacerbations: Systematic Review, Meta-Analysis, and Clinical Perspective.

COPD guidelines report that systemic corticosteroids are preferred over inhaled corticosteroids in the treatment of exacerbations, but the inhaled route is considered to be an option. To conduct a systematic review and meta-analysis regarding the efficacy and safety of inhaled corticosteroids for COPD exacerbations. The second objective was to provide pharmacologic and clinical perspectives of inhaled corticosteroids for COPD exacerbations. The primary outcome was a change in FEV1 baseline versus the last measured value. Secondary outcomes were a change in (PaO2 ) and (PaCO2 ) baselines versus the last measured values; FEV1, PaO2 , and PaCO2 at 24 or 72 h; and hyperglycemia. Each of the 9 studies included in the meta-analysis was conducted in subjects who were hospitalized and not critically ill. Our meta-analysis indicated that high-dose nebulized budesonide 4-8 mg/d was noninferior to systemic corticosteroids on the change in FEV1 between baseline and the last measured value (mean difference of 0.05, 95% CI -0.01 to 0.12, P = .13) and PaCO2 (mean difference of -1.14, 95% CI -2.56 to 0.27, P = .11) but of inferior efficacy for PaO2 changes (mean difference of -1.46, 95% -2.75 to -0.16, P = .03). Hyperglycemia was less frequent with high-dose nebulized budesonide (risk ratio, 0.13; 95% CI 0.03-0.46; P = .002). Based on our meta-analysis with a change in FEV1 as the primary end point, high-dose nebulized budesonide was an acceptable alternative to systemic corticosteroids in hospitalized subjects with COPD exacerbations who were not critically ill. Additional well-designed prospective studies are needed in both the acute care and ambulatory settings. We provide perspective on how this evidence might be applied in clinical practice.

Medication Regimens for Managing COPD Exacerbations.

Exacerbations are a hallmark feature of COPD and contribute to morbidity and mortality. There is general agreement that the pharmacotherapy of COPD exacerbations includes bronchodilators, corticosteroids, and antibiotics. Strong evidence exists for the benefit of corticosteroids for exacerbations and of antibiotics in the acute hospital setting. There remains considerable uncertainty, however, in the best drug selection, dose, route, and duration of treatment. This article reviews the evidence base and expert recommendations for drug treatment of COPD exacerbations in the out-patient and in-patient settings.

Treatment With Systemic Steroids in Severe Chronic Obstructive Pulmonary Disease Exacerbations: Use of Short Regimens in Routine Clinical Practice and Their Impact on Hospital Stay

IntroductionIt is not known whether clinical practice guidelines for the treatment of COPD exacerbations with short courses of systemic corticosteroids (SC-SCS) are followed in clinical practice. MethodProspective, observational cohort study in patients admitted due to severe COPD exacerbation. The primary endpoint was the percentage of patients who received SC-SCS as treatment for severe exacerbation (doses of 200–300mg for 5–6 days). Secondary variables were percentage of patients with duration or reduced dose, dose in the first 24h, days of intravenous systemic corticosteroids (SCS), and duration of hospital length of stay (LOS). Simple linear regression was performed with LOS as a dependent variable and multivariate analysis with factors associated with LOS. Results158 patients were evaluated. 4.4% (7) patients received SC-SCS, 8.7% received a reduced dose and duration was reduced in 15.8%. The median dose and duration of SCS were 602.5mg (200–1625) and 14 (4–36) days, respectively. We observed an association between days of SCS and LOS (P<.001) and doses of intrahospital SCS and LOS (P<.001). Factors associated with LOS were doses of intrahospital SCS received (0.01 [95% CI: 0.007–0.013]; P<.001), days of steroid treatment (0.14 [95% CI: 0.03–0.25], P=.009) and PAFI (pO2/FiO2 ratio) at admission (−0.012 [95% CI: −0.012 to -0.002], P=.015). ConclusionsThe SCS schedules used in routine clinical practice are longer and administered at a higher dose than recommended, leading to a longer hospital stay.

The Use of Fractional Exhaled Nitric Oxide in COPD: The Relationship to Pulmonary Function Tests and Its Importance in Differential Diagnosis

SESSION TITLE: COPD 2 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: To study the values of FENO in COPD exacerbation, the relationship with disease stage and pulmonary function test and the use of FENO in differential diagnosis of COPD exacerbation and bronchial asthma METHODS: This was a prospective study. FFNO has been measured in 112 patients with COPD exacerbation, 98 male and 14 female, mean age 63 (±11.1) years and 122 patients with bronchial asthma. FENO was measured by an electrochemical nitric oxide analyzer (NIOX MINO; Aerocrine AB, Solna, Sweden), consistent with the ATS guidelines published in 2005. We used t test and ANOVA. Significance was defined as a p value of < 0.05. RESULTS: The mean of FENO in asthma and COPD was 41.4 ± 36,7 SD and 11.9 ppb ± 7.6 SD respectively. This difference is statistically significant (p <0.01). Among the 112 subjects with COPD the FENO values according to the severity of bronchial obstruction are: Small airways 13,8 ± 9,3 SD, Mild 11,8 ±6,1 SD, Moderate 11.5 ± 8 SD, Severe 11 ± 5,8 SD, Very severe 11,6 ± 7,7SD. CONCLUSIONS: There was no significant change between the mean of FENO to the degrees of bronchial obstruction of COPD exacerbation. There is no correlation between FENO values with the values of FEV1, FVC, FEV1/FVC, TLC, RV, RV/TLC, Raw, MEF 25, MEF 50, MEF 75 in COPD patients.On future it is important to know which are the FENO values after the treatment of COPD exacerbations. CLINICAL IMPLICATIONS: FENO is important biomarker in differential diagnosis of asthma with COPD exacerbation. DISCLOSURE: The following authors have nothing to disclose: Eugerta Dilka, Artan Simaku, Eritjan Tashi, Esmeralda Nushi, Dafina Todri, Alma Teferici, Oltion Sina, Serxho Golgota, Jetmira Shehu, Jeta Beli, Roland Kore, Perlat Kapisyzi No Product/Research Disclosure Information

Tratamiento con esteroides sistémicos en agudización grave de enfermedad pulmonar obstructiva crónica: empleo de pautas cortas en práctica clínica habitual y relación con la estancia hospitalaria

IntroductionIt is not known whether clinical practice guidelines for the treatment of COPD exacerbations with short coursesofsystemic corticosteroids(SC-SCS) are followed in clinical practice. MethodProspective, observational cohort study in patients admitted due to severe COPD exacerbation. The primary endpoint was the percentage of patients who received SC-SCS as treatment for severe exacerbation (doses of 200-300mg for 5-6 days). Secondary variables were percentageof patients with duration or reduced dose, dose in the first 24hours, days of intravenous systemic corticosteroids (SCS), and duration of hospital length of stay (LOS). Simple linear regression was performed with LOS as a dependent variable and multivariate analysis with factors associated with LOS. Results158 patients were evaluated. 4.4% (7) patients received SC-SCS, 8.7% received a reduced dose and duration was reduced in 15.8%. The median dose and duration of SCS were 602.5mg (200-1625) and 14 (4-36) days, respectively. We observed an association between days of SCSand LOS (P<.001) and doses of intrahospitalSCSand LOS (P<.001). Factors associated with LOS were doses of intrahospitalSCS received (.01 [95% CI:.007-.013]; P<0.001), days of steroid treatment (.14 [95% CI .03-.25], P=.009) and PAFI (pO2/FiO2 ratio) at admission (-.012 [95% CI: -.012 to -.002], P=.015). ConclusionsThe SCS schedules used in routine clinical practice are longer and administered at a higher dose than recommended, leading toa longer hospital stay.

Adherence to GOLD Guidelines in the Inpatient COPD Population

Purpose: The Global Initiative for Chronic Obstructive Lung Disease guidelines provide recommendations to manage chronic obstructive lung disease (COPD) exacerbations. This study assessed the management of inpatient COPD exacerbations at an urban teaching hospital. Methods: A retrospective cohort analysis of adults admitted between December 2010 and August 2012 with a COPD exacerbation was conducted. Patient demographics, length of stay (LOS), Charlson comorbidity score, inpatient pulmonary medications, and 30-day readmission were collected. Descriptive statistics characterized guideline adherence and readmission. Results: 94 patients were included with median LOS of 3 days (interquartile range [IQR]: 1-5 days) and median Charlson comorbidity score of 6 (IQR: 5-8). All patients received an inhaled short-acting beta agonist, and 52 (55.3%) also received an inhaled short-acting anticholinergic. Seventy-eight (83%) received systemic corticosteroids, of which 3 received guideline-recommended doses. Sixty-four (68.1%) received antibiotics for a pulmonary indication, of which 71.9% received appropriate antibiotics per indication. Of the 94 patients, 2 were managed in complete adherence with GOLD recommendations. A total of 24 (25.5%) patients were readmitted within 30 days of discharge, 9 of these for COPD. Conclusion: COPD exacerbation treatment deviated from GOLD recommendations. This provides opportunities for further optimization of treatment of COPD exacerbations.

Treating COPD in Older and Oldest Old Patients.

The treatment of older and oldest old patients with COPD poses several problems and should be tailored to specific outcomes, such as physical functioning. Indeed, impaired homeostatic mechanisms, deteriorated physiological systems, and limited functional reserve mainly contribute to this complex scenario. Therefore, we reviewed the main difficulties in managing therapy for these patients and possible remedies. Inhaled long acting betaagonists (LABA) and anticholinergics (LAMA) are the mainstay of therapy in stable COPD, but it should be considered that pharmacological response and safety profile may vary significantly in older patients with multimorbidity. Their association with inhaled corticosteroids is recommended only for patients with severe or very severe airflow limitation or with frequent exacerbations despite bronchodilator treatment. In hypoxemic patients, long-term oxygen therapy (LTOT) may improve not only general comfort and exercise tolerance, but also cognitive functions and sleep. Nonpharmacological interventions, including education, physical exercise, nutritional support, pulmonary rehabilitation and telemonitoring can importantly contribute to improve outcomes. Older patients with COPD should be systematically evaluated for the presence of risk factors for non-adherence, and the inhaler device should be chosen very carefully. Comorbidities, such as cardiovascular diseases, chronic kidney disease, osteoporosis, obesity, cognitive, visual and auditory impairment, may significantly affect treatment choices and should be scrutinized. Palliative care is of paramount importance in end-stage COPD. Finally, treatment of COPD exacerbations has been also reviewed. Therapeutic decisions should be founded on a careful assessment of cognitive and functional status, comorbidity, polypharmacy, and agerelated changes in pharmacokinetics and pharmacodynamics in order to minimize adverse drug events, drug-drug or drug-disease interactions, and non-adherence to treatment.

Comparison of two systemic steroid regimens for the treatment of COPD exacerbations

RationaleSystemic steroids shorten recovery time, improve lung function and hypoxemia in COPD exacerbations. Although several studies have shown that both parenteral and oral steroids are effective and GOLD guideline recommends use of oral steroids at a dose of 30–40 mg/day, very little data exists as to whether any route of admininstration (parenteral vs oral) or any dose is more effective and/or safer. MethodsThis was a randomized, parallel-group study aiming to compare the effectiveness and safety of orally administered lower dose of steroids with parenteral administration of higher doses. Thus, a total of 40 patients were included; one group (Group 1, n = 20) received methylprednisolone (MP) as recommended by the GOLD guideline (PO 32 mg/day for seven days) and the other (Group 2, n = 20) was given IV MP at 1 mg/kg/day for four days and 0.5 mg/kg/day for three days. ResultsThe two groups were similar with regards to age (69.0 ± 10.5 vs 67.1 ± 8.4 years), duration of COPD (11.8 ± 8.3 vs 9.7 ± 7.7 years), FEV1 (41.3 ± 17.3 vs 34.0 ± 12.0%), PaO2 levels (55.5 ± 9.9 vs 59.1 ± 11.0 mmHg) and dyspnea scores (9.4 ± 1.1 vs 10.0 ± 1.0). Worsening hypercapnic respiratory failure developed in two patients from Group 1 on days 1 and 2, these were intubated and thus excluded from the study. At day 7, both groups showed significant improvements in FEV1 levels (50.8 ± 19.4 and 43.8 ± 21.4%, respectively) (Table 2), PaO2 levels (66.5 ± 12.5 and 65.3 ± 10.6 mmHg, respectively) (Table 3) and dyspnea scores (3,5 ± 2,8 and 4.2 ± 2.8) (Fig. 1). The length of hospital stay was similar for the two groups (11.0 ± 3.9 vs 12.7 ± 6.4). Regarding adverse events, four patients in Group 1 vs 11 patients in group 2 developed hyperglycemia. Besides, three patients in group 2 had worsening of previously controlled hypertension. All events were treated and controlled with administration of proper medications. All patients were followed up for three months. Eight patients in group 1 and 15 patients in group 2 had unplanned visits to their physicians or to the emergency rooms for recurring exacerbations. Four patients in group 1 and five patients in group 2 were readmitted to hospital for recurrence (p = NS). During the follow-up two patients from group 1 died. ConclusionThese data show that oral administration of MP at a dose 32 mg/day for seven days significantly improves lung function, symptom scores and oxygenation in patients admitted to the hospital for COPD exacerbation and is as effective as and possibly safer than parenteral admininistration of higher doses.

Treatment of COPD exacerbations

Treatment of COPD exacerbations

Acute Application of Noninvasive Ventilation Outside the ICU: When Is It Safe?

The literature supporting the use of noninvasive ventilatory support (NIV) in acute respiratory failure has markedly increased over the last 20 years.[1][1]–[3][2] Most would now consider NIV as first line therapy in the treatment of COPD exacerbations, cardiogenic pulmonary edema, and acute

COPD exacerbations in general practice: variability in oral prednisolone courses.

BackgroundThe use of oral corticosteroids as treatment of COPD exacerbations in primary care is well established and evidence-based. However, the most appropriate dosage regimen has not been determined and remains controversial. Corticosteroid therapy is associated with a number of undesirable side effects, including hyperglycaemias, so differences in prescribing might be relevant. This study examines the differences between GPs in dosage and duration of prednisolone treatment in patients with a COPD exacerbation. It also investigates the number of general practitioners (GPs) who adjust their treatment according to the presence of diabetic co-morbidity.MethodsCross-sectional study among 219 GPs and 25 GPs in training, located in the Northern part of the Netherlands.ResultsThe response rate was 69%. Nearly every GP prescribed a continuous dose of prednisolone 30 mg per day. Among GPs there were substantial differences in treatment duration. GPs prescribed courses of five, seven, ten, or fourteen days. A course of seven days was most common. The duration of treatment depended on exacerbation and disease severity. A course of five days was especially prescribed in case of a less severe exacerbation. In a more severe exacerbation duration of seven to fourteen days was more common. Hardly any GP adjusted treatment to the presence of diabetic co-morbidity.ConclusionUnder normal conditions GPs prescribe prednisolone quite uniformly, within the range of the current Dutch guidelines. There is insufficient guidance regarding how to adjust corticosteroid treatment to exacerbation severity, disease severity and the presence of diabetic co-morbidity. Under these circumstances, there is a substantial variation in treatment duration.

Antibiotic Treatment of Respiratory Tract Infections in Ambulatory Care in Belgium

This study aims to analyse antibiotic treatment of respiratory tract infections in ambulatory care in Belgium by: a) mapping antibiotic consumption over time and breaking down antibiotic consumption by infection type; b) discussing antibiotic treatment as recommended by Belgian guidelines; and c) reviewing the current evidence on the cost- effectiveness of antibiotic treatment. IMS Health data showed that the total volume of antibiotic consumption in ambulatory care in Belgium has increased over the years. Antibiotic consumption mainly originated from the use of broad-spectrum penicillins. The volume of fluoroquinolone use remains well controlled. Policy makers need to target the main drivers of inappropriate antibiotic consumption rather than a specific class of antibiotics when they aim to promote better use of antibiotics in ambulatory care. A s-lactam-based therapy for CAP is recommended as first choice in Belgian guidelines and moxifloxacin is advocated for CAP outpatients with comorbid conditions or outpatients in whom infection with atypical pathogens needs to be considered. Because of its high eradicating power against the target organisms and because H. influenzae is the main pathogen to be covered, amoxicillin-clavulanic acid may be a first choice to treat COPD exacerbations, although this choice is subject to debate. Moxifloxacin is recommended in case of IgE-mediated s-lactam allergy or severe intolerance to s-lactam antibiotics for the treatment of COPD exacerbations or for the treatment of upper respiratory tract infections on the rare occasion that antibiotic treatment is warranted. One study supported the cost- effectiveness of first-line treatment of CAP with moxifloxacin in Belgium.

How do COPD patients respond to exacerbations?

BackgroundAlthough timely treatment of COPD exacerbations seems clinically important, nearly half of these exacerbations remain unreported and subsequently untreated. Recent studies have investigated incidence and impact of failure to seek medical treatment during exacerbations. Yet, little is known about type and timing of other self-management actions in periods of symptom deterioration. The current prospective study aims at determining the relative incidence, timing and determinants of three types of patient responses.MethodsIn a multicentre observational study, 121 patients (age 67 ± 11 years, FEV1pred. 48 ± 19) were followed for 6 weeks by daily diary symptom recording. Three types of action were assessed daily: planning periods of rest, breathing techniques and/or sputum clearing (type-A), increased bronchodilator use (type-B) and contacting a healthcare provider (type-C).ResultsType-A action was taken in 70.7%, type-B in 62.7% and type C in 17.3% of exacerbations (n = 75). Smokers were less likely to take type-A and B actions. Type-C actions were associated with more severe airflow limitation and increased number of hospital admissions in the last year.ConclusionsOur study shows that most patients are willing to take timely self-management actions during exacerbations. Future research is needed to determine whether the low incidence of contacting a healthcare provider is due to a lack of self-management or healthcare accessibility.

Randomized Trial of Zileuton for Treatment of COPD Exacerbations Requiring Hospitalization

Rationale: Leukotrienes have been implicated in the pathogenesis of acute exacerbations of COPD, but leukotriene modifiers have not been studied as a possible therapy for exacerbations. Objective: We sought to test the safety and efficacy of adding oral zileuton (a 5-lipoxygenase inhibitor) to usual treatment for acute exacerbations of COPD requiring hospitalization. Methods: Randomized double-blind, placebo-controlled, parallel group study of zileuton 600 mg orally, 4 times daily versus placebo for 14 days starting within 12 hours of hospital admission for COPD exacerbation. Primary outcome measure was hospital length of stay; secondary outcomes included treatment failure and biomarkers of leukotriene production. Main Findings: Sixty subjects were randomized to zileuton and 59 to placebo (the study was stopped short of enrollment goals because of slow recruitment). There was no difference in hospital length of stay (3.75 ± 2.19 vs. 3.86 ± 3.06 days for zileuton vs. placebo, p = 0.39) or treatment failure (23% vs. 27% for zileuton vs. placebo, p = 0.63) despite a decline in urinary LTE4 levels in the zileuton-treated group as compared to placebo at 24 hours (change in natural log-transformed ng/mg creatinine −1.38 ± 1.19 vs. 0.14 ± 1.51, p < 0.0001) and 72 hours (−1.32 ± 2.08 vs. 0.26 ± 1.93, p<0.006). Adverse events were similar in both groups. Principal Conclusions: While oral zileuton during COPD exacerbations that require hospital admission is safe and reduces urinary LTE4 levels, we found no evidence suggesting that this intervention shortened hospital stay, with the limitation that our sample size may have been insufficient to detect a modest but potentially meaningful clinical improvement.