Treatment Of COPD Research Articles

Сучасні підходи до лікування запальних захворювань кишечника в дітей відповідно до останніх рекомендацій Європейської організації з вивчення хвороби Крона і коліту, Європейського товариства дитячих гастроентерологів, гепатологів та нутриціологів

Modern outpatient management of ulcerative colitis (UC) continues to be a difficult task, as 20% of children still need colectomy (there are no official statistics for Ukraine). Therefore, the European Organization for the Study of Crohn's Disease and Colitis (ECCO) and the European Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists (ESPGHAN), seeking to standardize the daily treatment of inflammatory bowel disease (IBD), have developed a protocol for the management and treatment of children with VC. Based on the analysis of medical research, followed by an evidentiary assessment of each provision, the 2012 recommendations were updated. The aim is to present the provisions of the updated protocol on therapeutic management of children with ulcerative colitis and to consolidate the material on a clinical case. Materials and methods. The article presents updated recommendations of ECCO and ESPGHAN (2018) on the treatment of COPD in children, the algorithm of induction and maintenance of remission of UC and COPD unclassified. A clinical case is given for an example of application of the algorithm of induction and support of remission of IBD at children, assessment of severity and the scheme of management of patients with this pathology is provided. Results and conclusions. The updated recommendations of ECCO and ESPGHAN facilitate the treatment of unclassified UC and IBD, provide a clear scheme for monitoring children with this pathology, which improves treatment outcomes and quality of life of young patients. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: ulcerative colitis, recommendations. children, anti-TNF, calprotectin, unclassified inflammatory bowel disease, monitoring, activity index, treatment.

High-fiber diets attenuate emphysema development via modulation of gut microbiota and metabolism

Dietary fiber functions as a prebiotic to determine the gut microbe composition. The gut microbiota influences the metabolic functions and immune responses in human health. The gut microbiota and metabolites produced by various dietary components not only modulate immunity but also impact various organs. Although recent findings have suggested that microbial dysbiosis is associated with several respiratory diseases, including asthma, cystic fibrosis, and allergy, the role of microbiota and metabolites produced by dietary nutrients with respect to pulmonary disease remains unclear. Therefore, we explored whether the gut microbiota and metabolites produced by dietary fiber components could influence a cigarette smoking (CS)-exposed emphysema model. In this study, it was demonstrated that a high-fiber diet including non-fermentable cellulose and fermentable pectin attenuated the pathological changes associated with emphysema progression and the inflammatory response in CS-exposed emphysema mice. Moreover, we observed that different types of dietary fiber could modulate the diversity of gut microbiota and differentially impacted anabolism including the generation of short-chain fatty acids, bile acids, and sphingolipids. Overall, the results of this study indicate that high-fiber diets play a beneficial role in the gut microbiota-metabolite modulation and substantially affect CS-exposed emphysema mice. Furthermore, this study suggests the therapeutic potential of gut microbiota and metabolites from a high-fiber diet in emphysema via local and systemic inflammation inhibition, which may be useful in the development of a new COPD treatment plan.

Gut microbiota modulates COPD pathogenesis: role of anti-inflammatory Parabacteroides goldsteinii lipopolysaccharide

ObjectiveChronic obstructive pulmonary disease (COPD) is a global disease characterised by chronic obstruction of lung airflow interfering with normal breathing. Although the microbiota of respiratory tract is established to be...

The Impact of Exacerbation Frequency on Clinical and Economic Outcomes in Swedish COPD Patients: The ARCTIC Study.

PurposeThe aim of this study was to assess the association between exacerbation frequency and clinical and economic outcomes in patients with COPD.Patients and MethodsElectronic medical record data linked to National Health Registries were collected from COPD patients at 52 Swedish primary care centers (2000–2014). The outcomes analyzed were exacerbation rate, mortality, COPD treatments, lung function and healthcare costs during the follow-up period. Based on the exacerbation rate two years before index date, the patients were initially classified into three groups, either 0, 1 or ≥2 exacerbations per year. After the index date, the classification into exacerbation groups was updated each year based on the exacerbation rate during the last year of follow-up. A sensitivity analysis was conducted excluding patients with asthma diagnosis from the analysis.ResultsIn total 18,586 COPD patients were analyzed. A majority of the patients (60–70%) who either have had no exacerbation or frequent exacerbations (≥2/year) during the pre-index period remained in their group (ie, with 0 or ≥2 annual exacerbations) during up to 11 years of follow-up. Compared with having no exacerbation, mortality was higher in patients having 1 (HR; 2.06 [1.93–2.20]) and ≥2 (4.58 [4.33–4.84]) exacerbations at any time during the follow-up. Lung function decline was more rapid in patients with frequent exacerbations and there was an almost linear relationship between exacerbations frequency and mortality. Total healthcare costs were higher in the frequent exacerbation group (≥2/year) than in patients with no or one exacerbation annually (p<0.0001 for both). The results did not differ from the main analysis after exclusion of patients with a concurrent asthma diagnosis.ConclusionIn addition to faster lung function decline and increased mortality, frequent exacerbations in COPD patients imply a significant economic burden.

Comparative studies of dual bronchodilation in COPD.

Dual bronchodilation therapy is becoming the cornerstone for the treatment of COPD because the clinical benefits of LABA/LAMA fixed-dose combinations (FDCs) are now extensively established. Therefore, it not surprising that a number of LAMA/LABA combinations in a single inhaler have now been approved for clinical use as treatments for patients with COPD. Regrettably, very few head-to-head studies between all of the available LABA/LAMA FDCs have been carried out. This makes choosing the most appropriate FDC difficult. Comparative effectiveness research that also uses conventional meta-analyses to compare different care strategies can help generate useful information. A bidimensional comparative analysis across LAMA/LABA FDCs has suggested constant superiority for tiotropium/olodaterol. However, considering that there is not an equivalent amount of evidence on efficacy outcomes for all LAMA/LABA FDCs, a proper comparison between the different LAMA/LABA FDCs cannot be made yet, and the information available is still rather inconsistent.

The pulmonary rehabilitation utilization rate among older people with chronic obstructive pulmonary disease in Japan: A retrospective study using medical and long-term care insurance claims data

This study aimed to improve the understanding of the utilization rates and the characteristics of users of pulmonary rehabilitation (PR) among people with chronic obstructive pulmonary disease. We used medical and long-term care claims data from between April 2012 and March 2013 from Kashiwa city in Chiba prefecture, Japan. The study participants included patients of ≥63 years of age, who had received outpatient treatment for COPD (ICD-10 codes: J41-J44) two or more times during the study period, and who had been prescribed two or more COPD-related drugs. We extracted data on inpatient and outpatient PR using respiratory rehabilitation fee (I) (II) codes, and on home-based PR using home-care rehabilitation or nursing codes from medical insurance or long-term care insurance data. The mean age of the patients was 76.8 years (total participation: n = 2,708). There were 61 (2.3%) inpatient PR users, 25 (0.9%) outpatient PR users, and 101 (3.8%) home-based PR users. The median duration of usage by the inpatient, outpatient and home-based PR users was 1 month, 2 months, and 11 months, respectively. The mean age of non-PR and outpatient PR users was 76 years, while that of the inpatient PR users and home-based PR users was approximately 80 years. Approximately 20-30% of non-PR users and outpatient PR users were certified for long-term care. In contrast, approximately half of the inpatient users and almost all of the home-based PR users were certified for long-term care. Since the PR utilization rates were low in both hospital-based and home-based settings, it is necessary to take measures to disseminate each PR based on the characteristics of the intervention duration and service users.

НАСТАНОВА З ХОЗЛ ТА СІМЕЙНІ ЛІКАРІ: ЯКИЙ РІВЕНЬ ПРИХИЛЬНОСТІ?

Y. M. Mostovoy, T. V. Konstantinovych, O. R. Lindiuk, O. V. Bugaichuk Abstract Majority of COPD patients should receive medical care provided by family practitioners. Only the cases of severe, uncontrolled diseases must be managed by pulmonologists. That is why family practitioners must be well informed on actual requirements on diagnosis and treatment of COPD in order to give effective care to this population of patients. Following the aim to study quality of medical care, provided to COPD patients by family practitioners, we analyzed 220 out-patient records (95 men (43,2 %), 125 women (56,8 %); mean age 69 years). Analyzing medical records the attention was mainly focused at two issues — accuracy of diagnosis formulation and correctness of treatment prescription. It was revealed that the clinical group of disease was not mentioned in 107 (48,6 %) patients. This made impossible to prescribe maintenance treatment correctly. Long-acting anticholinergic drugs and it combinations were prescribed unreasonably rarely (11 (5 %) vs needed 97 (44,1 %) cases). On the contrary, short-acting bronchodilators (salbutamol, berodual monotherapy) and inhaled corticosteroid/long-acting beta 2 agonist combination were used in 51 (23,2 %) and 50 (22,7 %) cases, respectively. Among them 48 (48,9 %) patients required hospitalization, use of antibiotics and systemic corticosteroids. This is mainly explained by incorrect use of maintenance therapy for COPD. The authors conclude about low adherence of family practitioners to state and international COPD guidelines. Further work is needed to increase the knowledge of physician regarding COPD diagnosis and treatment along with active consultancy of out-patient facilities by the pulmonologists.

Identification and Validation of Autophagy-Related Genes in Chronic Obstructive Pulmonary Disease.

PurposeAutophagy plays essential roles in the development of COPD. We aim to identify and validate the potential autophagy-related genes of COPD through bioinformatics analysis and experiment validation.MethodsThe mRNA expression profile dataset GSE38974 was obtained from GEO database. The potential differentially expressed autophagy-related genes of COPD were screened by R software. Then, protein–protein interactions (PPI), correlation analysis, gene-ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were applied for the differentially expressed autophagy-related genes. Finally, RNA expression of top five differentially expressed autophagy-related genes was validated in blood samples from COPD patients and healthy controls by qRT-PCR.ResultsA total of 40 differentially expressed autophagy-related genes (14 up-regulated genes and 26 down-regulated genes) were identified between 23 COPD patients and 9 healthy controls. The PPI results demonstrated that these autophagy-related genes interacted with each other. The GO and KEGG enrichment analysis of differentially expressed autophagy-related genes indicated several enriched terms related to autophagy and mitophagy. The results of qRT-PCR showed that the expression levels of HIF1A, CDKN1A, BAG3, ERBB2 and ATG16L1 in COPD patients and healthy controls were consistent with the bioinformatics analysis results from mRNA microarray.ConclusionWe identified 40 potential autophagy-related genes of COPD through bioinformatics analysis. HIF1A, CDKN1A, BAG3, ERBB2 and ATG16L1 may affect the development of COPD by regulating autophagy. These results may expand our understanding of COPD and might be useful in the treatment of COPD.

Determining Factors Associated with Inhaled Therapy Adherence on Asthma and COPD Treatment: A Systematic Review and Meta-Analysis of the Global Literature

Determining Factors Associated with Inhaled Therapy Adherence on Asthma and COPD Treatment: A Systematic Review and Meta-Analysis of the Global Literature

МОЖЛИВОСТІ НЕТРАДИЦІЙНОЇ МЕДИЦИНИ У ДОДАТКОВІЙ ТЕРАПІЇ ЗАПАЛЬНИХ ЗАХВОРЮВАНЬ ДИХАЛЬНИХ ШЛЯХІВ

POSSIBILITIES OF NONTRADITIONAL MEDICINE IN ADDITIONAL TREATMENT FOR INFLAMMATORY DISEASES OF THE RESPIRATORY TRACT O. О. Rechkina, O. V. Strafun, М. О. Polianska, М. Р. Budyonna Abstract Oxidative stress plays an important role іn the pathogenesis of airway inflammatory diseases. Multivitamin preparations containing antioxidants, nutritional supplements are significant support in the fight against oxidative stress. The healing properties of one such supplement, badger fat, have been known for centuries. It is used in folk medicine as a natural and effective agent with bactericidal, anti-inflammatory, immunostimulating and general strengthening effects. The main active components of badger fat include unsaturated fatty acids and vitamins, especially A, E and D. Vitamins of these groups enhance the anti-inflammatory effect of unsaturated fatty acids, and also exhibit high antioxidant activity, while unsaturated fatty acids (including omega-3, omega-6), help to improve metabolic processes and tissue trophism, exhibiting anti-inflammatory and antioxidant effects. The article presents the characteristics of the dietary supplement “Borsukovy zhyr”, the results of studies of its effectiveness and tolerability in the complex treatment of chronic bronchitis and AE COPD, as a component of therapy of adults and children with bronchopulmonary diseases, showing its effectiveness, safety and good tolerability. The supplement can be used in the complex treatment of bronchopulmonary pathology in both adults and children as a safe source of fat-soluble vitamins and polyunsaturated fatty acids. Key words: oxidative stress, antioxidants, dietary supplement, badger fat.

EFFICIENT COMPREHENSIVE TREATMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE EXACERBATION AND POSTCOVIDAL SYNDROME IN ELDERLY PATIENTS.

The aim: The purpose of the study is to increase the efficacy of сomprehensive treatment in elderly patients with COPD , who have suffered of coronavirus disease-COVID-19 in the last 3-6 months, by using nebulizer therapy with N-acetylcysteine and 3% hypertonic sodium chloride solution (Flu-Acyl broncho) and the drug glycine, to correct psychosomatic disorders. Materials and methods: Under our supervision there were 60 elderly patients with COPD gr D, who underwent Covid 19 in the last 3-6 months, were under observation. The average age was 66.3±2.1 years. Рatients of the main and control groups were prescribed complex basic therapy. However, mucolytic therapy was administered to patients in the main group using combined drug - N-acetylcysteine and 3% hypertonic sodium chloride solution through a 5.0 №10 nebulizer. For the treatment of astheno-neurotic disorders of postcovidal syndrome was prescribed glycine 100 mg 2 times a day for 10 days. Subsequently, Flu-Acyl broncho through a nebulizer at 5.0 No.10, and glycised was used in courses once a day for 10 days per month. Patients in the control group were prescribed acetylcysteine 200 mg 3 times a day N10. Results: The results of observation for 6 months showed that in patients of the main group, recurrence of the disease was not observed. whereas in patients of the control group in 6 patients (20%). Conclusions: Comprehensive treatment of elderly patients with comorbid pathology - COPD group D and postcovidal syndrome, with the additional use of nebulizer delivery of the combined drug - N-acetylcysteine and 3% hypertonic sodium chloride solution in combination with the sedative drug glycine, promotes improving the quality of life in patients, reducing the duration of treatment, prevents recurrence and progression of COPD.

The evaluation of disease awareness, caregiver burden, and workday loss in caregivers of COPD patients

Our aim is to determine the caregiver burden of chronic obstructive lung disease (COPD) patient's caregivers, and to determine whether there is a work day loss. 252 COPD patients and their caregivers were included. Disease information of the patients were recorded and a questionnaire was applied. Socio-demographic characteristics of the caregivers were recorded and a questionnaire consisting of 24 questions including COPD disease, treatment and loss of working days and Zarit Scale were used. 128(50.8%) of the patients according to GOLD were group-D. 97(38.5%) of the patient's relatives were working. 62(24.7%) were not able to go to work for 1-14 days. 125(57.1%) spent outside the home from 1 to 14 nights, because those accompanied to patients. In univariate analysis were detected modified medical research council (mMRC) (p<0.001), CAT(p<0.001), the number of comorbidities of patients (p=0.027), forced expiratory volume in 1 FEV1cc(p=0.009), FEV1%(p<0.001), the presence of long term oxygen therapy (LTOT) and the number of comorbidities of the patient's relatives (p=0.06) increased the care load. In multipl linear regression analysis, age (p=0.03), COPD assessment test (CAT) score (p=0.001), FEV1%(<0.068) and the number of comorbidities of patients (p=0.01) and the number of comorbidities of caregivers (p=0.003) increased the caregiving burden. In COPD increases caregiving burden. This burden is greater in symptomatic patients and when comorbidities are present. Psycho-social and legal regulations should be investigated and solutions should be produced for the caregivers of COPD patients.

Consistent Pulmonary Drug Delivery with Whole Lung Deposition Using the Aerosphere Inhaler: A Review of the Evidence.

Metered dose inhalers (MDIs) are one of the most common device types for delivering inhaled therapies. However, there are several technical challenges in development and drug delivery of these medications. In particular, suspension-based MDIs are susceptible to suspension heterogeneity, in vitro drug–drug interactions, and patient handling errors, which may all affect drug delivery. To overcome these challenges, new formulation approaches are required. The AerosphereTM inhaler, formulated using co-suspension delivery technology, combines drug crystals with porous phospholipid particles to create stable, homogenous suspensions that dissolve once they reach the airways. Two combination therapies using this technology have been developed for the treatment of COPD: glycopyrrolate/formoterol fumarate (GFF MDI; dual combination) and budesonide/glycopyrrolate/formoterol fumarate (BGF MDI; triple combination). Here, we review the evidence with a focus on studies assessing dose delivery, lung deposition, and effects on airway geometry. In vitro assessments have demonstrated that the Aerosphere inhaler provides consistent dose delivery, even in the presence of simulated patient handling errors. Combination therapies delivered with this technology also show a consistent fine particle fraction (FPF) and an optimal particle size distribution for delivery to the central and peripheral airways even when multiple drugs are delivered via the same inhaler. Studies using gamma scintigraphy and functional respiratory imaging have demonstrated that GFF MDI is effectively deposited in the central and peripheral airways, and provides clinically meaningful benefits on airway volume and resistance throughout the lung. Overall, studies suggest that the Aerosphere inhaler, formulated using co-suspension delivery technology, may offer advantages over traditional formulations, including consistent delivery of multiple components across patient handling conditions, optimal particle size and FPF, and effective delivery to the central and peripheral airways. Future studies may provide additional evidence to further characterize the clinical benefits of these technical improvements in MDI drug delivery.

Low Level Laser Therapy and Chronic Obstructive Pulmonary Disease

A novel treatment modality for the treatment of COPD is presented. A patient story in which a patient was brought from a pulmonary capacity of 25% to a pulmonary capacity of 44% over a series of 13 treatments is presented. The patient in question had a concomitant improvement in quality of life that is hitherto unheard of in this patient category. This study was neither planned nor theorized. On the contrary, it came about due to a patient query that caught me by surprise. Where she was before the treatment unable to carry out many activities of daily living without assistance, she was after the treatment able to carry out nearly all her activities of daily living without assistance. A case for the dissemination of this effective treatment is made. Low level laser therapy definitely has its place in the treatment of any inflammatory process for which reason it is clearly relevant in the COPD sphere. Experience of the author in related fields is shortly presented as well as the political and financial aspects discussed. There is no doubt that low level laser therapy will enjoy much further dissemination in the years to come, and this article is a step in that direction.

Clinical Management of COPD in a Real-World Setting. A Big Data Analysis

ObjectiveThe aim of this study was to evaluate the quality of diagnosis and treatment of COPD using Big Data methodology on the Savana Manager 2.1 clinical platform. Materials and methodsA total of 59,369 patients with a diagnosis of COPD were included from a population of 1,219,749 adults over 40 years of age. ResultsIn total, 78% were men. Spirometry data were available for only 26,453 (43.5%) subjects. Disease severity was classified in 18,172 patients: 4396 mild, 7100 moderate, and 6676 severe, although only 27%, 34%, and 28%, respectively, presented obstructive spirometry. The clinical management of COPD is mainly the responsibility of the primary care and pulmonology departments, while internal medicine and, to a lesser extent, geriatrics also participate. Drug treatment was based on bronchodilators and inhaled corticosteroids (ICS). A marked decline in the use of long-acting beta-2 agonists (LABA) in monotherapy and a slight reduction in ICS/LABA combinations, associated with a long-acting anticholinergic (LAMA) in 74% of cases, were observed. All-cause in-hospital mortality among the overall population was 5.6% compared to 1% of the general population older than 40 years. In total, 35% were admitted to hospital, with an average stay of 6.6 days and an in-hospital mortality rate in this group of 10.74%. DiscussionThis study identifies the main features of an unselected COPD population and the main errors made in the management of the disease.

N-Acetyl Cysteine in treatment of COPD

Introduction: In COPD excess expectoration secondary to tracheobronchial secretions contributes to symptoms, airflow obstruction and is diagnostic criterion. It also causes increased mortality, risk of hospitalizations and accelerated decline in FEV1. N-acetylcysteine (NAC) helps in liquefying mucus and DNA (via disruption of disulfide bonds) and has antioxidant effects. Aims: Evaluate add-on effect of NAC on clinical-physiological parameters in COPD patients treated according to GOLD guidelines. Material and Methods: Single labeled, randomized, parallel group prospective Observational study. In 120 stable COPD patients Modified medical research council (MMRC) dyspnoea score, COPD Assessment test (CAT score), number of exacerbations and hospitalizations in the last year were recorded and were randomized into 2 groups of 60 each. Group A received NAC 600mg twice daily along with standard treatment. Group B received standard treatment only. Mean and Standard Deviation was compared between groups using unpaired t-test. After 1 year, changes in above parameters were reassessed. Statistical Analysis: Unpaired t-test and chi square test were used. Statistical significance was set at Results: MMRC score reduced from 3.37 study group) to 2.91, difference being -0.46, and in control from 3.37 to 1.18, difference of -0.22 and p value of p

Adherence to GOLD Recommendations among Swiss Pulmonologists and General Practitioners

Significant variability in adherence to COPD management recommendations has been reported. We aimed to evaluate real-life COPD pharmacotherapy prescribing patterns and adherence to the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) global strategy in Switzerland. A questionnaire-based survey was conducted among Swiss general practitioners (GPs) and pulmonologists (PULs) from May 1 to November 30, 2017. Participants were invited to complete a questionnaire on their next 5–10 consecutive patients already receiving a pharmacological treatment for COPD. They were requested to assess dyspnea using the modified Medical Research Council (mMRC) dyspnea scale and to determine whether a treatment adjustment was indicated. Fifty-three PULs and 39 GPs completed questionnaires on 511 COPD patients. Dyspnea with mMRC grade ≥2 was reported in 62.5% of the patients, and 31.9% had had at least two exacerbations (or at least one with hospital admission) in the last 12 months. The vast majority (87.1%) of GOLD A patients were overtreated. In the GOLD B group, 52.2% of prescriptions were concordant with GOLD 2017 recommendations, but 37% of patients were overtreated. Among GOLD C patients, 49.2% received GOLD-adherent treatment and 47.5% were overtreated. In the GOLD D category, 78.8% of the patients received a treatment consistent with recommendations but 15.2% were undertreated. After reassessment of patient status, treatment was modified in 50.3% of the patients. This study confirms that discordance of real-world prescription patterns with international guidance is frequent. Further educational efforts are required to improve adherence to COPD management recommendations.

Physician's attitude against COPD guidelines and the choice of first-line treatment for COPD

AimOur aim was to evaluate changes in attitudes of pulmonologists in Turkey towards COPD guidelines and their choice of first-line treatments for COPD patients. Material-method333 physicians who completed the questionnaire were included in this cross-sectional questionnaire study. The questionnaire contained demographic data, professional information, extent of guideline use, rationales behind using or not using a guideline. The data was compared with the same survey conducted previously in 2011 and was analyzed by appropriate statistical methods. Results80 physicians were resident pulmonologists (24%), 250 physicians were specialists (75.1%). 298 (89.5%) physicians reported that they follow at least one guideline for selection of the appropriate treatment in COPD. The current application of guidelines when compared with the first survey in 2011, was found to be decreased, 91.2% and 89.5%, respectively (p = 0.07). 46.8% (n = 156) of participants thought that guidelines provided the physicians more legal protection (p < 0.001). The number of physicians who didn't follow the guidelines due to workload increased over this period of time (36.8% in 2011, 85.3% in 2018, p < 0.001). The number of physicians using inhaler steroid combinations as their first choice of treatment was found to be similar with the previous survey (p = 0.909). ConclusionAccording to the results of previous questionnaire, the application of COPD guidelines has decreased. The number of pulmonologists who declared they have no time for following or applying guidelines has profoundly increased since 2011. Despite the warnings of these guidelines, the use of inhaler steroid combination as a first treatment option in COPD is still common.

Chronic obstructive pulmonary disease and atrial fibrillation: an interdisciplinary perspective.

Chronic obstructive pulmonary disease (COPD) is highly prevalent among patients with atrial fibrillation (AF), shares common risk factors, and adds to the overall morbidity and mortality in this population. Additionally, it may promote AF and impair treatment efficacy. The prevalence of COPD in AF patients is high and is estimated to be ∼25%. Diagnosis and treatment of COPD in AF patients requires a close interdisciplinary collaboration between the electrophysiologist/cardiologist and pulmonologist. Differential diagnosis may be challenging, especially in elderly and smoking patients complaining of unspecific symptoms such as dyspnoea and fatigue. Routine evaluation of lung function and determination of natriuretic peptides and echocardiography may be reasonable to detect COPD and heart failure as contributing causes of dyspnoea. Acute exacerbation of COPD transiently increases AF risk due to hypoxia-mediated mechanisms, inflammation, increased use of beta-2 agonists, and autonomic changes. Observational data suggest that COPD promotes AF progression, increases AF recurrence after cardioversion, and reduces the efficacy of catheter-based antiarrhythmic therapy. However, it remains unclear whether treatment of COPD improves AF outcomes and which metric should be used to determine COPD severity and guide treatment in AF patients. Data from non-randomized studies suggest that COPD is associated with increased AF recurrence after electrical cardioversion and catheter ablation. Future prospective cohort studies in AF patients are needed to confirm the relationship between COPD and AF, the benefits of treatment of either COPD or AF in this population, and to clarify the need and cost-effectiveness of routine COPD screening.

A Comparison of the Real-Life Clinical Effectiveness of the Leading Licensed ICS/LABA Combination Inhalers in the Treatment for COPD.

IntroductionThe Fostair® 100/6 (BDP/FF) pressurized metered-dose inhaler, delivering an extrafine formulation, is licensed for asthma and COPD in the UK. However, its real-life effectiveness for COPD has not been evaluated. This study compared the clinical effectiveness of BDP/FF against other licensed ICS/LABA combination inhalers: the Seretide® Accuhaler® (FP/SAL) and the Symbicort® Turbohaler® (BUD/FF).MethodsA matched historical cohort study was conducted using records of patients with diagnostic codes for COPD from the Optimum Patient Care Research Database (OPCRD). Patients who had received BDP/FF as their first ICS/LABA were matched 1:1 with patients who had received FP/SAL or BUD/FF, resulting in two matched comparisons. Additional analysis was conducted on patients who had never had diagnostic codes for asthma. Noninferiority in terms of the proportion of patients with moderate/severe COPD exacerbations on the different inhalers in the following year was assessed. Noninferiority was achieved if the upper CI limit were ≤1.2.ResultsThis study included 537 and 540 patient pairs in the BDP/FF vs FP/SAL cohort and the BDP/FF vs BUD/FF cohort, respectively. The proportion of patients with COPD exacerbations in the BDP/FF group was not significantly different from either the FP/SAL (68.7% vs 70.2%, AOR 0.89, 95% CI 0.67–1.19) or BUD/FF group (68.5% vs 69.4%, AOR 0.79, 95% CI 0.58–1.08). Noninferiority of BDP/FF in preventing COPD exacerbations was fulfilled in both comparisons. In patients without asthma, BDP/FF was also noninferior to BUD/FF (proportion with COPD exacerbations, 67.8% vs 64.7%, AOR 0.79, 95% CI 0.51–1.1997). Additionally, a significantly lower proportion of patients prescribed BDP/FF had COPD exacerbations than FP/SAL (64.8% vs 73.7%, AOR 0.64 95% CI 0.43–0.96).ConclusionInitiating ICS/LABA treatment of COPD with extrafine-formulation BDP/FF was noninferior in preventing moderate/severe exacerbations compared to FP/SAL and BUD/FF.