Figure 1 - available via license: Creative Commons Attribution-NonCommercial 4.0 International
Content may be subject to copyright.
Treatment effect of tiotropium versus control by mean exacerbation frequency at different time points over 4 years. Abbreviation: FEV 1 , forced expiratory volume in one second.
Source publication
Exacerbations affect morbidity in chronic obstructive pulmonary disease (COPD). We sought to evaluate the association between exacerbation frequency and spirometric and health status changes over time using data from a large, long-term trial.
This retrospective analysis of data from the 4-year UPLIFT(®) (Understanding Potential Long-term Impacts on...
Similar publications
Background
Since the Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups A–D were introduced, the lung function changes according to group have been evaluated rarely.
Objective
We investigated the rate of decline in annual lung function in patients categorized according to the 2014 GOLD guidelines.
Methods
Patients with COPD incl...
SETTING: Frequent exacerbation is an important phenotype in chronic obstructive pulmonary disease (COPD), while emphysema is associated with many comorbidities and lung function decline.OBJECTIVE: To investigate unique features of frequent exacerbators and test the hypothesis that
emphysematous phenotype is associated with frequent exacerbations of...
Background
The role of interleukin (IL)-33 in patients with chronic obstructive pulmonary disease (COPD) has not been well elucidated. The aim of this study is to analyze the association between plasma IL-33 level and acute exacerbation of COPD.
Methods
Plasma IL-33 was measured in 62 COPD patients during their stable state. Patients were prospect...
Purpose
Population data on the burden of chronic obstructive pulmonary disease (COPD) are often based on patient-reported diagnoses of COPD, emphysema or chronic bronchitis, without spirometry. We aimed to investigate the relationship between health burden, quality of life and severity of airway obstruction in Australian adults aged ≥40 years.
Met...
Background
It is unclear if type-2 inflammation is associated with accelerated lung function decline in individuals with asthma and chronic obstructive pulmonary disease (COPD). We tested the hypothesis that type-2 inflammation indicated by elevated blood eosinophils (BE) and fraction of exhaled nitric oxide (FeNO) is associated with accelerated lu...
Citations
... 17 Frequent exacerbations have a significant negative impact, including an up to three-fold increase in mortality, a chance of developing depressive symptoms, a decline in lung function, a reduction in quality of life, and a decrease in physical activity. 18 ...
... Colitis is a long-term illness that influences people with changes in age where inflammatory agents and free radicals have an important role in its induction. Ulcerative colitis has a combined prevalence of 150-250/100000 population [6]. Anti-inflammatory drugs and steroids are used in the therapy of colitis to reduce inflammation and eventually cure it so that the colon may resume its normal function [7]. ...
Colorectal cancer is also the third most common cause of cancer-related death, and in the US, it ranks as the third most prevalent kind of cancer. The cells that produce mucus to lubricate the colon and rectum can be the source of colorectal cancer. Natural substances known as phytochemicals contain anti-oxidant, anti-inflammatory, and anti-tumor properties. These properties may be crucial for the treatment of a number of debilitating illnesses. The extract of vitamin B17, or amygdalin, is made from the kernels of apricots. Nitrilosides are naturally occurring compounds that contain cyanide. Natural substances called amygdalin have been utilized in traditional Chinese medicine to treat a wide range of illnesses. Its various pharmacological qualities include anti-inflammatory, antioxidant, antitussive, anti-asthmatic, and anti-ulcer effects. findings, When colitis mice were given acetic acid injections via the anal route, they had diarrhoea, obvious rectal bleeding, and weight loss.serum ALT, AST, and ALP values were higher in the colitis group than in the control and vitamin B17 groups. Conversely, there was a notable drop in the colitis group's blood albumin and total protein levels when compared to the control and vitamin B17 groups. In contrast, as compared to the colitis group, vitamin B17 therapy for colitis resulted in a substantial decrease in the levels of ALT, AST, and ALP and an increase in the levels of albumin and total proteins. Serum urea and creatinine levels were higher in the colitis group in comparison to the vitamin B17 and control groups. However, there is a significant decrease in serum urea and creatinine levels in treated colitis with vitamin B17 group when compared with the colitis group. Compared to the vitamin B17 and control groups, the colitis group had higher blood levels of potassium and sodium ions. On the other hand, compared to the colitis group, the treated colitis with vitamin B17 group had significantly lower blood levels of potassium and sodium ions. When compared to the control and vitamin B17 groups, the colitis group's RBC levels and HB% were considerably lower; however, vitamin B17 therapy for colitis regulates and improves these alterations. In contrast to the control and vitamin B17 groups, the colitis group's WBC and platelet counts considerably increased. Conversely, the colitis group's WBC and platelet counts fell when treated with vitamin B17.
... To date, studies that have explored the characteristics associated with increased hospitalisation risk have used measures that may not be commonly available to clinicians at the bedside, such as spirometry 6 and questionnaire-based measures of feelings of depression and anxiety and health-related quality of life (HRQoL). [8][9][10] For example, an audit of clinical practice for people hospitalised with an exacerbation of COPD found that measures of spirometry were performed on less than one in 4 cases. 11 The current study addresses this issue by exploring whether or not variables that are readily available to clinicians (at the bedside) can predict hospitalisation risk. ...
Objective
To identify the characteristics of people with chronic obstructive pulmonary disease (COPD) who require hospitalisation for exacerbations.
Methods
People with COPD were recruited either during hospitalisation or from out-patient respiratory medicine clinics. Hospital admissions were tracked throughout the 5-months recruitment period. For participants who were admitted, hospital readmissions were tracked for at least 30 days following discharge. Participants were grouped as either needing; (i) no hospital admission during the study period (no admission; ø-A), (ii) one or more hospital admissions during the study period but no readmission within 30 days of discharge (no rapid readmission; ø-RR) or (iii) one or more hospital admissions with a readmission within 30 days of discharge (rapid readmission; RR).
Results
Compared with the ø-A group ( n=211), factors that independently increased the risk of ø-RR ( n=146) and/or RR ( n=57) group membership were being aged >60 years, identifying as an Indigenous person (relative risk ratio, 95% confidence interval 7.8 [1.8 to 34.0]) and the use of a support person or community service for activities of daily living (1.5 [1.0 to 2.4]. A body mass index ≥25 kg/m ² was protective.
Conclusions
Variables recorded at the bedside or in clinic provided information on hospitalisation risk.
... The COPD exacerbator phenotype is characterised by two or more exacerbations per year [4]. Frequent exacerbations cause acceleration in lung function and health status decline (measured by SGRQ), as well as increased mortality [5] and number of comorbidities. It is reported that 13-47% of COPD patients are frequent exacerbators [6]. ...
C-reactive protein (CRP) and leukocyte count are standard tools for recognising inflammation in COPD patients. This study aimed to find if there is a pattern in monocyte related haematological indices - monocyte to neutrophil ratio (MNR) and monocyte to lymphocyte ratio (MLR) - which could be helpful in differentiating COPD patients in need for hospitalization due to acute exacerbation of COPD or differentiating frequent COPD exacerbators from non-frequent COPD exacerbators. The study included 119 patients with COPD and 35 control subjects, recruited at the Clinic for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, Croatia. Complete blood count was performed on Sysmex XN-1000, CRP on Cobas c501, and Fbg on BCS XP analyser. Data were analysed with MedCalc statistical software. The COPD patients were divided into three groups – frequent exacerbators (FE), non-frequent exacerbators (NFE), patients hospitalized for acute COPD exacerbations (HAE) and the control group were healthy smokers (HS). A statistically significant difference was found in the values of MNR while comparing these groups of patients: FE vs HAE (p<0.000), NFE vs HAE (p<0.000) and HS vs HAE (p<0.001); and for the values of MLR: FE vs HAE (p<0.022), NFE vs HAE (p<0.000) and HS vs HAE (p<0.000). As MLR and MNR have shown the statistical difference comparing the group of HAE to NFE, FE and HS, MLR and MNR could be valuable and available markers of acute COPD exacerbations and need for hospitalization.
... Chronic obstructive pulmonary disease (COPD) is a major disease that seriously endangers social health, with high incidence, mortality, and prevalence. 1 2 Acute exacerbations of COPD (AECOPD) are important events that affect the natural course of COPD and acted as primary determining factors of health status and prognosis. 3 Frequent acute exacerbations trigger off the deterioration of disease, which can lead to the decline of pulmonary function, 4 loss of labor force and serious decline in quality of life 5 and increased mortality. 6 The global initiative for chronic obstructive lung diseases (GOLD) recommend patients with acute exacerbations should be followed-up for 4-6 weeks after discharge. ...
Background
Chronic Obstructive Pulmonary Disease (COPD) is a major chronic disease with high incidence, mortality, and prevalence. Acute exacerbations mostly occur in a centralized period after an acute exacerbation, during which are extremely easy to occur again. We call this “high-risk period” as the “AECOPD risk window” (AECOPD-RW). At present, Western medicine lacks specific guidance on the medication of AECOPD-RW. Chinese herbal medicine has good efficacy and advantages in the treatment of COPD. Based on the clear distribution of syndrome in the previous period, this study aims to evaluate the clinical efficacy and safety of Chinese herbal medicine on AECOPD-RW.
Methods
This proposed study is a multi-center, double-blind, randomized controlled trial (RCT) to compare the efficacy of two therapies for patients with AECOPD-RW. 336 subjects will be randomly assigned in a 1:1 ratio to experimental group or control group for 8 weeks treatment and 18 weeks follow-up. Based on health education and conventional treatment, the experimental group will receive Chinese herbal medicine granule according to Chinese medicine syndrome types, while the control group will receive Chinese herbal medicine placebo granule according to Chinese medicine syndrome types. The primary outcomes are acute exacerbation rate in the AECOPD-RW, COPD Assessment Test (CAT) in the AECOPD-RW, and secondary outcomes include time to the first acute exacerbation, degree of acute exacerbation in the AECOPD-RW, acute exacerbation rate in the follow-up period, degree of acute exacerbation in the follow-up period, lung function, mMRC, quality of life and index of security. Outcome measurements will be evaluated at week 0, 8 of the treatment period and at week 16, 26 of the follow-up period. The results will provide evidence for the clinical efficacy and safety of traditional Chinese medicine in the treatment of AECOPD RW, and provide a reliable scheme for the treatment of AECOPD-RW.
Discussion
This is the first multicenter, randomized, double-blind, placebo-controlled parallel trial designed to investigate the efficacy of Chinese herbal medicine in the treatment of AECOPD-RW. The result of this RCT may help effectively reduce the possibility of AECOPD recurrence, change the course of disease deterioration, and provide evidence-based evidence for Chinese herbal medicine prevention and treatment of AECOPD-RW.
Trial registration
This trial was registered in ClinicalTrials.gov, NCT04851093. Registered on 14 April 2021.
... Exacerbations are related to disease progression, impaired pulmonary function, and mortality in COPD patients. 3,4 Frequent hospitalizations for AECOPD are associated with poor long-term prognosis and increased mortality. 4 Respiratory viral infections are the primary triggers for AECOPDs, although bacterial infections and environmental factors can also provoke them. ...
Purpose
Several studies report decreased hospital admissions for acute exacerbations of COPD (AECOPD) during the COVID-19 pandemic. However, there are no studies that compare AECOPD admissions with admissions for respiratory infections, including COVID-19. This study aimed to examine hospital admission rates for AECOPD, pneumonia, influenza, and COVID-19 among COPD patients, before and during the COVID-19 pandemic.
Patients and Methods
We obtained anonymized data on hospital admissions of patients with COPD and a primary diagnosis code for AECOPD, pneumonia, influenza, or COVID-19, from the hospital patient admission register at a large Swedish hospital. The study compared the pandemic period (February 2020–March 2022) to a period before the pandemic (June 2017–January 2020). Sequential phases of the pandemic were evaluated separately. Monthly admission rates were compared using Poisson regression, controlling for admission month.
Results
Comparing monthly admission rates during the pandemic with the prepandemic period, incidence rate ratios were 0.72 for AECOPD (95% CI 0.67–0.77; p<0.001), 0.56 for pneumonia (95% CI 0.49–0.62; p<0.001), 0.18 for influenza during the winter period (95% CI 0.10–0.30; p<0.001) and 0.79 for total COPD admissions, including COVID-19 (95% CI 0.75–0.84; p<0.001). The study showed significantly lower rate ratios for AECOPD, pneumonia, and total COPD admissions during the first, second, third, and fifth (Omicron) waves. No significant effect on admissions was seen after the withdrawal of restriction measures.
Conclusion
There was a significant reduction in the overall rate of hospital admissions among COPD patients for AECOPD, pneumonia, and respiratory viral infections during the pandemic despite the rise in COVID-19 admissions. However, prepandemic admission levels returned in the post-restriction period.
... The definition of an exacerbation is the worsening of COPD symptoms leading to the need for additional pharmacological treatment [95]. Among the poor outcomes for COPD patients with frequent exacerbations are reduced lung function and high mortality rate [126,127]. The common causes of COPD exacerbations include viral [128][129][130][131] and bacterial [40,129] infections [7]. ...
Chronic obstructive pulmonary disease (COPD) is significant cause of morbidity and mortality worldwide. There is mounting evidence suggesting that COPD patients are at increased risk of severe COVID-19 outcomes; however, it remains unclear whether they are more susceptible to acquiring SARS-CoV-2 infection. In this comprehensive review, we aim to provide an up-to-date perspective of the intricate relationship between COPD and COVID-19. We conducted a thorough review of the literature to examine the evidence regarding the susceptibility of COPD patients to COVID-19 infection and the severity of their disease outcomes. While most studies have found that pre-existing COPD is associated with worse COVID-19 outcomes, some have yielded conflicting results. We also discuss confounding factors such as cigarette smoking, inhaled corticosteroids, and socioeconomic and genetic factors that may influence this association. Furthermore, we review acute COVID-19 management, treatment, rehabilitation, and recovery in COPD patients and how public health measures impact their care. In conclusion, while the association between COPD and COVID-19 is complex and requires further investigation, this review highlights the need for careful management of COPD patients during the pandemic to minimize the risk of severe COVID-19 outcomes.
... reported an inverse relationship between exacerbations and FEV 1 but the correlation was weak (r = − 0.12, and − 0.27, respectively). [33,34] The findings of significantly more frequent exacerbations in our patients with very severe airflow limitation and a weak correlation with PB-FEV 1 are consistent with the findings of these studies. ...
Background:
Management strategies of chronic obstructive pulmonary disease (COPD) need to be tailored to the forced expiratory volume in one second (FEV1), exacerbations, and patient-reported outcomes (PROs) of individual patients. In this study, we analyzed the association and correlation between the FEV1, exacerbations, and PROs of patients with stable COPD.
Methods:
This was a post-hoc analysis of pooled data from two cross-sectional studies that were previously conducted in Malaysia from 2017 to 2019, the results of which had been published separately. The parameters measured included post-bronchodilator FEV1 (PB-FEV1), exacerbations, and scores of modified Medical Research Council (mMRC), COPD Assessment Test (CAT), and St George's Respiratory Questionnaire for COPD (SGRQ-c). Descriptive, association, and correlation statistics were used.
Results:
Three hundred seventy-four patients were included in the analysis. The PB-FEV1 predicted was < 30% in 85 (22.7%), 30-49% in 142 (38.0%), 50-79% in 111 (29.7%), and ≥ 80% in 36 (9.6%) patients. Patients with PB-FEV1 < 30% predicted had significantly more COPD exacerbations than those with PB-FEV1 30-49% predicted (p < 0.001), 50-79% predicted (p < 0.001), and ≥ 80% predicted (p = 0.002). The scores of mMRC, CAT, and SGRQ-c were not significantly higher in patients with more severe airflow limitation based on PB-FEV1 (p = 0.121-0.271). The PB-FEV1 predicted had significant weak negative correlations with exacerbations (r = - 0.182, p < 0.001), mMRC (r = - 0.121, p = 0.020), and SGRQ-c scores (r = - 0.114, p = 0.028). There was a moderate positive correlation between COPD exacerbations and scores of mMRC, CAT, and SGRQ-c (r = 0.407-0.482, all p < 0.001). There were significant strong positive correlations between mMRC score with CAT (r = 0.727) and SGRQ-c scores (r = 0.847), and CAT score with SGRQ-c score (r = 0.851) (all p < 0.001).
Conclusions:
In COPD patients, different severity of airflow limitation was not associated with significant differences in the mMRC, CAT, and SGRQ-c scores. Exacerbations were significantly more frequent in patients with very severe airflow limitation only. The correlation between airflow limitation with exacerbations, mMRC, and SGRQ-c was weak.
... 1 Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with significant rates of hospitalization and accelerated disease progression, leading to greater patient disability. 2,3 Many interventions aim to reduce exacerbation frequency and hospitalizations. 4 These include pharmacologic and nonpharmacologic therapies. ...
Background
Chronic obstructive pulmonary disease (COPD) is prevalent and results in high healthcare resource utilization. The largest impact on health status and proportion of healthcare costs in COPD are related to hospitalizations for acute exacerbations. Accordingly, the Centers for Medicare & Medicaid Services have advocated for remote patient monitoring (RPM) to aid in chronic disease management. However, there has been a lack of evidence for the effectiveness of RPM in reducing the need for unplanned hospitalizations for patients with COPD.
Methods
This pre/post study was a retrospective analysis of unplanned hospitalizations in a cohort of COPD subjects started on RPM at a large, outpatient pulmonary practice. The study included all subjects with at least one unplanned, all-cause hospitalization or emergency room visit in the prior year, who had elected to enroll in an RPM service for assistance with clinical management. Additional inclusion criteria included being on RPM for at least 12 months and a patient of the practice for at least two years (12 months pre- and post-initiation of RPM).
Results
The study included 126 subjects. RPM was associated with a significantly lower rate of unplanned hospitalizations per patient per year (1.09 ± 0.07 versus 0.38 ± 0.06, P<0.001).
Conclusion
Unplanned, all-cause hospitalization rates were lower in subjects started on RPM for COPD when compared to their prior year. These results support the potential of RPM to improve the long-term management of COPD.
... The frequency of acute COPD exacerbations is associated with disease progression, impaired lung function, and mortality among COPD patients [9]. Exacerbations are mainly caused by viral infections, such as rhinovirus, influenza virus, and RSV (Respiratory Syncytial Virus] [10]. ...
Introduction: Coronavirus infection is a particular risk for patients with chronic obstructive pulmonary disease (COPD), because they are much more likely to become severely ill due to oxygen supply problems. Primary prevention, including COVID-19 vaccination is of paramount importance in this disease group. The aim of our study was to assess COVID-19 vaccination coverage in COPD patients during the first vaccination campaign of the COVID-19 pandemic.
Methods: A cross-sectional observational study (CHANCE) has been conducted in COPD patients in the eastern, western and central regions of Hungary from 15th November 2021. The anthropometric, respiratory function test results and vaccination status of 1,511 randomly selected patients were recorded who were aged 35 years and older.
Results: The median age was 67 (61–72) years, for men: 67 (62–73) and for women: 66 (60–72) years, with 47.98 % men and 52.02 % women in our sample. The prevalence of vaccination coverage for the first COVID-19 vaccine dose was 88.62 %, whereas 86.57 % of the patients received the second vaccine dose. When unvaccinated (n = 172) and double vaccinated (n = 1308) patients were compared, the difference was significant both in quality of life (CAT: 17 (12–23) vs 14 (10–19); p < 0.001) and severity of dyspnea
(mMRC: 2 (2–2) vs 2 (1–2); p = 0.048). The COVID-19 infection rate between double vaccinated and unvaccinated patients was 1.61 % vs 22.67 %; p < 0.001 six months after vaccination. The difference between unvaccinated and vaccinated patients was significant (8.14 % vs 0.08 %; p < 0.001) among those with acute COVID-19 infection hospitalized. In terms of post-COVID symptoms, single or double vaccinated patients had significantly fewer outpatient hospital admissions than unvaccinated patients (7.56
vs 0 %; p < 0.001).
Conclusion: The COVID-19 vaccination coverage was satisfactory in our sample. The uptake of COVID-19 vaccines by patients with COPD is of utmost importance because they are much more likely to develop severe complications.
