The Effects of Air Pollution and #Temperature on #COPD

https://www.researchgate.net/publication/287483743_The_Effects_of_Air_Pollution_and_Temperature_on_COPD

The limited existing data suggests that indoor particulate matter and nitrogen dioxide concentrations are linked to increased respiratory symptoms among patients with COPD. In addition, with the projected increases in temperature and extreme weather events in the context of climate change there has been increased attention to the effects of heat exposure.

#Metformin and Health Care Utilization in Patients With Coexisting #COPD and Diabetes

https://lnkd.in/exYiP2p

CONCLUSIONS: Our study showed that patient with coexisting chronic obstructive pulmonary disease and diabetes mellitus who received metformin were less likely to be admitted to the hospital for all cause and COPD related hospitalization as compared to those on insulin during the 2 year follow up period

A Randomized Trial of Long-Term #Oxygen for #COPD with Moderate Desaturation https://lnkd.in/eCi-qyG In patients with stable COPD and resting or exercise-induced moderate desaturation, the prescription of long-term supplemental oxygen did not result in a longer time to death or first hospitalization than no long-term supplemental oxygen, nor did it provide sustained benefit with regard to any of the other measured outcomes

Effect of Home Noninvasive #Ventilation With #Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute #COPD Exacerbation
A Randomized Clinical Trial http://jamanetwork.com/journals/jama/fullarticle/2627985 Importance Outcomes after exacerbations of chronic obstructive pulmonary disease (COPD) requiring acute noninvasive ventilation (NIV) are poor and there are few treatments to prevent hospital readmission and death. The median time to readmission or death was 4.3 months (IQR, 1.3-13.8 months) in the home oxygen plus home NIV group vs 1.4 months (IQR, 0.5-3.9 months) in the home oxygen alone group, adjusted hazard ratio of 0.49 (95% CI, 0.31-0.77; P = .002). The 12-month risk of readmission or death was 63.4% in the home oxygen plus home NIV group vs 80.4% in the home oxygen alone group, absolute risk reduction of 17.0% (95% CI, 0.1%-34.0%). At 12 months, 16 patients had died in the home oxygen plus home NIV group vs 19 in the home oxygen alone group. Conclusions and Relevance Among patients with persistent hypercapnia following an acute exacerbation of COPD, adding home noninvasive ventilation to home oxygen therapy prolonged the time to readmission or death within 12 months.

Adverse cardiac events associated with incident #opioid drug use among older adults with #COPD

https://link.springer.com/article/10.1007/s00228-017-2278-3

We evaluated whether incident opioid drug use was associated with adverse cardiac events among older adults with chronic obstructive pulmonary disease (COPD).

Incident use of any opioid was associated with significantly decreased rates of emergency room (ER) visits and hospitalizations for congestive heart failure (CHF) among community-dwelling older adults (HR 0.84; 95% CI 0.73–0.97), but significantly increased rates of ischemic heart disease (IHD)-related mortality among long-term care residents (HR 2.15; 95% CI 1.50–3.09). In the community-dwelling group, users of more potent opioid-only agents without aspirin or acetaminophen combined had significantly increased rates of ER visits and hospitalizations for IHD (HR 1.38; 95% CI 1.08–1.77) and IHD-related mortality (HR 1.83; 95% CI 1.32–2.53).

Conclusions

New opioid use was associated with elevated rates of IHD-related morbidity and mortality among older adults with COPD. Adverse cardiac events may need to be considered when administering new opioids to older adults with COPD, but further studies are required to establish if the observed associations are causal or related to residual confounding.

#COPD and #asthma: the emergency is clear, now is the time for action
http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(17)30308-9/fulltext

An excellent Article1 has been published in The Lancet Respiratory Medicine on the risk and disease estimates of chronic obstructive pulmonary disease (COPD) and asthma as part of the Global Burden of Disease Study (GBD) 2015. The Article provides a good overview of the mortality, prevalence, disability-adjusted life years (DALYs), and years lived with disability for the two most common respiratory diseases. The findings show that the prevalence of and mortality due to COPD, as well as the prevalence of asthma, increased between 1990 and 2015. However, age-standardised results indicate that this phenomenon is mainly due to an ageing population. Globally, more than 174 million people have COPD and more than 358 million people have asthma. With an ageing population, this number is expected to increase, especially for COPD. Mortality due to COPD is eight times higher than mortality due to asthma. COPD and—to a lesser extent—asthma clearly impose a substantial burden in terms of both impaired quality of life and physical, psychological, and social disability

Childhood #predictors of lung function trajectories and future #COPD risk: a prospective cohort study from the first to the sixth decade of life

http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(18)30100-0/fulltext

Of the 8583 participants in the original cohort, 2438 had at least two waves of lung function data at age 7 years and 53 years and comprised the study population. We identified six trajectories: early below average, accelerated decline (97 4% participants); persistently low (136 6% participants); early low, accelerated growth, normal decline (196 8% participants); persistently high (293 12% participants); below average (772 32% participants); and average (944 39% participants). The three trajectories early below average, accelerated decline; persistently low; and below average had increased risk of COPD at age 53 years compared with the average group (early below average, accelerated decline: odds ratio 35·0, 95% CI 19·5–64·0; persistently low: 9·5, 4·5–20·6; and below average: 3·7, 1·9–6·9). Early-life predictors of the three trajectories included childhood asthma, bronchitis, pneumonia, allergic rhinitis, eczema, parental asthma, and maternal smoking. Personal smoking and active adult asthma increased the impact of maternal smoking and childhood asthma, respectively, on the early below average, accelerated decline trajectory.

Interpretation
We identified six potential FEV1 trajectories, two of which were novel. Three trajectories contributed 75% of COPD burden and were associated with modifiable early-life exposures whose impact was aggravated by adult factors. We postulate that reducing maternal smoking, encouraging immunisation, and avoiding personal smoking especially in those with smoking parents or low childhood lung function, might minimise COPD risk. Clinicians and patients with asthma should be made aware of the potential long-term implications of non-optimal asthma control for lung function trajectory throughout life, and the role and benefit of optimal asthma control on improving lung function should be investigated in future intervention trials

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Once-Daily Single-Inhaler #Triple versus Dual Therapy in Patients with #COPD

https://www.nejm.org/doi/full/10.1056/NEJMoa1713901?query=featured_home


The rate of moderate or severe exacerbations in the triple-therapy group was 0.91 per year, as compared with 1.07 per year in the fluticasone furoate–vilanterol group (rate ratio with triple therapy, 0.85; 95% confidence interval CI, 0.80 to 0.90; 15% difference; P<0.001) and 1.21 per year in the umeclidinium–vilanterol group (rate ratio with triple therapy, 0.75; 95% CI, 0.70 to 0.81; 25% difference; P<0.001). The annual rate of severe exacerbations resulting in hospitalization in the triple-therapy group was 0.13, as compared with 0.19 in the umeclidinium–vilanterol group (rate ratio, 0.66; 95% CI, 0.56 to 0.78; 34% difference; P<0.001). There was a higher incidence of pneumonia in the inhaled-glucocorticoid groups than in the umeclidinium–vilanterol group, and the risk of clinician-diagnosed pneumonia was significantly higher with triple therapy than with umeclidinium–vilanterol, as assessed in a time-to-first-event analysis (hazard ratio, 1.53; 95% CI, 1.22 to 1.92; P<0.001).

CONCLUSIONS
Triple therapy with fluticasone furoate, umeclidinium, and vilanterol resulted in a lower rate of moderate or severe COPD exacerbations than fluticasone furoate–vilanterol or umeclidinium–vilanterol in this population. Triple therapy also resulted in a lower rate of hospitalization due to COPD than umeclidinium–vilanterol.

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Daily duration of long-term #oxygen therapy and risk of hospitalization in oxygen-dependent #COPD patients

https://www.dovepress.com/daily-duration-of-long-term-oxygen-therapy-and-risk-of-hospitalization-peer-reviewed-article-COPD


A total of 2,249 patients with COPD (59% women) were included. LTOT 24 h/d was prescribed to 539 (24%) and LTOT 15–16 h/d to 1,231 (55%) patients. During a median follow-up of 1.1 years (interquartile range, 0.6–2.1 years), 1,702 (76%) patients were hospitalized. No patient was lost to follow-up. The adjusted rate of all-cause hospitalization was similar between LTOT 24 and 15–16 h/d (subdistribution hazard ratio SHR 0.96; 95% CI 0.84–1.08), as was cause-specific hospitalizations analyzed for respiratory disease (SHR: 1.00; 95% CI: 0.86–1.17) and nonrespiratory disease (SHR: 0.92; 95% CI: 0.75–1.14).
Conclusion: LTOT prescribed for 24 h/d was not associated with decreased hospitalization rates compared with LTOT for 15–16 h/d in patients with oxygen-dependent COPD. The results should be validated in a randomized controlled trial.

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#Triple therapy in the management of chronic obstructive pulmonary disease: systematic review and meta-analysis

https://www.bmj.com/content/363/bmj.k4388

21 trials (19 publications) were included. Triple therapy consisted of a long acting muscarinic antagonist (LAMA), long acting β agonist (LABA), and inhaled corticosteroid (ICS). Triple therapy was associated with a significantly reduced rate of moderate or severe exacerbations compared with LAMA monotherapy (rate ratio 0.71, 95% confidence interval 0.60 to 0.85), LAMA and LABA (0.78, 0.70 to 0.88), and ICS and LABA (0.77, 0.66 to 0.91). Trough forced expiratory volume in 1 second (FEV1) and quality of life were favourable with triple therapy.

The overall safety profile of triple therapy is reassuring, but #pneumonia was significantly higher with triple therapy than with dual therapy of LAMA and LABA (relative risk 1.53, 95% confidence interval 1.25 to 1.87).

Conclusions Use of triple therapy resulted in a lower rate of moderate or severe exacerbations of #COPD, better lung function, and better health related quality of life than dual therapy or monotherapy in patients with advanced COPD.

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Chronic Obstructive Pulmonary Disease Prevalence Among Adults Who Have Never Smoked, by #Industry and Occupation — United States, 2013–2017

https://www.cdc.gov/mmwr/volumes/68/wr/mm6813a2.htm

Highest prevalences were among workers aged ≥65 years (4.6%), women (3.0%), and those reporting fair/poor health (6.7%). Among industries and occupations, the highest #COPD prevalences were among workers in the information industry (3.3%) and office and administrative support occupations (3.3%).

Among women, the highest prevalences were among those employed in the information industry (5.1%) and in the transportation and material moving occupation (4.5%), and among men, among those employed in the agriculture, forestry, fishing, and hunting industry (2.3%) and the administrative and support, waste management, and remediation services industry (2.3%). High COPD prevalences in certain industries and occupations among persons who have never smoked underscore the importance of continued surveillance, early identification of COPD, and reduction or elimination of COPD-associated risk factors, such as the reduction of workplace exposures to dust, vapors, fumes, chemicals, and exposure to indoor and outdoor air pollutants.

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#C-Reactive Protein Testing to Guide Antibiotic Prescribing for #COPD Exacerbations

https://www.nejm.org/doi/full/10.1056/NEJMoa1803185

Point-of-care testing of C-reactive protein (CRP) may be a way to reduce unnecessary use of antibiotics without harming patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD).

A lower percentage of patients in the CRP-guided group than in the usual-care group received an antibiotic prescription at the initial consultation (47.7% vs. 69.7%, for a difference of 22.0 percentage points; adjusted odds ratio, 0.31; 95% CI, 0.21 to 0.45) and during the first 4 weeks of follow-up (59.1% vs. 79.7%, for a difference of 20.6 percentage points; adjusted odds ratio, 0.30; 95% CI, 0.20 to 0.46). Two patients in the usual-care group died within 4 weeks after randomization from causes considered by the investigators to be unrelated to trial participation.

CONCLUSIONS
CRP-guided prescribing of antibiotics for exacerbations of COPD in primary care clinics resulted in a lower percentage of patients who reported antibiotic use and who received antibiotic prescriptions from clinicians, with no evidence of harm.

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#Metoprolol for the Prevention of Acute Exacerbations of #COPD

Observational studies suggest that beta-blockers may reduce the risk of exacerbations and death in patients with moderate or severe chronic obstructive pulmonary disease (COPD), but these findings have not been confirmed in randomized trials.

. There was no significant between-group difference in the median time until the first exacerbation, which was 202 days in the metoprolol group and 222 days in the placebo group (hazard ratio for metoprolol vs. placebo, 1.05; 95% confidence interval [CI], 0.84 to 1.32; P=0.66). Metoprolol was associated with a higher risk of exacerbation leading to hospitalization (hazard ratio, 1.91; 95% CI, 1.29 to 2.83). The frequency of side effects that were possibly related to metoprolol was similar in the two groups, as was the overall rate of nonrespiratory serious adverse events. During the treatment period, there were 11 deaths in the metoprolol group and 5 in the placebo group.

CONCLUSIONS
Among patients with moderate or severe COPD who did not have an established indication for beta-blocker use, the time until the first COPD exacerbation was similar in the metoprolol group and the placebo group. Hospitalization for exacerbation was more common among the patients treated with metoprolol.

https://www.nejm.org/doi/full/10.1056/NEJMoa1908142

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C-Reactive Protein Testing to Guide Antibiotic Prescribing for #COPD Exacerbations

Point-of-care testing of C-reactive protein (#CRP) may be a way to reduce unnecessary use of antibiotics without harming patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD).

A lower percentage of patients in the CRP-guided group than in the usual-care group received an antibiotic prescription at the initial consultation (47.7% vs. 69.7%, for a difference of 22.0 percentage points; adjusted odds ratio, 0.31; 95% CI, 0.21 to 0.45) and during the first 4 weeks of follow-up (59.1% vs. 79.7%, for a difference of 20.6 percentage points; adjusted odds ratio, 0.30; 95% CI, 0.20 to 0.46). Two patients in the usual-care group died within 4 weeks after randomization from causes considered by the investigators to be unrelated to trial participation.

CONCLUSIONS
CRP-guided prescribing of antibiotics for exacerbations of COPD in primary care clinics resulted in a lower percentage of patients who reported antibiotic use and who received antibiotic prescriptions from clinicians, with no evidence of harm.

https://www.nejm.org/doi/10.1056/NEJMoa1803185

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Comparisons of exacerbations and mortality among regular inhaled therapies for patients with stable chronic obstructive pulmonary disease: Systematic review and Bayesian network meta-analysis

..Compared with placebo, all drug classes significantly reduced the total exacerbations and moderate to severe exacerbations. ICS/LAMA/LABA was the most efficacious treatment for reducing the exacerbation risk (odds ratio [OR] = 0.57; 95% credible interval [CrI] 0.50–0.64; posterior probability of OR > 1 [P(OR > 1)] < 0.001). In addition, in contrast to the other drug classes, ICS/LAMA/LABA and ICS/LABA were associated with a significantly higher probability of reducing mortality than placebo (OR = 0.74, 95% CrI 0.59–0.93, P[OR > 1] = 0.004; and OR = 0.86, 95% CrI 0.76–0.98, P[OR > 1] = 0.015, respectively).

The results minimally changed, even in various sensitivity and covariate-adjusted meta-regression analyses. ICS/LAMA/LABA tended to lower the risk of cardiovascular mortality but did not show significant results. ICS/LAMA/LABA increased the probability of pneumonia (OR for triple therapy = 1.56; 95% CrI 1.19–2.03; P[OR > 1] = 1.000). The main limitation is that there were few RCTs including only less symptomatic patients or patients at a low risk.

Conclusions
These findings suggest that triple therapy can potentially be the best option for stable #COPD patients in terms of reducing exacerbation and all-cause mortality.

https://journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.1002958&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+plosmedicine%2FNewArticles+%28PLOS+Medicine+-+New+Articles%29

Lung #MRI as a Potential Complementary Diagnostic Tool for Early #COPD

Many knowledge gaps in the nature of early chronic obstructive pulmonary disease (COPD) still exist, mainly because COPD has always been considered a disease of the elderly. Little attention has been paid to the pathologic changes in the lungs of young adults with risk factors for COPD, such as bronchopulmonary dysplasia. One major limitation is the current lack of noninvasive ways to sensitively measure or image functional declines from subjects who are at risk for COPD but haven't yet developed more significant clinical symptoms of the disease.

Methods

We report the use of lung magnetic resonance imaging with hyperpolarized gas in the diagnostic workup for bronchopulmonary dysplasia with underlying chronic airflow limitation in presence of spirometry criteria that meet the diagnosis of early-onset COPD.

Conclusions

In the postsurfactant era, where more young adults will be spirometrically diagnosed with COPD, patients should be classified not only on the basis of their airflow limitation, but also on lung abnormalities identified with safe, comprehensive imaging technologies that allow regular, longitudinal follow-up.

https://bit.ly/3bUazPl

Factors associated with #sleep disturbance in patients with chronic #obstructive pulmonary disease
https://2medical.news/2020/08/07/factors-associated-with-sleep-disturbance-in-patients-with-chronic-obstructive-pulmonary-disease/

Poor sleep quality in patients with chronic obstructive pulmonary disease (#COPD ) has been associated with poor health outcomes. However, there is a lack of research on factors associated with sleep disturbance in patients with COPD.. This was a prospective, multicenter cross‐sectional study enrolling a sample of 245 COPD subjects. All patients completed the patient‐reported measure, the COPD and Asthma Sleep Impact Scale (CASIS) to …

Interstitial #lung abnormalities and the clinical course in patients with #COPD
https://2medical.news/2020/09/06/interstitial-lung-abnormalities-and-the-clinical-course-in-patients-with-copd/

The presence and progression of interstitial lung abnormalities (ILA) is known to be associated with a decline of lung function and increased risk of mortality. Research question We aimed to elucidate the clinical course according to ILA in patients with chronic obstructive pulmonary disease (COPD).. ..Of 363 patients with COPD, 44 and 103 patients had equivocal and definite ILA, respectively. Patients with ILA were significantly …