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Latest & greatest articles for copd exacerbations
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Benralizumab for the Prevention of COPDExacerbations. The efficacy and safety of benralizumab, an interleukin-5 receptor alpha-directed cytolytic monoclonal antibody, for the prevention of exacerbations in patients with moderate to very severe chronicobstructivepulmonarydisease (COPD) are not known.In the GALATHEA and TERRANOVA trials, we enrolled patients with COPD (at a ratio of approximately 2:1 on the basis of eosinophil count [≥220 per cubic millimeter vs. <220 per cubic millimeter (...) ]) who had frequent exacerbations despite receiving guideline-based inhaled treatment. Patients were randomly assigned to receive benralizumab (30 or 100 mg in GALATHEA; 10, 30, or 100 mg in TERRANOVA) every 8 weeks (every 4 weeks for the first three doses) or placebo. The primary end point was the treatment effect of benralizumab, measured as the annualized COPDexacerbation rate ratio (benralizumab vs. placebo) at week 56 in patients with baseline blood eosinophil counts of 220 per cubic millimeter
Effect of Aclidinium Bromide on Major Cardiovascular Events and Exacerbations in High-Risk Patients With ChronicObstructivePulmonaryDisease: The ASCENT-COPD Randomized Clinical Trial. There is concern that long-acting muscarinic antagonists increase cardiovascular morbidity or mortality in patients with chronicobstructivepulmonarydisease (COPD).To determine the cardiovascular safety (noninferiority) and efficacy (superiority) of aclidinium bromide, 400 μg twice daily, in patients (...) %]), and upper respiratory tract infection (aclidinium, 86 events [4.8%]; placebo, 101 events [5.6%]).Among patients with COPD and increased cardiovascular risk, aclidinium was noninferior to placebo for risk of MACE over 3 years. The rate of moderate to severe COPDexacerbations was reduced over the first year.ClinicalTrials.gov Identifier: NCT01966107.
People with chronicobstructivepulmonarydiseaseexacerbations prefer early discharge, then treatment at home. The studyHome treatment of COPDexacerbation selected by DECAF score: a non-inferiority, randomised controlled trial and economic evaluationEchevarria C, Gray J, Hartley T, Miller J, Simpson AJ, Gibson GJ, Bourke SCPublished on 24 April 2018 Thorax 2018;73:713-22This project was funded by the National Institute for Health Research-Research for Patient Benefit Programme (project number (...) PB-PG-0213-30105).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000691/hospital-at-home-treatment-for-copd-flare-ups.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Capturing Exacerbations of ChronicObstructivePulmonaryDisease with EXACT. A Subanalysis of FLAME Chronicobstructivepulmonarydiseaseexacerbations accelerate lung function decline, reduce quality of life, and increase mortality. A subset of patients (n = 457) from the FLAME (Effect of Indacaterol Glycopyrronium vs. Fluticasone Salmeterol on COPDExacerbations) study used the Exacerbations of COPD Tool (EXACT) to capture symptom-defined exacerbations.To evaluate the effect of indacaterol (...) /glycopyrronium versus salmeterol/fluticasone on symptom-defined exacerbations measured using EXACT, and to assess differences between these events and exacerbations requiring healthcare resource use (HCRU).All patients in FLAME used an electronic diary to record and detect symptom deteriorations; HCRU-related exacerbations were confirmed by investigators. In patients using the EXACT questionnaire, the onset, recovery, and magnitude of symptom-defined exacerbations were identified by changes in total scores
of moderate aggravation in patients with chronicobstructivepulmonarydisease (COPD), it is preferable to prescribe antibiotics as a first-line treatment only when the suspicion of bacterial infection is reinforced by an increase in sputum purulence. Patients with chronicobstructivepulmonarydisease (COPD) are subject to exacerbations of their disease, i.e. episodes of prolonged aggravation. The known causes are mainly viral and bacterial infections. Some exacerbations justify hospitalisation: severe (...) COPD, rapid increase in respiratory signs, presence of associated diseases (e.g. diabetes, cardiovascular diseases). When exacerbation is moderate, the results of available trials show that seven out of ten patients recover in less than four weeks without antibiotics. About one in ten patients heals faster with antibiotic therapy, which may also extend the interval until the next exacerbation. Antibiotic therapies expose patients to the carrying of resistant bacteria, which are sources of harder
for primary care [ ], Management of COPDexacerbations: a European Respiratory Society/American Thoracic Society guideline [ ] and Global initiative for chronicobstructivelungdisease. Global strategy for the diagnosis, management, and prevention of chronicobstructivepulmonarydisease. 2019 repor t [ ]. Recommendation on oxygen administration are taken from the British Thoracic Society guideline BTS guideline for oxygen use in adults in healthcare and emergency settings [ ] which states (...) [ ], and the clinical guidelines COPD-X: concise guide for primary care [ ] and Global initiative for chronicobstructivelungdisease (GOLD). Global strategy for the diagnosis, management, and prevention of chronicobstructivepulmonarydisease. 2019 repor t [ ]. Short-acting bronchodilators — clinical guidance from NICE, GOLD and the Lung Foundation Australia is in agreement on increasing the dose or frequency of use of inhaled medication for acute exacerbations of COPD. NICE did not review the evidence
the lung and dissipating phlegm method in the treatment of acute exacerbation of chronicobstructivepulmonarydisease: A systematic review and meta-analysis. World J Tradit Chin Med [serial online] 2019 [cited 2021 Feb 2];5:61-9. Available from: Introduction The 2018 Global Initiative for ChronicObstructiveLungDisease (COLD) has re-defined the chronicobstructivepulmonarydisease (COPD) as a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms (...) of the clearing the lung and dissipating phlegm method in the treatment of acute exacerbation of chronicobstructivepulmonarydisease (COPD) and to provide evidence for the treatment of the disease. Materials and Methods: Literature was searched from the United States National Library of Medicine (PubMed), Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database (Wanfang), and the Full-Text Database of Chinese Scientific and Technical Periodicals (VIP). A comprehensive collection
Nebulized terbutaline & ipratropium bromide vs terbutaline alone in acute exacerbation of COPD requiring noninvasive ventilation: a randomized double blind controlled trial Short-acting β2 -agonists are the mainstay of treatment of patients with acute exacerbation of chronicobstructivepulmonarydisease (AECOPD) in the emergency department (ED). It is still unclear whether the addition of short-acting anticholinergics is clinically more effective care compared to treatment with β2 -agonists (...) regarding baseline demographic and clinical characteristics. Hospital admission was observed in 70 patients (59.8%) in the terbutaline/IB group and in 75 patients (65.2%) in the terbutaline group (respiratory rate [RR] = 1.09, 95% confidence interval [CI] = 0.93 to 1.27, p = 0.39). ICU admission was required in 37 (32.2%) patients in the terbutaline/IB group and 30 patients (25.6%) in terbutaline group (RR = 1.25, 95% CI = 1.02 to 1.54, p = 0.27). There were no significant differences in dyspnea score
Effect of Theophylline as Adjunct to Inhaled Corticosteroids on Exacerbations in Patients With COPD: A Randomized Clinical Trial. Chronicobstructivepulmonarydisease (COPD) is a major global health issue and theophylline is used extensively. Preclinical investigations have demonstrated that low plasma concentrations (1-5 mg/L) of theophylline enhance antiinflammatory effects of corticosteroids in COPD.To investigate the effectiveness of adding low-dose theophylline to inhaled corticosteroids (...) in COPD.The TWICS (theophylline with inhaled corticosteroids) trial was a pragmatic, double-blind, placebo-controlled, randomized clinical trial that enrolled patients with COPD between February 6, 2014, and August 31, 2016. Final follow-up ended on August 31, 2017. Participants had a ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) of less than 0.7 with at least 2 exacerbations (treated with antibiotics, oral corticosteroids, or both) in the previous year and were
Use of adjunct cardiovascular therapy in patients hospitalised for acute exacerbations of COPD In real-life practice, acute exacerbation of COPD is often treated as a cardiopulmonary syndrome http://ow.ly/uAnk30luMYz.
Circulating eosinophil levels do not predict severe exacerbations in COPD: a retrospective study Whether the level of circulating eosinophils in chronicobstructivepulmonarydisease (COPD) patients can predict the risk of exacerbations of COPD (ECOPD) or response to treatment is debated. Here, we evaluate the prevalence of elevated eosinophils in COPD patients and its relationship with severe ECOPD requiring hospitalisation. We retrospectively reviewed the charts of COPD patients hospitalised (...) patients, 121 had one or more ECOPD during the year after the index event. The prevalence of eosinophils ≥2% was 72% in ECOPD patients and 71% in controls (p=0.93). Among ECOPD patients, eosinophil levels ≥2%, ≥4% or ≥300 cells·μL-1, either when clinically stable or during hospitalisation, did not show a significant association with the rate of recurrent severe exacerbations. The severity of airflowlimitation was associated with recurrent exacerbations, but inhaled corticosteroid treatment
exacerbations : a European Respiratory Society/American Thoracic Society guideline Jadwiga A. Wedzicha (ERS co-chair) , Marc Miravitlles , John R. Hurst , Peter M.A (...) of chronicobstructivepulmonarydisease ( COPD ) exacerbations . Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach (...) Week 08, Ovid 2011 12. Management of COPDexacerbations : a European Respiratory Society/American Thoracic Society guideline. This document provides clinical recommendations for treatment of chronicobstructivepulmonarydisease ( COPD ) exacerbations.Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development
):450 17. Papala M, Kerenidi N, Gourgoulianis KI (2013) Everyday clinical practice and its relationship to 2010 and 2011 GOLD guideline recommendations for the management of COPD[J. Prim Care Respir J 22(3:362–364 18. Lim BL, Kelly AM (2010) A meta-analysis on the utility of peripheral venous blood gas analyses in exacerbations of chronicobstructivepulmonarydisease in the emergency department[J. Eur J Emerg Med 17(5):246–248 19. Adrogue H J, Madias N E. Influence of chronicrespiratory acid-base (...) − -Schätzungen verglichen werden kann. Für pO 2 gilt dies dagegen nicht. Introduction Chronicobstructivepulmonarydisease (COPD) is one of the heaviest burdens placed on medical institutions, not to mention governments, all over the world [ ]. Acute exacerbation of COPD (AECOPD) is defined as a progressive deterioration of ventilatory function in patients with COPD, leading to hypoxia and hypercarbia [ ]. Arterial blood gas (ABG) is a gold standard to obtain information on the potential of hydrogen (pH
Intensified Therapy with Inhaled Corticosteroids and Long-Acting beta2-Agonists at the Onset of Upper Respiratory Tract Infection to Prevent ChronicObstructivePulmonaryDiseaseExacerbations. A Multicenter, Randomized, Double-Blind, Placebo-controlled T The efficacy of intensified combination therapy with inhaled corticosteroids (ICS) and long-acting β2-agonists (LABA) at the onset of upper respiratory tract infection (URTI) symptoms in chronicobstructivepulmonarydisease (COPD (...) analysis, effect size was modified by disease severity, fractional exhaled nitric oxide, and the body mass index-airflowobstruction-dyspnea, and exercise score. Compared with the stable period, evidence of at least one virus was significantly more common at URTI, 10 days after URTI, and at exacerbation.Intensified combination therapy with ICS/LABA for 10 days at URTI onset did not decrease the incidence of any COPDexacerbation but prevented severe exacerbation. Patients with more severe disease had
Home treatment of COPDexacerbation selected by DECAF score: a non-inferiority, randomised controlled trial and economic evaluation Previous models of Hospital at Home (HAH) for COPDexacerbation (ECOPD) were limited by the lack of a reliable prognostic score to guide patient selection. Approximately 50% of hospitalised patients have a low mortality risk by DECAF, thus are potentially suitable.In a non-inferiority randomised controlled trial, 118 patients admitted with a low-risk ECOPD (DECAF 0 (...) or 1) were recruited to HAH or usual care (UC). The primary outcome was health and social costs at 90 days.Mean 90-day costs were £1016 lower in HAH, but the one-sided 95% CI crossed the non-inferiority limit of £150 (CI -2343 to 312). Savings were primarily due to reduced hospital bed days: HAH=1 (IQR 1-7), UC=5 (IQR 2-12) (P=0.001). Length of stay during the index admission in UC was only 3 days, which was 2 days shorter than expected. Based on quality-adjusted life years, the probability of HAH
Dapagliflozin for prednisone-induced hyperglycaemia in acute exacerbation of chronicobstructivepulmonarydisease The aim of the present study was to compare the effectiveness and safety of add-on treatment with dapagliflozin to placebo in patients with prednisone-induced hyperglycaemia during treatment for acute exacerbation of chronicobstructivepulmonarydisease (AECOPD). We enrolled 46 patients hospitalized for an AECOPD in a multicentre double-blind randomized controlled study in which
Management of chronicobstructivepulmonarydiseaseexacerbations at the Nasser Medical Complex: a clinical audit. The frequency and severity of chronicobstructivepulmonarydisease (COPD) exacerbations are the most important determinants of prognosis in COPD. The aim of this study was to assess the management of patients presenting with COPDexacerbations at the Nasser Medical Complex in the Gaza Strip and to compare the management with the Global Initiative for ChronicObstructiveLung (...) Disease guidelines (GOLD 2015).We reviewed the medical records of all patients admitted to Nasser Medical Complex and diagnosed with COPDexacerbation between Jan 1, 2014, and Dec 31, 2016. Clinical practice was compared with GOLD guidelines. Ethical approval was obtained from the General Directorate of Human Resources.55 patient records were reviewed. The mean age was 66·4 years (SD 8·5), and 54 (98%) patients were male. All patients received inhaled bronchodilators. 36 (65%) patients received short
) and/or diarrhoea, including Clostridium difficile -associated diarrhoea (associated with the use of antibiotics). Definition Chronicobstructivepulmonarydisease (COPD) is "a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflowlimitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases." Global Initiative for ChronicObstructiveLungDisease. Global strategy for the diagnosis (...) , management and prevention of chronicobstructivepulmonarydisease. November 2017 [internet publication] http://goldcopd.org/gold-reports/ An exacerbation of COPD may be defined as "an acute worsening of respiratory symptoms that results in additional therapy." Global Initiative for ChronicObstructiveLungDisease. Global strategy for the diagnosis, management and prevention of chronicobstructivepulmonarydisease. November 2017 [internet publication] http://goldcopd.org/gold-reports/ History and exam