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Latest & greatest articles for copd exacerbations
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ACP Journal Club. Amoxicillin/clavulanate vs placebo: more exacerbation cures, fewer recurrences in mild-to-moderate COPD. 23552686 2013 05 13 2013 04 04 1539-3704 158 6 2013 Mar 19 Annals of internal medicine Ann. Intern. Med. ACP Journal Club. Amoxicillin/clavulanate vs placebo: more exacerbation cures, fewer recurrences in mild-to-moderate COPD. JC3 10.7326/0003-4819-158-6-201303190-02003 Adams Sandra G SG University of Texas Health Science Center at San Antonio and South Texas Veterans
Comorbidities and Short-term Prognosis in Patients Hospitalized for Acute Exacerbation of COPD: The EPOC en Servicios de Medicina Interna (ESMI) Study Comorbidities are frequent in patients hospitalized for COPDexacerbation, but little is known about their relation with short-term mortality and hospital readmissions. Our hypothesis is that the frequency and type of comorbidities impair the prognosis within 12 weeks after discharge.A longitudinal, observational, multicenter study of patients (...) hospitalized for a COPDexacerbation with spirometric confirmation was performed. Comorbidity information was collected using the Charlson index and a questionnaire that included other common conditions not included in this index. Dyspnea, functional status, and previous hospitalization for COPD or other reasons among other variables were investigated. Information on mortality and readmissions for COPD or other causes was collected up to 3 months after discharge.We studied 606 patients, 594 men (89.9
or S2 or S3 or S5 Search modes - Boolean/Phrase 9484 Inhospital Physiotherapy for AECOPD: A Rapid Review. January 2013; pp. 1–28. 23 S5 chronic bronchitis or emphysema Search modes - Boolean/Phrase 1880 S4 (MH "Emphysema+") Search modes - Boolean/Phrase 1189 S3 copd or coad Search modes - Boolean/Phrase 5022 S2 (chronicobstructive and (lung* or pulmonary or airway* or airflow or respiratory) and (disease* or disorder*)) Search modes - Boolean/Phrase 7495 S1 (MH "PulmonaryDisease, Chronic (...) Inhospital Physiotherapy for AECOPD: A Rapid Review. January 2013; pp. 1–28. 20 Cochrane Library ID Search Hits #1 MeSH descriptor: [PulmonaryDisease, ChronicObstructive] explode all trees 1838 #2 chronic near/2 obstructive near/2 (lung* or pulmonary or airway* or airflow or respiratory) next (disease* or disorder*):ti,ab,kw OR copd or coad:ti,ab,kw OR chronicairflow obstruction:ti,ab,kw 7234 #3 MeSH descriptor: [Emphysema] explode all trees 92 #4 (chronic near/2 bronchitis) or emphysema:ti,ab,kw 1932
Short-term vs Conventional Glucocorticoid Therapy in Acute Exacerbations of ChronicObstructivePulmonaryDisease: The REDUCE Randomized Clinical Trial. International guidelines advocate a 7- to 14-day course of systemic glucocorticoid therapy in acute exacerbations of chronicobstructivepulmonarydisease (COPD). However, the optimal dose and duration are unknown.To investigate whether a short-term (5 days) systemic glucocorticoid treatment in patients with COPDexacerbation is noninferior (...) to conventional (14 days) treatment in clinical outcome and whether it decreases the exposure to steroids. DESIGN, SETTING, AND PATIENTS REDUCE: (Reduction in the Use of Corticosteroids in ExacerbatedCOPD), a randomized, noninferiority multicenter trial in 5 Swiss teaching hospitals, enrolling 314 patients presenting to the emergency department with acute COPDexacerbation, past or present smokers (≥20 pack-years) without a history of asthma, from March 2006 through February 2011.Treatment with 40 mg
Are Routine Antibiotics Beneficial For Exacerbations of ChronicObstructivePulmonaryDisease? SystematicReviewSnapshot TAKE-HOME MESSAGE Despite some limitations in current evidence, antibiotics appear to be bene?cial for patients with acute exacerbations of chronicobstructivepulmonarydisease, particularly those of higher severity. METHODS DATA SOURCES The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Litera- ture, Allied (...) . 2. Hoyert DL, Xu J, et al. Deaths: preliminary data for 2011. Natl Vital Stat Rep. 2012; 61:1-51. 3. Tsai CL, Griswold SK, Clark S, et al. Factors associated with frequency of emergency department visits for chronicobstructivepulmonarydiseaseexacerbation. J Gen Intern Med. 2007;22: 799-804. 4. Dalal AA, Shah M, D’Souza AO, et al. Costs of COPDexacerbations in the emergency department and inpatient setting. Respir Med. 2011;105:454- 460. 5. Rabe KF, Wedzicha JA. Controversies in treatment
of this assessment has been made for the HTA database. Citation McCurdy BR. Inhospital physiotherapy for acute exacerbations of chronicobstructivepulmonarydisease (AECOPD): a rapid review. Toronto: Health Quality Ontario (HQO). Rapid Review. 2013 Authors' conclusions There is low quality evidence that certain airway clearance techniques have beneficial impacts on some outcomes, as described below: Airway clearance techniques that apply a positive pressure to the airways, such as intrapulmonary percussive (...) Inhospital Physiotherapy for Acute Exacerbations of ChronicObstructivePulmonaryDisease (AECOPD): A Rapid Review Inhospital physiotherapy for acute exacerbations of chronicobstructivepulmonarydisease (AECOPD): a rapid review Inhospital physiotherapy for acute exacerbations of chronicobstructivepulmonarydisease (AECOPD): a rapid review McCurdy BR Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality
Efficacy of antibiotic therapy for acute exacerbations of mild to moderate chronicobstructivepulmonarydisease Antimicrobial therapy remains a controversial issue in nonsevere exacerbations of chronicobstructivepulmonarydisease (COPD).To evaluate the efficacy of antibiotic therapy in moderate exacerbations of mild-to-moderate COPD.This study involved a multicenter, parallel, double-blind, placebo-controlled, randomized clinical trial. Patients aged 40 years or older, smokers, or ex-smokers (...) of 10 pack-years or more with spirometrically confirmed mild-to-moderate COPD (FEV(1) > 50% predicted and FEV(1)/FVC ratio < 0.7) and diagnosed with an exacerbation were enrolled in the study. The patients were randomized to receive amoxicillin/clavulanate 500/125 mg three times a day or placebo three times a day for 8 days.The primary outcome measure was clinical cure at end of therapy visit (EOT) at Days 9 to 11. A total of 310 subjects fulfilled all the criteria for efficacy analysis. A total
Hospital-at-home programs for patients with acute exacerbations of chronicobstructivepulmonarydisease (COPD): an evidence-based analysis Hospital-at-home programs for patients with acute exacerbations of chronicobstructivepulmonarydisease (COPD): an evidence-based analysis Hospital-at-home programs for patients with acute exacerbations of chronicobstructivepulmonarydisease (COPD): an evidence-based analysis McCurdy BR Record Status This is a bibliographic record of a published health (...) technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation McCurdy BR. Hospital-at-home programs for patients with acute exacerbations of chronicobstructivepulmonarydisease (COPD): an evidence-based analysis. Toronto: Medical Advisory Secretariat (MAS). Volume 12(10). 2012 Authors' objectives The objective of this analysis was to compare hospital-at-home care with inpatient hospital care for patients with acute
therapeutic use Forced Expiratory Volume Humans Macrolides adverse effects pharmacology therapeutic use Male Middle Aged PulmonaryDisease, ChronicObstructive immunology prevention & control Respiratory Function Tests 2012 7 27 6 0 2012 7 27 6 0 2012 8 3 6 0 ppublish 22830464 10.1056/NEJMct1115170 (...) Antibiotic Prevention of Acute Exacerbations of COPD. 22830464 2012 08 02 2012 11 08 1533-4406 367 4 2012 Jul 26 The New England journal of medicine N. Engl. J. Med. Antibiotic prevention of acute exacerbations of COPD. 340-7 10.1056/NEJMct1115170 Wenzel Richard P RP Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, USA. email@example.com Fowler Alpha A AA 3rd Edmond Michael B MB eng Journal Article Review United States N Engl J Med 0255562 0028-4793
Dyspnoea severity and pneumonia as predictors of in-hospital mortality and early readmission in acute exacerbations of COPD Rates of mortality and readmission are high in patients hospitalised with acute exacerbations of chronicobstructivepulmonarydisease (AECOPD). In this population, the prognostic value of the Medical Research Council Dyspnoea Scale (MRCD) is uncertain, and an extended MRCD (eMRCD) scale has been proposed to improve its utility. Coexistent pneumonia is common and, although (...) readmitted within 28 days of discharge. During their stable state prior to admission, 34.2% of patients were too breathless to leave the house. Mortality was significantly higher in pneumonic than in non-pneumonic exacerbations (20.1% vs 5.8%, p<0.001). eMRCD was a significantly better discriminator than either CURB-65 or the traditional MRCD scale for predicting in-hospital mortality, and was a stronger prognostic tool than CURB-65 in the subgroup of patients with pneumonic AECOPD.The severity
Validation of a novel risk score for severity of illness in acute exacerbations of COPD Clinicians lack a validated tool for risk stratification in acute exacerbations of COPD (AECOPD). We sought to validate the BAP-65 (elevated BUN, altered mental status, pulse > 109 beats/min, age > 65 years) score for this purpose.We analyzed 34,699 admissions to 177 US hospitals (2007) with either a principal diagnosis of AECOPD or acute respiratory failure with a secondary diagnosis of AECOPD. Hospital
Effect of long-acting beta-agonists on the frequency of COPDexacerbations: a meta-analysis Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Procalcitonin and C-Reactive Protein in Hospitalized Adult Patients With Community-Acquired Pneumonia or Exacerbation of Asthma or COPD Antibiotic overuse in respiratory illness is common and is associated with drug resistance and hospital-acquired infection. Biomarkers that can identify bacterial infections may reduce antibiotic prescription. We aimed to compare the usefulness of the biomarkers procalcitonin and C-reactive protein (CRP) in patients with pneumonia or exacerbations of asthma (...) or COPD.Patients with a diagnosis of community-acquired pneumonia or exacerbation of asthma or COPD were recruited during the winter months of 2006 to 2008. Demographics, clinical data, and blood samples were collected. Procalcitonin and CRP concentrations were measured from available sera.Sixty-two patients with pneumonia, 96 with asthma, and 161 with COPD were studied. Serum procalcitonin and CRP concentrations were strongly correlated (Spearman rank correlation coefficient [rs] = 0.56, P < .001). Patients
COPD, chronicobstructivepulmonarydisease; FEV1, forced expiratory volume in one second; FVC, forced vital capacity; ICU, intensive care unit; ITU, intensive treatment unit. Clinical Bottom Line In line with NICE guidelines, oral steroids should be given to patients with acute exacerbations of COPD in the absence of any contraindications. Level of Evidence Level 1 - Recent well-done systematic review was considered or a study of high quality is available. References de Jong YP, Uil SM, Grotjohan (...) MEDLINE 1948 to Feb Week 4 2011 with the following search strategy ((COPD OR coad).af OR (‘chronicobstructive’ adj3 disease).af) AND (steroid.af) AND (intravenous.af OR oral.af) AND ((acute OR emergen$ OR urgen$ OR decompensat$ OR sudden).af) Search Outcome One-hundred and seventy-four papers were found, of which two were considered relevant to the three-part question. Relevant Paper(s) Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses de Jong
Pulmonary rehabilitation effective following exacerbations of chronicobstructivepulmonarydisease PEARLS Practical Evidence About Real Life Situations PEARLS are succinct summaries of Cochrane Systematic Reviews for primary care practitioners. They Pulmonary rehabilitation effective following exacerbations of chronicobstructivepulmonarydisease Clinical question How effective is pulmonary rehabilitation following exacerbations of chronicobstructivepulmonarydisease (COPD)? Bottom line (...) in these patients. In patients with unstable COPD who have suffered from an exacerbation recently, however, the effects of pulmonary rehabilitation are less established. Cochrane Systematic Review Puhan M et al. Pulmonary rehabilitation following exacerbations of chronicobstructivepulmonarydisease. Cochrane Reviews 2009. Issue 1. Article No. CD005305. DOI:10.1002/14651858. CD005305.pub2. This review contains 6 studies involving 219 participants. PEARLS No. 202, September 2009, written by Brian R McAvoy
WITHDRAWN: Antibiotics for exacerbations of chronicobstructivepulmonarydisease. Most patients with an exacerbation of chronicobstructivepulmonarydisease (COPD) are treated with antibiotics. However the value of their use remains uncertain. Some controlled trials of antibiotics have shown benefit (Berry 1960; Pines 1972) while others have not (Elmes 1965b; Nicotra 1982).To conduct a systematic review of the literature estimating the value of antibiotics in the management of acute COPD (...) exacerbations.We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2005, issue 4) which contains the Acute Respiratory Infections Group's Specialized Register; MEDLINE (1966 to December 2005); EMBASE (1974 to December 2005); Web of Science (December 2005), and other electronically available databases.Randomised controlled trials (RCTs) in patients with acute COPDexacerbations comparing antibiotic (for a minimum of five days) and placebo.Data were analysed using
Impact of care pathways for in-hospital management of COPDexacerbation: a systematic review Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Azithromycin for prevention of exacerbations of COPD. Acute exacerbations adversely affect patients with chronicobstructivepulmonarydisease (COPD). Macrolide antibiotics benefit patients with a variety of inflammatory airway diseases.We performed a randomized trial to determine whether azithromycin decreased the frequency of exacerbations in participants with COPD who had an increased risk of exacerbations but no hearing impairment, resting tachycardia, or apparent risk of prolongation (...) , 143 to 215) among participants receiving placebo (P<0.001). The frequency of exacerbations was 1.48 exacerbations per patient-year in the azithromycin group, as compared with 1.83 per patient-year in the placebo group (P=0.01), and the hazard ratio for having an acute exacerbation of COPD per patient-year in the azithromycin group was 0.73 (95% CI, 0.63 to 0.84; P<0.001). The scores on the St. George's Respiratory Questionnaire (on a scale of 0 to 100, with lower scores indicating better
Tiotropium versus salmeterol for the prevention of exacerbations of COPD. Treatment guidelines recommend the use of inhaled long-acting bronchodilators to alleviate symptoms and reduce the risk of exacerbations in patients with moderate-to-very-severe chronicobstructivepulmonarydisease (COPD) but do not specify whether a long-acting anticholinergic drug or a β(2)-agonist is the preferred agent. We investigated whether the anticholinergic drug tiotropium is superior to the β(2)-agonist (...) salmeterol in preventing exacerbations of COPD.In a 1-year, randomized, double-blind, double-dummy, parallel-group trial, we compared the effect of treatment with 18 μg of tiotropium once daily with that of 50 μg of salmeterol twice daily on the incidence of moderate or severe exacerbations in patients with moderate-to-very-severe COPD and a history of exacerbations in the preceding year.A total of 7376 patients were randomly assigned to and treated with tiotropium (3707 patients) or salmeterol (3669
The effects of `on-call/out of hours` physical therapy in acute exacerbations of chronicobstructivepulmonarydisease: a randomized controlled trial To assess the effectiveness of an on-call physical therapy programme in the management of acute exacerbations of chronicobstructivepulmonary diseases.Randomized controlled trial.Secondary care level, rural hospital.Thirty-eight patients with acute exacerbations of chronicobstructivepulmonary disease.Regular physical therapy and on-call (...) physical therapy was given to two groups of patients with 19 in each arm. On-call physical therapy included providing respiratory physical therapy as required by the patient out of business hours.Peak expiratory flow rate, sustained maximal inspiration, six-minute walk distance and rating of perceived exertion post six-minute walk test.In the group receiving on-call physical therapy, peak expiratory flow rate and six-minute walk test showed a significant difference (52.1 L/min and 98.16 m, respectively