Prognostic risk factors for moderate-to-severe exacerbations in patients with chronic obstructive pulmonary disease: a systematic literature review

Respiratory Research, Год журнала: 2022, Номер 23(1)

Опубликована: Авг. 23, 2022

Abstract Background Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. COPD exacerbations are associated with worsening lung function, increased burden, mortality, and, therefore, preventing their occurrence an important goal management. This review was conducted to identify the evidence base regarding risk factors predictors moderate-to-severe in patients COPD. Methods A literature performed Embase, MEDLINE, MEDLINE In-Process, Cochrane Central Register Controlled Trials (CENTRAL). Searches were from January 2015 July 2019. Eligible publications peer-reviewed journal articles, published English, that reported or for adults age ≥ 40 years diagnosis Results The identified 5112 references, which 113 (reporting results 76 studies) met eligibility criteria included review. Among studies included, 61 observational 15 randomized controlled clinical trials. Exacerbation history strongest predictor future exacerbations, 34 reporting significant association between moderate severe exacerbations. Other multiple severity bronchodilator reversibility (39 studies), comorbidities (34 higher symptom burden (17 blood eosinophil count (16 studies). Conclusions systematic several demographic characteristics predict Prior exacerbation confirmed as most These prognostic may help clinicians at high major driver global COPD, including mortality.

Язык: Английский

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GOLD 2023 Update: Implications for Clinical Practice

International Journal of COPD, Год журнала: 2023, Номер Volume 18, С. 745 - 754

Опубликована: Май 1, 2023

Abstract: In 2022, over 3 million people died of chronic obstructive pulmonary disease (COPD) and the global burden is expected to increase coming decades. Recommendations for treatment management patients with COPD are published by Global Initiative Chronic Obstructive Lung Disease, updated annually scientific evidence-based recommendations. The 2023 updates, in November contain key changes recommendations diagnosis that anticipated have a significant impact on clinical practice COPD. Updates how defined diagnosed, including expansion contributing factors beyond tobacco use, potential lead more allow implementation early interventions during stages disease. Simplification algorithms, placement triple therapy within these will support clinicians providing appropriate, timely focus reducing risk future exacerbations. Finally, recognition mortality reduction as goal supports an use therapy, only pharmacological intervention has been demonstrated improve survival Although further guidance clarification needed some areas, such blood eosinophil counts guiding decisions protocols following hospitalizations, recent updates GOLD addressing current gaps patient care. Clinicians should utilize drive COPD, identification exacerbations, selection treatments patients. Keywords: disease, respiratory, implications, practice, primary care, guidelines

Язык: Английский

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Turnover of type I and III collagen predicts progression of idiopathic pulmonary fibrosis

Respiratory Research, Год журнала: 2021, Номер 22(1)

Опубликована: Июль 15, 2021

Abstract Background Idiopathic pulmonary fibrosis (IPF) is characterized by the accumulation of fibrillar collagens in alveolar space resulting reduced function and a high mortality rate. Biomarkers measuring turnover type I III collagen could provide valuable information for prognosis treatment decisions IPF. Methods Serological biomarkers reflecting formation (PRO-C3) degradation (C1M) (C3M) were evaluated real-world cohort 178 newly diagnosed IPF patients. Blood samples clinical data collected at baseline, six, 12 months. Baseline longitudinal biomarker levels related to disease progression (defined as ≥ 5% decline forced vital capacity (FVC) and/or 10% diffusing carbon monoxide (DLco) all-cause months). Furthermore, we analysed differences percentage change from baseline between patients receiving antifibrotic or not. Results Increased associated with greater risk within months compared low turnover. Patients progressive had higher serum C1M (P = 0.038) PRO-C3 0.0022) those stable over one year. There no pirfenidone, nintedanib, antifibrotics. Conclusion Longitudinal disease. Moreover, therapy did not affect these may be potential behavior

Язык: Английский

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IgE is associated with exacerbations and lung function decline in COPD

Respiratory Research, Год журнала: 2022, Номер 23(1)

Опубликована: Янв. 4, 2022

Abstract Background Both allergen-specific IgE and total in serum play a major role asthma. However, the of chronic obstructive pulmonary disease (COPD) is poorly understood. It was aim this study to systematically analyze relationship between levels characteristics large COPD cohorts. Methods COSYCONET comprehensively characterized cohort patients with COPD: specific common aeroallergens were measured 2280 patients, related clinical patients. WISDOM another population (2477 patients): database contains information whether elevated (≥ 100 IU/l) or normal COPD. Results WISDOM, > 30% higher men than women, currently not smoking men. In COSYCONET, history asthma and/or allergies. Men at least one exacerbation last 12 months (50.6% all COSYCONET) had median (71.3 without exacerbations (48.3 IU/l): difference also observed subgroups Surprisingly, did impact on women Patients highest tertiles (> 91.5 IU/ml, adjusted OR: 1.62, 95% CI 1.12–2.34) 0.19 2.15, 1.32–3.51) risk lung function decline (adjusted by: age, gender, body mass index, initial function, status, asthma, allergy). Conclusion These data suggest that may subgroups. Clinical trials using antibodies targeting pathway (such as omalizumab), especially recurrent IgE, could elucidate potential therapeutic implications our observations.

Язык: Английский

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Rational use of inhaled corticosteroids for the treatment of COPD

npj Primary Care Respiratory Medicine, Год журнала: 2023, Номер 33(1)

Опубликована: Июль 24, 2023

Abstract Inhaled corticosteroids (ICS) are the mainstay of treatment for asthma, but their role in chronic obstructive pulmonary disease (COPD) is debated. Recent randomised controlled trials (RCTs) conducted patients with COPD and frequent or severe exacerbations demonstrated a significant reduction (~25%) ICS combination dual bronchodilator therapy (triple therapy). However, suggestion mortality benefit associated these has since been rejected by European Medicines Agency US Food Drug Administration. Observational evidence from routine clinical practice demonstrates that bronchodilation better outcomes than triple broad population infrequent exacerbations. This reinforces guideline recommendations ICS-containing maintenance should be reserved high blood eosinophils (~10% population), those concomitant asthma. data indicate overuse, up to 50–80% prescribed ICS. Prescription not fulfilling criteria puts at unnecessary risk pneumonia other long-term adverse events also cost implications, without any clear control. In this article, we review benefits risks use COPD, drawing on RCTs observational studies primary care. We provide practical guide prescribing ICS, based latest global guidelines, help care providers identify whom outweigh risks.

Язык: Английский

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Differences in Blood Eosinophil Level During Stable Disease and During Exacerbation of COPD and Exacerbation Risks

Lung, Год журнала: 2025, Номер 203(1)

Опубликована: Фев. 27, 2025

Abstract Background Although blood eosinophil count (BEC) has been extensively studied as a biomarker in chronic obstructive pulmonary disease (COPD), there remain challenges and controversy using single reading. It not determined whether the difference BEC between baseline that during an acute exacerbation of COPD (AECOPD) any role predicting subsequent AECOPD. Methods A prospective study was conducted to investigate possible differences from AECOPD predict future risk. The expressed absolute difference: at index moderate-to-severe ( E i ) – 0 ). Results Among 348 Chinese patients with COPD, 158 who experienced were analyzed. Using cut-off 105 cells/µL for by receiver operating characteristic (ROC) analysis, ≥ had shorter time adjusted hazard ratio (aHR) 1.68 (95% CI = 1.02–2.74; p 0.040). They also higher annual number (2.49 ± 2.84/year vs 1.58 2.44/year, 0.023). Similar findings shown subgroup stable-state < 300 cells/µL. Conclusion Greater upon might be associated next AECOPD, well more episodes

Язык: Английский

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The pharmacological management of asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS)

Expert Opinion on Pharmacotherapy, Год журнала: 2020, Номер 21(2), С. 213 - 231

Опубликована: Янв. 19, 2020

Introduction: Asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) is a phenotype that shares T helper lymphocyte cell Th1/neutrophilic/non-Type-2 Inflammation pathways thought to be key in COPD and Th2/eosinophilic/Type-2 inflammatory of asthma. The pharmacology treating ACOS challenging severe circumstances.Areas covered: This review evaluates the stepwise treatment using pharmacological treatments used both most common medications involve same inhalers treat asthma patients. Advanced therapies for patients are based on patient characteristics biomarkers. Very few clinical trials exist focus specifically patients.Expert opinion: After inhalers, advanced including phosphodiesterase inhibitors, macrolides, N-acetylcysteine statin therapy those with appearance exacerbations available. In atopic exacerbations, (leukotriene receptor antagonists synthesis blocking agents.) used. elevated blood eosinophil/IgE levels considered immunotherapy or therapeutic monoclonal antibodies specific Th2/Type-2 interleukins IgE. Symptom control, stabilization/improvement function reduced metrics success. More needed better understand which benefit from treatments.Abbreviations: 5-LOi: 5-lipoxygenase inhibitor; ACOS: – syndrome; B2AR: Beta2 adrenergic receptors; cAMP: cyclic adenosine monophosphate; cGMP: guanosine CI: confidence interval; COPD: chronic disease; CRS : rhinosinusitis; cys-LT: cysteinyl leukotrienes; DPI: dry powder inhaler; EMA: European Medicines Agency; FDA: US Food Drug Administration; FDC: fixed-dose combination; FeNO: exhaled nitric oxide; FEV1: forced expiratory volume one second; FVC: vital capacity; GM-CSF: granulocyte-macrophage colony-stimulating factor; ICS inhaled corticosteroids; IL: interleukin; ILC2: Type 2 innate lymphoid cells; IP3: Inositol triphosphate; IRR: incidence rate ratio; KOLD: Korean Obstructive Lung Disease; LABA: long-acting B2 agonist; LAMA: muscarinic antagonist; LRA: leukotriene LT: MDI: metered-dose inhalers; MN: M-subtype MRA: NAC: N-acetylcysteine; NEB: nebulization; OR: odds PDE: phosphodiesterase; PEFR: peak flow rate; PGD2: prostaglandin D2; PRN: as needed; RR: risk SABA: short-acting SAMA: SDMI: spring-driven mist Th1: 1 lymphocyte; Th2: lymphocytes; TNF-α: tumor necrosis factor alpha; United States

Язык: Английский

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Eosinophils in COPD—Current Concepts and Clinical Implications

The Journal of Allergy and Clinical Immunology In Practice, Год журнала: 2020, Номер 8(8), С. 2565 - 2574

Опубликована: Апрель 3, 2020

Язык: Английский

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COPD Exacerbation History and Impact on Future Exacerbations – 8-Year Retrospective Observational Database Cohort Study from Germany

International Journal of COPD, Год журнала: 2021, Номер Volume 16, С. 2407 - 2417

Опубликована: Авг. 1, 2021

Recent studies evaluating the predictive value of different variables on future exacerbations suggest exacerbation history as strongest predictor. We examined effect subsequent events in a large sample population with over 250,000 COPD patients using up to 8 years longitudinal healthcare data from Germany.

Язык: Английский

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Prevalence and Baseline Clinical Characteristics of Eosinophilic Chronic Obstructive Pulmonary Disease: A Meta-Analysis and Systematic Review

Frontiers in Medicine, Год журнала: 2019, Номер 6

Опубликована: Дек. 10, 2019

Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease, with different clinical and pathophysiological characteristics. Accumulative evidences show that eosinophil levels may be connected to therapy effect phenotypes of COPD. However, the prevalence eosinophilic inflammation in COPD baseline characteristics remain unknown. Our study investigated >2% among Methods We searched Cochrane Central Library, Medline, Embase, Web Science for trials COPD, published from database inception May 1, 2019. Results: A sum 40,112 patients were involved nineteen final analysis. The was range 18.84% 66.88%, 54.95% on whole. found higher rate male, ex-smoker ischemic heart (OR 1.36, 95%CI 1.26–1.46, P0.05). Conclusions: analysis suggested prevalent Eosinophilic prone ex-smoker, lager BMI high risk some comorbidity, but had low proportion mild airflow limitation patients.

Язык: Английский

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