Impact of Fluticasone Propionate and Salmeterol Combined with Pulmonary Rehabilitation on Pulmonary Function, Exercise Tolerance, and Quality of Life in Elderly Patients with Stable Chronic Obstructive Pulmonary Disease

British Journal of Hospital Medicine, Год журнала: 2025, Номер unknown, С. 1 - 13

Опубликована: Март 16, 2025

Aims/Background Chronic obstructive pulmonary disease (COPD) is a common respiratory characterized by persistent problems. COPD has become major public health concern worldwide as the population ages. Therefore, we investigated impact of fluticasone propionate and salmeterol inhalation combined with rehabilitation on function, exercise tolerance, quality life in elderly patients stable COPD. Methods This retrospective study included 102 who were treated between January 2021 October 2023. Based previous treatment regimens, divided into group (n = 58) alone 44). We collected baseline data upon admission other relevant after 3 months follow-up. Furthermore, evaluated function [forced expiratory volume first second (FEV1), forced vital capacity (FVC), peak flow (PEF)], inflammatory markers [interleukin-8 (IL-8), interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), factor-β (TNF-β)], tolerance [6-minute walk test (6MWT)], [COPD Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ)] two experimental groups. Additionally, recurrence rate adverse events during 3-month follow-up examined. Results Compared to baseline, FEV1, FVC, PEF, 6MWT levels significantly improved both groups at follow-up, performing better than (p < 0.05). CAT SGRQ scores decreased significantly, scoring lower Inflammatory markers, such IL-8, IL-6, TNF-α, TNF-β reduced The was 0.018), no significant difference incidence > Conclusion Fluticasone can reduce rates, improve status, thereby enhancing for

Язык: Английский

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The safety and efficacy of non-typeable Haemophilus influenzae and Moraxella catarrhalis vaccine in chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized controlled trials

Frontiers in Medicine, Год журнала: 2025, Номер 12

Опубликована: Апрель 4, 2025

Background Non-typeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis (Mcat) are major pathogens implicated in bacterial exacerbations of chronic obstructive pulmonary disease (COPD). Their involvement contributes to antibiotic resistance poses significant immune challenges, underscoring the need for targeted vaccine strategies. This systematic review meta-analysis assessed safety efficacy NTHi-Mcat/NTHi vaccines COPD patients. Research design methods Randomized controlled trials (RCTs) assessing were systematically searched across four databases (PubMed, CENTRAL, Embase, Medline) from inception October 2024. Meta-analyses conducted using random-effects or fixed-effects models, with subgroup analyses investigate possible sources heterogeneity. Results analysis included eight RCTs involving 1,574 participants, primarily Europe ( n = 3) Australia 2), interventions administered orally intramuscularly at varying frequencies (twice three times). The revealed that did not affect incidence acute (relative risk (RR): 1.02, 95% confidence interval (CI): 0.76 1.36), all-cause mortality (RR: 0.91, CI: 0.38 2.21), hospitalization rate 0.50, 0.09 2.77). Regarding safety, significantly increase serious adverse events 1.00, 0.84 1.19) grade 3 1.20, 0.93 1.53). However, it was associated a higher local systemic reactions, including pain 5.33, 1.98 14.33), swelling 12.15, 4.67 31.67), redness (first dose: RR: 12.74, 3.48 46.59; second 11.55, 3.90 34.22), headaches 1.00 1.43), erythema 15.38, 5.64 41.92), fever (after 2.33, 1.24 4.38). Conclusion Although well-tolerated patients, they reduce mortality. These findings suggest further research is needed validate these results identify potential subgroups may derive clinical benefit. Systematic registration study registered PROSPERO (ID: CRD42023381488).

Язык: Английский

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Prevention of exacerbation in patients with moderate-to-very severe COPD with the intent to modulate respiratory microbiome: a pilot prospective, multi-center, randomized controlled trial

Frontiers in Medicine, Год журнала: 2024, Номер 10

Опубликована: Янв. 5, 2024

Considering the role of bacteria in onset acute exacerbation COPD (AECOPD), we hypothesized that use influenza-Streptococcus pneumoniae vaccination, oral probiotics or inhaled amikacin could prevent AECOPD. In this pilot prospective, muti-central, randomized trial, moderate-to-very severe subjects with a history moderate-to-severe exacerbations previous year were enrolled and assigned ratio 1:1:1:1 into 4 groups. All participants managed based on conventional treatment recommended by GOLD 2019 report for 3 months, three groups receiving additional (0.4 g twice daily, 5-7 days monthly months), probiotic Lactobacillus rhamnosus GG (1 tablet daily influenza-S. vaccination. The primary endpoint was time to next AECOPD from enrollment. Secondary endpoints included CAT score, mMRC adverse events, survival 12 months. Among all 112 analyzed (101 males, 96 smokers ex-smokers, mean ± SD age 67.19 7.39 years, FEV1 41.06 16.09% predicted), those who given dual vaccination (239.7 vs. 198.2 days, p = 0.044, 95%CI [0.85, 82.13]) (248.8 0.017, [7.49, 93.59]) had significantly delayed than received only. For high symptom burden, group as compared (237.3 179.1 0.009, [12.40,104.04]). interventions seemed be safe well tolerated patient stable COPD. vaccine long-term LGG can delay Periodically inhalation seems work symptomatic patients. findings current study warrants validation future studies microbiome investigation.Clinical trial registration:https://clinicaltrials.gov/, identifier NCT03449459.

Язык: Английский

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Benefit–Harm Analysis of Earlier Initiation of Triple Therapy for Prevention of Acute Exacerbation in Patients with Chronic Obstructive Pulmonary Disease

Annals of the American Thoracic Society, Год журнала: 2024, Номер 21(8), С. 1139 - 1146

Опубликована: Апрель 5, 2024

Rationale: Reducing the risk of exacerbation is a fundamental goal in managing stable COPD. Guidelines recommend triple therapy (inhaled corticosteroids, long-acting muscarinic antagonists, and beta-agonists [ICS/LAMA/LABA]) only as step-up from dual (LAMA/LABA) for patients at continued high exacerbation, due to trade-off an increased pneumonia associated with ICS-containing therapies. However, there little evidence on optimum timing initiating therapy. Objectives: To perform benefit-harm analysis evaluate net benefit earlier initiation prevention acute exacerbations COPD, compared standard recommended current guidelines. Methods: We used validated whole disease microsimulation model COPD Canadian general population aged ≥40 years determine over 20-year time horizon, care. assessed change quality-adjusted life-years (QALYs) reduction treatment-related subgroups defined by history, symptoms, severity. Model parameters were determined clinical trials other published literature. Key varied one-way sensitivity analysis. Results: In (54.7% female, mean age 74.0, 68% GOLD grade I-II), was QALY gain 4.8 per 100 20 years, The 5.9 subgroup symptom burden (mMRC>1). Earlier remained beneficial all scenarios. Conclusions: Modeling suggests that likely be even greater burden. Further research needed verify these findings empirical studies.

Язык: Английский

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CRP, Fibrinogen, White Blood Cells, and Blood Cell Indices as Prognostic Biomarkers of Future COPD Exacerbation Frequency: The TIE Cohort Study

Journal of Clinical Medicine, Год журнала: 2024, Номер 13(13), С. 3855 - 3855

Опубликована: Июнь 30, 2024

Background/Objective: Systemic inflammation is common in chronic obstructive pulmonary disease (COPD), and evidence suggests that inflammatory biomarkers can predict acute exacerbations (AECOPDs). The aim of this study was to analyse whether C-reactive protein (CRP), fibrinogen, white blood cell count (WBC), or the indices PLR (platelet-to-lymphocyte ratio), SII (systemic immune index), SIRI response AISI (aggregate index systemic inflammation) future AECOPDs. Methods: In Tools Identifying Exacerbations (TIE) cohort study, participants with spirometry-confirmed COPD were recruited from primary secondary care three Swedish regions assessed during a stable phase COPD. AECOPD frequency three-year follow-up reviewed medical records. Associations analysed via ordinal logistic regressions. Results: Of 571 participants, 46% had ≥1 follow-up, mean ± SD 0.63 1.2/year. unadjusted analyses, high levels CRP (odds ratio 1.86, 95% CI 1.29–2.67), fibrinogen (2.09, 1.38–3.16), WBCs (2.18, 1.52–3.13), (1.52, 1.05–2.19), (1.76, 1.23–2.52), (1.99, 1.38–2.87) associated higher frequency. After adjustment for history, age, sex, smoking, body mass index, Assessment Test score, lung function, inhaled corticosteroid use, associations remained (adjusted odds 1.64; 1.08–2.49), (1.55; 1.07–2.24), WBC (1.65; 1.10–2.47). Conclusions: CRP, WBC, stable-phase COPD, enhanced prediction, whereas PLR, SII, SIRI, did not.

Язык: Английский

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Clinical Concepts for Triple Therapy Use in Patients with COPD: A Delphi Consensus

International Journal of COPD, Год журнала: 2023, Номер Volume 18, С. 1853 - 1866

Опубликована: Авг. 1, 2023

Role of triple therapy in chronic obstructive pulmonary disease (COPD) management is supported by growing evidence, but consensus lacking on various aspects. We conducted a Delphi survey respiratory experts the effects exacerbation reduction, early optimization, pneumonia risk, and mortality benefits COPD management.The study comprised 2-round online surveys participant meeting with 21 from 10 countries. The 31-statement questionnaire was prepared using Decipher software after literature review. Responses were recorded Likert scale ranging 1 (disagreement) to 9 (agreement) threshold 75%.All participated both 14/21 attended meeting. Consensus reached 13/31 questions first 4/14 second on: therapy; comparable risk between single inhaler (SITT) multiple (81%); preference SITT for patients high eosinophil count (95%); reduction healthcare cost initiation post exacerbation-related hospitalization (<30 days) (86%). No line use resulting diagnosis (62%).This demonstrated that there among regarding many key concepts about appropriate clinical COPD. More evidence required evaluating optimisation therapy.

Язык: Английский

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Dual Phosphodiesterase 3 and 4 Inhibitor Ensifentrine Reduces Exacerbation Rate and Risk in Patients With Moderate-to-Severe Chronic Obstructive Pulmonary Disease

CHEST Journal, Год журнала: 2024, Номер unknown

Опубликована: Авг. 1, 2024

Exacerbations in COPD can be life-threatening and lead to irreversible declines lung function quality of life. Medications that reduce exacerbation burden are an unmet need, because exacerbations put patients at risk more decrease Ensifentrine is a novel, first-in-class, selective, dual inhibitor phosphodiesterase 3 4 with demonstrated nonsteroidal antiinflammatory activity bronchodilatory effects.

Язык: Английский

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Preclinical Evaluation of Electronic Health Records (EHRs) to Predict Poor Control of Chronic Respiratory Diseases in Primary Care: A Novel Approach to Focus Our Efforts

Journal of Clinical Medicine, Год журнала: 2024, Номер 13(18), С. 5609 - 5609

Опубликована: Сен. 21, 2024

Background/Objectives: Managing chronic respiratory diseases such as asthma and obstructive pulmonary disease (COPD) within the Spanish Sistema Nacional de Salud (SNS) presents significant challenges, particularly due to their high prevalence poor control rates—approximately 45.1% for 63.2% COPD. This study aims develop a novel predictive model using electronic health records (EHRs) estimate likelihood of in these patients, thereby enabling more efficient management primary care settings. Methods: The Seleida project employed bioinformatics approach identify clinical variables from EHR data centers Seville Valencia. Statistically were incorporated into logistic regression predict patients with COPD patients. Key included number short-acting β-agonist (SABA) muscarinic antagonist (SAMA) canisters, prednisone courses, antibiotic courses over past year. Results: developed demonstrated accuracy, sensitivity, specificity predicting poorly controlled both These findings suggest that could serve valuable tool early identification at-risk allowing healthcare providers prioritize optimize resource allocation Conclusions: Integrating this practice enhance proactive COPD, potentially improving patient outcomes reducing burden on systems. Further validation diverse settings is warranted confirm model’s efficacy generalizability.

Язык: Английский

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Impact of Aerobika® oscillating positive expiratory pressure in improving small airway resistance, lung function, symptoms and exercise capacity in chronic obstructive pulmonary disease

Frontiers in Medicine, Год журнала: 2023, Номер 10

Опубликована: Июнь 2, 2023

Background Aerobika ® oscillating positive expiratory pressure (OPEP) device promotes airway clearance in many respiratory diseases. However, studies have yet to focus on its effectiveness improving small resistance via impulse oscillometry (IOS) measurement COPD subjects. We aim evaluate the improvement of ( IOS), lung function (spirometry), exercise capacity [ 6-min walking test (6MWT)], symptoms [COPD assessment (CAT)] and severe exacerbation events among subjects using OPEP. Methods This was a prospective, single-arm interventional study with disease. Subjects were instructed use twice daily OPEP (10 min each session); for 24 weeks; as an additional standard therapy. IOS, spirometry, 6MWT, CAT score evaluated at baseline, 12 weeks weeks. Results Fifty-three completed study. usage showed IOS parameters; e.g. 5 Hz (R5), cmH20/L/s, (12-week p = 0.008, 24-week &lt; 0.001), R5% predicted 0.007, 0.001) (R5–R20), 0.021, 0.001). There function; FEV 1 , L 0.018, % 0.025, FEF 25–75 0.023, 0.002), 0.024, improved had (6MWT, metres) after 0.016). there no significant difference before usage. Conclusion demonstrated early usage, sustained administration significantly function, scores over events.

Язык: Английский

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Clinically Important Deterioration (CID) and Ageing in COPD: A Systematic Review and Meta-Regression Analysis According to PRISMA Statement

International Journal of COPD, Год журнала: 2023, Номер Volume 18, С. 2225 - 2243

Опубликована: Окт. 1, 2023

Purpose: Clinically important deterioration (CID) is a composite endpoint developed to quantify the impact of pharmacological treatment in clinical trials for Chronic Obstructive Pulmonary Disease (COPD), also showing prognostic value. CID defined as any following condition: forced expiratory volume 1 s decrease ≥ 100 mL from baseline, and/or St. George's Respiratory Questionnaire total score increase 4-unit occurrence moderate-to-severe exacerbation COPD. Although most COPD patients experience worsening they get older, date, no specific studies assessed correlation between ageing and Therefore, aim this study was investigate on patients. Patients Methods: Data obtained 55219 were extracted 17 papers, mostly post-hoc analyses. A pairwise meta-analysis meta-regression analysis performed according PRISMA-P guidelines therapy determine whether might modulate risk Results: Inhaled treatments resulted generally effective reducing (relative risk: 0.81, 95% confidence interval 0.79– 0.84; P < 0.001). The indicated trend toward significance (P = 0.063) linear relationship age CID. Of note, significantly 0.05) increased when associated with lower post-bronchodilator FEV . These results not affected by significant bias. Conclusion: This quantitative synthesis suggests that inhaled COPD, although such protective effect may be older impaired lung function. Further specifically designed are needed confirm these results. Keywords: ageing, clinically deterioration, chronic obstructive pulmonary disease, elderly, meta-analysis,

Язык: Английский

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