Assessment of Health-related Quality of Life in Different Phenotypes of COPD (article from 2017 Current Respiratory Medicine Reviews)

Introduction: Phenotypic characterization of COPD subjects may rely on clinical and physiological manifestations, imaging, assessment of patient-related outcomes (health related quality of life), COPD comorbidities, COPD exacerbations and systemic inflammation. The aim of the study was to evaluate and to analyze the health-related quality of life (HRQL) in COPD patients classified into different phenotypes.

Methods: 395 consecutive COPD patients were enrolled into the study. Spirometric data were analyzed (FEV1, FVC, FEV1/FVC). HRQL was assessed by the St. George Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT) and Clinical COPD Questionnaire (CCQ).

Results: The cohort consisted of 395 COPD patients with mean age 62.7 ± 9.4 years, 79 % were males. Patients were divided in 4 groups according to phenotypes: 44% of the patients were nonexacerbators, 35% frequent exacerbators with chronic bronchitis (CB), 12% frequent exacerbators without CB, and 8% were patients with asthma-COPD overlap syndrome (ACOS). There were statistically significant differences in HRQL and lung function between COPD phenotypes. Frequent exacerbators with chronic CB and without CB had the similar total SGRQ scores, CCQ scores and CAT, and these scores were worse in comparison with HRQL of non-exacerbators and patients with ACOS.

Conclusion: Frequent exacerbators with chronic CB and without CB have a more severe deterioration of the HRQL and worse lung function then non-exacerbators and patients with ACOS.

full text:

http://www.eurekaselect.com/154321

Pulmonary rehabilitation and cardiovascular risk in COPD: a systematic review (Free Full text from 2017 COPD Research and Practice)

Introduction

Pulmonary Rehabilitation (PR) is an effective intervention in COPD however the value of PR in reducing cardiovascular risk in COPD (measured by aortic pulse wave velocity, PWV) is unclear and there is no existing systematic review.

Objectives
To conduct a systematic review examining whether PR results in alteration of CV risk in COPD (as measured by aPWV).

Methods

An electronic systematic search concordant with PRISMA guidelines was conducted. The search was complete to the 27th of May 2017. Six databases were examined: Embase, Medline, AMED, Web of Science, Cochrane clinical trials, and CINAHL.

Results

This study generated 767 initial matches, which were filtered using inclusion/exclusion criteria. Three studies (201 COPD participants) were included. Our analysis does not confirm that PR affects aPWV but studies were heterogeneous.

Conclusion

There is currently insufficient information on the effect of PR on reducing CV risk in COPD. Therefore controversy remains, with the possibility that there might be some subjects who benefit and others who might experience an increase in CV risk in response to PR. These results will be of value to those interested in gaining a better understanding of the benefits of PR on CV risk in COPD. 

Free full text:

https://copdrp.biomedcentral.com/articles/10.1186/s40749-017-0026-9

2017 update on the pharmacotherapeutic management of lower respiratory tract infections (article from Expert Opinion on Pharmacotherapy)

Introduction: Our knowledge about lower respiratory tract infections (LRTIs) has improved substantially in the last years, but the management of respiratory infections is still a challenge and we are still far from precision medicine in the treatment of LRTIs.

Areas covered: The approaches developed in recent years to improve the pharmacotherapeutic management of LRTIs, such as novel diagnostic assays to facilitate medical decision-making, attempts for selecting an optimal empiric antibiotic regimen, and the role of new and possibly unproven adjunctive therapies, are described.
Expert opinion: Early and appropriate antibiotics remain the cornerstone in the treatment of LRTIs. The updated trend is to apply antimicrobial stewardship principles and initiatives to optimize both the management and the outcomes of LTRIs. Biomarkers, mainly C-reactive protein (CRP) and procalcitonin (PCT), can improve the diagnostic and prognostic assessment of LRTIs and aid to guide antibiotic therapy. The widespread use of antimicrobial agents has greatly contributed to faster development of antibiotic resistance and the emergence of opportunistic pathogens, which substitute the indigenous microbiota. However, very few new antibiotics in development to overcome existing resistance and ensure continued success in the treatment of LRTIs have been approved, likely because antibiotic stewardship programs discourage the use of new agents.
Full text:
http://www.tandfonline.com/doi/abs/10.1080/14656566.2017.1328497

ERS Guidelines 2017: exhaled biomarkers in lung disease

Breath tests cover the fraction of nitric oxide in expired gas (F_eNO), volatile organic compounds (VOCs), variables in exhaled breath condensate (EBC) and other measurements. For EBC and for F_eNO, official recommendations for standardised procedures are more than 10 years old and there is none for exhaled VOCs and particles. The aim of this document is to provide technical standards and recommendations for sample collection and analytic approaches and to highlight future research priorities in the field. For EBC and F_eNO, new developments and advances in technology have been evaluated in the current document. This report is not intended to provide clinical guidance on disease diagnosis and management.

Clinicians and researchers with expertise in exhaled biomarkers were invited to participate. Published studies regarding methodology of breath tests were selected, discussed and evaluated in a consensus-based manner by the Task Force members.

Recommendations for standardisation of sampling, analysing and reporting of data and suggestions for research to cover gaps in the evidence have been created and summarised.

Application of breath biomarker measurement in a standardised manner will provide comparable results, thereby facilitating the potential use of these biomarkers in clinical practice.

Full text:

http://erj.ersjournals.com/content/49/4/1600965

Phenotyping Before Starting Treatment in COPD? (Free full text from Journal of COPD 2017)

Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous and complex disease with great morbidity and mortality. Despite the new developments in the managements of COPD, it was recognized that not all patients benefit from the available medications. Therefore, efforts to identify subgroups or phenotypes had been made in order to predict who will respond to a class of drugs for COPD. 

This review will discuss phenotypes, endotypes, and subgroups such as the frequent exacerbator, the one with systemic inflammation, the fast decliner, ACOS, and the one with co-morbidities and their impact on therapy. It became apparent, that the “inflammatory” phenotypes: frequent exacerbator, chronic bronchitic, and those with a number of co-morbidities need inhaled corticosteroids; in contrast, the emphysematous type with dyspnea and lung hyperinflation, the fast decliner, need dual bronchodilation (deflators). However, larger, well designed studies clustering COPD patients are needed, in order to identify the important subgroups and thus, to lead to personalize management in COPD.

This is an Accepted Manuscript of an article published by Taylor & Francis in COPD: Journal of Chronic Obstructive Pulmonary Disease on 7 April 2017, available online: http://www.tandfonline.com/eprint/JjF9xAcnsrjwNYAuysBI/full

Management of COPD in Patients with Cardiovascular Diseases (Hot Topic Review from Drugs 2017)

Dear Friends we are happy to present you Review from Drugs Journal on Hot Topic: Management of COPD in Patients with Cardiovascular Diseases by great Italian Respiratory team: Mario Cazzola, Luigino Calzetta, Barbara Rinaldi, Clive Page, Giuseppe Rosano, Paola Rogliani, Maria Gabriella Matera!!!

Chronic obstructive pulmonary disease (COPD) and cardiovascular diseases often coexist. The mechanistic links between these two diseases are complex, multifactorial and not entirely understood, but they can influence the therapeutic approach. Therapy can be primarily directed towards treating the respiratory symptoms and reducing lung inflammation. Smoking cessation, bronchodilators and inhaled corticosteroids are central to this therapeutic approach. 

The underlying pathophysiological mechanisms that are responsible for the increased cardiovascular risk in COPD remain unclear, but might include arterial stiffness, inflammation and endothelial dysfunction as a consequence of systemic exposure to chemicals in cigarette smoke or airborne pollution. Therefore, it is plausible that treatment of cardiovascular co-morbidities might reduce morbidity and mortality in patients with COPD and, consequently, therapy of COPD should be shifted to the treatment of cardiovascular diseases and systemic inflammation. In support of this approach, early data suggest that patients with COPD treated with angiotensin-converting enzyme inhibitors, angiotensin II type 1 receptor blockers, statins, anti-platelet drugs or β-adrenoceptor blockers may have improved survival and reduced hospitalisation from acute exacerbations of COPD. In this review, the potential impact of traditional therapies for COPD that are centred on treating the lungs and newer strategies potentially able to affect and mitigate cardiovascular risks in patients with COPD are discussed.

Full text is 

HERE

Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline 2017 (Free full text)

This document provides clinical recommendations for treatment of chronic obstructive pulmonary disease (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 and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of COPD experts.

After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made: 1) a strong recommendation for noninvasive mechanical ventilation of patients with acute or acute-on-chronic respiratory failure; 2) conditional recommendations for oral corticosteroids in outpatients, oral rather than intravenous corticosteroids in hospitalised patients, antibiotic therapy, home-based management, and the initiation of pulmonary rehabilitation within 3 weeks after hospital discharge; and 3) a conditional recommendation against the initiation of pulmonary rehabilitation during hospitalisation.

The Task Force provided recommendations related to corticosteroid therapy, antibiotic therapy, noninvasive mechanical ventilation, home-based management, and early pulmonary rehabilitation in patients having a COPD exacerbation. These recommendations should be reconsidered as new evidence becomes available.

Free full text is 

HERE

The impact of anaemia and iron deficiency in COPD: A clinical overview (free full text from 2017 Revista Portuguesa de Pneumologia)

Anaemia is increasingly recognised as an important comorbidity in the context of chronic obstructive pulmonary disease (COPD), but remains undervalued in clinical practice. This review aims to characterise the impact of anaemia and iron deficiency in COPD.

Methods

Literature review of studies exploring the relationship between anaemia/iron deficiency and COPD, based on targeted MEDLINE and Google Scholar queries.

Results

The reported prevalence of anaemia in COPD patients, ranging from 4.9% to 38.0%, has been highly variable, due to different characteristics of study populations and lack of a consensus on the definition of anaemia. Inflammatory processes seem to play an important role in the development of anaemia, but other causes (including nutritional deficiencies) should not be excluded from consideration. Anaemia in COPD has been associated with increased morbidity, mortality, and overall reduced quality of life. The impact of iron deficiency, irrespective of anaemia, is not as well studied, but it might have important implications, since it impacts production of red blood cells and respiratory enzymes. Treatment of anaemia/iron deficiency in COPD remains poorly studied, but it appears reasonable to assume that COPD patients should at least receive the same type of treatment as other patients.

Conclusions

Anaemia and iron deficiency continue to be undervalued in most COPD clinical settings, despite affecting up to one-third of patients and having negative impact on prognosis. Special efforts should be made to improve clinical management of anaemia and iron deficiency in COPD patients as a means of achieving better patient care.

Free full text:

http://www.sciencedirect.com/science/article/pii/S2173511517300052

Chronic obstructive pulmonary disease and diabetes (free full text from COPD Research and Practice)

Diabetes occurs more often in individuals with COPD than in the general population, however there are still many issues that need to be clarified about this association. The exact prevalence of the association between diabetes and COPD varies between studies reported, however it is known that diabetes affects 2–37 % of patients with COPD, underlining the need to better understand the link between these two conditions. In this review, we evaluated the epidemiological aspects of the association between diabetes and COPD analyzing potential common issues in the pathological mechanisms underlying the single disease. 

The close association suggests the occurrence of similar pathophysiological process that leads to the development of overt disease in the presence of conditions such as systemic inflammation, oxidative stress, hypoxemia or hyperglycemia. Another, but not less important, aspect to consider is that related to the influence of the pharmacological treatment used both for the patient affected by COPD and from that affected by diabetes. It is necessary to understand whether the treatment of COPD affect the clinical course of diabetes, it is also essential to learn whether treatment for diabetes can alter the natural history of COPD.

Free full text:

https://copdrp.biomedcentral.com/articles/10.1186/s40749-015-0005-y

LAMA plus LABA versus LABA plus ICS for stable COPD (free full text from The Cochrane Library)

BACKGROUND:

Three classes of inhaler medications are used to manage chronic obstructive pulmonary disease (COPD): long-acting beta-agonists (LABA), long-acting muscarinic antagonists (LAMA), and inhaled corticosteroids (ICS). When two classes of medications are required, LAMA plus LABA (LAMA+LABA) and LABA plus ICS (LABA+ICS) are often selected because these combinations can be administered via a single medication device. The previous Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidance recommended LABA+ICS as the first-line treatment for managing stable COPD in high-risk people of categories C and D. However, the updated GOLD 2017 guidance recommends LAMA+LABA over LABA+ICS.

 OBJECTIVES:

To compare the benefits and harms of LAMA+LABA versus LABA+ICS for treatment of people with stable COPD.

SEARCH METHODS:

We performed an electronic search of the Cochrane Airways Group Specialised Register (2 February 2016), ClinicalTrials.gov (4 June 2016), and the World Health Organization Clinical Trials Search Portal (4 June 2016), followed by a handsearch (5 June 2016). Two review authors screened and scrutinised the selected articles.

SELECTION CRITERIA:

We included individual randomised controlled trials, parallel-group trials, and cross-over trials comparing LAMA+LABA and LABA+ICS for stable COPD. The minimum accepted trial duration was one month and trials should have been conducted in an outpatient setting.

DATA COLLECTION AND ANALYSIS:

Two review authors independently extracted data and evaluated risk of bias. We resolved any discrepancies through discussion. We analysed dichotomous data as odds ratios (OR), and continuous data as mean differences (MD), with 95% confidence interval (CI) using Review Manager 5. Exacerbations were measured by counting the number of people experiencing one or more exacerbation.

MAIN RESULTS:

We included 11 studies comprising 9839 participants in our quantitative analysis. Most studies included people with moderate to severe COPD, without recent exacerbations. One pharmaceutical sponsored trial that included only people with recent exacerbations was the largest study and accounted for 37% of participants. All but one study were sponsored by pharmaceutical companies, thus we rated them as having a high risk of 'other bias'. The unsponsored study was at high risk of performance and detection bias, and possible selective reporting.Five studies recruited GOLD Category B participants, one study recruited Category D participants, two studies recruited Category A/B participants, and three studies recruited participants regardless of category. Follow-up ranged from 6 to 52 weeks.Compared to the LABA+ICS arm, the results for the pooled primary outcomes for the LAMA+LABA arm were as follows: exacerbations, OR 0.82 (95% CI 0.70 to 0.96, P = 0.01, I² = 17%, low quality evidence); serious adverse events (SAE), OR 0.91 (95% CI 0.79 to 1.05, P = 0.18, I² = 0, moderate quality evidence); St. George's Respiratory Questionnaire (SGRQ) total score change from the baseline, MD -1.22 (95% CI -2.52 to 0.07, P = 0.06, I² = 71%, low quality evidence); and trough forced expiratory volume in one second (FEV₁) change from the baseline, MD 0.08 L (95% CI 0.06 to 0.09, P < 0.0001, I² = 50%, moderate quality evidence). Compared to the LABA+ICS arm, the results for the pooled secondary outcomes for the LAMA+LABA arm were as follows: pneumonia, OR 0.57 (95% CI 0.42 to 0.79, P = 0.0006, I² = 0%, low quality evidence); all-cause death, OR 1.01 (95% CI 0.61 to 1.67, P = 0.88, I² = 0%, low quality evidence); and SGRQ total score change from the baseline of 4 points or greater (the minimal clinically important difference for the SGRQ is 4 points), OR 1.25 (95% CI 1.09 to 1.44, P = 0.002, I² = 0%, moderate quality evidence).

AUTHORS' CONCLUSIONS:

For the treatment of COPD, LAMA+LABA has fewer exacerbations, a larger improvement of FEV₁, a lower risk of pneumonia, and more frequent improvement in quality of life as measured by an increase over 4 units or more of the SGRQ. These data were supported by low or moderate quality evidence generated from mainly participants with moderate to severe COPD in heterogeneous trials with an observation period of less than one year. Our findings support the recently updated GOLD guidance.
Free full text:
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD012066.pub2/abstract;jsessionid=41D11BDBD96F61F
6133E5DDBCDD5A748.f02t02

Procalcitonin could safely halve antibiotic administration in COPD exacerbations (Free full text from European Respiratory Review 2017)

Our latest meta-analysis is now available online!!
Current evidence suggests that serum procalcitonin could safely halve antibiotic administration in COPD exacerbations!

Challenges in the differentiation of the aetiology of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have led to significant overuse of antibiotics. Serum procalcitonin, released in response to bacterial infections, but not viral infections, could possibly identify AECOPD requiring antibiotics. In this meta-analysis we assessed the clinical effectiveness of procalcitonin-based protocols to initiate or discontinue antibiotics in patients presenting with AECOPD.

Based on a prospectively registered protocol, we reviewed the literature and selected randomised or quasi-randomised trials comparing procalcitonin-based protocols to initiate or discontinue antibiotics versus standard care in AECOPD. We followed Cochrane and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidance to assess risk of bias, quality of evidence and to perform meta-analyses.

We included eight trials evaluating 1062 patients with AECOPD. Procalcitonin-based protocols decreased antibiotic prescription (relative risk (RR) 0.56, 95% CI 0.43–0.73) and total antibiotic exposure (mean difference (MD) −3.83, 95% CI (−4.32–−3.35)), without affecting clinical outcomes such as rate of treatment failure (RR 0.81, 0.62–1.06), length of hospitalisation (MD −0.76, −1.95–0.43), exacerbation recurrence rate (RR 0.96, 0.69–1.35) or mortality (RR 0.99, 0.58–1.69). However, the quality of the available evidence is low to moderate, because of methodological limitations and small overall study population.

Procalcitonin-based protocols appear to be clinically effective; however, confirmatory trials with rigorous methodology are required.

Free full text:

http://ow.ly/c693304JkYB 

Free full text on Researchgate:

https://www.researchgate.net/publication/313160789_Procalcitonin_to_guide_antibiotic_administration_in_COPD_exacerbations_a_meta-analysis 

 

Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report published in Blue Journal

This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. 

The most significant changes include: 

i) the assessment of COPD has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; 

ii) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; 

iii) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; 

iv) nonpharmacologic therapies are comprehensively presented and; 

v) the importance of comorbid conditions in managing COPD is reviewed. 

Link to full text:

http://www.atsjournals.org/doi/abs/10.1164/rccm.201701-0218PP

Introducing COPD Research and Practice

Dear friends we are happy to present you new Respiratory Journal: COPD Research and Practice!

COPD Research and Practice publishes basic and clinical research and cutting edge reviews related to chronic obstructive pulmonary disease (COPD). The journal aims to facilitate discussion and dissemination of knowledge to help translate new ideas from bench to bedside by encouraging international and interdisciplinary collaboration.
Editorial from Editor in Chief Professor Mario Cazzola from the University of Rome Tor Vergata, Rome, Italy:

COPD is now the fourth leading cause of death globally, and the World Health Organization (WHO) has predicted that it will become the third most common cause of death in the world by 2030 [1]. In developed countries, current information estimates a prevalence of 8 % to 10 % among adults 40 years of age and older, whereas in developing countries, prevalence varies significantly among countries and is difficult to quote [2].

It is estimated that more than 210 million people have the disease worldwide [3]. Concerning a large number of subjects, COPD generates important health and social costs. However, although COPD is one of the most common chronic diseases and has a high health and social impact, it is still poorly recognized among the general public and also clinicians. Consequently, there is a major and urgent need to better understand this complex disease.

Free full text:

http://copdrp.biomedcentral.com/articles/10.1186/s40749-015-0007-9

The Most Popular Posts of 2016 on Respiratory Decade: Updated guidelines 2017 on COPD & asthma!

Thank you for all your permanent help and support in this hard year! We realized very useful things for promotion of ALL Respiratory conditions! We are hoping that we will continue this work with your help and in 2017!

We are happy to present you our Top 3 posts of 2016!!!

3. Systematic Review of Errors in Inhaler Use: Has Patient Technique Improved Over Time?

2. New Global Strategy for Diagnosis, Management, and Prevention of COPD - 2017 Update (free full text link)

 1. Asthma 2016 Guidelines on World Asthma Day 2016: The 2016 update of the Global Strategy for Asthma Management and Prevention

Prevalence and burden of comorbidities in Chronic Obstructive Pulmonary Disease (FREE FULL TEXT ARTICLE from RESPIRATORY INVESTIGATION 2016)

We are happy to present you article Prevalence and burden of comorbidities in Chronic Obstructive Pulmonary Disease from RESPIRATORY INVESTIGATION 2016 which was published today!

The classical definition of Chronic Obstructive Pulmonary Disease (COPD) as a lung condition characterized by irreversible airway obstruction is outdated. The systemic involvement in patients with COPD, as well as the interactions between COPD and its comorbidities, justify the description of chronic systemic inflammatory syndrome. The pathogenesis of COPD is closely linked with aging, as well as with cardiovascular, endocrine, musculoskeletal, renal, and gastrointestinal pathologies, decreasing the quality of life of patients with COPD and, furthermore, complicating the management of the disease. The most frequently described comorbidities include skeletal muscle wasting, cachexia (loss of fat-free mass), lung cancer (small cell or non-small cell), pulmonary hypertension, ischemic heart disease, hyperlipidemia, congestive heart failure, normocytic anemia, diabetes, metabolic syndrome, osteoporosis, obstructive sleep apnea, depression, and arthritis. These complex interactions are based on chronic low-grade systemic inflammation, chronic hypoxia, and multiple common predisposing factors, and are currently under intense research. 

This review article is an overview of the comorbidities of COPD, as well as their interaction and influence on mutual disease progression, prognosis, and quality of life.

Free full text:

http://www.sciencedirect.com/science/article/pii/S2212534516300703

New Global Strategy for Diagnosis, Management, and Prevention of COPD - 2017 Update (free full text link)

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) works with health care professionals and public health officials around the world to raise awareness of Chronic Obstructive Pulmonary Disease (COPD) and to improve prevention and treatment of this lung disease.

Through the development of evidence-based strategy documents for COPD management, and events such as the annual celebration of World COPD Day, GOLD is working to improve the lives of people with COPD in every corner of the globe.

The GOLD report is presented as a “strategy document” for health care professionals to use as a tool to implement effective management programs based on available health care systems.  GOLD has been fortunate to have a network of international distinguished health professionals from multiple disciplines. Many of these experts have initiated investigations of the causes and prevalence of COPD in their countries, and have developed innovative approaches for the dissemination and implementation of the GOLD management strategy. The GOLD initiative will continue to work with National Leaders and other interested health care professionals to bring COPD to the attention of governments, public health officials, health care workers, and the general public to raise awareness of the burden of COPD and to develop programs for early detection, prevention and approaches to management. 

Full text:

http://goldcopd.org/download/326/

World COPD Day 2016: COPD on the rise, but still underrated from BioMed Central’s blog network

To mark World COPD Day 2016 we invited Dr. Alexandru Corlateanu to give us a background on chronic obstructive pulmonary disease and how it can be managed. He also tells us about World COPD Day and what its aims are. It also has been highlighted on COPD Research and Practice website!

Read full text blog post: 

http://blogs.biomedcentral.com/on-medicine/2016/11/16/copd-on-the-rise-but-still-underrated/