Long-Term Oxygen Therapy in COPD Patients Who Do Not Meet the Actual Recommendations (Hot topic article from Journal of COPD 2017)

Chronic respiratory failure due to chronic obstructive pulmonary disease (COPD) is an increasing problem worldwide. Many patients with severe COPD develop hypoxemic respiratory failure during the natural progression of disease. Long-term oxygen therapy (LTOT) is a well-established supportive treatment for COPD and has been shown to improve survival in patients who develop chronic hypoxemic respiratory failure. The degree of hypoxemia is severe when partial pressure of oxygen in arterial blood (PaO₂) is ≤55 mmHg and moderate if PaO₂ is between 56 and 69 mmHg. 

Although current guidelines consider LTOT only in patients with severe resting hypoxemia, many COPD patients with moderate to severe disease experience moderate hypoxemia at rest or during special circumstances, such as while sleeping or exercising. The efficacy of LTOT in these patients who do not meet the actual recommendations is still a matter of debate, and extensive research is still ongoing to understand the possible benefits of LTOT for survival and/or functional outcomes such as the sensation of dyspnea, exacerbation frequency, hospitalizations, exercise capacity, and quality of life. Despite its frequent use, the administration of “palliative” oxygen does not seem to improve dyspnea except for delivery with high-flow humidified oxygen. This narrative review will focus on current evidence for the effects of LTOT in the presence of moderate hypoxemia at rest, during sleep, or during exercise in COPD.

Full text link:

http://www.tandfonline.com/doi/full/10.1080/15412555.2017.1319918

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

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

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

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

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/