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 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

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

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

Management of Stable COPD: An Update 2014

Dear Respiratory friends, we are happy to present our new article: Management of Stable COPD: An Update 2014 from Current Respiratory Medicine Reviews! Free for download!

http://benthamscience.com/journal/abstracts.php?journalID=crmr&articleID=120557

ABSTRACT Chronic obstructive pulmonary disease (COPD) is a major problem for public health worldwide and an important cause of morbidity and mortality at the global level. Its burden is expected to increase progressively in the next years. This article summarizes the most current aspects of the non-pharmacological and pharmacological treatment of stable COPD. Non-pharmacological therapies, such as smoking cessation, vaccinations, oxygen therapy and pulmonary rehabilitation are covered briefly. Drug classes covered are short acting beta agonists (SABA), short acting muscarinic antagonists (SAMA), long acting beta agonists (LABA), long acting antimuscarinics (LAMA), inhaled corticosteroids (ICS), LABA/ICS combinations and specific phosphodiesterase (PDE4) inhibitors.

COPD Istanbul 2014: International update on COPD

I would like to share with you my experience and impressions about the COPD Istanbul 2014, which took place in Istanbul, Turkey at 8-10 March 2014. The main topic of the Congress was COPD. The conference was attended by a wide range of professionals (more than 500 persons) such as industry leaders, university academics and researchers from all the regions including Turkey, Middle East, Asia, North Africa and Europe. It was high level meeting, the speakers were world known leader in COPD and in Respiratory medicine:

Antonio Anzueto, USA Ashraf Alzaabi, UAE Abdel Rahman Anani, Jordan Nasser Behbehani, Kuwait Francesco Blasi, Italy Miron Bogdan, Romania Demosthenes Bouros, Greece Jean Bousquet, France Vito Brusasco, Italy Mario Cazzola, Italy Alexander Chuchalin, Russia Alexandru Corlateanu, Moldovia Mukadder Calikoglu, Turkey Ronald Dahl, Denmark Giuseppe Di Maria, Italy Anh-Tuan Dinh Xuan, France Pinar Ergun, Turkey Leonardo Fabbri, Italy Mina Gaga, Greece Christina Gratziou, Greece Hakan Gunen, Turkey Gazi Gulbas, Turkey Nilgun Gurses, Turkey Nicola Alexander Hanania, USA Ashraf Hatem, Egypt Ismail Hanta, Turkey Loay El Husseini, Jordan Yavor Ivanov, Bulgaria Nadim Kanj, Lebanon Adel Khatab, Egypt Gunseli Kilinc, Turkey Kosta Kostov, Bulgaria Filiz Kosar, Turkey Jan Lotvall, Sweden

Bassam Mahboub, UAE Maria Gabriella Matera, Italy Florin Mihaltan, Romania Marc Miravitlles, Spain Arzu Mirici, Turkey Mostafa Moin, Iran Levent Cem Mutlu, Turkey Denis O'Donnell, Canada Mustafa Ozhan, Turkey Can Ozturk, Turkey Onder Ozturk, Turkey Clive Page, UK Reynold Panettieri, USA Alberto Papi, Italy Mehmet Polatli, Turkey Nikolaos Siafakas, Greece Joan Soriano, Spain Mecit Suerdem, Turkey Sema Umut, Turkey Omar Usmani, UK Esra Uzaslan, Turkey Thys Van der Molen, The Netherlands Mirna Waket, Lebanon Wisia Wedzicha, UK

1^st  Day of the COPD Istanbul 2014  was dedicated to hot topics in COPD:

Phenotyping the heterogeneity of COPD

Inhaled corticosteroids for COPD

Bench to bedside approach in COPD

New GOLD 2014 Staging: COPD Treatment from A to D

Outcomes for COPD

Pulmonary rehabilitation in COPD; highlights

Emerging therapies for COPD

Prof. Mario Cazzola, Italy and Prof. Gunseli Kilinc, Turkey. Opening Ceremony of COPD Istanbul 2014.

2^nd Day of the COPD Istanbul 2014 was dedicated to:

Overlap syndromes in COPD

COPD: markers and inflammation

COPD guidelines: the important thing is not to stop questioning

Exacerbation of COPD: New perspectives

Management of COPD with NIV

this my presentation: 

The assessment of management of stable COPD: an update 2014 by Corlateanu for COPD Istanbul 2014 from Alexandru Corlateanu

3rd Day of the COPD Istanbul 2014 was dedicated to:

Small airways in COPD – no longer silent

COPD: Effects beyond the Lungs

Prof. Nikos Siafakas, Greece. Closing ceremony of COPD Istanbul 2014

Finally we would like to thank COPD Istanbul 2014 Scientific committee and its Chair Prof. Mario Cazzola, Italy and Vice-chairs Prof. Nikos Siafakas, Greece and Prof. Gunseli Kilinc, Turkey for a successful Conference and remarkable annual organization which allowed taking part in different discussions, to acquire useful information and to establish relations with international specialists.

World COPD Day 2013 is under corner

Dear Respiratory friends World COPD Day 2013 is under corner!!! Join our Social Media event: World COPD Day 2013 on Respiratory Decade!!

or direct link:

https://www.facebook.com/events/231327290364322/

Efforts to improve early diagnosis, develop new treatments, and better predict patients’ prognoses are leading to renewed optimism in the fight against one of the world’s most prevalent respiratory diseases.

The illness, chronic obstructive pulmonary disease (COPD), is a non-communicable lung disease that progressively robs sufferers of breath. COPD is the fourth leading cause of death worldwide, causing more than 3 million deaths every year, and up to half of people with the disease don’t know they have it.

20 November 2013 is the twelfth annual World COPD Day, an event held each November to raise awareness of COPD worldwide. This year’s World COPD Day theme, “It’s not too late,” emphasizes the meaningful actions people can take to improve their respiratory health, at any stage before or after a COPD diagnosis.

Personalized, Predictive, Preventive, and Participatory medicine for Respiratory diseases

Last decade we are witnessing change from traditional reactive approach to new complex P4 assessment of diseases. The P4 medicine is a proposed new form of medical practice that combines Personalized, Predictive, Preventive, and Participatory elements. This new paradigm with success can be applied for management of respiratory diseases. For example: what does P4 medicine mean for COPD? It will be “personalized” because it will be based on the genome of each person; it will be “predictive” because this personalized information will be able to determine the risk for COPD in each individual; it will be “preventive” because, given the prediction of risk of COPD, prophylactic measures will be able to be taken to decrease risk also with accent on awareness in each individual case; and it will be “participative” because many of these prophylactic interventions will require the participation of the COPD patient.