Four patients with a history of acute exacerbations of COPD: implementing the CHEST/Canadian Thoracic Society guidelines for preventing exacerbations

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Systemic inflammation in chronic obstructive pulmonary disease: a population-based study

<p>Abstract</p> <p>Background</p> <p>Elevated circulating levels of several inflammatory biomarkers have been described in selected patient populations with COPD, although less is known about their population-based distribution. The aims of this study were to compare the levels of several systemic biomarkers between stable COPD patients and healthy subjects from a population-based sample, and to assess their distribution according to clinical variables.</p> <p>Methods</p> <p>This is a cross-sectional study design of participants in the EPI-SCAN study (40-80 years of age). Subjects with any other condition associated with an inflammatory process were excluded. COPD was defined as a post-bronchodilator FEV₁/FVC < 0.70. The reference group was made of non-COPD subjects without respiratory symptoms, associated diseases or prescription of medication. Subjects were evaluated with quality-of-life questionnaires, spirometry and 6-minute walk tests. Serum C-reactive protein (CRP), tumor necrosis factor (TNF)-α, interleukins (IL-6 and IL-8), alpha1-antitrypsin, fibrinogen, albumin and nitrites/nitrates (NOx) were measured.</p> <p>Results</p> <p>We compared 324 COPD patients and 110 reference subjects. After adjusting for gender, age, BMI and tobacco consumption, COPD patients showed higher levels of CRP (0.477 ± 0.023 vs. 0.376 ± 0.041 log mg/L, p = 0.049), TNF-α (13.12 ± 0.59 vs. 10.47 ± 1.06 pg/mL, p = 0.033), IL-8 (7.56 ± 0.63 vs. 3.57 ± 1.13 pg/ml; p = 0.033) and NOx (1.42 ± 0.01 vs. 1.36 ± 0.02 log nmol/l; p = 0.048) than controls. In COPD patients, serum concentrations of some biomarkers were related to severity and their exercise tolerance was related to serum concentrations of CRP, IL-6, IL-8, fibrinogen and albumin.</p> <p>Conclusions</p> <p>Our results provide population-based evidence that COPD is independently associated with low-grade systemic inflammation, with a different inflammatory pattern than that observed in healthy subjects.</p

Value of supplemental interventions to enhance the effectiveness of physical exercise during respiratory rehabilitation in COPD patients. A Systematic Review

BACKGROUND: There is a controversy about the additional benefit of various supplemental interventions used in clinical practice to further enhance the effectiveness of respiratory rehabilitation in patients with Chronic obstructive pulmonary disease (COPD). The aim of this research was to assess randomised controlled trials (RCTs) testing the additional benefit of supplemental interventions during respiratory rehabilitation in COPD patients. METHODS: Systematic review with literature searches in six electronic databases, extensive hand-searching and contacting of authors. Two reviewers selected independently eligible RCTs, rated the methodological quality and extracted the data, which were analyzed considering the minimal important difference of patient-important outcomes where possible. FINDINGS: We identified 20 RCTs whereof 18 provided sufficient data for analysis. The methodological quality was low and sample sizes were too small for most trials to produce meaningful results (median total sample size = 28). Data from five trials showed that supplemental oxygen during exercise did not have clinically meaningful effects on health-related quality of life while improvements of exercise capacity may be even larger for patients exercising on room air. RCTs of adding assisted ventilation, nutritional supplements or a number of anabolically acting drugs do not provide sufficient evidence for or against the use any of these supplemental interventions. INTERPRETATION: There is insufficient evidence for most supplemental interventions during respiratory rehabilitation to estimate their additional value, partly due to methodological shortcomings of included RCTs. Current data do not suggest benefit from supplemental oxygen during exercise, although the methodological quality of included trials limits conclusions. To appropriately assess any of the various supplemental interventions used in clinical practice, pragmatic trials on respiratory rehabilitation of COPD patients need to consider methodological aspects as well as appropriate sample sizes

Budesonide/formoterol as effective as prednisolone plus formoterol in acute exacerbations of COPD A double-blind, randomised, non-inferiority, parallel-group, multicentre study

<p>Abstract</p> <p>Background</p> <p>Oral corticosteroids and inhaled bronchodilators with or without antibiotics represent standard treatment of COPD exacerbations of moderate severity. Frequent courses of oral steroids may be a safety issue. We wanted to evaluate in an out-patient setting whether a 2-week course of inhaled budesonide/formoterol would be equally effective for treatment of acute COPD exacerbations as standard therapy in patients judged by the investigator not to require hospitalisation.</p> <p>Methods</p> <p>This was a double-blind, randomised, non-inferiority, parallel-group, multicentre study comparing two treatment strategies; two weeks' treatment with inhaled budesonide/formoterol (320/9 μg, qid) was compared with prednisolone (30 mg once daily) plus inhaled formoterol (9 μg bid) in patients with acute exacerbations of COPD attending a primary health care centre. Inclusion criteria were progressive dyspnoea for less than one week, FEV₁30–60% of predicted normal after acute treatment with a single dose of oral corticosteroid plus nebulised salbutamol/ipratropium bromide and no requirement for subsequent immediate hospitalisation, i.e the clinical status after the acute treatment allowed for sending the patient home.</p> <p>A total of 109 patients (mean age 67 years, 33 pack-years, mean FEV₁45% of predicted) were randomized to two weeks' double-blind treatment with budesonide/formoterol or prednisolone plus formoterol and subsequent open-label budesonide/formoterol (320/9 μg bid) for another 12 weeks. Change in FEV₁was the primary efficacy variable. Non-inferiority was predefined.</p> <p>Results</p> <p>Non-inferiority of budesonide/formoterol was proven because the lower limit of FEV₁-change (97.5% CI) was above 90% of the efficacy of the alternative treatment. Symptoms, quality of life, treatment failures, need for reliever medication (and exacerbations during follow-up) did not differ between the groups. No safety concerns were identified.</p> <p>Conclusion</p> <p>High dose budesonide/formoterol was as effective as prednisolone plus formoterol for the ambulatory treatment of acute exacerbations in non-hospitalized COPD patients. An early increase in budesonide/formoterol dose may therefore be tried before oral corticosteroids are used.</p> <p>Clinical trial registration</p> <p>NCT00259779</p

Ectopic adiposity and cardiometabolic health in COPD

Val&eacute;rie Coats,1 Jean-Pierre Despr&eacute;s,1 Natalie Alm&eacute;ras,1 Micka&euml;l Martin,1 Don D Sin,2 R&eacute;mi Rabasa-Lhoret,3 &Eacute;ric Larose,1 Wan C Tan,2 Jean Bourbeau,4 Fran&ccedil;ois Maltais1On behalf of the CanCOLD Collaborative Research Group and the Canadian Respiratory Research Network 1Centre de recherche, Institut universitaire de cardiologie et de pneumologie de Qu&eacute;bec, Universit&eacute;, Laval, QC, Canada; 2University of British Columbia, Vancouver, BC, Canada; 3Institut de Recherches Cliniques de Montr&eacute;al, D&eacute;partement de Nutrition et Service d&rsquo;Endocrinologie, Centre Hospitalier de l&rsquo;Universit&eacute; de Montr&eacute;al, Montr&eacute;al, QC, Canada; 4Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, CanadaRationale: Obesity/overweight is the most prevalent body composition abnormality in COPD. However, little is known about the impact of fat distribution on cardiometabolic health in COPD.Objective: To study the associations between ectopic adiposity, cardiometabolic health, and COPD.Methods: A total of 263 subjects (166 males; age=65&plusmn;9 years) were randomly selected from the general population. Subjects were classified as non-COPD controls and COPD, according to the Global initiative for chronic Obstructive Lung Disease (GOLD) classification, and the presence of cardiometabolic comorbidities was recorded. Ectopic fat accumulation was documented from computed tomography measurements of visceral adipose tissue cross-sectional areas and muscle mean attenuation, assessed at L4&ndash;L5. Blood glucose, lipid, and adipokine profiles were also evaluated.Results: After correcting for age, sex, and tobacco exposure, visceral adipose tissue cross-sectional area was higher in GOLD 2+ compared to GOLD 1 individuals. Consistent with this, mean muscle tissue attenuation was lower in GOLD 2+ vs GOLD 1 and non-COPD controls (P&lt;0.001). In multiple regression models, visceral adipose tissue cross-sectional area was strongly associated with hypertension (P&lt;0.001) and diabetes (P&lt;0.001), while muscle attenuation was associated with coronary artery disease (P&lt;0.001). Blood glucose, lipid, and adipokine profiles were similar across groups with the exception of leptin level which was higher in GOLD 2+ subjects compared to GOLD 1 and controls.Conclusion: GOLD 2+ COPD was associated with ectopic fat accumulation which modulated cardiometabolic health. Keywords: chronic obstructive pulmonary disease, obesity, abdominal, comorbidity, ectopic adiposity, cardiometabolic healt

Ectopic fat accumulation in patients with COPD: an ECLIPSE substudy

Micka&euml;l Martin,1 Natalie Almeras,1 Jean-Pierre Despr&eacute;s,1 Harvey O Coxson,2 George R Washko,3 Isabelle Vivodtzev,4 Emiel FM Wouters,5 Erica Rutten,6 Michelle C Williams,7 John T Murchison,8 William MacNee,7 Don D Sin,2 Fran&ccedil;ois Maltais1 On behalf of the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Study Group 1Research Centre, Institut universitaire de cardiologie et de pneumologie de Qu&eacute;bec, Universit&eacute; Laval, Qu&eacute;bec, QC, 2Department of Radiology, University of British Columbia, Vancouver, BC, Canada; 3Department of Medicine, Brigham and Women&rsquo;s Hospital, Harvard Medical School, Boston, MA, USA; 4Hypoxia Pathophysiology Laboratory, Grenoble University Hospital, Grenoble, France; 5Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, 6Research and Development, CIRO, Horn, the Netherlands; 7Department of Respiratory Medicine, University of Edinburgh, 8Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK Background: Obesity is increasingly associated with COPD, but little is known about the prevalence of ectopic fat accumulation in COPD and whether this can possibly be associated with poor clinical outcomes and comorbidities. The Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) substudy tested the hypothesis that COPD is associated with increased ectopic fat accumulation and that this would be associated with COPD-related outcomes and comorbidities.Methods: Computed tomography (CT) images of the thorax obtained in ECLIPSE were used to quantify ectopic fat accumulation at L2&ndash;L3 (eg, cross-sectional area [CSA] of visceral adipose tissue [VAT] and muscle tissue [MT] attenuation, a reflection of muscle fat infiltration) and CSA of MT. A dose&ndash;response relationship between CSA of VAT, MT attenuation and CSA of MT and COPD-related outcomes (6-minute walking distance [6MWD], exacerbation rate, quality of life, and forced expiratory volume in 1&nbsp;second [FEV1] decline) was addressed with the Cochran&ndash;Armitage trend test. Regression models were used to investigate possible relationships between CT body composition indices and comorbidities.Results: From the entire ECLIPSE cohort, we identified 585 subjects with valid CT images at L2&ndash;L3 to assess body composition. CSA of VAT was increased (P&lt;0.0001) and MT attenuation was reduced (indicating more muscle fat accumulation) in patients with COPD (P&lt;0.002). Pro&shy;gressively increasing CSA of VAT was not associated with adverse clinical outcomes. The probability of exhibiting low 6MWD and accelerated FEV1 decline increased with progressively decreasing MT attenuation and CSA of MT. In COPD, the probability of having diabetes (P=0.024) and gastroesophageal reflux (P=0.0048) at baseline increased in parallel with VAT accumulation, while the predicted MT attenuation increased the probability of cardiovascular comorbidities (P=0.042). Body composition parameters did not correlate with coronary artery scores or with survival.Conclusion: Ectopic fat accumulation is increased in COPD, and this was associated with relevant clinical outcomes and comorbidities. Keywords: metabolic syndrome, obesity, abdominal adiposity, muscl

Implementación del sistema de seguridad y salud en el trabajo, para reducir el índice de accidentabilidad en el área de operaciones de la empresa Art Electricistas E.I.R.L. – Lima – 2016

El estudio presentado tiene como título “Implementación del Sistema de Gestión y Seguridad en el Trabajo, para reducir el índice de accidentabilidad en el Área de Operaciones de la empresa ART Electricistas E.I.R.L. – Lima – 2016”. Su objetivo general es: Determinar, como la implementación de un Sistema de Seguridad y Salud en el Trabajo, reduce el índice de accidentabilidad en el Área de Operaciones de la empresa ART Electricistas E.I.R.L. – Lima – 2016. El estudio, presenta variable independiente: Sistema de Seguridad y Salud en el Trabajo con dimensiones: Política, Organización, Planificación, Evaluación y Mejora, esto basada en la Ley N° 29783. También presenta la variable dependiente: Índice de Accidentabilidad, el cual representa la estadística de los accidentes descritos en la Norma internacional ANSI. Se dimensiona en la Frecuencia y Severidad de Accidentes de Trabajo. La fórmula para hallar el índice de accidentabilidad se complementa en el D.S. 055-2010-EM. El estudio empleó como metodología la investigación científica de diseño cuasi experimental, de tipo aplicativa, de nivel descriptivo y explicativo. La población fueron los accidentes de trabajo respecto a 27 empleados de muestra intacta. En el estudio, se utilizó la técnica de la observación y en la recolección de datos instrumentos validados por juicios de expertos como registros, documentos, tablas y check list para explicar la fuente del problema y la obtención de resultados. Se utilizó el programa SPSS22 para el análisis de datos. Se realizó la estadística descriptiva e inferencial, asimismo la Prueba T de muestras emparejadas con sig. menor a 0.05. Como conclusión, se afirma que el implementar el sistema de seguridad y salud en el trabajo reduce el índice de accidentabilidad y la difusión de la política de seguridad y salud en el trabajo, la capacitación constante y la absolución de las no conformidades producto de auditorías internas