Vital prognosis after hospitalization for COPD: A study of a random population sample

AbstractStudy aim: To examine survival after admission due to chronic obstructive pulmonary disease (COPD) in a population sample over a time span of 15 years.Design: Linkage between a prospective population cohort and register information on hospitalization and mortality.Setting: The Copenhagen City Heart Study (CCHS).Participants: A total of 267 men and 220 women who had participated in the CCHS and who were hospitalized with a discharge diagnosis of COPD (ICD-8 491-2).Main results: The crude 5-yr survival rate after a COPD admission was 45% (37% for men and 52% for women). Mortality risk increased with age and with decreasing forced expiratory volume in 1 s (FEV1)% predicted; for subjects with an FEV1 ≤40% at the CCHS survey, 5-yr survival after subsequent hospitalization was only 28%. Smoking and presence of chronic mucus hypersecretion at the examination in CCHS were not strongly associated with prognosis. Survival after admission due to COPD did not change significantly over time.Conclusion: Compared to previous studies of COPD patients, the present study indicates that prognosis after hospital admission remains virtually unchanged over the last decades. FEV1 is still the strongest predictor of survival in this patient group

Extrafine beclomethasone/formoterol in severe COPD patients with history of exacerbations

The FORWARD study is a randomised, double-blind trial that compares the efficacy and safety of 48 weeks treatment with extrafine beclomethasone dipropionate/formoterol fumarate (BDP/FOR), 100/6 μg pMDI, 2 inhalations BID, vs. FOR 12 μg pMDI, 1 inhalation BID, in severe COPD patients with a history of exacerbations. Co-primary endpoints were exacerbation rate over 48 weeks and pre-dose morning FEV1 at 12 weeks. The ITT population included 1186 patients (69% males, mean age 64 years) with severe airflow limitation (mean post-bronchodilator FEV1 42% predicted). Salbutamol as rescue therapy, theophylline and tiotropium (if stable regimen prior to screening) were allowed. Compared to FOR, BDP/FOR: (1) reduced the exacerbation rate (rate ratio: 0.72 [95% confidence interval 0.62–0.84], p < 0.001); (2) improved pre-dose morning FEV1 (mean difference: 0.069 L [0.043–0.095] p < 0.001); (3) prolonged the time to first exacerbation; (4) improved the SGRQ total score. The percentage of patients with adverse events was similar (52.1% with BDP/FOR and 49.2% with FOR). Pneumonia incidence was low, slightly higher with BDP/FOR (3.8%) than with FOR (1.8%). No difference for laboratory values, ECG or vital signs. Extrafine BDP/FOR significantly reduces the exacerbation rate and improves lung function of patients with severe COPD and history of exacerbations as compared to FOR alone

Associations between gastro-oesophageal reflux, its management and exacerbations of chronic obstructive pulmonary disease

To determine factors, overall and by sex, associated with self-reported gastro-oesophageal reflux disease (GORD) in chronic obstructive pulmonary disease (COPD) patients, and to evaluate relationships between GORD, its modification by acid suppression medications (Proton Pump Inhibitors [PPI]/histamine-2 receptor antagonists [H2RA]) and exacerbations of COPD and mortality

Outcomes in elderly Danish citizens admitted with community-acquired pneumonia. Regional differencties, in a public healthcare system

SummaryObjectivesTo evaluate regional differences in and risk factors for admission, length of stay, mortality, and readmission for community-acquired pneumonia in elderly Danish patients.MethodsNational registry study on elderly Danish citizens with an acute admission in 2009 owing to community-acquired pneumonia. We studied differences among hospitals in length of stay, in-hospital mortality, mortality within 30 days of discharge, and readmission within 30 days after discharge using Cox regression models with adjustments for age, sex, ventilatory support, and co-morbidity by Charlson's index score.ResultsA total of 11,332 elderly citizens were admitted with community-acquired pneumonia. Mortality during admission and 30-days from discharge were 11.6% and 16.2%, respectively. Readmission rates within 30 days of discharge were 12.3%. There were significantly differences between hospitals in length of stay. A high Charlson index score and advanced age were significantly risk factors for death during admission and within 30 days of discharge. Male sex and high Charlson index score were significant risk factors for readmission. Admission to large bed capacity hospital was a significant risk factor for death and readmission within 30 days of discharge.ConclusionsLength of stay, rate of admission, mortality and readmission in elderly Danish patients with community-acquired pneumonia follows international findings. There are regional differences between hospitals. In depth investigation in regional differences could reveal potential feasible clinical interventions with an improvement of readmission-, mortality rates and cost

Inhaled corticosteroids for chronic obstructive pulmonary disease-the shifting treatment paradigm

Chronic obstructive pulmonary disease (COPD) guidelines suggest using inhaled corticosteroids (ICS) in patients with severe airflow limitation or those at high risk of exacerbations. This recommendation is based on evidence demonstrating that ICS, especially when prescribed in fixed-dose combinations (FDC) with long-acting β2 agonists (LABA), improve quality of life (QoL), decrease exacerbations and hospitalisations, and have been associated with a trend towards a reduction in all-cause mortality. Audit shows that routine prescribing practice frequently uses inhaler therapies outside current guidelines recommendations; severe to very severe disease constitutes about 20% of all COPD patients, but up to 75% of COPD patients are prescribed an ICS, with significant numbers given ICS/LABA as first-line maintenance therapy. The role of ICS in the treatment paradigm for COPD is changing, driven by the growing evidence of increased risk of pneumonia, and the introduction of a new class of FDC; LABA and long-acting muscarinic antagonists (LAMA), which simplify dual bronchodilation and present a plausible alternative therapy. As the evidence base for dual therapy bronchodilation expands, it is likely that maximal bronchodilation will move up the treatment algorithm and ICS reserved for those with more severe disease who are not controlled on dual therapy. This change has already manifested in local COPD algorithms, such as those at Tayside, and represents a significant change in recommended prescribing practice. This review reassesses the role of ICS in the shifting treatment paradigm, in the context of alternative treatment options that provide maximal bronchodilation

Exhaled breath condensate in chronic obstructive pulmonary disease: Methodological challenges and clinical application

Collection of exhaled breath condensate (EBC) is a non-invasive method to sample the airway lining fluid. The composition of EBC may reflect physiological and pathophysiological processes within the lower airways, which could otherwise be investigated only with more invasive techniques. Hence, analysis of the condensate fluid seems feasible in chronic obstructive pulmonary disease (COPD) to monitor disease processes and facilitate personalized therapy. In the past two decades, a multitude of molecules has been assessed in EBC samples from patients with COPD, characterizing inflammation, oxidative and nitrative stress in this disorder. Recently, multimarker profiling with sensitive metabolomic or proteomic approaches, optimized for the EBC matrix, has also been applied, which could overcome the pitfalls of single marker detection using commercial assay systems. In this review, we describe the theoretical background of EBC formation, systematically discuss technical and methodological difficulties of sample collection and analysis and summarize data on EBC biomarkers in COPD. Finally, based on previous findings and our experience, we propose potential future directions for the EBC research community, which could pave the way for introducing EBC analysis in clinical practice. © 2018 EDIZIONI MINERVA MEDICA