244 research outputs found
Associations of oxygenated hemoglobin with disease burden and prognosis in stable COPD : Results from COSYCONET
We studied whether in patients with stable COPD blood gases (BG), especially oxygenated hemoglobin (OxyHem) as a novel biomarker confer information on disease burden and prognosis and how this adds to the information provided by the comorbidity pattern and systemic inflammation. Data from 2137 patients (GOLD grades 1–4) of the baseline dataset of the COSYCONET COPD cohort were used. The associations with dyspnea, exacerbation history, BODE-Index (cut-off ≤2) and all-cause mortality over 3 years of follow-up were determined by logistic and Cox regression analyses, with sex, age, BMI and pack years as covariates. Predictive values were evaluated by ROC curves. Capillary blood gases included SaO2, PaO2, PaCO2, pH, BE and the concentration of OxyHem [haemoglobin (Hb) x fractional SaO2, g/dL] as a simple-to-measure correlate of oxygen content. Inflammatory markers were WBC, CRP, IL-6 and -8, TNF-alpha and fibrinogen, and comorbidities comprised a broad panel including cardiac and metabolic disorders. Among BG, OxyHem was associated with dyspnoea, exacerbation history, BODE-Index and mortality. Among inflammatory markers and comorbidities, only WBC and heart failure were consistently related to all outcomes. ROC analyses indicated that OxyHem provided information of a magnitude comparable to that of WBC, with optimal cut-off values of 12.5 g/dL and 8000/µL, respectively. Regarding mortality, OxyHem also carried independent, additional information, showing a hazard ratio of 2.77 (95% CI: 1.85–4.15, p  8000/µL was 2.33 (95% CI: 1.60–3.39, p < 0.0001). In stable COPD, the concentration of oxygenated hemoglobin provided additional information on disease state, especially mortality risk. OxyHem can be calculated from hemoglobin concentration and oxygen saturation without the need for the measurement of PaO2. It thus appears well suited for clinical use with minimal equipment, especially for GPs
Associations of oxygenated hemoglobin with disease burden and prognosis in stable COPD: Results from COSYCONET
We studied whether in patients with stable COPD blood gases (BG), especially oxygenated hemoglobin (OxyHem) as a novel biomarker confer information on disease burden and prognosis and how this adds to the information provided by the comorbidity pattern and systemic inflammation. Data from 2137 patients (GOLD grades 1-4) of the baseline dataset of the COSYCONET COPD cohort were used. The associations with dyspnea, exacerbation history, BODE-Index (cut-off 8000/mu L was 2.33 (95% CI: 1.60-3.39, p<0.0001). In stable COPD, the concentration of oxygenated hemoglobin provided additional information on disease state, especially mortality risk. OxyHem can be calculated from hemoglobin concentration and oxygen saturation without the need for the measurement of PaO2. It thus appears well suited for clinical use with minimal equipment, especially for GPs
Effect of tiotropium on COPD exacerbations: A systematic review
Exacerbation frequency is related to disease progression, quality of life, and prognosis in COPD. Earlier diagnosis, along with interventions aimed at preventing exacerbations and delaying progression, may help reduce the global burden of disease. Long-acting inhaled bronchodilators are effective at maintaining symptom relief and are recommended as first-choice therapy for more symptomatic patients and those at risk of exacerbation.Published (Open Access)This article is freely available via Open Access. Click on the 'Additional Link' above to access the full-text from the publisher's site
Efficacy and Safety of Umeclidinium/Vilanterol in Current and Former Smokers with COPD: A Prespecified Analysis of The EMAX Trial.
INTRODUCTION: Smoking may reduce the efficacy of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD), but its impact on bronchodilator efficacy is unclear. This analysis of the EMAX trial explored efficacy and safety of dual- versus mono-bronchodilator therapy in current or former smokers with COPD. METHODS: The 24-week EMAX trial evaluated lung function, symptoms, health status, exacerbations, clinically important deterioration, and safety with umeclidinium/vilanterol, umeclidinium, and salmeterol in symptomatic patients at low exacerbation risk who were not receiving ICS. Current and former smoker subgroups were defined by smoking status at screening. RESULTS: The analysis included 1203 (50%) current smokers and 1221 (50%) former smokers. Both subgroups demonstrated greater improvements from baseline in trough FEV1 at week 24 (primary endpoint) with umeclidinium/vilanterol versus umeclidinium (least squares [LS] mean difference, mL [95% CI]; current: 84 [50, 117]; former: 49 [18, 80]) and salmeterol (current: 165 [132, 198]; former: 117 [86, 148]) and larger reductions in rescue medication inhalations/day over 24 weeks versus umeclidinium (LS mean difference [95% CI]; current: - 0.42 [- 0.63, - 0.20]; former: - 0.25 - 0.44, - 0.05]) and salmeterol (current: - 0.28 [- 0.49, - 0.06]; former: - 0.29 [- 0.49, - 0.09]). Umeclidinium/vilanterol increased the odds (odds ratio [95% CI]) of clinically significant improvement at week 24 in Transition Dyspnea Index versus umeclidinium (current: 1.54 [1.16, 2.06]; former: 1.32 [0.99, 1.75]) and salmeterol (current: 1.37 (1.03, 1.82]; former: 1.60 [1.20, 2.13]) and Evaluating Respiratory Symptoms-COPD versus umeclidinium (current: 1.54 [1.13, 2.09]; former: 1.50 [1.11, 2.04]) and salmeterol (current: 1.53 [1.13, 2.08]; former: 1.53 [1.12, 2.08]). All treatments were well tolerated in both subgroups. CONCLUSIONS: In current and former smokers, umeclidinium/vilanterol provided greater improvements in lung function and symptoms versus umeclidinium and salmeterol, supporting consideration of dual-bronchodilator therapy in symptomatic patients with COPD regardless of their smoking status
Sex-specific associations of comorbidome and pulmorbidome with mortality in chronic obstructive pulmonary disease : results from COSYCONET
In patients with COPD, it has not been comprehensively assessed whether the predictive value
of comorbidities for mortality difers between men and women. We therefore aimed to examine
sex diferences of COPD comorbidities in regard with prognosis by classifying comorbidities into a
comorbidome related to extrapulmonary disorders and a pulmorbidome, referring to pulmonary
disorders. The study population comprised 1044 women and 1531 men with the diagnosis of
COPD from COSYCONET, among them 2175 of GOLD grades 1–4 and 400 at risk. Associations
of comorbidities with mortality were studied using Cox regression analysis for men and women
separately. During the follow-up (median 3.7 years) 59 women and 159 men died. In men, obesity,
hypertension, coronary artery disease, liver cirrhosis, osteoporosis, kidney disease, anaemia
and increased heart rate (HR) predict mortality, in women heart failure, hyperuricemia, mental
disorders, kidney disease and increased HR (p< 0.05 each). Regarding the pulmorbidome, signifcant
predictors in men were impairment in difusion capacity and hyperinfation, in women asthma and
hyperinfation. Similar results were obtained when repeating the analyses in GOLD 1–4 patients only.
Gender diferences should be considered in COPD risk assessment for a tailored approach towards the
treatment of COPD
Gender-specific differences in COPD symptoms and their impact for the diagnosis of cardiac comorbidities
Background In chronic obstructive pulmonary disease (COPD), gender-specifc diferences in the prevalence of symptoms
and comorbidity are known.
Research question We studied whether the relationship between these characteristics depended on gender and carried diag nostic information regarding cardiac comorbidities.
Study design and methods The analysis was based on 2046 patients (GOLD grades 1–4, 795 women; 38.8%) from the
COSYCONET COPD cohort. Assessments comprised the determination of clinical history, comorbidities, lung function,
COPD Assessment Test (CAT) and modifed Medical Research Council dyspnea scale (mMRC). Using multivariate regres sion analyses, gender-specifc diferences in the relationship between symptoms, single CAT items, comorbidities and
functional alterations were determined. To reveal the relationship to cardiac disease (myocardial infarction, or heart failure,
or coronary artery disease) logistic regression analysis was performed separately in men and women.
Results Most functional parameters and comorbidities, as well as CAT items 1 (cough), 2 (phlegm) and 5 (activities), dif fered signifcantly (p<0.05) between men and women. Beyond this, the relationship between functional parameters and
comorbidities versus symptoms showed gender-specifc diferences, especially for single CAT items. In men, item 8 (energy),
mMRC, smoking status, BMI, age and spirometric lung function was related to cardiac disease, while in women primarily
age was predictive.
Interpretation Gender-specifc diferences in COPD not only comprised diferences in symptoms, comorbidities and func tional alterations, but also diferences in their mutual relationships. This was refected in diferent determinants linked to
cardiac disease, thereby indicating that simple diagnostic information might be used diferently in men and women.
Clinical trial registration The cohort study is registered on ClinicalTrials.gov with identifer NCT01245933 and on Ger manCTR.de with identifer DRKS00000284, date of registration November 23, 2010. Further information can be obtained
on the website http://www.asconet.net
The impact of COPD on polyneuropathy : results from the German COPD cohort COSYCONET
Background: Peripheral neuropathy is a common comorbidity in COPD. We aimed to investigate associations
between alterations commonly found in COPD and peripheral neuropathy, with particular emphasize on the
distinction between direct and indirect effects.
Methods: We used visit 4 data of the COPD cohort COSYCONET, which included indicators of polyneuropathy
(repeated tuning fork and monofilament testing), excluding patients with diabetes a/o increased HbA1c. These
indicators were analysed for the association with COPD characteristics, including lung function, blood gases, 6-min
walk distance (6-MWD), timed-up-and-go-test (TUG), exacerbation risk according to GOLD, C-reactive protein (CRP),
and ankle-brachial index (ABI). Based on the results of conventional regression analyses adjusted for age, BMI,
packyears and gender, we utilized structural equation modelling (SEM) to quantify the network of direct and
indirect relationships between parameters.
Results: 606 patients were eligible for analysis. The indices of polyneuropathy were highly correlated with each
other and related to base excess (BE), ABI and TUG. ABI was linked to neuropathy and 6-MWD, exacerbations
depended on FEV1, 6-MWD and CRP. The associations could be summarized into a SEM comprising polyneuropathy
as a latent variable (PNP) with three measured indicator variables. Importantly, PNP was directly dependent on ABI
and particularly on BE. When also including patients with diabetes and/or elevated values of HbA1c (n = 742) the
SEM remained virtually the same.
Conclusion: We identified BE and ABI as major determinants of peripheral neuropathy in patients with COPD. All
other associations, particularly those with lung function and physical capacity, were indirect. These findings
underline the importance of alterations of the micromilieu in COPD, in particular the degree of metabolic
compensation and vascular status
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Treatment of COPD with Long-Acting Bronchodilators: Association Between Early and Longer-Term Clinically Important Improvement.
Introduction: This post hoc analysis of the "Early MAXimization of bronchodilation for improving COPD stability" (EMAX) trial investigated whether patients achieving early clinically important improvement (CII) sustained longer-term improvements and lower risk of clinically important deterioration (CID). Methods: Patients were randomized to umeclidinium/vilanterol, umeclidinium, or salmeterol for 24 weeks. The patient-reported outcomes (PROs) Transition Dyspnea Index (TDI), Evaluating Respiratory Symptoms, St George's Respiratory Questionnaire (SGRQ) and COPD Assessment Test (CAT) were assessed. CII, defined as attaining minimum clinically important differences (MCID) in ≥2 PROs, was assessed at Weeks 4, 12 and 24. CID was defined as a deterioration in CAT, SGRQ, TDI by the MCID and/or a moderate/severe exacerbation from Day 30. Results: Of 2425 patients, 50%, 53% and 51% achieved a CII at Weeks 4, 12 and 24, respectively. Patients with a CII at Week 4 versus those without had significantly greater odds of achieving a CII at Weeks 12 and 24 (odds ratio: 5.57 [95% CI: 4.66, 6.66]; 4.09 [95% CI: 3.44, 4.86]). The risk of a CID was higher in patients who did not achieve a CII at Week 4 compared with patients who did (hazard ratio [95% CI]: 2.09 [1.86, 2.34]). Patients treated with umeclidinium/vilanterol versus either monotherapy had significantly greater odds of achieving CII at Weeks 4, 12 and 24. Conclusion: Achieving a CII at Week 4 was associated with longer-term improvement in PROs and a reduced risk of deterioration. Further research is required to investigate the importance of an early response to treatment on the long-term disease course
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