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A simple algorithm for the identification of clinical COPD phenotypes This study aimed to identify simple rules for allocating chronic obstructive pulmonary disease (COPD) patients to clinical phenotypes identified by cluster analyses.Data from 2409 COPD patients of French/Belgian COPD cohorts were analysed using cluster analysis resulting in the identification of subgroups, for which clinical relevance was determined by comparing 3-year all-cause mortality. Classification and regression trees (...) (CARTs) were used to develop an algorithm for allocating patients to these subgroups. This algorithm was tested in 3651 patients from the COPD Cohorts Collaborative International Assessment (3CIA) initiative.Cluster analysis identified five subgroups of COPD patients with different clinical characteristics (especially regarding severity of respiratory disease and the presence of cardiovascular comorbidities and diabetes). The CART-based algorithm indicated that the variables relevant for patient
COPDCOPD - Symptoms, diagnosis and treatment | BMJ Best Practice Search COPD Last reviewed: February 2019 Last updated: November 2018 Summary Progressive disease state characterised by airflow limitation that is not fully reversible. Suspected in patients with a history of smoking, occupational and environmental risk factors, or a personal or family history of chronic lung disease. Presents with progressive shortness of breath, wheeze, cough, and sputum production, including haemoptysis (...) . Diagnostic tests include pulmonary function tests, chest x-ray, chest computed tomography scan, oximetry, and arterial blood gas analysis. Patients should be encouraged to stop smoking or occupational exposure and be vaccinated against viral influenza and Streptococcus pneumoniae . Treatment options include bronchodilators, inhaled corticosteroids, and systemic corticosteroids. Long-term oxygen therapy improves survival in severe COPD. Definition COPD is a preventable and treatable disease state
Overview of COPD Overview of COPD - Summary of relevant conditions | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Overview of COPD Last reviewed: February 2019 Last updated: June 2018 Introduction Chronic obstructive pulmonary disease (COPD) is a disorder that is usually progressive, characterised by airflow limitation that is not fully reversible. Sutherland ER, Cherniack RM. Management of chronic obstructive pulmonary disease. N Engl J Med. 2004;350 (...) :2689-2697. http://www.ncbi.nlm.nih.gov/pubmed/15215485?tool=bestpractice.com Around 90% of cases of COPD are caused by cigarette smoking; other strong risk factors include more advanced age (may be related to longer period of smoking) and genetic factors (e.g., alpha-1 antitrypsin deficiency). Related conditions Condition Description Suspected in patients with a history of smoking, occupational/environmental risk factors, or a personal or family history of chronic lung disease. Presents
Comparison of two scores of short term serious outcome in COPD patients. Chronic Obstructive Pulmonary Disease (COPD) related visits to the emergency department have increased substantially during the past decade. An important challenge facing emergency physicians when treating COPD patients is deciding on disposition. The aim of this study was to evaluate Integrated Pulmonary Index scoring to guide the disposition decisions of emergency physicians by comparing its compatibility with Ottawa (...) COPD Risk Score.This is a prospective methodological study, in which we compared the accuracies of the Integrated Pulmonary Index and Ottawa COPD Risk Score in predicting of the short-term serious outcomes in patients admitted to the emergency department with COPD exacerbation. Patients who admitted to our emergency department between 01.01.2019-31.03.2019 were evaluated.Among the 208 patients, there were 154 (74.0%) short-term serious outcomes. The AUCs were 0.915 and 0.943 for Integrated
Trelegy Ellipta - fluticasone furoate umeclidinium vilanterol - Chronic obstructive pulmonary disease (COPD) fluticasone furoate/umeclidinium/vilanterol | CADTH.ca Find the information you need fluticasone furoate/umeclidinium/vilanterol fluticasone furoate/umeclidinium/vilanterol Last Updated: September 19, 2018 Result type: Reports Project Number: SR0562-000 Product Line: Generic Name: fluticasone furoate umeclidinium vilanterol Brand Name: Trelegy Ellipta Manufacturer: GlaxoSmithKline Inc (...) . Indications: Chronic obstructive pulmonary disease (COPD) Manufacturer Requested Reimbursement Criteria 1 : For the long-term, once daily, maintenance treatment of chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema, where the following clinical criteria are met: - Moderate to severe COPD as defined by spirometry; and - At risk of exacerbations despite a long-acting bronchodilator (LAMA or LABA); or - Symptomatic or at risk of exacerbations despite a LAMA/LABA
Singing for adults with chronic obstructive pulmonary disease (COPD). Singing is a complex physical activity dependent on the use of the lungs for air supply to regulate airflow and create large lung volumes. In singing, exhalation is active and requires active diaphragm contraction and good posture. Chronic obstructive pulmonary disease (COPD) is a progressive, chronic lung disease characterised by airflow obstruction. Singing is an activity with potential to improve health outcomes in people (...) with COPD.To determine the effect of singing on health-related quality of life and dyspnoea in people with COPD.We identified trials from the Cochrane Airways Specialised Register, ClinicalTrials.gov, the World Health Organization trials portal and PEDro, from their inception to August 2017. We also reviewed reference lists of all primary studies and review articles for additional references.We included randomised controlled trials in people with stable COPD, in which structured supervised singing training
Natural history of COPD: gaps and opportunities Understanding the natural history of a disease is as important as knowing its cause(s) for effective disease prevention and treatment. Yet, our current understanding of the natural history of chronic obstructive pulmonary disease (COPD) is incomplete and often controversial. This article discusses the current gaps, and hence opportunities for research, in this field. In particular, it discusses the following six specific questions. 1) Is COPD (...) a "single" disease? 2) Is COPD "only" a lung disease? 3) When does COPD begin or what is "early" COPD? 4) How does COPD "progress"? 5) How do we assess disease "severity"? 6) Can COPD be prevented (beyond smoking cessation) or its course be modified once detected?
The effectiveness of a nurse-led illness perception intervention in COPD patients: a cluster randomised trial in primary care The new COPD-GRIP (Chronic Obstructive Pulmonary Disease - Guidance, Research on Illness Perception) intervention translates evidence regarding illness perceptions and health-related quality of life (HRQoL) into a nurse intervention to guide COPD patients and to improve health outcomes. It describes how to assess and discuss illness perceptions in a structured way (...) . This study aimed to assess the effectiveness of the intervention in primary care. A cluster randomised controlled trial was conducted within 30 general practices and five home-care centres, including 204 COPD patients. 103 patients were randomly assigned to the intervention group and 101 patients to the usual-care group. To assess differences, repeated multilevel linear mixed modelling analyses were used. Primary outcome was change in health status on the Clinical COPD Questionnaire (CCQ) at 9 months
A qualitative study of patients' experiences of participating in SPACE for COPD: a Self-management Programme of Activity, Coping and Education The aim of this study was to understand experiences of participation in a supported self-management programme for chronic obstructive pulmonary disease (COPD). There is a wealth of clinical trials examining the outcomes of self-management interventions for individuals with COPD, but current understanding regarding patients' perspectives of such complex (...) interventions is limited. Further insight may help to tailor self-management interventions and maximise patient engagement. Semi-structured interviews were conducted with individuals participating in a self-management programme, SPACE for COPD. Interviews took place at 6 weeks and 6 months following the programme. Data were analysed at each time point using inductive thematic analysis, and subsequently re-examined together. 40 interviews were undertaken and four themes emerged from the analysis: perceptions
Long-Acting β-Agonists (LABA) Combined With Long-Acting Muscarinic Antagonists or LABA Combined With Inhaled Corticosteroids for Patients With Stable COPD. Are inhaled long-acting muscarinic antagonists (LAMA) combined with long-acting β-agonists (LABA) associated with differences in the incidence of chronic obstructive pulmonary disease (COPD) exacerbation and serious adverse events and with differences in quality of life and forced expiratory volume in the first second of expiration (FEV1) vs (...) inhaled LABA plus inhaled corticosteroids therapy for the treatment of stable COPD?Compared with inhaled LABA combined with corticosteroids, inhaled LAMA combined with LABA may be associated with a lower risk of COPD exacerbation and with greater improvement in FEV1 without differences in the incidence of serious severe adverse events or quality of life.
Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline | European Respiratory Society Main menu User menu Search Search for this keyword Search for this keyword Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline Jadwiga A. Wedzicha (ERS co-chair) , Marc Miravitlles , John R. Hurst , Peter M.A (...) 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
Asthma-COPD overlap syndrome: pathogenesis, clinical features, and therapeutic targets. Asthma-COPD overlap syndrome (ACOS) or asthma-COPD overlap captures the subset of patients with airways disease who have features of both asthma and chronic obstructive pulmonary disease (COPD). Although definitions of ACOS vary, it is generally thought to encompass persistent airflow limitation in a patient older than 40 years of age with either a history of asthma or large bronchodilator reversibility (...) . ACOS affects about a quarter of patients with COPD and almost a third of patients who previously had asthma. Compared with their counterparts with asthma or COPD alone, patients with ACOS have significantly worse respiratory symptoms, poorer quality of life, and increased risk of exacerbations and hospital admissions. Whether this condition emerges after gradual shifts in airway remodelling and inflammation in a patient with COPD, as the result of noxious exposures in a patient with asthma, or even
Spiolto Respimat (tiotropium/olodaterol) - chronic obstructive pulmonary disease (COPD) Spiolto Respimat® (tiotropium/olodaterol) × Insert searchphrase to search the website Insert searchphrase to search the website > > > Spiolto Respimat® (tiotropium/olodaterol) Conclusion Spiolto Respimat® (tiotropium/olodaterol) combines a long-acting muscarinic antagonist (LAMA) with a long-acting beta agonist (LABA) and is approved for maintenance bronchodilator treatment to relieve symptoms in adult (...) patients with chronic obstructive pulmonary disease (COPD). The LAMA component, tiotropium (Spiriva®), and the LABA component, olodaterol (Striverdi®), each have the same indication as Spiolto Respimat®. Despite statistically significant differences in several patient-specific measures of effectiveness (e.g. quality of life) favouring Spiolto Respimat® over the individual components, the efficacy is assessed to have limited clinical relevance in patients not yet started on relevant symptom-alleviating
Home-based maintenance tele-rehabilitation reduces the risk for acute exacerbations of COPD, hospitalisations and emergency department visits Pulmonary rehabilitation (PR) remains grossly underutilised by suitable patients worldwide. We investigated whether home-based maintenance tele-rehabilitation will be as effective as hospital-based maintenance rehabilitation and superior to usual care in reducing the risk for acute chronic obstructive pulmonary disease (COPD) exacerbations (...) and hospital-based PR remained independent predictors of a lower risk for 1) acute COPD exacerbation (incidence rate ratio (IRR) 0.517, 95% CI 0.389-0.687, and IRR 0.635, 95% CI 0.473-0.853), respectively, and 2) hospitalisations for acute COPD exacerbation (IRR 0.189, 95% CI 0.100-0.358, and IRR 0.375, 95% CI 0.207-0.681), respectively. However, only home-based maintenance tele-rehabilitation and not hospital-based, outpatient, maintenance PR was an independent predictor of ED visits (IRR 0.116, 95% CI
Effects of combined tiotropium/olodaterol on inspiratory capacity and exercise endurance in COPD Two replicate, double-blind, 6-week, incomplete-crossover studies (MORACTO 1 and 2) assessed the effects of tiotropium/olodaterol on inspiratory capacity and exercise endurance time in patients with moderate to severe chronic obstructive pulmonary disease.For each patient, four of five treatments were administered once daily for 6 weeks, with a 21-day washout between treatments: tiotropium
Colistin for Prophylactic Use in Non-Cystic Fibrosis Bronchiectasis or COPD with Exacerbations: A Review of Clinical and Cost-Effectiveness and Guidelines Colistin for Prophylactic Use in Non-Cystic Fibrosis Bronchiectasis or COPD with Exacerbations: A Review of Clinical and Cost-Effectiveness and Guidelines | CADTH.ca Find the information you need Colistin for Prophylactic Use in Non-Cystic Fibrosis Bronchiectasis or COPD with Exacerbations: A Review of Clinical and Cost-Effectiveness (...) and Guidelines Colistin for Prophylactic Use in Non-Cystic Fibrosis Bronchiectasis or COPD with Exacerbations: A Review of Clinical and Cost-Effectiveness and Guidelines Published on: June 27, 2017 Project Number: RC0896-000 Product Line: Research Type: Drug Report Type: Summary with Critical Appraisal Result type: Report Question What is the clinical effectiveness of colistin for the prophylactic treatment of adults with either non-cystic fibrosis bronchiectasis or patients with chronic obstructive
Umeclidinium bromide versus placebo for people with chronic obstructive pulmonary disease (COPD). People with chronic obstructive pulmonary disease (COPD) have poor quality of life, reduced survival, and accelerated decline in lung function, especially associated with acute exacerbations, leading to high healthcare costs. Long-acting bronchodilators are the mainstay of treatment for symptomatic improvement, and umeclidinium is one of the new long-acting muscarinic antagonists approved (...) ) of parallel design comparing umeclidinium bromide versus placebo in people with COPD, for at least 12 weeks.We used standard Cochrane methodological procedures. If we noted significant heterogeneity in the meta-analyses, we subgrouped studies by umeclidinium dose.We included four studies of 12 to 52 weeks' duration, involving 3798 participants with COPD. Mean age of participants ranged from 60.1 to 64.6 years; most were males with baseline mean smoking pack-years of 39.2 to 52.3. They had moderate