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Cost-effectiveness of antibiotics for COPD management: observational analysis using CPRD data It is often difficult to determine the cause of chronic obstructive pulmonary disease (COPD) exacerbations, and antibiotics are frequently prescribed. This study conducted an observational cost-effectiveness analysis of prescribing antibiotics for exacerbations of COPD based on routinely collected data from patient electronic health records. A cohort of 45 375 patients aged 40 years or more who (...) attended their general practice for a COPD exacerbation during 2000-2013 was identified from the Clinical Practice Research Datalink. Two groups were formed ("immediate antibiotics" or "no antibiotics") based on whether antibiotics were prescribed during the index general practice (GP) consultation, with data analysed according to subsequent healthcare resource use. A cost-effectiveness analysis was undertaken from the perspective of the UK National Health Service, using a time horizon of 4 weeks
Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation: A Randomized Clinical Trial. Outcomes after exacerbations of chronic obstructive pulmonary disease (COPD) requiring acute noninvasive ventilation (NIV) are poor and there are few treatments to prevent hospital readmission and death.To investigate the effect of home NIV plus oxygen on time to readmission or death in patients with persistent (...) hypercapnia after an acute COPD exacerbation.A randomized clinical trial of patients with persistent hypercapnia (Paco2 >53 mm Hg) 2 weeks to 4 weeks after resolution of respiratory acidemia, who were recruited from 13 UK centers between 2010 and 2015. Exclusion criteria included obesity (body mass index [BMI] >35), obstructive sleep apnea syndrome, or other causes of respiratory failure. Of 2021 patients screened, 124 were eligible.There were 59 patients randomized to home oxygen alone (median oxygen
A qualitative study of women's experiences of living with COPD To explore women's experiences of living with chronic obstructive pulmonary disease (COPD) at home.An explorative and descriptive qualitative design.A consecutive sample of nine women with COPD living at home. Data were collected in 2014 using semi-structured interviews and analysed using a qualitative content analysis.Three main themes were identified: having a good life with COPD despite limitations; predictability and confidence (...) in getting help; and the struggle to achieve a balance between insight and compliance with management of COPD. These women experienced limitations related to the traditional female role and felt unable to fulfil their own expectations. They experienced a good life despite limitations arising from adaptation and coping strategies. To feel safe, they needed to feel confident that they would receive the necessary help in case of exacerbation of their disease. To enhance compliance with COPD management
CRACKCast E074 – COPD CRACKCast E074 - COPD - CanadiEM CRACKCast E074 – COPD In , by Adam Thomas May 1, 2017 This episode of CRACKCast covers Rosen’s Chapter 74, COPD. This airway disease process is one of the most common causes of death worldwide. Approximately 20% of all hospital admissions for patients over age 65 are related to COPD, and so an approach to management will have nearly daily benefit for an emergency physician. Shownotes – Rosens in Perspective Pathophysiology of COPD According (...) to Global Initiative for Chronic Obstructive Lung Disease (GOLD), COPD is: “a preventable and treatable disease with some significant extra-pulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible… the airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases.” This used to include elements of reversible airflow
Cardiovascular outcomes with an inhaled beta2-agonist/corticosteroid in patients with COPD at high cardiovascular risk Cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) often coexist. We assessed the effect of inhaled COPD treatments on CVD outcomes and safety in patients with COPD and at heightened CVD risk.The SUMMIT (Study to Understand Mortality and MorbidITy) was a multicentre, randomised, double-blind, placebo-controlled, event-driven trial in 16 485 patients (...) with moderate COPD who had or were at high risk of CVD. Here, we assessed the prespecified secondary endpoint of time to first on-treatment composite CVD event (CVD death, myocardial infarction, stroke, unstable angina or transient ischaemic attack (TIA)) by Cox regression and by clinician-reported CVD adverse events across the four groups: once-daily inhaled placebo (n=4111), long-acting beta2-agonist (vilanterol (VI) 25 µg; n=4118), corticosteroid (fluticasone furoate (FF) 100 µg; n=4135) and combination
Palliative and end-of-life care conversations in COPD: a systematic literature review Chronic obstructive pulmonary disease (COPD) is a chronic life-limiting disorder characterised by persistent airflow obstruction and progressive breathlessness. Discussions/conversations between patients and clinicians ensure palliative care plans are grounded in patients' preferences. This systematic review aimed to explore what is known about palliative care conversations between clinicians and COPD patients (...) conversations is generally poor. Patients and physicians identified many barriers and important topics were not discussed. Patients and clinicians reported tension between remaining hopeful and the reality of the patients' condition. When discussions did happen, they often occurred at an advanced stage of illness and in respiratory wards and intensive care units. In conclusion, current care practices do not facilitate satisfactory conversations about palliative care between COPD patients and clinicians
Procalcitonin and CRP as Biomarkers in Discrimination of Community-acquired Pneumonia and Exacerbation of COPD Serum procalcitonin (PCT) and C-reactive protein (CRP) are markers of systemic inflammation and bacterial infection. We aimed to compare the usefulness of procalcitonin and CRP in patients with community-acquired pneumonia and exacerbations of chronic obstructive pulmonary disease (COPD).A total of 116 consecutive patients were included in the study: 76 with chronic obstructive (...) pulmonary disease in group 1, and 40 with pneumonia in group 2.Median serum CRP level was 44 mg/L in the COPD group and 132 mg/L in the pneumonia group. Median value of serum PCT was found to be 0.07 in the COPD group and 0.14 ng/mL in the pneumonia group. Serum PCT and CRP levels were significantly higher in the pneumonia group compared to the COPD group (p<0.001). The area under the ROC curve was 0.788 (CI: 0.704-0.872) for CRP and 0.699 (CI: 0.599-0.800) for procalcitonin to identify
Chronic Obstructive Pulmonary Disease (COPD): Diagnosis and Management ' ? s E G u s Y G ? T W ? Ž l Ž Ð Ž u ? E | s ? Ž ? ? Ž w w s ? G G Chronic Obstructive Pulmonary Disease (COPD): Diagnosis and Management E ective Date: February 22, 2017 Scope This guideline provides recommendations for the diagnosis and management of adults aged = 19 years with chronic obstructive pulmonary disease (COPD). Key Recommendations • Use spirometry to con$rm air%ow obstruction in all patients suspected (...) of having COPD. [Amended, 2017] • Promote smoking cessation or reduction (even in long-term smokers) to improve symptom control and slow the progression of COPD, among other bene$ts.  • Refer patients with moderate to severe COPD to pulmonary rehabilitation.  • Implement pharmacologic therapy in a stepwise approach and use the lowest step that achieves optimal control based on the patient’s severity of COPD. [New, 2017] • Develop an exacerbation action plan with the patient for pharmacologic
Oxygen Saturation Target of 88-92% in COPD: Evidence-based Medicine? Oxygen Saturation Target of 88-92% in COPD: Evidence-based Medicine? – Clinical Correlations Search Oxygen Saturation Target of 88-92% in COPD: Evidence-based Medicine? April 12, 2017 6 min read By Christopher V. Cosgriff Peer Reviewed The American College of Physicians (ACP) recommends supplemental long-term oxygen therapy (LTOT) in all patients who have severe resting hypoxemia, defined as a PaO 2 ≤55 mmHg or an SpO 2 ≤88 (...) , and no benefit for all secondary outcomes; the authors noted that the consistency of the null result across all outcomes strengthens their findings. It can thus be concluded from these studies that LTOT provides a mortality benefit in severely hypoxemic patients with COPD, but does not improve mortality in those with mild-to-moderate hypoxemia. These trials do not indicate an optimal target range for supplemental oxygenation. The currently accepted oxygen saturation target of 88%-92% is an attempt to provide
Cardiopulmonary response during whole-body vibration training in patients with severe COPD Several studies in patients with chronic obstructive pulmonary disease (COPD) have shown that whole-body vibration training (WBVT) has beneficial effects on exercise capacity. However, the acute cardiopulmonary demand during WBVT remains unknown and was therefore investigated in this study. Ten patients with severe COPD (forced expiratory volume in 1 s: 38±8% predicted) were examined on two consecutive (...) uptake after 3 min of squat exercises increased from 339±40 mL·min-1 to 1060±160 mL·min-1 with WBVT and 988±124 mL min-1 without WBV (p=0.093). However, there were no significant differences between squat exercises with and without WBVT in oxygen saturation (90±4% versus 90±4%, p=0.068), heart rate (109±13 bpm versus 110±15 bpm, p=0.513) or dyspnoea (Borg scale 5±2 versus 5±2, p=0.279). Combining squat exercises with WBVT induced a similar cardiopulmonary response in patients with severe COPD
Long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA) versus LABA plus inhaled corticosteroid (ICS) for stable chronic obstructive pulmonary disease (COPD). 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.To compare the benefits and harms of LAMA+LABA versus LABA+ICS for treatment of people with stable COPD.We performed an electronic
Community pharmacy COPD services: what do researchers and policy makers need to know? COPD is a leading cause of morbidity and mortality across the world and is responsible for a disproportionate use of health care resources. It is a progressive condition that is largely caused by smoking. Identification of early stage COPD provides an opportunity for interventions, such as smoking cessation, which prevent its progression. Once diagnosed, ongoing support services potentially provide
Systematic review of interventions to improve patient uptake and completion of pulmonary rehabilitation in COPD. Pulmonary rehabilitation is considered a key management strategy for chronic obstructive pulmonary disease (COPD), but its effectiveness is undermined by poor patient uptake and completion. The aim of this review was to identify, select and synthesise the available evidence on interventions for improving uptake and completion of pulmonary rehabilitation in COPD. Electronic databases (...) and was assessed as having a high risk of bias. The point estimate of effect did, however, indicate greater programme completion and attendance rates in participants allocated to pulmonary rehabilitation plus a tablet computer (enabled with support for exercise training) compared with controls (pulmonary rehabilitation only). There is insufficient evidence to guide clinical practice on interventions for improving patient uptake and completion of pulmonary rehabilitation in COPD. Despite increasing awareness