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Triple Inhaled Therapy at Two Glucocorticoid Doses in Moderate-to-Very-Severe COPD. Triple fixed-dose regimens of an inhaled glucocorticoid, a long-acting muscarinic antagonist (LAMA), and a long-acting β2-agonist (LABA) for chronicobstructivepulmonarydisease (COPD) have been studied at single dose levels of inhaled glucocorticoid, but studies at two dose levels are lacking.In a 52-week, phase 3, randomized trial to evaluate the efficacy and safety of triple therapy at two dose levels (...) of inhaled glucocorticoid in patients with moderate-to-very-severe COPD and at least one exacerbation in the past year, we assigned patients in a 1:1:1:1 ratio to receive twice-daily inhaled doses of triple therapy (inhaled glucocorticoid [320 μg or 160 μg of budesonide], a LAMA [18 μg of glycopyrrolate], and a LABA [9.6 μg of formoterol]) or one of two dual therapies (18 μg of glycopyrrolate plus 9.6 μg of formoterol or 320 μg of budesonide plus 9.6 μg of formoterol). The primary end point
Home noninvasive positive-pressure ventilation reduces mortality and intubations in COPD with hypercapnia. Wilson ME, Dobler CC, Morrow AS, et al. Association of home noninvasive positive pressure ventilation with clinical outcomes in chronicobstructivepulmonarydisease: a systematic review and meta-analysis. JAMA. 2020;323:455-65. 32016309.
Association of Dysanapsis With ChronicObstructivePulmonaryDisease Among Older Adults. Smoking is a major risk factor for chronicobstructivepulmonarydisease (COPD), yet much of COPD risk remains unexplained.To determine whether dysanapsis, a mismatch of airway tree caliber to lung size, assessed by computed tomography (CT), is associated with incident COPD among older adults and lung function decline in COPD.A retrospective cohort study of 2 community-based samples: the Multi-Ethnic Study (...) of Atherosclerosis (MESA) Lung Study, which involved 2531 participants (6 US sites, 2010-2018) and the Canadian Cohort of ObstructiveLungDisease (CanCOLD), which involved 1272 participants (9 Canadian sites, 2010-2018), and a case-control study of COPD: the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS), which involved 2726 participants (12 US sites, 2011-2016).Dysanapsis was quantified on CT as the geometric mean of airway lumen diameters measured at 19 standard anatomic locations
Should You Recommend Inhaled Corticosteroids for This Patient With ChronicObstructivePulmonaryDisease?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Approximately 12 million adults in the United States receive a diagnosis of chronicobstructivepulmonarydisease (COPD) each year, and it is the fourth leading cause of death. Chronicobstructivepulmonarydisease refers to a group of diseases that cause airflowobstruction and a constellation of symptoms, including cough (...) , sputum production, and shortness of breath. The main risk factor for COPD is tobacco smoke, but other environmental exposures also may contribute. The GOLD (Global Initiative for ChronicObstructiveLungDisease) 2020 Report aims to provide a nonbiased review of the current evidence for the assessment, diagnosis, and treatment of patients with COPD. To date, no conclusive evidence exists that any existing medications for COPD modify mortality. The mainstay of treatment for COPD is inhaled
No Additional Therapy? Conclusions Summary of Recommendations In patients with chronicobstructivepulmonarydisease (COPD) who complain of dyspnea or exercise intolerance, we recommend long-acting b 2 -agonist (LABA)/long-acting muscarinic antagonist (LAMA) combination therapy over LABA or LAMA monotherapy (strong recommendation, moderate certainty evidence). In patients with COPD who complain of dyspnea or exercise intolerance despite dual therapy with LABA/LAMA, we suggest the use of triple therapy (...) advise against the use of maintenance oral corticosteroid therapy (conditional recommendation, low certainty evidence). In individuals with COPD who experience advanced refractory dyspnea despite otherwise optimal therapy, we suggest that opioid-based therapy be considered for dyspnea management, within a personalized shared decision- making approach (conditional recommendation, very low certainty evidence). Introduction The Global Initiative for ChronicObstructiveLungDisease 2019 report de?nes
Association Between Initiation of Pulmonary Rehabilitation After Hospitalization for COPD and 1-Year Survival Among Medicare Beneficiaries. Meta-analyses have suggested that initiating pulmonary rehabilitation after an exacerbation of chronicobstructivepulmonarydisease (COPD) was associated with improved survival, although the number of patients studied was small and heterogeneity was high. Current guidelines recommend that patients enroll in pulmonary rehabilitation after hospital (...) discharge.To determine the association between the initiation of pulmonary rehabilitation within 90 days of hospital discharge and 1-year survival.This retrospective, inception cohort study used claims data from fee-for-service Medicare beneficiaries hospitalized for COPD in 2014, at 4446 acute care hospitals in the US. The final date of follow-up was December 31, 2015.Initiation of pulmonary rehabilitation within 90 days of hospital discharge.The primary outcome was all-cause mortality at 1 year. Time
, and severity of COPD exacerbations. Thorax . 2002 ; 57 : 759–764 | | | , x 7 Seemungal, T., Harper-Owen, R., Bhowmik, A. et al. Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronicobstructivepulmonarydisease. Am J Respir Crit Care Med . 2001 ; 164 : 1618–1623 | | | , x 8 Sethi, S. Bacteria in exacerbations of chronicobstructivepulmonarydisease: phenomenon or epiphenomenon?. Proc Am Thorac Soc . 2004 ; 1 : 109–114 | | | , x 9 Bafadhel, M., McKenna, S (...) ., Frei, A., Steurer-Stey, C.A. et al. Antibiotics for exacerbations of chronicobstructivepulmonarydisease. Cochrane Database Syst Rev . 2018 ; 10 : CD010257 Limitations of this meta-analysis include no consideration of underlying chronicobstructivepulmonarydisease severity across trials because of poor reporting of lung function and other parameters. Studies were not limited to patients with suspected bacterial infection, who demonstrate the greatest benefit from antibiotics. Thus, the lack
. There is no evidence to use or not to use oral or inhaled corticosteroids outside usual guidelines in COPD patients with COVID19. Antibiotics should be issued only if suspicion of secondary bacterial infection.” Please refer to that document. Please also refer to the NICE Rapid Guideline for the community-based care of patients with chronicobstructivepulmonarydisease (COPD): https://www.nice.org.uk/guidance/ng168 This reiterates the importance of smoking cessation. Strongly encourage patients with COPD who (...) ), there is no routine indication to take rescue antibiotics or additional oral steroids. Do not offer patients with COPD a short course of oral corticosteroids and/or antibiotics to keep at home unless clinically indicated, as set out in the NICE guideline on chronicobstructivepulmonarydisease in over 16s. There should be NO alteration to advanced rescue-pack prescribing or stockpiling inhalers. These seriously compromise the medicines supply chain and equitable access. Best practice at all times
Permalink Copy Page navigation Thorax Actions . 2020 May;75(5):413-421. doi: 10.1136/thoraxjnl-2019-214246. Epub 2020 Mar 30. Supervised Pulmonary Tele-Rehabilitation Versus Pulmonary Rehabilitation in Severe COPD: A Randomised Multicentre Trial , , , , , , , , , , Affiliations Expand Affiliations 1 Respiratory Research Unit, Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark email@example.com. 2 Department of Physical and Occupational Therapy, Bispebjerg Hospital (...) and Infectious Diseases, Hillerød Hospital, Hillerød, Denmark. 9 Department of Public Health, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark. PMID: 32229541 DOI: Item in Clipboard Supervised Pulmonary Tele-Rehabilitation Versus Pulmonary Rehabilitation in Severe COPD: A Randomised Multicentre Trial Henrik Hansen et al. Thorax . 2020 May . Show details Thorax Actions . 2020 May;75(5):413-421. doi: 10.1136/thoraxjnl-2019-214246. Epub 2020 Mar 30. Authors
to the clinical effectiveness of the technology. Further information about how the evidence for this briefing was selected is available on request by contacting firstname.lastname@example.org. Published evidence Published evidence Three studies are summarised in this briefing, including 2 randomised controlled trials and 1 observational study. In total, there were 167 people with chronicobstructivepulmonarydisease (COPD) in these studies. The clinical evidence and its strengths and limitations is summarised (...) myCOPD for self-management of chronicobstructivepulmonarydisease myCOPD for self-management of chronicobstructivepulmonarydisease Medtech innovation briefing Published: 1 April 2020 www.nice.org.uk/guidance/mib214 pathways Summary Summary • The technology technology described in this briefing is myCOPD. It helps people with chronicobstructivepulmonarydisease (COPD) to manage their symptoms and reduce the number of healthcare visits they need. It also helps the healthcare professionals
, is a major public health problem that is both preventable and treatable. COPD is characterized by persistent airflowlimitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and lungs to noxious articles or gases. Exacerbations and comorbidities contribute to overall severity in individual patients. Recommendations for the diagnosis and treatment of patients with concurrent COPD and asthma are excluded from this guideline because these patients (...) . In addition to identifying the recently published guidelines that meet the above standards, a literature search was conducted to identify studies relevant to the key questions that are not addressed by the external guidelines. External guidelines eligible for adapting ? 2019 Update of 2017 Global Initiative for ChronicObstructiveLungDisease (GOLD): Global strategy for the diagnosis, management and prevention of COPD ? 2018 KP National Clinical Practice Guideline: ChronicObstructivePulmonaryDisease
. Guan WJ, Liang WH, Zhao Y, et al. Comorbidity and its impact on 1590 patients with Covid-19 in China: A Nationwide Analysis. Eur Respir J. 2020:2000547. 8. Lippi G, Henry BM. Chronicobstructivepulmonarydisease is associated with severe coronavirus disease 2019 (COVID-19). Respiratory Medicine. 2020. DOI: https://doi.org/10.1016/j.rmed.2020.105941 9. Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. 2020;395(10223 (...) distancing in the workplace setting is difficult to implement. Until we fully understand the risks associated with SARS-CoV-2 infection in patients with chroniclungdisease we have placed a high value on limiting exposure based on prior experience with influenza. COPD Management – General Statement In the absence of direct or indirect data that use of current inhaled COPD therapies impacts the severity of SARS-CoV-2 infection, we recommend that maintenance and exacerbation management for COPD
Purified human alpha1-proteinase inhibitor (A1-PI) for the treatment of alpha1-proteinase inhibitor deficiency, leading to chronicobstructivepulmonarydisease (COPD) 1 Public Summary Document Application No. 1530 – Purified human alpha1-proteinase inhibitor for the treatment of alpha1-proteinase inhibitor deficiency, leading to chronicobstructivepulmonarydisease Applicant: National Blood Authority (NBA) Date of MSAC consideration: MSAC 74th Meeting, 22-23 November 2018 Context for decision (...) : MSAC makes its advice in accordance with its Terms of Reference, visit the MSAC website 1. Purpose of application An application requesting National Product List (NPL) blood product listing of purified human alpha1-proteinase inhibitor (A1-PI) for the treatment of A1-PI deficiency, leading to chronicobstructivepulmonarydisease (COPD), was received from the National Blood Authority (NBA) by the Department of Health. 2. MSAC’s advice to the Minister After considering the strength of available
: Targeted lung denervation (TLD) is a bronchoscopic radiofrequency ablation therapy for chronicobstructivepulmonarydisease (COPD), which durably disrupts parasympathetic pulmonary nerves to decrease airway resistance and mucus hypersecretion. Objectives: To determine the safety and impact of TLD on respiratory adverse events. Methods: We conducted a multicenter, randomized, sham bronchoscopy-controlled, double-blind trial in patients with symptomatic (modified Medical Research Council dyspnea scale (...) treated with TLD combined with optimal pharmacotherapy had fewer study-defined respiratory adverse events, including hospitalizations for COPD exacerbation.Clinical trial registered with www.clinicaltrials.gov ( ). Keywords: anticholinergic; bronchoscopy; chronicobstructivepulmonarydisease; nerves; targeted lung denervation. Figures Figure 1. 5 Respiratory adverse events between 3... Figure 1. 13 Respiratory adverse events between 3 and 6.5 months after bronchoscopy for the... Figure 1. Respiratory
COVID-19. Signpost to charities (such as the British Lung Foundation) and support groups (such as NHS Volunteer Responders), and UK government guidance on the mental health and wellbeing aspects of COVID-19. 1.2 Explain to patients with chronicobstructivepulmonarydisease (COPD), and their families and carers, that they are at increased risk of severe illness from COVID-19. 1.3 Be aware that the NICE guideline on chronicobstructivepulmonarydisease in over 16s defines severe airflowobstruction (...) , and they should take appropriate precautions such as: • performing airway clearance techniques in a well-ventilated room • performing airway clearance techniques away from other family members if possible • advising other family members not to enter the room until enough time has passed for aerosols to clear. Find out more from UK government guidance on COVID-19: infection prevention and control. COVID-19 rapid guideline: community-based care of patients with chronicobstructivepulmonarydisease (COPD
. The manufacturer had no other role in any part of the trial.To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000820/crp-testing-safely-reduces-antibiotic-use-for-copd-flare-ups.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. (...) C reactive protein testing in general practice safely reduces antibiotic use for flare-ups of COPD. The studyButler CC, Gillespie D, White P, et al. C-reactive protein testing to guide antibiotic prescribing for COPD exacerbations. N Engl J Med 2019;381:111-20.This research was funded by the NIHR Technology Assessment Programme (project number 12/33/12). The testing machines used in the study were loaned to researchers by the manufacturer, who also provided training on their use
Metoprolol for the Prevention of Acute Exacerbations of COPD. Observational studies suggest that beta-blockers may reduce the risk of exacerbations and death in patients with moderate or severe chronicobstructivepulmonarydisease (COPD), but these findings have not been confirmed in randomized trials.In this prospective, randomized trial, we assigned patients between the ages of 40 and 85 years who had COPD to receive either a beta-blocker (extended-release metoprolol) or placebo. All (...) the patients had a clinical history of COPD, along with moderate airflowlimitation and an increased risk of exacerbations, as evidenced by a history of exacerbations during the previous year or the prescribed use of supplemental oxygen. We excluded patients who were already taking a beta-blocker or who had an established indication for the use of such drugs. The primary end point was the time until the first exacerbation of COPD during the treatment period, which ranged from 336 to 350 days, depending
, and Blood Institute. COPD national action plan. Washington, D.C.: U.S. Department of Health and Human Services; 2017 [accessed 2018 Jul 6]. Available from: . van Agteren JE, Hnin K, Grosser D, Carson KV, Smith BJ. Bronchoscopic lung volume reduction procedures for chronicobstructivepulmonarydisease. Cochrane Database Syst Rev. 2017;2:CD012158. - - Kaplan RM, Ries AL. Health-related quality of life in emphysema. Proc Am Thorac Soc. 2008;5:561–566. - - Vogelmeier CF, Criner GJ, Martínez FJ, Anzueto (...) similar articles Cited by 1 PubMed Central articles NS Hopkinson. Am J Respir Crit Care Med 200 (11), 1329-1331. 2019. PMID 31560561. References Wheaton AG, Cunningham TJ, Ford ES, Croft JB Centers for Disease Control and Prevention (CDC) Employment and activity limitations among adults with chronicobstructivepulmonarydisease: United States, 2013. MMWR Morb Mortal Wkly Rep. 2015;64:289–295. - - U.S. Department of Health and Human Services, National Institutes of Health and National Heart, Lung
Efficacy and safety of inhaled alpha1-antitrypsin in patients with severe alpha1-antitrypsin deficiency and frequent exacerbations of COPD Patients with inherited α1-antitrypsin (AAT) deficiency (ZZ-AATD) and severe chronicobstructivepulmonarydisease (COPD) frequently experience exacerbations. We postulated that inhalation of nebulised AAT would be an effective treatment.We randomly assigned 168 patients to receive twice-daily inhalations of 80 mg AAT solution or placebo for 50 weeks (...) in the AAT-treated group and 2.67 in the placebo group (p=0.31). More patients receiving AAT reported treatment-related treatment-emergent adverse events compared to placebo (57.5% versus 46.9%, respectively) and they were more likely to withdraw from the study. After the first year of the study, when modifications to the handling of the nebuliser were introduced, the rate of safety events in the AAT-treated group dropped to that of the placebo group.We conclude that in AATD patients with severe COPD