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Self management of patients with mild COPD in primary care: randomised controlled trial. To evaluate the effectiveness of telephone health coaching delivered by a nurse to support self management in a primary care population with mild symptoms of chronicobstructivepulmonarydisease (COPD).Multicentre randomised controlled trial.71 general practices in four areas of England.577 patients with Medical Research Council dyspnoea scale scores of 1 or 2, recruited from primary care COPD registers (...) COPD.The primary outcome was health related quality of life at 12 months using the short version of the St George's Respiratory Questionnaire (SGRQ-C).The intervention was delivered with good fidelity: 86% of scheduled calls were delivered; 75% of patients received all four calls. 92% of patients were followed-up at six months and 89% at 12 months. There was no difference in SGRQ-C total score at 12 months (mean difference -1.3, 95% confidence interval -3.6 to 0.9, P=0.23). Compared with patients
Intrinsic factors influence self-management participation in COPD: effects on self-efficacy Personal traits should be addressed before offering self-management programmes to patients with COPD http://ow.ly/DtNh30k1A15.
Influence of dietary nitrate supplementation on lung function and exercise gas exchange in COPD patients. During exercise as pulmonary blood flow rises, pulmonary capillary blood volume increases and gas exchange surface area expands through distention and recruitment. We have previously demonstrated that pulmonary capillary recruitment is limited in COPD patients with poorer exercise tolerance. Hypoxia and endothelial dysfunction lead to pulmonary vascular dysregulation possibly in part (...) related to nitric oxide related pathways.To determine if increasing dietary nitrate might influence lung surface area for gas exchange and subsequently impact exercise performance.Subjects had stable, medically treated COPD (n = 25), gave informed consent, filled out the St George Respiratory Questionnaire (SGRQ), had a baseline blood draw for Hgb, performed spirometry, and had exhaled nitric oxide (exNO) measured. Then they performed the intra-breath (IB) technique for lung diffusing capacity
Tai Chi and Pulmonary Rehabilitation Compared for Treatment-Naive Patients With COPD: A Randomized Controlled Trial In COPD, functional status is improved by pulmonary rehabilitation (PR) but requires specific facilities. Tai Chi, which combines psychological treatment and physical exercise and requires no special equipment, is widely practiced in China and is becoming increasingly popular in the rest of the world. We hypothesized that Tai Chi is equivalent (ie, difference less than ±4 St (...) . George's Respiratory Questionnaire [SGRQ] points) to PR.A total of 120 patients (mean FEV1, 1.11 ± 0.42 L; 43.6% predicted) bronchodilator-naive patients were studied. Two weeks after starting indacaterol 150 μg once daily, they randomly received either standard PR thrice weekly or group Tai Chi five times weekly, for 12 weeks. The primary end point was change in SGRQ prior to and following the exercise intervention; measurements were also made 12 weeks after the end of the intervention.The between
Home treatment of COPD exacerbation selected by DECAF score: a non-inferiority, randomised controlled trial and economic evaluation Previous models of Hospital at Home (HAH) for COPD exacerbation (ECOPD) were limited by the lack of a reliable prognostic score to guide patient selection. Approximately 50% of hospitalised patients have a low mortality risk by DECAF, thus are potentially suitable.In a non-inferiority randomised controlled trial, 118 patients admitted with a low-risk ECOPD (DECAF 0 (...) or 1) were recruited to HAH or usual care (UC). The primary outcome was health and social costs at 90 days.Mean 90-day costs were £1016 lower in HAH, but the one-sided 95% CI crossed the non-inferiority limit of £150 (CI -2343 to 312). Savings were primarily due to reduced hospital bed days: HAH=1 (IQR 1-7), UC=5 (IQR 2-12) (P=0.001). Length of stay during the index admission in UC was only 3 days, which was 2 days shorter than expected. Based on quality-adjusted life years, the probability of HAH
with COPD exacerbations do not return to baseline within 3 months of an exacerbation. Many thanks to Dr. Melissa Lesko, Pulmonologists at NYU, for peer reviewing this episode. References (2:44 to end) Vogelmeier CF et al. “Global Strategy for the diagnosis, management, and prevention of chronicobstructivelungdisease 2017 report. GOLD executive summary.” Am J Respir Crit Care Med. 2017 Mar 1;195(5):557-582. (3:04) Wedzicha JA “Oral corticosteroids for exacerbations of chronicobstructivepulmonary (...) Initiative for ChronicObstructiveLungDisease) define a COPD exacerbation? (2:44) What outcomes do steroids actually improve in treating a COPD exacerbation? (5:08) What is the evidence behind a 5 day steroid “burst”? (7:20) Are IV steroids more powerful than PO? (9:00) Subscribe to CORE IM on any podcast app! Follow us on Facebook || Twitter || Instagram . Please give any feedback at . Show Notes A moderate to severe COPD exacerbation is defined as at least 2 of the 3 cardinal symptoms : change
Clinical Endpoint Committee CHMP Committee for Medicinal Products for Human Use CI confidence interval COPDchronicobstructivepulmonarydisease CPRD Clinical Practice Research Database CRF/eCRF case report form/electronic case report form CSR clinical study report CT computed tomography CV cardiovascular ECG electrocardiogram EMA European Medicines Agency EPAR European Public Assessment Report ERS European Respiratory Society EXACT-RS Exacerbations of ChronicPulmonaryDisease Tool EXT Extension (...) the centralised procedure under Article 3 (2)(b) of Regulation (EC) No 726/2004. The eligibility to the centralised procedure was agreed upon by the EMA/CHMP on 18 May 2017. The eligibility to the centralised procedure under Article 3(2)(b) of Regulation (EC) No 726/2004 was based on demonstration of interest of patients at Community level. The applicant applied for the following indication: Maintenance treatment in adult patients with moderate to severe chronicobstructivepulmonarydisease (COPD) who
and current guidance The NICE guideline on chronicobstructivepulmonarydisease (COPD) is currently being updated (expected publication date November 2018). The current COPD guideline states that COPD is characterised by airflowobstruction that is usually progressive and not fully reversible, and is predominantly caused by smoking. COPD causes symptoms, disability and impaired quality of life, which may respond to pharmacological and other therapies that have limited or no measurable impact (...) chronicobstructivepulmonarydisease (COPD) who are not adequately treated by a combination of an ICS and a LABA (summary of product characteristics). Ov Overview erview This evidence summary discusses 2 randomised controlled trials (RCTs) looking at the safety and efficacy of fluticasone furoate/umeclidinium/vilanterol (an ICS/LAMA and LABA combination inhaler) in people with COPD who were symptomatic despite regular maintenance treatment and who either had a history, or were at risk
Narrative medicine educational project to improve the care of patients with chronicobstructivepulmonarydiseaseChronicobstructivepulmonarydisease (COPD) is characterised by a progressive loss of pulmonary function. Often patients do not adhere to inhaled therapies and this leads clinicians to switch treatments in order to improve control of the symptoms. Narrative medicine is a useful approach that helps healthcare professionals to think over the doctor-patient relationship and how (...) patients live with their disease. The aim of this training project was to teach pulmonologists the basics of narrative medicine: to carefully listen to patients and to practice reflective writing in their relationship with them. Training on narrative medicine and parallel charts was provided through a webinar and a weekly newsletter. Across 362 narratives, written by 74 Italian pulmonologists, 92% of patients had activity limitations at their first visit. The main factor influencing the effectiveness
Single-inhaler triple therapy in symptomatic COPD patients: FULFIL subgroup analyses Triple inhaled corticosteroid (ICS)/long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA) therapy is recommended for symptomatic patients with chronicobstructivepulmonarydisease (COPD) and at risk of exacerbations. However, the benefits versus side-effects of triple inhaled therapy for COPD, based on distinct patient clinical profiles, are unclear. FULFIL, a phase III, randomised, double (...) -blind study, compared 24 weeks of once-daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100/62.5/25 µg using the Ellipta inhaler with twice-daily budesonide/formoterol (BUD/FOR) 400/12 µg using the Turbuhaler. Subgroup analyses of forced expiratory volume in 1 s (FEV1), St George's Respiratory Questionnaire (SGRQ) Total score and exacerbation rates were carried out. Subgroups were defined by COPD medication at screening (ICS+LABA, BUD+FOR, ICS+LABA+LAMA, LAMA alone, tiotropium alone
Inspiratory muscle training does not improve clinical outcomes in 3-week COPD rehabilitation: results from a randomised controlled trial The value of inspiratory muscle training (IMT) in pulmonary rehabilitation in chronicobstructivepulmonarydisease (COPD) is unclear. The RIMTCORE (Routine Inspiratory Muscle Training within COPD Rehabilitation) randomised controlled trial examined the effectiveness of IMT added to pulmonary rehabilitation.In total, 611 COPD patients (Global Initiative (...) for ChronicObstructiveLungDisease stage II-IV) received a 3-week inpatient pulmonary rehabilitation, of which 602 patients were included in the intention-to-treat analyses. The intervention group (n=300) received highly intensive IMT and the control group (n=302) received sham IMT. The primary outcome was maximal inspiratory pressure (PImax). The secondary outcomes were 6-min walk distance, dyspnoea, quality of life and lung function. Outcomes were assessed pre- and post-pulmonary rehabilitation
Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD. The benefits of triple therapy for chronicobstructivepulmonarydisease (COPD) with an inhaled glucocorticoid, a long-acting muscarinic antagonist (LAMA), and a long-acting β2-agonist (LABA), as compared with dual therapy (either inhaled glucocorticoid-LABA or LAMA-LABA), are uncertain.In this randomized trial involving 10,355 patients with COPD, we compared 52 weeks of a once-daily combination of fluticasone furoate (...) (an inhaled glucocorticoid) at a dose of 100 μg, umeclidinium (a LAMA) at a dose of 62.5 μg, and vilanterol (a LABA) at a dose of 25 μg (triple therapy) with fluticasone furoate-vilanterol (at doses of 100 μg and 25 μg, respectively) and umeclidinium-vilanterol (at doses of 62.5 μg and 25 μg, respectively). Each regimen was administered in a single Ellipta inhaler. The primary outcome was the annual rate of moderate or severe COPD exacerbations during treatment.The rate of moderate or severe exacerbations
) significant atelectasis on the chest radiograph (when obtained). history of hemodynamically significant congenital heart disease, chroniclungdisease, and immunocompromised state have been associated with higher morbidity and mortality among inpatients.  List potential complications of RSV. Apnea Respiratory failure Dehydration Hospitalization Secondary bacterial infection (otitis media, UTI, bacteremia, meningitis) Over investigation and overtreatment with antibiotics Wisecracks  What’s (...) CRACKCast E169 – Paediatric Respiratory Emergencies: Lower AirwayObstruction CRACKCast E169 - Paediatric Respiratory Emergencies: Lower AirwayObstruction - CanadiEM CRACKCast E169 – Paediatric Respiratory Emergencies: Lower AirwayObstruction In , , by Adam Thomas April 12, 2018 This episode of CRACKCast covers Rosen’s Chapter 168 (9th Ed.). Respiratory presentations are very common in kids, and you will be a pro at managing lower respiratoryobstruction after listening to this episode
of variable pitch caused by partial airwayobstruction or collapse and the resultant turbulent airflow through some portion of the airway, from the nose to the trachea. Stridor is described by timing in the respiratory cycle (inspiratory, expiratory, biphasic) and quality (coarse or high-pitched). Inspiratory = pathology above the glottis Biphasic = pathology at the glottis Expiratory = pathology below the glottis I before E. (see figure 167.2 in R osens)  Provide a differential diagnosis for stridor (...) CRACKCast E168 – Pediatric Respiratory Emergencies: Upper AirwayObstruction and Infections CRACKCast E168 – Pediatric Respiratory Emergencies: Upper AirwayObstruction and Infections - CanadiEM CRACKCast E168 – Pediatric Respiratory Emergencies: Upper AirwayObstruction and Infections In , , by Adam Thomas April 9, 2018 This episode of CRACKCast Covers Rosen’s Chapter 167, Pediatric Upper Airway Emergencies. Stridor is a very common presentation and this episode will help out with diagnosis
Noninvasive ventilation in stable hypercapnic COPD: what is the evidence? Long-term noninvasive ventilation (NIV) to treat chronic hypercapnic respiratory failure is still controversial in severe chronicobstructivepulmonarydisease (COPD) patients. However, with the introduction of high-intensity NIV, important benefits from this therapy have also been shown in COPD. In this review, the focus will be on the arguments for long-term NIV at home in patients with COPD. The rise of (high-intensity (...) ) NIV in COPD and the randomised controlled trials showing positive effects with this mode of ventilation will be discussed. Finally, the challenges that might be encountered (both in clinical practice and in research) in further optimising this therapy, monitoring and following patients, and selecting the patients who might benefit most will be reviewed.
in a nationally representative sample of adults aged 20 years or older from ten provinces, autonomous regions, and municipalities in mainland China. All participants underwent a post-bronchodilator pulmonary function test. COPD was diagnosed according to 2017 Global Initiative for ChronicObstructiveLungDisease (GOLD) criteria.Between June, 2012, and May, 2015, 57 779 individuals were invited to participate, of whom 50 991 (21 446 men and 29 545 women) had reliable post-bronchodilator results and were (...) Prevalence and risk factors of chronicobstructivepulmonarydisease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study. Although exposure to cigarette smoking and air pollution is common, the current prevalence of chronicobstructivepulmonarydisease (COPD) is unknown in the Chinese adult population. We conducted the China Pulmonary Health (CPH) study to assess the prevalence and risk factors of COPD in China.The CPH study is a cross-sectional study