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Effects of inspiratory muscle training on dyspnoea in severe COPD patients during pulmonary rehabilitation: controlled randomised trial The benefit of inspiratory muscle training (IMT) combined with a pulmonary rehabilitation programme (PRP) is uncertain. We aimed to demonstrate that, in severe and very severe chronicobstructivepulmonarydisease (COPD) patients, IMT performed during a PRP is associated with an improvement of dyspnoea.In a single-blind randomised controlled trial, 150 severe (...) or very severe COPD patients were allocated to follow PRP+IMT versus PRP alone. The evaluations were performed at inclusion and after 4 weeks. The primary outcome was the change in dyspnoea using the Multidimensional Dyspnoea Profile questionnaire at the end of a 6-min walk test (6MWT) at 4 weeks. Secondary outcomes were changes in dyspnoea using the Borg (end of the 6MWT) and modified Medical Research Council scales and in functional parameters (maximal inspiratory pressure (PImax), inspiratory
ChronicObstructivePulmonaryDisease in Sweden: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy Socioeconomic, ethnic and gender disparities in ChronicObstructivePulmonaryDisease (COPD) risk are well established but no studies have applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) within an intersectional framework to study this outcome. We study individuals at the first level of analysis (...) and combinations of multiple social and demographic categorizations (i.e., intersectional strata) at the second level of analysis. Here we used MAIHDA to assess to what extent individual differences in the propensity of developing COPD are at the intersectional strata level. We also used MAIHDA to determine the degree of similarity in COPD incidence of individuals in the same intersectional stratum. This leads to an improved understanding of risk heterogeneity and of the social dynamics driving socioeconomic
The nurseâ€²s challenge of caring for patients with chronicobstructivepulmonarydisease in primary health care The aim was to describe asthma and chronicobstructivepulmonarydisease nurses' experiences of caring for patients with chronicobstructivepulmonarydisease in primary health care.Descriptive qualitative research.Ten asthma and chronicobstructivepulmonarydisease specialized nurses were interviewed. Systematic Text Condensation by Malterud was used to analyse the data.Two main (...) categories were found: the patient-nurse relationship and available resources. Several challenges emerged when connecting with patients and the nurses found it difficult to individualize care. They struggled with a lack of time and support from other professionals. Being responsible for asthma and chronicobstructivepulmonarydisease practice was experienced as positive, but could become overwhelming. The asthma and chronicobstructivepulmonarydisease nurses described several challenges and the need
at the study centre. The disease management intervention included a self-management programme, home telemonitoring, care coordination and medical management. The primary end-point was the number of unplanned all-cause hospitalisation days in the intention-to-treat (ITT) population. Secondary end-points included acute care hospitalisation days, BODE (body mass index, airflowobstruction, dyspnoea and exercise) index and exacerbations. Safety end-points included adverse events and deaths.For the 157 (disease (...) COMET: a multicomponent home-based disease-management programme versus routine care in severe COPD The COPD Patient Management European Trial (COMET) investigated the efficacy and safety of a home-based COPDdisease management intervention for severe COPD patients.The study was an international open-design clinical trial in COPD patients (forced expiratory volume in 1 s <50% of predicted value) randomised 1:1 to the disease management intervention or to the usual management practices
Fluticasone Furoate, Vilanterol, and Lung Function Decline in Patients with Moderate ChronicObstructivePulmonaryDisease and Heightened Cardiovascular Risk Many patients with chronicobstructivepulmonarydisease (COPD) have an accelerated loss of lung function. It is unclear whether drug treatment can modify this in patients with moderately severe disease.In a prespecified analysis of the key secondary outcome in SUMMIT (Study to Understand Mortality and Morbidity), we investigated whether (...) the inhaled corticosteroid fluticasone furoate (FF; 100 μg), the long-acting β-agonist vilanterol (VI; 25 μg), or their combination (FF/VI) modified the rate of decline in FEV1 compared with placebo. We also investigated how baseline covariates affected this decline.Spirometry was measured every 12 weeks in this event-driven, randomized, placebo-controlled trial of 16,485 patients with moderate COPD and heightened cardiovascular risk. An average of seven spirometric assessments per subject among
Dapagliflozin for prednisone-induced hyperglycaemia in acute exacerbation of chronicobstructivepulmonarydisease The aim of the present study was to compare the effectiveness and safety of add-on treatment with dapagliflozin to placebo in patients with prednisone-induced hyperglycaemia during treatment for acute exacerbation of chronicobstructivepulmonarydisease (AECOPD). We enrolled 46 patients hospitalized for an AECOPD in a multicentre double-blind randomized controlled study in which
Long-term Use of Inhaled Corticosteroids in COPD and the Risk of Fracture It is uncertain whether long-term use of inhaled corticosteroids (ICSs), widely used to treat COPD, increases the risk of fracture, particularly in women, in view of the postmenopausal risks. We assessed whether long-term ICS use in patients with COPD increases the risk of hip or upper extremity fractures, and examined sex-related differences.The Quebec health-care databases were used to form a cohort of patients (...) with COPD over 1990 to 2005, followed until 2007 for the first hip or upper extremity fracture. In a nested case-control analysis, each case of fracture was matched with 20 control subjects on age, sex, and follow-up time. The adjusted rate ratio (RR) of fracture with ICS use, by duration and dose, was estimated using conditional logistic regression, with an interaction term to compare the risk in men and women.In the cohort of 240,110 subjects, 19,396 sustained a fracture during a mean 5.3 years (rate
Management of chronicobstructivepulmonarydisease exacerbations at the Nasser Medical Complex: a clinical audit. The frequency and severity of chronicobstructivepulmonarydisease (COPD) exacerbations are the most important determinants of prognosis in COPD. The aim of this study was to assess the management of patients presenting with COPD exacerbations at the Nasser Medical Complex in the Gaza Strip and to compare the management with the Global Initiative for ChronicObstructiveLung (...) Disease guidelines (GOLD 2015).We reviewed the medical records of all patients admitted to Nasser Medical Complex and diagnosed with COPD exacerbation between Jan 1, 2014, and Dec 31, 2016. Clinical practice was compared with GOLD guidelines. Ethical approval was obtained from the General Directorate of Human Resources.55 patient records were reviewed. The mean age was 66·4 years (SD 8·5), and 54 (98%) patients were male. All patients received inhaled bronchodilators. 36 (65%) patients received short
COPD: time to improve its taxonomy? Due to well-conducted epidemiological studies and advances in genetics, molecular biology, translational research, the advent of computed tomography of the lungs and bioinformatics, the diagnosis of chronicobstructivepulmonarydisease (COPD) as a single entity caused by susceptibility to cigarette smoke is no longer tenable. Furthermore, the once-accepted concept that COPD results from a rapid and progressive loss of lung function over time is not true (...) for a sizeable proportion of adults with the disease. Now we know that some genetic predisposition and/or different environmental interactions (nutritional, infectious, pollution and immunological) may negatively modulate post-natal lung development and lead to poorly reversible airflowlimitation later in life, consistent with COPD. We believe it is time to rethink the taxonomy of this disease based on the evidence at hand. To do so, we have followed the principles outlined in the 1980s by J.D. Scadding who
Do-not-resuscitate orders as part of advance care planning in patients with COPD There is growing awareness of the need for advance care planning in patients with chronicobstructivepulmonarydisease (COPD). However, do-not-resuscitate (DNR) order implementation remains a challenge in clinical practice. We retrospectively analysed an observational cohort of 569 COPD patients with 2.5-8 years of follow-up in secondary care, to evaluate potential determinants and the prognostic significance (...) with a DNR order died within the first year after admission; of them, 66% died in the hospital. Age, forced expiratory volume in 1 s, chronic oxygen dependency and previous mechanical ventilation were significantly and independently associated with DNR order implementation. DNR order specification was significantly associated with increased mortality, even after adjustment for age and disease severity. These findings identify DNR orders as independent determinants of mortality, mainly implemented just
Extrafine inhaled triple therapy versus dual bronchodilator therapy in chronicobstructivepulmonarydisease (TRIBUTE): a double-blind, parallel group, randomised controlled trial. Evidence is scarce on the relative risk-benefit of inhaled triple therapy, consisting of inhaled corticosteroid, long-acting muscarinic antagonist, and long-acting β2-agonist, versus dual bronchodilation for chronicobstructivepulmonarydisease (COPD). We aimed to compare a single-inhaler triple combination (...) of beclometasone dipropionate, formoterol fumarate, and glycopyrronium (BDP/FF/G) versus a single-inhaler dual bronchodilator combination of indacaterol plus glycopyrronium (IND/GLY) in terms of the rate of moderate-to-severe COPD exacerbations over 52 weeks of treatment.This randomised, parallel-group, double-blind, double-dummy study was done at 187 sites across 17 countries. Eligible patients had symptomatic COPD, severe or very severe airflowlimitation, at least one moderate or severe exacerbation
2018LancetControlled trial quality: predicted high
- tive pulmonarydisease (COPD). We concluded “There are no proven clinically meaningful benefits in terms of reduc- tion in mortality or total serious adverse events…” for this indication based on 12 trials in 6,947 patients. In this Letter we report systematic reviews of 3 other inhaled LABA drugs licensed for COPD: formoterol, arformoterol and salmeterol. Objective To determine the clinical efficacy of inhaled formoterol, arformoterol and salmeterol as compared to placebo for chronic maintenance (...) Inhaled long acting Beta-2 (?2) agonists for COPD Inhaled long acting ß2 agonists for COPD November - December 2017 Mailing Address: Therapeutics Initiative The University of British Columbia Department of Anesthesiology, Pharmacology & Therapeutics 2176 Health Sciences Mall Vancouver, BC Canada V6T 1Z3 Tel.: 604 822 0700 Fax: 604 822 0701 E-mail: email@example.com www.ti.ubc.ca 109 I n Therapeutics Letter #102 1 we reviewed the inhaled long acting ß2 agonist (LABA) indacaterol for chronic obstruc
Fluticasone furoate / umeclidinium / vilanterol (Trelegy Ellipta) - maintenance treatment in adult patients with moderate to severe chronicobstructivepulmonarydisease (COPD) Published 12 February 2018 Product Update fluticasone furoate, umeclidinium, vilanterol (as trifenatate) 92 micrograms / 55 micrograms / 22 micrograms inhalation powder (Trelegy ® Ellipta ® ) SMC No 1303/18 GlaxoSmithKline UK 12 January 2018 The Scottish Medicines Consortium (SMC) has completed its assessment (...) of the above product and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use in NHS Scotland. The advice is summarised as follows: ADVICE: following an abbreviated submission fluticasone furoate / umeclidinium / vilanterol (as trifenatate) (Trelegy ® Ellipta ® ) is accepted for restricted use within NHS Scotland. Indication under review: maintenance treatment in adult patients with moderate to severe chronicobstructivepulmonarydisease (COPD) who are not adequately treated
How did prior understanding of COPD pathophysiology lead to COPD classifications in the past? (3:25) How is COPD diagnosed? (6:13) How has COPD been classified and why? (6:42) Subscribe to CORE IM on any podcast app! Follow us on Facebook || Twitter || Instagram . Please give any feedback at . Show Notes : ChronicObstructiveLungDisease (COPD) , is a disease of small airway inflammation defined by at FEV1/FVC ratio less than 0.70 and symptoms of chronic bronchitis and/or emphysema. In 1998 (...) , the U.S. National Heart, Lung, and Blood Institute and the World Health Organization helped to form the Global Initiative for ChronicObstructiveLungDisease (GOLD) . The program’s goal was “to produce recommendations for management of COPD based on the best scientific information available.” GOLD began publishing clinical guidelines in 2001; initially they separated COPD into the clinical syndrome of “blue bloaters”, or chronic bronchitis, and “pink puffers”, or chronicemphysema, however
Association of Cardiovascular Risk With Inhaled Long-Acting Bronchodilators in Patients With ChronicObstructivePulmonaryDisease: A Nested Case-Control Study The associations between cardiovascular disease (CVD) and inhaled long-acting β2-agonists (LABAs) or long-acting antimuscarinic antagonists (LAMAs) in chronicobstructivepulmonarydisease (COPD) are greatly debated. Pivotal and relevant randomized clinical trials included prior LABA or LAMA users and excluded patients with baseline CVD (...) , 71.4 years; 68.9% men), retrieved from the Taiwan National Health Insurance Research Database for health care claims from 2007 to 2011.LABA or LAMA use was measured in the year preceding the event or index date, stratified by duration since initiation of LABA or LAMA treatment, new and prevalent users, concomitant COPD medications, and individual agents.Cases with inpatient or emergency care visits for coronary artery disease, heart failure, ischemic stroke, or arrhythmia were identified
(total) Deaths from respiratory failure Deaths from COPD with cor pulmonale Expectorated valve Removal of valve Seizure (unrelated) 23 5 2 2 2 1 1 5 2 0 16 NR 2 2 0 0 0 4 2 0 22 3 0 1 0 0 0 0 0 1 20 NR 0 1 0 0 0 0 0 1 0.4 patients; 0.4 events 0.7 0.5 1.0 0.5 1.0 1.0 - - 1.0 COPD: chronicobstructivepulmonarydisease; EBV: endobronchial valve. Endobronchial valves for treatment of emphysema: Update March 2017 8 Effectiveness At 3 months, improvement in mean forced expiratory volume in one second (FEV (...) -patients-emphysema/ [Accessed 14 December 2016]. 5. Choi, M., Lee, W. S. et al (2015). 'Effectiveness of bronchoscopic lung volume reduction using unilateral endobronchial valve: a systematic review and meta- analysis'. International journal of chronicobstructivepulmonarydisease, 10, 703-10. 6. Jarad, N. (2016). 'Clinical review: Endobronchial valve treatment for emphysema'. Chronicrespiratorydisease, 13 (2), 173-88. 7. Tenda, E. D.& Yakub, A. (2016). 'Endobronchial Valve as Treatment of Emphysema
Effects of umeclidinium/vilanterol on exercise endurance in COPD: a randomised study This multicentre, randomised, double-blind, placebo-controlled, two-period crossover study assessed the effect of umeclidinium/vilanterol (UMEC/VI) on exercise capacity in patients with chronicobstructivepulmonarydisease (COPD) using the endurance shuttle walk test (ESWT). Patients were randomised 1:1 to one of two treatment sequences: 1) UMEC/VI 62.5/25 µg followed by placebo or 2) placebo followed by UMEC (...) /VI 62.5/25 µg. Each treatment was taken once daily for 12 weeks. The primary end-point was 3-h post-dose exercise endurance time (EET) at week 12. Secondary end-points included trough forced expiratory volume in 1 s (FEV1) and 3-h post-dose functional residual capacity (FRC), both at week 12. COPD Assessment Test (CAT) score at week 12 was also assessed. UMEC/VI treatment did not result in a statistically significant improvement in EET change from baseline at week 12 versus placebo (p=0.790