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Indacaterol for chronicobstructivepulmonarydisease inhaler air 75 µg benefit? Indacaterol for chronicobstructivepulmonarydisease September - October 2016 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: firstname.lastname@example.org www.ti.ubc.ca 102 C hronic obstructivepulmonarydisease (COPD) is an inflammatory (...) condition characterized by irreversibleairflowobstruction. It is caused by exposure to noxious particles or gases, with exposure to cigarette smoke the most common cause. Several classes of drugs can be pre- scribed: short and long-acting beta 2 (ß2) agonist, short and long-acting anti muscarinic, inhaled corticosteroids and phosphodiesterase-4 inhibitors. We are conduct- ing a class review of all long-acting beta 2 (ß2) agonist (LABA) drugs and indacaterol is the first of this series. All drugs
Chronicobstructivepulmonarydisease and Î²â€blocker treatment in Asian patients with heart failure Chronicobstructivepulmonarydisease (COPD) and heart failure (HF) are increasingly frequent in Asia and commonly coexist in patients. However, the prevalence of COPD among Asian patients with HF and its impact on HF treatment are unclear.We compared clinical characteristics and treatment approaches between patients with or without a history of COPD, before and after 1:2 propensity matching (...) (for age, sex, geographical region, income level, and ethnic group) in 5232 prospectively recruited patients with HF and reduced ejection fraction (HFrEF, <40%) from 11 Asian regions (Northeast Asia: South Korea, Japan, Taiwan, Hong Kong, and China; South Asia: India; Southeast Asia: Thailand, Malaysia, Philippines, Indonesia, and Singapore). Among the 5232 patients with HFrEF, a history of COPD was present in 8.3% (n = 434), with significant variation in geography (11.0% in Northeast Asia vs. 4.7
Survival significance of coexisting chronicobstructivepulmonarydisease in patients with early lung cancer after curative surgery The impact of chronicobstructivepulmonarydisease (COPD) severity on survival after curative resection of early-stage lung cancer (NSCLC) has not been sufficiently elucidated.We retrospectively reviewed 250 consecutive patients who underwent lobectomy with lymph nodal dissection for pathological stage I-II NSCLC.Among the COPD patients, 28 were classified (...) as Global Initiative for ChronicObstructiveLungDisease (GOLD) 1, 21 as GOLD 2, and one as GOLD 3. The cumulative overall survival (OS) of the non-COPD, GOLD 1, and GOLD 2-3 groups at five years was 90.7%, 85.7%, and 55.3%, respectively, (P < 0.0001), while recurrence-free survival (RFS) between the groups at five years was 84.7%, 80.7%, and 72.9%, respectively. Although RFS in the GOLD 2-3 group tended to indicate a poor prognosis, there was no statistical difference between the groups (P = 0.385
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 chronicobstructivepulmonarydisease (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 chronicobstructivepulmonarydisease (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.
on the management of #COPD exacerbations from @ERStalk and @atscommunity Executive summary Chronicobstructivepulmonarydisease (COPD) exacerbations are episodes of increased respiratory symptoms, particularly dyspnoea, cough and sputum. The European Respiratory Society (ERS) and American Thoracic Society (ATS) collaborated to develop guidelines that address questions regarding the treatment of COPD exacerbations that are not clearly answered by current guidelines. Key recommendations from the guidelines (...) recommendation, very low quality of evidence). Introduction The chronic and progressive course of chronicobstructivepulmonarydisease (COPD) is often punctuated by “exacerbations”, defined clinically as episodes of increasing respiratory symptoms, particularly dyspnoea, cough and sputum production, and increased sputum purulence. COPD exacerbations have a negative impact on the quality of life of patients with COPD [ , ], accelerate disease progression, and can result in hospital admissions and death
Effect of early follow-up after hospital discharge on outcomes in patients with heart failure or chronicobstructivepulmonarydisease: a systematic review Effect of early follow-up after hospital discharge on outcomes in patients with heart failure or chronicobstructivepulmonarydisease: a systematic review Effect of early follow-up after hospital discharge on outcomes in patients with heart failure or chronicobstructivepulmonarydisease: a systematic review Health Quality Ontario Record (...) Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Health Quality Ontario. Effect of early follow-up after hospital discharge on outcomes in patients with heart failure or chronicobstructivepulmonarydisease: a systematic review. Toronto: Health Quality Ontario (HQO). Ontario health technology assessment series; 17(8). 2017 Authors' conclusions Based
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 airwaysdisease who have features of both asthma and chronicobstructivepulmonarydisease (COPD). Although definitions of ACOS vary, it is generally thought to encompass persistent airflowlimitation in a patient older than 40 years of age with either a history of asthma or large bronchodilator reversibility (...) as a de novo disease with its own pathology is yet to be determined. Nevertheless, using treatments developed for asthma or COPD that target eosinophilic, neutrophilic, or paucigranulocytic airway inflammation may be a helpful approach to these patients until further clinical trials can be performed.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.
Mepolizumab for Eosinophilic ChronicObstructivePulmonaryDisease. Patients with chronicobstructivepulmonarydisease (COPD) with an eosinophilic phenotype may benefit from treatment with mepolizumab, a monoclonal antibody directed against interleukin-5.We performed two phase 3, randomized, placebo-controlled, double-blind, parallel-group trials comparing mepolizumab (100 mg in METREX, 100 or 300 mg in METREO) with placebo, given as a subcutaneous injection every 4 weeks for 52 weeks (...) phenotype. This finding suggests that eosinophilic airway inflammation contributes to COPD exacerbations. (Funded by GlaxoSmithKline; METREX and METREO ClinicalTrials.gov numbers, NCT02105948 and NCT02105961 .).
Tiotropium in Early-Stage ChronicObstructivePulmonaryDisease. Patients with mild or moderate chronicobstructivepulmonarydisease (COPD) rarely receive medications, because they have few symptoms. We hypothesized that long-term use of tiotropium would improve lung function and ameliorate the decline in lung function in patients with mild or moderate COPD.In a multicenter, randomized, double-blind, placebo-controlled trial that was conducted in China, we randomly assigned 841 patients (...) with COPD of Global Initiative for ChronicObstructiveLungDisease (GOLD) stage 1 (mild) or 2 (moderate) severity to receive a once-daily inhaled dose (18 μg) of tiotropium (419 patients) or matching placebo (422) for 2 years. The primary end point was the between-group difference in the change from baseline to 24 months in the forced expiratory volume in 1 second (FEV1) before bronchodilator use. Secondary end points included the between-group difference in the change from baseline to 24 months
Palliative care and management of troublesome symptoms for people with chronicobstructivepulmonarydisease. People with advanced chronicobstructivepulmonarydisease (COPD) have distressing physical and psychological symptoms, often have limited understanding of their disease, and infrequently discuss end-of-life issues in routine clinical care. These are strong indicators for expert multidisciplinary palliative care, which incorporates assessment and management of symptoms and concerns (...) , patient and caregiver education, and sensitive communication to elicit preferences for care towards the end of life. The unpredictable course of COPD and the difficulty of predicting survival are barriers to timely referral and receipt of palliative care. Early integration of palliative care with respiratory, primary care, and rehabilitation services, with referral on the basis of the complexity of symptoms and concerns, rather than prognosis, can improve patient and caregiver outcomes. Models
What does endotyping mean for treatment in chronicobstructivepulmonarydisease? Chronicobstructivepulmonarydisease (COPD) is a complex and heterogeneous disease, both at the clinical and biological level. However, COPD is still diagnosed and treated according to simple clinical measures (level of airflowlimitation, symptoms, and frequency of previous exacerbations). To address this clinical and biological complexity and to move towards precision medicine in COPD, we need to integrate (...) (bioinformatics) and interpret (clinical science) the vast amount of high-throughput information that existing technology provides (systems biology and network medicine) so diagnosis, stratification, and treatment of patients with COPD can occur on the basis of their pathobiological mechanism (ie, endotypes). Therefore, this Series paper discusses a possible new taxonomy of COPD, the role of endotypes and associated biomarkers and phenotypes, the gaps (and opportunities) in existing knowledge of COPD
Discontinuing noninvasive ventilation in severe chronicobstructivepulmonarydisease exacerbations: a randomised controlled trial We assessed whether prolongation of nocturnal noninvasive ventilation (NIV) after recovery from acute hypercapnic respiratory failure (AHRF) in chronicobstructivepulmonarydisease (COPD) patients with NIV could prevent subsequent relapse of AHRF.A randomised controlled trial was performed in 120 COPD patients without previous domiciliary ventilation, admitted (...) for AHRF and treated with NIV. When the episode was resolved and patients tolerated unassisted breathing for 4 h, they were randomly allocated to receive three additional nights of NIV (n=61) or direct NIV discontinuation (n=59). The primary outcome was relapse of AHRF within 8 days after NIV discontinuation.Except for a shorter median (interquartile range) intermediate respiratory care unit (IRCU) stay in the direct discontinuation group (4 (2-6) versus 5 (4-7) days, p=0.036), no differences were
patients with chronicobstructivepulmonarydisease (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 (...) Spiolto Respimat (tiotropium/olodaterol) - chronicobstructivepulmonarydisease (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
Incruse (umeclidinium) - chronicobstructivepulmonarydisease Incruse® (umeclidinium) × Insert searchphrase to search the website Insert searchphrase to search the website > > > Incruse® (umeclidinium) Conclusion Incruse® is a new inhalation product of the type of long-acting muscarinic antagonists (LAMA) approved for the maintenance treatment of patients with chronicobstructivepulmonarydisease (COPD). The treatment is given once daily, and the registered dose is 55 micrograms (µg (...) , Karabis A. Int J Chron Obstruct Pulmon Dis. 2015 Nov 16;10:2495-517. 3. IRFs præparatanmeldelser af Anoro, 28/1-2015: 4. IRFs præparatanmeldelser af Relvar, 11/7-2014: 5. Tiotropium versus placebo for chronicobstructivepulmonarydisease. Karner C, Chong J, Poole P.Cochrane Database Syst Rev. 2014 Jul 21;7:CD009285. 23 August 2016 The Danish Health Authority Islands Brygge 67 2300 København S Denmark Telephone: +45 72 22 74 00
FULFIL Trial: Once-Daily Triple Therapy for Patients with ChronicObstructivePulmonaryDisease Randomized data comparing triple therapy with dual inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) therapy in patients with chronicobstructivepulmonarydisease (COPD) are limited.We compared the effects of once-daily triple therapy on lung function and health-related quality of life with twice-daily ICS/LABA therapy in patients with COPD.The FULFIL (Lung Function and Quality of Life (...) Assessment in ChronicObstructivePulmonaryDisease with Closed Triple Therapy) trial was a randomized, double-blind, double-dummy study comparing 24 weeks of once-daily triple therapy (fluticasone furoate/umeclidinium/vilanterol 100 μg/62.5 μg/25 μg; ELLIPTA inhaler) with twice-daily ICS/LABA therapy (budesonide/formoterol 400 μg/12 μg; Turbuhaler). A patient subgroup remained on blinded treatment for up to 52 weeks. Co-primary endpoints were change from baseline in trough FEV1 and in St. George's
Patient experience of lung volume reduction procedures for emphysema: a qualitative service improvement project The aim of this service improvement project was to gain understanding of the patient experience of lung volume reduction surgery (LVRS) and endobronchial valve (EBV) placement, from referral through to post-discharge care. Focus group interviews were carried out in two tertiary centres in London and Leicester, UK. Sixteen patients who had undergone lung volume reduction surgery (LVRS (...) ), endobronchial valve (EBV) placement, or both, were recruited. Prior to participation in each focus group, participants completed a questionnaire to guide and focus discussion. Thematic analysis identified common themes to the participant experience of receiving lung volume reduction interventions. Themes included patient focus on declining health and the need to "fight" for a referral; consequences of having procedures and potential unexpected complications; and vulnerability post discharge and limited
PerceptÄ±on scale of barrÄ±ers to contraceptÄ±ve use: a methodologÄ±cal study The objective of this study was to design and develop the Perception Scale of Barriers to Contraceptive Use (PSBCU) as a measurement tool for the qualitative assessment of the barriers and obstacles women perceived with regard to contraceptive use or low rates of contraceptive use in women using family planning services.The data for this methodological study were collected using the face-to-face interview technique
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 chronicobstructivepulmonarydisease (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