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Chronic Obstructive Pulmonary Disease
Published in Adam T. Hill, F. X. Emmanuel, W.H.B. Wallace, Pulmonary Infection, 2004
Adam T. Hill, F. X. Emmanuel, W.H.B. Wallace
Exacerbation of COPD is defined as a deterioration in symptoms from when the patient is clinically stable. Usually patients present with increased breathlessness, wheeze, and chest tightness. In addition, some patients have increased sputum volume and sputum purulence. Both infection (viral and/or bacterial) and air pollution can precipitate an exacerbation. Secondary causes of an exacerbation include pneumonia, pulmonary embolism, pneumothorax, rib fractures, inappropriate medication such as (3-blockers or excess sedatives, cardiac arrhythmias, cardiac failure, or other diseases such as gastrointestinal bleeding.
Which one is superior in predicting 30 and 90 days mortality after COPD exacerbation: DECAF, CURB-65, PSI, BAP-65, PLR, NLR
Published in Expert Review of Respiratory Medicine, 2021
Mine Gayaf, Gülistan Karadeniz, Filiz Güldaval, Gülru Polat, Merve Türk
This study is a prospective observational cohort study. Data from 141 consecutive patients who were hospitalized with the diagnosis of COPD exacerbation between January 2018 and March 2019 and agreed to participate in the study were prospectively recorded. COPD diagnosis is made according to GOLD criteria, which is postbronchodilator FEV1/FVC less than 70% in any pulmonary function test performed at the time of diagnosis of each patient [1]. The exacerbation of COPD was defined as acute change in a patient’s respiratory symptoms that is beyond normal variability, and that is sufficient to warrant a change in therapy. COPD exacerbation was defined as symptoms, such as increased dyspnea, increased sputum production, sputum color change, decreased performance in daily activities, increased cough, high fever, and/or impaired mental state [1,17].
Blood eosinophils in COPD to inform inhaled corticosteroid use: Ready to be used in clinical practice
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
Finally, blood eosinophils are not a prognostic biomarker, for example, a biomarker that can identify the likelihood of a clinical event, disease recurrence or disease progression in patients with a disease or medical condition of interest. One important feature of COPD, is the frequent occurrence symptoms worsening, known as an exacerbation. It would be useful if eosinophil levels could predict the risk of exacerbations. In a post-hoc analysis6 of pooled data from 11 Phase III and IV of 22,125 patients from randomized COPD studies with similar methodologies, patients were grouped according to their baseline blood eosinophil count, baseline ICS use and number of exacerbations in the year prior to each study. The study did not find a clinically important relationship between blood eosinophil count and exacerbation rate which align with other studies on this topic.7,8 These results indicate that blood eosinophil counts are not a clinically useful predictor of future exacerbation risk.
Current challenges in managing comorbid heart failure and COPD
Published in Expert Review of Cardiovascular Therapy, 2018
J. Alberto Neder, Alcides Rocha, Maria Clara N. Alencar, Flavio Arbex, Danilo C. Berton, Mayron F. Oliveira, Priscila A. Sperandio, Luiz E. Nery, Denis E. O’Donnell
A COPD exacerbation is frequently a life-threatening event in patients with HF–COPD [14]. Exacerbations are also mechanistically linked to lung function deterioration and muscle dysfunction, which are highly undesirable in these patients [150]. Although ICS might reduce exacerbation frequency in some patients, there is an ongoing controversy on the long-term use of these medications [151]. It is now apparent that higher than required doses to decrease exacerbation burden were used in the past in patients who were infrequent exacerbators [152]. This led an increased incidence of bacterial pneumonia, particularly those treated with fluticasone [153]. The risk of pneumonia is higher with ICS showing high lipophilicity and longer residency time thereby allowing easier sub-mucosal translocation of bacteria (fluticasone > beclomethasone > budesonide > ciclesonide) [154]. Thus, low-to-moderate doses of a safer ICS should be preferred in patients with a clear history of exacerbations which are classified as: ‘frequent’ (at least 2 per year in the preceding 2 years) or ‘life-threatening’ (at least 1 prompting hospitalization) [13]. A more liberal approach to ICS prescription should be exerted in patients associated with asthma and/or high blood eosinophils [155]. Chronic oral steroid should be discouraged not only due to lack of efficacy and increases risk of pneumonia but also due to the fluid retention effects.