An Integrated Approach to the Medical Treatment of Chronic Obstructive Pulmonary Disease
Asthma and COPD Program, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. The Medical clinics of North America
(Impact Factor: 2.61).
07/2012; 96(4):811-26. DOI: 10.1016/j.mcna.2012.05.002
COPD is a treatable condition for which careful and objective evaluation of patients’ lung function, symptoms, exercise capacity, and exacerbation history on an ongoing basis is essential so that treatments may be individualized as much as possible. Although the comparative effectiveness of drug classes has not yet been tested completely in COPD, virtually all inhaled COPD therapies improve lung function, quality of life, and reduce COPD exacerbations, which fulfills the major goals of care. Pulmonary rehabilitation is safe, effective, and a crucial component of COPD therapy. Newer therapies have been developed with the specific purpose of reducing COPD exacerbations and should be prescribed to individuals who have evidence of recurrent exacerbations despite maximal inhaled maintenance medications.
Available from: Irene Torres Sánchez
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ABSTRACT: Anxiety and depression are highly prevalent comorbid complications in COPD. Breathing techniques can improve anxiety and depression in subjects hospitalized due to COPD exacerbation. We conducted a randomized clinical study using two groups. The sample comprised 46 male patients aged 67-86 years hospitalized with acute COPD exacerbation. Patients were randomly and equally divided into the control and controlled breathing intervention groups.The sample comprised 46 male patients aged 67-86 years hospitalized with acute COPD exacerbation. Patients were randomly and equally divided into the control and controlled breathing intervention groups.
Baseline and post-intervention recordings of Dyspnea, Anxiety and depression, Quality of life (SGRQ and EURQoL), Respiratory pressures (PImax-PEmax), Hand-grip test and Sleep quality were taken in all subjects. Subjects hospitalized due to acute COPD exacerbation showed high levels of dyspnea and low values in overall quality of life as measured with the St. George's Respiratory Questionnaire (SGRQ).
Controlled breathing techniques had a significant effect on dyspnea, anxiety and mobility (p<0.05). All the measured areas were improved in the intervention group. The control group had poorer values in all the areas after the hospitalization period.
Controlled breathing exercises benefit patients hospitalized due to COPD exacerbation in anxiety and depression values.
07/2013; 59(2). DOI:10.4187/respcare.02565
Available from: PubMed Central
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The study aimed to compare the efficacy and safety of nebulized steroid (NS) with systemic corticosteroids (SC) and to determine optimal NS dose in the treatment of patients with COPD exacerbations requiring hospitalization.
The study was a randomized, parallel design trial. Eligible patients (n=86) were randomly allocated to 1 of the 3 treatment groups: parenteral corticosteroid (PS) (n=33), 4 mg (NB) (n=27), or 8 mg NB (n=26). Partial pressure of arterial oxygen (PaO2), carbon dioxide (PaCO2), pH, and oxygen saturation (SaO2) were evaluated at baseline, 24 h, 48 h, and discharge. Airway obstruction (forced vital capacity [FVC] and forced expiratory volume 1 s [FEV1]) was evaluated at admission and discharge.
There were no significant differences between the groups for all parameters at all time periods, except for higher FEV1 value in the 8-mg NB group at baseline. In groups, significant differences were determined for FVC, FEV1, PaO2, and SaO2 (p<0.001), but not for PaCO2 and pH, in comparison to their baseline values. As adverse events, hyperglycemia and oral moniliasis were observed in the PS group (n=4) and in the NB groups (n=5), respectively, and treatment change was required in 9 patients (2 patients in the PS group and 7 patients in the NB groups) (p=0.57).
Nebulized budesonide may be used as an alternative to SC because of its equal effectiveness and lesser systemic adverse effects. The choice of optimal dosage needs to be evaluated carefully because adverse effect and dropout rates varied according to dosage. However, there is a need for further studies including more severe cases and evaluating long-term outcomes or relapses comparing the 3 arms.
Medical science monitor: international medical journal of experimental and clinical research 03/2014; 20:513-20. DOI:10.12659/MSM.890210 · 1.43 Impact Factor
Available from: Sarah Landis
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To assess the symptomatic and cost burden among patients initiating long-acting bronchodilator (LABD) therapy and impact of adherence on healthcare resource use and costs.
This retrospective cohort study identified patients with COPD who were newly prescribed a LABD (long-acting muscarinic antagonist [LAMA], long-acting beta2-agonist [LABA], a combination of LABA+LAMA or combination of LABA with inhaled corticosteroid [ICS]/LABA) between January 1, 2009 and November 30, 2013 from the UK Clinical Practice Research Datalink. Health care resource use, costs and symptom burden up to 24 months after treatment initiation were estimated. Adherence in the follow-up period was assessed using the medication possession ratio (MPR ≥80 %).
The cohort comprised 8283 LABD initiators (16 % LABA, 81 % LAMA and 3 % LABA+LAMA) and 9246 LABA+ICS initiators with generally similar baseline characteristics; prior exacerbation rate was higher in the LABA+ICS cohort. Less than half the patients (LAMA:42 %; LABA:34 % and LABA+ICS:34 %) were adherent to their index medication. Among adherent patients, the total annual per patient cost of COPD was £3008 for LAMA initiators, £2783 for LABA initiators and £3376 for LABA+ICS initiators; primarily due to general practitioner interactions. Among patients with a Medical Research Council dyspnea score recorded during 24 months follow-up, a substantial proportion of adherent patients (LAMA: 41 %; LABA: 45 %; LABA+ICS 44 %) had clinically significant dyspnoea (MRC ≥ 3).
Cost and symptomatic burden of COPD was high among patients initiating maintenance treatment, including patients adherent with their initial treatment. General practitioner interactions were the primary driver of costs. Further, real world studies are required to address unmet needs and optimize treatment pathways to improve COPD symptom burden and outcomes.
Respiratory research 11/2015; 16(1):141. DOI:10.1186/s12931-015-0295-2 · 3.09 Impact Factor
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