COPD: Journal of Chronic Obstructive Pulmonary Disease最新文献

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Self-Reported Physician Diagnosed Asthma with COPD is Associated with Higher Mortality than Self-Reported Asthma or COPD Alone – A Prospective 24-Year Study in the Population of Helsinki, Finland 一项针对芬兰赫尔辛基人群的24年前瞻性研究表明,医生自述诊断哮喘合并COPD的死亡率高于自述哮喘或单纯COPD的死亡率
IF 2.2 4区 医学
COPD: Journal of Chronic Obstructive Pulmonary Disease Pub Date : 2022-04-26 DOI: 10.1080/15412555.2022.2061935
J. Jalasto, P. Kauppi, R. Luukkonen, A. Lindqvist, A. Langhammer, H. Kankaanranta, H. Backman, E. Rönmark, A. Sovijärvi, P. Piirilä
{"title":"Self-Reported Physician Diagnosed Asthma with COPD is Associated with Higher Mortality than Self-Reported Asthma or COPD Alone – A Prospective 24-Year Study in the Population of Helsinki, Finland","authors":"J. Jalasto, P. Kauppi, R. Luukkonen, A. Lindqvist, A. Langhammer, H. Kankaanranta, H. Backman, E. Rönmark, A. Sovijärvi, P. Piirilä","doi":"10.1080/15412555.2022.2061935","DOIUrl":"https://doi.org/10.1080/15412555.2022.2061935","url":null,"abstract":"Abstract Asthma and COPD are common chronic obstructive respiratory diseases. COPD is associated with increased mortality, but for asthma the results are varying. Their combination has been less investigated, and the results are contradictory. The aim of this prospective study was to observe the overall mortality in obstructive pulmonary diseases and how mortality was related to specific causes using postal questionnaire data. This study included data from 6,062 participants in the FinEsS Helsinki Study (1996) linked to mortality data during a 24-year follow-up. According to self-reported physician diagnosed asthma, COPD, or smoking status, the population was divided into five categories: combined asthma and COPD, COPD alone and asthma alone, ever-smokers without asthma or COPD and never-smokers without asthma or COPD (reference group). For the specific causes of death both the underlying and contributing causes of death were used. Participants with asthma and COPD had the highest hazard of mortality 2.4 (95% CI 1.7–3.5). Ever-smokers without asthma or COPD had a 9.5 (3.7–24.2) subhazard ratio (sHR) related to lower respiratory tract disease specific causes. For asthma, COPD and combined, the corresponding figures were 10.8 (3.4–34.1), 25.0 (8.1–77.4), and 56.1 (19.6–160), respectively. Ever-smokers without asthma or COPD sHR 1.7 (95% CI 1.3–2.5), and participants with combined asthma and COPD 3.5 (1.9–6.3) also featured mortality in association with coronary artery disease. Subjects with combined diseases had the highest hazard of overall mortality and combined diseases also showed the highest hazard of mortality associated with lower respiratory tract causes or coronary artery causes. Abbreviations: Cig Cigarette COPD Chronic obstructive pulmonary disease CVD Cardiovascular disease FEV1 Forced Expiratory Volume in one second FVC Forced Vital Capacity FinEsS Finland, Estonia, and Sweden study on chronic obstructive pulmonary diseases HR Hazard Ratio sHR Subhazard Ratio ICD-10 International Statistical Classifications of Diseases and Related Health Problems (Version 10)","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"21 1","pages":"226 - 235"},"PeriodicalIF":2.2,"publicationDate":"2022-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83215292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Chronic Obstructive Pulmonary Disease-Related Mortality in Brazil, 2000–2019: A Multiple-Cause-of-Death Study 2000-2019年巴西慢性阻塞性肺疾病相关死亡率:一项多死因研究
IF 2.2 4区 医学
COPD: Journal of Chronic Obstructive Pulmonary Disease Pub Date : 2022-04-13 DOI: 10.1080/15412555.2022.2061934
A. H. Santo, F. L. Fernandes
{"title":"Chronic Obstructive Pulmonary Disease-Related Mortality in Brazil, 2000–2019: A Multiple-Cause-of-Death Study","authors":"A. H. Santo, F. L. Fernandes","doi":"10.1080/15412555.2022.2061934","DOIUrl":"https://doi.org/10.1080/15412555.2022.2061934","url":null,"abstract":"Abstract Chronic obstructive pulmonary disease (COPD) remains a compelling cause of morbidity and mortality; however, it is underestimated and undertreated in Brazil. Using multiple causes of death data from the Information System on Mortality, we evaluated, from 2000 to 2019, national proportional mortality; trends in mortality rates stratified by age, sex, and macro-region; and causes of death and seasonal variation, considering COPD as an underlying and associated cause of death. COPD occurred in 1,132,968 deaths, corresponding to a proportional mortality of 5.0% (5.2% and 4.7% among men and women), 67.6% as the underlying, and 32.4% as an associated cause of death. The standardized mortality rate decreased by 25.8% from 2000 to 2019, and the underlying, associated, male and female, Southeast, South, and Center-West region deaths revealed decreasing standardized mortality trends. The mean age at death increased from 73.2 (±12.5) to 76.0 (±12.0) years of age. Respiratory diseases were the leading underlying causes, totaling 69.8%, with COPD itself reported for 67.6% of deaths, followed by circulatory diseases (15.8%) and neoplasms (6.24%). Respiratory failure, pneumonia, septicemia, and hypertensive diseases were the major associated causes of death. Significant seasonal variations, with the highest proportional COPD mortality during winter, occurred in the southeast, south, and center-west regions. This study discloses the need and value to accurately document epidemiologic trends related to COPD in Brazil, provided its burden on mortality in older age as a significant cause of death, aiming at effective planning of mortality prevention and control.","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"85 1","pages":"216 - 225"},"PeriodicalIF":2.2,"publicationDate":"2022-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80937016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
The Association between Fat-Free Mass and Exercise Test Outcomes in People with Chronic Obstructive Pulmonary Disease: A Systematic Review 慢性阻塞性肺疾病患者无脂量与运动试验结果之间的关系:一项系统综述
IF 2.2 4区 医学
COPD: Journal of Chronic Obstructive Pulmonary Disease Pub Date : 2022-04-12 DOI: 10.1080/15412555.2022.2049737
Kaveh Gaynor-Sodeifi, H. Lewthwaite, A. Jenkins, Letícia Fernandes Belo, E. Koch, Ahzum Mujaddid, Dana Raffoul, Lauren Tracey, D. Jensen
{"title":"The Association between Fat-Free Mass and Exercise Test Outcomes in People with Chronic Obstructive Pulmonary Disease: A Systematic Review","authors":"Kaveh Gaynor-Sodeifi, H. Lewthwaite, A. Jenkins, Letícia Fernandes Belo, E. Koch, Ahzum Mujaddid, Dana Raffoul, Lauren Tracey, D. Jensen","doi":"10.1080/15412555.2022.2049737","DOIUrl":"https://doi.org/10.1080/15412555.2022.2049737","url":null,"abstract":"Abstract People with chronic obstructive pulmonary disease (COPD) tend to have abnormally low levels of fat-free mass (FFM), which includes skeletal muscle mass as a central component. The purpose of this systematic review was to synthesise available evidence on the association between FFM and exercise test outcomes in COPD. MEDLINE, Cochrane Library, EMBASE, Web of Science, and Scopus were searched. Studies that evaluated exercise-related outcomes in relation to measures of FFM in COPD were included. Eighty-three studies, containing 18,770 (39% female) COPD participants, were included. Considerable heterogeneity was identified in the ways that FFM and exercise test outcomes were assessed; however, higher levels of FFM were generally associated with greater peak exercise capacity. This association was stronger for some exercise test outcomes (e.g. peak rate of oxygen consumption during incremental cycle exercise testing) than others (e.g. six-minute walking distance). This review identified heterogeneity in the methods used for measuring FFM and exercise capacity. There was, in general, a positive association between FFM and exercise capacity in COPD. There was also an identified lack of studies investigating associations between FFM and temporal physiological and perceptual responses to exercise. This review highlights the significance of FFM as a determinant of exercise capacity in COPD. Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2022.2049737 .","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"55 1","pages":"182 - 205"},"PeriodicalIF":2.2,"publicationDate":"2022-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74115618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Usefulness of Glucose to Lymphocyte Ratio to Predict in-Hospital Mortality in Patients with AECOPD Admitted to the Intensive Care Unit 葡萄糖与淋巴细胞比值预测重症监护病房AECOPD患者住院死亡率的有效性
IF 2.2 4区 医学
COPD: Journal of Chronic Obstructive Pulmonary Disease Pub Date : 2022-04-07 DOI: 10.1080/15412555.2022.2052272
Tianyang Hu, Xiaoqiang Liu, Yanan Liu
{"title":"Usefulness of Glucose to Lymphocyte Ratio to Predict in-Hospital Mortality in Patients with AECOPD Admitted to the Intensive Care Unit","authors":"Tianyang Hu, Xiaoqiang Liu, Yanan Liu","doi":"10.1080/15412555.2022.2052272","DOIUrl":"https://doi.org/10.1080/15412555.2022.2052272","url":null,"abstract":"Abstract The purpose of this study was to investigate the relationship between glucose to lymphocyte ratio (GLR) and the outcome of acute exacerbation chronic obstructive pulmonary disease (AECOPD) patients admitted to the intensive care unit (ICU). This study included 3573 patients from the eICU Collaborative Research Database (eICU-CRD) and 926 AECOPD patients admitted to ICU from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. The optimal cutoff value for GLR was 5.6. Kaplan-Meier analysis demonstrated that patients in lower GLR (< 5.6) group showed a better overall survival than patients in higher GLR (≥ 5.6) group in all sets. Multivariate Cox regression analysis demonstrated that age, Sequential Organ Failure Assessment (SOFA) score, SpO2, albumin and GLR are independent predictors of poor overall survival in the training cohort and were incorporated into the nomogram for in-hospital mortality as independent factors. The nomogram exhibited excellent discrimination with C-indexes in training cohort, internal validation and external validation cohort were (0.801, 95%CI: 0.769-0.863), (0.805, 95%CI: 0.759-0.851) and (0.811, 95%CI: 0.772-0.850), respectively. The calibration plot indicated an adequate fit of the nomogram for predicting the risk of in-hospital mortality in all sets. Moreover, the ROC analyses demonstrated that the discrimination abilities of GLR were better than other blood-based inflammatory biomarkers. As an easily available biomarker, GLR can independently predict the in-hospital mortality in AECOPD patients admitted to ICU. The nomogram combining GLR with other significant indicators exhibited excellence predictive performance for in-hospital mortality.","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"66 1","pages":"158 - 165"},"PeriodicalIF":2.2,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86780784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
Physiological Impairments on Respiratory Oscillometry and Future Exacerbations in Chronic Obstructive Pulmonary Disease Patients without a History of Frequent Exacerbations 无频繁发作史的慢性阻塞性肺疾病患者呼吸振荡测量的生理损伤和未来的加重
IF 2.2 4区 医学
COPD: Journal of Chronic Obstructive Pulmonary Disease Pub Date : 2022-04-07 DOI: 10.1080/15412555.2022.2051005
Yi Zhang, N. Tanabe, H. Shima, Yusuke Shiraisi, T. Oguma, A. Sato, S. Muro, S. Sato, T. Hirai
{"title":"Physiological Impairments on Respiratory Oscillometry and Future Exacerbations in Chronic Obstructive Pulmonary Disease Patients without a History of Frequent Exacerbations","authors":"Yi Zhang, N. Tanabe, H. Shima, Yusuke Shiraisi, T. Oguma, A. Sato, S. Muro, S. Sato, T. Hirai","doi":"10.1080/15412555.2022.2051005","DOIUrl":"https://doi.org/10.1080/15412555.2022.2051005","url":null,"abstract":"Abstract Respiratory oscillometry allows measuring respiratory resistance and reactance during tidal breathing and may predict exacerbations in patients with chronic obstructive pulmonary disease (COPD). While the Global Initiative for Chronic Obstructive Lung Disease (GOLD) advocates the ABCD classification tool to determine therapeutic approach based on symptom and exacerbation history, we hypothesized that in addition to spirometry, respiratory oscillometry complemented the ABCD tool to identify patients with a high risk of exacerbations. This study enrolled male outpatients with stable COPD who were prospectively followed-up over 5 years after completing mMRC scale and COPD assessment test (CAT) questionnaires, post-bronchodilator spirometry and respiratory oscillometry to measure resistance, reactance, and resonant frequency (Fres), and emphysema quantitation on computed tomography. Total 134 patients were classified into the GOLD A, B, C, and D groups (n = 48, 71, 5, and 9) based on symptoms on mMRC and CAT and a history of exacerbations in the previous year. In univariable analysis, higher Fres was associated with an increased risk of exacerbation more strongly than other respiratory oscillometry indices. Fres was closely associated with forced expiratory volume in 1 sec (FEV1). In multivariable Cox-proportional hazard models of the GOLD A and B groups, either lower FEV1 group or higher Fres group was associated with a shorter time to the first exacerbation independent of the GOLD group (A vs B) and emphysema severity. Adding respiratory oscillometry to the ABCD tool may be useful for risk estimation of future exacerbations in COPD patients without frequent exacerbation history.","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"26 1","pages":"149 - 157"},"PeriodicalIF":2.2,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78251576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical Characteristics of Non-Smoking Chronic Obstructive Pulmonary Disease Patients: Findings from the KOCOSS Cohort 非吸烟慢性阻塞性肺疾病患者的临床特征:来自KOCOSS队列的发现
IF 2.2 4区 医学
COPD: Journal of Chronic Obstructive Pulmonary Disease Pub Date : 2022-04-07 DOI: 10.1080/15412555.2022.2053088
Joon Young Choi, Jin Woo Kim, Y. Kim, K. Yoo, K. Jung, J. H. Lee, S. Um, W. Lee, Dongil Park, H. Yoon
{"title":"Clinical Characteristics of Non-Smoking Chronic Obstructive Pulmonary Disease Patients: Findings from the KOCOSS Cohort","authors":"Joon Young Choi, Jin Woo Kim, Y. Kim, K. Yoo, K. Jung, J. H. Lee, S. Um, W. Lee, Dongil Park, H. Yoon","doi":"10.1080/15412555.2022.2053088","DOIUrl":"https://doi.org/10.1080/15412555.2022.2053088","url":null,"abstract":"ABSTRACT Chronic obstructive pulmonary disease (COPD) has been regarded as a disease of smokers, but the prevalence of non-smoking COPD patients have been reported to be considerable. We investigated differences in clinical characteristics between smoking and non-smoking COPD patients. We used data from the Korea COPD Subgroup Study (KOCOSS) database, which is a multicenter cohort that recruits patients from 54 medical centres in Korea. Comprehensive comparisons of smoking and non-smoking COPD patients were performed based on general characteristics, exacerbations, symptom scores, radiological findings, and lung-function tests. Of the 2477 patients included in the study, 8.1% were non-smokers and 91.9% were smokers. Non-smoking COPD patients were more likely to be female and to have a higher body mass index and lower level of education. Non-smoking COPD patients had more comorbidities, including hypertension, osteoporosis, and gastroesophageal reflux disease, and experienced more respiratory and allergic diseases. No significant differences in exacerbation rates, symptom scores, or exercise capacity scores were observed between the two groups. Smoking COPD patients had more emphysematous lung according to the radiological findings, and non-smoking patients had more tuberculosis-destroyed lung and bronchiectasis. Lung-function testing revealed no significant difference in the forced expiratory capacity in 1 sec between the two groups, but smokers had more rapid lung-function decline in the 5 years of follow-up data. We found differences in general characteristics and radiological findings between smoking and non-smoking COPD patients. No significant differences in exacerbation or symptom scores were observed, but decline in lung function was less steep in non-smoking patients. Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2022.2053088 .","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"17 1","pages":"174 - 181"},"PeriodicalIF":2.2,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78186779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Age and Sex Differences in Balance Outcomes among Individuals with Chronic Obstructive Pulmonary Disease (COPD) at Risk of Falls 有跌倒风险的慢性阻塞性肺疾病(COPD)患者平衡结局的年龄和性别差异
IF 2.2 4区 医学
COPD: Journal of Chronic Obstructive Pulmonary Disease Pub Date : 2022-04-07 DOI: 10.1080/15412555.2022.2038120
S. Alsubheen, M. Beauchamp, C. Ellerton, R. Goldstein, J. Alison, G. Dechman, K. Haines, S. Harrison, A. Holland, A. Lee, A. Marques, L. Spencer, M. Stickland, E. Skinner, D. Brooks
{"title":"Age and Sex Differences in Balance Outcomes among Individuals with Chronic Obstructive Pulmonary Disease (COPD) at Risk of Falls","authors":"S. Alsubheen, M. Beauchamp, C. Ellerton, R. Goldstein, J. Alison, G. Dechman, K. Haines, S. Harrison, A. Holland, A. Lee, A. Marques, L. Spencer, M. Stickland, E. Skinner, D. Brooks","doi":"10.1080/15412555.2022.2038120","DOIUrl":"https://doi.org/10.1080/15412555.2022.2038120","url":null,"abstract":"Abstract No previous research has examined age and sex differences in balance outcomes in individuals with chronic obstructive pulmonary disease (COPD) at risk of falls. A secondary analysis of baseline data from an ongoing trial of fall prevention in COPD was conducted. Age and sex differences were analyzed for the Berg Balance scale (BBS), Balance Evaluation System Test (BEST test) and Activities-specific Balance Confidence Scale (ABC). Overall, 223 individuals with COPD were included. Females had higher balance impairments than males [BBS: mean (SD) = 47 (8) vs. 49 (6) points; BEST test: 73 (16) vs. 80 (16) points], and a lower confidence to perform functional activities [ABC = 66 (21) vs. 77 (19)]. Compared to a younger age (50–65 years) group, age >65 years was moderately associated with poor balance control [BBS (r = − 0.37), BEST test (r = − 0.33)] and weakly with the ABC scale (r = − 0.13). After controlling for the effect of balance risk factors, age, baseline dyspnea index (BDI), and the 6-min walk test (6-MWT) explained 38% of the variability in the BBS; age, sex, BDI, and 6-MWT explained 40% of the variability in the BEST test; And BDI and the 6-MWT explained 44% of the variability in the ABC scale. This study highlights age and sex differences in balance outcomes among individuals with COPD at risk of falls. Recognition of these differences has implications for pulmonary rehabilitation and fall prevention in COPD, particularly among females and older adults.","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"9 1","pages":"166 - 173"},"PeriodicalIF":2.2,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87248059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Discontinuation of Inhaled Corticosteroids from Triple Therapy in COPD: Effects on Major Outcomes in Real World Clinical Practice 慢性阻塞性肺病三联治疗中停止吸入皮质类固醇:对现实世界临床实践主要结果的影响
IF 2.2 4区 医学
COPD: Journal of Chronic Obstructive Pulmonary Disease Pub Date : 2022-04-07 DOI: 10.1080/15412555.2022.2045265
S. Suissa, S. Dell'aniello, P. Ernst
{"title":"Discontinuation of Inhaled Corticosteroids from Triple Therapy in COPD: Effects on Major Outcomes in Real World Clinical Practice","authors":"S. Suissa, S. Dell'aniello, P. Ernst","doi":"10.1080/15412555.2022.2045265","DOIUrl":"https://doi.org/10.1080/15412555.2022.2045265","url":null,"abstract":"Abstract Recent reports provide evidence-based guidelines for the withdrawal of inhaled corticosteroids (ICS) in COPD, but data on patients treated with ICS-based triple therapy are sparse and contradictory. We assessed the effect of ICS discontinuation on the incidence of severe exacerbation and pneumonia in a real-world population of patients with COPD who initiated triple therapy. We identified a cohort of patients with COPD treated with LAMA-LABA-ICS triple therapy during 2002–2018, age 50 or older, from the UK’s CPRD database. Subjects who discontinued ICS were matched 1:1 on time-conditional propensity scores to those continuing ICS and followed for one year. Hazard ratios (HR) of severe exacerbation and pneumonia were estimated using Cox regression. The cohort included 42,667 patients who discontinued ICS matched to 42,667 who continued ICS treatment. The hazard ratio of a severe exacerbation with ICS discontinuation relative to ICS continuation was 0.86 (95% CI: 0.78–0.95), while for severe pneumonia it was 0.96 (95% CI: 0.88–1.05). The incidence of severe exacerbation after ICS discontinuation was numerically higher than after continuation among patients with two or more exacerbations in the prior year (HR 1.09; 95% CI: 0.94–1.26) and among those with FEV1 <30% predicted (HR 1.29; 95% CI: 1.04–1.59). This large real-world study in the clinical setting of COPD treatment suggests that certain patients on triple therapy can be safely withdrawn from ICS and remain on bronchodilator therapy. As residual confounding cannot be ruled out, ICS discontinuation is not warranted for patients with multiple exacerbations and with very severe airway obstruction.","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"12 1","pages":"133 - 141"},"PeriodicalIF":2.2,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83196644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Fluticasone-Based versus Budesonide-Based Triple Therapies in COPD: Real-World Comparative Effectiveness and Safety 基于氟替卡松与基于布地奈德的三联治疗COPD:真实世界的比较有效性和安全性
IF 2.2 4区 医学
COPD: Journal of Chronic Obstructive Pulmonary Disease Pub Date : 2022-04-06 DOI: 10.1080/15412555.2022.2035705
S. Suissa, S. Dell'aniello, P. Ernst
{"title":"Fluticasone-Based versus Budesonide-Based Triple Therapies in COPD: Real-World Comparative Effectiveness and Safety","authors":"S. Suissa, S. Dell'aniello, P. Ernst","doi":"10.1080/15412555.2022.2035705","DOIUrl":"https://doi.org/10.1080/15412555.2022.2035705","url":null,"abstract":"Abstract Triple therapy for chronic obstructive pulmonary disease (COPD) is recommended for some patients, but the inhaled corticosteroids (ICS) may differ in effectiveness and safety. We compared budesonide-based and fluticasone-based triple therapy given in two inhalers on the incidence of exacerbation, mortality and severe pneumonia, using an observational study approach. We identified a cohort of patients with COPD, new users of triple therapy given in two inhalers during 2002–2018, age 50 or older, from the UK’s CPRD database, and followed for one year. The hazard ratio (HR) of exacerbation, all-cause death and pneumonia was estimated using the Cox regression model, weighted by fine stratification of the propensity score of treatment initiation. The cohort included 29,716 new users of fluticasone-based triple therapy and 9,646 of budesonide-based. The HR of a first moderate or severe exacerbation with budesonide-based triple therapy was 0.98 (95% CI: 0.94–1.03), relative to fluticasone-based, while for a severe exacerbation it was 0.97 (95% CI: 0.87–1.07). The incidence of all-cause death was lower with budesonide-based therapy among patients with no prior exacerbations (HR 0.80; 95% CI: 0.66–0.98). The HR of severe pneumonia with budesonide-based therapy was 0.84 (95% CI: 0.75–0.95). In a real-world clinical setting of COPD treatment, budesonide-based triple therapy given in two inhalers was generally as effective at reducing exacerbations as fluticasone-based triple therapy. However, the budesonide-based triple therapy was associated with a lower incidence of severe pneumonia and possibly also of all-cause death, especially among patients with no prior exacerbations for whom triple therapy is not recommended. Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2022.2035705 .","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"44 1","pages":"109 - 117"},"PeriodicalIF":2.2,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86986056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Development and Validation of a Screening Questionnaire of COPD from a Large Epidemiological Study in China 中国大型流行病学研究中COPD筛查问卷的开发和验证
IF 2.2 4区 医学
COPD: Journal of Chronic Obstructive Pulmonary Disease Pub Date : 2022-04-06 DOI: 10.1080/15412555.2022.2042504
Dingyi Wang, Guohui Fan, Sinan Wu, Ting Yang, Jianying Xu, Lan Yang, Jianping Zhao, Xiangyan Zhang, Chunxue Bai, Jian Kang, P. Ran, Huahao Shen, Fuqiang Wen, Kewu Huang, Yahong Chen, Tie-ying Sun, G. Shan, Yingxiang Lin, Guodong Xu, Rui-ying Wang, Zhihong Shi, Yong-jian Xu, Xianwei Ye, Yuanlin Song, Qiuyue Wang, Yumin Zhou, Wen Li, Liren Ding, C. Wan, W. Yao, Yanfei Guo, F. Xiao, Yong Lu, Xiaoxia Peng, Biao Zhang, D. Xiao, Zuomin Wang, X. Bu, Hong Zhang, Xiaolei Zhang, Li An, Shu Zhang, Jianguo Zhu, Zhixin Cao, Q. Zhan, Yuanhua Yang, L. Liang, H. Dai, Bin Cao, Jiang He, Chen Wang
{"title":"Development and Validation of a Screening Questionnaire of COPD from a Large Epidemiological Study in China","authors":"Dingyi Wang, Guohui Fan, Sinan Wu, Ting Yang, Jianying Xu, Lan Yang, Jianping Zhao, Xiangyan Zhang, Chunxue Bai, Jian Kang, P. Ran, Huahao Shen, Fuqiang Wen, Kewu Huang, Yahong Chen, Tie-ying Sun, G. Shan, Yingxiang Lin, Guodong Xu, Rui-ying Wang, Zhihong Shi, Yong-jian Xu, Xianwei Ye, Yuanlin Song, Qiuyue Wang, Yumin Zhou, Wen Li, Liren Ding, C. Wan, W. Yao, Yanfei Guo, F. Xiao, Yong Lu, Xiaoxia Peng, Biao Zhang, D. Xiao, Zuomin Wang, X. Bu, Hong Zhang, Xiaolei Zhang, Li An, Shu Zhang, Jianguo Zhu, Zhixin Cao, Q. Zhan, Yuanhua Yang, L. Liang, H. Dai, Bin Cao, Jiang He, Chen Wang","doi":"10.1080/15412555.2022.2042504","DOIUrl":"https://doi.org/10.1080/15412555.2022.2042504","url":null,"abstract":"Abstract Objective We aimed to establish an easy-to-use screening questionnaire with risk factors and suspected symptoms of COPD for primary health care settings. Methods Based on a nationwide epidemiological study of pulmonary health among adults in mainland China (China Pulmonary Health, CPH study) between 2012 and 2015, participants ≥40 years who completed the questionnaire and spirometry tests were recruited and randomly divided into development set and validation set by the ratio of 2:1. Parameters including sex, age, BMI, residence, education, smoking status, smoking pack-years, biomass exposure, parental history of respiratory diseases and daily respiratory symptoms were initially selected for the development of scoring system. Receiver operating characteristic (ROC) curve, area under curve (AUC), positive and negative predictive values were calculated in development set and validation set. Results After random split by 2:1 ratio, 22443 individuals were assigned to development set and 11221 to validation set. Ten variables were significantly associated with COPD independently in development set after a stepwise selection by multivariable logistic model and used to develop scoring system. The scoring system yielded good discrimination, as measured by AUC of 0.7737, and in the validation set, the AUC was 0.7711. When applying a cutoff point of ≥16, the sensitivity in development set was 0.69 (0.67 − 0.71); specificity 0.72 (0.71 − 0.73), PPV 0.25 (0.24 − 0.26) and NPV 0.94 (0.94 − 0.95). Conclusion We developed and validated a comprehensive screening questionnaire, COPD-CPHS, with good discrimination. The score system still needs to be validated by large cohort in the future. Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2022.2042504 .","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"20 1","pages":"118 - 124"},"PeriodicalIF":2.2,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75986543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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