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David M.G. Halpin, DPhil, FRCP1 Donald P. Tashkin, MD2 Bartolome R. Celli, MD3 Inge Leimer, PhD4 Norbert Metzdorf, PhD4 Marc Decramer, MD5
Author Affiliations
- Royal Devon & Exeter Hospital, Exeter, United Kingdom
- David Geffen School of Medicine, University of California- Los Angeles
- Brigham and Women’s Hospital, Boston, Massachusetts
- Boehringer Ingelheim, Ingelheim, Germany
- University of Leuven, Belgium
Address correspondence to:
Prof DMG Halpin
Consultant Physician and Honorary Associate Professor
Respiratory Clinical Lead, NHS SW
Royal Devon and Exeter Hospital
Barrack Road
Exeter, Devon
EX2 5DW
United Kingdom
Tel: +44 (0) 1392 402133
Fax: +44 (0) 1392 402828
Email: d.halpin@nhs.net
Abstract
This article does not contain an abstract.
Citation
Citation: Halpin DMG, Tashkin DP, Celli BR, Leimer I, Metzdorf N, Decramer M. Effect of tiotropium on outcomes in patients with COPD, categorized using the new GOLD grading system: Results of the UPLIFT randomized controlled trial. J COPD F. 2015; 2(3): 236-251. doi: http://dx.doi.org/10.15326/jcopdf.2.3.2014.0142
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David M. Mannino, MD1 Tzy-Chyi Yu, MHA, PhD2 Huanxue Zhou, MS3 Keiko Higuchi, MPH2
Author Affiliations
- University of Kentucky College of Public Health, Lexington
- Novartis Pharmaceuticals Company, East Hanover, New Jersey
- KMK Consulting Inc., Florham Park, New Jersey
Address correspondence to:
David M. Mannino, M.D.
University of Kentucky College of Public Health
111 Washington Avenue
Lexington, KY 40536
P: 859-218-2099
F: 859-257-9862
dmannino@uky.edu
Abstract
Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines recommend specific drug therapy protocols for chronic obstructive pulmonary disease (COPD) patients based on symptoms and exacerbation risk. This study used electronic health records (EHRs) to assess the effect of adherence and nonadherence to GOLD prescribing guidelines on COPD symptom burden, exacerbations, and health care resource utilization (HCRU) during the 180 days following index treatment start. Included patients had COPD (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 490.xx, 491.xx, 492.xx, 496.xx), a valid GOLD stage within the study period (January 1, 2007 to December 31, 2012), and were 40 to 90 years of age at first GOLD staging (GOLD date). Adherence or nonadherence to GOLD-defined prescribing was based on COPD medication prescribed within 180 days on either side of the GOLD date. Of 4234 patients included in the analysis, approximately 36% were prescribed GOLD-adherent pharmacotherapy. Prevalence of all COPD-related symptoms during the 180 days following index treatment start were significantly reduced in the GOLD-adherent (n=1531) versus the GOLD-nonadherent group (n=2703). GOLD-adherent prescribing was associated with significant reductions in proportions of patients with all-cause hospitalizations and emergency department (ED) visits (unadjusted odds ratios [ORs], 0.69 and 0.63, respectively), as well as respiratory-specific ED visits (unadjusted OR, 0.65), compared with GOLD-nonadherent prescribing. In analyses that divided patients receiving GOLD-nonadherent treatment into undertreated and overtreated patients, undertreatment was associated with significant increases in many COPD symptoms, and both undertreatment and overtreatment were associated with increases in some HCRU endpoints. GOLD-adherent prescribing delivers moderate benefits with respect to COPD symptoms and HCRU.
Citation
Citation: Mannino DM, Yu TC, Zhou H, Higuchi K. Effects of GOLD-Adherent prescribing on COPD symptoms burden, exacerbations and health care utilization in a real-world setting. J COPD F. 2015; 2(3): 223-235. doi: http://dx.doi.org/10.15326/jcopdf.2.3.2014.0151
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Farbod N. Rahaghi, MD, PhD1 Carolyn E. Come, MD1 James C. Ross, PhD2 Rola Harmouche, PhD2 Alejandro A. Diaz, MD1 Raul San José Estépar, PhD2 George R. Washko, MD, MPH1
Author Affiliations
- Brigham and Women’s Hospital, Pulmonary and Critical Care Division, Department of Medicine, Boston, Massachusetts
- Department of Radiology, Harvard School of Medicine, Surgical Planning Laboratory, Boston, Massachusetts
Address correspondence to:
Farbod N. Rahaghi, M.D., Ph.D.
Brigham and Women’s Hospital
Pulmonary and Critical Care Division
Department of Medicine
75 Francis Street, PBB – CA 3
Boston, MA 02115
frahaghi@partners.org
Ph: 617-525-9899
Abstract
Introduction: Endoscopic lung volume reduction has been used to reduce lung hyperinflation in selected patients with severe emphysema. Little is known about the effect of this procedure on the intraparenchymal pulmonary vasculature. In this study we used computed tomography (CT)- based vascular reconstruction to quantify the effect of the procedure on the pulmonary vasculature.
Methods: Intraparenchymal vasculature was reconstructed and quantified in 12 patients with CT scans at baseline and 12 weeks following bilateral introduction of sealants in the upper lobes. The volume of each lung and each lobe was measured, and the vascular volume profile was calculated for both lower lobes. The detected vasculature was further labeled manually as arterial or venous in the right lower lobe.
Results: There was an increase in the volume of the lower lobes (3.14L to 3.25L, p=0.0005). There was an increase in BV5, defined as the volume of blood vessels with cross sectional area of less than 5mm2, (53.2ml to 57.9ml, p=0.03). This was found to be correlated with the increase in lower lobe volumes (R=0.65, p=0.02). The changes appear to be symmetric for veins and arteries with a correlation coefficient of 0.87 and a slope of near identity.
Conclusion: In the individuals studied, there was an increase, from baseline, in BV5 in the lower lobes that correlated with the change in the volume of the lower lobes. The change appeared to be symmetric for both arteries and veins. The study illustrates the use of intraparenchymal pulmonary vascular reconstruction to study morphologic changes in response to interventions.
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Laura H. Thomsen, MD, PhD1 Saher B. Shaker, MD, PhD1 Asger Dirksen, DMSci1 Jesper H. Pedersen2 Ruth Tal-Singer, MD, PhD3 Per Bakke, DMSci4 Jørgen Vestbo, DMSci1,5
Author Affiliations
- Department of Respiratory Medicine, Gentofte Hospital, University of Copenhagen, Denmark
- Department of Cardiothoracic Surgery, University of Copenhagen, Denmark
- GlaxoSmithKline, King of Prussia, Pennsylvania
- Department of Clinical Science, University of Bergen, and Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Respiratory and Allergy Research Group, Manchester Academic Health Science Centre, University Hospital South Manchester; NHS Foundation Trust, Manchester, United Kingdom
Abstract
Background: Emphysema is an important component of COPD; however, in previous studies of the correlation between airflow limitation (AFL) and computed tomography (CT) lung density as a surrogate for emphysema has varied. We hypothesised a good correlation between lung function (forced expiratory volume in first second [FEV1]) and emphysema (15th percentile density [PD15]) and that this correlation also exists between loss of lung tissue and decline in lung function even within the time frame of longitudinal studies of relatively short duration.
Methods: We combined 2 large longitudinal studies (the Danish Lung Cancer Screening Trial [DLCST] and the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints [ECLIPSE]) of smokers or former smokers, with a wide range of AFL and CT lung density, and analysed data from 2148 participants who did not change smoking habits and who had at least 2 CT scans and 2 FEV1 measurements at least 3 years apart.
Results: Baseline correlation between FEV1 and PD15 was high (r=0.716, 95% confidence interval [CI]: 0.694-0.736, p<0.001) indicating that at least half of the variation in FEV1 can be explained by variation in CT lung density. Correlation between the decline in FEV1 and progression of PD15 was considerably weaker (r= 0.081, 95% CI: 0.038-0.122, p<0.001).
Conclusions: Correlation is very high between lung density and lung function in a broad spectrum of smokers and ex-smokers. In contrast, the temporal associations (slopes) are weakly correlated, probably due to uncertainty in the estimation of slopes within a time frame of 3-4 years.
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Erin R. Narewski, DO1 Victor Kim, MD1 Nathaniel Marchetti, DO1 Michael R. Jacobs, PharmD1 Gerard J. Criner, MD1
Author Affiliations
- Temple University Hospital, Division of Pulmonary and Critical Care Medicine, Philadelphia, Pennsylvania
Address correspondence to:
Erin R. Narewski, DO
Temple University Hospital, Division of Pulmonary and Critical Care Medicine
3401 North Broad Street
Philadelphia, PA 19140
Erin.Narewski.DO@gmail.com
Abstract
Background: Although methicillin-resistant Staphylococcus aureus (MRSA) colonization is common in chronic obstructive pulmonary disease (COPD) patients, its effect on the course of COPD hospitalization remains unknown.
Methods: Records of 160 patients hospitalized at our institution January 1, 2008 to May 1, 2010 with acute exacerbations of COPD who were screened for MRSA were examined and outcomes from their hospitalizations were quantified.
Results: Of the 160 patients, 33 (20.6%) were MRSA colonized on screening. These patients had similar demographics, spirometry, Charlson Indexes, and APACHE-II scores when compared to patients who were not MRSA colonized (n=127), but MRSA colonized patients had more hospitalizations within the 2 years prior to admission (2 [1-4.8] versus 1 [0-3], p=0.03). While hospitalized, MRSA colonized patients had a longer length of stay (9 [5.3-15.5] versus 5 [3-7.8] days, p=0.01) and more antibiotic days (7 [5-10.8] versus 5 [0-7] days, p= 0.01). They were also more likely to receive intensive care (51.5% versus 23.6%, p= 0.01) and to develop respiratory failure that required noninvasive ventilation (56.3% versus 38.2%, p= 0.05). Trends towards increased use of invasive mechanical ventilation and readmission within 30 days were also present.
Conclusions: COPD patients colonized with MRSA have longer hospitalizations, require longer courses of antibiotics, and are more likely to require intensive care.
Citation
Citation: Narewski ER, Kim V, Marchetti N, Jacobs MR, Criner GJ. Is methicillin- resistant Staphylococcus aureus colonization associated with worse outcomes in COPD hospitalizations? J COPD F. 2015; 2(3): 252-258. doi: http://dx.doi.org/10.15326/jcopdf.2.3.2014.0147
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