|
Tyree H. Kiser, PharmD1 Jonathan E. Sevransky, MD, MHS2 Jerry A. Krishnan, MD, PhD3 James Tonascia, PhD4 Robert A. Wise, MD5 William Checkley, MD, PhD5 John W. Walsh6† Jamie B. Sullivan, MPH6 Kevin C. Wilson, MD7 Marc Moss, MD8 R. William Vandivier, MD8 for the DECIDE Investigators*
Author Affiliations
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora
- Division of Pulmonary and Critical Care Medicine, Emory University, Atlanta, Georgia
- Population Health Sciences Program, University of Illinois Hospital & Health Sciences System, Chicago
- Department of Epidemiology and Biostatistics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- COPD Foundation, Washington D.C. †Died March 7, 2017
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts and Official Documents Department, American Thoracic Society, New York, New York
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora
- *DECIDE - DosE of CorticosteroIDs for Exacerbations of COPD
Address correspondence to:
Tyree H. Kiser, PharmD
12850 E Montview Blvd, C238
Pharmacy and Pharmaceutical Sciences Building
Aurora, CO 80045
Email: ty.kiser@ucdenver.edu
Phone: 303-724-2883
Abstract
Background: For over 40 years, systemic corticosteroids have been a mainstay of treatment for patients with exacerbations of chronic obstructive pulmonary disease (COPD). Surprisingly, the optimal dosage of corticosteroids is unknown in critically ill patients requiring assisted ventilation, a group with high morbidity and mortality.
Methods: We surveyed 39 academic physicians within the United States Critical Illness and Injury Trials Group (USCIITG) and the Prevention and Early Treatment of Acute Lung Injury Trials Network (PETAL) to determine the range of corticosteroid dosages used to treat patients with COPD exacerbations requiring assisted ventilation. We also asked if these physicians believe that a clinical trial is needed to determine the optimal dosage of corticosteroids in this population.
Results: Thirty-two physicians (82%) responded to the survey. Usual practice was to start intravenous methylprednisolone at a median dose of 120 mg/day (range 40-500 mg/day). In the context of a clinical trial, 78% of physicians were comfortable initiating methylprednisolone at a dose as low as 40 mg/day. In contrast, physicians were split on the highest acceptable methylprednisolone dose, with 44% comfortable initiating doses as high as 500 mg/day, 44% at 240 mg/day, and 12% at doses less than 240 mg/day. Ninety-four percent of respondents believed that a randomized controlled trial is needed to determine the optimal corticosteroid dose to treat patients with COPD exacerbations requiring assisted ventilation.
Conclusions: These results demonstrate sufficient clinical equipoise to support the conduct of a clinical trial to identify the optimal dose of systemic corticosteroids for patients with COPD exacerbations requiring assisted ventilation.
Citation
Citation: Kiser TH, Sevransky JE, Krishnan JA, et al for the DECIDE investigators. A survey of corticosteroid dosing for exacerbations of chronic obstructive pulmonary disease requiring assisted ventilation. Chronic Obstr Pulm Dis. 2017; 4(3): 186-193. doi: http://dx.doi.org/10.15326/jcopdf.4.3.2016.0168
|
Annemarie L. Lee, BPhysio, MPhysio, PhD1,2, Roger S. Goldstein, MBCHB, FRCP(C), FRCP (UK)1,2,3 Dina Brooks, BSc(PT), MSc, PhD1,2
Author Affiliations
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Ontario, Canada
Address correspondence to:
Dina Brooks, MSc, PhD
Department of Physical Therapy
University of Toronto, 160-500 University Avenue
Toronto, M5G 1V7
Ontario, Canada
Email: dina.brooks@utoronto.ca
Phone: 00 1 416 978 1739; Fax 00 1 416 243 3747
Abstract
Background: Although pain is a common symptom in chronic obstructive pulmonary disease (COPD), pain characteristics such as frequency, duration and type are unclear. The primary study aim was to identify these pain characteristics in individuals with COPD versus healthy control participants. The secondary aim was to explore the clinical and psychological associations with pain in those with COPD.
Methods: Participants with COPD and age and gender-matched, healthy controls completed questionnaires to elicit pain characteristics. Those with COPD also had assessments of dyspnea, health-related quality of life, psychological associations (anxiety and depression) and physical activity.
Results: Sixty-four participants with COPD (mean [standard deviation (SD)] age 71[10] , forced expiratory volume in 1 second [FEV1] 38% predicted) and 64 control participants (mean [SD] age 67 [13] , FEV1 91% predicted) were included. Chronic pain was more prevalent in individuals with COPD compared to control participants (41% versus 29%, p=0.03). The pain was more prevalent in the chest and upper back (p=0.04). COPD participants with chest or upper back pain had a higher total lung capacity (mean difference 2.0L, 95% confidence interval [CI] 0.6 to 3.0L) compared to COPD participants without pain.Greater dyspnea (p<0.001), more depression (p=0.02) and lower physical activity levels (p=0.03) were also present in people with COPD experiencing pain.
Conclusions: Chronic pain is common in COPD. It is associated with higher dyspnea and depression and lower physical activity.
Citation
Citation: Lee AL, Goldstein RS, Brooks D. Chronic pain in people with chronic obstructive pulmonary disease: Prevalence, clinical and psychological implications. Chronic Obstr Pulm Dis. 2017; 4(3): 194-203. doi: http://dx.doi.org/10.15326/jcopdf.4.3.2016.0172
|
Tatsiana Beiko, MD, MSCR1 Michael G. Janech, PhD2 Alexander V. Alekseyenko, PhD3 Carl Atkinson, PhD4 Harvey O. Coxson, PhD5 Jeremy L. Barth, PhD6 Sarah E. Stephenson, PhD1 Carole L. Wilson, PhD1 Lynn M. Schnapp, MD1 Alan Barker, MD7 Mark Brantly, MD8 Robert A. Sandhaus, MD, PhD9 Edwin K. Silverman, MD, PhD10 James K. Stoller, MD, MS11 Bruce Trapnell, MD12 Charlie Strange, MD1 for QUANTUM-1 Investigators *
Author Affiliations
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston
- Division of Nephrology, Medical University of South Carolina, Charleston
- Biomedical Informatics Center, Departments of Public Health Sciences and Oral Health Sciences, Medical University of South Carolina, Charleston
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston
- Centre for Heart Lung Innovation and Department of Radiology, University of British Columbia, Vancouver, Canada
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston
- Oregon Health and Science University, Portland
- University of Florida Health Science Center, Gainesville
- National Jewish Health, Denver, Colorado
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Cleveland Clinic Foundation, Ohio
- University of Cincinnati/Cincinnati Children's Hospital Medical Center, Ohio
* QUANTitative lung CT UnMasking emphysema progression in AATD. A list of the QUANTUM investigators is provided in the Acknowledgements section at the end of the article.
Address correspondence to:
Tatsiana Beiko, MD, MSCR
Medical University of South Carolina
96 Jonathan Lucas Street
Charleston, SC 29425
Email: beiko@musc.edu
Abstract
Computed tomography (CT) lung density is an accepted biomarker for emphysema in alpha-1 antitrypsin deficiency (AATD), although concerns for radiation exposure limit its longitudinal use. Serum proteins associated with emphysema, particularly in early disease, may provide additional pathogenic insights. We investigated whether distinct proteomic signatures characterize the presence and progression of emphysema in individuals with severe AATD and normal forced expiratory volume in 1 second (FEV1). QUANTitative lung CT UnMasking emphysema progression in AATD (QUANTUM-1) is a multicenter, prospective 3-year study of 49 adults with severe AATD and FEV1 post-bronchodilator values (Post-BD) ≥ 80% predicted. All participants received chest CT, serial spirometry, and contributed to the serum biobank. Volumetric imaging display and analysis (VIDA) software defined the baseline 15th percentile density (PD15) which was indexed to CT-derived total lung capacity (TLC). We measured 317 proteins using a multiplexed immunoassay (Myriad Discovery MAP® panel) in 31 individuals with a complete dataset. We analyzed associations between initial PD15/TLC, PD15/TLC annual decline, body mass index (BMI), and protein levels using Pearson’s product moment correlation. C-reactive protein (CRP), adipocyte fatty acid-binding protein (AFBP), leptin, and tissue plasminogen activator (tPA) were found to be associated with baseline emphysema and all but leptin were associated with emphysema progression after adjustments were made for age and sex. All 4 proteins were associated with BMI after further adjustment for multiple comparisons was made. The relationship between these proteins and BMI, and further validation of these findings in replicative cohorts require additional studies.
Citation
Citation: Beiko T, Janech MG, Alekseyenko AV, et al; for QUANTUM-1 Investigators. Serum proteins associated with emphysema progression in severe alpha-1 antitrypsin deficiency. Chronic Obstr Pulm Dis. 2017; 4(3): 204-216. doi: http://dx.doi.org/10.15326/jcopdf.4.3.2016.0180
|
Gulshan Sharma, MD, MPH1 Donald A. Mahler, MD, FCCP2 Valerie M. Mayorga, PharmD3 Kathleen L. Deering, PharmD3 Qing Harshaw, MD, PhD3 Vaidyanathan Ganapathy, PhD4
Author Affiliations
- University of Texas Medical Branch, Galveston, Texas
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire and Valley Regional Hospital, Claremont, New Hampshire
- EPI-Q, Inc., Oak Brook, Illinois
- Sunovion Pharmaceuticals, Inc, Marlborough, Massachusetts
Address correspondence to:
Gulshan Sharma, MD, MPH
Professor and Director, Division of Pulmonary Critical Care & Sleep Medicine
University of Texas Medical Branch
301 University Blvd
Galveston, TX 77555
Telephone: 409-772-2436
Email: gusharma@utmb.edu
Abstract
Background: Low peak inspiratory flow rate (PIFR) (<60 L/min) among patients with chronic obstructive pulmonary disease (COPD) may result in ineffective medication inhalation, leading to poor bronchodilation.
Objective: The objectives of this analysis were to evaluate the prevalence of low PIFR at the time of discharge from a COPD-related hospitalization and to examine the real-world treatment patterns and rehospitalizations by PIFR.
Methods: Patients at 7 sites in the United States were screened for enrollment at hospital discharge. PIFR was measured using the InCheckTM DIAL to simulate resistance of the DISKUS® dry powder inhaler (DPI). An equal number of patients were enrolled into low PIFR (<60 L/min) or normal PIFR (≥60 L/min) cohorts. Demographics, COPD-related clinical characteristics, health status, treatment and rehospitalization data were collected.
Results: Mean PIFR was 71±22.12 L/min among 268 screened patients; 31.7% (n=85) of patients had low PIFR. Among all enrolled patients (n=170), the low PIFR cohort was older (66.2±10.04 years versus 62.1±9.41 years, p=0.006) and more likely to be female (61.2% versus 42.4%, p=0.014). There was an increase in DPI use at discharge, compared with admission, in the low PIFR cohort (62.4% versus 70.6%, p=0.020). The incidences of all-cause rehospitalization up to 180 days were similar between the low and normal PIFR cohorts.
Conclusions: At discharge following hospitalization for an exacerbation of COPD, approximately one-third of patients had a PIFR <60 L/min. More patients with a low PIFR were discharged with a DPI medication compared with use at admission. There was no difference in the rehospitalization rates by PIFR.
Citation
Citation: Sharma G, Mahler DA, Mayorga VM, Deering KL, Harshaw Q, Ganapathy V. Prevalence of low peak inspiratory flow rate at discharge in patients hospitalized for COPD exacerbation.
Chronic Obstr Pulm Dis. 2017; 4(3): 217-224. doi: http://dx.doi.org/10.15326/jcopdf.4.3.2017.0183
|
|