Humans ; Patient Compliance ; Practice Guidelines as Topic ; Pulmonary Disease, Chronic Obstructive ; diagnosis ; etiology ; mortality ; therapy ; Survival Rate

BACKGROUND: Although intensively studied in patients with cardiovascular diseases (CVDs), the prognostic value of diastolic blood pressure (DBP) has little been elucidated in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study aimed to reveal the prognostic value of DBP in AECOPD patients. METHODS: Inpatients with AECOPD were prospectively enrolled from 10 medical centers in China between September 2017 and July 2021. DBP was measured on admission. The primary outcome was all-cause in-hospital mortality; invasive mechanical ventilation and intensive care unit (ICU) admission were secondary outcomes. Least absolute shrinkage and selection operator (LASSO) and multivariable Cox regressions were used to identify independent prognostic factors and calculate the hazard ratio (HR) and 95% confidence interval (CI) for adverse outcomes. RESULTS: Among 13,633 included patients with AECOPD, 197 (1.45%) died during their hospital stay. Multivariable Cox regression analysis showed that low DBP on admission (<70 mmHg) was associated with increased risk of in-hospital mortality (HR = 2.16, 95% CI: 1.53-3.05, Z = 4.37, P <0.01), invasive mechanical ventilation (HR = 1.65, 95% CI: 1.32-2.05, Z = 19.67, P <0.01), and ICU admission (HR = 1.45, 95% CI: 1.24-1.69, Z = 22.08, P <0.01) in the overall cohort. Similar findings were observed in subgroups with or without CVDs, except for invasive mechanical ventilation in the subgroup with CVDs. When DBP was further categorized in 5-mmHg increments from <50 mmHg to ≥100 mmHg, and 75 to <80 mmHg was taken as reference, HRs for in-hospital mortality increased almost linearly with decreased DBP in the overall cohort and subgroups of patients with CVDs; higher DBP was not associated with the risk of in-hospital mortality. CONCLUSION: Low on-admission DBP, particularly <70 mmHg, was associated with an increased risk of adverse outcomes among inpatients with AECOPD, with or without CVDs, which may serve as a convenient predictor of poor prognosis in these patients. CLINICAL TRIAL REGISTRATION Chinese Clinical Trail Registry, No. ChiCTR2100044625.
Humans ; Blood Pressure ; Pulmonary Disease, Chronic Obstructive/therapy* ; Cohort Studies ; Respiration, Artificial ; Inpatients ; Hospital Mortality

Chronic obstructive pulmonary disease (COPD) is a critical condition with high morbidity and mortality. Although several medications are available, there are no definite treatments. However, recent advances in the understanding of stem and progenitor cells in the lung, and molecular changes during re-alveolization after pneumonectomy, have made it possible to envisage the regeneration of damaged lungs. With this background, numerous studies of stem cells and various stimulatory molecules have been undertaken, to try and regenerate destroyed lungs in animal models of COPD. Both the cell and drug therapies show promising results. However, in contrast to the successes in laboratories, no clinical trials have exhibited satisfactory efficacy, although they were generally safe and tolerable. In this article, we review the previous experimental and clinical trials, and summarize the recent advances in lung regeneration therapy for COPD. Furthermore, we discuss the current limitations and future perspectives of this emerging field.
Cell- and Tissue-Based Therapy ; Drug Therapy ; Emphysema ; Lung* ; Models, Animal ; Mortality ; Pneumonectomy ; Pulmonary Emphysema ; Pulmonary Disease, Chronic Obstructive* ; Regenerative Medicine ; Retinoids ; Stem Cells

The goals of management of stable chronic obstructive pulmonary disease (COPD) are to reduce both current symptoms and future risks with minimal side effects from treatment. Identification and reduction of exposure to risk factors are important in the treatment and prevention of COPD. Appropriate pharmacologic therapy can reduce symptoms and exacerbations, and improve health status and exercise tolerance. To date, none of the existing medications for COPD has been shown to modify disease progression or reduce mortality. The classes of medication are bronchodilators including beta2-agonist, anticholinergics and anti-inflammatory drug including inhaled corticosteroid and phosphodiesterase-4 inhibitor such as roflumilast. Each treatment regimen needs to be individualized as the relationship between severity of symptoms, airflow limitation and severity of exacerbation can differ between patients.
Bronchodilator Agents ; Cholinergic Antagonists ; Cyclic Nucleotide Phosphodiesterases, Type 4 ; Disease Progression ; Drug Therapy ; Exercise Tolerance ; Humans ; Mortality ; Phosphodiesterase 4 Inhibitors ; Pulmonary Disease, Chronic Obstructive ; Risk Factors

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation that is usually progressive. It is a major cause of morbidity and mortality worldwide, leading to substantial and increasing economic and social burden. Palliative care for COPD patients aims to reduce symptoms and exacerbations and improve exercise tolerance and quality of life. It is difficult to make a prognosis for COPD patients due to the variable illness trajectory and advanced care of patients. However, severity of breathlessness, assessment of lung function impairment, and frequency of exacerbations can help to identify palliative care needs and determine effective methods to mitigate symptoms, which is discussed in this paper. In these patients, it is recommended to provide individualized palliative care along with curative/restorative care at the onset of COPD symptoms. Before launching a palliative care system in Korea, it is necessary to prepare pulmonary rehabilitation resources, patient-centered communication, timely palliative responsiveness, and a program for effective advanced care planning. A multidisciplinary approach involving collaboration with not only the respiratory and palliative care teams but also primary care offers a new model of care for these patients and should be considered with a priority.
Cooperative Behavior ; Dyspnea ; Exercise Tolerance ; Hospice Care ; Hospices* ; Humans ; Korea ; Lung ; Mortality ; Palliative Care* ; Primary Health Care ; Prognosis ; Pulmonary Disease, Chronic Obstructive* ; Quality of Life ; Rehabilitation ; Respiratory Therapy

BACKGROUNDAccurate prediction for prognosis is important for hospitalized patients with chronic obstructive pulmonary disease (COPD) requiring invasive mechanic ventilation (IMV) and for their family members to make end-of-life decisions. The response to therapy in such a patient population has rarely been investigated. The aim of the study was to evaluate the risk factors in these patients and investigate their response to IMV and the relationship between their responses and prognosis.

METHODSA cohort of 138 patients with COPD requiring IMV >or= 12 hours for acute respiratory failure of diverse etiological factors during a 4-year period were retrospectively studied using prospectively gathered data. All variables potentially related to hospital mortality were evaluated by univariate and multiple stepwise logistic regression analysis.

RESULTSThe mean age of all patients investigated was (65.7 +/- 11.6) years and the hospital mortality was 39.9% (31.1% with COPD exacerbation). Correction of acidosis (pH >or= 7.30) was seen in 58 patients (69.9%) in survivors but only 12 patients (21.8%) in nonsurvivors (P < 0.05) after ventilation. Using multivariate logistic analysis, the variables independently associated with hospital mortality were a higher acute physiology score before intubation, lower pH value measured 24 hours after the onset of ventilation and development of multiorgan dysfunction syndrome (MODS).

CONCLUSIONSIn COPD patients requiring IMV, the postintubation pH value can not only reflect patients' response to treatment, but also serve as an independent determinant of hospital mortality apart from other risk factors such as a higher preintubation APACHE II score and development of MODS. A close correlation between the response to IMV and prognosis was proved in these patients.

Adult ; Aged ; Cohort Studies ; Female ; Forced Expiratory Volume ; Hospital Mortality ; Humans ; Hydrogen-Ion Concentration ; Logistic Models ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; mortality ; physiopathology ; therapy ; Respiration, Artificial ; Retrospective Studies ; Risk Factors

BACKGROUND: There are contradictory reports concerning hypercapnia as a predictor of a better outcome in COPD. This study examined the clinical implications of hypercapnea in COPD patients (M:F = 59:19) who required mechanical ventilation. METHODS: The clinical parameters at the time of MICU admission, the total ventilation time, the APACHE II score and the pulmonary function testing were retrospectively analyzed between the survivors and nonsurvivors. RESULTS: Univariate analysis showed that compared with the nonsurvivors, the survivors had lower AaDO2 values (59.8+/-53.5 vs. 105.0+/-73.3 mmHg, p=0.000), higher PaCO2 values (64.9+/-16.0 vs. 48.9+/-17.8 mmHg, p=0.000), lower APACHE II scores (19.0+/-3.8 vs. 24.1+/-5.1, p=0.002), the more frequent application of initial noninvasive positive pressure ventilation (44.0 vs. 14.3%, p=0.008), and a lower combined rate of septic shock (4.0 vs. 39.3%, p=0.000). Multivariate analysis revealed that a lower PaCO2 (OR: 0.94, p=0.008), the presence of septic shock (OR: 10.16, p=0.011), a higher APACHE II score (OR: 1.22, p=0.040) and a longer ventilation time (OR: 1.002, p=0.041) were the risk factors for mortality. A lower PaCO2 was also verified as the predictor for mortality by multivariate analysis when excluding septic shock. CONCLUSIONS: Hypercapnia at admission is thought to be an independent predictor of better survival for the COPD patients who require mechanical ventilation.
*Treatment Outcome ; Survival Analysis ; Risk Factors ; Retrospective Studies ; Respiratory Insufficiency ; *Respiration, Artificial/methods ; Pulmonary Disease, Chronic Obstructive/*mortality/therapy ; Prognosis ; Patient Admission ; Multivariate Analysis ; Male ; *Hypercapnia ; Humans ; Female ; Biological Markers ; Aged ; APACHE

Acute exacerbation(s) of chronic obstructive pulmonary disease (AECOPD) tend to be critical and debilitating events leading to poorer outcomes in relation to chronic obstructive pulmonary disease (COPD) treatment modalities, and contribute to a higher and earlier mortality rate in COPD patients. Besides pro-active preventative measures intended to obviate acquisition of AECOPD, early recovery from severe AECOPD is an important issue in determining the long-term prognosis of patients diagnosed with COPD. Updated GOLD guidelines and recently published American Thoracic Society/European Respiratory Society clinical recommendations emphasize the importance of use of pharmacologic treatment including bronchodilators, systemic steroids and/or antibiotics. As a non-pharmacologic strategy to combat the effects of AECOPD, noninvasive ventilation (NIV) is recommended as the treatment of choice as this therapy is thought to be most effective in reducing intubation risk in patients diagnosed with AECOPD with acute respiratory failure. Recently, a few adjunctive modalities, including NIV with helmet and helium-oxygen mixture, have been tried in cases of AECOPD with respiratory failure. As yet, insufficient documentation exists to permit recommendation of this therapy without qualification. Although there are too few findings, as yet, to allow for regular andr routine application of those modalities in AECOPD, there is anecdotal evidence to indicate both mechanical and physiological benefits connected with this therapy. High-flow nasal cannula oxygen therapy is another supportive strategy which serves to improve the symptoms of hypoxic respiratory failure. The therapy also produced improvement in ventilatory variables, and it may be successfully applied in cases of hypercapnic respiratory failure. Extracorporeal carbon dioxide removal has been successfully attempted in cases of adult respiratory distress syndrome, with protective hypercapnic ventilatory strategy. Nowadays, it is reported that it was also effective in reducing intubation in AECOPD with hypercapnic respiratory failure. Despite the apparent need for more supporting evidence, efforts to improve efficacy of NIV have continued unabated. It is anticipated that these efforts will, over time, serve toprogressively decrease the risk of intubation and invasive mechanical ventilation in cases of AECOPD with acute respiratory failure.
Anti-Bacterial Agents ; Bronchodilator Agents ; Carbon Dioxide ; Catheters ; Head Protective Devices ; Humans ; Intubation ; Mortality ; Noninvasive Ventilation ; Oxygen ; Oxygen Inhalation Therapy ; Prognosis ; Pulmonary Disease, Chronic Obstructive* ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency* ; Steroids

OBJECTIVES: Smoking cessation decreases morbidity and mortality due to chronic obstructive pulmonary disease (COPD). Pharmacotherapy for smoking cessation is highly effective. However, the optimal prescription rate of smoking cessation medications among smokers with COPD has not been systemically studied. The purpose of this study was to estimate the national prescription rates of smoking cessation medications among smokers with COPD and to examine any disparities therein. METHODS: We conducted a retrospective study using National Ambulatory Medical Care Survey data from 2007 to 2012. We estimated the national prescription rate for any smoking cessation medication (varenicline, bupropion, and nicotine replacement therapy) each year. Multiple survey logistic regression was performed to characterize the effects of demographic variables and comorbidities on prescriptions. RESULTS: The average prescription rate of any smoking cessation medication over 5 years was 3.64%. The prescription rate declined each year, except for a slight increase in 2012: 9.91% in 2007, 4.47% in 2008, 2.42% in 2009, 1.88% in 2010, 1.46% in 2011, and 3.67% in 2012. Hispanic race and depression were associated with higher prescription rates (odds ratio [OR], 5.15; 95% confidence interval [CI], 1.59 to 16.67 and OR, 2.64; 95% CI, 1.26 to 5.51, respectively). There were no significant differences according to insurance, location of the physician, or other comorbidities. The high OR among Hispanic population and those with depression was driven by the high prescription rate of bupropion. CONCLUSIONS: The prescription rate of smoking cessation medications among smokers with COPD remained low throughout the study period. Further studies are necessary to identify barriers and to develop strategies to overcome them.
Bupropion ; Comorbidity ; Continental Population Groups ; Depression ; Drug Therapy ; Health Care Surveys ; Hispanic Americans ; Humans ; Insurance ; Logistic Models ; Mortality ; Nicotine ; Prescriptions* ; Pulmonary Disease, Chronic Obstructive* ; Retrospective Studies ; Smoke* ; Smoking Cessation* ; Smoking* ; Tobacco Use Cessation Products ; United States* ; Varenicline