Respiratory viral infection is associated with exacerbations of COPD. Rhinovirus was the most common infecting agent identified and in two cases human metapneumovirus was also detected. Dual infections were only seen amongst those patients admitted to hospital with acute exacerbations of COPD. Viruses were more commonly detected in those with more severe airways disease.
This article describes health and social care professionals' perceptions of palliative care and facilitators and barriers to the delivery of such care for patients with advanced chronic obstructive pulmonary disease. Health professionals participated in semi structured interviews and focus groups which were analysed using content analysis. According to participants, care of patients with chronic obstructive pulmonary disease is focused upon the management of symptoms, with emphasis focused predominately on an acute model of care. Key barriers towards the delivery of palliative care included the reluctance to negotiatie end-of-life decisions and a perceived lack of understanding among patients and carers regarding the illness trajectory. Consequently the delivery of palliative care was viewed as a specialist role rather than an integral component of care. There is a need for education and training for health and social care professions to plan and provide high quality end-of-life care.
Latent viral infection has been implicated in the pathophysiology of chronic obstructive pulmonary disease (COPD). Epstein-Barr virus (EBV) is known to be important in pulmonary fibrosis. The current authors hypothesised that EBV is associated with the pathogenesis of COPD.Sputum samples were collected from patients both during exacerbations of COPD and when stable. A control group of smokers who did not have airways obstruction also had their sputum examined. The presence of EBV DNA was established and quantified using a real-time nucleic acid amplification assay.A total of 136 patients with COPD were recruited during an acute exacerbation and a total of 68 when stable. EBV was detected in 65 (48%) exacerbation cases and 31 (46%) stable patients. In the comparison group of 16 nonobstructed smokers, EBV was demonstrated in only one (6%) case. Risk of COPD in patients with EBV and who are smokers confers an odds ratio of 12.6.Epstein-Barr virus DNA is more frequently identified in the respiratory tract of chronic obstructive pulmonary disease patients in comparison with unaffected smokers. It is present both during exacerbation and when stable, suggesting that infection is persistent. Smokers who do not develop chronic obstructive pulmonary disease rarely have Epstein-Barr virus in their sputum. This finding may be of importance in the pathogenesis of chronic obstructive pulmonary disease.
Introduction: Chronic obstructive pulmonary disease (COPD) is a common condition associated with an increasing mortality and morbidity. There are also significant economic implications with hospital admission accounting for the majority of the total COPD health care expenditure. Mild exacerbations of COPD can be treated at home; severe exacerbations require hospitalization. The purpose of this programme of care was to integrate and optimize treatment using current guidelines. Methods: This was a prospective study of management of severe exacerbations of COPD following implementation of a structured care pathway. The project was based at a district general hospital in inner city Belfast. Key measures of improvement were length of hospital stay, readmission rates within one month and hospital mortality. A multidisciplinary care pathway incorporated a score that was developed with one point for each of the following markers of a severe exacerbation: dyspnoea at rest, bed bound, tachypnoea (>25), tachycardia (>110), pyrexia (>38.5), use of accessory muscles of respiration and peripheral oedema. We have called this the ‘Mater COPD score’. The aim was for optimal management, education and identification of appropriate time for discharge. Patient treatment was standardized using oral steroid therapy, nebulized bronchodilators (air cylinders were used to provided nebulization where appropriate) and antibiotic therapy. Results: A total of 85 patients were studied, 40 men with a mean (SEM) age of 68.6 (1.7) years. The mean COPD score on admission was 2.3 (range 0–6). Mean score on discharge was 0.4 (range 0–3). Mean forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were 0.97 and 1.83 L, respectively. Seven patients were readmitted within one month. The mean length of an episode was reduced from 9.4 to 5.5 days, with a national average of 9.7 days at that time. However, delayed discharge in 25 cases (due to co-morbidity, social problems or other factors) resulted in the overall length of stay being reduced to 6.5 days. Continued follow-up using this pathway reduced the length of stay of all admissions with COPD by four days to 5.4 days. Nebulizers were routinely changed from oxygen driven to air driven. There was a 1700% increase in air cylinders used over the two years following introduction. This was associated with a 57% reduction in mortality. Conclusions: A multidisciplinary care pathway in the management of acute exacerbations of COPD ensures optimal treatment for patients and results in a significant reduction in the length of stay and a reduced mortality rate without increasing readmission rates.
This research will explore the experiences of patients with Chronic Obstructive Pulmonary Disease, Interstitial Lung Disease and Bronchiectasis and their caregivers from the perspective of the bereaved caregiver. The outcomes of this study will provide a critical first step in the development of more responsive palliative care for this client group and have important implications for future practice and policy in the palliative care provided to this client group.
severe asthma. We wished to investigate the effects on CANO of the addition of coarse or fine particle inhaled corticosteroids to standard therapy in severe asthma.Methods Severe asthmatics taking ¼1600 mg/daybudesonide or equivalent performed a randomised open-label crossover study. Subjects with FEV 1 <80%, gas trapping and elevated CANO (¼2 ppb) entered a 6 week dose-ramp run-in of Fluticasone/Salmeterol (FPSM) 250/50 mg twice daily for 3 weeks, then 500/50 mg twice daily for 3 weeks. Patients then received additional HFA-BDP200 mg twice daily or FP 250 mg twice daily for 3 wks in a crossover. Participants then received prednisolone (PRED) 25 mg/day for 1 week. Nitric oxide, lung function, mannitol challenge, systemic inflammatory markers and urinary cortisol were measured. Background Non-adherence to inhaled combination therapy (ICT) is a major contributor to poor control in difficult asthma 1 ; however identifying non-adherence in this population is challenging. We have shown that suppression of fractional exhaled nitric oxide (FeNO), following directly observed inhaled corticosteroid can identify nonadherence 2 ; it has previously been suggested that a single high FeNO measurement can identify non-adherence in difficult asthma. Methods We performed a retrospective analysis of patients attending a difficult asthma clinic between January 2007 and December 2010. Prescription refill data, patient demographics, FeNO and lung function were collated. ICT prescription refill ratio % was calculated as the number of doses refilled/number of doses prescribed over 6 months 3 100.1 Non-parametric correlation analysis was performed. Tests for non-adherence defined as ICT prescription refill cut-offs of <80% and <50% were assessed. Results One hundred and forty-six patients underwent systematic evaluation during the time period. Patient characteristics are displayed in Abstract S10 table 1. FeNO level and ICT prescription refill ratio did not correlate significantly (r¼À0.11, p¼0.2). For FeNO >45 ppb, there was a trend with ICT prescription refill ratio of <80% (p¼0.06); significant in patients not prescribed oral steroids (n¼99, p¼0.016). No relationship existed between FeNO >100 ppb at both prescription refill ratio cut-offs. Using FeNO >45 ppb to define non-adherence, negative (NPV) and positive predictive values (PPV) were: 66% and 61% for <80% ICT prescription refill ratio; 71% and 33% for <50% prescription refill ratio. Using FeNO >100 ppb, NPV and PPV were: 55% and 52% for <80%; 69% and 32% for <50% prescription refill ratio.Abstract S10 Introduction BTS/SIGN asthma management guidelines recommend a stepwise approach to the use of anti-inflammatory therapy, including the addition of inhaled combination therapy (ICT) atStep 3. In NI, ICT accounts for 47% (£23 million) of the entire respiratory drug spend suggesting excessive utilisation of ICT. Methods Using data from a large representative sample of GP practices in NI, we looked at subjects who had a new prescription of ICT (Symbicort, Seretide, Fostair). Data we...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.