Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Bafadhel, Mona; McKenna, Susan; Terry, Sarah; Mistry, Vijay; Reid, C; Haldar, Pranabashis; McCormick, Margaret; Haldar, Koirobi; Kebadze, Tatiana; Duvoix, Annelyse; Lindblad, Kerstin; Patel, Hemu; Rugman, Paul; Dodson, P M; Jenkins, Martin; Saunders, Michael D.; Newbold, Paul; Green, Ruth H.; Venge, Per; Lomas, David A.; Barer, Michael R.; Johnston, Sebastian L.; Pavord, Ian D.; Brightling, Christopher E.

doi:10.1164/rccm.201104-0597oc

Cited by 849 publications

(515 citation statements)

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“…In a 1-year study involving 145 COPD patients, sputum eosinophilia was associated with 17% of exacerbations and was involved jointly with bacterial and/or viral infection in a further 10% of cases. 19 The treatment models in asthma and COPD are markedly different. In asthma, early anti-inflammatory treatment with an ICS or (less frequently) leukotriene modifier is recommended for all those who require more than twice weekly use of a reliever bronchodilator.…”

Section: Copd Is Not Asthmamentioning

confidence: 99%

“…The second is those COPD patients who are frequent exacerbators despite optimal bronchodilator treatment, a phenotype that may involve increased eosinophilic (asthma-like) inflammation. 19 COPD patients with identified sputum eosinophilia who received increasing doses of ICS and oral corticosteroids according to eosinophil levels, in a strategy designed to reduce eosinophilic airway inflammation, had a significant reduction in exacerbations compared with patients treated according to traditional guidelines. 18 The definition of COPD patients as frequent exacerbators is based on expert opinion rather than a rigorous phenotypic assessment.…”

mentioning

confidence: 99%

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Risk-to-benefit ratio of inhaled corticosteroids in patients with COPD

Price

Yawn

Brusselle

et al. 2012

Primary Care Respiratory Journal

158

139

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While the pharmacological management of chronic obstructive pulmonary disease (COPD) has evolved from the drugs used to treat asthma, the treatment models are different and the two diseases require clear differential diagnosis in order to determine the correct therapeutic strategy. In contrast to the almost universal requirement for anti-inflammatory treatment of persistent asthma, the efficacy of inhaled corticosteroids (ICS) is less well established in COPD and their role in treatment is limited. There is some evidence of a preventive effect of ICS on exacerbations in patients with COPD, but there is little evidence for an effect on mortality or lung function decline. As a result, treatment guidelines recommend the use of ICS in patients with severe or very severe disease (forced expiratory volume in 1 second <50% predicted) and repeated exacerbations. Patients with frequent exacerbations -a phenotype that is stable over time -are likely to be less common among those with moderate COPD (many of whom are managed in primary care) than in those with more severe disease. The indiscriminate use of ICS in COPD may expose patients to an unnecessary increase in the risk of side-effects such as pneumonia, osteoporosis, diabetes and cataracts, while wasting healthcare spending and potentially diverting attention from other more appropriate forms of management such as pulmonary rehabilitation and maximal bronchodilator use. Physicians should carefully weigh the likely benefits of ICS use against the potential risk of side-effects and costs in individual patients with COPD.

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Section: Copd Is Not Asthmamentioning

confidence: 99%

mentioning

confidence: 99%

Risk-to-benefit ratio of inhaled corticosteroids in patients with COPD

Price

Yawn

Brusselle

et al. 2012

Primary Care Respiratory Journal

158

139

View full text Add to dashboard Cite

show abstract

“…Eosinophilic airway inflammation is present in 20-30% of people with COPD during stable periods and acute exacerbations 6,12 and there is some evidence of increased mortality in people with COPD and eosinophilia. 13 In the Copenhagen General Population study, with a median follow up of 3.3 years, people with spirometry-confirmed COPD and blood eosinophil concentrations > 0.34 × 9 9 cells/L had a 76% increased risk of severe COPD exacerbations.…”

Section: Copd and Eosinophilsmentioning

confidence: 99%

Nuggets of Knowledge: COPD – targeting the use of inhaled corticosteroids

Bryant¹

2016

J Prim Health Care

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“…Her atak gelecek ataklar için havayollarını daha duyarlı hale getirdiğinden, atak sıklığı ve şiddeti giderek artmaktadır (15). Faktör ve küme analizleri ile klinik fenotipleri öngören en önemli biyolojik belirteçlerin bakteriyel olaylarda balgamda IL-1b, virüs ilişkili olaylarda kanda CXCL10 (IP-10), eozinofilik ataklarda periferik kan eozinofilisi olduğu bildirilmiş-tir (16).…”

Section: Atak Kri̇terleri̇ Koahunclassified