Acute exacerbations of chronic obstructive pulmonary disease: in search of diagnostic biomarkers and treatable traits

Mathioudakis, Alexander G.; Janssens, Wim; Sivapalan, Pradeesh; Singanayagam, Aran; Dransfield, Mark T.; Jensen, Jens‐Ulrik Stæhr; Vestbo, Jørgen

doi:10.1136/thoraxjnl-2019-214484

Cited by 111 publications

(131 citation statements)

References 103 publications

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“…Second, eosinophilic exacerbations are associated with a favorable treatment outcome with steroid treatment but are also associated with an increased risk of exacerbation relapse [32]. The presence of respiratory viruses at exacerbation are predictive for a higher symptom burden and a delayed recovery [33]. Certain risk factors predispose COPD patients to an AECOPD.…”

Section: Acute Exacerbations Of Copdmentioning

confidence: 99%

Role of acute exacerbations in skeletal muscle impairment in COPD

Gosker

Langen

Simons

2020

Expert Review of Respiratory Medicine

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Introduction: Muscle impairments are prevalent in COPD and have adverse clinical implications in terms of physical performance capacity, disease burden, quality of life and even mortality. During acute exacerbations of COPD (AECOPDs) the respiratory symptoms worsen and this might also apply to the muscle impairments. Areas covered: This report includes a review of both clinical and pre-clinical peer-reviewed literature of the past 20 years found in PubMed providing a comprehensive view on the role of AECOPD in muscle dysfunction in COPD, the putative underlying mechanisms and the treatment perspectives. Expert opinion: The contribution of AECOPD and its recurrent nature to muscle impairment in COPD cannot be ignored and can be attributed to the acutely intensifying and converging disease-related drivers of muscle deterioration, in particular disuse, systemic inflammation and corticosteroid treatment. The search for novel treatment options should focus on the AECOPD-enhanced drivers of muscle dysfunction as well as on the underlying, mainly catabolic, mechanisms. Considering the impact of AECOPD on muscle function, and that of muscle impairment on the recurrence of exacerbations, counteracting muscle deterioration in AECOPD provides an unprecedented therapeutic opportunity.

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Section: Acute Exacerbations Of Copdmentioning

confidence: 99%

Role of acute exacerbations in skeletal muscle impairment in COPD

Gosker

Langen

Simons

2020

Expert Review of Respiratory Medicine

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“…Previous studies reported that the cause of exacerbations is associated with treatment and patient outcomes. [27][28][29][30] This will have to be examined in welldesigned and well-planned prospective registry studies. Fifth, almost all patients (>90% at each center) were treated with antibiotics, and we could not perform any reliable analysis of the impact of concomitant antibiotics use.…”

Section: Discussionmentioning

confidence: 99%

<p>Comparison of the Clinical Outcomes Between Nebulized and Systemic Corticosteroids in the Treatment of Acute Exacerbation of COPD in China (CONTAIN Study): A Post Hoc Analysis</p>

Chen

Liu

Zhang

et al. 2020

COPD

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Background and Objective: Although corticosteroids have been widely used in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), few studies have evaluated the effectiveness of nebulized corticosteroids (NCS), systemic corticosteroids (SCS), and NCS plus SCS in the management of AECOPD in China. This study aimed to evaluate the effectiveness of NCS, SCS, and NCS plus SCS in Chinese patients with AECOPD. Patients and Methods: This was a real-world study of AECOPD patients at 43 sites from January to September 2014. During hospitalization, patients treated with nebulized budesonide (NCS group, n=1091), SCS (SCS group, n=709), or both (NCS+SCS group, n=1846) were included. Propensity score matching (PSM) and subgroup analyses were performed. The primary outcomes were the length of hospital stay, mortality, and change in arterial blood gases from baseline. Results: Multivariable analysis showed that the three treatments at the same severity of AECOPD were not significantly different regarding intubation rates, rates of pneumonia improvement at discharge, rates of new-onset pneumonia in hospital, and mortality. Following PSM, NCS+SCS was associated with greater length of hospital stay than both NCS and SCS (in patients without respiratory failure [RF, P<0.001] and with type I RF [P=0.022]), and more hospitalization costs than the other two treatments (in patients without RF [P<0.001]). Conclusion: NCS is effective for patients with AECOPD, which may be an alternative treatment option. Further clinical trials are urgently needed to better understand the efficacy of NCS, SCS, and NCS+SCS in AECOPD management in China.

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“…(2) the proportion of patients that were using inhaled corticosteroids; (3) the mean FEV 1 of the participants; (4)-(5) same as above; (6) proportion of patients with bacterial co-infection and (7) proportion of patients that received antiviral treatment. For conducting these analyses, we will use a random-effects model and for metaregression analyses of proportions, we will use the inverse variance method with logit transformed proportions.…”

Section: Meta-regression and Sensitivity Analysesmentioning

confidence: 99%

Prevalence and clinical implications of respiratory viruses in stable chronic obstructive pulmonary disease (COPD) and exacerbations: a systematic review and meta-analysis protocol

et al. 2020

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IntroductionBoth stable chronic obstructive pulmonary disease (COPD) and acute exacerbations represent leading causes of death, disability and healthcare expenditure. They are complex, heterogeneous and their mechanisms are poorly understood. The role of respiratory viruses has been studied extensively but is still not adequately addressed clinically. Through a rigorous evidence update, we aim to define the prevalence and clinical burden of the different respiratory viruses in stable COPD and exacerbations, and to investigate whether viral load of usual respiratory viruses could be used for diagnosis of exacerbations triggered by viruses, which are currently not diagnosed or treated aetiologically.Methods and analysisBased on a prospectively registered protocol, we will systematically review the literature using standard methods recommended by the Cochrane Collaboration and the Grading of Recommendations Assessment, Development and Evaluation working group. We will search Medline/PubMed, Excerpta Medica dataBASE (EMBASE), the Cochrane Library, the WHO’s Clinical Trials Registry and the proceedings of relevant international conferences on 2 March 2020. We will evaluate: (A) the prevalence of respiratory viruses in stable COPD and exacerbations, (B) differences in the viral loads of respiratory viruses in stable COPD vs exacerbations, to explore whether the viral load of prevalent respiratory viruses could be used as a diagnostic biomarker for exacerbations triggered by viruses and (C) the association between the presence of respiratory viruses and clinical outcomes in stable COPD and in exacerbations.Ethics and disseminationEthics approval is not required since no primary data will be collected. Our findings will be presented in national and international scientific conferences and will be published in peer reviewed journals. Respiratory viruses currently represent a lost opportunity to improve the outcomes of both stable COPD and exacerbations. Our work aspires to ‘demystify’ the prevalence and clinical burden of viruses in stable COPD and exacerbations and to promote clinical and translational research.PROSPERO registration numberCRD42019147658.

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Acute exacerbations of chronic obstructive pulmonary disease: in search of diagnostic biomarkers and treatable traits

Cited by 111 publications

References 103 publications

Role of acute exacerbations in skeletal muscle impairment in COPD

Role of acute exacerbations in skeletal muscle impairment in COPD

<p>Comparison of the Clinical Outcomes Between Nebulized and Systemic Corticosteroids in the Treatment of Acute Exacerbation of COPD in China (CONTAIN Study): A Post Hoc Analysis</p>

Prevalence and clinical implications of respiratory viruses in stable chronic obstructive pulmonary disease (COPD) and exacerbations: a systematic review and meta-analysis protocol

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