Controversies and Limitations in the Diagnosis of Chronic Obstructive Pulmonary Disease

Reyes-García, Alejandro; Torre-Bouscoulet, Luis; Pérez‐Padilla, Rogelio

doi:10.24875/ric.18002626

Cited by 3 publications

(2 citation statements)

References 45 publications

(63 reference statements)

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“…The disease is associated with an abnormal inflammatory response of the lung to harmful particles or gases, especially tobacco, with significant systemic repercussions. 1 , 2 The prevalence of COPD is high worldwide and there is a trend towards a continued increase. 2 , 3 In Spain, the estimated prevalence of COPD is 11.8% (EPISCAN II) in people aged 40 or older.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Economic Impact of Long-Term Inhaled Corticosteroid Withdrawal in Patients with Chronic Obstructive Pulmonary Disease Treated with Triple Therapy in Spain

García¹,

Vallejo-Aparicio²,

Ismaila³

et al. 2022

COPD

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Purpose To determine the clinical and economic impact of inhaled corticosteroid (ICS) withdrawal in Spanish patients with COPD receiving triple therapy (TT) with ICS, long-acting β 2 -agonist (LABA), and long-acting muscarinic antagonist (LAMA). Patients and Methods This was an observational, retrospective study of BIG-PAC database medical records. Patients aged ≥40 years receiving TT from 2016 to 2018 were followed for 1 year. Two cohorts were identified: patients continuing TT (ICS+LABA+LAMA), and patients receiving TT with ICS withdrawn (LABA+LAMA). Variables included medication, exacerbations (moderate and severe), pneumonia, mortality, health resource use (HRU), and cost per patient/year. Cohorts were compared using propensity score matching (PSM). Multivariate statistical analysis using analysis of covariance and Cox proportional risks was conducted. Results Of 6541 patients included, 5740 (87.8%) continued TT and 801 (12.2%) had ICS withdrawn. Patients with ICS withdrawal were younger, had lower disease burden, higher ICS doses, and more exacerbations compared with those continuing ICS. PSM matched 795 patients in each cohort. Mean age was 68.5 years (SD: 11.2), 69.9% were male, and mean Charlson index was 2.0. Patients with ICS withdrawal had more total exacerbations in the 12 months following withdrawal compared with patients continuing TT (36.6% vs 31.4%; p=0.030). No significant differences were found for pneumonia (3.3% vs 3.6%; p=0.583) and mortality (9.9% vs 7.5%; p=0.092). Median time to first exacerbation was shorter in patients with ICS withdrawal compared with those continuing ICS (HR: 0.69, 95% CI: 0.57–0.83; p<0.001). Mean health cost per patient/year among patients with ICS withdrawal was higher than those continuing TT (€2993 vs €2130; p<0.001). Conclusion ICS withdrawal in patients with COPD receiving TT was associated with increased exacerbations, HRU, and costs compared with continuing TT, with health and economic impacts on patients and the Spanish National Healthcare System, respectively. Pneumonia and mortality rates were similar between groups.

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Section: Introductionmentioning

confidence: 99%

Clinical and Economic Impact of Long-Term Inhaled Corticosteroid Withdrawal in Patients with Chronic Obstructive Pulmonary Disease Treated with Triple Therapy in Spain

García¹,

Vallejo-Aparicio²,

Ismaila³

et al. 2022

COPD

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“…Inflammation possesses a key role in the development of chronic obstructive pulmonary disease resulting in structural changes in the lungs 5 . Although it presents a variety in clinical manifestations, there are few cardinal symptoms that describe it and these are dyspnea and chronic and productive cough 6 . Especially, dyspnea is the reason that will lead a person to seek medical help.…”

Section: Introductionmentioning

confidence: 99%

Exhaled breath condensate: a potential tool to evaluate the relationship between inflammation and dyspnea in patients with chronic obstructive pulmonary disease

Patsiris¹,

Stelios²,

Papanikolaou³

et al. 2021

J Lung Health Dis

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Chronic obstructive pulmonary disease (COPD) is a respiratory disease with high prevalence. Many factors contribute to its development, and probably that leads to its various clinical pictures. Inflammation is the mechanism responsible for the structural alterations in the lungs. Despite its heterogeneity, there are a couple of primary symptoms characterizing it, which are chronic and productive cough and dyspnea. The understanding of dyspnea in COPD is based on theories deriving from the interaction of a network formed between the cardiorespiratory and the neuromuscular system and their receptors. Many factors contribute to its occurrence, making it complex and giving it a very subjective character for a person to perceive. Various methods are used to study COPD. Non-invasive ones seem to attract attention nowadays. One of them is the exhaled breath condensate. It is a biofluid with rich content, which can capture a picture of the pathological processes happening in the lungs. Its study has shown that some markers of inflammation and oxidative stress, such as 8-isoprostane and H2O2, are elevated and able to connect dyspnea and inflammation. Additionally, they seem to provide information of the ongoing inflammatory process in the lungs as well as a picture of the severity of the symptoms. This evidence may enhance the association of dyspnea with dysfunctional breathing. Despite these interesting findings, further research is necessary both in dyspnea and inflammation in COPD to clarify their mechanisms and connective pathways. The utility of non-invasive techniques such as the exhaled breath condensate could be of significant help, but its establishment in the medical field requires extra studies.

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David¹,

Edwards

2020

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Controversies and Limitations in the Diagnosis of Chronic Obstructive Pulmonary Disease

Cited by 3 publications

References 45 publications

Clinical and Economic Impact of Long-Term Inhaled Corticosteroid Withdrawal in Patients with Chronic Obstructive Pulmonary Disease Treated with Triple Therapy in Spain

Clinical and Economic Impact of Long-Term Inhaled Corticosteroid Withdrawal in Patients with Chronic Obstructive Pulmonary Disease Treated with Triple Therapy in Spain

Exhaled breath condensate: a potential tool to evaluate the relationship between inflammation and dyspnea in patients with chronic obstructive pulmonary disease

Forced Expiratory Volume

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