Diagnosis and Outpatient Management of Chronic Obstructive Pulmonary Disease

Riley, Craig; Sciurba, Frank C.

doi:10.1001/jama.2019.0131

Cited by 179 publications

(145 citation statements)

References 83 publications

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“…Patients prescribed insulin (ATC code: A10A) and diagnosed with type 1 diabetes (T1DM) in the NPR for in-hospital or outpatient care were considered to have T1DM. Chronic Obstructive Pulmonary Disease (COPD) was defined as admission for COPD or a complication of COPD with COPD as secondary diagnosis in the NPR for in-hospital care (ICD-10: J44) or prescription of an anticholinergic drug (ATC code: R03BB), long-acting beta-2 agonist (ATC codes: R03AC12-R03AC18), or a combination of these (ATC code: R03AL) indicating moderate to severe COPD [16]. Cerebrovascular disease was defined as subarachnoid haemorrhage (ICD-10: I60), intracerebral haemorrhage (ICD-10: I61), ischaemic stroke (ICD-10: I63), or acute cerebral event not specified as haemorrhage or ischaemia (ICD-10: I64) registered in the NPR for in-hospital or outpatient care.…”

Section: Definition Of Covariatesmentioning

confidence: 99%

Association between metabolic surgery and cardiovascular outcome in patients with hypertension: A nationwide matched cohort study

et al. 2020

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Background Hypertension, together with obesity, is a leading cause of mortality and disability. Whilst metabolic surgery offers remission of several metabolic comorbidities, the effect for patients with hypertension remains controversial. The objective of the present study was to evaluate the effect of metabolic surgery on cardiovascular events and mortality on patients with morbid obesity (body mass index [BMI] � 35 kg/m 2) and hypertension. Methods and findings We conducted a matched cohort study of 11,863 patients with morbid obesity and pharmacologically treated hypertension operated on with metabolic surgery and a matched nonoperated-on control group of 26,199 subjects with hypertension (matched by age, sex, and area of residence) of varied matching ratios from 1:1 to 1:9, using data from the Scandinavian Obesity Surgery Register (SOReg), the Swedish National Patient Registers (NPR) for in-hospital and outpatient care, the Swedish Prescribed Drug Register, and Statistics Sweden. The main outcome was major adverse cardiovascular event (MACE), defined as first occurrence of acute coronary syndrome (ACS) event, cerebrovascular event, fatal cardiovascular event, or unattended sudden cardiac death. The mean age in the study group was 52.1 ± 7.46 years, with 65.8% being women (n = 7,810), and mean BMI was 41.9 ± 5.43 kg/ m 2. MACEs occurred in 379 operated-on patients (3.2%) and 1,125 subjects in the control group (4.5%). After adjustment for duration of hypertension, comorbidities, and education, a reduction in risk was seen in the metabolic surgery group (adjusted hazard ratio [HR] 0.73, 95% confidence intervals [CIs] 0.64-0.84, P < 0.001). The surgery group had lower risk for ACS events (adjusted HR 0.52, 95% CI 0.41-0.66, P < 0.001) and a tendency towards lower risk for cerebrovascular events (adjusted HR 0.81, 95% CI 0.63-1.01, P = 0.060)

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Section: Definition Of Covariatesmentioning

confidence: 99%

Association between metabolic surgery and cardiovascular outcome in patients with hypertension: A nationwide matched cohort study

et al. 2020

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“…Improving HRQoL is a key aim in German disease management guidelines for COPD patients [ 19 ], but overall prediction of COPD outcomes still remains difficult [ 20 ]. Despite being an important management variable, actual guidelines often fail to account for high BMI [ 21 , 22 ] or cover obesity rather casually [ 23 ]. By evaluating the association of BMI and HRQoL across different COPD severity grades, this study aims to provide current easy-to-understand guidance for optimal weight recommendations in COPD patients.…”

Section: Introductionmentioning

confidence: 99%

The relationship between body mass index and health-related quality of life in COPD: real-world evidence based on claims and survey data

et al. 2020

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Background Body mass index (BMI) is an important parameter associated with mortality and health-related quality of life (HRQoL) in chronic obstructive pulmonary disease (COPD). However, informed guidance on stratified weight recommendations for COPD is still lacking. This study aims to determine the association between BMI and HRQoL across different severity grades of COPD to support patient management. Methods We use conjunct analysis of claims and survey data based on a German COPD disease management program from 2016 to 2017. The EQ-5D-5L visual analog scale (VAS) and COPD Assessment Test (CAT) are used to measure generic and disease-specific HRQoL. Generalized additive models with smooth functions are implemented to evaluate the relationship between BMI and HRQoL, stratified by COPD severity. Results 11,577 patients were included in this study. Mean age was 69.4 years and 59% of patients were male. In GOLD grades 1–3, patients with BMI of around 25 had the best generic and disease-specific HRQoL, whereas in GOLD grade 4, obese patients had the best HRQoL using both instruments when controlled for several variables including smoking status, income, COPD severity, comorbidities, emphysema, corticosteroid use, and days spent in hospital. Conclusion This real-world analysis shows the non-linear relationship between BMI and HRQoL in COPD. HRQoL of obese patients with mild to severe COPD might improve following weight reduction. For very severe COPD, a negative association of obesity and HRQoL could not be confirmed. The results hint at the need to stratify COPD patients by disease stage for optimal BMI management.

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“…Inhaled pharmacologic treatments for COPD include drugs stimulating adrenergic receptors in airway smooth muscle (long-acting ß-agonists; LABA) or preventing acetylcholine binding to muscarinic receptors in the airways (long-acting muscarinic antagonists; LAMA) to induce bronchodilation, relax airway smooth muscle, and reduce airway inflammation [3]. LABA and LAMA also reduce exacerbation risk, and adding inhaled corticosteroids in dual or triple therapy may also enhance this effect in some patients [1,4].…”

Section: Introductionmentioning

confidence: 99%

Design for a multicenter, randomized, sham-controlled study to evaluate safety and efficacy after treatment with the Nuvaira® lung denervation system in subjects with chronic obstructive pulmonary disease (AIRFLOW-3)

Slebos¹,

Degano²,

Valipour³

et al. 2020

BMC Pulm Med

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Background: Targeted lung denervation (TLD) is a bronchoscopically delivered ablation therapy that selectively interrupts pulmonary parasympathetic nerve signaling. The procedure has the potential to alter airway smooth muscle tone and reactivity, decrease mucous secretion, and reduce airway inflammation and reflex airway hyperresponsiveness. Secondary outcome analysis of a previous randomized, sham-controlled trial showed a reduction in moderate-to-severe exacerbations in patients with COPD after TLD treatment. A pivotal trial, AIRFLOW-3 has been designed to evaluate the safety and efficacy of TLD combined with optimal medical therapy to reduce moderate or severe exacerbations throughout 1 year, compared with optimal medical therapy alone. Methods: The study design is a multicenter, randomized, full sham bronchoscopy controlled, double-blind trial that will enroll 400 patients (1:1 randomization). Key inclusion criteria are FEV 1 /FVC < 0.7, FEV 1 30 to 60% of predicted, post-bronchodilator, ≥ 2 moderate or 1 severe COPD exacerbations in the prior year, and COPD assessment test (CAT) ≥ 10. Primary objective will be the comparison of moderate or severe COPD exacerbations through 12 months of TLD therapy with optimal medical therapy versus optimal medical therapy alone. The sham group will be allowed to cross over at 1 year. Patients will be followed for up to 5 years. Discussion: The multicenter, randomized, full sham bronchoscopy controlled, double-blind AIRFLOW-3 trial will evaluate the efficacy of TLD to reduce moderate or severe COPD exacerbations beyond optimal medical therapy alone. The target population are patients with COPD, who suffer persistent symptoms and exacerbations despite optimal treatment, defining an unmet medical need requiring novel therapeutic solutions. This trial is registered at clinicaltrials.gov: NCT03639051.

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Diagnosis and Outpatient Management of Chronic Obstructive Pulmonary Disease

Cited by 179 publications

References 83 publications

Association between metabolic surgery and cardiovascular outcome in patients with hypertension: A nationwide matched cohort study

Association between metabolic surgery and cardiovascular outcome in patients with hypertension: A nationwide matched cohort study

The relationship between body mass index and health-related quality of life in COPD: real-world evidence based on claims and survey data

Design for a multicenter, randomized, sham-controlled study to evaluate safety and efficacy after treatment with the Nuvaira® lung denervation system in subjects with chronic obstructive pulmonary disease (AIRFLOW-3)

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