Nonpharmacologic Therapies in Patients With Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review With Meta-Analysis

Dobler, Claudia C.; Morrow, Allison S.; Farah, Magdoleen H.; Beuschel, Bradley; Majzoub, Abdul M.; Wilson, Michael E.; Hasan, Bashar; Seisa, Mohamed O.; Daraz, Lubna; Prokop, Larry J.; Murad, M. Hassan; Wang, Zhen

doi:10.1016/j.mayocp.2020.01.018

Cited by 13 publications

(9 citation statements)

References 45 publications

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“…Noninvasive ventilation in AECOPD with hypercapnic respiratory failure is a very important therapy as it prevents the need for invasive ventilation and reduces mortality in AECOPD [43]. Antibiotics reduce treatment failure [44], but probably have limited benefit in outpatient settings [45]. Most AECOPD patients receive corticosteroid treatment, though recent studies have shown that corticosteroid treatment can be guided by peripheral eosinophil count [46].…”

Section: Acute Exacerbations Of Copdmentioning

confidence: 99%

“…However, since prevention is better than cure, attempting to avoid muscle deterioration by PR during AECOPD hospitalization in the first place would make sense (as a side note, the term 'rehabilitation' during the admission phase does not seem appropriate and maybe should be reconsidered in this context). Recently, Dobler et al conducted a systematic review including a meta-analysis on non-pharmacologic therapies and showed that exercise interventions and pulmonary rehabilitation programs may indeed ameliorate functional decline in patients hospitalized for an AECOPD [153]. In-hospital rehabilitation (with focus on exercise training) during admission attenuates muscle mass decline during AECOPD [154,155] and aerobic exercise training during admission, despite being experienced as intense, was found to be safe [156].…”

Section: Treatment Of Muscle Impairment In Aecopdmentioning

confidence: 99%

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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%

Section: Treatment Of Muscle Impairment In Aecopdmentioning

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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“…Specifically, 30.2% (36/119) were on a maintenance LAMA and 31% (37/119) on a LABA. Often, during hospitalization for acute COPD exacerbations, the LA maintenance inhalers are held while frequent short-acting bronchodilators are utilized [5]. At discharge, 31.9% (38/119) were on a LAMA and 34.5% (41/119) were on a LABA.…”

Section: Resultsmentioning

confidence: 99%

LA inhalers for COPD: perceptions/reality of ABCD GOLD tool use

Boryushkina

Kumar

Barnes

et al. 2020

Journal of Community Hospital Internal Medicine Perspectives

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Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) created an ABCD tool to assess staging and severity of COPD subgroups that respond to LAMA or LABA with improved quality of life and reduced exacerbations. Our study assesses perception of physicians at five community hospitals towards LAMA use for patients admitted with COPD exacerbations according to the GOLD guidelines and describes the experience at our hospital. Methods: Electronic survey forms regarding LAMA use and the GOLD criteria ABCD for COPD treating physicians were sent to five hospitals. A one-year chart review at our hospital determined prevalent use of a maintenance LAMA or LABA inhaler in patients admitted with acute COPD exacerbation. Currently, our EMR does not require a field for the GOLD ABCD categorization. Results: We obtained a 33% (45/136) response rate. Of these, 63% felt a LAMA to be essential on formulary; 60% were neutral or unlikely to initiate LAMA on admission; 47.7% likely or very likely to start a LAMA during hospitalization; 82% were neutral to very likely to discharge a patient on a LAMA if deemed necessary for maintenance. Of those admitted for acute COPD exacerbations to our hospital, over a third of COPD patients were not on a maintenance LAMA or LABA. Conclusions: Most physicians felt it important to prescribe a maintenance LAMA to COPD patients hospitalized for acute exacerbation. Our hospital's use of LAMA or LABA demonstrates the need to incorporate strategies to encourage appropriate prescribing of these LA inhalers per GOLD guidelines.

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“…Based on the results of previous systematic reviews, hard outcomes such as in-hospital death and 30-day mortality could not be evaluated in the present study because of its sample size. 7,8 Moreover, the time to the next exacerbation could not be evaluated because of unmeasured confounding factors, such as post-admission baseline treatments for COPD. In a previous retrospective cohort study with unmeasured confounding factors, antibiotic use was associated with improvements in the long-term mortality and time to the next exacerbation.…”

Section: Discussionmentioning

confidence: 99%

“…6 An initial empirical treatment with narrow-spectrum antibiotics, such as aminopenicillin with clavulanic acid, macrolide, and tetracycline, is recommended for the entire population with COPD exacerbation, based on previous systematic reviews. 7,8 However, evidence that can guide decisions regarding whether to choose narrow-spectrum or broad-spectrum antibiotics is lacking. Based on expert opinions, local bacterial resistance patterns should be considered.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of empirical anti-pseudomonal antibiotics in patients with recurrent COPD exacerbation: A multicenter retrospective cohort study

Shiroshita¹,

Miyakoshi²,

Tsutsumi³

et al. 2021

Preprint

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Background: Although frequent chronic obstructive pulmonary disease (COPD) exacerbation has been associated with the isolation of Pseudomonas aeruginosa (PA) in sputum cultures, it remains unknown whether the empirical use of anti-pseudomonal antibiotics can improve outcomes in patients with frequent COPD exacerbations. Research Question: Does empirical use of anti-pseudomonal antibiotics improve the length of the hospital stay in patients with recurrent COPD exacerbation?Study Design and Methods: This multicenter retrospective cohort study was conducted in seven hospitals in Japan. We included patients aged ≥40 years who were admitted to the hospital with COPD exacerbation more than twice during the study period (April 1, 2008 to July 31, 2020). The primary outcome was the length of the hospital stay. For statistical analysis, a log-linked Gamma model was used. Parameters were estimated using a generalized estimating equation model with an exchangeable correlation structure accounting for repeated observations from a single patient. Covariates included age, body mass index, home oxygen therapy use, respiratory rate, heart rate, oxygen use on admission, mental status, systemic steroid use, activities of daily living, and number of recurrences. Hospital-specific effects were specified as fixed effects.Results: Among 1573 patients with COPD exacerbation, 344 patients and 965 observations of recurrent COPD exacerbations were selected. Anti-pseudomonal antibiotics were used in 173 patients (18%). The estimated change in the length of the hospital stay between the anti-pseudomonal and non-anti-pseudomonal antibiotics groups was 0.044 days [95% confidence interval; -0.077, 0.166]. Interpretation: Use of empirical anti-pseudomonal antibiotics based only on recurrence may not be necessary. Further large-scale studies are needed to more precisely evaluate the effectiveness of empirical anti-pseudomonal antibiotics.

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Nonpharmacologic Therapies in Patients With Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review With Meta-Analysis

Cited by 13 publications

References 45 publications

Role of acute exacerbations in skeletal muscle impairment in COPD

Role of acute exacerbations in skeletal muscle impairment in COPD

LA inhalers for COPD: perceptions/reality of ABCD GOLD tool use

Effectiveness of empirical anti-pseudomonal antibiotics in patients with recurrent COPD exacerbation: A multicenter retrospective cohort study

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