Background:The burden of frequent respiratory exacerbations in COPD patients with mild-to-moderate spirometric impairment and smokers with preserved lung function is unknown. Methods:We categorized COPD participants in COPDGene with post-bronchodilator FEV1%predicted≥50% by the annual exacerbation frequency into three groups: i)frequent exacerbators (top 5%; n = 109), ii)exacerbators (>0 but less than frequent exacerbators; n = 1,009), and iii)No exacerbation (n = 981). Exacerbations were defined as respiratory episodes requiring antibiotics and/or systemic steroids. We performed a Cox proportional hazards regression analysis to examine the association with mortality. We repeated the same process in current/former smokers with preserved spirometry (FEV1≥80%predicted and FEV1/FVC≥0.7). Results:Among 2,099 COPD participants, frequent exacerbators had ≥1.8 exacerbations/year and were responsible for 34.3% of the total exacerbations. There were 102 (10.4%) deaths in the group with no exacerbations, 119 (11.8%) in the exacerbator group, and 24 (22%) in the frequent exacerbators. Adjusted mortality in frequent exacerbators was higher relative to individuals with no exacerbations (hazard ratio (HR) = 1.98; 95%CI = 1.25-3.13). An increase in frequency of exacerbations by one exacerbation/year was associated with increased mortality (HR = 1.40,95%CI = 1.21-1.62). Among 3,143 participants with preserved spirometry, frequent exacerbators had ≥0.8 exacerbations/year and were responsible for more than half of the exacerbations. There were 93 (4.2%) deaths in the group with no exacerbations, 28 (3.8%) in the exacerbator group, and 14 (7.6%) in the frequent exacerbators. The adjusted mortality was increased in frequent exacerbators with preserved spirometry relative to those with no exacerbations (HR = 2.25; 95%CI = 1.26-4.01). Conclusions:In COPD participants with mild-to-moderate spirometric impairment and smokers with preserved spirometry, the frequent exacerbator phenotype is responsible for a large proportion of total exacerbations and associated with high mortality.
BackgroundNonadherence to treatment recommendation, common in patients with COPD and Asthma, leads to poor disease control, frequent exacerbations and emergency room visits. We studied the effect of a single home visit (HV) on adherence and health care utilization in a cohort of non-compliant Asthma and COPD patients.MethodsPatients with severe Asthma and COPD with frequent exacerbations deemed non-compliant were subjected to a single home visit by a multidisciplinary team. Adherence to inhalers and office visits, and healthcare utilization were assessed a year prior to and after the home visit.ResultsA total of 60 patients had an attempted home visit. Contact was made with 36 patients during the home visits and these were subject to analyses. Mean age was 60, and 61% were women. Average FEV1 was 1.56 L (55% predicted). There was a significant increase in compliance with office visits in the year following the HV as compared to the year before HV (87 vs 145 visits post-HV). Similarly, there was a significant reduction in the ER visits (76 visits vs 34 visits post-HV), and hospital admission (39 visits vs 24 post HV) and this was associated with a significant improvement in patient adherence to maintenance inhaler use - 17% (6 of 36) vs 53% (19 of 36).ConclusionIn patients with frequent exacerbations of Asthma and COPD with confirmed non-compliance, a single home visit by a multidisciplinary team improved patient adherence to inhalers and office visits and reduced healthcare utilization.
BackgroundDiagnosing and monitoring of children with respiratory disorders is often challenging. Respiratory sounds (RS) are simple, non-invasive and universally available measures that are directly related to movement of air, within the tracheobronchial tree. Thus, RS may be valuable indicators of respiratory health, their characteristics in the paediatric population are scattered in the literature and not systematized.AimSystematically review the different acoustic RS properties in healthy children and in children with different respiratory disorders. Methods: MEDLINE, EMBASE, AMED and CINHAL databases were searched on Sept 2020. One author extracted data and two independently assessed the quality of the articles using the National Heart Lung and Blood Institute quality assessment tool.ResultsTwenty-eight studies were included with a total 2032 participants (44% with a respiratory condition, such as asthma, bronchiolitis, cystic fibrosis, presence of wheezing and non-specified low respiratory tract infections). A high heterogeneity in the procedures, outcomes and outcome measures used was found. Healthy participants showed lower values of F50 (from 194 ± 26 to 521 ± 18Hz) than those with asthma (from 140 ± 8 to 769 ± 85Hz) or bronchiolitis (from 100 to 80Hz). F50 tend to increase with provocation tests (136 ± 9 to 909 ± 81Hz) and decrease with treatments (128 ± 6 to 781 ± 57Hz). Wheeze rates ranged from 0 to 24.7 ± 25% on asthmatic participants. Crackles findings ranged from 6% on people with recurrent wheezing to 30.8% in middle lobe atelectasis.ConclusionRS show different acoustic properties in healthy children vs with different respiratory disorders and thus may be useful in the diagnostic and monitoring on paediatrics.
•The main pathophysiological traits of COPD patients while exercising are the excess ventilation and dynamic hyperinflation.•In COPD patients, Sacin, a marker of small airway dysfunction, can predict excess ventilation and dynamic hyperinflation.•Small airways dysfunction crucially impacts on functional status of COPD patients.
As Covid-19 affects millions of people worldwide, the global health care will encounter an increasing burden of the aftermaths of the disease. Evidence shows that up to a fifth of the patients develop fibrotic tissue in the lung. The SARS outbreak in the early 2000 resulted in chronic pulmonary fibrosis in a subset (around 4%) of the patients, and correlated to reduced lung function and forced expiratory volume (FEV). The similarities between corona virus infections causing SARS and Covid-19 are striking, except that the novel coronavirus, SARS-CoV-2, has proven to have an even higher communicability. This would translate into a large number of patients seeking care for clinical signs of pulmonary fibrosis, given that the Covid-19 pandemic has up till now (Sept 2020) affected around 30 million people. The SARS-CoV-2 is dependent on binding to the angiotensin converting enzyme 2 (ACE2), which is part of the renin-angiotensin system (RAS). Downregulation of ACE2 upon virus binding disturbs downstream activities of RAS resulting in increased inflammation and development of fibrosis. The poor prognosis and risk of developing pulmonary fibrosis are therefore associated with the increased expression of ACE2 in risk groups, such as obesity, heart disorders and aging, conferring plenty of binding opportunity for the virus and subsequently the internalization of ACE2, thus devoiding the enzyme from acting counter-inflammatory and antifibrotic. Identifying pathways that are associated with Covid-19 severity that result in pulmonary fibrosis may enable early diagnosis and individualized treatment for these patients to prevent or reduce irreversible fibrotic damage to the lung.
