Background: COPD puts a significant burden on health care systems. Remote monitoring of patients has been evaluated but with varying results, probably due to variations in design, choices of outcomes and patient adherence. We aimed to evaluate the patient-equipment interface and patient preferences in the use of a tablet-based remote monitoring system for COPD. Methods: Patients with COPD were offered a tablet system (c-vitals, Luscii, the Netherlands) during a 12-week period, bluetooth connected to devices that measured blood pressure, heart rate, weight, SpO2 and physical activity. Symptoms questionnaire were filled out through the tablet. Information was collected twice a week. Weekly videocalls with a nurse were scheduled. The outcome measures were the participation rate, patient experience of predifned aspects using a VAS scale and the description of technical proplems. Results: Sixteen patients (mean age 69±10 y) were included of which (87.5%) completed the 12 weeks study period and provided on average 91% of planned measurements. The average proportion of available measurements per patient was 91%. The top 3 barriers encountered were incorrect bluetooth connections, incomplete transfer of data and video-connection stability. Figure 1 shows the patient evaluation using a VAS scale. Conclusions: Remote monitoring is feasible, well tolerated and appreciated by COPD patients with a high adherence to the system.

Background COPD has increased in prevalence worldwide over several decades until the first decade after the millennium shift. Evidence from a few recent population studies indicate that the prevalence may be levelling or even decreasing in some areas in Europe. Since the 1970s, a substantial and ongoing decrease in smoking prevalence has been observed in several European countries including Sweden. The aim of the current study was to estimate the prevalence, characteristics and risk factors for COPD in the Swedish general population. A further aim was to estimate the prevalence trend of COPD in Northern Sweden from 1994 to 2009. Methods Two large random population samples were invited to spirometry with bronchodilator testing and structured interviews in 2009–2012, one in south-western and one in northern Sweden, n = 1839 participants in total. The results from northern Sweden were compared to a study performed 15 years earlier in the same area and age-span. The diagnosis of COPD required both chronic airway obstruction (CAO) and the presence of respiratory symptoms, in line with the GOLD documents since 2017. CAO was defined as post-bronchodilator FEV 1 /FVC < 0.70, with sensitivity analyses based on the FEV 1 /FVC < lower limit of normal (LLN) criterion. Results Based on the fixed ratio definition, the prevalence of COPD was 7.0% (men 8.3%; women 5.8%) in 2009–2012. The prevalence of moderate to severe (GOLD ≥ 2) COPD was 3.5%. The LLN based results were about 30% lower. Smoking, occupational exposures, and older age were risk factors for COPD, whereof smoking was the most dominating risk factor. In northern Sweden the prevalence of COPD, particularly moderate to severe COPD, decreased significantly from 1994 to 2009, and the decrease followed a decrease in smoking. Conclusions The prevalence of COPD has decreased in Sweden, and the prevalence of moderate to severe COPD was particularly low. The decrease follows a major decrease in smoking prevalence over several decades, but smoking remained the dominating risk factor for COPD.

Chronic Obstructive Pulmonary Disease (COPD) is a complex disease defined by airflow limitation and characterized by a spectrum of treatable and untreatable pulmonary and extra-pulmonary disease characteristics. Nonpharmacological management related to physical activity, physical capacity, body composition, breathing and energy-saving techniques, coping strategies, and self-management is as important as its pharmacological management. Most patients with COPD carry other chronic diagnoses and this poses a key challenge, as it lowers the quality of life, increases mortality, and impacts healthcare consumption. A personalized, multi-, and interprofessional approach is key. Today, healthcare is poorly organized to meet this complexity with the isolation between care levels, logic silos of the different healthcare professions, and lack of continuity of care along the patient's journey with the healthcare system. In order to meet the criteria for integrated, personalized care for COPD, the structural capabilities of healthcare to support a comprehensive approach and continuity of care needs improvement. COPD is preeminently a disease that requires a transition from a reactive single-specialty approach to a proactive interprofessional approach. In this study, we discuss the issues that need to be addressed when moving from current health care practice to a person-centered model where the care processes and information are aligned to the individual personal needs of the patient.

Triple inhaler therapy in COPD might in some real-life situations be useful outside of the strict indications reported by the registration agencies, but at the same time in some other situations it could be better avoided, even when recommended http://ow.ly/CbOe30njXV2

A recent editorial in the European Respiratory Journal highlighted the strategic importance of the Clinical Research Collaborations (CRCs) launched in 2013 by the European Respiratory Society (ERS) [1]. These have the aim of 1) promoting the exchange of research ideas among clinicians and affiliated scientists in Europe and/or globally; 2) building an infrastructure for prospective clinical research; 3) securing additional funding through national and European Union funding streams; and 4) facilitating the planning, implementation, evaluation and publication of clinical and translational studies at pan-European level and beyond. So far, there are currently 17 ongoing CRCs that cover eight major respiratory disease domains (airway diseases, interstitial lung diseases, pulmonary vascular diseases, sleep and breathing disorders, respiratory critical care, paediatric respiratory diseases, respiratory infections and thoracic oncology), all of them linked to one or more ERS assemblies [2–12]. The ERS launches a new Clinical Research Collaboration (CADSET) to study the determinants and implications of different lung function trajectories through life We are grateful for the support from the ERS office in Lausanne, Switzerland, in logistics and organisation of CADSET.

Together with the adequate delivery of the right drugs to the right patient at the right dosage, and aimed at the right outcomes, the most important management goals in patients with chronic obstructive pulmonary disease (COPD) are the following: smoking abstinence, physical activity and a balanced diet; adhering to complex medication regimens; and developing the ability to recognise signs and symptoms of deterioration, and knowing what to do to prevent or reverse them [1]. Managed care may reduce mortality in severe COPD patients with previous hospitalisation

Chronic obstructive pulmonary disease (COPD) develops in small airways. Severity of small airway pathology relates to progression and mortality. The present study evaluated the prediction of COPD of a validated test for small airway disease, i.e. a slope of the alveolar plateau of the single breath nitrogen test (N-2-slope). The N-2-slope, spirometry, age, smoking habits, and anthropometric variables at baseline were obtained in a population-based sample (n = 592). The cohort was followed for first COPD events (first hospital admission of COPD or related conditions or death from COPD) during 38 years. During follow-up, 52 subjects (8.8%) had a first COPD event, of which 18 (3.0%) died with a first COPD diagnosis. In the proportional hazard regression analysis adjusted for age and smoking habits, the cumulative COPD event incidence increased from 5% among those with high forced expired volume in one second (FEV1) to 25% among those with low FEV1, while increasing from 4% among those with the lowest N-2-slope to 26% among those with the highest. However, combining the N-2-slope and FEV1 resulted in considerable synergy in the prediction of first COPD event and even more so when taking account of smoking habits. The cumulative COPD event incidence rate was 75% among heavy smokers with the highest N-2-slope and lowest FEV1, and less than 1% among never smokers with the lowest N-2-slope and highest FEV1. Thus, combining the results of the single breath N-2-slope and FEV1 considerably improved the prediction of COPD events as compared to either test alone.

Objective and background: Few studies have assessed the effectiveness of inhaled corticosteroid therapy exclusively in Asian patients with asthma. The present analysis compared the efficacy of early intervention with inhaled budesonide in Caucasian and Asian patients over the first 3 years of the inhaled Steroid Treatment As Regular Therapy in early asthma study.Methods: Patients aged 5–66 years with mild persistent asthma of ≤2 years’ duration were randomized to 3 years of double‐blind treatment with once‐daily budesonide 200 µg (for patients aged <11 years) or 400 µg administered via Turbuhaler or placebo, plus usual asthma therapy.Results: Budesonide significantly improved asthma outcomes in both Caucasian (n = 4661) and Asian (n = 1995) patients compared with reference therapy (placebo plus usual asthma therapy). Budesonide reduced the risk of a first severe asthma‐related event by 42% and 49% in Caucasian and Asian patients, respectively, over the 3‐year treatment period (P < 0.001 for both). Moreover, budesonide significantly increased symptom‐free days, decreased nights with sleeping problems, improved pre‐ and postbronchodilator FEV1 and reduced the need for additional asthma medications of particular drug classes compared with reference therapy. Except for differences in the patterns of use of additional asthma medications, outcomes with budesonide and overall adverse events were similar in the Caucasian and Asian patient populations.Conclusion: Inhaled budesonide administered once daily in Asian patients with recent‐onset, mild persistent asthma significantly improved asthma control and pulmonary function compared with reference therapy. Moreover, this effectiveness paralleled that observed in Caucasian patients.

STUDY OBJECTIVES:Asthmatic patients lose lung function faster than normal subjects. The effectiveness of early intervention with inhaled corticosteroids on this decline in lung function is not established in recent-onset disease. DESIGN:The Inhaled Steroid Treatment as Regular Therapy in Early Asthma study was a randomized, double-blind study in 7,165 patients (5 to 66 years old), with persistent asthma for < 2 years to determine whether early intervention with low-dose inhaled budesonide prevents severe asthma-related events and the decline in lung function. Patients received budesonide (200 mug qd for children < 11 years old and 400 mug qd for others) or placebo for 3 years in addition to usual asthma medications. RESULTS:Treatment with budesonide significantly improved prebronchodilator and postbronchodilator FEV(1) percentage of predicted and reduced the mean declines from baseline for postbronchodilator FEV(1) at 1 year and 3 years: - 0.62% and - 1.79% for budesonide and - 2.11% and - 2.68% for placebo, respectively (p < 0.001). The decline was more marked for male patients, active smokers, and patients > 18 years old, and the smallest treatment effects were in adolescents. CONCLUSIONS:Long-term, once-daily treatment with low-dose budesonide improved both prebronchodilator and postbronchodilator FEV(1) in patients with recent-onset, persistent asthma, and reduced the loss of lung function over time.

Background The role of long-acting, inhaled beta(2)-agonists in treating asthma is uncertain. In a double-blind study, we evaluated the effects of adding inhaled formoterol to both lower and higher doses of the inhaled glucocorticoid budesonide.Methods After a four-week run-in period of treatment with budesonide (800 mu g twice daily), 852 patients being treated with glucocorticoids were randomly assigned to one of four treatments given twice daily by means of a dry-powder inhaler (Turbuhaler): 100 mu g of budesonide plus placebo, 100 mu g of budesonide plus 12 mu g of formoterol, 400 mu g of budesonide plus placebo, or 400 mu g of budesonide plus 12 mu g of formoterol. Terbutaline was permitted as needed. Treatment continued for one year; we compared the frequency of exacerbations of asthma, symptoms, and lung function in the four groups. A severe exacerbation was defined by the need for oral glucocorticoids or a decrease in the peak flow to more than 30 percent below the base-line value on two consecutive days.Results The rates of severe and mild exacerbations were reduced by 26 percent and 40 percent, respectively, when formoterol was added to the lower dose of budesonide. The higher dose of budesonide alone reduced the rates of severe and mild exacerbations by 49 percent and 37 percent, respectively. Patients treated with formoterol and the higher dose of budesonide had the greatest reductions - 63 percent and 62 percent, respectively. Symptoms of asthma and lung function improved with both formoterol and the higher dose of budesonide, but the improvements with formoterol were greater.Conclusions In patients who have persistent symptoms of asthma despite treatment with inhaled glucocorticoids, the addition of formoterol to budesonide therapy or the use of a higher dose of budesonide may be beneficial. The addition of formoterol to budesonide therapy improves symptoms and lung function without lessening the control of asthma. (C) 1997, Massachusetts Medical Society.

Pharmacology & ToxicologyVolume 77, Issue s3 p. 36-39 β-Adrenoceptor Agonists in Future Asthma Theraphy Anders Ullman, Anders Ullman Clinical R & D, Astra Draco AB, Box 34, S-221 00 Lund, SwedenSearch for more papers by this author Anders Ullman, Anders Ullman Clinical R & D, Astra Draco AB, Box 34, S-221 00 Lund, SwedenSearch for more papers by this author First published: November 1995 https://doi.org/10.1111/j.1600-0773.1995.tb01940.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume77, Issues3November 1995Pages 36-39 RelatedInformation