Interventions to reduce rehospitalizations following COPD exacerbations: a systematic review
Valentin Prieto-CenturionMichael MarkosNorma I. RameyHélène A. GussinSharmilee M. NyenhuisMin J. JooBharati PrasadNina BrackenRobert J. DiDomenicoPatrick O. GodwinHoward JaffeRavi KalhanA. Simon PickardBarry R. PittendrighJamie L. SullivanByron ThomashowMark V. WilliamsJerry A. Krishnan
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Impact and prevention of severe exacerbations of COPD: a review of the evidence David MG Halpin,1 Marc Miravitlles,2 Norbert Metzdorf,3 Bartolomé Celli4 1Department of Respiratory Medicine, Royal Devon and Exeter Hospital, Exeter, UK; 2Pneumology Department, Hospital Universitari Vall d’Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; 3Respiratory Medicine, Boehringer Ingelheim Pharma GmBH & Co KG, Ingelheim am Rhein, Germany; 4Pulmonary Division, Brigham and Women’s Hospital, Boston, MA, USA Abstract: Severe exacerbations of COPD, ie, those leading to hospitalization, have profound clinical implications for patients and significant economic consequences for society. The prevalence and burden of severe COPD exacerbations remain high, despite recognition of the importance of exacerbation prevention and the availability of new treatment options. Severe COPD exacerbations are associated with high mortality, have negative impact on quality of life, are linked to cardiovascular complications, and are a significant burden on the health-care system. This review identified risk factors that contribute to the development of severe exacerbations, treatment options (bronchodilators, antibiotics, corticosteroids [CSs], oxygen therapy, and ventilator support) to manage severe exacerbations, and strategies to prevent readmission to hospital. Risk factors that are amenable to change have been highlighted. A number of bronchodilators have demonstrated successful reduction in risk of severe exacerbations, including long-acting muscarinic antagonist or long-acting β2-agonist mono- or combination therapies, in addition to vaccination, mucolytic and antibiotic therapy, and nonpharmacological interventions, such as pulmonary rehabilitation. Recognition of the importance of severe exacerbations is an essential step in improving outcomes for patients with COPD. Evidence-based approaches to prevent and manage severe exacerbations should be implemented as part of targeted strategies for disease management. Keywords: severe COPD exacerbations, hospitalization, prevention, treatment, bronchodilators, long-acting muscarinic antagonist
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Synopsis: In a population-based review of patients with chronic obstructive pulmonary disease, treatment of an exacerbation with an antibiotic appeared to reduce the risk of subsequent exacerbations. Source: Roede BM, Bresser P, Prins JM, et al. Reduced risk of next exacerbation and mortality associated with antibiotic use in COPD. Eur Respir J. 2009;33:282–288.
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Clinical trials evaluating the management of #AECOPD use different diagnostic criteria for COPD and exacerbations, limiting their comparability http://bit.ly/33eIUUX.
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Background: COPD exacerbations represent important events in the life of a COPD patient. Rate of COPD exacerbations impacts adversely on the natural course of COPD, have a major impact on a patient's health related quality of life and is an independent risk factor for future hospitalisation and mortality. The aim of the study was to compare the efficiency of different approaches for the assessment of the risk of exacerbations in patients with COPD. Methods: The study was conducted in 433 patients with COPD. Spirometric data were analyzed (FEV1, FVC, FEV1/FVC) and E-BODE. Were applied different classification of COPD: GOLD 2001, GOLD ABCD 2011, GOLD ABCD 2017 and phenotypes. Results: The cohort consisted of 433 COPD patients of which 352 (81%) men and 81 (19%) women with mean age 62,7 ± 9,8 years. The multidimensional index E-BODE and phenotypic classification of COPD demonstrated excellent discriminatory power (E-BODE AUC 0.908 and phenotypic classification AUC 0.995), while all GOLD classifications underestimated the risk of COPD exacerbations (GOLD 2001 AUC - 0.623, GOLD ABCD AUC - 0.546 and GOLD ABCD 2017 AUC - 0.545) when they were used to assess the risk of COPD exacerbation. Conclusions: Our analyses showed best discriminatory performance for the E-BODE index and phenotypic classification of COPD in patients with COPD for the assessment of the risk of exacerbations, another approaches underestimated the risk of COPD exacerbations.
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