Integrating Telemonitoring in COPD Exacerbations Care: A Multinational Study Using the Alsayed System for Applied Medical-Care Improvement (ASAMI) Database

The Complex Relationship Between Ischemic Heart Disease and COPD Exacerbations

BackgroundRecurrent acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common, debilitating, costly and often difficult to prevent.MethodsWe reviewed records of patients who had COPD and immunoglobulin (Ig) treatment as adjunctive preventative treatment for AECOPD, and documented all AECOPD episodes for one year before and after initiation of Ig treatment. We graded AECOPD episodes as moderate for prescription of antibiotics and/or corticosteroids or for visit to the Emergency Department, and as severe for hospital admission. We conducted a retrospective within-subject self-controlled risk interval analysis to compare the outcome of annual AECOPD rate before and after treatment.ResultsWe identified 22 cases of certain COPD, of which three had early discontinuation of Ig treatment due to rash and local swelling to subcutaneous Ig, and five had incomplete records leaving 14 cases for analyses. The median baseline IgG level was 5.9 g/L (interquartile range 4.1–7.4). Eight had CT radiographic bronchiectasis. Overall, the incidence of AECOPD was consistently and significantly reduced in frequency from mean 4.7 (± 3.1) per patient-year before, to 0.6 (± 1.0) after the Ig treatment (p = 0.0001). There were twelve episodes of severe AECOPD (in seven cases) in the year prior, and one in the year after Ig treatment initiation (p = 0.016).ConclusionsIg treatment appears to decrease the frequency of moderate and severe recurrent AECOPD. A prospective, controlled evaluation of adjunctive Ig treatment to standard therapy of recurrent AECOPD is warranted.

Sputum bacteriology in patients with acute exacerbations of COPD in Hong Kong

Background:The association between gastro-oesophageal reflux disease (GORD) and chronic obstructive pulmonary disease (COPD) exacerbation has so far remained unclear.Objective:To prospectively establish the clinical significance of GORD symptoms on exacerbation.Methods:82 patients...

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) describe the phenomenon of sudden worsening in airway function and respiratory symptoms in patients with COPD. These exacerbations can range from self-limited diseases to episodes of florid respiratory failure requiring mechanical ventilation. The average patient with COPD experiences two such episodes annually, and they account for significant consumption of health care resources. Although bacterial infections are the most common causes of AECOPD, viral infections and environmental stresses are also implicated. AECOPD episodes can be triggered or complicated by other comorbidities, such as heart disease, other lung diseases (e.g., pulmonary emboli, aspiration, pneumothorax), or systemic processes. Pharmacologic management includes bronchodilators, corticosteroids, and antibiotics in most patients. Oxygen, physical therapy, mucolytics, and airway clearance devices may be useful in selected patients. In hypercapneic respiratory failure, noninvasive positive pressure ventilation may allow time for other therapies to work and thus avoid endotracheal intubation. If the patient requires invasive mechanical ventilation, the focus should be on avoiding ventilator-induced lung injury and minimizing intrinsic positive end-expiratory pressure. These may require limiting ventilation and "permissive hypercapnia." Although mild episodes of AECOPD are generally reversible, more severe forms of respiratory failure are associated with a substantial mortality and a prolonged period of disability in survivors.

This study aimed to describe the molecular epidemiology and seasonality of human rhinovirus (HRV) in chronic obstructive pulmonary disease (COPD) and its association with COPD exacerbations in Abu Dhabi, the United Arab Emirates (UAE). Sputum specimens were collected for analysis from all COPD patients who visited a medical center from November 2021 to October 2022. The real-time quantitative polymerase chain reaction (qPCR) test was used to detect HRV. Of the 78 COPD patients included in the study, 58 (74%) patients presented with one or more exacerbation episodes. The incidence of COPD exacerbation peaked over the winter and substantially decreased during the summer. HRV positivity in patients during exacerbation (E1) was 11/58 (19%) and 15/58 (26%) two weeks after the exacerbation episode (E2). There was no significant difference in the HRV load in these patients. No statistically significant difference was observed in the detection of HRV during exacerbation compared to patients with stable COPD. This is the first study to assess the association between HRV detection by qPCR and COPD exacerbations in the UAE. The high sensitivity of the detection technology helped collect reliable epidemiologic data. Few studies have provided similar Middle East data. This study’s pattern of COPD exacerbations and HRV detection parallels that of temperate countries. This information can help with future, more extensive surveillance of respiratory viruses in the UAE and the Middle East and their association with COPD exacerbations.

Introduction: Chronic obstructive pulmonary disease (COPD) exacerbations are associated with increased symptom burden and risk of future exacerbations. One standardized tool that is commonly used to assess the level of health impairment is the COPD Assessment Test (CAT). Objective measures of airway function, such as impulse oscillometry system (IOS) parameters, may offer additional insights into disease activity and outcomes. This study investigated whether IOS parameters, specifically peripheral airway resistance measures (R5-20) and reactance area (AX), were associated with changes in CAT scores and risk of future exacerbation. We hypothesized that IOS parameters would correlate with CAT scores across different time points during and after hospitalization. Methods: A prospective observational study was conducted on 16 patients hospitalized for COPD exacerbation at the Providence VA Medical Center. Each patient underwent IOS testing and completed the CAT at three time points: hospital admission, discharge, and follow up on 4 weeks. Pearson correlation analysis was used to examine the relationship between IOS parameters and CAT scores, with a focus on determining if IOS measurements could serve as predictors of symptom burden and changes over time. Results: The mean CAT scores decreased from admission (30.00) to discharge (27.45) and further reduced at follow-up (22.62), suggesting an improvement in symptom burden post-exacerbation. Similarly, IOS parameters showed improvement across these time points, with R5-20 decreasing from 2.46 (admission) to 1.63 (discharge) and 1.46 (follow-up), and AX reducing from 28.53 (admission) to 20.94 (discharge) and 13.50 (follow-up). There was a positive correlation between changes in R5-20 and AX with CAT score, with R5-20 demonstrating the strongest relationship with CAT scores (r = 0.48) – indicating that higher airway resistance correlated with higher symptom burden. Discussion: The findings support the utility of IOS parameters as objective predictors of symptom severity and recovery trajectories in COPD patients following exacerbations. This small study suggests that respiratory impedence parameters reflect patient-centered outcomes, and this relationship warrants further investigation in larger cohorts to establish IOS as a potential predictive tool in clinical management – potentially guiding treatment interventions and risk of impending COPD exacerbation.

Background: Community-acquired pneumonia is a differential diagnosis of acute exacerbation of chronic obstructive pulmonary disease (COPD); further both have similar pathogenic spectra. Both the American Thoracic Society and the European Respiratory Society follow similar empirical antibiotic choices for the two conditions. However, there are some differences in the bacterial spectra between the two conditions, particularly when the severity of the disease differs. In the present study, we want to study the differences in the clinical features, bacteriological spectra, and antibiotic susceptibilities in patients with community-acquired pneumonia versus patients with COPD exacerbation and provide a scientific basis for antibiotic selection. Aims: 1. To analyze the differences in the pathogenic spectra and antibiotic sensitivity profile between COPD exacerbation and community acquired pneumonia. 2. To study the differences in the clinical features and outcomes of the two conditions. Subjects and Methods: The study was a prospective observational study conducted from November 2019 to May 2020 in Bangalore Medical College and Research Institute on 30 patients diagnosed with acute exacerbation of COPD and 30 patients diagnosed with community acquired pneumonia. Detailed history, physical examination, and standard laboratory tests were taken on admission. The presence of new consolidation on chest radiograph was recorded. Sputum specimens collected by expectoration and tracheal suctioning or bronchoalveolar lavage were analyzed by Gram staining and microscopy and also by culture. The isolates were also tested for antibiotic sensitivity. The severity of Chronic obstructive pulmonary disease (COPD) exacerbation was assessed by the DECAF score and the severity of the CAP group was assessed by the Pneumonia Severity Index. The differences between the two groups were analyzed. The progression of the disease and the outcomes were observed. Results: Out of 30 (100%) participants in each group, both pneumonia and COPD participants had higher percentage of male participants; 24 (80%) and 26 (86.7%) participants, respectively. The COPD-exacerbation group was significantly older than the community-acquired pneumonia group (63.20 ± 11.82 vs. 43.73 ± 16.58). Klebsiella pneumoniae, Pseudomonas, Streptococcus pneumoniae, and Escherichia Coli were the most commonly isolated species in COPD subjects, whereas S. pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and other organisms were more commonly isolated from pneumonia participants. The drug-resistance rates of S. pneumoniae to penicillin, macrolide and quinolone antibiotics commonly used empirically to treat community acquired pneumonia was 52.6%, 79% and 79% respectively. The sensitivity of Pseudomonas to Carbapenems was 50% and to fluoroquinolones was 16.7% while all the strains were found to be resistant to Aminoglycosides, Penicillin, Cephalosporins, and Macrolides. Conclusions: In our study, we found that K. pneumoniae was the most common pathogen in patients with an exacerbation of COPD while S. pneumoniae was the most common pathogen in patients with community acquired pneumonia. In our study the organisms responsible for community acquired pneumonia were largely resistant to penicillins, macrolides, and tetracyclines, which are the antibiotics of choice for empirical treatment. Similarly, in patients with exacerbation of COPD, the organisms isolated had a far greater degree of resistance to the above-mentioned antibiotics than that seen in our patients with pneumonia. We conclude that antibiotic regimens should be culture driven rather than empirical to be effective while also countering drug resistance.

<b>Introduction:</b> Early detection of acute exacerbations in COPD (AECOPD) may allow early intervention, however practical markers are limited. The forced oscillation technique (FOT) is known to be a sensitive predictor of recovery from AECOPD in hospital. As a home monitoring tool, the feasibility of FOT has been established, but not its utility in detection of AECOPD. <b>Aim:</b> To study changes in resistance (Rrs) and reactance (Xrs) versus symptoms obtained from home telemonitoring prior to AECOPDs. <b>Methods:</b> Severe to very severe COPD patients were monitored over a period of 8-9 months. They performed unsupervised FOT measurements once daily using the Resmon Pro Diary (Restech srl, Milan, Italy). Daily symptoms were assessed by an electronic diary based on the COPD Assessment Test (CAT). AECOPD was assessed by weekly phone interviews, and defined as initiation of oral/systemic steroid or antibiotic treatment, a visit to the emergency department or hospitalisation. Daily Rrs, Xrs and their coefficient of variation (CV, over a 7-day running window) and CAT scores within a week prior to an AECOPD were compared using one-way repeated measures ANOVA. <b>Results:</b> Data from 10 patients are presented (7:3 male:female, mean±SD age 69.7±10.8 years, %predFEV1 38.4±5.2). 27 AECOPDs were identified; 3 excluded due to missing FOT/CAT data. Out of the FOT indices examined, only CV Xrs changed significantly with time (p=0.0018), from 20.9±12.2% at 7 days to 26.6±3.9% at 1 day prior to AECOPD. Daily CAT increased from 21.8±6.2 to 23.7±7.5, but not significantly (p=0.08). <b>Conclusions:</b> FOT is more sensitive than symptoms in detecting changes prior to an AECOPD, and may be useful as an early marker.

BackgroundChronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases worldwide. Episodes of acute exacerbations of COPD (AECOPD) are associated with disease severity and progression. Although substantial progress has been made in understanding the dynamics of AECOPD, little is known about the sputum microbiome of AECOPD in the Chinese population.MethodsIn this study, we characterized the sputum microbiomes from sputum specimens collected from healthy controls (n = 10), stable (n = 4), AECOPD (n = 36), and recovery (n = 18) stages by sequencing the V3-V4 region of the 16S rRNA gene with a HiSeq sequencer.ResultsStreptococcus was the most dominant genus among all the different types of sputum. A random forest model was developed to identify bacterial taxa that differentiate AECOPD samples from others. Most of the top predictors, except Pseudomonas, were less abundant in AECOPD samples. We also developed random forest models to differentiate subtypes of AECOPD based on blood eosinophil counts, the frequency of AECOPD, and sputum eosinophils. Bacterial taxa associated with Pasteurellaceae, Fusobacterium, Solobacterium, Haemophilus, Atopobium, Corynebacterium and Streptococcus, were enriched in the sputum microbiomes of eosinophilic AECOPD. Random forest models also demonstrate that a total of 2 bacterial OTUs were needed to differentiate frequent from non-frequent AECOPDs, and 23 OTUs were enough to accurately predict sputum-eosinophilic (sputum eosinophilic concentration ≥ 3%) AECOPD.ConclusionThis study expanded our understanding of the sputum microbiome associated with different subtypes and clinical status of patients with AECOPD in a Chinese cohort, which provides insights into novel and more targeted management of the different subtypes of AECOPD.

Background: Chronic obstructive pulmonary disease (COPD) is a disease state characterized by airflow limitation that is not fully reversible. COPD is the umbrella term used to include three different respiratory conditions defined clinically as chronic bronchitis and pathologically as Emphysema and it also includes small airway disease. COPD patients mostly present with the features of acute respiratory infectionsbut there may be a number of metabolic derangements arising out of the disease process or as a consequence of the therapy instituted like hyponatremia, hypokalemia, elevated liver enzymes and blood urea. These abnormalities are very often missed and may contribute to morbidity and mortality, if overlooked. Objectives: To study the levels of hypoxemia and serum electrolytes like sodium and potassium in cases of acute exacerbation of COPD and to assess the significance of dyselectrolytemia, as a prognostic marker in these patients. Materials and methods: The study was undertaken from November 2014 to October 2016 among the patients attending, Victoria hospital and Bowring and Lady Curzon hospital attached to Bangalore Medical College and Research Institute, with acute exacerbation of COPD diagnosed clinically and by the pulmonary function tests. 50 patients with acute exacerbation of COPD and 50 disease free healthy controls were included in the study. The Statistical software SAS 9.2, SPSS 15.0, were used for the analysis of the data and Microsoft word and excel have been used to generate graphs, tables etc. Conclusion: Electrolyte abnormalities are most commonly seen in patients with COPD with acute exacerbation and carry very poor prognosis in this group of patients. Thus, overlooking of coexistant metabolic abnormalities may contribute to a great deal of mortality and morbidity in COPD patients during their acute exacerbation episodes. Keywords: pulmonary disease; COPD; dyselectrolytemia; acute exacerbation

Introduction Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, which may be further aggravated by episodes of acute exacerbationof COPD (AECOPD). Electrolyte imbalances during these episodes may add to the duration of hospitalization and disease outcome. Aims and objectives This study aims to compare the serum electrolyte levels of patients with AECOPD and stable COPD and correlate them with the severity of exacerbation and disease outcome. Materials and methods The study was conducted as a case-control study between January 2021 and December 2022. Patients with AECOPD and stable COPD were included as "cases" and "controls," respectively. The various serum electrolyte levels were defined as per recent guidelines. Statistical analysis was performed using SPSS 20.0 (IBM Corp., Armonk, NY). Results A total of 75 patients wereincludedwith 41 in the study group and 34 in the control group. The majority of people were between the ages of 61 and 70. The most frequent electrolyte abnormality found was hyponatremia.The mean serum sodium and calcium levels were lower in patients with AECOPD while the mean serum potassium levels were higher. A total of five deaths were recorded in patients with two or more electrolyte imbalances. The latter also had a requirement for home oxygen or non-invasive ventilation at the time of discharge. Conclusion Patients of AECOPD with multiple electrolyte imbalances need scrutinized treatment as they are more prone to develop complications, have poorer outcomes, and prolonged hospital stays.

Rationale: Substantial evidence from rigorously controlled clinical trials demonstrates the benefit of combination long-acting inhaled therapies to reduce future exacerbations and improve symptoms among patients with a recent COPD exacerbation. However, the effect of adherence to these therapies on patient outcomes in clinical practice is poorly understood. We hypothesized that increased adherence would be associated with lower occurrence of COPD exacerbation and death. Methods: We conducted a national cohort study of patients discharged after hospitalization for a COPD exacerbation at Veterans Affairs (VA) medical centers from 2010-2019. We restricted the cohort to patients receiving current guideline-recommended therapy with dual long-acting bronchodilators (long-acting beta agonists (LABA) and long-acting muscarinic antagonists (LAMA)) or triple therapy (LABA/LAMA and inhaled corticosteroid (ICS)). We assessed adherence to LAMA/LABA or LAMA/LABA/ICS therapy 3 months after discharge and excluded patients who died or experienced a repeat exacerbation during this time. We measured adherence using the ReComp score, a standardized metric representing the proportion of days a medication is available based on pharmacy fills. Our primary exposure was a dichotomous measure with adherence defined as ReComp ≥0.8 across all inhaled therapies. In secondary analyses, we examined ReComp as a categorical and continuous measure averaged across therapies. The primary composite outcome was any COPD exacerbation or death 3-6 months after hospital discharge. We used mixed effects logistic regression to test the association of the outcome with medication adherence using VA facility as a random effect and adjusting for demographics, smoking status, comorbidities, health care utilization, and indicators of disease severity. Results: Of 20,259 patients included in the cohort, 20% (n=4,022) experienced the primary composite outcome. Patients tended to be older, White males (average age 69 years, 78.7% White, and 96.3% male). Approximately 31% (n=6,318) met adherence criteria for all prescribed therapies. Overall, adherence to inhaled therapies was not associated with the composite outcome of COPD exacerbation or death (Table 1). Adherence also wasn't associated with the individual components of the composite outcome, except for a decrease in mortality associated with increasing adherence using continuous ReComp scores. Conclusion: Overall, adherence was poor. We did not observe a difference in COPD exacerbation or death among patients who were adherent to inhaled therapies. These findings suggest that adherence to inhaled therapies, as measured using claims data, is insufficient to improve COPD outcomes and other factors such as actual inhaler usage or inhaler technique may contribute to similar outcomes regardless of measured adherence.

IntroductionCOPD exacerbation negatively impacts the patient’s quality of life and lung function, increases mortality, and increases socioeconomic costs. In a real-world setting, the majority of patients with COPD have mild-to-moderate airflow limitation. Therefore, it is important to evaluate COPD exacerbation in patients with mild-to-moderate airflow limitation, although most studies have focused on the patients with moderate or severe COPD. The objective of this study was to evaluate factors associated with COPD exacerbation in patients with mild-to-moderate airflow limitation.MethodsPatients registered in the Korean COPD Subtype Study cohort were recruited from 37 tertiary referral hospitals in Korea. We obtained their clinical data including demographic characteristics, past medical history, and comorbidities from medical records. Patients were required to visit the hospital to document their COPD status using self-administered questionnaires every 6 months.ResultsA total of 570 patients with mild-to-moderate airflow limitation were enrolled. During the first year of follow-up, 30.5% patients experienced acute exacerbation, with exacerbations being more common in patients with poor lung function. Assessed factors associated with COPD exacerbation included COPD assessment test scores, modified Medical Research Council dyspnea assessment test scores, St George’s Respiratory Questionnaire for COPD scores, a previous history of exacerbation, and histories of pneumonia and allergic rhinitis. Logistic regression tests revealed St George’s Respiratory Questionnaire for COPD scores (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.00–1.04; P=0.034), a previous history of exacerbation (OR, 3.12; 95% CI, 1.35–7.23; P=0.008), and a history of pneumonia (OR, 1.85; 95% CI, 1.06–3.25; P=0.032) as risk factors for COPD exacerbation.ConclusionOur results suggest that COPD exacerbation in patients with mild-to-moderate airflow limitation is associated with the patient’s quality of life, previous history of exacerbation, and history of pneumonia.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease characterized by airflow limitation that is not fully reversible. It is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases, along with significant extrapulmonary effects that contribute to disease severity. The COPD Assessment Test (CAT) is a validated, self-completed questionnaire consisting of 8 items scored on a 6-point scale (0-5). It is designed to evaluate the perceived severity of COPD symptoms (e.g., shortness of breath, cough, and phlegm) and should be administered to all COPD patients irrespective of disease severity. Objectives: To assess and compare CAT scores, Pulmonary Function Tests (PFTs) in patients with acute exacerbation of COPD (AECOPD) and stable COPD. Materials and Methods: A hospital-based descriptive observational study was conducted over 18 months at Navodaya Medical College, Raichur, Karnataka. The study included 50 diagnosed cases of COPD (25 stable, 25 AECOPD). Detailed patient histories, clinical examinations, and laboratory investigations were conducted. CAT scores were evaluated in the patients' vernacular languages. Results: The mean CAT score was significantly higher in the AECOPD group compared to the stable COPD group (33.76 &plusmn; 0.72 vs. 20.92 &plusmn; 2.61; p < 0.01). Furthermore, AECOPD patients demonstrated significantly reduced FVC and FEV1 parameters compared to stable patients. Conclusion: The CAT score is a concise and valid tool for monitoring COPD health status. The strong clinical correlations observed in this study reinforce the discriminative validity of the CAT and its importance in evaluating the true impact of COPD on patients? daily lives. Its implementation is highly recommended in both hospital and primary care settings.