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Voorham, Jaco, Massimo Corradi, Alberto Papi, Claus F. Vogelmeier, Dave Singh, Leonardo M. Fabbri, Marjan Kerkhof, Janwillem H. Kocks, Victoria Carter, and David Price. "Comparative effectiveness of triple therapy versus dual bronchodilation in COPD." ERJ Open Research 5, no. 3 (July 2019): 00106–2019. http://dx.doi.org/10.1183/23120541.00106-2019.
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This real-world study compared the effectiveness of triple therapy (TT; long-acting muscarinic antagonists (LAMAs)/long-acting inhaled β-agonists (LABAs)/inhaled corticosteroids (ICSs)) versus dual bronchodilation (DB; LAMAs/LABAs) among patients with frequently exacerbating COPD. A matched historical cohort study was conducted using United Kingdom primary care data. Patients with COPD aged ≥40 years with a history of smoking were included if they initiated TT or DB from no maintenance/LAMA therapy and had two or more exacerbations in the preceding year. The primary outcome was time to first COPD exacerbation. Secondary outcomes included time to treatment failure, first acute respiratory event, and first acute oral corticosteroid (OCS) course. Potential treatment effect modifiers were investigated. In 1647 matched patients, initiation of TT reduced exacerbation risk (adjusted hazard ratio (HR) 0.87, 95% CI 0.76–0.99), risk of acute respiratory event (HR 0.74, 95% CI 0.66–0.84) and treatment failure (HR 0.83, 95% CI 0.73–0.95) compared with DB. Risk reduction for acute respiratory events was greater for patients with higher rates of previous exacerbations. At baseline blood eosinophil counts (BECs) ≥ 0.35×109 cells·L−1, TT was associated with lower risk of OCS prescriptions than DB. This study provides real-life evidence of TT being more effective in reducing exacerbation risk than DB, which became more accentuated with increasing BEC and previous exacerbation rate.
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Lu, Fengfeng, Nengluan Xu, and Jianshi Zheng. "Association of β2-Agonist Receptor Gene Polymorphisms with Acute Exacerbations of COPD: A Prospective Observational Study." Emergency Medicine International 2022 (September 12, 2022): 1–5. http://dx.doi.org/10.1155/2022/2711489.
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Objective. To investigate the relationship between β2-agonist receptor gene polymorphisms and acute exacerbations of chronic obstructive pulmonary disease (COPD). Methods. Retrospective analysis of 99 patients in the respiratory and critical care unit of Fujian Provincial Hospital from 2018 to 2020. The clinical characteristics of different genotypes were compared, and the treatments of different genotypes and the analysis of factors associated with acute exacerbations of COPD were compared. Results. During the 12-month follow-up period, 53 patients developed acute exacerbations, with the 16Arg/Arg homozygous requiring significantly more antibiotics and hormones than the other two genotypes; when agonist receptor 16 gene polymorphism was associated with the risk of acute exacerbation, 16Arg/Gly patients had a 5.286-fold increased risk of acute exacerbation (OR = 6.286, 95% CI. 1.476–26.759, P = 0.013 ). 16Arg/Arg patients had a 5.060-fold increased risk of acute exacerbation (OR = 6.060, 95% confidence interval: 1.407–26.161, P = 0.016 ). Conclusion. Acute exacerbation of 16Arg/Arg COPD is very serious; 16Arg/Gly increases the risk of acute exacerbation in COPD patients; and provides help for future treatment and management options of the disease.
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Ruzanov, D. Yu, E. V. Voropaev, V. A. Vorobey, S. V. Mironova, O. V. Osipkina, L. N. Semenova, I. V. Buynevich, A. A. Zyatkov, N. N. Rubanik, and N. A. Bonda. "Etiological verification of infectious exacerbation of chronic obstructive lung disease using molecular genetics methods." Health and Ecology Issues, no. 2 (June 28, 2019): 94–102. http://dx.doi.org/10.51523/2708-6011.2019-16-2-18.
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Objective: To study the possibilities of the method of determining the 16S rRNA gene of bacteria in the determination of the bacterial spectrum of acute exacerbation of chronic obstructive pulmonary disease (COPD) using a protected material sampling Materials and Methods: 68 Hospitalized patients with acute exacerbation of COPD were prospectively evaluated. Molecular genetic determination of the 16S rRNA gene of bacteria and cultural microbiological techniques from sputum and a bronchial tree material obtained using a protected brush biopsy were used. Results: Bacterial agents were detected in 91,2 % of cases of acute exacerbation of COPD. Pseudomonas aeruginosa was detected in the biopsy material 1.8 times more often than with the use of routine methods. Patterns of COPD with frequent exacerbations, infectious exacerbations and Pseudomonas etiology of exacerbations were determined. Conclusion: Using the method of molecular-genetic determination of the 16S rRNA gene allows to verify the bacterial spectrum of acute exacerbation of COPD.
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Xiao, Wei, Long-yi Du, Bing Mao, Ti-wei Miao, and Juan-juan Fu. "Endotype-driven prediction of acute exacerbations in chronic obstructive pulmonary disease (EndAECOPD): protocol for a prospective cohort study." BMJ Open 9, no. 11 (November 2019): e034592. http://dx.doi.org/10.1136/bmjopen-2019-034592.
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IntroductionCurrent strategies for the prevention of acute exacerbations in chronic obstructive pulmonary disease (COPD) are primarily based on clinical measurements but fail to target the pathophysiological mechanisms, namely endotypes, of the disease. Studies identifying endotypes underlying exacerbation susceptibility and discovering specific biomarkers may lead to the development of targeted therapeutics but are lacking. This study aims to assess a broad spectrum of biomarkers at multiple biological levels (genetics, airway inflammation and respiratory microbiome) for their ability in predicting acute exacerbations of COPD, thus enables high-resolution disease endotyping and may lead to precision treatment of the disease.Methods and analysisIn this prospective cohort study, participants with stable COPD (n=600) will be recruited and assessed for demographics, symptom scores, spirometry, medication use and comorbidities at baseline. Blood will be obtained for genotyping variants in a panel of nine genes. Induced sputum will be collected for the profile of microbiota using 16S rRNA gene sequencing, quantification of bacterial load, inflammatory mediators assay and sputum cytometry. Participants will be followed up for their exacerbations till 12 months and reassessed for the clinical measurements as baseline. The primary outcomes are total number of exacerbations, severe exacerbations, moderate exacerbations and time to first exacerbation. The secondary outcomes are changes in lung function and symptom scores. The effect of biomarkers representing genetic variants, airway inflammation and respiratory microbiome on predicting the frequent exacerbator phenotype and exacerbation frequency will be analysed with multivariable modelling, and time to first exacerbation with a Cox regression model.Ethics and disseminationThe study has been approved by the Clinical Trial and Biomedical Ethics Committee of West China Hospital of Sichuan University (No. 2018–298). The results of the study will be published on peer-reviewed journals.Trial registration numberChiCTR1800019063.
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Müllerová, Hana, Jonathan Marshall, Enrico de Nigris, Precil Varghese, Nick Pooley, Nina Embleton, Clementine Nordon, and Zoe Marjenberg. "Association of COPD exacerbations and acute cardiovascular events: a systematic review and meta-analysis." Therapeutic Advances in Respiratory Disease 16 (January 2022): 175346662211136. http://dx.doi.org/10.1177/17534666221113647.
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Background: The majority of patients with chronic obstructive pulmonary disease (COPD) suffer from comorbid cardiovascular (CV) disease. Accumulating evidence suggests a temporal association between COPD exacerbations and acute CV events, possibly due to lung hyperinflation, increased hypoxemia and systemic inflammation. The aims of the study were to estimate the risk of (1) acute CV events [acute myocardial infarction (AMI), CV-related death] or stroke in the months following a COPD exacerbation and (2) COPD exacerbation in the months following an acute CV event. Methods: A systematic literature review of observational studies published since 2000 was conducted by searching literature databases (Medline and Embase). Studies were eligible if conducted in adults with COPD, exposed to either COPD exacerbation or acute CV events, with outcomes of acute CV events or COPD exacerbation reported. Studies were appraised for relevance, bias and quality. Meta-analyses, using random-effect models, were performed for each outcome of interest, thus providing a pooled relative risk (RR) and its 95% confidence interval. Results: Eight studies were identified, of which seven were used for the meta-analyses examining the risk of CV events 1–3 months after an exacerbation compared with none. For stroke (six studies), RR was 1.68 (95% CI = 1.19–2.38). For AMI (six studies), RR was 2.43 (95% CI = 1.40–4.20). No studies exploring risk of exacerbation following an acute CV event were identified. Conclusion: This meta-analysis identified a markedly increased risk of stroke or AMI within a relatively short period of time following a COPD exacerbation. Although the underlying mechanisms are not fully elucidated, patients with COPD should be monitored for risk of CV outcomes after exacerbations. In addition, preventing exacerbations may decrease the risk of subsequent acute CV events. Registration: The study protocol was published via PROSPERO: International Prospective Register of Systematic Reviews (#CRD42020211055).
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Matsuse, Hiroto, Tomoko Tsuchida, Susumu Fukahori, Tetsuya Kawano, Shinya Tomari, Nobuko Matsuo, Tomoya Nishino, Chizu Fukushima, and Shigeru Kohno. "Retrospective Cohort Study of Leukotriene Receptor Antagonist Therapy for Preventing Upper Respiratory Infection-Induced Acute Asthma Exacerbations." Allergy & Rhinology 4, no. 3 (January 2013): ar.2013.4.0062. http://dx.doi.org/10.2500/ar.2013.4.0062.
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Upper respiratory tract infections (URIs) represent the most frequent cause of acute asthma exacerbations. It has yet to be determined whether leukotriene receptor antagonist (LTRA) treatment prevents URI-induced acute asthma exacerbations in adults. The objective of the present study was to evaluate the preventive effects of LTRA treatment on URI-induced acute asthma exacerbations. The incidences of URI alone, acute asthma exacerbation without URI, and URI-induced acute asthma exacerbation were determined retrospectively by analyzing diary and medical records of 321 adult asthmatic patients (mean age, 56.3 ± 17.2 years; male/female ratio, 117:204) over 1 year. Results were compared between patients who had been taking an LTRA (n = 137) and those who had never taken any LTRA (n = 184) during the study periods. Significantly fewer URIs alone and acute asthma exacerbations without URI occurred in patients with than in those without prophylactic daily use of LTRA. LTRA treatment significantly reduced the durations of URIs alone and of total acute asthma exacerbations, as well as the incidence of mild exacerbations of asthma. In contrast, in patients with URI-induced acute asthma exacerbations, LTRA treatment failed to significantly reduce the interval between URI onset and acute asthma exacerbation, as well as the duration and severity of both URIs and acute asthma exacerbations. Use of an LTRA for adult asthmatic patients appears to reduce the incidences of URIs alone and acute asthma exacerbations without URI, but it failed to prevent URI-induced acute asthma exacerbations once a URI occurred.
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Rong, Yiran, John P. Bentley, Gerald McGwin, Yi Yang, Benjamin F. Banahan, Sara L. Noble, Terri Kirby, and Sujith Ramachandran. "Association Between Transient Opioid Use and Short-Term Respiratory Exacerbation Among Adults With Chronic Obstructive Pulmonary Disease: A Case-Crossover Study." American Journal of Epidemiology 188, no. 11 (August 30, 2019): 1970–76. http://dx.doi.org/10.1093/aje/kwz169.
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Abstract The association of historical opioid use with health care use and death among patients with chronic obstructive pulmonary disease (COPD) has been tested. Using Mississippi Medicaid data, we examined the association of transient or short-term opioid use and acute respiratory exacerbations among adults with COPD. We used a case-crossover design and 2013–2017 Mississippi Medicaid administrative claims data. A total of 1,972 qualifying exacerbation events occurred in 1,354 beneficiaries. The frequency and dose of opioid exposure in the 7 days before the exacerbation were examined and compared with the opioid exposure in 10 control windows, each 7 days long, before the exacerbation. Adjusted odds ratios were estimated using conditional logistic regression models to estimate the risk of opioid use on exacerbations after accounting for use of bronchodilators, corticosteroids, benzodiazepines, and β-blockers. Overall, opioid exposure in the 7 days before an exacerbation was significantly associated with acute respiratory exacerbation (odds ratio = 1.81; 95% confidence interval: 1.60, 2.05). Each 25-mg increase in morphine equivalent daily dose was associated with an 11.2% increase in the odds of an acute respiratory exacerbation (odds ratio = 1.11; 95% confidence interval: 1.04, 1.20). Transient use of opioids was significantly associated with acute respiratory exacerbation of COPD.
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Li, A. K., M. Barton, J. A. Delport, and D. Ashok. "Edwardsiella tardaInfection Triggering Acute Relapse in Pediatric Crohn’s Disease." Case Reports in Infectious Diseases 2019 (March 20, 2019): 1–3. http://dx.doi.org/10.1155/2019/2094372.
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Crohn’s disease exacerbations can often be associated with bacterial infections causing gastroenteritis. We report a child who experienced exacerbation of his Crohn’s disease associated with a positive stool culture forEdwardsiella tarda (E. tarda). Endoscopy showed features of moderate inflammation similar to exacerbation of Crohn’s disease. The patient was treated simultaneously with intravenous steroids and antibiotics, and his symptoms resolved. This case report highlights the importance of clinicians being able to promptly recognize and treat concurrent bacterial infections in Crohn’s disease exacerbations.
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Collard, Harold R., Luca Richeldi, Dong Soon Kim, Hiroyuki Taniguchi, Inga Tschoepe, Maurizio Luisetti, Jesse Roman, et al. "Acute exacerbations in the INPULSIS trials of nintedanib in idiopathic pulmonary fibrosis." European Respiratory Journal 49, no. 5 (May 2017): 1601339. http://dx.doi.org/10.1183/13993003.01339-2016.
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Time to first investigator-reported acute exacerbation was a key secondary end-point in the INPULSIS trials of nintedanib in patients with idiopathic pulmonary fibrosis (IPF).We used the INPULSIS trial data to investigate risk factors for acute exacerbation of IPF and to explore the impact of nintedanib on risk and outcome of investigator-reported and adjudicated confirmed/suspected acute exacerbations. Mortality following these events and events adjudicated as not acute exacerbations was analysed using the log rank test.Risk of acute exacerbations was most strongly associated with the following variables: baseline forced vital capacity (higher risk with lower value), baseline supplemental oxygen (higher risk with use), baseline antacid medication (higher risk with use), treatment (higher risk with placebo), and for confirmed/suspected acute exacerbations, cigarette smoking. Mortality was similar following investigator-reported and adjudicated confirmed/suspected acute exacerbations. Nintedanib had no significant effect on risk of mortality post-exacerbation.Investigator-reported acute exacerbations of IPF are associated with similar risk factors and outcomes as adjudicated confirmed/suspected acute exacerbations.
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Park, Sang Hyun, Chang Min Kang, Dae Seong Kim, Han Ho Kim, and Young Yoo. "Cytokine Imbalance in a 15-year-old Boy with Pandemic Influenza an Infection Requiring Extracorporeal Membrane Oxygenation." Hong Kong Journal of Paediatrics Research 4, no. 3 (December 30, 2021): 38–41. http://dx.doi.org/10.37515/pediatric.5887.4302.
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Acute severe asthma is an acute episode of intractable asthma that is poorly responsive to standard management. Acute respiratory failure or acute respiratory distress syndrome (ARDS) requiring ventilator support may be life-threatening. Although respiratory viral infections are responsible for most asthma exacerbations, the seasonal influenza virus has not been considered a risk factor. However, the 2009 H1N1 influenza A pandemic strain (pH1N1), which has resulted in numerous hospitalizations and mortalities worldwide, has been reported to be closely related to asthma exacerbation. Thus, with over 300 million people suffering from asthma worldwide, further studies are needed to protect this vulnerable population that is highly susceptible to pH1N1 infection. Dysregulation of Th1/Th2 cytokines may be involved in asthma exacerbation. We report the case of a paediatric patient with acute respiratory failure due to asthma exacerbation triggered by pH1N1 infection. The patient exhibited Th2 polarization in the acute phase of exacerbation and recovered from ARDS through timely ventilator support and subsequent extracorporeal membrane oxygenation. Further investigation regarding the mechanism of immune response in asthma exacerbations associated with pH1N1 infection may elucidate the optimal treatment for asthma.
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Goss, Christopher H. "Acute Pulmonary Exacerbations in Cystic Fibrosis." Seminars in Respiratory and Critical Care Medicine 40, no. 06 (October 28, 2019): 792–803. http://dx.doi.org/10.1055/s-0039-1697975.
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AbstractWith the improving survival of cystic fibrosis (CF) patients and the advent of highly effective cystic fibrosis transmembrane conductance regulator therapy, the clinical spectrum of this complex multisystem disease continues to evolve. One of the most important clinical events for patients with CF in the course of this disease is an acute pulmonary exacerbation. Clinical and microbial epidemiology studies of CF pulmonary exacerbations continue to provide important insight into the disease course, prognosis, and complications. This work has now led to a number of large scale clinical trials with the goal of improving the treatment paradigm for CF pulmonary exacerbation. The primary goal of this review is to provide a summary of the pathophysiology, the clinical epidemiology, microbial epidemiology, outcome and the treatment of CF pulmonary exacerbation.
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Reechaipichitkul, Wipa. "Precipitating causes and outcomes of chronic obstructive pulmonary disease exacerbation at a tertiary care center in northeast Thailand." Asian Biomedicine 8, no. 2 (April 1, 2014): 229–36. http://dx.doi.org/10.5372/1905-7415.0802.283.
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Abstract Background: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a leading cause of hospitalization and economic burden. Frequent exacerbations impair quality of life and effect decline of lung function. Objective: We evaluated characteristics of COPD patients with frequent exacerbations. The precipitating causes, outcomes, hospital stay, and cost of admission were also determined. Methods: The study population included COPD patients admitted because of acute COPD exacerbation at Srinagarind Hospital between 1 January 2006 and 31 December 2010. Results: Over the 5-year period, 183 patients were admitted. Their mean age was 74.9 (SD 9.28) years and the male to female ratio was 170:13. Most patients (144; 79%) had one exacerbation per year and 39 (21%) had more than one per year. The group with more exacerbations, had a higher stage of the disease than those with only one exacerbation (p = 0.023), but there was no significant difference in the mortality rate (18% vs 14%, p = 0.53). A total of 245 episodes of acute exacerbation of COPD occurred in 183 patients. The mean duration of symptoms was 4.1 (SD 3.46) days. Forty-seven percent presented with Anthonisen type III, 42.4% with Anthonisen type II, and 10.6% with Anthonisen type I exacerbations. For 44 exacerbations (18%), the precipitating causes were not determined. The most common precipitating cause was pneumonia, which occurred in 90 episodes (36.7%). The second common was bronchitis (27.8%); followed by heart failure (8.2%), infected bronchiectasis (5.3%), diarrhea (1.2%), acute urinary retention (0.8%), unstable angina (0.4%), pneumothorax (0.4%), urinary tract infection (0.4%), atrial fibrillation (0.4%) and drug induced cough (0.4%). The organisms responsible for respiratory tract infection were identified in 31% cases of pneumonia and 18% of bronchitis cases. The top three common pathogens for pneumonia were Pseudomonas aeruginosa (9%), Acinetobacter baumannii (8%), and Klebsiella pneumoniae (8%). The top three common pathogens for bronchitis were P aeruginosa (7%), Haemophilus influenza (6%), and K pneumoniae (4%). About one quarter (25.3%) of acute exacerbations were complicated by respiratory failure. The mean duration of admission was 17.3 days (range 1-682 days). The mean cost of admission per exacerbation was 80,010 Thai baht (US $2,666) (range, 2,779-3,433,108 baht). The total cost for 245 exacerbations was 19.6 million baht ($653,000). Conclusion: Respiratory tract infections were common causes of COPD exacerbation and one quarter of which developed respiratory failure. Preventive measures such as vaccination, smoking cessation, lung rehabilitation, and appropriate drug use are helpful.
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Yudina, L. V. "ANTIBIOTIC THERAPY IN ACUTE EXACERBATION OF COPD:AN OPTIMAL WAY TO SUCCESS." Ukrainian Pulmonology Journal 29, no. 2 (2021): 35–40. http://dx.doi.org/10.31215/2306-4927-2021-29-2-35-40.
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Currently, chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally. Acute exacerbation of the disease is associated with fast clinical deterioration, increased respiratory tract inflammation and lung function disorders. Acute exacerbation of COPD dramatically worsens patient�s prognosis and serves as an important indicator of therapy effectiveness. Family practitioner should recognize this condition and correctly chose proper antibiotic. Diagnosis of COPD exacerbation is based on clinical manifestations of the disease. Depending on presence of primary or secondary symptoms COPD exacerbations are divided into several types. Antibiotic therapy appears to be more beneficial in patients with type 2 or 3 exacerbation. Sputum purulence is considered an obligatory symptom. As a rule, in complicated course of acute exacerbation of COPD protected aminopenicillins or 3rd generation cephalosporins are the firsline antibiotics. In most cases of COPD exacerbation antibiotics are prescribed orally. If first-line antibacterial therapy fails, the respiratory fluoroquinolones (levofloxacin of moxifloxacin) are prescribed. The author, using her own experience with levofloxacin, gives an example of proper choice of antibiotic if such a situation. Successful experience of management of acute exacerbation of COPD may be useful for general practitioners, physicians, pulmonologists. Key words: chronic obstructive pulmonary disease, exacerbation, antibiotic therapy, levofloxacin.
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Luo, Ruqiao, You Xia, Shengtao Li, and Yinju Ding. "Significance of Cardiometabolic Index in Predicting Acute Exacerbation of Stable Chronic Obstructive Pulmonary Disease for Clinical Nursing." Evidence-Based Complementary and Alternative Medicine 2022 (November 7, 2022): 1–5. http://dx.doi.org/10.1155/2022/7539520.
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Objective. To evaluate the level of cardiometabolic index (CMI) to predict the risk of acute exacerbation in patients with stable chronic obstructive pulmonary disease (COPD), and to provide a basis for early identification and intervention of high-risk patients in clinical nursing work. Methods. Patients with stable chronic obstructive pulmonary disease who were admitted to the outpatient department of respiratory medicine in a tertiary hospital or followed up after discharge from January to December 2021 were retrospectively selected. CMI was measured and statistical analysis was performed to determine the optimal threshold for predicting acute exacerbation of chronic obstructive pulmonary disease. Results. A total of 63 patients with chronic obstructive pulmonary disease were enrolled. The median number of episodes in the previous year was 1.00; 44 patients had ≥1 acute exacerbation. The CMI was positively correlated with the frequency of acute exacerbations and the British Medical Research Council (mMRC) score in the previous year, and negatively correlated with the percentage of forced expiratory volume in 1 second to the predicted value (FEV1% PRED). The cut-off point of CMI for predicting acute exacerbations in stable chronic obstructive pulmonary disease patients was 2.05, with a sensitivity of 0.864% and specificity of 0.842%. It is a risk factor for acute exacerbation in COPD patients. Conclusion. CMI can be used as a biological index to predict acute exacerbation in stable COPD patients. Clinical nursing needs to evaluate patients' CMI and provide personalized nursing intervention for patients with CMI≥2.05.
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Trottier, Evelyne D., Kevin Chan, Dominic Allain, and Laurel Chauvin-Kimoff. "Managing an acute asthma exacerbation in children." Paediatrics & Child Health 26, no. 7 (November 1, 2021): 438. http://dx.doi.org/10.1093/pch/pxab058.
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Abstract Children and youth with acute asthma exacerbations frequently present to an emergency department with signs of respiratory distress. The most severe episodes are potentially life-threatening. Effective treatment depends on the accurate and rapid assessment of disease severity at presentation. This statement addresses the assessment, management, and disposition of paediatric patients with a known diagnosis of asthma who present with an acute asthma exacerbation. Guidance includes the assessment of asthma severity, treatment considerations, proper discharge planning, follow-up, and prescription for inhaled corticosteroids to prevent exacerbation and decrease chronic morbidity.
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Alam, Muhammad Absar, Muhammad Sarfraz, Arsalan Hafeez, Zafar Ali Zafar, Touseef Anwar, and Muhammad Rizwan. "Frequency of acute exacerbation of chronic obstructive pulmonary disease in patients taking low dose azithromycin prophylaxis." Professional Medical Journal 27, no. 11 (November 10, 2020): 2438–44. http://dx.doi.org/10.29309/tpmj/2020.27.11.4059.
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Objectives: To assess the frequency of acute exacerbation of chronic obstructive pulmonary disease in patients taking low dose azithromycin prophylaxis. Study Design: Cross Sectional study. Setting: Department of Medicine, Independent University Hospital, Faisalabad. Period: 01-07-2017 to 30-06-2018. Material & Methods: 100 patients having diagnosis of COPD according to the operational definition were selected from medical opd of hospital after consent of patients. All patients were given tablet azithromycin 250mg thrice weekly for 12 months, then these patients were followed up for episodes of exacerbations in one year. All patients were properly instructed to report in any change in their symptoms. Any episode of acute exacerbation was noted. There was no conflict of interest. Results: Frequency of acute exacerbation of chronic obstructive pulmonary disease was seen in 70 out of 100(70%) patients taking low dose azithromycin prophylaxis. In female patients frequency of acute exacerbation was high as compared to male patients. i.e. 62.9% vs. 37.1%. Frequency of acute exacerbation was higher in patients whose duration of disease was longer. i.e. 7-10 years followed by patients whose duration of disease was 4-6 years (28.6%) and 1-3 years (25.7%). Presence of acute exacerbation was significantly associated with decline in lung functions. Highest frequency of acute exacerbation was seen in patients who had 3-4 episodes. Conclusion: Results of this study showed a high frequency of acute exacerbation of COPD even with the prophylaxis of low dose azithromycin. However literature reported effectiveness of low dose azithromycin for acute exacerbation in patients of COPD. So further study in the form of randomized trail is needed to prove the efficacy of azithromycin.
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Suzuki, Naohito, and Ken Ohta. "3. Acute Exacerbation." Nihon Naika Gakkai Zasshi 97, no. 6 (2008): 1184–91. http://dx.doi.org/10.2169/naika.97.1184.
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Cushny, Alexander. "Acute asthma exacerbation." Nursing Standard 27, no. 52 (August 28, 2013): 59. http://dx.doi.org/10.7748/ns2013.08.27.52.59.s46.
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Khatun, Maksuda, Moinuddin Hossain, Dahlia Sultana, Mohammad Ariful Islam, and Mohammad Afjal Hossain. "Clinical Profile of Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients Admitted in Tertiary Care Hospital." Sir Salimullah Medical College Journal 30, no. 2 (October 20, 2022): 161–67. http://dx.doi.org/10.3329/ssmcj.v30i2.61933.
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Background: COPD is one of the most widespread noncommunicable diseases, and its incidence is on the rise in developing countries. Acute COPD exacerbation is linked to a higher financial burden on the health system, as well as a negative impact on patients’ health in terms of lost working days, functional capacity, and mortality. COPD exacerbation is characterized by a worsening of symptoms such as cough and dyspnea, as well as a considerable risk of type-II respiratory failure. An understanding of the symptoms and signs, as well as the causes linked to acute COPD exacerbation in our population, is thought to aid in the prevention of such exacerbations, reducing the burden on patients and the community. Aim: This study is meant to bring forth the clinical profile and variables related with acute exacerbation of COPD among our community, taking into account the specific symptoms preceding an exacerbation of COPD and the variety of factors associated with it in different parts of the world. This study characterizes the clinical signs and symptoms of COPD acute exacerbations, as well as investigates the involvement of a respiratory tract infection in COPD exacerbation establishing a relationship between smoking and COPD exacerbation. Method: This is a hospital-based cross-sectional observational study. The study was conducted at the Dhaka Medical College Hospital’s Department of Medicine (DMCH). A method of purposive sampling was applied. The study took place from November 2012 until June 2013. The sample size computed for this study is 75. Result: Age above 7th decade increases mortality risk by 2.32 times. Meanwhile, comorbidity, low BMI (<18.5 kg/m2), smoking and frequent acute exacerbation increases risk by 1.29 times, 1.16 times, 0.03 times and by 2.07 times respectively in patients having COPD. Conclusion: Chronic obstructive pulmonary disease (COPD) is more frequent in the 6th decade of life and is male predominant. Recovery period has been found longer in the presence of dyspnea or symptoms of a common cold at exacerbations onset, higher PaCO2 and lower pH has been found in the patients admitted in ICU. Low BMI, RTI, Smoking and Comorbidity are more frequent in patients with chronic obstructive pulmonary disease (COPD). Sir Salimullah Med Coll J 2022; 30: 161-167
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Suh, Hee-Sook, Min-Seok Chang, Iseul Yu, Sunmin Park, Ji-Ho Lee, Seok Jeong Lee, Won-Yeon Lee, Suk Joong Yong, and Sang-Ha Kim. "Adherence to Long-Acting Inhaler Use for Initial Treatment and Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Retrospective Cohort Study." Journal of Personalized Medicine 12, no. 12 (December 15, 2022): 2073. http://dx.doi.org/10.3390/jpm12122073.
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We aimed to determine the effect of long-acting inhaler use adherence on acute exacerbations in treatment-naïve patients with chronic obstructive pulmonary disease (COPD) using claims data from the Korean Health Insurance Review and Assessment Service from July 2015–December 2016. Patients with COPD aged ≥ 40 years who used long-acting inhalers were enrolled and observed for 6 months. Medication adherence was determined by the medication possession ratio (MPR); patients were categorized to adherence (MPR ≥ 80%) and non-adherence (MPR < 80%) groups. Ultimately, 3959 patients were enrolled: 60.4% and 39.6% in the adherence and non-adherence groups, respectively. The relative risk of acute exacerbation in the non-adherence group was 1.58 (95% confidence interval [CI] 1.25–1.99) compared with the adherence group. The adjusted logistic regression analysis revealed a relative risk of acute exacerbation in the non-adherence vs. adherence group of 1.68 (95% CI 1.32–2.14) regarding the number of inhalers used. Poor adherence to long-acting inhalers influenced increased acute exacerbation rates among patients with COPD. The acute exacerbation of COPD risk requiring hospitalization or ED visits was high in the non-adherence group, suggesting that efforts to improve medication adherence may help reduce COPD exacerbations even in the initial management of treatment-naïve patients.
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Aziz, Javaira, Muhammad Amir, Abrar Akbar, Sadia Aziz, Nadia Shams, and Lubna Meraj. "Hypomagnesaemia in Acute Exacerbation Chronic Obstructive Airway Disease; Association with Anthonisen’s Levels of Exacerbation." Journal of Rawalpindi Medical College 26, no. 2 (June 30, 2022): 195–201. http://dx.doi.org/10.37939/jrmc.v26i2.1758.
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Background: COPD is major public health issue causing morbidity and mortality. Lower serum magnesium levels are seen in patients with acute exacerbations compared to stable COPD patients. This study aims at identifying hypomagnesemia as predictor of COPD exacerbations that may help reduce the burden of readmissions and mortality.
Material and Methods: The Descriptive cross-sectional study was conducted DHQ Hospital Rawalpindi from 16 July 2016 to 15 Jan 2017 after the ethical approval and informed consent. The indoor adult (> 18 years) diagnosed cases of COPD exacerbation were included by consecutive sampling. Patients with malignancy, pregnancy and receiving magnesium supplements were excluded. Demographic details documented and after complete clinical evaluation, serum Magnesium levels of were assessed. Serum Magnesium < 1.80 mg/dl labeled hypomagnesaemia. Data was analyzed by SPSS with significant p< 0.05.
Results: Amongst 176 patients; there were 93(52.8%) males and 83(47.2%) females. Mean age was 56+7 years. Mean duration of COPD was 6.56 + 5.24 years (2-10 years). Mean height in the study was 181 +12 cm and mean weight was 56.06 + 7.08 kg. The mean serum magnesium level was 1.5 + .49mg/dl. Low serum magnesium (<1.8 mg/dl) observed in 103(58.5%), gender wasn’t associated with hypomagnesaemia (p=0.294). Hypomagnesaemia in accordance to types of Anthonisen’s criteria was observed in 19(44.2%) with Type I, 37(57.8%) with Type II and 47(68.1%) with Type III COPD exacerbation. Hypomagnesaemia had significant association with Anthinosen’s levels of exacerbation (p=0.043). The mean age in patients with hypomagnesaemia was 56.61+6.78 Vs. 55.30+7.47 in patients without hypomagnesaemia (p=0.228).
Conclusion: The study concludes mean serum magnesium levels are significantly lower in patients with acute exacerbation of COPD (58.5%), particularly in type II and III. Magnesium levels should be performed in all COPD exacerbations irrespective of gender and age. Replacement of magnesium may be helpful in alleviating symptoms and reducing frequency of exacerbations.
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Urso, Domenico Lorenzo. "Acute exacerbation of asthma: a case report." Clinical Management Issues 5, no. 3 (September 15, 2011): 79–85. http://dx.doi.org/10.7175/cmi.v5i3.501.
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Asthma is a chronic inflammatory disease of the airways with a worldwide prevalence ranging from 1% to 18%. We report the case of a 43-year-old man with acute asthma exacerbation admitted to Emergency Department. All patients with asthma are at risk of having exacerbations characterised by worsening symptoms, airflow obstruction, and an increased requirement for rescue bronchodilators. Patients should be evaluated and triaged quickly to assess the presence of exacerbations and the need for urgent intervention. The goals of treatment may be summarised as maintenance of adequate oxygen saturation with supplemental oxygen, relief of airway obstruction with repetitive administration of rapid-acting inhaled bronchodilators, and treatment of airway inflammation with systemic corticosteroids.
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Salonen, Johanna, Mervi Kreus, Siri Lehtonen, Hannu Vähänikkilä, Minna Purokivi, and Riitta Kaarteenaho. "Decline in Mast Cell Density During Diffuse Alveolar Damage in Idiopathic Pulmonary Fibrosis." Inflammation 45, no. 2 (October 22, 2021): 768–79. http://dx.doi.org/10.1007/s10753-021-01582-0.
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Abstract Mast cells (MCs) are known to be involved in the pathogenesis of idiopathic pulmonary fibrosis (IPF), although their role in acute exacerbations of IPF has not been investigated. The aims of the study were to evaluate the numbers of MCs in fibrotic and non-fibrotic areas of lung tissue specimens of idiopathic pulmonary fibrosis (IPF) patients with or without an acute exacerbation of IPF, and to correlate the MC density with clinical parameters. MCs of IPF patients were quantified from surgical lung biopsy (SLB) specimens (n = 47) and lung tissue specimens taken at autopsy (n = 7). MC density was higher in the fibrotic areas of lung tissue compared with spared alveolar areas or in controls. Female gender, low diffusion capacity for carbon monoxide, diffuse alveolar damage, and smoking were associated with a low MC density. MC densities of fibrotic areas had declined significantly in five subjects in whom both SLB in the stable phase and autopsy after an acute exacerbation of IPF had been performed. There were no correlations of MC densities with survival time or future acute exacerbations. The MC density in fibrotic areas was associated with several clinical parameters. An acute exacerbation of IPF was associated with a significant decline in MC counts. Further investigations will be needed to clarify the role of these cells in IPF and in the pathogenesis of acute exacerbation as this may help to identify some potential targets for medical treatment for this serious disease.
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Bostock, Beverley. "Rescue packs for COPD: problem or panacea?" Practice Nursing 33, no. 5 (May 2, 2022): 182–85. http://dx.doi.org/10.12968/pnur.2022.33.5.182.
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Exacerbations of COPD require additional acute treatment. Beverley Bostock discusses the rationale for offering rescue packs as part of patient self-management For many people who have been diagnosed with COPD, there is a risk of experiencing an exacerbation of their symptoms which will require additional acute treatment to supplement their usual therapy. Exacerbations of COPD are associated with reduced quality of life, loss of lung function and a higher risk of dying. People living with COPD may be advised to keep a ‘rescue pack’ of oral corticosteroids and antibiotics to start if they develop symptoms of an exacerbation. Patient education should include advice on how to recognise exacerbations and when and how to treat them, with information about the effects and side-effects of any medication.
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Yang, Dawei, Jennifer M. Wilson, Chunxue Bai, John Yee, Pearce G. Wilcox, Nasreen Khalil, and Robert D. Levy. "Exacerbation of Pulmonary Fibrosis Following Single Lung Transplantation." Canadian Respiratory Journal 19, no. 1 (2012): e3-e4. http://dx.doi.org/10.1155/2012/258485.
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Acute exacerbations of interstitial lung disease present as clinical deteriorations, with progressive hypoxemia and parenchymal consolidation not related to infection, heart failure or thromboembolic disease. Following single lung transplantation, patients receive maintenance immunosuppression, which could mitigate the development of acute exacerbations in the native lung. A 66-year-old man with fibrotic, nonspecific interstitial pneumonitis presented with fever, hypoxemia and parenchymal consolidation limited to the native lung four years after single lung transplantation. Investigations were negative for infection, heart failure and thromboembolic disease. The patient worsened over the course of one week despite broad-spectrum antimicrobial therapy, but subsequently improved promptly with augmentation of prednisone dosed to 50 mg daily and addition of N-acetylcysteine. Hence, the patient fulfilled the criteria for a diagnosis of an acute exacerbation of pulmonary fibrosis in his native lung. Clinicians should consider acute exacerbation of parenchymal lung disease of the native lung in the differential diagnosis of progressive respiratory deterioration following single lung transplantation for pulmonary fibrosis.
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MacDonald, Martin I., Christian R. Osadnik, Lauren Bulfin, Elizabeth Leahy, Paul Leong, Eskandarain Shafuddin, Kais Hamza, Paul T. King, and Philip G. Bardin. "MULTI-PHACET: multidimensional clinical phenotyping of hospitalised acute COPD exacerbations." ERJ Open Research 7, no. 3 (June 3, 2021): 00198–2021. http://dx.doi.org/10.1183/23120541.00198-2021.
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BackgroundThe generic term “exacerbation” does not reflect the heterogeneity of acute exacerbations of COPD (AECOPD). We utilised a novel algorithmic strategy to profile exacerbation phenotypes based on underlying aetiologies.MethodsPatients hospitalised for AECOPD (n=146) were investigated for aetiological contributors summarised in a mnemonic acronym ABCDEFGX (A: airway virus; B: bacterial; C: co-infection; D: depression/anxiety; E: eosinophils; F: failure (cardiac); G: general environment; X: unknown). Results from clinical investigations were combined to construct AECOPD phenotypes. Relationships to clinical outcomes were examined for both composite phenotypes and their specific aetiological components. Aetiologies identified at exacerbation were reassessed at outpatient follow-up.ResultsHospitalised AECOPDs were remarkably diverse, with 26 distinct phenotypes identified. Multiple aetiologies were common (70%) and unidentifiable aetiology rare (4.1%). If viruses were detected (29.5%), patients had longer hospitalisation (7.7±5.6 versus 6.0±3.9 days, p=0.03) despite fewer “frequent exacerbators” (9.3% versus 37%, p=0.001) and lower mortality at 1 year (p=0.03). If bacterial infection was found (40.4%), patients were commonly “frequent exacerbators” (44% versus 18.4%, p=0.001). Eosinophilic exacerbations (28%) were associated with lower pH (7.32±0.06 versus 7.36±0.09, p=0.04), higher venous carbon dioxide tension (PvCO2) (53.7±10.5 versus 48.8±12.8, p=0.04), greater noninvasive ventilation (NIV) usage (34.1% versus 18.1%) but shorter hospitalisation (4 (3–5) versus 6 (4–9) days, p<0.001) and lower infection rates (41.4% versus 80.9%, p<0.0001). Cardiac dysfunction and severe anxiety/depression were common in both infective and non-infective exacerbations. Characteristics identified at exacerbation often persisted after recovery.ConclusionsHospitalised AECOPDs have numerous causes, often in combination, that converge in complex, multi-faceted phenotypes. Clinically important differences in outcomes suggest that a phenotyping strategy based on aetiologies can enhance AECOPD management.
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Mayhew, David, Nathalie Devos, Christophe Lambert, James R. Brown, Stuart C. Clarke, Viktoriya L. Kim, Michal Magid-Slav, et al. "Longitudinal profiling of the lung microbiome in the AERIS study demonstrates repeatability of bacterial and eosinophilic COPD exacerbations." Thorax 73, no. 5 (January 31, 2018): 422–30. http://dx.doi.org/10.1136/thoraxjnl-2017-210408.
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BackgroundAlterations in the composition of the lung microbiome associated with adverse clinical outcomes, known as dysbiosis, have been implicated with disease severity and exacerbations in COPD.ObjectiveTo characterise longitudinal changes in the lung microbiome in the AERIS study (Acute Exacerbation and Respiratory InfectionS in COPD) and their relationship with associated COPD outcomes.MethodsWe surveyed 584 sputum samples from 101 patients with COPD to analyse the lung microbiome at both stable and exacerbation time points over 1 year using high-throughput sequencing of the 16S ribosomal RNA gene. We incorporated additional lung microbiology, blood markers and in-depth clinical assessments to classify COPD phenotypes.ResultsThe stability of the lung microbiome over time was more likely to be decreased in exacerbations and within individuals with higher exacerbation frequencies. Analysis of exacerbation phenotypes using a Markov chain model revealed that bacterial and eosinophilic exacerbations were more likely to be repeated in subsequent exacerbations within a subject, whereas viral exacerbations were not more likely to be repeated. We also confirmed the association of bacterial genera, including Haemophilus and Moraxella, with disease severity, exacerbation events and bronchiectasis.ConclusionsSubtypes of COPD have distinct bacterial compositions and stabilities over time. Some exacerbation subtypes have non-random probabilities of repeating those subtypes in the future. This study provides insights pertaining to the identification of bacterial targets in the lung and biomarkers to classify COPD subtypes and to determine appropriate treatments for the patient.Trial registration numberResults, NCT01360398.
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Gronkiewicz, Cynthia, and Marilyn Borkgren-Okonek. "Acute Exacerbation of COPD." Critical Care Nursing Quarterly 27, no. 4 (October 2004): 336–52. http://dx.doi.org/10.1097/00002727-200410000-00005.
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Ko, Fanny W., Ka Pang Chan, David S. Hui, John R. Goddard, Janet G. Shaw, David W. Reid, and Ian A. Yang. "Acute exacerbation of COPD." Respirology 21, no. 7 (March 30, 2016): 1152–65. http://dx.doi.org/10.1111/resp.12780.
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Dewan, Naresh A., Salem Rafique, Badar Kanwar, Hemant Satpathy, Kay Ryschon, Glenn S. Tillotson, and Michael S. Niederman. "Acute Exacerbation of COPD." Chest 117, no. 3 (March 2000): 662–71. http://dx.doi.org/10.1378/chest.117.3.662.
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Kaufman, Jane S. "Acute exacerbation of COPD." Nurse Practitioner 42, no. 6 (June 2017): 1–7. http://dx.doi.org/10.1097/01.npr.0000515997.35046.b8.
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Vlachou, E., M. Dalal, A. Monaghan, and H. Nishikawa. "Acute exacerbation of macroglossia." British Journal of Plastic Surgery 58, no. 6 (September 2005): 877–80. http://dx.doi.org/10.1016/j.bjps.2004.12.010.
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Kherad, Omar, Pierre-Olivier Bridevaux, Laurent Kaiser, Jean-Paul Janssens, and Olivier T. Rutschmann. "Is Acute Exacerbation of COPD (AECOPD) Related to Viral Infection Associated with Subsequent Mortality or Exacerbation Rate?" Open Respiratory Medicine Journal 8, no. 1 (April 4, 2014): 18–21. http://dx.doi.org/10.2174/1874306401408010018.
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Background: There is a growing interest in better defining risk factors associated with increased susceptibility to exacerbation in patients with COPD. Introduction: The aim of the study was to determine whether identification of a respiratory virus during a severe acute exacerbation of COPD (AECOPD) increases the risk of subsequent exacerbations and mortality during a one-year followup. Methods: Secondary analysis of 86 COPD patients admitted for AECOPD between June 2007 and December 2008 at Geneva’s University Hospital who were followed up for 1 year. Fifty-one percent of index AECOPD were related to viral infection. Rate of AECOPD, time to next AECOPD, and all-cause mortality were compared between patients with vs without viral index AECOPD. Results: Eighty-one cases were included in this secondary follow-up analysis. Mean exacerbation rate was 1.9 AECOPD per person-year for patients with viral index AECOPD vs 4.0 AECOPD per person year for those with non-viral index AECOPD. Incidence rate ratio (IRR) for subsequent AECOPD during one year follow up was lower for patients with viral index AECOPD (IRR 0.57; [CI 95% 0.39-0.84]), after controlling for previous exacerbations, and was strongly associated with the number of exacerbations in the year preceding the index AECOPD. During the one-year follow-up period, 16 patients (19%) died. In a Cox regression model, patients with a proven viral infection did not have a higher mortality (HR 0.56 [CI 95% 0.20 -1.58]). Conclusion: Viral AECOPD was not associated with a higher rate of subsequent exacerbations or mortality during the following year.
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Erhabor, G. E., B. Adeniyi, A. O. Arawomo, O. Akinwalere, G. Adetona, F. T. Fagbohun, J. Aigbirior, and J. O. Erhabor. "Acute Exacerbation of COPD: Clinical Perspectives and Literature Review." West Africa Journal of Medicine 38, no. 11 (November 30, 2021): 1129–42. http://dx.doi.org/10.55891/wajm.v38i11.25.
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Chronic Obstructive Pulmonary Disease (COPD) COPD is a significant cause of morbidity and the third leading cause of death worldwide. COPD is a chronic progressive disease which may be interspersed by periods of acute worsening of respiratory symptoms beyond normal day-to-day variations, called exacerbations, which substantially impact health status and has cumulative effects on lung function. Acute exacerbation of COPD negatively affects disease progression, facilitating decline in pulmonary function and resulting in impaired quality of life and increased mortality risk. Therefore, early introduction of preventive measures in patients at risk of COPD remains the cornerstone of management. This article summarizes clinical perspectives and current knowledge on COPD exacerbations, with insights into practices in low- and middle-income countries.
Keywords: Chronic obstructive pulmonary disease; exacerbations; progression.
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Shrestha, S. K., S. Adhikari, M. Karki, U. R. Mohsin, R. Khunjeli, B. Srivastava, R. Chaudhary, and S. Bhatta. "Organisms isolated in induced sputum samples in acute exacerbation of severe and very severe chronic obstructive pulmonary disease." Journal of Chitwan Medical College 5, no. 3 (February 15, 2017): 25–31. http://dx.doi.org/10.3126/jcmc.v5i3.16522.
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Acute exacerbations pose a very high economic burden on Chronic Obstructive Pulmonary Disease (COPD) patients and are commonly infective in nature. Gram’s staining and bacterial cultures are baseline investigations for sputum examination for COPD. This study evaluated these techniques for characterization and identification of various organism involved in acute infective exacerbations of COPD. Sodium Chloride (3%) induced sputum samples from 122 severe and very severe COPD subjects presenting in acute exacerbation who had history of frequent exacerbations and frequent antibiotics use were evaluated. The sputum samples were evaluated by Gram’s staining and bacterial culture from January 2013 to March 2014. Induction technique was able to obtain adequate samples from 86 (70.48% of 122) subjects. Gram’s stain showed 30 samples of Gram positive cocci (34.88%), 23 samples (26.74%) of Gram Negative Cocci and 50 samples (58.13%) of Gram Negative Bacilli. Bacterial culture showed predominant growth of Gram negative organisms including Pseudomonas sp, Acinetobacter sp, Klebsiella pneumoniae and Citrobacter Freundii. Gram negative bacilli are the most common isolated pathogens responsible for the acute exacerbation in severe and very severe COPDs with history of frequent exacerbations and hospital visits.
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Goddard, Rob D., Shelly A. McNeil, Kathryn L. Slayter, and R. Andrew McIvor. "Antimicrobials in Acute Exacerbations of Chronic Obstructive Pulmonary Disease - An Analysis of the Time to Next Exacerbation Before and After Implementation of Standing Orders." Canadian Journal of Infectious Diseases 14, no. 5 (2003): 254–59. http://dx.doi.org/10.1155/2003/392617.
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OBJECTIVE: To compare the mean time to next exacerbation in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) before and after the implementation of standing orders.SETTING: Tertiary care hospital, Halifax, Nova Scotia, Canada.POPULATION STUDIED: The records of 150 patients were analyzed, 76 were in the preimplementation group, 74 in the postimplementation group.INTERVENTION: The management and outcomes of patients admitted with an acute exacerbation of COPD before and after the implementation of standing orders were compared.DESIGN: A retrospective chart review.MAIN RESULTS: There was no difference in the mean time to next exacerbation between treatment groups (preimplementation group: 310 days, postimplementation group: 289 days, P=0.53). Antibiotics were used in 90% of the cases (preimplementation group: 87%, postimplementation group: 93%). The postimplementation group had a 20% increase in the use of first-line agents over the preimplementation group. Overall, first-line agents represented only 37% of the antibiotic courses.CONCLUSIONS: The implementation of standing orders encouraged the use of first-line agents but did not influence subsequent symptom resolution, length of hospital stay, or the infection-free interval in patients with acute exacerbations of COPD.
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El Sawy, Ihab H., Reham M. Wagdy, Afaf G. Ibrahim, and Suzy W. Ibrahim. "Risk factors associated with severe asthma exacerbations in children attending Alexandria University Children’s Hospital, Egypt." International Journal Of Community Medicine And Public Health 5, no. 12 (November 24, 2018): 5019. http://dx.doi.org/10.18203/2394-6040.ijcmph20184670.
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Background: Severe asthma exacerbation is one of the common pediatric medical emergencies that necessitates hospital visits. The study aimed to identify risk factors associated with pediatric severe asthma exacerbations that might have the potential to guide the parents for early medical consultations and physicians at primary health care centers for proper management.Methods: A case-control study was conducted on over 100 asthmatic children below 12 years attending the Emergency Department of Alexandria University Children’s Hospital in acute exacerbation. Based on a modified pulmonary index score, the patients were allocated into 2 groups; study group (50 patients with severe asthma exacerbation) and control group (50 patients with mild asthma exacerbations). Demographic data, history of illness, alarming clinical signs, medications, and outcome of all participants were recorded.Results: Severe asthma exacerbations were more encountered among males, older age, and with a longer duration of asthma (X±SD=28.4±15.9 months) with significant differences when compared to controls. Comparing the studied groups revealed higher risk for severe asthma exacerbations mainly with; history of sudden onset of severe respiratory distress (Odds ratio “OR”=30.13, 95% CI, 13.78-66.69) and chronic steroid-dependent asthma (OR=14.46, 95% CI, 3.97-52.65). Cyanosis, lethargy, and inability to talk were alarming signs in patients with severe asthma exacerbation when compared to those with mild asthma exacerbation (p<0.05).Conclusions: Severe asthma exacerbation in children is still associated with many risk factors that may alert the patients’ caregivers and physicians prospectively for early proper management.
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Avdeev, S. N., V. V. Gaynitdinova, Z. M. Merzhoeva, G. V. Neklyudova, N. A. Tsareva, and G. S. Nuralieva. "Exacerbation of idiopathic pulmonary fibrosis." Terapevticheskii arkhiv 92, no. 3 (April 27, 2020): 73–77. http://dx.doi.org/10.26442/00403660.2020.03.000402.
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Idiopathic pulmonary fibrosis (IPF) is usually characterized by a chronic and slowly progressive course. According to several studies, a small number of patients with IPF (about 515%) develops an acute deterioration of deasese exacerbation of IPF. Exacerbations of IPF can occur at any time of the disease and sometimes becomes the first manifestation of IPF. Pulmonary hypertension in IPF is a fairly frequent complication, which leads to severe violations of gas exchange and reduced tolerance to physical stress. Currently, proven effective treatments for exacerbations of IPF do not exist, the management of this condition is based on supportive therapy (oxygen, respiratory support) and interventions with inadequate evidences (corticosteroids, immunosuppressant). During exacerbation of IPF a careful search of all the possible triggers is justified. In the presented clinical case of exacerbation of IPF there was demonstrated the efficacy of complex therapy including antifibrotic therapy, PAH-specific medicines and enhanced oxygen therapy.
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Shunmugam, Muthukumar. "COPD: Microbial Pattern in Acute Exacerbation in Tertiary Care." Journal of Medical Science And clinical Research 04, no. 12 (December 28, 2016): 15070–74. http://dx.doi.org/10.18535/jmscr/v4i12.124.
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Aydin, Cihan, Birsen Pınar Yıldız, and Didem Görgün Hattatoğlu. "D-dimer/Fibrinogen ratio and recurrent exacerbations might have a potential impact to predict 90-day mortality in patients with COPD exacerbation." Malawi Medical Journal 33, no. 4 (December 22, 2021): 276–80. http://dx.doi.org/10.4314/mmj.v33i4.8.
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BackgroundAccording to the World Health Organisation reports (WHO), COPD is the third leading cause of overall in the World by 2020. AimWe aimed to determine the prognostic predictors of 90-day mortality after an initial exacerbation in patients with acute exacerbation of COPD (AECOPD). Results Increased Charlson Comorbidity Score(CCS) (HR:1.47; p<0.05), readmission after initial exacerbation (HR:1.47; p<0.05) were predictive risk factors for 30-day mortality in multivariable regression model. The 90-day mortality rate was %11.8. Hypertension, increased median age, nutrition risk score (NRS), CCS, CAT score, and mMRC 4th level were possible risk factors for 90-day mortality. There was a significant difference in the mortality of patients with D-dimer/Fibrinogen ratios>0.11 and ≤0.11 (HR:2.47; p<0.05). Recurrent exacerbations after discharge were predictive risk factors for 90-day mortality in the multivariable regression model (HR:2.25; p<0.001) with the increased mortality risk 4.73 times (HR:4.73; p=0.002). Furthermore, a 1-unit increment of acute exacerbation increased the mortality risk 3.39 times (HR:3.39; p<0.001). ConclusionOur study showed that D-dimer/Fibrinogen ratio but not D-dimer and recurrent exacerbations after discharge might have a critical impact on 90-day mortality
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Kakavas, Sotirios, Aggeliki Papanikolaou, Steven Kompogiorgas, Eleftherios Stavrinoudakis, Evangelos Balis, and Georgios Bulbasakos. "Sit-to-stand tests in patients hospitalised for chronic obstructive pulmonary disease exacerbation: association with pulmonary function tests and risk of future exacerbations." International Journal of Therapy and Rehabilitation 27, no. 12 (December 2, 2020): 1–11. http://dx.doi.org/10.12968/ijtr.2019.0005.
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Background/Aims The sit-to-stand test is a quick and cost-effective measure of exercise tolerance and lower body strength. The literature focuses on its use in stable patients with chronic obstructive pulmonary disease. This study in patients hospitalised for chronic obstructive pulmonary disease exacerbation aimed to investigate possible associations of the sit-to-stand test with pulmonary function and risk of future acute exacerbations. Methods This study was conducted on a sample of 22 patients with chronic obstructive pulmonary disease. Participants' clinical details were recorded before they undertook spirometry, 30-second and five-repetition sit-to-stand tests. Participants were assessed via a structured telephone interview for the occurrence of acute exacerbation events in the 12 months following discharge. Results Patients were classified based on the presence or absence of acute exacerbations of chronic obstructive pulmonary disease over 12 months. A negative correlation was observed between five-repetition sit-to-stand test performance time and number of repetitions during the 30-second sit-to-stand test; longer sit-to-stand times and fewer repetitions were observed in patients who experienced exacerbations during follow up. The 30-second sit-to-stand test repetitions correlated positively with forced expiratory volume in 1 second (FEV1). Five-repetition sit-to-stand test performance correlated negatively with FEV1, FEV1% predicted, forced vital capacity and FEV1/forced vital capacity ratio. From the various exercise parameters, five-repetition sit-to-stand test performance time demonstrated a moderate ability to predict exacerbations. Conclusions This study is the first to focus on the use of the sit-to-stand tests in inpatients with acute exacerbation of chronic obstructive pulmonary disease. There was a significant correlation between the 30-second sit-to-stand test and five-repetition sit-to-stand test results. Both tests were associated with pulmonary function indices and risk of future chronic obstructive pulmonary disease exacerbations.
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Tangpricha, Vin, Joshua Lukemire, Yuqing Chen, José Nilo G. Binongo, Suzanne E. Judd, Ellen S. Michalski, Moon J. Lee, et al. "Vitamin D for the Immune System in Cystic Fibrosis (DISC): a double-blind, multicenter, randomized, placebo-controlled clinical trial." American Journal of Clinical Nutrition 109, no. 3 (February 22, 2019): 544–53. http://dx.doi.org/10.1093/ajcn/nqy291.
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ABSTRACT Background Patients with cystic fibrosis (CF) have increased risk of vitamin D deficiency owing to fat malabsorption and other factors. Vitamin D deficiency has been associated with increased risk of pulmonary exacerbations of CF. Objectives The primary objective of this study was to examine the impact of a single high-dose bolus of vitamin D3 followed by maintenance treatment given to adults with CF during an acute pulmonary exacerbation on future recurrence of pulmonary exacerbations. Methods This was a multicenter, double-blind, placebo-controlled, intent-to-treat clinical trial. Subjects with CF were randomly assigned to oral vitamin D3 given as a single dose of 250,000 International Units (IU) or to placebo within 72 h of hospital admission for an acute pulmonary exacerbation, followed by 50,000 IU of vitamin D3 or an identically matched placebo pill taken orally every other week starting at 3 mo after random assignment. The primary outcome was the composite endpoint of the time to next pulmonary exacerbation or death within 1 y. The secondary outcomes included circulating concentrations of the antimicrobial peptide cathelicidin and recovery of lung function as assessed by the percentage of predicted forced expiratory volume in 1 s (FEV1%). Results A total of 91 subjects were enrolled in the study. There were no differences between the vitamin D3 and placebo groups in time to next pulmonary exacerbation or death at 1 y. In addition, there were no differences in serial recovery of lung function after pulmonary exacerbation by FEV1% or in serial concentrations of plasma cathelicidin. Conclusions Vitamin D3 initially given at the time of pulmonary exacerbation of CF did not alter the time to the next pulmonary exacerbation, 12-mo mortality, serial lung function, or serial plasma cathelicidin concentrations. This trial was registered at clinicaltrials.gov as NCT01426256.
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Kim, Victor, and Shawn D. Aaron. "What is a COPD exacerbation? Current definitions, pitfalls, challenges and opportunities for improvement." European Respiratory Journal 52, no. 5 (September 20, 2018): 1801261. http://dx.doi.org/10.1183/13993003.01261-2018.
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Chronic obstructive pulmonary disease (COPD) is a chronic illness that can be periodically punctuated by exacerbations, characterised by acute worsening of symptoms, including increased dyspnoea, cough, sputum production and sputum purulence. COPD exacerbations are common and have important clinical and economic consequences, including lost work productivity, increased utilisation of healthcare resources, temporary or permanent reductions in lung function and exercise capacity, hospitalisation, and sometimes death. Over the past two decades, clinicians and researchers have broadened their treatment goals for COPD to extend beyond improving lung function and symptoms, and have begun to address the importance of preventing and reducing exacerbations. However, despite the best efforts of clinicians and guideline committees, current definitions of COPD exacerbations are imperfect and fraught with problems. The cardinal symptoms of a COPD exacerbation are nonspecific and can result from acute cardiorespiratory illnesses other than COPD. A proposed definition, which may be more specific than current definitions, suggests that COPD exacerbation be defined as an acute or subacute worsening of dyspnoea (≥5 on a visual analogue scale that ranges from 0 to 10) sometimes but not necessarily accompanied by increased cough, sputum volume and/or sputum purulence. Necessary laboratory criteria for an exacerbation include oxygen desaturation ≤4% below that of stable state, elevated levels of circulating blood neutrophils or eosinophils (≥9000 neutrophils·mm−3 or ≥2% blood eosinophils) and elevated C-reactive protein (≥3 mg·L−1), without evidence of pneumonia or pulmonary oedema on chest radiography and with negative laboratory test results for other aetiologies. Herein, we discuss the current state of the art with respect to how we define COPD exacerbations, associated pitfalls and challenges, and opportunities for improvement.
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Dougherty, R. H., and J. V. Fahy. "Acute exacerbations of asthma: epidemiology, biology and the exacerbation-prone phenotype." Clinical & Experimental Allergy 39, no. 2 (February 2009): 193–202. http://dx.doi.org/10.1111/j.1365-2222.2008.03157.x.
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Gayan-Ramirez, Ghislaine, and Marc Decramer. "Mechanisms of striated muscle dysfunction during acute exacerbations of COPD." Journal of Applied Physiology 114, no. 9 (May 1, 2013): 1291–99. http://dx.doi.org/10.1152/japplphysiol.00847.2012.
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During acute exacerbations of chronic obstructive pulmonary disease (COPD), limb and respiratory muscle dysfunction develops rapidly and functional recovery is partial and slow. The mechanisms leading to this muscle dysfunction are not yet fully established. However, recent evidence has shown that several pathways involved in muscle catabolism, apoptosis, and oxidative stress are activated in the vastus lateralis muscle of patients during acute exacerbations of COPD, while those implicated in mitochondrial function are downregulated. These pathways may be targeted in different ways by factors related to exacerbations. These factors include enhanced systemic inflammation, oxidative stress, impaired energy balance, hypoxia, hypercapnia and acidosis, corticosteroid treatment, and physical inactivity. Data on the respiratory muscles are limited, but these muscles are undoubtedly overloaded during exacerbations. While they are also subjected to the same systemic elements as the limb muscles (except for inactivity), they also face a specific mechanical disadvantage caused by changes in lung volume during exacerbation. The latter will affect the ability to generate force by the foreshortening of the muscle (especially for the diaphragm), but also by altering rib orientation and motion (especially for the parasternal intercostals and the external intercostals). Because acute exacerbations of COPD are associated with an increase in both prevalence and severity of generalized muscle dysfunction, and both remain present even during recovery, early interventions to minimize muscle dysfunction during exacerbation are warranted. Although rehabilitation may be promising, other therapeutic strategies such as counterbalancing the adverse effects of exacerbations on skeletal muscle pathways may also be used.
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D. B., Jyothi, and Gajanan P. Kulkarni. "A retrospective study on drug utilization in patients with acute exacerbation of bronchial asthma in adults at tertiary teaching hospital in Bidar." International Journal of Basic & Clinical Pharmacology 6, no. 2 (January 28, 2017): 389. http://dx.doi.org/10.18203/2319-2003.ijbcp20170335.
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Background: Drug utilization plays a role in helping the health care system to understand, interpret and improve the drug use and continuous quality improvement. It plays an essential part of pharmaco Epidemiological studies.Methods: 100 prescriptions from patients with established diagnosis of acute exacerbation of Bronchial asthma were assessed from the Department of Pulmonary Medicine and the data gathered was analysed using MS Excel.Results: Majority of the prescriptions irrespective of severity received inhalation β2 agonist (formoterol) as a bronchodilator. Nebulization route was given for managing the acute exacerbations followed by inhalation route. Hydrocortisone was prescribed to all patients for managing acute Exacerbations. Montelukast was used an adjuvant therapy. Most of them were prescribed combination therapy. Theophylline was prescribed among all the methylxanthines.Conclusions: β2 agonists Combinations and corticosteroids are the most commonly prescribed combination drugs for asthma followed by methylxanthines. The most commonly prescribed asthmatic Medication in combination therapy was inhaled salbutamol with ipratropium followed by intravenous Hydrocortisone and oral Montelukast. The most commonly prescribed methylxanthine was intravenous Theophylline. Nebulization was preferred route to tackle the acute exacerbation of asthmatic symptoms.
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Kumar, Surinder, Ruma Dev Roy, GR Sethi, and Sanjeev R. Saigal. "Mycoplasma pneumoniae infection and asthma in children." Tropical Doctor 49, no. 2 (December 11, 2018): 117–19. http://dx.doi.org/10.1177/0049475518816591.
Full textAbstract:
A clinical association between exacerbation of asthma symptoms and Mycoplasma pneumoniae ( M. pneumoniae) infection has long been suspected. We studied 80 children aged 5–15 years; 50 with asthma (Group 1) and 30 without an acute exacerbation of asthma (Group 2) for detection of M. pneumoniae by serology and polymerase chain reaction (PCR) on nasopharyngeal aspirates. Our study confirms that lower respiratory tract infections with M. pneumoniae are frequently associated with exacerbations of asthma in children.
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Anna Mackway-Jones, R. N., and Laura Howard. "BET 1: is the patient’s perception of shortness of breath a useful triage tool in exacerbations of COPD?" Emergency Medicine Journal 37, no. 2 (January 24, 2020): 112.2–113. http://dx.doi.org/10.1136/emermed-2019-209390.2.
Full textAbstract:
A shortcut review was carried out to establish whether the degree of breathlessness in patients with an acute exacerbation of COPD is indicative of the severity of the exacerbation. Three hundred and forty-seven papers were found using the reported searches, of which five presented the best available evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these five papers are tabulated. It is concluded that increased shortness of breath is associated with a worse prognosis in patients with acute exacerbations of COPD. Dyspnoea assessment should be included in the triage process.
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Su, Linfan, Yixian Qiao, Jinmei Luo, Rong Huang, and Yi Xiao. "Exome and Sputum Microbiota as Predictive Markers of Frequent Exacerbations in Chronic Obstructive Pulmonary Disease." Biomolecules 12, no. 10 (October 14, 2022): 1481. http://dx.doi.org/10.3390/biom12101481.
Full textAbstract:
Frequent acute exacerbations are the leading cause of high rates of hospitalization and mortality in chronic obstructive pulmonary disease (COPD). Despite the enormous worldwide medical burden, reliable molecular markers for effective early diagnosis and prognosis of acute exacerbations are still lacking. Both the host genetics and airway microbiome are known to play potential roles in the pathogenesis of frequent exacerbations. Here, we performed whole exome sequencing (WES) and 16S rRNA gene sequencing to explore the interaction between these two factors and their implications in the pathogenesis of frequent exacerbations. We collected peripheral blood (n = 82), sputum samples (n = 59) and clinical data from 50 frequent-exacerbation phenotype (FE) COPD patients and 32 infrequent-exacerbation phenotype (IE) as controls. Based on filtering the deleterious sites, candidate mutated genes shared only in FE patients and did not occur in the IE group were identified. Microbiota analysis revealed significant differences in bacterial diversity and composition between FE and IE groups. We report the underlying pathogenic gene including, AATF, HTT, CEP350, ADAMTS9, TLL2 genes, etc., and explore their possible genotypic-phenotypic correlations with microbiota dysbiosis. Importantly, we observed that AATF gene mutations were significantly negatively correlated with microbial richness and diversity. Our study indicated several deleterious mutations in candidate genes that might be associated with microbial dysbiosis and the increased risk of frequent acute exacerbations in COPD patients. These results provide novel evidence that exomes and related microbiomes may potentially serve as biomarkers for predicting frequent acute exacerbations in COPD patients.
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Goeminne, Pieter C., Bianca Cox, Simon Finch, Michael R. Loebinger, Pallavi Bedi, Adam T. Hill, Tom C. Fardon, Kees de Hoogh, Tim S. Nawrot, and James D. Chalmers. "The impact of acute air pollution fluctuations on bronchiectasis pulmonary exacerbation: a case-crossover analysis." European Respiratory Journal 52, no. 1 (June 14, 2018): 1702557. http://dx.doi.org/10.1183/13993003.02557-2017.
Full textAbstract:
In bronchiectasis, exacerbations are believed to be triggered by infectious agents, but often no pathogen can be identified. We hypothesised that acute air pollution exposure may be associated with bronchiectasis exacerbations.We combined a case-crossover design with distributed lag models in an observational record linkage study. Patients were recruited from a specialist bronchiectasis clinic at Ninewells Hospital, Dundee, UK.We recruited 432 patients with clinically confirmed bronchiectasis, as diagnosed by high-resolution computed tomography. After excluding days with missing air pollution data, the final model for particles with a 50% cut-off aerodynamic diameter of 10 µm (PM10) was based on 6741 exacerbations from 430 patients and for nitrogen dioxide (NO2) it included 6248 exacerbations from 426 patients. For each 10 µg·m−³ increase in PM10 and NO2, the risk of having an exacerbation that same day increased significantly by 4.5% (95% CI 0.9–8.3) and 3.2% (95% CI 0.7–5.8) respectively. The overall (lag zero to four) increase in risk of exacerbation for a 10 μg·m−3 increase in air pollutant concentration was 11.2% (95% CI 6.0–16.8) for PM10 and 4.7% (95% CI 0.1–9.5) for NO2. Subanalysis showed higher relative risks during spring (PM10 1.198 (95% CI 1.102–1.303), NO2 1.146 (95% CI 1.035–1.268)) and summer (PM10 2.142 (95% CI 1.785–2.570), NO2 1.352 (95% CI 1.140–1.602)) when outdoor air pollution exposure would be expected to be highest.In conclusion, acute air pollution fluctuations are associated with increased exacerbation risk in bronchiectasis.