Non-communicable diseases like heart disease, cancer, respiratory diseases and diabetes are now the leading causes of death worldwide according to the WHO. Chronic respiratory diseases such as COPD are a major contributor to this global burden. COPD is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced inflammatory response in the lungs to noxious particles or gases like cigarette smoke. Spirometry is required to diagnose COPD, with a post-bronchodilator FEV1/FVC ratio of less than 0.7 used to indicate airflow limitation. The severity of COPD is classified based on symptoms and the degree of airflow obstruction measured by spirometry. Treatment involves smoking cessation, bronchodil
At the end of this lecture student able to:
Define COPD
List causes of COPD
List risk factors of COPD
List signs and symptoms of COPD
List diagnostic measures
Describe treatment of COPD
Identify complications of COPD
Use nursing process
Discuss relevant patient / family education
At the end of this lecture student able to:
Define COPD
List causes of COPD
List risk factors of COPD
List signs and symptoms of COPD
List diagnostic measures
Describe treatment of COPD
Identify complications of COPD
Use nursing process
Discuss relevant patient / family education
COPD is a chronic respiratory illness that is associated with an abnormal inflammatory response of the lungs to noxious particles and gases. Severe COPD can lead to respiratory failure, repeated hospitalization and death. One of the most important risk factors for COPD is tobacco smoking.
Chronic Obstructive Pulmonary Disease BY
Dr Akram Yousuf
Resident Internal Medicine
Liaquat University of Medical Health and Sciences Jamshoro Pakistan
COPD is a chronic respiratory illness that is associated with an abnormal inflammatory response of the lungs to noxious particles and gases. Severe COPD can lead to respiratory failure, repeated hospitalization and death. One of the most important risk factors for COPD is tobacco smoking.
Chronic Obstructive Pulmonary Disease BY
Dr Akram Yousuf
Resident Internal Medicine
Liaquat University of Medical Health and Sciences Jamshoro Pakistan
COPD is a lung disease that makes it hard to breathe. It is caused by damage to the lungs over many years, usually from smoking.
The main symptoms are:
• A long-lasting (chronic) cough.
• Mucus that comes up when you cough.
• Shortness of breath that gets worse when you exercise.
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Chronic obstructive pulmonary disorders COPD is a [preventable and treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual clients.
It is characterized by airflow limitation that is not completely reversible.
Nursing management of the client with increased intracranial pressureANILKUMAR BR
The rigid cranial vault contains brain tissue (1,400 g), blood (75 mL), and CSF (75 mL)
The volume and pressure of these three components are usually in a state of equilibrium and produce the ICP.
ICP is usually measured in the lateral ventricles; normal ICP is 10 to 20 mm Hg. Increased ICP is a syndrome that affects many patients with acute neurologic conditions.
This is because pathologic conditions alter the relationship between intracranial volume and pressure. Although an elevated ICP is most commonly associated with head injury, it also may be seen as a secondary effect in other conditions, such as brain tumours, subarachnoid haemorrhage, and toxic and viral encephalopathies
Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles. Or •Bronchiectasis is characterized by permanent, abnormal dilation of one or more large bronchBronchiectasis.
The latest guidelines on the management of a COPD patient ( Stable COPD, patient with an exacerbation of COPD), latest modalities of treatment of a COPD patient
Chronic Obstructive Pulmonary Disease (COPD) by Dr Kemi DeleKemi Dele-Ijagbulu
Presentation on definition and general overview of COPD, how to differentiate COPD from Asthma, how to make diagnosis of COPD, simple tools for assessment of COPD; available therapeutic options; as well as management of stable COPD, COPD exacerbations and comorbidities
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June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
1. COPD Update
Dr.Veerendra Singh
Vice President UP Diabetes Association
Fellow UP Diabetes Association
Member Indian College Of Allergy Asthma & Immunology
3. 63 % of deaths in 2008 were due
to NCDs
– Cardiovascular diseases (48%)
– Cancer (21%)
– Chronic Respiratory Diseases (12%)
– Diabetes (3%)
4. Last 5-6
decades
Last 2
decades
More deaths due to
CDs than NCDs
e.g. TB, Malaria,
HIV/AIDs, Leprosy,
Dengue
Deaths due to CDs have
declined sharply
More people now die
due to NCDs
Chronic respiratory
diseases e.g.COPD top
this list
CDs: Communicable Diseases
NCDs: Non-Communicable Diseases
Scenario in India
JAPI 2012; 60 (Suppl):5-7
6. Crude estimates suggest there are 30 million
COPD patients in India. [8] India contributes
the highest COPD mortality in the world
COPD Burden in India
8. PRIOR TO 2004
• Chronic Bronchitis
Clinical diagnosis as chronic productive
cough for three months each in
two successive years.
• Emphysema
Pathological diagnosis as the permanent
enlargement of the airspaces and destruction of the airways
• Asthma
Loss of function
ATS/ERS Guidelines
Now first two of these (chronic bronchitis and emphysema)
are included under a single umbrella
COPD
19. Role of Chest X Ray in COPD
Near normal except a
flat diaphragm and
increased
bronchovascular
markings
Seldom diagnostic but
valuable to exclude
alternative diagnoses
and comorbidities.
34. Bronchodilators in COPD
Beta 2 Agonists
Short Acting Beta 2 agonists (SABA) Salbutamol
,Terbutaline
Long Acitng Beta 2 agonists (LABA) Formoterol
,Salmeterol,Indacaterol, Vilanterol
Anticholinergics
Short Acting Muscarinic Antagonist (SAMA) Ipratropium
,Oxitropium
Long Acting Muscarinic Antagonists (LAMA) Tiotropium,
Aclidinium, glycopyronnium,Umeclidinium)
SABA & SAMA for short term use in acute cases
LABA & LAMA for long term maintenance therapy
35. MABAs are a type of agent that have both
β2-agonist and anticholinergic activity in one
drug.
59. This is probably the group in which triple therapy may be very effective
60. Smoking is by far
recognized to be most important risk
factor for development of COPD
61. But smoking is not the only risk factor!
Biomass smoke
Occupational exposure
Outdoor pollution
3 billion people exposed to biomass fuel
worldwide
Long-term exposure to ambient air pollutants
increased the risk of COPD by 2-fold
Eur J Epidemiol 2003; 18: 45-53 , JAPI 2012; 60 (Suppl):5-7
62. Non smokers reported greater lifetime burdens of respiratory
disease
10-12% of individuals with COPD have never smoked
Indian Edition /Vol.4,No.1,2014
63. COPD in non smokers
• In INSEARCH phase II study, approximately
60% of chronic bronchitis patients were
nonsmokers.
• Respiratory symptoms were reported in 13%
of 3,608 nonsmoking women involved in
domestic cooking.
64. • Mosquito coil
One mosquito coil emitts particulate matter equivalent to those with
around 100 cigarettes
• Pulmonary tuberculosis
Prevalence of airflow obstruction varies from 28 to 68%.
• Asthma
10-fold increased risk of chronic bronchitis and 17-fold increased risk of
emphysema
• Alpha-1 antitrypsin deficiency and other genetic factors
COPD in non smokers:
Other causes
65. 25 years of COPD Management
1990-2015
1990s:
Salbutamol
Theophyllin
Steroids alone with
salbutamol
LABA :salmeterol or
formeterol
anticholinergics
2015:
Anticholinergics
LABA
SR Theophyllin
ICS alone or in
combination with
LABA
Salbutamol only need
based
67. Dual bronchodilation vs an ICS-LABA
in milder patients in patients with more severe disease
Both studies showed that LABA/LAMA seems to be more efficient than
the LABA-ICS combinations.
69. Cochrane Database Syst Rev. 2013 Nov 28;11:CD009764.
Prophylactic antibiotic therapy for chronic obstructive pulmonary disease (COPD).
Herath SC1, Poole P.
• Seven RCTs involving 3170 patients were included in this systematic review. All
studies were published between 2001 and 2011.
• The antibiotics investigated were azithromycin, erythromycin, clarithromycin and
moxifloxacin.
• With use of continuous prophylactic antibiotics the number of patients
experiencing an exacerbation was reduced (odds ratio (OR) 0.55; 95% confidence
interval (CI) 0.39 to 0.77, 3 studies, 1262 participants, high quality).
• Use of continuous prophylactic antibiotics results in a clinically significant benefit
in reducing exacerbations in COPD patients. All trials of
continuous antibiotics used macrolides hence the noted benefit applies only to the
use of continuous macrolide antibiotics. The impact of pulsed antibiotics remains
uncertain and requires further research.The
Use of continuous prophylactic antibiotics results in a
clinically significant benefit in reducing exacerbations
in COPD patients.
70. Respir Med. 2013 Sep;107(9):1385-92. doi: 10.1016/j.rmed.2013.05.004. Epub 2013 Jun 12.
A meta-analysis on the prophylactic use of macrolide antibiotics for the prevention
of disease exacerbations in patients with Chronic Obstructive Pulmonary Disease.
Donath E1, Chaudhry A, Hernandez-Aya LF, Lit L.
• INTRODUCTION:
• Macrolides are of unique interest in preventing COPD exacerbations because they possess a variety of antibacterial, antiviral and anti-inflammatory
properties. Recent research has generated renewed interest in prophylactic macrolides to reduce the risk of COPD exacerbations. Little is known about
how well these recent findings fit within the context of previous research on this subject. The purpose of this article is to evaluate, via exploratory meta-
analysis, whether the overall consensus favors prophylactic macrolides for prevention of COPD exacerbations.
• METHODS:
• EMBASE, Cochrane and Medline databases were searched for all relevant randomized controlled trials (RCTs). Six RCTs were identified. The primary
endpoint was incidence of COPD exacerbations. Secondary endpoints including mortality, hospitalization rates, adverse events and likelihood of having at
least one COPD exacerbation were also examined.
• RESULTS:
• There was a 37% relative risk reduction (RR = 0.63, 95% CI: 0.45-0.87, p value = 0.005) in COPD exacerbations among patients taking macrolides compared
to placebo. Furthermore, there was a 21% reduced risk of hospitalization (RR = 0.79, 95% CI: 0.69-0.90, p-value = 0.01) and 68% reduced risk of having at
least one COPD exacerbation (RR = 0.34, 95% CI 0.21-0.54, p-value = 0.001) among patients taking macrolides versus placebo. There was also a trend
toward decreased mortality and increased adverse events among patients taking macrolides but these were not statistically significant.
• CONCLUSIONS:
• Prophylactic macrolides are an effective approach for reducing incident COPD exacerbations. There were several limitations to this study including a lack
of consistent adverse event reporting and some degree of clinical and statistical heterogeneity between studies
There was a 37% relative risk reduction (RR = 0.63, 95% CI: 0.45-0.87,
p value = 0.005) in COPD exacerbations among patients taking
macrolides compared to placebo. Furthermore, there was a 21%
reduced risk of hospitalization
71. PLoS One. 2015 Mar 26;10(3):e0121257. doi: 10.1371/journal.pone.0121257. eCollection 2015.
Prophylactic use of macrolide antibiotics for the prevention of chronic obstructive pulmonary disease
exacerbation: a meta-analysis.
Ni W1, Shao X1, Cai X1, Wei C1, Cui J1, Wang R2, Liu Y1.
• BACKGROUND:
• Acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) can lead to high frequencies and rates of hospitalization and mortality.
Macrolides are a class of antibiotics that possess both antimicrobial and anti-inflammatory properties. Since the occurrence of AECOPDs is
associated with aggravation of airway inflammation and bacterial infections, prophylactic macrolide treatment may be an effective approach
towards the prevention of AECOPDs.
• METHODS:
• We systemically searched the PubMed, Embase and Cochrane Library databases to identify randomized controlled trials (RCTs) that evaluated the
effect of prophylactic macrolide therapy on the prevention of AECOPDs. The primary outcomes were the total number of patients with one or more
exacerbations as well as the rate of exacerbations per patient per year.
• RESULTS:
• Nine RCTs comprising 1666 patients met the inclusion criteria. Pooled evidence showed macrolides could reduce the frequency of exacerbations in
patients with COPD by both unweighted (RR = 0.70; 95% CI: 0.56-0.87; P < 0.01) and weighted approaches (RR = 0.58, 95% CI: 0.43-0.78, P < 0.01).
Subgroup analysis showed only 6-12 months of erythromycin or azithromycin therapy could be effective. Moreover, among studies with 6-12
months of azithromycin therapy, both the daily dosing regimen and the intermittent regimen significantly reduced exacerbation rates. The overall
number of hospitalizations and the all-cause rate of death were not significantly different between the treatment and control groups. A tendency for
more adverse events was found in the treatment groups (OR = 1.55, 95%CI: 1.003-2.39, P = 0.049).
• CONCLUSIONS:
• Our results suggest 6-12 months erythromycin or azithromycin therapy could effectively reduce the frequency of exacerbations in patients
with COPD. However, Long-term treatment may bring increased adverse events and the emergence of macrolide-resistance. A recommendation for
the prophylactic use of macrolide therapy should weigh both the advantages and disadvantages.
6-12 months erythromycin or azithromycin therapy could
effectively reduce the frequency of exacerbations in patients
with COPD
73. Int J Chron Obstruct Pulmon Dis. 2014 Aug 6;9:825-36. doi: 10.2147/COPD.S51057. eCollection 2014.
Update on the pathological processes, molecular biology, and clinical utility of N-acetylcysteine
in chronic obstructive pulmonary disease.
Tse HN1, Tseng CZ1.
N-acetylcysteine (NAC) is a mucolytic agent with both antioxidant and anti-inflammatory
properties. This paper also reviews the use of NAC in patients with COPD, especially the dose-
dependent properties of NAC, eg, its effects on lung function and the exacerbation rate in
patients with the disease. Earlier data from BRONCUS (the Bronchitis Randomized on NAC Cost-
Utility Study) did not suggest that NAC was beneficial in patients with COPD, only indicating that
it reduced exacerbation in an "inhaled steroid-naïve" subgroup. With regard to the dose-
dependent properties of NAC, two recent randomized controlled Chinese trials suggested that
high-dose NAC (1,200 mg daily) can reduce exacerbations in patients with COPD, especially in
those with an earlier (moderately severe) stage of disease, and also in those who are at high risk
of exacerbations. However, there was no significant effect on symptoms or quality of life in
patients receiving NAC. Further studies are warranted to investigate the effect of NAC at higher
doses in non-Chinese patients with COPD.
High-dose NAC (1,200 mg daily) can reduce
exacerbations in patients with COPD, especially in those
with an earlier (moderately severe) stage of disease, and
also in those who are at high risk of exacerbations.
75. Int J Clin Pract. 2008 Sep;62(9):1373-8.
Statins may reduce episodes of exacerbation and the requirement for intubation in patients
with COPD: evidence from a retrospective cohort study.
Blamoun AI1, Batty GN, DeBari VA, Rashid AO, Sheikh M, Khan MA.
• This is a retrospective cohort study of 185 patients with COPD exacerbation, with a 1-year follow-up. Outcomes examined
were repeat hospitalisation and intubations for COPD exacerbation. Baseline characteristics for which the p-value was < or =
0.10 were considered as covariates for inclusion in a multivariate model.
• RESULTS:
• The statin group had fewer episodes of exacerbation and required intubation fewer times than the subjects not
receiving statins (p < 0.0001 for both outcomes). Unadjusted odds ratios (OR) for no statin use vs. statin use were 9.54 (95%
CI: 4.54-20.02) for exacerbation and 10.47 (CI: 4.56-24.01) for intubation. The OR, adjusted for the use of angiotensin-
converting enzyme inhibitors or angiotensin receptor blockers (ORa), were 2.35 (CI: 1.01-5.50) for non-statin users
exhibiting an exacerbation and 10.36 (CI: 2.77-38.76) for this group requiring intubation, compared with statin users.
Similarly, ORa for long-acting beta(2) agonists as a covariate were 3.01 (CI: 1.46-6.10) for exacerbation and 8.89 (CI: 3.67-
21.32) for intubation. Time to outcome during the observation period was reduced by statins with the hazard ratio (HR) for
exacerbation of 0.19 (CI: 0.06-0.14); HR for statins reducing intubation was 0.14 (95% CI: 0.10-0.30).
• CONCLUSIONS:
• These data suggest that the use of statins may be associated with lower incidence of both exacerbations and
intubations in patients with COPD.
These data suggest that the use of statins may be
associated with lower incidence of both exacerbations and
intubations in patients with COPD.
76. Chest. 2009 Sep;136(3):734-43. doi: 10.1378/chest.09-0194. Epub 2009 Apr 17.
Statins in COPD: a systematic review.
Janda S1, Park K, FitzGerald JM, Etminan M, Swiston J.
• The 3-hydroxy 3-methylglutaryl coenzyme A reductase inhibitors (ie, statins) are widely used for the treatment of patients with
hypercholesterolemia and cardiovascular disease. Emerging evidence suggests a beneficial effect of statins on the morbidity and mortality
of patients with COPD. The objective of this study was to perform a systematic review of the literature evaluating the effect of statin therapy
on outcomes in patients with COPD.
• METHODS:
• Medline, Excerpta Medica Database, PapersFirst, and the Cochrane collaboration and Cochrane Register of controlled trials were searched.
Randomized controlled trials (RCTs), observational cohort studies, case-control studies, and population-based analyses were considered for
inclusion.
• RESULTS:
• Nine studies were identified for review (four retrospective cohorts, one nested case-control study of a retrospective cohort, one
retrospective cohort and case series, two population-based analyses, and one RCT). All studies showed a benefit from statin therapy for
various outcomes in COPD patients, including the number of COPD exacerbations (n = 3), the number of and time to COPD-related
intubations (n = 1),pulmonary function (eg, FEV(1) and FVC) [n = 1], exercise capacity (n = 1), mortality from COPD (n = 2), and all-cause
mortality (n = 3). No studies describing a negative or neutral effect from statin therapy on outcomes in COPD patients were identified.
• CONCLUSIONS:
• The current literature collectively suggests that statins may have a beneficial role in the treatment of COPD. However, the majority of
published studies have inherent methodological limitations of retrospective studies and population-based analyses. There is a need for
prospective interventional trials designed specifically to assess the impact of statins on clinically relevant outcomes in COPD.
The current literature collectively suggests that statins may
have a beneficial role in the treatment of COPD.
78. PLoS One. 2014 Nov 26;9(11):e113048. doi: 10.1371/journal.pone.0113048. eCollection 2014.
Beta-blockers reduced the risk of mortality and exacerbation in patients with COPD: a meta-
analysis of observational studies.
Du Q1, Sun Y1, Ding N1, Lu L1, Chen Y1.
• An extensive search of the EMBASE, MEDLINE and Cochrane was performed to retrieve the
studies of beta-blockers treatment in patients with COPD. The random effects model meta-
analysis was used to evaluate effect on overall mortality and exacerbation of COPD.
• Fifteen original observational cohort studies with a follow-up time from 1 to 7.2 years were
included. The results revealed that beta-blockers treatment significantly decreased the risk of
overall mortality and exacerbation of COPD. The relative risk (RR) for overall mortality was 0.72
(0.63 to 0.83), and for exacerbation of COPD was 0.63 (0.57 to 0.71). In subgroup analysis
of COPD patients with coronary heart disease or heart failure, the risk for overall mortality was
0.64 (0.54-0.76) and 0.74 (0.58-0.93), respectively.
• The findings of this meta-analysis confirmed that beta-blocker use in patients
with COPD may not only decrease the risk of overall mortality but also reduce the
risk of exacerbation of COPD. Beta-blocker prescription for cardiovascular diseases
needs to improve in COPD patients.
Beta-blocker use in patients with COPD may not only
decrease the risk of overall mortality but also reduce the risk
of exacerbation of COPD.
79. Ann Pharmacother. 2004 Jan;38(1):142-5.
Use of beta-blockers in patients with COPD.
Andrus MR1, Holloway KP, Clark DB.
• To evaluate the safety and cardiovascular benefits of beta-blocker therapy in patients
with chronic obstructive pulmonary disease(COPD).
• DATA SOURCES:
• Clinical literature was accessed through MEDLINE (1966-February 2003). Key search
terms included chronic obstructive pulmonary disease and adrenergic beta-
antagonists.
• DATA SYNTHESIS:
• beta-Blockers are often avoided in patients with COPD because of fear of
bronchoconstriction, despite the known cardiovascular mortality benefits. A review of
studies evaluating the use of beta-blockers in COPD was undertaken.
• CONCLUSIONS:
• The literature supports the safety and mortality benefits of using beta-blockers
in COPD. Patients with mild to moderate COPDshould receive cardioselective
beta-blocker therapy when a strong indication exists.
The literature supports the safety and mortality benefits of using
beta-blockers in COPD. Patients with mild to moderate COPD
should receive cardioselective beta-blocker therapy when a strong
indication exists.
81. Respir Res. 2014 Dec 13;15(1):131. doi: 10.1186/s12931-014-0131-0.
Severe vitamin D deficiency is associated with frequent exacerbations and
hospitalization in COPD patients.
Malinovschi A1, Masoero M2, Bellocchia M3, Ciuffreda A4, Solidoro P5, Mattei A6, Mercante L7, Heffler E8, Rolla G9, Bucca C10.
• Serum vitamin D (25-hydroxyvitamin D) levels were measured in 97 COPD patients and
related to lung function, comorbidities, FEV1 decline, AECOPD and hospital admission during
the previous year.
• Most patients (96%) had vitamin D deficiency, which was severe in 35 (36%). No significant
relationship was found between vitamin Dand FEV1 or annual FEV1 decline. No difference
between patients with and without severe vitamin D deficiency was found in age, gender,
BMI, smoking history, lung function, and comorbidities, apart from osteoporosis (60.9% in
severe deficiency vs 22.7%, p=0.001). In multiple logistic regression models, severe
deficiency was independently associated with AECOPD [adjusted odds ratios (aOR) of 30.5
(95% CI 5.55, 168), p<0.001] and hospitalization [aOR 3.83 (95% CI 1.29, 11.4), p=0.02]. The
odds ratio of being a frequent exacerbator if having severe vitamin Ddeficiency was 18.1
(95% CI 4.98, 65.8) (p<0.001), while that of hospitalization was 4.57 (95% CI 1.83, 11.4) (p=
0.001).
• In COPD patients severe vitamin D deficiency was related to more
frequent disease exacerbations and hospitalization.
In COPD patients severe vitamin D deficiency was related
to more frequent disease exacerbations and hospitalization.
82. American Journal of Respiratory and Critical Care Medicine, Vol. 185, No. 3 (2012),
Vitamin D and Chronic Obstructive Pulmonary Disease: Justified Optimism or
False Hope?
Seif O. Shaheen Ph.D. , and Adrian R. Martineau Ph.D.
•Data from observational studies are conflicting, both from studies of patients
with COPD and from population-based research.
•A recent cross-sectional study observed a positive association between 25(OH)D
concentrations and FEV1 in patients with COPD (12). In contrast, a longitudinal
study of continuous smokers with COPD found no difference in baseline 25(OH)D
concentrations between individuals who had a rapid decline in lung function and
those with a slow decline
•To date, population-based data on the relation of 25(OH)D to lung function
decline are lacking, although preliminary data, reported in the form of an
abstract, have suggested a possible relation between lower vitamin D status and
faster decline in the FEV1/FVC ratio (but not FEV1) in an elderly population (16).
To date, population-based data on the relation of 25(OH)D to lung
function decline are lacking, although preliminary data suggested a
possible relation between lower vitamin D status and faster decline in
the FEV1/FVC ratio (but not FEV1) in an elderly population.
In India, 70% of the homes use biomass fuel for cooking and heating purposes in poorly ventilated kitchens, and the amount of particulate matter pollution generated by the burning of biomass fuel is extremely high. Ninety percent of rural households and 32% of urban households cook their meals on a biomass stove
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What&apos;s Hot in Nebs and Meds
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The NHLBI/WHO guidelines for the diagnosis, treatment and management of COPD, otherwise known as the GOLD guidelines, outline approaches that define severity of disease by pulmonary function, FEV1, and symptoms.
These guidelines then outline appropriate medial therapy for patients at each level of severity, in a cumulative fashion.
All patients, starting at Stage I, or mild COPD, should have efforts to reduce risk factors, the primary issue here being smoking, influenza vaccine, and short-acting bronchodilators to use when needed.
At Stage II, or moderate COPD, and above, regular treatment with one or more bronchodilators and rehabilitation should be added to the care regimen
At Stage III, or severe COPD, and above, inhaled glucocorticosteriods should be added if patients have repeated exacerbations.
At Stage IV, or very severe COPD, and above, long-term oxygen should be added if patients have chronic respiratory failure, and surgical options should be considered.
BROVANA is an appropriate medicine to consider for patients with moderate and above COPD who are not adequately controlled with or who overuse SABAs.