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BMJ Open Respiratory Research Apr 2024Chronic obstructive pulmonary disease (COPD) is a multisystem disease, and many patients have multiple conditions. We explored multimorbidity patterns that might inform...
Modifiable risk factors that may be addressed in routine care to prevent progression to and extension of multimorbidity in people with COPD: a systematic literature review.
Chronic obstructive pulmonary disease (COPD) is a multisystem disease, and many patients have multiple conditions. We explored multimorbidity patterns that might inform intervention planning to reduce health-care costs while preserving quality of life for patients. Literature searches up to February 2022 revealed 4419 clinical observational and comparative studies of risk factors for multimorbidity in people with COPD, pulmonary emphysema, or chronic bronchitis at baseline. Of these, 29 met the inclusion criteria for this review. Eight studies were cluster and network analyses, five were regression analyses, and 17 (in 16 papers) were other studies of specific conditions, physical activity and treatment. People with COPD more frequently had multimorbidity and had up to ten times the number of disorders of those without COPD. Disease combinations prominently featured cardiovascular and metabolic diseases, asthma, musculoskeletal and psychiatric disorders. An important risk factor for multimorbidity was low socioeconomic status. One study showed that many patients were receiving multiple drugs and had increased risk of adverse events, and that 10% of medications prescribed were inappropriate. Many patients with COPD have mainly preventable or modifiable multimorbidity. A proactive multidisciplinary approach to prevention and management could reduce the burden of care.
Topics: Humans; Disease Progression; Multimorbidity; Pulmonary Disease, Chronic Obstructive; Quality of Life; Risk Factors
PubMed: 38653506
DOI: 10.1136/bmjresp-2023-002272 -
Cureus Feb 2024Vanishing lung syndrome (VLS), also known as idiopathic giant bullous emphysema, is defined by the emergence of sizable bullae causing compression on healthy lung...
Vanishing lung syndrome (VLS), also known as idiopathic giant bullous emphysema, is defined by the emergence of sizable bullae causing compression on healthy lung tissue. The elusive etiology of VLS mandates a diagnosis based on radiographic evidence showcasing giant bullae occupying at least one-third of the hemithorax in one or both lungs. This report presents a case of VLS in a 36-year-old female smoker devoid of any prior medical history. Additionally, we conducted a systematic review to discern the demographics, risk factors, and treatment modalities for individuals diagnosed with VLS.
PubMed: 38314388
DOI: 10.7759/cureus.53443 -
BMC Pulmonary Medicine Oct 2023Coronavirus disease 2019 (COVID-19) has posed increasing challenges to global health systems. We aimed to understand the effects of pulmonary air leak (PAL), including... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Coronavirus disease 2019 (COVID-19) has posed increasing challenges to global health systems. We aimed to understand the effects of pulmonary air leak (PAL), including pneumothorax, pneumomediastinum and subcutaneous emphysema, on patients with COVID-19.
METHODS
We searched PubMed, Embase and Web of Science for data and performed a meta-analysis with a random-effects model using Stata 14.0. This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS
Thirty-five articles were included in the meta-analysis. The data came from 14 countries and included 3,047 COVID-19 patients with PAL, 11,3679 COVID-19 patients without PAL and 361 non-COVID-19 patients with PAL. We found that the incidence of PAL was much higher in COVID-19 patients than in non-COVID-19 patients (odds ratio (OR) = 6.13, 95% CI: 2.09-18.00). We found that the group of COVID-19 patients with PAL had a longer hospital stay (standardized mean difference (SMD) = 0.79, 95% CI: 0.27-1.30) and intensive care unit (ICU) stay (SMD = 0.51, 95% CI: 0.19-0.83) and comprised more ICU (OR = 15.16, 95% CI: 6.51-35.29) and mechanical ventilation patients (OR = 5.52, 95% CI: 1.69-17.99); furthermore, the mortality rate was also higher (OR = 2.62, 95% CI: 1.80-3.82).
CONCLUSIONS
Patients with lung injuries caused by COVID-19 may develop PAL. COVID-19 patients with PAL require more medical resources, have more serious conditions and have worse clinical outcomes.
PROSPERO REGISTRATION NUMBER
CRD42022365047.
Topics: Humans; COVID-19; Length of Stay; Pneumothorax
PubMed: 37858100
DOI: 10.1186/s12890-023-02710-2 -
Journal of Thoracic Disease Jul 2023Lung volume reduction (LVR) and lung transplantation (LTx) have been used in different populations of chronic obstructive pulmonary disease (COPD) patients. To date,...
BACKGROUND
Lung volume reduction (LVR) and lung transplantation (LTx) have been used in different populations of chronic obstructive pulmonary disease (COPD) patients. To date, comparative study of LVR and LTx has not been performed. We sought to address this gap by pooling the existing evidence in the literature.
METHODS
An electronic search was performed to identify all prospective studies on LVR and LTx published since 2000. Baseline characteristics, perioperative variables, and clinical outcomes were extracted and pooled for meta-analysis.
RESULTS
The analysis included 65 prospective studies comprising 3,671 patients [LTx: 15 studies (n=1,445), LVR: 50 studies (n=2,226)]. Mean age was 60 [95% confidence interval (CI): 58-62] years and comparable between the two groups. Females were 51% (95% CI: 30-71%) in the LTx group 28% (95% CI: 21-36%) in LVR group (P=0.05). Baseline 6-minute walk test (6MWT) and pulmonary function tests were comparable except for the forced expiratory volume in 1 second (FEV1), which was lower in the LTx group [21.8% (95% CI: 16.8-26.7%) 27.3% (95% CI: 25.5-29.2%), P=0.04]. Postoperatively, both groups experienced improved FEV1, however post-LTx FEV1 was significantly higher than post-LVR FEV1 [54.9% (95% CI: 41.4-68.4%) 32.5% (95% CI: 30.1-34.8%), P<0.01]. 6MWT was also improved after both procedures [LTx: 212.9 (95% CI: 119.0-306.9) to 454.4 m (95% CI: 334.7-574.2), P<0.01; LVR: 286 (95% CI: 270.2-301.9) to 409.1 m (95% CI: 392.1-426.0), P<0.01], however, with no significant difference between the groups. Pooled survival over time showed no significant difference between the groups.
CONCLUSIONS
LTx results in better FEV1 but otherwise has comparable outcomes to LVR.
PubMed: 37559607
DOI: 10.21037/jtd-23-63 -
BMJ Open Jun 2023Studies have suggested contradictory results on the relationship between chronic obstructive pulmonary disease (COPD) and periodontal disease (PD). The aim of this study... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Studies have suggested contradictory results on the relationship between chronic obstructive pulmonary disease (COPD) and periodontal disease (PD). The aim of this study was to determine whether PD increased the risk of COPD and COPD-related clinical events.
DESIGN
A systematic review and meta-analysis.
DATA SOURCES
PubMed, Ovid EMBASE and Ovid CENTRAL were searched from inception to 22 February 2023.
ELIGIBILITY CRITERIA FOR STUDIES
We included trials and observational studies evaluating association of PD with the risk of COPD or COPD-related events (exacerbation and mortality), with statistical adjustment for smoking.
DATA EXTRACTION AND SYNTHESIS
Two investigators independently extracted data from selected studies using a standardised Excel file. Quality of studies was evaluated using the Newcastle-Ottawa Scale. OR with 95% CI was pooled in a random-effect model with inverse variance method.
RESULTS
22 observational studies with 51 704 participants were included. Pooled analysis of 18 studies suggested that PD was weakly associated with the risk of COPD (OR: 1.20, 95% CI 1.09 to 1.32). However, in stratified and subgroup analyses, with strict adjustment for smoking, PD no longer related to the risk of COPD (adjusting for smoking intensity: OR: 1.14, 95% CI 0.86 to 1.51; smokers only: OR: 1.46, 95% CI 0.92 to 2.31; never smokers only: OR: 0.93, 95% CI 0.72 to 1.21). Moreover, PD did not increase the risk of COPD-related exacerbation or mortality (OR: 1.18, 95% CI 0.71 to 1.97) in the pooled result of four studies.
CONCLUSIONS
This study demonstrates PD confers no risk for COPD and COPD-related events when strictly adjusted by smoking. Large-scale prospective cohort studies with control of potential confounding factors are warranted to validate the present findings.
Topics: Humans; Disease Progression; Quality of Life; Prospective Studies; Pulmonary Disease, Chronic Obstructive; Periodontal Diseases
PubMed: 37369414
DOI: 10.1136/bmjopen-2022-067432 -
Physical Therapy May 2023Pulmonary rehabilitation programs that use minimal equipment for exercise training, rather than gymnasium equipment, would enable delivery of pulmonary rehabilitation to... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Pulmonary rehabilitation programs that use minimal equipment for exercise training, rather than gymnasium equipment, would enable delivery of pulmonary rehabilitation to a greater number of people with chronic obstructive pulmonary disease (COPD). The effectiveness of minimal equipment programs in people with COPD is unclear. This systematic review and meta-analysis aimed to determine the effects of pulmonary rehabilitation using minimal equipment for aerobic and/or resistance training in people with COPD.
METHODS
Literature databases were searched up to September 2022 for randomized controlled trials (RCTs) comparing the effect of minimal equipment programs with usual care or with exercise equipment-based programs for exercise capacity, health-related quality of life (HRQoL), and strength.
RESULTS
Nineteen RCTs were included in the review and 14 RCTs were included in the meta-analyses, which reported low to moderate certainty of evidence. Compared with usual care, minimal equipment programs increased 6-minute walk distance (6MWD) by 85 m (95% CI = 37 to 132 m). No difference in 6MWD was observed between minimal equipment and exercise equipment-based programs (14 m, 95% CI = -27 to 56 m). Minimal equipment programs were more effective than usual care for improving HRQoL (standardized mean difference = 0.99, 95% CI = 0.31 to 1.67) and were not different from exercise equipment-based programs for improving upper limb strength (6 N, 95% CI = -2 to 13 N) or lower limb strength (20 N, 95% CI = -30 to 71 N).
CONCLUSION
In people with COPD, pulmonary rehabilitation programs using minimal equipment elicit clinically significant improvements in 6MWD and HRQoL and are comparable with exercise equipment-based programs for improving 6MWD and strength.
IMPACT
Pulmonary rehabilitation programs using minimal equipment may be a suitable alternative in settings where access to gymnasium equipment is limited. Delivery of pulmonary rehabilitation programs using minimal equipment may improve access to pulmonary rehabilitation worldwide, particularly in rural and remote areas and in developing countries.
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Quality of Life; Resistance Training; Exercise Therapy; Exercise Tolerance
PubMed: 37140475
DOI: 10.1093/ptj/pzad013 -
International Journal of Chronic... 2023Both COPD and interstitial lung abnormalities (ILAs) are conditions associated with smoking and age. The impact of coexistent ILAs on the manifestations and outcomes of...
BACKGROUND
Both COPD and interstitial lung abnormalities (ILAs) are conditions associated with smoking and age. The impact of coexistent ILAs on the manifestations and outcomes of COPD or emphysema awaits evaluation.
METHODS
We searched PubMed and Embase using Medical Subject Headings terms in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
RESULTS
Eleven studies were included in the review. The sample size of the studies ranged from 30 to 9579. ILAs were reported in 6.5% to 25.7% of the patients with COPD/emphysema, higher than that reported in the general populations. COPD/emphysema patients with ILAs were older, mostly male, and had a higher smoking index than those without ILAs. Hospital admission and mortality were increased in COPD patients with ILAs compared to those without ILAs, whereas the frequency of COPD exacerbations was discrepant in 2 of the studies. The FEV and FEV% predicted tended to be higher in the group with ILAs, but not significantly in most of the studies.
CONCLUSION
ILAs were more frequent in subjects with COPD/emphysema than in the general population. ILAs may have a negative impact on hospital admission and mortality of COPD/emphysema. The impact of ILAs on lung functions and exacerbations of COPD/emphysema was discrepant in these studies. Further prospective studies are warranted to provide high-quality evidence of the association and interaction between COPD/emphysema and ILAs.
Topics: Humans; Male; Female; Pulmonary Disease, Chronic Obstructive; Pulmonary Emphysema; Emphysema; Smoking; Lung
PubMed: 36890863
DOI: 10.2147/COPD.S392349 -
Health Science Reports Mar 2023Chronic obstructive pulmonary disease (COPD) is a common disease of the lungs known as the third reason for death worldwide. Frequent COPD exacerbations compel health...
INTRODUCTION
Chronic obstructive pulmonary disease (COPD) is a common disease of the lungs known as the third reason for death worldwide. Frequent COPD exacerbations compel health care workers to apply interventions that are not adverse effect free. Accordingly, adding or replacing Curcumin, a natural meal flavoring, may indicate advantages in this era by its antiproliferative and anti-inflammatory effects.
METHODS
The PRISMA checklist was employed for the systematic review study. On June 3, 2022, PubMed/Medline, Scopus, and Web of Science were searched for studies associated with COPD and Curcumin in the last 10 years. Duplicate or non-English publications and articles with irrelevant titles and abstracts were excluded. Also, preprints, reviews, short communications, editorials, letters to the editor, comments, conference abstracts, and conference papers were not included.
RESULTS
Overall, 4288 publications were found eligible, after the screening, 9 articles were finally included. Among them, one, four, and four in vitro, in vivo, and both in vivo and in vitro research exist respectively. According to the investigations, Curcumin can inhibit alveolar epithelial thickness and proliferation, lessen the inflammatory response, remodel the airway, produce ROS, alleviate airway inflammation, hinder emphysema and prevent ischemic complications.
CONCLUSION
Consequently, the findings of the current review demonstrate that Curcumin's modulatory effects on oxidative stress, cell viability, and gene expression could be helpful in COPD management. However, for data confirmation, further randomized clinical trials are required.
PubMed: 36890804
DOI: 10.1002/hsr2.1145 -
Medicina Clinica Apr 2023Telemedicine is defined as the use of electronic technology for information and communication by healthcare professionals with patients (or care givers) aiming at... (Review)
Review
Telemedicine is defined as the use of electronic technology for information and communication by healthcare professionals with patients (or care givers) aiming at providing and supporting healthcare to patients away from healthcare institutions. This systematic review over the last decade (2013-2022) investigates the use of telemedicine in patients with chronic obstructive pulmonary disease (COPD). We identified 53 publications related to: (1) home tele-monitorization; (2) tele-education and self-management; (3) telerehabilitation; and (4) mobile health (mHealth). Results showed that, although evidence is still weak in many of these domains, results are positive in terms of improvement of health-status, use of health-care resources, feasibility, and patient satisfaction. Importantly, no safety issues were identified. Thus, telemedicine can be considered today as a potential complement to usual healthcare.
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Health Status; Telemedicine; Patient Satisfaction
PubMed: 36801105
DOI: 10.1016/j.medcli.2023.01.008 -
Chronic Respiratory Disease 2022Computed tomography (CT) is commonly utilized in chronic obstructive pulmonary disease (COPD) for lung cancer screening and emphysema characterization. Computed... (Review)
Review
BACKGROUND
Computed tomography (CT) is commonly utilized in chronic obstructive pulmonary disease (COPD) for lung cancer screening and emphysema characterization. Computed tomography-morphometric analysis of body composition (muscle mass and adiposity) has gained increased recognition as a marker of disease severity and prognosis. This systematic review aimed to describe the CT-methodology used to assess body composition and identify the association of body composition measures and disease severity, health-related quality of life (HRQL), cardiometabolic risk factors, respiratory exacerbations, and survival in patients with COPD.
METHODS
Six databases were searched (inception-September 2021) for studies evaluating adult COPD patients using thoracic or abdominal CT-muscle or adiposity body composition measures. The systematic review was conducted in accordance with the PRISMA guidelines.
RESULTS
Twenty eight articles were included with 15,431 COPD patients, across all GOLD stages with 77% males, age range (mean/median 59-78 years), and BMI range 19.8-29.3 kg/m. There was heterogeneity in assessment of muscle mass and adiposity using thoracic ( = 22) and abdominal ( = 8) CT-scans, capturing different muscle groups, anatomic locations, and adiposity compartments (visceral, subcutaneous, and epicardial). Low muscle mass and increased adiposity were associated with increased COPD severity measures (lung function, exercise capacity, dyspnea) and lower HRQL, but were not consistent across studies. Increased visceral adiposity ( = 6) was associated with cardiovascular disease or risk factors (hypertension, hyperlipidemia, and diabetes). Low muscle CSA was prognostic of respiratory exacerbations or mortality in three of six studies, whereas the relationship with increased intermuscular adiposity and greater mortality was only observed in one of three studies.
CONCLUSION
There was significant variability in CT-body composition measures. In several studies, low muscle mass was associated with increased disease severity and lower HRQL, whereas adiposity with cardiovascular disease/risk factors. Given the heterogeneity in body composition measures and clinical outcomes, the prognostic utility of CT-body composition in COPD requires further study.
Topics: Adult; Aged; Body Composition; Body Mass Index; Cardiovascular Diseases; Early Detection of Cancer; Female; Humans; Lung Neoplasms; Male; Middle Aged; Obesity; Pulmonary Disease, Chronic Obstructive; Quality of Life; Tomography, X-Ray Computed
PubMed: 36223552
DOI: 10.1177/14799731221133387