Current Issue : January - March Volume : 2018 Issue Number : 1 Articles : 6 Articles
Background: The most commonly applied treatment for acute exacerbations of chronic obstructive pulmonary\ndisease (AECOPD) is a 5-day course of high-dose systemic corticosteroids. However, this treatment has not been\nshown to reduce mortality and can potentially have serious side effects.\nRecent research has shown that, presumably, only a subgroup of COPD patients identifieable by blood eosinophil count\nbenefit from a rescue course of prednisolone. By applying a biomarker-guided strategy, the aim of this study is to determine\nwhether it is possible to reduce the use of systemic corticosteroids in AECOPD without influencing the outcome.\nMethods: This is an ongoing prospective multicenter randomized controlled open label trial comprising 320 patients with\nAECOPD recruited from four hospitals in Denmark. The patients are randomized 1:1 to either standard care or eosinophilguided\ncorticosteroid-sparing therapy where prednisolone is not administered if the daily blood sampling reveals an eosinophil\nlevel below 0.3 Ã?â?? 109 cells/L. The primary endpoint is length of hospital stay within 14 days after recruitment. The secondary\nendpoints are treatment failure, 30-day mortality rate, COPD related re-admission rate, change in FEV1, and a number of\nadverse effect measures obtained within 3 months after the index hospitalisation date related to corticosteroid usage.\nDiscussion: This will be a very large RCT providing knowledge about the effectiveness of individualized biomarker-guided\ncorticosteroid therapy in hospitalised patients with AECOPD....
Background: Decorin is one of the most abundant proteoglycans of the extracellular matrix and is mainly secreted\nand deposited in the interstitial matrix by fibroblasts where it plays an important role in collagen turnover and\ntissue homeostasis. Degradation of decorin might disturb normal tissue homeostasis contributing to extracellular\nmatrix remodeling diseases. Here, we present the development and validation of a competitive enzyme-linked\nimmunosorbent assay (ELISA) quantifying a specific fragment of degraded decorin, which has potential as a novel\nnon-invasive serum biomarker for fibrotic lung disorders.\nMethods: A fragment of decorin cleaved in vitro using human articular cartilage was identified by mass-spectrometry\n(MS/MS). Monoclonal antibodies were raised against the neo-epitope of the cleaved decorin fragment and a competitive\nELISA assay (DCN-CS) was developed. The assay was evaluated by determining the inter- and intra-assay precision,\ndilution recovery, accuracy, analyte stability and interference. Serum levels were assessed in lung cancer patients,\npatients with idiopathic pulmonary fibrosis (IPF), patients with chronic obstructive pulmonary disease (COPD) and\nhealthy controls.\nResults: The DCN-CS ELISA was technically robust and was specific for decorin cleaved by cathepsin-S. DCN-CS\nwas elevated in lung cancer patients (p < 0.0001) and IPF patients (p < 0.001) when compared to healthy\ncontrols. The diagnostic power for differentiating lung cancer patients and IPF patients from healthy controls\nwas 0.96 and 0.77, respectively.\nConclusion: Cathepsin-S degraded decorin could be quantified in serum using the DCN-CS competitive ELISA.\nThe clinical data indicated that degradation of decorin by cathepsin-S is an important part of the pathology of\nlung cancer and IPF....
Background. St. Joseph�s Health System has implemented an integrated comprehensive care bundle care (ICC) program with the\nhopes that it would improve patients� care while reducing overall costs. The aim of this analysis was to evaluate the performance\nof the ICC program within patients admitted with chronic pulmonary obstructive disease (COPD). Methods. We conducted\na retrospective observational cohort study comparing ICC patients to non-ICC patients admitted to St. Joseph�s Healthcare\nHamilton for COPD being discharged with support services between June 2012 and March 2015, using administrative data.\nConfounding adjustment was achieved through the use of propensity score matching. Medical resource utilizations during the\ninitial hospitalization and within the 60 days following discharge were compared using regression models. Results. All 76 patients\nwho entered the ICC program (100.0%) were matched 1 : 1 to 76 eligible non-ICC patients (28.4%). Length of stay (6.47 [7.29]\nversus 9.55 [10.21] days) and resource intensity weights (1.16 [0.80] versus 1.64 [1.69]) were lower in the ICC group within the initial\nhospitalization but, while favoring the ICC program, healthcare resource use tended not to differ statistically following discharge.\nInterpretation. The ICC program was able to reduce initial medical resource utilization without increasing subsequent medical\nresource use....
Background: Physical activity (PA) is associated with disease severity in idiopathic pulmonary fibrosis (IPF), but\nlongitudinal studies evaluating its prognostic value and changes over time are lacking.\nMethods: We measured PA (steps per day, SPD) in a cohort of 46 IPF-patients (mean age, 67 years; mean FVC, 76.\n1%pred.) by accelerometry at baseline, recorded survival status during 3 years follow-up and repeated measurements\nin survivors. We compared the prognostic value of PA to established mortality predictors including lung function\n(FVC, DLCO) and 6-min walking-distance (6MWD).\nResults: During follow-up (median 34 months) 20 patients (43%) died. SPD and FVC best identified non-survivors\n(AUROC-curve 0.79, p < 0.01). After adjustment for confounders (sex, age, therapy), a standardized increase (i.e. one SD)\nin SPD, FVC%pred. or DLCO%pred. was associated with a more than halved risk of death (HR < 0.50; p < 0.01).\nCompared to baseline, SPD, FVC, and 6MWD annually declined in survivors by 973 SPD, 130 ml and 9 m, resulting in\nrelative declines of 48.3% (p < 0.001), 13.3% (p < 0.001) and 7.8% (p = 0.055), respectively.\nConclusion: While PA predicts mortality of IPF patients similar to established functional measures, longitudinal decline\nof PA seems to be disproportionally large. Our data suggest that the clinical impact of disease progression could be\nunderestimated by established functional measures....
Background: Asthma exacerbation may require a visit to the emergency room as well as hospitalization and can\noccasionally be fatal. However, there is limited information about the prognostic factors for asthma exacerbation\nrequiring hospitalization, and no methods are available to predict an inpatientââ?¬â?¢s prognosis. We investigated the\nclinical features and factors affecting in-hospital mortality of patients with asthma exacerbation and generated a\nnomogram to predict in-hospital death using a national inpatient database in Japan.\nMethods: We retrospectively collected data concerning hospitalization of adult patients with asthma exacerbation\nbetween July 2010 and March 2013 using the Japanese Diagnosis Procedure Combination database. We recorded\npatient characteristics and performed Cox proportional hazards regression analysis to assess the factors associated\nwith all-cause in-hospital mortality. Then, we constructed a nomogram to predict in-hospital death.\nResults: A total of 19,684 patients with asthma exacerbation were identified; their mean age was 58.8 years\n(standard deviation, 19.7 years) and median length of hospital stay was 8 days (interquartile range, 5ââ?¬â??12 days).\nAmong study patients, 118 died in the hospital (0.6%). Factors associated with higher in-hospital mortality\nincluded older age, male sex, reduced level of consciousness, pneumonia, and heart failure. A nomogram was\ngenerated to predict the in-hospital death based on the existence of seven variables at admission. The nomogram\nallowed us to estimate the probability of in-hospital death, and the calibration plot based on these results was well\nfitted to predict the in-hospital prognosis. Conclusion: Our nomogram allows physicians to predict individual risk of in-hospital death in patients with asthma\nexacerbation...
We report the case of a patient with pulmonary fibrosis, developed as an adverse\nreaction to nitrofurantoin therapy received for totally 6 months for the\nprevention of recurrent urinary tract infections. Chest X-ray and CT scan revealed\nextensive elements of interstitial pulmonary fibrosis. After diagnosis,\nadministration of nitrofurantoin was immediately stopped; and specific prolonged\ntherapy with low-dose corticosteroids per os and inhaled steroids were\nadministered. The patient responded successfully both clinically and biochemically\nand possible digestive system side effects were prevented through the\nadministration of gastroprotection medication. For the prevention of urinary\ntract infection, the patient received well tolerated therapy with fosfomycin\nwhich was further continued as a prophylactic agent....
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