To study whether mortality and cardiovascular morbidity differ in non-invasive ventilation (NIV)-treated patients with severe obesity-hypoventilation syndrome (OHS) as compared with CPAP-treated ...patients with obstructive sleep apnea syndrome (OSAS), and to identify independent predictors of mortality in OHS.
Two retrospective cohorts of OHS and OSAS were matched 1:2 according to sex, age (± 10 year) and length of time since initiation of CPAP/NIV therapy (± 6 months).
Three hundred and thirty subjects (110 patients with OHS and 220 patients with OSAS) were studied. Mean follow-up time was 7 ± 4 years. The five year mortality rates were 15.5% in OHS cohort and 4.5% in OSAS cohort (p< 0.05). Patients with OHS had a 2-fold increase (OR 2; 95% CI: 1.11-3.60) in the risk of mortality and 1.86 fold (OR 1.86; 95% CI: 1.14-3.04) increased risk of having a cardiovascular event. Diabetes, baseline diurnal SaO2 < 83%, EPAP < 7 cmH2O after titration and adherence to NIV < 4 hours independently predicted mortality in OHS.
Mortality of severe OHS is high and substantially worse than that of OSAS. Severe OHS should be considered a systemic disease that encompasses respiratory, metabolic and cardiovascular components that require a multimodal therapeutic approach.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
It was as early as 1959 that the report of the CIBA Symposium described the possible coexistence of different obstructive airway diseases, such as asthma, chronic bronchitis and/or emphysema, in the ...same individual. However, because there were no specific therapies for all these different expressions of lung disease, these overlaps were largely ignored by guidelines. In 1995, the American Thoracic Society chronic obstructive pulmonary disease (COPD) statement included a Venn diagram with the different possible overlaps of clinical presentation of obstructive lung diseases 1, but no specific recommendations of treatment were provided for them. It was not until 2007 that the Canadian COPD guidelines specified that: “if the asthma component (in COPD) is prominent, earlier introduction of inhaled corticosteroids (ICS) may be justified” 2. Later, in 2010, the Japanese guidelines for COPD dedicated a chapter to “Treatment of COPD complicated by asthma” 3. To the best of our knowledge, the Spanish guidelines for COPD (GesEPOC) in 2012 were the first to propose specific criteria for the identification of the so-called asthma–COPD overlap (ACO) 4, 5. Because there was no internationally accepted definition of ACO, a group of experts proposed diagnostic criteria for ACO in COPD 6 and these were adopted in the document. The major criteria were as follows: a very positive bronchodilator response (>400 mL and >15% increase in forced expiratory volume in 1 s (FEV1)), sputum eosinophilia or a previous diagnosis of asthma. Minor criteria were an increased total serum IgE, previous history of atopy or a positive bronchodilator test (>200 mL and >12% in FEV1) on at least two occasions 6. To be diagnosed with ACO, a patient must fulfil two major or one major and two minor criteria. Other national guidelines for COPD, such as the Finnish 7 and the Czech guidelines 8, followed this approach and proposed similar criteria for ACO.
We aimed to describe the differences and similarities between patients with chronic obstructive airway disease classified on the basis of classical diagnostic labels (asthma, chronic obstructive ...pulmonary disease (COPD), or asthma-COPD overlap (ACOS)) or according to the underlying inflammatory pattern (Th-2 signature, either Th-2-high or Th-2-low).We performed a cross-sectional study of patients aged ≥40 years and with a post-bronchodilator forced expiratory volume in 1 s to forced vital capacity ratio ≤0.7 with a previous diagnosis of asthma (non-smoking asthmatics (NSA)), COPD or ACOS, the latter including both smoking asthmatics (SA) and patients with eosinophilic COPD (COPD-e). Clinical, functional and inflammatory parameters (blood eosinophil count, IgE and exhaled nitric oxide fraction (
)) were compared between groups. Th-2 signature was defined by a blood eosinophil count ≥300 cells·μL
and/or a sputum eosinophil count ≥3%.Overall, 292 patients were included in the study: 89 with COPD, 94 NSA and 109 with ACOS (44 SA and 65 with COPD-e). No differences in symptoms or exacerbation rate were found between the three groups. With regards the underlying inflammatory pattern, 94 patients (32.2%) were characterised as Th-2-high and 198 (67.8%) as Th-2-low. The Th-2 signature was found in 49% of NSA, 3.3% of patients with COPD, 30% of SA and 49.3% of patients with COPD-e. This classification yielded significant differences in demographic, functional and inflammatory characteristics.We conclude that a classification based upon the inflammatory profile, irrespective of the taxonomy, provides a more clear distinction of patients with chronic obstructive airway disease.
Severe asthma imposes a significant burden on patients, families and healthcare systems. Management is difficult, due to disease heterogeneity, co‐morbidities, complexity in care pathways and ...differences between national or regional healthcare systems. Better understanding of the mechanisms has enabled a stratified approach to the management of severe asthma, supporting the use of targeted treatments with biologicals. However, there are still many issues that require further clarification. These include selection of a certain biological (as they all target overlapping disease phenotypes), the definition of response, strategies to enhance the responder rate, the duration of treatment and its regimen (in the clinic or home‐based) and its cost‐effectiveness. The EAACI Guidelines on the use of biologicals in severe asthma follow the GRADE approach in formulating recommendations for each biological and each outcome. In addition, a management algorithm for the use of biologicals in the clinic is proposed, together with future approaches and research priorities.
To assess the outcome of 54 patients with obesity-hypoventilation syndrome (OHS) who were treated with nasal intermittent positive-pressure ventilation (NIPPV)
Descriptive analysis of retrospectively ...collected clinical data
From March 1995 to December 2002, OHS (defined as a body mass index BMI of > 30 kg/m2, a daytime Paco2of ≥ 50 mm Hg, and a Pao2of < 60 mm Hg in the absence of COPD) was diagnosed in 69 cases. Fifteen patients (21.7%) refused to be treated with NIPPV, and 20 patients were started on NIPPV therapy electively and 34 following an acute exacerbation. We employed daytime arterial blood gas values and overnight pulse oximetry to determine the initial NIPPV modes and settings. The outcome measures were survival, clinical status, and arterial blood gas levels
Among the 54 study patients (18 women), the mean (± SD) age was 56 ± 13 years. The mean BMI was 44 ± 8.8 kg/m2. Sleep apnea syndrome (apnea-hypopnea index, > 5) was present in 87% of the patients. At presentation, 22 of the 54 patients had experienced an acute hypercapnic respiratory failure (pH < 7.34). None of these patients required orotracheal intubation after NIPPV treatment. Initially, 2 patients were treated with volume-preset ventilation, 49 patients used pressure-preset equipment, and 3 patients employed continuous positive airway pressure (CPAP). Forty-seven patients required supplemental oxygen. At the end of the follow-up period (mean duration, 50 months), Pao 2had increased by 24 mm Hg from baseline (95% confidence interval CI, 21 to 28 mm Hg; p < 0.0001) and Paco 2had decreased by 17 mm Hg (95% CI, 13 to 20 mm Hg; p < 0.0001). NIPPV therapy improved subjective sleepiness (mean Epworth sleepiness scale score decrease, 16 ± 5 to 6 ± 2; p < 0.001), and dyspnea decreased in all but four patients. During follow-up, three patients died (one of them due to the progression of respiratory failure). NIPPV therapy could be withdrawn in 5 patients who had achieved a sufficient weight loss, and the conditions of 16 patients could be maintained without respiratory failure by the use of simple therapy with CPAP
NIPPV therapy is effective in the treatment of patients with OHS, providing a significant improvement in clinical status and gas exchange
Asthma is an airway disease characterised by chronic inflammation with intermittent or permanent symptoms including wheezing, shortness of breath, chest tightness, and cough, which vary in terms of ...their occurrence, frequency, and intensity. The most common associated feature in the airways of patients with asthma is airway inflammation. In recent decades, efforts have been made to characterise the heterogeneous clinical nature of asthma. The interest in improving the definitions of asthma phenotypes and endotypes is growing, although these classifications do not always correlate with prognosis nor are always appropriate therapeutic approaches. Attempts have been made to identify the most relevant molecular and cellular biomarkers underlying the immunopathophysiological mechanisms of the disease. For almost 50 years, immunoglobulin E (IgE) has been identified as a central factor in allergic asthma, due to its allergen-specific nature. Many of the mechanisms of the inflammatory cascade underlying allergic asthma have already been elucidated, and IgE has been shown to play a fundamental role in the triggering, development, and chronicity of the inflammatory responses within the disease. Blocking IgE with monoclonal antibodies such as omalizumab have demonstrated their efficacy, effectiveness, and safety in treating allergic asthma. A better understanding of the multiple contributions of IgE to the inflammatory continuum of asthma could contribute to the development of novel therapeutic strategies for the disease.
INTRODUCTION AND OBJECTIVES: Stable chronic obstructive pulmonary disease (COPD) caused by biomass smoke (B-COPD) has some differences from tobacco-induced-COPD (T-COPD), but acute exacerbations ...(AECOPD) have not been well characterized in B-COPD.
OBJECTIVE: To compare the incidence, characteristics and outcomes of AECOPD in B-COPD with those of T-COPD.
METHODS: A retrospective observational study that included consecutive patients seen at a specialized COPD clinic (2008-2021). The incidence of severe AECOPD that required hospital admission was studied. For the first AECOPD, the following variables were recorded: fever, coexistence of pneumonia, purulent sputum, eosinophil count, neutrophil to lymphocyte ratio, hypercapnia, and respiratory acidosis. Outcome variables were intensive care unit (ICU) admission, length of hospital stay, and mortality within 1 month of hospital admission.
RESULTS: Of 1060 subjects, 195 (18.4%) belonged to the B-COPD group and 865 (81.6%) to the T-COPD group. During a follow-up of 67.9 (37.8-98.8) months, 75 (38.4%) patients in the B-COPD group and 319 (36.8%) in the T-COPD group suffered at least one severe AECOPD. The only difference between groups was in a higher risk of ICU admission for the T-COPD group. The incidence, characteristics, and the rest of the outcomes of AECOPD were similar for both groups.
CONCLUSION: AECOPD are similar events for B-COPD and T-COPD and should be managed similarly.
Patients with severe allergic and eosinophilic asthma could qualify for different biologic therapies.
To evaluate the efficacy and safety of weight-based intravenous reslizumab dosing in patients who ...have previously failed therapy with omalizumab.
We carried out a 24-week prospective, multicenter, open-label, single-group, self-controlled study in patients with severe eosinophilic asthma who had previously failed to respond to omalizumab. The main objective was to determine whether treatment with reslizumab significantly improved asthma symptoms assessed by the Asthma Control Test (ACT) at week 24. Secondary objectives were to evaluate symptoms at weeks 4 and 12, change in FEV1 at week 24, and the incidence of severe exacerbations over the study period.
Twenty-nine patients (62.1% women, median age, 50.8 years) were included in the study. The median ACT score significantly increased from 13.0 (interquartile range, 8.0-18.0) at baseline to 21.0 (interquartile range, 14.0-24.0) at 24 weeks (P = .002). Only 2 of 29 patients developed at least 1 severe exacerbation during follow-up and none of them required hospitalization. Overall, 15 of 25 patients (60%) were considered as being controlled (ACT score of ≥20 and no exacerbations) at week 24. The percentage of patients who were receiving daily systemic corticosteroids significantly decreased from 72.4% to 52.0% (P = .019). Adverse events were mostly moderate and within the range of previously reported side effects with reslizumab.
Reslizumab is an effective and safe option for patients with severe eosinophilic asthma and a history of omalizumab failure.
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