Acute exacerbation of chronic obstructive pulmonary disease and antibiotics: what studies are still needed?

Sohy, Carine; Pilette, Charles; Niederman, Michael S.; Sibille, Yves

doi:10.1183/09031936.02.00291302

Cited by 24 publications

(10 citation statements)

References 67 publications

(86 reference statements)

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“…Conditional logistic regression was used for matched case-control data to obtain crude and adjusted odds ratios as estimates of rate ratios (RR) of COPD exacerbations that were associated with the use of ICS. Adjustment was performed for severity of COPD, which is thought to be closely related to severe and/or more frequent exacerbations [25], as well as for concurrent diseases.…”

Section: Discussionmentioning

confidence: 99%

Inhaled corticosteroids and the risk of a first exacerbation in COPD patients

Melo¹,

Ernst²,

Suissa³

2004

Eur Respir J

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Inhaled corticosteroids and the risk of a first exacerbation in COPD patients. M.N. de Melo, P. Ernst, S. Suissa. #ERS Journals Ltd 2004. ABSTRACT: The role of inhaled corticosteroids (ICS) in asthma is well established, but their benefit in the management of chronic obstructive pulmonary disease (COPD) is still controversial. The current study assessed whether ICS are effective in preventing a first exacerbation of COPD.A cohort of newly treated COPD patients was formed from the Administrative Databases of Saskatchewan Health. The outcome was the occurrence of a first moderate or severe exacerbation from 1990-1999. Moderate exacerbations involved prescriptions for an antibiotic and an oral corticosteroid on the same day. Severe exacerbations were hospitalisations with a primary discharge diagnosis of COPD. A nested case-control design was used and matched on year of birth and cohort entry. Rate ratios (RR) were further adjusted for use of other medication and other confounders.There were 995 exacerbations among 4,455 subjects. The rate of a first exacerbation was increased with any use of ICS in the year prior to the index date (RR: 1.27; 95% CI: 1.08-1.48) and with current use (RR: 1.51; 95% CI: 1.22-1.87), and it increased with increasing daily doses of ICS.Inhaled corticosteroids do not seem to be beneficial in reducing the risk of a first exacerbation of chronic obstructive pulmonary disease.

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Section: Discussionmentioning

confidence: 99%

Inhaled corticosteroids and the risk of a first exacerbation in COPD patients

Melo¹,

Ernst²,

Suissa³

2004

Eur Respir J

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“…Normal function of the airway mucociliary clearance system prevents the attachment and colonization of pulmonary pathogens in the upper airways. Mucociliary dysfunction caused by impaired ciliary motility results in mucus accumulation, airway obstruction, and bacterial colonization, increasing the likelihood of infection in the lower airway [1][2][3]. Mucociliary clearance is affected by exposure to a number of environmental agents [4,5], including cigarette smoke.…”

Section: Introductionmentioning

confidence: 99%

Differential in Vivo Effects of Whole Cigarette Smoke Exposure Versus Cigarette Smoke Extract on Mouse Ciliated Tracheal Epithelium

Elliott

Sisson

West

et al. 2006

Experimental Lung Research

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In this study the authors compared the affect of vapor phase cigarette smoke (CS) versus cigarette smoke extract (CSE) on the lungs and upper airway of C57BL/6 mice. The authors found that CSE treatment significantly increased neutrophil influx (P < .001), baseline ciliary beat frequency (CBF) (P < .05), and protein kinase C activity compared to CS and controls. Isoproterenol increased CBF with CS exposure, but decreased CBF with CSE (P < .01). Isoproterenol increased protein kinase A (PKA) activity in all groups except CSE. CSE exposure induced inflammatory cell bronchiolitis. These data indicate that CSE exposure has differential effects on the lungs and tracheal epithelium compared to CS exposure.Ciliary motility provides the driving force for mucociliary clearance. Normal function of the airway mucociliary clearance system prevents the attachment and colonization of pulmonary pathogens in the upper airways. Mucociliary dysfunction caused by impaired ciliary motility results in mucus accumulation, airway obstruction, and bacterial colonization, increasing the likelihood of infection in the lower airway [1][2][3]. Mucociliary clearance is affected by exposure to a number of environmental agents [4,5], including cigarette smoke. Exposure to cigarette smoke (CS) has been linked to the development of lung cancer, emphysema, chronic bronchitis, and chronic obstructive pulmonary disease (COPD) [6]. Smokers are at a higher risk for pulmonary infection [7]. Chronic exposure to tobacco smoke is associated with increased ciliary abnormality [8] and reduced mucociliary clearance [9]. The increased risk for infection seen in smokers may be due to alterations in ciliary function in the upper airway.Several studies have revealed that ciliary activity is controlled by phosphorylation of axonemal proteins [10][11][12]. Protein kinase C (PKC) and cyclic adenosine monophosphate (CAMP)-Address correspondence to Todd A. Wyatt, PhD, University of Nebraska Medical Center, 985300 Nebraska Medical Center, Omaha, NE 68198-5300, USA. E-mail: twyatt@unmc.edu. NIH Public Access Author ManuscriptExp Lung Res. Author manuscript; available in PMC 2007 November 21. Published in final edited form as:Exp Lung Res. 2006 ; 32(3-4): 99-118. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript dependent protein kinase (PKA) are important regulators of airway ciliary beat frequency (CBF). Agents that increase PKC are associated with decreased CBF [13][14][15]. Alternatively, agents associated with increased CBF also increase PKA activity [16]. In past studies, we have shown that exposure of ciliated epithelial cells to cigarette smoke extract (CSE) in culture and whole cigarette smoke in vivo induces an increase in epithelial cell PKC activity [15,[17][18][19]. Many animal models of exposure to cigarette smoke components exist. Most recently, Miller and colleagues have developed a method of exposure consisting of intranasal administration of CSE [20]. This method was shown to induce an inflammatory response similar to ...

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“…This represents a crucial medical and economic problem. 13 The cellular and molecular mechanisms by which viruses cause exacerbations remain undetermined. Future research efforts to understand these mechanisms would aid the development of novel therapeutics to reduce the morbidity and mortality of this disease.…”

Section: Discussionmentioning

confidence: 99%

Study of Clinical Profile of Chronic Obstructive Pulmonary Disease and Evaluation of Pulmonary Hypertension With Ecg and 2d Echo Findings

G¹,

Apuroopa²

2016

jemds

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BACKGROUNDThe recent definition by American Thoracic Society defines chronic obstructive pulmonary disease as a disease characterised by the presence of air flow obstruction due to chronic bronchitis or emphysema, which is generally progressive, maybe accompanied by airway hyperactivity and maybe partially reversible. In India, COPD is the second most common lung disorder after pulmonary TB. Tobacco smoking is by far the most important risk factor for COPD. Smoking cessation is the only intervention which has shown to slow down the progress of the disease. COPD should be considered in any patient presenting with cough, sputum production, or dyspnoea, especially if an exposure to risk factors for the disease has been present. Clinical diagnosis needs to be confirmed by standardised spirometric tests in the presence of incompletely reversible airflow limitation. Pulmonary arterial hypertension is the major cardiovascular complication of COPD and is associated with the development of Right ventricular hypertrophy (cor pulmonale) and is associated with poor prognosis. ECG is a simple bedside investigation, and right ventricular hypertrophy on ECG has a reasonably high specificity. Detectable tricuspid regurgitation by Echo Doppler is probably the best technique to measure pulmonary artery pressure noninvasively. Therefore, the present study is conducted to correlate the diagnostic values of ECG and Echo findings in COPD patients, which help in early detection of cardiac complications of chronic obstructive pulmonary disease giving time for early intervention.

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Acute exacerbation of chronic obstructive pulmonary disease and antibiotics: what studies are still needed?

Cited by 24 publications

References 67 publications

Inhaled corticosteroids and the risk of a first exacerbation in COPD patients

Inhaled corticosteroids and the risk of a first exacerbation in COPD patients

Differential in Vivo Effects of Whole Cigarette Smoke Exposure Versus Cigarette Smoke Extract on Mouse Ciliated Tracheal Epithelium

Study of Clinical Profile of Chronic Obstructive Pulmonary Disease and Evaluation of Pulmonary Hypertension With Ecg and 2d Echo Findings

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