Clinical Outcomes and Cost Analysis of Exacerbations in Chronic Obstructive Pulmonary Disease

Miravitlles, Marc; García-Polo, Cayo; Domenech, Adolfo; Villegas, Gustavo; Conget, F.; Roza, Cristian de la

doi:10.1007/s00408-013-9487-z

Cited by 39 publications

(21 citation statements)

References 32 publications

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“…They are associated with increased health care costs [31] and significant impairment in HRQoL of patients [32], and in our study showed a strong association with the presence of depressive symptoms. Moreover, a large followup study has found an increased risk of exacerbations (adjusted incidence rate ratio (IRR), 1.51; 95% confidence interval (CI), 1.01e2.24) and hospitalizations (adjusted IRR, 1.72; 95%CI, 1.04e2.85) in patients with probable depression identified by HADs (Hospital Anxiety and Depression) scores !11, compared with patients without depression [7].…”

Section: Discussionmentioning

confidence: 53%

Factors associated with depression and severe depression in patients with COPD

Miravitlles

Molina²,

Quintano³

et al. 2014

Respiratory Medicine

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Section: Discussionmentioning

confidence: 53%

Factors associated with depression and severe depression in patients with COPD

Miravitlles

Molina²,

Quintano³

et al. 2014

Respiratory Medicine

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“…Antibiotic therapy in patients with previous severe exacerbations is one of the key factors in promoting further Aspergillus species isolation. In a recent study conducted in Spain, approximately 73% of COPD patients received antibiotics [31]. …”

Section: Discussionmentioning

confidence: 99%

Aspergillus colonization in patients with chronic obstructive pulmonary disease

et al. 2015

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Background and Purpose:Chronic obstructive pulmonary disease (COPD) has been recognized as a risk factor for invasive aspergillosis. Airway colonization by Aspergillus species is a common feature of chronic pulmonary diseases. Nowadays, the incidence of COPD has increased in critically ill patients. The aim of the present study was to isolate and identify Aspergillus colonies in the respiratory tract of COPD patients.Materials and Methods:This study was performed on 50 COPD patients, who were aged above 18 years, and were in intensive care units of three hospitals in Sari, Iran, for at least six days. All the samples obtained from sputum, bronchoalveolar lavage, and tracheal aspirates were cultured for fungi each week. According to the conventional techniques, Aspergillus isolates were initially based on growth and standard morphological characteristics. To confirm the identification of grown Aspergillus, the partial beta-tubulin gene was sequenced using specific primers. Results:A total of 50 patients, who met our inclusion criteria, were enrolled in the study during 2012-14. The results showed that 27 (54%) and 23 (46%) of the participants were male and female, respectively. The majority of the patients developed dyspnea followed by hemoptysis, chest pain, and high fever. Corticosteroids and broad-spectrum antibacterial agents were administered to 75% and 80% of the patients, respectively. Based on the conventional and molecular approaches, A. fumigatus (seven cases; 43.7%), A. flavus (five cases; 31.2%), A. niger (one case; 6.2%), A. terreus (one case; 6.2%), A. orezea (one case; 6.2%), and A. tubingensis (one case; 6.2%) were recovered.Conclusion:Recovery of Aspergillus species from the respiratory tract of COPD patients with pneumonia indicates two possibilities: either colonization or invasive aspergillosis.

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“…isolation. In fact, in a recent publication, it was found that almost 73% of COPD patients in Spain presenting with a Type I Anthonisen exacerbation received antibiotics [27]. Prospective studies focusing on this specific population are much needed to determine whether Aspergillus spp.…”

Section: Discussionmentioning

confidence: 99%

Importance of Aspergillus spp. isolation in Acute exacerbations of severe COPD: prevalence, factors and follow-up: the FUNGI-COPD study

et al. 2014

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BackgroundAcute exacerbations of COPD (AECOPD) are often associated with infectious agents, some of which may be non-usual, including Aspergillus spp. However, the importance of Aspergillus spp. in the clinical management of AECOPD still remains unclear.ObjectivesThe aims of the study were to analyze the prevalence and risk factors associated with Aspergillus spp. isolation in AECOPD, and to investigate the associated clinical outcomes during a 1-year follow-up period.MethodsPatients presenting with an AECOPD requiring hospitalization were prospectively included from four hospitals across Spain. Clinical, radiological and microbiological data were collected at admission and during the follow-up period (1, 6 and 12 months after discharge), and re-admissions and mortality data collected during the follow-up.ResultsA total of 240 patients with severe AECOPD were included. Valid sputum samples were obtained in 144 (58%) patients, and in this group, the prevalence of Aspergillus spp. isolation was 16.6% on admission and 14.1% at one-year follow-up. Multivariate logistic-regression showed that AECOPD in the previous year (OR 12.35; 95% CI, 1.9-29.1; p < 0.001), concurrent isolation of pathogenic bacteria (OR 3.64; 95% CI 1.65-9.45, p = 0.001) and concomitant isolation of Pseudomonas aeruginosa (OR 2.80; 95% IC, 1.81-11.42; p = 0.001) were the main risk factors for Aspergillus spp. isolation.ConclusionsThe main risk factors for Aspergillus spp. isolation were AECOPD in the previous year and concomitant isolation of Pseudomonas aeruginosa. However, although Aspergillus spp. is often isolated in sputum samples from patients with AECOPD, the pathogenic and clinical significance remains unclear.

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Clinical Outcomes and Cost Analysis of Exacerbations in Chronic Obstructive Pulmonary Disease

Cited by 39 publications

References 32 publications

Factors associated with depression and severe depression in patients with COPD

Factors associated with depression and severe depression in patients with COPD

Aspergillus colonization in patients with chronic obstructive pulmonary disease

Importance of Aspergillus spp. isolation in Acute exacerbations of severe COPD: prevalence, factors and follow-up: the FUNGI-COPD study

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