Effects of an Immunostimulating Agent on Acute  Exacerbations and Hospitalizations in Patients with  Chronic Obstructive Pulmonary Disease

Collet, Jean‐Paul; Shapiro, Stan; Ernst, Pierre; Renzi, Paolo; Ducruet, Thiérry; Robinson, Ann

doi:10.1164/ajrccm.156.6.9612096

Cited by 193 publications

(83 citation statements)

References 13 publications

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“…COPD patients often require emergency and hospital admissions [7,8], which are the largest contributors to healthcare costs [9]. The Obstructive Lung Disease in Northern Sweden (OLIN) studies showed that hospitalisation costs account for .65% of all COPD costs and up to 90% of the diseaserelated expenses of those with more severe disease [9].…”

mentioning

confidence: 99%

Self-management reduces both short- and long-term hospitalisation in COPD

Ma¹,

Schwartzman²,

Rouleau³

et al. 2005

Eur Respir J

171

103

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The aim of the present study was to assess the long-term impact on hospitalisation of a self-management programme for chronic obstructive pulmonary disease (COPD) patients.A multicentre, randomised clinical trial was carried out involving 191 COPD patients from seven hospitals. Patients who had one or more hospitalisations in the year preceding study enrolment were assigned to a self-management programme ''Living Well with COPD TM '' or to standard care. Hospitalisations from all causes were the primary outcome and were documented from the provincial hospitalisation database; emergency visits were recorded from the provincial health insurance database.Most patients were elderly, not highly educated, had advanced COPD (reflected by a mean forced expiratory volume in one second of 1 L), and almost half reported a dyspnoea score of 5/5 (modified Medical Research Council). At 2 years, there was a statistically significant and clinically relevant reduction in all-cause hospitalisations of 26.9% and in all-cause emergency visits of 21.1% in the intervention group as compared to the standard-care group. After adjustment for the self-management intervention effect, the predictive factors for reduced hospitalisations included younger age, sex (female), higher education, increased health status and exercise capacity.In conclusion, in this study, patients with chronic obstructive pulmonary disease who received educational intervention with supervision and support based on disease-specific self-management maintained a significant reduction in hospitalisations after a 2-year period.

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mentioning

confidence: 99%

Self-management reduces both short- and long-term hospitalisation in COPD

Ma¹,

Schwartzman²,

Rouleau³

et al. 2005

Eur Respir J

171

103

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“…We have utilized an oral bacterial extract (Broncho-Vaxom OM-85) derived from a mixture of heat-killed respiratory pathogens, which has previously been used in a number of clinical and experimental settings. These include studies of immunostimulation in normal adult experimental animals (7,8) and double-blind multicenter clinical trials with humans with chronic obstructive pulmonary disease (12,30). The principal end points employed for the present study are production of immunoglobulin G1 (IgG1) and IgG2b subclass antibodies, which in the rat are respectively dependent upon Th2 versus Th1 cytokines (14,36).…”

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confidence: 99%

Selective Enhancement of Systemic Th1 Immunity in Immunologically Immature Rats with an Orally Administered Bacterial Extract

Bowman

Holt

2001

Infect Immun

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Infant rats primed during the first week of life with soluble antigen displayed adult-equivalent levels of T-helper 2 (Th2)-dependent immunological memory development as revealed by production of secondary immunoglobulin G1 (IgG1) antibody responses to subsequent challenge, but in contrast to adults failed to prime for Th1-dependent IgG2b responses. We demonstrate that this Th2 bias in immune function can be redressed by oral administration to neonates of a bacterial extract (Broncho-Vaxom OM-85) comprising lyophilized fractions of several common respiratory tract bacterial pathogens. Animals given OM-85 displayed a selective upregulation in primary and secondary IgG2b responses, accompanied by increased gamma interferon and decreased interleukin-4 production (both antigen specific and polyclonal), and increased capacity for development of Th1-dependent delayed hypersensitivity to the challenge antigen. We hypothesize that the bacterial extract functions via enhancement of the process of postnatal maturation of Th1 function, which is normally driven by stimuli from the gastrointestinal commensal microflora.During the preweaning period, the immature immune system is faced with antigenic challenges that are qualitatively and quantitatively different from those encountered during fetal life. In particular, it must learn to discriminate between antigens on pathogenic microorganisms and trivial antigens from domestic animals and plant sources (e.g., danders and pollens), and it must also develop the capacity to respond in a fashion that is qualitatively and quantitatively appropriate to these different types of challenges.Failure to develop such immune competence in a timely fashion after birth confers increased risk of development of a number of diseases. For example, it is well recognized that transient maturational deficiencies in immune and inflammatory functions predispose infant animals and humans to infections (42). Therefore, interest in the concept that similar deficiencies may predispose toward allergic sensitization against environmental allergens and development of some autoimmune diseases (16, 19) is growing. The precise nature of these maturational deficiencies remains to be determined. However, a common feature appears to be an imbalance between the T-helper 1 (Th1) and Th2 arms of the cellular immune response (e.g., see references 1, 17, 27, and 33).As a result of a series of regulatory mechanisms that selectively dampen aspects of Th1 function, such as gamma interferon (IFN-␥) production (18, 41), the fetal immune system appears constitutively biased toward Th2 function, and this imbalance is not usually redressed until biological weaning. Antigen challenge during this period evokes relatively lowlevel immune responses, which prime selectively for Th2 immunity (3-5, 35), and the relative deficiency in Th1 memory generation can be partially corrected by the use of potent Th1-selective adjuvants (4).Accumulating evidence suggests that the normal postnatal maturation of immune competence, and in particu...

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“…OM-85 BV, which works through mucosa-associated tissue, activates and regulates various components of the immune system. Several randomized clinical trials [10][11][12][13] have shown that OM-85 BV can reduce the number of acute respiratory tract infections (RTIs) by 25% to 50% compared with placebo in adults and children with a history of recurrence.…”

Section: Introductionmentioning

confidence: 99%

Prospective, randomized comparison of OM-85 BV and a prophylactic antibiotic in children with recurrent infections and immunoglobulin A and/or G subclass deficiency

Genel

Kütükçüler

2003

Current Therapeutic Research

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Background: Patients with immunoglobulin (Ig)A and/or IgG subclass deficiency may be asymptomatic or may have recurrent, mainly respiratory infections.Objective: This study compared the clinical efficacy and tolerability of prophylactic therapy with either the oral immunomodulator bacterial extract OM-85 BV or benzathine penicillin G (BPG) in the prevention of recurrent infections in symptomatic patients.Methods: In this 26-month, prospective, randomized study conducted at the Department of Pediatric Immunology, Ege University (Izmir, Turkey), children aged 1 to 12 years with recurrent infections and IgA and/or IgG subclass deficiency were enrolled. After an initial 12-month control period, patients were randomized to receive OM-85 BV or BPG. OM-85 BV (3.5-mg capsule) was given once daily for the first 10 days of each month for the first 3 months of the study. IM injections of BPG were given at a dose of 1.2 million units (for patients with body weight Ͼ27 kg) or at a half-dose (for patients with body weight Յ27 kg) every 3 weeks for 12 months. In nonresponders (ie, those who continued to have recurrent infections at 12-month follow-up), IV immunoglobulin (IVIG) replacement therapy at 400 mg/kg body weight was given every 4 weeks for an additional 12 months. The results of IVIG therapy were assessed by the authors using clinical observation. Adverse effects and adverse drug reactions were documented by the authors for each vaccine, prophylactic therapy, and IVIG.Results 52] months; P ϭ 0.036) and had lower serum IgG (P Ͻ 0.001), IgG1 (P ϭ 0.006), IgG2 (P ϭ 0.003), IgG3 (P ϭ 0.035), and IgM (P ϭ 0.008) levels and antibody responses to tetanus toxoid and Haemophilus influenzae type b (Hib) vaccines (P ϭ 0.036 and 0.013, respectively). At 12-month follow-up, a protective effect of the prophylactic IVIG therapy was seen, with a statistically significant reduction in the number of infections to 3.3 (2.4) and in the number of antibiotic courses to 2.7 (2.5) (both P ϭ 0.005). Conclusions:In this study population of children with recurrent infections and IgA and/or IgG subclass deficiency, prophylactic therapy with either OM-85 BV or an antibiotic significantly decreased the number of infections per year. In addition, nonresponders benefited from IVIG replacement therapy. (Curr Ther Res Clin Exp. 2003;64:600-615)

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Effects of an Immunostimulating Agent on Acute Exacerbations and Hospitalizations in Patients with Chronic Obstructive Pulmonary Disease

Cited by 193 publications

References 13 publications

Self-management reduces both short- and long-term hospitalisation in COPD

Self-management reduces both short- and long-term hospitalisation in COPD

Selective Enhancement of Systemic Th1 Immunity in Immunologically Immature Rats with an Orally Administered Bacterial Extract

Prospective, randomized comparison of OM-85 BV and a prophylactic antibiotic in children with recurrent infections and immunoglobulin A and/or G subclass deficiency

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