Inhaled corticosteroid/long-acting bronchodilator treatment mitigates STEMI clinical presentation in COPD patients

Contoli, Marco; Campo, Gianluca; Pavasini, Rita; Marchi, Irene; Pauletti, Alessia; Balla, Cristina; Spanevello, Antonio; Ferrari, Roberto; Papi, Alberto

doi:10.1016/j.ejim.2017.08.016

Cited by 14 publications

(12 citation statements)

References 40 publications

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“…[15] Moreover, ICS/LABA treatment can reduce the severity of ST-elevation myocardial infarction in patients with COPD. [16] This study indicated that the use of ICS could increase the abundance of sputum ora, which is in line with the ndings of previous studies; however, we showed that newly emerged lung shadows on CT scan decreased in the with-GC group. One possible explanation is that ICS can increase colonizing bacteria but does not necessarily cause pneumonia.…”

Section: Discussionsupporting

confidence: 92%

Effects of Inhaled Corticosteroids on Hospitalized Chronic Obstructive Pulmonary Disease Exacerbations: A Retrospective, Multicenter, Propensity Score-Matched Study in China

Li¹,

Tao²,

Pan³

et al. 2020

Preprint

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Background: Exacerbations are important events when managing chronic obstructive pulmonary disease (COPD) because they negatively impact disease progression. Inhaled corticosteroid (ICS) usage in patients with COPD is controversial. Therefore, we reviewed the benefits and risks of regular ICS treatment in patients with COPD regarding hospitalized acute exacerbation.Methods: This retrospective multicenter study—conducted in 18 medical centers across China—included 1,862 participants from 34 hospitals in northern China. Baseline characteristics, comorbidities, and administered medicines in the last year were matched using 1:1 propensity score-matching. We reviewed electronic patient medical records to ascertain symptoms, tests, in-hospital treatment, and prognosis. Subsequently, we reviewed computed tomography imaging results and pathogen identification tests.Results: Patients who used ICS in the past year presented more severe respiratory symptoms during acute exacerbations of COPD but less frequent right heart failure or consciousness disturbance. More antibiotics were used during hospitalization, resulting in higher costs; however, their prognosis was not different from patients who did not use ICS. Additionally, although ICS usage could increase gram-negative bacilli in sputum smears, it did not increase the probability of pulmonary infection.Conclusions: ICS use could protect patients from right heart failure, without detrimentally affecting prognosis during hospitalized exacerbations. Therefore, the risk of cardiovascular disease should be taken into consideration when making decisions regarding the potential administration of ICS in patients with COPD.

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Section: Discussionsupporting

confidence: 92%

Effects of Inhaled Corticosteroids on Hospitalized Chronic Obstructive Pulmonary Disease Exacerbations: A Retrospective, Multicenter, Propensity Score-Matched Study in China

Li¹,

Tao²,

Pan³

et al. 2020

Preprint

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“…These patients are at increased risk of poor clinical outcomes, including death, as compared to patients without COPD. Contoli et al showed that in COPD patients, treatment with ICS/LABD may reduce the severity of clinical manifestations during the acute phase of a STEMI, compared to other inhaled treatments [25]. These results may also apply during HF exacerbations.…”

Section: Discussionmentioning

confidence: 99%

Morbidity and mortality in a population of patients affected by heart failure and chronic obstructive pulmonary disease: an observational study

Cosentino

Landolfo

Bentivenga

et al. 2019

BMC Cardiovasc Disord

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BackgroundChronic obstructive pulmonary disease (COPD) and heart failure (HF) often coexist. Moreover, elderly patients suffering from HF have a higher incidence of COPD, which further complicates their clinical condition. Indacaterol/glycopirronium has shown benefits in the treatment of COPD, with few cardiologic adverse effects. We evaluated the safety and efficacy of this therapy in patients with history of HF.MethodsWe enrolled 56 patients with a history of HF (New York Heart Association [NYHA] classes II and III) and stable COPD. We evaluated blood samples, clinical assessment, echocardiograms and basal spirometry at baseline and after 6 months of therapy with indacaterol/glycopirronium. In addition, the number of re-hospitalizations during the treatment period was evaluated.ResultsThe treatment was well tolerated. Brain natriuretic peptide (BNP) levels were significantly reduced compared with baseline (p < 0.001) after 6 months of treatment, and a higher percentage of patients improved their clinical status compared with baseline (p < 0.001). Minor changes were noted in the hemodynamic and metabolic parameters. Significant improvements in the echocardiographic parameters were noted in HF with reduced ejection fraction (HFrEF) patients. All respiratory parameters (forced expiratory volume in 1 s [FEV1], FEV1/forced vital capacity [FVC] ratio and COPD Assessment Test [CAT] scores) improved significantly (p < 0.001). No hospitalizations owing to HF or COPD exacerbation occurred. One patient died of respiratory failure.ConclusionIndacaterol/glycopirronium was well-tolerated and effective in the treatment of COPD in this cohort of patients with a history of HF. Further studies are needed to clarify whether this compound can have a direct role in improving overall cardiovascular function.

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“…We applied broad inclusion criteria ensuring representation across the research field, but confined our review to recent literature in order to ensure relevancy. We did not include studies where COPD was only relevant due to being contained in a list of covariates (as is often done, for example as part of the Charlson Comorbidity Index) [31] since an accurate case definition for this purpose holds less importance. However, this means that our review does not fully encompass the whole spectrum of the use of 'COPD' in electronic health data research.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Identifying COPD in routinely collected electronic health records: a systematic scoping review

et al. 2021

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Although routinely collected electronic health records (EHR) are widely used to examine outcomes related to chronic obstructive pulmonary disease (COPD), consensus regarding the identification of cases from electronic healthcare databases is lacking. We systematically examine and summarise approaches from the recent literature.MEDLINE via EBSCOhost was searched for COPD-related studies using EHR published from January 1, 2018 to November 30, 2019. Data were extracted relating to the case definition of COPD and determination of COPD severity and phenotypes.From 185 eligible studies, we found widespread variation in the definitions used to identify people with COPD in terms of code sets used (with 20 different code sets in use based on the ICD-10 classification alone) and requirement of additional criteria (relating to age (n=139), medication (n=31), multiplicity of events (n=21), spirometry (n=19) and smoking status (n=9)). Only 7 studies used a case definition which had been validated against a reference standard in the same dataset. Various proxies of disease severity were used since spirometry results and patient-reported outcomes were not often available.To enable the research community to draw reliable insights from electronic health records and aid comparability between studies, clear reporting and greater consistency of the definitions used to identify COPD and related outcome measures is key.

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Inhaled corticosteroid/long-acting bronchodilator treatment mitigates STEMI clinical presentation in COPD patients

Cited by 14 publications

References 40 publications

Effects of Inhaled Corticosteroids on Hospitalized Chronic Obstructive Pulmonary Disease Exacerbations: A Retrospective, Multicenter, Propensity Score-Matched Study in China

Effects of Inhaled Corticosteroids on Hospitalized Chronic Obstructive Pulmonary Disease Exacerbations: A Retrospective, Multicenter, Propensity Score-Matched Study in China

Morbidity and mortality in a population of patients affected by heart failure and chronic obstructive pulmonary disease: an observational study

Identifying COPD in routinely collected electronic health records: a systematic scoping review

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