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Background and Objective: Whether immunological biomarkers combined with clinical characteristics measured during an exacerbation-free period are predictive of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) frequency and severity is unknown., Method: We measured immunological biomarkers and clinical characteristics in 271 stable chronic obstructive pulmonary disease (COPD) patients (67% male, mean age 63 years) from "The Obstructive Pulmonary Disease Outcomes Cohort of Switzerland" cohort on a single occasion. One-year follow-up data were available for 178 patients. Variables independently associated with AECOPD frequency and severity were identified by multivariable regression analyses. Receiver operating characteristic analysis was used to obtain optimal cutoff levels and measure the area under the curve (AUC) in order to assess if baseline data can be used to predict future AECOPD., Results: Higher number of COPD medications (adjusted incident rate ratio [aIRR] 1.17) and platelet count (aIRR 1.03), and lower FEV1% predicted (aIRR 0.84) and IgG2 (aIRR 0.84) were independently associated with AECOPD frequency in the year before baseline. Optimal cutoff levels for experiencing frequent (>1) AECOPD were ≥3 COPD medications (AUC = 0.72), FEV1 ≤40% predicted (AUC = 0.72), and IgG2 ≤2.6 g/L (AUC = 0.64). The performance of a model using clinical and biomarker parameters to predict future, frequent AECOPD events in the same patients was fair (AUC = 0.78) but not superior to a model using only clinical parameters (AUC = 0.79). The IFN-lambda rs8099917GG-genotype was more prevalent in patients who had severe AECOPD., Conclusions: Clinical and biomarker parameters assessed at a single point in time correlated with the frequency of AECOPD events during the year before and the year after assessment. However, only clinical parameters had fair discriminatory power in identifying patients likely to experience frequent AECOPD., (© 2021 The Author(s). Published by S. Karger AG, Basel.)

Background: In patients with obstructive sleep apnea syndrome (OSAS), the preference-based, health-related quality of life in terms of utility has not been extensively studied., Objective: To address this point, we compared the performance of different instruments assessing utility in patients with OSAS undergoing continuous positive airway pressure (CPAP) therapy., Materials and Methods: Data of 208 patients with OSAS (28 women, mean ± SE age 54.4 ± 0.7 years, apnea-hypopnea index (AHI) 51.9 ± 1.8/h, Epworth sleepiness score 13.4 ± 0.2) participating in a randomized trial of different CPAP modalities over 2 years were analyzed. Evaluations included sleep studies, Epworth sleepiness scale, and several utility instruments that measure subjective health preference on a scale ranging from 1 (most preferred and perfect health) to 0 (least preferred and very poor health)., Results: After 2 years of CPAP therapy, the mean ± SE AHI was 6.7 ± 1.5/h and Epworth score 7.9 ± 0.4, both p < 0.001 versus baseline. Baseline utilities and changes (95% confidence interval) after 2 years of CPAP therapy were EuroQol 5-dimensions 0.79 ± 0.01, 0.02 (0.00-0.05, p = 0.064); short-form 6-dimension medical outcome questionnaire 0.72 ± 0.01, 0.06 (0.04-0.08, p < 0.001); Euro-thermometer visual analog scale 0.70 ± 0.01, 0.09 (0.07-0.12, p < 0.001); time trade-off 0.82 ± 0.01, 0.03 (0.01-0.06, p = 0.002); and standard gamble 0.82 ± 0.01, -0.01 (-0.03 to 0.02, p = 0.712)., Conclusion: The short-form 6-dimensions questionnaire, the Euro-thermometer, and the time trade-off instruments reflected the major clinical improvements in OSAS, while the EuroQoL 5-dimensions and standard gamble tests were not sensitive to CPAP effects. These results indicate that the evaluation of utility of a treatment for OSAS depends critically on the instrument used, which is important from an individual and societal perspective., (© 2021 The Author(s) Published by S. Karger AG, Basel.)

The Swiss National Guidelines 2013 for chronic obstructive pulmonary disease have been revised in order to acknowledge recent progress in diagnosis and management of this disease. The resulting new Swiss recommendations are based on best evidence from the literature, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2018 report and other published national guidelines. Misdiagnosis of chronic obstructive pulmonary disease is common and means that patients do not always receive optimal treatment. To improve the management of patients with chronic obstructive pulmonary disease in Switzerland, these recommendations encourage a more comprehensive assessment of patients, based on the combined assessment of symptoms, degree of airflow limitation, risk of exacerbation and the presence of comorbidities. Recommendations for evidence-based preventive measures, as well as pharmacological and non-pharmacological strategies for the management of both stable and acute exacerbations of chronic obstructive pulmonary disease are provided in this update., (© 2018 S. Karger AG, Basel.)

Among patients with sleep apnea the reported prevalence of precapillary pulmonary hypertension (PH) has varied largely, depending on patient selection, disease definition, and associated conditions, in particular chronic pulmonary disease. However, in the absence of comorbidities, PH seems to be rare in patients with sleep apnea. Conversely, sleep-related breathing disorders have been commonly found in patients with PH and they have been associated with an impaired quality of life. Since sleep-related breathing disorders may affect the pulmonary circulation and vice versa, patients with sleep-related breathing disorders should be evaluated for risk factors, symptoms and clinical signs of PH and right ventricular heart failure and patients with PH should be evaluated for sleep apnea. Therapeutic options for patients with sleep apnea and PH may include supplemental oxygen, drugs and positive pressure ventilation. Both nocturnal oxygen administration and acetazolamide have been shown to improve sleep apnea in patients with PH. In addition, oxygen therapy also improved exercise performance. Further studies are needed to corroborate the efficacy of these and other treatments., (© 2016 S. Karger AG, Basel.)

Background: The European COPD Audit initiated by the European Respiratory Society (ERS) evaluated the management of hospital admissions due to exacerbation of chronic obstructive pulmonary disease (COPD) in several European countries. Data on the treatment of severe acute exacerbations of COPD (AECOPDs) in Switzerland are scarce., Objectives: In light of the GOLD 2010 guidelines, this work aims to examine the quality of care for AECOPD and to provide specific recommendations for the management of severe AECOPD in Switzerland., Methods: A total of 295 patients requiring hospital admission to 19 Swiss hospitals due to exacerbation of COPD during a predefined 60 days in 2011 were included in the study. We compared the Swiss data to the official GOLD 2010 recommendations and to the results of the other European countries., Results: Approximately 43% of the Swiss patients with severe AECOPD were current smokers at hospital admission, compared to 33% of the patients in other European countries (p < 0.001). In Switzerland and in Europe, spirometry data were not available for most patients at hospital admission (65 and 60%, respectively; p = 0.08). In comparison to other European countries, antibiotics were prescribed 14% less often in Switzerland (p < 0.001). Only 79% of the patients in the Swiss cohort received treatment with a short-acting bronchodilator at admission., Conclusions: Considering the overall high standard of health care in Switzerland, in light of the GOLD 2010 guidelines we are able to make 7 recommendations to improve and standardize the management of severe AECOPD for patients treated in Switzerland., (© 2017 S. Karger AG, Basel.)

Background: Existing prediction models for mortality in chronic obstructive pulmonary disease (COPD) patients have not yet been validated in primary care, which is where the majority of patients receive care., Objectives: Our aim was to validate the ADO (age, dyspnoea, airflow obstruction) index as a predictor of 2-year mortality in 2 general practice-based COPD cohorts., Methods: Six hundred and forty-six patients with COPD with GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages I-IV were enrolled by their general practitioners and followed for 2 years. The ADO regression equation was used to predict a 2-year risk of all-cause mortality in each patient and this risk was compared with the observed 2-year mortality. Discrimination and calibration were assessed as well as the strength of association between the 15-point ADO score and the observed 2-year all-cause mortality., Results: Fifty-two (8.1%) patients died during the 2-year follow-up period. Discrimination with the ADO index was excellent with an area under the curve of 0.78 [95% confidence interval (CI) 0.71-0.84]. Overall, the predicted and observed risks matched well and visual inspection revealed no important differences between them across 10 risk classes (p = 0.68). The odds ratio for death per point increase according to the ADO index was 1.50 (95% CI 1.31-1.71)., Conclusions: The ADO index showed excellent prediction properties in an out-of-population validation carried out in COPD patients from primary care settings.

Background: Utility indices are used in cost-effectiveness analyses as a measure of quality of life reflecting the patient's preference for a given health state on a scale anchored at 0 (corresponding to death) to 1 (perfect health). It is uncertain which utility instruments are most suitable for application in patients with the obstructive sleep apnea syndrome (OSA)., Objectives: To compare utility indices obtained in OSA patients by various instruments., Methods: In 66 untreated OSA patients (median Epworth score 12, apnea/hypopnea index, AHI, 57/h), five different utility instruments were employed. In 34 OSA patients, changes in utility after 4 months of continuous positive airway pressure (CPAP) were retrieved from published SF-36 data., Results: In 66 OSA patients, median (quartiles) utility indices were: standard gamble 0.97 (0.89; 0.99); time trade-off 0.94 (0.81; 0.99); EuroQol questionnaire (EQ-5D) 0.92 (0.83; 1.00); Euro-thermometer visual analog scale 0.80 (0.70; 0.90); SF-36 questionnaire (SF-6D) 0.75 (0.69; 0.85; p < 0.05 SF-6D and Euro-thermometer utility vs. other indices). Different utility indices were poorly correlated among each other and with AHI and Epworth scores. SF-6D utility after 4 months of CPAP had changed by 0.04 (0.02; 0.12, p = 0.026)., Conclusions: Utility indices measured by different instruments vary largely and some indices reflect the impaired quality of life in OSA poorly. Interpretation of cost-effectiveness analyses should account for the utility instrument used., (Copyright 2009 S. Karger AG, Basel.)

Background: Portable respiratory inductive plethysmography (RIP) is promising for noninvasive monitoring of breathing patterns in unrestrained subjects. However, its use has been hampered by requiring recalibration after changes in body position., Objectives: To facilitate RIP application in unrestrained subjects, we developed a technique for adjustment of RIP calibration using position sensor feedback., Methods: Five healthy subjects and 12 patients with lung disease were monitored by portable RIP with sensors incorporated within a body garment. Unrestrained individuals were studied during 40-60 min while supine, sitting and upright/walking. Position was changed repeatedly every 5-10 min. Initial qualitative diagnostic calibration followed by volume scaling in absolute units during 20 breaths in different positions by flow meter provided position-specific volume-motion coefficients for RIP. These were applied during subsequent monitoring in corresponding positions according to feedback from 4 accelerometers placed at the chest and thigh. Accuracy of RIP was evaluated by face mask pneumotachography., Results: Position sensor feedback allowed accurate adjustment of RIP calibration during repeated position changes in subjects and patients as reflected in a minor mean difference (bias) in breath-by-breath tidal volumes estimated by RIP and flow meter of 0.02 liters (not significant) and limits of agreement (+/-2 SD) of +/-19% (2,917 comparisons). An average of 10 breaths improved precision of RIP (limits of agreement +/-14%)., Conclusions: RIP calibration incorporating position sensor feedback greatly enhances the application of RIP as a valuable, unobtrusive tool to investigate respiratory physiology and ventilatory limitation in unrestrained healthy subjects and patients with lung disease during everyday activities including position changes., (Copyright 2009 S. Karger AG, Basel.)