29 results on '"Roche, Nicolas"'
Search Results
2. The Evolving Contours of Chronic Obstructive Pulmonary Disease.
- Author
-
Roche, Nicolas and Han, MeiLan K.
- Subjects
CHRONIC obstructive pulmonary disease ,COUGH ,OBSTRUCTIVE lung diseases - Abstract
The authors discuss a study by Y. Colak and colleagues, published within the issue, which described the occurrence of chronic obstructive pulmonary disease (COPD) during follow-up in subjects with no airflow obstruction. Topics include definition of the term predisease, the earliest structural change in the development of COPD, and an important opportunity to improve understanding of disease development and to develop early intervention strategies.
- Published
- 2024
- Full Text
- View/download PDF
3. Current concepts in targeting chronic obstructive pulmonary disease pharmacotherapy: making progress towards personalised management
- Author
-
Woodruff, Prescott G, Agusti, Alvar, Roche, Nicolas, Singh, Dave, and Martinez, Fernando J
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Chronic Obstructive Pulmonary Disease ,Lung ,Clinical Research ,Detection ,screening and diagnosis ,4.1 Discovery and preclinical testing of markers and technologies ,Respiratory ,Good Health and Well Being ,Biomarkers ,Disease Management ,Disease Progression ,Eosinophilia ,Evidence-Based Medicine ,Humans ,Inflammation ,Precision Medicine ,Pulmonary Disease ,Chronic Obstructive ,Th2 Cells ,alpha 1-Antitrypsin Deficiency ,Medical and Health Sciences ,General & Internal Medicine ,Biomedical and clinical sciences ,Health sciences - Abstract
Chronic obstructive pulmonary disease (COPD) is a common, complex, and heterogeneous disorder that is responsible for substantial and growing morbidity, mortality, and health-care expense worldwide. Of imperative importance to decipher the complexity of COPD is to identify groups of patients with similar clinical characteristics, prognosis, or therapeutic needs, the so-called clinical phenotypes. This strategy is logical for research but might be of little clinical value because clinical phenotypes can overlap in the same patient and the same clinical phenotype could result from different biological mechanisms. With the goal to match assessment with treatment choices, the latest iteration of guidelines from the Global Initiative for Chronic Obstructive Lung Disease reorganised treatment objectives into two categories: to improve symptoms (ie, dyspnoea and health status) and to decrease future risk (as predicted by forced expiratory volume in 1 s level and exacerbations history). This change thus moves treatment closer to individualised medicine with available bronchodilators and anti-inflammatory drugs. Yet, future treatment options are likely to include targeting endotypes that represent subtypes of patients defined by a distinct pathophysiological mechanism. Specific biomarkers of these endotypes would be particularly useful in clinical practice, especially in patients in which clinical phenotype alone is insufficient to identify the underlying endotype. A few series of potential COPD endotypes and biomarkers have been suggested. Empirical knowledge will be gained from proof-of-concept trials in COPD with emerging drugs that target specific inflammatory pathways. In every instance, specific endotype and biomarker efforts will probably be needed for the success of these trials, because the pathways are likely to be operative in only a subset of patients. Network analysis of human diseases offers the possibility to improve understanding of disease pathobiological complexity and to help with the development of new treatment alternatives and, importantly, a reclassification of complex diseases. All these developments should pave the way towards personalised treatment of patients with COPD in the clinic.
- Published
- 2015
4. Risk of Pneumonia in Patients with COPD Initiating Fixed Dose Inhaled Corticosteroid (ICS) / Long-Acting Bronchodilator (LABD) Formulations Containing Extrafine Beclometasone Dipropionate versus Patients Initiating LABD Without ICS.
- Author
-
Price, David, Henley, William, Cançado, José Eduardo Delfini, Fabbri, Leonardo M, Kerstjens, Huib AM, Papi, Alberto, Roche, Nicolas, Şen, Elif, Singh, Dave, Vogelmeier, Claus F, Nudo, Elena, Carter, Victoria, Skinner, Derek, Vella, Rebecca, Soriano, Joan B, Kots, Maxim, and Georges, George
- Subjects
PNEUMONIA ,CHRONIC obstructive pulmonary disease ,RANDOMIZED controlled trials - Abstract
Background: Combined ICS and long-acting bronchodilators (LABD) more effectively reduce COPD exacerbations than LABD therapy alone. Corticosteroid-related adverse effects, including pneumonia, limit ICS use. Previous data suggest this risk is lower for extrafine beclometasone (ef-BDP). We compared pneumonia risk among new users of fixed dose ICS/LABD formulations containing ef-BDP, versus patients initiating LABD without any ICS. Methods: A propensity-matched historical cohort study design used data from OPCRD. COPD patients with ≥ 1 year of continuous data who initiated LABD or ICS/LABD formulations containing ef-BDP were matched. Primary outcome was time to pneumonia event, as treated, using either sensitive (physician diagnosed) or specific (physician diagnosed and x-ray or hospital admission confirmed) definitions, with non-inferiority boundary of 15%. Results: 23,898 COPD patients were matched, who were 68± 11 years, 54.3% male and 56% current-smokers, while 43% were former-smokers. Initiation of ef-BDP/LABD was not associated with an increased risk of pneumonia versus LABD, for either a sensitive 0.89 (0.78– 1.02), P = 0.08 or a specific 0.91 (0.78– 1.05), P = 0.18 definition of pneumonia. The probability of remaining pneumonia free 1-year after ef-BDP/LABD was 98.4%, which was comparable to LABD at 97.7%, and was sustained up to 6 years of observation; non-inferiority criterion was met for both definitions. Initiation of ef-BDP/LABD was also associated with a reduced risk of developing LRTIs in the propensity matched cohort. Conclusion: Risk of pneumonia when using ICS for the management of COPD reported in several randomised controlled trials may not be relevant with ef-BDP in a diverse real-world clinical population. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
5. Relationship between gender and survival in a real-life cohort of patients with COPD
- Author
-
Zysman, Maeva, Burgel, Pierre-Régis, Court-Fortune, Isabelle, Brinchault-Rabin, Graziella, Nesme-Meyer, Pascale, Surpas, Pascale, Deslée, Gaetan, Perez, Thierry, Le Rouzic, Olivier, Jebrak, Gilles, Chanez, Pascal, Paillasseur, Jean-Louis, Caillaud, Denis, Roche, Nicolas, and on behalf of the Initiatives BPCO scientific committee and investigators
- Published
- 2019
- Full Text
- View/download PDF
6. Is atopy a risk indicator of chronic obstructive pulmonary disease in dairy farmers?
- Author
-
Veil-Picard, Matthieu, Soumagne, Thibaud, Vongthilath, Rechana, Annesi-Maesano, Isabella, Guillien, Alicia, Laurent, Lucie, Andujar, Pascal, Roche, Nicolas, Jouneau, Stephane, Cypriani, Benoit, Laplante, Jean-Jacques, Degano, Bruno, and Dalphin, Jean-Charles
- Published
- 2019
- Full Text
- View/download PDF
7. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary.
- Author
-
Agustí, Alvar, Celli, Bartolome R., Criner, Gerard J., Halpin, David, Anzueto, Antonio, Barnes, Peter, Bourbeau, Jean, Han, MeiLan K., Martinez, Fernando J., de Oca, Maria Montes, Mortimer, Kevin, Papi, Alberto, Pavord, Ian, Roche, Nicolas, Salvi, Sundeep, Sin, Don D., Singh, Dave, Stockley, Robert, López Varela, M. Victorina, and Wedzicha, Jadwiga A.
- Subjects
OBSTRUCTIVE lung diseases ,REPORTING of diseases ,THERAPEUTICS ,CHRONIC obstructive pulmonary disease ,ADRENERGIC agonists - Abstract
The article focuses on the Global Initiative for Chronic Obstructive Lung Disease which has published the complete 2023 GOLD report, that can be freely downloaded from its web page together with a pocket guide and a teaching slide set. Topics include considered it contains important changes compared to earlier versions, and incorporates several new references.
- Published
- 2023
- Full Text
- View/download PDF
8. The Ongoing Quest for Predictive Biomarkers in Chronic Obstructive Pulmonary Disease.
- Author
-
Regard, Lucile, Roche, Nicolas, and Burgel, Pierre-Régis
- Subjects
CHRONIC obstructive pulmonary disease ,BIOMARKERS - Abstract
The article presents the discussion on chronic obstructive pulmonary disease (COPD) being characterized by dyspnea, cough, sputum production, and/or exacerbations. Topics include disease burden and symptom severity among patients with similar degrees of airflow limitation are highly heterogeneous; and participants in these trials must be selected by phenotype or endotype to maximize the chances of meaningful findings.
- Published
- 2023
- Full Text
- View/download PDF
9. Artificial intelligence to differentiate asthma from COPD in medico-administrative databases
- Author
-
Joumaa, Hassan, Sigogne, Raphael, Maravic, Milka, Perray, Lucas, Bourdin, Arnaud, Roche, Nicolas, MORNET, Dominique, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), IQVIA, Hôpital Lariboisière-Fernand-Widal [APHP], Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Hôpital Arnaud de Villeneuve [CHRU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Mucoviscidose et bronchopathies chroniques : biopathologie et phénotypes cliniques (EA 2511), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)
- Subjects
[SDV.IB] Life Sciences [q-bio]/Bioengineering ,[INFO.INFO-AI] Computer Science [cs]/Artificial Intelligence [cs.AI] ,Pulmonary and Respiratory Medicine ,Male ,Databases, Factual ,Epidemiology ,Healthcare administrative databases ,Chronic obstructive pulmonary disease ,[INFO.INFO-IA]Computer Science [cs]/Computer Aided Engineering ,[SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract ,[INFO.INFO-IA] Computer Science [cs]/Computer Aided Engineering ,Asthma ,Prevalence ,COPD ,Algorithms ,ICD code ,[INFO.INFO-AI]Computer Science [cs]/Artificial Intelligence [cs.AI] ,Pulmonary Disease, Chronic Obstructive ,Artificial Intelligence ,[SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract ,Humans ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,[SDV.IMM.ALL]Life Sciences [q-bio]/Immunology/Allergology ,[SDV.IMM.ALL] Life Sciences [q-bio]/Immunology/Allergology - Abstract
Introduction Discriminating asthma from chronic obstructive pulmonary disease (COPD) using medico-administrative databases is challenging but necessary for medico-economic analyses focusing on respiratory diseases. Artificial intelligence (AI) may improve dedicated algorithms. Objectives To assess performance of different AI-based approaches to distinguish asthmatics from COPD patients in medico-administrative databases where the clinical diagnosis is absent. An “Asthma COPD Overlap” category was defined to further test whether AI can detect complexity. Methods This study included 178,962 patients treated by two “R03” treatment prescriptions at least from January 2016 to December 2018 and managed by either a general practitioner and/or a pulmonologist participating in a permanent longitudinal observatory of prescription in ambulatory medicine (LPD). Clinical diagnoses are available in this database and were used as gold standards to develop diagnostic rules. Three types of AI approaches were explored using data restricted to demographics and treatment dispensations: multinomial regression, gradient boosting and recurrent neural networks (RNN). The best performing model (based on metric properties) was then applied to estimate the size of asthma and COPD populations based on a database (LRx) of treatment dispensations between July, 2018 and June, 2019. Results The best models were obtained with the boosting approach and RNN, with an overall accuracy of 68%. Performance metrics were better for asthma than COPD. Based on LRx data, the extrapolated numbers of patients treated for asthma and COPD in France were 3.7 and 1.2 million, respectively. Asthma patients were younger than COPD patients (mean, 49.9 vs. 72.1 years); COPD occurred mostly in men (68%) compared to asthma (33%). Conclusion AI can provide models with acceptable accuracy to distinguish between asthma, ACO and COPD in medico-administrative databases where the clinical diagnosis is absent. Deep learning and machine learning (RNN) had similar performances in this regard.
- Published
- 2021
10. Recent Advances: Pulmonary Medicine
- Author
-
Roche, Nicolas
- Published
- 1999
11. In Patients with Mild-to-Moderate COPD, Tobacco Smoking, and Not COPD, Is Associated with a Higher Risk of Cardiovascular Comorbidity
- Author
-
Soumagne, Thibaud, Guillien, Alicia, Roche, Nicolas, Annesi-Maesano, Isabella, Andujar, Pascal, Laurent, Lucie, Jouneau, Stéphane, Botebol, Martial, Laplante, Jean-Jacques, Dalphin, Jean-Charles, Degano, Bruno, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Institute for Advanced Biosciences / Institut pour l'Avancée des Biosciences (Grenoble) (IAB), Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Mucoviscidose et bronchopathies chroniques : biopathologie et phénotypes cliniques (EA 2511), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5), ESIM - Déterminants Sociaux de la Santé et du Recours aux Soins (DS3), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), CHI Créteil, CHU Pontchaillou [Rennes], Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Mutualité Sociale Agricole - Caisse de Dijon (MSA de Dijon), Caisse Centrale de la Mutualité Sociale Agricole (CCMSA), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC), Hypoxie : Physiopathologie Respiratoire et Cardiovasculaire (HP2), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), COPD screening program, Novartis Pharma, Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université d'Angers (UA), and Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Universitaire [Grenoble] (CHU)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)
- Subjects
[SDV]Life Sciences [q-bio] ,International Journal of Chronic Obstructive Pulmonary Disease ,respiratory tract diseases ,cardiovascular diseases ,chronic obstructive pulmonary disease ,Pulmonary Disease, Chronic Obstructive ,comorbidity ,Cross-Sectional Studies ,Risk Factors ,diabetes mellitus ,Prevalence ,Humans ,tobacco smoking ,Original Research - Abstract
Thibaud Soumagne,1 Alicia Guillien,2 Nicolas Roche,3 Isabella Annesi-Maesano,4 Pascal Andujar,5,6 Lucie Laurent,1 Stéphane Jouneau,7,8 Martial Botebol,9 Jean-Jacques Laplante,10 Jean-Charles Dalphin,1,11 Bruno Degano12,13 1Service de Pneumologie, Oncologie Thoracique et Allergologie Respiratoire, CHU de Besançon, Besançon, France; 2Equipe d’Epidémiologie Environnementale, Institute for Advanced Biosciences, Centre de Recherche UGA, INSERM U1209, CNRS UMR 5309, Grenoble, France; 3Service de Pneumologie, Groupe Hospitalier Cochin, Site Val de Grâce, AP-HP and Université Paris Descartes (EA2511), Sorbonne-Paris-Cité, Paris, France; 4Epidemiology of Allergic and Respiratory Diseases UMR-S 707 Inserm/UPMC, Université Paris 6, Paris, France; 5Centre Hospitalier Intercommunal de Créteil, Service de Pathologie Professionnelle et de l’Environnement, Créteil, France; 6Université Paris-Est Créteil, Faculté de Médecine, Créteil, France; 7Service de Pneumologie, CHU de Rennes, Rennes, France; 8Univ Rennes, CHU Rennes, Inserm, EHESP, Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR-S 1085, Rennes, France; 9Fédération des Maisons de Santé Comtoises (FéMaSaC), Beure, France; 10Mutualité Sociale Agricole (MSA), Besançon, France; 11UMR CNRS Chrono Environnement, Université de Franche-Comté, Besançon, France; 12Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, CHU Grenoble, Alpes, France; 13Université Grenoble Alpes, INSERM U 1042, Grenoble, FranceCorrespondence: Thibaud Soumagne Email thibaud_soumagne@live.frBackground: Comorbidities including cardiovascular diseases are very common in chronic obstructive pulmonary disease (COPD) secondary to tobacco smoking and contribute to the overall severity of the disease. In non-smoking COPD, which accounts for about 25% of COPD cases worldwide, current knowledge on the frequency and determinants of comorbidities remains scarce. The aims of the current study were to assess the frequency of major comorbidities and to evaluate their determinants in a group of non-selected patients with mild-to-moderate COPD who were exposed to organic dust (dairy farmers), to tobacco smoking, or to both, and in controls without COPD who were exposed to organic dust (dairy farmers), or to tobacco smoking, or to both, or who were without exposure.Patients and Methods: A total of 4665 subjects (2323 dairy farmers and 2342 non-farmers) including 355 patients with COPD and 4310 controls with normal spirometry were recruited through a large COPD screening program. Self-reported physician-diagnosed diseases with plausible links to COPD were recorded in this cross-sectional study.Results: Whatever the exposure, cardiovascular comorbidities were not more frequent in patients with COPD than their counterparts without airflow limitation. A higher risk of major cardiovascular comorbidities was associated with tobacco smoking and a lower risk was associated with exposure to organic dusts.Conclusion: Tobacco smoking (but not COPD) is associated with higher frequency of cardiovascular comorbidities. By contrast, being a dairy farmer exposed to organic dusts is associated with a lower frequency of the same comorbidities. This reinforces the crucial need for controlling established cardiovascular risk factors even in patients with mild-to-moderate COPD.Keywords: cardiovascular diseases, chronic obstructive pulmonary disease, comorbidity, diabetes mellitus, tobacco smoking
- Published
- 2020
12. Obstructive Sleep Apnea in Patients with Chronic Obstructive Pulmonary Disease: Facts and Perspectives.
- Author
-
Lurie, Alain and Roche, Nicolas
- Subjects
- *
CHRONIC obstructive pulmonary disease , *SLEEP apnea syndromes , *RAPID eye movement sleep , *HYPERTENSION risk factors , *RESPIRATORY obstructions - Abstract
The co-occurrence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) in the same patient, named the overlap syndrome (OS), was first described in 1985. Although the American Thoracic Society underlined the limited knowledge of OS, stated research priorities for this condition, and recommended a "screening" strategy to identify OSA in COPD patients with chronic stable hypercapnia, research studies on OS remain scarce. This review aims to summarize the current knowledge and perspectives related to OSA in COPD patients. OS prevalence is 1.0–3.6% in the general population, 3–66% in COPD patients, and 7–55% in OSA patients. OS patients may have worse sleep quality than those with OSA or COPD alone. Scoring hypopneas may be difficult in COPD patients; desaturation episodes may have origins in these patients, namely upper airway obstruction, hypoventilation during paradoxical sleep, ventilation/perfusion mismatches, and obesity. The apnea–hypopnea index is similar in OSA and OS patients. Desaturations may be greater and more prolonged in OS patients than in patients with COPD or OSA alone. Low body mass index, hyperinflation, and less collapsible airways reduce the risk of OSA in COPD patients. OSA is a risk factor for pulmonary hypertension in COPD patients. Whether OS increases mortality and morbidity risks compared to COPD or OSA alone remains to be confirmed. No guidelines currently recommend specific approaches to the treatment of OSA in patients with COPD. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
13. A scintigraphy study of budesonide/glycopyrrolate/formoterol fumarate metered dose inhaler in patients with moderate-to-very severe chronic obstructive pulmonary disease.
- Author
-
Usmani, Omar, Roche, Nicolas, Wahab, Ezanul, Israel, Samuel, Jenkins, Martin, Trivedi, Roopa, Dorinsky, Paul, and Aurivillius, Magnus
- Subjects
- *
METERED-dose inhalers , *CHRONIC obstructive pulmonary disease , *FORMOTEROL , *RADIONUCLIDE imaging , *GLYCOPYRROLATE , *HEAD & neck cancer , *CHRONIC bronchitis , *PREDICTIVE tests , *EVALUATION research , *ADRENERGIC beta agonists , *CLINICAL trials , *LUNGS , *TECHNETIUM compounds , *SEVERITY of illness index , *TREATMENT effectiveness , *INHALATION administration , *OBSTRUCTIVE lung diseases , *CONVALESCENCE , *NEBULIZERS & vaporizers , *RESEARCH , *RESEARCH methodology , *MUSCARINIC antagonists , *COMPARATIVE studies , *BRONCHODILATOR agents , *GLUCOCORTICOIDS , *TIME - Abstract
Background: Triple therapy with inhaled corticosteroids/long-acting muscarinic antagonists/long-acting β2-agonists (ICS/LAMA/LABA) is recommended for patients with chronic obstructive pulmonary disease (COPD) with continued symptoms or exacerbations, despite treatment with LAMA/LABA or ICS/LABA. The pulmonary, extrathoracic, and regional lung deposition patterns of a radiolabeled ICS/LAMA/LABA triple fixed-dose combination budesonide/glycopyrrolate/formoterol fumarate (BGF 320/18/9.6 μg), delivered via a single Aerosphere metered dose inhaler (MDI) were previously assessed in healthy volunteers and showed good deposition to the central and peripheral airways (whole lung deposition: 37.7%). Here, we report the findings assessing BGF in patients with moderate-to-very severe COPD.Methods: This phase I, single-dose, open-label gamma scintigraphy imaging study (NCT03906045) was conducted in patients with moderate-to-very severe COPD. Patients received two actuations of BGF MDI (160/9/4.8 μg per actuation) radiolabeled with technetium‑99‑pertechnetate, not exceeding 5 MBq per actuation. Immediately following each inhalation, patients performed a breath-hold of up to 10 s, then exhaled into an exhalation filter. Gamma scintigraphy imaging of the anterior and posterior views of the lungs and stomach, and a lateral head and neck view, were performed immediately after exhalation. The primary objective of the study was to assess the pulmonary deposition of BGF. Secondary objectives assessed the deposited dose of radiolabeled BGF in the oropharyngeal and stomach regions, on the actuator, and on the exhalation filter in addition to regional airway deposition patterns in the lungs.Results: The mean BGF emitted dose deposited in the lungs was 32.1% (standard deviation [SD] 15.6) in patients with moderate-to-very severe COPD, 35.2% (SD 12.8) in patients with moderate COPD, and 28.7% (SD 18.4) in patients with severe/very severe COPD. Overall, the mean normalized outer/inner ratio was 0.55 (SD 0.19), while the standardized central/peripheral ratio was 2.21 (SD 1.64).Conclusions: Radiolabeled BGF 320/18/9.6 μg was efficiently delivered and deposited throughout the entire lung, including large and small airways, in patients with moderate-to-very severe COPD, with similar deposition in patients with moderate COPD and patients with severe/very severe COPD.Trial Registration: ClinicalTrials.gov, NCT03906045. Registered 8 April 2019, https://clinicaltrials.gov/ct2/show/NCT03906045. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
14. Maximizing Adherence and Gaining New Information For Your Chronic Obstructive Pulmonary Disease (MAGNIFY COPD): Study Protocol for the Pragmatic, Cluster Randomized Trial Evaluating the Impact of Dual Bronchodilator with Add-On Sensor and Electronic Monitoring on Clinical Outcomes
- Author
-
Price, David, Jones, Rupert, Pfister, Pascal, Cao, Hui, Carter, Victoria, Kemppinen, Anu, Holzhauer, Björn, Kaplan, Alan, Clark, Allan, Halpin, David MG, Pinnock, Hilary, Chalmers, James D, van Boven, Job FM, Beeh, Kai M, Kostikas, Konstantinos, Roche, Nicolas, Usmani, Omar, and Mastoridis, Paul
- Subjects
CLUSTER randomized controlled trials ,NONINVASIVE ventilation ,OBSTRUCTIVE lung diseases ,RESEARCH protocols ,TREATMENT failure ,PRIMARY care - Abstract
Background: Poor treatment adherence in COPD patients is associated with poor clinical outcomes and increased healthcare burden. Personalized approaches for adherence management, supported with technology-based interventions, may offer benefits to patients and providers but are currently unproven in terms of clinical outcomes as opposed to adherence outcomes. Methods: Maximizing Adherence and Gaining New Information For Your COPD (MAGNIFY COPD study), a pragmatic cluster randomized trial, aims to evaluate the impact of an adherence technology package (interventional package), comprising an adherence review, ongoing provision of a dual bronchodilator but with an add-on inhaler sensor device and a connected mobile application. This will compare time to treatment failure and other clinical outcomes in patients identified at high risk of exacerbations with historic poor treatment adherence as measured by prescription collection to mono/dual therapy over one year (1312 patients) versus usual care. Treatment failure is defined as the first occurrence of one of the following: (1) moderate/severe COPD exacerbation, (2) prescription of triple therapy (inhaled corticosteroid/long-acting β
2 -agonist/long-acting muscarinic antagonist [ICS/LABA/LAMA]), (3) prescription of additional chronic therapy for COPD, or (4) respiratory-related death. Adherence, moderate/severe exacerbations, respiratory-related healthcare resource utilization and costs, and intervention package acceptance rate will also be assessed. Eligible primary care practices (N=176) participating in the Optimum Patient Care Quality Improvement Program will be randomized (1:1) to either adherence support cluster arm (suitable patients already receiving or initiated Ultibro® Breezhaler® [indacaterol/glycopyrronium] will be offered interventional package) or the control cluster arm (suitable patients continue to receive usual clinical care). Patients will be identified and outcomes collected from anonymized electronic medical records within the Optimum Patient Care Research Database. On study completion, electronic medical record data will be re-extracted to analyze outcomes in both study groups. Registration Number: ISRCTN10567920. Conclusion: MAGNIFY will explore patient benefits of technology-based interventions for electronic adherence monitoring. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
15. Never-smokers with occupational COPD have better exercise capacities and ventilatory efficiency than matched smokers with COPD.
- Author
-
Soumagne, Thibaud, Guillien, Alicia, Roche, Nicolas, Dalphin, Jean-Charles, and Degano, Bruno
- Subjects
OBSTRUCTIVE lung diseases ,MICROBIOLOGICAL aerosols ,EXERCISE tolerance ,EXERCISE tests - Abstract
Chronic obstructive pulmonary disease (COPD) in never-smokers exposed to organic dusts is still poorly characterized. Therapeutic strategies in COPD are only evaluated in smoking-related COPD. Understanding how never-smokers with COPD behave during exercise is an important prerequisite for optimal management. The objective of this study was to compare physiological parameters measured during exercise between never-smokers with COPD exposed to organic dusts and patients with smoking-related COPD matched for age, sex, and severity of airway obstruction. Healthy control subjects were also studied. Dyspnea (Borg scale), exercise tolerance, and ventilatory constraints were assessed during incremental cycle cardiopulmonary exercise testing in COPD patients at mild to moderate stages [22 exposed to organic dusts: postbronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) z score 2.44 ± 0.72 and FEV1 z score 1.45 ± 0.78; 22 with smokingrelated COPD: FEV1/FVC z score 2.45 ± 0.61 and FEV1 z score 1.43±0.69] and 44 healthy control subjects (including 22 neversmokers). Despite the occurrence of similar significant dynamic hyperinflation, never-smoker COPD patients exposed to organic dusts had lower dyspnea ratings than those with smoking-related COPD. They also had better ventilatory efficiency, higher peak oxygen consumption and peak power output than smoking-related COPD patients, all these parameters being similar to control subjects. Differences in exercise capacity between the two COPD groups were mainly driven by better ventilatory efficiency stemming from preserved diffusion capacity. Never-smokers exposed to organic dusts with mild to moderate COPD have better exercise capacities, better ventilatory efficiency, and better diffusion capacity than matched patients with smoking-related COPD. NEW & NOTEWORTHY It is unknown whether or not neversmokers with chronic obstructive pulmonary disease (COPD) behave like their smoking counterparts during exercise. This is the first study showing that never-smokers with mild to moderate COPD [defined by a postbronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < lower limit of normal] have preserved exercise capacities. They also have lower exertional dyspnea than patients with smoking-related COPD. This suggests that the two COPD groups should not be managed in the same way. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
16. Chronic obstructive pulmonary disease guidelines in Europe: a look into the future.
- Author
-
Miravitlles, Marc, Roche, Nicolas, Cardoso, João, Halpin, David, Aisanov, Zaurbek, Kankaanranta, Hannu, Kobližek, Vladimir, Śliwiński, Paweł, Bjermer, Leif, Tamm, Michael, Blasi, Francesco, and Vogelmeier, Claus F.
- Subjects
- *
LUNG diseases , *LUNG disease treatment , *PHYSICIAN practice patterns , *DISEASE management , *MEDICAL protocols , *PATIENTS - Abstract
Clinical practice guidelines are ubiquitous and are developed to provide recommendations for the management of many diseases, including chronic obstructive pulmonary disease. The development of these guidelines is burdensome, demanding a significant investment of time and money. In Europe, the majority of countries develop their own national guidelines, despite the potential for overlap or duplication of effort. A concerted effort and consolidation of resources between countries may alleviate the resource-intensity of maintaining individual national guidelines. Despite significant resource investment into the development and maintenance of clinical practice guidelines, their implementation is suboptimal. Effective strategies of guideline dissemination must be given more consideration, to ensure adequate implementation and improved patient care management in the future. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
17. Indacaterol/glycopyrronium is cost-effective compared to salmeterol/fluticasone in COPD: FLAME-based modelling in a Swedish population.
- Author
-
Bjermer, Leif, van Boven, Job F. M., Costa-Scharplatz, Madlaina, Keininger, Dorothy L., Gutzwiller, Florian S., Lisspers, Karin, Mahon, Ronan, Olsson, Petter, and Roche, Nicolas
- Subjects
OBSTRUCTIVE lung disease treatment ,INDACATEROL ,GLYCOPYRROLATE ,SALMETEROL ,FLUTICASONE ,CIGARETTE smokers ,HEALTH ,SMOKING ,DISEASE exacerbation ,THERAPEUTICS ,DISEASES - Abstract
Background: This study assessed the cost-effectiveness of indacaterol/glycopyrronium (IND/GLY) versus salmeterol/fluticasone (SFC) in chronic obstructive pulmonary disease (COPD) patients with moderate to very severe airflow limitation and ≥1 exacerbation in the preceding year.Methods: A previously published and validated patient-level simulation model was adapted using clinical data from the FLAME trial and real-world cost data from the ARCTIC study. Costs (total monetary costs comprising drug, maintenance, exacerbation, and pneumonia costs) and health outcomes (life-years (LYs), quality-adjusted life-years (QALYs)) were projected over various time horizons (1, 5, 10 years, and lifetime) from the Swedish payer's perspective and were discounted at 3% annually. Uncertainty in model input values was studied through one-way and probabilistic sensitivity analyses. Subgroup analyses were also performed.Results: IND/GLY was associated with lower costs and better outcomes compared with SFC over all the analysed time horizons. Use of IND/GLY resulted in additional 0.192 LYs and 0.134 QALYs with cost savings of €1211 compared with SFC over lifetime. The net monetary benefit (NMB) was estimated to be €8560 based on a willingness-to-pay threshold of €55,000/QALY. The NMB was higher in the following subgroups: severe (GOLD 3), high risk and more symptoms (GOLD D), females, and current smokers.Conclusion: IND/GLY is a cost-effective treatment compared with SFC in COPD patients with mMRC dyspnea grade ≥ 2, moderate to very severe airflow limitation, and ≥1 exacerbation in the preceding year. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
18. Blood Eosinophils and Response to Maintenance Chronic Obstructive Pulmonary Disease Treatment. Data from the FLAME Trial.
- Author
-
Roche, Nicolas, Chapman, Kenneth R., Vogelmeier, Claus F., Herth, Felix J. F., Chau Thach, Fogel, Robert, Olsson, Petter, Patalano, Francesco, Banerji, Donald, Wedzicha, Jadwiga A., and Thach, Chau
- Subjects
HORMONE therapy ,HYDROCARBONS ,QUINOLONE antibacterial agents ,ADRENERGIC beta agonists ,ADRENOCORTICAL hormones ,COMBINATION drug therapy ,COMPARATIVE studies ,EOSINOPHILS ,OBSTRUCTIVE lung diseases ,RESEARCH methodology ,MEDICAL cooperation ,RESEARCH ,RESEARCH funding ,EVALUATION research ,RANDOMIZED controlled trials ,TREATMENT effectiveness ,BLIND experiment ,LEUKOCYTE count ,THERAPEUTICS - Abstract
Rationale: Post hoc analyses suggest that blood eosinophils have potential as a predictive biomarker of inhaled corticosteroid efficacy in the management of chronic obstructive pulmonary disease (COPD).Objectives: We prospectively investigated the value of blood eosinophils as a predictor of responsiveness to an inhaled corticosteroid/long-acting β2-agonist combination versus a long-acting β2-agonist/long-acting muscarinic antagonist combination for exacerbation prevention.Methods: We conducted prespecified analyses of data from the FLAME (Effect of Indacaterol Glycopyronium vs Fluticasone Salmeterol on COPD Exacerbations) study, which compared once-daily long-acting β2-agonist/long-acting muscarinic antagonist indacaterol/glycopyrronium 110/50 μg with twice-daily long-acting β2-agonist/inhaled corticosteroid salmeterol/fluticasone combination 50/500 μg in patients with one or more exacerbations in the preceding year. Subsequent post hoc analyses were conducted to address further cutoffs and endpoints.Measurements and Main Results: We compared treatment efficacy according to blood eosinophil percentage (<2% and ≥2%, <3% and ≥3%, and <5% and ≥5%) and absolute blood eosinophil count (<150 cells/μl, 150 to <300 cells/μl, and ≥300 cells/μl). Indacaterol/glycopyrronium was significantly superior to salmeterol/fluticasone for the prevention of exacerbations (all severities, or moderate or severe) in the <2%, ≥2%, <3%, <5%, and <150 cells/μl subgroups, and at no cutoff was salmeterol/fluticasone superior to indacaterol/glycopyrronium. Furthermore, the rate of moderate or severe exacerbations did not increase with increasing blood eosinophils. The incidence of pneumonia was higher in patients receiving salmeterol/fluticasone than indacaterol/glycopyrronium in both the <2% and ≥2% subgroups.Conclusions: Our prospective analyses indicate that indacaterol/glycopyrronium provides superior or similar benefits over salmeterol/fluticasone regardless of blood eosinophil levels in patients with COPD. Clinical trial registered with www.clinicaltrials.gov (NCT01782326). [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
19. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Lung Disease 2017 Report.
- Author
-
Vogelmeier, Claus F., Criner, Gerard J., Martinez, Fernando J., Anzueto, Antonio, Barnes, Peter J., Bourbeau, Jean, Celli, Bartolome R., Chen, Rongchang, Decramer, Marc, Fabbri, Leonardo M., Frith, Peter, Halpin, David M.G., López Varela, M. Victorina, Nishimura, Masaharu, Roche, Nicolas, Rodriguez‐Roisin, Roberto, Sin, Don D., Singh, Dave, Stockley, Robert, and Vestbo, Jørgen
- Subjects
OBSTRUCTIVE lung diseases ,SPIROMETRY ,SYMPTOMS ,CLINICAL pathology ,DRUG therapy ,COMORBIDITY - Abstract
ABSTRACT This Executive Summary of the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: (i) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; (ii) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; (iii) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; (iv)non-pharmacological therapies are comprehensively presented and (v) the importance of co-morbid conditions in managing COPD is reviewed. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
20. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary.
- Author
-
Vogelmeier, Claus F., Criner, Gerard J., Martinez, Fernando J., Anzueto, Antonio, Barnes, Peter J., Bourbeau, Jean, Celli, Bartolome R., Chen, Rongchang, Decramer, Marc, Fabbri, Leonardo M., Frith, Peter, Halpin, David M.G., Varela, M. Victorina López, Nishimura, Masaharu, Roche, Nicolas, Rodriguez-Roisin, Roberto, Sin, Don D., Singh, Dave, Stockley, Robert, and Vestbo, Jørgen
- Abstract
Copyright of Archivos de Bronconeumología (English Edition) is the property of Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2017
- Full Text
- View/download PDF
21. Lung Function Abnormalities in Smokers with Ischemic Heart Disease.
- Author
-
Franssen, Frits M. E., Soriano, Joan B., Roche, Nicolas, Bloomfield, Paul H., Brusselle, Guy, Fabbri, Leonardo M., García-Rio, Francisco, Kearney, Mark T., Namhee Kwon, Lundbäck, Bo, Rabe, Klaus F., Raillard, Alice, Muellerova, Hana, Cockcroft, John R., and Kwon, Namhee
- Subjects
BRONCHODILATOR agents ,ANALYSIS of variance ,CORONARY disease ,LUNGS ,OBSTRUCTIVE lung diseases ,MEDICAL cooperation ,QUALITY of life ,RESEARCH ,SMOKING ,SPIROMETRY ,COMORBIDITY ,LOGISTIC regression analysis ,DISEASE prevalence ,CROSS-sectional method ,VITAL capacity (Respiration) ,DISEASE complications ,THERAPEUTICS - Abstract
Rationale: The aim of the ALICE (Airflow Limitation in Cardiac Diseases in Europe) study was to investigate the prevalence of airflow limitation in patients with ischemic heart disease and the effects on quality of life, healthcare use, and future health risk.Objectives: To examine prebronchodilator and post-bronchodilator spirometry in outpatients aged greater than or equal to 40 years with clinically documented ischemic heart disease who were current or former smokers.Methods: This multicenter, cross-sectional study was conducted in 15 cardiovascular outpatient clinics in nine European countries. Airflow limitation was defined as post-bronchodilator FEV1/FVC less than 0.70.Measurements and Main Results: Among the 3,103 patients with ischemic heart disease who were recruited, lung function was defined for 2,730 patients. Airflow limitation was observed in 30.5% of patients with ischemic heart disease: 11.3% had mild airflow limitation, 15.8% moderate airflow limitation, 3.3% severe airflow limitation, and 0.1% very severe airflow limitation. Most patients with airflow limitation (70.6%) had no previous spirometry testing or diagnosed pulmonary disease. Airflow limitation was associated with greater respiratory symptomatology, impaired health status, and more frequent emergency room visits (P < 0.05).Conclusions: Airflow limitation compatible with chronic obstructive pulmonary disease affects almost one-third of patients with ischemic heart disease. Although airflow limitation is associated with additional morbidity and societal burden, it is largely undiagnosed and untreated. Clinical trial registered with www.clinicaltrials.gov (NCT 01485159). [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
- View/download PDF
22. Current Controversies in the Pharmacological Treatment of Chronic Obstructive Pulmonary Disease.
- Author
-
Singh, Dave, Roche, Nicolas, Halpin, David, Agusti, Alvar, Wedzicha, Jadwiga A., and Martinez, Fernando J.
- Abstract
Clinical phenotyping is currently used to guide pharmacological treatment decisions in chronic obstructive pulmonary disease (COPD), a personalized approach to care. Precision medicine integrates biological (endotype) and clinical (phenotype) information for a more individualized approach to pharmacotherapy, to maximize the benefit versus risk ratio. Biomarkers can be used to identify endotypes. To evolve toward precision medicine in COPD, the most appropriate biomarkers and clinical characteristics that reliably predict treatment responses need to be identified. FEV1 is a marker of COPD severity and has historically been used to guide pharmacotherapy choices. However, we now understand that the trajectory of FEV1 change, as an indicator of disease activity, is more important than a single FEV1 measurement. There is a need to develop biomarkers of disease activity to enable a more targeted and individualized approach to pharmacotherapy. Recent clinical trials testing commonly used COPD treatments have provided new information that is likely to influence pharmacological treatment decisions both at initial presentation and at follow up. In this Perspective, we consider the impact of recent clinical trials on current COPD treatment recommendations. We also focus on the movement toward precision medicine and propose how this field needs to evolve in terms of using clinical characteristics and biomarkers to identify the most appropriate patients for a given pharmacological treatment. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
23. Association of chronic nasal symptoms with dyspnoea and quality-of-life impairment in chronic obstructive pulmonary disease.
- Author
-
Caillaud, Denis, Chanez, Pascal, Escamilla, Roger, Burgel, Pierre‐Régis, Court‐Fortune, Isabelle, Nesme‐Meyer, Pascale, Deslee, Gaëtan, Perez, Thierry, Pinet, Christophe, and Roche, Nicolas
- Subjects
DYSPNEA ,QUALITY of life ,OBSTRUCTIVE lung diseases patients ,RHINITIS ,ALLERGIC rhinitis ,DISEASE risk factors - Abstract
Background and objective Previous studies suggested that chronic nasal symptoms ( CNS) are frequent in chronic obstructive pulmonary disease ( COPD) subjects, but their contribution to dyspnoea and quality-of-life ( QoL) impairment is not clearly established. Methods Data from the French COPD cohort 'Initiatives bronchopneumopathie chronique obstructive' were analyzed to assess the frequency of CNS (rhinorrhea, obstruction, anosmia) in COPD patients and analyze their impact and associated risk factors. Univariate and multivariate analyses were performed to assess the relationship between CNS with sociodemographic and anthropometric characteristics, risk factors, respiratory symptoms, spirometry, QoL ( Saint George's respiratory questionnaire ( SGRQ)), dyspnoea (modified Medical Research Council ( mMRC) scale), mood disorders ( Hospital Anxiety and Depression Scale ( HADS)), number of exacerbations and comorbid conditions. Results CNS were reported by 115 of 274 COPD subjects (42%). Among them, rhinorrhea and nasal obstruction were reported by 62% and 43%, respectively. In multivariate analysis, COPD patients with CNS had higher SGRQ total scores, corresponding to worse QoL ( P = 0.01), while no independent association was found with exacerbations, lung function and HADS. Among SGRQ domains, an independent association was found with the activity score ( P = 0.007). When SGRQ score was forced out of the model to avoid redundancy, mMRC score was independently associated with CNS ( P = 0.01). Among risk factors, cumulative smoking, hay fever and atopic dermatitis but not occupational exposures were independently associated with CNS. Conclusions In this group of COPD subjects, CNS were frequently observed and associated with dyspnoea and poorer QoL. CNS should be systematically assessed and could be a potential target in the management of COPD. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
24. Chronic bronchitis in the general population: Influence of age, gender and socio-economic conditions.
- Author
-
Ferré, Alexis, Fuhrman, Claire, Zureik, Mahmoud, Chouaid, Christos, Vergnenègre, Alain, Huchon, Gérard, Delmas, Marie-Christine, and Roche, Nicolas
- Abstract
Summary: Chronic bronchitis (CB) is an indicator of an increased risk of developing COPD, but its symptoms are often underestimated. Demographic and socio-economic conditions might influence its prevalence, reporting and impact. Data from a large epidemiological survey of the French general population were analyzed to determine the burden of CB, the magnitude of under-diagnosis and the influence of age, gender and socio-economic conditions. Altogether, 9050 participants aged 45 years or more provided complete data. The prevalence of symptoms and diagnosis of CB was 3.5% and 3.4%, respectively. CB was associated with impaired health status and activity and, in women, work loss. Among subjects with symptoms of CB, only 28.6% declared a known diagnosis of respiratory disease. Factors associated with symptoms of CB in multivariate analysis were male gender, active smoking, lower income and occupational category: the highest prevalence was observed in manual workers (5.6%) and self-employed subjects (5.2%). The under-diagnosis of CB was more marked in men and subjects of higher socio-economic categories. These results confirm that CB is markedly under-diagnosed in the general population. Socio-economic conditions influence both its prevalence (higher in low categories) and rate of diagnosis (lower in high categories), which should be considered when elaborating prevention and detection campaigns. [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
- View/download PDF
25. The Effect of an Information Leaflet upon Knowledge and Awareness of COPD in Potential Sufferers.
- Author
-
Carré, Philippe C., Roche, Nicolas, Neukirch, Françoise, Radeau, Thierry, Perez, Thierry, Terrioux, Philippe, Ostinelli, Juliette, Pouchain, Denis, and Huchon, Gérard
- Subjects
- *
OBSTRUCTIVE lung diseases , *RESPIRATORY insufficiency , *LUNG diseases , *RESPIRATORY obstructions , *COUGH , *SPUTUM , *SMOKING - Abstract
Background: Chronic obstructive pulmonary disease (COPD) is markedly under-diagnosed, which may be related to the under-reporting of symptoms and poor awareness of the disease. We hypothesized that written information on COPD may help increase awareness of the disease in people at risk of developing it. Objectives: To evaluate the impact of an information leaflet sent by postal mail on the level of knowledge of COPD in subjects with or at risk of COPD. Methods: A total of 860 subjects with or at risk of COPD were selected by using a phone questionnaire. All subjects who reported a known diagnosis of COPD, a chronic cough and sputum production, or a smoking history of at least 15 pack-years were eligible for selection. Their knowledge of COPD was assessed during a telephone interview (baseline). They were randomized into 2 groups, with only 1 group receiving the information leaflet, and were then contacted 3 months later for a second interview. The changes in the knowledge of COPD from baseline were compared between subjects who reported receiving and reading the leaflet (true sensitized group) and subjects to whom the leaflet was not sent (control group). Results: At the follow-up interview, the proportion of patients who spontaneously mentioned ‘respiratory difficulties’, when asked about the meaning of COPD, significantly increased in the true sensitized group (+11.9%) compared with the control group (+2.6%, p < 0.05). In addition, the frequency of patients who cited lung function test as the primary diagnostic tool for COPD increased by +14.4% in the true sensitized group versus+2.0% in the control group (p < 0.05). However, there was no short-term leaflet-dependent improvement in smoking behaviour or utilization of health-care resources. Conclusions: This study shows that an information leaflet sent by postal mail to subjects with or at risk of COPD can significantly improve their knowledge of COPD; however, it has no significant impact on their behaviour. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]
- Published
- 2008
- Full Text
- View/download PDF
26. Current concepts in targeting chronic obstructive pulmonary disease pharmacotherapy: making progress towards personalised management
- Author
-
Woodruff, Prescott G., Alvar Agusti Garcia-Navarro, Roche, Nicolas, Singh, Dave, and Martinez, Fernando J.
- Subjects
Inflammation ,Chronic Obstructive ,screening and diagnosis ,Evidence-Based Medicine ,Chronic Obstructive Pulmonary Disease ,Disease Management ,Medical and Health Sciences ,4.1 Discovery and preclinical testing of markers and technologies ,Pulmonary Disease ,Detection ,Th2 Cells ,Good Health and Well Being ,Clinical Research ,alpha 1-Antitrypsin Deficiency ,General & Internal Medicine ,Eosinophilia ,Disease Progression ,Respiratory ,Humans ,Precision Medicine ,Lung ,Biomarkers - Abstract
Chronic obstructive pulmonary disease (COPD) is a common, complex, and heterogeneous disorder that is responsible for substantial and growing morbidity, mortality, and health-care expense worldwide. Of imperative importance to decipher the complexity of COPD is to identify groups of patients with similar clinical characteristics, prognosis, or therapeutic needs, the so-called clinical phenotypes. This strategy is logical for research but might be of little clinical value because clinical phenotypes can overlap in the same patient and the same clinical phenotype could result from different biological mechanisms. With the goal to match assessment with treatment choices, the latest iteration of guidelines from the Global Initiative for Chronic Obstructive Lung Disease reorganised treatment objectives into two categories: to improve symptoms (ie, dyspnoea and health status) and to decrease future risk (as predicted by forced expiratory volume in 1 s level and exacerbations history). This change thus moves treatment closer to individualised medicine with available bronchodilators and anti-inflammatory drugs. Yet, future treatment options are likely to include targeting endotypes that represent subtypes of patients defined by a distinct pathophysiological mechanism. Specific biomarkers of these endotypes would be particularly useful in clinical practice, especially in patients in which clinical phenotype alone is insufficient to identify the underlying endotype. A few series of potential COPD endotypes and biomarkers have been suggested. Empirical knowledge will be gained from proof-of-concept trials in COPD with emerging drugs that target specific inflammatory pathways. In every instance, specific endotype and biomarker efforts will probably be needed for the success of these trials, because the pathways are likely to be operative in only a subset of patients. Network analysis of human diseases offers the possibility to improve understanding of disease pathobiological complexity and to help with the development of new treatment alternatives and, importantly, a reclassification of complex diseases. All these developments should pave the way towards personalised treatment of patients with COPD in the clinic.
27. Assessing the clinical value of fast onset and sustained duration of action of long-acting bronchodilators for COPD.
- Author
-
Cazzola, Mario, Beeh, Kai M., Price, David, and Roche, Nicolas
- Subjects
- *
OBSTRUCTIVE lung diseases , *BRONCHODILATOR agents , *DYSPNEA , *PULMONARY manifestations of general diseases , *RESPIRATORY diseases - Abstract
The long-acting inhaled bronchodilators available for use in chronic obstructive pulmonary disease (COPD) vary in their pharmacological class (β 2 -adrenergic agonist or antimuscarinic/anticholinergic, alone or combined), durations of action and speed of onset of bronchodilator effect. In the early stages of development of a maintenance bronchodilator, the goals are to identify a molecule with the theoretically ‘ideal’ profile of fast onset and prolonged duration of action in comparison with existing agents, while minimizing non-specific activity at organs outside the lungs. The move towards increasing duration of bronchodilator action is generally paralleled by improved effects on clinical outcomes, and the advent of more potent agents seems likely to provide an opportunity to reduce overreliance on the use of inhaled corticosteroids in treating COPD. In terms of onset of action, an immediately perceived benefit in reducing dyspnea, although not definitively demonstrated, might prove useful in increasing adherence, which is very poor among patients with COPD. Once-daily administration may also be helpful in this respect. Shared decision-making between patient and physician in the choice of treatment is important in optimizing adherence and, thus, treatment effectiveness. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
28. Influence of ICU Case-Volume on the Management and Hospital Outcomes of Acute Exacerbations of Chronic Obstructive Pulmonary Disease.
- Author
-
Dres, Martin, Thi-Chien Tran, Aegerter, Philippe, Rabbat, Antoine, Guidet, Bertrand, Huchon, Gerard, and Roche, Nicolas
- Subjects
- *
DISEASE exacerbation , *INTENSIVE care units , *HOSPITAL administration , *OBSTRUCTIVE lung diseases , *VENTILATION , *COHORT analysis , *MULTIVARIATE analysis - Abstract
Objectives: To study the relationship between case-volume and the use of noninvasive ventilation during acute exacerbations of chronic obstructive pulmonary disease in ICUs. Design: A 13-year multicenter retrospective cohort study of prospectively collected data. Setting: Medical ICUs. Patients: From 1998 to 2010, patients with acute exacerbations of chronic obstructive pulmonary disease were identified through a regional database. Interventions: The characteristics of hospitalization (including the type of mechanical ventilation) and demographic data of the patients were analyzed. ICUs were categorized into tertiles of the running mean annual volume of admissions. A logistic model performed a conditional multivariate analysis of prognostic factors after matching on a propensity score of being admitted to a highvolume unit and on the year of admission. Measurements and Main Results: Fourteen thousand four hundred forty acute exacerbations of chronic obstructive pulmonary disease were identified. The Simplified Acute Physiology Score II and ICU mortality increased during the study period (36 to 41 and 1 2% to 14%, respectively). The proportion of patients receiving any mechanical ventilation support also increased during the study period (from 64% to 86%), with a marked increase in the use of rioninvasive ventilation (from 1 8% to 49%) and a decrease in the use of invasive ventilation (from 340/s to 19%). Participating units were distributed into low-volume (< 25 patients per year), medium-volume (26-47 patients per year), and high-volume (> 47 patients per year) tertiles. There was a significant association between case-volume and 1) the proportion of patients receiving noninvasive ventilation (highest vs lowest case-volume tertiles: odds ratio, 1.43 [95% Cl, 1.23-1 .66]) and 2) lower mortality. Conclusions: Between 1998 and 2010, severity and mortality of acute exacerbations of chronic obstructive pulmonary disease admitted to College des Utilisateurs de Données en Reanimation ICUs increased. There was an increasing use of noninvasive ventilation and a decreasing use of invasive ventilation. Use of nonirivasive ventilation was related to case-volume, suggesting that increasing experience favors the use of noninvasive ventilation and was associated with a strong trend toward decreased mortality. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
29. Characterization of chronic obstructive pulmonary disease in dairy farmers.
- Author
-
Soumagne, Thibaud, Degano, Bruno, Guillien, Alicia, Annesi-Maesano, Isabella, Andujar, Pascal, Hue, Sophie, Adotevi, Olivier, Jouneau, Stéphane, Botebol, Martial, Laplante, Jean-Jacques, Roche, Nicolas, and Dalphin, Jean-Charles
- Subjects
- *
OBSTRUCTIVE lung diseases , *DAIRY farmers , *MICROBIOLOGICAL aerosols , *SMOKING , *BLOOD testing - Abstract
Although farming is often considered a risk factor for COPD, data regarding the burden and characteristics of COPD in dairy farmers are sparse and conflicting. To characterize COPD in dairy farmers. 4788 subjects entered two parallel COPD screening programs, one in agricultural workers and one in general practice from 2011 to 2015. Subjects with COPD were invited to participate in the characterization phase of the study. Those who accepted were included in two subgroups: dairy farmers with COPD (DF-COPD) (n = 101) and non-farmers with COPD (NF-COPD) (n = 85). Patients with COPD were frequency-matched with subjects with normal spirometry for age, sex and tobacco smoking (pack-years and status) (DF-controls n = 98, NF-controls n = 89). All subjects from these four groups underwent lung function and exercise testing, questionnaires and blood analysis. The frequency of COPD in dairy farmers was 8.0% using the GOLD criterion and 6.2% using the lower limit of normal criterion and was similar in non-farming subjects (7.3% and 5.2%, respectively) although dairy farmers had lower tobacco consumption (screening phase). DF-COPD had better pulmonary function, exercise capacity and quality of life, fewer symptoms and comorbidities than NF-COPD, and higher levels of some Th2 biomarkers (MCP-2, periostin) (characterization phase). In farmers, COPD was not related to occupational exposure factors, supporting the role of host factors. COPD secondary to organic dust exposure (dairy farming) appears less severe and associated with fewer comorbidities than COPD secondary to tobacco smoking. • The frequency of COPD in dairy farmers is 8.0% using the GOLD criterion and 6.2% using the LLN criterion. • Dairy farmers with COPD have greater pulmonary function, exercise capacity and quality of life than patients with tobacco-related COPD matched on age, BMI and gender. • In addition, they have fewer symptoms, comorbidities and systemic inflammation than patients with tobacco-related COPD. • COPD in dairy farmers is associated with some Th2 phenotype markers. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.