Jama copd exacerbation steroids

Results   A total of 116 patients (mean [SD] age of 67 [10] years, 53% female, mean BMI of [IQR, -], mean [SD] forced expiratory volume in the first second of expiration of L [ L], and mean [SD] Pa co 2 while breathing room air of 59 [7] mm Hg) were randomized. Sixty-four patients (28 in home oxygen alone and 36 in home oxygen plus home NIV) completed the 12-month study period. The median time to readmission or death was months (IQR, - months) in the home oxygen plus home NIV group vs months (IQR, - months) in the home oxygen alone group, adjusted hazard ratio of (95% CI, -; P  = .002). The 12-month risk of readmission or death was % in the home oxygen plus home NIV group vs % in the home oxygen alone group, absolute risk reduction of % (95% CI, %-%). At 12 months, 16 patients had died in the home oxygen plus home NIV group vs 19 in the home oxygen alone group.

Results  During follow-up, 3083 exacerbations were recorded (mean, /participant). In the first year of follow-up, multivariable-adjusted odds ratios for having frequent exacerbations were (95% CI, -; 17 events/1000 person-years) for individuals with 1 high biomarker, (95% CI, -; 32 events/1000 person-years) for individuals with 2 high biomarkers, and (95% CI, -; 81 events/1000 person-years) for individuals with 3 high biomarkers compared with individuals who had no elevated biomarkers (9 events/1000 person-years; trend: P  = 2 × 10 −5 ). Corresponding hazard ratios using maximum follow-up time were (95% CI, -), (95% CI, -), and (95% CI, -), respectively (trend: P  = 1 × 10 −8 ). The addition of inflammatory biomarkers to a basic model including age, sex, FEV 1 percent predicted, smoking, use of any inhaled medication, body mass index, history of previous exacerbations, and time since most recent prior exacerbation improved the C statistics from to (comparison: P  = 9 × 10 −5 ). Relative risks were consistent in those with milder COPD, in those with no history of frequent exacerbations, and in the 2 studies separately. The highest 5-year absolute risks of having frequent exacerbations in those with 3 high biomarkers (vs no high biomarkers) were 62% (vs 24%) for those with Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades C-D (n = 558), 98% (vs 64%) in those with a history of frequent exacerbations (n = 127), and 52% (vs 15%) for those with GOLD grades 3-4 (n = 465).

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  • Citation tools Download this article to citation manager Bischoff Erik W M A , Akkermans Reinier , Bourbeau Jean , van Weel Chris , Vercoulen Jan H , Schermer Tjard R J et al. Comprehensive self management and routine monitoring in chronic obstructive pulmonary disease patients in general practice: randomised controlled trial BMJ 2012; 345 :e7642
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    Genetics play a role in the development of COPD. [9] It is more common among relatives of those with COPD who smoke than unrelated smokers. [9] Currently, the only clearly inherited risk factor is alpha 1-antitrypsin deficiency (AAT). [46] This risk is particularly high if someone deficient in alpha 1-antitrypsin also smokes. [46] It is responsible for about 1–5% of cases [46] [47] and the condition is present in about 3–4 in 10,000 people. [16] Other genetic factors are being investigated, [46] of which there are likely to be many. [11]

    Chronic obstructive pulmonary disease is characterized by recurrent flare-ups that can cause intermittent periods of severe clinical deterioration requiring hospitalization and ventilator support. To investigate the effect of home noninvasive ventilation (NIV; use of a mask and machine to support breathing) plus oxygen on time to hospital readmission or death, Nicholas Hart, ., of Guy’s and St. Thomas’ NHS Foundation Trust, London, and colleagues randomly assigned patients with persistent hypercapnia after a COPD flare-up to home oxygen alone (n = 59) or home oxygen plus home NIV (n = 57).

    Symptom severity is assessed using the CAT or mMRC ( table 7 ) [ 103 ]. Lung function in addition to the number of exacerbations and hospitalizations for exacerbations in the previous 12 months can be used to predict future risk. A history of zero or one exacerbation in the past 12 months and GOLD 1 or 2 spirometric level suggests a low future risk of exacerbations, while two or more exacerbations or a hospitalized exacerbation or GOLD 3 or 4 spirometric level suggest a high future risk [ 8 ]. These components are combined into four groups as follows:

    Jama copd exacerbation steroids

    jama copd exacerbation steroids

    Genetics play a role in the development of COPD. [9] It is more common among relatives of those with COPD who smoke than unrelated smokers. [9] Currently, the only clearly inherited risk factor is alpha 1-antitrypsin deficiency (AAT). [46] This risk is particularly high if someone deficient in alpha 1-antitrypsin also smokes. [46] It is responsible for about 1–5% of cases [46] [47] and the condition is present in about 3–4 in 10,000 people. [16] Other genetic factors are being investigated, [46] of which there are likely to be many. [11]

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