Navigation Links
Exacerbations in COPD: One thing leads to another
Date:2/19/2009

New research shows that individual exacerbations in chronic obstructive lung disease (COPD) themselves increase the likelihood of repeat exacerbations, even after five days of full, asymptomatic recoverybad news for patients with COPD, where each exacerbation can drive the progression of the disease.

"This concept that exacerbations are not random has important implication for the analysis of clinical trial data and identifies a specific high-risk period for recurrent exacerbation during which preventative interventions might be targeted," wrote lead author, John Hurst, M.D., of the Royal Free and University College Medical School, in London.

The results appeared in the first issue for March of the American Journal of Respiratory and Critical Care Medicine, a publication of the American Thoracic Society.

In patients with COPD, exacerbations are generally defined as an acute worsening of symptoms. Exacerbations in and of themselves are inherently dangerous and can lead to hospitalization and serious complications. But beyond their acute dangers, exacerbations drive lung function decline, and many patients never recover their baseline level of lung function after exacerbations. Prior to this research, however, exacerbations were assumed to be isolated events unrelated to one another despite observational data that suggested a dependency.

To test the validity of this assumption, which not only informs treatment plans for patients with COPD, but also forms the basis of research design and analysis, Dr. Hurst and colleagues analyzed daily symptom diaries that were kept for at least one year by 297 COPD patients, describing nearly 2,000 distinct exacerbation events. Two or more new or worsening symptoms, one of which must be "major" (e.g., dyspnea, more sputum, or a change in color of sputum) constituted an exacerbation, and after five days of symptoms reverting to baseline severity, the exacerbation was considered to be over. A second exacerbation occurring within an eight-week period was considered to be a recurrent exacerbation. The researchers further analyzed seasonality of exacerbations, comparing their winter (November to January) frequency with their summer (June-August) frequency.

In addition to the finding that exacerbations were clustered in time within individuals, the researchers found that they were significantly more common in the winter than the summer. They also noted that "isolated" exacerbations tended on average to be about 25 percent more severe than the first of serial exacerbations.

But most importantly, the researchers identified an eight-week period of time during which monitoring and follow-up is crucial to prevent or minimize further exacerbations in the COPD patient. "Our finding of a high-risk period for recurrent exacerbation may be important in guiding patient follow-up," wrote Dr. Hurst.

"The mechanisms of exacerbation recurrence remain unexplored, and it is unknown whether recurrence is due to persistence of an existing organism or to acquisition of a new one," noted Dr. Hurst. However, there are some clues that may guide future research. "The failure to eradicate bacteria with exacerbation therapy has been associated with an incomplete recovery in inflammatory markers and we have recently reported a relationship between elevated C-reactive protein during the recovery period of an initial exacerbation and shorter time to the next." Furthermore, the paper noted that "symptoms more typical of viral infection are significantly more common during isolated events."

"This knowledge is very important for physicians," wrote Shawn D. Aaron, M.D., of the Ottawa Health Research Institute, in Canada, in an editorial in the same issue of the journal. "Clinicians should now be aware that their patients with COPD who experience an exacerbation may be particularly 'brittle' during a subsequent eight-week period. Close monitoring and follow-up during this time would hopefully lead to earlier therapy for recurrent exacerbations that may improve clinical outcomes."


'/>"/>

Contact: Keely Savoie
ksavoie@thoracic.org
212-315-8620
American Thoracic Society
Source:Eurekalert

Related medicine news :

1. A Biologic Drug Superior to Spiriva in Reducing COPD-Related Exacerbations Would Earn a Higher Patient Share in Europe Than in the U.S.
2. Long-term antibiotics reduce COPD exacerbations, raise questions
3. FDA Approves Advair(R) 250/50 for Reduction of Exacerbations in Patients With COPD
4. Philippine Birthing Centers Help New Mothers, Healthy Infants
5. Nothing But Nets and Union of Reform Judaism Help Save Lives in Kenya
6. Brez(R), the First Over-the-Counter, Intranasal Breathing Aid Clinically Proven to Reduce Primary Snoring, Debuts in Rite Aid Pharmacies
7. Sleep disordered breathing and obesity: Independent effects, causes
8. ING and Fit Miami Foundation Name Winners of ING Run For Something Better Student Essay Contest
9. Vicks VapoRub Linked to Infant Breathing Problems
10. KnowYourTeeth.com Launches as the Internets New Go-To Resource for All Things Dental
11. Breathing easier
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/23/2017)... Long Beach, CA (PRWEB) , ... June 23, 2017 , ... ... (ANRF) has earned its ninth consecutive four-star rating from premier online charity evaluator, Charity ... ANRF in the top 1% of all charities reviewed by Charity Navigator and earns ...
(Date:6/23/2017)... (PRWEB) , ... June 23, 2017 , ... Military ... were recently denied entry to the JFK Virgin Atlantic lounge. , Bensko is ... a wheelchair six years ago, Bensko dedicated her life to supporting our wounded veterans. ...
(Date:6/23/2017)... ... June 23, 2017 , ... Georgia State University will host ... , The two-day conference is focused on advancing scientific knowledge about the aggressive ... and eliminating racial breast cancer-related disparities. The conference theme is “Illuminating Actionable Biology.” ...
(Date:6/23/2017)... ... June 23, 2017 , ... American Farmer, will feature Chr. ... is slated to air fourth quarter 2017. American Farmer airs Tuesdays at 8:30aET on ... Danish pharmacist, founded Chr. Hansen in Denmark in 1874 after a groundbreaking discovery of ...
(Date:6/23/2017)... , ... June 23, 2017 , ... ... and personal financial planning to families and business owners in North Central West ... to help provide services to differently abled residents in the region. , The ...
Breaking Medicine News(10 mins):
(Date:6/12/2017)... June 12, 2017 Kineta, Inc., a biotechnology company ... Kineta Vice President of R&D and Head of Virology ... Pandemic Preparedness for the Northwest and Beyond meeting sponsored ... June 14, 2017 from 8:30-10:30 AM PDT at the Agora ... Dr. Bedard will be joined by other leaders ...
(Date:6/9/2017)... 2017 AirXpanders, Inc. (ASX: AXP) (AirXpanders or ... manufacture, sale and distribution of the AeroForm® Tissue Expander ... its commercial roll-out in the United States ... one hundred (100) medical institutions and health systems, located ... needle-free alternative for women who choose reconstructive surgery following ...
(Date:6/8/2017)...   Responding to Heath Ledger,s father,s recent ... singer Chris Cornell in May, the mental health ... free online psychiatric drug side effects search ... psychotropic drug risks. The father of the ... accidental overdose, has called for tighter rules on prescription drugs. ...
Breaking Medicine Technology: