mesa 2.5. jose luis lopez

Mesa 2. Control y biomarcadores

Dr. José Luis

López-Campos

Hospital Virgen del Rocío. Sevilla


[ATS] Symptom Burden Of

COPD Patients - Real Life

Data From The German

Daccord Registry

Buhl R, Criee CP, Kardos P,

Vogelmeier CF,

Worth H


Introduction

Patients’ symptoms are the key parameters that drive therapeutic

interventions in COPD. (O’Hagan P. et al., Curr Med Res Opin 2014;

30:301–14). So far, limited data have been published on COPD symptoms.

Methods

In the prospective, real-life DACCORD registry, 6,208 patients with COPD

completed mMRC and CAT questionnaires and reported their COPD

symptoms and co-morbidities at baseline.


Results

Mean age of the patients was 65.7 years (range 40-96 years), 45 % were younger than 65

years and 59.6 % were males. The number of patients reporting ≥1 exacerbation in the 6

months prior to documentation was 28 %.

• Free of symptoms : 3 %

• Dyspnea on exertion: 85 %

• Cough: 65 %, of these:

• Dry cough: 39 %

• Wet cough: 61 %

• Limitations of exercise tolerance 55 %

• Other: dyspnea at rest, chest tightness, wheezing or prolonged expiration: 20 %


Results

In subgroup analyses, patients with CAT <10 reported fewer symptoms than

patients with CAT >30


Results

The vast majority of patients (>90 %) was primarily symptomatic during

daytime and in the morning.

The most common co-morbidity was cardiovascular disease (CD, 52 % of

total population).

In patients with CAT >30, the second most frequent co-morbidity were

psychiatric disorders with a 4-fold higher incidence compared to patients

with CAT < 10 (23,7 % vs 5,5 % respectively).


Conclusion

This extensive real-world study in Germany provides insights into COPD

symptoms in a large patient population of over 6.000 patients. The most

frequent COPD symptom reported was dyspnea on exertion. Patients with

CAT <10 reported fewer comorbidities than patients with CAT >30. In a

majority of patients, symptoms occur in the morning or during daytime and

CD is the most common comorbidity.


[ATS] Stable Blood

Eosinophil Percentage

Predicts Exacerbation

Recovery In COPD

Donaldson GC, Mackay AJ,

Whitmore GA, Aaron SD,

Wedzicha JA


Rationale

A recent study has shown non-inferiority of blood eosinophilia at

exacerbation to guide treatment of COPD exacerbations with oral

corticosteroids (Bafadhel et al. AJRCCM 2012;186:48-55).

It was unclear whether eosinophil count measured at baseline (stable) or

exacerbation would be the best indicator as 80 % of patients with ≥ 2 %

eosinophil count at exacerbation had ≥ 2 % at baseline.

We examined in exacerbations treated with oral corticosteroids, whether the

percentage of eosinophils in blood sampled at baseline was predictive of

exacerbation duration.


Methods

This study consists of data collected from the London COPD cohort between 3/10/2005 and

the 21/3/2014. COPD was defined as FEV1 <80 %, FEV1 / FVC ratio <0,7. Exacerbations

were defined as the first of two or more days in which the patient recorded two or more new

or worsening respiratory symptoms that had to include dyspnoea, sputum purulence or

sputum volume. Exacerbation duration was defined as the number of days from onset until

two consecutive days without worse than normal respiratory symptoms.

To allow for repeated measures this analysis was performed with shared frailty survival

models. A stable blood sample was collected 4 weeks after and 2 weeks before the onset of

any exacerbation.


Results

184 COPD patients had at least one oral corticosteroid treated

exacerbation. Their mean FEV1 was 1.22 l (SD 0.49); FEV1 % predicted,

49.2 % (16.1); FEV1 /FVC ratio, 0.46 (0.12); age 70.1 (8.6); 61.5 % male.

There were an average 10.2 stable blood samples per patient: 61 patients

had an average eosinophil count < 2 % eosinophils and 123 patients ≥ 2 %.

No significant differences were seen between these two groups with the

median annual exacerbation frequency in patients <2 % was 2.62 per year

(IQR 1.96-3.8) and for patients ≥ 2 %, 2.54 per year (IQR 1.7-3.8; negative

binomial regression p=0.89).


Results

The 184 patients had 991 oral corticosteroid treated exacerbations (average

5.4 per patient) for which the duration of the exacerbation was known.

A raised stable eosinophil count was associated with a shorter exacerbation

time; hazard ratio =1.34 (95 % CI 1.10-1.65; p=0.004; see figure 1).

The median exacerbations duration in patient <2 % and ≥ 2 % was 13.5

days (IQR 8-26) and 11 days respectively (IQR 7-18; Wilcoxon; p=0.001).


Conclusion

The results suggest that a stable eosinophil count may be able to classify

patients prior to exacerbation presentation into whether they will have

shorter exacerbations in response to oral corticosteroid therapy. This

classification will be useful when rapid blood analysis is unavailable.


[ERS] Long-term effects of

inhaled corticosteroids on

sputum bacterial and viral

loads in COPD patientsContoli M, Pauletti A, Casolari P,

Hnesini G, Magnoni MS, Currandi G,

et al.


RationaleThe use of inhaled corticosteroid (ICS) in COPD reduces the risk of exacerbations

but it is associated with increased risk of pneumonia

ObjectivesWe compared the effects of 1-year treatment with either fluticasone

propionate/salmeterol (SALM/FP) or salmeterol (SALM) alone on sputum bacterial

and viral loads in moderate COPD patients


Methods

60 stable moderate COPD patients were recruited and randomized to receive

either SALM/FP 50/500 mcg bid or SALM 50 mcg bid for 12 months. After

baseline assessment, patients were seen every 3 months. At each visit lung

function was assessed and induced sputum collected to evaluate the

inflammatory cell profile and quantitative/qualitative bacteriology/virology


ResultsAfter 1-year treatment, sputum total bacterial load significantly increased in the

SALM/FP group (D +1.3 [-3 – 5] Log10 CFU/ml, p < 0.01) but not in the SALM

group (D0 [-5 – 4] Log10 CFU/ml, p > 0.05). A non-significant increase of

potentially pathogen bacterial load was observed in sputum samples of

SALM/FP treated patients. No difference in respiratory virus detection rate was

observed between the two arms. The increase in airway total bacterial load did

not correlate with any of the clinical outcomes assessed during the study.

Among SALM/FP treated patients, the increase in total bacterial load occurred

in those subjects with no sputum eosinophil detection throughtout the study

(p=ns)


Conclusions

In moderate COPD patients ICS-treatment is associated with a significant

increase in airway total bacterial load, not related to clinical outcomes, when

eosinophils are persistently absent in sputum samples.


Muchas gracias

por su atención

mesa 2.5. jose luis lopez

Health & Medicine