How To Assess Severity and Prognosis
|
|
- Easter James
- 6 years ago
- Views:
Transcription
1 How To Assess Severity and Prognosis Gregory Tino, M.D. Chief, Department of Medicine Penn Presbyterian Medical Center Associate Professor of Medicine Perelman School of Medicine at the University of Pennsylvania Philadelphia, PA
2 Disclosures Research grant support: Bronchiectasis Research Registry/COPD Foundation Advisory Board: Bayer Grifols Aradigm
3 Assessing Severity and Prognosis Clinical course and natural history of bronchiectasis are variable Ability to accurately assess severity and prognosis has been an unmet need.. but we ve made significant progress
4 77 y.o. African-American man: Followed at Penn since 1966 Pneumonia at 18 months of age Diagnosed with bronchiectasis in Alabama at age 12 after presenting with cough of two years duration with ½ cup purulent sputum production Tuberculosis excluded
5
6
7 Clinical Course Left pneumonectomy recommended, but declined by his parents Did well as teenager and adult - fathered two children, retired after career as a parole officer Managed for many years with rotating antibiotics, including ciprofloxacin, + chest physiotherapy
8 PFT FEV 1 : 1.65L (72% pred) 2.17L FVC: 2.10 L (68% pred) 2.70L FEV 1 / FVC ratio: 78% 80% TLC: 75% predicted RV: 110% predicted D L CO: 60% predicted
9 Clinical Course Has quinolone-resistant Pseudomonas aeruginosa infection + Pulmonary MAC infection (macrolide-sensitive, for which he s declined antimicrobials) 2-3 acute infectious exacerbations per year requiring IV antibiotics Daily sputum production - 40ml/day Perceives QOL as declining
10 How would you assess the severity of this patient s bronchiectasis?
11 Bronchiectasis: Clinical Impact Has adverse impact on quality of life Factors influencing QOL Dyspnea FEV 1 Sputum volume Pseudomonas aeruginosa infection Wilson et al. Eur Respir J 1997;10: Martinez-Garcia et al. Chest 2005;128:
12 Bacterial load is a significant predictor of recurrent exacerbations and an independent predictor of hospitalization ** * * * * Antibiotic therapy reduces bacterial load and markers of inflammation. Bacterial load cfu/ml Bacterial load cfu/ml Chalmers, et al. AJRCCM, 2012.
13 Mortality in Bronchiectasis 91 patients in the UK followed over 13 years starting in 1994; 56% had idiopathic BE Mean age: 52 years 29.7% died Expected death rate 14.7% for males, and 8.9% for females Respiratory causes accounted for 70.4% of deaths Predictors: older age, P. aeruginosa infection, lower FEV1, SGRQ Loebinger et al. Eur Respir J 2009; 34.
14 Bronchiectasis Severity Index (BSI) Clinical prediction tool for disease severity Derived from a prospective cohort study in the UK patients Patients with active NTM excluded 9 parameters Validated in several independent cohorts Chalmers et al. AJRCCM 2013; 189.
15 Bronchiectasis Severity Index Chalmers et al. AJRCCM 2013; 189.
16 Bronchiectasis Severity Index Independent predictors of hospitalization Prior admissions MRC dyspnea score > 4 FEV 1 < 30% Pseudomonas colonization 3 or more lobes involved on HRCT Chalmers et al. AJRCCM 2013; 189.
17 Bronchiectasis Severity Index Independent predictors of mortality Older age Low FEV 1 Lower BMI Prior hospitalization 3 or more exacerbations in previous year Chalmers et al. AJRCCM 2013; 189.
18 FACED Score Classifies severity according to prognosis Derived from an observational study from 7 centers in Spain patients 5 variables, 7 point score Mild: 0-2 points Moderate: 3-4 points Severe: 5-7 points Martinez-Garcia et al. ERJ 2014.
19 FACED Score Validated to predict 5-year all-cause mortality Martinez-Garcia et al. ERJ 2014.
20 E-FACED Score Expanded the capacity of the original tool to predict exacerbations Martinez-Garcia et al. Int J COPD 2017; 12.
21 Bronchiectasis Mortality: BSI vs FACED Evaluated in a 91 patient cohort followed since 1994 in the UK; median follow-up 18.8 years Both scores were similarly predictive of 5-year and 15-year mortality; FACED did slightly better for the latter Huw et al. ERJ 2016; 47.
22 Bronchiectasis: Clinical Phenotypes Four clusters identified in European cohort; 3- year follow-up Cluster % of patients Median SGRQ Hospitalizations during 1-yr follow-up Mortality during 1-year follow-up Chronic Pseudomonas Other chronic infection 15.8% 58 42% 5.1% 24.1% 43 16% 1.5% Daily sputum 33.0% 39 16% 3.6% (N=1145) Dry bronchiectasis 27.1% 29 14% 4.9% Aliberti S, et al. Eur Respir J
23 Bronchiectasis: Comorbidities Seitz AE, et al. CHEST 2012; 142.
24 Bronchiectasis Aetiology Comorbidity Index (BACI) Cohort analysis of 986 outpatients Assesses impact of comorbidities on mortality Median of 4 comorbidities 13 comorbidities independently predicted mortality -> BACI McDonnell et al. Lancet 2016; 4.
25 Bronchiectasis Aetiology Comorbidity Index (BACI) Predicts 5-year mortality rate, hospitalizations, QOL across all BSI risk strata Validated in 2 independent cohorts: UK and Serbia McDonnell et al. Lancet 2016; 4.
26 NTM Infection: Impact on QOL Prospective observational study: SGRQ and Medical Outcomes Short-Form (SF-36) 51 patients Mean age 67; 80% were female 84% MAC, 8% M. abscessus 71% had nodular bronchiectatic (NB) pattern, 22% fibrocavitary (FC) 80% actively or previously treated 98% had cough, sputum production, 49% with fatigue, 31% with weight loss Mehta and Marras. Resp Med, 2011
27 NTM Infection: Impact on QOL Mean SF-36 scores - summary and in all domains - were worse than population-based normals in statistically significant fashion SGRQ also worse than normal No important differences between untreated patients compared to those treated for more than 3 months Multivariate analysis: Higher FVC% and DLCO%: better SF-36 scores Lower FVC% and emphysema: worse SGRQ scores Tendency toward worse SGQR scores for M. abscessus Mehta and Marras. Resp Med, 2011
28 MAC: Prognostic Factors Retrospective review of 634 HIV negative patients with MAC Mean follow-up period: 4.7 years 76% had NB disease; 16.6%had FC, 4.7% had both Only 27% treated within 6 months 0-1 drug: 479 patients (75.6%) 2-5 drugs: 131 patients (20.7%) Unknown: 24 patients (3.8%) Hayashi al, AJRCCM; 2011, 185.
29 MAC: Prognostic Factors 160 patients (25.2%) died in follow-up period Overall mortality rates 5-year: 23.9% 10-year: 46.5% MAC-specific mortality rate 5-year: 5.4% 10-year: 15.7% Hayashi al, AJRCCM; 2011, 185.
30 MAC: Prognostic Factors Negative prognostic factors - all cause mortality Male sex Older age Systemic or respiratory comorbidity Non-nodular bronchiectatic radiographic features BMI < 18.5 kg/m2 Anemia, hypoalbuminemia ESR > 50 Hayashi al, AJRCCM; 2011, 185.
31 MAC: Prognostic Factors Negative prognostic factors: MAC specific mortality FC or FC + NB radiographic features BMI < 18.5 kg/m2 Anemia CRP > 1 Hayashi al, AJRCCM; 2011, 185.
32 MAC NB Pattern Retrospective review of 782 HIV negative patients; mean age 68 years Mean follow-up period was 4.3 years Almost 70% of patients did not receive antimicrobial therapy 5 and 10 year mortality All cause: 12.5%, 27.4% Progressive MAC: 2%, 4.8% Radiographic progression: 41.2% Gochi et al, BMJ Open, 2015, 5.
33 Negative prognostic factors - All cause mortality Male sex Older age BMI < 18.5 kg/m2 Hypoalbuminemia ESR > 40 Absence of bloody sputum Gochi et al, BMJ Open, 2015, 5.
34 Macrolide Resistant MAC Macrolide monotherapy or combination with a quinolone are risk factors 51 patients, 47%NB, 53% cavitary disease One-year mortality in those who remained culture positive despite therapy was 34% compared to 0% who became culture negative Griffith et al. AJRCCM; 174: 2006
35 MAC vs Other NTM 167 patients Median survival time: MAC: 13 years Other NTM: 4.6 years Age and serious comorbidities were significant predictors of survival Kotilainen et al. Eur J Clin Microbiol Infect Dis; 2015, 34.
36 How would you assess the severity of this patient s bronchiectasis? BSI score - 13 FACED score - 5 Both scores - c/w severe bronchiectasis
37 Summary Natural history and prognosis of bronchiectasis and NTM infection have been difficult to predict A number of validated tools have been developed - BSI, FACED Specific factors associated with worse outcomes Bronchiectasis: Older age, worse lung function, chronic P. aeruginosa infection and comorbidities NTM infection: Older age, male sex, cavitary disease, macrolide resistance
CCLI. Bronchiectasis Treatment Antibiotics. Charles Haworth. Physician / Patient Conference, Georgetown University, May 2017
Physician / Patient Conference, Georgetown University, May 2017 Bronchiectasis Treatment Antibiotics Charles Haworth CCLI Cambridge Centre for Lung Infection Disclosures Educational talks and / or consultancy
More informationNON-CF BRONCHIECTASIS IN ADULTS
Séminaire de Pathologie Infectieuse Jeudi 25 juin 2008 Cliniques Universitaires UCL de Mont-Godinne, Yvoir NON-CF BRONCHIECTASIS IN ADULTS Dr Robert Wilson Royal Brompton Hospital, London, UK Aetiology
More informationDr Conroy Wong. Professor Richard Beasley. Dr Sarah Mooney. Professor Innes Asher
Professor Richard Beasley University of Otago Director Medical Research Institute of New Zealand Wellington Dr Sarah Mooney Physiotherapy Advanced Clinician Counties Manukau Health NZ Respiratory and Sleep
More informationBronchiectasis Domiciliary treatment. Prof. Adam Hill Royal Infirmary and University of Edinburgh
Bronchiectasis Domiciliary treatment Prof. Adam Hill Royal Infirmary and University of Edinburgh Plan of talk Background of bronchiectasis Who requires IV antibiotics Domiciliary treatment Results to date.
More informationC.S. HAWORTH 1, A. WANNER 2, J. FROEHLICH 3, T. O'NEAL 3, A. DAVIS 4, I. GONDA 3, A. O'DONNELL 5
Inhaled Liposomal Ciprofloxacin in Patients With Non-Cystic Fibrosis Bronchiectasis and Chronic Pseudomonas aeruginosa: Results From Two Parallel Phase III Trials (ORBIT-3 and -4) C.S. HAWORTH 1, A. WANNER
More informationUnderstanding the heterogeneity of the disease
Symposium: Bronchiectasis in Europe: an update from the European Bronchiectasis Network (EMBARC) Understanding the heterogeneity of the disease Stefano Aliberti Health Science Department University of
More informationTR Protocol Number: TR02-107
TR02-107 A PLACEBO CONTROLLED, RANDOMIZED, PARALLEL COHORT, SAFETY AND TOLERABILITY STUDY OF TWO DOSE LEVELS OF LIPOSOMAL AMIKACIN FOR INHALATION (ARIKACE ) IN PATIENTS WITH BRONCHIECTASIS COMPLICATED
More informationThe management of bronchiectasis in Europe
The management of bronchiectasis in Europe Data from the European Bronchiectasis Registry James Chalmers University of Dundee, UK Presenter disclosures Clinical Trials AstraZeneca, Aradigm corporation,
More informationBronchiectasis exacerbations; differences and management. Michael Loebinger Royal Brompton Imperial College
Bronchiectasis exacerbations; differences and management Michael Loebinger Royal Brompton Imperial College Plan Bronchiectasis background and burden Exacerbation and Management Longer term Management Cases
More informationOnline Data Supplement. Impulse Oscillometry in Adults with Bronchiectasis
Online Data Supplement Impulse Oscillometry in Adults with Bronchiectasis Wei-jie Guan *1, Ph. D.; Yong-hua Gao *2, Ph. D.; Gang Xu *3, Ph. D.; Zhi-ya Lin 1, Ph. D.; Yan Tang 1, M. D.; Hui-min Li 1, M.
More informationCOPD Bronchiectasis Overlap Syndrome.
COPD Bronchiectasis Overlap Syndrome. John R Hurst 1, J Stuart Elborn 2, and Anthony De Soyza 3 on Behalf of the BRONCH-UK Consortium (D Bilton, J Bradley, JS Brown, J Duckers, F Copeland, A Floto, J Foweraker,
More informationAsthma and COPD in older people lumping or splitting? Christine Jenkins Concord Hospital Woolcock Institute of Medical Research
Asthma and COPD in older people lumping or splitting? Christine Jenkins Concord Hospital Woolcock Institute of Medical Research Concord Hospital Woolcock Institute of Medical Research Joe has asthma What
More informationDiagnostic Evaluation of NTM and Bronchiectasis
Division of Pulmonary, Critical Care and Sleep Medicine Diagnostic Evaluation of NTM and Bronchiectasis Ashwin Basavaraj, MD, FCCP NTM patient education program November 9, 2016 Involves a combination
More informationThe team. Medical staff Dr Adam Hill Vacant post- Dr Lithgow Dr Ruzanna Frangulyan Specialist Trainee
Bronchiectasis The team Medical staff Dr Adam Hill Vacant post- Dr Lithgow Dr Ruzanna Frangulyan Specialist Trainee Specialist staff Kim Turnbull Denise Gillian Jenny Scott Jo Pentland Research nurses
More informationBronchiectasis in Adults - Suspected
Bronchiectasis in Adults - Suspected Clinical symptoms which may indicate bronchiectasis for patients Take full respiratory history including presenting symptoms, past medical & family history Factors
More informationConference Bronchiectasis A Growing Problem
Conference 2015 Bronchiectasis A Growing Problem Bronchiectasis (in Children) What is it? Why such a concern in NZ? What to look out for? Management Positives? Just a note that the bar for diagnosis, referral
More informationInhaled Antibiotics in Non-CF. Dr Michael Loebinger Host Defence Unit Royal Brompton Hospital London, United Kingdom
Inhaled Antibiotics in Non-CF Dr Michael Loebinger Host Defence Unit Royal Brompton Hospital London, United Kingdom Advantages Increased drug concentrations locally Reduced systemic adverse effects Home
More informationPredictive Models of Emphysema Progression in HIV
Predictive Models of Emphysema Progression in HIV Janice Leung, MD FRCPC A. Malagoli, A. Santoro, G. Besutti, G. Ligabue, D. Dai, J. Mayo, S. Lam, D. Sin, S. Man, G. Guaraldi COPD: An Emerging Comorbidity
More informationNON-CYSTIC FIBROSIS BRONCHIECTASIS
NON-CYSTIC FIBROSIS BRONCHIECTASIS MARK L. METERSKY, MD PROFESSOR OF MEDICINE UNIVERSITY OF CONNECTICUT SCHOOL OF MEDICINE FARMINGTON, CT Mark Metersky, MD, FCCP, FACP is a Professor of Medicine at the
More informationAirway Vista Background
Airway Vista 2013 Chronic Obstructive Airway Diseases Symposium Asan Medical Center, Seoul, South Korea When Should Macrolide Antibiotics be Prescribed to Prevent COPD Exacerbations in Usual Clinical Practice?
More informationA Place For Airway Clearance Therapy In Today s Healthcare Environment
A Place For Airway Clearance Therapy In Today s Healthcare Environment Michigan Society for Respiratory Care 2015 Fall Conference K. James Ehlen, MD October 6, 2015 Objectives Describe patients who will
More informationThe Role of CPET (cardiopulmonary exercise testing) in Assessing Lung Disease in CF
The Role of CPET (cardiopulmonary exercise testing) in Assessing Lung Disease in CF Dr. Meir Mei-Zahav Kathy and Lee Graub CF Center Schneider CMCI 1 תאריך Exercise in CF You are probably quite sure that
More informationEffect of sputum bacteriology on the quality of life of patients with bronchiectasis
Eur Respir J 1997; 10: 1754 1760 DOI: 10.1183/09031936.97.10081754 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1997 European Respiratory Journal ISSN 0903-1936 Effect of sputum bacteriology
More informationBronchiectasis it s effects on the NZ population and what we can do to address this
NZ Respiratory Conference - 2017 Bronchiectasis it s effects on the NZ population and what we can do to address this Conroy Wong Middlemore Hospital Auckland, NZ Bronchiectasis in NZ and new developments
More informationTBLB is not recommended as the initial biopsy option in cases of suspected IPF and is unreliable in the diagnosis of rare lung disease (other than
TBLB is not recommended as the initial biopsy option in cases of suspected IPF and is unreliable in the diagnosis of rare lung disease (other than PAP) BAL is not required as a diagnostic tool in patients
More informationEpidemiology of COPD Prof. David M. Mannino, M.D.
Epidemiology of COPD David M. Mannino, M.D. Professor Department of Preventive Medicine and Environmental Health College of Public Health University of Kentucky 1 Outline Definitions Severity Progression
More informationBronchiectasis. What is bronchiectasis? What causes bronchiectasis?
This factsheet explains what bronchiectasis is, what causes it, and how it is diagnosed and managed. More detailed information is available on the Bronchiectasis Patient Priorities website: www.europeanlunginfo.org/bronchiectasis
More informationMEDICAL STUDENT INVOLVEMENT IN ASSESSING RESPIRATORY SYMPTOMS TO IMPROVE EARLY DETECTION OF LUNG DISEASE IN HIV PATIENTS.
MEDICAL STUDENT INVOLVEMENT IN ASSESSING RESPIRATORY SYMPTOMS TO IMPROVE EARLY DETECTION OF LUNG DISEASE IN HIV PATIENTS Simone Neri Definition of COPD COPD, a common preventable and treatable disease,
More informationNontuberculous Mycobacterial Lung Disease
Non-TB Mycobacterial Disease Jeffrey P. Kanne, MD Nontuberculous Mycobacterial Lung Disease Jeffrey P. Kanne, M.D. Consultant Disclosures Perceptive Informatics Royalties (book author) Amirsys, Inc. Wolters
More informationCOPD, Asthma, Or Something In Between? Sharon R. Rosenberg Assistant Professor of Medicine Northwestern University December 4, 2013
COPD, Asthma, Or Something In Between? Sharon R. Rosenberg Assistant Professor of Medicine Northwestern University December 4, 2013 None Disclosures Definitions Asthma Asthma is a chronic inflammatory
More informationCOPD: From Phenotypes to Endotypes. MeiLan K Han, M.D., M.S. Associate Professor of Medicine University of Michigan, Ann Arbor, MI
COPD: From Phenotypes to Endotypes MeiLan K Han, M.D., M.S. Associate Professor of Medicine University of Michigan, Ann Arbor, MI Presenter Disclosures MeiLan K. Han Consulting Research support Novartis
More informationCOPD exacerbation. Dr. med. Frank Rassouli
Definition according to GOLD report: - «An acute event - characterized by a worsening of the patients respiratory symptoms - that is beyond normal day-to-day variations - and leads to a change in medication»
More informationCOPD UPDATE ıdr Shitrit David ıhead of the Pulmonary Department ımeir Medical Center
COPD UPDATE 2012 ıdr Shitrit David ıhead of the Pulmonary Department ımeir Medical Center Definition of COPD COPD is a preventable and treatable disease with some significant extra pulmonary effects that
More informationNatural history of Mycobacterium avium complex lung disease in untreated patients with stable course
ORIGINAL ARTICLE RESPIRATORY INFECTIONS Natural history of Mycobacterium avium complex lung disease in untreated patients with stable course Ji An Hwang 1,3, Sunyoung Kim 2,3, Kyung-Wook Jo 1 and Tae Sun
More informationUpdate on heterogeneity of COPD, evaluation of COPD severity and exacerbation
Update on heterogeneity of COPD, evaluation of COPD severity and exacerbation Yung-Yang Liu, MD Taipei Veterans General Hospital Aug 29, 2015 G O lobal Initiative for Chronic bstructive L D ung isease
More informationManagement of Co morbidities in Idiopathic Pulmonary Fibrosis. Disclosures
Management of Co morbidities in Idiopathic Pulmonary Fibrosis Joyce S. Lee, MD MAS Director, Interstitial Lung Disease Clinic University of California, San Francisco Disclosures Intermune, advisory board
More informationNontuberculous Mycobacteria
Nontuberculous Mycobacteria When antibiotics are not enough a surgical approach John D. Mitchell, M.D. Davis Endowed Chair in Thoracic Surgery Professor and Chief Section of General Thoracic Surgery University
More informationInhalational antibacterial regimens in non-cystic fibrosis patients. Jeff Alder Bayer HealthCare
Inhalational antibacterial regimens in non-cystic fibrosis patients Jeff Alder Bayer HealthCare Alder - Inhaled therapy for non-cf - EMA 25-26 Oct 2012 1 Inhalational antibacterials: two approaches 1.
More informationSystemic markers of inflammation in stable bronchiectasis
Eur Respir J 1998; 12: 820 824 DOI: 10.1183/09031936.98.12040820 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1998 European Respiratory Journal ISSN 0903-1936 Systemic markers of inflammation
More informationWhat do pulmonary function tests tell you?
Pulmonary Function Testing Michael Wert, MD Assistant Professor Clinical Department of Internal Medicine Division of Pulmonary, Critical Care, and Sleep Medicine The Ohio State University Wexner Medical
More informationHow Do I Manage Nontuberculous Mycobacterial (NTM) Lung Disease Patients?
How Do I Manage Nontuberculous Mycobacterial (NTM) Lung Disease Patients? David E. Griffith, M.D. Professor of Medicine University of Texas Health Science Center, Tyler Potential COI Statement I was a
More informationShannon Kasperbauer, M.D. National Jewish Health University of Colorado Health Sciences Center. Property of Presenter. Not for Reproduction
Shannon Kasperbauer, M.D. National Jewish Health University of Colorado Health Sciences Center Consultant: Johnson and Johnson Speaker/consultant: Insmed Examine characteristics of the RGM Define the main
More informationPneumococcal pneumonia
Pneumococcal pneumonia Wei Shen Lim Consultant Respiratory Physician & Honorary Professor of Medicine Nottingham University Hospitals NHS Trust University of Nottingham Declarations of interest Unrestricted
More information2018 Vindico Medical Education. Non-tuberculous Mycobacteria: Circumventing Difficulties in Diagnosis and Treatment
Activity presentations are considered intellectual property. These slides may not be published or posted online without permission from Vindico Medical Education (cme@vindicocme.com). Please be respectful
More informationC hronic obstructive pulmonary disease (COPD) is one of
589 RESPIRATORY INFECTIONS Time course of recovery of health status following an infective exacerbation of chronic bronchitis S Spencer, P W Jones for the GLOBE Study Group... Thorax 2003;58:589 593 See
More informationOPAT FOR INFECTION IN BRONCHIECTASIS
OPAT FOR INFECTION IN BRONCHIECTASIS AN AUDIT EVALUATING THE USAGE OF OUTPATIENT ANTIBIOTIC THERAPY FOR INFECTIVE EXACERBATIONS OF BRONCHIECTASIS AGAINST CURRENT BRITISH THORACIC SOCIETY GUIDELINES Dr
More informationBronchiectasis: An Imaging Approach
Bronchiectasis: An Imaging Approach Travis S Henry, MD Associate Professor of Clinical Radiology Cardiac and Pulmonary Imaging Section University of California, San Francisco Large Middle Small 1 Bronchiectasis
More information9/22/2015 CONFLICT OF INTEREST OBJECTIVES. Understanding COPD - Recent Research and the Evolving Definition of COPD for MNACVPR
Understanding COPD - Recent Research and the Evolving Definition of COPD for MNACVPR by Scott Cerreta, BS, RRT Director of Education www.copdfoundation.org scerreta@copdfoundation.org CONFLICT OF INTEREST
More informationUnderstanding COPD - Recent Research and the Evolving Definition of COPD for MNACVPR
Understanding COPD - Recent Research and the Evolving Definition of COPD for MNACVPR by Scott Cerreta, BS, RRT Director of Education www.copdfoundation.org scerreta@copdfoundation.org CONFLICT OF INTEREST
More informationNontuberculous Mycobacteria
Nontuberculous Mycobacteria Epidemiology and Clinical Management Kevin L. Winthrop, MD, MPH Associate Professor, Divisions of Infectious Diseases, Public Health and Preventive Medicine Oregon Health &
More informationClinical phenotypes in adult patients with bronchiectasis
ORIGINAL ARTICLE BRONCHIECTASIS Clinical phenotypes in adult patients with bronchiectasis Stefano Aliberti 1, Sara Lonni 1, Simone Dore 2, Melissa J. McDonnell 3, Pieter C. Goeminne 4,5, Katerina Dimakou
More informationLife-long asthma and its relationship to COPD. Stephen T Holgate School of Medicine University of Southampton
Life-long asthma and its relationship to COPD Stephen T Holgate School of Medicine University of Southampton Definitions COPD is a preventable and treatable disease with some significant extrapulmonary
More informationPulmonary function abnormalities in adult patients with acute exacerbation of bronchiectasis: A retrospective risk factor analysis
Original Article Pulmonary function abnormalities in adult patients with acute exacerbation of bronchiectasis: A retrospective risk factor analysis Chronic Respiratory Disease 2015, Vol. 12(3) 222 229
More informationEvidence for early Pulmonary Rehabilitation following hospitalisation for exacerbation of COPD
Centre for Inflammation Research Evidence for early Pulmonary Rehabilitation following hospitalisation for exacerbation of COPD Pulmonary Rehabilitation Clinicians Day Roberto A. Rabinovich ELEGI/Colt
More informationCOPD-Related Musculoskeletal Disease. Jessica Bon Field, MD, MS 2017 Update in Internal Medicine October 20, 2017
COPD-Related Musculoskeletal Disease Jessica Bon Field, MD, MS 2017 Update in Internal Medicine October 20, 2017 A 60-year old man with COPD comes into your office for a routine office visit. He is a former
More informationJUERGEN FROEHLICH, JANICE DAHMS, DAVID CIPOLLA,
Reduction in Frequency of Pulmonary Exacerbations With Inhaled ARD-315 in Non-Cystic Fibrosis Bronchiectasis (NCFB) Patients is Independent of Pseudomonas aeruginosa Susceptibility at Baseline JUERGEN
More informationSupplementary Online Content
Supplementary Online Content Regan EA, Lynch DA, Curran-Everett D, et al; Genetic Epidemiology of COPD (COPDGene) Investigators. Clinical and radiologic disease in smokers with normal spirometry. Published
More informationPatient with FVC>90% predicted. Demosthenes Bouros, Vasilios Tzilas University of Athens
Patient with FVC>90% predicted Demosthenes Bouros, Vasilios Tzilas University of Athens CASE OVERVIEW A 63-year-old, male patient with progressive exertional dyspnoea lasting for 2 years and dry cough
More informationASTHMA-COPD OVERLAP SYNDROME 2018: What s All the Fuss?
ASTHMA-COPD OVERLAP SYNDROME 2018: What s All the Fuss? Randall W. Brown, MD MPH AE-C Association of Asthma Educators Annual Conference July 20, 2018 Phoenix, Arizona FACULTY/DISCLOSURES Randall Brown,
More informationCOPD: A Renewed Focus. Disclosures
COPD: A Renewed Focus Heath Latham, MD Assistant Professor Division of Pulmonary and Critical Care Medicine Disclosures No Business Interests No Consulting No Speakers Bureau No Off Label Use to Discuss
More information11/27/18. Challenges in Pulmonary and Critical Care: COPD So Much is New! Faculty. Disclosures
Challenges in Pulmonary and Critical Care: 2018 COPD So Much is New! 1 Faculty Anas Hadeh, MD, FCCP Director, Pulmonary and Critical Care Medicine Fellowship Program Affiliate Assistant Professor of Clinical
More informationChronic Obstructive Pulmonary Disease (COPD) KAREN ALLEN MD PULMONARY & CRITICAL CARE MEDICINE VA HOSPITAL OKC / OUHSC
Chronic Obstructive Pulmonary Disease (COPD) KAREN ALLEN MD PULMONARY & CRITICAL CARE MEDICINE VA HOSPITAL OKC / OUHSC I have no financial disclosures Definition COPD is a preventable and treatable disease
More informationERS 2016 Congress Highlights Interstitial Lung Disease (ILD)
ERS 216 Congress Highlights Interstitial Lung Disease (ILD) London, UK September 3 rd 7 th 216 The 26 th European Respiratory Society International Congress, (ERS) the largest respiratory meeting in the
More informationTurning Science into Real Life Roflumilast in Clinical Practice. Roland Buhl Pulmonary Department Mainz University Hospital
Turning Science into Real Life Roflumilast in Clinical Practice Roland Buhl Pulmonary Department Mainz University Hospital Therapy at each stage of COPD I: Mild II: Moderate III: Severe IV: Very severe
More informationElevated interleukin-6 and bronchiectasis as risk factors for acute exacerbation in patients with tuberculosis-destroyed lung with airflow limitation
Original Article Elevated interleukin-6 and bronchiectasis as risk factors for acute exacerbation in patients with tuberculosis-destroyed lung with airflow limitation Jee Youn Oh 1, Young Seok Lee 1, Kyung
More informationAcute Respiratory Infection. Dr Anthony Gibson
Acute Respiratory Infection Dr Anthony Gibson Range of Conditions Upper tract Common Cold coryza Sore Throat- Pharyngitis Sinusitis Epiglottitis Range of Conditions Lower Acute Bronchitis Acute Exacerbation
More informationLung Volume Reduction Surgery. February 2013
Lung Volume Reduction Surgery February 2013 Presentation Outline Lung Volume Reduction Surgery (LVRS) Rationale & Historical Perspective NETT Results Current LVRS Process (from referral to surgery) Diagnostic
More informationPalliative and Supportive Care in Cystic Fibrosis
Palliative and Supportive Care in Cystic Fibrosis Dr William Flight Consultant in Respiratory Medicine Oxford Adult Cystic Fibrosis Centre 27 th January 2017 Overview 1. Cystic Fibrosis Clinical Aspects
More informationThey Can t Bury You while You re Still Moving: Update on Pulmonary Rehabilitation
They Can t Bury You while You re Still Moving: Update on Pulmonary Rehabilitation Richard ZuWallack, MD Associate Chief, Pulmonary and Critical Care St. Francis Hospital, Hartford, CT Professor of Medicine
More informationCOPD as a comorbidity of heart failure in elderly patients
COPD as a comorbidity of heart failure in elderly patients Professor Mitja Lainscak, MD, PhD, FESC, FHFA Departments of Cardiology and Research&Education, General Hospital Celje Faculty of Medicine, University
More informationNon-CF bronchiectasis: Alexander Duarte, MD Pulmonary, Critical Care & Sleep Medicine University of Texas Medical Branch Galveston, TX
Non-CF bronchiectasis: Alexander Duarte, MD Pulmonary, Critical Care & Sleep Medicine University of Texas Medical Branch Galveston, TX Pioneer of Respiratory Medicine 2016 marked 200th anniversary of his
More informationSlowly Growing Nontuberculous Mycobacterial Infections
Slowly Growing Nontuberculous Mycobacterial Infections Charles L. Daley, MD National Jewish Health University of Colorado, Denver Disclosures Advisory Board Horizon, Johnson and Johnson, Otsuka and Spero
More informationINHALED ANTIBIOTICS THERAPY IN NON-CF LUNG DISEASE
INHALED ANTIBIOTICS THERAPY IN NON-CF LUNG DISEASE Hannah Blau MBBS Pulmonary Institute and Graub CF Center SCHNEIDER CHILDREN S MEDICAL CENTER OF ISRAEL Chipap 18 th February 2015 Inhaled antibiotic therapy:
More informationClinical Study Synopsis
Clinical Study Synopsis This Clinical Study Synopsis is provided for patients and healthcare professionals to increase the transparency of Bayer's clinical research. This document is not intended to replace
More informationIPF AND OTHER FIBROSING LUNG DISEASE: WHAT DRUGS MIGHT WORK AND ON WHOM DO THEY W ORK?
IPF AND OTHER FIBROSING LUNG DISEASE: WHAT DRUGS MIGHT WORK AND ON WHOM DO THEY W ORK? KEVIN K. BROWN, MD PROFESSOR AND VICE CHAIRMAN, DEPARTMENT OF MEDICINE NATIONAL JEWISH HEALTH DENVER, CO Kevin K.
More informationDisease progression in COPD:
Disease progression in COPD: What is it? How should it be measured? Can it be modified? Professor Paul Jones MD, PhD, FERS Emeritus Professor of Respiratory Medicine; St George s, University of London
More informationEfficacy of Pseudomonas aeruginosa eradication regimens in bronchiectasis
Efficacy of Pseudomonas aeruginosa eradication regimens in bronchiectasis Vallières, E., Tumelty, K., Tunney, M. M., Hannah, R., Hewitt, O., Elborn, J. S., & Downey, D. G. (2017). Efficacy of Pseudomonas
More informationChapter 22. Pulmonary Infections
Chapter 22 Pulmonary Infections Objectives State the incidence of pneumonia in the United States and its economic impact. Discuss the current classification scheme for pneumonia and be able to define hospital-acquired
More informationSupplementary Online Content
Supplementary Online Content Deslée G, Mal H, Dutau H, et al; REVOLENS Study Group. Lung volume reduction coil treatment vs usual care in patients with severe emphysema: the REVOLENS randomized clinical
More informationLVRS and Endobronchial Therapy for Emphysema: Is it Still Viable?
LVRS and Endobronchial Therapy for Emphysema: Is it Still Viable? Malcolm M. DeCamp, MD Fowler McCormick Professor of Surgery Feinberg School of Medicine Chief, Division of Thoracic Surgery Disclosures
More informationHigh mortality in patients with Mycobacterium avium complex lung disease: a systematic review
Diel et al. BMC Infectious Diseases (2018) 18:206 https://doi.org/10.1186/s12879-018-3113-x RESEARCH ARTICLE High mortality in patients with Mycobacterium avium complex lung disease: a systematic review
More informationSGRQ Questionnaire assessing respiratory disease-specific quality of life. Questionnaire assessing general quality of life
SUPPLEMENTARY MATERIAL e-table 1: Outcomes studied in present analysis. Outcome Abbreviation Definition Nature of data, direction indicating adverse effect (continuous only) Clinical outcomes- subjective
More informationFrancesco Blasi Head Respiratory Medicine Section Cardio-Thoracic Department University of Milan, Italy
COPD EXACERBATIONS Francesco Blasi Head Respiratory Medicine Section Cardio-Thoracic Department University of Milan, Italy COPD OUTCOMES Cazzola M et al. ERJ 2008 COPD AND CARDIOVASCULAR DISEASE Cumulative
More informationChronic Lung Disease in vertically HIV infected children. Dr B O Hare Senior Lecturer in Paediatrics and Child Health, COM, Blantyre
Chronic Lung Disease in vertically HIV infected children Dr B O Hare Senior Lecturer in Paediatrics and Child Health, COM, Blantyre Natural history of HIV in vertically infected children without and with
More informationPulmonary rehabilitation in severe COPD.
Pulmonary rehabilitation in severe COPD daniel.langer@faber.kuleuven.be Content Rehabilitation (how) does it work? How to train the ventilatory limited patient? Chronic Obstructive Pulmonary Disease NHLBI/WHO
More informationPathophysiology of COPD 건국대학교의학전문대학원
Pathophysiology of COPD 건국대학교의학전문대학원 내과학교실 유광하 Rate per 100 0,000 population 550 500 450 400 350 300 250 200 150 100 50 0 Heart disease Cancer Stroke 1970 1974 1978 1982 1986 1990 1994 1998 2002 Year of
More informationAssessing response to treatment of exacerbations of bronchiectasis in adults
Eur Respir J 2009; 33: 312 317 DOI: 10.1183/09031936.00122508 CopyrightßERS Journals Ltd 2009 Assessing response to treatment of exacerbations of bronchiectasis in adults M.P. Murray, K. Turnbull, S. MacQuarrie
More informationCOPD or not COPD, that is the question.
COPD or not COPD, that is the question. Asthma-COPD Overlap Syndrome: ACOS Do we really need this? Michelle Harkins Disclosure Slide Slide help - William Busse, MD Organizational Interests ATS, ACCP, ACP
More informationSwyer-James Syndrome: An Infrequent Cause Of Bronchiectasis?
ISPUB.COM The Internet Journal of Pulmonary Medicine Volume 12 Number 1 Swyer-James Syndrome: An Infrequent Cause Of Bronchiectasis? A Huaringa, S Malek, M Haro, L Tapia Citation A Huaringa, S Malek, M
More informationChanging Epidemiology: Quick Facts 9/28/2018. During the year New Treatment Options for COPD: Phenotypes, Endotypes or Treatable Traits?
New Treatment Options for COPD: Phenotypes, Endotypes or Treatable Traits? Conflict of Interest Statement 2018 Speakers Bureau Astra Zeneca Boehringer Ingelheim Genentech Sunovion Ron Balkissoon MD DIH
More informationClinical and radiographic predictors of GOLD-Unclassified smokers in COPDGene
Clinical and radiographic predictors of GOLD-Unclassified smokers in COPDGene Emily S. Wan, John E. Hokanson, James R. Murphy, Elizabeth A. Regan, Barry J. Make, David A. Lynch, James D. Crapo, Edwin K.
More informationOutline FEF Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications?
Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications? Fernando Holguin MD MPH Director, Asthma Clinical & Research Program Center for lungs and Breathing University of Colorado
More informationAlpha-1 Antitrypsin Deficiency Alpha-1 Lung Disease
Alpha-1 Antitrypsin Deficiency Alpha-1 Lung Disease Chronic obstructive pulmonary disease (COPD) affects millions of people each year. Chronic means long term, obstructive means it is hard to get air in
More informationCOPD: Current Medical Therapy
COPD: Current Medical Therapy Angela Golden, DNP, FNP-C, FAANP Owner, NP from Home, LLC Outcomes As a result of this activity, learners will be able to: 1. List the appropriate classes of medications for
More informationLevel 3 Sleep Study Utilization and Interpretation. CSIM October 14, 2015 Dr. Nicole Drost
Level 3 Sleep Study Utilization and Interpretation CSIM October 14, 2015 Dr. Nicole Drost Disclosures I have no financial disclosures that would present a conflict of interest with this presentation Objectives
More information7/7/2015. Somboon Chansakulporn, MD. History of variable respiratory symptoms. 1. Documented excessive variability in PFT ( 1 test)
Definition of Asthma GINA 2010: Chronic inflammatory disorder of the airways Airway hyper-responsiveness Recurrent wheezing, breathlessness, chest tightness, coughing Variable, reversible airflow obstruction
More informationSupplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Goyal V, Grimwood K, Byrnes CA, et al. Amoxicillin
More informationManagement of bronchiectasis in adults
STATE OF THE ART MANAGEMENT OF BRONCHIECTASIS IN ADULTS Management of bronchiectasis in adults James D. Chalmers 1, Stefano Aliberti 2 and Francesco Blasi 3 Affiliations: 1 Tayside Respiratory Research
More informationChallenges in Pulmonary and Critical Care 2017
Challenges in Pulmonary and Critical Care 2017 Idiopathic Pulmonary Fibrosis: New Advances in Therapy Outcome Report: Boehringer Ingelheim Grant # ME201722329 February 2, 2018 Level 1 (Participation) Practice
More informationCOPD Treatable. Preventable.
My COPD Action Plan Patient s Copy (Patient s Name) Date Canadian Respiratory COPD Treatable. Preventable. This is to tell me how I will take care of myself when I have a COPD flare-up. My goals are My
More information