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Echocardiographic Evidence of Pulmonary Hypertension is Associated with Increased 1-year Mortality in Patients Admitted with Chronic Obstructive Pulmonary Disease.

Pulmonary hypertension (PH) is associated with decreased overall survival in patients with chronic lung disease. The purpose of this study was to determine the effect of echocardiographic evidence of PH on 1-year survival in patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (COPD).

This is a retrospective study of patients admitted to a respiratory intermediate care unit with COPD exacerbation between October 1, 2002 and September 30, 2004. All patients who had 2D echocardiograms and pulmonary function tests done within 12 months prior to hospital admission or during the admission were examined. Charts were reviewed for the following outcomes: length of hospital stay, need for mechanical ventilation, survival at discharge, and mortality over the next year. Data were analyzed using multiple logistic regression and p values calculated using Fisher's exact test.

Forty-three patients met study entry criteria, and PH, defined as systolic right ventricular pressure greater than 45 mmHg, was found in 23 (53%). Sixteen of the 23 patients (70%) with PH died during the 1-year follow-up period compared to 5 of 20 (25%) patients with no PH (p = 0.0058). The effect of PH on survival was independent of age, forced expiratory volume in 1 s (FEV(1)), arterial pH, pCO(2), or pO(2) (p < 0.01).

Echocardiographic evidence of PH is associated with increased 1-year mortality in patients admitted with COPD exacerbation. Further studies are needed to determine if PH is a cause of increased mortality in this population or an indicator of other cardiovascular disease.

A new perspective on optimal care for patients with COPD.

Worldwide, clinicians face the task of providing millions of patients with the best possible treatment and management of COPD. Currently, management primarily involves short-term 'here-and-now' goals, targeting immediate patient benefit. However, although there is considerable knowledge available to assist clinicians in minimising the current impact of COPD on patients, relatively little is known about which dominant factors predict future risks. These predictors may vary for different outcomes, such as exacerbations, mortality, co-morbidities, and the long-term consequences of COPD.

We propose a new paradigm to achieve 'optimal COPD care' based on the concept that here-and-now goals should be integrated with goals to improve long-term outcomes and reduce future risks. Whilst knowledge on risk factors for poorer outcomes in COPD is growing and some data exist on positive effects of pharmacological interventions, information on defining the benefits of all commonly used interventions for reducing the risk of various future disease outcomes is still scarce. Greater insight is needed into the relationships between the two pillars of optimal COPD care: 'best current control' and 'future risk reduction'.

This broader approach to disease management should result in improved care for every COPD patient now and into the future.

Phosphodiesterase 4 inhibitors for chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) affects symptoms, lung function, quality of life and life expectancy. Apart from smoking cessation, there are no other treatments that slow lung function decline.

Roflumilast and cilomilast are oral phosphodiesterase 4 (PDE(4)) inhibitors proposed to reduce the airway inflammation and bronchoconstriction seen in COPD.

Development of a decision tree to assess the severity and prognosis of stable COPD.

The aim of this study was to develop and validate a new method: a classification and regression tree (CART) based on easily accessible measures to predict mortality in patients with stable COPD.

Prospective study of two independent prospective cohorts: a derivation cohort with 611 recruited patients and a validation cohort with 348 patients, all followed for 5 years. CART analysis was used to predict 5-year mortality risk using the following covariates from the derivation cohort: age, forced expiratory volume in the first second as a percentage of predicted (FEV1%), dyspnoea, physical activity, general health, and number of hospital admissions for COPD exacerbations in the prior 2 years.

Age (≥75 years or <75) provided the first branch of the COPD-CART. The highest mortality risk (0.74) was seen in patients older than 75 with higher levels of dyspnoea and with FEV1% <50%. Patients with the lowest risk of 5-year mortality (0.04) were those under age 55 years with FEV1% >35% and with 1 or no recent hospitalizations for COPD exacerbations.

A simple decision tree that uses variables generally gathered by physicians can provide a quick assessment of the severity of the disease, as measured by the risk of 5-year mortality.

Properties of the COPD Assessment Test (CAT) in a cross-sectional European study.

A short, easy-to-use health status questionnaire is needed in the multidimensional assessment of chronic obstructive pulmonary disease (COPD) in routine practice.

The performance of the 8-item COPD Assessment Test (CAT) was analysed in 1817 patients from primary care in seven European countries. The CAT has a scoring range from 0-40 (high score representing poor health status).

Mean CAT scores indicated significant health status impairment that was related to severity of airway obstruction, but within each GOLD Stage (I to IV) there was a wide range of scores (I: 16.2±8.8; II: 16.3±7.9; III: 19.3±8.2; IV: 22.3±8.7. I vs.II, p=0.88; II vs. III, p<0.0001; III vs. IV, p=0.0001). CAT scores showed relatively little variability across countries (within ±12% of the mean across all countries). Scores were significantly better in patients who were stable (17.2±8.3) vs. those suffering an exacerbation (21.3±8.4) (p<0.0001); and in patients with zero (17.3±8.1) or 1-2 (16.6±8.2) vs. ≥3 (19.7±8.5) comorbidities (p<0.0001 for both).

The CAT distinguished between classes of other impairment measures and was strongly correlated with the St George's Respiratory Questionnaire (r=0.8, p<0.0001). The CAT is a simple and easy-to-use questionnaire that distinguishes between patients of different degrees of COPD severity and appears to behave the same way across countries. (Study number: 111749).

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