25 Matching Annotations
  1. Nov 2022
    1. Lung function didnot decrease significantly during the prodromal period, but byDay 0, PEFR had fallen from baseline by a median 8.6 (IQR 0to 22.9) L/min, FEV1 by 24.0 (IQR 216.1 to 84.3) ml, and FVCby 76.0 (IQR 240.4 to 216.4) ml. The declines in lung func-tion, whether measured by PEFR, FEV1, or FVC, were allhighly significant (p , 0.001). Significantly greater decreasesin PEFR were seen when the exacerbation was associated withsymptoms of increased dyspnea (r 5 20.12 [n 5 449]; p 50.014), colds (r 5 20.09 [n 5 449]; p 5 0.047), or increasedwheeze (r 5 20.12 [n 5 449]; p 5 0.009), but not with othersymptoms.
    2. Before onset of exacerbation there was deterioration inthe symptoms of dyspnea, sore throat, cough, and symptoms of acommon cold (all p , 0.05), but not lung function.

      La función pulmonar no cambia días antes de la exacerbación



    1. Combined initial COPD assessment

      Punto a destacar: - A partir del 2011, se incluye el CAT y el mMRC para tomar en consideración los PROs para guiar el tratamiento en pacientes con COPD. - The newest change regarding this topic in the 2023 guide, is the modification from the ABCD to the ABE assessment tool. This approach recognizes the clinical relevance of exacerbations, independently of the level of symptoms of the patient. CD are joined and form the E, to highlight Exacerbations. This still has to be validated.

    2. It should be noted that the use of a fixed FEV1/FVC ratio (< 0.7) to define airflowobstruction may result in over-diagnosis of COPD in the elderly,(30,31) and under-diagnosis in young adults,(31

      Importante para el reclutamiento de pacientes



    1. Case

      Caso muy interesante. Es lo que queremos que pase en nuestro pacientes. Solo se han evaluado dos variables: RR y PR. Se mide como porcentaje de cambio y se establece un umbral que está descrito en los gráficos.



    1. There have now been several large population studies (8–10)showing that the number and severity of exacerbations are lowerin patients with mild to moderate COPD (FEV1  50% pre-dicted), whereas in severe disease the rate of COPD exacerba-tions may increase to 1.5 to 2.5/patient/yr.

      Nos puede servir como parámetro para elegir a nuestros pacientes, enfocándonos en aquellos que tienen una estadío moderado/grave.



    1. Recently, Williams et al. sug-gested that the incremental shuttle walking test (ISWT)could be substituted for the 6MWT as an alternativemeasure of exercise capacity within the index and intro-duced the i-BODE (4). As field exercise tests, the ISWTand 6MWT are closely related (5, 6), though ISWT isconsidered to be closer to a maximal exercise test (7),whereas the 6MWT reflects a more functional exerciseperformance

      Diferencias entre el ISWT vs 6MWT.



    1. Subjects were followed-up at 3 months, 6 months, and every 6 monthsthereafter for a maximum of 3 years. All patients had their vital statusconfirmed 3 years after recruitment.Information on COPD exacerbations was collected at scheduled visitsby investigators using the case report forms and based on either sub-jects’ recall of exacerbation events or available medical records for exac-erbation events, supplemented by monthly phone calls. For the purposeof the current analysis, we focused on those exacerbation episodes thatrequired hospital admission (hospitalized exacerbation).

      Seguimiento de pacientes parecido a la propuesta de TOLIFE.



    1. Multicomponent scales have been developed toimprove prognosis prediction in COPD, and they haveproved to be better predictors of survival than anyisolated variable.

      Lo importante de esto es que podamos hacer las escalas con las medidas de los sensores. Leer la continuación del párrafo. Destaca que el BODE fue desarrollado para pacientes sin comorbilidades, pero que esta el BODEX y el DOSE.

      Si se van a usar los indices es importante que haya una frecuencia de visitas cada 3 meses, por ejemplo, porque se los obtiene a través de variables que hay que medirse en las visitas.

      Pensar en que se quieren hacer modelos predictivos tomando en cuenta solo la información de los sensores. Sería bueno contar con estos indices de manera automática con la información que se obtiene de los sensores.

    2. This newly proposed CODEX index is essentially anevolution of the BODE and BODEX indexes, retain-ing their cutoffs for dyspnea, obstruction, and previousexacerbations, but replacing BMI with comorbiditymeasured using the original Charlson index modifiedby age.

      Importante considerar esta variante de los indices previos.



    1. BODE2 (body mass index [BMI], airflow obstruction, dyspnea, andexercise capacity), BODEX3 (BMI, airflow obstruction, dyspnea, and previous severeexacerbations), ADO4 (age, dyspnea, and airflow obstruction), and DOSE5 (dyspnea,airflow obstruction, smoking status, and exacerbation frequency

      ¿Se pueden incluir estas variables?



    1. We were not able to include all potential predictorsavailable from the literature, such as exercise capacity, theSt George’s Respiratory Questionnaire, oxygen therapy,and gastroesophageal reflux

      Variables a incluir



    1. such as bloodeosinophil count, chronic bronchitis, gastroesophagealreflux, socioeconomic status, and insurance coverageimprove risk prediction remains to be investigated.

      Considerar estas variables a medir.

      • Blood eosinphil count
      • Chronic bronchitis
      • Gastroesophageal reflux
      • SES (cómo lo vamos a medir?)
      • Insurance coverage

      Tal vez no sea lo más importante porque queremos que el modelo esté construído con variables a partir de los sensores

    2. Second, ACCEPT does not advance ourunderstanding of how various risk factors operatein combination. Many variables appear to be simplymarkers of severity rather than biological predictors ofreal risk. The authors address one of these: contrary toestablished literature, current smoking confers reducedrisk of exacerbation, probably because patients withsevere disease and high frequency of exacerbations aremore likely to have quit smoking.

      Dos cosas importantes: - Nosotros tenemos que resaltar que no medidos marcadores de severidad. - Resaltan la posible confusión entre fumar y un riesgo reducido de exacerbaciones

    3. Finally, preventionof severe exacerbations is needed before they occur,and performance of this risk tool in individuals whohave never had an exacerbation is not clear and needsto be tested.

      Cómo evaluaremos a los pacientes que no han tenido exacerbaciones?




      Podemos dividir el tratamiento según la familia de fármacos que esté recibiendo el paciente. Así como la base de datos de Urban Training.

      • Beta adrenergic
      • Muscarinic
      • Oral Glucocorticoid
      • Inhaled glucocorticoid
      • Antimicrobial therapy (antibiotics, antiviral)
    2. More than 80percent of exacerbations of COPD can be managed on an outpatient basis, sometimes afterinitial treatment in the office or emergency department.

      Debido a este hecho: ¿Deberíamos hacer un check list sobre la toma de decisiones para ingresar o no a los pacientes con exacerbaciones? El hecho de que no ingresen a pacientes que debieron, puede aumentar el riesgo de exacerbaciones?

      Variables a considerar para ingresar a un paciente con COPD - Inadequate response to outpatient or emergency department management - Onset of new signs (eg, cyanosis, altered mental status, peripheral edema) - Marked increase in intensity of symptoms over baseline (eg, new onset resting dyspnea) accompanied by increased oxygen requirement or signs of respiratory distress - Severe underlying COPD (eg, forced expiratory volume in one second [FEV ] ≤50 percent of predicted) - History of frequent exacerbations or prior hospitalization for exacerbations - Serious comorbidities including pneumonia, cardiac arrhythmia, heart failure, diabetes mellitus, renal failure, or liver failure - Frailty - Insufficient home support


      ¿Sería bueno crear una variable: viral infections? Y tal vez las demás infecciones virales del COVID.

    1. Vitamin D supplementation — Adhering to current guidelines regarding vitamin Dsupplementation in patients with a 25-hydroxyvitamin D level <20 or 30 ng/mL (50 or 75nmol/L) reduces COPD exacerbations in addition to benefits in reducing falls and fractures

      Otra variables que se podría añadir. Revisarlo bien porque el resultado de los metaanálisis son mixtos

    2. Noninvasive ventilation — For patients who require noninvasive ventilation (NIV) during ahospitalization for a COPD exacerbations and who remain hypercapnic, nocturnal NIV athome significantly reduces the risk of rehospitalization

      Importante porque puede afectar a el riesgo de hospitalización y depende de como queramos medir las exacerbaciones

    3. Prophylactic azithromycin

      Para pacientes con exacerbaciones recurrentes (>= a 2 por año) la administación profiláctica de azitromicina puede ayudar a reducir la frecuencia de exacerbaciones.


      Sección de prevención de exacerbaciones de COPD en uptodate. Importante leer que la sección comienza con medidas para reducir la exacerbaciones. Estas medidas pueden ser incluidas cómo variables a preguntar.

      Irán señaladas, pero igual: - Smoking cessation - Proper use of medications - Vaccination against seasonal influenza - Vaccination against COVID - Pneumococcal vaccination

    5. Pulmonary rehabilitation

      Posible variables a añadir: tiempo en rehabilitación pulmonar? ha estado en rehabilitación pulmonar en el ultimo año? Más de 6 meses en el último año? Cuántos meses en el último año?

    6. Smoking cessation (see "Overview of smoking cessation management in adults")•Proper use of medications (including inhaler technique) ( table 5 and table 6and table 7 and table 8) (see "The use of inhaler devices in adults")•Vaccination against seasonal influenza (see "Seasonal influenza vaccination inadults")•Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)(see "COVID-19: Vaccines")•Pneumococcal vaccination ( figure 1) (see "Pneumococcal vaccination in adults")

      Posibles variables a añadir.