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2. PLUS-IS-LESS project: Procalcitonin and Lung UltraSonography-based antibiotherapy in patients with Lower rESpiratory tract infection in Swiss Emergency Departments: study protocol for a pragmatic stepped-wedge cluster-randomized trial

Author

Bessat, Cécile, Bingisser, Roland, Schwendinger, Markus, Bulaty, Tim, Fournier, Yvan, Della Santa, Vincent, Pfeil, Magali, Schwab, Dominique, Leuppi, Jörg D., Geigy, Nicolas, Steuer, Stephan, Roos, Friedemann, Christ, Michael, Sirova, Adriana, Espejo, Tanguy, Riedel, Henk, Atzl, Alexandra, Napieralski, Fabian, Marti, Joachim, Cisco, Giulio, Foley, Rose-Anna, Schindler, Melinée, Hartley, Mary-Anne, Fayet, Aurélie, Garcia, Elena, Locatelli, Isabella, Albrich, Werner C., Hugli, Olivier, and Boillat-Blanco, Noémie

Published
2024
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4. Severe Asthma Standard-of-Care Background Medication Reduction With Benralizumab: ANDHI in Practice Substudy

Author

Pohl, Wolfgang, Doberer, Daniel, Martinot, Jean Benoit, Deschampheleire, Maud, Himpe, Ulrike, Chapman, Kenneth, Cheema, Amarjit, Dorscheid, Delbert, Ramsey, Clare, Rolf, Jeffrey, Walker, Brandie, Olivenstein, Ronald, Poirier, Claude, Larivee, Pierre, Bjerrum, Anne Sofie, Titlestad, Ingrid, Hilberg, Ole, Kilpeläinen, Maritta, Bonniaud, Philippe, Taillé, Camille, Tiotiu, Iuliana-Angelica, Girodet, Pierre-Olivier, Blanc, François-Xavier, Pradelli, Johana, Didier, Alain, Nocent Ejnaini, Cecilia, Deslee, Gaetan, Pison, Christophe, Douadi, Youcef, Mahay, Guillaume, Devouassoux, Gilles, Melloni, Boris, Roux, Pauline-Marie, Bourdin, Arnaud, Fry, Stephanie, Schaum, Thomas, Schulz, Christian, Skowasch, Dirk, Taube, Christian, Welte, Tobias, Gleiber, Wolfgang, Brehler, Randolf, Schreiber, Jens, Schuette, Wolfgang, Kronsbein, Juliane, Bonnet, Reiner, Beck, Ekkehard, Lacedonia, Donato, Senna, Gianenrico, Caruso, Cristiano, Crimi, Nunzio, Blasi, Francesco, Santus, Pierachille, Canonica, Giorgio Walter, Guarnieri, Gabriella, Pelaia, Girolamo, Milanese, Manlio, Micheletto, Claudio, Corsico, Angelo Guido, Scichilone, Nicola, Spadaro, Giuseppe, Langeveld, Bas, Holters, Jurgen, Willem van den Berg, Jan, Smit, Arthur, Conemans, Lennart, van Veen, Helena, Staaks, Gerald, Lehmann, Sverre, Echave-Sustaeta, Jose Maria, Ribas, Christian Domingo, de Luiz Martinez, Gustavo, Gonzalez Perez, Ruperto, Garcia Rivero, Juan Luis, Gall, Xavier Muñoz, Soto Campos, Jose Gregorio, Mozo, Paloma Campo, Pan, Carmen Vidal, Fernandez, Ana Gomez-Bastero, Tellez, Sergio Campos, Rivera, Carlos Martinez, Bobolea, Irina Diana, Guerrero, Raquel Morillo, Garcia, Ismael Ali, Rodriguez Hermosa, Juan Luis, Stenfors, Nikolai, Tunsäter, Alf, Curiac, Dan, von Garnier, Christophe, Leuppi, Joerg, Schmid-Grendelmeier, Peter, Nasser, Shuaib, Chaudhuri, Rekha, Nordstrom, Monica, Saralaya, Dinesh, Pfeffer, Paul, Mansur, Adel, Short, Philip, Wenzel, Sally, Cherry, William Brett, Zafra, Heidi, Gonzalez, Erika, Soong, Weily, Davis, Benjamin, Kao, Neil, Hussain, Iftikhar, Maselli Caceres, Diego Jose, Harris, James, Calhoun, William, Rodicio, Ileana, Kaufman, David, Moss, Mark, Sztejman, Eric, DeLeon, Samuel, Sumino, Kaharu, Kashyap, Ravindra, Leflein, Jeffrey, Hajal, Rizan, Fakih, Faisal, Hill, David, Lin, Robert, Jarratt, Mikell, Subramaniam, Vijay, Sussman, Robert, Mumneh, Nayla, Reibman, Joan, Darveaux, Jared, Tan, Ricardo, Tanus, Tonny, Sikand, Vinay, Marshall, Gailen, Mehta, Hemalini, Cole, Jeremy, Goodman, Brad, Goss, Deborah, Bardelas, Jose, Milstone, Aaron, Mehta, Vinay, Clore, Lee, Millard, Mark, Palumbo, Michael, Puppala, Dileep, Leong, Mila, Prenner, Bruce, Robinette, Emory, Heidarian Raissy, Hengameh, Fost, David, Pleskow, Warren, Marcus, Michael, Ilowite, Jonathan, Moore, Wendy, Steven, Gary, De la Cruz, Luis, Chupp, Geoffrey, Berger, William, Randolph, Christopher, Holguin, Fernando, Kureishy, Shahrukh, Campbell, Edward, Peche, Rudi, Pini, Laura, Papi, Alberto, Beghé, Bianca, Peveri, Silvia, Henriquez Santa, Aythamy, Ramos Gonzalez, Jacinto, Vinge, Ines, St. John, Roy, Louis, Renaud, Harrison, Tim W., Chanez, Pascal, Menzella, Francesco, Philteos, George, Cosio, Borja G., Lugogo, Njira L., de Luiz, Gustavo, Burden, Annie, Adlington, Timothy, Keeling, Nanna, Kwiatek, Justin, and Garcia Gil, Esther

Published
2023
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6. Inhaled aviptadil for the possible treatment of COVID-19 in patients at high risk for ARDS: study protocol for a randomized, placebo-controlled, and multicenter trial

Author

Boesing, Maria, Abig, Kristin, Brändle, Michael, Brutsche, Martin, Burri, Emanuel, Frye, Björn C., Giezendanner, Stéphanie, Grutters, Jan C., Haas, Philippe, Heisler, Justian, Jaun, Fabienne, Leuppi-Taegtmeyer, Anne B., Lüthi-Corridori, Giorgia, Müller-Quernheim, Joachim, Nüesch, Reto, Pohl, Wolfgang, Rassouli, Frank, and Leuppi, Jörg D.

Published
2022
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7. High-dose vitamin D substitution in patients with COVID-19: study protocol for a randomized, double-blind, placebo-controlled, multi-center study—VitCov Trial

Author

Jaun, Fabienne, Boesing, Maria, Lüthi-Corridori, Giorgia, Abig, Kristin, Makhdoomi, Anja, Bloch, Nando, Lins, Christina, Raess, Andrea, Grillmayr, Victoria, Haas, Philippe, Schuetz, Philipp, Gabutti, Luca, Muser, Jürgen, Leuppi-Taegtmeyer, Anne B., Giezendanner, Stéphanie, Brändle, Michael, and Leuppi, Jörg D.

Published
2022
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8. Effects of serial NT-proBNP measurements in patients with acute decompensated heart failure: Results of the POC-HF pilot trial.

Author

Boesing, Maria, Bierreth, Frederick, Abig, Kristin, Giezendanner, Stéphanie, Leuppi-Taegtmeyer, Anne B., Lüthi-Corridori, Giorgia, Maier, Sabrina, Züsli, Stephanie, Leuppi, Jörg D., and Dieterle, Thomas

Subjects
BRAIN natriuretic factor, LENGTH of stay in hospitals, ACE inhibitors, HEART failure, PHYSICIANS
Abstract

Introduction: Serial N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements have proven to be useful for therapy monitoring in patients hospitalized for acute decompensated heart failure (ADHF). The POC-HF pilot study investigated whether serial NTproBNP measurements influenced treatment decisions in these patients. Methods: Patients hospitalized for ADHF were randomly assigned to an intervention group (serial NT-proBNP measurements made available to treating physicians) or a control group (care as usual). HF therapy was administered at the discretion of the treating physician. The primary endpoint was dose changes in HF therapy during hospitalization. Secondary endpoints included changes in NT-proBNP levels, recovery from HF symptoms, length of hospital stay, and quality of life. Results: 52 patients (35% female; mean age 81.8 years) were included. The availability of serial NT-proBNP values was associated with higher dosages of ACE inhibitors (relative treatment effect (RTE) day 11:0.74, p = 0.007) and loop diuretics (RTE day 11:0.77, p = 0.005), and lower dosages of beta-blockers (RTE day 11:0.43, p = 0.002). NT-proBNP levels decreased (-752 pg/ml, p = 0.162) and recovery rates from ADHF symptoms were more pronounced in the intervention group, but without statistical significance. No differences were found in terms of the length of hospital stay and quality of life. Conclusion: The results of this pilot trial indicate that serial NT-proBNP measurements are possibly associated with faster up-titration of HF medication, more pronounced NT-proBNP decrease, and faster recovery from symptoms than symptom-guided therapy in patients hospitalized for ADHF. These preliminary findings require further validation through larger studies. [ABSTRACT FROM AUTHOR]

Published
2024
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9. Proteinuria Assessment and Therapeutic Implementation in Chronic Kidney Disease Patients—A Clinical Audit on KDIGO ("Kidney Disease: Improving Global Outcomes") Guidelines.

Author

Adelakun, Gabriela, Boesing, Maria, Mbata, Munachimso Kizito, Pasha, Zahra, Lüthi-Corridori, Giorgia, Jaun, Fabienne, Burkhalter, Felix, and Leuppi, Jörg D.

Subjects
CHRONIC kidney failure, KIDNEY diseases, PROTEINURIA, ALBUMINURIA, PEOPLE with diabetes
Abstract

Background/Objectives: Chronic kidney disease (CKD) is a major health problem with a rising prevalence due to comorbidities like diabetes and hypertension. The aim of this research was to audit the assessment and therapeutic management of proteinuria in CKD patients at the Cantonal Hospital Baselland (KSBL) in Switzerland and determine associations between patient comorbidities, rehospitalisation, death, and the quality of therapeutic management. Methods: We analysed data from 427 adults with CKD (eGFR < 45 mL/min/1.73 m2) hospitalised on the internal medicine ward in 2022. Results: The mean age was 85 years (range: 79–89), 45.9% were female, and the median eGFR was 32.8 mL/min/1.73 m2 (range: 25–40). Proteinuria assessment was performed in 120 (28.1%) patients (the ProtU group), and a corresponding treatment was prescribed in 59%. The ProtU group had a higher quota of patients with diabetes (44.1% vs. 33%, p = 0.048) and obesity (21.2% vs. 12.5%, p = 0.039) when compared to the group without proteinuria assessment (the Ustix group). Twelve-month survival was not significantly different between the groups (HR: 0.75; 95% CI: 0.488–1.154; p-value = 0.191). However, survival was significantly better in patients who received an antiproteinuric treatment compared to those who did not (HR: 0.30; 95% CI: 0.121–0.0761; p = 0.011). Conclusions: Improvements need to be made in managing CKD at the KSBL in accordance with the guidelines. [ABSTRACT FROM AUTHOR]

Published
2024
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10. The Predictive Performance of Risk Scores for the Outcome of COVID-19 in a 2-Year Swiss Cohort.

Author

Boesing, Maria, Lüthi-Corridori, Giorgia, Büttiker, David, Hunziker, Mireille, Jaun, Fabienne, Vaskyte, Ugne, Brändle, Michael, and Leuppi, Jörg D.

Subjects
RECEIVER operating characteristic curves, COVID-19, DISEASE risk factors, EARLY warning score, MEDICAL microbiology
Abstract

Various scoring systems are available for COVID-19 risk stratification. This study aimed to validate their performance in predicting severe COVID-19 course in a large, heterogeneous Swiss cohort. Scores like the National Early Warning Score (NEWS), CURB-65, 4C mortality score (4C), Spanish Society of Infectious Diseases and Clinical Microbiology score (COVID-SEIMC), and COVID Intubation Risk Score (COVID-IRS) were assessed in patients hospitalized for COVID-19 in 2020 and 2021. Predictive accuracy for severe course (defined as all-cause in-hospital death or invasive mechanical ventilation (IMV)) was evaluated using receiver operating characteristic curves and the area under the curve (AUC). The new 'COVID-COMBI' score, combining parameters from the top two scores, was also validated. This study included 1,051 patients (mean age 65 years, 60% male), with 162 (15%) experiencing severe course. Among the established scores, 4C had the best accuracy for predicting severe course (AUC 0.76), followed by COVID-IRS (AUC 0.72). COVID-COMBI showed significantly higher accuracy than all established scores (AUC 0.79, p = 0.001). For predicting in-hospital death, 4C performed best (AUC 0.83), and, for IMV, COVID-IRS performed best (AUC 0.78). The 4C and COVID-IRS scores were robust predictors of severe COVID-19 course, while the new COVID-COMBI showed significantly improved accuracy but requires further validation. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Diagnostic and prognostic value of cardiac troponins in emergency department patients presenting after a fall: A prospective, multicenter study

Author

Espejo, Tanguy, primary, Terhalle, Lukas, additional, Malinovska, Alexandra, additional, Riedel, Henk B., additional, Arntz, Laura, additional, Hafner, Livia, additional, Delport‐Lehnen, Karen, additional, Zuppinger, Joanna, additional, Geigy, Nicolas, additional, Leuppi, Jörg, additional, Somasundaram, Rajan, additional, Bingisser, Roland, additional, and Nickel, Christian H., additional

Published
2024
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16. Effect of different corticosteroid regimes for hospitalised patients with exacerbated COPD: pooled analysis of individual participant data from the REDUCE and CORTICO-COP trials

Author

Sivapalan, Pradeesh, Rutishauser, Jonas, Ulrik, Charlotte Suppli, Leuppi, Jörg D., Pedersen, Lars, Mueller, Beat, Eklöf, Josefin, Biering-Sørensen, Tor, Gottlieb, Vibeke, Armbruster, Karin, Janner, Julie, Moberg, Mia, Lapperre, Therese S., Nielsen, Thyge L., Browatzki, Andrea, Mathioudakis, Alexander, Vestbo, Jørgen, Schüetz, Philipp, and Jensen, Jens-Ulrik

Published
2021
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19. Adherence to the GOLD Guidelines in Primary Care: Data from the Swiss COPD Cohort

Author

Mangold, Veronika, primary, Boesing, Maria, additional, Berset, Camille, additional, Bridevaux, Pierre-Olivier, additional, Geiser, Thomas, additional, Joos Zellweger, Ladina, additional, Kohler, Malcolm, additional, Lüthi-Corridori, Giorgia, additional, Maier, Sabrina, additional, Miedinger, David, additional, Thurnheer, Robert, additional, von Garnier, Christophe, additional, and Leuppi, Jörg Daniel, additional

Published
2023
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20. The Correct Indication to Induce Labour in a Swiss Cantonal Hospital

Author

Mbata, Munachimso Kizito, primary, Boesing, Maria, additional, Lüthi-Corridori, Giorgia, additional, Jaun, Fabienne, additional, Vetter, Grit, additional, Gröbli-Stäheli, Jeanette, additional, Leuppi-Taegtmeyer, Anne B., additional, Frey Tirri, Brigitte, additional, and Leuppi, Jörg D., additional

Published
2023
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21. Early response to benralizumab in severe, eosinophilic asthma: a real-world study in Switzerland

Author

Schuoler, Claudio, primary, Van Iperen, Peter, additional, Stolz, Daiana, additional, Charbonnier, Florian, additional, Bridevaux, Pierre-Olivier, additional, Jandus, Peter, additional, Fiechter, René, additional, Leuppi, Jörg D., additional, Hauser, Thomas, additional, Pavlov, Nikolay, additional, Scherer, Thomas, additional, Huber, Michael, additional, Azzola, Andrea, additional, Piecyk, Andreas, additional, and Rothe, Thomas, additional

Published
2023
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22. Occurrence of sensitive topics during ward round: an ancillary analysis of the BEDSIDE-OUTSIDE trial

Author

Gross, Sebastian, primary, Becker, Christoph, additional, Beck, Katharina, additional, Memma, Valentina, additional, Gaab, Jens, additional, Schütz, Philipp, additional, Leuppi, Jörg D, additional, Schaefert, Rainer, additional, Langewitz, Wolf, additional, Trendelenburg, Marten, additional, Breidthardt, Tobias, additional, Eckstein, Jens, additional, Osthoff, Michael, additional, Bassetti, Stefano, additional, and Hunziker, Sabina, additional

Published
2023
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28. The Management of Acute Exacerbations in COPD: A Retrospective Observational Study and Clinical Audit.

Author

Boesing, Maria, Ottensarendt, Nicola, Lüthi-Corridori, Giorgia, and Leuppi, Jörg D.

Subjects
DISEASE exacerbation, CHRONIC obstructive pulmonary disease, SMOKING cessation
Abstract

(1) Background: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are not only associated with increased patient morbidity and mortality, but with extensive healthcare costs. Thus, adequate clinical management is crucial. The aim of this project was to evaluate the management of acute COPD exacerbations in a public teaching hospital in Switzerland. (2) Methods: We retrospectively analyzed clinical routine data of patients presenting with an acute exacerbation of COPD at the emergency department of a Swiss hospital between January 2019 and February 2020. Management was evaluated against recommendations from the GOLD 2019 report and previous audits. (3) Results: The data of 184 patients (mean age 73.5 years, range 41–95 years, 53% male) with 226 visits were included. While the documentation of GOLD stage (I-IV) and smoking status was consistent (81.0% and 91.6%), GOLD risk category (A-D) was only documented in 36% of the cases. Patients' respiratory rate upon presentation was measured in 73%, and blood gas analysis was performed in 70%. A total of 94% of the patients received a chest imaging; spirometry was performed in 10%. Initial symptomatic therapy with short acting bronchodilators was applied in 56%. Systemic steroid treatment was installed in 86%. Antibiotics were given in 56%, but in one fourth the indication was not clear. Non-invasive ventilation was applied in 25% of the indicated cases. Smoking cessation was recommended to 26% of the current smokers and referral to pulmonary rehabilitation was given in 16%. (4) Conclusion: GOLD recommendations were not comprehensively implemented, especially with regard to the assessment of severity, initial symptomatic therapy, and non-invasive ventilation. These results show the importance of the frequent revision of routine practice and may help to create awareness among practitioners and ultimately improve the quality of COPD management. [ABSTRACT FROM AUTHOR]

Published
2024
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29. COPD – eine unterschätzte Erkrankung

Author

Leuppi, Jörg D, Bridevaux, Pierre-Olivier, Charbonnier, Florian, Clarenbach, Christian F, Duchna, Hans-Werner, Fellrath, Jean-Marc, Gianella, Pietro, Jochmann, Anja, Kern, Lukas, Pavlov, Nikolay, Rothe, Thomas, Steurer-Stey, Claudia, and von Garnier, Christophe

Subjects
610 Medicine & health
Abstract

COPD - An Underestimated Disease Abstract: Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition with a complex clinical picture. The diagnosis is not easy to make because COPD can develop insidiously and remain unnoticed for a long time. Therefore, general practitioners play a central role in the early detection of the disease. Suspected COPD can be confirmed by special examinations in collaboration with pulmonologists. The new GOLD guideline defines three COPD risk groups (A-B-E) which should guide the personalized treatment concept. A short- or long-acting bronchodilator (SAMA/SABA or LAMA/LABA) is recommended for group A, and a dual long-acting bronchodilator therapy (LABA+LAMA) is recommended for group B and E. In case of blood eosinophilia (≥300 cells/µl) and/or recent hospitalization for COPD exacerbation, triple therapy (LABA+LAMA+ICS) is recommended. General practitioners are important in implementing non-pharmacological measures (smoking cessation, regular exercise, vaccinations, patient selfmanagement education). However, this also underlines the high demands of the implementation of the GOLD guideline in daily practice., COPD ist eine heterogene Erkrankung mit komplexem Krankheitsbild. Die Diagnose ist nicht einfach zu stellen, denn COPD kann sich schleichend entwickeln und lange unbemerkt bleiben. Hausärztinnen und -ärzten kommt daher für die Früherkennung eine zentrale Rolle zu. Der COPD-Verdacht kann in Zusammenarbeit mit Pneumologen durch spezielle Untersuchungen abgesichert werden als Voraussetzung für das medikamentöse Therapiekonzept. Die neue GOLD-Guideline definiert drei COPD-Risikogruppen (A-B-E). Für Gruppe A wird ein kurz- oder langwirksamer Bronchodilatator (SAMA/SABA bzw. LAMA/LABA) empfohlen. Für Gruppe B und E wird eine Kombinationstherapie LABA+LAMA empfohlen. Bei Bluteosinophilie (≥ 300 Zellen/μl) und/oder kürzlicher Hospitalisierung aufgrund einer COPD-Exazerbation wird eine Dreifachtherapie (LABA+LAMA+ICS) empfohlen. Hausärztinnen und -ärzte sind wichtig bei der Umsetzung therapiebegleitender Massnahmen (Coaching von Patientinnen und Patienten, Impfungen, Rauchstopp, regelmässige Bewegung). Dies unterstreicht aber auch die hohen Anforderungen der Umsetzung der GOLD-Guideline in den Praxisalltag.

Published
2023

30. Effect of Single High Dose Vitamin D Substitution in Hospitalized COVID-19 Patients with Vitamin D Deficiency on Length of Hospital Stay

Author

Jaun, Fabienne, primary, Boesing, Maria, additional, Luethi-Corridori, Giorgia, additional, Abig, Kristin, additional, Bloch, Nando, additional, Giezendanner, Stéphanie, additional, Grillmayr, Victoria, additional, Haas, Philippe, additional, Leuppi-Taegtmeyer, Anne B., additional, Muser, Jürgen, additional, Raess, Andrea, additional, Schuetz, Philipp, additional, Brändle, Michael, additional, and Leuppi, Jörg D., additional

Published
2023
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31. Are Predictors for Overall Mortality in COPD Patients Robust over Time?

Author

Sievi, Noriane A, primary, Sepin, Jerome, additional, Roeder, Maurice, additional, Brack, Thomas, additional, Brutsche, Martin H, additional, Frey, Martin, additional, Irani, Sarosh, additional, Leuppi, Jörg D., additional, Thurnheer, Robert, additional, Clarenbach, Christian F., additional, and Kohler, Malcolm, additional

Published
2023
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33. Glucocorticoid withdrawal and glucocorticoid-induced adrenal insufficiency: Study protocol of the randomized controlled «TOASST' (Taper Or Abrupt Steroid STop) multicenter trial

Author

Komminoth, Mathis; https://orcid.org/0000-0002-0024-6284, Donath, Marc Y, Hepprich, Matthias; https://orcid.org/0000-0002-6905-6235, Schuetz, Philipp, Blum, Claudine A; https://orcid.org/0000-0003-0487-5587, Mueller, Beat, Reny, Jean-Luc, Gosselin, Pauline, Breville, Gautier; https://orcid.org/0000-0003-0890-1981, Brändle, Michael, Henzen, Christoph, Leuppi, Jörg D, Kistler, Andreas D; https://orcid.org/0000-0002-4114-9560, Thurnheer, Robert, Beuschlein, Felix, Rudofsky, Gottfried, Aeberli, Daniel, Villiger, Peter M, Böhm, Stephan, Chifu, Irina; https://orcid.org/0000-0002-6741-2689, Fassnacht, Martin, Meyer, Gesine, Bojunga, Jörg, Cattaneo, Marco; https://orcid.org/0000-0002-6610-8431, Sluka, Constantin; https://orcid.org/0000-0001-7672-4986, Schneider, Helga, Rutishauser, Jonas, «TOASST» study group, Komminoth, Mathis; https://orcid.org/0000-0002-0024-6284, Donath, Marc Y, Hepprich, Matthias; https://orcid.org/0000-0002-6905-6235, Schuetz, Philipp, Blum, Claudine A; https://orcid.org/0000-0003-0487-5587, Mueller, Beat, Reny, Jean-Luc, Gosselin, Pauline, Breville, Gautier; https://orcid.org/0000-0003-0890-1981, Brändle, Michael, Henzen, Christoph, Leuppi, Jörg D, Kistler, Andreas D; https://orcid.org/0000-0002-4114-9560, Thurnheer, Robert, Beuschlein, Felix, Rudofsky, Gottfried, Aeberli, Daniel, Villiger, Peter M, Böhm, Stephan, Chifu, Irina; https://orcid.org/0000-0002-6741-2689, Fassnacht, Martin, Meyer, Gesine, Bojunga, Jörg, Cattaneo, Marco; https://orcid.org/0000-0002-6610-8431, Sluka, Constantin; https://orcid.org/0000-0001-7672-4986, Schneider, Helga, Rutishauser, Jonas, and «TOASST» study group

Abstract

BACKGROUND Despite the widespread use of glucocorticoids in inflammatory and autoimmune disorders, there is uncertainty about the safe cessation of long-term systemic treatment, as data from prospective trials are largely missing. Due to potential disease relapse or glucocorticoid-induced hypocortisolism, the drug is often tapered to sub-physiological doses rather than stopped when the underlying disease is clinically stable, increasing the cumulative drug exposure. Conversely, the duration of exposure to glucocorticoids should be minimized to lower the risk of side effects. METHODS We designed a multicenter, randomized, triple-blinded, placebo-controlled trial to test the clinical noninferiority of abrupt glucocorticoid stop compared to tapering after ≥28 treatment days with ≥420 mg cumulative and ≥7.5 mg mean daily prednisone-equivalent dose. 573 adult patients treated systemically for various disorders will be included after their underlying disease has been stabilized. Prednisone in tapering doses or matching placebo is administered over 4 weeks. A 250 mg ACTH-test, the result of which will be revealed a posteriori, is performed at study inclusion; all patients are instructed on glucocorticoid stress cover dosing. Follow-up is for 6 months. The composite primary outcome measure is time to hospitalization, death, initiation of unplanned systemic glucocorticoid therapy, or adrenal crisis. Secondary outcomes include the individual components of the primary outcome, cumulative glucocorticoid doses, signs and symptoms of hypocortisolism, and the performance of the ACTH test in predicting the clinical outcome. Cox proportional hazard, linear, and logistic regression models will be used for statistical analysis. CONCLUSION This trial aims to demonstrate the clinical noninferiority and safety of abrupt treatment cessation after ≥28 days of systemic glucocorticoid therapy in patients with stabilized underlying disease. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NC

Published
2023

34. Are Predictors for Overall Mortality in COPD Patients Robust over Time?

Author

Sievi, Noriane A; https://orcid.org/0000-0003-1758-4586, Sepin, Jerome; https://orcid.org/0000-0002-8893-8903, Roeder, Maurice; https://orcid.org/0000-0002-4261-0881, Brack, Thomas, Brutsche, Martin H; https://orcid.org/0000-0002-1612-3609, Frey, Martin, Irani, Sarosh, Leuppi, Jörg D; https://orcid.org/0000-0002-5554-0675, Thurnheer, Robert; https://orcid.org/0000-0002-8851-2830, Clarenbach, Christian F, Kohler, Malcolm, Sievi, Noriane A; https://orcid.org/0000-0003-1758-4586, Sepin, Jerome; https://orcid.org/0000-0002-8893-8903, Roeder, Maurice; https://orcid.org/0000-0002-4261-0881, Brack, Thomas, Brutsche, Martin H; https://orcid.org/0000-0002-1612-3609, Frey, Martin, Irani, Sarosh, Leuppi, Jörg D; https://orcid.org/0000-0002-5554-0675, Thurnheer, Robert; https://orcid.org/0000-0002-8851-2830, Clarenbach, Christian F, and Kohler, Malcolm

Abstract

(1) Background: Mortality is a major outcome in research on chronic obstructive pulmonary disease (COPD) with various predictors described. However, the dynamic courses of important predictors over time are disregarded. This study evaluates if longitudinal assessment of predictors provides additional information on the mortality risk in COPD when compared with a cross-sectional analysis.; (2) In a longitudinal, prospective, non-interventional cohort study including mild to very severe COPD patients, mortality and its various possible predictors were annually assessed up to seven years.; (3) Results: 297 patients were analysed. Mean (SD) age was 62.5 (7.6) years and 66% males. Mean (SD) FEV1 was 48.8 (21.4)%. A total of 105 events (35.4%) happened with a median (95% CI) survival time of 8.2 (7.2/NA) years. No evidence for a difference between the raw variable and the variable history on the predictive value for all tested variables over each visit was found. There was no evidence for changing effect estimates (coefficients) across the study visits due to the longitudinal assessment; (4) Conclusions: We found no evidence that predictors of mortality in COPD are time dependent. This implies that cross-sectional measured predictors show robust effect estimates over time and multiple assessments seem not to change the predictive value of the measure.

Published
2023

35. Adherence to the GOLD Guidelines in Primary Care: Data from the Swiss COPD Cohort

Author

Mangold, Veronika, Boesing, Maria; https://orcid.org/0000-0001-8605-1893, Berset, Camille, Bridevaux, Pierre-Olivier; https://orcid.org/0000-0002-8021-0950, Geiser, Thomas, Joos Zellweger, Ladina, Kohler, Malcolm, Lüthi-Corridori, Giorgia, Maier, Sabrina, Miedinger, David, Thurnheer, Robert, von Garnier, Christophe, Leuppi, Jörg Daniel; https://orcid.org/0000-0002-5554-0675, Mangold, Veronika, Boesing, Maria; https://orcid.org/0000-0001-8605-1893, Berset, Camille, Bridevaux, Pierre-Olivier; https://orcid.org/0000-0002-8021-0950, Geiser, Thomas, Joos Zellweger, Ladina, Kohler, Malcolm, Lüthi-Corridori, Giorgia, Maier, Sabrina, Miedinger, David, Thurnheer, Robert, von Garnier, Christophe, and Leuppi, Jörg Daniel; https://orcid.org/0000-0002-5554-0675

Abstract

(1) Introduction: Chronic obstructive pulmonary disease (COPD) and its associated morbidity and mortality are a global burden on both affected patients and healthcare systems. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) issues guidelines with the aim of improving COPD management. Previous studies reported significant variability in adherence to these recommendations. The objective of this study was to evaluate Swiss primary practitioners’ adherence to the GOLD guidelines for the pharmacological treatment of stable COPD. (2) Methods: We studied patients who were included in the Swiss COPD cohort study, an ongoing prospective study in a primary care setting, between 2015 and 2022. The key inclusion criteria are age ≥ 40 years, FEV1/FVC ratio < 70%, and a smoking history of at least 20 pack-years. Adherence to the GOLD guidelines was assessed per visit and over time. (3) Results: The data of 225 COPD patients (mean age 67 ± 9 years, 64% male) and their respective 1163 visits were analyzed. In 65% of visits (726/1121), treatment was prescribed according to the GOLD guidelines. Non-adherence was most common in GOLD groups A and B (64% and 33%) and mainly consisted of over-treatment (two long-acting bronchodilators in group A (98/195, 50%) and ICS in groups A (21/195, 11%) and B (198/808, 25%)). In group D, the prescriptions conformed with the guidelines in 99% of cases (109/108). Guideline adherence was associated with high symptom load (COPD Assessment Test) (OR 1.04, p = 0.002), high number of exacerbations (OR = 2.07, p < 0.001), asthma overlap (OR 3.36, p = 0.049), and diabetes mellitus (OR 2.82, p = 0.045). (4) Conclusion: These results confirm a conflict between the GOLD recommendations and primary practice, mainly concerning over-treatment in GOLD groups A and B. Patients with high symptom load, high exacerbation risk, asthma overlap, and diabetes mellitus are more likely to be treated in conformity with the guidelines. Further research is ne

Published
2023

37. BPCO : une maladie encore négligée

Author

Leuppi, Jörg D., primary, Bridevaux, Pierre-Olivier, additional, Charbonnier, Florian, additional, Clarenbach, Christian F., additional, Duchna, Hans-Werner, additional, Fellrath, Jean-Marc, additional, Gianella, Pietro, additional, Jochmann, Anja, additional, Kern, Lukas, additional, Pavlov, Nikolay, additional, Rothe, Thomas, additional, Steurer-Stey, Claudia, additional, and Von Garnier, Christophe, additional

Published
2023
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39. [Untitled]

Author

Leuppi, Jörg D, Bridevaux, Pierre-Olivier, Charbonnier, Florian, Clarenbach, Christian F, Duchna, Hans-Werner, Fellrath, Jean-Marc, Gianella, Pietro, Jochmann, Anja, Kern, Lukas, Pavlov, Nikolay, Rothe, Thomas, Steurer-Stey, Claudia, and von Garnier, Christophe

Subjects
610 Medicine & health
Abstract

COPD - An Underestimated Disease Abstract: Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition with a complex clinical picture. The diagnosis is not easy to make because COPD can develop insidiously and remain unnoticed for a long time. Therefore, general practitioners play a central role in the early detection of the disease. Suspected COPD can be confirmed by special examinations in collaboration with pulmonologists. The new GOLD guideline defines three COPD risk groups (A-B-E) which should guide the personalized treatment concept. A short- or long-acting bronchodilator (SAMA/SABA or LAMA/LABA) is recommended for group A, and a dual long-acting bronchodilator therapy (LABA+LAMA) is recommended for group B and E. In case of blood eosinophilia (≥300 cells/µl) and/or recent hospitalization for COPD exacerbation, triple therapy (LABA+LAMA+ICS) is recommended. General practitioners are important in implementing non-pharmacological measures (smoking cessation, regular exercise, vaccinations, patient selfmanagement education). However, this also underlines the high demands of the implementation of the GOLD guideline in daily practice., COPD ist eine heterogene Erkrankung mit komplexem Krankheitsbild. Die Diagnose ist nicht einfach zu stellen, denn COPD kann sich schleichend entwickeln und lange unbemerkt bleiben. Hausärztinnen und -ärzten kommt daher für die Früherkennung eine zentrale Rolle zu. Der COPD-Verdacht kann in Zusammenarbeit mit Pneumologen durch spezielle Untersuchungen abgesichert werden als Voraussetzung für das medikamentöse Therapiekonzept. Die neue GOLD-Guideline definiert drei COPD-Risikogruppen (A-B-E). Für Gruppe A wird ein kurz- oder langwirksamer Bronchodilatator (SAMA/SABA bzw. LAMA/LABA) empfohlen. Für Gruppe B und E wird eine Kombinationstherapie LABA+LAMA empfohlen. Bei Bluteosinophilie (≥ 300 Zellen/μl) und/oder kürzlicher Hospitalisierung aufgrund einer COPD-Exazerbation wird eine Dreifachtherapie (LABA+LAMA+ICS) empfohlen. Hausärztinnen und -ärzte sind wichtig bei der Umsetzung therapiebegleitender Massnahmen (Coaching von Patientinnen und Patienten, Impfungen, Rauchstopp, regelmässige Bewegung). Dies unterstreicht aber auch die hohen Anforderungen der Umsetzung der GOLD-Guideline in den Praxisalltag.

Published
2023
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42. COPD – eine unterschätzte Erkrankung.

Author

Leuppi, Jörg D., Bridevaux, Pierre-Olivier, Charbonnier, Florian, Clarenbach, Christian F., Duchna, Hans-Werner, Fellrath, Jean-Marc, Gianella, Pietro, Jochmann, Anja, Kern, Lukas, Pavlov, Nikolay, Rothe, Thomas, Steurer-Stey, Claudia, and von Garnier, Christophe

Subjects
*GENERAL practitioners, *CHRONIC obstructive pulmonary disease, *EARLY diagnosis, *GOLD, *SMOKING cessation, *PATIENT education
Abstract

Abstract: Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition with a complex clinical picture. The diagnosis is not easy to make because COPD can develop insidiously and remain unnoticed for a long time. Therefore, general practitioners play a central role in the early detection of the disease. Suspected COPD can be confirmed by special examinations in collaboration with pulmonologists. The new GOLD guideline defines three COPD risk groups (A-B-E) which should guide the personalized treatment concept. A short- or long-acting bronchodilator (SAMA/SABA or LAMA/LABA) is recommended for group A, and a dual long-acting bronchodilator therapy (LABA+LAMA) is recommended for group B and E. In case of blood eosinophilia (≥300 cells/µl) and/or recent hospitalization for COPD exacerbation, triple therapy (LABA+LAMA+ICS) is recommended. General practitioners are important in implementing non-pharmacological measures (smoking cessation, regular exercise, vaccinations, patient selfmanagement education). However, this also underlines the high demands of the implementation of the GOLD guideline in daily practice. [ABSTRACT FROM AUTHOR]

Published
2023
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44. Inhaled aviptadil for the possible treatment of COVID-19 in patients at high risk for ARDS: study protocol for a randomized, placebo-controlled, and multicenter trial

Author

Longziekten, Infection & Immunity, Boesing, Maria, Abig, Kristin, Brändle, Michael, Brutsche, Martin, Burri, Emanuel, Frye, Björn C, Giezendanner, Stéphanie, Grutters, Jan C, Haas, Philippe, Heisler, Justian, Jaun, Fabienne, Leuppi-Taegtmeyer, Anne B, Lüthi-Corridori, Giorgia, Müller-Quernheim, Joachim, Nüesch, Reto, Pohl, Wolfgang, Rassouli, Frank, Leuppi, Jörg D, Longziekten, Infection & Immunity, Boesing, Maria, Abig, Kristin, Brändle, Michael, Brutsche, Martin, Burri, Emanuel, Frye, Björn C, Giezendanner, Stéphanie, Grutters, Jan C, Haas, Philippe, Heisler, Justian, Jaun, Fabienne, Leuppi-Taegtmeyer, Anne B, Lüthi-Corridori, Giorgia, Müller-Quernheim, Joachim, Nüesch, Reto, Pohl, Wolfgang, Rassouli, Frank, and Leuppi, Jörg D

Published
2022

45. Glucocorticoid withdrawal and glucocorticoid-induced adrenal insufficiency: Study protocol of the randomized controlled «TOASST" (Taper Or Abrupt Steroid STop) multicenter trial.

Author

Komminoth, Mathis, Donath, Marc Y., Hepprich, Matthias, Schuetz, Philipp, Blum, Claudine A., Mueller, Beat, Reny, Jean-Luc, Gosselin, Pauline, Breville, Gautier, Brändle, Michael, Henzen, Christoph, Leuppi, Jörg D., Kistler, Andreas D., Thurnheer, Robert, Beuschlein, Felix, Rudofsky, Gottfried, Aeberli, Daniel, Villiger, Peter M., Böhm, Stephan, and Chifu, Irina

Subjects
GLUCOCORTICOIDS, ADRENAL insufficiency, RESEARCH protocols, STEROIDS, AUTOIMMUNE diseases, DISEASE relapse
Abstract

Background: Despite the widespread use of glucocorticoids in inflammatory and autoimmune disorders, there is uncertainty about the safe cessation of long-term systemic treatment, as data from prospective trials are largely missing. Due to potential disease relapse or glucocorticoid-induced hypocortisolism, the drug is often tapered to sub-physiological doses rather than stopped when the underlying disease is clinically stable, increasing the cumulative drug exposure. Conversely, the duration of exposure to glucocorticoids should be minimized to lower the risk of side effects. Methods: We designed a multicenter, randomized, triple-blinded, placebo-controlled trial to test the clinical noninferiority of abrupt glucocorticoid stop compared to tapering after ≥28 treatment days with ≥420 mg cumulative and ≥7.5 mg mean daily prednisone-equivalent dose. 573 adult patients treated systemically for various disorders will be included after their underlying disease has been stabilized. Prednisone in tapering doses or matching placebo is administered over 4 weeks. A 250 mg ACTH-test, the result of which will be revealed a posteriori, is performed at study inclusion; all patients are instructed on glucocorticoid stress cover dosing. Follow-up is for 6 months. The composite primary outcome measure is time to hospitalization, death, initiation of unplanned systemic glucocorticoid therapy, or adrenal crisis. Secondary outcomes include the individual components of the primary outcome, cumulative glucocorticoid doses, signs and symptoms of hypocortisolism, and the performance of the ACTH test in predicting the clinical outcome. Cox proportional hazard, linear, and logistic regression models will be used for statistical analysis. Conclusion: This trial aims to demonstrate the clinical noninferiority and safety of abrupt treatment cessation after ≥28 days of systemic glucocorticoid therapy in patients with stabilized underlying disease. Trial registration: ClinicalTrials.gov Identifier: NCT03153527; EUDRA-CT: 2020–005601–48 https://clinicaltrials.gov/ct2/show/NCT03153527?term=NCT03153527&draw=2&rank=1. [ABSTRACT FROM AUTHOR]

Published
2023
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46. Inhaled Aviptadil for the treatment of COVID-19 in patients at high risk for ARDS: Study protocol for a randomized, placebo controlled multicentre trial.

Author

Boesing, Maria, primary, Abig, Kristin, additional, Brändle, Michael, additional, Brutsche, Martin, additional, Burri, Emanuel, additional, Frye, Björn C, additional, Giezendanner, Stéphanie, additional, Grutters, Jan C, additional, Haas, Philippe, additional, Heisler, Justian, additional, Jaun, Fabienne, additional, Leuppi-Taegtmeyer, Anne B, additional, Lüthi-Corridori, Giorgia, additional, Müller-Quernheim, Joachim, additional, Nüesch, Reto, additional, Pohl, Wolfgang, additional, Rassouli, Frank, additional, and Leuppi, Jörg D, additional

Published
2022
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48. Additional file 1 of Inhaled aviptadil for the possible treatment of COVID-19 in patients at high risk for ARDS: study protocol for a randomized, placebo-controlled, and multicenter trial

Author

Boesing, Maria, Abig, Kristin, Brändle, Michael, Brutsche, Martin, Burri, Emanuel, Frye, Björn C., Giezendanner, Stéphanie, Grutters, Jan C., Haas, Philippe, Heisler, Justian, Jaun, Fabienne, Leuppi-Taegtmeyer, Anne B., Lüthi-Corridori, Giorgia, Müller-Quernheim, Joachim, Nüesch, Reto, Pohl, Wolfgang, Rassouli, Frank, and Leuppi, Jörg D.

Abstract

Additional file 1. Summary of statistical analysis plan.

Published
2022
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49. Nouveautés dans la prise en charge de l’asthme

Author

Leuppi, Jörg D, Bridevaux, Pierre-Olivier, Charbonnier, Florian, Clarenbach, Christian F, Duchna, Hans-Werner, Gianella, Pietro, Jochmann, Anja, Kern, Lukas, Meyer, Franca, Pavlov, Nikolay, Rothe, Thomas, Steurer-Stey, Claudia, von Garnier, Christophe, and University of Zurich

Subjects
610 Medicine & health, General Medicine, 10060 Epidemiology, Biostatistics and Prevention Institute (EBPI)
Published
2022
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50. Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease

Author

Smid, Dionne E., Franssen, Frits M.E., Gonik, Maria, Miravitlles, Marc, Casanova, Ciro, Cosio, Borja G., de Lucas-Ramos, Pilar, Marin, Jose M., Martinez, Cristina, Mir, Isabel, Soriano, Joan B., de Torres, Juan P., Agusti, Alvar, Atalay, Nart B., Billington, Julia, Boutou, Afroditi K., Brighenti-Zogg, Stefanie, Chaplin, Emma, Coster, Samantha, Dodd, James W., Dürr, Selina, Fernandez-Villar, Alberto, Groenen, Miriam T.J., Guimarães, Miguel, Hejduk, Karel, Higgins, Victoria, Hopkinson, Nicholas S., Horita, Nobuyuki, Houben-Wilke, Sarah, Janssen, Daisy J.A., Jehn, Melissa, Joerres, Rudolf, Karch, Annika, Kelly, Julia L., Kim, Yu-Il, Kimura, Hiroshi, Koblizek, Vladimir, Kocks, Janwillem H., Kon, Samantha S.C., Kwon, Namhee, Ladeira, Inês, Lee, Sang-Do, Leuppi, Joerg D., Locantore, Nicholas, Lopez-Campos, José L., D-C Man, William, Maricic, Lana, Mendoza, Laura, Miedinger, David, Mihaltan, Florin, Minami, Seigo, van der Molen, Thys, Murrells, Trevor J., Nakken, Nienke, Nishijima, Yu, Norman, Ian J., Novotna, Barbora, O'Donnell, Denis E., Ogata, Yoshitaka, Pereira, Eanes D., Piercy, James, Price, David, Pothirat, Chaicharn, Raghavan, Natya, Ringbaek, Thomas, Sajkov, Dimitar, Sigari, Naseh, Singh, Sally, Small, Mark, da Silva, Guilherme F., Tanner, Rebecca J., Tsiligianni, Ioanna G., Tulek, Baykal, Tzanakis, Nikolaos, Vanfleteren, Lowie E.G.W., Watz, Henrik, Webb, Katherine A., Wouters, Emiel F.M., Xie, Guogang G., Yoshikawa, Masanori, and Spruit, Martijn A.

Published
2017
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