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1. Effect of beta-blockers on exacerbation rate and lung function in chronic obstructive pulmonary disease (COPD)

Author

Duffy, Sean, Marron, Robert, Voelker, Helen, Albert, Richard, Connett, John, Bailey, William, Casaburi, Richard, Cooper, J Allen, Curtis, Jeffrey L, Dransfield, Mark, Han, MeiLan K, Make, Barry, Marchetti, Nathaniel, Martinez, Fernando, Lazarus, Stephen, Niewoehner, Dennis, Scanlon, Paul D, Sciurba, Frank, Scharf, Steven, Reed, Robert M, Washko, George, Woodruff, Prescott, McEvoy, Charlene, Aaron, Shawn, Sin, Don, Criner, Gerard J, and the NIH COPD Clinical Research Network and the Canadian Institutes of Health Research

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Chronic Obstructive Pulmonary Disease, Clinical Trials and Supportive Activities, Clinical Research, Heart Disease, Lung, Cardiovascular, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Respiratory, Adrenergic beta-Antagonists, Aged, Cohort Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive, Respiratory Function Tests, Retrospective Studies, Treatment Outcome, COPD, Exacerbation, Beta-blocker, NIH COPD Clinical Research Network and the Canadian Institutes of Health Research, Cardiorespiratory Medicine and Haematology, Respiratory System, Cardiovascular medicine and haematology, Clinical sciences
Abstract

BackgroundBeta-blockers are commonly prescribed for patients with cardiovascular disease. Providers have been wary of treating chronic obstructive pulmonary disease (COPD) patients with beta-blockers due to concern for bronchospasm, but retrospective studies have shown that cardio-selective beta-blockers are safe in COPD and possibly beneficial. However, these benefits may reflect symptom improvements due to the cardiac effects of the medication. The purpose of this study is to evaluate associations between beta-blocker use and both exacerbation rates and longitudinal measures of lung function in two well-characterized COPD cohorts.MethodsWe retrospectively analyzed 1219 participants with over 180 days of follow up from the STATCOPE trial, which excluded most cardiac comorbidities, and from the placebo arm of the MACRO trial. Primary endpoints were exacerbation rates per person-year and change in spirometry over time in association with beta blocker use.ResultsOverall 13.9% (170/1219) of participants reported taking beta-blockers at enrollment. We found no statistically significant differences in exacerbation rates with respect to beta-blocker use regardless of the prevalence of cardiac comorbidities. In the MACRO cohort, patients taking beta-blockers had an exacerbation rate of 1.72/person-year versus a rate of 1.71/person-year in patients not taking beta-blockers. In the STATCOPE cohort, patients taking beta-blockers had an exacerbation rate of 1.14/person-year. Patients without beta-blockers had an exacerbation rate of 1.34/person-year. We found no detrimental effect of beta blockers with respect to change in lung function over time.ConclusionWe found no evidence that beta-blocker use was unsafe or associated with worse pulmonary outcomes in study participants with moderate to severe COPD.

Published
2017

2. Prediction of acute respiratory disease in current and former smokers with and without COPD.

Author

Bowler, Russell P, Kim, Victor, Regan, Elizabeth, Williams, André AA, Santorico, Stephanie A, Make, Barry J, Lynch, David A, Hokanson, John E, Washko, George R, Bercz, Peter, Soler, Xavier, Marchetti, Nathaniel, Criner, Gerard J, Ramsdell, Joe, Han, MeiLan K, Demeo, Dawn, Anzueto, Antonio, Comellas, Alejandro, Crapo, James D, Dransfield, Mark, Wells, J Michael, Hersh, Craig P, MacIntyre, Neil, Martinez, Fernando, Nath, Hrudaya P, Niewoehner, Dennis, Sciurba, Frank, Sharafkhaneh, Amir, Silverman, Edwin K, van Beek, Edwin JR, Wilson, Carla, Wendt, Christine, and Wise, Robert A

Subjects
Humans, Respiratory Tract Diseases, Pulmonary Disease, Chronic Obstructive, Acute Disease, Hospitalization, Incidence, Proportional Hazards Models, Risk Factors, Longitudinal Studies, Follow-Up Studies, Smoking, Quality of Life, Aged, Middle Aged, United States, Female, Male, Clinical Research, Lung, Chronic Obstructive Pulmonary Disease, Respiratory, Good Health and Well Being, Clinical Sciences, Respiratory System
Abstract

BackgroundThe risk factors for acute episodes of respiratory disease in current and former smokers who do not have COPD are unknown.MethodsEight thousand two hundred forty-six non-Hispanic white and black current and former smokers in the Genetic Epidemiology of COPD (COPDGene) cohort had longitudinal follow-up (LFU) every 6 months to determine acute respiratory episodes requiring antibiotics or systemic corticosteroids, an ED visit, or hospitalization. Negative binomial regression was used to determine the factors associated with acute respiratory episodes. A Cox proportional hazards model was used to determine adjusted hazard ratios (HRs) for time to first episode and an acute episode of respiratory disease risk score.ResultsAt enrollment, 4,442 subjects did not have COPD, 658 had mild COPD, and 3,146 had moderate or worse COPD. Nine thousand three hundred three acute episodes of respiratory disease and 2,707 hospitalizations were reported in LFU (3,044 acute episodes of respiratory disease and 827 hospitalizations in those without COPD). Major predictors included acute episodes of respiratory disease in year prior to enrollment (HR, 1.20; 95% CI, 1.15-1.24 per exacerbation), airflow obstruction (HR, 0.94; 95% CI, 0.91-0.96 per 10% change in % predicted FEV1), and poor health-related quality of life (HR, 1.07; 95% CI, 1.06-1.08 for each 4-unit increase in St. George's Respiratory Questionnaire score). Risks were similar for those with and without COPD.ConclusionsAlthough acute episode of respiratory disease rates are higher in subjects with COPD, risk factors are similar, and at a population level, there are more episodes in smokers without COPD.

Published
2014

3. Simvastatin for the Prevention of Exacerbations in Moderate-to-Severe COPD

Author

Criner, Gerard J, Connett, John E, Aaron, Shawn D, Albert, Richard K, Bailey, William C, Casaburi, Richard, Cooper, J Allen D, Curtis, Jeffrey L, Dransfield, Mark T, Han, MeiLan K, Make, Barry, Marchetti, Nathaniel, Martinez, Fernando J, Niewoehner, Dennis E, Scanlon, Paul D, Sciurba, Frank C, Scharf, Steven M, Sin, Don D, Voelker, Helen, Washko, George R, Woodruff, Prescott G, and Lazarus, Stephen C

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Chronic Obstructive Pulmonary Disease, Prevention, Clinical Research, Lung, Clinical Trials and Supportive Activities, Cardiovascular, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Respiratory, Good Health and Well Being, Adult, Aged, Female, Forced Expiratory Volume, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Lipids, Male, Middle Aged, Prospective Studies, Pulmonary Disease, Chronic Obstructive, Quality of Life, Severity of Illness Index, Simvastatin, Treatment Failure, Vital Capacity, COPD Clinical Research Network, Canadian Institutes of Health Research, Medical and Health Sciences, General & Internal Medicine, Biomedical and clinical sciences, Health sciences
Abstract

BackgroundRetrospective studies have shown that statins decrease the rate and severity of exacerbations, the rate of hospitalization, and mortality in chronic obstructive pulmonary disease (COPD). We prospectively studied the efficacy of simvastatin in preventing exacerbations in a large, multicenter, randomized trial.MethodsWe designed the Prospective Randomized Placebo-Controlled Trial of Simvastatin in the Prevention of COPD Exacerbations (STATCOPE) as a randomized, controlled trial of simvastatin (at a daily dose of 40 mg) versus placebo, with annual exacerbation rates as the primary outcome. Patients were eligible if they were 40 to 80 years of age, had COPD (defined by a forced expiratory volume in 1 second [FEV1] of less than 80% and a ratio of FEV1 to forced vital capacity of less than 70%), and had a smoking history of 10 or more pack-years, were receiving supplemental oxygen or treatment with glucocorticoids or antibiotic agents, or had had an emergency department visit or hospitalization for COPD within the past year. Patients with diabetes or cardiovascular disease and those who were taking statins or who required statins on the basis of Adult Treatment Panel III criteria were excluded. Participants were treated from 12 to 36 months at 45 centers.ResultsA total of 885 participants with COPD were enrolled for approximately 641 days; 44% of the patients were women. The patients had a mean (±SD) age of 62.2±8.4 years, an FEV1 that was 41.6±17.7% of the predicted value, and a smoking history of 50.6±27.4 pack-years. At the time of study closeout, the low-density lipoprotein cholesterol levels were lower in the simvastatin-treated patients than in those who received placebo. The mean number of exacerbations per person-year was similar in the simvastatin and placebo groups: 1.36±1.61 exacerbations and 1.39±1.73 exacerbations, respectively (P=0.54). The median number of days to the first exacerbation was also similar: 223 days (95% confidence interval [CI], 195 to 275) and 231 days (95% CI, 193 to 303), respectively (P=0.34). The number of nonfatal serious adverse events per person-year was similar, as well: 0.63 events with simvastatin and 0.62 events with placebo. There were 30 deaths in the placebo group and 28 in the simvastatin group (P=0.89).ConclusionsSimvastatin at a daily dose of 40 mg did not affect exacerbation rates or the time to a first exacerbation in patients with COPD who were at high risk for exacerbations. (Funded by the National Heart, Lung, and Blood Institute and the Canadian Institutes of Health Research; STATCOPE ClinicalTrials.gov number, NCT01061671.).

Published
2014

4. Long-term Comparative Immunogenicity of Protein Conjugate and Free Polysaccharide Pneumococcal Vaccines in Chronic Obstructive Pulmonary Disease

Author

Dransfield, Mark T, Harnden, Sarah, Burton, Robert L, Albert, Richard K, Bailey, William C, Casaburi, Richard, Connett, John, Cooper, J Allen D, Criner, Gerard J, Curtis, Jeffrey L, Han, MeiLan K, Make, Barry, Marchetti, Nathaniel, Martinez, Fernando J, McEvoy, Charlene, Nahm, Moon H, Niewoehner, Dennis E, Porszasz, Janos, Reilly, John, Scanlon, Paul D, Scharf, Steven M, Sciurba, Frank C, Washko, George R, Woodruff, Prescott G, Lazarus, Stephen C, and Network, for the NIH COPD Clinical Research

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Lung, Infectious Diseases, Clinical Research, Pneumonia & Influenza, Prevention, Clinical Trials and Supportive Activities, Pneumonia, Immunization, Biotechnology, Vaccine Related, Chronic Obstructive Pulmonary Disease, 3.4 Vaccines, Prevention of disease and conditions, and promotion of well-being, Respiratory, Infection, Good Health and Well Being, Aged, Cohort Studies, Female, Heptavalent Pneumococcal Conjugate Vaccine, Humans, Immunoglobulin G, Male, Middle Aged, Phagocytosis, Pneumococcal Infections, Pneumococcal Vaccines, Proportional Hazards Models, Pulmonary Disease, Chronic Obstructive, NIH COPD Clinical Research Network, Biological Sciences, Medical and Health Sciences, Microbiology, Clinical sciences
Abstract

BackgroundAlthough the 23-valent pneumococcal polysaccharide vaccine (PPSV23) protects against invasive disease in young healthy persons, randomized controlled trials in chronic obstructive pulmonary disease (COPD) have demonstrated no benefit in the intention-to-treat population. We previously reported that the 7-valent diphtheria-conjugated pneumococcal polysaccharide vaccine (PCV7) is safe and induced greater serotype-specific immunoglobulin G (IgG) and functional antibody than did PPSV23 1 month after vaccination. We hypothesized that these advantages would persist at 1 and 2 years.MethodsOne hundred eighty-one patients with moderate to severe COPD were randomized to receive PPSV23 (n = 90) or PCV7 (1.0 mL; n = 91). We measured IgG by enzyme-linked immunosorbent assay and assessed functional antibody activity by a standardized opsonophagocytosis assay, reported as a killing index (OPK). We determined differences in IgG and OPK between vaccine groups at 1 and 2 years.ResultsRelative to PPSV23, PCV7 induced greater OPK at both 1 and 2 years for 6 of 7 serotypes (not 19F). This response was statistically greater for 5 of 7 serotypes at 1 year and 4 of 7 at 2 years. Comparable differences in IgG were observed but were less often statistically significant. Despite meeting Centers for Disease Control and Prevention criteria for PPSV23 administration, almost 50% of individuals had never been vaccinated. No differences in the frequency of acute exacerbations, pneumonia, or hospitalization were observed.ConclusionsPCV7 induces a greater functional antibody response than PPSV23 in patients with COPD that persists for 2 years after vaccination. This superior functional response supports testing of conjugate vaccination in studies examining clinical end points.Clinical trials registrationNCT00457977.

Published
2012

5. Pulmonary effects of immediate versus deferred antiretroviral therapy in HIV-positive individuals: a nested substudy within the multicentre, international, randomised, controlled Strategic Timing of Antiretroviral Treatment (START) trial

Author

Kunisaki, Ken M, Niewoehner, Dennis E, Collins, Gary, Aagaard, Bitten, Atako, Nafisah B, Bakowska, Elzbieta, Clarke, Amanda, Corbelli, Giulio Maria, Ekong, Ernest, Emery, Sean, Finley, Elizabeth B, Florence, Eric, Infante, Rosa M, Kityo, Cissy M, Madero, Juan Sierra, Nixon, Daniel E, Tedaldi, Ellen, Vestbo, Jørgen, Wood, Robin, and Connett, John E

Published
2016
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12. Outpatient management of severe COPD

Author

Niewoehner, Dennis E.

Subjects
Bronchodilator agents -- Usage, Lung diseases, Obstructive -- Case studies, Lung diseases, Obstructive -- Diagnosis, Lung diseases, Obstructive -- Care and treatment, Shortness of breath -- Case studies, Shortness of breath -- Diagnosis, Shortness of breath -- Care and treatment
Abstract

The case of a 67-year-old man with a history of dyspnea is discussed to better understand the causes, diagnosis and treatment of severe chronic obstructive pulmonary disease (COPD). The different treatment methodologies and management regimes for COPD are also highlighted.

Published
2010

15. Supplementary_File – Supplemental material for Adjudication of cardiovascular events in patients with chronic obstructive pulmonary disease: SUMMIT trial

Author

Wise, Robert A, Anderson, Julie A, Amarenco, Pierre, Cowans, Nicholas J, Crim, Courtney, Denvir, Martin A, Gomez, Camilo R, Jones, Matthew PA, Morris, Andrea, Niewoehner, Dennis, and Yates, Julie C

Subjects
FOS: Clinical medicine, 160807 Sociological Methodology and Research Methods, 111599 Pharmacology and Pharmaceutical Sciences not elsewhere classified, FOS: Sociology
Abstract

Supplemental material, Supplementary_File for Adjudication of cardiovascular events in patients with chronic obstructive pulmonary disease: SUMMIT trial by Robert A Wise, Julie A Anderson, Pierre Amarenco, Nicholas J Cowans, Courtney Crim, Martin A Denvir, Camilo R Gomez, Matthew PA Jones, Andrea Morris, Dennis Niewoehner and Julie C Yates in Clinical Trials

Published
2020
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16. Contributors

Author

Abrams, Charles S., primary, Accurso, Frank J., additional, Afdhal, Nezam H., additional, Akin, Cem, additional, Aksamit, Allen J., additional, Al-Awqati, Qais, additional, Allos, Ban Mishu, additional, Altshuler, David, additional, Aminoff, Michael J., additional, Anderson, Jeffrey L., additional, Anderson, Karl E., additional, Anderson, Larry J., additional, Antman, Karen H., additional, Antony, Aśok C., additional, Appel, Gerald B., additional, Appelbaum, Frederick R., additional, Arend, William P., additional, Arguin, Paul, additional, Armitage, James O., additional, Armstrong, Cheryl A., additional, Arnaout, M. Amin, additional, Arnold, Robert, additional, Atkins, David, additional, Atkinson, William L., additional, Ausiello, Dennis, additional, Bacon, Bruce R., additional, Bagby, Grover C., additional, Bain, Barbara J., additional, Bajorin, Dean F., additional, Ballow, Mark, additional, Baloh, Robert W., additional, Barasch, Jonathan, additional, Barbano, Richard L., additional, Baron, Murray G., additional, Barrett-Connor, Elizabeth, additional, Barry, Michael J., additional, Barshop, Bruce A., additional, Bartlett, John G., additional, Barton, Mary, additional, Basner, Robert C., additional, Baum, Stephen G., additional, Bausch, Daniel G., additional, Bayer, Arnold S., additional, Bazari, Hasan, additional, Beigel, John H., additional, Beller, George A., additional, Bennett, Robert M., additional, Berger, Joseph R., additional, Berk, Paul, additional, Berliner, Nancy, additional, Bernat, James L., additional, Bierman, Philip J., additional, Bistrian, Bruce R., additional, Biundo, Joseph J., additional, Blanke, Charles D., additional, Blankson, Joel N., additional, Blaser, Martin J., additional, Blattner, William A., additional, Bleck, Thomas P., additional, Boden, William E., additional, Boland, C. Richard, additional, Bolognia, Jean, additional, Bonomo, Robert, additional, Borish, Larry, additional, Bosque, Patrick J., additional, Brand, Randall, additional, Brook, Itzhak, additional, Brunetti, Enrico, additional, Buchner, David M., additional, Buffet, Pierre A., additional, Bunn, H. Franklin, additional, Calabresi, Peter A., additional, Calfee, David P., additional, Calkins, Hugh, additional, Cameron, Douglas, additional, Camilleri, Michael, additional, Cannon, Grant W., additional, Cappellini, Maria Domenica, additional, Carabello, Blase A., additional, Carvalho, Edgar M., additional, Castellanos, Agustin, additional, Chalasani, Naga P., additional, Chambers, Henry, additional, Charlson, Mary, additional, Cheshire, William P., additional, Chinnery, Patrick F., additional, Christiani, David C., additional, Clemmons, David R., additional, Cohen, Jeffrey, additional, Cohen, Myron S., additional, Cohen, Steven P., additional, Cohn, Steven L., additional, Colebunders, Robert, additional, Connors, Joseph M., additional, Cook, Deborah J., additional, Corey, C. Ralph, additional, Cowan, Kenneth H., additional, Craig, William A., additional, Croft, Simon L., additional, Crow, Mary K., additional, Crump, John A., additional, Cullen, Mark R., additional, Curhan, Gary C., additional, Damon, Inger K., additional, Daniels, Troy E., additional, Davidson, Nancy, additional, DeAngelis, Lisa M., additional, DeCamp, Malcolm M., additional, Del Rio, Carlos, additional, Demetri, George D., additional, Demling, Robert H., additional, Deuster, Patricia A., additional, Diasio, Robert B., additional, Diemert, David J., additional, Digre, Kathleen B., additional, Douglas, John M., additional, Drazen, Jeffrey M., additional, Dreskin, Stephen C., additional, Drew, W. Lawrence, additional, Drusano, George L., additional, DuBose, Thomas D., additional, Duffy, F. Daniel, additional, DuPont, Herbert L., additional, Duvic, Madeleine, additional, Edwards, Kathryn M., additional, Edwards, N. Lawrence, additional, Einhorn, Lawrence H., additional, Elin, Ronald J., additional, Eliopoulos, George M., additional, Elliott, Perry, additional, Ellner, Jerrold J., additional, Elsas, Louis J., additional, Elston, Dirk M., additional, Emanuel, Ezekiel J., additional, Erickson, Gregory F., additional, Ernst, Armin, additional, Ernst, Joel D., additional, Ettinger, David S., additional, Evoli, Amelia, additional, Faigel, Douglas O., additional, Falk, Gary W., additional, Favus, Murray J., additional, Feder, Gene, additional, Fihn, Stephan D., additional, Firestein, Gary S., additional, Fishman, Neil, additional, Fleisher, Lee A., additional, Ford, Marsha D., additional, Forsmark, Chris E., additional, Fowler, Vance G., additional, Fox, Jay W., additional, Franco, Manuel A., additional, French, Martyn A., additional, Freund, Karen, additional, Fried, Linda P., additional, Gabay, Cem, additional, Gage, Kenneth L., additional, Gagel, Robert F., additional, Galgiani, John N., additional, Gallagher, Patrick G., additional, Galun, Eithan, additional, Ganz, Leonard, additional, Garcia-Tsao, Guadalupe, additional, Gates, Jonathan D., additional, Geisler, William M., additional, George, Tony P., additional, Gerding, Dale N., additional, Gershwin, M. Eric, additional, Gertz, Morie A., additional, Ginder, Gordon D., additional, Ginsberg, Jeffrey, additional, Ginsburg, Geoffrey S., additional, Glogauer, Michael, additional, Gnann, John W., additional, Golden, Matthew R., additional, Goldman, Lee, additional, Goldstein, Ellie J., additional, Goodnough, Lawrence T., additional, Goronzy, Jörg J., additional, Gotuzzo, Eduardo, additional, Grady, Deborah, additional, Grammer, Leslie C., additional, Greco, F. Anthony, additional, Greenberg, Harry B., additional, Gregersen, Peter K., additional, Griggs, Robert C., additional, Guay-Woodford, Lisa M., additional, Guerrant, Richard L., additional, Hadigan, Colleen, additional, Hainsworth, John D., additional, Hamsten, Anders, additional, Hande, Kenneth R., additional, Handsfield, H. Hunter, additional, Hansson, Göran K., additional, Haque, Rashidul, additional, Harris, Raymond C., additional, Hauser, Stephen Crane, additional, Hayden, Frederick G., additional, Healey, Letha, additional, Heimburger, Douglas C., additional, Hewlett, Erik L., additional, Hill, David R., additional, Hill, Nicholas S., additional, Hillis, L. David, additional, Hirsh, Jack, additional, Holers, V. Michael, additional, Holland, Steven M., additional, Hollenberg, Steven, additional, Hook, Edward W., additional, Huang, Laurence, additional, Hudson, Leonard D., additional, Hyman, Steven E., additional, Iannuzzi, Michael, additional, Inman, Robert D., additional, Inouye, Sharon K., additional, Insogna, Karl L., additional, Inzucchi, Silvio E., additional, Isselbacher, Eric M., additional, Jemal, Ahmedin, additional, Jen, Joanna, additional, Jensen, Dennis M., additional, Jensen, Michael D., additional, Jensen, Robert T., additional, Jessup, Mariell, additional, Johnson, Stuart, additional, Józefowicz, Ralph F., additional, Kaler, Stephen G., additional, Kamya, Moses R., additional, Kantarjian, Hagop, additional, Karp, David R., additional, Kastner, Daniel L., additional, Katzka, David A., additional, Katzman, Debra K., additional, Kauffman, Carol A., additional, Kaushansky, Kenneth, additional, Keeffe, Emmet B., additional, Kern, Morton, additional, Keusch, Gerald T., additional, Kim, David H., additional, Kim, Matthew, additional, Kirchhoff, Louis V., additional, Klag, Michael J., additional, Klein, Samuel, additional, Knopman, David S., additional, Knox, Tamsin A., additional, Ko, Albert I., additional, Komrokji, Rami S., additional, Kontoyiannis, Dimitrios P., additional, Koppel, Barbara S., additional, Korenblat, Kevin, additional, Korf, Bruce R., additional, Korman, Neil J., additional, Kovacs, Joseph A., additional, Kraft, Monica, additional, Kramer, Christopher M., additional, Krasnewich, Donna M., additional, Krause, Peter J., additional, Kronenberg, Henry M., additional, Kuipers, Ernst J., additional, Ladenson, Paul, additional, Landry, Donald W., additional, Lane, Nancy E., additional, Lang, Anthony E., additional, Lange, Richard A., additional, Lawry, George V., additional, Lee, Thomas H., additional, Lee, William M., additional, Leggett, James, additional, Lerner, Adam, additional, Levin, Stuart, additional, Levine, Stephanie M., additional, Lichtenstein, Gary R., additional, Lim, Henry W., additional, Lima, Aldo A.M., additional, Limper, Andrew H., additional, Ling, Geoffrey S.F., additional, List, Alan F., additional, Little, William C., additional, Loeser, Richard F., additional, Lorber, Bennett, additional, Low, Donald E., additional, Lucey, Daniel R., additional, Lupski, James R., additional, Lynch, Henry T., additional, Lyness, Jeffrey M., additional, Lytle, Bruce W., additional, MacKenzie, C. Ronald, additional, MacMillan, Harriet, additional, Madoff, Robert D., additional, Mahowald, Mark W., additional, Malhotra, Atul, additional, Mandell, Lionel A., additional, Manu, Peter, additional, Marcus, Marsha D., additional, Marelli, Ariane J., additional, Markman, Maurie, additional, Marks, Andrew R., additional, Marr, Kieren A., additional, Marrie, Thomas J., additional, Martin, Paul, additional, Mason, Joel B., additional, Massie, Barry M., additional, Masur, Henry, additional, Matteson, Eric L., additional, Maurer, Toby, additional, Mayer, Emeran A., additional, McClave, Stephen A., additional, McCool, F. Dennis, additional, McCulloch, Charles E., additional, McGuigan, Michael A., additional, McHutchison, John, additional, McKenna, William, additional, McLaughlin, Vallerie, additional, McMurray, John J.V., additional, McNaughton-Collins, Mary, additional, McQuaid, Kenneth, additional, Miller, Frederick W., additional, Minaker, Kenneth L., additional, Mink, Jonathan W., additional, Mishell, Daniel R., additional, Mitch, William E., additional, Molitch, Mark E., additional, Molitoris, Bruce A., additional, Montoya, José G., additional, Morady, Fred, additional, Moscow, Jeffrey A., additional, Murr, Andrew H., additional, Myerburg, Robert J., additional, Naguwa, Stanley, additional, Naides, Stanley J., additional, Nash, Theodore E., additional, Nath, Avindra, additional, Neilson, Eric G., additional, Neinstein, Lawrence S., additional, Newman, Thomas B., additional, Nichols, William L., additional, Nieman, Lynnette K., additional, Niewoehner, Dennis E., additional, Norrby, S. Ragnar, additional, Norris, David A., additional, O’Brien, Susan, additional, O’Connor, Francis G., additional, O’Connor, Patrick G., additional, O'Dell, James R., additional, O'Donnell, Anne E., additional, Oh, Jae K., additional, Olgin, Jeffrey E., additional, Olin, Jeffrey W., additional, Orenstein, Walter A., additional, Osmon, Douglas R., additional, Otto, Catherine M., additional, Paget, Stephen A., additional, Papania, Mark, additional, Pappas, Peter G., additional, Pasricha, Pankaj Jay, additional, Paterson, David L., additional, Patrono, Carlo, additional, Pawlotsky, Jean-Michel, additional, Pearson, Richard D., additional, Perencevich, Eli N., additional, Perl, Trish M., additional, Perry, Michael C., additional, Petri, William A., additional, Pfeffer, Marc A., additional, Pickhardt, Perry J., additional, Pier, Gerald B., additional, Pisetsky, David S., additional, Posner, Marshall R., additional, Prather, Charlene, additional, Pruitt, Basil A., additional, Pyeritz, Reed E., additional, Quinn, Thomas C., additional, Radhakrishnan, Jai, additional, Raghu, Ganesh, additional, Ragni, Margaret V., additional, Raja, Srinivasa N., additional, Rajkumar, S. Vincent, additional, Raoult, Didier, additional, Rebar, Robert W., additional, Reboli, Annette C., additional, Reddy, K. Rajender, additional, Redelmeier, Donald A., additional, Reef, Susan E., additional, Resnick, Neil M., additional, Reuben, David B., additional, Reynolds, Herbert Y., additional, Rivers, Emanuel P., additional, Rizza, Robert A., additional, Roberts, Lewis R., additional, Rolain, Jean-Marc, additional, Romero, José R., additional, Roodman, G. David, additional, Rosen, Clifford, additional, Rosene-Montella, Karen, additional, Rosenthal, Philip J., additional, Rothenberg, Marc E., additional, Rugo, Hope S., additional, Russell, James A., additional, Rustgi, Anil K., additional, Salata, Robert A., additional, Salmon, Jane E., additional, Santos, Renato M., additional, Sawka, Michael N., additional, Schafer, Andrew I., additional, Schaffner, William, additional, Scheld, W. Michael, additional, Schneider, Eileen, additional, Schnitzer, Thomas J., additional, Schooley, Robert T., additional, Schriger, David L., additional, Schroeder, Steven A., additional, Schuchter, Lynn M., additional, Schulman, Sam, additional, Schwartz, Lawrence B., additional, Schwartz, Robert S., additional, Seas, Carlos, additional, Seifert, Steven A., additional, Seifter, Julian L., additional, Semenkovich, Clay F., additional, Semrad, Carol E., additional, Service, F. John, additional, Shaw, George M., additional, Shaw, Pamela J., additional, Sherwin, Robert S., additional, Shy, Michael E., additional, Sibbitt, Wilmer L., additional, Sidransky, Ellen, additional, Siliciano, Robert F., additional, Simberkoff, Michael S., additional, Simel, David L., additional, Skorecki, Karl, additional, Slutsky, Arthur S., additional, Small, Eric J., additional, Smetana, Gerald W., additional, Southwick, Frederick S., additional, Spiera, Robert F., additional, Spinola, Stanley M., additional, Stankiewicz, Pawel, additional, Stark, Paul, additional, Steinbach, Lynne S., additional, Steinberg, Martin H., additional, Steiner, Theodore S., additional, Stephens, David S., additional, Stevens, David A., additional, Stevenson, William G., additional, Stillman, Arthur E., additional, Stoller, James K., additional, Stone, John H., additional, Su, Edwin P., additional, Sutter, Roland W., additional, Swartz, Morton N., additional, Swerdloff, Ronald S., additional, Sykes, Megan, additional, Tami, Thomas A., additional, Tarlo, Susan M., additional, Taylor, Victoria M., additional, Tefferi, Ayalew, additional, Teirstein, Paul S., additional, Telford, Sam R., additional, Tempero, Margaret, additional, Thun, Michael J., additional, Tolkoff-Rubin, Nina, additional, Tosti, Antonella, additional, Treanor, John J., additional, Turner, Ronald B., additional, Upton, Arthur C., additional, Van den Berghe, Greet, additional, Varga, John, additional, Vella, Adrian, additional, Verbalis, Joseph G., additional, Victor, Ronald G., additional, Vincent, Angela, additional, Volberding, Paul A., additional, Vose, Julie M., additional, Wachter, Robert M., additional, Wagner, Edward H., additional, Walsh, Edward E., additional, Walsh, Thomas J., additional, Wang, Christina, additional, Wanke, Christine, additional, Wasserman, Stephen I., additional, Wedemeyer, Heiner, additional, Weinberg, Geoffrey A., additional, Weinstein, David A., additional, Weinstein, Robert S., additional, Weiss, Roger D., additional, Weisse, Martin, additional, Weitz, Jeffrey I., additional, Wells, Samuel A., additional, Wenzel, Richard P., additional, Werth, Victoria P., additional, West, Sterling G., additional, Weyand, Cornelia M., additional, White, A. Clinton, additional, White, Christopher J., additional, White, Perrin C., additional, Whitley, Richard J., additional, Whyte, Michael P., additional, Wiebe, Samuel, additional, Wiener-Kronish, Jeanine P., additional, Wildes, Jennifer E., additional, Wilmer, Alexander, additional, Winkenwerder, William, additional, Wolfsdorf, Joseph I., additional, Wormser, Gary P., additional, Wysolmerski, John J., additional, Yanoff, Myron, additional, Young, Neal S., additional, Young, William F., additional, Yu, Alan S.L., additional, Zeidel, Mark L., additional, Zimetbaum, Peter, additional, and Zivin, Justin A., additional

Published
2012
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22. Azithromycin for Prevention of Exacerbations of COPD

Author

Albert, Richard K., Connett, John, Bailey, William C., Casaburi, Richard, Cooper, Allen J.D., Jr., Criner, Gerard J., Curtis, Jeffrey L., Dransfield, Mark T., Han, MeiLan K., Lazarus, Stephen C., Make, Barry, Marchetti, Nathaniel, Martinez, Fernando J., Madinger, Nancy E., McEvoy, Charlene, Niewoehner, Dennis E., Porsasz, Janos, Price, Connie S., Reilly, John, Scanlon, Paul D., Sciurba, Frank C., Scharf, Steven M., Washko, George R., Woodruff, Prescott G., and Anthonisen, Nicholas R.

Published
2011
Full Text
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25. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease

Author

Niewoehner, Dennis E., Erbland, Marcia L., Deupree, Robert H., Collins, Dorothea, Gross, Nicholas J., Light, Richard W., Anderson, Paula, and Morgan, Nancy A.

Subjects
Lung diseases, Obstructive -- Drug therapy, Methylprednisolone -- Evaluation
Abstract

Corticosteroids appear to have a moderate benefit when used to treat exacerbations of chronic obstruction pulmonary disease (COPD) but the effect does not last long. Researchers randomly assigned 271 hospital patients with COPD exacerbations to receive placebo, two weeks of intravenous and oral methylprednisolone, or eight weeks of intravenous and oral methylprednisolone. Those who received methylprednisolone had shorter hospital stays and better lung function. However, six months later there was no difference in lung function among all three groups. Those who received methylprednisolone were more likely to develop elevated blood sugar levels.

Published
1999

37. The Impact of Severe Exacerbations on Quality of Life and the Clinical Course of Chronic Obstructive Pulmonary Disease

Author

Niewoehner, Dennis E.

Subjects
Lung diseases, Obstructive -- Care and treatment, Drug therapy -- Health aspects, Quality of life -- Research, Health, Health care industry
Abstract

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2006.08.006 Byline: Dennis E. Niewoehner Keywords: Chronic obstructive pulmonary disease; Exacerbation; Quality of life Abstract: Severe exacerbations of chronic obstructive pulmonary disease (COPD) are morbid events with slow recovery periods. They consume substantial healthcare resources, and they may cause a more rapid reduction in lung function over time. Quality of life (QOL) deteriorates in patients who experience exacerbations, and the more frequent the exacerbations, the more rapid the decline in QOL. Hospitalizations due to exacerbations account for up to 70% of the cost of medical care for patients with COPD. Patients with more severe COPD have more hospitalizations compared with those with less severe disease. A number of therapeutic interventions reduce the number of exacerbations and hospitalizations due to respiratory disease. The long-acting anticholinergic bronchodilator tiotropium, influenza vaccination, and possibly case management appear to reduce need for hospitalization substantially. COPD management should include drugs and other interventions that reduce the frequency of exacerbations and minimize their negative impact on the clinical course of the disease. Author Affiliation: University of Minnesota, Minneapolis, Minnesota, USA; and Pulmonary Section, Department of Veterans Affairs Medical Center, Minneapolis, Minnesota, USA

Published
2006

46. Exacerbations of Chronic Obstructive Pulmonary Disease and Cardiac Events: A Cohort Analysis

Author

Kunisaki, Ken M, Dransfield, Mark T, Anderson, Julie A, Brook, Robert D, Calverley, Peter M. A., Celli, Bartolome R., Crim, Courtney, Hartley, Benjamin F, Martinez, Fernando J., Newby, David E, Pragman, Alexa A, Vestbo, Jørgen, Yates, Julie C., and Niewoehner, Dennis E

Subjects
Journal Article, cardiovascular diseases
Abstract

RATIONALE: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common, associated with acute inflammation, and may increase subsequent cardiovascular disease (CVD) risk.OBJECTIVE: Determine if AECOPD events are associated with increased risk of subsequent CVD.METHODS: A secondary cohort analysis of the Study to Understand Mortality and MorbidITy (SUMMIT) trial, a convenience sample of current/former smokers with moderate COPD from 1,368 centers in 43 countries. All had CVD or increased CVD risk. AECOPD was defined as an increase in respiratory symptoms requiring treatment with antibiotics, systemic corticosteroids and/or hospitalization. CVD events were a composite outcome of cardiovascular death, myocardial infarction, stroke, unstable angina, and transient ischemic attack. All CVD events were adjudicated. Cox proportional hazards models compared the hazard for a CVD event prior to AECOPD versus following AECOPD.MEASUREMENTS AND MAIN RESULTS: Among 16,485 participants in SUMMIT, 4,704 participants had at least one AECOPD and 688 had at least one CVD event. The hazard ratio (HR) for CVD events following AECOPD was increased, particularly in the first 30 days following AECOPD (HR 3.8; 95%CI: 2.7 to 5.5) and was elevated up to one year post-AECOPD. The 30-day HR following hospitalized AECOPD was more than two-fold greater (HR 9.9; 95%CI: 6.6 to 14.9).CONCLUSIONS: In COPD patients with CVD or risk factors for CVD, exacerbations confer an increased risk of subsequent CVD events, especially in hospitalized patients and within the first 30 days post-exacerbation. Patients and clinicians should have heightened vigilance for early CVD events following AECOPD. Clinical trial registration available at www.clinicaltrials.gov, ID NCT01313676.

Published
2018

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