Controversies In Copd

COPD is one of the most common diseases worldwide and is projected to be the third leading cause of death by 2020. But that does not mean it is easy to understand or manage. In everyday practice, pulmonologists face areas of controversy in COPD, for which evidence-based medicine is often unavailable. This ERS Monograph considers where the current controversies in COPD lie, discussing areas such as screening, premature birth, asthma–COPD overlap syndrome, treatment, rehabilitation and palliative care. This book will be of great interest to both clinicians and scientists, and aims to stimulate further discussion about this diverse and fascinating disease. "...contains a vast amount of information on the disease, its prevalence, signs and symptoms, diagnositc tests and treatment options. The book's format makes it quick and simple to find out what you need to know, and its size would make it easy to take to work for use in practice [...] invaluable for anyone working with patients with the disease." Emma Vincent, Nursing Standard

Chronic obstructive pulmonary disease (COPD) affects millions of people across the world. COPD is not only a major burden to patients but is also costly and results in billions of dollars of direct and indirect costs annually. In recent years and with advancement of science, the understanding of COPD has improved significantly. Fortunately, current management guidelines consider COPD a preventable and treatable condition, and recent studies clearly indicate that available pharmacological and non-pharmacological interventions may improve various clinical outcomes. COPD: A Guide to Diagnosis and Clinical Management offers an exciting, evidence-based assessment of the field and will be of significant interest to clinicians who care for patients with COPD, including primary care providers and specialists. Comprehensive and state-of-the-art, this title is authored by experts who took the task of developing a resource that focuses on the essential issues in caring for patients with COPD. The first four chapters of the book cover major points about the systemic nature of COPD, the clinical and physiological assessments, and the outcome measures and prognostic markers. In the following section, various pharmacologic and non-pharmacological management strategies are reviewed based on the available evidence. The final sections outline the non-pulmonary effects of COPD and their management. COPD: A Guide to Diagnosis and Clinical Management is a vital, evidence-based text that will prove invaluable for all clinicians who care for patients with this debilitating disorder.

Chronic Obstructive Pulmonary Disease Exacerbations covers the definition, diagnosis, epidemiology, mechanisms, and treatment associated with COPD exacerbations. This text also addresses imaging and how it plays a pivotal role in the diagnosis and study of exacerbations.Written by today's top experts, Chronic Obstructive Pulmonary Disease Exacerbat

Placing specialists at the cutting-edge of therapeutic and biotechnological research, this reference reviews the extensive array of pharmaceutical options available for the management of patients with COPD. The book considers disease severity, dosing regimens, administration methods, and monitoring procedures, as well as medication-related side-effects for improved lung function, reduction of disease symptoms, and enhanced quality of life. Contributions from world-renowned authorities reflect recent practices, controversies, and procedures in the control of COPD symptoms and detail the development and efficacy of therapies such as anticholinergics, beta adrenergics, and corticosteroids.

In this unique title, the full range of chronic respiratory conditions and their association with psychiatric comorbidities are explored and targeted management options are outlined. Indeed recent studies indicate a far higher prevalence of depression and anxiety in patients afflicted with chronic respiratory conditions than in patients with other chronic disorders. Unlike other publications in the field of pulmonary disease, Depression and Anxiety in Patients with Chronic Respiratory Diseases details this significant correlation. The book is comprehensive in scope, covering such topics as depression and anxiety across the age spectrum, diagnostic tools for anxiety and depression, anxiety and depression in COPD patients, depression and anxiety in adult patients with asthma, and end-stage lung disease and lung transplantation, among others. In this novel work, the volume Editors enlist a team of renowned experts in the fields of respiratory and psychiatric disorders to combine a thorough synthesis of the literature with targeted, practical strategies for management. Depression and Anxiety in Patients with Chronic Respiratory Diseases is an invaluable resource for all clinicians who care for patients with chronic and advanced lung diseases.

Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are common partners with common problems. Both are chronic systemic disorders incurring significant morbidity and mortality. Although around one third of patients with HF have concurrent COPD,1 remarkably few reports have addressed this often ignored combination. The systematic review presented within this thesis defines the diagnostic challenges, prevalence and prognostic implications of HF with coexistent COPD. I then critically appraise the twin controversies of [beta]-blockade in COPD and [beta]-agonists in HF. The two are inextricably linked, each therapy exerting the reverse pharmacologic activity of the other. The evidence for symptomatic or prognostic benefit from either therapy is limited, and in the case of [beta]-agonists adverse consequences appear more likely. A Cochrane meta-analysis concluded that long term cardioselective [beta]-blockade is safe and well tolerated in patients with moderate to severe or reversible COPD. 2 Although often cited,3 these conclusions are simply not true. Of the 20 randomised controlled trials included in the meta-analysis, 11 involved single doses and only one lasted longer than a month. The 9 'long term' studies (defined as more than a single treatment dose) involved 147 young, predominantly male patients with moderate airways obstruction (mean forced expiratory volume in 1 second (FEV1) 1.8 litres). The effect on health status has never been assessed in any cohort with COPD. The long term impact of [beta]-blockade on pulmonary function, symptoms and quality of life is therefore largely unknown. Most importantly, no study has included patients with HF. I randomised 27 patients with HF and coexistent moderate or severe COPD to receive bisoprolol or placebo, titrated to maximum tolerated dose over 4 months. Patients were elderly and predominantly male. Cardiovascular comorbidity, smoking history and pulmonary function were similar in each group (mean FEV1 1.37L vs 1.26L). There were several key findings. A reduction in FEV1 occurred after 4 months following treatment with bisoprolol compared with placebo ( -70 ml vs +120 ml, p=0.01). Reversibility following inhaled [beta]2-agonist and static lung volumes were not impaired by bisoprolol. All measures of health status exhibited a consistent non-significant improvement, including the Short Form 36 physical and mental component scores, Minnesota Living with Heart Failure Questionnaire, and Chronic Respiratory Questionnaire. The mean number of COPD exacerbations was similar in the bisoprolol and placebo groups. Although recruitment was limited, the results pose crucial questions and provide direction for larger randomised controlled trials. I analysed cross-sectional data from 61 primary care practices (377,439 patients) participating in the Scottish Continuous Morbidity Recording scheme. The prevalence of COPD in patients with HF increased year on year from 19.8% in 1999 to 23.8% in 2004. These changes may previously have been attributed to an ageing population or increasing age of presentation. However, the trend remained significant after age standardisation. A clear socioeconomic gradient was observed, with prevalence greatest in the most deprived. Consultation rates for HF or COPD in those with both conditions were greater than disease specific contact rates in patients with either condition alone. Cardiovascular comorbidity was similar in HF patients with and without COPD, despite differences in smoking history (respectively 76% vs 47%, p

A panel of recognized authorities comprehensively review the medical, surgical, and pathophysiologic issues relevant to lung volume reduction surgery for emphysema. Topics range from the open technique and video-assisted thoracoscopic approaches to LVRS, to anesthetic management, to perioperative and nursing care of the patient. The experts also detail the selection of candidates for LVRS, the clinical results and clinical trials in LVRS, and the effects of LVRS on survival rates.

"The field of Biomarkers and Precision Medicine in drug development is rapidly evolving and this book presents a snapshot of exciting new approaches. By presenting a wide range of biomarker applications, discussed by knowledgeable and experienced scientists, readers will develop an appreciation of the scope and breadth of biomarker knowledge and find examples that will help them in their own work." -Maria Freire, Foundation for the National Institutes of Health Handbook of Biomarkers and Precision Medicine provides comprehensive insights into biomarker discovery and development which has driven the new era of Precision Medicine. A wide variety of renowned experts from government, academia, teaching hospitals, biotechnology and pharmaceutical companies share best practices, examples and exciting new developments. The handbook aims to provide in-depth knowledge to research scientists, students and decision makers engaged in Biomarker and Precision Medicine-centric drug development. Features: Detailed insights into biomarker discovery, validation and diagnostic development with implementation strategies Lessons-learned from successful Precision Medicine case studies A variety of exciting and emerging biomarker technologies The next frontiers and future challenges of biomarkers in Precision Medicine Claudio Carini, Mark Fidock and Alain van Gool are internationally recognized as scientific leaders in Biomarkers and Precision Medicine. They have worked for decades in academia and pharmaceutical industry in EU, USA and Asia. Currently, Dr. Carini is Honorary Faculty at Kings’s College School of Medicine, London, UK. Dr. Fidock is Vice President of Precision Medicine Laboratories at AstraZeneca, Cambridge, UK. Prof.dr. van Gool is Head Translational Metabolic Laboratory at Radboud university medical school, Nijmegen, NL.

This is the first book to offer a comprehensive guide to involving patients in health technology assessment (HTA). Defining patient involvement as patient participation in the HTA process and research into patient aspects, this book includes detailed explanations of approaches to participation and research, as well as case studies. Patient Involvement in HTA enables researchers, postgraduate students, HTA professionals and experts in the HTA community to study these complementary ways of taking account of patients’ knowledge, experiences, needs and preferences. Part I includes chapters discussing the ethical rationale, terminology, patient-based evidence, participation and patient input. Part II sets out methodology including: Qualitative Evidence Synthesis, Discrete Choice Experiments, Analytical Hierarchy Processes, Ethnographic Fieldwork, Deliberative Methods, Social Media Analysis, Patient-Reported Outcome Measures, patients as collaborative research partners and evaluation. Part III contains 15 case studies setting out current activities by HTA bodies on five continents, health technology developers and patient organisations. Each part includes discussion chapters from leading experts in patient involvement. A final chapter reflects on the need to clearly define the goals for patient involvement within the context of the HTA to identify the optimal approach. With cohesive contributions from more than 80 authors from a variety of disciplines around the globe, it is hoped this book will serve as a catalyst for collaboration to further develop patient involvement to improve HTA. "If you’re not involving patients, you're not doing HTA!" - Dr. Brian O’Rourke, President and CEO of CADTH, Chair of INAHTA