Jama copd exacerbation steroids

Results   A total of 116 patients (mean [SD] age of 67 [10] years, 53% female, mean BMI of [IQR, -], mean [SD] forced expiratory volume in the first second of expiration of L [ L], and mean [SD] Pa co 2 while breathing room air of 59 [7] mm Hg) were randomized. Sixty-four patients (28 in home oxygen alone and 36 in home oxygen plus home NIV) completed the 12-month study period. The median time to readmission or death was months (IQR, - months) in the home oxygen plus home NIV group vs months (IQR, - months) in the home oxygen alone group, adjusted hazard ratio of (95% CI, -; P  = .002). The 12-month risk of readmission or death was % in the home oxygen plus home NIV group vs % in the home oxygen alone group, absolute risk reduction of % (95% CI, %-%). At 12 months, 16 patients had died in the home oxygen plus home NIV group vs 19 in the home oxygen alone group.

In the context that one major purpose of a staging system is to establish prognosis, attention has focused on the value of including weight (ie, body mass index [BMI]), dyspnea, and exercise capacity (ie, the 6-minute walk distance), with FEV 1 in staging COPD. 19 Indeed, the resultant index, called BODE (for BMI, obstruction, dyspnea, and exercise capacity) has been shown to better predict survival in COPD than FEV 1 alone. BODE scores of 0 to 10 (most impaired) are stratified into 4 quartiles, which discriminate mortality risk better than FEV 1 alone. Other multifactorial prognostic systems (eg, ADO [for age, dyspnea, and obstruction] and DOSE [for dyspnea, obstruction, smoking, and exercise capacity]) have also been proposed. 20,21

Clinical Takeaway: In the properly selected patient azithromycin appears to be a safe and effective means of prophylaxis against COPD exacerbations. However, the prevalence of cardiovascular disease and risk factors among people with COPD makes "proper selection" of patients a challenge. A cautious approach would exclude patients with known risks of cardiovascular disease, qTc prolongation on initial EKGs or follow up EKGs with qTc prolongation, and those on other medications known to prolong QTc. Smoking cessation is the first line therapy for COPD, and active smokers might not derive benefit from azithromycin prophylaxis.

Psychosocial support is particularly important for Māori and Pacific peoples with COPD. People with COPD have an increased risk of developing symptoms of anxiety and depression, both of which are linked to poor health outcomes. 10,23 In addition, Māori and Pacific adults have a higher prevalence of mental health disorders in general than other ethnic groups. 24 Cognitive behavioural approaches have been shown to significantly reduce depression and improve the health status of people with severe COPD. 25 Strategies include relaxation, breathing techniques, positioning and chest clearing techniques and modification of negative thoughts. 25

Jama copd exacerbation steroids

jama copd exacerbation steroids

Psychosocial support is particularly important for Māori and Pacific peoples with COPD. People with COPD have an increased risk of developing symptoms of anxiety and depression, both of which are linked to poor health outcomes. 10,23 In addition, Māori and Pacific adults have a higher prevalence of mental health disorders in general than other ethnic groups. 24 Cognitive behavioural approaches have been shown to significantly reduce depression and improve the health status of people with severe COPD. 25 Strategies include relaxation, breathing techniques, positioning and chest clearing techniques and modification of negative thoughts. 25

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