Longer Duration of Palliative Care in Patients With COPD Is Associated With Death Outside the Hospital.

Patients with advanced chronic obstructive pulmonary disease (COPD) have a significant symptom burden despite maximal medical therapy, yet few are referred for concomitant palliative care. To evaluate the utilization and impact of palliative care on the location of death and to identify clinical variables associated with palliative care contact. Retrospective chart review from 2010 to 2016 at the VA Western New York Healthcare System using ICD-9/10 diagnosis of COPD.

Bacterial regulation of macrophage bacterial recognition receptors in COPD are differentially modified by budesonide and fluticasone propionate.

Rationale: Patients with COPD have an increased risk for community-acquired pneumonia, which is further increased by inhaled corticosteroids.

Objective: To assess effects of the corticosteroids, budesonide and fluticasone propionate, on macrophage bacterial responses in COPD.

Methods: Monocyte-derived macrophages (MDMs) generated from blood monocytes from 10 non-smoker controls (NoS), 20 smokers without COPD (Sm), and 40 subjects with moderate to severe COPD (21 ex-smokers (COPD-ES) and 19 current smokers (COPD-S)) were pre-treated with budesonide or fluticasone (10 nM-1 μM) and challenged with live non-typeable Haemophilus influenzae (NTHI) or Streptococcus pneumoniae (SP).

Calcium restores the macrophage response to nontypeable haemophilus influenzae in chronic obstructive pulmonary disease.

Alveolar macrophages in chronic obstructive pulmonary disease (COPD) have demonstrated impaired bacterial phagocytosis and disordered cytokine secretion, which are calcium-dependent processes. We determined how calcium moderates the macrophage response to nontypeable Haemophilus influenzae (NTHI). We hypothesized that augmenting extracellular calcium during bacterial challenge would restore bacterial phagocytosis and cytokine secretion in monocyte-derived macrophages (MDMs) from subjects with COPD.