COPD Archives - PulmCCM
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COPD Articles

Mar 162014
 
Beta blockers safe for most patients with asthma or COPD?

Beta-Blockers: Safe (and Effective?) for Most Patients with Asthma, COPD Once upon a time in 1964, it was noted that propranolol, a nonselective beta-blocker, could precipitate severe bronchospasm in patients with asthma, especially at high doses. Additional small studies showed propranolol and other nonselective beta blockers could increase airway resistance. British guidelines advise avoiding beta [... read more]

Feb 112014
 
Vitamin D: no relationship to COPD exacerbations

After a stupefying amount of research on vitamin D — with 70 vitamin D studies published in PubMed in January 2014 alone — there is no consistent signal tying vitamin D supplementation to improvement in any health condition. A recent “futility analysis” (a form of meta-analysis) of 40 randomized trials suggests vitamin D does not [... read more]

Feb 012014
 
Spiriva and heart attack risk: new safety kerfuffle

Last year, PulmCCM reported on the TIOSPIR safety trial comparing the Spiriva dry-powder HandiHaler against the Respimat mist-delivery device. TIOSPIR showed no difference in all-cause mortality or composite cardiovascular risk endpoints between either Spiriva preparation. But this week, a group of drug safety researchers report their granular analysis of TIOSPIR data shows the Respimat device [... read more]

Nov 062013
 
Olodaterol, a new once-daily LABA, proven effective for COPD

Olodaterol Olodaterol, a new once-daily inhaled long-acting beta agonist, improved lung function and exercise capacity in chronic obstructive pulmonary disease (COPD) in two randomized trials (n=199) presented by Gregory Feldman et al at the Chest 2013 meeting in Chicago. The new once-daily LABA olodaterol will reportedly be marketed by Boehringer Ingelheim under the trade name Striverdi [... read more]

Oct 312013
 
Breo Ellipta (vilanterol/fluticasone) matches Advair in RCT

Breo Ellipta (GlaxoSmithKline) is the first FDA-approved combination product with a once-daily long acting beta agonist (vilanterol) and inhaled corticosteroid (fluticasone). Additional once daily combination ICS/LABA and LABA/antimuscarinics are expected to launch over the next decade, increasing the options for treatment of asthma and COPD. GSK got good news in the October Chest, with the publication [... read more]

Oct 312013
 
Indacaterol vs Tiotropium: Tie on FEV1; Spiriva wins on exacerbations

Once-daily long-acting beta agonist indacaterol (Arcapta Neohaler) went head to head against tiotropium (Spiriva) in a randomized trial among 3,444 patients with severe COPD, funded by indacaterol makers Novartis. Indacaterol, approved in 2011 as a treatment for COPD, was deemed noninferior to tiotropium according to the prespecified criteria of the trial, bronchodilating almost identically (a [... read more]

Oct 162013
 
Spiriva Respimat inhaler as safe as HandiHaler (TIOSPIR)

Tiotropium: Safe In Either Form Tiotropium (Spiriva) comes in two devices: the Respimat in Europe delivers a mist, while the Handihaler in the U.S. delivers a dry powder. The Respimat has been bronchodilating under a dark cloud in Europe for the past 2 years, since a BMJ meta-analysis suggested there was a 52% increased risk of [... read more]

Oct 062013
 
Pulmonary rehabilitation: no benefit at one year, even with extended Rx? (Review)

Pulmonary Rehabilitation: No Benefit After 12 Months Light, Infrequent Workouts Don’t Sustain Fitness Gains Pulmonary rehabilitation (“pulmonary rehab”) is a dressed-up name for what are essentially supervised exercise programs for people living with chronic lung disease. Although pulmonary rehab programs often include multidimensional support (nutrition, education, breathing exercises and psychological counseling), it’s the exercise that produces [... read more]

Sep 132013
 
Mild weight gain after quitting smoking outweighed by cessation's benefits

Weight Gain After Quitting Smoking Usually Mild, Harmless Nicotine is an anorexigen, or appetite suppressant. This “benefit” of cigarette smoking is no secret, certainly not to teenage girls, who in surveys report smoking to stay thin. Even among women smokers over age 40, more than half said they would not quit smoking if it meant they would [... read more]

Aug 032013
 
Oral N-acetylcysteine (NAC) reduces COPD exacerbations in RCT

image: Vitacost N-acetylcysteine (NAC) Improves COPD Outcomes Oxidative stress (imbalance between oxidants and antioxidants) is part of the story of how COPD causes symptoms of cough and shortness of breath. Cigarette smoke is the main source of oxidation damage in the lungs leading to COPD, but even after they quit smoking, people with COPD still [... read more]

Jul 182013
 
Biomarkers help predict COPD exacerbations

Biomarkers Predict COPD Exacerbations (Sort Of) In addition to daily breathlessness, people with chronic obstructive pulmonary disease (COPD) often experience exacerbations of shortness of breath and coughing. Those with more severe COPD tend to have more frequent and severe exacerbations, lower enjoyment of life, and more rapid loss of lung function. The strongest predictor of [... read more]

Jul 052013
 
In COPD exacerbations, 5 days steroids seem as good as 14 (REDUCE trial)

For COPD Exacerbations, 5 Days Corticosteroids As Good as 2+ Weeks COPD exacerbations — worsening of shortness of breath and cough, often requiring medical treatment — are a major problem for many people living with COPD. People with moderate or severe emphysema and chronic bronchitis (together called chronic obstructive pulmonary disease) experience an average of [... read more]

Jun 022013
 
How to prevent COPD exacerbations

How to Prevent Acute COPD Exacerbations Acute exacerbations of chronic obstructive pulmonary disease (COPD) are a major problem for many people living with COPD. Acute exacerbations or attacks occur more often in people with more severe COPD (about 1-2 per year), and these disease flares may either signal or cause a more rapid progression of [... read more]

May 162013
 
FDA approves Breo Ellipta, a new once-daily COPD inhaler treatment

FDA Approves Breo Ellipta, Once-Daily LABA/ICS for COPD The FDA approved the new drug Breo Ellipta as a once-daily inhaled therapy for chronic obstructive pulmonary disease (COPD). Breo Ellipta includes the corticosteroid fluticasone, and vilanterol — a once-daily long acting beta agonist — in a combination dry powder inhaler. This was the FDA’s first approval [... read more]

Apr 252013
 
Pulse oximetry as time machine: Lag times confuse doctors, complicate intubations (EMCrit)

image: wikimedia Pulse Oximetry: The 30-Second Time Machine Why does it seem to take so long to re-oxygenate your crashing patient? Because your pulse oximeter is lying to you, no matter how good it is. Telescopes show us how a star looked millions or billions of years ago; pulse oximeters create a similar, though tiny [... read more]

Mar 212013
 
Big Tobacco win: Feds to take breather in fight for scary cigarette labeling

Feds to Big Tobacco on Cigarette Labeling Fight: “Uncle!” The feds are admitting defeat for now in their fight for graphic, negative imagery to be displayed on all cigarette packaging and advertisements. Attorney General Eric Holder announced yesterday that the Justice Department will not ask the Supreme Court to reverse their loss in a federal [... read more]

Mar 172013
 
FDA warns of sudden cardiac death with use of azithromycin

FDA Warns of Sudden Cardiac Death Risk from Azithromycin Last summer, PulmCCM reported on a New England Journal paper suggesting an increased risk of sudden cardiac death in patients taking even a short 5-day course of azithromycin. Yesterday, the FDA expressed its official concern in a Drug Safety Communication and statement to the press on [... read more]

Jan 242013
 
Continuing beta blockers safe during acute COPD exacerbations

Continuing Selective Beta Blockers Safe During COPD Exacerbations by Blair Westerly, MD Many COPD patients also have congestive heart failure or ischemic heart disease, two conditions where beta blocker therapy improves survival, but it has consistently been underutilized. The fear physicians have of instituting beta blockers in COPD is mostly secondary to the theoretical concern [... read more]

Jan 232013
 
Does your COPD patient need in-flight oxygen? New algorithm may help

Who Needs In-Flight Oxygen? New Method May Help by Brett Ley, MD COPD patients without a long-term indication for supplemental oxygen may still be at risk for severe hypoxemia during air travel since cabin pressures are generally maintained to simulate altitudes of about 8000 feet. In-flight supplemental oxygen is recommended when the partial pressure of [... read more]