COPD

Nov 172018
 
Home non-invasive ventilation reduced health costs in severe COPD

by Ed Susman, Contributing Writer, MedPage Today SAN DIEGO — Noninvasive ventilation aimed for use at home by late-stage patients with chronic obstructive pulmonary disease (COPD) actually saves patients and the healthcare system money by helping to keep individuals out of the hospital and doctors’ offices, researchers said here. Nightly home noninvasive ventilation (commonly called BiPAP) was [… read more]

Nov 042018
 
Don't use procalcitonin to withhold antibiotics in severe COPD exacerbations

Procalcitonin (PCT) is an FDA-approved test for use in guiding clinical decisions on starting, continuing, or stopping antibiotics in patients with lower respiratory tract infections, such as community-acquired pneumonia. Procalcitonin is also approved for use in determining whether to stop antibiotics. Most of the small studies testing procalcitonin-driven algorithms have shown the method to be generally safe [… read more]

Oct 172018
 
Seven days (or fewer) of corticosteroids advised for severe COPD exacerbations: GOLD

How many days of steroids should be taken by people with COPD exacerbations severe enough to require hospitalization? In 2013, the REDUCE trial (JAMA) suggested five days of systemic corticosteroids are as good as longer 10-14 day courses, among 314 patients hospitalized with severe COPD exacerbations. This contradicted the prevailing GOLD guidelines at the time, [… read more]

Sep 262018
 
Endobronchial valves now FDA approved for severe COPD

In the lungs of patients with severe emphysema (COPD), relatively large spaces previously containing lung tissue (obliterated by smoking) become filled with stagnant air that doesn’t circulate with breathing. This ominously-named “dead-space ventilation” reduces the overall mechanical efficiency of breathing, often causing disabling dyspnea. Lung volume reduction surgery (cutting out the dead space, usually at [… read more]

Sep 172018
 

by Salynn Boyles, MedPage Today Contributing Writer Treatment with the first approved once-daily, single inhaler triple therapy for COPD resulted in a significantly lower rate of exacerbations, as well as better lung function and quality of life compared to dual therapy in patients with a history of exacerbations, researchers reported. Results from the huge IMPACT trial supported an [… read more]

Sep 082018
 
High Flow Oxygen in Chronic Obstructive Pulmonary Disease: improved work of breathing or respiratory effort?

Jon-Emile S. Kenny MD [@heart_lung] “WANTED: Somebody to go back in time with me.  This is not a joke …” -John Silveira Case A 78 year old man with known moderate-to-severe emphysema is extubated in the ICU; he was initially admitted with hypercapneic respiratory failure secondary to influenza pneumonia and pulmonary edema from the medical [… read more]

Aug 192018
 
Aspirin Appears Protective in COPD Patients

by Ed Susman, Contributing Writer, MedPage Today SAN DIEGO – Patients diagnosed with chronic obstructive pulmonary disease (COPD) who are also on aspirin therapy appear to have a lower rate of COPD exacerbations, researchers reported at the annual conference of the American Thoracic Society. The risk of experiencing any acute exacerbation of COPD was reduced by 18% among [… read more]

Jun 052018
 
Varenicline May Increase Cardiovascular Risk

by Salynn Boyles, Contributing Writer, MedPage Today Cardiovascular event risk may increase in smokers who start using the cessation-assist drug varenicline (Chantix), according to findings from an observational study. The retrospective analysis of medical records for close to 57,000 new users of varenicline living in Ontario, Canada, showed a statistically significant 34% increased risk for [… read more]

Mar 182018
 
Regular Aspirin Use May Slow COPD Progression

By Salynn Boyles, Contributing Writer, MedPage Today Regular aspirin use was associated with a more than 50% reduction in emphysema/chronic obstructive pulmonary disease (COPD) progression in an elderly cohort over a decade in a longitudinal analysis of data from a large lung study. The association was seen across aspirin doses, and was greatest in older study participants [… read more]

Feb 182018
 
Cardiovascular events were higher after starting a long-acting inhaler for COPD

People with chronic obstructive pulmonary disease (COPD) had an increased rate of heart attacks and strokes in the first month after starting long-acting inhaled bronchodilators. That’s the conclusion of an observational study from Taiwan, published in JAMA Internal Medicine. Researchers analyzed data on 284,220 Taiwanese adults with COPD who had never used bronchodilators, and were started on [… read more]

Feb 062018
 
Meta-analysis: statins for COPD associated with better walk distance and quality of life

By Salynn Boyles, Contributing Writer, MedPage Today Treatment with statins may be beneficial in terms of improving exercise tolerance, pulmonary function and quality-of-life among chronic obstructive pulmonary disease (COPD) patients with co-existing cardiovascular disease, increased systemic inflammation or hyperlipidemia. That is the finding from meta-analysis of 10 randomized, controlled trials involving close to 1,500 patients, [… read more]

Jan 262018
 
FDA Approves First Nebulized LAMA for COPD

by Salynn Boyles, MedPage Today The FDA approved a nebulized formulation of glycopyrrolate (Lonhala Magnair) for long-term maintenance treatment of patients with moderate-to-severe COPD, said manufacturer Sunovion Pharmaceuticals. It’s the first long-acting muscarinic antagonist (LAMA) to be sold in this form. Recommended dosing is 25 mcg twice daily. The approval was made on the strength of data [… read more]

Dec 082017
 
FDA Approves First Nebulized LAMA for COPD

by Salynn Boyles, Contributing Writer, MedPage Today The FDA approved a nebulized formulation of glycopyrrolate (Lonhala Magnair) for long-term maintenance treatment of patients with moderate-to-severe COPD, said manufacturer Sunovion Pharmaceuticals. It’s the first long-acting muscarinic antagonist (LAMA) to be sold in this form. Recommended dosing is 25 mcg twice daily. The approval was made on the strength [… read more]

Nov 032017
 
Mepolizumab reduced exacerbations in COPD with eosinophilia, but missed target

The injectible monoclonal antibody mepolizumab (Nucala, GSK) is FDA-approved for severe asthma with blood eosinophilia, uncontrolled with standard controller inhaler treatments. Two randomized placebo-controlled trials keep alive for GSK the possibility of an FDA indication to reduce exacerbations in people with chronic obstructive pulmonary disease (COPD) with high blood eosinophil counts, expanding the drug’s market. The ~1,500 [… read more]

Oct 282017
 
Home BiPAP reduced readmissions after COPD exacerbations

Acute exacerbations of chronic obstructive pulmonary disease (COPD) are one of the top causes of hospital admission — and readmission: up to 30% of patients “bounce back” to the hospital within 90 days after a COPD exacerbation. Patients with severe COPD exacerbations with acute hypercapneic respiratory failure often receive noninvasive ventilation (NIV), commonly known as [… read more]

Sep 192017
 
FDA approves first three-in-one inhaler for COPD

GlaxoSmithKline and Innoviva reported the U.S. Food and Drug Administration (FDA) has approved Trelegy Ellipta, the first once-daily, three-drugs-in-one inhaler for treatment of chronic obstructive pulmonary disease (COPD). Trelegy Ellipta contains the antimuscarinic umeclidinium, the corticosteroid fluticasone furoate, and the long acting beta agonist vilanterol. The drugs provide bronchodilation and anti-inflammatory effects through three different [… read more]

Sep 142017
 
ICU Physiology in 1000 Words: High Flow Oxygen Therapy

Jon-Emile S. Kenny MD [@heart_lung] That high flow oxygen applied via nasal cannula lends itself to treating hypoxemic respiratory failure may be obvious.  With adequate heat and humidification, oxygen can be employed relatively comfortably at very high flow rates – upwards of 60 L/min – to the nares.  At such rates, the effort of the [… read more]

Sep 082017
 
Tiotropium helped in early COPD in randomized trial

Tiotropium (trade names Spiriva, Stiolto) was originally FDA-approved after patients with severe chronic obstructive pulmonary disease (COPD) had improved lung function and fewer COPD exacerbations taking Spiriva compared to placebo.  In a recent randomized trial of 841 patients in China, tiotropium showed benefits in milder, early COPD as well. Patients with COPD GOLD stage 1 or [… read more]

Apr 222017
 
ICU Physiology in 1000 Words: Weaning-Induced Cardiac Dysfunction & the Passive Leg Raise

Jon-Emile S. Kenny MD [@heart_lung] Reminder: Help me with my master’s thesis!  Please complete a learning module, and fill out this exceptionally brief survey! Perhaps the landmark trial elaborating an evolving cardiac dysfunction during the spontaneous breathing trial [SBT] is that of Lemaire and colleagues – published in 1988 [1].  One particularly memorable patient of [… read more]

Apr 112017
 
600,000 albuterol (Ventolin) inhalers recalled

GlaxoSmithKline is voluntarily recalling more than 590,000 albuterol inhalers (brand name Ventolin), citing a defect that may cause the inhalers to deliver fewer doses of the medicine than prescribed, the British drugmaker announced. Patients complained about a bulging of the outside wrapper of Ventolin’s packaging; a leak of the medicine’s propellant is suspected to be [… read more]