COPD

Jul 262012
 
Alpha-1 Antitrypsin Deficiency in COPD and Asthma: Review

Alpha-1 Antitrypsin Deficiency: Review & Update More PulmCCM Topic Updates Alpha-1 antitrypsin deficiency is underrecognized and by implication undertreated. But many people with alpha-1 antitrypsin deficiency are asymptomatic and will never develop significant emphysema, and the benefits of antiprotease replacement therapy are still unknown. Should you routinely test your patients with chronic obstructive pulmonary disease [… read more]

Jul 142012
 
Talking to COPD patients about end-of-life makes them like you more?

We may see it more often, but we doctors don’t really know anything more about death than anyone else, and we find it just as scary. Yet we are expected to spontaneously discuss death-as-a-coming-event with seriously ill patients who (we assume) probably want to avoid the subject, well, like the plague. Maybe they do. But [… read more]

Jun 232012
 
Acupuncture improved COPD in a "real" randomized trial

Acupuncture has danced on the fringes of mainstream Western medical therapy for decades. Acupuncture has been shown to improve numerous conditions –for example, reducing dyspnea in patients with cancer, asthma and chronic obstructive pulmonary disease (COPD) in a few randomized trials. But — unsurprisingly, given complementary medicine’s lack of funding and acceptance among traditional academics — [… read more]

Jun 092012
 
COPD self-care program fail; unexplained deaths at VA hospitals (RCT)

Chronic diseases like chronic obstructive pulmonary disease (COPD) account for at least 2/3 of medical care spending in the U.S. Policy makers, payers, and many physicians recognize that the outpatient clinic-based model is poorly suited to provide support in between physician visits, when most complications or exacerbations occur. Many hospitalizations and decline in function could [… read more]

Jun 012012
 
Bronchodilator reversibility testing in COPD: Bill for it, but don't believe it

(image: flickrCC) Why do we test chronic obstructive pulmonary disease (COPD) patients for bronchodilator responsiveness (besides getting to charging a few extra bucks for it)? If I am reading this article right, the answer is, there’s no good reason. Consider this: Bronchodilator responsiveness (BDR) or the lack thereof does not distinguish COPD from asthma. Bronchodilator [… read more]

May 132012
 
Chantix: no excess cardiovascular risk in new meta-analysis

(image: People’s Pharmacy) Sure to re-light controversy around Pfizer’s varenicline (Chantix): a new study concludes the smoking cessation drug likely carries no increased risk for cardiovascular events.  Judith Prochaska and Joan Hilton (University of California – San Francisco) report the results in the May 4 BMJ. Sonal Singh (Johns Hopkins) et al’s previous meta-analysis, reported in CMAJ [… read more]

Apr 132012
 
Vitamin D supplements don't prevent COPD exacerbations in RCT

Vitamin D deficiency has been linked to many chronic medical conditions, including asthma and chronic obstructive pulmonary disease (COPD). In some cases, more severe vitamin D deficiency is associated with more severe chronic illness. However, it’s never been shown that vitamin D deficiency supplemenation improves or prevents illness; i.e., that vitamin D deficiency causes or exacerbates [… read more]

Feb 232012
 

GlaxoSmithKline has a new once-daily inhaled corticosteroid called fluticasone furoate; it has enhanced affinity for glucocorticoid receptors and a longer duration of action compared to the commonly-used fluticasone propionate, which must be taken twice daily to achieve a steady bioavailable concentration. In the January Thorax, William Busse et al report the findings of a Phase [… read more]

Feb 142012
 

Chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are common and together contribute enormously to the global burden of chronic disease. Although surely these conditions overlap and interact, surprisingly little study has been given to their interrelationship. Macchia et al prospectively evaluated and followed two cohorts of patients aged > 59, recruited from [… read more]

Feb 082012
 

One-third of smokers try to quit each year, but few stay quit. Even with varenicline (Chantix), the most effective smoking cessation aid to date, only 10% are abstinent at one year. Anne Joseph, Steven Fu, Dorothy Hatsukami et al wonder if that’s partly because our (fee-for-service-driven) intermittent-visit model of patient care and counseling leaves craving [… read more]

Jan 142012
 

When given to people with acute exacerbations of chronic obstructive pulmonary disease, corticosteroids aren’t proven to reduce mortality, but they improve FEV1, reduce hospitalization by ~1 day, and increase 30-day treatment success, according to a 2009 Cochrane review of 10 randomized trials. Patients in ICUs were excluded from the analyzed studies, and it’s unclear whether steroids are [… read more]

Jan 062012
 
Big bucks riding on FDA's little dosing decision for indacaterol (NEJM)

In July 2011, FDA approved indacaterol, Novartis’s new once-daily long-acting beta agonist, for the treatment of chronic obstructive pulmonary disease. In contrast to its European counterpart (EMA), which approved indacaterol there at doses up to 300 mcg, FDA only approved indacaterol in the 75 mcg daily dose. The FDA’s Badrul Chowdhury explains why in the [… read more]

Jan 022012
 
FDA approves Aclidinium (Tudorza Pressair), a b.i.d. "me-too" to Spiriva for COPD

July 29, 2012 Last week, the FDA approved aclidinium bromide (Tudorza Pressair) as a daily inhaler treatment for chronic obstructive pulmonary disease (COPD), the agency announced in a press release. Aclidinium is a long-acting muscarinic antagonist (or “anticholinergic”) bronchodilator that will compete with tiotropium (Spiriva), which was launched in 2004 and until now was the [… read more]

Jan 012012
 

Macrolide antibiotics are increasingly recognized for their salutary anti-inflammatory effects in lung disease, potentially distinct from any antimicrobial effect. Albert et al report that among 1,142 people with severe COPD (FEV1 ~40% predicted) who were randomized to take either azithromycin 250 mg or placebo daily for one year, those taking azithromycin had fewer exacerbations, as [… read more]

Jan 012012
 

Air Travel for Patients with Lung Disease (BTS Recommendations) Some interesting facts, figures, and recommendations on air travel for those with chronic lung disease, thanks to Ahmedzai et al who produced this 32 page document for the British Thoracic Society: At 8,000 feet in a commercial aircraft, you’re breathing 15% O2, and normal people’s SpO2 [… read more]

Jan 012012
 

The smoking cessation drug varenicline (Chantix) got a black-box warning in 2009 after the FDA received >500 reports of suicidal thoughts and behaviors, and 32 completed suicides in the U.S. (This was out of several million prescriptions filled, though.) After that postmarketing surprise, the FDA sponsored 2 observational studies in Chantix users: one at the [… read more]

Dec 272011
 

COPD is a progressive disease causing inexorable decline in lung function, right? We were all taught it, but maybe no one checked first. Vestbo et al’s ECLIPSE, a simple but large and elegant observational study that continues to furnish new insights into COPD, shows the truth is far more nuanced and complicated. After following 2,163 patients with COPD of [… read more]

Dec 262011
 

Chong J et al review the 23 placebo-randomized trials of just-FDA-approved roflumilast and its sister cilomilast, the oral phosphodiesterase-4 inhibitors. The overall mean improvements in quality of life (1 point on the SGRQ scale) and lung function (46 mL of FEV1) were tiny. The drugs did significantly reduce exacerbations with an odds ratio of 0.78 — as [… read more]