COPD

Dec 182011
 

Who’s the best bronchodilator on the block? In 725 centers, in 25 countries, among COPD’ers with FEV1<=70% (moderate-or-worse) and an exacerbation in the past year, after using tiotropium or salmeterol (double-dummy) for 1 year, the winner is…. Tiotropium … probably! With a time-to-first-exacerbation of 187 vs. 145 days — but only in the quartile of [… read more]

Nov 262011
 

Many people with chronic respiratory failure literally waste away — as evidenced by the contribution of “B” (for body mass index) in the BODE index’s prediction of survival in severe COPD. Although long-term oxygen therapy improves survival and quality of life, and pulmonary rehabilitation improves exercise capacity and QOL, efforts to halt or reverse the [… read more]

Nov 012011
 

In a non-inferiority study, Buhl et al randomized 1,600 adults with moderate or severe COPD to use the new extra-long-acting beta agonist indacaterol 150 mcg or tiotropium 18 mcg inhaled once daily for 12 weeks. At the end of the study period, pre-dose FEV1 improvements were similar in both groups (~125 mL). Indacaterol induced higher post-dose FEV1 improvements [… read more]

Nov 012011
 

Karner et al further confirmed the lack of general lack of evidence for “triple therapy” (inhaled corticosteroid, tiotropium, and long-acting beta agonist) for COPD. In a Cochrane analysis, they could only identify one randomized trial (n=293) testing LABA+tiotropium vs. triple-therapy (LABA+tiotropium+ICS). The trial suffered from high and uneven dropout rates between treatment arms, precluding any [… read more]

Oct 302011
 

How many licks does it take to get to the middle of a Tootsie Roll Pop? How many angels can dance on the head of a pin? And that other timeless mystery: How many airways do patients with COPD have, how narrowed are they, and what is the relationship between said narrowing, coexisting emphysematous destruction, [… read more]

Oct 292011
 

While we were screening our heavy smokers for lung cancer with chest CTs, the Dutch and Belgians have been screening their own (in the NELSON trial, which will report results in 2015). They double-dipped their imaging data here to ask the question, how good is chest CT at identifying undiagnosed chronic obstructive pulmonary disease? 1,140 [… read more]

Oct 102011
 

Ischemic heart disease makes COPD symptoms worse both at rest and during exacerbations, without increasing the frequency of COPD exacerbations, according to an epidemiologic study by Patel et al. They prospectively observed 386 Londoners with COPD for one year, 64 of whom had ischemic heart disease (with or without history of myocardial infarction, defined by [… read more]

Oct 092011
 

Smoking cessation counseling may feel like a waste of the time and effort required, since most smokers don’t quit. But evidence shows that even the <10% success rate of smoking cessation counseling saves millions of lives, compared to doing nothing. According to a recent smoking cessation review in the NEJM: Even those not ready to quit do 8% of the time [… read more]

Oct 072011
 

Non-invasive positive pressure ventilation (NIPPV or NPPV or NIV), overnight or during the day, has not been shown to help most people with stable COPD and daytime hypercarbia. Citing their own previous findings, Dreher, Windisch et al argue that’s because you can’t just use wimpy ordinary settings — you’ve got to crank that sucker to [… read more]

Sep 262011
 

Gershon et al used Canadian health administrative databases to identify all new diagnoses of COPD in Ontario from 1996-2010, a cohort of 13 million people. Lifetime risk of COPD (by age 80) was 27.6%. Smoking status was not available/included in the analysis. These were physicians’ diagnoses of COPD (using a validated case definition); there was [… read more]

Sep 222011
 

If air trapping causes symptoms and limitation in people with emphysema, why not un-trap the air? Say, by poking holes in bronchi leading to areas of severe emphysema, and putting paclitaxel-eluting stents in place to maintain patency? The air should naturally become freed, flow out, and improve respiratory mechanics. Only, it didn’t. Shah et al [… read more]

Sep 132011
 
Millions of adults quit smoking since 2005 (MMWR)

From 2005 to 2010, the percent of U.S. adults identifying themselves as smokers fell from 20.9% to 19.3% — about 3 million fewer smokers than would be expected. The results come from the CDC’s national telephone health surveys. More remarkably, adults reported smoking far fewer cigarettes: The proportion of adults reporting smoking more than a [… read more]

Sep 122011
 

Skeletal muscle dysfunction is common in people with COPD, although debate exists as to whether that’s simply due to deconditioning, or something more. In people with severe COPD (GOLD stage III and IV), it’s known that pulmonary rehabilitation improves some of these muscle abnormalities. Vogiatzis et al report the results of putting 46 people with [… read more]

Sep 112011
 

ATS / ERS guidelines recommend using % predicted FEV1 as the metric to define severity of obstructive, restrictive, and mixed ventilatory disorders. The main driver: FEV1 is the most robust variable as an overall measure of health (epidemiologically speaking). Critics charge that this overestimates severity of obstruction when restriction is also present, causing confusion, misdiagnosis, [… read more]

Sep 062011
 

Enriquez et al analyzed data from the NHLBI Dynamic Registry, comparing 860 people with COPD to 10,048 without who underwent percutaneous coronary intervention between 1999-2006. Their main findings: COPD patients were sicker and had worse outcomes. Demographically, they had a higher rate of diabetes, slightly more lesions (3.2 vs. 3.0), and slightly lower ejection fractions. Only [… read more]

Sep 032011
 

Everything new in COPD from the 10th Lund COPD Symposium, including biomarkers, risk factors, research into systemic effects and exacerbation prevention, and the latest cutting edge treatment: “Activity Promotion” (the article declares this a “paradigm shift” …. but wasn’t trying to get people to move more also part of the old paradigm?) Proc Am Thorac [… read more]

Aug 092011
 

Hersh et al analyzed spirometry and patient-reported data on family history from the COPDGene study, comparing 821 people with COPD to 776 smoking controls. Subject-recalled parental history of COPD had an odds ratio of 1.7 for COPD in the subject. The population attributable risk from family history for COPD was 18.6%. They acknowledge the vulnerability [… read more]