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]
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]
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]
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]
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]
Low physical activity is associated with mortality in COPD, but until now, only on the basis of self-reported activity levels. Waschki et al prospectively followed 170 people (~75% men, ~65 years old) with stable COPD for 48 months. Besides spirometry (mean FEV1 56% predicted), the investigators also collected other data expected to be predictive, including [… read more]
Among ~26,000 patients discharged from 129 VA hospitals for COPD exacerbation, those living in isolated rural areas had a 5.0% 30-day mortality, compared to 3.8% for those living in urban areas. Those in not-so-isolated rural areas didn’t seem to be at elevated risk, report Abrams et al. Ann Intern Med 2011;155:80-86.
Murphy et al report a pilot study in which they used parasternal electromyography (noninvasive electrode over the 2nd intercostal space) to measure respiratory work in 30 subjects admitted for acute exacerbations of COPD. The so-called neural respiratory drive index predicted clinical recovery and identified patients destined to be readmitted within 14 days. Thorax 2011;66:602-608.
Singanayagam et al prospectively observed 490 COPD patients admitted for community acquired pneumonia with COPD; 77% were using inhaled corticosteroids. As would be expected, ICS users had worse COPD (higher GOLD stage) than non-ICS-users. There were no differences between cohorts in pneumonia severity, mortality at 30 or 180 days, or requirement for mechanical ventilation or [… read more]
Chapman et al extended their 6-month Phase III trial for once-daily long-acting beta agonist indacaterol for another 6 months. FEV1 improvements of 170 mL, reduced albuterol use of 1 puff / day, and slight absolute decreases in exacerbation rates were all preserved, without evidence of tolerance or increased adverse events. The drug made about 24% [… read more]
Pulmonary rehabilitation, realities in clinical practice. Birnbaum S, CHEST 2011;139:1498-1502. Having trouble finding a pulmonary rehab program to refer your COPD patient into? That may be because in 2011, according to Mr. Birnbaum, Medicare paid outpatient centers $28 per rehabilitation session, per patient.
In association with United Biosource Corp., Jones et al are championing a patient questionnaire called EXACT-PRO that seeks to standardize the definition of a COPD exacerbation. Here, they report on the production of their proposed 14-item measure to diagnose and grade the severity of COPD exacerbations. Breathlessness, cough-and-sputum, and chest symptoms form the core of [… read more]
Singh et al analyzed 5 randomized trials comparing tiotropium mist to placebo, and found a 46% relative increased risk of all-cause mortality among the treated arms. The Respimat inhaler is available in Europe, but the FDA has not approved it in the US. BMJ 2011;342:d3215.
Jones et al randomized 1,647 people with moderate to severe COPD for the two trials, to receive either aclidinium inhaled (a potential tiotropium competitor) once daily or placebo for 1 year. Aclidinium improved FEV1 by ~65 mL. An absolute ~8% more people taking the drug achieved a 4-point SGRQ improvement over those taking placebo. Time [… read more]
Retrospectively looking at a database of 5,977 COPD patients’ hospital admissions (TARDIS), pharmacy data, and death records in Scotland, Short et al found an overall 22% lower mortality in those taking beta blockers (88% were cardioselective BBs). The benefit was seen equally in those also taking long-acting beta agonists or antimuscarinics. For those 2,712 patients with serial [… read more]
Using Canadian population-linked databases including 565,073 people with COPD aged 66 or older, Stephenson et al identified cases of acute urinary retention in 9,432 men and 1,806 women. The episodes were serious enough to result in an ED visit, hospitalization, or same-day surgery. Cross-matching against a drug claims benefit database, the odds ratio for AUR in those [… read more]
PARC/CCL-18 is a protein with unknown function, secreted predominantly by lung macrophages. Sin et al analyzed the relationship of PARC/CCL-18 to COPD using two large preexisting cohorts, the Lung Health Study and ECLIPSE, which they used as derivation and replication cohorts, respectively. PARC/CCL-18’s associations with outcomes were inconsistent across the cohorts. In ECLIPSE, the protein was elevated [… read more]
In a community-based sample of 3,802 Spaniards aged 40-80, 4.6% had FEV1/FVC <0.7 but above the lower limit of normal. Mostly older men, they had the same respiratory exacerbation frequency, activity levels, cardiovascular risk, and 6-minute walk distances as matched controls with a ratio >0.7. They did report lower health-related quality of life in all [… read more]
Lung cancer in COPD: enhancing surgical options and outcomes, Raviv S et al, AJRCCM 2011;183:1138-1146.
Never-smokers make up >25% of the people with COPD in some studies. Who are these people? The BOLD study gathered data from 14 countries (in the U.S., Europe, Turkey, China, South Africa, Philippines and Australia), including spirometry and questionnaires on environmental exposures and symptoms from 10,000 people. Of the 4,291 never-smokers, 4% had ATS-defined COPD (5.6% by [… read more]