Inhaled corticosteroids and mortality in chronic obstructive pulmonary disease

ARTICLE IN PRESS 106 Background: Clinical studies suggest that inhaled corticosteroids reduce exacerbations and improve health status in chronic obstructive pulmonary disease (COPD). However, their effect on mortality is unknown. Methods: A pooled analysis, based on intention to treat, of individual patient data from seven randomised trials (involving 5085 patients) was performed in which the effects of inhaled corticosteroids and placebo were compared over at least 12 months in patients with stable COPD. The end point was allcause mortality. Results: Overall, 4% of the participants died during a mean follow-up period of 26 months. Inhaled corticosteroids reduced all-cause mortality by about 25% relative to placebo. Stratification by individual trials and adjustments for age, sex, baseline post-bronchodilator percentage predicted forced expiratory volume in 1 s, smoking status, and body mass index did not materially change the results (adjusted hazard ratio (HR) 0.73; 95% confidence interval (CI) 0.55–0.96). Although there was considerable overlap between subgroups in terms of effect sizes, the beneficial effect was especially noticeable in women (adjusted HR 0.46; 95% CI 0.24–0.91) and former smokers (adjusted HR 0.60; 95% CI 0.39–0.93). Conclusions: Inhaled corticosteroids reduce all-cause mortality in COPD. Further studies are required to determine whether the survival benefits persist beyond 2–3 years. Reproduced with permission from the BMJ Publishing Group. doi: 10.1016/j.rmedu.2006.01.024

Mid-arm muscle area is a better predictor of mortality than body mass index in COPD Chest 2005;128:2108–15 J.J. Soler-Cataluna, L. Sanchez-Sanchez, M.A. Martinez-Garcia, P.R. Sanchez, E. Salcedo, M. Navarro Unidad de Neumologyia, Servicio de Medicina Interna, Hospital General de Requena, Paraje Casablanca s/n, 46340 Requena, Valencia, Spain E-mail address: [email protected] (J.J. Soler-Cataluna).

Background: A low body mass index (BMI) has been shown to be an independent indicator of poor

Literature Review prognosis in patients with COPD. However, some studies suggest that muscle mass depletion (MD) is the main factor responsible for the negative effects attributable to malnutrition. Study objective: To evaluate the prognostic influence of MD estimated from anthropometric parameters. Design and measurements: Mortality was studied in a prospective cohort of 96 male patients with COPD (average age, 6979 years; FEV1 percentage of predicted, 44718% [7SD]) followed up for 3 years, with an evaluation of the prognostic influence of the following anthropometric parameters: BMI, mid-arm muscle area (MAMA), and fat-free mass index. Other risk factors were also analyzed, such as age, comorbidity (Charlson index), basal dyspnea index, the St. George’s Respiratory Questionnaire score, the number of hospital admissions in the year prior to nutritional evaluation, the number of hospital admissions in the year immediately after nutritional evaluation (Hpost), spirometry, and blood gases. Results: In the multivariate study, Pa(CO2) (P ¼ 0:003; hazard ratio, 1.08), Hpost (P ¼ 0:005; hazard ratio, 4.63), and a MAMA value less than or equal to percentile 25 of the reference value (p25) [P ¼ 0:025; hazard ratio, 3.78] were found to be independent indicators of poor prognosis. Respiratory mortality after 12, 24, and 36 months in the patients with MAMApp25 was 12.1%, 31.4%, and 39.2%, respectively, vs. 5.9%, 7.9%, and 13% in the group of patients without MD (P ¼ 0:006). In normal-weight or overweight patients, MAMApp25 increased the risk of mortality 3.4-fold (P ¼ 0:032). Conclusions: MD is a better predictor of mortality than BMI in patients with COPD, fundamentally in normal-weight or overweight patients. The prognostic influence of MD can be estimated indirectly by determining the MAMA, an inexpensive, simple, and rapidly obtained anthropometric measure. & 2005 American College of Chest Physicians doi: 10.1016/j.rmedu.2006.01.025