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COPD news
ARTICLE IN PRESS R E S P I R AT O RY M E D I C I N E : C O P D U P D AT E
4 (2008) 88– 89
COPD NEWS
Combined therapy may be more beneficial for COPD patients Researchers in the UK have found that patients may benefit from a combined long-acting bronchodilator/anti-inflammatory treatment rather than the standard treatment of a longacting bronchodilator alone. Jadwiga Wedzicha and colleagues, whose results are published in the American Journal of Respiratory and Critical Care Medicine, carried out a two-year randomised, double blind, double parallel study of 1323 patients with a mean age of 64 years. They found no difference in exacerbation rates between patients treated with the salmetorol/fluticasone propionate combination and those treated with tiotropium. However, those receiving the combined therapy had improved health, fewer deaths, and were less likely to withdraw from treatment. Source: http://ajrccm.atsjournals.org/cgi/content/abstract/177/1/19
New prognostic index predicts COPD hospitalisation, exacerbation, and mortality A new prognostic tool for COPD has been developed that not only predicts mortality but also hospitalisations and exacerbations. The severity of COPD can be determined by forced expiratory volume in one second (FEV1), or the recent BODE index, both of which predict mortality as the sole outcome. Andrew Briggs of the University of Glasgow and colleagues obtained data from a pooled analysis of 12 randomised controlled trials, and developed three specific indexes, using factors such as quality of life, history of exacerbations, gender, age, FEV1 and body mass index. They then created a composite index which they found to be 71% accurate for both mortality and hospitalisation. Each 10-point change in the composite index corresponded to a 54% increase in the hazard ratio of death, a 57% increase in the hazard ratio of hospitalisation, and a 21% increase in the incidence of exacerbations. In their article, published in the Archives of Internal Medicine, the authors point out that the factors included in the index 1745-0454/$ - see front matter doi:10.1016/j.rmedu.2008.02.009
are not difficult to obtain, making it suitable for use in both primary and secondary care settings. Sources: http://archinte.ama-assn.org/cgi/content/abstract/168/1/71 www.newtocopd.com/currentaffairsnews/list751_ item23141.aspx
Beta blockers may reduce mortality from cardiovascular disease in COPD patients US researchers have found that the use of beta-blockers among COPD patients with acute exacerbations may be associated with reduced mortality from cardiovascular disease. Mark Dransfield and colleagues at the University of Alabama analysed data on hospital patients admitted with acute COPD exacerbations between 1999 and 2006. 142 of the 825 patients were receiving beta-blockers, and they were older and more frequently had cardiovascular disease than those not receiving the treatment. The study, published in Thorax, concluded that the use of beta-blockers among COPD inpatients is well tolerated and may be associated with reduced mortality. Source: Dransfield MT, Rowe SM, Johnson JE, Bailey WC, Gerald LB. Beta-blocker use and the risk of death in hospitalised patients with acute exacerbations of COPD. Thorax. Published online first: 19 October 2007. doi:10.1136/thx. 2007.081893.
COPD associated with marginal bone loss in periodontitis A study from Norway has shown that chronic marginal periodontitis is common in patients with severe COPD. Inga Leuckfeld and colleagues carried out a retrospective cross-sectional study of patients evaluated for lung transplantation — 130 of the patients had COPD and 50 did not. As described in their Respiratory Medicine paper, they believed measuring periodontitis using radiographs rather than clinical examination was more suitable for
ARTICLE IN PRESS R E S P I R AT O RY M E D I C I N E : C O P D U P D AT E
this study, and took orthopantomograms of the jaws of all patients. They found that chronic marginal periodontitis is common in patients with severe COPD (44%), higher than reported in previous studies, and six times higher than in the patients without COPD (7.3%). The high prevalence appears to be independent of possible risk factors for periodontitis such as age, cigarette pack years smoked, body mass index, use of corticosteroids and bone mineral density. The authors conclude that more research is needed to elucidate the relationship between COPD and periodontitis. Sources: Respir Med 2007, in press. doi:10.1016/j.rmed.2007.12.001 www.newtocopd.com/currentaffairsnews/list751_ item23096.aspx
Maximal static mouth pressures may have role in monitoring COPD severity A new study has found that maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) in COPD patients, indicators of respiratory muscle strength, may help clinicians to monitor the severity of COPD. Daniela Ceccarelli and colleagues at the University of Rome ‘‘La Sapienza’’ analysed the MIP and MEP of patients with stable COPD — 31 mild, 39 moderate and 28 severe — and 21 healthy subjects. They found that MIP and MEP were lower in patients with severe COPD. MEP was not significantly reduced among patients with mild or moderate COPD, but MIP decreased which they believe could suggest an earlier deterioration of inspiratory muscles among these patients. Among the COPD patients, both MIP and MEP values correlated positively with forced expiratory volume in 1 s FEV1 peak expiratory flow, total lung capacity (TLC), and height, but not with residual volume (RV), the ratio of RV to TLC, weight, or age. MIP and MEP were shown to be statistically different between mild and severe COPD patients, and between moderate and severe patients. The study is published in Respiratory Research, and the authors suggest that studies on a larger population group are needed to confirm these results. Source: http://respiratory-research.com/content/9/1/8/abstract www.newtocopd.com/currentaffairsnews/list751_ item23251.aspx
4 (2008) 88 – 89
89
Pseudomonas aeruginosa infections and COPD exacerbations Infection with Pseudomonas aeruginosa in COPD patients has been characterised by US researchers. Timothy Murphy, of Buffalo Veterans Affairs Medical Center, New York, and colleagues carried out a prospective study of 126 patients for a period of more than 10 years, taking sputum samples and assessing immune responses. They observed 57 episodes of acquisition of P. aeruginosa in 39 patients. COPD exacerbations were reported at 42.6% of patient visits when a new strain was isolated. When no new strain was isolated the exacerbation rate was just 18%. The authors conclude that acquisition of P. aeruginosa was associated with an exacerbation. In their article, published in the American Journal of Respiratory and Critical Care Medicine, they noted distinct patterns of carriage by the bacterium—short-term colonisation followed by clearance, and long-term persistence. Antibiotics did not account for clearance of the infection. Sources: Am J Respir Crit Care Med 2008 doi:10.1164/rccm.200709-1413OC www.newtocopd.com/currentaffairsnews/list751_ item23189.aspx
Telemedicine for COPD patients New initiatives in the UK highlight the role of telemedicine in treating COPD patients. People in Sheffield with COPD have been given Telehealth equipment to use at home. It measures their blood pressure, pulse rate, oxygen saturation levels and body temperature. Data are sent electronically for analysis. Medical staff will be alerted if there are any abnormal readings, and support can be given to the patient to prevent their condition deteriorating and leading to hospital admission. In a similar move, COPD patients in Hull and Walsall will monitor their condition at home, as part of an initiative that also includes patients with congestive heart failure. Milton Keynes Primary Care Trust is also using a similar system. These initiatives show the potential for technology combined with a clinical support system to help patients to self-care. Sources: www.thestar.co.uk/news/System-helps-lung-patients. 3630363.jp www.publictechnology.net/modules.php?op= modload&name=News&file=article&sid=13121
4 (2008) 88– 89
COPD NEWS
Combined therapy may be more beneficial for COPD patients Researchers in the UK have found that patients may benefit from a combined long-acting bronchodilator/anti-inflammatory treatment rather than the standard treatment of a longacting bronchodilator alone. Jadwiga Wedzicha and colleagues, whose results are published in the American Journal of Respiratory and Critical Care Medicine, carried out a two-year randomised, double blind, double parallel study of 1323 patients with a mean age of 64 years. They found no difference in exacerbation rates between patients treated with the salmetorol/fluticasone propionate combination and those treated with tiotropium. However, those receiving the combined therapy had improved health, fewer deaths, and were less likely to withdraw from treatment. Source: http://ajrccm.atsjournals.org/cgi/content/abstract/177/1/19
New prognostic index predicts COPD hospitalisation, exacerbation, and mortality A new prognostic tool for COPD has been developed that not only predicts mortality but also hospitalisations and exacerbations. The severity of COPD can be determined by forced expiratory volume in one second (FEV1), or the recent BODE index, both of which predict mortality as the sole outcome. Andrew Briggs of the University of Glasgow and colleagues obtained data from a pooled analysis of 12 randomised controlled trials, and developed three specific indexes, using factors such as quality of life, history of exacerbations, gender, age, FEV1 and body mass index. They then created a composite index which they found to be 71% accurate for both mortality and hospitalisation. Each 10-point change in the composite index corresponded to a 54% increase in the hazard ratio of death, a 57% increase in the hazard ratio of hospitalisation, and a 21% increase in the incidence of exacerbations. In their article, published in the Archives of Internal Medicine, the authors point out that the factors included in the index 1745-0454/$ - see front matter doi:10.1016/j.rmedu.2008.02.009
are not difficult to obtain, making it suitable for use in both primary and secondary care settings. Sources: http://archinte.ama-assn.org/cgi/content/abstract/168/1/71 www.newtocopd.com/currentaffairsnews/list751_ item23141.aspx
Beta blockers may reduce mortality from cardiovascular disease in COPD patients US researchers have found that the use of beta-blockers among COPD patients with acute exacerbations may be associated with reduced mortality from cardiovascular disease. Mark Dransfield and colleagues at the University of Alabama analysed data on hospital patients admitted with acute COPD exacerbations between 1999 and 2006. 142 of the 825 patients were receiving beta-blockers, and they were older and more frequently had cardiovascular disease than those not receiving the treatment. The study, published in Thorax, concluded that the use of beta-blockers among COPD inpatients is well tolerated and may be associated with reduced mortality. Source: Dransfield MT, Rowe SM, Johnson JE, Bailey WC, Gerald LB. Beta-blocker use and the risk of death in hospitalised patients with acute exacerbations of COPD. Thorax. Published online first: 19 October 2007. doi:10.1136/thx. 2007.081893.
COPD associated with marginal bone loss in periodontitis A study from Norway has shown that chronic marginal periodontitis is common in patients with severe COPD. Inga Leuckfeld and colleagues carried out a retrospective cross-sectional study of patients evaluated for lung transplantation — 130 of the patients had COPD and 50 did not. As described in their Respiratory Medicine paper, they believed measuring periodontitis using radiographs rather than clinical examination was more suitable for
ARTICLE IN PRESS R E S P I R AT O RY M E D I C I N E : C O P D U P D AT E
this study, and took orthopantomograms of the jaws of all patients. They found that chronic marginal periodontitis is common in patients with severe COPD (44%), higher than reported in previous studies, and six times higher than in the patients without COPD (7.3%). The high prevalence appears to be independent of possible risk factors for periodontitis such as age, cigarette pack years smoked, body mass index, use of corticosteroids and bone mineral density. The authors conclude that more research is needed to elucidate the relationship between COPD and periodontitis. Sources: Respir Med 2007, in press. doi:10.1016/j.rmed.2007.12.001 www.newtocopd.com/currentaffairsnews/list751_ item23096.aspx
Maximal static mouth pressures may have role in monitoring COPD severity A new study has found that maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) in COPD patients, indicators of respiratory muscle strength, may help clinicians to monitor the severity of COPD. Daniela Ceccarelli and colleagues at the University of Rome ‘‘La Sapienza’’ analysed the MIP and MEP of patients with stable COPD — 31 mild, 39 moderate and 28 severe — and 21 healthy subjects. They found that MIP and MEP were lower in patients with severe COPD. MEP was not significantly reduced among patients with mild or moderate COPD, but MIP decreased which they believe could suggest an earlier deterioration of inspiratory muscles among these patients. Among the COPD patients, both MIP and MEP values correlated positively with forced expiratory volume in 1 s FEV1 peak expiratory flow, total lung capacity (TLC), and height, but not with residual volume (RV), the ratio of RV to TLC, weight, or age. MIP and MEP were shown to be statistically different between mild and severe COPD patients, and between moderate and severe patients. The study is published in Respiratory Research, and the authors suggest that studies on a larger population group are needed to confirm these results. Source: http://respiratory-research.com/content/9/1/8/abstract www.newtocopd.com/currentaffairsnews/list751_ item23251.aspx
4 (2008) 88 – 89
89
Pseudomonas aeruginosa infections and COPD exacerbations Infection with Pseudomonas aeruginosa in COPD patients has been characterised by US researchers. Timothy Murphy, of Buffalo Veterans Affairs Medical Center, New York, and colleagues carried out a prospective study of 126 patients for a period of more than 10 years, taking sputum samples and assessing immune responses. They observed 57 episodes of acquisition of P. aeruginosa in 39 patients. COPD exacerbations were reported at 42.6% of patient visits when a new strain was isolated. When no new strain was isolated the exacerbation rate was just 18%. The authors conclude that acquisition of P. aeruginosa was associated with an exacerbation. In their article, published in the American Journal of Respiratory and Critical Care Medicine, they noted distinct patterns of carriage by the bacterium—short-term colonisation followed by clearance, and long-term persistence. Antibiotics did not account for clearance of the infection. Sources: Am J Respir Crit Care Med 2008 doi:10.1164/rccm.200709-1413OC www.newtocopd.com/currentaffairsnews/list751_ item23189.aspx
Telemedicine for COPD patients New initiatives in the UK highlight the role of telemedicine in treating COPD patients. People in Sheffield with COPD have been given Telehealth equipment to use at home. It measures their blood pressure, pulse rate, oxygen saturation levels and body temperature. Data are sent electronically for analysis. Medical staff will be alerted if there are any abnormal readings, and support can be given to the patient to prevent their condition deteriorating and leading to hospital admission. In a similar move, COPD patients in Hull and Walsall will monitor their condition at home, as part of an initiative that also includes patients with congestive heart failure. Milton Keynes Primary Care Trust is also using a similar system. These initiatives show the potential for technology combined with a clinical support system to help patients to self-care. Sources: www.thestar.co.uk/news/System-helps-lung-patients. 3630363.jp www.publictechnology.net/modules.php?op= modload&name=News&file=article&sid=13121