Concerns about the safety of long-acting antimuscarinic agents for the treatment of COPD, This large well-conducted randomised study compared the use of tiotropium through the Handihaler (18 µg) with tiotropium at two doses (2.5 µg and 5.0 µg) through the Respimat in over 17 000 patients with COPD. It showed no difference in mortality or efficacy between the two delivery systems, nor even a trend for a mortality difference. It is now worth reviewing the data that led to these concerns and the lessons that may be learned. Two systematic reviews played a key role in raising concerns over tiotropium. Antimuscarinic agents were generally considered safe and well tolerated until a meta-analysis of trials that included short-acting and long-acting antimuscarinic agents suggested an increase in cardiac events and mortality.
We present the final results of the effect of lung cancer screening with low-dose CT on the smoking habits of participants in a 5-year screening trial.
The Danish Lung Cancer Screening Trial (DLCST) was a 5-year screening trial that enrolled 4104 subjects; 2052 were randomised to annual low-dose CT (CT group) and 2052 received no intervention (control group). Participants were current and ex-smokers (≥4 weeks abstinence from smoking) with a tobacco consumption of ≥20 pack years. Smoking habits were determined annually. Missing values for smoking status at the final screening round were handled using two different models.
There were no statistically significant differences in annual smoking status between the CT group and control group. Overall the ex-smoker rates (CT + control group) significantly increased from 24% (baseline) to 37% at year 5 of screening (p<0.001). The annual point prevalence quit rate increased from 11% to 24% during the five screening rounds; the ex-smokers’ relapse rate remained stable, around 11%, across the same period.
Screening with low-dose CT had no extra effect on smoking status compared with the control group, but overall the screening programme probably promoted smoking cessation.
There is growing recognition of the clinical importance of non-tuberculous mycobacteria (NTM), a group of versatile opportunistic bacterial pathogens.
We describe the characteristics of NTM isolates in Scotland over an 11-year period using data held by the Scottish Mycobacteria Reference Laboratory. American Thoracic Society microbiological criteria were used to evaluate the clinical significance of isolates. Data presented include analysis of trends across time, species/body site associations, gender and age differences, geographical variations and the association between cystic fibrosis and Mycobacterium abscessus.
We emphasise the need for standardised reporting criteria for NTM isolates to ensure optimal surveillance of NTM disease.