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Distribution of Clinical Phenotypes in Patients With Chronic Obstructive Pulmonary Disease Caused by Biomass and Tobacco Smoke.

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Distribution of Clinical Phenotypes in Patients With Chronic Obstructive Pulmonary Disease Caused by Biomass and Tobacco Smoke.

Arch Bronconeumol. 2014 Feb 24;

Authors: Golpe R, Sanjuán López P, Cano Jiménez E, Castro Añón O, Pérez de Llano LA

Abstract
INTRODUCTION: Exposure to biomass smoke is a risk factor for chronic obstructive pulmonary disease (COPD). It is unknown whether COPD caused by biomass smoke has different characteristics to COPD caused by tobacco smoke.
OBJECTIVE: To determine clinical differences between these two types of the disease.
METHODS: Retrospective observational study of 499patients with a diagnosis of COPD due to biomass or tobacco smoke. The clinical variables of both groups were compared.
RESULTS: There were 122subjects (24.4%) in the biomass smoke group and 377 (75.5%) in the tobacco smoke group. In the tobacco group, the percentage of males was higher (91.2% vs 41.8%, P<.0001) and the age was lower (70.6 vs 76.2 years, P<.0001). Body mass index and FEV1% values were higher in the biomass group (29.4±5.7 vs 28.0±5.1, P=.01, and 55.6±15.6 vs 47.1±17.1, P<.0001, respectively). The mixed COPD-asthma phenotype was more common in the biomass group (21.3% vs 5%, P<.0001), although this difference disappeared when corrected for gender. The emphysema phenotype was more common in the tobacco group (45.9% vs 31.9%, P=.009). The prevalence of the chronic bronchitis and exacerbator phenotypes, the comorbidity burden and the rate of hospital admissions were the same in both groups.
CONCLUSION: Differences were observed between COPD caused by biomass and COPD caused by tobacco smoke, although these may be attributed in part to uneven gender distribution between the groups.

PMID: 24576449 [PubMed - as supplied by publisher]

Bronchodilator efficacy of tiotropium-formoterol via single pressurized meter dose inhaler (pMDI) versus tiotropium alone in COPD

Bronchodilators form the main stay of treatment for COPD. When symptoms are not adequately controlled with one bronchodilator, addition of another bronchodilator is recommended. The authors have recently developed a combination of tiotropium and formoterol in a single pressurized metered dose inhaler (pMDI).

The aim of this study was to compare the bronchodilator effects of a single dose of 18mcg of tiotropium versus a single dose of a combination of 18mcg tiotropium plus 12mcg formoterol administered via a pMDI in subjects with moderate–to–severe COPD. A combination of tiotropium plus formoterol administered via a single inhaler produced a superior bronchodilator response than tiotropium alone over a period of 24h.

Methods

  • 44 COPD subjects were enrolled in this randomized, double-blind, multi-centre, cross-over study.
  • 18mcg tiotropium and 18mcg tiotropium plus 12mcg formoterol were administered via pressurized metered dose inhalers on two separate days.
  • FEV1, FVC and Inspiratory capacity (IC) were measured before, 15, 30min, 1, 2, 3, 4, 6, 8, 12 and 24h after the study drugs were administered.

Results

  • Compared with tiotropium alone, a combination of tiotropium plus formoterol showed a faster onset of bronchodilator response (p<0.01 for FEV1 and FVC), a greater mean maximum change in FEV1 (p=0.01) and FVC (p=0.008) and greater AUC0–24h values for FEV1, FVC and IC.
  • Trough FEV1 and FVC values were also greater in the combination group.

Conclusion : A combination of tiotropium plus formoterol administered via a single inhaler produced a superior bronchodilator response than tiotropium alone over a period of 24 h.

New developments in the assessment of COPD: early diagnosis is key. Free Fulltext

Chronic obstructive pulmonary disease (COPD) is the most common chronic lung disease in the world, and its associated health burdens and costs are mounting.

Until recently, it was generally accepted that targeting the diagnosis of COPD early in its course was a relatively fruitless effort, since treatments other than already ubiquitous smoking-cessation efforts were unlikely to alter its course. However, there is strong evidence to suggest that the majority of patients with objective COPD are not aware of their condition, and this leads to a significant delay in diagnosis, more aggressive smoking-cessation intervention, and potential treatment.

Novel methods of diagnostic testing, community health programs, and primary-care provider recommendations hold promise to expand the recognition of COPD in its incipient stages – where recent evidence suggests a rapid decline in lung function occurs and may be prevented if acted upon.

This review explores the evidence to support the efforts to justify programs aimed at early diagnosis, alternative diagnostic strategies that may augment traditional spirometry, therapeutic modalities that could potentially be used in the future to alter early lung-function decline, and emphasizes the necessary cooperative role that physicians, patients, communities, and governments need to play to realize the significant health impact that stands to be gained.

Montelukast versus budesonide as a first line preventive therapy in mild persistent asthma in 2 to 18 years

The aim of this study is to compare the efficacy of oral Montelukast and inhaled Budesonide as a first line preventive therapy in mild persistent asthma in age group 2–18 y. The present study suggests that oral Montelukast is not inferior to Budesonide in treatment of mild persistent asthma in 2 to 18 y children in terms of control of symptoms and improvement in pulmonary function tests over a 12 wk period. However, there was more significant improvement in day time symptoms, more significant increase in FEV1/FVC ratio and less exacerbation in patients receiving Budesonide compared to those receiving Montelukast.

Methods

  • This prospective randomized controlled clinical study was conducted for 12 wk.
  • Sixty patients of mild persistent asthma aged 2 to 18 y were randomly allocated to either oral Montelukast (n=60) or inhaled Budesonide (n=60) group.
  • Outcomes measured were improvement in peak expiratory flow rate (PEFR), forced expiratory volume 1 s/forced vital capacity (FEV1/FVC), day time and night time symptoms and frequency of exacerbations and need to change medications.

Results

  • There was significant improvement in PEFR, FEV1/FVC, day time and night time symptoms and frequency of exacerbations in both groups.
  • However, more significant improvement in FEV1/FVC (CI 95 %, p=0.029) and day time symptoms (CI 95 %, p=0.002) was seen in Budesonide group compared to Montelukast group.

Conclusions : The present study suggests that oral Montelukast is not inferior to Budesonide in treatment of mild persistent asthma in 2 to 18 y children in terms of control of symptoms and improvement in pulmonary function tests over a 12 wk period. However, there was more significant improvement in day time symptoms, more significant increase in FEV1/FVC ratio and less exacerbation in patients receiving Budesonide compared to those receiving Montelukast. However, side effects due to long term use of steroids such as growth stunting and bone osteopenia should also be considered before recommending.

Treatment of invasive fungal infections in cancer patients-updated recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO).

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Treatment of invasive fungal infections in cancer patients-updated recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO).

Ann Hematol. 2014 Jan;93(1):13-32

Authors: Mousset S, Buchheidt D, Heinz W, Ruhnke M, Cornely OA, Egerer G, Krüger W, Link H, Neumann S, Ostermann H, Panse J, Penack O, Rieger C, Schmidt-Hieber M, Silling G, Südhoff T, Ullmann AJ, Wolf HH, Maschmeyer G, Böhme A

Abstract
The Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO) here presents its updated recommendations for the treatment of documented fungal infections. Invasive fungal infections are a main cause of morbidity and mortality in cancer patients undergoing intensive chemotherapy regimens. In recent years, new antifungal agents have been licensed, and agents already approved have been studied in new indications. The choice of the most appropriate antifungal treatment depends on the fungal species suspected or identified, the patient's risk factors (e.g., length and depth of neutropenia), and the expected side effects. This guideline reviews the clinical studies that served as a basis for the following recommendations. All recommendations including the levels of evidence are summarized in tables to give the reader rapid access to the information.

PMID: 24026426 [PubMed - indexed for MEDLINE]

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