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Use of mortality within 30 days of a COPD hospitalisation as a measure of COPD care in UK hospitals

Mortality rate has been proposed as a metric of hospital chronic obstructive pulmonary disease (COPD) care in light of variation seen in national COPD audits. Using Hospital Episode Statistics (hospital ‘coding’) we examined 30-day mortality after COPD hospitalisation in 150 UK hospitals during 2006–2007 and 2007–2008. Mean and median 30-day mortalities were similar each year but the coefficient of variation was >20% and hospitals could change from a low or high quartile to the median by chance. We could not detect any reasons for hospitals being at the extremes. 30-day mortality after COPD hospitalisation is a complex variable and unlikely to be useful as a primary annual COPD metric.

Should we give long-term macrolide therapy for COPD?

We would like to take this opportunity to respond to the invitation from the editors of Thorax to engage in a debate over the current place of macrolide therapy in patients with chronic obstructive pulmonary disease (COPD). We believe that the optimism imparted by Albert et al1 may hide harmful effects that outweigh the currently perceived benefits. In this placebo-controlled, parallel group (but not double-blind) randomised trial, one-quarter of screened patients were excluded from study entry. The main reason for exclusion was the presence of ‘cardiac issues’ related to the known potential of macrolides to prolong the electrocardiographic QT interval and, thus, the propensity for the development of the potentially malignant arrhythmia ‘Torsades de Pointes’; an effect that could be further potentiated by the many other QT interval-prolonging drugs commonly taken by older patients. The study reassuringly found no significant difference in mortality between the two study...

Surgery for early stage small cell lung cancer

In this database study from the USA, survival following surgical treatment for stage I and II small cell lung cancer (SCLC) was investigated. The Surveillance, Epidemiology and End Results (SEER) database, sponsored by the National Cancer Institute, covers almost one third of the US population and captures 98% of all cancer cases in the surveyed areas. All patients between 1988 and 2007 with stage I or II SCLC were retrieved from the SEER database together with information regarding demographics, stage of disease, radiotherapy, resection as the treatment and survival. If available, pathological staging was used, otherwise patients were staged clinically.

Three thousand five hundred and sixty six patients were included, and 25% underwent surgery, primarily lobectomy. The unadjusted median survival in the surgical group was 34 months compared with 16 months in patients who did not undergo surgery. The multivariable adjusted Cox regression model showed that patients with stage I or...

Pulmonary arterial enlargement and acute exacerbations of COPD

This multicentre observational trial used data from the COPDGene Study to investigate whether pulmonary vascular disease is associated with acute exacerbations of chronic obstructive pulmonary disease (COPD). Although severe pulmonary hypertension is a well recognised late complication of the disease, the study questioned whether earlier radiological changes could be used as a predictor for exacerbations. CT was used to provide a measure of pulmonary artery (PA) enlargement, using the ratio of PA diameter as compared with the diameter of the aorta (A).

The study population included 3464 patients with a diagnosis of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II–IV COPD. These patients were longitudinally followed up for a median duration of 2.1years, as was an external validation cohort from the US ECLIPSE trial. Multivariate logistic regression analysis demonstrated a significant association between those with PA enlargement (PA:A ratio >1) and a history of severe...

Daily physical activity in subjects with newly diagnosed COPD

Information about daily physical activity levels (PAL) in subjects with undiagnosed chronic obstructive pulmonary disease (COPD) is scarce. This study aims to assess PA and to investigate the associations between PA and clinical characteristics in subjects with newly diagnosed COPD.

 Methods

Fifty-nine subjects with a new spirometry-based diagnosis of mild (n=38) and moderate (n=21) COPD (63±6 years, 68% male) were matched with 65 smoking controls (62±7 years, 75% male). PA (daily steps, time spent in moderate-to-vigorous intense physical activities (MVPA) and PAL) was measured by accelerometry. Dyspnoea, complete pulmonary function tests, peripheral muscle strength and exercise capacity served as clinical characteristics.

 Results

PA was significantly lower in COPD versus smoking controls (7986±2648 vs 9765±3078 steps, 64 (27–120) vs 110 (55–164) min of MVPA, 1.49±0.21 vs 1.62±0.24 PAL respectively, all p<0.05). Subjects with COPD with either mild symptoms of dyspnoea (mMRC 1), those with lower diffusion capacity (TL,co), low 6 min walking distance (6MWD) or low maximal oxygen uptake (VO2 peak) had significantly lower PA. Multiple regression analysis identified 6 MWD and TL,co as independent predictors of PA in COPD.

 Conclusions

The reduction in PA starts early in the disease, even when subjects are not yet diagnosed with COPD. Inactivity is more pronounced in subjects with mild symptoms of dyspnoea, lower levels of diffusion capacity and exercise capacity.

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