Which is the optimal bronchodilator therapy for chronic obstructive pulmonary disease?
Chronic obstructive pulmonary disease is an inflammatory disorder characterized by airflow limitation. Its cardinal symptom is dyspnea, which develops gradually with even low levels of exercise.
Bronchodilators (BDs) are the most effective drugs for relieving dyspnea. Two main types of BD are currently available, β-mimetics and anticholinergics, with different subtypes according to their duration of action. The most useful agents are those administered once daily, also called ‘ultralong-acting’ BDs. As a high proportion of patients remain insufficiently controlled with only one BD, all guidelines currently recommend the combination of two long-acting agents. A number of studies have demonstrated that combination therapy is functionally and, in general, clinically superior to individual drugs.
Although various combinations have been assessed, the current trend is to use ultralong-acting agents due to their more convenient dosing schedule and, probably, their greater efficacy. In the research setting, some of these agents are combined in a single device, an approach that may become the standard treatment for many patients with chronic obstructive pulmonary disease.
Intrapleural hyperthermic perfusion chemotherapy in subjects with metastatic pleural malignancies
Publication date: May 2013
Source:Respiratory Medicine, Volume 107, Issue 5
Author(s): Ahmet Feridun Işık , Maruf Şanlı , Miray Yılmaz , Fatih Meteroğlu , Öner Dikensoy , Alper Sevinç , Celaletdin Camcı , Bülent Tunçözgür , Levent Elbeyli
Objectives Malignant pleural effusion (MPE) means poor prognosis in the majority of cases. Intrapleural Hyperthermic perfusion chemotherapy (HIPEC) looks promising approach for these patients. We aimed to investigate whether cytoreductive surgery followed by HIPEC provides any survival benefit in cases with metastatic MPEs.
Methods Between January 2009 and December 2011, 19 patients with metastatic MPEs were treated with HIPEC following surgical interventions such as pleurectomy/decortication and/or lung resection (Group 1). Comparison was done with historical control groups consisted of patients who received either talc pleurodesis or pleurectomy/decortication followed by systemic treatment for the management of metastatic MPEs between June 2007 and June 2008 (group 2 and 3). Statistical analyses including overall survival, disease free interval were done for the group comparisons.
Results Median survival in group 1, 2 and 3 were 15.4, 6, 8 months, respectively. One year survival was 54.7% in group 1 where it was 0.6% and 0.8% in group 2 and 3, respectively. There was no operative mortality. Morbidity was occurred in 1 patient in group 1 (5.3%).
Conclusions HIPEC combined with cytoreductive surgery seems to be a promising treatment option for subjects with metastatic MPEs. Further studies are needed for the optimization of HIPEC method, drug of choice, and the best combination therapy for the multimodal treatment.
Source:Respiratory Medicine, Volume 107, Issue 5
Author(s): Ahmet Feridun Işık , Maruf Şanlı , Miray Yılmaz , Fatih Meteroğlu , Öner Dikensoy , Alper Sevinç , Celaletdin Camcı , Bülent Tunçözgür , Levent Elbeyli
Safety and efficacy of the once-daily anticholinergic BEA2180 compared with tiotropium in patients with COPD
Publication date: June 2013
Source:Respiratory Medicine, Volume 107, Issue 6
Author(s): Roger Abrahams , Petra Moroni-Zentgraf , Joe Ramsdell , Hendrik Schmidt , Elizabeth Joseph , Jill Karpel
Background To determine the safety and efficacy of BEA2180, an anticholinergic agent in patients with chronic obstructive pulmonary disease (COPD).
Methods Smokers or ex-smokers ≥40 years with COPD and a postbronchodilator forced expiratory volume in 1 s (FEV1 ) <80% predicted and FEV1 /forced vital capacity ≤70% participated in this multinational, randomised, double-blind, parallel study. Patients received BEA2180 (50, 100 or 200 μg), tiotropium (5 μg) or placebo once daily via Respimat® Soft Mist™. The primary endpoint was trough FEV1 after 24 weeks. Secondary endpoints included Transition Dyspnoea Index (TDI) focal score, St George's Respiratory Questionnaire (SGRQ) total score, exacerbations and adverse events.
Results Patients (n = 2080, 64.5% male) had a mean age of 64.2 years and a baseline FEV1 of 1.2 L. Trough FEV1 at 24 weeks with all BEA2180 doses (0.044–0.087 L) and tiotropium 5 μg (0.092 L) was significantly higher (p < 0.0001) than placebo (−0.034 L) and BEA2180 (200 μg) was noninferior to tiotropium. Mean TDI focal scores were higher with BEA2180 (1.43–1.48) or tiotropium (1.46) versus placebo (0.94; p ≤ 0.01 for all). Mean SGRQ total scores also improved with BEA2180 (40.1–40.7) or tiotropium (39.5) compared with placebo (43.0, p < 0.01 for all). COPD exacerbation rates were reduced for all active treatments, reaching statistical significance for BEA2180 (50 and 200 μg) (p < 0.05, for both).
Conclusion All study doses of BEA2180 improved lung function, reduced symptoms and exacerbations, and improved health status in COPD; all treatments were well tolerated. Clinical trial identifier : NCT00528996 .
Source:Respiratory Medicine, Volume 107, Issue 6
Author(s): Roger Abrahams , Petra Moroni-Zentgraf , Joe Ramsdell , Hendrik Schmidt , Elizabeth Joseph , Jill Karpel
Chronic treatment with indacaterol and airway response to salbutamol in stable COPD
Publication date: June 2013
Source:Respiratory Medicine, Volume 107, Issue 6
Author(s): Mario Cazzola , Paola Rogliani , Paolo Ruggeri , Andrea Segreti , Alfio Proietto , Stefano Picciolo , Maria Gabriella Matera
Tolerance to both the bronchoprotective effect, and, to a lesser extent, the bronchodilator activity, occurs with all inhaled β2 -agonists. Assumed the importance of this topic and the lack of a clinical evaluation specifically designed to assess the impact of chronic administration of indacaterol on the response to salbutamol, we sought to compare the effect of 4-week treatment with indacaterol 150 μg once-daily versus formoterol 12 μg twice-daily on the dose-response curve to inhaled salbutamol (total cumulative dose of 800 μg) in a non-double-blinded, crossover, randomised, and controlled pilot trial that enrolled 20 outpatients with moderate to severe COPD. At the end of 4-week treatments, there was not a statistically significant difference between the two trough FEV1 (p = 0.16), and both indacaterol and formoterol were able to produce a significant (p < 0.001) increase in FEV1 mean differences (L ) = indacaterol 0.15 (95% confidence interval (CI) 0.12–0.18); formoterol 0.10, (95% CI 0.08–0.12) 2 h after their inhalation. Salbutamol elicited an evident dose-dependent increase in FEV1 and this occurred also after regular treatment with indacaterol and formoterol with a further mean maximum increase of 0.10L (95% CI 0.05–0.14) and 0.05L (95% CI 0.02–0.08), respectively. The differences between indacaterol and formoterol in FEV1 increases after salbutamol were never statistically significant. The results of this study support the use of salbutamol as rescue medication for rapid relief of bronchospasm in patients suffering from COPD, even when they are under regular treatment with indacaterol.
Source:Respiratory Medicine, Volume 107, Issue 6
Author(s): Mario Cazzola , Paola Rogliani , Paolo Ruggeri , Andrea Segreti , Alfio Proietto , Stefano Picciolo , Maria Gabriella Matera
Effect of aerobic exercise training on fatigue and physical activity in patients with pulmonary arterial hypertension
Publication date: May 2013
Source:Respiratory Medicine, Volume 107, Issue 5
Author(s): Ali A. Weinstein , Lisa M.K. Chin , Randall E. Keyser , Michelle Kennedy , Steven D. Nathan , Joshua G. Woolstenhulme , Gerilynn Connors , Leighton Chan
Objective To investigate the effectiveness of an exercise intervention for decreasing fatigue severity and increasing physical activity in individuals with pulmonary arterial hypertension (PAH). A small, phase 2 randomized clinical trial of the effect of aerobic exercise training on fatigue severity and physical activity in patients with idiopathic or PAH associated with other conditions was conducted.
Methods Twenty-four patients with PAH (24 female; age: 54.4 ± 10.4 years; BMI: 30.8 ± 7.2 kg/m2) participated in the study. A convenience sample was recruited in which 9% (28 of 303) of screened patients were enrolled. The project was carried out in a clinical pulmonary rehabilitation clinic during existing pulmonary rehabilitation program sessions. Patients with PH were randomized into a 10-week program that consisted of patient education only or patient education plus an aerobic exercise-training regimen. Both groups received 20 lectures, two per week over the 10-weeks, on topics related to PAH and its management. The aerobic exercise training consisted of 24–30 sessions of treadmill walking for 30–45 min per session at an intensity of 70–80% of heart rate reserve, three days per week over the 10 weeks.
Results After 10-weeks of intervention, patients receiving aerobic exercise training plus education reported routinely engaging in higher levels of physical activity (p < 0.05) and a decrease in fatigue severity (p = 0.03). Patients in the education only group did not report changes in fatigue severity or participation in physical activity.
Conclusions The 10-week aerobic exercise training intervention resulted in increased physical activity and decreased fatigue in individuals with PAH. ClinicalTrials.gov Identifier: NCT00678821 .
Source:Respiratory Medicine, Volume 107, Issue 5
Author(s): Ali A. Weinstein , Lisa M.K. Chin , Randall E. Keyser , Michelle Kennedy , Steven D. Nathan , Joshua G. Woolstenhulme , Gerilynn Connors , Leighton Chan