Effect of fluticasone/salmeterol combination on dyspnea and respiratory mechanics in mild-to-moderate COPD.

Respir Med. 2013 Feb 16;

Authors: Guenette JA, Webb KA, O'Donnell DE

Abstract
The purpose of this exploratory physiological study was to evaluate the effects of inhaled fluticasone/salmeterol combination (FSC) on sensory and physiological responses to exercise in subjects with mild-to-moderate COPD. In a randomized, double-blind, placebo-controlled, crossover study, subjects underwent 6-week treatments with FSC or placebo (PLA). Detailed pulmonary function and constant-work rate cycle exercise tests were performed following each treatment period. Fifteen subjects completed the study (mean ± SD): age 64 ± 10 years; smoking history 47 ± 29 pack-years; post-bronchodilator forced expiratory volume in 1 s 86 ± 15 %predicted (10 mild and 5 moderate COPD); peak incremental oxygen uptake 71 ± 16 %predicted. Compared with PLA, FSC treatment was associated with improved: FEV(1) by 0.23 ± 0.18 L; inspiratory capacity by 0.18 ± 0.23 L; functional residual capacity by -0.28 ± 0.30 L; and specific airways resistance by -4.6 ± 4.5 cmH(2)O s (all p < 0.01). There were no significant changes in dyspnea intensity throughout exercise and endurance time did not change significantly (1.2 ± 3.0 min, p = 0.149). Following FSC, inspiratory capacity at rest and throughout exercise increased by 0.2-0.3 L with concomitant increases in tidal volume and ventilation (p < 0.05). Compared with PLA, the work of breathing and the ratio of respiratory muscle effort to tidal volume improved with FSC during exercise (p < 0.05). In mild-to-moderate COPD, FSC was associated with significant improvements in airway function at rest and during exercise. Despite important mechanical improvements, there were no significant effects on dyspnea intensity and exercise endurance.

PMID: 23421968 [PubMed - as supplied by publisher]

Usefulness of the COPD assessment test (CAT) in primary care.

Prim Care Respir J. 2013 Feb 21;

Authors: Langhammer A, Jones R

PMID: 23429862 [PubMed - as supplied by publisher]

Trends in the lifetime risk of COPD exacerbation requiring hospitalisation.

Eur Respir J. 2013 Feb 21;

Authors: Lykkegaard J, Christensen RD, Davidsen JR, Støvring H, Andersen M, Søndergaard J

Abstract
This study aimed to estimate time-trends in the lifetime risk of hospitalisation with exacerbation of chronic obstructive pulmonary disease (COPD) in Denmark.During the period from 1994 to 2008 a register-based cohort study was conducted covering each subject in the entire population of Denmark (5.43 million in 2008).Based on previously validated diagnosis codes, all COPD hospitalisations were identified. Individual look-back periods of 8 years were used to determine first-time hospitalisations. From year 2002 to 2008 all first-time COPD hospitalised subjects aged 30 years and above were identified. The calculation of lifetime risk was based on age- and sex-specific first-time COPD hospitalisation rates and rates of COPD hospitalisation-free survival, assuming them to be calendar time stationary.The study included 23.9 million person-years of risk time and identified 48 959 first-time COPD hospitalisations. For 30-year-olds in Denmark, the lifetime risk of COPD hospitalisation was 12.0% (95% CI 11.9-12.2) for females and 10.9% (95% CI 10.8-11.1) for males. Trends were generally equal in both sexes. During the period from year 2002 to 2008, the rate of first-time COPD hospitalisations decreased, while the survival of never COPD hospitalised subjects increased. In consequence the lifetime risk of COPD hospitalisation remained constant.

PMID: 23429915 [PubMed - as supplied by publisher]

The long-term effect of ambulatory oxygen in normoxaemic COPD patients: A randomised study.

Chron Respir Dis. 2013 Feb 21;

Authors: Ringbaek T, Martinez G, Lange P

Abstract
Aim: To study the long-term benefits of ambulatory oxygen (AO) in combination with pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) patients experiencing exertional desaturation. Patients and methods: Normoxaemic COPD who participated in outpatient PR and desaturated >4% and <90% during endurance shuttle walk test (ESWT) were randomised to control (n = 23) or AO 2 L/min from a portable oxygen concentrator (n = 22) to be used during exercise. PR consisted of supervised training for 20 weeks combined with unsupervised daily training at home followed by 13 weeks without supervised training. Results: Only 45 of 165 eligible patients wanted to participate. Mean forced expiratory volume in 1 s = 32% (SD 13.8) and Medical Research Council (MRC) = 4.5 (3-5). Supplemental oxygen improved oxygen saturation during ESWT by 2.3% (95% CI: 1.2%-3.5%; p < 0.001). In the study period of 33 weeks, 10 and 6 patients withdrew from the AO group and control group, respectively. Patients spent an average of 7.9 h/week on oxygen. PR improved ESWT by 18,076 s (95% CI: 101-258 s; p < 0.001) and St. George's Respiratory Questionnaire (SGRQ) score by 2.6 units (95% CI: 0.1-5.1 s; p = 0.04) after 7 weeks, and these gains remained at 33 weeks of evaluation. There were no differences between the AO group and control group at 33 weeks of evaluation with regard to change in ESWT (223 vs. 241 s; p = 0.32), change in SGRQ (-3.6 vs. -4.5 units, 0.91), and number of patients with acute exacerbation in COPD (AECOPD), hospital admission or dropout (17 of 22 vs. 20 of 23, p = 0.59). Conclusions: AO seems not to provide additional beneficial effects in patients with COPD participating in pulmonary rehabilitation and experiencing exertional desaturation without severe resting hypoxaemia.

PMID: 23431028 [PubMed - as supplied by publisher]