Occupation and chronic obstructive pulmonary disease (COPD).

Br Med Bull. 2012 Oct 18;

Authors: Cullinan P

Abstract
IntroductionThere is growing interest in preventable, non-smoking causes of chronic obstructive pulmonary disease (COPD), among which are chronic exposures to respiratory irritants in the workplace.Sources of dataReviews of occupational COPD in specific occupations and industries and in general populations; supplemented with other or more recently published material.Areas of agreementThere is good evidence for an increased risk of COPD from certain specific exposures (coal mine dust, silica, welding fume, textile dust, agricultural dust, cadmium fume).Areas of controversyLess clear is the causal role of non-specific dusts or fumes/gases in general populations where the available literature is notably uncritical.Growing pointsOther specific exposures, such as diesel fume; interactions between specific exposures and cigarette smoking; the development of safe working limits.Areas timely for developing researchOccupations with large numbers of exposed employees, particularly in low-income countries.

PMID: 23080418 [PubMed - as supplied by publisher]

A Home Telemonitoring Program Reduced Exacerbation and Healthcare Utilization Rates in COPD Patients with Frequent Exacerbations.

Telemed J E Health. 2012 Oct 19;

Authors: Alrajab S, Smith TR, Owens M, Areno JP, Caldito G

Abstract
Abstract Rationale: As the impact of home telemonitoring on patients with chronic obstructive pulmonary disease (COPD) is not fully understood and reduction in healthcare utilization is not proven, we attempt to evaluate the effects of home telemonitoring on healthcare utilization in patients with COPD. Subjects and Methods: We conducted a retrospective cohort study using the Veterans Health Administration database of COPD patients enrolled in the Care Coordination Home Telehealth (CCHT) program. We evaluated the effects of monitoring through this program in patients with moderate to severe COPD and frequent exacerbations. Numbers of emergency department (ED) visits, urgent care (UC) visits, and hospitalizations were all evaluated before and after enrollment. The differences in average pre-enrollment and during-enrollment numbers of hospital admissions, ED/UC visits, and exacerbations were tested for significance among all patients enrolled in the program who had one or more exacerbations at pre-enrollment; results were expressed on a per-year basis. Results: Data were available on a total of 1,133 patients with COPD enrolled in the CCHT program between 2005 and 2009. Given the objectives of our study, we only included 369 patients who had at least one exacerbation per year in the year prior to enrollment. Of these, 71.5% had a reduction in numbers of ED visits and exacerbations requiring hospitalizations after enrollment in the program. The average number of hospital admissions, ED visits, and total exacerbations were all reduced (0.41±1.68, 0.15±1.65, and 0.56±2.3, respectively; all with p<0.01). The pre-enrollment number of exacerbations was the only factor observed to be significantly associated with the reduction in number of exacerbations. Conclusions: In patients with COPD and frequent exacerbations, enrollment in a home telemonitoring program may decrease healthcare utilization.

PMID: 23082792 [PubMed - as supplied by publisher]

Related Articles

Effect of Combination Fluticasone Propionate and Salmeterol or Inhaled Corticosteroids on Asthma-Related Outcomes in a Medicare-Eligible Population.

Am J Geriatr Pharmacother. 2012 Oct 16;

Authors: Stanford RH, Blanchette CM, Roberts MH, Petersen H, Fuhlbrigge AL

Abstract
BACKGROUND: National asthma treatment guidelines recommend either the use of inhaled corticosteroids (ICS) or ICS in combination with a long-acting bronchodilator for the treatment of moderate to severe asthma. Even though asthma is common among older adults, few studies have assessed the differences in effectiveness between these two recommended therapies in patients over 65 years of age. OBJECTIVE: The aim of this study was to assess the association of the fluticasone-salmeterol combination (FSC) or ICS initiation on asthma-related events in Medicare-eligible asthma patients. METHODS: This was a retrospective observational study using a large health claims database (July 1, 2001 to June 30, 2008). Subjects 65 to 79 years of age with 12-month preindex and 3- to 12-month postindex eligibility, an asthma diagnosis (ICD-493.xx), and with 1 or more FSC or ICS claims at index were included. Subjects with an FSC or ICS claim in the preindex and any claim for chronic obstructive pulmonary disease were excluded. Subjects were observed until they had an event (emergency department [ED] inpatient hospitalization [IP], combined IP/ED or oral corticosteroid [OCS] use) or were no longer eligible in the database, whichever came first. Cox proportional hazards regression was used to assess risk of an asthma-related event (IP, ED, or IP/ED). Baseline characteristics (age, sex, region, index season, comorbidities, preindex use of short-acting β-agonists, OCS, other asthma controllers, and asthma-related ED/IP visits) were independent covariates in the model. RESULTS: A total of 10,837 met the criteria (4843 ICS and 5994 FSC). Age (70.4 and 70.5 years, respectively) and the percentage of female subjects (65.5% and 64.8%, respectively) were similar. Asthma-related events were also similar at baseline. Postindex unadjusted rates occurring after >30 days were ED (1.8% vs 1.5%, P = 0.18), IP (2.7% vs 1.7%, P < 0.001), and ED/IP (4.1% vs 2.8%, P < 0.001) for ICS and FSC, respectively. Subjects who received FSC were associated with a 32% (adjusted HR = 0.68; 95% CI, 0.51-0.91) lower risk of experiencing an IP visit and a 22% (HR = 0.78; 95% CI, 0.62-0.98) lower risk of experiencing an ED/IP visit. No differences were observed for ED visits (HR = 0.94; 95% CI, 0.68-1.29). CONCLUSIONS: In Medicare-eligible asthma patients, FSC use was associated with lower rates of asthma-related serious exacerbations compared with ICS.

PMID: 23083688 [PubMed - as supplied by publisher]

Related Articles

Effect of an additional dose of indacaterol in COPD patients under regular treatment with indacaterol.

Respir Med. 2012 Oct 17;

Authors: Cazzola M, Segreti A, Stirpe E, Puxeddu E, Ora J, Rogliani P, Matera MG

Abstract
AIM: In this randomized, double-blind, crossover study, we explored the acute effects on respiratory function and safety of an additional dose of indacaterol 150 μg in stable COPD patients regularly treated with a conventional dose of indacaterol 150 μg. METHODS: On two non-consecutive days, patients inhaled indacaterol 150 μg. After 180 min, they inhaled an additional dose of indacaterol 150 μg or placebo. Lung function, oxygen saturation by pulse oximetry (SpO(2)) and heart rate were measured before the first drug administration and up to 360 min thereafter. RESULTS: In both treatment groups, indacaterol induced a significant (P < 0.05) bronchodilation during all the study time. The difference between the FEV(1) AUCs(0-180 min) was not statistically significant (P = 0.971). On the contrary, the difference between the FEV(1) AUCs(180-360 min) was significant (P < 0.0001). However, only 8 out of 20 patients showed a further increase of at least 100 ml from the peak obtained after the first administration of indacaterol 150 μg with the second dose of 150 μg. Indacaterol 150 μg induced a modest but significant decrease in SpO(2) up to 60 min and a second dose of indacaterol 150 μg significantly decreased the SpO(2) mean value up to 360 min. CONCLUSION: This study suggests that it is reasonable and safe to increase the dose of indacaterol in those stable COPD patients who are under regular therapy with indacaterol 150 μg from which they do not draw the maximum benefit because they are unable to perceive bronchodilation. However, only a minority of patients seem to benefit from this dose escalation, at least in terms of spirometric improvement.

PMID: 23083839 [PubMed - as supplied by publisher]