Publication year: 2012
Source: Respiratory Medicine, Available online 15 February 2012

A.M. Moga, M. de Marchie, D. Saey, J. Spahija

Individuals with chronic obstructive pulmonary disease (COPD) are often limited in their ability to perform exercise due to a heightened sense of dyspnea and/or the occurrence of leg fatigue associated with a reduced ventilatory capacity and peripheral skeletal muscle dysfunction, respectively. Pulmonary rehabilitation programs have been shown to improve exercise tolerance and health related quality of life. Additional therapeutic approaches such as non-invasive ventilatory support (NIVS), heliox (He–O2) and supplemental oxygen have been used as non-pharmacologic adjuncts to exercise to enhance the ability of patients with COPD to exercise at a higher exercise-intensity and thus improve the physiological benefits of exercise. The purpose of the current review is to examine the pathophysiology of exercise limitation in COPD and to explore the physiological mechanisms underlying the effect of the adjunct therapies on exercise in patients with COPD. This review indicates that strategies that aim to unload the respiratory muscles and enhance oxygen saturation during exercise alleviate exercise limiting factors and improve exercise performance in patients with COPD. However, available data shows significant variability in the effectiveness across patients. Further research is needed to identify the most appropriate candidates for these forms of therapies.

Publication year: 2012
Source: Respiratory Medicine, Available online 20 February 2012

Guy Brusselle, Rudi Peché, Paul Van den Brande, Albert Verhulst, Wim Hollanders, ...

BackgroundThe efficacy and safety of extrafine beclomethasone dipropionate 100 μg/formoterol 6 μg (BDP/F HFA) pressurized metered dose inhaler (pMDI) in patients with moderate-to-severe persistent asthma, has been demonstrated in randomised controlled trials (RCTs). The aim of this prospective observational study was to assess real-life effectiveness in terms of asthma control in smoking (most of the time excluded from RCTs) and non-smoking asthmatics.MethodsAdult patients with persistent asthma, in whom treatment with an inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) combination is indicated, were included. Pulmonary function (FEV1%pred or PEF absolute value), Asthma Control Questionnaire (ACQ) and asthma control according to GINA criteria were measured at baseline as well as 2–8 months and >8–14 months after treatment initiation with BDP/F HFA.ResultsOverall, 619 patients were enrolled by 97 investigators. In the effectiveness cohort (N = 568), at baseline, smoking asthmatics (N = 123) had higher ACQ6 (p < 0.0001) and lower asthma control (p = 0.021) than non-smoking asthmatics. Treatment with BDP/F HFA pMDI was associated with significant (p < 0.0001) improvements in pulmonary function (+7.1% in FEV1% pred), ACQ6 (−1.32) and GINA asthma control (improvement of control in 49.8% of patients). Importantly, the same treatment benefits were observed in former or current smokers compared with non-smoking asthmatics. There was a reduction in the dose of ICS from 489 ± 192 μg BDP extrafine equivalents at baseline to 265 ± 125 μg after one year. The drug was well-tolerated.ConclusionThis prospective cohort study demonstrates the real-life effectiveness and safety of BDP/F HFA in adult asthma patients, including smokers, in normal clinical practice.

Publication year: 2012
Source: Respiratory Medicine, Available online 21 February 2012

Katja Rudell, Asha Hareendran, Nikki Bonner, Rob Arbuckle, Claire Burbridge, ...

BackgroundClinical guidelines consider the concept of ‘asthma control’ as the primary goal of asthma treatment. This study aimed to explore patients’ views of concepts that are important for understanding and evaluating asthma control.MethodsPatients with mild to severe asthma in four countries completed the Asthma Control Questionnaire (ACQ) and discussed their experiences in focus groups. Clinicians evaluated patients’ levels of asthma control based on Global Initiative for Asthma (GINA) guidelines. Clinician- and questionnaire-based ratings of asthma control were compared. Thematic analysis was used to identify key concepts from focus group transcripts.ResultsThe sample consisted of 55 patients. Classification of asthma control, based on the ACQ, was consistent with clinician rating in 28 cases (51%). In focus groups, patients discussed concepts related to symptoms, asthma attacks (exacerbations), activity limitations, panic/fear, tiredness, sleep disturbances (nocturnal awakening and difficulty falling asleep), and rescue medication use when describing asthma control. Clinical guidelines also focus on symptoms, activity limitations, rescue medication use, and exacerbations but, in addition include lung function parameters. Guidelines do not take into account asthma-related panic/fear or tiredness and sleep disturbances beyond nocturnal awakening.ConclusionThe results of this study suggest that patients’ understanding of asthma control extends beyond the usual clinical manifestation of respiratory symptoms and lung function. This may have implications for clinical practice, for setting and achieving the goals of asthma control as well as for evaluation of treatments for asthma from the patients’ perspective.

Conclusions COPD exacerbations exhibit two distinct patterns—sudden and gradual onset. Sudden onset exacerbations are associated with increased respiratory symptoms but shorter exacerbation recovery times. (Source: Thorax)