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Geographic isolation and the risk for chronic obstructive pulmonary disease-related mortality: a cohort study.

Geographic isolation and the risk for chronic obstructive pulmonary disease-related mortality: a cohort study.

Ann Intern Med. 2011 Jul 19;155(2):80-6

Authors: Abrams TE, Vaughan-Sarrazin M, Fan VS, Kaboli PJ

Background: Little is known about the possible differences in outcomes between patients with chronic obstructive pulmonary disease (COPD) who live in rural areas and those who live in urban areas of the United States. Objective: To determine whether COPD-related mortality is higher in persons living in rural areas, and to assess whether hospital characteristics influence any observed associations. Design: Retrospective cohort study. Setting: 129 acute care Veterans Affairs hospitals. Patients: Hospitalized patients with a COPD exacerbation. Measurements: Patient rurality (primary exposure); 30-day mortality (primary outcome); and hospital volume and hospital rurality, defined as the mean proportion of hospital admissions coming from rural areas (secondary exposures). Results: 18 809 patients (71% of the study population) lived in urban areas, 5671 (21%) in rural areas, and 1919 (7%) in isolated rural areas. Mortality was increased in patients living in isolated rural areas compared with urban areas (5.0% vs. 3.8%; P = 0.002). The increase in mortality associated with living in an isolated rural area persisted after adjustment for patient characteristics and hospital rurality and volume (odds ratio [OR], 1.42 [95% CI, 1.07 to 1.89]; P = 0.016). Adjusted mortality did not seem to be higher in patients living in nonisolated rural areas (OR, 1.09 [CI, 0.90 to 1.32]; P = 0.47). Results were unchanged in analyses assessing the influence of an omitted confounder on estimates. Limitations: The study population was limited to mostly male inpatients who were veterans. Results were based on administrative data. Conclusion: Patients with COPD living in isolated rural areas of the United States seem to be at greater risk for COPD exacerbation-related mortality than those living in urban areas, independent of hospital rurality and volume. Mortality was not increased for patients living in nonisolated rural areas. Primary Funding Source: U.S. Department of Veterans Affairs.

PMID: 21768581 [PubMed - in process]

Handgrip strength measurement as a predictor for successful dry powder inhaler treatment : Application in older individuals with COPD.

Handgrip strength measurement as a predictor for successful dry powder inhaler treatment : Application in older individuals with COPD.

Z Gerontol Geriatr. 2011 Jul 17;

Authors: Frohnhofen H, Hagen O

BACKGROUND: More than 10% of elderly people suffer from chronic obstructive pulmonary disease (COPD). Drug treatment for COPD involves inhalants. Dry powder inhalers (DPIs) have proven easiest for the elderly to use. Their effectiveness is dependent, however, on the inspiratory flow which can be generated, and it is unclear which geriatric assessment parameter permits inspiratory flow to be assessed. METHODS: In a randomly generated group of geriatric hospital patients, manual strength was measured as a complement to basic geriatric assessment and inspiratory flow assessed using a Turbohaler trainer. RESULTS: A total of 87 (27%) men (mean age 81±7 years) and 231 (73%) women (mean age 82±8 years) were included in the study. The threshold value of 40 l/min for minimum inspiratory flow was achieved by 194 (61%) of the patients. Manual strength was the only assessment parameter to correlate with the minimum inspiratory flow achieved. ROC analysis produced a threshold value for manual strength of 10 kg. The sensitivity and specificity for this threshold value were 70% each, while the positive and negative predictive values were 79% and 84%, respectively. CONCLUSION: A threshold value of 10 kg for manual strength enables the inspiratory flow achievable by elderly patients to be predicted satisfactorily. This is the only parameter which correlates sufficiently with inspiratory flow. Manual strength should be measured in all geriatric patients with COPD and should be taken into account when deciding whether or not to initiate differential treatment.

PMID: 21769511 [PubMed - as supplied by publisher]

Therapeutic Decision-Making for Sleep Apnea and Hypopnea Syndrome Using Home Respiratory Polygraphy: A Large Multicentric Study.

CONCLUSION: The HRP-based therapeutic decision was adequate when AHI was high, but deficient in the large population of patients with mild to moderate AHI. Therefore, both selecting patients with a high suspicion/severity of SAHS and future prospective cost-effectiveness studies are necessary. PMID: 21737584 [PubMed - as supplied by publisher] (Source: American Journal of Respiratory and Critical Care Medicine)

Matrix Elastin: A Promising Biomarker for COPD.

Authors: Turino GM, Ma S, Lin YY, Cantor JO, Luisetti M Chronic Obstructive Pulmonary Disease (COPD) is a major health problem worldwide and is now the third leading cause of death in the U.S. There is a lack of therapies which can stop progression of the disease and improve survival. New drug discovery can be aided by the development of biomarkers which can act as indicators of severity in the course of the disease and responses to therapy. This perspective brings together the laboratory and clinical evidence which suggests that elastin degradation products can fulfill the need for such a biomarker. Elastin is a recognized target for injury in COPD. The amino acids, desmosine and isodesmosine (DI) exist only in matrix elastin, can be measured specifically and sensitively in plasma, ur...

Asthma control in patients receiving inhaled corticosteroid and long-acting beta2-agonist fixed combinations. A real-life study comparing dry powder inhalers and a pressurized metered dose inhaler extrafine formulation.

Background: Although patients have more problems using metered dose inhalers, clinical comparisons suggest they provide similar control to dry powder inhalers. Using real-life situations this study was designed to evaluate asthma control in outpatients with moderate to severe persistent asthma and to compare efficacy of fixed combinations of inhaled corticosteroids (ICS) and long acting beta-agonists (LABA). Methods: This real-life study had a cross-sectional design. Patients using fixed combinations of ICS and LABA had their asthma control and spirometry assessed during regular visits. Results: 111 patients were analyzed: 53 (47.7%) received maintenance therapy of extrafine beclomethasone-formoterol (BDP/F) pressurized metered dose inhaler (pMDI), 25 (22.5%) fluticasone-salmeterol (FP/S) dry powder inhaler (DPI), and 33 (29.7%) budesonide-formoterol (BUD/F) DPI. Severity of asthma at time of diagnosis, assessed by the treating physician, was comparable among groups. Asthma control was achieved by 45.9% of patients; 38.7% were partially controlled and 15.3% were uncontrolled. In the extrafine BDF/F group, asthma control total score, daytime symptom score and rescue medication use score were significantly better than those using fixed DPI combinations (5.8+/-6.2 vs. 8.5+/-6.8; 1.4+/-1.8 vs. 2.3+/-2.1; 1.8+/-2.2 vs. 2.6+/-2.2; p=0.0160; p=0.012 and p=0.025, respectively) and the mean daily ICS dose were significantly lower. Conclusions: pMDI extrafine BDP/F combination demonstrated better asthma control compared to DPIs formulated with larger particles. This could be due to the improved lung deposition of the dose or less reliance on the optimal inhalation technique or both.Key words: inhaler, fixed combinations, asthma control, extrafine.

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