Publication date: Available online 13 April 2014 Source:Respiratory Medicine

Author(s): Augustine S. Lee , Isabella Mira-Avendano , Jay H. Ryu , Craig E. Daniels

Idiopathic pulmonary fibrosis (IPF) is a fibrotic lung disease of unknown cause characterized by relentlessly progressive restrictive-ventilatory limitation, hypoxia, dyspnea, and cough. Both the incidence and prevalence of IPF appears to be increasing, with little impact on its dismal 3-year median survival, despite two decades of clinical trials. Increasingly recognized are the serious associated comorbid illnesses, including pulmonary hypertension, chronic obstructive pulmonary disease, gastroesophageal reflux disease, obstructive sleep apnea, obesity, lung cancer, and depression that further contribute to the substantial rise in the use of IPF-related healthcare resources. At present, lung transplantation remains the sole viable treatment for the few who qualify. Pharmacologic interventions targeting lung function and survival have remained largely disappointing, and very few investigations have specifically targeted comorbid conditions, symptoms, quality-of-life, and healthcare resource utilization. In reviewing the burden of illness associated with IPF, including the epidemiology, comorbidities, quality-of-life and the physical, psychosocial, and economic costs of this devastating disease, we hope to highlight some of the unmet medical needs associated with IPF, and encourage both public support and further investigations into these and other patient-centered outcomes and not just that of survival and lung function.

Publication date: May 2014 Source:Respiratory Medicine, Volume 108, Issue 5

Author(s): Luis Puente-Maestu , Myriam Calle , Ángel Ortega-González , Antonia Fuster , Cruz González , Eduardo Márquez-Martín , Pedro Jorge Marcos-Rodriguez , Carmen Calero , Juan Luis Rodríguez-Hermosa , Rosa Malo de Molina , Myriam Aburto , Patricia Sobradillo , Bernardino Alcázar , Gema Tirado-Conde

Chronic obstructive pulmonary disease (COPD) is frequently associated with chronic heart failure (CHF) or coronary artery disease (CAD). In spite of the recommendation to use beta-blockers (BB) they are likely under-prescribed to patients with concurrent COPD and heart diseases. To find out the prevalence of use of BB, 256 COPD patients were consecutively recruited by pulmonary physicians from 14 hospitals in 7 regions of Spain in their outpatient offices if they had a diagnosis of COPD, were not on long-term oxygen therapy, had CHF or CAD, and met the criteria for BB treatment. In patients with indication 58% (95%CI, 52–64%) of the COPD patients and 97% of the non-COPD patients were on BB (p < 0.001). In patients with COPD, several factors were independently related to at least one visit to the emergency room in the previous year such as use of BB, adjusted OR = 0.27 (95% CI 0.15–0.50), GOLD stage D, OR = 2.52 (1.40–4.53), baseline heart rate >70, OR 2.19 (1.24–3.86) use of long-acting beta2-agonists OR = 2.18 (1.29–3.68), previous episodes of left ventricular failure OR 2.27 (1.19–4.33) and diabetes, OR = 1.82 (1.08–3.38). We conclude that, according to what is recommended by current guidelines, BB are still under-prescribed in COPD patients. COPD patients with CHF or CAD using BB suffer fewer exacerbations and visits to the ER. GOLD stage, use of long-acting beta2-agonists, baseline heart rate and comorbidities are also risk factors for exacerbations in this population.

Publication date: April 2014 Source:Respiratory Medicine, Volume 108, Issue 4

Author(s): Helgo Magnussen , Henrik Watz , Anne Kirsten , Marc Decramer , Ronald Dahl , Peter M.A. Calverley , Lesley Towse , Helen Finnigan , Kay Tetzlaff , Bernd Disse

Long-acting bronchodilators in combination with inhaled corticosteroids (ICS) are recommended to decrease the risk of recurrent exacerbations in patients with Global initiative for chronic Obstructive Lung Disease (GOLD) stage 3–4 chronic obstructive pulmonary disease (COPD). There is increasing concern about the clinical benefit and long-term safety of ICS use in COPD patients. The WISDOM (Withdrawal of Inhaled Steroids During Optimised bronchodilator Management) study (NCT00975195) aims to evaluate the need for ICS use via stepwise withdrawal of ICS in COPD patients (GOLD 3–4 with a history of at least one exacerbation during the 12-month period prior to screening) receiving dual bronchodilation. During the 6-week run-in period, 2456 patients receive tiotropium 18 μg once daily, salmeterol 50 μg twice daily and fluticasone 500 μg twice daily. In a randomized, double-blind, parallel-group, active-controlled fashion, one group of patients continues to receive tiotropium, salmeterol and fluticasone, while the second group initiates stepwise withdrawal of fluticasone. The primary end point is time to first moderate or severe exacerbation following randomized treatment over 52 weeks. Lung function, symptoms and safety are also assessed. A sub-study aims to identify sub-populations and markers of steroid need. This study will determine the benefit of continued ICS therapy in combination with dual long-acting bronchodilators in COPD.

Publication date: May 2014 Source:Respiratory Medicine, Volume 108, Issue 5

Author(s): Jonathan A. Galli , Jason S. Krahnke , A. James Mamary , Kartik Shenoy , Huaqing Zhao , Gerard J. Criner

Rationale Patients with COPD and hypercapnic respiratory failure have a worse prognosis and experience a faster deterioration in their pulmonary function. The benefit of home NPPV following an acute exacerbation of COPD with hypercapnic respiratory failure is not well understood. Objectives To evaluate the effect of home NPPV use in patients following a hospitalization for AECOPD with acute hypercapnic respiratory failure on event-free survival after an index admission. Methods We conducted a retrospective, single-center, chart review on patients hospitalized in 2011 with a diagnosis of AECOPD, hypercapnia, and used NPPV during hospitalization. 166 patients were included and were divided into two groups: patients who used NPPV post discharge and patients who did not. Results Patients in the NPPV post discharge group demonstrated superior event-free survival compared to the no-NPPV post discharge group (х ² = 23.8, p < 0.0001). The NPPV post discharge group had a statistically significant reduction in hospital readmissions (40% versus 75%, p < 0.0001) through 180 days from the index admission. Conclusions Patients who used NPPV following an admission for AECOPD with hypercapnic respiratory failure had lower readmission rates and improved event-free survival after 180 days from an index admission compared to patients who did not use NPPV post discharge.