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Indacaterol. A long-acting beta-2 agonist, no advantages in COPD.

Indacaterol. A long-acting beta-2 agonist, no advantages in COPD.

Prescrire Int. 2011 Sep;20(119):201-5

Authors:

Abstract
In patients with chronic obstructive pulmonary disease (COPD), bronchodilator drugs have only modest symptomatic efficacy. There is no evidence that they slow disease progression. A short-acting beta-2 agonist such as salbutamol is the first-choice treatment, used either on demand or on a regular basis. Long-acting beta2 agonists are an option for patients with nocturnal symptoms. Indacaterol is a long-acting beta-2 agonist that is inhaled once a day. Indacaterol has not been compared with a short-acting beta-2 agonist. Clinical evaluation is based on 4 double-blind randomised placebo-controlled trials, 3 of which also included a group treated with another long-acting bronchodilator (formoterol, salmeterol or tiotropium. The symptomatic efficacy of indacaterol was only modest, and similar to that of other long-acting bronchodilators. Indacaterol has the known adverse effect profile of beta-2 agonists. Some adverse effects seem to be more frequent than with other long-acting bronchodilators, including post-inhalation cough, hyperglycaemia, respiratory tract infections, and possibly cardiac disorders. There is no evidence that once-daily inhalation has any advantages over twice-daily inhalation, even in terms of convenience. In addition, as efficacy is limited, there is a risk that patients will use the drug more frequently, resulting in additional adverse effects. The nebulizer used to inhale the powder in the capsules is similar to the one provided with Foradil (formoterol. In practice, indacaterol offers no therapeutic advantage over existing treatments for patients with COPD. It is better to use the best-documented drugs and, if necessary, to add non-drug measures. Eliminating exposure to toxic agents, especially tobacco smoke, remains the only treatment with a proven benefit on the course of COPD.

PMID: 21954512 [PubMed - in process]

The economic burden of chronic obstructive pulmonary disease.

The economic burden of chronic obstructive pulmonary disease.

Respirology. 2011 Sep 29;

Authors: Teo WS, Tan WS, Chong WF, Abisheganaden J, Lew YJ, Lim TK, Heng BH

Abstract
SUMMARY AT A GLANCE: The economic burden of COPD is poorly quantified and reported. We investigated the costs incurred in an Asian country (Singapore) at different care levels and researched the allocation of health care resources and related comorbidities. Inpatient admissions were the major cost driver and overall COPD represents a significant burden to the public health system. ABSTRACT: Background and objective:  The aim of this study was to estimate the direct medical costs of COPD in two public health clusters in Singapore from 2005 to 2009. Methods:  Patients aged 40 years and over, who had been diagnosed with COPD, were identified in a Chronic Disease Management Data-mart (CDMD). Annual utilization of health services in inpatient, specialist outpatient, emergency department (ED) and primary care settings was extracted from the CDMD. Trends in attributable costs, proportions of costs and health care utilization were analyzed across each level of care. A weighted attribution approach was used to allocate costs to each health care utilization episode, depending on the relevance of comorbidities. Results:  The mean total cost was approximately $9.9 million per year. Inpatient admissions were the major cost driver, contributing an average of $7.2 million per year. The proportion of hospitalization costs declined from 75% in 2005 to 68% in 2009. Based on the five-year average, attendances at primary care clinics, ED and specialist clinics contributed 3%, 5% and 17%, respectively, of overall COPD costs. On average, 42% of the total cost burden was incurred for the medical management of COPD. The share of cost incurred for the treatment of conditions related and unrelated to COPD were 29% and 26%, respectively, of the total average costs. Conclusions:  COPD is likely to represent a significant burden to the public health system in most countries. Our findings are particularly relevant to understanding the allocation of health care resources and informing appropriate cost containment strategies.

PMID: 21954985 [PubMed - as supplied by publisher]

Extrapulmonary comorbidities in chronic obstructive pulmonary disease: state of the art.

Extrapulmonary comorbidities in chronic obstructive pulmonary disease: state of the art.

Expert Rev Respir Med. 2011 Oct;5(5):647-62

Authors: Patel AR, Hurst JR

Abstract
Extrapulmonary comorbidities are common and significant in chronic obstructive pulmonary disease (COPD), often contributing to symptoms, exacerbations, hospital admissions and mortality. Cardiovascular, musculoskeletal and psychological conditions are among the most prevalent and important of these. In particular, ischemic heart disease is a leading cause of death in the COPD population as a whole. Here, we provide a state-of-the-art summary of key comorbidities observed in COPD patients in terms of their prevalence, impact, pathophysiology and prognosis. In addition, we review clinical, diagnostic and management strategies that may differ in COPD patients from the rest of the population.

PMID: 21955235 [PubMed - in process]

Adverse health consequences in COPD patients with rapid decline in FEV1 - evidence from the UPLIFT trial.

Adverse health consequences in COPD patients with rapid decline in FEV1 - evidence from the UPLIFT trial.

Respir Res. 2011 Sep 28;12(1):129

Authors: Kesten S, Celli B, Decramer M, Liu D, Tashkin D

Abstract
ABSTRACT: BACKGROUND: The rate of decline in forced expiratory volume in 1 second (FEV1) is representative of the natural history of COPD. Sparse information exists regarding the associations between the magnitude of annualised loss of FEV1 with other endpoints. METHODS: Retrospective analysis of UPLIFT(R) trial (four-year, randomized, double-blind, placebo-controlled trial of tiotropium 18 ug daily in chronic obstructive pulmonary disease [COPD], n = 5993). Decline of FEV1 was analysed with random co-efficient regression. Patients were categorised according to quartiles based on the rate of decline (RoD) in post-bronchodilator FEV1. The St George's Respiratory Questionnaire (SGRQ) total score, exacerbations and mortality were assessed within each quartile. RESULTS: Mean (standard error [SE]) post-bronchodilator FEV1 increased in the first quartile (Q1) by 37 (1) mL/year. The other quartiles showed annualised declines in FEV1 (mL/year) as follows: Q2 = 24 (1), Q3 = 59 (1) and Q4 = 125 (2). Age, gender, respiratory medication use at baseline and SGRQ did not distinguish groups. The patient subgroup with the largest RoD had less severe lung disease at baseline and contained a higher proportion of current smokers. The percentage of patients with [greater than or equal to] 1 exacerbation showed a minimal difference from the lowest to the largest RoD, but exacerbation rates increased with increasing RoD. The highest proportion of patients with [greater than or equal to] 1 hospitalised exacerbation was in Q4 (Q1 = 19.5% [tiotropium], 26% [control]; Q4 = 33.8% [tiotropium] and 33.1% [control]). Time to first exacerbation and hospitalised exacerbation was shorter with increasing RoD. Rate of decline in SGRQ increased in direct proportion to each quartile. The group with the largest RoD had the highest mortality. CONCLUSION: Patients can be grouped into different RoD quartiles with the observation of different clinical outcomes indicating that specific (or more aggressive) approaches to management may be needed. (ClinicalTrials.gov number, NCT00144339.).

PMID: 21955733 [PubMed - as supplied by publisher]

Noninvasive ventilation with helium-oxygen in children.

Noninvasive ventilation with helium-oxygen in children.

J Crit Care. 2011 Sep 27;

Authors: Martinón-Torres F

Abstract
Most existing literature on noninvasive ventilation (NIV) in combination with helium-oxygen (HELIOX) mixtures focuses on its use in adults, basically for treatment of acute exacerbations of chronic obstructive pulmonary disease. This article reviews and summarizes the theoretical basis, existing clinical evidence, and practical aspects of the use of NIV with HELIOX in children. There is only a small body of literature on HELIOX in pediatric NIV but with positive results. The reported experience focuses on treatment for patients with severe acute bronchiolitis who cannot be treated with standard therapies. The inert nature of helium adds no biological risk to NIV performance. Noninvasive ventilation with HELIOX is a promising therapeutic option for children with various respiratory pathologies who do not respond to conventional treatment. Further controlled studies should be warranted.

PMID: 21958976 [PubMed - as supplied by publisher]

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