Effect of long-acting beta-agonists on the frequency of COPD exacerbations: a meta-analysis.

J Clin Pharm Ther. 2011 Jul 11;

Authors: Wang J, Nie B, Xiong W, Xu Y

What is Known and Objective:  Inhaled long-acting beta-agonists have been licensed for the treatment of chronic obstructive pulmonary disease (COPD) since the late 1990s, and they improve lung function and symptoms of dyspnoea. However, the evidence that long-acting beta-agonists alone can reduce the rate of COPD exacerbations is not conclusive. This meta-analysis was performed to evaluate their effect on the frequency of exacerbations. Methods:  MEDLINE, EMBASE, CINAHL and the Cochrane trials database were searched for the review. Randomized controlled trials of greater than or equal to 24 weeks' treatment duration comparing long-acting beta-agonists (LABAs) with placebo were reviewed. Studies were pooled to yield odds ratios (ORs) with 95% confidence intervals (CIs). Results and Discussion:  Seventeen randomized controlled trials (11871 randomized subjects) met the inclusion criteria and were selected for analysis. Salmeterol, formoterol and indacaterol significantly reduced COPD exacerbations compared with placebo. Salmeterol significantly reduced COPD exacerbations with both study arms exposed or not exposed to inhaled corticosteroids (ICS). The summary ORs were 0·79 (95% CI: 0·67-0·92; P < 0·01) and 0·80 (95% CI: 0·65-0·99; P = 0·04), respectively. However, when both arms were not exposed to ICS, there was no significant reduction in exacerbations with formoterol compared with placebo. The 'summary OR was 0·93 (95% CI: 0·75-1·15; P = 0·50). What is New and Conclusion:  Long-acting beta-agonists reduce the frequency of COPD exacerbations. Salmeterol, formoterol and indacaterol significantly reduced COPD exacerbations compared with placebo. Salmeterol but not formoterol decreased exacerbations significantly in the absence of ICS.

PMID: 21740451 [PubMed - as supplied by publisher]

Chester Step Test in Patients With COPD: Reliability and Correlation With Pulmonary Function Test Results.

Respir Care. 2011 Jul;56(7):995-1001

Authors: de Camargo AA, Justino T, de Andrade CH, Malaguti C, Dal Corso S

The 5-stage Chester step test assesses aerobic capacity in healthy subjects. It has not been tested in patients with COPD.

PMID: 21740727 [PubMed - in process]

[Anxiety and depression in COPD: A review.]

Rev Mal Respir. 2011 Jun;28(6):739-748

Authors: Ninot G

INTRODUCTION: COPD does not only affect the respiratory function of a patient. It also affects his/her cognitive and affective functions. These effects can be seen particularly in the incidence of anxiety and depressive disorders at different periods during the stage of the illness. This review of the literature suggests some contemporary definitions of these disorders, their link to COPD, and procedures for their assessment during clinical practice. BACKGROUND: The neurocognitive functions and the emotional resources of the patient are disturbed by the insidious development of COPD and the disabling effects that follow. The prevalence stands at 50% for anxiety disorders and 33% for depressive disorders. These symptoms deteriorate dyspnoea, reduce the exercise tolerance of patients, intensify the effects of fatigue, increase emotional instability, alter compliance, favor risk behavior in relation to health, and affect communication with caregivers. These symptoms also increase the annual number of exacerbations and hospitalizations. For practical purposes, while a semidirective clinical interview remains the better method to highlight the symptoms, the auto-questionnaire "hospitalization anxiety depression" has proved to be a reliable and sensitive tool. VIEWPOINTS: In patients who do not suffer from a major depressive or anxiety disorder (from a source external to COPD) anxiety and depressive symptoms reveal a lack of comprehension of the illness, difficulties in adjusting psychologically to the illness, misunderstanding and solitude. Except for serious cases, in which resort to medication is necessary, psychological support is a solution, therapeutic education, acceptance, behavior control through rehabilitation and development of the patient-caregiver relationship and networks. CONCLUSION: Anxiety and depressive disorders occur at any time in the life of a patient suffering from COPD. Health professionals should not neglect the signs, thinking them inevitable, attributing them to the personality of the patient, the natural evolution of the illness, or ageing. Therapeutic solutions exist.

PMID: 21742235 [PubMed - as supplied by publisher]

[Structural abnormalities and inflammation in COPD: A focus on small airways.]

Rev Mal Respir. 2011 Jun;28(6):749-760

Authors: Burgel PR, Bourdin A, Pilette C, Garcia G, Chanez P, Tillie-Leblond I

Chronic obstructive pulmonary disease (COPD) is characterized by poorly reversible airflow limitation associated with airway remodelling and inflammation of both large and small airways. The site of airflow obstruction in COPD is located in the small airways, justifying a focus on this compartment. The structural abnormalities that are found in bronchioles with a diameter less than 2mm are characterized by increased airway wall thickness with peribronchial fibrosis, and by luminal obstruction by mucous exudates. Destruction of alveolar walls, the hallmark of emphysema, may be related to protease-antiprotease imbalance, and to mechanisms involving apoptosis, senescence, and autoimmunity. Cigarette smoke inhalation triggers the recruitment of innate immune cells (neutrophils and macrophages) and putatively adaptive immunity mediated via T and B lymphocytes and lymphoid follicles in the small airways. These data suggest a potential role for therapies that can target remodelling and inflammation in the small airways of patients with COPD.

PMID: 21742236 [PubMed - as supplied by publisher]