Lung disease experts at Johns Hopkins have made a call for greater caution for prescribing inhaled corticosteroids to people with COPD (chronic obstructive pulmonary disease). This call was made after evidence was found that the widely used anti-inflammatory medications tend to raise the risk of pneumonia by a full third.

It is believed that more than 11 million Americans are living with COPD and a vast majority of this population belongs to the former or current smokers’ category.

From News-Medical.Net:

Despite the increased pneumonia risk, the team found no clear evidence that the drug therapy also pushes up rates for other steroid-related problems, such as bone fractures, nor was there an increase in deaths.

Senior study investigator and critical care specialist Eddy Fan, M.D., says the results of the analysis should not alarm patients or cause them to stop taking their medications but should spur physicians to screen and monitor their patients to find the lowest possible steroid dose that works, especially in the elderly, people with immune system problems, and people who have had multiple bouts of pneumonia and for whom repeat bacterial infection might be a life-threatening complication.

“Inhaled corticosteroids are not of equal benefit to all, and what we are seeing is that the treatment may be more harmful and pose a greater risk of harm to some,” says Fan, an instructor at the Johns Hopkins University School of Medicine.

According to pulmonologist M. Brad Drummond, M.D., M.H.S., who led the study, these new findings are expected to serve as a reminder to all those people with severe lung disease to plan and take steps that can minimize the chances of getting pneumonia, which doubles their risk of dying.

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According to a London-based study, prolonged usage of a macrolide antibiotic could possible minimize exacerbations in patients with moderate to severe COPD (chronic obstructive pulmonary disease) by as much as 35 percent.

It was found that there is a significant effect of low-dose macrolide therapy, minimizing exacerbation frequency, and severity with moderate to severe COPD, according to lead author of the paper, Terence A. R. Seemungal, Ph.D., and Jadwiga Wedzicha, M.D., principle investigator.

From News-Medical.Net:

The researchers found that not only did the patients randomized to receive erythromycin have fewer exacerbations, but among the patients studied, 60 percent of the exacerbations that occurred were within the placebo group. While the number of exacerbation-related hospitalizations was small, more than twice as many occurred among the placebo group—14 versus 6. The median duration of exacerbations from onset to resolution of symptoms was 9 days in the erythromycin group and 13 days in the placebo group.

“Our results did not allow us to determine a mechanism for these findings. However based on in-vitro studies we suspect that the mechanism is likely to involve the anti-inflammatory properties of erythromycin,” noted Dr. Seemungal.

While their findings are encouraging, Dr. Seemungal points out that they must be put in context with future findings. Furthermore, the threat of growing antibiotic resistance resulting from widespread prophylactic use of erythromycin is not a trivial concern. “In this scenario, substantial, widespread emergence of macrolide bacterial resistance is virtually foreordained, with attendant reduction in the antimicrobial usefulness of this drug class,” wrote Ken M. Kunisaki, M.D. and Denise E. Niewoehner, M.D., of the Veterans Affairs Medical Center in Minneapolis, in the accompanying editorial. “Balancing benefit against harm could pose a dilemma for which there might be no clear answers.”

John Heffner, M.D., past president of the ATS, remarked observations that intervention might possibly reduce the frequency and severity of acute exacerbations in COPD showcase present significant public health implications.

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According to lung disease experts at Johns Hopkins, there is a great need for caution by physicians in prescribing inhaled corticosteroids for patients with COPD (chronic obstructive pulmonary disease). This finding was revealed after it was found out that anti-inflammatory medications increase the risk of pneumonia by a full third.

It is presently estimated that more than 11 million Americans, most of them former or current smokers, are suffering from COPD that is characterized by the fatal and lung-diminishing conditions of emphysema and chronic bronchitis.

From News-Medical.Net:

Senior study investigator and critical care specialist Eddy Fan, M.D., says the results of the analysis should not alarm patients or cause them to stop taking their medications but should spur physicians to screen and monitor their patients to find the lowest possible steroid dose that works, especially in the elderly, people with immune system problems, and people who have had multiple bouts of pneumonia and for whom repeat bacterial infection might be a life-threatening complication.

“Inhaled corticosteroids are not of equal benefit to all, and what we are seeing is that the treatment may be more harmful and pose a greater risk of harm to some,” says Fan, an instructor at the Johns Hopkins University School of Medicine.

“Physicians really need to strongly evaluate a patient’s individual characteristics before prescribing these steroid medications, and patients, in turn, should weigh the risks and benefits of taking the drugs, despite their proven record in providing symptomatic relief,” he says.

According to pulmonologist M. Brad Drummond, M.D., M.H.S., who led the study, “catching this bacterial infection can seriously disrupt quality of life, making it harder for COPD patients to breathe and possibly leading to hospitalization.”

Fan says that COPD is expected to become the third leading cause of death in the United States by 2020, behind heart ailments and cancer and ahead of stroke.

During the study, it was advised that physicians need to exercise a higher sense of caution than what is observed by them nowadays so that inhaled corticosteroids do not pose any danger to health of their patients. For this, patients and their families need to be made aware of the pros and cons of inhaled corticosteroid trearment.

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Scientists from the Imperial College, London have claimed that they are just one the verge of finding an amicable solution to one of the most common and fatal diseases in the UK - smokers lung - in relation to difficulties in treating it with a steroid treatment. In this regard, clinical trials of a potential therapy have already begun.

Chronic Obstructive Pulmonary Disease (COPD) – chronic bronchitis and emphysema, or ‘smoker’s lung’ - is responsible for affecting approximately 6 percent of UK’s population.

From News-Medical.Net:

Steroids would normally be effective at treating inflammatory diseases such as COPD. However, COPD patients do not respond to steroid therapy. This is a major clinical problem due to the prevalence of the disease and the fact that it gets progressively worse.

Inflammation is caused by cells producing certain chemical signals. They do this by ‘switching on’ specific genes. Switching these genes off – and stopping inflammation – requires an enzyme called Histone Deacetylase 2 (HDAC2).

Professor Peter Barnes and his colleagues discovered that steroids act as a ‘molecular bridge’ to recruit HDAC2 to the appropriate genes where it can act to switch them off.

The London researchers found that in COPD, levels of HDAC2 are very low compared to normal cells, so that the steroids have no effect in switching off the activated inflammatory genes.

They then found that in lung cells in vitro, and in rats, low doses of a cheap and widely available drug raised the levels of HDAC2 and broke the steroid resistance.

The first stages of clinical trials to test low doses of this drug, theophylline, in COPD patients are now underway. If successful, this may lead to a change in the treatment of COPD and other severe inflammatory diseases that do not respond well to steroid therapy.

Professor Peter Barnes and his colleagues found that steroids act a ‘molecular bridge’ in the recruitment of HDAC2 to the concerned genes where it can possibly act to switch them off. It was further found that low doses of theophylline can raise the levels of HDAC2 and break the resistance of steroids.

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A study claimed that taking inhaled corticosteroids may lower the risk of lung cancer among people with chronic obstructive pulmonary disease (COPD). Inhaled corticosteroids reduce inflammation in the airways thereby improving symptoms associated with the disease.

Researchers said inflammation in the lungs is thought to play an important role in both COPD and lung cancer, and the results suggest that daily use of inhaled corticosteroids may help fight inflammation and prevent the progression from COPD to lung cancer.

From Bio-Medicine:

The study conducted by the University of Washington suggests people who took at least 1,200 micrograms per day of inhaled corticosteroids had a 61% lower risk of developing lung cancer than non-users.

Researchers followed a group of more than 10,000 mostly older male U.S. veterans with COPD who were treated in Veterans Affairs primary care clinics from 1996 to 2001. Of these, 517 were regular users of inhaled corticosteroids as determined by records of pharmacy refills and were included in the study’s analysis.

The results, published in the American Journal of Respiratory and Critical Medicine, suggested that compared with non-users of corticosteroids, those who took 1,200 micrograms or more per day of inhaled corticosteroids were 61% less likely to develop lung cancer.

The researchers note that this is an observational study that “cannot conclude that [inhaled corticosteroids] reduce lung cancer” and that the results need confirmation. They also say no drugs have been clinically proven to prevent lung cancer among those at risk, but several are under investigation.

Previous studies have shown that inhaled corticosteroids reduce markers of inflammation such as C-reactive protein and reduce airway inflammation.

Smoking is a primary cause of COPD, which includes two inflammatory lung diseases that interfere with breathing: chronic bronchitis and emphysema. An estimated 11 million adults suffer from COPD which could lead to lung cancer.

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Scientists from the Imperial College, London have found the reason why lungs of smokers are resistant to steroid treatment along with finding a solution to this resistance.

Chronic Obstructive Pulmonary Disease (COPD) - ‘smoker’s lung’, or chronic bronchitis and emphysema - presently affects 6 percent population of the United Kingdom and is considered to be the fourth most common death cause in the land of the Queen.

It is seen that steroids are normally very effective in the treatment of inflammatory ailments such as COPD but some COPD patients do not respond as per expectations to steroid therapy.

From News-Medical.Net:

Professor Peter Barnes and his colleagues discovered that steroids act as a ‘molecular bridge’ to recruit HDAC2 to the appropriate genes where it can act to switch them off.

The London researchers found that in COPD, levels of HDAC2 are very low compared to normal cells, so that the steroids have no effect in switching off the activated inflammatory genes.

They then found that in lung cells in vitro, and in rats, low doses of a cheap and widely available drug raised the levels of HDAC2 and broke the steroid resistance.

The first stages of clinical trials to test low doses of this drug, theophylline, in COPD patients are now underway. If successful, this may lead to a change in the treatment of COPD and other severe inflammatory diseases that do not respond well to steroid therapy.

Professor Peter Barnes commented, ‘COPD kills tens of thousands of people in the UK every year and currently we can only treat the symptoms, not the underlying problem of inflammation of the lungs. Our work has finally provided an explanation for steroid resistance in COPD, and has allowed us to identify ways to combat this.

Professor Peter Barnes and his colleagues found out that steroid are effective in playing an active role for acting as a molecular bridge in the recruitment of Histone Deacetylase 2 (HDAC2), an enzyme, to the relevant genes where it can switch them off.

They also discovered that levels of HDAC2 were very low compared to normal cells in the COPD patients. This means that the steroids are no longer potent enough to have any effect in switching off the activated inflammatory genes. In this direction, a new steroid has been found that can raise the levels of HDAC2 and break the resistance of steroids.

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Lung Disease Experts at the Johns Hopkins have found evidence that inhaled corticosteroids can raise the risk of pneumonia by a full third in COPD (chronic obstructive pulmonary disease) patients. They advised physicians to be more careful before prescribing inhaled corticosteroids to these patients.

The involved researchers suspected that the corticosteroids tend to suppress the immune system of the body and are not sure how and why the corticosteroids’ treatment raises the risk of lung infection.

From News-Medical.Net:

“Physicians really need to strongly evaluate a patient’s individual characteristics before prescribing these steroid medications, and patients, in turn, should weigh the risks and benefits of taking the drugs, despite their proven record in providing symptomatic relief,” he says.

According to pulmonologist M. Brad Drummond, M.D., M.H.S., who led the study, “catching this bacterial infection can seriously disrupt quality of life, making it harder for COPD patients to breathe and possibly leading to hospitalization.”

Drummond says the new findings should serve as a reminder to people with the severe lung disease to take steps that reduce the chance of getting pneumonia, which doubles their risk of dying when compared to people with healthy lungs. He also advises COPD sufferers, in addition to weighing the benefits and harms of steroids, to get the pneumonia vaccination every five years and an annual flu vaccination because these shots reduce the chance of getting a lung infection.

A postdoctoral clinical research fellow at Hopkins, Drummond also advises lung disease sufferers to take additional precautions, including more frequent hand washing, and vigilant monitoring for the first and earliest signs of sickness, such as increased phlegm in the throat, shortness of breath, fever or chills.

Till Now, inhaled corticosteroids were being prescribed to the COPD patients by physicians to cure COPD symptoms such as phlegm, shortness of breath, physical exhaustion after a short exercise session, and wheezing.

Eddy Fan, M.D., senior study investigator, Johns Hopkins University School of Medicine and critical care specialist, said that there is no need to panic for patients but the physicians prescribing inhaled corticosteroids must be extra-cautious to screen and monitor the patients and must ascertain the lowest possible working doses of steroids.

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A study published in American Journal of Respiratory and Critical Care Medicine showed that patients with chronic obstructive pulmonary disease (COPD) who were prescribed with high dosage of inhaled corticosteroids are prone to develop greater risk of nonvertebral fractures than those who do not use inhaled corticosteroids.

According to Dr. Todd A. Lee, patients with COPD are frequently prescribed with inhaled corticosteroids (ICS) since it is the best option available. However, before the study the risks of having fractures associated with inhaled corticosteroids were unclear to these patients.

From Medscape CME:

From a cohort of 40,157 Veterans Affairs patients with a new diagnosis of COPD between Oct. 1, 1998. and Sept. 30, 1999, who were treated during a one-year follow-up, the investigators identified 1,708 cases with nonvertebral fractures and matched them to 6,817 control patients. Average age was 62.7 years, and 94% of patients were male. Prescription records were used to quantitate ICS exposure and to convert it to beclamethasone equivalents.

Conditional logistic regression models revealed that exposure to ICS at any time during follow-up was not associated with an increased fracture risk (adjusted odds ratio [OR], 0.97; 95% confidence interval [CI], 0.84 - 1.11). However, the risk of fracture was increased in current users of high-dose ICS (at least 700 µg daily) compared with patients with no exposure (adjusted OR, 1.68; 95% CI, 1.10 - 2.57).

“In patients with COPD, current use of high-dose ICS was associated with an increased risk of nonvertebral fractures,” the authors write. “The increase in the risk of fracture associated with ICS use found in this study does not by itself warrant the stopping of treatment in patients with COPD.

The results of the study suggest that inhaled corticosteroids need not to be stopped but rather prescribed the lowest effective dose of the medication to manage COPD.

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According to a new study published in the CHEST, a peer-reviewed journal of the American College of Chest Physicians (ACCP), patients with COPD (Chronic obstructive pulmonary disease) who use inhaled corticosteroids are believed to have a decreased mortality risk.

Christine Macie, MD, FCCP, Cambridge Hospital, Ontario, Canada and author of this study, remarked that the survival is longer in COPD patients who make use of inhaled corticosteroids.

From Bio-medicine.org:

“Our results indicate that the effect of inhaled corticosteroids is relatively short-term and that those currently using it are relatively better protected, ” said Dr. Macie. “Inhaled corticosteroids should be prescribed as soon as clinically indicated. By treating COPD with inhaled corticosteroids, we have the potential to reduce the effect and prolong life.”

“The findings from this study are intriguing for clinicians and point to the need for further research to define the role and mechanisms of the effect of inhaled corticosteroids on both cardiovascular and respiratory mortality,” said W. Michael Alberts, MD, FCCP, President of the ACCP.

Dr. Macie also remarked that patients who are using inhaled corticosteroids are relatively better protected than those not using it.

It was found during the study that patients receiving inhaled corticosteroids within thirty days of discharge from the hospital had a 25% reduced all-cause mortality rate. Furthermore, cardiovascular related deaths were reduced by as much as 38% in patients using corticosteroids paired with beta-agonists.

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