Inhaling corticosteroids can elevate chances of being diagnosed with type 2 diabetes, according to investigators from the Jewish General Hospital’s Lady Davis Institute for Medical Research (LDI) in Montreal.

The investigators’ findings suggested that asthmatics and those suffering from chronic obstructive pulmonary disorder (COPD) taking corticosteroids may be at a considerable risk.

From Healthjockey.com:

Dr. Samy Suissa, Director of the Centre for Clinical Epidemiology at the LDI, and lead investigator, highlighted, “These are not insubstantial numbers. Over a large population the absolute numbers of affected people are significant. We recommend that physicians reserve the use of inhaled steroids for the patients who truly benefit from these medications, namely asthmatics, and curb their use in COPD to the few patients for whom they are indicated. In all cases, patients using high doses should be assessed for possible hyperglycemia and the lowest effective dose targeted.”

The study was published in the American Journal of Medicine.

Tags: COPD, corticosteroids, Inhaled steroids

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The use of corticosteroids is effective for reducing the morbidity and mortality of severe bacterial pneumonia, Dr. Antoni Torres said at the 12th International Congress on Infectious Diseases.

The finding was supported by results from two positive randomized trials, multiple observational studies, and animal models.

From Internalmedicinenews.com:

A prospective observational study by Dr. Torres and his coworkers involving 1,424 CAP patients hospitalized at 15 medical centers was among the work that fanned interest in the use of steroids in pneumonia. In that study, 15% of the patients experienced empirical treatment failure, which was associated with an adjusted 11-fold increase in hospital mortality.

The independent risk factors for treatment failure included multilobar CAP, radiologic cavitation, pleural effusion, liver disease, leukopenia, and pneumonia risk class (Thorax 2004;59:960–5).

However, it was the factors identified as protective against treatment failure, such as influenza vaccination, initial treatment with a fluoroquino-lone, and especially chronic obstructive pulmonary disease (COPD), that caught the researchers’ attention. Dr. Torres and his coworkers hypothesized that COPD‘s protective effect might involve the use of steroids in affected patients.

The first randomized trial was a multicenter, double-blind, Italian study involving 46 patients with severe CAP on placebo or 200 mg of hydrocortisone as an IV bolus, followed by 7 days of therapy at 10 mg/hour.

Tags: COPD, corticosteroids, steroids, use of steroids

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In a large 12-month randomized trial, Roflumilast was found effective for improving lung function and prevent exacerbations in patients with COPD with chronic bronchitis and severe airflow obstruction.

Dr. Andrew McIvor said at the annual meeting of the American College of Chest Physicians that results of the 1,568-patient, double-blind, placebo-controlled study known as the M2-125 trial indicate that roflumilast is an important potential advance in the treatment of a subset of patients with COPD.

From Internalmedicinenews.com:

Participants in the eight-nation M2-125 trial had to have at least one documented moderate or severe COPD exacerbation during the year prior to enrollment. They were randomized to roflumilast 500 mcg once daily or placebo for 1 year, on top of background long-acting beta2-agonist or short-acting anticholinergic therapy at stable doses, along with short-acting beta2-agonists as needed. Long-acting anticholinergics and inhaled corticosteroids were not permitted.

The rate of moderate to severe COPD exacerbations requiring systemic steroids and/or treatment in a hospital—one of two co-primary study end points—was 1.21 cases per patient per year in the roflumilast group and 1.49 in controls, for a highly significant 18.5% relative risk reduction.

The other primary end point was improvement in lung function as reflected in mean change from baseline in forced expiratory volume in 1 second (FEV1) prior to administration of a bronchodilator.

Again, roflumilast showed a highly significant advantage, with a 33-mL increase in FEV1 as compared to a 25-mL decrease with placebo over the course of 12 months.

Dr. McIvor of St. Joseph’s Healthcare Hamilton (Ont.) explained that Roflumilast (Daxas) is an investigational selective phosphodiesterase 4 inhibitor that can target the inflammation that is a hallmark of the disease when taken daily in an oral form.

Tags: COPD, corticosteroids, Roflumilast, steroids

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Significant reductions in mortality rate can be noticed in COPD (chronic obstructive pulmonary disease) patients when inhaled corticosteroids are used.

This finding was disclosed by a study appearing in an issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP).

From Sciencedaily.com:

Dr. Macie and colleagues found that the mortality rates in patients 65+ who received inhaled corticosteroids were 11.7 percent, compared with 13.1 percent for those who did not. Patients in the younger group showed even greater results, with a mortality rate of 3.0 percent for patients receiving inhaled corticosteroids within 90 days, compared with 6.0 percent for those who did not, providing a mortality reduction rate of 53 percent. When patients who received steroids in the year prior were removed from the analysis, mortality was reduced by 34 percent. Researchers attribute this finding to multifactorial reasons, including reductions in exacerbations of the disease and suppression of inflammation.

Researchers also found a 23 percent reduced risk of death when comparing the effects of inhaled steroids with bronchodilators in patients in the 65+ group. In all cases, the most significant results were found when inhaled corticosteroids were administered within the first 30 days following hospital discharge.

It was reported by this study that individuals making use of steroids paired with beta-agonists demonstrated a fall in cardiovascular-related death alone by 38 percent.

Tags: chronic obstructive pulmonary disease, COPD, corticosteroids, steroids, use of steroids

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According to a study appearing in an issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), mortality rate can be significantly reduced in COPD (chronic obstructive pulmonary disease) patients when inhaled corticosteroids are used.

The study reported that patients making use of steroids paired with beta-agonists experienced a fall in cardiovascular-related death alone by 38 percent.

From Sciencedaily.com:

Dr. Macie and colleagues found that the mortality rates in patients 65+ who received inhaled corticosteroids were 11.7 percent, compared with 13.1 percent for those who did not. Patients in the younger group showed even greater results, with a mortality rate of 3.0 percent for patients receiving inhaled corticosteroids within 90 days, compared with 6.0 percent for those who did not, providing a mortality reduction rate of 53 percent. When patients who received steroids in the year prior were removed from the analysis, mortality was reduced by 34 percent. Researchers attribute this finding to multifactorial reasons, including reductions in exacerbations of the disease and suppression of inflammation.

Researchers also found a 23 percent reduced risk of death when comparing the effects of inhaled steroids with bronchodilators in patients in the 65+ group. In all cases, the most significant results were found when inhaled corticosteroids were administered within the first 30 days following hospital discharge.

W. Michael Alberts, MD, FCCP, President of the ACCP, said the study findings are intriguing for clinicians and suggest the need of future research for defining the roles and mechanisms of the effect of inhaled steroids on both cardiovascular and respiratory mortality.

Tags: chronic obstructive pulmonary disease, COPD, corticosteroids, steroids, use of steroids

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A potential form of treatment in context of one of the most common and fatal diseases in the UK – smokers lung – is about to be identified by scientists from the Imperial College, London that can solve problems in treatment with steroids.

Chronic Obstructive Pulmonary Disease (COPD) – chronic bronchitis and emphysema, or ‘smoker’s lung’, is considered to affect approximately 6 percent of population in the United Kingdom.

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.

It was discovered by Professor Peter Barnes and his colleagues that steroids play the role of molecular bridges for recruiting HDAC2 in the context of respective genes where they can be made to switch off.

Tags: COPD, smokers lung, steroid therapy, steroids

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Reduced mortality risk can be noticed in patients afflicted with chronic obstructive pulmonary disease (COPD) when they are treated with inhaled steroids.

It was remarked by Christine Macie, MD, FCCP, Cambridge Hospital, Ontario, Canada and author of the study that patients on steroids are relatively better protected than those not making use of them.

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 inhaled corticosteroids could be highly effective to prolong lives of patients with COPD.

Tags: chronic obstructive pulmonary disease, COPD, inhaled corticosteroids, steroids

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According to Lung disease experts at Johns Hopkins, physicians treating their patients afflicted with COPD (chronic obstructive pulmonary disease) need to observe extra caution while dealing with them.

It was remarked by lead author and pulmonologist M. Brad Drummond, M.D., M.H.S. that this finding has implications and serves a reminder to COPD patients so that they could take necessary preventive steps for avoiding pneumonia, which doubles their risk of death.

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.

As many as 11 million Americans are afflicted with COPD every year and a big majority of this population belongs to the category of past or present-day smokers.

Tags: chronic obstructive pulmonary disease, COPD, corticosteroids, inhaled corticosteroids, pneumonia, steroid

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Chronic obstructive pulmonary disease (COPD), which is one of the five leading causes of death worldwide, is characterized by an inflammatory response to inhaled fumes such as tobacco smoke that results in breath shortness, limited airflow, and loss of lung function.

Fluticasone propionate, which is an inhaled steroid, could minimize the ability of major pathogens for invading the respiratory epithelium, as per a study by Sebastian Albertí (Institut Universitari d’Investigacions en Ciències de la Salut, IUNICS, Palma de Mallorca, Spain) and colleagues.

From Medicalnewstoday.com:

Patients affected by COPD often suffer episodes of worsening of symptoms called acute exacerbations, mostly caused by bacterial infections. These episodes of exacerbation impact negatively on the health status of the patients, worsen their prognosis and are associated with a very significant social and economic cost.

Treatment with inhaled steroids, such as fluticasone propionate, reduces the frequency and severity of acute exacerbations in patients with COPD, but their role in controlling bacterial infection is controversial.

In healthy subjects the lung is sterile, but in patients with COPD it is not and bacteria like S. pneumoniae and H. influenzae is frequently isolated.

Findings of the study are expected to provide implications to physicians all over the world when it comes to treating COPD patients.

Tags: chronic obstructive pulmonary disease, COPD, fluticasone propionate, inhaled steroid, steroids

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Patients afflicted with chronic obstructive pulmonary disease or COPD can be effectively treated and experienced reduced mortality risk when treated with inhaled corticosteroids, as per a study appearing in the CHEST, which is a peer-reviewed journal of the American College of Chest Physicians (ACCP).

COPD patients who make use of inhaled corticosteroids benefit from improved survival rates as per Christine Macie, MD, FCCP, Cambridge Hospital, Ontario, Canada and author of this study.

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.

COPD patients administered with inhaled steroids are relatively in a better position than those not using it, as per Dr. Macie. It was also revealed in the study that cardiovascular related deaths were reduced by as much as 38% and a 25% reduced all-cause mortality rate was noticed among patients administered with inhaled corticosteroids within thirty days of discharge from the hospital.

Tags: chronic obstructive pulmonary disease, COPD, inhaled corticosteroids, steroids

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