New research points that a combination of inhaled steroids and long acting beta agonist (LABA) does not reduce the incidence of severe Chronic Obstructive Pulmonary Disease (COPD) exacerbations.

Further studies show that combined treatment increased the patient’s risk of developing pneumonia by 63 percent, viral respiratory infections by 22 percent and fungal infections in the mouth, such as oral thrush, by 59 percent.

However, the combination therapy significantly reduced the risk of moderate COPD flare-ups compared with single drug therapy.

Overall mortality rate was not reduced using the two-drug approach compared to the single drug therapy.

Dr. Gustavo J. Rodrigo from the Hospital Central de las Fuerzas Armadas in Montevideo, Uruguay, and his associates, reviewed the efficacy of the combination therapy versus the single drug therapy.

After this extensive systematic review, Dr. Rodrigo and associates pointed out the flaw in the current guidelines in treating patients with COPD. The drug combination is still being used for severe and very and severe COPD patients.

According to the authors, the benefits did not reach the suggested clinically important minimal differences.

They concluded that patients with severe COPD should be better treated with LABA alone, until further research would identify which type or severity of COPD would most likely benefit from the combined therapy.

From Reuters Health:

NEW YORK (Reuters Health) - In people who suffer from COPD, a progressive lung disease that makes it hard to breathe, adding an inhaled steroid to a so-called “long-acting beta-2 agonist” may do more harm than good, new research hints.

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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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According to researchers who are advocating the development and need of a triple inhaler, triple inhaled therapy (two bronchodilators and a steroid) is highly effective for treating COPD patients.

Study leader Professor Jadwiga Wedzicha, head of respiratory medicine at the Royal Free and University College Medical School in London, said that the findings are some of the most interesting results of all as all the concerned drugs have varying and possible synergistic clinical activities.

From Pulsetoday.co.uk:

Data from the INSPIRE trial, comparing salmeterol/fluticasone with tiotropium in 1,323 patients with severe COPD found exacerbation rates were similar between the two groups.

But the nature of the exacerbations seemed to differ between the two groups. Patients who suffered an exacerbation while using salmeterol/fluticasone were more likely to need antibiotics while thos eon tiotropium tended to be treated with steroids.

Study leader Professor Jadwiga Wedzicha, head of respiratory medicine at the Royal Free and University College Medical School in London, said: ‘This is possibly the most interesting result of all - that these drugs have different and possibly synergistic clinical activity.’

The study is expected to offer a new paradigm for helping COPD patients fight strongly against COPD, one of the most common ailments all over the world.

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According to a new research, prolonged pulmonary rehabilitation can prove out to be an effective option for ensuring a slowdown decline of lung function in COPD patients.

Study leader Dr David Stav, a pulmonary specialist from Tel Aviv University, Israel, said that 3 years of pulmonary rehab is effective since it offers innumerable benefits on the rate of FEV1 decline along with advantages of this treatment modality for patients.

From Pulsetoday.co.uk:

Their study is the first to show benefits of pulmonary rehabilitation for disease progression, with patients receiving the treatment having significantly better lung function than controls after three years.

Researchers randomised 80 patients with moderate to severe COPD to receive pulmonary rehabilitation or usual care, consisting of follow-up appointments with a pulmonary specialist every three months.

After three years, patients receiving pulmonary rehabilitation had a decline in FEV1 of 74ml, compared with 149ml in the control group.

The pulmonary rehabilitation group also had significantly improved exercise endurance, maximal sustained work limits and BMIs, compared with controls.

Study leader Dr David Stav, a pulmonary specialist from Tel Aviv University, Israel, said: ‘Three years of pulmonary rehabilitation has an important beneficial impact on the rate of FEV1 decline, in addition to previously reported advantages of this treatment modality for COPD patients.’

The results - published online by the journal BMC Pulmonary Medicine - are a boost for the Department of Health’s forthcoming clinical strategy for COPD, due to be released later this year, which is expected to focus on the patchy provision of pulmonary rehabilitation.

These findings are expected to offer a new paradigm when it comes to finding effective treatment ways to cure COPD patients.

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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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