Exacerbations in patients suffering from moderate to severe COPD (chronic obstructive pulmonary disease) could be reduced by as much as 35 percent with use of macrolide antibiotic in the long run, as per a London-based study.

John Heffner, M.D., past president of the ATS, said that intervention could minimize the severity and frequency of acute exacerbations in COPD suggesting significant public health implications.

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.”

The study disclosed that macrolide therapy involving low doses can be useful to reduce frequency of exacerbations 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.

Tags: COPD, erythromycin, exacerbations

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Reduced mortality risk is experienced in patients with COPD (Chronic obstructive pulmonary disease) who are administered with inhaled corticosteroids. This finding was disclosed in a study published in the CHEST, peer-reviewed journal of the American College of Chest Physicians (ACCP).

It was said by Christine Macie, MD, FCCP, Cambridge Hospital, Ontario, Canada and author of the study that inhaled corticosteroids are effective in prolonging lives of patients with COPD.

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 who are using inhaled corticosteroids are relatively better protected than those not making use of them, as per Dr. Macie.

Tags: chronic obstructive pulmonary disease, COPD, inhaled corticosteroids

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According to a London-based study, frequency of exacerbations in patients with moderate to severe chronic obstructive pulmonary disease (COPD) can be reduced by almost 35 percent with the use of a macrolide antibiotic in the long term.

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

From News-Medical.Net:

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.”

Moreover, not all of the study patients were treated with guideline-recommended therapy, such as inhaled corticosteroids or inhaled long-acting bronchodilators, which have been shown to decrease exacerbation frequency. The degree of added benefit of erythromycin over and above standard therapy will require further study.

“Observations that any intervention might decrease the frequency and severity of acute exacerbations in COPD present considerable public health implications,” observed John Heffner, M.D., past president of the ATS. “Exacerbations occur about once a year among patients with moderate to severe COPD and account for more than $30 billion dollars in direct and indirect costs annually in the United States alone.”

The study results were published in the first issue for December of the American Journal of Respiratory and Critical Care Medicine, which is published by the American Thoracic Society.

Tags: chronic obstructive pulmonary disease, COPD, corticosteroids, exacerbations

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Vinpocetine, a natural product derived from the periwinkle plant, can one day be used as a novel anti-inflammatory agent for treating inflammatory conditions such as chronic obstructive pulmonary disease, or COPD.

There is an urgent need for developing new and safe therapies for treating inflammatory diseases as the commonly used agents of today such as steroids can result in severe side effects including damage to the liver.

From Sciencedaily.com:

Vinpocetine is a well-known natural product that was originally discovered nearly 30 years ago and is currently used as a dietary supplement for the prevention and treatment of cognitive disorders, such as stroke and memory loss, in Europe, Japan and China. The therapy has no evidence of toxicity or noticeable side effects in human patients. Scientists at the University of Rochester hope to reposition this compound as an anti-inflammatory agent for the treatment of COPD, and potentially other inflammatory conditions, such as asthma, otitis media, rheumatoid arthritis, atherosclerosis and psoriasis in the future.

While steroids successfully combat inflammation, patients often pay a high price when it comes to side effects. Steroids can cause liver damage, and can also suppress the immune system, increasing the likelihood of infections. With such a high risk profile, steroids are usually only used for a short period of time, which is problematic when treating chronic diseases.

“In managing chronic conditions such as COPD, it is crucial to have a therapy that can be used safely over the long term,” said Jian-Dong Li, M.D., Ph.D., professor in the Department of Microbiology and Immunology at the University of Rochester Medical Center and a senior author of the study. “There is a great need for a drug like vinpocetine, because patients currently have no good options when it comes to long-term care.”

This finding was disclosed in a study that was published May 3 in the Proceedings of the National Academy of Sciences.

Tags: COPD, periwinkle, steroids, Vinpocetine

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Medical practitioners generally recommend inhaled steroids to patients affected by Chronic Obstructive Pulmonary Disease (COPD) but a study has found out that these anti-inflammatory drugs could increase the risk of pneumonia.

It was remarked by the researchers that present inhaled corticosteroid use was linked with a significant 70 percent increase in the risk of being hospitalization for pneumonia. This remark came after evaluating a large cohort of patients with COPD.

From Sciencedaily.com:

Pierre Ernst, M.D., a clinical epidemiologist at McGill University, Canada, along with three other researchers from the university’s department of medicine, analyzed the hospitalization and drug prescription information from 1988 to 2003 of 175,906 patients with COPD living in Quebec, Canada. During that time, 23,942 of the patients were hospitalized for pneumonia.

In their report, the researchers noted that the admission rate for pneumonia increased with higher doses of inhaled steroids and that reduction in risk was observed once the medications were stopped. Among all patients taking inhaled steroids, there was a 53 percent increase in pneumonia deaths within 30 days of being admitted to the hospital.

The investigators noted that these findings are particularly relevant, given that pneumonia is the third leading cause of hospitalization in the United States and that inhaled corticosteroid use among patients with COPD increased from 13.2 to 41.4 percent from 1987 to 1995.

These findings were reported in the second issue of the July American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

Tags: chronic obstructive pulmonary disease, COPD, Inhaled steroids, steroids

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A great sense of caution has been recommended by lung disease experts at John Hopkins when it comes to prescribing inhaled corticosteroid drugs to patients with chronic obstructive pulmonary disease (COPD).

This caution call was made after evidence was found suggesting that a widely used anti-inflammatory medication increases the risk of pneumonia by a full third.

It was remarked by the researchers that it is not clear why the corticosteroid treatment increases the risk but it is suspected that it is because corticosteroids suppress the immune system.

From Sciencedaily.com:

In breaking down the overall rise in risk, the researchers found that in people taking the highest possible dose of each inhaled corticosteroid, there was a 46 percent increase in risk for pneumonia. Infection risk nearly doubled in those who had less than 40 percent normal lung function, as opposed to those whose lungs were stronger.

Drummond says the absence of an overall difference in death rates between users and non-users of corticosteroids was likely due to the short-term follow-up of three years or less across all of the studies.

Fan says further research is needed to identify precisely which groups benefit long-term and which ones do not from inhaled corticosteroids, and to see if there is a link between higher risk and death.

He notes that COPD kills more than 120,000 Americans every year and is expected to become the nation’s third leading cause of death in the United States by 2020, ahead of stroke and behind heart disease and cancers.

Funding for this latest study was provided by The Johns Hopkins Hospital’s General Clinical Research Center.

Pulmonologist M. Brad Drummond, M.D., M.H.S., led the study and was supported by Eddy Fan, M.D.; other researchers involved in this study, conducted solely at Hopkins, were Elliott Dasenbrook, M.D., M.H.S.; Marshall Pitz, M.D., M.H.S., now at the University of Manitoba, in Winnipeg, Canada; and David Murphy, M.D.

Tags: chronic obstructive pulmonary disease, COPD, corticosteroid, corticosteroid drugs, corticosteroids

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More and more patients suffering from Chronic Obstructive Pulmonary Disease (COPD) are relying upon inhaled corticosteroids for controlling exacerbations of the disease but this practice does not get any support from a recent study.

The study found out that the anti-inflammatory drugs increase the risk of pneumonia development in such patients leading them to face hospitalization.

From Bio-Medicine.Org:

In their report, the researchers noted that the admission rate for pneumonia increased with higher doses of inhaled steroids and that reduction in risk was observed once the medications were stopped. Among all patients taking inhaled steroids, there was a 53 percent increase in pneumonia deaths within 30 days of being admitted to the hospital.

The investigators noted that these findings are particularly relevant, given that pneumonia is the third leading cause of hospitalization in the United States and that inhaled corticosteroid use among patients with COPD increased from 13.2 to 41.4 percent from 1987 to 1995.

Adverse effects of inhaled corticosteroids in patients with COPD, the authors said, are particularly troublesome given the limited evidence for their efficacy.

Pierre Ernst, M.D., a clinical epidemiologist at McGill University, Canada, along with three other researchers from the university’s department of medicine, analyzed hospitalization and drug prescription information from 1988-2003 of 175,906 patients with COPD and living in Quebec, Canada.

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

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Patients with COPD (Chronic obstructive pulmonary disease) and being administered with inhaled corticosteroids experienced lower mortality risk than their counterparts not on steroids, as per a new study published in the CHEST, peer-reviewed journal of the American College of Chest Physicians (ACCP).

It was remarked by Christine Macie, MD, FCCP, Cambridge Hospital, Ontario, Canada and author of this study that COPD patients on corticosteroids benefit from longer survival durations.

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 said that patients on inhaled corticosteroids are relatively better positioned to stay protected than those not using them.

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

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Hospital admissions can be reduced significantly among people with chronic obstructive pulmonary disorder (COPD) because of self-management education programs, as per report by researchers in a new systematic review of studies.

Lead author Tanja Effing, an institutional researcher in the department of pulmonary medicine at the Medisch Spectrum Twente, a hospital in Enschede, the Netherlands, said that the most important finding is that self-management education is associated with significant and is clinically relevant for reductions in hospital admissions.

From News-Medical.Net:

People with COPD suffer from abnormalities in the lungs that make it difficult for them to breathe. Generally, two distinct diseases are involved: emphysema and chronic bronchitis. According to the World Health Organization, 75 percent of deaths from COPD that occur in developed countries relate directly to smoking.

Those who develop COPD often must undergo major adjustments. They might have to “wear” oxygen — that is, carry supplemental oxygen tanks — wherever they go. They must cope with side effects from steroids – usually prednisone – used to treat the chronic disease and from antibiotics prescribed for infections to which COPD patients are prone.

Their roles at work and home can change dramatically, as they lose the stamina needed to perform their usual tasks and leisure activities requiring physical exertion leave them short of breath. In addition, COPD patients can find themselves becoming regular visitors to hospital emergency rooms.

The review appeared in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, which is an international organization examining medical research.

Tags: bronchitis, Chronic Obstructive Pulmonary Disorder, COPD, emphysema, Prednisone, steroids

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A mechanism that increases lung inflammation to make Chronic Obstructive Pulmonary Disorder (COPD) more severe has been identified by an international team of researchers. This finding is expected to provide improved and alternative ways to develop new treatment options.

The research team from Imperial College London, Royal Brompton Hospital and the University of British Columbia reported in the New England Journal of Medicine that there is a correlation between increased lung inflammation and histone deacetylase (HDAC), a loss of activity in an enzyme responsible for switching off inflammatory genes and cells.

From News-Medical.Net:

The team believe that the loss of HDAC activity may also explain why COPD is not responsive to steroids, as steroids require HDAC in order to switch off the inflammation.

Previous research by Professor Barnes has shown that low doses of theophylline, a substance occurring in tea leaves which helps relax the bronchial tubes, could help restore HDAC activity, and potentially reverse the resistance to steroids.

Professor Barnes adds: “Although this research is at a fundamental level, the discovery that COPD affects HDAC activity, which in turn can be affected by theophylline, could be the first step towards the development of an effective treatment.”

Professor Peter Barnes, from Imperial College London and the Royal Brompton Hospital, and senior author of the research, said that identification of this mechanism could be of great importance for treating COPD in the future.

Tags: Chronic Obstructive Pulmonary Disorder, COPD, steroids

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