scholarly journals Roflumilast succeeds where traditional therapy fails: a case report

2015 ◽  
Vol 79 (3-4) ◽  
Author(s):  
Gabriella Guarnieri
Keyword(s):  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
High Dose ◽  
Welding Fumes ◽  
Obstructive Pulmonary Disease ◽  
Once Daily ◽  
X Ray ◽  
Clinical Control ◽  
History Of ◽  
Chest X Ray

The case of a 72-year-old man with a long history of chronic obstructive pulmonary disease (COPD, patient D according to Guidelines GOLD 2013) in a subject professionally exposed to welding fumes is presented. Diagnosis was based on symptoms and spirometry and confirmed by chest X-ray examination. Since 1997 the patient has been under different therapies, including high-dose inhaled corticosteroids and bronchodilators, with poor clinical control and frequent exacerbations. Roflumilast 500 μg once daily was started in January 2012 and patient’s respiratory symptoms, number of exacerbations and spirometry values have gradually improved since then. Roflumilast was an effective treatment in this case of difficult to treat severe COPD.

scholarly journals Association between inhaled corticosteroids and upper respiratory tract infection in patients with chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hong Chen ◽  
Yulin Feng ◽  
Ke Wang ◽  
Jing Yang ◽  
Yuejun Du
Keyword(s):  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
Controlled Trials ◽  
High Dose ◽  
Upper Respiratory Tract ◽  
Short Term ◽  
Obstructive Pulmonary Disease ◽  
Randomized Controlled ◽  
Upper Respiratory

Abstract Background We aimed to assess the association between inhaled corticosteroids (ICSs) and the risk of upper respiratory tract infection (URTI) in patients with chronic obstructive pulmonary disease (COPD). Methods PubMed, Embase, Cochrane Library and Clinical Trials.gov were searched from inception to October 2019. Randomized controlled trials (RCTs) of any ICSs vs control for COPD with reporting of URTI as an adverse event were included. The study was registered with PROSPERO prospectively (#CRD42020153134). Results Seventeen RCTs (20,478 patients) were included. ICSs significantly increased the risk of URTI in COPD patients (RR, 1.13; 95% CI 1.03–1.24; P = 0.01; heterogeneity: I2 = 7%). Futher subgroup analyses suggested that short-term use of ICSs increased the risk of URTI (RR, 1.29; 95% CI 1.06–1.56; P = 0.01; heterogeneity: I2 = 14%) but not for long-term use (RR, 1.08; 95% CI 0.97–1.2; P = 0.14; heterogeneity: I2 = 0%). Short-term use of high-dose fluticasone increased the risk of URTI (RR, 1.33; 95% CI 1.03–1.71; P = 0.03; heterogeneity: I2 = 0%) but not for long-term use (RR, 1.12; 95% CI 0.97–1.29; P = 0.13; heterogeneity: I2 = 50%). Medium-dose (RR, 0.97; 95% CI 0.71–1.32; P = 0.84; heterogeneity: I2 = 0%) and low-dose (RR, 1.39; 95% CI 0.92–2.1; P = 0.12; heterogeneity: I2 = 30%) fluticasone did not increase the risk of URTI regardless of duration. Neither mometasone (RR, 1.05; 95% CI 0.87–1.26; P = 0.61; heterogeneity: I2 = 0%) nor budesonide (RR, 1.08; 95% CI 0.77–1.5; P = 0.67; heterogeneity: I2 = 46%) increased the risk of URTI, regardless of dosage or duration. Conclusions Long-term use of ICSs does not increase the risk of URTI in patients with COPD. Short-term use of high-dose fluticasone increases the risk of URTI in patients with COPD, but not mometasone or budesonide.

scholarly journals Salbutamol use in relation to maintenance bronchodilator efficacy in COPD: a prospective subgroup analysis of the EMAX trial

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
F. Maltais ◽  
I. P. Naya ◽  
C. F. Vogelmeier ◽  
I. H. Boucot ◽  
P. W. Jones ◽  
...  
Keyword(s):  
Inhaled Corticosteroids ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Once Daily ◽  
Fractional Polynomial ◽  
Exacerbation Risk ◽  
Symptom Outcome ◽  
Post Hoc

Abstract Background Short-acting β2-agonist (SABA) bronchodilators help alleviate symptoms in chronic obstructive pulmonary disease (COPD) and may be a useful marker of symptom severity. This analysis investigated whether SABA use impacts treatment differences between maintenance dual- and mono-bronchodilators in patients with COPD. Methods The Early MAXimisation of bronchodilation for improving COPD stability (EMAX) trial randomised symptomatic patients with low exacerbation risk not receiving inhaled corticosteroids 1:1:1 to once-daily umeclidinium/vilanterol 62.5/25 μg, once-daily umeclidinium 62.5 μg or twice-daily salmeterol 50 μg for 24 weeks. Pre-specified subgroup analyses stratified patients by median baseline SABA use (low, < 1.5 puffs/day; high, ≥1.5 puffs/day) to examine change from baseline in trough forced expiratory volume in 1 s (FEV1), change in symptoms (Transition Dyspnoea Index [TDI], Evaluating Respiratory Symptoms-COPD [E-RS]), daily SABA use and exacerbation risk. A post hoc analysis used fractional polynomial modelling with continuous transformations of baseline SABA use covariates. Results At baseline, patients in the high SABA use subgroup (mean: 3.91 puffs/day, n = 1212) had more severe airflow limitation, were more symptomatic and had worse health status versus patients in the low SABA use subgroup (0.39 puffs/day, n = 1206). Patients treated with umeclidinium/vilanterol versus umeclidinium demonstrated statistically significant improvements in trough FEV1 at Week 24 in both SABA subgroups (59–74 mL; p < 0.001); however, only low SABA users demonstrated significant improvements in TDI (high: 0.27 [p = 0.241]; low: 0.49 [p = 0.025]) and E-RS (high: 0.48 [p = 0.138]; low: 0.60 [p = 0.034]) scores. By contrast, significant reductions in mean SABA puffs/day with umeclidinium/vilanterol versus umeclidinium were observed only in high SABA users (high: − 0.56 [p < 0.001]; low: − 0.10 [p = 0.132]). Similar findings were observed when comparing umeclidinium/vilanterol and salmeterol. Fractional polynomial modelling showed baseline SABA use ≥4 puffs/day resulted in smaller incremental symptom improvements with umeclidinium/vilanterol versus umeclidinium compared with baseline SABA use < 4 puffs/day. Conclusions In high SABA users, there may be a smaller difference in treatment response between dual- and mono-bronchodilator therapy; the reasons for this require further investigation. SABA use may be a confounding factor in bronchodilator trials and in high SABA users; changes in SABA use may be considered a robust symptom outcome. Funding GlaxoSmithKline (study number 201749 [NCT03034915]).

scholarly journals Infective Exacerbation ofPasteurella multocida

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Mayumi Hamada ◽  
Noha Elshimy ◽  
Hatem Abusriwil
Keyword(s):  
Pasteurella Multocida ◽  
Complete Recovery ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Left Hand ◽  
History Of ◽  
Chest X Ray ◽  
Animal Bites ◽  
Exacerbation Of Copd ◽  
Severe Type

An 89-year-old lady presented with a one-day history of shortness of breath as well as a cough productive of brown sputum. Her medical history was significant for chronic obstructive pulmonary disease (COPD). She was in severe type one respiratory failure and blood tests revealed markedly raised inflammatory markers; however her chest X-ray was clear. On examination there was bronchial breathing with widespread crepitations and wheeze. She was treated as per an infective exacerbation of COPD. Subsequent blood cultures grewPasteurella multocida, a common commensal in the oropharynx of domesticated animals. The patient was then asked about any contact with animals, after which she revealed she had a dog and was bitten on her left hand the day before admission. We should not forget to enquire about recent history of injuries or animal bites when patients present acutely unwell. She made a complete recovery after treatment with penicillin.

scholarly journals Study on prevalence of left ventricular diastolic dysfunction in chronic obstructive pulmonary disease

2019 ◽  
Vol 6 (2) ◽  
pp. 222
Author(s):  
Mohamed Rafi ◽  
Monna Mohamed Jaber
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Diastolic Dysfunction ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
X Ray ◽  
Copd Patients ◽  
Ventricular Diastolic Dysfunction ◽  
Chest X Ray

Background: Left ventricular diastolic dysfunction (LVD) is very common in chronic obstructive pulmonary disease (COPD) patients. The aim of the present study was to LVD function in COPD patients using echocardiogram and to detect the presence of LVD dysfunction in all stages of COPD.Methods: This was an observational study done at Institute of Internal Medicine, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, during the period from March 2015 to August 2015. The study included 100 patients with COPD. All patients were subjected to chest X-ray, electrocardiogram, pulmonary function test (PFT) and echocardiogram.Results: The results showed the prevalence rate of LVD dysfunction in 80% patients with COPD. There was a good significant correlation between age (p<0.001), status of smoking (p<0.05), chest X-ray findings (p<0.001) and stages of COPD (p<0.001) with incidence of LVD in study population.Conclusions: High prevalence of LVD dysfunction was noticed in patients with COPD. Hence patients with COPD should undergo routine examinations timely to prevent the incidence of associated cardiovascular complications.

Osteoporosis and fracture risk associated with ICS use among Swedish COPD patients: the ARCTIC study

2020 ◽  
pp. 2000515
Author(s):  
Christer Janson ◽  
Karin Lisspers ◽  
Björn Ställberg ◽  
Gunnar Johansson ◽  
Florian S. Gutzwiller ◽  
...  
Keyword(s):  
Inhaled Corticosteroids ◽  
Bone Fractures ◽  
Dose Effect ◽  
The Arctic ◽  
Chronic Obstructive ◽  
High Dose ◽  
Related Event ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Similar Dose

The effect of inhaled corticosteroids (ICS) on the risk of osteoporosis and fracture in patients with chronic obstructive pulmonary disease (COPD) remains uncertain. The aim of this study was to assess this risk in patients with COPD.Electronic medical record data linked to National Health Registries were collected from COPD patients and matched reference controls at 52 Swedish primary care centres (2000–2014). The outcomes analysed were the effect of ICS on all fractures, fractures typically related to osteoporosis, recorded osteoporosis diagnosis, prescriptions of drugs for osteoporosis and a combined measure of any-osteoporosis-related event. The COPD patients were stratified by the level of ICS exposure.A total of 9651 patients with COPD and 59 454 matched reference controls were analysed. During the follow-up, 19.9% of COPD patients had at least one osteoporosis-related event compared with 12.9% of reference controls (p<0.0001). Multivariate analysis in the COPD population demonstrated a dose-effect relationship, with high-dose ICS being significantly associated with any osteoporosis-related event (risk ratio [RR; 95% confidence interval] 1.52 [1.24–1.62]), while the corresponding estimate for low-dose ICS was 1.27 (1.13–1.56), compared with COPD patients not using ICS. A similar dose-related adverse effect was found for all four of the specific osteoporosis-related events: all fractures, fractures typically related to osteoporosis, prescriptions of drugs for osteoporosis and diagnosis of osteoporosis.We conclude that patients with COPD have a greater risk of bone fractures and osteoporosis and high-dose ICS use increased this risk further.

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