COPD
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Comparative Study
Survival with tiotropium compared to long-acting Beta-2-agonists in Chronic Obstructive Pulmonary Disease.
Chronic Obstructive Pulmonary Disease (COPD) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase. Tiotropium has been shown to reduce exacerbations, hospitalizations, symptoms, and improve health-related quality of life in patients with COPD. Its effect on mortality and its effects relative to long-acting beta-agonists (LABAs), however, remain unknown. ⋯ In conclusion, in older patients recently discharged from hospital for COPD, receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agonist. This result suggests that tiotropium might also be associated with decreased mortality compared to no treatment at all. Randomized placebo-control trials are needed to confirm these findings.
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A significant proportion of patients with COPD show post-bronchodilator improvement in lung volume even though this response is rarely considered when classifying subjects as having reversible or irreversible airway disease. We studied 266 patients with a clinical and physiological diagnosis of COPD who underwent pulmonary function testing and had their spirometric response to 5 mg salbutamol assessed. After the bronchodilator 125 (47%) patients increased their forced vital capacity by more than the known variability of the test while 60 (23%) showed only a volume response without improvement in expiratory flow. ⋯ Subjects with evidence of greater dynamic airway collapse, assessed by the ratio of early to mid expiratory flow, were less likely to have a flow response but more likely to have a volume response after salbutamol (p < 0.005). This would be compatible with volume response being commoner in patients who exhibit tidal expiratory flow limitation. We suggest that post-bronchodilator absolute change in FVC provides important additional physiological information when interpreting bronchodilator reversibility testing.
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Randomized Controlled Trial Comparative Study
Efficacy of tiotropium inhalation powder in african-american patients with chronic obstructive pulmonary disease.
Responsiveness to pharmacologic agents may differ among subpopulations compared with the general population. In patients of African descent, possible differences have been observed for inhaled beta-agonists. However, pharmacologic responsiveness to a long-acting anticholinergic has not been prospectively evaluated. ⋯ Tiotropium significantly improved pulmonary function in African-American COPD patients.
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Randomized Controlled Trial Multicenter Study Comparative Study
Effect of nebulized arformoterol on airway function in COPD: results from two randomized trials.
Arformoterol, a single isomer long-acting beta(2)-agonist, was developed as an inhalation solution for the maintenance treatment of bronchoconstriction in COPD. ⋯ In these trials, COPD subjects administered nebulized arformoterol demonstrated significant and sustained improvement in lung function over 12 weeks.
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Randomized Controlled Trial Multicenter Study
Spirometry, rapid FEV1 decline, and lung cancer among asbestos exposed heavy smokers.
We assessed whether spirometric measurements are associated with the development of accelerated FEV(1) decline and lung cancer among active and previous smokers with a wide range of lung function. Bivariate and multivariate analyses that adjusted for age, intervention arm, smoking status at enrollment and smoking history, years exposed to asbestos, and evidence of asbestosis were used to assess whether baseline FEV(1) and FEV(1)/FVC ratio were associated with accelerated FEV(1) decline and incident lung cancer. The 3,041 participants enrolled from 1985 to 1994 were followed through April 30, 2005. ⋯ Baseline FEV(1)/FVC ratio<0.7 was also significantly associated with an increased risk of developing lung cancer, even when baseline FEV(1) was >80%. Lung cancer risk among participants with baseline airflow obstruction and FEV(1)<60% was 4-fold higher than participants without baseline airflow obstruction and FEV(1)>80% (p<0.001), even among former smokers. These data indicate an FEV(1)/FVC<0.7 among smokers is significantly associated with faster airflow loss, and an increased risk for developing lung cancer, even among those individuals with a normal FEV(1).