COPD

BOSTON -- The so-called Mediterranean diet -- high in fruits, vegetables, fish, and whole grains -- is associated with a 50% reduction in the risk of chronic obstructive pulmonary disease, according to researchers here.

OMAHA, Neb. -- Infliximab (Remicade), the tumor necrosis-factor alpha inhibitor, has proved ineffective for moderate to severe chronic obstructive pulmonary disease.

NEW YORK -- Eating too much bacon and sausage may increase the risk of chronic obstructive pulmonary disease, found researchers here.

ALBUQUERQUE, N.M. -- Moderate use of statins is associated with a sharply reduced risk of death from chronic obstructive pulmonary disease, researchers here found.

SEATTLE -- High doses of inhaled corticosteroids may reduce the risk of lung cancer in men with chronic obstructive pulmonary disease, suggested researchers here.

Sleep complaints are common in patients with chronic obstructive pulmonary disease (COPD). Many patients complain of morning tiredness, early awakenings, difficulty in falling asleep, restlessness, and daytime sleepiness. Functional status may eventually be impaired by the resulting chronic fatigue that is compounded by dyspnea.

BARCELONA Spain -- Smokers who get plenty of exercise regularly may slow the inevitable decline of their lung function and reduce their risk of chronic obstructive pulmonary disease, researchers here reported.

abstract: Depression and anxiety are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), and like COPD, they are often underrecognized. Both of these comorbidities can adversely affect the course of COPD. Anxiety, for example, is associated with more severe dyspnea, greater disability, and impaired functional status; it also is a significant predictor of hospitalizations for acute exacerbations of COPD. When evaluating depressive symptoms, it is important to rule out cognitive impairment, particularly in patients with severe COPD and hypoxemia. Treatment options include antidepressants and cognitive behavioral therapy. Participation in a pulmonary rehabilitation program also can help reduce anxiety and depressive symptoms in patients with COPD. (J Respir Dis. 2007;28(3):94-103)

LIVERPOOL, England -- The combination of an inhaled corticosteroid and a long-acting beta2 agonist did not quite reach a significant overall survival improvement in chronic obstructive pulmonary disease, investigators in the TORCH trial reported. But the drug duo significantly improved symptoms and overall health.

EDMONTON, Alberta -- A mixture of helium and oxygen allowed patients with chronic obstructive pulmonary disease to increase their exercise capacity, found researchers here.

Results of a large prospective study

FRANKFURT, Germany -- Therapy with inhaled corticosteroids plus a long-acting bronchodilator appears to significantly improve exacerbations and other outcomes for chronic obstructive pulmonary disease (COPD), according to German researchers.

PAVIA, Italy, Jan. 2 -- Chronic cough and phlegm in a young adult nearly double the risk of developing chronic obstructive pulmonary disease (COPD), researchers here said.

On a warm August day, a 79-year-old man is hospitalized because of progressive lethargy over the past week. Previously, he was alert and able to converse. He has no chest pain, dyspnea, or cough. His history includes hypertension of unknown duration, chronic obstructive pulmonary disease, and a recent hospitalization for pneumonia.

Patients with COPD are at greater risk for osteopeniaand osteoporosis than persons who do not haveCOPD. Studies have reported osteopenia in 35% to 72%and osteoporosis in 36% to 60% of patients with COPD.1,2

ABSTRACT: The key factor in reducing morbidityand mortality in patients with chronicobstructive pulmonary disease (COPD)continues to be smoking cessation. Newerformulations of nicotine replacementtherapy-a nasal spray and an inhaler-provide rapid delivery of nicotine and maybe appropriate for highly dependent smokers.Bupropion has been shown to improvesmoking cessation rates, either when usedalone or with a nicotine patch. Both theinfluenza and pneumococcal vaccines arerecommended to reduce the morbidity andmortality associated with respiratory infectionsin patients with COPD.

A46-year-old white man is hospitalized with increasing dyspnea of 3weeks’ duration. He has a history of stable chronic obstructive pulmonarydisease secondary to heavy smoking (2 packs of cigarettes a day for 27years, discontinued 6 years previously) and uses inhaled bronchodilators.

Q:Does theophylline still play a role in the treatment of chronicobstructive pulmonary disease (COPD), or has it been supersededby newer agents?

Q:What is the latest thinking on the use of dailyinhaled corticosteroids in the managementof chronic obstructive pulmonary disease (COPD)?

A:Theophylline remains useful in the maintenance management of COPD. It is most commonly prescribed as an adjunct to an inhaled β-agonist, ananticholinergic, or a combination of these agents.

Oral corticosteroids arecommonly used inambulatory patientsas short- or long-termtherapy for a numberof diseases. For example, patientswith acute exacerbations of asthmaor chronic obstructive pulmonary diseaseare routinely given 1- to 2-weekcourses of prednisone, methylprednisolone,or another oral corticosteroid.In addition, oral corticosteroidsare used as maintenance therapy inpatients with such conditions assystemic lupus erythematosus, sarcoidosis,and post-organ transplantcomplications.

Q:I am trying to encourage a patient with chronicobstructive pulmonary disease (COPD) to quitsmoking. He began smoking at age 14 years and hassmoked 1 pack of cigarettes a day for 35 years. His lungfunction is moderately decreased (forced expiratoryvolume in 1 second [FEV1], 65% of predicted). What othermeasures can I recommend to help restore lung functionso that he has more stamina and less shortness ofbreath on exertion?

An 82-year-old man suddenly became extremely short of breath while helpinghis wife wash dishes. The dyspnea was not accompanied by pain, and it was notrelieved by sitting. He was taken to the emergency department after diaphoresisand cyanosis developed.

Chronic obstructive pulmonary disease(COPD) is the fourth leadingcause of chronic morbidity and mortalityin the United States.1 Its prevalenceand impact are increasing,and the World Bank/World HealthOrganization has projected that it willrank fifth in 2020 as a global burdenof disease.2,3 The economic and publichealth impact of COPD is staggering,because this chronic conditionrequires long-term care, frequentoffice visits, and use ofemergency department and hospitalservices. Thus, there is a pressingneed to discover new therapies thatcontrol symptoms and prevent diseaseprogression.

Q:Is there a role for inhaled corticosteroids in chronic obstructivepulmonary disease (COPD)?

The goals of therapy in chronic obstructive pulmonary disease are to ameliorate symptoms, improve daily function, preserve lung function, identify and reduce exacerbations and, if possible, decrease mortality. A comprehensiveapproach that includes prevention, early identification, and pharmacotherapy-and oxygen therapy, pulmonary rehabilitation, and/or surgery when appropriate-can optimize patient outcomes.

Although the estimates of prevalence vary, there is convincing evidence that patients with chronic obstructive pulmonary disease (COPD) are at increased risk for depression. Moreover, depression has been associated with diminished functional status, increased symptoms, and increased mortality in patients with COPD. Encouraging news comes from Nguyen and Carrieri-Kohlman, who report that a dyspnea self-management program that includes exercise can reduce both dyspnea and depressed mood in these patients.

NPPV should be considered theventilatory modality of first choicein patients presenting to an acutecare hospital with an exacerbationof COPD. This is based on the findingsof multiple randomized controlledtrials as well as meta-analyses.These have shown that NPPVused in such patients brings about amore rapid improvement in dyspnea,vital signs, and PaCO2 thandoes oxygen therapy with standardmedical treatment. Use of NPPV resultsin significant reductions in theneed for intubation, morbidity andmortality rates, and in some studies,the length of hospital stay. These latterbenefits are unquestionably relatedto the avoidance of the complicationsof intubation, includingnosocomial infections, that increasein occurrence as the duration of intubationbecomes prolonged.

LOS ANGELES -- Patients with asthma and chronic obstructive pulmonary disease (COPD) receive only half the care that they should, according to a national sample.

SALT LAKE CITY -- Upgrading nebulizers to deliver less medicine less often saved staff time and overall costs without adverse effects on inpatients with chronic obstructive pulmonary disease, researchers reported here.