Dual Bronchodilators Don’t Work for COPD-like Symptoms
New research supported by the National Institutes of Health has found that people with respiratory symptoms and a history of smoking who do not meet the lung function criteria for COPD are not helped by dual bronchodilators.
The study involved 535 adults at 20 medical centers in the U.S. who had mild symptoms similar to those seen in people diagnosed with COPD. The subjects were randomized to receive an inhaler with a dual bronchodilator or placebo and instructed to use them twice daily.
While some participants in both groups reported improved symptoms at the end of the 12-week study, no significant differences were seen between those using the active inhaler and the placebo. Overall, 56% of those in the active inhaler group saw improvement vs. 59% in the placebo group.
The authors believe this finding suggests the current practice of giving people with COPD symptoms dual bronchodilators without first confirming a diagnosis of COPD using spirometry is ill-advised.
“We’ve assumed these medications worked in patients who don’t meet lung function criteria for COPD, but we never checked,” said study author MeiLan K. Han, MD. “We now know these existing medications don’t work for these patients.”
She believes more research is needed to find medications that do work.
“The next question is, can we develop more targeted therapies for these patients who are on the milder end of the spectrum?” she said.
The study was published by The New England Journal of Medicine and presented at the European Respiratory Society International Congress. Read More
Rural Americans More Likely to Smoke
Cigarette smoking is higher among people living in rural areas, find researchers from Indiana University (IU), who analyzed data from the U.S. Department of Health and Human Services’ 2010-20 National Survey on Drug Use.
The study showed that 19.2% of people in rural areas were smokers in 2020 compared to 14.4% of those in urban areas. Between 2010 and 2020, the odds of quitting were 75% lower for people in rural areas, although in 2020, quit rates were similar, at 52.9% and 53.9%, respectively.
“Our findings support that a persistent rural/urban disparity exists,” said study author Maria Parker, who worked on the study with colleagues from IU, Rutgers University, and Yeshiva University. “Rural residents may face more barriers to using smoking cessation services than urban residents, or they may be in an earlier stage of motivation to quit.”
She believes quit-smoking interventions at various levels in the health care system could improve smoking cessation services for rural residents and suggests providers could leverage existing quitlines and telehealth solutions to help minimize barriers to access.
The study was published by JAMA Open Network. Read More
Who Should Get Antibiotics for a COPD Exacerbation?
COPD patients suffering from an acute exacerbation are often prescribed antibiotics, even though most exacerbations are viral in nature.
Researchers from Germany who set out to see if these antibiotics help these patients found mixed results. Their study showed patients with GOLD stage 1 or 2 COPD received no benefit from the antibiotics, but those in GOLD stage 3 or 4 did.
“The trial failed to demonstrate that antibiotics [are] not needed for patients with acute moderate exacerbation of COPD across all stages of the disease,” said Gernot Rohde, MD, of Frankfurt University Hospital, during a presentation at the European Respiratory Society annual meeting. “But we are very confident that at least we can say that this treatment is unnecessary in GOLD stages 1/2, and we have to say it cannot be withheld in GOLD stages 3/4.”
The study was conducted among 294 patients who were randomized to the antibiotic sultamicillin or placebo. All patients also received standard care, which included prednisone, oxygen if needed, and the continuation of inhaled therapy. Adverse events were higher in the antibiotic group, but serious adverse events did not differ between the groups. Read More
Genetic Factor May Improve Absorption of CF Drug
According to researchers from RUDN University and the Research and Clinical Cystic Fibrosis Department of Research Centre for Medical Genetics in Russia, genetic factors may explain why ciprofloxacin is more effective in some cystic fibrosis patients than in others.
The investigators arrived at that conclusion after analyzing blood samples taken from children aged two to 18, eight of whom were under five before they were started on ciprofloxacin and then every hour and a half after.
The frug concentration in the blood serum was measured by chromatography and results showed the pharmacokinetics of ciprofloxacin were associated with a gene involved in metabolism known as CYP2C9. Specifically, the GCLC 7/7 modification of the CYP2C9 gene correlated with an increased concentration of the drug in the blood, suggesting that the drug is better absorbed by people with this modification.
“We found a significant relationship between GCLC 7/7 genotype and high ciprofloxacin levels 7.5 hours post-dose,” said study author Olga Butranova, PhD. “The elevated concentrations of ciprofloxacin contribute to an increase in its therapeutic efficacy.”
The study was published by Biomedicines. Read More
CPAP Video Just for Children
The American Academy of Sleep Medicine (AASM) has released a new video aimed at helping kids who require CPAP for sleep apnea feel more comfortable using the device.
Dubbed “CPAP Tips for Kids,” the informational video includes step-by-step instructions for using CPAP and focuses on practicing with CPAP to help children get used to the machine. The video urges children to wear the mask during regular daily activities (without turning on the CPAP) to familiarize them with how it feels. It also suggests they run the machine in small increments at first to get accustomed to it.
“While people can find lots of helpful videos that feature tips for adults with sleep apnea, videos geared toward children with sleep apnea are hard to find,” said Carol Rosen, MD, a pediatric sleep physician and member of the AASM board. “The AASM’s video is a welcome tool to help children and their families get started on CPAP treatment.” Read More
Vaping Linked to Constrictive Bronchiolitis
New research from Massachusetts General Hospital investigators suggests vaping can cause small airway fibrosis with constrictive bronchiolitis.
The study was based on a microscopic evaluation of pulmonary tissues taken from four e-cigarette users who had been vaping for three to eight years. All underwent pulmonary function tests, high-resolution chest imaging, and a surgical biopsy to acquire the pulmonary tissue for analysis.
All four patients showed signs of constrictive bronchiolitis, along with overexpression of MUC5AC, a protein in the mucus layer of the airway previously identified in vapers. Three of the four patients also showed signs of emphysema, although this was attributed to their prior history of smoking traditional cigarettes.
When the patients stopped vaping, their conditions improved, but some residual scarring in the lung tissue remained.
“All four individuals we studied had injury localized to the same anatomic location within the lung, manifesting as small airway-centered fibrosis with constrictive bronchiolitis, which was attributed to vaping after thorough clinical evaluations excluded other possible causes,” said lead author Lida Hariri, MD, PhD. “We also observed that when patients ceased vaping, they had a partial reversal of the condition over one to four years, though not complete due to residual scarring in the lung tissue.”
The study was published by NEJM Evidence. Read More
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