September 6th 2024
In a large study of patients with COPD, a small increase in 5-year all-cause mortality risk was observed among those using roflumilast.
Clinical Citations: Managing pneumonia: Do practice guidelines really help save lives?
April 1st 2006Guidelines for the management of community-acquired pneumonia (CAP) have been published by several medical organizations, including the British Thoracic Society, the American Thoracic Society, and the Infectious Diseases Society of America (IDSA). Do these guidelines help improve survival rates? Yes, according to a study that focused on adherence to the IDSA guidelines and outcomes for patients with severe CAP. This study also underscores the importance of providing adequate coverage for Pseudomonas aeruginosa in patients with risk factors such as chronic obstructive pulmonary disease (COPD), malignancy, or recent antibiotic treatment.
COPD in women, part 2: Treatment considerations
March 1st 2006Abstract: Smoking cessation is still the most important intervention in patients with chronic obstructive pulmonary disease (COPD), regardless of sex. There is some evidence that nicotine replacement therapy may be less effective in women than in men. However, women may derive greater benefits from a sustained quit attempt. For example, one study found that compared with men, women who were sustained quitters had a greater initial rise and a slower age-related decline in forced expiratory volume in 1 second. Men and women do not appear to differ in their response to bupropion or to the various types of bronchodilators. A number of factors contribute to the increased risk of osteoporosis in women with COPD. Both smoking and the degree of airflow obstruction have been identified as important risk factors for osteoporosis. Women may be particularly susceptible to the effects of smoking on bone metabolism. Immobility and decreased physical activity have also been shown to accelerate bone loss. (J Respir Dis. 2006;27(3):115-122)
Anxiety and depression in asthma and COPD: Results of recent studies
March 1st 2006A number of studies have found an increased prevalence of anxiety and depression in patients with asthma and chronic obstructive pulmonary disease (COPD). Although the relationship is not completely understood, it is clear that psychological disorders can adversely affect the course of both diseases.
COPD in women, part 1: A review of recent trends
February 1st 2006Abstract: The increase in cigarette smoking among women is now being reflected in an increased incidence of chronic obstructive pulmonary disease (COPD). Since 1985, the rate of COPD-related deaths in women has steadily risen, and it nearly tripled from 1980 to 2000. There continues to be debate about whether women are more susceptible than men to COPD. Women on average have airways that are 17% smaller, and further narrowing of the airways by COPD may make women more vulnerable to symptomatic airways obstruction. There also is some evidence of greater bronchial hyperreactivity in women, although conflicting findings have been reported. Gender bias appears to exist in the diagnosis and workup of COPD. For example, there is some evidence that clinicians are more likely to consider the diagnosis of COPD in men than in women. One study showed that women who had symptoms consistent with COPD were significantly less likely than men to undergo spirometric assessment. (J Respir Dis. 2006;27(2):70-74)
When should you suspect asbestos-related pulmonary disease?
November 1st 2005Abstract: A number of factors complicate the diagnosis of asbestos-related pulmonary diseases. Most persons who have had heavy exposure to asbestos are now aged at least 65 years and, therefore, are more likely to have other respiratory problems, such as chronic obstructive pulmonary disease, that may be difficult to differentiate from asbestosis. An accurate assessment of exposure history is particularly challenging because of poor recall of events by patients and because critical variables, such as fiber type, size, and length, can be difficult to evaluate. High-resolution CT (HRCT) has better sensitivity and specificity for asbestos-related pleural disease and neoplasms than does chest radiography. However, HRCT findings in patients with asbestosis are relatively nonspecific. Bronchoalveolar lavage and lung biopsy can provide definitive information about the extent of asbestos exposure. (J Respir Dis. 2005;26(11):499-510)
Dry Powder Inhalers: Teaching Correct Use to Maximize Benefit
November 1st 2005Dry powder inhalers are used by millions of patients with asthma or chronic obstructive pulmonary disease. Although these devices are easier to use than metered-dose inhalers, errors still occur and drug efficacy may be reduced or lost.
If You Use a Dry Powder Inhaler
November 1st 2005Millions of people with asthma and chronic obstructive pulmonary disease (COPD) use dry powder inhalers (DPIs). These devices are generally easier to use than metered-dose inhalers; however, errors still occur that may reduce the effectiveness of the drug.
Clinical Consultation: Is scuba diving off-limits for patients with asthma or COPD?
October 1st 2005Under what circumstances would asthma or chronic obstructive pulmonary disease (COPD) be a contraindication to scuba diving? What precautions should patients with either asthma or COPD take if they are determined to go diving?
Pauci-Immune Crescentic Glomerulonephritis
September 14th 2005Following two witnessed tonic-clonic seizures, a 65-year-old woman with a history of chronic obstructive pulmonary disease was admitted to the hospital. Results of laboratory studies included serum creatinine level, 2 mg/dL; blood urea nitrogen level, 28 mg/dL; and erythrocyte sedimentation rate, 61 mm/h. The patient's antinuclear antibody (ANA) titer was 1:40 with a speckled pattern, and creatinine clearance was 17 mL/min. An ultrasonogram revealed bilateral small kidneys. CT and MRI of the head revealed no abnormalities.
Acute Dilatation of the Stomach
September 14th 2005A 70-year-old man was brought from a nursing home to the emergency department with abdominal distention and vomiting of recent onset and a 2-day history of fever and abdominal pain. The patient had chronic obstructive pulmonary disease, type 2 diabetes mellitus, and hypertension. His gastric feeding tube, which had been placed via percutaneous endoscopic gastrostomy, was blocked.
Clinical Consultation: Tai Chi for COPD
September 1st 2005Tai Chi (also known as T'ai Chi Chuan, Taijiquan) is a form of mind-body exercise that has its roots in ancient Chinese martial arts. Throughout Asia, it is often practiced for preventive health, especially among the elderly. In recent years, Tai Chi has become popular in the West among all age groups and has been studied as a therapy for various medical conditions.
Clinical Citations: Does regular use of acetaminophen increase the risk of COPD?
September 1st 2005Studies have indicated that the use of acetaminophen is associated with an increased risk of asthma. Now there is evidence linking acetaminophen use to an increased risk of chronic obstructive pulmonary disease (COPD).
Diagnostic Puzzlers: Recurrent dyspnea, fever, and pneumonia in a 67-year-old woman
September 1st 2005A 67-year-old woman was referred for evaluation of exertional dyspnea, with multiple episodes of fever, cough, and pneumonia. She had a long history of cough with sputum and had been admitted several times for exacerbations of chronic obstructive pulmonary disease and pneumonia. She received maintenance therapy with an ipratropium and albuterol combination, fluticasone, and salmeterol, but she continued to experience exertional dyspnea, with an average of 5 or 6 exacerbations and 2 hospital admissions a year.
Managing COPD, part 2: Acute exacerbations
August 1st 2005Abstract: The standard therapies for acute exacerbations of chronic obstructive pulmonary disease include short-acting bronchodilators, supplemental oxygen, and systemic corticosteroids. For most patients, an oxygen saturation goal of 90% or greater is appropriate. Bilevel positive airway pressure (BiPAP) is usually beneficial in patients with progressive respiratory acidosis, impending respiratory failure, or markedly increased work of breathing. However, BiPAP should not be used in patients with respiratory failure associated with severe pneumonia, acute respiratory distress syndrome, or sepsis. Systemic corticosteroids are appropriate for moderate to severe acute exacerbations; many experts recommend relatively low doses of prednisone (30 to 40 mg) for 7 to 14 days. Antibiotic therapy is controversial, but evidence supports the use of antibiotics in patients who have at least 2 of the following symptoms: increased dyspnea, increased sputum production, and sputum purulence. (J Respir Dis. 2005;26(8):335-341)
Managing COPD: How to deal with the most common problems
July 1st 2005Abstract: Although smoking cessation is still the most impor- tant intervention in chronic obstructive pulmonary disease (COPD), a variety of pharmacologic therapies are available to help manage symptoms. Short-acting ß2-agonists and/or ipratropium should be taken as needed, and the use of additional therapies is based on the severity of disease. Patients with moderate or severe COPD should regularly take 1 or more long-acting bronchodilators. The long-acting ß2-agonists salmeterol and formoterol have been demonstrated to improve health-related quality of life. Newer therapies include the long-acting anticholinergic tiotropium and a salmeterol-fluticasone combination. These agents improve forced expiratory volume in 1 second and may reduce the rate of acute exacerbations. For patients with moderate to very severe COPD, participation in a pulmonary rehabilitation program can improve health status, quality of life, and exercise tolerance. (J Respir Dis. 2005;26(7):284-289)
Clinical Citations: Antihypertensive therapy and COPD: The effect of ß-blockers on mortality
April 1st 2005Cardiovascular disease is a leading cause of death in patients with chronic obstructive pulmonary disease (COPD). While some physicians may be reluctant to prescribe ß-blockers for these patients, because of concern about adverse effects on lung function, a study conducted by Au and associates indicates that ß-blockers may have an edge over other antihypertensive agents in reducing mortality risk.
Matters of the Heart: Aortitis
May 2nd 2004An obese 61-year-old man who hadchronic obstructive pulmonary diseaseand sleep apnea heard a “pop”in his stomach while lifting a heavyweight; severe abdominal pain followed.He was short of breath thenext morning, and his physician empiricallyprescribed cephalexin.
Anxiety in Patients With Respiratory Disorders:How to Help
March 2nd 2004Anxiety is a common and troubling symptom in many patients with chronic obstructive pulmonary disease (COPD), even when their degree of respiratory impairment is only mild to moderate. Anxiety may also accompany other chronic, progressive pulmonary disorders, such as interstitial fibrosis and cystic fibrosis, and a wide variety of other, less common diseases that are characterized by progressive dyspnea on exertion.
Management of COPD: What's New, What's Next
January 1st 2004Bronchodilators, preferably inhaled, are recommended for all patients with chronic obstructive pulmonary disease; ipratropium, with a 6- to 8-hour duration of action, is effective maintenance therapy. Tiotropium is currently being reviewed by the FDA for release in the United States; its once-daily dosing schedule may facilitate adherence. Criteria for long-term oxygen therapy are severe hypoxemia (PaO2, 55 mm Hg or lower) or a PaO2 of 60 mm Hg or lower with signs of cor pulmonale or secondary polycythemia (hematocrit higher than 55%). When symptoms are disabling despite optimal medical management, referral for pulmonary rehabilitation is the next step. Patients with upper lobe-predominant emphysema and low exercise capacity may benefit most from lung volume reduction surgery. Consider transplantation if the patient has severe lung disease that is refractory to medical therapy and survival is expected to be less than 2 to 3 years.
Chronic Obstructive Pulmonary Disease: New Treatments Against an Old Foe
January 1st 2004The key factor in reducing morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD) continues to be smoking cessation. Newer formulations of nicotine replacement therapy-a nasal spray and an inhaler-provide rapid delivery of nicotine and may be appropriate for highly dependent smokers. Bupropion has been shown to improve smoking cessation rates, either when used alone or with a nicotine patch. Both the influenza and pneumococcal vaccines are recommended to reduce the morbidity and mortality associated with respiratory infections in patients with COPD.