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L'essentiel de la littérature réçente en Pneumologie

In this heading we propose you a review of the literature through a selection of abstracts of recent original articles.
we will try to keep you informed about the last news on Pulmonology. We provide you only the summary of the article and the corresponding link, to reach the article in full text you must be registered with the corresponding review.

Click here to consult the list of the available free medical journals in lung diseases.


Considerations for new dual-acting bronchodilator treatments for chronic obstructive pulmonary disease. Print E-mail
Friday, 10 January 2014 11:06
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Considerations for new dual-acting bronchodilator treatments for chronic obstructive pulmonary disease.

Expert Opin Investig Drugs. 2014 Jan 7;

Authors: de Miguel-Díez J, Jiménez-García R

Abstract
Current guidelines recommend treatment with one or more bronchodilators for chronic obstructive pulmonary disease (COPD) patients. Combination therapy with long-acting muscarinic antagonists (LAMA) and long-acting β2-agonists (LABA) should be recommended in patients who are not fully controlled with one of them. In this article, two closely related approaches to provide long-acting treatments are compared: the LABA/LAMA fixed-dose combination therapy, and the dual-acting muscarinic receptor antagonist and β2-adrenoceptor agonist (MABA). The author in that study concludes that both approaches have been shown to provide clinically enhanced bronchodilator activity that is superior to that offered by current standard treatment. LAMA/LABA fixed-dose combinations are expected to become a new standard in the treatment of COPD. It is important to know the characteristics of the different LAMA or LABA, the inhalation device and the duration of action, because diversity can help to personalize the treatment. Dose-finding studies are required. It is also required to investigate the existence of pharmacodynamics or pharmacokinetic interactions between the components as well as the safety profile. MABA represent an alternative to these combinations, but there is little clinical data yet reported. They have the potential to act as a useful platform for the development of triple therapy in one inhaler.

PMID: 24392807 [PubMed - as supplied by publisher]

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Hospital admissions and exercise capacity decline in patients with COPD. Print E-mail
Friday, 10 January 2014 11:06
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Hospital admissions and exercise capacity decline in patients with COPD.

Eur Respir J. 2014 Jan 3;

Authors: Ramon MA, Gimeno-Santos E, Ferrer J, Balcells E, Rodríguez E, de Batlle J, Gómez FP, Sauleda J, Ferrer A, Barberà JA, Agustí A, Gea J, Rodriguez-Roisin R, Antó JM, Garcia-Aymerich J, the PAC-COPD Study Group

Abstract
Exercise capacity declines with time and is an important determinant of health status and prognosis in patients with chronic obstructive pulmonary disease (COPD). We hypothesised that hospital admissions are associated with exercise capacity decline in these patients.Clinical and functional variables were collected for 342 clinically stable COPD patients. The 6-min walk distance (6MWD) was determined at baseline and after a mean±sd of 1.7±0.3 years. Information on hospitalisations during follow-up was obtained from centralised administrative databases. Linear regression was used to model changes in exercise capacity.Patients were mostly male (92%), with mean±sd age 67.9±8.6 years, post-bronchodilator forced expiratory volume in 1 s 54±17% predicted and baseline 6MWD 433±93 m. During follow-up, 6MWD decreased by 21.9±51.0 m·year(-1) and 153 (45%) patients were hospitalised at least once. Among patients admitted only for COPD-related causes (50% of those ever admitted), the proportion presenting a clinically significant loss of 6MWD was higher than in patients admitted for only nonrespiratory conditions (53% versus 29%, p = 0.040). After adjusting for confounders, annual 6MWD decline was greater (26 m·year(-1), 95% CI 13-38 m·year(-1); p<0.001) in patients with more than one all-cause hospitalisation per year, as compared with those with no hospitalisations.Hospitalisations are related to a greater decline in exercise capacity in COPD.

PMID: 24389867 [PubMed - as supplied by publisher]

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Determinants of arterial stiffness in COPD. Print E-mail
Friday, 10 January 2014 11:05
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Determinants of arterial stiffness in COPD.

BMC Pulm Med. 2014;14(1):1

Authors: Bhatt SP, Cole AG, Wells JM, Nath H, Watts JR, Cockcroft JR, Dransfield MT

Abstract
BACKGROUND: Cardiovascular morbidity and mortality is high in patients with chronic obstructive pulmonary disease (COPD) and arterial stiffness is a potentially modifiable risk factor with added predictive value beyond that obtained from traditional risk factors. Arterial stiffness has been the target of pharmacologic and exercise interventions in patients with COPD, but the effects appear limited to those patients with more significant elevations in arterial stiffness. We aimed to identify predictors of increased arterial stiffness in a cohort with moderate to severe COPD.
METHODS: Aortic pulse wave velocity (aPWV) was measured in subjects with moderate to severe COPD enrolled in a multicenter randomized controlled trial. Subjects were categorized into quartiles based on aPWV values and factors affecting high arterial stiffness were assessed. Multivariate models were created to identify independent predictors of high aPWV, and cardiovascular disease (CVD).
RESULTS: 153 patients were included. Mean age was 63.2 (SD 8.2) years and mean FEV1 was 55.4 (SD 15.2) % predicted. Compared to the quartile with the lowest aPWV, subjects in the highest quartile were older, had higher systolic blood pressure (SBP), were more likely to be current smokers, and had greater burden of thoracic aortic calcification. On multivariate analyses, age (adjusted OR 1.14, 95%CI 1.05 to 1.25, p = 0.003) and SBP (adjusted OR 1.06, 95% CI 1.02 to 1.09, p = 0.001) were independent predictors of elevated aPWV. Body mass index, therapy with cholesterol lowering medications and coronary calcification were independent predictors of CVD.
CONCLUSIONS: Elevated arterial stiffness in patients with COPD can be predicted using age, blood pressure and thoracic aortic calcification. This will help identify subjects for enrollment in clinical trials using aPWV for assessing the impact of COPD therapies on CV outcomes.
TRIAL REGISTRATION: Clinicaltrials.gov NCT00857766.

PMID: 24387157 [PubMed - in process]

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