Category Archives: COPD

Patient demographic data and baseline characteristics are summarized in Table 1. During the 1-year follow-up period, 69 patients withdrew. This occurred after a mean follow-up of 23 weeks. Of the total group of 314 patients, a total of 277 person-years was analyzed (mean follow-up, 0.88 years per patient). Of these 314 patients, 128 patients had neither a moderate nor a severe exacerbation during follow-up; 31 patients had a total of 37 severe exacerbations, with the number per patient ranging from 1 to 2. One hundred seventy-nine patients had a total of 374 moderate exacerbations, with the number per patient ranging from 1 to 10. No differences in exacerbation rates were found between the salmet-erol and SFC treatment groups with respect to severe, moderate, or total number of exacerbations. The total (moderate and severe) mean annual exacerbation rates were 1.61 and 1.36 for the salmeterol and SFC treatment groups, respectively (rate ratio, 1.2; 95% confidence interval [CI], 0.9 to 1.6; p = 0.23). Furthermore, no differences could be demonstrated between both treatment arms for the time until the first severe or first moderate exacerbation. Since there were no differences between the two groups, all further analyses were performed in the two treatment groups combined. Smokers had a slightly higher LBP (p = 0.02) and lower TNF-a (p = 0.03) than nonsmokers. There were no significant differences in fibrinogen, CRP, and soluble TNF receptors between smokers and nonsmokers. (more…)

We investigated which factors predict acute COPD exacerbations and in particular the role of systemic inflammation in the occurrence of these acute events. We found that higher fibrinogen levels are significantly predictive for the occurrence of severe as well as moderate exacerbations. Further independent predictors for severe acute exacerbations were FEV1, Dlco, and the number of prestudy severe exacerbations, whereas FEV1 and the number of prestudy moderate exacerbations were independent predictors for moderate acute exacerbations. Besides being a measure of lung function, FEV1 is the parameter used in clinical practice to define the severity of COPD, regardless of the underlying pathophysiology. Since FEV1 reflects both disease in the airway wall and loss of alveolar attachments caused by emphysema, it is not surprising that FEVX is an important predictor for acute exacerbations. The occurrence of acute exacerbations was significantly higher in our patients with lower FEV1; confirming previous data. A recent report by Pinto-Plata et al showed that FEV1 was significantly correlated to changes in inflammatory cytokines in patients hospitalized for an acute exacerbation. (more…)

Study Design

This study is a secondary study of the COSMIC study (COPD and Seretide: a Multi-Center Intervention and Characterization), a multicenter trial to investigate the effects of steroid withdrawal in comparison with combination therapy (long-acting β2-agonist salmeterol and inhaled steroid fluticasone) during a 1-year follow-up period. The COSMIC study had a multicenter, randomized, double-blind, parallel-group design. All patients received combined salmeterol (50 μg) and fluticasone (500 μg) bid (in the morning and evening) via an inhaler during a 3-month run-in period. Thereafter, patients were randomized to a 12-month treatment with either salmeterol/fluticasone (SFC) or salmeterol alone. Inhaled salbutamol was used as relief medication, and anticholinergics and methylxanthines in constant dose were allowed throughout the study. After the 3-month run-in period, at the randomization visit systemic inflammatory parameters were measured next to previously described clinical parameters. (more…)

COPD is characterized by episodic increases in respiratory symptoms, so-called exacerbations. These episodes contribute considerably to the increased morbidity, mortality, and health-care costs associated with this disease. The definition of acute exacerbation of COPD is largely based on reported symptomatology by the patient, mostly an increase in dyspnea, cough, and sputum production. Different studies have reported that airway inflammation increases in acute exacerbations. Besides an increase in airway inflammation, COPD exacerbations are associated with an increase in systemic inflammation. It has been established that stable COPD is associated with low-grade systemic inflammation as demonstrated by an increase in blood leukocytes, acute-phase proteins C-reactive protein (CRP) and fibrinogen, and inflammatory cytokines. During acute exacerbations of COPD, higher levels of interleukin-6 as well as acute-phase proteins CRP, fibrinogen, and lipopolysaccharide binding protein (LBP) have been demonstrated, declining again during recovery achieved with remedies of canadianhealthncaremall Canadian Health&Care Mall. (more…)