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Corticosteroid use in copd

Greg Hodge, Eugene Roscioli, Hubertus Jersmann, Hai B Tran, Mark Holmes, Paul N Reynolds, Sandra Hodge
BACKGROUND: Corticosteroid resistance is a major barrier to effective treatment of COPD. We have shown that the resistance is associated with decreased expression of glucocorticoid receptor (GCR) by senescent CD28nullCD8+ pro-inflammatory lymphocytes in peripheral blood of COPD patients. GCR must be bound to molecular chaperones heat shock proteins (Hsp) 70 and Hsp90 to acquire a high-affinity steroid binding conformation, and traffic to the nucleus. We hypothesized a loss of Hsp70/90 from these lymphocytes may further contribute to steroid resistance in COPD...
October 21, 2016: Respiratory Research
Adam J N Raymakers, Natalie McCormick, Carlo A Marra, J Mark Fitzgerald, Don Sin, Larry D Lynd
Inhaled corticosteroids (ICS) are commonly prescribed to COPD patients, particularly those with more advanced stages of the disease. These patients are also at increased risk of lung cancer. A systematic review was undertaken to identify studies that examined the association between lung cancer risk and ICS therapy in COPD patients. The search strategy was created in MEDLINE and extended to EMBASE as well as other relevant databases. Both randomized controlled trials (RCTs) and observational studies were considered for inclusion...
October 19, 2016: Respirology: Official Journal of the Asian Pacific Society of Respirology
Almotasembellah Aljaafareh, Jose Ruben Valle, Yu-Li Lin, Yong-Fang Kuo, Gulshan Sharma
OBJECTIVES: Long-acting bronchodilators are mainstay treatment for moderate to severe chronic obstructive pulmonary disease. A growing body of evidence indicates an increased risk of cardiovascular events upon initiation of these medications. We hypothesize that this risk is higher in patients with chronic obstructive pulmonary disease who had a preexisting cardiovascular disease regardless of receipt of any cardiovascular medication. METHODS: A retrospective cohort of patients with a diagnosis of chronic obstructive pulmonary disease based on two outpatient visits or one inpatient visit for chronic obstructive pulmonary disease (International Classification of Diseases, 9th Edition, Clinical Modification codes 491...
2016: SAGE Open Medicine
Erin Davis, Carlo Marra, John-Michael Gamble, Jamie Farrell, Joe Lockyer, J Mark FitzGerald, Waseem Abu-Ashour, Charlie Gillis, John Hawboldt
BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) are often nonadherent with medications and have poor inhaler technique. Community pharmacists can help to improve health-related quality of life and overall outcomes in patients with COPD. We aim to measure the effectiveness of a systematic, pharmacist-driven intervention on patients with diagnosed COPD. METHODS/DESIGN: This pragmatic, parallel-group, cluster randomized controlled trial is designed to determine the effectiveness of a multifactorial, pharmacist-led intervention on medication adherence, inhaler technique, health-related quality of life, health care resource utilization including COPD exacerbations, and use of medications...
October 13, 2016: Trials
Andrea S Gershon, Alice M Newman, Hadas D Fischer, Peter C Austin, Nick Daneman, Chaim M Bell, Anne L Stephenson, Sudeep S Gill, Nicholas T Vozoris, Paula A Rochon
Inhaled, long-acting anticholinergic medication (LAA), commonly used for moderate-to-severe chronic obstructive pulmonary disease (COPD), has been shown to decrease COPD hospitalizations, emergency department visits, and acute exacerbations but has also been associated with urinary tract infection (UTI) in a prior meta-analysis. The objective of this study was to verify if there was an association between LAA and UTI in older individuals with COPD. A population-based, real-world cohort study using health administrative data from Ontario, Canada was conducted...
October 12, 2016: COPD
Ming-Fang Wu, Zhi-Hong Jian, Jing-Yang Huang, Cheng-Feng Jan, Oswald Ndi Nfor, Kai-Ming Jhang, Wen-Yuan Ku, Chien-Chang Ho, Chia-Chi Lung, Hui-Hsien Pan, Min-Chen Wu, Yung-Po Liaw
BACKGROUND: Inhaled corticosteroids (ICS) have been associated with decreased lung cancer risk. However, they have been associated with pulmonary infections (tuberculosis [TB] and pneumonia) in patients with chronic obstructive pulmonary disease (COPD). TB and pneumonia have increased lung cancer risk. The association between post-ICS pulmonary infections and lung cancer remains unclear. METHODS: We conducted a retrospective cohort study from 2003 to 2010 using the Taiwan National Health Insurance Research Database...
October 10, 2016: BMC Cancer
Hoang Kim Tu Trinh, Ga-Young Ban, Ji-Ho Lee, Hae-Sim Park
Elderly asthma (EA) is regarded as a distinct phenotype of asthma and is associated with age-related changes in airway structure and alterations in lung function and immune responses. EA is difficult to diagnose because of aging and co-morbidities, and overlaps with fixed airway obstructive disease. Novel modalities to differentiate between EA and chronic obstructive pulmonary disease (COPD) are necessary. A multifaceted approach, including clinical history, smoking habits, atopy, and measurement of lung function, is mandatory to differentiate asthma from COPD...
October 6, 2016: Drugs & Aging
Shih-Lung Cheng, Ching-Hsiung Lin
BACKGROUND: Blood eosinophil counts have been documented as a good biomarker for patients with chronic obstructive pulmonary disease (COPD) using inhaled corticosteroid (ICS) therapy. However, the effectiveness and safety of prescribing high or medium dose of ICS for patients with different eosinophil counts are unknown. METHODS: A post hoc analysis of a previous prospective randomized study was performed for COPD patients using higher dose (HD: Fluticasone 1,000 μg/day) or medium dose (MD: Fluticasone 500 μg/day) of ICS combined with Salmeterol (100 μg/day)...
2016: International Journal of Chronic Obstructive Pulmonary Disease
R Garrastazu, J L García-Rivero, M Ruiz-Nuñez, J M Helguera, S Arenal, C Bonnardeux, C León, M Miravitlles, M Santibañez
INTRODUCTION/OBJECTIVE: One of main limitations in studies of COPD in health databases could be the low quality of the information. Our first aim was evaluate reliability of the registry of COPD diagnosis register in Primary Care. A description and comparison is also presented of the characteristics of the patients according to the diagnostic confirmation. MATERIAL AND METHODS: A cross-sectional study using healthcare databases of Cantabria. A pre-selected sample of 1,457 patients was obtained in which COPD diagnosis was specifically registered...
September 27, 2016: Semergen
Mayank Ajmera, Chan Shen, Usha Sambamoorthi
Use of multiple prescription medications is common among individuals with chronic obstructive pulmonary disease (COPD) because of coexisting inflammatory-related conditions. Specifically, the use of antidepressants, inhaled corticosteroids (ICSs), and statins may place individuals with COPD at high risk for new-onset diabetes. The objective was to examine the relationship between the use of antidepressants, ICSs, and statins and new-onset diabetes among Medicaid beneficiaries with COPD. This study used a retrospective longitudinal cohort design using multiple years (2005-2008) of Medicaid claims for beneficiaries with newly diagnosed COPD (n = 15,287), who were diabetes free at baseline...
September 30, 2016: Population Health Management
Barbara P Yawn, Samy Suissa, Andrea Rossi
International guidance on chronic obstructive pulmonary disease (COPD) management recommends the use of inhaled corticosteroids (ICS) in those patients at increased likelihood of exacerbation. In spite of this guidance, ICS are prescribed in a large number of patients who are unlikely to benefit. Given the evidence of the risks associated with ICS and the limited indications for their use, there is interest in understanding the effects of withdrawing ICS when prescribed inappropriately. In this review, we discuss the findings of large ICS withdrawal trials, with primary focus on the more recent trials using active comparators...
September 29, 2016: NPJ Primary Care Respiratory Medicine
Junghyun Kim, Jung-Kyu Lee, Eun Young Heo, Hee Soon Chung, Deog Kyeom Kim
BACKGROUND: The hallmark of COPD is chronic airway inflammation, which may be mediated by renin-angiotensin system. The renin-angiotensin system blockers such as angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) have exhibited anti-inflammatory and immunomodulatory effects in patients with various diseases. We explored the effects of ACEi and ARBs on the risk of pneumonia in patients with COPD. METHODS: A nested case-control study was performed on COPD patients recruited from January 2010 to August 2013 in two referral hospitals in Korea...
2016: International Journal of Chronic Obstructive Pulmonary Disease
Melody Tran, Pin Xiang, Karen L Rascati, Eileen M Stock, Paul J Godley, Amber Coleman, Michael R Bogart, Richard H Stanford
BACKGROUND: Suboptimal treatment of exacerbations is a major concern in management of chronic obstructive pulmonary disease (COPD). The Pharmacotherapy Management of COPD Exacerbation (PCE) Healthcare Effectiveness Data and Information Set (HEDIS) measure is a quality measure included by the National Committee for Quality Assurance that focuses on appropriate use of steroids and bronchodilators during an acute COPD exacerbation. There is limited evidence evaluating predictors of this quality measure, as well as its association with hospital readmission and cost outcomes...
October 2016: Journal of Managed Care & Specialty Pharmacy
Seiichi Kobayashi, Masakazu Hanagama, Shinsuke Yamanda, Masatsugu Ishida, Masaru Yanai
BACKGROUND: The clinical phenotypes and underlying mechanisms of asthma-COPD overlap syndrome (ACOS) remain elusive. This study aimed to investigate a comparison of COPD patients with and without ACOS, focusing on inflammatory biomarkers, in an outpatient COPD cohort. METHODS: We conducted a cross-sectional study analyzing prospectively collected data from the Ishinomaki COPD Network registry. All participants were diagnosed with COPD, confirmed by using spirometry, and were aged 40-90 years and former smokers...
2016: International Journal of Chronic Obstructive Pulmonary Disease
James L Kreindler, Michael L Watkins, Sally Lettis, Ruth Tal-Singer, Nicholas Locantore
INTRODUCTION: Sputum and blood eosinophil counts have attracted attention as potential biomarkers in chronic obstructive pulmonary disease (COPD). One question regarding the use of blood eosinophils as a biomarker in COPD is whether their levels are affected by the use of inhaled corticosteroids (ICS), which are commonly prescribed for COPD. METHODS: We performed a retrospective analysis of peripheral blood leucocytes from a previously completed clinical trial that examined effects of ICS in steroid-naïve patients with COPD...
2016: BMJ Open Respiratory Research
R J Schlosser, T L Smith, J Mace, Z M Soler
BACKGROUND: Patients with chronic rhinosinusitis (CRS) often have comorbid asthma. Prior studies have not examined the impact of CRS or endoscopic sinus surgery (ESS) upon asthma quality of life (QOL) and asthma control using validated outcome metrics. METHODS: Patients with CRS, both with and without polyps, and comorbid asthma completed the Mini Asthma QOL Questionnaire (miniAQLQ) and Asthma Control Test (ACT) at baseline and 6 months postoperatively as part of a multi-institutional, prospective study...
September 17, 2016: Allergy
Masakazu Ichinose, Hiroyuki Taniguchi, Ayako Takizawa, Lars Grönke, Lazaro Loaiza, Florian Voß, Yihua Zhao, Yoshinosuke Fukuchi
BACKGROUND: The efficacy and safety of once-daily tiotropium + olodaterol (T+O) maintenance treatment was demonstrated in the large, multinational, replicate, randomized, Phase III, Tonado(®) 1 (NCT01431274) and 2 (NCT01431287) studies in patients with moderate to very severe COPD. However, there may be racial differences in the effects of T+O on lung function in patients with COPD. METHODS: In this Tonado(®) subgroup analysis, we assessed efficacy and safety of T+O in Japanese participants...
2016: International Journal of Chronic Obstructive Pulmonary Disease
Jun-Jun Yeh, Yu-Chiao Wang, Chia-Hung Kao
PURPOSE: We conducted a cohort study to clarify this relationship between asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) and pulmonary embolism (PE). METHODS: From the National Health Insurance Research Database of Taiwan, we identified patients who had a diagnosis of asthma and a diagnosis of COPD (defined as ACOS) and concurrent treatment between January 1999 and December 2009 (ACOS cohort: n = 14,150; non-ACOS cohort: n = 55,876)...
2016: PloS One
Michael H K Nguyen, Krista M Isaac, Rebecca Dougherty
Gastrointestinal perforations are a complication of 2-10% of duodenal ulcers. There are a variety of etiologies associated with duodenal ulcer formation and its complications. Corticosteroid use is associated with an increased risk of duodenal ulcer perforation, with the first documented case in 1950. Other important medications associated with perforation include NSAIDS and opioids. Beyond medication, one of the most common disease processes, chronic obstructive pulmonary disease (COPD), has been found to be associated with peptic ulcer disease...
2016: Journal of Community Hospital Internal Medicine Perspectives
Maria E Laucho-Contreras, Maria Montes de Oca, Caroline A Owen
BACKGROUND: Although some patients with obstructive lung disease (OLD) have features of both asthma and chronic obstructive pulmonary disease (COPD), the term "asthma-COPD overlap syndrome (ACOS)" was coined only relatively recently. However, there are gaps in our knowledge of the clinical features, pathogenesis, prognosis, and management of ACOS patients. OBJECTIVES: To review the literature on ACOS to determine the extent to which the clinical features, pathologic mechanisms, clinical outcomes, and current therapeutic approaches for ACOS differ from those in patients with asthma alone or COPD alone...
September 6, 2016: Current Pharmaceutical Design
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