Assessment of osteoporosis using the FRAX method and the importance of vitamin D levels in COPD patients

[Bone metabolism in patients evaluated for lung transplantation]

Introduction

Introduction: the prevalence of osteoporosis among candidates for lung transplantation is high and its pathophysiology is multifactorial. Objectives: to evaluate differences in bone mineral density, risk of fractures and bone remodeling markers in patients with terminal lung disease, at the time they are evaluated for lung transplantation, comparing two types of pathologies. Material and methods: fifty-nine subjects, proposed to receive a lung transplant due to advanced lung disease, were included in this study. They were divided into two groups according to their respiratory pathology: chronic obstructive pulmonary disease (COPD) and diffuse interstitial pulmonary disease (ILD). Demographic data were collected and bone densitometry, blood analysis with markers of bone remodeling, spirometry, six-minute walk test (6MWT), echocardiography and cardiac catheterization were performed Results: no differences were found between the groups, regarding their age, sex, BMI or exposure to tobacco. A higher prevalence of osteoporosis and a higher FRAX were observed in the group with COPD. Regarding bone remodeling markers, higher parathyroid hormone (PTH) and higher osteocalcin were found in the COPD group. Vitamin D was lower in COPD patients. Conclusions: two out of three of the patients evaluated for lung transplantation had osteopenia or osteoporosis. The prevalence of osteoporosis and FRAX is higher in COPD patients. Vitamin D supplementation should be considered in certain patients. Differences in bone remodeling markers may be useful for suspected osteoporosis and therapeutic management.

Mometasone/Indacaterol/Glycopyrronium (MF/IND/GLY) and MF/IND at Different MF Strengths versus Fluticasone Propionate/Salmeterol Xinafoate (FLU/SAL) and FLU/SAL+ Tiotropium in Patients with Asthma

Background

Once-daily, single-inhaler mometasone furoate/indacaterol acetate/glycopyrronium bromide (MF/IND/GLY, an ICS/LABA/LAMA) and MF/IND (an ICS/LABA) via Breezhaler® have been approved for the maintenance treatment of patients with asthma inadequately controlled with medium-or high-dose ICS or medium-or high-dose ICS/LABA treatment.

Objective

Once-daily (o.d.) formulations of MF/IND/GLY and MF/IND at different MF dose strengths have been compared with twice-daily (b.i.d.) fluticasone propionate/salmeterol xinafoate (FLU/SAL), and b.i.d. FLU/SAL+ o.d. tiotropium (TIO) in the PALLADIUM, IRIDIUM and ARGON studies.

Methods

The similarity in study design and consistent outcomes in these studies prompted the pooling of data in this review to better characterise these novel once-daily controller formulations.

Results

Pooled data from PALLADIUM and IRIDIUM studies showed comparable or greater efficacy with o.d. MF/IND formulations versus b.i.d. FLU/SAL. The o.d. MF/IND/GLY was superior to b.i.d. FLU/SAL in the IRIDIUM study, and similar to, if not more efficacious than b.i.d. FLU/SAL + o.d. TIO in the ARGON study.

Conclusion

These formulations therefore provide novel once-daily treatment options for patients across asthma severity and flexibility for clinicians to step-up or step-down the treatment using the same device and formulations.

A Comprehensive Review on Vitamin D as a Novel Therapeutic Agent in Chronic Obstructive Pulmonary Disease

Vitamin D has been playing an important role in the treatment of lung diseases. The non-calcemic effects of this vitamin and its role in chronic obstructive pulmonary disease (COPD) has drawn significant attention recently. Many studies have been conducted to explore the relationship between the two. We tested the hypothesis that vitamin D can act as an effective therapeutic agent for COPD by reviewing the correlation between the two and effectiveness along with the safety of supplemental vitamin D when used to treat chronic bronchitis and emphysema through clinical trials. An electronic search was conducted using combinations of keywords "vitamin D" and "COPD" from PubMed and Google scholar. Only relevant, human studies of all types were included from the last decade. A total of 36 articles were selected for review. Observational studies indicate a correlation between low serum 25(OH)D levels and obstructive lung disease pathology as well as clinical outcomes. Moreover, clinical trials were aimed to understand the impact of the use of vitamin D in improving disease indexes. These clinical trials used different drug regimes, mode of administration, and intervention duration with contrasting outcomes. Hypovitaminosis D is a common and harmful variant of this group of obstructive lung diseases, and correcting this deficiency can improve exacerbations, inflammation, lung functions, symptoms, and quality of life. These benefits are more prevalent in patients with low baseline serum 25 hydroxyvitamin D(25(OH)D) levels. Peroral is the most frequently used route of drug administration, however, further work is required to explore the pharmacological properties of vitamin D. There was not enough literature available about the safety of the drug of intervention.

Logistic regression analysis of environmental and other variables and incidences of tuberculosis in respiratory patients

The objective of this study was to examine the association of 14 variables with TB in respiratory patients. The variables included: urban/rural, persons in 1200 sqft area, TB in family, crowding, smoking (family member), gender, age, education, smoking, workplace, kitchen location, cooking fuel, ventilation, and kerosene uses. Eight hundred respiratory patients were tested for sputum positive pulmonary TB; 500 had TB and 300 did not. An analysis of the unadjusted odds ratio (UOR) and adjusted OR (AOR) was undertaken using logistic regression to link the probability of TB incidences with the variables. There was an inconsistency in the significance of variables using UOR and AOR. A subset model of 4 variables (kerosene uses, ventilation, workplace, and gender) based on significant AOR was adjudged acceptable for estimating the probability of TB incidences. Uses of kerosene (AOR 2.62 (1.95, 3.54)) consistently related to incidences of TB. It was estimated that 50% reduction in kerosene uses could reduce the probability of TB by 13.29% in respiratory patients. The major recommendation was to replace kerosene uses from households with a supply of clean fuel like liquid petroleum or natural gas and rural electrification.

Heart of glass: fatal hematemesis caused by bronchiole-cardiac fistula

A 58-year old woman presented for autopsy after having been found unresponsive in a public bathroom surrounded by a pool of blood. During attempts at resuscitation, blood was noted in her airway. She had a past medical history that included surgical repair of Tetralogy of Fallot as a child. At autopsy, a shard of glass was identified projecting from the surface of the left lung, having formed densely fibrotic adhesions at the pleural surface. The glass also penetrated through a bronchiole lumen and into a previously surgically repaired bulging right ventricular outflow tract, forming a bronchiole-cardiac fistula, allowing for the massive hemoptysis that led to her death. After further inquiry, it was discovered that the decedent also had a history of seizure disorder and had fallen through a glass door during a seizure many years ago, requiring several shards of glass to be removed from her chest wall.

Association of COPD with osteoporosis in male smokers: A case control study in a tertiary medical college hospital in Bangladesh

OBJECTIVES

Chronic obstructive pulmonary disease (COPD) may increase the risk of osteoporosis and resulting fractures can contribute to disability and mortality of patients. We intended to evaluate the frequency of osteoporosis in male smokers with and without COPD and study whether any correlation existed between osteoporosis and COPD.

MATERIALS AND METHODS

This case-control study was carried out in the Department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh between July 2013 and June 2015. Seventy four male smokers with COPD and 66 age-matched male smokers without COPD were enrolled. All individuals underwent Bone Mass Densitometry (BMD) by Dual-Energy X-Ray Absorptiometry (DEXA).

RESULTS

COPD and non-COPD groups did not differ regarding age and smoking pack-years. Osteoporosis at femoral neck (48.6% versus 16.7%; p< 0.001) and lumbar spine (68.9% versus 37.9%; p< 0.01) was significantly higher in COPD compared to controls. Osteopenia did not differ significantly. Patients with COPD were 4.5 times more likely to develop osteoporosis than controls after adjusting age, smoking-pack years and BMI (adjusted OR = 4.5; 95% CI = 1.8-11.5).

CONCLUSIONS

Osteoporosis is more frequent in male smokers with COPD compared to smokers without COPD. COPD is a risk factor of osteoporosis independent of age, smoking and BMI.