Clinical effects of inhaled corticosteroids in chronic obstructive pulmonary disease

Effects of inhaled corticosteroids in stable chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) has been described as a heterogeneous multifactorial disorder associated with an abnormal inflammatory response of the peripheral airways and with variable morphologic, physiologic and clinical phenotypes. This notion of the disease is actually poorly supported by data, and there are substantial discrepancies and a weak correlation between inflammation, structural damage, functional impairment and degree of clinical symptoms. This problem is compounded by a poor understanding of the complexity and intricacies on the inflammatory pathways in COPD. Despite the evidence for efficacy of inhaled corticosteroids (ICS) on selected clinical endpoints in COPD, we cannot assume that anti-inflammatory treatment with ICS alone or in combination with long-acting bronchodilators will necessarily improve the underlying inflammatory processes and patient relevant outcomes in COPD. Given the widespread use of inhaled corticosteroids (ICS) alone or in combination for the treatment of COPD across all severities, it is important to weigh their clinically proven benefits and shortcomings cautiously and critically. Reviewed is the current evidence-based role of ICS on inflammatory markers and patient relevant outcomes in COPD.

Multidimensional analyses of long-term clinical courses of asthma and chronic obstructive pulmonary disease

Asthma and chronic obstructive pulmonary disease (COPD) are chronic respiratory disorders involving obstructive airway defects. There have been many discussions on their similarities and differences. Although airflow limitation expressed as forced expiratory volume in one second (FEV(1)) has been considered to be the main diagnostic assessment in both diseases, it does not reflect the functional impairment imparted to the patients by these diseases. Therefore, multidimensional approaches using multiple measurements in assessing disease control or severity have been recommended, and multiple endpoints in addition to FEV(1) have been set recently in clinical trials so as not to miss the overall effects. In particular, as improving symptoms and health status as well as pulmonary function are important goals in the management of asthma and COPD, some patient-reported measurements such as health-related quality of life or dyspnea should be included. Nonetheless, there have been few reviews on the long-term clinical course comparing asthma and COPD as predicted by measurements other than airflow limitation. Here, we therefore analyzed and compared longitudinal changes in both physiological measurements and patient-reported measurements in asthma and COPD. Although both diseases showed similar long-term progressive airflow limitation similarly despite guideline-based therapies, disease progression was different in asthma and COPD. In asthma, patient-reported assessments of health status, disability and psychological status remained clinically stable over time, in contrast to the significant deterioration of these parameters in COPD. Thus, because a single measurement of airflow limitation is insufficient to monitor these diseases, multidimensional analyses are important not only for disease control but also for understanding disease progression in asthma and COPD.

Occasional review: influenza in COPD: pathogenesis, prevention, and treatment

Influenza viruses cause respiratory tract infections that in patients with underlying lung diseases such as chronic obstructive pulmonary disease (COPD) are associated with exacerbations and excess morbidity and mortality. Typically, influenza B is associated with relatively mild, local outbreaks, whereas influenza A is the cause of world-wide pandemics. Upon infection, two antigens present on the viral surface, hemagglutinin and neuraminidase result in human immunity, but since many subtypes of these antigens exist that vary over time, immunity in the population is blunted. Vaccination is advocated in high-risk groups including patients with underlying (lung) diseases and in the elderly, and needs to be repeated annually with vaccines expected to cover the expected change in viral antigenicity. When started early, antiviral drugs, especially neuraminidase-inhibitors can be prescribed in adjunct to nonspecific interventions in an attempt to shorten disease duration and to prevent complications in case of an influenza infection. Currently, the effectiveness of antiviral drugs specifically in patients with COPD has not been proven.

[A case of recurrent gastric cancer with improvement of obstructive symptoms caused by carcinomatous peritonitis and prolonged survival by chemotherapy with combined use of Paclitaxel and 5-FU]

A 29-year-old male underwent Cur B surgery including total gastrectomy, pancreaticoduodenectomy, transverse colectomy, and D 2 dissection for scirrhous gastric carcinoma accompanied by duodenal and pancreatic infiltration. Thereafter, the patient suffered from recurrence with development of ileus caused by carcinomatous peritonitis. Ileus tube was inserted, followed by conservative therapy without ingestion. But, as the symptoms aggravated without any alleviation, an emergency surgical procedure was conducted. As disseminated changes were observed in the entire region of the abdominal cavity of the epigastric region, ileus by-pass procedure and ileostomy were performed. Though ileus symptoms were improved, peroral intake was difficult,and the ileus tube had to be left in place. Thereafter, chemotherapy with combined use of paclitaxel and 5-FU was initiated, and peroral intake become possible. The Ileus tube could be removed after improvement of obstructive symptoms. The patient was treated at the outpatient clinic with nutritional help of HPN, but died 14 months after the recurrence.

The role of combination therapy with corticosteroids and long-acting beta2-agonists in the prevention of exacerbations in COPD

Acute exacerbations of COPD can complicate the course of the disease in patients with severe airway obstruction. Reduction of exacerbations is an important clinical outcome in evaluating new therapies in COPD. Combination therapies with long-acting beta-agonists and inhaled corticosteroids have now been approved for use. Three 1-year randomized clinical trials, which studied the effect of combining a long-acting beta2-agonist with an inhaled corticosteroid in COPD, documented that exacerbation frequency was lower with therapy than placebo. Combination therapy had a similar effect to its monocomponents in the trial evaluating salmeterol/fluticasone combination. However, when patients with more severe COPD were studied using a combination of budesonide and formoterol, a clear improvement was seen in the overall exacerbation rates compared with the use of a long-acting beta2-agonist alone.