COPD

Bronchodilator Combo Works Best for COPD

Bronchodilator Combo Works Best for COPD

Bronchodilator Combo Works Best for COPD

 

Bronchodilator Combo Works Best for COPD

 

NBN Infusions delivers comprehensive services to patients of all ages, from pediatric to geriatric, providing a full range of care for Home Infusion Therapy. NBN Infusions on-site, licensed pharmacy can provide prescription medications, equipment, supplies and skilled nursing care needed for Home Infusion Therapy.

Home Infusion Therapy is a more convenient and cost-effective option than traditional inpatient therapy, with care administered in the comfortable surroundings of one’s own home. Home Infusion Therapy allows for a more active role in one’s own health care. It can also ease stress and anxiety that is sometimes associated with inpatient treatment, resulting in better patient outcomes.

 

CHICAGO — Combining bronchodilators formoterol (Foradil Aerolizer) and aclidinium (Tudorza Pressair) in a single twice-daily inhaler was better than either drug alone in chronic obstructive pulmonary disease (COPD), a randomized trial showed.

 

The combination of the long-acting beta2 agonist and long-acting muscarinic antagonist (LABA/LAMA) had a significantly stronger impact on lung function measured by forced expiratory volume in 1 s (FEV1) both at peak and trough time points compared with the single agent inhalers and compared with placebo.

 

The safety profile came out similar to either drug alone and to placebo, Anthony D’Urzo, MD, of the University of Toronto, and colleagues reported in the AUGMENT trial here at the CHEST meeting.

 

“For patients with moderate-to-severe COPD, a fixed-dose combination of two agents with different mechanisms of action is often recommended for improved bronchodilation, patient compliance, and cost-effectiveness,” D’Urzo noted at the late-breaking clinical trial session.

 

A variety of other fixed-dose combination inhalers are in development for COPD, noted Charles Powell, MD, chief of pulmonary, critical care, and sleep medicine at Mount Sinai Hospital in New York City.

 

“I think we can look for multiple drugs that combine LABA and LAMA medications into single device being introduced into clinical practice,” Powell said in an interview. “As of today, there are none yet available in the United States but I believe we can look forward to seeing multiple drugs with multiple actions available, these could include even a triplet of a LABA, LAMA, and a long-acting corticosteroid. I believe that’s the future.”

 

A once-daily LABA/LAMA combination of glycopyrronium/indacaterol showed promising results in cutting COPD exacerbations compared with either single agent in the SPARK trial last month.

 

While a single dose of a single inhaler would be convenient, some patients might benefit more from a twice-daily regimen, commented late-breaking session co-chair Andrew Berman, MD, director of pulmonology at Rutgers New Jersey Medical School in Newark.

 

“When you deliver that second dose at the 12-hour point, when they get an additional boost from the drug, some of our patients who are brittle really do benefit from that,” he told MedPage Today. “This group of patients is usually using rescue inhalers periodically through the day, so a b.i.d. drug is not really one that is inconvenient.”

 

The trial included 1,692 moderate-to-severe COPD patients randomized to aclidinium alone at 400 mcg, formoterol alone at 12 mcg, the combination at those doses, the combination with a lower 6-mcg dose of formoterol, or placebo for 24 weeks.

 

For one co-primary endpoint, FEV1 after the morning dose was 87 mL higher with the combination using the lower dose of formoterol and 108 mL higher with full dose combination than with aclidinium alone (both P<0.0001), showing the additive effect of formoterol.

 

For the other co-primary, change from baseline at the trough drug concentration before the morning dose was 45 mL greater with the full dose combination than with formoterol as monotherapy (P=0.0102).

 

The lower formoterol dose combination had a 26 mL advantage at trough over the formoterol monotherapy inhaler, but this didn’t reach statistical significance.

 

All four treatment arms came out significantly better than placebo on both measures, as expected.

 

The main point of the trial was to show that the combination wasn’t worse than monotherapy, which it did, Berman pointed out.

 

D’Urzo called the combination well-tolerated, with a rate of treatment-emergent adverse events of 61% to 64% compared with 57% and 62% in the monotherapy arms and 55% in the placebo group.

 

“Common treatment emergent adverse events were not different than in other trials looking at other compounds in same class,” he noted.

 

The most common were cough (4% to 5%), nasopharyngitis (5%), and headache (4% to 5%).

 

The trial included smokers and nonsmokers, which D’Urzo pointed to as supporting generalizability to clinical practice.

 

“The reality is there are still many patients with COPD out there who smoke,” he said.

 

Longer-term data is needed with the combination to see impact on COPD exacerbations, quality of life, and mortality, Powell noted.

 

Originally posted: MedPageToday.com 

 

 

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Exercise cuts risk of COPD flare-ups

Exercise cuts risk of COPD flare-ups

Exercise cuts risk of COPD flare-ups

 

Exercise cuts risk of COPD flare-ups

 

NBN Infusions delivers comprehensive services to patients of all ages, from pediatric to geriatric, providing a full range of care for Home Infusion Therapy. NBN Infusions on-site, licensed pharmacy can provide prescription medications, equipment, supplies and skilled nursing care needed for Home Infusion Therapy.

Home Infusion Therapy is a more convenient and cost-effective option than traditional inpatient therapy, with care administered in the comfortable surroundings of one’s own home. Home Infusion Therapy allows for a more active role in one’s own health care. It can also ease stress and anxiety that is sometimes associated with inpatient treatment, resulting in better patient outcomes.

 

Regular physical activity can halve the risk of hospital re-admissions for people with chronic obstructive pulmonary disease (COPD), according to a Spanish study.

 

Researchers from the Municipal Institute of Medical Investigation in Barcelona undertook a one-year study of 340 men with COPD following their admission to one of four hospitals. The researchers collected details of each patient’s lifestyle and medical treatments.

 

During the study period, almost two-thirds of the men were readmitted to hospital on at least one occasion. Just under a third died.

 

After taking into account factors such as disease severity, exposure to passive smoking and general health status, the researchers found that routine physical activity was the most important factor in reducing the risk of hospital readmission.

 

In fact, the patients who engaged in the equivalent of one hour’s walking a day reduced their risk of a hospital readmission by almost half.

 

The researchers suggest that exercise conditions the cardiovascular system to help it cope more effectively during a COPD flare-up.

 

Commenting on the findings, researchers said, “COPD patients often suffer a long, debilitating illness, which places a heavy burden on both health and social services resources.

 

“This study shows that offering exercise and rehabilitation can improve patient care and also result in more effective use of social services resources.”

 

The respiratory disorder – characterised by permanent and gradually worsening obstruction of the airflow to and from the lungs – is expected to become the third leading cause of death and fifth leading cause of disability worldwide by 2020.

 

Originally Posted: http://www.tele-management.ca

 

 

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