Research

Nocturnal CPAP improves walking capacity in COPD patients with obstructive sleep apnoea

Tsai-Yu Wang^1†, Yu-Lun Lo^1†, Kang-Yun Lee¹, Wen-Te Liu^2,3, Shu-Min Lin¹, Ting-Yu Lin¹,Yung-Lun Ni⁴, Chao-Yung Wang⁵, Shu-Chuan Ho^1,3 and Han-Pin Kuo^1*

• *Corresponding author: Han-Pin Kuo q8828@ms11.hinet.net
• † Equal contributors

Author Affiliations

¹Department of Thoracic Medicine, Chang Gung Memorial Hospital and Chang Gung University, School of Medicine, Taipei, Taiwan

²Division of Pulmonary, Department of Internal Medicine, Shuang Ho Hospital, Taipei, Taiwan

³School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan

⁴Department of Chest Medicine, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung, Taiwan

⁵Department of Cardiology Medicine, Chang Gung Memorial Hospital and Chang Gung University, School of Medicine, Taipei, Taiwan

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Respiratory Research 2013, 14:66 doi:10.1186/1465-9921-14-66

The electronic version of this article is the complete one and can be found online at:http://respiratory-research.com/content/14/1/66

Received:	11 February 2013
Accepted:	17 June 2013
Published:	19 June 2013

© 2013 Wang et al.; licensee BioMed Central Ltd. 

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Exercise limitation is an important issue in patients with chronic obstructive pulmonary disease (COPD), and it often co-exists with obstructive sleep apnoea (overlap syndrome). This study examined the effects of nocturnal continuous positive airway pressure (CPAP) treatment on walking capacity in COPD patients with or without obstructive sleep apnoea.

Methods

Forty-four stable moderate-to-severe COPD patients were recruited and completed this study. They all underwent polysomnography, CPAP titration, accommodation, and treatment with adequate pressure. The incremental shuttle walking test was used to measure walking capacity at baseline and after two nights of CPAP treatment. Urinary catecholamine and heart rate variability were measured before and after CPAP treatment.

Results

After two nights of CPAP treatment, the apnoea-hypopnoea index and oxygen desaturation index significantly improved in both overlap syndrome and COPD patients, however these changes were significantly greater in the overlap syndrome than in the COPD group. Sleep architecture and autonomic dysfunction significantly improved in the overlap syndrome group but not in the COPD group. CPAP treatment was associated with an increased walking capacity from baseline from 226.4 ± 95.3 m to 288.6 ± 94.6 m (P < 0.05), and decreased urinary catecholamine levels, pre-exercise heart rate, oxygenation, and Borg scale in the overlap syndrome group. An improvement in the apnoea-hypopnoea index was an independent factor associated with the increase in walking distance (r = 0.564).

Conclusion

Nocturnal CPAP may improve walking capacity in COPD patients with overlap syndrome.

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Trial registration

NCT00914264

Keywords: 

Chronic obstructive pulmonary disease; Obstructive sleep apnoea; Walking capacity; Autonomic dysfunction; Continuous positive airway pressure

 

International Journal of Chronic Obstructive Pulmonary Disease

Inhaled corticosteroid use in patients with chronic obstructive pulmonary disease and the risk of pneumonia: a retrospective claims data analysis

Original Research

(419) Total Article Views

Authors: Yawn BP, Li YF, Tian HJ, Zhang J, Arcona S, Kahler KH

Published Date June 2013 Volume 2013:8 Pages 295 - 304

DOI: http://dx.doi.org/10.2147/COPD.S42366

Received:	05 January 2013
Accepted:	22 March 2013
Published:	27 June 2013

Barbara P Yawn,¹ Yunfeng Li,² Haijun Tian,² Jie Zhang,² Steve Arcona,² Kristijan H Kahler<sup>2

1</sup>Department of Research, Olmsted Medical Center, Rochester, MN, USA; ²Department of Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA

Background: The use of inhaled corticosteroids in patients with chronic obstructive pulmonary disease (COPD) has been associated with an increased risk of pneumonia in controlled clinical trials and case-control analyses.
Objective: Using claims databases as a research model of real-world diagnosis and treatment, to determine if the use and dose of inhaled corticosteroids (ICS) among patients with newly diagnosed COPD are associated with increased risk of pneumonia.
Patients and methods: This was a retrospective cohort analysis of patients diagnosed with COPD between January 01, 2006 and September 30, 2010, drawn from databases (years 2006–2010). Patients (aged ≥45 years) were followed until first pneumonia diagnosis, end of benefit enrollment, or December 31, 2010, whichever was earliest. A Cox proportional hazard model was used to assess the association of ICS use and risk of pneumonia, controlling for baseline characteristics. Daily ICS use was classified into low, medium, and high doses (1 µg–499 µg, 500 µg–999 µg, and ≥1000 µg fluticasone equivalents daily) and was modeled as a time-dependent variable.
Results: Among 135,445 qualifying patients with a total of 243,097 person-years, there were 1020 pneumonia incidences out of 5677 person-years on ICS (crude incidence rate, 0.180 per person-year), and 27,730 pneumonia incidences out of 237,420 person-years not on ICS (crude incidence rate, 0.117 per person-year). ICS use was associated with a dose-related increase in risk of pneumonia, with adjusted hazard ratios (versus no use; (95% confidence interval) of 1.38 (1.27–1.49) for low-dose users, 1.69 (1.52–1.88) for medium-dose users, and 2.57 (1.98–3.33) for high-dose users (P - 0.01 versus no use and between doses).
Conclusion: The use of ICS in newly diagnosed patients with COPD is potentially associated with a dose-related increase in the risk of pneumonia.

Keywords: COPD, ICS, LABA, pneumonia



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Thorax 2013;68:658-663 doi:10.1136/thoraxjnl-2012-203109

• Epidemiology

• Original article

Effectiveness of influenza vaccination in working-age adults with diabetes: a population-based cohort study

1. Darren Lau1, 
2. Dean T Eurich1, 
3. Sumit R Majumdar1,2, 
4. Alan Katz3, 
5. Jeffrey A Johnson1

+Author Affiliations

1. ¹Department of Public Health Sciences, University of Alberta, Edmonton, Canada
2. ²Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
3. ³Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada

1. Correspondence toDr Jeffrey A Johnson, 2-040G Li Ka Shing Center for Health Research Innovation, 8602 112 Street, Department of Public Health Sciences, University of Alberta, Edmonton, Canada, AB T6G 2E1; jeff.johnson@ualberta.ca

• Received 7 December 2012
• Revised 7 February 2013
• Accepted 2 March 2013
• Published Online First 27 March 2013

Abstract

Background Guidelines recommend influenza vaccinations in all diabetic adults, but there is limited evidence to support vaccinating working-age adults ( - 65 years) with diabetes. We examined the effectiveness of influenza vaccine in this subgroup, compared with elderly adults (+ 65 years) for whom vaccination recommendations are well accepted.

Methods We identified all adults with diabetes, along with a sample of age-matched and sex-matched comparison subjects without diabetes, from 2000 to 2008, using administrative data from Manitoba, Canada. With multivariable Poisson regression, we estimated vaccine effectiveness (VE) on influenza-like illnesses (ILIs), pneumonia and influenza (PI) hospitalisations and all-cause (ALL) hospitalisations during periods of known circulating influenza. Analyses were replicated outside of influenza season to rule out residual confounding.

Results We included 543 367 person-years of follow-up, during which 223 920 ILI, 5422 PI and 94 988 ALL occurred. The majority (58%) of adults with diabetes were working age. In this group, influenza vaccination was associated with relative reductions in PI (43%, 95% CI 28% to 54%) and ALL (28%, 95% CI 24% to 32%) but not ILI (−1%, 95% CI −3% to 1%). VE was similar in elderly adults for ALL (33–34%) and PI (45–55%), although not ILI (12–13%). However, similar estimates of effectiveness were also observed for all three groups during non-influenza control periods.

Conclusions Working-age adults with diabetes experience similar benefits from vaccination as elderly adults, supporting current diabetes-specific recommendations. However, these benefits were also manifest outside of influenza season, suggesting residual bias. Vaccination recommendations in all high-risk adults would benefit from randomised trial evidence.

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The Asthma Phenotype in the Obese: Distinct or Otherwise?

Journal of Allergy
Volume 2013 (2013), Article ID 602908, 8 pages
http://dx.doi.org/10.1155/2013/602908

Review Article

The Asthma Phenotype in the Obese: Distinct or Otherwise?

Sherry Farzan

North Shore-Long Island Jewish Health System, Division of Allergy and Immunology, 865 Northern Bouelvard Suite 101, Great Neck, NY 11021, USA

Received 12 February 2013; Accepted 9 May 2013

Academic Editor: Anurag Agrawal

Copyright © 2013 Sherry Farzan. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Asthma is a heterogenous disorder that can be classified into several different phenotypes. Recent cluster analyses have identified an “obese-asthma” phenotype which is characterized by late onset, female predominance and lack of atopy. In addition, obesity among early-onset asthmatics clearly exists and heightens the clinical presentation. Observational studies have demonstrated that asthma among the obese has a clinical presentation that is more severe, harder to control, and is not as responsive to standard controller therapies. While weight loss studies have demonstrated improvement in asthma outcomes, further studies need to be performed. The current knowledge of the existence of two obesity-asthma phenotypes (early- versus late-onset asthma) should encourage investigators to study these entities separately since just as they have distinct presentations, their course, response to therapies, and weight loss strategies may be different as well.

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Research

Tolerance to alternative cyclooxygenase-2 inhibitors in nonsteroidal anti-inflammatory drug hypersensitive patients

Wendy SJ Malskat, André C Knulst, Carla AFM Bruijnzeel-Koomen and Heike Röckmann

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Clinical and Translational Allergy 2013, 3:20 doi:10.1186/2045-7022-3-20

Published: 24 June 2013

Abstract (provisional)

Background

Non-steroidal anti-inflammatory drugs (NSAIDs) frequently cause adverse drug reactions. Many studies have shown that drugs which selectively inhibit the cyclooxygenase-2 enzyme (COX-2) are safe alternatives in the majority of patients. However, hypersensitivity reactions to COX-2 inhibitors have been published. Hardly any data are available regarding the safety of alternatives in case of COX-2 inhibitor hypersensitivity. We aimed to investigate the tolerance to COX-2 inhibitors in patients with non-selective NSAID hypersensitivity. Furthermore, in COX-2 hypersensitive patients tolerance of a second COX-2 inhibitor was investigated.

Methods

We retrospectively analyzed 91 patients with proven non-selective NSAID hypersensitivity that underwent oral challenges with a COX-2 inhibitor. Patients with intolerance to the first challenged COX-2 inhibitor received a second challenge with a different COX-2 inhibitor.

Results

19 out of 91 (21% ) patients had a positive reaction to the first oral challenge with a COX-2 inhibitor. 14 of them underwent a second challenge with a different COX-2 inhibitor and 12 (86% ) did not react.

Conclusions

A relatively high percentage (21% ) of the non-selective NSAID hypersensitive patients did not tolerate a COX-2 inhibitor and oral challenge is advised prior to prescription of a COX-2 inhibitor. For the majority of patients reacting to a COX-2 inhibitor an alternative can be found.

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Peptide-Based Vaccinology: Experimental and Computational Approaches to Target Hypervariable Viruses

Clinical and Developmental Immunology
Volume 2013 (2013), Article ID 521231, 12 pages
http://dx.doi.org/10.1155/2013/521231

Review Article

Peptide-Based Vaccinology: Experimental and Computational Approaches to Target Hypervariable Viruses through the Fine Characterization of Protective Epitopes Recognized by Monoclonal Antibodies and the Identification of T-Cell-Activating Peptides

Matteo Castelli,¹ Francesca Cappelletti,¹ Roberta Antonia Diotti,¹ Giuseppe Sautto,¹ Elena Criscuolo,¹Matteo Dal Peraro,² and Nicola Clementi¹

¹Microbiology and Virology Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
²Laboratory for Biomolecular Modeling, Institute of Bioingeneering, School of Life Sciences, Ecole Polytechnique Fédérale, 1015 Lausanne, Switzerland

Received 8 May 2013; Accepted 6 June 2013

Academic Editor: Roberto Burioni

Copyright © 2013 Matteo Castelli et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Defining immunogenic domains of viral proteins capable of eliciting a protective immune response is crucial in the development of novel epitope-based prophylactic strategies. This is particularly important for the selective targeting of conserved regions shared among hypervariable viruses. Studying postinfection and postimmunization sera, as well as cloning and characterization of monoclonal antibodies (mAbs), still represents the best approach to identify protective epitopes. In particular, a protective mAb directed against conserved regions can play a key role in immunogen design and in human therapy as well. Experimental approaches aiming to characterize protective mAb epitopes or to identify T-cell-activating peptides are often burdened by technical limitations and can require long time to be correctly addressed. Thus, in the last decade many epitope predictive algorithms have been developed. These algorithms are continually evolving, and their use to address the empirical research is widely increasing. Here, we review several strategies based on experimental techniques alone or addressed by in silico analysis that are frequently used to predict immunogens to be included in novel epitope-based vaccine approaches. We will list the main strategies aiming to design a new vaccine preparation conferring the protection of a neutralizing mAb combined with an effective cell-mediated response.

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