Efficacy of Inhaled Steroids in Undiagnosed Subjects at High Risk for COPD

Albers, Mieke; Schermer, Tjard; Boom, G. van den; Akkermans, Reinier; Schayck, Constant van; Herwaarden, Cees van; Weel, Chris van

doi:10.1378/chest.126.6.1815

Cited by 19 publications

(4 citation statements)

References 30 publications

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“…Fiz [31] and Albers [32] are able to identify objectively the presence of an obstructive pathology. Likewise, Meslier and Charbonneau [33] associate wheezes to the following pathologies:

Infections such as croup (infection that generally affects infants from less than three years), whooping cough, laryngitis, acute tracheobronchilis

Laryngo-, tracheo-, or bronchomalacia

Laryngeal or tracheal tumours

Tracheal stenosis

Emotional laryngeal stenosis

Foreign body aspiration

Airway compression

Asthma: wheeze detection in asthma [34], identification of nocturnal asthma [35],..

…”

Section: Lung Sounds Characteristicsmentioning

confidence: 99%

Analysis of Respiratory Sounds: State of the Art

Reichert¹,

Gass²,

Brandt

et al. 2008

Clinical medicine. Circulatory, respiratory and pulmonary medic

195

117

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Objective: This paper describes state of the art, scientifi c publications and ongoing research related to the methods of analysis of respiratory sounds. Methods and material:Review of the current medical and technological literature using Pubmed and personal experience. Results:The study includes a description of the various techniques that are being used to collect auscultation sounds, a physical description of known pathologic sounds for which automatic detection tools were developed. Modern tools are based on artifi cial intelligence and on technics such as artifi cial neural networks, fuzzy systems, and genetic algorithms… Conclusion: The next step will consist in fi nding new markers so as to increase the effi ciency of decision aid algorithms and tools.

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“…Fiz [31] and Albers [32] are able to identify objectively the presence of an obstructive pathology. Likewise, Meslier and Charbonneau [33] associate wheezes to the following pathologies:

Infections such as croup (infection that generally affects infants from less than three years), whooping cough, laryngitis, acute tracheobronchilis

Laryngo-, tracheo-, or bronchomalacia

Laryngeal or tracheal tumours

Tracheal stenosis

Emotional laryngeal stenosis

Foreign body aspiration

Airway compression

Asthma: wheeze detection in asthma [34], identification of nocturnal asthma [35],..

…”

Section: Lung Sounds Characteristicsmentioning

confidence: 99%

Analysis of Respiratory Sounds: State of the Art

Reichert¹,

Gass²,

Brandt

et al. 2008

Clinical medicine. Circulatory, respiratory and pulmonary medic

195

117

View full text Add to dashboard Cite

show abstract

“…The goal of pharmacologic therapy in COPD management is to slow the rate of decline in lung function, ultimately reducing COPD-related mortality. Although no individual clinical trial has shown a reduction in mortality, [16][17][18][19]26,80,81,[90][91][92][93][94] a recent pooled analysis 95 of 5085 subjects enrolled in seven randomized controlled trials [16][17][18][19]80,81,92 (the Inhaled Steroid Effects Evaluation in COPD (ISEEC) study) found that participants randomized to ICS had a lower risk of mortality (HR 0.75; 95% Confidence Interval (CI): 0.57 to 0.99) compared with placebo. The ISEEC study investigators also analyzed the decline in FEV 1 among these same seven RCTs 96 and concluded that in the first six months of treatment, ICS use was associated with a significant increase in FEV 1 , compared with placebo.…”

Section: Ics Efficacy In Copdmentioning

confidence: 99%

“…RCTs generally have strict entry and exclusion criteria. Among RCTs estimating the efficacy of ICS among persons with COPD, frequent exclusion criteria include: individuals with a history of asthma, 17,80,81,[92][93][94]119 individuals with bronchodilator reversibility of more than 10-15% of baseline FEV 1 , 17,19,26,80,94 individuals with conditions that could have lead to death within the timeframe of the study, 80,81,92,94,119 and individuals with no history of smoking. 16,17,19,26,90,91,80,81,92,94,119 A benefit of observational studies is that the sample size can be large, providing the ability to analyze effectiveness within subgroups, while maintaining a large enough sample size to detect differences (providing that internal validity is adequate).…”

Section: Hetereogeneity Of Response To Icsmentioning

confidence: 99%

Effectiveness of Inhaled Corticosteroids in Preventing Morbidity and Mortality in Individuals with Chronic Obstructive Pulmonary Disease and the Impact of Coexisting Asthma.

Goring¹,

Levy²,

Carleton³

et al. 2009

C50. Copd: Pharmacological Treatment Inhaled Corticosteroids

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Background: Chronic obstructive pulmonary disease (COPD) is a devastating illness that affects 4.3% of the population of British Columbia over the age of 45 years. Asthma is known to coexist in 10-20% of individuals with obstructive lung disease, and adds to the substantial burden of illness posed by COPD alone. Inhaled corticosteroids (ICS) are currently recommended for the management of COPD among individuals with frequent exacerbations; however, the ability of inhaled corticosteroids to reduce death and hospitalizations among individuals with COPD is controversial. Less is known about the effectiveness of ICS among individuals who are afflicted with both COPD and asthma. Methods: We used a retrospective cohort study design and administrative data to estimate the relative effectiveness of ICS in reducing hospitalizations or death among individuals with concomitant asthma and COPD, compared with individuals with COPD alone. We used an extended Cox model to estimate this association, with a time-varying measure of exposure to ICS. Results: We did not find any association between ICS and hazard of death or hospitalization among individuals with COPD alone (HR = 0.99; 95% CI: 0.94-1.05), however the hazard was 18% lower (HR = 0.82; 95% CI: 0.69-0.99) among individuals with concomitant disease. Conclusions: Individuals with combined COPD and asthma show significant benefit from the use of ICS and are more responsive to the effects of ICS than individuals with COPD alone.

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“…Using the lower limit of normal (LLN) values for FEV1/FVC, that are based on the normal distribution and classify the bottom 5% of the healthy population as abnormal, is one way to minimize the potential misclassification." Considering the paucity of evidence for a benefit from any intervention for mild COPD other than smoking cessation (10,11), falsely affixing a COPD label is likely to cause more harm than good (12). 3.…”

mentioning

confidence: 99%

Don't Diagnose Mild COPD Without Confirming Airway Obstructionafteran Inhaled Bronchodilator

Enright

Quanjer

2007

COPD: Journal of Chronic Obstructive Pulmonary Disease

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Spirometry results from the excellent PLATINO study of COPD prevalence in Latin American countries, as reported in this issue (1), provide 3 important lessons for both clinicians and pulmonary epidemiologists:1. People with a low pre-test probability for COPD should not be screened for COPD; 2. Values below the 5th percentile of FEV 1 /FVC from healthy subjects should be used to detect airway obstruction (not the fixed ratio 0.70 recommended by GOLD); and 3. Post-bronchodilator (post-BD) spirometry must be done for smokers with mild pre-BD airway obstruction, since up to one-third do not have COPD.The multi-center PLATINO study used a spirometer with excellent quality checks and demonstrated long-term accuracy (2).A strict spirometry quality assurance program, with the same standardized protocol used by the Burden of Obstructive Lung Disease (BOLD) Initiative (3), successfully produced 95% of pre-and post-BD test sessions exceeding American Thoracic Society 1994 goals. Multiple methods of interpreting airflow limitation and describing BD reversibility were analyzed and compared. In short, the study design, population-based sampling and spirometry methods, results, and analyses were superb.1. The investigators wisely separated the adults into two groups: low pre-test probability for COPD and high pretest probability (risk) for COPD. The very low prevalence of airway obstruction (about 6% overall) in those with low pre-test probability for COPD argues strongly that screening spirometry should not be done for people without respiratory symptoms, less than 10 years of smoking, no history of asthma, and low workplace exposures to respiratory hazards. Unfortunately, screening spirometry programs at sporting events in the United States have targeted tens of thousands of such individuals during the past 5 years (4). In our opinion, the "selling of sickness" in relatively low risk populations will detract from legitimate COPD case-finding among high risk patients in primary care settings (5). 2. The PLATINO investigators also confirmed previous studies demonstrating that the overly simplistic 2001 GOLD definition of airway obstruction (6) using a fixed ratio (0.70) causes a very large false positive rate in older people (7). Since almost all studies show that in healthy subjects the FEV 1 /FVC falls with normal aging (8) to well below 0.7, and that all office spirometers have a microprocessor which computes the appropriate lower limit of the normal range (the 5th percentile) for spirometry variables, we are not impressed with rationalizations for continued support of an arbitrary fixed ratio to define airway obstruction. The GOLD group acknowledged this in their 2006 update of recommendations (9): "However, because the process of aging does affect lung volumes, the use of this fixed ratio may result in over diagnosis of COPD in the elderly, especially of mild disease. Using the lower limit of normal (LLN) values for FEV1/FVC, that are based on the normal distribution and classify the bottom 5% of the healthy population as...

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Efficacy of Inhaled Steroids in Undiagnosed Subjects at High Risk for COPD

Abstract: There are no indications that early treatment with inhaled corticosteroids modifies a rapid decline in lung function or respiratory symptoms and quality of life.

Cited by 19 publications

References 30 publications

Analysis of Respiratory Sounds: State of the Art

Analysis of Respiratory Sounds: State of the Art

Effectiveness of Inhaled Corticosteroids in Preventing Morbidity and Mortality in Individuals with Chronic Obstructive Pulmonary Disease and the Impact of Coexisting Asthma.

Don't Diagnose Mild COPD Without Confirming Airway Obstructionafteran Inhaled Bronchodilator

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