Short- and long-term efficacy of fluticasone propionate in subjects with early signs and symptoms of chronic obstructive pulmonary disease. Results of the DIMCA study

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

doi:10.1016/j.rmed.2003.08.001

Cited by 27 publications

(16 citation statements)

References 23 publications

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“…Pharmacologic treatment for COPD often bases its efficacy on the ability to influence FEV 1 . Although there are contradictory studies, inhaled steroids, ␤ 2 agonists, and anticholinergic agents have all been shown to have this effect to some degree (30)(31)(32). This raises the concern that by classifying decline in FEV 1 by quartiles, we may have inadvertently separated patients based on their level of medical care.…”

Section: Discussionmentioning

confidence: 99%

Lung Function Decline and Outcomes in an Adult Population

Mannino

Reichert

Davis

2006

Am J Respir Crit Care Med

129

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Section: Discussionmentioning

confidence: 99%

Lung Function Decline and Outcomes in an Adult Population

Mannino

Reichert

Davis

2006

Am J Respir Crit Care Med

129

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“…Four studies reported no significant differences in respiratory system symptoms when comparing inhaled corticosteroid with placebo. 18,23,26,28 Three studies detected no overall differences in respiratory systems symptoms but did detect signifi cant improvements in subscales, such as daily cough scores, sputum volume, 27 night time awakenings, 19 and dyspnea. 29 In comparisons with placebo, 1 trial reported signifi cantly lower symptom scores in patients during 2 years' treatment with budesonide 1,600 mg/d 21 and another during 3 years' treatment with fl uticasone 1,000mg/d.…”

Section: Functional Capacity and Quality Of Lifementioning

confidence: 97%

“…18,19,22,26,27 Two trials Two Dutch studies originating from the DIMCA (Detection, Intervention, and Monitoring of COPD and Asthma) program, which recruited patients with mild COPD through population screening, did not fi nd any differences in functional capacity for patients on fl uticasone 500 mg/d and those on placebo after 2 years of treatment. 24,28 Respiratory Symptoms Most studies assessed respiratory system symptom scores, but the reported data were mixed and insuffi cient for meta-analysis. Four studies reported no significant differences in respiratory system symptoms when comparing inhaled corticosteroid with placebo.…”

Section: Functional Capacity and Quality Of Lifementioning

confidence: 99%

Efficacy and Safety of Inhaled Corticosteroids in Patients With COPD: A Systematic Review and Meta-Analysis of Health Outcomes

Gartlehner¹

2006

The Annals of Family Medicine

111

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PURPOSE We wanted to review systematically the effi cacy, effectiveness, and safety of inhaled corticosteroids with respect to health outcomes in patients with chronic obstructive pulmonary disease (COPD). METHODSWe searched MEDLINE, EMBASE, The Cochrane Library, and the International Pharmaceutical Abstracts to identify relevant articles. We limited evidence to double-blinded randomized controlled trials (RCTs) for effi cacy, but we also reviewed observational evidence for safety. Outcomes of interest were overall mortality, exacerbations, quality of life, functional capacity, and respiratory tract symptoms. When possible, we pooled data to estimate summary effects for each outcome.RESULTS Thirteen double-blinded RCTs determined the effi cacy of an inhaled corticosteroid compared with placebo; 11 additional studies assessed the safety of inhaled corticosteroid treatment in patients with asthma or COPD. Overall, COPD patients treated with inhaled corticosteroids experienced signifi cantly fewer exacerbations than patients taking placebo (relative risk [RR] = 0.67; 95% CI, 0.59-0.77). No signifi cant difference could be detected for overall mortality (RR = 0.81; 95% CI, 0.60-1.08). Evidence on quality of life, functional capacity, and respiratory tract symptoms is mixed. Adverse events were generally tolerable; pooled discontinuation rates did not differ signifi cantly between inhaled corticosteroid and placebo treatment groups (RR = 0.92; 95% CI, 0.74-1.14). Observational evidence, however, indicates a dose-related risk of cataract and open-angle glaucoma. Severe adverse events, such as osteoporotic fractures, are rare; the clinical importance of the additional risk is questionable.CONCLUSIONS Overall, the risk-benefi t ratio appears to favor inhaled corticosteroid treatment in patients with moderate to severe COPD. Existing evidence does not indicate a treatment benefi t for patients with mild COPD. INTRODUCTIONC hronic obstructive pulmonary disease (COPD) is among the leading causes of morbidity and mortality worldwide.1 In 2000 COPD accounted for approximately 20.7 million outpatient visits, 3.4 million emergency department visits, 6.3 million hospitalizations, and 116,513 deaths in the United States. 2 The World Health Organization estimates that by the year 2020, COPD will be the third-leading cause of death and the fi fth-leading cause of disability worldwide. COPD is characterized by a progressive, irreversible limitation of airfl ow associated with an abnormal infl ammatory response to noxious particles or gases. It is caused primarily by smoking. 3,4 Gerald Gartlehner, MD 254 INHALED CORTICOSTEROIDS AND COPDThe benefi cial effect of inhaled corticosteroid treatment for COPD remains controversial, 3,5 in part because only smoking cessation is reliably shown to slow the rate of decline in lung function. 4 Although the Food and Drug Administration (FDA) has not approved inhaled corticosteroids as monotherapy for the treatment of COPD, they are frequently prescribed to reduce or alleviate symptoms...

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“…Especially in primary care it is difficult to distinguish both entities when the symptoms are presented in an early stage [18]. In particular the treatment response in this stage often seem to be not strongly related to the stated diagnoses [19,20], and also the treatment response of COPD in the long term course is disappointing [21]. …”

Section: Introductionmentioning

confidence: 99%

Are ICD-10 codes appropriate for performance assessment in asthma and COPD in general practice? Results of a cross sectional observational study

Schneider

Gantner

Maag

et al. 2005

BMC Health Serv Res

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BackgroundThe increasing prevalence and impact of obstructive lung diseases and new insights, reflected in clinical guidelines, have led to concerns about the diagnosis and therapy of asthma and COPD in primary care. In Germany diagnoses written in medical records are used for reimbursement, which may influence physicians' documentation behaviour. For that reason it is unclear to what respect ICD-10 codes reflect the real problems of the patients in general practice. The aim of this study was to assess the appropriateness of the recorded diagnoses and to determine what diagnostic information is used to guide medical treatment.MethodsAll patients with lower airway symptoms (n = 857) who had attended six general practices between January and June 2003 were included into this cross sectional observational study. Patients were selected from the computerised medical record systems, focusing on ICD-10-codes concerning lower airway diseases (J20-J22, J40-J47, J98 and R05). The performed diagnostic procedures and actual medication for each identified patient were extracted manually. Then we examined the associations between recorded diagnoses, diagnostic procedures and prescribed treatment for asthma and COPD in general practice.ResultsSpirometry was used in 30% of the patients with a recorded diagnosis of asthma and in 58% of the patients with a recorded diagnosis of COPD. Logistic regression analysis showed an improved use of spirometry when inhaled corticosteroids were prescribed for asthma (OR = 5.2; CI 2.9–9.2) or COPD (OR = 4.7; CI 2.0–10.6). Spirometry was also used more often when sympathomimetics were prescribed (asthma: OR = 2.3; CI 1.2–4.2; COPD: OR = 4.1; CI 1.8–9.4).ConclusionsThis study revealed that spirometry was used more often when corticosteroids or sympathomimetics were prescribed. The findings suggest that treatment was based on diagnostic test results rather than on recorded diagnoses. The documented ICD-10 codes may not always reflect the real status of the patients. Thus medical care for asthma and COPD in general practice may be better than initially found on the basis of recorded diagnoses, although further improvement of practice patterns in asthma and COPD is still necessary.

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Short- and long-term efficacy of fluticasone propionate in subjects with early signs and symptoms of chronic obstructive pulmonary disease. Results of the DIMCA study

Cited by 27 publications

References 23 publications

Lung Function Decline and Outcomes in an Adult Population

Lung Function Decline and Outcomes in an Adult Population

Efficacy and Safety of Inhaled Corticosteroids in Patients With COPD: A Systematic Review and Meta-Analysis of Health Outcomes

Are ICD-10 codes appropriate for performance assessment in asthma and COPD in general practice? Results of a cross sectional observational study

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