This study supports that antiplatelet drugs improve survival and β-blockers decrease survival in oxygen-dependent COPD.

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BackgroundIt is not known why survival differs between men and women in oxygen-dependent chronic obstructive pulmonary disease (COPD). The present study evaluates differences in comorbidity between men and women, and tests the hypothesis that comorbidity contributes to sex-related differences in mortality in oxygen-dependent COPD.MethodsNational prospective study of patients aged 50 years or older, starting long-term oxygen therapy (LTOT) for COPD in Sweden between 1992 and 2008. Comorbidities were obtained from the Swedish Hospital Discharge Register. Sex-related differences in comorbidity were estimated using logistic regression, adjusting for age, smoking status and year of inclusion. The effect of comorbidity on overall mortality and the interaction between comorbidity and sex were evaluated using Cox regression, adjusting for age, sex, PaO2 breathing air, FEV1, smoking history and year of inclusion.ResultsIn total, 8,712 patients (55% women) were included and 6,729 patients died during the study period. No patient was lost to follow-up. Compared with women, men had significantly more arrhythmia, cancer, ischemic heart disease and renal failure, and less hypertension, mental disorders, osteoporosis and rheumatoid arthritis (P<0.05 for all odds ratios). Comorbidity was an independent predictor of mortality, and the effect was similar for the sexes. Women had lower mortality, which remained unchanged even after adjusting for comorbidity; hazard ratio 0.73 (95% confidence interval, 0.68–0.77; P<0.001).ConclusionsComorbidity is different in men and women, but does not explain the sex-related difference in mortality in oxygen-dependent COPD.

The aim of this study was to compare the effects of formoterol, ipratropium bromide and a placebo on walking distance, lung function, symptoms and quality of life (QoL) in chronic obstructive pulmonary disease (COPD) patients.A total of 183 patients (mean age 64 yrs, 86 female) with moderate-to-severe nonreversible COPD participated in this randomised, double-blind, parallel-group study. After a 2-week placebo run-in, patients were randomised to formoterol Turbuhaler1 18 mg b.i.d. (delivered dose), ipratropium bromide 80 mg t.i.d. via a pressurised metered dose inhaler, or placebo for 12 weeks. Inhaled short-acting b 2 -agonists were allowed as relief medication and inhaled glucocorticosteroids were allowed at a constant dose. The primary variable was walking distance in the shuttle walking test (SWT). Baseline mean SWT distance was 325 m, mean forced expiratory volume in one second (FEV1) was 40% predicted.Clinically significant improvements in SWT (w30 m) were seen in 41, 38 and 30% of formoterol, ipratropium and placebo patients, respectively (not significant). Mean increases from run-in were 19, 17 and 5 m in the formoterol, ipratropium and placebo groups, respectively. Both active treatments significantly improved FEV1, forced vital capacity, peak expiratory flow and daytime dyspnoea score compared with placebo. Formoterol reduced relief medication use compared with placebo. Neither active treatment improved QoL.Formoterol and ipratropium improved airway function and symptoms, without significant improvements in the shuttle walking test. Eur Respir J 2002; 20: 1138- Chronic obstructive pulmonary disease (COPD) is characterised by slowly developing airway obstruction, with increasing impairment of exercise performance due to dyspnoea. The pharmacological therapy of COPD is mainly focused on the use of bronchodilators such as anticholinergics and b 2 -agonists, and the role of inhaled glucocorticosteroids (GCS) is currently being discussed [1][2][3][4][5]. The goal of treatment is to improve exercise capacity, lung function and arterial blood gas tensions, and to reduce the symptoms of dyspnoea. However, studies have shown, that the effects of bronchodilators on these different outcome variables are not always well correlated [6,7].Long-acting bronchodilators are effective in the treatment of asthma, reducing symptoms and decreasing exacerbations [8]. In COPD, the long-acting b 2 -agonists are less well studied. One study of salmeterol showed symptom reduction and lung function improvement [9] and some improvement in quality of life (QoL) when the drug was used in low doses [10]. Formoterol is a b 2 -agonist with a long-acting bronchodilating effect in asthma lasting 12 h but unlike salmeterol, it has an onset of action as fast as salbutamol [11]. However, formoterol has been subject to few long-term studies in COPD. Ipratropium bromide has an established position in the treatment of COPD and has been suggested as the first choice of treatment for this condition [1,3].Exercise capacity of patients w...

Exposure for birch and hardwood dust may contribute to the risk for IPF in men.