Anxiety and depressive symptoms are common in patients affected by COPD, even when their disease is mild in terms of FEV1 and respiratory symptoms. Female patients appear to be more exposed to psychological impairment, which correlates well with some specific symptomatic aspects of the disease, such as dyspnea. Psychological aspects need to be carefully assessed in COPD patients, particularly in females.

Expiratory flow limitation (EFL) during tidal breathing is a major determinant of dynamic hyperinflation and exercise limitation in chronic obstructive pulmonary disease (COPD). Current methods of detecting this are either invasive or unsuited to following changes breath-by-breath. It was hypothesised that tidal flow limitation would substantially reduce the total respiratory system reactance (Xrs) during expiration, and that this reduction could be used to reliably detect if EFL was present.To test this, 5-Hz forced oscillations were applied at the mouth in seven healthy subjects and 15 COPD patients (mean¡SD forced expiratory volume in one second was 36.8¡11.5 % predicted) during quiet breathing. COPD breaths were analysed (n=206) and classified as flow-limited if flow decreased as alveolar pressure increased, indeterminate if flow decreased at constant alveolar pressure, or nonflow-limited.Of these, 85 breaths were flow-limited, 80 were not and 41 were indeterminate. Among other indices, mean inspiratory minus mean expiratory Xrs (DXrs) and minimum expiratory Xrs (Xexp,min) identified flow-limited breaths with 100% specificity and sensitivity using a threshold between 2. Unlike healthy subjects who do not develop expiratory flow limitation (EFL) even during exhaustive exercise [1], many chronic obstructive pulmonary disease (COPD) patients are flow-limited (FL) at rest [2]. These patients can only increase their expiratory flow rate during exercise by allowing their end-expiratory lung volume (VL) to rise, an energetically inefficient strategy that is accompanied by severe dyspnoea that reduces exercise duration [3,4]. The severity of dyspnoea in COPD is better predicted by the presence of EFL during tidal breathing than by the forced expiratory volume in one second (FEV1) [5,6]. Thus, a simple method of detecting EFL during tidal breathing would be a potentially useful clinical tool. Several noninvasive methods have been proposed to detect tidal EFL in COPD patients, but each has its limitations and, to the best of the authors9 knowledge, to date none has been tested against any form of "gold standard" in spontaneously breathing patients.In 1993, PESLIN et al. [7] reported that some COPD patients during mechanical ventilation developed large negative swings in the respiratory system input reactance (Xrs, i.e. the imaginary part of total input impedance) measured by a forced oscillation technique (FOT). Similar behaviour was observed in a simplified mechanical model of the respiratory system when a flow-limiting segment was included [8] and in mechanically ventilated rabbits [9] after intravenous methacholine infusion. This phenomenon occurs because the linear velocity of gas passing through flow-limiting segments (choke points) equals the local speed of wave propagation [10]. Normally the reactance reflects the elastic and inertial properties of the respiratory system but when flow limitation is present, the oscillatory signal cannot pass through the choke points and reach the alveoli, producing a ...

Budesonide/formoterol single inhaler therapy has the potential to provide a complete asthma management approach with one inhaler, demonstrating a high level of efficacy in patients with moderate to severe asthma.

on behalf of the INLIGHT-2 (Indacaterol Efficacy Evaluation Using 150-mg Doses with COPD Patients) study investigators ABSTRACT: Indacaterol is a novel, inhaled, once-daily, ultra-long-acting b 2 -agonist bronchodilator recently approved in Europe for the treatment of chronic obstructive pulmonary disease (COPD). The aim of the present study was to investigate the efficacy and safety of indacaterol compared with placebo and the twice-daily b 2 -agonist, salmeterol, as an active control.Patients with moderate-to-severe COPD were randomised to 6 months double-blind treatment with indacaterol (150 mg once daily), salmeterol (50 mg twice daily) or placebo. The primary efficacy end-point was trough (24 h post-dose) forced expiratory volume in 1 s (FEV1) after 12 weeks.1,002 patients were randomised and 838 (84%) completed the study. Indacaterol increased trough FEV1 at week 12 by 170 mL over placebo (p,0.001) and by 60 mL over salmeterol (p,0.001). Both active treatments improved health status (St George's Respiratory Questionnaire) and dyspnoea (transition dyspnoea index) compared with placebo, with differences between them favouring indacaterol. Safety profiles were similar across the treatment groups, and both indacaterol and salmeterol were well tolerated.Once-daily treatment with 150 mg indacaterol had a significant and clinically relevant bronchodilator effect over 24 h post-dose and improved health status and dyspnoea to a greater extent than twice-daily 50 mg salmeterol. Indacaterol should prove a useful additional treatment for patients with COPD. KEYWORDS: Bronchodilator, chronic obstructive pulmonary disease, clinical trial, indacaterol, salmeterol C hronic obstructive pulmonary disease (COPD) is estimated to affect 10% of the world's population aged o40 yrs, and prevalence is expected to continue to increase over coming years [1,2]. Regular treatment with one or more long-acting inhaled bronchodilators is an important and recommended element in managing the symptoms of patients with COPD [3]. These agents are administered twice daily (the b 2 -agonists formoterol and salmeterol) or once daily (the anticholinergic tiotropium). Indacaterol is an inhaled ultra-long-acting b 2 -agonist bronchodilator that has demonstrated 24-h efficacy on once-daily administration, and was recently approved in the EU at two doses, 150 and 300 mg once daily, for use in the maintenance treatment of patients with COPD.In deciding whether to use a new agent, it is clearly useful to know how the efficacy and safety of indacaterol compare with other longacting bronchodilators using studies of suitable design and appropriate duration. The present study is one of a series designed to compare indacaterol with currently available long-acting bronchodilators. The other studies were a 6-month comparison of indacaterol (150 and 300 mg) with tiotropium [4] and a 1-yr comparison of indacaterol (300 mg) with formoterol [5]. The present study compares indacaterol (150 mg once daily) with salmeterol (50 mg twice daily) over 6 months. METHODSTh...

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There is a close correlation between anxiety and depression, and a poor asthma. A better understanding of this association may have major clinical implications, mainly in patients with poor controlled asthma in whom the presence of anxiety and depression should be investigated.

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Background In hospitalized patients with COVID-19 pneumonia, progression to acute respiratory failure requiring invasive mechanical ventilation (MV) is associated with significant morbidity and mortality. Severe dysregulated systemic inflammation is the putative mechanism. We hypothesize that early prolonged methylprednisolone (MP) treatment could accelerate disease resolution, decreasing the need for ICU and mortality. Methods We conducted a multicenter, observational study to explore the association between exposure to prolonged, low-dose, MP treatment and need for ICU referral, intubation or death within 28 days (composite primary endpoint) in patients with severe COVID-19 pneumonia admitted to Italian respiratory high-dependency units. Secondary outcomes were invasive MV-free days and changes in C-reactive protein (CRP) levels. Results Findings are reported as MP (n=83) vs. control (n=90). The composite primary endpoint was met by 19 vs. 40 [adjusted hazard ratio (HR) 0.41; 95% confidence interval (CI): 0.24-0.72]. Transfer to ICU and need for invasive MV was necessary in 15 vs. 27 (p=0.07) and 14 vs. 26 (p=0.10), respectively. By day 28, the MP group had fewer deaths (6 vs. 21, adjusted HR=0.29; 95% CI: 0.12-0.73) and more days off invasive MV (24.0 ± 9.0 vs. 17.5 ± 12.8; p=0.001). Study treatment was associated with rapid improvement in PaO2:FiO2 and CRP levels. The complication rate was similar for the two groups (p=0.84). Conclusion In patients with severe COVID-19 pneumonia, early administration of prolonged MP treatment was associated with a significantly lower hazard of death (71%) and decreased ventilator dependence. Treatment was safe and did not impact viral clearance. A large RCT (RECOVERY trial) has been performed that validates these findings. Clinical trial registration ClinicalTrials.gov NCT04323592