Effects of Theophylline Withdrawal in Severe Chronic Obstructive Pulmonary Disease

Kirsten, D; Wegner, Robert; Jörres, Rudolf A.; Magnussen, H

doi:10.1378/chest.104.4.1101

Cited by 64 publications

(26 citation statements)

References 25 publications

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“…The BDI and TDI have been validated over their development [5][6][7][8] and the TDI has been shown to be responsive to a wide variety of interventions [9][10][11][12][13][14][15][16][17][18][19][20]. The large cohort in the clinical trials evaluating efficacy of the bronchodilator tiotropium afforded the opportunity to validate the BDI/TDI instrument in a multinational setting.…”

Section: Discussionmentioning

confidence: 99%

“…The responsiveness to therapy has been shown by improvements in the TDI following both pharmacological [9][10][11][12][13] and nonpharmacological [14][15][16][17][18][19][20] interventions. Furthermore, the TDI was evaluated in an observational cohort over a 2-yr observation in patients with moderate COPD (44% predicted forced expiratory volume in one second (FEV1)) and a reduction of nearly 1 unit in focal score was observed [21].…”

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confidence: 99%

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Minimal important difference of the transition dyspnoea index in a multinational clinical trial

2003

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Dyspnoea is a primary symptom of chronic obstructive pulmonary disease (COPD). The baseline (BDI) and transition (TDI) dyspnoea indices are commonly used instruments to assess breathlessness and the impact of intervention. Its validity and pattern of response in multinational clinical trials has not been established.In a retrospective analysis of a cohort of 997 COPD patients who received tiotropium, salmeterol or placebo, in addition to usual care, the validity and pattern of response of the BDI and TDI were examined.The BDI was significantly correlated with the dyspnoea diary (DD) score and the symptom and activity components of the St. George9s respiratory questionnaire (SGRQ), establishing concurrent validity. Furthermore, the TDI was also correlated with the changes in DD, SGRQ symptom and activity scores. Construct validity was established by the association between baseline forced expiratory volume in one second (FEV1) and BDI and DFEV1 with TDI. Physician9s global evaluation (PGE) was significantly associated with BDI as well as DPGE with TDI. Significant correlations have also been observed when the cohorts were classified according to native English and native non-English speaking countries. A change in PGE of 1 category (i.e. 2 units on an 8-point scale) was associated with a mean TDI of y1 unit (0.9-1.3 mean focal score), lending further support to the clinical significance of this change inherent in the instrument9s descriptors. TDI responders (i.e. focal score ¢1 unit) used less supplemental salbutamol, had fewer exacerbations and had significantly improved health status as measured by impacts and total SGRQ scores compared with nonresponders.In conclusion, the transition dyspnoea index is a valid instrument when used in a multinational clinical trial and the patterns of response confirm a 1-unit change in the transition dyspnoea index focal score as being clinically important.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Minimal important difference of the transition dyspnoea index in a multinational clinical trial

2003

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“…The CRQ has been used to assess the effects of bronchodilators [71,75,76] and to make comparisons between bronchodilators or aerosol delivery mechanisms [45], modes of ventilation [77], long-term oxygen therapy [78] and pulmonary rehabilitation [73,[79][80][81][82][83][84][85]. It has been translated into many languages including Dutch [86], Spanish [25,87] and German [88]. Although the CRQ has been adapted for self-administration, reliability and validity data are limited.…”

Section: Disease-specific Measures In Chronic Obstructive Pulmonary Dmentioning

confidence: 99%

The assessment of health status among patients with COPD

Curtis¹,

Patrick²

2003

Eur Respir J

116

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Survival and physiological measures alone do not represent the full experiences of patients with chronic obstructive pulmonary disease. Reducing the personal and social burden of disease by improving patients9 symptoms, functional status and quality of life are also important goals.There has been a substantial increase in the use of newly developed tools that measure health status and it is important for clinicians and researchers to understand these instruments9 strengths and weaknesses in providing insight into a patient9s condition and experience.Relying only on mortality and physiological outcomes could blind a clinician to significant benefits patients may receive from a treatment. A growing body of research utilises end-points assessed directly by patients whose self-reported health status includes health-related quality of life and functional status.This article reviews major concepts and methods in health-status assessments for patients with chronic obstructive pulmonary disease, which will have an important role in assessing the efficacy and effectiveness of new treatments. Eur Respir J 2003; 21: Suppl. 41, 36s-45s.

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“…Exercise performance was assessed as the 6 min walking distance (6MWD) in a self-paced treadmill walking test (LE 2000; Jaeger, Würzburg, Germany) on a horizontal treadmill [20].…”

Section: Exercise Testingmentioning

confidence: 99%

Testosterone levels in men with chronic obstructive pulmonary disease with or without glucocorticoid therapy

Kamischke¹,

Kemper²,

Castel³

et al. 1998

Eur Respir J

163

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Under the clinical impression that patients with chronic obstructive pulmonary disease (COPD) may demonstrate signs compatible with hypogonadism, we investigated whether oral glucocorticoid therapy is associated with testosterone deficiency. Thirty six men with COPD of whom 16 were receiving oral glucocorticoid medication (mean+/-SEM dose 9.4+/-1.1 mg prednisolone) were investigated in a cross-sectional cohort study. Patients with or without oral glucocorticoid therapy were not different in terms of age, smoking history and additional therapy. Vital capacity, forced expiratory volume in one second, airway resistance, intrathoracic gas volume and blood gases at rest were not different between the groups. However, patients receiving glucocorticoids had a shorter 6 min walking distance (mean+/-SEM 205+/-27 versus 288+/-26 m; p=0.02) compared to patients without oral steroid therapy. Serum levels of testosterone (mean+/-SEM 13.7+/-0.9) were below normal (<12 nM) in 15 of 36 patients. Serum testosterone did not correlate with any other evaluated parameter. Serum levels of free testosterone (free T) (mean+/-SEM 172.3+/-7.8 pM) were decreased in 25 of the 36 patients, including all patients receiving glucocorticoid treatment. In the 16 patients taking glucocorticoids free T was correlated (p=0.016) with the current glucocorticoid dosage (r=-0.504; p=0.007) and the body mass index (r=0.241; p=0.037). All other parameters examined revealed no significant correlations in multiple regression analysis. Glucocorticoid treatment appears to aggravate hypogonadism and a therapeutic study using testosterone in patients with chronic obstructive pulmonary disease receiving glucocorticoid medication appears warranted.

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Effects of Theophylline Withdrawal in Severe Chronic Obstructive Pulmonary Disease

Cited by 64 publications

References 25 publications

Minimal important difference of the transition dyspnoea index in a multinational clinical trial

Minimal important difference of the transition dyspnoea index in a multinational clinical trial

The assessment of health status among patients with COPD

Testosterone levels in men with chronic obstructive pulmonary disease with or without glucocorticoid therapy

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