Intensified Therapy with Inhaled Corticosteroids and Long-Acting β<sub>2</sub>-Agonists at the Onset of Upper Respiratory Tract Infection to Prevent Chronic Obstructive Pulmonary Disease Exacerbations. A Multicenter, Randomized, Double-Blind, Placebo-controlled Trial

Stolz, Daiana; Hirsch, Hans H.; Schilter, Daniel; Louis, Renaud; Rakic, Janko; Boeck, Lucas; Papakonstantinou, Eleni; Schindler, Christian; Grize, Leticia; Tamm, Michael

doi:10.1164/rccm.201709-1807oc

Cited by 43 publications

(40 citation statements)

References 41 publications

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“…Inhaled corticosteroids (ICSs) are effective in reducing airway inflammation, nonspecific airway hyperresponsiveness, and airway obstruction in patients with COPD [ 4 ]. An ICS combined with a long-acting β 2 agonist (LABA) is more effective than monotherapy in improving lung function, reducing symptoms, increasing exercise tolerance, decreasing the frequency of exacerbation and hospitalization, and improving patient health [ 5 ]. According to the current Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, ICSs in combination with LABAs are suggested for patients with moderate-to-very severe COPD [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Risk of Cardiovascular Events Associated with Inhaled Corticosteroid Treatment in Patients with Chronic Obstructive Pulmonary Disease: A Meta-Analysis

Xia

2018

Canadian Respiratory Journal

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Background The cardiovascular (CV) safety of inhaled corticosteroids (ICSs) in chronic obstructive pulmonary disease (COPD) is controversial because different studies have suggested that ICSs either increase or reduce the risk of CV events in COPD patients. In this meta-analysis, we assess the CV safety of ICS therapy in COPD. Methods A meta-analysis of randomized, double-blind, parallel-group, placebo-controlled trials of ICS treatment for COPD that include at least 4 weeks of follow-up was performed. A random-effects model was used to evaluate the effects of ICS treatment on CV events. CV events were documented in each trial, and the relative risk (RR) and 95% confidence intervals (CIs) for ICSs were estimated. Results Thirty-one trials were included in this meta-analysis. The risk of CV events was not different between ICS-treated and control groups (RR: 0.99; 95% CI: 0.93 to 1.06; P=0.801). In a subgroup analysis, there were no significant differences in CV events between an ICS combined with long-acting β2 agonist (LABA) (ICS + LABA) group and an LABA-only group (RR: 1.00; 95% CI: 0.90 to 1.10; P=0.930), as well as between a combination group (ICS + LABA) and a long-acting muscarinic antagonist (LAMA) combined with LABA (LAMA + LABA) group (RR: 0.78; 95% CI: 0.39 to 1.55; P=0.473). In addition, there was no difference in the risk of CV events between ICS treatment and control groups (RR: 0.99; 95% CI: 0.90 to 1.09; P=0.872). Conclusions These results demonstrate that ICSs do not increase the risk of CV events in COPD patients.

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Section: Introductionmentioning

confidence: 99%

Risk of Cardiovascular Events Associated with Inhaled Corticosteroid Treatment in Patients with Chronic Obstructive Pulmonary Disease: A Meta-Analysis

Xia

2018

Canadian Respiratory Journal

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“…Τhe PREVENT study [27] is an investigator-initiated and -driven study compiled to the Declaration of Helsinki and Good Clinical Practice Guidelines. The study was approved by the responsible ethics committee (EKNZ 306/10) and was registered at www.controlledtrials.com (identifier ISRCTN 45572998).…”

Section: Methodsmentioning

confidence: 99%

Endothelial dysfunction is not a predictor of outcome in chronic obstructive pulmonary disease

et al. 2020

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Background: Local airway inflammation may cause systemic changes which result in endothelial dysfunction. Only a few studies have used reactive hyperemia peripheral arterial tonometry (RH-PAT) in patients with chronic obstructive pulmonary disease (COPD) in order to measure their endothelial dysfunction. Objective: To determine the efficacy of endothelial dysfunction, measured by RH-PAT, in assessing disease severity and systemic burden in a cohort of COPD patients. Methods: In this prospective, monocentric study, 157 patients with moderate to very severe COPD (GOLD class II-IV) were examined for endothelial dysfunction using RH-PAT (Itamar medical Ltd., Caesarea, Israel). In a nestedcohort, examination was repeated at exacerbation. The association between reactive hyperemia index (RHI), augmentation index (AI) and disease severity and outcome parameters was analysed. Results: 57% of the COPD patients had a dysfunctional endothelium and the median (IQR) RHI was 1.42 (1.27-1.53). Exacerbation of COPD was not associated with a significant change in RHI (p = 0.625) or ΑΙ (p = 0.530). None of the diagnostic or clinical outcomes of COPD was associated with RHI or arterial stiffness. Conclusion: Endothelial dysfunction is common in COPD. However, it does not seem to be a predictor neither of disease severity, nor of outcome and does not change during exacerbations of the disease.

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“…(Ding et al, 2016) Intensified combination therapy with ICS/LABA for 10 days at URTI onset could be associated with a reduction of exacerbations, particularly in patients with severe disease. (Stolz et al, 2018) In a recent RCT, the addition of doxycycline to oral corticosteroid an outpatient setting did not prolong time to next exacerbation. (van Velzen et al, 2017) A small pilot RCT (n = 29) reported that six weeks of high-flow nasal cannula oxygen therapy reduced hypercapnia and improved health-related quality of life in patients with stable hypercapnic COPD.…”

Section: Chaptermentioning

confidence: 95%

Lungenexperten diskutieren den Steroideinsatz bei COPD

Pampel¹

2019

Pneumo News

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When the Global Initiative for Chronic Obstructive Lung Disease (GOLD) program was initiated in 1998, a goal was to produce recommendations for management of COPD based on the best scientific information available. The first report, Global Strategy for Diagnosis, Management and Prevention of COPD was issued in 2001. In 2006 and again in 2011 a complete revision was prepared based on published research. These reports, and their companion documents, have been widely distributed and translated into many languages and can be found on the GOLD website (www.goldcopd.org). The GOLD Science Committee ‡ was established in 2002 to review published research on COPD management and prevention, to evaluate the impact of this research on recommendations in the GOLD documents related to management and prevention, and to post yearly updates on the GOLD website. Its members are recognized leaders in COPD research and clinical practice with the scientific credentials to contribute to the task of the Committee and are invited to serve in a voluntary capacity.

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Intensified Therapy with Inhaled Corticosteroids and Long-Acting β₂-Agonists at the Onset of Upper Respiratory Tract Infection to Prevent Chronic Obstructive Pulmonary Disease Exacerbations. A Multicenter, Randomized, Double-Blind, Placebo-controlled Trial

Cited by 43 publications

References 41 publications

Risk of Cardiovascular Events Associated with Inhaled Corticosteroid Treatment in Patients with Chronic Obstructive Pulmonary Disease: A Meta-Analysis

Risk of Cardiovascular Events Associated with Inhaled Corticosteroid Treatment in Patients with Chronic Obstructive Pulmonary Disease: A Meta-Analysis

Endothelial dysfunction is not a predictor of outcome in chronic obstructive pulmonary disease

Lungenexperten diskutieren den Steroideinsatz bei COPD

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Intensified Therapy with Inhaled Corticosteroids and Long-Acting β2-Agonists at the Onset of Upper Respiratory Tract Infection to Prevent Chronic Obstructive Pulmonary Disease Exacerbations. A Multicenter, Randomized, Double-Blind, Placebo-controlled Trial

Cited by 43 publications

References 41 publications

Risk of Cardiovascular Events Associated with Inhaled Corticosteroid Treatment in Patients with Chronic Obstructive Pulmonary Disease: A Meta-Analysis

Risk of Cardiovascular Events Associated with Inhaled Corticosteroid Treatment in Patients with Chronic Obstructive Pulmonary Disease: A Meta-Analysis

Endothelial dysfunction is not a predictor of outcome in chronic obstructive pulmonary disease

Lungenexperten diskutieren den Steroideinsatz bei COPD

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Product

Resources

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Intensified Therapy with Inhaled Corticosteroids and Long-Acting β₂-Agonists at the Onset of Upper Respiratory Tract Infection to Prevent Chronic Obstructive Pulmonary Disease Exacerbations. A Multicenter, Randomized, Double-Blind, Placebo-controlled Trial