S27 The effects of statin therapy on inflammatory markers in patients with copd: a double blind randomised controlled trial

Abstract

baseline and 7 weeks. Within and between group differences were analysed using paired and unpaired t-tests respectively. Results Please see table 1. Conclusion SPACE for COPD can improve dyspnoea and endurance capacity over 7 weeks to a similar level to PR, although it remains unclear to its noniferiority to PR. The SPACE for COPD programme does offer a number of health benefits despite it involving limited support and could offer a suitable alternative to patients with COPD who would otherwise not attend conventional rehabilitation. Background There is good evidence that pulmonary rehabilitation (PR) provides benefit for patients with chronic obstructive pulmonary disease (COPD) in terms of quality of life and daily functioning. However it is generally accepted that the benefits diminish over time. REFERENCESMethods We conducted a randomised controlled parallel study of a maintenance programme, following standard PR, consisting of a two hour session of education and strength and endurance training every 3 months versus standard care. Measurements were made, at baseline (prior to a standard PR programme), at randomisation (after successful completion of a PR programme) and after 12 months, of the chronic respiratory questionnaire (CRQ), endurance shuttle walk test (ESWT), EuroQol (EQ5D), hospital anxiety and depression score (HADS) and activity questionnaires. CRQ was also completed every 3 months by post. Results 250 (139 male) patients, mean (SD) age of 69.2 (9.2) years, FEV1 41 (16)% predicted, provided informed consent to participate in the study. The mean (95% CI) improvement in CRQ following the initial PR was 0.76 (0.59, 0.93) units. 148 patients entered the randomised part of the study. There remained a significant improvement in CRQ dyspnoea at 12 months compared to baseline for the group as a whole. However, there was no statistically significant differences detected between the intervention and control groups for the CRQ dyspnoea score, which amounted to 0.19 (-0.26, 0.64) units, or other domains of the CRQ. There was no difference in the ESTW distance between the two groups (109.1 (-100.1 to 318.2) metres) or HADS (-0.2 (-2.41,2) units). There was a higher level of selfreported activity, according to the visual analogue score of 16.2/ 100, in the maintenance group but not the reported metabolic equivalent (MET)-minutes per week. There was no difference in any of the CRQ measures at any of 3 monthly measurements between the intervention and control groups Conclusion A maintenance programme of 3monthly 2 hour sessions does not improve outcomes in patients with COPD after 12 months. We cannot recommend that our maintenance programme is adopted. It is likely that a maintenance programme should commence earlier than 3 months and possibly be more intensive. Introduction In moderate exacerbations of COPD, patients with the eosinophilic phenotype (>2% of the total leukocyte count) have better outcomes with prednisolone. However, it remains unclear whether patients with severe exacerbations displaying the eos...

The Immunomodulatory Effects of Statins on Macrophages

“…A similar result was seen in a study conducted by Hothersall et al where the effect of daily oral atorvastatin treatment was found to reduce the number of macrophages in the sputum, although there was no improvement in the control of asthma symptoms [181]. In opposition to this, John et al found no significant difference in patients treated with simvastatin [182]. Finally, a recent study by Kauerova et al investigating the influence of statin treatment on macrophage polarization in human adipose tissue reported statin therapy to increase the proportion of M2-like macrophages compared to M1-like ones [103].…”

Effect of Statins on COPD

“…Ultimately, 10 of the 20 studies were selected 4-5, 11, 14-20 ; of those not included, three were excluded because they did not use a placebo control [21][22][23] , three because they used the same dataset as another study included in this meta-analysis [24][25][26] , one because it was a post-hoc analysis of a large statin-heart failure RCT 27 , one because one-quarter of the recruited patients did not complete the study 28 , one because most of the patients did not fulfil GOLD criteria for COPD 29 , and one because no outcomes of interest were reported 30 . All the included trials were published as peer-reviewed articles, and all of them were in English.…”

Review of the British Thoracic Society Winter Meeting 2013, 4–6 December, London, UK

“…An investigation of the anti-inflammatory effects of statin therapy in COPD, while negative, provided novel thinking into treatments of the disease 42. For severe hospitalised exacerbations, the different response of eosinophilic and non-eosinophilic phenotypes further suggested that exacerbations may be a target for stratified treatment (and reducing harm of unnecessary drug prescription) 43.…”