Results of the study suggest that there is a significant effect of low-dose macrolide therapy on the frequency of exacerbation, and severity with moderate to severe COPD, according to lead author of the paper, Terence A. R. Seemungal, Ph.D., and Jadwiga Wedzicha, M.D., principle investigator.

From News-Medical.Net:

While their findings are encouraging, Dr. Seemungal points out that they must be put in context with future findings. Furthermore, the threat of growing antibiotic resistance resulting from widespread prophylactic use of erythromycin is not a trivial concern. “In this scenario, substantial, widespread emergence of macrolide bacterial resistance is virtually foreordained, with attendant reduction in the antimicrobial usefulness of this drug class,” wrote Ken M. Kunisaki, M.D. and Denise E. Niewoehner, M.D., of the Veterans Affairs Medical Center in Minneapolis, in the accompanying editorial. “Balancing benefit against harm could pose a dilemma for which there might be no clear answers.”

Moreover, not all of the study patients were treated with guideline-recommended therapy, such as inhaled corticosteroids or inhaled long-acting bronchodilators, which have been shown to decrease exacerbation frequency. The degree of added benefit of erythromycin over and above standard therapy will require further study.

“Observations that any intervention might decrease the frequency and severity of acute exacerbations in COPD present considerable public health implications,” observed John Heffner, M.D., past president of the ATS. “Exacerbations occur about once a year among patients with moderate to severe COPD and account for more than $30 billion dollars in direct and indirect costs annually in the United States alone.”

The study results were published in the first issue for December of the American Journal of Respiratory and Critical Care Medicine, which is published by the American Thoracic Society.

Chronic obstructive pulmonary disease

As per a study by Sebastian Albertí (Institut Universitari d’Investigacions en Ciències de la Salut, IUNICS, Palma de Mallorca, Spain) and colleagues, the effects of an inhaled steroid (fluticasone propionate) could significantly minimize the capability of major pathogens to invade the respiratory epithelium.

From Medicalnewstoday.com:

Patients affected by COPD often suffer episodes of worsening of symptoms called acute exacerbations, mostly caused by bacterial infections. These episodes of exacerbation impact negatively on the health status of the patients, worsen their prognosis and are associated with a very significant social and economic cost.

Treatment with inhaled steroids, such as fluticasone propionate, reduces the frequency and severity of acute exacerbations in patients with COPD, but their role in controlling bacterial infection is controversial.

In healthy subjects the lung is sterile, but in patients with COPD it is not and bacteria like S. pneumoniae and H. influenzae is frequently isolated.

This finding is expected to offer implications to medical practitioners all over the world to treat COPD patients.

Inhaled corticosteroids

It was disclosed in the study that the risk of developing pneumonia is increased with the use of anti-inflammatory drugs and even leads to an increased number of hospitalization cases.

From Bio-Medicine.Org:

In their report, the researchers noted that the admission rate for pneumonia increased with higher doses of inhaled steroids and that reduction in risk was observed once the medications were stopped. Among all patients taking inhaled steroids, there was a 53 percent increase in pneumonia deaths within 30 days of being admitted to the hospital.

The investigators noted that these findings are particularly relevant, given that pneumonia is the third leading cause of hospitalization in the United States and that inhaled corticosteroid use among patients with COPD increased from 13.2 to 41.4 percent from 1987 to 1995.

Adverse effects of inhaled corticosteroids in patients with COPD, the authors said, are particularly troublesome given the limited evidence for their efficacy.

Hospitalization and drug prescription information from 1988-2003 of 175,906 patients with COPD and living in Quebec, Canada, were analyzed by Pierre Ernst, M.D., a clinical epidemiologist at McGill University, Canada, along with three other researchers from the university’s department of medicine.

The research revealed that patients who were administered with inhaled corticosteroids within a period of one month of hospital discharge noticed reductions of 25 and 38 percent in terms of all-cause mortality rate and cardiovascular-related deaths in patients using steroids paired with beta-agonists, respectively.

From News-Medical.Net:

Researchers also found a 23 percent reduced risk of death when comparing the effects of inhaled steroids with bronchodilators in patients in the 65+ group. In all cases, the most significant results were found when inhaled corticosteroids were administered within the first 30 days following hospital discharge.

“Our results indicate that the effect of inhaled corticosteroids is relatively short-term and that those currently using it are relatively better protected, ” said Dr. Macie. “Inhaled corticosteroids should be prescribed as soon as clinically indicated. By treating COPD with inhaled corticosteroids, we have the potential to reduce the effect and prolong life.”

“The findings from this study are intriguing for clinicians and point to the need for further research to define the role and mechanisms of the effect of inhaled corticosteroids on both cardiovascular and respiratory mortality,” said W. Michael Alberts, MD, FCCP, President of the ACCP.

Author Christine Macie, MD, FCCP, Cambridge Hospital, Ontario, Canada, said that the study evaluated the effects of corticosteroids and was endorsed by resulting highlighting that survival is longer in patients using inhaled corticosteroids.

This call for caution was made after it was found that some of the presently used anti-inflammatory medications increase the risk of pneumonia by a full third.

Almost 11 million Americans on a yearly basis are suffering from COPD and most of them belong to the category of present or former smokers.

From News-Medical.Net:

Despite the increased pneumonia risk, the team found no clear evidence that the drug therapy also pushes up rates for other steroid-related problems, such as bone fractures, nor was there an increase in deaths.

Senior study investigator and critical care specialist Eddy Fan, M.D., says the results of the analysis should not alarm patients or cause them to stop taking their medications but should spur physicians to screen and monitor their patients to find the lowest possible steroid dose that works, especially in the elderly, people with immune system problems, and people who have had multiple bouts of pneumonia and for whom repeat bacterial infection might be a life-threatening complication.

“Inhaled corticosteroids are not of equal benefit to all, and what we are seeing is that the treatment may be more harmful and pose a greater risk of harm to some,” says Fan, an instructor at the Johns Hopkins University School of Medicine.

Lead author of this study, pulmonologist M. Brad Drummond, M.D., M.H.S., was of the view that this finding will serve as a reminder to the doctors and patients with severe lung disease to plan and take steps for reducing the risk of pneumonia that doubles the risk of death.

It was remarked by lead author of the paper, Terence A. R. Seemungal, Ph.D., and Jadwiga Wedzicha, M.D., principle investigator, that the results show a significant effect of low-dose macrolide therapy, reducing exacerbation frequency and severity with moderate to severe COPD.

From News-Medical.Net:

Moreover, not all of the study patients were treated with guideline-recommended therapy, such as inhaled corticosteroids or inhaled long-acting bronchodilators, which have been shown to decrease exacerbation frequency. The degree of added benefit of erythromycin over and above standard therapy will require further study.

“Observations that any intervention might decrease the frequency and severity of acute exacerbations in COPD present considerable public health implications,” observed John Heffner, M.D., past president of the ATS. “Exacerbations occur about once a year among patients with moderate to severe COPD and account for more than $30 billion dollars in direct and indirect costs annually in the United States alone.”

This groundbreaking study’s results were published in the first issue for December of the American Journal of Respiratory and Critical Care Medicine that is published by the American Thoracic Society. The study is the first-ever year-long randomized, double-blind, placebo-controlled study of the effects of erythromycin in chronic obstructive pulmonary disease (COPD).

Results showed that inhaled steroids could slow down the effects of COPD in patients, which is restricted inhalation and exhalation. COPD patients usually experience a decrease in their ability to take in large volumes of air and their ability to exhale air is restricted.

COPD patients were established to benefit greatly from inhaled steroids especially if administered in large doses.

COPD encompasses different respiratory diseases such as emphysema and bronchitis. These two most common COPD condition is closely linked to cigarette smoking. It is reported to be the fourth leading cause of death in the United States.

Researchers concluded that a large dose of steroids is effective in slowing down the effects of COPD. However, further studies should be conducted to identify the ideal dose and the best time for administration, as well as other drugs that work best with steroids.

From Online News Pakistan:

ISLAMABAD : While inhaled steroids undoubtedly help patients with asthma, doctors have seesawed on whether these drugs are useful for a common lung problem called chronic obstructive pulmonary disease (COPD).

The survival rate of these patients gets improved by a considerable extent, according to Christine Macie, MD, FCCP, Cambridge Hospital, Ontario, Canada and author of this study.

From Bio-medicine.org:

“Our results indicate that the effect of inhaled corticosteroids is relatively short-term and that those currently using it are relatively better protected, ” said Dr. Macie. “Inhaled corticosteroids should be prescribed as soon as clinically indicated. By treating COPD with inhaled corticosteroids, we have the potential to reduce the effect and prolong life.”

“The findings from this study are intriguing for clinicians and point to the need for further research to define the role and mechanisms of the effect of inhaled corticosteroids on both cardiovascular and respiratory mortality,” said W. Michael Alberts, MD, FCCP, President of the ACCP.

Dr. Macie was quick to remark that COPD patients administered with corticosteroids showed far better improvements than those not making a use of them. It was also remarked that COPD patients (on corticosteroids paired with beta- agonists) experienced a 25 percent reduced all-cause mortality rate and 38 percent reduced death rate within 30 days of hospital discharge.

As per lead author of the paper, Terence A. R. Seemungal, Ph.D., and Jadwiga Wedzicha, M.D., principle investigator, attained results display a significant effect of low-dose macrolide therapy reducing the exacerbation frequency and severity with moderate to severe COPD.

From News-Medical.Net:

While their findings are encouraging, Dr. Seemungal points out that they must be put in context with future findings. Furthermore, the threat of growing antibiotic resistance resulting from widespread prophylactic use of erythromycin is not a trivial concern. “In this scenario, substantial, widespread emergence of macrolide bacterial resistance is virtually foreordained, with attendant reduction in the antimicrobial usefulness of this drug class,” wrote Ken M. Kunisaki, M.D. and Denise E. Niewoehner, M.D., of the Veterans Affairs Medical Center in Minneapolis, in the accompanying editorial. “Balancing benefit against harm could pose a dilemma for which there might be no clear answers.”

Moreover, not all of the study patients were treated with guideline-recommended therapy, such as inhaled corticosteroids or inhaled long-acting bronchodilators, which have been shown to decrease exacerbation frequency. The degree of added benefit of erythromycin over and above standard therapy will require further study.

“Observations that any intervention might decrease the frequency and severity of acute exacerbations in COPD present considerable public health implications,” observed John Heffner, M.D., past president of the ATS. “Exacerbations occur about once a year among patients with moderate to severe COPD and account for more than $30 billion dollars in direct and indirect costs annually in the United States alone.”

This recently concluded study is considered as the first ever year-long randomized and placebo-controlled study of erythromycin’s effects in COPD. The study results were published in the first issue for December of the American Journal of Respiratory and Critical Care Medicine that is published by the American Thoracic Society.