Category Archives: Pulmonary Function

Inhaled Corticosteroids and Mortality in COPD: Recommendation

The reduction in all-cause mortality that we found was of similar magnitude to that observed in other cohort studies and was present in time-dependent analyses that were comparable to those that produced negative results. Randomized trials of ICSs in COPD patients have not shown significant mortality effects, but pooled data from these trials have shown a mortality benefit of similar magnitude to ours. We believe that it is likely that ICSs do indeed reduce mortality in COPD patients, but further evidence from randomized trials would be helpful in resolving the controversy.
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Inhaled Corticosteroids and Mortality in COPD: Conclusion

Inhaled Corticosteroids and Mortality in COPD: ConclusionOur study has a number of strengths. It examined a large unselected population of patients, including those < 65 years of age, using a comprehensive database. We attempted to assess and adjust for comorbidities and disease severity by examining the use of other respiratory drugs and physician exposure. Excluding patients with a previous diagnosis of asthma, or those who had previously used ICSs did not affect our results. We avoided immortal time bias” by excluding deaths within the first 90 days of hospital discharge. We were further able to examine mortality in relation to the timing of the receipt of ICSs. starlix 60 mg
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Inhaled Corticosteroids and Mortality in COPD: Discussion

To ascertain the relationship between the length of time ICSs were used and mortality, we carried out nested case-control analyses examining a series of time frames. Subjects (n = 503) > 65 years of age who died within 90 to 365 days of hospital discharge were compared to age-matched and gender-matched control subjects who survived to the index date with respect to the timing of exposure to ICSs before the death of the case patient. Those who died (data not shown) had more comorbidities and physician visits, and received more prescriptions for respiratory medications other than ICSs than did control subjects.
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Inhaled Corticosteroids and Mortality in COPD: Research

Inhaled Corticosteroids and Mortality in COPD: ResearchIn the cohort analysis, subjects were classified into ICS users and nonusers on the basis of drug dispensation in the 90 days following discharge from the hospital. Subsequently, the two groups differed substantially in terms of the receipt of ICSs; 79.5% of those classified as users at 90 days had filled a prescription for ICSs between 90 and 365 days after hospital discharge compared with 12.0% of nonusers. Each month, between 90 days and the 12th month, approximately 40 to 45% of ICS users received additional ICSs compared to 5 to 10% of initial nonusers.
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Inhaled Corticosteroids and Mortality in COPD: Results

Among 1,007 subjects between 35 and 64 years of age, 42 (4.1%) died within the first 90 days and were excluded from the analysis. The remaining 965 subjects were divided into the following two groups: 369 subjects (38.2%) who received ICSs within 90 days of discharge from the hospital; and 596 subjects (61.8%) who did not (Table 1).
The characteristics of subjects who were treated and not treated with ICSs are compared in Table 1, In both age groups, those subjects who received ICSs were more likely to receive other medications within 90 days following hospital discharge. During the year prior to the hospitalization, they visited physicians more frequently for COPD and asthma, and were more likely to be treated with respiratory drugs. Among subjects in the older group, treatment with ICSs was significantly associated with less comorbidity. natural breast enhancement
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Inhaled Corticosteroids and Mortality in COPD: Statistical Analysis

Inhaled Corticosteroids and Mortality in COPD: Statistical AnalysisIn a nested case-control analysis, subjects who died within 90 to 365 days of hospital discharge were compared with respect to ICS exposure before death (ie, the index date) to age-matched and gender-matched control subjects who had survived to the same point in time. It was thus possible for the same individual to be both a case patient and a control subject. We compared case patients and control subjects regarding the most recent receipt of ICS between hospital discharge and the index date. Exposure to ICSs was divided into the following five mutually exclusive groups: ICSs within 30 days; ICSs in 30 to 60 days; ICSs in 60 to 90 days; and ICSs in > 90 days prior to death or not at all. We repeated this analysis for deaths ascribed to COPD and to cardiovascular causes.
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Inhaled Corticosteroids and Mortality in COPD: Subjects

We identified all people who had been admitted to the hospital between April 1, 1996, and March 31, 2000, and had been discharged from the hospital with a primary diagnosis of COPD (ie, International Classification of Diseases, ninth revision [ICD-9], codes 490 [not otherwise specified bronchitis], 491 [chronic bronchitis], 492 [emphysema], and 496 [chronic airflow obstruction]). Subjects had to be > 35 years of age on hospital admission as well as permanent residents of the province for at least 1 year prior to hospital admission and 1 year after discharge from the hospital or until death. eye drops for red eye
The outcome variable was death from any cause in the 365 days following discharge from the hospital. We extracted the date and cause of death. The causes of death were derived from death certificates and were divided into the following three groups: COPD and asthma (ICD-9 code 493); cardiovascular (ICD-9 codes 390-459 and 798); and all other causes.
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Inhaled Corticosteroids and Mortality in COPD

Inhaled Corticosteroids and Mortality in COPDSeveral studies have examined the course of COPD patients to whom inhaled corticosteroids (ICSs) were prescribed. In four studies, ICSs were prescribed within 90 days after discharge from the hospital for a COPD exacerbation, which is a time of relative instability when the risk for hospital readmission or death is high and therapy with ICSs might be expected to be administered to high-risk patients. In such patients > 65 years of age who are treated with ICSs, the risk of death was reduced by 21% over 1 year of follow-up in Ontario’ and 25% over 3 years of follow-up in Alberta. In the United Kingdom, the unadjusted risk of death was reduced by 30% in COPD patients > 50 years of age. On the other hand, there was no reduction in the 1-year mortality rate observed in patients > 55 years of age in Saskatchewan. All-cause mortality over 3 years was also reduced in patients > 50 years of age in the United Kingdom who had received at least three prescriptions of fluticasone over the initial 6-month period. Such a benefit was not found in the US study and the Saskatchewan study using either intent-to-treat or time-dependent analysis. Our objective was to determine the effect of ICSs on total and cause-specific mortality in a cohort of COPD patients using the Province of Manitoba health research database. buy glucophage
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Etiology and Outcomes of Pulmonary and Extrapulmonary Acute Lung Injury/ARDS in a Respiratory ICU in North India: Discussion

Etiology and Outcomes of Pulmonary and Extrapulmonary Acute Lung Injury/ARDS in a Respiratory ICU in North India: DiscussionIn our study, although patients with ALI/ARDSexp were younger and sicker (ie, higher baseline and maximum SOFA scores) than their ALI/ARDSp counterparts, we found no difference in the occurrence of new organ dysfunction/failure (ie, ASOFA scores), time to the development of the first organ dysfunction/organ failure, the duration of RICU stay, and length of hospital survival between the two categories of patients. Moreover, the classification of ARDS had no impact on the ultimate length of hospital survival after adjusting for various other risk factors like gender, baseline disease severity (ie, baseline SOFA scores), and the occurrence of new-onset organ dysfunction (ie, ASOFA scores). The lack of agreement among various studies can be explained by differences in baseline status, the prevalence of the disease precipitating ARDS in each center, the impact of therapy, and the overall distribution of these factors in the studied population. Another reason for the lack of agreement is probably the fact that the differentiation between direct and indirect insult is often straightforward only in patients with pneumonia or ARDS originating from intraabdominal sepsis, but a precise identification of the pathogenetic pathway is somewhat difficult to ascertain in other situations. Source
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Etiology and Outcomes of Pulmonary and Extrapulmonary Acute Lung Injury/ARDS in a Respiratory ICU in North India: Results

Patients with ALI/ ARDSexp had higher maximum SOFA scores, but the ASOFA (signifying the new-onset organ dysfunction and/or organ failure) scores were similar in the two groups (Table 2). Similarly, there was no difference between the two groups in terms of the length of time to the first development of nonpulmonary organ dysfunction and organ failure (Table 2).
Figure 1 shows the Pa02/Fl02 scores and PEEP levels, and Figure 2 shows Cstat and Pplat values over the course of the hospital stay. Although the initial Pplat values (ie, day 0 to day 3) were higher in ALI/ARDSp patients than in ALI/ARDSexp patients, there were no significant differences in the progression of lung mechanics and gas exchange variables over time. Ninety-four of the 180 patients with ALI/ARDS were discharged from the hospital; there was no difference in hospital survival between the two categories of ARDS patients (ALI/ARDSp, 70 of 123 [56.9%]; ALI/ARDSexp, 24 of 57 [42.1%]). review

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