Lung Disease: Monthly Essentials January 2018


  • Global Monthly Essentials
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The 2 essential studies on Lung Disease this month, selected from 258 peer-reviewed studies

1. Self-guided breathing retraining, now freely available online, can significantly improve QoL for patients with asthma. An accompanying editorial affirms evidence of efficacy while reminding readers the therapy can only be an adjunct. See our essential synopsis of the article from Lancet Respir Med below.

2. In patients with COPD, initiating long-acting inhaled bronchodilators confers an approximate 1.5-fold elevated risk for a cardiovascular disease (CVD) event in the first 30 days. Risk increases independent of previous CVD or exacerbation history. Vigilance is warranted on initiating long-acting β2-agonists or long-acting antimuscarinic antagonists. See our essential synopsis of the article from JAMA Intern Med below.


Takeaway
  • Self-guided breathing retraining, now freely available online, can significantly improve QoL for patients with asthma.
  • An accompanying editorial affirms evidence of efficacy while reminding readers the therapy can only be an adjunct.
Key results
  • Asthma Quality of Life Questionnaire (AQLQ) scores after both breathing retraining interventions were higher than in the usual care group (DVD plus booklet [DVDB], 5.40; face to face, 5.33; usual care, 5.12).
  • Both interventions' adjusted mean AQLQ score differences vs usual care were significant (P<.05) in both intention-to-treat and per protocol populations.
  • DVDB vs face-to-face groups’ scores did not significantly differ.
  • Number needed to treat was 8 for DVDB vs usual care, 7 for face-to-face vs usual care.
Study design
  • Multicenter, randomized controlled, observer-blinded trial, 655 UK residents aged 16-70 years experiencing impaired asthma-related QoL (AQLQ score <5.5).
  • Researchers created breathing retraining module comprising a DVDB.
  • Participants were randomly assigned (2:1:2) to receive DVDB (n=261), 3 in-person breathing retraining sessions (n=132), or usual care (n=262) for 12 months.
  • Primary outcome: AQLQ score at 12 months.
  • Funding: National Institute of Health Research (UK).
Why this matters
  • Breathing retraining for asthma can be helpful, but expensive and difficult to access.


Takeaway
  • In patients with COPD, initiating long-acting inhaled bronchodilators confers an approximate 1.5-fold elevated risk for a cardiovascular disease (CVD) event in the first 30 days.
  • Risk increases independent of previous CVD or exacerbation history.
  • Vigilance is warranted on initiating long-acting β2-agonists (LABAs) or long-acting muscarinic antagonists (LAMAs).
Key results
  • 37,719 patients with CVD matched to 146,139 control patients.
  • First 30 days of LAMA/LABA use increased CVD event risk within 30 days of initiation: 
    • LABA: 1.50-fold increase (95% CI, 1.35-1.67; P<.001); and
    • LAMA: 1.52-fold increase (95% CI, 1.28-1.80; P<.001).
  • Risk largely normalized after ≥30 days of use of either drug.
Study design
  • Nested case-control study; 284,220 LABA-/LAMA-naive patients with COPD aged ≥40 years, in Taiwan National Health Insurance Research claims database, 2007-2011.
  • Each case of coronary artery disease, heart failure, ischemic stroke, arrhythmia requiring inpatient or emergency care assessed for prior LAMA/LABA use, stratified and matched with 4 control patients.
  • Mean follow-up, 2.0 years.
  • Funding: Ministry of Science and Technology (China).
Why this matters
  • Whether LABAs/LAMAs provoke CVD events in COPD is unclear.

View Abstract