February

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Scientific findings published in the ERJ in February.

 

  • COPD patients exercise less as their condition worsens
  • Antibiotics may improve COPD survival

COPD patients exercise less as their condition worsens

The amount of exercise that chronic obstructive pulmonary disease (COPD) patients are able to do, gives doctors an idea of how serious their disease may be. Patients with severe COPD can have limited activity but doctors do not yet know at what specific stage exercising becomes difficult.

Doctors use a system called GOLD to describe how serious someone’s COPD is. GOLD Stage 1 describes someone with mild COPD who does not show many symptoms and may not even know that their lungs are not working normally. Symptoms progress through GOLD stages 2 and 3 until Stage 4, which describes very severe COPD with restricted breathing and regular symptoms.

A German team studied 163 COPD patients and 29 patients with chronic bronchitis to compare how much exercise patients could do at different stages of COPD. Patients wore an armband that measured the number of steps they took each day and how much exercise they did for 5 days. The researchers tried to find out whether the amount of exercise completed was linked to how bad their conditions were, to decide whether exercise is a reliable measure of COPD stage.

Mild COPD patients and those who became breathless with exercise were less likely to walk any distance compared to patients with chronic bronchitis. Patients with severe and very severe COPD and those who became very short of breath with little exercise were most likely to be the least active when all the patients in the study were compared.

Exercise becomes more difficult for COPD patients when their condition is moderately severe and it is harder for them to breathe (GOLD stage 2). The amount of exercise completed by patients with severe COPD patients (GOLD stage 3) was significantly less compared with patients with mild COPD (GOLD stage 1).

However, characteristics used to consider how bad COPD is, do not always accurately match the amount of exercise that the patient is able to do. Peer-pressure and the weather may also influence exercise participation, so it might be useful to consider these things for future studies.

Antibiotics may improve COPD survival

Studies have shown that treating severe chronic obstructive pulmonary disease (COPD) with corticosteroids and/ or antibiotics – greatly improves recovery at times when a patient experiences worsening symptoms (this is called an exacerbation). A team of scientists in the Netherlands has studied the long-term risk of regular exacerbations in primary care COPD patients who received oral corticosteroids with and without antibiotics. All of the patients who took part in the study were on maintenance respiratory drugs, were at least 50 years old, and had been treated for worsening symptoms.

Of the 842 patients studied, just under half were treated with corticosteroids after the first sign that symptoms were getting worse and just over half were treated with corticosteroids and antibiotics (using an antibiotic called doxycyclin in half of the cases).

A total of 595 patients had a second exacerbation and 450 patients had a third exacerbation during the study.

The amount of time that passed between exacerbations was recorded. Time between the first and second occasions of worsening symptoms was similar amongst the two patient groups. However, the time taken between the second and third occasions of worsening symptoms was significantly shorter in patients who did not receive antibiotics and so these patients were likely to deteriorate more quickly than patients who were taking antibiotics with corticosteroids. Analysing all exacerbations, the risk of a subsequent exacerbation was lower after treatment with antibiotics added to corticosteroids.

Furthermore, a survival benefit was shown in the patient group treated with oral corticosteroids and antibiotics at first exacerbation during follow-up.
The use of antibiotics prescribed without a course of oral corticosteroids, irrespective of the indication, almost halved the risk of a subsequent exacerbation.

Exacerbations can occur when bacteria are present. Antibiotics kill these bacteria so exacerbations may occur less often. Patients with severe COPD are likely to have a lot of bacteria present in their lungs. If the time between exacerbations can be increased, a patient’s health will not deteriorate as quickly and they will have a better quality of life.

If future studies confirm that antibiotics delay worsening symptoms and increase the lifetime of some COPD patients, there may be many changes to how doctors treat COPD patients when they have exacerbations.

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