What’s New in COPD? A Recap of 7 Key Studies for Primary Care

Training reduces inhaler errors and symptoms in geriatrics. For patients aged ≥65 years with COPD, intensive training for 8 days improved their handling of inhalers and reduced clinical symptoms in a prospective intervention study. Those who had cognitive abnormalities also benefitted. Handling mistakes per patient decreased from 3.0 to 0.5. COPD Assessment Test score decreased from 19.5 to 14.5, indicating a substantial reduction of clinical symptoms. Forced expiratory volume in 1 s and forced vital capacity increased only slightly. BMC Geriatrics.

Jury still out on nocturnal oxygen. In a trial of whether nocturnal oxygen provided for 3 to 4 years decreases mortality or worsening of disease in patients with COPD such that they meet current specifications for long-term oxygen therapy, the findings provided no indication that nocturnal oxygen has a positive or negative effect. At 3 years of follow-up, 39% of patients assigned to nocturnal oxygen and 42% of those assigned to placebo met Nocturnal Oxygen Therapy Trial–defined criteria for long-term oxygen therapy or had died. New England Journal of Medicine.

Pulmonary rehab offers a lift. An 8-week pulmonary rehabilitation program for patients with COPD resulted in sustained improvement in anxiety and quality of life (QoL) over 2 years. At 8 weeks, statistically significant improvements were seen in dyspnea measured by modified Medical Research Council questionnaire, QoL assessed by Saint George’s Respiratory Questionnaire, and anxiety measured by Anxiety Inventory for Respiratory Disease and Depression Anxiety Stress Scale. Short-term improvements in dyspnea, depression, and stress symptoms were not maintained at 2 years. Chest.

Late failure of noninvasive ventilation clarified. In a recent study, the risk factors for noninvasive ventilation (NIV) failure after initial success in patients with acute exacerbation of COPD were nosocomial pneumonia; heart rate at initiation of NIV; and consciousness, acidosis, and oxygenation at 1–2 hours of NIV. Late failure of NIV (patients requiring intubation or dying during NIV after initial success) was associated with longer ICU stay and higher hospital mortality. Canadian Respiratory Journal.

Older adults ill-disposed to cannabinoids. New use of oral synthetic cannabinoids (nabilone, dronabinol) was found to be associated with elevated rates of adverse outcomes among older adults with COPD. Their rate of hospitalization for COPD was not significantly different from that of controls, but rates of all-cause mortality were significantly higher. Those who received higher-dose cannabinoids had higher rates of hospitalization and all-cause mortality. Thorax.