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Perspective
The Risks and Benefits of Indacaterol — The FDA's Review
In July 2011, the Food and Drug Administration (FDA) approved Arcapta Neohaler (indacaterol maleate powder), a long-acting beta-agonist (LABA), at a dose of 75 μg once daily as a bronchodilator for patients with chronic obstructive pulmonary disease (COPD). Since the European Medicines Agency (EMA)…
- December 15, 2011
- Chowdhury B.A., Seymour S.M., Michele T.M., et al.
- N Engl J Med 2011; 365:2247 - 2249
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In July, the FDA approved Arcapta Neohaler (indacaterol maleate powder), a long-acting beta-agonist, at a daily dose of 75 μg for chronic obstructive pulmonary disease. Why was this dose selected, after the European Medicines Agency approved 150-μg and 300-μg doses?
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Editorial
Emphysema — A Disease of Small Airways or Lung Parenchyma?
In 1984, the Division of Lung Diseases at the National Heart, Lung, and Blood Institute funded a workshop that led to what is still the basis for most definitions of emphysema: "a condition of the lung characterized by abnormal, permanent enlargement of airspaces distal to the terminal bronchiole,…
- October 27, 2011
- Mitzner W.
- N Engl J Med 2011; 365:1637 - 1639
In 1984, the Division of Lung Diseases at the National Heart, Lung, and Blood Institute funded a workshop that led to what is still the basis for most definitions of emphysema: “a condition of the lung characterized by abnormal, permanent enlargement of ...
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Original Article
Small-Airway Obstruction and Emphysema in Chronic Obstructive Pulmonary Disease
Direct measurement of the distribution of resistance in the lower respiratory tract has established that small airways (i.e. <2 mm in internal diameter) become the major sites of obstruction in patients with chronic obstructive pulmonary disease (COPD).– Resistance to flow through tubes is…
- October 27, 2011
- McDonough J.E., Yuan R., Suzuki M., et al.
- N Engl J Med 2011; 365:1567 - 1575
- Video
Patients with COPD have increased peripheral airway resistance. In this study, increased peripheral airway resistance was strongly associated with a reduction in the number of terminal bronchioles rather than narrowing of airways.
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Editorial
Variable Loss of Lung Function in COPD
Chronic obstructive pulmonary disease (COPD) is a large and increasing global health problem. Although cigarette smoking is the most common preventable cause of COPD, not all cases of COPD are associated with smoking. Most of the clinical limitations stem from the accelerated loss of lung function…
- September 29, 2011
- Burney P.
- N Engl J Med 2011; 365:1246 - 1247
Chronic obstructive pulmonary disease (COPD) is a large and increasing global health problem.¹ Although cigarette smoking is the most common preventable cause of COPD, not all cases of COPD are associated with smoking.²,³ Most of the clinical limitations ...
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Original Article
Changes in Forced Expiratory Volume in 1 Second over Time in COPD
Since the seminal study by Fletcher et al. in the 1970s,, it has been widely accepted that chronic obstructive pulmonary disease (COPD) is characterized by an accelerated decline in forced expiratory volume in 1 second (FEV1). However, surprisingly few longitudinal studies of patient cohorts have…
- September 29, 2011
- Vestbo J., Edwards L.D., Scanlon P.D., et al.
- N Engl J Med 2011; 365:1184 - 1192
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- CME
In patients with chronic obstructive pulmonary disease (COPD), lung function decreases rapidly. Analysis of data from a large observational study of COPD showed that the rate of such loss is highly variable, and current smoking was associated with a rapid loss.
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Original Article
Azithromycin for Prevention of Exacerbations of COPD
Acute exacerbations of chronic obstructive pulmonary disease (COPD) result in frequent visits to physicians' offices and emergency rooms and numerous hospitalizations and days lost from work; they also account for a substantial percentage of the cost of treating COPD.– Patients who have acute…
- August 25, 2011
- Albert R.K., Connett J., Bailey W.C., et al.
- N Engl J Med 2011; 365:689 - 698
- CME
Exacerbations of chronic obstructive pulmonary disease (COPD) are a source of substantial morbidity. In this randomized, controlled trial involving patients with moderately severe COPD, daily treatment with azithromycin for 1 year was associated with fewer exacerbations.
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Editorial
Preventing Exacerbations of COPD — Advice from Hippocrates
Severe acute exacerbations of chronic obstructive pulmonary disease (COPD) are devastating, life-threatening events; the 30-day mortality is greater than that with acute myocardial infarction (26% vs. 7.8%). Acute exacerbations of COPD dramatically change the course of the disease, since they are…
- August 25, 2011
- Siafakas N.M.
- N Engl J Med 2011; 365:753 - 754
Severe acute exacerbations of chronic obstructive pulmonary disease (COPD) are devastating, life-threatening events; the 30-day mortality is greater than that with acute myocardial infarction (26% vs. 7.8%).¹,² Acute exacerbations of COPD dramatically ...
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Editorial
Choice of Bronchodilator Therapy for Patients with COPD
Chronic obstructive pulmonary disease (COPD) is a progressive airway inflammatory condition that is associated with accelerated decline of lung function and is characterized by worsening dyspnea with episodes of increased number and severity of symptoms, termed exacerbations. The main objectives of…
- March 24, 2011
- Wedzicha J.A.
- N Engl J Med 2011; 364:1167 - 1168
Chronic obstructive pulmonary disease (COPD) is a progressive airway inflammatory condition that is associated with accelerated decline of lung function and is characterized by worsening dyspnea with episodes of increased number and severity of symptoms, ...
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Original Article
Tiotropium versus Salmeterol for the Prevention of Exacerbations of COPD
Chronic obstructive pulmonary disease (COPD) is a leading cause of disability and death worldwide.– Exacerbations of COPD indicate instability or worsening of the patient's clinical status and progression of the disease and have been associated with the development of complications, an increased…
- March 24, 2011
- Vogelmeier C., Hederer B., Glaab T., et al.
- N Engl J Med 2011; 364:1093 - 1103
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- CME
An important goal in the treatment of COPD is the prevention of exacerbations. In this trial, the investigators found that treatment with tiotropium, as compared with salmeterol, prolonged the time to the first exacerbation of COPD and decreased the number of exacerbations.
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Original Article
Lung Volumes and Emphysema in Smokers with Interstitial Lung Abnormalities
The relationship between exposure to tobacco smoke and chronic obstructive pulmonary disease (COPD) is well described. Two manifestations of COPD include emphysematous destruction of the lung parenchyma and elevated measures of total lung capacity. However, there is increasing awareness that…
- March 10, 2011
- Washko G.R., Hunninghake G.M., Fernandez I.E., et al.
- N Engl J Med 2011; 364:897 - 906
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- CME
Smokers with more than a 10-pack-year history of smoking who were part of an ongoing study had CT scans and lung-function tests. Approximately 1 in 12 had interstitial abnormalities; these patients had less emphysema and lower total lung capacities than did patients without such changes.
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Editorial
Smoking and Subclinical Interstitial Lung Disease
The relationships between cigarette smoking and heart disease, lung cancer, and chronic obstructive pulmonary disease (COPD) are well known; in contrast, the topic of the relationship between smoking and interstitial lung disease is almost obscure. Despite its lack of a public persona, this…
- March 10, 2011
- King T.E.
- N Engl J Med 2011; 364:968 - 970
The relationships between cigarette smoking and heart disease, lung cancer, and chronic obstructive pulmonary disease (COPD) are well known; in contrast, the topic of the relationship between smoking and interstitial lung disease is almost obscure. ...
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Editorial
Endobronchial Valves to Reduce Lung Hyperinflation
Chronic obstructive pulmonary disease (COPD) is characterized by progressive limitation of airflow that results in air trapping and hyperinflation. Some patients with this disease also have irreversible pulmonary emphysema due to the destruction of alveolar septa in the lung. These abnormalities…
- September 23, 2010
- Anzueto A.
- N Engl J Med 2010; 363:1280 - 1281
Chronic obstructive pulmonary disease (COPD) is characterized by progressive limitation of airflow that results in air trapping and hyperinflation. Some patients with this disease also have irreversible pulmonary emphysema due to the destruction of ...
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Original Article
A Randomized Study of Endobronchial Valves for Advanced Emphysema
Emphysema is a leading cause of disability and death. Lung-volume–reduction surgery, in which selected areas of hyperinflated lungs are resected, improves exercise tolerance and prolongs life in selected patients. However, concern regarding the risk of perioperative death and complications…
- September 23, 2010
- Sciurba F.C., Ernst A., Herth F.J.F., et al.
- N Engl J Med 2010; 363:1233 - 1244
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One of the characteristics of severe emphysema is hyperinflation of regions of the lungs. In this trial, valves that prevented air entry but allowed air to escape were placed in lobar airways. Patients receiving endobronchial valves had modest improvements in lung function and exercise performance.
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Original Article
Susceptibility to Exacerbation in Chronic Obstructive Pulmonary Disease
The natural history of chronic obstructive pulmonary disease (COPD) is punctuated by exacerbations — acute worsening of symptoms. Exacerbations appear to accelerate the decline in lung function that characterizes COPD,, resulting in reduced physical activity, poorer quality of life, and an…
- September 16, 2010
- Hurst J.R., Vestbo J., Anzueto A., et al.
- N Engl J Med 2010; 363:1128 - 1138
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- CME
This study examined the rate of exacerbations among patients with COPD over a period of 3 years. The strongest predictor of an exacerbation in a given year was the presence of an exacerbation in the previous year.
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Editorial
Frequent Exacerbations of Chronic Obstructive Pulmonary Disease — A Distinct Phenotype?
Chronic obstructive pulmonary disease (COPD) is a partially reversible disorder characterized by progressive airflow obstruction, the course of which is punctuated by episodes of acute symptomatic worsening (exacerbations) of variable severity and frequency. Exacerbations have an important effect…
- September 16, 2010
- Tashkin D.P.
- N Engl J Med 2010; 363:1183 - 1184
Chronic obstructive pulmonary disease (COPD) is a partially reversible disorder characterized by progressive airflow obstruction, the course of which is punctuated by episodes of acute symptomatic worsening (exacerbations) of variable severity and ...
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Perspective
The Safety of Tiotropium — The FDA's Conclusions
Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide, and the rate of COPD-related death is increasing. No current drug therapy alters the progressive decline in lung function that characterizes this disease. In 2004, the Food and Drug Administration (FDA) approved the…
- September 16, 2010
- Michele T.M., Pinheiro S., Iyasu S.
- N Engl J Med 2010; 363:1097 - 1099
- Free Full Text
Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide, and the rate of COPD-related death is increasing.¹ No current drug therapy alters the progressive decline in lung function that characterizes this disease. In 2004, the ...
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Clinical Practice
Outpatient Management of Severe COPD
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage. A 67-year-old…
- April 15, 2010
- Niewoehner D.E.
- N Engl J Med 2010; 362:1407 - 1416
- CME
- Full Text Audio
A 67-year-old man presents with progressive dyspnea. He has smoked cigarettes since he was 15 years of age. Worsening breathlessness forced him to retire as a laborer. His physical examination is notable for distant breath sounds on auscultation, with a prolonged expiratory phase. Spirometry reveals severe airflow obstruction (ratio of forced expiratory volume in first second [FEV₁] to forced vital capacity, 0.43; FEV₁, 34% of the predicted value). How should this case be managed?
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Original Article
Percent Emphysema, Airflow Obstruction, and Impaired Left Ventricular Filling
Chronic obstructive pulmonary disease (COPD), defined as airflow obstruction that is not fully reversible, is currently the fourth leading cause of death in the United States. COPD overlaps partially with emphysema, which is characterized by the destruction of alveolar walls and the permanent…
- January 21, 2010
- Barr R.G., Bluemke D.A., Ahmed F.S., et al.
- N Engl J Med 2010; 362:217 - 227
- Free Full Text
In a population-based study, emphysema was quantified by computed tomography, pulmonary function was assessed by spirometry, and cardiac volumes and function were measured by magnetic resonance imaging. Both percent emphysema and the severity of airflow obstruction were linearly related to reductions in left ventricular end-diastolic volume, stroke volume, and cardiac output. These effects were more pronounced among smokers.
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Editorial
The Shrinking Heart in Chronic Obstructive Pulmonary Disease
In patients with emphysema, the cardiac silhouette on the radiograph is typically long and narrow. The common explanation for this finding is the altered, more vertical position of the heart in the thoracic cavity. The study by Barr et al. in this issue of the Journal provides an alternative…
- January 21, 2010
- Vonk-Noordegraaf A.
- N Engl J Med 2010; 362:267 - 268
In patients with emphysema, the cardiac silhouette on the radiograph is typically long and narrow. The common explanation for this finding is the altered, more vertical position of the heart in the thoracic cavity. The study by Barr et al. in this issue ...
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Editorial
Matrix Metalloproteinase 12, Asthma, and COPD
Asthma and chronic obstructive pulmonary disease (COPD) are obstructive airway diseases that involve chronic inflammation of the lower respiratory tract. They differ from each other in the pattern of inflammation, their immunologic mechanisms, the extent of reversibility of airflow limitation, and…
- December 31, 2009
- Brusselle G.G.
- N Engl J Med 2009; 361:2664 - 2665
Asthma and chronic obstructive pulmonary disease (COPD) are obstructive airway diseases that involve chronic inflammation of the lower respiratory tract. They differ from each other in the pattern of inflammation, their immunologic mechanisms, the extent ...
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