geoffrey modest medical blogs

a recently released report, presented at the American Thoracic Society, found that patients with COPD benefited more from the combination of a long-acting  b -agonist (LABA) plus a long-acting anti-muscarinic (LAMA), as opposed to a LABA plus inhaled steroid (see  copd  LAMA LABA better than LABA steroid nejm2016  indropbox , or DOI: 10.1056/NEJMoa1516385). details of the FLAME trial (drug company sponsored trial), a double-blind, double-dummy, parallel-group, non-inferiority trial: --3354 patients with COPD, from 356 centers in 43 countries. Inclusion criteria: >40  yo , grade 2 or greater in modified MRC dyspnea scale (patient describing shortness of breath as "I walk slower than people of the same age on the level because of breathlessness or have to stop for breath when walking at my own pace on the level"), post-bronchodilator FEV 1  25-60% of predicted value with FEV 1 /FVC <70%, and documen...

The recent SUMMIT  study assessed the efficacy of combination steroid plus long acting  b -agonist (LABA) therapy in patients with COPD, specifically looking at survival in those at high cardiovascular risk (see  copd LABA steroid SUMMIT lancet2016  in dropbox, or Vestbo J. Lancet 2016; 387: 1817), finding no increased mortality. A drug company sponsored study. details: --16,485 patients 40-80 yo from 1368 centers in 43 countries, with cardiovascular disease (CVD) or at high risk of CVD, and post-bronchodilator FEV 1  of 50-70% of predicted. Also at least 10 pack-years of smoking and modified MRC dyspnea scale of at least 2 (patient describing shortness of breath as: “I walk slower than people of the same age on the level because of breathlessness or have to stop for breath when walking at my own pace on the level” --mean age 65, 25% women, 81% white/17% Asian, BMI 28, 47% current smokers, post-bronchodilator predicted FEV 1  60% (with 8% reversibility...