Tuesday, August 1, 2006; HE04

chronic obstructive pulmonary disease

· THE QUESTION Two commonly used inhaled drugs have been shown to reduce the wheezing and breathing difficulties that accompany chronic obstructive pulmonary disease (COPD). When symptoms of this progressive lung condition become more severe, do the inhalers still yield comparable results?

· THIS STUDY combined data from 22 studies involving 15,276 people with COPD. In some of the studies, participants had been randomly assigned to use an anticholinergic bronchodilator or a placebo; in other studies, they had used a beta-agonist bronchodilator or a placebo. Beta-agonists used in the studies were albuterol (Proventil, Ventolin, Volmax), metaproterenol (Alupent), formoterol (Foradil) and salmeterol (Serevent, Advair); anticholinergics used were ipratropium (Atrovent) and tiotropium (Spiriva). People who took anticholinergics were 33 percent less likely than those who took placebos to have severe symptoms requiring hospitalization; the hospitalization rate for people who took beta-agonists did not differ from that of the placebo group. Anticholinergics reduced the risk of death by 73 percent vs. placebo (two deaths among 4,036 people, compared with 12 deaths among 3,845 people), whereas beta-agonists more than doubled the risk of death from COPD (21 deaths among 1,320 people vs. eight deaths among 1,084 people).

· WHO MAY BE AFFECTED BY THESE FINDINGS? People with COPD, estimated to number 24 million in the United States. Smoking is a key cause of the disease, but air pollution, respiratory infections and asthma also may contribute.

· CAVEATS All studies of beta-agonists allowed people in the placebo groups to use the drug as needed, thus creating a comparison of regular use vs. as-needed use rather than the standard comparison of treatment vs. no treatment. The authors suggested that the increase in respiratory deaths among beta-agonist users may have been due in part to increased cardiovascular problems, something they were not always able to determine. They also theorized that beta-agonists may keep COPD symptoms in check but not control worsening of the underlying disease.

· FIND THIS STUDY Online issue of the Journal of General Internal Medicine; abstract available at http://www.blackwell-synergy.com/loi/jgi (click "Online early issue" and search for "COPD").

· LEARN MORE ABOUT COPD at http://www.cdc.gov/nceh and http://familydoctor.org .

· THE QUESTION The omega-3 fatty acids found in fish are believed to help the heart and the brain. Might eating fish also help prevent macular degeneration, the deterioration of the part of the eye that lets people see fine detail?

· THIS STUDY analyzed dietary data and eye exam results for 2,335 people, most in their early sixties. During a five-year period, 152 were diagnosed with age-related macular degeneration. Those who ate at least one serving of fish a week were 38 percent less likely to develop the disorder than were those who ate fish less than once a month. People who ate fish at least three times a week were 75 percent less likely to have advanced macular degeneration.

· WHO MAY BE AFFECTED BY THESE FINDINGS? Older people. Macular degeneration sometimes occurs during middle age but usually affects people 60 and older. About 30 percent of those over 75 have the disorder.

· CAVEATS People who ate the most fish may also have had other healthy habits that lowered their risk.

· FIND THIS STUDY July issue of Archives of Ophthalmology; abstract available online at http://www.archophthalmol.com .

· LEARN MORE ABOUT macular degeneration at http://www.nei.nih.gov/health and http://www.amd.org .

· THE QUESTION Facing a chronic disease with no cure, people often switch from one treatment to another. Might a drug approved in December for rheumatoid arthritis offer relief to those who have not found success with methotrexate, a commonly prescribed medication?

· THIS STUDY involved 652 adults who had had rheumatoid arthritis an average of nine years but whose disease remained active despite their having taken methotrexate for at least three months. They were randomly assigned to be given abatacept or a placebo intravenously once a month; all participants continued taking methotrexate. After a year, symptoms overall had been reduced in 73 percent of those taking abatacept, compared with 40 percent of the placebo group, and the ability to function physically had improved in 64 percent of the abatacept group, vs. 39 percent of the others. X-rays showed that joint damage had slowed among abatacept users.

· WHO MAY BE AFFECTED BY THESE FINDINGS? People with rheumatoid arthritis, which is characterized by inflammation of the lining of the joints, causing chronic pain and stiffness.

· CAVEATS The findings may not apply to people who have had the disease for a shorter period of time or who have not already used methotrexate. Any effects from long-term use of abatacept remain unclear. The study was funded by Bristol-Myers Squibb, which developed the drug; the company helped design the study and analyze the data. Of the 11 authors, six received fees from the pharmaceutical company, and three were its employees.

· FIND THIS STUDY June 20 issue of Annals of Internal Medicine; abstract available online at http://www.annals.org .

· LEARN MORE ABOUT rheumatoid arthritis at http://www.arthritis.org and http://www.niams.nih.gov/hi .

--Linda Searing

The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment's effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.