New Zealand COPD Guidelines: Quick Reference Guide.

The purpose of the Asthma and Respiratory Foundation of New Zealand's COPD Guidelines: Quick Reference Guide is to provide simple, practical, evidence-based recommendations for the diagnosis, assessment, and management of chronic obstructive pulmonary disease (COPD) in clinical practice. The intended users are health professionals responsible for delivering acute and chronic COPD care in community and hospital settings, and those responsible for the training of such health professionals.

Reducing medication errors for hospital inpatients with Parkinsonism.

Background: Patients with Parkinsonism are 1.5 times more likely than comparators to be hospitalised and have a significantly longer length of stay in hospital. Medication delays, inappropriate medication omission, and administration of contraindicated medications likely contribute to these poor outcomes.

Cognitive function during exacerbations of chronic obstructive pulmonary disease.

Background: The reported prevalence of cognitive impairment in patients with stable chronic obstructive pulmonary disease (COPD) ranges 36-77%. Few studies report the prevalence of cognitive impairment in acutely unwell COPD patients.

Aims: To determine the prevalence and time course of cognitive impairment in patients with COPD during and after an admission to hospital with an exacerbation of the disease.

Expiratory reactance abnormalities in patients with expiratory dynamic airway collapse: a new application of impulse oscillometry.

Expiratory dynamic airways collapse (EDAC) is a condition that affects the central airways; it is not well characterised physiologically, with relatively few studies. We sought to characterise impulse oscillometry (IOS) features of EDAC in patients with normal spirometry. Expiratory data were hypothesised to be the most revealing.

Serum periostin in obstructive airways disease.

Serum periostin is a potential biomarker of response to therapies that target type 2 inflammation in asthma. The objectives of this study were to describe: 1) the distribution of serum periostin levels in adults with symptomatic airflow obstruction; 2) its relationship with other variables, including type 2 biomarkers; and 3) the effect of inhaled corticosteroids on periostin levels.Serum periostin levels were measured in a cross-sectional study exploring phenotypes and biomarkers in 386 patients aged 18-75 years who reported wheeze and breathlessness in the past 12 months.

Interventions for sexual dysfunction in people with chronic obstructive pulmonary disease (COPD).

Background: People with chronic obstructive pulmonary disease (COPD) are believed be at higher risk of problems with sexual function than age-matched peers. Problems with sexuality or sexual function associated with COPD may arise as a results of hormonal, physiological, or psychological problems, or as a result of changes in intimate relationships arising from the chronic nature of the condition.

Objectives: To evaluate the effectiveness of interventions for sexual dysfunction in people with COPD.

The effect of 1g of acetaminophen twice daily for 12 weeks on alanine transaminase levels--A randomized placebo-controlled trial.

Objective: Acetaminophen is often used on a regular, daily basis for the treatment of chronic pain; however, the safety of regular acetaminophen is still debated. This study determined whether 12 weeks of treatment with acetaminophen at half the maximum recommended daily dose causes an increase in alanine transaminase (ALT) in healthy adults participating in a clinical trial of the effect of acetaminophen on asthma control and severity.

Design And Methods: 94 healthy adults aged 18-65 years with mild to moderate asthma and with no history of previous liver dysfunction and an ALT within 1.

Treatment responsiveness of phenotypes of symptomatic airways obstruction in adults.

Background: Asthma and chronic obstructive pulmonary disease (COPD) are heterogeneous disorders encompassing different phenotypes of airflow obstruction, which might differ in their response to treatment.

Objective: The aim of this study was to determine distinct phenotypes comprising the syndromes of asthma and COPD and the treatment responsiveness of these phenotypes to inhaled β-agonist, antimuscarinic, and corticosteroid therapy.

Methods: We undertook a cross-sectional study with 3 phases.

Combination budesonide/formoterol inhaler as maintenance and reliever therapy in Māori with asthma.

Background And Objective: There are significant health disparities between Māori and non-Māori with asthma, a pattern seen between other ethnic populations. This study investigates outcomes for Māori in a randomized controlled trial (RCT) of combination budesonide/formoterol inhaler therapy in asthma.

Methods: This 24-week multicentre RCT recruited 303 adult asthma patients, 44 of whom were Māori.

Randomised placebo-controlled study of the effect of paracetamol on asthma severity in adults.

Objective: To investigate the effect of regular paracetamol on bronchial hyper-responsiveness (BHR) and asthma control in adult asthma.

Setting: Single research-based outpatient clinic.

Participants: 94 adults with mild-to-moderate asthma received randomised treatment; 85 completed the study.

Occupational risk factors for chronic respiratory disease in a New Zealand population using lifetime occupational history.

Objectives: To investigate associations between respiratory disease and occupational exposures in a New Zealand urban population, the Wellington Respiratory Survey.

Methods: Multiple regression analyses in a population sample of 1017 individuals aged 25 to 74 years with spirometry and questionnaire information, including a lifetime occupational history.

Results: Chronic bronchitis symptoms were associated with self-reported exposure to hairdressing, paint manufacturing, insecticides, welding, detergents and with ALOHA Job Exposure Matrix-assessed gases/fumes exposure.

Efficacy and safety of maintenance and reliever combination budesonide-formoterol inhaler in patients with asthma at risk of severe exacerbations: a randomised controlled trial.

Background: The Single combination budesonide-formoterol inhaler Maintenance And Reliever Therapy (SMART) regimen reduces severe asthma exacerbations in patients, but whether the high doses of corticosteroid and β agonist increase the risk of adverse effects with both short-term and cumulative exposure is not certain. Our aim was to investigate whether the SMART regimen would reduce the risk of overuse of β agonist, reduce the likelihood of patients to seek medical review when such episodes occurred, and if any reduction in severe asthma exacerbations would be at the cost of a higher burden of systemic corticosteroid.

Methods: In this 24-week trial undertaken at four primary health-care practices and one hospital in New Zealand, patients (aged 16-65 years) with a recent asthma exacerbation were randomly assigned in a 1:1 ratio to the SMART or standard fixed-dose regimen.

Use of metered-dose inhaler electronic monitoring in a real-world asthma randomized controlled trial.

Background: Electronic monitoring of inhaled asthma medications is one method to measure medication adherence and patterns of use. Information on the performance of monitors in a randomized controlled trial allows researchers and clinicians to understand their utility and limitations. The Smartinhaler Tracker is an electronic monitor for metered-dose inhalers (MDIs) that records the date, time, and number of actuations.

The value of the CRB65 score to predict mortality in exacerbations of COPD requiring hospital admission.

Background And Objective: The CRB65 score, a risk stratification method validated for use in community-acquired pneumonia, has recently been shown to have utility in acute exacerbations of COPD (AECOPD). The objective of this study was to independently validate the CRB65 score as a predictor of mortality in patients who required hospital admission with AECOPD.

Methods: The medical records of patients admitted to Wellington Hospital with AECOPD during a 12-month period from June 2006 were reviewed.

The multiple dimensions of airways disease: targeting treatment to clinical phenotypes.

Purpose Of Review: The recognition that asthma and chronic obstructive pulmonary disease (COPD) are not single diseases, but syndromes made up of multiple separate disorders that overlap, has led to attempts to develop a new taxonomy for the disorders of airflow obstruction. A better understanding of the distinct disorders of airways disease has the potential to inform on underlying mechanisms, risk factors, natural history, monitoring and treatment.

Recent Findings: Recent attempts to describe the different phenotypes have largely been based on cluster analysis.

Reference ranges for exhaled nitric oxide derived from a random community survey of adults.

Rationale: Measurement of the fraction of nitric oxide in exhaled breath (Fe(NO)) has been proposed as a noninvasive marker of airway inflammation. Before the widespread use of this test, there is a need to develop reference ranges to allow clinicians to interpret Fe(NO) measurements.

Objectives: To derive reference ranges for Fe(NO) and to determine which factors in health and disease influence Fe(NO) levels.

External validity of randomized controlled trials in COPD.

Background: COPD is a heterogeneous disease comprising a wide range of clinical phenotypes, depending on the degree to which emphysema, chronic bronchitis, reversible bronchospasm and small airways inflammation are present. Not all of these phenotypes may be represented among the subjects included in randomized controlled drug trials (RCTs) in COPD, making it difficult for doctors to know to what extent RCT evidence applies to individual patients. From a respiratory health survey of adults randomly selected from the community, we have estimated the proportion of subjects with COPD who would have been eligible for inclusion in major COPD RCTs.

External validity of randomised controlled trials in asthma: to whom do the results of the trials apply?

Background: Asthma is a heterogeneous disease with a wide range of clinical phenotypes, not all of which may be encompassed in the subjects included in randomised controlled trials (RCTs). This makes it difficult for clinicians to know to what extent the evidence derived from RCTs applies to a given patient.

Aim: To calculate the proportion of individuals with asthma who would have been eligible for the major asthma RCTs from the data of a random community survey of respiratory health.