The Experts below are selected from a list of 306 Experts worldwide ranked by ideXlab platform
Donald P Tashkin - One of the best experts on this subject based on the ideXlab platform.
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Bronchodilator responsiveness in patients with copd
European Respiratory Journal, 2008Co-Authors: Donald P Tashkin, Bartolome R Celli, Marc Decramer, D Burkhart, Cara Cassino, S KestenAbstract:The degree of acute improvement in spirometric indices after Bronchodilator inhalation varies among chronic obstructive pulmonary disease (COPD) patients, and depends upon the type and dose of Bronchodilator and the timing of administration. Acute Bronchodilator responsiveness at baseline was examined in a large cohort of patients with moderate-to-very-severe COPD participating in the Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT) trial, a 4-yr randomised double-blind trial evaluating the efficacy of 18 μg tiotropium daily in reducing the rate of decline in lung function. After wash-out of respiratory medications, patients received 80 μg ipratropium followed by 400 μg salbutamol. Spirometry was performed before and 90 min following ipratropium administration. The criteria used for forced expiratory volume in one second (FEV 1 ) responsiveness were: ≥12% increase over baseline and ≥200 mL; ≥15% increase over baseline; and ≥10% absolute increase in the percentage predicted value. Of the patients, 5,756 had data meeting the criteria for analysis (age 64.5 yrs; 75% male; baseline FEV 1 1.10 L (39.3% predicted) and forced vital capacity (FVC) 2.63 L). Compared with baseline, mean improvements were 229 mL in FEV 1 and 407 mL in FVC. Of these patients, 53.9% had ≥12% and ≥200 mL improvement in FEV 1 , 65.6% had ≥15% improvement in FEV 1 , and 38.6% had ≥10% absolute increase in FEV 1 % pred. The majority of patients with moderate-to-very-severe chronic obstructive pulmonary disease demonstrate meaningful increases in lung function following administration of inhaled anticholinergic plus sympathomimetic Bronchodilators.
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Bronchodilator response in the lung health study over 11 yrs
European Respiratory Journal, 2005Co-Authors: N R Anthonisen, Donald P Tashkin, Richard E Kanner, Paula Lindgren, Paul D Scanlon, John E ConnettAbstract:Long-term changes in Bronchodilator response in people with mild chronic obstructive pulmonary disease were assessed in this study. Changes in forced expiratory volume in one second (FEV1) in response to isoproterenol was measured in 4,194 participants in the Lung Health Study annually for 5 yrs, and again 11 yrs after study entry. Responses were quantitated in terms of mL (absolute), as per cent of the pre-Bronchodilator value (relative), and as a per cent of the predicted normal value (% predicted). At baseline, the mean pre-Bronchodilator FEV1 was 75.4% predicted, and responses were small. Relative and percentage predicted responses were similar in males and females; and correlated positively with methacholine reactivity, and negatively with smoking intensity and age. Baseline Bronchodilator responses did not correlate with subsequent decline in FEV1. There was a substantial increase in response over the first year of the study, largely due to smoking cessation, with larger increases in those who stopped smoking. After the first year absolute responses changed little in those who maintained smoking cessation, but increased in those who did not. Mean relative and percentage predicted responses increased in all participants throughout the study. There was substantial annual variability of absolute response, and it was poorly reproducible in individual participants. In conclusion, smoking cessation increased Bronchodilator response, and response did not predict the rate of decline of forced expiratory volume in one second.
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long term treatment benefits with tiotropium in copd patients with and without short term Bronchodilator responses
Chest, 2003Co-Authors: Donald P Tashkin, S KestenAbstract:Objectives: To determine whether long-term symptomatic improvement occurs in COPD patients with maintenance Bronchodilator therapy despite a nonsignificant short-term improvement in FEV 1 following Bronchodilator inhalation obtained at a single time point. Methods: Data obtained during two identical 1-year, placebo-controlled trials of tiotropium, 18 μg once daily, were analyzed retrospectively to determine the associations of long-term improvements in lung function and patient health status with short-term improvements in FEV 1 , as measured on the first day of treatment. Based on the presence or absence of a short-term improvement in FEV 1 of ≥ 12% and ≥ 200 mL, respectively, patients who had been treated with tiotropium were characterized as being responsive to tiotropium (TIO-R) or poorly responsive to tiotropium (TIO-PR). Results: Baseline characteristics were similar other than baseline FEV 1 , which was higher in the TIO-R group than in both the TIO-PR and placebo groups (p 1 was 1.08 L in the TIO-R group (n = 263), 0.95 L in the TIO-PR (n = 255), and 0.99 L in the placebo group (n = 328). The mean (± SD) morning predose FEV 1 at 1 year significantly (p 1 response to the end-of-trial trough response ( r = 0.43), but there was only a weak correlation to TDI focal score ( r = 0.17) or SGRQ total score ( r = −0.12). Conclusions: Tiotropium was effective in the treatment of patients with COPD, irrespective of the presence or absence of a short-term response on the first day of treatment. The short-term Bronchodilator response should not be used as a definitive criterion for prescribing long-term treatment with inhaled Bronchodilators.
S Kesten - One of the best experts on this subject based on the ideXlab platform.
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Bronchodilator responsiveness in patients with copd
European Respiratory Journal, 2008Co-Authors: Donald P Tashkin, Bartolome R Celli, Marc Decramer, D Burkhart, Cara Cassino, S KestenAbstract:The degree of acute improvement in spirometric indices after Bronchodilator inhalation varies among chronic obstructive pulmonary disease (COPD) patients, and depends upon the type and dose of Bronchodilator and the timing of administration. Acute Bronchodilator responsiveness at baseline was examined in a large cohort of patients with moderate-to-very-severe COPD participating in the Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT) trial, a 4-yr randomised double-blind trial evaluating the efficacy of 18 μg tiotropium daily in reducing the rate of decline in lung function. After wash-out of respiratory medications, patients received 80 μg ipratropium followed by 400 μg salbutamol. Spirometry was performed before and 90 min following ipratropium administration. The criteria used for forced expiratory volume in one second (FEV 1 ) responsiveness were: ≥12% increase over baseline and ≥200 mL; ≥15% increase over baseline; and ≥10% absolute increase in the percentage predicted value. Of the patients, 5,756 had data meeting the criteria for analysis (age 64.5 yrs; 75% male; baseline FEV 1 1.10 L (39.3% predicted) and forced vital capacity (FVC) 2.63 L). Compared with baseline, mean improvements were 229 mL in FEV 1 and 407 mL in FVC. Of these patients, 53.9% had ≥12% and ≥200 mL improvement in FEV 1 , 65.6% had ≥15% improvement in FEV 1 , and 38.6% had ≥10% absolute increase in FEV 1 % pred. The majority of patients with moderate-to-very-severe chronic obstructive pulmonary disease demonstrate meaningful increases in lung function following administration of inhaled anticholinergic plus sympathomimetic Bronchodilators.
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long term treatment benefits with tiotropium in copd patients with and without short term Bronchodilator responses
Chest, 2003Co-Authors: Donald P Tashkin, S KestenAbstract:Objectives: To determine whether long-term symptomatic improvement occurs in COPD patients with maintenance Bronchodilator therapy despite a nonsignificant short-term improvement in FEV 1 following Bronchodilator inhalation obtained at a single time point. Methods: Data obtained during two identical 1-year, placebo-controlled trials of tiotropium, 18 μg once daily, were analyzed retrospectively to determine the associations of long-term improvements in lung function and patient health status with short-term improvements in FEV 1 , as measured on the first day of treatment. Based on the presence or absence of a short-term improvement in FEV 1 of ≥ 12% and ≥ 200 mL, respectively, patients who had been treated with tiotropium were characterized as being responsive to tiotropium (TIO-R) or poorly responsive to tiotropium (TIO-PR). Results: Baseline characteristics were similar other than baseline FEV 1 , which was higher in the TIO-R group than in both the TIO-PR and placebo groups (p 1 was 1.08 L in the TIO-R group (n = 263), 0.95 L in the TIO-PR (n = 255), and 0.99 L in the placebo group (n = 328). The mean (± SD) morning predose FEV 1 at 1 year significantly (p 1 response to the end-of-trial trough response ( r = 0.43), but there was only a weak correlation to TDI focal score ( r = 0.17) or SGRQ total score ( r = −0.12). Conclusions: Tiotropium was effective in the treatment of patients with COPD, irrespective of the presence or absence of a short-term response on the first day of treatment. The short-term Bronchodilator response should not be used as a definitive criterion for prescribing long-term treatment with inhaled Bronchodilators.
Paul Aurora - One of the best experts on this subject based on the ideXlab platform.
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repeatability and Bronchodilator reversibility of lung function in young children
European Respiratory Journal, 2013Co-Authors: Samatha Sonnappa, Cristina M Bastardo, Angie Wade, Andrew Bush, Janet Stocks, Paul AuroraAbstract:Knowledge of short- and longer-term repeatability of lung function in health and disease is essential to determine Bronchodilator reversibility thresholds and to recognise if changes in lung function represent disease progression, therapeutic intervention or normal variability. Multiple-breath washout indices (lung clearance index, conductive ventilation inhomogeneity ( S cond)) and specific airway resistance (s R aw) were measured in healthy children and stable wheezers. Measurements were performed at baseline and after 20 min without intervention to assess repeatability and determine Bronchodilator reversibility thresholds. Bronchodilator reversibility was assessed by repeating baseline measurements 20 min after inhaled salbutamol. 28 healthy controls, mean±sd age 6.1±0.7 years and 62 wheezers 5.4±0.6 years were tested. Baseline variability in multiple-breath washout indices and s Raw was not significantly different between wheezers and healthy controls. Significant Bronchodilator reversibility was only observed in wheezers for S cond (16%), but in both wheezers (37%) and healthy controls (20%) for s R aw. Some wheezers and healthy controls demonstrated increases in multiple-breath washout indices post-Bronchodilator. Lung clearance index and s R aw demonstrate low baseline variability in healthy and diseased subjects. Neither multiple-breath washout indices nor s R aw are ideal for assessing Bronchodilator reversibility in young children with stable wheeze. These findings will help to interpret the effect of therapeutic interventions in children with respiratory diseases.
Sonia Buist - One of the best experts on this subject based on the ideXlab platform.
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pre and post Bronchodilator lung function as predictors of mortality in the lung health study
Respiratory Research, 2011Co-Authors: David M Mannino, Enrique Diazguzman, Sonia BuistAbstract:Background: Chronic obstructive pulmonary disease (COPD) is supposed to be classified on the basis of postBronchodilator lung function. Most longitudinal studies of COPD, though, do not have post-Bronchodilator lung function available. We used pre-and post Bronchodilator lung function data from the Lung Health Study to determine whether these measures differ in their ability to predict mortality. Methods: We limited our analysis to subjects who were of black or white race, on whom we had complete data, and who participated at either the 1 year or the 5 year follow-up visit. We classified subjects based on their baseline lung function, according to COPD Classification criteria using both pre- and post-Bronchodilator lung function. We conducted a survival analysis and logistic regression predicting death and controlling for age, sex, race, treatment group, smoking status, and measures of lung function (either pre- or post-Bronchodilator. We calculated hazard ratios (HR) with 95% confidence intervals (CI) and also calculated area under the curve for the logistic regression models. Results: By year 15 of the study, 721 of the original 5,887 study subjects had died. In the year 1 sample survival models, a higher FEV1 % predicted lower mortality in both the pre-Bronchodilator (HR 0.87, 95% CI 0.81, 0.94 per 10% increase) and post-Bronchodilator (HR 0.84, 95% CI 0.77, 0.90) models. The area under the curve for the respective models was 69.2% and 69.4%. Similarly, using categories, when compared to people with “normal” lung function, subjects with Stage 3 or 4 disease had similar mortality in both the pre- (HR 1.51, 95% CI 0.75, 3.03) and post-Bronchodilator (HR 1.45, 95% CI 0.41, 5.15) models. In the year 5 sample, when a larger proportion of subjects had Stage 3 or 4 disease (6.4% in the pre-Bronchodilator group), mortality was significantly increased in both the pre- (HR 2.68, 95% CI 1.51, 4.75) and post-Bronchodilator (HR 2.46, 95% CI 1.63, 3.73) models. Conclusions: Both pre- and post-Bronchodilator lung function predicted mortality in this analysis with a similar degree of accuracy. Post-Bronchodilator lung function may not be needed in population studies that predict longterm outcomes.
John E Connett - One of the best experts on this subject based on the ideXlab platform.
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Bronchodilator response in the lung health study over 11 yrs
European Respiratory Journal, 2005Co-Authors: N R Anthonisen, Donald P Tashkin, Richard E Kanner, Paula Lindgren, Paul D Scanlon, John E ConnettAbstract:Long-term changes in Bronchodilator response in people with mild chronic obstructive pulmonary disease were assessed in this study. Changes in forced expiratory volume in one second (FEV1) in response to isoproterenol was measured in 4,194 participants in the Lung Health Study annually for 5 yrs, and again 11 yrs after study entry. Responses were quantitated in terms of mL (absolute), as per cent of the pre-Bronchodilator value (relative), and as a per cent of the predicted normal value (% predicted). At baseline, the mean pre-Bronchodilator FEV1 was 75.4% predicted, and responses were small. Relative and percentage predicted responses were similar in males and females; and correlated positively with methacholine reactivity, and negatively with smoking intensity and age. Baseline Bronchodilator responses did not correlate with subsequent decline in FEV1. There was a substantial increase in response over the first year of the study, largely due to smoking cessation, with larger increases in those who stopped smoking. After the first year absolute responses changed little in those who maintained smoking cessation, but increased in those who did not. Mean relative and percentage predicted responses increased in all participants throughout the study. There was substantial annual variability of absolute response, and it was poorly reproducible in individual participants. In conclusion, smoking cessation increased Bronchodilator response, and response did not predict the rate of decline of forced expiratory volume in one second.
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effects of smoking intervention and the use of an inhaled anticholinergic Bronchodilator on the rate of decline of fev1 the lung health study
JAMA, 1994Co-Authors: Nicholas R Anthonisen, Paul L Enright, Sonia A Buist, John E Connett, James P Kiley, Murray D Altose, William C Bailey, William A Conway, Richard E Kanner, Peggy OharaAbstract:Objective. —To determine whether a program incorporating smoking intervention and use of an inhaled Bronchodilator can slow the rate of decline in forced expiratory volume in 1 second (FEV 1 ) in smokers aged 35 to 60 years who have mild obstructive pulmonary disease. Design. —Randomized clinical trial. Participants randomized with equal probability to one of the following groups: (1) smoking intervention plus Bronchodilator, (2) smoking intervention plus placebo, or (3) no intervention. Setting. —Ten clinical centers in the United States and Canada. Participants. —A total of 5887 male and female smokers, aged 35 to 60 years, with spirometric signs of early chronic obstructive pulmonary disease. Interventions. —Smoking intervention: intensive 12-session smoking cessation program combining behavior modification and use of nicotine gum, with continuing 5-year maintenance program to minimize relapse. Bronchodilator: ipratropium bromide prescribed three times daily (two puffs per time) from a metered-dose inhaler. Main Outcome Measures. —Rate of change and cumulative change in FEV 1 over a 5-year period. Results. —Participants in the two smoking intervention groups showed significantly smaller declines in FEV 1 than did those in the control group. Most of this difference occurred during the first year following entry into the study and was attributable to smoking cessation, with those who achieved sustained smoking cessation experiencing the largest benefit. The small noncumulative benefit associated with use of the active Bronchodilator vanished after the Bronchodilator was discontinued at the end of the study. Conclusions. —An aggressive smoking intervention program significantly reduces the age-related decline in FEV 1 in middle-aged smokers with mild airways obstruction. Use of an inhaled anticholinergic Bronchodilator results in a relatively small improvement in FEV 1 that appears to be reversed after the drug is discontinued. Use of the Bronchodilator did not influence the long-term decline of FEV 1 . ( JAMA . 1994;272:1497-1505)