Lung Disease Steroid Disappoints in Study
Inhaled corticosteroids, the most common treatment for chronic obstructive pulmonary disease, actually provide little or no benefit, according to a new study by researchers at the Mayo Clinic. And what little benefit may be present is more than offset by the side effects of the medication, they found.
Chronic obstructive pulmonary disease, commonly abbreviated as COPD, includes chronic bronchitis and emphysema. It is thought to result from inflammation of the airway caused by smoking, leading to a progressive decline in lung function. More than 100,000 Americans die each year from COPD, making it the fourth-leading cause of death in the United States.
Inhaled corticosteroids, such as triamcinolone, are known to be effective treatments for the inflammation of asthma, and physicians have assumed they would work equally well for COPD. That appears not to be the case, however.
Dr. Paul Scanlon and his colleagues at Mayo studied 1,116 current smokers or recent quitters with COPD, giving half an inhaled corticosteroid and half a placebo. They reported in the Dec. 28 New England Journal of Medicine that they found no difference in the decline in lung function between the two groups. Those receiving the steroid had slightly fewer flare-ups, “but not enough to justify widespread use of the medication,” they said. Those receiving the drug also had a small decline in bone density and more instances of bruising, indicating capillary fragility caused by the triamcinolone.
Parkinson’s Therapy Gets an Endorsement
The drug seligiline slows the progression of Parkinson’s disease, but some small studies have suggested that it also increases the risk of death, leading many patients to avoid its use. A new report indicates that those small studies were wrong and that the drug is safe.
“This is exciting news because this drug is the first that showed even the possibility of slowing the course of the disease, not just treating its symptoms,” said Dr. William Langston of the Parkinson’s Institute in Sunnyvale.
Dr. Peter Donnan and his colleagues at the University of Dundee in Scotland studied 97 patients newly diagnosed with Parkinson’s in the Tayside region of Scotland between 1989 and 1995 and compared them to 902 people in the community who did not have the disease. The study looked at death rates for Parkinson’s patients taking only levodopa (the most common treatment for the disease), for those taking only seligiline, and for those taking both drugs.
The team reported in the Dec. 26 issue of Neurology that, overall, patients with Parkinson’s were twice as likely to die during the study period as their healthy counterparts. But those patients taking seligiline in combination with levodopa were no more likely to die than those without Parkinson’s. Those taking levodopa alone had the highest death rate among the three treatment groups.
Cholesterol Drug May Be Under-Prescribed
Only about a third of U.S. heart attack patients leave the hospital with a prescription for cholesterol-lowering drugs called statins, even though as many as 90% of them could benefit from the medication, according to a new UCLA study. Several previous studies showed that these drugs can reduce the risk of a second heart attack, even among patients whose cholesterol is not elevated.
Dr. Gregg C. Fonarow and his colleagues examined a nationwide registry of 138,000 patients treated at 1,470 hospitals in 1998 and 1999. They report in the Jan. 2 issue of Circulation: Journal of the American Heart Assn. that statins were given 18% less often to patients between the ages of 65 and 74 than to those younger than 55, despite evidence that the drug benefits the older patients, and that these patients are at greater risk of a second attack. Women were 31% less likely to get the drugs than men, and African Americans were 13% less likely to get them than others.
VA Centers Rate Well for Heart Attack Care
Heart attack patients receive care at Veterans Affairs hospitals that is just as good as that at community-based hospitals, and the VA system does not deserve its reputation as inferior, according to a new study. Some veterans hesitate to seek treatment at VA hospitals because they fear inadequate care. That reputation has persisted for at least two decades since a congressionally mandated study showed poor care at VA hospitals, but the agency has made great strides in improving its services.
Dr. Laura A. Peterson and her colleagues at the Houston Veterans Affairs Hospital examined the records of men age 65 and older who were taken to hospitals after a heart attack. The study involved 2,486 veterans treated at 81 VA hospitals and 29,249 Medicare patients treated at 1,530 non-VA hospitals in seven states.
They reported in the Dec. 28 New England Journal of Medicine that, even though the men taken to VA hospitals were sicker, the same percentage in each group, 68%, was still alive one year after the heart attack. At one month after the heart attack, 82% of the patients in each group were still alive.
Angioplasty Sometimes Beats Medication
Angioplasty is more effective than clot-dissolving drugs at saving the lives of heart attack victims, but only when it is performed at hospitals that do a high volume of the procedure, according to a new study. The study complements a growing volume of literature which indicates that, for any given surgical procedure ranging from transplants to cancer surgery, hospitals that perform large numbers have better results than those which perform only a few.
Angioplasty involves threading a catheter into the blood vessel leading into the heart and expanding a balloon to compress a blood clot, thereby reopening the artery. Clot-dissolving drugs eat away the clot, also reopening the artery, but must be used within three hours of a heart attack.
Dr. David Magid and his colleagues at Kaiser Permanente in Denver examined the records of 62,299 heart attack patients. At hospitals which performed large numbers of angioplasties, they reported in the Dec. 27 Journal of the American Medical Assn., the death rate was only 3.4% in the angioplasty patients, compared to 5.4% in those receiving drugs. But at low-volume hospitals, the death rate for those receiving angioplasty was 6.2%, compared to 5.9% for those receiving drugs. High-volume hospitals were those that did at least 49 emergency angioplasties per year. Low-volume centers performed 16 or fewer.
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Medical writer Thomas H. Maugh II can be reached at thomas.maugh@latimes.com.
