Clinical Briefs by Louis Kuritzky, MD
Clinical Briefs
By Louis Kuritzky, MD, Clinical Assistant Professor, University of Florida, Gainesville. Dr. Kuritzky is a consultant for GlaxoSmithKline and is on the speaker's bureau of GlaxoSmithKline, 3M, Wyeth-Ayerst, Pfizer, Novartis, Bristol-Myers Squibb, AstraZeneca, Jones Pharma, and Boehringer Ingelheim.
Best Combination for Symptomatic Relief in COPD
Source: Rabe KF, et al. Comparison of a combination of tiotropium plus formoterol to salmeterol plus fluticasone in moderate COPD. Chest 2008;134:255-262.
There are no disease-modifying pharmacotherapies for COPD. That is, although bronchodilators, anticholinergic agents, and inhaled corticosteroids improve FEV1 and reduce symptoms, decline in pulmonary function continues unabated and lung function returns promptly to pretreatment status once medication is stopped.
Overall, in COPD anticholinergic therapy (e.g., ipratropium, tiotropium) provides greater improvements in pulmonary function than beta-adrenergic therapy or inhaled corticosteroids. Combination therapy (anticholinergic + beta agonist or beta agonist + inhaled steroid) is more effective than either monotherapy. Which combination therapy is to be preferred has not yet been established.
Patients with moderate COPD were randomized to receive 6 weeks of either tiotropium + formoterol or salmeterol + fluticasone. At the end of this time period, an assessment of lung function over a 12-hour period was performed. The endpoint was the area under the curve of pulmonary function for 12 hours at end of study.
The tiotropium + formoterol combination was statistically significantly superior to the salmeterol + fluticasone combination; for instance, the mean difference in FEV1 was 78 mL (P = 0.0006). Need for use of rescue medications was the same for both groups.
At least over the short term, the bronchodilator combination of tiotropium + formoterol provides superior improvements in bronchodilation compared to salmeterol + fluticasone.
Which Is Best for Weight Loss: Low Carb, Low Fat, or Mediterranean?
Source: Shai I, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 2008;359:229-241.
In overweight individuals, the single most critical marker of success is simply reduction of weight. On the other hand, proponents of diets that specifically target individual dietary components, such as carbohydrate or fat, point to putative benefits of specific restrictions. If weight loss is the ultimate arbiter of success, it remains unclear which dietary plan is the best. To date, the best evidence for endpoint reduction resides with the Mediterranean diet in secondary prevention of cardiovascular events: A greater than 70% relative risk reduction has been demonstrated (superior, to that obtained with statins in a similar setting).
A two-year trial randomized obese (BMI = 31 kg/m2) subjects to either a fat-restricted, carbohydrate-restricted, or Mediterranean diet. Patients received intensive instruction from dietitians. The low-fat and Mediterranean diets each provided 1500 kcal/d (women) or 1800 kcal/d (men). The low-carbohydrate diet did not have an absolute calorie limit; instead, subjects were restricted to a maximum intake of 120 g/d carbohydrate.
At two years, the low-carbohydrate and Mediterranean diets produced a 5.5 kg and 4.6 kg weight loss, respectively. The low-fat diet resulted on a 2.9 kg weight loss. The authors suggest that either of the two more successful diets might be appropriate; since the Mediterranean diet provided better glycemic control, and the low-carbohydrate diet resulted in better lipid effects, individual choice of diet could be informed by baseline risk factors.
Body Composition and Treatment of Hypogonadism
Source: Svartberg J, et al. Testosterone treatment in elderly men with subnormal testosterone levels improves body composition and BMD in the hip. Int J Impot Res 2008;20:378-387.
The Tromso study is an ongoing health survey of men who live in the municipality of Tromso, Norway. In 2001, men aged 60-80 years (n = 335) with hypogonadism (HGO) were identified and matched with eugonadal age-matched controls; in 2005, these hypogonadal men were enrolled in a 1-year testosterone treatment intervention.
At baseline, HGO subjects had a greater percentage of fat mass, including visceral, subcutaneous, and total fat mass, than their matched controls. Fasting glucose, 2-hour glucose levels, and triglycerides were also higher in the HGO group, reflecting a correspondingly higher level of insulin resistance.
The testosterone treatment intervention was carried out in 69 men of the HGO group. Treatment produced an increase in fat-free mass, a decrease in fat mass, and a decrease specifically in total abdominal adipose tissue. As in prior trials, testo-sterone replacement increased bone mineral density, predominantly in the hip. Metabolic defects seen in HGO were not corrected by testosterone replacement. Testosterone replacement has numerous favorable effects on body composition in hypogonadal men.
There are no disease-modifying pharmacotherapies for COPD. That is, although bronchodilators, anticholinergic agents, and inhaled corticosteroids improve FEV1 and reduce symptoms, decline in pulmonary function continues unabated and lung function returns promptly to pretreatment status once medication is stopped.Subscribe Now for Access
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