Researchers Identify Determinants of COPD Exacerbation Frequency: Presented at ATS

TORONTO -- May 26, 2008 -- Chronic intermittent pulsed therapy with moxifloxacin provided significant reductions in the frequency of exacerbations in chronic obstructive pulmonary disease (COPD), according to findings presented here at the 104th International Conference of the American Thoracic Society (ATS).

The results were presented here on May 18 by lead author Sanjay Sethi, MD; Attending Physician; Department of Pulmonary, Critical Care, and Sleep Services; Veterans Affairs Western New York Healthcare System in Buffalo, New York.

Frequent exacerbations of COPD increase both morbidity and mortality. They may result in a faster decline of lung function and may lead to a significant reduction in quality of life. Reducing both the frequency and severity of these exacerbations is one of the main goals of maintenance therapy.

Long-acting bronchodilators and inhaled corticosteroids are commonly used but have only moderate efficacy.

In a poster presentation, Dr. Sethi said that as many as 40% to 50% of COPD exacerbations may be related to bacterial infections. Bacterial strains that are new to patients are thought to be the main cause of acute exacerbations. Current therapeutic approaches focus on treating the exacerbations as they happen.

An effective suppressive regimen might involve disrupting the cycle of chronic bacterial colonisation and chronic inflammation, which might lead to fewer exacerbations.

That rationale led to this randomised, double-blind, parallel-group, multicentre trial conducted at 76 centres in 15 countries. Treatment was administered for 5 days every 8 weeks for a total of 6 courses. Patients were randomised to moxifloxacin 400 mg once daily or placebo once daily.

Patients were evaluated for exacerbations and adverse events for up to 24 weeks post-treatment.

The primary efficacy endpoint was frequency of exacerbations from randomisation to the end of treatment at 48 weeks in the per-protocol (PP) end-of-therapy (EOT) population.

A total of 1,404 patients were assessed for eligibility; 573 patients were randomised to receive moxifloxacin and 584 to placebo. Four patients in each group did not receive treatment, thus the intention-to-treat (ITT) arms had 569 and 580 patients, respectively. The PP EOT populations consisted of 351 patients in the moxifloxacin group and 387 in the placebo arm.

Approximately 31% of PP EOT patients in both arms were colonised by a respiratory pathogen at baseline. Approximately 10% of both groups were colonised by Haemophilus influenzae at baseline.

In both the ITT and the PP EOT groups, the significant variables influencing the number of exacerbations (P <= .05) were the severity of the underlying COPD as measured by the percent of predicted forced expiratory volume, treatment versus placebo, number of exacerbations in the previous year (<2>=2), and baseline colonisation with H influenzae (no baseline colonisation vs colonisation).

Geographic regions also demonstrated significant differences. Each region was compared with the mean value for all the other regions. In the ITT population, the use of systemic corticosteroids was an additional risk factor for exacerbations.

The study results also confirmed that antibiotics such as the fluoroquinolone moxifloxacin may provide benefits to maintenance therapy by preventing exacerbations and the subsequent inflammatory response, the researchers noted.


Original article located at www.docguide.com

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Allsup Adds Financial Planning and Healthcare Information Services to Expand Solutions for Individuals with Disabilities

BELLEVILLE, Ill. - (Business Wire) More than 8.9 million individuals with disabilities and their families rely on Social Security Disability Insurance (SSDI) as a key source of income. That’s nearly 700,000 more than the population of New York City.

For these people, disability is a life-altering event that often has a significant impact on their financial situations. In response, Allsup is introducing a series of new financial and healthcare-related services for people with disabilities to complement the nationwide SSDI representation services it has been offering for nearly 25 years.

“Without ongoing, experienced support from the outset, the financial well-being of individuals with disabilities too often falls through the cracks,” said Paul Gada, Allsup’s personal financial planning director. “We designed our new services to deliver true help from the start. Allsup wants to help people not only efficiently navigate the SSDI process, but also establish sound financial plans and manage their healthcare costs and options.”

The first service to launch is Financial Matters, a free online information portal specifically designed to help individuals with disabilities better manage their personal finances. Allsup will introduce other services over the next several months, including customized Medicare analysis solutions to help individuals evaluate and choose the best Medicare options for their specific situation, and custom financial planning services.

Free Financial Matters Portal: Informative, Useful Planning Resources for Today and the Future

The new Financial Matters portal provides specific, easy-to-understand information on:

• Financial planning, including budgeting, cash flow and expense management considerations for individuals with disabilities.
• Managing healthcare costs, including detailed discussions of COBRA, Medicare, drug assistance programs and other sources for helping to reduce healthcare costs.
• Managing taxes, including information on the tax treatment of SSDI payments, tax credits for low-income individuals and tax-filing assistance resources.

Among the real-world issues addressed by Financial Matters are the dangers in using home equity loans, second mortgages and reverse mortgages as sources of income. This is particularly important for people with disabilities to understand because a significant number of all mortgage foreclosures are the result of injury, illness or high medical bills.

“In most states, a person’s home is protected if he is forced into bankruptcy, but if he took out a mortgage, that amount can be lost in the bankruptcy proceedings,” Gada explained, adding that the portal details other income alternatives individuals may want to evaluate.

Financial Matters also helps people navigate the complex world of Medicare options. An overall comparison of the various programs is available and a detailed discussion is provided about Medicare Advantage plans. These often are the more suitable option for those with disabilities because they tend to offer more coverage at a lower out-of-pocket cost.

Financial planning calculators, resource links, checklists and highlighted tip boxes all help present the information in a more user-friendly way. The site also includes a comprehensive section on the SSDI process. Allsup will regularly add more sections and content to the site to better support the financial planning needs of consumers with disabilities.

“Addressing the physical and emotional issues related to a disability are significant hurdles,” Gada continued. “Compounding this, most individuals find themselves in a bureaucratic world where they don’t speak the language and there are no clear guide posts. Often, they are passed from one organization to the next without getting answers. We are focused on stepping in and using our experience to help people with disabilities understand important financial and healthcare issues. We want to help them take control and reclaim their lives.”

Original posted located on www.earthtimes.org

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