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Abstracts:
7.5.2001

Aktuelle Studien 07.05.01


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Chest 2001 Mar;119(3):745-52

The direct medical costs of alpha(1)-antitrypsin deficiency.

Mullins CD, Huang X, Merchant S, Stoller JK
University of Maryland School of Pharmacy, Baltimore, MD 21201, USA. dmullins@rx.umaryland.edu BACKGROUND: For individuals with emphysema because of severe alpha(1)-antitrypsin deficiency, specific therapy called IV augmentation therapy has been available since 1989. Such therapy consists of IV infusion of pooled human plasma alpha(1)-antiprotease. METHODS: To assess the direct medical costs of having alpha(1)-antitrypsin deficiency, the current study surveyed members of the Alpha One Foundation Registry for Individuals With alpha(1)-Antitrypsin Deficiency regarding their annual expenditures for treatment of this disease. Data regarding demographic features, alpha(1)-antitrypsin status, and health-resource utilization were collected from a self-administered questionnaire. Respondents were asked to provide total health-care expenditures, but costs by specific items of care (eg, drugs, physician visits, etc) were not available. RESULTS: Mean annual cost estimates were higher for PI*ZZ-phenotype individuals ($30,948, n = 292) than for non-PI*ZZ-phenotype individuals ($20,673, n = 53; p = 0.049). Among PI*ZZ-phenotype individuals, self-reported costs of health-care services were further analyzed for those 288 individuals whose alpha(1)-antiprotease use status was reported. For the 185 current alpha(1)-antiprotease users, the mean annual cost was $40,123 (median, $36,000). CONCLUSIONS: Annual health-care expenditures by individuals with alpha(1)-antitrypsin deficiency are very high, whether or not they are currently receiving augmentation therapy. Augmentation therapy adds substantial costs, especially for heavier individuals who are receiving weekly infusions. PMID: 11243952, UI: 21139945

Kosten der Alpha-1-Antitrypsin Erkrankung pro Patient in den USA.

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Chest 2001 Mar;119(3):852-61

Smoking, respiratory symptoms, and diseases : a comparative study between northern Sweden and northern Finland: report from the FinEsS study.

Lindstrom M, Kotaniemi J, Jonsson E, Lundback B
Department of Occupational Medicine, National Institute for Working Life, Stockholm, Sweden. STUDY OBJECTIVES: The influences of different smoking categories on the prevalence of respiratory symptoms, asthma, and chronic bronchitis have been examined in the most northern province of Sweden, Norrbotten, and in Lapland, Finland. The two areas have similar geographic and demographic conditions. METHODS AND STUDY POPULATION: The study is a part of the FinEsS studies, which are epidemiologic respiratory surveys in progress in Sweden, Finland, and Estonia. A random sample of 20- to 69-years-olds were invited to answer a postal questionnaire about respiratory symptoms, smoking habits, and occupation. In Norrbotten, 8,333 subjects were invited and 7,104 responded (85%). In Lapland, 8,005 were invited and 6,633 responded (83%). RESULTS: The participation by age and sex was similar in both countries. The prevalence of smokers in Lapland was 32% vs 26% in Norrbotten. Significantly more women than men in Norrbotten were smokers, while the opposite was true for Lapland. Sputum production was the most prevalent symptom in both areas, 25% in Lapland vs 19% in Norrbotten. The prevalence of chronic productive cough was 11% in Lapland and 7% in Norrbotten. Bronchitic symptoms were more prevalent in Lapland among both smokers and nonsmokers. A positive family history of chronic obstructive airway disease together with increased number of consumed cigarettes showed an additive effect for both chronic productive cough and wheezing. The odds ratio (OR) for wheezing during the last 12 months was 3.8 for subjects without a family history of obstructive airway disease who consumed > 14 cigarettes per day compared with nonsmokers, but if the subjects had a family history of obstructive airway disease, the risk for wheezing increased to OR 8.4. CONCLUSION: Bronchitic symptoms were more common in Finland. The difference remained also after correction for demographic variables including smoking habits, age and socioeconomic group, and family history of obstructive airway disease. Identical methods, sample composition, and the high participation rate contribute to the validity of the results. Air pollution, including environmental tobacco smoke, may contribute to the difference. To explain the difference, further analysis and investigations of social and environmental factors as well as genetic factors are needed. PMID: 11243968, UI: 21139961

Das Risiko f™r eine chronische Bronchitis, Husten und Auswurf ist sowohl bei Patienten mit positiver Familienanamnese, als auch bei Zigarettenkonsum deutlich erhðht.

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Chest 2001 Mar;119(3):737-44

Longitudinal follow-up of patients with alpha(1)-protease inhibitor deficiency before and during therapy with IV alpha(1)-protease inhibitor.

Wencker M, Fuhrmann B, Banik N, Konietzko N
Ruhrlandklinik, Department of Pneumology, University Hospital, Essen, Germany. mwencker@aol.com BACKGROUND: The efficacy of IV augmentation therapy with human alpha(1)-protease inhibitor (alpha(1)-Pi) in patients with severe alpha(1)-Pi deficiency is still under debate. STUDY OBJECTIVES: To evaluate the progression of emphysema in patients with alpha(1)-Pi deficiency before and during a period in which they received treatment with alpha(1)-Pi. DESIGN: Multicenter, retrospective cohort study. SETTING: Outpatient clinics of 26 university clinics and pulmonary hospitals. PATIENTS: Ninety-six patients with severe alpha(1)-Pi deficiency receiving weekly augmentation therapy with human alpha(1)-Pi, 60 mg/kg of body weight, had a minimum of two lung function measurements before and two lung function measurements after augmentation therapy was started. Lung function data were followed up for a minimum of 12 months both before and during treatment (mean, 47.5 months and 50.2 months, respectively). MEASUREMENTS AND RESULTS: Patients were grouped according to the severity of their lung function impairment. The change in FEV(1) was compared during nontreatment and treatment periods. In the whole group, the decline in FEV(1) was significantly lower during the treatment period (49.2 mL/yr vs 34.2 mL/yr, p = 0.019). In patients with FEV(1) > 65%, IV alpha(1)-Pi treatment reduced the decline in FEV(1) by 73.6 mL/yr (p = 0.045). Seven individuals had a rapid decline of FEV(1) before treatment, and the loss in FEV(1) could be reduced from 256 mL/yr to 53 mL/yr (p = 0.001). CONCLUSION: Some patients with severe alpha(1)-Pi deficiency and well-preserved lung function show a rapid decline in FEV(1). These patients profit from weekly IV therapy with human alpha(1)-Pi and have less rapid decline if treated. Early detection of patients at risk and early start of augmentation therapy may prevent accelerated loss of lung tissue. Publication Types: ˆ Multicenter study PMID: 11243951, UI: 21139944

Die Lungenfunktion von Patienten mit Alpha-1-Antitrypsin-Mangel verschlechtert sich jØhrlich unter Therapie mit A1-Proteinase-Inhibitor (Prolastin) signifikant weniger als ohne Substitutionstherapie.

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Chest 2001 Mar;119(3):726-30

Systemic glucocorticoids in severe exacerbations of COPD.

Sayiner A, Aytemur ZA, Cirit M, Unsal I
Department of Chest Diseases, Ege University Medical School, Izmir, Turkey. asayiner@med.ege.edu.tr OBJECTIVE: This study aimed to compare the efficacies of 3-day and 10-day courses of methylprednisolone (MP) treatment in severe COPD exacerbations necessitating hospitalization for respiratory failure. DESIGN: Prospective, randomized, single-blind study. SETTING: Tertiary-care center. PATIENTS AND METHODS: Thirty-six patients were included in the study and randomized into two groups: group 1 received MP, 0.5 mg/kg q6h for 3 days, and group 2 was administered the same dosage of MP for the first 3 days, after which it was tapered and terminated on the tenth day. There was no difference between the groups for age, baseline FEV(1), PaO(2), PaCO(2), and pH levels. One patient in group 1 who developed pneumothorax and one patient in group 2 who had steroid-related psychosis could not complete the study. RESULTS: Both groups showed significant improvements in PaO(2) and FEV(1) levels, but these were more marked in group 2 (p = 0.012 and p = 0.019, respectively). There was a significant increase in FVC levels in group 2 only (p = 0.003). Group 2 also had a more marked improvement in dyspnea on exertion. There was no difference between the two groups with regards to other parameters, including pH, PaCO(2) levels, and other symptom scores. Six patients in group 1 and five patients in group 2 developed new exacerbations within the following 6 months. Hyperglycemia occurred in two patients in each group. CONCLUSION: In severe COPD exacerbations, a 10-day course of steroid treatment is more effective than a 3-day course in improving the outcome, but has no benefit in reducing exacerbation rates. Publication Types: ˆ Clinical trial ˆ Randomized controlled trial PMID: 11243949, UI: 21139942

Systemische Glucocorticoide sind bei infektexacerbierter COPD ™ber 10 Tage lang gegeben effektiver als nur ™ber 3 Tage appliziert.
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