CHEST 2015

MONTREAL – A structured regimen of regular yoga exercises was as effective as a standard pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease for improving lung function, exercise tolerance, dyspnea severity, and quality of life in a single-center, randomized comparison of the two strategies with 60 patients.

In addition, chronic obstructive pulmonary disease (COPD) patients had a higher level of acceptance of yoga and were more comfortable doing it, compared with standard pulmonary rehabilitation, and it is a cost-effective approach given the minimal equipment required, Dr. Randeep Guleria said at the annual meeting of the American College of Chest Physicians.

“Patients with difficulty walking, osteoarthritis, knee problems, or unable to do exercises like cycling or treadmill found yoga to be much more acceptable,” said Dr. Guleria in an interview. Acceptance of yoga was also higher than standard rehabilitation among patients with more severe COPD, said Dr. Guleria, professor and head of the department of pulmonary medicine and sleep disorders at the All India Institute of Medical Sciences in New Delhi.

“I think that yoga could be a very valuable adjunct” to pulmonary rehabilitation in COPD patients, commented Dr. Roger S. Goldstein, director of the divisional program in respiratory rehabilitation at the University of Toronto. Dr. Goldstein speculated that even better than comparing yoga against conventional pulmonary rehabilitation would be a study that compared a combined yoga plus rehabilitation program against standard rehabilitation alone. Yoga is “a tremendous opportunity,” he said.

The 12-week study enrolled 60 patients who averaged 56 years old who had been diagnosed with COPD for an average of 8 years. Just under a third of the patients had moderate COPD, 42% had severe COPD, and 28% had very severe COPD.

Dr. Guleria and his associates randomized 30 patients into a yoga program that included 4 weeks of biweekly 1-hour sessions that instructed patients in a series of specially designed yoga exercises. That was followed by 8 weeks during which patients were mostly left to perform their learned exercises on their own, but with a supervised session once every 2 weeks. The other 30 patients participated in a standard pulmonary rehabilitation program for 12 weeks.

The researchers measured several parameters at baseline and after 12 weeks, including two measures of dyspnea severity, 6-minute walk distance, a quality of life assessment, and two serum markers of inflammation, C-reactive protein and interleukin 6.

Both interventions resulted in modest but statistically significant improvements, such as increases in 6-minute walk distance and a reduced modified Borg scale assessment. The Borg scale score fell from an average of 1.5 at baseline to 1.0 after 12 weeks in the yoga patients, and from an average 3.0 at baseline to 0.5 after 12 weeks in the rehabilitation patients.

A score that measured total quality of life improved by an average of 32% in the yoga patients and by an average of 21% in the rehabilitation patients, changes that approached statistical significance in both subgroups.

Comparing the assessment measures after 12 weeks in both arms of the study showed no statistically significant between-group differences, Dr. Guleria reported.

The researchers commissioned a specially designed yoga program from a professional yoga instructor who had been briefed about COPD. The yoga exercises included physical postures, breathing technique, and meditation and relaxation. The pulmonary rehabilitation program included patient education, upper and lower limb exercises, and breathing exercises.

Dr. Guleria said he believed the opportunity exists to further modify the yoga program to better optimize its potential to benefit COPD patients.

Dr. Guleria had no relevant disclosures. Dr. Goldstein had no relevant disclosures.

[email protected]

On Twitter@mitchelzoler

MONTREAL – A structured regimen of regular yoga exercises was as effective as a standard pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease for improving lung function, exercise tolerance, dyspnea severity, and quality of life in a single-center, randomized comparison of the two strategies with 60 patients.

In addition, chronic obstructive pulmonary disease (COPD) patients had a higher level of acceptance of yoga and were more comfortable doing it, compared with standard pulmonary rehabilitation, and it is a cost-effective approach given the minimal equipment required, Dr. Randeep Guleria said at the annual meeting of the American College of Chest Physicians.

“Patients with difficulty walking, osteoarthritis, knee problems, or unable to do exercises like cycling or treadmill found yoga to be much more acceptable,” said Dr. Guleria in an interview. Acceptance of yoga was also higher than standard rehabilitation among patients with more severe COPD, said Dr. Guleria, professor and head of the department of pulmonary medicine and sleep disorders at the All India Institute of Medical Sciences in New Delhi.

“I think that yoga could be a very valuable adjunct” to pulmonary rehabilitation in COPD patients, commented Dr. Roger S. Goldstein, director of the divisional program in respiratory rehabilitation at the University of Toronto. Dr. Goldstein speculated that even better than comparing yoga against conventional pulmonary rehabilitation would be a study that compared a combined yoga plus rehabilitation program against standard rehabilitation alone. Yoga is “a tremendous opportunity,” he said.

The 12-week study enrolled 60 patients who averaged 56 years old who had been diagnosed with COPD for an average of 8 years. Just under a third of the patients had moderate COPD, 42% had severe COPD, and 28% had very severe COPD.

Dr. Guleria and his associates randomized 30 patients into a yoga program that included 4 weeks of biweekly 1-hour sessions that instructed patients in a series of specially designed yoga exercises. That was followed by 8 weeks during which patients were mostly left to perform their learned exercises on their own, but with a supervised session once every 2 weeks. The other 30 patients participated in a standard pulmonary rehabilitation program for 12 weeks.

The researchers measured several parameters at baseline and after 12 weeks, including two measures of dyspnea severity, 6-minute walk distance, a quality of life assessment, and two serum markers of inflammation, C-reactive protein and interleukin 6.

Both interventions resulted in modest but statistically significant improvements, such as increases in 6-minute walk distance and a reduced modified Borg scale assessment. The Borg scale score fell from an average of 1.5 at baseline to 1.0 after 12 weeks in the yoga patients, and from an average 3.0 at baseline to 0.5 after 12 weeks in the rehabilitation patients.

A score that measured total quality of life improved by an average of 32% in the yoga patients and by an average of 21% in the rehabilitation patients, changes that approached statistical significance in both subgroups.

Comparing the assessment measures after 12 weeks in both arms of the study showed no statistically significant between-group differences, Dr. Guleria reported.

The researchers commissioned a specially designed yoga program from a professional yoga instructor who had been briefed about COPD. The yoga exercises included physical postures, breathing technique, and meditation and relaxation. The pulmonary rehabilitation program included patient education, upper and lower limb exercises, and breathing exercises.

Dr. Guleria said he believed the opportunity exists to further modify the yoga program to better optimize its potential to benefit COPD patients.

Dr. Guleria had no relevant disclosures. Dr. Goldstein had no relevant disclosures.

[email protected]

On Twitter@mitchelzoler

MONTREAL – A structured regimen of regular yoga exercises was as effective as a standard pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease for improving lung function, exercise tolerance, dyspnea severity, and quality of life in a single-center, randomized comparison of the two strategies with 60 patients.

In addition, chronic obstructive pulmonary disease (COPD) patients had a higher level of acceptance of yoga and were more comfortable doing it, compared with standard pulmonary rehabilitation, and it is a cost-effective approach given the minimal equipment required, Dr. Randeep Guleria said at the annual meeting of the American College of Chest Physicians.

“Patients with difficulty walking, osteoarthritis, knee problems, or unable to do exercises like cycling or treadmill found yoga to be much more acceptable,” said Dr. Guleria in an interview. Acceptance of yoga was also higher than standard rehabilitation among patients with more severe COPD, said Dr. Guleria, professor and head of the department of pulmonary medicine and sleep disorders at the All India Institute of Medical Sciences in New Delhi.

“I think that yoga could be a very valuable adjunct” to pulmonary rehabilitation in COPD patients, commented Dr. Roger S. Goldstein, director of the divisional program in respiratory rehabilitation at the University of Toronto. Dr. Goldstein speculated that even better than comparing yoga against conventional pulmonary rehabilitation would be a study that compared a combined yoga plus rehabilitation program against standard rehabilitation alone. Yoga is “a tremendous opportunity,” he said.

The 12-week study enrolled 60 patients who averaged 56 years old who had been diagnosed with COPD for an average of 8 years. Just under a third of the patients had moderate COPD, 42% had severe COPD, and 28% had very severe COPD.

Dr. Guleria and his associates randomized 30 patients into a yoga program that included 4 weeks of biweekly 1-hour sessions that instructed patients in a series of specially designed yoga exercises. That was followed by 8 weeks during which patients were mostly left to perform their learned exercises on their own, but with a supervised session once every 2 weeks. The other 30 patients participated in a standard pulmonary rehabilitation program for 12 weeks.

The researchers measured several parameters at baseline and after 12 weeks, including two measures of dyspnea severity, 6-minute walk distance, a quality of life assessment, and two serum markers of inflammation, C-reactive protein and interleukin 6.

Both interventions resulted in modest but statistically significant improvements, such as increases in 6-minute walk distance and a reduced modified Borg scale assessment. The Borg scale score fell from an average of 1.5 at baseline to 1.0 after 12 weeks in the yoga patients, and from an average 3.0 at baseline to 0.5 after 12 weeks in the rehabilitation patients.

A score that measured total quality of life improved by an average of 32% in the yoga patients and by an average of 21% in the rehabilitation patients, changes that approached statistical significance in both subgroups.

Comparing the assessment measures after 12 weeks in both arms of the study showed no statistically significant between-group differences, Dr. Guleria reported.

The researchers commissioned a specially designed yoga program from a professional yoga instructor who had been briefed about COPD. The yoga exercises included physical postures, breathing technique, and meditation and relaxation. The pulmonary rehabilitation program included patient education, upper and lower limb exercises, and breathing exercises.

Dr. Guleria said he believed the opportunity exists to further modify the yoga program to better optimize its potential to benefit COPD patients.

Dr. Guleria had no relevant disclosures. Dr. Goldstein had no relevant disclosures.

[email protected]

On Twitter@mitchelzoler

MONTREAL – Some of the sickest patients treated at U.S. hospitals receive high levels of radiation exposure, based on a review of more than 4,000 medical ICU patients treated recently at one U.S. quaternary-care center.

During 2013, 98 patients admitted to the medical ICU at the Cleveland Clinic – 2% of the 4,155 patients who passed through the medical ICU that year – had cumulative radiation exposure of at least 50 mSv while in the ICU, thereby exceeding the U.S. standard for maximum annual workplace exposure, Dr. Sudhir Krishnan said at the annual meeting of the American College of Chest Physicians. The finding raises questions of whether all these exposures are appropriate and whether they reflect overuse of certain imaging modalities.

Mitchel L. Zoler/Frontline Medical News

Dr. Krishnan and his associates ran a retrospective review of case records for the medical ICU–admitted patients at the Cleveland Clinic during 2013 (Chest. 2015 Oct 25. doi: 10.1378/chest.2278486). During their ICU stay, 3,490 patients (84%) received some amount of radiation exposure. Exposure averaged 7 mSv, with a median of 1.5 mSv. The radiation exposure came primarily from imaging and more specifically from CT examinations, which produced more than half of all radiation-exposure episodes. Other sources included x-rays, nuclear scans, and interventional procedures.

Based on typical radiation dosages received during each type of procedure, the researchers calculated an estimated total radiation dosage received by each patient during their ICU stay. Nearly two-thirds of patients had an exposure of less than 3 mSv, the average annual exposure a person receives from ambient radiation. A quarter of the patients had an exposure of 3-14 mSv, 11% had an exposure of 15-49 mSv, and 2% – 98 patients – had exposure during their ICU stay that ran to 50 mSv or greater, exceeding the U.S. workplace annual maximum . Thirteen patients had an exposure level during their ICU stay that reached 100 mSv or higher; the maximum exposure level was in a patient with cumulative exposure of 176 mSv, said Dr. Krishnan, a critical-care medicine specialist at the Cleveland Clinic.

He and his coworkers did a multivariate analysis to identify factors that linked with a higher likelihood of having high radiation exposure. Patients at greatest risk for high exposure levels were sicker patients with higher APACHE 3 scores, longer stays in the ICU, and the presence of cirrhosis, but those most at risk also tended to be younger. Rates of both ICU deaths and deaths during the entire hospitalization were significantly higher among those with radiation exposure that was 50 mSv or greater.

Dr. Krishnan cautioned that he has not run any analysis that assessed the appropriateness of the imaging that the ICU patients received, nor did he have any data documenting the clinical consequences to the patients who had higher radiation exposure. Despite that uncertainty, he suggested that efforts focus on avoiding unnecessary radiation exposure to patients.

[email protected]

On Twitter @mitchelzoler

MONTREAL – Some of the sickest patients treated at U.S. hospitals receive high levels of radiation exposure, based on a review of more than 4,000 medical ICU patients treated recently at one U.S. quaternary-care center.

During 2013, 98 patients admitted to the medical ICU at the Cleveland Clinic – 2% of the 4,155 patients who passed through the medical ICU that year – had cumulative radiation exposure of at least 50 mSv while in the ICU, thereby exceeding the U.S. standard for maximum annual workplace exposure, Dr. Sudhir Krishnan said at the annual meeting of the American College of Chest Physicians. The finding raises questions of whether all these exposures are appropriate and whether they reflect overuse of certain imaging modalities.

Mitchel L. Zoler/Frontline Medical News

Dr. Krishnan and his associates ran a retrospective review of case records for the medical ICU–admitted patients at the Cleveland Clinic during 2013 (Chest. 2015 Oct 25. doi: 10.1378/chest.2278486). During their ICU stay, 3,490 patients (84%) received some amount of radiation exposure. Exposure averaged 7 mSv, with a median of 1.5 mSv. The radiation exposure came primarily from imaging and more specifically from CT examinations, which produced more than half of all radiation-exposure episodes. Other sources included x-rays, nuclear scans, and interventional procedures.

Based on typical radiation dosages received during each type of procedure, the researchers calculated an estimated total radiation dosage received by each patient during their ICU stay. Nearly two-thirds of patients had an exposure of less than 3 mSv, the average annual exposure a person receives from ambient radiation. A quarter of the patients had an exposure of 3-14 mSv, 11% had an exposure of 15-49 mSv, and 2% – 98 patients – had exposure during their ICU stay that ran to 50 mSv or greater, exceeding the U.S. workplace annual maximum . Thirteen patients had an exposure level during their ICU stay that reached 100 mSv or higher; the maximum exposure level was in a patient with cumulative exposure of 176 mSv, said Dr. Krishnan, a critical-care medicine specialist at the Cleveland Clinic.

He and his coworkers did a multivariate analysis to identify factors that linked with a higher likelihood of having high radiation exposure. Patients at greatest risk for high exposure levels were sicker patients with higher APACHE 3 scores, longer stays in the ICU, and the presence of cirrhosis, but those most at risk also tended to be younger. Rates of both ICU deaths and deaths during the entire hospitalization were significantly higher among those with radiation exposure that was 50 mSv or greater.

Dr. Krishnan cautioned that he has not run any analysis that assessed the appropriateness of the imaging that the ICU patients received, nor did he have any data documenting the clinical consequences to the patients who had higher radiation exposure. Despite that uncertainty, he suggested that efforts focus on avoiding unnecessary radiation exposure to patients.

[email protected]

On Twitter @mitchelzoler

MONTREAL – Some of the sickest patients treated at U.S. hospitals receive high levels of radiation exposure, based on a review of more than 4,000 medical ICU patients treated recently at one U.S. quaternary-care center.

During 2013, 98 patients admitted to the medical ICU at the Cleveland Clinic – 2% of the 4,155 patients who passed through the medical ICU that year – had cumulative radiation exposure of at least 50 mSv while in the ICU, thereby exceeding the U.S. standard for maximum annual workplace exposure, Dr. Sudhir Krishnan said at the annual meeting of the American College of Chest Physicians. The finding raises questions of whether all these exposures are appropriate and whether they reflect overuse of certain imaging modalities.

Mitchel L. Zoler/Frontline Medical News

Dr. Krishnan and his associates ran a retrospective review of case records for the medical ICU–admitted patients at the Cleveland Clinic during 2013 (Chest. 2015 Oct 25. doi: 10.1378/chest.2278486). During their ICU stay, 3,490 patients (84%) received some amount of radiation exposure. Exposure averaged 7 mSv, with a median of 1.5 mSv. The radiation exposure came primarily from imaging and more specifically from CT examinations, which produced more than half of all radiation-exposure episodes. Other sources included x-rays, nuclear scans, and interventional procedures.

Based on typical radiation dosages received during each type of procedure, the researchers calculated an estimated total radiation dosage received by each patient during their ICU stay. Nearly two-thirds of patients had an exposure of less than 3 mSv, the average annual exposure a person receives from ambient radiation. A quarter of the patients had an exposure of 3-14 mSv, 11% had an exposure of 15-49 mSv, and 2% – 98 patients – had exposure during their ICU stay that ran to 50 mSv or greater, exceeding the U.S. workplace annual maximum . Thirteen patients had an exposure level during their ICU stay that reached 100 mSv or higher; the maximum exposure level was in a patient with cumulative exposure of 176 mSv, said Dr. Krishnan, a critical-care medicine specialist at the Cleveland Clinic.

He and his coworkers did a multivariate analysis to identify factors that linked with a higher likelihood of having high radiation exposure. Patients at greatest risk for high exposure levels were sicker patients with higher APACHE 3 scores, longer stays in the ICU, and the presence of cirrhosis, but those most at risk also tended to be younger. Rates of both ICU deaths and deaths during the entire hospitalization were significantly higher among those with radiation exposure that was 50 mSv or greater.

Dr. Krishnan cautioned that he has not run any analysis that assessed the appropriateness of the imaging that the ICU patients received, nor did he have any data documenting the clinical consequences to the patients who had higher radiation exposure. Despite that uncertainty, he suggested that efforts focus on avoiding unnecessary radiation exposure to patients.

[email protected]

On Twitter @mitchelzoler

MONTREAL – A relatively new system for delivering noninvasive respiratory support, high-flow nasal cannula therapy, appeared well suited to ventilation therapy for coronary care unit patients, according to a single-center experience in New Zealand with 497 adult patients.

“The high-flow nasal cannula largely replaced noninvasive ventilation in our CCU patients with no change in escalation rates or mortality. The high-flow nasal cannula should be considered a first-line treatment in this setting,” said Dr. Troy S. Browne at the annual meeting of the American College of Chest Physicians.

He and his associates at Tauranga (New Zealand) Hospital compared their experience using standard noninvasive ventilation on 249 CCU patients who needed respiratory support during May-November 2012 with 248 patients who received ventilation with a high-flow nasal cannula once it became the default strategy in the coronary care unit. The high-flow nasal cannula produced similar outcomes while being “better tolerated and less of a burden for the nursing staff to manage,” said Dr. Browne, an anesthesiologist and critical care medicine specialist at Tauranga Hospital. A key feature of the high-flow nasal cannula system is the warmed and humidified mix of oxygen and air that it pumps.

“If you run a nasal cannula without this, you dry out the patient’s nose at 5 or 6 L/min, and it’s very uncomfortable. But I’ve worn a high-flow nasal cannula with 30 L/min flow and I couldn’t tell I was wearing it,” commented Dr. Thomas Fuhrman, chief of anesthesiology at the Bay Pines (Fla.) VA Healthcare System. “It’s high enough flow to open the lungs but much better tolerated” than standard noninvasive ventilation, Dr. Fuhrman said in an interview. Patients can open their mouths, swallow, and eat while wearing the high-flow nasal cannula, he noted.

“This report is a step forward and will help spur adoption” of the high-flow nasal cannula, Dr. Fuhrman predicted. Many cardiologists are not yet aware of it as it’s usually placed by intensivists. Over time, additional indications for the device will develop, he added.

The specific system used in Tauranga Hospital”s coronary care unit is the Optiflow high-flow nasal cannula along with the Airvo pumping system, both marketed by Fisher & Paykel Healthcare. During the 6 months preceding November 2012, 107 of 249 (43%) CCU patients underwent noninvasive ventilation during the first 40 hours following CCU admission. During the subsequent period ventilation started on 67 of 248 (27%) during the first 40 hours. Of those, 60 (90%) received sufficient treatment with a high-flow nasal cannula, while 7 (10%) required standard noninvasive ventilation. Patient outcomes during the two periods were similar.

A more definitive comparison of noninvasive ventilation and high-flow nasal cannula treatment requires a prospective, randomized study, Dr. Browne said.

[email protected]

On Twitter @mitchelzoler

MONTREAL – A relatively new system for delivering noninvasive respiratory support, high-flow nasal cannula therapy, appeared well suited to ventilation therapy for coronary care unit patients, according to a single-center experience in New Zealand with 497 adult patients.

“The high-flow nasal cannula largely replaced noninvasive ventilation in our CCU patients with no change in escalation rates or mortality. The high-flow nasal cannula should be considered a first-line treatment in this setting,” said Dr. Troy S. Browne at the annual meeting of the American College of Chest Physicians.

He and his associates at Tauranga (New Zealand) Hospital compared their experience using standard noninvasive ventilation on 249 CCU patients who needed respiratory support during May-November 2012 with 248 patients who received ventilation with a high-flow nasal cannula once it became the default strategy in the coronary care unit. The high-flow nasal cannula produced similar outcomes while being “better tolerated and less of a burden for the nursing staff to manage,” said Dr. Browne, an anesthesiologist and critical care medicine specialist at Tauranga Hospital. A key feature of the high-flow nasal cannula system is the warmed and humidified mix of oxygen and air that it pumps.

“If you run a nasal cannula without this, you dry out the patient’s nose at 5 or 6 L/min, and it’s very uncomfortable. But I’ve worn a high-flow nasal cannula with 30 L/min flow and I couldn’t tell I was wearing it,” commented Dr. Thomas Fuhrman, chief of anesthesiology at the Bay Pines (Fla.) VA Healthcare System. “It’s high enough flow to open the lungs but much better tolerated” than standard noninvasive ventilation, Dr. Fuhrman said in an interview. Patients can open their mouths, swallow, and eat while wearing the high-flow nasal cannula, he noted.

“This report is a step forward and will help spur adoption” of the high-flow nasal cannula, Dr. Fuhrman predicted. Many cardiologists are not yet aware of it as it’s usually placed by intensivists. Over time, additional indications for the device will develop, he added.

The specific system used in Tauranga Hospital”s coronary care unit is the Optiflow high-flow nasal cannula along with the Airvo pumping system, both marketed by Fisher & Paykel Healthcare. During the 6 months preceding November 2012, 107 of 249 (43%) CCU patients underwent noninvasive ventilation during the first 40 hours following CCU admission. During the subsequent period ventilation started on 67 of 248 (27%) during the first 40 hours. Of those, 60 (90%) received sufficient treatment with a high-flow nasal cannula, while 7 (10%) required standard noninvasive ventilation. Patient outcomes during the two periods were similar.

A more definitive comparison of noninvasive ventilation and high-flow nasal cannula treatment requires a prospective, randomized study, Dr. Browne said.

[email protected]

On Twitter @mitchelzoler

MONTREAL – A relatively new system for delivering noninvasive respiratory support, high-flow nasal cannula therapy, appeared well suited to ventilation therapy for coronary care unit patients, according to a single-center experience in New Zealand with 497 adult patients.

“The high-flow nasal cannula largely replaced noninvasive ventilation in our CCU patients with no change in escalation rates or mortality. The high-flow nasal cannula should be considered a first-line treatment in this setting,” said Dr. Troy S. Browne at the annual meeting of the American College of Chest Physicians.

He and his associates at Tauranga (New Zealand) Hospital compared their experience using standard noninvasive ventilation on 249 CCU patients who needed respiratory support during May-November 2012 with 248 patients who received ventilation with a high-flow nasal cannula once it became the default strategy in the coronary care unit. The high-flow nasal cannula produced similar outcomes while being “better tolerated and less of a burden for the nursing staff to manage,” said Dr. Browne, an anesthesiologist and critical care medicine specialist at Tauranga Hospital. A key feature of the high-flow nasal cannula system is the warmed and humidified mix of oxygen and air that it pumps.

“If you run a nasal cannula without this, you dry out the patient’s nose at 5 or 6 L/min, and it’s very uncomfortable. But I’ve worn a high-flow nasal cannula with 30 L/min flow and I couldn’t tell I was wearing it,” commented Dr. Thomas Fuhrman, chief of anesthesiology at the Bay Pines (Fla.) VA Healthcare System. “It’s high enough flow to open the lungs but much better tolerated” than standard noninvasive ventilation, Dr. Fuhrman said in an interview. Patients can open their mouths, swallow, and eat while wearing the high-flow nasal cannula, he noted.

“This report is a step forward and will help spur adoption” of the high-flow nasal cannula, Dr. Fuhrman predicted. Many cardiologists are not yet aware of it as it’s usually placed by intensivists. Over time, additional indications for the device will develop, he added.

The specific system used in Tauranga Hospital”s coronary care unit is the Optiflow high-flow nasal cannula along with the Airvo pumping system, both marketed by Fisher & Paykel Healthcare. During the 6 months preceding November 2012, 107 of 249 (43%) CCU patients underwent noninvasive ventilation during the first 40 hours following CCU admission. During the subsequent period ventilation started on 67 of 248 (27%) during the first 40 hours. Of those, 60 (90%) received sufficient treatment with a high-flow nasal cannula, while 7 (10%) required standard noninvasive ventilation. Patient outcomes during the two periods were similar.

A more definitive comparison of noninvasive ventilation and high-flow nasal cannula treatment requires a prospective, randomized study, Dr. Browne said.

[email protected]

On Twitter @mitchelzoler

MONTREAL – The immunosuppressant mycophenolate mofetil worked as effectively as cyclophosphamide for treating scleroderma-related interstitial lung disease while being better tolerated and causing fewer adverse effects in a multicenter, head-to-head comparison with 142 randomized patients.

“The findings support the increasingly common clinical practice of prescribing MMF [mycophenolate mofetil] for this disease,” said Dr. Donald P. Tashkin at the annual meeting of the American College of Chest Physicians.

Mitchel L. Zoler/Frontline Medical News

Another limitation of cyclophosphamide is that it is usually not used for more than 1 year because of concerns that longer use substantially increases a patient’s risk for developing malignancy. That’s another reason why there is a “strong need for longer and safer immunosuppressive treatment with a drug like MMF,” said Dr. Tashkin, a pulmonologist at the University of California, Los Angeles.

When used in this trial on patients with scleroderma, as defined by the American College of Rheumatology and with a baseline forced vital capacity of no more than 80% of predicted, “MMF was effective at reducing the rate of decline in vital capacity, improving symptoms such as dyspnea – the cardinal symptom of interstitial lung disease, and reducing lung fibrosis seen on CT scans, and MMF was better tolerated” than cyclophosphamide, Dr. Tashkin said in an interview. Cyclophosphamide treatment in this new trial “was associated with more toxicity, especially hematologic toxicity, an was not nearly as well tolerated, with more patients withdrawing because of side effects or a perceived lack of benefit.”

“Cyclophosphamide has a lot of side effects. MMF is just now coming into increased use. I think we’ll see it being used more for first-line treatment because the side effects with cyclophosphamide are so bad,” commented Dr. Thomas Fuhrman, chief of anesthesiology at the Bay Pines (Fla.) VA Healthcare System.

Dr. Tashkin and his associates conceived the Scleroderma Lung Study II (SLSII) as a follow-up to the first SLS run about a decade ago that compared cyclosphosphamide against placebo for controlling progression of interstitial lung disease in scleroderma patients. The results from the first SLS trial established cyclosphosphamide as a treatment that could preserve forced vital capacity percent predicted in patients with scleroderma-induced interstitial lung disease (N Engl J Med. 2006 Jun 22;354[25]:2655-666).

For the new study they enrolled patients who averaged 52 years old, with an average scleroderma duration of almost 3 years. Their average percent predicted forced vital capacity was 67%, and their baseline dyspnea index was 7.1.

Patients received either a target oral MMF dosage of 1.5 g b.i.d. for 2 years, or a target cyclophosphamide dosage of 2 mg/kg/day for up to 1 year, followed by a year of placebo. Cyclophosphamide treatment was capped at 1 year to protect against causing malignancy. Among the 73 patients randomized to the cyclophosphamide arm, 58 had data available after 12 months with 48 patients continuing on cyclophosphamide, and 53 had data available out to 2 years, with 37 patients remaining on their assigned regimen. Among 69 patients randomized to MMF 58 had data available after 12 months with 53 continuing on MMF, and 53 patients had data available through 24 months with 49 remaining on their MMF regimen.

After 24 months, the average percent predicted forced vital capacity, the study’s primary endpoint, had increased by 3.3% among patients on MMF and 3.0% among those in the cyclophosphamide arm in an intention-to-treat analysis, a nonsignificant difference. After 24 months 72% of patients in the MMF arm and 65% in the cyclophosphamide arm had a positive change, compared with baseline, in their percent predicted forced vital capacity, Dr. Tashkin reported.

MMF also showed a superior overall safety profile. Patients on cyclophosphamide had a significantly increased rate of withdrawal from the study medication. Drug discontinuations occurred in 36 of the cyclophosphamide patients and in 20 of those on MMF. Serious adverse events attributable to study medication occurred in eight patients on cyclophosphamide and three patients on MMF. The most frequent protocol-defined adverse event was leukopenia, which occurred in 30 patients on cyclophosphamide and four patients on MMF.

[email protected]

On Twitter @mitchelzoler

MONTREAL – The immunosuppressant mycophenolate mofetil worked as effectively as cyclophosphamide for treating scleroderma-related interstitial lung disease while being better tolerated and causing fewer adverse effects in a multicenter, head-to-head comparison with 142 randomized patients.

“The findings support the increasingly common clinical practice of prescribing MMF [mycophenolate mofetil] for this disease,” said Dr. Donald P. Tashkin at the annual meeting of the American College of Chest Physicians.

Mitchel L. Zoler/Frontline Medical News

Another limitation of cyclophosphamide is that it is usually not used for more than 1 year because of concerns that longer use substantially increases a patient’s risk for developing malignancy. That’s another reason why there is a “strong need for longer and safer immunosuppressive treatment with a drug like MMF,” said Dr. Tashkin, a pulmonologist at the University of California, Los Angeles.

When used in this trial on patients with scleroderma, as defined by the American College of Rheumatology and with a baseline forced vital capacity of no more than 80% of predicted, “MMF was effective at reducing the rate of decline in vital capacity, improving symptoms such as dyspnea – the cardinal symptom of interstitial lung disease, and reducing lung fibrosis seen on CT scans, and MMF was better tolerated” than cyclophosphamide, Dr. Tashkin said in an interview. Cyclophosphamide treatment in this new trial “was associated with more toxicity, especially hematologic toxicity, an was not nearly as well tolerated, with more patients withdrawing because of side effects or a perceived lack of benefit.”

“Cyclophosphamide has a lot of side effects. MMF is just now coming into increased use. I think we’ll see it being used more for first-line treatment because the side effects with cyclophosphamide are so bad,” commented Dr. Thomas Fuhrman, chief of anesthesiology at the Bay Pines (Fla.) VA Healthcare System.

Dr. Tashkin and his associates conceived the Scleroderma Lung Study II (SLSII) as a follow-up to the first SLS run about a decade ago that compared cyclosphosphamide against placebo for controlling progression of interstitial lung disease in scleroderma patients. The results from the first SLS trial established cyclosphosphamide as a treatment that could preserve forced vital capacity percent predicted in patients with scleroderma-induced interstitial lung disease (N Engl J Med. 2006 Jun 22;354[25]:2655-666).

For the new study they enrolled patients who averaged 52 years old, with an average scleroderma duration of almost 3 years. Their average percent predicted forced vital capacity was 67%, and their baseline dyspnea index was 7.1.

Patients received either a target oral MMF dosage of 1.5 g b.i.d. for 2 years, or a target cyclophosphamide dosage of 2 mg/kg/day for up to 1 year, followed by a year of placebo. Cyclophosphamide treatment was capped at 1 year to protect against causing malignancy. Among the 73 patients randomized to the cyclophosphamide arm, 58 had data available after 12 months with 48 patients continuing on cyclophosphamide, and 53 had data available out to 2 years, with 37 patients remaining on their assigned regimen. Among 69 patients randomized to MMF 58 had data available after 12 months with 53 continuing on MMF, and 53 patients had data available through 24 months with 49 remaining on their MMF regimen.

After 24 months, the average percent predicted forced vital capacity, the study’s primary endpoint, had increased by 3.3% among patients on MMF and 3.0% among those in the cyclophosphamide arm in an intention-to-treat analysis, a nonsignificant difference. After 24 months 72% of patients in the MMF arm and 65% in the cyclophosphamide arm had a positive change, compared with baseline, in their percent predicted forced vital capacity, Dr. Tashkin reported.

MMF also showed a superior overall safety profile. Patients on cyclophosphamide had a significantly increased rate of withdrawal from the study medication. Drug discontinuations occurred in 36 of the cyclophosphamide patients and in 20 of those on MMF. Serious adverse events attributable to study medication occurred in eight patients on cyclophosphamide and three patients on MMF. The most frequent protocol-defined adverse event was leukopenia, which occurred in 30 patients on cyclophosphamide and four patients on MMF.

[email protected]

On Twitter @mitchelzoler

MONTREAL – The immunosuppressant mycophenolate mofetil worked as effectively as cyclophosphamide for treating scleroderma-related interstitial lung disease while being better tolerated and causing fewer adverse effects in a multicenter, head-to-head comparison with 142 randomized patients.

“The findings support the increasingly common clinical practice of prescribing MMF [mycophenolate mofetil] for this disease,” said Dr. Donald P. Tashkin at the annual meeting of the American College of Chest Physicians.

Mitchel L. Zoler/Frontline Medical News

Another limitation of cyclophosphamide is that it is usually not used for more than 1 year because of concerns that longer use substantially increases a patient’s risk for developing malignancy. That’s another reason why there is a “strong need for longer and safer immunosuppressive treatment with a drug like MMF,” said Dr. Tashkin, a pulmonologist at the University of California, Los Angeles.

When used in this trial on patients with scleroderma, as defined by the American College of Rheumatology and with a baseline forced vital capacity of no more than 80% of predicted, “MMF was effective at reducing the rate of decline in vital capacity, improving symptoms such as dyspnea – the cardinal symptom of interstitial lung disease, and reducing lung fibrosis seen on CT scans, and MMF was better tolerated” than cyclophosphamide, Dr. Tashkin said in an interview. Cyclophosphamide treatment in this new trial “was associated with more toxicity, especially hematologic toxicity, an was not nearly as well tolerated, with more patients withdrawing because of side effects or a perceived lack of benefit.”

“Cyclophosphamide has a lot of side effects. MMF is just now coming into increased use. I think we’ll see it being used more for first-line treatment because the side effects with cyclophosphamide are so bad,” commented Dr. Thomas Fuhrman, chief of anesthesiology at the Bay Pines (Fla.) VA Healthcare System.

Dr. Tashkin and his associates conceived the Scleroderma Lung Study II (SLSII) as a follow-up to the first SLS run about a decade ago that compared cyclosphosphamide against placebo for controlling progression of interstitial lung disease in scleroderma patients. The results from the first SLS trial established cyclosphosphamide as a treatment that could preserve forced vital capacity percent predicted in patients with scleroderma-induced interstitial lung disease (N Engl J Med. 2006 Jun 22;354[25]:2655-666).

For the new study they enrolled patients who averaged 52 years old, with an average scleroderma duration of almost 3 years. Their average percent predicted forced vital capacity was 67%, and their baseline dyspnea index was 7.1.

Patients received either a target oral MMF dosage of 1.5 g b.i.d. for 2 years, or a target cyclophosphamide dosage of 2 mg/kg/day for up to 1 year, followed by a year of placebo. Cyclophosphamide treatment was capped at 1 year to protect against causing malignancy. Among the 73 patients randomized to the cyclophosphamide arm, 58 had data available after 12 months with 48 patients continuing on cyclophosphamide, and 53 had data available out to 2 years, with 37 patients remaining on their assigned regimen. Among 69 patients randomized to MMF 58 had data available after 12 months with 53 continuing on MMF, and 53 patients had data available through 24 months with 49 remaining on their MMF regimen.

After 24 months, the average percent predicted forced vital capacity, the study’s primary endpoint, had increased by 3.3% among patients on MMF and 3.0% among those in the cyclophosphamide arm in an intention-to-treat analysis, a nonsignificant difference. After 24 months 72% of patients in the MMF arm and 65% in the cyclophosphamide arm had a positive change, compared with baseline, in their percent predicted forced vital capacity, Dr. Tashkin reported.

MMF also showed a superior overall safety profile. Patients on cyclophosphamide had a significantly increased rate of withdrawal from the study medication. Drug discontinuations occurred in 36 of the cyclophosphamide patients and in 20 of those on MMF. Serious adverse events attributable to study medication occurred in eight patients on cyclophosphamide and three patients on MMF. The most frequent protocol-defined adverse event was leukopenia, which occurred in 30 patients on cyclophosphamide and four patients on MMF.

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On Twitter @mitchelzoler

MONTREAL – Daily treatment with the antihypertensive drug losartan for a year appeared to slow progression of emphysema, compared with placebo, in a controlled pilot study involving 46 patients at one U.S. center, Dr. Allison Lambert reported at the annual meeting of the American College of Chest Physicians.

One year of daily, 100-mg oral treatment with the angiotensin receptor–blocking drug losartan in patients with emphysema produced a statistically significant regression of the disease in their right-middle lung lobes, compared with progression of right-middle lung lobe disease among control patients, as assessed by CT lung scans. In this lung segment, emphysema regressed by 0.72% in patients on losartan (Cozaar), compared with an average 3.34% rate of progression in patients on placebo.

Mitchel L. Zoler/Frontline Medical News

The losartan-treated patients also showed a consistent pattern of either substantially slowed or reversed emphysema throughout multiple lung segments, although the between-group differences did not reach statistical significance in any other segment, said Dr. Lambert, a pulmonologist at Johns Hopkins Hospital in Baltimore.

Throughout the entire lung, 12 months of losartan treatment was linked to an average 0.32% reduction in emphysema extent from baseline when measured by CT, compared with a 2.18% rate of emphysema progression in control patients on usual care, which just missed statistical significance (P = .064).

Data from other researchers “suggest the right-middle lobe most commonly progresses in emphysema,” which may explain why that lung segment showed the most dramatic effect from treatment, she suggested. Another finding Dr. Lambert found striking was the consistent trend toward slowed emphysema progression in multiple segments throughout patients’ lungs.

Dr. Lambert called this a phase II, “proof of concept” trial. She and her associates have begun a larger, phase III version that will study the effect of 100-mg daily losartan during 1 year of treatment in 220 patients with emphysema, she said. This trial received funding from the Pulmonary Trials Cooperative of the National Heart Lung and Blood Institute.

“These are some of the most interesting and exciting data I’ve seen,” commented Dr. David P.L. Sachs, a pulmonologist who practices in Stanford, Calif., and cochaired the session in which Dr. Lambert gave her report. “Having an agent that could slow progression of emphysema would be unique,” he said in an interview. One aspect that makes this treatment especially attractive is losartan’s extensive safety record as an antihypertensive drug that is also often used to treat patients with heart failure, Dr. Sachs noted.

To put the 100-mg/day dosage used in the current study in perspective, results from a multicenter randomized trial of more than 3,800 heart failure patients published in 2009 showed that a losartan dosage of 150 mg once daily was safe and effective and produced outcomes superior to those seen with a 50 mg once-daily dosage (Lancet. 2009;374[9704]:1840-8).

Dr. Lambert and her associates designed this pilot study because of previously reported results from other groups showing favorable effects of losartan on animal models of emphysema or other lung disease, as well as suggestions from nonprospective clinical studies of benefits from angiotensin-receptor blockers on lung function and on chronic obstructive pulmonary disease (COPD) in particular.

The current study enrolled patients with mild to severe COPD who were current or former cigarette smokers who had at least a 10 pack-year history and were on stable treatment for their COPD. The researchers excluded patients already taking an angiotensin-receptor blocker or angiotensin-converting enzyme inhibitor.

The study included a total of 106 patients with COPD, including the 46 with emphysema at baseline. Their average age was about 58 years old, the enrolled patients included roughly equal numbers of men and women, and about two-thirds were current smokers. All patients underwent CT lung scans at baseline and after 6 and 12 months, as well as other lung function assessments. The study’s primary endpoint was the amount of additional emphysema in their lungs beyond that seen at baseline using CT imaging.

The entire group of 106 COPD patients showed no significant differences in emphysema progression at either 6 or 12 months between the 54 patients treated with losartan and the 52 controls on placebo, but a second, prespecified analysis that focused only on the 46 enrolled patients who had visible emphysema at baseline showed a significant slowing of progression at the 1-year follow-up, Dr. Lambert said.

The study received partial funding from Merck, which markets losartan (Cozaar). Dr. Lambert had no disclosures. Dr. Sachs had no disclosures.

[email protected]

On Twitter @mitchelzoler

MONTREAL – Daily treatment with the antihypertensive drug losartan for a year appeared to slow progression of emphysema, compared with placebo, in a controlled pilot study involving 46 patients at one U.S. center, Dr. Allison Lambert reported at the annual meeting of the American College of Chest Physicians.

One year of daily, 100-mg oral treatment with the angiotensin receptor–blocking drug losartan in patients with emphysema produced a statistically significant regression of the disease in their right-middle lung lobes, compared with progression of right-middle lung lobe disease among control patients, as assessed by CT lung scans. In this lung segment, emphysema regressed by 0.72% in patients on losartan (Cozaar), compared with an average 3.34% rate of progression in patients on placebo.

Mitchel L. Zoler/Frontline Medical News

The losartan-treated patients also showed a consistent pattern of either substantially slowed or reversed emphysema throughout multiple lung segments, although the between-group differences did not reach statistical significance in any other segment, said Dr. Lambert, a pulmonologist at Johns Hopkins Hospital in Baltimore.

Throughout the entire lung, 12 months of losartan treatment was linked to an average 0.32% reduction in emphysema extent from baseline when measured by CT, compared with a 2.18% rate of emphysema progression in control patients on usual care, which just missed statistical significance (P = .064).

Data from other researchers “suggest the right-middle lobe most commonly progresses in emphysema,” which may explain why that lung segment showed the most dramatic effect from treatment, she suggested. Another finding Dr. Lambert found striking was the consistent trend toward slowed emphysema progression in multiple segments throughout patients’ lungs.

Dr. Lambert called this a phase II, “proof of concept” trial. She and her associates have begun a larger, phase III version that will study the effect of 100-mg daily losartan during 1 year of treatment in 220 patients with emphysema, she said. This trial received funding from the Pulmonary Trials Cooperative of the National Heart Lung and Blood Institute.

“These are some of the most interesting and exciting data I’ve seen,” commented Dr. David P.L. Sachs, a pulmonologist who practices in Stanford, Calif., and cochaired the session in which Dr. Lambert gave her report. “Having an agent that could slow progression of emphysema would be unique,” he said in an interview. One aspect that makes this treatment especially attractive is losartan’s extensive safety record as an antihypertensive drug that is also often used to treat patients with heart failure, Dr. Sachs noted.

To put the 100-mg/day dosage used in the current study in perspective, results from a multicenter randomized trial of more than 3,800 heart failure patients published in 2009 showed that a losartan dosage of 150 mg once daily was safe and effective and produced outcomes superior to those seen with a 50 mg once-daily dosage (Lancet. 2009;374[9704]:1840-8).

Dr. Lambert and her associates designed this pilot study because of previously reported results from other groups showing favorable effects of losartan on animal models of emphysema or other lung disease, as well as suggestions from nonprospective clinical studies of benefits from angiotensin-receptor blockers on lung function and on chronic obstructive pulmonary disease (COPD) in particular.

The current study enrolled patients with mild to severe COPD who were current or former cigarette smokers who had at least a 10 pack-year history and were on stable treatment for their COPD. The researchers excluded patients already taking an angiotensin-receptor blocker or angiotensin-converting enzyme inhibitor.

The study included a total of 106 patients with COPD, including the 46 with emphysema at baseline. Their average age was about 58 years old, the enrolled patients included roughly equal numbers of men and women, and about two-thirds were current smokers. All patients underwent CT lung scans at baseline and after 6 and 12 months, as well as other lung function assessments. The study’s primary endpoint was the amount of additional emphysema in their lungs beyond that seen at baseline using CT imaging.

The entire group of 106 COPD patients showed no significant differences in emphysema progression at either 6 or 12 months between the 54 patients treated with losartan and the 52 controls on placebo, but a second, prespecified analysis that focused only on the 46 enrolled patients who had visible emphysema at baseline showed a significant slowing of progression at the 1-year follow-up, Dr. Lambert said.

The study received partial funding from Merck, which markets losartan (Cozaar). Dr. Lambert had no disclosures. Dr. Sachs had no disclosures.

[email protected]

On Twitter @mitchelzoler

MONTREAL – Daily treatment with the antihypertensive drug losartan for a year appeared to slow progression of emphysema, compared with placebo, in a controlled pilot study involving 46 patients at one U.S. center, Dr. Allison Lambert reported at the annual meeting of the American College of Chest Physicians.

One year of daily, 100-mg oral treatment with the angiotensin receptor–blocking drug losartan in patients with emphysema produced a statistically significant regression of the disease in their right-middle lung lobes, compared with progression of right-middle lung lobe disease among control patients, as assessed by CT lung scans. In this lung segment, emphysema regressed by 0.72% in patients on losartan (Cozaar), compared with an average 3.34% rate of progression in patients on placebo.

Mitchel L. Zoler/Frontline Medical News

The losartan-treated patients also showed a consistent pattern of either substantially slowed or reversed emphysema throughout multiple lung segments, although the between-group differences did not reach statistical significance in any other segment, said Dr. Lambert, a pulmonologist at Johns Hopkins Hospital in Baltimore.

Throughout the entire lung, 12 months of losartan treatment was linked to an average 0.32% reduction in emphysema extent from baseline when measured by CT, compared with a 2.18% rate of emphysema progression in control patients on usual care, which just missed statistical significance (P = .064).

Data from other researchers “suggest the right-middle lobe most commonly progresses in emphysema,” which may explain why that lung segment showed the most dramatic effect from treatment, she suggested. Another finding Dr. Lambert found striking was the consistent trend toward slowed emphysema progression in multiple segments throughout patients’ lungs.

Dr. Lambert called this a phase II, “proof of concept” trial. She and her associates have begun a larger, phase III version that will study the effect of 100-mg daily losartan during 1 year of treatment in 220 patients with emphysema, she said. This trial received funding from the Pulmonary Trials Cooperative of the National Heart Lung and Blood Institute.

“These are some of the most interesting and exciting data I’ve seen,” commented Dr. David P.L. Sachs, a pulmonologist who practices in Stanford, Calif., and cochaired the session in which Dr. Lambert gave her report. “Having an agent that could slow progression of emphysema would be unique,” he said in an interview. One aspect that makes this treatment especially attractive is losartan’s extensive safety record as an antihypertensive drug that is also often used to treat patients with heart failure, Dr. Sachs noted.

To put the 100-mg/day dosage used in the current study in perspective, results from a multicenter randomized trial of more than 3,800 heart failure patients published in 2009 showed that a losartan dosage of 150 mg once daily was safe and effective and produced outcomes superior to those seen with a 50 mg once-daily dosage (Lancet. 2009;374[9704]:1840-8).

Dr. Lambert and her associates designed this pilot study because of previously reported results from other groups showing favorable effects of losartan on animal models of emphysema or other lung disease, as well as suggestions from nonprospective clinical studies of benefits from angiotensin-receptor blockers on lung function and on chronic obstructive pulmonary disease (COPD) in particular.

The current study enrolled patients with mild to severe COPD who were current or former cigarette smokers who had at least a 10 pack-year history and were on stable treatment for their COPD. The researchers excluded patients already taking an angiotensin-receptor blocker or angiotensin-converting enzyme inhibitor.

The study included a total of 106 patients with COPD, including the 46 with emphysema at baseline. Their average age was about 58 years old, the enrolled patients included roughly equal numbers of men and women, and about two-thirds were current smokers. All patients underwent CT lung scans at baseline and after 6 and 12 months, as well as other lung function assessments. The study’s primary endpoint was the amount of additional emphysema in their lungs beyond that seen at baseline using CT imaging.

The entire group of 106 COPD patients showed no significant differences in emphysema progression at either 6 or 12 months between the 54 patients treated with losartan and the 52 controls on placebo, but a second, prespecified analysis that focused only on the 46 enrolled patients who had visible emphysema at baseline showed a significant slowing of progression at the 1-year follow-up, Dr. Lambert said.

The study received partial funding from Merck, which markets losartan (Cozaar). Dr. Lambert had no disclosures. Dr. Sachs had no disclosures.

[email protected]

On Twitter @mitchelzoler

MONTREAL – A structured regimen of regular yoga exercises was as effective as a standard pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease for improving lung function, exercise tolerance, dyspnea severity, and quality of life in a single-center, randomized comparison of the two strategies with 60 patients.

In addition, chronic obstructive pulmonary disease (COPD) patients had a higher level of acceptance of yoga and were more comfortable doing it, compared with standard pulmonary rehabilitation, and it is a cost-effective approach given the minimal equipment required, Dr. Randeep Guleria said at the annual meeting of the American College of Chest Physicians.

“Patients with difficulty walking, osteoarthritis, knee problems, or unable to do exercises like cycling or treadmill found yoga to be much more acceptable,” said Dr. Guleria in an interview. Acceptance of yoga was also higher than standard rehabilitation among patients with more severe COPD, said Dr. Guleria, professor and head of the department of pulmonary medicine and sleep disorders at the All India Institute of Medical Sciences in New Delhi.

“I think that yoga could be a very valuable adjunct” to pulmonary rehabilitation in COPD patients, commented Dr. Roger S. Goldstein, director of the divisional program in respiratory rehabilitation at the University of Toronto. Dr. Goldstein speculated that even better than comparing yoga against conventional pulmonary rehabilitation would be a study that compared a combined yoga plus rehabilitation program against standard rehabilitation alone. Yoga is “a tremendous opportunity,” he said.

The 12-week study enrolled 60 patients who averaged 56 years old who had been diagnosed with COPD for an average of 8 years. Just under a third of the patients had moderate COPD, 42% had severe COPD, and 28% had very severe COPD.

Dr. Guleria and his associates randomized 30 patients into a yoga program that included 4 weeks of biweekly 1-hour sessions that instructed patients in a series of specially designed yoga exercises. That was followed by 8 weeks during which patients were mostly left to perform their learned exercises on their own, but with a supervised session once every 2 weeks. The other 30 patients participated in a standard pulmonary rehabilitation program for 12 weeks.

The researchers measured several parameters at baseline and after 12 weeks, including two measures of dyspnea severity, 6-minute walk distance, a quality of life assessment, and two serum markers of inflammation, C-reactive protein and interleukin 6.

Both interventions resulted in modest but statistically significant improvements, such as increases in 6-minute walk distance and a reduced modified Borg scale assessment. The Borg scale score fell from an average of 1.5 at baseline to 1.0 after 12 weeks in the yoga patients, and from an average 3.0 at baseline to 0.5 after 12 weeks in the rehabilitation patients.

A score that measured total quality of life improved by an average of 32% in the yoga patients and by an average of 21% in the rehabilitation patients, changes that approached statistical significance in both subgroups.

Comparing the assessment measures after 12 weeks in both arms of the study showed no statistically significant between-group differences, Dr. Guleria reported.

The researchers commissioned a specially designed yoga program from a professional yoga instructor who had been briefed about COPD. The yoga exercises included physical postures, breathing technique, and meditation and relaxation. The pulmonary rehabilitation program included patient education, upper and lower limb exercises, and breathing exercises.

Dr. Guleria said he believed the opportunity exists to further modify the yoga program to better optimize its potential to benefit COPD patients.

Dr. Guleria had no relevant disclosures. Dr. Goldstein had no relevant disclosures.

[email protected]

On Twitter@mitchelzoler

MONTREAL – A structured regimen of regular yoga exercises was as effective as a standard pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease for improving lung function, exercise tolerance, dyspnea severity, and quality of life in a single-center, randomized comparison of the two strategies with 60 patients.

In addition, chronic obstructive pulmonary disease (COPD) patients had a higher level of acceptance of yoga and were more comfortable doing it, compared with standard pulmonary rehabilitation, and it is a cost-effective approach given the minimal equipment required, Dr. Randeep Guleria said at the annual meeting of the American College of Chest Physicians.

“Patients with difficulty walking, osteoarthritis, knee problems, or unable to do exercises like cycling or treadmill found yoga to be much more acceptable,” said Dr. Guleria in an interview. Acceptance of yoga was also higher than standard rehabilitation among patients with more severe COPD, said Dr. Guleria, professor and head of the department of pulmonary medicine and sleep disorders at the All India Institute of Medical Sciences in New Delhi.

“I think that yoga could be a very valuable adjunct” to pulmonary rehabilitation in COPD patients, commented Dr. Roger S. Goldstein, director of the divisional program in respiratory rehabilitation at the University of Toronto. Dr. Goldstein speculated that even better than comparing yoga against conventional pulmonary rehabilitation would be a study that compared a combined yoga plus rehabilitation program against standard rehabilitation alone. Yoga is “a tremendous opportunity,” he said.

The 12-week study enrolled 60 patients who averaged 56 years old who had been diagnosed with COPD for an average of 8 years. Just under a third of the patients had moderate COPD, 42% had severe COPD, and 28% had very severe COPD.

Dr. Guleria and his associates randomized 30 patients into a yoga program that included 4 weeks of biweekly 1-hour sessions that instructed patients in a series of specially designed yoga exercises. That was followed by 8 weeks during which patients were mostly left to perform their learned exercises on their own, but with a supervised session once every 2 weeks. The other 30 patients participated in a standard pulmonary rehabilitation program for 12 weeks.

The researchers measured several parameters at baseline and after 12 weeks, including two measures of dyspnea severity, 6-minute walk distance, a quality of life assessment, and two serum markers of inflammation, C-reactive protein and interleukin 6.

Both interventions resulted in modest but statistically significant improvements, such as increases in 6-minute walk distance and a reduced modified Borg scale assessment. The Borg scale score fell from an average of 1.5 at baseline to 1.0 after 12 weeks in the yoga patients, and from an average 3.0 at baseline to 0.5 after 12 weeks in the rehabilitation patients.

A score that measured total quality of life improved by an average of 32% in the yoga patients and by an average of 21% in the rehabilitation patients, changes that approached statistical significance in both subgroups.

Comparing the assessment measures after 12 weeks in both arms of the study showed no statistically significant between-group differences, Dr. Guleria reported.

The researchers commissioned a specially designed yoga program from a professional yoga instructor who had been briefed about COPD. The yoga exercises included physical postures, breathing technique, and meditation and relaxation. The pulmonary rehabilitation program included patient education, upper and lower limb exercises, and breathing exercises.

Dr. Guleria said he believed the opportunity exists to further modify the yoga program to better optimize its potential to benefit COPD patients.

Dr. Guleria had no relevant disclosures. Dr. Goldstein had no relevant disclosures.

[email protected]

On Twitter@mitchelzoler

MONTREAL – A structured regimen of regular yoga exercises was as effective as a standard pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease for improving lung function, exercise tolerance, dyspnea severity, and quality of life in a single-center, randomized comparison of the two strategies with 60 patients.

In addition, chronic obstructive pulmonary disease (COPD) patients had a higher level of acceptance of yoga and were more comfortable doing it, compared with standard pulmonary rehabilitation, and it is a cost-effective approach given the minimal equipment required, Dr. Randeep Guleria said at the annual meeting of the American College of Chest Physicians.

“Patients with difficulty walking, osteoarthritis, knee problems, or unable to do exercises like cycling or treadmill found yoga to be much more acceptable,” said Dr. Guleria in an interview. Acceptance of yoga was also higher than standard rehabilitation among patients with more severe COPD, said Dr. Guleria, professor and head of the department of pulmonary medicine and sleep disorders at the All India Institute of Medical Sciences in New Delhi.

“I think that yoga could be a very valuable adjunct” to pulmonary rehabilitation in COPD patients, commented Dr. Roger S. Goldstein, director of the divisional program in respiratory rehabilitation at the University of Toronto. Dr. Goldstein speculated that even better than comparing yoga against conventional pulmonary rehabilitation would be a study that compared a combined yoga plus rehabilitation program against standard rehabilitation alone. Yoga is “a tremendous opportunity,” he said.

The 12-week study enrolled 60 patients who averaged 56 years old who had been diagnosed with COPD for an average of 8 years. Just under a third of the patients had moderate COPD, 42% had severe COPD, and 28% had very severe COPD.

Dr. Guleria and his associates randomized 30 patients into a yoga program that included 4 weeks of biweekly 1-hour sessions that instructed patients in a series of specially designed yoga exercises. That was followed by 8 weeks during which patients were mostly left to perform their learned exercises on their own, but with a supervised session once every 2 weeks. The other 30 patients participated in a standard pulmonary rehabilitation program for 12 weeks.

The researchers measured several parameters at baseline and after 12 weeks, including two measures of dyspnea severity, 6-minute walk distance, a quality of life assessment, and two serum markers of inflammation, C-reactive protein and interleukin 6.

Both interventions resulted in modest but statistically significant improvements, such as increases in 6-minute walk distance and a reduced modified Borg scale assessment. The Borg scale score fell from an average of 1.5 at baseline to 1.0 after 12 weeks in the yoga patients, and from an average 3.0 at baseline to 0.5 after 12 weeks in the rehabilitation patients.

A score that measured total quality of life improved by an average of 32% in the yoga patients and by an average of 21% in the rehabilitation patients, changes that approached statistical significance in both subgroups.

Comparing the assessment measures after 12 weeks in both arms of the study showed no statistically significant between-group differences, Dr. Guleria reported.

The researchers commissioned a specially designed yoga program from a professional yoga instructor who had been briefed about COPD. The yoga exercises included physical postures, breathing technique, and meditation and relaxation. The pulmonary rehabilitation program included patient education, upper and lower limb exercises, and breathing exercises.

Dr. Guleria said he believed the opportunity exists to further modify the yoga program to better optimize its potential to benefit COPD patients.

Dr. Guleria had no relevant disclosures. Dr. Goldstein had no relevant disclosures.

[email protected]

On Twitter@mitchelzoler