Regular inhaled short acting ß2 agonists for the management of stable chronic obstructive pulmonary disease:

Cochrane systematic review and meta-analysis
Background: Despite the lack of reversibility, patients with chronic obstructive pulmonary disease (COPD) often report symptomatic improvement with inhaled short acting ß2 agonist bronchodilators (ISABAs) in the management of both stable and acute exacerbations of COPD. A review of the literature was undertaken to determine the effectiveness of regular treatment with ISABAs compared with placebo in stable COPD.

Methods: A search for randomised controlled trials was carried out using the Cochrane Collaboration database of trials up to and including May 2002.

Results: Thirteen studies of 7 days to 8 weeks in duration on 237 patients aged 56–70 years with forced expiratory volume in 1 second (FEV1) 60–70% predicted were included in the review. All studies used a crossover design with adequate washout periods and were of high methodological quality. ISABA was delivered either through a nebuliser or a pressurised metered dose inhaler. Spirometric tests performed at the end of the study and after the treatment (post-bronchodilator) showed a slight but significant increase in FEV1 and forced vital capacity (FVC) compared with placebo. In addition, both morning and evening peak expiratory flow rate (PEFR) were significantly better during active treatment than during placebo. An improvement in the daily breathlessness score was observed with ISABA treatment. The risk of treatment failure was reduced by more than 50% with ISABA. Preference for ISABA was nine times higher than for placebo.

Conclusions: Use of ISABA on a regular basis for at least 7 days in patients with stable COPD is associated with improvements in post-bronchodilator lung function and decreases in both breathlessness and treatment failure. This review has shown that regular administration of ISABAs is an effective and inexpensive treatment for the management of patients with stable COPD.

Thorax 2003;58:580-584

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Antibiotics May Help Prevent Strokes
NEW YORK (Reuters Health) - Doctors usually prescribe antibiotics for problems like pneumonia, but new research suggests that these drugs, especially penicillin, may also protect against strokes.

How could a drug that kills bacteria prevent a problem that involves the blockage of blood vessels supplying the brain?

Strokes often occur when cholesterol plaques in blood vessels rupture and block blood flow to the brain. Interestingly, recent reports have shown that these plagues can contain bacteria. Some researchers believe that the presence of these bugs makes plaque rupture more likely.

This is where antibiotics come in. If an antibiotic can kill these bacteria, the plaque might become more stable and less likely to cause a stroke.

To study the link between antibiotics and stroke, Dr. Paul Brassard, from Royal Victoria Hospital in Montreal, and colleagues compared antibiotic use between 1888 stroke patients and 9440 similar people who didn't experience a stroke.

The new findings are reported in Stroke: Journal of the American Heart Association.

People who used antibiotics within the previous year were about 20 percent less likely to have a stroke than people who didn't. Although several kinds of antibiotics seemed to lower the stroke risk, penicillins, such as amoxicillin and ampicillin, had the most pronounced effect.

Current penicillin users were 47 percent less likely to experience a stroke than non-users, the researchers note. Past penicillin use was also tied to a reduced stroke risk, but the benefit was not as strong as with current use.

"Penicillin use was consistently associated with a reduced stroke risk," Dr. Brassard told Reuters Health. "The only explanation I can offer is that because penicillins" kill so many different types of bugs, they may be destroying several kinds found in blood vessel plaques, he added.

Two or three studies are currently underway to see if antibiotics can prevent problems like stroke in heart attack patients, Dr. Brassard noted. If these go well, perhaps the stroke-preventing ability of antibiotics will be tested in people without any heart or blood vessel problems.

Ultimately, we may one day see antibiotics prescribed to otherwise healthy people simply as means of preventing stroke, he added.

SOURCE: Stroke, August 8, 2003

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