Tuesday, August 19, 2008

Vitamin D, COPD and Kevin MD

I am back from break and desperately trying to catch up with patient messages, lab results, etc. as well as the latest medical news.

Reader take on Kevin MD
Thank to Kevin for posting my reading take As psychiatry goes, so will primary care on his blog. Medical blogs written by physicians tend to focus on either health care policy/politics, personal experiences or comments on medically relevant items. This blog focuses on the latter, but I recently sent this reader take to Kevin on the future of primary care.

Vitamin D
A new study published in the Annals of Internal Medicine showed that women with low vitamin D levels have a much greater risk of fracture than women with normal or high vitamin D levels.
According to the National Osteoporosis Foundation, "adults under age 50 need 400-800 IU of vitamin D daily, and adults age 50 and older need 800 – 1,000 IU of vitamin D daily." Though vitamin D supplementation has not been proven to prevent fractures, the strong association with fracture prevention, biologic role in bone formation and low risk of taking it seem to support these recommendations

Inhaled Steroids in COPD
Another study that came out while I was away was a post-hoc analysis of the TORCH study that showed that a combination of an inhaled steroid and long acting beta agonist (Advair) slowed the progression of lung function loss in patients with COPD. Chronic Obstructive Lung Disease (COPD) contributes to the 4th leading cause of death in the US. Normally, in people who don't smoke, the amount of air you can forcefully blow out in one second (FEV1) declines as we age. In patients who smoke and/or have COPD, that rate of loss of lung function is much more rapid, leading to substantial declines in the ability to function as well as premature death. Up until this study, the only thing that had been shown to slow this progression of lung function decline was to stop smoking. This is the first drug that is able to make that claim.

The Toward a Revolution in COPD Health (TORCH) study, was designed to show that Advair reduced mortality compared to placebo or the individual components alone in over 6000 patients taking one of these agents for over 3 years. Though Advair decreased mortality, it was not statistically significant. There was a significant reduction in exacerbations, though there were a few excess pneumonias as well. This analysis was done after the trial was completed and found that both the long acting beta agonist (salmeterol), the inhaled steroid (fluticasone) and the combination (Advair) all slowed the rate of decline in FEV1 compared to placebo, though reduction was greater with the combination.

Though nothing beats stopping smoking, this is good news for patients with COPD who may benefit from medications that address not only their symptoms but other factors, including loss of lung function.

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