A simple rule to identify patients with chronic obstructive pulmonary disease who may need treatment reevaluation

BACKGROUND: A simple rule based on short-acting inhaled β2-agonist (SABA) use could identify patients with chronic obstructive pulmonary disease (COPD) at increased risk of exacerbations and signal the need for maintenance therapy change, similar to asthma "Rules of Two(®)". METHODS: Associations between SABA use, COPD exacerbations, and health care costs over 1 year were examined retrospectively using de-identified patient data from the Optum Research Database (ORD; N = 56,581) and the Impact National Benchmark Database (IMPACT™; N = 9423). Nebulized and metered-dose inhaler (MDI) SABA doses were normalized to 2.5 mg and 90 mcg albuterol equivalents, respectively. RESULTS: The GOLD initiative establishes ≥2 exacerbations/year as indicative of increased risk in COPD. We identified a correlation (p < 0.0001) between 1.5 SABA doses/day and this frequency of exacerbations. In ORD, patients using ≥1.5 versus <1.5 SABA doses/day experienced significantly more exacerbations: 1.92 (95% confidence interval [CI], 1.89-1.96) versus 1.36 (95% CI, 1.34-1.38) per patient year (PPY). Above-threshold use was associated with higher average annual COPD-related costs (2010 $US):$21,868 (standard deviation [SD], $53,910) versus$11,686 (SD, $32,707) for nebulized SABA only,$9216 (SD, $30,710) versus$7334 (SD, $24,853) for MDI SABA only, and$15,806 (SD, $35,260) versus$11,233 (SD, $27,006) for both nebulized and MDI SABA. IMPACT™ validated these findings. CONCLUSION: Patients with COPD using ≥1.5 SABA doses/day were at increased risk of exacerbations. Our results suggest a "Rule of 3-2": SABA use ≥3 times in 2 days should be considered a clinical marker for needing treatment reevaluation

Identification of proteins involved in excess boron stress in roots of carrot (Daucus carota L.) and role of niacin in the protein profiles

WOS: 000298555400012Plants are constantly challenged by various biotic and abiotic stresses in nature. Boron toxicity have become one of the important abiotic stress factor for plants. Boron toxicity responses of plants is reflected by alterations in protein expression level, activity, location and concentration. In this study, we identified the proteins which respond to the boron excess stress in Daucus carota root cells, and examined the effects of niacin (nicotinamide) on the protein profiles of boron excess. Protein profile changes in responce to boron and niacin were compared with the control using sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS PAGE) gel electrophoresis. Protein bands of interest were excised from gel and digested by trypsin. The trypsin-digested peptides were analyzed on nanoLC-ESI-MS/MS. Six different proteins involved in plant defense system were identified in total [CR16 (Major allergen Dau c1), glutathion peroxidase, glyoxylase I, isocitrate dehydrogenase (NADP(+)), adenosyl homocysteinase, EDPG precursor)]. Our results clearly demonstrated the presence of boron and niacin in growth medium stimulated expression and synthesis of proteins role in plant defence mechanism