New developments in the management of COPD: clinical utility of indacaterol 75 µg

Paschalis Steiropoulos,1 Kostas Archontogeorgis,1 Evangelia Nena,2 Demosthenes Bouros1 1Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece; 2Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece Abstract: Chronic obstructive pulmonary disease (COPD) is a global health challenge and a major cause of mortality worldwide. Bronchodilators, particularly long-acting β2-agonists and long-acting antimuscarinic agents, used singly or in combination, aim to improve lung function, reduce symptoms, prevent exacerbations, and enhance quality of life of COPD patients. Indacaterol is a novel, inhaled, long-acting β2-agonist, with rapid onset of action and once-daily dosing providing 24-hour bronchodilation. Currently, the recommended dose differs between Europe (150 µg; maximum 300 µg) and USA (75 µg), the latter is lower than that assessed in the majority of the conducted studies. This review summarises published evidence regarding the efficacy, tolerability, and safety of indacaterol at a dose of 75 µg. Indacaterol 75 µg was found to be superior than placebo regarding lung function, dyspnea, health status, use of rescue medication, and rate of exacerbations. Furthermore, indacaterol 75 µg was well tolerated, while the most frequent adverse effect was deterioration of COPD occurring at a frequency similar to placebo, without major cardiovascular adverse effects. In conclusion, indacaterol 75 µg, administered once daily, is efficacious and has an excellent tolerability and safety profile, and is therefore a valid alternative in the treatment of COPD patients. Keywords: chronic obstructive pulmonary disease, long-acting bronchodilators, β2-agonists, indacatero

Serratia pneumonia presenting as hemoptysis in a patient with sarcoidosis: a case report

Paul Zarogoulidis1, Konstantinos Porpodis1, Maria Konoglou2, Maria Saroglou2, Alexandros Mitrakas1, Dimitrios Matthaios3, Panagiotis Touzopoulos1, Konstantinos Archontogeorgis4, Andrew Koulelidis4, Konstantinos Zarogoulidis1, Stavros Tryfon21Pulmonary Department, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Greece; 21st Pulmonary Clinic, “G. Papanikolaou” General Hospital, Thessaloniki, Greece; 31st Internal Medicine Department, University General Hospital of Alexandroupolis, Greece; 4Pulmonary Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, GreeceIntroduction: Serratia marcescens is a Gram-negative bacillus which belongs to the family Enterobacteriaceae. It is a facultative anaerobe and produces red pigment at room temperature. It naturally occurs in soil and water as well as the intestines, and it is responsible for nosocomial infections. There have been few reports about community acquired pneumonia of Serratia.Case presentation: This report presents a 37-year-old man with hemoptysis, fever, and shortness of breath. The clinical and laboratory examinations revealed that the patient had pseudohemoptysis due to S. marcescens pneumonia, on an immunocompromised pattern, because of the coexistence of sarcoidosis (stage 1).Conclusion: Appropriate antibiotic therapy for Serratia was administered, and the patient's symptoms regressed. The patient is healthy and asymptomatic after 1-year follow-up. To the best of the authors' knowledge, this is the first reported case of a pseudohemoptysis in a patient with pulmonary sarcoidosis.Keywords: Serratia marcescens, pseudohemoptysis, pulmonary sarcoidosi

Genetics of Obstructive Sleep Apnea: Vitamin D Receptor Gene Variation Affects Both Vitamin D Serum Concentration and Disease Susceptibility

Obstructive sleep apnea syndrome (OSAS) is a multifactorial and common disorder affecting 10-17% of men and 3-9% of women. A low vitamin D serum concentration has been reportedly linked to OSAS susceptibility, but the underlying molecular genetic mechanisms are poorly understood thus far. We report here original findings on the ways in which vitamin D receptor (VDR) gene polymorphic variation (FokI, BsmI, ApaI, and TaqI polymorphisms) impacts serum vitamin D concentration and, additionally, susceptibility to OSAS. In a sample of 176 consecutive subjects (144 patients with OSAS and 32 healthy controls) phenotyped by full polysomnography (PSG), we characterized human genetic variation in VDR using the Sequenom MassARRAY iPLEX platform. A logistic regression analysis was employed to account and correct for covariates such as sex, age, body mass index, and comorbidities. Importantly, we observed that the FokI CC genotype frequency was markedly higher in patients with OSAS compared with controls (50.7% vs. 28.1%; p = 0.027). VDR FokI polymorphism explained 14.5% of vitamin D serum concentration variability. Moreover, the VDR FokI polymorphism was also associated with excessive daytime sleepiness (p = 0.016). To the best of our knowledge, this is the first clinical genetics study examining the role of VDR polymorphic variation on OSAS as phenotyped using full PSG. We call for further studies of vitamin D-related mechanisms that might contribute to OSAS risk in independent populations