Tiotropium versus Salmeterol for the Prevention of Exacerbations of COPD

BACKGROUND Treatment guidelines recommend the use of inhaled long-acting bronchodilators to alleviate symptoms and reduce the risk of exacerbations in patients with moderate-tovery-severe chronic obstructive pulmonary disease (COPD) but do not specify whether a long-acting anticholinergic drug or a β2-agonist is the preferred agent. We investigated whether the anticholinergic drug tiotropium is superior to the β2-agonist salmeterol in preventing exacerbations of COPD. METHODS In a 1-year, randomized, double-blind, double-dummy, parallel-group trial, we compared the effect of treatment with 18 μg of tiotropium once daily with that of 50 μg of salmeterol twice daily on the incidence of moderate or severe exacerbations in patients with moderate-to-very-severe COPD and a history of exacerbations in the preceding year. RESULTS A total of 7376 patients were randomly assigned to and treated with tiotropium (3707 patients) or salmeterol (3669 patients). Tiotropium, as compared with salmeterol, increased the time to the first exacerbation (187 days vs. 145 days), with a 17% reduction in risk (hazard ratio, 0.83; 95% confidence interval [CI], 0.77 to 0.90; P<0.001). Tiotropium also increased the time to the first severe exacerbation (hazard ratio, 0.72; 95% CI, 0.61 to 0.85; P<0.001), reduced the annual number of moderate or severe exacerbations (0.64 vs. 0.72; rate ratio, 0.89; 95% CI, 0.83 to 0.96; P=0.002), and reduced the annual number of severe exacerbations (0.09 vs. 0.13; rate ratio, 0.73; 95% CI, 0.66 to 0.82; P<0.001). Overall, the incidence of serious adverse events and of adverse events leading to the discontinuation of treatment was similar in the two study groups. There were 64 deaths (1.7%) in the tiotropium group and 78 (2.1%) in the salmeterol group. CONCLUSIONS These results show that, in patients with moderate-to-very-severe COPD, tiotropium is more effective than salmeterol in preventing exacerbations. (Funded by Boehringer Ingelheim and Pfizer; ClinicalTrials.gov number, NCT00563381.

Обґрунтування метода визначення динамічних параметрів оператора мобільної пожежної установки

The object of this study is the process of functioning of the "man-robot" system. The task to coordinate parameters of the human operator and the robot is investigated. Aligning these parameters is based on the method of determining the dynamic parameters of the human operator using mathematical models that describe two types of relative errors. The first type includes relative errors in determining the dynamic parameters of the operator, which depend on the error in determining the signals characterizing his response to the test impact. The second type of relative errors is the methodical error, which is due to the approximation of partial derivatives. The formation of a test impact on the operator is carried out using an interactive whiteboard. The method is based on finding the roots of a linear system of algebraic equations, for the construction of which an approximation of partial derivatives from signals characterizing the operator's response to the test effect is used. The parameters of this system of algebraic equations depend on time parameters. Determination of time parameters is carried out using tolerance criteria and using nomograms. When justifying the main parameter of the test impact on the operator – the speed of movement of the fire front on the interactive whiteboard screen, the properties of the angular eye control system of the mobile fire installation operator are used. These properties are formalized as a mathematical model of dynamic error, which occurs in the process of tracking by the operator the image of a fire on the interactive whiteboard screen. To verify the obtained results, a test problem has been solved; it is shown that the error in determining the dynamic parameters of the operator does not exceed 1.0 %. The results reported here could be used for designing mobile fire installations of a new generation, the structure of which is based on the use of segwaysОб’єктом дослідження є процес функціонування системи «людина-робот». Досліджується проблема узгодження параметрів людини-оператора і робота. Узгодження цих параметрів базується на методі визначення динамічних параметрів людини-оператора із використанням математичних моделей, які описують два види відносних похибок. До першого виду відносяться відносні похибки визначення динамічних параметрів оператора, які залежать від похибки визначення сигналів, що характеризують його реакцію на тест-вплив. До другого виду відносних похибок відноситься методична похибка, яка обумовлена апроксимацією частинних похідних. Формування тест-впливу на оператора здійснюється за допомогою інтерактивної дошки. В основі метода лежить знаходження коренів лінійної системи алгебраїчних рівнянь, для побудови якої використана апроксимація частинних похідних від сигналів, що характеризують реакцію оператора на тест-вплив. Параметри цієї системи алгебраїчних рівнянь залежать від часових параметрів. Визначення часових параметрів здійснюється за допомогою допускових критеріїв та із використанням номограм. При обґрунтуванні основного параметра тест-впливу на оператора – швидкості переміщення фронту пожежі на екрані інтерактивної дошки використовуються властивості системи кутового управління очима оператора мобільної пожежної установки. Ці властивості формалізовані у вигляді математичної моделі динамічної похибки, яка має місце в процесі відстеження оператором зображення пожежі на екрані інтерактивної дошки. Для верифікації одержаних результатів вирішена тест-задача і показано, що похибка визначення динамічних параметрів оператора не перевищує 1,0&nbsp;%. Отримані результати можуть бути використані при розробці мобільних пожежних установок нового покоління, в основі побудови яких лежить використання сігвеї

The prevalence, burden and risk factors associated with chronic obstructive pulmonary disease in Commonwealth of Independent States (Ukraine, Kazakhstan and Azerbaijan): results of the CORE study

Abstract Background In the Commonwealth of Independent States (CIS) countries the epidemiology of chronic obstructive pulmonary disease (COPD) is poorly characterized. The objective of this analysis is to present the prevalence, burden and risk factors associated with COPD in three CIS countries as part of the CORE study (Chronic Obstructive Respiratory Diseases), the rationale and design of which have been described elsewhere. Methods A total of 2842 adults (≥18 years) were recruited (964 in Ukraine, Kiev, 945 in Kazakhstan, Almaty and 933 in Azerbaijan, Baku) between 2013 and 2015 during household visits. Two-step cluster randomization was used for the sampling strategy. All respondents were interviewed about respiratory symptoms, smoking status and medical history, and underwent spirometry with bronchodilator. COPD was defined as (i) “previously diagnosed” when the respondent reported that he/she had previously been diagnosed with COPD by a doctor, (ii) “diagnosed by spirometry” using the GOLD criteria (2011) based on spirometry conducted during the study (FEV1/FVC <  0.70), and (iii) “firstly diagnosed by spirometry”, when the patient had received the COPD diagnosis for the first time based on the spirometry results obtained in this study. Results The prevalence of “previously diagnosed” COPD was 10.4, 13.8 and 4.3 per 1000, and the prevalence of COPD “diagnosed by spirometry” was 31.9, 66.7 and 37.5 per 1000 in Ukraine, Kazakhstan, and Azerbaijan, respectively. Almost all respondents with COPD were diagnosed for the first time during this study. A statistically significant relationship was shown between smoking and COPD in Kazakhstan (odds ratio, OR: 3.75) and Azerbaijan (OR: 2.80); BMI in Ukraine (OR: 2.10); tuberculosis in Ukraine (OR: 32.3); and dusty work in Kazakhstan (OR: 2.30). Co-morbidities like cardiovascular diseases and a history of pneumonia occurred significantly (p <  0.05) more frequently in the COPD population compared to the non-COPD population across all participating countries. For hypertension, this was the case in Ukraine and Azerbaijan. Conclusion In CIS countries (Ukraine, Kazakhstan and Azerbaijan), the prevalence of COPD “diagnosed by spirometry” was significantly higher than the prevalence of previously diagnosed COPD. Compared to many other countries, the prevalence of COPD seems to be relatively low in CIS countries. Factors such as limited funding from the government; lack of COPD knowledge and the attitude within the population, and of primary care physicians; as well as low access to high-quality spirometry may play a role in this under-diagnosis of COPD. The information provided in this paper will be helpful for healthcare policy makers in CIS countries to instruct COPD management and prevention strategies and to allocate healthcare resources accordingly

Correction to: Chronic obstructive pulmonary disease, bronchial asthma and allergic rhinitis in the adult population within the commonwealth of independent states: rationale and design of the CORE study

Abstract After publication of this work [1] it was noticed three author names were spelt incorrectly. Liudmila Iashyna should be Liudmyla Iashyna, Marina Polyanskaya should be Maryna Polianska and Elcan Mamamdbayov should be Eljan Mammadbayov

Additional file 1: of Chronic obstructive pulmonary disease, bronchial asthma and allergic rhinitis in the adult population within the commonwealth of independent states: rationale and design of the CORE study

“Study questionnaires used in the CORE study” contains description of the patient-reported questionnaires used in the CORE study. (DOCX 16 kb