ACO (Asthma-COPD Overlap) Is Independent from COPD: The Case Against

Over the last decade interest has been shown in people with symptomatic lung disease who have features both of COPD and asthma. In this review we examine how COPD and asthma are defined and examine clinical characteristics of people defined by researchers as having asthma-COPD overlap (ACO). We look at pathological and physiological features along with symptoms and consider the impact of each diagnosis upon therapeutic management. We highlight challenges in the diagnosis and management of airway disease and the various phenotypes that could be part of ACO, in so doing suggesting ways for the clinician to manage patients with features of both asthma and COPD

Movement and Home Range of Nile Crocodiles in Ndumo Game Reserve, South Africa

The study of movement patterns and home range is fundamental in understanding the spatial requirements of animals and is important in generating information for the conservation and management of threatened species. Ndumo Game Reserve, in north-eastern KwaZulu-Natal, bordering Mozambique, has the third largest Nile crocodile (Crocodylus niloticus) population in South Africa. Movement patterns of 50 Nile crocodiles with a total length of between 202 cm and 472 cm were followed over a period of 18 months, using mark-resight, radio and satellite telemetry. The duration of radio transmitter attachment (131 ± 11.4 days) was significantly and negatively related to total length and reproductive status. Satellite transmitters failed after an average of 15 ± 12.5 days. Home range was calculated for individuals with 10 or more radio locations, spanning a period of at least 6 months. There was a significant relationship between home range size and total length, with sub-adults (1.5 m – 2.5 m) occupying smaller, more localised home ranges than adults (> 2.5 m). The largest home ranges were for adults (> 2.5 m). Home ranges overlapped extensively, suggesting that territoriality, if present, does not result in spatially discrete home ranges of Nile crocodiles in Ndumo Game Reserve during the dry season. Larger crocodiles moved farther and more frequently than smaller crocodiles. The reserve acts as a winter refuge and spring breeding site for an estimated 846 crocodiles, which also inhabit the Rio Maputo during the summer months. Nile crocodile movement out of the reserve and into the Rio Maputo starts in November and crocodiles return to the reserve as water levels in the floodplain recede in May. Conservation implications: Movement patterns of Nile crocodiles show the important role the reserve plays in the conservation of Nile crocodile populations within the greater Ndumo Game Reserve–Rio Maputo area

Reduction of exacerbations by the PDE4 inhibitor roflumilast - the importance of defining different subsets of patients with COPD

<p>Abstract</p> <p>Background</p> <p>As chronic obstructive pulmonary disease (COPD) is a heterogeneous disease it is unlikely that all patients will benefit equally from a given therapy. Roflumilast, an oral, once-daily phosphodiesterase 4 inhibitor, has been shown to improve lung function in moderate and severe COPD but its effect on exacerbations in unselected populations was inconclusive. This led to the question of whether a responsive subset existed that could be investigated further.</p> <p>Methods</p> <p>The datasets of two previous replicate, randomized, double-blind, placebo-controlled, parallel-group studies (oral roflumilast 500 μg or placebo once daily for 52 weeks) that were inconclusive regarding exacerbations were combined in a post-hoc, pooled analysis to determine whether roflumilast reduced exacerbations in a more precisely defined patient subset.</p> <p>Results</p> <p>The pooled analysis included 2686 randomized patients. Roflumilast significantly decreased exacerbations by 14.3% compared with placebo (p = 0.026). Features associated with this reduction were: presence of chronic bronchitis with or without emphysema (26.2% decrease, p = 0.001), presence of cough (20.9% decrease, p = 0.006), presence of sputum (17.8% decrease, p = 0.03), and concurrent use of inhaled corticosteroids (ICS; 18.8% decrease, p = 0.014). The incidence of adverse events was similar with roflumilast and placebo (81.5% vs 80.1%), but more patients in the roflumilast group had events assessed as likely or definitely related to the study drug (21.5% vs 8.3%).</p> <p>Conclusions</p> <p>This post-hoc, pooled analysis showed that roflumilast reduced exacerbation frequency in a subset of COPD patients whose characteristics included chronic bronchitis with/without concurrent ICS. These observations aided the design of subsequent phase 3 studies that prospectively confirmed the reduction in exacerbations with roflumilast treatment.</p> <p>Trials registration</p> <p>ClinicalTrials.gov identifiers: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00076089">NCT00076089</a> and <a href="http://www.clinicaltrials.gov/ct2/show/NCT00430729">NCT00430729</a>.</p