Association between COPD and hearing loss with impaired speech recognition: a cross-sectional study.

INTRODUCTION: Studies have identified a greater risk of sensory neural hearing loss in individuals with COPD compared to healthy individuals, but it is unclear whether they are at increased risk of hearing loss with impaired speech recognition. The aim of this study was to assess whether COPD is associated with hearing loss that affects speech recognition. METHODS: This is a case-control study. We screened individuals from health facilities in the municipality of Jundiai. We enrolled a test group of individuals with COPD and an age-matched control group composed of individuals with asthma. The selected individuals attended an appointment with a chest physician, responded questionnaires and underwent tonal and speech audiometry. Adjusted binary logistic regression analysis evaluated whether COPD was associated with reduced speech recognition. RESULTS: We enrolled 36 individuals with COPD and 72 with asthma. Individuals with COPD were more likely to have a reduced speech recognition compared to asthmatic individuals [Reduced recognition of three-syllable words: adjusted OR 3.72, 95 CI (1.38 - 10.02)] [Reduced recognition of monosyllable words: adjusted OR 4.74, 95 CI (1.52 - 14.76)]. CONCLUSION: We conclude that individuals with COPD from primary and secondary healthcare facilities have at least 38% greater risk of hearing loss with reduced speech recognition compared to an age-matched control group of individuals with asthma recruited from the same facilities. We recommend that longitudinal studies evaluate whether regular screening could contribute to the prevention or early treatment of hearing loss in individuals with moderate-severe COPD.

Evaluating the relationship between the type of rescue medication and the adequacy of asthma maintenance therapy.

INTRODUCTION: Current guidelines incorporate the option of a rapid onset bronchodilator (ROB) plus an inhaled corticosteroid (ICS) for the relief of asthma symptoms, but there is doubt whether the combined therapy for relief could lead to suboptimal maintenance therapy since individuals might prefer it to the maintenance therapy. The objective of this study was to assess whether the type of rescue medication that the individual with asthma has available is associated with suboptimal maintenance therapy. METHODS: This cross-sectional study included non-smokers with asthma, ≥12 years old. The individuals attended an appointment with a physician, responded questionnaires and performed a spirometry. Adjusted regression analysis evaluated whether the type of rescue medication was associated with suboptimal maintenance therapy. RESULTS: We enrolled 953 individuals, of which 221 reported having no rescue medication, 171 carried any ROB + ICS for symptoms relief and 561 carried SABA alone to rescue. The frequency of suboptimal maintenance therapy was not different between individuals carrying the combination and those carrying SABA alone for symptoms relief, but individuals who reported having no rescue medication had less suboptimal maintenance therapy (P < 0.01). CONCLUSIONS: The frequency of suboptimal maintenance therapy for asthma was similar between individuals carrying any ROB + ICS for symptoms relief and those carrying SABA alone to rescue, whilst it was less frequent in the group that reported not having any reliever medication. Data from this study indicate that recent changes in asthma guidelines regarding the use of rescue medication have little risk of impairing maintenance therapy.