Characteristics of reversible and nonreversible COPD and asthma and COPD overlap syndrome patients: an analysis of salbutamol Easyhaler data.

The choice of inhaler device for bronchodilator reversibility is crucial since suboptimal inhalation technique may influence the result. On the other hand, bronchodilator response also varies from time to time and may depend on patient characteristics. In this study, patients with airway obstruction (forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] ratio <70% in chronic obstructive pulmonary disease [COPD]; <80% in asthma) were included (n=121, age: 57.8±17.3 years). Bronchodilator reversibility (American Thoracic Society/European Respiratory Society criteria) was tested in patients with COPD (n=63) and asthma and COPD overlap syndrome (ACOS; n=12). Forty-six asthmatics served as controls. Reversibility was tested with 400 µg salbutamol dry powder inhaler (Buventol Easyhaler, Orion Pharma Ltd, Espoo, Finland). Demographic data and patients' perceptions of Easyhaler compared with ß2-agonist pressurized metered dose inhalers (pMDIs) were analyzed. American Thoracic Society/European Respiratory Society guideline defined reversibility was found in 21 out of 63 COPD patients and in two out of 12 ACOS patients. Airway obstruction was more severe in COPD patients as compared with controls (mean FEV1 and FEV1% predicted both P<0.0001). Average response to salbutamol was significantly lower in COPD patients compared with asthma controls (P<0.0001). Reversibility was equally often found in smokers as in never-smokers (33% vs 34%). Nonreversible COPD patients had higher mean weight, body mass index, and FEV1/FVC compared with reversible COPD patients. Most patients preferred Easyhaler and defined its use as simpler and more effective than use of a pMDI. Never-smokers and patients with asthma experienced Easy-haler somewhat easier to use than smokers and patients with COPD. In conclusion, a substantial part of patients with COPD or ACOS showed reversibility to salbutamol dry powder inhaler. Nonreversible patients with COPD were characterized by higher weight and body mass index, and a higher FEV1/FVC ratio. Most patients preferred Easyhaler compared with a pMDI.

Inhaler competence and patient satisfaction with Easyhaler®: results of two real-life multicentre studies in asthma and COPD.

OBJECTIVE: The aim of this study was to investigate patients' inhaler competence and satisfaction with the Easyhaler(®) dry powder inhaler. DESIGN: Two open, uncontrolled, non-randomised studies. SETTING: Real life based on patients attending 56 respiratory clinics in Hungary. PARTICIPANTS: Patients with asthma or chronic obstructive pulmonary disease (COPD) (n = 1016). INTERVENTION: In a 3-month study, adult patients (age range 18-88 years; n = 797) received twice-daily inhalations of formoterol via Easyhaler(®), and in a consequential study (from one visit to another, with 3-12 months in-between) children and adolescents (age range 4-17 years; n = 219) received salbutamol via Easyhaler(®) as needed. MAIN OUTCOME MEASURES: Control of six Easyhaler(®) handling steps and patients' satisfaction with Easyhaler(®) based on questionnaires. RESULTS: Correct performances (minimum and maximum of the six steps) were noticed after one demonstration in 92-98% of the adults, 87-99% of the elderly, 81-96% of the children and 83-99% of the adolescents. These figures had markedly increased at the last visit. Repeat instructions were necessary in 26% of the cases. Investigators found Easyhaler(®) easy to teach in 87% of the patients and difficult in only 0.5%. Patients found Easyhaler(®) easy to learn and use, and the patients' (and parents') satisfaction with the inhaler was very high. Lung function values [forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF)] improved statistically significantly during the studies, indicating good inhaler competence and treatment adherence. CONCLUSION: Investigators found Easyhaler(®) easy to teach and patients found it easy to use, and their satisfaction with the device was high.

Adenosine triphosphate concentration of exhaled breath condensate in asthma.

BACKGROUND: Purinergic signaling is involved in asthma pathogenesis. Not only adenosine but also adenosine triphosphate (ATP) might play a role, but human evidence is scarce. ATP can be measured in exhaled breath condensate (EBC), a noninvasive airway sample suggested as being suitable for patient monitoring. We determined EBC ATP concentration in asthma, investigated its relation to disease parameters, and calculated airway ATP level. METHODS: EBC was collected from 45 patients with persistent asthma (age 34.7 +/- 13.2 years; FEV(1), 87.0 +/- 15.5% predicted; mean +/- SD) and 32 healthy control subjects (age 36.9 +/- 12.6 years; FEV(1), 98.9 +/- 9.9% predicted). Exhaled nitric oxide concentration (FeNO) and lung function were measured, and Asthma Control Test (ACT) score was obtained. EBC ATP was measured in luciferin-luciferase assay. Airway ATP concentration was calculated using dilution estimated from conductivity of vacuum-treated EBC samples. Parametric tests were applied in the analyses. ATP concentrations and nitric oxide levels were logarithmically transformed. RESULTS: EBC ATP and calculated airway ATP concentrations were not elevated in asthma, and none of them was related to FeNO or ACT score. EBC ATP concentration was influenced by airway droplet dilution (r = -0.32, P < .05), and there was a relation between calculated airway ATP level and FEV(1) (r = -0.35, P < .05). CONCLUSIONS: EBC ATP concentration does not seem to be useful for asthma monitoring. The relation between EBC mediator concentration and EBC conductivity highlights the importance of further standardization of EBC methodology and the need for more studies to understand airway droplet formation.

Inhibition of EGFR tyrosine-kinase in NSCLC treatment: the Hungarian experience with gefitinib in the context of an expanded access programme.

The ZD1839 (Iressa, gefitinib) treatment in phase I trials for patients with advanced non-small cell lung cancer (NSCLC) was associated with disease stabilization and tumor regression. The aim of this study was to analyze the efficacy of gefitinib monotherapy as a second- or third-line treatment for locally-advanced and advanced NSCLC. Data for 50 patients were analyzed. Patients were treated at 5 centers in Hungary as part of the gefitinib Expanded Access Programme (EAP). The response rate was 10% (all partial responses), with disease stabilization in 46% of patients. Disease progression was observed in 44% of patients. The median survival according to the Kaplan-Meier method was 8 months. Median survival of patients with adenocarcinoma was significantly increased compared with squamous cell carcinoma and, of the patients responding to therapy, 80% had adenocarcinoma. The 1-year survival rate was 34%. All patients were evaluable for safety; the adverse events seen with gefitinib were generally mild and only two patients had to be withdrawn from the study due to adverse events. The Hungarian experience suggests gefitinib therapy is effective and well tolerated.