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At the heart of general practice since 1960

Major regional variations over antibiotic scripts

An inhaled anticholinergic bronchodilator can protect COPD patients from exacerbations, a US study reports.

Researchers compared once-daily 18µg tiotropium with placebo over six months in 1,829 patients with moderate to severe COPD.

Tiotropium significantly reduced the proportion of patients experiencing one exacerbation or more, from 32.3 per cent to 27.9 per cent.

Some 7.0 per cent of patients on tiotropium were hospitalised with a COPD exacerbation compared with 9.5 per cent of controls, although the difference was only of borderline statistical significance.

Annals of Internal Medicine 2005;143:317-26

Obesity linked to embolisms and DVT

Obesity is strongly linked to pulmonary embolism and deep vein thrombosis, according to a US study.

Researchers analysed over 20 years of medical records from the National Hospital Discharge Survey, including more than 12 million obese patients and 700 million patients who were not obese.

Obese patients were 2.2 times as likely as non-obese patients to suffer a pulmonary embolism and 2.5 times as likely to suffer deep vein thrombosis.

The American Journal of Medicine

2005;118:978-80

Airway treatment lifts depression

Treatment with continuous positive airway pressure can ease depression in patients with obstructive sleep apnea, US researchers report.

Their study evaluated the effect of continuous positive airway pressure on depression symptoms in 50 patients with obstructive sleep apnea, 19 of whom were receiving antidepressants prior to referral.

Scores on the Beck inventory of depression decreased from 4.1 before treatment to 1.0 afterwards, with falls recorded both in patients who had taken antidepressants and those who had not.

Chest 2005;128:1304-9

Moxonidine an effective BP add-on

Moxonidine has a significant add-on effect in elderly patients with resistant hypertension, a UK study shows.

The University of Birmingham research evaluated the effect of 200-400µg moxonidine in 14 elderly patients whose blood pressure remained poorly controlled by two or more antihypertensive drugs.

Mean daytime systolic blood pressure decreased from 169.2mmHg to 153.8mmHg and night-time systolic blood pressure from 151.1mmHg to 141.2mmHg. Diastolic blood pressure also fell significantly.

The drug was well-tolerated in 11 of the 14 patients.

Journal of Clinical Pharmacy and Therapeutics 2005;30:433-8

C-reactive protein levels mark COPD

C-reactive protein appears to be a marker of the inflammatory process that occurs in COPD, a UK study concludes.

Researchers evaluated levels of C-reactive protein in 88 patients with COPD with no evidence of unstable ischaemic heart disease, comparing them with 33 smoker and 38 non-smoker controls.

Serum C-reactive protein was 5.03mg/l in COPD patients but only 2.02 in the smoker controls and 2.24 in the non-smokers. Levels of C-reactive protein were reduced in patients treated with inhaled steroids.

Thorax 2005 September 2

early online publication

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