ERYTHROMYCIN REDUCES COLD-RELATED COPD EXACERBATIONS

A prospective, randomized, controlled trial has evaluated erythromycin’s efficacy in lowering the incidence of the common cold and cold-induced exacerbations of respiratory difficulties in patients with chronic obstructive pulmonary disease (COPD).

Erythromycin was found to have beneficial effects after 109 patients with COPD were randomized in September 1997 to receive either the drug (55 patients) or no active treatment (54 patients). Follow-up began one month later and continued for one year. Cold symptoms, such as sneezing, nasal discharge, nasal congestion, malaise, headache, chills, feverishness, sore throat, hoarseness, and cough, were individually rated on a severity scale ranging from 0 to 3. A cold was diagnosed when a patient had a total symptom score above 5. COPD exacerbations were defined as worsening of COPD symptoms severe enough to require a change in therapy.

The two groups of patients were similar in baseline characteristics, including pulmonary function test results. During follow-up, there was an average of 1.24 colds per person in the erythromycin group, compared with 4.54 in the control group. Overall, the proportions of patients experiencing exacerbations in the erythromycin and control groups were 11% and 56%, respectively. However, the proportion of colds resulting in COPD exacerbations was similar (21% vs 26%, respectively).

Because of the risk of the emergence of erythromycin-resistant organisms, the researchers suggested that this treatment be reserved only for those patients at high risk for COPD exacerbations. However, their results show that the efficacy of low-dose erythromycin in reducing cold frequency and COPD exacerbations is not in doubt.

Suzuki T, Yanai M, Yamaya M, et al. Erythromycin and common cold in COPD. Chest. 2001;120:730-733.

ABCIXIMAB DOES NOT INCREASE STROKE RISK

The risk for stroke faced by patients who receive abciximab while undergoing percutaneous coronary intervention (PCI) is no greater than the risk faced by PCI patients given placebo.

Akkerhuis et al evaluated data from four double-blind, placebo-controlled, randomized trials that included 8,555 patients. These studies took place in 257 American and European hospitals between November 1991 and October 1997.

Patients were divided into groups receiving a bolus and an infusion of the platelet glycoprotein IIb/IIIa receptor inhibitor (n = 5,476) or placebo (n = 3,079). Stent deployment may or may not have been involved in any of the procedures.

The main outcome evaluated was risk of hemorrhagic or non-hemorrhagic stroke within 30 days of treatment; 33 such strokes occurred in 31 patients. No significant difference in the rate of stroke was found between the abciximab and placebo groups; 0.4% of the patients given abciximab suffered strokes, compared with 0.29% of patients receiving placebo. Non-hemorrhagic and hemorrhagic strokes in the abciximab group occurred at rates of 0.24% and 0.16%, respectively; the placebo group experienced those events at rates of 0.20% and 0.10%, respectively.

In three of the four studies, some patients received standard-dose heparin along with abciximab; the rate of hemorrhagic stroke in these patients was 0.27%. Two of the studies also included low-dose heparin regimens; the hemorrhagic stroke rate was only 0.04% when low-dose heparin was administered. Because of the small numbers of patients involved, however, this difference did not reach statistical significance.

The conclusion drawn by the researchers was that using abciximab in conjunction with heparin does not increase stroke risk in PCI patients; heparin, they said, should be given in low, weight-adjusted doses.

Akkerhuis KM, Deckers JW, Lincoff AM, et al. Risk of stroke associated with abciximab among patients undergoing percutaneous coronary intervention. JAMA. 2001;286:78-82.

OBSTRUCTIVE SLEEP APNEA COMPLICATES SURGICAL OUTCOMES

Obstructive sleep apnea syndrome (OSAS) is a risk factor for postoperative morbidity in patients undergoing hip or knee replacement surgery.

A recent case-control study compared 101 such patients with OSAS against 101 controls without the condition. In 36 cases, the operation was performed within three years before OSAS diagnosis; in the other 65 cases, it was done afterwards.

Complications of any type developed in 39 of the OSAS patients and in 18 of the controls. Serious complications developed in 24 and nine patients, respectively. Furthermore, the study authors determined that hospital stays were longer for patients with OSAS than for those without it: 6.8 days versus 5.1 days, respectively.

The researchers opined that airway obstructions are common in joint replacement patients with OSAS because of the postoperative requirement that such patients remain supine, which has been shown to double a patient’s respiratory distress index. Another aggravating factor may be the postoperative use of intravenous narcotics, which could aggravate respiratory complications in patients with OSAS.

Furthermore, the investigators stated that most complications occurred in the 24 hours immediately following surgery, suggesting that the sedatives, anesthetics, and narcotics administered during that period could increase upper airway resistance by relaxing upper airway dilator muscles. The fact that patients using continuous positive airway pressure at home before surgery experienced fewer complications than did the other patients with OSAS led the investigators to question whether early intervention for such patients might be associated with better outcomes.

Reference
Gupta RM, Parvizi J, Hanssen AD, Gay PC. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study. Mayo Clin Proc. 2001;76:897-905.