2 NEWS
2 NEWS
16 FEBRUARY 2024 ausdoc . com . au
Regular spirometry for chronic productive cough ?
Rachel Fieldhouse PATIENTS with a chronic productive cough should undergo regular spirometry for early detection of COPD and asthma , regardless of smoking status or duration , Australian doctors report .
The University of Melbourne-led team , who identified six subclasses of cough , said those with chronic or intermittent productive cough had worse lifetime lung function trajectories than patients with minimal cough .
“ Our findings indicate that productive cough should be managed proactively , including through routine measurement of lung function ,” they wrote in The Lancet Respiratory Medicine .
Respiratory physician Professor Peter Wark , who was not involved in the study , said spirometry was under-utilised for early chronic airway disease detection .
“ There is a role to look for accelerated loss of lung function , so doing spirometry on a regular basis has definitely got value for people with established airway disease ,” he told Australian Doctor .
Professor Peter Wark .
“ You certainly do not diagnose bronchiectasis based on spirometry or lung function , but you do get an understanding about prognosis and the degree of disease .”
But Professor Wark said the optimal frequency of spirometry tests in such patients was unclear .
The researchers analysed data from 2200 participants in the prospective Tasmanian Longitudinal Health Study who had their respiratory symptom history , lung function , allergies and smoking status recorded five times from the mean age of 7-53 .
At final follow-up , six distinct cough subclasses were identified based on responses to a questionnaire :
• Minimal cough ( 9 %)
• Cough with colds only ( 54 %)
• Cough with allergies ( 14 %)
• Intermittent productive cough ( 10 %)
• Chronic dry cough ( 7 %)
• Chronic productive cough ( 7 %) Chronic productive cough was deemed the “ most clinically
important subclass ” and was linked to the highest prevalence of comorbidities , including COPD , asthma , chronic rhinosinusitis and obstructive sleep apnoea .
Patients with chronic or intermittent productive cough had the worst lifetime FEV 1 and FEV 1
/ forced vital capacity trajectories , the poorest spirometry results at age 53 and the highest exposure to smoking compared with other subclasses .
Professor Wark , from John Hunter Hospital in Newcastle , said that having six different categories “ sounds fairly complex ”.
“ But the underlying thing is that cough is a symptom , and it often is associated with a number of different disorders so it does require taking that history and considering the epidemiology to decide what your next step should be .”
Limitations of the study included use of an old definition of chronic cough ( lasting at least three months instead of the current 8-week threshold ) and lack of specific information on cough severity . Lancet Respir Med 2023 ; 15 Dec .
Warning on osteoporosis medication
FROM PAGE 1 monitoring of calcium levels is recommended during treatment , especially in the first two weeks of initiating therapy ,” the product information says .
It recommends that doctors correct hypocalcaemia before starting treatment and prescribe daily calcium and vitamin D supplementation .
The FDA alert was based on the results of two studies , one of which included 2800 women on dialysis .
It revealed a 41 % cumulative incidence of severe hypocalcaemia for patients taking denosumab versus a 2 % incidence for oral bisphosphonates .
The second study — comparing outcomes for 1.6 million women taking denosumab or bisphosphonate — reported that the rate of severe hypocalcaemia increased with worsening chronic kidney disease .
The FDA said it had also received 77 reports of patients experiencing hypocalcaemia after starting denosumab , with about a third having chronic kidney disease and some also having recurrent hypocalcaemia despite treatment with calcium and vitamin D .