TORONTO--New hope for older patients with chronic obstructive pulmonary disease, new findings about the nighttime breathing disorder known as sleep apnea in postmenopausal women, and evidence of treatment bias toward elderly lung cancer patients were presented here today at a press panel at the ATS2000, the American Thoracic Society's 96th International Conference.
Inhaled Steroids Reduce Death Risk for Elderly COPD Patients Elderly patients with chronic obstructive pulmonary disease (COPD) who use inhaled steroids after being discharged from the hospital can significantly reduce their risk of rehospitalization and death, according to a study presented today at the ATS2000 press panel.
Researchers at the University of Toronto and University of Alberta studied records of 22,225 COPD patients age 65 and older, who were hospitalized at least once for COPD (emphysema and chronic bronchitis) between 1992 and 1996. Of these, 52% received one or more prescriptions of inhaled steroids within 90 days of being discharged from the hospital. Those who received inhaled steroids were 20% less likely to be rehospitalized or to die over the next year compared with patients who didn't take inhaled steroids.
Lead researcher Don D. Sin, M.D., noted that until now, the role of inhaled steroids in the management of COPD patients has not been well known. "A major component of COPD is airway inflammation, and corticosteroids suppress airway inflammation," Dr. Sin explained. He noted that the steroids were more likely to reduce hospitalizations and deaths in patients with more severe COPD.
Sleep Apnea Risk Increases After Menopause
Women who have gone through menopause are more likely than premenopausal women to have the nighttime breathing disorder known as sleep apnea, and to have a more severe form of the problem, according to a study presented today at the ATS2000 press panel.
The study included 290 premenopausal women and 400 postmenopausal women referred to a sleep clinic for sleep-related symptoms. Postmenopausal women were more obese and had a larger neck size than premenopausal women—both known risk factors for sleep apnea—but even after taking these factors into account, postmenopausal women still had more severe sleep apnea than premenopausal women.
The researchers founds that sleep apnea was significantly more likely to occur in postmenopausal women (47%) compared with premenopausal women (21%). In addition, sleep apnea was more likely to be severe in postmenopausal women compared with premenopausal women (an average of 17 breathing stoppages per hour vs. 9).
Sleep apnea is a condition in which a person stops breathing for at least 10 seconds at a time repeatedly during the night. These breathing pauses can occur many times within an hour. A person wakes up in order to breathe again, resulting in excessive daytime sleepiness. Sleep apnea is the most common medical disorder that causes excessive daytime sleepiness.
According to lead author David R. Dancy, M.D., of St. Michael's Hospital at the University of Toronto, the findings suggest that functional, rather than anatomical, differences in the upper airway may explain the difference in the prevalence and severity of sleep apnea between these two groups of women. "One theory is that estrogen and progesterone influence upper airway function, protecting premenopausal women from sleep apnea," said Dr. Dancey. "This effect is lost after menopause, given the absence of these hormones. Treatment of postmenopausal women with hormone replacement therapy might protect them from sleep apnea, and treating these women who already have sleep apnea might improve their condition."
Age Bias Seen in Lung Cancer Patients
Elderly lung cancer patients in the United Kingdom are being denied treatment purely on the basis of their age, which reduces their chance for survival, according to a study presented at the ATS2000 press panel today.
Researchers from the Royal College of Physicians in London studied 1652 lung cancer patients, with an average age of 69, and found that older patients were less likely to receive active treatment of any sort, to undergo surgery if diagnosed with non-small-cell lung cancer, or to survive six months after diagnosis. "Older patients with exactly the same extent and type of lung cancer, prognostic factors and co-existing diseases were being less actively treated," said researcher Michael Peake, M.D.
Dr. Peake explained that the average age of patients with lung cancer at the time of diagnosis is around 70 years. The only real hope of "cure" or long term survival for most patients is surgery, though high-dose radiotherapy and chemotherapy are successful in a smaller number of patients, he noted. Several previous studies have shown that age alone has little or no effect on the outcomes of such treatments, and he and his colleagues decided to investigate this question.
Dr. Peake and colleagues found that in patients with good performance status (a measure of patients' activity and dependence on caregivers), lung cancer that had not spread, and no COPD, 23% of patients under 65 died within six months compared with 31% of patients 65-74, and 33% ages 75 and older. In lung cancer patients with good performance status, cancer that had not spread and no COPD, surgery was performed in 37% of patients under 65, 24% in patients 65-74, and 15% of patients over 75; i.e. the rate of potentially curable surgery in the oldest group was less than half that in the youngest.
The death rate at 6 months showed that this under-treatment was being translated into a higher death rate--even taking into account other causes of death in older patients, Dr. Peake said. In the group with the best prognosis, 76% of patients under 65 years of age were alive, compared with 67% of patients between 65-74 but only 58% of patients of 75 and over.
"Many physicians seem to assume that older patients have a worse prognosis and deny them access to a surgeon or oncologist," Dr. Peake said. "Some physicians may feel it's not worthwhile to treat these patients because of the poor overall survival statistics. And older patients may not wish to go through what they perceive as the traumas of such treatments, although their decision often is very dependent on the knowledge and enthusiasm of the doctor involved."