UAB MEDICINE PULMONARY SERVICES
FEATURE STORIES
WINTER 2020
To read these and past stories online, please visit uabmedicine.org/pulmupdate.
BETA BLOCKERS DON’T REDUCE RISK OF FLARE-UPS IN COPD PATIENTS
New research from UAB Medicine scientists published in the
New England Journal of Medicine found that beta blockers
used in a clinical trial for patients with chronic obstructive
pulmonary disease (COPD) do not reduce the risk of flare-ups,
also called COPD exacerbations.
“It is well-known that patients who have experienced a heart
attack have better outcomes after taking beta blockers,” says
study lead author Mark Dransfield, MD. “Beta blockers protect
the heart by lowering pulse and blood pressure. However, we
wanted to test the effects of beta blockers in patients with
COPD to see if this could also have a positive impact on the
lung disease itself, and specifically whether it would reduce the
risk of exacerbations.”
For a long time, people with COPD were not given beta
blockers – even when they had heart attacks – because
doctors were afraid it would worsen lung function, Dr.
Dransfield says. This continued even though the available
data suggest that patients with COPD who have heart attacks
benefit from beta blockers just as much as those without COPD.
More recent studies also suggested beta blockers may reduce
mortality and the risk of COPD exacerbations, regardless of
whether patients had underlying cardiovascular disease.
However, Dr. Dransfield says the study findings showed no
evidence that beta blockers were helpful.
“What we found was that beta blockers don’t do anything
to reduce the overall risk of exacerbation, but they did
increase the rate of severe exacerbations that required
hospitalization,” he says. “The explanation for the higher risk
of COPD hospitalization is not certain, though we did not see
any evidence that lung function itself was worsened with beta
blockers.”
The 532 participants of the trial ranged in age from 40 to 85
and had a clinical history of COPD, at least moderate airflow
limitation, and were at increased risk for exacerbation. Patients
already taking beta blockers or who had proven indications for
the drugs were excluded, and the results do not directly apply
to those groups.
Nearly 12 million people in the United States and roughly 10% of
the general population in Alabama have been diagnosed with
COPD. Smoking is the most common risk factor among them.
INNOVATIVE TOOL GIVES RESEARCHERS NEW LOOK AT NASAL AIRWAYS IN CF PATIENTS
A paper published in Science Translational Medicine describes
a simple, minimally invasive new tool for viewing differences in
the nasal airways of cystic fibrosis patients in vivo at a cellular
level. The new technique provides high-resolution images of
the hair-like structures called cilia that line nasal airways, as well
as of the detailed features of the clearance of mucus, which is
impaired in people with CF, causing significant morbidity.
The imaging catheter, which is about 2 mm in diameter, uses
optical coherence tomography (OCT) with a resolution of about
1 micrometer — a 50th the size of a human hair — allowing
researchers to probe the nasal passages of patients without
sedating them.
Among the researchers’ findings were that, in CF patients,
the mucus was dehydrated and moved slowly, impacting cilia
speed. The mucus also contained more inflammatory cells.
There were other surprises, too; for example, researchers found
that they could measure the greater viscosity of the mucus, and
patches of CF patients’ cilia and epithelium were ablated.
The approximately 30,000 cystic fibrosis patients in the United
States have an average life expectancy of over 45 years. The
new technique will allow clinicians to diagnose and monitor
diseases that affect the airways earlier and optimize drug
therapies for CF patients.
“Visualizing abnormal mucus will be a powerful tool,” says
investigator Steven M. Rowe, MD, director of the Gregory
Fleming James Cystic Fibrosis Research Center. “Now we’ll be
able to see how various treatments — not only those intended
to fix the mucus, but also agents that repair the basic CF defect
— affect airways.”
The researchers expect micro-OCT to have many applications
beyond cystic fibrosis, from diagnosing and treating respiratory
ailments like primary ciliary dyskinesia, chronic sinus disease,
and COPD to screening the GI tract for disease and imaging
coronary artery cells.
“The goal is to figure out who else it can be used to help and
make it more broadly accessible as a device,” Dr. Rowe says.