News in brief: Two biomarkers flag accelerated lung function decline in COPD; Decrease in PBS prescriptions for respiratory conditions; COVID-19 vax booster needed for immunocompromised patients: ATAGI

Tuesday, 28 Sep 2021

Two biomarkers flag accelerated lung function decline in COPD

Two biomarkers can predict people who are likely o develop COPD in middle age, Victorian researchers shave shown.

Measuring CC16 and C-reactive protein (CRP) levels in late adulthood could help identify patients with normal or accelerated lung function decline leading to COPD and according to Dr Dinh Bui and colleagues at Melbourne University.

Published in ERJ Open Research, their study assessed several biomarkers’ abilities to predict lung function trajectories in 154 53-year-old COPD patients and 720 controls, defined as never-smokers with average FEV1 trajectories.

It found patients with accelerated lung function decline had significantly lower CC16 (odds ratio [OR]: 0.79, 95% CI: 0.63–0.98 per unit increase) and higher CRP levels (OR: 1.07, 95% CI: 1.00–1.13 per unit increase) than those with normal decline.

Although CC16 (area under the curve [AUC]: 0.69, 95% CI: 0.56–0.81, P = 0.002) and CRP (AUC: 0.63, 95% CI: 0.53–0.72, P = 0.01) alone could differentiate between accelerated and normal decline trajectories, the combination (AUC: 0.72, 95% CI: 0.60–0.83, P < 0.001) was most effective, the authors found.

Meanwhile, interleukins 4, 5,  6 and 10 and tumour necrosis factor-α levels were similar between accelerated decline, normal decline and control patients, they wrote.

Their observations could reflect an underlying excessive inflammatory response in accelerated decline and poor lung development in normal decline trajectories, the authors suggested.

“If so, it is possible that individuals in the accelerated decline trajectory (identified by low CC16 and high CRP levels) may benefit most from treatment with anti-inflammatory drugs, whereas those in the normal decline trajectory (and no evidence of abnormal inflammatory response) are unlikely to do so,” they wrote.

COVID-19 vax booster needed for immunocompromised patients: ATAGI

A third COVID-19 vaccine booster dose will soon be recommended for some Australians with immunocompromising conditions, according to the Australian Technical Advisory Group on Immunisation (ATAGI).

In advice released on 23 September, ATAGI said it anticipated that “a relatively small cohort of individuals, such as those with severely immunocompromising conditions, are likely to require a third dose as part of their primary course of vaccination to ensure optimal vaccine effectiveness.”

ATAGI added that boosters for other populations may be required in the future, and it was preparing recommendations to be released in the next few weeks.

Factors to be considered in recommendations for boosters include the duration of protection provided by additional doses, timing of booster doses to cover anticipated future peaks and the balance of efficacy and safety of third doses of mRNA vaccines, it said. ATAGI is also reviewing the types of vaccine to be used as boosters and the potential for newer  types such as the protein subunit vaccines variant vaccines as they become available.

In the meantime it said first and second dose coverage remained a priority for achieving protection in the current Delta outbreak.

Pandemic sees drop in PBS prescriptions for respiratory conditions

A significant decrease has been reported in dispensing of PBS subsidised respiratory medications during the COVID-19 pandemic. Dispensing of medicines used to treat respiratory related conditions such as asthma and COPD, fell 24.1% from 3.8 million in early 2020 to 2.9 million bin the first quarter of 2021, according to figures from the Australian Institute of Health and Welfare (AIHW).

Respiratory medications showed the largest decline of any medication group, the AIHW report said, with an overall decline in prescriptions dispensed of 6.3% from 79.1 million to 74.1 million between 2020 and 2021.

Some of the decrease was likely due to high demand for medicines and stockpiling during the initial phase of  the pandemic, the AIHW said.

However there were many other changes to prescribing and dispensing of PBS medicines implemented, as well as telehealth arrangements, which may have affected medication dispensing, the report said.

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