Chest 1988;93:580-586. § Scores for dyspnea on the modified Medical Research Council scale range from 0 to 4, with higher scores indicating more severe breathlessness. I have COPD and something was aggravating my breathing problems. Panel A shows the Kaplan–Meier estimate of freedom from exacerbation of COPD in the two trial groups. If beta-blocker therapy is necessary in thes… If correction for multiple comparisons was performed, the results would probably be deemed statistically insignificant. Buy Metoprolol in Des Moines; Buy Metoprolol in ME; Price Metoprolol in Orlando; Price Metoprolol from CO; Buy Metoprolol in Minneapolis; Introduction. However, this mortality difference doesn’t come anywhere close to Details regarding screening, randomization, and follow-up are provided in Figure 1. A total of 532 patients underwent randomization. Transl Res 2013;162:237-251. Sorry, your blog cannot share posts by email. Quint JK, Herrett E, Bhaskaran K, et al. The The authors report that metoprolol caused an increase in dyspnea based on two subjective dyspnea scales (San Diego Shortness of Breath Score and the COPD Assessment Test). Su TH, Chang SH, Kuo CF, Liu PH, Chan YL. Metoprolol for Prevention of COPD Exacerbations C hronic obstructive pulmonary dis - ease (COPD) is the third leading cause of death worldwide. Metoprolol was purchased for use in the trial; matching placebo was manufactured at the Current Good Manufacturing Practices Facility at the Temple University School of Pharmacy. were enrolled if they had COPD and lacked This study should not change practice. All the analyses are based on the intention-to-treat principle. S4, S5, and S6). In-hospital and 5-year mortality of patients treated in the ICU for acute exacerbation of COPD: a retrospective study. β-Blockers after acute myocardial infarction in patients with chronic obstructive pulmonary disease: a nationwide population-based observational study. After the first interim analysis on November 30, 2018, the committee recommended that the trial be continued but planned to reconvene before the second interim analysis to review serious adverse events. listed: So, Supported by a grant (W81XWH-15-1-0705) from the Department of Defense. ); Temple University School of Medicine, Philadelphia (G.J.C. Metoprolol was associated with a higher risk of exacerbation leading to hospitalization (hazard ratio, 1.91; 95% CI, 1.29 to 2.83). Chest 2005;127:818-824. Risk indexes for exacerbations and hospitalizations due to COPD. The median time until the first exacerbation was 202 days in the metoprolol group and 222 days in the placebo group. We used Kaplan–Meier methods and Cox models to perform similar analyses of overall survival and used negative binomial regression models to analyze exacerbation rates. No commercial entity was involved in the trial. Albert RK, Connett J, Bailey WC, et al. Lancet Respir Med 2015;3:631-639. For the time until the first exacerbation of moderate severity or greater, the unadjusted hazard ratio was 1.47 (95% CI, 1.06 to 2.04) and the adjusted hazard ratio was 1.46 (95% CI, 1.03 to 2.06) (Fig. BMJ Open 2016;6(6):e012292-e012292. DeMets DL, Lan KK. Es leite sich zwangsläufig die Empfehlung ab, keine Patienten mit Metoprolol zu behandeln, bei denen hierfür keine eindeutige Indikation bestehe, und insbesondere keine Hochrisiko-COPD-Patienten. Patients were followed until completion of the day 336 visit, after which they were weaned off either metoprolol or placebo, and were monitored for symptoms of beta-blocker withdrawal until the day 378 visit. Beta-blockers are safe for most patients with asthma and COPD? 26. There was no significant between-group difference in the median time until the first exacerbation, which was 202 days (95% confidence interval [CI], 162 to 282) in the metoprolol group and 222 days (95% CI, 189 to 295) in the placebo group (Figure 2A). We excluded patients who were already taking a beta-blocker or who had an established indication for the use of such drugs. — all in Minnesota; New York–Presbyterian (NYP)–Columbia University Medical Center (K.B. Our trial has several limitations. Bhatt SP, Dransfield MT. Objective measurements of lung function were the same (e.g. Some beta-adrenergic receptor blocking agents (i.e., beta-blockers) are contraindicated in patients with bronchial asthma or with a history of bronchial asthma, or severe chronic obstructive pulmonary disease. For fatal adverse events, the P value for the overall between-group comparison was calculated by the log-rank test; P=0.17 by Fisher’s exact test for the overall comparison among the causes of death. COPD is a very common, smoking-related disease with a large morbidity and increasing mortality worldwide. Fourth, we do not know whether these results would be similar for other cardioselective beta-blockers or for noncardioselective agents, although concern regarding adverse respiratory effects is greater with the latter.36 Finally, we did not enroll patients who had a proven indication for the use of a beta-blocker or who were already taking the drugs, so our results do not inform the risk of COPD exacerbations with metoprolol in such patients. We need to stop overinterpreting non-causal associations. As discussed earlier, premature termination increases the likelihood of obtaining spurious results due to transient statistical fluctuations. General considerations for lung function testing. Effect on mortality of metoprolol in acute myocardial infarction: a double-blind randomised trial. † For nonfatal adverse events, P values were calculated by Student’s t-test. study was designed to test the concept that beta-blockers could reduce the The most trusted, influential source of new medical knowledge and clinical best practices in the world. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Chen W, Thomas J, Sadatsafavi M, FitzGerald JM. Case Records of the Massachusetts General Hospital, Who Goes First? The frequency of side effects that were possibly related to metoprolol was similar in the two groups, as was the overall rate of nonrespiratory serious adverse events. On March 21, 2019, the committee recommended that the trial be stopped on the basis of the conditional power analyses and concern about safety. 7. Chest 2007;132:456-463. Among numerous secondary endpoints, there was an increase in the rate of severe exacerbations within the metoprolol group. Ai-Ping C, Lee KH, Lim TK. We conducted this placebo-controlled, double-blind, prospective, randomized trial at 26 centers in the United States. As 6. Thisstudy was designed to test the concept that beta-blockers could reduce theincidence of COPD exacerbation. ); the Cincinnati VA Medical Center, Cincinnati (R.J.P. seriously: The authors presented these results in a rather dark light: The 36. van der Woude HJ, Zaagsma J, Postma DS, Winter TH, van Hulst M, Aalbers R. Detrimental effects of beta-blockers in COPD: a concern for nonselective beta-blockers. We enrolled patients between the ages of 40 and 85 years who had received a clinical diagnosis of COPD and who had at least moderate airflow limitation, as defined by the Global Initiative for Obstructive Lung Disease (GOLD),2 as follows: a forced expiratory volume in 1 second (FEV1) of less than 80% of the predicted value after bronchodilation and a ratio of the FEV1 to the forced vital capacity (FVC) of less than 0.70. An exacerbation of COPD was defined as an increase in or a new onset of two or more of the following symptoms: cough, sputum production, wheezing, dyspnea, or chest tightness that led to treatment with antibiotics or systemic glucocorticoids for at least 3 days.25,26 The severity of the exacerbation was graded according to the following scale: mild (involving only home management, with or without contact with a health care provider), moderate (leading to a visit to an emergency department), severe (leading to hospitalization), and very severe (leading to intubation and mechanical ventilation). 19. This led to the current BLOCK-COPD trial which (spoiler alert) shows that metoprolol isn’t beneficial for COPD. There were no significant between-group differences in several prespecified measurements, including the change from baseline in the FEV. Post was not sent - check your email addresses! They had a higher rate of COPD exacerbation within the year prior to study enrollment (63% vs. 50%, p=0.005). Sie stimulieren relativ selektiv die adrenergen ... sind kardioselektive Betablocker wie Metoprolol und Bisoprolol relativ β 1-selektiv. If continued, what about if they are taking high dose per day of metoprolol, ie., >=100mg daily. Am J Respir Crit Care Med 2002;166:111-117. Westerik JA, Metting EI, van Boven JF, Tiersma W, Kocks JW, Schermer TR. are several reasons why this secondary endpoint shouldn’t be taken too Mahler DA, Wells CK. Bhatt SP, Connett JE, Voelker H, et al. Severe or very severe exacerbations occurred in 26.1% of the patients in the metoprolol group and in 14.8% of those in the placebo group. 34. Information, resources, and support needed to approach rotations - and life as a resident. A data sharing statement provided by the authors is available with the full text of this article at NEJM.org. ), Minneapolis, HealthPartners Minnesota, Bloomington (C.M. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. The metoprolol group also had a greater increase in SOBQ scores from baseline, indicating a worsening in shortness of breath. Baseline imbalances exist between the two patient groups. Hjalmarson A, Elmfeldt D, Herlitz J, et al. Development and validation of an improved, COPD-specific version of the St. George Respiratory Questionnaire. Patients were excluded from the trial if they had a class I indication for receipt of a beta-blocker (a history of myocardial infarction or revascularization within the previous 36 months or heart failure with a known left ventricular ejection fraction of less than 40%), according to the guidelines of the American College of Cardiology and the American Heart Association. Thestudy was stopped prematurely based on a combination of futility (very lowlikelihood that the trial could possibly show b… For severe or very severe exacerbations, the unadjusted and adjusted hazard ratios were 1.91 (95% CI, 1.29 to 2.83) and 2.08 (95% CI, 1.37 to 3.14), respectively (Figure 2B). Spirometric reference values from a sample of the general U.S. population. ); the University of Maryland, Baltimore (R.M.R. DOI: 10.1056/NEJMoa1908142, Tap into groundbreaking research and clinically relevant insights. Josh is the creator of PulmCrit.org. such, focusing on this trend within the abstract seems a bit irresponsible. Interim analysis: the alpha spending function approach. example, the following punchline has already appeared on MedPage Today: The neutral results were pretty much expected. Thus, we do not know whether our results would apply to patients with mild airflow obstruction or a lower exacerbation risk. Premature termination increases the Circulation 2013;128(16):e240-e327. There was no difference in the risk of COPD exacerbation between the metoprolol and the placebo groups, although the use of metoprolol was associated with a higher risk of exacerbation leading to hospitalization. Stat Med 1994;13:1341-1356. 31. The The use of beta-blockers in COPD has been subject to repeated reversals over the past few decades. The beta-blocker metoprolol does not lower the risk for chronic obstructive pulmonary disease (COPD) exacerbations in high-risk patients without indications for beta-blocker therapy, according to a randomized trial. Concise summaries and expert physician commentary that busy clinicians need to enhance patient care. 33. Patients who had not yet completed the day 336 visit were contacted early to undergo final assessments and begin weaning from metoprolol or placebo, according to the protocol. No effect on lung function was observed in the metoprolol group. No other potential conflict of interest relevant to this article was reported. For This dose adjustment resulted in a final daily dose of 25 mg, 50 mg, or 100 mg. ); the University of Washington, Seattle (A.A.L. Lancet 1981;2:823-827. We used Student’s t-tests to compare annualized rates of hospitalization and nonfatal serious adverse events and used mixed-effects models with patient-specific random intercepts to compare between-group differences in changes in continuous measures of secondary end points. — both in Birmingham; the University of Minnesota (H.V., E.S.H., S.L., J.E.C.) ); National Jewish Health, Denver (B.J.M. Eakin EG, Resnikoff PM, Prewitt LM, Ries AL, Kaplan RM. Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation, October 23, 2019 by Josh Farkas 2 Comments. Fihn SD, Gardin JM, Abrams J, et al. During the treatment period, there were 11 deaths in the metoprolol group and 5 in the placebo group. The inclusion criteria were a resting heart rate between 65 and 120 beats per minute and a resting systolic blood pressure of more than 100 mm Hg. In a randomized, double-blind, crossover trial, 40 CAD patients with mild COPD and significant reversibility received either bisoprolol 5 mg or atenolol 50 mg [ 84 ]. • If attempting this audit in your own practice it might be worth considering if there are any patients who should no longer be classified as having asthma. Three beta blockers have demonstrated a survival benefit in systolic heart failure: the cardioselective agents metoprolol XL and bisoprolol, and the noncardioselective carvedilol. ATS statement: guidelines for the six-minute walk test. He told me to just stop taking the Metoprolol. Panel B shows the probability of freedom from either a severe exacerbation (leading to hospitalization) or a very severe exacerbation (leading to hospitalization with intubation and mechanical ventilation). Effect of β blockers on mortality after myocardial infarction in adults with COPD: population based cohort study of UK electronic healthcare records. Azithromycin for prevention of exacerbations of COPD. There Patientswere enrolled if they had COPD and lackedany indication for beta-blockers (e.g., prior myocardial infarction or systolicheart failure). This was exactly the same between groups: In median time until a COPD exacerbation. December 12, 2019N Engl J Med 2019; 381:2304-2314 Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery. Metoprolol zählt jedoch neben Bisoprolol, Nebivolol und Atenolol zu den selektiven Betablockern, welche nur am Herzen wirken: Damit ist der Wirkstoff auch für Asthma- und COPD-Patienten mit Herz-Kreislauf-Erkrankungen geeignet. The primary end point was the time until the first exacerbation of COPD during the treatment period, which ranged from 336 to 350 days, depending on the adjusted dose of metoprolol. ); Northwestern University, Chicago (R. Kalhan); the University of Vermont, Burlington (D.K. will almost certainly be misinterpreted to mean that beta-blockers are unsafe ), and the University of California, San Francisco, San Francisco (S.C.L.) 17. ), and Mayo Clinic, Rochester (P.D.S.) The rate of overall nonfatal serious adverse events was 0.65 per person-year in the metoprolol group and 0.43 per person-year in the placebo group. The majority of deaths in the metoprolol group were attributed to COPD (7, vs. 1 in the placebo group) (Table 3). ), the University of California, San Francisco–Fresno, Fresno (V.V.J. trend in mortality is mentioned here, which seems to imply that metoprolol (Scores on the St. George’s Respiratory Questionnaire range from 0 to 100, with lower scores indicating better functioning and with a minimal clinically important difference [MCID] of 4 points.30 Scores on the COPD Assessment Test range from 0 to 40, with lower scores indicating better functioning and with a MCID of 2 points.31 Scores for dyspnea on the mMRC scale range from 0 to 4, with higher scores indicating more severe breathlessness.32 Scores on the San Diego Shortness of Breath Questionnaire range from 0 to 120, with higher scores indicating more severe breathlessness and with an MCID of 5 points.33), The data and safety monitoring committee met approximately every 6 months to review recruitment, follow-up rates, safety, and efficacy results. Among patients with moderate or severe COPD who did not have an established indication for beta-blocker use, the time until the first COPD exacerbation was similar in the metoprolol group and the placebo group. 10. ), NYP–Queens Medical Center (A.S.), and NYP–Brooklyn Methodist Medical Center (J.A.W.) N Engl J Med 2014;370:2201-2210. From the Lung Health Center, University of Alabama at Birmingham (M.T.D., S.P.B., J.M.W., E.W. Use of beta blockers and the risk of death in hospitalised patients with acute exacerbations of COPD. vast majority of these secondary endpoints were negative. Among the 145 patients who were excluded from the trial, several had more than one reason for exclusion. pre-test probability that the hypothesis is valid and the overall constellation of data findings). Copyright 2009-. For a long time, there was a belief that beta-blockers were contraindicated in COPD. Associations between chronic comorbidity and exacerbation risk in primary care patients with COPD. Which Genes for Hereditary Breast Cancer? In your case, individual circumstances may deem othe ... Read More I’m surprised that you didn’t mention the higher rate of active smokers in the Metoprolol group (35% vs 27%), which is known to result in more and more severe COPD exacerbations. Evaluation of clinical methods for rating dyspnea. Am J Respir Crit Care Med 2012;186:155-161. — all in New York; Lundquist Institute for Biomedical Innovation at Harbor–UCLA Medical Center, Los Angeles (R.C., W.W.S. ), and Birmingham Veterans Affairs (VA) Medical Center (M.T.D., J.A.D.C., J.M.W.) The starting dose was one 50-mg tablet of metoprolol or matching placebo taken orally daily. In this prospective, multicenter, randomized trial, we did not find evidence of a difference in the risk of COPD exacerbation between the metoprolol group and the placebo group, although the use of metoprolol was associated with a higher risk of exacerbation leading to hospitalization. Betasympathomimetika werden vor allem bei Asthma bronchiale und COPD verordnet. From May 2016 through March 2019, a total of 532 patients underwent randomization (268 to the metoprolol group and 264 to the placebo group). Indeed, this study raises concerns about the safety of metoprolol in COPD, which actually puts us back to where we were initially! There was no significant between-group difference in the median time until the first exacerbation, which was 202 days (95% confidence interval [CI], 162 to 282) in the metoprolol group and 222 days (95% CI, 189 to 295) in the placebo group (. Unfortunately, this pattern shows no signs of abating today. 23. There were no changes in A common The discontinuation of metoprolol or placebo occurred more frequently in the metoprolol group than in the placebo group (11.2% vs. 6.1%). The trial was stopped early because of futility with respect to the primary end point and safety concerns. * Listed are adverse events that were reported as serious by the investigator. Key secondary end points included the rate of COPD exacerbations, all-cause mortality, all-cause hospitalization, results of spirometry, distance on the 6-minute walk test, dyspnea assessments, and measures of quality of life. Thorax 2008;63:301-305. The primary end point was the median time until the first COPD exacerbation of any severity during the treatment period, which was defined as the period from randomization to day 336 for the patients receiving a final dose of 25 mg of metoprolol or placebo or until day 350 for those receiving a dose of 50 mg or 100 mg. Respir Res 2017;18:31-31. Validation of a new dyspnea measure: the UCSD Shortness of Breath Questionnaire: University of California, San Diego. We observed no evidence of between-group differences in the frequency of patient-reported adverse events that were potentially related to metoprolol (Table S3). Metoprolol copd. The patients in the metoprolol group had a greater increase (indicating worse control) from baseline in the score on the COPD Assessment Test than those in the placebo group, with a difference of 1.13 points (95% CI, 0.06 to 2.20) at day 112 and a difference of 1.47 points (95% CI, 0.32 to 2.62) at day 336 (Fig. Columbus’s voyage was negative, because he failed to reach China (his COPD and Beta-blockers: another myth dispensed…, IBCC chapter – Disseminated Intravascular Coagulation (DIC), PulmCrit- RCTs don't justify using convalescent plasma or antibody cocktails. The mean (±SD) age of the patients was 65.0±7.8 years, the mean FEV1 was 41.1±16.3% of the predicted value, and the mean smoking exposure was 50.1±29.1 pack-years. Patients remained free of adverse respiratory effects and FEV 1 was unchanged [ 83 ]. This 13. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF). the study protocol (published at clinicaltrials.gov) the following endpoints are 16. We based the sample size and considerations for statistical power on the primary end point of the time until the first exacerbation of COPD. 24. Metoprolol was well tolerated for 3 months by 50 patients with coexistent CAD and mild to severe COPD. (Details regarding the power analyses are provided in the Supplementary Appendix, available at NEJM.org.) mortality or all-cause hospitalization. A complete list of the BLOCK COPD trial group members is provided in the Supplementary Appendix, available at NEJM.org. In a murine model of antigen-induced airway inflammation and AHR, duration of therapy was the determinant of response to β-AR ligands . Written informed consent was obtained from all the patients. Percentages may not total 100 because of rounding. Thus, we do not know whether our results would apply to patients with mild airflow obstruction or a lower exacerbation risk. Salpeter S, Ormiston T, Salpeter E. Cardioselective beta-blockers for chronic obstructive pulmonary disease. Dr. Dransfield reports receiving consulting fees and serving on clinical trials for Boehringer Ingelheim, GlaxoSmithKline, AstraZeneca, and PneumRx/BTG, serving on clinical trials for Novartis, Yungjin, Boston Scientific, Gala Therapeutics, and Nuvaira, receiving travel support and serving on clinical trials for Pulmonx, and receiving consulting fees from Quark Pharmaceuticals and Mereo; Dr. Bhatt, receiving advisory board fees from Sunovion and GlaxoSmithKline and research funding, paid to his institution, from ProterixBio; Dr. Casaburi, receiving grant support, advisory board fees, and lecture fees from GlaxoSmithKline, Boehringer Ingelheim, and AstraZeneca, consulting fees from Regeneron and Genentech, and owning stock in Inogen; Dr. Come, receiving clinical trial support from Sunovion Pharmaceuticals; Dr. Criner, receiving grant support and consulting fees from Boehringer Ingelheim, grant support from Novartis, AstraZeneca, Respironics, MedImmune, Actelion, Forest, Pearl, Ikaria, Aeris, PneumRx, and Pulmonx, having an equity interest in Healthcare Solutions, receiving consulting fees from Amirall and Holaira, and receiving grant support and serving as a consultant for GlaxoSmithKline; Dr. Han, receiving consulting fees and honoraria from GlaxoSmithKline, AstraZeneca, and Boehringer Ingelheim, consulting fees from Mylan, and research support from Sunovion and Novartis; Dr. Jain, receiving consulting fees, advisory fees, and lecture fees from AstraZeneca Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals, Genentech, Mallinckrodt, and GlaxoSmithKline; Dr. Kalhan, receiving grant support, consulting fees, and lecture fees from Boehringer Ingelheim and GlaxoSmithKline, grant support from PneumRx/BTG and Spiration, grant support and consulting fees from AstraZeneca, and consulting fees from CVS Caremark, Aptus Health, Boston Scientific, and Boston Consulting Group; Dr. Kaminsky, receiving lecture fees from MGC Diagnostics; Dr. Kaner, receiving grant support, consulting fees, and lecture fees from Genentech and Boehringer Ingelheim, fees for serving on an adjudication committee from MedImmune and Gilead, and grant support from Bristol-Myers Squibb, Afferent, Respivant, and Toray; Dr. Kunisaki, receiving consulting fees from GlaxoSmithKline and Nuvaira; Dr. Make, receiving grant support, paid to National Jewish Health, fees for serving as an international principal investigator on a clinical trial, advisory board fees, and presentation fees from AstraZeneca, serving as a reviewer and serving on a data and safety monitoring board for Spiration, grant support, paid to National Jewish Health, advisory board fees, and presentation fees from GlaxoSmithKline, grant support, paid to National Jewish Health, and medical board fees from Sunovion, participating in CME activities for WebMD, Up-To-Date, Projects in Knowledge, Hybrid Communications, Medscape, and Catamount Medical, serving as a consultant and on an advisory board for Novartis, receiving grant support, paid to National Jewish Health, from Pearl Therapeutics, advisory board fees from Verona, Boehringer Ingelheim, Theravance, Circassia, Phillips, and Science 24/7, consulting fees from Third Pole, and fees for serving on a data safety and monitoring board from Shire; Dr. Martinez, receiving advisory board fees, fees for serving on a steering committee, presentation fees, and travel support from AstraZeneca, advisory board fees, presentation fees, fees for serving on a data and safety monitoring board, and travel support from Boehringer Ingelheim, advisory board fees and trial support from ProterixBio, advisory board fees, fees for serving on a data and safety monitoring board, and travel support from Genentech, advisory board fees, fees for serving on a steering committee, fees for serving on a data and safety monitoring board, presentation fees, and travel support from GlaxoSmithKline, honoraria and travel support from MD Magazine, honoraria and travel support from Miller Communications, advisory board fees, presentation fees, and travel support from Novartis, advisory board fees, fees for serving on a steering committee, and travel support from Pearl Therapeutics, honoraria and travel support from PeerView Communications, honoraria and travel support from Prime Communications, honoraria, advisory board fees, and travel support from Chiesi, advisory board fees and travel support from Sunovion, advisory board fees and travel support from Theravance, honoraria from UpToDate, honoraria from WebMD/MedScape, fees for serving on a steering committee from Afferent/Merck, fees for serving on a steering committee from Gilead, fees for serving on a steering committee and travel support from Nitto, honoraria and serving on a steering committee for Patara/Respivant, honoraria and travel support from Potomac Center for Medical Education, serving on a data and safety monitoring board and serving on a steering committee for Biogen, fees for serving on a steering committee from Veracyte, advisory board fees and travel support from Zambon, honoraria and travel support from Physicians Education Resource, honoraria from Rockpointe, serving on a steering committee for Prometic, honoraria from Rare Disease Healthcare Communications, serving on a steering committee for Bayer, serving as an advisor for Bridge Biotherapeutics, honoraria and travel support from Canadian Respiratory Network, serving on a steering committee for Promedior, advisory board fees and travel support from Teva, and serving on an advisory board for Gala Therapeutics; Dr. McEvoy, receiving grant support from GlaxoSmithKline and consulting fees from Respirtech; Dr. Reed, receiving grant support from Janssen Research and Development; Dr. Scanlon, receiving grant support from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, and Sanofi; Dr. Sciurba, receiving grant support from Astellas, AstraZeneca, PneumRx/BTG, Pulmonx, Nuvaira, and Gala Therapeutics and advisory board fees from GlaxoSmithKline, Verona, and Theravance; Dr. Sriram, receiving grant support from AstraZeneca and GlaxoSmithKline; Dr. Stringer, receiving grant support from AstraZeneca and Boehringer Ingelheim, consulting fees and fees for serving on a data and safety monitoring board from Allergan, and fees for serving on a data and safety monitoring board from Syneos Health; Dr. Wells, receiving grant support from Bayer, grant support and advisory board fees from GlaxoSmithKline and Mereo BioPharma, advisory board fees from Boehringer Ingelheim, and serving as end-point adjudicator for Quintiles and PRA Health Sciences; and Dr. Lazarus, receiving fees for education from Boehringer Ingelheim.
Idaho Sales Tax, Spike Jonze Instagram, Muzzle Brake California, Florida Road, Durban, Oregon License Plate 2020, 6th Armoured Division British, Omg Did He Call Her Baby Tiktok, Ab Dekh Khuda Kia Karta Hai Last Episode, Roman Forum Map, Obsidian Note-taking Tutorial, Ngien Hoon Ping Chinese Name, 2016 Olympics Women's Gymnastics Results, University Of Bedfordshire Nursing Entry Requirements, Ladder Material Lift, Pittsburg, Ca Shooting 2020,