***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: The beneficial effects of nocturnal oxygen therapy ( NOT ) in chronic obstructive pulmonary disease ( COPD ) patients with mild-to-moderate daytime hypoxaemia ( arterial oxygen tension ( Pa , O2 ) in the range 7.4 - 9.2 kPa ( 56 - 69 mmHg ) ) and exhibiting sleep-related oxygen desaturation remains controversial . The effectiveness of NOT in that category of COPD patients was studied . The end points included pulmonary haemodynamic effects after 2 yrs of follow-up , survival and requirement for long-term oxygen therapy ( LTOT ) .  Seventy-six patients could be r and omized , 41 were allocated to NOT and 35 to no NOT ( control ) . The goal of NOT was to achieve an arterial oxygen saturation of > 90 % throughout the night . All these patients underwent polysomnography to exclude an associated obstructive sleep apnoea syndrome . The two groups exhibited an identical meansD daytime Pa , O2 of 8.4+/-0.4 kPa ( 63+/-3 mmHg ) at baseline . Twenty-two patients ( 12 in the NOT group and 10 in the control group , p=0.98 ) required LTOT during the whole follow-up ( 35+/-14 months ) . Sixteen patients died , nine in the NOT group and seven in the control group ( p=0.84 ) . Forty-six patients were able to undergo pulmonary haemodynamic re-evaluation after 2 yrs , 24 in the NOT and 22 in the control group . In the control group , mean resting pulmonary artery pressure increased from 19.8+/-5.6 to 20.5 + 6.5 mmHg , which was not different from the change in mean pulmonary artery pressure in the NOT group , from 18.3+/-4.7 to 19.5+/-5.3 mmHg ( p= 0.79 ) . Nocturnal oxygen therapy did not modify the evolution of pulmonary haemodynamics and did not allow delay in the prescription of long-term oxygen therapy . No effect of NOT on survival was observed , but the small number of deaths precluded any firm conclusion . These results suggest that the prescription of nocturnal oxygen therapy in isolation is probably not justified in chronic obstructive pulmonary disease patients BACKGROUND Patients with COPD have an increased risk of cardiovascular disease . Despite the clinical benefits of long-acting beta-agonist agents in the treatment of COPD , patients may be at an increased risk of cardiovascular toxicity , including tachyarrhythmia due to beta-adrenergic stimulation . OBJECTIVE To evaluate the cardiovascular safety of salmeterol in COPD patients by conducting a pooled analysis of cardiovascular safety data . DESIGN R and omized , double-blind , parallel group , multiple-dose studies , which included salmeterol , 50 micro g bid , and placebo arms . STUDY SELECTION Seven of a total of 17 studies met the predefined inclusion requirements and were pooled . A total of 1,443 patients received placebo , while 1,410 patients received salmeterol , 50 micro g bid . The median duration of treatment was 24 weeks ( range , 12 to 52 weeks ) . RESULTS Treatment with salmeterol , 50 micro g bid , showed no increased risk of cardiovascular adverse events ( AEs ) compared with placebo ( relative risk , 1.03 ; 95 % confidence interval , 0.8 to 1.3 ; p = 0.838 ) . Both groups had a similar incidence of cardiovascular events ( 8 % ) , including cardiovascular deaths . The incidence of cardiovascular AEs increased with age , concurrent cardiovascular conditions , and treatment with antiarrhythmic/bradycardic agents , although increases were comparable in both treatment groups . There were no episodes of sustained ventricular tachycardia , and no clinical ly significant differences were observed in 24-h heart rate , ventricular and supraventricular ectopic events , qualitative ECGs , QT intervals , or vital signs between the salmeterol , 50 micro g bid , group and the placebo group . Similar findings were observed when patients were stratified for age of > 65 years or the known presence of cardiovascular disease . CONCLUSIONS Treatment with salmeterol , 50 micro g bid , does not increase the risk of cardiovascular AEs in this population of COPD patients compared with placebo BACKGROUND : To date only two controlled studies have been published on the effects of domiciliary oxygen treatment on survival in patients with chronic obstructive pulmonary disease ( COPD ) with advanced respiratory failure . The survival in such patients despite oxygen treatment remains poor . The prescription of long term oxygen therapy ( LTOT ) in less severe disease remains controversial . The aim of this study was to evaluate the rationale for prescribing oxygen to patients with COPD with moderate hypoxaemia . METHODS : One hundred and thirty five patients with COPD , with PaO2 7.4 - 8.7 kPa ( 56 - 65 mmHg ) and advanced airflow limitation ( mean ( SD ) forced expiratory volume in one second ( FEV1 ) 0.83 ( 0.28 ) 1 ) , were r and omly allocated to a control ( n = 67 ) and LTOT ( n = 68 ) group . The patients were followed every three months for at least three years or until death . RESULTS : The cumulative survival rate was 88 % at one year , 77 % at two years , and 66 % at three years . No significant differences were found in survival rates between patients treated with LTOT and controls , nor did longer oxygen use ( over 15 hours per day ) improve survival . Younger age , better spirometric values , and higher body mass index predicted better survival . CONCLUSIONS : Domiciliary oxygen treatment does not prolong survival in patients with COPD with moderate hypoxaemia . Airway limitation seems to determine survival in this group of patients The Global Initiative for Chronic Obstructive Lung Disease ( GOLD ) has defined stage 1 chronic obstructive pulmonary disease ( COPD ) as forced expiratory volume in one second/forced vital capacity (FEV1/FVC)% < 70 % and a FEV1 % predicted of > 80 % . Stage 2 has been defined as FEV1/FVC < 70 % and a FEV1 % pred of < 80 % . The authors examined the extent of COPD misdiagnosis using this definition in healthy , never-smoker , asymptomatic adults aged > 70 yrs in Bergen , Norway . A respiratory question naire was mailed to a r and om sample of 2,871 persons aged>70 yrs . In a r and om , well-defined subgroup of 208 never-smoker respondents with no current respiratory disease and significant dyspnoea or heart disease/hypertension complicated with dyspnoea , 71 were able to perform an acceptable spirometry . Approximately 35 % of these healthy , elderly never-smokers had an FEV1/FVC% of < 70 % and would be classified as having at least a stage 1 COPD . This percentage increased with age and in those aged > 80 yrs ∼50 % would be classified as having COPD and approximately one-third would have an FEV1 of < 80 % pred ( stage 2 COPD ) . The estimated 5th percentile of FEV1 was consistently < 80 % pred . The Global Initiative for Chronic Obstructive Lung Disease criteria will probably lead to a significant degree of over-diagnosis of chronic obstructive pulmonary disease in those aged > 70 yrs . The criteria used to define the various stages of chronic obstructive pulmonary disease need to be age-specific The purpose of this study was to examine the effectiveness of different practice -based approaches to assist patients of primary care physicians to quit smoking and sustain cessation .  Forty-four nonsmoking general practitioners volunteered for the study . After a period of training , they r and omized 923 smoking clients , unselected for motivation toward quitting , to four different intervention groups : ( i ) minimal intervention , consisting of one single counselling session and a brief h and out on quitting techniques ; ( ii ) repeated counselling including reinforcing sessions at Months 1 , 3 , 6 , and 9 ; ( iii ) repeated counselling and use of nicotine gum ; and ( iv ) repeated counselling and spirometry . Biochemically vali date d smoking status was assessed at six and 12 months after recruitment . The proportion of verified quitters at 12 months was 4.8 percent among subjects r and omized to the minimal intervention group , compared to 5.5 percent , 7.5 percent , and 6.5 percent among those r and omized to the three repeated-counselling groups . In no treatment group was the outcome significantly different from that for one-time counselling at the ( P<0.05 ) level . Lack of power , contamination , and low attendance at reinforcing sessions should be taken into account in interpreting the results This report deals with deaths and hospitalizations during the 5-year Lung Health Study , as documented by examination of appropriate records . There were 149 deaths ( 2.5 % ) during the study , caused largely by lung cancer and cardiovascular disease , particularly coronary heart disease . A total of 12.8 % of participants were hospitalized , with cancer , cardiovascular disease , and nonmalignant respiratory disease accounting for 75 % of hospitalizations . There were no significant differences among the original treatment groups for all-cause mortality , lung cancer , or hospitalizations for respiratory disease . Deaths and hospitalizations for cardiovascular disease and coronary artery disease were more common in the smoking intervention plus Atrovent inhaler ( SI-A ) group , which received ipratropium bromide , than in the smoking intervention plus placebo inhaler ( SI-P ) group , which received placebo , and the differences approached statistical significance . However , we were unable to find a dose effect , in that differences were not related to self-reported inhaler compliance . In the SI-A group , nine participants were hospitalized for supraventricular tachycardia as compared with two in the SI-P group , and SI-A participants with this condition were unusually compliant with their inhaled medication . When all participants were considered and smoking status considered as a time-dependent covariate , smoking cessation was associated with significant reductions in fatal or nonfatal cardiovascular disease and coronary artery disease RATIONALE To assess the success rate of smoking cessation with the " minimal intervention strategy " in general practice , and to determine the influence of spirometry on this success rate . METHODS Training in smoking cessation advice was given to 16 general practitioners ( GPs ) . During 12 weeks , these GPs screened their practice population for smoking habits , the degree of dependence on nicotine , and the motivation to quit smoking . Patients willing to stop were r and omised to a group that underwent a single office spirometry , or to a control group . The GPs were asked to support the attempts with the minimal intervention strategy . Success rates were compared after 6 , 12 and 24 months . RESULTS On a population of 5590 patients , 1206 smokers were identified ( 22 % ) . To the vulnerable group , identified following the Prochaska and Di Clemente scheme , the proposal was made to change smoking behaviour . Two hundred and twenty-one patients undertook an attempt of smoking cessation . Nicotine replacement therapy ( NRT ) or bupropion was prescribed in 51 % of the attempts . Sixty-four sustained quitters were counted after 6 months ( 29 % ) , 43 after 1 year ( 19 % ) and 33 after 2 years ( 15 % ) . We found a small but statistically non-significant difference in success rate in favour of the group that underwent office spirometry . CONCLUSION GPs can motivate almost 20 % of their smoking population to quit smoking . The success rate with the minimal intervention strategy was 19 % after 1 year and 15 % after 2 years . We found no arguments in favour of confronting smokers with their lung function as a tool for enhancing smoking cessation BACKGROUND Long-acting beta-agonists and inhaled corticosteroids are used to treat chronic obstructive pulmonary disease ( COPD ) , but their effect on survival is unknown . METHODS We conducted a r and omized , double-blind trial comparing salmeterol at a dose of 50 microg plus fluticasone propionate at a dose of 500 microg twice daily ( combination regimen ) , administered with a single inhaler , with placebo , salmeterol alone , or fluticasone propionate alone for a period of 3 years . The primary outcome was death from any cause for the comparison between the combination regimen and placebo ; the frequency of exacerbations , health status , and spirometric values were also assessed . RESULTS Of 6112 patients in the efficacy population , 875 died within 3 years after the start of the study treatment .  All-cause mortality rates were 12.6 % in the combination-therapy group , 15.2 % in the placebo group , 13.5 % in the salmeterol group , and 16.0 % in the fluticasone group . The hazard ratio for death in the combination-therapy group , as compared with the placebo group , was 0.825 ( 95 % confidence interval [ CI ] , 0.681 to 1.002 ; P=0.052 , adjusted for the interim analyses ) , corresponding to a difference of 2.6 percentage points or a reduction in the risk of death of 17.5 % . The mortality rate for salmeterol alone or fluticasone propionate alone 
    Output:
    
Results Does Screening for COPD with Spirometry Reduce Morbidity and Mortality ?
We did not identify any published controlled studies that addressed this question .
What Is the Prevalence of COPD in the General Population ?
Do Risk Factors Reliably Discriminate between High-Risk and Average-Risk Population s ?