COPD World News Week of June 26, 2016
Depression Plagues Many With COPD
Manchester,
UK - Struggling with chronic obstructive pulmonary disorder (COPD) may
raise the risk of depression among patients with the incurable
respiratory illness, two new studies suggest. One report, from
scientists at Manchester Metropolitan University in England, found one
in four patients with COPD suffered persistent depressive symptoms over
the three years of the study. If untreated, depression can have a
negative effect on the patients' overall health and the effectiveness of
their treatment, the researchers noted. A second study from the
University of Texas analyzed data from a random sample of 5 percent of
Medicare beneficiaries diagnosed with COPD between 2001 and 2011. The
researchers found that 22 percent of those patients had one or more
psychological disorders. The study also showed that the odds of 30-day
readmission to the hospital were higher in patients with COPD who had
depression, anxiety, psychosis, alcohol abuse and drug abuse, compared
with those who did not have these disorders. Both studies were published
recently in the journal CHEST. COPD is an umbrella term for progressive
lung diseases that include chronic bronchitis and emphysema. It affects
24 million Americans, and is characterized by increased breathlessness,
coughing and wheezing, according to the COPD Foundation. Depression
makes it tougher for those with COPD to adhere to needed therapies,
especially since they tend to fault themselves for developing the
disease by smoking, explained Dr. David Mannino. He is a professor of
medicine in the division of pulmonary, critical care and sleep medicine
at the University of Kentucky. "They call it 'the shame-and-blame game'
because a lot of people who have it [COPD] feel like they brought it on
themselves and got what they deserved," said Mannino, who was not
involved in either study. "Part of this is the message that smoking's
bad and no one should do it. That leads to the misguided interpretation
that 'smokers are bad people.' " However, COPD can also be caused by
factors like asthma or dusty work places, Mannino noted. Dr. Norman
Edelman, scientific consultant for the American Lung Association, said
depression is relatively common among those with a disabling chronic
illness such as COPD. However, "what's not so clear and very important
is whether depression itself makes the disease worse, or how it could,"
he added. Exercise can be a COPD patient's biggest ally, according to
Edelman. Those with COPD should work out to their level of tolerance,
said Edelman, a professor of preventive medicine and internal medicine
at the State University of New York at Stony Brook. "Otherwise, their
muscles get deconditioned, and that makes their shortness of breath on
any kind of exercise worse," he said. But, "you can imagine that someone
depressed doesn't want to exercise, go to the mall or the store,"
Edelman acknowledged. One way to overcome that mindset is by
incorporating psychological counseling into COPD care as long as it's
feasible, he said. Meanwhile, family and friends can also help. "The
thing to do is engage the patient: Don't let Joe sit in the corner and
watch television all day," Edelman said. "Get him up and out, doing
things he can tolerate. And ask questions. That's not so easy. If you
ask old Grandpa if he's depressed, he'll snarl at you." So, the
situation has to be handled "sensitively and gently," Edelman said.
Still, Mannino said, patients have to assume their share of
responsibility for their own welfare. "The key intervention for people
still smoking is to stop," he said. Beyond that, COPD patients should
make sure they're using their inhalers correctly. "Nearly half our
patients aren't using them as directed," Mannino said. "Every device is a
little different. If you're not using them right, you're not getting
the correct dose."
For more information: https://www.nlm.nih.gov/medlineplus/news/fullstory_159436.html
COPD World News Week of June 19, 2016
COPD Discovery Might Improve Treatment
Dundee,
Scotland - Researchers say they've found a new way to predict how
chronic obstructive pulmonary disease will progress, a discovery they
believe could improve COPD treatment. Their research might help doctors
determine which patients are less likely to respond to standard
treatment and are at higher risk for disease advancement, the study
authors explained. COPD -- chronic obstructive pulmonary disease -- is a
chronic lung disease that makes it tough to breathe. It includes
chronic bronchitis and emphysema, according to the American Lung
Association. The new discovery concerns something called neutrophilic
airway inflammation, which is associated with COPD. Neutrophils are
white blood cells that are important for fighting infection. Scientists
said that a type of neutrophil behavior called neutrophil extracellular
trap (NET) formation in the lungs of COPD patients appears to reduce
their ability to destroy bacteria. "We have known for many years that
neutrophils should be able to fight infection, but we haven't fully
understood why they don't work in COPD," said study author Dr. James
Chalmers, from the University of Dundee in Scotland. "Some recent
studies described the presence of NETs in the COPD lung, so we wanted to
know whether there was any relationship between NETs and outcomes in
COPD patients," he said in a news release from the American Thoracic
Society. For the study, the researchers collected blood and sputum
samples from 141 patients at the end of acute COPD flare-ups. The
researchers found the amount of NET formations in participants' lungs
was directly related to the severity of their lung disease and their
risk for COPD flare-ups that didn't respond to treatment with
corticosteroids. NETs result in more infections as well as worse lung
function and quality of life, the study authors concluded. "This marker
may help us identify patients at higher risk of disease progression,"
said Chalmers. "And it identifies a subset of patients who may need
treatments other than corticosteroids. Our data show that inhaled
steroids may even exacerbate NETs, so we need to identify new COPD
treatments and discover whether inhibiting NET formation will result in
improved clinical outcomes for patients with COPD." The researchers plan
to continue their investigation, examining why NET formation occurs and
whether it can be prevented or treated. "While our new research is at
an early stage, we hope that detecting NETs may be a biomarker that can
identify patients at risk of deterioration, and that we can work toward
testing whether inhibiting NET formation would be a beneficial treatment
in COPD," Chalmers said. The findings were to be presented Sunday at
the American Thoracic Society's annual meeting, in San Francisco.
Research presented at meetings usually is regarded as preliminary until
published in a peer-reviewed medical journal.
For more information: https://www.nlm.nih.gov/medlineplus/news/fullstory_158852.html
COPD World News Week of June 12, 2016
Hospital-initiated smoking cessation programs work
Ottawa,
ON - A new study from the University of Ottawa Heart Institute (UOHI),
in collaboration with the Institute for Clinical Evaluative Sciences
(ICES), has established that greater adoption of hospital-initiated
tobacco cessation interventions improve patient outcomes and decrease
further healthcare utilization. The study was published in the British
Medical Journal's Tobacco Control. In Canada, tobacco smoking is a
leading cause of hospitalization, of overall healthcare utilization, and
of mortality, and people who smoke daily average twice as many hospital
days as people who have never been daily smokers. Hospitalization
therefore provides a unique opportunity to initiate smoking cessation
interventions. The before and after study compared hospitalized people
who smoke at one of 14 Ontario hospitals who had received the Ottawa
Model for Smoking Cessation (n=726), to hospitalized people who smoke
who had not (n=641), or who had received "usual care", to determine if
implementation of the Ottawa Model for Smoking Cessation would reduce
mortality and downstream healthcare use. Results showed that: 35% of the
patients who participated in the Ottawa Model were smoke-free at
6-month follow up, compared to only 20% of the usual care participants.
Patients who received the Ottawa Model were 50% less likely to be
re-admitted to the hospital for any cause, and 30% less likely to visit
an emergency department in the 30 days following their initial
hospitalization. Smokers who received the Ottawa Model were 21% less
likely to be re-hospitalized and 9% less likely to visit an emergency
department, 2 years following their hospitalization. Most importantly,
the study showed a 40% reduction in 2-year mortality risk among patients
who received the Ottawa Model. "Given the low cost of these
interventions, systematic smoking cessation programs that initiate
treatments in hospital and attach patients to follow up support should
be offered to all patients who smoke," said Kerri-Anne Mullen, lead
author and program manager for the Ottawa Model for Smoking Cessation
Network at the University of Ottawa Heart Institute, and also a student
scientist at ICES at the time of the study. "It's a healthcare
no-brainer. Strategies like this are cost-effective, will reduce
subsequent healthcare use, but most importantly, they are life-saving
and will distinctly enhance the well-being of our patients who smoke."
Developed and powered by the University of Ottawa Heart Institute, the
Ottawa Model for Smoking Cessation is a change management strategy that
offers practical training to healthcare staff and implements clinical
tools and procedures that ultimately lead to: the systematic
identification and documentation of smoking status of all patients; the
offer of strategic advice and pharmacological support to all smokers;
and, the long-term follow up of smokers after hospital discharge.
For more information: http://www.eurekalert.org/pub_releases/2016-05/uooh-css052416.php
COPD World News Week of June 5, 2016
Colistin resistance detected in US patient for first time
Bethesda,
Maryland - Colistin resistance has been detected in a patient in the
United States for the first time, further magnifying fears over
antibiotic resistance. The discovery was made by Defense Department
researchers who recently began looking for resistance to the last-resort
antibiotic in specimens submitted to the clinical microbiology
laboratory at Walter Reed National Military Medical Center. They
detected the colistin-resistant mcr-1 gene in an Escherichia coli
culture taken from a female patient with a urinary tract infection. CDC
Director Thomas R. Frieden, MD, MPH, announced the finding during an
address at the National Press Club and warned that better stewardship
was needed to fight antibiotic resistance. “The medicine cabinet is
empty for some patients,” Frieden said. “It is the end of the road for
antibiotics unless we act urgently.” The specimen came from a woman who
sought treatment at a Pennsylvania clinic in April. The woman, aged 49
years, reported no travel within the previous 5 months, according to
Patrick McGann, PhD, microbiologist at Walter Reed, and colleagues, who
published their findings in Antimicrobial Agents and Chemotherapy. “To
the best of our knowledge,” they wrote, “this is the first report of
mcr-1 in the United States.” The E. coli cultured from the woman’s
urine, MRSN 388634, was forwarded to the lab at Walter Reed, where
researchers began testing for resistance to colistin in response to the
discovery of mcr-1, which they called a “truly pan-drug resistant
bacteria.” MRSN 388634 belongs to a rare E. coli sequence type that was
first identified in 2008 from a urine culture in the United Kingdom and
later identified from a bloodstream culture in Italy, McGann and
colleagues wrote. They warned that they were in the early stages of
testing and that continued surveillance was needed to determine the true
prevalence of mcr-1 in the population. “The more we look, the more
we’ll find,” Frieden said. “The more we look at drug resistance, the
more concerned we are. We need to do a very comprehensive job so we can
have [antibiotics] and our children can have them. We can make new ones,
but without better stewardship and identification of outbreaks, we’ll
lose these miracle drugs.”
For more information: http://tinyurl.com/jp8a4yw
COPD World News Week of May 29, 2016
High medication cost remains major barrier for patients
San
Francisco -- Many patients with chronic obstructive pulmonary disease
in this country lack access to basic therapies and care that can improve
their quality of life, mostly because they can't afford them, according
to findings from a report on COPD care written by more than 2 dozen
leading respiratory medicine specialists in the U.S. The report
highlights major barriers to adequate care for a significant percentage
of COPD patients, said lead author Meilan K. Han, MD, of the University
of Michigan, Ann Arbor. She presented the findings at the ATS 2016
International Conference, the annual meeting of the American Thoracic
Society. The report was commissioned by The Lancet Respiratory Medicine,
which published key findings late last week. Even though COPD is now
the third leading cause of death in the U.S., there is still a patchwork
approach to patient care, with disproportionately affected lower-income
patients often unable to afford the most effective medications, she
said. "We can talk about state-of-the-art treatments all we want, but we
know that these medications often aren't covered by insurance and our
patients can't afford them," she said. The report called for greater
patient access to education to help them manage their disease, as well
as drug therapies, pulmonary rehabilitation and other
non-pharmacological interventions and it noted that "insufficient
disease-specific training" remains a significant problem among
providers, especially primary care doctors who treat the majority of
patients with COPD. Inadequate coordination of care was identified as a
significant challenge, especially among patients who are treated by both
a primary care physician and specialist and those who frequently
transition between in-patient and out-patient care. "The absence of
written care protocols for inpatients, as have already been established
for other diseases, has inadvertently led to COPD having low priority in
hospital care," Han and colleagues wrote. There are roughly 15 million
adults in the U.S. (6.5% of U.S. adults) with a diagnosis of COPD, but
it is estimated that as many as 29 million Americans have the disease.
Key challenges highlighted in the report included providing care
consistent with guidelines or best practices evidence in the primary
care and hospital settings. "In hospitals in the U.S. only about 30% of
COPD patients are receiving what we would consider ideal care. There is a
lot of variation," Han said. She noted that lack of access to
specialized care is, at present, the norm for most patients with COPD.
While COPD rates have skyrocketed, the number of pulmonologists in the
U.S. has remained somewhat static since the mid 1990s, she said. "There
are a lot of patients with COPD that won't even get close to a
pulmonologist, so I think we need to think about other ways to getting
patients access to specialty care, whether that is through telehealth or
other innovative solutions," she said. She added that the high rate of
comorbidities like diabetes and cardiovascular disease among COPD
patients greatly complicates care, as does the fact that COPD medication
adherence is much lower than adherence to medications COPD patients
take for these other chronic conditions. "And we wonder why our patients
aren't doing better," she said. "I just saw a patient in clinic last
week who had just left the hospital after his third readmission and I
asked him if he was taking his (COPD) medications. He told me that he
wasn't because he couldn't afford the co-pays. My suspicion is that
probably has something to do with why he has been in the hospital three
times," she said. Research funding for COPD also lags far behind other
major chronic diseases, she said. When researchers compared NIH funding
for COPD and other chronic diseases to disability adjusted life years,
which is a metric of disease burden, they found that in general funding
matches disease burden except for COPD, where funding is much below
burden. "This is something that absolutely will have to be rectified, "
Han said.
For more information: http://tinyurl.com/hussru3
COPD World News Week of May 22, 2016
Bacterial Susceptibility May Explain Persistent COPD Inflammation
Nashville,
TN - Increased susceptibility to airway bacteria caused by an immune
system defect may explain why patients with chronic obstructive
pulmonary disease (COPD) experience persistent lung inflammation and
disease progression even after they stop smoking, researchers reported.
In a mouse model, the researchers showed that lacking the key mucus
secretion antibody known as secretory immunoglobulin A (IgA) increased
susceptibility to bacterial infection, which mimicked the lung damage
and persistent inflammation characteristic of COPD in the aging mice.
Treatment of the IgG-deficient mice with the anti-inflammatory COPD drug
roflumilast halted the lung damage. The results suggest that medical
treatments that restore normal immune barrier function to the small
airways or reduce airway bacteria may be effective therapeutic
strategies for patients with COPD, wrote researcher Bradley W. Richmond,
MD, of Vanderbilt University School of Medicine in Nashville, Tenn.,
and colleagues, in the journal Nature Communications. COPD is the third
leading cause of death in the United States, and smoking accounts for
eight out of 10 deaths from the disease, which is characterized by
chronic lung inflammation, fibrotic remodeling of the small airways, and
destruction of lung parenchyma. The researchers noted that the
predominant hypothesis regarding COPD pathogenesis has been that
inhalation of cigarette smoke and other toxic gases causes
oxidant-mediated injury, airway inflammation, and disruption of the
protease/anti-protease balance, leading to lung parenchymal destruction.
"However, this theory does not fully explain the central role of the
small airways in this disease or continued airway inflammation and
disease progression after smoking cessation," they wrote. In earlier
work, the researchers identified secretory IGA deficiency in the small
airways of patients with COPD, leading the team to hypothesize that
immuno-barrier dysfunction resulting from reduced secretory IgA
contributes to chronic airway inflammation and disease progression.
Future studies to investigate the incidence and progression of
obstructive lung disease in IgA-deficient individuals could be
informative," the team concluded.
For more information: http://tinyurl.com/zzb43lz
COPD World News Week of May 15, 2016
Persistent childhood asthma linked to COPD
Boston,
MA - The development of persistent childhood asthma-characterized by
having trouble breathing on an almost daily basis - is not well
understood. In most cases, childhood asthma resolves with time, but as
many as 20 percent of children with asthma will go on to have
potentially severe symptoms in adulthood. In the largest and longest
U.S. analysis of persistent asthmatics to date, investigators at Brigham
and Women's Hospital (BWH) found a link between persistent childhood
asthma and chronic obstructive pulmonary disease (COPD) in early
adulthood. The study found that early lung function predicts lung growth
later in life, regardless of asthma treatment and smoking exposure.
"This work tells us that persistent childhood asthma can develop into
COPD, something that up until now has not been well described," said
Scott T. Weiss, MD, one of the paper's senior authors and Co-Director of
the Systems Genetics and Genomics Section of the BWH Channing Division
of Network Medicine. "Children who had low lung function at the start of
the trial followed a series of predicted growth patterns: most had
reduced lung growth with time and a significant number would go on to
meet the criteria for COPD." The study followed 684 participants in the
Childhood Asthma Management Program (CAMP) from ages 5-12 until they
were at least 23 years old. Each participant reported once a year to one
of eight research centers around the U.S. and Canada to complete lung
function measurements like spirometry, a test that records how much air a
participant can breathe out in one second. With these annual
recordings, the researchers were able to characterize the patterns of
growth in asthmatics' lung function. By the end of the study, 11 percent
met the criteria for COPD, a progressive disease that makes breathing
difficult. In addition to low lung function at the start of the study,
being male also predicted worse outcomes, but this is likely a
consequence of higher asthma prevalence in boys. By early adulthood, 75
percent of the children with persistent asthma displayed an early
decline in lung function and/or reduced lung growth. Treatment did not
change these patterns. "It is astonishing," said co-senior author Robert
C. Strunk, MD, professor of pediatrics at Washington University School
of Medicine, who died unexpectedly April 28. "For people barely into
adulthood to already have COPD is terrible. As the COPD evolves, they
are likely to have health problems that will make it difficult to
participate in normal day-to-day responsibilities such as holding a
job." "With this understanding, physicians need to identify at-risk
children earlier and counsel them about potential preventative measures.
Since asthma itself is a risk factor for developing COPD, these
patients should be advised against risk related environmental exposures,
like smoking, that could intensify their symptoms and increase their
COPD risk," said Weiss. "It is important that we recognize this link
between persistent childhood asthma and COPD as a potential problem and
focus on prevention efforts."
For more information: http://www.medicalnewstoday.com/releases/310208.php?tw
COPD World News Week of May 8, 2016
Newfoundland public payer program to cover new COPD product
Great
news for COPD patients in Newfoundland. AstraZeneca has announced that
it has obtained public payer listing for Duaklir as a Special
Authorization Benefit in Newfoundland. Duaklir is a fixed-dose LAMA/LABA
combination of two long-acting bronchodilators—aclidinium bromide, a
long-acting muscarinic antagonist (LAMA), and formoterol fumarate, a
long-acting beta-agonist (LABA). The criteria is similar to other
LAMA/LABAs: For the treatment of moderate to severe chronic obstructive
pulmonary disease (COPD), as defined by spirometry, in patients with an
inadequate response to a long-acting beta-2 agonist (LABA) or
long-acting anticholinergic (LAAC). With this announcement, Duaklir is
now reimbursed in almost all provinces across Canada (including SK, Nova
Scotia, New Brunswick, Ontario, Manitoba, Alberta, BC, PEI, Yukon.)
This means that the majority of Canadian patients now have access to
this product. COPD patients in Newfoundland now have both public and
private payer coverage for Duaklir.
For more information: http://tinyurl.com/zywolxt
COPD World News Week of May 1, 2016
Saskatchewan drug program to cover new COPD product
Mississauga,
ON - Great news for Canadians with COPD. AstraZeneca has announced that
it has received public payer listing for Duaklir in Saskatchewan as an
Exception Drug Status (EDS). The criteria is similar to other LABA/LAMA
combinations in SK.. Duaklir is a fixed-dose LAMA/LABA combination of
two long-acting bronchodilators—aclidinium bromide, a long-acting
muscarinic antagonist (LAMA), and formoterol fumarate, a long-acting
beta-agonist (LABA). Duaklir is covered for treatment of patients with
moderate to severe COPD who have had an inadequate response to a
long-acting beta-2-agonist [LABA] or long-acting anticholinergic
[LAAC]). With this announcement, Duaklir is reimbursed in almost all
provinces across Canada (including Nova Scotia, New Brunswick, Ontario,
Manitoba, Alberta, BC, PEI and Yukon) and is another option for Canadian
COPD patients and their physicians.
For more information: http://tinyurl.com/zywolxt
COPD World News Week of April 24, 2016
Anxiety Common Among COPD Patients
Toronto, ON - Levels
of anxiety are up to three times higher in older adults with chronic
obstructive pulmonary disease (COPD) than in patients without COPD,
according to findings published in COPD: Journal of Chronic Obstructive
Pulmonary Disease. Researchers from the University of Toronto studied a
sample of more than 11,000 patients in order to investigate the
independent relationship between COPD and anxiety in adults. The
patients, who were aged 50 and older, were measured for sociodemographic
factors, social support, health behaviors, sleep problems, pain,
functional limitations and early childhood adversities. More than 700
adults reported their COPD diagnosis during the 2012 Canadian Community
Health Survey. The researchers found that one in 17 adults with COPD
had anxiety within the past year, or about 5.8 percent. When the
researchers adjusted for age, sex and race, the anxiety levels were four
times higher for COPD patients than for those without (about 3.90).
When the researchers adjusted for all 18 characteristics they measured
for, the odds declined to 1.72 between COPD and non COPD patients.
“Even after accounting for 18 possible risk factors for GAD, individuals
with COPD still had 70 percent higher odds of GAD compared to those
without COPD,” lead author, Professor Esme Fuller-Thomson said in a
press release. Some of the leading risk factors for anxiety among COPD
patients, the researchers reported, were lack of social support and
exposure to parental domestic violence during the patients’ childhoods.
The older adults without social support involved in their important
decision making had more than seven times the odds of having anxiety in
comparison with the patients who did have a friend or social support.
When the COPD adults had more than 10 exposures during their childhood
to parental domestic violence, their odds for anxiety in comparison to
the adults without COPD rose to about five times the risk. The
researchers believe that this violence may have triggered a
predisposition to anxiety in the patients. The study “highlights how
healthcare providers can play a significant role in identifying and
providing promising interventions to reduce anxiety for individuals with
COPD, in particular by screening for and addressing pain and functional
limitations and targeting those most at risk,” Fuller-Thomson
concluded.
For more information: http://www.hcplive.com/medical-news/anxiety-common-among-copd-patients
COPD World News Week of April 17, 2016
Exercise May Keep Your Brain 10 Years Younger
Miami, FL - Older adults who exercise regularly could buy an extra decade of good brain functioning, a new study suggests. The study found that seniors who got moderate to intense exercise retained more of their mental skills over the next five years, versus older adults who got light exercise or none at all. On average, those less-active seniors showed an extra 10 years of "brain aging," the researchers said. The findings do not prove that exercise itself slows brain aging, cautioned senior researcher Dr. Clinton Wright, a neurologist at the University of Miami Miller School of Medicine. It's possible, he said, that there are other reasons why active older adults stayed mentally sharper. The researchers accounted for some of those other explanations -- including people's education levels, smoking habits and health conditions such as high blood pressure and diabetes. And exercise levels were still connected to the participants' performance on tests of memory and "processing speed" -- the ability to digest a bit of new information, then respond to it. Plus, Wright said, it's plausible that exercise would affect those mental skills. Other research has shown that physical activity boosts blood flow to the brain, and may enhance the connections among brain cells, for example. Exercise can also help manage "vascular risk factors," such as high blood pressure, unhealthy cholesterol levels and diabetes, Wright pointed out. That's important because many studies have suggested that some of the same risk factors for heart disease and stroke also boost the odds of dementia. The new study findings were published in the journal Neurology. Dr. Ezriel Kornel, a neurosurgeon who was not involved in the study, agreed that the findings don't prove that exercise will keep you thinking clearly. "It could simply be that people who are drawn to exercise are also at lower risk of cognitive decline," said Kornel, a clinical assistant professor of neurological surgery at Weill Cornell Medical College, in New York City. That said, he called the study "important," because it at least suggests that exercise could have a big impact on people's mental function as they age. "We already know that exercise is highly valuable for cardiovascular health," Kornel said. The potential to add extra years of healthy brain function might motivate more people to get moving, he said. The findings are based on nearly 900 older adults who took standard tests of memory, attention and other mental skills at an average age of 71. They repeated the tests five years later. At the time of the first test, they also underwent MRI scans of the brain, which allowed the researchers to look for changes associated with early mental impairment. Overall, 10 percent of the group said they regularly got moderate to high-intensity exercise -- which meant activities such as jogging, aerobics and calisthenics. It turned out that those men and women showed substantially less mental decline over five years than the rest of the group -- who were either sedentary or got light exercise, like walking. When it came to tests of episodic memory -- remembering words from a list -- less-active and sedentary seniors showed the equivalent of 10 extra years of brain aging. According to Wright, the results suggest that a casual walk around your neighborhood is not enough to preserve brain function as you age. "It seems like we're not going to get off easy," he said. "There's increasing evidence that it needs to be exercise that gets your heart rate up." However, Wright added, the necessary exercise regimen is far from clear. Seeking some answers, his team is running a trial testing the effects of exercise on stroke survivors' brain function over time. According to Kornel, exercise could theoretically benefit the brain in a range of ways. "Improved blood flow to the brain is one logical assumption," he said. But, he added, exercise can also keep people mentally engaged -- by making them learn new things or concentrate, for example. And if you exercise with other people, Kornel noted, there's a social aspect, too. "If you're out in the world, physically active, there are many things going on that are probably not happening when you're just sitting on your sofa," he said.
For more information: https://www.nlm.nih.gov/medlineplus/news/fullstory_157919.html
COPD World News Week of April 10, 2016
Beta-blockers could reduce risk of exacerbations
Ghent,
Belgium - Beta-blockers could be used to reduce the risk of chronic
obstructive pulmonary disease (COPD) exacerbations, according to new
findings. Beta-blockers are primarily used to treat stress or heart
problems, such as high blood pressure and angina but these new findings
suggest they could have a potential benefit for patients with COPD. COPD
exacerbations involve a worsening of symptoms, in particular increased
breathlessness. Although beta blockers are suspected to tighten the
muscles in the airways, contributing to breathing problems, previous
research has suggested beneficial effects of β-blocker use in patients
with COPD. This study aimed to understand this link and to analyse if
any potential benefit on exacerbations existed for COPD patients taking
the drug. The research, presented at the recent European Respiratory
Society's Lung Science Conference, analysed health records of 1,621 COPD
patients included in the Rotterdam Study. Patients were followed until
an exacerbation occurred and researchers collected data on the use of
different kinds of beta-blockers and whether the patient also
experienced heart failure. The findings revealed that the use of cardio
selective beta-blockers, which are primarily used to treat heart
disease, reduced the relative risk of exacerbations by 21%. The benefits
were increased for patients with heart failure who saw a reduced risk
of 55%. Lies Lahousse, lead author and FWO postdoctoral fellow from
Ghent University Hospital in Belgium, commented: "The overlap in
symptoms and risk factors associated with lung and heart disease can be
complicated and we know that a reduction in lung function is also
associated with a reduction in heart function. These preliminary
findings offer a useful insight into the potential benefits of beta
blockers for patients living with heart disease at the same time as
COPD. If randomised controlled trials confirm our findings, we could see
promising clinical implications."
For more information: http://www.medicalnewstoday.com/releases/307803.php?tw
COPD World News Week of April 3, 2016
BC and Manitoba PharmaCare programs cover new COPD product
Mississauga, ON - Great news for Canadians with COPD. AstraZeneca has announced that it has received public payer listing for Duaklir in British Columbia, effective April 5th. Duaklir is a fixed-dose LAMA/LABA combination of two long-acting bronchodilators—aclidinium bromide, a long-acting muscarinic antagonist (LAMA), and formoterol fumarate, a long-acting beta-agonist (LABA). Duaklir is now covered under the British Columbia public drug plan formulary with the following Special Authority criteria: For treatment of patients with moderate to severe COPD who have had an inadequate response despite an adequate trial (3 months) of a long-acting bronchodilator (long-acting beta-2-agonist [LABA] or long-acting anticholinergic [LAAC]). It should not be used in combination with another LAAC or LABA. AstraZeneca has also received public payer listing for Duaklir in Manitoba, effective April 18th. Duaklir will be added to the Manitoba Pharmacare program as a Part 3 Exception Drug Status (EDS) benefit with the following limited use criteria: For treatment of patients with moderate to severe COPD who have had an inadequate response despite an adequate trial (3 months) of a long-acting bronchodilator (long-acting beta-2-agonist [LABA] or long-acting anticholinergic [LAAC]). It should not be used in combination with another LAAC or LABA. With these announcements, Duaklir is reimbursed in seven provinces across Canada (including BC, Nova Scotia, New Brunswick, Ontario, Manitoba (effective April 18), Alberta and Yukon.) This means that the majority of qualifying Canadian patients now have access to Duaklir through public drug access programs.
For more information: http://tinyurl.com/zywolxt
Screening for COPD of asymptomatic people of no benefit
Washington, DC - The U.S. Preventive Services Task Force (USPSTF) does not recommend screening for chronic obstructive pulmonary disease (COPD) in persons who do not have symptoms suggestive of COPD. The report appears in JAMA. This is a D recommendation, indicating that there is moderate or high certainty that screening has no net benefit or that the harms outweigh the benefits. About 14 percent of U.S. adults age 40 to 79 years have COPD, and it is the third leading cause of death in the U.S. Persons with severe COPD are often unable to participate in normal physical activity due to deterioration of lung function. To update its 2008 recommendation, the USPSTF reviewed the evidence on whether screening for COPD in asymptomatic adults (those who do not recognize or report respiratory symptoms) improves health outcomes. The USPSTF reviewed the diagnostic accuracy of screening tools (including pre-screening questionnaires and spirometry [a test of the air capacity of the lungs]); whether screening for COPD improves the delivery and uptake of targeted preventive services, such as smoking cessation or relevant immunizations; and the possible harms of screening for and treatment of mild to moderate COPD. The USPSTF is an independent, volunteer panel of experts that makes recommendations about the effectiveness of specific preventive care services such as screenings, counseling services, and preventive medications.
For more information: http://jama.jamanetwork.com/article.aspx?articleid=2510917#.VwUdYboKNqM
COPD World News Week of March 27, 2016
Physical activity improves outcomes after being hospitalized
Boston,
MA - Any amount of moderate to vigorous physical activity can
effectively reduce the risk of dying after hospitalization for chronic
obstructive pulmonary disease (COPD), according to a new study. The
research, published today in ERJ Open Research, significantly adds to
the mounting evidence that physical activity should be used to monitor
and treat patients with COPD. Patients with COPD can be hospitalized if
they experience an acute exacerbation of their symptoms.
Re-hospitalization and death rates are high following any initial
hospitalization and in addition, hospitalizations due to severe
exacerbations of COPD account for up to 70% of the healthcare costs
associated with COPD. It is crucial that healthcare professionals can
identify patients at a high-risk of readmission. Researchers studied
health records of 2,370 patients from Kaiser Permanente Southern
California who were hospitalized for COPD for one year, looking at
exercise as a vital sign which was self-reported in the clinic as a
measure of physical activity and monitoring deaths from all causes
within that time frame. The results found that patients who were active
had a 47% lower risk of death in the 12 months following a COPD
hospitalization, compared to inactive patients. Patients who were active
but at insufficient levels still maintained a 28% lower risk of death,
compared to inactive patients. The authors concluded that monitoring
levels of physical activity with a simple exercise “vital sign”, could
help healthcare professionals identify, monitor and treat those patients
at a high risk of death following hospitalization. Lead author, Dr
Marilyn Moy, Assistant Professor at Harvard Medical School, commented:
“We know that physical activity can have a positive benefit for people
with COPD and these findings confirm that it may reduce the risk of
dying following hospitalization for an acute exacerbation. The results
also demonstrate the importance of routinely assessing physical activity
in clinical care to identify high-risk patients as part of a larger
strategy to promote physical activity in this highly sedentary
population."
For more information: http://tinyurl.com/j4hyoft
COPD World News Week of March 20, 2016
'Cold Turkey' May Work Best for Quitting Smoking
Oxford,
UK - What's the best way to kick a smoking habit? New research suggests
quitting all at once beats a more gradual approach. The study found
that after four weeks, nearly half of those who quit "cold turkey" were
still not smoking. But, among people who quit gradually over two weeks,
only 39 percent were smoke-free at four weeks, researchers said. "Most
people thought cutting down would suit them better," said study lead
author Nicola Lindson-Hawley. She's a post-doctoral researcher with the
University of Oxford in the United Kingdom. "But whatever they thought,
it turned out they were better to try to quit abruptly." Findings from
the study were published online March 14 in the Annals of Internal
Medicine. Smoking is still the leading preventable cause of death,
according to the U.S. Centers for Disease Control and Prevention (CDC).
Each year, approximately 400,000 Americans die because of smoking, the
CDC says. And for every person who dies due to smoking, another 30
people are living with smoking-related illness, the government agency
reports. The good news is that stopping smoking greatly reduces the risk
of smoking-related diseases, the CDC notes. Unfortunately, quitting
smoking for good is no easy task. And no wonder: Research has suggested
that nicotine is as addicting as drugs such as heroin and cocaine, the
CDC says. Smokers who try to quit often suffer from stress, hunger and
weight gain, according to the CDC. These all contribute to low quit
rates. Strategies such as using nicotine replacement therapy and getting
counseling can help, however. And many people do succeed in quitting,
even if it takes several attempts. The latest research included just
under 700 adult smokers from England. The study participants smoked an
average of 20 cigarettes a day. More than nine in 10 of the participants
were white. The average age of the smokers was 49, and half were women.
The study volunteers were randomly assigned to quit smoking abruptly or
to cut down gradually by 75 percent over two weeks. Before the day they
quit, the gradual quitters used nicotine patches plus short-term
products such as gum and lozenges; the abrupt quitters used only
nicotine replacement patches. All of the participants received
counseling assistance from nurses and short-term nicotine replacement
medications after the quit day. The researchers followed up at four
weeks and six months after the experiment started. Blood testing was
used to confirm whether smokers had actually quit. At four weeks, 39
percent of those who'd gradually quit had stopped smoking compared to 49
percent of those who stopped abruptly. At six months, 16 percent of the
gradual quitters and 22 percent of the abrupt quitters were still
non-smokers, the study found. The percentages of smokers who
successfully quit may seem quite low, but Lindson-Hawley said those
percentages are normal. Dr. Michael Fiore, a professor at the University
of Wisconsin-Madison who's helped develop federal guidelines about
quitting smoking, pointed out that the percentages are still higher than
quitting without support from counseling or medication.
For more information: https://www.nlm.nih.gov/medlineplus/news/fullstory_157753.html
COPD World News Week of March 13, 2016
Mom's Smoking May Put Kids at Higher Risk of COPD in Adulthood
Melbourne,
Australia - The children of mothers who smoke heavily may face a much
higher risk for developing chronic obstructive pulmonary disease (COPD)
as adults, new research suggests. The finding is based on the tracking
of COPD risk among nearly 1,400 adults, and it suggests that heavy
maternal smoking -- more than 20 cigarettes per day -- increases a
child's long-term COPD risk nearly threefold. "The findings were not
surprising to us," said study author Jennifer Perret. She is a
postdoctoral fellow with the Centre for Air Quality and Evaluation in
the Melbourne School of Population & Global Health at the University
of Melbourne in Australia. "Smoking in later life can result in
deficits in lung function by middle age. So it was not unexpected to see
that mothers' smoking . . . could also adversely influence the growing
lungs of [their children]," Perret said. And, "reduced lung function
potential in childhood predisposes an individual to having reduced lung
function as an adult," she added. However, the study did not prove that a
mother's heavy smoking habit caused her children to have an increased
risk for COPD later in life; the researchers only found an association.
Perret and her colleagues reported their findings in the March 10 issue
of the journal Respirology. According to the U.S. National Heart, Lung,
and Blood Institute, COPD is a progressively worsening illness that
greatly compromises a person's ability to breathe. Smoking is the
leading cause of COPD, which is now the third leading cause of death
around the world, the researchers said. To see how COPD risk related to
parental smoking patterns, the authors reviewed surveys completed in
2004 by more than 5,700 men and women (average age of 45) who had been
participating in a long-running study that began in 1968. Nearly 40
percent said that when they were 7 years old they lived with a mother
who smoked, and 17 percent of this group said their mothers were heavy
smokers. Nearly 60 percent grew up with smoking fathers, 34 percent of
whom were heavy smokers. Twelve percent said they grew up in households
where both parents were heavy smokers. Only 8 percent grew up in a
household where the mom was the sole smoker. About two-thirds of the
study participants said they had a history of asthma, and one-quarter
said they still had the respiratory condition. More than four in 10 said
they had never smoked themselves. Nearly 1,400 of the survey
respondents underwent lung-function tests between 2006 and 2008. The
investigators uncovered no evidence of elevated COPD risk among those
who had grown up with smoking dads, or moms who smoked less than 20
cigarettes a day. But those who grew up with mothers who smoked heavily
were 2.7 times more likely than others to have a kind of lung impairment
that is indicative of COPD. Additional testing revealed that the
already elevated risk for COPD seen among offspring who smoked
themselves was driven even higher if they had grown up with a mom who
smoked heavily. There were indications that boys might be somewhat more
vulnerable to the negative impact of maternal smoking than girls. Perret
suggested this could be due to a range of gender-based "biological
differences" that unfold throughout childhood development. Regardless,
the team said the findings should bolster current recommendations that
pregnant women and young mothers should avoid smoking altogether.
Meanwhile, for those whose moms smoked heavily, what can be done to
minimize their COPD risk? "If there are concerns or symptoms such as
breathlessness on exertion, cough or phlegm, they may wish to seek the
advice of a doctor who could measure their lung function," Perret
advised. And, she suggested, "as there may be a combined effect with
other smoking and environmental exposures, it would be advisable for
them not to smoke, and avoid smoky, dusty and polluted environments
where possible." Dr. David Mannino, chief scientific officer for the
COPD Foundation, expressed little surprise at the findings. But he
cautioned that there is no specific magic bullet for reducing COPD risk
among those with this kind of family history. As for everyone, said
Mannino, the focus should be placed on the "same factors that are
important to maintaining good health: don't smoke, exercise, and watch
your diet."
For more information: https://www.nlm.nih.gov/medlineplus/news/fullstory_157712.html
COPD World News Week of March 6, 2016
OLA Urges Speedy Passage of New E-cigarette Regulations
Toronto -- The Ontario Lung Association is welcoming proposed changes to Ontario’s tobacco and e-cigarette legislation that will expand no-smoking rules to apply to medical marijuana and prohibit the use of e-cigarettes in areas where smoking tobacco is banned. “The proposed new regulations are a sensible and measured response to the lung health concerns associated with the growing popularity of e-cigarettes and the increasing use of marijuana for medical purposes,” said Andrea Stevens Lavigne, vice-president of provincial programs with the Ontario Lung Association. Releasing a public consultation paper today, the Associate Minister of Health and Long-Term Care, Dipika Damerla, called for feedback on proposed amendments to the Smoke Free Ontario Act and to regulations under the Electronic Cigarettes Act that, if approved, would: Prohibit the use of e-cigarettes and the smoking and vaping of medical marijuana in all enclosed public places, enclosed workplaces, and specified outdoor areas. Expand the list of places where selling e-cigarettes is banned Establish rules for the display and promotion of e-cigarettes and prohibit the testing of e-cigarettes in places where they are sold. “We have enough evidence about vaping’s negative impact on lung health,” said Stevens Lavigne. “Furthermore, a recent study showed that teenagers who use e-cigarettes are twice as likely to go on to smoke tobacco. “In the final analysis, it doesn’t make much difference whether it’s e-cigarette vapour or marijuana smoke – inhaling foreign substances damages your own lungs and those who breathe those substances second-hand. “Every Ontarian has the right to breathe clean, fresh air. We urge the government to respect that right by passing this legislation without further delay.”
For more information: https://www.on.lung.ca/new-regulations-for-e-cigarettes
COPD World News Week of February 28, 2016
COPD therapy should also focus on patient’s quality of life
Lisbon,
Portugal - When chronic obstructive pulmonary disease (COPD) is managed
with a focus on how the symptoms impact the patient, quality of life
and outcomes can be improved, UK researchers found. Exercise training,
behavior modification, and education delivered by a multidisciplinary
team, and in some cases pulmonary rehabilitation, can be helpful. Such
interventions should be as carefully considered and tailored to
individual patients as drug dosages, Paul W. Jones and colleagues wrote
in the International Journal of Chronic Obstructive Pulmonary Disease on
February 19, 2016. Jones of the Division of Clinical Science, St.
George’s, at the University of London, and colleagues reviewed
information presented at the 1st World Lung Disease Summit. Although the
symptoms of COPD are well-documented, the degree to which they limit a
patient’s quality of life (QoL) “varies depending on a number of
factors, for example, their disease severity and comorbidities” say the
researchers. Additionally, the time of day that the patient experiences
symptoms affects QoL. There are several instruments available for
clinicians to evaluate patients’ symptoms: the COPD Assessment Test
(CAT), the Clinical COPD Questionnaire (CCQ), the modified Medical
Research Council dyspnea score (mMRC), and the St. George’s Respiratory
Questionnaire SGRQ, as well as the Global Initiative for Chronic
Obstructive Lung Disease (GOLD) classification system. Patients with
COPD are progressively less active. A decline in physical activity
usually begins early in the disease. The reviewers reported that one
study concluded, “the objective measurement of physical activity is the
strongest predictor of all-cause mortality in patients.” In light of
those findings, the researchers say, “an appropriate level of physical
activity is very important in patients with COPD, as it plays a key role
in maintaining health.” COPD, like other chronic conditions, is often
accompanied by comorbidities which impact COPD symptoms and QoL. The
reviewers say, “Comorbidities make COPD management more challenging and
increase the use of health care services.” Identifying common
comorbidity clusters could help in the management of COPD. Optimizing
both the time and method of delivery of bronchodilators, the “mainstay
of therapy in COPD” according to researchers, can help improve exercise
tolerance and improve levels of physical activity.
For more information: http://tinyurl.com/zpt5zmo
COPD World News Week of February 21, 2016
Ottawa seeks to join provinces to cut cost of prescription drugs
Ottawa,
ON - The federal government is set to join the provinces in lowering
the cost of prescription drugs by co-ordinating their purchases, a move
that could signal a new era of co-operation between Ottawa and
provincial leaders. The collaboration is expected to come as early as
this week when Federal Health Minister Jane Philpott joins her
provincial and territorial counterparts for a meeting in Vancouver. The
meeting is the first in what will be a critical year as Ottawa works to
hammer out a new deal on health that will set national standards and
deliver the stable funding promised by the Liberals during the election.
The new federal minister, herself a family doctor, said she expects
this week’s meeting to be the beginning of a “year-long project” to
reach a new health accord and lay the groundwork for transforming
Canada’s health system. Even before the two days of meetings begin
Wednesday, a number of provincial health ministers are staking out their
positions on future federal health transfers. Some, such as B.C. Health
Minister Terry Lake, want extra per-capita funding for seniors, while
Manitoba Health Minister Sharon Blady said the same consideration should
be given to First Nations populations. Alberta Health Minister Sarah
Hoffman, whose province stands to lose if transfers are adjusted based
on age, is opposed to such changes. Dr. Philpott, who will join the
meeting on the second day, wants to steer the talk away from dollars.
“My hope is that we won’t allow ourselves to be inappropriately
distracted by conversations about details of the transfer at this stage
of the conversation,” she said. Dr. Philpott said reducing the cost of
prescription drugs is one of her top priorities. “Canadians pay some of
the highest costs for prescription drugs. That is an area that I am
quite determined to address,” she said. Joining the Pan-Canadian
Pharmaceutical Alliance, an initiative started in 2010 by the provinces
and territories to drive down costs of publicly funded drug programs
through bulk buying, is the first step, she said. Federal drug programs
that cover the military, First Nations and inmates make Ottawa the
fifth-largest spender on pharmaceuticals in Canada, Dr. Philpott said.
“We will be a major buyer that will be coming to the table and
participating in the bulk purchasing, which I think obviously will help
our purchasing power,” she said. The new federal government is looking
at other ways to reduce drug costs, she said, including changes to the
Patented Medicine Prices Review Board, the quasi-judicial body that
regulates the prices of patented drugs. A study this fall by the
Organization for Economic Co-operation and Development ranked Canada as
the fourth-highest spender on pharmaceuticals among 29 countries when
measured by population. Pharmaceutical spending in Canada worked out to
$713 (U.S.) a person in 2013, well above the OECD average of $515. Steve
Morgan, a professor of health policy at the University of British
Columbia, said the federal move to join the Pan-Canadian Pharmaceutical
Alliance is a sign of “good will and good faith,” but pointed out the
majority of Canadians pay for prescriptions out of pocket or through
private drug plans. Home care is another priority for the federal Health
Minister, following on the Liberal party’s $3-billion campaign pledge.
Dr. Philpott wants to tie new federal money to performance targets, but
said it’s too soon to say what they will be. Mr. Lake, B.C.’s Health
Minister, who will lead the provincial-territorial talks, said the issue
of physician-assisted death also must be a top priority, given last
week’s Supreme Court ruling. “We really need to have some serious
discussions with the federal government over how they’re going to move
forward,” he said. “I would prefer to see a consistent approach across
Canada so that we don’t develop different regulatory regimes in every
province. That will be a topic of intense discussion.”
For more information: http://tinyurl.com/hs4xm24
COPD World News Week of February 14, 2016
How stigma affects COPD research and care
Toronto,
ON - "Unfortunately, I believe that a tendency to blame the patient has
contributed to COPD (chronic obstructive pulmonary disease) getting
less attention than other common chronic diseases. There was a belief
that, because people with COPD smoked, they were deserving of their fate
and not deserving of resources put towards their disease. I think this
is wrong on many levels. Luckily, things are changing," said Dr.
Gershon, an assistant professor of medicine at the University of
Toronto. She was responding to questions related to her latest study,
which investigates the efficacy of different treatments for older adults
with COPD. Her point on stigma is an interesting one, as it offers an
example of how popular stigmas may directly affect both research and
care. Dr. Gershon's study - published in JAMA - also makes the point
that, despite COPD being a leading cause of death, there is
comparatively little available evidence on how to treat COPD patients -
particularly elderly patients and those who have other similar diseases,
such as asthma. But how does stigma surrounding COPD begin? For the
COPD patient the dreaded question is: "Did you smoke?" They believe in
the end they will be shamed and blamed for smoking." Smoking does cause
the majority of COPD cases although it is estimated that 25% of COPD
patients have never smoked. Dr. Gershon feels that COPD stigma has
impacted negatively on research. To arrive at this conclusion, Dr.
Gershon's team examined administrative health records for 2,129 older
adults who were only taking long-acting beta agonists for COPD and
compared them with the records for 5,594 adults taking these drugs in
conjunction with corticosteroids. The researchers found that seniors
taking both long-acting beta agonists and corticosteroids had 8% fewer
deaths and hospitalizations during the period of study than those who
were taking long-acting beta agonists alone. The team describes the 8%
disparity as "modest but significant." However, among patients who had
both COPD and asthma, those taking the two medications had a 16% lower
risk of hospitalization and death, compared with patients who only took
long-acting beta agonists. More than a quarter of the study participants
had both asthma and COPD. Dr. Gershon says that, previously, doctors
have not "really known how to treat these patients," as studies have
generally excluded COPD patients who also have asthma. "I believe this
was because the effectiveness of interventions in people with COPD would
be known with more certainty, for instance, without having to wonder if
an intervention was effective because it was treating another disease,
like asthma, that was also present. While this approach has its merits,
it means that many patients with both COPD and asthma were excluded. As a
result, there is little evidence on which to base our treatment
recommendations for these patients."
For more information: http://www.health--insurance.me/articulo.php?id=389
COPD World News Week of February 7, 2016
No Clear Winner Seen Among Stop-Smoking Aids
Madison, WI – “If you're
trying to quit smoking, using the nicotine patch, the drug Chantix, or a
combination of the patch and lozenges all appear to work equally well,”
researchers report. "To our surprise, all three treatments were
essentially identical," said lead author Dr. Michael Fiore, director of
the University of Wisconsin Center for Tobacco Research and Intervention
in Madison. Results of the three approaches did not differ
significantly at either six months or a year, the investigators found.
At six months, the quit rate was 23 percent for the patch, 24 percent
for Chantix, and 27 percent for the combination of patch and lozenges.
At a year, the quit rate was 21 percent, 19 percent and 20 percent,
respectively, the findings showed. In the past, Chantix (varenicline) or
the combination of the nicotine patch and nicotine lozenges were shown
in studies to be more effective than the patch alone, he said. "But no
one had compared them," Fiore explained. Although the reasons why the
treatments worked equally well aren't known, wanting to quit smoking has
a strong effect, Fiore suggested. "A person's desire to quit is really
powerful," Fiore said. "The treatments are important and boost quit
rates, but that in no way discounts the incredibly powerful influence of
a person's commitment to change their behavior -- particularly a
behavior so dangerous as smoking is," he said. The report was published
Jan. 26 in the Journal of the American Medical Association. Patricia
Folan is director of the Center for Tobacco Control at Northwell Health,
in Great Neck, N.Y. She said, "When a smoker tries to quit, there are
many factors that influence their decision to try to quit, and their
ability to stay quit." Reasons people quit include doctor's advice,
family pressure, the impact of smoking bans, the cost of smoking, and
anti-tobacco ads. In addition, not smoking again depends on motivation,
support, level of comfort and use of cessation medications, she said.
"While studies have demonstrated that cessation medications are an
important factor in quitting, a comprehensive approach to quitting is
often necessary for success," Folan added. In their head-to-head
comparison, Fiore and his colleagues randomly assigned smokers to one of
three 12-week programs: the nicotine patch only; Chantix only; or the
nicotine patch plus nicotine lozenges. In addition, participants were
offered six counseling sessions. According to Fiore, all the medications
were well-tolerated. However, people taking Chantix had more frequent
side events, including vivid dreams, insomnia, nausea, constipation,
sleepiness and indigestion. Pfizer Inc., the maker of Chantix, said in a
statement that the results of this study are inconsistent with findings
from previous research that reported "superior efficacy of varenicline
[Chantix] and combination therapy, compared with nicotine-replacement
therapy alone." Moreover, the best type of trial is one in which people
randomly receive Chantix, or nicotine-replacement therapy or a placebo,
but not know which. However, such a trial has not been done, the company
said. Folan said that the latest findings may have been skewed by the
type of people who were studied. Specifically, most smoked less than a
pack a day and most had tried to quit before. "Prior experiences with
quitting, the fact that they were not heavy smokers, their motivation to
quit and the provision of counseling sessions most likely had an impact
on their quit success, regardless of the medication used," she said.
Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New
York City, said that "most of the people who quit are those who want to
quit." He also said that it's not surprising that replacing nicotine by
any means results in the same outcome. In addition, Horovitz said many
of his patients are unwilling to take Chantix because of its side
effects. Horovitz added that for many smokers, several tries are needed
before they can quit for good. "Just because you have gone around the
turnstile once or twice and have not quit does not mean that you are
doomed to fail. In fact, the more times you try, the more likely it is
that you will finally succeed," he said.
For more information: https://www.nlm.nih.gov/medlineplus/news/fullstory_156905.html
Coils in lungs might boost ability to exercise with emphysema
Reims, France - Implanting coils in the lungs may help improve the ability to exercise in people with severe emphysema, a new study suggests. Emphysema is a type of chronic obstructive pulmonary disease (COPD) that damages the airways and makes it difficult to breathe. Current treatments for severe emphysema have limited effectiveness. Lung volume reduction surgery can help, but carries a risk of complications and death, the study authors explained. Dr. Gaetan Deslee, of Reims University Hospital in France, and colleagues recruited 100 patients for the study. Fifty patients received usual care -- rehabilitation and bronchodilators with or without inhaled corticosteroids and oxygen. The remaining 50 received usual care and also had coils placed in their lungs. The researchers said the coils were placed in the lungs using an endoscope -- a slender, flexible device inserted into the mouth. The study was conducted at 10 university hospitals in France. After six months, more than one-third of the patients in the coil group had improvement of at least 59 yards in a 6-minute walk test. Just 9 percent of those in the usual care group had a similar improvement. The patients in the coil group also had a significant decrease in lung hyperinflation and sustained improvement in quality of life. The average one-year per-patient cost difference between the two groups of patients was nearly $48,000, the study showed. Further research is needed to determine the long-term benefits and cost effectiveness of the coil treatment, the researchers concluded. The study was published in the Jan. 12 issue of the Journal of the American Medical Association.
For more information: https://www.nlm.nih.gov/medlineplus/news/fullstory_156661.html
COPD World News Week of January 24, 2016
No Antibiotics for Common Respiratory Infections
Atlanta, GA - Antibiotics are not needed for adults who have the common cold, bronchitis, sore throat or sinus infections. That's the advice from the American College of Physicians and the U.S. Centers for Disease Control and Prevention, which just issued guidelines for prescribing antibiotics for acute respiratory tract infections (ARTIs) in adults. These types of infections are the most common reason for visits to the doctor and for outpatient antibiotic prescriptions for adults, the researchers said. The advice, published Jan. 18 in Annals of Internal Medicine, is designed to combat what the two organizations see as overuse of such treatments. According to an ACP news release, unpublished CDC data estimates "50 percent of antibiotic prescriptions may be unnecessary or inappropriate in the outpatient setting, which equates to over $3 billion in excess costs." "Inappropriate use of antibiotics for ARTIs is an important factor contributing to the spread of antibiotic-resistant infections, which is a public health threat," ACP President Dr. Wayne Riley said in the news release. "Reducing overuse of antibiotics for ARTIs in adults is a clinical priority and a High Value Care way to improve quality of care, lower health care costs, and slow and/or prevent the continued rise in antibiotic resistance," he added. Doctors should advise patients with the common cold that symptoms can last up to two weeks and they should follow up only if the symptoms worsen or exceed the expected time of recovery. Antibiotics should also not be prescribed for uncomplicated bronchitis unless pneumonia is suspected: "Patients may benefit from symptomatic relief with cough suppressants, expectorants, antihistamines, decongestants and beta-agonists." In most cases, antibiotics should be prescribed for a sore throat only if a strep test confirms streptococcal pharyngitis. "Physicians should recommend analgesic therapy such as aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs, and throat lozenges, which can help reduce pain." Uncomplicated sinus infections typically clear up without antibiotics. Antibiotics should be prescribed only if there are persistent symptoms for more than 10 days, or if a patient develops severe symptoms or a high fever, has nasal discharge or facial pain for at least three days in a row, or worsening symptoms following a typical viral illness that lasted five days, which was initially improving."
For more information: https://www.nlm.nih.gov/medlineplus/news/fullstory_156749.html
COPD World News Week of January 17, 2016
Quality of life worse in patients with COPD than cancer
New York, NY – According to a release by Reuters Health, respiratory health-related quality of life (HRQoL) is worse in breathless COPD patients than in breathless cancer patients, researchers have found. Although breathlessness is common in patients with advanced chronic obstructive pulmonary disease (COPD) and in patients with advanced cancers of all primary sites, little is known about the impact of breathlessness on HRQoL. Dr. Morag Farquhar and colleagues from the University of Cambridge, U.K., used the Chronic Respiratory Questionnaire-Original (CRQ-Original) to examine differences in respiratory HRQoL between 139 patients with breathlessness due to advanced COPD or advanced cancer who were referred for palliative care. Patients with advanced COPD had lower median scores for all four CRQ domains, compared with patients with advanced cancer, though the differences were statistically significant only for three domains: dyspnea, emotional function, and mastery. The differences in emotional function and mastery exceeded the minimally clinically important difference of 0.5 (on a scale of 0-7), the researchers report in BMJ Supportive & Palliative Care, online December 18. "Acknowledging that patients with advanced COPD experience breathlessness differently from those with cancer is imperative if we are to direct our interventions effectively and improve access to palliative care for patients with advanced COPD," the researchers conclude. "Further, formal psychometric testing of the CRQ in patients with respiratory symptoms due to cancer may be warranted to establish its suitability for use in this group, which could benefit both research and clinical practice." Dr. Nicholas Wysham from Duke Clinical Research Institute in Durham, North Carolina, told Reuters Health by email that the cancer patients may have been referred for palliative care for a variety of reasons. "Studies like these are complicated by the choice of comparisons. By choosing to compare groups at time of palliative care referral, (the authors) are able to make inferences about referral patterns more than they are about the patients or diseases themselves," said Dr. Wysham, who has done similar research. "A comparison with lung cancer patients (as was in my manuscript and others that preceded it), might be more appropriate and may or may not have demonstrated such a difference." "Physicians who care for patients with advanced COPD should promptly recognize uncontrolled symptoms or persistent distress and manage these using the full range of therapeutic options, or make appropriate and timely referral to others who can," Dr. Wysham said. "This report suggests that brief HRQoL instruments, like the CRQ, CAT (COPD Assessment Test), and others, can be helpful for detecting patients with poor quality of life and should probably be incorporated into the routine care of such patients." "To make capture of HRQoL more routine, though, we need to push EHR vendors and health systems to integrate these items within the medical record as discreet data, giving them the importance you might to a heart rate or a pain score," Dr. Wysham added. "Furthermore, rather than consume physicians' or nurses' time collecting and entering this data, we need to explore ways for these patients to directly contribute these survey items."
For more information: http://tinyurl.com/jnf7qfc
COPD World News Week of January 10, 2016
COPD Treatment Pipeline Lacks Robust Innovation
New York, NY - Despite an influx of new therapies over recent years, the Chronic Obstructive Pulmonary Disease treatment market has a number of unmet needs, and the innovation in its product development pipeline is lagging in comparison to other indications, says business intelligence provider GBI Research. According to the company’s latest report, while currently-available drugs aim to manage the symptoms associated with COPD by reducing the frequency and severity of exacerbations and improving lung function, none have been shown to modify long-term disease progression. Yasser Mushtaq, Senior Analyst for GBI Research, states that in addition to the need for disease-modifying drugs, much of the unmet need associated with COPD has been linked to poor adherence to medication. Mushtaq says: “Tedious drug delivery processes and the need for frequent daily doses ultimately lead to poor compliance and management of COPD symptoms. As a consequence, drug development programs are focusing on long-acting medication. “There is also a need for alternative anti-inflammatory agents. Traditionally reliant on Inhaled Corticosteroids (ICS), analysis of the COPD product development pipeline has confirmed greater interest into novel anti-inflammatory agents.” The analyst adds that beyond ICS therapy, the current market offers very limited anti-inflammatory treatment, which is a notable unmet need in COPD. GBI Research’s report also states that first-in-class product development in COPD treatment constitutes only 16.5% of the pipeline, which is relatively small compared to other respiratory indications. For example, asthma therapeutics exhibit greater innovation, with first-in-class products making up 23% of the pipeline. Mushtaq continues: “There are suggestions that such innovation is filtering through into the COPD therapeutics pipeline, as asthma and COPD share mechanisms of pathophysiology, making it likely that products will be applicable to both diseases. “In this way, innovations in the asthma treatment pipeline will significantly aid that of COPD. However, there is no clear indication that disease-modifying drugs will be released onto the COPD market any time soon, making it an attractive proposition for major pharma players.”
For more information: http://tinyurl.com/jq5annr
COPD World News Week of January 3, 2016
Doctor-Patient e-mails can help the chronically ill
Oakland, CA - For people with chronic conditions, the ability to communicate with their doctor via email may improve their health, new research suggests. The study included just over 1,000 patients in northern California diagnosed with conditions such as asthma, coronary artery disease, congestive heart failure, diabetes or high blood pressure. The patients had access to an online portal, which let them review their health records, make appointments, refill prescriptions and send confidential emails to their doctor. A survey found that 56 percent of the patients had sent their doctor an email within the past year, and 46 percent had used email as the primary way to contact their doctor about medical issues. Thirty-two percent of those who exchanged emails with their doctor reported improvements in their health, according to the study published in the December issue of the American Journal of Managed Care. Meanwhile, 67 percent said emailing their doctor had no effect on their overall health, the findings showed. "We found that a large proportion of patients used email as their first method of contacting health care providers across a variety of health-related concerns," lead study author, Mary Reed, said in a news release from Kaiser Permanente. Reed is a staff scientist with Kaiser Permanente's research division in Oakland, Calif. "As more patients gain access to online portal tools associated with electronic health records, emails between patients and providers may shift the way that health care is delivered and also impact efficiency, quality and health outcomes," she added. For 42 percent of the patients, using email to communicate with their doctor reduced the number of phone calls they made to the office, and 36 percent said they made fewer office visits, according to the report. Among those who used email to communicate with their doctor, 85 percent had co-pays of $60 or more for each office visit, or high deductibles, compared to 63 percent with lower cost sharing, the study found.
For more information: https://www.nlm.nih.gov/medlineplus/news/fullstory_156514.html