COPD World News Week of June 26, 2011
Pfizer's Chantix carries "small, increased" cardiovascular risk
Silver Spring, MD - The FDA announced recently that Pfizer's smoking cessation drug Chantix (varenicline) may be linked "with a small, increased risk of certain cardiovascular adverse events in patients who have cardiovascular disease." The agency said that the information will be added to the product's label.
The regulator reviewed a clinical trial involving 700 patients with cardiovascular disease who received either Chantix or placebo. According to the FDA, Chantix "was effective in helping patients quit smoking and remain abstinent from smoking for as long as one year." However the agency noted that despite cardiovascular adverse events being infrequent overall, Chantix was associated with more frequent events than placebo.
In the study, seven patients receiving Chantix reported a heart attack, compared to three patients who took placebo, while eight patients who received Pfizer's drug had a need for coronary revascularisation, versus three for placebo. The drugmaker commented that the study, which was published in January last year, "was not designed to detect small differences in cardiovascular outcomes."
The FDA indicated that it is continuing to look at the safety of Chantix, and has asked Pfizer to undertake a large analysis of existing studies. The product, which had sales of $755 million last year, has previously been linked with an increased risk of serious mental health events, including changes in behaviour and suicidal thoughts.
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COPD World News Week of June 19, 2011
COPD Drug Via Mist Inhaler Could Raise Death Risk
Baltimore, Maryland - A mist inhaler with the drug Spiriva is associated with a 52 percent increased risk of death among people with chronic obstructive pulmonary disease (COPD), a new review shows. The mist inhaler with the soluble form of Spiriva (tiotropium) is approved in 55 countries, but is not yet approved in the United States. However, the powdered form of Spiriva is commonly used to treat COPD patients in the United States.
"Tiotropium is an inhaled drug used commonly in the treatment of COPD. Its major purpose is to reduce obstruction to airflow," explained Dr. Mark Rosen, director of pulmonary rehabilitation at North Shore University Hospital in Manhasset, N.Y., and Long Island Jewish Medical Center in New Hyde Park, N.Y. "In the U.S., it is available only in the 'Handihaler' device that delivers the drug in a powder form," said Rosen, who was not involved in the new study.
"Another form of tiotropium is available in Europe, but not the U.S., in a mist using a 'Respimat' device." In the new study, researchers led by Dr. Sonal Singh, an assistant professor of general internal medicine at the Johns Hopkins University School of Medicine in Baltimore, analyzed the findings of five published studies that included a total of more than 6,500 patients. They compared the mist inhaler with Spiriva against a mist inhaler with a placebo. Those who used the inhaler with Spiriva were 52 percent more likely to die than those who used the inhaler with the placebo. There was one excess death due to the mist inhaler with Spiriva for every 124 patients who were treated for a year. Cardiovascular disease is the main reason for the increased risk of death, Singh said.
"What we think is going on is that the mist inhaler is delivering a higher concentration of tiotropium than it should and that may be increasing the risk of death," Singh said in a Hopkins news release. Rosen said that American patients need not be alarmed, but the findings should give regulators something to consider. Patients need to discuss the risks and benefits of COPD treatments with their doctors, Singh advised.
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COPD World News Week of June 12, 2011
Potential new target for smoking cessation without weight gain
New Haven, Conn - A new study uncovers a brain mechanism that could be targeted for new medications designed to help people quit smoking without gaining weight. This research, funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, shows that a specific subclass of brain nicotinic receptor is involved in nicotine’s ability to reduce food intake in rodents.
Prior research shows that the average weight gain after smoking is less than 10 pounds, but fear of weight gain can discourage some people who would like to quit. In the study, researchers found that a nicotine-like drug, cytisine, specifically activated nicotinic receptors in the hypothalamus — a brain center that controls feeding. This resulted in the activation of a circuit that reduced food intake and body fat in a mouse model. This effect was very specific, since a drug that prevented cytisine from binding to its hypothalamic receptors blocked the reduction in food intake.
Through the use of tobacco, nicotine is one of the most heavily used addictive drugs and the leading preventable cause of disease, disability, and death in the United States. According to the Centers for Disease Control and Prevention, cigarette smoking results in more than 440,000 preventable deaths each year — about 1 in 5 U.S. deaths overall. Despite the well-documented health costs of smoking, many smokers report great difficulty quitting.
"These mouse models allow us to explore the mechanisms through which nicotine acts in the brain to reduce food intake," said Dr. Marina Picciotto, of Yale University, New Haven, Conn. and senior author for the article. "We found that nicotine reduced eating and body fat through receptors implicated in nicotine aversion and withdrawal rather than reward and reinforcement." "These results indicate that medications that specifically target this pathway could alleviate nicotine withdrawal as well as reduce the risk of overeating during smoking cessation," said NIDA Director Dr. Nora D. Volkow.
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COPD World News Week of June 5, 2011
Researchers look at barriers to pulmonary rehab attendance.
Melbourne, Australia - Researchers here completed a new systematic review of clinical data looking at why people with COPD do not attend pulmonary rehab.
Pulmonary rehabilitation is an essential component of care for people with chronic obstructive pulmonary disease (COPD) and is supported by strong scientific evidence. Despite this, many people with COPD do not complete their program or choose not to attend at all. The aim of this study was to determine the factors associated with uptake and completion of pulmonary rehabilitation for people with COPD.
Seven electronic databases were searched for qualitative or quantitative studies that documented factors associated with uptake and completion of pulmonary rehabilitation in people with COPD. Two reviewers independently extracted data, which was synthesized to provide overall themes.
Travel and transport were consistently identified as barriers to both uptake and completion. A lack of perceived benefit of pulmonary rehabilitation also influenced both uptake and completion. The only demographic features that consistently predicted non-completion were being a current smoker and depression. The limited data available regarding barriers to uptake indicated that disruption to usual routine, influence of the referring doctor and program timing were important.
Enhancing attendance in pulmonary rehabilitation will require more attention to transportation, smoke cessation and support for those at risk of non-completion and greater involvement of patients in informed decisions about their care.
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COPD World News Week of May 29, 2011
Certain COPD Meds Linked to Urinary Troubles in Men
Toronto, ON - New research suggests that a certain class of drugs used to treat chronic obstructive pulmonary disease (COPD) boosts the risk that male patients will be unable to urinate.
The disease, which makes breathing difficult due to inflammation and blockage in the body's air passages, affects an estimated 10 percent of people aged 40 and older. A class of drugs called "inhaled anticholinergic" medications are used to treat the conditions, but there are concerns about their side effects. These drugs include tiotropium (Spiriva), ipratropium bromide (brand name Atrovent) or Combivent, which is ipratropium combined with albuterol.
In the new Canadian study, Dr. Anne Stephenson of St. Michael's Hospital in Toronto and colleagues examined medical records from people in Ontario, aged 66 and older, who suffered from chronic obstructive pulmonary disease. Of the more than 565,000 patients studied, 9,432 men and 1,806 women developed an inability to urinate. Among men, the researchers found a statistically significant link between those who took the drugs and those who didn't. Among those taking the drugs, the odds of the urinary condition were about 40 percent higher in those who'd been using the drugs for 4 weeks or less, and they were 80 percent higher among those with enlarged prostate glands.
"Physicians should highlight for patients the possible connection between urinary symptoms and inhaled respiratory medication use to ensure that changes in urinary flow (i.e., incomplete voiding, urinary incontinence, and decreased urinary flow) are reported to the physician," the authors wrote. The researchers added that low doses of the drugs may reduce a patient's risk for these urinary problems.
The study is published in the May 23 issue of the Archives of Internal Medicine. For more information:
COPD World News Week of May 22, 2011
Walk Test Predicts Death Risk in COPD
Denver, CO - The six-minute walk test can accurately pick out COPD patients at increased risk of death, a researcher recently reported at the annual meeting of the American Thoracic Society.
In a three-year observational study, the risk of death rose as the baseline distance walked in six minutes fell, according to Martijn Spruit, PhD, of the Centre of Expertise for Chronic Organ Failure in Horn, the Netherlands. There was also a steady increase in the risk of exacerbations needing inpatient care as baseline walk distance fell, Spruit said.
The findings confirm previous observations that a poor six-minute walk test predicts mortality and that the test can help clinicians understand disease severity in COPD patients. And, according to study co-author Michael Polkey, MD, PhD, of Royal Brompton Hospital in London, their study extends those observations by tying the walk test results to the risk of severe exacerbations.
COPD severity is usually measured by the one-second forced expiratory volume, or FEV1, Spruit noted, but that measure fails to capture some systemic features of the disease, such as muscle weakness. To evaluate the six-minute test, he and his colleagues enrolled 2,110 patients with clinically stable GOLD II to IV disease and gave them a six-minute walk test at baseline and annually for three years. At baseline, patients had moderate to severe disease, characterized by an average FEV1 of 48% predicted. They also had a normal body composition, an impaired health status, and shortness of breath. On average, Spruit said, they also did poorly on the six-minute walk test -- 369 meters.
The average decline in the walk test was 5.7 meters a year, after adjusting for country, age, sex, and lung function, but the rate of decline was higher with worsening GOLD status: 1.6 meters a year for patients in GOLD II, 9.8 for those in GOLD III, and 8.5 for those in GOLD IV. Using receiver operating characteristic curves, the researchers found that those whose six-minute walk distance was below 334 meters were at increased risk of death.
Over the three-year study, 200 patients died and 650 needed inpatient care for exacerbations. On average, the baseline distance walked by survivors was 376 meters, compared with just 303 for those who died. Similarly, those whose distance was below 357 meters were at increased risk of exacerbations that needed inpatient care.
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COPD World News Week of May 15, 2011
Donor Lungs Kept Alive Outside Body
Toronto, ON - Using a technique that looks like it could have been pulled from a science fiction thriller, transplant surgeons can now keep lungs alive outside of the body, giving them time to heal and allowing surgeons to better assess the health of the lungs before transplant.
In the new procedure, lungs are placed in a protective glass dome after being removed from the donor. They're then hooked up to a ventilator, so the lungs can continue to breathe, and the lungs are given what's known as a perfusion solution to mimic blood circulating through them. "We've developed a technique that allows us to assess and treat lungs outside of the body," said the study's senior author, Dr. Shaf Keshavjee, director of the Toronto Lung Transplant Program at Toronto General Hospital. "The pleasant surprise from our study was that we set out to prove these lungs would be equivalent, but we now have data showing that these patients can even do better," he said. Results of the study are published in the New England Journal of Medicine.
Currently, more than 80 percent of donor lungs are unsuitable for transplant, with fewer than 15 percent of lungs from multiorgan donors able to be used, according to the study. Because of the relatively small number of organs that are deemed to be acceptable, mortality is high among patients awaiting transplantation, the authors pointed out.
Keshavjee said that the reason so few lungs are suitable for transplant is that brain death and complications from treatments received often damage the lungs. Then, when the lungs are removed from the body, they don't have a chance to begin healing. "What we've tried to do is make the lungs think they're still in the body. This allows them the chance to recover," said Keshavjee.
Lungs are only placed on the machine for two to four hours, but that's enough time for them to start to heal, he said. The other big benefit is that because the lungs are essentially alive in the glass dome, surgeons can assess the health and function of the lungs before transplant.
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COPD World News Week of May 8, 2011
Inhaled Meds May Save COPD/Pneumonia Patients' Lives
Washington, DC - Inhaled corticosteroids can actually reduce the risk of death in patients with chronic obstructive pulmonary disease, who are hospitalized with pneumonia, a new study has found.
U.S. researchers examined the medical records of 15,768 COPD patients older than 65 who were admitted to VA hospitals for pneumonia between 2002 and 2007. Of those patients, 52.5 percent were treated with inhaled corticosteroids. The all-cause death rate after 30 days was 10.2 percent for inhaled corticosteroid users and 13.6 percent for those who weren't treated with inhaled corticosteroids. After 90 days, the death rate was 17.3 percent among inhaled corticosteroid users and 22.8 percent for those who didn't receive inhaled corticosteroids, the investigators found.
Overall, patients not treated with inhaled corticosteroids were about 25 percent more likely to die than those who received the medication, the researchers concluded. The study findings were released online in advance of publication in an upcoming print issue of the American Journal of Respiratory and Critical Care Medicine.
Previous research found that inhaled corticosteroid use in COPD patients increases the risk of pneumonia. It was therefore believed that inhaled corticosteroids also increased the risk of death in these patients. This study found the opposite to be true. "These results have clear implications for current clinical practice, which has been informed in the past by a series of studies that found an increased risk of pneumonia with inhaled corticosteroid use," principal investigator Dr. Eric Mortensen, an investigator at the Veterans Evidence-Based Research, Dissemination, and Implementation Center (VERDICT), a VA Health Services research and development program, said in a news release from the American Thoracic Society.
"In contrast, our study would suggest that inhaled corticosteroid use may confer a survival benefit to these patients and may be employed when there are not contraindications. These results should reassure clinicians that they can give their COPD patients inhaled corticosteroids without fearing that the increased risk of pneumonia will translate into higher risk of mortality," he said.
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COPD World News Week of May 1, 2011
Smokers who quit have less aggressive kidney cancer
New York, NY - Researchers have found that kidney cancer is not only more common among heavy smokers, it also appears to be more aggressive. According to a recent study, more than one in four smokers undergoing kidney cancer surgery had advanced stages of the disease, compared to only one in five patients who didn't light up.
Researchers say about 70 percent of people with early-stage tumors survive at least five years, whereas that number plummets to just eight percent after the cancer has begun spreading. About one in 70 Americans, most of them elderly, develop kidney cancer, according to the American Cancer Society.
But the findings aren't all bad news. Indeed, former smokers who'd kicked the habit had a smaller chance of turning up with advanced cancer. While the study wasn't designed to prove that quitting can slow tumor growth, Dr. Thomas J. Polascik, who led the work, said he believes that to be the case. "It can't bring you down to the risk of a nonsmoker, but it can get you almost there," said Polascik, a surgeon at Duke University in Durham, North Carolina.
Polascik and his colleagues looked at data for 845 people who'd had surgery for kidney cancer at their hospital. A quarter of the patients had advanced disease, defined as cancer spreading beyond the kidney. The odds of finding late-stage cancer were 60 percent higher in smokers -- about a fifth of the patients -- than non-smokers, even after taking age and other factors into account. And the more cigarettes they had smoked, the higher the odds. Former smokers also had higher odds of advanced disease. But the odds fell by nine percent for every decade they had been smoke-free.
The researchers say that means smoking might not only up the chances the a tumor will form in the first place, but might also fuel cancer growth, perhaps by suppressing the immune system. However, Alexander S. Parker, a kidney cancer expert at the Mayo Clinic in Jacksonville, Florida, said it's also possible that smokers are less likely to seek medical care than non-smokers. "If this is true, then it would not be the case that the biology of these tumors is different," he said. "Rather, just that the individuals themselves have less contact with the health care system and are less likely to be diagnosed when their cancers are at an early, treatable stage."
Still, Parker, who was not involved in the new study, said the findings lined up with earlier data showing that smokers have twice the risk of developing kidney cancer, in addition to other health problems. "In the end," he said, "we need to be clear that smoking accounts for hundreds of thousands of deaths every year in the U.S. and therefore, the overall effort should still be focused on getting people to quit smoking and to keep young people from starting in the first place."
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COPD World News Week of April 24, 2011
Nearly 20% of Lung Cancer Patients Keep Smoking
Winston-Salem, NC - Many patients diagnosed with lung cancer, as well as their family caregivers, continue to smoke even though doing so may jeopardize their recovery and long-term health outcome, says a study sponsored by the U.S. National Cancer Institute.
Researchers report that nearly one in five recently diagnosed lung cancer patients continues to light up, which can make them feel guilty or socially stigmatized. which can make them feel guilty or socially stigmatized. "The biggest obstacle is fatalism, the belief that it is too late to quit smoking so why bother," said Kathryn E. Weaver, study lead author and assistant professor of social sciences and health policy at Wake Forest Baptist Medical Center in Winston-Salem, N.C.
"There are benefits to be gained by quitting that have important implications for survival, response to treatments, and quality of life," she said.
The findings point to the need for family support, counseling and medication to help patients and/or family caregivers overcome their addiction and adopt healthy lifestyle choices, said Weaver.
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COPD World News Week of April 17, 2011
Babies Who Sleep in Smokers' Rooms Face 'Thirdhand' Smoke
Madrid, Spain - A new Spanish study has found that levels of nicotine in the hair of infants who sleep in the same room with parents who smoke are three times higher than in babies who sleep in another room. The nicotine is from cigarette smoke particles that impregnate the parents' skin, clothes and hair, which is known as "thirdhand smoke," the Spanish researchers explained.
The investigators analyzed hair samples from 252 babies younger than 18 months and interviewed their parents about their smoking habits. Seventy-three percent of the parents said they smoked or allowed smoking in their homes, and 83 percent of the babies' hair samples showed high levels of nicotine.
The study also found that cigarette smoke toxins are still present in homes even when parents try to take action to protect their children's health, such as smoking by a window, ventilating bedrooms after smoking, or smoking when the baby is in a different room or not in the house.
"Passive smoking is the leading preventable cause of childhood death in developed countries," lead author Guadalupe Ortega said in a Plataforma SINC news release.
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COPD World News Week of April 10, 2011
Emphysema Less Common With Interstitial Disease
Boston, MA - Smokers with radiographic evidence of interstitial lung abnormalities were less likely to have emphysema and more likely to have reduced total lung capacity than were smokers without interstitial findings, researchers said. But these smokers are not without risk, cautioned Ivan O. Rosas, MD, of Brigham and Women's Hospital in Boston, and colleagues in the COPD Gene Investigators group.
Patients with interstitial abnormalities had higher rates of restrictive lung deficit, they wrote in the March 10 issue of the New England Journal of Medicine. Moreover, they noted, following these individuals over time may show that the interstitial abnormalities "will progress to clinically significant disease" such as idiopathic pulmonary fibrosis. Rosas and colleagues indicated that smoking is a well-known contributing factor to emphysema and the pulmonary hyperinflation that results, but a role for smoking in promoting interstitial lung abnormalities - reflecting areas of increased lung density - has only recently been recognized. Moreover, there have been hints that smokers with these abnormalities are less prone to emphysema and elevated lung capacity.
To explore the issue, they obtained high-resolution CT chest scans for 2,416 long-term smokers who were participating in a genetic study of COPD, and analyzed them for the presence of several types of interstitial lung abnormalities.
In an accompanying editorial, Talmadge King Jr., MD, of the University of California San Francisco, raised the possibility "that the pathobiology of smoking can lead to two distinct patterns of injury." He suggested that the damage may either be overt and destructive, which is emphysema, or it may be more subtle in the form of interstitial lung disease. But King also noted that the study's methodology could not rule out the possibility that interstitial lung disease simply masks emphysema - or that interstitial disease is inherently limited in patients with severe emphysema.
Observing that many subclinical effects of smoking may be reversible when people quit, King urged that clinicians not prescribe aggressive treatments for interstitial disease on the basis of high resolution chest CT. "The findings of this study, while intriguing, should not change clinical practice - except to intensify our efforts in smoking prevention and cessation," King wrote.
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COPD World News Week of April 3, 2011
Heavy Smoking Declines in U.S
San Diego, CA -The number of people who smoke a pack or more a day has dropped significantly in the United States, and perhaps nowhere more than in California, a new study finds. The number of people smoking less than a pack but at least 10 cigarettes a day has also dropped significantly, added the researchers, who examined national data on smoking rates from 1965 to 2007 to come to their conclusion.
"Public health advocacy can have a major impact on social norms and lead to major changes in population behavior," said lead researcher John P. Pierce, a professor of family and preventive medicine at the University of California San Diego. In addition, there has been a significant decline in lung cancer rates in California, and those rates will continue to drop faster than in the rest of the country over the next 15 years, he noted.
"The Tobacco Control Program in California has aimed to change social norms in the population, and this has had a major impact," Pierce said. "Such programs need to be disseminated more widely. The change in social norms in California impacted both initiation and cessation."
For the study, Pierce's team collected data on 1,801,529 people who took part in the National Health Interview Surveys, 1965-1994 and the Current Population Survey Tobacco Supplements, 1992-2007. A total of 139,176 responders were in California, and 1,662,353 were located throughout the rest of the United States.
In 1965, 56 percent of all smokers in the United States smoked a pack (20 cigarettes) a day or more. In California, this represented 23.2 percent of smokers while in the rest of the country the prevalence of heavy smokers was 22.9 percent, the researchers found. By 2007, this prevalence of heavy smokers was 2.6 percent in California and 7.2 percent in other states, they added. For those who smoked 10 to 19 cigarettes a day, the prevalence in 1965 was 11.1 percent in California and 10.5 percent in the rest of the country.
By 2007, the prevalence in California was 3.4 percent while it was 5.4 percent in the rest of the United States, the researchers noted. "This decline has not been accompanied by higher rates of lower-intensity smoking," Pierce said. "This decline in intensity of smoking has come about by a major change in the number of young people who have taken up even a half-pack per day habit." There has also been a major cessation effect, Pierce added.
Danny McGoldrick, vice president for research at the Campaign for Tobacco-Free Kids, noted that "California has reduced overall smoking and high-intensity smoking much faster than the rest of the country, and this has led to declines in lung cancer rates that are larger than the rest of the country, saving lives and health-care dollars. The ban on public smoking seems to help people quit," he said. "But, the job is not over, 20 percent of Americans still smoke, so there is still a long way to go. But we have begun to turn the tide in lung cancer and it looks like it's happening in chronic obstructive pulmonary disease."
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COPD World News Week of March 27, 2011
New Test for Emphysema on the Horizon
New York, NY - A simple and inexpensive blood test designed to uncover early signs of emphysema may one day find its place among the standard work-up that most Americans undergo during their yearly physical, new research suggests. Although the novel screening method has shown considerable promise in preliminary investigations sponsored by the U.S. National Institutes of Health, the researchers caution that more studies are needed before the test could become available. An easily administered test that could spot emphysema even before symptoms show up would be an enormous boon to the care of smokers, who are the most vulnerable to the onset of the disabling and potentially deadly disease.
"We know from other studies that smokers who learn from objective evidence that their health is in danger are much more likely to quit," Dr. Ronald G. Crystal, chairman and professor of genetic medicine and internal medicine at Weill Cornell Medical College and the study's lead author, said in a news release. "That is the only thing that will help them avoid this deadly disorder." "We need a blood test that can be administered to the 20 percent of American adults who smoke as well as nonsmokers exposed to secondhand smoke, all who may not understand their risk of developing this progressive lung disease," he added.
The new screening mechanism for emphysema was designed to measure the presence in the bloodstream of capillary debris, known as endothelial microparticles, or EMP, that results from injury to the lung's air sacs, called alveoli. The researchers noted that air sacs are central to respiratory function, and their COPD-driven deterioration ultimately shreds the lungs, producing the Swiss-cheese appearance that's telltale of the disease.
When tested on healthy nonsmokers, healthy smokers and smokers with signs of lung disease, the new test for EMP was found to be nearly foolproof in detecting early signs of emphysema, compared with the current emphysema screening method, known as DLCO, or lung diffusion testing, which measures how well the lungs exchange oxygen and carbon dioxide.
The new test, according to the researchers, also is better than the current one at uncovering the earliest signs of disease and can be done without the involvement of a pulmonologist. In addition, they said, being able to easily diagnose emphysema at an early stage could be the leg up that health practitioners need to get their patients who smoke to finally kick the addiction.
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COPD World News Week of March 20, 2011
Lung injury after cigarette smoking is particle related
Research Triangle Park, NC - Researchers here proposed that injury and disease following cigarette smoking is associated with exposure to and retention of particles produced during smoking. Smoking one cigarette exposes the human respiratory tract to between 15,000 and 40,000 µg of particulate matter and that this matter is a result of an incomplete combustion.
There are numerous human exposures to other particles, and these vary widely in composition, absolute magnitude, and size of the particle. The researchers also looked into the biological effects of particles associated with cigarette smoking. Do these particles share a single mechanism of injury with all particles? Individuals exposed to all these particles share a common clinical presentation with a loss of pulmonary function, increased bronchial hyperresponsiveness, pathologic changes of emphysema and fibrosis, and comorbidities, including cardiovascular disease, cerebrovascular disease, peripheral vascular disease, and cancers.
Mechanistically, all particle exposures produce an oxidative stress, which is associated with a series of reactions, including an activation of kinase cascades and transcription factors, release of inflammatory mediators, and apoptosis.
If disease associated with cigarette smoking is recognized to be particle related, then certain aspects of the clinical presentation can be predicted; this would include worsening of pulmonary function and progression of pathological changes and comorbidity (eg, emphysema and carcinogenesis) after smoking cessation since the particle is retained in the lung and the exposure continues.
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COPD World News Week of March 13, 2011
British study looks at oxygen use
London, UK - A recent British study looks at reasons why portable oxygen users in the UK don't use their portable systems. The aim of this study was to obtain in-depth information about perceptions and use of prescribed ambulatory oxygen systems from patients with COPD to inform and improve ambulatory oxygen design, prescription and management.
A qualitative design for the study was used, involving semi-structured face-to-face interviews. Twenty-seven UK community-dwelling COPD patients using NHS prescribed ambulatory systems were recruited. They found that for the average COPDer, portable oxygen can be intimidating for a number of reasons.
Based on their patient interviews, the researchers concluded that COPD patients did not use their portable O2 systems because they were poorly instructed on how to use the system or were uncertain about the benefits of using it.
Other reasons cited to the researchers were that the patients didn't trust the instrument gauges and were afraid they'd run out of O2 if they left their homes. A few mentioned that they were embarrassed to be seen with oxygen tanks and were concerned about managing the weight of the equipment.
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COPD World News Week of March 6, 2011
COPD May Make Shingles More Likely
Taipei, Taiwan - People with chronic obstructive pulmonary disease, or COPD, are more likely than others to develop shingles, according to a new study. Shingles is a reactivation of the chickenpox virus, and results in a painful rash with lesions.
Though it was already known that people with a weakened immune system face an increased risk for the condition, the researchers of the current study wanted to look specifically at people with chronic obstructive pulmonary disease. The study authors analyzed data on 42,430 Taiwan residents, including 8,486 people with COPD.
During the follow-up period, 321 cases of shingles were diagnosed among those with COPD (16.4 cases per 1,000 person-years) and 759 cases among the others (8.8 cases per 1,000 person-years). The risk was highest for people taking inhaled or oral corticosteroids to treat COPD, the investigators found.
Hui-Wen Lin and colleagues from the Taipei Medical University wrote that it's also possible that "increased [COPD] severity further contributed to the increased risk of herpes zoster associated with chronic obstructive pulmonary disease."
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COPD World News Week of February 27, 2011
Smokers at Risk of Developing ALS
Cambridge, MA - Cigarette smoking appears to be associated with an increased risk of amyotrophic lateral sclerosis -- although the reasons for the relationship may be complex -- according to data analysis of five large cohort studies. The analysis -- involving more than 1.1 million study participants, 832 of whom had ALS, found that among current smokers, the age- and sex-adjusted risk for ALS was greater than for non-smokers.
No cause has been identified for the motor neuron disorder, commonly called Lou Gehrig's disease after its most famous victim -- but some investigators have suggested that cigarette smoking might play a role. Previous studies looking at this association have had conflicting results, however, possibly because of small sample sizes and selection or survival bias.
To more fully explore the possible relationship between smoking and ALS, O'Reilly and colleagues analyzed data from the Nurses' Health Study, the Health Professionals Follow-up Study, the National Institutes of Health-AARP Diet and Health Study, the Multiethnic Cohort, and the CPS-II Nutrition Cohort. Among the entire sample, which included 562,804 men and 556,276 women, the researchers identified 832 cases of ALS. In all five of the cohorts studied, more men were affected and the rates of ALS increased with age. The risk of ALS also increased according to pack-years of smoking, though not in a linear fashion.
In addition, the relative risk for ALS increased by 10% for each additional 10 cigarettes smoked daily, and by 9% for each decade of smoking. The relative risk tended to be slightly higher among women, but not significantly so. Younger age at starting smoking was associated with ALS risk, with each five-year increment of younger age at smoking initiation having a greater pooled relative risk.
O'Reilly and colleagues offered several other hypotheses from their research. Early smoking is more important, during adolescent development of motor neurons. Smoking triggers neurodegeneration but the subsequent progression of ALS is independent of cigarette use. Long-term smokers who don't develop the disease have little susceptibility.
Some components in tobacco smoke may have beneficial effects that can compensate for harmful effects of other chemicals. "The latter hypothesis may seem far-fetched, but it is indirectly corroborated by the low risk of Parkinson disease among smokers," O'Reilly's group observed. "Better understanding of the relation between smoking and ALS may further the discovery of other risk factors and help elucidate the nature of the disease," they concluded.
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COPD World News Week of February 20, 2011
Many with asthma, emphysema may misuse inhalers
New York, NY - Many people with asthma or emphysema could be taking their inhaled medicines incorrectly, researchers say. When they asked 100 adults hospitalized for asthma or a lung disease like emphysema to show how they used their inhalers at home, most made some type of mistake. Fortunately, it wasn't hard for them to learn the correct methods.
Overall, patients misused metered-dose inhalers nearly nine out of 10 times, and Diskus inhalers seven out of 10 times, the researchers report in the Journal of General Internal Medicine. Both types of inhalers deliver medication directly to the airways.
Diskus inhalers are used mainly for "controller" medications -- the ones patients take regularly to keep asthma or other lung disease symptoms under control. Metered-dose inhalers can be used for controller or "rescue" medications, which patients take during severe episodes of breathlessness and other symptoms. The two types of inhalers work by different mechanisms, and require different steps to deliver the medication to the lungs. So for people who use both -- which is quite common -- the ins-and-outs of correct use can be particularly tricky, said lead researcher Dr. Valerie G. Press of the University of Chicago.
With metered-dose inhalers, people have to inhale slowly, for example, while the Diskus device requires a sharp inhalation. "Respiratory inhalers require multiple coordinated steps," Press told Reuters Health. "They are not just point-and-shoot." Ideally, people who use inhalers should bring them to their doctor appointments and demonstrate how they use the devices at home, Press noted. But in reality, that may not happen.
"The key for patients is, don't assume that inhalers should be easy to use, and don't be afraid to ask questions," Press said. The 100 patients in the study were at one of two Chicago hospitals because of serious asthma or worsening of their chronic obstructive lung disease, or COPD.
Some of the patients, Press said, were hospitalized due to near-fatal complications -- making it especially critical that they know how to properly use their inhalers.
When the researchers asked everyone to demonstrate how they used their inhalers at home, one of the biggest problems was that patients failed to breathe out fully before placing the inhaler in the mouth. One of the obstacles, Press and her colleagues found, appeared to be vision problems. Nearly all patients with poor vision used the Diskus inhaler incorrectly, compared with slightly more than half of those with adequate vision. It might be that vision problems make it harder for people to read the inhalers' instructions, which are typically written in very small letters, Press said.
On the bright side, though, the researchers also found it didn't take much to improve people's inhaler use. Forty-two participants were given one or two lessons on how to use the devices, which included having them "teach" the techniques back to the researchers. All were able to master the techniques for both inhalers.
"In general," Press said, "it's very important for people to know how to use their medications properly." For people with asthma or COPD, she said, trouble controlling symptoms might be a sign the inhaler isn't being used correctly, and they should ask their doctor to evaluate how they're using it.
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COPD World News Week of February 13, 2011
Impact of early detection on burden of COPD
Lyngby, Denmark - Researchers here looked at early detection to determine the possibility for interventions to reduce the future burden of COPD. The Danish National Board of Health recommends that individuals older than 35 years with tobacco and/or occupational exposure, and at least 1 respiratory symptom should be offered a spirometry to facilitate early detection of COPD.
The aim or their study was to provide evidence for the feasibility and impact of doing spirometry in this target population. Participating general practitioners (Danish GPs) recruited consecutively, subjects with over 35 years exposure, no previous diagnosis of obstructive lung disease, and at least 1 of the following symptoms: cough, dyspnea, wheezing, sputum, or recurrent respiratory infection. Data on subject's age, smoking status, pack-years, body mass index, dyspnea score, and pre-bronchodilator spirometry (FEV1, FEV1% predicted, FEV1/FVC) were obtained.
A total of 3.095 (51% females) subjects were studied with a mean age 58 years, BMI 26.3, and 31.5 pack-years. They found that the prevalence of airway obstruction increased with age and decreased with increasing BMI, and was higher in men and current smokers. According to the level of FEV1, 79% of the subjects with airway obstruction had mild to moderate COPD.
The researchers concluded that more than one-third of the recruited subjects had airway obstruction. And, that early detection of COPD appears to be feasible through offering spirometry to adults with tobacco and/or occupational exposure and at least 1 respiratory symptom.
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COPD World News Week of February 6, 2011Campaign Moves 1 Million People to Get Screened for COPD
Ridgefield, CT- DRIVE4COPD announced that it recently achieved its goal of screening 1 million Americans to determine their risk for chronic obstructive pulmonary disease (COPD) in its first year. The health awareness campaign aims to make a fundamental change in how COPD is addressed in the USA and an important part of this effort is to find the millions who may be at risk for COPD and do not know it.
COPD permanently damages the lungs and makes it harder to breathe but if identified, COPD can be managed. Of the estimated 24 million Americans who may have COPD, half don't know it. The validated COPD Population Screener™ offered by DRIVE4COPD is an important first step for those who might be at risk.
"For many, taking the brief, five-question screener may be the first indication that they are at risk for COPD," said Brian Carlin, MD, FCCP, Chair, COPD Alliance. "The results of the screener can prompt those at risk to have a conversation with a healthcare professional and if needed, take steps to prevent irreversible lung damage." Nearly 20 percent of the people who have taken the screener scored high enough to indicate they may be at risk for COPD. The campaign asks those who identify as at-risk to share the results of the screener with their healthcare professional.
All Americans age 35 or older who have smoked 100 cigarettes in their lifetime are encouraged to log onto DRIVE4COPD.COM and be screened. The true reach of the campaign extends even beyond the 1 million who have taken the screener. In the past year, DRIVE4COPD has touched hundreds of millions more lives by sharing vital information on COPD symptoms and the need to take action.
Partnering organizations, committed Celebrity Ambassadors and corporate partners have supported DRIVE4COPD and helped spread the campaign to people across the country. In addition, DRIVE4COPD has collaborated with businesses nationwide to educate their employees and customers about COPD and the importance of getting screened for risk.
"We are thrilled that in just one year, we have already made a mark on reaching the millions of people who may be at risk for COPD," said Chris Barrett, Senior Vice President at Boehringer Ingelheim Pharmaceuticals, Inc. "With our campaign partners we've been able to reach a far greater audience than we ever could have alone, and we welcome other partners to join our mission." This remarkable accomplishment attests to the campaign's success in working to change the way COPD is viewed and addressed in America, but much work remains.
COPD is the only leading cause of death in America that is on the rise and still takes one life every four minutes.
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COPD World News Week of January 30, 2011Increasingly, Other Ailments Prove Fatal for People With COPD
Karlskrona, Sweden - People with chronic obstructive pulmonary disease are more likely today than in the past to die from cardiovascular disease or other conditions that are not respiratory ailments, a new Swedish study has found. This suggests that doctors need to be more aware of these risks when treating people with COPD.
In recent years, the average age of COPD patients beginning long-term oxygen therapy has grown in Sweden from 66 to 73 years, Dr. Magnus P. Ekstrom, respiratory medicine physician and researcher at Blekinge Hospital in Karlskrona, Sweden, said in a news release from the American Thoracic Society. The proportion of women starting the therapy also has increased, said Ekstrom, who worked on the study.
"We wanted to determine if these changes had resulted in a shift in the causes of death for COPD patients with long-term oxygen therapy," he said of the study, published in the American Journal of Respiratory and Critical Care Medicine.
The researchers analyzed data on 7,628 adults who began long-term oxygen therapy for COPD between 1987 and 2004. During the study, which followed the participants for an average of 1.7 years, 5,497 of them died. Lung cancer and respiratory disease became less common causes of death each year, but the risk for circulatory and digestive organ disease both grew, the study found.
Overall, the risk for death from cardiovascular disease increased by almost 62 percent, according to the study. The difference seemed to be due, at least in part, to the older age of people starting oxygen therapy, the study found.
"Tobacco exposure has decreased overall in Sweden, resulting in a delay in the decline of lung function, which means patients are generally older when they require" oxygen therapy, Ekstrom said. "However, although smoking has decreased overall, the rate of decrease has been greater in men than in women."
Because people are older when starting therapy for COPD, they "have a progressively higher burden of coexisting diseases and conditions, and become more vulnerable with increasing age," he said. Because of this, Ekstrom added, doctors treating COPD with long-term oxygen therapy "need to be aware of these shifts and to monitor for other conditions that may influence the risk of death in these patients."
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COPD World News Week of January 23, 2011Study of lung disease in urban drug users
Baltimore, MD - Researchers here looked at unrecognized obstructive lung disease among urban drug users. It was noted that Obstructive Lung Disease (OLD) is frequently unrecognized and under-treated among urban drug users. And that they tend to be at higher risk for OLD due to race, behavioral, and socioeconomic characteristics, yet little data exist on prevalence and risk factors associated with unrecognized OLD in this population.
The objective of their study was to determine the prevalence of unrecognized OLD in an urban population and identify the characteristics associated with lack of physician-diagnosed OLD. The study design used cross-sectional analysis from the Acquired Immunodeficiency Syndrome Linked to the Intravenous Experience (ALIVE) study, an observational study of current and former injection drug users in Baltimore, Maryland, USA.
All participants with spirometry-defined airflow obstruction were stratified by the presence or absence of physician diagnosis of OLD. Using cross-sectional demographic, clinical, and spirometric measurements, multivariable regression models were generated to identify factors independently associated with unrecognized obstructive lung disease.
Of the 1083 participants evaluated in the ALIVE lung sub-study, 176 (16.3%) met spirometric criteria for OLD. Of those, only 88 (50%) had a physician diagnosis of OLD. The prevalence of unrecognized OLD decreased as severity of airflow obstruction increased. Factors independently associated with unrecognized OLD were absence of respiratory symptoms and less severe dyspnea (breathlessness).
In the subset of human immunodeficiency virus (HIV)–infected participants, the use of antiretroviral therapy (ART) was independently associated with an increased prevalence of unrecognized OLD.
In a cohort of current and former urban drug users, obstructive lung disease is substantially under recognized and associated with lack of respiratory symptoms. Relying on the presence of respiratory symptoms as a trigger to perform spirometry may result in a substantial under diagnosis of obstructive lung disease in this population.
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COPD World News Week of January 16, 2011Reseachers look at gender difference in malnourished patients with COPD
Gothenburg, Sweden - Circulating markers of inflammation in chronic obstructive pulmonary disease (COPD) may correlate to disease progression and complications such as malnourishment. Researchers here said that surprisingly little is known about gender-related differences for circulating inflammatory markers in COPD. The purpose of their study was to characterize differences in circulating markers of inflammation in malnourished female and male patients with COPD.
Participating in the study were thirty female and 11 male patients with a clinical diagnosis of COPD and malnourishment were examined. A group of control subjects without evidence of COPD was recruited for comparison of some variables. Blood samples from the patients and control subjects were drawn, and the following parameters were studied: leukocytes and differential counts, C-reactive protein (CRP), tumor necrosis factor-α, interleukin (IL)-6 and IL-8, myeloperoxidase (MPO), neutrophil elastase (NE), intracellular adhesion molecule-1, vascular endothelial adhesion molecule-1, and E-selectin.
The researchers found that the mean neutrophil concentration was significantly higher in female than in male patients with COPD and significantly higher than in female control subjects. The mean CRP values were considerably higher in female (4.9 mg/mL) than in male patients with COPD, but the difference was not statistically significant.
The mean concentrations of IL-6 and IL-8 tended to be higher in female than in male patients with COPD, but these differences did not reach statistical significance either . Confounding factors (smoking, medication) could not explain the gender differences noted. The concentrations of MPO and NE displayed a strong correlation but revealed no gender differences. The latter was true for concentrations of adhesion molecules as well.
Their study puts forward evidence of a gender-related difference in systemic inflammation in malnourished patients with COPD in terms of circulating neutrophils being more abundant in female patients. Among these female patients, there was also a trend toward an increase in two neutrophil-mobilizing cytokines.
New and better-powered studies are warranted to confirm and characterize this potentially important phenomenon in greater detail. The study was conducted by Sven Larsson, Anita Nordenson, Pernilla Glader, Shigemi Yoshihara, Anders Lindén, and Frode Slinde of the Department of Internal Medicine Respiratory Medicine and Allergology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
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COPD World News Week of January 9, 2011Better Ventilation Yields More Donated Lungs
Turin, Italy - A lung-protective ventilation strategy for organ donors after brain death can double the number of lungs viable for transplantation, a randomized trial showed. Lower tidal volume, higher positive end-expiratory pressure (PEEP) ventilation increased the number of patients who met lung donor criteria six hours after brain death, to 95%, compared with 54% with usual care in the trial led by V. Marco Ranieri, MD, of the University of Turin and San Giovanni Battista Molinette Hospital in Turin, Italy.
This study breaks important new ground in providing a solid evidence base for the care of potential organ donors and testing techniques of organ preservation," according to Mark S. Roberts, MD, MPP, of the University of Pittsburgh. Even though the numbers in the trial were small, the lack of detrimental effect was clear, he said. If incorporated into U.S. practice, doubling the number of donated organs with the strategy has the potential to not only eliminate the gap between supply and steady-state demand for lung transplantation, but also to reduce the waiting-list backlog, Roberts suggested.
Currently only 15% to 20% of donor lungs are suitable for transplantation after the post-mortem degradation takes its toll, Ranieri's group noted. The number of potential donors from whom lungs were actually harvested was lower than the eligible proportion in both groups, but remained significantly better after protective ventilation (54% versus 27% with conventional ventilation).
Patients who received lungs from these donors tended to have better survival if the protective ventilation strategy had been used (75% versus 69% six-month survival rate), although the difference wasn't significant. The number of other organs -- heart, livers, and kidneys -- harvested from the donors didn't differ significantly by ventilation strategy.
The researchers warned that stopping trials early for efficacy may inflate their estimated treatment effect, but noted that this may not have been a relevant issue since the decision to stop their trial was made prior to unblinding.
Another limitation was that the study interventions could not be blinded, but the researchers attempted to minimize the potential for bias by assessing lung viability using well-established cutoffs and leaving the decisions on organ harvesting to blinded surgeons not involved in the study. Which of the several components of the lung-protective strategy were responsible for the benefits seen in the trial couldn't be determined, Ranieri's group added. The reason for the effect, though, likely had to do with prevention of the elevated levels of inflammatory cytokines seen in conventionally-ventilated donors in the trial, Roberts noted.
"Further studies are needed to determine whether tailored preservation strategies will increase the viability of other organs," he concluded.
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COPD World News Week of January 2, 2011Respiratory diseases pass stroke as leading cause of death in 2008
Atlanta, GA - While deaths from stroke and several other chronic diseases are down, deaths due to chronic lower respiratory disease increased in 2008. Stroke is now the fourth leading cause of death in the United States, down from the third place ranking it has held for decades, according to preliminary 2008 death statistics released today by CDC's National Center for Health Statistics.
There were 133,750 deaths from stroke in 2008. Age-adjusted death rates from stroke declined 3.8 percent between 2007 and 2008. Meantime, there were 141,075 deaths from chronic lower respiratory disease and the death rate increased by 7.8 percent. Some of the increase in deaths may be due to a modification made by the World Health Organization in the way deaths from chronic lower respiratory diseases are classified and coded.
The National Center for Health Statistics will conduct a thorough analysis on this change and its effect on the chronic lower respiratory disease category before the final 2008 deaths data are released. "Deaths: Preliminary Data for 2008," also finds that life expectancy at birth dropped slightly to 77.8 years from 77.9 years in 2007. Life expectancy was down by one-tenth of a year (a little over a month) for both men and women. However, black males had a record high life expectancy in 2008 of 70.2 years – up from 70 years in 2007. The life expectancy gap between the white and black populations was 4.6 years in 2008, a decrease of two-tenths of a year from 2007.
The data are based on 99 percent of death certificates reported to NCHS through the National Vital Statistics System from all 50 states, the District of Columbia and U.S. territories. Other findings reported are that heart disease and concer, the two leading causes of death, still accounted for nearly half (48 percent) of all deaths in 2008.
In addition to stroke, mortality rates declined significantly for five of the other 15 leading causes of death: accidents/unintentional injuries (3.5 percent), homicide (3.3 percent), diabetes (3.1 percent), heart disease (2.2 percent), and cancer (1.6 percent). In addition to chronic lower respiratory disease, death rates increased significantly in 2008 for Alzheimer's disease (7.5 percent), influenza and pneumonia (4.9 percent), high blood pressure (4.1 percent), suicide (2.7 percent), and kidney disease (2.1 percent).
The preliminary infant mortality rate for 2008 was 6.59 infant deaths per 1,000 live births, a 2.4 percent decline from the 2007 rate of 6.77 and an all-time record low. Birth defects were the leading cause of infant death in 2008, followed by disorders related to preterm birth and low birth weight.
Overall, there were 2,473,018 deaths in the United States in 2008, according to the preliminary deaths report – 49,306 more deaths than the 2007 total. The age-adjusted death rate for the U.S. population fell to 758.7 deaths per 100,000 in 2008 compared to the 2007 rate of 760.2.
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