COPD World News Week of August 6, 2017

'Loneliness Epidemic' called a major public health threat    

Provo, Utah - Loneliness may be more hazardous to your health than obesity -- and a growing number of Americans are at risk, researchers report. About 42.6 million American adults over age 45 are believed to suffer from chronic loneliness, according to AARP. "Being connected to others socially is widely considered a fundamental human need -- crucial to both well-being and survival. Extreme examples show infants in custodial care who lack human contact fail to thrive and often die, and indeed, social isolation or solitary confinement has been used as a form of punishment," said Julianne Holt-Lunstad. She is a professor of psychology at Brigham Young University in Provo, Utah. "Yet an increasing portion of the U.S. population now experiences isolation regularly," she added during a presentation Saturday at the annual meeting of the American Psychological Association (APA) in Washington, D.C. Holt-Lunstad presented results of two large analyses. In one, researchers analyzed 148 studies that included a total of more than 300,000 people. Those studies linked greater social connection to a 50 percent lower risk of early death. The researchers also reviewed 70 studies involving more than 3.4 million people to gauge the impact of social isolation, loneliness and living alone on the risk of premature death. The conclusion: The effect of the three was equal to or greater than well-known risk factors such as obesity. More than one in four Americans lives alone, more than half are unmarried, and marriage rates and the number of children per household are declining, according to U.S. Census data. "These trends suggest that Americans are becoming less socially connected and experiencing more loneliness," Holt-Lunstad said in an APA news release. She said there is strong evidence that social isolation and loneliness increase the risk of early death more than many other factors. "With an increasing aging population, the effect on public health is only anticipated to increase. Indeed, many nations around the world now suggest we are facing a 'loneliness epidemic.' The challenge we face now is what can be done about it," Holt-Lunstad said. Possible solutions, she said, include getting doctors to screen patients for social isolation, and training schoolchildren in social skills. Older people should prepare for retirement socially as well as financially, she added, noting that many social ties are related to the workplace. Holt-Lunstad also suggested that community planners include spaces that encourage people to gather together, such as recreation centers and community gardens. Research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

For more information: https://medlineplus.gov/news/fullstory_167643.html


COPD World News Week of July 30, 2017

High-Dose influenza vaccine reduces hospital visits for elderly  

Providence, RI - A new study suggests that when compared with standard-dose vaccine, high-dose influenza vaccine can reduce the risk of respiratory-related hospital admissions from nursing home residents aged 65 years and older. The research suggests that giving this population a high-dose flu vaccine, one with four times the usual amount of immune-spurring antigens, can greatly cut their risk of hospitalization from the flu. The vaccine seemed to help even the oldest seniors, the Brown University team said. According to Dr. Stefan Gravenstein, the high-dose vaccine would also work better than regular-dose vaccine in the population considered least able to respond. The study was published July 21 in the journal The Lancet Respiratory Medicine http://dx.doi.org/10.1016/S2213-2600(17)30235-7 One expert in caring for very ill people said that influenza poses special dangers for nursing home residents. "Patients who are already suffering from other chronic diseases are helped with a better quality of life because they are not moved out of their comfortable environment to a hospital," noted Dr. Theodore Strange. "This [new vaccine] is a huge in terms of cost of care and in quality of life for these patients," said Strange, who is associate director of medicine at Staten Island University Hospital in New York City. In the new study, the Brown team analyzed Medicare claims data from more than 38,000 residents of 823 nursing homes in 38 states during the 2013-2014 flu season. A high-dose flu vaccine was given to residents of more than 400 of the homes, while residents in the other homes received the standard dose. The result: Overall hospitalization rates were 3.4 percent for residents who received the high-dose vaccine and 3.8 percent for those who received the standard dose. The risk of hospitalization for respiratory illness, in particular, was nearly 13 percent lower in the high-dose group. That group also had a much lower rate of hospitalization for any reason, respiratory or otherwise, Gravenstein's group said. "Respiratory illness as the primary reason for hospitalization accounted for only about a third of the reduction in hospitalization that we measured," noted Gravenstein, who believes the shot may help ward off hospitalization for causes beyond lung troubles.

For more information: http://tinyurl.com/ya2est57


COPD World News Week of July 23, 2017

Reduced risk of acute exacerbation of COPD after bariatric surgery

Boston, MA - Obesity is common among individuals with chronic obstructive pulmonary disease (COPD) and associated with increased COPD morbidities. However, little is known about the impact of weight reduction on COPD-related outcomes in obese patients. Using the population-based emergency department (ED) and inpatient sample in three U.S. states (California, Florida, and Nebraska), we performed a self-controlled case series study of 481 obese adults (aged 40-65 years) with COPD who underwent bariatric surgery. The primary outcome was an ED visit or hospitalization for acute exacerbation of COPD (AECOPD) from 2005 through 2011. We compared each patient’s risk of the outcome during sequential 12-month periods using pre-surgery months 13-24 as the reference period. During 13-24 months before bariatric surgery (i.e., reference period), 28% of patients had an ED visit or hospitalization for AECOPD. In the subsequent 12-month pre-surgery period, the risk did not change materially. By contrast, during the first 12 months after bariatric surgery, the risk declined significantly by 12%. Likewise, in the subsequent period of 13-24 months after bariatric surgery, the risk remained significantly low. The researchers concluded that the risk of an ED visit or hospitalization for AECOPD substantially decreased after bariatric surgery in obese patients. This observation suggests the effectiveness of substantial weight reduction on COPD morbidity.

For more information: http://journal.chestnet.org/article/S0012-3692(17)31244-8/fulltext


COPD World News Week of July 16, 2017

Ottawa hospital launches screening program for long-time smokers  

Ottawa, ON - The Ottawa Hospital has started a new screening program targeting people at high risk of developing lung cancer in an effort to catch and treat the disease sooner. A pilot program that launched June 1 is urging people between the ages of 55 and 74 who have smoked for 20 years or more — not necessarily consecutively — to get screened in hopes of treating lung cancer before it's too late. Debi Lascelle credits early screening for her cancer-free status today. After smoking cigarettes for 27 years, she took part in a study about lung screening in 2011. "I had it in the back in my mind that I could perhaps have lung cancer. I had been a very heavy smoker, although I had quit at that time. I had been around smoking all my life, and I thought it would be an interesting thing to do," she said on CBC Radio's Ottawa Morning. Fortunately, Lascelle's lung cancer was small and detected. Now doctors at the Ottawa Hospital want others to follow Lascelle's example. "We really think that getting the disease earlier will make an impact on survival," said Dr. Donna Maziak, thoracic surgeon at the Ottawa hospital. "If it's caught early, the survival for Stage 1 [lung cancer] based on previous data is approximately 69 to 75 per cent." Lung cancer is the second-most diagnosed cancer in Ontario, and it accounts for the most cancer deaths — more than colorectal, breast and prostate cancer combined, according to Maziak. "The idea of the lung screening is that we'll catch it earlier. And the key to a successful screening program for lung is smoking cessation. It goes hand in hand," she said. "You're not getting a CT scan every year just to give you a licence to smoke one more year because you didn't get lung cancer. It's really to help the whole patient." The Ottawa Hospital's screening program is aimed at longtime smokers who may be at high risk of developing lung cancer. The Ottawa Hospital also wants to reduce the stigma around the disease, something Lascelle experienced often when she first told people she had lung cancer. "I would suggest there's still quite a bit of stigma. I don't know too many smokers who are happy they're smokers. But it is a true addiction. Certainly quitting was something that was extremely difficult to do," she said. Lascelle is encouraging anyone who may be at risk to take advantage of this screening program. "Please do it. Don't hesitate. It's such a difference when it's caught early," she said.  "They can do something and you can be a survivor. It makes the world of difference. Do this for yourself and your family."

For more information: http://tinyurl.com/ybpz3toh


COPD World News Week of July 9, 2017

COPD patients who live alone are less active  

Seattle, WA - Patients with chronic obstructive pulmonary disease (COPD) who live with a spouse, partner, or other caregiver are more active than patients who live alone, and are also more likely to participate in pulmonary rehabilitation programs, researchers report. Compared with patients who lived alone, those who lived with a spouse, partner, or other caregiver walked, on average, close to half a mile more each day, the results showed. And having a live-in spouse or partner caregiver was associated with an 11-fold higher likelihood of participation in a pulmonary rehabilitation program, according to the retrospective analysis of data from the CASCADE (COPD Activity: Serotonin Transporter, Cytokines and Depression) study of depression and functioning among COPD patients, to be published online in Annals of the American Thoracic Society. Earlier studies have shown social support to be a strong predictor of participation in cardiac rehabilitation programs, but the impact of social support on pulmonary rehab utilization and activity among patients with COPD has not been widely studied, the study's lead author, Huang Nguyen, PhD, of Kaiser Permanente Southern California and the University of Washington at Seattle, said. "This analysis showed that COPD patients who live with others are more likely to take more steps -- close to 1,000 more steps a day. Living with someone else may be a factor in engaging in more activities, or it could be that these patients are more active because they are engaged in caring for a spouse." The analysis included 282 CASCADE study participants with moderate to severe (GOLD Stage II-IV) COPD (age: 68 ± 9; FEV1% predicted: 45 ± 16) recruited from two Veterans Administration hospitals and two academic medical centers. Eighty percent of the patients were white men, 90% reported having a family caregiver, and 75% lived with others (family members or friends).Physical activity was measured with a validated accelerometer at baseline, and at 1 and 2 years. Additional self-care behaviors assessed included pulmonary rehabilitation attendance, smoking status, receipt of influenza and/or pneumococcal vaccinations, and medication adherence. Structural social support indicators included living status, being partnered, the number of close friends/relatives, and the presence of a family caregiver. Functional social support was measured with the Medical Outcomes Social Support Survey (MOSSS), and mixed-effects and logistic regression models were also used. Participants who lived with others took 903 more steps per day than those who lived alone Increases in the MOSSS total score were associated with more steps per day) The odds of pulmonary rehabilitation participation were more than 11 times higher if a patient had a spouse or partner caregiver compared with not having a caregiver Higher functional social support (MOSSS total score) was associated with marginally lower odds of smoking and higher odds of pneumococcal vaccination No significant relationships were seen between social support and influenza vaccination or adherence with inhaler or nebulizer medications The researchers noted that since higher levels of physical activity have been shown to be associated with lower risk of exacerbations, hospitalizations, and all-cause mortality in patients with COPD, the finding that living with others increases activity levels is especially important.

For more information: http://tinyurl.com/ybtoclyt


COPD World News Week of July 2, 2017

Flu vaccine patch in development

New York, NY - An experimental flu vaccine patch with dissolving microneedles appears safe and effective, a preliminary study shows. The patch has 100 solid, water-soluble and painless microneedles that are just long enough to penetrate the skin. Researchers say it could offer a pain-free and more convenient alternative to flu shots. "This bandage-strip sized patch of painless and dissolvable needles can transform how we get vaccinated," said Dr. Roderic Pettigrew, director of the U.S. National Institute of Biomedical Imaging and Bioengineering, which funded the study. "A particularly attractive feature is that this vaccination patch could be delivered in the mail and self-administered. In addition, this technology holds promise for delivering other vaccines in the future," he said in an institute news release. The study of 100 adults found that the patch triggered a strong immune response and did not cause any serious side effects. At most, some patients developed local skin reactions to the patches, which involved faint redness and mild itching that lasted two to three days. The flu vaccine is released by the microneedles, which dissolve within a few minutes. The patch is then peeled off and thrown away. Researchers at Georgia Institute of Technology and Emory University led the study. The results were published online June 27 in The Lancet. These early results "suggest the emergence of a promising new option for seasonal vaccination," Drs. Katja Hoschler and Maria Zambon wrote in an accompanying editorial. They are with Public Health England's National Infections Service. The "more exciting features" of the microneedle patch include its low cost, safety, storage convenience and durability, they said. "Microneedle patches have the potential to become ideal candidates for vaccination programs, not only in poorly resourced settings, but also for individuals who currently prefer not to get vaccinated," the editorialists wrote. One flu expert agreed. "The flu microneedle patch is easy to use -- it can be self-administered and, like other medication patches, it is well absorbed through the skin," said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City. "This development eliminates the need for intramuscular injection [a flu shot] by a health care professional," he added. Also, "this patch does not need to be refrigerated -- it has a long shelf life," Horovitz noted. "Standard vaccines can loose potency if left out of refrigeration repeatedly, as occurs in most settings."
  
For more information: https://medlineplus.gov/news/fullstory_166897.html


COPD World News Week of June 25, 2017

Excess Alcohol May Speed Muscle Loss in Older Women  

Seoul, South Korea - Heavy drinking may hasten muscle loss in older women, a new study warns. Both aging and menopause can lead to loss of muscle mass and strength, a condition called sarcopenia. Muscle mass loss typically starts in midlife, and progresses at a rate of 6 percent per decade, the researchers said. Usually, only three-quarters of midlife muscle mass remains after the age of 80. This loss of muscle affects balance, gait and the ability to do daily tasks, the researchers said. By 2030, the number of people in the world 60 or older is estimated to grow by 56 percent, and older people will number one in six individuals globally, according to the South Korean researchers. Their study looked at nearly 2,400 postmenopausal women, average age 62. Of those, 8 percent had sarcopenia. Rates of sarcopenia were nearly four times higher among high-risk drinkers than among low-risk drinkers, the study found. High-risk drinking was defined as frequent and significant alcohol use, along with a lack of control over drinking, blackouts and injuries related to drinking. Women in the high-risk group were more likely to smoke and have higher blood pressure and total cholesterol. They were also significantly younger. The researchers were from Yonsei University College of Medicine, in Seoul. "With this study suggesting that more muscle loss leads to sarcopenia and other studies suggesting that even one drink of alcohol may increase the risk of breast cancer, postmenopausal women should limit their alcohol intake," said JoAnn Pinkerton, executive director of the North American Menopause Society (NAMS). The study was published online June 7 in Menopause, a NAMS journal.

For more information: http://tinyurl.com/yc359wmc


COPD World News Week of June 18, 2017

Analysis finds no statin primary prevention for seniors  

New York, NY - Seniors don't get a cardiovascular or mortality benefit from taking a moderate-dose statin for primary prevention, according to a post hoc subgroup analysis of ALLHAT-LLT. In the overall neutral open-label trial, analysis restricted to participants ages 65 and older, showed that randomization to pravastatin (Pravachol) likewise didn't impact the primary endpoint of all-cause mortality during 6 years, Benjamin Han, MD, MPH, of the New York University School of Medicine in New York City, and colleagues reported online in JAMA Internal Medicine. In the 65- to 74-year-olds, the mortality rate was 15.5% on pravastatin and 14.2% with usual care (HR 1.08, P=0.55). For adults 75 years and older, the trend actually neared significance in the wrong direction (24.5% pravastatin vs 18.5%, HR 1.34, P=0.07). Coronary heart disease events came out similar between groups, including after multivariable regression, with no treatment by age interaction. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial-Lipid-Lowering Trial -- nested within the ALLHAT hypertension trial -- included 2,867 ambulatory adults, ages 65 and older, for the analysis out of the overall population 55 and older with hypertension and at least one additional heart disease risk factor. No one had baseline atherosclerotic cardiovascular disease (ASCVD) or baseline statin use. An accompanying editor's note by Gregory Curfman, MD, of Harvard Medical School in Boston, acknowledged statin risks that "may be particularly problematic in older people" and concluded the ALLHAT-LLT results "should be considered before prescribing or continuing statins for patients in this age category." Many physicians were universally skeptical that the analysis should have any clinical impact. "I think the most important part of this report may be the section on Limitations, which states that it is a post hoc secondary analysis of a trial of a subgroup of patients. I always tell students to avoid this type of analysis," commented Daniel Blumenthal, MD, MPH, president of the American College of Preventive Medicine. James Stein, MD, director of the Preventive Cardiology Program at the University of Wisconsin in Madison, pointed to the "null bias due to the small difference in achieved LDL-C" between groups. While agreeing that post hoc subgroup analyses can be misleading, Noel Bairey-Merz, MD, director of the Preventive Cardiac Center at Cedars-Sinai Medical Center in Los Angeles, noted that "given the declining CVD mortality rate in the U.S., particularly in the over 65-year-olds, due to improved public health (less smoking) and healthcare (Medicare), demonstration of mortality benefit of anything now is rare." Kim Williams, MD, of Rush University in Chicago and a past president of the American College of Cardiology, pointed to the moderate 40-mg pravastatin dose used, too. While the findings might seem to contradict the ACC/American Heart Association lipid guidelines, he noted that the study was consistent with a 15% to 30% relative reduction in coronary events, although not significant.

For more information: http://tinyurl.com/y9mt72bf


COPD World News Week of June 11, 2017

Nursing home residents have high antibiotic-resistant bacteria   

New York, NY - Multidrug-resistant bacteria, such as E. coli, can be found in more than one-quarter of people living in nursing homes, a research review finds. Reviewing eight prior studies, researchers reported rates ranged from 11 percent of residents to an alarming 59 percent, with 27 percent the average. "Nursing home residents are at higher risk to become colonized with these bacteria," said study author Sainfer Aliyu, a doctoral candidate at Columbia University School of Nursing in New York City. But just because nursing home residents are colonized with the bacteria doesn't mean they have an illness. "Someone who is colonized has the bacteria on them, but may not know it. They may not show any symptoms. But they can spread the germ to others, and they have the potential to become sick themselves," Aliyu said. As the nation's "superbug" list grows, health officials are particularly concerned about infections resistant to carbapenems -- powerful antibiotics used as a last resort, the study authors noted. People in nursing homes often have health conditions that can weaken their immune system, and they're often on prolonged antibiotic use, which contributes to antibiotic-resistance. Plus, nursing home residents share many spaces and interact with each other, giving the germs a chance to move from person to person, Aliyu said. The study looked specifically for bacteria known as multidrug-resistant gram-negative bacteria (MDR-GNB). Infections with these types of bacteria are common in nursing homes, according to the study authors. And treatment options are limited. The researchers looked through the medical literature for studies on MDR-GNB and nursing home residents. Eight studies done between 2005 and 2016 were included in the analysis. Aliyu said the study shows the need to "further educate staff on infection prevention," as well as come up with "policies for infection prevention that are more nursing-home specific." An infectious-disease specialist praised the new research. "This was a well-done study that quantifies the degree of colonization in long-term care facilities," said Linda Greene. She's president-elect of the Association for Professionals in Infection Control and Epidemiology, Inc., in Rochester, N.Y. Greene said it's hard to know just how high colonization rates are in the general community, and the rates seen in nursing homes are likely higher than in hospitals. "It stands to reason that colonization rates may be higher because the nursing home is people's residences. And this is where the challenges occur, because how do we curtail this? There's so much interaction between nursing home residents. But we don't want people confined to their rooms," she said. One simple way to prevent infection is hand-washing, said Greene. "Hand hygiene is one of the number one ways to prevent infection," she said. Dr. David Gifford is senior vice president of quality and regulatory affairs for the American Health Care Association, a trade group representing long-term care facilities. He agreed that hand-washing is crucial for preventing infection. And he said people should always ask health care providers -- whether in the doctor's office, hospital or long-term care facility -- if they've washed their hands before examining you. "Health care providers shouldn't be offended by this question," he said. As for the current study, Gifford said it's very tough to know where people became colonized with these difficult-to-treat bugs. "Everyone likes to point fingers, but we really don't know where the bacteria came from. Some probably originated in the nursing homes, some in hospitals and some in the community. Ninety percent of admissions to nursing homes come from a hospital," he said. "What we need to do is collectively work together to address this problem," Gifford said. "The findings from this study reflect the fact that -- in the U.S. in particular -- we administer antibiotics much more frequently than is necessary. As you give out more and more antibiotics, you're going to develop more antibiotic resistance," he explained. Gifford called the over-prescribing of antibiotics "a real and serious threat in the U.S." And over-prescribing isn't just an issue in nursing homes, he added. It's also when children or adults get antibiotics for a virus. "Changing antibiotic prescribing is as important as infection controls," he said. Greene agreed that hospitals and long-term care facilities need to work together to combat the problem. She said communication between facilities needs to improve, especially when someone is transferred while taking antibiotics to ensure that they finish their full course of antibiotics.

For more information: https://medlineplus.gov/news/fullstory_166075.html


COPD World News Week of June 4, 2017

Smart T-shirt monitors if you're breathing easy

Laval, PQ - We've seen a variety of "smart clothes" over the years, with most generally functioning like wearable fitness trackers, packed with sensing equipment to capture a variety of biometric data. Researchers in Canada have focused instead on creating a smart T-shirt with the potential to help diagnose respiratory illnesses or for real-time monitoring of respiratory rates for people with conditions such as asthma, sleep apnea or chronic obstructive pulmonary disease (COPD). The challenge for the researchers at Université Laval's Faculty of Science and Engineering and its Center for Optics, Photonics, and Lasers, was creating a smart T-shirt that operates without any wires, electrodes or sensors needing to come into direct contact with the wearer's body. To achieve this, they embedded the T-shirt with an antenna made of a hollow optical fiber coated with a thin layer of silver that sits at chest level. The antenna acts as both a sensor and a transmitter, collecting and transmitting data on the body's respiratory movements. With each breath, the smart fiber tracks thorax circumference and the volume of air in the lungs. "These changes modify some of the resonant frequency of the antenna," explains Professor Younes Messaddeq, whose team developed the technology. "That's why the T-shirt doesn't need to be tight or in direct contact with the wearer's skin. The oscillations that occur with each breath are enough for the fiber to sense the user's respiratory rate." The idea is that the smart T-shirt would transmit its data in real time to a smartphone or computer, allowing the monitoring of respiratory patterns that could help diagnose certain illnesses. The technology also can work as a real-time monitor, potentially allowing alarms to be triggered for those who suffer from irregular respiration while they sleep. Because the smart fiber is light and can be innocuously sown into a regular garment, Messaddeq notes that it doesn't inhibit natural movements and offers reliable data regardless of whether the wearer is lying down, standing, moving or sitting. Another major benefit is that the garment can be washed in a regular way without damaging any of the internal components as the smart fiber's surface is covered in a polymer that allows it to withstand to rigors of being run through a washing machine without any problems. The technology is still in the early stages, but the team foresee it being incorporated into a variety of garments for applications such as patient monitoring in hospitals or nursing homes. The team's research was published in the journal Sensors.

For more information: http://newatlas.com/smart-t-shirt-monitors-breathing/49605/


COPD World News Week of May 28, 2017

First-try antibiotics now fail in 1 in 4 adult pneumonia cases    

Las Angeles - The first prescription of an antibiotic that the average U.S. adult with pneumonia receives is now ineffective in about a quarter of cases, a new study finds. In these cases, more or different antibiotics were needed, or the patient's condition worsened to require ER admission or hospitalization within a month of the antibiotics being taken, the research team said. The results are concerning, because pneumonia is the leading cause of death from infectious disease in the United States, said lead researcher Dr. James McKinnell, an infectious disease specialist at LA BioMed, a California-based research foundation. Speaking in a news release from the American Thoracic Society, he added that, "the additional antibiotic therapy noted in the study increases the risk of antibiotic resistance and complications like C. difficile infection, which is difficult to treat and may be life-threatening, especially for older adults." Infectious disease experts have sounded the alarm for years on the growing problem of antibiotic resistance -- germs mutating around these lifesaving drugs. One expert who reviewed the new findings said they highlight that threat. The fact that a quarter of pneumonia patients failed their initial antibiotic therapy, "could be related to change in the bacterial resistance in the community," said Dr. Bushra Mina, who directs the medical ICU at Lenox Hill Hospital in New York City. And he noted that with pneumonia, "a certain percentage" of cases are caused by viruses, for which antibiotics are useless. In the new study, McKinnell's team tracked data from nearly 252,000 adults who were prescribed antibiotics to treat pneumonia contracted outside of a hospital ("community-acquired"). Patients were cared for at either a doctor's office or other outpatient facility. Just over 22 percent of the patients did not respond to their initial prescription of antibiotic treatment, the study found. "Our findings suggest that the community-acquired pneumonia treatment guidelines should be updated," McKinnell said. Any update should include data on what risk factors leave patients vulnerable to antibiotic failure, he added. According to their new findings, one key risk factor is age. "Patients over the age of 65 were nearly twice as likely to be hospitalized compared to younger patients" after adjusting for other risk factors, McKinnell said. Because of this, "elderly patients are more vulnerable and should be treated more carefully, potentially with more aggressive antibiotic therapy." Two other experts in pulmonary infections said the study did have its flaws, however. Dr. Howard Selinger is chair of family medicine at Quinnipiac University's school of medicine in Hamden, Conn. He said the study was unclear on how the pneumonia diagnoses were made -- in many cases, what doctors thought was an antibiotic-responsive illness might have been viral bronchitis or other disease that antibiotics won't help. For this reason, Selinger said, "I strongly doubt 25 percent resistance to multiple different classes of antibiotics." Instead, many of the cases in the study may have been viral to begin with, Selinger said. Dr. Alan Mensch, a pulmonologist at Northwell Health's Plainview Hospital in Plainview, N.Y., agreed. He said that too few of the patients in the study had the "gold standard" sputum (phlegm) test that is needed to confirm a bacterial, not viral, infection. But he said there is still much to learn from the findings. "Clearly, the current guidelines for community-acquired pneumonia published in 2007 by the American Thoracic Society and Infectious Disease Society of America need updating," Mensch said. Any update should include protocols to better identify the cause of a pneumonia, and perhaps quicker hospital admission for elderly patients who haven't responded to drug therapy,' he said. The study was slated to be presented on Sunday at the American Thoracic Society's annual meeting, in Washington, D.C. Findings presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

For more information: https://medlineplus.gov/news/fullstory_165801.html


COPD World News Week of May 21, 2017

Ventilation plus oxygen works for patients with persistent hypercapnia  

Washington, DC - Patients with persistent hypercapnia following an acute exacerbation of chronic obstructive pulmonary disease (COPD) had a longer time to death or re-hospitalization if non interventional ventilation was added to their home oxygen therapy, researchers found. Median time to readmission or death was 4.3 months in the group that had the ventilation treatment added to home oxygen, versus 1.4 months for the group that had oxygen alone (adjusted hazard ratio 0.49, 95% CI 0.31-0.77, P=0.002). The 12-month risk of readmission or death was 63.4% in the oxygen-plus-ventilation group compared with 80.4% for the oxygen-alone group, reported Patrick B. Murphy, PhD, of St. Thomas' Hospital in London, and colleagues in JAMA. The findings were also presented at the American Thoracic Society annual meeting. "Murphy, et. al. suggest that home oxygen plus home [ventilation] 'should be considered' for patients with persistent hypercapnia," Nicholas Hill, MD, of Tufts Medical Center in Boston, in Boston, and Aylin Ozsancak Ugurlu, MD, of Baskent University in Istanbul, Turkey, wrote in an accompanying editorial. "This is a reasonable suggestion as long as patients with reversible hypercapnia are given sufficient time to recover (2-4 weeks after hospital discharge) and PaCO2 levels remain substantially elevated (≥52 mm Hg)." Although treating patients with COPD and acute respiratory failure with non-invasive ventilation improves outcomes, persistent hypercapnia after an exacerbation is associated with excess mortality and early re-hospitalization, the study authors noted. "In 2013, the 28-day COPD re-admission rate was around 20%, and there were financial penalties in place in the United Kingdom and United States for such early re-admissions." Using ventilation in addition to oxygen therapy in the home setting is one treatment alternative to consider for patients with hypercapnia. Although some small, uncontrolled studies showed the physiological efficacy of home noninvasive ventilation in patients with COPD, "subsequent clinical studies failed to demonstrate either physiological (reduced hypercapnia) or clinical (mortality) efficacy, and questions remain regarding whether the application of the intervention was optimized in these randomized clinical trials," the authors noted. The researchers hypothesized that the addition of home noninvasive ventilation to home oxygen therapy would prolong the time to readmission or death among patients with persistent hypercapnia following an acute life-threatening exacerbation of COPD requiring acute noninvasive ventilation.

For more information: http://tinyurl.com/m5tx84r    

COPD World News Week of May 14, 2017

COPD exacerbations in those with CVD may increase Heart Attack/Stroke risk   

Washington, DC - After an acute exacerbation of chronic obstructive pulmonary disease, or COPD, people with a history of cardiovascular disease (CVD) or people at risk for CVD appear more likely to suffer a heart attack or stroke, according to new research presented at the ATS 2017 International Conference. The researchers found that within 30 days after an acute exacerbation, the odds of heart attack or stroke was nearly four-fold higher. Within 31 days to a year after the exacerbation, the odds were nearly double. A year after the exacerbation, the risk was not significantly different. “Previous studies have shown that lower lung function, such as occurs with COPD, is a risk factor for cardiovascular disease,” said Ken M. Kunisaki, MD, MS, lead study author and associate professor of medicine at the University of Minnesota and Minneapolis VA Health Care System. “One theory for why this happens is that COPD triggers inflammation and that, in turn, leads to CVD,” he added. “Because COPD exacerbations lead to particularly high levels of inflammation, we wondered if these exacerbations would be linked to higher rates of CVD events.” The researchers analyzed data from the Study to Understand Mortality and MorbidiTY (SUMMIT) trial. SUMMIT enrolled current and former smokers between the ages of 40 and 80 who had CVD or multiple risk factors for CVD and whose forced expiratory volume in one second (FEV1) was 50-70 percent of predicted and whose FEV1/forced vital capacity (total volume of exhalation) was ≤ 70 percent. Their findings have led the researchers to consider interventions they might study following a COPD exacerbation in patients with CVD. “One approach might be to study currently used cardiac medications, such as antiplatelet agents, statins and/or beta-blockers immediately following COPD exacerbations,” Dr. Kunisaki said. “Another approach might be to use experimental drugs that specifically reduce inflammation.” Until effective interventions are identified, he added, patients who have recently experienced a COPD exacerbation “should pay attention to and seek immediate care” for symptoms of heart attack, such as chest pain and sudden worsening of shortness of breath, and stroke, including weakness of one limb, sudden changes in vision and the inability to speak clearly. Care providers, he said, should be particularly aware of the risk of a CVD event in patients seeking acute medical care following a COPD exacerbation. Study limitations include the fact that all patients in the study had a CVD history or multiple risk factors for CVD. It is not known if COPD exacerbations would pose the same risk of a CVD in patients with no or lower CVD risk.

For more information: http://tinyurl.com/ksbw84o

COPD World News Week of May 7, 2017

Effects of Geriatric COPD rehabilitation on hospital admissions and exercise tolerance   

Amsterdam, The Netherlands - Frail COPD patients are frequently not accepted for regular pulmonary rehabilitation programs due to low physical condition and functional limitations. Although rehabilitation programs in nursing homes for geriatric patients with COPD have been developed the effects of such programs are largely unknown. A recent study assessed the course of COPD-related hospital admissions and exercise tolerance in a cohort of frail COPD patients participating in geriatric COPD rehabilitation. It was a retrospective observational study with a follow up of 12 months after discharge from rehabilitation. COPD related hospital admission days were measured in the year before and after participating rehabilitation. Exercise tolerance was measured by the six minute walk test (6MWT) at admission and at discharge from rehabilitation. Fifty-eight participants accomplished the rehabilitation program. Twelve patients died in the first year after discharge. The median number of hospital admission days in the year before participating rehabilitation was 21 (IQR 10-33). The first year after discharge this was decreased to a median of 6 (IQR 0-12). The 6MWT increased from 194 (SD 85) meters at admission to 274 (SD 95) meters at discharge (mean difference 80 m, SD 72; p < 0.05). The researchers concluded that geriatric COPD rehabilitation in a nursing home setting seems to reduce hospital admissions in frail COPD patients and to increase exercise tolerance.

For more information: https://www.ncbi.nlm.nih.gov/pubmed/28447319


COPD World News Week of April 30, 2017

New COPD guidelines released by ERS and ATS  

London, UK - A new set of guidelines aimed at helping clinicians care for COPD patients with an acute exacerbation, has been released by the American Thoracic Society and European Respiratory Society. While the guidelines do not recommend pulmonary rehab during the hospital stay itself, they do recommend beginning such a program within three weeks of discharge. They also recommend a home-based management approach for patients who present to the hospital or emergency department with a COPD exacerbation. “Pulmonary rehabilitation implemented within three weeks after discharge following a COPD exacerbation reduces hospital admissions and improves quality of life,” write the authors. Additional studies to identify interventions that provide the biggest benefits to patients and test strategies to overcome barriers to and facilitators of the integration of pulmonary rehab into the patient’s plan of care are needed. When it comes to home management of patients, the authors note that the “home-based management program model in patients with a COPD exacerbation reduces hospital admissions, making it a safe and effective way of discharging patients with additional home-based support in appropriately selected patients.” They call for more study to define the patient selection criteria and key elements of such programs, particularly who will staff them – for example, nurses or inter-professional teams that include a physician, respiratory therapist, or social worker. Other recommendations in the guidelines call for a course of oral corticosteroids of 14 days or less in ambulatory patients, along with antibiotics, with selection of antibiotics to be based on local sensitivity patterns. The administration of oral corticosteroids rather than intravenous corticosteroids is also recommended, if gastrointestinal access and function are intact. In patients with acute or acute-on-chronic hypercapnic respiratory failure, they believe noninvasive ventilation may be warranted in patients who are hospitalized as well.

For more information: http://erj.ersjournals.com/content/49/3/1600791


COPD World News Week of April 23, 2017

Unproven stem cell treatments emerging problem  

New York, NY - The American Journal of Respiratory and Critical Care Medicine, a publication of the American Thoracic Society (ATS), has published an article stating that unproven stem cell treatments for lung diseases are an emerging public health problem. Every organ in the body has a small number of cells that serve as organ-specific stem cells, the article states. These cells work to replace or repair damaged tissue. In the future, stem cells may be used to reverse or even cure some lung diseases. But today, there are no proven stem cell treatments for any lung disease. “Unproven stem cell treatments are those that have not been fully tested for safety and effectiveness (how well they work),” the article states. “The best way to test potential stem cell therapies is through clinical research trials that have to follow certain rules. These rules are set by national regulatory agencies such as the FDA (U.S. Food and Drug Administration) to make sure that the treatments are tested following proper scientific methods without any conflict of interest. “Unfortunately, there are hundreds of clinics and other groups offering unproven stem cell treatments in the U.S. A frequent method that they use to treat lung disease involves removing cells from a person’s fat or bone marrow and giving the cells back to the person through his or her bloodstream. These approaches have not been proven to work and are not FDA-regulated or approved as accepted treatments for any type of lung disease.” The concerns expressed in the ATS article echo those found in a 2015 statement from The Medical and Scientific Advisory Committee (MASAC) of the Alpha-1 Foundation. The MASAC statement advises Alpha-1 patients to take part only in approved research studies and to avoid unproven claims of stem cell and other cell-based "therapies."

For more information: http://tinyurl.com/myxv82v

COPD World News Week of April 16, 2017

Nearly 1 billion people still smoke daily 

Seattle, WA - Despite strong declines in the rate of tobacco smoking over the past 25 years, one out of every four men still smoke daily, as do one out of every 20 women. In a new analysis from the Global Burden of Disease study (GBD) published today (April 5, 2017) in The Lancet, authors discovered that the prevalence of daily smoking declined on a global scale – decreasing by 28% for men and 34% for women between 1990 and 2015. But while the rate of smoking has fallen over the past few decades, the number of daily smokers globally continues to rise year-over-year due to population growth. As of 2015, there were 933 million daily smokers. “Robust tobacco control efforts have led to progress in reducing the deadly habit of smoking in much of the world, but much more can be done,” said senior author Dr. Emmanuela Gakidou, Professor of Global Health at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle. “Growth in the sheer number of daily smokers still outpaces the global decline in daily smoking rates, indicating the need to prevent more people from starting the tobacco habit and to encourage smokers to quit.” The three countries with the most male daily smokers in 2015 accounted for over half of all men who smoked daily worldwide. Countries with the most male daily smokers in 2015 were China with 254 million, India with 91 million, and Indonesia with 50 million. The three countries with the highest number of female daily smokers in 2015 accounted for just over 25% of all female daily smokers worldwide. Countries with the most female daily smokers in 2015 were the Unites States with 17 million, followed by China with 14 million, and India with 13.5 million. These results suggest that the tobacco smoking epidemic is less geographically concentrated for women than for men, with implications that global efforts may need to be different to reach male smokers compared to female smokers. “With sustained commitment to implementing proven measures to reduce tobacco use, governments can help curb a global epidemic projected to kill 1 billion people this century,” said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. “Countries that have acted decisively to implement policies like those called for in the FCTC have seen the most dramatic drops in tobacco use. Without urgent action, more than 80% of tobacco-related deaths will occur in low- and middle-income countries by 2030.” There were 13 countries that sustained significant annual rates of decline between both from 1990 to 2005 and 2005 to 2015, including Australia, the United States, and Brazil. Further, the daily smoking prevalence declined faster between 2005 and 2015 in 18 countries, including Nepal, Chile, and Ukraine. Smoking is the second-leading cause of death globally. More than 11% of all global deaths in 2015 were attributed to smoking, totaling 6.4 million. Over half of these smoking-related deaths took place in just four countries: China, India, the United States, and Russia. In addition, daily smoking still contributes to a significant amount of the world’s overall health burden, measured using the disability-adjusted life years (DALYs) metric, which combines years of healthy life lost due to illness with those lost due to premature death. Most DALYs attributable to daily smoking were due to cardiovascular diseases (41%), cancers (28%), and chronic respiratory diseases (21%).

For more information: http://tinyurl.com/mhr2msp      

COPD World News Week of April 9, 2017

COPD patients needing colectomy do better with laparascopic surgery

Houston, TX - Patients with severe chronic obstructive pulmonary disease (COPD) requiring colectomy experience fewer complications and smoother recovery with laparoscopic surgery versus open procedures, reported Medical Post Today. In a retrospective registry study, COPD patients who underwent laparoscopic colectomy exhibited markedly lower risk of serious compared with an open colectomy group, reported Sarath Sujatha-Bhaskar, MD, of University of California, Irvine School of Medicine, at the 2017 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) meeting. And 30-day mortality was also reduced significantly with laparascopic surgery. "Despite presumed physiological contraindications associated with pneumoperitoneum, laparoscopic colonic operation was well tolerated in COPD patients," Sujatha-Bhaskar stated during his oral presentation. "The minimally invasive approach was associated with lower risk of postoperative respiratory complications, shorter length of stay, and decrease in readmission," he added. Panel moderator Mark H. Whiteford, MD, director of colon and rectal surgery at the Oregon Clinic, was not surprised by the results. "We've actually had data for a long time that show that laparoscopy, probably because it is a smaller incision and less pain, the patients do better after the surgery ... so this goes along with our suspicion," he said. Sujatha-Bhaskar and colleagues examined clinical data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) on 10,743 patients with COPD who electively underwent laparoscopic (37%) and open colectomy (63%) from 2006 to 2014.

For more information: http://tinyurl.com/knd5lch

COPD World News Week of April 2, 2017

Drug tied to dementia risk over-prescribed to seniors    

Detroit - A drug linked to a raised risk of dementia is taken by millions of older Americans who have an overactive bladder, researchers say. More than one-quarter of patients with the urinary problem had been prescribed the drug oxybutynin (Ditropan), an international team of investigators found. Yet, "oxybutynin is a particularly poor drug for overactive bladder in elderly patients," said study lead author Dr. Daniel Pucheril, a urologist at Henry Ford Hospital in Detroit. Prior studies have linked the drug to thinking problems and increased risk of dementia in older people, possibly because of the way it affects brain chemicals, he said. "It's a great and effective drug for younger patients, but is a risky drug for older patients," Pucheril said. It boosts dementia risk even when not taken indefinitely, he said. Alternatives exist but they're more expensive and may not be covered by insurance, at least initially, the study authors explained. For instance, "most Medicare Part D plans have a tiered drug formulary, which means that patients must try and 'fail' oxybutynin before they will be eligible for the newer generation of [so-called] antimuscarinic medications," Pucheril said. Also, there's debate over the safety of alternatives. The Urology Care Foundation estimates 33 million Americans have an overactive bladder. These people often need to urinate urgently, frequently or both. Some also suffer from incontinence. Non-medical treatments -- including changes in diet, exercises and scheduled urination -- are usually the first line of treatment. Surgery is sometimes an option, as are prescription antimuscarinic medications like oxybutynin. A Canadian specialist noted that immediate-release oxybutynin is the form most linked to dementia. "Older patients on the drug should consider a review with their clinician," said Dr. Adrian Wagg, director of geriatric medicine at the University of Alberta. There's no evidence that a family history of dementia adds to the drug's risk, he said, or that people who already have dementia will face the same added risk as others. The study was released at the European Association of Urology conference in London. Research presented at meetings should be considered preliminary until published in a peer-reviewed journal.

For more information: https://medlineplus.gov/news/fullstory_164375.html

COPD World News Week of March 26, 2017

Study shows potential of stem cell therapy to repair lung damage

Estoril, Portugal - A new study has found that stem cell therapy can reduce lung inflammation in an animal model of chronic obstructive pulmonary disease (COPD) and cystic fibrosis. Although, still at a pre-clinical stage, these findings have important potential implications for the future treatment of patients. The findings were presented in Estoril, Portugal today at the Lung Science Conference. The new research investigated the effectiveness of MSC therapy in a mouse model of chronic inflammatory lung disease, which reflects some of the essential features of diseases such as COPD and cystic fibrosis. Researchers delivered stem cells intravenously to β-ENaC overexpressing mice at 4 and 6 weeks of age, before collecting samples tissue and cells from the lungs at 8 weeks. They compared these findings to a control group that did not receive the MSC therapy. The results showed that inflammation was significantly reduced in the group receiving MSC therapy. Cells counts for both monocytic cells and neutrophils, both signs of inflammation, were significantly reduced after MSC therapy. Analysis of lung tissue revealed a reduction in the mean linear intercept and other measures of lung destruction in MSC treated mice. As well as reducing inflammation in the lung, MSC therapy also resulted in significant improvements in lung structure, suggesting that this form of treatment has the potential to repair the damaged lung. Dr. Declan Doherty, from Queens University Belfast, UK, commented: “These preliminary findings demonstrate the potential effectiveness of MSC treatment as a means of repairing the damage caused by chronic lung diseases such as COPD. The ability to counteract inflammation in the lungs by utilising the combined anti-inflammatory and reparative properties of MSCs could potentially reduce the inflammatory response in individuals with chronic lung disease whilst also restoring lung function in these patients. Although further research is needed to improve our understanding of how MSCs repair this damage, these findings suggest a promising role for MSC therapy in treating patients with chronic lung disease." Professor Rachel Chambers, ERS Conferences and Research Seminars Director, commented: "This paper offers novel results in a pre-clinical model which demonstrates the potential of MSC stem cell therapy for the treatment of long-term lung conditions with exciting potential implications for the future treatment of patients with COPD and cystic fibrosis. Although, still at an early stage in terms of translation to the human disease situation, this paper is one of many cutting-edge abstracts from the Lung Science Conference, which aims to provide an international platform to highlight novel experimental lung research with therapeutic potential. We rely on high quality basic and translational respiratory science, such as these latest findings, to develop novel therapeutic approaches for the millions of patients suffering from devastating and often fatal respiratory conditions."

For more information: http://tinyurl.com/llvu37u

COPD World News Week of March 19, 2017

Impact of fruit and vegetable consumption on COPD

Stockholm, Sweden – A recent study published in the journal Thorax looked at antioxidants present in fruits and vegetables and whether they may protect the lung from oxidative damage and prevent COPD. The aim of the study was to determine the association between fruit and vegetable consumption and risk of COPD by smoking status in men. The researchers used a population-based prospective Cohort of Swedish Men included 44 335 men, aged 45–79 years, with no history of COPD at baseline. Fruit and vegetable consumption was assessed with a self-administered questionnaire. During a mean follow-up of 13.2 years, 1918 incident cases of COPD were ascertained. A strong inverse association between total fruit and vegetable consumption and COPD was observed in smokers but not in never-smokers (p-interaction=0.02). The age-standardised incidence rate per 100 000 person-years in the lowest quintile (<2 servings/day) of total fruit and vegetable consumption was 1166 in current smokers and 506 in ex-smokers; among those in the highest quintile (≥5.3 servings/day), 546 and 255 per 100 000 person-years, respectively. The multi-variable HR of COPD comparing extreme quintiles of total fruit and vegetable consumption was 0.60 (95% CI 0.47 to 0.76, p-trend <0.0001) in current smokers and 0.66 (95% CI 0.51 to 0.85, p-trend=0.001) in ex-smokers. Each one serving per day increment in total fruit and vegetable consumption decreased risk of COPD significantly by 8% (95% CI 4% to 11%) in current smokers and by 4% (95% CI 0% to 7%) in ex-smokers. The researchers concluded that the high consumption of fruits and vegetables is associated with reduced COPD incidence in both current and ex-smokers but not in never-smokers.

For more information: http://tinyurl.com/mj895np

COPD World News Week of March 12, 2017

Is Need for More Sleep a Sign of Pending Dementia?   

Boston, MA - Seniors who begin sleeping more than nine hours a night may face a higher risk of dementia down the road suggests a new study that appears in the journal Neurology. The researchers estimated that the risk of dementia grew by almost 2.5 times for those who found themselves recently needing extra sleep. The chances of dementia rose six-fold for people without a high school degree who suddenly needed to sleep nine hours or more, the study contended. The study authors said this finding hinted that education might somehow offer a bit of protection from dementia. People with dementia often suffer from disrupted sleep, "but we don't know much about whether these changes come first," said study co-author Matthew Pase. He's a neurology fellow at the Boston University School of Medicine. Dementia "is by no means a certain fate" in those who find themselves sleeping longer as they age, Pase said. The new study only found an association between added sleep and dementia, not cause and effect. Still, Pase thinks monitoring sleep habits might be a good idea in certain cases. "If someone reported recently becoming a longer sleeper, they could undergo a memory assessment," he suggested. Past research in this area compared people who already had dementia to those who didn't have it, instead of tracking people over time, he noted. The new study tried a different strategy, Pase said. "We asked a very basic question: How does one's sleep duration relate to being diagnosed with clinical dementia in the future?" The researchers looked at seniors in the Framingham Heart Study, which has tracked people and their descendants in a Massachusetts community since 1948. The researchers followed two groups of older people -- all over 60 -- from 1986-1990 and 1998-2001 onward. Nearly 2,500 people were included in the study. Their average age was 72. Fifty-seven percent were women. Over 10 years, 10 percent of the participants were diagnosed with dementia, with the wide majority thought to have Alzheimer's disease. The researchers didn't find any heightened dementia risk in people who'd been sleeping nine or more hours a night for more than an average of 13 years. But those who'd begun sleeping more than nine hours recently had nearly double the risk of dementia compared to other people -- 20 percent of the new long-sleepers were diagnosed with dementia. These people also appeared to have smaller brain volumes, Pase said. Pase said it appears that the extra sleep is a sign of something else, not a direct cause of dementia. It could indicate chemical changes that are happening in the brain, he said. Or, he said, the development of dementia could make people more tired. Dementia tests may be appropriate for older people who notice they're sleeping longer, Pase said. But he doesn't recommend people try to wake up earlier. "They shouldn't restrict sleep," he said. "There are no implications for treatment based on our findings." Dr. Jiu-Chiuan Chen is an associate professor with the Keck School of Medicine at the University of Southern California. He wasn't involved with the study, but said the research seems valid. Chen agreed that there's no need to offer any special treatment to older people who start to sleep over nine hours, because it's not yet clear what's going on. The next step for researchers is to study people as they sleep to better understand how sleep and dementia are connected, Pase said.

For more information: http://tinyurl.com/jn6qv42

COPD World News Week of March 5, 2017

High-dose influenza vaccine more effective at preventing deaths among seniors

Atlanta, GA - A study published in The Journal of Infectious Diseases indicated that high-dose influenza vaccine was significantly more effective for preventing post-influenza deaths among older adults than standard-dose vaccine. “It has been recognized at least since the 1957 A (H2N2) pandemic that older persons and those with some chronic health conditions, including pulmonary and cardiac compromise, are at the greatest risk of severe influenza outcomes,” David K. Shay, MD MPH, of the influenza division of the CDC, Atlanta, and colleagues wrote. “This is the population that everybody worries about,” Shay said in a press release accompanying the study. “Many of the most serious outcomes of flu infections occur in older people.” The researchers reviewed data from Medicare beneficiaries aged 65 years and older who received either a standard-dose (n = 1,683,264) or high-dose influenza vaccine (n = 1,039,654) during the 2012-2013 flu season, as well as recipients vaccinated during the 2013-2014 season (standard, n = 1,877,327; high-dose, n = 1,508,176). The primary outcome was death within 30 days after an emergency department or inpatient visit for influenza. Overall, Shay and colleagues reported that there were 0.028 post-influenza deaths per 10,000 person-weeks among those who had received high-dose vaccines, and 0.038 deaths per 10,000 person-weeks among standard-dose recipients. The researchers wrote that overall comparative effectiveness was 24% (95% CI, 0.6%-42%). High-dose vaccine recipients were 36.4% less likely to die than standard-dose recipients in the 2012-2013 flu season (95% CI, 9%-56%). This fell to 2.5% in the 2013-2014 season (95% CI, -47% to 35%). Researchers noted that the H3N2 influenza virus, which is linked to greater mortality in senior citizens, was predominant in the 2012-2013 season. H1N1 viruses, which are more susceptible to the standard-dose vaccine, were more common in 2013-2014. “The high-dose vaccine does appear, at least in this particular H3N2 season, to be more effective at preventing deaths that occur within 30 days of an influenza hospitalization,” Shay said in the press release. “We didn’t see a significant effect on post-influenza deaths during the 2013-2014 H1N1 season.”

For more information: http://tinyurl.com/zggcfuc

COPD World News Week of February 26, 2017

Canadians could save billions with universal drug coverage  

Ottawa, ON - Canadians and private drug-plan sponsors could save more than $4-billion a year if the federal government adopted universal coverage for a group of commonly prescribed essential medicines, according to a new analysis in the Canadian Medical Association Journal. The study used economic modelling to determine the government would have to spend an estimated $1.2-billion a year to provide universal coverage for 117 essential medicines, which accounted for 44 per cent of the prescriptions filled in Canada in 2015. Individuals and private plans would save nearly $4.3-billion if such a system were introduced, according to the economic modelling used in the study. The government would be able to use bulk purchasing power, which is why it would cost so much less to cover the cost of those essential medicines – drugs that are deemed necessary for public health – than it would for individuals and private drug plans. The drugs include those used to treat some heart conditions, rheumatoid arthritis, HIV, anaphylaxis and migraines. The federal government is facing increasing pressure to address the rising cost of prescription drugs, but has not committed to a national pharmacare program. The overall savings to individual Canadians and drug-plan sponsors of the universal coverage recommended in the study more than justifies the cost, said Steve Morgan, one of the study’s authors and a professor at the School of Population and Public Health at the University of British Columbia, while ensuring all Canadians have access to vital prescription drugs. “The benefit of having a universal plan is to make sure that nobody falls through the cracks of our currently fragmented private and public drug coverage system,” Dr. Morgan said. The researchers found Canada pays substantially more than Sweden, New Zealand and the U.S. Veterans Affairs drug program for the same generic medications. Dr. Morgan said this shows the federal government could save a significant amount of money by purchasing drugs in bulk as part of a universal coverage program. The study found that generic essential medicines cost 47 per cent less under the U.S. Veterans Affairs program; 60 per cent less under Sweden’s national drug program; and 84 per cent less under New Zealand’s program.

For more information: http://tinyurl.com/hj8kmg9

COPD World News Week of February 19, 2017

Vaping to kick the smoking habit

Boston, MA - Cigarette smokers with chronic diseases -- especially conditions associated with tobacco use -- are more likely to try electronic cigarettes than healthy smokers, according to an analysis of recent survey data. Findings from the nationally representative 2014 and 2015 National Health Interview Survey (NHIS) showed that current and former smokers with COPD, asthma, and cardiovascular disease -- but not cancer -- had higher odds of e-cigarettes ever use than smokers and former smokers without these diseases. The study is the first to examine national prevalence and patterns of e-cigarette use among U.S. adults with medical comorbidities. While the data showed small, non-significant increases in e-cigarette ever-use among adult smokers and former smokers between 2014 and 2015, they also showed a slight decrease in current e-cigarette use among smokers, Gina R. Kruse, MD, of Massachusetts General Hospital in Boston, and colleagues reported in the American Journal of Preventive Medicine. Kruse said that it is not possible to say why sick smokers are trying e-cigarettes or why fewer of them reported current use than "ever" use, given the limitations of the NHIS, which did not explore the reasons for e-cigarette use. Still, she speculated that cigarette smokers with smoking-related diseases and other medical conditions are vaping to help them quit conventional cigarettes or reduce their use. "Smokers with comorbidities might be trying them and finding them not very helpful, or e-cigarettes may be helping people quit so they don't need these products anymore," she said. "That would be very hopeful, but we have no way of knowing if this is the case." Study limitations included the self-reported nature of the survey, lack of data on length of e-cigarette use or reasons for use, and the survey description of e-cigarettes as "looking like cigarettes," which would exclude many newer vaping products. Kruse noted that a main goal of the ongoing, longitudinal, NIH-sponsored Population Assessment of Tobacco and Health (PATH) will be to better understand why people use tobacco products, including e-cigarettes. She added that, because it is not clear that the benefits of e-cigarettes outweigh the risks, she does not recommend them to her patients for smoking cessation.

For more information: http://tinyurl.com/he4agbf
    

COPD World News Week of February 12, 2017

Inhaler handling errors lead to increase in COPD exacerbations   

Bordeaux, France - Inhaler device handling errors are associated with an increased risk of severe chronic obstructive pulmonary disease (COPD) exacerbations, leading to a higher proportion of patients requiring hospitalisation or emergency room treatment. Inhaler device handling errors are associated with an increased risk of severe chronic obstructive pulmonary disease (COPD) exacerbations, leading to a higher proportion of patients requiring hospitalisation or emergency room treatment. The study, published in the ERJ, asked 212 GPs and 50 pulmonologists to provide assessment on the use of inhaler devices of 2,935 patients who were over the age of 40 years, were current or ex-smokers of more than 10 years, and who had been using an inhaler device for more than 1 month for continuous treatment of COPD. Patients were requested to take a puff of their regular inhaler device and were rated for technique by physicians. The results showed that handling errors were observed in over 50% of cases regardless of the device used. The most common errors were failure to breathe out before actuation (22.5%), inhalation through the nose (22.2%) and not holding breath a few seconds after inhalation (26.9%). In patients treated for at least 3 months, the rate of severe exacerbations doubled between patients with no error (3.3%) and patients with at least one critical error (6.9%), suggesting poor technique is responsible for less effective clinical outcomes and an increased risk of COPD exacerbation.
The authors conclude that inhaler errors, which are not taken into account in clinical trials, are reducing treatment benefit in the real-world. They believe that physicians should aim to improve patient technique of inhaler use, instead of focusing on the choice of inhaler characteristics, to reduce the frequency of COPD exacerbations.    

For more information: http://tinyurl.com/jjyh9yl

COPD World News Week of February 5, 2017

Study looks at improving COPD patient’s rehab uptake and completion

Lincolnshire, UK - Pulmonary rehabilitation is considered a key management strategy for chronic obstructive pulmonary disease (COPD), but its effectiveness is undermined by poor patient uptake and completion. The aim of this review was to identify, select and synthesise the available evidence on interventions for improving uptake and completion of pulmonary rehabilitation in COPD. Electronic databases and trial registers were searched for randomised trials evaluating the effect of an intervention compared with a concurrent control group on patient uptake and completion. The primary outcomes were the number of participants who attended a baseline assessment and at least one session of pulmonary rehabilitation (uptake), and the number of participants who received a discharge assessment (completion). Only one quasi-randomised study (n=115) (of 2468 records identified) met the review inclusion criteria and was assessed as having a high risk of bias. The point estimate of effect did, however, indicate greater programme completion and attendance rates in participants allocated to pulmonary rehabilitation plus a tablet computer (enabled with support for exercise training) compared with controls (pulmonary rehabilitation only). There is insufficient evidence to guide clinical practice on interventions for improving patient uptake and completion of pulmonary rehabilitation in COPD. Despite increasing awareness of patient barriers to pulmonary rehabilitation, our review highlights the existing under-appreciation of interventional trials in this area. This knowledge gap should be viewed as an area of research priority due to its likely impact in undermining wider implementation of pulmonary rehabilitation and restricting patient access to a treatment considered the cornerstone of COPD.

For more information: http://openres.ersjournals.com/content/3/1/00089-2016?ctkey=shareline    

COPD World News Week of January 29, 2017

Can Air Pollution Heighten Alzheimer's Risk?    

Los Angeles, CA - Air pollution may cause more than just lung disease: New research suggests that if tiny particles in the air from power plants and cars are inhaled, they might also invade the brain, increasing the risk for dementia. "Although the link between air pollution and Alzheimer's disease is a new scientific frontier, we now have evidence that air pollution, like tobacco, is dangerous to the aging brain," said study co-senior author Caleb Finch. He's with the University of Southern California's (USC) Leonard Davis School of Gerontology. For the study, the USC scientists collected samples of air particles with technology designed by university engineers. The researchers used the technology to expose female mice to air pollution. "Our state-of-the-art aerosol technologies, called particle concentrators, essentially take the air of a typical urban area and convert it to the air of a freeway or a heavily polluted city like Beijing," study co-author Constantinos Sioutas, a professor of civil and environmental engineering, explained in a university news release. "We then use these samples to test exposure and assess adverse neuro-developmental or neuro-degenerative health effects," he added. The mice carried a certain genetic variation, called the APOE4 gene, which increases the risk for Alzheimer's. After being exposed to air pollution for 15 weeks, the mice had 60 percent more amyloid plaque, the clusters of protein associated with the degenerative disease, the researchers said. They also analyzed data on more than 3,600 3U.S. women between the ages of 65 and 79 years from 48 states. None of the women had dementia when the study began. After considering certain variables -- such as race, ethnicity, lifestyle and health -- the researchers found older women living in areas where miniscule air pollution particles exceed federal safety standards may be at 81 percent higher risk for cognitive decline. They may also face a 92 percent greater likelihood of developing dementia, including Alzheimer's disease. The negative effects of air pollution on the brain were particularly notable among the women who the APOE4 gene, the study authors added. The research was published Jan. 31 in the journal Translational Psychiatry. If their findings were extended to include the general population, the study's authors calculate that air pollution might be to blame for about 21 percent of all cases of dementia. The research comes with several caveats. First, it did not prove that air pollution causes the risk of dementia to rise. Second, studies involving animals frequently fail to produce similar results in humans. Finch said: "Microscopic particles generated by fossil fuels get into our body directly through the nose into the brain. Cells in the brain treat these particles as invaders and react with inflammatory responses, which over the course of time, appear to exacerbate and promote Alzheimer's disease." Jiu-Chiuan Chen, co-senior author of the study, said, "Our study -- the first of its kind conducted in the U.S. -- provides the inaugural scientific evidence of a critical Alzheimer's risk gene possibly interacting with air particles to accelerate brain aging." "The experimental data showed that exposure of mice to air particles collected on the edge of [the] USC damaged neurons in the hippocampus, the memory center that is vulnerable to both brain aging and Alzheimer's disease," added Chen, who is an associate professor of preventive medicine at USC's Keck School of Medicine. Less than one-third of all U.S. counties have ozone or particle pollution monitors, according to the American Lung Association. The group notes that six of the 10 most polluted U.S. cities are in California. The USC researchers said the findings could have global implications because pollution has no borders.

For more information: https://medlineplus.gov/news/fullstory_163365.html

COPD World News Week of January 22, 2017

Finland's plan to be tobacco-free

Helsinki, Finland - The Finnish government has set an ambitious goal for residents in a bid to benefit their health -- and their bank balances. Officials plan to make the country tobacco-free by 2040, meaning they want less than 2% of their adults to consume tobacco -- in any form -- by that deadline. So that's more than 98% of the Finnish population saying no to cigarettes, snuff and other forms of smokeless tobacco, cigars, pipes and even e-cigarettes. As per the trend in industralized countries, smoking rates in Finland have been on the decline in recent decades due to measures such as bans on advertising and shop displays, and the creation of smoke-free public spaces. In 2013, 16% of 15- to 64-year-olds in Finland smoked on a daily basis, while nearby in the UK, 19% of adults were smokers in 2014. But at the start of this year, a new level of control measures came into force. According to Kaari Passo, head of harm prevention, "We want to get rid of all tobacco products." Experts agree that the Finnish government is using innovation and creativity to get everyone to kick the habit. Rather than targeting one area at a time, such as exposure in public spaces or cigarette use, Paaso said his ministry wants to be precautionary from every angle. It doesn't go down the path of advocating milder products that may do less harm, such as e-cigarettes or snuff. "It's a comprehensive set of policies," he said. Sweden has also seen a dramatic reduction in the number of smokers -- just 12.7% among men and 15.2% among women in 2013 -- but achieved this in part by promoting the use of snus, an oral smokeless tobacco product. The product, along with all other forms of oral tobacco, is banned in other member states of the European Union. The UK is also adopting a harm reduction approach to reduce the number of smokers. Instead of snus, it backs the use of e-cigarettes to help people kick the habit. But Finland wants rid of it all. "We don't want to fall into the trap of other policies that have less harmful products," said Paaso, who fears that promoting other products will result in a new addiction for health officials to deal with in the future. "We want to phase out all products." Experts agree that one of the strongest policies in terms of tobacco control globally has been taxation. The rising cost of the habit, linked to higher taxes, has meant that many can no longer afford to smoke, and those who can smoke provide revenue for anti-smoking campaigns and quitting support services, to name a few options. "The evidence suggests increasing pricing is the single most effective way to reduce demand," said Vaughan Rees, director of the Center for Global Tobacco Control at the Harvard T.H. Chan School of Public Health.

For more information: http://tinyurl.com/zmnuny2

COPD World News Week of January 15, 2016

Short stretches of exercise may have anti-inflammatory effect  

San Diego, CA - Just 20 minutes of moderate exercise may dampen inflammation in the body, researchers say. The study findings suggest that "exercise doesn't have to be tremendously hard for you to see health benefits from it," said study author Suzi Hong. She is an associate professor at the University of California, San Diego. The researchers focused on inflammation -- swelling -- in the body. The immune system produces swelling by rushing to protect the body from injuries and invaders, such as germs. But inflammation can become permanent, poisoning tissues in the body and contributing to diseases, including diabetes, Hong explained. Obesity, for example, is thought to produce higher levels of inflammation. That inflammation can contribute to heart disease by affecting the arteries, Hong said. Studies have suggested that exercise lowers inflammation, especially when you're active on a regular basis. However, "what is less known is how that is happening," Hong added. For the new study, Hong and her colleagues recruited 47 volunteers -- a mostly white group of 26 males and 21 females -- with an average age of 41. The researchers gave them blood tests before and after the study participants walked at a moderate speed on a treadmill for 20 minutes. The investigators found a 5 percent decline in immune cells linked to inflammation. Hong called this a "tangible" and "significant" improvement. But it's not clear what it means for a person's health, and the study did not prove cause and effect. Still, she said, it could be helpful for people, regardless of whether they have a disease linked to inflammation. It's also unclear whether more exercise means a greater benefit. However, "if you're seeing this benefit every time you exercise, it'll have a cumulative effect," Hong suggested. David Nieman, director of the Appalachian State University Human Performance Lab, said the new research did not represent a breakthrough -- it just reinforced existing knowledge. "It's definitely not a high-level study, just confirming things we already know," he said. "But it's fine, another bit of information that confirms what we all know in the world of lifestyle and inflammation." Nieman said it's important to fight off inflammation because "it's a serious issue that undergirds just about every major chronic disease that modern-day men and women experience. It really needs to be managed and reduced." The most powerful way to do that, he said, is by controlling weight. As for future research, Hong said it would be helpful to better understand exactly how exercise affects the body. "We want to break it down into bite-size pieces for the public and say there are specific immune-based, cell-based changes you're making when you exercise," she said. The study was published online recently in the journal Brain, Behavior, and Immunity.

For more information: https://medlineplus.gov/news/fullstory_163122.html

COPD World News Week of January 8, 2017

Scientists shed light on why people with lung conditions are vulnerable to air pollution  

Osaka, Japan - Researchers in Japan have been investigating why air pollution is particularly harmful to people with lung conditions. Being exposed to air pollution can trigger symptoms among people with lung conditions, such as asthma attacks, chronic obstructive pulmonary disease (COPD) exacerbations, difficulty breathing, wheezing, coughing and irritation. However, the bodily mechanisms that lead to this response are still unclear. This new study, published in the journal, Immunity, looked at how the immune system responded to a common pollutant, particulate matter (PM) 2.5, among a group of mice. Scientists found that PM 2.5 seemed to destroy immune cells called macrophages, which would then go on to release a substance called interleukin which is associated with inflammation. This then set off a chain of events that caused common symptoms among people with lung conditions. The researchers are hopeful that greater understanding of this process could help with the development of treatments to protect people from experiencing pollution-related symptoms – however, more research is needed.

For more information: http://www.cell.com/immunity/abstract/S1074-7613(16)30482-4

COPD World News Week of January 1, 2017

Ban on smoking in public housing has potential to harm

Washington, DC - When the US Housing and Urban Development Department (HUD) recently announced it will require all public housing developments in the US to go smoke free, federal officials were correct to attack a significant and pervasive problem—smoking exposure among low income Americans. However, it’s less clear if their attempted solution is the best and most effective way to solve this problem. The goals are to reduce secondhand smoke exposure, aid smokers to quit, as well as to eliminate preventable fires, reduce the renovation costs associated with smoking, and to meet market demands. This new policy stems from global trends in smoke-free laws in public places, such as restaurants and bars, public parks, and university campuses. Research has consistently shown the significance of public smoking bans on reducing secondhand exposure, changing smoking norms, limiting smoking initiation, and preventing opportunities to smoke. Although critics frequently contend that smoking bans undermine citizen’s individual rights, the facts that multi-unit public housing facilities expose residents to secondhand smoke exposure through air ducts and that children represent approximately one third of public housing residents highlight smoking in public housing as a formidable public health concern beyond privacy arguments. However, the smoking ban in public housing is not without concerns, and care must be taken to address the unique needs of vulnerable residents. While smoking rates in the US continue to decline, smoking remains concentrated among low income individuals, with 26% of individuals below the poverty line currently smoking, compared to 14% of those not in poverty. Importantly, the smallest reductions in smoking prevalence have been among groups with lower socioeconomic status. This highlights the consistent challenges and external circumstances that may undermine even the most effective clinical interventions among resource challenged individuals in public housing. It is not that disadvantaged individuals do not wish to quit smoking, but rather that their external stressors; limited wealth; and increased risk of mental illness, discrimination, and marginalization frequently increase a sense of powerlessness that may inhibit attempts to quit. Sometimes, there are simply bigger problems to deal with. For instance, my previous research has shown that increased exposure to social stressors reduces the likelihood of maintaining home smoking restrictions. While a non-smoking policy may provide a catalyst for some to quit, these policies are unable to address the broader social causes of poverty and need to be cautious that they do not intensify social stigma, which may further marginalize or increase stress for smokers living in public housing. Dealing with noncompliance without increasing vulnerability remains a challenge. Policies related to smoking related lease violations will need to continue to be incremental and non-punitive, with care taken to ensure that smoking violations do not impact current or future housing opportunities. Lease violations that result in fines and potential evictions may compromise the many benefits of a controlled non-smoking environment. For example, fear of reprisal may lead smokers to take actions to conceal their smoking by either smoking indoors with closed windows or in vehicles, thereby increasing the potential risk of secondhand exposure. Fear of surveillance may also undermine social support networks or diminish relationships with building supervisors. For instance, people who choose to smoke in their units may be less likely to report poor living conditions, call attention to safety concerns, or to have control over their environments for fear of being reported. There are also potential safety concerns. While smoking away from the home reduces secondhand smoke for others, it may also increase additional exposure to unsafe areas, particularly at night time or in cold weather or for those with disabilities. Parents negotiating the choice between leaving children either unattended or with siblings, versus bringing children to unsafe and potentially dangerous environments at night, may favor a third option of smoking indoors. All individuals have a right to a smoke-free environment. A smoking ban in areas typically overburdened by tobacco marketing and outlet density will help offset the culture of smoking. The partnering of HUD with local organizations to change tobacco culture and assist with smoking cessation in a high prevalence smoking environment is an admirable and urgent first step in reducing initiation, current smoking, and secondhand exposure. But smoking cessation is a long-term process that requires consistency and smoker buy-in, with attention paid to the broader social conditions and vulnerability of populations that smoke—all of which may challenge anti-smoking policies. Sustainable efforts need to ensure that smokers and their children are not at heightened risk of eviction, reduced accessibility to housing, or increased levels of stigma factors that may undermine or compromise any efforts to quit or reduce smoke exposure. As a sociologist dedicated to understanding how social policies affect health inequalities and disparities, I feel it is imperative that any implementation of smoke-free policies must continue to be undertaken in a fair manner, which acknowledges the unique needs and challenges of disadvantaged populations, and considers policies’ potential to harm as well as their numerous advantages.

For more information: http://tinyurl.com/j9mq335