COPD World News
COPD World News Week of December 3, 2017
FDA approves first nebulized LAMA for COPD
Silver Spring, Maryland - The FDA approved a nebulized formulation of glycopyrrolate (Lonhala Magnair) for long-term maintenance treatment of patients with moderate-to-severe COPD, said manufacturer Sunovion Pharmaceuticals. It's the first long-acting muscarinic antagonist (LAMA) to be sold in this form. Recommended dosing is 25 mcg twice daily. The approval was made on the strength of data from two 12-week, randomized, multicenter trials in which the drug demonstrated improvements in forced expiratory volume in one second (FEV1) compared to placebo. An additional 48-week safety trial compared the Sunovion product to inhaled tiotropium bromide (Spiriva HandiHaler). Results from that trial showed that the nebulized glycopyrrolate treatment was well tolerated over the treatment period and that treatment-related adverse events were comparable between the two drugs. The FDA accepted Sunovion's new drug application in October 2016, but it was initially rejected last May with no public explanation. Pulmonary specialist James F. Donohue, MD, of the University of North Carolina in Chapel Hill, said the availability of a nebulized LAMA represents a significant advance in the treatment of COPD. "Glycopyrrolate is a very effective agent," he said. "We haven't had a long-term anti muscarinic in nebulizer form, and that has been a defect." The FDA is currently considering approval of a second nebulized LAMA, Theravance Biopharma and Mylan's drug revefenacin, which has been investigated as a once-daily COPD treatment. Donohue presented positive phase III data on that drug last month in Toronto at the CHEST annual meeting, and he was also involved in the research for the Sunovion product. "As a doctor, I'm really looking forward to having these agents available," he said. "Many patients are sent home now with their nebulizer LABA [long-acting beta agonist] plus an inhaled corticosteroid. We need the LAMA component." Sunovion also highlighted the "virtually silent, portable, closed system nebulizer," which it said delivers the drug over 2-3 minutes while patients breathe normally. The firm expects to have the new LAMA product on pharmacy shelves in early 2018.
For more information: https://tinyurl.com/y6vdpjfq
COPD World News Week of November 26, 2017
Tobacco warnings should mention COPDVienna, Austria – According to MEP Karin Kadenbach, progress has been made on tobacco products health warnings but the next round of graphic labelling should also mention the less-known chronic obstructive pulmonary disease (COPD). Karin Kadenbach is an Austrian member of the Group of the Progressive Alliance of Socialists and Democrats (S&D) in the European Parliament. In Europe only a few countries have adopted national management plans for diseases like COPD. COPD in Europe affects 1 in 10 people over 45 and it is among the 10 top causes of death in the European Union, varying from country to country. "The EU needs to rethink their healthcare systems to respond to the needs of patients with chronic respiratory diseases and the European Commission should take stock of the good examples that exist, and propose a white paper or a strategy guiding member states on what policies to consider preventing and managing diseases like COPD," said Kadenbach. "Not only to ensure the EU in all policies approach, but also to warn about lethal but slow diseases like chronic respiratory diseases. The EU cannot afford the cost of inaction against COPD and cannot hide behind the lack of health competence to act." According to Kadenbach, the EU can adopt policies that can positively affect COPD, like tobacco control measures, air pollutants levels, research, or healthy ageing policies. According to the World Health Organisation (WHO), chronic obstructive pulmonary disease (COPD) is a lung disease that results in changes in several different parts of the respiratory system and lungs at the same time. But it is far more than just a ‘smoker’s cough’. Lost productivity due to COPD is enormous. Although the damage caused by COPD cannot be repaired, the care planned for COPD patients has to focus on stopping the disease from progressing, with treatment, but also with complementary medicines like kinesiotherapy and psychology. Access to these disciplines is unequal depending on the member state but research shows that it does work, so doctors should be prescribing them more often. The EU also needs to facilitate patients remaining at work, as it has been demonstrated that having an active life decreases the level of severity of the disease, and reduces healthcare costs due to COPD. Although there is no great European performer in the field of COPD management, the European association representing COPD patients (efanet.org) has documented good practices at national level. In Germany, Ireland and the UK, doctors are performing COPD screening lung tests in health check-ups, which is the very first step to fight the disease back. All countries should include spirometry for people at risk of developing COPD, similar to the ease of access patients have receiving an electrocardiogram or a mammography. Austria, Belgium, Poland, Portugal, Spain and Sweden, have been providing access to pulmonary rehabilitation and smoking cessation programmes for free. Professional support and reimbursement of treatment to quit smoking is a fundamental measure to decrease respiratory disease. At present, the EU has focused on decreasing tobacco consumption through marketing measures, but that doesn’t cut the problem off. Plain packaging (combined with graphic warnings) are definitely going in the right direction; but the next round of pictures for graphic warnings should also mention COPD, which is a disease that is not known enough by EU citizens.
For more information: https://tinyurl.com/y79h2qnj
COPD World News Week of November 19, 2017
Cost of pneumonia in Canada predicted to increase
Ottawa, ON - Pneumonia is a respiratory illness that not only presents more commonly among the elderly, but also among children and those with compromised immune systems. In addition to affecting health and well-being, the disease can also incur huge costs to the health care system, caregivers, and the economy. Pneumonia can also arise as a complication among individuals with other underlying chronic conditions (comorbidities), such as cardiovascular disease and chronic lung illness. While the death rate from pneumonia alone can be as high as 15 per cent, mortality rises to over one in four affected individuals (26 per cent) in the presence of comorbidities. Since pneumonia is a preventable disease, and because it affects several vulnerable populations, there is an opportunity to offset its large impact on individuals, caregivers, the health care system, and the broader economy. The Conference Board of Canada is engaged in a three-part research series on the burden of pneumonia in Canada. The first briefing aimed to estimate the health and economic burden of pneumonia over time. The second aims to examine trends in the likelihood of developing complications after hospitalization for pneumonia, and any impact these complications may have on the cost of treatment and recovery. The forthcoming and final briefing will discuss the policy implications of this research and explore the opportunities to better address the burden of pneumonia in Canada. The first briefing of the series, The Economic Burden of Pneumonia in Canada: A Status Quo Forecast, quantified the economic impact of the disease by taking into account costs to the health care system. Hospitalized pneumonia among the senior population is forecast to increase dramatically in the next decade with the aging of the population and population growth. Hospitalizations due to pneumonia are projected to double by 2025 for the population aged 65 years and over, increasing from 24,761 hospitalizations per year in 2010 to 49,424 in 2025. Along with the rising cost of treating each case of pneumonia, the annual direct health care cost of pneumonia is forecast to increase from $216.2 million in 2010 to $532.2 million in 2025. Population growth and aging are the main cost drivers, especially since seniors, particularly those aged 75 and over, are more susceptible to developing pneumonia and tend to have costlier hospitalizations.
For more information: http://tinyurl.com/yaqvepwt
COPD World News Week of November 12, 2017
Novel agent boosts quality of life in COPD
Toronto, ON - An investigational long-acting drug for chronic obstructive pulmonary disease (COPD), delivered by nebulizer, improved patient quality of life in two pivotal studies, researchers said here. In a pooled analysis of the placebo-controlled phase III trials 0126 and 0127, patients reported marked improvement on two scales, the St George's Respiratory Questionnaire (SGRQ) and COPD Assessment Test (CAT) with revefenacin treatment, according to James Donohue, MD, of the University of North Carolina in Chapel Hill, and colleagues. On both scales, patients reported "clinically meaningful" responses to the drug in secondary analyses, Donohue reported at CHEST, the American College of Chest Physicians annual meeting. If approved, revefenacin would be the first once daily, long-acting muscarinic antagonist (LAMA) indicated for patients with COPD, Donohue said. It would be an important addition to the armamentarium of therapy for patients who require a nebulized treatment. "What's unique is that it's in a nebulizer and it's 24 hours," he noted. The results of the study are "important," commented CHEST session co-moderator Arthur Gelb, MD, of the University of California Los Angeles. "Hopefully, [the drug] will reach clinical utilization soon." Donohue said the FDA is expected to make a decision soon, although it's unclear which of two tested doses will get the nod. Gelb said that one advantage of revefenacin is that it would be the "only LAMA that would be inline," which would make it more economical to use for patients admitted to hospital. The two studies were identical, with 1,229 patients randomly assigned on a 1:1:1 basis to placebo, 88 μg of revefenacin, or 175 μg of the drug. The primary endpoints were efficacy and safety over a 12-week period, he said. Patients in the study were well balanced across the arms in terms of demographics. About half were current smokers and a similar proportion reported a modified Medical Research Council dyspnea score of at least 2. Patients had moderate to severe COPD with a high risk of exacerbations.
For more information: http://tinyurl.com/yb8zl7jj
COPD World News Week of November 5, 2017
Great news for Ontario seniors
Toronto, ON – The Ontario government has announced a new senior’s strategy that empowers people to make the choices that are right for them when it comes to their care, their independence, and how they access government services - whether that's finding ways to keep up an active lifestyle or getting the support needed to live at home longer. One of the highlights of this new action plan for the COPD community is that beginning in the 2018-19 flu season, Ontario will invest $17 million per year to provide a high-dose influenza vaccine, targeted to protect seniors, which will be available free of charge as part of the Ontario Universal Influenza Immunization Program. Currently one must pay out-of-pocket for this new vaccine which has proven to be highly effective at reducing the incidence of flu and the severity of the disease should a senior come down with the flu. Older Canadians suffer disproportionately from flu-related morbidity and mortality. Adults 65+ represent 15% of the Canadian population. However, during influenza season they account for 70% of the hospitalizations. Complications of influenza often result in COPD exacerbations which can then trigger heart attacks and stroke. Influenza-attributed death is 12 times greater among those 65+ who also have a chronic lung disease. The National Advisory Committee on Immunization (NACI) recommends that those age 65+ receive a flu vaccine each year. A recent study concluded that the new high-dose influenza vaccine significantly reduced hospital visits for the elderly. Currently, only Manitoba provides free access to these high-dose flu vaccines - specifically for nursing home residents - who have the greatest mortality risk from influenza of all Canadians. Other highlights of the governments senior’s strategy include the introduction of: Easy-to-find information: A "one-stop" website (Ontario.ca/AgingWell) has been developed where seniors can find information about tax credits, drug coverage, powers of attorney, recreation programs and more. People can also get this information by phone at 1-888-910-1999 or by calling 211 ― which offers information 24 hours a day in over 150 languages.
For complete information on the senior’s plan: http://tinyurl.com/y9pvfwsr
COPD World News Week of October 29, 2017
Pollution causing more deaths worldwide than war or smoking
London, UK - Environmental pollution — from filthy air to contaminated water — is killing more people every year than all war and violence. More than smoking, hunger or natural disasters. More than AIDS, tuberculosis and malaria combined. One of out every six premature deaths in the world in 2015 — about nine million — was attributed to disease from toxic exposure, according to a major study released Thursday in the Lancet medical journal. The financial cost from pollution-related death, sickness and welfare is equally massive, the report says, costing some $4.6 trillion in annual losses — or about 6.2 per cent of the global economy. "There's been a lot of study of pollution, but it's never received the resources or level of attention as, say, AIDS or climate change," said epidemiologist Philip Landrigan, dean of global health at the Icahn School of Medicine at Mount Sinai in New York City, and lead author on the report. It marks the first attempt to pull together data on disease and death caused by all forms of pollution combined. "Pollution is a massive problem that people aren't seeing because they're looking at scattered bits of it," Landrigan said. Experts say the nine million premature deaths the study found was just a partial estimate, and the number of people killed by pollution is undoubtedly higher once new methods of assessing harmful impacts are developed. Areas like Sub-Saharan Africa have yet to even set up air pollution monitoring systems. Soil pollution has received scant attention. And there are still plenty of potential toxins still being ignored, with less than half of the 5,000 new chemicals widely dispersed throughout the environment since 1950 having been tested for safety or toxicity. "In the West, we got the lead out of the gasoline, so we thought lead was handled. We got rid of the burning rivers, cleaned up the worst of the toxic sites. And then all of those discussions went into the background" just as industry began booming in developing nations, said Richard Fuller, head of the global toxic watchdog Pure Earth and one of the 47 scientists, policymakers and public health experts who contributed to the 51-page report. Raisina hill, government seat of power, is seen engulfed in morning smog a day after the Diwali festival, in New Delhi, India on Friday. Levels of dangerous, lung-clogging particulate matter known as PM2.5 went 90 times the recommended limit by the World Health Organization. (Manish Swarup/Associated Press) Asia and Africa are the regions putting the most people at risk, the study found, while India tops the list of individual countries. One out of every four premature deaths in India in 2015, or some 2.5 million, was attributed to pollution. China's environment was the second deadliest, with more than 1.8 million premature deaths, or one in five, blamed on pollution-related illness, the study found. 5 highest rates of pollution-related deaths per 100,000 population (percentage of all deaths)." The report's authors gave Alberta's oilsands and Ontario's chemical valley, home to 40 per cent of the country's chemical manufacturing, as Canadian pollution hotspots. Fuller said that people often don't realize that pollution can damage economies since those who are sick or dead cannot contribute to the economy. "There is this myth that finance ministers still live by, that you have to let industry pollute or else you won't develop," he said. "It just isn't true." The report cites EPA research showing that the U.S. has gained some $30 US in benefits for every dollar spent on controlling air pollution since 1970, when Congress enacted the Clean Air Act, one of the world's most ambitious environmental laws. Removing lead from gasoline has earned the U.S. economy another $6 trillion cumulatively since 1980, according to studies by the U.S. Centers for Disease Control and Prevention. Some experts cautioned, however, that the report's economic message was murky. Reducing the pollution quantified in the report might impact production, and so would not likely translate into gains equal to the $4.6 trillion in economic losses. The report "highlights the social and economic justice of this issue," said Marc Jeuland, associate professor with the Sanford School of Public Policy and the Duke Global Health Institute at Duke University, who was not involved in the study. Without more concrete evidence for how specific policies might lead to economic gains, "policy makers will often find it difficult to take action, and this report thus only goes part way in making the case for action," he said. Jeuland also noted that, while the report counts mortality by each pollutant, there are possible overlaps — for example, someone exposed to both air pollution and water contamination — and actions to address one pollutant may not reduce mortality. The study's conclusions on the economic cost of pollution measure lost productivity and health care costs, while also considering studies measuring people's "willingness to pay" to reduce the probability of dying. While these types of studies yield estimates at best, they are used by many governments and economists trying to understand how societies value individual lives. While there has never been an international declaration on pollution, the topic is gaining traction. The World Bank in April declared that reducing pollution, in all forms, would now be a global priority. And in December, the United Nations will host its first conference on the topic of pollution.
For more information: http://www.cbc.ca/news/health/pollution-worldwide-deaths-1.4363613
COPD World News Week of October 22, 2017
COPD a risk in women with rheumatoid arthritis
Boston, MA - Women with rheumatoid arthritis (RA) were at increased risk of developing chronic obstructive pulmonary disease (COPD) independent of smoking, analysis of data from the prospective Nurses' Health Study (NHS) found. After adjustment for age and year of RA diagnosis, the hazard ratio for incident COPD was a significant 1.52 (95% CI 1.17-1.97), and after further adjusting for smoking either before or after the index date of RA diagnosis, the hazard ratio was again statistically significant at 1.43 (95% CI 1.09-1.87), according to Jeffrey A. Sparks, MD, and colleagues from Harvard University in Boston. Then, after adjustment for multiple other potentially time-varying covariates, including BMI, diet, physical activity, menopausal status, and postmenopausal hormone use, women with RA had a 68% greater risk than controls for incident COPD (HR 1.68, 95% CI 1.36-2.07), they reported in Seminars in Arthritis & Rheumatism. The lung is important in RA, with roles in both pathogenesis and clinical manifestations, according to the authors. "Inflammation in the bronchiolar mucosa may be an initial trigger for immune tolerance breakdown that leads to the formation of RA-related autoantibodies, perhaps years prior to the clinical onset of RA," they explained. Smoking and other environmental triggers also have been implicated in RA pathogenesis, and individuals who smoke and have a genetic predisposition may be particularly susceptible to immune system disturbances in the airways.
Pulmonary fluid specimens obtained from newly diagnosed RA patients have shown the presence of aggregated lymphocytes that can produce the RA-specific autoantibodies anti-citrullinated protein antibodies in the airways and parenchyma, which in turn may compromise bronchiolar function, possibly leading to COPD regardless of exposure to smoke. Other factors that may contribute to COPD after the diagnosis of RA include chronic systemic and airway inflammation and adverse effects of drugs such as methotrexate. Previous studies that have suggested links between RA and COPD/asthma have been limited by retrospective designs and inadequate information about smoking. Accounting for the influence of smoking on risk for both RA and respiratory disease is particularly challenging, because smoking is a strong risk factor for both and can be considered "on the causal pathway between the exposure and outcome," according to the authors. The association between RA and COPD seen in this analysis suggests that there may be factors such as inflammation specific to RA contributing to the risk independent of smoking, and "these results are particularly pertinent since patients with RA are at markedly elevated risk for respiratory mortality," Sparks' group noted. "Future studies are needed to investigate shared environmental or genetic factors and RA-specific factors such as citrullination, autoimmunity, and systemic inflammation that might further explain the respiratory burden of RA," they concluded. Study limitations included the possibility of mis-classification of COPD and asthma as well as a lack of data on RA disease activity and treatments.
For more information: http://tinyurl.com/yc63smv9
COPD World News Week of October 15, 2017
More HCPs get Flu shot when employer requires it
Atlanta, GA - Most healthcare personnel received a flu shot during the 2016-2017 season, with the highest coverage among those who worked at hospitals, CDC researchers found. While more than three-quarters of healthcare personnel reported receiving the influenza vaccination, that number jumped to 92.3% of all healthcare professionals working in hospitals, reported Carla L. Black, PhD, of the CDC's National Center for Immunization and Respiratory Diseases, and colleagues. Lower coverage was observed among healthcare personnel working in long-term and ambulatory care settings, and in healthcare facilities where the employer did not provide or recommend vaccination coverage, the authors wrote in the Morbidity and Mortality Weekly Report (MMWR). They noted that the CDC's Advisory Committee for Immunization Practices (ACIP) recommends that all healthcare personnel receive the influenza vaccine every year. The team conducted an opt-in internet panel survey of 2,348 healthcare personnel to provide estimates for the 2016-2017 influenza season. Overall coverage is similar to vaccination coverage reported over the last three influenza seasons, and not surprisingly, continues to be highest (96.7%) in settings where an employer requires vaccination, the investigators said. Ensuring that healthcare personnel and patients are protected from influenza requires workplace strategies to improve vaccination coverage among healthcare personnel, "including vaccination requirements or active promotion of on-site vaccinations at no cost." Notably, 93.7% of healthcare personnel working in hospitals said their employer either required vaccination coverage or provided on-site vaccination for at least 1 day. Vaccination coverage was at least 90% for hospital employees "of all occupational groups," the authors said. Only about 40% of respondents reported that receiving the influenza vaccine was part of their job requirement. About 70% of hospitals were likely to have this requirement compared with less than 40% of those working in ambulatory care, a quarter of long-term care healthcare professionals, and 22% of those working in other clinical settings. Moreover, vaccination coverage was the lowest among healthcare personnel where vaccination was not "required, promoted, or offered on-site" (45.8%). Around 30% of workers in long-term care and "other clinical settings" said that their employer did not require, promote, or provide vaccination compared with about 20% of those in ambulatory care settings and less than 4% of those working in hospital settings. Vaccination coverage was lower among healthcare professionals working in ambulatory (76.1%) and long-term care settings (68.0%). Black and colleagues noted that influenza vaccination in long-term care settings is "especially important because influenza vaccine effectiveness is generally lowest in the elderly, who are at increased risk for severe disease," and it "confers health benefits to patients, including reduced risk for mortality."
For more information: http://tinyurl.com/yb9zx3lh
COPD World News Week of October 8, 2017
Why Australia's rough flu season could be bad news for Canada
Ottawa, ON - A rough flu season in the Southern Hemisphere could be a warning sign of what’s in store for Canada in the next few months. Health officials in North America are bracing for a particularly miserable flu season because Australians faced a heavy burden of flu cases, which could prove as a predictor for what might happen in Canada. In Australia, the 2017 flu season is possibly the biggest on record, with nearly three times the number of confirmed flu cases compared to 2016. According to a report from the Public Health Agency of Canada, the flu is currently inter-seasonal, but several indicators show above expected levels compared to previous seasons. Flu season in Canada typically runs from November to March. In early September, the majority of influenza cases in Canada came from a virus known as H3N2. That virus is historically linked to heavier flu seasons and is known to be particularly hard on seniors. "It is still too early to say whether it will be a predominantly H3N2 season, but if that is the case it tends to be a more severe flu type,” Dr. Theresa Tam, head of the Public Health Agency of Canada, told CTV News recently. The H3N2 virus also showed up in Canada last year. Some pharmacies and clinics are already giving vaccine shots, and officials say it might be a good idea to get one. Studies show that people who receive flu shots have a 40 to 60 per cent lower chance of getting seriously ill than those who are unvaccinated. Learn more about influenza as Canada prepares for the upcoming flu season. Influenza myths & facts has recently been posted on the COPD Canada web site.
For more information: http://www.copdcanada.info/47.html
COPD World News Week of October 1, 2017
FDA approves first triple therapy for COPD
London, UK - The US FDA has approved Trelegy Ellipta, a once-daily, single inhaler triple therapy fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) for the long-term, once-daily, maintenance treatment of patients with COPD, according to a press announcement from GlaxoSmithKline and Innoviva Inc. The therapy is approved for COPD patients who are on a fixed-dose combination of fluticasone furoate and vilanterol for airflow obstruction. Trelegy Ellipta is not indicated for relief of acute bronchospasm or the treatment of asthma, GSK and Innoviva noted. Trelegy Ellipta is a combination of an inhaled corticosteroid, a long-acting muscarinic antagonist (LAMA), and a long-acting beta2-adrenergic agonist (LABA), delivered once-daily in GSK’s Ellipta dry powder inhaler. It is the first once-daily product approved in the US that combines three active molecules in a single inhaler for the maintenance treatment of appropriate patients with COPD. The FDA-approved strength is FF/UMEC/VI 100/62.5/25 mcg. “COPD is a progressive disease that can worsen over time, and represents a significant burden to patients and healthcare systems. The approval of Trelegy Ellipta, and the addition of a once-daily single inhaler triple therapy to our portfolio of respiratory medicines, is an important milestone for GSK that builds on our long heritage in this area,” said Eric Dube, SVP & Head, GSK Global Respiratory Franchise. Mike Aguiar, CEO of Innoviva Inc, added, “This approval represents a significant therapeutic convenience for those appropriate patients already on Breo Ellipta, that require additional bronchodilation or for those patients already on a combination of Breo Ellipta and Incruse Ellipta. Trelegy Ellipta is the latest development in our collaboration with GSK and is testament to our ongoing efforts to advance respiratory medicine.” GSK and Innoviva believe Trelegy Ellipta will be available for use in the US shortly. Regulatory applications have been submitted and are undergoing assessment in a number of other countries, including the European Union, Australia and Canada.
For more information: http://tinyurl.com/ybrofru9
COPD World News Week of September 24, 2017
Disinfectant use tied to COPD incidence in nurses
Milan, Italy - There was a prospective association between exposure to disinfectants and higher chronic obstructive pulmonary disease (COPD) incidence in nurses, researchers reported here. Analysis of data from the U.S. Nurses Health Study II (NHS II) showed that nurses who used various disinfectants to clean surfaces in hospitals had a 22% increased risk of developing COPD within 8 years (adjusted odds ration, according to Orianne Dumas, PhD, of the French Institute of Health and Medical Research (INSERM) in Villejuif, France, and colleagues. About 37% of the nurses reported weekly involvement in using disinfectants to clean surfaces, Dumas said at a press conference at the European Respiratory Society (ERS) International Congress. She also reported that a suggested association for weekly use of disinfectants to clean instruments. High level exposure to specific disinfectant evaluated by the researchers -- glutaraldehyde, bleach, hydrogen peroxide, and quaternary ammonia compounds (also known as quats) -- were associated with incident COPD (P<0.05), with ORs ranging from 1.24 to 1.32. Dumas noted that previous studies have linked exposure to disinfectants with breathing problems, such as asthma, among healthcare workers. The potential adverse effects of exposure to disinfectants on COPD have received much less attention, although previous research has shown that working as a cleaner was associated with a higher risk of COPD. In a separate 2017 study, Dumas' group described disinfectants used by U.S. nurses, and investigate qualitative and quantitative differences according to workplace characteristics and region. They found that working in a hospital was tied to a higher disinfectant use but lower spray use. Also, nurses working in smaller hospitals (<50 beds vs ≥200 beds) were more likely to use disinfectants and sprays "To the best of our knowledge, we are the first to report [at ERS] a link between disinfectants and COPD among healthcare workers, and to investigate specific chemicals that may underlie this association.
For more information: http://tinyurl.com/y96q6af7
COPD World News Week of September 17, 2017
E-Cigs May Still Damage Blood Vessels
Milan, Italy - Nicotine exposure from vaping was associated with a transient, but potentially harmful, increase in arterial stiffness, according to researchers here. The study included 15 young adults (average age of 26) with no history of electronic cigarette use who identified themselves as seldom smokers, meaning that they smoked no more than 10 cigarettes a month. They vaped e-cigarettes with nicotine for 30 minutes on one study day and non-nicotine containing e-cigarettes for the same length of time on another study day in a controlled setting, explained Magnus Lundback, MD, PhD, of the Karolinska Institute in Stockholm, and colleagues. During the first 30 minutes after smoking e-cigarettes containing nicotine, a three-fold increase in arterial stiffness was observed, as well as increases in blood pressure and heart rate. These effects were not seen following the non-nicotine vaping session, they reported at the European Respiratory Society (ERS) International Congress. These early findings may have important implication for the use of e-cigarettes in smoking cessation, the authors noted. In addition, it is the first clinical trial to link e-cigarette exposure to arterial stiffening in humans, they stated. "There are thousands of toxins in conventional cigarettes, and the thinking has been that they, and not nicotine, are responsible for these cardiovascular effects," he said. "But this study suggests that that might not be the case. It may be that continuous, repeated exposure to e-cigarettes may chronically alter vascular stiffness and increase the risk for cardiovascular events in the future." While the effects on blood pressure, heart rate, and arterial stiffness seen in the study lasted no more than 30 minutes, they mimicked the temporary effects on arterial stiffness seen in cigarette smokers. Lundback noted that chronic exposure to both active and passive conventional cigarette smoke is known to permanently increase arterial stiffness over time. His group took measurements of blood pressure, heart, and arterial stiffness at three, time points during each vaping session: during the first 30 minutes following exposure and at 2 and 4 hours post-exposure. Because exposure to non-nicotine e-cigarettes was not associated with an increase in these cardiovascular risk factors, the immediate increase was most likely attributable to nicotine, Lundback said. "Our results underline the necessity of maintaining a critical and cautious attitude towards e-cigarettes, especially for healthcare professionals," he said.
For more information: http://tinyurl.com/yd5ylxrc
COPD World News Week of September 10, 2017
Smokers, non-smokers tend to underestimate relative risk
Palo Alto, CA - Everyone knows smoking cigarettes is dangerous, but smokers and non-smokers have significant mis-perceptions about the magnitude of the risk associated with lighting up, researchers found. Jon Krosnick, PhD, of Stanford University in Palo Alto, Calif., and colleagues found that people tend to overestimate the absolute risk and underestimate the relative risk associated with tobacco use. They suggested that framing public health messages about cigarette use in terms of a smoker's relative risk for lung cancer, COPD, cardiovascular disease, and other health harms may have a bigger impact on behavior than more commonly used methods of educating the public about smoking's dangers. According to the CDC, cigarette smokers are 15 to 30 times more likely to develop lung cancer or die from lung cancer than non-smokers. "Researchers who study risk look at the (relative risk) ratio all the time. They never look at the percentage point difference," Krosnick said. "But this way of thinking about risk is often absent from public health discussions about smoking." In their study, published in the journal PLOS One, Krosnick and colleagues analyzed data from national surveys that assessed perceived smoking risk for lung cancer among current smokers, former smokers, and non-smokers. They compared three risk perception measures (absolute, attributable, and relative risk) in terms of their associations with smoking cessation and the desire to quit. "Perceptions of relative risk were associated, as expected, with smoking onset and smoking cessation, whereas perceptions of absolute risk and attributable risk were not," the researchers wrote. "Additionally, the relation of relative risk with smoking status was stronger among people who held their risk perceptions with more certainty." Krosnick and colleagues found that current smokers, former smokers, and never-smokers all tended to underestimate the relative risk of smoking. They concluded that the findings should encourage "consideration of a different approach to communicating health risks," adding that quantifying relative risk in public health messages could have a measurable effect on smoking cessation and smoking avoidance rates. Krosnick noted that cigarette packaging labels in the United States include warnings from the Surgeon General that focus on specific health problems associated with tobacco use, but they do not provide information to help consumers quantify the risk. "This may be why quantitative information about relative risk on cigarette packages in Australia (e.g., 'Tobacco smoking causes more than four times the number of deaths caused by car accidents') appears to have been effective in encouraging smoking cessation," the researchers wrote. "We all need to be better informed about the relative risk of smoking with regard to lung cancer, heart disease, COPD and all of the related health consequences," Krosnick said.
For more information: http://tinyurl.com/y9j292lh
COPD World News Week of September 3, 2017
Manitoba to cover high-dose flu vaccine
Winnipeg, MB - Manitoba is the first province in Canada to introduce a high-dose flu vaccine to better protect vulnerable residents of personal care homes from influenza, Health, Seniors and Active Living Minister Kelvin Goertzen announced today. “Studies show that people over the age of 65 that live in personal care homes are most at risk of complications or death related to influenza,” said Goertzen. “That’s why we’re the first in Canada to introduce this new type of vaccine to better protect these vulnerable people and keep them healthy when the flu starts to circulate this winter.” This year, the high-dose seasonal influenza vaccine is being offered to people 65 years of age or older who are living in a personal care home. The vaccine provides a higher level of protection against two types of influenza A and one type of influenza B predicted to be circulating in North America this fall and winter. Lower respiratory tract infections, including pneumonia and bronchitis, are a leading cause of hospital admissions in adults aged 65 years or older, especially in frail older adults. The number of personal care home residents admitted to hospital varies considerably between facilities, but is more frequent during the time of peak influenza activity. The minister noted public health officials will review data about the use and effectiveness of the high-dose flu vaccine in personal care homes to support future vaccine decisions. To protect people from getting influenza (flu), Manitoba Health, Seniors and Active Living encourages all Manitobans to get a free flu vaccine early every fall. The flu vaccine is typically available from health-care providers in early October. Information on seasonal flu and the flu vaccine, is available on the MB government web site: www.gov.mb.ca/health/flu/.
For more information: http://news.gov.mb.ca/news/index.html?archive=&item=42125
COPD World News Week of August 27, 2017
New study looks at lung volume reduction procedures for emphysema
London, UK – A new study looked at the patient experience of lung volume reduction surgery (LVRS) and endobronchial valve (EBV) placement, from referral through to post-discharge care. Evidence based management of chronic obstructive pulmonary disease (COPD) is focused on improving breathlessness, quality of life and healthcare utilization. Inhaled therapies and non-pharmacological treatment options such as pulmonary rehabilitation (PR) provide improvements, but many patients nevertheless experience intractable breathlessness. Interventional approaches such as lung volume reduction surgery (LVRS) may be indicated. LVRS can improve exercise capacity, lung function, quality of life (QoL) and survival in selected patients with emphysema. Evidence is emerging that endobronchial valve placement (EBV) may produce similar benefits. Few procedures are performed relative to the disease burden and likely prevalence of suitable individuals, and survey data suggest a lack of knowledge among clinicians about indications and processes for referral. The researchers wished to discover more about patient experience of the clinical pathways for lung volume reduction to find ways to improve the process and consider other patient-relevant outcome measures. Focus group interviews were carried out in two tertiary centres in London and Leicester, UK. Sixteen patients who had undergone lung volume reduction surgery (LVRS), endobronchial valve (EBV) placement, or both, were recruited. Prior to participation in each focus group, participants completed a questionnaire to guide and focus discussion. Thematic analysis identified common themes to the participant experience of receiving lung volume reduction interventions. Themes included patient focus on declining health and the need to “fight” for a referral; consequences of having procedures and potential unexpected complications; and vulnerability post discharge and limited continuity of care. Participants were clear that the benefits of having had either LVRS or EBV procedures outweighed any difficulties experienced. Participants were keen to have further similar interventions if appropriate. The data produced confirmed the need to develop more systematic lung volume reduction pathways, provide appropriate information, and ensure that post-discharge care is optimal. The participants in the groups were clear that the benefits of having either LVRS or EBV procedures outweighed any difficulties they experienced, and they were keen to have further similar interventions if beneficial. This information may help clinicians who may not refer patients because of overestimating the risk versus benefit of intervention. The researchers concluded that work is needed to improve referral pathways, patient information and post-discharge care.
For more information: http://openres.ersjournals.com/content/3/3/00031-2017
COPD World News Week of August 20, 2017
Many hospitals fail to support smoking cessation for CHD patients
Springfield, MA - Smokers who were hospitalized for cardiac events were highly motivated to kick the habit, but initiation of in-hospital smoking cessation therapy is still low among these patients, researchers reported. In a retrospective study of data from 282 U.S. hospitals, just over one in five (22.7%) smokers hospitalized for coronary heart disease (CHD) received a smoking cessation pharmacotherapy during their hospital stay, according to Quinn Pack, MD, of Baystate Medical Center in Springfield, Mass., and colleagues in JAMA Internal Medicine. There was also wide variation across hospitals in smoking cessation therapy initiation, with the best performing hospitals initiating treatment in around two-thirds of smokers hospitalized for CHD events, and the worst performing initiating therapy in less than 10%, Pack said. "The hospital was a more important predictor of receiving smoking cessation counseling and treatment than the patient," Pack said. "We saw big hospitals, small hospitals, urban, not urban all vary widely across the range, and none of these variables were predictive." A similar study in JAMA Cardiology also found a low prevalence of smoking cessation medication use in older heart attack patients following hospitalization. In that study, just 7% of MI patients who were Medicare beneficiaries filled prescriptions for a smoking-cessation drug within 90 days of hospital discharge. Pack said the two studies together suggest that, "we are really missing the boat when it comes to helping patients at this very critical time. This is really about the administration and the hospital culture. Some hospitals are really pushing this, and at others, smoking cessation treatment doesn't seem to be on the radar." "Hospitalization for a cardiac event provides a teachable moment with high patient motivation to quit smoking; however, our findings suggest that many hospitals are missing this opportunity to improve outcomes for smokers hospitalized for CHD," Pack's group wrote. Although the analysis did not explore why some hospitals had much higher rates of smoking cessation treatment initiation among CHD patients, Pack said that having a smoking cessation protocol in place, and having smoking cessation counsellors on staff, may be important strategies for achieving this outcome. "We know these medications work. They can really make a big difference for these patients," he said.
For more information: http://tinyurl.com/y7xyxqa3
COPD World News Week of August 13, 2017
Depression increases hospital use in AECOPD
Manchester, UK - Results from a 3-year longitudinal follow-up of the ECLIPSE cohort looked at the association of depressive symptoms with rates of acute exacerbations in patients with COPD. Depression increases disability and health care utilization in older patients with chronic obstructive pulmonary disease (COPD). The objectives of the research was to determine the contribution of depressive symptoms to the incidence of moderate-severe and severe acute exacerbations of COPD (AECOPD) over 3 years. Researchers analyzed data collected from a prospective cohort of patients with COPD (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints; ECLIPSE). This multicentered outpatient study looked at a total of 2059 patients with COPD with complete data (63.7% men, mean age 63.4 + 7.1 years). Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Moderate-severe AECOPDs were collected; a subset of very severe AECOPD was defined as requiring hospital admission. The results showed that a total of 540 (26%) patients with COPD reported high depressive symptoms (CES-D ≥16). High depressive symptoms at baseline related to an increased risk of moderate-severe and severe AECOPD during the follow-up (odds ratio [OR] 1.18; 95% confidence interval [CI] 1.07–1.30; for moderate-severe and OR 1.36; 95% CI 1.09–1.69 for severe events risk of hospitalizations) independent of key covariates of an AECOPD history before recruitment in the study, history of gastroesophageal reflux, baseline severity of airflow limitation, and white blood cell count that were also associated with an increased risk of moderate to severe exacerbations. The researchers concluded that the presence of high depressive symptoms at baseline were associated with subsequent moderate-severe exacerbations and hospital admissions in patients with COPD over 3 years, independent of a history of exacerbations and other demographic and clinical factors. Targeted personalized medicine that focuses both on AECOPD risk and depression may be a step forward to improving prognosis of patients with COPD.
For more information: http://www.jamda.com/article/S1525-8610(17)30303-1/fulltext
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