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