COPD World News Week of June 30, 2013

Pain a Common Problem for People With COPD

Philadelphia, PA - Chronic obstructive pulmonary disease patients experience a significant amount of pain, new research suggests. Pain levels are nearly on par with the kind of discomfort experienced by many osteoarthritis and rheumatoid arthritis patients, according to the study, which is scheduled for presentation Tuesday at the American Thoracic Society annual meeting in Philadelphia. "Several studies have found high rates of pain medication use among COPD patients, and pain has also been an important determinant of overall health status and quality of life in COPD," study author Melissa Roberts, a senior research associate at the Lovelace Clinic Foundation in Albuquerque, N.M., said in a society news release. The researchers analyzed data on nearly 8,000 COPD patients over the age of 40. Nearly 16,000 other men and women not diagnosed with COPD also were included in the study. All were enrolled between 2006 and 2010 in the same managed-care insurance system in the southwestern United States. Pain levels among the participants were determined by reviewing diagnostic codes and pain medication prescriptions as noted in their medical records. COPD patients were found to have more chronic pain indicators and used more pain meds, including both long- and short-acting opioid (narcotic) drugs. The pain experienced among COPD patients did not appear to be a direct function of their airflow obstruction. "We found the prevalence of chronic pain among adults with chronic disease to be almost twice as high as among individuals without chronic disease," Roberts said. "Among those with chronic disease, individuals with COPD were similar to those with rheumatoid arthritis or osteoarthritis in their experience of pain, but with even greater use of opioids." Because this study is being presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

For more information: http://www.nlm.nih.gov/medlineplus/news/fullstory_137047.html

COPD World News Week of June 23, 2013

5-Day Steroid Tx Works in COPD

Basel, Switzerland - A short-term course of systemic glucocorticoid therapy in patients with acute chronic obstructive pulmonary disease (COPD) was as effective as treatment of longer duration, researchers reported here. In a multicenter Swiss trial, a 5-day glucocorticoid treatment course achieved non-inferiority when compared to a standard 14-day course among COPD patients presenting to the emergency department with exacerbations, reported Jorg Leuppi, MD, PhD, from University Hospital of Basel, and colleagues at the annual meeting of the American Thoracic Society. Also, 35.9% of the patients on the short-course therapy reached the primary endpoint of time to exacerbation at 6-month follow-up versus 36.8% in the long-course group, they wrote in an article published simultaneously online in the Journal of the American Medical Association. "There was no difference between groups in time to death, the combined end point of exacerbation, death, or both and recovery of lung function," the authors wrote. "These findings support the use of a 5-day glucocorticoid treatment in acute exacerbations of COPD." International guidelines suggest 7- to 14-days of glucocorticoid therapy in these patients, but the optimal dose and duration are not known, the authors pointed out. The REDUCE (Reduction in the Use of Corticosteroids in Exacerbated COPD) was conducted at five Swiss teaching hospitals. The study randomized 314 COPD patients who presented to the emergency department with acute exacerbations. Past and present smokers without a history of asthma were enrolled from 2006 to 2011. They were treated with 40 mg oral prednisone daily or matching placebo. The study had some limitations. In addition to glucocorticoids, enrolled patients were treated with inhaled, long-acting beta-agonists and tiotropium throughout the trial so some of them may have been over-treated. This "may explain the lower than expected re-exacerbation rates, implying that our power estimates may have been too high," the authors acknowledged. Also, most of the patients had severe COPD so the results may not apply to those with less severe disease. In an accompanying JAMA editorial, Don Sin, MD, and Hye Yun Park, MD, PhD, of the University of British Columbia in Vancouver, suggested that the trial's findings should override current international guidelines for treatment of acute COPD exacerbations. "Until novel strategies are found, the study by Leuppi, et al, provides convincing evidence that less is more for steroid use in chronic obstructive pulmonary disease and that a 5-day regimen rather than the 10-day to 14-day course recommended by most national and international guidelines ... this is welcome news for patients for COPD who experience multiple exacerbations annually and are exposed to repeated course of systemic corticosteroids," they wrote.

For more information: http://www.medpagetoday.com/MeetingCoverage/ATS


COPD World News Week of June 16, 2013

Azithromycin May Reduce COPD Flare-Ups

Philadelphia, PA - Long-term antibiotic treatment of patients with chronic obstructive pulmonary disease may prolong the time it takes for the disease to exacerbate, researchers suggested here.The time to the next respiratory hospitalization following the first respiratory-related hospitalization was significantly longer in COPD patients treated with azithromycin for a year than those given placebo, according to Fernando Martinez, MD, director of pulmonary diagnostic services at the University of Michigan Health System in Ann Arbor. The differences in re-hospitalization began after 40 days and continued to grow for 160 days before the effect began to wane, Martinez said at the American Thoracic Society meeting. He demonstrated that at 40 days, about 90% of patients had avoided re-hospitalization in both the placebo and azithromycin groups; after 200 days, about 80% of patients treated with azithromycin had been free of respiratory-related re-hospitalization compared with about 60% of those on placebo. "Also, looking at re-hospitalization due to any cause, we found there was a trend toward a delay between first and subsequent all-cause hospitalizations for patients taking azithromycin compared to those that did not take it," he said. All patients who participated in the study either had experienced an acute exacerbation of COPD in the 12 months prior to study enrollment or had used supplemental oxygen at the time of enrollment. Patients were randomized to receive either a daily dose of 250 mg of azithromycin or placebo for one year. The researchers observed that 45 azithromycin patients were re-hospitalized for any reason compared with 65 placebo patients. "These are very preliminary results," Martinez said. He has plans to perform a prospective trial to definitively answer the question. "Preventing respiratory-related re-hospitalizations is a key component of COPD therapy, and previous research has shown that a 12-month course of azithromycin decreases the risk of acute exacerbations of COPD," he said. "COPD patients who have been hospitalized for a respiratory event are at particularly high risk for re-hospitalization, and we wanted to examine whether chronic azithromycin therapy might provide a benefit in these patients." Martinez explained that in the current healthcare environment "there is a keen interest in addressing the issue of how one can mitigate the risk of re-hospitalization in patients with COPD. This is an approach that is in evolution. We should not take away from this study that the dataset we explored validates this approach. The use of chronic antibiotics has to be used with care due to concerns about antibiotic resistance that occurs and because there can be adverse events with chronic antibiotic use. This is a very preliminary study."

For more information: http://www.medpagetoday.com/MeetingCoverage/ATS

COPD World News Week of June 9, 2013

New COPD drugs approved for coverage by provincial drug plans

Ottawa, ON -
Canadians with COPD got some welcome news this month with two new drugs being approved for coverage in Quebec and BC. In Quebec, as of June 1st, INESSS has made a recommendation to add Seebri Breezhaler to the "Listes de médicaments" as a general benefit effective June 1st.
Info here > http://www.ramq.gouv.qc.ca/fr/regie/publications-legales/pages/liste-medicaments.aspx 
British Columbia’s Pharmacare program has decided that they will provide Special Authority coverage of Onbrez Breezhaler (indacaterol maleate) for patients with a diagnosis of chronic obstructive pulmonary disorder (COPD) and that have an inadequate response on optimal short acting beta agonist therapy.
Info here > http://www.health.gov.bc.ca/pharmacare/sa/criteria/restricted/indacaterol-maleate.html
The Feds have also recommended coverage for Seebri Breezhaler (Indacterol) The Canadian Drug Expert Committee (CDEC)’s final recommendation was that glycopyrronium bromide (Seebri Breezhaler) be listed for the treatment of chronic obstructive pulmonary disease (COPD) with the following condition: List in a manner similar to tiotropium. All in all a pretty good month for those COPD patients who benefit from drug coverage through provincial drug formularies.

For more information: http://www.cadth.ca/media/cdr/complete/cdr_complete_Seebri-May-17-13.pdf

COPD World News Week of June 2, 2013

COPD Linked to Insomnia

Baltimore, MD - Chronic obstructive pulmonary disease was associated with increased risks of insomnia symptoms and hospitalizations, researchers reported here. Based on survey data of non-institutionalized participants, roughly half of those with COPD had insomnia symptoms (48.1%), twice the rate of those without COPD, according to Maurice Ohayon, MD, PhD, of the Stanford Sleep Epidemiology Research Center in Palo Alto, Calif. Co-occurrence of mental disorders with insomnia symptoms also increased likelihood of hospitalization by four times among those with COPD, Ohayon said in a poster session during the SLEEP meeting. COPD is a major cause of disability, and it is estimated that sleep disturbance is highly prevalent among patients with COPD, though no prior research had examined the relationship between the two. Ohayon studied sleeping habits, life habits, health, DSM-IV mental disorders, DSM-IV and ICSD sleep disorders in relation to COPD in a population of 8,768 non-institutionalized participants in Germany, Spain, and the U.S. through telephone interviews.COPD was defined as physician-diagnosed chronic bronchitis or emphysema that was treated or untreated. Of those sampled, 2.5% reported receiving a COPD diagnosis. Those who reported a COPD diagnosis had greater than twofold odds of co-presenting with insomnia symptoms versus those without COPD (OR 2.4). Common symptoms -- versus those without COPD -- included nocturnal awakenings and global sleep dissatisfaction. After adjusting for age, sex, and weight, breathing pauses during sleep and snoring were not significantly associated with COPD. Of participants with COPD and sleep difficulties, 11.8% reported insomnia symptoms to a healthcare professional, and the odds of hospitalization due to related mental disorders were raised fourfold, he reported. Participants with COPD also reported that insomnia and psychiatric disorders were tied to diminished quality of life. Ohayon concluded that the condition was "a debilitating disease accompanied with sleep disturbances in the overwhelming majority of cases." He added that comorbidity associated with insomnia symptoms accompanying COPD increased healthcare utilization and had a detrimental impact on quality of life among sufferers.

For more information: http://www.medpagetoday.com/MeetingCoverage/SLEEPPulm

COPD World News Week of May 26, 2013

Smoke-free subsidized housing would save millions of dollars

Atlanta, GA - The estimated annual cost savings from eliminating smoking in all U.S. subsidized housing would be $521 million, according to a new study from the Centers for Disease Control and Prevention. This is the first study to estimate the costs that could be saved by prohibiting smoking in subsidized housing, including public housing and other rental assistance programs. The bulk of those annual savings – $341 million – would come from reduced health care expenditures related to secondhand smoke. The study also estimates savings of $108 million in annual renovation expenses and $72 million in annual smoking-related fire loses. "Many of the more than 7 million Americans living in subsidized housing in the United States are children, the elderly or disabled," said Tim McAfee, M.D., M.P.H., director of the Office on Smoking and Health at CDC. "These are people who are most sensitive to being exposed to secondhand smoke. This report shows that there are substantial financial benefits to implementing smoke-free policies, in addition to the health benefits those policies bring." The study also estimated the cost savings associated with prohibiting smoking in all U.S. public housing, which is a portion of subsidized housing managed by public housing authorities. The total annual savings for public housing would be about $154 million a year, including $101 million from health care costs related to secondhand smoke exposure, $32 million from renovation expenses, and $21 million from smoking-attributable fire losses. Studies have shown that people who live in multiunit housing can be particularly affected by unwanted secondhand smoke exposure. Other studies have shown that most people who live in subsidized housing favor smoke-free policies. "Secondhand smoke enters nearby apartments from common areas and apartments where smoking is occurring," said Brian King Ph.D., an epidemiologist with CDC’s Office on Smoking and Health and lead author of the report. "Opening windows and installing ventilation systems will not fully eliminate exposure to secondhand smoke. Implementing smoke-free policies in all areas is the most effective way to fully protect all residents, visitors, and employees from the harmful effects of secondhand smoke." Secondhand smoke is responsible for about 50,000 deaths a year in the United States.

For more information:  http://www.cdc.gov/media/releases/2013/p0416-smokefree-housing.html

COPD World News Week of May 19, 2013

Certain COPD Meds Might Raise Heart Risks

Toronto, ON - Long-acting inhaled medications used by millions of people with chronic obstructive pulmonary disease (COPD) may raise the risk of cardiovascular complications among older patients, a new large Canadian study reveals. The finding centers around patients over age 65 who are prescribed long-acting bronchodilators -- either anticholinergics (such as Spiriva) or beta-agonists (such as Serevent). Both medications are commonly used to relieve the shortness of breath that characterizes moderate to severe COPD and to improve lung function. The team found that compared with patients who do not use either medication, those using either of these bronchodilators face a notably higher risk for experiencing a cardiac event, such as heart attack or heart failure. "The bad news is that, although everybody's different, there's a chance that by using these long-acting bronchodilators you may have a mild to moderate risk for cardiovascular problems," said study lead author Dr. Andrea Gershon, a scientist and respirologist in the department of medicine at Sunnybrook Health Sciences Center in Toronto. "The good news is that each of the medications we looked at can also help you if you have COPD." Gershon said she wouldn't recommend a medication if she didn't think that the benefits outweighed the risks. "And I do. But at the same time I feel the choice has to be made on an individual basis," she said. "And there's an obligation to inform our patients that the risk is there, based on the best evidence we have available, which is this study." The investigators found that during the study time frame, 28 percent of the patients experienced a cardiovascular "event" that resulted in their being taken to an emergency department and/or being hospitalized. Both long-acting medications were linked to a higher risk for experiencing events such as a heart attack or heart failure. Neither drug was linked, however, to a boost in the risk for an irregular heart rhythm or stroke. (Use of anticholinergics appeared to offer a measure of protection against ischemic stroke among newly prescribed users, something not found among beta-agonist users.) In sum, the authors said the findings indicated that all COPD patients using either type of medication need to be closely monitored for signs of related heart trouble.
"The thing is that we tend to treat diseases as if they're each in a silo," said Gershon, "but in reality they all interact with one another. People with COPD have a number of co-morbidities [or co-existing conditions]. And cardiovascular disease is one of the major ones. So questions regarding risk of this kind are very important for this type of patient population."

For more information:  http://www.nlm.nih.gov/medlineplus/news/fullstory_137012.html


COPD World News Week of May 12, 2013

E-cigarettes primarily used to quit tobacco

New York, NY - Although the long-term health effects of electronic cigarettes are unknown, a new survey finds people who use the devices think of them as a safer alternative to tobacco and a means to break the smoking habit. Researchers from the UK surveyed about 1,400 e-cigarette users on the Internet, 76 percent of whom said they started using their devices to replace cigarettes entirely. A much smaller percentage said their goal was to quit smoking or to improve their health. One researcher who has studied e-cigarette users said the findings allay fears that people are using the devices to get more nicotine on top of what's already in tobacco cigarettes, instead of for smoking cessation. "This study really indicates people are using them specifically to try to quit smoking or try to get off cigarettes. This dual-use idea is simply not a tenable idea anymore," said Boston University's Dr. Michael Siegel, who was not involved in the new research. E-cigarettes were first introduced in China in 2004. The battery-powered devices let users inhale nicotine-infused vapors, which don't contain the harmful tar and carbon monoxide in tobacco smoke. Lynne Dawkins and her colleagues from the University of East London write in the journal Addiction that there are currently over 100 brands of e-cigarettes, and 3.5 million devices were sold in 2012. Despite the devices' growing popularity, the researchers say, little is known about who uses e-cigarettes and why. For the new study, they created an Internet survey that was accessible from the websites of two e-cigarette manufacturers from September 2011 to May 2012. The survey took about 15 to 20 minutes to complete. Overall, 1,123 ex-smokers and 218 current smokers from 33 different countries took the survey. About 16 percent of participants were from the U.S. and another 77 percent were from Europe. Seventy percent were men. About three quarters of respondents said they started using e-cigarettes as a "complete alternative to smoking," and 22 percent said they started using the devices for "other reasons" - including stopping smoking (7 percent), for health reasons (6 percent) and to get around smoking restrictions (3 percent). Some 86 percent said they had either not smoked cigarettes for several weeks or months since using the e-cigarette or that the amount they smoked had decreased dramatically. The researchers also found that the majority of people responding to the surveys felt their health had improved since using the devices. "Most people reported great health benefits. Their cough was reduced and their breathing was improved," said Dawkins, who added that the benefits are most likely from people smoking fewer cigarettes and not an effect of the devices or vapors. Still, Dawkins told Reuters Health that more research is needed on the long-term effects of e-cigarettes. Siegel said there's no question that e-cigarettes are safer than smoking, but there are concerns over some of the vapors' ingredients - including propylene glycol, which irritates airways, and formaldehyde, which is known to raise lung and nasal cancer risk when it's inhaled.

For more information:  http://www.nlm.nih.gov/medlineplus/news/fullstory_135604.html

COPD World News Week of May 5, 2013

Certain Steroids May Raise Risk of Dangerous Blood Clots

Aarhus, Netherlands - People who use drugs called glucocorticoids -- a class of steroids -- are at increased risk for blood clots in their veins, according to a new study. Glucocorticoids are anti-inflammatory drugs widely used to treat conditions such as chronic obstructive pulmonary disease. Researchers looked at data from nearly 39,000 people in Denmark who were diagnosed with blood clots between January 2005 and December 2011. The patients were classified as current, recent and former users of glucocorticoids. Current users were divided into new and continuing users. The study by Sigrun Johannesdottir, of Aarhus University Hospital, the Netherlands, and colleagues was published online in the Journal of Internal Medicine (JAMA). The use of glucocorticoids was associated with increased risk of blood clots in current, new, continuing and recent users of the drugs, but not former users, according to journal news release. While the study found an association between glucocorticoid use and blood clot risk, it did not prove cause-and-effect. Blood clots can be dangerous and potentially deadly if they break free and travel to areas such as the brain, heart and lungs.

For more information: http://www.nlm.nih.gov/medlineplus/news/fullstory_135460.html

COPD World News Week of April 28, 2013

Hiring Bans on Smokers Still Controversial

Philadelphia, PA - Healthcare facilities that won't hire smokers may produce better health outcomes overall, but do they challenge medicine's basic tenet to care for all individuals? That was the quandary posed by two opposing Perspective articles online in the New England Journal of Medicine. "It seems paradoxical for healthcare organizations that exist to care for the sick to refuse to employ smokers," wrote Harald Schmidt, PhD, of the University of Pennsylvania's Center for Health Incentives and Behavioral Economics, and colleagues. "Many patients are treated for illnesses to which their behavior has contributed, including chronic obstructive pulmonary disease, heart failure, diabetes, and infections spread through unprotected sex or other voluntary activities." "These policies engender controversy, and we recognize that they risk creating or perpetuating injustices," said David A. Asch, MD, also of the University of Pennsylvania, and colleagues. "However, these policies may also save lives, directly and through their potential effects on social norms." The University of Pennsylvania, where the lead authors of both articles are employed, recently announced that beginning July 1, it will no longer hire tobacco users to work in its health system. Both articles nod to the health and financial consequences of smoking: Asch and colleagues cite the 440,000 tobacco-related deaths annually that amount to more than those caused by HIV, illegal drug use, motor vehicle accidents, suicides, and murders combined. Schmidt and colleagues refer to the $4,000 that the average smoker creates in insurance and health-related costs each year. And both acknowledge that quitting addictive nicotine is difficult, citing the estimated 70% of smokers who say they want to quit versus the 2% to 3% who are successful.
But Asch and colleagues defend the hiring bans, citing Cleveland Clinic's pioneer ban that started in 2005: Smoking rates in the county where the clinic is located decreased from 20.7% in 2005 to 15% in 2009. By comparison, statewide smoking rates declined from 22.4% to 20.3. Saying that public health is a shared responsibility, Schmidt and co-authors noted that employers have an obligation to contribute to the public health mission promulgated by the Institute of Medicine: to fulfill "society's interest is assuring conditions in which people can be healthy." "By cherry-picking 'low-risk' employees and denying employment to smokers, employers neglect this obligation, risk hurting vulnerable groups, and behave unethically," they concluded.

For more information: http://www.medpagetoday.com/PrimaryCare/Smoking

Ontario government to cover new COPD drug

The Ontario government's drug coverage plan, the Ontario Drug Benefit (ODB) formulary has announced that it will include Onbrez Breezhaler 75mcg (Indacterol) for limited use criteria for patients with moderate to severe COPD with persistent respiratory symptoms despite an adequate trial of, or intolerance to, a regularly scheduled short-acting bronchodilator AND a long-acting anticholinergic. This is good news for those COPD patients who are covered by the formulary as it will add to the treatment options currently available. Coverage is effective April 30th - the link to the OBD formulary follows (see page 3 for details):

http://www.health.gov.on.ca/en/pro/programs/drugs/formulary/41_update_at_20130419.pdf
 

COPD World News Week of April 21, 2013

Smoke's Genetic Impact Lingers

Bethesda, Maryland - Smoking is linked to gene expression changes, some of which appear to persist after quitting, researchers found. More than 100 genes were expressed significantly differently in smokers than in non-smokers across two large population-based studies, Roby Joehanes, PhD, of the National Institutes of Health in Bethesda, Md., and colleagues showed. "These genes were associated with many pathways, including immune response, response to stress, blood coagulation, platelet activation, and apoptosis," the group noted. Three of these genes showed up as differentially expressed in former smokers as well, they reported at the American Heart Association's Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism meeting in New Orleans. Some of the pathways were expected, while others appeared novel, the organization's president, Donna Arnett, PhD, MSPH, noted, an epidemiologist specializing in cardiovascular genetics at the University of Alabama at Birmingham. "We've known for a long time that smoking increases the risk of cardiovascular disease, particularly myocardial infarction. We've also known for long time that it is associated with increased coagulation disorders and platelet aggregation," she told MedPage Today. "The study is showing that also includes genes involved in immune response and in response to stress, which is new. Apoptosis is also a new pathway." Joehanes's group first compared whole-blood gene expression among 2,446 participants in the Framingham Heart Study after adjusting for sex, age, and family relationships within the cohort. Self-reported smoking status across 37 years of observation in the study indicated that most used to smoke (1,460) but relatively few still did (204). Another 782 never smoked. In that cohort, 1,602 genes were expressed significantly different between current and never smokers. Among those differentially expressed genes, 112 again were associated with smoking in a replication analysis of the San Antonio Family Heart Study. Replication in a second population adds confidence to the findings, but the single observation is a limitation, Arnett noted. Without comparing individual before and after smoking initiation, the study couldn't draw causal conclusions. "There could be other factors associated with smoking that could also explain the results," she pointed out.

For more information: http://www.medpagetoday.com/Cardiology/Prevention

COPD World News Week of April 14, 2013

Same CVD Risk When Former Smokers Gain Weight

Lausanne, Switzerland - Weight gained after someone quits smoking has no effect on the cardiovascular benefits of butting out, at least among people without diabetes, researchers reported. In a prospective community-based cohort with more than 20 years of data, former smokers had about half the risk of developing cardiovascular disease as smokers, according to Carole Clair, MD, of the University of Lausanne in Lausanne, Switzerland, and colleagues. But adjusting those estimates for weight gained after stopping smoking had no significant effect, Clair and colleagues reported. The results, strictly speaking, apply only to participants without diabetes, Clair and colleagues reported, but estimates were similar among those with diabetes, although they did not reach statistical significance. They concluded that the findings support "a net cardiovascular benefit of smoking cessation, despite subsequent weight gain." Indeed, "overall, the study supports the belief that smoking cessation is beneficial for smokers," commented Michael Fiore, MD, and Timothy Baker, PhD, both of the University of Wisconsin School of Medicine and Public Health in Madison. And importantly, they argued in an accompanying editorial, "no subpopulation has yet been identified that shows significantly reduced benefit from quitting, let alone harm." Clinicians, they concluded, can use the study to reassure smokers that any weight gain won't take away the cardiovascular benefits of quitting tobacco. Although the knowledge may not assuage concerns about appearance, Fiore and Baker argued, it still might help tip the balance. The researchers cautioned that they did not use biochemical measures to verify smoking status. In addition, the participants were mostly white, so it's not clear how widely the findings apply.

For more information: http://www.medpagetoday.com/PrimaryCare/Smoking

COPD World News Week of April 7, 2013

Antibiotic Linked to Heart Problems in COPD Patients

Dundee City, UK - A widely used antibiotic may increase the risk of heart problems in patients with lung conditions, according to a new study. The antibiotic clarithromycin is commonly used to treat lower respiratory infections such as pneumonia and sudden worsening of chronic obstructive pulmonary disease (COPD). Previous research has suggested that the use of clarithromycin may increase the risk of heart problems such as heart failure, heart rhythm disorders and sudden cardiac death. In this study, British researchers looked at data from about 1,300 patients with sudden worsening of COPD and about 1,600 patients with pneumonia. They found that 26 percent of the COPD patients who received clarithromycin experienced at least one heart problem over the next year, compared with 18 percent of those who were not given the antibiotic. Twelve percent of pneumonia patients who received clarithromycin experienced at least one heart problem during the next year, compared with 7 percent of those who were not given the antibiotic, according to the study by James Chalmers of the University of Dundee, in Scotland, and colleagues. The findings were published online March 21 in the journal BMJ. In COPD patients, there was a significant association between the use of clarithromycin and death from heart-related problems. This association was not seen in pneumonia patients, according to a journal news release. The longer patients with COPD or pneumonia used clarithromycin, the greater their risk of more heart problems. This was not the case with other antibiotics, which suggests an effect specific to clarithromycin, according to the study authors. Overall, their findings suggest that there would be one additional heart problem for every eight COPD patients and every 11 pneumonia patients who receive clarithromycin, compared to patients who are not given the antibiotic. The results also suggest that the increased risk of heart problems may last after patients stop taking clarithromycin, possibly due to the effect that the antibiotic has on the inflammation process in patients with chronic lung conditions, the researchers said. They said their findings need to be confirmed before any changes in the treatment of COPD and pneumonia patients are made. Although the study showed a link between the use of clarithromycin and possible heart problems, it did not establish a cause-and-effect relationship.

For more information: http://www.nlm.nih.gov/medlineplus/news/fullstory_135193.html

COPD World News Week of March 31, 2013

Success in the Nation's First "Breathing Lung" Transplant at UCLA

Los Angeles, CA - 57 year-old Fernando Padilla, the first American participant in the INSPIRE lung transplant trial, is doing well after his November 2012 surgery. Transplant patients can breathe easy. A new organ preservation device called the Organ Care System™, or OCS, is now being tested at medical centers in the U.S. and Europe, with the prospect of increasing the number of donated organs that survive to be transplanted. Fernando Padilla had pulmonary fibrosis, a condition that causes scarring of the lungs, making it difficult to breathe and hard to get enough oxygen into his blood. Now, four months after receiving his new "breathing lungs," he is able to walk several miles a day and enjoy life with his family again. The OSC LUNG machine offers a promising alternative to traditional organ preservation. For the past 30 years, the standard method has been to preserve organs in an icebox. The problem is that once the lungs are removed from the donor’s body, the tissue can quickly die. With OCS, donated lungs are transported in a near lifelike state outside the body. The OSC machine simulates breathing and infuses the lungs with oxygen and red blood cells immediately after harvest from the donor. Dr. Abbas Ardehali is the director of the heart, lung, and heart-lung transplantation programs at Ronald Reagan UCLA Medical Center, and leads the U.S. arm of the INSPIRE study to evaluate the effectiveness of OCS. He says OCS may expand the window of time in which a donated organ can be used, improve patient health outcomes, and help more patients who are on waiting lists secure an organ. Ardehali stresses the importance of the time factor. “Lungs preserved on ice can be subject to significant injury,” he says. “We are working against the clock. Once we’re beyond eight hours, the organ is often no longer viable.” OCS may expand that window of time to as much as 18 to 24 hours. This will allow organs to be transported across greater distances, and will give transplant teams more time to clean and treat the lungs prior to surgery, which may improve patient outcomes. “Patients with chronic lung disease now die on the waiting list because there are not enough useable organs available,” Ardehali says. “The most exciting prospect of this technology is that it may expand the number of useable organs and help us save more lives. The INSPIRE study will evaluate the success of lung preservation using the Organ Care System™ developed by TransMedics.

For more information: http://www.clinicaltrials.gov using identifier: NCT01630434.

COPD World News Week of March 24, 2013

Secondhand smoke riskier than cholesterol

New York, NY - The risk of clogged arteries is greater from secondhand smoke than from several well-known heart disease risk factors, including high cholesterol, researchers found. The overall prevalence of coronary artery plaque in those exposed to secondhand smoke was 24%, which rose to 26% in those with the highest exposure compared with 19% for the general public, Harvey S. Hecht, MD, of Mount Sinai Medical Center in New York City, and colleagues reported online in JACC: Cardiovascular Imaging. Those with the highest amount of exposure to passive smoke were 90% more likely to have coronary plaque compared with the general public. Even after adjusting for other cardiovascular risk factors, the odds associated with developing coronary disease from secondhand smoke were greater than from other well-established danger signs. Although previous studies have shown a marked increase in cardiac events related to secondhand smoke, the authors said this study is the first to demonstrate a clear dose-response relationship between secondhand smoke exposure and the earliest detectable signs of heart disease. "This research provides additional evidence that secondhand smoke is harmful and may be even more dangerous than we previously thought," Hecht said in a statement. He also said that inquiring about secondhand smoke exposure should be part of every routine exam. The study was limited by the nature of self-reported data and being retrospective.

For more information: http://www.medpagetoday.com/Cardiology

COPD World News Week of March 17, 2013

One in four Ontario hospital visits treats disease caused by smoking

Toronto, ON - Chronic obstructive pulmonary disease (COPD) is placing a huge burden on emergency rooms, an Ontario study has found. A quarter of all hospital visits in Ontario are made by patients with a condition linked to smoking, a new study has found. Ontarians who have chronic obstructive pulmonary disease (COPD) — about 11 per cent of the population — account for one in four of all hospital and emergency room visits, according to the study, reported in the Toronto Star. The Toronto-based Institute for Clinical Evaluative Sciences  found in smokers older than 35, COPD often is a terminal disease that only gets worse with age. In the short term, a person with COPD suffers from shortness of breath, wheezing and coughing. Long term, it can lead to heart and lung diseases. Respirologist Andrea S. Gershon spent the last year poring over every single medical file belonging to the province’s 853,438 COPD patients. Alongside her team of four other doctors, Gershon discovered that patients with the disease are clogging up hospital waiting rooms. “What we found is that it really has a huge burden on these emergency departments. They aren’t just for COPD; they’re for a lot of different things caused by COPD: shortness of breath, coughing up stuff, wheezing. They might be tired, have decreased exercise tolerance and sometimes they need oxygen,” Gershon said. COPD remains the fourth leading cause of death in Canada, but it receives less money and attention than conditions like cancer and heart disease. Some doctors claim the reason is that COPD has been labelled a “smoker’s disease.” Because of this stigma, Gershon insisted her study shouldn’t be used to add blame to smokers — it only perpetuates the problem. “Accusing them stops us from treating this seriously because we just blame the patient. And if one quarter (of visits) are made by people with COPD, we need to do something about it rather than blame them and call them victims of their own fate,” she said. Instead, Gershon said Ontario needs programs that teach patients how to deal with the disease at home. These could include on-call nurses, medications and oxygen tanks inside a patient’s home. “There are diabetes programs out there. There are heart programs out there — they can go see nurses or nutritionists. There’s nothing like that for COPD,” she said. “We need respiratory educators teaching people with COPD how to handle their disease at home so they don’t have to end up in ER.” The study also revealed that people with COPD have a 63 per cent higher rate of hospitalization than Ontarians without the disease. In addition, 35 per cent of people in Ontario nursing homes and retirement homes are diagnosed with COPD. Gershon’s study was the first of its kind because it analyzed each and every COPD file in the province.

For more information: http://tinyurl.com/c38w9rw

COPD World News Week of March 10, 2013

More Evidence That Smoking Raises Breast Cancer Risk

Atlanta, GA - Cigarette smoking appears to increase the risk of breast cancer, especially when women start smoking early in life, new research indicates. For years, experts have questioned whether cigarette smoking is directly linked with breast cancer risk or whether the association is complicated by the fact that many women who smoke also drink alcohol, which has also been tied to breast cancer risk. Studies have produced conflicting results. When the U.S. Surgeon General last reviewed the issue in 2004, the report concluded that there was no cause-and-effect relationship between smoking and breast cancer risk. Now, however, researchers who took another look, analyzing data from more than 73,000 women, have found strong evidence for a link between cigarette smoking and breast cancer. "It's not just a relationship between alcohol and breast cancer, but in fact smoking by itself is related to breast cancer," said Mia Gaudet, director of genetic epidemiology at the American Cancer Society. She led the study, which was published online Feb. 28 in the Journal of the National Cancer Institute. The timing of the smoking appears to affect the degree of risk, she said. "It seems that women who start smoking before their first birth are at greatest risk of breast cancer," Gaudet said. The researchers looked at data from women enrolled in a large, long-term cancer society study involving lifestyle factors and prevention. Over the follow-up of nearly 14 years, more than 3,700 cases of invasive breast cancer were found. When the women entered the study in 1992, they were aged 50 to 74. They supplied information on smoking habits, past and present. At the start, about 8 percent smoked, about 36 percent had quit and about 56 percent never smoked. The incidence of invasive breast cancer was 24 percent higher in current smokers and 13 percent higher in former smokers, compared to never smokers, the researchers found. The researchers next focused on the timing of the smoking. "Women who started smoking before their first menstrual period were 61 percent more likely [to get breast cancer than non-smokers]," Gaudet said. Women who took up the smoking habit after their period had started but 11 or more years before giving birth were at a 45 percent higher risk, compared to non-smokers. To analyze whether the cigarette smoking by itself -- not the combination of drinking and smoking -- affects breast cancer risk, Gaudet first looked at both smoking and drinking in the same model. ''It showed that the relationship still existed between smoking and breast cancer," she said. Next, she looked separately at the groups of drinkers --never, former and current -- and analyzed their risk of breast cancer. For the never drinkers, smoking now or in the past was not linked with breast cancer risk. Ideally, she said, all three groups would have a similar risk to prove smoking by itself is a risk factor. However, she acknowledged, "We did not see that." Gaudet said she is not sure why that was, but that there may be something about the combination of smoking and drinking that affects breast cancer risk. "Or the numbers [of women] may be too small to show an accurate result." Even so, she said, the new research suggests that smoking by itself drives up breast cancer risk. The researchers found a link or association, but cannot prove cause and effect. One cancer expert praised the study. "This paper is another important step toward the conclusion that smoking is a risk factor [for breast cancer] on its own," said James Lacey, an associate professor of cancer etiology at the City of Hope Comprehensive Cancer Center in Duarte, Calif. He was not involved with the research. One interesting finding, he said, is that the window before a woman has children seems to be the period of most concentrated increased risk. "It should allow our lab colleagues to look more closely at this window," Lacey said. Among the questions to be answered, he said, is this: "Is the smoking making the tissue more susceptible to other cancer-causing agents or is it starting the cancer in the breast?" Gaudet said that experts think breast tissue is more susceptible to toxic exposures before a woman gives birth the first time compared to after. The study finding, Gaudet said, ''provides additional motivation for young women who are thinking of starting to smoke not to." Those who smoked while young and gave up the habit still had a higher risk of breast cancer, she said, than never smokers.

For more information: http://www.nlm.nih.gov/medlineplus/news/fullstory_134477.html 

COPD World News Week of March 3, 2013

Drinking can derail women's efforts to quit smoking

Houston, TX - You're sharing a bottle of wine at a party or sipping a margarita at the bar when you feel a strong urge for a cigarette -- even though you've quit smoking. Unfortunately, willpower is all too weak in these situations, new research suggests. Women trying to stop smoking may at greater risk for relapse if they drink alcohol, according to the study from the University of Texas School of Public Health. Researchers found that women who drink to cope with the stress of trying to kick the habit may actually trigger more intense urges to smoke. Awareness of this effect may spur strategies to help drinkers tempted to return to tobacco. "Identification of situations that increase the risk for relapse will aid in the development of novel interventions that can address these situations in the moment of occurrence," Michael Businelle, an assistant professor and study co-author, said in a UT news release. The researchers tracked the smoking urges of 302 Seattle women aged 18 to 70 who were in the process of giving up smoking. The study focused on women because they have more difficulty quitting. The women used hand-held computers to record their urges to smoke throughout the day. Participants also completed an assessment of each smoking urge they experienced. On days when the women drank alcohol, their smoking urges were different. "Interestingly, these higher, more volatile smoking urges were reported before the individual actually began drinking, suggesting that alcohol consumption may have been in re sponse to smoking urges rather than vice versa," Businelle noted. Women also were more likely to drink alcohol if they woke up with a strong urge to smoke. This suggests that women trying to stop smoking may turn to alcohol to ease the stress of trying to quit, the researcher say. However, since drinking actually triggers more intense urges to smoke, it could increase women's risk of relapse, study authors concluded. Smoking-related illnesses are the leading cause of preventable deaths in the United States, claiming more than 1,200 lives daily, the release noted.

For more information: http://www.nlm.nih.gov/medlineplus/news/fullstory_134073.html

COPD World News Week of February 24, 2013

Researchers identify substance to stimulate growth of air sacs in the lungs

Baltimore, MD - Researchers have identified a naturally occurring substance, known as a growth factor, which could help stimulate growth of the air sacs (alveoli) in the lungs. The scientists believe that their findings could lead to new treatments to regrow the alveoli, which are often damaged in people with chronic obstructive pulmonary disease (COPD). The study, published in the journal PLOS Genetics¸ investigated a growth factor called hepatocyte growth factor (HGF). They looked at the effects of the substance on mice with COPD. Half of the mice received HGF and the other half of the group received a fake treatment, called a placebo. The results showed that the mice receiving HGF had a 17% improvement in the size of their alveoli, compared to those that received the placebo. The HGF also offered a protective effect, preventing any further damage or destruction to the alveoli. The researchers believe their study is an important demonstration that a growth factor can be used as an effective treatment for COPD. In a study of mice, researchers at Johns Hopkins have identified a new molecular pathway involved in the growth of tiny air sacs called alveoli that are crucial for breathing. The scientists say their experiments may lead to the first successful treatments to regrow the air sacs in people who suffer from diseases such as emphysema in which the air sacs have been destroyed by years of smoking. The work may also suggest new therapy for premature infants born before their lungs are fully developed. "One of the most daunting challenges we face as physicians is helping patients with chronic obstructive pulmonary disease, such as emphysema, who have lost alveoli that are so crucial for lung function," says Enid Neptune, M.D., associate professor of pulmonary and critical care medicine at the Johns Hopkins University School of Medicine. "Once those tiny air sacs are destroyed, there are no effective treatments to bring them back." Neptune is the senior author of a study described in an article in PLOS Genetics in which the researchers used hepatocyte growth factor (HGF) to regrow alveoli and restore lung structure in mice genetically engineered to develop a human-like form of emphysema. Theirs is believed to be the first study using HGF in mice with established emphysema. Growth factors, such as HGF, have been used to promote wound healing. Neptune says previous studies had shown that HGF had a role in the functioning of alveoli, which enable lungs to exchange oxygen and carbon dioxide and send oxygen into the bloodstream to nourish organs throughout the body. Reduction in the number or quality of the sacs seriously compromises breathing. Even though they cannot be seen by the naked eye, tiny, spherical alveoli are covered with thin walls and have a blood supply. The researchers conducted experiments in mice with a genetically induced form of emphysema to see if HGF could stimulate the formation of alveoli. One experiment involved adult mice with genetically induced emphysema. Half of the mice received HGF, delivered under the skin using a special pump for two weeks. The other half of the group received a placebo - not the HGF. Another group of mice with healthy lungs, the "control" group, was divided in half to receive either HGF or a placebo. "We found that the mice with emphysema, when given the HGF, developed a 17 percent improvement in the size of their air sacs compared to placebo-treated mice, consistent with improved lung structure and function. The HGF also was protective, preventing destruction of the alveoli by reducing the oxidative stress that contributes to lung injury," says Neptune. "In essence, the HGF was able to block a major enemy of the functioning alveoli." In addition, the healthy mice that received HGF showed no difference in alveolar size. The mice with emphysema that were treated with a placebo did not show any improvement.

For more information: http://www.medicalnewstoday.com/releases/256431.php

COPD World News Week of February 17, 2013

Lungs from heavy smokers OK for transplant

Philadelphia, PA - Lungs of heavy smokers can be donated safely for use in adult double-lung transplants, but recipients need to know the source of the potential transplant, researchers in a new study say. Researchers from Temple University in Philadelphia found that lungs from carefully selected donors who smoked at least a pack a day for more than 20 years may be used in certain transplant situations without affecting recipients' survival rates or deaths from lung cancer. The study authors said the use of lungs donated by heavy smokers could help more patients get the life-saving double-lung transplant they need. "Our findings demonstrate that the current criteria for lung transplantation can potentially be revised to include donors with a heavy smoking history," Dr. Sharven Taghavi, from Temple University Hospital, said in a news release from the Society of Thoracic Surgeons. "This may help decrease the shortage of donor lungs and decrease waiting list mortality." "For example, a surgeon may choose to transplant lungs from a healthy donor who has good lung function despite heavy smoking, or lungs may be accepted from a less-than-ideal donor for a very sick patient," Taghavi said. In conducting the study, the researchers examined data from the United Network for Organ Sharing on 5,900 people who received a double-lung transplant between 2005 and 2011. Of these patients, 13 percent received lungs donated by a heavy smoker. The study found that patients who received carefully screened lungs from donors who smoked had short- and medium-term survival rates similar to those who got lungs from people who didn't smoke. The researchers added that the lung function of the patients who received lungs from heavy smokers was not worse and there was no difference in deaths from cancer. The study's authors noted, however, that lungs from heavy smokers must be examined closely to ensure they are free of cancer and other disease. Dr. Yoshiya Toyoda, also from Temple, said the smoking history of the patients providing the lungs might not always be accurate. "Lungs from heavy smokers must be carefully evaluated," Toyoda said in the news release. "We recommend a CT scan for evidence of tumors and emphysema in addition to routine assessment including blood gas, bronchoscopy and visual inspection." Toyoda also said potential recipients of lungs from heavy smokers must be made aware of the possible higher risk of developing lung cancer. The U.S. National Heart, Lung, and Blood Institute reports that every year only 50 percent of people who need a double-lung transplant will actually get one. Complicating matters, double-lung transplants now outnumber single-lung transplants. More than 1,600 people were on the Organ Procurement and Transplantation Network waiting list for a lung transplant at the end of 2012, the study authors said. The study was to be presented Tuesday at the annual meeting of the Society of Thoracic Surgeons in Los Angeles. Research presented at medical meetings is considered preliminary because it hasn't been subjected to the same scrutiny as studies published in peer-reviewed publications.

For more information: http://www.nlm.nih.gov/medlineplus/news/fullstory_133520.html

COPD World News Week of February 10, 2013

Smokers Light Up Even in Hospital

San Francisco, CA - Nearly one in five smokers continued to light up while hospitalized, an observational study in a large urban hospital revealed. Overall, 18.4% (95% CI 16.8 to 20) of patients who smoked before admission also reported cigarette use during their inpatient stay, despite the fact that almost two-thirds were given nicotine patches, according to Susan Regan, PhD, of Harvard Medical School in Boston, and colleagues. This represented a decline from 25% of inpatients who smoked during hospitalization a decade earlier, the researchers noted online in Archives of Internal Medicine. In an invited commentary, Steven Schroeder, MD, of the University of California San Francisco, wrote, "like other aspects of tobacco control, this study shows us how far we have come and how much more needs to be done." Hospitals today are required to be smoke-free in order to maintain accreditation, but many permit smoking outdoors by patients, employees, and visitors. The negative consequences of permitting smoking on hospital grounds include exposure of patients to cold and wet weather, their lack of availability for necessary treatments, and medical compromise such as delays in wound healing. To determine the effects of efforts by public health authorities and policy-makers to limit tobacco use in and around medical centers, Regan and colleagues surveyed 5,399 patients admitted to Massachusetts General Hospital in Boston, a 900-bed teaching hospital, between 2007 and 2010. The hospital has a program in place that provides cessation counseling and nicotine replacement therapy to smokers. Smoking was self-reported at the time of counseling and then 2 weeks after discharge. Most of the participants were men (58%) with a mean age of 53, and an average length of hospital stay of 5 days. Most reported smoking about a pack a day. The median time when patients were seen by tobacco counselors was on day three, at which time 14.9% had already smoked between admission and the counselor's visit. This early return to smoking was more frequent among patients who reported typically smoking more than 10 cigarettes per day, with an adjusted relative risk of 1.43 and among those who rated their nicotine cravings as severe. Some of the decline in smoking during hospitalization since the earlier survey may be explained by the much more frequent use of nicotine replacement, according to the researchers. However, this did not entirely prevent smoking, and for heavy smokers or those with long stays the dose may need to be increased, they suggested. Routinely asking patients about their cravings throughout their admission might also help, they added. Additional measures that could be taken include extending the ban on smoking to all outdoor areas surrounding the hospital and instituting policies not permitting patients to leave the hospital building.

For more information: http://www.medpagetoday.com/PrimaryCare/Smoking

COPD World News Week of February 3, 2013

PEI expands provincial drug formulary

Charlottetown, PEI - New medications have been added to Prince Edward Island ‘s drug formulary, effective January 21, 2013, says Health and Wellness Minister Doug Currie. “These medications will support hundreds of Islanders facing various health conditions, including asthma, AIDS, rosacea, cancer, chronic obstructive pulmonary disease and overactive bladder,” said Minister Currie. “By adding drugs to our formulary, we are giving Islanders more choice and lessening the burden of prescription drug costs for patients and their families.” The province is adding coverage of ten medications to the provincial drug programs. Patients must meet both the clinical and program criteria to be eligible for coverage. Of the ten medications, one falls under the high-cost drug category, Votrient, for Islanders facing advanced renal cell carcinoma, a type of kidney cancer. Coverage of the following medications will be provided to patients who meet established clinical criteria and who qualify through the Family Health Benefit, Financial Assistance / Children-In-Care, Nursing Home, and Senior’s Drug Cost Assistance Programs. People with COPD should be pleased that one of the new drugs is Onbrez, specifically for the treatment of chronic obstructive pulmonary disease. “Today’s announcement builds on the ongoing progress Government has been making since 2007 to improve the quality of health care in Prince Edward Island,” said Minister Currie. “Since 2007, Government has increased spending on drug programs by 42%, to a total of $33.4 million this fiscal year. This is great news, but we know that there is still more work to be done and our department will continue working to provide Islanders quality, accessible health care services.” The increase in drug program spending this year is partially a result of the fair drug pricing reform implemented in summer 2012.

For more information: http:www.healthpei.ca/drugprograms

COPD World News Week of January 27, 2013

Heavy Smoking May Raise Odds for Lethal Bladder Cancer

Miami, FL - Heavy smokers are more likely to develop aggressive and deadly bladder cancers than those who smoke less or non-smokers, new research shows. Smoking is one of the most common causes of bladder cancer, but it hasn't been known how it affects the progress of the disease. In this study, researchers looked at data from 212 bladder cancer patients in Los Angeles County, in California. Patients who were heavier smokers were more likely to have deadly bladder cancer than those who were lighter smokers or those who never smoked. The study also identified changes in certain proteins that are often present in lethal bladder cancer. Patients with changes in six to nine proteins fared badly, which suggests that they could have benefited from more aggressive treatment. The greater the number of changes in these proteins, the worse a patient's outcome, according to the study published online Jan. 14 in the journal Cancer. Although the study tied heavier smoking to higher death risk from bladder cancer, it did not establish a cause-and-effect relationship. The findings are important because bladder cancer is one of the most expensive types of cancer to treat, study co-author Dr. Richard Cote, of the University of Miami Miller School of Medicine, said in a journal news release. He said treatment tailored to individual bladder cancer patients is "urgently needed."

For more information: http://www.nlm.nih.gov/medlineplus/news/fullstory_133056.html

COPD World News Week of January 20, 2013

Mood drug no help for smoking cessation 

New York, NY - The addition of the antidepressant nortriptyline to conventional smoking cessation therapy didn't improve the chances of long-term success among male prisoners, Australian researchers have found. Depression and other mental illnesses raise the likelihood of smoking, and quitting can depress a person's mood - which in turn can make it harder to quit. Studies have shown that antidepressants, including nortriptyline, can improve the success of smoking cessation efforts. And prison inmates are notoriously heavy smokers, with higher rates of depression and other mental illness than the general population. But the new study found that nortriptyline (marketed as Aventyl) - which is not FDA-approved for smoking cessation but often is used for that purpose - did not seem to help inmate smokers stay tobacco-free over time. Compliance with the therapy appeared to a significant issue, however, said Robyn Richmond, a public health researcher at the University of New South Wales, in Kensington, who led the study. Prisoners who were faithful to the treatment as ordered at least three-quarters of the time were much more likely to break their smoking habit than those who could not stick to the regimen, Richmond told Reuters Health. Another factor, Richmond added, was that the prison population in the study tended to migrate, making follow-up of the participants difficult. "One thinks that you have a captive audience" in prison studies, she said. "However, half of the prisoners were either transferred to another prison within the study or released into the community."  The study, which appears in the journal Addiction, included 425 male inmates from prisons across Australia. All were smokers, with a habit lasting on average 20 years and more than 23 cigarettes a day.  Nearly three-quarters of the inmates in the study had tried to quit in the previous year, according to the researchers. All of the prisoners in the study received 10 weeks of smoking cessation therapy consisting of nicotine patches and two sessions of behavioral counseling. To that was added either a dummy pill or nortriptyline. The researchers recorded the inmates' tobacco use at three, six and 12 months after the end of treatment, relying on self-reporting and direct measurements of exhaled carbon monoxide, a by-product of smoking. At the three-month mark, about one-quarter of prisoners who had received the antidepressant had managed to stay off smoking continuously, compared with 16 percent of those who had not taken the drug. But by the one year mark, the abstinence rate had fallen to about 11 percent for both groups. Psychologist Karen Cropsey, a smoking researcher at the University of Alabama at Birmingham, said most jails and prisons in the United States have significantly restricted tobacco use by inmates. Roughly half of prisons, and many jails, now ban smoking completely, she said, while facilities that permit it typically require inmates to go outside to smoke. Cropsey, who has studied tobacco use by female inmates, said the latest work is the first to look at smoking by male inmates.

For more information: http://www.nlm.nih.gov/medlineplus/news/fullstory_132704.html 

COPD World News Week of January 13, 2013

Old Smokers May Benefit from CT Screening

Atlanta, GA - Annual low-dose CT screening for lung cancer is appropriate for older smokers and can be recommended for those who meet certain criteria, according to a new guideline from the American Cancer Society. The weight of the evidence, particularly the results of the National Lung Screening Trial (NLST), favors screening for patients ages 55 to 74 who have at least a 30-pack-year smoking history and still smoke or have quit within the last 15 years, according to the guideline. But screening should be done at a facility experienced in lung cancer screening, and clinicians need to have a detailed conversation with patients about the risks, benefits, and limitations of screening, making them aware of the risk of false-positives and the likely need for additional invasive testing. "We're placing a strong impetus on the importance of individuals having conversations with their doctors," said Robert Smith, PhD, director of cancer screening at the ACS and professor of epidemiology at Emory University. The guidance was published online in CA: A Cancer Journal for Clinicians. An earlier review of evidence upon which the guidance is based was done in conjunction with several other groups, including the American College of Chest Physicians, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network. Many of those groups have issued their own recommendations based on the same evidence review, and are thus largely the same as the one now being issued by the ACS. The NLST found a 20% reduction in lung cancer death for high-risk patients who had annual screening with low-dose CT compared with screening chest x-rays. In combination with previous trials -- the earlier evidence review included eight trials, three of which reported mortality -- cancer experts have come to the conclusion that there's "sufficient evidence to support screening." Among the benefits that should be discussed with patients prior to screening are the mortality reduction, but it should also be noted that screening won't detect all lung cancers and not all patients who have a lesion detected on CT will escape death from lung cancer, Smith and colleagues wrote. Harms include the fact that there is a "significant" chance of false-positive results, which requires additional testing and sometimes an invasive procedure, and can cause anxiety. There's also exposure to radiation from repeated tests, they noted. . In a statement, the American College of Radiology said "screening is appropriate when performed in the context of careful patient selection and follow-up. We urge patience and support while the guidelines and standards infrastructure to create a safe, sustainable, and effective lung cancer screening program are created and put in place."

For more information: http://www.medpagetoday.com/HematologyOncology/LungCancer 

COPD World News Week of January 6, 2013

COPD awareness returns to 2008 levels

Bethesda, Maryland - Physicians note that a major barrier to diagnosis is under-reported symptoms. Awareness of chronic obstructive pulmonary disease (COPD) has been rising gradually in recent years, but the results of a national survey show current awareness levels have returned to those of 2008. The survey was released today by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. Sixty-five percent of adults reported that they have heard of COPD, compared to 71 percent in 2011. Among people most at risk for COPD, awareness stood at 74 percent for current smokers and 73 percent for former smokers; in 2011 these values were 78 percent and 76 percent, respectively. COPD, which in 2010 surpassed stroke to become the third leading cause of death in the United States, is a serious and progressive lung disease that makes breathing difficult and can affect quality of life. COPD, includes conditions such as emphysema and chronic bronchitis, and has been diagnosed in an estimated 12 million men and women in the United States, with just as many more likely remaining undiagnosed. "Although these current numbers do not indicate a trend, we are concerned that the awareness level has not continued to increase. We plan to use this as an opportunity to mobilize and re-energize our efforts." said James P. Kiley, Ph.D., director of the NHLBI Division of Lung Diseases. "COPD is the only major chronic disease where deaths are not decreasing, which makes it critical for people to understand whether they are at risk for it and recognize its symptoms as early as possible. COPD can be treated — but the challenge is that more than 1 in 3 Americans do not know what it is or what its health outcomes are." Kiley noted that the NHLBI plans to engage more with COPD patients, caregivers, and members of advocacy organizations including the American Lung Association and COPD Foundation, and medical societies like the American Thoracic Society. The NHLBI will also work with partners through the COPD Learn More Breathe Better campaign to expand mobilization of local COPD coalitions and state COPD task forces to enhance message penetration and activation at the community level. In 2007, the NHLBI along with leading professional societies, health organizations, and advocacy groups, launched the COPD Learn More Breathe Better campaign to raise public awareness and understanding of COPD. The campaign encourages people at risk for COPD to get a simple diagnostic breathing test and talk to their health care provider about selection of treatment options; the campaign also encourages those diagnosed with COPD to take personal ownership of and responsibility for their overall care and treatment plans. COPD develops slowly, and its symptoms — which can include shortness of breath, chronic coughing or wheezing, production of excess sputum, or a feeling of being unable to take a deep breath — are often mistaken for a consequence of aging or being out of shape. Therefore, many people dismiss their symptoms early on and delay seeking diagnosis and treatment until the disease is in its late stages. According to the results of a parallel survey of health care providers, 48 percent of primary care physicians say that one of the biggest barriers to diagnosing COPD is that patients do not fully report these kinds of symptoms. "Early diagnosis and treatment can go a long way toward improving quality of life for those with COPD, but the first step to breathing better is reporting symptoms to a health care provider," said Kiley. "That’s why it is so vital that we do more to not only raise awareness of COPD, but also increase public understanding of how COPD can affect daily life."

For more information: http://www.nih.gov/news/health/nov2012/nhlbi-20.htm