COPD World News Week of December 28, 2014

Cheap Natural Compound May Help Smokers Quit

Auckland, NZ - The naturally occurring plant compound cytisine may be more effective than nicotine replacement therapy in helping smokers quit, a new study suggests. Cytisine, an acid-like chemical found in the seeds of the golden rain tree, has been used in Eastern Europe for decades to help smokers quit, researchers say. But it's not widely available. "Cytisine is one of the most affordable smoking cessation medicines available," said lead researcher Natalie Walker, an associate director of the Center for Addiction Research at the University of Auckland in New Zealand. "It is much cheaper than nicotine patches, gum and/or lozenges and other smoking cessation medicines," she said. "However, currently cytisine is only sold in a number of countries in Eastern and Central Europe. It is important that cytisine become more widely accessible and available." For the study, Walker and her colleagues randomly assigned more than 1,300 men and women who called a national smoking quit line in New Zealand to 25 days of treatment with cytisine or eight weeks of nicotine replacement therapy with patches, gum and/or lozenges. All participants also received telephone support. After a month, 40 percent of those taking cytisine pills said they hadn't smoked, compared with 31 percent of those who used nicotine replacement therapy, the researchers found.  Cytisine mimics nicotine so smokers get the same satisfaction as if they smoked, the experts said. "To the brain, cytisine looks a little like nicotine, and so it works to alleviate any urges to smoke and reduces the severity of nicotine withdrawal symptoms," Walker explained. "Plus, if you do smoke while using cytisine, it will be less satisfying -- making quitting easier," she said. Cytisine was more effective than nicotine replacement therapy in helping smokers stay off cigarettes in the first week, and after two and six months, the researchers found. However, cytisine can cause side effects, Walker said. "Three out of every 10 people who used cytisine had a side effect, compared to two out of every 10 that used nicotine patches, gum and/or lozenges," she said. The side effects didn't last long and weren't serious. "Some people felt nauseous or sick and some had sleep disturbances, such as bad dreams," Walker said. Dr. Nancy Rigotti, a professor of medicine at Harvard Medical School and author of an accompanying journal editorial, said she supports cytisine's use as a smoking cessation tool. “Cytisine is an old medication, and studies like this one have shown that it is effective," she said. "We need to find a way to make treatment of tobacco use accessible and affordable to all of the world's smokers." The challenge, Rigotti said, is to figure out how to get cytisine licensed as a tobacco treatment in all countries, including the United States, while still keeping it affordable. Tobacco use is the leading preventable cause of death worldwide, Rigotti noted. "A majority of smokers now live in low- and middle-income countries," she added. "We have effective treatments to help smokers, but they are generally too expensive for smokers in low- and middle-income countries to afford."

For more information: http://www.nlm.nih.gov/medlineplus/news/fullstory_150009.html

COPD World News Week of December 21, 2014

COPD linked to malnutrition and economic burden

Abbott, Park, IL - A recent study around the global economic burden of malnutrition tied to chronic illness found that patients with COPD experience the highest rates of malnourishment. Although close to 60 percent of patients suffering from chronic illness are never screened for malnutrition, disease-associated malnutrition imposes an economic burden on society of about $157 billion per year, according to research published in a supplemental issue of the Journal of Parenteral and Enteral Nutrition (JPEN). The study explains that when malnutrition goes undiagnosed, particularly in seniors, it can lead to an increase in health complications, hospital re-admissions rates, and overall health care costs, which also increases health care costs. In the eight specific diseases that were evaluated by direct medical costs, the years of quality life lost, and mortality to determine the total economic burden, more than 80 percent of the total cost came from cases of depression, chronic obstructive pulmonary disease (COPD), coronary heart disease, and dementia. Patients with COPD had the highest malnutrition rate at 11 percent. Because patients with COPD require up to 10 times the calories needed by a patient without COPD, it is important for patients to make sure they are getting the nutrients and energy their body requires. Proper eating habits can help fight body infections and help produce the energy required to function normally. Malnutrition can be treated if the patient is screened and offered nutritional support when they are at risk. Dieticians can guide patients by working out a diet plan that recommends high calorie foods that are easy to prepare.

For more information: http://tinyurl.com/mvryh3y

COPD World News Week of December 14, 2014

Anti-Smoking Campaign Successful and Cost-Effective

Atlanta, GA - A national anti-smoking campaign featuring tips from former smokers was highly successful and cost-effective, a new study reports. The 2012 Tips From Former Smokers campaign spent $480 per smoker who quit and $393 per year of life saved, the U.S. Centers for Disease Control and Prevention (CDC) found. "Our mission is to protect the public health, and the 2012 Tips ads did this by motivating 1.6 million smokers to make a quit attempt," study co-author Dr. Tim McAfee, director of the CDC's Office on Smoking and Health, said in an agency news release. "In addition, our responsibility is to spend public dollars as wisely and efficiently as possible." A widely accepted limit for the cost-effectiveness of a public health program is $50,000 per year of life saved, according to the agency. The CDC noted that the cost-effectiveness of anti-smoking campaigns can include expenses related to medications, counseling and other treatments to help people quit smoking. Even when those expenses are added to the cost of the Tips campaign, the total is still 15 times less than the $50,000 cost-effectiveness threshold, the CDC said. The findings were published Dec. 10 in the American Journal of Preventive Medicine. "There is no question the Tips campaign is a 'best buy' for public health -- it saves lives and saves money," CDC Director Dr. Tom Frieden said in the news release. "Smoking-related disease costs this nation more than $289 billion a year. The Tips campaign is one of the most cost-effective of all health interventions. This study shows how much the Tips campaign accomplished by being on the air for just 12 weeks. We would expect the benefits to be even greater if Tips was on the air all year," Frieden added. The $48 million effort was the first federally funded national mass media anti-smoking campaign and led to about 100,000 smokers quitting permanently, according to the study authors. The study also noted the campaign will save about 179,000 healthy life-years at a cost of $268 per year of healthy life gained. The campaign will also help prevent about 17,000 premature deaths. The cost will be about $2,200 per premature death averted, the study found. "This is further proof the Tips campaign is a smart, effective and efficient use of taxpayer dollars," McAfee said. Smoking is the leading preventable cause of disease and death in the United States, killing almost half a million Americans every year, the CDC reported. And, most smokers -- 70 percent -- want to quit, the study authors noted in the news release. Cigarette smoking costs about $170 billion a year in U.S. health care expenses, other new research from the CDC has found. Almost two-thirds of those expenses are paid through public programs such as Medicare or Medicaid, the agency said.

For more information: http://www.nlm.nih.gov/medlineplus/news/fullstory_149898.html

COPD World News Week of December 7, 2014

Secondhand Pot Smoke Impairs Arterial Function in Rats

Chicago, IL - Secondhand marijuana smoke may be as harmful as tobacco smoke in terms of vascular endothelial function, researchers said here. In an animal study, the endothelial functioning of the rats decreased 50% to 70% after they were exposed to secondhand marijuana smoke, said Matthew Springer, PhD, from the University of California San Francisco, and colleagues. "Secondhand smoke is bad for you," Springer said at a press conference at the American Heart Association annual meeting. "Fortunately, the general public has figured this out for cigarettes, but they haven't necessarily made the connection to marijuana secondhand smoke. A lot of people will actively avoid being exposed to cigarette secondhand smoke, but they don't mind marijuana secondhand smoke," adding that people are more likely to say of marijuana 'There's no nicotine, it's natural' -- whatever that means -- 'it's a medicine.'" His group wanted to evaluate whether secondhand smoke from marijuana could "impair the ability of blood vessels to pass enough blood when they need to, a measure of vascular endothelial function," he explained. "If people are exposed to tobacco over and over again, they develop long-term vascular dysfunction, and we wanted to see if that happens with marijuana [secondhand smoke] ... we have developed a rat model that allows us to study in controlled conditions how well vascular function is occurring." They employed a flow-mediated vasodilation (FMD) model and exposed groups of eight anesthetized rats to marijuana secondhand smoke using a modified cigarette smoking machine. They measured FMD at baseline, 10 minutes after the end of exposure, and 40 minutes after the end of exposure. The impact of exposure was measured by micro-ultrasound measurements of femoral artery diameter before and after transient surgical occlusion of the common iliac artery, they stated. They noted that secondhand marijuana smoke at both low and high doses led to substantial impairment of FMD. "There were no significant differences between the extents of FMD impairment by high dose, low dose, and THC-marijuana smoke exposure," Springer said, adding that "there were no differences when the rats were exposed to chamber air." Springer pointed out that the study results did not apply to marijuana edibles or marijuana capsules. AHA press conference moderator Donna Arnett, PhD, chair of epidemiology at the University of Alabama at Birmingham School of Public Health, stated that the study was "compelling." "I think the message should be clear from a public health perspective that tobacco smoke is not different from marijuana smoke in terms of its effect on endothelial function, and perhaps we need to have policy to cover banning marijuana smoke in open setting," said Arnett, past president of the AHA. Springer agreed that "the implications for the public are that the exposure to secondhand smoke should be avoided whether that source is marijuana or tobacco. Clinicians should be aware of this also when they are going over this with patients' basic wellness routine; they might want to ask about all sources of secondhand smoke." "The main conclusion, put simply, is that smoke is smoke, and specific to this study, marijuana and tobacco secondhand smoke impairs arterial function similarly after comparable exposure conditions," Springer said. "We in the public health community tell people all the time that cigarette smoke is bad for them, but we don't say that marijuana smoke is bad for them, so they assume it isn't."

For more information: http://tinyurl.com/ou7cz2t

COPD World News Week of November 30, 2014

Premature aging of the lung may contribute to COPD

Edinburgh, UK - Aging is associated with a progressive degeneration of the tissues, which has a negative impact on the structure and function of vital organs and is among the most important known risk factors for most chronic diseases. Since the proportion of the world’s population aged over 60 years will double in the next four decades, this will be accompanied by an increased incidence of chronic age-related diseases that will place a huge burden on healthcare resources. Around 100,000 people worldwide die each day of age-related causes. There is increasing evidence that many chronic inflammatory diseases represent an acceleration of the aging process. Chronic obstructive pulmonary diseases represents an important component of the increasingly prevalent multiple chronic debilitating diseases, which are a major cause of morbidity and mortality, particularly in the elderly. The lungs age and it has been suggested that chronic obstructive pulmonary disease (COPD) is a condition of accelerated lung aging and that aging may provide a mechanistic link between COPD and many of its extrapulmonary effects and comorbidities. The number of changes in the body that occur with age is remarkably long and include changes in appearance, such as wrinkled skin, gradual reduction in height and weight loss due to loss of muscle and bone mass, decline in sexual activity, and decline in the function of most organs such as renal, pulmonary, cardiac and cerebral. Immune and endocrine functions are also affected. It has been suggested that aging results from a range of intrinsic phenomena that affect the whole organism and consequently leads to the “weakest link” organ failing, culminating in death. However, the aging process does not share its core features with any particular disease and it is not a disease in itself, but increases vulnerability to disease. All organs tend to lose function with age and this is well described in the lung where there is a progressive decline in lung function after the age of 25 years. There is increasing evidence that chronic inflammatory conditions such as COPD represent an acceleration of the aging process.

For more information: http://ow.ly/BGd52

COPD World News Week of November 23, 2014

High incidence of bowel disease seen in people with lung conditions

Montreal, PQ - People with airway diseases, including asthma and chronic obstructive pulmonary disease (COPD), have a higher incidence of inflammatory bowel disease, such as Crohn’s disease and ulcerative colitis, according to the findings of a new study. The research, which is published online today (19 November 2014) in the European Respiratory Journal, is the first population-based study to examine the association between airway diseases and the incidence of bowel disease. The news comes on World COPD Day, which aims to improve awareness and care of COPD. The results showed that the incidence of Crohn’s disease was 27% higher in people with asthma and 55% higher in people with COPD, compared to the general population. The incidence of ulcerative colitis was 30% higher in people with COPD compared to the general population. Previous studies have suggested a link between the two conditions, which could be a result of common genetic and environmental factors, or similar inflammatory responses seen in the immune system. If the link is proven, it would have key implications for clinicians treating people with airway diseases. Researchers used a health database to retrieve information on both airway disease and inflammatory bowel disease from 2001 to 2006. By using information on the prescriptions of both asthma and COPD medications during that time period, the researchers identified 136,178 people with asthma and 143,904 people with COPD. Data from doctor and hospital visits was then used to identify the bowel conditions, Crohn’s disease and ulcerative colitis, in both groups. Dr Paul Brassard, lead author of the study from the Lady Davis Institute for Medical Research of the Jewish General Hospital in Montreal, Canada, said: “These findings have important implications for the early detection of inflammatory bowel disease in airway disease patients. Although a link has previously been suggested, this is the first study to find significantly increased rates of inflammatory bowel disease incidence in people with asthma and COPD. If we can confirm a link between the two conditions it will help diagnose and treat people sooner, reducing their symptoms and improving their quality of life.”

For more information: http://tinyurl.com/o94yyro

COPD World News Week of November 16, 2014

Lung Cancer Screening Can Be Cost Effective

Hanover, NH - Lung cancer screening with CT scans can be cost-effective while saving lives, a new study suggests. But, there are two caveats to that finding -- the procedure has to be performed by skilled professionals and the screening must be done on a very specific set of long-time smokers, the researchers noted. Results from the National Lung Screening Trial (NLST) showed four years ago that annual CT scans can reduce lung cancer deaths by 20 percent in older, long-time smokers. The new study, which uses data gathered during that national trial, concludes that screening for lung cancer would cost $81,000 for each year of quality life gained -- lower than the generally accepted $100,000-per-year threshold for cost effectiveness. "While it sounds like an awful lot, $100,000 to $150,000 per quality-adjusted life-year is considered a reasonable value within the United States," said study author Dr. William Black, a professor of radiology at the Dartmouth University Institute for Health Policy and Clinical Practice. "It's plausible to design a screening program for lung cancer that ultimately would be cost-effective." Black said the cost of screening always has been a concern among NLST researchers. "We decided early on there would be a cost-effectiveness study if it was proven there were a benefit," he said. A study earlier this year reported that lung cancer screening could cost Medicare $9.3 billion over five years, which amounts to a $3 per month premium increase for every Medicare patient. Concerns have been raised over those costs, which prompted the U.S. Centers for Medicare and Medicaid Services to delay covering the procedure while it conducted a careful review. CMS is expected to announce its decision on lung cancer screening within the next few days, according to Black. These new findings determined that screening can be cost-effective, but only if it is conducted on current or former smokers at particularly high risk, researchers report. The results are published in the Nov. 6 issue of the New England Journal of Medicine. Specifically, screening should target current and former smokers aged 55 to 79 with at least a 30 pack-year history of smoking. Pack years are determined by multiplying the number of packs smoked daily by the number of years a person has smoked. "It's very important to target that population so when we start paying for screening, we reach the people who will benefit from it," Black said, noting that only about a third of smokers in that age group have smoked enough to qualify for screening. In addition, screening must be done by skilled radiologists who can accurately detect cancerous lesions, and followed up by talented doctors who are conservative in conducting additional scans or ordering biopsies, he said. For example, since the initial NLST findings were published, researchers have determined it's not necessary to follow up on detected nodules in the lungs that are between 4 millimeters (mm) and 6 mm in size, Black said. "You could cause harm, and you could cause a lot of expense, so it's important we set our criteria so we are detecting these small curable cancers but we aren't over-treating them," he said. Dr. Otis Brawley, chief medical officer for the American Cancer Society, agreed that professional judgment and medical skill will be crucial in performing CT lung cancer screening cost effectively. Brawley noted that in the trial, screening prevented 87 deaths for every 25,000 people screened, but also caused 16 deaths per 25,000 due to complications from biopsies. Six of those 16 deaths were in people who did not have cancer. The screenings for the trial were conducted at medical centers that are highly skilled in imaging and cancer treatment, Brawley said. He is concerned that as lung cancer screening becomes more widespread, people will be over-diagnosed and harmed. "For every 5.4 lives saved from lung cancer by screening, one life was lost due to screening," he said. "If you go to hospitals that aren't as good, you're going to have an even higher proportion. You really need to have some quality assurances, to try to prevent these deaths from happening."

For more information: http://www.nlm.nih.gov/medlineplus/news/fullstory_149294.html

COPD World News Week of November 9, 2014

Stopping Inhaled Steroids in COPD Feasible

Austin, TX - Withdrawing inhaled corticosteroids (ICS) from patients with severe chronic obstructive pulmonary disease (COPD) did not lead to an increased rate of exacerbations, investigators reported. Steroid withdrawal was associated with 1,097 exacerbations of any severity among 1,242 patients, which met statistical criteria for non-inferiority versus continuation of ICS (1,078 exacerbations in 1,243 patients). The frequency of severe or moderate/severe exacerbations did not differ between groups or within any subgroups. The time to first COPD exacerbation also was similar between groups. Withdrawal of ICS was associated with a larger drop in FEV1 during the final step of withdrawal, Helgo Magnussen, MD, of the Pulmonary Research Institute in Grosshansdorf, Germany, said here at CHEST 2014. "In patients with GOLD [Global Initiative for Chronic Obstructive Lung Disease] 3-4 COPD, receiving dual bronchodilators, the risk for moderate to severe exacerbations is statistically non-inferior with ICS withdrawal compared with ICS therapy," Magnussen said. "On the basis of these results we conclude that inhaled corticosteroids may be successfully withdrawn in patients receiving dual bronchodilator therapy with a long-acting muscarinic antagonist (LAMA) and a long-acting beta-agonist (LABA)." In contrast, hospitalized patients with severe COPD had an increased risk of subsequent hospitalization for pneumonia if they did not receive prophylactic antibiotic therapy, according to results of a separate study reported at the meeting. Previous studies have shown that LAMA-ICS combination therapy reduces the risk of exacerbations in severe COPD as compared with monotherapy, Magnussen said by way of background. Additionally, dual bronchodilator therapy with a LAMA and a LABA has demonstrated superiority over either agent alone.

For more information: http://tinyurl.com/pugp67d

COPD World News Week of November 2, 2014

COPD Symptoms Diminish With Portable Ventilator

Austin, TX - Assessment scores for chronic obstructive pulmonary disease (COPD) improved by more than 50% during treatment with a non-invasive open ventilation system (NIOV), results of a small prospective trial showed. The mean score on the modified British Medical Research Council (mMRC) dyspnea scale decreased by 58% and the mean for the COPD Assessment Test (CAT) by 54%. The decline in scores represented a transition from moderate to severe COPD status before treatment to mild and moderate COPD in the first 12 months after NIOV treatment began. A COPD patient population like the 21 participants in the NIOV evaluation would have been expected to have deteriorating lung function and health status during follow-up, Brian W. Carlin, MD, of Drexel University School of Medicine in Philadelphia, reported here at CHEST 2014. "These patients were on maximal medical therapy and were still very symptomatic," Carlin told MedPage Today. "Putting them on the NIOV system improved their dyspnea and substantially improved their COPD assessment scores. "We think the improvements that we observed have the potential to reduce resource utilization and possibly the cost of care," he added. "As people feel better about themselves and their shortness of breath improves and they have fewer symptoms, they will not be coming back to the doctor's office as much, and they will not be coming into the hospital as much. It's going to be less costly for the healthcare system overall." The FDA-approved NIOV system increases tidal volume by means of positive pressure ventilation. Reported benefits included reduced dyspnea, increased oxygenation, enhanced exercise endurance, and reduced respiratory muscle activity. The system was developed as an aid for patients with severe respiratory insufficiency but who can breathe spontaneously and achieve a minimum tidal volume of 3.5 cc/kg of predicted body weight. The system's portability facilitates continuous use during ambulatory activities, physical therapy, occupational therapy, respiratory therapy, and other rehabilitative activities at home or in an institutional setting. Healthcare personnel, patients, and caregivers can learn to operate the NIOV system. In a recent clinical study, investigators evaluated the wearable 1-lb NIOV system in 15 men with exercise-induced desaturation associated with COPD. Use of the device with compressed oxygen resulted in significantly greater improvement in exercise duration, surface inspiratory muscle electromyography, dyspnea, and oxygenation as compared with unaided exercise, nasal oxygen, and NIOV plus compressed air. At CHEST 2012, Carlin and colleagues presented results of a study to assess the impact of the NIOV system on activities of daily living (ADL) in 30 patients with COPD. Each patient performed a specified ADL with conventional oxygen therapy. Following a rest period, the patient repeated the ADL with the NIOV system. The results showed significant improvement (P<0.01 to P<0.0001) in scores associated with dyspnea, comfort, and fatigue, and in ADL endurance. At CHEST 2014, Carlin reported findings from a 24-month study involving 21 patients with various types of chronic respiratory insufficiency: chronic obstructive bronchitis (seven patients), bullous emphysema (five), emphysema and obstructive bronchitis (three), and one case each of bullous emphysema plus alpha-1 antitrypsin deficiency, bronchiolitis obliterans, chronic obstructive bronchitis plus alpha-1 antitrypsin deficiency, pulmonary hypertension, and chronic obstructive bronchitis plus bronchiectasis. The trial was conducted in two phases: 14.6 months of treatment with standard medications and equipment, followed by a 10.2-month evaluation period with the NIOV system added to existing treatment. The primary outcome of the single-arm, unblinded study was the change in mean mMRC and CAT scores from the 12 months before NIOV to the treatment period with NIOV. In the 12 months before NIOV, the 21 patients had a mean mMRC score of 3.38 (score >2 indicates increased dyspnea) and a mean CAT score of 26.71 (score >10 reflects moderate to high impact of respiratory symptoms on health status). The follow-up evaluations during the 12-month period after the addition of NIOV showed mean scores of 1.43 and 12.33 for the mMRC and CAT scores, respectively. "The significant improvements in clinical measures seen in this study are similar to the results we see in the clinic when patients add a portable noninvasive open ventilation system to an existing regimen, that may included pharmacological agents and oxygen therapy," said Larry C. Casey, MD, PhD, of Mayo Clinic Health System and Franciscan Healthcare in La Crosse, Wis. "Improvements of this magnitude have rarely occurred over the past several decades, and these findings support the use of a portable noninvasive open ventilation system as part of the treatment paradigm for patients living with chronic lung disease." In a recent editorial about clinical experience with the NIOV system, Casey said the system "has the potential to reduce hospitalization, ICU days, mechanical ventilation days, resulting in substantial cost savings. My experience with using NIOV is that after a patient uses it once during the initial trial, they want to take it home and they don't want to give it up. With 30 years of academic pulmonary medicine, I've never seen such an immediate and profound impact on a patient's quality of life."

For more information: http://tinyurl.com/mmm5y8a

COPD World News Week of October 26, 2014

Two-Pronged Program Looks Best for Helping Smokers Quit

London, UK - A combination of counseling and medication greatly increases smokers' chances of quitting, according to new research. The study included 1,560 adult smokers in England who made at least one attempt to quit over six months. About 45 percent used no aids to help them quit, while about 5 percent used prescription medication (nicotine replacement therapy, bupropion or varenicline) in combination with behavioral counseling. Another 21 percent used prescription medication with brief advice, and about 30 percent used over-the-counter nicotine replacement products. After six months, 23 percent of the participants were no longer smoking. Those who used the medication/counseling method were nearly three times more likely to quit than those who did not use medication or counseling. Taking a prescription medication with brief advice was also more effective than unaided attempts to quit. However, smokers who used over-the-counter nicotine replacement therapy with no counseling had a reduced success rate, according to the study in the October issue of the journal Mayo Clinic Proceedings. "The results clearly show that tdsfdsfhe combination of prescription medication with behavioral support is the most successful method. More smokers should be guided towards these forms of treatment," researcher Daniel Kotz, from the University of Maastricht in the Netherlands, said in a journal news release. Smoking cessation is one of the most important health behavior changes that physicians can encourage in their patients, Dr. J. Taylor Hays, director of the Mayo Clinic Nicotine Dependence Center in Rochester, Minn., said in the news release. "Hundreds of clinical trials that included thousands of patients have demonstrated the efficacy of combined behavioral therapy and pharmacotherapy for tobacco-dependence treatment." This study shows "that this approach can be translated to the real world and provide real benefit. This is a case where there is happily little difference between 'theory and practice,'" Hays said. "Health systems, hospitals, clinics, and providers now need to practice the well-established standard of care to save real lives in their real world."

For more information:http://www.nlm.nih.gov/medlineplus/news/fullstory_148982.html

COPD World News Week of October 19, 2014

Smoking-Related Illnesses in U.S. Total 14 Million, Report Finds

Atlanta, GA - Cigarette smoking accounts for approximately 14 million major medical conditions that plague the lives of U.S. adults, according to a new government report. "For each annual death, there are 15 to 20 people living with major disease caused by smoking," said senior study author Terry Pechacek, associate director for science at the office on smoking and health of the U.S. Centers for Disease Control and Prevention. "Smoking not only will kill you, it will damage your health and make your life worse." Smoking harms nearly every organ in the body, often causing multiple serious illnesses such as emphysema, diabetes and colon cancer, according to the report from the U.S. Food and Drug Administration and the CDC. Chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, is the illness most tightly linked to smoking, researchers report. About 7.5 million U.S. adults suffer from smoking-related COPD, which makes it harder and harder to draw breath as time passes. But the study, also links smoking to: 2.3 million cases of heart attack, 1.3 million cases of cancer, 1.2 million cases of stroke and 1.8 million cases of diabetes. The researchers said their findings regarding diabetes are particularly concerning. "We've known for quite a while that smoking makes diabetes outcomes worse, and diabetics who smoke are really placing themselves at great risk," Pechacek said. "But if people smoke who have a tendency toward diabetes, are pre-diabetic, they are at a much higher risk of progressing to full diabetes." "Smoking causes diabetes and makes it much worse," he said. "People are not aware of that." The study relied on data gathered from two national health surveys from 2006 through 2012 to produce the first estimate of smoking-related illness since 2000, when the CDC estimated that 8.6 million people had 12.7 million major medical conditions caused by smoking. This time they found that 6.9 million U.S. adults had a combined 10.9 million smoking-related medical conditions. Then they factored in COPD estimates and concluded that U.S. adults had a combined 14 million smoking-related illnesses in 2009. "The implication is that smoking causes more harm than we previously thought, much of it in chronic pulmonary obstructive disease," said Dr. Steven Schroeder, a professor of medicine at University of California, San Francisco and head of its Smoking Cessation Leadership Center. "When you think about how smoking hurts you, people usually think about deaths first, and then those who are sick. There is much more lifetime illness related to smoking." Schroeder said he was surprised that researchers found even though women have a lower overall rate of smoking than men, they have a higher rate of COPD. An estimated 4.3 million female smokers have COPD, compared with 3.2 million male smokers. "Part of it might be that women may be more susceptible to getting pulmonary disease when they smoke," he said. "It also might be that they live longer, and so have an enhanced lifetime risk." Even though these facts are gloomy, there is one bright ray of hope in them, said Dr. Norman Edelman, senior medical advisor for the American Lung Association. "Smoking is still the most correctable cause of death and illness in the United States," he said. "When I have a patient with sleep apnea because he's overweight, it's very, very hard to get him to lose weight. But we have shown that we can effectively help people quit smoking. We've been able to reduce smoking rates in the adult population by about half. It's a health crisis that's amenable to a solution, if we make an effort." Pechacek agreed. "Millions and millions more people would have suffered and died, or still be suffering with disease, if we hadn't cut the smoking rate," he said. "The message is clear. Quit, quit as early in life as possible, and don't be afraid to talk to your friends and family who are still smoking."

For more information: http://www.nlm.nih.gov/medlineplus/news/fullstory_148883.html

COPD World News Week of October 12, 2014

Boehringer pilots inhalers with sensors to encourage patient adherence

Ridgefield, CT - Boehringer Ingelheim envisions someday selling a smart inhaler that can tell patients when its medication is running low, and remind them if they missed a scheduled dose. To that end, the company is testing the use of its Respimat inhalers with a Propeller Health sensor attached to the back. Propeller Health specializes in designing sensors and apps for asthma and COPD patients. According to Propeller Health CEO David Van Sickle, "The goal is really to passively collect this information and to try to put it to work in a new way that's made possible by digital health interventions that are able to put computing power and new interfaces to work on the sensor-captured information. Really trying to get contextually relevant, personally meaningful interventions in the moment, without asking the patient and the caregiver to do much at all. "It means the sensors sort of knowing how much medication is remaining and suggesting an appropriate time for refilling the prescription. And it means thinking about ways to put information about the daily use of these medications to work, to think of ways we can reward individuals intrinsically and extrinsically to motivate better adherence," said Van Sickle. The payoff for Boehringer would come in the form of improved patient adherence with dosing instructions. That's an issue all pharma companies are struggling with. In a recent speech, CVS Health CEO Larry Merlo said that medication non-adherence is costing the healthcare system about $300 billion per year in unnecessary costs. Boehringer is also working with healthcare company AdhereTech to develop smart wireless pill bottles. Inhalers are a natural target for sensor technology because the devices are not separated from the medication that lies inside prior to delivery. The company's director of its New Business Model and Healthcare Innovation group, Larry Brook, said that he wants more industry players to test the technology in order to make it interoperable between inhalers. "If I go to a health plan and I tell them that I have a solution for our inhaler, but you can't get it for any other inhaler and you have to work with a different company for that, it's not going to take off," he said.

For more information: http://tinyurl.com/na8txyj

COPD World News Week of October 5, 2014

More than one kind of message may convince smokers to quit 

Washington, DC - Positive messages about the health benefits of quitting smoking may help some people kick the habit, a new study that involved 740 participants suggests. Although smokers who think quitting will be difficult responded better to "loss-framed" messages about the harmful effects of smoking, researchers found smokers who believe they can quit whenever they want benefit more from "gain-framed," or positive, messages about how quitting will improve their health. The researchers concluded that using a mix of both types of messages might get more people to stop smoking. "This study shows us that leveraging both gain- and loss-framed messaging may prompt more smokers to quit," lead investigator Darren Mays, a population scientist at Georgetown Lombardi Comprehensive Cancer Center, said in a university news release. Most tobacco warnings on cigarette packages in the United States and around the world are "loss-framed" messages. The researchers cautioned that these statements may not convince many smokers to quit. The 2009 Family Smoking Prevention and Tobacco Control Act authorized the U.S. Food and Drug Administration to regulate tobacco products. The law also required new picture labels to be posted on the labels of cigarette packs. However, implementation of this legislation has been delayed by lawsuits from the tobacco industry. Because its nine proposed graphic label warnings were struck down in court in 2012, the FDA is pursuing more research to support these graphic warning label requirements.  The researchers examined the effects of four images: a man using a device to help him breathe; a healthy lung next to a diseased lung; a man lying on a white sheet with stitches on his chest, and a mouth ravaged by cancer. These images had either "loss-framed" or "gain-framed" messages. "Gain-framed" messages stressed the health benefits of quitting, such as a reduced risk of death from tobacco. Meanwhile, "loss-framed" messages emphasized negative outcomes from smoking, such as increased risk of death. The American Cancer Society-supported study found each image was effective. The researchers said their findings could provide additional evidence for new graphic warnings proposed for U.S. cigarette packages. "Leveraging policies such as graphic warnings for cigarette packs to help smokers quit is critical to improve public health outcomes," concluded Mays. "Our study shows that framing messages to address smokers' pre-existing attitudes and beliefs may help achieve this goal."

For more information: http://www.nlm.nih.gov/medlineplus/news/fullstory_148434.html

COPD World News Week of September 28, 2014

Combo Therapy Best for COPD

Toronto, ON - A combination drug therapy aimed at opening the airways and reducing inflammation appears to be the best treatment for older adults with chronic obstructive pulmonary disease (COPD), especially those with asthma, a new study finds. COPD patients who received a combination of long-acting beta agonists and inhaled corticosteroids were less likely to die or require hospitalization because of their breathing disorder, compared to people receiving only one of the two medications, Canadian researchers report. The study findings were published in the Sept. 17 issue of the Journal of the American Medical Association. The findings go against the official guidelines for treating COPD, but actually support what most chest physicians are doing in the clinic, said lead author Dr. Andrea Gershon, a scientist with the Sunnybrook Health Sciences Center and the Institute for Clinical Evaluative Sciences in Toronto. Current treatment guidelines call for COPD patients to first receive a long-acting beta agonist, which relaxes the muscles of the airways and widens them, resulting in easier breathing. If that doesn't work, physicians then can add an inhaled corticosteroid, which reduces inflammation. "We found the combination therapy appeared to be more effective, and we found that a lot of people are being started on this combination therapy straight away," Gershon said. "Maybe doctors have had an intuitive sense of these benefits, or maybe drug companies had really good marketing." Further, researchers found that the combination therapy did not compound a person's risk of side effects from either drug, most notably osteoporosis and pneumonia. "I suspect when doctors read this, they are going to skip that first step and go straight to combination drug therapy," said Dr. Norman Edelman, senior medical advisor to the American Lung Association. COPD is the third leading cause of death worldwide, researchers said in background information. The disease makes it progressively more difficult for patients to draw a breath, with symptoms slowly worsening over time. The study involved government health data in Ontario on almost 12,000 people with COPD between 2003 and 2011, including 8,712 patients newly placed on combination therapy and 3,160 new users of long-acting beta agonists. The records involved real-world situations, with doctors treating patients according to their best judgment, Edelman noted. "It's one thing to perform a drug trial and select patients very carefully and see how your drugs perform, and another to look back and see how people have done in the real world with real doctors," he said. Researchers found that about 37.3 percent of people died while using beta agonists alone, compared with 36.4 percent of people using the combination therapy. Similar results occurred for hospitalizations caused by COPD -- about 30.1 percent for people on the single drug, versus 27.8 percent for people taking the combination. Overall, the use of combination therapy reduced risk of death or hospitalization by 3.7 percent, compared with beta agonists alone, the study found. The greatest difference was among COPD patients who had also been diagnosed with asthma. Overall, those on combination therapy had a 6.5 percent reduced risk of either death or hospitalization compared with those taking a single drug. The researchers noted, however, that the combination therapy appeared to be less effective for people who are using inhaled long-acting anticholinergic medication, a different class of COPD medication that works by inhibiting the transmission of certain nerve impulses to help reverse airway resistance. Those who received the combination therapy and had never taken a long-acting anticholinergic had an 8.4 percent reduced risk of death or hospitalization. The findings are likely to reassure most physicians that they already are doing the right thing, given that many already are prescribing combination therapy, said Dr. Darcy Marciniuk, the immediate past president of the American College of Chest Physicians and head of the division of respirology, critical care and sleep medicine at the University of Saskatchewan in Saskatoon, Canada. Before paring down their patient sample for research purposes, the Canadian researchers determined that doctors had started 34,289 new patients on combination therapy during the period in question, compared with 3,258 who were prescribed beta agonists alone. "About 10 times more people were started on combination therapy than were started on the single therapy," Marciniuk said. "That speaks for itself."

For more information: http://www.nlm.nih.gov/medlineplus/news/fullstory_148411.html

COPD World News Week of September 21, 2014

FDA Panel Greenlights COPD Mist Drug

Washington, DC - A mist formulation of a drug aimed at chronic obstructive pulmonary disease (COPD) should be approved, an FDA panel agreed, with concerns about its safety described as "niggling." The 13-member Pulmonary-Allergy Drugs Advisory Committee agreed unanimously that data show that the mist formulation of tiotropium bromide (Spiriva Respimat) is effective in reducing both bronchospasm and exacerbations of COPD. And nine of the 13 members were persuaded that the drug has no significant risk of all-cause mortality, despite what one member called a "lingering unease" that there might be an elevated risk of fatal heart attack. "I feel very confident about the all-cause mortality," said Erica Brittain, PhD, of the National Institute of Allergy and Infectious Diseases in Bethesda, Md. But, she added, "it just seems that a lot of different sources of data are pointing to cardiovascular issues." Brittain voted to approve the drug, but said it was a "close call." Four panel members voted that the evidence does point to a meaningful mortality risk. On the key question -- whether the data support approval of the drug -- the committee voted 10-3 in favor. The FDA is not obliged to follow the advice of its committees, but usually does so. A dry powder version of tiotropium bromide (Spiriva HandiHaler) is already indicated to reduce exacerbations of COPD, but the mist version -- which is dosed differently as well -- has run into repeated concerns about the risk of mortality and cardiovascular events. To help allay those concerns, the drug's maker, Boehringer Ingelheim, conducted a large randomized safety study -- dubbed TIOSPIR -- that compared the safety of Spiriva Respimat and Spiriva HandiHaler. And the company submitted the results of a new study -- known as 205.372 -- to support claims that the mist version cuts COPD exacerbations. Tiotropium is a long-acting anticholinergic agent that acts as a bronchodilator. The dry powder version has well-known side effects related to the anticholinergic effects, including dry mouth, constipation, and urinary retention. The HandiHaler uses a propellant, whereas the liquid mist is delivered from a spring-loaded actuator. The mist formulation is easier to use for some patients, said Robert Wise, MD, of Johns Hopkins University, who was lead investigator on the TIOSPIR trial. Appearing on behalf of Boehringer Ingelheim, Wise told the panel that newly diagnosed patients, those with impaired manual dexterity, and those whose inhalations are weak would among those who might benefit. 

For more information: http://tinyurl.com/nj5atyj

COPD World News Week of September 14, 2014

Smoking Worsens Psoriatic Arthritis

Copenhagen, Denmark - Patients with psoriatic arthritis who smoke have worse patient-reported disease features at baseline and don't respond as well as non-smokers to anti-tumor necrosis factor (TNF) treatment, a Danish study found. Current smokers had higher patient global scores on a 100-mm visual analog scale compared with patients who had never smoked, higher scores for fatigue, and worse functional status on the Health Assessment Questionnaire, according to Bente Glintborg, MD, of Copenhagen University Hospital, and colleagues. They also had lower rates of response on the American College of Rheumatology (ACR) 20% and 50% improvement criteria at 6 months the researchers reported online in Annals of the Rheumatic Diseases. Patients who smoked also had shorter disease duration at the time of initiating anti-TNF therapy, "which may indicate a more aggressive disease course among smokers," they commented. "The impact of smoking on disease activity and functional status is well described in rheumatoid arthritis, but has scarcely been investigated in psoriatic arthritis," Glintborg and colleagues wrote. To address this, they analyzed data from the DANBIO registry, which includes more than 90% of Danish patients receiving treatment with biologic medications. The analysis included 1,388 patients with psoriatic arthritis who had begun treatment with etanercept (Enbrel), infliximab (Remicade), or adalimumab (Humira). One third were current smokers, while 41% had never smoked and 26% had smoked in the past but had quit. While smoking did influence patient-reported disease features, less effect was seen on objective measures such as swollen joint count and C-reactive protein level. When response was assessed according to the criteria of the European League Against Rheumatism (EULAR), 34% of never smokers had good responses compared with 23% of current smokers. Responses were most pronounced among men, with EULAR good responses for never smokers being 42% compared with 24% of current smokers. The researchers also considered the possible interaction between smoking and the individual type of TNF inhibitor, and found that current smokers were less likely to be adherent to treatment with infliximab and etanercept although not with adalimumab. Possible explanations for smoking's adverse impact on disease include increases in inflammatory cytokines such as TNF-alpha, interference with drug bioavailability, and alterations in absorption following injections. The researchers also noted that patients who had stopped smoking more than 4 years before beginning treatment showed very similar rates of adherence to treatment as did those who had never smoked. "This may illustrate a gradual normalization of pathological processes and smoking-related behavior, and is noteworthy, as tobacco smoking is a potentially modifiable lifestyle factor," they observed. This potential reversibility of the negative influence of smoking on disease and treatment highlights the need for clinicians to encourage patients to quit, they also noted. Limitations of the study included a lack of information about pack-years of smoking and about the effects of socioeconomic factors and co-morbid diseases.

For more information: http://tinyurl.com/mtkn6gm

COPD World News Week of September 7, 2014

Benefits of E-Cigarettes May Outweigh Harms, Study Finds

Richmond, VA - Strict regulation of electronic cigarettes isn't warranted based on current evidence, a team of researchers says. On the contrary, allowing e-cigarettes to compete with regular cigarettes might cut tobacco-related deaths and illness, the researchers concluded after reviewing 81 prior studies on the use and safety of the nicotine-emitting devices. "Current evidence suggests that there is a potential for smokers to reduce their health risks if electronic cigarettes are used in place of tobacco cigarettes and are considered a step toward ending all tobacco and nicotine use," said study researcher Thomas Eissenberg, co-director of the Center for the Study of Tobacco Products at Virginia Commonwealth University in Richmond. The study, partly funded by the U.S. National Institutes of Health, was published July 30 in the journal Addiction. Whether e-cigarettes should be regulated, and how strictly, is being debated by regulatory agencies around the world. Several medical organizations have called for restrictions on use of the increasingly popular devices. Although long-term risks of e-cigarettes remain unknown, the new study concluded the benefits of e-cigarettes as a no-smoking aid outweigh potential harms. "If there are any risks, these will be many times lower than the risks of smoking tobacco," said senior author Dr. Hayden McRobbie, from the Wolfson Institute of Preventive Medicine at Queen Mary University of London. "We need to think carefully about how these products are regulated," he said. "What we found is that there is no evidence that these products should be regulated as strictly as tobacco, as or even more strictly than tobacco." No evidence has shown that the vapor produced by e-cigarettes is harmful to users or bystanders in contrast to cigarette smoke, he added. It's not the nicotine in cigarettes that kills people, he said. "Use of e-cigarettes by people who don't smoke is very rare," McRobbie said. Furthermore, there is no evidence to support arguments that e-cigarettes are a gateway to smoking tobacco, he added. "There is evidence that e-cigarettes enable some users to quit smoking or reduce their consumption," McRobbie said. "If there is evidence that e-cigarettes reduce smoking-related harm, then they need to be easily obtainable and not regulated more strongly than tobacco products." Dr. Norman Edelman, a senior medical consultant for the American Lung Association, disagrees. The U.S. Food and Drug Administration should have authority over all tobacco products and e-cigarettes, said Edelman, a professor of medicine and physiology and biophysics at the State University of New York at Stony Brook. "It is imperative that the FDA finalize proposed e-cigarette regulations by the end of 2014," he said. "The FDA needs to crack down on quit-smoking and other health claims that e-cigarette companies are making," Edelman said. Edelman said it's too soon to know if e-cigarettes will cause long-term damage. "So far there hasn't been very much chronic use of e-cigarettes. So it's not possible to say there will be no harm," he said. "Since we are talking about a recreational drug -- it's not essential to life, it doesn't cure any illness -- it would only make sense to regulate it rigorously until we find out whether it's good or bad," Edelman said. Earlier this month, the Forum of International Respiratory Societies, which includes more than 70,000 members worldwide, urged governments to ban or limit e-cigarettes until more is known about their health effects. And this month, the American Medical Association requested tighter restrictions on the sale and marketing of e-cigarettes. The AMA's recommendations include a minimum age of purchase; childproof packaging; restrictions on flavors that appeal to young people, and a ban on unsupported claims that the devices help people quit smoking. Preventing the marketing of e-cigarettes to minors is another priority, the medical association says.

For more information: http://www.nlm.nih.gov/medlineplus/news/fullstory_147594.html

COPD World News Week of August 31, 2014

Hospital Discharge a Key Time to Help Smokers Quit

Boston, MA - The weeks after a hospital discharge may be a great time to help smokers quit the habit, and one study suggests a particular program might help. The program involved giving patients free quit-smoking drugs. It also included automated phone calls that helped them manage their medications, encouraged their efforts to quit and tracked whether they might need more anti-smoking counseling. The study suggests that hospitalization -- a time when smoking isn't allowed -- can be used as an opportunity for a lasting intervention for healthier living. The study included almost 400 patients and was led by Dr. Nancy Rigotti, of Massachusetts General Hospital in Boston. Patients averaged 53 years of age, and all said that they wanted to quit smoking after they left the hospital. About half of the patients were enrolled in the specialized quit-smoking program, while the rest were simply discharged from the hospital. After six months, 26 percent of patients in the program had quit smoking, compared with only 15 percent of those in the standard care group, according to the study. The study also boosted by 71 percent the number of patients with confirmed tobacco abstinence for at least six months after discharge from the hospital -- "a standard measure of long-term smoking cessation," the researchers said in a journal news release. They added that the intervention appeared to be effective across a broad range of smokers and provided high-value care at a relatively low cost. It was noted that hospital admission offers an opportunity for patients to try to stop smoking -- they are in the hospital with an acute illness and many times, it can be directly or indirectly linked to smoking. They no longer have accessibility to tobacco products and treatment for nicotine withdrawal can begin. Another expert agreed, calling hospitalization a potential "teachable moment" for smokers.

For more information: http://www.nlm.nih.gov/medlineplus/news/fullstory_147936.html

COPD World News Week of August 24, 2014

Prevalence of airflow limitation in outpatients with cardiovascular diseases in Japan

Tokyo, Japan - Cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) commonly coexist and share common risk factors. The prevalence of COPD in outpatients with a smoking history and CVD in Japan is unknown. The aim of this study was to determine the proportion of Japanese patients with a smoking history being treated for CVD who have concurrent airflow limitation compatible with COPD. A secondary objective was to test whether the usage of lung function tests performed in the clinic influenced the diagnosis rate of COPD in the patients identified with airflow limitation. In a multicenter observational prospective study conducted at 17 centers across Japan, the prevalence of airflow limitation compatible with COPD (defined as forced expiratory volume by handheld spirometry) was investigated in cardiac outpatients ≥40 years old with a smoking history who routinely visited the clinic for their CVD. Each patient completed the COPD Assessment Test prior to spirometry testing. Data were available for 995 patients with a mean age of 66.6±10.0 years, of whom 95.5% were male. The prevalence of airflow limitation compatible with COPD was 27.0%, and 87.7% of those patients did not have a prior diagnosis of COPD. The prevalence of previously diagnosed airflow limitation was higher in sites with higher usage of lung function testing (14.0%, 15.2% respectively) compared against sites where it is performed seldom (11.1%), but was still low. The researchers concluded that a quarter of outpatients with CVD have COPD, almost all of whom are undiagnosed. This suggests that it is important to look routinely for COPD in CVD outpatients.

For more information: http://tinyurl.com/nh6eq5f

COPD World News Week of August 17, 2014

One in 10 Cancer Survivors Still Smoke Years Later, Study Finds

New York, NY - 10 percent of people who survive cancer are still smoking a decade later, a new study from the American Cancer Society shows. Experts said the findings, reported online Aug. 6 in the journal Cancer Epidemiology, Biomarkers and Prevention, show that some cancer survivors need ongoing help with kicking the smoking habit. The study also underscores how tough it can be to quit tobacco, said Dr. Norman Edelman, senior medical advisor to the American Lung Association. "Am I surprised by the findings? No," said Edelman, who was not involved in the study. "It's consistent with what I've seen in clinical practice. With cancer survivors, one of the problems we have is convincing them there's a point [to quitting]." Yet it's clear there is a point, Edelman said, since kicking the habit may lower the odds of not only a cancer recurrence, but also such killers as emphysema and heart disease. "Smoking can kill you in a lot of ways," Edelman said. The new findings are based on nearly 3,000 U.S. adults taking part in a long-term study of cancer survivors. "We really haven't known what happens [to smoking habits] years after a person's cancer diagnosis," said lead researcher Lee Westmaas, director of tobacco control research at the cancer society. His team found that over 9 percent of cancer survivors were smoking almost a decade after their diagnosis. "And they were smoking pretty heavily," Westmaas said. Current smokers averaged 15 cigarettes a day, though 40 percent smoked more than that. What's more, people who had survived lung or bladder cancers -- two cancers closely linked to tobacco -- had the highest rates of current smoking (at 15 percent and 17 percent, respectively). Edelman was not surprised that lung cancer survivors were among the most likely to still be smoking. "These are the hard-core smokers," he said. "Smoking cessation is not easy for them. It takes a lot of patience. Rarely do people quit on the first try." Westmaas said it's not clear whether some of the persistent smokers had tried to quit but were unsuccessful. The "good news," he added, is that of study participants who were smoking at the time of their diagnosis, one-third did manage to quit.
According to Westmaas, the findings suggest that doctors "could do a better job" of asking cancer survivors about their smoking habits, and helping them to quit. "For these patients," he said, "quitting smoking is the single best thing they can do to increase their survival and improve their general health in the long run." And it's never too late to quit, according to Jamie Ostroff, director of the tobacco treatment program at Memorial Sloan Kettering Cancer Center in New York City. "There is scientific evidence that quitting smoking improves cancer patients' prognosis," Ostroff said. That means not only better odds of surviving the cancer, but also better overall health in the long run, she noted. So quitting is key for all cancer patients, Ostroff said -- and not just those with types of cancer that are clearly linked to smoking. "We have safe and effective ways to quit smoking, and they should be offered to all cancer patients," Ostroff said. Among the options are nicotine replacement therapy, medications and behavioral counseling. And most people need help. According to the cancer society, only 4 percent to 7 percent of smokers are able to quit on their own on the first try. The reality, Edelman said, is that most people need to make several attempts before they quit for good.

For more information: http://www.nlm.nih.gov/medlineplus/news/fullstory_147710.html

COPD World News Week of August 10, 2014

FDA Approves Long-Acting COPD Inhaler

Washington, DC - The FDA approved another once-daily bronchodilator, olodaterol (Striverdi Respimat), for maintenance treatment of chronic obstructive pulmonary disease (COPD). Approved indications for the long-acting beta-adrenergic agonist (LABA) drug included long-term use in cases including chronic bronchitis and emphysema with airflow obstruction. The agency warned that olodaterol shouldn't be used in rapidly deteriorating cases or for rescue therapy in acute bronchospasm. It can cause serious side effects, including narrowing and obstruction of the respiratory airway (paradoxical bronchospasm) and cardiovascular effects, the FDA warned. Olodaterol hasn't been proven or approved for treatment of asthma and carries a boxed warning that drugs in the LABA class increase the risk of asthma-related death, the FDA stressed. The approval followed near-unanimous backing from an FDA advisory panel in January, despite what agency reviewers called modest benefit. Three of the four 48-week trials of olodaterol in COPD showed improvement in pulmonary function with the drug. Forced expiratory volume in 1 second (FEV1) improved by 0.164 L, 0.134 L, 0.151 L, and 0.129 L (P<0.0001) on average within 3 hours after taking olodaterol via inhaler. The trough FEV1 response rates were less dramatic, albeit significant, with differences over placebo of 0.084 L, 0.033 L, 0.078 L, and 0.053 L across the four 48-week trials. While there are plenty of other bronchodilators and LABAs already on the market in COPD, it's useful to have another option, commented Stephen Rennard, MD, of the University of Nebraska Medical Center in Omaha. "Having multiple choices available is really essential," he said. "I don't know how many we need. But because there's a dramatically large number of people that are undertreated or untreated with COPD, we clearly need more than we've got." Choosing among the options goes back to mechanism of action, duration of action, and slight differences in efficacy based on how full an agonist a drug is, he said. Olodaterol is also being assessed for use in a combination inhaler with tiotropium, and combinations are where the field is moving, Rennard suggested. Not only is a single inhaler more convenient, but real-world efficacy appears better with fixed-dose inhalers, he said. "I'm enthusiastic," he said. "Adherence is maybe the big part of it ... but at the end of the day, if the patient is doing better that's all you care about." The most common side effects reported with single-agent olodaterol in the trials were nasopharyngitis, upper respiratory tract infection, bronchitis, cough, urinary tract infection, dizziness, rash, diarrhea, back pain, and arthralgia. The drug is distributed by Boehringer Ingelheim.

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

COPD World News Week of August 3, 2014

Patch Plus Pill Better to Help Smokers Quit

Cape Town, SA - Adding a nicotine patch to varenicline (Chantix) during quit-smoking attempts substantially improved short-term success in kicking the addiction, a trial showed. The combination boosted the exhaled carbon monoxide-confirmed continuous abstinence rate for the final 4 weeks of a 3-month treatment period to 55.4%, compared with 40.9% with varenicline alone, Coenraad Koegelenberg, MD, PhD, of Stellenbosch University in Cape Town, South Africa, and colleagues found. The odds of confirmed, continued abstinence at 6 months remained nearly double that with varenicline alone. The number needed to treat for one additional successful quit attempt was seven, the researchers reported in the July 9 issue of the Journal of the American Medical Association. Both products target the same class of nicotine receptors, so it's not entirely clear why there is additive efficacy, they noted. One possibility is that the fast onset of varenicline and slower onset of nicotine from the patch are better for receptor agonism, the group suggested. The combination of a long-acting nicotine replacement therapy and a short-acting one has been shown more effective than a single formulation alone and roughly equivalent to varenicline alone in previous studies. One prior clinical trial had shown no difference in adding nicotine replacement therapy to varenicline but was likely underpowered. The greater statistical power from this larger, longer, and more rigorously performed trial likely explains the difference, suggested Hal Strelnick, MD, chief of community health at Albert Einstein College of Medicine in New York City, who was not involved with the study. "I think this will aid particularly smokers who've had difficultly quitting before but who are still highly motivated to quit," he said. "I'm rooting for this to hold up with further studies." The labeling for varenicline currently recommends against combination with nicotine replacement, and it's likely to take more studies to prompt the FDA to approve a change, Strelnick noted. Any impact on varenicline's rare side effects of depression, suicidality, and cardiovascular events couldn't be determined from a trial like Koegelenberg's, he pointed out. "Further studies are needed to assess long-term efficacy and safety," the researchers agreed, cautioning that their study wasn't adequately powered for safety and tolerability endpoints for even the more common events. Their trial included 446 generally healthy smokers who sought help with tobacco cessation at seven centers in South Africa who were randomized to blinded treatment over a 12-week treatment period and a further 12 weeks of follow-up. Nicotine or placebo patch treatment began 2 weeks before the target quit date; varenicline started 1 week prior to the target quit date and was tapered off during week 13. Among the secondary endpoints, the confirmed continuous abstinence rate from weeks nine through 24 came out at 49.0% with the varenicline and nicotine patch combination compared with 32.6% with varenicline and the placebo patch. The fairly healthy population, "as well as the specific timing of initiation of both interventions and the tapering of varenicline, may differ from the everyday practice and limit the generalizability of our findings," they added. "Future studies should include a broader range of smokers, other forms of nicotine replacement therapy, and more detailed assessments of tolerability and cost/benefit comparisons with alternative therapies."

For more information: http://tinyurl.com/ljvrnj6

COPD World News Week of July 27, 2014

Flu Can Infect Many Without Causing Symptoms

Oxford, UK - Think you know who has the flu? Think again: a new study finds that three-quarters of people infected with seasonal flu and swine flu in recent years showed no symptoms. Researchers analyzed data gathered in England during the winter flu seasons between 2006 and 2011, including the 2009 H1N1 "swine flu" pandemic. Overall, about 18 percent of unvaccinated people became infected with an influenza virus, but only 23 percent of them went on to develop flu symptoms, the researchers reported March 16 in The Lancet Respiratory Medicine. What's more, only about 17 percent of infected people became ill enough to see a doctor, the British study found. And compared with some of the seasonal flu strains, the 2009 swine flu strain actually caused much milder symptoms. The findings suggest that relying on data about flu-related visits to primary care doctors underestimates the extent of flu infections and illnesses, the researchers said. Overall, the infection rate for the winter flu seasons as calculated in the study were an average of 22 times higher than the rates recorded by standard methods. "Reported cases of influenza represent the tip of a large clinical and subclinical iceberg that is mainly invisible to national surveillance systems that only record cases seeking medical attention," study lead author Dr. Andrew Hayward, of University College London, said in a journal news release. "Most people don't go to the doctor when they have flu," he added. "Even when they do consult they are often not recognized as having influenza. Surveillance based on patients who consult greatly underestimates the number of community cases, which in turn can lead to overestimates of the proportion of cases who end up in hospital or die." An important question that needs to be answered is whether people who have the flu but have only mild or no symptoms can still easily pass on the virus, Dr. Peter William Horby from the Oxford University Clinical Research Unit in Vietnam, wrote in an accompanying editorial. Even if only mildly infectious, a large number of these people could play a major role in spreading flu each season, he suggested.

For more information: http://www.nlm.nih.gov/medlineplus/news/fullstory_145139.html

COPD World News Week of July 20, 2014

Doctors turning to metal coils for new emphysema treatment

Saint Foy-Quebec City, PQ - Doctors in Canada, the United States and Europe are experimenting with a new treatment that involves inserting Slinky-like metal coils into damaged portions of the lungs to restore their lost elasticity, allowing patients to breathe normally. “What the coil does, actually, is it acts like a spring,” said Dr. Antoine Delage, of the Institut Universitaire De Cardiologie Et De Pneumologie in Quebec. “It recoils the lung back to a smaller size, so it’s easier for these patients to breathe.” Emphysema develops when the lungs become damaged, usually from a lifetime of smoking. As the damage builds up, the lungs lose their elasticity and have greater difficulty expanding and contracting. The chronic disease worsens over time, making it even more difficult for sufferers to breathe. Emphysema is sometimes treated by simply cutting out the stiff, diseased lung tissue. Taking medication or specialized exercise programs can also help slow the disease. But this coil treatment is something new that doctors can soon offer patients, Delage says.To insert the coils, doctors place a narrow tube inside a patient’s nose or mouth before threading the tiny coil into the airway of the lung. The coil then attaches to the diseased tissue and pulls it tight, compressing the unhealthy portion of the lung. This gives healthier lung tissue room to expand; several coils can be inserted to improve overall lung capacity. Early studies suggest that patients who’ve undergone the treatment report improved lung function and the ability to exercise. However, more research is needed to determine which patients are best-suited for the treatment. Doctors say they are looking to test the treatment on 300 patints, screening for possible side effects like infection and pneumonia. Final results are expected early next year.

For more information: http://tinyurl.com/n6vp28j

COPD World News Week of July 13, 2014

Patch Plus Pill Better to Help Smokers Quit

Cape Town, SA - Adding a nicotine patch to varenicline (Chantix) during quit-smoking attempts substantially improved short-term success in kicking the addiction, a trial showed. The combination boosted the exhaled carbon monoxide-confirmed continuous abstinence rate for the final 4 weeks of a 3-month treatment period to 55.4%, compared with 40.9% with varenicline alone, Coenraad Koegelenberg, MD, PhD, of Stellenbosch University in Cape Town, South Africa, and colleagues found. The odds of confirmed, continued abstinence at 6 months remained nearly double that with varenicline alone. The number needed to treat for one additional successful quit attempt was seven, the researchers reported in the July 9 issue of the Journal of the American Medical Association. Both products target the same class of nicotine receptors, so it's not entirely clear why there is additive efficacy, they noted. One possibility is that the fast onset of varenicline and slower onset of nicotine from the patch are better for receptor agonism, the group suggested. The combination of a long-acting nicotine replacement therapy and a short-acting one has been shown more effective than a single formulation alone and roughly equivalent to varenicline alone in previous studies. One prior clinical trial had shown no difference in adding nicotine replacement therapy to varenicline but was likely underpowered. The greater statistical power from this larger, longer, and more rigorously performed trial likely explains the difference, suggested Hal Strelnick, MD, chief of community health at Albert Einstein College of Medicine in New York City, who was not involved with the study. "I think this will aid particularly smokers who've had difficultly quitting before but who are still highly motivated to quit," he said. "I'm rooting for this to hold up with further studies." The labeling for varenicline currently recommends against combination with nicotine replacement, and it's likely to take more studies to prompt the FDA to approve a change, Strelnick noted. Any impact on varenicline's rare side effects of depression, suicidality, and cardiovascular events couldn't be determined from a trial like Koegelenberg's, he pointed out. "Further studies are needed to assess long-term efficacy and safety," the researchers agreed, cautioning that their study wasn't adequately powered for safety and tolerability endpoints for even the more common events. Their trial included 446 generally healthy smokers who sought help with tobacco cessation at seven centers in South Africa who were randomized to blinded treatment over a 12-week treatment period and a further 12 weeks of follow-up. Nicotine or placebo patch treatment began 2 weeks before the target quit date; varenicline started 1 week prior to the target quit date and was tapered off during week 13. Among the secondary endpoints, the confirmed continuous abstinence rate from weeks nine through 24 came out at 49.0% with the varenicline and nicotine patch combination compared with 32.6% with varenicline and the placebo patch. The fairly healthy population, "as well as the specific timing of initiation of both interventions and the tapering of varenicline, may differ from the everyday practice and limit the generalizability of our findings," they added. "Future studies should include a broader range of smokers, other forms of nicotine replacement therapy, and more detailed assessments of tolerability and cost/benefit comparisons with alternative therapies."

For more information: http://tinyurl.com/ljvrnj6

COPD World News Week of July 6, 2014

Cutting Cigarette Scenes From TV Shows May Have Helped Reduce Smoking

Philadelphia, PA - Scenes of cigarette use have become less common on prime-time television shows, and it may be linked to reduced smoking rates in the United States, a new study suggests. Researchers from the Annenberg Public Policy Center at the University of Pennsylvania in Philadelphia looked at cigarette use depicted in more than 1,800 hours of popular U.S. prime-time dramas broadcast between 1955 and 2010. They also looked at smoking rates among adults during that period. Scenes involving cigarette use on such shows fell from nearly five scenes per hour of programming (excluding commercials) in 1961 to about 0.3 scenes per hour in 2010, according to the study published online April 3 in the journal Tobacco Control. After taking cigarette prices and other factors into account, the researchers concluded that one less depiction of smoking per hour over two years of prime-time programming was associated with an overall drop of almost two packs of cigarettes (38.5 cigarettes) a year for every adult. This impact of fewer smoking scenes in prime-time shows is significant and half as large as the impact of higher cigarette prices, according to the researchers. However, they said the fact that cigarette use is still shown on TV shows may have prevented an even faster decline in rates of smoking, which is the leading cause of preventable death in the United States, according to a journal news release. The new findings add to previous research showing that seeing other people smoke prompts cigarette cravings in adult smokers, the study authors said. Further research is needed to learn more about how depictions of smoking in other media, such as cable TV and YouTube, affect smoking rates, they concluded.

For more information:http://news.health.com/2014/04/04/cutting-cigarette-scenes-from-tv-shows-may-have-helped-reduce-smoking/