COPD World News
COPD World News - Week of February 11, 2018
Many smokers are not honest about quitting
Kansas City, KA - Almost half (40%) of recently hospitalized smokers enrolled in smoking cessation trials fail biochemical verification of self-reported abstinence from smoking, according to a recent study published in the journal Addiction and summarized on-line by MDLinx. “Participants may feel pressure to say they have quit when they have not, so it is essential in studies to verify claims of quitting using an objective test such as cotinine to know true quit rates,” said lead author Taneisha Scheuermann, PhD, researcher, University of Kansas Cancer Center, Kansas City, KA. In the body, nicotine is converted into cotinine by the liver. Measuring cotinine via saliva sampling is a highly accurate measure of whether someone has smoked in the past few days. Dr. Scheuermann and fellow researchers conducted this study, therefore, to estimate the prevalence and possible predictors of failed biochemical verification of self-reported smoking abstinence in subjects enrolled in trials of hospital-initiated smoking cessation interventions. They compared characteristics in subjects who verified, and those who failed to verify, self-reported smoking cessation. They included 1,178 recently hospitalized smokers reporting tobacco abstinence for 6 months after randomization, who provided a saliva sample for verification, and who were enrolled in multi-site randomized clinical trials performed between 2010 and 2014 in hospitals throughout the US. Adequate saliva samples were returned by 822 subjects, who reported that they had quit smoking for the past 7 days. In all, 57.8% of subjects were verified as quitting when the 10 ng/mL cut-off was used and 60.6% were verified at the 15 ng/mL cut-off). Researchers found that the factors independently associated with verification at the 10 ng/mL cut-off included education beyond high school, continuous abstinence since hospitalization, mailed vs in-person sample and race. African American subjects were less likely to verify abstinence compared with white subjects. These findings were similar for verification at the 15 ng/mL cut-off, and verification rates did not differ by treatment group. Misreporting may have been even higher, as 18.6% of subjects who said they had quit smoking did not reply, despite multiple attempts and an offer of $50 to $100 for providing a sample. Yet Dr. Scheuermann noted that the most important tool in helping smokers quit is not a biological test, but rather, the patient-provider relationship. Providers must recognize how difficult overcoming an addiction can be. “Providers can create a non-judgmental, collaborative atmosphere that will help smokers better engage in the treatment process and discuss when they slip and smoke. They should tell patients that they know it’s hard to quit, and that they’re prepared to help patients change medications and sources of support until they get the right combination—the one that helps the patient quit,” she said. Still, if patients do not accurately report their tobacco habits, providers cannot provide the best care. “It’s hard to quit smoking. Slips and relapses are part of the normal process for quitting. We encourage smokers to be open with their health care providers about their struggles to quit. Providers can help them switch tactics to figure out the best strategy to help them quit for good,” Dr. Scheuermann concluded.
For more information: https://tinyurl.com/yaah8hbe
COPD World News - Week of February 4, 2018
Researchers confirm link between flu and heart attack
Toronto, ON - In the study published in the January 25 issue of the New England Journal of Medicine, the researchers found a significant association between acute respiratory infections, particularly influenza, and acute myocardial infarction. The risk may be higher for older adults, patients with influenza B infections, and patients experiencing their first heart attack. The researchers also found elevated risk – albeit not as high as for influenza – with infection from other respiratory viruses. “Our findings, combined with previous evidence that influenza vaccination reduces cardiovascular events and mortality, support international guidelines that advocate for influenza immunization in those at high risk of heart attacks,” says Kwong. The researchers looked at nearly 20,000 Ontario adult cases of laboratory-confirmed influenza infection from 2009 to 2014 and identified 332 patients who were hospitalized for a heart attack within one year of a laboratory-confirmed influenza diagnosis. “People at risk of heart disease should take precautions to prevent respiratory infections, and especially influenza, through measures including vaccinations and handwashing,” says Kwong. The researchers add that patients should not delay medical evaluation for heart symptoms particularly within the first week of an acute respiratory infection. The author block includes: Kwong JC, Schwartz KL, Campitelli MA, Chung H, Crowcroft NS, Karnauchow T, Katz K, Ko DT, McGeer AJ, McNally D, Richardson D, Rosella LC, Simor A, Smieja M, Zahariadis G, Gubbay JB. The article is titled, “Acute myocardial infarction after laboratory-confirmed influenza infection”
For more information: https://tinyurl.com/y7nybjfb
COPD World News - Week of January 28, 2018
Smoking duration provides stronger risk estimate of COPD than pack-years
London, UK – Researchers here stated that cigarette smoking is the strongest risk factor for COPD. Smoking burden is frequently measured in pack-years, but the relative contribution of cigarettes smoked per day versus duration towards the development of structural lung disease, airflow obstruction and functional outcomes is not known. The researchers analysed cross-sectional data from a large multicentre cohort (COPDGene) of current and former smokers. Primary outcome was airflow obstruction (FEV1/FVC); secondary outcomes included five additional measures of disease: FEV1, CT emphysema, CT gas trapping, functional capacity (6 min walk distance, 6MWD) and respiratory morbidity (St George’s Respiratory Questionnaire, SGRQ). Generalised linear models were estimated to compare the relative contribution of each smoking variable with the outcomes, after adjustment for age, race, sex, body mass index, CT scanner, centre, age of smoking onset and current smoking status. We also estimated adjusted means of each outcome by categories of pack-years and combined groups of categorised smoking duration and cigarettes/day, and estimated linear trends of adjusted means for each outcome by categorised cigarettes/day, smoking duration and pack-years. Results were based on 10,187 subjects. For FEV1/FVC, standardised beta coefficient for smoking duration was greater than for cigarettes/day and pack-years. After categorisation, there was a linear increase in adjusted means FEV1/FVC with increase in pack-years and duration over all ranges of smoking cigarettes/day but a relatively flat slope for cigarettes/day across all ranges of smoking duration. Strength of association of duration was similarly greater than pack-years for emphysema, gas trapping, FEV1, 6MWD and SGRQ. The researchers concluded that smoking duration alone provides stronger risk estimates of COPD than the composite index of pack-years. The study was recently published in the British Thoracic Society’s journal Thorax.
For more information: http://thorax.bmj.com/content/early/2018/01/11/thoraxjnl-2017-210722?rss=1
COPD World News - Week of January 21, 2018
Respimat inhaler awarded Arthritis Foundation’s ease of use commendation
Ridgefield, CT - The Arthritis Foundation has recently recognized Respimat by awarding the inhaler an ease of use commendation. “The Arthritis Foundation awards its Ease of Use Commendation when a product’s design or packaging has been proven to make taking medication easy and comfortable for people living with arthritis,” said Cindy McDaniel, Senior Vice President, Consumer Health, Arthritis Foundation. “To earn this Commendation, the Respimat inhaler went through a series of evaluations from experts and people living with arthritis.” The Respimat inhaler was designed to deliver the medication through a slow-moving mist, which gets medicine deep into patients’ lungs. The slow-moving mist of the Respimat inhaler provides patients with enough time to breathe in the medication. In addition, the Respimat inhaler operates independent of inspiratory effort, helping patients effectively breathe the medicine into their lungs without having to sharply inhale the medicine. As with all inhaled drugs, the actual amount of drug delivered to the lung may depend on patient factors, such as coordination between actuation of the inhaler and inspiration through the delivery system. The duration of inhalation should be at least as long as the spray duration (1.5 seconds). To earn the Ease of Use Commendation, the Respimat inhaler was independently tested by experts at the Intuitive Design Applied Research Institute(link is external) lab in Atlanta and evaluated by people with arthritis. “We are proud of our Respimat inhaler as being the first and only inhaler recognized by the Arthritis Foundation as easy-to-use for everyone,” said Jean-Michel Boers, president, Human Pharma, Boehringer Ingelheim Pharmaceuticals, Inc. “For nearly a century, we have been committed to advancing care for serious respiratory diseases, and the Respimat inhaler is an important achievement as part of this long-standing commitment.” Boehringer Ingelheim’s Respimat family of products includes four FDA-approved medicines for COPD as well as one for asthma.
For more information: https://tinyurl.com/yd4adomy
Genetic Lung Variants May Identify COPD Risk
New York, NY - Genetic variations in the anatomy of the lungs could potentially identify smokers at high risk for developing chronic obstructive pulmonary disease (COPD), researchers reported. Inherited lung central airway branch variants were identified in about a quarter of the study population using CT scanning, and the most commonly seen variant was associated with higher COPD and chronic bronchitis prevalence in smokers and nonsmokers, according to Benjamin M. Smith, MD, of Columbia University Medical Center in New York City, and McGill University in Montreal, and colleagues. The second most common airway branch variant was associated with higher COPD risk among smokers, but not non-smokers they wrote in the Proceedings of the National Academy of Sciences. "The central airway tree develops early in life," Smith said. "We found that central airway branch variants, which are easily detected with standard clinical CT, were associated with higher odds of COPD later in life. These findings suggest that the central airway tree may be a useful biomarker to identify people at higher or lower COPD risk." James Kiley, MD, director of the division of lung diseases at the National Heart Lung and Blood Institute, noted that the findings raise interesting questions for researchers. "Understanding precisely why these genes influence the development of COPD may lead to entirely new and more effective ways of preventing or treating this disease," Kiley noted in a press statement. "This novel study suggests that a CT scan, which is widely available, can be used to measure airway structure and predict who is at higher risk for smoke-induced lung injury." Other than smoking risk, susceptibility to COPD is poorly understood. "Cigarette smoking is the major COPD risk factor, but COPD is not rare among those who have never smoked cigarettes and many smokers do not develop COPD," Smith's group wrote. "Furthermore, approximately half of older adults with COPD exhibit low lung function early in life. These observations suggest that host factors beyond smoking may contribute to COPD risk and may create opportunities for personalized disease prevention and treatment." Genome-wide association studies (GWAS) have identified several genes that regulate tracheobronchial tree formation in utero, which may influence susceptibility to COPD and other lung diseases, they noted. Smith's demonstrated that lower-lobe segmental airway branch variants were common among participants in the large Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study, which included both non-smokers and current and former smokers.
For more information: https://tinyurl.com/yapy49bb
COPD World News - Week of January 14, 2018
Hamilton hospitals over capacity as flu season surges
Hamilton, ON - Emergency rooms in Hamilton are over capacity, as local hospitals feel the strain of flu season spreading through the city. Health officials across the country are reporting higher than normal lab-confirmed cases of the flu. Hamilton has mostly dodged that bullet, local officials say, with numbers sitting in the mid-level range for what the city usually experiences around this time of year. The face of health-care cuts were illustrated as a grandmother dies and while no paramedics were available to help Flu activity in Canada 'high' and continuing to rise, latest public health numbers say. But even without a larger-than-normal spike, hospitals are still over capacity, says Ian Preyra, chief of emergency medicine at St. Joseph's Hamilton. St. Joes is currently 28 beds over capacity due to the surge. "When we're over capacity, it's not just a number. People really feel it," Preyra said. "It means those ambulances can't be offloaded, patients may wait longer, and patients who are admitted to hospital may wait to find a bed." As is the norm when hospitals are crowded, code zero ambulance events — which is when there is only one or fewer ambulances across the service's entire fleet available for a call — have spiked. There have been 16 code zeros in Hamilton already this month, only halfway through January. Code zero ambulance events have spiked in January during flu season, city statistics show. (CBC) Last year there were 21 code zero events in all of January, and that was the highest number for a single month in the whole year. The union representing local paramedics has long said code zeros are dangerous. Union officials say they're caused by a surge in call volumes for help, coupled with increasingly long wait times offloading patients in local hospitals. Hamilton Health Sciences is operating over capacity too, said spokesperson Lillian Badzioch in an email. "Our adult medical/surgical bed occupancy rate has been consistently over 105 per cent since October 2016 and was 114 per cent yesterday (Jan. 15)," she wrote. Emergency department physicians have also identified that there has been an increase in overall respiratory complaints and that overall volume has gone up, she said. In the first week of January there were 44 lab-confirmed cases of flu in Hamilton, according to the city. There were 19 the week before, in the last week of 2017. That's a middle-of-the-road situation for what Hamilton sees most years, said Dr. Ninh Tran, associate medical officer of health. "That will give us a sense as to if the trend is going up," Tran said. While Hamilton's numbers remain relatively steady, the number of people stricken by flu continues to rise across the country, with 15,572 laboratory-confirmed cases for the season to date.
For more information: http://www.cbc.ca/news/canada/hamilton/emergency-room-flu-1.4489745
COPD World News - Week of January 7, 2018
Study suggests dietary antioxidants slow lung function decline
Hamburg and Erfurt in Germany; Ipswich and Norwich in the UK; and Bergen in Norway - The relationship between lung function decline and dietary antioxidants over 10 years in adults from three European countries was investigated. Adults from three participating countries of the European Community Respiratory Health Survey (ECRHS) answered a questionnaire and underwent spirometry (forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC)), which were repeated 10 years later. Dietary intake was estimated at baseline with food frequency questionnaires (FFQ). Associations between annual lung function decline (mL) and diet were examined with multivariable analyses. A total of 680 individuals (baseline mean age 43.8±6.6 years) were included. A controlled increase in apple and banana intake was associated with a 3.59 mL·year−1 (95% CI 0.40, 7.68) and 3.69 mL·year−1 (95% CI 0.25, 7.14) slower decline in FEV1 and FVC, respectively. Tomato intake was also associated with a slower decline in FVC (4.5 mL·year−1; 95% CI 1.28, 8.02). Subgroup analyses showed that apple, banana and tomato intake were all associated with a slower decline in FVC in ex-smokers. Intake of fruits and tomatoes might delay lung function decline in adults, particularly in ex-smokers. One limitation of the study is that the researchers only had dietary assessments at baseline on one occasion for the three countries. They had to assume that diet remained relatively constant in adult life, and evidence for this exists. Investigations of the association between single nutrients and disease might not accurately reflect a specific dietary habit or dietary behaviour, as neither foods, nor nutrients are consumed in isolation. Information on nutrient supplementation was not collected, and we cannot rule out whether adjustment for this might have altered estimates. However, studies on nutrient supplementation and lung function have shown little evidence of an association. In conclusion, the study suggests that dietary factors might play a role in preserving ventilatory function in adults, by slowing down a decline in lung function. In particular, dietary antioxidants possibly contribute to restoration, following damage caused by exposure to smoking, among adults who have quit. The study was published in a recent edition of the European Respiratory Journal.
For more information: http://erj.ersjournals.com/content/50/6/1602286?ctkey=shareline