COPD World News - 2019


COPD World News - Week of June 23, 2019

Study finds that pulmonary rehab can improve patient activation

New South Wales, Australia - Patient activation is associated with health behaviors including lifestyle behaviors (exercise, diet), clinical indicators (body mass index [BMI], blood pressure, cholesterol), health service utilization (hospitalizations, use of emergency departments, participation in preventive screening and immunizations, and having regular checkup), and reporting better patient experience. Patient activation is defined as “having the knowledge, skill, and confidence to manage one’s health and health care”. Chronic disease self-management is important to manage symptoms, prevent complications, and participate in treatment decisions, and this requires a high level of activation. Previous research in people with chronic obstructive pulmonary disease (COPD) has shown that only a minority of people with COPD are activated for self-management, and patient activation can be influenced by anxiety, illness perception, BMI, age, disease severity, and comorbidities. An association between COPD and activation has also been shown to be dependent on social support. Patient activation is a significant predictor of health behaviors; however, the level of activation in people attending a pulmonary rehabilitation program and the effect of pulmonary rehabilitation on patient activation have not been measured. Furthermore, the potential determinants and relationship between patient activation and characteristics of people attending pulmonary rehabilitation have not previously been reported. The Patient Activation Measure (PAM) was measured in people with a chronic respiratory disease or congestive cardiac failure at a baseline pulmonary rehabilitation assessment and again at the completion of the 8-week outpatient program. This study included 194 people with chronic respiratory disease or congestive cardiac failure (41% male; mean [standard deviation, SD] age: 73 [11] years; mean [SD] forced expiratory volume in 1 second % predicted: 60% [20%]). The pulmonary rehabilitation program was completed by 61% (n = 118) of participants. The mean (SD) PAM score at baseline was 60.5 (15.7), which improved to 65.4 (15.5) after completion of the pulmonary rehabilitation program (P = .001). In a stepwise forward multiple regression analysis, anxiety, lung information needs, and health-related quality of life impact were found to be significant determinants of baseline PAM. This model explained 12% (P < .001) of the variance. The researchers concluded that people with a chronic respiratory disease or congestive cardiac failure commencing a pulmonary rehabilitation program demonstrated a moderate level of activation, which improved following an 8-week hospital outpatient pulmonary rehabilitation program. Anxiety, a higher level of lung information needs, and greater health-related quality of life impact were significantly associated with poor patient activation. Lead author of the study; Renae J McNamara, Dept. of Physiotherapy, Prince of Wales Hospital, New South Wales, Australia.

For more information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6558947/

COPD World News - Week of June 16, 2019

Music and dance treatment in chronic lung disease

London, UK - Arts in Health interventions show potential to improve the quality of life of people with chronic lung disease. Listening to music, making music, and dance have accepted and established roles in the lives of people without chronic disease. However, their potential utility in chronic disease management is infrequently considered by medical professionals. The aim of this review is to examine the use of music and dance in the treatment and self-management of chronic lung disease. Although the evidence base is currently limited, existing research suggests a range of biopsychosocial benefits. As personalized medicine and social prescribing become more prominent, further research is required to establish the role of arts interventions in chronic lung disease. Physical activity and physical performance are important components of living well in chronic lung disease. Pulmonary rehabilitation is one of the most effective components of chronic disease management; however, access is highly variable, completion rates are often poor and benefits are often of limited duration. Therefore, other forms of physical activity and exercise training should be considered to complement formal pulmonary rehabilitation. A recent systematic review and meta-analysis found that dance interventions can be equally and occasionally more effective at improving a range of health outcomes compared with other forms of physical activity. With an appreciation of the impacts seen in other groups, dance groups for people with chronic lung disease now exist. This includes South Asian dance sessions in both community and hospital settings, and a community dance group in North London, UK. Furthermore, interest from other people with chronic lung disease in using music and dance as adjuncts to physical activity has also been shown. Other groups may well exist. There are currently no published studies on the impact of dance in chronic lung diseases. However, studies are taking place in Canada and the UK. Such approaches may also have applications in other countries. In South Africa, dance and exercise to music are being used on multidrug-resistant tuberculosis wards, with participants and staff giving very positive reports. In the Kyrgyz Republic, during stakeholder engagement for the development of a pulmonary rehabilitation program, the potential for including music and dance was highlighted as a particular area of enthusiasm and interest by both participants and staff delivering programs.

For more information: https://tinyurl.com/y3raoscy

COPD World News - Week of June 9, 2019

Council backs universal, single-payer, public pharmacare

Ottawa, ON - Canada should have a universal, single-payer, public pharmacare program, according to the final report of a federal advisory panel summarized in a recent edition of CMAJ. Health advocates are calling the report a victory for patients, 1 in 5 of whom are either uninsured or underinsured for medications. The current patchwork of public and private drug plans cannot handle the rising costs of medicines,  Pharmacare. A universal, single-payer, public pharmacare system will provide better coverage and save Canadians an estimated $5 billion a year, he told reporters Wednesday.  The advisory council’s 171-page report calls for the creation of a national drug agency to oversee universal coverage of a shortlist of essential medicines by 2022. This initial list would include about half of the most common prescriptions, and gradually expand to a comprehensive formulary by 2027. Under the proposed plan, Canadians would pay no more than $2 per prescription for essential medicines, and $5 per prescription for all other drugs on the national formulary, up to an annual limit of $100 per household. People with disabilities, those on social assistance and low-income seniors would not pay anything. The advisory council estimates the plan will cost an extra $15.3 billion annually by 2027. The report recommends the federal government cover these additional costs through a new targeted fund, separate from the Canada Health Transfer. “As with medicare, it will be up to individual provinces and territories to opt in to national pharmacare by agreeing to the national standards and funding parameters,” the report notes. Hoskins acknowledged that building pharmacare requires substantial public investment. However, “we can’t afford to push this aside,” he said. Canadians spent $34 billion on prescription medicines last year, and unless something changes, that could increase to $55 billion by 2027, Hoskins said. Per capita, only the United States and Switzerland pay more for drugs. Yet there are huge gaps in access, with 1 in 5 Canadians struggling to afford prescriptions. The advisory council estimates Canadian families will save an average $350 per year under national pharmacare, while business owners will save $750 per employee. According to Hoskins, it’s time to show “courage and boldness” to do “some nation building.” “This is our generation’s national project: better access to the medicines we need, improved health outcomes and a fairer and more sustainable prescription medicine system,” he said. Dr. Danielle Martin, vice-president of Women’s College Hospital in Toronto, called the report a victory for patients. “It’s patients who are bearing the brunt of the non-system we currently have, and it’s patients who are going to win when this report is implemented,” she said. Martin said that, in addition to gaps in access, the advisory council’s recommendations will address “the huge amounts of overprescribing we see happening in the absence of a coordinated, evidence-based formulary, and the massive overpayment we see happening because we’re not coordinating our purchasing power to get better prices.” Steve Morgan, a professor in the faculty of medicine at the University of British Columbia who has researched pharmacare extensively, noted that the council’s recommendations are “consistent with literally every major commission that’s looked at this question, all the way back to the 1940s.” Heading into a federal election, “the only party at the national level that would argue against this will be the Conservatives,” he said. However, the proposed eight-year window for implementing pharmacare may provide some political wiggle room. “That to me looks like it’s already putting this out two election cycles in the future,” Morgan said. Martin, meanwhile, hopes that political pressure during the election “can put the heat on elected officials to consider moving even more quickly.” In a statement, Health Minister Ginette Petitpas Taylor said the government will carefully review the advisory council’s final report and recommendations. “We know that our existing patchwork of drug coverage is not working well, leading to poorer health for some and higher costs for us all. We have to do better.”

For more information: https://tinyurl.com/y4qvm6sk

COPD World News - Week of June 2, 2019

FDA study gets to the heart of expired medicine and safety

Silver Spring, Maryland - The big question is, do pills expire? With a splitting headache, you reach into your medicine cabinet for some aspirin only to find the stamped expiration date on the medicine bottle is more than a year out of date. So, does medicine expire? Do you take it or don't you? If you decide to take the aspirin, will it be a fatal mistake or will you simply continue to suffer from the headache? This is a dilemma many people face in some way or another. A column published in Psychopharmacology Today offers some advice. It turns out that the expiration date on a drug does stand for something, but probably not what you think it does. Since a law was passed in 1979, drug manufacturers are required to stamp an expiration date on their products. This is the date at which the manufacturer can still guarantee the full potency and safety of the drug. Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military. With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90% of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date. So the expiration date doesn't really indicate a point at which the medication is no longer effective or has become unsafe to use. Medical authorities state if expired medicine is safe to take, even those that expired years ago. A rare exception to this may be tetracycline, but the report on this is controversial among researchers. It's true the effectiveness of a drug may decrease over time, but much of the original potency still remains even a decade after the expiration date. Excluding nitroglycerin, insulin, and liquid antibiotics, most medications are as long-lasting as the ones tested by the military. Placing a medication in a cool place, such as a refrigerator, will help a drug remain potent for many years. Is the expiration date a marketing ploy by drug manufacturers, to keep you restocking your medicine cabinet and their pockets regularly? You can look at it that way. Or you can also look at it this way: The expiration dates are very conservative to ensure you get everything you paid for. And, really, if a drug manufacturer had to do expiration-date testing for longer periods it would slow their ability to bring you new and improved formulations. The next time you face the drug expiration date dilemma, consider what you've learned here. If the expiration date passed a few years ago and it's important that your drug is absolutely 100% effective, you might want to consider buying a new bottle. And if you have any questions about the safety or effectiveness of any drug, ask your pharmacist. He or she is a great resource when it comes to getting more information about your medications.

For more information: https://tinyurl.com/y7geve67

COPD World News - Week of May 26, 2019

Study investigates self-management of COPD

Reykjavik, Iceland – A recent study by Jonina Sigurgeirsdottir and colleagues at the Faculty of Medicine, University of Iceland, looked at patients’ experiences, self-reported needs, and needs-driven strategies to cope with self-management of COPD. In this phenomenological study, 10 participants with mild to severe COPD were interviewed 1–2 times, until data saturation was reached. In total, 15 in-depth interviews were conducted, recorded, transcribed, and analyzed. The results concluded that COPD negatively affected participants’ physical and psychosocial well-being, their family relationships, and social life. They described their experiences of COPD like fighting a war without weapons in an ever-shrinking world with a loss of freedom at most levels, always fearing possible breathlessness. Fourteen needs were identified and eight clusters of needs-driven strategies that participants used to cope with self-management of COPD. Coping with the reality of COPD, a life-threatening disease, meant coping with dyspnea, feelings of suffocation, indescribable smoking addiction, anxiety, and lack of knowledge about the disease. Reduced participation in family and social life meant loss of ability to perform usual and treasured activities. Having a positive mindset, accepting help and assuming healthy lifestyle was important, as well as receiving continuous professional health care services. The participants’ needs-driven strategies comprised conducting financial arrangements, maintaining hope, and fighting their smoking addiction, seeking knowledge about COPD, thinking differently, facing the broken chain of health care, and struggling with accepting support. Procrastination and avoidance were also evident. Finally, the study also found that participants experienced a perpetuating cycle of dyspnea, anxiety, and fear of breathlessness due to COPD which could lead to more severe dyspnea and even panic attacks. The researchers concluded COPD negatively affects patients’ physical and psychosocial well-being, family relationships and, social life. Identifying patients’ self-reported needs and needs-driven strategies can enable clinicians to empower patients by educating them to improve their self-management.

For more information: https://www.dovepress.com/articles.php?article_id=45880

COPD World News - Week of May 19, 2019

Air pollution may be damaging every organ in the body

Chicago, IL - Air pollution may be damaging every organ and virtually every cell in the human body, according to a comprehensive new global review. The research shows head-to-toe harm, from heart and lung disease to diabetes and dementia, and from liver problems and bladder cancer to brittle bones and damaged skin. Fertility, fetuses and children are also affected by toxic air, the review found. The systemic damage is the result of pollutants causing inflammation that then floods through the body and ultrafine particles being carried around the body by the bloodstream. Air pollution is a “public health emergency”, according to the World Health Organization, with more than 90% of the global population enduring toxic outdoor air. New analysis indicates 8.8m early deaths each year – double earlier estimates – making air pollution a bigger killer than tobacco smoking. But the impact of different pollutants on many ailments remains to be established, suggesting well-known heart and lung damage is only “the tip of the iceberg”. “Air pollution can harm acutely, as well as chronically, potentially affecting every organ in the body,” conclude the scientists from the Forum of International Respiratory Societies in the two review papers, published in the journal Chest. “Ultrafine particles pass through the [lungs], are readily picked up by cells, and carried via the bloodstream to expose virtually all cells in the body.” Prof Dean Schraufnagel, at the University of Illinois at Chicago and who led the reviews, said: “I wouldn’t be surprised if almost every organ was affected. If something is missing from the review it is probably because there was no research yet.” The review represents “very strong science”, said Dr Maria Neira, WHO director of public and environmental health: “It adds to the very heavy evidence we have already. There are more than 70,000 scientific papers to demonstrate that air pollution is affecting our health.” She said she expected even more impacts of air pollution to be shown by future research: “Issues like Parkinson’s or autism, for which there is some evidence but maybe not the very strong linkages, that evidence is coming now.”

For more information: https://tinyurl.com/yy2cqckw

COPD World News - Week of May 12, 2019

The burdens of living with COPD studied

Motala, Sweden – A recent study led by Helena Johansson of the Department of Medicine, Linkoping University, Motala, Sweden looked at the consequences of symptom burden of COPD. Chronic obstructive pulmonary disease is a prevalent illness that, due to its symptoms and treatment, entails a significant burden for the affected person, and his/her family, health care and private finances. The researchers believed that knowledge and understanding are sparse regarding COPD-affected persons’ own lived experiences and about the symptom burden and its effect on their daily life. Due to this knowledge gap the aim of their study was to identify and describe the symptom burden and its effect on daily life in people with COPD, based on their own lived experiences. Eleven males and 14 females in GOLD stages III and IV, in an age range of 58–82 years, were interviewed. An interview guide was used to direct the face-to-face interviews. Data was analyzed with thematic analysis following the six steps according to Braun and Clarke. The results highlighted one theme: an altered everyday life. The altered everyday life leads to a need for support to handle everyday life and for different strategies to live as desired. Persons with COPD need to take each day as it comes and their life is not easy to plan since it depends on how they feel from day to day. Life is handled with several strategies such as breathing techniques, and ways to take care of the home and garden as well as the emotions. Support from the next of kin, society and the health care service is important. This study provides the insight that persons with COPD in stages III and IV have an altered life caused by the symptom burden. They must struggle with strategies to handle everyday life. There is a need of support from the next of kin and society to facilitate daily living, but this support needs to be well-balanced.

For more information: https://tinyurl.com/yylfk6zw

COPD World News - Week of May 5, 2019

Sex-related differences in management of COPD patients 

Orebro, Sweden – A recent study led by researcher Joakim Aberg of the School of Medicine, Orebro University, Orebro, Sweden looked at the differences by sex in the care of patients with COPD. Women with chronic obstructive pulmonary disease (COPD) have more symptoms, more exacerbations, lower health status scores, and more comorbidity. However, it is unclear whether management of COPD differs by sex. They looked at a population included 1329 primary and secondary care patients with a doctor´s diagnosis of COPD in central Sweden. Data were obtained from patient questionnaires and included patient characteristics and data on achieved COPD care. Analyses included cross-tabulations, chi-squared test and multiple logistic regression using several measures in COPD management as dependent variables, female sex as independent variable, and with adjustment for age groups, previous exacerbations, COPD Assessment Test, level of dyspnea assessed by the modified Medical Research Council scale, comorbid conditions, self-rated moderate/severe disease, level of education and body mass index. The researchers found that womenwere more likely to receive triple therapy (OR 1.86 (95% CI 1.38–2.51)), to have any maintenance treatment (OR 1.82 (95% CI 1.31–2.55)), to be on sick leave (OR 2.16 (95% CI 1.19–3.93)), to have received smoking cessation support (OR 1.80 (95% CI 1.18–2.75)) and to have had pneumococcal vaccination (OR 1.82 (95% CI 1.37–2.43)), all independently of age, severity of disease or other potential confounders.They concluded that the management of COPD differs by sex, with women being more actively managed than men. It is unclear whether this is due to patient- or care-related factors.

For more information: https://tinyurl.com/yxb4j23a

COPD World News - Week of April 28, 2019

The doctors taking care of people with COPD

Toronto, ON - There is limited knowledge on what proportions of patients with COPD receive ambulatory care from primary care physicians, pulmonologists, or other specialists. Researchers here evaluated the types and combinations of physicians who provide ambulatory care to patients with COPD. They conducted a population-based cross-sectional study using health administrative datasets from Ontario, Canada between April 1, 2014 and March 31, 2015. Individuals age 35 years and older with physician-diagnosed COPD were identified, using a previously validated COPD case definition. The primary outcomes were ambulatory visits to primary care physicians, pulmonologists, and all other specialists within a 1-year period. There were 895,155 individuals identified as having physician-diagnosed COPD. Of those, 56,533 individuals (6.3%) had no ambulatory care visits, 802,327 (89.6%) saw primary care physicians, and 95,782 (10.7%) consulted pulmonologists. By comparison, 736,496 (82.3%) saw other specialists, and 218,997 (24.5%) saw cardiologists. There were 32,473 individuals (3.6%) who underwent COPD-related hospitalizations. Of those in the sub-cohort with one hospitalization, about 30.0% saw pulmonologists; 43.7% of those who underwent two or more hospitalizations saw pulmonologists, and 9.9% with no hospitalization consulted pulmonologists. The researchers concluded that primary care physicians play a substantial role in caring for patients with COPD. But only one-half as many patients with COPD saw pulmonologists than cardiologists, suggesting that COPD may receive less specialty care compared with other chronic medical conditions. This information can help inform COPD care strategies to improve COPD care and minimize exacerbations and associated health-care costs. It also suggests a need for more research to provide guidance on when patients with COPD should be referred to pulmonologists. The study was led by Dr. Eunice E. Cho of the University of Toronto. Drs Graham Mecredy, Harvey Wong, Mathew Stanbrook and Andrea Gershon collaborated. Their study was published in the journal Chest.

For more information: http://tinyurl.com/y4jwjrok

COPD World News - Week of April 21, 2019
   
Prevalence of COPD in elderly in an air-polluted cities

Omuta City, Japan - In subjects aged greater than 50 years, researchers determined how respiratory function, respiratory symptoms, and the prevalence of COPD were influenced by exposure to air pollution and cigarette smoke. They performed screening in 433 individuals from Omuta City, Japan (an area with high levels of air pollution), via spirometry and medical questionnaires. A high estimated COPD prevalence rate of 16% was reported for non-smokers. The estimated prevalence rate of COPD was 29% and 37% in seniors (50- to 74-years group) and in the elderly (>75 years group), respectively, in a population of smokers. They also noted that levels of suspended particulate matter correlated with COPD. The consequences of smoking or chronic exposure to air pollution (>5 years) were: decreased respiratory function, exacerbated respiratory symptoms, and increased prevalence of COPD. To facilitate early detection of respiratory disease in elderly patients, periodic screening for these subjects was strongly advised.

For more information: http://tinyurl.com/y59zwe5u

COPD World News - Week of April 14, 2019

NIH begins first-in-human trial of a universal influenza vaccine candidate

Bethesda, Maryland - The first clinical trial of an innovative universal influenza vaccine candidate is examining the vaccine’s safety and tolerability as well as its ability to induce an immune response in healthy volunteers. Scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, developed the experimental vaccine, known as H1ssF_3928. H1ssF_3928 is designed to teach the body to make protective immune responses against diverse influenza subtypes by focusing the immune system on a portion of the virus that varies relatively little from strain to strain. The vaccine candidate was developed as part of a broader research agenda to create a so-called “universal” influenza vaccine that can provide long-lasting protection for all age groups from multiple influenza subtypes, including those that might cause a pandemic. “Seasonal influenza is a perpetual public health challenge, and we continually face the possibility of an influenza pandemic resulting from the emergence and spread of novel influenza viruses,” said NIAID Director Anthony S. Fauci, M.D. “This Phase 1 clinical trial is a step forward in our efforts to develop a durable and broadly protective universal influenza vaccine.” The clinical trial is being conducted at the NIH Clinical Center in Bethesda, Maryland. It is being led by Grace Chen, M.D., of NIAID’s Vaccine Research Center (VRC) Clinical Trials Program.  “This Phase 1 clinical trial is the culmination of years of research and development made possible by the unique collaborative setting that the VRC offers by bringing together top scientists, manufacturing expertise, and an outstanding clinical team,” said VRC Director John Mascola, M.D. A team of VRC scientists developed the universal influenza vaccine prototype. The VRC expects the clinical trial to complete enrollment by the end of 2019 and hopes to begin reporting results in early 2020. More information about the trial and be found at ClinicalTrials.gov - use search identifier NCT03814720.

For more information: http://tinyurl.com/y45cuzwc

COPD World News - Week of April 7, 2019

No Causal Link Between Smoking and Dementia

Chicago, IL - Dementia affects an estimated 47 million people worldwide, and this number is expected to rise to 131 million in 2050, resulting in huge social and economic costs. Several lines of evidence have listed smoking as a modifiable risk factor for the most common form of dementia – Alzheimer's disease (AD). "Not everyone who smokes will get dementia, but stopping smoking is thought to reduce your risk down to the level of non-smokers," according to the Alzheimer's Society. Some of the reasoning behind this assertion includes the presence of toxins in cigarette smoke that may increase oxidative stress and inflammation -- two stressors linked to the development of AD. However, it is not clear what single constituent or combination of chemicals could trigger the inexorable passage from mild cognitive impairment to AD. Genetic traits may distinguish some smokers from the general population when it comes to assessing the role of smoking in the onset of dementia. Many smokers may also die prematurely before they reach an age at which dementia will develop. In addition, it may be difficult to tease out the influences of other lifestyle risk factors. For instance, smokers are also likely to drink alcohol – another known risk factor for dementia. Erin Abner, PhD, of the University of Kentucky in Lexington, and colleagues wanted to explore the smoking-dementia association using a different method of data analysis. "The underlying data [in the earlier studies] was solid, but the analysis didn't take into account the idea of competing risk of mortality, which we felt was an important factor to consider in this case since smoking is so strongly associated with earlier death," Abner said in a news release. "If, for example, we were studying cancer deaths and smoking, and one of the people in the study died from heart disease, what do we do with that person's data?" she explained. "That person can't possibly die from cancer since a competing event (death from heart disease) has occurred. If we ignore that information, the data are not telling the right story." Data drawn from the University of Kentucky's Alzheimer's Disease Center's BRAiNS cohort, which provided a large sample of initially cognitively normal older adults (age 60+) followed for many years, with ample exposure to tobacco smoking (52.7% of participants had a smoking history) were used in this competing risk analysis. When deaths that occurred during the study period were treated as competing events, smoking was no longer associated with dementia. Simply put, smokers tended to die of causes that were not associated with dementia. "While our study results could influence smoking-cessation policy and practice, we feel that the most important consequence of our work is to demonstrate how this method could change the way we approach dementia research and to advocate for its adoption in the appropriate areas of study," she said in the press statement. "To be clear, we are absolutely not promoting smoking in any way. We're saying that smoking doesn't appear to cause dementia in this population."

For more information: https://tinyurl.com/y2mm8x3o

COPD World News - Week of March 31, 2019 

Daily aspirin use may reduce respiratory morbidity in COPD 

San Diego, CA - Research study recently published in CHEST reported that aspirin use in COPD has been associated with reduced all-cause mortality in meta-regression analysis with few equivocal studies. However, the effect of aspirin on COPD morbidity is unknown.  Self-reported daily aspirin use was obtained at baseline from SPIROMICS participants with COPD (FEV1/FVC < 70%). Acute exacerbations of COPD (AECOPD) were prospectively ascertained through quarterly structured telephone questionnaires up to 3 years and categorized as moderate (symptoms treated with antibiotics or oral corticosteroids) or severe (requiring ED visit or hospitalization). Aspirin users were matched one-to-one with nonusers, based on propensity score. The association of aspirin use with total, moderate, and severe AECOPD was investigated using zero-inflated negative binomial models. Linear or logistic regression was used to investigate the association with baseline respiratory symptoms, quality of life, and exercise tolerance. Among 1,698 participants, 45% reported daily aspirin use at baseline. Propensity score matching resulted in 503 participant pairs. Aspirin users had a lower incidence rate of total AECOPD (adjusted incidence rate ratio [IRR], 0.78; 95% CI, 0.65-0.94), with similar effect for moderate but not severe AECOPD (IRR, 0.86; 95% CI, 0.63-1.18). Aspirin use was associated with lower total St. George’s Respiratory Questionnaire score (β, –2.2; 95% CI, –4.1 to –0.4), reduced odds of moderate-severe dyspnea (modified Medical Research Council questionnaire score ≥ 2; adjusted odds ratio, 0.69; 95% CI, 0.51-0.93), and COPD Assessment Test score (β, –1.1; 95% CI, –1.9 to –0.2) but not 6-min walk distance (β, 0.7 m; 95% CI, –14.3 to 15.6). The researchers concluded that daily aspirin use is associated with reduced rate of COPD exacerbations, less dyspnea, and better quality of life. Randomized clinical trials of aspirin use in COPD are warranted to account for unmeasured and residual confounding.

For more information: https://tinyurl.com/y2t5hcyf

COPD World News - Week of March 24, 2019

Millions of people across Canada can’t afford medications

Toronto, ON – An interview recently published by the Canadian Medical Association highlighted the gap between diagnosis and treatment in Canada. As a family doctor at St. Michael’s Hospital in Toronto, Dr. Persaud details a typical scenario he sees in his practice. A patient with poorly controlled diabetes or high blood pressure comes in and he prescribes them medication, but the patient doesn’t take it because they can’t afford it. At some point, the same patient returns with the same problem. In his early years of practice, Dr. Persaud believed there was nothing he could do to fix this cycle. But once some of these same patients started having heart attacks and strokes, he felt compelled to act. “It’s unacceptable that people are being harmed unnecessarily, when there are relatively inexpensive treatments that could prevent it,” Dr. Persaud explains. “There are millions of people across Canada who can’t afford medications, so let’s do something that might inform public policy and improve the situation for everyone.” So in 2016, Dr. Persaud launched the CLEAN Meds (Carefully selected and easily accessible at no charge medications) study, a randomized controlled trial testing the effects of providing patients access to more than 125 “essential medicines” for free. Almost 800 people are now taking part in the study through seven health centres: four in Toronto and three in the Manitoulin Island area. At the time they were enrolled, all the patients had reported being unable to afford a medication during the previous 12 months. “The current system - a mishmash of private insurance, public insurance and no insurance - is a mess that leaves taxi drivers, factory workers, entrepreneurs, musicians and others in a position where often, they can’t afford to take medications, and have to make very difficult decisions.” Half of the participants were randomly placed in the control group, without any additional support for filling their prescription. The other half were assigned to the intervention group and had a pharmacist in the study mail their medications — for free — directly to their homes. A patient with diabetes, for instance, would receive metformin and insulin at no charge.  “By comparing the two groups, we can determine the effects of free and convenient access to medications,” says Dr. Persaud. “Do people take the medications as instructed, are the medications more likely to be prescribed appropriately, and do people have better control of their conditions and diseases?” The list of essential medicines created for the study is adapted from a similar list published by the World Health Organization and tailored to the Canadian market. It ranges from inexpensive medications such as acetaminophen and vitamin D to what Dr. Persaud calls “fantastically expensive” biologics such as dolutegravir, a new HIV treatment that costs roughly $10,000 a year. He says several drugs that are commonly prescribed were kept off the list because there was no evidence, they are effective. Results from the first 12 months of the CLEAN Meds study are expected to be published in early 2019, shortly before the Advisory Council on the Implementation of National Pharmacare issues its final report. The council, chaired by Dr. Eric Hoskins, is leading a national dialogue on how to implement affordable national pharmacare for Canadians and their families, employers and governments. 

For more information: https://www.cma.ca/dr-nav-persaud


COPD World News - Week of March 17, 2019 

Lung transplant patients told to fund-raise to pay for life saving treatment

Halifax, NS - CBC Radio reported that some patients in Atlantic Canada can't afford cost of lung transplants, and are choosing to die instead. Atlantic Canadian patients who need lung transplants must move to Toronto for the life-saving surgery, but because the high cost of the move is not fully financially supported, some are simply choosing to die. "I have now had three patients, from Nova Scotia, who have decided not to go," said Dr. Meredith Chiasson, a respirologist based in Halifax. Those patients have not died yet, but "are coming to the end of their lives," she told The Current's guest host Piya Chattopadhyay. Lung transplants are covered by the health-care system, but as the operation is not available in Atlantic Canada, patients must relocate to Toronto for potentially six to 12 months. Each province has its own allowances to help with the cost: patients from P.E.I. get $1,000 a month; there's $1,500 a month available in Nova Scotia and New Brunswick; and $3,000 a month for those from Newfoundland and Labrador. They face financial ruin to get a new lung. Some are choosing to die instead That financial aid can fall short of Toronto's high cost of living however, leaving patients scrambling to make up the difference. Natalie Jarvis, a patient who spoke to CBC News, tried to find accommodation in Toronto and was quoted rental rates as high as $5,000 a month. Chiasson said that in order to get her patients to Ontario for treatment, she has to tell them to fundraise. "I hate having to tell them that right now, when you can barely speak a full sentence, I need you to go out and pound the pavement to try and earn money so you can live," she told Chattopadhyay. You are going to have to do fundraising or something else to come up with this money, because right now it's not coming from our government,” said Dr. Meredith Chiasson. "I tell them that's the reality of the situation we're in right now: you are going to have to do fundraising or something else to come up with this money, because right now it's not coming from our government." She said that conversations around health become secondary at that point, as money becomes the focus. "I have a hard time getting them to listen to some of the other things I need them to hear," she said. "We need to talk about the drugs they have to take, and the side-effects, and survival after a lung transplant. "There's a big conversation we need to have about transplants, but all they focus on is the money."

For more information: https://tinyurl.com/y2o6e3n9

COPD World News - Week of March 10, 2019

Cost-effectiveness of home-based COPD patient management

Montreal, PQ – Researchers here looked at effective management strategies of COPD patients within the means of limited health care budgets are urgently required. Their analysis aimed to evaluate the cost-effectiveness of a home-based disease management (DM) intervention vs usual management (UM) in patients from the COPD Patient Management European Trial (COMET). They felt that efficient management of COPD represents an international challenge. Cost-effectiveness was evaluated in 319 intention-to-treat patients over 12 months in COMET. The analysis captured unplanned all-cause hospitalization days, mortality, and quality-adjusted life expectancy. Costs were evaluated from a National Health Service perspective for France, Germany, and Spain, and in a pooled analysis, and were expressed in 2015 Euros (EUR). Quality of life was assessed using the 15D health-related quality-of-life instrument and mapped to utility scores. Home-based DM was associated with improved mortality and quality-adjusted life expectancy. DM and UM were associated with equivalent direct costs (DM reduced costs by EUR -37 per patient per year) in the pooled analysis. DM was associated with lower costs in France (EUR -806 per patient per year) and Spain (EUR -51 per patient per year), but higher costs in Germany (EUR 391 per patient per year). Evaluation of cost per death avoided and cost per quality-adjusted life year (QALY) gained showed that DM was dominant (more QALYs and cost saving) in France and Spain, and cost-effective in Germany vs UM. Nonparametric bootstrapping analysis, assuming a willingness-to-pay threshold of EUR 20,000 per QALY gained, indicated that the probability of home-based DM being cost-effective vs UM was 87.7% in France, 81.5% in Spain, and 75.9% in Germany. They concluded that home-based disease management improved clinical outcomes at equivalent cost vs usual management in France and Spain, and in the pooled analysis. DM was cost-effective in Germany with an incremental cost-effectiveness ratio of EUR 2,541 per QALY gained. The COMET home-based DM intervention could represent an attractive alternative to usual management for European health care payers. The study was led by Dr. Jean Bourbeau of McGill University, Montreal.

For more information: https://tinyurl.com/y2c8v2qx    

COPD World News - Week of March 3, 2019

Overdiagnosis of COPD in subjects with unobstructed spirometry

Salzburg, Austria There are several reports on underdiagnosis of COPD, while little is known about COPD overdiagnosis and overtreatment. Researchers here describe the overdiagnosis and the prevalence of spirometrically defined false positive COPD, as well as their relationship with overtreatment across 23 population samples in 20 countries participating in the BOLD Study between 2003 and 2012. A false positive diagnosis of COPD was considered when participants reported a doctor’s diagnosis of COPD, but postbronchodilator spirometry was unobstructed (FEV1/FVC > LLN). Additional analyses were performed using the fixed ratio criterion (FEV1/FVC < 0.7). Among 16,177 participants, 919 (5.7%) reported a previous medical diagnosis of COPD. Postbronchodilator spirometry was unobstructed in 569 subjects (61.9%): false positive COPD. A similar rate of overdiagnosis was seen when using the fixed ratio criterion (55.3%). In a subgroup analysis excluding participants who reported a diagnosis of “chronic bronchitis” or “emphysema” (n = 220), 37.7% had no airflow limitation. The site-specific prevalence of false positive COPD varied greatly, from 1.9% in low- to middle-income countries to 4.9% in high-income countries. In multivariate analysis, overdiagnosis was more common among women, and was associated with higher education; former and current smoking; the presence of wheeze, cough, and phlegm; and concomitant medical diagnosis of asthma or heart disease. Among the subjects with false positive COPD, 45.7% reported current use of respiratory medication. Excluding patients with reported asthma, 34.4% of those with normal spirometry still used a respiratory medication. The researchers concluded that false positive COPD is frequent. This might expose non-obstructed subjects to possible adverse effects of respiratory medication. The study was published in the journal CHEST.

For more information: https://journal.chestnet.org/article/S0012-3692(19)30066-2/fulltext

COPD World News - Week of February 24, 2019      

The risks of e-cigarette use in COPD might be greater than in people without COPD

Sydney, Australia – A study recently published in the European Respiratory Journal looked at e-cigarettes that are often used as an alternative to cigarette smoking and as nicotine replacement therapy. Some suggestions are that they are markedly less harmful than cigarettes to the user. The confusion around the safety of e-cigarettes stems from contradictory findings in which variations in experimental methodology and the testing of different devices has not been accounted for. The harms associated with their use are not well understood and this is commonly misconceived as meaning that they are a healthy alternative to smoking. This misconception is further exacerbated by physicians and public health bodies which have made recommendations without strong scientific evidence. Multiple studies have concluded that e-cigarette vapour exposure could lead to inflammation, emphysema and a greater risk of bacterial and viral infection. The lack of a defined model for e-cigarette exposure for both in vitro cellular and in vivo animal studies has led to contradictory findings between studies. Such differences can be attributed to different devices (first versus fourth generation), vaporisation temperature, different E-liquids or the concentration of e-cigarette vapour used. The confusion caused by contradictory findings leaves consumers and clinicians to form their own opinions about e-cigarettes safety which may lead to further public health issues in the future. Furthermore, no studies have compared responses in cells from people with chronic obstructive pulmonary disease (COPD), a disease state where the use of e-cigarettes is particularly attractive. However, COPD lung cells are known to be hyperresponsive to a range of environmental stimuli including cigarette smoke and pollution, and therefore might also respond differently to e-cigarette vapour. The aim of this study was to evaluate dose–response relationships of e-cigarette stimulation of primary airway smooth muscle cells (ASMCs) from people with and without COPD under realistic physiological conditions. ASMCs were chosen for this study because of their contribution to pathological processes in COPD. Not only is smooth muscle bulk increased in COPD airways, ASMCs have been shown to secrete increased inflammatory mediators and chemokines compared with cells from smokers without COPD, suggesting their response to inflammatory stimuli might contribute to lung inflammation and/or disease progression in COPD. We have previously shown that ASMCs and airway fibroblasts from people with COPD are hyperresponsive to cigarette smoke, and hypothesised that they would also be hyperresponsive to e-cigarettes. We also hypothesised that the increased toxic by-product formation seen at higher vaporisation temperatures would result in greater cytotoxicity in ASMCS. Patients with COPD, or smokers, might switch to e-cigarettes as an alternative nicotine source, believing that they are safer. All e-cigarette aerosols increased CXCL8 production in ASMCs irrespective of flavour or nicotine concentration. This suggests that e-cigarettes would stimulate lung neutrophilic inflammation. Furthermore, our data suggests that e-cigarette aerosol stimulates COPD cells in a similar manner to cigarette smoke, resulting in an increased production of CXCL8 from COPD cells compared with non-COPD cells. Overall, our data suggests that COPD patients should avoid using e-cigarettes as a smoking cessation aid as they have a similar ability to stimulate inflammation and lung damage as cigarette smoke, and thus potentially accelerate their disease progression.


For more information: https://tinyurl.com/yxlfnvsb


COPD World News - Week of February 17, 2019

Triple therapy (ICS/LABA/LAMA) in COPD: thinking out of the box

London, UK - Triple inhaler therapy in COPD might in some real-life situations be useful outside of the strict indications reported by the registration agencies, but at the same time in some other situations it could be better avoided, even when recommended. A current hot topic in COPD is that two “fixed triple” combinations of an inhaled corticosteroid (ICS), a long-acting β2-agonist (LABA) and a long-acting muscarinic antagonist (LAMA) in a single inhaler have become available for patients with COPD, and a third triple therapy is in advanced development with the first large randomised clinical trial (RCT) recently published in Lancet Respiratory Medicine Vol 5 Issue 1.Whether triple therapy in a single inhaler outperforms the three individual components given in separate inhalers is unknown. In fact, there is only one study where the triple therapy in a single inhaler was compared to triple therapy in separate inhalers, but the LAMA was different with glycopyrronium in the former (BDP/FF/G) and tiotropium in the latter. The two triple therapies were equally effective, and both superior to tiotropium alone [1]. For the time being, the additional benefit of a fixed triple LABA/LAMA/ICS combination is related to convenience for the patient, and possibly improved compliance. However, the researchers here speculated that the simultaneous delivery to the target organ of three agents with different mechanisms of action may improve positive interactions between them. In addition, triple therapy might improve activity levels through bronchodilation or reduced breathlessness, and thereby improve respiratory muscle strength and impact upon disease progression.There is only one triple therapy currently available in Canada as a single inhaler. The brand name if Trelegy Ellipta - fluticasone-furoate/vilanterol/umeclidinium  

1 Vestbo JPapi ACorradi Met al. Single inhaler extrafine triple therapy versus long-acting muscarinic antagonist therapy for chronic obstructive pulmonary disease (TRINITY): a double-blind, parallel group, randomised controlled trial. Lancet 2017; 389: 1919–1929.

For more information: https://tinyurl.com/y5uoxc5l

COPD World News - Week of February 10, 2019

No type of smoking is safe: cigarettes, heated tobacco, vaping all cause serious lung damage

London, UK - If you thought ditching regular smokes for an e-cig or heated tobacco device was a way to save your lungs, you’d be wrong. That’s the message coming from a team of Australian researchers who say that any kind of smoking is ‘toxic’. It’s at odds with plenty of campaigners who say that vaping and heated tobacco devices are safer than traditional cigarettes. But the scientists took a look at a ‘next generation’ heated tobacco device on sale globally and found it still damaged human lungs by changing their structure and creating an inflammatory response. Dr Sukhwinder Sohal led the study from the University of Tasmania, which looked at cigarettes, e-cigarettes and the heated tobacco IQOS device made by tobacco giant Philip Morris International. ‘Our results suggest that all three are toxic to the cells of our lungs and that these new heated tobacco devices are as harmful as smoking traditional cigarettes. ‘Damage to these two types of lung cells can destroy lung tissue leading to fatal diseases such as chronic obstructive pulmonary disease, lung cancer and pneumonia, and can increase the risk of developing asthma, including in unborn children. ‘So we should not assume that these devices are a safer option.’ While e-cigarettes and heated tobacco still contain nicotine (the addictive substance in ciggies) but it’s in liquid form and is heated into vapour. Which limits some of the damage caused by standard cigarette smoke and ash. As part of the study, the team did lab tests on the effects of all three devices on epithelial cells (which line your organs) and smooth muscle cells taken from the human airways. Cigarette smoke and heated tobacco were highly toxic while vaping induced a ‘cry for help’ inflammatory response. Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, who was not involved in the research, said the study suggested a need for ‘considerable caution’ on heat-not-burn products, although their impact is not fully understood. E-cigarettes produce vaporized nicotine (PA) He said: ‘E-cigarettes are often presented as safer than cigarettes because they also deliver nicotine but contain no tar, the cause of lung cancer. ‘But they contain many things not found in conventional cigarettes. ‘We really have very little idea about the specific risks associated with e-cigarettes but the evidence that is emerging indicates that they are far from safe, with risks to the heart and lungs. This study adds to that body of evidence.’ Public Health England has urged smokers to use e-cigarettes, calling concerns over vaping ‘false fears’. But the study, published in the journal ERJ Open Research, says both e-cigarettes and heated tobacco devices causes the same type of damage to cells seen in people with chronic obstructive pulmonary disease (COPD), asthma, bronchitis and emphysema who struggle to breathe. Smoking tobacco will destroy your epithelial cells (Getty Images) Professor Charlotta Pisinger is Chair of the European Respiratory Society’s Tobacco Control Committee and was not involved in the research. She said: ‘These new heated tobacco devices are marketed as producing 95% lower levels of toxic compounds because the tobacco is heated, not burned. However, the first independent studies have shown that combustion is taking place and toxic and carcinogenic compounds are released, some in lower levels than in conventional cigarette smoke, others in higher levels. ‘A review of the tobacco industry’s own data on these devices has shown that, in rats, there is evidence of lung inflammation, and there is no evidence of improvement in lung inflammation and function in smokers who switch to heated tobacco.’ ‘The introduction and vigorous marketing of new devices is very tempting to smokers who want to stop smoking and mistakenly believe they can switch to another harmless tobacco product. ‘It is also opening another avenue for attracting young people to use and become addicted to nicotine. This study adds to evidence that these new devices are not the safe substitute to cigarette smoking they are promoted to be.

For more information: https://tinyurl.com/y2bfnpqr

COPD World News - Week of February 3, 2019 

Effectiveness of long-term use of statins in COPD

Lanzhou, Gansu, People’s Republic of China - Researchers here performed a general meta-analysis to assess the efficacy of long-term treatment of statins for chronic obstructive pulmonary disease (COPD), and to answer which one is better. For the effect of mortality, inflammatory factors, and lung function index in COPD patients, pooled estimates were produced. They identified the eligible studies from PubMed, Web of Science, Embase, and China National Knowledge Infrastructure, and performed a network meta-analysis to synthetically compare the effectiveness of using different statins in COPD patients. Reduced risks of all-cause mortality, heart disease-related mortality, and COPD acute exacerbation were found in association with statin use in COPD patients in general meta-analysis. In network meta-analysis, the higher cumulative probability in reducing C-reactive protein (CRP) in COPD patients was shown by fluvastatin (97.7%), atorvastatin (68.0%), and rosuvastatin (49.3%) vs other statins. Fluvastatin and atorvastatin more effectively attenuated CRP and pulmonary hypertension (PH) in COPD patients. Overall, statins can attenuate the risk of mortality, the level of CRP, and PH in COPD patients.

For more information: https://tinyurl.com/y2z2og3w

COPD World News - Week of January 27, 2019

Smoking cessation rate double with e-cigarettes vs nicotine replacement

London, UK - Cigarette smokers who attempted to stop smoking with electronic cigarettes and behavioral support were almost twice as likely to be abstinent a year later than those using nicotine-replacement therapies (NRT), a randomized trial showed. British researchers randomly assigned adults attending U.K. National Health Service stop-smoking services to receive either NRT products of their choice, including combinations of products, provided for up to 3 months, or an e-cigarette starter pack (e-liquid strength, 18 mg/mL) with instructions to purchase further e-liquids in the flavors and nicotine strength of their choice. Both groups were also offered weekly behavioral support, reported Dunja Przulj, PhD, of Queen Mary University in London, and colleagues. A year later, the sustained abstinence rate was almost twice as high among the smokers randomized to the e-cigarette group: 18.0% versus 9.9% (relative risk 1.83, 95% CI 130-2.58, P<0.001), they wrote in the New England Journal of Medicine. Przulj said the study findings confirm that e-cigarettes are an effective way for smokers to quit smoking. But in an accompanying editorial, Belinda Borrelli, PhD, and George T. O'Connor, MD, both of Boston University, noted that while just 9% of study participants in the NRT arm who were not smoking 1 year after randomization were still using nicotine replacement, 80% of those who stopped smoking using e-cigarettes were still vaping 1 year later. "This differential pattern of long-term use raises concerns about the health consequences of long-term e-cigarette use," they wrote, adding that e-cigarette vapor has been shown to contain toxins that have the potential to negatively impact human cells. They further noted that early studies in mice and humans suggested that these biologic effects impact lung function, although to a lesser extent than cigarette smoking. And, the editorialists worried about second-hand effects on children of those who continue vaping. Not only could those include direct health impacts, but children could also pick up the habit themselves from viewing parents as role models. "These findings argue against complacency in accepting the transition from tobacco smoking to indefinite e-cigarette use as a completely successful smoking-cessation outcome," Borrelli and O'Connor wrote. The randomized trial originally included 886 participants recruited at three NHS smoking cessation service sites from May of 2015 to February of 2018. Adult smokers were invited to participate if they were not pregnant or breast-feeding, had no strong preference to use or not use NRT or e-cigarettes, and were not using either type of product at recruitment. Those randomized to the e-cigarette arm of the trial received a second-generation refillable e-cigarette with one 30 ml bottle of nicotine e-liquid. They were encouraged to purchase future e-liquids online or from local vape shops, and to experiment with different nicotine strengths and flavors if the provided e-liquid did not meet their needs. Participants in the NRT group were informed about the range of products available (gum, patch, lozenge, nasal spray, inhalator, mouth spray, mouth strip, and microtabs) and they selected their preferred product. Combination use -- typically a patch and fast-acting oral NRT -- was encouraged. Participants could also switch products during the trial. The behavioral therapy was offered to both treatment groups as weekly one-on-one sessions delivered for at least 4 weeks after the quit date. Participants were contacted by telephone at weeks 26 and 52, and interviewers asked about product use and smoking abstinence. Respondents who reported abstinence or a reduction in smoking of at least 50% at 52 weeks were invited back to provide carbon monoxide readings to confirm smoking status. Overall, adherence was similar in the two groups, but e-cigarettes were used more frequently and for longer than nicotine replacement over 52 weeks (63 of 79 e-cigarette users who quit smoking were still vaping at 1-year vs four of 44 NRT users who quit smoking cigarettes). "Both e-cigarettes and nicotine-replacement were perceived to be less satisfying than cigarettes," the researchers wrote. "However, e-cigarettes provided greater satisfaction and were rated as more helpful to refrain from smoking than nicotine-replacement products

For more information: https://tinyurl.com/yamoz3kw


COPD World News - Week of January 20, 2019 

Reviewing inhaler technique for older people with COPD can improve disease control  

London, UK - Educating older adults with chronic obstructive pulmonary disease or asthma about the correct way to use their inhalers, as part of disease management, can reduce their risk of exacerbations. Either a demonstration using a placebo inhaler or written information appears effective for this. This review pooled the results of four trials, with a total of 1,225 participants. It found that a pharmacist or nurse intervention to improve inhaler technique for older adults can reduce exacerbations. People with exacerbations reduced from 58% in the usual care group to 43% in the inhaler education group. However, there was no difference in quality of life or lung function. Nevertheless, regularly ensuring good technique should prevent unnecessary increases in inhaler doses or additional treatments and is considered good practice. It may also be cost effective if it reduces exacerbations requiring hospital admission. Approximately 1.2 million people have been diagnosed with chronic obstructive pulmonary disease (COPD) in the UK while eight million have asthma. Inhaled short and long-acting bronchodilators and corticosteroids are the mainstays of treatment. They improve symptoms and reduce the risk of exacerbations in people with asthma. They also provide symptom relief for people with COPD, but their effects on the underlying disease processes are unclear. However, up to 90% of people aren’t using their inhalers properly, meaning the full dose of medicine isn’t being delivered to the lungs. Previous Cochrane systematic reviews have shown some benefit from education in younger adults though not how best to improve inhaler technique. The current study aimed to address whether educational interventions that aim to improve inhaler technique for older adults can reduce exacerbations and improve quality of life. This review included eight studies overall and a meta-analysis of 1,225 adults from four randomised controlled trials. The studies compared an educational intervention with usual care for people mostly aged 65 and older with COPD, and a few with asthma. The studies took place in Canada, the Netherlands, Belgium and Northern Ireland. The intervention included individualised inhaler training by pharmacists or nurses in pharmacies and hospitals. This involved physical demonstrations with bias in the randomised trials which were rated as low to moderate quality evidence. The inhaler education group had fewer exacerbations, occurring in 43% (268/618) of older adults compared with 58% (353/607) of the confidence interval [CI] 0.59 to 0.86, four trials). There was no clear difference in the quality of life between the two groups (standardised mean difference [SMD] 0.12, 95% CI 0.26 to 0.03). There were no differences between the two groups in lung function tests (SMD 0.06, 95% CI 0.35 to 0.47). The NICE guidelines for adults with COPD (2018) and asthma (2017) say patients should only be prescribed an inhaler after being shown how to use it, and if their clinician is confident that they can use it correctly. Inhaler technique should also be regularly assessed, particularly if their condition is not under control and whenever they change devices, medication or doses. The UK Inhaler Group – a coalition of not-for-profit organizations and professional societies, which promotes the correct use of inhaled therapies – stresses that both initial prescribers and those clinicians reviewing patients’ care should be able to demonstrate device techniques correctly and clearly to patients and those who care for them. The review provides moderate quality evidence that teaching and reviewing correct inhaler technique to older adults with COPD and asthma can reduce exacerbations. The studies included people with mild to severe COPD, a range of inhaler medications and types of devices, and additional individualised education and strategies, which limits firm conclusions. Nevertheless, the principles of regularly ensuring good inhaler technique are in line with national and international guidance and research in other age groups and are unlikely to cause harm.

For more information: https://tinyurl.com/ycwdnxtk

COPD World News - Week of January 13, 2019

Adding low dose theophylline to inhaled corticosteroids does not reduce COPD exacerbations   

London, UK - Taking low-dose theophylline tablets in addition to inhaled corticosteroids did not significantly reduce chronic obstructive pulmonary disease flare-ups (exacerbations). This NIHR funded study found that people taking the combination and those taking an inhaled steroid had the same number of exacerbations - just over two per year. People who experience frequent exacerbations are often prescribed steroid inhalers to reduce inflammation of the airways. Theophylline also helps open up the airways, but the amount needed to be effective can produce unwanted side effects. Some earlier evidence suggested that low-dose theophylline might improve the anti-inflammatory effects of inhaled steroids and therefore could be useful for those who continue to suffer exacerbations and hospital admissions. However, the results of this study confirm  guideline recommendations that, for the majority of people, the combination of oral theophylline plus inhaled steroid is not useful. Chronic obstructive pulmonary disease (COPD) is a progressive lung disease costing the NHS approximately £1 billion annually. Estimates vary, but it is thought over one million people are living with COPD in the UK. This figure is probably not a true reflection as many cases remain undiagnosed. There is no cure, but with maintenance treatment, the symptoms can be managed although many people still experience frequent exacerbations. Exacerbations are associated with hospital admission and lung function decline. Theophylline tablets can aid breathing but may have severe side effects at the doses usually used. NICE guidance recommends the use of this drug only when inhaled bronchodilators are not possible Some small studies have suggested that lower doses of theophylline can increase the anti-inflammatory effect of inhaled corticosteroids and might thereby reduce the risk of exacerbations. This larger scale study helps address this uncertainty.

For more information: https://tinyurl.com/ybvhhcav

COPD World News - Week of January 6, 2019
   
Not too late to get flu shot, health officials say  

Despite early start to 2018-2019 flu season, vaccine still offers benefit is the message from health experts. The dominant strain of flu circulating this year is H1N1, which has circulated around the globe since emerging in 2009. According to Ottawa Public Heath (OPH), H1N1 was also the dominant influenza strain during the 2013-2014 and 2015-2016 seasons. As for the current season, the health authority said there have been 79 cases of lab-confirmed influenza in Ottawa between Sept. 1, 2018 and Jan. 2, 2019.There were also two influenza-related deaths involving people 65 and older, OPH said. "My recommendation is go get the flu shot. The influenza season is in full swing at the moment in Canada," Tam said. "Especially if you're elderly. This strain also impacts younger kids [and] not enough Canadians with underlying medical conditions are getting vaccinated." The flu shot is available through family doctors as well as major pharmacies. Despite the early start to the flu season, health officials are still encouraging people to get vaccinated to protect both themselves and the vulnerable. Dr. Theresa Tam, Canada's chief public health officer, said that while flu season ordinarily begins around Christmas and New Year's, this time it started five weeks early.

For more information: https://tinyurl.com/y6wrrz2h