COPD World News - 2024

Week of February 18, 2024

Disposable vapes to be banned for children's health, government says

London, UK - Disposable vapes are set to be banned as part of plans to tackle the rising number of young people taking up vaping, the government says. Measures will also be introduced to prevent vapes being marketed at children and to target under-age sales. Prime Minister Rishi Sunak suggested adult smokers trying to quit would still have access to alternatives like vapes under the proposals. The ban is expected to be introduced across the UK, the government said. It is already illegal to sell any vape to anyone under 18, but disposable vapes - often sold in smaller, more colourful packaging than refillable ones - are a "key driver behind the alarming rise in youth vaping", according to the government. Figures from the Action on Smoking and Health (Ash) charity suggest 7.6% of 11 to 17-year-olds now vape regularly or occasionally, up from 4.1% in 2020. Announcing the plans on Monday, Mr Sunak said it was right that "strong action" was taken to stamp out vaping in children. "Children shouldn't be vaping, we don't want them to get addicted, we still don't understand the full long-term health impacts," he said. 'Maintain vapes for adult smokers' Mr Sunak suggested the proposals struck the right balance between restricting access for children and maintaining access for adult smokers trying to quit smoking. "It is important that we maintain vapes for adult smokers who want to stop," the Prime Minister continued, adding that he wanted to target "all the things that make sure children don't have access to vapes." Vaping is substantially less harmful than smoking, but it has not been around for long enough for its long-term risks to be known, according to the NHS. The vapour that is inhaled can still contain small amounts of  chemicals that are found in cigarettes, including nicotine - which is addictive but not seen by the health service as one of the most problematic ingredients in cigarettes. The proposals follow last year's announcement of a ban on the sale of cigarettes to anyone born on or after 1 January 2009 as part of an attempt to create a "smoke-free generation". Health Secretary Victoria Atkins told the BBC she was confident the new bill would pass Parliament by the time of the general election - expected to be this year - with it coming into force in early 2025. Once the timing is confirmed, retailers will be given six months to implement it. 

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Week of February 11, 2024

Omicron's surprise parting gift - evolution of the human immune system 

Seoul, South Korea - It has been four years since the start of the COVID-19 pandemic. SARS-CoV-2 has yet to be eradicated and new variants are continuously emerging. Despite the extensive immunization programs, breakthrough infections (infection after vaccination) by new variants are common. New research suggests that human immune responses are also changing in order to combat the never-ending emergence of new SARS-CoV-2 variants. Specifically, it has been discovered the immune system that encountered breakthrough infection by the omicron variant acquires enhanced immunity against future versions of the omicron. The study is published in Science Immunology. A team of South Korean scientists led by Professor Shin Eui-Cheol of the Korea Virus Research Institute Center for Viral Immunology within the Institute for Basic Science (IBS) announced that the memory T cells that form during the omicron breakthrough infection respond to subsequent strains of the virus. Emerging in late 2021, the SARS-CoV-2 omicron variant had drastically increased transmissibility in comparison to its predecessors, which quickly allowed it to become the dominant strain in 2022. New strains of omicron have kept emerging ever since then. Starting with BA.1 and BA2, BA.4/BA.5, BQ.1, XBB strains, and more recently JN.1 strains were among the new strains of the omicron variant. This has led to widespread breakthrough infection despite vaccination. After becoming infected or vaccinated, the body creates neutralizing antibodies and memory T cells against the virus. The neutralizing antibody serves to prevent host cells from being infected by the virus. While memory T cells cannot prevent the infection, they can quickly search and destroy infected cells, preventing the viral infection from progressing into a severe disease. The research team's goal was to find out the changes that occur in our body's immune system after suffering from post-vaccination breakthrough infection. In order to answer that question, they focused on the memory T cells that formed after the omicron infection. The previous studies on the omicron variant have mostly focused on vaccine efficacy or neutralizing antibodies, and the research related to memory T cells has been comparatively lacking. 

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Week of February 4, 2024

Palliative telecare team improves quality of life in COPD

Aurora, CO - Receiving care from a palliative telecare team resulted in more improvements in quality of life than usual care among patients with COPD, interstitial lung disease or heart failure, according to study results published in JAMA. “This new approach can reduce the burden of illness for patients,” David B. Bekelman, MD, MPH, professor of medicine and psychiatry at the University of Colorado School of Medicine at the Anschutz Medical Campus, said. “Many patients with COPD, heart failure or interstitial lung disease suffer from persistent symptoms (shortness of breath, fatigue) and depression and anxiety despite disease-specific treatments,” Bekelman continued. “We found that a palliative telecare team of a nurse and social worker, who collaborate with physicians, improved multiple quality of life outcomes for patients with these illnesses.” In a single-blind, randomized trial of two Veterans Administration health care systems, Bekelman and colleagues assessed 306 outpatients (mean age, 68.9 years; 90.2% men; 80.1% white) with COPD, ILD or heart failure; self-reported poor quality of life; and a heightened risk for hospitalization or death to find out how palliative telecare from a nurse and social worker team (ADAPT intervention) impacts quality of life vs. usual care (educational handout). Within the team, the nurse helped patients with symptom management, whereas the social worker offered psychosocial care to each patient. The nurse and the social worker each called the patient six times and met with each other, a primary care physician and a palliative care physician once a week. A pulmonologist and cardiologist joined the discussion if needed, according to researchers. Researchers used Functional Assessment of Chronic Illness Therapy-General (FACT-G) questionnaire scores to assess how quality of life changed between baseline and 6 months in both groups. A score closer to 100 signaled better quality of life, whereas a score closer to zero signaled poor quality of life. The cohort was split into the ADAPT intervention group (n = 154) and the usual care group (n = 152); however, only 112 of those from the intervention group completed a minimal dose of the intervention, including “nursing calls that included all nursing topics, all social work topics and a close-out call,” according to researchers. “We were delighted to see that the improvement in quality-of-life lasted months after the intervention ended,” Bekelman said.

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Week of January 28, 2024

Global tobacco use tumbles despite industry lobbying

Geneva, Switzerland - Global tobacco use has tumbled in a generation with one in five people smoking versus one in three in 2000, the World Health Organization said on Tuesday. The drop comes despite what the U.N. global health agency said were ongoing efforts by Big Tobacco to seek to influence global health policies to its own advantage. "Good progress has been made in tobacco control in recent years, but there is no time for complacency," said Dr Ruediger Krech, Director of WHO Department of Health Promotion. "I'm astounded at the depths the tobacco industry will go to pursue profits at the expense of countless lives." The global report said 1.25 billion people aged 15 or over used tobacco in 2022 versus 1.36 billion in 2000. Tobacco use is set to fall further by 2030 to around 1.2 billion people even as the world's population grows, the study said. One example of tobacco companies' efforts to win influence cited by the WHO was their offers of technical and financial support to countries ahead of a major WHO meeting on tobacco control in Panama in February. The regions with the biggest portion of smokers are Southeast Asia and Europe, the WHO said, with roughly a quarter of the population. In a handful of countries, tobacco use is still rising, including in Egypt, Jordan and Indonesia, according to the study. The report published every two years gave some preliminary data on the prevalence of vaping on which the WHO is urging governments to apply tobacco-style control measures. It said there were at least 362 million adult users of smokeless tobacco products globally but admitted this might be an underestimate due to missing data. 

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Week of January 21, 2024

Inhaled corticosteroids increasingly used for COPD outside recommended indications

Seattle, WA - From 2010 to 2018, a rising number of veterans with COPD received inhaled corticosteroid prescriptions as first-line therapy outside recommended indications, according to results published in Annals of the American Thoracic Society. “Our study has the greatest implications for health systems that are trying to improve value-based prescribing,” Kevin I. Duan, MD, MS, acting instructor in the division of pulmonary, critical care and sleep medicine at University of Washington, reported Healio. “However, for the everyday clinician, the study is a reminder that updating our inhaler prescribing norms to better align with the latest evidence and recommendations is needed. Currently, our study suggests that just under half of patients with COPD starting inhalers are getting a therapy that is not the recommended first-line therapy.” In a cross-sectional study, Duan and colleagues analyzed 131,009 veterans with COPD and new use of inhaler therapy in the U.S. Department of Veterans Affairs between January 2010 and December 2018, to determine national trends in low-value inhaled corticosteroid prescriptions during this timeframe using multivariable logistic regression models. Researchers defined an inhaled corticosteroid prescription as “low value” if it was given to a patient without asthma, with a low risk for future exacerbations or with a serum eosinophil count of less than 300 cells/L. Of the total cohort, nearly 45% (n = 57,472) of veterans had low-value inhaled corticosteroids as their first therapy, and this prescription appeared frequently across states (range, 32%-56%). Researchers found that the chances for a low-value inhaled corticosteroid prescription grew as the years progressed, which can be seen through a 0.42 percentage-point rise (95% CI, 0.31-0.53) per year in the probability for this outcome following adjustment for several covariates. Researchers also divided the cohort according to rural (n = 54,151; mean age, 68 years; 2% women; 88% white) vs. urban (n = 76,297; mean age, 68 years; 3% women; 77% white) residence and conducted fixed effects logistic regression to see if low-value inhaled corticosteroid prescribing differed by location. Results showed the probability for low-value inhaled corticosteroids heightened by 2.5 percentage points (95% CI, 1.9-3.1) for veterans living in rural vs. urban areas after adjustment. Using the complexity level of the VA medical center where each patient was treated, researchers observed increased probabilities for low-value inhaled corticosteroid prescriptions among rural residents treated in the most complex (2.5 percentage points; 95% CI, 1.8-3.2) and moderately complex (1.6 percentage points; 95% CI, 0.01-3.2) facilities vs. urban residents. Compared with urban residents treated in a least complex facility, rural residents in the same facilities did not have a higher probability for the assessed prescription, according to researchers. “For patients with COPD, the differences in disease burden and clinical outcomes between rural and urban areas is well documented, which was part of the motivation to conduct our rural-urban analysis,” Duan told Healio. “While we did detect a small difference, I was surprised that there wasn’t a more pronounced difference. The more important finding is that the issue of low-value prescribing is widespread and persistent over time, in both rural and urban areas alike.” Further, researchers observed similar results during sensitivity analyses that used the GOLD 2017 recommendations for classifying low-value inhaled corticosteroids, which do not factor in serum eosinophil counts. A sensitivity analysis that used the 6-point National Center for Health Statistics Urban-Rural Classification scheme also showed that more rurality meant higher chances for receiving low-value inhaled corticosteroids, according to researchers. After accounting for spirometric confounders, an analysis of 12,531 veterans with spirometry results revealed a 2.2% (95% CI, 0.1%-4.3%) heightened probability for receiving low-value inhaled corticosteroids among those living in rural vs. urban areas. “Additional work is needed to evaluate whether similar prescribing patterns are occurring outside of the VA system,” Duan told Healio. 

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Week of January 14, 2024

Daily nitrate-rich beetroot juice decreases blood pressure in COPD

London, UK - Consuming nitrate-rich beetroot juice daily for 12 weeks resulted in decreased blood pressure and better 6-minute walk distance in patients with COPD compared with placebo, according to data published in European Respiratory Journal. “At the end of the study, we found that the blood pressure of people taking the nitrate-rich beetroot juice drink was lower and their blood vessels became less stiff,” Nicholas S. Hopkinson, PhD, professor of respiratory medicine at Imperial College London, said in a press release from the European Respiratory Society. “The juice also increased how far people with COPD could walk in 6 minutes compared to placebo.” Consuming nitrate-rich beetroot juice daily for 12 weeks resulted in decreased blood pressure and better 6-minute walk distance in patients with COPD compared with placebo, according to data published in European Respiratory Journal. In a randomized, double-blind, placebo-controlled parallel trial, Hopkinson and colleagues assessed 81 patients with COPD and a home systolic blood pressure of 130 mmHg or higher to determine if 70 mL of nitrate-rich beetroot juice (n = 40) per day for 12 weeks positively changed blood pressure vs. nitrate-depleted placebo juice (n = 41). Researchers also evaluated 6-minute walk distance, measures of endothelial function, plasma nitrate and platelet function between the two groups. Baseline characteristics of each group were similar. Within the total cohort, none of the patients experienced a serious adverse event; however, three patients (active treatment, n = 1; placebo, n = 2) withdrew because the juice was “unpalatable,” according to researchers. By week 12, patients drinking nitrate-rich beetroot juice had greater reductions in systolic blood pressure vs. patients drinking nitrate-depleted placebo juice (Hodges-Lehmann estimator treatment effect, –4.5 mmHg; 95% CI, –3 to –5.9). Researchers also observed more improvement in 6-minute walk distance among individuals in the nitrate-rich juice group (+30.04 m; 95% CI, 15.7-44.2). Notably, this measurement was only collected from 24 patients in the nitrate-rich juice group and 20 patients in the placebo group. To assess endothelial function, researchers used an EndoPAT device (Itamar Medical) and found improvements in reactive hyperemia index (+0.34; 95% CI, 0.03-0.63) and augmentation index corrected for heart rate 75% (–7.61%; 95% CI, –14.3% to –0.95%) among those drinking the nitrate-rich juice vs. the nitrate-depleted placebo juice. Patients consuming the nitrate-rich juice also had a “substantial increase” in plasma nitrate at the end of the study compared with baseline, according to researchers. Between the two groups, researchers did not find any changes in platelet aggregation. “This is one of the longest-duration studies in this area so far,” Hopkinson said in the release. “The results are very promising, but will need to be confirmed in larger, longer-term studies.” 

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Week of January 7, 2024

Tobacco smoking attributed to more than 1 million cancer deaths in seven countries

Lyon, France - A total of 1.9 million cancer deaths were attributable to alcohol, tobacco smoking, excess body weight and HPV infections. Smoking tobacco resulted in 20.8 million years of life lost among patients with cancer. Among four preventable risk factors for cancer mortality, smoking tobacco resulted in the most deaths and years of life lost in seven countries, according to data published in eClinical Medicine. “We concluded that smoking, alcohol, overweight/obesity and HPV infections are the drivers of almost 2 million deaths from cancer across seven countries every year,” Harriet Rumgay, PhD, postdoctoral scientist of cancer surveillance at the WHO International Agency for Research on Cancer, said. “These findings highlight the key role of primary prevention to reduce cancer mortality by saving millions of lives from preventable cancers.” In a population-based study, Rumgay and colleagues assessed the estimated number of deaths and years of life lost (YLLs) to cancer in 2020 caused by alcohol consumption, tobacco smoking, overweight/obesity and HPV infections in Brazil, Russia, India, China, South Africa, the U.K. and the U.S. to evaluate the impact of these factors in patients with cancer across the world. Researchers determined the number and age-standardized YLL rates (ASYR) through life tables. When evaluating each risk factor in all seven countries, tobacco smoking contributed to the most cancer deaths (1.3 million) in 2020, followed by alcohol consumption (326,300 deaths), excess body weight (208,000 deaths) and HPV infection (190,400 deaths) for a total of 1.9 million deaths. Researchers further found that tobacco smoking was linked to the highest estimated YLLs out of the four factors, at 20.8 million. The second highest estimate of premature deaths was due to alcohol consumption (5.9 million), followed by HPV infection (4 million) and excess body weight (3.1 million). “We wanted to stress the continued impact of tobacco smoking on the burden of cancer, as we found that of the 2 million deaths from cancer due to the four risk factors in the seven countries, smoking was the driver of 1.3 million,” Rumgay told Healio. “Of the 30 million years of life lost from cancer due to the four risk factors, tobacco smoking had the biggest impact by far, leading to 20.8 million years of life lost. Our findings show that tobacco control should still be a priority even in countries where smoking rates have fallen, like the U.S. and U.K., as huge numbers of deaths from cancer due to tobacco are still emerging today.” 

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