COPD hospitalizations have risen by nearly 70% since 2002 in Canada
Vancouver, BC - Hospitalization for COPD is more common in recent years in Canada. Following adjustment for population growth and aging, those aged 40 to 64 years and women had more COPD admissions in 2017 vs. 2002. The crude rate of hospitalizations for COPD in Canada increased by nearly 70% in 2017 compared with 2002, according to results published in CMAJ. “Our results indicate that there is a persistent gap in outpatient care to prevent COPD exacerbations before they occur,” Kate M. Johnson, PhD, assistant professor in the faculty of medicine and faculty of pharmaceutical sciences at the University of British Columbia, said. “Strategies for improving outpatient care for COPD are urgently needed to avoid overburdening our already strained hospitals.” Johnson and colleagues assessed 1,134,359 hospital admissions for COPD of adults aged 40 years and older (average age, 74 years) in Canada to evaluate changes in annual rates from 2002 to 2017 and how these rates differed based on sex and age using spline regression. To evaluate age, researchers created a younger cohort including those aged 40 to 64 years (21.2%; 53% women) and an older cohort including those aged 65 years or older (50.9% men). Notably, the total number of admissions in 2017 was 89,384, demonstrating a 68.8% increase compared with the 52,937 admissions in 2002, according to researchers. The rise in COPD hospitalizations from 2002 to 2017 was also portrayed through crude admission rates per 100,000 people (368 vs. 479), which persisted following adjustment for population growth, age and sex (437 vs. 479). “We were surprised at the dramatic change in COPD admissions from 2002 to 2017, which increased by 9.6% after adjusting for demographic trends in population growth and aging,” Johnson said. “This trend is particularly in contrast to all-cause admissions, which declined by 23% over the study period. It suggests there is an increasing gap in care for COPD compared to other conditions.” Divided by age, both men and women in the younger cohort of individuals had heightened COPD admission rates from 2002 to 2017. Comparing the two sexes, younger men demonstrated a larger increase in this timeframe than younger women (men, 119 to 148 per 100,000 people vs. women, 139 to 156 per 100,000 people). Among those belonging to the older age group, women had a 29.8% rise in age-standardized rates, whereas men in this group had a 9% reduction (1,341 vs. 1,220 per 100,000), according to researchers. In an age subgroup analysis, researchers found that those aged 40 to 54 years had the greatest increase in the average relative change of the sex- and age-standardized COPD hospitalization rate at 2.4% per year (95% CI, 1.7%-3.1%), whereas those aged 65 to 74 years had the greatest reduction in this annual relative change (–0.9%; 95% CI, –1.3% to –0.5%). In terms of readmissions, the adjusted rate in 2017 was 15.4% higher than the rate in 2002 (209 per 100,000 people vs. 181 per 100,000 people). Despite the heightened rate of COPD admissions and readmissions that occurred over 16 years, both in-hospital mortality and hospitalization duration went down for these patients regardless of age or sex. Lastly, researchers found that five out of the eight most frequent comorbidities of this patient population with COPD occurred more often in 2017 than 2002, including acute kidney failure; bronchopneumonia; pneumonia; other lung diseases; and fluid-, electrolyte- and acid-based disorders. “Future studies should examine factors driving these trends,” Johnson said. “Possible explanations for increasing COPD hospitalizations are that COPD patients are living longer and developing more comorbidities leading to more repeat admissions. It’s also possible that patients are being discharged prematurely and returning to hospital more quickly.”
For more information: https://tinyurl.com/yc3kwate
Week of September 24, 2023
High abstinence likelihood with varenicline plus nicotine replacement therapy lozenges
Melbourne, Australia - Hospitalized smokers who received varenicline plus nicotine replacement therapy lozenges had an increased likelihood for abstinence, according to a presentation at the European Respiratory Society International Congress. “Varenicline (Champix) may be used in combination with oral nicotine replacement for better cessation outcomes,” Michael J. Abramson, PhD, professor of clinical epidemiology, public health and preventive medicine at Monash University, said during his presentation. “Combination therapy was effective on the self-reported outcomes and well tolerated.” Data were derived from Abramson MJ, et al. Abstract 4796. Presented at: European Respiratory Society International Congress; Sept. 9-13, 2023; Milan. In a randomized, double-blind, placebo-controlled trial, Abramson and colleagues analyzed 320 hospitalized adults (mean age, 52.5 years; 57.2% men) who had a smoking history of 10 or more cigarettes a day 1 month before being hospitalized to compare smoking abstinence rates between two treatments: varenicline plus nicotine replacement therapy lozenges vs. varenicline alone. While hospitalized, every patient received a standard dose of varenicline which consisted of once-a-day 0.5 mg varenicline on day 1 to day 3, 0.5 mg twice a day on day 4 to day 7 and 1 mg twice a day on day 8 through 11 weeks. Researchers also gave nicotine replacement therapy lozenges (2 mg) to 160 patients (mean age, 53.4 years; 57.5% men) for when they felt like they wanted to smoke, whereas the remainder of patients (n = 160; mean age, 51.5 years; 56.9% men) had placebo lozenges. For patients who succeeded in quitting, Abramson said they offered varenicline (1 mg twice a day) for an additional 12 weeks. Regardless of treatment group, every adult received an offer for behavioral support, according to researchers. At baseline, Abramson noted more patients receiving placebo had moderate nicotine dependence than patients receiving combination therapy (70.9% vs. 64.2%), and fewer patients in the placebo group tried quitting within the last 12 months (32.3% vs. 43.4%). Using logistic regression models adjusted for heaviness of smoking index score at baseline, researchers found that patients receiving combination therapy had better self-reported and biochemically verified abstinence rates compared with patients receiving varenicline alone. In terms of self-reporting, patients in the combination therapy group had higher odds for 7-day point prevalence smoking abstinence at 6 months (adjusted OR = 1.75; 95% CI, 1.06-2.87) and 12 months (aOR = 1.85; 95% CI, 1.1-3.13) vs. monotherapy. Researchers also observed significant increased odds for self-reported prolonged abstinence at 12 months with varenicline plus nicotine replacement therapy (aOR = 1.87; 95% CI, 1.1-3.18). Despite not reaching statistical significance, patients receiving combination therapy vs. monotherapy demonstrated a trend toward a higher likelihood for biochemically verified prolonged abstinence at 12 months (aOR = 2.79; 95% CI, 0.97-8.08). Patients from both groups reported comparable treatment-related adverse events, such as nausea, abnormal dreams and trouble sleeping at night, Abramson said. In regard to limitations, Abramson highlighted two areas of the study. “The limitations [of this study] were that the blinding of the intervention might not have been perfect; nicotine has a very distinctive taste,” Abramson said in his presentation. “And unfortunately, only a minority could have biochemical confirmation of their abstinence because of the restrictions imposed by the pandemic. “Further studies of combination pharmacotherapy are required in other groups of patients,” Abramson concluded.
For more information: https://tinyurl.com/2b8d2ucy
Week of September 17, 2023
COPD exacerbations heighten risk for severe cardiovascular events, death across countries
Milan, Italy – A new study points to the fact that risks for a cardiovascular event/death were high after moderate and severe COPD exacerbations. Across four countries, the risk for a severe cardiovascular event or death was high 1 to 6 months after a moderate COPD exacerbation, according to a poster presented at the European Respiratory Society International Congress. Further, severe COPD exacerbations led to substantially high risks for cardiovascular outcomes immediately following the exacerbation, with the risk persisting up to 1 year later. “As health care professionals, we all need to be aware of the increased cardiopulmonary risk associated with an exacerbation,” Nathaniel Hawkins, MD, MPH, MBChB, study investigator and associate professor at the University of British Columbia, told Healio. “We need to focus on preventing exacerbations of COPD before they arise so we can avoid the consequence of cardiovascular events. We must take action to prevent exacerbations and when exacerbations occur to make sure that we do not have repeat exacerbations. Clinicians should assess the patient’s cardiovascular risk and do everything they can to treat and reduce that cardiovascular risk.” In a multi-database cohort study, Claus F. Vogelmeier, MD, professor at Philipps University of Marburg, Hawkins and colleagues evaluated 126,795 patients (median age, 67 years; 60% men) from Germany, 142,787 patients (median age, 68 years; 51.7% men) from Canada, 8,020 patients (median age, 65 years; 52.7% men) from the Netherlands and 24,393 patients (median age, 68 years; 78.2% men) from Spain with COPD between 2014 and 2018 to determine the risk for a severe cardiovascular event within the 12 months after a moderate/severe exacerbation. A similar study was also presented at the American Thoracic Society International Conference. The U.S. version of this study found that patients who experienced a COPD exacerbation had a greater risk for acute cardiovascular events than patients who did not. Researchers defined a severe cardiovascular event as death or hospitalization for acute coronary syndrome, heart failure, arrhythmias or cerebral ischemia. During median follow-up of 36 months (Germany, the Netherlands and Spain) and 58 months (Canada), researchers observed at least one moderate exacerbation among 26.6% of the Canadian cohort, 29.7% of the German cohort, 58.6% of the Spanish cohort and 23.3% of the Netherlands cohort. The prevalence of one or more severe exacerbations was similar to that of moderate exacerbations in Canada (30.2%) and Germany (27%), whereas severe exacerbation occurred less frequently in Spain (9.5%) and the Netherlands (9.3%). Among all countries, Germany had the highest percentage of patients who experienced a cardiovascular event/death (38.6%), followed by Spain (35.8%), Canada (30.5%) and the Netherlands (13.7%). Notably, the risk for cardiovascular events/death was heightened in all four countries within 1 to 7 days after a moderate exacerbation, 8 to 14 days after and 15 to 30 days after. Within the span of 31 to 180 days after this type of exacerbation, researchers continued to find a high risk for a cardiovascular outcome/death among patients from Canada (adjusted HR = 1.13; 95% CI, 1.06-1.2), Germany (aHR = 1.08 95% CI, 1.04-1.13) and the Netherlands (aHR = 1.62; 95% CI, 1.26-2.08). For those who experienced a severe exacerbation, the risk for cardiovascular events/death was highest immediately (1 to 7 days) after the exacerbation in all countries. Patients in the Netherlands had the greatest risk (aHR = 48.57; 95% CI, 36.88-63.96), followed by Canada (aHR = 24.88; 95% CI, 23.75-26.07), Spain (aHR = 24.22; 95% CI, 21.77-26.96) and Germany (aHR = 15.84; 95% CI, 15.26-16.45). “The magnitude of the increased risk for cardiovascular events associated with exacerbations was surprising,” Hawkins said. Although not as high as the risks observed above, researchers continued to find elevated risks in all the evaluated timeframes within 1 year of a severe exacerbation. Within 181 days to 365 days after this type of exacerbation, patients from Spain had the highest risk (aHR = 3.1; 95% CI, 2.77-3.46), followed by the Netherlands (aHR = 1.61; 95% CI, 1.01-2.56) Canada (aHR = 1.47; 95% CI, 1.4-1.55) and Germany (aHR = 1.17; 95% CI, 1.11-1.23). There are two main areas of future research, Hawkins said. “The first is we need to characterize the actual causes of that increased cardiovascular risk and try to understand what is happening to patients from a physiological perspective following that exacerbation,” he said. “To do that, we’re going to need to follow large numbers of patients who’ve had an exacerbation and investigate them very thoroughly. “Second, we need to test strategies to avoid exacerbations and strategies to treat the cardiovascular risk once it’s actually happening,” he added. With the findings from this study and the U.S. study, researchers hope to demonstrate the widespread importance of cardiovascular events among patients who experience a COPD exacerbation. “One thing to highlight from this study is the importance of doing large population studies in multiple countries with diverse health care systems,” Hawkins said. “What you see here is consistency in results, which help us realize that these are truly findings that are generalizable in different health care systems across countries.”
For more information: https://tinyurl.com/2p8ydkff
Week of September 10, 2023
Smoking found to significantly increase the risk of depression
Aarhus, Denmark - Most of us know that smoking is unhealthy. Cigarette packets display shocking picture warnings of diseased lungs and rotting teeth. And we often hear in the media about how smoking can cause all sorts of cancer. But most of us probably do not know that smoking actually increases the risk of mental illness as well. In recent years, ever more research has indicated a strong correlation between smoking and mental illness. However, researchers have not been able to agree on whether smoking causes depression or other mental disorders, or whether we smoke because we need to lessen the symptoms of a latent mental disorder. But now we know. Together with two colleagues from Canada, Doug Speed from the Center for Quantitative Genetics and Genomics at Aarhus University has shown that smoking can lead to depression and bipolar disorder. "The numbers speak for themselves. Smoking does cause mental illness. Although it's not the only cause, smoking increases the risk of being hospitalized with a mental illness by 250 percent," he says. "Smoking typically comes before the mental illness. In fact, a long time before. On average, people from the data set began smoking at the age of 17, while they were typically not admitted to hospital with a mental disorder until after the age of 30." Based on health data from 350,000 people Before Doug Speed and his colleagues could answer whether smoking can cause mental disorders, they needed very large volumes of data. There can be many different reasons why we develop a mental disorder. It was therefore important that they had enough data to clean their figures from other possible effects. They gained access to the UK Biobank, one of the largest databases in the world of human health information. The database contains genetic data on more than half a million people. The genetic data was paired with a lot of other health information and answers provided by the participants regarding their lifestyle. They fed the data into a computer and began looking for patterns. Doug Speed and his colleagues are far from the first researchers to investigate this correlation, but they found a new way to do it, as he explains. "Previous research hasn't really considered that there may be a temporal dimension at play. People typically start to smoke before the age of 20, but aren't admitted to hospital with a mental disorder until they're between 30 and 60 on average." As many as 90 percent of the people in the data set who were still smokers or former smokers started before the age of 20. The likelihood that you will start smoking later in life is therefore quite small. In fact, your genes help determine whether or not you will become a smoker, explains Doug Speed. "When we looked at the many smokers in the database, we found a number of recurring genetic variants. By looking at twin studies, in which the twins had the same genes but grew up in separate homes, we could see that their genes could explain 43 percent of the risk of becoming a smoker." In the homes where the adoptive parents also smoked, the risk of the child starting to smoke increased. However, if the parents didn't smoke, the risk was lower, but still greater when the children's 'real' parents had been smokers and passed on certain genes. "There are a number of genetic variants that we can refer to as 'smoking-related genes'. The people in the data set who carried the smoking-related genes but did not smoke were less likely to develop mental disorders compared to those who carried the genes and smoked," he says and continues: "Because the genetic variants also seem to be linked with the risk of mental illness, this used to be a bit blurry. But in this study, we demonstrate that it's probable that the risk of starting to smoke causes the risk of developing mental disorders to increase due to the 'smoking-related genes'." Statistically, smoking seems to cause mental disorders such as depression, bipolar disorder and schizophrenia. However, Doug Speed and his colleagues have no explanation as to why. Only a number of theories. "We still need to find the biological mechanism that causes smoking to induce mental disorders. One theory is that nicotine inhibits absorption of the neurotransmitter serotonin in the brain, and we know that people with depression don't produce enough serotonin," he says. When you smoke a single cigarette, nicotine activates the production of serotonin in the brain. Among other things, this is what makes you feel relaxed after smoking. But if you continue to smoke, nicotine will have the opposite effect. Instead, it will inhibit the serotonin—which can make you anxious, upset and unstable. "Another explanation could be that smoking causes inflammation in the brain, which in the long term can damage parts of the brain and lead to various mental disorders. But as I said, We don't know for sure as yet," he says.One of the things the new figures show is that we rarely start smoking after the age of 20. Therefore, it might be a good idea to look into whether we should raise the age limit for buying cigarettes. "This could be a good way to prevent people from starting smoking. Again, we don't know why people don't start smoking after the age of 20, but perhaps it's because we become less and less willing to take risks with age," says Doug Speed, and continues: "Changing the law and raising the age limit may therefore have an effect. At least there are indications for this." The figures on which the study is based are from the UK. So they are not based on Danes. However, Speed believes that the differences, if any, are very small. "Denmark and the UK are very similar, and I would say that they are quite comparable. Having said that, our next step is actually to conduct the same study with figures from Denmark and Finland. However, getting access to this data is more expensive, which is why we did a pilot study with the British data to see if there was a correlation," he concludes.
For more information: https://tinyurl.com/yrjurrr5
COPD World News - Week of September 3, 2023
Active screening of patients with diabetes or COPD doubled new diagnoses of heart disease
Utrecht, Netherlands - In a new study, a diagnostic strategy utilizing tools readily available in primary care successfully identified new diagnoses of atrial fibrillation, CAD and HF among patients with type 2 diabetes or chronic obstructive pulmonary disease. “Type 2 diabetes and chronic obstructive pulmonary disease (COPD) are strong risk factors for developing CVD. In fact, 20% to 41% of these patients have an unknown but treatable CVD. Heart failure is present in around 20% to 28%, for example, and coronary artery disease in up to 41%,” Amy Groenewegen, MD, general practitioner in training/PhD student at the University Medical Center Utrecht, the Netherlands, said during a press conference at the European Society of Cardiology Congress. “We aimed to uncover CVD at an early stage with an easy-to-use diagnostic strategy in primary care patients with COPD and/or type 2 diabetes.” The RED-CVD researchers developed an early diagnosis strategy aimed at detecting AF, HF and CAD. The strategy consists of three steps: a patient questionnaire about symptoms of AF, HF and CAD; if patients scored above a certain threshold on the questionnaire, they underwent further screening, including physical examination, ECG and N-terminal pro-B-type natriuretic peptide measurement; and if any of the aforementioned tests were abnormal, referral to a cardiologist was made by the general practitioner at their discretion. The early diagnosis strategy was tested in a cluster-randomized trial in general practices across the Netherlands. Patients at practices in the intervention group underwent the early diagnosis strategy, which was performed by general practitioners and nurses during routine visits as part of their disease management, whereas patients from control practices received usual care. There were about 650 patients in each group, of whom 87% had type 2 diabetes and 20% had COPD. The average age was 68 years and 40% were women. After 1 year, new CVD diagnoses were made in 8% of the intervention group and 3% of the usual care group. The primary diagnosis was HF, with new diagnoses in 4.5% of the intervention group and 1.5% of the usual care group. Of all types of HF, HF with preserved ejection fraction was the most common diagnosis, in 3.2% of the intervention group and 0.7% of the usual care group, according to the results. The intervention also identified more patients with AF (2.1% vs. 0.8%) and CAD (2.6% vs. 1.4%), according to Groenewegen. “Our strategy more than doubled new diagnoses of heart failure, atrial fibrillation and CAD in patients with type 2 diabetes or COPD in primary care,” Groenewegen said during the press conference. The OR for new diagnoses was 2.62 (95% CI, 1.5-4.55), according to the results. Groenewegen said if they were to apply this screening strategy to the more than 920,000 patients with COPD and/or type 2 diabetes in the Netherlands, it would identify an estimated 48,000 additional CVD diagnoses.
For more information: https://tinyurl.com/5c2b2wdx
COPD World News - Week of August 27, 2023
Social isolation, loneliness common in adults with COPD
San Francisco, CA - Among adults aged 50 years and older, those with COPD experienced social isolation and loneliness more frequently than those without COPD, according to results published in Annals of the American Thoracic Society. “Our study question was informed by our clinical experience and so we were not surprised to learn that nearly one in five adults with COPD experience social isolation and loneliness,” Angela O. Suen, MD, pulmonary and critical care fellow in the division of pulmonary, critical care, allergy and sleep medicine at the University of California, San Francisco, told Healio. In a cross-sectional study, Suen and colleagues evaluated 10,384 adults (mean age, 68 years; 54% women; 10% Black) aged 50 years or older from the Health and Retirement Study to determine the prevalence of social isolation and loneliness among those with COPD, as well as what factors are linked to these outcomes through multivariable logistic regression. Researchers used the UCLA 3-item Loneliness Scale to determine loneliness and a 9-item scale to measure social isolation that assessed household contacts, social network interaction and community engagement. Of the total cohort, 1,100 adults (11%) had self-reported COPD and191 (2%) had self-reported COPD on supplemental oxygen. The remaining individuals (n = 9,284) did not have COPD. Using the scales outlined above, social isolation and loneliness were each observed in 12% of the total cohort, and 3% of patients presented with both. Among the three groups of adults, social isolation was most prevalent in patients with COPD on oxygen (20%), followed by patients with COPD (16%) and adults without COPD (11%) in a model adjusted for age, sex, race/ethnicity, marital status and net worth (P < .05). This same pattern was found when assessing loneliness, with the most frequent occurrence of this outcome in patients with COPD on oxygen (22%), followed by patients with COPD (18%) and adults without COPD (11%), according to researchers (P < .001). When evaluating social isolation and loneliness in patients with COPD, researchers observed several demographic and clinical characteristics linked to each outcome, with most factors differing between groups. Social isolation in COPD was significantly linked to male sex (22% vs. women, 13%), non-Hispanic white ethnicity (19% vs. Black, 7%), a net worth of less than $6,000 (32% vs. $6,001-$81,000, 28% vs. $81,001-$239,000, 10%), depression on the modified Center of Epidemiological Studies-Depression (CES-D) scale (24% vs. no depression, 14%), having at least one activity of daily living difficulty (22% vs. no difficulty, 14%) and current smoking status (24% vs. never smoking status, 13%), according to researchers. For loneliness in COPD, researchers observed that this was significantly linked to the age range of 50 to 64 years (22% vs. 75-84 years, 12%), single marital status (32% vs. married, 12%), depression on the CES-D scale (36% vs. no depression, 13%), having at least one activity of daily living difficulty (29% vs. no difficulty, 15%), a diagnosis of diabetes (26% vs. no diabetes, 17%) and a diagnosis of heart disease (23% vs. no heart disease, 17%). “We hope that clinicians will consider screening for social isolation and loneliness and consider how isolated and lonely adults may experience unique challenges to obtaining medical care,” Suen told Healio.
For more information: https://tinyurl.com/m3u78nxu
COPD World News - Week of August 20, 2023
Fixed-ratio spirometry misses COPD diagnoses in African American patients
Denver, CO - A fixed-ratio criteria of FEV1/FVC less than 0.7 for COPD resulted in fewer diagnoses in African American vs. non-Hispanic white individuals, according to results published in Journal of General Internal Medicine. “Relying only on spirometry for diagnosing COPD does not do justice to the known manifestations of the disease,” said Elizabeth A. Regan, MD, PhD, professor of medicine at National Jewish Health. “I expect that most clinicians already recognize the importance of symptoms, and this report allows them to follow their clinical judgement without being focused only on spirometry. For African Americans and other groups with a history of deprivation, moving beyond those criteria could facilitate earlier diagnosis. Initiating targeted smoking cessation efforts and symptom management via early diagnosis could reduce ongoing disparities in care.” In a multicenter, longitudinal cohort study, Regan and colleagues evaluated 10,198 current/former smokers with a 10 pack-year history or greater from the COPDGene study to see how using fixed-ratio spirometry criteria (FEV1/FVC < 0.7) differed in the diagnosis of COPD among non-Hispanic white individuals (n = 6,766) and African American individuals (n = 3,366). Compared with non-Hispanic white individuals, African Americans significantly differed in age (54.6 years vs. 62 years), prevalence of current smokers (80% vs. 39%) and smoking pack-years (38.2 vs. 47.2). In terms of socioeconomic characteristics, more African Americans vs. non-Hispanic whites received a poverty-level annual income (52% vs. 18%), had a lower prevalence of continuing education after high school (43% vs. 70%) and had higher area deprivation index [ADI] scores, which signal residence in deprived neighborhoods (mean score, 55.8 vs. 40.2). Notably, mortality over 12 years did not differ between both racial groups even after adjustment for several demographic characteristics. COPD, according to the fixed-ratio criteria, was less prevalent in African American individuals vs. non-Hispanic white individuals 30% vs. 51%). Researchers used Global Initiative for Obstructive Lung Disease (GOLD) categories to assess COPD in their population, creating a category they called “GOLD 0” to encompass the group with an FEV1/FVC of 0.7 or greater and an FEV1 percent predicted of 80% or greater. Those with only the former but an FEV1 percent predicted of less than 80% were categorized as “PRISm.” A greater proportion of African American than non-Hispanic white individuals in this cohort were categorized as GOLD 0 (54% vs. 38%) and PRISm (16% vs. 11%), having failed to meet the criteria for COPD. This resulted in 70% of African Americans and only 49% of non-Hispanic whites grouped into these categories that are not linked to a COPD diagnosis. When plotting raw spirometry values on density distribution plots, researchers found that African American individuals had “disproportionate reductions in FVC relative to FEV1” compared with non-Hispanic whites (between-group difference in FEV1 = 170 mL; FVC = 310 mL), and this resulted in heightened FEV1/FVC. “There were a number of African American participants whose lung volume (FVC) was lower on average than what would be usual for a non-Hispanic white person,” Regan said. “This meant that these African American participants would need to have worse airflow or FEV1 than a similar non-Hispanic white person in order to be considered to have COPD.” Regan told Healio this research will likely not change how clinicians currently diagnosis COPD but hopes that it will help raise awareness for missed diagnoses in African American individuals. “From a research perspective, this is likely to remain confusing and controversial for the future because there is no alternative ‘gold’ standard for diagnosis of COPD,” Regan said. “However, for clinical practice I hope that our findings can bring greater recognition of COPD in the African American community and result in better care. “We are expanding our understanding of social determinants of health for our population in order to recognize the relationship of those experiences in their risk of disease and progression of disease,” Regan added. “It is a complex situation.”
For more information: https://tinyurl.com/234au2j7
COPD World News - Week of August 13, 2023
B.C. doctors, researchers and teachers warn of another triple epidemic
Vancouver, BC - Several B.C. doctors warn the province is not prepared heading into the fall and winter respiratory illness season. As the province prepares to launch its fall COVID-19 vaccination campaign, doctors, researchers and teachers worry not enough is being done to avoid another triple epidemic. Dr. Sanjiv Gandhi, the B.C. Green party’s deputy leader, said the province is “horribly prepared” heading into the fall and winter respiratory illness season. “I think we’re less prepared this year than any time in the last several years,” Gandhi told the Vancouver Sun. Last year, the province still required masks in hospitals and health care settings. This year, “none of that currently exists,” he said. He also noted the province has also been slow to upgrade the ventilation systems in schools, hospitals and public indoor settings. “I’m very worried about what this means for our kids,” said Gandhi, a pediatric cardiothoracic surgeon and former chief of cardiac surgery at B.C. Children’s Hospital. Protect our Province B.C., a coalition of doctors, nurses, health researchers and school safety advocates, warns the province is headed for a repeat of the triple threat of COVID-19, respiratory syncytial virus (RSV), and flu that clogged hospitals and killed six children last winter. “In short, we are on track for a rinse-and-repeat of last year,” the group said this week in an open letter to Premier David Eby, Health Minister Adrian Dix and Education Minister Rachna Singh. “I do feel like we are in a worse position (than last winter) because of the complacency of people,” Jennifer Heighton, a Vancouver-based elementary school teacher and co-founder of Protect our Province B.C. “I think the pandemic has been downplayed this whole past year. And not enough has been explained to people about the long-term harm from previous COVID infections.” Dr. Lyne Filiatrault, a retired emergency physician who worked at Vancouver General Hospital for 22 years and a signatory to the open letter, said it’s important to look at what’s happening elsewhere in the world, including the United States, which has already had a 12.5 per cent increase in hospital admissions. Public health officials have learned “zero lessons” since the six child deaths and overcrowded emergency rooms last winter, Filiatrault said. “We are using a vax-only strategy,” she said, which ignores other safety measures like air filtration and masking. “This virus needs you to be two steps ahead,” she said. B.C.’s public health officials “are going to be reactive again.” Filiatrault is concerned the public health messaging is not focused enough on the potentially debilitating impacts of long COVID, symptoms that can include chronic pain, brain fog, shortness of breath, chest pain, fatigue and neurological symptoms. “There’s a level of complacency within public health that basically stops counting the impact of this virus after 30 days and it’s not counting the excess mortality,” she said. A University of British Columbia study showed that while B.C. had one of the lowest mortality rates from COVID-19 in North America, it had the highest excess deaths — the number of deaths above what would normally be expected based on modelling and previous years — of any Canada province. Protect our Province wants the government to install HEPA filters in all B.C. classrooms to improve air ventilation and reinstate school mask mandates. Heighton wants the province to bring back PCR testing to detect the prevalence of the virus instead of relying on less-accurate waste water monitoring. There were seven COVID-related deaths in the last week of July, the most recent data available through the B.C. Centre for Disease Control’s Situation report. In the past week, eight patients were in critical care in B.C. with COVID-19. Heighton, Gandhi and Filiatrault are concerned by B.C.’s low vaccination rate among children and youth: 16 per cent of children aged four and under are fully vaccinated, 19 per cent of kids between five and 11 have three doses, and 38 per cent of youth 12 to 17 have three doses. Public health officials are not pushing vaccination in kids, Filiatrault said. B.C. will be launching a fall vaccination campaign to roll out the updated COVID-19 vaccine, a new version of the COVID-19 mRNA vaccine by Pfizer-BioNTech and Moderna which is currently waiting for Health Canada approval. BC Health Minister, Dr. Bonnie Henry said because the new COVID-19 vaccines provide the best protection against the current strain of SARS CoV-2 and its variants, those who are fully vaccinated should wait for the updated dose rather than receive bivalent vaccine boosters now. “Similar to what we do with influenza, we look at what the likely strains to be circulating and causing illness in the upcoming season will be,” Henry said in the statement. “That is why it is really important to get this updated vaccine — it builds on the immunity that you’ve had from previous vaccinations.” The province will provide more details on the fall vaccination campaign in the coming weeks, Henry said.
For more information: https://tinyurl.com/5yma6prz
COPD World News - Week of August 6, 2023
First RSV vaccine for older adults approved in Canada
Mississauga, ON - Arexvy (respiratory syncytial virus vaccine) has been approved in Canada for the prevention of lower respiratory tract disease (LRTD) caused by respiratory syncytial virus (RSV) in individuals 60 years of age and older. Arexvy is the first RSV vaccine for older adults to be approved in Canada. RSV is a common, contagious virus that affects the lungs and respiratory airways. The virus can affect all ages, but the impact of RSV in older adults is significant. RSV caused an estimated 470,000 hospitalizations and 33,000 deaths in those aged 60 years and above in high-income countries in 2019.2 Marni Freeman, Country Medical Director, GSK, said: "A solution for RSV infection has been something scientists have been pursuing for decades. With the approval of Arexvy, we are excited to be able to offer an option to help protect the nearly 10 million Canadians aged 60 and older3 who are at risk of RSV disease. We’re hopeful that with a vaccine now available for older Canadians, the virus’ burden on our healthcare system will also be dramatically improved. We look forward to working with provincial, territorial, and national health authorities to ensure older Canadians at greatest risk of RSV infection can access the vaccine.” RSV season in Canada is typically from October until May, with most cases occurring in the winter months. For most people, the virus causes cold-like symptoms, but for older adults and adults with certain health conditions it can lead to more serious infection and complications such as pneumonia, hospitalization and even death.5,6 Older adults are at greater risk due in-part to the natural decline in immune function with age. Underlying medical conditions such as diabetes, chronic heart and lung disease6 can be exacerbated by RSV, leading to severe outcomes. Henry Roberts, Executive Committee Member, COPD Canada, said: “Even if people with COPD or other chronic conditions have been taking sufficient steps to manage their illness, RSV can still have a serious impact on their health. Until now, RSV was one of the major respiratory infectious diseases with no vaccine or specific treatment available for older adults. Having the opportunity to receive a vaccine that can prevent RSV infection for older Canadians, including those who are at higher risk of severe outcomes, is a welcome advancement and is a major step forward from a public health perspective.” Across multiple studies, the vaccine was generally well tolerated with an acceptable safety profile. The most frequently observed solicited adverse events were injection site pain, fatigue, myalgia, and headache. These were typically mild to moderate and transient. Approval of GSK’s RSV older adult vaccine in Canada follows authorizations in the US, Europe and the UK. Regulatory reviews are ongoing in Japan and several other countries. Arexvy is expected to be available in Canada ahead of the 2023/24 peak RSV season.
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COPD World News - Week of July 30, 2023
Prevalence of Chronic Obstructive Pulmonary Disease in England from 2000 to 2019
London, UK - Chronic obstructive pulmonary disease (COPD) is a chronic condition characterised by progressive airflow obstruction, which is not completely reversible. Airflow limitation may precede the development of significant symptoms of COPD by many years and its progression is directly linked to the continuing exposure to risk factors, particularly tobacco smoking. As COPD is difficult to diagnose clinically (without spirometry) in its milder forms, it is often diagnosed late - the average age at diagnosis of COPD in the UK is 67 years. Widespread use of spirometry to allow early detection of airflow obstruction has been increasingly advocated as it enables early management of COPD. There is considerable variation in the reported prevalence of COPD internationally. One reason for this is the differing definitions in use. The British Thoracic Society (BTS) criteria are based on the post bronchodilator values of forced expiratory volume in 1 second (FEV1) and the forced vital capacity (FVC), ie, FEV1/ FVC <0.70 and FEV1 <80% predicted, using British reference values derived from the Health Survey for England (HSfE). The National Institute for Health and Care Excellence (NICE) COPD guidelines originally developed using the BTS criteria and last updated in 2019, states that COPD should be diagnosed in people with clinical symptoms confirmed by airflow obstruction, defined as a reduced FEV1/FVC ratio less than 0.7. There is no consensus regarding using a fixed threshold to define airflow obstruction versus using the lower limit of normal (LLN) adjusted for age. Accurate estimates of disease prevalence are important for allocation of healthcare resources yet estimates of COPD prevalence in the UK have not been updated for a decade. Therefore, using routinely collected electronic healthcare record (EHR) data, we calculated yearly prevalence of COPD in England between 2000 and 2019 using multiple definitions of COPD. We then used validated definitions to calculate COPD and potentially undiagnosed COPD prevalence, stratified by age, gender, and region. There is considerable variation in reported chronic obstructive pulmonary disease (COPD) prevalence internationally, partly due to differing definitions in use. Accurate estimates of disease prevalence are important for allocation of health-care resources, yet UK estimates of COPD prevalence have not been updated for a decade. We calculated yearly COPD prevalence in England between 2000 and 2019 using different definitions of COPD. Researchers here used routinely collected primary care electronic healthcare record (EHR) data from the Clinical Practice Research Datalink (CPRD) Aurum database linked with secondary care data from the Hospital Episode Statistics (HES) Admitted Patient Care (APC) database. Mid-year point prevalence was calculated yearly from 2000 to 2019 in English adults aged ≥ 40 years using 5 definitions: (i) validated COPD, (ii) Quality and Outcomes Framework (QOF) COPD, (iii) COPD symptoms, inhaler prescription, and no asthma diagnosis, (iv) hospitalisation with COPD as any diagnosis, (v) hospitalisation with COPD as primary or secondary diagnosis. Prevalence was further stratified by gender, age group, and region. A total of 12,745,793 people were included over the 20-year period. Annual cohort sizes ranged from 4,373,538 in 2000 to 6,159,496 in 2019. Estimates of COPD prevalence increased every year from 2000 and the difference in estimated prevalence between the validated and QOF definitions has grown over time. In 2019, a COPD prevalence of 4.9% was found using validated events in either primary or secondary care (definition 1 or definition 5). Additionally, including potentially undiagnosed cases (definition 3) in the COPD definition produced an increased prevalence of 6.7%. The researchers concluded that common definitions of COPD (eg, QOF codes), may underestimate the true prevalence. The extent of this underestimate has increased over time and could lead to under-allocation of resources where need is estimated based on these definitions. Standardisation of COPD coding in routine EHRs and metrics such as spirometry is key to accurate disease monitoring.
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COPD World News - Week of July 23, 2023
Remote pulmonary rehabilitation yields ‘similar improvements’ to in-person program
Calgary, AB - Remote pulmonary rehabilitation during the COVID-19 pandemic demonstrated comparable outcomes to rehabilitation that took place in person prior to the pandemic, according to a research letter published in CHEST.“This study demonstrates that we can conduct pulmonary rehab at home using videoconferencing (ie, Zoom) and show similar improvements as standard in-person rehab,” Michael K. Stickland, PhD, professor in the division of pulmonary medicine at the University of Alberta, told Healio. “Because of this work, our virtual program has been adopted as an operational program. Patients can now choose whether to come down and do in-person rehab or do it virtually in their homes.” Remote pulmonary rehabilitation during the COVID-19 pandemic demonstrated comparable outcomes to rehabilitation that took place in person prior to the pandemic, according to a research letter published in CHEST. In an observational cohort study, Stickland and colleagues analyzed 171 patients (mean age, 68 years; 50% women) receiving pulmonary rehab virtually and 383 patients (mean age, 67 years; 41% women) receiving the program in-person to evaluate differences in outcomes of the two modes of delivery. The number of sessions was the same in both programs (16 sessions), and researchers noted that group education and supervised exercise were a repeated feature. To track changes in health-related quality of life, researchers had patients complete the COPD assessment test (CAT). They also compared changes in 6-minute walk distance (6MWD) after rehab. In this analysis, the most common disease classification was COPD in both the in-person (73%) and virtual (66%) program. Both groups showed similar rates of adherence, which was measured through attendance and dropout (< nine sessions) and had improved CAT scores. Notably, those attending rehab remotely vs. in-person showed less improvement in health-related quality of life, which may be due to isolation requirements put in place during the pandemic, the researchers wrote. Although in-person patients had greater 6MWD at baseline vs. virtual patients (377 m vs. 332 m; P < .001), researchers found that virtual patients had a significantly larger change from baseline to after rehab (+ 68 m vs. + 35 m) signaling better “functional exercise tolerance.” It should be noted that this finding was based on only two measures of 6MWD: one before remote rehab and one after remote rehab, whereas the in-person group did three tests before and after, according to researchers. Additionally, patients in the virtual rehab group did not report any adverse events. “We were really happy to see that there were no increased adverse events with the virtual program,” Stickland told Healio. “As clinicians, we are always a bit worried that conducting rehab at home might lead to greater falls, etc, but we saw no evidence of this.” To find out if there was a link between various baseline characteristics and dropout in patients attending rehab remotely (n = 36), researchers used logistic regression models. This assessment did not find a relationship between any baseline data/combination of data and dropout. “For our next steps, we are looking to integrate daily patient monitoring to obtain patient data, like symptoms and SpO2, so that we can better detect when patients might be needing extra help to prevent an exacerbation of their COPD,” Stickland said.
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COPD World News - Week of July 16, 2023
Moderna starts application process for RSV vaccine for older adults
Cambridge, MA - Moderna Inc (MRNA.O) said on Wednesday it had started the application process to get an approval for its respiratory syncytial virus (RSV) vaccine in older adults with regulators in the United States, Australia and Europe. The company said it had started rolling submission of data for the shot with the U.S. Food and Drug Administration. It is aiming to be the third vaccine maker to get an approval in the country after GSK (GSK.L) and Pfizer Inc (PFE.N). Moderna has also submitted applications to the European, Swiss and Australian regulators, the company said.Its RSV vaccine is one of the key products in Moderna's pipeline that is expected to help revive sales for the company next year as it transitions from a possible net loss this year. Moderna's shot, which it is aiming to launch in the United States in 2024, was found to be 82.4% effective against RSV lower respiratory tract disease with three or more symptoms in older adults in a late-stage trial. GSK and Pfizer are expected to launch their vaccines this fall season. The efficacy of Pfizer's vaccine fell to 78.6% through the middle of a second RSV season from 88.9% at the end of the first season in older adults, while that of GSK's shot fell to 84.6% from about 94% at the end of first. At a meeting of advisers to the U.S. Centers for Disease Control and Prevention, GSK said it expects to price its shot between $200 and $295 a dose. Meanwhile, Pfizer provided the CDC with a price range of $180 to $270 per dose but would not guarantee that its final price would fall within that range, saying it was in the middle of competitive price negotiations on the shots.
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COPD World News - Week of July 9, 2023
Sweden close to becoming first "smoke free" country in Europe
Stockholm, Sweden - On "World No Tobacco Day", Sweden, which has the lowest rate of smoking in the Europe Union, said that it is close to declaring itself "smoke free" — defined as having fewer than 5% daily smokers in the population. Many experts give credit to decades of anti-smoking campaigns and legislation, while others point to the prevalence of "snus," a smokeless tobacco product that is banned elsewhere in the EU but is marketed in Sweden as an alternative to cigarettes. Whatever the reason, the 5% milestone is now within reach. Only 6.4% of Swedes over 15 were daily smokers in 2019, the lowest in the EU and far below the average of 18.5% across the 27-nation bloc, according to the Eurostat statistics agency. Figures from the Public Health Agency of Sweden show the smoking rate has continued to fall since then, reaching 5.6% last year. "We like a healthy way to live, I think that's the reason," said Carina Astorsson, a Stockholm resident. Smoking never interested her, she added, because "I don't like the smell; I want to take care of my body." The risks of smoking appear well understood among health-conscious Swedes, including younger generations. Twenty years ago, almost 20% of the population were smokers — which was a low rate globally at the time. Since then, measures to discourage smoking have brought down smoking rates across Europe, including bans on smoking in restaurants. France saw record drops in smoking rates from 2014 to 2019 but that success hit a plateau during the height of the COVID-19 pandemic — blamed in part for causing stresses that drove people to light up. About one-third of people aged 18 to 75 in France professed to having smoked in 2021 — a slight increase on 2019. About a quarter smoke daily. Sweden has gone further than most to stamp out cigarettes, and says it's resulted in a range of health benefits, including a relatively low rate of lung cancer. "We were early in restricting smoking in public spaces, first in school playgrounds and after-school centers, and later in restaurants, outdoor cafes and public places such as bus stations," said Ulrika Årehed, secretary-general of the Swedish Cancer Society. "In parallel, taxes on cigarettes and strict restrictions on the marketing of these products have played an important role." She added that "Sweden is not there yet," noting that the proportion of smokers is higher in disadvantaged socio-economic groups. The sight of people lighting up is becoming increasingly rare in the country of 10.5 million. Smoking is prohibited at bus stops and train platforms and outside the entrances of hospitals and other public buildings. Like in most of Europe, smoking isn't allowed inside bars and restaurants, but since 2019 Sweden's smoking ban also applies to their outdoor seating areas. On Tuesday night, the terraces of Stockholm were full of people enjoying food and drinks in the late-setting sun. There was no sign of cigarettes, but cans of snus could be spotted on some tables. Between beers, some patrons stuffed small pouches of the moist tobacco under their upper lips. Swedish snus makers have long held up their product as a less harmful alternative to smoking and claim credit for the country's declining smoking rates. But Swedish health authorities are reluctant to advise smokers to switch to snus, another highly addictive nicotine product. "I don't see any reason to put two harmful products up against each other," Årehed said. "It is true that smoking is more harmful than most things you can do, including snus. But that said, there are many health risks even with snus." Some studies have linked snus to increased risk of heart disease, diabetes and premature births if used during pregnancy. Swedes are so fond of their snus, a distant cousin of dipping tobacco in the United States, that they demanded an exemption to the EU's ban on smokeless tobacco when they joined the bloc in 1995. "It's part of the Swedish culture, it's like the Swedish equivalent of Italian Parma ham or any other cultural habit," said Patrik Hildingsson, a spokesman for Swedish Match, Sweden's top snus maker, which was acquired by tobacco giant Philip Morris last year. He said policymakers should encourage the tobacco industry to develop less harmful alternatives to smoking such as snus and e-cigarettes. "I mean, 1.2 billion smokers are still out there in the world. Some 100 million people smoke daily in the EU. And I think we can (only) go so far with policymaking regulations," he said. "You will need to give the smokers other less harmful alternatives, and a range of them." WHO, the U.N. health agency, says Turkmenistan, with a rate of tobacco use below 5%, is ahead of Sweden when it comes to phasing out smoking, but notes that's largely due to smoking being almost nonexistent among women. For men, the rate is 7%. WHO attributes Sweden's declining smoking rate to a combination of tobacco control measures, including information campaigns, advertising bans and "cessation support" for those wishing to quit tobacco. However, the agency noted that Sweden's tobacco use is at more than 20% of the adult population, similar to the global average, when you include snus and similar products. "Switching from one harmful product to another is not a solution," WHO said in an email. "Promoting a so-called 'harm reduction approach' to smoking is another way the tobacco industry is trying to mislead people about the inherently dangerous nature of these products." Tove Marina Sohlberg, a researcher at Stockholm University's Department of Public Health Sciences, said Sweden's anti-smoking policies have had the effect of stigmatizing smoking and smokers, pushing them away from public spaces into backyards and designated smoking areas. "We are sending signals to the smokers that this is not accepted by society," she said. Paul Monja, one of Stockholm's few remaining smokers, reflected on his habit while getting ready to light up. "It's an addiction, one that I aim to stop at some point," he said. "Maybe not today, perhaps tomorrow."
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COPD World News - Week of July 2, 2023
CDC advisors recommend older adults consider RSV vaccination
Atlanta, GA - CDC vaccine advisors recently said that older adults in the United States should talk to their physicians about getting vaccinated against respiratory syncytial virus. In two separate votes, the Advisory Committee on Immunization Practices supported recommendations saying that people aged 60 years or older “may receive” one of the two RSV vaccines recently approved by the FDA — the first two RSV vaccines ever available — in consultation with their physician. They voted 13-0 with one abstention in favor of the recommendation for people aged 60 to 64 years, and 9-5 in support of the recommendation for adults aged 65 years or older. The language of the recommendation — that older patients “may receive” an RSV vaccine — is . many other vaccines. The committee instead chose to recommend that RSV vaccination in older adults be based on “shared clinical decision-making” — a designation it has applied to recommendations in the past addressing meningococcal B, hepatitis B, HPV and pneumococcal vaccination in different age groups. “Generally,” the CDC says, “ACIP makes shared clinical decision-making recommendations when individuals may benefit from vaccination, but broad vaccination of people in that group is unlikely to have population-level impacts.” The votes on Wednesday were based on data presented by the vaccine manufacturers, GSK and Pfizer, showing the efficacy of their vaccines over the course of two RSV seasons. Data shared by GSK showed that vaccine efficacy in preventing severe disease defined by three or more symptoms was 94.1% at the end of the first RSV season and fell to 84.6% through the middle of the second in older adults. Similarly, data shared by Pfizer showed that its vaccine was 88.9% effective in the first season and 78.6% effective through the middle of a second RSV season in older adults. GSK’s Arexvy became the first RSV vaccine ever approved by the FDA on May 3. The agency approved Pfizer’s Abrysvo on May 31.
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COPD World News - Week of June 25, 2023
E-cigarette sales surge to more than 22 million units per month
Atlanta, GA - Researchers noted increases in the number of brands and sales of disposable devices and flavors popular among youth. E-cigarette sales in the United States surged by nearly 47% from 2020 to 2022 to more than 22 million units per month, according to study findings recently published in MMWR. During the study period, there were increases in both the number of brands and in the sales of disposable devices and flavors that are popular among youth, the CDC noted. In recent years, the FDA has enforced several bans and penalties related to e-cigarettes, although there is other evidence the restrictions have not worked. “The dramatic spikes in youth e-cigarette use back in 2017 and 2018, primarily driven by JUUL, showed us how quickly e-cigarette sales and use patterns can change,” Deirdre Lawrence Kittner, PhD, MPH, director of CDC’s Office on Smoking and Health, said in a press release. “Retail sales data are key to providing real-time information on the rapidly changing e-cigarette landscape, which is essential to reducing youth tobacco use.” Overall, e-cigarette monthly unit sales increased by 46.6% from 15.5 million in January 2020 to 22.7 million in December 2022, according to the new study, which analyzed retail data from a U.S. data analytics and market research company. This study also found that the percentage of prefilled e-cigarettes cartridge sales decreased from 75.2% to 48%, whereas the share of disposable e-cigarettes increased from 24.7% to 51.8%. The number of available brands also increased by nearly half in the same time, from 184 to 269. Menthol-flavored e-cigarette sales remained stable, and unit shares of tobacco-flavored e-cigarettes decreased from 28.4% to 20.1% and mint-flavored products decreased from 10.1% to 5.9%, respectively. However, the sale of other flavors — including fruit, clove or spice, candy or sweets and chocolate — increased from 29.2% to 41.3%. “The surge in total e-cigarette sales during 2020-2022 was driven by nontobacco flavored e-cigarette sales, such as menthol, which dominates the prefilled cartridge market, and fruit and candy flavors, which lead the disposable e-cigarette market,” Fatma Romeh Ali, PhD, MA, a health economist at the CDC Foundation and co-author of the study, said in the release. “Data from the 2022 National Youth Tobacco Survey also highlight the popularity of these flavored e-cigarettes among U.S. middle and high school students.”
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COPD World News - Week of June 18, 2023
COPD exacerbations raise risk for acute cardiovascular events
Washington, DC - Patients who experienced a COPD exacerbation had a greater risk for acute cardiovascular events than patients who did not, according to a presentation at the American Thoracic Society International Conference. These presented data were part of the retrospective cohort study EXACOS-CV US, which, along with the EROS study, was one of two notable AstraZeneca-funded studies examining COPD presented at ATS 2023. “These results suggest patients with COPD should be considered at risk of cardiopulmonary events, including stroke, heart failure, pulmonary embolism, arrhythmia or heart attack, following an acute exacerbation, even those who are newly diagnosed,” Charlie Strange, MD, professor of pulmonary and critical care medicine at Medical University of South Carolina and investigator in the EROS study, said. In EXACOS-CV US, Kimberly Daniels, MS, PhD, senior researcher at HealthCore Inc., and colleagues evaluated 355,978 adults from the HealthCore Integrated Research Database to look at the difference in frequency of acute cardiovascular events between those who had an acute COPD exacerbation (n = 145,838; mean age, 63 years) and those who did not have an acute COPD exacerbation. According to the abstract, several hospitalizations were recognized as acute cardiovascular events, such as acute coronary syndrome, ischemic stroke, acute heart failure, pulmonary embolism, arrhythmia or cardiac arrest. Researchers assessed both sets of patients with Cox models that considered demographics, as well as past medical and prescription information. Of the patients with an acute COPD exacerbation, nearly half (48%) of the cohort had a cardiologist visit at baseline, while only a little more than a quarter (27%) had a pulmonologist visit at this time. Researchers found that the hazard ratio for an acute cardiovascular event within 30 days of a COPD exacerbation was 1.32 (95% CI, 1.11-1.35), signaling a 32% increased risk for this outcome in patients who experienced an exacerbation compared with patients who did not, according to a press release from AstraZeneca. This risk was also high at 1 year, with day 90 showing the greatest risk. When evaluating acute COPD exacerbations by severity, researchers observed a greater risk for an acute cardiovascular event outcome in those who experienced a severe exacerbation (30-day HR = 1.85; 95% CI, 1.6-2.14). Patients with a moderate exacerbation also showed a heightened risk for these events (30-day HR = 1.22; 95% CI, 1.11-1.35) compared with those without an exacerbation, although this risk was lower than that observed in those with a severe exacerbation. Further, the risk for an acute cardiovascular event rose with more COPD exacerbations, with two or three exacerbations raising the risk by more than twofold, according to the release. When put together with the EROS study, both have important implications for patients with COPD. “Sometimes clinicians are not as aggressive with COPD care when cardiovascular disease is contributing to dyspnea,” Strange told Healio. “This combination of studies [EXACOS-CV and EROS studies] suggests that the sickest patients should get triple therapy inhalers after exacerbations.”
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COPD World News - Week of June 11, 2023
Bringing awareness to consequences of depression, anxiety in patients with COPD
Washington, DC - Patients with COPD who also have depression and/or anxiety may not be receiving the treatment they need due to their respiratory disease, according to a presentation at the American Thoracic Society International Conference. “Anxiety and depression are often underrecognized or underappreciated because as clinicians caring for those with COPD, we tend to focus on [patients’] physical symptoms and trying to improve their respiratory symptoms,” Victor Kim, MD, ATSF, FAASM, professor of thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University, told Healio. “Additionally, symptoms of anxiety/depression can often mimic physical symptoms, such as fatigue, breathlessness and difficulty sleeping, making the distinction between anxiety/depression symptoms and symptoms due to respiratory disease a little bit more difficult.” In order to raise awareness for patients with COPD who are also struggling with a mood disorder, Kim presented data from several studies that demonstrate the prevalence of depression and/or anxiety in this patient population and how the combination of conditions can impact their lives. According to Kim, the link between COPD and depression/anxiety has been observed in several large cohort studies. In the ECLIPSE study of patients with COPD, smokers with normal lung function (ie, without COPD) and nonsmokers, more patients with COPD had depression symptoms, represented by a Center for Epidemiologic Studies Depression Scale (CES-D) score of 16 or higher, compared with smokers and nonsmokers (26% vs. 12% vs. 7%, respectively). Notably, patients with more severe COPD experienced more symptoms of depression. In a study of 5,331 patients with either no COPD, PRISm (preserved ratio impaired spirometry), GOLD I-II COPD and GOLD III-IV COPD, those with GOLD III-IV COPD had the greatest frequency of depressive symptoms. In addition to their mental health, depression in patients with COPD impacts other aspects of their lives, such as quality of life, breathlessness and fatigue, Kim said. Based on ECLIPSE, those with a CES-D score of 16 or higher had poorer 6-minute walk distance, Functional Assessment of Chronic Illness Therapy-Fatigue scores, Medical Research Council Dyspnea scores and St. George’s Respiratory Questionnaire scores compared with patients with COPD without depression (P < .001 for all). Another study Kim presented found that depression and anxiety have an influence on severe exacerbations. “Comorbid anxiety and depression can increase risk of severe exacerbations, (ie, requiring an emergency room visit or hospitalization),” Kim said during his presentation. “[The findings show that] mood disorders can increase risk of COPD exacerbations, so that does beg the question of whether mood disorders in COPD are comorbidities, or are these multi-morbidities, or separate disorders, that co-exist in the same patient. Do they have a common etiology or not?” In addition to an increased exacerbation risk, patients with COPD struggling with depression or anxiety also showed higher odds for all-cause readmissions 30 days following their discharge for an exacerbation or respiratory failure (depression aOR = 1.34; 95% CI, 1.29-1.39; anxiety aOR = 1.43; 95% CI, 1.37-1.5), according to another study in Kim’s presentation. Adjusted odds for readmission at 1 year were also elevated in patients with COPD and depression in a separate study, which Kim said demonstrates how the influence of depression is more than temporary. In terms of treatment, Kim described how depression and anxiety result in poor heart failure outcomes by the way of two proposed mechanisms: biological and behavioral. With this knowledge, Kim said treating the two mood disorders may help with heart failure, and it is possible that the same is true in the opposite direction. “The existence of anxiety/depression in patients with COPD increases the risk of several poor outcomes,” Kim told Healio. “For that reason, it's important to recognize mood disorders in the overall care of the patient. There is a lot of data now that mental illness and physical illness may be bidirectional. In other words, depression/anxiety does modify someone’s symptoms and vice versa. What needs to be discovered in the future is whether treatment of either will improve the patient’s physical symptoms. For example, starting an antidepressant, medicine or therapy to treat anxiety may reduce their perceptions of breathlessness and therefore health care utilization.”
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COPD World News - Week of June 4, 2023
Cigarette warning labels are about to get even harder to ignore
Ottawa, ON - Health Canada has announced new warning labels to be printed directly on cigarettes in an effort to deter new smokers, encourage quitting and reduce tobacco-related deaths — a world first that experts hope will have a significant impact. There will be multiple sets of six warnings on the cigarettes themselves that will change in rotation with messages like: "Cigarettes cause cancer," "Cigarettes damage your organs," "Tobacco smoke harms children" and "Poison in every puff." Health Canada will also include new health warnings on cigarette packaging, taking up a minimum of 75 per cent of the main display area of the package, that can be updated with the latest research available without having to change the regulations. "Having a warning on every cigarette sold in Canada is a world precedent-setting measure," said Rob Cunningham, senior policy analyst at the Canadian Cancer Society. "The health warning is going to be there during every smoke break. And for youth who experiment by borrowing a cigarette from a friend, they'll have exposure to the health warning there as well. I expect that many countries internationally will follow this Canadian world first." Health Canada has announced new warning labels to be printed directly on cigarettes in an effort to deter new smokers, encourage quitting and reduce tobacco-related deaths. (Health Canada) The regulations will begin to come into effect as of Aug. 1. Tobacco companies will be required to implement the first sets of restrictions for retail on king-size cigarettes (83-85 millimetres in length) by July 31, 2024, on regular-size cigarettes (70-73 millimetres in length) and on small cigars by April 30, 2025. Health Canada's new cigarette-labelling regulations come into effect starting Aug. 1. (Health Canada) The federal government's decision was announced on World No Tobacco Day and is part of Canada's Tobacco Strategy, which aims to achieve less than five per cent tobacco use by 2035.
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COPD World News - Week of May 28, 2023
Canada has some of the highest teen vaping rates in the world, new data shows
Waterloo, ON - Almost 1 in 4 older Canadian high school students reported vaping in past month. New national data shows the number of Canadian teenagers regularly using e-cigarettes ranks among the highest in the world, and experts say a lack of action from the federal government and the widespread availability of flavoured vapes is fuelling a growing crisis. The latest results from Health Canada's Canadian Student Tobacco, Alcohol and Drugs Survey, which surveyed 61,096 teenagers in grades 7 to 12 from nine provinces between September 2021 and June 2022, found that 29 per cent of Canadian students had ever tried an e-cigarette. That number is down slightly overall in Canada, from 34 per cent in 2018-19, but is higher in older age groups — with 41 per cent of students in grade 10 to 12 ever having vaped. Regular use of e-cigarettes also continues to be widespread in Canada, with 17 per cent of students having used an e-cigarette in the past month, down slightly from 20 per cent in 2018-19, but is again higher in grades 10 to 12 with over 24 per cent being monthly users. Daily vaping rates were eight per cent across all students surveyed and close to 12 per cent among those in grades 10 to 12 — which experts say are some of the highest ever reported globally. "The numbers have confirmed that Canada has one of the highest youth vaping rates in the world, especially as it relates to daily vaping," said David Hammond, a public health professor at the University of Waterloo and a leading Canadian youth vaping researcher. "We've essentially plateaued at historically high levels of daily vaping … this is maybe the best indication out there that we're in for a long haul of regular youth vaping — we've crossed the threshold of this being a fad." Australia has moved to ban vaping without a doctor’s prescription and several provinces have already banned flavoured products, but Health Canada has stalled on passing sweeping legislation. The numbers are higher than they were five years ago, when just 10 per cent of students had used an e-cigarette in the past 30 days and 11 per cent reported daily use in 2016-2017 — signalling a growing problem showing no signs of slowing down. The new youth vaping survey data also partially predates the widespread availability of disposable vapes that came onto the market last year and hold thousands of pre-loaded puffs, don't require refilling or cartridges and are linked to a surge in youth vaping. "We're very concerned by the long-term issue that e-cigarette use by teenagers continues to be very high — unacceptably high," said Rob Cunningham, senior policy analyst at the Canadian Cancer Society. "And we need the federal government to move immediately to ban flavoured e-cigarettes, a factor that is contributing to these high rates." When asked what flavour they preferred, the survey showed 63 per cent of students in grades 7 to 12 who vaped in the past month had used a fruit flavour most often. "There is no doubt that flavours are a very big part of youth vaping — they appeal to kids, they're one of the reasons why they start trying vaping in the first place, and fruit flavours and candy flavours are a big part of that," said Hammond. "The main reason adults vape is to help them quit or not to die from smoking — flavours has a much bigger relative influence in youth vaping than it does for adults." When asked what flavour they preferred, the survey showed 63 per cent of students in grades 7 to 12 who vaped in the past month had used a fruit flavour most often. Here, a flavoured vaping device is seen in a downtown Toronto vape shop on April 25, 2023. (Evan Mitsui/CBC) In contrast, youth cigarette smoking rates have continued to drop significantly in Canada — with just 14 per cent of Canadian high school students reporting ever having had a cigarette, down from 19 per cent in 2018-19, and only one per cent smoking daily. "We have seen over time some decreases in youth smoking. That's because of high taxes, high prices, plain packaging and menthol bans," Cunningham said. "But unfortunately, overall nicotine use when you include both smoking and e-cigarettes, is going up. We have an enormous problem, a new generation is becoming addicted to nicotine and we need government action immediately to respond to that."
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COPD World News - Week of May 21, 2023
FDA denies marketing of nearly 6,500 flavored e-cigarette products
Silver Spring, Maryland - The FDA has issued marketing denial orders to 10 companies that manufacture and market approximately 6,500 flavored e-liquid and e-cigarette products. The companies, including Imperial Vapors LLC, Savage Enterprises, Big Time Vapes, SWT Global Supply Inc., Great Lakes Vapor, DNA Enterprise LLC dba Mech Sauce, Absolute Vapor Inc., ECBlend LLC, among others, cannot market or distribute the products in the U.S. and retailers who sell them risk FDA enforcement action, according to a press release from the agency. FDA denies marketing of nearly 6,500 flavored e-cigarette products. Image: Adobe Stock The FDA stated in the release that “premarket tobacco product applications (PMTAs) submitted for various flavored e-cigarette products did not provide sufficient evidence to show that permitting the marketing of these products would be appropriate for public health.” This marketing denial order is among recent efforts the FDA has taken to review and issue decisions on applications for more than 26 million new tobacco products, the majority of which include e-cigarette products. “Science is a cornerstone of FDA’s tobacco product review process,” Matthew Farrelly, PhD, director of the Office of Science within FDA’s Center for Tobacco Products, said in the release. “Today’s decision to deny approximately 6,500 products was based on the lack of scientific evidence provided in the applications. We will continue to ensure all new tobacco products undergo robust, scientific premarket evaluation to determine whether they meet the appropriate public health standard to be legally marketed.”
For more information: https://tinyurl.com/vuuv7n3h
COPD World News - Week of May 14, 2023
CDC reports that cigarette smoking in 2021 lowest since 1965
Atlanta, GA - Although prevalence of cigarette smoking decreased, cigarettes were still the most used tobacco product in 2021. Compared with 2020, e-cigarette use increased in 2021. Among the estimated 46 million U.S. adults who used tobacco products in 2021, cigarette smoking prevalence decreased while e-cigarette use increased, according to CDC data published in Morbidity and Mortality Weekly Report. “Although cigarette smoking decreased over the past year, e-cigarette use increased, from 3.7% to 4.5%, largely driven by higher prevalence in use among persons aged 18 to 24 years,” Monica E. Cornelius, PhD, an epidemiologist and associate service fellow at the CDC, and colleagues wrote. “Further, declines in cigarette smoking among populations with diagnosed depression represent important successes in tobacco control. However, disparities in tobacco use remain.” Among the estimated 46 million U.S. adults who used tobacco products in 2021, cigarette smoking prevalence decreased while e-cigarette use increased, according to CDC data published in Morbidity and Using data from the 2021 National Health Interview Survey, Cornelius and colleagues evaluated tobacco usage of 29,482 adults in the U.S. and weighted data to determine national prevalence estimates of current usage for the year. Researchers assessed use of cigarettes, cigars, pipes, e-cigarettes and smokeless tobacco, and calculated differences in use from past years. Based on the weighted data, 46 million adults (18.7%) were estimated to be current users of a tobacco product and 35.6 million (14.5%) were estimated to be users of a combustible tobacco product. Use of at least two tobacco products was estimated in 8.3 million adults (3.4%). Researchers also reported 66.5% of adults had quit smoking. Of the five tobacco products, most people used cigarettes (28.3 million), followed by e-cigarettes (11.1 million), cigars (8.6 million), smokeless tobacco (5.2 million) and pipes (2.3 million), according to researchers. From 2020 to 2021, prevalence of cigarette use dropped from 12.5% to 11.5%, although e-cigarette use jumped from 3.7% to 4.5%. Among users of more than two tobacco products, 31.4% used both cigarettes and e-cigarettes, researchers reported. Other common combinations included cigarettes and cigars (21%), cigarettes and smokeless tobacco (7.9%), e-cigarettes and cigars (7%) and cigarettes and pipes (3.7%). Notably, 14% of adults used three or more products. According to researchers, cigarette use in 2019 was higher among those diagnosed with depression compared with those who did not have depression (22.9% vs. 12.3%), with similar reports in 2020 (20.5% vs. 10.9%) and 2021 (19.4% vs. 9.9%); still, overall smoking declined among Black, white and Hispanic adults during this time, regardless of depression status. Among those with depression, cigarette use was highest in Black adults in 2021, a departure from 2019 and 2020 when non-Hispanic adults of other races had the highest usage. However, non-Hispanic adults of other races who had not been diagnosed with depression had the highest prevalence of cigarette smoking in 2021 “Continued surveillance of tobacco product use, implementation of evidence-based tobacco control strategies (eg, hard-hitting media campaigns, smoke-free policies and tobacco price increases), conducting linguistically and culturally appropriate educational campaigns, and FDA regulation of tobacco products will aid in reducing tobacco-related disease, death and disparities among U.S. adults,” Cornelius and colleagues wrote.
For more information: https://tinyurl.com/ycnxj89u
COPD World News - Week of May 7, 2023
FDA approves first vaccine against RSV
Silver Spring, Maryland; GSK’s vaccine against RSV was approved by the FDA and is expected to be available for people aged 60 and older this fall. A second RSV vaccine, from Pfizer, could also be approved by the FDA this month. The FDA approved the world’s first vaccine against respiratory syncytial virus, which followed years of failed attempts by scientists to develop one. The vaccine, GSK’s Arexvy, is approved in the United States to prevent lower respiratory tract disease caused by RSV in adults aged 60 years or older. “Older adults, in particular those with underlying health conditions, such as heart or lung disease or weakened immune systems, are at high risk for severe disease caused by RSV,” Peter Marks, MD, PhD, director of the FDA’s Center for Biologics Evaluation and Research, said in a press release. “Today’s approval of the first RSV vaccine is an important public health achievement to prevent a disease which can be life-threatening.” The FDA’s Vaccines and Related Biological Products Advisory Committee recommended the approval of GSK’s shot in March, in addition to a second RSV vaccine made by Pfizer. The FDA is expected to issue a decision on Pfizer’s vaccine at some point this month. RSV is common, affecting people of all ages, but can cause serious infections, especially in older adults and infants. It kills up to 10,000 adults aged 65 years or older each year in the U.S., according to the CDC. The U.S. experienced a surge in RSV this past winter — part of a “tripledemic” of respiratory infections that also included influenza and COVID-19, both vaccine-preventable diseases. “We are pleased that we can now add a respiratory syncytial virus vaccine to providers’ options for patient care,” John Kennedy, MD, president of the American Medical Group Association, said in a press release issued by GSK. The FDA’s approval was based on data from an ongoing randomized, placebo-controlled phase 3 trial, for which participants will remain enrolled for three RSV seasons to assess the duration of efficacy and safety of repeat vaccination. In the trial, researchers found the vaccine reduced risk for developing RSV-related lower respiratory tract disease by 82.6% and reduced the risk for developing severe RSV-related lower respiratory tract disease by 94.1%. The vaccine was generally well-tolerated by trial participants, with the most common side effects being injection site pain, fatigue, muscle pain, headache and joint stiffness or pain. GSK is also conducting a clinical trial among people aged 50 to 59 years, including people with underlying comorbidities. It expects results from that trial sometime this year. Results from two other trials testing co-administration with influenza vaccines are expected in the next several weeks, ahead of a June meeting of the CDC’s Advisory Committee on Immunization Practices, which will make recommendations on the use of the vaccine in the U.S. GSK said the vaccine should be available before the start of the 2023-2024 RSV season. RSV vaccine research has ramped up over the past decade after a long delay in activity following a deadly vaccine trial in the 1960.
COPD World News - Week of April 30, 2023
Ontario introduces a "Vaping is not for Kids" Act to limit vaping for people under 21
Toronto, ON - MPP France Gelinas of the Nickle Belt introduced a private members bill, legislation that will reduce youth vaping. The Bill makes various amendments to the Smoke-Free Ontario Act, 2017. The main highlights of the act are to to prohibit the promotion of vapour products. The Act is amended to provide that no person shall sell or supply a tobacco product, vapour product or prescribed product or substance to a person who is less than 21 years old. Currently, the Act prohibits the sale at retail or the sale for the purposes of sale at retail of vapour products prescribed as a flavoured vapour product. The Act is amended to provide that this restriction applies with respect to flavoured vapour products generally, unless the flavour or flavouring agent contained in the vapour product is a tobacco flavour or tobacco flavouring agent. The Act is also amended to provide that this prohibition applies to vapour products that contain more than specified amounts of nicotine. The Act is also amended to provide that vapour products can only be sold in specialty vape stores or designated stores in remote or rural communities, as well as to provide that no person may operate a specialty vape store or sell vapour products at a designated store in a remote or rural community without the approval of the board of health of the area in which the store is to be located. Corresponding offences are added to the Act. It will also provide that the Minister may direct that tax revenue generated from the sale of vapour products at specialty vape stores and at designated stores in remote and rural communities be used for the purpose of educating the public about the health risks associated with vaping, provided that the Legislature has appropriated funds for this purpose. Ontario Health to prepare an annual report to the Minister respecting youth vaping that sets out information and recommendations to assist the Minister in developing policies to reduce youth vaping. This Act comes into force 120 days after it receives Royal Assent.
For more information: www.ola.org/en/legislative-business/bills/parliament-42/session-2/bill-85
COPD World News - Week of April 23, 2023
Mint-flavored E-cigarettes linked to worse lung function
Pittsburgh, PA - Use of electronic cigarettes with added menthol flavoring increased the number of inhaled particles and was associated with worse lung function in current or former combustion cigarette smokers, according to a study that used a specially designed robotic system that mimics the mechanics of breathing. Compared with e-cigarettes with liquids that were not flavored with menthol, menthol-flavored products produced a significantly higher level of 1-10 µm particles when inhaled, reported Kambez H. Benam, DPhil, of the University of Pittsburgh, and co-authors. In a retrospective analysis of data from the COPDGene cohort, menthol product users had an average 0.06 lower forced expiratory volume in the first second to the forced vital capacity of the lungs (FEV1/FVC) when compared with those who used other flavors (95% CI -0.01 to -0.12, P=0.01), they said in Respiratory Research. The addition of menthol flavor to the liquid base in e-cigarettes, measured as propylene glycol (PG) to vegetable glycerin (VG), led to increased particle counts across all particle size ranges (300 nm to 10 µm) even at a 0.01% dosage. When Benam and team compared popular product Vuse Alto Menthol with its non-menthol counterpart, Vuse Alto Golden Tobacco, they found that Vuse Alto Menthol produced larger amounts of 1-2.5 μm, 2.5-4 μm, and 4-10 μm particles when aerosolized. Menthol remains a popular option among those who vape, particularly younger users. As of October 2022, over 2.5 million middle and high school students in the U.Sopens in a new tab or window. reported use of e-cigarettes in the previous 30 days, with 85% using flavored products. One NIH study among adolescent and young adult users of flavored e-cigarettes found that the largest group (34%) selected mint as their flavor of choiceopens in a new tab or window. Menthol and other cooling flavors have only increased in popularity over the years, from 1.5 million units sold in 2017 to 12 million in 2021opens in a new tab or window. "Menthol is a substance naturally found in mint plants (and is added to some food/beverages), so some may assume it would be fine to inhale it," Benam said. "Just because something is or considered safe orally, does not mean it would be safe if inhaled." "For a middle/high schooler who has not smoked combustion cigarettes in the past and thinks it is cool to try a menthol-flavored vaping product, they should know that not only are they exposing their lungs to irritants and toxins in e-cigarette aerosols, but they are getting more particles into their lungs, just because of the menthol," he added. In their paper, the authors noted that an increase in the number of particles from the added menthol flavoring will increase aerosols -- known to contain many harmful substances such as nicotine and multi-functional carbonyls, including formaldehyde -- delivered to the lungs.
For more information: https://tinyurl.com/ywxz3vev
COPD World News - Week of April 16, 2023
Inhaled corticosteroids lower risk for all-cause mortality in patients with COPD
Chengdu, China - Inhaled corticosteroids were associated with lower odds for mortality in patients with COPD. An eosinophil count of 200 cells/μL or more was the greatest predictor of this association. Patients with COPD treated with inhaled corticosteroids for more than 6 months had a decreased risk for all-cause mortality, according to study results published in CHEST. Further, several demographic characteristics were identified as predictors of lower odds for mortality when receiving inhaled corticosteroids, according to researchers. “Inhaled therapy containing inhaled corticosteroids [ICSs], especially triple therapy, should be used in the maintenance treatment of patients with COPD, especially in those with eosinophil counts of [at least 200 cells/μL],” Hong Chen, MD, of the department of respiratory and critical care medicine at Chengdu Second People’s Hospital, and colleagues wrote. In a systematic review and meta-analysis, Chen and colleagues found and assessed 60 randomized controlled trials from a database search that included a total of 103,034 patients with COPD to find out how inhaled therapy including ICSs and the risk for all-cause mortality are related to each other. Researchers also looked for predictors of this association. Of the total cohort, 60,552 patients had inhaled therapy with ICSs and 42,482 patients had inhaled therapy without them. Compared with inhaled therapy not containing ICSs, researchers found a decreased risk for all-cause mortality linked to therapy with “More studies are needed to identify the exact subgroups of patients with COPD who could benefit from the inhaled therapy containing ICSs for a reduction in the all-cause mortality risk and the relevant mechanisms,” Chen and colleagues wrote. This study by Chen and colleagues contributes to growing literature on mortality risk associations with ICS for patients with COPD, but it has several limitations that should be considered when viewing the findings, according to an accompanying editorial by Darcy D. Marciniuk, MD, professor of respirology, critical care and sleep medicine at the University of Saskatchewan, and Luigino Calzetta, PhD, of the department of medicine and surgery at the University of Parma. “Although the results of this study were positive, the findings provided by Chen et al should be interpreted with thoughtfulness, because the analysis was affected by substantial heterogeneity resulting not only from the inclusion of several studies that enrolled heterogeneous populations of COPD patients, but also because several formulations characterized by different regimens of administrations (once daily vs. twice daily) were compared and administered via different inhaler devices,” Marciniuk and Calzetta wrote. “Moreover, several formulations were compared, although there was not consistency between the bronchodilators included in each combination.”
For more information: https://tinyurl.com/mszfnj6y
COPD World News - Week of April 9, 2023
Vaccinating older adults could substantially reduce RSV burden
Raritan, NJ - A model predicted 17.5 to 22.6 million symptomatic RSV cases per year among adults in the U.S. without a vaccine. Overall, 2 million symptomatic cases could be prevented each year with a hypothetical vaccine. Vaccinating older adults for respiratory syncytial virus could reduce the burden of disease by millions, according to approximations made by a disease transmission model. “Respiratory syncytial virus (RSV) is one of the most frequent causes of lower respiratory infections with 3.5 million cases in the U.S., causing the highest burden of disease in children and older adults,” Thierry Van Effelterre, PhD, scientific director at Janssen, told Healio. A disease transmission model showed that approximately 2 million symptomatic respiratory syncytial virus acute respiratory infections could be prevented each year among older adults after a hypothetical vaccine is introduced. “Although the burden of RSV in the older adult population has been studied, the true burden of RSV in adults may be underestimated due to lack of awareness amongst health care providers of RSV as a potential cause of influenza-like illnesses,” Van Effelterre said. According to Van Effelterre, the full burden of RSV in adults needs to be determined to accurately gauge the population-level impact of the adult RSV vaccines currently in development. These data would also be timely, as two of the vaccines in development — Pfizer's RSVpreF and GSK's RSVpreF3 OA — have been recommended for older adults by an FDA committee. The FDA is expected to make its decision for both vaccines on May 3. Van Effelterre added that, to date, only one disease transmission model examined the population-level effects of adult and infant vaccination programs in the U.S., although this model does not account for the “progressive build-up of immunity” beyond the first infection. Van Effelterre and colleagues developed an RSV disease transmission model using a sequential acquisition of immunity approach to understand and predict the population-level burden of symptomatic RSV acute respiratory infections (ARIs) in the U.S. According to the study, RSV ARI cases were projected with and without vaccination of older adults aged 60 and older using assumed vaccine efficacy and vaccine coverage. Van Effelterre said that the team also investigated the potential long-term population-level public health impact of RSV vaccination of older U.S. adults. Using a model that made estimates based on a scenario with no RSV vaccine, there would be a projected 17.5 to 22.6 million symptomatic RSV ARI cases per year among people aged 18 years and older in the U.S., according to the study. Approximately 3.6 to 4.8 million of these cases were projected to occur in adults aged 60 years and older. Additional modeling demonstrated that up to 2 million symptomatic RSV ARI cases could be prevented each year among this older population with a hypothetical vaccine that is 70% effective against symptomatic ARI with 60% coverage. Modeling also showed that up to 0.69 million cases per year could also be prevented in the nonvaccinated population with 50% vaccine impact on infectiousness. “The model projects a substantial RSV burden in adults and older adults in the absence of an intervention, indicating that the true burden of RSV in adults may be underestimated,” Van Effelterre said. “The model projects that vaccinating the 60-year-old-or-older adult population could reduce the burden of disease substantially, with additional indirect effect expected in the nonvaccinated aged-younger-than-60-year-old population if the vaccine reduces infectiousness.”
For more information: https://tinyurl.com/yck6pu97
COPD World News - Week of April 2, 2023
Persistent smoking linked to risk for CV events, death after acute ischemic stroke
Charleston, SC - In patients with acute ischemic stroke, persistent smoking conferred elevated risk for CV events and death vs. never smoking. Former smokers and those who quit after their stroke did not have elevated risk. Smoking consistently after acute ischemic stroke was associated with increased risk for CV events and death compared with never smoking, researchers reported. “In this study, we demonstrated an association between persistent smoking after stroke and higher risk of composite outcome of death, stroke and myocardial infarction. In addition, persistent smokers had double the risk of death compared to never smokers,” Mohammad Anadani, MD, of the department of neurosurgery at the Medical University of South Carolina, and colleagues wrote. “Interestingly, there was no significant difference in the risk of cardiovascular events or death between patients who were former smokers at baseline or those who quit smoking compared to never smokers, which implies that smoking cessation after stroke may reduce the risk of death and cardiovascular events.” In patients with acute ischemic stroke, persistent smoking conferred elevated risk for CV events and death vs. never smoking. A total of 2,874 individuals with acute ischemic stroke were included in the post hoc analysis of Secondary Prevention of Small Subcortical Strokes (SPS3), a randomized, multicenter trial conducted in 82 centers between March 2003 and April 2011 in Spain, North America and Latin America. The primary outcome was major adverse CV events, defined as stroke, MI and mortality, at 18 months, according to the study. Secondary outcomes included stroke, MI and death as individual outcomes. Outcomes were adjusted after the third month of enrollment until an outcome event or the end of the study follow-up. Individuals were stratified based on smoking status: never smokers, former smokers, smokers who quit at 3 months and persistent smokers. Of those included, 570 individuals (20%) were smokers when enrolled, of whom 408 (71.5%) continued smoking and 162 (28.4%) quit smoking by 3 months, the researchers wrote. Smoking status was assessed at baseline, 3 months and every 3 months following. The researchers found that 28.4% of smokers at baseline quit at 3 months and 34% quit at 18 months, whereas of those who quit smoking by 3 months, 14.2% had resumed smoking by 6 months and 20.4% had resumed by 12 months. A major adverse CV event occurred in 18.4% of persistent smokers, 12.4% of smokers who quit, 16.2% of prior smokers and 14.4% of never smokers at 18 months. After adjustment for age, sex, race, ethnicity, education, employment history, hypertension, diabetes, MI, hyperlipidemia and randomization arm of the trial, risk for the primary outcome was higher in persistent smokers compared with never smokers (adjusted HR = 1.56; 95% CI, 1.16-2.09), whereas those who quit smoking by 3 months did not have significantly different risk for the primary outcome compared with never smokers (aHR = 1.25; 95% CI, 0.77-2.02), according to the study. “Persistent smoking compared to never smoking after lacunar stroke was associated with a significant increase in the risk of major cardiovascular events and death,” Anadani and colleagues wrote. “The overall rate of smoking cessation after ischemic stroke was low, highlighting the need for more targeted and effective smoking cessation strategies.”
For more information: https://tinyurl.com/bderhpvd
COPD World News - Week of March 26, 2023
Sanofi, Regeneron unveil 'blow-out' smoker's lung drug data
Paris, France - Sanofi's asthma drug Dupixent met all targets in a trial to treat "smoker's lung", potentially adding billions to the French drugmaker's growth prospects, but also underscoring a heavy reliance on its bestseller. In a late stage trial Dupixent, jointly developed with Regeneron, led to a 30% reduction in moderate or severe acute exacerbations of chronic obstructive pulmonary disease (COPD) smokers also showed improvements in lung function, quality of life and respiratory symptoms. "COPD is an urgent global health concern and a notoriously difficult-to-treat disease due to its heterogeneity, with no novel treatments approved in more than a decade," said Regeneron Chief Scientific Officer George Yancopoulos. Sanofi added its "bold" decision to go without earlier-stage clinical COPD trials had shaved years off the development time. JP Morgan analyst Richard Vosser said the trial update had "blow-out data" in store for investors, and that market consensus for 2027 Dupixent sales of 15.7 billion euros would likely be topped-up by between 1 and 2 billion euros. "We see Dupixent data in COPD exceeding any expectations in the market for benefit," the analyst said. Jefferies analysts said the update yielded "perhaps best case efficacy" to treat the disease. Sanofi previously forecast Dupixent would generate up to 13 billion euros ($14.2 billion) in sales in its best year as it seeks to widen its use across several inflammatory conditions, but it has excluded COPD from its sales target. Sanofi said earlier it was too early to update its sales estimate for the product, which is also used to ease eczema. The anti-inflammatory drug accounted for 8.3 billion euros, or more than 19% of the French group's overall sales of 43 billion euros, last year. That was a currency-adjusted increase of 44% from a year earlier. Sanofi reports combined global Dupixent sales from its alliance with Regeneron. The companies said that full efficacy and safety results would be presented later. They added a second late-stage COPD Dupixent trial was ongoing, with the first data read-out expected next year. Overall rates of adverse events in the trial reporting results were 77% for Dupixent and 76% for placebo. Sanofi and Regeneron on Tuesday announced the European Commission had approved Dupixent to treat severe atopic dermatitis in young children. Prior to that, the drug was also approved in Europe to treat a type of esophagus inflammation.
For more information: https://tinyurl.com/57zn3w5a
COPD World News - Week of March 19, 2023
Researchers rethink e-cigarettes' role in treating cigarette smokers' nicotine addiction
Ann Arbor, MI - University Professor Emeritus at the University of Michigan's School of Public Health, says there is enough evidence to support e-cigarettes' use as a first-line aid for smoking cessation in adults. "Far too many adults who want to quit smoking are unable to do so," Warner said. "E-cigarettes constitute the first new tool to help them in decades. Yet relatively few smokers and indeed health care professionals appreciate their potential value." In a study published in Nature Medicine, Warner and colleagues took a global view of vaping, examining countries that promote vaping as a smoking cessation and countries that don't. While agencies in the United States and Canada acknowledge the potential benefit of e-cigarette use, they deem the evidence to recommend e-cigarettes for smoking cessation as insufficient, according to the authors. However, in the United Kingdom and New Zealand there is high-level support and promotion of e-cigarettes as a first-line smoking cessation treatment option. "We believe that governments, medical professional groups and individual health care professionals in countries such as the U.S., Canada and Australia should give greater consideration to the potential of e-cigarettes for increasing smoking cessation," Warner said. "E-cigarettes are not the magic bullet that will end the devastation wrought by cigarette smoking, but they can contribute to that lofty public health goal." Warner's previous research has found considerable evidence suggesting e-cigarettes are an effective smoking-cessation tool for adults in the U.S., where hundreds of thousands of people die of smoking-related illness each year. Electronic cigarettes are hand-held, battery-operated devices that heat a liquid containing propylene glycol and/or glycerin, flavoring compounds and typically nicotine to produce an aerosol that users inhale or vape. In addition to evaluating differences in regulatory activities across countries, the researchers examined evidence that vaping increases smoking cessation, the health consequences of e-cigarettes and the implications for clinical care. They also cite the Food and Drug Administration's designating some e-cigarette brands as "appropriate for the protection of the public health"—the standard required to receive approval for marketing. This action, the researchers say, implies indirectly that the FDA believes e-cigarettes can help some individuals quit smoking who would not do so otherwise. Warner and colleagues concluded that "acceptance of the promotion of e-cigarettes as a tool for smoking cessation will likely depend on continuing efforts to reduce access to, and use of, the products by young people who have never smoked. The two objectives can and should co-exist."
For more information: https://tinyurl.com/4kkkftf7
COPD World News - Week of March 12, 2023
Primary acre COPD screening tool shows mixed results
New York, NY - The five-question CAPTURE window screening tool showed high specificity but low sensitivity in detecting undiagnosed chronic obstructive pulmonary disease (COPD) in primary care. Of 110 patients with undiagnosed but clinically significant COPD, 53 had a positive result on CAPTURE with a specificity of 88.6% (95% CI 87.6%-89.6%) and a sensitivity of 48.2% (95% CI 38.6%-57.9%), reported Fernando J. Martinez, MD, MS, of Weill Cornell Medicine in New York City, and colleagues, in JAMA. The area under the receiving operator curve (AUC) was 0.81 (95% CI 0.77-0.85) for various positive screening thresholds. "The goal with trying to find COPD is to treat it earlier, which will help make patients feel better and hopefully prevent their disease from progressing," Martinez said in a statement. COPD is underdiagnosed in primary care and is the leading cause of death and morbidity, the researchers noted. "Undiagnosed patients experience impaired health status and greater risk of acute respiratory events, health care use, and all-cause mortality," they wrote. "Although there is insufficient evidence to support COPD screening in asymptomatic individuals, identifying patients with respiratory symptoms has been suggested." Whether the CAPTURE (COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk) screening tool is up to that task remains to be seen. "Sensitivity was influenced by the high proportion of individuals with airflow obstruction but limited respiratory symptoms; specificity was influenced by high prevalence of respiratory symptoms among those with a normal spirometry result," Martinez and co-authors noted. "Overall, this study demonstrates the challenge of identifying undiagnosed patients with COPD in primary care." For the cross-sectional study, 4,679 primary care patients (mean age 61.6; 63% female; predominantly white) without a prior COPD diagnosis were enrolled at seven U.S. primary care-based research networks from October 2018 to April 2022. A total of 4,325 people had data adequate for analysis. Of these, 44.6% had ever smoked cigarettes, 18.3% had a prior asthma diagnosis or used inhaled respiratory medications, 13.2% currently smoked cigarettes, and 10% reported at least one cardiovascular comorbidity. CAPTURE included questions on a patient's ability to breathe during physical activity; exposure to forms of smoke, dust, or pollution; change in breathing as a result of seasons, air quality, or weather; ease of fatigue versus peers; and lapses in work, school, or other activities due to colds, bronchitis, or pneumonia. Questionnaire scores can range from 0-6 with larger scores indicating symptoms, acute respiratory illness, or greater respiratory exposure. Positive results were defined as scores at ≥5, or scores 2, 3, or 4 that were accompanied by further spirometry and a peak expiratory flow rate (PEFR) below 350 L/min for males or below 250 L/min for females. Clinically significant COPD was defined as spirometry-defined COPD combined with either forced expiratory volume in the first second of expiration (FEV1), less than 60% of the predicted value, or a self-reported history of acute respiratory illness in the past year. Martinez's group noted this definition "was based on older criteria that focused on the severity of airflow obstruction and prior respiratory illnesses," whereas more up-to-date Global Initiative for Chronic Obstructive Lung Disease (GOLD) therapeutic strategies are dependent on symptoms and respiratory illness. Overall, 12.3% of all patients received a positive result for clinically significant for COPD via CAPTURE; of those, 43.8% obtained a result based solely on the questionnaire, while 56.2% received a positive result from CAPTURE plus PEFR. Among patients with a positive screening result, 88.7% had either COPD, a preserved ratio impaired spirometry result, or were symptomatic but with a normal spirometry result compared with 43.4% of patients with a negative screening result. One benefit of CAPTURE is that it can push physicians to escalate assessment of patients with respiratory symptoms, particularly if spirometry is too difficult to integrate into a brief primary care office visit, the researchers noted. "CAPTURE was designed to be easy for physicians to use," said Antonello Punturieri, MD, PhD, of the National Heart, Lung, and Blood Institute, which helped develop the tool. "The screening is simple, takes less than a minute, and helps identify adults with trouble breathing who should be evaluated further," he said in a statement. The sensitivity of CAPTURE needs improvement, Martinez and colleagues acknowledged. One possible strategy for boosting results "would be to consider using an alternate definition of clinically significant COPD that would be congruent with the current GOLD recommendations for treatment initiation," they wrote. "Evaluation is ongoing to optimize the approach and composition of the CAPTURE screening tool's questions."
For more information: https://tinyurl.com/mrxu2knd
COPD World News - Week of March 5, 2023
Europe strives for tobacco-free environment
Geneva, Switzerland: The European Respiratory Society (ERS) is supporting an ambitious goal of the European Citizens’ Initiative to achieve a tobacco-free environment and the first European tobacco-free generation by 2030. ERS calls on its network to join the new campaign, launched recently by the European Citizens’ Initiative, which urges European Union citizens to get behind calls for a tobacco-free environment and generation. The campaign has until January 2024 to gather one million signatures across the European Union. Once it reaches one million validated signatures, the European Commission is obliged to respond and take action. Any EU citizen, who is old enough to vote in European Parliament elections, can sign. The campaign aims to achieve several key objectives, including: Promote the first tobacco-free European generation by 2028, ending the sale of tobacco and nicotine products to citizens born since 2010. Create a European Net of tobacco-free and butts-free beaches and riverbanks, making this spaces more healthy and environmentally sustainable. Establish a European Net of tobacco-free and butts-free National Parks, making them healthier, reducing contamination and risk of fires. Extend outdoor smoke and vapor-free spaces, especially those frequented by minors (parks, swimming pools, sports events and centers, shows and restaurants terraces). Eliminate tobacco advertising and presence in audiovisual productions, social media, specially addressing covert advertising through influencers and product placement. Finance research and development projects for diseases caused by tobacco use to improve their prognosis and make them curable. Tobacco usage is the leading cause of preventable disease and premature death across Europe. The European Citizens’ Initiative’s campaign aligns with ERS policy on Tobacco Control. Prof. Carlos Robalo Cordeiro, ERS President, said: “Smoking/tobacco use remains to be a major concern for ERS, considering it is one of the main three factors which cause respiratory illness.” Helping people to stop smoking and cutting tobacco use is the most cost-effective health intervention we can make to prevent illnesses such as lung cancer, chronic lung diseases and countless other health problems. Estimates from the European Cancer Information System (ECIS), indicate that in 2020, almost 260,000 people may have died in the EU from lung cancer. Cigarette smoking is also estimated to cause 82 percent of lung cancer cases in Europe (EC/IARC 2015), and exposure to SHS has also been established to cause lung cancer. Globally, the WHO European Region has the highest prevalence of tobacco smoking among adults (28 percent). The WHO also estimates that the proportion of deaths from non-communicable diseases attributable to tobacco use in Europe was 18 percent in 2015, meaning that almost one in every five of deaths from non-communicable diseases could be avoided if tobacco use was eliminated altogether from the region.
For more information: https://tinyurl.com/fyv6wajr
COPD World News - Week of February 26, 2023
Hospital readmission penalties fail to improve care quality for patients with COPD
Chicago, IL - Quality of care for patients with acute exacerbations of COPD did not improve after the Hospital Readmissions Reduction Program was put in place compared with the period prior to the program’s implementation, according to study results. “Our hypothesis was that the Medicare Hospital Readmission Reduction Penalty would facilitate improved quality of care for patients with COPD through efforts to reduce readmissions,” Valerie G. Press, MD, MPH, FACP, FAAP, SFHM, ATSF, associate professor of medicine and pediatrics and executive medical director of specialty value-based care at The University of Chicago, told Healio. “While it was not unexpected that quality of care was improving prior to the implementation of the Medicare penalty, we did not expect that the rate of improvement would slow post-penalty implementation.” In a retrospective cohort study published in American Journal of Respiratory and Critical Care Medicine, Press and colleagues used data from the Premier Healthcare database to analyze the quality of care patients hospitalized with acute exacerbations of COPD aged older than 40 years received across 995 U.S. hospitals before and after COPD exacerbations became a condition of the Hospital Readmissions Reduction Program (HRRP) in October 2014. Researchers tracked changes in quality of care by evaluating adherence to recommended inpatient care treatments (including chest radiography, systemic corticosteroids, bronchodilators, and antibiotics) and non-recommended care (sputum examinations, acute spirometry, mucolytic agents or methylxanthine bronchodilators). They defined ideal care as receiving only the recommended care. The analysis included data of 662,842 patients (mean age, 67 years; 60% women; 75% white) before HRRP was implemented from January 2010 to September 2014 and 285,508 patients (mean age, 67 years; 61% women; 77% white) after HRRP was implemented from October 2014 to December 2018. Based on the findings, HRRP did not improve quality of care. Researchers found that use of recommended care only increased by 0.01% per month with HRRP compared with an increase of 0.16% per month before HRRP (P < .001). Per month, patients receiving non-recommended care decreased by 0.13% after HRRP, which was less than the decrease of 0.15% per month before HRRP implementation. Compared with the rate before HRRP, HRRP implementation was related to a lower increase in ideal care per month (0.11% vs. 0.24%; P < .001). Two important findings came out of these results. “First, clinicians need to remain vigilant about providing ideal care to our patients hospitalized with COPD exacerbations including providing guideline-recommended care and not providing care that is not recommended,” she said. “Second, policy only may not be sufficient to galvanize improved adherence to clinical guidelines such that system-based approaches are needed to facilitate providing high quality and value of care. “Ideally, future studies on the quality of care provided to patients hospitalized with COPD can evaluate both the clinical inpatient treatments as well as the care transition interventions provided across in-patient and outpatient settings to better ensure patients with COPD are supported to have high quality of life without repeat COPD exacerbations and/or the need to be re-hospitalized,” Press added.
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COPD World News - Week of February 19, 2023
Study finds new association between social isolation and dementia risk factors
Montreal, PQ - Social lifestyle determinants, including social isolation, are associated with neurodegeneration risk factors, according to a new study published this week in the open-access journal PLOS ONE by Kimia Shafighi of McGill University, Canada, and colleagues. Alzheimer's disease and related dementias (ADRD) is a growing public health crisis, with an annual global cost of more than $1 trillion US. There has been increasing evidence that social isolation is associated with an increased risk of ADRD, but the links between social lifestyle and other known ADRD risk factors are less well understood. In the new work, the researchers studied data on 502,506 UK Biobank participants and 30,097 people enrolled in the Canadian Longitudinal Study of Aging. Both studies had questionnaires that included questions about loneliness, frequency of social interaction and social support. The study found a large array of associations between potentially modifiable ADRD risk factors and both loneliness and lack of social support. Individuals who smoked more, excessively drank alcohol, experienced sleep disturbances, and failed to frequently participate in light to vigorous physical activities—all known risk factors for ADRD—had greater odds of being lonely and lacking social support. For instance, in the CLSA, increased regular participation in physical exercise with other people was associated with a 20.1% decrease in the odds of feeling lonely and 26.9% decrease in having poor social support. Physical and mental health factors previously linked to ADRD, such as cardiovascular disease, vision or hearing impairment, diabetes and neurotic and depressive behaviors, were also associated with both subjective and objective social isolation. In the UKBB, for instance, difficulty to hear with background noise corresponded to a 29.0% increase in the odds of feeling lonely and a 9.86% increase in the odds of lacking social support. The odds of feeling lonely and lacking social support were also 3.7 and 1.4 times greater, respectively, as a function of a participant's score for neuroticism. The authors conclude that social isolation, which can be modified more easily than genetic or underlying health risk factors, might be a promising target for preventive clinical action and policy interventions. The authors add, "Given the uncertain impact of social distancing measures imposed by COVID-19, our findings underscore the importance of investigating the multiscale effect of social isolation to inform public health interventions for ADRD."
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COPD World News - Week of February 12, 2023
Chest sensors allow remote 6-minute walk testing for lung patients
Rochester, NY - Chest sensors that measured heart rate and accelerometry enabled patients with pulmonary artery hypertension to undergo 6-minute walk tests remotely with similar data as those collected in clinic, according to study results in CHEST. Measuring cardiac effort rather than distance walked can overcome prior limitations of exercise tolerance home assessment, according to researchers. “We think this home 6-minute walk test could complement telemedicine or help when assessing clinical status or titrating a drug,” Daniel J. Lachant, DO, assistant professor of medicine at University of Rochester Medical Center, told Healio. In a single-center, prospective observational study, Lachant and colleagues evaluated 20 patients (median age, 59 years; 80% women) with PAH to see if a chest-based accelerometer (BioStamp nPoint, MC10 Inc.) that collects ECG heart rate data can accurately and safely estimate 6-minute walk test (6MWT) distance at home. Researchers also evaluated if cardiac effort — measured as the total number of heart beats during the test divided by the total distance walked — served as a better remote measure than distance walked. In the span of 2 weeks, patients took two 6MWTs in the clinic (first and last) and two to four 6MWTs remotely on their own schedules while wearing the sensors. Researchers compared the clinic and remote data using Wilcoxon matched-pairs signed rank tests, Spearman correlation coefficients and Bland-Altman plots. Of the patients, 30% had idiopathic PAH, 60% had connective tissue disease-related PAH and 10% had repaired congenital heart disease-related PAH. Based on data from 38 clinic 6MWTs, researchers found a strong correlation between walk distance estimated by the accelerometer-derived count of laps and directly measured distance (r = 0.99; P < .0001). Similarly, researchers observed a strong correlation between both estimated and reported remote 6MWTs distances (r = 0.81; P < .0001), with an average difference between the two of 2.8% (± 12.9%), which researchers wrote could reflect patient counting error or premature turns. When comparing median sensor-estimated walk test distances, the remote 6MWT was shorter compared with the clinic 6MWT (389 m vs. 405 m; P = .002). In terms of cardiac effort, researchers observed no difference between clinic measurements and remote measurements (1.75 beats/m; 95% CI, 1.48-2.2 vs. 1.85 beats/m; 95% CI, 1.57-2.14), which they said suggests cardiac effort is a less variable measure than distance walked and can correct for several factors such as more turns taken in smaller walking spaces or having no staff. “We started this in the first year of the COVID-19 pandemic when there was still a lot of uncertainties,” Lachant told Healio. “Our patients were very creative in the places they chose to complete the home 6-minute walk test. We were happy to find out that after adjusting for heart rate there was a similar measurement obtained in the clinic and home setting. “[In terms of future studies,] this data opens the idea of doing decentralized clinical trial with physiologic assessment remotely,” Lachant added.
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COPD World News - Week of February 5, 2023
Exacerbations hasten emphysema progression in former smokers with COPD
Birmingham, AL - Former smokers with COPD who experienced exacerbations had larger lung density declines than those without exacerbations, according to a letter to the editor published in Annals of the American Thoracic Society. “We found a stepwise greater loss of lung density with increasing exacerbation frequency, predominantly in former smokers who already had some pre-existing emphysema,” Surya P. Bhatt, MD, MSPH, associate professor of medicine in the division of pulmonary, allergy and critical care medicine at the University of Alabama School of Medicine and medical director of the UAB Pulmonary Function and Exercise Physiology Lab, and colleagues wrote. Data were derived from Bhatt SP, et al. Ann Am Thoracic Soc. 2022; doi:10.1513/Annals ATS.202112-1385RL. Using data from the COPDGene study, Bhatt and colleagues analyzed 3,874 adults (mean age, 63.4 years; 50.2% women; 25% African American) with COPD, either current (n = 1,522) or former persistent (n = 2,352) smokers, to find out if acute exacerbations are related to quicker emphysema progression. Patients underwent spirometry and CT at study enrollment and after 5 years, and researchers tracked patients’ interval exacerbations every 3 to 6 months within the study period. Of the total cohort, 1,829 patients had Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 0, 357 had GOLD stage 1, 756 had GOLD stage 2, 365 had GOLD stage 3 and 87 had GOLD stage 4 disease at baseline. Researchers characterized patients based on exacerbation frequency over 5 years: 2,590 (67%) patients had no exacerbations, 1,284 (33%) had at least one exacerbation, 864 (22%) had one to four exacerbations and 420 (11%) had at least five exacerbations. Adjusting for variables such as age, sex, race and BMI, researchers found that a higher number of exacerbations was linked to larger adjusted lung density declines among patients who formally smoked. Former smokers who had five or more exacerbations had a –5.22 g/L (95% CI, –6.23 to –4.21) change in lung density compared with a change of –4.16 g/L (95% CI, –4.91 to –3.41) among those who had one to four exacerbations and a change of –3.27 g/L (95% CI, –3.81 to –2.74) among those with no exacerbations (P < .0001 for all). Adjusted lung density estimates include aging effects, which researchers estimated to be 0.36 g/L per year. Researchers reported similar findings when evaluating former smokers with at least 5% emphysema (5 exacerbations, –5.92 g/L, 95% CI, –7.13 to –4.71; 1-4 exacerbations, –4.68 g/L, 95% CI –5.67 to –3.69; no exacerbations, –3.73 g/L, 95% CI, –4.6 to –2.87), although this association did not occur for those with less than 5% emphysema at baseline regardless of smoking status. On the other hand, patients who actively smoked had greater mean adjusted lung density changes than former smokers ( 5 exacerbations, –5.61 g/L, 95% CI, –7.39 to –3.83; 1-4 exacerbations, –5.58 g/L, 95% CI –6.84 to –4.32; no exacerbations, –4.89 g/L, 95% CI, –5.63 to –4.16), but researchers did not find the same effect modification that they found in the former smoker group. “Exacerbations are related to emphysema progression in a dose-dependent manner,” Bhatt and colleagues wrote. “Even low exacerbation frequency is associated with a high risk of emphysema progression, especially once emphysema has already set in. As emphysema is irreversible, these results underscore the importance of preventing exacerbations.”
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COPD World News - Week of January 29, 2023
Patients with COPD face high mortality risk, costs in year after surgery
Toronto, ON - One year after surgery, patients with COPD had a greater risk for mortality and higher health care costs than those without COPD, according to a study published in Canadian Medical Association Journal. “A big take-away from this study is that these patients are at increased risk of death and incur higher health care costs beyond 30 days after surgery,” said Ashwin Sankar, MD, MSc, FRCPC, clinician investigator in anesthesiology and perioperative medicine at St. Michael’s Hospital and University of Toronto. “Other studies of outcomes in patients who undergo surgery have typically focused on the first 30 days, and this outcome may not adequately capture the overall burden of surgery and how long it may take patients to recover.” Data were derived from Sankar A, et al. CMAJ. 2022;doi:10.1503/cmaj.220733. In a retrospective population-based cohort study, Sankar and colleagues used linked health administrative databases to evaluate 932,616 patients (median age, 65 years; 59.9% women) aged 35 years or older undergoing an elective noncardiac surgery in Ontario from 2005 to 2019, including 170,482 (18.3%) patients with COPD. They used Cox proportional hazard models to determine differences in survival and a linear regression model with log-transformed costs to determine differences in health system costs 1 year after surgery between patients with and without COPD. Of the total cohort, a greater percentage of patients with COPD died within the 1-year study period (10.6% vs. 4.5%) and within 30-days after surgery (3.4% vs. 1.2%) than those without COPD. Compared with those without COPD, those with COPD had a higher risk for death in models partially adjusted for sociodemographic factors and procedure type (adjusted HR = 1.61; 95% CI, 1.58-1.64) and fully models that additionally considered comorbidities (aHR = 1.26; 95% CI, 1.24-1.29). Further, patients with COPD had 13.1% (95% CI, 12.7%-13.4%) greater total health care costs in partially adjusted models and 4.6% (95% CI, 4.3%-5%) greater total costs in fully adjusted models. Depending on the type of surgical procedure, the impact of COPD on cost differed; researchers noted that cost for these patients was greater after orthopedic and lower abdominal surgery. Researchers also found that frailty, cancer and procedure type altered the association between COPD and outcomes. “As a follow-up to this study, we are currently working on identifying whether there are subsets of COPD patients or specific features of COPD which make certain patients high risk for complications after surgery,” Sankar told Healio. “This work would also be informative to clinicians on which patients require further assessment prior to surgery, and potentially also need additional support after surgery.” Because these findings impact the everyday clinician, Sankar told Healio a few things they should keep in mind when treating patients with COPD. “First, our study quantifies the additional risks faced by patients with COPD,” he said. “Informing patients of risk of surgery is an important component of the informed-consent process prior to surgery. We would suggest that clinicians and patients weigh these risks when deciding to proceed with surgery. “Next, we found that COPD often coexists with other conditions like diabetes, coronary artery disease and frailty. What we would suggest to clinicians is to use COPD as a flag for other conditions, and to ensure that modifiable risk factors are optimized prior to surgery,” Sankar continued. “Lastly, our finding that patients with COPD are at risk beyond 30 days after surgery suggests that it may be worthwhile to additionally support these patients' recovery beyond the first month after surgery.”
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COPD World News - Week of January 22, 2023
Cutting back on smoking no help for dementia risk
Seoul, Korea - Quitting smoking was associated with a lower risk of dementia but cutting back was linked with an even higher risk, according to a Korean cohort study. In the study of nearly 800,000 participants, most of whom were men with a long history of smoking, those who quit over a median follow-up of 6.3 years had a significantly lower risk of all dementia compared with those who sustained their smoking habits (adjusted HR 0.92, 95% CI 0.87-0.97), reported Dong Wook Shin, MD, DrPH, MBA, of Sungkyunkwan University School of Medicine in Seoul, and co-authors. However, smoking reduction -- decreasing the number of cigarettes smoked by at least 50% per day -- was associated with an increased risk of dementia versus those who sustained their smoking intensity (aHR 1.25, 95% CI 1.18-1.33), while a more modest increased risk was seen for those who started smoking more (aHR 1.12, 95% CI 1.06-1.18), they noted in JAMA Network. "One possible explanation for this finding is the sick quitter phenomenon. A reduction or cessation of cigarette smoking could suggest behavioral changes toward a healthy lifestyle because of health concerns, considering the higher number of prevalent comorbidities in the reducer group than the sustainer group," Shin and team wrote. "In this context, the decreased risk of dementia associated with smoking cessation could be underestimated because of the sick quitter phenomenon. However, the protective association between smoking cessation and dementia despite the high number of comorbid conditions in those who quit suggests that the sick quitter or reducer phenomenon cannot solely explain the findings," they continued. Those who reduced their number of cigarettes by 20-50% per day saw a dementia risk that was not significantly different than the sustained smoking group (aHR 1.06, 95% CI 1.00-1.12). Shin and colleagues emphasized the need for encouragement and support for patients’ intent on quitting smoking, rather than focusing on reducing their cigarette use. "Despite the lack of benefits from smoking reduction for risk of dementia, a reduction-to-quit intervention may be an important first step toward smoking cessation," they noted. In analyses stratified by age, sex, and alcohol drinking, results were consistent with the main findings. The decreased risk of all dementia in participants who quit smoking was greater in those younger than 65 compared with those 65 and older (aHR 0.81 vs 0.97, P=0.003 for interaction), while there was no significant difference between men and women. The decreased risk of all dementia for those who quit smoking was also more prominent among alcohol drinkers compared with non-drinkers (aHR 0.84 vs 1.02, P<0.001 for interaction). This study included 789,532 participants ages 40 and older from the National Health Insurance Service database of Korea (95.8% men, mean age 52.2). They underwent biennial health exams in 2009 and 2011 and were current smokers at the first exam. They were followed until the end of 2018. Nearly 35% had been smokers for 30 years or longer, and 80.2% had been smoking for 20 years or more. At the time of the 2011 examination, 14.6% of participants had quit smoking, 21.9% had reduced smoking habits, and 15.9% had increased cigarette use. They were put into five groups, based on the changes made to their smoking intensity from the time of their first examination to their second: quitter, reducer I (at least 50% fewer cigarettes per day), reducer II (20-50% fewer per day), sustainer, or increaser (20% or more per day). During the median 6.3-year follow-up, 11,912 dementia events, including 8,880 cases of Alzheimer's disease and 1,889 cases of vascular dementia, were observed. Smoking cessation was associated with a significantly lower risk of vascular dementia (HR 0.84, 95% CI 0.73-0.97) but not Alzheimer's disease (HR 0.94, 95% CI 0.88-1.01). Shin and team acknowledged that the study being made up almost entirely of men was a limitation. In addition, they were unable to collect some information on dementia risk factors, such as education level and apolipoprotein E ε4 level. Information on second-hand smoking or use of products like electronic cigarettes was also not available. In addition, they noted that "because dementia progresses insidiously during the early stages, a follow-up duration of 6 years may not be sufficient to fully elucidate the associations between changes in smoking and risk of dementia."
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COPD World News - Week of January 15, 2023
Most older patients with Chronic Obstructive Pulmonary Disease in good mental health
Toronto, ON - A majority of adults older than 50 years with COPD had no psychiatric disorders and had good mental health, according to a study published in International Journal of Environmental Research and Public Health. “Most of the previous research on COPD, including my own, has focused on those who are not doing well with respect to depression and anxiety,” Esme Fuller-Thomson, PhD, director of the Institute for Life Course and Aging at the University of Toronto and professor in the Factor-Inwentash Faculty of Social Work, told Healio. “The nationally representative findings of our current study are good news that should be shared with patients and their families. Knowing that most people with COPD are happy and mentally healthy may be very reassuring for the newly diagnosed. Results from this study suggest that many patients with COPD are “mentally flourishing” with more than four in every five without any psychiatric disorders and two-thirds in good mental health, according to the researchers. “However, since one in eight older adults with COPD are dealing with a mental illness, it is still important for clinicians to screen their COPD patients and to refer those who are struggling for therapy,” Fuller-Thomson added. “Individuals who are depressed or anxious can benefit from efficacious talk therapy such as cognitive behavioral therapy.” Fuller-Thomson and colleagues used data from the 2012 Canadian Community Health Survey–Mental Health to identify adults aged 50 years or older, 703 of whom (55.9% women) had COPD and 10,189 of whom (50.2% women) did not have COPD. Researchers performed bivariate and logistic regression analyses to compare the mental health — measured via the absence of psychiatric disorders (APD) and complete mental health (CMH) or being free from mental illness — between these two groups. They also sought to determine the factors linked to having no psychiatric disorders and being in good mental health among patients with COPD. To measure APD, individuals reported whether they had experienced depressive disorders, anxiety disorders, bipolar disorders, substance dependence or suicidal ideation in the past year. CMH was classified as APD in the past year plus nearly daily emotional well-being (such as life satisfaction or happiness) and high accounts of social and psychological well-being in the past month, as assessed by the Mental Health Continuum-Short Form (MHC-SF). Overall, researchers found that patients with COPD had a significantly lower frequency of APD (86.7% vs. 95%) and CMH (66.7% vs. 77%; P < .001 for both) than individuals without COPD. Despite these differences, these results suggest that many patients with COPD are “mentally flourishing” with more than four in every five without any psychiatric disorders and two-thirds in good mental health, according to the researchers. “COPD is a very serious and potentially fatal condition, so we were amazed to learn that the vast majority of older adults with COPD were free of any mental illness,” said Fuller-Thomson.
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COPD World News - Week of January 8, 2023
Nearly half of deaths for 12 cancers in California are due to tobacco, higher than previously reported
Sacramento, CA - Despite California's success in reducing tobacco use, a new study published today in JAMA Network Open demonstrates the continued and significant burden tobacco inflicts on people with cancer. The study was conducted by researchers at UC Davis Comprehensive Cancer Center who used data collected from the California Cancer Registry, a state-mandated population-based cancer surveillance system managed by UC Davis. The study looked at people diagnosed with one of 12 tobacco-related cancers from 2014-2019 in California. The analyses showed that close to half of the cancer deaths over two years between 2017-2019, totaling 93,764 Californians, were associated with tobacco use. "This is almost double what was previously estimated in a study that looked at 2014 data," said California Cancer Registry researcher Frances Maguire, who is the lead author of the study. "However, we believe this is a more accurate representation since tobacco use data came directly from individual patients with cancer rather than estimates based on general population surveys. This study is also specific to the 12 tobacco-related cancers." From 2014-2016 to 2017-2019, there was a decline in the proportion of deaths due to smoking from 48% to 45%, with larger declines for women compared with men. The overall number of smoking-attributed cancer deaths declined by approximately 10%. "Our analyses of changes over the two time periods suggest promising trends in tobacco behavior among Californians newly diagnosed with cancer, which could be related to the state's ongoing tobacco control efforts," senior author of the study UC Davis Health internist and tobacco researcher Elisa Tong said. In November 2016, a $2 per pack tobacco tax was passed by California voters, which also helps support the activities of the California Tobacco Control Program. However, a separate study did not find that the smoking behavior in the general population had decreased significantly. However, the overall quit ratio in the study, at 69.6%, is a little higher than the general population in California of 65.9%. There was also an increase in this ratio over the two time periods, which reflects improvement after the implementation of the state tax. "Current tobacco use among the people diagnosed with cancer was higher than among the general population but decreased over time," said Maguire. "This suggests that tobacco control efforts have contributed to a decline in cancer mortality in California, but smoking cessation efforts targeted at patients with cancer are needed." Over half (57.6%) of Californians in the cancer study had used tobacco at some point and current tobacco use was higher than the general population (17.5% vs. 11%), totaling 69,103 patients. "What is important to note in the study findings is the number of Californians diagnosed with these 12 types of cancers that still use tobacco: about 1 in 5 men (19.6%) and 1 in 7 women (14.5%). Some people with lung cancer or laryngeal cancer had even higher use rates at 30-37%," Tong said. "It's important to remember that it's never too late to quit smoking even after a cancer diagnosis because quitting can improve cancer treatment outcomes and significantly reduce mortality." Tobacco status data used in the study included use of cigarettes, other smoked tobacco products (such as cigars and pipes) and smokeless tobacco products (such as chewing tobacco and snuff). The use of vaping products is not yet collected by the registry. The study results showed that among the nearly 400,000 patients diagnosed with a tobacco-related cancer from 2014-2019, most were over 60 years old (72.3%). The majority (57.7%) were non-Hispanic white, were men (58%) and nearly half (46.6%) had lung or colorectal cancers. The greatest number of deaths attributable to tobacco, for both men and women, were from cancers of the lung and bladder. "Smoking remains the largest preventable cause of death from cancer and other diseases," said UC Davis researcher Theresa Keegan, study co-author and co-principal investigator with the California Cancer Registry. "This study shows that tobacco continues to kill Californians with cancer at an alarming rate. Cancer registries can play an important role in monitoring progress for this priority population."
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COPD World News - Week of January 1, 2023
2023 GOLD report reflects COPD field that is improving on a trajectory for the better
Philadelphia, PA - The 2023 Global Initiative for Chronic Obstructive Lung Disease report defines several changes regarding definitions, assessment tools and treatments for COPD, all of which underscore recent advances in the field.“ COPD is not a stagnant disease,” Gerard J. Criner, MD, FACP, FACCP, director of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) International COPD conference, told Healio. “The report identifies disease-modification therapies because we’re improving outcomes and we’re changing mortality, which should give patients and clinicians hope that the field is improving on a trajectory for the better.” To learn more about the updates made in the 2023 GOLD COPD report, “Global Strategy for the Diagnosis, Management and Prevention of COPD,” Healio spoke with Criner about the key changes that were presented at the conference. One overarching significant change in the report is a revised definition of COPD that is more all-encompassing of the demographic that can develop COPD, according to Criner, who also serves as chair and professor of thoracic medicine and surgery at Lewis Katz School of Medicine at Temple University. “The modification of the definition acknowledged that it’s not just people who have been exposed to cigarette smoke but other types of exposures, such as biomass fuels,” Criner said. “The definition also includes people who work in jobs that expose them to a variety of conditions or poor climate. Additionally, it addresses a variety of host factors that may occur in the U.S., as well as non-U.S., such as being born premature or having a lot of childhood infections.” Along with this change in definition, the report also gives more attention to the roles chronic bronchitis and mucus hypersecretion play in the development of COPD and the pathogenesis of airflow obstruction. The 2023 report also has more information on the role of imaging and CT in diagnosing and managing COPD, highlighting the fact that CT has become increasingly available, leading to greater understand of COPD phenotypes, severity and outcomes. The report specifically recommends considering CT for patients with COPD and: persistent exacerbations; symptoms that exceed disease severity based on lung function testing; FEV1 less than 45% predicted with significant hyperinflation; who meet criteria for lung cancer screening. “We have written more about imaging and the importance of imaging to detect abnormalities that may exist in people with COPD that doesn’t cause airflow obstruction in its earlier stages,” Criner said. “The changes reflect that the importance of imaging is more ubiquitous, especially since the imaging with lung cancer screening and people who have been smoke-exposed determine structural abnormalities that may occur and may indicate people who are at greater risk to develop airflow obstruction. “The hope is to determine factors that may contribute to COPD earlier in life, so we can intercede and maybe transform the development or alter the trajectory,” he added.
For more information: https://tinyurl.com/y5zj4dy5