COPD World News         Week of December 30, 2007

Combo Therapy Surpasses Single Drug for Severe COPD

LONDON, UK -- Combination drug therapy with salmeterol (Serevent), a long-acting inhaled bronchodilator, and fluticasone (Flovent) improved survival and led to fewer treatment withdrawals compared with single-drug therapy in severe COPD.

A multicenter head-to-head study found a 52% reduction in the risk of all-cause mortality at any time during the study for the combo treatment compared with single-drug treatment, Jadwiga A. Wedzicha, M.D., of Royal Free & University College Medical School here, and colleagues reported in the first January issue of the American Journal of Critical Care Medicine.

Significantly, however, exacerbations, which are key drivers of morbidity and mortality, were similar for the two regimens, the researchers reported.

The study, Investigating New Standards for Prophylaxis in Reducing Exacerbations (INSPIRE), compared the relative efficacy of the combination treatment with monotherapy with the long-acting bronchodilator tiotropium (Spiriva).

Mortality was significantly lower for the combination treatment patients: 21 (3%) patients in this group died compared with 38 (6%) in the tiotropium group.

The exacerbation rates between the two groups were statistically indistinguishable, the researchers said. Although exacerbation rates were similar, there were differences in the treatment required. Oral corticosteroids were used more often to treat the tiotropium patients, whereas the combination patients required antibiotics more frequently, the researchers said.

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COPD World News         Week of December 23, 2007

Menopause Linked to Decreased Lung Function

BERGEN, Norway -- For perimenopausal women, neither too thin nor too fat may be the route to avoiding decreased lung function, allergies, and asthma, according to investigators here.

Women not menstruating for the previous six months had about an 80% increase in respiratory symptoms compared with those menstruating regularly, Francisco Gómez Real, M.D., of the University of Bergen, and colleagues reported in the December issue of the Journal of Allergy and Clinical Immunology.

In addition, the researchers found the association of amenorrhea with lower lung function was particularly strong and significant for the thinnest women, and was also linked to poorer lung function in the heaviest women, whereas there was no association for normal-weight women.

The literature on menopause and lung health is scarce, the researchers wrote, although reports have suggested that asthma in some women starts to worsen around menopause.

The authors speculated that as women undergo menopause, insulin resistance, a proinflammatory condition, could explain their poorer lung function. Smoking, related to earlier menopause and worsening respiratory health, was another limitation, although the analyses were adjusted for pack-years of smoking. Clinicians should be aware of an increased asthma risk and lower lung function in perimenopausal women, especially those who are thin, they added.

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COPD World News         Week of December 16, 2007

New Technique Reveals Insights Into Lung Disease

Leicester, UK - Universities of Leicester and Nottingham are collaborating to use a magnetic resonance technique to image and quantify the air spaces inside the lungs. The results of their research may lead to a link between childhood disease and later degenerative lung disease (COPD).

There are relatively few centres around the world which have access to this particular magnetic resonance technique, which is based in Nottingham University. Researchers at the University of Leicester have recruited cohorts of some 10,000 children – the largest to focus on respiratory illnesses in childhood. The two groups have combined forces, with a joint grant from the Wellcome Trust.

The method relies on the fact that certain noble gases (which are relatively rare in the atmosphere and are very un-reactive), when hyper-polarized in a very strong laser beam, can be detected by magnetic resonance methods.
Tests involve individuals inhaling a very small quantity (in this case 10ml or two teaspoons) of the hyper-polarized helium-3 gas. This technique provides the key to unlock a whole new area of research in the field of lung development.

This is quite different from the magnetic resonance scans are now commonplace in British hospitals. However, all magnetic resonance techniques function without the use of radioactive substances or ionising radiation (as is the case with x-ray techniques). They are thus very safe, and have no known side effects and are ideal for research into childhood illness.
The pulmonary alveolus is the most peripheral structure within the air spaces of the lung, in which the gases carbon dioxide and oxygen move between the air and the blood.

There are said to be about 500 million alveoli in the adult lung, and they have a combined surface area equivalent to about one tennis court. All the alveoli are formed by the age of 3 years, so early illnesses and exposures may leave children at risk of later lung disease.

Professor Silverman added: “The outcome that we are seeking is evidence that in young people and teenagers, there are differences in alveolar structure and number in association with disorders of fetal prenatal development and early childhood disease.

“We anticipate that there is an additional impact of teenage smoking on alveolar structure and function. If these observations are confirmed, they would provide for the first time evidence of impaired alveolar (as opposed to airway) development in childhood.

“This could be the link between childhood disease and later degenerative lung disease (COPD). We will then seek the specific factors (genetic or environmental) which lead to defective lung development, and will propose further research to ameliorate these factors.”

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COPD World News         Week of December 9, 2007

HAT inhibitors combat Asthma and COPD

Nottingham, UK - Two University of Nottingham studies exploring the causes and treatment of asthma and COPD could lead to the development of drugs to battle these debilitating conditions.

Researchers will explore histone acetyl transferase (HAT) inhibitors in asthma and COPD. This study will investigate a bank of plant extracts at the University of Strathclyde, seeking compounds that could combat the intercellular processes that result in the symptoms of asthma and COPD — inflammation of the airways which can lead to coughing, breathlessness and increased chest infections. Though they are different diseases, asthma and COPD affect the human body in a similar way. In asthma, allergens irritate the lungs, in COPD, this is done by cigarette smoke. This irritation inflames the sufferer’s airways, which the muscles then close, creating a narrowing effect.

Research done at the University over the past 15 years has found that the muscle layer in the airway is more complex than has traditionally been thought. As well as going into spasm during asthma and COPD attacks the muscle layer produces a wide range of mediators and cytokines — proteins that act as chemical signalers when it comes into contact with allergens or cigarette smoke.

In asthma and COPD sufferers, these proteins are produced by stimulation of airway muscle cell walls in the lungs, releasing intracellular signaling proteins called ‘transcription factors’ which alter the DNA of the cell and activate messenger RNA. It is these ‘transcription factors’ which activate the inflammation by causing release of mediators and cytokines. By exploring plant extracts that may reduce the activation of HATs within airway cells, the researchers may isolate compounds that could be used to suppress inflammation in respiratory disease.

Any drug successfully synthesised from such compounds could potentially revolutionise the treatment of respiratory disease. There is also the potential to treat other inflammatory diseases, such as rheumatoid arthritis and Inflammatory Bowel Disease.

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COPD World News     Week of December 2, 2007

Lung-on-a-chip leads to new insights on Pulmonary Diseases

Ann Arbor, MI - A new "lung-on-a-chip" developed at the University of Michigan mimics the fluid mechanics of the real thing on a plastic wafer just bigger than a quarter. It allows researchers to grow lung airway cells that act more like they're in a human body instead of a Petri dish.

Biomedical engineers used the device to show that the respiratory crackles stethoscopes pick up in patients with lung diseases aren't just symptoms, but may actually cause lung damage. "Our lung-on-a-chip causes the cells to really become lung-like in terms of function and protein secretion. They form the tight tissue connections that they do in the human lung. That doesn't happen in a dish. This device gives you the convenience and control of a dish but in physical conditions that are more like the body," said Shuichi Takayama, associate professor of biomedical engineering and principal investigator on this study.

A paper on the findings is published in Proceedings of the National Academy of Sciences and was adapted from materials provided by the University of Michigan.

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COPD World News         Week of November 25, 2007

Elite Panel Prescribes Tough Medicine for Noncommunicable Chronic Disease

LONDON, UK - A set of 20 "grand challenges" for a worldwide crusade against chronic but noncommunicable diseases has been proposed by an international panel. The 20 challenges, detailed in the Nov. 22 issue of Nature, form a "global roadmap to try to do something serious about reducing the burden of chronic disease," said Stig Pramming, M.D., executive director of the Oxford Health Alliance here.

The project is similar to the 2003 Grand Challenges in Global Health initiative, spearheaded by the Bill and Melinda Gates Foundation, which was aimed at infectious diseases. That chronic-disease strategy was developed by a panel of 155 health experts from 50 countries, who used a so-called Delphi process to agree on 20 of the most serious problems standing in the way of lowering the toll of chronic but noncommunicable diseases, Dr. Pramming and colleagues reported.

Such diseases - including type 2 diabetes, cardiovascular disease, some cancers, and chronic respiratory conditions - account for 60% of all deaths worldwide, Dr. Pramming said. That's double the number of deaths arising from the combination of infectious diseases (including HIV/AIDS, tuberculosis, and malaria), maternal and perinatal conditions, and nutritional deficiencies, he and colleagues said.

The researchers, led by Abdallah Daar, D.Phil., of the McLaughlin-Rotman Center for Global Health in Toronto, also propose a range of research projects intended to find ways of solving the challenges facing the world.

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Alpha-1 widely undiagnosed hereditary disorder

KING OF PRUSSIA, Pa. - A new study finds that a higher than expected number of COPD and severe asthma patients had abnormal low levels of alpha-1 antitrypsin (AAT), suggesting the need for broader criteria for AAT deficiency testing. AAT deficiency, also known as Alpha-1, is a widely undiagnosed hereditary disorder that is usually fatal in its severe form. Alpha-1 is estimated to affect up to 100,000 Americans, but up to 95 percent are undiagnosed or have been misdiagnosed as having another form of chronic obstructive pulmonary disorder (COPD). 

Details of the study were presented at CHEST, the annual meeting of the American College of Chest Physicians held in Chicago.  Study results were announced on World COPD Day to focus attention on the need for wider testing for AAT deficiency. "Findings from this study suggest that simply all patients with moderate or severe persistent asthma and/or COPD with chronic pulmonary symptoms should be tested for AAT deficiency," said Gary Rachelefsky, MD, Professor of Allergy and Immunology and Director of the Executive Care Center for Asthma, Allergy and Respiratory Diseases at UCLA School of Medicine and study investigator.

"Our surveillance study found that physicians cannot depend on typical patient profiles to assess whether AAT deficiency screening is necessary. There is no 'face' to AAT deficiency," said D. Kyle Hogarth, MD, FCCP, Assistant Professor of Medicine, University Chicago Medical Center, Director of the Alpha-1 Antitrypsin Deficiency Clinical Resource Center at the University of Chicago and lead author of the study.  "A number of patients who would not normally be screened based on suggested guidelines turned out in fact to be positive for AAT deficiency. 

In the real-world setting, this suggests that thousands of patients who have been diagnosed with COPD or severe asthma may actually have Alpha-1."

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COPD World News         Week of November 18, 2007

COPD nearly double previous estimates

Ottawa, ON. - Startling research findings released recently by The Lung Association demonstrate that as many as three million Canadians may have COPD, Canada's fourth leading cause of death. This is nearly double previous estimates and includes over one and a half million (1.6 million) undiagnosed Canadians and one and a half million (1.5 million) who say they currently suffer from this chronic lung disease.

The research also shows that the disease is highly prevalent among younger Canadian baby boomers - one in seven Canadians aged 45 to 49 (375,000) may have COPD. This research confirms recent global prevalence data published in The Lancet which states "evidence suggests that rates of disease (COPD) are generally underestimated."

"Smoking is the number one cause of COPD and it is astounding that millions of Canadians who may have COPD haven't been tested," said Dr. Anna Day, Director of the Gender Asthma and COPD Program at Women's College Hospital in Toronto. "It is essential that those who think they may have COPD talk to their physician about spirometry, a breathing test for COPD."

Updated COPD guidelines released in September by the Canadian Thoracic Society (CTS), the medical section of The Lung Association, indicate that early diagnosis, when coupled with successful smoking cessation interventions, will provide substantial long-term health benefits.

A simple breathing test, called Spirometry, is used to diagnose COPD.   When this test is performed in the disease's early stages, outcomes of COPD can be improved.  Spirometry involves blowing into a tube to calculate the amount of air the lungs can hold and the rate at which the air is expelled.

"The statistics that show the large number of younger Canadian baby boomers with this disease underscores the need to both educate Canadians and advocate on behalf of current COPD patients," said Nora Sobolov President & CEO of the Canadian Lung Association.  "Current and former smokers who have yet to get themselves tested for this disease, must take action - the devastating impact of COPD must be taken seriously."

Smoking is the main cause of COPD. Fifty-six per cent of all Canadian adults are current or ex-smokers: nearly five million (4.9 million) who currently smoke and nine and a half million ex-smokers. More men than woman currently smoke (20 per cent versus 17 per cent, respectively); however women are catching up to men, confirming projections that COPD is rapidly becoming a serious women's health issue.

For more information: or call the COPD "BreathWorks" hotline 1-866-717-COPD (2673).

American College of Physicians Issues Guidelines for COPD

Philadelphia, PA. - The American College of Physicians (ACP) today released a new clinical practice guideline on diagnosing and treating stable chronic obstructive pulmonary disease (COPD), a slowly progressive lung disease involving the airways and lung tissue, resulting in a gradual loss of lung function, typically as a result of smoking.

COPD affects more than 5 percent of the adult population in the United States and is the fourth leading cause of death and twelfth leading cause of illness. The symptoms of COPD range from chronic cough and wheezing to more severe symptoms such as shortness of breath and significant activity limitation.

The guideline offers six recommendations, including:

- In patients with respiratory symptoms, particularly shortness of breath, spirometry (a simple test in which a person blows into a machine that measures the amount of gas breathed into it over a period of time) should be performed to diagnose airflow obstruction. Spirometry should not be used to screen for airflow obstruction in asymptomatic individuals.
- Treatment of stable COPD should be reserved for patients who have respiratory symptoms and forced expiratory volume in one second (FEV1) less than 60 percent predicted, as documented by spirometry.
- For symptomatic patients with COPD and FEV1 less than 60 percent predicted, clinicians should prescribe long-acting inhaled fl-agonists, long-acting inhaled anticholinergics, or inhaled corticosteroids.
-Clinicians should prescribe oxygen therapy in patients with COPD and insufficient levels of oxygen in the circulating blood while resting.

"The evidence does not support using spirometry as a diagnostic strategy for individuals not reporting respiratory symptoms," said Steven Weinberger, MD, FACP, Senior Vice President, Medical Education and Publishing at ACP, and an author of the guideline. "However, adding spirometry to clinical examinations for individuals with respiratory symptoms, especially shortness of breath, has demonstrated benefits."

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COPD World News            Week of November 11, 2007

Research looks at monitoring at-home patients with wireless handhelds

HAMILTON, ON. - Wireless handhelds are revolutionizing almost every aspect of life these days. Now, a team of health scientists has launched a new study on how Blackberries might be used to improve the monitoring and treatment of patients suffering from chronic disease - and even to save lives.

Led by Neil Johnston of the Firestone Institute for Respiratory Health at St. Joseph's Healthcare in Hamilton, the study will use specially configured Blackberries to help monitor 120 patients living at home and suffering from Chronic Obstructive Pulmonary Disease (COPD). The study has two objectives: first to establish that the Blackberry-based reporting system, or diary, will work for this monitoring purpose, and secondly, to determine the factors that cause exacerbations of COPD throughout yearly cycles of the disease. Patients in the study will record their symptoms daily on their Blackberry and transmit the information to study nurses for review. If a patient experiences symptoms that suggest that an exacerbation is occurring a team member will go to the patient's home to assess the situation.

Early detection is important because the symptoms associated with a medical crisis often begin up to seven days prior to the peak. If treatment can be administered early, there is potential to reduce the severity and duration of the crisis, and as a result, reduce the need for emergency treatment in hospital. "We want to see whether this technology can be used to improve the early detection of serious complications in COPD patients so that health professionals can intervene in a more timely manner," said Johnston, who is an epidemiologist and Assistant Professor of Medicine at McMaster University. "We also are hoping to pinpoint with more precision the high-risk peak periods of the year," he said.

Johnston said there are signs that the period between Christmas and New Year's is a particularly risky period for COPD patients. Festive and family events, stress and different eating patterns may all have an impact on the severity of symptoms, he said but little is currently known about the causes of the Christmas epidemics of COPD.

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COPD World News            Week of November 4, 2007

Inhalers Difficult Challenge For Asthma, COPD Patients

CHICAGO, IL -- One in three patients with asthma or chronic obstructive pulmonary disease is unable to use an inhaler properly, a researcher said here. The rate of errors was higher for older patients and those with more severe disease, Siegfried Wieshammer, M.D., of Offenburg Hospital in Offenburg, Germany, told attendees at CHEST 2007, the annual meeting of the American College of Chest Physicians. On the other hand, if medical personnel took the time to instruct patients in the use of inhalers, the error rate dropped dramatically, Dr. Wieshammer said.

Dr. Wieshammer and a colleague studied 224 consecutive patients referred to their clinic by primary care practitioners, asking them how they were familiarized with their inhaler and then to demonstrate its use. Overall, 32.1% of the patients made what Dr. Wieshammer called "an essential error" and no medication got to the lungs. Among patients who weren't instructed on how to use the devices the error rate was 52.6%, he said. Encouragingly, Dr. Wieshammer said, the error rate fell to 23.1% if medical personnel had given instruction in how to use the devices, which rely on the force of the patient's inhalation to deliver the medication.

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Newly discovered fatty acids may lead to novel treatments for COPD and Asthma

Stockholm, Sweden - Eoxins may be another piece in the puzzle helping us to understand the mechanism for airway inflammation. Professor Hans-Erik Claesson, Karolinska Institute, presented new data on eoxins at the annual meeting of the European Respiratory Society (ERS) in Stockholm.

The discovery could pave the way for new medicines addressing respiratory diseases such as asthma and COPD. Eicosanoids is the collective name for a large number of fatty acids, all having important functions in the body. The most well-known are the prostaglandins, which for example regulate blood flow and parturition, but also cause fever and pain.

The recently discovered eoxins are mainly produced by cells in the respiratory tissue, where they can cause inflammation and oedema leading to airway obstructions. "Today, corticosteroids are being used to treat the inflammatory component in asthma and COPD, but this discovery could lead to the development of medicines with a completely new mechanism of action", says Professor Hans-Erik Claesson, Karolinska Institutet.

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COPD World News            Week of October 28, 2007

Drug-coated stent can relieve emphysema symptoms

NEW YORK, NY - Treatment with a stent coated with the drug paclitaxel to reduce hyperinflation of the lungs appears to be a feasible treatment for patients with severe emphysema, according to the results of a small study. This treatment can improve lung function and reduce shortness of breath, according to the results of small study.

"These results indicate that airway bypass is a potentially viable therapeutic option for patients with marked severe pulmonary destruction, whose only current option may be to wait for a lung transplant," lead author Dr. Paulo F. G. Cardoso, from Santa Casa de Porto Alegre-Pavilhao Pereira Filho Hospital in Brazil, said in a statement. Airway bypass along with less invasive treatments to relieve symptoms in patients with advanced disease, "may ultimately improve quality of life for patients with very severe disease or even those in the transplant waiting lists," he commented to Reuters Health.
Cardoso added that airway bypass is a particularly important advance for patients with "more uniform destruction of the lung" because usually their only option is a lung transplant.

The stents are placed through the airway walls to release the air trapped in diseased segments of the lung, allowing it to be expelled normally, Cardoso and colleagues' explained in their report, published in The Journal of Thoracic and Cardiovascular Surgery.

Airway bypass was first shown to be feasible in 2003, when researchers tested the procedure on diseased lung removed from emphysema patients. The focus then shifted to maintaining the opening of the stented segments, which led researchers to consider the use of drug-coated stents.

Stents are tiny wire mesh tubes used to prop open diseased heart arteries. This type of stent which releases a drug to keep the artery open -- is also used in heart patients to keep the vessels open after they are cleared of the clog-forming plaque that can cause heart attacks.

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COPD World News            Week of October 21, 2007

World COPD Day, November 14, 2007

World COPD Day, an annual awareness-raising event organized by GOLD and supported by ICC, is coming soon!  The theme for this year’s event is “Breathless Not Helpless!”  Materials and activities will also have an additional focus on “How You Can Help Yourself If You Have COPD.” 

To support this positive theme, Dr. Jochen Scheld will be developing COPD patient portraits to show how people can live full, active lives with this disease.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) works with health care professionals and public health officials around the world to raise awareness of Chronic Obstructive Pulmonary Disease (COPD) and to improve prevention and treatment of this lung disease.

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Holiday Peak in Pulmonary Admissions is Linked to Social Gatherings

Stockholm, Sweden - The Christmas peak in hospital admissions for COPD and asthma -- which always plays havoc with staff holiday rotas -- may be caused by patients catching infections at family get-togethers, according to research presented here at the Annual Congress of the European Respiratory Society (ERS).

Family social gatherings spread respiratory viruses to at-risk patients, according to Neil Johnston, MSc, epidemiologist, Firestone Institute for Respiratory Health, and Clinical Assistant Professor, McMaster University, Hamilton, Ontario, Canada.
Dr. Johnston and colleagues examined annual hospitalisation patterns for asthma, COPD and respiratory infections in a range of countries (Canada, England, New Zealand, Scotland and Sweden).

"For adults, especially the elderly, the risk of being hospitalized for COPD increases by 16% to 51% during the Christmas holidays", Mr. Johnston reported. "For asthma, the excess risk is 18% to 62%; and the hospitalization risk for a respiratory infection such as pneumonia goes up by 17% to 52%." New Zealand was the only country to escape this trend, with one hypothesis being that their Christmas comes during the summer months.

Hospital admissions for all 3 examined lung conditions also increased during respiratory-virus epidemics, the Canadian team noted, but the "Christmas epidemics" seem to occur independently of influenza virus, respiratory syncytial virus (RSV) or parainfluenza virus and adenovirus isolation rates.

"While no particular virus has been associated with the Christmas epidemic", Mr. Johnston explained, "it is still probable that the phenomenon is caused by viral infections, transmitted from person to person, and particularly from children to adults."

The researchers emphasize that family get-togethers during the holidays provide a perfect opportunity for viruses to spread to vulnerable subjects. The sharp rises in hospitalization rates cannot, in their view, be explained by the closure of primary medical services during this time.

"Patients at risk of complications…such as asthmatics and people with COPD, should prepare carefully for the flu season and the Christmas holidays. They should, for example, make sure that their prescriptions are up to date and that they are prepared to treat an exacerbation, if one occurs," Mr. Johnston and his colleagues told the Congress.

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COPD World News            Week of October 14, 2007

Statins reduce loss of function, keeping old lungs young

Boston, MA - Statins are known to be good for lowering cholesterol and maybe even fighting dementia, and now they have another reported benefit: they appear to slow decline in lung function in the elderly even in those who smoke.

According to researchers in Boston, it may be the anti-inflammatory and antioxidant properties of statins that help achieve this effect. Their findings were published in the second issue for October in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

"We hypothesized that statins would have a protective effect on decline in lung function,"  wrote Dr. Joel Schwartz, Ph.D., professor of environmental epidemiology at Harvard School of Public Health, a lead researcher on the study, the first to examine the relationships between statins and lung function decline. "The link between lung function and mortality and the reduced levels of lung function in the elderly indicates the importance of a possibility of reducing the rate of decline,"  wrote Dr. Schwartz.

To investigate whether statins had an effect of loss of lung function, the researchers used data from the ongoing and longitudinal Veterans Administration Normative Aging Study, which began in 1963. They analyzed 803 subjects who had had their lung function measured at least twice between January 1995 and June 2005. Both forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were measured. The study subjects also completed questionnaires on pulmonary disorders, smoking and medication usage.

The investigators found that subjects taking statins experienced a markedly slower annual decline in lung function. In FEV1, statin users lost 10.9 ml on average, whereas nonusers lost an average of 23.9 ml each year more than twice that of the statin group. Similarly, statin users lost an average of 14 ml a year in FVC, whereas nonusers lost an average of 36.2 ml.

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COPD World News            Week of October 7, 2007

Unprecedented Air Purifier Regulations To Take Effect In CA

Sacramento, CA - The Golden State is cracking down on air purifiers. According to the California Air Resources Board, some popular in-home ozone air purifiers do more harm than good. The Board claims the purifiers can actually aggravate conditions such as asthma and bronchitis -- problems that product advertisements claim to relieve.

More than two million residents of California use some type of air purifier. The board estimates more than 500,000 people have been exposed to unhealthy levels of ozone. New regulations to relieve the air purifier setbacks are scheduled to take effect in 2009.

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COPD World News            Week of September 30, 2007

The Canadian Thoracic Society (CTS) releases new treatment guidelines for COPD

Toronto, Canada - The Canadian Thoracic Society (CTS) has released new guidelines for the treatment of chronic obstructive pulmonary disease (COPD), incorporating the latest evidence to provide physicians with up-to-date guidance to treat this disease.

Two of the most significant areas addressed by the 2007 guidelines are the prevention and management of exacerbations and new algorithms to ensure patients are receiving adequate therapy appropriate to their disease severity.
Exacerbations or worsening of symptoms can be triggered by simple occurrences such as a common cold, change in weather, or allergies. They can often result in visits to the local Emergency Department, hospitalization and, in severe cases, can lead to death.

“It’s vital that physicians recognize the importance of exacerbations in the life of a patient with COPD, “says Hernandez. “COPD is not just a nuisance disease that people live with, but a serious disease that people die from. We should consider exacerbations in COPD patients as important as myocardial infarction in people with ischemic heart disease. We need to not only prevent the first exacerbation, but work more proactively to prevent all subsequent flare ups of the disease.”
New treatment algorithms outline optimal pharmacological and non-pharmacological management for COPD according to disease severity. With appropriate treatment, patients with COPD should expect to experience less shortness of breath, better exercise tolerance, fewer hospitalizations and improved quality of life.

The 2007 guidelines emphasize the importance of spirometry as not just a diagnostic tool for COPD, but to determine which patients will benefit most from specific pharmacological interventions.

“The important take-away message for physicians from the revised guidelines is that this is a treatable disease, and with the right treatment options available, patients can do better,” says Dr. Denis O’Donnell, Chair of the CTS COPD Guidelines Development Committee and Professor of Medicine and Physiology, Queen’s University. “Through early diagnosis and correct assessment of disease severity through spirometry testing, along with early and aggressive treatment with both lifestyle changes and medications, COPD can be managed and patients can maintain an improved  quality of life.”

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COPD World News            Week of September 23, 2007

Intelligent Nebuliser Benefits Patients With COPD

Stockholm, Sweden - An "intelligent' nebuliser that provides feedback and adapts drug delivery to breathing pattern appears to have benefits for patients with chronic obstructive pulmonary disease (COPD), according to a study presented here at the Annual Congress of the European Respiratory Society (ERS).

Nicola Goodman, RN, Respiratory Physiologist and Senior Research Assistant, Respiratory Clinical Trials Unit, Department of Respiratory Medicine, Glenfield Hospital, Leicester, United Kingdom and her colleagues evaluated a device that employs new adaptive aerosol delivery (AAD) technology.

This technology aims to overcome a shortcoming of traditional jet nebulisers: the difficulty in predicting how much of the medication placed in the nebuliser cup is actually delivered to the patient.

With the new system, the amount of drug inhaled depends on the patient's breathing pattern. Sensors within the nebuliser handpiece monitor the patient's breathing pattern to detect pressure changes during inspiration and expiration. These sensors determine when to pulse the aerosol delivery of medication during the first part of inspiration. Throughout the treatment, the sensors monitor the preceding three breaths and adapt to the patient's inspiratory and expiratory pattern.
"The device provides active feedback to the patient regarding treatment progression. The system is also fitted with an on-board patient logging system, allowing adherence to treatment and compliance to the correct use of the device to be monitored," Ms. Goodman explained.

"Patients expressed statistically significant preferences that favoured AAD over their previous nebuliser for six out of seven ease-of-use questions, and all ten satisfaction questions. Patients found the AAD nebuliser to be significantly easier to use, showed significantly greater satisfaction and conferred a clinically significant improvement in dyspnoea when compared with the patient's previous nebuliser," the authors reported.

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COPD World News            Week of September 16, 2007

Ten Best Respiratory Hospitals in USA

New York, NY - U.S. News has ranked 192 hospitals in 17 specialties. Detailed information on the hospitals can be found by selecting a specialty or by browsing their alphabetical index of all hospitals.

1. National Jewish Medical and Research Center, Denver

2. Mayo Clinic, Rochester, Minn.

3. Johns Hopkins Hospital, Baltimore

4. Massachusetts General Hospital, Boston

5. Cleveland Clinic

6. Barnes-Jewish Hospital/Washington University, St. Louis

7. University of Colorado Hospital, Denver

8. University of California, San Diego Medical Center

9. University of California, San Francisco Medical Center

10 Duke University Medical Center, Durham, N.C.

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Portland, Oregon - The prevalence of COPD is higher and stages of disease are more advanced than has previously been reported, according to findings from the Burden of Obstructive Lung Disease initiative.

Contrary to common beliefs, smoking is not the only factor contributing to COPD prevalence, the investigators report in The Lancet. The research group, led by Dr. A. Sonia Buist at Oregon Health and Science University in Portland, examined the prevalence of COPD and its risk factors in adults who were at least 40 years old and were living in 12 cities on 5 continents.

More than 9,000 subjects were interviewed, and test results were obtained from 8,775. The study revealed risk factors other than smoking.  For instance Cape Town reported very high levels of previous tuberculosis and occupational exposures, as well as high smoking rates.

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COPD World News            Week of September 9, 2007

Heart attacks decline following Irish smoking ban

Vienna, Austria -- In the 12 months following implementation of a nationwide smoking ban in Ireland, the number of hospital admissions for acute coronary syndrome (acs) decreased by 11%.

While the decrease was impressive, Edward Cronin, M.D., of Cork University Hospital in Wilton, said the report was based on hospital records in just two counties -- Cork and Kerry.  Moreover, he said "this is an observational study so we cannot prove an association between the smoking ban and the decline in acs admissions."

Ireland, which banned smoking in workplaces including restaurants and pubs on March 29, 2004, was the first European Union nation to enact a smoking ban. That action was particularly compelling given the fact that Ireland had the second highest rate of cardiovascular deaths among western European nations-only Finland posted higher cardiovascular mortality.

During the 12 months before the smoking ban, there were about 1,200 admissions for acute coronary syndrome, Dr. Cronin said. In the following year, March 29, 2004 through March 29, 2005, the number of admissions declined by 11%. "Most of the reduction occurred in admissions for non-ST elevation MI," he said. Unlike lung cancer in which the risk of cigarette smoking continues for years after smoking is stopped, the benefit to the heart is fairly quick, he said.

Dr. Cronin's study follows one published in April that reported an 83% reduction in indoor air pollution and an 80% drop in airborne carcinogens in Dublin restaurants and pubs in the 12 months following the ban. That reduction in secondhand smoke exposure was accompanied by significant reductions in respiratory illness among bar and restaurant workers.

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COPD World News            Week of September 2, 2007

Inside or Outside Air Affects COPD Symptoms

ABERDEEN, Scotland, -- COPD patients may be as much at risk from air pollution inside their homes as they are outside, researcher here found.

Fine particulate pollution levels in the homes of COPD patients reached on average of up to four times higher than maximum recommended. The higher levels-mainly from secondhand smoke-were significantly linked to greater symptom burden.

Outdoor air quality, including particulate matter levels, have been well documented to have an impact on respiratory mortality and hospital admissions, they said. But, "indoor air quality has assumed greater importance for health," commented Mark D. Eisner, M.D., M.P.H., of the University of California, San Francisco.

"Residents of developed countries spend the majority of their time indoors, which provides more potential for indoor exposures," he said. "At the same time, changes in home and office building construction have resulted in lower air exchange rates, increasing personal exposure to pollutants emitted indoors."

Further research is needed to test the long-term impact of indoor air quality on COPD patients as well as to determine whether indoor pollutant exposure increases frequency of exacerbations, the investigators said.

For more information:

COPD World News            Week of August 26, 2007

Genes promoting lung cancer may not normalize when smoking stops

VANCOUVER, British Columbia -- For some genes involved in the development of lung cancer, smoking may be forever, according to researchers here.

Smoking irreversibly activates some lung genes and down-regulates others, offering a possible explanation for the elevated lung cancer risk of former smokers, reported Raj Chari, Ph.D., of the British Columbia Cancer Agency, and colleagues, online in BMC Genomics.

They studied lung biopsy specimens from current, former, and nonsmokers and found that smoking induces specific changes in gene activity, some of which are permanent. DNA repair genes are irreversibly damaged by smoking, which also turns off genes that protect against lung cancer. Down-regulated genes that regain normal function with smoking cessation are involved in xenobiotic functions, nucleotide metabolism, and mucus secretion.

"Expression levels of some of the genes related to tobacco smoking return to levels similar to never-smokers upon cessation of smoking, while expression of others appears to be permanently altered despite prolonged smoking cessation," the authors concluded. "These irreversible changes may account for the persistent lung cancer risk despite smoking cessation." Recent gene microarray studies revealed differences in gene expression among current, former, and nonsmokers.

The studies linked smoking's genetic effects to specific functions and showed that some smoking-induced changes are not reversed by smoking cessation.

For more information:

COPD World News            Week of August 19, 2007

Ambulatory oxygen questioned for daily dypsnea in COPD

TORONTO, Canada -- Ambulatory oxygen, a big-ticket item for Medicare, may not be all it's cracked up to be for chronic obstructive pulmonary disease without resting hypoxemia. So found Roger S. Goldstein, M.B., Ch.B., of the University of Toronto, and colleagues, with 27 COPD patients, each acting as his or her own control, a series of double-blind N-of-1 randomized control trials.

Although ambulatory oxygen improved endurance and the number of steps taken in a walk test, few patients with COPD and no resting hypoxemia had improved dyspnea and quality of life scores, the investigators reported in the second August issue of the American Journal of Respiratory and Critical Care Medicine.

This study does not support the general application of extended ambulatory oxygen therapy for COPD patients who do not meet criteria for mortality reduction with long-term oxygen, they said. In this trial design, participants served as their own controls, crossing over between two masked treatments several times.

The patients underwent three pairs of two-week blinded trials using either oxygen during one period of each pair and a placebo mixture (compressed air) during the other. At the end of each trial, patients were assessed with the Chronic Respiratory Questionnaire (CRQ) for dyspnea and the St George's Respiratory Questionnaire and given a home five-minute walk test to assess exercise performance. In the entire group, neither the dyspnea score nor the St. George's Respiratory Questionnaire showed any statistical or clinical differences between oxygen and placebo, Dr. Goldstein and colleagues said.

A potential limitation of this trial was its sample size, the researchers noted. However, the analysis suggested that it would be extremely unlikely that enrolling more patients would have altered the conclusion. In an accompanying editorial, M. Bradley Drummond, M.D., and Robert A. Wise, M.D., of Johns Hopkins, praised the novel design of the study, but added that the broad clinical application of this complex study design might be difficult.

Implicit in the study authors' conclusion, they said, is the assumption that patients were in fact mobile and active during the study period. After all, they wrote, an intervention designed to improve dyspnea will have no effect if the patient is not involved in activities that induce dyspnea.

They noted that in this study, the total time per day participants used portable oxygen was approximately 40 minutes per day, raising questions as to their level of dyspnea-inducing activities.

For more information:

COPD World News            Week of August 12, 2007

Pot smoking impacts large airways 

Wellington, New Zealand - Smoking cannabis is linked to a dose-related impairment of large airway function, resulting in airflow obstruction and hyperinflation, according to the results of a study published in the July 31 Online First issue of Thorax.

"Cannabis is the most widely used illegal drug worldwide," write Sarah Aldington, from the Medical Research Institute of New Zealand in Wellington, and colleagues. "Long-term use of cannabis is known to cause chronic bronchitis and airflow obstruction, but the prevalence of macroscopic emphysema, the dose-response relationship and the dose equivalence of cannabis with tobacco has not been determined."

The investigators recruited a convenience sample of 339 adults from the greater Wellington region and grouped them according to smoking status: cannabis only, tobacco only, cannabis and tobacco smoking, and neither cannabis nor tobacco smoking.

To evaluate pulmonary structure and function, subjects underwent high-resolution computed tomography (CT) scanning of the lung, pulmonary function testing, and a questionnaire about respiratory and smoking status. Analysis of covariance and logistic regression were used to determine associations between respiratory status and cannabis use.

"Smoking cannabis was associated with a dose-related impairment of large airways function resulting in airflow obstruction and hyperinflation," the authors write. "In contrast, cannabis smoking was seldom associated with macroscopic emphysema.

The 1:2.5 - 5 dose equivalence between cannabis joints and tobacco cigarettes for adverse effects on lung function is of major public health significance."

For more information:

COPD World News            Week of August 5, 2007

Women hit harder by COPD than men

ANN ARBOR, Mich. -- Chronic obstructive pulmonary disease (COPD) with severe emphysema strikes women harder than men on clinical and physiological measures, researchers reported.

In the first direct comparison study, women with advanced COPD reported greater breathlessness and depression than men at the same lung function and health status, found Fernando J. Martinez, M.D., of the University of Michigan here, and colleagues.

Anatomy and distribution of emphysema lesions also differed significantly between the sexes, they reported in the Aug. 1 issue of the American Journal of Respiratory and Critical Care Medicine.

In an accompanying editorial, Dawn L. DeMeo, M.D., M.P.H., of Brigham and Women's Hospital in Boston, said the reason for the differences and whether they are based culturally, genetically, or anatomically remains unknown. But, what is not debatable, she said, is that these differences impact clinical care of patients, and notably so from a public health perspective, "because in 2000, the number of women dying of COPD surpassed the number of men."

For more information: 

COPD World News            Week of July 29, 2007

Harm from Smoking during Pregnancy

UTRECHT, Netherlands -- Exposure to tobacco smoke before birth may raise blood pressure substantially in infancy, which could have consequences later in life, researchers here said.

In a population-based study, infants whose mothers smoked during pregnancy had systolic blood pressure that was half a standard deviation higher than babies not exposed prenatally (5.4 mm Hg, P=0.01), according to a report published online in Hypertension: Journal of the American Heart Association.

The findings add to the evidence of harm associated with smoking and tobacco smoke exposure during pregnancy, such as fetal hypoxia and intrauterine growth retardation, they wrote. Previous studies have linked prenatal smoke exposure to higher childhood blood pressure, but whether the risk was set in utero or after birth by a shared environment was not clear, the researchers said.

For more information:

COPD World News            Week of July 22, 2007

Smoking may bring on early menopause

Women who smoke are more likely to begin menopause before the age of 45 years, which puts them at increased risk of osteoporosis and heart disease, Norwegian researchers report.

Among a group of 2,123 women aged 59 to 60 years old, those who currently smoked were 59 per cent more likely than non-smokers to have undergone early menopause, Dr Thea F Mikkelsen of the University of Oslo and her colleagues found.

For the heaviest smokers, the risk of early menopause was nearly doubled. However, women who were smokers, but quit at least 10 years before menopause, were substantially less likely than current smokers to have stopped menstruating before age 45.

There is evidence that smoking later in life makes a woman more likely to have early menopause, while smokers who quit before middle age may not be affected, Mikkelsen and her team note in the online journal BMC Public Health. They investigated the relationship further and determined if exposure to second-hand smoke might also influence the timing of menopause. The researchers found that nearly 10 per cent of the women went through menopause before the age of 45.

For more information:

COPD World News            Week of July 15, 2007

Inhaled Steroids Linked to Pneumonia Hospitalizations in COPD

MONTREAL, -- Chronic obstructive pulmonary disease patients who inhaled corticosteroids had a 70% increase in the risk of pneumonia hospitalization over those not given the drugs, researchers here reported.

In a nested case-control study, the risk of dying within 30 days of hospitalization for pneumonia was 53% higher for COPD patients who inhaled corticosteroids, Pierre Ernst, M.D., of Royal Victoria Hospital, and colleagues, reported in the July 15 issue of the American Journal of Respiratory and Critical Care Medicine. Moreover, there was a dose-dependent relationship between risk of pneumonia and corticosteroid use so that patients inhaling doses equivalent to at least 1,000 µg/day of fluticasone had a 2.25 rate ratio for pneumonia hospitalization (95% CI 2.02-2.44), they wrote.

The study was conducted within a cohort of 175, 906 COPD patients from the province of Quebec who were treated from 1988 through 2003, including 23,942 who were hospitalized for pneumonia and 95,768 matched controls. In an editorial Mark Woodhead, D.M., of Manchester Royal Infirmary in Manchester, England noted that the findings of this study confirm an earlier randomized trial that found corticosteroids reduced COPD exacerbations, but the price was an increase in hospitalizations for pneumonia.

For more information:

COPD World News            Week of July 8, 2007

Questions surround effectiveness of smoking ban

London, UK - The sight of nicotine addicts huddling outside pubs, restaurants and offices to get their nicotine fix is about to become a common English spectacle. On 1 July, England followed the lead of Scotland, Wales and Northern Ireland and banned smoking in enclosed public places, making the UK ban complete.

The government says its chief aim is to reduce passive smoking. But a secondary consequence is that more people will take the opportunity to quit.

"We estimate that a complete smoking ban might reduce smoking rates by 1.7%, taking smoking from 24% now, down to 22%," says a Department of Health spokeswoman. "This will mean around 600,000 fewer smokers in the long term. It is estimated that there are 10 million smokers in England.

Robert West, director of cancer studies at Cancer Research UK, believes that the government is being optimistic and that they're likely to only see 80,000 - 200,000 smokers quit as a result of the ban.

The effect of the ban may not be all against smoking, says Gordon Tinline, business psychologist at Robertson Cooper, because while the majority will feel under pressure to quit, those that continue to smoke could harden their attitude. "Those determined to go on smoking at all costs may dig in their heels and get pleasure from being defiant and saying "You're not going to control me".

For more information:

COPD World News            Week of July 1, 2007

COPD and Osteoporosis Linked to Arterial Stiffness

Patients with chronic obstructive pulmonary disease have arterial stiffness, and those with chronic obstructive pulmonary disease and osteoporosis have even greater arterial stiffness, according to the results of a study published in the June 15 issue of the American Journal of Respiratory and Critical Care Medicine.

"Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of cardiovascular events and osteoporosis," write Ramsey Sabit from Cardiff University, United Kingdom, and colleagues. "Increased arterial stiffness is an independent predictor of cardiovascular disease.... A factor potentially linking COPD and cardiovascular risk is the increased occurrence of osteoporosis, which in individuals without COPD is associated with atherosclerosis and arterial calcification." "Increased arterial stiffness was related to the severity of airflow obstruction and may be a factor in the excess risk for cardiovascular disease in COPD," the authors write. "The increased aortic PWV in patients with osteoporosis and the association with systemic inflammation suggest that age-related bone and vascular changes occur prematurely in COPD."

In an accompanying editorial, Claus Vogelmeier, MD, and Robert Bals, MD, PhD, from Philipps-University in Marburg, Germany, note that the current study "is the first to report a relationship among arterial stiffness, severity of airflow limitation, osteoporosis, and systemic inflammation." "As always, more data are mandatory," they write. "In particular, we need to learn more about the acceleration of aging and how it can be stopped." COPD is a major cause of morbidity and mortality, with systemic contributions to adverse outcomes, and there is a 2- to 3-fold increased risk for cardiovascular disease with COPD independent of the effect of smoking, accounting for 50% of deaths.

There is an inverse relationship between airway obstruction and the rate of decline in lung function and cardiovascular disease, according to the authors, which involves changes in arterial stiffness and loss of large artery elasticity; aortic PWV and augmentation index, as well as peripheral brachial pulse pressure, are clinically relevant measures of arterial stiffness and can independently predict cardiovascular risk. In addition, osteoporosis is more prevalent in COPD and is associated with atherosclerosis and arterial calcification.

For more information:

COPD World News            Week of June 24, 2007

Smoking could kill 1 billion this century: WHO

BANGKOK (Reuters) - One billion people will die of tobacco-related diseases this century unless governments in rich and poor countries alike get serious about preventing smoking, top World Health Organization (WHO) experts said on Monday.

"Tobacco is a defective product. It kills half of its customers," Douglas Bettcher, head of the WHO's Tobacco Free Initiative, said at the start of an international conference in Bangkok to draw up a masterplan for the world to kick the habit. "It kills 5.4 million people per year and half of those deaths are in developing countries. That's like one jumbo jet going down every hour," he said.

With smoking rates in many developing countries on the rise, particularly among teenagers, that annual death toll would rise to 8.3 million within the next 20 years, he added. However, if governments introduced measures such as aggressive taxation, banning cigarette advertising and making offices and public places totally tobacco-free, smoking rates could halve by 2050, he said.

For more information:

COPD World News            Week of June 17, 2007

Nebulized Bronchodilator Measures Up to Inhaled Powder for COPD

SAN FRANCISCO, -- Nebulized formoterol (Perforomist) appears to treat chronic obstructive pulmonary disease as effectively as the dry-powder formulation (Foradil), researchers said here.

In the pivotal trial that led to FDA approval of nebulized formoterol on May 11, the two formulations yielded similar lung function improvements on all measures, reported Nicholas Gross, M.D., of the Hines VA Hospital in Chicago, and colleagues. But, the nebulized long-acting beta2-agonist may be more convenient and less expensive for older patients, Dr. Gross said here at the American Thoracic Society meeting.

"It fills a gap and from all we've seen so far it's very safe and effective," he said. "Until recently, nebulized treatment for COPD was limited to short-acting bronchodilators requiring multiple administrations."

The double-blind study included 351 patients with moderate-to-severe COPD who were randomized to twice daily dosing of 20 μg of nebulized formoterol, 12 μg of formoterol given via a dry-powder inhaler, or placebo. All patients were over age 40 (mean age 62.8); about half were current smokers (52%). 

For more information:  

COPD World News            Week of June 10, 2007

Early Vascular and Bone Changes in COPD Tied to Heart Risk 

CARDIFF, Wales - Premature arterial stiffness and bone aging in patients with chronic obstructive pulmonary disease may explain why cardiovascular disease may emerge, researchers here reported. Furthermore, osteoporosis in COPD patients, a common complication of the disease, was linked to even greater arterial stiffening, Dennis J. Shale, M.D., of Cardiff University, and colleagues reported in the second June 2007 issue of the American Journal of Respiratory and Critical Care Medicine.

In a study of 75 clinically stable COPD patients (mean age 63) with various levels of airway obstruction, and 42 healthy smokers or ex-smoker controls who were free of cardiovascular disease, the researchers tested the hypothesis that COPD patients would have increased arterial stiffness, which would be associated with osteoporosis and systemic inflammation.

All participants underwent spirometry, measurement of aortic (carotid-femoral) pulse wave velocity and augmentation index, a measure of arterial stiffness, as well as dual-energy x-ray absorptiometry, and blood sampling for inflammatory mediators.

For more information:

COPD World News            Week of June 3, 2007

Paramedic Treatment of Breathing Trouble Saves Lives

Ottawa -- Training paramedics to better improve the breathing of people rushed to the hospital in respiratory distress saves lives, a Canadian study shows.

"It's estimated that of all the ambulance transports in North America, about 20 percent have shortness of breath caused by lots of different conditions," explained Dr. Ian G. Stiell, chair of the department of emergency medicine at the University of Ottawa. "In the United States, perhaps two million people a year are taken to the hospital for trouble breathing."

Helping those people breathe by giving a drug, implanting a tube or another method reduced the death rate by 30 percent in the two-phase trial of more than 8,100 patients, which was reported in the May 25 New England Journal of Medicine.

In the first phase of the trial, paramedics riding ambulances were not trained in advanced respiratory life support and did not give advanced assistance to those with breathing difficulties. In the second phase, paramedics trained in advanced life support helped more than half the patients by such methods as implanting a breathing tube (1.4 percent of patients) or giving intravenous drugs (15 percent of patients).

"The rate of death among all patients decreased significantly, from 14.3 percent to 12.4 percent," the report said. That works out to a 30 percent increase in survival among those in the advanced care group versus those in the basic care cohort. "When you consider how common such breathing difficulties are, giving this help could affect literally tens of thousands of lives each year," Stiell said.

For more information:

COPD World News            Week of May 27, 2007

Airways Stent Trial Begins

Researchers at Cedars-Sinai Medical Center announced today the start of the EASE (Exhale Airway Stents for Emphysema) Trial, an international, multi-center clinical trial to explore an investigational treatment that may offer a new, minimally-invasive option for those suffering with advanced widespread emphysema. The study focuses on an experimental procedure called airway bypass designed to create pathways in the lung for trapped air to escape with the goal of relieving shortness of breath and other emphysema symptoms.

"We are excited to be part of this study because currently there are limited treatment options for the emphysema patients," said Zab Mosenifar, M.D., Medical Director of Cedars-Sinai Center for Chest Diseases and principal investigator of the study at Cedars-Sinai. Patients are often in poor physical condition, struggling with each breath. By creating new pathways for airflow with the airway bypass procedure, we hope to reduce hyperinflation and improve lung function. If patients can breathe easier it is likely to improve their quality of life."

During airway bypass, physicians will use a flexible bronchoscope to go through the mouth into the airways. There the physician will create new small pathways and place an Exhale Drug-Eluting Stent manufactured by Broncus Technologies, Inc. - to allow the trapped air in the lung to escape.

"The airway bypass procedure could be a good option for those who would possibly spend years on a lung transplant list or not be suitable candidates for lung transplant surgery, which is one of the only other treatment options available for patients with this type of emphysema," said Mosenifar.

For more information:

COPD World News            Week of May 20, 2007

Rapid Progressors Speed to End-Stage Pulmonary Fibrosis

MEXICO CITY, -- A difference in genetic patterns may explain why some idiopathic pulmonary fibrosis patients, especially men who smoke, die more quickly than others do.These rapid progressors were 6.5-fold more likely to be men and seven-fold more likely to have been smokers than slow progressors, found MoisÈs Selman, M.D., of the Instituto Nacional de Enfermedades Respiratorias here, and colleagues.

In the retrospective study, gene expression patterns differed between fast and slow progressors, implying biologically-distinct phenotypes of the disease, they wrote online in the journal Public Library of Science ONE. The findings suggest that physicians should pay more attention to the time of onset of symptoms to identify these patients who are at greater risk, they said.

Most idiopathic pulmonary fibrosis patients have symptoms long before diagnosis, then slowly progress, with death coming within five years of diagnosis, they noted.

For more information:

COPD World News            Week of May 13, 2007

Secondhand Smoke Increases Risk of Dementia

Boston -- Exposure to secondhand tobacco smoke increases the risk of developing dementia, according to research that will be presented at the American Academy of Neurology’s 59th Annual Meeting in Boston, April 28 – May 5, 2007.

For the study, researchers evaluated 3,602 people age 65 and older in the Cardiovascular Health Study. Of those, 985 people had no cardiovascular disease, no dementia, and were never smokers. A total of 495 people reported their lifetime secondhand smoke exposure, with an average of about 28 years of exposure. Then the researchers evaluated which participants developed dementia over a six-year period. Based on preliminary results, the study authors found that elderly people with high lifetime exposure to secondhand smoke were approximately 30 percent more likely to develop dementia than those with no lifetime secondhand smoke exposure.

High exposure was defined as more than 30 years of exposure to secondhand smoke. “We are still conducting analyses to control for other factors that may be influencing these results, but this finding potentially implicates lifetime exposure to secondhand tobacco smoke as a risk factor for dementia in older adults,” said study author Thaddeus Haight of UC Berkeley.

The study also found that exposure to secondhand smoke resulted in a greater occurrence of dementia for people who had not been diagnosed with cardiovascular disease but who had detectable abnormalities of their carotid arteries, based on carotid ultrasound imaging, compared to those without these underlying abnormalities. These abnormalities included narrower carotid arteries and thicker carotid arterial walls, and serve as indicators of preclinical cardiovascular disease and are risk factors for stroke. People with these underlying conditions and high lifetime exposure to secondhand smoke were nearly two-and-a-half times as likely to develop dementia as those with no secondhand smoke exposure and no indications of carotid artery disease.

For more information:

COPD World News            Week of May 6, 2007

Promising Drug Fails to Improve COPD Symptoms

NEW YORK, NY -- A promising anti-inflammatory drug failed to improve symptoms of moderate to severe chronic obstructive pulmonary disease, or COPD, in a large, multi-center trial.

The results of the randomized, double-blind, placebo-controlled trial of infliximab were published in the second issue of the May American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

According to an editorial commenting on the research, the failure of the infliximab to provide any therapeutic benefit in COPD patients was unexpected because the drug has proven effective in treating other inflammatory diseases, particularly rheumatoid arthritis and Crohn's disease.  Source:  American Thoracic Society

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COPD World News         Week of April 29, 2007

Oxygen generator being recalled

ROCKVILLE, Md., -- Some 300,000 home continuous positive airway pressure devices have been recalled by ResMed after short circuits from faulty wiring in electrical plugs, reported the FDA. No patients were injured as a result of the defect in seven CPAP devices, which led to "thermal damage" that was not significant, the agency said.

The company said that patients who use supplemental oxygen should immediately discontinue use of the affected S8 flow generators because the wiring problem posed a fire hazard. Likewise patients should immediately discontinue devices that show signs of electrical malfunction such as intermittent power, crackling sounds, sparking, or charred smell. Patients who don't use supplemental oxygen who have devices that appear to be functioning normally can continue to use the equipment until they receive replacements, advised ResMed, which is headquartered in San Diego.

For more information:

COPD World News        Week of April 22, 2007

Genes linked to quitting smoking

U.S. researchers have identified 221 genes that distinguish successful quitters of smoking from those who were unsuccessful.

Dr. George Uhl of the National Institute on Drug Abuse and Dr. Jed Rose at the Centerfor Nicotine and Smoking Cessation Research at Duke University Medical Center say the findings may lead to individualized drug therapy for addiction, based on an individual's unique genetic make-up.

The research, published in BMC Genetics, found of the 221 genes that separated successful quitters from those who were unsuccessful, about87 of these genes have known functions, but 34 play unknown roles. The researchers also discovered at least 62 of the genes were previously identified as factors in a person becoming dependent on other drugs, and also contribute to nicotine dependence, according to Uhl.

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Cured Meat Consumption Increases Risk for COPD in Adults

New York — In adults 45 years and older, frequent consumption of cured meats was associated with decreased lung function and increased risk for chronic obstructive pulmonary disease (COPD), according to the results of a cross-sectional study reported in the April 15 issue of the American Journal of Respiratory and Critical Care Medicine.

"Cured meats are high in nitrites," write Rui Jiang, MD, PhD, from Columbia University in New York, and colleagues. "Nitrites generate reactive nitrogen species that may cause nitrative and nitrosative damage to the lung resulting in emphysema."

This cross-sectional study evaluated 7352 participants in the Third National Health and Nutrition Examination Survey (NHANES III), aged 45 years or older, who underwent spirometry and had adequate measures of cured meat, fish, fruit, and vegetable intake.

For more information:

COPD World News        Week of April 15, 2007

COPD Deaths May Be Lowered By Statins

ALBUQUERQUE, N.M. - The moderate use of statins is associated with a sharply reduced risk of death from chronic obstructive pulmonary disease, researchers here found. In a large matched cohort study of 76,232 patients, moderate use of statins was associated with an 83% reduction in the risk of death from COPD, they reported in the April issue of CHEST.

Use of statins also was linked to a 40% reduced risk of death from pneumonia or flu, according to Floyd Frost, Ph.D., of the Lovelace Respiratory Research Institute here, and colleagues. The findings were confirmed in two separate case-control studies -- one each for COPD and for pneumonia and flu -- which yielded similar risk reductions, Dr. Frost and colleagues said.The study provided additional evidence that statins, in addition as lowering LDL levels, also can modulate the immune system -- a property that may be important in the event of a new flu pandemic, Dr. Frost and colleagues said.

The Lovelace study is "extremely valuable because it suggests that statin therapy may well be efficacious in real-world application to COPD patients and possibly for acute influenza," said John Mancini, M.D., of the University of British Columbia in Vancouver, in an accompanying editorial.

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EASE study looks at new air pathways to lungs

Pennsylvania - Researchers are studying an experimental airway bypass treatment to help people with emphysema breathe easier. The EASE (Exhale Airway Stents for Emphysema) study will examine a treatment that involves creating pathways in the lung for trapped air to escape, which, in turn, may relieve shortness of breath and other symptoms of emphysema, said the researchers at the University of Pennsylvania School of Medicine.

"There are limited treatment options right now for these patients who struggle for each breath. This new, cutting-edge, non-surgical procedure actually creates new pathways for airflow and could offer another option for those who would otherwise possibly spend years waiting on a lung transplant list," principal investigator Dr. John Kucharczuk, a thoracic surgeon and assistant professor of surgery, said in a prepared statement. The new small pathways in the lungs are created by using a special kind of needle. Stents are then inserted to keep the new air passages open.

For more information:

COPD World News        Week of April 8, 2007

Inhaled Corticosteroids May Lower Lung Cancer Risk in COPD

SEATTLE, - High doses of inhaled corticosteroids may reduce the risk of lung cancer in men with chronic obstructive pulmonary disease (COPD), according to researchers here.

In a cohort study of 517 mostly male veterans who used inhaled corticosteroids, a dose of more than 1,200 mcg a day led to a 61% reduction in the risk of lung cancer compared with a cohort of non-users, found David Au, M.D., of the Veterans Administration Puget Sound Health Care System here, and colleagues.

In contrast, men with COPD who used less than 1,200 mcg a day had a slightly elevated risk of developing lung cancer, although the trend did not reach statistical significance, Dr. Au and colleagues reported in the first April issue of the American Journal of Respiratory and Critical Care Medicine. Because tobacco has an inflammatory effect and inhaled corticosteroids have an anti-inflammatory effect, the researchers hypothesized that the medications might have a chemopreventive effect on lung cancer, he said.

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Encouraging Indications in COPD Research

Although the incidence of COPD is rising, several major developments within the last few years have sparked new optimism for treating COPD patients. Advances in cellular and molecular immunology have given scientists new ways of looking at lung disease. Research into the human genome may help explain why some people have a higher risk of developing COPD than others. Scientists anticipate that current research will lead to new breakthroughs in the early detection and cure of COPD.

Several excellent resources are available that address current understanding of this disease. The National Heart, Lung, and Blood Institute (NHLBI) recently convened an expert group charged with recommending future directions for COPD research.

The expert panel found "encouraging indications for future COPD research" as they examined enigmas and apparent contradictions in COPD research to date. They identified promising areas of current research, including the diversity of protease functions, mucous hyper-secretion, apoptosis, the role of blood vessels, the possibility of alveolar regeneration, identification of chemical markers, the influence of heredity, developments in imaging technologies, and the potential for new pharmaceuticals. The group's recommendations were published in the American Journal of Respiratory and Critical Care Medicine.

For more information:

COPD World News        Week of April 1, 2007

Smoking linked to arterial stiffness

Dublin, Ireland - A new study has shown that it takes 10 years or more for the arteries of ex-smokers to return to the same pliability levels as people who never smoked. Noor A. Jatoi, MD, from St. James's Hospital in Dublin, Ireland, and colleagues, report their findings in the March 19 Online First issue of Hypertension.

Report author Azra Mahmud, MD stated, "There is evidence that the risk of heart disease reduces a few years after stopping smoking, but no one is sure of the mechanism. We wanted to see if arterial stiffness plays a role." She added that their group has previously shown that smoking increases arterial stiffness, but it was not clear if smoking cessation would be associated with reduced arterial stiffness.

The researchers studied 554 people who had hypertension but had never been treated for it and divided them into the following categories: "current smokers," "ex-smokers," and "never-smokers." They further categorized ex-smokers according to how long they were not smoking cigarettes ó less than 1 year, more than 1 but less than 10 years, and more than 10 years of smoking cessation.

They found that current and ex-smokers of only 1 year had significantly higher stiffness measurements compared with nonsmokers. And, in ex-smokers, duration of smoking cessation was directly related to improvement in arterial stiffness. They found some improvement after 1 to 10 years, but arterial stiffness parameters only reached normal levels after more than a decade of smoking cessation.

The researchers say their results are in agreement with published data reporting cardiovascular risk reduction with smoking cessation for periods ranging from 3 to 20 years. Nevertheless, they point out that these results need to be confirmed in a prospective, longitudinal study.

"Although it may take more than a decade to reverse these vascular changes, and the effect is relatively small, smoking cessation may help reduce cardiovascular events through amelioration in arterial stiffening even in long-term hypertensive smokers," the authors say.

Dr. Mahmud said that in their hypertension clinic they routinely use arterial stiffness as a prognostic indicator. "If we have someone whose blood pressure [BP] is not too high, but their arteries are stiff, we will keep a closer eye on them." She said a cutoff point has been established for PWV, with a figure of more than 11 m/seconds putting a person in a higher risk category, and for Alx, with a value of 35% and above causing concern. But a validated cutoff point for TR has yet to be properly established, she noted.

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COPD World News                 March 25, 2007

Nitric Oxide Called No Good for Acute Lung Injury

TORONTO, -- The common practice of giving patients with acute lung injury nitric oxide may do more harm than good. In a meta-analysis, patients with acute lung injury or acute respiratory distress syndrome (ARDS) treated with nitric oxide had no significant improvements in in-hospital mortality, duration of ventilation, or ventilator-free days, and were at increased risk for renal dysfunction, the investigators found.

"Nitric oxide improves oxygenation temporarily but does not improve survival and may harm," reported Neill K.J. Adhikari, M.D., of the University of Toronto, and colleagues, online in BMJ. "We do not recommend routine use of nitric oxide in patients with acute lung injury." They added, "Despite a lack of evidence for benefit, some clinicians may still consider nitric oxide for life threatening hypoxemia, in conjunction with other supportive therapies. Given the challenges of enrolling such severely ill patients into large trials, definitive data supporting or refuting a role for nitric oxide in such desperate situations may not be forthcoming, leaving clinicians to rely on their judgment and the current evidence."

Their meta-analysis added to the evidence garnered in a systematic review of nitric oxide for acute hypoxic respiratory failure in children and adults, published by a separate group of University of Toronto researchers in 2003 in Anesthesia and Analgesia. In that study, which looked at five randomized trials of nitric oxide, the authors found that there was no effect of the gas on mortality or ventilator-free days, although one study showed an improvement in oxygenation. They concluded that the effect of nitric oxide in this setting was uncertain.

This time, Dr. Adhikari and colleagues cast a wider net, reviewing the literature on use of inhaled nitric oxide to treat acute lung injury and ARDS in adults and children. Their main outcome measures were mortality, duration of ventilation, oxygenation, pulmonary arterial pressure, and adverse events. The investigators noted that their study was limited by the lack of complete data from some of the studies in the meta-analysis, and uncertainties about the heterogeneity of data on physiological outcomes due to small sample sizes.

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COPD World News                 Week of March 18, 2007

Less than 2% of COPD Patients Can Access Rehab Programs

TORONTO, Canada - While the number of respiratory rehabilitation programs in Canada has doubled in the last five years, a new study by researchers at West Park Healthcare Centre shows that less than two per cent of people with a debilitating lung disease could access programs proven to significantly improve their lives.

The study, published today in the Canadian Respiratory Journal, examined the national capacity for rehabilitation of patients with chronic obstructive pulmonary disease (COPD) - the fourth leading cause of death in Canada. There is no cure and the disease gets progressively worse, but patients can significantly improve their quality of life with rehabilitation programs.

"Our patients are breathless, but not helpless," says Dr. Roger Goldstein, a Respirologist at West Park Healthcare Centre, expert in COPD and co-author of the study. "Through rehabilitation programs, COPD patients can learn simple techniques that help them regain their mobility and independence."

"Recommended services include supervised exercise training, education self-management, as well as psychological and social support," said Dr. Dina Brooks, Associate Professor in the Department of Physical Therapy at the University of Toronto, a West Park Research Associate and co-author of the study. "These types of services are inexpensive compared to the economic burden on the Canadian health care system from patients without access to rehabilitation services."

The study, based on a 2005 survey of healthcare facilities across Canada, concluded that 60 facilities offered 98 pulmonary rehabilitation programs, with 41 of those programs located in Ontario. The total capacity for all of the programs was 8,927 people per year - about 1.2 per cent of the estimated 750,000 Canadians diagnosed with COPD.

Compared to a similar study in 1999, the recent survey showed significant growth in the number of pulmonary rehabilitation programs, doubling from 44 programs to 98. The most significant increases have been in Ontario (23 to 41 programs), Quebec (four to 21 programs) and Alberta (three to eight programs).

"Despite this improvement, Canada is still woefully under-serviced in rehabilitation programs that are vital to people living with COPD," says Nora Sobolov, President and CEO of the Canadian Lung Association. "This study highlights the urgent need for continued investment in rehabilitation programs throughout Canada." Also involved in the study were: Rebecca Sottana, Barbara Bell, Mary Hanna, Lisanne Laframboise and Sugi Selvanayagarajah.

West Park Healthcare Centre provides specialized rehabilitation, complex continuing care and long-term care, helping people overcome their health barriers, to live the fullest lives possible after an illness or injury. The centre is recognized internationally for its expertise and research in respiratory rehabilitation for those with chronic respiratory diseases and its care of those with tuberculosis.

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Vince Rice, Director, Public Relations Phone: (416) 243-3730, E-mail:

COPD World News                     Week of March 11, 2007

Exercise Slows Lung Function Decline in Smokers

BARCELONA, Spain, -- Smokers who get plenty of exercise regularly may slow the inevitable decline of their lung function and reduce their risk of chronic obstructive pulmonary disease, researchers here reported.

Compared with indolent smokers, the physically active who reported moderate to high levels of exercise had a slower decline in FEV1 and FEV and a more than 20% reduced risk of developing COPD, according to a report in the March issue of the American Journal of Respiratory and Critical Care Medicine.

Moderate to high levels of physical activity among smokers avoided 21% of the potentially new COPD cases. These findings emerged from a population-based sample of 6,790 smokers and non-smokers (43% men, mean age 52) recruited from the Copenhagen City Heart Study over 10 years, starting in 1981 to 1983, and followed through 1991-1994.

Of the participants, 23%, 22%, and 55% were never-, former-, and active smokers, respectively. Mean level of physical activity between baseline and follow-up was classified as low (15.6%), moderate (50%), and high (38%), according to a questionnaire. Smoking status during the 10-year study did not change for 86% of the participants, although 10% quit, 2% started, and 2% resumed smoking.

Active smokers with moderate to high physical activity had a reduced risk of developing COPD compared with the low physical activity group (odds ratio, 0.77; P=0.027), the researchers reported.  Among active smokers, there was a dose-response relationship: the higher the level of physical activity, the lower the lung function decline or COPD incidence, the researchers reported. By way of explanation, the researchers suggested that the biological mechanism on which both physical activity and smoking interact antagonistically is an exaggerated inflammatory response in the lungs as well as an antioxidant mechanism.

The increase in smoking and sedentary lifestyle in developing countries is likely to have an important impact with respect to COPD, which already has a leading position both for mortality and disability throughout the world. Beyond the importance of reinforcing antismoking initiatives, the recommendation of increasing the level of physical activity may be especially important in active smokers, as supported by the findings of this study, the researchers concluded.

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COPD World News        Week of March 4, 2007

Investigational Oral Drug Controls Asthma Safely

SAN DIEGO, USA - For controlling asthma, an investigational oral anti-inflammatory drug with multiple actions, called MN-001, appears to be safe and effective, researchers reported here on the basis of a phase II trial.

In the randomized controlled study in 147 patients with mild-to-moderate asthma, MN-001 was significantly more effective than placebo at improving lung function after four weeks, with no significant adverse events, reported William W. Busse, M.D., of the University of Wisconsin in Madison, and colleagues.

MN-001 is an oral anti-inflammatory agent that inhibits the enzymes phosphodiesterase IV and 5-lipoxegynase, and has also action against leukotriene receptors, similar to montelukast (Singulair) and related agents, Dr. Busse and colleagues said at the American Academy of Allergy, Asthma & Immunology meeting here. The drug is currently in phase III.

"MN-001 was well tolerated, with 89% of patients completing four weeks of treatment," the authors wrote. "There was no apparent difference between placebo and any MN-001 group in adverse event discontinuations or in adverse events attributable to treatment. No serious adverse events were reported." 

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COPD World News            Week of February 25, 2007

Artificial lung saves transplant patient

Transplant surgeons have successfully used an external artificial lung to keep a dying patient alive while they waited for donated lungs to become available, the Toronto surgical team announced Wednesday. The device has proved to be a lifesaver in the U.S. battle hospitals of Iraq, but it's believed this is the first time it has been used in North America as a transplant bridge – a way to prolong the life of someone waiting for new lungs. 

"This has taken lung transplantation and the number of patients we can save to a new height," said Dr. Shaf Keshavjee, director of the lung transplant program at Toronto General Hospital, one of three hospitals that make up the University Hospital Network.

The hospital is planning a clinical trial using the Novalung to help them – and others – determine the best uses for the device, which could serve both as a temporary lung replacement until transplantation and as a way to take the strain off disease-injured lungs until they have a chance to heal.

Doctors in the hospital inserted catheters into the femoral artery and femoral vein (large blood vessels at the top of the thigh) of Yen Tran, a 21-year-old mother of three, on Dec. 2.

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