COPD World News Week of September 4, 2010
Washington, DC - Good news for seniors who want to quit smoking. Medicare will now cover tobacco cessation counseling, the Department of Health and Human Services announced. The new coverage was mandated by the Affordable Care Act (ACA), which contains a number of measures that focus on preventing diseases before they occur, such as paying for cancer screenings, and annual no-cost wellness checkups.
"For too long, many tobacco users with Medicare coverage were denied access to evidence-based tobacco cessation counseling," HHS Secretary Kathleen Sebelius said in a statement announcing the new benefit. "Most Medicare beneficiaries want to quit their tobacco use. Now, older adults and other Medicare beneficiaries can get the help they need to successfully overcome tobacco dependence."
Of the 46 million Americans who smoke, about 4.5 million are Medicare beneficiaries over age 65, and another million receive Medicare benefits because of a disability, according to HHS. Previously, Medicare only covered smoking cessation counseling if a recipient had already been diagnosed with a tobacco-related disease or showed symptoms of such a disease.
All Medicare beneficiaries already have access to smoking cessation prescription medication through Medicare's prescription drug program, Part D. Under the new coverage, which applies to Medicare Part A and Part B, any Medicare beneficiary who smokes will be able to receive counseling from a "qualified physician or other Medicare-recognized practitioner" who can help them quit smoking. The benefit will cover up to two separate tobacco cessation attempts per year -- and each stint in stop-smoking counseling can include up to four sessions.
"Giving older Americans and persons with disabilities who rely on Medicare the coverage they need for counseling treatments that can aid them in quitting will have a positive impact on their health and quality of life," said CMS Administrator Don Berwick, MD, in a prepared statement. "As a result, all Medicare beneficiaries now have more help to avoid the painful, and often deadly, consequences of tobacco use."
HHS will issue guidance in the next few months on a Medicaid provision in the ACA that requires states to help pregnant women quit smoking.
For more information:
http://www.medpagetoday.com/Pulmonology/Smoking/tb/21901
COPD World News Week of August 29, 2010
De Soto, Kansas - A new blood test, called Early CDT-Lung, provided by OncImmune, aids in the early detection of lung cancer and has the potential to replace the need for invasive diagnostic procedures.
This is an important new option, because occasionally, nodules develop in lungs, and it needs to be determined whether or not they are cancerous. Although the majority of the nodules people develop are non-cancerous, and the list of causes of those nodules long, those with COPD can be at a much greater risk of developing lung cancer than people without COPD.
Standard PET and CAT scans might initially indicate nodules, but they might not be able to accurately determine the nature of a nodule. Ordinarily, the next step is usually an invasive procedure such as a needle biopsy or perhaps a bronchoscopy. Needle biopsies, however, are often risky or contraindicated for those with damaged lungs. When needle biopsies are considered too problematic, a "wait and see" attitude is adapted to see what happens to the nodules over time to determine whether or not they behave or grow like cancers.
This new simple blood test can assist in assessing the risk of the nodule being cancerous. The CDT-Lung test looks for "markers" to identify cancer. These "markers" indicate the presence of specific molecules, called antigens. The antigens they are looking for are produced by tumors, suggesting, therefore, that cancer is present.
The manufacturer's web site, explains the accuracy and proper use of this test. It has limitations. For example, it can't be used on people with a history of cancer.
For more information:
http://www.oncimmune.com
COPD World News Week of August 22, 2010
U.S. Clears MERCK Lung Drug Dulera
Silver Spring, MD - Merck & Co Inc's new two-in-one respiratory drug Dulera has been approved by the U.S. Food and Drug Administration, the U.S. company said confirming an earlier Reuters report. But Britain's *SkyePharma Plc (SKP.L) said it was no longer hopeful of a U.S. green light for its rival combination treatment Flutiform.
The new product combines the dual action of an inhaled corticosteroid and a long-acting beta agonist (LABA) to improve lung function in asthma sufferers. That makes Dulera a rival for GlaxoSmithKline Plc's (GSK.L) market-leading Advair and AstraZeneca Plc's (AZN.L) Symbicort, both of which act in a similar way.
Recently the FDA has taken a critical look at LABA drugs, drawing up new warnings earlier this month for the inhaled treatments. Some analysts said the issues over LABA safety may have delayed the FDA's decision on Dulera, which had initially been expected by April. In the end, however, the agency gave approval for the medicine and disclosed the move in an update on its website before Merck issued a press release.
Merck said it expected Dulera to be available in retail pharmacies across the United States by the end of July 2010. The drug is also being developed as a treatment for COPD. SkyePharma, meanwhile, saw its stock end 18 percent lower after announcing that the FDA had set tougher than expected demands for approving Flutiform, which could prove insurmountable. "The company is working with its advisors to review all of the options available to it with a view to determining whether there is a viable way forward for Flutiform in the United States," it said.
For more information:
http://www.reuters.com/article/idUSLDE65N0S320100624
COPD World News Week of August 15, 2010
Copenhagen, Denmark - Intravenous augmentation therapy for people with the inherited disorder alpha-1 antitrypsin deficiency is costly, risky, and has no clinical benefit, according to a systematic review.
Based on the data, culled from two randomized placebo-controlled trials, intravenous augmentation with the missing substance "cannot be recommended," argued Peter Gotzsche, MD, and Helle Krogh Johansen, MD, both of the Nordic Cochrane Centre at Copenhagen's Rigshospitalet. The crucial question, they said online in the Cochrane Database of Systematic Reviews, is whether the therapy decreases the risk of death from the deficiency, which leads to shortness of breath, reduced ability to exercise, and wheezing and is especially hazardous in smokers. However, neither of the two published studies reported whether augmentation therapy affected mortality, they noted.
Alpha-1 antitrypsin deficiency is an inherited disorder that can cause either lung or liver disease; the genotype associated with the most severe cases affects about one in 1,600 to 5,000 people. The therapeutic approach is to supply the missing substance, a protease inhibitor, intravenously. But the infusion therapy is extremely costly, the researchers noted -- about $150,000 a year per patient in the U.S. and has well-known risks, including dyspnea, deterioration of serious heart failure, and serious allergic reactions.
"The effects (of treatment) appear contradictory and of uncertain clinical significance," they wrote. But from a clinical point of view, there's no evidence of benefit for what is an expensive therapy, so it cannot be recommended. Any future studies should not use surrogate markers of clinical efficacy, but should be large enough to see if the therapy has an effect on mortality, the reviewers added.
Both the American Thoracic Society and European Respiratory Society have guidelines that promote alpha-1 antitrypsin replacement, the reviewers noted. "Both societies recommend augmentation therapy for patients with breathing problems related to alpha-1 antitrypsin deficiency. In our opinion, these recommendations are not reasonable," they said
For more information:
http://www.medpagetoday.com/Pulmonology/GeneralPulmonary/tb/21062
COPD World News Week of August 8, 2010
Rochester, MN - The volume of procedures done by a transplant center explained only 15% of the variation in patient survival among the nation's lung transplantation centers, according to a major study.
An analysis of more than 15,000 lung transplants found that five-year survival ranged from 30% to 61.1% among the more than 60 U.S. centers performing lung transplants that were included in the study. While higher procedure volume had a significant association with patient survival after lung transplant, there were also significant survival variations. "This study suggests that true variability exists in the quality of care provided across lung transplantation centers," Gabriel Thabut, MD, PhD, of the Mayo Clinic in Rochester, Minn., and coauthors wrote in conclusion.
"There is a great need to explore practices at high-performing centers with the goal of exporting beneficial practices to lower-performing centers. If such efforts do not equalize outcomes for lung transplant recipients, consideration might be given to further regionalizing the lung transplantation system in the United States."
Reasons for the variability in outcome have yet to be determined, but "disentangling these multiple potential explanations" could identify ways to improve care and the lung allocation process. Toward that end, Thabut and coauthors analyzed data from the United Network for Organ Sharing registry and identified 15,642 lung transplant procedures performed from 1987 to 2009 at 61 U.S. centers still active as of 2008. Overall survival at one month, one year, three years, and five years was 93.4%, 79.7%, 63%, and 49.5%, respectively.
Characteristics of donors, recipients, and surgical techniques varied markedly across the 61 centers. After adjusting for center volume, the authors found that significant variability persisted, which they could not trace to specific factors. However, they found some clues. For example, center performance was substantially more heterogeneous during the first year after transplantation than later on, suggesting variability in centers' peri-operative and early post-operative practices.
For more information:
http://tinyurl.com/24uj9tv
COPD World News Week of August 1, 2010
Albuquerque, N.M. - Exposure to wood smoke may increase the risk of chronic obstructive pulmonary disease,particularly among current smokers, researchers have found.
Breathing in wood smoke, either through home heating, cooking, or ambient outdoor pollution, was associated with a two-fold increased risk of airflow obstruction, according to Yohannes Tesfaigzi, PhD, of Lovelace Respiratory Research Institute in Albuquerque, N.M., and colleagues. They reported their findings in the American Journal of Respiratory and Critical Care Medicine.
"Because exposure to wood smoke appears to increase the risk of reducing lung function, cigarette smokers should try to avoid heating their homes or cooking with wood stoves and try to avoid environments where wood smoke is likely, for example, neighborhoods where wood smoke is common," Tesfaigzi said in a statement. Wood smoke-associated chronic obstructive pulmonary disease (COPD) is common among women in developing countries, but hasn't been adequately described in developed countries, the researchers said. So to determine whether wood smoke exposure was a risk factor for COPD among smokers in the U.S., the researchers conducted a cross-sectional study of 1,827 patients from the Lovelace Smokers' Cohort, which is predominantly female and maintains records of wood smoke exposure. About 28% of the cohort reported such exposure.
The researchers found that breathing wood smoke was independently associated with greater odds of respiratory disease, particularly among current smokers, non-Hispanic whites, and men. Self-reported exposure was independently associated with a significant risk of low percent predicted forced expiratory volume. It was also associated with a higher prevalence of airflow obstruction and chronic bronchitis. The associations were significantly stronger among current cigarette smokers, non-Hispanic whites, and men, the researchers said.
"Future studies may show that it would be appropriate to screen patients for lung cancer if these exposures to wood smoke were present for prolonged periods. "The study was limited because it may not be generalizable, the authors wrote. Still, the researchers called for additional studies on associations between wood smoke and COPD in cigarette smokers - "with particular emphasis on understanding the characteristics and dose-response relationship of wood smoke exposure."
For more information:
http://www.medpagetoday.com/Pulmonology/SmokingCOPD/tb/21236
COPD World News Week of July 25, 2010
San Francisco, CA - The lung function tests used to diagnose conditions like asthma may need to be adjusted to account for differences in patients' genetic ancestry, a new study suggests. Now, physicians adjust the test results to account for factors like age, sex, race and weight, but not for mixed ancestry.
The study, published in the New England Journal of Medicine, indicates more adjustments may be necessary because many people have mixed ancestry, which influences the test results. "People throughout the world have a richer genetic heritage than can be captured by our current definitions of race," said study senior author Dr. Esteban G. Burchard in a journal news release.
"When we force patients into an individual box, such as 'African-American' or 'Caucasian,' we're missing a lot of genetic information," added Burchard, director of the University of California, San Francisco's Center for Genes, Environment and Health. In the study, which looked at data from more than 3,000 patients, the researchers found that genetic ancestry significantly affects performance on the lung function tests.
The breathing tests can detect signs of illness like asthma and chronic obstructive pulmonary disease.
Test results can also help doctors make decisions about disability claims and eligibility for lung transplants. "Taking genetic ancestry into account could result in more appropriate treatment for patients," said study lead author Dr. Rajesh Kumar, an associate professor at Northwestern University Feinberg School of Medicine, in the release. In an interview, Mayo Clinic pulmonologist Dr. Paul D. Scanlon said the study findings offer "a step forward in our understanding."
Blacks generally score lower on the tests than whites, added Scanlon, who wrote a commentary accompanying the new study. If test results aren't adjusted to account for this fact, patients may be wrongly diagnosed with lung disease because their test results appear too low. Right now, the tests are a "very crude tool" because the benchmarks aren't designed to account for someone of mixed race like President Obama, he said.
For more information:
http://www.nlm.nih.gov/medlineplus/news/fullstory_100802.html
COPD World News Week of July 18, 2010
New South Wales, NZ - A new study reports that longer hospital stays and more deaths heve been noted in those with COPD plus high blood sugar.
People with diabetes who are hospitalized for sudden worsening of symptoms of chronic obstructive pulmonary disease have longer hospital stays and are more likely to die than COPD patients without diabetes, a new study has found. This might be because impairment of their immune response due to high blood sugar may result in more severe infections, explained the researchers at Liverpool Hospital in Australia.
The investigators reviewed the records of COPD patients admitted with a sudden worsening of symptoms (acute exacerbations) during 2007. The average length of stay for patients with diabetes was 7.8 days, which was 10.3 percent longer than the average stay of 6.5 days for patients without diabetes. Among hospitalized patients, the death rate for COPD patients with diabetes was 8 percent, compared with 4 percent for those without diabetes, according to the report published in the June issue of the journal Respirology.
"Taken together with other studies, our study shows that diabetes was an adverse prognostic factor in COPD patients. We believe that better control of diabetes in patients with COPD could improve outcomes; in particular, reducing length of hospital stays and risk of death," study leader Dr. Ali Parappil, of the Liverpool Hospital's respiratory medicine department, said in a news release from the journal's publisher.
For more information:
http://www.nlm.nih.gov/medlineplus/news/fullstory_100365.html
COPD World News Week of July 11, 2010
Auckland , NZ - Wiping virtually all branding off cigarette and tobacco packets could prove crucial in turning teenagers off smoking, a New Zealand study indicates. Australia is the first country to announce a plan to force tobacco into plain packaging with large pictorial health warnings - a move the industry says it will fight.
From 2012, the only remnant of branding would be the name of the product, in uniform print. Gone would be the colours and attractive pictures. "I think it would be hugely powerful for young people," Auckland University researcher Judith McCool said last night. "The pack is the last bastion of tobacco industry promotion.
"Dr McCool co-supervised master's degree research by Lisa Webb in which 80 students aged 14 or 15 from six Auckland schools were interviewed about their attitudes to smoking, smokers, tobacco packaging and plain packets. The Heart Foundation-funded study found the teenagers considered the plain packets they were shown to be dull, but said they enhanced the impact of the graphic health warnings. "These perceptions were transferred to the act of cigarette smoking as an unattractive or uncool behaviour," the researchers said. The teenagers thought plain packaging would remove the "purpose" of smoking. It then became simply a "bad habit" rather than a cool and rebellious behaviour".
Many submitters to the Maori affairs select committee's tobacco inquiry have urged the MPs to recommend the Government impose plain packaging on the industry among a range of new tobacco control policies. Otago University marketing expert Professor Janet Hoek said plain packaging "would be a very powerful measure to decrease the attractiveness of smoking."
"When you ask young smokers, a lot say they thought smoking was cool. A lot also regret it when they become addicted. Ninety per cent of adult smokers regret it."
The Auckland study found that although the present graphic warnings - some of which show body parts diseased from smoking - were designed to prompt adult smokers to quit, they also led teenagers to view smokers as undesirable, prompting descriptions like "addicted", "lacking in common sense" and "social outcasts". But, the teenagers were confused by the health messages appearing on brightly coloured packets alongside brand imagery, and the researchers said this blunted the effect of the warnings.
For more information:
http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10653991
COPD World News Week of July 4, 2010
New Orleans, LA - Obese patients with chronic obstructive pulmonary disease stand to gain as much from pulmonary rehabilitation as their slimmer counterparts, even though as a group they have a lower exercise capacity, according to new research from the University Hospitals of Leicester in the UK.
"Like the healthy population, the prevalence of obesity is increasing in those with COPD," said Neil Greening, M.B.B.S, M.R.C.P., who led the study. "There is evidence that obesity may lower exercise capacity but at the same time appears to confer a survival advantage, which is known as the obesity paradox. Pulmonary rehabilitation is effective in improving exercise capacity and health status in COPD but it is unclear whether these benefits accrue in patients with extreme obesity. We wanted to compare the outcomes of a pulmonary rehabilitation program in patients with obesity of varying severity and normal weight subjects."
The results of their study was reported at the ATS 2010 International Conference in New Orleans. To compare the effects of pulmonary rehabilitation between obese and non-obese patients, Dr. Greening and colleagues recruited patients with clinical and spirometric COPD and classified them according to their level of obesity, from normal weight (BMI 21-25kg/m2) to extreme obesity (BMI >40 kg/m2). The patients underwent pulmonary rehabilitation at a single center in the UK.
The improvements in their exercise performance and endurance, as well as their health status (chronic respiratory questionnaire) and baseline characteristics were assessed. "We found that obese people with COPD are more disabled in terms of exercise capacity, despite having less severe airflow obstruction (the measure used to quantify severity of COPD). However, they do just as well with rehab including those with extreme obesity," said Dr. Greening. "There is no difference between obesity subgroups in the proportion of patients achieving a clinically significant improvement in the incremental shuttle walk test."
This is the first study to look at PR in extreme obesity. While the researchers expected to find that some improvement would be seen after the pulmonary rehabilitation program, they were surprised to see no difference in training effects between normal weight and extremely obese patients. "Patients with COPD, irrespective of body mass, improve following a pulmonary rehabilitation program. Therefore extremely obese patients with COPD should still be considered for enrolment," said Dr. Greening, adding that although there are no weight limits for pulmonary rehabilitation programs, there is likely some discrimination by medical staff who may emphasize weight loss over exercise.
"We are planning a study to look at the underlying mechanisms of skeletal muscle dysfunction and obesity in COPD," said Dr. Greening. "Rather than a larger multi-centre study looking at epidemiology, we are trying to understand why obesity affects patients with COPD in the way it does.
For more information:
http://www.medicalnewstoday.com/articles/188911.php