Great news for Ontario seniors
Toronto, ON – The Ontario government has announced a new senior’s strategy that empowers people to make the choices that are right for them when it comes to their care, their independence, and how they access government services - whether that's finding ways to keep up an active lifestyle or getting the support needed to live at home longer. One of the highlights of this new action plan for the COPD community is that beginning in the 2018-19 flu season, Ontario will invest $17 million per year to provide a high-dose influenza vaccine, targeted to protect seniors, which will be available free of charge as part of the Ontario Universal Influenza Immunization Program. Currently one must pay out-of-pocket for this new vaccine which has proven to be highly effective at reducing the incidence of flu and the severity of the disease should a senior come down with the flu. Older Canadians suffer disproportionately from flu-related morbidity and mortality. Adults 65+ represent 15% of the Canadian population. However, during influenza season they account for 70% of the hospitalizations. Complications of influenza often result in COPD exacerbations which can then trigger heart attacks and stroke. Influenza-attributed death is 12 times greater among those 65+ who also have a chronic lung disease. The National Advisory Committee on Immunization (NACI) recommends that those age 65+ receive a flu vaccine each year. A recent study concluded that the new high-dose influenza vaccine significantly reduced hospital visits for the elderly. Currently, only Manitoba provides free access to these high-dose flu vaccines - specifically for nursing home residents - who have the greatest mortality risk from influenza of all Canadians. Other highlights of the governments senior’s strategy include the introduction of: Easy-to-find information: A "one-stop" website (Ontario.ca/AgingWell) has been developed where seniors can find information about tax credits, drug coverage, powers of attorney, recreation programs and more. People can also get this information by phone at 1-888-910-1999 or by calling 211 ― which offers information 24 hours a day in over 150 languages.
For complete information on the senior’s plan: http://tinyurl.com/y9pvfwsr
COPD World News Week of October 29, 2017
Pollution causing more deaths worldwide than war or smoking
London, UK - Environmental pollution — from filthy air to contaminated water — is killing more people every year than all war and violence. More than smoking, hunger or natural disasters. More than AIDS, tuberculosis and malaria combined. One of out every six premature deaths in the world in 2015 — about nine million — was attributed to disease from toxic exposure, according to a major study released Thursday in the Lancet medical journal. The financial cost from pollution-related death, sickness and welfare is equally massive, the report says, costing some $4.6 trillion in annual losses — or about 6.2 per cent of the global economy. "There's been a lot of study of pollution, but it's never received the resources or level of attention as, say, AIDS or climate change," said epidemiologist Philip Landrigan, dean of global health at the Icahn School of Medicine at Mount Sinai in New York City, and lead author on the report. It marks the first attempt to pull together data on disease and death caused by all forms of pollution combined. "Pollution is a massive problem that people aren't seeing because they're looking at scattered bits of it," Landrigan said. Experts say the nine million premature deaths the study found was just a partial estimate, and the number of people killed by pollution is undoubtedly higher once new methods of assessing harmful impacts are developed. Areas like Sub-Saharan Africa have yet to even set up air pollution monitoring systems. Soil pollution has received scant attention. And there are still plenty of potential toxins still being ignored, with less than half of the 5,000 new chemicals widely dispersed throughout the environment since 1950 having been tested for safety or toxicity. "In the West, we got the lead out of the gasoline, so we thought lead was handled. We got rid of the burning rivers, cleaned up the worst of the toxic sites. And then all of those discussions went into the background" just as industry began booming in developing nations, said Richard Fuller, head of the global toxic watchdog Pure Earth and one of the 47 scientists, policymakers and public health experts who contributed to the 51-page report. Raisina hill, government seat of power, is seen engulfed in morning smog a day after the Diwali festival, in New Delhi, India on Friday. Levels of dangerous, lung-clogging particulate matter known as PM2.5 went 90 times the recommended limit by the World Health Organization. (Manish Swarup/Associated Press) Asia and Africa are the regions putting the most people at risk, the study found, while India tops the list of individual countries. One out of every four premature deaths in India in 2015, or some 2.5 million, was attributed to pollution. China's environment was the second deadliest, with more than 1.8 million premature deaths, or one in five, blamed on pollution-related illness, the study found. 5 highest rates of pollution-related deaths per 100,000 population (percentage of all deaths)." The report's authors gave Alberta's oilsands and Ontario's chemical valley, home to 40 per cent of the country's chemical manufacturing, as Canadian pollution hotspots. Fuller said that people often don't realize that pollution can damage economies since those who are sick or dead cannot contribute to the economy. "There is this myth that finance ministers still live by, that you have to let industry pollute or else you won't develop," he said. "It just isn't true." The report cites EPA research showing that the U.S. has gained some $30 US in benefits for every dollar spent on controlling air pollution since 1970, when Congress enacted the Clean Air Act, one of the world's most ambitious environmental laws. Removing lead from gasoline has earned the U.S. economy another $6 trillion cumulatively since 1980, according to studies by the U.S. Centers for Disease Control and Prevention. Some experts cautioned, however, that the report's economic message was murky. Reducing the pollution quantified in the report might impact production, and so would not likely translate into gains equal to the $4.6 trillion in economic losses. The report "highlights the social and economic justice of this issue," said Marc Jeuland, associate professor with the Sanford School of Public Policy and the Duke Global Health Institute at Duke University, who was not involved in the study. Without more concrete evidence for how specific policies might lead to economic gains, "policy makers will often find it difficult to take action, and this report thus only goes part way in making the case for action," he said. Jeuland also noted that, while the report counts mortality by each pollutant, there are possible overlaps — for example, someone exposed to both air pollution and water contamination — and actions to address one pollutant may not reduce mortality. The study's conclusions on the economic cost of pollution measure lost productivity and health care costs, while also considering studies measuring people's "willingness to pay" to reduce the probability of dying. While these types of studies yield estimates at best, they are used by many governments and economists trying to understand how societies value individual lives. While there has never been an international declaration on pollution, the topic is gaining traction. The World Bank in April declared that reducing pollution, in all forms, would now be a global priority. And in December, the United Nations will host its first conference on the topic of pollution.
For more information: http://www.cbc.ca/news/health/pollution-worldwide-deaths-1.4363613
COPD World News Week of October 22, 2017
COPD a risk in women with rheumatoid arthritis
Boston, MA - Women with rheumatoid arthritis (RA) were at increased risk of developing chronic obstructive pulmonary disease (COPD) independent of smoking, analysis of data from the prospective Nurses' Health Study (NHS) found. After adjustment for age and year of RA diagnosis, the hazard ratio for incident COPD was a significant 1.52 (95% CI 1.17-1.97), and after further adjusting for smoking either before or after the index date of RA diagnosis, the hazard ratio was again statistically significant at 1.43 (95% CI 1.09-1.87), according to Jeffrey A. Sparks, MD, and colleagues from Harvard University in Boston. Then, after adjustment for multiple other potentially time-varying covariates, including BMI, diet, physical activity, menopausal status, and postmenopausal hormone use, women with RA had a 68% greater risk than controls for incident COPD (HR 1.68, 95% CI 1.36-2.07), they reported in Seminars in Arthritis & Rheumatism. The lung is important in RA, with roles in both pathogenesis and clinical manifestations, according to the authors. "Inflammation in the bronchiolar mucosa may be an initial trigger for immune tolerance breakdown that leads to the formation of RA-related autoantibodies, perhaps years prior to the clinical onset of RA," they explained. Smoking and other environmental triggers also have been implicated in RA pathogenesis, and individuals who smoke and have a genetic predisposition may be particularly susceptible to immune system disturbances in the airways.
Pulmonary fluid specimens obtained from newly diagnosed RA patients have shown the presence of aggregated lymphocytes that can produce the RA-specific autoantibodies anti-citrullinated protein antibodies in the airways and parenchyma, which in turn may compromise bronchiolar function, possibly leading to COPD regardless of exposure to smoke. Other factors that may contribute to COPD after the diagnosis of RA include chronic systemic and airway inflammation and adverse effects of drugs such as methotrexate. Previous studies that have suggested links between RA and COPD/asthma have been limited by retrospective designs and inadequate information about smoking. Accounting for the influence of smoking on risk for both RA and respiratory disease is particularly challenging, because smoking is a strong risk factor for both and can be considered "on the causal pathway between the exposure and outcome," according to the authors. The association between RA and COPD seen in this analysis suggests that there may be factors such as inflammation specific to RA contributing to the risk independent of smoking, and "these results are particularly pertinent since patients with RA are at markedly elevated risk for respiratory mortality," Sparks' group noted. "Future studies are needed to investigate shared environmental or genetic factors and RA-specific factors such as citrullination, autoimmunity, and systemic inflammation that might further explain the respiratory burden of RA," they concluded. Study limitations included the possibility of mis-classification of COPD and asthma as well as a lack of data on RA disease activity and treatments.
For more information: http://tinyurl.com/yc63smv9
COPD World News Week of October 15, 2017
More HCPs get Flu shot when employer requires it
Atlanta, GA - Most healthcare personnel received a flu shot during the 2016-2017 season, with the highest coverage among those who worked at hospitals, CDC researchers found. While more than three-quarters of healthcare personnel reported receiving the influenza vaccination, that number jumped to 92.3% of all healthcare professionals working in hospitals, reported Carla L. Black, PhD, of the CDC's National Center for Immunization and Respiratory Diseases, and colleagues. Lower coverage was observed among healthcare personnel working in long-term and ambulatory care settings, and in healthcare facilities where the employer did not provide or recommend vaccination coverage, the authors wrote in the Morbidity and Mortality Weekly Report (MMWR). They noted that the CDC's Advisory Committee for Immunization Practices (ACIP) recommends that all healthcare personnel receive the influenza vaccine every year. The team conducted an opt-in internet panel survey of 2,348 healthcare personnel to provide estimates for the 2016-2017 influenza season. Overall coverage is similar to vaccination coverage reported over the last three influenza seasons, and not surprisingly, continues to be highest (96.7%) in settings where an employer requires vaccination, the investigators said. Ensuring that healthcare personnel and patients are protected from influenza requires workplace strategies to improve vaccination coverage among healthcare personnel, "including vaccination requirements or active promotion of on-site vaccinations at no cost." Notably, 93.7% of healthcare personnel working in hospitals said their employer either required vaccination coverage or provided on-site vaccination for at least 1 day. Vaccination coverage was at least 90% for hospital employees "of all occupational groups," the authors said. Only about 40% of respondents reported that receiving the influenza vaccine was part of their job requirement. About 70% of hospitals were likely to have this requirement compared with less than 40% of those working in ambulatory care, a quarter of long-term care healthcare professionals, and 22% of those working in other clinical settings. Moreover, vaccination coverage was the lowest among healthcare personnel where vaccination was not "required, promoted, or offered on-site" (45.8%). Around 30% of workers in long-term care and "other clinical settings" said that their employer did not require, promote, or provide vaccination compared with about 20% of those in ambulatory care settings and less than 4% of those working in hospital settings. Vaccination coverage was lower among healthcare professionals working in ambulatory (76.1%) and long-term care settings (68.0%). Black and colleagues noted that influenza vaccination in long-term care settings is "especially important because influenza vaccine effectiveness is generally lowest in the elderly, who are at increased risk for severe disease," and it "confers health benefits to patients, including reduced risk for mortality."
For more information: http://tinyurl.com/yb9zx3lh
COPD World News Week of October 8, 2017
Why Australia's rough flu season could be bad news for Canada
Ottawa, ON - A rough flu season in the Southern Hemisphere could be a warning sign of what’s in store for Canada in the next few months. Health officials in North America are bracing for a particularly miserable flu season because Australians faced a heavy burden of flu cases, which could prove as a predictor for what might happen in Canada. In Australia, the 2017 flu season is possibly the biggest on record, with nearly three times the number of confirmed flu cases compared to 2016. According to a report from the Public Health Agency of Canada, the flu is currently inter-seasonal, but several indicators show above expected levels compared to previous seasons. Flu season in Canada typically runs from November to March. In early September, the majority of influenza cases in Canada came from a virus known as H3N2. That virus is historically linked to heavier flu seasons and is known to be particularly hard on seniors. "It is still too early to say whether it will be a predominantly H3N2 season, but if that is the case it tends to be a more severe flu type,” Dr. Theresa Tam, head of the Public Health Agency of Canada, told CTV News recently. The H3N2 virus also showed up in Canada last year. Some pharmacies and clinics are already giving vaccine shots, and officials say it might be a good idea to get one. Studies show that people who receive flu shots have a 40 to 60 per cent lower chance of getting seriously ill than those who are unvaccinated. Learn more about influenza as Canada prepares for the upcoming flu season. Influenza myths & facts has recently been posted on the COPD Canada web site.
For more information: http://www.copdcanada.info/47.html
COPD World News Week of October 1, 2017
FDA approves first triple therapy for COPD
London, UK - The US FDA has approved Trelegy Ellipta, a once-daily, single inhaler triple therapy fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) for the long-term, once-daily, maintenance treatment of patients with COPD, according to a press announcement from GlaxoSmithKline and Innoviva Inc. The therapy is approved for COPD patients who are on a fixed-dose combination of fluticasone furoate and vilanterol for airflow obstruction. Trelegy Ellipta is not indicated for relief of acute bronchospasm or the treatment of asthma, GSK and Innoviva noted. Trelegy Ellipta is a combination of an inhaled corticosteroid, a long-acting muscarinic antagonist (LAMA), and a long-acting beta2-adrenergic agonist (LABA), delivered once-daily in GSK’s Ellipta dry powder inhaler. It is the first once-daily product approved in the US that combines three active molecules in a single inhaler for the maintenance treatment of appropriate patients with COPD. The FDA-approved strength is FF/UMEC/VI 100/62.5/25 mcg. “COPD is a progressive disease that can worsen over time, and represents a significant burden to patients and healthcare systems. The approval of Trelegy Ellipta, and the addition of a once-daily single inhaler triple therapy to our portfolio of respiratory medicines, is an important milestone for GSK that builds on our long heritage in this area,” said Eric Dube, SVP & Head, GSK Global Respiratory Franchise. Mike Aguiar, CEO of Innoviva Inc, added, “This approval represents a significant therapeutic convenience for those appropriate patients already on Breo Ellipta, that require additional bronchodilation or for those patients already on a combination of Breo Ellipta and Incruse Ellipta. Trelegy Ellipta is the latest development in our collaboration with GSK and is testament to our ongoing efforts to advance respiratory medicine.” GSK and Innoviva believe Trelegy Ellipta will be available for use in the US shortly. Regulatory applications have been submitted and are undergoing assessment in a number of other countries, including the European Union, Australia and Canada.
For more information: http://tinyurl.com/ybrofru9
COPD World News Week of September 24, 2017
Disinfectant use tied to COPD incidence in nurses
Milan, Italy - There was a prospective association between exposure to disinfectants and higher chronic obstructive pulmonary disease (COPD) incidence in nurses, researchers reported here. Analysis of data from the U.S. Nurses Health Study II (NHS II) showed that nurses who used various disinfectants to clean surfaces in hospitals had a 22% increased risk of developing COPD within 8 years (adjusted odds ration, according to Orianne Dumas, PhD, of the French Institute of Health and Medical Research (INSERM) in Villejuif, France, and colleagues. About 37% of the nurses reported weekly involvement in using disinfectants to clean surfaces, Dumas said at a press conference at the European Respiratory Society (ERS) International Congress. She also reported that a suggested association for weekly use of disinfectants to clean instruments. High level exposure to specific disinfectant evaluated by the researchers -- glutaraldehyde, bleach, hydrogen peroxide, and quaternary ammonia compounds (also known as quats) -- were associated with incident COPD (P<0.05), with ORs ranging from 1.24 to 1.32. Dumas noted that previous studies have linked exposure to disinfectants with breathing problems, such as asthma, among healthcare workers. The potential adverse effects of exposure to disinfectants on COPD have received much less attention, although previous research has shown that working as a cleaner was associated with a higher risk of COPD. In a separate 2017 study, Dumas' group described disinfectants used by U.S. nurses, and investigate qualitative and quantitative differences according to workplace characteristics and region. They found that working in a hospital was tied to a higher disinfectant use but lower spray use. Also, nurses working in smaller hospitals (<50 beds vs ≥200 beds) were more likely to use disinfectants and sprays "To the best of our knowledge, we are the first to report [at ERS] a link between disinfectants and COPD among healthcare workers, and to investigate specific chemicals that may underlie this association.
For more information: http://tinyurl.com/y96q6af7
COPD World News Week of September 17, 2017
E-Cigs May Still Damage Blood Vessels
Milan, Italy - Nicotine exposure from vaping was associated with a transient, but potentially harmful, increase in arterial stiffness, according to researchers here. The study included 15 young adults (average age of 26) with no history of electronic cigarette use who identified themselves as seldom smokers, meaning that they smoked no more than 10 cigarettes a month. They vaped e-cigarettes with nicotine for 30 minutes on one study day and non-nicotine containing e-cigarettes for the same length of time on another study day in a controlled setting, explained Magnus Lundback, MD, PhD, of the Karolinska Institute in Stockholm, and colleagues. During the first 30 minutes after smoking e-cigarettes containing nicotine, a three-fold increase in arterial stiffness was observed, as well as increases in blood pressure and heart rate. These effects were not seen following the non-nicotine vaping session, they reported at the European Respiratory Society (ERS) International Congress. These early findings may have important implication for the use of e-cigarettes in smoking cessation, the authors noted. In addition, it is the first clinical trial to link e-cigarette exposure to arterial stiffening in humans, they stated. "There are thousands of toxins in conventional cigarettes, and the thinking has been that they, and not nicotine, are responsible for these cardiovascular effects," he said. "But this study suggests that that might not be the case. It may be that continuous, repeated exposure to e-cigarettes may chronically alter vascular stiffness and increase the risk for cardiovascular events in the future." While the effects on blood pressure, heart rate, and arterial stiffness seen in the study lasted no more than 30 minutes, they mimicked the temporary effects on arterial stiffness seen in cigarette smokers. Lundback noted that chronic exposure to both active and passive conventional cigarette smoke is known to permanently increase arterial stiffness over time. His group took measurements of blood pressure, heart, and arterial stiffness at three, time points during each vaping session: during the first 30 minutes following exposure and at 2 and 4 hours post-exposure. Because exposure to non-nicotine e-cigarettes was not associated with an increase in these cardiovascular risk factors, the immediate increase was most likely attributable to nicotine, Lundback said. "Our results underline the necessity of maintaining a critical and cautious attitude towards e-cigarettes, especially for healthcare professionals," he said.
For more information: http://tinyurl.com/yd5ylxrc
COPD World News Week of September 10, 2017
Smokers, non-smokers tend to underestimate relative risk
Palo Alto, CA - Everyone knows smoking cigarettes is dangerous, but smokers and non-smokers have significant mis-perceptions about the magnitude of the risk associated with lighting up, researchers found. Jon Krosnick, PhD, of Stanford University in Palo Alto, Calif., and colleagues found that people tend to overestimate the absolute risk and underestimate the relative risk associated with tobacco use. They suggested that framing public health messages about cigarette use in terms of a smoker's relative risk for lung cancer, COPD, cardiovascular disease, and other health harms may have a bigger impact on behavior than more commonly used methods of educating the public about smoking's dangers. According to the CDC, cigarette smokers are 15 to 30 times more likely to develop lung cancer or die from lung cancer than non-smokers. "Researchers who study risk look at the (relative risk) ratio all the time. They never look at the percentage point difference," Krosnick said. "But this way of thinking about risk is often absent from public health discussions about smoking." In their study, published in the journal PLOS One, Krosnick and colleagues analyzed data from national surveys that assessed perceived smoking risk for lung cancer among current smokers, former smokers, and non-smokers. They compared three risk perception measures (absolute, attributable, and relative risk) in terms of their associations with smoking cessation and the desire to quit. "Perceptions of relative risk were associated, as expected, with smoking onset and smoking cessation, whereas perceptions of absolute risk and attributable risk were not," the researchers wrote. "Additionally, the relation of relative risk with smoking status was stronger among people who held their risk perceptions with more certainty." Krosnick and colleagues found that current smokers, former smokers, and never-smokers all tended to underestimate the relative risk of smoking. They concluded that the findings should encourage "consideration of a different approach to communicating health risks," adding that quantifying relative risk in public health messages could have a measurable effect on smoking cessation and smoking avoidance rates. Krosnick noted that cigarette packaging labels in the United States include warnings from the Surgeon General that focus on specific health problems associated with tobacco use, but they do not provide information to help consumers quantify the risk. "This may be why quantitative information about relative risk on cigarette packages in Australia (e.g., 'Tobacco smoking causes more than four times the number of deaths caused by car accidents') appears to have been effective in encouraging smoking cessation," the researchers wrote. "We all need to be better informed about the relative risk of smoking with regard to lung cancer, heart disease, COPD and all of the related health consequences," Krosnick said.
For more information: http://tinyurl.com/y9j292lh
COPD World News Week of September 3, 2017
Manitoba to cover high-dose flu vaccine
Winnipeg, MB - Manitoba is the first province in Canada to introduce a high-dose flu vaccine to better protect vulnerable residents of personal care homes from influenza, Health, Seniors and Active Living Minister Kelvin Goertzen announced today. “Studies show that people over the age of 65 that live in personal care homes are most at risk of complications or death related to influenza,” said Goertzen. “That’s why we’re the first in Canada to introduce this new type of vaccine to better protect these vulnerable people and keep them healthy when the flu starts to circulate this winter.” This year, the high-dose seasonal influenza vaccine is being offered to people 65 years of age or older who are living in a personal care home. The vaccine provides a higher level of protection against two types of influenza A and one type of influenza B predicted to be circulating in North America this fall and winter. Lower respiratory tract infections, including pneumonia and bronchitis, are a leading cause of hospital admissions in adults aged 65 years or older, especially in frail older adults. The number of personal care home residents admitted to hospital varies considerably between facilities, but is more frequent during the time of peak influenza activity. The minister noted public health officials will review data about the use and effectiveness of the high-dose flu vaccine in personal care homes to support future vaccine decisions. To protect people from getting influenza (flu), Manitoba Health, Seniors and Active Living encourages all Manitobans to get a free flu vaccine early every fall. The flu vaccine is typically available from health-care providers in early October. Information on seasonal flu and the flu vaccine, is available on the MB government web site: www.gov.mb.ca/health/flu/.
For more information: http://news.gov.mb.ca/news/index.html?archive=&item=42125
COPD World News Week of August 27, 2017
New study looks at lung volume reduction procedures for emphysema
London, UK – A new study looked at the patient experience of lung volume reduction surgery (LVRS) and endobronchial valve (EBV) placement, from referral through to post-discharge care. Evidence based management of chronic obstructive pulmonary disease (COPD) is focused on improving breathlessness, quality of life and healthcare utilization. Inhaled therapies and non-pharmacological treatment options such as pulmonary rehabilitation (PR) provide improvements, but many patients nevertheless experience intractable breathlessness. Interventional approaches such as lung volume reduction surgery (LVRS) may be indicated. LVRS can improve exercise capacity, lung function, quality of life (QoL) and survival in selected patients with emphysema. Evidence is emerging that endobronchial valve placement (EBV) may produce similar benefits. Few procedures are performed relative to the disease burden and likely prevalence of suitable individuals, and survey data suggest a lack of knowledge among clinicians about indications and processes for referral. The researchers wished to discover more about patient experience of the clinical pathways for lung volume reduction to find ways to improve the process and consider other patient-relevant outcome measures. Focus group interviews were carried out in two tertiary centres in London and Leicester, UK. Sixteen patients who had undergone lung volume reduction surgery (LVRS), endobronchial valve (EBV) placement, or both, were recruited. Prior to participation in each focus group, participants completed a questionnaire to guide and focus discussion. Thematic analysis identified common themes to the participant experience of receiving lung volume reduction interventions. Themes included patient focus on declining health and the need to “fight” for a referral; consequences of having procedures and potential unexpected complications; and vulnerability post discharge and limited continuity of care. Participants were clear that the benefits of having had either LVRS or EBV procedures outweighed any difficulties experienced. Participants were keen to have further similar interventions if appropriate. The data produced confirmed the need to develop more systematic lung volume reduction pathways, provide appropriate information, and ensure that post-discharge care is optimal. The participants in the groups were clear that the benefits of having either LVRS or EBV procedures outweighed any difficulties they experienced, and they were keen to have further similar interventions if beneficial. This information may help clinicians who may not refer patients because of overestimating the risk versus benefit of intervention. The researchers concluded that work is needed to improve referral pathways, patient information and post-discharge care.
For more information: http://openres.ersjournals.com/content/3/3/00031-2017
COPD World News Week of August 20, 2017
Many hospitals fail to support smoking cessation for CHD patients
Springfield, MA - Smokers who were hospitalized for cardiac events were highly motivated to kick the habit, but initiation of in-hospital smoking cessation therapy is still low among these patients, researchers reported. In a retrospective study of data from 282 U.S. hospitals, just over one in five (22.7%) smokers hospitalized for coronary heart disease (CHD) received a smoking cessation pharmacotherapy during their hospital stay, according to Quinn Pack, MD, of Baystate Medical Center in Springfield, Mass., and colleagues in JAMA Internal Medicine. There was also wide variation across hospitals in smoking cessation therapy initiation, with the best performing hospitals initiating treatment in around two-thirds of smokers hospitalized for CHD events, and the worst performing initiating therapy in less than 10%, Pack said. "The hospital was a more important predictor of receiving smoking cessation counseling and treatment than the patient," Pack said. "We saw big hospitals, small hospitals, urban, not urban all vary widely across the range, and none of these variables were predictive." A similar study in JAMA Cardiology also found a low prevalence of smoking cessation medication use in older heart attack patients following hospitalization. In that study, just 7% of MI patients who were Medicare beneficiaries filled prescriptions for a smoking-cessation drug within 90 days of hospital discharge. Pack said the two studies together suggest that, "we are really missing the boat when it comes to helping patients at this very critical time. This is really about the administration and the hospital culture. Some hospitals are really pushing this, and at others, smoking cessation treatment doesn't seem to be on the radar." "Hospitalization for a cardiac event provides a teachable moment with high patient motivation to quit smoking; however, our findings suggest that many hospitals are missing this opportunity to improve outcomes for smokers hospitalized for CHD," Pack's group wrote. Although the analysis did not explore why some hospitals had much higher rates of smoking cessation treatment initiation among CHD patients, Pack said that having a smoking cessation protocol in place, and having smoking cessation counsellors on staff, may be important strategies for achieving this outcome. "We know these medications work. They can really make a big difference for these patients," he said.
For more information: http://tinyurl.com/y7xyxqa3
COPD World News Week of August 13, 2017
Depression increases hospital use in AECOPD
Manchester, UK - Results from a 3-year longitudinal follow-up of the ECLIPSE cohort looked at the association of depressive symptoms with rates of acute exacerbations in patients with COPD. Depression increases disability and health care utilization in older patients with chronic obstructive pulmonary disease (COPD). The objectives of the research was to determine the contribution of depressive symptoms to the incidence of moderate-severe and severe acute exacerbations of COPD (AECOPD) over 3 years. Researchers analyzed data collected from a prospective cohort of patients with COPD (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints; ECLIPSE). This multicentered outpatient study looked at a total of 2059 patients with COPD with complete data (63.7% men, mean age 63.4 + 7.1 years). Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Moderate-severe AECOPDs were collected; a subset of very severe AECOPD was defined as requiring hospital admission. The results showed that a total of 540 (26%) patients with COPD reported high depressive symptoms (CES-D ≥16). High depressive symptoms at baseline related to an increased risk of moderate-severe and severe AECOPD during the follow-up (odds ratio [OR] 1.18; 95% confidence interval [CI] 1.07–1.30; for moderate-severe and OR 1.36; 95% CI 1.09–1.69 for severe events risk of hospitalizations) independent of key covariates of an AECOPD history before recruitment in the study, history of gastroesophageal reflux, baseline severity of airflow limitation, and white blood cell count that were also associated with an increased risk of moderate to severe exacerbations. The researchers concluded that the presence of high depressive symptoms at baseline were associated with subsequent moderate-severe exacerbations and hospital admissions in patients with COPD over 3 years, independent of a history of exacerbations and other demographic and clinical factors. Targeted personalized medicine that focuses both on AECOPD risk and depression may be a step forward to improving prognosis of patients with COPD.
For more information: http://www.jamda.com/article/S1525-8610(17)30303-1/fulltext
COPD World News Week of August 6, 2017
'Loneliness Epidemic' called a major public health threat
Provo, Utah - Loneliness may be more hazardous to your health than obesity -- and a growing number of Americans are at risk, researchers report. About 42.6 million American adults over age 45 are believed to suffer from chronic loneliness, according to AARP. "Being connected to others socially is widely considered a fundamental human need -- crucial to both well-being and survival. Extreme examples show infants in custodial care who lack human contact fail to thrive and often die, and indeed, social isolation or solitary confinement has been used as a form of punishment," said Julianne Holt-Lunstad. She is a professor of psychology at Brigham Young University in Provo, Utah. "Yet an increasing portion of the U.S. population now experiences isolation regularly," she added during a presentation Saturday at the annual meeting of the American Psychological Association (APA) in Washington, D.C. Holt-Lunstad presented results of two large analyses. In one, researchers analyzed 148 studies that included a total of more than 300,000 people. Those studies linked greater social connection to a 50 percent lower risk of early death. The researchers also reviewed 70 studies involving more than 3.4 million people to gauge the impact of social isolation, loneliness and living alone on the risk of premature death. The conclusion: The effect of the three was equal to or greater than well-known risk factors such as obesity. More than one in four Americans lives alone, more than half are unmarried, and marriage rates and the number of children per household are declining, according to U.S. Census data. "These trends suggest that Americans are becoming less socially connected and experiencing more loneliness," Holt-Lunstad said in an APA news release. She said there is strong evidence that social isolation and loneliness increase the risk of early death more than many other factors. "With an increasing aging population, the effect on public health is only anticipated to increase. Indeed, many nations around the world now suggest we are facing a 'loneliness epidemic.' The challenge we face now is what can be done about it," Holt-Lunstad said. Possible solutions, she said, include getting doctors to screen patients for social isolation, and training schoolchildren in social skills. Older people should prepare for retirement socially as well as financially, she added, noting that many social ties are related to the workplace. Holt-Lunstad also suggested that community planners include spaces that encourage people to gather together, such as recreation centers and community gardens. Research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.
For more information: https://medlineplus.gov/news/fullstory_167643.html
COPD World News Week of July 30, 2017
High-Dose influenza vaccine reduces hospital visits for elderly
Providence, RI - A new study suggests that when compared with standard-dose vaccine, high-dose influenza vaccine can reduce the risk of respiratory-related hospital admissions from nursing home residents aged 65 years and older. The research suggests that giving this population a high-dose flu vaccine, one with four times the usual amount of immune-spurring antigens, can greatly cut their risk of hospitalization from the flu. The vaccine seemed to help even the oldest seniors, the Brown University team said. According to Dr. Stefan Gravenstein, the high-dose vaccine would also work better than regular-dose vaccine in the population considered least able to respond. The study was published July 21 in the journal The Lancet Respiratory Medicine http://dx.doi.org/10.1016/S2213-2600(17)30235-7 One expert in caring for very ill people said that influenza poses special dangers for nursing home residents. "Patients who are already suffering from other chronic diseases are helped with a better quality of life because they are not moved out of their comfortable environment to a hospital," noted Dr. Theodore Strange. "This [new vaccine] is a huge in terms of cost of care and in quality of life for these patients," said Strange, who is associate director of medicine at Staten Island University Hospital in New York City. In the new study, the Brown team analyzed Medicare claims data from more than 38,000 residents of 823 nursing homes in 38 states during the 2013-2014 flu season. A high-dose flu vaccine was given to residents of more than 400 of the homes, while residents in the other homes received the standard dose. The result: Overall hospitalization rates were 3.4 percent for residents who received the high-dose vaccine and 3.8 percent for those who received the standard dose. The risk of hospitalization for respiratory illness, in particular, was nearly 13 percent lower in the high-dose group. That group also had a much lower rate of hospitalization for any reason, respiratory or otherwise, Gravenstein's group said. "Respiratory illness as the primary reason for hospitalization accounted for only about a third of the reduction in hospitalization that we measured," noted Gravenstein, who believes the shot may help ward off hospitalization for causes beyond lung troubles.
For more information: http://tinyurl.com/ya2est57
COPD World News Week of July 23, 2017
Reduced risk of acute exacerbation of COPD after bariatric surgery
Boston, MA - Obesity is common among individuals with chronic obstructive pulmonary disease (COPD) and associated with increased COPD morbidities. However, little is known about the impact of weight reduction on COPD-related outcomes in obese patients. Using the population-based emergency department (ED) and inpatient sample in three U.S. states (California, Florida, and Nebraska), we performed a self-controlled case series study of 481 obese adults (aged 40-65 years) with COPD who underwent bariatric surgery. The primary outcome was an ED visit or hospitalization for acute exacerbation of COPD (AECOPD) from 2005 through 2011. We compared each patient’s risk of the outcome during sequential 12-month periods using pre-surgery months 13-24 as the reference period. During 13-24 months before bariatric surgery (i.e., reference period), 28% of patients had an ED visit or hospitalization for AECOPD. In the subsequent 12-month pre-surgery period, the risk did not change materially. By contrast, during the first 12 months after bariatric surgery, the risk declined significantly by 12%. Likewise, in the subsequent period of 13-24 months after bariatric surgery, the risk remained significantly low. The researchers concluded that the risk of an ED visit or hospitalization for AECOPD substantially decreased after bariatric surgery in obese patients. This observation suggests the effectiveness of substantial weight reduction on COPD morbidity.
For more information: http://journal.chestnet.org/article/S0012-3692(17)31244-8/fulltext
COPD World News Week of July 16, 2017
Ottawa hospital launches screening program for long-time smokers
Ottawa, ON - The Ottawa Hospital has started a new screening program targeting people at high risk of developing lung cancer in an effort to catch and treat the disease sooner. A pilot program that launched June 1 is urging people between the ages of 55 and 74 who have smoked for 20 years or more — not necessarily consecutively — to get screened in hopes of treating lung cancer before it's too late. Debi Lascelle credits early screening for her cancer-free status today. After smoking cigarettes for 27 years, she took part in a study about lung screening in 2011. "I had it in the back in my mind that I could perhaps have lung cancer. I had been a very heavy smoker, although I had quit at that time. I had been around smoking all my life, and I thought it would be an interesting thing to do," she said on CBC Radio's Ottawa Morning. Fortunately, Lascelle's lung cancer was small and detected. Now doctors at the Ottawa Hospital want others to follow Lascelle's example. "We really think that getting the disease earlier will make an impact on survival," said Dr. Donna Maziak, thoracic surgeon at the Ottawa hospital. "If it's caught early, the survival for Stage 1 [lung cancer] based on previous data is approximately 69 to 75 per cent." Lung cancer is the second-most diagnosed cancer in Ontario, and it accounts for the most cancer deaths — more than colorectal, breast and prostate cancer combined, according to Maziak. "The idea of the lung screening is that we'll catch it earlier. And the key to a successful screening program for lung is smoking cessation. It goes hand in hand," she said. "You're not getting a CT scan every year just to give you a licence to smoke one more year because you didn't get lung cancer. It's really to help the whole patient." The Ottawa Hospital's screening program is aimed at longtime smokers who may be at high risk of developing lung cancer. The Ottawa Hospital also wants to reduce the stigma around the disease, something Lascelle experienced often when she first told people she had lung cancer. "I would suggest there's still quite a bit of stigma. I don't know too many smokers who are happy they're smokers. But it is a true addiction. Certainly quitting was something that was extremely difficult to do," she said. Lascelle is encouraging anyone who may be at risk to take advantage of this screening program. "Please do it. Don't hesitate. It's such a difference when it's caught early," she said. "They can do something and you can be a survivor. It makes the world of difference. Do this for yourself and your family."
For more information: http://tinyurl.com/ybpz3toh
COPD World News Week of July 9, 2017
COPD patients who live alone are less active
Seattle, WA - Patients with chronic obstructive pulmonary disease (COPD) who live with a spouse, partner, or other caregiver are more active than patients who live alone, and are also more likely to participate in pulmonary rehabilitation programs, researchers report. Compared with patients who lived alone, those who lived with a spouse, partner, or other caregiver walked, on average, close to half a mile more each day, the results showed. And having a live-in spouse or partner caregiver was associated with an 11-fold higher likelihood of participation in a pulmonary rehabilitation program, according to the retrospective analysis of data from the CASCADE (COPD Activity: Serotonin Transporter, Cytokines and Depression) study of depression and functioning among COPD patients, to be published online in Annals of the American Thoracic Society. Earlier studies have shown social support to be a strong predictor of participation in cardiac rehabilitation programs, but the impact of social support on pulmonary rehab utilization and activity among patients with COPD has not been widely studied, the study's lead author, Huang Nguyen, PhD, of Kaiser Permanente Southern California and the University of Washington at Seattle, said. "This analysis showed that COPD patients who live with others are more likely to take more steps -- close to 1,000 more steps a day. Living with someone else may be a factor in engaging in more activities, or it could be that these patients are more active because they are engaged in caring for a spouse." The analysis included 282 CASCADE study participants with moderate to severe (GOLD Stage II-IV) COPD (age: 68 ± 9; FEV1% predicted: 45 ± 16) recruited from two Veterans Administration hospitals and two academic medical centers. Eighty percent of the patients were white men, 90% reported having a family caregiver, and 75% lived with others (family members or friends).Physical activity was measured with a validated accelerometer at baseline, and at 1 and 2 years. Additional self-care behaviors assessed included pulmonary rehabilitation attendance, smoking status, receipt of influenza and/or pneumococcal vaccinations, and medication adherence. Structural social support indicators included living status, being partnered, the number of close friends/relatives, and the presence of a family caregiver. Functional social support was measured with the Medical Outcomes Social Support Survey (MOSSS), and mixed-effects and logistic regression models were also used. Participants who lived with others took 903 more steps per day than those who lived alone Increases in the MOSSS total score were associated with more steps per day) The odds of pulmonary rehabilitation participation were more than 11 times higher if a patient had a spouse or partner caregiver compared with not having a caregiver Higher functional social support (MOSSS total score) was associated with marginally lower odds of smoking and higher odds of pneumococcal vaccination No significant relationships were seen between social support and influenza vaccination or adherence with inhaler or nebulizer medications The researchers noted that since higher levels of physical activity have been shown to be associated with lower risk of exacerbations, hospitalizations, and all-cause mortality in patients with COPD, the finding that living with others increases activity levels is especially important.
For more information: http://tinyurl.com/ybtoclyt
COPD World News Week of July 2, 2017
Flu vaccine patch in development
New York, NY - An experimental flu vaccine patch with dissolving microneedles appears safe and effective, a preliminary study shows. The patch has 100 solid, water-soluble and painless microneedles that are just long enough to penetrate the skin. Researchers say it could offer a pain-free and more convenient alternative to flu shots. "This bandage-strip sized patch of painless and dissolvable needles can transform how we get vaccinated," said Dr. Roderic Pettigrew, director of the U.S. National Institute of Biomedical Imaging and Bioengineering, which funded the study. "A particularly attractive feature is that this vaccination patch could be delivered in the mail and self-administered. In addition, this technology holds promise for delivering other vaccines in the future," he said in an institute news release. The study of 100 adults found that the patch triggered a strong immune response and did not cause any serious side effects. At most, some patients developed local skin reactions to the patches, which involved faint redness and mild itching that lasted two to three days. The flu vaccine is released by the microneedles, which dissolve within a few minutes. The patch is then peeled off and thrown away. Researchers at Georgia Institute of Technology and Emory University led the study. The results were published online June 27 in The Lancet. These early results "suggest the emergence of a promising new option for seasonal vaccination," Drs. Katja Hoschler and Maria Zambon wrote in an accompanying editorial. They are with Public Health England's National Infections Service. The "more exciting features" of the microneedle patch include its low cost, safety, storage convenience and durability, they said. "Microneedle patches have the potential to become ideal candidates for vaccination programs, not only in poorly resourced settings, but also for individuals who currently prefer not to get vaccinated," the editorialists wrote. One flu expert agreed. "The flu microneedle patch is easy to use -- it can be self-administered and, like other medication patches, it is well absorbed through the skin," said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City. "This development eliminates the need for intramuscular injection [a flu shot] by a health care professional," he added. Also, "this patch does not need to be refrigerated -- it has a long shelf life," Horovitz noted. "Standard vaccines can loose potency if left out of refrigeration repeatedly, as occurs in most settings."
For more information: https://medlineplus.gov/news/fullstory_166897.html
COPD World News Week of June 25, 2017
Excess Alcohol May Speed Muscle Loss in Older Women
Seoul, South Korea - Heavy drinking may hasten muscle loss in older women, a new study warns. Both aging and menopause can lead to loss of muscle mass and strength, a condition called sarcopenia. Muscle mass loss typically starts in midlife, and progresses at a rate of 6 percent per decade, the researchers said. Usually, only three-quarters of midlife muscle mass remains after the age of 80. This loss of muscle affects balance, gait and the ability to do daily tasks, the researchers said. By 2030, the number of people in the world 60 or older is estimated to grow by 56 percent, and older people will number one in six individuals globally, according to the South Korean researchers. Their study looked at nearly 2,400 postmenopausal women, average age 62. Of those, 8 percent had sarcopenia. Rates of sarcopenia were nearly four times higher among high-risk drinkers than among low-risk drinkers, the study found. High-risk drinking was defined as frequent and significant alcohol use, along with a lack of control over drinking, blackouts and injuries related to drinking. Women in the high-risk group were more likely to smoke and have higher blood pressure and total cholesterol. They were also significantly younger. The researchers were from Yonsei University College of Medicine, in Seoul. "With this study suggesting that more muscle loss leads to sarcopenia and other studies suggesting that even one drink of alcohol may increase the risk of breast cancer, postmenopausal women should limit their alcohol intake," said JoAnn Pinkerton, executive director of the North American Menopause Society (NAMS). The study was published online June 7 in Menopause, a NAMS journal.
For more information: http://tinyurl.com/yc359wmc
COPD World News Week of June 18, 2017
Analysis finds no statin primary prevention for seniors
New York, NY - Seniors don't get a cardiovascular or mortality benefit from taking a moderate-dose statin for primary prevention, according to a post hoc subgroup analysis of ALLHAT-LLT. In the overall neutral open-label trial, analysis restricted to participants ages 65 and older, showed that randomization to pravastatin (Pravachol) likewise didn't impact the primary endpoint of all-cause mortality during 6 years, Benjamin Han, MD, MPH, of the New York University School of Medicine in New York City, and colleagues reported online in JAMA Internal Medicine. In the 65- to 74-year-olds, the mortality rate was 15.5% on pravastatin and 14.2% with usual care (HR 1.08, P=0.55). For adults 75 years and older, the trend actually neared significance in the wrong direction (24.5% pravastatin vs 18.5%, HR 1.34, P=0.07). Coronary heart disease events came out similar between groups, including after multivariable regression, with no treatment by age interaction. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial-Lipid-Lowering Trial -- nested within the ALLHAT hypertension trial -- included 2,867 ambulatory adults, ages 65 and older, for the analysis out of the overall population 55 and older with hypertension and at least one additional heart disease risk factor. No one had baseline atherosclerotic cardiovascular disease (ASCVD) or baseline statin use. An accompanying editor's note by Gregory Curfman, MD, of Harvard Medical School in Boston, acknowledged statin risks that "may be particularly problematic in older people" and concluded the ALLHAT-LLT results "should be considered before prescribing or continuing statins for patients in this age category." Many physicians were universally skeptical that the analysis should have any clinical impact. "I think the most important part of this report may be the section on Limitations, which states that it is a post hoc secondary analysis of a trial of a subgroup of patients. I always tell students to avoid this type of analysis," commented Daniel Blumenthal, MD, MPH, president of the American College of Preventive Medicine. James Stein, MD, director of the Preventive Cardiology Program at the University of Wisconsin in Madison, pointed to the "null bias due to the small difference in achieved LDL-C" between groups. While agreeing that post hoc subgroup analyses can be misleading, Noel Bairey-Merz, MD, director of the Preventive Cardiac Center at Cedars-Sinai Medical Center in Los Angeles, noted that "given the declining CVD mortality rate in the U.S., particularly in the over 65-year-olds, due to improved public health (less smoking) and healthcare (Medicare), demonstration of mortality benefit of anything now is rare." Kim Williams, MD, of Rush University in Chicago and a past president of the American College of Cardiology, pointed to the moderate 40-mg pravastatin dose used, too. While the findings might seem to contradict the ACC/American Heart Association lipid guidelines, he noted that the study was consistent with a 15% to 30% relative reduction in coronary events, although not significant.
For more information: http://tinyurl.com/y9mt72bf
COPD World News Week of June 11, 2017
Nursing home residents have high antibiotic-resistant bacteria
New York, NY - Multidrug-resistant bacteria, such as E. coli, can be found in more than one-quarter of people living in nursing homes, a research review finds. Reviewing eight prior studies, researchers reported rates ranged from 11 percent of residents to an alarming 59 percent, with 27 percent the average. "Nursing home residents are at higher risk to become colonized with these bacteria," said study author Sainfer Aliyu, a doctoral candidate at Columbia University School of Nursing in New York City. But just because nursing home residents are colonized with the bacteria doesn't mean they have an illness. "Someone who is colonized has the bacteria on them, but may not know it. They may not show any symptoms. But they can spread the germ to others, and they have the potential to become sick themselves," Aliyu said. As the nation's "superbug" list grows, health officials are particularly concerned about infections resistant to carbapenems -- powerful antibiotics used as a last resort, the study authors noted. People in nursing homes often have health conditions that can weaken their immune system, and they're often on prolonged antibiotic use, which contributes to antibiotic-resistance. Plus, nursing home residents share many spaces and interact with each other, giving the germs a chance to move from person to person, Aliyu said. The study looked specifically for bacteria known as multidrug-resistant gram-negative bacteria (MDR-GNB). Infections with these types of bacteria are common in nursing homes, according to the study authors. And treatment options are limited. The researchers looked through the medical literature for studies on MDR-GNB and nursing home residents. Eight studies done between 2005 and 2016 were included in the analysis. Aliyu said the study shows the need to "further educate staff on infection prevention," as well as come up with "policies for infection prevention that are more nursing-home specific." An infectious-disease specialist praised the new research. "This was a well-done study that quantifies the degree of colonization in long-term care facilities," said Linda Greene. She's president-elect of the Association for Professionals in Infection Control and Epidemiology, Inc., in Rochester, N.Y. Greene said it's hard to know just how high colonization rates are in the general community, and the rates seen in nursing homes are likely higher than in hospitals. "It stands to reason that colonization rates may be higher because the nursing home is people's residences. And this is where the challenges occur, because how do we curtail this? There's so much interaction between nursing home residents. But we don't want people confined to their rooms," she said. One simple way to prevent infection is hand-washing, said Greene. "Hand hygiene is one of the number one ways to prevent infection," she said. Dr. David Gifford is senior vice president of quality and regulatory affairs for the American Health Care Association, a trade group representing long-term care facilities. He agreed that hand-washing is crucial for preventing infection. And he said people should always ask health care providers -- whether in the doctor's office, hospital or long-term care facility -- if they've washed their hands before examining you. "Health care providers shouldn't be offended by this question," he said. As for the current study, Gifford said it's very tough to know where people became colonized with these difficult-to-treat bugs. "Everyone likes to point fingers, but we really don't know where the bacteria came from. Some probably originated in the nursing homes, some in hospitals and some in the community. Ninety percent of admissions to nursing homes come from a hospital," he said. "What we need to do is collectively work together to address this problem," Gifford said. "The findings from this study reflect the fact that -- in the U.S. in particular -- we administer antibiotics much more frequently than is necessary. As you give out more and more antibiotics, you're going to develop more antibiotic resistance," he explained. Gifford called the over-prescribing of antibiotics "a real and serious threat in the U.S." And over-prescribing isn't just an issue in nursing homes, he added. It's also when children or adults get antibiotics for a virus. "Changing antibiotic prescribing is as important as infection controls," he said. Greene agreed that hospitals and long-term care facilities need to work together to combat the problem. She said communication between facilities needs to improve, especially when someone is transferred while taking antibiotics to ensure that they finish their full course of antibiotics.
For more information: https://medlineplus.gov/news/fullstory_166075.html
COPD World News Week of June 4, 2017
Smart T-shirt monitors if you're breathing easy
Laval, PQ - We've seen a variety of "smart clothes" over the years, with most generally functioning like wearable fitness trackers, packed with sensing equipment to capture a variety of biometric data. Researchers in Canada have focused instead on creating a smart T-shirt with the potential to help diagnose respiratory illnesses or for real-time monitoring of respiratory rates for people with conditions such as asthma, sleep apnea or chronic obstructive pulmonary disease (COPD). The challenge for the researchers at Université Laval's Faculty of Science and Engineering and its Center for Optics, Photonics, and Lasers, was creating a smart T-shirt that operates without any wires, electrodes or sensors needing to come into direct contact with the wearer's body. To achieve this, they embedded the T-shirt with an antenna made of a hollow optical fiber coated with a thin layer of silver that sits at chest level. The antenna acts as both a sensor and a transmitter, collecting and transmitting data on the body's respiratory movements. With each breath, the smart fiber tracks thorax circumference and the volume of air in the lungs. "These changes modify some of the resonant frequency of the antenna," explains Professor Younes Messaddeq, whose team developed the technology. "That's why the T-shirt doesn't need to be tight or in direct contact with the wearer's skin. The oscillations that occur with each breath are enough for the fiber to sense the user's respiratory rate." The idea is that the smart T-shirt would transmit its data in real time to a smartphone or computer, allowing the monitoring of respiratory patterns that could help diagnose certain illnesses. The technology also can work as a real-time monitor, potentially allowing alarms to be triggered for those who suffer from irregular respiration while they sleep. Because the smart fiber is light and can be innocuously sown into a regular garment, Messaddeq notes that it doesn't inhibit natural movements and offers reliable data regardless of whether the wearer is lying down, standing, moving or sitting. Another major benefit is that the garment can be washed in a regular way without damaging any of the internal components as the smart fiber's surface is covered in a polymer that allows it to withstand to rigors of being run through a washing machine without any problems. The technology is still in the early stages, but the team foresee it being incorporated into a variety of garments for applications such as patient monitoring in hospitals or nursing homes. The team's research was published in the journal Sensors.
For more information: http://newatlas.com/smart-t-shirt-monitors-breathing/49605/
COPD World News Week of May 28, 2017
First-try antibiotics now fail in 1 in 4 adult pneumonia cases
Las Angeles - The first prescription of an antibiotic that the average U.S. adult with pneumonia receives is now ineffective in about a quarter of cases, a new study finds. In these cases, more or different antibiotics were needed, or the patient's condition worsened to require ER admission or hospitalization within a month of the antibiotics being taken, the research team said. The results are concerning, because pneumonia is the leading cause of death from infectious disease in the United States, said lead researcher Dr. James McKinnell, an infectious disease specialist at LA BioMed, a California-based research foundation. Speaking in a news release from the American Thoracic Society, he added that, "the additional antibiotic therapy noted in the study increases the risk of antibiotic resistance and complications like C. difficile infection, which is difficult to treat and may be life-threatening, especially for older adults." Infectious disease experts have sounded the alarm for years on the growing problem of antibiotic resistance -- germs mutating around these lifesaving drugs. One expert who reviewed the new findings said they highlight that threat. The fact that a quarter of pneumonia patients failed their initial antibiotic therapy, "could be related to change in the bacterial resistance in the community," said Dr. Bushra Mina, who directs the medical ICU at Lenox Hill Hospital in New York City. And he noted that with pneumonia, "a certain percentage" of cases are caused by viruses, for which antibiotics are useless. In the new study, McKinnell's team tracked data from nearly 252,000 adults who were prescribed antibiotics to treat pneumonia contracted outside of a hospital ("community-acquired"). Patients were cared for at either a doctor's office or other outpatient facility. Just over 22 percent of the patients did not respond to their initial prescription of antibiotic treatment, the study found. "Our findings suggest that the community-acquired pneumonia treatment guidelines should be updated," McKinnell said. Any update should include data on what risk factors leave patients vulnerable to antibiotic failure, he added. According to their new findings, one key risk factor is age. "Patients over the age of 65 were nearly twice as likely to be hospitalized compared to younger patients" after adjusting for other risk factors, McKinnell said. Because of this, "elderly patients are more vulnerable and should be treated more carefully, potentially with more aggressive antibiotic therapy." Two other experts in pulmonary infections said the study did have its flaws, however. Dr. Howard Selinger is chair of family medicine at Quinnipiac University's school of medicine in Hamden, Conn. He said the study was unclear on how the pneumonia diagnoses were made -- in many cases, what doctors thought was an antibiotic-responsive illness might have been viral bronchitis or other disease that antibiotics won't help. For this reason, Selinger said, "I strongly doubt 25 percent resistance to multiple different classes of antibiotics." Instead, many of the cases in the study may have been viral to begin with, Selinger said. Dr. Alan Mensch, a pulmonologist at Northwell Health's Plainview Hospital in Plainview, N.Y., agreed. He said that too few of the patients in the study had the "gold standard" sputum (phlegm) test that is needed to confirm a bacterial, not viral, infection. But he said there is still much to learn from the findings. "Clearly, the current guidelines for community-acquired pneumonia published in 2007 by the American Thoracic Society and Infectious Disease Society of America need updating," Mensch said. Any update should include protocols to better identify the cause of a pneumonia, and perhaps quicker hospital admission for elderly patients who haven't responded to drug therapy,' he said. The study was slated to be presented on Sunday at the American Thoracic Society's annual meeting, in Washington, D.C. Findings presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.
For more information: https://medlineplus.gov/news/fullstory_165801.html
COPD World News Week of May 21, 2017
Ventilation plus oxygen works for patients with persistent hypercapnia
Washington, DC - Patients with persistent hypercapnia following an acute exacerbation of chronic obstructive pulmonary disease (COPD) had a longer time to death or re-hospitalization if non interventional ventilation was added to their home oxygen therapy, researchers found. Median time to readmission or death was 4.3 months in the group that had the ventilation treatment added to home oxygen, versus 1.4 months for the group that had oxygen alone (adjusted hazard ratio 0.49, 95% CI 0.31-0.77, P=0.002). The 12-month risk of readmission or death was 63.4% in the oxygen-plus-ventilation group compared with 80.4% for the oxygen-alone group, reported Patrick B. Murphy, PhD, of St. Thomas' Hospital in London, and colleagues in JAMA. The findings were also presented at the American Thoracic Society annual meeting. "Murphy, et. al. suggest that home oxygen plus home [ventilation] 'should be considered' for patients with persistent hypercapnia," Nicholas Hill, MD, of Tufts Medical Center in Boston, in Boston, and Aylin Ozsancak Ugurlu, MD, of Baskent University in Istanbul, Turkey, wrote in an accompanying editorial. "This is a reasonable suggestion as long as patients with reversible hypercapnia are given sufficient time to recover (2-4 weeks after hospital discharge) and PaCO2 levels remain substantially elevated (≥52 mm Hg)." Although treating patients with COPD and acute respiratory failure with non-invasive ventilation improves outcomes, persistent hypercapnia after an exacerbation is associated with excess mortality and early re-hospitalization, the study authors noted. "In 2013, the 28-day COPD re-admission rate was around 20%, and there were financial penalties in place in the United Kingdom and United States for such early re-admissions." Using ventilation in addition to oxygen therapy in the home setting is one treatment alternative to consider for patients with hypercapnia. Although some small, uncontrolled studies showed the physiological efficacy of home noninvasive ventilation in patients with COPD, "subsequent clinical studies failed to demonstrate either physiological (reduced hypercapnia) or clinical (mortality) efficacy, and questions remain regarding whether the application of the intervention was optimized in these randomized clinical trials," the authors noted. The researchers hypothesized that the addition of home noninvasive ventilation to home oxygen therapy would prolong the time to readmission or death among patients with persistent hypercapnia following an acute life-threatening exacerbation of COPD requiring acute noninvasive ventilation.
For more information: http://tinyurl.com/m5tx84r
COPD World News Week of May 14, 2017
COPD exacerbations in those with CVD may increase Heart Attack/Stroke risk
Washington, DC - After an acute exacerbation of chronic obstructive pulmonary disease, or COPD, people with a history of cardiovascular disease (CVD) or people at risk for CVD appear more likely to suffer a heart attack or stroke, according to new research presented at the ATS 2017 International Conference. The researchers found that within 30 days after an acute exacerbation, the odds of heart attack or stroke was nearly four-fold higher. Within 31 days to a year after the exacerbation, the odds were nearly double. A year after the exacerbation, the risk was not significantly different. “Previous studies have shown that lower lung function, such as occurs with COPD, is a risk factor for cardiovascular disease,” said Ken M. Kunisaki, MD, MS, lead study author and associate professor of medicine at the University of Minnesota and Minneapolis VA Health Care System. “One theory for why this happens is that COPD triggers inflammation and that, in turn, leads to CVD,” he added. “Because COPD exacerbations lead to particularly high levels of inflammation, we wondered if these exacerbations would be linked to higher rates of CVD events.” The researchers analyzed data from the Study to Understand Mortality and MorbidiTY (SUMMIT) trial. SUMMIT enrolled current and former smokers between the ages of 40 and 80 who had CVD or multiple risk factors for CVD and whose forced expiratory volume in one second (FEV1) was 50-70 percent of predicted and whose FEV1/forced vital capacity (total volume of exhalation) was ≤ 70 percent. Their findings have led the researchers to consider interventions they might study following a COPD exacerbation in patients with CVD. “One approach might be to study currently used cardiac medications, such as antiplatelet agents, statins and/or beta-blockers immediately following COPD exacerbations,” Dr. Kunisaki said. “Another approach might be to use experimental drugs that specifically reduce inflammation.” Until effective interventions are identified, he added, patients who have recently experienced a COPD exacerbation “should pay attention to and seek immediate care” for symptoms of heart attack, such as chest pain and sudden worsening of shortness of breath, and stroke, including weakness of one limb, sudden changes in vision and the inability to speak clearly. Care providers, he said, should be particularly aware of the risk of a CVD event in patients seeking acute medical care following a COPD exacerbation. Study limitations include the fact that all patients in the study had a CVD history or multiple risk factors for CVD. It is not known if COPD exacerbations would pose the same risk of a CVD in patients with no or lower CVD risk.
For more information: http://tinyurl.com/ksbw84o
COPD World News Week of May 7, 2017
Effects of Geriatric COPD rehabilitation on hospital admissions and exercise tolerance
Amsterdam, The Netherlands - Frail COPD patients are frequently not accepted for regular pulmonary rehabilitation programs due to low physical condition and functional limitations. Although rehabilitation programs in nursing homes for geriatric patients with COPD have been developed the effects of such programs are largely unknown. A recent study assessed the course of COPD-related hospital admissions and exercise tolerance in a cohort of frail COPD patients participating in geriatric COPD rehabilitation. It was a retrospective observational study with a follow up of 12 months after discharge from rehabilitation. COPD related hospital admission days were measured in the year before and after participating rehabilitation. Exercise tolerance was measured by the six minute walk test (6MWT) at admission and at discharge from rehabilitation. Fifty-eight participants accomplished the rehabilitation program. Twelve patients died in the first year after discharge. The median number of hospital admission days in the year before participating rehabilitation was 21 (IQR 10-33). The first year after discharge this was decreased to a median of 6 (IQR 0-12). The 6MWT increased from 194 (SD 85) meters at admission to 274 (SD 95) meters at discharge (mean difference 80 m, SD 72; p < 0.05). The researchers concluded that geriatric COPD rehabilitation in a nursing home setting seems to reduce hospital admissions in frail COPD patients and to increase exercise tolerance.
For more information: https://www.ncbi.nlm.nih.gov/pubmed/28447319
COPD World News Week of April 30, 2017
New COPD guidelines released by ERS and ATS
London, UK - A new set of guidelines aimed at helping clinicians care for COPD patients with an acute exacerbation, has been released by the American Thoracic Society and European Respiratory Society. While the guidelines do not recommend pulmonary rehab during the hospital stay itself, they do recommend beginning such a program within three weeks of discharge. They also recommend a home-based management approach for patients who present to the hospital or emergency department with a COPD exacerbation. “Pulmonary rehabilitation implemented within three weeks after discharge following a COPD exacerbation reduces hospital admissions and improves quality of life,” write the authors. Additional studies to identify interventions that provide the biggest benefits to patients and test strategies to overcome barriers to and facilitators of the integration of pulmonary rehab into the patient’s plan of care are needed. When it comes to home management of patients, the authors note that the “home-based management program model in patients with a COPD exacerbation reduces hospital admissions, making it a safe and effective way of discharging patients with additional home-based support in appropriately selected patients.” They call for more study to define the patient selection criteria and key elements of such programs, particularly who will staff them – for example, nurses or inter-professional teams that include a physician, respiratory therapist, or social worker. Other recommendations in the guidelines call for a course of oral corticosteroids of 14 days or less in ambulatory patients, along with antibiotics, with selection of antibiotics to be based on local sensitivity patterns. The administration of oral corticosteroids rather than intravenous corticosteroids is also recommended, if gastrointestinal access and function are intact. In patients with acute or acute-on-chronic hypercapnic respiratory failure, they believe noninvasive ventilation may be warranted in patients who are hospitalized as well.
For more information: http://erj.ersjournals.com/content/49/3/1600791
COPD World News Week of April 23, 2017
Unproven stem cell treatments emerging problem
New York, NY - The American Journal of Respiratory and Critical Care Medicine, a publication of the American Thoracic Society (ATS), has published an article stating that unproven stem cell treatments for lung diseases are an emerging public health problem. Every organ in the body has a small number of cells that serve as organ-specific stem cells, the article states. These cells work to replace or repair damaged tissue. In the future, stem cells may be used to reverse or even cure some lung diseases. But today, there are no proven stem cell treatments for any lung disease. “Unproven stem cell treatments are those that have not been fully tested for safety and effectiveness (how well they work),” the article states. “The best way to test potential stem cell therapies is through clinical research trials that have to follow certain rules. These rules are set by national regulatory agencies such as the FDA (U.S. Food and Drug Administration) to make sure that the treatments are tested following proper scientific methods without any conflict of interest. “Unfortunately, there are hundreds of clinics and other groups offering unproven stem cell treatments in the U.S. A frequent method that they use to treat lung disease involves removing cells from a person’s fat or bone marrow and giving the cells back to the person through his or her bloodstream. These approaches have not been proven to work and are not FDA-regulated or approved as accepted treatments for any type of lung disease.” The concerns expressed in the ATS article echo those found in a 2015 statement from The Medical and Scientific Advisory Committee (MASAC) of the Alpha-1 Foundation. The MASAC statement advises Alpha-1 patients to take part only in approved research studies and to avoid unproven claims of stem cell and other cell-based "therapies."
For more information: http://tinyurl.com/myxv82v
COPD World News Week of April 16, 2017
Nearly 1 billion people still smoke daily
Seattle, WA - Despite strong declines in the rate of tobacco smoking over the past 25 years, one out of every four men still smoke daily, as do one out of every 20 women. In a new analysis from the Global Burden of Disease study (GBD) published today (April 5, 2017) in The Lancet, authors discovered that the prevalence of daily smoking declined on a global scale – decreasing by 28% for men and 34% for women between 1990 and 2015. But while the rate of smoking has fallen over the past few decades, the number of daily smokers globally continues to rise year-over-year due to population growth. As of 2015, there were 933 million daily smokers. “Robust tobacco control efforts have led to progress in reducing the deadly habit of smoking in much of the world, but much more can be done,” said senior author Dr. Emmanuela Gakidou, Professor of Global Health at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle. “Growth in the sheer number of daily smokers still outpaces the global decline in daily smoking rates, indicating the need to prevent more people from starting the tobacco habit and to encourage smokers to quit.” The three countries with the most male daily smokers in 2015 accounted for over half of all men who smoked daily worldwide. Countries with the most male daily smokers in 2015 were China with 254 million, India with 91 million, and Indonesia with 50 million. The three countries with the highest number of female daily smokers in 2015 accounted for just over 25% of all female daily smokers worldwide. Countries with the most female daily smokers in 2015 were the Unites States with 17 million, followed by China with 14 million, and India with 13.5 million. These results suggest that the tobacco smoking epidemic is less geographically concentrated for women than for men, with implications that global efforts may need to be different to reach male smokers compared to female smokers. “With sustained commitment to implementing proven measures to reduce tobacco use, governments can help curb a global epidemic projected to kill 1 billion people this century,” said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. “Countries that have acted decisively to implement policies like those called for in the FCTC have seen the most dramatic drops in tobacco use. Without urgent action, more than 80% of tobacco-related deaths will occur in low- and middle-income countries by 2030.” There were 13 countries that sustained significant annual rates of decline between both from 1990 to 2005 and 2005 to 2015, including Australia, the United States, and Brazil. Further, the daily smoking prevalence declined faster between 2005 and 2015 in 18 countries, including Nepal, Chile, and Ukraine. Smoking is the second-leading cause of death globally. More than 11% of all global deaths in 2015 were attributed to smoking, totaling 6.4 million. Over half of these smoking-related deaths took place in just four countries: China, India, the United States, and Russia. In addition, daily smoking still contributes to a significant amount of the world’s overall health burden, measured using the disability-adjusted life years (DALYs) metric, which combines years of healthy life lost due to illness with those lost due to premature death. Most DALYs attributable to daily smoking were due to cardiovascular diseases (41%), cancers (28%), and chronic respiratory diseases (21%).
For more information: http://tinyurl.com/mhr2msp
COPD World News Week of April 9, 2017
COPD patients needing colectomy do better with laparascopic surgery
Houston, TX - Patients with severe chronic obstructive pulmonary disease (COPD) requiring colectomy experience fewer complications and smoother recovery with laparoscopic surgery versus open procedures, reported Medical Post Today. In a retrospective registry study, COPD patients who underwent laparoscopic colectomy exhibited markedly lower risk of serious compared with an open colectomy group, reported Sarath Sujatha-Bhaskar, MD, of University of California, Irvine School of Medicine, at the 2017 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) meeting. And 30-day mortality was also reduced significantly with laparascopic surgery. "Despite presumed physiological contraindications associated with pneumoperitoneum, laparoscopic colonic operation was well tolerated in COPD patients," Sujatha-Bhaskar stated during his oral presentation. "The minimally invasive approach was associated with lower risk of postoperative respiratory complications, shorter length of stay, and decrease in readmission," he added. Panel moderator Mark H. Whiteford, MD, director of colon and rectal surgery at the Oregon Clinic, was not surprised by the results. "We've actually had data for a long time that show that laparoscopy, probably because it is a smaller incision and less pain, the patients do better after the surgery ... so this goes along with our suspicion," he said. Sujatha-Bhaskar and colleagues examined clinical data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) on 10,743 patients with COPD who electively underwent laparoscopic (37%) and open colectomy (63%) from 2006 to 2014.
For more information: http://tinyurl.com/knd5lch
COPD World News Week of April 2, 2017
Drug tied to dementia risk over-prescribed to seniors
Detroit - A drug linked to a raised risk of dementia is taken by millions of older Americans who have an overactive bladder, researchers say. More than one-quarter of patients with the urinary problem had been prescribed the drug oxybutynin (Ditropan), an international team of investigators found. Yet, "oxybutynin is a particularly poor drug for overactive bladder in elderly patients," said study lead author Dr. Daniel Pucheril, a urologist at Henry Ford Hospital in Detroit. Prior studies have linked the drug to thinking problems and increased risk of dementia in older people, possibly because of the way it affects brain chemicals, he said. "It's a great and effective drug for younger patients, but is a risky drug for older patients," Pucheril said. It boosts dementia risk even when not taken indefinitely, he said. Alternatives exist but they're more expensive and may not be covered by insurance, at least initially, the study authors explained. For instance, "most Medicare Part D plans have a tiered drug formulary, which means that patients must try and 'fail' oxybutynin before they will be eligible for the newer generation of [so-called] antimuscarinic medications," Pucheril said. Also, there's debate over the safety of alternatives. The Urology Care Foundation estimates 33 million Americans have an overactive bladder. These people often need to urinate urgently, frequently or both. Some also suffer from incontinence. Non-medical treatments -- including changes in diet, exercises and scheduled urination -- are usually the first line of treatment. Surgery is sometimes an option, as are prescription antimuscarinic medications like oxybutynin. A Canadian specialist noted that immediate-release oxybutynin is the form most linked to dementia. "Older patients on the drug should consider a review with their clinician," said Dr. Adrian Wagg, director of geriatric medicine at the University of Alberta. There's no evidence that a family history of dementia adds to the drug's risk, he said, or that people who already have dementia will face the same added risk as others. The study was released at the European Association of Urology conference in London. Research presented at meetings should be considered preliminary until published in a peer-reviewed journal.
For more information: https://medlineplus.gov/news/fullstory_164375.html
COPD World News Week of March 26, 2017
Study shows potential of stem cell therapy to repair lung damage
Estoril, Portugal - A new study has found that stem cell therapy can reduce lung inflammation in an animal model of chronic obstructive pulmonary disease (COPD) and cystic fibrosis. Although, still at a pre-clinical stage, these findings have important potential implications for the future treatment of patients. The findings were presented in Estoril, Portugal today at the Lung Science Conference. The new research investigated the effectiveness of MSC therapy in a mouse model of chronic inflammatory lung disease, which reflects some of the essential features of diseases such as COPD and cystic fibrosis. Researchers delivered stem cells intravenously to β-ENaC overexpressing mice at 4 and 6 weeks of age, before collecting samples tissue and cells from the lungs at 8 weeks. They compared these findings to a control group that did not receive the MSC therapy. The results showed that inflammation was significantly reduced in the group receiving MSC therapy. Cells counts for both monocytic cells and neutrophils, both signs of inflammation, were significantly reduced after MSC therapy. Analysis of lung tissue revealed a reduction in the mean linear intercept and other measures of lung destruction in MSC treated mice. As well as reducing inflammation in the lung, MSC therapy also resulted in significant improvements in lung structure, suggesting that this form of treatment has the potential to repair the damaged lung. Dr. Declan Doherty, from Queens University Belfast, UK, commented: “These preliminary findings demonstrate the potential effectiveness of MSC treatment as a means of repairing the damage caused by chronic lung diseases such as COPD. The ability to counteract inflammation in the lungs by utilising the combined anti-inflammatory and reparative properties of MSCs could potentially reduce the inflammatory response in individuals with chronic lung disease whilst also restoring lung function in these patients. Although further research is needed to improve our understanding of how MSCs repair this damage, these findings suggest a promising role for MSC therapy in treating patients with chronic lung disease." Professor Rachel Chambers, ERS Conferences and Research Seminars Director, commented: "This paper offers novel results in a pre-clinical model which demonstrates the potential of MSC stem cell therapy for the treatment of long-term lung conditions with exciting potential implications for the future treatment of patients with COPD and cystic fibrosis. Although, still at an early stage in terms of translation to the human disease situation, this paper is one of many cutting-edge abstracts from the Lung Science Conference, which aims to provide an international platform to highlight novel experimental lung research with therapeutic potential. We rely on high quality basic and translational respiratory science, such as these latest findings, to develop novel therapeutic approaches for the millions of patients suffering from devastating and often fatal respiratory conditions."
For more information: http://tinyurl.com/llvu37u
COPD World News Week of March 19, 2017
Impact of fruit and vegetable consumption on COPD
Stockholm, Sweden – A recent study published in the journal Thorax looked at antioxidants present in fruits and vegetables and whether they may protect the lung from oxidative damage and prevent COPD. The aim of the study was to determine the association between fruit and vegetable consumption and risk of COPD by smoking status in men. The researchers used a population-based prospective Cohort of Swedish Men included 44 335 men, aged 45–79 years, with no history of COPD at baseline. Fruit and vegetable consumption was assessed with a self-administered questionnaire. During a mean follow-up of 13.2 years, 1918 incident cases of COPD were ascertained. A strong inverse association between total fruit and vegetable consumption and COPD was observed in smokers but not in never-smokers (p-interaction=0.02). The age-standardised incidence rate per 100 000 person-years in the lowest quintile (<2 servings/day) of total fruit and vegetable consumption was 1166 in current smokers and 506 in ex-smokers; among those in the highest quintile (≥5.3 servings/day), 546 and 255 per 100 000 person-years, respectively. The multi-variable HR of COPD comparing extreme quintiles of total fruit and vegetable consumption was 0.60 (95% CI 0.47 to 0.76, p-trend <0.0001) in current smokers and 0.66 (95% CI 0.51 to 0.85, p-trend=0.001) in ex-smokers. Each one serving per day increment in total fruit and vegetable consumption decreased risk of COPD significantly by 8% (95% CI 4% to 11%) in current smokers and by 4% (95% CI 0% to 7%) in ex-smokers. The researchers concluded that the high consumption of fruits and vegetables is associated with reduced COPD incidence in both current and ex-smokers but not in never-smokers.
For more information: http://tinyurl.com/mj895np
COPD World News Week of March 12, 2017
Is Need for More Sleep a Sign of Pending Dementia?
Boston, MA - Seniors who begin sleeping more than nine hours a night may face a higher risk of dementia down the road suggests a new study that appears in the journal Neurology. The researchers estimated that the risk of dementia grew by almost 2.5 times for those who found themselves recently needing extra sleep. The chances of dementia rose six-fold for people without a high school degree who suddenly needed to sleep nine hours or more, the study contended. The study authors said this finding hinted that education might somehow offer a bit of protection from dementia. People with dementia often suffer from disrupted sleep, "but we don't know much about whether these changes come first," said study co-author Matthew Pase. He's a neurology fellow at the Boston University School of Medicine. Dementia "is by no means a certain fate" in those who find themselves sleeping longer as they age, Pase said. The new study only found an association between added sleep and dementia, not cause and effect. Still, Pase thinks monitoring sleep habits might be a good idea in certain cases. "If someone reported recently becoming a longer sleeper, they could undergo a memory assessment," he suggested. Past research in this area compared people who already had dementia to those who didn't have it, instead of tracking people over time, he noted. The new study tried a different strategy, Pase said. "We asked a very basic question: How does one's sleep duration relate to being diagnosed with clinical dementia in the future?" The researchers looked at seniors in the Framingham Heart Study, which has tracked people and their descendants in a Massachusetts community since 1948. The researchers followed two groups of older people -- all over 60 -- from 1986-1990 and 1998-2001 onward. Nearly 2,500 people were included in the study. Their average age was 72. Fifty-seven percent were women. Over 10 years, 10 percent of the participants were diagnosed with dementia, with the wide majority thought to have Alzheimer's disease. The researchers didn't find any heightened dementia risk in people who'd been sleeping nine or more hours a night for more than an average of 13 years. But those who'd begun sleeping more than nine hours recently had nearly double the risk of dementia compared to other people -- 20 percent of the new long-sleepers were diagnosed with dementia. These people also appeared to have smaller brain volumes, Pase said. Pase said it appears that the extra sleep is a sign of something else, not a direct cause of dementia. It could indicate chemical changes that are happening in the brain, he said. Or, he said, the development of dementia could make people more tired. Dementia tests may be appropriate for older people who notice they're sleeping longer, Pase said. But he doesn't recommend people try to wake up earlier. "They shouldn't restrict sleep," he said. "There are no implications for treatment based on our findings." Dr. Jiu-Chiuan Chen is an associate professor with the Keck School of Medicine at the University of Southern California. He wasn't involved with the study, but said the research seems valid. Chen agreed that there's no need to offer any special treatment to older people who start to sleep over nine hours, because it's not yet clear what's going on. The next step for researchers is to study people as they sleep to better understand how sleep and dementia are connected, Pase said.
For more information: http://tinyurl.com/jn6qv42
COPD World News Week of March 5, 2017
High-dose influenza vaccine more effective at preventing deaths among seniors
Atlanta, GA - A study published in The Journal of Infectious Diseases indicated that high-dose influenza vaccine was significantly more effective for preventing post-influenza deaths among older adults than standard-dose vaccine. “It has been recognized at least since the 1957 A (H2N2) pandemic that older persons and those with some chronic health conditions, including pulmonary and cardiac compromise, are at the greatest risk of severe influenza outcomes,” David K. Shay, MD MPH, of the influenza division of the CDC, Atlanta, and colleagues wrote. “This is the population that everybody worries about,” Shay said in a press release accompanying the study. “Many of the most serious outcomes of flu infections occur in older people.” The researchers reviewed data from Medicare beneficiaries aged 65 years and older who received either a standard-dose (n = 1,683,264) or high-dose influenza vaccine (n = 1,039,654) during the 2012-2013 flu season, as well as recipients vaccinated during the 2013-2014 season (standard, n = 1,877,327; high-dose, n = 1,508,176). The primary outcome was death within 30 days after an emergency department or inpatient visit for influenza. Overall, Shay and colleagues reported that there were 0.028 post-influenza deaths per 10,000 person-weeks among those who had received high-dose vaccines, and 0.038 deaths per 10,000 person-weeks among standard-dose recipients. The researchers wrote that overall comparative effectiveness was 24% (95% CI, 0.6%-42%). High-dose vaccine recipients were 36.4% less likely to die than standard-dose recipients in the 2012-2013 flu season (95% CI, 9%-56%). This fell to 2.5% in the 2013-2014 season (95% CI, -47% to 35%). Researchers noted that the H3N2 influenza virus, which is linked to greater mortality in senior citizens, was predominant in the 2012-2013 season. H1N1 viruses, which are more susceptible to the standard-dose vaccine, were more common in 2013-2014. “The high-dose vaccine does appear, at least in this particular H3N2 season, to be more effective at preventing deaths that occur within 30 days of an influenza hospitalization,” Shay said in the press release. “We didn’t see a significant effect on post-influenza deaths during the 2013-2014 H1N1 season.”
For more information: http://tinyurl.com/zggcfuc
COPD World News Week of February 26, 2017
Canadians could save billions with universal drug coverage
Ottawa, ON - Canadians and private drug-plan sponsors could save more than $4-billion a year if the federal government adopted universal coverage for a group of commonly prescribed essential medicines, according to a new analysis in the Canadian Medical Association Journal. The study used economic modelling to determine the government would have to spend an estimated $1.2-billion a year to provide universal coverage for 117 essential medicines, which accounted for 44 per cent of the prescriptions filled in Canada in 2015. Individuals and private plans would save nearly $4.3-billion if such a system were introduced, according to the economic modelling used in the study. The government would be able to use bulk purchasing power, which is why it would cost so much less to cover the cost of those essential medicines – drugs that are deemed necessary for public health – than it would for individuals and private drug plans. The drugs include those used to treat some heart conditions, rheumatoid arthritis, HIV, anaphylaxis and migraines. The federal government is facing increasing pressure to address the rising cost of prescription drugs, but has not committed to a national pharmacare program. The overall savings to individual Canadians and drug-plan sponsors of the universal coverage recommended in the study more than justifies the cost, said Steve Morgan, one of the study’s authors and a professor at the School of Population and Public Health at the University of British Columbia, while ensuring all Canadians have access to vital prescription drugs. “The benefit of having a universal plan is to make sure that nobody falls through the cracks of our currently fragmented private and public drug coverage system,” Dr. Morgan said. The researchers found Canada pays substantially more than Sweden, New Zealand and the U.S. Veterans Affairs drug program for the same generic medications. Dr. Morgan said this shows the federal government could save a significant amount of money by purchasing drugs in bulk as part of a universal coverage program. The study found that generic essential medicines cost 47 per cent less under the U.S. Veterans Affairs program; 60 per cent less under Sweden’s national drug program; and 84 per cent less under New Zealand’s program.
For more information: http://tinyurl.com/hj8kmg9
COPD World News Week of February 19, 2017
Vaping to kick the smoking habit
Boston, MA - Cigarette smokers with chronic diseases -- especially conditions associated with tobacco use -- are more likely to try electronic cigarettes than healthy smokers, according to an analysis of recent survey data. Findings from the nationally representative 2014 and 2015 National Health Interview Survey (NHIS) showed that current and former smokers with COPD, asthma, and cardiovascular disease -- but not cancer -- had higher odds of e-cigarettes ever use than smokers and former smokers without these diseases. The study is the first to examine national prevalence and patterns of e-cigarette use among U.S. adults with medical comorbidities. While the data showed small, non-significant increases in e-cigarette ever-use among adult smokers and former smokers between 2014 and 2015, they also showed a slight decrease in current e-cigarette use among smokers, Gina R. Kruse, MD, of Massachusetts General Hospital in Boston, and colleagues reported in the American Journal of Preventive Medicine. Kruse said that it is not possible to say why sick smokers are trying e-cigarettes or why fewer of them reported current use than "ever" use, given the limitations of the NHIS, which did not explore the reasons for e-cigarette use. Still, she speculated that cigarette smokers with smoking-related diseases and other medical conditions are vaping to help them quit conventional cigarettes or reduce their use. "Smokers with comorbidities might be trying them and finding them not very helpful, or e-cigarettes may be helping people quit so they don't need these products anymore," she said. "That would be very hopeful, but we have no way of knowing if this is the case." Study limitations included the self-reported nature of the survey, lack of data on length of e-cigarette use or reasons for use, and the survey description of e-cigarettes as "looking like cigarettes," which would exclude many newer vaping products. Kruse noted that a main goal of the ongoing, longitudinal, NIH-sponsored Population Assessment of Tobacco and Health (PATH) will be to better understand why people use tobacco products, including e-cigarettes. She added that, because it is not clear that the benefits of e-cigarettes outweigh the risks, she does not recommend them to her patients for smoking cessation.
For more information: http://tinyurl.com/he4agbf
COPD World News Week of February 12, 2017
Inhaler handling errors lead to increase in COPD exacerbations
Bordeaux, France - Inhaler device handling errors are associated with an increased risk of severe chronic obstructive pulmonary disease (COPD) exacerbations, leading to a higher proportion of patients requiring hospitalisation or emergency room treatment. Inhaler device handling errors are associated with an increased risk of severe chronic obstructive pulmonary disease (COPD) exacerbations, leading to a higher proportion of patients requiring hospitalisation or emergency room treatment. The study, published in the ERJ, asked 212 GPs and 50 pulmonologists to provide assessment on the use of inhaler devices of 2,935 patients who were over the age of 40 years, were current or ex-smokers of more than 10 years, and who had been using an inhaler device for more than 1 month for continuous treatment of COPD. Patients were requested to take a puff of their regular inhaler device and were rated for technique by physicians. The results showed that handling errors were observed in over 50% of cases regardless of the device used. The most common errors were failure to breathe out before actuation (22.5%), inhalation through the nose (22.2%) and not holding breath a few seconds after inhalation (26.9%). In patients treated for at least 3 months, the rate of severe exacerbations doubled between patients with no error (3.3%) and patients with at least one critical error (6.9%), suggesting poor technique is responsible for less effective clinical outcomes and an increased risk of COPD exacerbation.
The authors conclude that inhaler errors, which are not taken into account in clinical trials, are reducing treatment benefit in the real-world. They believe that physicians should aim to improve patient technique of inhaler use, instead of focusing on the choice of inhaler characteristics, to reduce the frequency of COPD exacerbations.
For more information: http://tinyurl.com/jjyh9yl
COPD World News Week of February 5, 2017
Study looks at improving COPD patient’s rehab uptake and completion
Lincolnshire, UK - Pulmonary rehabilitation is considered a key management strategy for chronic obstructive pulmonary disease (COPD), but its effectiveness is undermined by poor patient uptake and completion. The aim of this review was to identify, select and synthesise the available evidence on interventions for improving uptake and completion of pulmonary rehabilitation in COPD. Electronic databases and trial registers were searched for randomised trials evaluating the effect of an intervention compared with a concurrent control group on patient uptake and completion. The primary outcomes were the number of participants who attended a baseline assessment and at least one session of pulmonary rehabilitation (uptake), and the number of participants who received a discharge assessment (completion). Only one quasi-randomised study (n=115) (of 2468 records identified) met the review inclusion criteria and was assessed as having a high risk of bias. The point estimate of effect did, however, indicate greater programme completion and attendance rates in participants allocated to pulmonary rehabilitation plus a tablet computer (enabled with support for exercise training) compared with controls (pulmonary rehabilitation only). There is insufficient evidence to guide clinical practice on interventions for improving patient uptake and completion of pulmonary rehabilitation in COPD. Despite increasing awareness of patient barriers to pulmonary rehabilitation, our review highlights the existing under-appreciation of interventional trials in this area. This knowledge gap should be viewed as an area of research priority due to its likely impact in undermining wider implementation of pulmonary rehabilitation and restricting patient access to a treatment considered the cornerstone of COPD.
For more information: http://openres.ersjournals.com/content/3/1/00089-2016?ctkey=shareline
COPD World News Week of January 29, 2017
Can Air Pollution Heighten Alzheimer's Risk?
Los Angeles, CA - Air pollution may cause more than just lung disease: New research suggests that if tiny particles in the air from power plants and cars are inhaled, they might also invade the brain, increasing the risk for dementia. "Although the link between air pollution and Alzheimer's disease is a new scientific frontier, we now have evidence that air pollution, like tobacco, is dangerous to the aging brain," said study co-senior author Caleb Finch. He's with the University of Southern California's (USC) Leonard Davis School of Gerontology. For the study, the USC scientists collected samples of air particles with technology designed by university engineers. The researchers used the technology to expose female mice to air pollution. "Our state-of-the-art aerosol technologies, called particle concentrators, essentially take the air of a typical urban area and convert it to the air of a freeway or a heavily polluted city like Beijing," study co-author Constantinos Sioutas, a professor of civil and environmental engineering, explained in a university news release. "We then use these samples to test exposure and assess adverse neuro-developmental or neuro-degenerative health effects," he added. The mice carried a certain genetic variation, called the APOE4 gene, which increases the risk for Alzheimer's. After being exposed to air pollution for 15 weeks, the mice had 60 percent more amyloid plaque, the clusters of protein associated with the degenerative disease, the researchers said. They also analyzed data on more than 3,600 3U.S. women between the ages of 65 and 79 years from 48 states. None of the women had dementia when the study began. After considering certain variables -- such as race, ethnicity, lifestyle and health -- the researchers found older women living in areas where miniscule air pollution particles exceed federal safety standards may be at 81 percent higher risk for cognitive decline. They may also face a 92 percent greater likelihood of developing dementia, including Alzheimer's disease. The negative effects of air pollution on the brain were particularly notable among the women who the APOE4 gene, the study authors added. The research was published Jan. 31 in the journal Translational Psychiatry. If their findings were extended to include the general population, the study's authors calculate that air pollution might be to blame for about 21 percent of all cases of dementia. The research comes with several caveats. First, it did not prove that air pollution causes the risk of dementia to rise. Second, studies involving animals frequently fail to produce similar results in humans. Finch said: "Microscopic particles generated by fossil fuels get into our body directly through the nose into the brain. Cells in the brain treat these particles as invaders and react with inflammatory responses, which over the course of time, appear to exacerbate and promote Alzheimer's disease." Jiu-Chiuan Chen, co-senior author of the study, said, "Our study -- the first of its kind conducted in the U.S. -- provides the inaugural scientific evidence of a critical Alzheimer's risk gene possibly interacting with air particles to accelerate brain aging." "The experimental data showed that exposure of mice to air particles collected on the edge of [the] USC damaged neurons in the hippocampus, the memory center that is vulnerable to both brain aging and Alzheimer's disease," added Chen, who is an associate professor of preventive medicine at USC's Keck School of Medicine. Less than one-third of all U.S. counties have ozone or particle pollution monitors, according to the American Lung Association. The group notes that six of the 10 most polluted U.S. cities are in California. The USC researchers said the findings could have global implications because pollution has no borders.
For more information: https://medlineplus.gov/news/fullstory_163365.html
COPD World News Week of January 22, 2017
Finland's plan to be tobacco-free
Helsinki, Finland - The Finnish government has set an ambitious goal for residents in a bid to benefit their health -- and their bank balances. Officials plan to make the country tobacco-free by 2040, meaning they want less than 2% of their adults to consume tobacco -- in any form -- by that deadline. So that's more than 98% of the Finnish population saying no to cigarettes, snuff and other forms of smokeless tobacco, cigars, pipes and even e-cigarettes. As per the trend in industralized countries, smoking rates in Finland have been on the decline in recent decades due to measures such as bans on advertising and shop displays, and the creation of smoke-free public spaces. In 2013, 16% of 15- to 64-year-olds in Finland smoked on a daily basis, while nearby in the UK, 19% of adults were smokers in 2014. But at the start of this year, a new level of control measures came into force. According to Kaari Passo, head of harm prevention, "We want to get rid of all tobacco products." Experts agree that the Finnish government is using innovation and creativity to get everyone to kick the habit. Rather than targeting one area at a time, such as exposure in public spaces or cigarette use, Paaso said his ministry wants to be precautionary from every angle. It doesn't go down the path of advocating milder products that may do less harm, such as e-cigarettes or snuff. "It's a comprehensive set of policies," he said. Sweden has also seen a dramatic reduction in the number of smokers -- just 12.7% among men and 15.2% among women in 2013 -- but achieved this in part by promoting the use of snus, an oral smokeless tobacco product. The product, along with all other forms of oral tobacco, is banned in other member states of the European Union. The UK is also adopting a harm reduction approach to reduce the number of smokers. Instead of snus, it backs the use of e-cigarettes to help people kick the habit. But Finland wants rid of it all. "We don't want to fall into the trap of other policies that have less harmful products," said Paaso, who fears that promoting other products will result in a new addiction for health officials to deal with in the future. "We want to phase out all products." Experts agree that one of the strongest policies in terms of tobacco control globally has been taxation. The rising cost of the habit, linked to higher taxes, has meant that many can no longer afford to smoke, and those who can smoke provide revenue for anti-smoking campaigns and quitting support services, to name a few options. "The evidence suggests increasing pricing is the single most effective way to reduce demand," said Vaughan Rees, director of the Center for Global Tobacco Control at the Harvard T.H. Chan School of Public Health.
For more information: http://tinyurl.com/zmnuny2
COPD World News Week of January 15, 2016
Short stretches of exercise may have anti-inflammatory effect
San Diego, CA - Just 20 minutes of moderate exercise may dampen inflammation in the body, researchers say. The study findings suggest that "exercise doesn't have to be tremendously hard for you to see health benefits from it," said study author Suzi Hong. She is an associate professor at the University of California, San Diego. The researchers focused on inflammation -- swelling -- in the body. The immune system produces swelling by rushing to protect the body from injuries and invaders, such as germs. But inflammation can become permanent, poisoning tissues in the body and contributing to diseases, including diabetes, Hong explained. Obesity, for example, is thought to produce higher levels of inflammation. That inflammation can contribute to heart disease by affecting the arteries, Hong said. Studies have suggested that exercise lowers inflammation, especially when you're active on a regular basis. However, "what is less known is how that is happening," Hong added. For the new study, Hong and her colleagues recruited 47 volunteers -- a mostly white group of 26 males and 21 females -- with an average age of 41. The researchers gave them blood tests before and after the study participants walked at a moderate speed on a treadmill for 20 minutes. The investigators found a 5 percent decline in immune cells linked to inflammation. Hong called this a "tangible" and "significant" improvement. But it's not clear what it means for a person's health, and the study did not prove cause and effect. Still, she said, it could be helpful for people, regardless of whether they have a disease linked to inflammation. It's also unclear whether more exercise means a greater benefit. However, "if you're seeing this benefit every time you exercise, it'll have a cumulative effect," Hong suggested. David Nieman, director of the Appalachian State University Human Performance Lab, said the new research did not represent a breakthrough -- it just reinforced existing knowledge. "It's definitely not a high-level study, just confirming things we already know," he said. "But it's fine, another bit of information that confirms what we all know in the world of lifestyle and inflammation." Nieman said it's important to fight off inflammation because "it's a serious issue that undergirds just about every major chronic disease that modern-day men and women experience. It really needs to be managed and reduced." The most powerful way to do that, he said, is by controlling weight. As for future research, Hong said it would be helpful to better understand exactly how exercise affects the body. "We want to break it down into bite-size pieces for the public and say there are specific immune-based, cell-based changes you're making when you exercise," she said. The study was published online recently in the journal Brain, Behavior, and Immunity.
For more information: https://medlineplus.gov/news/fullstory_163122.html
COPD World News Week of January 8, 2017
Scientists shed light on why people with lung conditions are vulnerable to air pollution
Osaka, Japan - Researchers in Japan have been investigating why air pollution is particularly harmful to people with lung conditions. Being exposed to air pollution can trigger symptoms among people with lung conditions, such as asthma attacks, chronic obstructive pulmonary disease (COPD) exacerbations, difficulty breathing, wheezing, coughing and irritation. However, the bodily mechanisms that lead to this response are still unclear. This new study, published in the journal, Immunity, looked at how the immune system responded to a common pollutant, particulate matter (PM) 2.5, among a group of mice. Scientists found that PM 2.5 seemed to destroy immune cells called macrophages, which would then go on to release a substance called interleukin which is associated with inflammation. This then set off a chain of events that caused common symptoms among people with lung conditions. The researchers are hopeful that greater understanding of this process could help with the development of treatments to protect people from experiencing pollution-related symptoms – however, more research is needed.
For more information: http://www.cell.com/immunity/abstract/S1074-7613(16)30482-4
COPD World News Week of January 1, 2017
Ban on smoking in public housing has potential to harm
Washington, DC - When the US Housing and Urban Development Department (HUD) recently announced it will require all public housing developments in the US to go smoke free, federal officials were correct to attack a significant and pervasive problem—smoking exposure among low income Americans. However, it’s less clear if their attempted solution is the best and most effective way to solve this problem. The goals are to reduce secondhand smoke exposure, aid smokers to quit, as well as to eliminate preventable fires, reduce the renovation costs associated with smoking, and to meet market demands. This new policy stems from global trends in smoke-free laws in public places, such as restaurants and bars, public parks, and university campuses. Research has consistently shown the significance of public smoking bans on reducing secondhand exposure, changing smoking norms, limiting smoking initiation, and preventing opportunities to smoke. Although critics frequently contend that smoking bans undermine citizen’s individual rights, the facts that multi-unit public housing facilities expose residents to secondhand smoke exposure through air ducts and that children represent approximately one third of public housing residents highlight smoking in public housing as a formidable public health concern beyond privacy arguments. However, the smoking ban in public housing is not without concerns, and care must be taken to address the unique needs of vulnerable residents. While smoking rates in the US continue to decline, smoking remains concentrated among low income individuals, with 26% of individuals below the poverty line currently smoking, compared to 14% of those not in poverty. Importantly, the smallest reductions in smoking prevalence have been among groups with lower socioeconomic status. This highlights the consistent challenges and external circumstances that may undermine even the most effective clinical interventions among resource challenged individuals in public housing. It is not that disadvantaged individuals do not wish to quit smoking, but rather that their external stressors; limited wealth; and increased risk of mental illness, discrimination, and marginalization frequently increase a sense of powerlessness that may inhibit attempts to quit. Sometimes, there are simply bigger problems to deal with. For instance, my previous research has shown that increased exposure to social stressors reduces the likelihood of maintaining home smoking restrictions. While a non-smoking policy may provide a catalyst for some to quit, these policies are unable to address the broader social causes of poverty and need to be cautious that they do not intensify social stigma, which may further marginalize or increase stress for smokers living in public housing. Dealing with noncompliance without increasing vulnerability remains a challenge. Policies related to smoking related lease violations will need to continue to be incremental and non-punitive, with care taken to ensure that smoking violations do not impact current or future housing opportunities. Lease violations that result in fines and potential evictions may compromise the many benefits of a controlled non-smoking environment. For example, fear of reprisal may lead smokers to take actions to conceal their smoking by either smoking indoors with closed windows or in vehicles, thereby increasing the potential risk of secondhand exposure. Fear of surveillance may also undermine social support networks or diminish relationships with building supervisors. For instance, people who choose to smoke in their units may be less likely to report poor living conditions, call attention to safety concerns, or to have control over their environments for fear of being reported. There are also potential safety concerns. While smoking away from the home reduces secondhand smoke for others, it may also increase additional exposure to unsafe areas, particularly at night time or in cold weather or for those with disabilities. Parents negotiating the choice between leaving children either unattended or with siblings, versus bringing children to unsafe and potentially dangerous environments at night, may favor a third option of smoking indoors. All individuals have a right to a smoke-free environment. A smoking ban in areas typically overburdened by tobacco marketing and outlet density will help offset the culture of smoking. The partnering of HUD with local organizations to change tobacco culture and assist with smoking cessation in a high prevalence smoking environment is an admirable and urgent first step in reducing initiation, current smoking, and secondhand exposure. But smoking cessation is a long-term process that requires consistency and smoker buy-in, with attention paid to the broader social conditions and vulnerability of populations that smoke—all of which may challenge anti-smoking policies. Sustainable efforts need to ensure that smokers and their children are not at heightened risk of eviction, reduced accessibility to housing, or increased levels of stigma factors that may undermine or compromise any efforts to quit or reduce smoke exposure. As a sociologist dedicated to understanding how social policies affect health inequalities and disparities, I feel it is imperative that any implementation of smoke-free policies must continue to be undertaken in a fair manner, which acknowledges the unique needs and challenges of disadvantaged populations, and considers policies’ potential to harm as well as their numerous advantages.
For more information: http://tinyurl.com/j9mq335