COPD World News Week of December 25, 2016

Scientists shed light on why people with lung conditions are vulnerable to air pollution

Tokyo, 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.

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COPD World News Week of December 18, 2016

Watch for Post Stroke Epilepsy in Chronic Stroke Patients

Houston, TX - Physicians should be on the lookout for epilepsy after chronic stroke, particularly in younger stroke patients and those with more brain damage, researchers reported here. In a retrospective U.K. study cohort, about 11% of stroke patients developed post-stroke epilepsy (PSE), according to Beate Diehl, MD, PhD, of University College London (UCL), and colleagues at the American Epilepsy Society meeting. Those who developed PSE were younger (44 versus 56) and had more extensive brain damage on MRI scans, they added. "Many physicians treating stroke patients don't realize that falls, episodes of confusion, and loss of consciousness may be signs of post-stroke epilepsy," Diehl said in a statement. "Post-stroke epileptic seizures can negatively affect stroke recovery and rehabilitation." Epilepsy often goes undiagnosed in the elderly, the researchers said. The leading cause of epilepsy in these older patients is stroke, which accounts for as much as 45% of epilepsy in people over age 60. Although some risk factors for PSE have been identified, the exact mechanisms by which stroke causes epilepsy aren't known, Diehl and colleagues said. Their findings are in line with recent reports of a higher percentage of stroke patients developing epilepsy, they said, and concluded that doctors treating stroke patients should keep in mind that PSE is common, so they should watch for risk factors, such as extent of brain damage and younger age.Houston, TX - Physicians should be on the lookout for epilepsy after chronic stroke, particularly in younger stroke patients and those with more brain damage, researchers reported here. In a retrospective U.K. study cohort, about 11% of stroke patients developed post-stroke epilepsy (PSE), according to Beate Diehl, MD, PhD, of University College London (UCL), and colleagues at the American Epilepsy Society meeting. Those who developed PSE were younger (44 versus 56) and had more extensive brain damage on MRI scans, they added. "Many physicians treating stroke patients don't realize that falls, episodes of confusion, and loss of consciousness may be signs of post-stroke epilepsy," Diehl said in a statement. "Post-stroke epileptic seizures can negatively affect stroke recovery and rehabilitation." Epilepsy often goes undiagnosed in the elderly, the researchers said. The leading cause of epilepsy in these older patients is stroke, which accounts for as much as 45% of epilepsy in people over age 60. Although some risk factors for PSE have been identified, the exact mechanisms by which stroke causes epilepsy aren't known, Diehl and colleagues said. Their findings are in line with recent reports of a higher percentage of stroke patients developing epilepsy, they said, and concluded that doctors treating stroke patients should keep in mind that PSE is common, so they should watch for risk factors, such as extent of brain damage and younger age.

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COPD World News Week of December 11, 2016

SanofiPasteur launches new high dose flu vaccine for seniors 

Toronto, ON - SanofiPasteur announces Health Canada’s approval of FLUZONE® High-Dose vaccine, the first and only influenza vaccine developed for adults 65 years of age and older with evidence demonstrating that it is significantly more effective in preventing lab-confirmed influenza illness versus a standard dose trivalent influenza vaccine. Canada’s National Advisory Committee on Immunization (NACI) has stated: ‘Considering the burden of disease associated with influenza A(H3N2) and the evidence of superior efficacy of high dose TIV compared to standard dose TIV, it appears that high dose TIV would provide the greatest benefit to the ≥65 years age group. As the immune system declines with age, older adults do not respond to standard dose influenza vaccines as well as younger adults. FLUZONE® High-Dose vaccine was developed to address the need for an enhanced immune response in those 65 years of age and older.1 Importantly, FLUZONE® High-Dose was recognized by Health Canada and NACI to have demonstrated higher efficacy against lab-confirmed influenza illness compared to a standard dose vaccine in adults 65 years of age and older. “Reducing the rates of influenza and its complications in the senior adult population is a key public health priority,” said Dr. Janet McElhaney, Geriatrician, Medical Lead for Seniors Care, Health Sciences North Volunteer Association Chair in Healthy Aging and Scientific Director for the Advanced Medical Research Institute of Canada. “There is now strong data which demonstrates that this high dose vaccine provides those 65 years of age and older with enhanced protection against influenza. This is the first randomized trial that has shown not only an increase in efficacy, but has also translated into clinically important outcomes.” A large, randomized, controlled study, published in the New England Journal of Medicine, in a study population of approximately 32,000 adults 65 years of age and older, demonstrated that about one quarter of all breakthrough influenza illnesses influenza caused by any influenza viral types or subtypes could be prevented if high dose vaccine were used instead of a standard dose TIV.

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COPD World News Week of December 4, 2016

Canada needs 'defined model' of universal pharmacare 

Ottawa, ON - Canada needs a comprehensive system of universal drug coverage to eliminate variations between the provinces and territories, a citizen-driven panel looking at the idea of national pharmacare recommends. The Citizens' Reference Panel on Pharmacare in Canada — comprised of 35 volunteers randomly selected from across Canada, similar to a coroner's jury — met in Ottawa for five days and heard from 20 experts to produce a report on the issue. The report, entitled "Necessary Medicines", has been presented to the House of Commons' Standing Committee on Health. "In public opinion research that's been conducted, Canadians routinely support some form of pharmacare," panel chair Paul MacLeod said. "But that's always been a placeholder. We haven't really had a defined model that Canadians are saying they would endorse. That's part of what this report provides." The panel's recommendations include: Creating a new national formulary of universally publicly covered medicines that accommodates the full range of individual patient needs, including rare diseases. Requiring all covered drugs to undergo a rigorous evaluation process to ensure both the efficacy and value-for‐money of funded treatments. Endorsing an ongoing role for private insurers in providing supplemental coverage. Canada is the only developed country with universal health coverage that does not also offer universal prescription drug benefits. The Organization for Economic Co-operation and Development has also found that Canada has the second-highest per capita spending on prescription drugs in the OECD. An estimated one in 10 Canadians can't fill prescriptions because of the expense.

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COPD World News Week of November 27, 2016

GSK, Propeller 'smart inhaler' gets FDA green light 

Silver Spring, Maryland - Propeller Health scored an FDA clearance for the use of its digital respiratory disease management system with GlaxoSmithKline’s dry powder inhaler, Ellipta. The clearance comes after the duo teamed up on “smart inhaler” tech back in December 2015. Propeller Health’s sensor attaches to various inhalers to track when patients take their medication. Usage data is transmitted via Bluetooth to a smartphone app, where patients and physicians can see where, when and why patients use their inhalers. The sensor forms the base of Propeller’s digital therapy platform, which uses machine learning to help patients manage their condition, Propeller said. “The approval of the Propeller platform for use with the Ellipta inhaler will help us understand how patients interact with the Ellipta accurately and in real-time,” said Dave Allen, Glaxo’s respiratory R&D chief, in a statement. “… We hope to gain valuable insights into usage patterns with the ultimate goal of driving improvements in patient care while reducing the complexity and cost of clinical trials.” When the companies teamed up last year, Propeller agreed to develop a custom sensor for the Ellipta inhaler. While it was GSK’s first foray into smart inhalers, Propeller had previously created a sensor for the Diskus, another Glaxo inhaler, but did not partner with the company to do so. This is Propeller’s eighth FDA clearance to date. The company has inked more than 45 commercial programs around its tech in the U.S., with healthcare systems, payers, employers and other partners

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COPD World News Week of November 20, 2016

Five Questions May Pinpoint COPD Sooner in Primary Care Setting

New York, NY - Asking patients five simple questions and performing peak expiratory flow (PEF) meter measurement could be the answer to identifying more patients with chronic obstructive pulmonary disease (COPD) in the primary care setting, researchers reported. Fernando J. Martinez, MD, of Weill Cornell Medical College in New York City, and colleagues, evaluated 44 possible questions related to elevated risk for the disease. Using comprehensive statistical analysis and interviews with patients, they narrowed the list down to five questions for their case finding model, published in the American Journal of Respiratory and Critical Care Medicine:
1. Have you ever lived or worked in a place with dirty or polluted air, smoke, secondhand smoke, or dust?
2. Does your breathing change with seasons, weather, or air quality?
3. Does your breathing make it difficult to do things such as carry heavy loads, shovel dirt or snow, jog, play tennis, or swim?
4. Compared with others your age, do you tire easily?
5. In the past 12 months, how many times did you miss work, school, or other activities due to a cold, bronchitis, or pneumonia?
It is estimated that half of the roughly 24 million Americans living with COPD have not been diagnosed. More than a decade after the GOLD guidelines for the diagnosis and management of COPD were introduced, awareness and adherence to the guidelines remains low in primary care. "We believe asking these five questions and performing peak flow measurement can identify patients who are likely to have COPD of the severity significant enough to justify therapy," said Martinez. "If the answer is 'no' to all of them, the likelihood that a patient has COPD that needs treatment is very low. If the answer is 'yes' to most of them, there is a very good chance of having COPD, and this patient needs to be evaluated with spirometry." The questions, written at a sixth-grade level, could be asked in questionnaire form and patients whose answer put them in the middle to high range for risk would be asked to perform peak expiratory flow (PEF) testing during their physician office visit.

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COPD World News Week of November 13, 2016

New research quantifies genetic mutations caused by smoking  

Houston, TX - Smoking one pack of cigarettes a day could cause 150 extra genetic mutations in lung cells every year, according to new research. The study, published in the journal Science, analysed the DNA sequence of cells from more than 5,000 cancers from both smokers and non-smokers. Overall, the study found cancer cells from smokers tended to have a greater number of mutations within certain mutational signatures than non-smokers. For example, most lung and throat cancers from smokers had many mutations in signature 4. The researchers went on to describe the other individual mutational signatures where they found differences for smokers versus non-smokers, including signatures 2, 5, 13 and 16. The researchers were able to estimate the number of mutations that would be caused in different types of cells. The results support the theory that smoking causes cancer by increasing the number of mutations found in the cellular DNA, though the exact mechanism by which this happens isn't completely clear. Professor Sir Mike Stratton, joint lead author, said: "This study of smoking tells us that looking in the DNA of cancers can provide provocative new clues to how cancers develop and thus, potentially, how they can be prevented."

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COPD World News Week of November 6, 2016

The Projected Epidemic of COPD Hospitalizations Over the Next 15 Years

Vancouver, BC - COPD is currently one of the leading causes of hospitalizations in industrialized countries. The future burden of COPD is uncertain as the trends in the prevalence of the main risk factors for COPD, namely cigarette smoking and population aging, are moving in opposite directions in many jurisdictions. Here, we used data from British Columbia (BC), a Canadian Province of 4.7 million people, as an exemplary jurisdiction to illustrate the projected growth of COPD hospitalizations over the next 15 years in developed countries. We combined forecasts of population growth and aging with an Autoregressive Integrated Moving Average (ARIMA) model applied to BC’s population-based administrative health databases (2001 to 2010) to project the trends in the incidence, prevalence, deaths, and total length of inpatient stays to 2030. Based on this model, we predict that the absolute number of COPD cases will increase by more than 150% from 2010 to 2030 with the greatest growth in the older age group (75 years of age and older), where the absolute number will increase by 220%. The burden of inpatient care, measured as the total annual inpatient days, will grow by 185%. Assuming no disruptive changes in the prevention and the treatment of COPD in the near future, the burden of COPD, especially the burden of inpatient care, will significantly escalate over the next 15 years, driven predominantly by population aging. There is a pressing need to develop new preventive strategies and treatments to reduce the future burden of COPD.

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COPD World News Week of October 30, 2016

Smoking Still Takes Big Toll in U.S. Cancer Deaths

Great Neck, NY - Nearly one-third of cancer deaths among Americans aged 35 or older are caused by smoking, and the rate is much higher in the South, a new study finds. Researchers tracking 2014 federal government data found that more than 167,000 cancer deaths among adults 35 and older in 2014 -- 28.6 percent -- were attributable to cigarette smoking. Most of the states with the highest rates of smoking-linked cancer deaths were in the South, including nine of the top 10 ranked states for men and six of the top 10 ranked states for women, according to the study. Some of these southern states have particularly lax anti-smoking controls in place, the researchers said. "Not surprisingly, states with underfunded tobacco-control programs have the highest prevalence of smoking, as well as the highest proportion of cancer deaths attributable to cigarette smoking," noted Patricia Folan, who directs the Center for Tobacco Control at Northwell Health in Great Neck, N.Y. She reviewed the new findings. The study was led by Joannie Lortet-Tieulent of the American Cancer Society. Her team found that, among men, rates of smoking-related cancer deaths ranged from a low of about 22 percent in Utah to highs of 39.5 percent in Arkansas, 38.5 percent in Tennessee and Louisiana, and 38.2 percent in Kentucky and West Virginia. With the exception of Utah, all states had rates of smoking-linked cancer deaths of at least about 30 percent among men, the study authors noted. For women, rates ranged from a low of about 11 percent in Utah to a high of 29 percent in Kentucky. Dr. Len Horovitz is a lung health specialist at Lenox Hill Hospital in New York City. Although great strides have been made against smoking, "there are still 40 million smokers in the U.S., so we can continue to expect large numbers of cancer deaths and heart disease as a result," he pointed out. "Smoking continues to be the biggest threat to health in this country -- it's time to help people quit," Horovitz said. Folan agreed, adding that there are tried-and-true steps that states can take. "Comprehensive tobacco-control programs can have a huge impact in reducing smoking and cancer rates," she said. Particularly effective are those that "include hard-hitting anti-smoking media campaigns, smoke-free laws, increased taxes on cigarettes and other tobacco products, state Quitlines, and funding for cessation medications and reimbursement for counseling." Lortet-Tieulent's team also stressed that the study likely underestimated deaths caused by cigarette smoking, because they only looked at 12 types of cancer.

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COPD World News Week of October 23, 2016

Statins Often Interact With Heart Drugs

Silver Spring, Maryland - Cholesterol-lowering statins can interact with other drugs prescribed for heart disease. But there are ways to navigate the problem, according to new recommendations from the American Heart Association. Statins are among the mostly widely prescribed drugs in the United States. Roughly one-quarter of Americans age 40 and up are on a statin, according to a 2014 study by the U.S. Centers for Disease Control and Prevention. The drugs are prescribed to people who either have atherosclerosis (clogged arteries) or are at risk of it, which means many statin users also take other cardiovascular drugs, the heart association says. The benefits of those drug combinations will generally outweigh the risks, said Barbara Wiggins, a clinical pharmacy specialist in cardiology at the Medical University of South Carolina. But doctors and patients should be aware of how the drugs can interact, said Wiggins, lead author of the new recommendations. A whole range of heart medications can interact with statins, according to the heart association. The list, published Oct. 17 in the journal Circulation, includes: Other cholesterol drugs called fibrates, particularly gemfibrozil (Lopid). Blood pressure medications called calcium channel blockers, which include amlodipine (Norvasc), verapamil (Calan, Covera-HS) and diltiazem (Cardizem, Dilacor). Clot-preventing drugs such as warfarin (Coumadin) and ticagrelor (Brilinta). Drugs used to treat heart-rhythm problems, such as amiodarone (Cordarone, Pacerone), dronedarone (Multaq) and digoxin (Digox, Lanoxin). Heart failure medications like ivabradine (Corlanor) and sacubitril/valsartan (Entresto). The most common issue, Wiggins said, is that the other drugs boost statin levels in the blood. That, in turn, raises the risk of muscle-related side effects. Statins can injure muscle tissue, most often causing muscle weakness or pain. Rarely, people develop a more severe problem called rhabdomyolosis, where the muscle fibers break down and may damage the kidneys. There are a couple of other potential consequences of statin interactions, the AHA says. Statins may, for example, raise blood levels of the clot-preventing drug warfarin, which could increase the risk of internal bleeding. Many of the interactions between statins and other heart drugs are "minor," and simply limiting the statin dose is often enough, Wiggins said. But there are some drug combinations that should be avoided, the heart association warns. Lovastatin (Mevacor), simvastatin (Zocor) and pravastatin (Pravachol) should not be used with the fibrate cholesterol drug gemfibrozil, for example, because of the risk of muscle injury. Dr. Thomas Whayne, a professor of medicine at the University of Kentucky's Gill Heart Institute, agreed. For people who need a fibrate with their statin, he said, the better choice is a medication called fenofibrate. Fenofibrate (Fenoglide, Tricor) boosts statin levels by only a minor amount, according to the AHA. Wiggins and Whayne emphasized the general safety of statins. "These are wonderful medications, and people shouldn't be afraid of them," said Whayne, who wasn't involved with the study. At the same time, he added, everyone needs to be aware of the potential for drug interactions -- and not just when it comes to statins and other heart medications. Tell your doctor about all of the medications and over-the-counter supplements you're taking, Whayne advised. "We all need to realize there can be interactions between supplements and drugs, too," he said. Wiggins made another point: Even when someone has been on a particular drug combination for a while, it's possible to develop "late" problems with interactions. If, for example, a person's kidney function changes over time, that can make an interaction more likely, Wiggins explained. She suggested that people talk to their doctor any time they develop symptoms, like muscle weakness or pain, that could be related to their statin or other medications. "They should also talk to their doctor or pharmacist any time their medications are changed -- even when a drug is removed," Wiggins added. Any of those changes, she said, could potentially affect how medications are metabolized, and the likelihood of side effects.

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Public payer programs to cover new COPD product

Mississauga, ON – GSK has recently announced that Breo Ellipta is now listed on numerous drug plans across the country. Breo Ellipta is a combination of the inhaled corticosteroid (ICS) fluticasone furoate and the long-acting beta2-agonist (LABA) vilanterol, administered by the new Ellipta dry powder inhaler. The formularies now listing Breo Ellipta for coverage include British Columbia, Ontario, New Brunswick, Nova Scotia, Yukon, Saskatchewan, PEI and Manitoba. Breo Ellipta (fluticasone furoate/vilanterol) was been approved for sale in Canada since July 2013. It is used for the long-term once-daily maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease, including chronic bronchitis and/or emphysema, and to reduce exacerbations of COPD in patients with a history of exacerbations. GSK has also announced that Incruse Ellipta is now listed on the RAMQ regular drug list in Quebec.

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COPD World News Week of October 16, 2016

Pulmonary Rehab Improves Outcomes in COPD Independent of Disease Burden

Birmingham, Alabama - According to a recent study published in the American Thoracic Society journal pulmonary rehabilitation results in significant improvement in quality of life, dyspnea and functional capacity independent of baseline disease burden. Rationale Current practice guidelines recommend pulmonary rehabilitation as an adjunct to standard pharmacologic therapy for individuals with moderate to severe chronic obstructive pulmonary disease (COPD). Whether pulmonary rehabilitation benefits all subjects with COPD independent of baseline disease burden is not known. Objective To test whether pulmonary rehabilitation benefits patients with COPD independent of baseline exercise capacity, dyspnea and lung function. Methods Data from a prospectively maintained database of participants with COPD enrolled in pulmonary rehabilitation at the University of Alabama at Birmingham from 1996 to 2013 was retrospectively analyzed. Subjects were divided into 4 quartiles based on baseline level of dyspnea as assessed by the San Diego Shortness of Breath Questionnaire (SOBQ) at the initial visit. Similar quartiles were assessed for FEV1 %predicted as well as the 6-minute walk distance (6MWD). Primary outcome was the change in quality of life as measured by the Short Form 36 Health Survey (SF-36). Secondary outcomes were change in dyspnea, 6MWD and depression scores assessed using the Beck Depression Inventory (BDI)-II. Differences between baseline and final scores were compared using paired t- test, and across quartiles using Analyses of Variance. Measurements and Main Results 229 subjects were included. Mean age was 66.5(SD 9) years. 91(40 %) were female and 42(18%) were African American. Mean FEV1 was 46.3 (20.0) % predicted. On completion of pulmonary rehabilitation, clinically significant improvements were seen in most components of SF-36: physical function 11.5 (95%CI 7.4 to 15.5;p<0.001), health perception 2.1 (95%CI -0.7 to 4.8;p=0.12), physical role 16.7 (95%CI 10.3 to 23.1;p<0.001), emotional role 14.7 (95%CI 7.1 to 22.3;p<0.001), social function 16.4 (95%CI 11.3 to 21.5;p<0.001), mental health 5.4 (95%CI 2.6 to 8.3;p<0.001), pain 5 (95%CI 1 to 9.1;p=0.02), vitality 12.4 (95%CI 8.8 to 16.1;p<0.001) and depression 0.01 (95%CI -0.11 to 0.07;p=0.54). There was no difference in improvement in SF-36 across quartiles of SOBQ, 6MWD and FEV1 %predicted.

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COPD World News Week of October 9, 2016

Over 90% of world exposed to unsafe levels of air pollution 

Geneva, Switzerland - A new World Health Organisation (WHO) air quality model has found that 92% of the world’s population are exposed to levels of ambient air pollution that exceed safe limits, as outlined in the WHO’s most detailed health data related to global outdoor air pollution. The report claims that in 2012 3 million deaths worldwide, including some 479,000 from the European region, are linked to exposure to outdoor air pollution, due to its impact on non-communicable diseases such as chronic obstructive pulmonary disease (COPD), lung cancer and various cardiovascular conditions. The new model carefully calibrated ground and satellite data to improve the reliability of air pollution measurements, and researchers analysed air pollution exposures against population and air pollution levels at a grid resolution of about 10 km x 10 km. WHO have collated the results in an online, interactive map, which provides information on population-weighted exposure to particulate matter of an aerodynamic diameter of less than 2.5 micrometres (PM2.5) for all countries. The map also indicates data on monitoring stations for PM10 and PM2.5 values for about 3000 cities and towns.
Dr Flavia Bustreo, Assistant Director General at WHO, speaking on the new model, says “The new WHO model shows countries where the air pollution danger spots are, and provides a baseline for monitoring progress in combatting it.” "Air pollution continues to take a toll on the health of the most vulnerable populations - women, children and the older adults," adds Dr Bustreo. "For people to be healthy, they must breathe clean air from their first breath to their last." The revelations of this latest WHO report highlight the necessity of movements such as this year’s Healthy Lungs for Life ‘Breathe Clean Air’ campaign, as the true scale of unsafe ambient air pollution levels are exposed and the devastating impact on global public health revealed.

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COPD World News Week of October 2, 2016

Smoking Bans May Keep Young Men From Heavy Smoking

Cleveland, OH - Smoking bans may help reduce smoking among young American men, a new study finds. Researchers examined data from more than 4,300 people in 487 cities nationwide who were interviewed annually between 2004 and 2011 when they were aged 19 to 31. Among young men who were light smokers and lived in areas with smoking bans, their rate of smoking in the past 30 days was 13 percent. It was 19 percent for young men in areas without such bans. Rates were the same (11 percent) for women in areas with and without smoking bans. "These findings provide some of the most robust evidence to date on the impact of smoking bans on young people's smoking," said study co-author Mike Vuolo, an assistant professor of sociology at Ohio State University. The researchers also found that the percentage of people in the study living in a city with a comprehensive smoking ban increased from almost 15 percent in 2004 to nearly 60 percent in 2011. Smoking bans didn't reduce or end smoking for people who smoked more than a pack a day when the bans began. But, bans did seem to prevent light smokers from becoming heavy smokers, the researchers said. "We found that locations that have had a smoking ban for longer periods of time have fewer youth, regardless of gender, who are heavy smokers than other areas," Vuolo said in a university news release. The findings were published in the September issue of the Journal of Health and Social Behavior.

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COPD World News Week of September 25, 2016

Opioid drug use among older adults with COPD studied 

Ottawa, ON – Researchers here evaluated risk of adverse respiratory outcomes associated with incident opioid use among older adults with chronic obstructive pulmonary diseases (COPD). This was a retrospective population-based cohort study using a validated algorithm applied to health administrative data to identify adults aged 66 years and older with COPD. Inverse probability of treatment weighting using the propensity score was used to estimate hazard ratios comparing adverse respiratory outcomes within 30 days of incident opioid use compared to controls. Incident opioid use was associated with significantly increased emergency room visits for COPD or pneumonia (HR 1.14, 95% CI 1.00–1.29; p=0.04), COPD or pneumonia-related mortality (HR 2.16, 95% CI 1.61–2.88; p<0.0001) and all-cause mortality (HR 1.76, 95% CI 1.57–1.98; p<0.0001), but significantly decreased outpatient exacerbations (HR 0.88, 95% CI 0.83–0.94; p=0.0002). Use of more potent opioid-only agents was associated with significantly increased outpatient exacerbations, emergency room visits and hospitalisations for COPD or pneumonia, and COPD or pneumonia-related and all-cause mortality. Incident opioid use, and in particular use of the generally more potent opioid-only agents, was associated with increased risk for adverse respiratory outcomes, including respiratory-related mortality, among older adults with COPD. Potential adverse respiratory outcomes should be considered when prescribing new opioids in this population.

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COPD World News Week of September 18, 2016

'Good' cholesterol not so good for COPD 

London, UK - Higher levels of high-density lipoprotein (HDL) cholesterol were associated with greater declines in lung function over time in an analysis of six, pooled population-based cohort studies presented here. Among more than 32,000 adults followed for up to 25 years, higher baseline protein HCV cholesterol showed a direct association with more rapid lung function declines, according to researcher Elizabeth Oelsner, of Columbia University, New York City, and colleagues. Over seven years median follow-up, compared to participants in the lowest HDL cholesterol quartile at baseline, those in the higher HDL cholesterol quartile showed a 9 mL greater decline in FEV1(P<0.0001). This effect size is similar to a 10-year increment in pack-years smoking, the researchers noted. Oelsner presented the study findings Sept. 5 at the European Respiratory Society International Congress 2016. "Our findings are preliminary, but we think they are very interesting with respect to the emerging understanding of the lipid biology of the lung," Oelsner said. "We also believe that it is interesting to consider the possible target effects of HDL raising therapies that are aiming to reduce cardiovascular disease." Oelsner noted that while COPD is a leading cause of death and chronic illness, smoking remains one of the few modifiable risk factors for the disease. "The biology remains poorly understood," she said. "There has been some very exciting work linking (the lipid molecule) ceramide biology with COPD risk and, more specifically, emphysema." Earlier research by Oelsner and colleagues showed that a gene that regulates HDL metabolism, which impacts lipid biology, may play a role in emphysema. Higher HDL levels were associated with lower FEV1/FVC ratio and greater percent emphysema in study, published in 2014, leading the researchers to conclude that the apolipoprotein M/HDL pathway may play a novel role in the pathogenesis of COPD and emphysema. Their latest study expands on this research by examining the hypothesis that higher HDL cholesterol would be associated with greater lung function declines over time in a large, general population-based sample of adults. The researchers examined data from the National Heart, Lung and Blood Institute's Pooled Cohorts Study, which included six large studies that had data on both HDL cholesterol levels and spirometry readings. Pre-bronchodilator spirometry was measured repeatedly following ATS/ERS guidelines. Among the six different cohorts, participants had, on average, between two and five measures of spirometry over an interval of between four and 24 years. The researchers included only spirometry readings that were reproducible on two or more acceptable curves within 200 mL. HDL cholesterol was measured using enzymatic methods and mixed models, with cohort-specific covariance structure adjusted for baseline age, sex, race/ethnicity, smoking pack-years, hypertension, LDL and total cholesterol, cohort, and time-varying height, weight, and smoking status. The researchers developed several mixed models to assess the cross-sectional associations between baseline HDL cholesterol and baseline lung function, and the longitudinal association between baseline HDL and 10-year decline in lung function. Among 32,350 adults with longitudinal spirometry measures (mean age 49±19 years, 45% never smokers, 25% obese, 14% with airflow limitation, median 2 measures), the mean HDL cholesterol was 1.4±0.4 mmol L. The mean rate of FEV1 decline was 29.2±0.1 mL/year. In adjusted models, higher HDL cholesterol was associated with a greater rate of decline in FEV1 (P<0.0001) and FEV1/FVC (P<0.0001). In stratified analyses, findings were similar in men and women, in never smokers, in non-obese study participants, and in those without airflow limitations. The results were consistent when the FEV1/FVC ratio was considered. Oelsner said that it is too soon to draw clinical or pharmaceutical conclusions from the preliminary data, and she noted that the magnitude of the effect was relatively small. "From a biological standpoint it is quite interesting to consider whether lipids are important in respiratory health, and, specifically, COPD and airflow limitation," she said. "But any other interpretation is unwarranted at this point."

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COPD World News Week of September 11, 2016

US COPD-related deaths down in men, less so in women 

Hyattsville, Maryland - The death rate associated with chronic obstructive pulmonary disease (COPD) declined by more than 20% among men in a little over a decade, while deaths have remained relatively stable among women, according to newly released statistics from the CDC. From 2000 through 2014, age-adjusted COPD-related deaths decreased by 22.5% in men, versus just 3.8% among women. These decreases were mainly in the 65-84 age group. Still, the death rate remained higher for men than women, although this gender gap has decreased, the report noted. Increases in COPD-related deaths were seen among men and women in their 4os, 50s, and early 60s, and in women who were age 85 and older. The mortality analysis, derived from National Vital Statistics System data, appears in the latest National Center for Health Statistics (NCHS) Data Brief, published online Sept. 8. All death records with COPD reported on the death certificate (any mention of COPD) either as an underlying or contributing cause were considered to be a COPD-related death. Fifteen million Americans have a diagnosis of COPD and many millions more with low pulmonary function have the disease and don't know it, according to the CDC. COPD is the third leading cause of death in the United States. Among white women, the modest decline in COPD-related deaths reported in the latest NCHS analysis represents a reversal of an upward trend in COPD mortality seen in earlier mortality analyses. Deaths related to COPD continued to rise among black women, but not black men. The top three underlying causes of COPD-related deaths were COPD, heart disease, and cancer. Other findings from the analysis of data from 2000 to 2014 included: Among men age 25 and older, the age-adjusted COPD-related death rate declined from 183 per 100,000 population in 2000 to 142 per 100,000 in 2014; in women it declined from close to 105 to 101 during the period. The COPD-related death rate decreased by 29.7% among men age 65-84 and 22.5% among older men, and it increased by 12.8% among men age 45-64 The death rate decreased by 16% among women age 65-84, but increased 24.4% among women age 45-64 Overall, the age-adjusted death rate for black ad lts declined by 11.5%, from around 99 deaths per 100,000 in 2000 to 87.4 deaths in 2014 Among black men, the age-adjusted death rate declined by 24.3% during the period; for black women the rate increased by 4.2%, from 64.1 in 2000 to 66.8 in 2014 Around 50% of COPD-related deaths had COPD as the underlying cause of death for both men and women. Close to one in five (19.4%) deaths listed heart disease as the underlying cause, while 15.3% listed cancer as the cause. The declining COPD mortality among men is consistent with previous reports based on underlying cause of death.

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COPD World News Week of September 4, 2016

When respiratory symptoms are not COPD

San Francisco, CA - About half of current and former heavy smokers who did not meet the criteria for chronic obstructive pulmonary disease (COPD) had respiratory symptoms similar to those seen in patients with mild-to-moderate COPD, researchers reported. Symptoms including respiratory exacerbations, activity limitations, and evidence of airway disease were present in 50% of study participants with a smoking history of more than 20 pack-years who had normal spirometry findings indicative of preserved pulmonary function, according to Prescott Woodruff, MD, of the University of California San Francisco, and colleagues. The finding suggests that the use of spirometry to diagnose COPD may not "adequately cover the breadth of symptomatic smoking-related lung disease," they wrote in the New England Journal of Medicine. The Sub-populations and Intermediate Outcome Measures in COPD Study (SPIROMICS) is one of two recent major trials to show evidence of respiratory disease in smokers and former smokers with preserved pulmonary function. In a study published last fall, researchers concluded that the effect of smoking on the lungs is underestimated by spirometry alone. "From a narrative standpoint, these studies are significant because, to some degree, they dispel the myth of the healthy smoker," said Woodruff. "COPD affects 15% to 20% of smokers by the usual definition, so this expands the group of smokers in whom there is some chronic lung disease. It suggests the problem is bigger than we have thought." The observational study included 2,736 heavy smokers (>20 pack-years) or controls (≤1 pack-year) between the ages of 40 and 80 whose respiratory symptoms were measured using the COPD Assessment Test (CAT). The researchers examined whether current or former smokers who had preserved pulmonary function and had symptoms associated with COPD (CAT score ≥10) had a higher risk of respiratory exacerbations than current or former smokers with preserved pulmonary function who were asymptomatic (CAT score <10). According to the results, the mean rate of respiratory exacerbations among symptomatic current or former smokers was significantly higher than rates among asymptomatic current or former smokers, and among controls who never smoked. Also, independent of asthma history, symptomatic current or former smokers also had greater limitation of activity, slightly lower FEV1, FVC, and inspiratory capacity, and greater airway-wall thickening. Among symptomatic current or former smokers, 42% used bronchodilators and 23% used inhaled glucocorticoids. The study had some limitations, namely that the authors did not enroll a random sample so could not estimate the population prevalence of symptoms. Woodruff noted that while many symptomatic smokers and former smokers without COPD are being treated with bronchodilators, it is not clear if this therapy is beneficial in this population. "If these patients don't have obstruction on spirometry, why would they benefit from treatment with bronchodilators, which relieve obstruction?" he asked. "The answer could be that they do benefit, and we are just not good at measuring their obstruction. Or it could be that they don't benefit because there is no obstruction.

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COPD World News Week of August 28, 2016

MRE identifies fibrosis in patients with alpha-1 antitrypsin deficiency

San Diego, CA - Magnetic resonance elastography appeared to accurately identify fibrosis in patients with homozygous Z genotype alpha-1 antitrypsin deficiency, according to a pilot prospective study published in Alimentary Pharmacology & Therapeutics. “Our data show serum biomarkers most commonly elevated in individuals with other forms of metabolic liver disease are not elevated in individuals with alpha-1 antitrypsin deficiency liver disease,” Rohit G. Loomba, MD,professor in the department of medicine at the University of California at San Diego (UCSD) School of Medicine, and colleagues wrote. “We believe that magnetic resonance elastography may be an accurate, noninvasive method for diagnosis of liver fibrosis in patients with ZZ genotype alpha-1 antitrypsin.” Currently, clinicians do not look for liver disease in patients with alpha-1 antitrypsin (AAT) deficiency until it is very late, Loomba told In a pilot prospective study inspired by David A. Brenner, MD, dean of UCSD School of Medicine, Loomba and colleagues performed a study of 33 adults who underwent liver biopsy, clinical research evaluation and MRE. The researchers separated those who underwent liver biopsy into AAT, NAFLD and control groups. The researchers quantified liver stiffness with MRE and histological fibrosis with the Ishak 6-point scale. Afterward, they used receiver operating characteristic (ROC) analysis to assess MRE diagnostic performance. After adjusting for stage of fibrosis, they found that serum alanine aminotransferase levels were similar between the control and AAT groups, but significantly lower in AAT compared with NAFLD (P = .0172). MRE-estimated stiffness in fibrosis detection had an area under the ROC curve of 0.9 (P < .0001). Further, an MRE threshold of at least 3 kPa provided 88.9% accuracy with 80% sensitivity and 100% specificity to detect the presence of fibrosis at any stage. These results suggest that MRE  may be accurate for identifying fibrosis in patients with AAT deficiency, the researchers concluded. “Clinicians with expertise in select places may apply this in their clinical practice as it is a rare disease but larger data from a multicenter setting would be needed for more widespread utilization and recommendations,” Loomba said.

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COPD World News Week of August 21, 2016

Study Finds Quitting Smoking May Widen Social Network 

Madison, Wisconsin - Some smokers fear that quitting will result in losing friends, but the opposite seems to be true, according to a new study. Smokers may worry that trying to quit will alienate them from other smokers, said co-author Megan E. Piper of the Center for Tobacco Research and Intervention at the University of Wisconsin-Madison. But in practice, people who quit actually gain non-smoking friends, she told Reuters Health by phone. "That's definitely a concern that smokers will tell us; they are worried that their friends won't want to hang out with them," Piper said. "Our data suggest they will have fewer smokers in their network but they don't end up with fewer friends." Smoking is less common now than it's been for many years, so if you're in the market for friends, the nonsmoking community is much bigger, she noted. "This is the first time we've looked at what happens to the social networks of people who do and don't quit," she said. Piper and her coauthors analyzed the social networks of 691 smokers enrolled in a smoking-cessation trial, including number of friends, new members, smoking habits, and romantic partner smoking. Over a three-year period, participants were tested for chemical by-products of smoking to assess whether they had successfully quit, and the researchers matched these results to changes in social networks over time. Participants filled out surveys, first about the 14 most important members of their social networks, and later about the nine most important members. The researchers classified social networks in several ways: large with many smoking buddies, large with few smoking buddies, small network of friends with a smoking romantic partner, and small network of friends with smoking friends. People who had quit by year one and two had also experienced social shifts, usually to less contact with smokers and to larger social networks overall, as reported in Nicotine and Tobacco Research. "Perhaps you haven't gone and joined a group or team or done an activity because you've been worried about not being accepted because you're a smoker," but when you quit those activities are more attractive, Piper said. And smoking may be the activity around which a friendship is built, but when you quit you learn that you have little else in common, she said. "As doctors listen to smokers and hear what their concerns are, this would be an opportunity if someone expresses a concern about losing friends," she said. "You may not be friends with all the same people if you quit smoking but you will have friends."

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COPD World News Week of August 14, 2016

COPD Patients Undergo Brain Changes in Fear Zones

Leuven, Belgium - Chronic obstructive pulmonary disease (COPD) patients may undergo structural changes to their brains, including the areas that cause breathlessness, fear, and sensitivity to pain, according to findings published in CHEST. Researchers from the University of Leuven in Belgium investigated structural brain changes in COPD patients in order to examine the patients’ suffering from chronic dyspnea, disease-specific fears and avoidance of physical activity. The researchers used MRIs to measure differences in brain region degeneration and regional gray matter among 30 patients with moderate to severe COPD. The patients were matched with 20 matched healthy control subjects based on sex, height, weight, and body mass index. There were differences, though: the COPD group showed lower lung function in FEV 1 percent predicted, FVC percent predicted and FEV 1/ FVC. The COPD group contained more smokers compared to the population of the control group. All of the participants had normal ranges for anxiety and depression. Patients in the COPD group showed greater levels of fear of dyspnea and fear of physical activity. All of the patients also filled out COPD anxiety questionnaires. COPD patients showed no generalized cortical degeneration, the researchers reported; however, there was decreased gray matter in some brain regions, including the in posterior cingulate cortex, anterior and midcingulate cortex, hippocampus and amygdala. The researchers also noted that the levels of patients’ brain degeneration were linked to the length of their COPD disease duration. Individuals with more degeneration demonstrated a greater fear of breathlessness and fear of physical activity – which, in turn, the researchers added, can impact the progression of the disease. Some of the limitations of the study included the use of the questionnaire, which, while useful, do not fully assess patients’ changes. The researchers suggest that longitudinal study designs should include measures of physical activity, like activity monitors, in order to track changes in relation to activity avoidance in COPD. “Targeting disease specific fears in patients with COPD might not only improve outcomes of clinical interventions such as pulmonary rehabilitation, but also reverse structural brain changes in these patients,” the study authors concluded.

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COPD World News Week of August 7, 2016

Drug makers race for smart devices 

London, UK - Makers of inhalers to treat asthma and chronic lung disease are racing to develop a new generation of smart devices with sensors to monitor if patients are using their puffers properly. Linked wirelessly to the cloud, the gadgets are part of a medical "Internet of Things" that promises improved adherence, or correct use of the medication, and better health outcomes. They may also hold the key to company profits in an era of increasingly tough competition. Drug makers believe giving patients and doctors the ability to check inhaler use in this way could be a big help in proving the value of their medicines to governments and insurers, though they need to tread carefully on data privacy. GlaxoSmithKline, AstraZeneca and Novartis are all chasing the opportunity via deals with device firms including U.S.-based Propeller Health and Australian-listed Adherium, as well as technology players like Qualcomm. Over the past half century, inhalers have revolutionized care by delivering medicines direct into the lungs and avoiding the serious side effects seen with older oral drugs. But getting patients to take their medication correctly is a challenge. "Technique is critical. You might have the world's best blockbuster drug in an inhaler, but if patients don't use it properly they won't get the benefits," said Omar Usmani, a consultant physician at Imperial College London. With asthma and chronic obstructive pulmonary disease (COPD) affecting about 500 million people worldwide, the opportunity is large, and reducing serious attacks by improving adherence could save $19 billion a year in U.S. healthcare costs alone, Goldman Sachs analysts estimated in a report last year. Usmani envisages a future of high-tech inhalers that not only record doses but also use gyroscopic and acoustic sensors to check medicine flow, while monitoring the environment for allergens such as pollen. All that data can be fed to remote computer servers known as the cloud. It is an idea big drug companies have embraced enthusiastically, in the knowledge that they need to find new ways to sell their products as cheap generics undercut long-established brands. The first generic copies of GSK's Advair, the world's biggest inhaler with worldwide sales of nearly $6 billion in 2015, are expected to reach the U.S. market next year. "It's a race to the starting line," Propeller CEO David Van Sickle told Reuters, describing the current jockeying among leading pharmaceutical firms. "Today, there is really no major respiratory pharma company that doesn't have a program to add connectivity to their inhaled medicines."

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COPD World News Week of July 31, 2016

Smokers Show COPD Symptoms Despite Being Undiagnosed

Ann Arbor, MI - According to a new study, smokers commonly demonstrate symptoms of COPD even though they are not diagnosed with the condition. A research team from the University of Michigan Health System observed more than 2,700 current or former smokers in order to evaluate their respiratory symptoms with the COPD Assessment Test. The researchers note that a number of smokers do not meet the definition of COPD but still have respiratory problems. A report from HCP Live indicates that the patients underwent FEV 1 examination to test whether current or former smokers with preserved pulmonary function were asymptomatic or displayed COPD symptoms, as well as to what degree. The patients were tested on their 6-minute walk distance, lung function, and a high-resolution computer tomographic scan of the chest. The results of the study revealed that half of the current or former smokers displayed respiratory symptoms and the rate of the respiratory exacerbations among the current or former smokers was notably higher than in the asymptomatic current or former smokers, in addition to the control group of non-smokers in the study. “Clinically, this is an important group of patients that we as physicians currently have no guidance on how to treat,” explains lead author of the study Meilan Han, MD. “A significant percentage of these symptomatic smokers with ‘normal’ breathing tests had been given respiratory medications by their doctors to treat their symptoms, but this is a group of individuals that has never really been studied with those medications in clinical trials. Therefore, physicians really have no evidence base to guide decision making.” In addition, regardless of their history of asthma, current or former smokers with respiratory symptoms had greater limitation of activity, lower FEV 1, FVC, inspiratory capacity and greater airway wall thickening without emphysema than the asymptomatic current or former smokers, according to HCP Live. Meilan says, “I think we do need a name for this condition so we can define these patients and develop treatments. However, it’s still unclear whether these patients have ‘early’ COPD, in that they will ultimately progress to airflow obstruction that we can detect on a breathing test. More information is still needed.” Meilan adds, “This study is just the first step in trying to better identify these patients so we can develop targeted treatments. 

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COPD World News Week of July 24, 2016

FDA Bolsters Warnings About Class of Antibiotics

Silver Spring, Maryland - The U.S. Food and Drug Administration announced Tuesday that it's strengthening label warnings on a class of antibiotics called fluoroquinolones because the drugs can lead to disabling side effects, including long-term nerve damage and ruptured tendons. The agency also cautioned that these bacteria-fighting drugs -- including levofloxacin (Levaquin) and ciprofloxacin (Cipro) -- shouldn't be prescribed for sinusitis, chronic bronchitis or simple urinary tract infections unless no other treatments options exist. "Fluoroquinolones have risks and benefits that should be considered very carefully," Dr. Edward Cox said in an FDA news release. He's director of the Office of Antimicrobial Products at the FDA's Center for Drug Evaluation and Research. "It's important that both health care providers and patients are aware of both the risks and benefits of fluoroquinolones and make an informed decision about their use," Cox said. A safety review revealed that potentially permanent side effects involving tendons, muscles, joints, nerves and the central nervous system can occur hours or weeks after exposure to fluoroquinolone pills or injections. Also, two or more serious side effects can occur together, the FDA said. Because of this, the FDA recommends reserving these antibiotics for serious bacterial infections, such as anthrax, plague and bacterial pneumonia. In these cases, "the benefits of fluoroquinolones outweigh the risks and it is appropriate for them to remain available as a therapeutic option," the agency said. Besides Cipro and Levaquin, other fluoroquinolones include moxifloxacin (Avelox), ofloxacin (Floxin) and gemifloxacin (Factive). The new labeling action will include an updated boxed warning and revisions to the Warnings and Precautions section of the label. Also, a medication guide that patients receive describes the safety issues tied to these drugs, the agency said. The FDA has reported concerns about fluoroquinolones since 2008. At that time, it added a boxed warning because of increased risk of tendinitis and tendon rupture. Almost three years later, the FDA warned that the drugs could worsen symptoms of the neuromuscular disease myasthenia gravis. The potential for serious nerve damage (irreversible peripheral neuropathy) was detailed in 2013. Finally, last year an FDA advisory committee said uncomplicated sinus, urinary and bronchial infections should be treated with other options.  

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COPD World News Week of July 17, 2016

Palliative Care Underused in End-Stage COPD 

Vancouver, BC - Only a very small minority of patients with end-stage chronic obstructive pulmonary disease (COPD) were referred for palliative care even though these patients have a short life expectancy and a large symptom burden, according to Canadian researchers. While the utilization of palliative care services increased 4.5-fold from 2006 to 2012 among hospitalized COPD patients on home oxygen included in the study, the overall rate of referral was still just 1.7% during this time, reported Barret Rush, MD, of the University of British Columbia in Vancouver, and colleagues. The rates were even lower among blacks and Hispanics, patients living in poverty, and those living in rural areas, they wrote in CHEST. Even though palliative care is endorsed for COPD patients with end-stage disease by the majority of respiratory societies, the uptake of this service has lagged far behind that seen in patients with metastatic cancer, the authors noted. "Like patients with end-stage cancers, this is a population with huge symptom burden and a short life expectancy," said Rush. "The opportunity to improve quality of life in these patients is enormous, but palliative care is an under recognized and underutilized therapy in patients with COPD." Rush noted that patients admitted to hospitals with a COPD exacerbation have a median survival of about 2 years, and half of these patients will be readmitted within 6 months. End-stage patients on home oxygen therapy that required mechanical ventilation during hospitalization for an exacerbation were found to have a 1-year mortality of 45% in one recent study. The current nationwide analysis included patients with COPD on home oxygen therapy who were admitted to hospitals for COPD exacerbations from 2006 to 2012. The researchers analyzed data from the Nationwide Inpatient Sample (NIS). During this time frame, there were more than 55 million hospitalizations for COPD recorded in the database, with 181,689 patients on home oxygen admitted to hospitals. Just 3,145 of these patients (1.7%) had a palliative care contact. From 2006 to 2012, there was a more than four-fold increase in referrals, with palliative care referral uptake greatest among patients who had metastatic cancer, non-metastatic cancer, invasive mechanical ventilation, non-invasive mechanical ventilation, and do not resuscitate (DNR) status. Of the 4,234 patients who underwent invasive and non-invasive mechanical ventilation, 344 (8%) and 655 (5%), respectively, received a palliative care consult. Patients treated at urban teaching hospitals were more than twice as likely to be referred for palliative care as those treated at rural hospitals. Rush noted that the increase in palliative care consultation in these larger hospitals probably explains the increase in access to these services among patients with end-stage COPD. He also noted that while the use of hospital discharge data in this study may limit the generalizability of the findings, it is clear that palliative care uptake in COPD is very low nationwide. "I do expect that the use of palliative care will increase for patients with diseases like COPD and heart failure as awareness grows," he said.

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COPD World News Week of July 10, 2016

Cancer patients keep smoking despite risks 

Toronto, ON - Not even cancer can be enough to scare smokers off cigarettes, suggests new Canadian research that shows a significant proportion keep smoking after being handed a cancer diagnosis. Researchers found “minimal differences” in smoking behaviours between those with cancer and those without. One in five Canadians who answered yes in a national health survey when asked, “Do you have cancer,” also reported smoking daily or occasionally, virtually the same as the rest of the population. The finding, experts say, speaks to the grip of nicotine addiction as well as a serious under-appreciation of the hazards of continued smoking. Some believe the damage has already been done — why bother stopping now? In fact, evidence shows smoking blunts the effects of chemotherapy and radiation, meaning lower survival; it worsens the side effects of treatment and increases the likelihood of a second cancer. “And that’s true whether or not it’s a smoking-related cancer in the first place, or even if it’s not a cancer with a strong relationship to smoking,” said Dr. David Mowat, senior scientific lead for population health at the Canadian Partnership Against Cancer and the study’s senior author. “We’re not laying blame on anybody,” Mowat said, adding people who have never smoked have difficulty fathoming the pull of addiction. “I think most of us who are non-smokers, we have our own view of the world. We think, ‘oh, sure, if I was given a diagnosis of cancer, I’d quit on the spot.’ “This is an addiction, and it’s very, very difficult to quit.” The new study, published in the latest edition of the journal Current Oncology, is based on four years of self-reported data (2011 to 2014) from the Canadian Community Health Survey. The researchers identified 338,450 cancer patients and 22.5 million people without cancer. Of the two per cent identified as “current cancer patients”, 20.1 per cent reported smoking, compared to 19.3 per cent in the non-cancer population. The findings show “that a considerable proportion of smokers did not quit when faced with a cancer diagnosis in Canada,” the researchers write. The survey was a snapshot in time, meaning it’s impossible to know from the data how many had in fact quit after being told they had cancer, how many were trying to quit or how many had quit but relapsed. Other studies have found up to half to two thirds of people quit smoking after being diagnosed with certain cancers. Depression, lack of access to smoking cessation programs and, paradoxically, the stress of dealing with cancer, are reasons why people might keep smoking, the authors said. As well, while lung cancer patients are more likely to directly link their tumors with smoking — and quit — people with breast, bladder, anal or other cancers might not see the connection, and thus be less motivated. Historically, doctors themselves have been reluctant to broach the subject, Mowat said. “If you go far back many decades ago, certainly when I was in medical school, the approach was, they have cancer, you don’t want to bother them right now, it’s too late, there’s nothing that can be done and (smoking) is a little comfort they have.” Even today, “some doctors might say, ‘well, I don’t do prevention,” Mowat said. “This is not about prevention — stopping smoking is part of the treatment and it will improve the outcomes.” Many provincial cancer organizations are now working to imbed smoking cessation programs into their programs, he added.

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COPD World News Week of July 3, 2016

Universal patient language launched by BMS

Princeton, NJ - Bristol-Myers Squibb announced its commitment to moving toward a new way of communicating with patients and caregivers: the Universal Patient Language (UPL). The UPL addresses widely voiced concerns among consumers and health care advocates that communications about medicines are not designed for an optimal patient experience. The UPL is rooted in core principles and tools that guide Bristol-Myers Squibb in creating communications that are designed to enable patient and caregiver learning. These principles and tools were created over two years in collaboration with patients, caregivers and health care and communication experts during interactive co-creation sessions. A range of patient advocacy organizations also validated the UPL. The result is communications that are visualized and formatted to help patients and caregivers quickly find the most important or relevant information and improve comprehension and understanding. One area where Bristol-Myers Squibb is using the UPL is to educate patients about immunotherapy, a new approach to fighting various cancers that works with the patient’s immune system. While there is a lot of interest around immunotherapy, the science of immunotherapy is very complex. The UPL uses straightforward language, illustrations and analogies to explain the basics of immunotherapy in a way that is easier for most people to understand. “As the global leader in immuno-oncology, we knew it was important for us to lead the changes to help patients better understand the treatments their physicians prescribe and the science behind their treatments,” said Emmanuel Blin, Head of Commercialization, Policy & Operations, Bristol-Myers Squibb. “The UPL helps build trust and improve the patient experience.” Patients, health care providers and advocacy groups have enthusiastically embraced the UPL in therapeutic areas such as Oncology, Immunoscience and Virology. Currently, the UPL is being applied to the company’s communications for its cancer treatments and rheumatoid arthritis treatment, among others, in order to optimize these materials for patient understanding. For all of these applications, patients and advocacy organizations collaborated with Bristol-Myers Squibb to co-create new ways to communicate complex information using UPL. “Our ambition is to leverage the UPL for patient communications across the organization by co-creating with patients and other stakeholders,” said Elizabeth Turcotte, Director of the Patient Hub andUPL Lead, Bristol-Myers Squibb. Collaborators who have participated in co-creation sessions value how the UPL meaningfully brings patient perspectives to communications. "What's so gratifying is how participatory the patients and the caregivers were, how much their voice came to the forefront, how willing they were to share their experiences," said Patricia Goldsmith, Chief Executive Officer, CancerCare. "Thank you to Bristol-Myers Squibb for doing the right thing and putting the patients at the table. Keep it up." Demonstrating its commitment to putting the patient first, Bristol-Myers Squibb also announced the launch of to make the Universal Patient Language’s principles, tools and case studies widely available for use by hospitals, medical schools, health care networks, health advocacy groups, academics, journalists, pharmaceutical companies, and others who communicate with patients. “The UPL already has a vibrant network of users across Bristol-Myers Squibb,” said Nancy Phelan, Head of Worldwide Customer Operations, Bristol-Myers Squibb. “By making the UPL widely available via, we hope to see others adopt and contribute to the UPL.” 

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