COPD World News Week of June 29, 2014

Text Messages May Double Smoker's Odds of Quitting

Washington, DC - Text messages providing tips, reminders and advice can help smokers quit, according to a new study. Researchers found that this type of cellphone program doubles the chances that a smoker will kick the habit. "Text messages seem to give smokers the constant reminders they need to stay focused on quitting," said the study's lead author, Lorien Abroms. She is an associate professor of prevention and community health at George Washington University's Milken Institute School of Public Health, in Washington D.C. "However, additional studies must be done to confirm this result and to look at how these programs work when coupled with other established anti-smoking therapies," she said in a university news release. Traditional methods to help people stop smoking include phone counseling and nicotine replacement therapies. The study's authors pointed out that research suggests text messaging on cellphones could also be effective. These programs, such as Text2Quit and SmokefreeTXT, work by sending advice, reminders and tips to smokers' cellphones. These texts are intended to help people manage their cigarette cravings and stick to a set quit date. More than 75,000 people in the United States have enrolled in these programs through quit lines, note the researchers. The study, involved 503 smokers who were recruited from the Internet. Smokers were randomly assigned to participate in a text-messaging program or receive self-help material designed to help smokers quit. Smokers involved in the texting program were able to respond to their texts and ask for additional help or pick a new quit date. Those who faced a strong urge to smoke could send a text to receive a tip or a game that could help them overcome their craving for a cigarette. After six months, the researchers found those using the text-messaging program were much more likely to quit than the group that received self-help material. The study showed that 11 percent of smokers using the text-messaging program quit and were still not smoking when the study ended. In contrast, only 5 percent of those who did not use the text-messaging program did the same. The researchers took saliva samples from the smokers who said they quit to confirm they actually stopped smoking. After screening the samples for traces of a nicotine by-product, they found the quit rates for people with confirmed abstinence after six months was still twice as high as the other smoking group. Although text-messaging programs show promise as a tool to help people quit smoking, the study's authors pointed out their research involved people who were already motivated to quit and were looking for help. More studies are needed, they added, to see how these programs work for people who are less motivated and not as technologically advanced.

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COPD World News Week of June 22, 2014

Metal coils used in new emphysema treatment

Montreal, PQ - Doctors in Canada, the United States and Europe are experimenting with a new treatment that involves inserting Slinky-like metal coils into damaged portions of the lungs to restore their lost elasticity, allowing patients to breathe normally. “What the coil does, actually, is it acts like a spring,” said Dr. Antoine Delage, of the Institut Universitaire De Cardiologie Et De Pneumologie in Quebec. “It recoils the lung back to a smaller size, so it’s easier for these patients to breathe.” Emphysema develops when the lungs become damaged, usually from a lifetime of smoking. As the damage builds up, the lungs lose their elasticity and have greater difficulty expanding and contracting. The chronic disease worsens over time, making it even more difficult for sufferers to breathe. Emphysema is sometimes treated by simply cutting out the stiff, diseased lung tissue. Taking medication or specialized exercise programs can also help slow the disease. But this coil treatment is something new that doctors can soon offer patients, Delage says. “It is … exciting to see there are new developments in  a disease where there have been very few in the past few years,” he said. To insert the coils, doctors place a narrow tube inside a patient’s nose or mouth before threading the tiny coil into the airway of the lung. The coil then attaches to the diseased tissue and pulls it tight, compressing the unhealthy portion of the lung. This gives healthier lung tissue room to expand; several coils can be inserted to improve overall lung capacity. Art Grenier, one of the patients who has undergone the treatment, says he has felt a dramatic improvement in his breathing. Grenier started smoking at the age of 9 and has been suffering from emphysema for years. “I would have to stop every three or four words and catch my breath,” he says. “It was very difficult to do anything strenuous.” That all changed after the procedure. “My stomach was more relaxed, I didn’t have any pain in my abdomen, my diaphragm wasn’t compressed,” he says. “I can inhale deeply. I didn’t have problems anymore. It was amazing.” Early studies suggest that patients who’ve undergone the treatment report improved lung function and exercisability. However, more research is needed to determine which patients are best-suited for the treatment. Doctors say they are looking to test the treatment on 300 patients, screening for possible side effects like infection and pneumonia. Final results are expected early next year. While other treatments exist for emphysema  -- also known as COPD, or chronic obstructive pulmonary disease -- the condition has no cure.

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COPD World News Week of June 15, 2014

Ontario Métis have higher prevalence of asthma and COPD than general population

Toronto, ON - Aboriginal populations in Canada are at increased risk of asthma and chronic obstructive pulmonary disease (COPD) according to a study that looked at the risk of these diseases in Canada’s Métis population, who have mixed Aboriginal and European ancestry. The study linked the Métis Nation of Ontario Citizenship Registry with health administrative databases to compare the burden of asthma and COPD between Métis and non-Métis populations in Ontario from 2009 to 2012. Their key findings were that the prevalence of asthma and COPD were 30% and 70% higher, respectively, in the Métis compared to the general population. General physician and specialist ambulatory care visits were significantly lower in Métis with asthma; specialist visits for COPD were also lower. Emergency department visits and hospitalizations were generally higher for Métis with either disease. All-cause mortality in Métis with COPD was 1.3 times higher compared to non-Métis with COPD. These findings suggest deficiencies in primary care access for these diseases for the Métis, which may in turn make this population more reliant on emergency services. The researchers concluded that future research should focus on identifying specific factors that contribute to higher rates of asthma and COPD among the Métis with a goal to determine strategies to minimize the disease burden for this at-risk population.

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Smoking, Drinking Combo Raises Odds for Esophageal Cancer

New York, NY - People who smoke and drink are nearly twice as likely to develop esophageal cancer as those with only one of those unhealthy habits, a new study indicates. Previous research has shown that smoking and drinking are risk factors for esophageal cancer, but this is the first study to show the risk associated with smoking and drinking combined, the investigators said. The finding, which was based on an analysis of numerous databases, is published in The American Journal of Gastroenterology. "Our study suggests that not only do alcohol and tobacco play an important role in the development of esophageal cancer, the combination of their use markedly increases their potency as carcinogens," study author Dr. Anoop Prabhu, of the Icahn School of Medicine at Mount Sinai in New York City, said in a journal news release. "As a result, we as physicians should focus efforts directed at controlling the burden of esophageal cancer on those who consume both of these substances," Prabhu added. This year, about 18,000 Americans will be diagnosed with esophageal cancer and more than 15,000 will die from the disease, according to the U.S. National Cancer Institute.

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COPD World News Week of June 8, 2014

COPD Patients Face Greater Risk of Heart Failure

San Diego, CA - People with chronic obstructive pulmonary disease (COPD) have a significantly increased risk of developing heart failure and the risk is highest among black patients, according to a new study. Researchers analyzed more than 386 million hospital patient discharge records in the United States from 2001 through 2010, including more than 33 million COPD patients aged 40 and older. Nearly 29 percent of COPD patients had heart failure, compared with 13 percent of patients without COPD. The researchers then analyzed the data by race and found that about 35 percent of blacks with COPD had heart failure, compared with about 15 percent of blacks without COPD. Among whites, nearly 29 percent of those with COPD and nearly 13 percent of those without COPD had heart failure. Among people of other races, the rates were about 25 percent and 11 percent, respectively, the investigators found. In cases where race was not reported, the rates were about 28 percent and 13 percent, respectively. Among patients aged 40 to 59, heart failure occurred in 18 percent of those with COPD and about 5 percent of those without COPD. The rates among those aged 60 to 79 were about 27 percent and 14 percent, respectively. Among those aged 80 and older, the rates were about 39 percent and 24 percent, respectively, the study authors noted. The study also revealed that patients with both COPD and heart failure had longer hospital stays, higher in-hospital death rates and were more likely to be discharged to long-term care facilities than those with COPD alone. The study was presented at the American Thoracic Society's annual meeting. Research presented at meetings should be viewed as preliminary until published in a peer-reviewed medical journal. "The co-existence of COPD and heart failure, which share common symptoms, may pose diagnostic and therapeutic challenges," study corresponding author Dr. Marilyn Foreman, from the Morehouse School of Medicine in Atlanta, said in a society news release. "The long-term effect of both diagnoses over time remains to be determined," she added. The association between COPD and heart failure seen in the study does not prove a cause-and-effect link.

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COPD World News Week of June 1, 2014

Diet Tied to Better Breathing in COPD Patients

San Diego, CA - People with certain chronic lung diseases might breathe a bit easier when their diets contain healthy foods like fruits and fish, a new study suggests. Researchers found that among nearly 2,200 adults with chronic obstructive pulmonary disease (COPD), those who ate fish, grapefruit, bananas and cheese tended to have better lung function and fewer symptoms than their counterparts who did not eat those foods. COPD is an umbrella term for the progressive lung diseases emphysema and chronic bronchitis. In the United States, about 15 million people have COPD, and the disease is the third leading cause of death nationwide, according to the U.S. Centers for Disease Control and Prevention. Smoking is the leading cause of COPD. It's not clear yet whether diet has direct effects on COPD patients' lungs. The new study, reported at the American Thoracic Society's annual meeting in San Diego, only shows an association between certain foods and better lung function. That doesn't prove cause-and-effect, said lead researcher Corrine Hanson, who was scheduled to present the results on Wednesday. And no one is saying bananas are the magic bullet against COPD, stressed Hanson, an assistant professor at the University of Nebraska Medical Center in Omaha.  But COPD patients who eat fruit, fish and dairy products might have a healthy, well-rounded diet, Hanson said. And it's "plausible," she said, that foods that have antioxidant and anti-inflammatory effects could benefit COPD patients' lungs. "It's probably the overall dietary pattern that matters," Hanson said. That, in fact, is what some past research suggests, said Dr. Carlos Camargo, a professor at Harvard Medical School who was not involved in the new study. In his own research, Camargo has found that people with diets high in fruits, vegetables, fiber-rich grains and fish are less likely to develop COPD compared to people who eat a lot of processed foods, red meat and sweets. "We think that diet as a whole is important," Camargo said. He added, though, that to really prove that a healthy diet improves lung function, you'd have to do a clinical trial -- where people with COPD would be randomly assigned to follow a particular eating plan or not. "A trial like that is hard to do," Camargo noted. "But it can be done." As an example, he cited the recent PREDIMED trial, which showed that the classic Mediterranean diet can cut the odds of heart attack and stroke in high-risk older adults. "We should do something similar with COPD," Camargo said. For the current study, Hanson's team used data from a larger project that followed COPD patients over three years. At eight different time points, the participants were asked whether they had eaten grapefruit, bananas, fish or cheese over the past 24 hours. In general, people who had eaten any of those foods showed better lung function on standard tests, had a quicker walking pace, and tended to have lower levels of certain inflammatory indicators in the blood. In some cases, the relationship was immediate, meaning people who ate a certain food did better on certain tests the next day. In other cases, the link was longer-term, meaning certain foods were tied to better lung function over time. Hanson said it's possible that some foods, such as fruits and vegetables, have a short-term anti-inflammatory effect. But it's more likely that the individual foods in this study are signs of a higher-quality diet. There's no good reason to suspect that eating a lot of cheese, for example, would boost lung function. But, Hanson said, cheese might be an indicator of people's intake of vitamin D, which, some evidence suggests, might help COPD patients breathe a bit easier. "I think the take-away is that diet may be a modifiable factor for COPD patients," Hanson said. "When we think about diet and disease, we usually think about heart disease and diabetes. But people with lung disease should be thinking about diet, too." Camargo agreed. "The lesson that's emerging is that foods like fruits, vegetables and fish may be beneficial for lung health," he said. And if you're looking for a generally healthful way of eating, Camargo and Hanson pointed to the Mediterranean diet. It's rich in fruits and vegetables, whole grains, fish, beans and unsaturated "good" fats from sources such as olive oil and nuts. It's also low in processed foods, high-fat dairy and red meat.

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COPD World News Week of May 25, 2014

Lung Foam Disappoints in COPD

San Diego, CA - A trial of hydrogel-based lung volume reduction therapy in patients with chronic obstructive pulmonary disease (COPD) complicated by emphysema failed to show consistent enough results and has been abandoned by the agent's developer, researchers said here. More than 50% of the patients receiving the emphysematous lung sealant (AeriSeal) along with medical treatment experienced Minimal Clinically Improvement Change Scores in forced expiratory volume in 1 s (FEV1), in the St. George Respiratory Questionnaire, and in the Modified Medical Research Council Dyspnea scale, reported George Washko, Jr., MD, of Brigham & Women's Hospital in Boston, and colleagues at the American Thoracic Society (ATS) annual meeting. However, Washko said the improvements in lung function came at a cost -- 43% of the patients treated with the lung sealant required hospitalization compared with 19% of the patients in the medical treatment-only control group (P<0.05). Also, about 39% of the patients in the treatment group were hospitalized for adverse respiratory events versus 15% in the control group. Finally, there was one treatment-related death among the patients in the study arm (versus no deaths in the control group). The planned year-long evaluation of the lung foam was cut short at 6 months by Aeris Therapeutics, the product's maker. The ASPIRE trial was a multicenter, randomized, controlled study started in September 2012. Eligible patients were at least 40-years-old and had smoked at least 20-pack years of cigarettes. They had to have a diagnosis of upper lobe emphysema and have an FEV1 of less than 50%. Patients with previous surgery for lung volume reduction, those who had active lung infections, and those who had left ventricular ejection fraction of less than 45% were excluded. Patients who made it into the study were about 65-years-old and more than half were women. Both controls and treated patients had accumulated 50-pack years of smoking. The trial's primary endpoint was improvement in FEV1 at 12 months relative to baseline. At the time of termination, safety data were available for 90 patients. The authors reported that at 3 and 6 months, patients treated with the lung sealant saw improvements in FEV1 by 11% and 19%, respectively. Scores on the St. George Respiratory Questionnaire decreased by 11 points at 3 months and by 12 points at 6 months. Scores on the Modified Medical Research Council Dyspnea Scale decreased by 1 point at 3 months and that reduction was maintained at 6 months. Changes among the controls were minimal, the group reported.  ATS session moderator Klaus Rabe, MD, from the University of Kiel in Germany, described the study as "well-composed ... the researchers were very open, and it was not presented in a company-bias form. [Washko] was trying to find out if patients' outcomes would be better." He added that "there is clear harm for some patients. There is benefit for others." But Rabe pointed out that there are a number of different competing options for different morphologies of the lung (mainly emphysema), such as coils, steam, foam, and valves. "Of all the options for lung volume reduction, the foam one is the least likely to make it to the market because it is irreversible," he said. "The long-term effects are not known. I think it is valves and coils that are at the forefront." He said that he would prefer to work with an "inert material that I could remove again. I think that the problem with foam is that you squirt it somewhere and there it is. There is no way to get rid of it. It is easy to place things; it is difficult to take them out."

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COPD World News Week of May 18, 2014

Statins don't prevent COPD exacerbations

San Diego, CA - Statins don't prevent chronic obstructive pulmonary disease exacerbations or improve outcomes in sepsis-related respiratory failure, a series of trials showed. For patients with acute respiratory distress syndrome (ARDS) from sepsis in the ICU, rosuvastatin (Crestor) didn't cut 60-day in-hospital mortality compared with placebo or boost ventilator-free days. Putting patients on the lipid-lowering drug actually contributed to hepatic and renal failure, Jonathon D. Truwit, MD, of the Medical College of Wisconsin in Milwaukee, and colleagues found in the ARDS Clinical Trials Network study. In the STATCOPE trial, simvastatin (Zocor) didn't prevent COPD exacerbations or delay them,compared with placebo, Gerard Criner, MD, of Temple University in Philadelphia, reported. Both National Heart, Lung, and Blood Institute-sponsored trials were reported at a late-breaking clinical trials session at the American Thoracic Society meeting. A third randomized trial presented at the ATS meeting -- RODEO -- confirmed reduced systemic inflammation with short-term treatment with rosuvastatin in stable COPD patients without known cardiovascular disease. But again it showed no benefit for pulmonary function, Anke Neukamm, MD, of Akershus University Hospital in Oslo, Norway, and colleagues found. In the 99-patient trial, 10 mg rosuvastatin daily for 12 weeks reduced high-sensitivity C-reactive protein and cut the rise in interleukin-6 as markers of inflammation compared with placebo. But lung function as measured by forced expiratory volume in 1 second (FEV1) and the ratio of FEV1 to forced vital capacity showed no difference between groups.. Observational studies had suggested better outcomes in patients on statins in both COPD and sepsis. It was reported that despite the negative results in the randomized trials, they had to be done. It would have been a big mistake to accept the findings without a test it was said. This kind of "discovery-in-practice" route to clinical trials is likely to be increasingly seen as electronic health records are exploited for big data.

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COPD World News Week of May 11, 2014

COPD Drugs Need No Extra CV Study, Group Says

Durham, NC – Don’t take drugs for chronic obstructive pulmonary disease (COPD) down the same path as those for diabetes by requiring cardiovascular outcome safety trials; a think tank panel told the FDA. Both conditions carry a heavy burden of cardiovascular disease, but setting the bar too high for proof of safety in COPD could actually end up hurting patients, said Philip Sager, MD, a session chair at the meeting between the FDA and the Duke University-linked think tank Cardiac Safety Research Consortium earlier this month. "There's a tension between having as much data as possible and potential implications of requiring outcomes studies, which could include delays in patients getting drugs to treat the disorder, ability or willingness of companies to make the necessary investments, and, potentially, scientific challenges in interpreting the data in patients who are highly symptomatic," he said. Tiotropium (Spiriva) was an example of the scientific challenge cited by Peter Kowey, MD, of Jefferson Medical College in Philadelphia, who presented the industry and academic viewpoint. The UPLIFT trial showed the drug to be a clear winner in COPD with a possible mortality advantage over placebo. But then questions about risk with the Respimat inhaler device keep coming up even after the large TIOSPIR outcomes trial to settle the issue. The main consensus between the FDA and the panel of academic and industry representatives was that outcomes trials are most warranted only when there has been a "meaningful" cardiovascular risk signal in the clinical development program. That differed from the stance taken with diabetes drugs, where the agency adopted stricter standards for proof of cardiovascular safety of drugs in 2008 following the rosiglitazone (Avandia) debacle. The COPD think tank did call, though, for being extra care to be taken in collecting the underlying cardiovascular history on patients who have cardiovascular events in trials. "The idea is to collect data in a more robust fashion prospectively so if you do need it a few years down the line you have it," said Sager, of California's Stanford Cardiovascular Institute and a voting member of the FDA Cardio-Renal Advisory Committee. "What sometimes happens is you get into late phase II and see you have some imbalance of cardiovascular events but when you go back to look at them, because the studies were done a few years earlier and it wasn't something you were focusing on, the amount of data is sparse." While not a new concept, that strategy together with an adequate safety database and a trial population enriched with patients at extra risk due to comorbidities should often prevent the need for big, long, expensive outcomes trials, agreed Sally Seymour, MD, who spoke at the meeting as deputy director for safety of the FDA division tasked with evaluating pulmonary drugs.

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COPD World News Week of May 4, 2014

Ontario study finds ‘benzo’ drugs worsen breathing problems for some seniors

Toronto, ON - Benzodiazepines, commonly used for insomnia and anxiety, "significantly increase the risk" of breathing problems in seniors with emphysema, researchers found. Seniors with serious respiratory problems should think twice about taking benzodiazepines, a group of drugs that treats insomnia and anxiety, a massive new study by Toronto researchers suggests. The drug class, which is also prescribed to treat breathing issues, was found to actually worsen pulmonary problems in older adults with emphysema, the European Respiratory Journal reported. Last year, the drug class was subject to a federal safety review by Health Canada, the results of which have not been released in a public report, as highlighted in a recent Toronto Star investigation. It’s unknown what triggered the review or what government officials found. Benzodiazepines, which include brand name pills like Ativan and Xanax, were among the 10 most-prescribed classes of medication in Canada last year. The Canadian Rx Atlas, an online compendium that analyses drug use and spending data for more than 10,000 medications, noted that prescriptions for seniors (age 66 and older) accounted for half of all sales in the class, which topped $330 million. A third of Canadian seniors with emphysema take benzodiazepines, often called “benzos.” While long-term use has been associated with increased risk of addiction, dizziness and falls, the seven-year, population-based study carried out by Dr. Nicholas Vozoris of St. Michael’s Hospital in Toronto, paints an even more alarming picture. Until now, no study on the respiratory side effects of benzodiazepines has measured “real-world, important clinical outcomes and real-world dosing with this breadth of people,” said Vozoris, a respirologist. The study tracked nearly 100,000 seniors across Ontario age 66 and older. Half of them were new users of benzodiazepines who suffered from chronic obstructive pulmonary disease (COPD or emphysema) between 2003 and 2009. The other half included seniors in the same health group who had not taken benzodiazepines in the past year. Vozoris found that patients in the first category faced a 45 per cent higher risk of having a side effect that forced them to seek outpatient care for respiratory-related problems. This group was also 92 per cent likelier to visit an emergency department because their respiratory condition had deteriorated or they had developed pneumonia. While previous studies examined respiratory risk based on a single, often low dose of the drug with limited follow-up, the Toronto group monitored patients for 30 days after taking the drug. In many cases, troubling symptoms appeared within the first week. Adverse events included increased shortness of breath, more coughing than usual, and thicker or darker phlegm. Excessive fatigue was “a more significant and concerning symptom,” Vozoris said. “That may happen if someone let their breathlessness go on too long.” There are three prime reasons why benzodiazepines are prescribed in people with emphysema. It can treat shortness of breath that can’t be controlled with other medications. It can help with insomnia, which is very common in this group. And it can help manage anxiety, which goes hand-in-hand with not being able to breathe normally, Vozoris explained. Bottom line: “Physicians, when prescribing these pills, need to be careful, use caution and monitor the patients for respiratory side effects,” Vozoris said. “Patients should also be diligent about monitoring themselves if they’re worsening from a respiratory perspective and seek medical attention so the medications can be reassessed.”

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COPD World News Week of April 27, 2014

Smoking May Dull Ability to Sense Bitter Tastes

Paris, FR - Coffee's full taste might be lost on smokers and former smokers, a new study suggests. Researchers in France found that smokers and former smokers were less able to detect bitter tastes than non-smokers. They theorized that it's the result of exposure to toxic tobacco chemicals, although they didn't establish a direct cause-and-effect relationship. The researchers tested how well about 450 people could recognize the four basic tastes -- sweet, sour, bitter and salty -- and the intensity of each taste. The participants were divided into groups of smokers, former smokers and non-smokers. Smoking had no impact on the ability to detect salty, sour or sweet tastes, but did affect the ability to detect the bitter taste of caffeine, the study found. Typically, the tongue's bitter receptors are able to detect this taste at very low concentrations. About one in five smokers could not correctly identify the bitter taste of caffeine, compared with about one-quarter of former smokers and 13 percent of non-smokers, according to the study, which was published online in the March issue of the journal Chemosensory Perception. A buildup of certain compounds from tobacco smoke might hamper the regeneration of taste buds and reduce a person's ability to detect some types of tastes even after they quit smoking, said study leader Nelly Jacob and her colleagues from Pitie-Salpetriere Hospital in Paris. "We consider that the perception of bitter taste should be examined more closely, both as a tool for smoking cessation or for preventing smoking initiation," Jacob said in a journal news release. "More generally, it would be worthwhile to consider the role of chemosensory   perceptions in smoking behavior." It was already known that smoking can cause a loss of taste, but it wasn't clear whether the full taste range returns to normal after a person quits smoking or how long that might take, the researchers said.

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COPD World News Week of April 20, 2014

Aspirin Tied to Fewer Deaths in COPD Flares

Vancouver, BC - High platelet counts in chronic obstructive pulmonary disease (COPD) exacerbations were linked to elevated mortality, which being on an antiplatelet drug appeared to counteract, an observational study showed. Thrombocytosis, found in 12% of COPD patients admitted for exacerbations, was associated with 2.37-fold elevated in-hospital mortality and 53% elevated 1-year mortality, respectively, Michelle Harrison, MD, of the University of Dundee in Scotland, and colleagues found. Aspirin or clopidogrel treatment didn't significantly cut the likelihood of dying in the hospital but did correlate with a 37% reduced risk of 1-year mortality after adjustment for other factors, the group reported online in Thorax. However, the findings couldn't be entirely explained by cardiovascular events. Cardiovascular hospitalizations were not more common in thrombocytosis, nor was there an association between antiplatelet therapy and cardiovascular hospitalization or cardiovascular death. While the study couldn't prove causation or elucidate mechanisms, inflammation and hypoxia from acute exacerbations are plausible causes, the researchers suggested. They recommended a clinical trial of antiplatelet therapy in COPD exacerbation. Low-dose aspirin might be a reasonable strategy during and after acute exacerbations, Don Sin, MD, MPH, of St. Paul's Hospital in Vancouver, argued in an accompanying editorial. "Unless there is a medical contraindication, low-dose aspirin (ie, 80–100 mg/day) appears to be a reasonable therapeutic choice for most patients with COPD in view of their increased risk of cardiovascular disease and colorectal cancer," he wrote. In the study, 53% of patients were on antiplatelet agents, which matched the rate reported in another British cohort; that study showed that only half of high-cardiovascular-risk COPD patients were on any antithrombotic medication. The current study, a secondary analysis of the prospective EXODUS (Exacerbations of Obstructive lung Disease managed in UK Secondary care) cohort, included 1,343 adults over age 40 with spirometry-confirmed COPD admitted to 12 U.K. hospitals from 2009 to 2011. Whereas the COPD severity GOLD classification didn't differ by platelet levels at admission for exacerbation, other measures -- such as frequency of acidosis, use of non-invasive ventilation, and white blood cell counts -- suggested the thrombocytosis group was sicker. In-hospital mortality rates were 12% with thrombocytosis (platelet counts over 400 x 109cells/mm3) compared with 5% in those with normal platelet counts. "Although it would be useful to have included more detailed assessment of platelet and clotting function rather than the crude numbers, platelet count is readily available to all clinicians on a day-to-day basis," the researchers noted. Too few patients had low thrombocytopenic platelet counts (3% had counts below 150 x 109cells/mm3) recorded on admission to separately analyze. The researchers acknowledged the potential for a 'healthy user effect' in the observational data despite adjustment for factors such as comorbidities. "We regard this explanation as unlikely since antiplatelet therapies are generally prescribed for cardiovascular and cerebrovascular diseases which are associated with increased mortality, and therefore the effect of anti-platelets may be potentially underestimated," they noted, however.

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COPD World News Week of April 13, 2014

E-Cigs: No Help in Quitting

San Francisco, CA - Electronic cigarettes didn't help smokers quit or even smoke less, according to a longitudinal study that may quash some public health hopes for the nicotine-delivery devices. Smokers who also reported any e-cigarette use at baseline in the web-based study weren't significantly more likely to have quit tobacco 1 year later, said Pamela Ling, MD, MPH, of the University of California San Francisco. The same was true for prior 30-day e-cigarette use after accounting for baseline intent to quit, cigarette consumption, and dependence, the group reported in a research letter online in JAMA Internal Medicine. Among people who didn't quit, "vaping" wasn't associated with smoking fewer cigarettes over time either. These findings from analysis of 949 smokers in a nationally representative panel followed from 2011 through 2012 by web-based market research firm Knowledge Networks (now GfK) add to similar findings from population-based and Quitline studies. "Although electronic cigarettes are aggressively promoted as smoking cessation aids, studies of their effectiveness for cessation have been unconvincing," Ling's group wrote. For example, one placebo-controlled but underpowered trial suggested e-cigarettes were at least as good as nicotine patches in helping smokers quit, but quit rates were dismal either way at 6% to 7%. "Regulations should prohibit advertising claiming or suggesting that e-cigarettes are effective smoking cessation devices until claims are supported by scientific evidence," Ling's group argued. The top reason for regular e-cigarette use cited in surveys has been kicking the tobacco habit, and some public health experts have been cautiously supporting that harm-reduction strategy. "As a harm reduction proponent, I would be willing to put aside the fact that any product with the name 'cigarette' (e- or otherwise) causes me reflex tachycardia and support electronic cigarettes ... if there were good data indicating that they helped smokers to stop,” JAMA Internal Medicine editor Mitchell Katz, MD, wrote in a note accompanying Ling's letter. However, he agreed with their conclusion and further advocated FDA regulation as drug-delivery devices. While the U.S. Supreme court struck down FDA attempts to regulate e-cigarettes as drugs or devices in 2010, the agency has regulations in the works that are expected to generally bring the same kind of restrictions to e-cigarettes as to other tobacco products. "The bottom line is e-cigarettes are not a good way to quit," commented Brian Tiep, MD, director of smoking cessation at City of Hope in Duarte, Calif. The devices may not have all the carcinogenic compounds found in burning tobacco, but that doesn't mean they're entirely safe, pointing to FDA analyses finding carcinogenic nitrosamines and the antifreeze component diethylene glycol in e-cigarette nicotine solutions. However, he noted that Ling's study population wasn't actively trying to quit and that an adequately-powered study is still needed to assess e-cigarettes' performance in a smoking cessation program. Ling's group also cautioned about limited statistical power, as smoking cessation was self-reported and included only nine of the 88 e-cigarette users. Their study lacked data on how frequently the population used e-cigarettes and motivation for use as well.

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COPD World News Week of April 6, 2014

Does COPD Dull the Mind?

Rochester, MN - Mild cognitive impairment was more likely in patients with chronic obstructive pulmonary disease, particularly the longer it went on, a study showed. Physician-diagnosed COPD was associated with an 83% elevated likelihood of developing non-amnestic mild cognitive impairment, Michelle M. Mielke, PhD, of the Mayo Clinic in Rochester, Minn., and colleagues found. That link was significant after full adjustment for other factors, including age, smoking and Alzheimer's genetics, although associations with the amnestic type of mild cognitive impairment -- thought to be a precursor to Alzheimer's disease -- were not, the researchers reported online in JAMA Neurology. There was a dose-response relationship with mild cognitive impairment both of the non-amnestic type and overall. Hazard ratios were highest among individuals with COPD diagnosed more than 5 years prior to the baseline assessment in the Mayo Clinic Study on Aging. That prospective population-based cohort included 1,425 people, ages 70 to 89, at baseline who were cognitively normal when randomly selected from the county around the Mayo Clinic. "Our findings highlight the importance of COPD as a risk factor for mild cognitive impairment and may provide a substrate for early intervention to prevent or delay the onset and progression of mild cognitive impairment," Mielke's group concluded. Prior studies have linked COPD, particularly severe cases, to poor performance on attention, memory, and executive function tests. Chronic lack of oxygen and excess carbon dioxide may damage the brain over time, and systemic inflammation and vascular problems also linked to COPD could play a role as well, Mielke and colleagues suggested.

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COPD World News Week of March 30, 2014

Why It's Hard to Kick the Smoking Habit

Philadelphia, PA - Nicotine withdrawal triggers changes to the brain that help explain why smokers have such a tough time quitting, a new study suggests. Up to 80 percent of smokers who try to quit eventually start smoking again. This latest finding might lead to new ways to identify smokers who are at high risk for failure when they try to quit, the researchers said. The study might also lead to more intensive treatment to help smokers quit for good. The researchers used fMRIs to scan the brains of 37 smokers, aged 19 to 61, immediately after they smoked and again after they had been smoke-free for 24 hours and were experiencing nicotine withdrawal. The researchers discovered that nicotine withdrawal weakens brain connections associated with the ability to control cravings for cigarettes, according to the study, which was published in this week's issue of the journal JAMA Psychiatry. Specifically, they have trouble shifting from an inward-focused brain network to one that helps them have more control over their desire for cigarettes and focus on quitting smoking, the researchers said. "Symptoms of withdrawal are related to changes in smokers' brains, as they adjust to being off of nicotine," study co-leader Caryn Lerman, head of the Brain and Behavior Change Program at the University of Pennsylvania, said in a university news release. "This study validates those experiences as having a biological basis." "The next step will be to identify in advance those smokers who will have more difficultly quitting and target [them with] more intensive treatments, based on brain activity and network connectivity," she added.

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COPD World News Week of March 23, 2014

ICU Patients May Face Mental Health Issues After Discharge

New York, NY - Critically ill people who survive a stay in the intensive care unit face a heightened risk of mental health problems in the months after hospital discharge, a large new study suggests. The study of more than 24,000 Danish ICU patients found that after discharge, people had an increased risk of developing depression, anxiety disorders or other psychiatric conditions. The rates weren't high: About 0.5 percent of patients had a new diagnosis in the three months post-discharge. But that was 22 times the rate seen in the general population over the same time period, the findings showed. Experts say the findings, reported in the March 19 issue of the Journal of the American Medical Association, highlight an emerging issue: As doctors get better at saving the lives of critically ill patients, more people will be at risk of longer-term problems beyond physical health. "We've been worried for some time that we're discharging people who will be at risk of (mental health) problems, due to their illness and their experience in the ICU," said lead researcher Dr. Hannah Wunsch, of Columbia University Medical Center in New York City. Based on her team's findings, that's the case. For the study, the researchers used records from Denmark's system of medical databases. They focused on 24,000 ICU patients who were ill enough to be placed on a ventilator for complications ranging from lung failure to life-threatening infections. Of those patients, almost 10,000 had no diagnosis of a mental health condition, or prescription for psychiatric drugs, in the prior five years. But in the three months after their discharge from the ICU, 0.5 percent received a new diagnosis, the researchers noted. Most often, that meant an anxiety disorder or "mood" disorder such as depression. Many more -- 13 percent -- received a new prescription for a psychiatric medication, including antidepressants and drugs for anxiety and insomnia, according to the report. In the ICU, many patients become delirious, because of illness and the medications they're given. "They don't know what's going on," Bienvenu said. "And they often develop memories that are distorted -- kind of like a nightmare." They may be aware of things happening around them, he noted, but have no understanding of it. Plus, patients on ventilators can't speak because of the breathing tube. "All they know is that people are doing things to them," Bienvenu explained. "And they may think those people are trying to harm them, rather than help them." Doctors don't routinely screen ICU patients for mental health problems. That's partly because the focus has been on, first, saving patients' lives, and then getting them into physical therapy or occupational therapy for any physical disabilities. But there's a growing awareness that ICU survivors often have mental health issues and lingering "cognitive" effects, like problems with memory or thinking and planning, Bienvenu said. And all of those problems can feed each other. "If you're depressed, it's hard to concentrate," Bienvenu noted. "If you can't walk, you're probably going to feel depressed. It's very important that we try to take care of the whole patient."

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COPD World News Week of March 16, 2014

Doctors missing chance to diagnose COPD in many cases

Plymouth, UK - A 20-year study led by researchers at Plymouth University Peninsula Schools of Medicine and Dentistry shows that many patients with chronic obstructive pulmonary disease (COPD) were being overlooked during initial assessments of respiratory symptoms. The study encompassed almost 39,000 patients and showed that, in the UK, opportunities to diagnose COPD are frequently missed in both primary and secondary care settings. The study was led by Dr. Rupert Jones, Clinical Research Fellow at Plymouth University Peninsula Schools of Medicine and Dentistry and a working GP in Plymouth. He said: "This was a project which came from my work with the Department of Health, on the National COPD outcomes strategy -- a stream of work which I have been involved in since 2005. We became acutely aware that many people were being diagnosed with COPD, a progressive and disabling lung disease, at a late stage when the damage done was severe and irreversible. Thus we wanted to examine the opportunities arising in primary care in order to diagnose COPD at an earlier stage and improve health outcomes, with potential to extend life expectancy and quality of life for patients." The research team used data from the General Practice and Optimum Patient Care Research databases. They assessed whether a diagnosis of COPD could have been made in an earlier visit to a doctor, whether in a primary or secondary care setting. From the databases 38,849 patients aged 40 or older and who had received a diagnosis for COPD were identified. The diagnoses had been made between 1990 and 2009 and for each data was available at least two years before and one year after diagnosis. Results showed that in the five years before diagnosis, 85 per cent of patients had visited their GP at least once with lower respiratory symptoms without the diagnosis of COPD being made. Opportunities for diagnosis were missed in 58 per cent of patients in the six to 10 years before diagnosis, and in 42 per cent in the 11 to 15 years before diagnosis. The study identified that, over the 20 year study period, there was a significant increase in the number of chest X-rays in the two years prior to diagnosis, but that only a third of those patients were given spirometry testing (a breathing test used to diagnose lung conditions and which measures how well the lungs work.  It is estimated that around 2.2 million people in the UK remain undiagnosed for COPD. The UK Department of Health estimates that earlier diagnosis and treatment could save the NHS more than £1 billion over 10 years. Said Dr. Jones: "The numbers are large, both in terms of people affected and the cost to already stretched NHS provision of care. We believe that the results of our study provide clear support to the argument for improved identification and diagnosis of COPD in general practice, with greater awareness so that early opportunities to diagnose -- such as presentation with lower respiratory tract symptoms or related conditions -- are seized and acted upon."

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COPD World News Week of March 9, 2014

Fire-Safe Cigarette Law Reduces Home Fires

Boston, MA - A Massachusetts law requiring that only fire-safe cigarettes be sold in the state reduced the number of residential fires there, a new study shows. Researchers examined data on accidental residential fires that occurred in the state between 2004 and 2010, including 1,629 fires that were caused by cigarettes. They found that those caused by cigarettes fell 28 percent after the fire-safe cigarettes law took effect in 2008. The largest declines were in fires caused by situations such as people falling asleep while smoking or cigarettes igniting flammable materials. The results were published online Feb. 13 in the American Journal of Public Health. "This study is the first rigorous population-based study to evaluate the effectiveness of the fire-safe cigarette standards, and shows that science-based tobacco product regulation can protect the public health," study author Hillel Alpert, a research scientist at the Center for Global Tobacco Control at the Harvard School of Public Health, said in a school news release. According to the U.S. National Fire Protection Association, fire-safe cigarettes are designed to reduce the risk of a cigarette continuing to burn if left unattended. This lowers the chances of a fire if a cigarette is accidentally dropped or left on a flammable surface. "This study confirms that the [law] has reduced the number of fires from cigarettes started by igniting furniture and bedding, as it was designed to do," Massachusetts Fire Marshal Stephen Coan said in the news release. Cigarettes are a leading cause of residential fires in the United States. Each year, cigarette-related fires cost millions of dollars in property damage, lost productivity, health care, injuries and deaths. According to the news release, those most at risk from such fires include young children, seniors, blacks and Native Americans, rural residents, those who are poor or live in substandard housing and firefighters. "We now have the science to support that all tobacco companies throughout the world should voluntarily make their cigarettes less likely to ignite fires," Gregory Connolly, director of the Center for Global Tobacco Control, said in the news release.

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COPD World News Week of March 2, 2014

Flu Shot May Lower Stroke Risk

Lincoln, UK - Getting the seasonal flu shot could provide a bonus: It might also significantly reduce your risk of stroke, a new study suggests. "We know that cardiovascular diseases tend to hit during winter, and that the risks may be heightened by respiratory infections such as flu. Our study showed a highly significant association between flu vaccination and reduced risk of stroke within the same flu season," said lead investigator Niro Siriwardena, a professor in the School of Health and Social Care at the University of Lincoln in England. The researchers analyzed data from more than 47,000 people in the United Kingdom who suffered a stroke or mini-stroke (transient ischemic attack) between 2001 and 2009. The investigators found that having a flu shot was associated with a 24 percent lower risk of stroke. However, this association does not prove a cause-and-effect relationship. The stroke risk reduction was strongest if a person received a shot early in the flu season, the study authors noted. But having a flu shot was not linked to a significantly reduced risk of mini-stroke, according to the study published online recently in the journal Vaccine. The researchers also found that pneumococcal vaccination -- which protects against infections such as pneumonia -- did not reduce the risk of stroke or mini-stroke. "Further experimental studies would be needed to better understand the relationship between flu vaccination and stroke risk," Siriwardena said in a university news release. "However, these findings reinforce the value of the U.K.'s national flu vaccination program with reduced risk of stroke appearing to be an added health benefit." In a previous study, the same team found that flu vaccination was linked to a lower risk of heart attack.

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COPD World News Week of February 23, 2014

Europe opens door to new COPD medicines

London, OK - This month, a number of medicines for the treatment of chronic obstructive pulmonary disease (COPD) were recommended for marketing authorisation by the CHMP - a committee of the European Medicines Agency. The Committee recommended granting marketing authorisations for six medicines for the treatment of respiratory diseases. Four of these, Anoro (umeclidinium bromide / vilanterol) and Laventair (umeclidinium bromide / vilanterol), as well as Incruse (umeclidinium bromide) and Ulunar Breezhaler (indacaterol / glycopyrronium bromide), are intended for the treatment of symptoms in adult patients with COPD. The remaining two, DuoResp Spiromax (budesonide / formoterol) and BiResp Spiromax (budesonide / formoterol), are intended for the treatment of asthma and COPD.

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Backing off Exercise Worsens COPD

Galdakao-Usansolo, Spain - Slowing down in exercise habits was associated with a subsequent increase in hospitalizations for exacerbation of chronic obstructive pulmonary disease (COPD), a prospective Spanish study showed. The odds of hospitalization for COPD exacerbation rose 2.49-fold in the 3 years after a shift from a daily walking routine of up to roughly 2 miles per day to none, or from getting around 2 to 4 miles daily to less or none, compared with staying highly active (P=0.004), Cristobal Esteban, MD, of the Hospital de Galdakao-Usansolo, Spain, and colleagues found. Those who moved from the highest level of activity to any lower category also doubled their subsequent risk (OR 2.13, P=0.017), the group reported online in Respirology. The associations were independent of age, lung function, and prior hospitalizations for exacerbations. "This suggests that small changes in physical activity habits could significantly improve an important outcome as hospitalization during exacerbation of COPD in those patients," the researchers concluded. However, maintaining a lower level of physical activity also roughly doubled risk compared with sticking to a higher level of physical exercise. And moving up a category from none to some exercise didn't wipe out the disadvantage of not being highly active (OR 1.51 versus staying in the high category, P=0.645). Nevertheless, plenty of prior studies have shown benefits to regular exercise in COPD, both in lower hospitalization risk and better survival, the researchers pointed out. The mechanism could be decreasing systemic inflammation, improving lung efficiency, or strengthening lung muscles, but reverse causation and unmeasured confounding were possible as well, they acknowledged. Their study included 543 consecutive stable COPD patients seen at five outpatient respiratory clinics affiliated with a single Spanish hospital who self-reported physical activity at baseline and 2-year follow-up, from which the change in activity was calculated. The emphasis was on walking, which "is by far the most usual form of physical activity during spare time in our environment," the researchers noted. Low physical activity was considered less than 1.9 miles (3 km) per day or less, moderate was 1.9 to 3.7 miles (3 to 6 km) daily, and high was anything above that.

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COPD World News Week of February 16, 2014

Quitting Smoking Linked to Better Mental Health

St Louis, MO - Quitting smoking may be as good for your mental health as it is for your physical health, a new study suggests. Researchers analyzed data from 4,800 daily smokers in the United States who took part in two surveys conducted three years apart. Those who had an addiction or other mental health problems in the first survey were less likely to have those issues in the second survey if they'd quit smoking, the investigators said. The first survey found that 40 percent of the participants had mood or anxiety disorders or a history of these conditions, 50 percent had alcohol problems and 24 percent had drug problems. The second survey showed that 29 percent of those who'd quit smoking had mood disorders, compared with 42 percent of those who still smoked. Alcohol problems were reported by 18 percent of quitters and 28 percent of ongoing smokers, and drug problems affected 5 percent of quitters and 16 percent of those who still smoked. The study findings were released online Feb. 11 in the journal Psychological Medicine. When treating those with mental health disorders, doctors may overlook their patients' smoking habit in the belief that it's best to deal with the psychiatric issues first, the researchers at the Washington University School of Medicine in St. Louis noted in a university news release. "Clinicians tend to treat the depression, alcohol dependence or drug problem first and allow patients to 'self-medicate' with cigarettes if necessary," lead investigator Patricia Cavazos-Rehg, an assistant professor of psychiatry, said in the news release. "The assumption is that psychiatric problems are more challenging to treat and that quitting smoking may interfere with treatment." However, these findings suggest a strong link between quitting smoking and improved mental health. But while the researchers found an association between the two, the study did not prove a cause-and-effect relationship. "We really need to spread the word and encourage doctors and patients to tackle these problems," Cavazos-Rehg said. "When a patient is ready to focus on other mental health issues, it may be an ideal time to address smoking cessation, too."

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COPD World News Week of February 9, 2014

Antioxidant for COPD Questioned

Rome, Italy - The antioxidant N-acetylcysteine may be popular in chronic obstructive pulmonary disease (COPD) after cutting exacerbations in some trials, but don't expect to see it in clinical guidelines any time soon, two pulmonologists argued. Most guidelines for stable COPD have shunned the supplement -- which is also an antidote to acetaminophen (Tylenol) -- despite widespread use in the community across all stages of COPD, noted Mario Cazzola, MD, of the University of Rome Tor Vergata, and Maria Gabriella Matera, MD, PhD, of the Second University of Naples, Italy. Their commentary accompanied the findings of a 22% relative reduction of acute exacerbations compared with placebo in the Chinese PANTHEON trial, reported online in Lancet Respiratory Medicine. "Although we are fascinated by Zheng and colleagues' results, we believe that the evidence that emerged from the PANTHEON study is not adequate to make N-acetylcysteine an integral component of COPD treatment," Cazzola and Matera wrote. The problem is evidence. The positive findings have all come from either small studies at high risk of selection or publication bias, or have been done in China; on the other hand, the large BRONCUS trial in a largely white European population showed no effect on lung function or exacerbations. Replication of PANTHEON's findings in white patients with COPD is "imperative," Cazzola and Matera suggested, noting that genetic, environmental, or dietary factors could explain a benefit in China that doesn't generalize to other populations. It's also possible that the high dose was key in PANTHEON, double the 600-mg daily dose used in BRONCUS, they added. The purported mechanism for N-acetylcysteine was through antioxidant action, but Cazzola and Matera likewise cast doubt on that. "At present, little is known about whether N-acetylcysteine acts as an antioxidant, an anti-inflammatory, or a mucolytic drug, or all three, when it prevents COPD exacerbations in humans," they wrote. "However, available evidence suggests to us that the favourable effect of N-acetylcysteine on acute exacerbations of COPD is attributable to its mucolytic action," they added. "This opinion is strengthened by the documentation that mucolytic drugs, irrespective of whether or not they are able to exert antioxidant effects, are associated with a small reduction in acute exacerbations of COPD." N-acetylcysteine has been popular as an antioxidant among AIDS and cancer patients as well. Antioxidant use, though, has been deemed problematic during metastatic cancer treatment as it may undermine mechanisms of action on cancer cell death.

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COPD World News Week of February 2, 2014

Smoking in Pregnancy Tied to Later Nicotine Addiction in Daughters

Providence, RI - Daughters exposed to their mother's stress hormones in the womb may be more likely to become nicotine-dependent later in life, a new long-term study suggests. It also found that girls whose mothers smoked during pregnancy were at higher risk for eventual nicotine dependence. Researchers analyzed data from 649 women and 437 men who were followed for 40 years after being born to mothers whose hormone levels and smoking status were recorded during pregnancy. The results showed that exposure to elevated levels of the stress hormone cortisol in the womb and having a mother who smoked during pregnancy was linked to an increased likelihood that daughters, but not sons, would be at raised risk for nicotine dependence as adults. The study was published in the January issue of the journal Biological Psychiatry. "Our findings highlight the particular vulnerability of daughters to long-term adverse outcomes following maternal stress and smoking during pregnancy," first author Dr. Laura Stroud said in a journal news release. "We don't yet know why this is, but possible mechanisms include sex differences in stress hormone regulation in the placenta and adaptation to prenatal environmental exposures," said Stroud. She is a researcher with the Centers for Behavioral and Preventive Medicine at the Miriam Hospital in Providence, R.I. "Also, cortisol and nicotine may affect developing male and female brains differently," she added. It may be that the daughters are more likely to pass on a similar risk of nicotine dependence to their own daughters, making a cycle that goes from one generation to the next, Stroud suggested. Stroud also said the findings suggest "that maternal smoking and high stress hormones represent a 'double-hit' in terms of increasing an offspring's risk for nicotine addiction as an adult. Because mothers who smoke are often more stressed and living in adverse conditions, these findings represent a major public health concern."

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COPD World News Week of January 26, 2014

Number of Nurses Who Smoke Is Down

Los Angeles, CA - The number of registered nurses in the United States who smoke fell by more than a third between 2003 and 2011, a new study shows. The researchers added that this trend is important because it sends clear message to patients about the importance of quitting smoking. Researcher says trend is important because it sends clear message to patients about quitting Researchers examined data collected from health professionals across the country and found no significant decline in smoking among registered nurses between 2003 and 2007, according to the findings, which were published recently in the Journal of the American Medical Association. However, the number of registered nurses who smoked dropped from 11 percent in 2007 to 7 percent in 2011, the study found. That's an overall decrease of 36 percent, and nearly three times higher than the 13 percent decline in smoking among the general population during the same period. The data also revealed that the portion of nurses who smoked and quit was higher than in the general population -- about 70 percent and 53 percent, respectively. "This decline is so important, not just for the health status of nurses but also because studies continue to show that smoking by health care professionals sends a mixed message to patients," principal investigator Linda Sarna, a professor in the School of Nursing at the University of California, Los Angeles, said in a university news release. "Nurses see every day the devastation smoking has on their patients," said Sarna, an oncology nurse. "Much has changed since the 1970s, when female nurses had higher smoker prevalence than women in the general population." The researchers also found that smoking declined for all health professionals included in the study -- physicians, registered nurses, licensed practical nurses, pharmacists, respiratory therapists and dental hygienists. Doctors had the lowest rate of current smokers (2 percent), while licensed practical nurses had the highest rate (nearly one-quarter), according to the study. The study also found that nearly 78 percent of health care professionals never started smoking, which is much higher than the 65 percent among the general population.

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COPD World News Week of January 19, 2014

Millions of U.S. children will die prematurely unless current smoking rates drop

Washington, DC - Approximately 5.6 million American children alive today – or one out of every 13 children under age 18 – will die prematurely from smoking-related diseases unless current smoking rates drop, according to a new Surgeon General’s report. Over the last 50 years, more than 20 million Americans have died from smoking. The new report concludes that cigarette smoking kills nearly half a million Americans a year, with an additional 16 million suffering from smoking-related conditions. It puts the price tag of smoking in this country at more than $289 billion a year in direct medical care and other economic costs. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, comes a half century after the historic 1964 Surgeon General’s report, which concluded that cigarette smoking causes lung cancer. Since that time, smoking has been identified as a cause of serious diseases of nearly all the body’s organs. Today, scientists add diabetes, colorectal and liver cancer, rheumatoid arthritis, erectile dysfunction, age-related macular degeneration, and other conditions to the list of diseases that cigarette smoking causes. In addition, the report concludes that secondhand smoke exposure is now known to cause strokes in non-smokers. “Smokers today have a greater risk of developing lung cancer than they did when the first Surgeon General’s report was released in 1964, even though they smoke fewer cigarettes,” said Acting Surgeon General Boris Lushniak, M.D., M.P.H. “How cigarettes are made and the chemicals they contain have changed over the years, and some of those changes may be a factor in higher lung cancer risks. Of all forms of tobacco, cigarettes are the most deadly – and cause medical and financial burdens for millions of Americans.” Twenty years ago male smokers were about twice as likely as female smokers to die early from smoking-related disease. The new report finds that women are now dying at rates as high as men from many of these diseases, including lung cancer, chronic obstructive pulmonary disease (COPD), and heart disease. In fact, death from COPD is now greater in women than in men. “Today, we’re asking Americans to join a sustained effort to make the next generation a tobacco-free generation,” said Health and Human Services Secretary Kathleen Sebelius. “This is not something the federal government can do alone. We need to partner with the business community, local elected officials, schools and universities, the medical community, the faith community, and committed citizens in communities across the country to make the next generation tobacco free”.

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COPD World News Week of January 12, 2014

Health Canada approves new combo drug for COPD

Dorval, PQ - Novartis Pharmaceuticals Canada Inc. announced this week that Health Canada has approved the use of long-term once-daily dual bronchodilator UltibroTM Breezhaler® (indacaterol 110 mcg / glycopyrronium 50 mcg) as a maintenance bronchodilator treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. “The availability of Ultibro Breezhaler is good news for my patients with COPD who struggle with disabling breathlessness as they attempt simple everyday tasks.” says Dr. Kenneth Chapman, Director, Asthma & Airway Centre of the University Health Network, located in Toronto. “A new treatment option that improves lung function and relieves breathlessness around the clock following just one inhalation is a welcome advance.” Health Canada approved Ultibro Breezhaler based on five studies from the IGNITE clinical program (SHINE, ILLUMINATE, SPARK, BRIGHT and ENLIGHTEN studies). These studies showed that Ultibro provided rapid and sustained improvements in lung function, and significantly reduced shortness of breath. These improvements were maintained throughout the duration of the trials. The IGNITE clinical program is one of the largest international phase III clinical trial programs in COPD, with 11 trials in total and more than 10 000 patients involved. Ultibro Breezhaler is a fixed-dose combination (FDC) of two bronchodilators, Onbrez® Breezhaler (indacaterol maleate), a long-acting beta2-adrenergic agonist (LABA) and Seebri® Breezhaler (glycopyrronium bromide), a long-acting anticholinergic (LAAC). Both are currently used by healthcare professionals as individual therapies to treat COPD in Canada. "COPD is known to affect an estimated 210 million people worldwide and is projected to be the third leading cause of death by 2020. Several patients find COPD symptoms really tough to cope with – even if they're already taking treatment," said Dr. Riad Sherif, President of Novartis. "With the approval of Ultibro Breezhaler, Novartis is pleased that Health Canada recognizes the efficacy of dual therapy, which has the potential to make a real difference for those with COPD."

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U.S. Panel Backs Routine Lung CT Scans for Older, Heavy Smokers

Portland, OR - A highly influential government panel of experts says that older smokers at high risk of lung cancer should receive annual low-dose CT scans to help detect and possibly prevent the spread of the fatal disease. In its final word on the issue published Dec. 30, the U.S. Preventive Services Task Force (USPSTF) concluded that the benefits to a very specific segment of smokers outweigh the risks involved in receiving the annual scans, said co-vice chair Dr. Michael LeFevre, a distinguished professor of family medicine at the University of Missouri. Specifically, the task force recommended annual low-dose CT scans for current and former smokers aged 55 to 80 with at least a 30 "pack-year" history of smoking who have had a cigarette sometime within the last 15 years. The person also should be generally healthy and a good candidate for surgery should cancer be found, LeFevre said. About 20,000 of the United States' nearly 160,000 annual lung cancer deaths could be prevented if doctors follow these screening guidelines, LeFevre said when the panel first proposed the recommendations in July. Lung cancer found in its earliest stage is 80 percent curable, usually by surgical removal of the tumor. "That's a lot of people, and we feel it's worth it, but there will still be a lot more people dying from lung cancer," LeFevre said. "That's why the most important way to prevent lung cancer will continue to be to convince smokers to quit." Pack years are determined by multiplying the number of packs smoked daily by the number of years a person has smoked. For example, a person who has smoked two packs a day for 15 years has 30 pack years, as has a person who has smoked a pack a day for 30 years. 

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COPD World News Week of January 5, 2014

CT Screening Ready But Lacking Patients

Chicago, IL - Most of the leading academic centers are operating CT-based lung cancer screening programs – and embedded in that screening is a smoking cessation program, researchers reported here. Of the 21 leading academic centers identified by US News and World Report, 19 responded to a survey regarding screening programs and 15 institutions said they already had programs up and running, said Phillip Boiselle, MD, professor of radiology at Beth Israel Deaconess Medical Center/Harvard Medical School, Boston. Eleven of those 15 programs offer optional smoking cessation courses, and three more make the smoking cessation course mandatory for individuals undergoing lung cancer screening, he reported at the annual meeting of the Radiological Society of North America. One of the centers did not include a smoking cessation program. "Most leading academic medical centers had an active screening program in March 2013 when the survey was conducted," Boiselle said, "but few patients were being screened." Boiselle and colleagues sought to determine how the recommendations of the National Lung Screening Trial – specifically that CT screening be conducted at academic institutions – were being implemented in practice, especially in light of varying recommendations on screening by several national organizations. He did not identify the medical centers that responded to the survey. “The surprising result of the survey is the magnitude – or rather the lack of magnitude – of uptake of the screening programs," said Alexander Bankier, MD, PhD, professor of medicine at Harvard Medical School, and co-moderator of the oral presentation session. In response, Boiselle said, "We did hear from a number of the institutions that 'we have everything set up, we just don't have any patients.' There appears to be a disconnect between the level of planning for the screening and the number of patients." In commenting on the study from the audience, Daniel Berman, MD, professor of medicine at the University of California, Los Angeles Cedars-Sinai Medical Center, "The number of cancer deaths and cardiovascular deaths that could be saved by increasing screening programs is staggering." He suggested that increasing self-referral as has happened with calcium screening in cardiovascular disease could increase the number of patients for lung screening, and lower the cost of the scans as well.

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Good news for COPD patients in Nova Scotia and PEI

Halifax, NS - The Nova Scotia government has added Seebri to their Pharmacare Program formulary effective December 30, 2013. The drug will be covered if breathlessness symptoms persist after 2-3 months of short-acting bronchodilator therapy (i.e. salbutamol at a maximum dose of 8 puffs/day or ipratropium at maximum dose of 12 puffs/day). Seebri can be provided without a trial of short-acting agent if there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1 /FVC ratio < 0.7) and significant symptoms (i.e. moderate to severe MRC score of 3-5).  Seebri (glycopyrronium bromide) is a long-acting anticholinergic (LAAC) indicated for long-term, once-daily maintenance bronchodilator treatment in patients with chronic bronchitis and emphysema. As an inhaled, steroid-free COPD treatment, it is not indicated as a rescue medication for the relief of acute deterioration of COPD. The government of Prince Edward Island has indicated that Seebri will be added to the PEI Formulary as a Special Authorization (SA) benefit effective January 20, 2014.

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