COPD World News Week of December 27, 2015

Could There Be a 'Quit-Smoking' Gene?

Hangzhou, China - Some smokers have much more difficulty kicking the habit than others. Now, a new review of prior research identifies a potential culprit: genes. Researchers analyzed genetic differences cited in 22 studies involving nearly 9,500 white smokers. Of particular interest were variations in genes involved in processing dopamine, a neurotransmitter that helps to regulate the brain's reward and pleasure centers. Experts believe that the nicotine found in tobacco boosts dopamine in the brain, leading to addiction. The researchers wondered if variants in genes that regulate dopamine might be associated with the ability to put out the butts for good. In the end, the scientists focused on a DNA sequence called Taq1A. They found that smokers who carried a variation of that sequence -- called A2/A2 -- appeared to have an easier time quitting smoking than those who carried other variations of the Taq1A sequence. "This variant has been studied for years, but this study provided more convincing evidence on the role of this genetic variant in smoking cessation by analyzing a significant large number of smoke samples," said study co-author Ming Li, a professor in the department of psychiatry and neurobehavioral sciences at the University of Virginia. The findings were published Dec. 1 online in Translational Psychiatry. Li, working with researchers from Zhejiang University School of Medicine in Hangzhou, China, noted that roughly 6 million people die worldwide every year because of smoking. The studies included in the current analysis were conducted between 1994 and 2014, and numbered from fewer than 100 participants to more than 2,000. Quitting success varied widely, ranging from less than 10 percent to nearly 67 percent, the researchers reported. Ultimately, the team found there was a "significant association" -- but no definitive proof -- between having the A2/A2 DNA variant and an increased ability to successfully quit. The authors said the finding should encourage more research into the genetics behind efforts to quit smoking. Such research could eventually lead to the development of personalized treatments that target each smoker's inherited predispositions, they suggested. However, Li's team cautioned that "research on this problem remains in its infancy." And Li further highlighted the complexity of the science by noting that "there are many genetic factors involved in smoking addiction. The variant studied in this report is just one of those." Meanwhile, Dr. Norman Edelman, senior medical consultant for the American Lung Association, expressed little surprise at the idea that genetics has a role to play. "There's a huge variability in the ability to quit smoking," said Edelman, a professor of medicine and preventive medicine at the State University of New York at Stony Brook. "Quitting cold turkey, for example, is only effective 5 percent of the time. But I have patients who got up one morning and decided to stop smoking and just stopped. And then I have patients who have tried 10 times and can't do it." Genetics likely explain some, but not all, of these differences, Edelman added. "The next step, in terms of advancing the science of smoking cessation, is trying to figure out exactly what the gene does, what proteins it codes for, and to see if there's some way to modify the way it works. That's probably going to turn out to be very hard." Still, Edelman called the current research "a good finding." As he sees it, "the more you know about smoking and the predilection to smoke and smoking cessation, the more you are going to be able to develop effective strategies to help patients."

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COPD World News Week of December 20, 2015

COPD Patients’ Mental Health Can Affect Life Quality

Marburg, Germany - The results of a recent study published in the journal Psychology & Health show that psychological factors — such as illness perception and an internal locus of control can influence health-related quality of life for patients with chronic obstructive pulmonary disease (COPD). “These factors should be considered when designing treatments for individuals with COPD, and adequate interventions should be provided to enhance illness understanding and self-management skills,” Ricarda Mewes, PhD, from the division of clinical psychology and psychotherapy and department of psychology at Philipps-University of Marburg in Marburg, Germany, and colleagues wrote, according to a recent news release. Chronic obstructive pulmonary disease is characterized by progressive airflow limitations that are associated with an abnormal inflammatory response to noxious particles or gases. Severe shortness of breath and coughing result in serious physical impairment and, subsequently, a low health-related quality of life (HRQL). The prevalence of COPD in the U.S. is estimated at around 20%, and that rate is steadily increasing. COPD was also ranked third in the global incidence of disease-related deaths in 2010 and, worldwide, is expected to become the fourth leading cause of death and the seventh leading cause of loss from disability-adjusted life in 2030. To explore the role of psychological factors on HRQL and disability, in the study titled “Psychological predictors for health-related quality of life and disability in persons with chronic obstructive pulmonary disease (COPD),” Mewes and colleagues administered an online survey to 502 individuals with a diagnosis of COPD. The mean age of the participants was 59.7 years, and the majority had severe COPD as rated by the Global Initiative on Obstructive Lung Disease (GOLD) staging (Stage I = 3% of enrolled patients; Stage II = 17%; Stage III = 34%; Stage IV = 46%). As part of the survey, the participants completed the COPD Assessment Test, the SF-12, Patient Health Questionnaire, and the Brief Illness Perception Questionnaire, which evaluates beliefs about illness and health. The investigators found high variances in questionnaire responses, with mental health-related quality of life showing the highest variance at 63% (disability comprised 56%, and physical HRQL comprised 28%). The results further revealed that better mental health, more optimistic illness perceptions, attribution to psychological causes, and a stronger internal locus of control were associated with lower disability and improved HRQL. Based on the findings, the researches suggest healthcare providers take psychological factors into account when designing treatments for COPD patients, and include interventions that enhance illness understanding and self-management skills.

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COPD World News Week of December 13, 2015

Active, Passive Smoking Tied to Infertility, Early Menopause

Buffalo, NY - Smoking and being exposed to secondhand smoke may trigger early menopause and infertility in women, a new study suggests. Other research has linked smoking with higher rates of infertility and perhaps earlier menopause. However, "secondhand smoke is less researched," especially among never-smoking women, said study author Andrew Hyland, chair of health behavior at Roswell Park Cancer Institute, in Buffalo, N.Y. In the study, Hyland and his colleagues evaluated women enrolled in the Women's Health Initiative, a large study launched in 1991 to look at a variety of health issues in more than 160,000 generally healthy, postmenopausal women. Hyland's team looked at information about age of menopause and fertility, along with tobacco exposure, among some of the women enrolled in the study. The investigators evaluated information available on about 88,000 women to look at the fertility effects. They also looked at information on about 80,000 to examine onset of natural, or nonsurgical, menopause. Both smoking and exposure to secondhand smoke were linked to fertility issues and early menopause (before the typical age of 50), the researchers found. Compared with never smokers, current or former smokers were 14 percent more likely to be infertile and 26 percent more likely to have early menopause. Early menopause has been linked with a higher risk of death from all causes, Hyland pointed out. Among never smokers, those exposed to the highest level of secondhand smoke (such as living with a smoker for 10 years or more) were 18 percent more likely to have fertility problems and early menopause, the study found. Women who had ever smoked reached menopause about 22 months before those who never smoked or never were exposed to smoke. Those exposed to the highest level of passive smoke reached menopause 13 months earlier than those not exposed, the findings showed. But the study cannot prove cause and effect, Hyland added.

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COPD World News Week of December 6, 2015

Study reveals the benefits of singing for people with lung conditions

London, UK - Researchers from London, UK have found that community singing groups can help reduce breathlessness and increase well-being among people living with long-term lung conditions.
The study was presented earlier this week (Wednesday 2 December, 2015) at the British Thoracic Society Winter Meeting. The scientists were interested in finding out whether regularly attending a singing group on a long-term basis would help people with lung conditions to have a better quality of life. The study involved 16 people with lung conditions, who attended a weekly hour-long singing group for periods ranging from 6–15 months. Participants in the study were asked to report on their health and well-being, and reported improvements in a range of areas, including managing their breathlessness, better mental health and developing new friendships and a community. A number of participants noted that in the year after they joined the programme, they made fewer trips to their doctor and had reduced symptoms of breathlessness. This type of singing group is growing in popularity across the UK, with the support of the British Lung Foundation, and it is hoped that they could be replicated across Europe to support more people living with lung conditions.

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COPD World News Week of November 29, 2015

Shorter People Less Likely to Get Lung Transplants

New York, NY - Short adults are much less likely than average-height adults to get a lung transplant, and they're more likely to die while waiting for one, the findings from a new study suggest. Women are particularly affected by this bias because they tend to be shorter than men, the researchers said. "Surgeons commonly try to match small transplant candidates with small donor lungs, because they believe it leads to better outcomes," study leader Dr. David Lederer, an associate professor of medicine and epidemiology at Columbia University Medical Center in New York City, said in a medical center news release. "But the latest evidence indicates that this approach causes short people to get fewer transplants and have worse outcomes. Small recipients can cope with larger lungs, and surgeons can reduce the size of lungs before transplant, with good results. So, there's no scientific or medical reason for this bias against shorter people," he noted. The researchers analyzed data from more than 13,000 adults who were potential lung transplant patients. They were all placed on the lung transplant waiting list in the United States between 2005 and 2011. Shorter people -- under five feet, four inches -- were 34 percent less likely to receive a transplant than taller folks between five feet, seven inches and five feet, nine-and-a-half inches, the study found. Shorter patients were 62 percent more likely to die than their taller peers while on the waiting list, and they were also more likely to be removed from the list because their health deteriorated, the study showed. And, shorter adults were 42 percent more likely to suffer respiratory failure while on the waiting list, the study revealed. The study was published online Nov. 16 in the American Journal of Respiratory and Critical Care Medicine. "Our data suggest that it may be time to revise how we prioritize transplant candidates, to ensure equal priority is given to people of shorter stature," lead author Jessica Sell, a data analyst at Columbia University Medical Center, said in the news release. "Addressing the height disparity might also help correct the gender disparity that is evident in waiting list outcomes as well," she added. In 2014, 1,880 adults and 45 children had lung transplants in the United States, and almost 2,600 people were added to the waiting list, the researchers said. As of April, 2015, there were more than 1,600 people awaiting a lung transplant, they noted.

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COPD World News Week of November 22, 2015

U.S. Adult Smoking Rate Dips Below 15 Percent

Atlanta, GA - The number of American adults who light up has fallen to a new low of just 14.9 percent, according to the latest figures from the U.S. Centers for Disease Control and Prevention. Just last week, the CDC published 2014 figures showing that last year, 16.8 percent of adults smoked. But the new statistics -- which tracked smoking rates to June of this year -- show the number has tumbled even further. Compare that to the nearly 25 percent of U.S. adults who smoked in 1997, and it's clear real progress has been made, one expert said. "This is indeed encouraging news that suggests that investment in public health and education initiatives to reduce smoking rates among adults are paying off," said Dr. Charles Powell. He directs the Mount Sinai--National Jewish Health Respiratory Institute in New York City. The latest figures were published online Nov. 17 by the CDC's National Center for Health Statistics. The CDC researchers said that men still smoke more than women, at 17 percent and about 13 percent, respectively. And people under 65 smoke more than seniors, with rates of about 16 percent and 8 percent, respectively. The 2014 statistics, released last week by the CDC, also suggested that the average number of cigarettes smoked each day has fallen as well -- from nearly 17 per day in 2005 to fewer than 14 by 2014. However, the CDC pointed out that smoking still kills half a million Americans every year, so the battle against the carcinogenic habit is far from over. "To get rates even lower, we need to put more resources and attention to our youth, for whom smoking rates are increasing and for whom the effects of cigarette smoke exposure can be particularly damaging," said Powell, who is also professor of medicine at the Icahn School of Medicine at Mount Sinai in New York. Another expert said new challenges have also emerged in the past few years. "While a drop in smoking in adults is encouraging, there is still the issue of teenage 'vaping' (electronic cigarettes) -- which often leads to smoking after the vaping habit is eliminated," said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City. "We cannot become complacent when looking at this drop in smoking in adults," he said. The CDC report on the 2014 data also found big disparities in rates of smoking between different groups. For example, investigators found that smoking rates among uninsured adults and Medicaid recipients were twice that of people with private insurance or seniors on Medicare. Those with only a high-school degree and non-whites also were far more likely to smoke than better-educated adults and/or whites, the researchers found. Smoking rates in 2014 were about 28 to 29 percent for the uninsured and for Medicaid enrollees, with similar numbers among multi-racial Americans, Native Americans and the very poor, the CDC reported. Among those with only a high school education, 43 percent were found to smoke in 2014. Still, progress is being made. Brian King, deputy director for research translation at the CDC's Office on Smoking and Health in Atlanta, pointed to some possible reasons why. "Interventions like increasing the price of tobacco and the passage of comprehensive smoke-free laws at both the state and local levels have made a difference," he said when the 2014 data was released. Mass-media education campaigns led by the CDC and the U.S. Food and Drug Administration have also contributed to dropping smoking rates, King added. However, as cigarette smoking declines, people are turning to other ways of getting nicotine, King said. "We're seeing increases in the use of e-cigarettes and hookah use, particularly among American youth," he said. "Going forward, we really need to carefully look at how all the different tobacco products are being used, and make sure we're not simply playing a game of whack-a-mole," King said.

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COPD World News Week of November 15, 2015

Anti-Smoking Programs May Sometimes Backfire

Hershey, PA - Programs that stigmatize smoking can backfire. That's the conclusion of new research that found that, while portraying smoking as socially unacceptable can persuade some smokers to quit, it can make others angry and defensive and harm their self-esteem, making it harder to quit. To reach that conclusion, the researchers reviewed nearly 600 studies. In one study, 27 percent of smokers felt they were treated differently due to their smoking. In another, between 30 percent and 40 percent of smokers reported experiencing high levels of family disapproval and social rejection. Yet another study found that 39 percent of smokers believed people thought less of them. In many studies, smokers used words such as "leper," "outcast," "bad person," "low-life" and "pathetic" to describe how negative public health messages about smoking made them feel. For some smokers, such stigmatization led to increased resistance to quitting, a return to smoking after quitting, increased stress and self-imposed social isolation. "The stereotypes that smokers deal with are almost universally negative," study co-author Sara Evans-Lacko said in a Pennsylvania State University news release. "The stigma for parents who smoke is particularly strong," added Evans-Lacko, a research fellow at the London School of Economics and Political Science in England. The findings show that while negative messages can persuade some smokers to quit, anti-smoking programs should also use positive approaches, such as highlighting the benefits of quitting, the researchers said. "Future research is needed to understand what factors are related to how individuals respond to smoking stigma," study co-author Rebecca Evans-Polce said in the news release. Evans-Polec is a postdoctoral fellow in Penn State's Methodology Center and the Bennett Pierce Prevention Research Center.

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COPD World News Week of November 8, 2015

Trends in Mortality From COPD Among Adults

Washington, DC - A recent study examined trends in mortality from COPD among US adults from 1968 to 2011. The COPD imposes a large public health burden internationally and in the United States. The objective of this study was to examine trends in mortality from COPD among US adults from 1968 to 2011. The data was taken from the National Vital Statistics System from 1968 to 2011 for 25 years of age or older. Among all adults, age-adjusted mortality rate rose from 29.4 per 100,000 population in 1968 to 67.0 per 100,000 population in 1999 and then declined to 63.7 per 100,000 population in 2011 (annual percentage change 2000-2011 was -0.2%. The age-adjusted mortality rate among men peaked in 1999 and then declined whereas the age adjusted mortality rate among women increased from 2000 to 2011, peaking in 2008. The study concluded that in the United States, the mortality rate from COPD has declined since 1999 in men but appears to be still rising in women, albeit at a reduced pace.

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COPD World News Week of November 1, 2015

COPD Foundation Hosts Second-Annual COPD Global Patient Leadership Summit

Washington, DC -  The 2nd COPD Global Patient Leadership Summit was held in Paris, France on October 28-30, 2015. Building on last year's summit in Madrid, Spain, this year's meeting welcomed patient representatives from additional countries – some traveling from as far as Australia, New Zealand, Singapore, China, and Canada.

Dubbed the 'United Nations of COPD,’ there were a number of informative presentations outlining problems, solutions, projects, and ambitions that dealt with regional as well as global issues. The event was organized by the COPD Foundation along with input from the leadership of a number of partner organizations.

Presentation topics included:
Genetic COPD: Rabiya Taok, Beirut, Lebanon
COPD in Urban Environment, Shirley Ngai, Hong Kong, China
COPD in Rural Environment, Adel Khattab, Cairo, Egypt
History of the Czech COPD/Lung Patients Organization, Stanislov Kos, Prague, Czech Republic
Pulmonary Rehabilitation: Thinking of the Patient's Needs, Jos Donkers, The Netherlands
How to influence government policy and advocate for better diagnosis and treatment, Lan Thi Thuyet, Vietnam
Pulmonary Rehab and Air Travel for COPD Patients: Dan Smyth, Ireland

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COPD World News Week of October 25, 2015

Yoga program effective in pulmonary rehab

Montreal, PQ - A supervised yoga program proved as effective as conventional pulmonary rehabilitation for patients with stable chronic obstructive pulmonary disease (COPD), a small clinical trial showed. The 6-minute walk test, Borg dyspnea scale, and self-rated dyspnea all improved significantly from baseline to 12 weeks among patients who received yoga training (P=0.014 to P<0.001). The patients' mean C-reactive protein (CRP) level declined by 30%, suggesting decreased inflammation, and quality-of-life (QOL) outcomes all improved but not significantly so. In contrast, a conventional pulmonary rehabilitation program led to significant improvement only in one (QOL) parameter. Between-group comparisons showed no significant differences for any of the outcomes, Randeep Guleria, MD, of the All India Institute of Medical Sciences in New Delhi, reported here at CHEST 2015. "Yoga is a cost-effective treatment and as effective as a standard pulmonary rehabilitation program," Guleria said. "An optimum regimen, comprising supervised outpatient and home-based exercise, needs to be developed." Whether yoga has a role in the management of COPD remains to be seen, but the results of the study suggest yoga could be an option for some patients, said discussion moderator Roger Goldstein, MD, of West Park Healthcare Center the University of Toronto. Moreover, culture differences that might have proven to be an obstacle to yoga as a COPD intervention have dissipated to a large extent. "Just over the past 10 years or so, clinicians in North America have become much more open to complementary and alternative medicine," Goldstein told MedPage Today. "Yoga instruction and participation have become more widely available and practiced. I think yoga could be a useful option for some patients with COPD. "However, this was just one small clinical study. Obviously, we need more information to determine whether yoga has a role in pulmonary rehabilitation, and if so, what that role might be." Yoga has been postulated as a potential aid to pulmonary rehabilitation. Anecdotal evidence and small, uncontrolled clinical evaluations hinted at a favorable effect of yoga on COPD outcomes, but the potential for yoga has remained unclear, Guleria said. To conduct a controlled trial of yoga in COPD, Guleria and colleagues enrolled patients with stable COPD symptoms and randomly assigned them to a standard pulmonary rehabilitation program or to a program of supervised yoga exercises. None of the patients had experience with yoga exercises before participating in the study. Prior to the study, the yoga instructor received information about COPD etiology, pathogenesis, and symptoms and developed exercises specific for the patient population, Guleria said.

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COPD World News Week of October 18, 2015

'Green' Public Housing May Help Families Breathe Easier

Boston, MA - Low-income families living in "green" public housing may have fewer problems with asthma and other respiratory conditions, a new study finds. Researchers found that children living in Boston's newer, greener public housing had fewer asthma attacks, hospital visits and missed school days, compared with their peers in standard public housing. Adults, meanwhile, were less likely to report symptoms consistent with a condition called "sick building syndrome" -- which include dizziness, headaches, nausea and eye irritation. The research, reported in the American Journal of Public Health, did not find a cause-and-effect link that proves green housing improves people's respiratory health. But it makes sense that it would, said lead researcher Meryl Colton, who was at the Harvard T.H. Chan School of Public Health in Boston when the study was conducted. It's known that indoor pollutants and allergens such as mold, cockroaches and cigarette smoke -- can trigger kids' asthma symptoms, explained Colton, who is now a medical student at the University of Colorado. And experts believe that exposure to those triggers partly explains why lower-income children are particularly hard-hit by asthma. "So we've got a likely mechanism to explain why green housing was associated with fewer symptoms," Colton said. Over the past decade, the Boston Housing Authority (BHA) has been moving toward greener public housing, Colton said. That has meant constructing new mid-rise buildings and townhouses with eco-friendly materials, solar panels on the roof, and a "tighter" exterior to make them more energy-efficient. But besides cutting heating and cooling costs, the greener designs also improve indoor quality, Colton explained. Mechanical ventilation systems move the "bad" air out and the fresh in. And common sources of indoor pollution are absent -- units have electric stoves rather than gas ones, for example. Green "policies" have been another key step, Colton said. Smoking is banned, and use of chemical pesticides has been slashed -- two moves the BHA has now extended to all public housing, according to background information in the study. Instead of spraying toxic fumes, buildings now use "integrated pest management," Colton said. That includes sealing up areas where pests can get in, and quickly fixing water leaks that can entice unwanted visitors. "They also educate residents on pest control, like limiting open food sources and reducing clutter," Colton said. "And if pests do get in, the buildings first use nonchemical methods, like bait traps." To see how all of those steps might be affecting residents' health, Colton's team visited 235 families living in one of three Boston public housing sites: 100 lived in green homes, and the rest lived in older, standard units. The group included 44 children with asthma, and the researchers found that those living in green housing were faring better. The kids were two-thirds less likely to have had an asthma attack in the past year, and 75 percent less likely to have made a trip to the hospital for worsening asthma. Meanwhile, adults in green housing reported 35 percent fewer symptoms of "sick building syndrome," attributed to indoor air pollution in modern buildings that are tightly sealed, but not necessarily well-ventilated. One medical expert not involved with the research was excited to see these study results. Dr. Elizabeth Garland, an associate professor of preventive medicine and pediatrics at Mount Sinai School of Medicine in New York City, has studied the effects of green public housing in New York. In a 2013 study, her team found similar benefits among children with asthma who were living in green buildings in the South Bronx, she said. "I think this really is the wave of the future," Garland said. In New York City, she noted, it is now law that all new affordable housing meet certain "green" standards. There is still more research to be done, according to Colton. "Are these health benefits maintained over time?" she said. "Is it possible that they increase?" Research into the financial side is also important. "Green housing does take a large initial investment," Colton said. But, she added, the move could pay for itself in the form of not only lower energy bills, but lower health care costs. "People sometimes think of 'green building' as an upper-middle-class luxury," Colton said. "But it can be much more than that." Even when cities are not in a financial position to start building new public housing, they can switch to green policies, both Colton and Garland said. Banning smoking and reducing chemical pesticides are two important steps, Garland said -- though, she added, that also means the public health system has to do a better job of helping people with smoking cessation. Garland also suggested that whenever possible, people take their own steps to clear the indoor air -- by avoiding chemical-containing air fresheners and opting for less-toxic cleaning products, for example.

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COPD World News Week of October 11, 2015

New Diagnostic for COPD

Lexington, Kentucky - A novel approach for the identification of COPD has been developed by a team of researchers in the USA. The findings, presented at ERS 2015, could speed up current diagnosis times for the disease and uncover COPD before serious exacerbations and further loss of lung function have occurred. This new study aimed at creating a simple tool, consisting of several questions that can be used with or without peak flow, to aid clinicians to find people with moderate or severe COPD, or people at risk of exacerbations of COPD before loss of lung function. As part of the study, 186 people with clinically-significant COPD were compared with a control group of 160 people with mild or no COPD. Both groups completed questionnaires and had their lung function measured using peak flow and spirometry. Authors used a method of analysis known as, random forests, to analyze the data and identify the best and smallest set of questions that differentiated patients with clinically significant COPD from controls. The value of adding peak flow to these questions was also assessed. The results produced a set of five “yes or no” questions that together can accurately identify people with moderate or severe COPD or people at risk of exacerbations of COPD. The questions ask about breathing, how easily a person tires and acute respiratory illness and did not ask about smoking, cough or sputum. When peak flow results were included the accuracy of the diagnosis was enhanced. “The results of our study indicate that a 5-item questionnaire of carefully selected questions can help identify people before they have serious complications of COPD,” said professor David Mannino, presenting author from the University of Kentucky College of Public Health. “This is also the first time a questionnaire has included assessment of exacerbation risk. Previous screening methods focused on smoking histories and sputum production. Our study also found that when clinicians include peak flow measurements in addition to the questionnaire, the identification of people with COPD is even more accurate. “We hope these findings will improve how physicians find COPD and benefit patients by identifying those with more severe disease and at risk of exacerbations so they can be treated.”

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COPD World News Week of October 4, 2015

Differences in Smokers, Non-smokers Developing Lung Cancer

Lisbon, Portugal - A group of Portuguese researchers has found significant differences in clinical particularities and survival between smokers and non-smokers who develop NSCLC. According to research presented at ERS 2015, scientists analyzed 904 Portuguese smokers and 504 Portuguese non-smokers with NSCLC and found that the non-smoking patients were more likely to be women, with adenocarcinoma (the most common form of NSCLC), with less COPD, heart disease, previous cancer of the larynx and weight loss. They also found that non-smokers had a significant longer survival after diagnosis: 51 months as opposed to 25 months for smokers. “In Portugal, information on the differences in the risk and survival between smokers and non-smokers with NSCLC, has been very limited up to now,” said Dr Cátia Saraiva, from the Department of Pulmonology, of Portuguese Institute of Oncology, Lisbon, Portugal. “We believe that the differences we found between the two groups will help improve diagnosis, and prompt investigators to try to find out why these differences occur.” “This is the first study to look at the differences in symptoms and prognoses in in non-smokers and smokers with NSCLC in Europe, says Dr Saravia. “We believe that we have made a major contribution towards improving diagnosis and treatment for these patients.” The researchers suggest further prospective studies in order to find different prognostic factors in the areas of ageing, human pre-disposition and life-style between the two groups. “In the non-smoking group, we found professional exposure to carcinogens in 9%, a family history of lung cancer in 5%, and a previous cancer diagnosis in 6%. Additionally, 18% had high blood pressure,” Dr Saraiva said. The non-smoking group were often diagnosed at an advanced stage of disease, 59% of them at stage IV, where the cancer had already spread to other parts of the body, namely different areas in the same lung, the opposite lung, bones, and brain. “It seems plausible that the non-smoking Portuguese population is not aware of lung cancer risks. But we need to confirm our results through population-based studies, before public education issues can be addressed,” says Dr Saravia.

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COPD World News Week of September 27, 2015

Novel Drug Shows Promise as COPD Therapy

Amsterdam, The Netherlands - An investigational inhaled drug for chronic obstructive pulmonary disease (COPD) inhibited neutrophil enhancement and inflammatory cytokine release in a small clinical study, a researcher reported here. The drug in question, still undergoing clinical trials, is known as AZD7624 (or simply 7624), an inhaled p38 inhibitor developed by AstraZeneca. The drug appeared to show promise for its anti-inflammatory properties when it was tested using lung and systemic markers of inflammation following a lipopolysaccharide (LPS) challenge. "The anti-inflammatory potential indicates 7624 as a novel treatment for COPD," said lead study author Naimish Patel, MD, PhD, a research scientist at AstraZeneca, the drug's manufacturer. "We can dampen some of the inflammation of COPD, but more remains to be seen in follow-up studies." Patel presented the findings at the European Respiratory Society International Congress. Patel and colleagues randomized 30 healthy volunteers in a double-blind, placebo-controlled cross-over study. Participants received a single inhaled dose of AZD7624 (1200 micrograms) or placebo 30 minutes prior to undergoing an LPS challenge, a test designed to trigger the body's inflammatory response mechanisms. Sputum induction followed 6 hours after the LPS challenge, and blood samples were taken at 0.25, 6.5, 12, and 24 hours post-dose in order to measure cell counts and inflammatory biomarkers. The research team found that inhaled AZD7624 reduced LPS challenge-induced inflammation in both sputum and blood, attenuating a sputum neutrophil differential increase of 56.8% (P<0.001) compared with the placebo. This reduction, Patel noted during his presentation, is more than twice that of other p38 inhibitors. The target is mitogen-activated protein kinase long recognized for its pro-inflammatory properties. During the study, AZD7624 also mitigated an increase of interleukin-6, an inflammatory cytokine, in the sputum by 76.5%, and led to attenuated differential increases of blood neutrophil counts by 43.5% and blood interleukin-6 by 70%. Perhaps most tellingly, however, AZD7624 completely inhibited the macrophage inflammatory protein known as MIP-1β or CCL4, in the blood. AZD7624 also attenuated the degree of C-reactive protein increase by 93% in the blood following the LPS challenge. There also was a significant change in sputum neutrophilia and interleukin 6, correlated with change in blood neutrophilia (R=0.531, P<0.0001) and interleukin-6 (R=0.492, P=0.0003). As a result of the findings, the study authors concluded, "inhaled AZD7624 significantly inhibits LPS-induced lung and systemic inflammation, and lung inflammation markers correlate with systemic markers indicating a potential for AZD7624 as an inhaled treatment for COPD." Though the study was a big first step, Patel said the research team is continuing to work to answer more questions about the drug. Patel and other AstraZeneca officials are currently recruiting participants for a phase IIa study to investigate the efficacy and safety of AZD7624 in COPD patients who are on standard maintenance therapy.

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COPD World News Week of September 20, 2015

Medical Costs Soar for Smokers Who Develop Artery Disease

Minneapolis, MN - Smoking significantly increases medical costs among people with peripheral artery disease (PAD), a new study suggests. PAD is a condition in which a buildup of plaque in the arteries restricts blood flow to the legs and feet. Researchers analyzed 2011 health insurance claims data from more than 22,000 PAD patients in Minnesota, and found that annual per-patient health care costs were $18,000 higher among smokers than among non-smokers. The hospitalization rate was 49 percent among smokers, 35 percent higher than among non-smokers, the findings showed. Smokers were more likely to be hospitalized for leg problems, heart attack and heart disease than non-smokers, the University of Minnesota Medical School researchers found. Sue Duval, an associate professor of cardiology and biostatistics, led the project. The study was published online Sept. 28 in the Journal of the American College of Cardiology. The findings highlight the need to get PAD patients to stop smoking, which can benefit their health and significantly reduce their medical costs, Dr. Elizabeth Jackson, of the University of Michigan Health System, wrote in an accompanying editorial.

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COPD World News Week of September 13, 2015

Ten-year trends in direct costs of COPD

Vancouver, BC - The objectives of this population-based study were to determine the excess costs of COPD and to look at the trend in costs from 2001 to 2010 in British Columbia. The data suggests that the direct economic burden of COPD is high and has increased significantly between 2001 and 2010. The increase is over and above the increase in the healthcare costs of the general population. The authors of the study used British Columbia’s administrative health data to construct a cohort of patients with COPD and a matched comparison cohort of subjects without COPD. They followed each patient from the time of first COPD-related health-care event (or equivalent time for the comparison cohort). The direct medical costs (in 2010 Canadian dollars) were calculated based on billing records pertaining to hospital admissions, outpatient services use, medication dispensations, and community care services. They determined the excess medical costs of COPD by calculating the difference in overall medical costs between the COPD and the comparison cohorts. The COPD and comparison cohorts comprised 153,570 and 246,801 people, respectively - for both cohorts. The mean age at entry was 66.9 years and 47.2% patients in the study were female. The excess costs of COPD during the study period were $5,452 per patient-year. Inpatient, outpatient, medication, and community care costs were responsible for 57%, 16%, 22%, and 5% of the excess costs, respectively. The researchers concluded that further investigation is required to elucidate the underlying reasons for the increase in COPD direct costs. The lead author of the study is Khakban A.

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COPD World News Week of September 6, 2015

Non-smokers Account for Rising Proportion of Lung Cancer Cases

Duarte, Ca - Non-smokers account for a growing percentage of aggressive lung cancer cases in the United States and the United Kingdom, new research finds. In one study, British researchers found that over seven years the proportion of U.K. never-smokers with non-small cell lung cancer jumped from 13 percent to 28 percent. Similarly, a study of lung cancer patients at three U.S. hospitals reported that never-smokers accounted for a growing percentage of non-small cell lung cancer patients between 1990 and 2013. These non-smokers with lung cancer were more likely to be women, the researchers said. The findings didn't surprise Dr. Karen Reckamp, medical director of the lung cancer and thoracic oncology program at the City of Hope Cancer Center in Duarte, Calif. "As smoking rates declined, we continue to see more patients diagnosed with lung cancer who do not have a prior smoking history," said Reckamp, who wasn't involved in either study. The lung cancer that affects non-smokers appears to be a different disease, Reckamp said. "We know that nonsmoking lung cancer is a distinct entity and often presents with specific genetic changes in the cancer that drive tumor growth," she said. She and other experts suspect genetic and environmental factors may be to blame. Non-small cell cancer -- by far the most common type -- is aggressive and usually diagnosed at a later stage when it is harder to treat, according to the American Cancer Society. It is especially challenging to detect in non-smokers because there are no known risk factors that merit screening, researchers said. The British findings were based on medical records for 2,170 U.K. patients who underwent surgery for lung cancer between 2008 and 2014. In the U.S. study, a team led by Dr. Lorraine Pelosof analyzed data on more than 12,000 lung cancer patients at the University of Texas Southwestern Medical Center at Dallas, Parkland Hospital in Dallas and Vanderbilt University in Nashville. Pelosof and colleagues compared data compiled from 1990-1995 and 2011-2013. "In 1990 to 1995, 9 percent of non-small cell patients were never-smokers. By 2011-2013, nearly 15 percent were," said Pelosof, an assistant professor of hematology-oncology at the University of Texas Southwestern Medical Center. In comparison, non-smokers with small cell lung cancers -- a less common form of disease -- increased only slightly, from 1.7 percent to 2.5 percent in the later period, the study found. Small cell cancers account for about 10 percent to 15 percent of U.S. lung cancer cases, the American Cancer Society says. Results of both studies were scheduled for presentation this week in Denver at a conference organized by the International Association of the Study of Lung Cancer. Data and conclusions should be considered preliminary until they're published in a peer-reviewed medical journal. Experts said they can't explain why non-smokers are a growing proportion of lung cancer diagnoses, or why women seem especially vulnerable. Besides smoking, Pelosof said, exposure to asbestos and radon are known risks for lung cancer. Genetic factors are thought to play a role, too. The increased proportion of non-smokers with lung cancer doesn't seem to be due to better diagnostic methods, she said. However, Pelosof acknowledged her team's findings need to be confirmed in other studies, noting that one limitation of her research is that participants' smoking status was self-reported. Reckamp said other studies are looking at genetic risk and family history to zero in on who might be at risk for these cancers, despite no tobacco exposure. Most lung cancers don't cause noticeable symptoms until the disease is advanced, says the American Cancer Society. However, if you have a persistent cough or bronchitis or hoarseness, the society recommends seeing your doctor for a checkup.

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COPD World News Week of August 30, 2015

U.S. Smoking Rate Falls to 15 Percent

Atlanta, GA - - The U.S. smoking rate continues to decline, with just over 15 percent of adults reporting they're current smokers, a new government survey reveals. That's down from nearly 17 percent in 2014 and almost 18 percent in 2013. The falloff reflects a continued decline that started in 2010 after a decade of no progress against smoking, the U.S. Centers for Disease Control and Prevention reported Tuesday. Higher tobacco taxes, tough anti-smoking messages and smoke-free laws that ban smoking from indoor and outdoor areas appear to be dissuading even hard-core, heavily addicted smokers from continuing the habit, said Patricia Folan, director of the Center for Tobacco Control at North Shore-LIJ Health System in Great Neck, N.Y. "I hear from smokers all the time, 'When I can't smoke here, I can't smoke there, when people see me smoke they look at me like I'm a pariah -- it makes me want to not smoke anymore,' " said Folan, who applauded the continued decline of smoking in America. The new data comes from the CDC's 2015 National Health Interview Survey, an annual survey that tracks a variety of public health issues. The smoking rate has fallen dramatically since 1965, when 42 percent of adults smoked, the CDC said. But between 2004 and 2009, progress stalled, and the U.S. smoking rate hovered around 20 percent. Anti-smoking activists wondered if there would be no way to convince the remaining diehard smokers to quit tobacco. These [new] numbers show that America's current anti-smoking strategy works, and that we need to do "more of the same," said Thomas Carr, director of national policy for the American Lung Association. Carr cited smoke-free laws as one innovation that's made a real difference. But he added that only one state -- North Dakota -- has passed a comprehensive smoke-free law within the last five years. There still are 22 states that haven't passed any limitations on where a person can smoke, he said. "It could have an impact on the smoking rate, and definitely would protect more people from secondhand smoke," Carr said. Carr and Folan also cited anti-smoking ads that feature smokers talking about the toll the habit has taken on their lives and their health. "Smokers find them so painful to watch that they keep changing the channel, but these ads are running everywhere," Folan said. She's heard from smokers that these spots have motivated them to quit and to resist the temptation to resume. The U.S. Food and Drug Administration's push to begin regulating other smoking products, such as cigars, hookahs and e-cigarettes, could also help further reduce the smoking rate, Carr added. "That's something the Obama Administration needs to move on," Carr said. Experts don't know whether e-cigarettes have played a role in the reduction of the smoking rate, as there haven't been enough studies conducted to assess their impact, Carr and Folan said. "We haven't seen the evidence of that yet," Carr said. "Up to 75 percent of the users are dual users. They use e-cigarettes and traditional cigarettes at the same time. That's not reducing your risk at all." Who continues to smoke? More men smoke than women -- 17 percent compared with 13 percent, the CDC reported. Race also plays a factor, with more blacks (18 percent) smoking than whites (17 percent) or Hispanics (10 percent). Folan believes that future anti-smoking efforts will need to be more targeted. For example, people without a high school diploma, people with low income, and those struggling with mental health issues or substance abuse are all groups that have proven resistant to the anti-smoking groundswell. Cliff Douglas, American Cancer Society vice president for Tobacco Control and director of the American Cancer Society's Tobacco Control Center, said the new numbers are "encouragingly consistent with the decrease we've seen since 2009, especially following the stagnation of the mid-2000s." Douglas said the differences in smoking between men and women and between the races "highlight the importance of something that's crucial to us -- addressing disparities in the tobacco epidemic."

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COPD World News Week of August 23, 2015

P.E.I. e-cigarette, vaping restrictions begin Sept. 1

Charlottetown, PEI - New restrictions on e-cigarettes and vaping products will go into affect on P.E.I. September 1.
Beginning on that date, e-cigarettes will be banned in the same places where regular cigarettes are not allowed. A person using an e-cigarette will have to be 15 feet away from an entryway.  By Oct. 1, the provincial government plans to restrict advertising and visibility of vaping products. Stores will be required to place them behind a barrier like tobacco products. The decision on whether government will move forward on a proposed ban of flavoured tobacco products has not been made said Joe Bradley, environmental health manager. "What the changes to the legislation have allowed is the province could regulate the sale of flavoured tobacco products in regulation," he said. "And what the department is proposing to do is to go out to public consultation, give the public opportunity to respond what they feel the restriction should look like." The consultations may take place in September. Bradley said it'll likely be early 2016 before any possible changes are made.

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COPD World News Week of August 16, 2015

COPD patients with psychological conditions have higher rates of early hospital readmission

Galveston, TX - Researchers from The University of Texas Medical Branch at Galveston found that people with a psychological condition such as depression, anxiety, psychosis, or alcohol/drug abuse are more likely to be readmitted early into a hospital for complications of chronic obstructive pulmonary disease. The study was recently published in the journal, Chest. “These psychological disorders are more likely to predict early readmission than other significant factors,” said Gurinder Singh, a fellow in the UTMB department of internal medicine, division of pulmonary critical care and sleep medicine. COPD is a serious public health concern that affects 12 to 24 million people and is the third leading cause of death in the U.S. Each year, thousands of people have acute COPD flare-ups that require hospitalization. About one in five of these patients require readmission within 30 days of discharge among older adults. Rehospitalizations among elderly patients with COPD costs around $924 million annually. In an effort to maximize health care resources, the U.S. Centers for Medicare & Medicaid Services penalizes hospitals when they have excess levels of early hospital readmissions for certain conditions under the Hospital Readmission Reduction Program. COPD, heart attack, congestive heart failure and pneumonia are part of this initiative. Reasons for early readmission are complex, and may be related to underlying severity of COPD, coexisting illnesses, outpatient follow-up and the presence of psychological disorders. Psychological conditions are common in patients with COPD. Up to 55 percent of patients with COPD suffer from anxiety or depression. Although there is growing understanding about the impact of psychological disorders on COPD, their role in early readmission has not been well understood. Using a sample of Medicare beneficiaries, the study examined the association of psychological conditions with early readmission for patients with COPD. Between 2001 and 2011, 135,498 hospitalizations occurred for COPD in 80,088 fee-for-service Medicare patents. Of these, 30,218 or 22 percent had one or more psychological conditions and their rate of early readmission was at 5 to 14 percent higher than patients without these conditions. These patients had a longer initial length of time in the hospital and a lower rate of outpatient follow-up visits within the first month after discharge.Patients with alcohol abuse, psychosis, more than one psychological condition and a low income level had even higher readmission rates. “This is likely related to the limited ability of these patients to handle the COPD, poor social support or community resources and non-adherence with treatment,” said Singh. “Because of the complexity of this situation, hospitals and health-care providers need more guidance to reduce readmission in patients with COPD, and it may not be practical to penalize hospitals for higher early readmission rates. More studies are needed in this area.” Other authors include UTMB’s Wei Zhang, Yong-Fang Kuo and Gulshan Sharma. This research was supported by the Agency for Healthcare Research and Quality, the Patient Centered Outcomes Research Institute, the National Institutes of Health and the UTMB Claude D. Pepper Older Americans Independence Center.

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COPD World News Week of August 9, 2015

Government of Canada launches Run To Quit smoking cessation program

Kamloops, BC - Cathy McLeod, Parliamentary Secretary to the Minister of Health and MP for Kamloops –Thompson - Cariboo, announced Run to Quit, a program to help smokers quit by incorporating running into their daily lives. She was joined by John Stanton, President of the Running Room and Martin Kabat, Chief Executive Officer of the Canadian Cancer Society (Ontario Division). Run to Quit is an innovative program in which participants learn to run 5 kilometres over 10 weeks while receiving support to quit smoking. Participants will be given two options to take part in the program: an in-person running clinic at a Running Room store, offered by a Run to Quit coach trained to deliver the smoking cessation curriculum as well as the running program; and an on-line running clinic they can complete at home which will include accessible online support by trained coaches. Each participant will receive free self-help materials developed by the Canadian Cancer Society and will be connected to the quit smoking helpline in their province or territory. All participants will also be entered into a "Quit and Win" challenge in which prizes and incentives will be provided. The project will roll out to all 100 Running Room locations over five years. It is expected that approximately 4500 Canadians will participate in Run to Quit through in-person clinics and online training. Run to Quit is Canada's first organized in-person and on-line smoking cessation program based on adopting running as a means to quit smoking paired with behavioural counselling and social support. Running has been shown to help 25% of smokers quit successfully compared to only 4% who quit without supports, i.e. cold turkey. A pilot project of Run to Quit in Ottawa demonstrated quitting rates of 29% six months after completion of the program (smoke-free for the previous 30 days), as well as higher physical activity rates. Tobacco is the leading cause of preventable death in Canada, and is a risk factor for chronic disease such as cancer, respiratory and cardiovascular disease. The risk of heart disease is cut in half after one year of quitting smoking, and the odds of getting many diseases go down the longer you are smoke free. The Public Health Agency of Canada, the Running Room, the Canadian Cancer Society and theUniversity of Toronto are investing $6.5 million in this initiative over five years.

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COPD World News Week of August 2, 2015

Lung function declines in COPD after steroid withdrawal

Leiden, The Netherlands - Patients with moderate to severe chronic obstructive pulmonary disease (COPD) experienced significant decreases in lung function for up to 5 years after discontinuing long-term inhaled corticosteroid (ICS) treatment, a Dutch study found. These patients also experienced steady worsening in airway hyper-responsiveness (AHR) and quality of life, according to investigators led by Lisette Kunz, MD, of Leiden University, The Netherlands, reporting in the journal CHEST. Previous ICS withdrawal studies have reported similar results, but those only followed patients for 6 to 12 months, Kunz and colleagues noted. ICS withdrawal in COPD patients has not been well studied overall, they said. The current study, involving 114 patients with moderate to severe COPD, was a follow-up to a randomized trial in which participants were assigned to 30 months of treatment with inhaled fluticasone (500 µg bid), 30 months of fluticasone plus salmeterol (500/50 µg bid), or placebo. The study authors reported previously that the 30-month ICS treatment decreased bronchial inflammation, attenuated lung function decline, and improved quality of life. After the treatment phase of the study, the patients were prospectively followed for 5 years. During this time, they were treated by their physicians according to standard guideline recommendations. Some of these patients continued ICS therapy, some did not, and some used it intermittently. Post-bronchodilator FEV1 (forced expiratory volume in 1 second), AHR, and quality of life were assessed at baseline, at 30 months, and annually during the 5 years of follow up. Only about half the patients (58) completed the study. Patients who used ICS during the treatment phase, but discontinued or used ICS intermittently during the 5 years of follow-up, showed significant annual declines in FEV1. For the fluticasone group the decline was -73mL/year (95% CI minus 119-minus 26;P=0.002). For the fluticasone plus salmeterol group the decline was -68 mL/year (95% CI minus 112-minus 25; P=0.002). These patients also experienced significant declines in methacholine PC20, indicating worsened AHR. For the fluticasone group, the decline was -1.1 doubling dose/year (95% CI minus 1.8-minus 0.5; P=0.001). For the fluticasone plus salmeterol group, the decline was -1.3 doubling dose/year (95% CI minus 2.0-minus 0.5; P=0.002). Finally, patients in the treatment groups who completely discontinued ICS during the follow-up experienced significant yearly declines in quality of life measures. These included a decline of 2.5 points per year on the St. George's Respiratory Questionnaire (P=0.03), a decline of 1 point per year on the Clinical COPD Questionnaire (P=0.03), and a decline of 0.2 points per year on the Medical Research Council Dyspnea Score (P=0.006). "We show that discontinuation of ICS after 30-month randomized treatment seems to accelerate lung function decline during five years of prospective follow-up, together with a deterioration in airway hyper-responsiveness and health-related quality of life," Kunz said. "Our results indicate that the benefits of long-term ICS treatment on COPD progression are confined to active treatment and are not sustained after long-term cessation of ICS," Kunz said. However, the study results are not enough to support continuing long-term ICS treatment in patients with COPD indefinitely, Kunz said. "The study was not designed to show evidence of continued benefits of prolonged ICS therapy," Kunz said. "In addition, only half of the patients completed the entire 7.5 years of follow-up, mostly due to the natural course of the disease with associated mortality and comorbidities." This small sample size could have led to a loss of statistical power and a selection bias, she noted. "Therefore, clinicians should follow the current guidelines for prescribing ICS in COPD patients while new studies will focus on long-term benefits of ICS," Kunz said.

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COPD World News Week of July 26, 2015

Exercise, But Not Vitamin D, Cuts Injuries From Falls in Older Women

Tampere, Finland - Neither routine exercise nor vitamin D supplementation does anything to lower the overall risk for accidental falls among older women, a new Finnish study says. However, the risk of serious injury as a result of falling was cut by more than half when elderly women engaged in regular exercise, according to the study. "Falls are the leading cause of unintentional injuries and fractures in older adults -- head injuries and fractures being the most severe consequences," explained study lead author Kirsti Uusi-Rasi, a senior researcher and adjunct professor with the UKK Institute for Health Promotion Research in Tampere, Finland. "Therefore, falls prevention is important when trying to prevent injuries." Uusi-Rasi and her colleagues discuss their findings in the March 23 online issue of JAMA Internal Medicine. Vitamin D is known to help preserve bone health, but Uusi-Rasi noted that prior research exploring the relationship between vitamin D supplements and/or strength and balance training and fall risk among seniors has been inconclusive. To explore the protective potential of both exercise and vitamin D, investigators focused on just over 400 women between the ages of 70 and 80. The women lived at home in Finland during the study period between 2010 and 2013. None were deficient in vitamin D prior to the study. Participants were divided into four groups: a vitamin D alone group; a vitamin D with exercise group; an exercise alone group; and a group that neither exercised nor took vitamin D. Those taking vitamin D were given a daily dosage of 800 IUs. Those who exercised did so under the supervision of physical therapists in a class setting, twice a week for the first year and once-weekly classes during the second year. Classes focused on improving balance, strength, agility, movement, and the ability to lift weight. The result: Over the course of two years the risk for falling was found to be more or less equal across all groups. However, supervised physical training was associated with a dramatically lower risk for serious injury when falls did happen. Serious injury was defined as experiencing a fall that results in having to seek medical care for bruising, abrasions, contusions, sprains, fractures and/or head injuries. The study suggests that "exercise seemed to be more effective in reducing injurious falls in this age group," Uusi-Rasi said, "with or without vitamin D." By contrast, vitamin D supplements were not linked to a lower risk for serious injury, whether taken alone or in combination with exercise. Vitamin D supplements did help maintain, or even slightly increase bone density in certain areas, according to the study. "Exercise improves functionality," said Uusi-Rasi, who added that the women who exercised showed improvements not only in muscle strength and power, but also in mobility and balance. Such improvements, she theorized, might generally enable older women to fall in a safer way, though her team did not specifically explore that question. Although the study didn't include male participants, Uusi-Rasi said exercise is probably equally protective for men. She noted that earlier research has suggested that exercise has a similar beneficial impact across gender. In an accompanying editorial, Dr. Erin LeBlanc, an investigator with the Kaiser Permanente Center for Health Research in Portland, Ore., cautioned that the conclusions about vitamin D may not apply to all seniors, given that the Finnish pool of subjects were all white females who started the study with optimal vitamin D levels. "[It's] surprising because previous studies have found that vitamin D can prevent falling," LeBlanc said. "But the studies have all been slightly different, and these differences could explain the different findings." On that score, she noted that it's possible that the specific vitamin D dosage offered to the Finnish group was somewhat lower than ideal. Regardless, LeBlanc argued that it's too soon to rule out vitamin D as a fall preventative, given that it -- and exercise -- are both inexpensive and low-risk, and have previously been associated with fostering greater muscle strength and balance.

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COPD World News Week of July 19, 2015

Secondhand Smoke Tied to Raised Stroke Risk in Study

Charleston, SC - New research suggests that exposure to secondhand smoke may increase non-smokers' risk of stroke by nearly one-third. "Our findings suggest the possibility for adverse health outcomes such as stroke among non-smokers exposed to secondhand smoke and add to the body of evidence supporting stricter smoking regulations," said lead author Angela Malek, of the Medical University of South Carolina in Charleston. Researchers analyzed data from nearly 22,000 white and black American adults older than 45. About 23 percent said they were exposed to secondhand smoke in the previous year. Between April 2003 and March 2012, there were 428 strokes among the study participants. There were 352 ischemic strokes (blockage of blood flow to the brain), 50 bleeding (hemorrhagic) strokes, and 26 strokes of unknown subtype. After adjusting for other stroke risk factors -- such as diabetes, high blood pressure and heart disease -- the researchers found that exposure to secondhand smoke was linked to about a 30 percent increase in non-smokers' risk of stroke. However, the association seen in the study does not prove a cause-and-effect relationship. The study was published recently in the American Journal of Preventive Medicine. "Future research will need to investigate the role of cardiovascular disease risk factors in the association and explore potential exposure to additional environmental variables, such as ambient air pollutants, in relation to stroke," Malek said in a journal news release. Each year, nearly 800,000 Americans suffer a stroke. Strokes cause one of every 19 deaths in the United States and are a leading cause of disability.

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COPD World News Week of July 12, 2015

Statins might reduce complications after major lung surgery

New York, NY - Widely used cholesterol-lowering drugs known as statins might help reduce major complications after lung surgery, new research suggests. Statins have been linked to fewer complications after heart surgery, and researchers at Memorial Sloan Kettering Cancer Center in New York City theorized they might also benefit patients undergoing major lung surgery. The researchers randomly assigned more than 160 study participants to receive the statin Lipitor (atorvastatin) or an inactive placebo before and after lung resection -- removal of part of the lung. Complications -- such as pneumonia, heart attack and acute respiratory failure -- were reported in 22 percent of patients receiving placebo, compared with 12 percent taking statins. Statins were also linked to a nearly 50 percent reduction in post-surgery rates of atrial fibrillation (abnormal heart rhythm), the researchers said. While the results are encouraging, they were not statistically significant. However, a subsequent analysis revealed an encouraging trend. The combined rates of major lung and heart complications in those undergoing surgery were three times higher in the placebo group than in the statin group, according to the study published in the June issue of the Journal of Thoracic and Cardiovascular Surgery. The study originally called for the enrollment of 480 patients. Due to difficulty finding people who had never taken statins, however, the study only included 164 participants and ended early, the authors noted in a news release from the American Association for Thoracic Surgery. "Imagine all the people who could potentially have benefited from the knowledge gained by this trial had it accrued as originally intended," said Dr. Betty Tong, a cardiovascular and thoracic surgeon at Duke University Medical Center in Durham, N.C., and author of an editorial accompanying the report. With continued clinical trials at multiple centers, "we will be able to elucidate further the role of therapies such as this in preventing complications after lung resection," Tong said in the news release. The study authors said a larger controlled study is needed to further investigate the potential benefits of statins for lung surgery patients before recommending them as standard clinical practice.

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COPD World News Week of July 5, 2015

Early Life Lung Function Gives Insight in COPD

Boston, MA - COPD patients who had lower lung function measures prior to turning 40 were more likely to develop COPD 20 years later compared with those who had higher lung function, an investigation into three independent cohorts found. Out of 657 participants who had forced expiratory volume in 1 second (FEV) of less than 80% of the predicted volume at baseline, 26% developed COPD 22 years later, however among 2,207 individuals who had FEV measures of 80% or better before turning 40 only 7% developed COPD after 22 years (P<0.001), according to Peter Lange, MD, DrMedSc, of Copenhagen University in Denmark, and colleagues. "The main new finding of this study is that the lung-function value reached in early adulthood seems to be important with respect to the diagnosis of COPD later in life," the authors wrote in the New England Journal of Medicine. "[I]t is important to continue to focus on cigarette smoking, which remains the major risk factor for the development of disease," Frank E. Speizer, MD, of Harvard Medical School, and James H. Ware, PhD, of the Harvard School of Public Health, wrote in an editorial in the New England Journal of Medicine. With inevitable weaknesses in the design of this study (i.e. selection effects, regression to the mean), and the difficulties involved with being able to conduct a better study (i.e. large cohort tracked from childhood through COPD progression), Speizer and Ware suggest not much will change in clinical practice with the knowledge presented by Lange's group. Lange's team pooled data from three independent studies: the Framingham Offspring Cohort, the Copenhagen City Heart Study, and the Lovelace Smokers Cohort. They collected the data on participants and split the groups into those who had high FEV (≥80%) or those who had low FEV (<80%) before turning 40, and then sorted them again based on who developed COPD from ages 50-65 and who didn't. Lange's team wrote that they recognized that COPD has a wide range of individual trajectories, and that dichotomizing persons with COPD into two specific trajectories was artificial, but nonetheless, conceptually helpful for understanding the nature of the disease.

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