COPD World News Week of June 28, 2015

Millions of Smokers May Have Undiagnosed Lung Disease

Denver, CO - Millions of long-term smokers may have undiagnosed lung disease, a new study finds. Fifty-five percent of those who pass lung function tests still have a respiratory impairment, researchers report. But, using advanced imaging techniques along with walking and quality-of-life tests can reveal early signs of chronic obstructive pulmonary disease (COPD). An incurable, progressive disease, COPD is associated with smoking and is the third-leading cause of death in the United States, the researchers added. "Smokers who have 'normal' lung-function tests often have significant respiratory disease. Many of those smokers likely have the early stages of chronic obstructive pulmonary disease," study author Dr. Elizabeth Regan, an assistant professor of medicine at National Jewish Health in Denver, said in a hospital news release. "We hope these findings will help debunk the myth of the healthy smoker and highlight the importance of smoking prevention and cessation to prevent lung disease and other long-term effects of smoking," Regan added. The study involved almost 9,000 people between the ages of 45 and 80 who had smoked at least one pack of cigarettes daily for 10 years. Most smoked more than one pack per day, but about half of them were considered disease-free based on their lung-function test results. To diagnose COPD, patients must blow as hard and as long as they can into a device called a spirometer. This measures how much air they can force out of their lungs and how much they can blow out in just one second depending on their age, size and gender. When the researchers used additional criteria to assess the participants' lung function, such as CT scans, use of respiratory medication and quality-of-life issues, they found most of those considered "disease-free" had some sort of lung problem. The study was published June 22 in the journal JAMA Internal Medicine. Lung scans found emphysema or airway thickening in 42 percent of those thought to be free of lung disease. Meanwhile, 23 percent of the participants had significant shortness of breath compared to almost 4 percent of those who never smoked. The researchers also found that 15 percent of those in the study took six minutes to walk about 1,000 feet, compared to 4 percent of nonsmokers. Smokers who thought their lungs were fully functioning also had much worse quality of life than those who didn't smoke. Lung imaging tests can help detect lung cancer, and reduce cancer deaths among former heavy smokers by 20 percent, the researchers said. Diagnosing and treating diseases like COPD early on can also improve people's long-term quality of life, they added.

For more information:

COPD World News Week of June 21, 2015

New COPD drug, Anoro Ellipta, now covered on Ontario formulary

Toronto, ON - Great news for Ontario COPD patients. Another new combination bronchodilator has been approved for coverage on the provincial formulary. The Ontario Public Drug Programs (OPDP) has announced its listing of ANORO™ ELLIPTA® on the provincial formulary as a Limited Use (LU) benefit for the long-term treatment of patients with moderate to severe chronic obstructive pulmonary disease (COPD) who have had an inadequate response to a long-acting bronchodilator (i.e., long-acting beta-2 agonist [LABA], or long-acting muscarinic antagonist [LAMA]). The effective date of the listing on the formulary is June 29, 2015. The time between announcement date (June 23, 2015) and effective date allows pharmacists to ensure systems are updated to reflect new product listings. The LU authorization period is for an indefinite length of time. The manufacturer of Anoro Ellipta is GlaxoSmithKline of Mississauga, ON. The COPD disease severity is based on spirometry tests, symptoms and disability. Moderate COPD is defined as shortness of breath from COPD causing the patient to stop after walking approximately 100m (or after a few minutes) on a level surface. Severe COPD is defined as shortness of breath from COPD resulting in the patient being too breathless to leave the house, breathless when dressing or undressing or the presence of chronic respiratory failure or clinical signs of right heart failure. Classification by impairment of lung function is based on spirometry testing (post bronchodilator) FEV1 predicted: Moderate: 50 to 79 percent; Severe: 30 to 49 percent; Very severe: Less than 30 percent.

For more information:

COPD World News Week of June 14, 2015

Seeing Their Clogged Arteries Can Spur Healthy Changes in Patients

Aarhus, Denmark - Seeing images of their narrowed heart arteries may convince some heart disease patients to adopt a healthier lifestyle and take prescribed medications, a new study suggests. "Seeing their calcified coronary arteries on the CT image was clearly an eye-opener for patients. We received comments such as, 'It is my coronary artery and my coronary artery calcification and I am facing a real risk and challenge,' " said study author Rikke Elmose Mols, a nurse and Ph.D. student at Aarhus University Hospital-Skejby in Denmark. "This may be the wake-up call patients need to take their medication and modify their behaviors to reduce their risk of having a coronary artery event," Mols said in a European Society of Cardiology news release. The research included 189 people recently diagnosed with early stage heart disease. Half were shown a CT image of calcium buildup on the walls of their heart arteries, a condition called coronary artery calcification. In addition, a nurse told the patients about the link between coronary artery calcification and the increased risk of heart problems, and gave them advice about a healthy diet, exercise, quitting smoking, controlling blood pressure and taking aspirin and cholesterol-lowering statin drugs. The other half of participants did not see images of their scans and were given standard follow-up, which included advice on reducing lifestyle and risk factors for heart disease. The patients who saw the images of their narrowed heart arteries were more likely to switch to a healthier diet, lose weight and stop smoking. They were also more likely to continue taking statins, which led to lower cholesterol levels. For example, just 9 percent of people who saw their arteries continued to smoke compared to 22 percent of the group given standard treatment. And just 44 percent of those who saw their blood vessels continued to eat unhealthy foods versus 64 percent of those in the usual care group. "The results of our study suggest that visualizing their health threat motivates patients to make changes to reduce their risk. A large-scale study is needed to confirm the findings and to determine the cost-effectiveness of implementing this intervention in clinical practice," Mols said. The study was to be presented June 15 at a European Society of Cardiology meeting in Dubrovnik, Croatia. Findings presented at meetings are generally viewed as preliminary until they've been published in a peer-reviewed journal.

For more information:

COPD World News Week of June 7, 2015

Company Receives Orphan Drug Designation for ARC-AAT

Madison, Wisc. - Arrowhead Research Corporation, a biopharmaceutical company developing targeted RNAi therapeutics, today announced the United States Food and Drug Administration (FDA) has granted ARC-AAT orphan drug designation. ARC-AAT is Arrowhead’s RNAi-based therapeutic candidate being investigated for the treatment of liver disease associated with Alpha-1 Antitrypsin Deficiency (AATD), a rare genetic disease that severely damages the liver and lungs of affected children and adults. Arrowhead is currently conducting part B of a Phase 1 study of ARC-AAT in patients with PiZZ genotype AATD. "Receiving orphan drug designation is an important milestone in the development of ARC-AAT, which we think is a very promising program aimed at providing a better option for patients with liver disease associated with alpha-1 antitrypsin deficiency,” said Bruce D. Given, M.D., Arrowhead’s Chief Operating Officer. “The Orphan Drug Act provides important incentives for sponsors to develop drugs that treat rare diseases and we look forward to more engagement with the FDA as the development of ARC-AAT progresses.” The ongoing Phase 1 trial of ARC-AAT is a multi-center, randomized, placebo-controlled, double-blind, single dose-escalation first-in-human study to evaluate the safety, tolerability and pharmacokinetics of ARC-AAT and the effect on circulating AAT levels. The study has been enrolling in dose cohorts of six participants each, with participants randomized at a ratio of 2:1 (active:placebo) to receive a single intravenous injection of either ARC-AAT or placebo (normal saline). The study consists of two parts; Part A in healthy volunteers, which has been completed, and Part B to be conducted in patients with PiZZ genotype AATD. The study evaluates participants for 28 days following dosing, with additional follow-up if needed every 2 weeks until AAT levels return to baseline. The FDA Office of Orphan Products Development (OOPD) mission is to advance the evaluation and development of products that demonstrate promise for the diagnosis and/or treatment of rare diseases or conditions. In fulfilling that task, OOPD evaluates scientific and clinical data submissions from sponsors to identify and designate products as promising for rare diseases and to further advance scientific development of such promising medical products. Orphan drug designation provides incentives for sponsors to develop products for rare diseases. These incentives include increased engagement with FDA on drug development activities, exemption from all future product-specific regulatory fees, the opportunity to apply for R&D funding, tax credits, an increased chance of priority review, and 7 years of orphan exclusivity at time of New Drug Application (NDA) approval.

For more information:

COPD World News Week of May 31, 2015

Trial results show effectiveness of Alpha-1 augmentation therapy

London, UK - Investigators in the RAPID Trial demonstrated the effectiveness of augmentation therapy in slowing emphysema due to Alpha-1 Antitrypsin Deficiency. The trial was published in The Lancet, one of the world’s oldest and most prestigious medical journals. The Lancet article was posted online this week. When the results were first announced at the international conference of the American Thoracic Society (ATS) in 2013, lead author Kenneth Chapman, MD, director of the Asthma and Airway Centre of the University Health Network in Toronto, Canada, called the trial “the most rigorous evidence to date that augmentation therapy slows the progression of emphysema in patients with Alpha-1 Antitrypsin Deficiency. The effect of A1-PI seen in this trial was both clinically and statistically significant, finally confirming its benefit in preventing the loss of lung tissue in patients with this potentially debilitating disease.” The Alpha-1 Foundation hailed the trial results and The Lancet publication. "We congratulate CSL on this landmark clinical trial, which provides the strongest evidence yet that augmentation therapy preserves the lung tissue of individuals with Alpha-1-related lung disease," said John Walsh, Foundation president and CEO. "We hope these results will support Alpha-1 communities around the world in their efforts to win access to therapy.” Walsh said, The Lancet article says that an interim analysis of data from the two-year extension trial suggest that early treatment with augmentation therapy shows persistent efficacy in patients with Alpha-1 and emphysema. In addition, when patients who had been receiving a placebo in the original two-year trial switched to treatment with augmentation therapy, their lung density decline (which was more rapid than the treated group in the main study) slowed to the same rate as the treatment group. “These findings should encourage early introduction of augmentation therapy [in patients with emphysema due to Alpha-1] and should stimulate further research into optimum dosing,” says the Lancet article.

For more information:

New bronchodilator approved on provincial formularies

Montreal, PQ - Great news for people with COPD in Ontario, New Brunswick, BC and the Yukon. Ultibro, a new long-acting combination LABA/LAMA bronchodilator is now available for coverage on these provincial formularies. Some conditions do apply based on spirometry results, symptoms and disability. However, this new class of LABA/LAMA combination product is a welcome addition to available therapies for the long-term treatment of patients with moderate to severe COPD who have had an inadequate response to either a LAMA or LABA product in the past. The manufacturer of Ultibro is Novartis Pharmaceuticals of Montreal.

For more information:

COPD World News Week of May 24, 2015

COPD Raises Cardiac Death Risk for Those With Irregular Heartbeat

Durham, NC - Chronic obstructive pulmonary disease (COPD) increases the risk of all-cause and heart-related death in people with the common heart rhythm disorder known as atrial fibrillation, a new study finds. However, COPD doesn't increase the risk of stroke, the researchers said. COPD is a term used to describe the diseases emphysema and chronic bronchitis. COPD is the third leading cause of death in the United States, according to the U.S. Centers for Disease Control and Prevention. "Other studies have shown that COPD is an independent risk factor for cardiovascular disease, but what hadn't been studied was whether COPD was an independent risk factor for stroke, specifically among patients with atrial fibrillation," study author Dr. Michael Durheim, a pulmonary and critical care fellow at Duke University in Durham, N.C., said in an American Thoracic Society news release. Atrial fibrillation is a known risk factor for stroke and blood clots because when the heart beats irregularly, it allows blood to pool and clots to form. For the study, researchers looked at more than 18,000 people with atrial fibrillation. Of those, 1,950 had COPD. Those with COPD were older, and more likely to be current or former smokers. They were also more likely to have other diseases that increase the risk of stroke, including coronary artery disease, heart failure and a prior heart attack, the researchers said. People with COPD had a 54 percent increased risk of death from all causes, including from heart-related problems such as heart disease and heart attack. However, COPD was not associated with an increased risk of stroke or a systemic embolism. Systemic embolism occurs when a blood clot in the heart travels to another part of the body and blocks blood flow. This usually occurs in the brain, but can occur in other parts of the body. Because COPD independently increases the risk of death in people with atrial fibrillation, further research is needed to determine how COPD increases this risk, Durheim said. The findings may change how these patients are treated, he added. The study was scheduled to be presented Wednesday at the American Thoracic Society meeting, in Denver. Findings presented at meetings are generally viewed as preliminary until they've been published in a peer-reviewed journal.

For more information:

COPD World News Week of May 17, 2015

Rural Poor Bear Higher Burden of COPD, Study Finds

Baltimore, MD - Being poor and living in a rural area are two risk factors for chronic obstructive pulmonary disease (COPD), a new study finds. COPD is a progressive and incurable lung condition that involves a combination of emphysema and chronic bronchitis. It is often linked to smoking, and is the third leading cause of death in the world. In the new study, researchers led by author Dr. Sarath Raju of the Johns Hopkins School of Medicine in Baltimore reviewed data from almost 88,000 American adults older than 40. They found that 7.2 percent of them had COPD. However, the rate of COPD was closer to 12 percent among those who lived in poor and rural areas, Raju's team found. Why would people in rural areas be at higher risk? The reasons aren't clear, the team said. They said there's a need for research "to understand the potential contribution of occupational exposures, fuel sources and indoor air pollutants to COPD prevalence in poor, rural areas." The study was to be presented Tuesday in Denver at the annual meeting of the American Thoracic Society. Experts note that findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal. SOURCE: American Thoracic Society, news release, May 19, 2015

For more information:

COPD World News Week of May 10, 2015

Expert Panel Unclear on Whether E-Cigarettes Help Smokers Quit

Great Neck, NY - An influential U.S. panel of experts says there's just not enough data to decide whether or not e-cigarettes can help smokers quit. For now, the U.S. Preventive Services Task Force (USPSTF) recommends behavioral therapy and federally approved medications, such as nicotine replacement treatments, for most adults seeing to kick the smoking habit. The exception: pregnant women. For them, the task force recommends behavioral therapy alone. In any case, doctors "should ask all patients whether they smoke, and provide appropriate interventions to help smokers quit," task force member Dr. Francisco Garcia said in a statement provided by the task force. "We're fortunate that doctors and patients have a choice of many interventions that have been proven to be effective," he said. The task force, an independent panel of volunteers, makes recommendations about the prevention of medical problems through strategies like screenings, counseling services and medications. According to the USPSTF, an estimated 18 percent of U.S. adults are smokers, and smoking remains the country's most serious preventable cause of death, disability and illness. Smoking causes 480,000 premature deaths a year, the task force said, and is responsible for about 20 percent of deaths. E-cigarette use is continuing to boom in popularity across the United States, and some proponents of the "vaping" device say it provides a safer alternative to cigarettes and a potential "bridge" to quitting. However, the USPSTF said there simply isn't enough good research for the panel to make a decision about whether e-cigarettes are a good idea for adults who wish to stop smoking. One expert agreed. "More studies are needed to determine the potential risks and benefits of these products before they are recommended to patients as smoking cessation aids," said Patricia Folan, director of the Center for Tobacco Control at North Shore-LIJ Health System in Great Neck, N.Y. She also stressed the importance of helping pregnant women quit the habit. "Smoking during pregnancy not only results in harm to the child in utero, but will also result in exposure to the hazards of secondhand smoke for the child if the mother is unable to quit or remain quit," Folan said. The task force will accept public comment on its recommendations until June 1.

For more information:

COPD World News Week of May 3, 2015

Study finds inhibitor for COPD lung destruction

Providence, RI - In a new study, a research team based at Brown and Yale implicates a specific mitochondrial protein and pathway in the development of chronic obstructive pulmonary disease (COPD) from exposure to cigarette smoke. Observations in human patients and experiments in mouse models show that suppression of the protein is a major cigarette-induced signature of the emphysema lung destruction that is seen in COPD. “This is a new school of thought in terms of what causes emphysema and a new school of thought regarding how cigarette smoke does what it does,” said pulmonologist Dr. Jack A. Elias, dean of medicine and biological sciences at Brown University and corresponding author of the study in the Journal of Clinical Investigation. “We’re showing that a lot of what’s going on is related to mitochondria.” In COPD the damage to lung tissue is done by an errant mitochondrial immune response pathway called the “MAVS/RIG-I-like helicase pathway,” whose natural purpose is to fight off viruses and provide other innate immune responses. The protein investigated in the new study, NLRX1, is a known inhibitor of the pathway. Its effect can be thought of as comparable to the sheet of glass that must be broken before someone can use a fire extinguisher. Under normal circumstances the glass prevents the extinguisher from being activated and NLRX1 prevents the MAVS/RIG-like helicase pathway from being activated. In COPD, cigarette smoke breaks the NLRX1 glass, unleashing an overly exuberant reaction under an inappropriate condition with awful results for patients. “Our observation is that NLRX1 is a critical inhibitor of MAVS/RIG-like helicase signaling that is affected by cigarette smoking exposure,” said study lead author Min-Jong Kang, a researcher at both Yale and Brown. The findings could eventually yield improvements in care, the researchers said. In one of the key experiments in mice, the scientists showed that promoting the overexpression of NLRX1 restored suppression of the MAVS/RIG-like helicase immune response, blocking the development of disease. In addition, by showing the key role of a measurable protein and associated gene, the researchers said, the study could lead to a new way of assessing a patient’s risk of developing COPD and could potentially predict its severity.

For more information:

COPD World News Week of April 26, 2015

COPD Tied to Raised Risk for Sudden Cardiac Death

Ghent, Belgium - Chronic obstructive pulmonary disease (COPD) is already the third leading cause of death in the world, and a new European study finds the respiratory illness might also raise a person's odds for sudden cardiac death. COPD is a progressive and incurable illness that involves a combination of emphysema and bronchitis, and is often tied to smoking. The researchers said that the disease has already been associated with an increased risk of heart disease and sudden cardiac death in certain high-risk patient populations. Now, the new study "shows that COPD is a risk indicator for sudden cardiac death in the general population, and that the risk increases with COPD severity," wrote a team led by Dr. Lies Lahousse, a postdoctoral researcher at Ghent University Hospital in Belgium. One expert in the United States said that even though the study can't prove that COPD helps trigger sudden cardiac death, the European findings aren't surprising. "Many patients who have COPD are or were smokers, and smoking is the number one cause of heart disease," said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City. "COPD is also associated with cardiac arrhythmia, such as atrial fibrillation," he added. Atrial fibrillation is an irregular heartbeat. "These events can lead to sudden cardiac death." The new study involved more than 13,000 people aged 45 and older, more than 1,600 of whom were diagnosed with COPD. Over the course of the study, 39 percent of the participants died. Of those deaths, 551 were related to sudden cardiac death. Breaking it down even further, the researchers found that 15 percent of those who died of sudden cardiac death had COPD. Overall, a diagnosis of COPD increased the risk for sudden cardiac death by 34 percent, the team concluded. Five years after being diagnosed with the lung condition, however, that risk nearly doubles, according to the study published online April 29 in the European Heart Journal. After five years of living with COPD, the risk for sudden cardiac death becomes more than threefold higher for people who suffer frequent COPD symptom flare-ups, such as shortness of breath and coughing, the findings showed. The study participants with COPD who experienced sudden cardiac death were more likely to die during the night, the researchers said. That last finding suggests that cardiac arrhythmias may play a role, according to Dr. Girish Nair, director of the Interstitial Lung Disease Program and Pulmonary Rehabilitation at Winthrop-University Hospital in Mineola, N.Y. He also wondered about the role of COPD medications. "Presuming that patients with more frequent [COPD] exacerbations are using inhalers more often, future studies should look into possible interactions between various medications and other mechanisms related with sudden cardiac death in this particular subset of patients," Nair said. There are ways to lessen heart risks for COPD patients, the researchers stressed. Some preventative treatments include beta-blocker medications, implanted defibrillators to regulate heartbeat, or avoiding certain drugs that affect the heart's electrical cycle, such as adrenaline, certain cold remedies, some antibiotics and antidepressants. Avoiding cigarettes and other tobacco products is also essential, the study authors added. "The most important way to prevent COPD and sudden cardiac death is not to smoke and to have a healthy lifestyle," study co-author Dr. Marieke Niemeijer of Erasmus Medical Centre in Rotterdam, the Netherlands, said in a journal news release. "If a person does develop COPD, then this is even more important, as smoking, an unhealthy and a sedentary lifestyle have been proven to increase the risk of sudden cardiac death." According to background information in the study, sudden cardiac death is responsible for about 50 percent of all heart disease deaths worldwide. There are several causes of sudden cardiac death, which makes diagnosis and treatment of the condition more difficult.

For more information:

COPD World News Week of April 19, 2015

Most Smokers Will Die Early If They Don't Quit

Canberra, Australia - Two-thirds of smokers will die early from their habit if they don't quit, a new study suggests. The findings indicate that it's never too late to quit smoking, one expert said. Researchers analyzed data from more than 200,000 people taking part in a study conducted by the Sax Institute in Australia. The study is a long-term investigation of healthy aging. "We knew smoking was bad, but we now have direct independent evidence that confirms the disturbing findings that have been emerging internationally," Emily Banks, scientific director of the Sax study and a researcher at the Australian National University, said in an institute news release. "Even with the very low rates of smoking that we have in Australia, we found that smokers have around threefold the risk of premature death of those who have never smoked. We also found smokers will die an estimated 10 years earlier than non-smokers," she added. Compared with not smoking, having just 10 cigarettes a day doubles the risk of dying early. And smoking a pack a day increases the risk four- to fivefold, according to the study published Feb. 24 in the journal BMC Medicine. It was long thought that smoking-related diseases would kill about half of smokers early, but newer research has put the figure as high as 67 percent. This study gives further credence to that larger death toll, the study authors noted in the news release. The findings offer an important message to smokers, according to Scott Walsberger, tobacco control manager at the Cancer Council NSW in Australia. "It's never too late to quit, no matter what your age or how much you smoke," Walsberger said.

For more information:

COPD World News Week of April 12, 2015

Scientists coax stem cells to form 3-D mini lungs

Ann Arbor, MI - Previous research has focused on deriving lung tissue from flat cell systems or growing cells onto scaffolds made from donated organs. In a study published in the online journal eLife the multi-institution team defined the system for generating the self-organizing human lung organoids, 3D structures that mimic the structure and complexity of human lungs. "These mini lungs can mimic the responses of real tissues and will be a good model to study how organs form, change with disease, and how they might respond to new drugs," says senior study author Jason R. Spence, Ph.D., assistant professor of internal medicine and cell and developmental biology at the University of Michigan Medical School. The scientists succeeded in growing structures resembling both the large airways known as bronchi and small lung sacs called alveoli. Since the mini lung structures were developed in a dish, they lack several components of the human lung, including blood vessels, which are a critical component of gas exchange during breathing. Still, the organoids may serve as a discovery tool for researchers as they churn basic science ideas into clinical innovations. A practical solution lies in using the 3-D structures as a next step from, or complement to, animal research. Cell behavior has traditionally been studied in the lab in 2-D situations where cells are grown in thin layers on cell-culture dishes. But most cells in the body exist in a three-dimensional environment as part of complex tissues and organs. Researchers have been attempting to re-create these environments in the lab, successfully generating organoids that serve as models of the stomach, brain, liver and human intestine. The advantage of growing 3-D structures of lung tissue, Spence says, is that their organization bears greater similarity to the human lung. To make these lung organoids, researchers at the U-M's Spence Lab and colleagues from the University of California, San Francisco; Cincinnati Children's Hospital Medical Center; Seattle Children's Hospital and University of Washington, Seattle manipulated several of the signaling pathways that control the formation of organs. First, stem cells -- the body's master cells -- were instructed to form a type of tissue called endoderm, which is found in early embryos and gives rise to the lung, liver and several other internal organs. Scientists activated two important development pathways that are known to make endoderm form three-dimensional tissue. By inhibiting two other key development pathways at the same time, the endoderm became tissue that resembles the early lung found in embryos. In the lab, this early lung-like tissue spontaneously formed three-dimensional spherical structures as it developed. The next challenge was to make these structures expand and develop into lung tissue. To do this, the team exposed the cells to additional proteins that are involved in lung development. The resulting lung organoids survived in the lab for over 100 days. "We expected different cells types to form, but their organization into structures resembling human airways was a very exciting result," says lead study author Briana Dye, a graduate student in the U-M Department of Cell and Developmental Biology.

For more Information:

COPD World News Week of April 5, 2015

Pedometer-based programme improves health in COPD

Santiago, Chile – Researchers in Santiago found that a pedometer-based programme produced clinically important improvements in physical activity and health status in COPD Physical inactivity is a cardinal feature of chronic obstructive pulmonary disease (COPD), and is associated with increased morbidity and mortality. Pulmonary rehabilitation is known to improve exercise capacity, but there are two important issues. First, access to this form of treatment remains limited because of resource constraints that particularly limit its possible application in patients with less severe disease and secondly, its effects on daily physical activity may be limited and short lived. Therefore, there is a need to find additional effective and scalable interventions that are cheap to implement and which can improve physical activity level in COPD patients. Pedometers can provide feedback to patients about their daily activity, and have been promoted as effective tools to monitor and increase physical activity levels in healthy populations, but it is not known if they are effective tools to improve physical activity levels in COPD patients. The aim of this randomised controlled trial was, therefore, to determine if a 3 month pedometer-based programme could be useful to increase daily step count in stable outpatients with COPD. Secondary outcomes were health status and exercise capacity. Pedometers, which have been used in healthy populations, might also increase physical activity in patients with COPD. COPD patients taking part in a 3-month individualised programme to promote an increase in their daily physical activity were randomised to either a standard programme of physical activity encouragement alone, or a pedometer-based programme. Assessments were performed by investigators blinded to treatment allocation. Change in average 1-week daily step count, 6-min walking distance (6MWD), modified Medical Research Council scale, St George’s respiratory questionnaire (SGRQ) and COPD assessment test (CAT) were compared between groups. For the study, 102 patients were recruited, of whom 97 completed the programme; 60.8% were male with a mean age of 68.7 years, and forced expiratory volume in 1 s (FEV1) 66.1% and FEV1/forced vital capacity 55.9%. Both groups had comparable characteristics at baseline. The pedometer group had significantly greater improvements in physical activity; 3080 steps/day versus 1950 steps/day) than patients receiving activity encouragement only. The researchers concluded that a simple physical activity enhancement programme using pedometers can effectively improve physical activity level and quality of life in COPD patients.

For more information:

COPD World News Week of March 29, 2015

Home Oxygen Raises Burn Risk for COPD Patients

Galveston, TX - Use of home oxygen puts patients with chronic obstructive pulmonary disease (COPD) at risk for burns, a new study indicates. Oxygen therapy is a common treatment for people with the lung disease. But there is a burn risk for patients who smoke, because having a heat or flame source near oxygen gas can trigger a fire. Researchers looked at 685 Medicare patients with COPD who suffered burns between 2001 and 2010 and 2,055 who did not. Those who suffered burns were more likely to have been prescribed home oxygen therapy within 90 days prior to their burns. "The benefits of oxygen in COPD patients outweigh the modest risks of burn injury," said senior study author Dr. Alexander Duarte, a professor in the division of pulmonary critical care and sleep medicine at the University of Texas Medical Branch at Galveston. "However, health care professionals should educate and counsel patients and their families on the potential risk of burn injury and attempt to decrease this risk before prescribing home oxygen therapy," he added in a university news release. Many of the burns occurred on the face, neck or hands. The death rate among patients who suffered burns was 10 times higher than among those with no burn injuries, the researchers found. Overall, one out of 1,421 COPD patients who were prescribed oxygen therapy suffered a burn each year, according to the study published March 30 in the journal Mayo Clinic Proceedings. Those most likely to suffer burns were men, poorer patients and those with three or more other medical conditions.

For more information:

COPD World News Week of March 22, 2015

New survey finds that Canadian COPD patients lack confidence with inhalers

Burlington, ON - A recent survey of COPD patients who use an inhaler reveals that more than one-third (36 per cent) of them are less motivated to use their inhaler as a result of the challenges they face using the devices. The online survey of 350 Canadians with COPD who currently use an inhaler as part of their treatment plan was completed between December 18, 2014 and January 1, 2015. The key issues it found are that 26% of inhaler users are unsure of getting the full dose due to difficulty breathing in with enough strength; that 25% are uncertain medication came out; 20% are unsure the dose was taken correctly and 17% find it difficult to coordinate inhaling at the right time when the dose is released. Of those who report challenges, 49% find it difficult to tell if medication is running low. "The survey results are concerning because COPD medication helps to reduce exacerbations, or flare-ups, which are associated with a more rapid decline in breathing capacity," says Dr. Mark FitzGerald, Professor and Head, Respiratory Medicine, University of British Columbia. "Exacerbations are one of the biggest reasons for disability and hospitalization in COPD patients. So, it's very important that medication is taken as prescribed." The study was conducted by Leger Marketing and was funded by Boehringer Ingelheim, manufacturers of a new class of inhalers known as a Soft Mist Inhaler, or SMI, that uses mechanical energy to deliver a soft mist. According to the manufacturer the slow-moving mist gives patients more time to inhale the dose of medication, and may improve delivery of medication to the lungs. The inhaler also has a dose indicator to help keep track of approximately how much medicine is remaining and it locks after all doses have been delivered.

For more information:

COPD World News Week of March 15, 2015

Dietary nitrate supplementation improves exercise performance in COPD patients

Charlotte, NC - Dietary nitrate supplementation via beetroot juice ingestion has been shown to increase the exercise capacity of younger and older adults according to a recently published scientific abstract. The purpose of this study was to investigate the effects of acute beetroot juice ingestion on the work rate exercise capacity of COPD patients. Fifteen patients were assigned in a randomized, single-blind, crossover design to receive one of two treatments (beetroot juice then placebo or placebo then beetroot juice). Submaximal constant work rate exercise time at 75% of the patient's maximal work capacity was the primary outcome. Secondary outcomes included plasma and nitrite levels, blood pressure, heart rate, oxygen consumption, dynamic hyperinflation, dyspnea (breathlessness) and leg discomfort. Relative to placebo, beetroot ingestion increased both plasma and nitrate levels. Median exercise time was significantly longer following the ingestion of beetroot versus placebo. Compared with placebo, beetroot ingestion significantly reduced iso-time and end exercise diastolic blood pressures by 6.4 and 5.6 mmHg, respectively. Resting systolic blood pressure was significantly reduced by 8.2 mmHg for the beetroot versus the placebo trial. No other variables were significantly different between the beetroot and placebo trials. Dietary nitrate supplementation appears to represent a promising new approach for enhancing aspects of the physiological response to exercise, such as muscle efficiency and oxygenation, which might augment performance. However, research is at an early stage and the precise conditions in which nitrates may influence performance have yet to be firmly established. Also, the patients in this study had mild to moderate COPD. The impact of dietary nitrate supplementation on exercise capacity for patients with severe or very severe COPD is unknown.

For more information:

COPD World News Week of March 8, 2015

Anticholinergic Drugs Linked to Higher Risk of Pneumonia in Seniors

Seattle, WA - A Journal of the American Geriatrics Society study reveals that the use of medications with anticholinergic effects was associated with a notably higher risk of developing pneumonia in a study of more than 3,000 older adults. For the study, more than 1,000 Group Health patients aged 65 to 94 years who developed pneumonia were compared with a control group of more than 2,000 patients who did not get the disease. Anticholinergic medications block the neurotransmitter called acetylcholine in the brain and body, and that can cause many side effects, including sedation, confusion, constipation, vision changes, retaining urine, and dry mouth and eyes, according to Science Daily. Kathleen Paul, MD, MPH, says, “We found a link between both acute and chronic use of anticholinergic medications and a much higher risk for developing pneumonia.” A Science Daily news report notes that acute use meant filling at least one prescription within 90 days before the pneumonia diagnosis and chronic use was filling at least three prescriptions in the prior year. Sascha Dublin, MD, PhD, senior author of the study, states, “Our study is the first to address whether oral anticholinergic medications affect the risk of pneumonia in older people. This is important because so many older people use these medications, and pneumonia is such a common cause of illness and death in this age group.” Paul explains, “It isn’t clear why anticholinergic medications might raise pneumonia risk, but one possibility is that by causing sedation and altered mental status, they raise the risk for breathing problems–and lung infections. But more research is needed.” Dublin adds, “Many older individuals are taking several medications, and our work confirms that clinicians should review them regularly to identify potential risks. It’s especially important for patients to tell their doctors about any over-the-counter medications that they are taking. Together, patients and providers can weigh the pros and cons–and discuss alternatives, making decisions in a shared way.”

For more information:

COPD World News Week of March 1, 2015

COPD Takes Big Toll on Employment, Mobility in U.S.

Atlanta, GA - CDC report finds a quarter of people with the illness are unable to work. The respiratory illness known as COPD takes a toll on mobility and employment, with a new report finding that nearly one-quarter of Americans with the condition are unable to work. People with chronic obstructive pulmonary disorder -- a combination of chronic bronchitis and emphysema often tied to smoking -- face a disabling illness with no cure, according to the report from the U.S. Centers for Disease Control and Prevention. Looking at U.S. health data for 2013, a team led by CDC investigator Anne Wheaton found that just over 24 percent of adults with COPD say they cannot work, compared to about 5 percent of adults in the general population. About half of those with COPD said they also had some form of "activity limitation" linked to their condition, and more than 38 percent said they found it difficult to walk or climb stairs. Because smoking is a major risk factor for COPD, the CDC advises people with the condition to quit if they do smoke. But the new report found that more than one-third of those with COPD continued to smoke. "Smoking cessation has been shown to slow the progression of COPD," the report said, and smoking raised the odds of activity limitations in patients. "This result reinforces the importance of smoking cessation by COPD patients," the experts said. Engaging in a "pulmonary rehabilitation" program is another way COPD patients can fight the illness, the CDC team said. "Although physical activity might be challenging for persons with COPD, exercise training is an essential part" of helping the body maximize its respiratory potential, Wheaton and her colleagues said. COPD remains a heavy burden to millions of patients and the health care system, the researchers said. The illness is the third leading cause of death in the United States, with health care costs estimated at $32 billion in 2010 alone. Another $4 billion was lost due to COPD-linked worker absenteeism, the authors noted. "Because there is currently no cure for COPD, public health efforts should focus on prevention, such as anti-smoking efforts, and treatment to slow the progression of the disease, manage [accompanying illnesses], and lessen symptoms," Wheaton's group said.

For more information:

COPD World News Week of February 22, 2015

U.S. Smoking Deaths May Be Underestimated

Washington, DC - Smoking may be killing more people than even current estimates indicate, a new study suggests. According to the U.S. Surgeon General, about 480,000 Americans die of smoking-related causes each year, but that figure may be closer to 540,000, researchers from the American Cancer Society report. While lung cancer takes the largest toll in smoking-related deaths, the additional 60,000 deaths appear to be caused by diseases not typically associated with tobacco, including kidney failure, intestinal disease, heart disease caused by high blood pressure (hypertension), infections, breathing problems, and breast and prostate cancer, they noted. "The Surgeon General's report claims 480,000 deaths directly caused by smoking, but we think that is really quite a bit off," said lead researcher Brian Carter, an epidemiologist at the cancer society. "Sixty thousand [extra] deaths is really a lot," he said. "That's more than the number of people killed each year by flu or motor vehicle accidents." The report was published Feb. 12 in the New England Journal of Medicine. "Though we've made great gains in reducing rates of smoking, tobacco control needs to remain a top health priority. We cannot rest on past tobacco control successes," said Dr. Graham Colditz, a professor of surgery at the Washington University School of Medicine in St. Louis and author of an editorial that accompanied the study. Tobacco needs to remain a top health priority, he said. "It is the primary cause of preventable disease and death," Colditz said. "And we need to continue to build on the progress we've made and work toward a future endgame for tobacco -- a time when it is all but eliminated as a health issue." Carter's team used data from five large databases that included nearly 1 million men and women aged 55 and older. During about 10 years of follow-up, more than 180,000 people died. The death rate among people who smoked was three times higher than among those who never smoked. Most of those deaths were the result of diseases known to be related to smoking, such as certain cancers, heart disease, stroke and chronic obstructive pulmonary disease (COPD). However, about 17 percent of the deaths in smokers were due to diseases that were not established as caused by smoking by the U.S. Surgeon General. Thus these deaths are not counted in estimates of the deaths from smoking, Carter said. Carter said that smoking was associated with at least a doubling of risk of death from several causes, including kidney failure, intestinal diseases, hypertensive heart disease, infections and respiratory diseases other than COPD. The risk of death from these diseases dropped after quitting smoking, the researchers found. Carter added that there is good evidence that smoking is a cause of death from these diseases, even though they are not yet included in estimates of deaths from smoking. In addition, smoking was linked with small increases in risk of death from breast cancer, prostate cancer and other cancers, he said. Dr. Norman Edelman, a senior consultant for scientific affairs at the American Lung Association, said, "This study tells us that we have a huge amount of work to do in terms of controlling the use of tobacco." Edelman added that it's never too late to quit cigarettes. "Stopping smoking at any time, even if you are old and sick, will extend your life," he said. "Don't smoke. Don't let kids start smoking."

For more information:

COPD World News Week of February 15, 2015

Prostate Cancer Patients Who Smoke Fare Worse

New York, NY – Smoking doubles the chances that a prostate cancer patient will see his disease spread and that he will eventually die from his illness, a new study finds. "Basically we found that people who smoke had a higher risk of their tumor coming back, of it spreading and, ultimately, even dying of prostate cancer," said study co-author Dr. Michael Zelefsky. He is vice chair of clinical research in the department of radiation oncology at Memorial Sloan Kettering Cancer Center in New York City. "But interestingly, this applied only to 'current smokers' who were smoking around the time they received external beam therapy," Zelefsky added, referring to the standard form of radiation treatment for prostate cancer. "Former smokers did not have the increased risk for disease spread and recurrence that current smokers did," he said. "However, we also looked at how smoking affected treatment side effects," from the radiation treatment, which can include rectal bleeding and/or frequent and urgent urination, he noted. "And we saw that both patients who smoked and former smokers seemed to have a higher risk of urinary-related side effects after therapy." Zelefsky and his colleagues reported the findings online Jan. 27 in the journal BJU International. The research team pointed out that 19 percent of American adults smoke. To explore the impact of smoking history on prostate cancer treatment and progression, the study authors focused on nearly 2,400 patients who underwent treatment for prostate cancer between 1988 and 2005. Nearly 50 percent were identified as "former smokers," even if they had only kicked their habit shortly before beginning cancer treatment. Disease progression, relapse, symptoms and deaths were all tracked for an average of eight years, as were all reactions to the radiation treatment. The researchers determined that the likelihood of surviving prostate cancer for a decade without experiencing any disease recurrence was about 66 percent among patients who had never smoked. By comparison, that figure fell to 52 percent among patients who were current smokers. Former smokers fared better than current smokers, with about 62 percent projected to hit the 10-year survival mark. But compared with those who had never smoked, both current and former smokers faced a notably higher risk for the toxic urinary side effects that can occur with radiation treatment. Zelefsky said the new study wasn't designed to highlight exactly how smoking worsens cancer prognosis. But he noted that one leading hypothesis is that smoking may reduce oxygen concentrations in the tumor region, perhaps making tumors less sensitive to radiation. "We can't say for any certainty that this is the case," he said. "But what we can say, of course, is that smoking is not good for you. Clearly. We've long known that it increases the chances for developing lung cancer and cardiovascular disease. But this finding suggests that smoking may also undermine the battle against prostate cancer, and perhaps all cancers in general," Zelefsky said. "So, at minimum this should make us more cognizant of the need to get a good smoking history on prostate cancer patients, and [to get] more proactive in terms of referring them for smoking cessation programs, rather than putting the issue on the backburner while undergoing treatment," he suggested. Dr. Stephen Freedland, a professor of surgery at Cedars-Sinai Health System in Los Angeles, said the finding adds to growing evidence that smoking is associated with aggressive prostate cancer. However, a cause-and-effect link was not proven in the new study. "They clearly found that the risk of dying from prostate cancer goes up for smokers," Freedland said. "And, importantly, they controlled for the fact that smokers generally have other health problems in addition to cancer, and still found that smoking independently raises the risk of dying specifically from the cancer. "So, I would say that quitting smoking is better than not quitting, and not starting in the first place is the best thing," he said. "But whichever is the case, it's not too late. If you're a smoker and you get prostate cancer, you should really consider that maybe it's time to stop."

For more information:

COPD World News Week of February 8, 2015

About 1 in 7 Older Adults Has Some Form of Lung Disease

Atlanta, GA - Nearly 15 percent, or about one out of seven, middle-aged and older U.S. adults suffer from lung disorders such as asthma or chronic obstructive pulmonary disease (COPD. While 10 percent of those people experience mild breathing problems, more than one-third of them report moderate or severe respiratory symptoms, the U.S. Centers for Disease Control and Prevention (CDC) reported. "There are a huge number of Americans that experience lung obstruction," said Dr. Norman Edelman, a senior medical advisor to the American Lung Association, who was not involved in the research. "It's a major problem; it's the third leading cause of death in the United States." People with asthma or COPD -- which includes emphysema and chronic bronchitis -- have reduced airflow and shortness of breath. For the report, CDC researchers analyzed national survey data on adults ages 40 to 79 between 2007 and 2012. The research team looked at results of breathing tests or self-reported oxygen use to determine the prevalence of lung obstruction. "The number of adults with lung obstruction has remained fairly stable since the last time these data were collected, in 2007 to 2010," said lead author Timothy Tilert, a data analyst with CDC's National Center for Health Statistics. According to the report, the incidence and severity of these lung diseases were similar for men and women, but prevalence increased with age. For example, 17 percent of people 60 to 79 had COPD or asthma compared with about 14 percent of those 40 to 59. Also, severity of asthma or COPD -- which is usually caused by smoking -- was related to education level, Tilert said. People with some college education had lower rates of moderate or severe disease than those with less schooling. Among people with either disease, more than half said they had one or more symptom, such as shortness of breath, wheezing, chronic cough or chronic phlegm. For those with moderate to severe disease, more than 80 percent said they experienced at least one symptom. Shortness of breath was most common. Tilert said the survey did not consider COPD and asthma individually, so separate figures for each disorder aren't available. However, because of the age of the population in the study, Edelman said these data probably are picking up more cases of COPD than asthma. COPD is a progressive, debilitating disease without a cure, he said. "Treatments are directed at symptom relief, so we have airway expanders and oxygen if the COPD is severe," he said. "There are also anti-inflammatory drugs that are used to reduce the number of flare-ups." Flare-ups are usually caused by infection, Edelman said. Lung function decreases after each episode, he added. Some people can live with COPD until they die from another cause, Edelman said. "But there is a fairly large number of people whose COPD gets worse and worse and they die of COPD," he said. About 85 percent of COPD cases are related to smoking, although sometimes asthma progresses to COPD, he added. "The majority of COPD can be prevented by not smoking," he said. With fewer Americans smoking, Tilert said COPD incidence will likely decline as more non-smokers age.

For more information:

COPD World News Week of February 1, 2015

Metabolizer Test Might Someday Take Guesswork Out of Quitting Smoking

New York, NY - Smoking is notoriously tough, and some smokers may try different approaches for years before they succeed, if ever. But new research suggests that someday, a simple test might point smokers toward the quitting strategy that's best for them. It's been long theorized that some smokers are genetically predisposed to process and rid the body of nicotine more quickly than others. And now a new study suggests that slower metabolizers seeking to kick the habit will probably have a better treatment experience with the aid of a nicotine patch than the quit-smoking drug varenicline (Chantix). The finding is based on the tracking of more than 1,200 smokers undergoing smoking-cessation treatment. Blood tests indicated that more than 660 were relatively slow nicotine metabolizers, while the rest were normal nicotine metabolizers. Over an 11-week trial, participants were prescribed a nicotine patch, Chantix, or a non-medicinal "placebo." As reported online Jan. 11 in The Lancet Respiratory Medicine, normal metabolizers fared better using the drug compared with the nicotine patch. Specifically, 40 percent of normal metabolizers who were given the drug option were still not smoking at the end of their treatment, the study found. This compared with just 22 percent who had been given a nicotine patch. Among the slow-metabolizing group, both treatments worked equally well at helping smokers quit, the researchers noted. However, compared with those treated with the nicotine patch, slow metabolizers treated with Chantix experienced more side effects. This led the team to conclude that slow metabolizers would fare better -- and likely remain cigarette-free -- when using the patch. The study was led by Caryn Lerman, a professor of psychiatry and director of the Center for Interdisciplinary Research on Nicotine Addiction at the University of Pennsylvania School of Medicine. She believes that the findings show that not all smokers are alike, and measuring each smokers' "nicotine metabolite ratio" might someday be a useful tool "to guide treatment choices." "This is a much-needed, genetically informed [measurement tool] that could be translated into clinical practice," Lerman said in a university news release. "Matching a treatment choice based on the rate at which smokers metabolize nicotine could be a viable strategy to help guide choices for smokers and ultimately improve quit rates." Anti-smoking experts agreed. "If clinicians can predict which cessation medications will work better for a particular smoker -- the slow nicotine metabolizer or the normal metabolizer -- the frustrating process of trial and error may be reduced or eliminated," said Patricia Folan, director of the Center for Tobacco Control at North Shore-LIJ Health System in Great Neck, N.Y. "Quitting is challenging for most tobacco users," Folan said. "Guiding them to appropriate treatment more quickly and efficiently will provide a more satisfying experience, with possibly less relapse." Dr. Len Horovitz is a pulmonary specialist at Lenox Hill Hospital in New York City. He said that, in the future, "a specific therapy may be tailored to the patient based on how the patient metabolizes nicotine. This eliminates the 'one-size-fits-all' approach."

For more information:

COPD World News Week of January 25, 2015

Where there’s smoke, there’s respiratory risk

Toronto, ON - Millions of Canadians will enjoy the ambience and warmth of a wood burning stove or fireplace this winter, but experts say that both doctors and the public should be more aware of the associated potential health hazard. Tiny particulates, produced from combusting wood are dangerous, especially for people with pre-existing respiratory issues, says Dr. Kenneth Chapman President of the Canadian Network for Respiratory Care. "It's the same thing that's harmful about tobacco smoke — minus the nicotine. There are volatile gases that you don't want to inhale and can irritate the airway and lungs," says Chapman, a professor of medicine at the University of Toronto. Tobacco has traditionally been pinned as the leading cause of chronic obstructive pulmonary disease (COPD) in North America. But while tobacco use is decreasing, COPD has been rising for three years. In 2013, 4.3% of Canadian adults over the age of 35 were diagnosed with COPD, an increase of 0.2% from 2011. Chapman says one possible contributing factor to the increase is exposure to wood smoke. According to Statistics Canada, 12% of Canadian households use wood as heating in their homes; 4% rely on it as the primary source of heating. Health Canada recommends a number of safety tips including cleaning chimneys, using dampers properly and installing an "advance combustion" insert in wood burning stoves.  However, the adverse effects of wood smoke don't come solely from direct indoor exposure; outdoor pollution is also to blame. A 2012 report by the Cdn. Council of Ministers of the Environment (CCME) estimated that 104 kilotonnes of fine particulate matter was emitted to the atmosphere in Canada from residential wood combustion in 2010; 44% of these emissions came from Quebec. The level of air pollution is one reason that as of 2020, the City of Montreal will forbid wood burning stoves that emit more than 1.3 grams of fine particulate matter per hour. And beginning in February 2015, residents will have to declare their wood stoves, says Karine Price, a toxicologist at the Public Health Department of Montreal. In addition, if there is a smog warning, the use of all types of wood burning stoves will be forbidden. The 2012 Canadian Council report recommends that wood burning appliances meet Canadian Standards Association rules for emissions, output and efficiency, but compliance is voluntary unless regulated provincially or municipally. As of 2012, five provinces had legislation regulating wood burning appliances and seven provinces offered incentives for upgrading to more efficient appliances. Greater length and intensity of exposure to wood smoke increases health risks, says Chapman. Short, sporadic exposures such as a campfire or lighting a scented candle are not as serious, although they should be avoided by people with lung disease. Wood smoke exposure is something Chapman says most Canadians and doctors are unaware of and could pay more attention to. "If I've got a COPD patient, and I've got them to quit tobacco smoking, have I done a complete job? Is there any chance of them being exposed to smokes and fumes at their work place setting, or at their winter cottage and home?" Chapman says more research on the effects of wood smoke, and the number of patients affected is also needed. "These sorts of exposures and problems will become more apparent over time as tobacco smoke becomes less and less common." The results of a large-scale, seven-year Australian study published in the BMJ in 2013, indicated that reducing the amount of wood smoke pollution was associated with reduced all-cause, cardiovascular and respiratory mortality. According to the World Health Organization, COPD is the third leading cause of death worldwide.Jason Nickerson, a clinical scientist at the Bruyère Research Institute in  Ottawa has seen these effects first hand as part of his work in programs concerning non-communicable respiratory diseases in low-income countries. He says that if nothing changes, COPD levels in these countries will significantly increase due to indoor pollution caused by cooking stoves. These stoves are cheap and readily available, but they consume a lot of wood and produce a lot of pollution, says Nickerson, who is also a respiratory therapist. "The challenge is to find something that works more efficiently." Chapman agrees that this is a worldwide problem, "if you can't afford a nice clean central heating system for your home fueled by a safe fuel, but rely on wood burning stove, you are now at not just an economic disadvantage but a mortality disadvantage." "You may be a woman in South Asia, South America or Africa, never having smoked tobacco, but developing emphysema every bit indistinguishable from a two-pack-a-day smoker, because you've prepared food and heated your hut with burning wood or biological fuels."

For more information:

COPD World News Week of January 18, 2015

Nearly Half of Older Adults With Asthma, COPD Still Smoke

Atlanta, GA - Close to half of U.S. adults over 40 who have trouble breathing due to asthma or COPD still continue to smoke, federal health officials reported Wednesday. The findings highlight the difficulty facing many smokers trying to quit -- even when smoking exacerbates an already distressing illness, one expert said. However, "with assistance, quitting may still be challenging but it is possible," said Patricia Folan, director of the Center for Tobacco Control at North Shore-LIJ Health System in Great Neck, N.Y. The new U.S. Centers for Disease Control and Prevention (CDC) statistics come a day after the release of another agency report, which found that 15 percent of Americans between 40 and 79 years of age suffer from some form of lung obstruction -- typically asthma or chronic obstructive pulmonary disease (COPD).COPD, a progressive illness often linked to smoking, includes two main conditions, chronic bronchitis and emphysema. According to the U.S. National Heart, Lung, and Blood Institute, COPD affects millions of people and is the third leading cause of death in the United States. In the new study, CDC researchers led by Ryne Paulose-Ram looked at data from the U.S. National Health and Nutrition Survey for the years 2007-2012. They found that during that time, about 46 percent of adults aged 40 to 79 who had a lung-obstructing illness currently smoked. That number rose to 55 percent when the researchers looked only at cases involving "moderate or worse" disease. Smoking rates were similar between the sexes, and rose as levels of education fell, the CDC said. The agency noted that rates of smoking for people with lung obstruction were more than double that of people without such illnesses -- about 20 percent. Why do people whose illnesses are brought on or exacerbated by smoking continue with the deadly habit? Folan said the issues are often complex and tough to change. "Approximately 40 percent of those with COPD experience high levels of depression and anxiety, making it more difficult to comply with treatment and quitting smoking," she said. "What works best to help patients with COPD quit smoking is treatment for their depression," Folan said. Also effective, she added, is "information about and availability of the most effective ways to quit, including FDA-approved cessation medications, empathetic counseling, motivational interviewing, and ongoing support from professionals, family and friends." The alternative -- to continue smoking -- exacerbates COPD symptoms and raises the odds for death, Folan said. Also, "since it is difficult to eat with shortness of breath, poor nutrition and unintended weight loss are also often consequences associated with COPD," she said. "Smoking can be an appetite suppressant and contribute to this weight loss." She said the effort needed to quit smoking may be tough, but can pay off in real dividends for health. "For patients with COPD, the single best thing they can do for their lungs is quit smoking," Folan said.

For more information:

COPD World News Week of January 11, 2015

Study finds growing acceptance of Respimat over HandiHaler

Osakasayama, Japan - Researchers here used a questionnaire on switching from the tiotropium HandiHaler to the Respimat inhaler in patients with chronic obstructive pulmonary disease. They were looking for changes in handling and preferences immediately and several years after the switch. The inhalers are used to deliver Tiotropium (Spiriva) which is an inhaled muscarinic antagonist for patients with chronic obstructive pulmonary disease (COPD), and is available in two forms: the HandiHaler and the Respimat inhaler. The aim of this study was to investigate the handling of and preference for each device immediately after switching from the HandiHaler to the Respimat and 2–3 years after the switch. The study comprised two surveys. A questionnaire was first administered to 57 patients with COPD (52 male and 5 female with a mean age of 73.6 years) 8 weeks after switching from the HandiHaler (18 µg) to the Respimat (5 µg). A second similar but simplified questionnaire was administered to 39 of these patients who continued to use the Respimat and were available for follow-up after more than 2 years. Pulmonary function was also measured during each period. In the first survey, 17.5% of patients preferred the HandiHaler, and 45.6% preferred the Respimat. There were no significant changes in pulmonary function or in the incidence of adverse events after the switch. In the second survey, performed 2–3 years later, the self-assessed handling of the Respimat had significantly improved, and the number of patients who preferred the Respimat had increased to 79.5%. The researchers concluded that the preference for the Respimat increased with continued use while the efficacy of the Respimat remained similar to that of the HandiHaler.

For more information:

COPD World News Week of January 4, 2015

Cigarettes Cause One-Third of U.S. Cancer Deaths

Atlanta, GA - A new study reveals that cigarettes are the cause of one-third of all cancer-related deaths. “Our results indicate that cigarette smoking causes about three in 10 cancer deaths in the contemporary United States. Reducing smoking prevalence as rapidly as possible should be a top priority for U.S. public health efforts to prevent future cancer deaths,” researchers from the American Cancer Society wrote. Despite large declines in smoking rates, cigarettes still cause about one-third of cancer deaths in the United States, according to a new study. "Our results indicate that cigarette smoking causes about three in 10 cancer deaths in the contemporary United States. Reducing smoking prevalence as rapidly as possible should be a top priority for U.S. public health efforts to prevent future cancer deaths," researchers from the American Cancer Society wrote. The researchers analyzed 2010 national data to get the latest numbers. The new cancer death estimate doesn't include deaths from secondhand smoke. It also doesn't include deaths from other types of tobacco use such as cigars, pipes, or smokeless tobacco. The study appears in the journal Annals of Epidemiology. More than 30 years ago, a ground-breaking study concluded that 30 percent of all cancer deaths in the United States were caused by smoking. Since that time, no new estimate of this percentage has been published in the scientific literature, the current study's authors noted. The researchers said the rate of smoking-related cancer deaths in 2010 is higher than the rate three decades ago. But they said that doesn't mean falling smoking rates have not helped reduce cancer deaths. Rather, other factors contributed to the higher rate in 2010. Those factors include an increasing number of cancers known to be caused by smoking, rising lung cancer death rates among women smokers, and progress in reducing deaths from cancers caused by factors other than smoking, the researchers said.

For more information: