COPD World News Week of June 26, 2016

Depression Plagues Many With COPD

Manchester, UK - Struggling with chronic obstructive pulmonary disorder (COPD) may raise the risk of depression among patients with the incurable respiratory illness, two new studies suggest. One report, from scientists at Manchester Metropolitan University in England, found one in four patients with COPD suffered persistent depressive symptoms over the three years of the study. If untreated, depression can have a negative effect on the patients' overall health and the effectiveness of their treatment, the researchers noted. A second study from the University of Texas analyzed data from a random sample of 5 percent of Medicare beneficiaries diagnosed with COPD between 2001 and 2011. The researchers found that 22 percent of those patients had one or more psychological disorders. The study also showed that the odds of 30-day readmission to the hospital were higher in patients with COPD who had depression, anxiety, psychosis, alcohol abuse and drug abuse, compared with those who did not have these disorders. Both studies were published recently in the journal CHEST. COPD is an umbrella term for progressive lung diseases that include chronic bronchitis and emphysema. It affects 24 million Americans, and is characterized by increased breathlessness, coughing and wheezing, according to the COPD Foundation. Depression makes it tougher for those with COPD to adhere to needed therapies, especially since they tend to fault themselves for developing the disease by smoking, explained Dr. David Mannino. He is a professor of medicine in the division of pulmonary, critical care and sleep medicine at the University of Kentucky. "They call it 'the shame-and-blame game' because a lot of people who have it [COPD] feel like they brought it on themselves and got what they deserved," said Mannino, who was not involved in either study. "Part of this is the message that smoking's bad and no one should do it. That leads to the misguided interpretation that 'smokers are bad people.' " However, COPD can also be caused by factors like asthma or dusty work places, Mannino noted. Dr. Norman Edelman, scientific consultant for the American Lung Association, said depression is relatively common among those with a disabling chronic illness such as COPD. However, "what's not so clear and very important is whether depression itself makes the disease worse, or how it could," he added. Exercise can be a COPD patient's biggest ally, according to Edelman. Those with COPD should work out to their level of tolerance, said Edelman, a professor of preventive medicine and internal medicine at the State University of New York at Stony Brook. "Otherwise, their muscles get deconditioned, and that makes their shortness of breath on any kind of exercise worse," he said. But, "you can imagine that someone depressed doesn't want to exercise, go to the mall or the store," Edelman acknowledged. One way to overcome that mindset is by incorporating psychological counseling into COPD care as long as it's feasible, he said. Meanwhile, family and friends can also help. "The thing to do is engage the patient: Don't let Joe sit in the corner and watch television all day," Edelman said. "Get him up and out, doing things he can tolerate. And ask questions. That's not so easy. If you ask old Grandpa if he's depressed, he'll snarl at you." So, the situation has to be handled "sensitively and gently," Edelman said. Still, Mannino said, patients have to assume their share of responsibility for their own welfare. "The key intervention for people still smoking is to stop," he said. Beyond that, COPD patients should make sure they're using their inhalers correctly. "Nearly half our patients aren't using them as directed," Mannino said. "Every device is a little different. If you're not using them right, you're not getting the correct dose."

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COPD World News Week of June 19, 2016

COPD Discovery Might Improve Treatment

Dundee, Scotland - Researchers say they've found a new way to predict how chronic obstructive pulmonary disease will progress, a discovery they believe could improve COPD treatment. Their research might help doctors determine which patients are less likely to respond to standard treatment and are at higher risk for disease advancement, the study authors explained. COPD -- chronic obstructive pulmonary disease -- is a chronic lung disease that makes it tough to breathe. It includes chronic bronchitis and emphysema, according to the American Lung Association. The new discovery concerns something called neutrophilic airway inflammation, which is associated with COPD. Neutrophils are white blood cells that are important for fighting infection. Scientists said that a type of neutrophil behavior called neutrophil extracellular trap (NET) formation in the lungs of COPD patients appears to reduce their ability to destroy bacteria. "We have known for many years that neutrophils should be able to fight infection, but we haven't fully understood why they don't work in COPD," said study author Dr. James Chalmers, from the University of Dundee in Scotland. "Some recent studies described the presence of NETs in the COPD lung, so we wanted to know whether there was any relationship between NETs and outcomes in COPD patients," he said in a news release from the American Thoracic Society. For the study, the researchers collected blood and sputum samples from 141 patients at the end of acute COPD flare-ups. The researchers found the amount of NET formations in participants' lungs was directly related to the severity of their lung disease and their risk for COPD flare-ups that didn't respond to treatment with corticosteroids. NETs result in more infections as well as worse lung function and quality of life, the study authors concluded. "This marker may help us identify patients at higher risk of disease progression," said Chalmers. "And it identifies a subset of patients who may need treatments other than corticosteroids. Our data show that inhaled steroids may even exacerbate NETs, so we need to identify new COPD treatments and discover whether inhibiting NET formation will result in improved clinical outcomes for patients with COPD." The researchers plan to continue their investigation, examining why NET formation occurs and whether it can be prevented or treated. "While our new research is at an early stage, we hope that detecting NETs may be a biomarker that can identify patients at risk of deterioration, and that we can work toward testing whether inhibiting NET formation would be a beneficial treatment in COPD," Chalmers said. The findings were to be presented Sunday at the American Thoracic Society's annual meeting, in San Francisco. Research presented at meetings usually is regarded as preliminary until published in a peer-reviewed medical journal. 

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COPD World News Week of June 12, 2016

Hospital-initiated smoking cessation programs work

Ottawa, ON - A new study from the University of Ottawa Heart Institute (UOHI), in collaboration with the Institute for Clinical Evaluative Sciences (ICES), has established that greater adoption of hospital-initiated tobacco cessation interventions improve patient outcomes and decrease further healthcare utilization. The study was published in the British Medical Journal's Tobacco Control. In Canada, tobacco smoking is a leading cause of hospitalization, of overall healthcare utilization, and of mortality, and people who smoke daily average twice as many hospital days as people who have never been daily smokers. Hospitalization therefore provides a unique opportunity to initiate smoking cessation interventions. The before and after study compared hospitalized people who smoke at one of 14 Ontario hospitals who had received the Ottawa Model for Smoking Cessation (n=726), to hospitalized people who smoke who had not (n=641), or who had received "usual care", to determine if implementation of the Ottawa Model for Smoking Cessation would reduce mortality and downstream healthcare use. Results showed that: 35% of the patients who participated in the Ottawa Model were smoke-free at 6-month follow up, compared to only 20% of the usual care participants. Patients who received the Ottawa Model were 50% less likely to be re-admitted to the hospital for any cause, and 30% less likely to visit an emergency department in the 30 days following their initial hospitalization. Smokers who received the Ottawa Model were 21% less likely to be re-hospitalized and 9% less likely to visit an emergency department, 2 years following their hospitalization. Most importantly, the study showed a 40% reduction in 2-year mortality risk among patients who received the Ottawa Model. "Given the low cost of these interventions, systematic smoking cessation programs that initiate treatments in hospital and attach patients to follow up support should be offered to all patients who smoke," said Kerri-Anne Mullen, lead author and program manager for the Ottawa Model for Smoking Cessation Network at the University of Ottawa Heart Institute, and also a student scientist at ICES at the time of the study. "It's a healthcare no-brainer. Strategies like this are cost-effective, will reduce subsequent healthcare use, but most importantly, they are life-saving and will distinctly enhance the well-being of our patients who smoke." Developed and powered by the University of Ottawa Heart Institute, the Ottawa Model for Smoking Cessation is a change management strategy that offers practical training to healthcare staff and implements clinical tools and procedures that ultimately lead to: the systematic identification and documentation of smoking status of all patients; the offer of strategic advice and pharmacological support to all smokers; and, the long-term follow up of smokers after hospital discharge.

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COPD World News Week of June 5, 2016

Colistin resistance detected in US patient for first time

Bethesda, Maryland - Colistin resistance has been detected in a patient in the United States for the first time, further magnifying fears over antibiotic resistance. The discovery was made by Defense Department researchers who recently began looking for resistance to the last-resort antibiotic in specimens submitted to the clinical microbiology laboratory at Walter Reed National Military Medical Center. They detected the colistin-resistant mcr-1 gene in an Escherichia coli culture taken from a female patient with a urinary tract infection. CDC Director Thomas R. Frieden, MD, MPH, announced the finding during an address at the National Press Club and warned that better stewardship was needed to fight antibiotic resistance. “The medicine cabinet is empty for some patients,” Frieden said. “It is the end of the road for antibiotics unless we act urgently.” The specimen came from a woman who sought treatment at a Pennsylvania clinic in April. The woman, aged 49 years, reported no travel within the previous 5 months, according to Patrick McGann, PhD, microbiologist at Walter Reed, and colleagues, who published their findings in Antimicrobial Agents and Chemotherapy. “To the best of our knowledge,” they wrote, “this is the first report of mcr-1 in the United States.” The E. coli cultured from the woman’s urine, MRSN 388634, was forwarded to the lab at Walter Reed, where researchers began testing for resistance to colistin in response to the discovery of mcr-1, which they called a “truly pan-drug resistant bacteria.” MRSN 388634 belongs to a rare E. coli sequence type that was first identified in 2008 from a urine culture in the United Kingdom and later identified from a bloodstream culture in Italy, McGann and colleagues wrote. They warned that they were in the early stages of testing and that continued surveillance was needed to determine the true prevalence of mcr-1 in the population. “The more we look, the more we’ll find,” Frieden said. “The more we look at drug resistance, the more concerned we are. We need to do a very comprehensive job so we can have [antibiotics] and our children can have them. We can make new ones, but without better stewardship and identification of outbreaks, we’ll lose these miracle drugs.”

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COPD World News Week of May 29, 2016

High medication cost remains major barrier for patients

San Francisco -- Many patients with chronic obstructive pulmonary disease in this country lack access to basic therapies and care that can improve their quality of life, mostly because they can't afford them, according to findings from a report on COPD care written by more than 2 dozen leading respiratory medicine specialists in the U.S. The report highlights major barriers to adequate care for a significant percentage of COPD patients, said lead author Meilan K. Han, MD, of the University of Michigan, Ann Arbor. She presented the findings at the ATS 2016 International Conference, the annual meeting of the American Thoracic Society. The report was commissioned by The Lancet Respiratory Medicine, which published key findings late last week. Even though COPD is now the third leading cause of death in the U.S., there is still a patchwork approach to patient care, with disproportionately affected lower-income patients often unable to afford the most effective medications, she said. "We can talk about state-of-the-art treatments all we want, but we know that these medications often aren't covered by insurance and our patients can't afford them," she said. The report called for greater patient access to education to help them manage their disease, as well as drug therapies, pulmonary rehabilitation and other non-pharmacological interventions and it noted that "insufficient disease-specific training" remains a significant problem among providers, especially primary care doctors who treat the majority of patients with COPD. Inadequate coordination of care was identified as a significant challenge, especially among patients who are treated by both a primary care physician and specialist and those who frequently transition between in-patient and out-patient care. "The absence of written care protocols for inpatients, as have already been established for other diseases, has inadvertently led to COPD having low priority in hospital care," Han and colleagues wrote. There are roughly 15 million adults in the U.S. (6.5% of U.S. adults) with a diagnosis of COPD, but it is estimated that as many as 29 million Americans have the disease. Key challenges highlighted in the report included providing care consistent with guidelines or best practices evidence in the primary care and hospital settings. "In hospitals in the U.S. only about 30% of COPD patients are receiving what we would consider ideal care. There is a lot of variation," Han said. She noted that lack of access to specialized care is, at present, the norm for most patients with COPD. While COPD rates have skyrocketed, the number of pulmonologists in the U.S. has remained somewhat static since the mid 1990s, she said. "There are a lot of patients with COPD that won't even get close to a pulmonologist, so I think we need to think about other ways to getting patients access to specialty care, whether that is through telehealth or other innovative solutions," she said. She added that the high rate of comorbidities like diabetes and cardiovascular disease among COPD patients greatly complicates care, as does the fact that COPD medication adherence is much lower than adherence to medications COPD patients take for these other chronic conditions. "And we wonder why our patients aren't doing better," she said. "I just saw a patient in clinic last week who had just left the hospital after his third readmission and I asked him if he was taking his (COPD) medications. He told me that he wasn't because he couldn't afford the co-pays. My suspicion is that probably has something to do with why he has been in the hospital three times," she said. Research funding for COPD also lags far behind other major chronic diseases, she said. When researchers compared NIH funding for COPD and other chronic diseases to disability adjusted life years, which is a metric of disease burden, they found that in general funding matches disease burden except for COPD, where funding is much below burden. "This is something that absolutely will have to be rectified, " Han said.

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COPD World News Week of May 22, 2016

Bacterial Susceptibility May Explain Persistent COPD Inflammation

Nashville, TN - Increased susceptibility to airway bacteria caused by an immune system defect may explain why patients with chronic obstructive pulmonary disease (COPD) experience persistent lung inflammation and disease progression even after they stop smoking, researchers reported. In a mouse model, the researchers showed that lacking the key mucus secretion antibody known as secretory immunoglobulin A (IgA) increased susceptibility to bacterial infection, which mimicked the lung damage and persistent inflammation characteristic of COPD in the aging mice. Treatment of the IgG-deficient mice with the anti-inflammatory COPD drug roflumilast halted the lung damage. The results suggest that medical treatments that restore normal immune barrier function to the small airways or reduce airway bacteria may be effective therapeutic strategies for patients with COPD, wrote researcher Bradley W. Richmond, MD, of Vanderbilt University School of Medicine in Nashville, Tenn., and colleagues, in the journal Nature Communications. COPD is the third leading cause of death in the United States, and smoking accounts for eight out of 10 deaths from the disease, which is characterized by chronic lung inflammation, fibrotic remodeling of the small airways, and destruction of lung parenchyma. The researchers noted that the predominant hypothesis regarding COPD pathogenesis has been that inhalation of cigarette smoke and other toxic gases causes oxidant-mediated injury, airway inflammation, and disruption of the protease/anti-protease balance, leading to lung parenchymal destruction. "However, this theory does not fully explain the central role of the small airways in this disease or continued airway inflammation and disease progression after smoking cessation," they wrote. In earlier work, the researchers identified secretory IGA deficiency in the small airways of patients with COPD, leading the team to hypothesize that immuno-barrier dysfunction resulting from reduced secretory IgA contributes to chronic airway inflammation and disease progression. Future studies to investigate the incidence and progression of obstructive lung disease in IgA-deficient individuals could be informative," the team concluded.

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COPD World News Week of May 15, 2016

Persistent childhood asthma linked to COPD

Boston, MA - The development of persistent childhood asthma-characterized by having trouble breathing on an almost daily basis - is not well understood. In most cases, childhood asthma resolves with time, but as many as 20 percent of children with asthma will go on to have potentially severe symptoms in adulthood. In the largest and longest U.S. analysis of persistent asthmatics to date, investigators at Brigham and Women's Hospital (BWH) found a link between persistent childhood asthma and chronic obstructive pulmonary disease (COPD) in early adulthood. The study found that early lung function predicts lung growth later in life, regardless of asthma treatment and smoking exposure. "This work tells us that persistent childhood asthma can develop into COPD, something that up until now has not been well described," said Scott T. Weiss, MD, one of the paper's senior authors and Co-Director of the Systems Genetics and Genomics Section of the BWH Channing Division of Network Medicine. "Children who had low lung function at the start of the trial followed a series of predicted growth patterns: most had reduced lung growth with time and a significant number would go on to meet the criteria for COPD." The study followed 684 participants in the Childhood Asthma Management Program (CAMP) from ages 5-12 until they were at least 23 years old. Each participant reported once a year to one of eight research centers around the U.S. and Canada to complete lung function measurements like spirometry, a test that records how much air a participant can breathe out in one second. With these annual recordings, the researchers were able to characterize the patterns of growth in asthmatics' lung function. By the end of the study, 11 percent met the criteria for COPD, a progressive disease that makes breathing difficult. In addition to low lung function at the start of the study, being male also predicted worse outcomes, but this is likely a consequence of higher asthma prevalence in boys. By early adulthood, 75 percent of the children with persistent asthma displayed an early decline in lung function and/or reduced lung growth. Treatment did not change these patterns. "It is astonishing," said co-senior author Robert C. Strunk, MD, professor of pediatrics at Washington University School of Medicine, who died unexpectedly April 28. "For people barely into adulthood to already have COPD is terrible. As the COPD evolves, they are likely to have health problems that will make it difficult to participate in normal day-to-day responsibilities such as holding a job." "With this understanding, physicians need to identify at-risk children earlier and counsel them about potential preventative measures. Since asthma itself is a risk factor for developing COPD, these patients should be advised against risk related environmental exposures, like smoking, that could intensify their symptoms and increase their COPD risk," said Weiss. "It is important that we recognize this link between persistent childhood asthma and COPD as a potential problem and focus on prevention efforts."

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COPD World News Week of May 8, 2016

Newfoundland public payer program to cover new COPD product

Great news for COPD patients in Newfoundland. AstraZeneca has announced that it has obtained public payer listing for Duaklir as a Special Authorization Benefit in Newfoundland. Duaklir is a fixed-dose LAMA/LABA combination of two long-acting bronchodilators—aclidinium bromide, a long-acting muscarinic antagonist (LAMA), and formoterol fumarate, a long-acting beta-agonist (LABA). The criteria is similar to other LAMA/LABAs: For the treatment of moderate to severe chronic obstructive pulmonary disease (COPD), as defined by spirometry, in patients with an inadequate response to a long-acting beta-2 agonist (LABA) or long-acting anticholinergic (LAAC). With this announcement, Duaklir is now reimbursed in almost all provinces across Canada (including SK, Nova Scotia, New Brunswick, Ontario, Manitoba, Alberta, BC, PEI, Yukon.) This means that the majority of Canadian patients now have access to this product. COPD patients in Newfoundland now have both public and private payer coverage for Duaklir.

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COPD World News Week of May 1, 2016

Saskatchewan drug program to cover new COPD product

Mississauga, ON - Great news for Canadians with COPD. AstraZeneca has announced that it has received public payer listing for Duaklir in Saskatchewan as an Exception Drug Status (EDS). The criteria is similar to other LABA/LAMA combinations in SK.. Duaklir is a fixed-dose LAMA/LABA combination of two long-acting bronchodilators—aclidinium bromide, a long-acting muscarinic antagonist (LAMA), and formoterol fumarate, a long-acting beta-agonist (LABA). Duaklir is covered for treatment of patients with moderate to severe COPD who have had an inadequate response to a long-acting beta-2-agonist [LABA] or long-acting anticholinergic [LAAC]). With this announcement, Duaklir is reimbursed in almost all provinces across Canada (including Nova Scotia, New Brunswick, Ontario, Manitoba, Alberta, BC, PEI and Yukon) and is another option for Canadian COPD patients and their physicians. 

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COPD World News Week of April 24, 2016

Anxiety Common Among COPD Patients

Toronto, ON - Levels of anxiety are up to three times higher in older adults with chronic obstructive pulmonary disease (COPD) than in patients without COPD, according to findings published in COPD: Journal of Chronic Obstructive Pulmonary Disease. Researchers from the University of Toronto studied a sample of more than 11,000 patients in order to investigate the independent relationship between COPD and anxiety in adults. The patients, who were aged 50 and older, were measured for sociodemographic factors, social support, health behaviors, sleep problems, pain, functional limitations and early childhood adversities. More than 700 adults reported their COPD diagnosis during the 2012 Canadian Community Health Survey. The researchers found that one in 17 adults with COPD had anxiety within the past year, or about 5.8 percent. When the researchers adjusted for age, sex and race, the anxiety levels were four times higher for COPD patients than for those without (about 3.90). When the researchers adjusted for all 18 characteristics they measured for, the odds declined to 1.72 between COPD and non COPD patients. “Even after accounting for 18 possible risk factors for GAD, individuals with COPD still had 70 percent higher odds of GAD compared to those without COPD,” lead author, Professor Esme Fuller-Thomson said in a press release. Some of the leading risk factors for anxiety among COPD patients, the researchers reported, were lack of social support and exposure to parental domestic violence during the patients’ childhoods. The older adults without social support involved in their important decision making had more than seven times the odds of having anxiety in comparison with the patients who did have a friend or social support. When the COPD adults had more than 10 exposures during their childhood to parental domestic violence, their odds for anxiety in comparison to the adults without COPD rose to about five times the risk. The researchers believe that this violence may have triggered a predisposition to anxiety in the patients. The study “highlights how healthcare providers can play a significant role in identifying and providing promising interventions to reduce anxiety for individuals with COPD, in particular by screening for and addressing pain and functional limitations and targeting those most at risk,” Fuller-Thomson concluded.

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COPD World News Week of April 17, 2016

Exercise May Keep Your Brain 10 Years Younger

Miami, FL - Older adults who exercise regularly could buy an extra decade of good brain functioning, a new study suggests. The study found that seniors who got moderate to intense exercise retained more of their mental skills over the next five years, versus older adults who got light exercise or none at all. On average, those less-active seniors showed an extra 10 years of "brain aging," the researchers said. The findings do not prove that exercise itself slows brain aging, cautioned senior researcher Dr. Clinton Wright, a neurologist at the University of Miami Miller School of Medicine. It's possible, he said, that there are other reasons why active older adults stayed mentally sharper. The researchers accounted for some of those other explanations -- including people's education levels, smoking habits and health conditions such as high blood pressure and diabetes. And exercise levels were still connected to the participants' performance on tests of memory and "processing speed" -- the ability to digest a bit of new information, then respond to it. Plus, Wright said, it's plausible that exercise would affect those mental skills. Other research has shown that physical activity boosts blood flow to the brain, and may enhance the connections among brain cells, for example. Exercise can also help manage "vascular risk factors," such as high blood pressure, unhealthy cholesterol levels and diabetes, Wright pointed out. That's important because many studies have suggested that some of the same risk factors for heart disease and stroke also boost the odds of dementia. The new study findings were published in the journal Neurology. Dr. Ezriel Kornel, a neurosurgeon who was not involved in the study, agreed that the findings don't prove that exercise will keep you thinking clearly. "It could simply be that people who are drawn to exercise are also at lower risk of cognitive decline," said Kornel, a clinical assistant professor of neurological surgery at Weill Cornell Medical College, in New York City. That said, he called the study "important," because it at least suggests that exercise could have a big impact on people's mental function as they age. "We already know that exercise is highly valuable for cardiovascular health," Kornel said. The potential to add extra years of healthy brain function might motivate more people to get moving, he said. The findings are based on nearly 900 older adults who took standard tests of memory, attention and other mental skills at an average age of 71. They repeated the tests five years later. At the time of the first test, they also underwent MRI scans of the brain, which allowed the researchers to look for changes associated with early mental impairment. Overall, 10 percent of the group said they regularly got moderate to high-intensity exercise -- which meant activities such as jogging, aerobics and calisthenics. It turned out that those men and women showed substantially less mental decline over five years than the rest of the group -- who were either sedentary or got light exercise, like walking. When it came to tests of episodic memory -- remembering words from a list -- less-active and sedentary seniors showed the equivalent of 10 extra years of brain aging. According to Wright, the results suggest that a casual walk around your neighborhood is not enough to preserve brain function as you age. "It seems like we're not going to get off easy," he said. "There's increasing evidence that it needs to be exercise that gets your heart rate up." However, Wright added, the necessary exercise regimen is far from clear. Seeking some answers, his team is running a trial testing the effects of exercise on stroke survivors' brain function over time. According to Kornel, exercise could theoretically benefit the brain in a range of ways. "Improved blood flow to the brain is one logical assumption," he said. But, he added, exercise can also keep people mentally engaged -- by making them learn new things or concentrate, for example. And if you exercise with other people, Kornel noted, there's a social aspect, too. "If you're out in the world, physically active, there are many things going on that are probably not happening when you're just sitting on your sofa," he said.

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COPD World News Week of April 10, 2016

Beta-blockers could reduce risk of exacerbations

Ghent, Belgium - Beta-blockers could be used to reduce the risk of chronic obstructive pulmonary disease (COPD) exacerbations, according to new findings. Beta-blockers are primarily used to treat stress or heart problems, such as high blood pressure and angina but these new findings suggest they could have a potential benefit for patients with COPD. COPD exacerbations involve a worsening of symptoms, in particular increased breathlessness. Although beta blockers are suspected to tighten the muscles in the airways, contributing to breathing problems, previous research has suggested beneficial effects of β-blocker use in patients with COPD. This study aimed to understand this link and to analyse if any potential benefit on exacerbations existed for COPD patients taking the drug. The research, presented at the recent European Respiratory Society's Lung Science Conference, analysed health records of 1,621 COPD patients included in the Rotterdam Study. Patients were followed until an exacerbation occurred and researchers collected data on the use of different kinds of beta-blockers and whether the patient also experienced heart failure. The findings revealed that the use of cardio selective beta-blockers, which are primarily used to treat heart disease, reduced the relative risk of exacerbations by 21%. The benefits were increased for patients with heart failure who saw a reduced risk of 55%. Lies Lahousse, lead author and FWO postdoctoral fellow from Ghent University Hospital in Belgium, commented: "The overlap in symptoms and risk factors associated with lung and heart disease can be complicated and we know that a reduction in lung function is also associated with a reduction in heart function. These preliminary findings offer a useful insight into the potential benefits of beta blockers for patients living with heart disease at the same time as COPD. If randomised controlled trials confirm our findings, we could see promising clinical implications." 

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COPD World News Week of April 3, 2016

BC and Manitoba PharmaCare programs cover new COPD product

Mississauga, ON - Great news for Canadians with COPD. AstraZeneca has announced that it has received public payer listing for Duaklir in British Columbia, effective April 5th. Duaklir is a fixed-dose LAMA/LABA combination of two long-acting bronchodilators—aclidinium bromide, a long-acting muscarinic antagonist (LAMA), and formoterol fumarate, a long-acting beta-agonist (LABA). Duaklir is now covered under the British Columbia public drug plan formulary with the following Special Authority criteria: For treatment of patients with moderate to severe COPD who have had an inadequate response despite an adequate trial (3 months) of a long-acting bronchodilator (long-acting beta-2-agonist [LABA] or long-acting anticholinergic [LAAC]). It should not be used in combination with another LAAC or LABA. AstraZeneca has also received public payer listing for Duaklir in Manitoba, effective April 18th. Duaklir will be added to the Manitoba Pharmacare program as a Part 3 Exception Drug Status (EDS) benefit with the following limited use criteria: For treatment of patients with moderate to severe COPD who have had an inadequate response despite an adequate trial (3 months) of a long-acting bronchodilator (long-acting beta-2-agonist [LABA] or long-acting anticholinergic [LAAC]). It should not be used in combination with another LAAC or LABA. With these announcements, Duaklir is reimbursed in seven provinces across Canada (including BC, Nova Scotia, New Brunswick, Ontario, Manitoba (effective April 18), Alberta and Yukon.) This means that the majority of qualifying Canadian patients now have access to Duaklir through public drug access programs.

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Screening for COPD of asymptomatic people of no benefit

Washington, DC - The U.S. Preventive Services Task Force (USPSTF) does not recommend screening for chronic obstructive pulmonary disease (COPD) in persons who do not have symptoms suggestive of COPD. The report appears in JAMA. This is a D recommendation, indicating that there is moderate or high certainty that screening has no net benefit or that the harms outweigh the benefits. About 14 percent of U.S. adults age 40 to 79 years have COPD, and it is the third leading cause of death in the U.S. Persons with severe COPD are often unable to participate in normal physical activity due to deterioration of lung function. To update its 2008 recommendation, the USPSTF reviewed the evidence on whether screening for COPD in asymptomatic adults (those who do not recognize or report respiratory symptoms) improves health outcomes. The USPSTF reviewed the diagnostic accuracy of screening tools (including pre-screening questionnaires and spirometry [a test of the air capacity of the lungs]); whether screening for COPD improves the delivery and uptake of targeted preventive services, such as smoking cessation or relevant immunizations; and the possible harms of screening for and treatment of mild to moderate COPD. The USPSTF is an independent, volunteer panel of experts that makes recommendations about the effectiveness of specific preventive care services such as screenings, counseling services, and preventive medications.

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COPD World News Week of March 27, 2016

Physical activity improves outcomes after being hospitalized

Boston, MA - Any amount of moderate to vigorous physical activity can effectively reduce the risk of dying after hospitalization for chronic obstructive pulmonary disease (COPD), according to a new study. The research, published today in ERJ Open Research, significantly adds to the mounting evidence that physical activity should be used to monitor and treat patients with COPD. Patients with COPD can be hospitalized if they experience an acute exacerbation of their symptoms. Re-hospitalization and death rates are high following any initial hospitalization and in addition, hospitalizations due to severe exacerbations of COPD account for up to 70% of the healthcare costs associated with COPD. It is crucial that healthcare professionals can identify patients at a high-risk of readmission. Researchers studied health records of 2,370 patients from Kaiser Permanente Southern California who were hospitalized for COPD for one year, looking at exercise as a vital sign which was self-reported in the clinic as a measure of physical activity and monitoring deaths from all causes within that time frame. The results found that patients who were active had a 47% lower risk of death in the 12 months following a COPD hospitalization, compared to inactive patients. Patients who were active but at insufficient levels still maintained a 28% lower risk of death, compared to inactive patients. The authors concluded that monitoring levels of physical activity with a simple exercise “vital sign”, could help healthcare professionals identify, monitor and treat those patients at a high risk of death following hospitalization. Lead author, Dr Marilyn Moy, Assistant Professor at Harvard Medical School, commented: “We know that physical activity can have a positive benefit for people with COPD and these findings confirm that it may reduce the risk of dying following hospitalization for an acute exacerbation. The results also demonstrate the importance of routinely assessing physical activity in clinical care to identify high-risk patients as part of a larger strategy to promote physical activity in this highly sedentary population."

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COPD World News Week of March 20, 2016

'Cold Turkey' May Work Best for Quitting Smoking

Oxford, UK - What's the best way to kick a smoking habit? New research suggests quitting all at once beats a more gradual approach. The study found that after four weeks, nearly half of those who quit "cold turkey" were still not smoking. But, among people who quit gradually over two weeks, only 39 percent were smoke-free at four weeks, researchers said. "Most people thought cutting down would suit them better," said study lead author Nicola Lindson-Hawley. She's a post-doctoral researcher with the University of Oxford in the United Kingdom. "But whatever they thought, it turned out they were better to try to quit abruptly." Findings from the study were published online March 14 in the Annals of Internal Medicine. Smoking is still the leading preventable cause of death, according to the U.S. Centers for Disease Control and Prevention (CDC). Each year, approximately 400,000 Americans die because of smoking, the CDC says. And for every person who dies due to smoking, another 30 people are living with smoking-related illness, the government agency reports. The good news is that stopping smoking greatly reduces the risk of smoking-related diseases, the CDC notes. Unfortunately, quitting smoking for good is no easy task. And no wonder: Research has suggested that nicotine is as addicting as drugs such as heroin and cocaine, the CDC says. Smokers who try to quit often suffer from stress, hunger and weight gain, according to the CDC. These all contribute to low quit rates. Strategies such as using nicotine replacement therapy and getting counseling can help, however. And many people do succeed in quitting, even if it takes several attempts. The latest research included just under 700 adult smokers from England. The study participants smoked an average of 20 cigarettes a day. More than nine in 10 of the participants were white. The average age of the smokers was 49, and half were women. The study volunteers were randomly assigned to quit smoking abruptly or to cut down gradually by 75 percent over two weeks. Before the day they quit, the gradual quitters used nicotine patches plus short-term products such as gum and lozenges; the abrupt quitters used only nicotine replacement patches. All of the participants received counseling assistance from nurses and short-term nicotine replacement medications after the quit day. The researchers followed up at four weeks and six months after the experiment started. Blood testing was used to confirm whether smokers had actually quit. At four weeks, 39 percent of those who'd gradually quit had stopped smoking compared to 49 percent of those who stopped abruptly. At six months, 16 percent of the gradual quitters and 22 percent of the abrupt quitters were still non-smokers, the study found. The percentages of smokers who successfully quit may seem quite low, but Lindson-Hawley said those percentages are normal. Dr. Michael Fiore, a professor at the University of Wisconsin-Madison who's helped develop federal guidelines about quitting smoking, pointed out that the percentages are still higher than quitting without support from counseling or medication.

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COPD World News Week of March 13, 2016

Mom's Smoking May Put Kids at Higher Risk of COPD in Adulthood

Melbourne, Australia - The children of mothers who smoke heavily may face a much higher risk for developing chronic obstructive pulmonary disease (COPD) as adults, new research suggests. The finding is based on the tracking of COPD risk among nearly 1,400 adults, and it suggests that heavy maternal smoking -- more than 20 cigarettes per day -- increases a child's long-term COPD risk nearly threefold. "The findings were not surprising to us," said study author Jennifer Perret. She is a postdoctoral fellow with the Centre for Air Quality and Evaluation in the Melbourne School of Population & Global Health at the University of Melbourne in Australia. "Smoking in later life can result in deficits in lung function by middle age. So it was not unexpected to see that mothers' smoking . . . could also adversely influence the growing lungs of [their children]," Perret said. And, "reduced lung function potential in childhood predisposes an individual to having reduced lung function as an adult," she added. However, the study did not prove that a mother's heavy smoking habit caused her children to have an increased risk for COPD later in life; the researchers only found an association. Perret and her colleagues reported their findings in the March 10 issue of the journal Respirology. According to the U.S. National Heart, Lung, and Blood Institute, COPD is a progressively worsening illness that greatly compromises a person's ability to breathe. Smoking is the leading cause of COPD, which is now the third leading cause of death around the world, the researchers said. To see how COPD risk related to parental smoking patterns, the authors reviewed surveys completed in 2004 by more than 5,700 men and women (average age of 45) who had been participating in a long-running study that began in 1968. Nearly 40 percent said that when they were 7 years old they lived with a mother who smoked, and 17 percent of this group said their mothers were heavy smokers. Nearly 60 percent grew up with smoking fathers, 34 percent of whom were heavy smokers. Twelve percent said they grew up in households where both parents were heavy smokers. Only 8 percent grew up in a household where the mom was the sole smoker. About two-thirds of the study participants said they had a history of asthma, and one-quarter said they still had the respiratory condition. More than four in 10 said they had never smoked themselves. Nearly 1,400 of the survey respondents underwent lung-function tests between 2006 and 2008. The investigators uncovered no evidence of elevated COPD risk among those who had grown up with smoking dads, or moms who smoked less than 20 cigarettes a day. But those who grew up with mothers who smoked heavily were 2.7 times more likely than others to have a kind of lung impairment that is indicative of COPD. Additional testing revealed that the already elevated risk for COPD seen among offspring who smoked themselves was driven even higher if they had grown up with a mom who smoked heavily. There were indications that boys might be somewhat more vulnerable to the negative impact of maternal smoking than girls. Perret suggested this could be due to a range of gender-based "biological differences" that unfold throughout childhood development. Regardless, the team said the findings should bolster current recommendations that pregnant women and young mothers should avoid smoking altogether. Meanwhile, for those whose moms smoked heavily, what can be done to minimize their COPD risk? "If there are concerns or symptoms such as breathlessness on exertion, cough or phlegm, they may wish to seek the advice of a doctor who could measure their lung function," Perret advised. And, she suggested, "as there may be a combined effect with other smoking and environmental exposures, it would be advisable for them not to smoke, and avoid smoky, dusty and polluted environments where possible." Dr. David Mannino, chief scientific officer for the COPD Foundation, expressed little surprise at the findings. But he cautioned that there is no specific magic bullet for reducing COPD risk among those with this kind of family history. As for everyone, said Mannino, the focus should be placed on the "same factors that are important to maintaining good health: don't smoke, exercise, and watch your diet."

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COPD World News Week of March 6, 2016

OLA Urges Speedy Passage of New E-cigarette Regulations

Toronto -- The Ontario Lung Association is welcoming proposed changes to Ontario’s tobacco and e-cigarette legislation that will expand no-smoking rules to apply to medical marijuana and prohibit the use of e-cigarettes in areas where smoking tobacco is banned. “The proposed new regulations are a sensible and measured response to the lung health concerns associated with the growing popularity of e-cigarettes and the increasing use of marijuana for medical purposes,” said Andrea Stevens Lavigne, vice-president of provincial programs with the Ontario Lung Association. Releasing a public consultation paper today, the Associate Minister of Health and Long-Term Care, Dipika Damerla, called for feedback on proposed amendments to the Smoke Free Ontario Act and to regulations under the Electronic Cigarettes Act that, if approved, would: Prohibit the use of e-cigarettes and the smoking and vaping of medical marijuana in all enclosed public places, enclosed workplaces, and specified outdoor areas. Expand the list of places where selling e-cigarettes is banned Establish rules for the display and promotion of e-cigarettes and prohibit the testing of e-cigarettes in places where they are sold. “We have enough evidence about vaping’s negative impact on lung health,” said Stevens Lavigne. “Furthermore, a recent study showed that teenagers who use e-cigarettes are twice as likely to go on to smoke tobacco. “In the final analysis, it doesn’t make much difference whether it’s e-cigarette vapour or marijuana smoke – inhaling foreign substances damages your own lungs and those who breathe those substances second-hand. “Every Ontarian has the right to breathe clean, fresh air. We urge the government to respect that right by passing this legislation without further delay.”

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COPD World News Week of February 28, 2016

COPD therapy should also focus on patient’s quality of life

Lisbon, Portugal - When chronic obstructive pulmonary disease (COPD) is managed with a focus on how the symptoms impact the patient, quality of life and outcomes can be improved, UK researchers found. Exercise training, behavior modification, and education delivered by a multidisciplinary team, and in some cases pulmonary rehabilitation, can be helpful. Such interventions should be as carefully considered and tailored to individual patients as drug dosages, Paul W. Jones and colleagues wrote in the International Journal of Chronic Obstructive Pulmonary Disease on February 19, 2016. Jones of the Division of Clinical Science, St. George’s, at the University of London, and colleagues reviewed information presented at the 1st World Lung Disease Summit. Although the symptoms of COPD are well-documented, the degree to which they limit a patient’s quality of life (QoL) “varies depending on a number of factors, for example, their disease severity and comorbidities” say the researchers. Additionally, the time of day that the patient experiences symptoms affects QoL. There are several instruments available for clinicians to evaluate patients’ symptoms: the COPD Assessment Test (CAT), the Clinical COPD Questionnaire (CCQ), the modified Medical Research Council dyspnea score (mMRC), and the St. George’s Respiratory Questionnaire SGRQ, as well as the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification system. Patients with COPD are progressively less active. A decline in physical activity usually begins early in the disease. The reviewers reported that one study concluded, “the objective measurement of physical activity is the strongest predictor of all-cause mortality in patients.” In light of those findings, the researchers say, “an appropriate level of physical activity is very important in patients with COPD, as it plays a key role in maintaining health.” COPD, like other chronic conditions, is often accompanied by comorbidities which impact COPD symptoms and QoL. The reviewers say, “Comorbidities make COPD management more challenging and increase the use of health care services.” Identifying common comorbidity clusters could help in the management of COPD. Optimizing both the time and method of delivery of bronchodilators, the “mainstay of therapy in COPD” according to researchers, can help improve exercise tolerance and improve levels of physical activity.

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COPD World News Week of February 21, 2016

Ottawa seeks to join provinces to cut cost of prescription drugs

Ottawa, ON - The federal government is set to join the provinces in lowering the cost of prescription drugs by co-ordinating their purchases, a move that could signal a new era of co-operation between Ottawa and provincial leaders. The collaboration is expected to come as early as this week when Federal Health Minister Jane Philpott joins her provincial and territorial counterparts for a meeting in Vancouver. The meeting is the first in what will be a critical year as Ottawa works to hammer out a new deal on health that will set national standards and deliver the stable funding promised by the Liberals during the election. The new federal minister, herself a family doctor, said she expects this week’s meeting to be the beginning of a “year-long project” to reach a new health accord and lay the groundwork for transforming Canada’s health system. Even before the two days of meetings begin Wednesday, a number of provincial health ministers are staking out their positions on future federal health transfers. Some, such as B.C. Health Minister Terry Lake, want extra per-capita funding for seniors, while Manitoba Health Minister Sharon Blady said the same consideration should be given to First Nations populations. Alberta Health Minister Sarah Hoffman, whose province stands to lose if transfers are adjusted based on age, is opposed to such changes. Dr. Philpott, who will join the meeting on the second day, wants to steer the talk away from dollars. “My hope is that we won’t allow ourselves to be inappropriately distracted by conversations about details of the transfer at this stage of the conversation,” she said. Dr. Philpott said reducing the cost of prescription drugs is one of her top priorities. “Canadians pay some of the highest costs for prescription drugs. That is an area that I am quite determined to address,” she said. Joining the Pan-Canadian Pharmaceutical Alliance, an initiative started in 2010 by the provinces and territories to drive down costs of publicly funded drug programs through bulk buying, is the first step, she said. Federal drug programs that cover the military, First Nations and inmates make Ottawa the fifth-largest spender on pharmaceuticals in Canada, Dr. Philpott said. “We will be a major buyer that will be coming to the table and participating in the bulk purchasing, which I think obviously will help our purchasing power,” she said. The new federal government is looking at other ways to reduce drug costs, she said, including changes to the Patented Medicine Prices Review Board, the quasi-judicial body that regulates the prices of patented drugs. A study this fall by the Organization for Economic Co-operation and Development ranked Canada as the fourth-highest spender on pharmaceuticals among 29 countries when measured by population. Pharmaceutical spending in Canada worked out to $713 (U.S.) a person in 2013, well above the OECD average of $515. Steve Morgan, a professor of health policy at the University of British Columbia, said the federal move to join the Pan-Canadian Pharmaceutical Alliance is a sign of “good will and good faith,” but pointed out the majority of Canadians pay for prescriptions out of pocket or through private drug plans. Home care is another priority for the federal Health Minister, following on the Liberal party’s $3-billion campaign pledge. Dr. Philpott wants to tie new federal money to performance targets, but said it’s too soon to say what they will be. Mr. Lake, B.C.’s Health Minister, who will lead the provincial-territorial talks, said the issue of physician-assisted death also must be a top priority, given last week’s Supreme Court ruling. “We really need to have some serious discussions with the federal government over how they’re going to move forward,” he said. “I would prefer to see a consistent approach across Canada so that we don’t develop different regulatory regimes in every province. That will be a topic of intense discussion.”

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COPD World News Week of February 14, 2016

How stigma affects COPD research and care

Toronto, ON - "Unfortunately, I believe that a tendency to blame the patient has contributed to COPD (chronic obstructive pulmonary disease) getting less attention than other common chronic diseases. There was a belief that, because people with COPD smoked, they were deserving of their fate and not deserving of resources put towards their disease. I think this is wrong on many levels. Luckily, things are changing," said Dr. Gershon, an assistant professor of medicine at the University of Toronto. She was responding to questions related to her latest study, which investigates the efficacy of different treatments for older adults with COPD. Her point on stigma is an interesting one, as it offers an example of how popular stigmas may directly affect both research and care. Dr. Gershon's study - published in JAMA - also makes the point that, despite COPD being a leading cause of death, there is comparatively little available evidence on how to treat COPD patients - particularly elderly patients and those who have other similar diseases, such as asthma. But how does stigma surrounding COPD begin? For the COPD patient the dreaded question is: "Did you smoke?" They believe in the end they will be shamed and blamed for smoking." Smoking does cause the majority of COPD cases although it is estimated that 25% of COPD patients have never smoked. Dr. Gershon feels that COPD stigma has impacted negatively on research. To arrive at this conclusion, Dr. Gershon's team examined administrative health records for 2,129 older adults who were only taking long-acting beta agonists for COPD and compared them with the records for 5,594 adults taking these drugs in conjunction with corticosteroids. The researchers found that seniors taking both long-acting beta agonists and corticosteroids had 8% fewer deaths and hospitalizations during the period of study than those who were taking long-acting beta agonists alone. The team describes the 8% disparity as "modest but significant." However, among patients who had both COPD and asthma, those taking the two medications had a 16% lower risk of hospitalization and death, compared with patients who only took long-acting beta agonists. More than a quarter of the study participants had both asthma and COPD. Dr. Gershon says that, previously, doctors have not "really known how to treat these patients," as studies have generally excluded COPD patients who also have asthma. "I believe this was because the effectiveness of interventions in people with COPD would be known with more certainty, for instance, without having to wonder if an intervention was effective because it was treating another disease, like asthma, that was also present. While this approach has its merits, it means that many patients with both COPD and asthma were excluded. As a result, there is little evidence on which to base our treatment recommendations for these patients."

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COPD World News Week of February 7, 2016

No Clear Winner Seen Among Stop-Smoking Aids

Madison, WI – “If you're trying to quit smoking, using the nicotine patch, the drug Chantix, or a combination of the patch and lozenges all appear to work equally well,” researchers report. "To our surprise, all three treatments were essentially identical," said lead author Dr. Michael Fiore, director of the University of Wisconsin Center for Tobacco Research and Intervention in Madison. Results of the three approaches did not differ significantly at either six months or a year, the investigators found. At six months, the quit rate was 23 percent for the patch, 24 percent for Chantix, and 27 percent for the combination of patch and lozenges. At a year, the quit rate was 21 percent, 19 percent and 20 percent, respectively, the findings showed. In the past, Chantix (varenicline) or the combination of the nicotine patch and nicotine lozenges were shown in studies to be more effective than the patch alone, he said. "But no one had compared them," Fiore explained. Although the reasons why the treatments worked equally well aren't known, wanting to quit smoking has a strong effect, Fiore suggested. "A person's desire to quit is really powerful," Fiore said. "The treatments are important and boost quit rates, but that in no way discounts the incredibly powerful influence of a person's commitment to change their behavior -- particularly a behavior so dangerous as smoking is," he said. The report was published Jan. 26 in the Journal of the American Medical Association. Patricia Folan is director of the Center for Tobacco Control at Northwell Health, in Great Neck, N.Y. She said, "When a smoker tries to quit, there are many factors that influence their decision to try to quit, and their ability to stay quit." Reasons people quit include doctor's advice, family pressure, the impact of smoking bans, the cost of smoking, and anti-tobacco ads. In addition, not smoking again depends on motivation, support, level of comfort and use of cessation medications, she said. "While studies have demonstrated that cessation medications are an important factor in quitting, a comprehensive approach to quitting is often necessary for success," Folan added. In their head-to-head comparison, Fiore and his colleagues randomly assigned smokers to one of three 12-week programs: the nicotine patch only; Chantix only; or the nicotine patch plus nicotine lozenges. In addition, participants were offered six counseling sessions. According to Fiore, all the medications were well-tolerated. However, people taking Chantix had more frequent side events, including vivid dreams, insomnia, nausea, constipation, sleepiness and indigestion. Pfizer Inc., the maker of Chantix, said in a statement that the results of this study are inconsistent with findings from previous research that reported "superior efficacy of varenicline [Chantix] and combination therapy, compared with nicotine-replacement therapy alone." Moreover, the best type of trial is one in which people randomly receive Chantix, or nicotine-replacement therapy or a placebo, but not know which. However, such a trial has not been done, the company said. Folan said that the latest findings may have been skewed by the type of people who were studied. Specifically, most smoked less than a pack a day and most had tried to quit before. "Prior experiences with quitting, the fact that they were not heavy smokers, their motivation to quit and the provision of counseling sessions most likely had an impact on their quit success, regardless of the medication used," she said. Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, said that "most of the people who quit are those who want to quit." He also said that it's not surprising that replacing nicotine by any means results in the same outcome. In addition, Horovitz said many of his patients are unwilling to take Chantix because of its side effects. Horovitz added that for many smokers, several tries are needed before they can quit for good. "Just because you have gone around the turnstile once or twice and have not quit does not mean that you are doomed to fail. In fact, the more times you try, the more likely it is that you will finally succeed," he said.

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COPD World News Week of January 31, 2016

Coils in lungs might boost ability to exercise with emphysema

Reims, France - Implanting coils in the lungs may help improve the ability to exercise in people with severe emphysema, a new study suggests. Emphysema is a type of chronic obstructive pulmonary disease (COPD) that damages the airways and makes it difficult to breathe. Current treatments for severe emphysema have limited effectiveness. Lung volume reduction surgery can help, but carries a risk of complications and death, the study authors explained. Dr. Gaetan Deslee, of Reims University Hospital in France, and colleagues recruited 100 patients for the study. Fifty patients received usual care -- rehabilitation and bronchodilators with or without inhaled corticosteroids and oxygen. The remaining 50 received usual care and also had coils placed in their lungs. The researchers said the coils were placed in the lungs using an endoscope -- a slender, flexible device inserted into the mouth. The study was conducted at 10 university hospitals in France. After six months, more than one-third of the patients in the coil group had improvement of at least 59 yards in a 6-minute walk test. Just 9 percent of those in the usual care group had a similar improvement. The patients in the coil group also had a significant decrease in lung hyperinflation and sustained improvement in quality of life. The average one-year per-patient cost difference between the two groups of patients was nearly $48,000, the study showed. Further research is needed to determine the long-term benefits and cost effectiveness of the coil treatment, the researchers concluded. The study was published in the Jan. 12 issue of the Journal of the American Medical Association.

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COPD World News Week of January 24, 2016

No Antibiotics for Common Respiratory Infections

Atlanta, GA - Antibiotics are not needed for adults who have the common cold, bronchitis, sore throat or sinus infections. That's the advice from the American College of Physicians and the U.S. Centers for Disease Control and Prevention, which just issued guidelines for prescribing antibiotics for acute respiratory tract infections (ARTIs) in adults. These types of infections are the most common reason for visits to the doctor and for outpatient antibiotic prescriptions for adults, the researchers said.
The advice, published Jan. 18 in Annals of Internal Medicine, is designed to combat what the two organizations see as overuse of such treatments. According to an ACP news release, unpublished CDC data estimates "50 percent of antibiotic prescriptions may be unnecessary or inappropriate in the outpatient setting, which equates to over $3 billion in excess costs." "Inappropriate use of antibiotics for ARTIs is an important factor contributing to the spread of antibiotic-resistant infections, which is a public health threat," ACP President Dr. Wayne Riley said in the news release. "Reducing overuse of antibiotics for ARTIs in adults is a clinical priority and a High Value Care way to improve quality of care, lower health care costs, and slow and/or prevent the continued rise in antibiotic resistance," he added. Doctors should advise patients with the common cold that symptoms can last up to two weeks and they should follow up only if the symptoms worsen or exceed the expected time of recovery. Antibiotics should also not be prescribed for uncomplicated bronchitis unless pneumonia is suspected: "Patients may benefit from symptomatic relief with cough suppressants, expectorants, antihistamines, decongestants and beta-agonists." In most cases, antibiotics should be prescribed for a sore throat only if a strep test confirms streptococcal pharyngitis. "Physicians should recommend analgesic therapy such as aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs, and throat lozenges, which can help reduce pain." Uncomplicated sinus infections typically clear up without antibiotics. Antibiotics should be prescribed only if there are persistent symptoms for more than 10 days, or if a patient develops severe symptoms or a high fever, has nasal discharge or facial pain for at least three days in a row, or worsening symptoms following a typical viral illness that lasted five days, which was initially improving."

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COPD World News Week of January 17, 2016

Quality of life worse in patients with COPD than cancer

New York, NY – According to a release by Reuters Health, respiratory health-related quality of life (HRQoL) is worse in breathless COPD patients than in breathless cancer patients, researchers have found. Although breathlessness is common in patients with advanced chronic obstructive pulmonary disease (COPD) and in patients with advanced cancers of all primary sites, little is known about the impact of breathlessness on HRQoL. Dr. Morag Farquhar and colleagues from the University of Cambridge, U.K., used the Chronic Respiratory Questionnaire-Original (CRQ-Original) to examine differences in respiratory HRQoL between 139 patients with breathlessness due to advanced COPD or advanced cancer who were referred for palliative care. Patients with advanced COPD had lower median scores for all four CRQ domains, compared with patients with advanced cancer, though the differences were statistically significant only for three domains: dyspnea, emotional function, and mastery. The differences in emotional function and mastery exceeded the minimally clinically important difference of 0.5 (on a scale of 0-7), the researchers report in BMJ Supportive & Palliative Care, online December 18. "Acknowledging that patients with advanced COPD experience breathlessness differently from those with cancer is imperative if we are to direct our interventions effectively and improve access to palliative care for patients with advanced COPD," the researchers conclude. "Further, formal psychometric testing of the CRQ in patients with respiratory symptoms due to cancer may be warranted to establish its suitability for use in this group, which could benefit both research and clinical practice." Dr. Nicholas Wysham from Duke Clinical Research Institute in Durham, North Carolina, told Reuters Health by email that the cancer patients may have been referred for palliative care for a variety of reasons. "Studies like these are complicated by the choice of comparisons. By choosing to compare groups at time of palliative care referral, (the authors) are able to make inferences about referral patterns more than they are about the patients or diseases themselves," said Dr. Wysham, who has done similar research. "A comparison with lung cancer patients (as was in my manuscript and others that preceded it), might be more appropriate and may or may not have demonstrated such a difference." "Physicians who care for patients with advanced COPD should promptly recognize uncontrolled symptoms or persistent distress and manage these using the full range of therapeutic options, or make appropriate and timely referral to others who can," Dr. Wysham said. "This report suggests that brief HRQoL instruments, like the CRQ, CAT (COPD Assessment Test), and others, can be helpful for detecting patients with poor quality of life and should probably be incorporated into the routine care of such patients." "To make capture of HRQoL more routine, though, we need to push EHR vendors and health systems to integrate these items within the medical record as discreet data, giving them the importance you might to a heart rate or a pain score," Dr. Wysham added. "Furthermore, rather than consume physicians' or nurses' time collecting and entering this data, we need to explore ways for these patients to directly contribute these survey items."

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COPD World News Week of January 10, 2016

COPD Treatment Pipeline Lacks Robust Innovation

New York, NY - Despite an influx of new therapies over recent years, the Chronic Obstructive Pulmonary Disease treatment market has a number of unmet needs, and the innovation in its product development pipeline is lagging in comparison to other indications, says business intelligence provider GBI Research. According to the company’s latest report, while currently-available drugs aim to manage the symptoms associated with COPD by reducing the frequency and severity of exacerbations and improving lung function, none have been shown to modify long-term disease progression. Yasser Mushtaq, Senior Analyst for GBI Research, states that in addition to the need for disease-modifying drugs, much of the unmet need associated with COPD has been linked to poor adherence to medication. Mushtaq says: “Tedious drug delivery processes and the need for frequent daily doses ultimately lead to poor compliance and management of COPD symptoms. As a consequence, drug development programs are focusing on long-acting medication. “There is also a need for alternative anti-inflammatory agents. Traditionally reliant on Inhaled Corticosteroids (ICS), analysis of the COPD product development pipeline has confirmed greater interest into novel anti-inflammatory agents.” The analyst adds that beyond ICS therapy, the current market offers very limited anti-inflammatory treatment, which is a notable unmet need in COPD. GBI Research’s report also states that first-in-class product development in COPD treatment constitutes only 16.5% of the pipeline, which is relatively small compared to other respiratory indications. For example, asthma therapeutics exhibit greater innovation, with first-in-class products making up 23% of the pipeline. Mushtaq continues: “There are suggestions that such innovation is filtering through into the COPD therapeutics pipeline, as asthma and COPD share mechanisms of pathophysiology, making it likely that products will be applicable to both diseases. “In this way, innovations in the asthma treatment pipeline will significantly aid that of COPD. However, there is no clear indication that disease-modifying drugs will be released onto the COPD market any time soon, making it an attractive proposition for major pharma players.”

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COPD World News Week of January 3, 2016

Doctor-Patient e-mails can help the chronically ill

Oakland, CA - For people with chronic conditions, the ability to communicate with their doctor via email may improve their health, new research suggests. The study included just over 1,000 patients in northern California diagnosed with conditions such as asthma, coronary artery disease, congestive heart failure, diabetes or high blood pressure. The patients had access to an online portal, which let them review their health records, make appointments, refill prescriptions and send confidential emails to their doctor. A survey found that 56 percent of the patients had sent their doctor an email within the past year, and 46 percent had used email as the primary way to contact their doctor about medical issues. Thirty-two percent of those who exchanged emails with their doctor reported improvements in their health, according to the study published in the December issue of the American Journal of Managed Care. Meanwhile, 67 percent said emailing their doctor had no effect on their overall health, the findings showed. "We found that a large proportion of patients used email as their first method of contacting health care providers across a variety of health-related concerns," lead study author, Mary Reed, said in a news release from Kaiser Permanente. Reed is a staff scientist with Kaiser Permanente's research division in Oakland, Calif. "As more patients gain access to online portal tools associated with electronic health records, emails between patients and providers may shift the way that health care is delivered and also impact efficiency, quality and health outcomes," she added. For 42 percent of the patients, using email to communicate with their doctor reduced the number of phone calls they made to the office, and 36 percent said they made fewer office visits, according to the report. Among those who used email to communicate with their doctor, 85 percent had co-pays of $60 or more for each office visit, or high deductibles, compared to 63 percent with lower cost sharing, the study found.

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