COPD World News - 2022

COPD World News - Week of May 15, 2022

Respiratory roundtable recommends that we continue to mask up

Ottawa, ON - As provincial, territorial and federal public health guidelines on COVID-19 continue to evolve, the COVID-19 Respiratory Roundtable recognizes that people, businesses and workplaces will react differently to any changes. Nevertheless, a common goal for all Canadians is to remain healthy. As a group of professional societies and patient organizations working closely with individuals living with lung disease and supporting the lung health of Canadians, members of the COVID-19 Respiratory Roundtable are concerned about the ongoing risk of COVID-19, particularly in the wake of easing of public health restrictions. People’s choices make a difference Despite a relatively high rate of vaccination across Canada, the risk of COVID-19 spread remains. The group urges that we need to be mindful of how the individual choices we make will affect vulnerable and high-risk groups: the elderly, children under five years of age who are not yet vaccinated, individuals with underlying health conditions and the health care professionals who have been working to protect and provide high-quality health care to Canadians throughout the pandemic. Wearing a mask also helps to protect you. An estimated 10% of those infected will experience Long COVID – a range of long-term symptoms, some quite serious, even for people who had mild initial illness. Improving indoor air quality is only part of the solution You may have heard that organizations and facilities are working to increase ventilation to improve indoor air quality. Keep in mind that although improving indoor air quality is an important measure, proper ventilation alone cannot protect you from exposure to the virus responsible for COVID-19. This is particularly true during close, unmasked contact and in the absence of other protective measures. The COVID-19 Respiratory Roundtable urges Canadians to continue wearing a mask indoors especially in poorly ventilated areas and when physical distancing may not be possible or proves to be challenging in crowded areas. If wearing a face mask is not possible, we recommend that individuals instead minimize exposure to indoor congregate settings.

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COPD World News - Week of May 8, 2022

Global quality standards for COPD management proposed

Cambridge, UK – A multidisciplinary group of clinicians with expertise in COPD management together with patient advocates from eight countries participated in a review of quality standards worldwide. The principal objective was to achieve consensus on global health system priorities to ensure consistent standards of care for COPD. These quality standard position statements were either evidence-based or reflected the combined views of the panel. Despite being a leading cause of death worldwide, chronic obstructive pulmonary disease (COPD) is underdiagnosed and underprioritized within healthcare systems. The group found that existing healthcare policies should be revisited to include COPD prevention and management as a global priority. The researchers described health system quality standard position statements that should be implemented as a consistent standard of care for patients with COPD. On the These experts adopted five quality standard position statements, including the rationale for their inclusion, supporting clinical evidence, and essential criteria for quality metrics. These quality standard position statements emphasize the core elements of COPD care, including (1) diagnosis, (2) adequate patient and caregiver education, (3) access to medical and nonmedical treatments aligned with the latest evidence-based recommendations and appropriate management by a respiratory specialist when required, (4) appropriate management of acute COPD exacerbations, and (5) regular patient and caregiver follow-up for care plan reviews. These practical quality standards may be applicable to and implemented at both local and national levels. While universally applicable to the core elements of appropriate COPD care, they can be adapted to consider differences in healthcare resources and priorities, organizational structure, and care delivery capabilities of individual healthcare systems. They encourage the adoption of these global quality standards by policymakers and healthcare practitioners alike to inform national and regional health system policy revisions to improve the quality and consistency of COPD care worldwide.

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COPD World News - Week of May 1, 2022

Different responses to pulmonary rehabilitation in COPD patients with different work efficiencies

New Taipei City, Taiwan - New report looks at different responses to pulmonary rehab amongst COPD patients. Chronic obstructive pulmonary disease (COPD) often involves the cardiopulmonary dysfunction that deteriorates health-related quality of life (HRQL) and exercise capacity. Work efficiency (WE) indicates the efficiency of overall oxygen consumption (VO2) during exercise. This study investigated whether different WEs have different effects on pulmonary rehabilitation (PR). The researchers here looked at forty-five patients with stable COPD who were scheduled for PR. The pulmonary rehab programs consisted of twice-weekly sessions for three months. These patients were comprehensively evaluated by cardiopulmonary exercise testing and COPD assessment test (CAT) before and after PR. They compared these parameters between patients with a normal versus poor WE. The researchers found that twenty-one patients had a normal WE and twenty-four patients had a poor WE (< 8.6 mL/min/watt). Patients with a poor WE had earlier anaerobic metabolism, a poorer oxygen pulse, lower exercise capacity, more exertional dyspnea, and a poorer health related quality of life than those with a normal WE. Pulmonary rehab improved exercise capacity, HRQL, anaerobic threshold, exertional dyspnea and leg fatigue in patients with either normal or poor WE. However, significant improvement of WE, oxygen pulse, respiratory frequency (Rf) during exercise, chest tightness, activity and sleepiness by CAT were noted only in patients with a poor WE. Among the patients with a poor work efficiency, 29% patients had their work efficiency return to normal after pulmonary rehabilitation. They concluded that the patients with different WE had different responses to PR. PR improved exercise capacity and HRQL regardless of a normal or poor WE. However, WE, oxygen pulse, Rf during exercise, chest tightness, activity and sleepiness were only improved in patients with a poor work efficiency. 

For the full report:

COPD World News - Week of April 17, 2022

Risk of death more than doubles with COVID-19 and flu co-infection

Edinburgh, Scotland - Adults who are hospitalized with COVID-19 and the flu at the same time are at a greater risk for serious illness and death, according to a new study. Researchers from the University of Edinburgh, University of Liverpool, Leiden University and Imperial College London studied more than 305,000 hospitalized COVID-19 patients and published their findings in The Lancet on Friday. Of the patients studied, nearly 7,000 had respiratory viral co-infections with 227 of these patients simultaneously having seasonal influenza and COVID-19. According to the study, patients with a co-infection of SARS-CoV-2, the virus that causes COVID-19, and influenza viruses were four times more likely to need ventilation during their hospital stay. The study also suggested these patients were 2.4 times more likely to die than patients hospitalized with just COVID-19. "We are seeing a rise in the usual seasonal respiratory viruses as people return to normal mixing, so we can expect flu to be circulating alongside COVID-19 this winter," Calum Semple, a professor of outbreak medicine at the University of Liverpool and one of the researchers behind the study, said in a press release on Monday. "We were surprised that the risk of death more than doubled when people were infected by both flu and COVID-19 viruses." Researchers said they hope this information could be used to help hospitals and ICUs better prepare for flu season. Although they note that co-infections are not very common, the study's authors suggested testing hospital patients for influenza viruses as a way to mitigate risks for patients. They also reiterated the importance of getting vaccinated against COVID-19 as well as getting the seasonal flu shot each year. "It is now very important that people get fully vaccinated and boosted against both viruses, and not leave it until it is too late," Semple said. According to a press release from the University of Edinburgh, this research is the largest-ever study of people with COVID-19 and other endemic respiratory viruses. The research was also delivered to the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC), which was created in 2013 to share information and prepare for any future pandemics. 

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COPD World News - Week of April 10, 2022

Risk for incident depression, antidepressant prescriptions elevated in patients with COPD

Nottingham, UK - Patients with confirmed COPD had an increased risk for depression and were more likely to receive a prescription for antidepressant medication than individuals without COPD, according to data published in Respiratory Medicine. “Mechanisms underlying the association between depression in COPD are not fully understood. Risk factors associated with increased prevalence of depression in COPD are likely multiple and include age, female gender and smoking. The COPD severity has also been associated with an increased prevalence of depression, regardless of how COPD severity is defined,” Rayan A. Siraj, MSc, from the division of respiratory medicine at the University of Nottingham, U.K., and colleagues wrote. “Breathlessness is a core symptom in COPD and has been associated with worse depression symptoms. There may also be a link between COPD and depression through lower socioeconomic class; a risk factor linked to both conditions.” Data were derived from Siraj RA, et al. Respir Med. 2022;doi:10.1016/j.rmed.2022.106804. The large population-based cohort study included 44,362 patients with confirmed COPD (mean age, 67.8 years; 37.5% women) in The Health Improvement Network (THIN) database. Patients were matched with individuals without COPD (n = 124,140; mean age, 67.5 years; 33.7% women) by age, sex and general practitioner. The incidence rate of depression was higher in patients with COPD compared with individuals without COPD: 11.4 vs. 5.7 per 1,000 person-years after COPD diagnosis (P < .001). In addition, patients with COPD also had more antidepressant prescriptions compared with individuals without COPD (17.9% vs. 11.7%; P < .001). Patients with COPD were 42% more likely to have incident depression (adjusted HR = 1.42; 95% CI, 1.32-1.53; P < .001) and 40% more likely to receive a prescription for antidepressant medication (aHR = 1.4; 95% CI, 1.35-1.45; P < .001) compared with individuals without COPD. The incidence of both depression and antidepressant prescription was also greater among patients with COPD (aHR = 1.41; 95% CI, 1.36-1.46; P < .001). In the cohort, 2,339 patients with COPD reported worse breathlessness and a Medical Research Council (MRC) dyspnea score of 4 to 5. Compared with the 20,853 patients with less breathlessness and an MRC dyspnea score of 1 to 3, these patients had a higher risk for incident depression (aHR = 1.28; 95% CI, 1.01-1.63; P = .044), antidepressant prescription (aHR = 1.29; 95% CI, 1.16-1.44; P < .001) or either (aHR = 1.32; 95% CI, 1.19-1.46; P < .001). “Early identification of depression allows health care professionals to develop appropriate treatment strategies, guide the choice of pharmacological and nonpharmacological therapies and minimize the risk of missing critical patients’ symptoms; all of which contribute to better clinical outcomes,” the researchers wrote.

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COPD World News - Week of April 3, 2022

New study looks at role of air pollutants in asthma and COPD

Magdeburg, Germany- In this review, researchers discuss the molecular and immunological mechanisms involved in physical barrier disruption induced by major airborne pollutants and outline their implications in the pathogenesis of asthma and COPD. Chronic exposure to environmental pollutants is a major contributor to the development and progression of obstructive airway diseases, including asthma and COPD. Understanding the mechanisms underlying the development of obstructive lung diseases upon exposure to inhaled pollutants will lead to novel insights into the pathogenesis, prevention and treatment of these diseases. The respiratory epithelial lining forms a robust physicochemical barrier protecting the body from inhaled toxic particles and pathogens. Inhalation of airborne particles and gases may impair airway epithelial barrier function and subsequently lead to exaggerated inflammatory responses and airway remodelling, which are key features of asthma and COPD. In addition, air pollutant-induced airway epithelial barrier dysfunction may increase susceptibility to respiratory infections, thereby increasing the risk of exacerbations and thus triggering further inflammation. In this review, we discuss the molecular and immunological mechanisms involved in physical barrier disruption induced by major airborne pollutants and outline their implications in the pathogenesis of asthma and COPD. We further discuss the link between these pollutants and changes in the lung microbiome as a potential factor for aggravating airway diseases. Understanding these mechanisms may lead to identification of novel targets for therapeutic intervention to restore airway epithelial integrity in asthma and COPD. They conclude that Inhalation of PM and noxious gases that are emitted into the air in cities on a daily basis is a risk factor for the development of asthma and COPD. Current knowledge on the pathogenesis of these lung diseases confirms the negative impacts of air pollutants on lung function in patients with airway diseases. Airway epithelial barrier disruption is one of the central features of asthma and COPD, and air pollution is considered to be a major trigger for its development. We have summarised the key mechanisms regulating airway epithelial barrier disruption upon exposure to various air pollutants, of which ROS-mediated mechanisms appear to be the common mechanism. Airway epithelial barrier dysfunction induced by air pollutants perpetuates inflammation and airway remodelling and increases susceptibility to infections which may explain the higher rate of exacerbations observed in the patients with asthma and patients with COPD living in polluted areas. As high levels of urban gas phase air pollutants were shown to be particularly associated with occurrence of COPD exacerbations, it is essential to widely scrutinise the impacts of these pollutants on airway epithelial barriers. Although changes in the lung microbiome induced by air pollutants may facilitate airway infection and as such exacerbations, the direct link with barrier dysfunction is unknown and requires further investigations. Furthermore, due to the role of viral and fungal pathogens in airway epithelial barrier dysfunction, it is relevant to investigate the impact of air pollutants on the lung virome and mycobiome and to delineate how putative changes may contribute to barrier dysfunction. Restoring barrier function by therapeutic compounds, particularly those suppressing excessive ROS production by AECs, such as resveratrol and for instance VitD3 in combination with the routine ICS/LABA/LAMA medications, may be an effective strategy to prevent development of new cases as well as exacerbations in current patients with asthma and patients with COPD residing in polluted areas.

For full details of the study published in The European Respiratory Review:

COPD World News - Week of March 27, 2022

Home dust allergen exposures common in patients with COPD

Baltimore, MD - Home dust allergen exposures are common in patients with COPD and exposure is associated with adverse outcomes in those who also have allergen sensitization, researchers reported in American Journal of Respiratory and Critical Care Medicine. “Environmental pollutant exposures, particularly indoor particulate matter exposures, have been associated with adverse outcomes in COPD, particularly among those with allergic sensitization,” Nirupama Putcha, MD, MHS, associate professor in the division of pulmonary and critical care medicine at Johns Hopkins University School of Medicine, and colleagues wrote. “However, to date, the association of allergen exposures with outcomes in COPD is not clearly known.” Researchers assessed allergen sensitization to five common indoor allergens: cat, dog, cockroach, mouse and dust mite. The study included 183 former smokers with COPD (mean age, 67.3 years; 44% women). Researchers assessed home-settled dust for the presence of corresponding allergens and determined patients’ sensitization and exposure status, adjusted for symptoms, lung function and exacerbations. Thirty-three percent of individuals were sensitized to at least one tested allergen: 22% sensitized to dust mite, 21% to cockroach, 11% to cat, 9.8% to dog and 2% to mouse. Seventy-seven percent of participants were exposed to at least one tested allergen and 17% had sensitization with a corresponding allergen exposure. Sensitization and exposure were associated with 8.3% lower lung function (beta = –8.29), higher St. George’s Respiratory Questionnaire total score (beta = 6.71) and a more than twofold higher risk for any reported exacerbation (OR = 2.31; 95% CI, 1.11-4.79) after adjustment. Among participants with lower lung function, these associations appeared more pronounced; individuals with an FEV1 percent predicted less than 50% had higher associations with risk for any exacerbation (OR = 3.77; 95% CI, 1.45-9.77) compared with individuals with an FEV1 percent predicted of 50% or more. “This study highlights the potential value of environmental modification strategies that have the potential to reduce morbidity and health care utilization in patients with COPD and allergic sensitization,” the researchers wrote. “Further studies are still required to better understand the specific allergens that, when targeted and mitigated, have the highest potential to improve outcomes.”

For more information:

COPD World News - Week of March 20, 2022

Impact of coexisting dementia on inpatient outcomes for patients admitted with a COPD exacerbation

Nottingham, UK - People with COPD are at a higher risk of cognitive dysfunction than the general population. However, the additional impact of dementia amongst such patients is not well understood, particularly in those admitted with a COPD exacerbation. Researchers here assessed the impact of coexisting dementia on inpatient mortality and length of stay (LOS) in patients admitted to hospital with a COPD exacerbation, using the United States based National Inpatient Sample database. Patients aged over 40 years and hospitalised with a primary diagnosis of COPD exacerbation from 2011 to 2015 were included in the study. Cases were grouped into patients with and without dementia. Multivariable logistic regression analysis, stratified by age, was used to assess risk of inpatient deaths. Cox regression was carried out to compare death rates and competing risk analysis gave estimates of discharge rates with time to death a competing variable. A total of 576,381 patients were included into the analysis, of which 35,372 (6.1%) had co-existent dementia. There were 6413 (1.1%) deaths recorded. The odds of inpatient death were significantly greater in younger patients with dementia (41– 64 years) [OR (95% CI) dementia vs without: 1.75 (1.04– 2.92), p=0.03]. Cases with dementia also had a higher inpatient mortality rate in the first 4 days [HR (95% CI) dementia vs without: 1.23 (1.08– 1.41), p=0.002] and a longer LOS [sub-hazard ratio (95% CI) dementia vs without: 0.93 (0.92– 0.94), p< 0.001].
The researchers concluded that dementia as a comorbidity is associated with worse outcomes based on inpatient deaths and LOS in patients admitted with COPD exacerbations.

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COPD World News - Week of March 13, 2022

The ongoing battle to address respiratory health in people experiencing homelessness

London, UK - Spurred into action by the COVID-19 pandemic, the British government tried something completely new. It made a serious effort to tackle homelessness. Local authorities in England were instructed to get people experiencing homelessness off the streets, out of communal shelters and into safe, single-room accommodation. Hotel rooms, bed and breakfasts, and student halls were booked en masse. Landlords were prevented from evicting tenants and welfare payments were increased. Alistair Story is the founder and clinical lead of Find and Treat, a specialist outreach service for homeless populations, funded by the National Health Service and based out of University College London Hospital. “If you have your own place, you have somewhere to eat, wash, and sleep in private. You have your own toilet. You can get warm. You can get dry. These are the sorts of things that keep people alive”, explained Story. According to the Office of National Statistics, there was a 12% decrease in deaths among people experiencing homelessness in England and Wales in 2020, compared with the previous year. There were just 13 documented deaths from COVID-19. “We saw something that we thought we would never see”, added Story. “This problem of homelessness, which was supposed to be chronic, intractable and irresolvable, became something that could be taken off the streets. It could be fixed. Individuals who were sleeping in shop doorways suddenly had a roof over their heads.” It now looks as if the fix was only temporary. The eviction ban has ended. Welfare payments have been cut. The nation is entering a cost-of-living crisis. The charity Shelter has warned that a surge in homelessness is likely. “We're flooded with calls from families and people of all ages who are homeless or on the verge of losing their home”, stated chief executive Polly Neate, in a press release late last year. The Lancet Respiratory Medicine visited Find and Treat on an icy day in December, 2021. The mobile clinic was parked in a small alleyway half a mile from the Houses of Parliament. Apartments in a development a few yards away were being offered for £1·75 million. The same street is home to a hostel, something of a rarity in that it is willing to accept people who have been ejected from other services or are still using drugs. “It is a bit of hardcore here; we see people who are entrenched in rough sleeping”, said Joyce, a young nurse who has been working with Find and Treat for a year or so. The van was in its first week back on duty, after a major refurbishment. A small ramp takes you into the waiting area. The mobile x-ray unit stands to the left. On the right, a door leads to the consulting room, where Joyce was offering vaccines against pneumonia, influenza, and COVID-19. The clinic had dispensed more than 7000 doses of the Pfizer vaccine against COVID-19 since the previous March. The booster campaign was well underway, though there were also plenty of people who were receiving their first and second doses. Over the next few weeks, the clinic would see a lot of cases linked to the omicron variant of SARS-CoV-2, mostly mild infections. ” Find and Treat's major focus is active case-finding for tuberculosis. The x-ray machine delivers the results on the spot. “Respiratory health is really poor among the people we see”, said Story. Most hostel residents have long histories of rough sleeping. “People here have survived outside with next to nothing, sleeping in doorways and under bridges inhaling traffic pollution. It wrecks their immune system. People get multiple pneumonias and early-onset chronic obstructive pulmonary disease [COPD]”, said Story. Users of crack-cocaine are exceptionally vulnerable. The drug is smoked, typically in short-stemmed, home-made pipes. The smoke is incredibly hot. “X-rays sometimes show up shocking damage in young people, which we are pretty sure comes down to thermal airways injury”, said Story. “Crack-cocaine takes out your first line of defence, the alveolar macrophages, and leaves you at much greater risk of any kind of respiratory infection.” High rates of tobacco use compound the problem, especially given the obstacles people experiencing homelessness encounter when trying to access stop-smoking services. “Our clients are just as likely as anyone else to want to quit smoking, but hardly any services are set up to help”, notes Story. Last year, WHO warned that the COVID-19 pandemic had “reversed years of global progress in tackling tuberculosis”. In 2020, the worldwide death toll from the disease rose for the first time in over a decade. Services all over the world have been badly affected. Find and Treat is no exception. “We have not had the capacity to do things at scale for the past 14 months”, said Story. “We are seeing a lot of delayed diagnosis, which leads to extended chains of transmission, and we are getting multiple calls from public health colleagues across the country to try to respond to outbreaks. Moreover, tuberculosis tends to rise during economic contractions. The reversed progress of the past couple of years could easily mark the beginnings of a downward trend. “Now is the time to ramp up case-finding and invest in supporting people to take their treatment”, said Story. “But I am not hopeful this is going to happen.” He added that the government's commitment to addressing homelessness seems to have waned. “There are no long-term strategies to sort out people's housing status”, said Story. “The pandemic has accelerated inequality; the next few years are going to be really tough.”

For more information:

COPD World News - Week of March 6, 2022

Omicron sub-lineage BA.2 not making people sicker in South Africa

Gauteng, South Africa - The BA.2 version of the Omicron variant of the coronavirus, while potentially more transmissible than its BA.1 predecessor, has not led to more hospitalizations or more severe disease in South Africa, researchers have found. Using national databases to track patients diagnosed with COVID-19 from Dec. 1 through Jan. 20, researchers reported on medRxiv ahead of peer review that hospitalization rates were 3.4% for those infected with original Omicron and 3.6% for individuals with BA.2 infections. Among 3,058 patients who required hospitalization for COVID-19, severe disease was diagnosed in 33.5% of original-Omicron patients and 30.5% of BA.2 patients. "By the end of January 2022, most COVID-19 infections were due to BA.2," said Dr. Nicole Wolter of South Africa's National Institute for Communicable Diseases in Gauteng. "We found that individuals that were infected with BA.2 did not have a higher risk of being admitted to hospital," she said. "While BA.2 may have a competitive advantage over BA.1 in some settings, the clinical profile of illness remains similar," the researchers concluded. However, they noted that because many people in South Africa had previously been infected with earlier variants, their findings may not be typical or translate easily to other countries.

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COPD World News - Week of February 27, 2022

Spirometry can be removed from list of Aerosol Generating Procedures (AGPs)

Bristol, UK - The AERATOR study showed that spirometry, PEFR & FeNO testing do not generate significant aerosols in comparison with cough. Standard viral filters are sufficiently effective to allow guidelines to remove lung function testing from the list of AGPs - according to conclusions from the AERATOR study led by Dr. Sadiyah Sheikh, which were recently published in Thorax. Pulmonary function tests are fundamental to the diagnosis and monitoring of respiratory diseases. There is uncertainty around whether potentially infectious aerosols are produced during testing and there are limited data on mitigation strategies to reduce risk to staff. Healthy volunteers and patients with lung disease underwent standardised spirometry, peak flow and FENO assessments. Aerosol number concentration was sampled using an aerodynamic particle sizer and an optical particle sizer. Measured aerosol concentrations were compared with breathing, speaking and voluntary coughing. Mitigation strategies included a standard viral filter and a full-face mask normally used for exercise testing (to mitigate induced coughing). 147 measures were collected from 33 healthy volunteers and 10 patients with lung disease. The aerosol number concentration was highest in coughs (1.45–1.61 particles/cm3), followed by unfiltered peak flow (0.37–0.76 particles/cm3). Addition of a viral filter to peak flow reduced aerosol emission by a factor of 10 without affecting the results. On average, coughs produced 22 times more aerosols than standard spirometry (with filter) in patients and 56 times more aerosols in healthy volunteers. FENO measurement produced negligible aerosols. Cardiopulmonary exercise test (CPET) masks reduced aerosol emission when breathing, speaking and coughing significantly. Lung function testing produces less aerosols than voluntary coughing. CPET masks may be used to reduce aerosol emission from induced coughing. The researchers concluded that standard viral filters are sufficiently effective to allow guidelines to remove lung function testing from the list of aerosol-generating procedures.

For more information:

COPD World News - Week of February 20, 2022

Omicron BA.2 sub-variant spreading

Vancouver, BC - A more contagious Omicron sub-variant known as BA.2 could complicate reopening plans now underway in most provinces. GETTY IMAGES The highly contagious Omicron sub-variant known as BA.2 is gaining a foothold in Canada just as provinces begin removing pandemic restrictions, according to newly released data.  The spread of BA.2, which is believed to be 1.4 times as contagious as the already highly transmissible original Omicron sub-variant, could complicate reopening plans now underway in most provinces. As it becomes dominant in the coming weeks, BA.2 could extend the current wave of the pandemic, increase case counts, or slow the decrease in cases at a time when provinces are dropping gathering restrictions and mask mandates. Experts say it will have an influence on case counts in Ontario but will likely not be a complete game changer. The Omicron wave is receding, booster rates are relatively high and some 3.5 million people were infected with COVID-19 during the intense Omicron wave that began in December, meaning there is widespread immunity. Sarah Otto, a professor of evolutionary virology and mathematical modelling at the University of British Columbia, and a leading Canadian expert on BA.2, said its rise in Canada “does not necessarily mean a second major Omicron wave will happen, more likely we’ll see a prolonged peak or a shoulder in the Omicron wave.” But scientists are watching it closely because there remains so much uncertainty about it and because it has been associated with a renewed spike in cases in some countries. Denmark, which dropped all pandemic restrictions in January, including masks, is now seeing record high case counts with the BA.2 sub-variant dominant. A recent study, led by Japanese researchers, argues that BA.2 is different enough from BA.1, and a bigger threat to public health, that it should not be considered Omicron at all, but should be given its own Greek name. The study found that it transmits at 1.4 times the rate of BA.1, replicates more easily in nasal cells and that experiments in hamsters show it is more virulent than BA.1 “Our multi-scale investigations suggest that the risk of BA.2 for global health is potentially higher than BA.1,” wrote the authors. Early research on BA.2 suggests that people who have been infected with BA.1 will not be re-infected with it, said Otto, who is tracking the sub-variant. That could lessen its impact in Ontario where, according to Dr. Peter Juni, scientific director of Ontario’s Science Advisory Table, some 3.5 million people were infected with Omicron between the beginning of December and the end of January, giving them immunity to the new sub-variant. Its virulence compared to the earlier sub-variant is not entirely understood, said Doug Manuel, a senior scientist at The Ottawa Hospital Research Institute and a member of Ontario’s Science Advisory Table, but he said there are no “red flags” suggesting it could be more virulent. Fully understanding its implications will take time, he said. In a report released this week, the B.C. COVID-19 modelling group, of which Otto is a member, found that BA.2 represents about 35 per cent of all COVID-19 cases in Alberta, nearly 12 per cent of cases in Ontario and 8.3 per cent of cases in British Columbia. Otto cautions that data about genetic sequencing of SARS-CoV-2 is frequently delayed and fragmentary across the country, which could mean BA.2 is now more widespread and could represent as much as 99 per cent of cases in Alberta and 34 per cent of cases in Ontario. Alberta, which dropped pandemic restrictions relatively quickly before the Omicron wave really began to diminish there, could see a bigger impact from the BA.2 variant, she said, such as a prolonged peak or double peak. Ontario, where case counts have dropped steadily in the past month, could be “spared the worst” of the BA.2 wave, she said. That is largely because so many people were infected with the original sub-variant of Omicron and booster rates are high Juni, who supports the province’s stepped reopening plans, says BA.2 will represent less of a challenge to the province since its main difference over BA.1, so far, appears to be transmissibility. Manuel said scientists, including wastewater researchers, continue to watch BA.2 closely. He said he and others have been paying close attention to Denmark, which was one of the first countries to drop all pandemic restrictions. But, unlike Ontario, Manuel said Denmark opened up completely while cases were still increasing. Ontario, which will drop most pandemic restrictions aside from indoor masks on March 1, is opening more cautiously than many jurisdictions at a time when the Omicron wave is receding. But many say masking requirements should not be lifted until the impact of reopening, and of the new sub-variant, are reviewed and understood. Otto cautioned against dropping mask mandates too soon, saying mandating masks in public places such as buses and in grocery stores is a “mild inconvenience” that can have a substantial impact on reducing transmission when cases are still relatively high. Premier Doug Ford suggested this week that he would like to see all pandemic restrictions gone sooner rather than later, saying he is “done with the pandemic.”

For more information:

COPD World News - Week of February 13, 2022

Referral to pulmonary rehab program ‘sub-optimal’ among suitable patients with COPD

Perth, Australia - Fewer than half of patients with COPD deemed suitable for pulmonary rehabilitation received a referral to a pulmonary rehabilitation program across three tertiary hospitals in Australia, according to findings published in Chest. “The implementation of pulmonary rehabilitation programs is problematic with earlier work showing that the proportion of people with COPD who are actually referred to a pulmonary rehabilitation program from primary or tertiary care is as low as 16%,” Sarah Hug, BSc, with the faculty of health sciences at the Curtin School of Allied Health and the department of physiotherapy at Royal Perth Hospital, Australia, and colleagues wrote. “Addressing this implementation gap is recognized as a global priority by international respiratory societies and understanding the reasons for suboptimal referral behaviors is an important first step.” Researchers recruited 391 adults with COPD (mean age, 69 years; 55% men) who were deemed appropriate candidates for pulmonary rehabilitation programs across three tertiary hospitals in Australia. Researchers collected data on age, gender, lung function, smoking status and interest in participating in a pulmonary rehabilitation program using interviews and medical records. Pulmonary rehabilitation referrals were tracked via electronic referral systems, medical records, and discussion with participants and physiotherapists responsible for coordination. There were 156 participants suitable for pulmonary rehabilitation and, of these, 47% were referred to a pulmonary rehabilitation program. “Although suboptimal, the proportion referred in our study was considerably higher than what is reported in earlier work,” the researchers wrote. Eighty-two participants suitable for rehabilitation were classified as missed referrals, with 11% offered referrals with the health care professional not completing said referral and 18% offered referral by a health care professional but denied the program. The only variable separating participants who were vs. who were not referred to a pulmonary rehabilitation program was the interest they had in attending a program, with a mean difference in interest on the visual analogue scale of 22 U. The most frequently reported barriers to not attending a pulmonary rehabilitation program reported by 26% of participants were related to environmental context and resources factors, including problems with travel distance, transport, paring or the inflexibility of programs that led to difficulties fitting it into their schedule. Researchers noted that attitudes of already doing enough exercise (5%), introverted personality traits (4%) and feelings of unworthiness (1%) reduced a participant’s interest in attending a pulmonary rehabilitation program. “Collaborations among people with COPD, clinicians and researchers presents a unique opportunity to develop novel strategies to enhance people’s interest and improve referral to pulmonary rehabilitation programs among people with COPD in our tertiary setting,” the researchers wrote.

 For more information:

COPD World News - Week of February 6, 2022

Adults, particularly those with obesity, gained weight during COVID-19 lock-down

San Luis Obispo, CA - The stay-at-home mandates to limit the spread of COVID-19 were associated with greater reported weight gain among adults with obesity during 3 months, according to study data published in Obesity. Researchers conducted an observational cohort study aimed to assess the weight gain by BMI for adults during the COVID-19 lockdown in the U.S., and the behavioral and psychosocial effects of this potential weight gain. A higher percentage of adults with obesity gained at least 2 kg of body weight during the COVID-19 lockdown compared with adults with normal weight at baseline. Data were derived from Seal A, et al. Obesity. 2021;doi:10.1002/oby.23293.  “We observed that state stay-at-home mandates, designed to slow the spread of COVID-19, had unintended consequences of promoting weight gain that disproportionately impacted individuals with obesity,” Adam Seal, PhD, a postdoctoral researcher at California Polytechnic State University in San Luis Obispo, and colleagues wrote. “In light of these data, as COVID-19 restrictions are lifted, it may be even more important to support programs and lifestyle interventions to reduce body weight, increase physical activity and promote mental health.” The researchers administered a national questionnaire in May 2020 and again in August 2020, with 1,516 adults (78.8% women; 86.7% white; 26.7% with obesity) responding both times. The questionnaire asked about height, weight, physical activity levels and dietary information as well as psychosocial and behavioral information, such as depressive symptoms, stress levels and sleep patterns. The researchers used the Epidemiological Studies Depression Scale (CES-D) to measure depressive symptoms among participants. At 3 months, about 30% of all participants reported any weight gain from baseline, with 18.4% reporting weight gain of more than 2 kg, a nearly 1% (0.6 kg) increase (76.7-77.3 kg; P = .002). Among participants with obesity, 26% reported a weight gain of more than 2 kg compared with 14.8% of those of normal weight (P < .001). Additionally, 53.3% of participants with obesity maintained a weight within 2 kg compared with 72.5% of participants with normal weight (P < .001), suggesting that weight gain “disproportionately affected individuals with obesity compared with individuals of normal weight,” according to the researchers.  Notably, the researchers found that fewer baseline minutes of physical activity per day (beta = 0.107; P = .004), greater decreases in amount of physical activity per day (beta = 0.076; P = .026), depressive symptoms (beta = 0.098; P = .034) and more additional time preparing food (beta = 0.075; P = .031) were all associated with weight gain. The authors said that the 0.6 kg weight gain is surprising considering the time frame of the study, and that if continued at the same rate, weight gain would “far exceed typical weight gain in a single year.”

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COPD World News - Week of January 30, 2022

Montreal study looks at Dementia: How to prevent cognitive decline

Montreal, PQ - Physical activity, nutrition and cognitively stimulating activities are all known to be good ways to prevent Alzheimer's disease and dementia. And older adults at risk can access a variety of lifestyle services to that end, including diet regimes and exercises for their body and mind. Now an international team of researchers led by Université de Montréal psychology professor Sylvie Belleville has determined how many of those intervention sessions are needed prevent cognitive decline in people at risk: only about a dozen. Published in Alzheimer's & Dementia : The Journal of the Alzheimer's Association, the study by Dr. Belleville and colleagues at the universities of Toulouse and Helsinki show that 12 to 14 sessions are all that’s were needed to observe an improvement in cognition. Until now, the number of sessions or "doses” needed for optimal effect has been unknown. “In pharmacological studies, every effort is made to define an optimal treatment dose needed to observe the expected effects, “ said Belleville, a neuropsychologist and researcher at the research centere of the Université de Montréal affiliated Institut universitaire de gériatrie de Montréal. “This is rarely done in non-pharmacological studies, especially those on the prevention of cognitive decline, where little information is available to identify this dose. “Defining an optimal number of treatment sessions is therefore crucial.,” she continued. “Indeed, proposing too few sessions will produce no noticeable improvement effects, but too many sessions is also undesirable as these interventions are costly. They are costly both for the individual who follows the treatments, in terms of time and involvement, and for the organization offering these treatments.” The study is based on a secondary analysis of data from the three-year Multidomain Alzheimer Preventive Trial (MAPT) and looked at 749 participants who received a range of interventions aimed at preventing cognitive decline. These included dietary advice, physical activity and cognitive stimulation to improve or maintain physical and cognitive abilities. In their research, Belleville’s team noted that people’s individuality should be considered when determining the optimal treatment dose. They evaluated the effects of the sessions in terms of each participant’s age, gender, education level, and cognitive and physical condition. The relationship between the “dose” each received, and their cognitive improvement was then analyzed. The main results show an increase with dose followed by a plateau effect after 12 to 14 sessions. In other words, you need enough dose to see an effect but offering more than 12 to 14 sessions of treatment does not mean better results. That said, participants with lower levels of education or more risk factors for frailty did benefit from more sessions. The conclusion? It’s important to identify and target an optimal dose and to customize the treatment for each individual, the researchers say. Not only is “dosage” an important component of behavioural interventions, it can also provide valuable information when time and money are limited, helping public-health agencies develop effective prevention programs and offer guidance to older adults and clinicians.

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COPD World News - Week of January 23, 2022

Exercising after COVID-19: What doctors need to know

Iowa City, Iowa - For many people, the pandemic has made an already-fraught relationship with fitness even worse–especially for those who’ve suffered a decline in fitness following a bout with COVID-19. Even after mild COVID-19 illness, many people need time to recover.  Emerging research has focused on several health issues linked to the return to exercise after COVID-19 infection. First, COVID-19 can lead to cardiac injury, including viral myocarditis, which can increase the risk of disease and death, according to the authors of guidance published in the BMJ.  The authors highlighted the results of a study suggesting ongoing myocardial inflammation as demonstrated by serum troponin levels and cardiovascular MRI findings at 71 days post-diagnosis. Although 67% convalesced at home, 33% needed hospitalization. Other risks include throwing clots, with pulmonary emboli linked to COVID-19. To date, it is unclear what the long-term pulmonary implications are, but data from the 2003 SARS-CoV epidemic indicated long-lasting impairments in pulmonary function and exercise capacity in survivors. One last concern that could interfere with function is psychiatric repercussions, such as psychosis. Psychosis can even crop up as a presenting symptom of COVID-19, with PTSD, anxiety, and depression also on the table further into the illness. According to the most recent research, between 10% and 20% of those infected with SARS-CoV-2 develop long-haul COVID-19 symptoms 12 weeks after the acute symptomatic phase. This manifestation is challenging to diagnose, with no current gold standard. This lack of diagnostic measures makes therapy unsure. Based on evidence from other chronic conditions, however, exercise may help. The authors of a narrative review published in the International Journal of Environmental Research and Public Health support the prospect of using exercise to counter the ill effects of long-haul symptoms. “There is sufficient evidence suggesting that tailored and supervised exercise training may be an effective multisystemic therapy for post-COVID-19 syndrome that suits the diversity of the cases and symptoms,” wrote the authors. “A multidisciplinary and integrative approach including exercise sciences is essential where clinical conditions are addressed but must integrate neurocognitive and psychological aspects into the assessment, as well as the social impact that this pathology entails.” Further research needs to be done to understand which types of exercise, as well as the intensity and load, are required to combat COVID-19. On a related note, physical deconditioning is the most common cause of impaired VO2max in those experiencing severe pneumonitis secondary to COVID-19, according to the results of a study published in the European Respiratory Journal. The authors wrote that these findings “underscore the importance of an early rehabilitative intervention in survivors of severe COVID-19 pneumonitis.” The authors of the aforementioned BMJ article suggested a stepwise approach to ensuring safety and decreasing the risk associated with returning to exercise. The patient should be ready to return to exercise following an asymptomatic stretch of 7 days. However, activities of daily living should be handily accomplished before a return to strenuous activity. There should also be no signs or symptoms of myocarditis or myocardial injury, such as chest pain, shortness of breath, heart failure, etc.  A primary care physician should evaluate the patient for ongoing symptoms, with rehabilitation services involved as necessary. It is not yet known whether graded physical activity is advisable, but graduated rehabilitation may be advisable in those who were hospitalized for COVID-19. Physical examination and diagnostic evaluation—including ECG, serum troponin levels, and echocardiography—could compel a referral to cardiology, although findings such as costochondritis could be managed by primary care. Findings of concern include additional heart sounds, edema, fibrosis, pleural effusion, and novel arrhythmias. Cough and breathlessness should dissipate after a few weeks, but persistent, progressive, or decompensating symptoms could indicate pulmonary embolism, pneumonia, or post-inflammatory bronchoconstriction. These patients should be referred out accordingly. Although exercise can boost mood and well-being, the patient should be psychologically ready for the endeavor. Mood, sleep, inclination, and appetite should all be assessed. Systems of support may be useful, such as self-care resources, community services, and peer support, as well as counseling and rehabilitation services.

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COPD World News - Week of January 16, 2022

Smoking cessation after lung cancer diagnosis linked to nearly 30% improvement in survival

Florence, Italy - Quitting smoking at or around time of diagnosis conferred a significant survival benefit for patients with lung cancer, according to results of a meta-analysis published in Journal of Thoracic Oncology. Treating physicians should educate these patients on the benefits of smoking cessation even after diagnosis and provide them with necessary support, researchers wrote.“It is really never too late to quit. Critically, this is a message for the patients, and for the doctors, as well,” Saverio Caini, MD, PhD, senior medical epidemiologist at Institute for Cancer Research, Prevention and Clinical Network (ISPRO) in Italy, told Healio. “Even if they are diagnosed with lung cancer, they can raise their chance to survive quite a lot by quitting smoking as soon as possible. Actually, we recommend that smoking cessation programs become fully integrated into multidisciplinary cancer care.”Caini and colleagues pursued avenues to increase the chances of survival for patients with lung cancer because, despite advances in immunotherapy, lung cancer on average is associated with a worse prognosis than many other cancers. “Everyone knows that smoking is a risk factor for lung cancer, and many [patients with lung cancer] are diagnosed when they are still active smokers,” Caini said. “Despite this, there was no certainty on whether (and how much) stopping smoking after diagnosis could improve survival.” The meta-analysis included 21 articles published between 1980 and October 2021 on the effect of smoking cessation at or around the time of diagnosis among a total of 10,938 patients with lung cancer. “We were surprised by the small number of studies that could be included, only 21, which is a tiny number compared to the number of studies that examine, for instance, the association between smoking and the risk [for] developing cancer,” Caini said. Caini and colleagues used random effect meta-analysis models to pool study-specific data into summary relative risk [SRR] and corresponding confidence intervals. Results showed patients who quit smoking after diagnosis had a 29% improvement in OS compared with patients who continued to smoke after their diagnosis (SRR = 0.71; 95% CI, 0.64-0.8). Researchers found benefits of quitting smoking regardless of histologic subtype, with SRRs for OS between quitters and continued smokers of 0.77 (95% CI, 0.66-0.9) among patients with non-small cell lung cancer based on eight studies, 0.75 (95% CI, 0.57-0.99) among patients with small cell lung cancer based on four studies, and 0.81 (95% CI, 0.68-0.96) among patients with lung cancer of both or unspecified histologic type based on six studies. Caini and colleagues were surprised by the magnitude of the effect.“A 20% to 30% reduction in the risk of dying for those who quit post-diagnosis to those who continue is huge because it falls in the range of the survival benefit that chemotherapy and immunotherapy bring to [patients with cancer],” Caini said. “We believe that not all doctors and health professionals are aware that smoking cessation — an intervention tolerable by everyone, with practically no adverse effects and costless — can produce such a big benefit for people with a disease as severe as lung cancer.” Based on the findings, oncologists and health care systems should educate, encourage and put systems in place to help patients quit smoking at time of diagnosis, even with the challenges it presents to many patients “It’s difficult because [patients with lung cancer} may be disheartened and discouraged and feel too depressed to engage themselves in smoking cessation, especially considering that they may have been smoking for decades, which makes quitting even more complicated,” Caini said. “Patients must be made aware that smoking cessation can be nearly as effective (for improving the chance of surviving) as chemotherapy, immune therapy, radiation therapy, etc., and that there is plenty of support for them if they decide to attempt to stop.”

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COPD World News - Week of January 9, 2022

Scientists urge pursuit of universal coronavirus vaccine

Boston, MA - A growing body of scientific evidence, considered together with ecological reality, strongly suggests that novel coronaviruses will continue to infect bats and other animal reservoirs and potentially emerge to pose a pandemic threat to humans. To counter future coronavirus outbreaks, the global scientific and medical research community should focus a major effort now on three goals: characterize the range of coronavirus genetic diversity in multiple animal species; better understand coronavirus disease pathogenesis in laboratory animal models and people; and apply this knowledge to the development of long-lasting, broadly protective coronavirus vaccines. So, argue physician-scientists Anthony S. Fauci, MD, Jeffery K. Taubenberger, MD, PhD, and David M. Morens, MD, of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, in a new commentary in The New England Journal of Medicine. The authors call for an international collaborative effort to extensively sample coronaviruses from bats as well as wild and farmed animals to help understand the full "universe" of existing and emerging coronaviruses. Such studies could, they say, provide early warning about coronaviruses poised to cause outbreaks in humans. They write that carefully controlled human challenge trials, in which volunteers are exposed to coronaviruses, could yield a fuller understanding of coronavirus disease processes and inform vaccine design. Despite the availability of safe, effective COVID-19 vaccines, it remains unknown whether and how permanent immunity can be achieved, the NIAID authors note. They say SARS-CoV-2, the virus that causes COVID-19, will probably continue to circulate indefinitely in periodic outbreaks, and animal coronaviruses of unknown transmissibility and lethality may emerge at any time. Therefore, we must greatly accelerate our efforts in coronavirus vaccinology, they write. The authors outline the features of an ideal universal coronavirus vaccine that would provide durable protection from most or all coronaviruses for individuals of all ages and communities at large. To achieve this goal, fundamental questions about the nature of coronavirus protective immunity must be addressed, including what vaccine approaches best elicit rapid responses (antibodies, for example) and lasting immune "memory" responses that could defend against newly emergent coronaviruses. The still-raging COVID-19 pandemic, coupled with the ever-present threat from new coronaviruses, necessitates the expeditious development of safe and broadly protective coronavirus vaccines. This is a challenge that we must now fully commit ourselves to addressing, the authors conclude.

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COPD World News - Week of January 2, 2022

Fluticasone-based ICS, LABA therapy changes airway microbiome in COPD

Vancouver, BC - Fluticasone-based inhaled corticosteroid treatment substantially changed airway microbiome diversity in patients with COPD, according to new data published in the American Journal of Respiratory and Critical Care Medicine. “Inhaled corticosteroids, especially potent ones like fluticasone, can change the microbial communities (which are called microbiome) of airways of COPD patients, rendering them more susceptible for pneumonia,” Don D. Sin, MD, director and De Lazzari Family Chair at the Centre for Heart Lung Innovation, Canada Research Chair in COPD and professor of medicine in the division of respiratory medicine in the department of medicine at St. Paul’s Hospital, Vancouver, British Columbia, told Healio. “We were puzzled as to why the use of inhaled corticosteroids increased the risk of pneumonia in COPD patients. We hypothesized that these therapeutics would adversely change the airway microbiome of COPD patients.” The study enrolled 63 clinically stable patients with COPD. Use of inhaled corticosteroid (ICS) was discontinued and substituted with formoterol (Teva) 12 µg twice daily. Patients were randomly assigned to receive budesonide/formoterol 400/12 µg (n = 20; mean age, 66.3 years; 85% men), fluticasone/salmeterol 250/50 µg (n = 22; mean age, 66 years; 77.3% men) or formoterol only 12 µg (n = 21; mean age, 62.5 years; 85.7% men), all twice daily for 12 weeks. The primary outcome was the comparison of airway microbiome changes during 12 weeks between the ICS/long-acting beta agonist (LABA) and LABA only groups. A total of 56 patients completed all clinic visits after seven patients withdrew between the first and second bronchoscopy visits. Airway microbiota diversity showed significant differences across groups following the treatment period with the most significant changes observed among those who received fluticasone/salmeterol and formoterol alone. In addition, longitudinal differential abundance analyses demonstrated more pronounced airway microbial shifts from baseline among those who received fluticasone/salmeterol. These greater shifts were related to reduced abundances of Pasteurellas, Pasteurellaceae and Haemophilus, according to Sin, it was surprising to find that 3-month LABA therapy improved the airway microbiome in this patient population and that 25% of patients who withdrew from ICS developed breathing troubles and dropped out. “New corticosteroids are being developed for COPD. We need to find out their effects on the airway microbiome of COPD patients before they are widely deployed in clinical care,” Sin said. “We also need to find out which bacterial organisms are responsible for keeping the airway microbiome healthy and develop novel therapeutics to restore the airway microbiome of COPD patients.”

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