COPD World News - 2019

COPD World News - Week of December 29, 2019

Study looks at trends in COPD mortality

Geneva, Switzerland - An international study examining trends in chronic obstructive pulmonary disease mortality over more than 2 decades showed that COPD mortality rates declined in most countries but remained stable among US women and increased in several European countries, with total mortality additionally increasing or remaining stable in most countries. The study, was published last from 1995-2017, based on data from the World Health Organization (WHO). COPD, which has been the third-leading cause of death worldwide since 2016, exhibited declines in global mortality rates since the 1990s, but as the study authors note, little is known about observed trends in COPD mortality in Latin America, as well as Oceania and Europe. Lead study author Joannie Lortet-Tieulent, MD, research fellow at the WHO International Agency for Research on Cancer, highlighted that while WHO data presents COPD as a burden of high importance, existing COPD mortality data was based on outdated statistics from a select number of high-income countries in Europe, Australia, Japan, and the United States. “There is a need to publish up-to-date estimates and to include mortality data from more varied regions of the world in international comparisons,” said Lortet-Tieulent. Researchers sought to address this lack of global representation by analyzing 3.36 million COPD deaths derived from the WHO mortality database based on age (50-84), sex, and year. The data set included 24 countries worldwide, each of which had a population of at least 2 million people and available high-quality mortality data from the previous decade: The study included 6 countries in Latin America and the Caribbean, 2 each in North America, Asia, and Oceania, and 12 European countries COPD mortality rates calculated through setting the number of COPD deaths per year against the population of each country in the same year Data standardized using a reference population to ensure accuracy of comparisons between populations over time. Based on data taken from 2 study periods conducted from 2000 to 2015, the combined mortality rate for all studied countries fell by 12% (2000: 68 deaths per 100,000 people per year; 2015: 60 deaths per 100,000 people per year), with total mortality increasing by 12% (2000: 180,950 estimated COPD deaths; 2015: 203,090 estimated COPD deaths). Lortet-Tieulent noted that the findings may be attributed to increased life expectancy worldwide, in which people dying from COPD is a result of aging populations. “The data suggests that the proportion of COPD patients who are dying early due to the disease is falling overall, and that is very encouraging. It means that people may be less exposed to COPD risk factors now and that COPD is being managed more effectively,” said Lortet-Tieulent. Among global populations exhibiting a heightened COPD mortality rate by sex, rates were highest in Hungary and Kyrgyzstan for men, and highest for women in the United States and Hungary. The analysis further showed that while the general trend of worldwide COPD death rates shows a decline, death rates for women remained constant in North America and increased in the European countries Czechia (+4.2%), Hungary (+4.8%), and Austria (+2%). "In the countries where women have been smoking as much and for as long as men, such as the USA, New Zealand and the UK, the female COPD death rate became very similar to that of men over time. Raising awareness of COPD in females could enable earlier diagnosis, thereby improving management and lowering the risk of death,” said Lortet-Tieulent. The study authors noted that the study data likely underestimated the true mortality burden of COPD, that more high-quality data from low-income countries is warranted to achieve accurate estimates of global COPD deaths.

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COPD World News - Week of December 22, 2019

Experts raise new fears about killer air pollution in UK

Munich, Germany - The UK’s failure to meet World Health Organisation standards limiting the amount of ultra-fine particles in the air represents a major danger to health that is only now being recognised, experts claim. Studies published this year link the particles to cancers, lung and heart disease, adverse effects on foetal development, and poor lung and brain development in children. They are considered a key threat to health because they go deep into the lungs and then reach other organs, including the brain. But European standards allow the levels of particles in the air to be 2.5 times higher than those stipulated by the WHO. Professor Annette Peters, director of the Institute of Epidemiology at the Helmholtz Zentrum, Munich, said Europe – and the UK – urgently needs to introduce tougher standards. She said: “Particles are a major and invisible danger to our health, especially in London and our big cities. The US has a standard of 12 micrograms of ultra-fine particles per cubic metre, while the WHO standard is 10 micrograms. “We [the UK and EU’s limits] are currently at 25 micrograms per cubic metre – double the US standards,” said Peters, who warned that scientific evidence confirming the threat they pose to human health “has really strengthened this year”. “We initially had evidence of the effect on the lungs and heart, but now we also have evidence that it alters the metabolism as well as impacting the brain.” Vehicle emissions are predominantly to blame, but domestic heating systems and industrial pollutants are also factors. “Recent studies from London and our work in a medium-sized community in southern Germany show there really is evidence that the ultra-fine particles go beyond the lungs,” Peters said. “Colleagues of mine have been able to show that ultra-fine particles are able to reactivate the herpes virus which lies dormant among carriers.” She said urgent studies were needed to look at the impact of fine particles on cognitive development, especially in children. Studies have documented that adverse health effects are observed even at concentrations well below the recommended WHO levels. According to a paper, written by Peters and published in the Lancet, ambient air pollution now ranks among the top 10 major risk factors for attributable death worldwide and leads to an average loss of life expectancy of approximately one year in Europe. Peters said ultra-fine particles could carry several thousand kilometres. “In most times you don’t see or smell it, the pollution, so it’s clear, if you look to India or the far east, the pollution is very visible. Here, we have blue skies but that doesn’t mean we have truly clean air.” Studies in London confirm wide geographical variations in the amount of fine particles in the air. While Oxford Street suffers major concentrations, nearby Hyde Park is considered far cleaner. Professor Jon Bennett, consultant respiratory physician and chair of the British Thoracic Society’s Board, described the particles as “a real and present health danger to society”. “It is really concerning that babies and children are particularly susceptible as air pollution can impair immune-system development in the womb and adversely affect children’s cognitive development,” he said. A WHO report estimated that in 2016 air pollution contributed to more than half a million deaths from respiratory tract infections in children under five years of age. “Everyone should have the right to breathe clean air,” Bennett said. “We must have a harder-hitting and better-funded national strategy that really tackles this issue across the board – including fast-tracking the delivery of more clean air zones in our most polluted cities and areas.”

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COPD World News - Week of December 15, 2019

Study looks at risk of death within 5 years of first unplanned hospital admission in older adults

Toronto, ON - The risk of death in people after their first admission to hospital or first presentation to the emergency department for any reason is not known. The objective of this study was to estimate the risk of death among older adults who had had no admissions to hospital or emergency department visits in the preceding 5 years. Researchers here used administrative data from Ontario, Canada, from 2007 to 2017 to measure the 5-year risk of death in community-dwelling adults aged 66 years and older after their first planned or unplanned hospital admission or emergency department visit, and among those who were neither admitted to hospital nor presented to the emergency department. They describes how this risk varied by age. Among 922 074 community-dwelling older adults, 12.7% died (116 940 deaths) over a follow-up of 3 112 528 person-years (standardized mortality rate 53.8 per 1000 person-years). After the first unplanned hospital admission, 39.7% died (59 234 deaths, standardized mortality rate 127.6 per 1000 person-years). After the first planned hospital admission, 13.0% died (10 775 deaths, standardized mortality rate 44.6 per 1000 person-years). After the first visit to the emergency department, 10.9% died (35 663 deaths, standardized mortality rate 36.2 per 1000 person-years). Among those with neither an emergency department visit nor hospital admission during follow-up, 3.1% died (11 268 deaths, standardized mortality rate 29.6 per 1000 person-years). Slightly more than half of all deaths were in those with first unplanned hospital admission (50.7%). Death within 5 years of first unplanned hospital admission for older adults is frequent and common. Knowledge of this risk may influence counselling and patient preferences and may be useful in research and analyses for health system planning. More than 420 million hospital admissions occur every year around the world. Short-term prognosis is favourable; most people survive beyond admission. In North American adults, all-cause 1-year mortality after hospital admission ranges between 7% and 12%. Certain conditions have a less favourable long-term outcome. Notably, as many as three-quarters of those admitted to hospital with heart failure do not live beyond 5 years. Only 5% of patients admitted to hospital with a new diagnosis of lung cancer are alive at 5 years. Several studies have measured mortality after a person’s first hospital admission for specific conditions including cancer, heart failure, chronic obstructive pulmonary disease (COPD), pneumonia, myocardial infarction and atrial fibrillation. However, the risk of death after first hospital admission for any cause, or how the relationship between first hospital admission and mortality might change across age, is not known. This study addresses existing knowledge gaps by estimating the risk of death after a first acute care encounter in a population of previously healthy older adults cared for in Ontario, Canada. Other work has generally focused on short-term outcomes. Thus, this study aimed to extend previous work by estimating the long-term risk of death across all health conditions and diagnoses among patients without previous hospital admission or emergency department visits at a population level. The researchers concluded that nearly 40% of older adults with a first unplanned hospital admission die within 5 years regardless of the reason for admission. Lead author of the study is Kieran L. Quinn of the University of Toronto.

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COPD World News - Week of December 8, 2019

Protecting the environment from pharmaceutical pollution

Brussels, Belgium - The European Commission have made suggestions about the types of actions that should be taken across Europe to protect the environment from pharmaceutical pollution. In a recent news release, they stated that the medicines we use can pollute the environment if they are not disposed of properly. This can pose a threat to animals and plant life, and potentially affect human health too. It’s not just the surplus medicines we throw away that cause pharmaceutical pollution (although there are things, we can all do to make sure unused medicines don’t add to the problem). Drugs and their waste products can also find their way into the environment when they are being made and used. This type of pollution affects water quality and marine life, changes the growth and survival of plants, and has even been shown to affect animal behaviour. There are also concerns that pharmaceutical pollution makes it easier for harmful bacteria, parasites, viruses and fungi to develop ways to resist treatment. This is known as antimicrobial resistance. The European Commission recommends that policy makers act to increase awareness of pharmaceutical pollution. Promote proper use and disposal of medicines. Support manufacture processes that produces less pollution and improve both local and national schemes that deal with pharmaceutical waste. They have also said that any actions taken to reduce the impact on the environment should not affect access to safe and effective medical treatment. As the amount of medicines that we use increases, it is even more important that we work to protect the environment from the effects of pharmaceutical pollution. Everyone can do their bit by asking their pharmacist or healthcare professional about local schemes for disposing of medicines safely. It’s also up to policy makers, drug manufacturers and healthcare professionals to make and enforce rules so that fewer drugs find their way into the environment. 

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COPD World News - Week of December 1, 2019

How Exercise May Fight Aging

Muncie, Indiana - The muscles of those who worked out looked like those of 25-year-olds and showed less of the inflammation that is tied to health problems as we age. Regular exercise throughout adulthood may protect our muscles against age-related loss and damage later, according to an interesting new study of lifelong athletes and their thighs. The study finds that active older men’s muscles resemble, at a cellular level, those of 25-year-olds and weather inflammatory damage much better than the muscles of sedentary older people. The study also raises some cautionary questions about whether waiting until middle age or later to start exercising might prove to be challenging for the lifelong health of our muscles. Physical aging is a complicated and enigmatic process, as any of us who are living and experiencing it know. Precipitated by little-understood changes in the workings of our cells and physiological systems, it proceeds in stuttering fits and starts, affecting some people and body parts earlier or more noticeably than others. Muscles are among the body parts most vulnerable to time. Almost all of us begin losing some muscle mass and strength by early middle age, with the process accelerating as the decades pass. While the full causes for this decline remain unknown, most aging researchers agree that a subtle, age-related rise in inflammation throughout our bodies plays a role.  “A lot of studies show that higher circulating inflammatory factors in people are associated with greater loss of muscle mass,” says Todd Trappe, a professor of exercise science at Ball State University in Muncie, Ind., who oversaw the new study with his brother Scott Trappe and other researchers. Dr. Trappe and his collaborators, who long have been studying the physiology of older athletes, also knew that physically fit people tend to have lower levels of inflammation in their bodies than inactive people. So, the researchers wondered, would active, older people also have more and healthier muscle mass than other older people? And if so, what might that tell us about how human muscles can optimally age? To find out, the Ball State scientists turned to a unique group of volunteers. Local men and women in their 70s or 80s who had been training continuously since the running boom of the 1970s, these volunteers already were part of several interrelated studies at Ball State. Now, the researchers wanted to look deep inside the older athletes’ blood and muscles. So, they gathered 21 of the elderly athletic men (results from a separate study of women will be published soon, Dr. Trappe says), along with 10 runners and cyclists in their 20s, and another 10 healthy but sedentary elderly men. They measured all of the men’s thighs, as a marker of muscle mass, and took blood and muscle-tissue samples. They noted immediately that the men’s thigh circumference reflected their ages and lifestyles, with the young athletes sporting the burliest legs, the elderly athletes slightly smaller ones, and the inactive elderly men the spindliest. The researchers next had the men complete a single session of brief, but strenuous, lower-body weight training, using a knee-extension machine. Since none of the men lifted weights, this exercise was expected to stress their muscles in an unfamiliar way. A few hours later, the researchers again drew blood and biopsied the men’s muscles. Then they checked the tissues for a broad slate of inflammatory cells and gene markers. Bogglingly complex, inflammation involves multiple genes and cells that talk to other genes and cells and dynamically ramp up, or tamp down, the process. Immediately after any bodily injury or strain, which includes strenuous exercise, inflammation helps tissues to heal and strengthen. But if inflammation lingers, it can become harmful and, in muscles, block them from growing larger and stronger after exercise. The researchers found that inflammatory responses differed in the men. The young athletes displayed the least amount of inflammation in their blood and muscles at the start of the study and continued to do so after the workout. While their muscles flared briefly after exercise with inflammatory cells and related gene activity, the microscopic examination found that countervailing anti-inflammatory signals were also increasing and should soon cool the inflammation. A similar response occurred inside the muscles of the elderly athletes, although their inflammatory markers were slightly higher and their anti-inflammatory reactions a bit lower. But in the untrained elderly men, inflammation was much more of a bushfire, spiking higher than among the other men and showing fewer cellular signs of resolving any time soon. Taken as a whole, these results suggest that long-term exercise may help aging muscles remain healthy in part by readying them to dissipate inflammation, Dr. Trappe says. But on the flip side, sedentary living seems to set up muscles to overreact to strain and remain inflamed, potentially leading to fewer muscular gains when someone does exercise. This study was small, though, and examined the men’s muscles only once, soon after exercise. It did not look into whether and how their muscles actually changed over time with training. More important, the findings should not discourage middle-aged or older people who have been inactive from starting to visit the gym, Dr. Trappe says. “Even if inflammation gets in the way a bit at first, your muscles will respond and grow,” he says, and eventually should start to resemble those of people who have been exercising lifelong.

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COPD World News - Week of November 24, 2109

Study finds e-cigarettes cause lung cancer in mice

New York, NY - E-cigarette vapor causes lung cancer and potentially bladder cancer in mice, damaging their DNA and leading researchers at New York University to conclude that vaping is likely “very harmful” to humans as well. “It’s foreseeable that if you smoke e-cigarettes, all kinds of disease comes out” over time, Moon-Shong Tang, the study’s lead researcher, said in an interview. “Long term, some cancer will come out, probably. E-cigarettes are bad news.” How carcinogenic e-cigarette use is for humans “may not be known for a decade to come,” but the study is the first to definitively link vaping nicotine to cancer. Funded by the National Institutes of Health, the study was published Monday in the Proceedings of the National Academy of Sciences. A February study by the University of Southern California found that e-cigarette users developed some of the same molecular changes in oral tissue that cause cancer in cigarette smokers, according to the study published in the International Journal of Molecular Sciences. In the NYU study, researchers found that e-cigarette vapor caused DNA damage in the lungs and bladder and “inhibits DNA repair in lung tissues.” Out of 40 mice exposed to e-cigarette vapor with nicotine over 54 weeks, 22.5% developed lung cancer and 57.5% developed precancerous lesions on the bladder. None of the 20 mice exposed to e-cigarette smoke without nicotine developed cancer over the four years they studied the mice, researchers said. That’s “statistically very significant,” said Tang, who’s a professor at the NYU School of Medicine. Tang said his results heighten the need for more research about the relationship between e-cigarette use and cancer in humans. Because the market is still relatively young, he said it might be another decade before its impact on humans is more thoroughly understood. Based on his findings in mice, Tang said he doesn’t think the research will show e-cigarette use is safe for human consumption. The amount of smoke the mice were exposed to was similar to what a human would inhale if they vaped regularly for about three to six years, Tang estimated. “If they use e-cigarettes regularly, that’s probably similar,” he said. Much like combustible cigarettes, Tang said his findings suggest that secondhand vaping fumes also pose a risk to other people within close proximity. There were limitations to the study. The mice did not inhale the vapor as deeply as a human would, for instance. It also was conducted in a small number of mice that were more likely to develop cancer over their lifetime, researchers noted. However, the data comes at a time of increased scrutiny of e-cigarettes as underage use rises and U.S. health officials trace an outbreak of a deadly lung disease back to vaping, mostly THC, the active compound in marijuana. Some of the more than 1,000 victims who have fallen ill have reported using only nicotine, leading doctors to say they can’t rule anything out. Flavored e-cigarettes have fueled what government regulators are calling a teen vaping epidemic. The Food and Drug Administration is currently finalizing its guidance to remove all nontobacco flavors of e-cigarettes, including mint and menthol, from the market to deter underage usage. Some state and local governments are starting the removal process, too. Market leader Juul, which didn’t respond to a request for comment, is under investigation for marketing their products as a safer alternative to smoking and as a way that adults can wean themselves off of cigarettes. Some research does back up those claims. The Federal Trade Commission also opened a probe in August of the industry’s marketing practices, seeking information from Juul and five other companies. However, Tang noted there’s a difference between being safer than cigarettes and safe in general. “Young kids think it’s safer,” Tang said. “But it will cause cancer in mice.” Tony Abboud, executive director of the Vapor Technology Association, disputed the findings. He cited a 2015 study by Public Health England that found e-cigarettes to be “at least 95% safer” than traditional cigarettes. “As with all individual studies there are enormous limitations such as the minute sample size that the authors in this specific study point out,” Abboud said in an emailed statement. “The larger body of scientific evidence must be considered and more research should be done, but today’s study in PNAS does not stand for the proposition that the headline suggests.” He also cited a 2016 report by British doctor’s group the Royal College of Physicians that said the harm caused by e-cigarettes equated to about 5% “of the burden caused by tobacco smoking.” Linda Cuthbertson, spokeswoman for the Royal College of Physicians, said “elements of our reports and statements have been used in isolation.” The report cited by Abboud said e-cigarettes, while less harmful than tobacco cigarettes, may still be more hazardous than other forms of nicotine replacement since the industry isn’t uniformly regulated and manufacturing varies, she noted. The same report said “some of the carcinogens, oxidants and other toxins present in tobacco smoke have also been detected in e-cigarette vapour, raising the possibility that long-term use of e-cigarettes may increase the risks of lung cancer, COPD, cardiovascular and other smoking-related diseases,” although it’s likely substantially less of a risk than in traditional smoking.

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COPD World News - Week of November 17, 2019

Province says video visits with doctors will save time for patients

Toronto, ON - More Ontarians will be able to have “video visits” with doctors over the next year as the provincial government takes the first steps to offering more digital health care as part of the strategy to end hallway health care, says Health Minister Christine Elliott. Changes to modernize communication between patients and health care providers will include secure messaging, online booking of appointments, better access for Ontarians to their own health care records and allowing care providers to look at patients’ full online records under new privacy rules. Patients should talk to their doctors to see if visits can be done from the comfort of their living rooms over their computers or smartphones, Elliott said Wednesday at Credit Valley Hospital in Mississauga. “If it’s something really difficult and complicated they’ll still need to have an in-person visit,” she said. “But for many people who just want to have a quick consult with their doctor, the virtual care visits are going to save them a lot of time.” The province will spend an additional $3 million this year to compensate physicians for video visits. Doctors at Credit Valley are already using video links to consult with patients and colleagues at other sites in the Trillium Health Partners network of hospitals. The Ontario Telemedicine Network facilitates similar connections between doctors and patients in northern and rural communities. Through proposed amendments to the Personal Health Information Protection Act, new Ontario Health teams being formed to oversee care for patients will be able to collect, use and share information from individual patients so they don’t have to tell their medical stories “over and over and over again,” Elliott said. This will help various providers involved with a patient to provide more “integrated” care, she added.

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COPD World News - Week of November 10, 2019

Sweeping new B.C. regulations on vape products

Victoria, BC – British Columbia has announced new rules on vape products, including higher taxes, restrictions on sales and advertising, limits on nicotine content and constraints on packaging. Beginning in the spring of 2020, vapour pods and liquids will only be allowed to contain 20 milligrams of nicotine per millilitre, and will have to be sold in plain packaging with health warnings. Flavoured products will only be sold in vape-specific shops with age restrictions, and no advertising will be allowed in public spaces like bus shelters or parks where young people gather. The tobacco tax rate will also be increased by two cents beginning in Jan. 1, while the government will introduce legislation to increase the PST on vaping products from 7 per cent to 20 per cent. The PST increase will apply to cannabis vape juice once legal sales begin later this year, but other cannabis products will continue to be taxed at seven per cent. Health Minister Adrian Dix, Education Minister Rob Fleming and Finance Minister Carole James announced the new regulations at a news conference Thursday morning. "Some vaping manufacturers are using flavours and advertising to entice and normalize vaping for youth — introducing a new generation to very high levels of a very addictive drug," Dix said in a news release. "As a result, youth vaping rates are rising, putting them at risk for addiction and serious illness." The province stopped short of banning flavoured products, as some states have done. Dix said B.C. will prohibit some flavours that "clearly attract young people," but those have yet to be defined.

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COPD World News - Week of November 3, 2019

The effects of marijuana smoking on lung function in older people

Vancouver, BC – A study by WC Tan, Jean Bourbeau and SD Aaron, into the effects of marijuana smoking on the elderly, was recently published in the European Respiratory Journal. In order to determine how lung function is influenced in the long-term by smoked marijuana, the researchers undertook a study with 5,291 population-based people, including a subset of 1,285 men and women (aged 40 years and older) who self-reported use (or nonuse) of marijuana and tobacco cigarettes. They examined the link between marijuana smoking and the risk of spirometrically-defined COPD [post-bronchodilator FEV1/FVC < 0·7] in 5,291 participants. They also assessed the rate of decline in FEV1 in the abovementioned subset. Findings revealed an increase in the risk of COPD among heavy marijuana smokers. In concomitant tobacco smokers, heavy marijuana smoking accelerated FEV1 drop beyond that observed with tobacco alone.

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COPD World News - Week of October 27, 2019

Bone mineral density in emphysema in hospitalized male COPD patients

Konya, Turkey – A study, led by B. Yormaz of Selcuk University, Faculty of Medicine, Department of Pulmonology, Konya, Turkey was recently published in The Journal of Clinical Respirology, looked at bone density in men with COPD. Since an increased risk of osteoporosis in COPD is normally overlooked, particularly in male patients, therefore, researchers here compared male COPD patients with emphysema and the chronic bronchitis phenotype with respect to bone mineral density (BMD) measurements. They assessed the link between density of emphysema and osteoporosis. In this prospective analysis, they analyzed 94 patients with COPD, and with emphysema and the chronic bronchitis phenotype. Among patients with emphysema and bronchitis, osteoporosis was present in 60.47% and 17.65% and osteopenia was found in 27.91% and 41.18% of patients, respectively. In patients with osteoporosis, high resolution computed tomography emphysema density was negatively correlated with bone densitometer t-score, and BMI was positively correlated with the bone densitometer t-score. Independent risk factors for a low BMD were BMI and emphysema score. Experts recommended assessment for osteoporosis in particularly male patients with emphysema, high dyspnea score, low BMI and frequent exacerbations.

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COPD World News - Week of October 20, 2019

Playing harmonica is therapy for Veterans with COPD

Tampa, FL - A new class offered by James A. Haley Veterans’ Hospital is offering Veterans the chance to make music while treating their breathing problems. The COPD Foundation and the Academy of Country Music for individuals with Chronic Obstructive Pulmonary Disease created the Harmonicas for Health program. COPD is a catch-all term that includes people diagnosed with illnesses like emphysema, asthma and chronic bronchitis. According to Dave Folds, the breathing used to play the harmonica is similar to the breathing exercises used in therapy for COPD. Folds is the Health Promotion-Disease Prevention Coordinator. “Harmonicas for Health is using a musical instrument to use the same inhale-exhale exercises used by pulmonary rehabilitation to strengthen the diaphragm muscles,” Folds explained. “Basically, the breathing exercises are pursed lips-style breathing, like breathing in and out of a straw. Breathing through a straw would be the same way you would blow in and out of a harmonica.” Veterans who enroll in the class are given their own harmonica, a music book and literature on COPD. They meet as a class once a week and are asked to continue to practice at home. Folds, who is also the class instructor, said being able to use the harmonica at home is one of the major benefits of this program. “By making music, it’s much more enjoyable than sitting at home for half an hour each day breathing in and out of a straw,” Folds said. “Most of the people in this class won’t do that for a half an hour, and they say so. But they will sit at home and practice their harmonica, some of them for hours.” Besides the physical benefits of the program, participants also often experience social benefits. “These are people who oftentimes don’t go anywhere without an oxygen bottle. Or they don’t go anywhere because they feel self-conscious about saying one or two words and then taking a breath,” Folds said. “They tend to be not shut-ins, but stay-at-homes. This is an opportunity for them to get out, talk with one another, socialize and meet new people.” Folds asks Veterans to commit to the program for 12 weeks. That allows them to pick up enough instruction and practice to be able to play simple songs so they’re more likely to continue with the harmonica at home after leaving the class. Army Veteran Don Gilbreath was diagnosed with COPD 12 years ago. He has been participating in Harmonicas for Health for 12 weeks and says he can feel the difference the class has made in that time. “I feel a difference and have more endurance. I won’t do the pursed lips exercises at home. All I do is just sit there, breathe in, breathe out. But with the harmonica, you’re actually achieving something and hopefully getting pleasant sounds out of it. “You’re getting the reward for the effort you put in, and that’s the one thing I really like about it. Even after class, I’ll take it home and practice because I see an improvement in my breathing.”

COPD World News - Week of October 13, 2019    

Study finds vaccine effectiveness reduces hospitalizations in elderly

Atlanta, GA - Vaccination is the best way to prevent influenza; however, greater benefits could be achieved. To help guide research and policy agendas, researchers here, led by Michelle M Hughes, aimed to quantify the magnitude of influenza disease that would be prevented through targeted increases in vaccine effectiveness (VE) or vaccine coverage (VC). For 3 influenza seasons (2011–12, 2015–16, and 2017–18), researchers used a mathematical model to estimate the number of prevented influenza-associated illnesses, medically attended illnesses, and hospitalizations across 5 age groups. Compared with estimates of prevented illness during each season, given observed VE and VC, we explored the number of additional outcomes that would have been prevented from a 5% absolute increase in VE or VC or from achieving 60% VE or 70% VC. They concluded that small, attainable improvements in effectiveness or VC of the influenza vaccine could lead to substantial additional reductions in the influenza burden. Improvements in VE would have the greatest impact in reducing hospitalizations in adults aged ≥65 years, and VC improvements would have the largest benefit in reducing illnesses in adults aged 18–49 years.

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Mice that vaped nicotine for a year had a dramatic increase in tumor growth, study finds

New York, NY - New research in mice suggests that long-term exposure to vaping liquids that contain nicotine greatly increases the risk of cancer. After breathing in the vapor for 20 hours a week for more than a year, 22.5% of the mice had cancerous tumors in the lining of the lungs, and 57.5% developed growths in their bladder tissue that can be precursors to cancer. Meanwhile, only 5.6% of mice in a control group that breathed only filtered air wound up with lung tumors, and none of them had growths in their bladders. In addition, a group of mice exposed to aerosolized vaping chemicals without nicotine developed no lung tumors, and just 6.3% of them had precancerous bladder growths. The scientists who conducted the study stressed that much more research is needed to know whether vaping leads to cancer in humans. But they hope their findings, published Monday in the journal Proceedings of the National Academy of Sciences, will make people think twice before trying e-cigarettes, which are widely perceived by teenagers and young adults as a safe alternative to smoking. “Right or wrong, millions of young people are using these right now, and the long-term, population-wide studies won’t be able to report out results for another decade,” said study leader Moon-Shong Tang, an environmental health expert at NYU School of Medicine. “We needed credible evidence to guide people in their choices, and it is unambiguous that nicotine alone will cause damage to the cells that make up organs, including lungs,” said Tang, who has studied how tobacco smoke promotes cancers of the lung and bladder. “Now, we can try to find measures to prevent incidents of e-cigarettes causing cancer.” Vaping has been linked to heart attacks, seizures and burns from exploding devices. And a growing outbreak of at least 1,080 vaping-related lung injuries serves as a stark reminder that it’s too soon to know whether e-cigarettes are a safe alternative to smoking. To get a better idea of the long-term effects of nicotine, Tang and his collaborators exposed 45 mice to an aerosol of nicotine dissolved in isopropylene glycol and vegetable glycerin, a common vehicle for vaping liquids. Another group of 20 mice was exposed to the same vehicle without nicotine. For 54 weeks, the animals were subjected to the aerosol mixes for four hours per day, five days per week. A third group of 20 mice spent their time in a room with ambient filtered air. (The study was limited to 54 weeks in order to minimize the effects of age-related cancers that could have cropped up occurred regardless of exposure to e-cigarette vapor.) Five mice in the group exposed to nicotine died over the course of the year. So did two of the mice in each of the other groups. When the 54 weeks were up, the remaining animals were killed and the researchers examined their tissues. Nine of the 40 mice in the nicotine group had tumors in their lungs, compared with none of the 18 mice that breathed the nicotine-free aerosol and one of the 18 mice exposed to filtered air. (Tang said he wasn’t surprised that a tumor was found in the control group, since mice typically have increased rates of lung cancer.) In addition, the researchers found that 23 of the 40 mice that inhaled the vapor with nicotine developed bladder hyperplasia, an out-of-control cell reproduction in the lining of the bladder that often precedes cancer. That compares with 1 out of 16 mice that inhaled vapor without nicotine and zero out of 17 mice that breathed filtered air. (Tissue samples from three of the mice were accidentally destroyed and could not be included in the analysis.) The differences were large enough for the researchers to conclude that the aerosolized vaping liquid with nicotine was responsible for the increased risk of tumors. For instance, the mice that inhaled the nicotine mixture were eight times more likely to develop lung tumors than the mice in the other two groups that weren’t exposed to nicotine. “This is compelling, and very scary,” said Dr. Mark Litwin, the chair of UCLA’s Department of Urology. “When the instructions encoded in DNA get mangled, the cells go on a craze and continue multiplying, unable to control themselves. That’s a hallmark of cancer. And at a glance, this already looks like precancer tissue.” The researchers also found that a few of the mice exposed to e-cigarette vapor — with or without nicotine — developed abdominal or skin tumors, while none of their counterparts in the filtered-air group did. However, those differences were small and could have been due to chance.

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COPD World News - Week of October 6, 2019

B.C. seniors face up to 2-month wait for more effective flu vaccine

Victoria, BC - Seniors in B.C. will have to wait longer for a flu vaccine that offers them better protection, because the province doesn't cover the vaccine, according to the vaccine's manufacturer. The Fluzone High-Dose vaccine isn't expected to land on shelves in B.C. until the end of November or early December, the B.C. Pharmacy Association said Tuesday. Fluzone High-Dose vaccine produces a stronger immune response in seniors who are vulnerable to the flu. Standard vaccines are expected to arrive in October. The vaccine, which Health Canada approved in 2015 for use in people aged 65 and older, contains four times the antigen of a standard flu vaccine and produces a stronger immune response in seniors. A 2014 study found the high-dose vaccine to be 24 per cent more effective in preventing the flu than standard vaccines in adults 65 or older. Seniors are more vulnerable to the flu because of their weaker immune systems. Adults 65 and older accounted for up to 90 per cent of seasonal flu-related deaths in recent years, and up to 70 per cent of seasonal flu-related hospitalizations, according to the U.S. Centers for Disease Control and Prevention. B.C. covers standard flu vaccines but does not publicly fund the high-dose version. Pharmacies in the province charge $75 for the shot.The vaccine's manufacturer, Sanofi Pasteur, said it prioritizes delivery of vaccines to provinces and territories that publicly cover the vaccine, including Ontario, Manitoba, Saskatchewan, Northwest Territories, Nova Scotia and Prince Edward Island. Ontario is the only province that offers the vaccines to all seniors. The other provinces and territories distribute the vaccines to people living in long-term care.

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Influenza Vaccine Effectiveness in Preventing Hospitalizations in Older Patients With Chronic Obstructive Pulmonary Disease

Toronto, ON - Annual influenza immunization is recommended for people with chronic obstructive pulmonary disease (COPD) by all major COPD clinical practice guidelines. Researchers here recently sought to determine the seasonal influenza vaccine effectiveness (VE) against laboratory-confirmed influenza-associated hospitalizations among older adults with COPD. They conducted a test-negative study of influenza VE in community-dwelling older adults with COPD in Ontario, Canada using health administrative data and respiratory specimens collected from patients tested for influenza during the 2010–11 to 2015–16 influenza seasons. Influenza vaccination was ascertained from physician and pharmacist billing claims. Multivariable logistic regression was used to estimate the adjusted odds ratio of influenza vaccination in people with, compared to those without, laboratory-confirmed influenza. They found that receipt of seasonal influenza vaccine was associated with an adjusted 22% (95% confidence interval [CI], 15%–27%) reduction in laboratory-confirmed influenza-associated hospitalization. Adjustment for potential misclassification of vaccination status increased this to 43% (95% CI, 35%–52%). Vaccine effectiveness was not found to vary by patient- or influenza-related variables. The researchers concluded that during the studied influenza seasons, influenza vaccination was at least modestly effective in reducing laboratory-confirmed influenza-associated hospitalizations in people with COPD. The imperfect effectiveness emphasizes the need for better influenza vaccines and other preventive strategies. The study was led by Andrea S Girshon, Sunnybrook Health Sciences Centre, Toronto.

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COPD World News - Week of September 29, 2019

Increased Synthetic Cannabinoid Use Found in Older Adults With COPD

Toronto, ON - Older adults above the age of 66 with chronic obstructive pulmonary disease (COPD) were found to be twice as likely to use prescription synthetic oral cannabinoids when compared with adults of the same age without COPD, according to a study published this week in the journal Drugs & Aging. Research led by Saint Michael’s Hospital in Toronto and the Institute for Clinical Evaluative Sciences (ICES) sought to examine the frequency of synthetic oral cannabinoid use, human-made versions of THC such as nabilone and dronabinol, in patients with COPD. Previous studies by the study group have revealed that other psychoactive drugs such as opioids and benzodiazepines have been frequently used for care related to COPD, which were correlated to a potential increase in mortality risk. Currently, safety recommendations advise against prescribing cannabinoids in patients with COPD. However, due to the effects of THC in the central nervous system which produce effects such as sedation and pain relief, many patients and physicians are turning to its use to manage symptoms. Researchers analyzed information obtained from a retrospective, population-based, cohort study on 172,282 adults with COPD and 1,068,256 older adults without COPD all aged 66 or older: Physician-diagnosed COPD identified using previously validated, highly specific algorithm Incident off-label oral cannabinoid use examined between April 1, 2005 and March 31, 2015 Descriptive statistics used to describe drug use patterns and multiple logistic regression used to identify characteristics correlated to incident drug use. Data from the study unveiled a significantly greater frequency in incident synthetic oral cannabinoid use for patients with COPD versus without (0.6% vs 0.3%; P < .001). When compared to older adults without COPD who use synthetic cannabinoids, patients with COPD exhibited increased high dosage frequency and significantly longer usage duration. Study results additionally found that cannabinoids were used more frequently in subgroups of older adults with COPD at a heightened risk for adverse events, such as patients receiving other sedating psychiatric medications and those with psychiatric disease. Lead study author Nicholas Vozoris, MD, a respirologist at Saint Michael’s and an associate scientist at Li Ka Shing Knowledge Institute and ICES, highlighted the study’s findings while also stressing for precaution. “Our study showed that patients and clinicians are turning to cannabinoids more frequently to manage the symptoms associated with COPD, but little is known about the potential dangers associated with this medication class,” said Vozoris. The management of prescribed doses, especially in patients with COPD is vital considering the study’s indication of their high dosage and longer duration use. “Though the use of these drugs isn’t too frequent today, without careful monitoring of the way they’re being prescribed and used now, we could end up with larger problems in the future,” said Vozoris. The study authors noted that further research into the respiratory safety of cannabinoid use is warranted among individuals with COPD. “We’d like [clinicians] to reflect on their own prescribing practices and ensure cannabinoid drugs are used and prescribed with vigilance,” said Vozoris.

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COPD World News - Week of September 22, 2019

Pelosi offers Medicare negotiation plan to curb drug prices

Washington, DC - House Speaker Nancy Pelosi, trying to seize the agenda on a top consumer issue, announced an ambitious prescription drug plan last week that would allow Medicare to negotiate prices for seniors and younger people. The proposal would direct Medicare to bargain over as many as 250, but no fewer than 25, of the costliest drugs. Insulin is on the list. Drug-makers that refuse to negotiate could face steep penalties. Companies that raise prices beyond inflation would have to pay rebates to Medicare. The plan would limit copays for seniors covered by Medicare’s “Part D” prescription drug program to $2,000 a year. Medicare-negotiated prices would be available to other buyers, such as employer health plans. It’s shaping up as a high-stakes gamble for all sides in Washington. Polls show that high drug prices have Americans worried, and regardless of party affiliation, they want Congress to act. As a candidate, President Donald Trump called for Medicare negotiations but later seemed to drop the idea. Pelosi, D-Calif., said her goal is a deal that Trump can sign onto and that could pass the GOP-controlled Senate. “We don’t want a political issue at the polls,” Pelosi said at a news conference. “We want a solution in Congress, and we want it now.” Pelosi’s proposal would authorize Medicare to negotiate prices for up to 250 drugs with the greatest total cost to society. That includes pharmacy drugs under the Part D prescription benefit, and Part B medications dispensed in doctors’ offices, such as many cancer drugs. Medicare would negotiate for as many drugs as possible on a list refreshed annually, but no fewer than 25. The maximum price would be determined using a blend of international prices, similar to a more limited proposal from the administration. Drug companies that balk at making a deal would face penalties that start at 65% of sales for the drug at issue. Currently, Medicare’s pharmacy benefit has no cap on copays, and the advent of drugs costing hundreds of thousands of dollars a year has left some seniors saddled with bills that rival a mortgage payment.

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COPD World News - Week of September 15, 2019

Winter virus season impact on acute dyspnoea in the emergency department

Toulouse, France – A study led by Christiaens H, et al. recently published in The Clinical Respiratory Journal looked at the impact of breathlessness during virus season on the use of emergency departments in hospitals. In this monocentric retrospective cohort study, researchers compared the epidemiology of dyspnoea presented to emergency departments (EDs) during and of winter virus season (WVS). Participants included all patients visiting the ED of the Rangueil University Hospital (Toulouse, France) for dyspnoea in September 2016 (off WVS period) and January 2017 (during WVS period). During the WVS period, they noted a doubling of the incidence of patients visiting because of dyspnoea. Significantly older patients with more extensive medical backgrounds and more serious diseases visited the ED because of dyspnoea during WVS period. They realized a large requirement of hospitalization in this time-consuming population, which is possibly responsible for emergency department's overcrowding during epidemics.

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COPD World News - Week of September 8, 2019

Program launched to combat e-cigarette use

New York, NY - In response to alarming levels of e-cigarette use among youth in the United States—including a 78 percent increase among high school students in just one year—Bloomberg Philanthropies today announced the creation of a new $160 million initiative to end the youth e-cigarette epidemic. Goals of the initiative, “Protect Kids: Fight Flavored E-Cigarettes,” include banning all flavored e-cigarettes—and stopping Juul and other e-cigarette companies from marketing their products to children. The three-year program will be led by the Campaign for Tobacco-Free Kids, which will partner with other leading organizations including parent and community groups concerned about the nation’s kids and health. More than 3.6 million middle and high school students in the United States use e-cigarettes, accounting for about one-third of all U.S. e-cigarette users. E-cigarettes with kid-friendly flavors such as mint, mango, gummy bear and cotton candy are fueling this epidemic; 97 percent of kids who use e-cigarettes use the flavored varieties, and 70 percent report the flavors as the reason they use e-cigarettes. Teen smoking rates in the United States declined by more than 70 percent between 2000 and 2018, but the spike in e-cigarette use among youth threatens to undo a generation’s worth of progress. The creation of the initiative comes as health authorities in 33 states are investigating more than 450 cases of severe respiratory illnesses associated with vaping, with many cases involving teens and young adults. A CDC health advisory released in response to these alarming incidents encourages e-cigarette users to stop using these products while investigations into the cause of these illnesses are ongoing. Recently the Food and Drug Administration said that Juul, the leading e-cigarette company, has violated federal regulations by promoting its tobacco products as healthier than traditional cigarettes. E-cigarettes are uniquely dangerous for kids due to nicotine’s highly addictive properties and its impact on their developing brains: adolescent exposure to nicotine can reduce attention, learning and memory. Juul—which now represents over 70 percent of the e-cigarette market in the United States—delivers high levels of nicotine, with each Juul pod delivering as much nicotine as a pack of 20 cigarettes. There is also substantial evidence that e-cigarette use increases the risk of using combustible tobacco cigarettes among youth and young adults. “E-cigarette companies and the tobacco companies that back them are preying on America’s youth. They are using the same marketing tactics that once lured kids to cigarettes, and the result is an epidemic that is spiraling out of control and putting kids in danger of addiction and serious health problems,” said Michael R. Bloomberg, Bloomberg Philanthropies Founder. “The federal government has the responsibility to protect children from harm, but it has failed – so the rest of us are taking action. I look forward to partnering with advocates in cities and states across the country on legislative actions that protect our kids’ health. The decline in youth smoking is one of the great health victories of this century, and we can’t allow tobacco companies to reverse that progress.” The initiative will support local advocacy efforts in cities and states including legislative and regulatory measures to: Remove flavored e-cigarettes from the marketplace. Researchers have identified more than 15,000 e-cigarette flavors available online. In addition to the role flavored products have played in driving the youth e-cigarette epidemic, studies have found that some flavoring chemicals may also have health risks.

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COPD World News - Week of September 1, 2019

Optimism boosts exceptional longevity

Washington, DC - The National Academy of Sciences recently released a study that examined the relationship between optimism and longevity. Studies regarding exceptional longevity, defined as living to age 85 or older, have largely focused on biomedical rather than psychological factors. To examine the effects of optimism on exceptional longevity, Lewina O. Lee and colleagues analyzed data from 69,744 women from the Nurses' Health Study and 1,429 men from the Veterans Affairs Normative Aging Study. The women's age range was 58-86 years when they completed an optimism assessment in 2004, and their mortality status was tracked through 2014; the men's age range was 41-90 years when they completed an optimism assessment in 1986, and their mortality status was tracked through 2016. The authors found that higher optimism was associated with increased odds of exceptional longevity, even after taking into account other relevant factors, such as demographics, health conditions, and health behaviors. On average, more optimistic individuals demonstrated 11-15% longer lifespan than less optimistic individuals. The findings suggest that optimism may be an important factor for healthy aging, according to the authors.

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COPD World News - Week of August 25, 2019

Flu vaccine associated with reduced risk for death, stroke in elderly ICU survivors

Aarhus, Denmark - In Denmark, elderly ICU survivors who received an influenza vaccine had an 8% decreased risk for death and a 16% reduced risk for hospitalization for stroke in the year after discharge compared with patients who were not vaccinated, according to findings from a population-based cohort study published in Intensive Care Medicine. “Patients aged 65 years or older who survive a hospitalization with intensive care admission are at high risk of morbidity and mortality within the first year after discharge,” Christian F. Christiansen, MD, PhD, associate professor of clinical epidemiology at Aarhus University Hospital in Denmark, told Infectious Disease News. “Our study shows that there are fewer deaths and strokes within the first year after discharge in intensive care survivors who have been vaccinated against influenza compared with unvaccinated individuals.” According to Christiansen and colleagues, 1-year mortality after hospital discharge among ICU patients aged 65 years or older ranges between 21% and 27% — three to four times higher than the mortality rate for the general population of the same age. As more critically ill elderly patients are admitted to ICUs and surviving intensive care, “long-term morbidity and mortality after the immediate critical illness are major concerns in this fragile population,” and any benefits from influenza vaccination among these patients would have a significant clinical impact, they noted. The researchers analyzed data from the Danish Intensive Care Database from 2005 through 2015 and included 89,818 ICU survivors aged 65 years or older in the study. The patients who were vaccinated for influenza (n = 34,871; 39%) were older, used more prescription medications and had more chronic diseases than the unvaccinated patients, according to the study. Vaccinated patients had an adjusted 1-year mortality of 19.3% vs. 18.8% for unvaccinated patients (adjusted HR = 0.92; 95% CI, 0.89-0.95), Christiansen and colleagues reported. Vaccination also was associated with a decreased risk for stroke (adjusted HR = 0.84; 95% CI, 0.78-0.92), but the researchers found no association between vaccination and subsequent hospitalization for pneumonia or heart failure. “We can only speculate about the potential mechanisms as our study did not provide such data,” Christiansen said. “There is growing evidence linking infection and inflammation to cardiovascular events, and it is possible that preventing influenza infection may decrease the risk of cardiovascular events, including stroke. Others suggest a nonspecific immunomodulatory effect of the vaccine itself, which may influence the outcome of critical illness.” Christiansen said the study’s findings support current recommendations that influenza vaccination be provided to high-risk groups, including individuals aged 65 years or older.

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COPD World News - Week of August 18, 2019

Doctors suspect vaping behind dozens of lung illnesses in US

New York, NY - As many as 50 people in at least six states have come down with breathing illnesses that may be linked to e-cigarettes or other vaping products. No deaths have been reported, but at least a few have come close.Some patients have likened onset of the illness to a heart attack, and others to the flu. Symptoms have included shortness of breath, fatigue, chest pain and vomiting. Doctors say the illnesses resemble an inhalation injury, with the body apparently reacting to a caustic substance that someone breathed in.Dr. Melodi Pirzada, a pediatric lung specialist at NYU Winthrop Hospital in New York, said she’s seen two cases this summer — one of them an athletic 18-year-old who almost died. “We’re all baffled,” Pirzada said. The only common factor was they had been vaping, she said. Wisconsin health officials said they’re seen 15 confirmed cases, with another 15 illnesses under investigation. New York state officials are investigating 10, Illinois has seen at least six, and Minnesota doctors this week said they have four more. California and Indiana have also been looking into reported illnesses. Health officials have only been counting certain lung illnesses in which the person had vaped within three months. Most are teens, but some adult cases have also been reported. No single vaping device or liquid is associated with the illnesses. Dylan Nelson, a 26-year-old Wisconsin man, went to see a doctor when he first became ill. He has asthma, was diagnosed with pneumonia and was treated and released. Within a few days, he could barely breathe. He went to a hospital and was put on a breathing tube. His two brothers kept a round-the-clock vigil over him in the ensuing days, and at one point one called his mother to the hospital, saying: “Mom, I don’t think he’s going to make it. ... He can’t die without his mom.” He rallied and was released from the hospital late last month. But “he still has lung damage and heart damage,” and doctors still don’t know how much they’ll heal, said his mother, Kim Barnes of Burlington, Wisconsin. Electronic cigarettes have been described as a less dangerous alternative to regular cigarettes, but health officials have been worried about kids using them. Most of the concern has focused on nicotine, which health officials say is harmful to developing brains and might make kids more likely to take up cigarettes. But some vaping products have been found to contain other potentially harmful substances, including flavoring chemicals and oils used for vaping marijuana, experts say. Wisconsin officials did do not know the names of the products the sick people had vaped, but added they could include several substances, including nicotine and THC — the main active chemical in marijuana. Dr. Anne Griffiths, a lung specialist who saw all four of the reported Minnesota cases, said each had vaped different products.

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COPD World News - Week of August 11, 2019

New transplant tech extends organ life outside human body

Vancouver, BC - The Ex Vivo Lung Perfusion Program is centred around a new machine at Vancouver General Hospital that is paving the way for surgeons to provide better, stronger donor lungs with faster access to life-saving transplants. The lung perfusion system allows lungs to live outside the body for up to 12 hours after retrieval. A set of lungs that might otherwise be rejected for transplant can be reassessed, even repaired and reconditioned in a bubble-like machine using  bloodless oxygenated liquid and a ventilator to force air in and out of the lungs. What it means for patients represents a sea change in both the number of available donors, and the length of the average wait time. Last year, doctors at VGH performed 50 double lung transplants. Using ex vivo, that number is expected to increase to about 60, according to the B.C. Lung Transplant Program. The hope is to also reduce patient deaths on the transplant wait list. A bronchoscope is inserted into the airway of a set of donated lungs to clear away infected material. This is one of the ways in which lungs are reconditioned prior to transplant. "We are constantly striving to save more lives and provide better care through innovation," said provincial executive director Ed Ferre. "The Ex Vivo Lung Perfusion Program offers hope to all those on the wait-list." The B.C. Lung Transplant Program at VGH is one of four such programs in Canada and offers life-saving treatment for end-stage lung disease.

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COPD World News - Week of August 4, 2019   

ECMO use outpacing mechanical ventilation in lung transplantation

Addison, Texas - In the past decade, the use of extracorporeal membrane oxygenation as a bridge to lung transplantation has increased significantly, whereas the use of mechanical ventilation has steadily decreased, researchers reported in The Journal of Heart and Lung Transplantation. Importantly, they added, this surge in use of ECMO has been accompanied by a significant improvement in survival that places the technique on par with mechanical ventilation.  “Until now, the traditional bridging strategy has been mechanical ventilation. After having undergone an iterative evaluation over a decade ago, [mechanical ventilation] as a bridge achieved outcomes that improved enough to allay initial safety concerns,” the researchers wrote. “Comparatively, ECMO was once considered a contraindication to [lung transplantation]. However, ECMO use has undergone a period of scrutiny and evolution to ultimately gain acceptance as a potentially acceptable contemporary bridging option. The improvement in technological design, use of membrane oxygenators and clinical expertise have each greatly enhanced its safety profile.” Using data from the Scientific Registry of Transplant Recipients (SRTR) Standard Transplant Analysis and Research files, the researchers evaluated 21,576 patients (mean age, 54 years; 41% women) who underwent lung transplantation in the U.S. from 2005 to 2017. Patients were analyzed according to whether they received pretransplant mechanical ventilation (n = 1,129), ECMO (n = 664) or no bridge (n = 19,783) and within the context of the early era (2005-2011; n = 11,004) or late era of use (2012-2017; n = 10,572). From the early to the late era, ECMO use increased from 1% to 5% (P < .001) as use of mechanical ventilation decreased from 6% to 4% (P < .001). Moreover, the median lung allocation scores of patients in the late era were higher than in the early era (37.5 vs. 36.1; P < .001). Although the risk for 1-year mortality was higher in both the mechanical ventilation (HR = 1.9; 95% CI, 1.64-2.2) and ECMO groups (HR = 1.93; 95% CI, 1.56-2.53) than in the no-bridge group, direct comparison demonstrated no significant differences between the two bridging strategies (HR = 0.99; 95% CI, 0.78-1.25). Five-year mortality risk was also higher with mechanical ventilation (P < .001) and ECMO (P < .001), as compared without bridging, but again, there was no difference between the two when directly compared (P = .817). Similar patterns regarding mortality risk with bridging vs. no bridging were noted in both the early and late eras, according to the data; however, analyses in the ECMO group only showed that the risk for 1-year mortality with ECMO decreased in the later era (HR = 0.5; 95% CI, 0.32-0.78). When compared with ECMO, patients who received mechanical ventilation were less likely to have ventilator support within 48 hours (P = .003), dialysis (P = .003) and postoperative ECMO (P = .006), but were more likely to be reintubated (P = .005). Length of stay, however, did not differ between the mechanical ventilation and ECMO groups. “There appears to be an improvement in the outcomes with ECMO, distancing itself somewhat from the prohibitive morbidity of the past and demonstrating a growth in volume that has now superseded that of mechanical ventilation. The use of ECMO is safe in this high-risk population. The increasing use of ECMO as a bridge to lung transplantation highlights the need to further define criteria and practice guidelines with which to steer clinical practice, accreditation and reimbursement,” the researchers wrote.

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COPD World News - Week of July 28, 2019

WHO says not enough people protected from smoking

Geneva, Switzerland - Many governments are making progress in the fight against tobacco, with 5 billion people protected by comprehensive tobacco control policies. But a new WHO report shows many countries are still not adequately implementing policies. 2.6 billion people remain unprotected, leaving them at risk of harms caused by tobacco use. Only 1 in 5 people are protected by complete tobacco smoking bans in indoor public spaces and workplaces. 6 in 10 tobacco users want to quit and with proven help, they can more than double their chances of quitting. “Quitting tobacco is one of the best things any person can do for their own health,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. Currently, there are an estimated 1.1 billion smokers, around 80% of whom live in low- and middle-income countries. Many governments are making progress in the fight against tobacco, with 5 billion people today living in countries that have introduced smoking bans, graphic warnings on packaging and other effective tobacco control measures - four times more people than a decade ago. But a new WHO report shows many countries are still not adequately implementing policies, including helping people quit tobacco, that can save lives from tobacco. The seventh WHO Report on the global tobacco epidemic analyses national efforts to implement the most effective measures from the WHO Framework Convention on Tobacco Control (WHO FCTC) that are proven to reduce demand for tobacco. These measures, like the “MPOWER” interventions, have been shown to save lives and reduce costs from averted healthcare expenditure. The MPOWER report was launched in 2007 to promote government action on tobacco control strategies. The focus of the latest report is on the progress countries have made to help tobacco users quit. It is being launched today in Brazil, a country that has become the second, after Turkey, to fully implement all the MPOWER measures at the highest level of achievement. Dr Ghebreyesus said governments should implement cessation services as part of efforts to ensure universal health coverage for their citizens. “Quitting tobacco is one of the best things any person can do for their own health. The MPOWER package gives governments the practical tools to help people kick the habit, adding years to their life and life to their years.” Progress is being made, with 2.4 billion people living in countries now providing comprehensive cessation services (2 billion more than in 2007). But only 23 countries are providing cessation services at the best-practice level, making it the most under-implemented MPOWER measure in terms of number of countries offering full coverage. Tobacco cessation services include national toll-free quit lines, “mCessation” services to reach larger populations via mobile phones, counselling by primary health care providers and cost-covered nicotine replacement therapy. Michael R. Bloomberg, WHO Global Ambassador for Noncommunicable Diseases and Injuries  and founder of Bloomberg Philanthropies, said the report shows government-led efforts to help people quit tobacco work when properly implemented. “More countries are making tobacco control a priority and saving lives, but there’s still much more work to be done,” said Mr Bloomberg. “The WHO’s new report shines a spotlight on global efforts to help people quit using tobacco and it details some of our most important gains.” The report, funded by Bloomberg Philanthropies, showed that while only 23 countries have implemented cessation support policies at the highest level, 116 more provide fully or partially cost-covered services in some or most health facilities, and another 32 offer services but do not cost-cover them, demonstrating a high level of public demand for support to quit. Tobacco use has also declined proportionately in most countries, but population growth means the total number of people using tobacco has remained stubbornly high. Currently, there are an estimated 1.1 billion smokers, around 80% of whom live in low- and middle-income countries (LMICs).

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COPD World News - Week of July 21, 2019

CRP test can guide antibiotic use in COPD

Oxford, UK - Point-of-care C-reactive protein (CRP) testing conducted to inform antibiotic prescribing in patients with chronic obstructive pulmonary disease (COPD) exacerbations was associated with lower overall antibiotic use, and with no evidence of increased harm, according to U.K. researchers. Fewer patients with acute COPD exacerbations in the CRP-guided treatment group were prescribed antibiotics at initial general medical practice consultation (47.7% vs 69.7% in the usual care group) and after the first month of follow-up (59.1% vs. 79.7%), reported Christopher C. Butler, MD, F.Med.Sci, of the University of Oxford in England, and colleagues. Between-group differences in scores on the Clinical COPD Questionnaire (CCQ) during follow-up were not clinically meaningful, suggesting that lower antibiotic use in the CRP-guided arm did not impact patient-reported, disease-specific quality of life during the weeks following initial consultation, they wrote in the New England Journal of Medicine. "The evidence from our trial suggests that CRP-guided antibiotic prescribing for COPD exacerbations in primary care clinics may reduce patient-reported use of antibiotics and the prescribing of antibiotics by clinicians," the authors stated. They noted that primary care physicians are the main prescribers of antibiotics for patients with COPD experiencing exacerbations, and that roughly half of patients living with COPD have one or more acute exacerbations of the disease annually, while approximately one in four patients have two or more exacerbations each year. "More than 80% of these patients receive antibiotic prescriptions in the United States and in Europe," they wrote. "Although many patients who have acute exacerbations of COPD are helped by these treatments, others are not." CRP is a well recognized biomarker for assessing COPD exacerbations that can readily be measured at the point of care, the researchers wrote. They hypothesized that CRP testing could reduce unnecessary antibiotic prescriptions for COPD exacerbations in the primary care setting. They tested the theory in a study involving 653 COPD patients seeking treatment for acute exacerbations at 86 general practice offices in the U.K. Clinicians were given guidance on how to interpret CRP test results, but they were also told that antibiotic prescribing decisions should be "based on a comprehensive assessment of likely risks and benefits, given a patient's underlying health status and clinical features." Based on findings from a 2012 study of antibiotic efficacy in COPD exacerbations, the clinicians were told that antibiotics were unlikely to benefit patients with CRP levels <20 mg/L. They were further told that antibiotics may benefit patients with CRP levels of 20 to 40 mg/L, "mainly, if purulent sputum is present," and that treatment with antibiotics was likely to benefit patients with CRP levels >40 mg/L. Two primary outcomes were assessed in the study: patient-reported antibiotic use within 4 weeks of study randomization and COPD-related health status, as measured by CCQ, 2 weeks after randomization. "Since we would need to show both a reduction in antibiotic use and no worsening of COPD-related health status in order for us to consider the CRP point-of-care test to be effective, we designed this study to answer both questions," Butler and colleagues wrote. They reported that antibiotic use was lower in the point-of-care CRP testing group (57.0% vs 77.4%, adjusted odds ratio 0.31, 95% CI 0.20-0.47). Also, at 2 weeks, the adjusted mean difference in CCQ score was −0.19 points (two-sided 90% CI −0.33 to −0.05) in favor of the CRP-guided group. At initial consultation, fewer patients in the CRP-testing group were prescribed antibiotics (47.7% vs 69.7%, for a difference of 22.0 percentage points, adjusted OR 0.31, 95% CI 0.21-0.45). A similar difference of 20.6 percentage points favoring the CRP-testing group was seen at 4 weeks follow-up (adjusted OR 0.30, 95% CI 0.20-0.46). The investigators concluded that the death of two patients in the usual care group within 4 weeks of study randomization was due to causes unrelated to trial participation.

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COPD World News - Week of July 14, 2019

Very difficult flu season may be on the horizon

Toronto, ON - Health ministry says it has ordered 300,000 more high-dose flu vaccines for this year. This year's flu season will likely be a bad one, Ontario's health minister said Monday, and the province is stocking up on extra high-strength vaccines in preparation. "We expect that it's going to be a very difficult year," Christine Elliott said after an unrelated announcement. "Based on what's happening in Australia we sort of take a look at what's likely to happen in Ontario." Australian health authorities are reporting an early flu season — unusually high activity for this time of year. Though the overall severity is reported as low, hospitalizations are three times what is normal for this time, and there have been more than 200 deaths so far, according to that country's department of health.  Ontario has already ordered 300,000 more doses of high-dose flu vaccines than last year, bringing the total order to 1.2 million doses, said a spokesman for Elliott.  'The anti-vaxxer theory is out there' That vaccine has four times the amount of antigens than the regular flu shot and is given to more vulnerable people, such as seniors. It can be provided in hospitals, long-term care homes and by primary care providers. Elliott said it was proven particularly effective last year, and that the government will also be rolling out an advertising campaign, encouraging people to get the flu shot. "It's really important to prevent it in the first place, but we also need to be prepared to deal with it when it does strike Ontario, both in terms of hospital care, home care and community care," she said. "We will be advertising to people that we want them to get out and get the flu shot and deal with some of the myths out there about  getting the flu vaccine because ... the anti-vaxxer theory is out there as well as far as the flu vaccine is concerned, too." Elliott did not yet have a specific date when the flu shot will be available, but she said it will be well in advance of flu season. Researchers reported early this year that the previous flu season's vaccine appeared to be highly effective. The analysis by researchers with the Canadian Sentinel Practitioner Surveillance Network and published online in the journal Euro Surveillance, shows it was 72 per cent effective in preventing infection with the H1N1 respiratory virus  overall across all age groups.  In the 2018-19 flu season, 34 per cent of adults in Canada aged 18-64 got the flu shot, and 70 per cent of seniors got it, according to the Public Health Agency of Canada.

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COPD World News - Week of July 7, 2019

Importance of patient choice in inhaled medication decision making

Toronto, ON - Asthma Canada and COPD Canada recently partnered to develop a white paper on the importance of patient choice. Some of the key points made in the report include: 

- Inhaled medications are the cornerstone of therapy for both asthma and COPD.

- Therapeutic guidelines help in the selection of safe and effective drugs; the selection of the device must also be patient-centered.

- There is abundant evidence that optimized patient outcomes, minimized exacerbations and maximized adherence are obtained only with careful patient-device alignment; this entails consideration of patient device preferences, physical constraints on device use, and regular inhaler technique education.

- Patients strongly prefer to have trusted health care practitioners who understand and incorporate their preferences when managing their care.

- Medication and device choices/switches should only be conducted by prescribers, with patient knowledge, consent and training, to support adherence and optimize outcomes.

- Drug or device restrictions or switches implemented for cost reasons should never compromise disease control or patient well-being. While budget and sustainability concerns are important to all parties, enforced or encouraged switches among non-equivalent respiratory devices are neither health-based nor patient-focused.

For the full report:

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