Omicron multiplies faster in airways, slower in lungs
Hong Kong, China - Major differences in how efficiently Omicron and other variants of the coronavirus multiply may help predict Omicron's effects, researchers said on Wednesday. Compared to the earlier Delta variant, Omicron multiplies itself 70 times more quickly in airway passages, which may facilitate person-to-person spread, they said. But in lung tissues, Omicron replicates 10 times more slowly than the original version of the coronavirus, which might contribute to less-severe illness. A formal report of the findings is under peer review for publication and has not been released by the research team. In a news release issued by Hong Kong University, study leader Dr. Michael Chan Chi-wai said, "It is important to note that the severity of disease in humans is not determined only by virus replication" but also by each person's immune response to the infection, which sometimes evolves into life-threatening inflammation. Chan added, "By infecting many more people, a very infectious virus may cause more severe disease and death even though the virus itself may be less pathogenic. Therefore, taken together with our recent studies showing that the Omicron variant can partially escape immunity from vaccines and past infection, the overall threat from Omicron variant is likely to be very significant."
For more information: https://tinyurl.com/yc58pvuy
Breathlessness in patients with long COVID may signal heart problems
Brussels, Belgium - A small study has suggested that COVID-19 patients who continue to be short of breath during physical activity one year after recovering from the infection may have suffered heart damage. The research is presented today at EuroEcho 2021, a scientific congress of the European Society of Cardiology (ESC). “The findings could help to explain why some patients with long COVID still experience breathlessness one year later and indicate that it might be linked to a decrease in heart performance,” said study author Dr. Maria-Luiza Luchian of University Hospital Brussels, Belgium. There is increasing evidence of cardiovascular complications due to COVID-19 and of long-lasting symptoms such as dyspnea (shortness of breath), known as long COVID. This study investigated whether subclinical heart abnormalities were more common in long COVID patients with dyspnea – thereby potentially explaining the reason for their symptoms. The study included 66 patients without previous heart or lung disease who were hospitalized with COVID-19 between March and April 2020 at University Hospital Brussels. At one-year after hospital discharge, spirometry together with chest computed tomography were used to assess lung function and possible sequela of COVID-19. Cardiac ultrasound was performed to examine heart function and included a new imaging technique called myocardial work which provides more precise information on heart function than previous methods. The average age of participants was 50 years and 67% were men. At one year, 23 patients (35%) had shortness of breath during effort. The researchers examined the association between imaging measures of heart function and shortness of breath at one year after adjusting for age and gender. The analysis showed that abnormal heart function was independently and significantly associated with persistent dyspnea. Cardiac imaging revealed poorer heart performance in patients with versus without dyspnea at one year after hospitalization due to COVID-19. Dr. Luchian said: “Our study shows that more than a third of COVID-19 patients with no history of heart or lung disease had persistent dyspnea on effort a year after discharge from hospital. When looking in detail at heart function by cardiac ultrasound, we observed subtle abnormalities that might explain the continued breathlessness.” She concluded: “Myocardial work could be a new echocardiographic tool for early identification of heart function abnormalities in patients with long COVID-19, who might need more frequent and long-term cardiac surveillance. Future studies including different COVID-19 variants and the impact of vaccination are needed to confirm our results on the long-term evolution and possible cardiac consequences of this disease.”
For more information: https://tinyurl.com/2p8jua4n
SHINGRIX approved in Canada for adults at increased risk of shingles due to immunodeficiency or immunosuppression
Mississauga, ON – GlaxoSmithKline Inc. announced that SHINGRIX (Zoster Vaccine Recombinant, Adjuvanted) has been approved in Canada for the prevention of shingles (herpes zoster) in adults aged 18 years and older who are or who will be at increased risk of shingles due to immunodeficiency or immunosuppression caused by known disease or therapy. Immunocompromised individuals are at greater risk of shingles and associated complications than immunocompetent individuals. This indication expansion marks an important step towards increasing access to a shingles vaccine for Canadians with diverse risk factors that put them at increased risk of shingles. “Older age and being immunocompromised are the most common risk factors for shingles disease,” said Marni Freeman, Country Medical Director, GSK. “GSK is proud to offer SHINGRIX for the prevention of shingles to this important patient population at increased risk for shingles and its complications by bringing them a vaccine option that can help prevent this painful condition.” SHINGRIX, a non-live, recombinant subunit adjuvanted vaccine, given intramuscularly in two doses, was initially approved in Canada in 2017 for the prevention of shingles in adults 50 years of age or older. SHINGRIX is the first shingles vaccine indicated for use in those who are or who will be at increased risk of the disease due to being immunodeficient or immunosuppressed due to known disease or therapy. It combines a non-live antigen (glycoprotein E) and an adjuvant system (AS01B) to generate a Varicella Zoster Virus (VZV)-specific immune response. SHINGRIX is not indicated for prevention of primary varicella infection (chickenpox). This indication expansion allows a greater number of Canadians to be eligible for SHINGRIX vaccination. The GSK Clinical Development Program evaluated the benefit-risk profile of SHINGRIX in heterogeneous immunocompromised patient populations. This approval for the new populations was based on clinical studies examining the safety and efficacy of SHINGRIX in adults 18 years of age and older who had undergone an autologous hematopoietic stem cell transplant (auHSCT) and those undergoing treatment for hematological malignancies (post-hoc analysis). Further safety and immunogenicity data were generated in adults 18 years of age and older who were, or were anticipated to be, immunodeficient or immunosuppressed due to known disease or therapy, including patients with HIV, solid tumors, and renal transplants. Shingles is caused by varicella zoster virus (VZV), the same virus that causes chickenpox. Shingles typically presents as a rash, with painful blisters across the chest, abdomen, or face. The pain is often described as aching, burning, stabbing or shock-like. Following the rash, a person can also experience post-herpetic neuralgia (PHN), pain that can last for months or years. PHN is the most common complication of shingles, occurring in up to 30 percent of all shingles cases. Shingles affects an estimated 130,000 Canadians annually. Incidence rates are similar throughout North America, Europe and Asia-Pacific regions. Older adults and those with conditions that compromise the immune system have the greatest risk for developing shingles. Nearly all adult Canadians (>90%) have had chickenpox and are therefore at risk for shingles. An estimated 30% will develop shingles in their lifetime and the risk increases to 50% for those who live to 85 years of age. SHINGRIX is currently publicly funded for eligible Canadians through the Ontario shingles immunization program, Yukon shingles immunization program, Veteran Affairs Canada Plan, First Nations Health Authority Plan and Non-Insured Health Benefits Program.
For more information: https://tinyurl.com/2p8mszyz
In a related development the Global Initiative for Chronic Obstructive Lung Disease (GOLD) added a note in their section relevant to shingles vaccination: In adults with COPD the US Centers for Disease Control (CDC) recommends the Tdap vaccination (also called dTaP/dTPa) to protect against pertussis (whooping cough), tetanus and diphtheria, in those who were not vaccinated in adolescence and Zoster vaccine to protect against shingles for adults with COPD aged ≥ 50 years. This is outlined in their Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease 2022 Report. November 2021
For more information: https://goldcopd.org/2022-gold-reports/
New York, NY - Pfizer-BioNTech said that two vaccine doses alone “may not be sufficient to protect against infection” by the Omicron variant but could still protect against severe disease. Pfizer and BioNTech said Wednesday that laboratory tests suggest that three doses of their coronavirus vaccine offer significant protection against the fast-spreading Omicron variant of the virus. The companies said that tests of blood from individuals who received only two doses found more than a 25-fold reduction in antibody levels against the Omicron variant compared to an earlier version of the virus. That finding indicates that two doses alone “may not be sufficient to protect against infection” by the new variant, the companies said. The blood samples obtained from people one month after they had received a booster shot showed neutralizing antibodies against the Omicron variant comparable to the levels of antibodies against a previous version of the virus after two doses, the companies said in a statement. At the same time, the tests suggested that the mutations in Omicron do not appear to significantly affect T cells — another critical part of the immune system’s response. That suggests “vaccinated individuals may still be protected against severe forms of the disease” after only two doses, the companies said. These experiments, done on cells and antibodies in the lab, cannot say for sure how the vaccines will perform in the real world. Vaccines stimulate a wide-ranging immune response that involves more than just antibodies. So, these experiments offer an incomplete picture of how well the vaccine protects against hospitalization or death from Omicron.For more information: https://tinyurl.com/2jp7awus
COVID-19 detected in three Quebec deer
Ottawa, ON - For the first time, the COVID-19 virus has been detected in Canadian wildlife. Environment Canada says the virus was detected late last month in three wild white-tailed deer in Quebec. The department says the deer all appeared healthy and showed no clinical signs of COVID-19. The discovery follows recent reports of the virus spreading among white-tailed deer in the United States. There has so far been no known transmission of COVID-19 from deer to humans and Environment Canada says it remains “largely a disease of human concern and typically spreads from human to human.” Still, until more is known, it says anyone exposed to respiratory tissues and fluids from deer should wear a well-fitting mask and avoid splashing of fluids as much as possible. COVID-19 has infected multiple species of animals, including dogs, cats, farmed mink and zoo animals. But this is the first time in Canada that it has spilled over into wildlife. Deer in the eastern region of Quebec were sampled Nov. 6 to 8. The National Centre for Foreign Animal Disease confirmed the virus in three of them on November 29th. The World Organization for Animal Health was notified on December 1st. “As this is the first detection of SARS-CoV-2 in wildlife in Canada, information on the impacts and spread of the virus in wild deer populations is currently limited,” Environment Canada said in a news release Wednesday. “This finding emphasizes the importance of ongoing surveillance for SARS-CoV-2 in wildlife to increase our understanding about SARS-CoV-2 on the human-animal interface.”
For more information: https://tinyurl.com/4hxjcxat
Scientists warn of new Covid variant with high number of mutations
London, UK - New B.1.1.529 variant was first spotted in Botswana and six cases have been found in South Africa Dr Tom Peacock of Imperial College London said the variant ‘could be of real concern’ but may just be an ‘odd cluster’ Scientists have said a new Covid variant that carries an “extremely high number” of mutations may drive further waves of disease by evading the body’s defences. Only 10 cases in three countries have been confirmed by genomic sequencing, but the variant has sparked serious concern among some researchers because a number of the mutations may help the virus evade immunity. The B.1.1.529 variant has 32 mutations in the spike protein, the part of the virus that most vaccines use to prime the immune system against Covid. Mutations in the spike protein can affect the virus’s ability to infect cells and spread, but also make it harder for immune cells to attack the pathogen. The variant was first spotted in Botswana, where three cases have now been sequenced. Six more have been confirmed in South Africa, and one in Hong Kong in a traveller returning from South Africa. Dr Tom Peacock, a virologist at Imperial College London, posted details of the new variant on a genome-sharing website, noting that the “incredibly high amount of spike mutations suggest this could be of real concern”. In a series of tweets, Peacock said it “very, very much should be monitored due to that horrific spike profile” but added that it may turn out to be an “odd cluster” that is not very transmissible. “I hope that’s the case,” he wrote. Dr Meera Chand, the Covid-19 incident director at the UK Health Security Agency, said that in partnership with scientific bodies around the globe, the agency was constantly monitoring the status of Sars-CoV-2 variants as they emerge and develop worldwide. “As it is in the nature of viruses to mutate often and at random, it is not unusual for small numbers of cases to arise featuring new sets of mutations. Any variants showing evidence of spread are rapidly assessed,” she said. The first cases of the variant were collected in Botswana on 11 November, and the earliest in South Africa was recorded three days later. The case found in Hong Kong was a 36-year-old man who had a negative PCR test before flying from Hong Kong to South Africa, where he stayed from 22 October to 11 November. He tested negative on his return to Hong Kong, but tested positive on 13 November while in quarantine. England no longer has a red list to impose restrictions on travellers arriving from abroad. People who are not fully vaccinated must test negative before flying and arrange two PCR tests on arrival. Those who are fully vaccinated need to have a Covid test within two days of landing. Scientists will be watching the new variant for any sign that it is gaining momentum and spreading more widely. Some virologists in South Africa are already concerned, particularly given the recent rise in cases in Gauteng, an urban area containing Pretoria and Johannesburg, where B.1.1.529 cases have been detected. Ravi Gupta, a professor of clinical microbiology at Cambridge University, said work in his lab found that two of the mutations on B.1.1.529 increased infectivity and reduced antibody recognition. “It does certainly look a significant concern based on the mutations present,” he said. “However, a key property of the virus that is unknown is its infectiousness, as that is what appears to have primarily driven the Delta variant. Immune escape is only part of the picture of what may happen.” Prof Francois Balloux, the director of the UCL Genetics Institute, said the large number of mutations in the variant apparently accumulated in a “single burst”, suggesting it may have evolved during a chronic infection in a person with a weakened immune system, possibly an untreated HIV/Aids patient. “I would definitely expect it to be poorly recognised by neutralising antibodies relative to Alpha or Delta,” he said. “It is difficult to predict how transmissible it may be at this stage. For the time being it should be closely monitored and analysed, but there is no reason to get overly concerned unless it starts going up in frequency in the near future.” The WHO recently named the variant Omicron.
For more information: https://tinyurl.com/yhmyjydu
Growing public health concern of COVID-19 chronic olfactory dysfunction
St. Louis, MO - As the world enters the second year of the COVID-19 pandemic, chronic (i.e. >6 months) olfactory dysfunction (COD) has emerged as one of the symptoms of long-term COVID-19. The loss of olfaction has been associated with decreased general quality of life, impaired food intake, inability to detect harmful gas and smoke, enhanced worries about personal hygiene, diminished social well-being, and the initiation of depressive symptoms. It is believed that no study on long-term COVID-19 olfactory dysfunction (OD) has measured long-term recovery beyond 6 months. Therefore, the rate and trajectory of recovery for COVID-19 COD is not known. The purpose of this a study that was undertaken by researchers at the Washington University in St. Louis was to estimate the scale of the public health concern of COVID-19 COD. The data they used to estimate the number of daily new cases of COVID-19 were publicly available (https://covidtracking.com/data/national). The COVID Tracking Project provides national data for positive cases, which include confirmed and probable cases. A probable case is one that receives a positive test result via antigen without a positive polymerase chain reaction result or other approved nucleic acid amplification test, one with clinical evidence of COVID-19 infection with no confirmatory laboratory testing performed for SARS-CoV-2, or one with COVID-19 listed on the death certificate with no confirmatory laboratory testing performed for SARS-CoV-2. Positive COVID-19 cases that occurred between January 13, 2020, and March 7, 2021, are included in their estimate of COD. A recent meta-analysis reported the incidence of acute COVID-19 OD as 52.7% (95% CI, 29.6%-75.2%). A prospective study reported the recovery rate from OD to be 95.3% (95% CI, 92.6%-98.0%). Based on these 2 studies and the number of daily cases, 3 estimates of the cumulative frequency of COVID-19 COD were created. Analyses were conducted using R, version 3.6.3 (R Foundation). During the COVID-19 pandemic, the mean (SD) number of daily cases was 68,468 (68,682). The incidence of COVID-19 peaked on January 8, 2021, with an estimated 295,121 US individuals receiving a diagnosis of confirmed COVID-19. COD due to SARS-CoV-2 emerged in August 2020, 6 months after the pandemic began (Figure). There was a steady increase in the cumulative number of US individuals with COD through April 2021. Starting in May 2021, the analysis predicted a near exponential increase in the slope of the cumulative number of US individuals with COD through August. Based on intermediate estimates, the number of US individuals expected to develop COD by August 2021 was 712,268. Based on low estimates for each event, the number of US individuals who are expected to develop COD is 170,238, and based on the highest estimate, the number is 1,600,241.
For more information: https://tinyurl.com/jkczku9s
New breath test can identify COVID-19 in critically ill patientsColumbus, OH - Instead of an invasive nasal swab, researchers at The Ohio State University Wexner Medical Center are exploring the use of a unique breath test for the rapid screening of patients for COVID-19. Results from the initial study in patients, published recently in the journal PLOS ONE, found the breath test is highly accurate in identifying COVID-19 infections in critically ill patients. "The gold standard for diagnosis of COVID-19 is a PCR test that requires an uncomfortable nasal swab and time in a lab to process the sample and obtain the results," said Dr. Matthew Exline, lead researcher, director of critical care at Ohio State Wexner Medical Center University Hospital and professor of internal medicine at The Ohio State University College of Medicine. "The breathalyzer test used in our study can detect COVID-19 within seconds." COVID-19 infection produces a distinct breath print from the interaction of oxygen, nitric oxide and ammonia in the body. The breath detector device, developed by Pelagia-Irene Gouma, researcher and professor in the Department of Materials Science and Engineering and the Department of Mechanical and Aerospace Engineering at The Ohio State University and Milutin Stanaćević, associate professor in the Department of Electrical and Computer Engineering at Stony Brook University, can detect the breath print of COVID-19 in exhaled breath within 15 seconds. "This novel breathalyzer technology uses nanosensors to identify and measure specific biomarkers in the breath," said Gouma. "This is the first study to demonstrate the use of a nanosensor breathalyzer system to detect a viral infection from exhaled breath prints." The study followed 46 patients in the intensive care unit with acute respiratory failure that required mechanical ventilation. Half of the patients had an active COVID-19 infection and the remaining half didn't have COVID-19. All patients had a PCR COVID-19 test when they were admitted to the unit. Researchers collected exhaled breath bags from the patients on day 1, 3, 7 and 10 of their inpatient stay. The breath bag samples were tested within 4 hours of sample collection in a lab. The breath print was identified in patients with COVID-19 pneumonia with 88% accuracy upon admission to the ICU. "PCR tests often miss early COVID-19 infections and results can be positive after the infection has resolved," Exline said. "However, this noninvasive breath test technology can pick up early COVID-19 infection within 72 hours of the onset of respiratory failure, allowing us to rapidly screen patients in a single step and exclude those without COVID-19 on mechanical ventilation." The use of breathalyzer technology to rapidly diagnose patients with respiratory infections has the potential to greatly improve the ability to rapidly screen both patients and asymptomatic people. Future studies will look at the use of this technology for less severe COVID-19 patients and will explore whether other diseases and infections could benefit from it. The research team has applied to the U.S. Food and Drug Administration for emergency use authorization of the breathalyzer technology.
US Task Force opposes screening for COPD in people without symptoms
Washington, DC - The U.S. Preventive Services Task Force posted a new draft recommendation in which it continues to recommend against screening for COPD in people without signs or symptoms. This is a D recommendation, according to the USPSTF. This recommendation does not apply to individuals who already have signs and symptoms of COPD, those who were previously diagnosed with COPD or those with disorders that can cause COPD, according to a USPSTF press release. The USPSTF draft recommendation statement and evidence review have been published for public comment on the USPSTF. Comments can be submitted until Dec. 6, 2021. In 2016, the USPSTF reviewed the evidence for COPD screening in asymptomatic individuals and issued a D recommendation, indicating no net benefit. The task force then used a reaffirmation deliberation process and again concluded with moderate certainty that COPD screening in asymptomatic individuals has no net benefit, according to the draft recommendation statement. “Although COPD can eventually lead to serious breathing problems, people without signs or symptoms should not be screened for COPD because it does not improve their health or save lives,” Chien-Wen Tseng, MD, MPH, MSEE, task force member; the Hawaii Medical Service Association endowed chair in health services and quality research; and professor and associate research director in the department of family medicine and community health at the University of Hawaii John S. Burns School of Medicine, said in the release. “Treatment focuses mainly on symptoms, so there is little benefit in screening for COPD in people who do not yet have symptoms.” The task force also posted a draft targeted evidence review. Researchers reviewed MEDLINE, the Cochrane Central Register of Controlled Trials and CINAHL from January 2015 to January 2021 and identified 16 trials published since the USPSTF’s recommendation in 2016. These trials included individuals with mild (FEV1 80% predicted) to moderate (FEV1 50% to 79% predicted) COPD or a mean population FEV1 of 60% or more predicted. No trials examined the effectiveness of screening for COPD on health outcomes. Of the 16, trials, three (n = 20,058) evaluated long-acting beta agonists, long-acting muscarinic antagonists and/or inhaled corticosteroids (ICS) and 13 (n = 3,657) evaluated nonpharmacologic interventions for COPD. The SUMMIT and UPLIFT trials reported that LABA, LAMA, ICS or LABA/ICS treatment reduced exacerbations or clinically important lung deterioration in individuals with symptomatic moderate COPD. In the UPLIFT trial, tiotropium reduced exacerbations in a subgroup analysis of individuals with minimal COPD symptoms. “The findings of this targeted evidence update are generally consistent with the findings of the previous systematic review supporting the 2016 recommendation. To date, there are still no comparative studies on the effectiveness of screening or active case finding for COPD on patient health outcomes. The demonstrated benefits of pharmacologic treatment for COPD are still largely limited to persons with moderate airflow obstruction; and there was no consistent benefit observed for a range of non-pharmacologic interventions in mild to moderate COPD, or in minimally symptomatic persons with COPD,” the authors concluded.
For more information: https://tinyurl.com/69ahbajw
Portable air cleaners may improve respiratory outcomes in former smokers with COPD
Baltimore, MD - Portable air cleaners improved respiratory outcomes among former smokers with COPD, with the greatest benefit found in those with greater adherence and those who spent more time indoors, according to results of the CLEAN AIR STUDY. “Although outdoor air pollution has known adverse respiratory effects, the indoor environment is of particular concern, as most individuals with COPD spend the majority of their time indoors and indoor air particulate matter concentrations in homes of former smokers with COPD have been associated with worse respiratory symptoms, worse quality of life and increased respiratory exacerbations,” Nadia N. Hansel, MD, MPH, professor of medicine at Johns Hopkins University School of Medicine and from the department of environmental health and engineering at Johns Hopkins Bloomberg School of Public Health, and colleagues wrote. The randomized controlled CLEAN AIR STUDY included 116 former smokers with moderate to severe COPD (mean age, 65.7 years; 51.7% women; 84.5% completed the study). All participants were randomly assigned to use an active portable high-efficiency particulate air (HEPA) cleaner (n = 58; Austin Air Cleaners) or a sham device that had internal HEPA and carbon filters removed (n = 58). Participants were asked to place the air cleaner in their bedroom and other room they reported spending the most time. Follow-up was 6 months. The intention-to-treat analysis included all participants, and the per-protocol analysis included participants with at least 80% adherence. “Portable air cleaner intervention strategies are practical and easily implemented by individuals at the household level, and improve respiratory symptoms in other chronic respiratory diseases, including in children with asthma; however, such intervention studies have not been conducted in COPD and it is unknown whether use of portable air cleaners in homes of individuals with COPD can reduce indoor pollutants and improve COPD outcomes,” the researchers wrote. The primary outcome was change in Saint George’s Respiratory Questionnaire (SGRQ) at 6 months. The researchers reported no significant difference in total SGRQ score in either group, but the active air cleaner group had a greater reduction in SGRQ symptom subscale (beta = –7.7; 95% CI, –15 to –0.37) and respiratory symptoms (beta = –0.8; 95% CI, –1.5 to –0.1) compared with the sham air cleaner group. At 6 months, there was no significant difference in the primary outcome between the two groups (SGRQ, –1.55; 95% CI, –5.75 to 2.65; P = .46) in the intention-to-treat analysis. In addition, compared with the sham air cleaner group, the active group had lower rates of moderate COPD exacerbations (incidence rate ratio [IRR] = 0.32; 95% CI, 0.12-0.91) and rescue medication use (IRR = 0.54; 95% CI, 0.33-0.86). In the per-protocol analysis, the researchers reported a significant difference in the 6-month change in SGRQ in the active air cleaner group compared with the sham group (beta = –4.76; 95% CI, –9.2 to –0.34). There were also significant differences in risk for moderate COPD exacerbations (beta = –0.51; 95% CI, –3.03 to –2), Breathlessness, Cough and Sputum Scale (beta = –0.81; 95% CI, –1.53 to –0.09) and 6-minute walk distance (beta = 54.5 m; 95% CI, –16.8 to 125.9). Participants in the active air cleaner group who spent more time indoors were most likely to experience a treatment benefit from the HEPA air cleaners, with a greater improvement in SGRQ (–6.8; 95% CI, –12.55 to –1.06; P = .021), risk for COPD exacerbations (–3.92; 95% CI, –7.22 to –0.49; P = .023) and Breathlessness, Cough and Sputum Scale (–1.86; 95% CI, –2.82 to –0.9; P < .001) compared with the sham group. “Though the study did not reach statistical significance for the primary outcome in intention-to-treat analysis, portable HEPA air cleaner use improved several respiratory outcomes, particularly among those with greater than 80% compliance with the air cleaner, and those that spent a larger portion of their time in their home,” the researchers wrote. “Interventions that improve air quality represent a potentially novel approach to reducing respiratory morbidity in patients with COPD and persistent respiratory symptoms and exacerbation risk despite smoking cessation. Further, given that environmental exposures contribute to a large proportion of COPD burden worldwide, the study may have broad implications.”
For more information: https://tinyurl.com/yr36t3ed
Quitting Smoking Tied to Slower Motor Decline in Multiple Sclerosis
Swansea, Wales - Smoking was linked with worse motor disability in people with multiple sclerosis (MS), but quitting smoking appeared to ameliorate that. In a large observational study of people with confirmed MS, current smoking was tied to shorter times to worsening in motor skills, walking ability, anxiety, and depression, said Jeff Rodgers, PhD, of Swansea University in Wales, in a presentation at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress. "Smoking causes real disability progression and mood worsening in people with MS," Rodgers said. "But when you stop smoking, that worsening stops as well." The research, published in Brain, showed that quitting smoking led to a slower motor disability deterioration rate so that it matched the rate of motor decline in people who had never smoked. While the negative effect of smoking in MS has been well established, there's less evidence about whether stopping smoking is beneficial to MS progression, the researchers said. Rodgers and colleagues evaluated data from 2011 to 2020 for 7,983 people with confirmed MS in the U.K. MS Register, an online registry in which participants enter data regularly. For this study, the researchers focused on three patient-reported outcomes: the MS Physical Impact Scale (MSIS-29-Phys), a measure of motor skills; the MS Walking Scale (MSWS-12), a measure of walking ability; and the Hospital Anxiety and Depression Scale (HADS-Anxiety and HADS-Depression). Smoking status was confirmed against clinical records. For time-to-event analysis, primary outcomes were a clinically significant 10-point increase in the MSIS-29-Phys or MSWS-12 score, or a 2-point increase in the HADS-anxiety and HADS-Depression score. A total of 4,130 people in the study had smoked, including 1,315 current smokers and 2,815 former smokers. At baseline, former smokers were older (mean age about 51) than current smokers (mean age about 45), and were more likely to have a progressive diagnosis. Never smokers were more likely to be women and more likely to be using disease-modifying treatment. At the time of completing their first questionnaire, current smokers had higher scores indicating higher disability compared with people who had never smoked: approximately 10 points difference in MSIS-29-Phys and MSWS-12, and 1.5-1.8 point difference in HADS-anxiety and HADS-depression. Among 923 participants followed prospectively, MSIS-29-Phy, MSWS-12, and HADS-Depression scores worsened over 4 years, while HADS-Anxiety remained stable. At year 4, current smokers had higher a MSIS-29-Phys score (3.05) while former smokers had lower a MSIS-29-Phys score (-2.91). Current smokers also had higher HADS-Anxiety scores at year 4. Of 4,642 participants in the time-to-event analysis, current smoking was associated with a shorter time to worsening in all outcomes: MSIS-29-Phys (P=0.0013), MSWS-12 (P=0.0061), HADS-Anxiety (P=0.0017), and HADS-Depression (P<0.0001). Worsening in motor disability -- MSIS-29-Phys and MSWS-12 scores -- was independent of baseline HADS-Anxiety and HADS-Depression scores. There was no statistically significant difference in the rate of worsening between never smokers and former smokers. One limitation of the analysis was that the U.K. MS Register uses self-reported data. As an observational study, causality could not be established. Selection bias may have occurred and reverse confounding may have been a factor in some patient-reported outcomes.
For more information: https://tinyurl.com/25j5wwma
Claims E-cigarettes Are a Harm Reduction Tool Unproven
New York, NY - “The American Thoracic Society reiterates our long-held position – e-cigarettes are not ‘safe’ and the claims that e-cigarettes are a harm reduction tool remain unproven. All e-cigarettes have significant health risks including nicotine addiction and respiratory disease,” said ATS President Lynn Schnapp, MD, ATSF. The ATS notes that the FDA has finally issued decisions on e-cigarette products that constitute a large share of the e-cigarette market. This is an important step by the FDA to finally reign in the U.S. e-cigarette marketplace. We are concerned that the agency has approved Vuse products with high nicotine concentration. While we appreciate that the FDA rejected RJR/Vuse application for flavored e-cigarette products, we note with concern that the agency has not yet rejected the Vuse application for menthol e-cigarette products. The presence of any flavored e-cigarette product poses an unacceptable risk to our nation’s youth. The ATS calls on the FDA to protect our nation’s youth by rejecting all flavored e-cigarette products – including menthol flavored e-cigarettes.
For more information: https://tinyurl.com/m7n9hzkx
This year’s flu season concerns
Marina del Rey, CA – “We did not see one flu case at Cedars-Sinai last year, which is unheard of. That was because everyone was masking, socially distancing, being very conscious of hand hygiene, and really trying to isolate if they were sick," said infectious disease specialist Soniya Gandhi, MD, vice president of Medical Affairs and associate chief medical officer at Cedars-Sinai. Now, as more people are mixing again in social situations and many kids are heading back to the classroom, some experts believe that the flu could come roaring back this fall. "We're in uncharted territory," Gandhi said. "It's possible that due to the relaxing of COVID-19 safety measures and with not enough public immunity to the flu because few people were exposed to it last year, we may be in for a more severe flu season. Because the symptoms of COVID-19 and the flu are so similar, it will be critical to get tested if you become sick." Gandhi spoke with the Cedars-Sinai Newsroom to explain why it's important to determine which illness you might have and to answer common questions about how to navigate this unprecedented flu season. Newsroom: Is there a way to tell if you have COVID-19 or the flu without getting tested? Gandhi: There is no reliable way from a symptom standpoint to assess whether or not you have COVID-19 versus the flu. Loss of taste and smell is associated with COVID-19. And symptoms like nausea, vomiting and diarrhea tend to be associated with COVID-19, unless you're a child, in which case the gastrointestinal symptoms are more common with the flu. But because the flu and COVID-19 are both respiratory illnesses and their symptoms really overlap, the only way to distinguish between the two is to get tested. We learned last year that continuing to mask, maintaining physical distance, self-isolating if you're sick, observing good hand hygiene, and covering coughs and sneezes are all important. But most important, get the flu shot and get vaccinated against COVID-19. To read the complete interview click on the link below.
For more information: https://tinyurl.com/w87n2f3f
Official launch of the first European Long COVID patient network
Heverlee, Belgium - More than 20 Long COVID patient associations from 17 different European countries officially launched Long COVID Europe (LCE), a network run by Long COVID patient organisations. Across Europe, patients are struggling with the same issues; lack of awareness and recognition of Long COVID, inadequate and unequal access to care and rehabilitation, and a severe shortage of funding for research into therapeutic approaches. LCE addresses these issues by sharing resources with its members, jointly calling on governments to recognise Long COVID as a public health crisis within and beyond the COVID-19 pandemic. Globally, more than 230 million people have already tested positive for SARS-CoV-2. In reality, many more have been infected. It is estimated that at least 10% of those infected continue to experience severely debilitating symptoms for longer than six months, ranging from post-viral fatigue and post-exertional symptom exacerbation to neuro-cognitive deficits, nervous system dysfunction, and chronic pain. For some patients, Long COVID also entails damage to vital organs. The World Health Organization (WHO) is due to publish the first clinical definition of Long COVID - referred to as the Post-Acute Sequelae of SARS-CoV-2 (PASC) - at the third WHO webinar on "Expanding our understanding of post COVID-19" on 6 October: https://www.who.int/news-room/events/detail/2021/10/06/default-calendar/expanding-ourunderstanding- of-post-covid-19-condition-web-series-rehabilitation-care. In the meantime, patient associations are continuing to fight for the recognition of Long COVID as a physiological medical condition. Funding for research into the disease mechanisms and targeted treatments by governments remains scarce, and the establishment of safe and universally available rehabilitation approaches is urgently needed. Thanks to the efforts of patient advocacy groups in the United Kingdom (UK), the UK government developed an initial five-step plan during the summer of 2020. This has since been updated and includes, amongst other initiatives, establishing more than 80 Long COVID clinics. In other countries, such as Greece and Hungary, governments have yet to acknowledge the extent and severity of Long COVID and its implications for citizens affected. Moving forward, LCE seeks to address the inequality and lack of management in its member countries and to pave the road for improved and adequate care for all Long COVID patients within the 53 countries in the WHO Europe region. LCE is a registered non-profit organization in Belgium.
For more information: To contact LCE, please reach out via Mail to firstname.lastname@example.org or contact Chantal Britt (German, English, French: +41 76 588 0824) or Ann Li (Dutch, English, German: +32 494 435 879).
Research team finds potential cause of COVID-19 'long-haulers'
Little Rock, Arkansas - A UAMS research team has identified a potential cause of long-lasting symptoms experienced by COVID-19 patients, often referred to as long-haulers. The findings were published in the journal PLOS ONE. At the heart of the team's findings is an antibody that shows up weeks after an initial infection and attacks and disrupts a key regulator of the immune system, said lead researcher John Arthur, MD, PhD, professor and chief of the Division of Nephrology in the UAMS College of Medicine, Department of Internal Medicine. As many as 30% of COVID-19 patients experience lingering fatigue, brain fog and shortness of breath. The cause of long COVID-19 has eluded scientists, but the UAMS team's discovery sheds important new light on the molecular-level mechanisms behind it. "Everything that we've found is consistent with this antibody as the instigator of long COVID, so it's an exciting development that merits further study," Arthur said. The antibody creates problems for the immune system by attacking the angiotensin-converting enzyme 2 (ACE2). The ACE2 enzyme helps regulate the body's response to the virus by metabolizing a peptide that activates the immune system. The attacking antibody interferes with ACE2's work, which makes the antibody a prime suspect for the long-lasting illness. The research team was brought together quickly this spring by the UAMS Translational Research Institute to test the hypothesis that developed through discussions between Arthur and UAMS' Terry Harville, MD, PhD, a professor in the Department of Pathology and medical director of the Histocompatibility and Immunogenetics Laboratories. Researchers Karl Boehme, PhD, Craig Forrest, PhD, and Shana Owens, PhD, in the Department of Microbiology and Immunology developed the assay (test) used to identify the two antibodies. Researchers tested plasma or serum for ACE2 antibodies in 67 patients with known SARS-CoV-2 (the virus that causes COVID-19) infection and 13 with no history of infection. In 81% of blood samples from patients in Arkansas and Oklahoma with a history of COVID-19, the samples had the antibody that attacked the ACE2. In participants with no history of COVID-19, no antibodies were created to attack the ACE2 enzyme. "If we show that the whole hypothesis is right, that this interference of ACE2 really does cause long COVID, then it opens up many potential treatments," Arthur said. "If our next steps confirm that this antibody is the cause of long COVID symptoms, there are medications that should work to treat them. If we get to that phase of research, the next step would be to test these drugs and hopefully relieve people of the symptoms they're having." The multidisciplinary team also includes College of Medicine researchers Christian Herzog, PhD, Department of Internal Medicine; Josh Kennedy, MD, Department of Pediatrics; and Juan Liu, PhD, from the Department of Pathology. "This is true team science," Arthur said. "We put together a great group of investigators that had never worked together to produce these very exciting results."
For more information: tinyurl.com/4e7spr58
Small airway dysfunction highly prevalent in China
Beijing, China - Spirometry-defined small airway dysfunction is prevalent among adults in China, and cigarette smoking, air pollution exposure and higher BMI are preventable risk factors, according to a study published in The Lancet Respiratory Medicine. “Our study shows that over 40% of Chinese adults aged 20 years and older had spirometry-defined small airway dysfunction, with cigarette smoking as a major preventable risk factor along with [fine particulate matter] exposure and increase of BMI,” Dan Xiao, MD, with the Tobacco Medicine and Tobacco Cessation Center and China-Japan Friendship Hospital, Beijing, and colleagues wrote. Researchers with the China Pulmonary Health Study Group analyzed 50,479 participants (mean age, 49.3 years; 58% women) with valid lung function testing results from June 2012 to May 2015. Diagnosis of small airway dysfunction was defined as presence of two of the following three indicators of lung function less than 65% predicted: maximal mid-expiratory flow, forced expiratory flow 50% and forced expiratory flow 75%. The prevalence of small airway dysfunction was 43.5% (95% CI, 40.7-46.3). Categorized further, 25.5% (95% CI, 23.6-27.5) had pre-small airway dysfunction, defined as normal FEV1 and FEV1/FVC ratio before bronchodilator inhalation, and 11.3% (95% CI, 10.3-12.5) had post-small airway dysfunction, defined as normal FEV1 and FEV1/FVC ratio before and after bronchodilator inhalation. The prevalence of small airway dysfunction was 51.2% among ever smokers, 45.1% among never smokers, 49.9% among current smokers and 56.5% among former smokers. The researchers identified age, gender, urbanization, education, smoking, air pollution exposure, history of chronic cough, pneumonia or bronchitis in childhood, parental history of respiratory diseases and increased BMI as significant risk factors for small airway dysfunction, according to logistic regression analysis. Among those with post-small airway dysfunction, the largest effect was observed in individuals who smoked and had air pollution exposure more than 50 g/m3 (adjusted OR = 1.45; 95% CI, 1.23-1.72) for the entire population and (aOR = 2.09; 95% CI, 1.38-3.16) for men. The researchers observed a dose-response association between cigarette smoking and post-small airway dysfunction among men, but not women. Xiao and colleagues estimated that, in 2015, 426 million individuals in China had small airway dysfunction, 253 million had pre-small airway dysfunction and 111 million had post-small airway dysfunction. “Our study further emphasizes the importance of implementation of comprehensive tobacco control for early lung care,” the researchers wrote. “Given that small airway dysfunction has been neglected as an important health issue globally, we call for global joint efforts on research, prevention, detection and management of the disease as a way of preventing early lung damage and injury.”For more information: https://tinyurl.com/3k2nxve5
Increasing temperatures linked to worsening COPD symptoms
Barcelona, Spain - Warmer weather was associated with worsening COPD symptoms, as early as 2 days after a rise in ambient temperature, in adults with COPD, according to new data presented at the virtual European Respiratory Society International Congress. “With increasing temperatures worldwide due to the ongoing climate crisis, the risks of increased morbidity are not equally distributed among all patient groups,” Supaksh Gupta, MD, pulmonary and critical care fellow at the University of Washington, Seattle, told Healio. “Individuals living with COPD may be one such subset of patients at increased risk due to the warming climate.” Data were derived from Gupta S, et al. Abstract OA103. Presented at: European Respiratory Society International Congress; Sept. 5-8, 2021 (virtual meeting). Gupta and colleagues conducted a time-stratified case-crossover analysis that evaluated 1,177 current and former smokers (mean age, 63.7 years; mean time to first exacerbation, 603 days) from the SPIROMICS cohort from 2010 to 2015. All participants had at least one COPD exacerbation. Researchers assessed COPD exacerbation risk based on local ambient temperatures that were measured on the day of exacerbation and in the preceding 7 days. Risk for COPD exacerbations increased with rising temperatures in the preceding 6 days. According to the researchers, the observed risk for exacerbation peaked at 2 days after temperatures rose. When researchers controlled for relative humidity during the study period, every 1°C increase in ambient temperature was associated with a 2% increase in odds of COPD exacerbation 2 days following increased temperatures (P = .002) “Existing data suggested that extremes of temperature, both hot and cold, as well as heat waves, were associated with an increased risk of exacerbations in individuals with COPD. It was surprising to us to see smaller increases in temperature, that were not necessarily outside of normally expected values, also appear to be associated with an increased risk of morbidity in COPD patients,” Gupta told Healio. The mechanisms underlying the link between temperature and COPD exacerbations are not fully understood, but may include hyperventilation, which can lead to increased pressure in the chest cavity and a subsequent decrease in blood flow back to the heart, according to an ERS press release. “Further research is warranted to better characterize the degree of risk in individuals with COPD based on various climate change-related exposures, along with an evaluation of potential protective factors that may mitigate those risks,” Gupta told Healio. “With the increasing frequency of wildfires due to the ongoing climate crisis, it will also be important to better understand the impact these fires and their smoke have upon respiratory health in individuals with preexisting lung diseases.”For more information: https://tinyurl.com/587bkwdm
Israel planning to administer forth Covid vaccine shot
Tel Aviv, Israel - The country's national coronavirus czar says people should expect to receive a new vaccination against the virus more frequently - 'every five to six months'. Israel expected to give out vaccines that have been specially adapted to cope with different variants of the coronavirus by late 2021 or early 2022, he says. Israel is set to begin preparations to administer fourth doses of the coronavirus vaccines as the country deals with soaring cases despite its trail-blazing roll-out of jabs. The country's national coronavirus czar Salman Zarka said the country needs to prepare for a fourth injection, which could be modified to better protect against new variants of the virus. 'Given that that the virus is here and will continue to be here, we also need to prepare for a fourth injection,' he told Kan public radio. 'This is our life from now on, in waves.' Last month, he told The Times of Israel that people should expect to receive more vaccines to deal with new variants. 'It seems that if we learn the lessons from the fourth wave, we must consider the [possibility of subsequent] waves with the new variants, such as the new one from South America,' he said at the time. 'Thinking about this and the waning of the vaccines and the antibodies, it seems every few months — it could be once a year or five or six months — we'll need another shot.' He added that he expects Israel to be given out vaccines that had been specially adapted to cope with different variants of the virus by late 2021 or early 2022. While Israel is seeing record case numbers in its fourth wave, the jabs are still protecting against severe illness with Covid deaths running at about half of the level of its second wave. Stats compiled by Oxford University-backed research team Our World in Data shows there were a record 1,892 Covid cases per million people in Israel on Wednesday — nearly 0.2 per cent of the entire population in a single day. That was significantly higher than second worst-hit Mongolia, where the rate was 1,119 per million, and double the figures for Kosovo (980), Georgia (976) and Montenegro (909), which rounded out the top five. Israel has become the Covid capital of the world just months after leading the charge on vaccines, according to data that shows jab protection is waning.
For more information: https://tinyurl.com/2nkk4bzs
Surge in smoking among young adults during lockdown
London, UK - The number of 18 – 34 year-olds who smoke increased by 25% in England during the first lockdown, according to a new study led by UCL researchers. This means that over 652,000 more young adults smoke, compared to before the pandemic. The study, published today in the journal Addiction and funded by Cancer Research UK, found that over 4.5 million more adults would be classed as high-risk drinkers during the same period as the number rose by 40%. But this trend was particularly worrying in women (up 55%) as well as people from lower socioeconomic groups (up 64%). Though existing heavy drinkers did make attempts to cut down, this was only observed in adults from higher socioeconomic groups, suggesting that if trends continue, health inequalities linked to alcohol could worsen. There were increases in the number of existing smokers quitting successfully, and overall levels of smoking in adults remains stable. However, the increased number of young adults who smoke means that, for the Government to deliver its goal for England to become smoke-free by 2030, smokers would need to quit at a rate of around 40% faster than predicted. While the study doesn't explain why these changes occurred, the researchers noted that people from lower income backgrounds, younger adults, and women are among those who have been disproportionately affected by the pandemic. Given that many people mistakenly believe that smoking and drinking help relieve stress, they suggest it's possible that some may have taken up these up for the first time or relapsed to help them cope. Smoking is the biggest preventable cause of cancer—it is known to cause at least 15 different cancer types—while drinking even small amounts of alcohol increases the risk of seven different types of cancer. Lead author Dr. Sarah Jackson (UCL Institute of Epidemiology & Health) said: "The first lockdown was unprecedented in the way it changed people's day-to-day lives. We found that many smokers took this opportunity to stop smoking, which is fantastic. However, the first lockdown was also a period of great stress for many people, and we saw rates of smoking and risky drinking increase among groups hardest hit by the pandemic. "It will be important to keep a close eye on how these increases in smoking and drinking develop over time to ensure appropriate support is made accessible for anyone who needs it." Michelle Mitchell, Cancer Research UK's chief executive, said: "There's no 'safe' level of smoking or drinking, and stopping smoking or cutting down drinking will help to reduce your risk of cancer. "Public health campaigns and prevention services have a vital role to play in helping people to quit and also maintaining the motivation of those who have already made positive changes. The upcoming tobacco control plan for England is a key opportunity for the Government to reduce smoking rates, but this can only be achieved with sufficient investment. "A Smokefree Fund—using tobacco industry funds, but without industry interference—could pay for the comprehensive measures needed to prevent people from starting to smoke and helping those who do, to quit." The Addiction study also involved researchers from the University of Sheffield. Cancer Research UK extrapolations comparing smoking prevalence of in 18–34 year olds in England 21.5% before lockdown (August 2019–February 2020) to 26.8% during the first lockdown (April 2020–July 2020) and using ONS mid-year population estimates for 2020 to estimate the number of people this represents. This includes those taking up smoking for the first time and those who have relapsed after not smoking for at least a year. Cancer Research UK estimates that around 3,300,000 18–34 year olds in England were classed as smokers during the first lockdown in April 2020–July 2020. Comparing high-risk drinking prevalence of all adults in England of 25.8% August 2019–February 2020 to 36% in April 2020–July 2020 and using ONS mid-year population estimates for 2020 to estimate the number of people this represents.
For more information: https://tinyurl.com/5frvkjma
Toronto, ON - Unvaccinated employees at the University Health Network could be forced to take a leave of absence during the fourth wave of COVID-19, as the health system considers new measures to convince vaccine-resistant workers to take the shot. The change in strategy comes after Ontario Premier Doug Ford authorized a new health directive impacting thousands of employees in health care and education, requiring proof of vaccination, a medical reason for remaining unvaccinated, or mandatory COVID-19 testing to weed out the virus. Ontario's Chief Medical Officer of Health Dr. Kieran Moore indicated the new rules – set to take effect on Sept. 7 – were a baseline and gave hospitals and other public sector employers the power the go further in order to drive up vaccine uptake. Kevin Smith, the health network's CEO, says roughly 950 employees – eight per cent of the workforce –remains unvaccinated and could be offered a stark choice in the coming weeks. "We have to insist that people actually participate in a vaccine program, or think about taking a leave of absence," Smith told CTV News Toronto. UHN was among the first employers in Ontario to require unvaccinated individuals to submit to regular COVID-19 testing before arriving for work, a policy that quickly boosted vaccination rates since it took effect in early august. Smith said the vaccine uptake rose from 85 per cent in late July to the current rate of 92 per cent of employees vaccinated against COVID-19. The remaining 950 employees entered into a "swabbing program" with regular testing up to 48 hours before their shift. While Smith said the first phase of the jab or swab program has been a "remarkable success" they encountered a small group of unvaccinated employees who refused to be regularly tested – leading to tough talk from hospital officials. "There was a very small number of people who said I don't want to test. And we said that that's really not an option," Smith said. The hospital went further and gave employees who resisted the hospital's rules a cooling off period from work. “We had very frank dialogues with [them] and said ... here's a couple of weeks off for you to consider whether that's really your position that you don't wish to comply with the hospital's policies. Happy to say we now have 100 per cent compliance," Smith said. The success of that hard lined approach, combined with new provincial guidelines, convinced UHN to take a second look at their minimum standards for employment, including asking unvaccinated employees to work from home or take a leave of absence. While Smith said UHN would "love to avoid termination wherever possible" it could be a last resort option if all other efforts fail the convince employees of the benefits of the vaccine. "The needs of the patient comes first. That at times will require us to make very difficult decisions by always in the best interests of patients," Smith said. "These need to be the safest possible environments for patients, families and our at-risk staff."
For more information: https://tinyurl.com/bhrujc9d
American Lung Association requires COVID-19 vaccine for all employees
Chicago, IL - In response to the growing need to increase vaccination rates, American Lung Association National President and CEO Harold P. Wimmer issued the following statement: “The American Lung Association is requiring all employees to be fully vaccinated against COVID-19 before reconvening in the workplace. And we are encouraging other for profit and nonprofit organizations to make this a requirement as well. We are aligned with the President’s statement earlier today urging a vaccine requirement for businesses in an effort to protect public health. “Vaccines in the United States are highly effective, including against the Delta variant, which is nearly twice as contagious as previous variants. Unvaccinated people are much more likely to contract the virus and are at the greatest risk for hospitalization and death. “As the leading non-profit organization advocating for lung health, the American Lung Association has been on the frontlines of the COVID pandemic. The availability of safe and effective COVID-19 vaccines offers an opportunity to end the pandemic and save lives. “To date, more than 61% of adults in the United States have been fully vaccinated. While this number is encouraging, our work is not finished yet. With more employers and organizations requiring vaccinations, we will continue to see vaccination rates increase, which will protect public health and help everyone get back to what they love."
For more information: https://tinyurl.com/35tsartv
Perioperative LAMA/LABA inhaled therapy optimal for patients with lung cancer, COPD
Tokyo, Japan - Perioperative combination therapy using a long-acting muscarinic antagonist and long-acting beta agonist may be an optimal treatment for patients with lung cancer and COPD undergoing cancer for lung surgery, researchers reported. “Because the prognosis of patients with lung cancer complicated by COPD is reportedly poor, it is important to provide respiratory care for an extended duration, not just during the perioperative period,” Yoko Azuma, MD, assistant professor in the division of chest surgery at Toho University School of Medicine, Tokyo, Japan, and colleagues wrote in BMC Pulmonary Medicine. “The aim of this study [was] to determine the effects of perioperative LAMA/LABA therapy on perioperative lung function, postoperative morbidity and mortality, and long-term prognosis for patients with COPD and lung cancer.” Researchers conducted a retrospective review of medical records of 130 consecutive patients who were newly diagnosed with COPD and underwent lung cancer surgery from January 2005 to October 2019. All patients received perioperative rehabilitation before being categorized into groups according to the type of perioperative inhaled therapy and management used: 64 patients received combination LAMA/LABA, 23 patients received LAMA only and 43 received rehabilitation only. The researchers reported that values for FEV1 and FEV1 percent predicted were significantly improved among patients who received preoperative LAMA/LABA therapy before lung cancer surgery (P < .001 for both). Lung function was significantly improved with LAMA/LABA therapy compared with patients receiving preoperative LAMA therapy (FEV1, 223.1 mL vs. 130 mL; FEV1 percent predicted, 10.8% vs. 6.8%).Patients who received LAMA/LABA had a lower frequency of postoperative complications compared with patients who received LAMA only (P = .007). Those who received LAMA/LABA had lower rates of any complications (21.9% vs. 52.2%), pneumonia (10.9% vs. 26.1%), acute respiratory failure (1.6% vs. 8.7%), prolonged air leakage (9.4% vs. 21.7%) and atrial fibrillation (6.3% vs. 8.7%). Compared with patients who received LAMA only or rehabilitation only, of the 61 patients with moderate-to-severe air flow limitation, those who received LAMA/LABA therapy had significantly longer overall survival (P = .049 and P = .001) and disease-free (P = .026 and P < .001) survival. Researchers also observed an association between lower recurrence rates and perioperative LAMA/LABA therapy compared with LAMA only (P = .006) and rehabilitation only (P = .008). “Our data demonstrate that LAMA/LABA therapy improves not only short-term outcomes such as respiratory function and postoperative complications, but also long-term prognosis in patients with lung cancer and COPD,” the Azuma and colleagues wrote. “Perioperative combined LAMA/LABA therapy is the optimal bronchodilator for patients with COPD who require surgery for lung cancer.”
For more information: https://tinyurl.com/ra8rfd72
Researchers to study COVID-19 vaccine efficacy and safety in transplant patients
Montreal, PQ - A national research study has just launched to investigate the effectiveness and safety of COVID-19 vaccines in transplant recipients. The Government of Canada, through its COVID-19 Immunity Task Force (CITF) and Vaccine Surveillance Reference Group (VSRG), is investing over $2.84 million in this research study, based at University Health Network and called PREVenT COVID, short for Prospective Evaluation of COVID-19 Vaccine in Transplant Recipients: A National Strategy. “Because people who have received a solid organ transplant and other immunosuppressed individuals, are generally excluded from clinical trials of vaccines, little data exists to guide clinical best practices for these populations,” says Dr. Deepali Kumar, project lead, Clinician Investigator at the Toronto General Hospital Research Institute and Director of Transplant Infectious Diseases at the Ajmera Transplant Centre. “Our research will address this knowledge gap by revealing how transplant recipients—who are on immune-suppressing medications to prevent organ rejection—respond to COVID-19 vaccines. We will compare their immune responses to non-transplanted individuals as well as those who have contracted COVID-19.” With this funding, Dr. Kumar’s team will launch this study across multiple transplant centres to examine short- and long-term antibody responses in transplant recipients following first and second doses of COVID-19 vaccines. The team will compare these responses to those of healthy individuals who have not undergone transplant and those of transplant recipients who naturally contracted COVID-19. The team will also assess the short- and long-term safety profile of vaccines in transplant recipients, tracking the rates of local and systemic reactions, organ rejection and other transplant complications. “People who have received an organ or stem cell transplant may have unique immunization needs. For example, we do not know whether the effectiveness of vaccines differs depending on the timing of immunization relative to transplant,” explains Dr. Kumar. The researchers will then develop a national COVID-19 vaccination safety surveillance system for transplant recipients. This system will build upon the Canadian National Vaccine Safety Network, an ongoing Canada-wide vaccine safety surveillance initiative. “Our goal is to help coordinate the efforts of provincial and national organizations that are involved in public health and vaccination research and facilitate information sharing among public health agencies and patient partners,” says Dr. Kumar. “This research will build on Canada’s leadership in transplant medicine and inform health policy to best protect transplant recipients from COVID-19.” COVID-19 vaccination remains one of the most effective ways to protect ourselves and others from COVID-19. This is why vaccination is important for the general population around immunosuppressed individuals who may have a reduced immune response to any authorized COVID-19 vaccine series. “It is imperative that we study the immune response and safety of vaccines not only in the general population, but in populations with specific health issues, such as persons having received organ transplants,” says Scott Halperin, Co-Chair of the Vaccine Surveillance Reference Group. “We need to ensure that vaccines are working in vulnerable Canadians: studies like this will help to inform us whether a booster dose is needed in this specific population.”
For more information: https://tinyurl.com/hheytxj4
UHN to implement mandatory COVID-19 home testing for unvaccinated staff
Toronto, ON - Ontario’s largest hospital network will require mandatory and frequent testing for any staff who choose not to be vaccinated against COVID-19 according to a recent article in The Toronto Star. The University Health Network, which includes Toronto General Hospital and Toronto Western Hospital among others, will be the first major hospital and research organization in Ontario to create requirements around immunization for health-care workers. The move comes as multiple countries have already made vaccination mandatory for health-care staff amid the rise of the fast-spreading Delta variant. And with fears of a fourth wave, Ontario’s lack of mandatory immunization policy has led some businesses and institutions to make their own policies. The UHN is aiming to implement new rules that will create testing requirements for unvaccinated staff in their network by Aug. 9. In an email to the Star, the UHN said it started communicating its new policy to staff at the end of June, so all employees, full-time, part-time or casual, would be well aware by the time it is enforced. “We are implementing this to keep patients and staff as safe as we possibly can. The best protection for anyone is double vaccination, which has been made available to all employees of UHN,” said Gillian Howard, a spokesperson for UHN. Once the policy is in place, staff must report whether they are vaccinated, whether they can’t be vaccinated due to a valid medical reason and provide documentation, whether they do not wish to report vaccination status, or whether they are choosing not to be vaccinated. All who are unvaccinated must complete rapid home COVID-19 tests 48 hours prior to their shifts, which amounts to about three times a week, said Howard. Those who are not reporting their vaccination status or choosing not to be vaccinated must complete an education module about the vaccine. About 18,000 UHN staff had already reported their vaccination status, as of July 12, and 750 home test kits were distributed, according to the UHN. The vaccination rate for full-time staff is now at 85 and 90 per cent, Howard said. “We are now working on ensuring that part-time and casual staff are aware of the reporting requirement,” she added. Last week, Ontario Premier Doug Ford said he did not support proof of immunization in any context. Ford said no one should be “forced” to get their shot. His comments came as multiple countries, including France and Italy, have implemented mandatory vaccination policies for those working in health care. France also introduced a COVID-19 health pass Wednesday as infections have surged as the country contends with a fourth wave of the virus. The pass requires a recent negative COVID-19 test or proof of vaccination in order to visit cultural centres, museums, sports venues and movie theatres. The Delta variant has continued to spread across Europe. There are concerns the same could happen in Canada if hundreds of thousands of people remain unvaccinated, despite the availability of an abundance of the vaccine.
For more information: https://tinyurl.com/dp4sucu6
Study identifies strategies for rapid access rehab program success post-COPD hospitalization
Toronto, ON - A new study published in Respiratory Medicine identified approaches for success in establishing a rapid access rehabilitation program following hospitalization for acute exacerbations of COPD. “Considering the demonstrated benefits of early post-acute exacerbation of COPD rehabilitation and the limited access to conventional programs, there is increasing interest in the provision of a rapid access rehabilitation program,” Ana Oliveira, PhD, researcher at the School of Rehabilitation Science at McMaster University, Hamilton, and West Park Healthcare Centre, Toronto, and the Respiratory Research and Rehabilitation Laboratory in the School of Health Sciences and the Institute of Biomedicine at the University of Aveiro in Portugal, and colleagues wrote. “The rapid access rehabilitation program accepts patients within 48 hours of their discharge from hospital to provide a bridge from the peri-exacerbation period to enrollment in a conventional pulmonary rehabilitation program.” Researchers conducted semi-structured interviews using phone calls with three patients recently hospitalized for acute exacerbations of COPD, 10 health care professionals and three policymakers who provided care for these patients from September to December 2020. All of those interviewed shared similar visions for the essential elements and approaches of a rapid access rehabilitation program, according to the researchers. The interviews led to the following themes for the development of a rapid access rehabilitation program: pre-rapid access rehabilitation aspects (management properties, eligibility); rapid access rehabilitation program (outcomes, structure, components); rapid access rehabilitation optimization (referral, uptake); partnership (collaboration, dedicated coordinator); and COVID-19 adaptations. In addition, patients, health care professionals and policymakers identified the following as essential elements for developing a program for this population: clear eligibility criteria, addressing patients’ needs at discharge, having structured education and self-management programs and modifying to respond to unexpected events. “There is ongoing interest in better understanding the role of post-acute exacerbation of COPD pulmonary rehabilitation and there does appear to be a consistent need for programs that are flexible to patient needs and that emphasize self-management,” the researchers wrote. For rapid access rehabilitation referral optimization, participants suggested a clear referral pathway, improving program awareness, assigning dedicated care coordinators to provide patient support, and establishing strong partnerships with different care settings and providers. One way to accomplish these tasks would be to make rapid access rehabilitation part of standard care and follow similar models from other rehabilitation areas, according to the researchers. “A structured program based on education and self-management customized to patients needs and adaptable to unexpected events such as COVID were considered essential components of rapid access rehabilitation development,” the researchers wrote. “Suggestions for optimizing referral, uptake and effectiveness include raising program awareness, having a clear referral pathway, a dedicated care coordinator and established partnership among different care settings and providers.” Currently, a Delphi study based on these results is being created to include a broader and international participant range to define final characteristics of a rapid access rehabilitation programs after hospital discharge, according to the researchers.
For more information: https://tinyurl.com/bkk7t9rj
Canadians would support use of vaccine passports, Angus Reid survey finds
Arnprior, ON - The idea of providing proof of vaccination is one Canadians would be on board with if it meant a return to the things they enjoy during the pandemic. In a recent survey by the Angus Reid Institute, 79 per cent of Canadians polled said they would carry a vaccine passport to travel internationally, while 76 per cent said they would carry one to cross the border to the United States. At home, 55 per cent of people said they would provide proof at public places such as restaurants, malls, movie theatres, and even workplaces. "If it meant I didn’t have to wear a mask anymore and we could open everything up and put everything back to normal, I’ll carry whatever they ask me to carry," said Shawn Lewis, who was out picking up groceries at the Metro location in Arnprior. "It would definitely make a lot of sense because you know everybody around you is vaccinated." In Renfrew County, more than 50 per cent of the population has received at least one dose of the COVID-19 vaccine. Medical Officer of Health Dr. Robert Cushman is anticipating that number to reach 70 per cent before vaccine hesitancy becomes prominent. "Renfrew County tends to be very pro-vaccine, which is great," says Dr. Cushman. "I think most people want their own private vaccine passport because they realize that it will help them in certain places." But there are some who say they don’t like the idea of a digital passport being scanned on their phone. "Personally, myself no," says Bob Lachance, who was also out running errands in Arnprior. "If we need a passport, maybe present it if you want to go somewhere. But personally I don’t think it’s necessary."For more information: https://tinyurl.com/58ndce5b
A 3-Year study of Tele-Pulmonary rehab program for COPD
Montreal, PQ – A new study published in the Annals of the American Thoracic Society looked at access to pulmonary rehab for people with chronic obstructive pulmonary disease. The researchers surmised that few individuals with COPD are able to access pulmonary rehabilitation (PR) despite its importance. Barriers include increased travel time and lack of resources. Tele-PR has been proposed as a novel solution to overcome such barriers and improve access. Their study aimed to provide information on implementing a novel province-wide standardized community-based tele-PR program and determine its accessibility, feasibility and safety. Secondary objectives examined the effectiveness of tele-PR compared to standard-PR and if clinical improvements were sustained over time. The researchers conducted a concurrent prospective study of people with COPD enrolled in either standard-PR or community-based tele-PR at satellite centers between January 2017 and January 2020. To determine accessibility and feasibility, they recorded the number of participating centers meeting eligibility criteria, centers remaining in the program over 3 years, number of delivered programs and major adverse events. Participants had a 6MWT and CAT at baseline, immediately post-PR and at 1,3,6 and 12 months. Descriptive analysis was carried out for accessibility, feasibility and safety. Mixed-effects random models were used to estimate change in 6MWT and CAT. Seven tele-sites were recruited into the tele-PR program with 6 continuing to participate at 3 years, delivering a total of 58 programs for 177 individuals with COPD. During that same period, the standard-PR site delivered 15 programs for 89 individuals with COPD. Over 70% of participants completed each program and no major adverse events were reported. There were significant improvements in the 6MWT and CAT scores in both groups immediately post-PR with no between-group differences. Participants in both programs had persistent 6MWT improvement at 1,3,6 and 12 months post-PR. Participants in tele-PR had persistent improvement of CAT scores but not in standard-PR beyond 1 month post-PR. The researchers concluded that this study provides real-world evidence demonstrating successful implementation of tele-PR. The Canadian standardized tele-PR program is an accessible, feasible, safe and effective model for delivering pulmonary rehabilitation for people with chronic obstructive pulmonary disease. The researchers who participated in the study are: Amr J Alwakeel, Albert Sicondolfo, Chantal Robitaille, Jean Bourbeau and Nathalie Saad.
For more information: https://pubmed.ncbi.nlm.nih.gov/34170802Please insert your text here.