COPD World News - 2024

Week of December 15, 2024

Dual use of cigarettes, e-cigarettes negatively impact abstinence likelihood

Gottingen, Germany - A smaller proportion of individuals who used both e-cigarettes and cigarettes achieved nicotine abstinence vs. individuals who used only cigarettes or only e-cigarettes, according to results published in ERJ Open Research. “Given these findings, we believe that dual use might prove to be a major hinderance in achieving smoking abstinence and this practice should not be recommended for treating nicotine addiction,” Josef Hamoud, of the University Medical Center Gottingen in Germany, said in a press release.“ In addition, while long term health effects of vapes need to be studied further, the double exposure to large amounts of nicotine and toxicants from both conventional cigarettes and vapes are a great concern for public health,” Hamoud continued. After searching two databases, Hamoud and colleagues examined 16 longitudinal, observational studies (12 studies in adults; four in youth/adolescents) of individuals who reported dual e-cigarette and cigarette use (n = 2,432) vs. e-cigarette only use and cigarette only use to determine how dual use impacts smoking cessation. The degree of heterogeneity in the studies was found to be “great,” according to researchers. Additionally, the risk of bias was stated to be moderate to high. Notably, the meta-analysis factored in findings from eight of the 16 studies. “Four studies among adult populations could not be included for meta-analysis due to clinical diversity and methodological heterogeneity,” Hamoud and colleagues wrote. An identical explanation was given for not including the four studies involving adolescents. Among individuals who made a switch from using both e-cigarettes and cigarettes, researchers reported that exclusive cigarette smoking was often what they transitioned to using. At a 4-to-8-month follow-up, the proportion of individuals who fit this description was 30%, and as more time passed, this went up (> 8 to 16 months, 47%; > 16 to 24 months, 58%; > 24 to 48 months, 55%). Although cigarette use among baseline dual users fell from 90% at 4 to 8 months to 63% at greater than 24 to 48 months, this proportion was still considered high by researchers. In terms of complete abstinence, there was a lower likelihood for this outcome among individuals who used both e-cigarettes and cigarettes at baseline vs. individuals who used only cigarettes or only e-cigarettes, according to the study. At each follow-up, the proportion of individuals moving to nicotine abstinence was always lower in the baseline dual user group vs. the baseline cigarette only and e-cigarette only groups (4 to 8 months, 3% vs. 6% and 8%; 8 to 16 months, 5% vs. 7% and 19%; 16 to 24 months, 13% vs. 17% and 26%; 24 to 48 months, 24% vs. 25% and 34%). During a 16-to-24-month follow-up in the dual user group, researchers observed that 19% continued to use both e-cigarettes and cigarettes, and this went down to 8% by the 24-to-48-month follow-up. “While it may have been argued that heavy smokers might benefit from dual use by reducing their daily cigarette consumption, the high nicotine content of vapes adds to the risk of continued nicotine addiction,” Hamoud said in the release. “Future studies must further stratify dual-use groups to investigate the health implications over time.” 

For more information: https://tinyurl.com/532vvx6d

Week of December 8, 2024

At 4 years since COPD diagnosis, patients without treatment common

San Antonio, TX - In patients who did receive treatment, the most prescribed form has been deemed “not optimal.” When diagnosed with COPD, 86.2% of patients did not receive treatment, and after 4 years, 63.8% still had not been treated, according to results published in BMC Pulmonary Medicine. “There is an urgent need to identify and diagnose COPD patients,” Antonio Anzueto, MD, MS, PhD, professor of medicine and section chief of pulmonary at South Texas Veterans Healthcare System, told Healio. “Additionally, once patients are diagnosed, the initial treatment must be long-active bronchodilators and not inhaled corticosteroids/long-acting beta-agonist,” Anzueto continued. Patients with an indication for ICS should be on triple therapy, Anzueto said. In a retrospective, noninterventional study, Anzueto and colleagues analyzed 238,158 individuals (mean age, 63.8 years; 52.9% women) newly diagnosed with COPD in 2015 to 2021 with commercial insurance (29.1%), Medicaid Managed Care (46.2%) or Medicare Advantage (37.3%) to track moderate and severe exacerbation occurrence and treatment decisions in the 4 years after diagnosis. For 6.5% of the population, insurance type was unknown, according to the study. Researchers found reports of at least one moderate or severe exacerbation between diagnosis and the 4-year mark for 32.9% of the population. A greater proportion of patients had moderate vs. severe exacerbations (25.8% vs. 13.8%). As time passed from diagnosis, researchers noted a reduction in the proportion of patients with a moderate exacerbation (year 1, 43.2%; year 4, 30.8%) and a severe exacerbation (year 1, 41.8%; year 4, 27%). When evaluating the proportion of untreated patients, this value was high at diagnosis (86.2%) and continued to be elevated at the 4-year mark (63.8%), which Anzueto told Healio was unexpected. When divided into those prescribed a short-acting treatment at diagnosis (n = 96,258), those treated by the end of year 1 (n = 205,177) and those treated by the end of year 4 (n = 157,896), LABA/ICS was the treatment option given to the highest proportion of patients in each group, according to the study. LAMA came in second in these groups, followed by LAMA/LABA. In the group of patients treated with a maintenance therapy at diagnosis, LABA/ICS was prescribed more than the other options (62%), according to researchers. “Current guidelines suggest that this treatment is not optimal for most patients and that the LAMA + LABA combination is the preferred approach, offering advantages in terms of efficacy and tolerability,” Anzueto and colleagues wrote. Further, over the course of the study period, researchers reported that high proportions of patients received LABA/ICS (year 1, 63.7%; year 2, 60.4%; year 3, 58.8%; year 4, 58.8%), whereas small proportions of patients received LAMA/LABA (year 1, 9.1%; year 2, 14.5%; year 3, 16.4%; year 4, 15.9%). “It is important to have observations, non-intervention real-world evidence studies that will help to understand the diagnosis and management of chronic lung conditions like COPD,” Anzueto told Healio. “Future studies need to focus on the long-term impact of appropriate diagnosis and treatment in COPD patients. “COPD is a treatable condition, [and] early diagnosis and appropriate interventions can change the course of the disease,” Anzueto added. 

For more information: https://tinyurl.com/ycxt4jxa

Week of December 1, 2024

CDC updates RSV vaccine guidance

Atlanta, GA - The CDC recommends  a single dose of any FDA approved respiratory syncytial virus (RSV) vaccine for all adults ages 75 years and older, as well as for 60 to 74yearolds who are at increased risk of severe illness from the virus. The CDC updated  its adult RSV vaccination recommendations in June after real world data  confirmed how effective RSV vaccines were in their first season of use against hospitalizations, critical illness, and emergency department visits among adults ages 60 and older, including those who were immunocompromised. The shift to a clear recommendation for vaccination goes beyond the prior guidance "just to encourage adults to talk to their provider to determine whether they should get an RSV vaccine," said the CDC's Amanda Payne, PhD, an author on a real world effectiveness study published in The Lancet. (The previous guidance simply recommended shared clinical decision making about the vaccine for all adults age 60 and up.) So what constitutes being at risk of severe disease in that 60 to 74yearold age group? The CDC lists 11 conditions, including chronic lung or respiratory disease, severe obesity, chronic cardiovascular disease, moderate or severe immune compromise, and living in a nursing home. Other conditions include end stage renal disease or dependence on hemodialysis, diabetes with comorbidities, certain neurologic or neuromuscular conditions, chronic liver disease, chronic hematologic conditions, and other chronic conditions determined risky by a healthcare provider. Notably, individuals can self attest to conditions that place them at high risk of severe illness from RSV, according to the CDC. "Age most certainly is not the only risk factor," said Angela Branche, MD, of the University of Rochester Medical Center in New York, who authored a comment about RSV effectiveness published in The Lancet. "One thing that often gets missed is that RSV is associated with a lot of exacerbations of underlying health conditions," such as chronic heart and lung problems, Branche added. Frequently, "what causes [an individual] to be hospitalized is not the virus itself," she said. For instance, most of the time when people end up in the hospital they are "starting to already clear the virus," but an underlying condition that has been exacerbated has led to the admission, she said. For instance, an individual may be in heart failure or struggling to breathe due to a flare up of chronic obstructive pulmonary disease (COPD) or asthma following RSV infection, Branche noted.

For more information: https://tinyurl.com/yc7y5hcv

Week of November 24, 2024

Even with treatment, patients with COPD regularly become frequent exacerbators

Boston, MA - Moving from Global Initiative for Chronic Obstructive Lung Disease, or GOLD, group A/B to group E was common among patients starting a new inhaled maintenance medication, according to a presentation at the CHEST Annual Meeting, reported Helio. “The majority of patients with GOLD A/B COPD progressed to GOLD E within 5 years, despite treatment with inhaled maintenance therapies,” Emily S. Wan, MD, MPH, assistant professor of medicine at Harvard Medical School, and colleagues wrote on a presentation slide. In a retrospective cohort study, Wan and colleagues assessed 156,462 adults with COPD starting a new inhaled maintenance medication via Optum’s Clinformatics Data Mart database of U.S. individuals on Medicare or commercial insurance plans to uncover how many patients originally grouped in GOLD A/B (less than two moderate exacerbations + no severe exacerbations in 12 months before starting new maintenance medication) move to GOLD E (two moderate or one severe exacerbation 1 year after starting new maintenance medication). As Healio previously reported, after progressing to GOLD group E, patients with COPD faced higher costs and used health care resources more. To capture a more detailed look at who progressed to GOLD E, researchers divided the GOLD A/B population into those with no moderate and severe exacerbations (GOLD A/B0; n = 112,324; mean age, 71 years; 51% men; 74% white) and those with one moderate and no severe exacerbations (GOLD A/B1; n = 44,138; mean age, 70 years; 47% men; 74% white). In both groups, the majority of patients had been prescribed long-acting beta-2 agonist/inhaled corticosteroid (GOLD A/B0, 45%; GOLD A/B1, 51%). Other inhaled COPD maintenance medications were prescribed to smaller proportions of patients, including LABA/long-acting muscarinic antagonist (GOLD A/B0, 20%; GOLD A/B1, 17%), LAMA alone (20%; 16%), LABA/LAMA/ICS in a single inhaler (12%; 13%), LABA/LAMA/ICS in multiple inhalers (both 2%) and LABA alone (both 1%). During a 5-year period, 45,079 patients progressed to GOLD E, of which more came from the GOLD A/B0 vs. GOLD A/B1 group (26,644 vs. 18,435), according to Wan’s presentation. Within the GOLD A/B0 COPD group, researchers found that more patients moved to GOLD E as years passed from the start of treatment. At the 1-year mark, 17% of patients progressed to GOLD E, and this grew to 30% at year 2 and then 53% at year 5. A similar pattern was observed in the GOLD A/B1 COPD group, with a higher proportion of patients transitioning to GOLD E as more time went by since the beginning of treatment. According to the presentation, 41% progressed to GOLD E at the 1-year mark, and this increased to 52% at 2 years and 71% at 5 years. Researchers also reported that the risk for GOLD E progression was significantly higher among those grouped under GOLD A/B1 compared with those grouped under GOLD A/B0 (HR = 2.92; 95% CI, 2.84-3; P < .001).“Given [these] data [show] all patients are at risk for exacerbating while on treatment, additional treatment strategies are needed to lower exacerbation risk in patients with COPD,” Wan and colleagues wrote on the presentation slide. 

For more information: https://tinyurl.com/49hjuv58

Week of November 17, 2024

Risk for all-cause mortality elevated in older adults with COPD, social isolation

San Francisco, CA - Among older adults with COPD, the risk for all-cause mortality was heightened with vs. without social isolation, according to a research letter published in JAMA Internal Medicine and reported by Helio. “Social isolation and loneliness are highly prevalent in people with COPD, affecting nearly one in five U.S. adults with COPD,” Angela O. Suen, MD, clinical instructor and research fellow in the division of pulmonary, critical care, allergy and sleep medicine at UCSF, told Healio. “Clinicians should consider asking about social connections as part of their routine management in COPD.” Suen and colleagues assessed 1,241 adults (mean age, 68.4 years; 59.3% women; 79.8% non-Hispanic white) aged 51 years or older with COPD from the 2006 to 2022 Health and Retirement Survey to establish how social isolation impacts all-cause mortality risk. Among adults aged 50 years and older, those with COPD experienced social isolation and loneliness more frequently than those without COPD. To measure social isolation, researchers used a 6-point scale. According to the study, responses that made up the total score focused on marital status, living situation, community participation and social contact with three groups of people: children, family and friends. Within the study population, fewer adults had a score signaling social isolation (n = 293; mean age, 68 years; 65.8% women; 76.3% non-Hispanic white) vs. signaling no social isolation (n = 948; mean age, 68.5 years; 57.2% women; 80.9% non-Hispanic white). A significantly greater proportion of adults with vs. without social isolation reported single marital status (87% vs. 31.4%), supplemental oxygen use (19.6% vs. 12.3%), high depressive symptoms (31.9% vs. 23.8%), cognitive impairment (19% vs. 15.4%) and dementia (5.9% vs. 2.9%), according to the study. The median follow-up period was 4.4 years, during which researchers reported 539 deaths. Following adjustment for several variables (age, sex, race and ethnicity, loneliness, education, comorbidities, cognitive impairment, depression and tobacco use), the risk for all-cause mortality was heightened among adults with vs. without social isolation (adjusted HR = 1.35; 95% CI, 1.04-1.75), according to the study. “I wasn’t surprised social isolation was associated with mortality because this has been shown in other studies,” Suen sai. “I think what is novel is that social isolation impacted mortality in those with COPD more than in the U.S. general population. “We hypothesize that social connections may be an important factor in patient resilience, such as helping patients with disease management, or even working through exacerbations or disease progression,” Suen said. In the social isolation group, 7 years was the median survival time, whereas in the group without social isolation, survival time was 9.1 years. Similar to above, researchers found a smaller 5-year survival rate with vs. without social isolation (62.9% vs. 71.1%). “We don’t know yet if interventions aimed to prevent or reduce social isolation could improve COPD outcomes and this could be a future area of study,” Suen told Healio. 

For more information: https://tinyurl.com/4cbfnpfk

Week of November 10, 2024

Cardiovascular risk may take decades to erase after quitting for heavy smokers

Seoul, South Korea - Ex-smokers with a light lifetime smoking burden had a CVD risk shortly after quitting similar to those who have never smoked, results from a cohort analysis showed. However, findings from the retrospective study suggest that ex-smokers who smoked heavily may need to restrain from smoking for more than 25 years to have a cardiovascular risk similar to those who have never smoked. The time passed after quitting smoking and the subsequent changes in (CVD) risk “are not properly reflected in guidelines and contemporary clinical practice,” according to Jun Hwan Cho, MD, from the Chung-Ang University Gwangmyeong Hospital in the Republic of Korea, and colleagues. “For instance, the latest clinical CVD risk stratification tool does not properly estimate the potential CVD risk of ex-smokers,” they wrote in JAMA Network Open. “Indeed, the time elapsed after smoking cessation and lifetime smoking burden may affect CVD risk for a certain period.” The researchers examined the risk for CVD among ex-smokers after cessation, as well as CVD risk based on the lifetime smoking burden of ex-smokers. They analyzed information from from the Korean National Health Insurance Service database from 2006 to 2008. The study included 5,391,231 participants, with a mean follow-up of 4.2 years. Of the sample, 15.8%, 1.9% and 82.2% were current, former and never-smokers, respectively. Cho and colleagues found a dose-dependent relationship between incident CVD and smoking regardless of continued smoking. They also reported higher incidences of CVD among both former and current smokers than among never smokers, with the adjusted HRs for CVD of 1.13 (95% CI, 1.1-1.15) for former smokers and 1.22 (95% CI, 1.02-1.24) for current smokers, both compared with never smokers. Overall, ex-smokers had a significantly lower risk for CVD within 5 years of quitting smoking (HR = 0.96; 95% CI, 0.92-0.99) and 5 to 10 years of quitting (HR = 0.91; 95% CI, 0.87-0.95). However, ex-smokers had a significantly greater risk for CVD vs. never-smokers that persisted up to 20 years of quitting. The researchers noted that ex-smokers with a lifetime smoking burden of less than 8 pack-years — considered light ex-smokers — had a significant decrease in cardiovascular disease risk within 10 years of cessation, with the risk similar to those of never-smokers. In comparison, ex-smokers with a lifetime smoking burden of at least eight pack-years showed a significantly greater risk for CVD vs. never-smokers after beginning cessation, with the risk similar to those of current smokers until 20 years. Ultimately, these heavy ex-smokers required over 25 years of cessation for the residual CVD risk to disappear. Cho and colleagues highlighted several clinical implications that arise from the findings. For example, they noted that the dose-dependent association “[emphasizes] the importance of preventing smoking initiation altogether.” For people who start smoking but do not reach the “point of no return” — in this case, 8 pack-years — “they may quit smoking with marked clinical improvements expected soon after quitting,” they wrote. Regarding heavy ex-smokers, “[they] should be considered to have a CVD risk equivalent to that of patients who continue to smoke, and management should be planned accordingly,” the researchers concluded. 

For more information: https://tinyurl.com/bddw4a36

Week of November 3, 2024

Costs, health care utilization rise after patients with COPD become frequent exacerbators

Boston, MA - After progressing to Global Initiative for Chronic Obstructive Lung Disease, or GOLD, group E, patients with COPD faced higher costs and used health care resources more, according to a poster presented at the CHEST Annual Meeting. “COPD-related costs more than doubled with progression to GOLD E, pointing to the significant economic impact of exacerbations and the need to prevent frequent or severe events,” Sanjay Sethi, MD, professor and chief of pulmonary, critical care and sleep medicine, as well as assistant vice president for health sciences at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences, and colleagues wrote on the poster. Sethi and colleagues assessed 156,462 adults with COPD starting a new inhaled maintenance medication via Optum’s Clinformatics Data Mart database of U.S. individuals on Medicare or commercial insurance plans to find out how patients originally grouped in GOLD A/B (less than two moderate exacerbations in 12 months prior to starting new maintenance medication) change after progressing to GOLD E (two moderate or one severe exacerbation 1 year after starting new maintenance medication) in terms of costs and health care resource utilization. Almost half of the total cohort (47%) had been prescribed long-acting beta-2 agonist/inhaled corticosteroid. Other inhaled COPD maintenance medications were prescribed to smaller proportions of patients, including LAMA alone (19%), long-acting muscarinic antagonist/LABA (19%), LABA/LAMA/ICS (14%) and LABA alone (1%). Within the total cohort of patients with GOLD A/B COPD, researchers found that 45,079 progressed to GOLD E during follow-up (mean, 232 days), of which 5,777 had data 12 months before and 12 months after progression for analysis. “Despite use of inhaled COPD maintenance treatments, over 50% of patients progressed to a frequently exacerbating status over 5 years,” Sethi and colleagues wrote. In the 12 months before progression to GOLD E, $3,740 was the mean COPD-related total annualized costs, whereas in the 12 months after progression, these costs went up to $9,990 (P < .001), according to the poster. Following a similar pattern, researchers observed higher COPD-related medical costs after vs. before progression to GOLD E (mean, $4,850 vs. $829; P < .001), and the same was true when capturing all-cause total annualized costs (mean after, $58,700 vs. before, $39,800; P < .001). Health care resource utilization related to COPD was divided into four categories: ED visits, inpatient/skilled nursing facility admissions, office visits and outpatient visits. The proportion of patients with office visits was elevated before progressing to GOLD E at 64% and grew to 71% after progressing to GOLD E. When assessing outpatient visits, more patients used this resource after vs. before progression to GOLD E (37% vs. 22%), according to the poster. Notably, no patients had ED visits before progressing to GOLD E, but after this GOLD grade change, 20% of patients experienced this type of visit. Similarly, researchers reported that the proportion of patients with an inpatient/skilled nursing facility admission rose from 0.4% before GOLD E progression to 11% after GOLD E progression. “New COPD therapies are needed that may help to prevent a broad population of patients with COPD from progressing to GOLD E,” Sethi and colleagues wrote. 

For more information: https://tinyurl.com/yvxrhutk

Week of October 27, 2024

Analysis finds extreme rainfall linked to heightened risk of heart and lung disease deaths

London, UK - Extreme rainfall events are associated with an increased risk of death from all causes as well as from heart and lung diseases, finds an analysis of data from 34 countries and regions published by The BMJ. The health effects of extreme rainfall varied by local climate and vegetation coverage, providing a global perspective on the effect of extreme rainfall events on health. Climate change is intensifying the frequency and severity of short term rainfall events, and emerging evidence suggests a compelling link between rainfall events and adverse health outcomes, particularly transmission of infectious diseases. But the influence of rainfall events on cardiovascular and respiratory health, and how varying rainfall intensities affect these conditions, remains understudied. To address this, researchers set out to examine the associations between daily rainfall (intensity, duration, and frequency) and all-cause, cardiovascular, and respiratory deaths. They analyzed daily mortality records and rainfall data from 645 locations across 34 countries or regions on six continents, comprising a total of 109,954,744 all-cause, 31,164,161 cardiovascular, and 11,817,278 respiratory deaths from 1980 to 2020. The main measure of interest was the association between daily deaths and rainfall events with return periods (expected intervals between events) of one year, two years, and five years. Factors that might affect this association, such as local climate type, rainfall variability, and vegetation coverage, were also taken into account. During the study period, a total of 50,913 rainfall events with a one year return period, 8,362 events with a two year return period, and 3,301 events with a five year return period were identified. Overall, across all locations, a day of extreme rainfall with a five year return period was associated with an 8% increase in all-cause deaths, a 5% increase in cardiovascular deaths, and a 29% increase in respiratory deaths over a 14-day period after the rainfall event. 

For more information: https://tinyurl.com/3f9r5uhw

Week of October 20, 2024

Study warns: Don't rely on AI chatbots for accurate, safe drug information

London, UK - Patients shouldn't rely on AI-powered search engines and chatbots to always give them accurate and safe information on drugs, conclude researchers in the journal BMJ Quality & Safety, after finding a considerable number of answers were wrong or potentially harmful. What's more, the complexity of the answers provided might make it difficult for patients to fully understand them without a degree level education, add the researchers. In February 2023, search engines underwent a significant shift thanks to the introduction of AI-powered chatbots, offering the promise of enhanced search results, comprehensive answers, and a new type of interactive experience, explain the researchers. While these chatbots can be trained on extensive datasets from the entire internet, enabling them to converse on any topic, including health-care-related queries, they are also capable of generating disinformation and nonsensical or harmful content, they add. Previous studies looking at the implications of these chatbots have primarily focused on the perspective of health care professionals rather than that of patients. To address this, the researchers explored the readability, completeness, and accuracy of chatbot answers for queries on the top 50 most frequently prescribed drugs in the US in 2020, using Bing copilot, a search engine with AI-powered chatbot features. To simulate patients consulting chatbots for drug information, the researchers reviewed research databases and consulted with a clinical pharmacist and doctors with expertise in pharmacology to identify the medication questions that patients most frequently ask their health care professionals. The chatbot was asked 10 questions for each of the 50 drugs, generating 500 answers in total. The questions covered what the drug was used for, how it worked, instructions for use, common side effects, and contraindications. Readability of the answers provided by the chatbot was assessed by calculating the Flesch Reading Ease Score which estimates the educational level required to understand a particular text. Text that scores between 0 and 30 is considered very difficult to read, necessitating degree level education. At the other end of the scale, a score of 91–100 means the text is very easy to read and appropriate for 11 year-olds. To assess the completeness and accuracy of chatbot answers, responses were compared with the drug information provided by a peer-reviewed and up-to-date drug information website for both health care professionals and patients (drugs.com) Current scientific consensus, and likelihood and extent of possible harm if the patient followed the chatbot's recommendations, were assessed by seven experts in medication safety, using a subset of 20 chatbot answers displaying low accuracy or completeness, or a potential risk to patient safety. The Agency for Health care Research and Quality (AHRQ) harm scales were used to rate patient safety events and the likelihood of possible harm was estimated by the experts in accordance with a validated framework. The overall average Flesch Reading Ease Score was just over 37, indicating that degree level education would be required of the reader. Even the highest readability of chatbot answers still required an educational level of high (secondary) school. Overall, the highest average completeness of chatbot answers was 100%, with an average of 77%. Five of the 10 questions were answered with the highest completeness, while question 3 (What do I have to consider when taking the drug?) was answered with the lowest average completeness of only 23%. Chatbot statements didn't match the reference data in 126 of 484 (26%) answers and were fully inconsistent in 16 of 484 (just over 3%). Evaluation of the subset of 20 answers revealed that only 54% were rated as aligning with scientific consensus. And 39% contradicted the scientific consensus, while there was no established scientific consensus for the remaining 6%. Possible harm resulting from a patient following the chatbot's advice was rated as highly likely in 3% and moderately likely in 29% of these answers. And a third (34%) were judged as either unlikely or not at all likely to result in harm, if followed. But irrespective of the likelihood of possible harm, 42% of these chatbot answers were considered to lead to moderate or mild harm, and 22% to death or severe harm. Around a third (36%) were considered to lead to no harm. The researchers acknowledge that their study didn't draw on real patient experiences and that prompts in different languages or from different countries may affect the quality of chatbot answers. "In this cross-sectional study, we observed that search engines with an AI-powered chatbot produced overall complete and accurate answers to patient questions," they write. "However, chatbot answers were largely difficult to read and answers repeatedly lacked information or showed inaccuracies, possibly threatening patient and medication safety," they add. A major drawback was the chatbot's inability to understand the underlying intent of a patient question, they suggest. "Despite their potential, it is still crucial for patients to consult their health care professionals, as chatbots may not always generate error-free information. Caution is advised in recommending AI-powered search engines until citation engines with higher accuracy rates are available," they conclude. 

For more information: https://tinyurl.com/yc42cup5

Week of October 13, 2024

Asthma patients who smoke may benefit from COPD treatment

San Antonio, TX - The lungs of patients with asthma who smoke begin to resemble those of patients with COPD, which may require changes in treatment, Brian Bizik, MS, PA-C, said at the 16th Annual Allergy, Asthma & Immunology CME Conference. “They have lots of remodeling,” Bizik, immediate past president of the Association of PAs in Allergy, Asthma and Immunology and pulmonary care coordinator of Terry Reilly Health Centers in Boise, Idaho, said during his presentation. These patients experience increases in smooth muscle mass, epithelial cell shedding, angiogenesis and subepithelial fibrosis, as well as increases in goblet cells, which make mucus. “You get more clumping of the epithelial cells, more blood vessels in the tissue. It gets bigger, thicker, boggier,” he said. “You have this thickening and this fibrotic layer.”Recommendations for treatment from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) may help, Bizik said. “Maybe I’m not going to change your inhaler, but the GOLD guidelines will help me,” Bizik said. “ Even though right now your diagnosis is asthma, I’m thinking that you may be more COPD-ish based on smoking.” Clinicians with these patients could consider macrolides early and provide them longer, according to GOLD. “Azithromycin is a workhorse for COPD. It works very well. I use it in lieu of steroids sometimes, or with steroids,” Bizik said. Physicians also should focus on exacerbation prevention via vaccinations and pulmonary rehabilitation, which patients typically do not receive even though Cochrane Reviews have called it effective, Bizik said. “You look at pulmonary rehabilitation, and Cochrane says ‘We recommend no further studies, because this is so good. We recommend no more studies comparing pulmonary rehab to not. Don’t do it anymore. It’s that good,’” Bizik said. Nebulizer therapy should be considered as well since these patients have such a difficult time inhaling medicine due to poor manual dexterity, cognitive function or inhalation capacity, he continued. Short-acting and long-acting beta 2 agonists and anticholinergics are available for nebulizers, as are short-acting beta 2 agonist and combinations. “I’ve had really good luck getting these,” Bizik said. “I have people on triple inhalers, but it’s on a nebulizer that they do twice a day.” Patients enjoy using the nebulizer too, he continued. “It’s very soothing. It’s very rewarding,” Bizik said. “They know they’re going to get the medicine. They know it’s going to work.”

For more information: https://tinyurl.com/3u5c7jee

Week of October 6, 2024

AI capable of predicting COPD exacerbations with continuous temperature data

London, UK - Using continuous temperature monitoring data from patients with COPD, an AI was able to predict exacerbations, according to a poster presented at the European Respiratory Society International Congress. “Continuous temperature monitoring is feasible in patients with COPD and might aid the early detection of exacerbations,” Mairi MacLeod, MD, clinical research fellow at the National Heart and Lung Institute, Imperial College London, and colleagues wrote on the poster. In this feasibility study, MacLeod and colleagues evaluated 37 patients (mean age, 71.8 years; 51% men) with COPD from the London COPD exacerbation (EXCEL) cohort to determine if continuous at-home temperature monitoring via an armband sensor helps identify exacerbations early. Researchers uncovered the value of temperature monitoring in relation to COPD exacerbations through an AI trained with previous exacerbations. According to the poster, they assessed how well the AI could predict an exacerbation based on temperature signature data from the past 7 days. During a monitoring period of 970 weeks, researchers found that 30 exacerbations — made known by patient reports and daily symptom diary cards — took place. The poster indicated that five exacerbations could not be included in the AI assessment due to insufficient temperature trace data quality. The AI demonstrated 84% sensitivity (predicted 21 out of 25 exacerbations) and 90.6% specificity, according to the poster. “Future work in larger cohorts should be undertaken to confirm this and the possible benefits of early detection and intervention in this group,” MacLeod and colleagues wrote on the poster. 

For more information: https://tinyurl.com/muakezb2

Week of September 29, 2024

First-Ever Biologic Approved for COPD

Silver Spring, MD - The FDA approved dupilumab (Dupixent) as the first biologic treatment for adults with chronic obstructive pulmonary disease (COPD), Sanofi and Regeneron announced . An injectable interleukin (IL)-4 and IL-13 pathway inhibitor, dupilumab is indicated as an add-on maintenance treatment for inadequately controlled COPD with an eosinophilic phenotype. Primary support for the approval came from two phase III trials – BOREAS  and NOTUS  involving more than 900 COPD patients on maximal inhaled therapy (typically triple therapy) and with blood eosinophil evidence of type 2 inflammation. Both studies met their primary endpoint, with dupilumab as a subcutaneous injection every 2 weeks reducing the annualized rate of moderate or severe COPD exacerbations versus placebo over a year. In BOREAS, add-on treatment with dupilumab led to a 30% reduction in annual exacerbations (0.78 vs 1.10, respectively; rate ratio [RR] 0.70, 95% CI 0.58-0.86, P<0.001). And in NOTUS, dupilumab maintenance yielded a 34% reduction (0.86 vs 1.30; RR 0.66, 95% CI 0.54-0.82, P<0.001). Trial data also showed improvements in quality of life and lung function, with numerically greater improvements in post-bronchodilator forced expiratory volume in 1 second (FEV1) and a significant improvement in pre-bronchodilator FEV1. COPD causes progressive declines in lung function and consistently ranks in the top five leading causes of death in the U.S., where an estimated 300,000 adults with COPD have inadequately controlled disease and an eosinophilic phenotype. "People living with inadequately controlled COPD have long awaited new medicines to help manage the daily suffering they experience from breathlessness, coughing, wheezing, exhaustion, and unpredictable hospitalization," Jean Wright, MD, CEO of the COPD Foundation, said in a statement. "These patients often struggle with everyday activities many people take for granted such as taking a walk or running errands outside the home. We welcome the approval of this new therapeutic option to offer patients a new way to help gain better control of their disease." The most common adverse events with dupilumab in BOREAS and NOTUS (>2%, and occurring more frequently than with placebo) included viral infection, headache, nasopharyngitis, back pain, diarrhea, arthralgia, urinary tract infection, injection site reactions, rhinitis, eosinophilia, toothache, and gastritis. Of note, cholecystitis was reported in more patients on dupilumab than placebo recipients (0.6% vs 0.1%). 

For more information: https://tinyurl.com/32484c2u

Week of September 22, 2024

Speech features change during onset, peak of COPD exacerbation

Maastricht, Netherlands - Patients with COPD experience changes in voice pitch and jitter during the onset and peak of an exacerbation, according to a poster presented at the European Respiratory Society International Congress. “Our findings pave the way for future tools to help people manage their own exacerbations with speech applications," Loes van Bemmel, MSc, PhD student and researcher in the department of respiratory medicine at Maastricht University Medical Center in the Netherlands, told Healio. “Hopefully our findings help lessen the burden on everyday clinicians in the future, and for now convince people of the importance and potential use of speech analysis.” Patients with COPD experience changes in voice pitch and jitter during the onset and peak of an exacerbation, according to a poster presentation. Image: Adobe Stock Using the TACTICAS smartphone app, van Bemmel and colleagues assessed speech recordings of 28 patients with COPD taken three times a day for 12 weeks to examine differences in speech at onset and peak of symptoms of a COPD exacerbation vs. speech at baseline. Patients filled out the EXACT questionnaire once a day, so researchers knew when they experienced an exacerbation (score ≥ 9 points above baseline for 3 days or ≥ 12 points above baseline for 2 days). According to a press release from the European Respiratory Society, recordings captured patients “saying ‘ahh’ for as long as they could manage with one breath, then either reading a short paragraph of a story or answering a question.” The Praat computer program allowed researchers to extract 25 speech features, such as pitch, voice breaks and jitter from sustained vowel /a/ in patients’ morning and evening recordings. By the 4-week mark, 11 patients (mean age, 68.6 years; 36.4% women) had at least one exacerbation, and by the 8-week mark, the study cohort reported 16 COPD exacerbations. In the morning recordings, researchers observed a significant difference between baseline and exacerbation onset in terms of minimum pitch (73.84 Hz vs. 101.48 Hz; P < .05) and number of voice breaks (11.75 vs. 5.38; P < .05). Similarly, minimum pitch in the morning was significantly higher at exacerbation peak vs. baseline (106.59 Hz vs. 73.84 Hz; P < .01) and the number of voice breaks was significantly lower (4.6 vs. 11.75; P < .05). In the evening recordings, the speech feature that significantly differed between baseline and the exacerbation time points was jitter (breathy or hoarse sounding voice). Local absolute jitter was significantly higher at exacerbation onset and peak vs. baseline (118.39 µs and 104.23 µs vs. 100.07 µs; P < .05). Additionally, jitter measured as five-point period perturbation quotient was significantly elevated at onset of an exacerbation vs. baseline (0.94% vs. 0.62%; P < .05) and at peak of an exacerbation vs. baseline (0.84% vs. 0.62%; P < .05). “Even though we hoped for it, we were surprised to see that the speech characteristics already change significantly the first day of the exacerbation,” van Bemmel told Healio. “We expected the speech to be different during the peak of symptoms, but finding significant difference on the onset day is very nice. “In future studies we will validate our findings with more data and design algorithms to predict exacerbations by speech as well,” van Bemmel said. “Furthermore, we will design an app specifically for people with COPD to also employ the algorithm.” 

For more information: https://tinyurl.com/4n6t7uxy

Week of September 15, 2024

China’s National Basic Public Health Services adds COPD 

Beijing, China - China includes COPD in their National Basic Public Health Service. This is significant in that China bears the highest burden of COPD globally, affecting 99.9 million people with 1.04 million deaths reported in 2019. The inclusion of COPD in the NBPHS is a positive sign that the political prioritization of COPD is on the rise, and it may well set a precedent for other countries to follow. To download the announcement: China NBPHS - COPD

Novel smart mask monitors exhaled breath continuously 

Pasadena, CA - Researchers here developed and validated a prototype of a mask-based device designed to continuously monitor exhaled breath condensate (EBC) in pilot studies. The EBCare mask looks similar to a KF94 mask and employs a self-cooling strategy, an automated microfluidic system, an electrochemical sensor array, and a wireless reading circuit, Wei Gao, PhD, of the California Institute of Technology in Pasadena, and colleagues reported in Science.  Unlike previous smart masks, EBCare provides real-time monitoring of multiple biomarkers simultaneously. The "tandem cooling and bioinspired microfluidic design ensure efficient EBC collection and transport, enabling in situ quantitative analysis," Gao told MedPage Today. The mask's "integration of highly selective electrochemical biosensors further enhances its capability to provide detailed molecular insights that were previously inaccessible with other wearable technologies," he added. EBC is a non-invasive aqueous matrix in which soluble gaseous and non-volatile biomarkers can be measured. Clinically, it's collected with a commercial condenser or condensation instruments, then analyzed in a lab using mass spectrometry or photometric assays to assess airway inflammation and substance metabolism. Other EBC capture methods rely on outside refrigeration, which can be difficult to incorporate, but EBCare uses a passive cooling system to effectively chill exhaled breath. "This research was motivated by the critical need for comprehensive respiratory monitoring, especially in light of recent respiratory pandemics," Gao said. The researchers validated the EBCare in various real-life settings. Their pilot studies included 31 healthy adults, 12 people newly recovered from COVID-19, 10 smokers, 10 people with asthma, and 9 people with chronic obstructive pulmonary disease (COPD). Over a span of 14 hours, participants went through both indoor and outdoor activities like exercise, eating, drinking, office work, and napping, wearing the mask the entire time except for 3-minute eating periods. After breakfast, ammonium concentration slightly decreased and then increased. These levels also rose more substantially after a protein-rich lunch and dinner. Alcohol consumption resulted in a rapid elevation of EBC alcohol concentration, and the levels were comparable to blood alcohol concentration. Patients with airway inflammation, especially with asthma, had higher nitrite levels than controls (P<0.0001), suggesting that EBC nitrite may help diagnose, monitor, or manage these patients. To demonstrate the clinical significance of EBC nitrite in asthma and other respiratory diseases, the researchers validated the EBCare sensors against fractional exhaled nitric acid (FeNO) and found a strong correlation (r=0.795) between EBC nitrite and FeNO in 31 people. Elevated EBC ammonium in COPD patients potentially indicated higher serum urea, and a lower EBC pH may be related to airway acidification in asthma patients, the researchers noted. "EBCare effectively monitors a range of biomarkers, including ammonium, pH, nitrite, and alcohol, across various indoor and outdoor activities," Gao said. This could have implications for monitoring respiratory conditions and metabolic disorders, as well as in respiratory pandemics like COVID. The alcohol metabolism monitoring capabilities could also be used by law enforcement or individuals, he added. Raed Dweik, MD, chief of the Integrated Hospital Care Institute at the Cleveland Clinic in Ohio, said that historically, devices to collect EBC have been bulky, so "collecting the breath condensate in a simple way that is reproducible, easy, and portable -- that is novel and exciting." While there are other ways to measure nitrite, alcohol, ammonia, and pH, Gao and his team demonstrated they can measure these biomarkers in EBC, he noted. "I think the concept that it can be done in a simple and portable way is great, but the things that they measure are not unusual," Dweik said. It's unclear whether EBCare has an immediate clinical application, Dweik observed, but he sees its potential. Future studies will need to determine whether the device helps in diagnosis, monitoring, and follow-up, and whether it can measure other things, he suggested. The researchers want to expand EBCare's biomarkers and perform more trials to validate its use in diverse populations and settings, Gao said. They also hope to further develop the device for affordable mass production and explore the possibility of integrated data analytics.

For more information: https://tinyurl.com/57wtfbz6

Week of September 9, 2024

New Canadian survey reveals widespread lack of awareness about Respiratory Syncytial Virus (RSV) 

Mississauga, ON - With healthy ageing becoming a topic of interest for many as our population in Canada continues to grow older, data from a new survey has highlighted significant gaps in knowledge among older Canadians about respiratory syncytial virus (RSV), which is a common contagious respiratory virus. The virus can lead to severe outcomes, including pneumonia and hospitalization, and can have lasting impact on adults’ daily function and independence. The online survey, commissioned by GSK, assessed the awareness and attitudes of a representative sample of 1,000 Canadians aged 50 and above towards RSV and other respiratory illnesses, as well as the impact of these conditions on their life. RSV is a leading cause of respiratory illness in adults. According to the most recent data available, RSV is estimated to have caused more than 5 million infections, 470,000 hospitalizations and 33,000 deaths among those aged 60 and above in high-income countries including Canada and the United States in 2019. Despite this high incidence, 46% of older Canadians surveyed had never heard of RSV. Even among those at increased risk of becoming seriously ill from an RSV infection due to an underlying medical condition, awareness remained low with less than 1 in 5 (18%) claiming to have at least moderate knowledge of RSV. Beyond just missing out on important life events, studies have shown that about one-third of older adults hospitalized with RSV experience acute functional decline and may never regain their pre-infection functioning. In addition, eight per cent saw an ongoing loss of independence six months after hospitalization. Marni Freeman, Country Medical Director, GSK Canada said: “RSV is a highly contagious virus and a major cause of respiratory illness in older adults. Those who are immunocompromised or suffer from underlying medical conditions such as chronic heart or lung disease, are at an even greater risk of severe outcomes. What may be of particular concern for many are the potential longer-term impacts of the virus that affect their level of independence and ability to fully take part in life’s cherished moments. The survey results highlight that more education is needed to ensure the full burden of disease is understood as well as ways to prevent it.” Various methods can help to reduce the risk of catching or spreading respiratory infections, including RSV. These include avoiding close contact with those who are unwell, practising good hygiene such as regular handwashing and coughing into a handkerchief, as well as vaccination. The survey aims to encourage more people to speak to their healthcare professional for guidance on how to reduce their risk of developing the potential serious consequences of RSV.

For citations and more information: https://tinyurl.com/45fvbwsr

RSV Vaccines Show High Effectiveness Against Hospitalization in Older Adults

Atlanta, GA - During the first season of use, respiratory syncytial virus (RSV) vaccination among older adults was associated with a substantially reduced risk of hospitalization, a test-negative, case-control study indicated. In adults 60 and over, vaccine effectiveness from October 2023 to March 2024 against RSV-associated hospitalization reached 75% (95% CI 50-87), according to researchers led by Diya Surie, MD, of the CDC in Atlanta. As reported in JAMA, effectiveness remained similar when estimated with inverse probability of vaccination weighting to balance for potential confounders (79%, 95% CI 56-90), and when analyzed across age groups: at 75% (95% CI 31-91) for adults ages 60 to 74 years and 76% (95% CI 40-91) for those age 75 and older. The CDC recommends a single dose of RSV vaccine for all adults age 75 and older, as well as for those ages 60 to 74 years at increased risk for severe RSV disease.  The agency  first recommended RSV vaccination for older adults in 2023 based on their high efficacy against RSV demonstrated in prelicensure randomized trials. However, the trials "were not powered to assess efficacy against RSV-associated hospitalization," the authors noted, and the studies excluded immunocompromised patients and underrepresented certain high-risk groups, such as those age 75 and older. Indeed, at the time the CDC made its initial recommendation, members of the Advisory Committee on Immunization Practices expressed concerns over trial data and whether enrolled participants represented those most at risk for serious outcomes. The current findings expand upon the prelicensure trial  in two ways, Surie and colleagues said. "First, they provide evidence of vaccine protection against RSV-associated, of which an estimated 60,000 to 160,000 occur annually among U.S. adults aged 65 years and older. Second, they demonstrate protection in a population that more closely represents those at high risk of severe RSV disease, including adults aged 75 years and older and those with immunocompromising conditions." For the study, 2,978 adults ages 60 and over were included: with 367 representing the case patients (12.3%) and the rest acting as controls. Among the 288 RSV cases with a known subtype, 73% were RSV B. Overall, the individuals had a median age of 72, a median Charlson Comorbidity Index score of 5, and 24.2% of them were immunocompromised. Participants were hospitalized with acute respiratory illness at one of 24 hospitals in 19 states participating in a surveillance network from Oct. 1, 2023 to March 31, 2024. They had clinical respiratory virus testing within 10 days of illness onset. Nasal swabs were tested by reverse transcription polymerase chain reaction for RSV, SARS-CoV-2, and influenza. Case patients tested positive for RSV only, and control patients tested negative for all of the viruses. RSV vaccination was defined as receipt of the vaccine 14 days or more before illness onset and status was determined via electronic medical records, immunization registries, and self-reporting; 2.5% of the case patients and 9.8% of control patients were vaccinated, with a median interval between vaccination and illness onset of 84 days. Vaccinated patients were more likely to be older (median 75 vs 72 years for unvaccinated patients), white (83% vs 61%), immunocompromised (32% vs 23%), and to have an outpatient visit in the past year (96% vs 90%). They were also more likely to live in communities with a lower Social Vulnerability Index score (median 0.37 vs 0.58, with a score of 1 representing the highest vulnerability; P<0.01 for all). Limitations of the study included that disparities in vaccine uptake and low uptake in the first season of use "might influence generalizability and the potential for residual confounding from unmeasured factors," Surie and colleagues wrote. Additionally, future studies are "important to confirm these findings and further examine vaccination effectiveness among subgroups and by time since vaccination." 

For more information: https://tinyurl.com/25wv2456

Week of September 1, 2024

Hospitalized patients with COPD misuse nearly 70% of inhalers

Fribourg, Switzerland - Inhaler misuse was high in hospitalized patients with COPD, with 69.4% of all inhalers at admission found to be misused, according to results published in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation. “As a hospital physician, these findings prompt me to systematically evaluate the inhalers used by COPD patients, regardless of their reason for hospitalization,” Gaёl Grandmaison, MD, assistant physician in internal medicine at University and Hospital of Fribourg in Switzerland, told Healio. “In response to these findings, we have implemented a systematic and standardized assessment of inhaler use among our patients, aiming to correct inhalation techniques or replace the inhaler if necessary,” Grandmaison continued. “This intervention has significantly reduced the number of improperly used inhalers at hospital discharge.” In a cross-sectional study, Grandmaison and colleagues evaluated 96 patients (mean age, 71.6 years; 63% men) in the internal medicine division of Fribourg Hospital with a diagnosis of COPD to find out how many patients in this population misuse inhalers via physiotherapist assessments and the In-Check Dial G16 (Alliance Tech Medical) over 9 months. Researchers cited inhaler misuse when a patient made a critical error in inhalation technique and/or had insufficient peak inspiratory flow (PIF). The total cohort had 160 inhalers, and nearly 70% (111 inhalers) had been misused. In the entire study population, 82.3% of patients used a minimum of one misused inhaler. “Numerous studies have highlighted the significant issue of improper inhaler use in outpatient settings,” Grandmaison said. “Our study confirms that this problem is also widespread.” A critical error in inhalation technique was behind more instances of inhaler misuse than insufficient PIF (105 inhalers; 65.6% vs. 22 inhalers; 13.8%), and this was also reflected in the proportions of patients who used a minimum of one inhaler with a critical error (81.3%) and had insufficient PIF (21.9%). To determine if targeted teaching can change the prevalence of inhaler misuse, researchers had physiotherapists carry out up to three teaching sessions and reassessed the number of inhalers with critical errors after each one. With each additional session, fewer inhalers had been used with critical errors (one session, 33 inhalers; two sessions, 15 inhalers; three sessions, nine inhalers). Five patients had cognitive disorders that inhibited them from reaching an adequate inhalation technique, according to researchers. A lack of coordination between inhaler activation and inspiration (n = 4) was another factor preventing adequate inhalation technique, followed by fine motor disorders and the inability to hold one’s breath sufficiently (each n = 2). Researchers further assessed how many inhalers were unsuitable, meaning they “cannot be used optimally, either because of an insufficient PIF or because of an inability to use an inhaler optimally despite specific teaching,” and found 27 (16.9%). Use of at least one unsuitable inhaler was noted in 25% of the study population. “Suboptimal inhaler use is associated with poor disease control, more frequent hospitalizations and increased costs,” Grandmaison said.

For more information: https://tinyurl.com/yww2ptw4

Week of August 25, 2024

Smoking is a key lifestyle factor linked to cognitive decline among older adults

London, UK - Smoking may be among the most important lifestyle factors affecting how quickly our cognitive skills decline as we age, suggests a new study led by UCL researchers. The study, published in Nature Communications, analyzed data from 32,000 adults aged 50 or over from 14 European countries who responded to surveys over 10 years. The researchers investigated how rates of cognitive decline might differ among cognitively healthy older adults with different combinations of health-related behaviors, including smoking, physical activity, alcohol consumption and social contact. Cognitive function was assessed according to participants' performance in memory and verbal fluency tests. Participants were grouped into lifestyles based on whether they smoked or not, whether they did both moderate and vigorous physical activity at least once per week, whether they saw friends and family at least weekly, and whether they drank more or the same/less than two alcoholic drinks per day (men) or one drink per day (women). They found that cognitive decline was faster for lifestyles that included smoking, while cognitive decline was generally similar for all non-smoking lifestyles. Smoking lifestyles had cognitive scores that declined up to 85% more over 10 years than non-smoking lifestyles. The exception was smokers who had a healthy lifestyle in all other areas—that is, they did regular exercise, drank alcohol in moderation, and socialized regularly. This group had a rate of cognitive decline similar to non-smokers. Lead author Dr. Mikaela Bloomberg (UCL Behavioral Science & Health) said, "Our study is observational so cannot definitively establish cause and effect, but it suggests smoking might be a particularly important factor influencing the rate of cognitive aging. "Previous evidence suggests individuals who engage in more healthy behaviors have slower cognitive decline; however, it was unclear whether all behaviors contributed equally to cognitive decline, or if there were specific behaviors driving these results. "Our findings suggest that among the healthy behaviors we examined, not smoking may be among the most important in terms of maintaining cognitive function. "For people who aren't able to stop smoking, our results suggest that engaging in other healthy behaviors such as regular exercise, moderate alcohol consumption and being socially active may help offset adverse cognitive effects associated with smoking." The researchers accounted for a range of factors that might have influenced the findings, including age, gender, country, education, wealth, and chronic conditions. The team used data from the English Longitudinal Study of Aging (ELSA) and the Survey of Health, Aging and Retirement in Europe (SHARE). 

For more information: https://tinyurl.com/5xszs8pa

Week of August 18, 2024

Canadian Pharmacies Emerge As 'First Stop' for Primary Care 

Toronto, ON - At its national summit on the future of primary care, the Canadian Pharmacists Association (CPhA) envisioned "a system where pharmacy is recognized as a first stop in the primary care journey for all peoples in Canada." Recent evidence suggests that this vision is being realized in some parts of the country. "Pharmacy-led clinics, where pharmacists provide direct patient care away from the dispensary area, have emerged as effective alternatives for nonemergency health issues," Danielle Paes, PharmD, CPhA's chief pharmacist officer, told Medscape Medical News. "Every healthcare service provided by a pharmacist is a potential avoided trip to the emergency room, especially for those Canadians without a family physician or nurse practitioner." Nova Scotia is "leading the way" with such clinics, she noted, citing the almost 10% decline in emergency department (ED) visits since the province embraced this model. A key reason for the impact is the support of governments across Canada for expanding pharmacist prescribing for minor ailments, she said. In addition to Nova Scotia's success, data show that Ontario has recorded more than 1 million minor ailment assessments since pharmacists' scope of practice was expanded in January 2023. "In British Columbia, pharmacists were granted that authority in June 2023 and provided more than 340,000 minor ailment and contraception  assessments as of March 2024," said Paes. Furthermore, in Prince Edward Island, pharmacists recently completed 100,000 assessments as part of their Pharmacy Plus program, she added. "These numbers illustrate that Canadians are increasingly turning to their pharmacists for care that they otherwise may have sought elsewhere, including emergency rooms." Allison Bodnar, CEO of the Pharmacy Association of Nova Scotia, provided context for the success of the pharmacy-led clinics that are serving as a model for other provinces. In 2021, Nova Scotia elected a new government that developed an Action for Health plan with the goal of ensuring that all healthcare practitioners, including pharmacists, were working within their full scope. "Part of our role as a professional body, within our contract with government, is to run pilot programs to demonstrate the value of pharmacy services," Bodnar told Medscape Medical News. One project currently underway involves community pharmacy primary care clinics. The clinics, which are in areas with the highest number of people without a family doctor, provide services at no charge to people with a Nova Scotia Health Card. These services include assessment and prescribing for strep throat, pink eye, and urinary tract infections; chronic disease management for diabetes, asthma, and chronic obstructive pulmonary disease; prescription renewals; vaccines; and medical injections. "We launched the project with 12 sites," said Bodnar. "The government immediately asked us to double that, and we now have 30 sites and are looking to increase some more." 

For more information: https://tinyurl.com/3xcjcm4e

Week of August 11, 2024

FDA grants breakthrough designation to tezepelumab for COPD

Silver Spring, Maryland - Tezepelumab has received an FDA breakthrough therapy designation as a maintenance treatment for patients with moderate to very severe COPD characterized by an eosinophilic phenotype, according to an Amgen press release. Tezepelumab (Tezspire; Amgen, AstraZeneca) is currently approved by the FDA as an add-on maintenance treatment of adults and children aged 12 years and older with severe asthma. The FDA has granted breakthrough therapy designation to tezepelumab for patients with moderate to very severe COPD, which could accelerate the development and regulatory review of the drug, according to a press release. The COPD designation was supported by the multicenter, randomized, double-blind, placebo-controlled phase 2a COURSE study, data presented at this year’s American Thoracic Society International Conference. In this study, researchers found that patients with moderate to very severe COPD receiving 420 mg tezepelumab every 4 weeks (n = 165) vs. placebo (n = 168) had a 17% decrease in the annualized rate of exacerbations. Dividing the cohort based on blood eosinophil count revealed a larger drop in exacerbation rate with tezepelumab, with decreases of 37% (rate ratio = 0.63; 95% CI, 0.43-0.93) in the 150 cells/μL or more count group, 34% (rate ratio = 0.66; 95% CI, 0.42-1.04) in the at least 150 cells/μL to less than 300 cells/μL count group and 46% (rate ratio = 0.54; 95% CI, 0.25-1.15) in the 300 cells/μL or more count group.In terms of safety, patients in the tezepelumab group and patients in the placebo group experienced a comparable number of adverse events and serious adverse events. “The FDA’s decision to grant breakthrough therapy designation for tezepelumab in COPD represents a significant milestone in our commitment to advancing effective treatment options for patients with moderate to very severe disease,” Sharon Barr, PhD, executive vice president and head of biopharmaceuticals research and development at AstraZeneca, and Jay Bradner, MD, executive vice president of research and development and chief scientific officer at Amgen, told Healio in a joint statement. “This recognition validates our belief in tezepelumab and its promise as a new treatment for COPD.” Breakthrough therapy designation is granted to accelerate development and regulatory review of investigational drugs that are intended to treat serious or life-threatening diseases and conditions. “As we advance our clinical development program, we look forward to working with the FDA to bring this potential therapy to these patients as quickly as possible,” Barr and Bradner continued. The release said phase 3 study planning “remains on track.” 

For more information: https://tinyurl.com/2vtbh9nm

Week of August 4, 2024

Researchers find that pneumonia diagnoses could be largely inaccurate

Salt Lake City, Utah - Over half of inpatient pneumonia diagnoses changed from the emergency department (ED) to discharge, and uncertainty was more common than not in clinical notes, according to a nationwide retrospective analysis of Veterans Affairs (VA) data. Among over 317,000 hospitalizations for pneumonia, 57% had discordance between initial and discharge diagnoses, and 58% of patient records examined indicated uncertainty in diagnosis, Barbara Jones, MD, MS, of the Salt Lake City VA Healthcare System and the University of Utah there, and colleagues reported in the Annals of Internal Medicine.  "We should anticipate diagnostic discordances and uncertainty in pneumonia," the authors wrote. "Clinicians often encounter pressure to provide distinct diagnostic labels to facilitate hospital admission, simplify handoffs, or satisfy patients." Of patients discharged with a positive initial chest image and a diagnosis of pneumonia, 33.4% never received an initial diagnosis in the ED. And of those who did have an initial diagnosis of pneumonia, 36.3% did not have it as a discharge diagnosis and 21% lacked positive initial chest imaging. While the study couldn't attribute causality, mortality differed between these groups. Pneumonia diagnosed by discharge but not initially had a 14.4% 30-day mortality rate compared with 10.6% when it was recorded on both initial and discharge diagnoses. "Pneumonia can be a difficult diagnosis," Mark Metersky, MD, of the University of Connecticut School of Medicine in Farmington, and Grant Waterer, MBBS, PhD, of the University of Western Australia and Curtin University in Perth, commented in an accompanying editorial.  "Very often at the time of admission, we do not know if the patient has pneumonia, an exacerbation of chronic obstructive pulmonary disease, heart failure, or a combination of these conditions," they pointed out. "We often treat for 2 or even all 3 diagnoses," the editorialists wrote. "The patient almost always improves and leaves the hospital with ongoing uncertainty about the correct diagnosis." And, in many cases, discordant diagnoses might not be inaccurate in patients with multiple conditions, they pointed out. "There is little mystery about why the diagnosis of pneumonia is often inaccurate," Metersky and Waterer commented, noting chest radiographs frequently lack inter-observer agreement on the presence or absence of pneumonia, even among radiologists. The most common sources of diagnostic error in the analysis were misinterpretation of chest imaging as positive when it was negative, failure to see chest image reports, and failure to appreciate whether signs of infection were present or absent. When researchers evaluated 50 patient charts, they found that 58% of ED notes and 49% of discharge notes expressed diagnostic uncertainty. Chart review also revealed that about 90% of patients received antibiotics, 27% received diuretics, and 36% received corticosteroids in the first 24 hours of admission. About 10% received treatment with all three medications. Patients with discordant diagnoses had greater uncertainty documented in clinical notes and received more treatments than those with concordant diagnoses. "These findings highlight substantial diagnostic uncertainty and treatment ambiguity in pneumonia that warrants recognition by systems, clinicians, and patients," Jones and colleagues wrote. The editorialists emphasized that "a clinical pathways should support diagnostic uncertainty as a productive component of clinical reasoning." Patients with diagnostic discordance had slightly more renal disease and heart failure, ED stays of longer than 8 hours, and treatment with both corticosteroids and diuretics than those with concordance. Those with concordant diagnoses were more likely to present with fever, abnormal white blood cell count, and elevated C-reactive protein and procalcitonin. Patients with discordance were also more likely to have less severe illness and lower levels of inflammatory markers. However, they underwent substantially fewer CT scans than patients with concordant diagnoses -- 7.4% versus 33.2%, respectively. Patients with discordance also had fewer microbiology tests performed, but the percentage of positive cultures were similar between the two groups. Researchers also found variations in diagnostic discordance between individual hospitals, noting that it was more common at high-complexity facilities with high patient loads. The analysis included over 2.4 million patient encounters at EDs that resulted in hospitalizations in the VA healthcare system. In total, 13.3% of encounters involved a diagnosis of pneumonia at the ED visit or by discharge, with 9.1% receiving an initial diagnosis and 10% getting a discharge diagnosis. Researchers identified pneumonia diagnoses using diagnostic codes assigned in the ED or at hospital discharge and based on notes from the ED, clinician, discharge, and radiology that identified a pneumonia diagnosis, as well as orders for or administration of antibiotics or antiviral medications. Using natural language processing tools, Jones and colleagues also looked for evidence of uncertainty in a subset of 50 randomly selected patient records -- for example, terms such as "possible pneumonia." The mean age of the pneumonia patients was about 72 years, with about three-quarters reporting white race and most being male, reflecting the VA population. The analysis had some limitations, the authors pointed out. Since the study relied on retrospective data, some discordance may have been due to coding or documentation errors. Also, the study did not address confounding factors and could not establish causal effects of diagnostic discordance on clinical outcomes. 

For more information: https://tinyurl.com/59fwzjhh

Week of July 28, 2024

World-first trial shows benefits of finding and treating undiagnosed asthma and COPD 

Ottawa, ON Finding and treating people with undiagnosed asthma or chronic obstructive pulmonary disease (COPD) improved their health and reduced their health care visits for respiratory symptoms in the year after diagnosis, according to a world-first clinical trial published in the New England Journal of Medicine. "It's estimated that 70% of people with asthma or COPD go undiagnosed," said study lead Dr. Shawn Aaron, a senior scientist and lung specialist at The Ottawa Hospital and professor at the University of Ottawa. "This is the first study to prove that treating those people makes a real difference to their health and quality of life." To find people with undiagnosed asthma and COPD, the research team called random phone numbers at 17 study sites across Canada from 2017 to 2023. An automated call asked whether any adults in the household had unexplained shortness of breath, wheezing, prolonged cough or were coughing up mucus in the past six months. The 26,905 people who reported these symptoms completed questionnaires. Those most likely to have asthma or COPD did a spirometry breathing test, the gold standard for diagnosis. A total of 595 people were diagnosed with either asthma or COPD, and 508 agreed to participate in a randomized controlled trial to compare different types of care. Half the people in the trial were randomly assigned to usual care (care provided by their primary care provider or a walk-in-clinic), while the other half were treated by a lung specialist and asthma/COPD educator (a specially-trained nurse or respiratory therapist). Individuals treated by a lung specialist and educator were prescribed inhalers to treat their asthma or COPD and were taught how to use them. Some were given action plans to help them manage disease flare-ups themselves. They were provided with smoking cessation treatment, exercise and weight counseling, and pneumonia and flu vaccines if appropriate. Of patients seen by a lung specialist and asthma/COPD educator, 92% started new medications for asthma or COPD, compared to 60% of patients who received usual care. The researchers found that patients seen by a lung specialist and asthma/COPD educator averaged 0.53 health care visits per year for respiratory symptoms in the year after diagnosis, compared to 1.12 visits in the usual care group. In addition, patients seen by a lung specialist and asthma/COPD educator saw their average score on the St. George's Respiratory Questionnaire rise by 10.2 points, compared to 6.8 points for the usual care group. A four-point rise means an improvement in health and quality of life. "In the real world, not everyone can see a lung specialist," explains Dr. Aaron. "The good news is that as long as a patient gets diagnosed and treated, their symptoms will improve. The people in our study who went to primary care providers and walk-in clinics had great outcomes, and those who went to a lung specialist and asthma/COPD educator had excellent outcomes." 

For more information: https://tinyurl.com/2zz6veef

Week of July 21, 2024

COPD, IPF end of life health care use differs from lung cancer

San Diego, CA -Six months before dying, patients with COPD and idiopathic pulmonary fibrosis vs. lung cancer had reduced odds for outpatient palliative care, according to a poster at the American Thoracic Society International Conference. “We were surprised by the extreme differences in end-of-life palliative care use in COPD and IPF compared to lung cancer,” Angela O. Suen, MD, clinical instructor and research fellow in the division of pulmonary, critical care, allergy and sleep medicine at UCSF, stated. Six months before dying, patients with COPD and idiopathic pulmonary fibrosis vs. lung cancer had reduced odds for outpatient palliative care, according to a study abstract. These findings were particularly surprising “in a health care system in which robust palliative care services are available to oncologic and non-oncologic diagnoses,” she continued. Using records of outpatient/inpatient visits at the University of California, San Francisco (UCSF), Suen and colleagues assessed 1,543 patients with lung cancer, 1,004 patients with COPD and 530 patients with IPF, all of whom had died, to see how palliative care and health care use during the patients’ final 6 months differed between those with lung cancer and those with either COPD or IPF. The COPD and IPF cohorts significantly differed (P < .001) from the lung cancer cohort on accounts of age at death, sex, race/ethnicity and comorbidity burden, according to researchers. “Compared to the lung cancer group, patients with COPD and IPF were more likely to be white, male, older at the time of death and have a lower burden of comorbidities,” Suen and colleagues wrote. Following adjustment for age, sex, race/ethnicity and weighted Charlson comorbidity index, the likelihood for outpatient palliative care was significantly reduced among those with COPD vs. those with lung cancer (adjusted OR = 0.34; 95% CI, 0.26-0.45), as was the likelihood for outpatient opioids (aOR = 0.52; 95% CI, 0.42-0.65). Researchers observed similar findings when evaluating patients with IPF vs. patients with lung cancer in terms of odds for outpatient palliative care (aOR = 0.53; 95% CI, 0.37-0.74) and odds for outpatient opioids (aOR = 0.42; 95% CI, 0.31-0.55). In contrast, patients with IPF faced elevated likelihoods for four assessed outcomes when placed against patients with lung cancer, including: intensive care (aOR = 3.75; 95% CI, 2.65-5.31); mechanical ventilation (aOR = 3.22; 95% CI, 2.18-4.75); high flow nasal oxygen (aOR = 2.87; 95% CI, 1.91-4.32); and inpatient palliative care consultation (aOR = 2.26; 95% CI, 1.59-3.21). The odds for intensive care were also heightened among those with COPD vs. those with lung cancer (aOR = 2.13; 95% CI, 1.65-2.75), according to researchers. The only other outcome patients with COPD had an increased likelihood for vs. patients with lung cancer was mechanical ventilation (aOR = 1.94; 95% CI, 1.41-2.67). “Overall, we learned that there is more work to be done to understand this discrepancy so that we may be able to address this,” Suen said. 

For more information: https://tinyurl.com/5d57uax8

Week of July 14, 2024

Triple therapy inhaler improves lung hyperinflation, exercise endurance time in COPD

San Diego, CA - An inhaler with beclomethasone dipropionate, formoterol fumarate and glycopyrronium lowered lung hyperinflation in patients with COPD, according to research presented at the American Thoracic Society International Conference. Further, this triple therapy inhaler, along with a dual therapy inhaler including beclomethasone dipropionate and formoterol fumarate, benefitted patients by improving exercise endurance time, according to researchers. An inhaler with beclomethasone dipropionate, formoterol fumarate and glycopyrronium lowered lung hyperinflation in patients with COPD, according to presented research.In a randomized, double-blind, three-period crossover, placebo-controlled phase 4 study, Henrik Watz, MD, co-leader of the Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North and member of the German Center for Lung Research, and colleagues assessed 106 patients (38% women) with symptomatic moderate to severe COPD to see how a single inhaler triple therapy, a single inhaler dual therapy and placebo each impact lung hyperinflation and exercise endurance time after 3 weeks of use. Researchers noted that included patients had hyperinflation while receiving stable mono or dual inhaled maintenance COPD treatment. The triple therapy was composed of 100 μg extra-fine beclomethasone dipropionate per actuation, 6 μg formoterol fumarate per actuation and 10 μg glycopyrronium per actuation (BDP/FF/G; Chiesi), whereas the dual therapy only included 100 μg BDP per actuation and 6 μg FF per actuation (BPD/FF). For all three treatments, the administration regimen was two inhalations twice a day. Between baseline and the end of the 3-week treatment period, researchers observed a significantly greater change in 2-hour post-dose inspiratory capacity with BDP/FF/G vs. placebo (0.315 L; 95% CI, 0.25-0.38; P < .001), as well as with BDP/FF vs. placebo (0.223 L; 95% CI, 0.16-0.285; P < .001). Additionally, compared with placebo, the change in 2-hour post-dose exercise endurance time from baseline was better with the triple therapy (69.2 seconds; 95% CI, 32.9-105.5; P < .001) and the dual therapy (70.1 seconds; 95% CI, 33.6-106.6; P < .001). In terms of changes in inspiratory capacity at isotime, which was defined as the “shortest [exercise endurance time] at either the start or end of each treatment period” from baseline, significant improvement was found with BDP/FF/G vs. placebo (0.245 L; 95% CI, 0.147-0.342; P < .001) but not with the dual therapy inhaler vs. placebo. Between the triple therapy inhaler and the dual therapy inhaler, researchers noted that BDP/FF/G improved inspiratory capacity 2-hour post-dose (0.092 L; 95% CI, 0.028-0.157; P = .005) and inspiratory capacity at isotime (0.149 L; 95% CI, 0.052-0.246; P = .003). With no reported safety signals from the researchers, the inhalers appear safe. 

For more information: https://tinyurl.com/je6mkks4

Week of July 7, 2024

Primary Care COPD Clinic Could Be a Model for Lasting Survival Benefit

Hong Kong - A regional primary care, nonphysician-based program for chronic obstructive pulmonary disease (COPD) was associated with improved longer-term survival, a propensity-matched cohort study in Hong Kong showed. COPD patients seen in family medicine and general outpatient clinics that participated in Nurse and Allied Health Clinic-Respiratory Care (NAHC-Respiratory) had lower risks of all-cause mortality through roughly 7 years of follow-up compared with patients who had usual care at other public outpatient clinics (32.1% vs 37.2%, HR 0.84, 95% CI 0.78-0.90), reported Kailu Wang, PhD, of the Prince of Wales Hospital in Hong Kong, and co-authors. NAHC-Respiratory was also associated with significant reductions in various cause-specific deaths:

• Pneumonia mortality (9.6% vs 11.3%, HR 0.85, 95% CI 0.74-0.97)
• Respiratory mortality (14.6% vs 16.8%, HR 0.86 95% CI, 0.77-0.96)
• Cardiovascular mortality (3.2% vs 4.3%, HR 0.74, 95% CI 0.59-0.93)

Exposure to the NAHC-Respiratory program was further associated with reduced rates of both visits to the emergency department (incidence rate ratio [IRR] 0.92, 95% CI 0.86-0.98) and hospitalizations through the emergency department (IRR 0.89, 95% CI 0.83-0.95), Wang and colleagues said in JAMA Health. "This study provides evidence that the care model involving nurses and allied health professionals can facilitate COPD treatment, highlighting that health care professionals other than physicians are important in patient follow-up and disease management in the primary care setting," the authors concluded. The report adds longer-term benefits to the existing evidence of improved lung function and quality of life among NAHC-Respiratory participants after 6 opens and 12 months. NAHC-Respiratory was introduced to Hong Kong primary care settings in 2009 as a program -- primarily coordinated by nurses, physiotherapists, and occupational therapists -- for patients with COPD and those with a high risk of developing COPD referred by physicians. The public sector program offered patient education on physical exercise and lifestyle, smoking cessation, vaccinations, and pulmonary rehabilitation for enrolled patients with a relatively low baseline mortality risk. Wang and colleagues suggested that the benefits they observed may be attributed to influenza and pneumococcal vaccinations and smoking cessation. Notably, the all-cause mortality benefit hinged on age, being statistically significant only for patients 60-79 years old at baseline (HR 0.82, 95% CI 0.74-0.90) and ever smokers (HR 0.75, 95% CI 0.68-0.84). Associations with all-cause mortality were not significant among patients who were under the age of 60, were 80 years old or above, were non-smokers, or for patients without smoking status records. "These findings indicate the program's potential to improve long-term health outcomes of patients with COPD and save health care resources of hospitals through a primary care intervention, although improvement of service provision may be needed for patients younger than 60 years," researchers wrote.

For more information: https://tinyurl.com/msv7tv2w

Week of June 30, 2024

CDC universally recommends RSV vaccines for oldest US adults

Atlanta, GA - The CDC’s vaccine advisors voted unanimously Wednesday to recommend that everyone aged 75 years or older get vaccinated against respiratory syncytial virus. The Advisory Committee on Immunization Practices (ACIP) also voted unanimously to recommend RSV vaccination for people aged 60 to 74 years who are at high risk for severe RSV disease. The CDC’s ACIP voted to change its RSV vaccination recommendation to a risk-based recommendation for the oldest adult population and those at high risk for severe disease. The votes supplant a weaker recommendation made by the CDC last year that said people aged 60 years or older should talk to their provider about getting vaccinated against RSV. Following the ACIP vote, CDC Director Mandy Cohen, MD, MPH, signed off on the recommendations, making them official. Cohen said the vaccines “provide an extra layer of protection” for patients at highest risk for severe RSV. “There was very strong desire to move away from shared clinical decision-making after hearing a lot of comments that it made it difficult for physicians and pharmacists to implement RSV vaccines,” Healio | Infectious Disease News Editorial Board Member William Schaffner, MD, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center and former medical director of the National Foundation for Infectious Diseases, said in an interview after the votes. “So, they looked over their data and went to the highest risk group and voted to make it routine that everybody age 75 and older receive a single dose.” ‘Shared clinical decision-making in sheep's clothing’ Both recommendations received unanimous support from the 11-member ACIP voting body. The committee clarified that only people who have not already received an RSV vaccine shout get a shot. Adults aged 60 to 74 years who are not at an increased risk for severe RSV disease are no longer included in the recommendations. The CDC will publish clinical considerations describing medical conditions and other risk factors for severe RSV disease for providers to reference. Online, the agency lists cardiopulmonary disease, kidney disorders, liver disorders, neurologic or neuromuscular conditions, hematologic disorders, diabetes and moderate or severe immune compromise as risk factors for severe RSV in adults aged 60 years or older. Schaffner said the risk-based approach “is not a lot easier than shared clinical decision-making.” “It's really shared clinical decision-making in sheep's clothing,” he said. “It's as difficult for doctors and pharmacists as shared clinical decision-making.” The ACIP reviewed updated data on the available RSV vaccines, including from Pfizer’s RENOIR trial, which showed that RSV vaccine, Abrysvo, was 89% (95% CI, 52%-97%) effective at preventing hospitalizations and emergency department visits caused by RSV-related lower respiratory tract disease (LRTD) in a study population that was 57% people aged older than 75 years and 14% immunocompromised. Updated data for GSK’s Arexvy showed that, over 2 years, the vaccine was 67.7% effective (95% CI, 52.3%-78.7%) at preventing RSV-related LRTD with a season covariate and 73.3% (95% CI, 60.7%-82.4%) without. Among study participants aged 70 years and older, the vaccine was 74.6% (95 CI, 52.6%-87.5%) and 79.1% (95% CI, 81.3%-89.7%) effective. Moderna presented data that showed its recently approved vaccine, mResvia, was 78.7% effective against RSV-related LRTD with two or more symptoms among adults aged 60 years or older and 80.9% effective against RSV-related LRTD with three more symptoms. Further analysis of 18-month data showed a vaccine efficacy of 50.3% and 49.9%, respectively. While the committee ultimately voted in favor of these changes to RSV vaccine recommendations, concerns were voiced before the vote regarding “backtracking” by removing older adults without underlying conditions or risk factors from the recommendations. “It is OK for us to reevaluate vaccines and use them as they are needed. We're one of the few countries that does not do that,” ACIP chair Helen Keipp TalbotMD, MPH, professor of medicine at Vanderbilt University, said during the meeting. “That only lends us credibility in saying, ‘We have reviewed this. This is the right use of medical funds. This is the right way to save lives. This is the right way to reduce risk of vaccines.’” The ACIP did not hold a vote on whether to recommend RSV vaccination for patients aged 50 to 59 years despite the FDA’s recent decision to extend the approval of GSK’s vaccine for high-risk patients in that age group.

For more information: https://tinyurl.com/vbkj7mad

Week of June 23, 2024

Lung cancer screening program identifies airways disease in previously undiagnosed COPD

San Diego, CA - More than 75% of individuals who underwent lung cancer screening without a reported history of COPD had airways disease, according to research presented at the American Thoracic Society International Conference. Airflow obstruction was also apparent in 36.5% of individuals with previously undiagnosed COPD and spirometry data, according to researchers. “These findings will help the everyday clinician target the most at-risk populations for previously undiagnosed COPD,” Michaela Seigo, DO, chief pulmonary and critical care fellow at Temple Health, told Healio. Using data from the Temple Healthy Chest Initiative (THCI) lung cancer screening program between October 2021 and October 2022, Seigo and colleagues evaluated 2,083 individuals with low-dose CT scans to determine how individuals with vs. without a history of COPD differ based on demographics and pulmonary comorbidities. Notably, the THCI also involves symptom detection during the time of the low-dose CT scan, in which patients report their symptoms through a phone call or a paper survey to a dedicated Nurse Navigator. Researchers divided up patients according to their COPD status noted in the electronic medical record. This record also housed patient demographic information and spirometry data. Between those with vs. without a history of COPD, researchers observed significant differences in mean age (65.8 years vs. 63.9 years), gender (women, 56.6% vs. 50.2%), smoking status (current, 49.2% vs. 59.6%; former, 50% vs. 35.9%) and the classification of a race other than Black, non-Hispanic; Asian/Native American/Pacific Islander; white, non-Hispanic; Hispanic; and unknown (4.3% vs. 5.6%). LungRADS scores also differed between the two groups. Compared with individuals with COPD, a greater proportion of individuals without COPD had a score of 1 (37.3% vs. 32.6%) and 3 (8.3% vs. 6.9%). In contrast, the group with vs. without COPD had a higher proportion of individuals with a score of 2 (52.3% vs. 50.2%) and 4 (7.6% vs. 3.8%). Researchers also found significant differences between the two groups with regard to the prevalence of various pulmonary comorbidities on low-dose CT. Significantly fewer individuals without vs. with a history of COPD had emphysema (27.5% vs. 72.5%), airways disease (76.2% vs. 84%), emphysema plus airways disease (25.9% vs. 32.3%), bronchiectasis (12% vs. 17.9%) and interstitial lung disease (6.7% vs. 11.3%). “We detected pulmonary comorbidities at higher rates than previously published,” Seigo said. “I think this is a reflection of how our population at Temple is unique: it is composed of more city-dwelling, lower income and racial/ethnic minorities/people of color.” Of the total cohort, less than one-third of patients completed a symptom survey (29%) and had spirometry data (30%). Symptom survey results revealed that those without COPD had a significantly higher proportion of individuals deemed less dyspneic than those with COPD (72% vs. 62.8%) and a significantly lower proportion of individuals with ever dyspnea (88.1% vs. 93.6%). Additionally, a significantly lower proportion of those without vs. with COPD had “more cough” (27.4% vs. 34.2%) and agreed with the statement, “breathing affects your ability to do things” (24.5% vs. 56.6%), according to researchers. Airflow obstruction was identified as an FEV1/FVC ratio less than 70% and was observed in 36.5% of those without a history of COPD vs. 69.2% of those with a history of COPD. When considering how future studies will be different, Seigo highlighted AI.“In the future, I think AI will play a dominant role,” she said. “At-risk populations will get [low-dose] CT scans and AI will spit out a list of pulmonary and extra-pulmonary comorbidities that may need to be addressed. “Together, with symptom detection plus strategic and more widely available access to screening in  general, there is a huge opportunity to intervene earlier and potentially save lives,” Seigo continued. 

For more information: https://tinyurl.com/4xykrj89

Week of June 16, 2024

FDA Expands Use of RSV Vaccine to Include More Adults

Silver Spring, Maryland - The FDA expanded the approval of GSK's respiratory syncytial virus (RSV) vaccine (Arexvy) to include adults ages 50 to 59 at risk of RSV-related lower respiratory tract disease (LRTD) due to underlying conditions, the company announced recently. Previously the adjuvanted RSV prefusion F protein-based vaccine had been approved only for adults 60 and older ; it is currently recommended for use via shared decision-making by the CDC and Advisory Committee on Immunization Practices. According to the vaccine maker, an estimated 13 million U.S. adults ages 50 to 59 years have medical conditions -- e.g., asthma, chronic obstructive pulmonary disease, diabetes, heart failure -- putting them at increased risk of RSV-related LRTD and its serious consequences, including pneumonia and death. "When it comes to the risks associated with RSV, age is just a number, an important number, but not the only factor to consider," Ann Falsey, MD, of University of Rochester School of Medicine in New York, said in a statement from GSK. "Many adults in this age group have underlying health conditions that place them at increased risk for serious illness with RSV infection compared with those without these conditions. Now there is a vaccine approved that can help protect them." About 42,000 hospitalizations occur each year in the U.S. among adults ages 50 to 64 years old, according to a systematic review and meta-analysis. That compares to approximately 159,000 annual hospitalizations in U.S. adults 65 and older. The new approval was based on results of a double-blind phase III multinational trial  that demonstrated noninferior immune responses with the vaccine for 1,140 participants ages 50 to 59 (half of whom had high-risk conditions for RSV-LRTD) versus older adults. In both of the younger groups, RSV-A and RSV-B neutralization titers were similar 1 month after administration of a single vaccine dose compared to the older group. Safety and reactogenicity were consistent with the pivotal trial data for adults 60 and over, said GSK, with most adverse events (AEs) being mild to moderate and also transient. In the adults ages 50 to 59, the most commonly reported AEs were pain at the injection site (76%), fatigue (40%), myalgia (36%), headache (32%), arthralgia (23%), erythema (13%), and swelling (10%). Safety information in the labeling also includes warnings about the potential for severe allergic reaction and syncope after administration, and that immunocompromised people may have a diminished immune response. 

For more information: https://tinyurl.com/3zyhpdzj

Week of June 9, 2024

New study claims biologics lower exacerbations, hospitalizations in COPD

San Diego, CA - After 1 year of biologic therapy, patients with COPD and Th2 inflammation experienced fewer exacerbations and hospitalizations, according to research presented at the American Thoracic Society International Conference. “Because we took a real-world approach including all comers with COPD who received biologics, this may be more directly relatable to patients at large and patients being treated by clinicians, primary care doctors and pulmonologists every day in the community,” stated Stephen R. Dachert, MD, a fellow in the department of thoracic medicine and surgery at Temple University Hospital. In a real-world, single-center, retrospective review, Dachert and colleagues evaluated 53 patients (mean age, 70.7 years; 58% women) with COPD and Th2 inflammation and a biologic prescription to find out how 1-year biologic use impacts acute exacerbations of COPD and lung function. Before starting biologic therapy, the average eosinophil count was 471 cells/µL. The most prescribed biologic in this cohort was mepolizumab (n = 40; 66.7%; Nucala, GSK), followed by benralizumab (n = 14; 23.3%; Fasenra, AstraZeneca), dupilumab (n = 5; 8.3%; Dupixent; Regeneron, Sanofi) and tezepelumab (n = 1; 1.7%; Tezspire; Amgen, AstraZeneca). Notably, this sample included patients with mild to severe emphysema and patients with airflow obstruction, which Dachert said are both underrepresented in randomized clinical trials. This cohort was also diverse in race/ethnicity, including white patients (65%), Black/African American patients (20%), Hispanic patients (8.4%) and patients from other racial/ethnic groups (6%). “Being from Temple, we are lucky that we have a very diverse patient population, which oftentimes is not the case in a lot of large, randomized clinical trials,” Dachert said. Compared with the number of exacerbations observed 1 year prior to biologic therapy use, researchers found that 1 year of biologic therapy significantly lowered the number of exacerbations by 1.883 (95% CI, 1.382-2.385). Further, 1 year of biologic use also led to a significant decrease in the number of hospitalizations vs. the year before biologic use (0.783; 95% CI, 0.427-1.14). “The big takeaway in our large, real-world study of diverse patients with a lot of comorbidities, including emphysema and high exacerbation burden, is that we showed a statistically significant reduction in both moderate and severe exacerbations, including hospitalizations,” Dachert said. “Specifically, the hospitalization finding has not been shown before, so we are novel in showing that.” To observe changes in spirometry following biologic therapy use, researchers assessed several measures of percent-predicted lung function: FEV1, FVC, total lung capacity, residual volume and diffusing capacity of the lungs for carbon monoxide (DLCO). For all the above measures, the difference between 1 year before and 1 year after biologic therapy use did not reach significance. The only measure of lung function that “trended towards significance” was an increase in DLCO, according to researchers. Considering the real-world aspect of this study, Dachert emphasized the value of the main findings for clinicians. “This information would be very useful to general clinicians and pulmonologists in that they may find that their patients look more like the patients that we looked at in our study,” he said. Future studies on this topic should strive to include more patients, Dachert told Healio. “In this study, we looked at things like emphysema and varying degrees of airflow obstruction and saw that there was no statistical difference in exacerbations in those specific groups,” Dachert said. “Moving forward, if we’re able to increase the amount of data that we have, we may be able to identify some kind of variable that would be associated with an even higher reduction in exacerbations.” 

For more information: https://tinyurl.com/bdsww47

Week of June 2, 2024

Inadequate social support contributes to depression, disease impact in COPD

Aalborg, Denmark - Perceived inadequate social support among patients with COPD living with a loved one was linked to more depression symptoms and greater disease impact, according to results published in Respiratory Medicine. “This study underlines the importance of addressing social support in the care for patients with COPD, even if they have a resident loved one,” Anna L. Stoustrup, PT, MSc, PhD fellow at Aalborg University Hospital in Denmark, and colleagues wrote. In a cross-sectional study, Stoustrup and colleagues assessed 191 patients with COPD (mean age, 65.6 years; 53.4% men; mean FEV1 47.3% percent predicted) living with a loved one to determine how inadequate vs. adequate social support impacts eight clinical outcomes: lung function, dyspnea, health status, anxiety symptoms, depression symptoms, care dependency, functional status and mobility.Researchers used the Medical Outcomes Study-Social Support Survey (MOS-SSS) to find out if patients perceived their social support as adequate or i nadequate. The most common relationship patients had with their resident loved one was spouse/partner (97.9%), with fewer patients living with their child (1.6%) or friend (0.5%). Of the total cohort, more patients reported adequate vs. inadequate social support (81.7% vs. 18.3%). In the adequate social support group, the average overall support index score was 4.5 out of 5 points, whereas this score was 2.8 out of 5 points in the inadequate social support group. Three of the eight assessed clinical outcomes significantly differed according to the level of perceived social support, with worse outcomes seen in the inadequate group, researchers wrote. Use of the COPD Test Assessment revealed a higher disease impact among patients with inadequate vs. adequate social support (25 points vs. 21 points; P = .004). To evaluate symptoms of depression and anxiety, researchers used the Hospital Anxiety and Depression Scale (HADS) and found scores signaling more depression symptoms in the group with perceived inadequate social support (8 points vs. 5 points; P = .004). Lastly, inadequate social support was linked to an elevated Care Dependency Scale score, suggesting more care dependency, when compared with adequate social support (69 points vs. 71 points; P = .04) in this study population. Lung function (FEV1 percent predicted), dyspnea (Modified Medical Research Council Dyspnea Scale score), anxiety symptoms (HADS-anxiety score), functional status (Instrumental Activity of Daily Living score) and mobility (Timed Up and Go test) did not significantly differ based on inadequate vs. adequate social support. “The relationship between perceived level of social support and actual support needs is relevant to unravel further when using the MOS-SSS or otherwise assessing social support among patients with COPD,” Stoustrup and colleagues wrote. 

For more information: https://tinyurl.com/3nmpsket

Week of May 26, 2024

Increasing doses of varenicline or nicotine replacement helps persistent smokers quit

Houston, TX - For most smokers, quitting on the first attempt is likely to be unsuccessful, but a new study from The University of Texas MD Anderson Cancer Center found patients were more likely to quit if their cessation regimen was altered and doses were increased. Researchers also found that varenicline, a cessation medication, was more effective than combined nicotine replacement therapy (CNRT), such as patches or lozenges. The study, published today in JAMA, revealed smokers who failed to quit with varenicline in the trial’s first phase were seven times more likely to quit by the end of the second phase if varenicline doses were increased. There also was a nearly two-fold increase in those who successfully quit if they were switched from a CNRT regimen to varenicline. These results are favorable compared to the near zero chance of abstinence seen in patients who were switched from varenicline to CRNT or left on the same treatment plans. "These data indicate that sticking to the same medication isn't effective for smokers who are unable to quit in the first six weeks of treatment," said lead researcher Paul Cinciripini, Ph.D., chair of Behavioral Science. “Our study should encourage doctors to check in on patients early in their cessation journey and, if patients are struggling, to try a new approach, such as increasing medication dosage." The double-blind, placebo-controlled trial followed 490 smokers who were randomized to receive six weeks of varenicline or CNRT. After the first phase, those unable to quit were re-randomized to continue, switch or increase medication dose for an additional six weeks. Initial treatment included 2 mg of varenicline or CNRT (21 mg patch plus 2 mg lozenge). Participants who were re-randomized either continued the same varenicline or CNRT dose, switched between varenicline and CNRT, or were given an increased dose of 3 mg of varenicline or CNRT (42 mg patch plus 2 mg lozenge). The study was conducted in Texas from June 2015 to October 2019.Of the patients who received varenicline and had their doses increased, 20% were still abstaining six weeks later. Meanwhile, the abstinence rate was 14% among patients who switched from  CRNT to varenicline or who had their CRNT doses increased. However, varenicline patients who switched to CNRT saw a 0% quit rate. After six months, only those who had their doses increased remained continuously abstinent. Tobacco use remains the leading preventable cause of death and disease in the U.S. Each year, about 480,000 Americans die from tobacco-related illnesses. Currently, more than 16 million Americans suffer from at least one disease caused by smoking, including cancer. Quitting tobacco can improve the chances of survival by 30-40% for cancer patients who smoke. Since the average smoker makes several attempts to quit before successfully beating the addiction, MD Anderson tackles the barriers to cessation at an individual and population level, factoring in cost, access to cessation services, and knowledge gaps among health care providers on treating tobacco addiction. In a larger ongoing trial, researchers are testing several different medication combinations as an alternative for those unable to quit on their initial doses of varenicline or CNRT.

For more information:  https://tinyurl.com/47ve7sv3

Week of May 19, 2024

Forget 'Pack-Years' for Lung Cancer Screening Eligibility, Study Suggests

Boston, MA - Dropping pack-years for lung cancer screening eligibility in favor of a simpler 20-year history of smoking could substantially increase the number of cancers detected and eliminate racial disparities as well, according to an analysis of smokers from two large cohort studies. Under current screening criteria from the U.S. Preventive Services Task Force (USPSTF), which call for a 20-pack-year history of smoking, researchers found that 58% of Black patients with lung cancer in the Southern Community Cohort Study (SCCS) would have been eligible for screening, compared with 74% of white patients with lung cancer in SCCS. But these percentages would increase to 85.3% and 82%, respectively, with the proposed 20-year duration of smoking criteria, "thus eliminating the racial disparity in screening eligibility," reported Chi-Fu Jeffrey Yang, MD, of Massachusetts General Hospital in Boston, and colleagues stated. Additionally, an analysis of the Black Women's Health Study (BWHS) showed a switch to the simpler requirement would have increased the percentage of Black women who qualified for screening from 43% to 64%. "These findings challenge the use of pack-year smoking history in determining lung cancer screening eligibility and support the use of smoking duration cutoffs instead as a simple yet effective change to increase the sensitivity of the guideline and improve equity in opportunities for screening," the researchers concluded. However, while the proposed change would make it easier to identify eligible screening participants and increase sensitivity, the benefits came with a considerable tradeoff -- a "notable decrease in specificity," wrote Hasmeena Kathuria, MD, and Renda Soylemez Wiener, MD, MPH, both of the Boston University Chobanian & Avedisian School of Medicine, said. In the two cohorts, the specificity with the pack-year cutoff (under current USPSTF guidelines) versus the proposed duration-of-smoking cutoff decreased as follows: Black people in SCCS: 63.6% to 29.3%, White people in the SCCS: 49.7% to 38.5%’ Black women in the BWHS: 86.8% to 71.7% "The lower specificity suggests that the proposed criteria would expand screening to many low-risk people who will never develop lung cancer, increasing the number exposed to screening-related harms," the editorialists said. Yang and colleagues acknowledged that under their proposed guidelines a higher percentage of Black individuals would become eligible for screening and be exposed to screening-related harms, such as false-positive findings leading to unnecessary tests, invasive procedures, and treatment." They will not, however, be at greater risk of harm than white individuals," the study authors wrote. "Furthermore, the very low risk of harm from lung cancer screening must be considered, as always, in the context of the life-saving potential of early lung cancer detection." 

For more information: https://tinyurl.com/bdcs6x92

Week of May 12, 2024

Undiagnosed COPD, asthma linked to worse quality of life, more health care use

Ottawa, ON - Compared with healthy individuals, having undiagnosed COPD or asthma negatively impacted quality of life and led to higher health care usage, according to results published in American Journal of Respiratory and Critical Care Medicine. “The detection of undiagnosed COPD or asthma at an earlier stage of disease may enable early interventions to manage disease progression and improve patient outcomes,” Emily Gerstein, research student at the Ottawa Hospital Research Institute, and colleagues wrote. In a multicenter population-based case-finding study in Canada, Gerstein and colleagues assessed adults with undiagnosed COPD/asthma to compare symptoms, quality of life, health care use and work productivity with that of patients with diagnosed COPD/asthma and healthy individuals (controls). Researchers identified those with undiagnosed COPD/asthma in a cohort of 2,857 individuals with respiratory symptoms using pre- and post-bronchodilator spirometry. From this population, 330 individuals (11.5%) met diagnostic criteria for COPD and 265 (9.3%) met the criteria for asthma. The COPD-focused analysis included the previously identified 330 individuals with undiagnosed COPD (mean age, 66.1 years; 63% men; mean BMI, 28.6 kg/m2), 231 healthy individuals (mean age, 61.5 years; 58% men; mean BMI, 28.4 kg/m2) and 101 patients with diagnosed COPD (mean age, 67.3 years; 66% men; mean BMI, 29.9 kg/m2). The asthma focused analysis included the 265 individuals with undiagnosed asthma (mean age, 58.7 years; 56% men; mean BMI, 30.7 kg/m2) identified above, the same 231 healthy individuals and 97 patients with diagnosed asthma (mean age, 60.9 years; 44% men; mean BMI, 31.9 kg/m2). Undiagnosed vs. healthy controls Between those with undiagnosed COPD/asthma and healthy individuals, researchers found worse outcomes in the undiagnosed cohorts. COPD Assessment Test (CAT) total scores showed that respiratory symptom burden had a greater negative impact on health status and daily activities of those with undiagnosed asthma vs. healthy individuals (adjusted mean difference, 11.8; 95% CI, 10.6-13), as well as those with undiagnosed COPD (adjusted mean difference, 13.1; 95% CI, 11.7-14.4). Health-related quality of life, assessed using the St. George’s Respiratory Questionnaire (SGRQ) total score, was also worse among individuals with undiagnosed asthma (adjusted mean difference, 31; 95% CI, 28.3-33.8) and individuals with undiagnosed COPD (adjusted mean difference, 32.6; 95% CI, 29.4-35.9) vs. healthy individuals. Further, both sets of undiagnosed individuals had poorer global health status than healthy individuals when evaluated via the 36-item Short Form Health Survey (SF-36) total score (adjusted mean difference: asthma, –15.9; 95% CI, –18.8 to –13.1; COPD, –20; 95% CI, –23.3 to –16.7), according to researchers. In the past 12 months, only 9% of healthy individuals had a physician visit for breathing difficulties, whereas 33% of individuals with undiagnosed asthma and 26% of those with undiagnosed COPD reported a visit. Lastly, researchers observed poorer work productivity and an impaired ability to do regular daily activities among those with undiagnosed asthma/COPD vs. healthy individuals. More individuals with undiagnosed COPD vs. healthy individuals missed work (14% vs. 2%; P = .002). The proportion of individuals who missed work was similar between the undiagnosed asthma group and the healthy control group.   Gerstein and colleagues wrote that results from a trial including individuals with undiagnosed COPD/asthma assessing intensive early treatment with guideline-based treatment vs. standard care will be shared in 2024. “This trial aims to determine if early intensive treatment for undiagnosed obstructive lung disease provides clinical benefit,” Gerstein and colleagues wrote. 

For more information: https://tinyurl.com/2fx7rtcu

Week of May 5, 2024

Race-neutral lung function equations impact spirometry interpretation

Rochester, Minnesota - Use of race-neutral vs. race-specific lung function equations led to different interpretations of spirometry findings, especially among Black individuals, according to study results. “[Global Lung Function Initiative (GLI)] Global offers a ‘race-neutral’ approach to the interpretation of lung function measurements, motivated by efforts to eliminate health disparities and structural racism in medicine,” Amjad N. Kanj, MD, MPH, pulmonary and critical care fellow at Mayo Clinic in Rochester, Minnesota, and colleagues wrote. Use of race-neutral vs. race-specific lung function equations led to different interpretations of spirometry findings, especially among Black individuals, according to study results. Image: Adobe Stock In a multicenter cross-sectional study published in American Journal of Respiratory and Critical Care Medicine, Kanj and colleagues assessed 109,447 individuals with spirometry tests to determine how predicted lung function measurements change with use of GLI Global race-neutral reference equations vs. GLI-2012 race-specific equations. The total cohort included 101,010 white individuals (mean age, 59.5 years; 51.6% women), 4,476 Black individuals (mean age, 52 years; 58.6% women), 236 Northeast Asian individuals (mean age, 53.9 years; 54.7% women), 1,472 Southeast Asian individuals (mean age, 51.9 years; 52.9% women) and 2,253 mixed/other race individuals (mean age, 48.7 years; 51.1% women). At baseline, researchers evaluated dyspnea in each group using the modified Medical Research Council (mMRC) scale score and found that 36.7% of Black individuals had a score of two or higher. The highest proportion of individuals meeting this score was found in this group compared with the other four groups. Researchers also noted differences in absolute FEV1 and FVC percent predicted based on race/ethnicity with use of GLI-2012 reference equations. For white and Northeast Asian individuals, FEV1 was between 2.47 L to 2.51 L and FVC was between 3.19 L to 3.36 L. Black, Southeast Asian and mixed/other race individuals had lower measures of lung function. White and Northeast Asian individuals continued to have higher measures of mean FEV1 and FVC percent predicted after use of GLI race-neutral equations. For Black, Southeast Asian and mixed/other race individuals, these measures went down, with the greatest decline observed in the Black cohort (FEV1, –8.4%; FVC, –8.6%). Use of race-neutral vs. race-specific equations further resulted in more Black individuals with possible restriction (33.1% vs. 21.9%). The only other group with an increase in individuals with possible restriction was the Southeast Asian group (19.1% vs. 13.9%). The cohort of white individuals was the only racial/ethnic group who had more individuals with obstruction after use of race-neutral vs. race-specific equations (21.6% vs. 19.7%). After representing each group included in this study equally, 10.2% of the total cohort had a different interpretation of lung function results with use of race-neutral vs. race-specific equations. Compared with white, Southeast Asian, Northeast Asian and mixed/other race individuals, more Black individuals had changes in the interpretation of their spirometry test results with the neutral equations, including a higher prevalence of abnormal test results (relative increase, 32.9%). Lastly, among those with obstruction according to race-neutral vs. race-specific equations, these individuals faced a higher likelihood for an mMRC score of at least two (OR = 1.7; 95% CI, 1.2-2.5) and air trapping (OR = 2.6; 95% CI, 1.4-5.1). Among those with possible restriction based on race-neutral vs. race-specific equations, researchers found a heightened likelihood for low total lung capacity (OR = 3.3; 95% CI, 2.7-4.2). “It is crucial to consider the intended use of spirometry interpretation and acknowledge the continued importance of placing these data within an appropriate clinical context,” Kanj and colleagues wrote. “More research is needed to understand the clinical implications of the changes in interpretation we observe using the GLI Global reference equations.” 

For more information: https://tinyurl.com/55v37nc3

Week of April 28, 2024

Quebec announces that shingles vaccine will be free for people aged 75 years+

Quebec City, PQ - The Minister of Health, Christian Dubé, as well as the Minister responsible for Seniors and Minister for Health, Sonia Bélanger, announce that the shingles vaccine will be free for people aged 75 years and over as of May 1st. It was previously offered to people aged 80 and over. Expanding the shingles vaccination program will help reduce the number of shingles cases and associated complications. The vaccine will be offered to people aged 75 and over from May 1 at local service points (PSL) as well as in pharmacies. It provides excellent long-term protection against the most common complications of this disease, notably post-herpetic neuralgia (PHN), with pain that can persist for several months, or avoid hospitalizations or deaths. In Quebec, each year there are approximately 27,000 cases of shingles, 600 hospitalizations and 10 deaths caused by the disease, approximately 80% of which occur in people aged 80 and over (MSSS, 2023). This is another step in the government's approach to prevention, according to the vision expressed in the Health Plan. “Expanding access to the shingles vaccine is part of one of the priorities of the Health Plan, which is to do more prevention. We aim to offer Quebecers complete protection against this disease, the complications of which can be very painful and, sometimes, fatal. I encourage all eligible people to take advantage of this opportunity to take advantage of the doses offered to reduce the risk of infection or complications,” said Christian Dubé, Minister of Health. Sonia Bélanger, Minister responsible for Seniors and Minister for Health added,  “Each process of expanding free eligibility for a vaccine is a step that we are taking in the right direction to ensure we have a population in perfect health, but also to reduce pressure on the health and care network. social services. I am all the more happy because this program mainly targets seniors and I invite them to take advantage of this opportunity. I thank all the teams as well as the health professionals who are mobilizing to help seniors stay healthy." 

For more information: Pour une meilleure prévention - Le vaccin contre le zona offert gratuitement aux personnes de 75 ans et plus (newswire.ca)

Week of April 21, 2024

Higher abstinence rate with e-cigarettes vs. nicotine gum

Peking, China - Individuals using e-cigarettes for smoking cessation had a higher 6-month abstinence rate than nicotine replacement therapy users and a similar rate to varenicline users, according to results published in JAMA Internal Medicine. “[E-cigarettes] were as effective in helping smokers quit as varenicline and more effective than nicotine chewing gum when all three products were provided with minimal behavioral support,” Hao-Xiang Lin, DrPH, of the Institute for Global Health and Development at Peking University in China, and colleagues wrote. In a multicenter, randomized clinical trial in China, Lin and colleagues assessed 1,068 individuals (mean age, 33.9 years; 33.5% women) smoking a daily minimum of 10 cigarettes to determine how e-cigarette use for 12 weeks compares with 12-week nicotine replacement therapy (NRT) and varenicline (Chantix, Pfizer) in terms of sustained abstinence at 6 months. Of the total cohort, 409 (38.3%) individuals received a cartridge-based e-cigarette with a 30 mg/mL nicotine salt dose for the first 2 weeks and then a 50 mg/mL dose. The varenicline group also consisted of 409 individuals, and the dosing of this drug started as 0.5 mg once daily for 3 days, followed by 0.5 mg twice daily for 4 days and 1 mg twice daily for the remainder of the time. Fewer patients randomly received nicotine chewing gum (n = 250; 23.4%), and the dose of this therapy was based on level of smoking (2 mg ≤ 20 cigarettes/day, n = 197; 4 mg, > 20 cigarettes/day, n = 53). Researchers additionally noted that each smoker was invited to join a self-help internet forum regardless of their cessation method group. Around 80% of individuals from each group had 6-month follow-up data. Using an expired-air carbon monoxide reading (< 8 parts per million), individuals using e-cigarettes had the highest abstinence rate at 6 months (15.7%), followed closely by varenicline users (14.2%) and then nicotine gum users (8.8%). Between the e-cigarette group and the varenicline group, researchers found similar quit rates (absolute risk reduction, 1.47%; 95% CI, –1.41% to 4.34%). However, when compared with the nicotine gum group, e-cigarette users had a higher likelihood of quitting (OR = 1.92; 95% CI, 1.15-3.21). Researchers continued to see the above results after controlling for education level and Fagerstrom Test for Cigarette Dependence baseline scores. 

For more information: https://tinyurl.com/3vka8fww

Week of April 14, 2024

New study shows vaping may help people quit smoking cigarettes

Buffalo, NY - Combustible cigarette smokers are now more likely to quit if they start on e-cigarettes, a trend not seen a decade ago, according to longitudinal data from adults in the Population Assessment of Tobacco and Health (PATH) study. Between 2016-2017 and 2018-2019, 20.1% of adult smokers who used electronic nicotine delivery systems discontinued cigarette smoking at follow-up compared with 16.5% of those who did not use e-cigarettes (P<0.05), reported Karin Kasza, PhD, of Roswell Park Comprehensive Cancer Center in Buffalo, New York, and co-authors. This trend continued between 2018-2019 to 2021, with 30.9% of those who used e-cigarettes discontinuing cigarette smoking at follow-up compared with 20% of those who did not use e-cigarettes (P<0.001), they detailed in Nicotine & Tobacco Research. Of note, between 2013 and 2016, rates of discontinuing cigarette smoking among U.S. adults were almost identical between those who used e-cigarettes, at 15.5%, and those who did not, at 15.6%. "Our findings here suggest that the times have changed when it comes to vaping and smoking cessation for adults in the U.S.," said Kasza in a press release. "While our study doesn't give the answers as to why vaping is associated with cigarette quitting in the population today when it wasn't associated with quitting years ago, design changes leading to e-cigarettes that deliver nicotine more effectively should be investigated. This work underscores the importance of using the most recent data to inform public health decisions." The researchers explained that in the nearly 20 years since electronic nicotine delivery system products entered the market, there have been varied results regarding the role they play in quitting smoking. These findings follow a recent randomized trial that showed e-cigarettes helped people better stick to smoking cessation. "Our full study period spanned a time in the United States when the ENDS [electronic nicotine delivery systems] marketplace was expanding; salt-based nicotine formulations gained market share in 2016 and ENDS products became available with increased nicotine yields over time, prevalence of ENDS use and frequent ENDS use was increasing, and various tobacco control actions were taken at state and federal levels," the group wrote. "Inconsistent findings may be due in part to differences in the samples and measures considered, differences in analytic approaches used, and/or may be because of the rapidly changing product environment or differing policy contexts," they added.

For more information: https://tinyurl.com/4a4trzuv

Week of April 7, 2024

Flu vaccine uptake tripled with simple promotion

San Francisco, CA - MedPage Today reported that a few simple interventions boosted flu vaccine uptake for patients waiting at the emergency department [ED], according to the cluster-randomized, controlled PROFLUVAXED trial. People in ED waiting areas who consented to view a 3-minute video with a scripted message, read a one-page flyer, and have a short discussion with an ED clinician about the flu vaccine had a 30-day follow-up vaccination rate of 41% versus 15% among patients that received no messaging about the vaccine. Even just asking people in the ED "Would you accept the influenza vaccine in the emergency department today if your doctor asked you to get it?" resulted in a 30-day vaccination rate of 32%, Robert Rodriguez, MD, of the University of California San Francisco, and colleagues reported in NEJM. "We fully expected the interventions to improve vaccine uptake but were surprised by how effective they were," Rodriguez stated. "The simple question intervention doubled vaccine uptake and the messaging intervention nearly tripled vaccine uptake." "There is a distinctly underserved population whose primary (and often only) healthcare access occurs in emergency departments," Rodriquez noted. "To decrease disparities, public health interventions, especially vaccine messaging and vaccine administration, can and should be delivered in emergency departments." To ensure the messages in the video and flyer reached medically underserved populations, researchers created five different versions with the same wording that featured African American, Latinx (English and Spanish versions), multiracial, or white physicians. The consequences of poor influenza vaccine uptake are particularly stark for members of racial and ethnic minority groups, Zanthia Wiley, MD, and Annelys Roque Gardner, MD, both of Emory University School of Medicine in Atlanta, wrote in an accompanying editorial. Black, Hispanic, and American Indian or Alaska Native adults have age-adjusted influenza hospitalization rates of 1.2 to 1.8 times the rate of non-Hispanic white adults, they noted. Moreover, it is common for people who lack health insurance and access to primary care to visit EDs for non-emergency care, they pointed out. "Exploring alternative methods of promoting vaccinations in racial and ethnic minority communities and for those individuals who have limited access to routine healthcare is essential for vaccine equity," Wiley and Gardner wrote. The study enrolled 767 participants from six emergency departments in San Francisco, Houston, Philadelphia, Seattle, and Durham, North Carolina from October 2022 to February 2023. No participant was critically ill, and the majority of ED visits were for conditions that would not preclude offering and administering vaccines.  

For more information: https://tinyurl.com/4ud32ymp

Week of March 31, 2024

Childhood cigarette smoking heightens COPD risk in adulthood

Hanover, NH - Childhood smoking was linked to an increased risk for COPD in adults aged 40 years or older. In adulthood, the risk for COPD rose with regular cigarette smoking starting before age 15 years, according to results published in American Journal of Respiratory and Critical Care Medicine. “In this sample, the developmental window for increased risk due to childhood smoking ended at about age 20 years, which coincides with the time [FEV1] reaches its peak during adolescence,” James D. Sargent, MD, Scott M. and Lisa G. Stuart Professor, as well as professor of pediatrics, professor of biomedical data science and professor of community and family medicine at Dartmouth Geisel School of Medicine, and colleagues wrote. Using data from the 2020 National Health Interview Survey, Sargent and colleagues assessed 22,374 adults (52.8% women; 75% white) aged 40 years or older to determine how COPD risk is linked to the age of smoking initiation (< 15 years old vs. ≥ 15 years old). Researchers used multivariable analysis that accounted for current smoking, cigarette pack-years and covariates to find this relationship. Over half of the total cohort never smoked (60%), and researchers observed more former smokers than current smokers (28% vs. 13%). Within the study population, 7.1% of adults self-reported a COPD diagnosis, and this diagnosis was reported more frequently in the cohort who started smoking regularly before age 15 years vs. the cohort who started smoking regularly at age 15 years or older and the cohort who never smoked (23.1% vs. 11.6% vs. 2.6%). Compared with the cohort of regular smokers at age 15 years or older, researchers found more median pack-years in the cohort of regular smokers before age 15 years (29 vs. 15). In terms of smoking intensity, the median number of cigarettes per day was 20 for those reporting early-onset/childhood smoking, whereas this number was smaller for those reporting later-onset smoking (10 cigarettes per day “Although it would be worthwhile to replicate the findings in other studies of COPD, this study gives child health providers and public health officials reason to be very concerned about future chronic disease among patients who begin smoking during early adolescence, both because of the increased risk of nicotine addiction and perhaps because of its impact on lung development,” Sargent and colleagues wrote. 

For more information: https://tinyurl.com/bdh5cbkp

Week of March 24, 2024

Commonly Used Fingertip Pulse Oximeters Not Up to Snuff

San Francisco, CA - Commonly used types of fingertip pulse oximeters were not consistent in their performance, with more frequent issues when tested in participants with darker skin tones, and sometimes fell short of regulations and manufacturer claims, according to a study from the Open Oximetry Project. Among 11 fingertip pulse oximeters used during hypoxemia in healthy participants, five devices had a root mean square error (ARMS) >3%, which falls outside the acceptable FDA performance range, reported Isabella Auchus, MD, of the University of California San Francisco, and co-authors. In addition, nine devices had worse performance in participants in the darkest skin pigmentation category versus those in the lightest category, they noted in eBioMedicine.  The reference device and eight other devices met International Organization for Standardization (ISO) criteria for ARMS of ≤4%, while 10 devices plus the reference device demonstrated higher ARMS in participants who were categorized at the lowest third of individual typology angle (ITA) values (having dark skin tones), compared with the highest third of ITA values (light skin tones) when measured at the area between the joint and the fingernail. Seven devices and the reference device demonstrated a positive bias in participants who had darker pigmentation compared with those with lighter pigmentation. Most devices also demonstrated higher ARMS at lower arterial oxygen saturation (SaO2) levels, particularly among individuals with darker skin pigmentation. "Our data support several steps that could be taken now to update regulatory guidance and improve performance standards," Auchus and team wrote. "The commonplace reliance on subjective, non-standardized skin pigmentation assessment tools (e.g., pFP [perceived Fitzpatrick Scale]) is problematic and should be abandoned for several reasons, including the lack of standardized colors, inter-operator variability and bias, and the misappropriation of the initial purpose of the scales." These findings come just over a month after an FDA advisory committee provided largely positive feedback to the agency's effort to improve the accuracy of pulse oximeters when used in darker-skinned patients. The FDA Medical Device Advisory Committee Anesthesiology and Respiratory Therapy Devices Panel did, however, raise some concerns, including the need for larger trials.

For more information: https://tinyurl.com/52z6kntp

Week of March 17, 2024

New government repeals New Zealand's tobacco ban

Wellington, NZ - Despite its diminutive size and geographic isolation, New Zealand has an international reputation for pragmatic and sensible political action.  As part of the newly elected coalition government's rush to tick 48 actions off its 100-day list by March 8, it has repealed the Smokefree Environments and Regulated Products Amendment Act of 2022. This act, passed by the previous Labour government, would have banned selling tobacco products to those born on or after January 1, 2009, reduced the nicotine in tobacco products to non-addictive levels, and slashed the number of outlets allowed to sell tobacco by 90%, from 6,000 to 600. Overall tobacco use was predicted to drop from the current 8% to lower than 5% by 2025, and the act was expected to create a tobacco-free generation. Clinical trials and modeling studies showed Smokefree policies would have reduced mortality rates by 22% for women and 9% for men, saving up to 5,000 lives annually. Also, it would have saved New Zealand $1.3 billion in healthcare expenditures over the next 20 years, and New Zealanders would have enjoyed a cumulative gain of $29 billion in disposable (and taxable) income by 2050. This world-leading legislation would have shown that fighting the tobacco industry is possible, encouraging other countries to do the same and perhaps eventually saving some of the more than 8 million  people who die annually from tobacco-related causes. Why would New Zealand's new coalition government, an alliance of the conservative National Party along with the libertarian ACT and populist New Zealand First parties, repeal data-driven and life- and money-saving legislation? Without a shred of evidence, Prime Minister Christopher Luxon and his coalition partners have repeatedly claimed restricting tobacco and reducing nicotine levels  experimental (as though that were a bad thing), leading to and a proliferation of crime.  ACT's health spokesperson Todd Stephenson, for example, said that  the "radical prohibitionism" of creating a smoke-free generation would "push smokers into the arms of gang members." This rhetoric uncannily echoes the tobacco lobby. Public health experts at the University of Otago recently released a damning report  showing that the coalition government's arguments in favor of a repeal closely mirror the tobacco industry's own narratives on this subject. So suspicious are the similarities between the flimsy remarks of coalition partners and tobacco companies' talking points that the report's authors are calling on all members of parliament to declare any past associations with tobacco companies. 

For more information: https://tinyurl.com/mry53e2v

Week of March 10, 2024

Gaseous vs. polluting fuels for cooking, heating lower odds for COPD

Liverpool, UK - Use of gaseous household fuels vs. polluting fuels for cooking and heating lowered an individual’s odds for COPD, wheeze and severe respiratory illness/death, according to study results published in Lancet Respiratory Medicine. “This article demonstrates a significantly lower risk for key health outcomes when switching from polluting solid fuels or kerosene to gaseous fuels for cooking or heating, suggesting cleaner fuels could contribute to reducing the global disease burden from exposure to household air pollution,” Elisa Puzzolo, MSc, MPH, PhD, senior research fellow and in the department of public health, policy and systems at University of Liverpool and co-director of the university’s CLEAN-Air (Africa) Global Health Research Unit, and colleagues wrote. Using 10 databases, Puzzolo and colleagues reviewed and assessed 116 studies published between Dec. 16, 2020, and Feb. 6, 2021, to find out how gaseous fuels (natural gas, liquified petroleum gas and biogas) used for cooking and heating impact various health outcomes compared with polluting fuels (wood, charcoal, kerosene) or clean energy (electricity, solar energy). A majority of the included studies followed a cross-sectional design (78 studies), with fewer cohort studies (23 studies), case-control studies (13 studies) and randomized controlled trials (2 studies). The number of studies conducted in low-income and middle-income countries (LMICs) was similar to the number of studies conducted in high-income countries (60 studies vs. 54 studies). Two studies featured countries from both income levels. Further, 92 studies focused on fuels used in cooking, whereas only 17 studies focused on fuels used in heating. Seven studies evaluated both fuel usage areas. Researchers obtained 215 effect estimates from the total population. Between gaseous household fuels and polluting fuels, use of gaseous household fuels proved to be more beneficial to an individual’s health, with reduced odds for several health effects and symptoms, including: pulmonary function deficit (OR = 0.27; 95% CI, 0.17-0.44); severe respiratory illness or death (OR = 0.27; 95% CI, 0.11-0.63); COPD (OR = 0.37; 95% CI, 0.23-0.6); self-reported breathlessness (OR = 0.4; 95% CI, 0.21-0.76); wheeze (OR = 0.42; 95% CI, 0.3-0.59); self-reported cough (OR = 0.44; 95% CI, 0.32-0.62); acute lower respiratory infections or pneumonia (OR = 0.54; 95% CI, 0.38-0.77); bronchitis (OR = 0.6; 95% CI, 0.43-0.82); preterm birth (OR = 0.66; 95% CI, 0.45-0.97); and low birth weight (OR = 0.7; 95% CI, 0.53-0.93). Researchers also found significantly decreased odds for COPD, bronchitis, pulmonary function deficit and severe respiratory illness or death pooled together (OR = 0.36; 95% CI, 0.27-0.48) with gas fuel vs. polluting fuel.In this a according to researchers. In contrast, individuals who used gaseous household fuels vs. electricity faced a higher likelihood for acute lower respiratory infections or pneumonia (OR = 1.26; 95% CI, 1.03-1.53), as well as COPD (OR = 1.15; 95% CI, 1.06-1.25). Researchers noted that in higher-quality studies, determined using the Liverpool Quality Assessment Tool, the relationship between these health outcomes and gas vs. electricity usage was non-significant. Use of gaseous household fuels vs. electricity lowered an individual’s odds for bronchitis (OR = 0.87; 0.81-0.93). Similar to the above asthma findings, the likelihood for asthma in adults and children in relation to gas use vs. electricity was not significant. Researchers observed additional non-significance in this analysis when assessing the odds for wheeze, cough and breathlessness. “For LMICs reliant on polluting solid fuels and kerosene, transitions to gaseous fuels for cooking or heating can potentially produce substantial health benefits,” Puzzolo and colleagues wrote. “However, where transitions to clean energy such as electricity are a realistic option (ie, scalable and accessible in the short term) further protection of health is probable.” 

For more information: https://tinyurl.com/mv54v3wd

Week of March 3, 2024

A tobacco-free generation: the end goal of the endgame

London, UK - Last year The Lancet Respiratory Medicine published an editorial discussing how the tobacco endgame initiative could best establish a tobacco-free generation, in which less than 5% of the European population uses tobacco by 2040. A major goal to achieve this initiative will be to ensure that children and adolescents receive adequate help to avoid tobacco-related and nicotine-related products, in particular electronic nicotine delivery systems which are highly addictive. These tobacco control discussions have continued and in January this year, The Lancet Respiratory Medicine was invited to a panel discussion focused on policy changes in the UK that would best serve those already addicted to smoking, and how to implement cessation in the most at-risk groups. A key component of this UK policy is in the tobacco control manifesto proposed by the Prime Minister, which will make it an offence for anyone born on or after Jan 1, 2009, to be sold tobacco products. Other action points in the manifesto include establishing an Illicit Tobacco Taskforce, led by HMRC and Border Force, to oversee the future evolution of an illicit tobacco strategy, £70 million per year for local authority-led stop smoking services, and £10 million over 2 years for financial incentives to support pregnant smokers to quit. In addition, there are efforts to make vape products less attractive to children by introducing restrictions on flavours, promotion, packaging, and point-of-sale displays. The event served as a sobering reminder of how lethal this legal substance is. One quarter of all cancers are linked to smoking, and smoking-related cancer services costs the UK NHS £2·4 billion each year. Jeanelle de Gruchy, England's Deputy Chief Medical Officer, noted in the discussions that social disparities and the attributable mortality by economic deprivation—that smoking exacerbates—can be readdressed with the implementation of the manifesto. The momentum towards the tobacco endgame gained thus far is due to the wholly unique alignment of the efforts of public health officials, governmental parties, and medical communities. The proposed UK manifesto is a comprehensive package and experts agreed that it needs to be implemented before the next UK election to have immediate impact. A lasting message from the meeting was that for the tobacco endgame to succeed across the globe, each individual agenda needs a champion, no public health charity or non-governmental organisation can gain enough traction on their own to enact change. Various coalitions are already established and working effectively and should be aligned with campaigners who can relentlessly push forward agendas. The smoke-free generation legislation will move us closer to making smoking obsolete, which is not just the endgame, but the end goal.

For more information: http://tinyurl.com/uzzya9kf

Week of February 25, 2024

Even Moderate Exposure to Radon Tied to Increased Stroke Risk

Chapel Hill, NC - An analysis of radon exposures in more than 150,000 postmenopausal women in the Women's Health Initiative revealed a 14% higher stroke risk in those exposed to the highest concentrations compared with those exposed to the lowest concentrations. Even moderate concentrations of radon were associated with a 6% higher stroke risk. Radon is the second leading cause of lung cancer, but little was known about how exposure to the gas might affect stroke risk in women.  "Our research found an increased risk of stroke among participants exposed to radon above — and as many as 2 picocuries per liter (pCi/L) below — concentrations that usually trigger Environmental Protection Agency recommendations to install a home radon mitigation system," senior author Eric A. Whitsel, MD, MPH, professor of epidemiology and medicine, University of North Carolina, Chapel Hill, said in a news release. Radon is a naturally occurring odorless radioactive gas produced when uranium or radium break down in rocks and soil. Its presence is increasing as a result of climate change, and it is increasingly being found in people's homes. When inhaled, this air pollutant releases ionizing radiation in the lungs and is seen as second only to smoking as an established cause of lung cancer. The National Radon Action Plan of the US Environmental Protection Agency (EPA) lays out testing and mitigation guidelines based on the known role of radon in lung carcinogenesis. But radon testing and mitigation are less common than recommended, and the EPA's action plan doesn't cover diseases other than lung cancer. Compared with men, women have a higher rate of stroke and, in the US, typically spend about 11% more hours per day indoors at home, which investigators note highlights a "potential role of the residential environment among other risk factors specific to women." Researchers examined longitudinal associations between home radon exposure and incident stroke in 158,910 women at baseline (mean age 63.2 years; 83% White) over a mean follow-up of 13.4 years. During this time, participants experienced a total of 6979 strokes. Participants' home addresses were linked to radon concentration data drawn from the US Geological Survey and the EPA, which recommends that average indoor radon concentrations not exceed 4 pCi/L.  The highest radon exposure group resided in areas where average radon concentrations were < 4 pCi/L; the middle exposure group lived in regions with average concentrations of 2-4 pCi/L; and the lowest exposure group lived in areas with average concentrations < 2 pCi/L.  The researchers adjusted for demographic, social, behavioral, and clinical characteristics. The incidence rates of stroke per 100,000 women in the lowest, middle, and highest radon concentration areas were 333, 343, and 349, respectively. The study was funded by the National Institute of Environmental Health Sciences and National Heart, Lung, and Blood Institute. Whitsel and coauthors report no relevant financial relationships. 

For more information: http://tinyurl.com/3hh6f3tv

Week of February 18, 2024

Disposable vapes to be banned for children's health, government says

London, UK - Disposable vapes are set to be banned as part of plans to tackle the rising number of young people taking up vaping, the government says. Measures will also be introduced to prevent vapes being marketed at children and to target under-age sales. Prime Minister Rishi Sunak suggested adult smokers trying to quit would still have access to alternatives like vapes under the proposals. The ban is expected to be introduced across the UK, the government said. It is already illegal to sell any vape to anyone under 18, but disposable vapes - often sold in smaller, more colourful packaging than refillable ones - are a "key driver behind the alarming rise in youth vaping", according to the government. Figures from the Action on Smoking and Health (Ash) charity suggest 7.6% of 11 to 17-year-olds now vape regularly or occasionally, up from 4.1% in 2020. Announcing the plans on Monday, Mr Sunak said it was right that "strong action" was taken to stamp out vaping in children. "Children shouldn't be vaping, we don't want them to get addicted, we still don't understand the full long-term health impacts," he said. 'Maintain vapes for adult smokers' Mr Sunak suggested the proposals struck the right balance between restricting access for children and maintaining access for adult smokers trying to quit smoking. "It is important that we maintain vapes for adult smokers who want to stop," the Prime Minister continued, adding that he wanted to target "all the things that make sure children don't have access to vapes." Vaping is substantially less harmful than smoking, but it has not been around for long enough for its long-term risks to be known, according to the NHS. The vapour that is inhaled can still contain small amounts of  chemicals that are found in cigarettes, including nicotine - which is addictive but not seen by the health service as one of the most problematic ingredients in cigarettes. The proposals follow last year's announcement of a ban on the sale of cigarettes to anyone born on or after 1 January 2009 as part of an attempt to create a "smoke-free generation". Health Secretary Victoria Atkins told the BBC she was confident the new bill would pass Parliament by the time of the general election - expected to be this year - with it coming into force in early 2025. Once the timing is confirmed, retailers will be given six months to implement it. 

For more information: http://tinyurl.com/4fe9sr54

Week of February 11, 2024

Omicron's surprise parting gift - evolution of the human immune system 

Seoul, South Korea - It has been four years since the start of the COVID-19 pandemic. SARS-CoV-2 has yet to be eradicated and new variants are continuously emerging. Despite the extensive immunization programs, breakthrough infections (infection after vaccination) by new variants are common. New research suggests that human immune responses are also changing in order to combat the never-ending emergence of new SARS-CoV-2 variants. Specifically, it has been discovered the immune system that encountered breakthrough infection by the omicron variant acquires enhanced immunity against future versions of the omicron. The study is published in Science Immunology. A team of South Korean scientists led by Professor Shin Eui-Cheol of the Korea Virus Research Institute Center for Viral Immunology within the Institute for Basic Science (IBS) announced that the memory T cells that form during the omicron breakthrough infection respond to subsequent strains of the virus. Emerging in late 2021, the SARS-CoV-2 omicron variant had drastically increased transmissibility in comparison to its predecessors, which quickly allowed it to become the dominant strain in 2022. New strains of omicron have kept emerging ever since then. Starting with BA.1 and BA2, BA.4/BA.5, BQ.1, XBB strains, and more recently JN.1 strains were among the new strains of the omicron variant. This has led to widespread breakthrough infection despite vaccination. After becoming infected or vaccinated, the body creates neutralizing antibodies and memory T cells against the virus. The neutralizing antibody serves to prevent host cells from being infected by the virus. While memory T cells cannot prevent the infection, they can quickly search and destroy infected cells, preventing the viral infection from progressing into a severe disease. The research team's goal was to find out the changes that occur in our body's immune system after suffering from post-vaccination breakthrough infection. In order to answer that question, they focused on the memory T cells that formed after the omicron infection. The previous studies on the omicron variant have mostly focused on vaccine efficacy or neutralizing antibodies, and the research related to memory T cells has been comparatively lacking. 

For more information: http://tinyurl.com/38xd4ym4

Week of February 4, 2024

Palliative telecare team improves quality of life in COPD

Aurora, CO - Receiving care from a palliative telecare team resulted in more improvements in quality of life than usual care among patients with COPD, interstitial lung disease or heart failure, according to study results published in JAMA. “This new approach can reduce the burden of illness for patients,” David B. Bekelman, MD, MPH, professor of medicine and psychiatry at the University of Colorado School of Medicine at the Anschutz Medical Campus, said. “Many patients with COPD, heart failure or interstitial lung disease suffer from persistent symptoms (shortness of breath, fatigue) and depression and anxiety despite disease-specific treatments,” Bekelman continued. “We found that a palliative telecare team of a nurse and social worker, who collaborate with physicians, improved multiple quality of life outcomes for patients with these illnesses.” In a single-blind, randomized trial of two Veterans Administration health care systems, Bekelman and colleagues assessed 306 outpatients (mean age, 68.9 years; 90.2% men; 80.1% white) with COPD, ILD or heart failure; self-reported poor quality of life; and a heightened risk for hospitalization or death to find out how palliative telecare from a nurse and social worker team (ADAPT intervention) impacts quality of life vs. usual care (educational handout). Within the team, the nurse helped patients with symptom management, whereas the social worker offered psychosocial care to each patient. The nurse and the social worker each called the patient six times and met with each other, a primary care physician and a palliative care physician once a week. A pulmonologist and cardiologist joined the discussion if needed, according to researchers. Researchers used Functional Assessment of Chronic Illness Therapy-General (FACT-G) questionnaire scores to assess how quality of life changed between baseline and 6 months in both groups. A score closer to 100 signaled better quality of life, whereas a score closer to zero signaled poor quality of life. The cohort was split into the ADAPT intervention group (n = 154) and the usual care group (n = 152); however, only 112 of those from the intervention group completed a minimal dose of the intervention, including “nursing calls that included all nursing topics, all social work topics and a close-out call,” according to researchers. “We were delighted to see that the improvement in quality-of-life lasted months after the intervention ended,” Bekelman said.

For more information: http://tinyurl.com/snbjzsjw

Week of January 28, 2024

Global tobacco use tumbles despite industry lobbying

Geneva, Switzerland - Global tobacco use has tumbled in a generation with one in five people smoking versus one in three in 2000, the World Health Organization said on Tuesday. The drop comes despite what the U.N. global health agency said were ongoing efforts by Big Tobacco to seek to influence global health policies to its own advantage. "Good progress has been made in tobacco control in recent years, but there is no time for complacency," said Dr Ruediger Krech, Director of WHO Department of Health Promotion. "I'm astounded at the depths the tobacco industry will go to pursue profits at the expense of countless lives." The global report said 1.25 billion people aged 15 or over used tobacco in 2022 versus 1.36 billion in 2000. Tobacco use is set to fall further by 2030 to around 1.2 billion people even as the world's population grows, the study said. One example of tobacco companies' efforts to win influence cited by the WHO was their offers of technical and financial support to countries ahead of a major WHO meeting on tobacco control in Panama in February. The regions with the biggest portion of smokers are Southeast Asia and Europe, the WHO said, with roughly a quarter of the population. In a handful of countries, tobacco use is still rising, including in Egypt, Jordan and Indonesia, according to the study. The report published every two years gave some preliminary data on the prevalence of vaping on which the WHO is urging governments to apply tobacco-style control measures. It said there were at least 362 million adult users of smokeless tobacco products globally but admitted this might be an underestimate due to missing data. 

For more information: http://tinyurl.com/266njetc

Week of January 21, 2024

Inhaled corticosteroids increasingly used for COPD outside recommended indications

Seattle, WA - From 2010 to 2018, a rising number of veterans with COPD received inhaled corticosteroid prescriptions as first-line therapy outside recommended indications, according to results published in Annals of the American Thoracic Society. “Our study has the greatest implications for health systems that are trying to improve value-based prescribing,” Kevin I. Duan, MD, MS, acting instructor in the division of pulmonary, critical care and sleep medicine at University of Washington, reported Healio. “However, for the everyday clinician, the study is a reminder that updating our inhaler prescribing norms to better align with the latest evidence and recommendations is needed. Currently, our study suggests that just under half of patients with COPD starting inhalers are getting a therapy that is not the recommended first-line therapy.” In a cross-sectional study, Duan and colleagues analyzed 131,009 veterans with COPD and new use of inhaler therapy in the U.S. Department of Veterans Affairs between January 2010 and December 2018, to determine national trends in low-value inhaled corticosteroid prescriptions during this timeframe using multivariable logistic regression models. Researchers defined an inhaled corticosteroid prescription as “low value” if it was given to a patient without asthma, with a low risk for future exacerbations or with a serum eosinophil count of less than 300 cells/L. Of the total cohort, nearly 45% (n = 57,472) of veterans had low-value inhaled corticosteroids as their first therapy, and this prescription appeared frequently across states (range, 32%-56%). Researchers found that the chances for a low-value inhaled corticosteroid prescription grew as the years progressed, which can be seen through a 0.42 percentage-point rise (95% CI, 0.31-0.53) per year in the probability for this outcome following adjustment for several covariates. Researchers also divided the cohort according to rural (n = 54,151; mean age, 68 years; 2% women; 88% white) vs. urban (n = 76,297; mean age, 68 years; 3% women; 77% white) residence and conducted fixed effects logistic regression to see if low-value inhaled corticosteroid prescribing differed by location. Results showed the probability for low-value inhaled corticosteroids heightened by 2.5 percentage points (95% CI, 1.9-3.1) for veterans living in rural vs. urban areas after adjustment. Using the complexity level of the VA medical center where each patient was treated, researchers observed increased probabilities for low-value inhaled corticosteroid prescriptions among rural residents treated in the most complex (2.5 percentage points; 95% CI, 1.8-3.2) and moderately complex (1.6 percentage points; 95% CI, 0.01-3.2) facilities vs. urban residents. Compared with urban residents treated in a least complex facility, rural residents in the same facilities did not have a higher probability for the assessed prescription, according to researchers. “For patients with COPD, the differences in disease burden and clinical outcomes between rural and urban areas is well documented, which was part of the motivation to conduct our rural-urban analysis,” Duan told Healio. “While we did detect a small difference, I was surprised that there wasn’t a more pronounced difference. The more important finding is that the issue of low-value prescribing is widespread and persistent over time, in both rural and urban areas alike.” Further, researchers observed similar results during sensitivity analyses that used the GOLD 2017 recommendations for classifying low-value inhaled corticosteroids, which do not factor in serum eosinophil counts. A sensitivity analysis that used the 6-point National Center for Health Statistics Urban-Rural Classification scheme also showed that more rurality meant higher chances for receiving low-value inhaled corticosteroids, according to researchers. After accounting for spirometric confounders, an analysis of 12,531 veterans with spirometry results revealed a 2.2% (95% CI, 0.1%-4.3%) heightened probability for receiving low-value inhaled corticosteroids among those living in rural vs. urban areas. “Additional work is needed to evaluate whether similar prescribing patterns are occurring outside of the VA system,” Duan told Healio. 

For more information: http://tinyurl.com/4wsr6duv

Week of January 14, 2024

Daily nitrate-rich beetroot juice decreases blood pressure in COPD

London, UK - Consuming nitrate-rich beetroot juice daily for 12 weeks resulted in decreased blood pressure and better 6-minute walk distance in patients with COPD compared with placebo, according to data published in European Respiratory Journal. “At the end of the study, we found that the blood pressure of people taking the nitrate-rich beetroot juice drink was lower and their blood vessels became less stiff,” Nicholas S. Hopkinson, PhD, professor of respiratory medicine at Imperial College London, said in a press release from the European Respiratory Society. “The juice also increased how far people with COPD could walk in 6 minutes compared to placebo.” Consuming nitrate-rich beetroot juice daily for 12 weeks resulted in decreased blood pressure and better 6-minute walk distance in patients with COPD compared with placebo, according to data published in European Respiratory Journal. In a randomized, double-blind, placebo-controlled parallel trial, Hopkinson and colleagues assessed 81 patients with COPD and a home systolic blood pressure of 130 mmHg or higher to determine if 70 mL of nitrate-rich beetroot juice (n = 40) per day for 12 weeks positively changed blood pressure vs. nitrate-depleted placebo juice (n = 41). Researchers also evaluated 6-minute walk distance, measures of endothelial function, plasma nitrate and platelet function between the two groups. Baseline characteristics of each group were similar. Within the total cohort, none of the patients experienced a serious adverse event; however, three patients (active treatment, n = 1; placebo, n = 2) withdrew because the juice was “unpalatable,” according to researchers. By week 12, patients drinking nitrate-rich beetroot juice had greater reductions in systolic blood pressure vs. patients drinking nitrate-depleted placebo juice (Hodges-Lehmann estimator treatment effect, –4.5 mmHg; 95% CI, –3 to –5.9). Researchers also observed more improvement in 6-minute walk distance among individuals in the nitrate-rich juice group (+30.04 m; 95% CI, 15.7-44.2). Notably, this measurement was only collected from 24 patients in the nitrate-rich juice group and 20 patients in the placebo group. To assess endothelial function, researchers used an EndoPAT device (Itamar Medical) and found improvements in reactive hyperemia index (+0.34; 95% CI, 0.03-0.63) and augmentation index corrected for heart rate 75% (–7.61%; 95% CI, –14.3% to –0.95%) among those drinking the nitrate-rich juice vs. the nitrate-depleted placebo juice. Patients consuming the nitrate-rich juice also had a “substantial increase” in plasma nitrate at the end of the study compared with baseline, according to researchers. Between the two groups, researchers did not find any changes in platelet aggregation. “This is one of the longest-duration studies in this area so far,” Hopkinson said in the release. “The results are very promising, but will need to be confirmed in larger, longer-term studies.” 

For more information: http://tinyurl.com/by7cvjnk

Week of January 7, 2024

Tobacco smoking attributed to more than 1 million cancer deaths in seven countries

Lyon, France - A total of 1.9 million cancer deaths were attributable to alcohol, tobacco smoking, excess body weight and HPV infections. Smoking tobacco resulted in 20.8 million years of life lost among patients with cancer. Among four preventable risk factors for cancer mortality, smoking tobacco resulted in the most deaths and years of life lost in seven countries, according to data published in eClinical Medicine. “We concluded that smoking, alcohol, overweight/obesity and HPV infections are the drivers of almost 2 million deaths from cancer across seven countries every year,” Harriet Rumgay, PhD, postdoctoral scientist of cancer surveillance at the WHO International Agency for Research on Cancer, said. “These findings highlight the key role of primary prevention to reduce cancer mortality by saving millions of lives from preventable cancers.” In a population-based study, Rumgay and colleagues assessed the estimated number of deaths and years of life lost (YLLs) to cancer in 2020 caused by alcohol consumption, tobacco smoking, overweight/obesity and HPV infections in Brazil, Russia, India, China, South Africa, the U.K. and the U.S. to evaluate the impact of these factors in patients with cancer across the world. Researchers determined the number and age-standardized YLL rates (ASYR) through life tables. When evaluating each risk factor in all seven countries, tobacco smoking contributed to the most cancer deaths (1.3 million) in 2020, followed by alcohol consumption (326,300 deaths), excess body weight (208,000 deaths) and HPV infection (190,400 deaths) for a total of 1.9 million deaths. Researchers further found that tobacco smoking was linked to the highest estimated YLLs out of the four factors, at 20.8 million. The second highest estimate of premature deaths was due to alcohol consumption (5.9 million), followed by HPV infection (4 million) and excess body weight (3.1 million). “We wanted to stress the continued impact of tobacco smoking on the burden of cancer, as we found that of the 2 million deaths from cancer due to the four risk factors in the seven countries, smoking was the driver of 1.3 million,” Rumgay told Healio. “Of the 30 million years of life lost from cancer due to the four risk factors, tobacco smoking had the biggest impact by far, leading to 20.8 million years of life lost. Our findings show that tobacco control should still be a priority even in countries where smoking rates have fallen, like the U.S. and U.K., as huge numbers of deaths from cancer due to tobacco are still emerging today.” 

For more information: https://tinyurl.com/3cm8sted