People with diabetes, heart failure, chronic obstructive pulmonary disease and inflammatory diseases such as rheumatoid arthritis are at increased risk of death when they are exposed to particulate air pollution, or soot, for one or more years, according to a study to be presented at the American Thoracic Society International Conference on May 22nd.
The study looked at hospital discharges for people with these four types of diseases living in 34 cities between 1985 and 1999. The researchers compared this information with 12-month averages of PM10, a type of particulate matter air pollution that includes particles with a diameter of 10 micrometers or less than 0.0004 inches or one-seventh the width of a human hair.
The study found that for an increase of 10 micrograms/per cubic meter of PM10 over two years, the risk of dying was increased by:
* 32% for people with diabetes
* 28% for people with COPD
* 27% in people with congestive heart failure
* 22% for people with inflammatory disease such as rheumatoid arthritis or lupus
"The study significantly strengthens evidence that breathing in particulate matter is associated with dying sooner," said researcher Joel Schwartz, Ph.D., Professor of Environmental Epidemiology at the Harvard School of Public Health in Boston.
"While previous studies have found that long-term exposure to air pollution is associated with increased risk of death, we looked at risk of death in the first three years after patients were discharged from the hospital, and saw that the risk increased in the first couple of years. That means if we can lower air pollution levels, people will start living longer right away--we don't have to wait many years to see health improvements. That wasn't clear from previous air pollution studies."
Technology that can reduce particulate matter levels already exists, Dr. Schwartz noted. "For instance, we know how to put scrubbers on coal-burning power plants, which are a major source of particulate matter. There is no safe level of particulate air pollution, so we need to get the levels as low as reasonably possible."
While previous studies have linked exposure to PM10 to harmful effects on breathing and respiratory systems, damage to lung tissue, cancer, and premature death, this is the first study to follow people with specific diseases to determine their risk of death in response to particle exposure, Dr. Schwartz said.
He noted an important difference between this new study and past air pollution studies. "Past studies have compared average air pollution conditions in one city to other cities, and you need to worry about potential confounders, or other factors that could affect the differences between the cities," he said. "In this study, we looked at air pollution and deaths within each city--we didn't compare across cities, so we didn't need to worry about confounding factors."
The study helps validate the findings of previous studies that have shown that long-term exposure to air pollution is associated with shortened survival in the general population, said Dr. Schwartz, a co-author of the Six Cities Study, which evaluated the effects of pollution on adults in the 1970s and 1980s. The results of that study found a strong, positive correlation between levels of air pollution and mortality. The study led to a revision of existing air quality standards by the U.S. Environmental Protection Agency. An eight-year follow up study found an association between people living longer and cities reducing the amount of fine particulate matter in their air. That study was published in the March 15, 2006 issue of the American Thoracic Society journal, The American Journal of Respiratory and Critical Care Medicine.
Jim Augustine or Bill Glitz
medsciearthlink
American Thoracic Society
thoracic
вторник, 31 мая 2011 г.
понедельник, 30 мая 2011 г.
GSK Receives Decision From FDA On Advair 500/50 For COPD
GlaxoSmithKline announced today that the U.S. Food and Drug Administration (FDA) has issued a not approvable letter for the supplemental drug application for the 500/50 strength of Advair Diskus (fluticasone propionate and salmeterol inhalation powder) in the treatment of patients with chronic obstructive pulmonary disease (COPD).
The FDA questioned how Advair 500/50 compared to the currently approved 250/50 strength in order to allow for appropriate dosing recommendations. GSK will be meeting with FDA to discuss this request in more detail and determine next steps, including discussion of data GSK has recently generated on the reduction of exacerbations with the Advair 250/50 strength.
"We are very surprised and disappointed by this FDA decision particularly given the outcome of the FDA advisory committee meeting earlier this year," said Katharine Knobil, M.D., Vice-President of Respiratory Clinical Development for COPD at GSK. "The advisory committee voted unanimously that Advair 500/50 demonstrated a significant reduction in the risk of exacerbations. We believe in the strength of the data; this application is based on the results of the largest COPD study conducted in more than 6,000 patients over three years. We are committed to working with the FDA to address any questions they have and to pursue a way forward."
About Advair in COPD
Advair 250/50 is currently indicated for the maintenance treatment of airflow obstruction in patients with COPD associated with chronic bronchitis. Advair does not replace fast-acting inhalers to treat sudden symptoms. Lower respiratory tract infections, including pneumonia, have been reported following the inhaled administration of corticosteroids, including fluticasone propionate and Advair Diskus. Patients with COPD often have multiple risk factors for reduced bone mineral density. Advair Diskus may increase this risk, therefore, bone mineral density assessment is recommended prior to starting Advair Diskus and periodically thereafter. Long-term use of inhaled corticosteroids, including Advair Diskus, may increase the risk for cataracts or glaucoma. Regular eye exams should be considered.
For more information about Advair please visit gsk-us.
About GlaxoSmithKline
Advair was developed and is marketed by GlaxoSmithKline, a research based pharmaceutical company and a world leader in respiratory care. GlaxoSmithKline is committed to improving the quality of human life by enabling people to do more, feel better and live longer. For company information please visit gsk.
Cautionary statement regarding forward-looking statements
Under the safe harbor provisions of the U.S. Private Securities Litigation Reform Act of 1995, the company cautions investors that any forward-looking statements or projections made by the company, including those made in this Announcement, are subject to risks and uncertainties that may cause actual results to differ materially from those projected. Factors that may affect the Group's operations are described under 'Risk Factors' in the 'Business Review' in the company's Annual Report on Form 20-F for 2006.
The FDA questioned how Advair 500/50 compared to the currently approved 250/50 strength in order to allow for appropriate dosing recommendations. GSK will be meeting with FDA to discuss this request in more detail and determine next steps, including discussion of data GSK has recently generated on the reduction of exacerbations with the Advair 250/50 strength.
"We are very surprised and disappointed by this FDA decision particularly given the outcome of the FDA advisory committee meeting earlier this year," said Katharine Knobil, M.D., Vice-President of Respiratory Clinical Development for COPD at GSK. "The advisory committee voted unanimously that Advair 500/50 demonstrated a significant reduction in the risk of exacerbations. We believe in the strength of the data; this application is based on the results of the largest COPD study conducted in more than 6,000 patients over three years. We are committed to working with the FDA to address any questions they have and to pursue a way forward."
About Advair in COPD
Advair 250/50 is currently indicated for the maintenance treatment of airflow obstruction in patients with COPD associated with chronic bronchitis. Advair does not replace fast-acting inhalers to treat sudden symptoms. Lower respiratory tract infections, including pneumonia, have been reported following the inhaled administration of corticosteroids, including fluticasone propionate and Advair Diskus. Patients with COPD often have multiple risk factors for reduced bone mineral density. Advair Diskus may increase this risk, therefore, bone mineral density assessment is recommended prior to starting Advair Diskus and periodically thereafter. Long-term use of inhaled corticosteroids, including Advair Diskus, may increase the risk for cataracts or glaucoma. Regular eye exams should be considered.
For more information about Advair please visit gsk-us.
About GlaxoSmithKline
Advair was developed and is marketed by GlaxoSmithKline, a research based pharmaceutical company and a world leader in respiratory care. GlaxoSmithKline is committed to improving the quality of human life by enabling people to do more, feel better and live longer. For company information please visit gsk.
Cautionary statement regarding forward-looking statements
Under the safe harbor provisions of the U.S. Private Securities Litigation Reform Act of 1995, the company cautions investors that any forward-looking statements or projections made by the company, including those made in this Announcement, are subject to risks and uncertainties that may cause actual results to differ materially from those projected. Factors that may affect the Group's operations are described under 'Risk Factors' in the 'Business Review' in the company's Annual Report on Form 20-F for 2006.
воскресенье, 29 мая 2011 г.
Prevention Of COPD May Need To Start In Fetal Life
COPD prevention should commence before birth, as poor airway function soon after birth is a known risk factor for airflow obstruction during early adulthood, according to an article in the latest issue of The Lancet.
Professor Fernando Martinez, Arizona Respiratory Centre, University of Arizona Health Sciences Center, Tucson, Arizona, USA and team carried out a study on 169 babies who were enrolled at birth in the Tucson Children's Respiratory Study during the period 1980-1883. Each baby had his/her maximum expiratory airflows measured using the chest compression technique at the age of 2.3 months. 123 of the babies had further lung function tests carried out when they were 11, 16 and 22 years old. The following measurements were taken:
-- forced expiratory volume in one second (FEV1)
-- forced vital capacity (FVC)
-- forced expiratory flow between 25% and 75% of FVC (FEF25-75)*, both before and after treatment with a bronchodilator (180 ??g albuterol)
The scientists found that those in the bottom 25% for maximum expiratory flows when they were babies had inferior values for FEV1, FVC, and FEF25-75 when they were 22 years old, compared to the top 25%. Adjustments were made for age, sex, height and weight. Even after further adjustments were made for wheeze, atopy, parental asthma and/or smoking the differences remained the same.
The writers concluded that those born with inferior lung function tend to continue this trend well into early adulthood. They said further research would tell us how the lungs develop in the fetus. It is possible that the process is being impaired in utero by either genetic or environmental factors, or both. Previous studies have linked poor lung function in infants and older children to maternal smoking.
The authors wrote "Our results suggest that a better understanding of the mechanisms that control normal lung growth in utero would contribute to development of strategies for the prevention of COPD in adult life."
Professor Michael Silverman, University of Leicester, UK, and Dr Claudia Kuehni, University of Bern, Switzerland, in an accompanying Comment, wrote: "As COPD is set globally to become the third most important cause of death, now is the time to add research into its earliest origins to the agenda."
"Poor airway function in early infancy and lung function by age 22 years: a non-selective longitudinal cohort study"
Debra A Stern, Prof Wayne J Morgan MD, Anne L Wright PhD, Stefano Guerra MD and Prof Fernando D Martinez MD
The Lancet 2007; 370:758-764 DOI:10.1016/S0140-6736(07)61379-8
Click here to view abstract online (log in required)
Professor Fernando Martinez, Arizona Respiratory Centre, University of Arizona Health Sciences Center, Tucson, Arizona, USA and team carried out a study on 169 babies who were enrolled at birth in the Tucson Children's Respiratory Study during the period 1980-1883. Each baby had his/her maximum expiratory airflows measured using the chest compression technique at the age of 2.3 months. 123 of the babies had further lung function tests carried out when they were 11, 16 and 22 years old. The following measurements were taken:
-- forced expiratory volume in one second (FEV1)
-- forced vital capacity (FVC)
-- forced expiratory flow between 25% and 75% of FVC (FEF25-75)*, both before and after treatment with a bronchodilator (180 ??g albuterol)
The scientists found that those in the bottom 25% for maximum expiratory flows when they were babies had inferior values for FEV1, FVC, and FEF25-75 when they were 22 years old, compared to the top 25%. Adjustments were made for age, sex, height and weight. Even after further adjustments were made for wheeze, atopy, parental asthma and/or smoking the differences remained the same.
The writers concluded that those born with inferior lung function tend to continue this trend well into early adulthood. They said further research would tell us how the lungs develop in the fetus. It is possible that the process is being impaired in utero by either genetic or environmental factors, or both. Previous studies have linked poor lung function in infants and older children to maternal smoking.
The authors wrote "Our results suggest that a better understanding of the mechanisms that control normal lung growth in utero would contribute to development of strategies for the prevention of COPD in adult life."
Professor Michael Silverman, University of Leicester, UK, and Dr Claudia Kuehni, University of Bern, Switzerland, in an accompanying Comment, wrote: "As COPD is set globally to become the third most important cause of death, now is the time to add research into its earliest origins to the agenda."
"Poor airway function in early infancy and lung function by age 22 years: a non-selective longitudinal cohort study"
Debra A Stern, Prof Wayne J Morgan MD, Anne L Wright PhD, Stefano Guerra MD and Prof Fernando D Martinez MD
The Lancet 2007; 370:758-764 DOI:10.1016/S0140-6736(07)61379-8
Click here to view abstract online (log in required)
'Harmless' bacterium found to cause 10 percent of COPD flare-ups
A ubiquitous bacterial strain thought to be uninvolved in chronic obstructive pulmonary disease (COPD) in fact is responsible for 2-4 million flare-ups of the condition that occur annually in the United States, researchers from the University at Buffalo have shown.
The bacterium, Moraxella catarrhalis or M. catarrhalis, often is present in sputum of adults with COPD. However, its potential role in the disease was ignored for decades, because studies in the early 1950s had found it to be relatively harmless.
A study published in the July 15 issue of the American Journal of Respiratory and Critical Care Medicine reports that M. catarrhalis was found to be responsible for approximately 10 percent of exacerbations of COPD.
Timothy F. Murphy, M.D., professor of medicine and microbiology in the UB School of Medicine and Biomedical Sciences, was lead author on the study.
"This paper is the first to study the involvement of M. catarrhalis in a prospective way in adults with COPD," Murphy said. "Using rigorous methods, our work has shown that acquiring M. catarrhalis is strongly associated with the onset of symptoms of an exacerbation.
"People with COPD, estimated to be about 20 million in the U.S., experience one to two exacerbations per year," said Murphy, chief of the UB medical school's Infectious Diseases Division and a pioneer in vaccine development for respiratory disease. "If 10 percent of all exacerbations are caused by M. catarrhalis, that translates to 2-4 million exacerbations annually."
COPD is the fourth leading cause of death in the U.S. and many of those deaths occur during exacerbations, he id. "Exacerbations also cause enormous morbidity and health-care costs. They lead to physician visits, emergency room visits, hospital admissions and respiratory failure requiring mechanical ventilation."
In addition to showing that M. catarrhalis is involved in exacerbations of COPD, the researchers also found that patients make immune responses to the bacterium when they acquire it.
"Both of these observations provide lines of evidence that M. catarrhalis is a pathogen for these patients and provide a strong rationale for pursuing the development of vaccines to prevent M. catarrhalis infections in people with COPD," Murphy said.
The study involved 104 adults with COPD who were seen at the outpatient clinic at the Buffalo Veterans Affairs Medical Center over 81 months. During this period, patients made 3,009 clinic visits, 560 of which were during exacerbations. Sputum samples were collected at each clinical visit and molecular typing of organisms was conducted, as well as assays to measure immune response.
Researchers identified 120 episodes of M. catarrhalis infections in 50 patients, nearly half of which were associated with flare-ups of COPD. There was no evidence that exacerbations were associated with acquisition of a new strain of another pathogen.
"We know that M. catarrhalis causes ear infections in children," said Murphy. "With these new observations regarding the importance of the bacterium in adults with COPD, we have even more reason to forge ahead with developing a vaccine to prevent M. catarrhalis infections."
Additional researchers on the study were Aimee L. Brauer, research technician in the UB Department of Medicine; Brydon J.B. Grant, M.D., UB professor of medicine, physiology and biophysics and social and preventive medicine, and Sanjay Sethi, M.D., UB associate professor of medicine.
The study was supported by grants from the Department of Veterans Affairs and the National Institutes of Health. The University at Buffalo is a premier research-intensive public university, the largest and most comprehensive campus in the State University of New York.
University at Buffalo
buffalo
The bacterium, Moraxella catarrhalis or M. catarrhalis, often is present in sputum of adults with COPD. However, its potential role in the disease was ignored for decades, because studies in the early 1950s had found it to be relatively harmless.
A study published in the July 15 issue of the American Journal of Respiratory and Critical Care Medicine reports that M. catarrhalis was found to be responsible for approximately 10 percent of exacerbations of COPD.
Timothy F. Murphy, M.D., professor of medicine and microbiology in the UB School of Medicine and Biomedical Sciences, was lead author on the study.
"This paper is the first to study the involvement of M. catarrhalis in a prospective way in adults with COPD," Murphy said. "Using rigorous methods, our work has shown that acquiring M. catarrhalis is strongly associated with the onset of symptoms of an exacerbation.
"People with COPD, estimated to be about 20 million in the U.S., experience one to two exacerbations per year," said Murphy, chief of the UB medical school's Infectious Diseases Division and a pioneer in vaccine development for respiratory disease. "If 10 percent of all exacerbations are caused by M. catarrhalis, that translates to 2-4 million exacerbations annually."
COPD is the fourth leading cause of death in the U.S. and many of those deaths occur during exacerbations, he id. "Exacerbations also cause enormous morbidity and health-care costs. They lead to physician visits, emergency room visits, hospital admissions and respiratory failure requiring mechanical ventilation."
In addition to showing that M. catarrhalis is involved in exacerbations of COPD, the researchers also found that patients make immune responses to the bacterium when they acquire it.
"Both of these observations provide lines of evidence that M. catarrhalis is a pathogen for these patients and provide a strong rationale for pursuing the development of vaccines to prevent M. catarrhalis infections in people with COPD," Murphy said.
The study involved 104 adults with COPD who were seen at the outpatient clinic at the Buffalo Veterans Affairs Medical Center over 81 months. During this period, patients made 3,009 clinic visits, 560 of which were during exacerbations. Sputum samples were collected at each clinical visit and molecular typing of organisms was conducted, as well as assays to measure immune response.
Researchers identified 120 episodes of M. catarrhalis infections in 50 patients, nearly half of which were associated with flare-ups of COPD. There was no evidence that exacerbations were associated with acquisition of a new strain of another pathogen.
"We know that M. catarrhalis causes ear infections in children," said Murphy. "With these new observations regarding the importance of the bacterium in adults with COPD, we have even more reason to forge ahead with developing a vaccine to prevent M. catarrhalis infections."
Additional researchers on the study were Aimee L. Brauer, research technician in the UB Department of Medicine; Brydon J.B. Grant, M.D., UB professor of medicine, physiology and biophysics and social and preventive medicine, and Sanjay Sethi, M.D., UB associate professor of medicine.
The study was supported by grants from the Department of Veterans Affairs and the National Institutes of Health. The University at Buffalo is a premier research-intensive public university, the largest and most comprehensive campus in the State University of New York.
University at Buffalo
buffalo
суббота, 28 мая 2011 г.
Broccoli May Help Protect Against Respiratory Conditions Like Asthma
Here's another reason to eat your broccoli: UCLA researchers report that a naturally occurring compound found in broccoli and other cruciferous vegetables may help protect against respiratory inflammation that causes conditions like asthma, allergic rhinitis and chronic obstructive pulmonary disease.
Published in the March edition of the journal Clinical Immunology, the research shows that sulforaphane, a chemical in broccoli, triggers an increase of antioxidant enzymes in the human airway that offers protection against the onslaught of free radicals that we breathe in every day in polluted air, pollen, diesel exhaust and tobacco smoke. A supercharged form of oxygen, free radicals can cause oxidative tissue damage, which leads to inflammation and respiratory conditions like asthma.
"This is one of the first studies showing that broccoli sprouts - a readily available food source - offered potent biologic effects in stimulating an antioxidant response in humans," said Dr. Marc Riedl, the study's principal investigator and an assistant professor of clinical immunology and allergy at the David Geffen School of Medicine at UCLA.
"We found a two- to three-fold increase in antioxidant enzymes in the nasal airway cells of study participants who had eaten a preparation of broccoli sprouts," Riedl said. "This strategy may offer protection against inflammatory processes and could lead to potential treatments for a variety of respiratory conditions."
The UCLA team worked with 65 volunteers who were given varying oral doses of either broccoli or alfalfa sprout preparations for three days. Broccoli sprouts are the richest natural source of sulforaphane; the alfalfa sprouts, which do not contain the compound, served as a placebo.
Rinses of nasal passages were collected at the beginning and end of the study to assess the gene expression of antioxidant enzymes in cells of the upper airways. Researchers found significant increases of antioxidant enzymes at broccoli sprout doses of 100 grams and higher, compared with the placebo group.
The maximum broccoli sprout dosage of 200 grams generated a 101-percent increase of an antioxidant enzyme called GSTP1 and a 199-percent increase of another key enzyme called NQO1.
"A major advantage of sulforaphane is that it appears to increase a broad array of antioxidant enzymes, which may help the compound's effectiveness in blocking the harmful effects of air pollution," Riedl said.
According to the authors, no serious side effects occurred in study participants receiving broccoli sprouts, demonstrating that this may be an effective, safe antioxidant strategy to help reduce the inflammatory impact of free radicals.
Riedl notes that more research needs to be done to examine the benefits of sulforaphane for specific respiratory conditions. It is too early to recommend a particular dosage.
Riedl recommends including broccoli and other cruciferous vegetables as part of a healthy diet.
Notes:
The study was supported by the National Institutes of Health, the National Institute of Environmental Health Sciences and the U.S. Environmental Protection Agency.
Other study authors include Dr. Andrew Saxon of the Hart and Louis Lyon Laboratory, division of clinical immunology and allergy in the department of medicine at the David Geffen School of Medicine at UCLA, and Dr. David Diaz-Sanchez of the human studies division of the U.S. Environmental Protection Agency.
Published in the March edition of the journal Clinical Immunology, the research shows that sulforaphane, a chemical in broccoli, triggers an increase of antioxidant enzymes in the human airway that offers protection against the onslaught of free radicals that we breathe in every day in polluted air, pollen, diesel exhaust and tobacco smoke. A supercharged form of oxygen, free radicals can cause oxidative tissue damage, which leads to inflammation and respiratory conditions like asthma.
"This is one of the first studies showing that broccoli sprouts - a readily available food source - offered potent biologic effects in stimulating an antioxidant response in humans," said Dr. Marc Riedl, the study's principal investigator and an assistant professor of clinical immunology and allergy at the David Geffen School of Medicine at UCLA.
"We found a two- to three-fold increase in antioxidant enzymes in the nasal airway cells of study participants who had eaten a preparation of broccoli sprouts," Riedl said. "This strategy may offer protection against inflammatory processes and could lead to potential treatments for a variety of respiratory conditions."
The UCLA team worked with 65 volunteers who were given varying oral doses of either broccoli or alfalfa sprout preparations for three days. Broccoli sprouts are the richest natural source of sulforaphane; the alfalfa sprouts, which do not contain the compound, served as a placebo.
Rinses of nasal passages were collected at the beginning and end of the study to assess the gene expression of antioxidant enzymes in cells of the upper airways. Researchers found significant increases of antioxidant enzymes at broccoli sprout doses of 100 grams and higher, compared with the placebo group.
The maximum broccoli sprout dosage of 200 grams generated a 101-percent increase of an antioxidant enzyme called GSTP1 and a 199-percent increase of another key enzyme called NQO1.
"A major advantage of sulforaphane is that it appears to increase a broad array of antioxidant enzymes, which may help the compound's effectiveness in blocking the harmful effects of air pollution," Riedl said.
According to the authors, no serious side effects occurred in study participants receiving broccoli sprouts, demonstrating that this may be an effective, safe antioxidant strategy to help reduce the inflammatory impact of free radicals.
Riedl notes that more research needs to be done to examine the benefits of sulforaphane for specific respiratory conditions. It is too early to recommend a particular dosage.
Riedl recommends including broccoli and other cruciferous vegetables as part of a healthy diet.
Notes:
The study was supported by the National Institutes of Health, the National Institute of Environmental Health Sciences and the U.S. Environmental Protection Agency.
Other study authors include Dr. Andrew Saxon of the Hart and Louis Lyon Laboratory, division of clinical immunology and allergy in the department of medicine at the David Geffen School of Medicine at UCLA, and Dr. David Diaz-Sanchez of the human studies division of the U.S. Environmental Protection Agency.
пятница, 27 мая 2011 г.
Aclidinium Bromide Demonstrates Rapid And Long-Acting Bronchodilatory Effect In COPD
Almirall's aclidinium bromide achieves a significant, rapid and long-acting bronchodilatory effect in patients with chronic obstructive pulmonary disease (COPD), according to results of a key phase IIa trial presented at the European Respiratory Society (ERS) Annual Congress in Stockholm. Preclinical and phase I data disclosed at ERS 2007 also support the selective airway activity and safety profile of this novel muscarinic receptor antagonist.
In the phase IIa trial, single doses of inhaled aclidinium produced a significant bronchodilatory response in patients with COPD.1 Mean FEV1 and FVC values - important measures of lung function - were significantly increased with aclidinium over a 24-hour time period, as compared to placebo. This bronchodilatory effect of aclidinium was both rapid and long-acting. Onset of significant bronchodilation was observed as early as 15 minutes after aclidinium treatment and was sustained for at least 24 hours. Up to 32 hours worth of bronchodilation was achieved with certain doses of the drug.
Aclidinium was well-tolerated during the phase IIa trial and no patients withdrew from the study because of adverse events. The majority of adverse events reported were mild to moderate in intensity, and at least three quarters were determined to be unrelated to aclidinium. Single doses of aclidinium did not result in any clinically significant adverse effect on physical examination, vital signs, heart function (as assessed by 12-lead ECG) or laboratory data.
The phase IIa study of aclidinium was a two-centre, double-blind, randomised, ascending single-dose, placebo-controlled, cross-over trial which enrolled 17 COPD patients. Treatment was with one of three doses of aclidinium (100 ??g, 300 ??g or 900 ??g) or placebo administered via dry-powder inhaler. The study's primary outcome measure was area under the normalised curve (AUC) of FEV1 over a 24-hour time period.
Phase I study findings also presented at ERS 2007 confirm the bronchodilatory efficacy of aclidinium seen in phase IIa.2 In the phase I study, 12 healthy volunteers were subjected to artificially-induced bronchoconstriction (a valid early clinical model for COPD) and then treated with one of three doses of aclidinium. Aclidinium proved superior to placebo in improving specific airway conductance, with a greater effect obtained at higher doses. This response to aclidinium was rapid and sustained, with a significant effect observed 1 hour after treatment and maintained for 24 hours (at 300 ??g and 600 ??g doses). Aclidinium also provided statistically significant and sustained bronchoprotection over 24 hours against methacholine-induced airway constriction. No study drug-related adverse events were reported and aclidinium was well tolerated throughout the trial.
Results of pharmacology studies also presented at the congress show that aclidinium has strong selectivity and a long duration of action as its target M3 receptors in the airway, but is rapidly cleared from the plasma.3 These beneficial features account for aclidinium's ability to provide a sustained clinical effect, coupled with a good safety and tolerability profile. Importantly, the drug's low systemic availability may provide the potential for improved tolerability over currently available anticholinergics that remain in the plasma. When compared to other bronchodilatory agents in vitro, aclidinium demonstrated potent anticholinergic activity comparable to both tiotropium and ipratropium, but with a faster onset of action than tiotropium and a significantly longer duration of action versus ipratropium4, allowing for a 24 hour duration of action.
About COPD
COPD is a preventable and treatable lung disease characterised by chronic airflow limitation that is not fully reversible.5 Globally, an estimated 80 million people suffer from moderate-to-severe COPD.6 In excess of 3 million people died of the condition in 2005, accounting for 5% of all deaths worldwide.7 Currently, there are only three long-acting bronchodilators available for the treatment of COPD. Given the high morbidity and mortality associated with this disease and the variable individual response to therapy, new treatment options for COPD are urgently needed.
Unmet need in COPD treatment
There are significant unmet needs in the treatment of COPD including efficacious anti-inflammatory medication and better methods for preventing or controlling exacerbations. Inhaled anticholinergic drugs have been used since the 1970s as safe and effective first-line bronchodilator therapies. These agents are limited because of the need for frequent dosing. A class of long acting muscarinic antagonists (LAMAs) has emerged as the mainstay of COPD therapy. Furthermore, inhaled LAMA therapies, such as aclidinium bromide, when administered via oral inhalation, can greatly reduce systemic exposure and may therefore have improved safety profiles.
Aclidinium bromide is a novel inhaled anticholinergic bronchodilator that is currently in phase III clinical development as a once-daily maintenance treatment for COPD.
About Almirall
Almirall, an international pharmaceutical company committed to health, headquartered in Barcelona, Spain, researches, develops, manufactures and commercialises its own R&D and licensed drugs with the aim of improving people's health and wellbeing.
The therapeutic areas on which Almirall focuses its research resources are related to the treatment of asthma, COPD (Chronic Obstructive Pulmonary Disease), psoriasis, rheumatoid arthritis and multiple sclerosis.
Almirall is currently present in over 80 countries. The company has direct presence in Europe and Latin America via affiliates in France, Germany, Italy, Portugal, Belgium and Mexico.
For further information please visit the website at: almirall.es
FEV1 - Forced expiratory volume at 1 second
FVC - Forced vital capacity
ECG - Electrocardiogram
References
1. Joos GF, Schelfhout VJ, Kanniess F et al. Bronchodilator effects of aclidinium bromide, a novel long-acting anticholinergic, in COPD patients: a phase II study. European Respiratory Society (ERS) Annual Congress, September 2007.
2. Schelfhout VJ, Joos GF, Gil EG et al. Bronchodilator/bronchoprotective effects of aclidinium bromide, a novel long-acting anticholinergic: a phase I study. European Respiratory Society (ERS) Annual Congress, September 2007.
3. Gavalda A, Miralpeix M, Ramos I et AL. Aclidinium bromide, a novel muscarinic receptor antagonist combining long residence at M3 receptors and rapid plasma clearance. European Respiratory Society (ERS) Annual Congress, September 2007..
4. Miralpeix M, Gavalda A, Morcillo E et al. Assessment of the potency and duration of action of aclidinium bromide in guinea pig isolated trachea in vitro. European Respiratory Society (ERS) Annual Congress, September 2007.
5. Global Initiative for Chronic Obstructive Lung Disease. MCR Vision Inc 2006.
6. World Health Organisation (WHO). Chronic obstructive pulmonary disease (COPD). Website page. Accessed August 2007. Available at: who.int/respiratory/copd/en/
7. World Health Organisation (WHO). Chronic obstructive pulmonary disease (COPD). Factsheet number 315; November 2006.
almirall.es
In the phase IIa trial, single doses of inhaled aclidinium produced a significant bronchodilatory response in patients with COPD.1 Mean FEV1 and FVC values - important measures of lung function - were significantly increased with aclidinium over a 24-hour time period, as compared to placebo. This bronchodilatory effect of aclidinium was both rapid and long-acting. Onset of significant bronchodilation was observed as early as 15 minutes after aclidinium treatment and was sustained for at least 24 hours. Up to 32 hours worth of bronchodilation was achieved with certain doses of the drug.
Aclidinium was well-tolerated during the phase IIa trial and no patients withdrew from the study because of adverse events. The majority of adverse events reported were mild to moderate in intensity, and at least three quarters were determined to be unrelated to aclidinium. Single doses of aclidinium did not result in any clinically significant adverse effect on physical examination, vital signs, heart function (as assessed by 12-lead ECG) or laboratory data.
The phase IIa study of aclidinium was a two-centre, double-blind, randomised, ascending single-dose, placebo-controlled, cross-over trial which enrolled 17 COPD patients. Treatment was with one of three doses of aclidinium (100 ??g, 300 ??g or 900 ??g) or placebo administered via dry-powder inhaler. The study's primary outcome measure was area under the normalised curve (AUC) of FEV1 over a 24-hour time period.
Phase I study findings also presented at ERS 2007 confirm the bronchodilatory efficacy of aclidinium seen in phase IIa.2 In the phase I study, 12 healthy volunteers were subjected to artificially-induced bronchoconstriction (a valid early clinical model for COPD) and then treated with one of three doses of aclidinium. Aclidinium proved superior to placebo in improving specific airway conductance, with a greater effect obtained at higher doses. This response to aclidinium was rapid and sustained, with a significant effect observed 1 hour after treatment and maintained for 24 hours (at 300 ??g and 600 ??g doses). Aclidinium also provided statistically significant and sustained bronchoprotection over 24 hours against methacholine-induced airway constriction. No study drug-related adverse events were reported and aclidinium was well tolerated throughout the trial.
Results of pharmacology studies also presented at the congress show that aclidinium has strong selectivity and a long duration of action as its target M3 receptors in the airway, but is rapidly cleared from the plasma.3 These beneficial features account for aclidinium's ability to provide a sustained clinical effect, coupled with a good safety and tolerability profile. Importantly, the drug's low systemic availability may provide the potential for improved tolerability over currently available anticholinergics that remain in the plasma. When compared to other bronchodilatory agents in vitro, aclidinium demonstrated potent anticholinergic activity comparable to both tiotropium and ipratropium, but with a faster onset of action than tiotropium and a significantly longer duration of action versus ipratropium4, allowing for a 24 hour duration of action.
About COPD
COPD is a preventable and treatable lung disease characterised by chronic airflow limitation that is not fully reversible.5 Globally, an estimated 80 million people suffer from moderate-to-severe COPD.6 In excess of 3 million people died of the condition in 2005, accounting for 5% of all deaths worldwide.7 Currently, there are only three long-acting bronchodilators available for the treatment of COPD. Given the high morbidity and mortality associated with this disease and the variable individual response to therapy, new treatment options for COPD are urgently needed.
Unmet need in COPD treatment
There are significant unmet needs in the treatment of COPD including efficacious anti-inflammatory medication and better methods for preventing or controlling exacerbations. Inhaled anticholinergic drugs have been used since the 1970s as safe and effective first-line bronchodilator therapies. These agents are limited because of the need for frequent dosing. A class of long acting muscarinic antagonists (LAMAs) has emerged as the mainstay of COPD therapy. Furthermore, inhaled LAMA therapies, such as aclidinium bromide, when administered via oral inhalation, can greatly reduce systemic exposure and may therefore have improved safety profiles.
Aclidinium bromide is a novel inhaled anticholinergic bronchodilator that is currently in phase III clinical development as a once-daily maintenance treatment for COPD.
About Almirall
Almirall, an international pharmaceutical company committed to health, headquartered in Barcelona, Spain, researches, develops, manufactures and commercialises its own R&D and licensed drugs with the aim of improving people's health and wellbeing.
The therapeutic areas on which Almirall focuses its research resources are related to the treatment of asthma, COPD (Chronic Obstructive Pulmonary Disease), psoriasis, rheumatoid arthritis and multiple sclerosis.
Almirall is currently present in over 80 countries. The company has direct presence in Europe and Latin America via affiliates in France, Germany, Italy, Portugal, Belgium and Mexico.
For further information please visit the website at: almirall.es
FEV1 - Forced expiratory volume at 1 second
FVC - Forced vital capacity
ECG - Electrocardiogram
References
1. Joos GF, Schelfhout VJ, Kanniess F et al. Bronchodilator effects of aclidinium bromide, a novel long-acting anticholinergic, in COPD patients: a phase II study. European Respiratory Society (ERS) Annual Congress, September 2007.
2. Schelfhout VJ, Joos GF, Gil EG et al. Bronchodilator/bronchoprotective effects of aclidinium bromide, a novel long-acting anticholinergic: a phase I study. European Respiratory Society (ERS) Annual Congress, September 2007.
3. Gavalda A, Miralpeix M, Ramos I et AL. Aclidinium bromide, a novel muscarinic receptor antagonist combining long residence at M3 receptors and rapid plasma clearance. European Respiratory Society (ERS) Annual Congress, September 2007..
4. Miralpeix M, Gavalda A, Morcillo E et al. Assessment of the potency and duration of action of aclidinium bromide in guinea pig isolated trachea in vitro. European Respiratory Society (ERS) Annual Congress, September 2007.
5. Global Initiative for Chronic Obstructive Lung Disease. MCR Vision Inc 2006.
6. World Health Organisation (WHO). Chronic obstructive pulmonary disease (COPD). Website page. Accessed August 2007. Available at: who.int/respiratory/copd/en/
7. World Health Organisation (WHO). Chronic obstructive pulmonary disease (COPD). Factsheet number 315; November 2006.
almirall.es
четверг, 26 мая 2011 г.
New Smoking Cessation Research Presented At CHEST 2009
New Formula Calculates More Accurate 'Lung Age' in Smokers
(#7896 )
A new formula more accurately calculates a smoker's "lung age," which researchers hope will help persuade patients to quit the habit. A research team from Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, CA, developed and evaluated a new lung age formula based on %FEV1/FEV6 rather than the current lung age formulas based on height and FEV1 or FVC. They found that the new formula closely approximated actual lung ages in 5,800 never-smokers, while values using the earlier formulas were erratic. They also found that in 3,500 current smokers, mean increases in lung age progressed to more than 25 years by age 50 and above, much higher but less erratic than using lung ages based on earlier formulas. Researchers conclude that sharing physiological lung age with smokers may be more effective in smoking cessation than sharing spirometry results.
Pulmonary Rehab May Improve Smoking Cessation Rates
(#8531)
New research shows that patients who smoke who participate in a structured pulmonary rehabilitation (PR) program achieve higher abstinence rates than those who receive usual care. A research team from Montreal compared smoking cessation rates among 413 patients with chronic obstructive lung disease (COPD). Of the patients, 27 subjects participated in a PR program, while 386 received standard care. After a follow-up of 31?±24 months, 81.5 percent of patients in the PR group had at least a short-term abstinence compared with only 46.1 percent in the non-PR group. Additionally, 37 percent of patients in the PR group showed signs of sustained quitting, compared with 8 percent in the non-PR group. Researchers conclude that PR may play a role in smoking cessation in patients with COPD.
Clinicians Lack Training in Smoking Cessation
(#8699)
Physicians, nurses, and other health-care providers receive limited training on smoking cessation strategies. University of Arizona researchers surveyed 250 hospital employees about the extent of their smoking cessation training and knowledge of smoking cessation methods. Results showed that more than 50 percent of nonphysician patient care providers talk at least weekly with their patients about smoking and smoking cessation. However, only 24 percent of nurses and 15 percent of medical technicians have formal training on the subject, and both groups had limited knowledge of smoking cessation strategies. Furthermore, less than half of the physicians surveyed reported having any formal training in techniques of smoking cessation, and only 54 percent were aware of patient support resources such as telephone help/quit lines. Researchers suggest that significant education of health-care providers at all levels is needed to allow them to effectively help their patients understand the risks of smoking and methods of smoking cessation.
Varenicline Effective and Well Tolerated for Smoking Cessation
(#450)
New research shows that varenicline is an effective therapy for smoking cessation and is well tolerated among patients with chronic obstructive lung disease (COPD). In a 27-center, double-blind, multinational study, researchers from the University of California, Los Angeles and UBC Scientific Solutions in the United Kingdom assessed the efficacy and safety of varenicline in patients with mild to moderate COPD. Patients were randomized to receive either varenicline (n=248) or placebo (n=251) for 12 weeks, with a 40-week nontreatment follow-up. At weeks 9 and 12, the continuous abstinence rate (CAR) was significantly higher for varenicline (42.3 percent) vs placebo (8.8 percent). Greater varenicline efficacy also was maintained during weeks 9 and 52 (varenicline CAR, 18.6 percent vs placebo CAR, 5.6 percent). Serious events adverse occurred in 2.8 percent of patients receiving varenicline and 4.4 percent of patients receiving placebo. Two patients receiving varenicline died during the study, as did one patient receiving placebo. One suicidal ideation event was reported for placebo; no such event was reported for varenicline. Reports of depression, depressed mood, and depressive symptoms were similar for both treatment groups.
(#7896 )
A new formula more accurately calculates a smoker's "lung age," which researchers hope will help persuade patients to quit the habit. A research team from Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, CA, developed and evaluated a new lung age formula based on %FEV1/FEV6 rather than the current lung age formulas based on height and FEV1 or FVC. They found that the new formula closely approximated actual lung ages in 5,800 never-smokers, while values using the earlier formulas were erratic. They also found that in 3,500 current smokers, mean increases in lung age progressed to more than 25 years by age 50 and above, much higher but less erratic than using lung ages based on earlier formulas. Researchers conclude that sharing physiological lung age with smokers may be more effective in smoking cessation than sharing spirometry results.
Pulmonary Rehab May Improve Smoking Cessation Rates
(#8531)
New research shows that patients who smoke who participate in a structured pulmonary rehabilitation (PR) program achieve higher abstinence rates than those who receive usual care. A research team from Montreal compared smoking cessation rates among 413 patients with chronic obstructive lung disease (COPD). Of the patients, 27 subjects participated in a PR program, while 386 received standard care. After a follow-up of 31?±24 months, 81.5 percent of patients in the PR group had at least a short-term abstinence compared with only 46.1 percent in the non-PR group. Additionally, 37 percent of patients in the PR group showed signs of sustained quitting, compared with 8 percent in the non-PR group. Researchers conclude that PR may play a role in smoking cessation in patients with COPD.
Clinicians Lack Training in Smoking Cessation
(#8699)
Physicians, nurses, and other health-care providers receive limited training on smoking cessation strategies. University of Arizona researchers surveyed 250 hospital employees about the extent of their smoking cessation training and knowledge of smoking cessation methods. Results showed that more than 50 percent of nonphysician patient care providers talk at least weekly with their patients about smoking and smoking cessation. However, only 24 percent of nurses and 15 percent of medical technicians have formal training on the subject, and both groups had limited knowledge of smoking cessation strategies. Furthermore, less than half of the physicians surveyed reported having any formal training in techniques of smoking cessation, and only 54 percent were aware of patient support resources such as telephone help/quit lines. Researchers suggest that significant education of health-care providers at all levels is needed to allow them to effectively help their patients understand the risks of smoking and methods of smoking cessation.
Varenicline Effective and Well Tolerated for Smoking Cessation
(#450)
New research shows that varenicline is an effective therapy for smoking cessation and is well tolerated among patients with chronic obstructive lung disease (COPD). In a 27-center, double-blind, multinational study, researchers from the University of California, Los Angeles and UBC Scientific Solutions in the United Kingdom assessed the efficacy and safety of varenicline in patients with mild to moderate COPD. Patients were randomized to receive either varenicline (n=248) or placebo (n=251) for 12 weeks, with a 40-week nontreatment follow-up. At weeks 9 and 12, the continuous abstinence rate (CAR) was significantly higher for varenicline (42.3 percent) vs placebo (8.8 percent). Greater varenicline efficacy also was maintained during weeks 9 and 52 (varenicline CAR, 18.6 percent vs placebo CAR, 5.6 percent). Serious events adverse occurred in 2.8 percent of patients receiving varenicline and 4.4 percent of patients receiving placebo. Two patients receiving varenicline died during the study, as did one patient receiving placebo. One suicidal ideation event was reported for placebo; no such event was reported for varenicline. Reports of depression, depressed mood, and depressive symptoms were similar for both treatment groups.
Chronic Obstructive Pulmonary Disease (COPD) Often Associated With Other Illnesses
This is according to an American study. Its authors recommend screening
for diabetes, arterial hypertension and cardiovascular disease in
patients with COPD.
The study, to be published in the forthcoming issue of the
European Respiratory Journal (ERJ), the scientific publication
of the European Respiratory Society, finds that chronic
obstructive pulmonary disease (COPD) is often associated
with other serious illnesses.
Conversely, a patient with diabetes or arterial hypertension
should also be screened for COPD and other respiratory conditions,
according to the study's authors.
COPD, which includes chronic bronchitis and emphysema, is
increasingly prevalent throughout the world. This serious respiratory
disease, caused largely by smoking, could become the third most
common cause of death in Western countries by 2020, according to
calculations by the World Health Organization (WHO).
In view of this danger, considerable efforts are under way to improve
management and prevention of COPD. In particular, researchers are
attempting to identify which illnesses are frequently linked with
COPD and assess their impact on the way the disease progresses.
Among them are David Mannino (Department of Preventive Medicine and
Environmental Health, University of Kentucky, Lexington, USA) and his
team, who set out to determine what links COPD to cardiovascular
disease, hypertension and diabetes, and to assess to what degree the
simultaneous presence of several diseases (comorbidity) could affect
hospitalisation and mortality rates.
Over 20,000 patients monitored for five years
For their project, two existing databases were combined, one from the
ARIC (Atherosclerosis Risk In Communities) cohort and the other from
the Cardiovascular Health Study (CHS). Launched in the late 1980s by
the US National Institutes of Health, both studies included thousands
of subjects, aged over 65 for the CHS and from 45 to 64 for ARIC.
Mannino's team only studied patients for whom adequate pulmonary
function data were available, selecting 15,341 volunteers from the
ARIC cohort and 4,955 from the CHS.
The total of 20,296 subjects were classified according to the
severity of their COPD, using a scale based on the GOLD (Global
Initiative for Chronic Obstructive Lung Disease) classification. This
involves five stages, from 0 (respiratory symptoms such as chronic
cough and expectoration, but without reduction of respiratory
function) to 4 (very severe disease with major anomalies revealed by
spirometric testing).
In each group of patients, the authors analysed the presence or
absence of diabetes, arterial hypertension, or a cardiovascular
disease, including angina pectoris, antecedents of myocardial
infarction, heart failure, stroke and transient ischaemic attack (TIA).
They also noted the levels of hospitalisation and mortality over the
five-year monitoring period of the studies.
Over half of patients have a comorbidity
The results published by the ERJ provide food for thought.
A total of 530 patients were in one of the more severe COPD
categories (GOLD 3 or 4), with another 2,076 suffering from moderate
COPD (GOLD 2) and 2,892 for whom the disease was just beginning (GOLD 1).
A further 4,511 subjects could be considered as potentially at risk
(GOLD 0) and 2,868 others were found by functional respiratory
testing to be suffering from restrictive syndrome (excessively small
lung volume).
Finally, the remaining 7,419 subjects, or approximately one-third of
the participants, could be classed as "normal" in terms of
respiratory function.
Mannino and his team report in the ERJ article that, having analysed
each of the groups for comorbidities, they found over half of the
COPD patients to be suffering from an associated condition.
This was particularly striking among patients with one of the severe
forms of COPD (GOLD stage 3 or 4), for whom the risk of diabetes was
increased by 50%, hypertension by 60% and cardiovascular disease by
140%.
Results are similar for the group of non-COPD patients with
restrictive syndrome.
In total, less than half of COPD patients (48.9%) did not have a
comorbidity. Over one-third (7,359, or 36.3%) had a single
comorbidity, while 2,597 (12.8%) had two. There were even 415
patients (2%) with all three.
What is more, the authors emphasise, the risk of hospitalisation
during the five-year study period was significantly higher for those
with one or more comorbidities.
The association between COPD and cardiovascular disease has not been
completely elucidated.
It could arise from a number of factors, including chronic infection,
inflammation or a shared risk factor, such as smoking.
Strangely, though, the association with cardiovascular disease
appears to be independent of the severity of the respiratory
condition: "the risk of cardiovascular disease is the same in
patients with severe COPD and those with only early signs of the
condition", Mannino comments.
He believes, therefore, that there would be benefits from systematic
screening for cardiovascular disease, hypertension and diabetes in
COPD patients, and vice versa.
Title Of The Original Article
"Prevalence and outcomes of diabetes, hypertension, and cardiovascular disease in COPD."
D.M. Mannino, D. Thorn, A. Swensen, F. Holguin
Eur Respir J 2008, doi:10.1183/09031936.00012408
Click here to view abstract online.
The European Respiratory Journal is the peer-reviewed scientific publication of the European Respiratory Society (more than 8,000 specialists in lung diseases and respiratory medicine in Europe, the United States and Australia).
European Respiratory Journal
for diabetes, arterial hypertension and cardiovascular disease in
patients with COPD.
The study, to be published in the forthcoming issue of the
European Respiratory Journal (ERJ), the scientific publication
of the European Respiratory Society, finds that chronic
obstructive pulmonary disease (COPD) is often associated
with other serious illnesses.
Conversely, a patient with diabetes or arterial hypertension
should also be screened for COPD and other respiratory conditions,
according to the study's authors.
COPD, which includes chronic bronchitis and emphysema, is
increasingly prevalent throughout the world. This serious respiratory
disease, caused largely by smoking, could become the third most
common cause of death in Western countries by 2020, according to
calculations by the World Health Organization (WHO).
In view of this danger, considerable efforts are under way to improve
management and prevention of COPD. In particular, researchers are
attempting to identify which illnesses are frequently linked with
COPD and assess their impact on the way the disease progresses.
Among them are David Mannino (Department of Preventive Medicine and
Environmental Health, University of Kentucky, Lexington, USA) and his
team, who set out to determine what links COPD to cardiovascular
disease, hypertension and diabetes, and to assess to what degree the
simultaneous presence of several diseases (comorbidity) could affect
hospitalisation and mortality rates.
Over 20,000 patients monitored for five years
For their project, two existing databases were combined, one from the
ARIC (Atherosclerosis Risk In Communities) cohort and the other from
the Cardiovascular Health Study (CHS). Launched in the late 1980s by
the US National Institutes of Health, both studies included thousands
of subjects, aged over 65 for the CHS and from 45 to 64 for ARIC.
Mannino's team only studied patients for whom adequate pulmonary
function data were available, selecting 15,341 volunteers from the
ARIC cohort and 4,955 from the CHS.
The total of 20,296 subjects were classified according to the
severity of their COPD, using a scale based on the GOLD (Global
Initiative for Chronic Obstructive Lung Disease) classification. This
involves five stages, from 0 (respiratory symptoms such as chronic
cough and expectoration, but without reduction of respiratory
function) to 4 (very severe disease with major anomalies revealed by
spirometric testing).
In each group of patients, the authors analysed the presence or
absence of diabetes, arterial hypertension, or a cardiovascular
disease, including angina pectoris, antecedents of myocardial
infarction, heart failure, stroke and transient ischaemic attack (TIA).
They also noted the levels of hospitalisation and mortality over the
five-year monitoring period of the studies.
Over half of patients have a comorbidity
The results published by the ERJ provide food for thought.
A total of 530 patients were in one of the more severe COPD
categories (GOLD 3 or 4), with another 2,076 suffering from moderate
COPD (GOLD 2) and 2,892 for whom the disease was just beginning (GOLD 1).
A further 4,511 subjects could be considered as potentially at risk
(GOLD 0) and 2,868 others were found by functional respiratory
testing to be suffering from restrictive syndrome (excessively small
lung volume).
Finally, the remaining 7,419 subjects, or approximately one-third of
the participants, could be classed as "normal" in terms of
respiratory function.
Mannino and his team report in the ERJ article that, having analysed
each of the groups for comorbidities, they found over half of the
COPD patients to be suffering from an associated condition.
This was particularly striking among patients with one of the severe
forms of COPD (GOLD stage 3 or 4), for whom the risk of diabetes was
increased by 50%, hypertension by 60% and cardiovascular disease by
140%.
Results are similar for the group of non-COPD patients with
restrictive syndrome.
In total, less than half of COPD patients (48.9%) did not have a
comorbidity. Over one-third (7,359, or 36.3%) had a single
comorbidity, while 2,597 (12.8%) had two. There were even 415
patients (2%) with all three.
What is more, the authors emphasise, the risk of hospitalisation
during the five-year study period was significantly higher for those
with one or more comorbidities.
The association between COPD and cardiovascular disease has not been
completely elucidated.
It could arise from a number of factors, including chronic infection,
inflammation or a shared risk factor, such as smoking.
Strangely, though, the association with cardiovascular disease
appears to be independent of the severity of the respiratory
condition: "the risk of cardiovascular disease is the same in
patients with severe COPD and those with only early signs of the
condition", Mannino comments.
He believes, therefore, that there would be benefits from systematic
screening for cardiovascular disease, hypertension and diabetes in
COPD patients, and vice versa.
Title Of The Original Article
"Prevalence and outcomes of diabetes, hypertension, and cardiovascular disease in COPD."
D.M. Mannino, D. Thorn, A. Swensen, F. Holguin
Eur Respir J 2008, doi:10.1183/09031936.00012408
Click here to view abstract online.
The European Respiratory Journal is the peer-reviewed scientific publication of the European Respiratory Society (more than 8,000 specialists in lung diseases and respiratory medicine in Europe, the United States and Australia).
European Respiratory Journal
среда, 25 мая 2011 г.
What Is Bronchitis? What Causes Bronchitis?
The bronchial tubes, or bronchi, connect the windpipe to the lungs. When the lining of the bronchial tubes becomes inflamed or infected, the condition is called bronchitis. Bronchitis reduces the amount of air and oxygen that can flow into the lungs and causes a heavy mucus or phlegm to form in the airways.
Bronchitis is considered to be acute or chronic. Acute bronchitis is a shorter illness that commonly develops after a cold or viral infection such as the flu. It generally consists of a cough with green sputum, chest discomfort or soreness, fever, and sometimes shortness of breath. Acute bronchitis usually lasts a few days or weeks.
Chronic bronchitis is characterized by a persistent, mucus-producing cough on most days of the month, three months of a year for two successive years in absence of a secondary cause of the cough. People with chronic bronchitis have varying degrees of breathing difficulties, and symptoms may get better and worsen during different parts of the year.
What causes bronchitis?
Bronchitis is caused by viruses, bacteria, and other particles that irritate the bronchial tubes.
Acute bronchitis is usually caused by a viral infection in the bronchi - often the same viruses that causes cold and flu. Bronchitis is actually part of the immune response to fighting against the infection, since additional swelling occurs in the bronchial tubes as the immune system's actions generate mucus. In addition to viruses, bacteria, exposure to tobacco smoke, exposure to pollutants or solvents, and gastroesophageal reflux disease (GERD) can also cause acute bronchitis.
Chronic bronchitis is most commonly caused by cigarette smoking. However, it can also be the result of continuous attacks of acute bronchitis. Air pollution, dust, toxic gases, and other industrial fumes are known to be responsible for the condition.
Who gets bronchitis?
People at increased risk of getting bronchitis and increased risk of having more severe symptoms include:
Smokers
People who are exposed to a lot of secondhand smoke
People with weakened immune systems
The elderly and infants
People with gastroesophageal reflux disease (GERD)
Those who are exposed to irritants at work, such as chemical fumes from ammonia, strong acids, chlorine, hydrogen sulfide, sulfur dioxide or bromine
What are the symptoms of bronchitis?
Signs and symptoms for both acute and chronic bronchitis include:
Inflammation or swelling of the bronchi
Coughing
Production of clear, white, yellow, grey, or green mucus (sputum)
Shortness of breath
Wheezing
Fatigue
Fever and chills
Chest pain or discomfort
Blocked or runny nose
Acute bronchitis usually results in a nagging cough that lingers for several weeks even after the bronchitis resolves. Chronic bronchitis's long-term inflammation leads to scarring of the bronchial tubes and airways, which leads to production of excessive mucus. Additional symptoms of chronic bronchitis include frequent respiratory infections and a cough that is worse in the mornings and in damp weather.
How is bronchitis diagnosed?
In addition to an examination of family and personal medical histories, there are several tests that are used to diagnose bronchitis. If a doctor hears wheezing or abnormal sounds when listening to your lungs with a stethoscope, he or she will often order chest X-rays. A pulmonary lung function test using a device called a spirometer may be employed to check for asthma or emphysema. Physicians will also order an analysis of sputum (material coughed up from lungs) called a sputum culture, which can reveal the type of bacteria, if any, that is present in your body. Additional tests include blood tests and oxygen saturation measurements.
Video: What is Chronic Bronchitis?
How is bronchitis treated?
People suffering from bronchitis are usually instructed to rest, drink fluids, breath warm and moist air, and take over-the-counter cough suppressants and pain relievers in order to manage symptoms and ease breathing. Many cases of acute bronchitis actually may go away without any specific treatment, but there is no cure for chronic bronchitis.
To keep bronchitis symptoms under control and relieve symptoms, doctors may prescribe:
Antibiotics - these are effective for bacterial infections, but not for viral infections. They may also prevent secondary infections.
Cough medicine - one must be careful not to completely suppress the cough, for it is an important way to bring up mucus and remove irritants from the lungs.
Bronchodilators - these open the bronchial tubes and clear out mucus.
Mucolytics - these thin or loosen mucus in the airways, making it easier to cough up sputum.
Anti-inflammatory medicines and glucocorticoid steroids - these are for more persistent symptoms.
Pulmonary rehabilitation program - this includes work with a respiratory therapist to help breathing.
Additional behavioral remedies include:
Avoiding tobacco smoke and quitting smoking
Using a humidifier
Cold-air face masks (if cold air aggravates cough)
Pursed-lip breathing (to slow breathing)
How can bronchitis be prevented?
Bronchitis is a somewhat preventable disease. Prevention methods include:
Avoiding tobacco smoke and exposure to second hand smoke
Quitting smoking
Avoiding people who are sick with colds or the flu
Getting a yearly flu vaccine
Getting a pneumonia vaccine (especially for those over 60 years of age)
Washing hands regularly
Avoiding cold, damp locations or areas with a lot of air pollution
Wearing a mask around people who are coughing and sneezing
Written by Peter Crosta M.A.
Original article date: 30th May 2004
Article updated: 10th November 2009
Bronchitis is considered to be acute or chronic. Acute bronchitis is a shorter illness that commonly develops after a cold or viral infection such as the flu. It generally consists of a cough with green sputum, chest discomfort or soreness, fever, and sometimes shortness of breath. Acute bronchitis usually lasts a few days or weeks.
Chronic bronchitis is characterized by a persistent, mucus-producing cough on most days of the month, three months of a year for two successive years in absence of a secondary cause of the cough. People with chronic bronchitis have varying degrees of breathing difficulties, and symptoms may get better and worsen during different parts of the year.
What causes bronchitis?
Bronchitis is caused by viruses, bacteria, and other particles that irritate the bronchial tubes.
Acute bronchitis is usually caused by a viral infection in the bronchi - often the same viruses that causes cold and flu. Bronchitis is actually part of the immune response to fighting against the infection, since additional swelling occurs in the bronchial tubes as the immune system's actions generate mucus. In addition to viruses, bacteria, exposure to tobacco smoke, exposure to pollutants or solvents, and gastroesophageal reflux disease (GERD) can also cause acute bronchitis.
Chronic bronchitis is most commonly caused by cigarette smoking. However, it can also be the result of continuous attacks of acute bronchitis. Air pollution, dust, toxic gases, and other industrial fumes are known to be responsible for the condition.
Who gets bronchitis?
People at increased risk of getting bronchitis and increased risk of having more severe symptoms include:
Smokers
People who are exposed to a lot of secondhand smoke
People with weakened immune systems
The elderly and infants
People with gastroesophageal reflux disease (GERD)
Those who are exposed to irritants at work, such as chemical fumes from ammonia, strong acids, chlorine, hydrogen sulfide, sulfur dioxide or bromine
What are the symptoms of bronchitis?
Signs and symptoms for both acute and chronic bronchitis include:
Inflammation or swelling of the bronchi
Coughing
Production of clear, white, yellow, grey, or green mucus (sputum)
Shortness of breath
Wheezing
Fatigue
Fever and chills
Chest pain or discomfort
Blocked or runny nose
Acute bronchitis usually results in a nagging cough that lingers for several weeks even after the bronchitis resolves. Chronic bronchitis's long-term inflammation leads to scarring of the bronchial tubes and airways, which leads to production of excessive mucus. Additional symptoms of chronic bronchitis include frequent respiratory infections and a cough that is worse in the mornings and in damp weather.
How is bronchitis diagnosed?
In addition to an examination of family and personal medical histories, there are several tests that are used to diagnose bronchitis. If a doctor hears wheezing or abnormal sounds when listening to your lungs with a stethoscope, he or she will often order chest X-rays. A pulmonary lung function test using a device called a spirometer may be employed to check for asthma or emphysema. Physicians will also order an analysis of sputum (material coughed up from lungs) called a sputum culture, which can reveal the type of bacteria, if any, that is present in your body. Additional tests include blood tests and oxygen saturation measurements.
Video: What is Chronic Bronchitis?
How is bronchitis treated?
People suffering from bronchitis are usually instructed to rest, drink fluids, breath warm and moist air, and take over-the-counter cough suppressants and pain relievers in order to manage symptoms and ease breathing. Many cases of acute bronchitis actually may go away without any specific treatment, but there is no cure for chronic bronchitis.
To keep bronchitis symptoms under control and relieve symptoms, doctors may prescribe:
Antibiotics - these are effective for bacterial infections, but not for viral infections. They may also prevent secondary infections.
Cough medicine - one must be careful not to completely suppress the cough, for it is an important way to bring up mucus and remove irritants from the lungs.
Bronchodilators - these open the bronchial tubes and clear out mucus.
Mucolytics - these thin or loosen mucus in the airways, making it easier to cough up sputum.
Anti-inflammatory medicines and glucocorticoid steroids - these are for more persistent symptoms.
Pulmonary rehabilitation program - this includes work with a respiratory therapist to help breathing.
Additional behavioral remedies include:
Avoiding tobacco smoke and quitting smoking
Using a humidifier
Cold-air face masks (if cold air aggravates cough)
Pursed-lip breathing (to slow breathing)
How can bronchitis be prevented?
Bronchitis is a somewhat preventable disease. Prevention methods include:
Avoiding tobacco smoke and exposure to second hand smoke
Quitting smoking
Avoiding people who are sick with colds or the flu
Getting a yearly flu vaccine
Getting a pneumonia vaccine (especially for those over 60 years of age)
Washing hands regularly
Avoiding cold, damp locations or areas with a lot of air pollution
Wearing a mask around people who are coughing and sneezing
Written by Peter Crosta M.A.
Original article date: 30th May 2004
Article updated: 10th November 2009
вторник, 24 мая 2011 г.
Daxas® (Roflumilast) Included As A New Treatment Option In Latest International COPD Guidelines
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has included roflumilast (Daxas®) as a new treatment option in its COPD management guidelines. A section on the new class, phosphodiesterase 4 (PDE4) inhibitors, describes the efficacy of roflumilast in patients with COPD.
'The Global Strategy for Diagnosis, Management and Prevention of COPD', provides evidence-based guidelines for COPD management and is updated annually by a committee of leading COPD experts. In the latest edition, PDE4 inhibitors have been added as a new treatment class.
The guidelines acknowledge that the principal action of PDE4 inhibitors is to reduce inflammation and its clinical implications in COPD patients. It states: ?«In patients with Stage III: Severe COPD or Stage IV: Very Severe COPD and a history of exacerbations and chronic bronchitis, the phosphodiesterase 4 inhibitor, roflumilast, reduces exacerbations treated with oral glucocorticosteroids. These effects are also seen when roflumilast is added to long-acting bronchodilators.?»(1)
Peter Calverley, Professor of Respiratory Medicine, University of Liverpool, UK: "COPD is a chronic progressive lung disease which kills millions of people every year. Despite current maintenance therapies, COPD remains a significant area of unmet medical need. As it progresses, patients suffer exacerbations or lung attacks when breathing can become extremely difficult and they may have to be admitted to hospital."
"Studies have shown that the PDE4 inhibitor, roflumilast, significantly reduces exacerbations. The GOLD guidelines recognise its contribution to the management of this debilitating disease and it is important that physicians who treat COPD have this information," Professor Calverley added.
Daxas has been approved in the European Union and in Canada recently. It has been launched in Germany, Denmark and UK, and is scheduled to be launched in other markets in 2011.
About Daxas (Roflumilast)
Daxas® (roflumilast) is an orally administered selective phosphodiesterase 4 (PDE4) enzyme inhibitor, which has been shown to inhibit COPD related inflammation with a novel mode of action(2). Daxas, a once-a-day tablet, is the first drug in a new class of treatment for severe COPD and the first oral anti-inflammatory treatment specifically developed for COPD patients.
Four large randomized placebo controlled trials have shown that roflumilast significantly reduces exacerbations and improves lung function when added to first-line maintenance therapy.
Daxas is generally well tolerated. In clinical COPD trials involving 12,000 patients, the most commonly reported adverse reactions were diarrhoea (5.9%), weight decreased (3.4%), nausea (2.9%), abdominal pain (1.9%) and headache (1.7%). The majority of these adverse reactions were mild or moderate. These adverse reactions mainly occurred within the first weeks of therapy and mostly resolved on continued treatment.
Other pharmacological treatment for COPD patients includes the use of inhaled bronchodilators and inhaled corticosteroids.
About COPD
COPD remains a significant area of unmet medical need. It is a progressive and irreversible lung disease resulting in difficulty in breathing. The disease is characterised by severe episodes of worsening, called exacerbations or lung attacks. According to World Health Organization (WHO) estimates, 80 million people have moderate to severe COPD worldwide. More than 3 million people died of COPD in 2005, which corresponds to 5% of all deaths globally. The WHO predicts that total deaths from COPD could increase by more than 30% in the next 10 years unless urgent action is taken to reduce the underlying risk factors, especially smoking.
(see who.int/respiratory/copd/burden/en/index.html)
(1) The Global Strategy for Diagnosis, Management and Prevention of COPD (Update 2010): goldcopd
(2) Hatzelmann A, Morcillo EJ, Lungarella G, et al. The preclinical pharmacology of roflumilast - a selective, oral phosphodiesterase 4 inhibitor in development for chronic obstructive pulmonary disease, Pulmonary Pharmacology & Therapeutics (2010), doi: 10.1016/j.pupt.2010.03.011
'The Global Strategy for Diagnosis, Management and Prevention of COPD', provides evidence-based guidelines for COPD management and is updated annually by a committee of leading COPD experts. In the latest edition, PDE4 inhibitors have been added as a new treatment class.
The guidelines acknowledge that the principal action of PDE4 inhibitors is to reduce inflammation and its clinical implications in COPD patients. It states: ?«In patients with Stage III: Severe COPD or Stage IV: Very Severe COPD and a history of exacerbations and chronic bronchitis, the phosphodiesterase 4 inhibitor, roflumilast, reduces exacerbations treated with oral glucocorticosteroids. These effects are also seen when roflumilast is added to long-acting bronchodilators.?»(1)
Peter Calverley, Professor of Respiratory Medicine, University of Liverpool, UK: "COPD is a chronic progressive lung disease which kills millions of people every year. Despite current maintenance therapies, COPD remains a significant area of unmet medical need. As it progresses, patients suffer exacerbations or lung attacks when breathing can become extremely difficult and they may have to be admitted to hospital."
"Studies have shown that the PDE4 inhibitor, roflumilast, significantly reduces exacerbations. The GOLD guidelines recognise its contribution to the management of this debilitating disease and it is important that physicians who treat COPD have this information," Professor Calverley added.
Daxas has been approved in the European Union and in Canada recently. It has been launched in Germany, Denmark and UK, and is scheduled to be launched in other markets in 2011.
About Daxas (Roflumilast)
Daxas® (roflumilast) is an orally administered selective phosphodiesterase 4 (PDE4) enzyme inhibitor, which has been shown to inhibit COPD related inflammation with a novel mode of action(2). Daxas, a once-a-day tablet, is the first drug in a new class of treatment for severe COPD and the first oral anti-inflammatory treatment specifically developed for COPD patients.
Four large randomized placebo controlled trials have shown that roflumilast significantly reduces exacerbations and improves lung function when added to first-line maintenance therapy.
Daxas is generally well tolerated. In clinical COPD trials involving 12,000 patients, the most commonly reported adverse reactions were diarrhoea (5.9%), weight decreased (3.4%), nausea (2.9%), abdominal pain (1.9%) and headache (1.7%). The majority of these adverse reactions were mild or moderate. These adverse reactions mainly occurred within the first weeks of therapy and mostly resolved on continued treatment.
Other pharmacological treatment for COPD patients includes the use of inhaled bronchodilators and inhaled corticosteroids.
About COPD
COPD remains a significant area of unmet medical need. It is a progressive and irreversible lung disease resulting in difficulty in breathing. The disease is characterised by severe episodes of worsening, called exacerbations or lung attacks. According to World Health Organization (WHO) estimates, 80 million people have moderate to severe COPD worldwide. More than 3 million people died of COPD in 2005, which corresponds to 5% of all deaths globally. The WHO predicts that total deaths from COPD could increase by more than 30% in the next 10 years unless urgent action is taken to reduce the underlying risk factors, especially smoking.
(see who.int/respiratory/copd/burden/en/index.html)
(1) The Global Strategy for Diagnosis, Management and Prevention of COPD (Update 2010): goldcopd
(2) Hatzelmann A, Morcillo EJ, Lungarella G, et al. The preclinical pharmacology of roflumilast - a selective, oral phosphodiesterase 4 inhibitor in development for chronic obstructive pulmonary disease, Pulmonary Pharmacology & Therapeutics (2010), doi: 10.1016/j.pupt.2010.03.011
понедельник, 23 мая 2011 г.
Updated GOLD Report Presents New Understandings In Diagnosis, Treatment And Prevention Of COPD
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has released new standards for the diagnosis, management and prevention of chronic obstructive pulmonary disease (COPD). The latest recommendations emphasize the importance of proper diagnosis, assessment of the disease's severity, and the need for a better understanding of co-morbidities to improve treatment of disease.
The GOLD report is updated annually online, but this is the first "complete makeover" since its initial publication in 2002. "This is an absolutely up-to-date summary of all the available evidence on the diagnosis, management and prevention of COPD," said Klaus Rabe, M.D., Ph.D., lead author of the report.
The executive summary of the updated GOLD report appears in the second issue for September of the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.
According to the report, COPD is the fourth leading cause of death in the U.S. and is projected to be fifth worldwide by 2020. It currently affects 15 to 25 percent of adults over the age of 40, says Dr. Rabe, of the Department of Pulmonology at the Leiden University Medical Center in the Netherlands. Yet in spite of the prevalence and seriousness of COPD as a public health threat, COPD is relatively unknown and ignored by the public as well as by health officials.
The new standards reflect the evolution of current scientific and medical thought. "One of the most important points is that we now say COPD is preventable and treatable," said Dr. Rabe. "There are steps we can take to prevent it, and it is no longer viewed with therapeutic nihilism."
Other updates include:
-- New staging guidelines for determining the severity of COPD;
-- Management recommendations for exacerbations including the use of antibiotics; and
-- Recommendations for identifying and building the comprehensive healthcare teams that are necessary for the coordinated treatment of patients with COPD, who frequently present with co-morbidities.
Unfortunately, despite the significant progress that has been made in the understanding and management of the disease, the behavioral and cultural factors that have pushed the disease into the top-five list of killer diseases worldwide remain largely unchanged.
Cigarette smoking and secondhand smoke exposure are the most commonly encountered risk factors for COPD in the developed world. In developing countries, COPD arises primarily from long-term exposure to smoke from biomass fuel used for indoor cooking and heating. Women, who began smoking in higher numbers after World War II, and who bear the brunt of indoor exposures in developing countries, are now more likely to die of the disease than men. Furthermore, because COPD generally develops over a period of decades, the current rise in cases is unlikely to abate soon.
"The prevalence and burden of COPD are projected to increase in the coming decades due to continued exposure to COPD risk factors and the changing age structure of the world's population," wrote the researchers.
While the new guidelines represent a significant step toward more comprehensive treatment and understanding of COPD, they are also a work in progress. "Continuous updates of the literature provide the opportunity to identify areas of weakness," noted Leonardo M. Fabbri, M.D., who wrote an editorial on the report in the same issue of the journal. As examples, he cited areas of COPD research that require more investigation and further refinement, including the need to improve methods for determining the severity of the disease, and developing a more comprehensive approach to assessing co-morbidities.
Between print updates, clinical trials with relevance to COPD management will be incorporated in the electronic version of the report, available at goldcopd.
American Thoracic Society (ATS)
61 Broadway
New York, NY 10006
United States
thoracic
The GOLD report is updated annually online, but this is the first "complete makeover" since its initial publication in 2002. "This is an absolutely up-to-date summary of all the available evidence on the diagnosis, management and prevention of COPD," said Klaus Rabe, M.D., Ph.D., lead author of the report.
The executive summary of the updated GOLD report appears in the second issue for September of the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.
According to the report, COPD is the fourth leading cause of death in the U.S. and is projected to be fifth worldwide by 2020. It currently affects 15 to 25 percent of adults over the age of 40, says Dr. Rabe, of the Department of Pulmonology at the Leiden University Medical Center in the Netherlands. Yet in spite of the prevalence and seriousness of COPD as a public health threat, COPD is relatively unknown and ignored by the public as well as by health officials.
The new standards reflect the evolution of current scientific and medical thought. "One of the most important points is that we now say COPD is preventable and treatable," said Dr. Rabe. "There are steps we can take to prevent it, and it is no longer viewed with therapeutic nihilism."
Other updates include:
-- New staging guidelines for determining the severity of COPD;
-- Management recommendations for exacerbations including the use of antibiotics; and
-- Recommendations for identifying and building the comprehensive healthcare teams that are necessary for the coordinated treatment of patients with COPD, who frequently present with co-morbidities.
Unfortunately, despite the significant progress that has been made in the understanding and management of the disease, the behavioral and cultural factors that have pushed the disease into the top-five list of killer diseases worldwide remain largely unchanged.
Cigarette smoking and secondhand smoke exposure are the most commonly encountered risk factors for COPD in the developed world. In developing countries, COPD arises primarily from long-term exposure to smoke from biomass fuel used for indoor cooking and heating. Women, who began smoking in higher numbers after World War II, and who bear the brunt of indoor exposures in developing countries, are now more likely to die of the disease than men. Furthermore, because COPD generally develops over a period of decades, the current rise in cases is unlikely to abate soon.
"The prevalence and burden of COPD are projected to increase in the coming decades due to continued exposure to COPD risk factors and the changing age structure of the world's population," wrote the researchers.
While the new guidelines represent a significant step toward more comprehensive treatment and understanding of COPD, they are also a work in progress. "Continuous updates of the literature provide the opportunity to identify areas of weakness," noted Leonardo M. Fabbri, M.D., who wrote an editorial on the report in the same issue of the journal. As examples, he cited areas of COPD research that require more investigation and further refinement, including the need to improve methods for determining the severity of the disease, and developing a more comprehensive approach to assessing co-morbidities.
Between print updates, clinical trials with relevance to COPD management will be incorporated in the electronic version of the report, available at goldcopd.
American Thoracic Society (ATS)
61 Broadway
New York, NY 10006
United States
thoracic
воскресенье, 22 мая 2011 г.
Collaborative Award-Winning Practice Initiative Reduces COPD-Related Hospital Admissions By 82%, UK
The outlook for patients of a GP practice is bright after it took part in an innovative and award-winning project with the Met Office, South West SHA and the Improvement Foundation.
Chilcote Surgery was already working with the Improvement Foundation's long-term conditions collaborative to reduce hospital admissions and improve the quality of life for those with chronic obstructive pulmonary disease (COPD), when the opportunity arose to work with the Met Office.
Certain types of weather, especially extreme temperatures, can cause the symptoms of people with COPD to worsen. By using Met Office twice-weekly weather forecasts, the practice was able to help patients identify any weather conditions that may exacerbate their COPD symptoms and thereby take appropriate action to manage their condition. The programme resulted in an 82 per cent reduction in COPD-related hospital admissions between September 2004 and 2006.
As a result the project has been awarded the Department of Health's Innovative Service Award as part of its Health and Social Care Awards scheme. Due to the success of the project, a commissioning framework for COPD has been developed to roll out the model of improvement across the Torbay Care Trust.
Alison Stephens, Programme Manager for the Improvement Foundation, said: "Our key aim now will be to develop this work further, locally rolling out the exemplar model to all practices in the Care Trust through a Locally Enhanced Service Commissioning Framework. With the Chief Executive's support, this service redesign model clearly underpins the DH's strategic plan for practice based commissioning development and the benefits realisation by spreading this work is significant.
"The work of Chilcote Surgery is an outstanding achievement. The practice has successfully demonstrated how partnership working and effective service redesign can transform the lives of patients with COPD," Alison continued.
Dr Tish Laing-Morton, Clinical Director at the Met Office, said: "This innovative collaboration with the NHS and the Improvement Foundation has demonstrated benefits to the NHS and patients with COPD. The Met Office Health Forecast service helps patients to understand their condition, know better how to self care, and achieve their potential for independence and wellbeing."
The work of Chilcote Surgery was supported and enhanced by the work of Torbay Care Trust, which established special procedures and appointed two community COPD nurse specialists to integrate services across the region.
Through the project, COPD patients were presented with special information packs, including room thermometers and a guide of action they could take to avoid symptoms worsening and requiring professional intervention. The practice developed a COPD register to identify those most at risk and appointed a Specialist Nurse Coordinator to make it easier and quicker to communicate with patients.
Where appropriate, some patients are also provided with personal management plans along with medication. When symptoms occur, patients are then able to start using their medication far more quickly, alerting their nurse or GP as soon as they do so to ensure they are effectively monitored.
Dr Pete Moor, GP for Chilcote Surgery, said: "We have been delighted with the results of the Met Office pilot scheme. Not only is there clear evidence for a reduction in hospital admissions but we have noticed far less demand for urgent appointments or visits for exacerbations of COPD. It even helps QOF points."
Julia Avery, Practice Nurse for Chilcote Surgery, said the project has meant real benefits for patients. "The timing of the Met Office pilot was perfect for us, as we were already focusing efforts on identifying and supporting our patients with COPD through our work with the Improvement Foundation.
"We had already established a specialist nurse team and contacted every patient with COPD to alert them to the fact that we were taking a more proactive approach to managing the condition. The Met Office pilot put us in direct contact with meteorology experts who, twice a week, provided us with detailed briefings including weather forecasts and rates of infections such as flu within the community. That information was then fed to our patients, together with support and advice about the possible implications for their health.
"The pilot was also very much about empowering patients to manage their condition themselves and, after meetings with every patient, we were able to provide specialist advice and resources via the Met Office, including room thermometers.
Julia continued: "The key aim was to reduce admissions and the impact was very marked. For the winter prior to our involvement in the pilot we recorded 35 admissions for patients with COPD; that fell to five for the following winter.
"Patients have told us that the project has made a real difference to their lives, by enabling them to take simple, practical steps to pre-empt situations which could exacerbate symptoms and therefore gain greater control over the condition."
About COPD
COPD is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease, all of which can occur together. It is one of the most common respiratory diseases in the UK and causes 30,000 deaths a year. COPD occurs as a result of damage to the lungs, usually through smoking, and symptoms can appear similar to those of asthma. However, whereas asthma can be controlled with treatment, COPD causes permanent damage to the lungs. Certain types of weather, especially extreme temperatures, can cause symptoms to worsen.
About the Improvement Foundation
The Improvement Foundation, a not-for-profit organisation, helps to develop capacity and capability for public service improvement. This is done by engaging frontline staff in quality improvement that improves the lives of people and communities. improvementfoundation
About Torbay Care Trust
The Torbay Care Trust is the only integrated community health and adult social care organisation in the south west. It was set up in December 2005 when social teams from Torbay Council joined community health colleagues in the new NHS Trust. torbaycaretrust.nhs.uk
Chilcote Surgery was already working with the Improvement Foundation's long-term conditions collaborative to reduce hospital admissions and improve the quality of life for those with chronic obstructive pulmonary disease (COPD), when the opportunity arose to work with the Met Office.
Certain types of weather, especially extreme temperatures, can cause the symptoms of people with COPD to worsen. By using Met Office twice-weekly weather forecasts, the practice was able to help patients identify any weather conditions that may exacerbate their COPD symptoms and thereby take appropriate action to manage their condition. The programme resulted in an 82 per cent reduction in COPD-related hospital admissions between September 2004 and 2006.
As a result the project has been awarded the Department of Health's Innovative Service Award as part of its Health and Social Care Awards scheme. Due to the success of the project, a commissioning framework for COPD has been developed to roll out the model of improvement across the Torbay Care Trust.
Alison Stephens, Programme Manager for the Improvement Foundation, said: "Our key aim now will be to develop this work further, locally rolling out the exemplar model to all practices in the Care Trust through a Locally Enhanced Service Commissioning Framework. With the Chief Executive's support, this service redesign model clearly underpins the DH's strategic plan for practice based commissioning development and the benefits realisation by spreading this work is significant.
"The work of Chilcote Surgery is an outstanding achievement. The practice has successfully demonstrated how partnership working and effective service redesign can transform the lives of patients with COPD," Alison continued.
Dr Tish Laing-Morton, Clinical Director at the Met Office, said: "This innovative collaboration with the NHS and the Improvement Foundation has demonstrated benefits to the NHS and patients with COPD. The Met Office Health Forecast service helps patients to understand their condition, know better how to self care, and achieve their potential for independence and wellbeing."
The work of Chilcote Surgery was supported and enhanced by the work of Torbay Care Trust, which established special procedures and appointed two community COPD nurse specialists to integrate services across the region.
Through the project, COPD patients were presented with special information packs, including room thermometers and a guide of action they could take to avoid symptoms worsening and requiring professional intervention. The practice developed a COPD register to identify those most at risk and appointed a Specialist Nurse Coordinator to make it easier and quicker to communicate with patients.
Where appropriate, some patients are also provided with personal management plans along with medication. When symptoms occur, patients are then able to start using their medication far more quickly, alerting their nurse or GP as soon as they do so to ensure they are effectively monitored.
Dr Pete Moor, GP for Chilcote Surgery, said: "We have been delighted with the results of the Met Office pilot scheme. Not only is there clear evidence for a reduction in hospital admissions but we have noticed far less demand for urgent appointments or visits for exacerbations of COPD. It even helps QOF points."
Julia Avery, Practice Nurse for Chilcote Surgery, said the project has meant real benefits for patients. "The timing of the Met Office pilot was perfect for us, as we were already focusing efforts on identifying and supporting our patients with COPD through our work with the Improvement Foundation.
"We had already established a specialist nurse team and contacted every patient with COPD to alert them to the fact that we were taking a more proactive approach to managing the condition. The Met Office pilot put us in direct contact with meteorology experts who, twice a week, provided us with detailed briefings including weather forecasts and rates of infections such as flu within the community. That information was then fed to our patients, together with support and advice about the possible implications for their health.
"The pilot was also very much about empowering patients to manage their condition themselves and, after meetings with every patient, we were able to provide specialist advice and resources via the Met Office, including room thermometers.
Julia continued: "The key aim was to reduce admissions and the impact was very marked. For the winter prior to our involvement in the pilot we recorded 35 admissions for patients with COPD; that fell to five for the following winter.
"Patients have told us that the project has made a real difference to their lives, by enabling them to take simple, practical steps to pre-empt situations which could exacerbate symptoms and therefore gain greater control over the condition."
About COPD
COPD is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease, all of which can occur together. It is one of the most common respiratory diseases in the UK and causes 30,000 deaths a year. COPD occurs as a result of damage to the lungs, usually through smoking, and symptoms can appear similar to those of asthma. However, whereas asthma can be controlled with treatment, COPD causes permanent damage to the lungs. Certain types of weather, especially extreme temperatures, can cause symptoms to worsen.
About the Improvement Foundation
The Improvement Foundation, a not-for-profit organisation, helps to develop capacity and capability for public service improvement. This is done by engaging frontline staff in quality improvement that improves the lives of people and communities. improvementfoundation
About Torbay Care Trust
The Torbay Care Trust is the only integrated community health and adult social care organisation in the south west. It was set up in December 2005 when social teams from Torbay Council joined community health colleagues in the new NHS Trust. torbaycaretrust.nhs.uk
суббота, 21 мая 2011 г.
Chronic Obstructive Pulmonary Disease On The Rise Across United States; Increasing Incidence Will Mean Greater Reliance On Home Oxygen Therapy
Chronic Obstructive
Pulmonary Disease (COPD) -- a respiratory condition that obstructs airflow
to the lungs and interferes with the ability to breathe properly -- is on
the rise nationwide, and will soon become the third leading cause of U.S.
deaths. According to the Council for Quality Respiratory Care (CQRC),
cost-effective home oxygen therapy will be crucial in coming years for
helping patients maintain independence and quality of life.
Currently, COPD is the fourth leading cause of death in the United
States, affecting more than 11 million Americans, and claiming 120,000
lives in the year 2002 alone. According to the National Heart, Lung, and
Blood Institute (NHLBI) of the National Institutes of Health (NIH), COPD
mortality has continued to rise over the past 30 years, while all other
major causes of death have decreased. The NHLBI estimates on top of the 11
million people diagnosed with COPD, an additional 12 million likely have
COPD and don't even know it.
Largely attributable to the long-term health effects on aging Americans
from a bygone era of alluring cigarette marketing, COPD is estimated to
cost the U.S. healthcare system more than $800 billion over the next 20
years, according to the American Thoracic Society. Incidence of COPD,
generally characterized by chronic bronchitis and emphysema, can also be
attributed to pre-existing lung disease, exposure to air pollutants and
heredity.
"Clearly, COPD is a national health crisis that will only gain momentum
in the years to come," said Peter Kelly, Chairman of the CQRC, a coalition
of the nation's leading providers and manufacturers of home oxygen therapy
and related equipment. "It's important that healthcare providers do what we
can now to prepare for the next generation of patients."
According to the CQRC, the average COPD patient is approximately 73
years old, female, lives alone, and has physical limitations that prevent
her from driving. While there are no existing medications that have proven
beneficial in reversing the effects of COPD, home oxygen therapy -- when
properly prescribed and used -- can slow or stop lung degeneration. A
recent federal government study highlights published clinical studies
showing that long-term oxygen therapy reduces the frequency of
hospitalization and the number of hospital days. Today, approximately one
million Medicare patients depend on the Medicare oxygen benefit for their
long-term survival, and for quality of care and quality of life in the home
environment.
The CQRC maintains that home oxygen therapy is the most cost-effective
and clinically effective treatment for COPD patients, and others with
diseases of the lung. Home oxygen therapy costs the Medicare program $7.62
per day vs. as much as $4,600 per day in the hospital. In 2002, there were
673,000 hospitalizations for COPD with an average length of stay of 5.2
days.
Florida leads the nation in the number of Medicare beneficiaries who
rely on home oxygen therapy; approximately 125,000 of that state's
residents receive help for lung ailments. Texas and California also have
notable populations of home oxygen users, with 110,000 and 88,000 users
respectively.
The Council for Quality Respiratory Care is a group of the nation's
leading home oxygen therapy providers and manufacturers, representing a
majority of the more than one million Medicare patients who depend on the
home oxygen benefit for their care in order to live in an independent
environment. CQRC members include Air Products, AirSep Corporation,
American HomePatient, Apria Healthcare, Invacare, Lincare, Pacific
Pulmonary Services, Praxair, Inc., Respironics, Inc., Rotech Healthcare
Inc. and Sunrise Medical, Inc.
Council for Quality Respiratory Care
Council for Quality Respiratory Care
Pulmonary Disease (COPD) -- a respiratory condition that obstructs airflow
to the lungs and interferes with the ability to breathe properly -- is on
the rise nationwide, and will soon become the third leading cause of U.S.
deaths. According to the Council for Quality Respiratory Care (CQRC),
cost-effective home oxygen therapy will be crucial in coming years for
helping patients maintain independence and quality of life.
Currently, COPD is the fourth leading cause of death in the United
States, affecting more than 11 million Americans, and claiming 120,000
lives in the year 2002 alone. According to the National Heart, Lung, and
Blood Institute (NHLBI) of the National Institutes of Health (NIH), COPD
mortality has continued to rise over the past 30 years, while all other
major causes of death have decreased. The NHLBI estimates on top of the 11
million people diagnosed with COPD, an additional 12 million likely have
COPD and don't even know it.
Largely attributable to the long-term health effects on aging Americans
from a bygone era of alluring cigarette marketing, COPD is estimated to
cost the U.S. healthcare system more than $800 billion over the next 20
years, according to the American Thoracic Society. Incidence of COPD,
generally characterized by chronic bronchitis and emphysema, can also be
attributed to pre-existing lung disease, exposure to air pollutants and
heredity.
"Clearly, COPD is a national health crisis that will only gain momentum
in the years to come," said Peter Kelly, Chairman of the CQRC, a coalition
of the nation's leading providers and manufacturers of home oxygen therapy
and related equipment. "It's important that healthcare providers do what we
can now to prepare for the next generation of patients."
According to the CQRC, the average COPD patient is approximately 73
years old, female, lives alone, and has physical limitations that prevent
her from driving. While there are no existing medications that have proven
beneficial in reversing the effects of COPD, home oxygen therapy -- when
properly prescribed and used -- can slow or stop lung degeneration. A
recent federal government study highlights published clinical studies
showing that long-term oxygen therapy reduces the frequency of
hospitalization and the number of hospital days. Today, approximately one
million Medicare patients depend on the Medicare oxygen benefit for their
long-term survival, and for quality of care and quality of life in the home
environment.
The CQRC maintains that home oxygen therapy is the most cost-effective
and clinically effective treatment for COPD patients, and others with
diseases of the lung. Home oxygen therapy costs the Medicare program $7.62
per day vs. as much as $4,600 per day in the hospital. In 2002, there were
673,000 hospitalizations for COPD with an average length of stay of 5.2
days.
Florida leads the nation in the number of Medicare beneficiaries who
rely on home oxygen therapy; approximately 125,000 of that state's
residents receive help for lung ailments. Texas and California also have
notable populations of home oxygen users, with 110,000 and 88,000 users
respectively.
The Council for Quality Respiratory Care is a group of the nation's
leading home oxygen therapy providers and manufacturers, representing a
majority of the more than one million Medicare patients who depend on the
home oxygen benefit for their care in order to live in an independent
environment. CQRC members include Air Products, AirSep Corporation,
American HomePatient, Apria Healthcare, Invacare, Lincare, Pacific
Pulmonary Services, Praxair, Inc., Respironics, Inc., Rotech Healthcare
Inc. and Sunrise Medical, Inc.
Council for Quality Respiratory Care
Council for Quality Respiratory Care
пятница, 20 мая 2011 г.
Term Chronic Systemic Inflammatory Syndrome Should Be Added To COPD
COPD (chronic obstructive pulmonary disease) is no longer seen as a disease of just the lungs, according to a Viewpoint in The Lancet, special COPD edition. According to Professor Klaus Rabe, Leiden University Medical Centre, Leiden, Netherlands, and Dr Leonardo Fabbri, University of Modena and Reggio Emilia, Italy "We propose to add the term chronic systemic inflammatory syndrome to the diagnosis of COPD to stimulate discussion around the frequent complex chronic comorbidities in people with COPD and to provoke a new view of the disease in general."
Skeletal muscle abnormalities are the most common comorbidities associated with COPD, as well as hypertension, diabetes, coronary artery disease, heart failure, cancer, lung infections and pulmonary vascular disease.
The writers tell us that chronic comorbid diseases affect COPD health outcomes. The majority of COPD patients who die do so as a result of non-respiratory disorders, such as cancer or cardiovascular disease.
For a diagnosis of chronic systemic inflammatory syndrome, the patient has to be over 40, a smoker for at least ten years (smoking at least a pack a day), have symptoms and abnormal lung function compatible with COPD, chronic heart failure, metabolic syndrome or increased reactive C-protein.
"Clinical practice guidelines in general seem to ignore the fact that most patients with a chronic disease have additional comorbidities. Guidelines designed largely by speciality-dominated committees for management of individual diseases provide clinicians with little advice for caring for people with several chronic diseases, resulting in poly-pharmacia. We suggest that the introduction of an overarching idea such as chronic systemic inflammatory syndrome will improve recognition of chronic comorbid disorders and will affect patients' care, particularly that of elderly people. Not only will clinicians have to agree to change their approach, to treating chronic diseases but also our health-care system must rise to this major challenge," the writers conclude.
From COPD to chronic systemic inflammatory syndrome?
Rabe, Leiden, Dr Leonardo Fabbri
The Lancet 2007; 370:797-799
Click here to see Full Text (There is no abstract - you have to sign in)
Skeletal muscle abnormalities are the most common comorbidities associated with COPD, as well as hypertension, diabetes, coronary artery disease, heart failure, cancer, lung infections and pulmonary vascular disease.
The writers tell us that chronic comorbid diseases affect COPD health outcomes. The majority of COPD patients who die do so as a result of non-respiratory disorders, such as cancer or cardiovascular disease.
For a diagnosis of chronic systemic inflammatory syndrome, the patient has to be over 40, a smoker for at least ten years (smoking at least a pack a day), have symptoms and abnormal lung function compatible with COPD, chronic heart failure, metabolic syndrome or increased reactive C-protein.
"Clinical practice guidelines in general seem to ignore the fact that most patients with a chronic disease have additional comorbidities. Guidelines designed largely by speciality-dominated committees for management of individual diseases provide clinicians with little advice for caring for people with several chronic diseases, resulting in poly-pharmacia. We suggest that the introduction of an overarching idea such as chronic systemic inflammatory syndrome will improve recognition of chronic comorbid disorders and will affect patients' care, particularly that of elderly people. Not only will clinicians have to agree to change their approach, to treating chronic diseases but also our health-care system must rise to this major challenge," the writers conclude.
From COPD to chronic systemic inflammatory syndrome?
Rabe, Leiden, Dr Leonardo Fabbri
The Lancet 2007; 370:797-799
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четверг, 19 мая 2011 г.
Undiagnosed COPD Has A Major Impact On Health Care Costs, USA
Chronic Obstructive Pulmonary Disease (COPD), which includes the smoking-related lung diseases emphysema and chronic bronchitis, is the fourth leading cause of death in the United States, and the prevalence of COPD is growing, especially among women.
Although COPD is common and has a very negative impact on both the quality and quantity of life, efforts to identify and treat persons with this disease are limited, and surveys have revealed that for every person who has been diagnosed with COPD, there is at least one other with significant airflow obstruction who has the disease but does not know it. One reason for this is that the impact of undiagnosed COPD on the health care system is unknown. Health care providers might assume that a disease that is not diagnosed is not costing anything to treat, but a recent study has shown that undiagnosed COPD does in fact cost the health care system thousands of dollars for each case every year.
In a project titled, "The Direct Medical Costs of Undiagnosed COPD", Dr. Douglas Mapel and his colleagues at the Lovelace Clinic Foundation reviewed the healthcare costs for 6864 COPD patients in the years before and immediately after they were first diagnosed, and compared them to similar patients who did not have COPD. In the twelve-month to two years prior to the initial diagnosis of COPD, costs averaged $1182 more for each COPD patient, and in the twelve months immediately before the initial COPD diagnosis, costs were $2489 greater. Most of the increased costs were attributable to hospital care.
"Our findings suggest that earlier diagnosis of COPD might not only be beneficial to the patient in terms of improved treatment and health outcomes, it is likely to be highly cost-effective for the health care system as well" says Dr. Mapel. "Some of the increased hospital use among undiagnosed COPD patients could be avoided or at least reduced by identifying these patients through screening programs for persons at risk for COPD."
The article will be published in Volume 11, Issue 6 of Value in Health, the official journal of the International Society for Pharmacoeconomics and Outcomes Research. Details about COPD diagnosis and treatment are available at goldcopd.
Value in Health (ISSN 1098-3015) publishes papers, concepts, and ideas that advance the field of pharmacoeconomics and outcomes research and help health care leaders to make decisions that are solidly evidence-based. The journal is published bi-monthly and has a regular readership of over 3,000 clinicians, decision-makers, and researchers worldwide.
ISPOR is a nonprofit, international organization that strives to translate pharmacoeconomics and outcomes research into practice to ensure that society allocates scarce health care resources wisely, fairly, and efficiently.
Value in Health Volume 11 Issue 6
ABSTRACT
ispor
Although COPD is common and has a very negative impact on both the quality and quantity of life, efforts to identify and treat persons with this disease are limited, and surveys have revealed that for every person who has been diagnosed with COPD, there is at least one other with significant airflow obstruction who has the disease but does not know it. One reason for this is that the impact of undiagnosed COPD on the health care system is unknown. Health care providers might assume that a disease that is not diagnosed is not costing anything to treat, but a recent study has shown that undiagnosed COPD does in fact cost the health care system thousands of dollars for each case every year.
In a project titled, "The Direct Medical Costs of Undiagnosed COPD", Dr. Douglas Mapel and his colleagues at the Lovelace Clinic Foundation reviewed the healthcare costs for 6864 COPD patients in the years before and immediately after they were first diagnosed, and compared them to similar patients who did not have COPD. In the twelve-month to two years prior to the initial diagnosis of COPD, costs averaged $1182 more for each COPD patient, and in the twelve months immediately before the initial COPD diagnosis, costs were $2489 greater. Most of the increased costs were attributable to hospital care.
"Our findings suggest that earlier diagnosis of COPD might not only be beneficial to the patient in terms of improved treatment and health outcomes, it is likely to be highly cost-effective for the health care system as well" says Dr. Mapel. "Some of the increased hospital use among undiagnosed COPD patients could be avoided or at least reduced by identifying these patients through screening programs for persons at risk for COPD."
The article will be published in Volume 11, Issue 6 of Value in Health, the official journal of the International Society for Pharmacoeconomics and Outcomes Research. Details about COPD diagnosis and treatment are available at goldcopd.
Value in Health (ISSN 1098-3015) publishes papers, concepts, and ideas that advance the field of pharmacoeconomics and outcomes research and help health care leaders to make decisions that are solidly evidence-based. The journal is published bi-monthly and has a regular readership of over 3,000 clinicians, decision-makers, and researchers worldwide.
ISPOR is a nonprofit, international organization that strives to translate pharmacoeconomics and outcomes research into practice to ensure that society allocates scarce health care resources wisely, fairly, and efficiently.
Value in Health Volume 11 Issue 6
ABSTRACT
ispor
среда, 18 мая 2011 г.
Supplemental Oxygen Company Offers Steps To Improve COPD Patients' Lives
What is the fourth leading cause of death in the United States? Many would be surprised to learn that chronic obstructive pulmonary disease (COPD) is, and the number of people with COPD is increasing. According to the COPD Foundation, more than 12 million Americans are currently diagnosed with COPD and an additional 12 million may not realize their shortness of breath and coughing are in fact symptoms of this debilitating condition.
Although such symptoms can begin as a mild annoyance, they can get worse with time. Eventually patients find themselves short of breath doing simple activities, like preparing a meal or getting dressed.
But there is reason for hope.
Once diagnosed with COPD, often also referred to as emphysema or chronic bronchitis, there are multiple treatment options and ways to manage the disease and improve one's quality of life.
The COPD Foundation offers multiple tips for better breathing and managing the often debilitating disease.
-- Avoid triggers and exposure to pollutants - Stay away from things such as dust, strong fumes and cigarette smoke that could irritate your lungs. Also, stay indoors as much as possible when the outside air quality is poor. It is best to avoid crowds during flu season and it is a good idea to get an annual flu shot.
-- Try various breathing techniques such as:
-- Pursed-lip breathing - Inhale through your nose for four seconds. Then exhale through your mouth for six-to-eight seconds, with your lips almost closed.
-- Belly breathing - Breathing with your diaphragm makes more space for your lungs to take in air.
-- Bend forward - Bending at the waist helps the diaphragm move more easily, allowing more air to fill the lungs. You can sit or stand with this technique, as long as you lean slightly forward from the waist, keeping your back straight.
-- Consider a change in lifestyle
-- Eat well - It is especially important for a COPD sufferer to eat a well balanced diet. Emphysema patients tend to be very thin and should include plenty of nutrients and supplements in their diet. Bronchitis patients on the other hand may be overweight, which places extra burden on the lungs.
-- Quit smoking - It is never too late to kick the habit.
Changing lifestyle habits, avoiding triggers and practicing breathing techniques may only go so far. A physician may recommend oxygen therapy for patients with severe COPD. To some, oxygen therapy is viewed as a death sentence because they think of the heavy oxygen tanks that must be wheeled behind them. Oxygen therapy patients no longer need to view their supplemental oxygen prescription as a homebound sentence. Bulky oxygen tanks and carts may one day be obsolete thanks to the LifeChoice® Oxygen Concentrator, a new home medical product for supplemental oxygen users.
"It is lighter and more compact than anything that I have seen," Dr. Robert Emerson, Chief of Pulmonary Medicine at the Austin Diagnostic Clinic, said. "As a pulmonary specialist who sees many COPD patients weekly, I notice a tremendous difference in those who use a portable oxygen concentrator, such as the LifeChoice®, versus those who lug around heavy tanks."
LifeChoice by Inova Labs is the smallest stationary and portable oxygen concentrator available, weighing less than five pounds. It offers true mobility for its users and allows them the freedom to again experience simple joys such as walking outside without cumbersome equipment.
"We have had numerous patients send us personal thank you notes expressing their deep gratitude for inventing something that has transformed how they live with COPD," David Shockley Jr., Inova Labs president, said.
The LifeChoice, with the patent pending Sleep Mode technology, is the only portable concentrator system designed with endless oxygen pulse for round-the-clock use.
Although such symptoms can begin as a mild annoyance, they can get worse with time. Eventually patients find themselves short of breath doing simple activities, like preparing a meal or getting dressed.
But there is reason for hope.
Once diagnosed with COPD, often also referred to as emphysema or chronic bronchitis, there are multiple treatment options and ways to manage the disease and improve one's quality of life.
The COPD Foundation offers multiple tips for better breathing and managing the often debilitating disease.
-- Avoid triggers and exposure to pollutants - Stay away from things such as dust, strong fumes and cigarette smoke that could irritate your lungs. Also, stay indoors as much as possible when the outside air quality is poor. It is best to avoid crowds during flu season and it is a good idea to get an annual flu shot.
-- Try various breathing techniques such as:
-- Pursed-lip breathing - Inhale through your nose for four seconds. Then exhale through your mouth for six-to-eight seconds, with your lips almost closed.
-- Belly breathing - Breathing with your diaphragm makes more space for your lungs to take in air.
-- Bend forward - Bending at the waist helps the diaphragm move more easily, allowing more air to fill the lungs. You can sit or stand with this technique, as long as you lean slightly forward from the waist, keeping your back straight.
-- Consider a change in lifestyle
-- Eat well - It is especially important for a COPD sufferer to eat a well balanced diet. Emphysema patients tend to be very thin and should include plenty of nutrients and supplements in their diet. Bronchitis patients on the other hand may be overweight, which places extra burden on the lungs.
-- Quit smoking - It is never too late to kick the habit.
Changing lifestyle habits, avoiding triggers and practicing breathing techniques may only go so far. A physician may recommend oxygen therapy for patients with severe COPD. To some, oxygen therapy is viewed as a death sentence because they think of the heavy oxygen tanks that must be wheeled behind them. Oxygen therapy patients no longer need to view their supplemental oxygen prescription as a homebound sentence. Bulky oxygen tanks and carts may one day be obsolete thanks to the LifeChoice® Oxygen Concentrator, a new home medical product for supplemental oxygen users.
"It is lighter and more compact than anything that I have seen," Dr. Robert Emerson, Chief of Pulmonary Medicine at the Austin Diagnostic Clinic, said. "As a pulmonary specialist who sees many COPD patients weekly, I notice a tremendous difference in those who use a portable oxygen concentrator, such as the LifeChoice®, versus those who lug around heavy tanks."
LifeChoice by Inova Labs is the smallest stationary and portable oxygen concentrator available, weighing less than five pounds. It offers true mobility for its users and allows them the freedom to again experience simple joys such as walking outside without cumbersome equipment.
"We have had numerous patients send us personal thank you notes expressing their deep gratitude for inventing something that has transformed how they live with COPD," David Shockley Jr., Inova Labs president, said.
The LifeChoice, with the patent pending Sleep Mode technology, is the only portable concentrator system designed with endless oxygen pulse for round-the-clock use.
вторник, 17 мая 2011 г.
Remote Monitoring Technologies Could Shave Health Care Costs By $197 Billion; Broadband-Based Applications Can Improve Care For Chronic Disease
The United States could cut $197 billion from its health care bill over the next 25 years by widespread use of remote monitoring to track the vital signs of patients with chronic diseases such as congestive heart failure and diabetes, according to a new study released today by economist Robert Litan. Litan said that savings would be maximized by public policy adjustments that encourage health care institutions and individual caregivers to accelerate the use of remote monitoring.
"Remote monitoring can spot health problems sooner, reduce hospitalization, improve life quality and save money," Litan said at a health care forum sponsored by Better Health Care Together.
But he warned that adoption of remote monitoring and other telemedicine opportunities will be slowed and benefits reduced unless the United States does a better job of reimbursing health care organizations for remote care and encouraging continued investment in broadband infrastructure that can be tailored to meet the privacy, security, and reliability requirements for telemedicine applications.
Failure to make the right policy adjustments will cut estimated health care savings by almost $44 billion over the 25-year period, Litan estimated.
Estimated Gain from Telemonitoring Under Baseline and Policy Cases:
- Net Present Value of Savings, Baseline Case: $153.2 billion
- Net Present Value of Savings, Policy Case: $197.0 billion
- Gain From Policy Implementation: $43.8 billion
- Average Gain From Implementation Per Year: $1.75 billion
"Hospitals and doctors can't provide services unless they get paid. We need insurance reimbursement policies, beginning with Medicare and Medicaid, that cover remote monitoring," Litan said. "We also need policies that deliver broadband, including "smart networks" that ensure that patients' critical data is secure and that communications are not disrupted."
Better Health Care Together Says Study Shows Need for New Directions
Jody Hoffman, Executive Director of Better Health Care Together said Litan's study illustrated how new directions in health care can enable the United States to deliver quality care at lower costs.
"Our first priority is to make sure every American has quality, affordable health coverage," Hoffman said. "In order to do that we also need to get better value for our health care dollars and we believe information technologies can help in a big way."
Hoffman said that the forum was an opportunity to consider some of the key issues surrounding telemedicine.
Big Savings from Chronic Diseases
Remote monitoring enables caregivers, often working through computerized data centers, to be alerted in real-time, seven days a week of vital sign changes that could be medically significant. The alerts enable earlier intervention to help patients before they are seriously ill. Without remote monitoring, caregivers must depend on notification from patients who may not report changes until physical symptoms are dramatic and more challenging to resolve.
Litan's savings estimates are tied to four specific conditions - congestive heart failure, diabetes, chronic obstruction pulmonary disease, and chronic skin ulcers and wounds.
Estimated Savings and Gain from Policy Implementation, by Condition:
Baseline Savings:
Heart Patients - $79.7 billion
Diabetes Patients - $42.3 billion
COPD Patients - $18.7 billion
Chronic Wound Patients - $12.5 billion
Total Baseline Savings - $153.2 billion
Policy Savings Savings:
Heart Patients - $102.5 billion
Diabetes Patients - $54.4 billion
COPD Patients - $24.1 billion
Chronic Wound Patients - $16.0 billion
Total Policy Savings - $197 billion
Gain from Policy Change:
Heart Patients - $22.8 billion
Diabetes Patients - $12.1 billion
COPD Patients - $5.4 billion
Chronic Wound Patients - $3.5 billion
Total Gain from Policy Change - $43.8 billion
Robert Litan is vice president of Research and Policy at the Kauffman Foundation, and a Senior Fellow in the Economic Studies Program at the Brookings Institution. Litan, who holds a law degree in addition to his PhD in economics, has served on the staff of the Council of Economic Advisers (1977-79), as Deputy Assistant Attorney General in the Antitrust Division of the Justice Department (1993-95), and Associate Director of the Office and Management and Budget (1995-96).
Better Health Care Together is a coalition of business, labor and public policy organizations that believe broad-based health care reform is among the most pressing economic and moral imperatives facing the United States.
The study "Vital Signs Via Broadband: Remote Health Monitoring Transmits Savings, Enhances Lives," is available at betterhealthcaretogether/news.
Better Health Care Together
"Remote monitoring can spot health problems sooner, reduce hospitalization, improve life quality and save money," Litan said at a health care forum sponsored by Better Health Care Together.
But he warned that adoption of remote monitoring and other telemedicine opportunities will be slowed and benefits reduced unless the United States does a better job of reimbursing health care organizations for remote care and encouraging continued investment in broadband infrastructure that can be tailored to meet the privacy, security, and reliability requirements for telemedicine applications.
Failure to make the right policy adjustments will cut estimated health care savings by almost $44 billion over the 25-year period, Litan estimated.
Estimated Gain from Telemonitoring Under Baseline and Policy Cases:
- Net Present Value of Savings, Baseline Case: $153.2 billion
- Net Present Value of Savings, Policy Case: $197.0 billion
- Gain From Policy Implementation: $43.8 billion
- Average Gain From Implementation Per Year: $1.75 billion
"Hospitals and doctors can't provide services unless they get paid. We need insurance reimbursement policies, beginning with Medicare and Medicaid, that cover remote monitoring," Litan said. "We also need policies that deliver broadband, including "smart networks" that ensure that patients' critical data is secure and that communications are not disrupted."
Better Health Care Together Says Study Shows Need for New Directions
Jody Hoffman, Executive Director of Better Health Care Together said Litan's study illustrated how new directions in health care can enable the United States to deliver quality care at lower costs.
"Our first priority is to make sure every American has quality, affordable health coverage," Hoffman said. "In order to do that we also need to get better value for our health care dollars and we believe information technologies can help in a big way."
Hoffman said that the forum was an opportunity to consider some of the key issues surrounding telemedicine.
Big Savings from Chronic Diseases
Remote monitoring enables caregivers, often working through computerized data centers, to be alerted in real-time, seven days a week of vital sign changes that could be medically significant. The alerts enable earlier intervention to help patients before they are seriously ill. Without remote monitoring, caregivers must depend on notification from patients who may not report changes until physical symptoms are dramatic and more challenging to resolve.
Litan's savings estimates are tied to four specific conditions - congestive heart failure, diabetes, chronic obstruction pulmonary disease, and chronic skin ulcers and wounds.
Estimated Savings and Gain from Policy Implementation, by Condition:
Baseline Savings:
Heart Patients - $79.7 billion
Diabetes Patients - $42.3 billion
COPD Patients - $18.7 billion
Chronic Wound Patients - $12.5 billion
Total Baseline Savings - $153.2 billion
Policy Savings Savings:
Heart Patients - $102.5 billion
Diabetes Patients - $54.4 billion
COPD Patients - $24.1 billion
Chronic Wound Patients - $16.0 billion
Total Policy Savings - $197 billion
Gain from Policy Change:
Heart Patients - $22.8 billion
Diabetes Patients - $12.1 billion
COPD Patients - $5.4 billion
Chronic Wound Patients - $3.5 billion
Total Gain from Policy Change - $43.8 billion
Robert Litan is vice president of Research and Policy at the Kauffman Foundation, and a Senior Fellow in the Economic Studies Program at the Brookings Institution. Litan, who holds a law degree in addition to his PhD in economics, has served on the staff of the Council of Economic Advisers (1977-79), as Deputy Assistant Attorney General in the Antitrust Division of the Justice Department (1993-95), and Associate Director of the Office and Management and Budget (1995-96).
Better Health Care Together is a coalition of business, labor and public policy organizations that believe broad-based health care reform is among the most pressing economic and moral imperatives facing the United States.
The study "Vital Signs Via Broadband: Remote Health Monitoring Transmits Savings, Enhances Lives," is available at betterhealthcaretogether/news.
Better Health Care Together
понедельник, 16 мая 2011 г.
Comedian Mary Walsh And Lung Association Speak Out About COPD, Canada
Celebrated comedian and actress Mary Walsh is using her voice to raise awareness about Chronic Obstructive Pulmonary Disease (COPD) for this year's World COPD campaign. Walsh is best known for her work on the acclaimed TV show This Hour Has 22 Minutes, especially her character, Marg Delahunty, a sword-wielding warrior princess who cornered Canadian politicians on camera.
"Many people know the lighter side of Mary, but COPD is something she is very serious about. This is a disease that has affected three of her family members. It's no laughing matter to her and that is why she has made a public service announcement for us," says Jennifer Schenkel, director of communication and marketing for The Lung Association.
To view Mary's public service announcement, visit: teamcopd.ca
Source
Canadian Lung Association
"Many people know the lighter side of Mary, but COPD is something she is very serious about. This is a disease that has affected three of her family members. It's no laughing matter to her and that is why she has made a public service announcement for us," says Jennifer Schenkel, director of communication and marketing for The Lung Association.
To view Mary's public service announcement, visit: teamcopd.ca
Source
Canadian Lung Association
воскресенье, 15 мая 2011 г.
Argenta Discovery Announces Entry Into Phase I For First Candidate From Collaboration With AstraZeneca To Develop Improved Inhaled Bronchodilators
Argenta Discovery Limited, the respiratory drug discovery and development company, announces a major milestone in its joint programme with AstraZeneca aimed at identifying improved inhaled bronchodilators to treat chronic obstructive pulmonary disease (COPD).
This important milestone marks the first candidate drug from the collaboration to enter Phase I safety and tolerability studies. This drug candidate is on track to enter Phase II 'proof-of-concept' trials later this year.
The original agreement between the two companies was announced in January 2007. Scientists from the two companies are collaborating to identify long-acting muscarinic (M3) antagonist (LAMA) and dual-acting muscarinic antagonist-??2 agonist (MABA) candidate drugs. These compounds will be developed as once-daily, inhaled mono or combination therapies. AstraZeneca will be responsible for the development and worldwide commercialisation of products arising out of the collaboration. Dependent upon success, Argenta is eligible for further development, regulatory and sales milestone payments. Royalties will also be payable to Argenta.
Commenting on the progress, Dr. Christopher Ashton, Argenta Discovery's CEO, said, "The programme continues to deliver beyond the expectations of both parties and we are firmly on track to achieve our joint strategic goals for the programme."
Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is a disease state characterized by airflow obstruction that is progressive and current therapies, including inhaled corticosteroids, fail to treat disease progression. COPD is a leading cause of morbidity and mortality worldwide with an overall prevalence in adults over 40 years currently estimated at between 9 and 10%. Unlike many other major diseases, deaths due to COPD are increasing and the World Health Organisation (WHO) estimates by 2030 that COPD will be the third leading cause of mortality and fifth leading cause of morbidity in the world. Thus there is a high level of unmet medical need for this progressive and debilitating disease.
About Argenta Discovery
Argenta Discovery was founded in August 2000. Argenta has expertise in chronic respiratory diseases, including Chronic Obstructive Pulmonary Disease (COPD) and severe asthma. The company has generated a portfolio of pre-clinical bronchodilator and anti-inflammatory programmes with the goal of demonstrating clinical proof-of-concept. In 2009, Argenta completed its first Phase II clinical trial with ADC4022, an investigational medicine for the treatment of Chronic Obstructive Pulmonary Disease (COPD) and severe asthma.
Argenta also has a contract research division that provides integrated drug discovery services to a range of leading pharmaceutical and biotechnology companies worldwide. Argenta employs approximately 160 people and is based in Harlow, Welwyn Garden City and Slough, UK. For more information about Argenta Discovery, please visit argentadiscovery
Source
AstraZeneca
This important milestone marks the first candidate drug from the collaboration to enter Phase I safety and tolerability studies. This drug candidate is on track to enter Phase II 'proof-of-concept' trials later this year.
The original agreement between the two companies was announced in January 2007. Scientists from the two companies are collaborating to identify long-acting muscarinic (M3) antagonist (LAMA) and dual-acting muscarinic antagonist-??2 agonist (MABA) candidate drugs. These compounds will be developed as once-daily, inhaled mono or combination therapies. AstraZeneca will be responsible for the development and worldwide commercialisation of products arising out of the collaboration. Dependent upon success, Argenta is eligible for further development, regulatory and sales milestone payments. Royalties will also be payable to Argenta.
Commenting on the progress, Dr. Christopher Ashton, Argenta Discovery's CEO, said, "The programme continues to deliver beyond the expectations of both parties and we are firmly on track to achieve our joint strategic goals for the programme."
Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is a disease state characterized by airflow obstruction that is progressive and current therapies, including inhaled corticosteroids, fail to treat disease progression. COPD is a leading cause of morbidity and mortality worldwide with an overall prevalence in adults over 40 years currently estimated at between 9 and 10%. Unlike many other major diseases, deaths due to COPD are increasing and the World Health Organisation (WHO) estimates by 2030 that COPD will be the third leading cause of mortality and fifth leading cause of morbidity in the world. Thus there is a high level of unmet medical need for this progressive and debilitating disease.
About Argenta Discovery
Argenta Discovery was founded in August 2000. Argenta has expertise in chronic respiratory diseases, including Chronic Obstructive Pulmonary Disease (COPD) and severe asthma. The company has generated a portfolio of pre-clinical bronchodilator and anti-inflammatory programmes with the goal of demonstrating clinical proof-of-concept. In 2009, Argenta completed its first Phase II clinical trial with ADC4022, an investigational medicine for the treatment of Chronic Obstructive Pulmonary Disease (COPD) and severe asthma.
Argenta also has a contract research division that provides integrated drug discovery services to a range of leading pharmaceutical and biotechnology companies worldwide. Argenta employs approximately 160 people and is based in Harlow, Welwyn Garden City and Slough, UK. For more information about Argenta Discovery, please visit argentadiscovery
Source
AstraZeneca
суббота, 14 мая 2011 г.
News From The May Issue Of Chest
Heart Attack Risk Doubles After COPD Exacerbation
Patients with chronic obstructive pulmonary disease (COPD) who experience an exacerbation have an increased risk for both myocardial infarctions (MI) and ischemic stroke. Researchers from the United Kingdom analyzed the risk of MI or stroke after exacerbation of COPD in 25,857 patients with the disease. Among the patients, 524 MI were identified in 426 patients and 633 ischemic strokes in 482 patients. Results showed that exacerbation rates were significantly higher in patients with COPD experiencing MI or stroke compared with those who did not suffer from these conditions. In addition, there was a 2.27-fold increased risk of MI 1 to 5 days after a COPD exacerbation and a 1.26-fold increase of stroke 1 to 49 days after a COPD exacerbation. Researchers suggest the findings provide good rationale for treating patients with COPD in both the stable and exacerbation states to reduce cardiovascular events. This study is published in the May issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians: CHEST 2010; 137(5):1091.
Snoring Incidence Triples In Obese Children
Obesity is commonly associated with sleep-disordered breathing and snoring in adults, but a new study confirms the same association in children. Italian researchers compared the frequency of snoring in 44 children with habitual snoring, 138 children with occasional snoring, and 627 children who did not snore. Of the children, 64 were defined as obese, 121 as overweight, and 624 as normal weight. Results showed that the incidence of snoring in obese children was three times (12.5 percent) that of normal weight children (4.6 percent) and more than two times that of overweight children (5.8 percent). In addition, the presence of obstructive sleep apnea in obese children was nearly two times that of normal and overweight children. Researchers conclude that sleep disorders should be addressed in children in order to help prevent comorbitities in adulthood. The article is published in the May issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians: CHEST 2010; 137(5):1085.
Simulation Training Improves Bronchoscopy Skills
Pulmonary fellowship training programs currently require 50 bronchoscopies for pulmonary trainees to achieve competency. However, new research suggests performance-based metrics can be used to evaluate bronchoscopy skills and establish competency. Researchers from Duke University Medical Center in Durham, NC, compared the bronchoscopy skills and cognitive knowledge of 22 fellows who received standard bronchoscopy training with 22 fellows who received additional bronchoscopy training, including simulation bronchoscopy and an online curriculum. Results showed that fellows who received additional simulation training significantly improved their bronchoscopy skills and accelerated the acquisition of skills compared with those who received standard training. Researchers speculate that the study findings may have implications for other procedures currently performed by trainees in internal medicine and its subspecialties. This article is published in the May issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians: CHEST 2010; 137(5):1040.
Patients with chronic obstructive pulmonary disease (COPD) who experience an exacerbation have an increased risk for both myocardial infarctions (MI) and ischemic stroke. Researchers from the United Kingdom analyzed the risk of MI or stroke after exacerbation of COPD in 25,857 patients with the disease. Among the patients, 524 MI were identified in 426 patients and 633 ischemic strokes in 482 patients. Results showed that exacerbation rates were significantly higher in patients with COPD experiencing MI or stroke compared with those who did not suffer from these conditions. In addition, there was a 2.27-fold increased risk of MI 1 to 5 days after a COPD exacerbation and a 1.26-fold increase of stroke 1 to 49 days after a COPD exacerbation. Researchers suggest the findings provide good rationale for treating patients with COPD in both the stable and exacerbation states to reduce cardiovascular events. This study is published in the May issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians: CHEST 2010; 137(5):1091.
Snoring Incidence Triples In Obese Children
Obesity is commonly associated with sleep-disordered breathing and snoring in adults, but a new study confirms the same association in children. Italian researchers compared the frequency of snoring in 44 children with habitual snoring, 138 children with occasional snoring, and 627 children who did not snore. Of the children, 64 were defined as obese, 121 as overweight, and 624 as normal weight. Results showed that the incidence of snoring in obese children was three times (12.5 percent) that of normal weight children (4.6 percent) and more than two times that of overweight children (5.8 percent). In addition, the presence of obstructive sleep apnea in obese children was nearly two times that of normal and overweight children. Researchers conclude that sleep disorders should be addressed in children in order to help prevent comorbitities in adulthood. The article is published in the May issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians: CHEST 2010; 137(5):1085.
Simulation Training Improves Bronchoscopy Skills
Pulmonary fellowship training programs currently require 50 bronchoscopies for pulmonary trainees to achieve competency. However, new research suggests performance-based metrics can be used to evaluate bronchoscopy skills and establish competency. Researchers from Duke University Medical Center in Durham, NC, compared the bronchoscopy skills and cognitive knowledge of 22 fellows who received standard bronchoscopy training with 22 fellows who received additional bronchoscopy training, including simulation bronchoscopy and an online curriculum. Results showed that fellows who received additional simulation training significantly improved their bronchoscopy skills and accelerated the acquisition of skills compared with those who received standard training. Researchers speculate that the study findings may have implications for other procedures currently performed by trainees in internal medicine and its subspecialties. This article is published in the May issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians: CHEST 2010; 137(5):1040.
пятница, 13 мая 2011 г.
COPD patients with most severe form more likely to harbor pneumocystis in their lungs
While smoking may be the most common cause of chronic obstructive pulmonary disease (COPD), severity of COPD could be influenced by a common organism that can colonize the lungs without causing outward symptoms, suggests results of a study published in the August 15 issue of the American Journal of Respiratory and Critical Care Medicine, a journal of the American Thoracic Society.
The organism, Pneumocystis jiroveci (previously known as Pneumocystis carinii), seldom causes serious problems for normal hosts, but in people with suppressed immune systems, such as transplant patients or cancer patients undergoing chemotherapy, it can result in a deadly lung infection. For patients with HIV, Pneumocystis is the most common and most serious AIDS-defining opportunistic infection.
The study, conducted at the University of Pittsburgh School of Medicine, involved 68 patients with COPD and 44 patients with other lung diseases, such as cystic fibrosis. Pneumocystis was more prevalent in the COPD patients, especially those with the most advanced disease; and neither smoking history, number of packs of cigarettes smoked over time, age or gender correlated with the existence of the organism in the lungs.
"Pneumocystis colonization is associated with severity of COPD, and airway obstruction was significantly worse in patients whose lungs were colonized than in those patients who had no evidence of the organism. Moreover, colonization did not appear to be the result of other clinical factors or concomitant conditions," stated Alison Morris, M.D., M.S., assistant professor of medicine in the division of pulmonary and critical care medicine at the University of Southern California who conducted the study while completing a fellowship at the University of Pittsburgh under Karen A. Norris, Ph.D. Dr. Norris, the paper's senior author, is an associate professor of immunology at Pitt's School of Medicine.
The researchers looked for the presence of Pneumocystis in lungs that had been explanted during transplantation or removed in part during lung resection surgery. Using a technique called polymerase chain reaction that detects DNA, they found Pneumocystis colonization in 11, or 36.7 percent, of 30 patients classified with the most severe form of COPD, all of whom received lung transplants; two of these patients developed Pneumocystis pneumonia within six months of transplantation. Yet only two, or 5.3 percent, of the 38 other COPD patients with less severe forms of the disease were colonized. All 68 COPD patients in the study were previous smokers.
Colonization was also associated with worse lung function in the COPD patients. Using a standard test that evaluates lung function by measuring the percentage of forced expiratory volume (FEV1) in one second, patients with Pneumocystis colonization had a median FEV1 of 20 percent of the predicted normal value, versus a median FEV1 of 62 percent in the Pneumocystis-negative patients.
Of the 44 patients who were transplanted for reasons other than COPD, who served as a control group, 12, or 27 percent, had been smokers, and four, or 9.1 percent, were colonized with Pneumocystis. Only one of these four colonized patients was a smoker. Overall, their median FEV1 was 31 percent.
"The strong association between Pneumocystis colonization and severity of airflow obstruction in those with a history of smoking strongly suggests the pathogen is at play, most likely inducing an exaggerated lung inflammatory response by specific immune system cells that, interestingly, are the same cells that infiltrate the lungs in COPD," explained Dr. Norris.
"Only 10 to 15 percent of smokers develop COPD, so the question remains whether chronic colonization with Pneumocystis is an added risk factor for smokers," she added.
Other questions the current study did not address include how long colonization must occur for it to impact disease progression, and whether Pneumocystis colonization results in acceleration of COPD or if some factor unique to COPD creates the right environment for the organism to colonize.
"Further work will be necessary to clarify whether the presence of Pneumocystis contributes to worsening lung function or whether patients with the poorest lung function are predisposed to Pneumocystis. However the correlation between the two cannot be ignored," said Frank C. Sciurba, M.D., associate professor of medicine in the division of pulmonary, allergy and critical care medicine at Pitt's School of Medicine.
In addition to Drs. Morris, Norris and Sciurba, other authors include: from the University of Pittsburgh, Irina P. Lebedeva, department of immunology; and Andrew Githaiga, M.D., department of medicine; W. Mark Elliott, Ph.D., and James C. Hogg, M.D., both of the University of British Columbia in Vancouver, Canada; and Laurence Huang, M.D., of the University of California, San Francisco.
The study was supported by the National Institutes of Health and the Canadian Institute for Health Research.
Lisa Rossi
RossiLupmc
412-647-3555
University of Pittsburgh
Jon Weiner
jonweinerusc
323-442-2830
USC Health Sciences
The organism, Pneumocystis jiroveci (previously known as Pneumocystis carinii), seldom causes serious problems for normal hosts, but in people with suppressed immune systems, such as transplant patients or cancer patients undergoing chemotherapy, it can result in a deadly lung infection. For patients with HIV, Pneumocystis is the most common and most serious AIDS-defining opportunistic infection.
The study, conducted at the University of Pittsburgh School of Medicine, involved 68 patients with COPD and 44 patients with other lung diseases, such as cystic fibrosis. Pneumocystis was more prevalent in the COPD patients, especially those with the most advanced disease; and neither smoking history, number of packs of cigarettes smoked over time, age or gender correlated with the existence of the organism in the lungs.
"Pneumocystis colonization is associated with severity of COPD, and airway obstruction was significantly worse in patients whose lungs were colonized than in those patients who had no evidence of the organism. Moreover, colonization did not appear to be the result of other clinical factors or concomitant conditions," stated Alison Morris, M.D., M.S., assistant professor of medicine in the division of pulmonary and critical care medicine at the University of Southern California who conducted the study while completing a fellowship at the University of Pittsburgh under Karen A. Norris, Ph.D. Dr. Norris, the paper's senior author, is an associate professor of immunology at Pitt's School of Medicine.
The researchers looked for the presence of Pneumocystis in lungs that had been explanted during transplantation or removed in part during lung resection surgery. Using a technique called polymerase chain reaction that detects DNA, they found Pneumocystis colonization in 11, or 36.7 percent, of 30 patients classified with the most severe form of COPD, all of whom received lung transplants; two of these patients developed Pneumocystis pneumonia within six months of transplantation. Yet only two, or 5.3 percent, of the 38 other COPD patients with less severe forms of the disease were colonized. All 68 COPD patients in the study were previous smokers.
Colonization was also associated with worse lung function in the COPD patients. Using a standard test that evaluates lung function by measuring the percentage of forced expiratory volume (FEV1) in one second, patients with Pneumocystis colonization had a median FEV1 of 20 percent of the predicted normal value, versus a median FEV1 of 62 percent in the Pneumocystis-negative patients.
Of the 44 patients who were transplanted for reasons other than COPD, who served as a control group, 12, or 27 percent, had been smokers, and four, or 9.1 percent, were colonized with Pneumocystis. Only one of these four colonized patients was a smoker. Overall, their median FEV1 was 31 percent.
"The strong association between Pneumocystis colonization and severity of airflow obstruction in those with a history of smoking strongly suggests the pathogen is at play, most likely inducing an exaggerated lung inflammatory response by specific immune system cells that, interestingly, are the same cells that infiltrate the lungs in COPD," explained Dr. Norris.
"Only 10 to 15 percent of smokers develop COPD, so the question remains whether chronic colonization with Pneumocystis is an added risk factor for smokers," she added.
Other questions the current study did not address include how long colonization must occur for it to impact disease progression, and whether Pneumocystis colonization results in acceleration of COPD or if some factor unique to COPD creates the right environment for the organism to colonize.
"Further work will be necessary to clarify whether the presence of Pneumocystis contributes to worsening lung function or whether patients with the poorest lung function are predisposed to Pneumocystis. However the correlation between the two cannot be ignored," said Frank C. Sciurba, M.D., associate professor of medicine in the division of pulmonary, allergy and critical care medicine at Pitt's School of Medicine.
In addition to Drs. Morris, Norris and Sciurba, other authors include: from the University of Pittsburgh, Irina P. Lebedeva, department of immunology; and Andrew Githaiga, M.D., department of medicine; W. Mark Elliott, Ph.D., and James C. Hogg, M.D., both of the University of British Columbia in Vancouver, Canada; and Laurence Huang, M.D., of the University of California, San Francisco.
The study was supported by the National Institutes of Health and the Canadian Institute for Health Research.
Lisa Rossi
RossiLupmc
412-647-3555
University of Pittsburgh
Jon Weiner
jonweinerusc
323-442-2830
USC Health Sciences
вторник, 10 мая 2011 г.
American College Of Physicians Launches Free Web-based Resource To Improve COPD Care
The American College of Physicians (ACP) today announced the ACP COPD (chronic obstructive pulmonary disease) Portal (copd.acponline ). The Web site provides concise answers to specific clinical and practice-management questions for internists, other health care professionals, and patients and their families.
COPD -- typically a result of smoking -- is a serious disease involving the airways and lung tissue that over time makes it difficult to breathe. More than 12 million people are currently diagnosed with COPD and an additional 12 million likely have the disease and don't even know it.
"Our goals for the ACP COPD Portal," said Steven E. Weinberger, MD, FACP, ACP's deputy executive vice president and senior vice president for medical education and publishing, "are to increase physician awareness of what constitutes high-quality, evidence-based COPD care; increase awareness of the gap between current practice and acceptable standards of care for COPD; and provide information for affected patients to help them manage the disease and any complications."
Internal Medicine - American College of Physicians
COPD -- typically a result of smoking -- is a serious disease involving the airways and lung tissue that over time makes it difficult to breathe. More than 12 million people are currently diagnosed with COPD and an additional 12 million likely have the disease and don't even know it.
"Our goals for the ACP COPD Portal," said Steven E. Weinberger, MD, FACP, ACP's deputy executive vice president and senior vice president for medical education and publishing, "are to increase physician awareness of what constitutes high-quality, evidence-based COPD care; increase awareness of the gap between current practice and acceptable standards of care for COPD; and provide information for affected patients to help them manage the disease and any complications."
Internal Medicine - American College of Physicians
понедельник, 9 мая 2011 г.
New Ramelteon Data Presented At AARC
A new study shows that ramelteon did not exacerbate respiratory depressant effects in patients (40 years and older) with moderate to severe chronic obstructive pulmonary disease (COPD), as measured by oxygenation or abnormal breathing events relative to placebo. Results of this double-blind, placebo-controlled trial were presented at the 53rd International Respiratory Congress of the American Association for Respiratory Care.
"Getting adequate sleep is essential to maintaining health in people who live with COPD. These results suggest that ramelteon is a sleep medication that can be used safely in adults suffering from moderate to severe COPD who are concerned with breathing impairment during sleep," said Thomas Roth, PhD, director, Henry Ford Sleep Research and Disorders Center. "While traditional sleep aids can negatively affect respiration during sleep in patients with COPD, this study demonstrated that ramelteon does not produce such respiratory depressant effects."
According to the National Institutes of Health, more than 12 million Americans are currently diagnosed with COPD. It is the fourth leading cause of death in the United States and causes serious, long-term disability.
"Patients with COPD - usually characterized by a combination of chronic bronchitis and emphysema - must take extreme care in ensuring they receive enough oxygen at all times, particularly when sleeping. Other medications used for insomnia may reduce upper airway muscle tone, which can lead to increased hypoxemia," said Dr. Roth. "This study shows that there was no difference in blood oxygen saturation all night between placebo and ramelteon."
Study Design
A total of 25 adults age 40 or older with moderate to severe COPD were randomized to receive ramelteon 8 mg or placebo 30 minutes before overnight monitoring of oxygen saturation (SaO2) by pulse oximetry and sleep by polysomnography. After a five- to ten-day washout, patients crossed over to the alternate treatment and repeated the procedure.
The primary endpoint was mean SaO2 for the entire night. The findings revealed that there was no statistically significant difference in SaO2 for the entire night observed among the patients treated with ramelteon compared to placebo (92.2 vs. 92.4%, P=0.576). Additional results showed:
* Compared with placebo, there was no statistically significant difference in the number of minutes in the night that SaO2 was
* Latency to persistent sleep was shorter with ramelteon vs placebo (23.1 vs 56.9 min) (P=0.051).
* Adverse events were reported in four patients with ramelteon and four patients with placebo treatment; none was noted as serious or led to study discontinuation.
People with COPD have few options for treating insomnia because the traditional sleep medications cause a sedative effect that can further depress respiration. "This study is important in helping us understand the effects of ramelteon in patients with moderate to severe COPD," said Louis J. Mini, MD, medical director, Neuroscience, Takeda Pharmaceuticals North America, Inc. "COPD is a common disorder seen in clinical practice, and studies of this type provide useful information for physicians treating this population."
About ROZEREM
Ramelteon 8 mg is currently marketed as ROZEREM™. ROZEREM is indicated for the treatment of insomnia characterized by difficulty with sleep onset. ROZEREM can be prescribed for long-term use. ROZEREM is the first and only prescription sleep medication that has shown no evidence of abuse or dependence in clinical studies,* and has not been designated as a controlled substance. With the exception of ROZEREM, all other prescription medications indicated for insomnia are classified as Schedule IV controlled substances by the U.S. Drug Enforcement Administration. ROZEREM has a unique therapeutic mechanism of action that targets MT1 and MT2 receptors. The activity at MT1 and MT2 receptors in the suprachiasmatic nucleus (SCN) is thought to promote sleep.
*ROZEREM is not a controlled substance. A clinical abuse liability study showed no differences indicative of abuse potential between ROZEREM and placebo at doses up to 20 times the recommended dose (N=14). Three 35-day insomnia studies showed no evidence of rebound insomnia or withdrawal symptoms with ROZEREM compared to placebo (N=2082).
Important Safety Information
ROZEREM™ should not be used in patients with hypersensitivity to any components of the formulation, severe hepatic impairment, or in combination with fluvoxamine. Failure of insomnia to remit after a reasonable period of time should be medically evaluated, as this may be the result of an unrecognized underlying medical disorder. Hypnotics should be administered with caution to patients exhibiting signs and symptoms of depression. ROZEREM has not been studied in patients with severe sleep apnea or in children or adolescents. The effects in these populations are unknown. Avoid taking ROZEREM with alcohol. Studies for severe COPD have not yet been evaluated by the FDA. ROZEREM has been associated with decreased testosterone levels and increased prolactin levels. Health professionals should be mindful of any unexplained symptoms which could include cessation of menses or galactorrhea in females, decreased libido or problems with fertility that are possibly associated with such changes in these hormone levels. ROZEREM should not be taken with or immediately after a high-fat meal. ROZEREM should be taken within 30 minutes before going to bed and activities confined to preparing for bed. The most common adverse events seen with ROZEREM that had at least a 2% incidence difference from placebo were somnolence, dizziness, and fatigue.
For complete Prescribing Information, visit ROZEREM.
Takeda Pharmaceuticals North America, Inc.
Based in Deerfield, Ill., Takeda Pharmaceuticals North America, Inc. is a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, the largest pharmaceutical company in Japan. In the United States, Takeda currently markets products for diabetes, insomnia, wakefulness and gastroenterology. Through the Takeda Global Research & Development Center, Inc., the company has a robust pipeline with compounds in development for diabetes, cardiovascular disease and other conditions. Takeda is committed to striving toward better health for individuals and progress in medicine by developing superior pharmaceutical products. To learn more about the company and its products, visit tpna/.
"Getting adequate sleep is essential to maintaining health in people who live with COPD. These results suggest that ramelteon is a sleep medication that can be used safely in adults suffering from moderate to severe COPD who are concerned with breathing impairment during sleep," said Thomas Roth, PhD, director, Henry Ford Sleep Research and Disorders Center. "While traditional sleep aids can negatively affect respiration during sleep in patients with COPD, this study demonstrated that ramelteon does not produce such respiratory depressant effects."
According to the National Institutes of Health, more than 12 million Americans are currently diagnosed with COPD. It is the fourth leading cause of death in the United States and causes serious, long-term disability.
"Patients with COPD - usually characterized by a combination of chronic bronchitis and emphysema - must take extreme care in ensuring they receive enough oxygen at all times, particularly when sleeping. Other medications used for insomnia may reduce upper airway muscle tone, which can lead to increased hypoxemia," said Dr. Roth. "This study shows that there was no difference in blood oxygen saturation all night between placebo and ramelteon."
Study Design
A total of 25 adults age 40 or older with moderate to severe COPD were randomized to receive ramelteon 8 mg or placebo 30 minutes before overnight monitoring of oxygen saturation (SaO2) by pulse oximetry and sleep by polysomnography. After a five- to ten-day washout, patients crossed over to the alternate treatment and repeated the procedure.
The primary endpoint was mean SaO2 for the entire night. The findings revealed that there was no statistically significant difference in SaO2 for the entire night observed among the patients treated with ramelteon compared to placebo (92.2 vs. 92.4%, P=0.576). Additional results showed:
* Compared with placebo, there was no statistically significant difference in the number of minutes in the night that SaO2 was
* Latency to persistent sleep was shorter with ramelteon vs placebo (23.1 vs 56.9 min) (P=0.051).
* Adverse events were reported in four patients with ramelteon and four patients with placebo treatment; none was noted as serious or led to study discontinuation.
People with COPD have few options for treating insomnia because the traditional sleep medications cause a sedative effect that can further depress respiration. "This study is important in helping us understand the effects of ramelteon in patients with moderate to severe COPD," said Louis J. Mini, MD, medical director, Neuroscience, Takeda Pharmaceuticals North America, Inc. "COPD is a common disorder seen in clinical practice, and studies of this type provide useful information for physicians treating this population."
About ROZEREM
Ramelteon 8 mg is currently marketed as ROZEREM™. ROZEREM is indicated for the treatment of insomnia characterized by difficulty with sleep onset. ROZEREM can be prescribed for long-term use. ROZEREM is the first and only prescription sleep medication that has shown no evidence of abuse or dependence in clinical studies,* and has not been designated as a controlled substance. With the exception of ROZEREM, all other prescription medications indicated for insomnia are classified as Schedule IV controlled substances by the U.S. Drug Enforcement Administration. ROZEREM has a unique therapeutic mechanism of action that targets MT1 and MT2 receptors. The activity at MT1 and MT2 receptors in the suprachiasmatic nucleus (SCN) is thought to promote sleep.
*ROZEREM is not a controlled substance. A clinical abuse liability study showed no differences indicative of abuse potential between ROZEREM and placebo at doses up to 20 times the recommended dose (N=14). Three 35-day insomnia studies showed no evidence of rebound insomnia or withdrawal symptoms with ROZEREM compared to placebo (N=2082).
Important Safety Information
ROZEREM™ should not be used in patients with hypersensitivity to any components of the formulation, severe hepatic impairment, or in combination with fluvoxamine. Failure of insomnia to remit after a reasonable period of time should be medically evaluated, as this may be the result of an unrecognized underlying medical disorder. Hypnotics should be administered with caution to patients exhibiting signs and symptoms of depression. ROZEREM has not been studied in patients with severe sleep apnea or in children or adolescents. The effects in these populations are unknown. Avoid taking ROZEREM with alcohol. Studies for severe COPD have not yet been evaluated by the FDA. ROZEREM has been associated with decreased testosterone levels and increased prolactin levels. Health professionals should be mindful of any unexplained symptoms which could include cessation of menses or galactorrhea in females, decreased libido or problems with fertility that are possibly associated with such changes in these hormone levels. ROZEREM should not be taken with or immediately after a high-fat meal. ROZEREM should be taken within 30 minutes before going to bed and activities confined to preparing for bed. The most common adverse events seen with ROZEREM that had at least a 2% incidence difference from placebo were somnolence, dizziness, and fatigue.
For complete Prescribing Information, visit ROZEREM.
Takeda Pharmaceuticals North America, Inc.
Based in Deerfield, Ill., Takeda Pharmaceuticals North America, Inc. is a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, the largest pharmaceutical company in Japan. In the United States, Takeda currently markets products for diabetes, insomnia, wakefulness and gastroenterology. Through the Takeda Global Research & Development Center, Inc., the company has a robust pipeline with compounds in development for diabetes, cardiovascular disease and other conditions. Takeda is committed to striving toward better health for individuals and progress in medicine by developing superior pharmaceutical products. To learn more about the company and its products, visit tpna/.
воскресенье, 8 мая 2011 г.
Newsfrom The July Issue Of Chest
SMOKING CESSATION MAY PROVIDE IMMEDIATE BENEFIT TO HEART
A new article suggests smoking cessation provides immediate benefits to patients. Researchers from the Feinstein Institute for Medical Research in Manhasset, NY, examined specific inflammatory biomarkers associated with cardiovascular disease (CVD) in "at risk" women during the smoking cessation process. Results showed that smoking cessation resulted in significant reductions in circulating tumor necrosis factor (TNF), soluble TNF receptors I and II, and soluble vascular cell adhesion molecule-1 (VCAM-1). Researchers conclude that there are rapid consequences of smoking cessation on inflammatory biomarkers in women at risk for CVD. The article is published in the July issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
ELECTRICAL MUSCLE STIMULATION MAY BENEFIT PATIENTS WITH COPD
Patients with severe chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF) may be physically limited by the severity of their disease, potentially leading to skeletal muscular impairment or muscle atrophy. New research shows that these patients may benefit from neuromuscular electrical stimulation (NMES). Researchers from The Netherlands reviewed 14 trials that examined the use of NMES in patients with CHF and COPD. They found that many of the studies reported significant improvements in muscle strength, exercise capacity, and/or health status. Researchers conclude that, although NMES looks promising for patients with COPD and CHF, additional studies are warranted. This study is published in the July issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
DEATHS FROM PULMONARY FIBROSIS HIGHEST IN WINTER
New research shows that mortality from idiopathic pulmonary fibrosis (IPF) and/or pulmonary fibrosis (PF) may be highest during the winter months. Using death records from the National Center for Health Statistics, a research team from the University of Colorado Health Sciences Center in Denver, CO, calculated the monthly mortality rates for persons with PF. Results showed that mortality rates from PF significantly varied by season. The average mortality rate among all persons with PF was 17.1 percent higher in the winter, 12.7 percent higher in spring, and 5.2 percent higher in fall than in the summer months. This study is published in the July issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
LONG-ACTING ??2-AGONISTS MAY NOT BENEFIT ASTHMA PATIENTS
New research shows that long-acting ??2-agonists (LABAs) may not have a clinically significant antiinflammatory effect as once believed. LABAs are recommended as add-on therapy to antiinflammatory treatment in chronic persistent asthma. However, in a metaanalysis of 32 studies (n=1,105 patients), researchers from McMaster University in Ontario, Canada, found that LABA therapy had no effect on sputum, bronchoalveolar lavage (BAL), or mucosal inflammatory cell findings in adults or children. LABAs did decrease exhaled nitric oxide levels and BAL albumin levels in adults, suggesting a possible benefit. The study is published in the July issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
A new article suggests smoking cessation provides immediate benefits to patients. Researchers from the Feinstein Institute for Medical Research in Manhasset, NY, examined specific inflammatory biomarkers associated with cardiovascular disease (CVD) in "at risk" women during the smoking cessation process. Results showed that smoking cessation resulted in significant reductions in circulating tumor necrosis factor (TNF), soluble TNF receptors I and II, and soluble vascular cell adhesion molecule-1 (VCAM-1). Researchers conclude that there are rapid consequences of smoking cessation on inflammatory biomarkers in women at risk for CVD. The article is published in the July issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
ELECTRICAL MUSCLE STIMULATION MAY BENEFIT PATIENTS WITH COPD
Patients with severe chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF) may be physically limited by the severity of their disease, potentially leading to skeletal muscular impairment or muscle atrophy. New research shows that these patients may benefit from neuromuscular electrical stimulation (NMES). Researchers from The Netherlands reviewed 14 trials that examined the use of NMES in patients with CHF and COPD. They found that many of the studies reported significant improvements in muscle strength, exercise capacity, and/or health status. Researchers conclude that, although NMES looks promising for patients with COPD and CHF, additional studies are warranted. This study is published in the July issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
DEATHS FROM PULMONARY FIBROSIS HIGHEST IN WINTER
New research shows that mortality from idiopathic pulmonary fibrosis (IPF) and/or pulmonary fibrosis (PF) may be highest during the winter months. Using death records from the National Center for Health Statistics, a research team from the University of Colorado Health Sciences Center in Denver, CO, calculated the monthly mortality rates for persons with PF. Results showed that mortality rates from PF significantly varied by season. The average mortality rate among all persons with PF was 17.1 percent higher in the winter, 12.7 percent higher in spring, and 5.2 percent higher in fall than in the summer months. This study is published in the July issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
LONG-ACTING ??2-AGONISTS MAY NOT BENEFIT ASTHMA PATIENTS
New research shows that long-acting ??2-agonists (LABAs) may not have a clinically significant antiinflammatory effect as once believed. LABAs are recommended as add-on therapy to antiinflammatory treatment in chronic persistent asthma. However, in a metaanalysis of 32 studies (n=1,105 patients), researchers from McMaster University in Ontario, Canada, found that LABA therapy had no effect on sputum, bronchoalveolar lavage (BAL), or mucosal inflammatory cell findings in adults or children. LABAs did decrease exhaled nitric oxide levels and BAL albumin levels in adults, suggesting a possible benefit. The study is published in the July issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
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