COPD Symptoms Worsened By Marijuana In Current Cigarette Smokers

Marijuana worsens breathing problems in current smokers with chronic obstructive pulmonary disease (COPD), according to a study presented at the American Thoracic Society 2007 International Conference, on Tuesday, May 22.



The study found that among people 40 and older, smokers were two-and-a-half times as likely as nonsmokers to develop COPD, while smoking cigarettes and marijuana together boosted the odds of developing COPD to three-and-a-half times the risk of someone who did not smoke either cigarettes or marijuana - in other words, adding marijuana smoking to cigarette smoking increased the risk by one-third, says Wan Tan, M.D., of St. Paul's Hospital in Vancouver, British Columbia.



The odds of cigarette smokers having any respiratory symptoms was 2.36 times that of nonsmokers, while the odds of someone who smoked both cigarettes and marijuana having respiratory symptoms was 18 times that of someone who smoked neither - an eightfold jump in risk, Dr. Tan says.



"This study suggests an interaction between cigarettes and marijuana smoking. These findings have not been reported before, and they have a big public health implication," Dr. Tan says.



A majority of cigarette smokers in the study were also marijuana smokers. In both younger and older adults in the study, 30% smoked both cigarettes and marijuana. Among younger cigarette smokers, 76% also smoked marijuana, while 58% of older cigarette smokers also smoked marijuana.



The findings come from a study of 648 adults ages 18 and older who answered questions on smoking, including their cigarette and marijuana use, and respiratory symptoms. Study subjects ages 40 and older had lung function tests.



The Vancouver researchers decided to study both marijuana and cigarette smoking because both cigarette and marijuana smoking is prevalent in their area, says Dr. Tan. They found that 49% of participants ages 18 to 39 and 46% of those 40 and older had smoked marijuana at least once. Among 18-39 year-olds, 17% said they currently smoked marijuana, compared with 13% in the 40+ age group. In the younger group, 31% said they had ever smoked cigarettes, and 16% were current smokers. In the 40+ group, 52% were ever-smokers while 16% were current smokers.







"The Impact of Cigarette and Marijuana Smoking in Chronic Obstructive Lung Disease Study in Vancouver, Canada" (Session C38; Abstract # 681; Poster Board # L42)



Contact: Suzy Martin


American Thoracic Society

ATS Statement on Home Care for Respiratory Disorders

In the just published "American Thoracic Society Statement on Home Care for Patients with Respiratory Disorders," an ad
hoc expert subcommittee pointed out that either reducing the frequency of or the length of hospitalization is the key to
lowering the total cost of chronic obstructive pulmonary disease (COPD) which affects 11.2 million U.S. adults and cost the
nation $37.2 billion during 2004.


Published in the second issue for June 2005 of the ATS peer-reviewed American Journal of Respiratory and Critical Care
Medicine, the new statement points out that home care services can offer great potential for patients with respiratory
disorders, especially pediatric and geriatric patients, by providing services and equipment at the place of residence for
individuals and families who have needs resulting from acute illness, long-term health conditions, permanent disability, or
terminal illness.


In the United States, home care includes home health care that offers episodic, post-acute illness assistance on an
intermittent basis; hospice care that is palliative, end-of-life care for the terminally ill; chronic home care assistance
directed at private duty aid offered on an hourly basis; and, in the home, the provision of and assistance with medical
equipment such as oxygen supplies, respiratory equipment, nebulized medications, infusion therapy, and other in-home medical
supplies.


According to the report, the most common diagnosis of patients with respiratory disorders referred for home health care is
COPD. Slightly over 11 percent of the 7.6 million patients who received home health care in 1998 had respiratory system
disease as their primary diagnosis. COPD and pneumonia are, respectively, the fourth and fifth most frequent reasons for
hospital discharge to home care for Medicare patients.


The expert subcommittee pointed out that chest physicians and pulmonologists need to recognize that earlier hospital
discharge, or avoidance of hospital care altogether, are important premises upon which home health care referrals can be
made.


American Thoracic Society journal news tips for June 2005 (second issue)


For the complete text of these articles, please see the American Thoracic Society Online Web Site at atsjournals. For either contact information or to
request a complimentary journalist subscription to ATS journals online, or if you would like to add your name to the
twice-monthly journal news e-mail list, contact Cathy Carlomagno at (212) 315-6442, or by e-mail at
ccarlomagnothoracic


Contact: Cathy Carlomagno

ccarlomagnothoracic

212-315-6442

American Thoracic Society

thoracic

Study Of Lung Disease Suggests New Therapy For Patients

A new study by researchers at Northwestern University's Feinberg School of Medicine may change current thinking about how best to treat patients in respiratory distress in hospital intensive care units.



It has been commonly believed that high levels of carbon dioxide (CO2) or hypercapnia in the blood and lungs of patients with acute lung disease may be beneficial to them. Now, for the first time, scientists have shown how elevated levels of CO2 actually have the opposite effect.



The excessive CO2 impairs the functioning of the lungs. Jacob Sznajder, M.D., chief of pulmonary and critical care at the Feinberg School, and his research team found that high levels of CO2 make it harder for the lungs to clear fluid.



The excess CO2 initiates a signaling cascade leading to the inhibition of the action of sodium "pumps" that help move water out of the air spaces. This creates a greater risk of edema in which the lungs flood with fluid.



The investigators worked with rats and human cells for the study, which was published in the February issue of the Journal of Clinical Investigation.



"Allowing high levels of CO2 may contribute to the high mortality of patients with diseases like chronic obstructive pulmonary disease (COPD)," said Sznajder, a professor of medicine and of cell and molecular biology at the Feinberg School and a physician at Northwestern Memorial Hospital. "This study argues toward therapies to reduce the high CO2 levels of patients toward normal levels, which is not the current practice in the intensive care unit."



COPD is the fourth leading cause of death in the United States, killing more than 120,000 people, according to the National Institutes of Health. When people have COPD, their lungs lose elasticity and have trouble exchanging carbon dioxide for oxygen. COPD used to be strictly a disease of smokers, but now it's also crippling the lungs of non-smokers.

Study Finds COPD Patients Taking Inhaled Steroids Are At Greater Risk For Severe Pneumonia

Patients with COPD (chronic obstructive pulmonary disease) are increasingly being prescribed inhaled corticosteroids to control exacerbations of the disease, but a new study finds that the anti-inflammatory drugs increase the chances that these patients will be hospitalized for pneumonia.


"In a large cohort of patients with COPD, we found that current inhaled corticosteroid use was associated with a significant 70 percent increase in the risk of being hospitalized for pneumonia," said the researchers. "Furthermore, for the severest pneumonias leading to death within 30 days of hospitalization, the risk with current inhaled corticosteroid use was also significantly increased."


These and other findings of the population-based study were reported in the second issue of the July American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.


Pierre Ernst, M.D., a clinical epidemiologist at McGill University, Canada, along with three other researchers from the university's department of medicine, analyzed the hospitalization and drug prescription information from 1988 to 2003 of 175,906 patients with COPD living in Quebec, Canada. During that time, 23,942 of the patients were hospitalized for pneumonia.


In their report, the researchers noted that the admission rate for pneumonia increased with higher doses of inhaled steroids and that reduction in risk was observed once the medications were stopped. Among all patients taking inhaled steroids, there was a 53 percent increase in pneumonia deaths within 30 days of being admitted to the hospital.


The investigators noted that these findings are particularly relevant, given that pneumonia is the third leading cause of hospitalization in the United States and that inhaled corticosteroid use among patients with COPD increased from 13.2 to 41.4 percent from 1987 to 1995.


"Adverse effects of inhaled corticosteroids in patients with COPD," the authors said, "are particularly troublesome given the limited evidence for their efficacy."


In an accompanying editorial, Mark Woodhead, D.M, of Manchester (U.K.) Royal Infirmary, wrote that this report confirms secondary findings from a prospective, placebo-controlled study of an inhaled corticosteroid with long-acting ??-agonist that was recently published. Given that this earlier study was not designed to analyze pneumonia frequency, its small size and high drop-out rate, he suggested, might lead a reader to reasonably conclude that its "pneumonia findings were spurious."


Now, with the addition of the Canadian population-based study, Dr. Woodhead wrote, the unexpected conclusion--that drugs prescribed to prevent COPD exacerbations put patients at greater risk for severe pneumonia-deserves further consideration and study through large prospective studies with objective pneumonia definitions.


"The finding of an association," he said, "between pneumonia frequency and inhaled corticosteroid use in studies of different design, in different populations, and with evidence of a dose-response relations means that the findings may be real and that these observations cannot simply be dismissed."



ThIs news brief is based on an article published in the American Thoracic Society's peer-reviewed journal, the American Journal of Respiratory and Critical Care Medicine .



Founded in 1905, the American Thoracic Society is the world's leading medical association dedicated to advancing pulmonary, critical care and sleep medicine. The Society has more than 18,000 members who prevent and fight respiratory disease around the globe, through research, education, patient care and advocacy.

thoracic

Lung Function Decline Slowed In COPD Patients, TORCH Study Finds

Treatment with a commonly used drug slows the decline in lung function in patients with chronic obstructive pulmonary disease (COPD), according to results from the TORCH (TOwards a Revolution in COPD Health) study presented at the American Thoracic Society 2007 International Conference, on Tuesday, May 22.



The study of 6,112 patients from 42 countries found that those treated with salmeterol/fluticasone propionate (Advair) had a slower rate of lung function decline compared with patients receiving a placebo over three years (39 vs. 55 milliliters per year).



"Until now, no intervention except smoking cessation has been shown to alter the rate of decline in lung function for patients with COPD," says one the study authors, Bartolome R. Celli, M.D., of St. Elizabeth's Medical Center in Boston. "This is the first time that pharmacotherapy has been shown to change the rate of decline in lung function."



Patients who received either the long-acting beta2-agonist salmeterol (Serevent) or the inhaled corticosteroid fluticasone propionate (Flovent) alone also had less of a decline in lung function than those receiving the placebo, but the decline was smaller than with the combined salmeterol/fluticasone propionate treatment.



The study also found that patients with a low body mass index (BMI) lose more lung function than those with a higher BMI.



The researchers also looked a geographic variations in lung function decline, and found that COPD patients who lived in East Asia and Eastern Europe lost lung function at a slower rate than those who lived in the United States or Western Europe. The study did not address the possible causes for this geographic difference.



The TORCH study is the largest ever, multicenter long-term COPD study. The study compared salmeterol at a dose of 50 mcg plus fluticasone propionate at a dose of 500 mcg twice daily combined in a single inhaler, with placebo, salmeterol alone, or fluticasone propionate alone for a period of three years.



In February 2007, the New England Journal of Medicine published results from the TORCH study that found that the reduction in death rates for patients taking the combination treatment was not significantly different from those in the placebo group. However, treatment with the combination treatment did result in significantly fewer COPD flareups and improved health-related quality of life and lung function, as compared with placebo.






"Salmeterol/Fluticasone Propionate (SFC) Improves Lung Function and Reduces Rate of Decline over Three Years in the TORCH Survival Study" (Session C97; Abstract # 3285)



"The TORCH Survival Study: Consistent Efficacy Results Seen in Geographic Regions in a Multi-National Study" (Session C97; Abstract # 3307)



Contact: Suzy Martin


American Thoracic Society



View drug information on Flovent Rotadisk; Serevent.

COPD And Quitting Smoking

New research shows that patients with chronic obstructive pulmonary disease (COPD) have higher smoking cessation rates with varenicline compared with placebo.



In a multinational study involving 27 centers, researchers from UCLA followed 504 patients with mild to moderate COPD who were randomized to receive either varenicline (N=250) or placebo (N=254). At weeks 9-12, abstinence rates for patients treated with varenicline were higher than for the placebo group (42.3 percent vs 8.8 percent), and they remained higher through 52 weeks (18.6 percent vs 5.6 percent).



Nausea, abnormal dreams, upper respiratory tract infection, and insomnia were the most commonly reported events with varenicline; however, serious adverse events were infrequent in both treatment groups.



Researchers conclude that varenicline was more effective than placebo for smoking cessation in patients with mild to moderate COPD.



This article is published in the March issue of Chest, the peer-reviewed journal of the American College of Chest Physicians: Chest 2011; 139(3):591-599.

Insights Into Lung Disease From Top Notch Decisions In The Developing Airways

In the normal lung, the airways are lined by a balanced mixture of ciliated, secretory and neuroendocrine cells which perform functions as diverse as air humidification, detoxification, and clearance of environmental particles. This balance can be altered dramatically by faulty adaptation responses of the lung to cigarette smoke or allergens in patients with Chronic Obstructive Pulmonary Disease (COPD) and asthma.



How these different cell types emerge from lung progenitor cells and how these fates are balanced in developing airways, remain an open question. A study from a research team led by Wellington Cardoso, MD, a professor at the Pulmonary Center Boston University School of Medicine and Director of the Program in Lung Development and Progenitor Cell Biology, sheds light into this problem.



The Notch pathway is a major regulator of cell fate decisions in developing cells from fruit flies to humans. Using mouse genetic models, the BU researchers inactivated Notch signaling in the lung and discovered that airways no longer formed secretory cells. Instead they became populated almost exclusively by ciliated cells. The researchers showed that this imbalance seems to result from the loss of a mechanism of cell fate choice triggered by the Notch called lateral inhibition.



"When you lose Notch signaling, you lose the ability to generate secretory cells that make the lining fluid critical for protection and integrity of airway, and the other fate, of ciliated cells is de-repressed" said Dr. Cardoso.



These findings help to understand how airways form and provide insights into how interfering with Notch signaling may be potentially useful as a therapeutic intervention in respiratory diseases, such as asthma and COPD, in which airways have an overabundance of secretory cells and paucity of ciliated cells in the airways. The link between hyperactive Notch and excessive secretion is now rapidly emerging from other recent reports.



Notes:

In addition to Cardoso, the study titled "Notch Signaling Controls the Balance of Ciliated and Secretory Cell Fates in Developing Airways. was authored by Po-Nien Tsao and Michelle Vasconcelos. It appears in the June online edition of Development, and is highlighted in the cover of this journal.

Modelling the future Dutch COPD population from diagnosis till death

A new COPD population model gives detailed information about the future burden of COPD in the Netherlands.


It has been shown to be a useful instrument for policy making.



The severity of chronic obstructive pulmonary disease (COPD) varies from mild to very severe. As the use of health care is strongly related to disease severity, the total burden of COPD for society is dependent on the COPD severity distribution in the patient population.


To provide health care policy makers with detailed data about the future burden of COPD for the Netherlands, Martine Hoogendoorn (Institute for Medical Technology Assessment, Erasmus MC, Rotterdam, the Netherlands) and her American and Dutch colleagues developed a model that simulates the developments in the Dutch COPD population over time.


Developments occur due to changes in the sex- and age distribution of the general population, changes in the percentage of smokers and ex-smokers and progression of the disease.


The model estimates the number of Dutch COPD patients by disease severity for future years, and can also be used to estimate the effect of cost-effectiveness of various disease management interventions, including smoking cessation.


Between 2000 and 2025 the model projects an increase of the total number of Dutch COPD patients from 306 to 494 thousand. The increase for women is higher than for men. The percentages of mild and very severe COPD patients are projected to increase, while the percentages of moderate and severe patients decrease.


Mean costs per patient are ??? 915. The total health care costs for COPD are projected to rise from 280 to 495 million Euros, with the highest increase in very severe COPD.


The authors also show that smoking cessation therapies for COPD patients are cost-effective. This detailed information about the future burden of COPD in the Netherlands is useful for policy making, both at the governmental and institutional level.



The European Respiratory Journal is the peer-reviewed scientific publication of the European Respiratory Society (more than 7,000 specialists in lung diseases and respiratory medicine in Europe, the United States and Australia).


European Respiratory Journal

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News From The August Issue Of Chest

X-RAY MACHINES MAY SPREAD INFECTIONS IN THE ICU



Poor infection control practices when using x-ray machines may lead to nosocomial infections in the ICU. In a new study, Israeli researchers observed 173, 113, and 120 ICU chest x-rays during observation, intervention, and follow-up periods, respectively. Adequate infection control was practiced during 1 percent of observation x-rays, 42 percent of intervention x-rays, and 10 percent of follow-up x-rays. The study also showed that x-ray machine surface cultures yielded resistant gram-negative bacteria on 39 percent, 0 percent, and 50 percent of the observation, intervention, and follow-up x-rays. The authors conclude that improved infection control practices could decrease the occurrence of resistant organisms on x-ray equipment. This study is published in the August issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.



AFRICAN-AMERICANS WITH COPD USE FEWER HEALTH SERVICES



New research shows that African-Americans (AA) with chronic obstructive pulmonary disease (COPD) use fewer health services than Caucasians with the condition. Researchers from the University of Maryland compared health services utilization and cost outcomes in 4,723 AA patients and 4,021 Caucasians with COPD, asthma, or both. After controlling for age, gender, cohort allocation, and comorbidities, results showed that AA adults with COPD, asthma, or coexisting asthma and COPD used fewer medical services and accounted for lower medical costs than Caucasians. The authors speculate that the differences in utilization and medical costs may provide an explanation for the racial disparities in outcomes of patients with COPD and asthma. The article is published in the August issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.



NEW REVIEW DEBATES NEED FOR ADDITIONAL LABA SAFETY TRIALS



In a new commentary, Malcolm R. Sears, MD, of McMaster University in Hamilton, ON, Canada, discusses the familiar debate about the safety of using long-acting ??2-agonists (LABA) in monotherapy for asthma. The commentary focuses on data provided in the metaanalysis recently undertaken by the FDA of safety outcomes of 60,954 individuals in 110 LABA trials. Results of the analysis found that LABA used with mandatory inhaled corticosteroid (ICS) was not associated with an increased risk of asthma-related mortality, intubations, or exacerbations. Dr. Sears argues that an additional analysis beyond the FDA study is not practical or needed. In addition, he suggests that the use of LABA, when indicated, in mandatory combination with appropriate doses of ICS, should remain the standard treatment for patients with moderate to severe asthma. This article is published in the August issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

COPD Patients Benefit More From Pulmonary Rehab In Earlier Stages

Patients with chronic obstructive pulmonary disease (COPD) who are in their final years of survival do not get the same benefits from pulmonary rehabilitation (PR) as patients who have more years left to live - regardless of their age, complicating illnesses or lung function, according to new research funded by the Veteran's Administration, which was presented at the American Thoracic Society's 2008 International Conference in Toronto on Tuesday, May 20.



The researchers recruited 106 patients with COPD who completed an eight-week course of PR. Each patient was evaluated at the beginning and the conclusion of the course for exercise capacity, dyspnea in daily activities, such as walking and carrying groceries, fatigue, quality of life, and other indices of health. The researchers then compared the results of patients who died within two years of the program to those who survived longer and found that even after controlling for potentially complicating factors - such as lung function, age and other present illnesses - patients who lived longer than two years were able to obtain more positive results from their PR program than those who had end-stage COPD (defined retrospectively as having died within two years of the program).



"Although people who died within two years after entering a pulmonary rehabilitation program improved their exercise capacity during the program, they improved less on this and other key variables than did those who lived longer," said Bonnie Steele, A.R.N.P., Ph.D., a respiratory clinical nurse specialist at the VA Puget Sound Health Care System in Seattle. "The finding was independent of age, lung function and the number of other illnesses they had."



The researchers anticipated that those with end-stage COPD would be more ill with lung or other diseases. "Previous work has taught us that even with severe obstructive lung disease based upon pulmonary function, people can derive significant benefits from PR," said Dr. Steele, "but our limited findings suggest that other, presently unappreciated factors present at end of life may contribute to poorer outcomes in end-stage patients with respect to exercise capacity and quality of life."



There are several possible explanations for the findings, including the possibility that patients in end-stage disease have overall poorer muscle function and greater levels of deconditioning and the possible specific impact of selected co-morbidities, such as heart failure.



"Our sample was too small to explicate this fully," said Dr. Steele, "but it suggests that treatments for end-stage patients with COPD may still be effective and introducing exercise training sooner in the course of their disease results in more improvement."

More Men Die From COPD Compared To Women

Men across the Asia-Pacific region have consistently higher mortality and hospitalization rates for chronic obstructive pulmonary disease (COPD) than corresponding rates for women in the region.


This higher rate for men reflects a different risk profile for men and women - in particular the higher prevalence of smoking among men across the Asia- Pacific region.


According to a study in Respirology published by Wiley-Blackwell, the average death rates ranged from 6.4 to 9.2 per 10 000 population for men while the corresponding rates for women only ranged from 2.1 to 3.5 per 10 000 population.


The study entitled "Trends in COPD mortality and hospitalization in countries and regions of Asia-Pacific" compares rates and trends in rates for COPD mortality and hospital morbidity from Asia-Pacific countries and regions to provide insights into age and gender factors that determine the burden of the disease.


"The global rise of COPD is particularly dramatic in Asia-Pacific where two recognized risk factors for COPD - tobacco smoking and indoor air pollution - are highly prevalent and are significant contributors to death and disease burden. Although there has been some reduction in mortality with the increasing awareness of COPD by health professionals, the COPD mortality and hospitalization rates in Asian countries are still high when compared to western developed countries", says Dr. Wan C. Tan from the iCapture Centre, UBC, St. Paul's Hospital, Vancouver, Canada.


COPD is a serious disease of the lungs where patients become progressively short of breath and require repeated admissions to hospital when they get acute deterioration in their condition.


Dr. Tan added, "The growing burden of COPD in the Asia-Pacific region supports the need for more intensive research and analysis to raise awareness of the disease and its causes. It is also important to reinforce the importance of persistent comprehensive anti-smoking strategies in individuals."



This paper is published in the January 2009 issue of Respirology (Vol. 14, Issue 1).
The article abstract is available free online www3.interscience.wiley/journal/121509442/abstract


About Respirology


Respirology is a journal of international standing, publishing peer-reviewed articles of scientific excellence in clinical and experimental respiratory biology and disease and its related fields of research including thoracic surgery, internal medicine, immunology, intensive and critical care, epidemiology, cell and molecular biology, pathology, pharmacology and physiology.



About Wiley-Blackwell


Wiley-Blackwell was formed in February 2007 as a result of the acquisition of Blackwell Publishing Ltd. by John Wiley & Sons, Inc., and its merger with Wiley's Scientific, Technical, and Medical business. Together, the companies have created a global publishing business with deep strength in every major academic and professional field. Wiley-Blackwell publishes approximately 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal. For more information on Wiley-Blackwell, please visit wiley/bw or interscience.wiley.


About Wiley


Founded in 1807, John Wiley & Sons, Inc. has been a valued source of information and understanding for 200 years, helping people around the world meet their needs and fulfill their aspirations. Since 1901, Wiley and its acquired companies have published the works of more than 350 Nobel laureates in all categories: Literature, Economics, Physiology/Medicine, Chemistry and Peace.



Our core businesses include scientific, technical, medical and scholarly journals, encyclopedias, books, and online products and services; professional/trade publishes books, subscription products, training materials, and online applications and websites; and educational materials for undergraduate and graduate students and lifelong learners. Wiley's global headquarters are located in Hoboken, New Jersey, with operations in the U.S., Europe, Asia, Canada, and Australia. The Company's Web site can be accessed at wiley. The Company is listed on the New York Stock Exchange under the symbols JWa and JWb.

John Wiley & Sons, Inc.

'Nycomed Submits For Regulatory Approval Of Daxas(R) In Europe' A Novel Approach To The Management Of COPD

The first in a new class of drugs that could challenge current thinking on the treatment of Chronic Obstructive Pulmonary Disease (COPD) has moved one step closer to market today. Nycomed announced the submission of a Marketing Authorisation Application (MAA) to the European Medicines Agency (EMEA) for Daxas® (roflumilast) as a once-daily oral treatment for patients with COPD associated with chronic bronchitis.



Daxas is an orally-administered phosphodiesterase 4 (PDE4) enzyme inhibitor targeting cells and mediators in the body believed to be important in the COPD disease process. Daxas is expected to act on the underlying mechanism of COPD. It could significantly improve the way this condition is managed, including reducing exacerbations (episodes of worsening) requiring medical intervention. If approved, Daxas, a once-a-day tablet, will be the first drug in its class. Current treatment for COPD patients includes the use of inhaled bronchodilators and inhaled corticosteroids.



The MAA submission is based on encouraging results from four Phase III trials of Daxas in the treatment of symptomatic COPD. Two pivotal 12-month studies met their primary endpoints, showing beneficial effects on exacerbation rates and pulmonary function (FEV1). Two supporting 6-month studies also confirmed the efficacy of Daxas when used with standard bronchodilator treatments. Full data from all four studies are to be published during 2009.



Commenting on today's announcement, H??kan Bj?¶rklund, Chief Executive Officer of Nycomed, said: "With its novel mode of action, Daxas represents an important new approach in the management of COPD - a disease which is predicted to become the third leading cause of death worldwide by 2030. Today's submission for Daxas, subject to acceptance and approval by the EMEA, represents a significant milestone for Nycomed."



Peter Calverley, Professor of Medicine in the Pulmonary and Rehabilitation Research Group at the University of Liverpool, and lead investigator in the roflumilast clinical programme commented: "This EU filing for roflumilast is an important milestone in our response to the major health problems associated with the increasing COPD burden. The prospect of targeting the inflammatory processes in COPD is good news for doctors and patients. This will provide us with a new approach to tackle this disease that targets the underlying mechanism. For patients, this development brings the possibility of reducing the number of serious exacerbations they experience, one of their major fears."



COPD remains a significant area of unmet medical need. It is a progressive and irreversible lung disease resulting in difficulty in breathing. According to the World Health Organization (WHO) estimates, 80 million people have moderate to severe COPD worldwide.1 More than three million people died of COPD in 2005, which corresponds to 5% of all deaths globally.1 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.1



According to the British Thoracic Society, recent figures show more than 27,000 people die of COPD each year in the UK.2 The underlying prevalence of COPD is now estimated to be more than 4 million.3 It is estimated that COPD causes at least 20.4 million lost working days amongst men and 3.5 million among women every year, more than any other respiratory condition.4



References:


1. World Health Organization. Available here.[last accessed 7 May 2009].


2. British Thoracic Society. The burden of lung disease 2006. Available here. [last accessed 7 May 2009].


3. Hill SL et al. Introducing a National Strategy for COPD in England. Am J Respir Crit Care 2009; 179: A2897.


4. British Lung Foundation briefing. COPD - September 2006. Available here. [last accessed 7 May 2009].



About Daxas



Nycomed is also preparing for the submission of a New Drug Application (NDA) to the U.S. Food and Drug Administration (FDA) for Daxas as a once-daily oral treatment for patients with COPD associated with chronic bronchitis.



Source
Nycomed

Psychiatric Disorders Common in Women with COPD

A total of 116 patients with COPD were tested (54 men and 62 women), and 57 percent of women and 35 percent of men were classified as having one or more anxiety disorders, the most common being panic disorder.


Thirty-one percent of women and 14 percent of men were classified as having one or more mood disorders, the most common being major depression.


While women and men had similar dyspnea scores and no difference in exacerbation rates or lung function, women showed significantly greater psychological distress, worse perceived control of symptoms, and worse disease-related quality of life.


A new study out of Sacr???-Coeur Hospital (Montr???al, Canada), the Montr???al Heart Institute (Montr???al, Canada), and the University of Qu???bec at Montr???al (Montr???al, Canada) found that psychiatric disorders are at least three times higher in patients with COPD than in those without the disease, and the rates are three times higher for women than men.


CHEST 2005 abstract highlights


Jennifer Stawarz

jstawarzchestnet

American College of Chest Physicians

chestnet

COPD Risk To Smokers Is Genetic

It's well known that puffing on cigarettes can eventually leave you out of puff. But why do a quarter of long-term smokers develop serious breathing problems, when others do not? New research published BioMed Central's open access journal Respiratory Research has found that the answers may lie in a smoker's genetics, which affect their chances of developing chronic obstructive pulmonary disease (COPD) in later life.



US-based researchers Alireza Sadeghnejad, Jill Ohar, Eugene Bleecker and colleagues from the Wake Forest School of Medicine and Saint Louis University, looked at a disintegrin and metalloprotease (ADAM) gene known as ADAM33 in 880 long-term heavy smokers. Located on chromosome 20, ADAM33 has been linked with asthma in previous studies. This new study is unique in comparing long-term smokers with COPD versus a control group of long-term smokers without COPD.



The researchers found five single nucleotide polymorphisms (SNPs) - human DNA sequence variations - in ADAM33 that were more frequent in the COPD group than in the group of smokers without COPD. One SNP, known as S1, had a particularly strong link to lung abnormalities. "Functional studies will be needed to evaluate the biologic significance of these polymorphisms in the pathogenesis of COPD," according to the authors.



COPD is characterized by progressive decline in lung function, and encompasses chronic bronchitis and emphysema. Almost 90% of COPD is caused by long-term cigarette smoking, yet only 25% of chronic tobacco smokers will go on to develop COPD.



Notes:



1. Adam33 polymorphisms are associated with COPD and lung function in long term tobacco smokers

Alireza Sadeghnejad, Jill A Ohar, Siqun L Zheng, David A Sterling, Gregory A Hawkins, Deborah A Meyers and Eugene R Bleecker

Respiratory Research (in press)


Article available at the journal website: respiratory-research/


All articles are available free of charge, according to BioMed Central's open access policy.



2. Respiratory Research is an Open Access, peer-reviewed, online journal that considers manuscripts on all aspects of respiratory function and disease.



The journal welcomes studies on asthma, chronic obstructive pulmonary disease, cystic fibrosis, genetics, infectious diseases, interstitial lung diseases, lung development, lung tumors, occupational and environmental factors, pulmonary circulation, pulmonary pharmacology and therapeutics, respiratory critical care, respiratory immunology, respiratory physiology, and sleep. The journal will also welcome state-of-the-art reviews on related topics.



3. BioMed Central (biomedcentral/) is an STM (Science, Technology and Medicine) publisher which has pioneered the open access publishing model. All peer-reviewed research articles published by BioMed Central are made immediately and freely accessible online, and are licensed to allow redistribution and reuse. BioMed Central is part of Springer Science+Business Media, a leading global publisher in the STM sector.

Nycomed Files European Marketing Authorisation Application For Daxas(R) In COPD

Nycomed has announced the submission of a Marketing Authorisation Application (MAA) to the European Medicines Agency (EMEA) for Daxas® as a once-daily oral treatment for patients with COPD associated with chronic bronchitis. The MAA submission is based on encouraging results from four Phase III trials of Daxas (roflumilast) in the treatment of symptomatic COPD. Two pivotal 12-month studies met their primary endpoints, showing effects on exacerbation rates and pulmonary function (FEV1). Two supporting six-month studies also confirmed the efficacy of Daxas when used with standard bronchodilator treatments. Full data from all four studies are to be published during 2009.


Nycomed is also preparing for the submission of a New Drug Application (NDA) to the U.S. Food and Drug Administration (FDA) for Daxas as a once-daily oral treatment for patients with COPD associated with chronic bronchitis.


Commenting on today's announcement, H??kan Bj?¶rklund, Chief Executive Officer of Nycomed, said: "With its novel mode of action, Daxas represents a potentially important new approach in the management of COPD - a disease which is predicted to become the third leading cause of death worldwide by 2030. The Daxas submission, subject to acceptance and approval by the EMEA, represents a significant milestone for Nycomed. Our search for a US partner is on track, and we will submit a regulatory filing to the FDA soon."


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. According to World Health Organization (WHO) estimates, 80 million people have moderate to severe COPD worldwide. More than three 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 here.)



About Daxas


Nycomed's Daxas is an orally administered phosphodiesterase 4 (PDE4) enzyme inhibitor targeting cells and mediators in the body believed to be important in the COPD disease process. Daxas is expected to act on the underlying mechanism of COPD and related inflammatory diseases. It could significantly improve the way these conditions are managed, reducing exacerbations requiring medical intervention, including hospitalisation. If approved, Daxas, a once-a-day tablet, will be the first drug in its class. It will also be the first new approach to the management of COPD in a generation. Current treatment for COPD patients includes the use of inhaled bronchodilators and inhaled corticosteroids.


About Nycomed


Nycomed is a privately owned global pharmaceutical company with a differentiated portfolio focused on branded medicines in gastroenterology, respiratory and inflammatory diseases, pain, osteoporosis and tissue management. An extensive range of OTC products completes the portfolio.
Its R&D is built to be open for partnerships as in-licensing is a cornerstone of the company's growth strategy.
Nycomed employs 12,000 associates worldwide, and its products are available in more than 100 countries. It has strong platforms in Europe and in fast-growing markets such as Russia/CIS and Latin America. While the US and Japan are commercialised through best-in-class partners, Nycomed will further strengthen its position in key Asian markets.
Headquartered in Zurich, Switzerland, the company generated in 2008 total sales of € 3,4 billion and an adjusted EBITDA of € 1,2 billion.
For more information visit nycomed

Source
Nycomed

80% Of Canadians Want Airlines To Offer Pet-Free Flights: Lung Association Poll

Eighty percent of Canadians believe Canada's airlines should offer some pet-free flights to protect the health and safety of passengers and crew members, according to a new survey released today by The Canadian Lung Association. The findings come as Air Canada prepares to join WestJet in allowing pets to travel in the passenger cabin of airplanes - pet allergens can trigger serious or even life-threatening reactions in people with lung diseases like asthma and COPD.


"If someone brings a dog or cat onto an airplane and there's someone with asthma on board, it can trigger a potentially fatal asthma attack," said Dr. Peter MacLeod, medical spokesperson for The Canadian Lung Association, "While such attacks would be rare if your asthma or COPD are properly managed, it would take just one fatal case to have these policies reversed, and it's a shame if it comes to that. From our perspective it is better to be safe now with the health of Canadian travelers and air crew, then sorry later."


Air inside airplane cabins re-circulates - it gets recycled through the vents. Because airplane cabins are small spaces, it means that even a small amount of allergen, like the hair, saliva or dander of a pet, can spread quickly throughout the airplane cabin. The allergen in the air can reach every passenger on the plane, even people sitting far away from the pet. For people with allergies who have asthma or COPD, pet allergens can trigger wheezing, coughing, and swelling in the airways - otherwise known as an asthma flare-up (asthma attack) or a COPD flare-up. These reactions can be serious and even life-threatening.


The poll also found that 75% of Canadians believe that the federal government has a responsibility to take action on this issue in order to protect the health and safety of passengers and crew. The Lung Association is calling on the House of Commons Standing Committee on Health to examine this issue when the Committee resumes sitting in the fall.


"Canadians are saying quite clearly that the issue of protecting the health of airline passengers and crew must take precedence over a desire to enhance customer service," said Brian Graham, Chair of Chronic Disease Policy for The Canadian Lung Association, "We believe that the airlines should do the right thing and offer pet-free flights as an option. For someone with asthma who has an allergy to cats or dogs, having a pet anywhere in the same airline cabin can trigger an episode of wheezing, coughing and shortness of breath."


"What people do not realize is that it can take a couple of weeks for someone with asthma to completely recover from just one allergen exposure and during that time they may require increasing medications which can be costly," added Mr. Graham, "It can also take weeks for the allergens from a dog or cat to be completely cleared from the airplane following the trip".


The Lung Association has written to Health Committee Chair Joy Smith calling for hearings on the issue of pets in the passenger cabins of airlines and has offered to appear before the Committee on this topic of importance to the millions of Canadians who suffer from asthma, COPD, allergies and other respiratory diseases.


"By large margins Canadians are saying that the federal government has a broader responsibility to protect the respiratory health of passengers and crew," said Cameron Bishop, Director of Government Affairs for The Lung Association, "We hope that the results of this poll will influence the Chair of the Standing Committee on Health, and indeed all members of the Committee, to review this policy decision at federal hearings in the fall."


"We all love pets. This is not about trying to deny people the privilege of travelling with their furry companions. We think we can arrive at an important middle ground that balances the love of our pets with the health and safety of airline passengers and crews" added Mr. Bishop.


In the interim, The Lung Association continues to urge all Canadians with asthma or other respiratory diseases that may be exacerbated by allergic reaction to animals, to ensure their disease is properly managed every day - including when they are planning to travel, and to bring their quick-relief medicine (usually in a blue puffer) in their carry-on luggage.


Source
The Canadian Lung Association

Novartis Study Shows Onbrez® Breezhaler® Is Superior To Salmeterol In Reducing Breathlessness For Patients With COPD

Results of the Phase III INSIST study show that Onbrez® Breezhaler® (indacaterol) given once-daily is significantly better at improving lung function and reducing breathlessness than twice-daily salmeterol[1], one of the current mainstays of treatment for patients with chronic obstructive pulmonary disease (COPD).


Patients with COPD using the novel Onbrez Breezhaler were also able to reduce their use of rescue medication compared to those using salmeterol[1], a widely prescribed drug in the long-acting beta-2 agonist (LABA) class. Onbrez Breezhaler has been described in scientific literature as the first "ultra-LABA" reflecting its longer duration of action compared to older LABAs[2].


Data from the INSIST study involving 1,123 patients aged 40 years or above in seven countries were presented today at the European Respiratory Society (ERS) congress in Barcelona, Spain. Results showed that Onbrez Breezhaler 150 ?µg once-daily provided superior 24-hour bronchodilation to salmeterol 50 ?µg twice-daily at the end of 12 weeks' treatment[1].


"Patients with COPD require treatment that combines a sustained improvement in lung function with better clinical outcomes," said the study's principal investigator, Dr Stephanie Korn from the Pulmonary Department at Mainz University Hospital in Germany. "The results of INSIST confirm that indacaterol is potentially an attractive maintenance treatment option for these patients."


COPD is a progressive, life-threatening disease associated with tobacco smoking, air pollution or occupational exposure, which causes obstruction of airflow in the lungs resulting in debilitating bouts of breathlessness. Although often considered a disease of the elderly, research has shown that a majority of COPD patients are under the age of 65[3], when they are likely to be at the peak of their earning power and family responsibilities.


INSIST was a 12-week, randomized, double-blind, head-to-head study involving patients with moderate-to-severe COPD (as defined by the GOLD 2007 criteria[4]). The study met its primary endpoint with Onbrez Breezhaler giving superior bronchodilation to salmeterol at week 12[1]. This was assessed by measuring patients' forced expiratory volume of breath in one second (FEV1) from five minutes to 11 hours 45 minutes post-dose (mean difference in FEV1 area under curve 60 mL, p







The INSIST study findings are supported by recently published data from the 26-week INLIGHT-2 Phase III study involving 1,002 patients with moderate-to-severe COPD[5]. In this study, Onbrez Breezhaler 150 ?µg once-daily provided a greater improvement in lung function after 12 weeks than salmeterol 50 ?µg twice-daily or placebo (24-hour trough FEV1 increased by 60 mL more than salmeterol and 170 mL more than placebo, both p

Gene Changes May Stunt Lung Development In Children

Mutations in a gene may cause poor lung development in children, making them more vulnerable to diseases such as chronic obstructive pulmonary disease (COPD) later in life, say researchers at the University of Pittsburgh Graduate School of Public Health and the German Research Center for Environmental Health. Their study, published online in Physiological Genomics, measured expression levels of the gene and its variants in both mouse lungs and children ages 9 to 11.



Study authors, led by George Leikauf, Ph.D., professor of occupational and environmental health at the University of Pittsburgh Graduate School of Public Health, and Holger Schulz, M.D., professor of medicine at the Institute of Lung Biology and Disease, German Research Center for Environmental Health, Munich, focused on a gene called superoxide dismutase 3 (SOD3), previously shown to protect the lungs from the effects of asbestos and oxidative stress.



"People lose lung function as they age, so it's important to identify possible genetic targets that control healthy development of the lungs during childhood," said Dr. Leikauf.



Drs. Leikauf, Schulz and colleagues compared SOD3 expression levels in strains of mice with poor lung function to one with more efficient airways and lungs two times the size. As with people, the lungs of mice fully form as they mature to adulthood. The better-functioning strain maintained higher levels of SOD3 - levels in these mice were four times higher at the final stage of lung development. They also found the presence of single nucleotide polymorphisms, or SNPs, variations in DNA sequences, in SOD3 that were linked to lung function in mice.



The researchers went on to assess SOD3 mutations in children ages 9 to 11 by testing for SNPs linked to lung function. After analyzing DNA from 1,555 children in Munich and Dresden who were part of the International Study of Asthma and Allergy in Children, they discovered two common SNPs associated with poorer lung function. One of these SNPs likely alters the expression levels of SOD3. Lung function was tested with spirometry, which measures the amount and speed of exhaled air.



Previously, genetic variants in SOD3 have been associated with loss of lung function in COPD, which is mainly caused by cigarette smoking. "We know SOD3 protects the lung against injury caused by chemicals in cigarette smoke, and it could be a link between childhood exposure to environmental tobacco smoke and poor lung development," said Dr. Leikaf. In the future it might be possible to identify at-risk children and to develop a medication that would foster optimal lung development, he added. The researchers also are exploring sex differences in SOD3 gene expression and lung development, and girls appear to be at greater risk than boys.



COPD is the fourth leading cause of death in the United States, accounting for more than 120,000 deaths annually and costing more than $30 billion per year. It is estimated that more than 16 million Americans have COPD.


Notes:


The study was funded by the National Institutes of Health and the German Research Center for Environmental Health. In addition to Drs. Leikauf and Schulz, study co-authors include Koustav Ganguly, M.D., and Martina Schreiber, M.D., German Research Center for Environmental Health; Martin Depner, M.D., and Erika von Mutius, M.D., Ludwig Maximilian's University, Munich; Cheryl Fattman, M.D., Kifai Bein, M.D., Tim D. Oury, M.D., and Fei Gao, M.D., University of Pittsburgh; Scott C. Wesselkamper, M.D., and Michael T. Borchers, M.D., University of Cincinnati; Michael Kabesch, M.D., Hannover Medical School, Germany.



The study can be viewed at: physiolgenomics.physiology/cgi/content/abstract/90363.2008v1

Tiotropium Associated With Reduced Mortality

New research suggests that tiotropium, a long-acting anticholinergic used in patients with COPD, may be associated with a reduction in all-cause mortality, cardiovascular mortality, and cardiovascular events. Researchers from Caritas-St. Elizabeth Medical Center in Boston, MA, reviewed the outcomes of 30 completed clinical trials in the tiotropium project database. Within the trials, 10,846 patients were treated with tiotropium and 8,699 patients received a placebo. Results indicated that patients treated with tiotropium had lower incidence rates (IR) of all-cause mortality, cardiovascular mortality, and cardiovascular events (IR = 3.44, .91, and 2.15 per 100 patients, respectively), compared with placebo (IR = 4.10, 1.24, and 2.67, respectively). Within the tiotropium group, the overall risk for serious or fatal lower respiratory events also was reduced. The mechanism by which tiotropium may reduce cardiovascular mortality is unclear, but researchers speculate that there may be an association with the reduction in respiratory events. The article is published in the January issue of Chest, the peer-reviewed journal of the American College of Chest Physicians.

Perforomist Inhalation Solution Data To Be Presented At American Thoracic Society Conference

Dey, L.P., a subsidiary of Mylan Inc. (NYSE: MYL), has announced that data from two presentations highlighting the use of Perforomist® (formoterol fumarate) Inhalation Solution will be featured in poster format at the International Conference of the American Thoracic Society on May 19, 2009 in San Diego.



In one analysis, use of Perforomist Inhalation Solution, when added to maintenance tiotropium, resulted in improved pulmonary function, dyspnea (shortness of breath) and rescue medication use versus treatment with tiotropium alone. In a second study, patient satisfaction increased in those treated with Perforomist Inhalation Solution twice daily compared with ipratropium/albuterol metered-dose inhaler (MDI) four times daily.



Presentation Details:



In COPD, Adding Nebulized Formoterol to Tiotropium Treatment Provides Added Benefits in Pulmonary Function, Dyspnea, and Rescue Medication Use: A Pooled Analysis; poster board # J51



Date: Tuesday, May 19, 2009

Poster viewing: 10:30 a.m. to 12:45 p.m. PT

Location: Area J (Sails Pavilion, Upper Level), San Diego Convention Center



Nebulized Formoterol Improved Efficacy and Increased Patient Satisfaction Compared with Ipratropium/Albuterol MDI; poster board # J50



Date: Tuesday, May 19, 2009

Poster viewing: 10:30 a.m. to 12:45 p.m. PT

Location: Area J (Sails Pavilion, Upper Level), San Diego Convention Center



About COPD



COPD is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.



COPD is the fourth leading cause of death in America, behind heart disease, cancer and stroke. 12 million Americans have been diagnosed with COPD, and at least another 12 million have symptoms but have not been diagnosed. COPD is not well understood or recognized - most Americans have not heard of it, not even those who may be living with the condition. The most common cause of COPD is cigarette smoking, which is responsible for an estimated 80 to 90 percent of COPD cases. For patients who smoke, quitting smoking is the single most important step a patient can take to treat or slow down COPD. Estimates of the total incidence of COPD in America range from 24 to 30 million.



About Nebulization



Of the three types of devices used to deliver bronchodilators - nebulizers, metered-dose inhalers, and dry powder inhalers - nebulizers convert medication into a fine liquid mist that the patient inhales through a mouthpiece or facemask. The patient breathes naturally, inhaling the medicine until the complete dosage has been delivered. Nebulization is a very gentle, but also very thorough, method of delivering medicine directly into the lungs.
















With Perforomist Inhalation Solution, nebulization may become a more widely used treatment option for many COPD patients at earlier treatment stages who could benefit from twice-daily maintenance dosing of a nebulized long-acting beta2-adrenergic agonists (LABAs) such as Perforomist Inhalation Solution. For example, this COPD treatment may be a valuable clinical option for many patients whose symptoms are not adequately controlled with their current therapy. COPD patients should consider asking their doctor whether nebulized treatment may be right for them.



About Perforomist® Inhalation Solution



Perforomist Inhalation Solution is indicated for the long-term, twice-daily (morning and evening) administration in the maintenance treatment of bronchoconstriction in patients with chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema.



Important Safety Information



Perforomist® (formoterol fumarate) Inhalation Solution belongs to a class of medications known as long-acting beta2-adrenergic agonists (LABAs). LABAs may increase the risk of asthma-related death. Data from a large placebo-controlled US study comparing the safety of another LABA (salmeterol) or placebo added to usual asthma therapy showed an increase in asthma-related deaths in patients receiving salmeterol. This finding with salmeterol may apply to formoterol (a LABA), the active ingredient in Perforomist Inhalation Solution.



Perforomist Inhalation Solution should not be initiated in patients with acutely deteriorating COPD, which may be a life threatening condition, or to treat acute symptoms. Acute symptoms should be treated with fast-acting rescue inhalers. Perforomist Inhalation Solution is not indicated to treat asthma. The safety and efficacy of Perforomist Inhalation Solution in asthma has not been established. Perforomist Inhalation Solution should not be used with other medications containing LABAs. Do not use more than one nebule twice daily. Perforomist Inhalation Solution should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias and hypertension.



In COPD clinical trials, the most common adverse events reported with Perforomist Inhalation Solution (>2% and more common than placebo) were diarrhea, nausea, nasopharyngitis, dry mouth, vomiting, dizziness, and insomnia.



Please see full Prescribing Information, including Boxed Warning, at perforomist.

COPD about end-of-life care: is the doctor-patient communication adequate?

Previous studies have shown that patients with severe COPD receive lower quality end-of-life care than patients with cancer. In part, this is because patients with COPD and their doctors find it very difficult to talk about end-of-life care.


The goal of this study was to identify which specific areas of communication about end-of-life care occur between patients with severe COPD and their physicians and how patients' rate the quality of this communication.


J. Randall Curtis (Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA) and colleagues adapted a 17-item Quality of Communication (QOC) questionnaire from prior research and from focus groups of patients with COPD, in order to identify the areas of communication most important to patients.


The US team then enrolled 115 patients with severe, oxygen-dependent COPD and administered the Quality of Communication (QOC) questionnaire to patients along with other questionnaires including satisfaction with care.


Patients rated physicians highly at listening and answering questions, but areas patients rated relatively low included discussing prognosis, what dying might be like, and spirituality/religion.
Patients reported that most physicians did not even discuss how long patients might have to live, what dying might be like, or patients' spirituality. Patients' assessments of physicians' overall communication and communication about treatment correlated well with the patients' ratings of the physician on QOC items, suggesting that the QOC questionnaire did a good job of assessing the quality of communication. Patients' overall satisfaction with care also correlated significantly with the QOC, suggesting that this type of communication is an important part of patients' assessment of the quality of care they receive.


In summary, this study identifies areas of communication that physicians do not address and areas that patients rate poorly, including talking about prognosis, dying, and spirituality. These areas may provide targets for interventions to improve communication about end-of-life care for patients with COPD and their physicians.


Contact:



J. Randall Curtis

Division of Pulmonary and Critical Care Medicine,

University of Washington,

Seattle, WA, USA

Tel: +1 206 731 3356

Fax: +1 206731 8584

Email: jrcu.washington


Title of original article:

Patient-physician communication about end-of-life care for patients with severe COPD

If you need this article, please address your request to: erjcedos.int.ch


The European Respiratory Journal is the peer-reviewed scientific publication of the European Respiratory Society (more than 7,000 specialists in lung diseases and respiratory medicine in Europe, the United States and Australia).

NIH Studies Effect Of Home Oxygen Therapy On Patients With Moderate COPD

The National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, is launching with the Centers for Medicare & Medicaid Services a six-year, $28 million randomized clinical trial of the effectiveness of long-term, home oxygen therapy for COPD. In this Long-term Oxygen Treatment Trial, researchers at 14 clinical centers across the United States will study about 3,500 patients with moderate COPD to determine whether supplemental oxygen will help them lead "longer, more active, and better quality lives," said a statement from NHLBI on November 20.??? The study aims to help CMS decide whether to extend coverage for home oxygen treatment to patients with moderate COPD. Currently, Medicare limits coverage of home oxygen therapy to beneficiaries with severe COPD (very low blood oxygen levels while resting).


???
???"COPD is a devastating, highly disabling disease. The prospect that home oxygen therapy could lessen the disability of COPD and perhaps even prolong life when given earlier during the course of the disease is enticing, but we need more information," said NHLBI Director Elizabeth G. Nabel, M.D.


???
The decision to undertake the study evolved from a scientific working group convened in May 2004 by NHLBI and the Department of Health and Human Services Agency for Healthcare Research and Quality, which called for more research on the safety and efficacy of long-term oxygen therapy in patients with COPD. Patient recruitment for the trial is expected to begin in late 2007. Participants will be randomly selected to receive or not to receive supplemental oxygen for approximately three years.


???
"As the population ages, the number of individuals affected by COPD is on the rise," noted James Kiley, PhD., director of the NHLBI Division of Lung Diseases. "It is more imperative than ever that we find treatments that will improve the health and function of patients with chronic lung diseases such as COPD." November is National COPD Awareness Month.??? See nih/news/pr/nov2006/nhlbi-20.htm for full statement.


American Association for Homecare

625 Slaters Lane, Suite 200

Alexandria, VA 22314??? 703-535-1881

aahomecare

Smokers Consuming Both Marijuana And Tobacco Have An Increased Risk Of COPD

A study in CMAJ reports the risk of respiratory symptoms and chronic obstructive pulmonary disease (COPD) increases when smoking both tobacco and marijuana. The increased risks however were not linked when smoking marijuana only.


The study differed from others since the population involved was older, and the incidence of tobacco smoking was lower in the 878 participants all from Vancouver, Canada aged 40 or over. The research was part of Burden of Obstructive Lung Disease (BOLD) Initiative that aims to find out the incidence of COPD in adults over 40 years old in the general population.


COPD is identified by diseased lungs and narrowed airways and linked to a high death rate.


Smokers were defined by the authors, as people having reportedly smoked at least 365 cigarettes in their lifetime and individuals who reported having smoked only marijuana.


The increased risk was linked with tobacco smoking. For smokers of both tobacco and marijuana the risk of developing respiratory symptoms was 2.5 higher and 3 times higher of having COPD as defined by spirometric testing.


"We were able to detect a significant synergistic effect between marijuana smoking and tobacco smoking," explains Dr. Wan Tan, University of British Columbia and St. Paul's Hospital and collaborators. "This effect suggests that smoking marijuana (at least in relatively low doses) may act as a primer, or sensitizer, in the airways to amplify the adverse effects of tobacco on respiratory health."


The limitations of the research were restricted to the available information on the potential differences in marijuana strength, on the variations in inhalation and the number of smokers who mix both substances in the same cigarette.


In an associated observation, Dr. Donald Tashkin, University of California Los Angeles (UCLA) says "the findings of Tan and colleagues add to the limited evidence of an association between marijuana use and COPD because their study focuses on an older population (aged 40 or older) that is at greater risk of COPD." Earlier studies were unsuccessful in discovering an additive effect of marijuana and tobacco on either chronic respiratory symptoms or abnormal lung functions in younger smokers. Dr. Tashkin remarks that "we can be close to concluding that marijuana smoking by itself does not lead to COPD."


However, Dr Wan Tan and colleagues write in conclusion that "Although our study had insufficient power to show an association between marijuana alone and increased risk for COPD, it remains uncertain whether marijuana by itself is harmful for the lungs. Larger studies are needed to address this critically important issue in the future."


"Marijuana and chronic obstructive lung disease: a population-based study"

Wan C. Tan, MB, Christine Lo, BSc, Aimee Jong, BSc, Li Xing, MSc, Mark J. FitzGerald, MB, William M. Vollmer, PhD, Sonia A. Buist, MD PhD, Don D. Sin, MD MPH for the Vancouver Burden of Obstructive Lung Disease (BOLD) Research Group

CMAJ ??? April 14, 2009; 180 (8). doi:10.1503/cmaj.081040.

cmaj.ca/


Written by Stephanie Brunner (B.A.)

Treating COPD With Inhaled Steroids: Killing Two Birds With One Stone?

Chronic obstructive pulmonary disease (COPD) is one of the five
leading causes of death worldwide. It is characterised by an
inflammatory response to inhaled fumes (mostly tobacco smoking) that
leads, in the long term, to the loss of lung function, limiting
airflow and causing shortness of breath.


Patients affected by COPD often suffer episodes of worsening of
symptoms called acute exacerbations, mostly caused by bacterial
infections. These episodes of exacerbation impact negatively on the
health status of the patients, worsen their prognosis and are
associated with a very significant social and economic cost.


Treatment with inhaled steroids, such as fluticasone propionate,
reduces the frequency and severity of acute exacerbations in patients
with COPD, but their role in controlling bacterial infection is
controversial.


In healthy subjects the lung is sterile, but in patients with COPD it
is not and bacteria like S. pneumoniae and H. influenzae are
frequently isolated.


This study by Sebastian Albert?­ (Institut Universitari
d'Investigacions en Ci??ncies de la Salut, IUNICS, Palma de Mallorca,
Spain) and colleagues focuses on the direct effect of fluticasone
propionate on the interaction of these pathogens with the lung
epithelium, using mice models and in vitro human cell cultures.
The authors demonstrate that, under the effects of fluticasone
propionate, the capacity of those major pathogens to invade the
respiratory epithelium is significantly decreased.


Therefore, this work provides another clue for the understanding of
the beneficial effects of fluticasone propionate in COPD patients.


TITLE OF THE ORIGINAL ARTICLE

Fluticasone propionate reduces bacterial airway epithelial invasion


The European Respiratory Journal


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).


erj.ersjournals


Source

Press Office

European Respiratory Society

Cedos International

23 Gourgas

1205 Geneva Switzerland

dev.ersnet

Indacaterol provides 24-hour efficacy with single dose in patients with asthma and COPD

Novartis announced today that its development compound indacaterol demonstrated effective and well-tolerated treatment of asthma and chronic obstructive pulmonary disease (COPD) over 24 hours with a rapid onset of action, according to new data presented at the congress of the European Respiratory Society (ERS) in Copenhagen, Denmark.


"The combination of 24-hour efficacy and a reassuring safety profile suggests that in time, a once-daily dose of indacaterol could become a new standard of care for bronchodilation in asthma and COPD," said Joerg Reinhardt, Global Head of Development, Novartis Pharma AG. "We are now concentrating on the development of this important new therapy for the benefit of patients who suffer from these debilitating and sometimes fatal diseases."


The results of a series of clinical studies presented at the meeting show that indacaterol (formerly known as QAB149) could become the first in a new class of 'once-daily beta2-agonists', offering potential therapeutic benefits for patients with asthma and COPD. Indacaterol could be the first beta2-agonist to be taken only once-daily providing full 24 hour symptom control with a single administration, in contrast to currently-available long-acting beta2-agonists (LABAs) such as salmeterol and formoterol which have to be taken twice-daily.


Key indacaterol data presented at ERS included those demonstrating its 24-hour bronchodilator efficacy in COPD, as well as in asthma. Even at high doses, indacaterol demonstrated a good overall safety profile with no concerns over key adverse events sometimes associated with beta2-agonists. These data reinforce the results of preclinical studies.


"Considered together, these results provide important insights into the future therapeutic potential of indacaterol, the first in a new generation of drugs that could accurately be described as 'once-daily beta2-agonists'," said Prof. Stephen Holgate, Southampton General Hospital, UK. "For patients with asthma or COPD, indacaterol could provide important clinical benefits in terms of improved compliance and more rapid and reliable long-term control of the potentially life-threatening symptoms of breathlessness and bronchial constriction associated with these conditions."


24-hour efficacy in asthma and COPD


The efficacy of indacaterol in both asthma and COPD was demonstrated in a series of placebo-controlled clinical studies using once-daily doses of indacaterol ranging from 25 to 2000 ???g.1-7 The duration of action of indacaterol was found to be largely independent of dose, with superior bronchodilation to placebo demonstrated at 24 hours after a single dose.1


The efficacy of indacaterol in patients with asthma was further investigated in three multiple-dose studies of 7, 14 and 28 days' duration.3-5 In these studies, the 24-hour bronchodilator efficacy of indacaterol observed on the first day was maintained for the duration of the studies, suggesting that regular use of indacaterol is not associated with the development of tolerance, or tachyphylaxis. Indacaterol also demonstrated 24-hour bronchodilator efficacy with no evidence of tachyphylaxis in patients with COPD.6,7















Strong safety profile


Data presented at ERS demonstrate that the 24-hour efficacy of indacaterol in asthma is accompanied by a positive safety profile. Single indacaterol doses up to 2000 ug were well-tolerated and were not associated with any clinically significant changes in known class effect adverse events such as hypokalaemia, hyperglycaemia, increased heart rate or altered QTc interval.1,2


These single-dose results were confirmed in multiple-dose asthma studies, in which indacaterol doses up to 800 ug once-daily for up to 28 days were associated with a good cardiovascular safety profile and no clinically relevant effects on blood pressure, QTc, glucose or potassium levels.3-5


The positive safety profile of indacaterol in asthma was also observed in patients with COPD, at doses up to 800 ug for up to 28 days.6,7


Findings supported by preclinical data


Data from preclinical studies were presented at ERS and confirmed the results of clinical studies, with indacaterol acting as a potent beta2-agonist and displaying high intrinsic efficacy in isolated human bronchial tissue.8 In other studies, indacaterol demonstrated a sustained duration of action in isolated human bronchial tissue9 and in guinea pigs.10 Preclinical data also support the lack of tachyphylaxis observed in clinical studies.11


The safety of indacaterol was also examined in the preclinical development programme. In a series of in vitro and in vivo studies, the safety of indacaterol was compared with that of two long-acting beta2-agonists (formoterol and salmeterol) in doses providing equivalent degrees of bronchodilation.12 Indacaterol demonstrated a better cardiovascular safety profile than formoterol and salmeterol.12 Importantly, studies using isolated human bronchial tissue suggest that indacaterol will not antagonise the bronchorelaxant effect of short-acting beta2-agonists, and therefore should not interfere with rescue medication use.8


About indacaterol


Indacaterol (previously known as QAB149) works by stimulating beta2-receptors in the smooth muscle of the airways. This causes relaxation of the muscle, thereby increasing the diameter of the airways, which become constricted in asthma and COPD.


Indacaterol is being developed both as monotherapy and as a fixed-dose combination with drugs such as NVA237, a long-acting anti-muscarinic agent for the treatment of COPD which has also been shown to be effective over 24 hours after a single dose.13


About asthma and COPD


Asthma is a major, chronic airway disorder that is a serious public health problem in many countries, and can have severe - sometimes fatal - consequences.14 Asthma is one of the most common chronic diseases worldwide, affecting more than 300 million people15 of whom an estimated 15 million suffer from severe disease.16 Their health and quality of life are often severely affected, and more than 180,000 people worldwide are believed to die from asthma each year.17


COPD is also a major cause of chronic morbidity and mortality throughout the world, with many people dying prematurely from the disease or its complications.18 COPD is currently the fourth leading cause of death in the world, and further increases in its prevalence can be predicted in the coming decades.18 It is estimated that COPD is prevalent in 4% of the population in the USA, Europe and Japan,19,20,21 and at least 15% of smokers will go on to develop the disease.18 COPD, which encompasses chronic bronchitis and emphysema or both conditions, progresses slowly and eventually leads to a largely irreversible loss of lung function.


The foregoing press release contains forward-looking statements that can be identified by the use of forward-looking terminology such as "could become", "future therapeutic potential", "should not", or similar expressions, or by express or implied discussions regarding the potential development and commercialization of indacaterol and NVA237. Such forward-looking statements involve known and unknown risks, uncertainties and other factors that may cause actual results to be materially different from any future results, performance or achievements expressed or implied by such statements. There can be no guarantee that the agreement that is the subject of this release will lead to commercialization of indacaterol or NVA237 in any market. Any such commercialization can be affected by, among other things, uncertainties relating to product development and clinical trials; regulatory actions or delays or government regulation generally; the ability to obtain or maintain patent or other proprietary intellectual property protection and competition in general; government, industry, and general public pricing pressures; as well as factors discussed in the Company's Form 20-F filed with the Securities and Exchange Commission. Should one or more of these risks or uncertainties materialize, or should underlying assumptions prove incorrect, actual results may vary materially from those described herein as anticipated, believed, estimated or expected. Novartis is providing this information as of this date and does not undertake any obligation to update any forward-looking statements contained in this document as a result of new information, future events or otherwise.


About Novartis


Novartis AG (NYSE: NVS) is a world leader in pharmaceuticals and consumer health. In 2004, the Group's businesses achieved net sales of USD 28.2 billion and pro forma net income of USD 5.6 billion. The Group invested approximately USD 4.2 billion in R&D. Headquartered in Basel, Switzerland, Novartis Group companies employ about 83,700 people and operate in over 140 countries around the world. For further information please consult novartis.


References


1. Duvauchelle T, et al. Single-dose indacaterol, a novel once-daily 2-agonist, is well tolerated in patients with mild asthma. Poster (P1727) presented at 15th European Respiratory Society Congress, Copenhagen, Denmark, 17-21 September 2005.

2. Beeh K-M, et al. Indacaterol: the first once-daily 2-agonist with 24-hour bronchodilation. Poster (P1725) presented at 15th European Respiratory Society Congress, Copenhagen, Denmark, 17-21 September 2005.

3. Tarral A, et al. Safety and tolerability of multiple-dose indacaterol, a novel once-daily 2-agonist, in patients with mild asthma. Poster (P1726) presented at 15th European Respiratory Society Congress, Copenhagen, Denmark, 17-21 September 2005.

4. Chuchalin AG, et al. Cardiovascular safety of indacaterol, a novel once-daily 2-agonist, in patients with asthma. Poster (P1728) presented at 15th European Respiratory Society Congress, Copenhagen, Denmark, 17-21 September 2005.

5. Kanniess F, et al. Indacaterol, a novel once-daily 2-agonist, demonstrates 24-hour efficacy and is well tolerated in patients with persistent asthma: a multiple-dose, dose-ranging study. Poster (P1729) presented at 15th European Respiratory Society Congress, Copenhagen, Denmark, 17-21 September 2005.

6. Beier J, et al. Safety of multiple-dose indacaterol, a novel once-daily 2-agonist, in moderate-to-severe COPD. Poster (P1965) presented at 15th European Respiratory Society Congress, Copenhagen, Denmark, 17-21 September 2005.

7. Aubier M, et al. Indacaterol, a novel once-daily 2-agonist, is effective and well tolerated on multiple dosing in patients with mild-to-moderate COPD. Poster (P1920) presented at 15th European Respiratory Society Congress, Copenhagen, Denmark, 17-21 September 2005.

8. Naline E, et al. Pharmacological characterization of indacaterol, a novel 2-agonist, on the isolated human bronchus. Poster (P1398) presented at 15th European Respiratory Society Congress, Copenhagen, Denmark, 17-21 September 2005.

9. Naline E, et al. Duration and onset of action of indacaterol, a novel once-daily 2-agonist, on the isolated human bronchus. Poster (P1399) presented at 15th European Respiratory Society Congress, Copenhagen, Denmark, 17-21 September 2005.

10. Lewis CA, et al. Indacaterol, a novel once-daily 2-agonist, demonstrates a long duration of action and fast onset in vitro and in vivo in the guinea pig. Poster (P835) presented at 15th European Respiratory Society Congress, Copenhagen, Denmark, 17-21 September 2005.

11. Battram CH, et al. Once-daily administration of indacaterol does not induce tachyphylaxis in vivo. Poster (P1400) presented at 15th European Respiratory Society Congress, Copenhagen, Denmark, 17-21 September 2005.

12. Lewis CA, et al. Indacaterol: preclinical evidence for an improved safety profile versus LABAs. Poster (P1401) presented at 15th European Respiratory Society Congress, Copenhagen, Denmark, 17-21 September 2005.

13. Langley SJ, et al. A randomized, double-blind, dose-ranging study to assess the effect of single doses of the inhaled anti-muscarinic AD 237 on FEV1 in patients with COPD. Proceedings of the American Thoracic Society 2005;2:A542.

14. Global Initiative for Asthma (GINA). NIH Publication 02-3659 issued January 1995 (updated 2004; accessed June 16, 2005). At: ginasthma

15. GINA. The Global Burden of Asthma Report 2004. At: ginasthma

16. American Thoracic Society. Proceedings of the ATS workshop on refractory asthma. Current understanding, recommendations, and unanswered questions. Am J Respir Crit Care Med 2000; 162:2341-2351.

17. World Health Organization. At: who.int/mediacentre/factsheets/fs206/en/

18. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. Updated 2003; accessed June 16, 2005. At goldcopd

19. National Institutes of Health - National Health, Lung, and Blood Institute. Data Fact Sheet: Chronic Obstructive Pulmonary Disease. At: nhlbi.nih/health/public/lung/other/copd_fact.pdf

20. Gulsvik A. Mortality in and prevalence of chronic obstructive pulmonary disease in different parts of Europe. Monaldi Arch Chest Dis. 1999 Apr;54(2):160-2.

21. Takemura H, Hida W, Sasaki T, Sugawara T, Sen T. Prevalence of Chronic Obstructive Pulmonary Disease in Japanese People on Medical Check-Up. Tohoku J Exp Med 2005;207(1):41-50.


John Taylor

John Gilardi

Novartis Pharma Communications Novartis Global Media Relations

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NOVARTIS

Enzyme Essential For Healthy Lung Development Discovered

Investigators at The Saban Research Institute of Children's Hospital Los Angeles have provided the first evidence that Eya1 protein phosphatase is a crucial regulator of the development of embryonic lung epithelial stem cells.



The correct functioning of lung epithelium is essential to life. Cellular polarity of lung epithelial cells, meaning that they have an asymmetrical orientation or a front and back, is crucial. Dysregulation of cell polarity has been associated with developmental disorders as well as cancer. Until now, little has been known about the mechanism that controls cell polarity, cell fate and self-renewal of embryonic lung epithelial stem cells. David Warburton, MD, director of Developmental Biology and Regenerative Medicine at The Saban Research Institute, and Ahmed El-Hashash, PhD, senior research scientist carrying out this study, will release their findings in the upcoming issue of Development.



"We know that loss of polarity in pulmonary epithelial cells is associated with lung cancer and chronic obstructive pulmonary disease. Knowing that Eya1 regulates polarity, we now have another target for intervening in those disease processes," said Dr. Warburton.



They have determined that Eya1, a protein phosphatase, controls cell polarity, cell fate and self-renewal in the mouse embryonic lung epithelial stem cells. They have also provided the first evidence that these stem cells are polarized with characteristic perpendicular cell divisions.



In vivo and in vitro experiments showed that interfering with Eya1 phosphatase function resulted in defective epithelial cell polarity and mitotic spindle orientation; disrupted Numb, a cell fate determinant; and inactivated Notch signaling, which is involved in cell segregation and division, thereby establishing Eya1 as an important regulator in the development of embryonic lung stem cells.



"Identification of Eya1 mechanisms of regulating cell polarity, cell fate and self-renewal, will help to harness the regenerative potential of lung stem cells, and to identify novel targets for the prevention or rescue therapy of fatal lung disease, and for lung regeneration. This will also help to develop stem cell-based therapy to treat patients with lung diseases, " said Dr. El-Hashash, PhD. "Solutions to the problems concerning regeneration of lung tissue for restoration of functional alveoli are at the cutting edge of identifying novel therapeutic options for lung diseases like COPD and fibrosis."

World COPD Day 2008 Features New Initiatives That Drive Enhanced Diagnosis And Treatment

World COPD Day 2008 features new patient and health professional initiatives that address the misconceptions and lack of awareness surrounding chronic obstructive pulmonary disease (COPD). These misconceptions -- revealed in a global survey, the International COPD Coalition (ICC) Report -- include poor public awareness that smoking is the main cause of COPD, a failure to diagnosis COPD in its early stages, when medication can be used to prevent further lung deterioration, and a mistaken belief that initial COPD symptoms, like coughing and shortness of breath, are a normal consequence of aging.


"This survey reveals the devastating extent to which COPD is an under-recognized and under-treated disease, despite the fact that it is the fourth leading cause of death worldwide," said Ms. Mariadelaide Franchi, ICC Co-Chair. "The results have driven us to develop a series of powerful new initiatives launching on World COPD Day 2008," she added.


Patient and Health Professional Initiatives


New initiatives include the UNITE! annual survey, designed to build on the ICC Report survey to secure country-specific COPD data while providing an overview of COPD prevalence and management challenges worldwide. This data will form the basis of a worldwide database of COPD statistics and information, providing national health care providers, public health and government officials with the information they need to develop targeted disease prevention and treatment programs.


The new "Ask About COPD" initiative is directed to health care providers and COPD patient organizations, and emphasizes their roles in educating patents about the disease's symptoms, diagnostic tools and management. ICC will provide buttons healthcare providers and other COPD experts can wear to stimulate patient's questions about COPD, as well as office posters and a COPD fact sheet that encourage patients to initiate a dialogue about their risk factors and symptoms. In addition, the new Faces Forward COPD! program will feature patient profiles and testimonials from COPD patient organizations around the world.


"Each of these programs is uniquely designed to motivate people to speak with their health professionals and other COPD experts about COPD risk factors and symptoms, and to get diagnosed early and receive the treatment they need to have a high quality of life," Dr. Yousser Mohammad, ICC Chairsaid.


Overview of Global Survey Results


The ICC Report revealed that the majority of COPD patients do not receive a COPD diagnosis until their disease has progressed to the "severe stage," after their COPD symptoms are substantial. As a result, there are a large number of patients who might have benefited from treatment earlier in their disease in order to prevent further lung deterioration.Lack of early diagnosis is due to several issues:



-- There is an overall lack of awareness of COPD causes and symptoms among the public
















-- Initial COPD symptoms, like coughing, sputum production and shortness of breath frequently are not recognized as the first signs of COPD; instead they are accepted as a normal consequence of aging


The survey also demonstrated there is low awareness among patients about COPD overall and key risk factors. For example, in many countries, smoking -- the main cause of COPD -- is not viewed as harmful or as a main cause of developing COPD. Other survey findings include:



Although most COPD patents receive their care from general practitioners (GPs), many lack the requisite knowledge to diagnose COPD, don't have appropriate diagnostic equipment (e.g., spirometers), do not follow COPD disease management algorithms and protocols, and have difficulties differentiating between asthma and COPD. Furthermore, many people with COPD have restricted access to lung specialists, medications and rehabilitation facilities due to affordability and reimbursement barriers


About World COPD Day 2008


World COPD Day 2008 will take place on Wednesday, November 19, and is organized by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in collaboration with health care professionals and ICC COPD patient groups throughout the world. Its aim is to raise awareness about COPD and improve care throughout the world.


Each year GOLD coordinates preparation and distribution of World COPD Day materials and resources. Since the first World COPD Day in 2001, organizers in more than 50 countries worldwide have carried out activities, making the day one of the world's most important COPD awareness and education events. Activities include:



-- Public service announcements, posters, billboards, stickers, newspaper articles, and radio advertisements highlighting the theme of World COPD Day 2008.



-- Demonstrations of Spirometry



-- World COPD day walks, runs, and swims involving people with COPD, and their families and friends



-- Exercise classes, dance performances, coping skills workshops, and support group sessions to help COPD patients live active fuller lives



-- Clinics and health fairs to brig attention to COPD and to provide attention to good COPD care



-- Seminars for physicians, nurses, and other healthcare providers on the latest providers on the latest international guidelines for COPD diagnosis and treatment


See what activities are planned for World COPD Day in your area.


About COPD


Chronic obstructive pulmonary disease (COPD) affects more than 340 million people worldwide and represents the fourth leading cause of death, after cerebrovascular, heart and infectious diseases. Although COPD is increasing in prevalence it is widely under-diagnosed and under-treated in many parts of the world. The early stages of COPD are often unrecognized, although determining a person's risk of developing COPD is straightforward. If COPD is detected early, treatments are available to prevent further lung deterioration.


About ICC


The International COPD Coalition (ICC) works with health care professionals and public health officials around the world to raise awareness of COPD and to improve prevention and treatment of this lung disease. Through the dissemination of evidence-based guidelines for COPD management, and events such as the annual celebration of World COPD Day, ICC is working to improve the lives of people with COPD in every corner of the globe.



International COPD Coalition

internationalcopd

Comment On The Publishing Of National Strategy For COPD Which Contains A Chapter On Asthma, UK

Asthma UK's Chief Executive Neil Churchill said: 'The launch of a national strategy for COPD, which contains a chapter on the care of adult asthma, represents an important stepping stone towards national standards for asthma in England.



'Asthma UK is currently working with PCTs across England to identify ways to improve care and reduce emergency admissions as tragically in the UK over 200 people a day are rushed to hospital with life-threatening asthma attacks. We believe that three-quarters of these admissions and up to 90% of deaths could be avoided with the right care and management but a lack of national standards has meant that huge variations within the health service puts lives at risk. The new strategy aims to achieve a 20% reduction in unscheduled hospital admissions, resulting in savings of around ??200m a year and making a big difference to people's quality of life.



'Whilst we are delighted that this first step has been taken, for this and future strategies to be effective the views of people with asthma need to be heard. We are encouraging all our supporters to tell the Department of Health what they think about this document, so to have your say contact us at asthma.uk/consultation.'

Source
Asthma UK

Pitt Researchers Identify Protein That Plays Key Role In Pulmonary Emphysema Development

Scientists at the University of Pittsburgh School of Medicine are blazing a trail down a molecular pathway that could lead to new treatments, and perhaps even prevention strategies, for the lung disease emphysema.


Their new study, which appears in the Feb. 27 issue of the Journal of Biological Chemistry, indicates that blocking the activity of a structural protein called caveolin-1 stops free radical-induced aging and damage of fibroblasts, a kind of lung cell, in an animal model of emphysema.


Emphysema typically occurs after long periods of cigarette smoking. Toxins in the smoke destroy the walls of the alveoli, the tiny air-filled sacs in lung tissue where oxygen exchange happens, impairing lung function and ultimately leading to death due to respiratory failure.


"It was thought that smoking-induced lung inflammation was the main reason for destruction of alveoli," said senior investigator Ferruccio Galbiati, Ph.D., associate professor of pharmacology and chemical biology at the Pitt School of Medicine. "Our findings indicate that the free radicals or oxidants produced by smoking accelerate the aging of lung fibroblasts, which may contribute to the pathogenesis of emphysema."


Cells cannot replicate forever, he explained. After a certain number of divisions, the cycle stops due to a cellular aging process called senescence. Oxidative stress, meaning increased production of free radicals, can induce that process prematurely.


In Dr. Galbiati's study, normal mice began to show signs of premature aging in lung fibroblasts after six weeks of exposure to cigarette smoke and developed pulmonary emphysema after six months. But premature senescence and emphysema induced by smoke exposure were significantly prevented in mice that lacked the gene to make caveolin-1.


"For our next step, we would like to identify drugs that can reduce the amount of caveolin-1 to see if they affect emphysema development," Dr. Galbiati said. "That way, we might be able to slow down or perhaps prevent some of the lung damage that smoking causes."


The research was supported by a grant from the National Institutes of Health.


The University of Pittsburgh School of Medicine is one of the nation's leading medical schools, renowned for its curriculum that emphasizes both the science and humanity of medicine and its remarkable growth in National Institutes of Health (NIH) grant support, which has more than doubled since 1998. For fiscal year 2007, the University ranked sixth out of more than 3,000 entities receiving NIH support with respect to the research grants awarded to its faculty. As one of the university's six Schools of the Health Sciences, the School of Medicine is the academic partner to the University of Pittsburgh Medical Center (UPMC). Their combined mission is to train tomorrow's health care specialists and biomedical scientists, engage in groundbreaking research that will advance understanding of the causes and treatments of disease and participate in the delivery of outstanding patient care.


University of Pittsburgh Medical Center