Use of Antibiotics Best for COPD Flare-Ups

Patients hospitalized due to chronic obstructive pulmonary disease (COPD) may do better receiving antibiotics without delay, according to a new study published in the Journal of the American Medical Association. Researchers found that patients who were given antibiotics early in their stay were less likely to require mechanical ventilation and less likely to be readmitted to the hospital.

These findings may have implications for routine treatment, which currently utilizes antibiotics only for CPOD patients who have an increase in sputum or purulent (pus-bearing) sputum. They do not mean that all patients will benefit from antibiotics, however, as only about half of COPD exacerbations are thought to be caused by infection.

Researchers are unsure as to which half of COPD patients will benefit from this treatment—those with exacerbations caused by infection, or those without.

According to researchers, exacerbations of COPD are responsible for more than 600,000 hospitalizations each year and result in direct costs of more than $20 billion. The research team studied the outcomes of almost 85,000 patients hospitalized in more than 400 U.S. hospitals over a period of almost two years.

Although 79% of patients received antibiotics for at least two days, the timing of treatment was critical to their outcome. Researchers found that fewer patients whose antibiotic therapy started in the first two days after admission needed to be put on a mechanical ventilator than patients whose treatment started later. In addition, fewer patients who received early treatment saw fatal outcomes or treatment failures. They also saw a lower rate of hospital readmission for acute exacerbations of COPD.

Though further study is needed, researchers expect that all patients requiring hospitalization due to COPD exacerbations will benefit from early administration of antibiotics.

Click Here to Access the Full Story on Health.com

Coping with COPD: Making the Return to Work

When suffering from chronic obstructive pulmonary disorder (COPD), returning to work may be the furthest thing from your mind. Flare ups and other symptoms may make a “normal” life seem almost impossible—but doing so for as long as possible is something you should strive for.

If you have been in the hospital or otherwise unable to work as a result of your COPD, evaluating your overall health and rate of recovery with your doctor is a step that should be taken before your journey back to the workplace. These considerations vary from patient to patient and will determine the timeline in which work can be resumed and the level of work in which you should partake.

Working as long as you are able is a strong coping-technique when suffering from COPD. Work provides a daily routine and time spent away from home can help improve your financial, emotional and physical health. However, if your job requires extensive physical activity, modifications may be required. This may involve retraining or, at worst, filing for disability.

Again, your doctor can help you decide if your job is too strenuous or could negatively affect your lung condition. Workplace environments that should be avoided by people with COPD include inhaled irritants such as gases, fumes and dust, extreme temperatures and work at higher altitudes for those with moderate to severe COPD.

Speaking with your employer is also a good idea, as they will need to be aware that at times you will require rest. This is particularly true for COPD patients with an asthmatic component, since they are more susceptible to having acute attacks while working and will need time to rest and take inhaled medications before returning to work.

By making lifestyle and activity changes, you can take an active role in treating COPD and improving your physical and emotional health. Resuming normal activities, with the go-ahead from your doctor, is a part of this. This should occur gradually, as symptoms improve, and never pushed past your comfort level. Life with COPD varies from patient to patient, and coping is no different.

Beta-blockers Protect Patients with Lung Disease

Beta-blockers, a commonly used blood pressure drug, can protect patients with lung disease, according to a new study published in the Archives of Internal Medicine. Researchers do not yet know why the drug appears to have a protective effect for patients with lung diseases like emphysema, but intend to conduct additional studies to uncover this link.

Previously, doctors avoided using beta-blockers on patients with chronic obstructive pulmonary disease (COPD) because of concerns that the drug may have adverse effects on the lungs. The new study suggests otherwise. Participants taking beta-blockers were 32% less likely to see a fatal outcome and 39% less likely to experience worsening of COPD, even if they were not suffering from any heart problems at the time.

''Our study is the first that clearly gives a hint that beta-blockers could also exert a pulmonary beneficial effect as shown by their reduction of exacerbations," says  researcher Frans Rutten, M.D., PhD, an assistant professor of medicine at the Julius Center for Health Sciences and Primary Care at the University Medical Center Utrecht, Netherlands.

The study examined more than 2,200 men and women, age 45 and older, who were diagnosed with COPD between 1996 and 2008. One group received beta-blockers, while others received different types of cardiovascular drugs, occasionally in combination. During the seven-year follow-up period, 31% saw fatal outcomes and 47.3% experienced at least one episode of worsening COPD.

Because COPD patients are also prone to cardiovascular disease, they often need medications to treat both. However, beta-blockers have often been replaced by more advanced medications.

Rutten says the next step is to compare beta-blockers with a placebo in patients with COPD, both with and without co-existing cardiovascular disease and high blood pressure, to confirm the results.

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Self Management Plan Suggested to Help Control COPD

Following the advice of the Department of Health to involve patients with long term conditions in their health with the use of self management tools, Harrogate and District Foundation Trust respiratory team created an individualized health management plan for chronic obstructive pulmonary disease (COPD) patients.

While consulting with COPD patients, researchers found that many who had been diagnosed with COPD more than five years prior still knew little about their condition and strategies to manage it. By identifying the knowledge gaps of those patients and their providers, the Trust determined the best approach to keep both in the know.

The result is the health management plan, a record that contains information about the patient’s individual respiratory and medical history. It also contains information regarding the aims of COPD care; how the condition affects the lungs; the benefits or keeping physically active; respiratory medicines and individual medication plans; use of oxygen and nebulised therapies; symptoms of exacerbation; and goal setting.

Patients are encouraged to bring the record with them to all consultations with healthcare practitioners so they receive well-informed and consistent care. It is already being widely used throughout the local primary care trust, and physicians and nurses are receiving training on how to use the record.

This was the first nurse led initiative in the local acute trust which determined gaps in patient knowledge and information needs before developing a new service. Click Here to Access the Full Story on NursingTimes.net.

Oral Vaccine said to Reduce Exacerbations in COPD patients

Australian researchers have developed a new oral immunotherapy (HI-164OV) that may help reduce the number and severity of exacerbations in patients with severe chronic obstructive pulmonary disease (COPD) and improve their overall health.

Researchers used Haemophilus influenza, the bacterium that causes meningitis in children, to develop the oral immunotherapy. Its efficacy was then tested on 38 patients with severe COPD in a randomized, multicenter, double blind, placebo-controlled trial.

Acute exacerbations of COPD are in part due to an inappropriate host response to abnormal bacterial colonization. By orally administering HI-164OV to patients with recurrent exacerbations of COPD, researchers found that they can drive a specific T-cell response that down-regulates bronchus inflammation.

Results of the study included a significant reduction in moderate to severe exacerbations (63 percent), mean duration of episode (37 percent), prescribed antibiotics (56 percent), and exacerbations requiring hospitalization (90 percent), with no adverse effects detected.

The abstract of this study was published in the April issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.  Click Here to Access the Abstract from CHEST

FDA Announces Phase-out of Inhalers using CFCs

The U.S. Food and Drug Administration (FDA) has announced that seven asthma and chronic obstructive pulmonary disease (COPD) metered-dose inhalers that use chlorofluorocarbons (CFCs) as propellants are being removed from the market, in compliance with the Montreal Protocol on Substances that Deplete the Ozone Layer.

Two of the targeted inhalers – the Tilade Inhaler and the Alupent Inhalation Aerosol – are among the first to be phased out. In both cases, their last date to be manufactured, sold or dispensed in the U.S. will be June 14.

According to the FDA, a ban on the general use of CFCs in consumer aerosols has been in effect for decades. Production of CFCs in the United States was eliminated altogether, except for certain limited uses which included metered-dose inhalers.

“During this transition, FDA wants to ensure that patients have access to safe and effective alternative medications to treat their asthma or COPD,” said Badrul Chowdhury, M.D., Ph.D., director of the Division of Pulmonary, Allergy, and Rheumatology Products in FDA’s Center for Drug Evaluation and Research. “We are currently working with professional societies and patient organizations to make sure patients understand which products will no longer be available and have information on which alternative medication might work best for them.”

The affected products and their phase-out dates are as follows:

• Tilade Inhaler: June 14, 2010
• Alupent Inhalation Aerosol:  June 14, 2010
• Azmacort Inhalation Aerosol: December 31, 2010
• Intal Inhaler: December 31, 2010
• Aerobid Inhaler System: June 30, 2011
• Combivent Inhalation Aerosol:  December 31, 2013
• Maxair Autohaler: December 31, 2013

Alternative medications that contain hydrofluoroalkanes are available to substitute for the CFC-based products. Patients should consult with their physicians to determine which alternative product or products will work best for them in terms of managing their disease in their current lifestyle. Click Here to Access the Full Story from the FDA.