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People with Severe Emphysema May Breathe Better after EBV Therapy, Study Shows

A trial published in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine reveals that a minimally invasive procedure may help patients with severe emphysema breathe better.

The study analyzes the use of a one-way valve that prevents air from entering diseased regions of the lung. This, in turn, enhances lung function and enables healthier areas of the lungs to expand.

sept2017image012Previous studies highlighting the placement of the valves using a bronchoscope found that this therapy can be used as an alternative to lung volume reduction surgery. Patients with severe emphysema that participate in endobronchial valve (EBV) therapy “appear to experience similar improvements in lung function, shortness of breath, exercise intolerance and quality of life,” yet do not experience the occurrences of morbidity and mortality which have been associated with surgery.

"EBVs have been shown to work in single center trials, but these studies tend to be performed at centers, and by physicians, with considerable experience, so the results may not be generalizable to other centers," said lead study author Samuel V. Kemp, MD, a respiratory physician and expert in interventional bronchoscopy at Royal Brompton Hospital. "What is interesting about this multicenter trial is that the results are at least as good as the single center studies, even though some of the investigators were new to the technique."

All study participants were ex-smokers over the age of 40 and had been diagnosed with severe heterogeneous emphysema. Out of the 97 participants, sixty-five received the valves and the remaining patients were provided with standard of care specific to each medical center's protocols for a patient that had received bronchoscopy.

Researchers discovered:

  • After three months, 55.4 percent of the EBV group had a 12 percent improvement in FEV1, the amount of air that can be forcefully exhaled in one second, compared to 6.5 percent of controls.
  • After six months, the percentage of those in the EBV group meeting the minimum FEV1 improvement was 56.3 percent, compared to 3.2 percent of controls.
  • The average increase in FEV1 in the EBV group was nearly 30 percent.
  • After six months, secondary endpoints among those in the EBV group were also clinically and statistically significant, including being able to walk nearly 80 meters longer in six minutes, retaining 750 fewer milliliters of air upon maximum expiratory effort, exhibiting less shortness of breath and reporting higher quality of life.
  • The most common adverse event in the EBV group was a collapsed lung, which occurred in 29.2 percent of the patients.

Click Here to Access the Full Article on News-Medical.net

Bariatric Surgery in Obese COPD Patients Lowers Risk of Hospitalization, Study Finds

According to a recent study in the journal Chest, titled, “Reduced Risk of Acute Exacerbation of COPD After Bariatric Surgery: A Self-Controlled Case Series Study,” the risk of hospitalizations and emergency room (ER) visits caused by acute exacerbations related to chronic obstructive pulmonary disease (COPD) decreases among obese patients who underwent bariatric surgery.

Nearly 6 percent of adults in the United States have COPD, 35 percent of whom are considered obese. According to studies, obesity may be a risk factor as it results in higher rates of acute exacerbations.

Researchers found that patients with COPD who lost weight realized enhanced outcomes, such as clinical scores and exercise tolerance. Yet, there are few statistics available regarding the impact weight reduction can have on additional issues associated with COPD, including acute exacerbations.

The study, conducted by researchers at Massachusetts General Hospital, analyzed 481 obese patients who were diagnosed with COPD and had undergone bariatric surgery between the years 2005 and 2011. The analysis studied each patient’s risk of acute exacerbations in COPD (AECOPD) that resulted in ER visits and hospitalizations over a two-year period, which was “compared to the patient’s risk in the pre-surgery period.”

sept2017image004.jpgIt was discovered that 28 percent of obese COPD patients were hospitalized or visited the ER due to AECOPD 13 to 24 months before their bariatric surgery. However, within 12 months of post-bariatric surgery, only 12 percent of patients were at risk of being hospitalized or visiting the ER.

Although the “mechanism behind weight loss and a decreased risk of AECOPD” has yet to be discovered, researchers suggest that weight loss may reverse the correlation between obesity and COPD. Lung function can be impaired due to obesity as it can alter gut bacteria and lung operations, create systemic inflammation caused by proinflammatory mediators, and increase the risk of infections and additional conditions.

It has been concluded that bariatric surgery among obese COPD patients can “reduce proinflammatory levels and decrease the incidence of obesity-related health problems”, and ultimately lower the risk of AECOPD, hospitalizations and ER visits.

Click Here to Access the Full Article on COPD News Today

Tips for Avoiding Pneumonia and Other Exacerbations When You Have COPD

Various complications can arise when an individual has chronic obstructive pulmonary disease (COPD), including increased susceptibility to lung infections such as pneumonia.

Defining Pneumonia

Pneumonia is the eighth leading cause of death in the United States and most common among individuals over the age of 65, smokers, young children and those with lung conditions including COPD. The infection can present in one or both lungs and often results from the prevalence of bacteria or viruses. Although rare, the infection can develop when certain fungi are directly touched or breathed in. Further, pneumonia can occur as a result of another illness “such as flu, measles, pneumococcus, whooping cough and Haemophilus influenzae type b (Hib).”

images/sept2017image002Pneumonia Symptoms

It is vital to contact your healthcare team if you are experiencing the following symptoms, as signs of pneumonia “can often be mistaken for a COPD exacerbation.”

  • Fever or shaking chills
  • Rapid breathing or shortness of breath more severe than usual
  • Excess coughing producing lots of mucus
  • Change in color of mucus
  • Increased heart rate
  • Pain in a specific area or areas of the chest when breathing deeply
  • Nausea or vomiting
  • Diarrhea

Although it remains essential to recognize the signs of pneumonia and other exacerbations and receive timely care, the COPD Foundation recommends taking preventative steps to reduce the risk of infections.

These include attending regular appointments with your healthcare team, washing your hands, quitting smoking and receiving annual flu and pneumonia vaccinations. Additional preventative steps individuals can take are refraining from touching their eyes, nose and mouth, avoiding large crowds throughout flu and cold season, eating a balanced diet and carrying writing implements instead of using another individual’s.

Click Here to Access the Full Article on COPD News Today

COPD Self-Care Appears to Improve with Social Support

According to the recent study, “Association between Social Support and Self-Care Behaviors in Adults with Chronic Pulmonary Disease,” published in the Annals of the American Thoracic Society, individuals with COPD who live with others and have a caregiver have a higher rate of participating in pulmonary rehabilitation and being active.

The study focused on 282 patients with COPD to determine if the prevalence of social support impacts the decision to participate in healthy behaviors.

"Patient engagement in self-care is the crux of COPD management," said senior study author Huong Q. Nguyen, PhD, RN, a research scientist at Kaiser Permanente Southern California and an affiliate associate professor at the University of Washington. "Our goal with this study was to identify factors associated with self-care activities, including physical activity, quitting smoking, participating in a pulmonary rehabilitation program, adherence to medications, and getting influenza and pneumococcal vaccinations."

aug2017008Researchers recruited participants from two Veterans Administration hospitals, as well as two academic medical center who had been diagnosed with moderate to severe COPD. The study focused on the correlation between healthy behaviors and two social supports: “structural, the type of social network a person has such as being married or living with a partner or caregiver, and functional, the support a person perceives his/her social network provides.”

Based upon the findings, researchers discovered that participants who lived with other individuals reported having enhanced functional support. The higher their functional support was, the higher likelihood that they had a pneumococcal vaccination and were less inclined to smoke. Further, participants that lived with someone took more than 900 steps more than those who lived alone. Participants with a spouse, partner or caregiver were also 11 times more likely to receive pulmonary rehabilitation.

“Clinicians should assess whether their patients have the necessary social support to do all they can do to remain healthy, “said Nguyen. “When social support is lacking, the health care team should assist patients in marshalling social support. Similarly, health and social policies should acknowledge and consider ways to support the nearly 45 million unpaid family caregivers in the United States who are responsible for the vast majority of the day-to-day care of their loved ones."

Click Here to Access the Full Article on ScienceDaily

Stem Cells Offer New Solutions for Lung Disease

As the fourth leading cause of death, projected to be the third by 2020, chronic obstructive pulmonary disease (COPD) is a major and growing health concern. In fact, COPD impacts more than 5% of the population in most countries, with a $600 billion financial toll. The disease causesexaggerated chronic inflammatory response leading to airway irregularities. As lung function declines, patients will begin to experiencesymptoms of the disease progression such as increase of cough, shortness of breath and mucus production. Additional indicators of COPD include extra-pulmonary complications including cardiovascular disease and depression.

There is no current cure for the disease, yet recent studies suggest that adult stem cells may have the ability to reverse the effects of diseases involving inflammatory or degenerative parts, like COPD. The primary function of adult stem cells is to heal and maintain the health of the tissues they are found in. Existing throughout the body, stem cells can renew themselves through cell division, as well as differentiate into specialized cell types. They can also be harvested from an individual’s own tissues, with the most plentiful source found in adipose (fat) tissue. “In fact, approximately 500 times more stem cells can be obtained from fat than bone marrow.”

aug2017004Stromal vascular fraction (SVF), a mixed population of cells containing most cellular elements of fat, can be isolated and obtained from fat tissue in 30-90 minutes in an out-patient clinic setting. This process can be completed using a mini-lipoaspirate technique, in which “tens to hundreds of millions of adipose-derived stem cells (ADSCs) can be obtained.” After the procedure and preparation of ADSC, patients can be provided with either an infusion or injection.

After having been exposed to stem cell therapy, many COPD patients are often willing “to receive additional cell infusions if possible, due to a feeling of well-being associated with the injection.” Previous studies have also shown that intravenous infusion of these cultured adipose stem cells can significantly improve smoke exposure-induced emphysema onset and progression.

Utilizing stem cells for regenerative purposes shows limitless potential. Patients now have access to innovate treatments that are compliant, effective and, importantly, safe. The research group involved with the studies have successfully and safely treated more than 7,000 patients. Stem cell treatments have increasing potential to become the optimal form of care concerning most degenerative diseases to truly enhance outcomes and quality of life for millions of individuals around the globe.

 

Click Here to Access the Full Article on Miami’s Community Newspapers

How Can Pharmacists Improve Flu Vaccination Rates in Patients with COPD?

Although individuals living with chronic obstructive pulmonary disease (COPD) have a significantly higher risk of morbidity and mortality if they acquire influenza, most do not receive the annual influenza vaccination. To improve vaccination rates among this group, pharmacists must prioritize the promotion of the flu vaccination by maintaining an awareness of the characteristics present in those who generally do not receive vaccinations. 

aug2017002Despite best attempts of Healthy People 2010 to achieve a 60% coverage rate for high-risk adults, less than 40% of individuals with COPD were vaccinated. Although Healthy People 2020’s goal has increased to 90% coverage, “vaccination rates among these patients rarely exceed 50%.” Concerning is the fact that unvaccinated patients with COPD have substantially higher risks of experiencing “exacerbations, greater pulmonary function impairment, reduced quality of life, and economic burden if they develop the flu.”

Researchers from the University of New Mexico have recently published a study, which appeared in the journal titled, “Research in Social and Administrative Pharmacy.” The study analyzed COPD patients who responded to the 2012 Behavioral Risk Factor Surveillance System in order to determine influenza vaccination rates. This data was then used “to identify predisposing, enabling, and need factors that influence the decision to be vaccinated.”

The findings revealed that 53% of respondents had been vaccinated. Data also suggested that the older the individual, the more likely they were to have been vaccinated. Patients who were never married had a significantly lower likelihood of being vaccinated in comparison to those who were married, divorced, widowed or separated. Additionally, participants who were current smokers or who had not seen a healthcare provider for a checkup in a year or more were also less likely to be vaccinated.

It was also discovered that unemployed individuals, as well as those who received care from a primary physician or were insured also had a higher likelihood of vaccination. Increased rates were associated with the prevalence “of a pharmacist immunizer on the staff of centers that serve the medically underserved.”

Although certain individuals may be less likely to receive the flu vaccination, sometimes a simple encouragement can make all the difference. Pharmacists can make an impact by screening for patients with COPD, determining which factors they may have that are associated poor vaccination rates, and providing encouragement to patients who are less likely to receive the vaccination.

Click Here to Access the Full Article on Pharmacy Times

9 Tips to Lower Your Risk of Lung Disease

Second only to heart disease, lung disease remains one of the leading causes of death in the United States. Although various lung diseases stem from genetics, many of them can be avoided by adhering to a “healthy lifestyle and avoiding lung irritants.” Adhere to the following tips to lower your risk of developing a lung disease.

june2017_006Choose a Healthy Diet and Consider Vaccines
Healthy foods might not heal lung damage, but a balanced diet will enhance your overall health and wellbeing and help to lower the risk of lung disease. It may also be helpful to receive an annual flue or pneumonia vaccination, particularly “if you have compromised health”.

Stop Smoking
The most effective way to prevent lung disease is to quit smoking. Although this might present challenges to heavy smokers, it is a feasible goal that will improve your overall health. In addition to cigarette smoke, marijuana, pipe and cigar smoke are also harmful. Avoiding secondhand smoke and smoky atmospheres is also equally as important.

Test for Radon
Radon, a radioactive gas, can exist in “homes and public buildings, particularly in small areas and in basements.” Invest in a radon testing kit, which can be purchased from your local hardware store. If positive results for radon are found, it is essential to ensure the building is appropriately ventilated and all cracks where the gas could flow through are sealed.

Avoid Asbestos
Being exposed to asbestos can have serious ramification on your lung health. Those working in certain construction-related industries can have a higher risk of being exposed and should regularly receive health and safety training. It is also vital to have your home inspected for asbestos as “asbestos is still contained in many public and private buildings”.

Stay Away from Dust and Chemical Fumes
Common household spray cans, such as hair spray, air fresheners and house paints, “can irritate lungs so use them sparingly in well-ventilated areas.” Also avoid dust inhalation by wearing a face mask.

Receive a Spirometry Test
In the case that you might feel your lungs may be compromised or you have “an increased risk of developing a lung disease due to your work history or lifestyle choices,” schedule an annual spirometry test. This can help to detect potential problems before they cause serious damage.

Contact Your Physician
Chronic cough that persists after several weeks could signify a medical issue with your lungs. It is vital that you schedule an appointment with your doctor to determine the cause. Additionally, it is essential to contact a medical provider if you are experiencing shortness of breath or chest pains.

Click Here to Access the Full Article on Bronchiectasis News Today

What to Know If You’ve Just Been Diagnosed With COPD

Learning to navigate through life after being diagnosed with chronic obstructive pulmonary disease (COPD) can be a challenging endeavor. In addition to the help that your healthcare team can provide, such as prescribing medications and enrolling you in pulmonary rehabilitation, there are also steps you can take to alleviate exacerbations and enhance your quality of life.

The British Lung Foundation highlights best practices you can leverage to avoid COPD symptoms.

june2017_004Stop Smoking
Smoking cessation is the “most important thing you can do to slow the progression of your COPD”. Quitting smoking is also an impactful way to improve your overall health and wellness. If you are finding it difficult to quit, take advantage of the resources your physician can offer to help you achieve success.

Learn Breathing Techniques
If you are experiencing difficulty breathing, incorporate breathing control techniques to “help ease through” these instances. These exercises include relaxing your shoulders and arms, as well as finding a more comfortable position. Your healthcare team, such as your physiotherapist or nurse, can demonstrate these techniques so you can gain a more thorough understanding.

Start Exercising
Incorporating gentle exercise into your daily routine can significantly improve your state of wellbeing. To begin building your strength and stamina, start with gentle walking for approximately 20 minutes per day. Pulmonary rehabilitation can provide additional support to “devise an exercise regimen that’s right for you.” 

Keep a Healthy Body Weight
Whether you weigh too little or too much, body weight plays a significant role in impacting COPD symptoms. To ensure you reach and maintain a healthy body weight, contact your physician or nutritionist, to create a supportive diet that’s conducive to you.

Choose Nutritious Foods
Eating “a healthy, balanced diet” containing whole foods is essential. Incorporate plenty of fruits, vegetables and fiber into your daily meals. Ensure that you are also eliminating “processed foods and foods which are high in saturated fat, salt and sugar.” Also remember to adhere to recommended water intake levels each day to ensure you avoid dehydration.

Have a Plan
Don’t wait until it’s too late. In the case that you experience a flare-up or exacerbation, it’s highly beneficial “to have a plan in place so that you and your family know what to do.” Reserve time to speak with your healthcare team and loved ones about your options.

Click Here to Access the Full Article on COPD News Today

Study Reveals How HIV Virus Destroys Lung Tissue

A recent study published in Cell Reports exposes the damage human immunodeficiency virus (HIV) has on lung tissue. Weill Cornell Medicine researchers discovered a mechanism that could explain why nearly “30 percent of HIV patients who are appropriately treated with antiretroviral therapies” are later diagnosed with emphysema. Further, the study reveals how HIV binds to and transforms basal cells lining airways. These altered cells then release enzymes that can “destroy lung tissue and poke holes in walls of air sacs.”

june2017_002“This research is important because although antiretroviral agents have turned HIV into a chronic, rather than deadly, disease, the viral reservoirs that remain in the lungs and other tissue continue to cause serious side effects,” said senior author Dr. Ronald Crystal, chairman of the Department of Genetic Medicine and the Bruce Webster Professor of Internal Medicine at Weill Cornell Medicine, and a pulmonologist at New York-Presbyterian/Weill Cornell Medical Center. “Now that we have more information about how the HIV virus might cause emphysema, we can learn more about this potential enzyme target and work toward developing a therapy to prevent this lung damage from happening.”

Although antiretroviral agents have helped to extend the lives of HIV-positive patients, they develop “degenerative disorders of the brain, heart and lungs” significantly more often than the general population. There are various explanations for this occurrence, including the belief that the antiretroviral drugs may in fact lead to these outcomes.

To gain insight, researchers exposed normal human airways basal cells, acquired from the lungs of nonsmokers, to HIV. Under observation, it was discovered that the virus “bonded to the basal cell’s surface and reprogrammed them to start producing an enzyme.” This enzyme then began to deteriorate proteins as well as destroy tissues. This finding is significant as emphysema originates in the airways, when basal cells are transformed due to the virus they begin to destroy healthy lung tissue which ultimately leads to emphysema.

“Our next step is to conduct additional research to determine what the preventive therapeutic target might be,” Crystal said, “And then, since basal cells are so important to normal lung anatomy and lung function, determine the other side effects of this re-programming.”

Click Here to Access the Full Article on Cornell

Using Apps to Persuade People with COPD to Increase Physical Activity

A study published in Journal of Medical Internet Research provides insight into how technology-based interventions could increase daily walking levels of people with COPD after they complete pulmonary rehabilitation to help them “experience a higher quality of life and fewer acute exacerbations. Researchers developed and implemented three prototype applications based on various persuasive technology design principles including “dialogue support, primary task support, and social support.”

“Our aim was to inform the choice of design principles and specific persuasive techniques in the design of an app that could be used to encourage physical activity in this population,” the researchers wrote.

may2017image004The first prototype utilized dialogue support, along with a virtual coach that addressed the user by their name and instructed them through their goals. Users had the option to receive reminders and “audio encouragement while walking.” The application also “provided a suggested exercise plan with daily goals.”

The second prototype was based upon a primary task support approach. This approach enabled users to set goals and track activity on their mobile device. While engaging in exercise, users were “offered feedback with activity levels for each day.” In addition, the prototype allowed for users to pick their preferred music and highlighted “local exercise facilities on a map.”

The third prototype incorporated the social support approach to “build a community of similar users to support physical activity.” Participants could compete and collaborate with other users, as well as share tracked activity. The application also, “awarded points when users achieved their goals with the potential for both virtual and real-world rewards.”

The study found that out of all three prototypes, the first was the most persuasive and most likely to be used. The second prototype was deemed the most likely application to encourage, “participants to use a technology.” The third prototype was reported to be the least persuasive and inappropriate as the competitive component could “dishearten users.”

Highly ranked features included “features of tips and advice on performing activity,” as well as the ability to set customized goals and view graphed levels of activity. The lowest ranked features included the identification of local sporting facilities, achieving trophies based on the completion of goals and the display of points earned by other participants.

“The findings suggest that a system that supports dialogue between the user and the technology alongside supporting the primary task (here, walking) to promote the self-regulation of physical activity is likely to be acceptable to [people with COPD] and perceived as persuasive,” the researchers wrote.

Click Here to Access the Full Article on The American Journal of Managed Care

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