Archives
Order Sets Help Decrease COPD Hospitalization
According to a recent study published in the Canadian Respiratory Journal, the use of order sets by physicians for the management of chronic obstructive pulmonary disease (COPD) is able to reduce hospitalization time and medication use outcomes. Hospitalization time and frequency continues to be a problem for patients of chronic diseases, specifically those with COPD, whose symptoms can flare from any number of activities.
Not familiar with order sets?
Order sets are a series of checklist recommendations designed to assist physicians in the decision making process about the most appropriate course of care in COPD patients. With COPD acting as the leading cause of hospitalization COPD in Canada, Samir Gupta, lead investigator of the study and a respirologist at St. Michael’s Hospital, was prompted to seek out just how helpful order sets are to lessening hospital admissions for those with worsening COPD.
Gupta believed that “by providing doctors with the best, evidence-based information at the point in time when they are deciding on medications and tests for their patients, doctors’ adherence to best practices [will improve].”
Study researchers “encouraged both physicians and other members of the hospital staff to use the order set, which provided comprehensive admission instructions. The checklist was created by a team from the respirology and internal medicine wards at St. Michael’s, particularly focusing on patients who were admitted to the hospital due to worsening COPD”.
Results indicated that the “length of patients’ average hospital stay decreased approximately two-and-a-half days in cases where physicians used the order sets”. “This is a dramatic drop, and points to one of the key, positive findings in our research,” noted Gupta. “The faster we can get patients home and breathing easier, the better for our patients and for our health-care system.”
Other findings indicated that that more patients were treated with proper antibiotics, leading to “fewer cases of over-treatment and antibiotic resistance, according to the order sets”.
Click Here to Access the Full Study on Canadian Respiratory Journal
COPD Risk Is Higher in Poor and Rural Communities
According to a new study released by the Johns Hopkins University School of Medicine in Baltimore, Maryland, the chance of having chronic obstructive pulmonary disease (COPD) is almost 12 percent higher if you live in a poor or rural community than if you live in a more urban or community-centric area. But why is this?
As the third leading cause of death in the United States, COPD makes even the most normal daily activities a struggle as those who suffer from the disease have trouble breathing and catching their breath. Researchers used data from the National Health Interview Survey, the U.S. Census, and the National Center for Health Statistics Urban-Rural Classification Scheme to study 87,701 participants. The participants self-reported to emphysema, chronic bronchitis and/or formally diagnosed COPD.
The goal of the study was to “identify the prevalence of COPD in urban and rural areas in the U.S. and determine how residence, region, poverty, race and ethnicity and other factors influence COPD rate.” The findings of the study indicated that biomass fuels (biomass is biological material derived from living, or recently living, organisms), found in predominantly rural areas played a role in the higher number of self-reported COPD cases.
The results also suggest that public advocacy, which appeared to be lacking in many rural communities, was also associated with a higher cessation rate.
Research Shows E-Cigarette Vapor Could Lead to Emphysema
Central Michigan University (CMU)researchers have found that inhaling the vapor of electronic cigarettes could lead to emphysema and even minimal exposure (as little as an hour) to the vapor created harmful changes to human bronchial epithelial cells that were used during testing.
E-cigarette companies tout these battery operated devices as a safe alternative to traditional cigarettes with claims that the devices are “tar- and tobacco-free”, but the nicotine and other chemicals that become an aerosol or vapor disrupt the protein processes in bronchial cells, gradually damaging alveoli.
Because the vapor takes the same path cigarette smoke and second-hand smoke takes in our bodies, people are just as likely to develop complications in breathing due to alveoli damage as those who smoke traditional cigarettes.
"What we are talking about is how these proteins are made and how they are degraded. This process of proteostasis in our cells has to be very — in layman's terms — tightly regulated, because if it goes off-balance, it's a big problem,” said Neeraj Vij, associate professor of molecular and cell biology, CMU.
Additionally, a recent report published in the New York Times found that “e-cigarette use among middle- and high-school students tripled from 2013 to 2014, and e-cigarettes are now more popular among high-school students than traditional cigarettes.” Study results, such as CMU’s, are timely and necessary as it becomes critical that teens and adults alike are properly informed about the hazards and risks associated with these devices.
Regenerative Medicine Breakthrough Pushes COPD Treatment Forward, Marks Win For Method
Scientists are moving beyond stem cells to research the ability of fully mature lung cells in the hope that they will help repair tissue damage in patients with conditions such as chronic obstructive pulmonary disease (COPD). In the study, currently published in Nature Communications, for the first time ever, the team observed the type 1 cells give rise to type 2 cells over about three weeks in various models of regeneration.
To elaborate on types of lung cells and the role they play, there are two main types - Type 1 cells, which is where oxygen and carbon dioxide are exchanged during breathing, and type 2, which secrete surfactants, a type of lubricant integral to the breathing process.
Researcher and University of Pennsylvania cardiologist Rajan Jain noted that new cells were observed growing back into new areas of the lung. “It's as if the lung knows it has to grow back and can call into action some type 1 cells to help in that process," According to Dr. Jon Eptein, also of the University of Pennsylvania, said the “observation suggested that there is much more flexibility in the pulmonary system than previously believed.”
So what does this mean for COPD patients?
If this research proves accurate and consistent, the ability to regrow damaged lung tissue on demand could completely change treatment options for COPD patients. Physicians could focus less on trying to specialize stem cells and could essentially force mature lung cells to revert back to a stem, specializing themselves.
Female Smokers More Susceptible to Emphysema
Due to a gene mutation called telomerase reverse transcriptase (TERT), researchers from Johns Hopkins Kimmel Cancer Center have found that females may be more susceptible to emphysema than men.
According to research published in the Journal of Clinical Investigation, of the 292 smokers studied for the mutation, “3 participants were identified to have the telomerase reverse transcriptase (TERT) gene mutation”. The mutation reduces the life of telomeres, which have the ability to repair the ends of chromosomes from degradation during cell division. This reduction results in telomere life shortening and higher risk for emphysema in those with the mutation.
To compare, the researchers also studied 50 Johns Hopkins patients who displayed symptoms of telomere shortening. Their findings indicated that of the “39 nonsmokers in that group, there were no cases of emphysema. There were 11 patients who were nonsmokers, including 6 females – all 6 females and one other patient all had emphysema. The researchers believe this suggests that female smokers with telomerase related mutations might be more susceptible to emphysema”.
“If we know that they have a telomerase mutation, it may help us take care of them in a more sophisticated way and delay the onset of those diseases” said study leader Mary Armanios, MD. Armanios also noted that a genetic history of lung diseases may also be a factor, along with age, and those women with any or all of these symptoms may be likely to have the mutation.
Identifying Which Smartphone App Features Aid Smoking Cessation
Smoking has been associated with the deaths of nearly six million people worldwide each year. So it’s no wonder there are over 400 smartphone applications, or apps, available to help people quit smoking. But which ones really work? And why?
Over 780,000 smoking cessation apps are downloaded per month, however, very little research has been done to research whether these apps really help people quit or not, until now.
Dr. Jaimee Heffner, PhD, and Dr. Jonathan Bricker, PhD, along with colleagues in the Public Health Sciences Division at the Fred Hutchinson Cancer Research Center evaluated the effectiveness of certain smartphone app techniques by tracking usage of 41 different app features, and then comparing this use against whether users successfully quit smoking. The team hopes this research will help increase the effectiveness of their recently piloted app “SmartQuit”.
“By studying how users engage with specific app features and whether use of these features predicts successful smoking cessation," said lead author Dr. Heffner, "we are identifying the basic building blocks needed to create effective interventions on the smartphone app platform, which reaches millions of smokers each year and has the potential to transform treatment delivery."
To the researchers’ surprise, “only 2 of the top 10 most-used features were prospectively associated with 30 days abstinence at the 60 day follow-up: viewing the quit plan and tracking the practice of letting urges pass.”
By updating and continually evaluating the effectiveness of cessation apps, researchers can more accurately predict which features will be most likely to help people quit smoking. The team adds that additional future work will allow for future experimentation of the causal relationships between feature usage and smoking cessation. "This would provide the most accurate and rigorous test of the each feature’s contribution to successful quitting,” said Dr. Heffner.
CDC Finds Nearly Half of Older Adults with Asthma, COPD Still Smoke
Although chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States, close to half of adults over 40 who have been diagnosed with asthma or COPD still continue to smoke – a leading cause of the disease – according to federal health officials. The findings highlight the difficulty in quitting smoking even for those whose condition is exacerbated by the habit.
The statistics released by the Centers for Disease Control and Prevention (CDC) used data from the U.S. National Health and Nutrition Survey for the years 2007-2012, which found “46 percent of adults aged 40 to 79 who had a lung-obstructing illness currently smoked. That number rose to 55 percent when the researchers looked only at cases involving ‘moderate or worse’ disease”. The researchers also noted that “rates of smoking for people with lung obstruction were more than double that of people without such illnesses -- about 20 percent.”
So why would people with an illness predominately caused and made worse by smoking continue to engage in the habit?
Researchers concluded that depression and anxiety, which is associated with about 40 percent of COPD patients, make it difficult to comply with necessary steps for quitting smoking.
Patricia Folan, director of the Center for Tobacco Control at North Shore-LIJ Health System in Great Neck, N.Y. suggests treating the depression before attempting to treat the habit. Folan added, “empathetic counseling, motivational interviewing, and ongoing support from professionals, family and friends” are other ways to help to treat and encourage quitting smoking, lessening exacerbations.
Click here to access the full story at U.S. News and World Report
Researchers Find New COPD Therapy Device Makes Breathing Easier
Millions of people suffering from chronic obstructive pulmonary disease (COPD) now have renewed hope, thanks to a new device that is demonstrated to improve breathlessness. The device, which moves mucous up and out of the lungs, promises to better a patient's quality of life while avoiding the use of prescription drugs during treatment.
The Aerobika Oscillating Positive Expiratory Pressure (OPEP) Therapy System recently won Gold at the Medical Design Excellence Awards, which recognizes cutting-edge innovations that are saving lives; improving patient healthcare; and transforming medical technology worldwide, with its ability to create airway clearance by engaging the cilia through oscillation generated by breathing into the device which aids in moving the mucous out of the airways. Treatments last from 10-20 minutes up to four times a day, depending on severity of symptoms.
“The overall goal of the device is to ensure the patients can maintain their treatments to control their symptoms, breathe easier, enjoy a better quality of life and ultimately, stay out of the hospital,” said Mitch Baran, CEO, Trudell.
The OPEP Therapy System was created by Trudell Medical International and tested by Dr. David McCormack and Grace Parraga from Western's Schulich School of Medicine & Dentistry and their team at Robarts Research Institute.
Video demonstration of the device can be seen here.
Treating COPD in the Elderly
The treatment of seniors (age 66 and older) who have both asthma and disease (COPD) has become increasingly difficult, as their younger counterparts are thought to experience less lung inflammation when receiving the same treatment. Thus, a study was undertaken to determine which medications work best for older adults with COPD.
Published in The Journal of American Medical Association, the study states that “knowing which prescription medications are the most effective in improving health outcomes for people with COPD is essential to maximizing health outcomes.”
It was determined that a combined treatment of long-acting beta agonists and inhaled corticosteroids is most effective treatment of COPD. Among seniors specifically, there were 8 percent fewer deaths and hospitalizations during the length of the study among those taking both medications. Even more striking was the 16 percent decrease in deaths and hospitalizations for those seniors with comorbidity who took only the long-acting beta agonists.
By singling out seniors aged 66 and older, researchers are able to emphasize the significance and potentially life-saving importance of personalized COPD treatment.
Diabetes More Prevalent in COPD Patients Without Emphysema
In a new study published in BMC Pulmonary Medicine, researchers aimed to determine the frequency of diabetes in those patients diagnosed with chronic obstructive pulmonary disease (COPD). The study, which consisted of 4,197 participants, found that those defined as non-emphysematous (without the symptoms of emphysema) had an increased prevalence of diabetes.
The method of the study “aimed to create a simplified distinction between emphysema-predominant and presumed airway-predominant COPD based on the presence or absence of emphysema on chest CT scan.” Based on this, researchers used two groups of participants, non-emphysematous and emphysema-predominant, to determine the prevalence of diabetes.
Although they were unable to determine the on-set of diabetes in the non-emphysematous participants, researchers were able to determine the prevalence of diabetes based on previous studies conducted, comprised of participant self-reporting.
Study authors suggest that “COPD patients without emphysema may warrant closer monitoring for diabetes, hypertension, and hyperlipidemia and vice versa.”
