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Asthma vs. COPD
Often times the signs and symptoms of asthma are confused with the symptoms of chronic obstructive pulmonary disease (COPD) by both the patient and physician; however the two are different and require different treatments.
A recent presentation at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting showed that “as many as 50 percent of older adults with obstructive airway disease have overlapping characteristics of asthma and COPD. And this percentage increases as people get older.”
Why is this?
Presenters determined that while the symptoms can be difficult to differentiate, the pathway to those symptoms is critical during the diagnosis stage. According to presenters, measurement of lung function, age of the patient, and smoking history are all good places to start when determining differences between asthma and COPD patients.
If a patient has already been diagnosed with one or the other and is not experiencing any symptom change, presenters recommend looking at the treatment the patient is receiving as they may have been misdiagnosed. This misdiagnoses and treatment can often lead to increased risk for exacerbations of both asthma and COPD.
"The primary treatment in COPD is bronchodilators. They help relax muscles around the airways in the lungs, allowing air to flow more freely," said allergist Michael Foggs, MD, ACAAI president. "They should not be given alone to people with asthma.”
Instead, asthma patients best respond to inhaled corticosteroids, however the use of inhaled corticosteroids in COPD patients has been associated with an “increased risk for pneumonia.”
Each patient’s signs and symptoms should be treated on a case-by-case basis, as personal triggers vary, but sharing all symptoms and medical history will help allergists to determine a correct diagnoses and treatment option.
"Lung Flute" Helps COPD Patients Breathe Easier
University of Buffalo (UB) researchers have created a device aimed at helping alleviate airflow restriction in patients diagnosed with chronic obstructive pulmonary disease (COPD) and chronic bronchitis. The device, when used over a period of six months, aims to clear mucus that can restrict airflow to the lungs, making it increasingly difficult to breathe.
During a trial study, 69 participants were instructed to blow twice into the Lung Flute “vigorously enough to make the reed oscillate, followed by 5 normal breaths. This was repeated 10 times, followed by 3 huff coughs to complete 1 cycle. Two such cycles were recommended twice a day.”
The goal, as described in a UB press release, was to use acoustic waves created by the device to loosen mucus within the lungs allowing for increased airflow.
The 26-week study “confirms that the Lung Flute improves symptoms and health status in COPD patients, decreasing the impact of the disease on patients and improving their quality of life,” said Sanjay Sethi, MD, principal author of the study and chief of the division of pulmonary, critical care, and sleep medicine in the Department of Medicine at the UB School of Medicine and Biomedical Sciences.
The positive results of this study are helping researchers to gain ground and credibility for treatments outside of medication and inhaled glucocorticoids. Medical Acoustics, the company enlisted to create the Lung Flute, plans to market the device, which recently received FDA clearance, through collaborations with the University of Buffalo team of researchers.
Click Here to Access Full Study from Clinical and Translational Medicine
COPD: Is Stepping Down Therapy Safe?
The results of a recent trial, published in The New England Journal of Medicine,that studied the gradual withdrawal of inhaled glucocorticoids and exacerbations of chronic obstructive pulmonary disease (COPD) found that there was a “significant decrease in lung function with completion of glucocorticoid withdrawal at week 18, which persisted to the end of the 12-month trial.”
The trial included 2,485 patients with a history of frequent COPD exacerbations on tiotropium (Spiriva), salmeterol (Serevent), and fluticasone for an initial 6-week period. Patients were randomly assigned to continued triple therapy or withdrawal of fluticasone over a 12-week period.
Those who continued withdrawal to week 18 saw a “greater decrease in lung function.” The results of those who continued triple therapy were “not clinically meaningful,” meaning the changes in exacerbations were not significant enough to count against the final results.
In an accompanying editorial, John J. Reilly, MD, University of Pittsburgh Pulmonary Division, concluded that "the results of this trial, taken together with the findings of other studies, suggest that the rationale for continuing glucocorticoid therapy in patients who are also taking long-acting bronchodilators should be based on symptomatic improvement attributable to the glucocorticoid rather on the prevention of exacerbations."
New Role for Medical Practitioners: COPD Patient Motivational Intervention
Patients with chronic obstructive pulmonary disease (COPD) often also suffer from psychosocial co-morbidity, the combination of multiple medical conditions at one time that affects the mental state. It’s a combination that makes it more difficult for patients to find motivation to engage in physical activities.
A study published in the October issue of BMC Family Practicehighlights the positive effects and “enduring motivational benefits” of psychological motivational intervention by liaison health workers (LHWs) to address the psychosocial needs of COPD patients. Because it requires long-term care and attention, COPD represents a serious challenge to health public services. Clinicians and providers are not available as long-term caregivers, leaving many patients to rely on self-management of the condition.
The study, described as a “short-term intervention”, involved 29 COPD patients and used 13 LHWs to assess the behavioral activation, cognitive restructuring and medication management of patients using liaison skills to adjust patient behavior to improve self-management.
The LHWs reported seeing a “positive impact on work targeting patients’ psychosocial requirements.” Based on these findings study authors suggest that “LHWs practices should be adopted to induce motivational changes in patients with COPD and other long-term conditions.”
Chronic Bronchitis, Pneumonia and Emphysema Associated with Lung Cancer Risk
In August, the American Journal of Respiratory and Critical Care Medicine released its findings that three common respiratory diseases--bronchitis, pneumonia and emphysema--are all linked to increased risk for developing lung cancer.
Based on findings of seven studies that included more than 25,000 people, researchers and investigators found that “people who had all three - chronic bronchitis, emphysema and pneumonia - had a higher risk of lung cancer than those with chronic bronchitis only.” The research also revealed that “there was no increased risk of lung cancer among those who had chronic bronchitis along with asthma or tuberculosis.”
Study author Ann Olsson, of the International Agency for Research in Cancer in Lyon, France, said the reason respiratory illnesses may affect lung cancer risk in different ways could have to do with underlying disease mechanisms. She also insisted that while the study did not show any cause and effect relationships, “having a better understanding of the links between respiratory ailments and lung cancer may help inform doctors on how best to monitor and help patients.”
The ABCs of COPD
Chronic obstructive pulmonary disease (COPD) has the job of acting as a catch-all term for bronchitis, emphysema and in some cases, chronic asthma, of which are all directly associated with airflow obstruction. While there is no cure for COPD, the goal is to slow the progression of the disease as much as possible to maintain quality of life and keep patients from getting worse.
Listed as the third leading cause of death in the United States, researchers and professionals have created an acronym to help COPD sufferers remember what factors affect their symptoms and quality of life.
“C” Is for Cigarettes
Millions of Americans live with the symptoms of COPD and may not even know they have it. However, for the more than 15 million Americans already diagnosed, it is important to know and understand the effects that smoking has on the body.
More than 80 percent of COPD patients are current or former smokers. While not all patients fall into this category, smoking is directly associated with increased exacerbations and a higher frequency for complications during treatment.
“O” is for Oxygen
As previously mentioned, COPD directly affects the airflow to the lungs, making it very difficult to breathe. While many COPD patients manage without oxygen therapy, or only use it as needed, others with severe COPD rely more heavily on oxygen.
Some sufferers must adjust travel arrangements or even avoid travel altogether in order to account for their oxygen tanks or the location they are traveling to.
If you are reliant on supplemental oxygen, physicians want you to know what options are available. Pressurized tanks are good for those less apt to travel. For those who do travel, favorable options include liquid oxygen, a portable solution and easily stowed and oxygen concentrators, which are also portable but require a constant source of electricity.
“P” is for Progressive
For sufferers of COPD, the difficulty of breathing is described as the equivalent of plugging your nose and then putting a straw in your mouth. The lungs of someone who has been diagnosed have lost their elasticity, making it difficult for them to expand and release carbon dioxide causing the airways to become “damaged, thick and inflamed.”
COPD is a slow moving disease and many of those diagnosed have no signs or symptoms until they have reached the moderate-to-severe phase. For example, for someone who starts smoking as a teen and persists into adulthood, damage can go on quietly for years. “Because you have two lungs and a lot of lung reserve, most lung diseases really don’t cause significant problems or symptoms until someone has lost 50 or 60 percent of their lung function,” according to Andrew Ries, a professor of family medicine and preventive medicine at the University of California–San Diego.
Ries suggests looking for signs and symptoms of breathlessness. Early prevention is often times the best way to slow the progression of COPD.
“D” is for Dealing With It
To some a COPD diagnoses seems bleak, but people living with COPD do have options including “taking prescription medications, keeping up with treatments, building endurance through exercise, accepting limitations and making adaptations in their homes, like rearranging kitchens so they can sit while preparing food.”
If none of these work, there are several other options including surgeries and physical therapies to increase lung capacity. If you are able to “build fitness and endurance” it is possible to reduce the likelihood of becoming sedentary, says Ries.
Click Here to Access the Full Story from U.S. News and World Report
Coping Techniques Help COPD Patients Improve Mentally and Physically
Patients diagnosed with chronic obstructive pulmonary disease (COPD) could boost their quality of life and improve physical symptoms by using coaches to “manage stress, practice relaxation and participate in light exercise.” That is according to a study by researchers from Duke University Medical Center posted on Psychosomatic Medicine.
Researchers utilized telephone-based coaching to determine if step-by-step instruction in relaxation techniques such as deep breathing, tensing and releasing muscles, and tips to manage reactions to stressful events would improve patient quality of life.
The study was conducted over five years and included a total of 298 patients, all of whom had been diagnosed with COPD. One group was provided with phone consultations that included specific coping techniques. A control group of 151 patients also received phone counseling, but it was limited to topics such as medication and nutrition.”
While the study showed no direct improvement of COPD-related hospitalizations or deaths, the low-cost approach could “enhance quality of life, reduce distress and somatic symptoms, and improve physical functioning for patients,” according to researchers.
James Blumenthal, Ph.D., with the J.P. Gibbons Professor of Behavioral Medicine in the Department of Psychiatry and Behavioral Sciences at Duke, stated that many “patients with COPD do not often seek mental health services,” even though, based on the findings, they “could be a valuable treatment for patients with other chronic conditions.”
Study Finds Half of COPD Patients Suffer from Breathlessness
A group of researchers from GlaxoSmithKline R&D, the research and development arm of the global healthcare company, recently conducted a study testing the frequency of and factors associated with dyspnoea, or shortness of breath, in patients diagnosed with chronic obstructive pulmonary disease (COPD). According to a report on their findings in Lung Disease News, 46 percent of the more than 49,000 patients studied had moderate-to-severe dyspnoea and 36 percent of the 49,000 showed signs of mild airflow obstruction, which is defined as abnormal inflammatory response of the lungs to harmful particles in the air.
Researchers found that those with even mild dyspnoea are at “high risk for exacerbations and increased disease severity during follow-ups.” Other risk factors include “female gender, old age, obesity, previous moderate-to-severe exacerbations and the need to see a general practitioner frequently.”
While the findings are consistent with previous observational studies, this specific study found a consistent relationship between dyspnoea and airflow obstruction, meaning those with moderate-to-severe dyspnoea were also at a higher and more frequent risk for air flow limitation. The study also concluded that “the presence of dyspnoea in patients with COPD was associated with markers of greater disease severity and increased risk of poor outcomes.”
While patients may have no control over their diagnoses, COPD sufferers can combat the associated factors, such as obesity, in an effort to limit the frequency of dyspnoea.
Study Reveals 76 Percent Reduction in Risk of Death with NPPV Intervention
In an eye opening estimation, experts have predicted chronic obstructive pulmonary disease (COPD) will become the third leading cause of death worldwide by 2030. It’s a prediction that is leaving many researchers scrambling to invest more time and money into studies that focus on the treatment of this disease.
A press release on The Wall Street Journal website identifies the study as being funded by Res-Med, a global leader in the treatment of sleep-disordered breathing and other respiratory conditions. The study began in 2004 to investigate the success of long-term, non-invasive positive pressure ventilation (NPPV), also known as non-invasive ventilation.
NPPV treatment is a form of mechanical support in which positive pressure delivers a mixture of air and oxygen throughout the respiratory tree via a non-invasive interface. It holds the possibility to offer important benefits for patients with severe COPD and is likely to influence future clinical guidelines for their therapy.
The study states that “the control group received optimized COPD therapy and the intervention group received optimized COPD therapy plus NPPV, and was advised to use NPPV for at least six hours per day.”
Researchers measured survival rates and found that 33 percent of patients in the control group died within one year, while the risk of death declined by 76 percent for the intervention group. The survival benefit in the intervention group was maintained for longer than the year of the main study, suggesting that the benefits are long term.
"COPD takes an enormous human toll, and is also a significant burden on healthcare systems, putting a higher priority on pursuing treatments that have the potential to improve survival and reduce spending for healthcare organizations worldwide" says ResMed Chief Medical Officer Dr. Glenn Richards. “This study aligns with our goal of improving lives with every breath."
Click Here to Access the Full Study on The Lancet Respiratory Medicine
New Study to Investigate Whether Ibuprofen Can Reverse the Effects of Emphysema
An estimated 12 million adults have been diagnosed with chronic obstructive pulmonary disease (COPD) and another 3.1 million with emphysema, both responsible for the destruction of lung tissue that leaves those affected struggling to breathe.
With chronic lower respiratory diseases listed as the third leading cause of death in the United States, an increased emphasis has been placed on finding solutions for conditions such as COPD and emphysema. An article from Temple University introduces a new nationwide clinical study that will test the possibility that ibuprofen can reverse the effects of this debilitating condition.
The $4.4 million study, funded by the National Institutes of Health’s National Heart, Lung and Blood Institute, will seek to determine if a common over-the-counter, non-steroidal, anti-inflammatory drug can provide a novel treatment for emphysema.
Gerard J. Criner, director of the Temple Lung Center and the trial’s local principal investigator claims that “if this treatment is successful, it could restore lost lung function and change the course of treatment for millions of Americans living with emphysema.”
Emphysema has long been considered irreversible. This trial looks specifically to determine whether or not ibuprofen can block the production of prostaglandin E (PGE) in the lower respiratory tract. Increased levels of PGE have been shown to slow the repair process in lungs. Therefore, by blocking production of PGE, the lungs have a greater probability of repairing themselves.
The measure of the trial’s success will be whether patients who receive ibuprofen have improvement in lung function and in the lung’s ability to repair itself. If successful, researchers will seek approval to conduct a larger clinical study.
