COPD mortality rates declining, but total deaths increasing

COPD mortality rates have declined from 1995 to 2017 in many countries. Still, the total number of deaths attributable to COPD has increased during the past 20 years, according to new data published in the European Respiratory Journal.

The existing COPD mortality data were based on outdated statistics from a select number of high-income countries in Europe, Australia, Japan and the U.S., says Joannie Lortet-Tieulent, Ph.D., a research fellow at the WHO International Agency for Research on Cancer.

Using COPD data recorded from 1995 to 2017 from the WHO mortality database, the researchers evaluated death counts according to age, sex, and year. Nearly 3.36 million COPD deaths from 24 countries were included in the analysis.

The researchers calculated COPD death rates by comparing the number of COPD deaths per year against the population of each country in the same year and standardized the data using a reference population. Additionally, they restricted their analysis to people aged 50 to 84 years.

Results revealed a 12% decrease — from 68 deaths per 100,000 person-years to 60 deaths per 100,000 person-years — in the combined COPD death rate for all countries from 2000 to 2015. But there also was a 12% increase in the number of total deaths for all countries from 180,950 to 203,090 estimated total COPD deaths.

Researchers think data suggests that the proportion of COPD patients who are dying early because the disease is falling overall, which is encouraging. Perhaps people are less exposed to COPD risk factors now, and that COPD is being managed more effectively.

Despite the general trend toward lower COPD mortality rates in 18 of the 24 countries examined during the study period, mortality rates overall were still twice as high in men than in women. The exceptions were in the United States, New Zealand and the United Kingdom, where rates were similar for both sexes.

“Our study does not explain why COPD death rates among women increased or remained stable in some countries, but we think this trend could be linked to the rise in the uptake of smoking among women over successive generations, as smoking is an important risk factor for COPD,” Lortet-Tieulent said. "In the countries where women have been smoking as much and for as long as men, such as the U.S., New Zealand, and the U.K., the female COPD death rate became very similar to that of men over time."

The researchers noted, though, that their results likely underestimate the burden of COPD mortality and that more data from low-income countries are necessary.

For additional information detailed in the report, visit Healio.

Provider Intervention Leads to Increased Flu Vaccination Rates Among Patients With COPD

Physician and nurse interventions are the most effective means of promoting influenza vaccinations among patients with chronic obstructive pulmonary disease (COPD), according to the results of a pilot project. Conducted at the National University Hospital in Singapore, the project is the most extensive prospective study of its kind aimed at increasing vaccination rates in patients with COPD.

The influenza virus, rhinovirus, and respiratory syncytial virus are the most common viral infections among patients with COPD.

Of the 348 participating patients, researchers found the initial baseline vaccination rate to be more than 47% while the final rate was nearly 81%. They also found that regular flu vaccinations reduced COPD exacerbations, which are one of the leading causes of hospitalizations around the globe and carry a mortality rate as high as 20%. In the United States, vaccination rates among people with COPD range between 20% and 60%.

To lower the number of people who did not receive their vaccination and decrease rates of infective exacerbations, researchers collected data from one of Singapore’s tertiary referral hospitals. Patients with COPD were enrolled in an “integrated nurse-led, specialist-supported” program called TAP. The program started in 2013 and researchers followed up with patients in 2015.

Physicians and nurses used various tactics to boost immunization rates. For example, physicians explaining the importance of immunizations and, in some cases, nurses following up with those who didn’t get their vaccinations. Patients and providers also completed surveys and questionnaires distributed at the time of vaccination to determine which intervention methods were the most successful.  

Physician intervention accounted for nearly 88% of the increase in vaccinations, with the remaining increase due to nurse reminders.

Researchers said local settings might contribute to the findings. Influenza vaccination awareness is low in Singapore. Those with COPD also were older and had poor health literacy. Also, because doctors knew patients’ vaccination rates would be monitored during the study, physicians consciously made an effort to address the issue, which may have improved the rates of vaccinations.

For additional information about the study, visit AJMC.

Review Suggests Combining Approaches for Identifying COPD

A review evaluating the methodological approaches of identifying chronic obstructive pulmonary disease (COPD) found that when more criteria are combined, the detection of CPOD is more accurate in terms of sensitivity and specificity.

Researchers conducted a systematic literature review of data from January 2000 through October 2018 using Medline via PubMed and Google Scholar. A manual review of the collected studies was then conducted with at least two independent raters.

In total, 151 publications were assembled and reviewed. Following the title and abstract screening, 39 papers were assessed. The most frequently used criteria set to identify COPD patients included the International Classification of Diseases (ICD) codes, hospitalization, and ambulatory visits.

“In general, it can be concluded that the more criteria are combined, the more accurate is the detection of COPD patients in terms of sensitivity and specificity. Drug data is by far the most comprehensive source of information if used alone,” concluded the authors.

Click here to read to the full article on AJMC.

Study Examines Cardiovascular Disease Impact in Patients With COPD

Cardiovascular disease is often associated with chronic obstructive pulmonary disease (COPD). A recent study investigating the relationship between cardiovascular and COPD symptoms shows there may be a link between a patient's diagnostic status and those of patients with suspicious echocardiographic findings, if these symptoms were undiagnosed and untreated.

https://pixabay.com/users/reaperdz-3530416/ " >The research was published in the International Journal of Chronic Obstructive Pulmonary Disease. Lung function data was collected including forced expiratory volume in 1 second (FEV1) and echocardiographic data on the left ventricular ejection fraction (LVEF) and end-diastolic diameter (LVEDD).

Researchers note that diagnosis of the predominant underlying disease and its contribution to COPD symptoms is a challenge, a situation complicated by the fact that even when objective measures of heart function are available, they do not necessarily correlate with the magnitude of symptoms.

“Patients may receive cardiovascular medication, which may alleviate symptoms to a variable degree, depending on the type and severity of cardiac disease … [but] the indication that led to medication in the past might not be verifiable at a later time.”

More than 1,590 patients were evaluated in the study, with 289 showing signs of ischemic heart disease, myocardial infarction or heart failure. Another 860 received at least one cardiovascular medication. Of the 948 patients without isolated hypertension, 38% had LVEF less than 50% and 53.4% with LVEDD greater than 56 mm, who lacked cardiac diagnosis and medication.

“The present study revealed a substantial prevalence of cardiac disease in patients with stable COPD. At least one of the three selected cardiac disorders were reported by about one-fifth of the patients, while the rate of suspicious echocardiographic left heart findings was lower. The overlap between reported cardiac history and abnormal echocardiography was low, and only a minority of patients with a respective history exhibited an impaired left ventricular systolic function or dilatation,” researchers wrote.

Researchers now suggest that the direct assessment of heart size and function is likely to be more reliable in the detection of concomitant cardiac disease in COPD patients.

Click here to read the full article on AJMC.

Emphysema Frequently Found During Cancer Screening

Emphysema that’s detected using lung-density analysis software during low-dose CT lung cancer screening can be highly predictive of lung cancer risk, new research shows.

The prevalence is about 60%, but "we don't know the threshold at which we should act on the emphysema," researchers said.

https://pixabay.com/users/publicdomainpictures-14/" >Despite such high numbers, it’s not clear how physicians should proceed when it is detected. At this point, because the findings are freshly discovered, there are no current care protocols for how to proceed.  

However, that doesn’t mean that the discovery is not important. The screening results may indicate a higher risk for malignancy associated with a higher incidence of cancer. Of these, folks, more severe emphysema is detected in these patients.

The research, led by the Cleveland Clinic lung cancer screening program, uses automated lung density analysis software to detect emphysema. The findings were presented at the American Thoracic Society 2019 International Conference in Dallas.

Researchers said caregivers and the healthcare community must better understand which patients should see a pulmonologist and be treated based on such a test.

For specifics about the screening, emphysema was detected in 125 (39%) of the 321 individuals reviewed. In the study cohort, 101 (31%) participants had previously been diagnosed with chronic obstructive pulmonary disease (COPD).

During the 12-month follow-up, patients with emphysema detected made more pulmonary outpatient visits than patients without emphysema (43% vs. 27%), and were more frequently prescribed treatment for COPD (47% vs. 25%). The rate of visits to the emergency department was similar in the emphysema and no-emphysema groups (35% vs. 30%), as was the rate of hospitalization (7% vs. 12%).

"Patients with emphysema detected had more outpatient visits and more need for inhalers," Choi reported,” investigator Humberto Choi, MD. "We need to better understand which patients should see a pulmonologist and be treated.”

Emphysema was also associated with a higher incidence of lung nodules in a separate study presented by the same team. Their analysis of 314 patients from the same Cleveland Clinic cohort assessed Lung-RADS assessment categories. Five patients were diagnosed with lung cancer during the four-year follow-up period.

Click here to read the full article on Medscape.

Emphysema vs. chronic bronchitis: Understanding the differences

Emphysema and chronic bronchitis are lung conditions under the term chronic obstructive pulmonary disease (COPD). Symptoms can be similar between the two, like shortness of breath and wheezing, but they are different conditions. Emphysema is a lung condition where the air sacs -- or alveoli -- become damaged. These air sacs supply oxygen to the blood, so when they are damaged, less oxygen can enter the blood. Chronic bronchitis is a lung condition that destroys tiny hairs, called cilia, in the airways of the lungs. The airways then become inflamed and narrower, making breathing difficult.

The symptoms of emphysema may include:

• being short of breath during everyday activities and exercise
• coughing daily or almost every day
• wheezing
• rapid breathing and heartbeat
• barrel-shaped chest
• fatigue
• difficulty sleeping
• weight loss
• heart issues
• depression
• anxiety
• wheezing
• chest pain or discomfort
• blueness in the fingernails, lips, or skin due to a lack of oxygen in the blood
• crackling breathing sounds
• swollen feet
• heart failure
• shortness of breath or difficulty breathing
• People may have chronic bronchitis if they have a cough that produces mucus for three months or longer per year over the course of two years.

The symptoms of chronic bronchitis may include:

Similarities

Chronic bronchitis and emphysema "often occur together" and make up COPD. Smoking is a leading cause of both conditions. The American Lung Association says cigarette smoking causes as much as 90% of all COPD cases. Family history of lung disease and high exposure to toxic fumes or secondhand smoke can contribute to both. Nevertheless, both conditions make breathing harder, lead to shortness of breath, coughing, wheezing and can eventually lead to heart issues.

Neither condition is curable. Treatment can manage symptoms and are similar, including bronchodilators and other steroids and medication to open airways and alleviate coughing. Oxygen can help people breathe and carry out their everyday activities. Pulmonary rehabilitation from a care team, and lifestyle changes – like stopping smoking and avoiding air pollutants and secondhand smoke -- can help systems from flaring.

Other treatments are more severe. While there is no cure except prevention (of smoking, for example), there are many tracts that may lead to some relief. For those afflicted, controlling the controllables can have a tremendous impact on quality of life.

Want to know more? Click here to read the full article in Medical News Today.

New Developments In Treating and Diagnosing COPD

Research continues to explore new ways to diagnose and treat COPD, and how medication and pharmacists can serve as valuable resources for COPD patients, providing information about the latest therapies.

New developments in treating COPD are happening on several fronts. For example, research is exploring ways to diagnose COPD early on before significant damage is done, with one path of research focused on non-invasive imaging known as Parametric Response Mapping (PRM). Through PRM, medical professionals can identify small airway abnormalities.

Blood tests, used to target asthma therapy, are also being studied for their use in COPD therapy. The tests measure the number of eosinophils to determine which patients might benefit from biologic drugs called IL-5 antagonists.

Stem cell therapy and less invasive methods of surgery also are being considered. Standard surgery to remove damaged lung sections previously required a large chest incision, but Northwestern Memorial Hospital recently became the first U.S. hospital to use a robotic device, LVRS, requiring only three small incisions to remove damaged lung sections, reducing pain and scarring.

COPD patients may benefit from pulmonary rehab, where patients learn about the benefits of exercise, vaccinations, and nutritional counseling. Further, COPD patients often receive multiple medications and inhalers to treat symptoms, which can lead to misuse and prohibitively expensive therapy.

“New therapies do not directly apply to pharmacists since they are medical procedures rather than medications,” said Lydia Wang, PharmD, a clinical pharmacist coordinator with Atrium Health, “but, pharmacists still play a role in being knowledgeable about these new therapies to better counsel and educate both patients and providers when selecting an individualized course of treatment for patients.” 

Wang argues that pharmacists are directly connected to patients and providers, so they can help them select the most effective medication and counsel on proper administration, side effects, and disposal.

“Not only can pharmacists provide extensive education and counseling about the disease state and medications, pharmacists play a crucial role in recommending guideline-directed, evidence-based medications to patients and providers to optimize medication regimens,” said Wang. “Pharmacists play a large role in realizing and recommending pulmonary rehab when appropriate, which can greatly improve patients’ COPD control.”

Click here to read the full article on Drug Topics.

Non-Smokers Can Get Emphysema From Air Pollution: Study

Long-term exposure to air pollution is linked to increases in emphysema, according to data produced from between 2000 and 2018. The study funded by NIEHS and the National Heart, Lung, and Blood Institute, the findings of which appeared August 13 in JAMA, adds evidence linking air pollution and emphysema, a lung disease that gets worse over time.

Emphysema, usually associated with smokers, is a chronic disease in which lung tissue is destroyed and becomes unable to effectively transfer oxygen.

“Air pollution is a significant public health concern around the world,” said Gwen Collman, Ph.D., director of the NIEHS Division of Extramural Research and Training. “It’s been a priority of NIEHS research for many years, so it’s great when we can accelerate our efforts by joining with other NIH [National Institutes of Health] institutes in supporting research on lung disease.”

The study included more than 7,000 men and women from the Multi-Ethnic Study of Atherosclerosis (MESA). Researchers followed individuals with emphysema, analyzing more than 15,000 computed tomography (CT) scans and lung function tests from the nearly two-decade period analyzed.

Over the same period, MESA carefully tracked air pollution in the varied metropolitan regions of Winston-Salem, N.C; St. Paul, Minn.; New York City; Baltimore; Chicago; and Los Angeles.

“These findings may offer one explanation for why emphysema is found in some people who never smoked,” said James Kiley, Ph.D., director of the NHLBI Division of Lung Diseases. “The study’s results, duration, and timing offer insight into the long-term effects of air pollution on the U.S. population.”

Clear and consistent associations between long-term exposure to air pollutants and progression of lung disease were found across the six localities.

Traffic-related air pollutants were identified as affecting emphysema.

“The combined health effect of multiple air pollutants — ozone, fine particles known as PM2.5, nitrogen oxides, and black carbon — was greater than when the pollutants were assessed individually,” said Bonnie Joubert, Ph.D., a scientific program director at NIEHS. “With the study’s long-running duration, repeated CT scans allowed analysis of changes in emphysema over time.”

“Rates of chronic lung disease in this country are going up and increasingly it is recognized that this disease occurs in nonsmokers,” said the study's senior co-author, Joel Kaufman, M.D., from the University of Washington. “We really need to understand what’s causing chronic lung disease, and it appears that air pollution exposures that are common and hard to avoid might be a major contributor.”

Click here to read more about the study on NIH’s site.

Glycopyrrolate Improves Lung Function in COPD, Regardless of Smoking Status

Glycopyrrolate inhalation powder may improve lung function significantly in patients with moderate to severe chronic obstructive pulmonary disease (COPD) regardless of baseline smoking status, according to a study published in Respiratory Research.

COPD develops in almost 50% of smokers, with 42% of all COPD-related deaths attributable to tobacco smoking. About 40% of patients continue to smoke after COPD diagnosis, which can impair treatment efficacy.

Glycopyrrolate inhalation powder is a long-acting muscarinic antagonist medication approved by the United States Food and Drug Administration, given at a dose of 15.6 µg twice daily for long-term maintenance treatment of airflow obstruction in patients with COPD.

Researchers analyzed pooled data from two 12-week studies in 867 patients (57% current smokers; 43% former smokers) to determine the effect of smoking status on the efficacy and safety of glycopyrrolate inhalation powder compared with placebo in patients with moderate to severe COPD.

Researchers found that glycopyrrolate inhalation powder significantly improved all lung function measures, total St. George’s Respiratory Questionnaire (a disease-specific instrument designed to measure impact on overall health, daily life, and perceived well-being in patients with obstructive airways disease) score. Rescue medication use and the incidence of adverse events and serious adverse events was also similar regardless of smoking status.

Current smokers receiving background inhaled corticosteroid therapy in addition to glycopyrrolate inhalation powder had no significant improvements. Also, treatment with glycopyrrolate inhalation powder showed clinically important improvements in COPD assessment test scores, transition dyspnea index focal scores and daily symptom scores in both current and former smokers.

“These data support the use of glycopyrrolate inhalation powder twice daily in patients with moderate to severe COPD regardless of their baseline smoking status, although the magnitude of benefit may differ between current and ex-smokers,” the researchers wrote.

Click here to read the complete article Pulmonology Advisor.