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Bacteria in Lungs May Make COPD Patients Sicker

While the medical profession has long agreed that bacteria in the lungs of chronic obstructive pulmonary disease (COPD) patients are harmless when independent of flare-ups or exacerbations of respiratory symptoms, a new study may suggest otherwise.


The study, “Bacterial Colonization Increases Daily Symptoms in Patients with Chronic Obstructive Pulmonary Disease,” which was published in the January 2014 issue of the Annals of the American Thoracic Society, found that COPD patients do in fact experience more respiratory symptoms when their lungs are colonized by bacteria, even in the absence of an acute exacerbation.


The study examined41 elderly male veterans with smoking-related COPD in the COPD Study Clinic at the Buffalo VA, focusing on four common pathogens encountered in COPD – Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae and Pseudomonas aeruginosa. Researchers used sensitive molecular detection methods, as well as conventional laboratory cultures, to detect these bacterial pathogens, while patients used electronic diaries to record daily symptoms of breathlessness, cough and sputum.


“The lungs are constantly being exposed to microbes ‘with every breath you take’ as well as from aspiration of small amounts of secretions from the throat, especially during sleep,” said senior author Sanjay Sethi, MD, professor of medicine and chief of pulmonary, critical care and sleep medicine and staff physician with the Veterans Affairs Western New York Healthcare System. “If the persistence of these bacteria contributes to increased symptoms and inflammation in the lungs in stable COPD, we should regard this as a chronic infection, not innocuous colonization.”


For that reason, Dr. Sethi believes that more must be cone to reduce chronic infections in COPD patients.


“These findings demonstrate that it’s time for a paradigm shift in how we treat patients with stable COPD,” said Dr. Sethi. “We need to go beyond traditional approaches of bronchodilation and anti-inflammatory agents to reduce symptoms. We need to put more emphasis on developing therapies that can decrease bacterial colonization in COPD.”


Click Here to Access the Full Story from the University of Buffalo.

Preparing for Airline Travel

For sufferers of chronic lung conditions such as emphysema, chronic bronchitis and chronic obstructive pulmonary disease (COPD), the use of supplemental oxygen may be necessary at some point in your treatment plan. Yet, this does not mean that these individuals cannot travel via airline transportation. In fact, many people who require supplemental oxygen fly on a regular basis. However, additional planning is required.


Pre-Travel Planning

Once approved for air travel by your physician or care team, it is important to check with the airline regarding their supplemental oxygen guidelines. While many will allow passengers to travel with a portable oxygen tank, some will not, meaning checking with your specific carrier is imperative before booking any flights.


Once you have identified an airline carrier who will accommodate your portable oxygen needs, it is important to identify any additional information they may need. Included in this may be a letter from your physician, a brief medical history and a current oxygen prescription. Passengers should also check to ensure that their portable oxygen concentrator has been approved for in-flight use.


Security Screening

Depending on your reliance on a portable oxygen device, the manner in which you will be screened by the Transportation Security Administration (TSA) may vary.


For those individuals who have been advised by their physician that they can safely disconnect from the portable oxygen concentrator, screening will occur through the airport’s Advanced Imaging Technology. In addition, TSA recommends that the passenger check the equipment as checked baggage whenever possible. If you would prefer to bring your oxygen concentrator on the flight as a carry-on bag, the equipment will either undergo X-ray screening or inspection.


If you are unable to or would prefer not to disconnect from the portable oxygen device, TSA will conduct the screening through a pat-down procedure similar to those that are used to resolve any alarms or anomalies identified by the imaging technology. 


Please note that it is important for the passenger to inform the security officer whether he or she can disconnect from the oxygen supply before the screening process begins.


For more information on the screening process for travelers requiring portable oxygen, please visit the TSA website for Travelers with Disabilities and Medical Conditions.


Additional Information

For additional information on traveling with COPD or emphysema, including a checklist for airline travel and tips for travelers, visit the Cleveland Clinic’s website for COPD - Traveling Tips for People with COPD. If you are newly diagnosed with a chronic lung condition, you may also find it helpful to read the following travel information, which can be found on our website under “Living with COPD.”

Lung Diseases May Affect More than Lungs

Chronic lung conditions in adults, such as chronic obstructive pulmonary disease (COPD) and bronchiectasis, may lead to gastroesophageal reflux according to a recent study published in the August issue of Respirology, Proximal and distal gastro-oesophageal reflux in COPD and bronchiectasis.


The study, which examined patients with COPD or bronchiectasis against a control group, found that those living with these chronic lung conditions were twice as likely to have reflux problems as those without lung disease, leaving researchers to believe that gastroesophageal reflux— a condition in which acid from the stomach leaks back up into the esophagus – is a common side effect of these lung conditions.


To reach this conclusion, researchers at the Melbourne School of Health Sciences at The University of Melbourne studied 27 participants who had COPD, 27 participants with bronchiectasis and 17 control participants without lung disease. Of the participants, 17 with COPD and 16 with bronchiectasis had previously been prescribed anti-reflux therapy.


Each participant completed a questionnaire about their reflux symptoms, then had the level of acid in their esophagus measured for 24 hours. Those participants with lung disease also had their pepsin levels (the substance in the stomach that helps break down food) measured and the severity of their lung disease monitored. 


With this information, researchers used the data collected to determine the prevalence of gastroesophageal reflux in all participants. 


Of the participants without lung disease, 18 percent were diagnosed with gastroesophageal reflux. That is compared to 37 percent of patients who had COPD and 40 percent of patients who had bronchiectasis. Meaning those participants with chronic lung conditions were twice as likely to have reflux problems than those without lung disease.


Researchers note that the severity of the lung disease did not affect the participants’ likelihood of having gastroesophageal reflux. Further, many of those individuals diagnosed with gastroesophageal reflux did not exhibit any obvious symptoms.


These findings may affect the way that doctors look for reflux symptoms in patients with chronic lung conditions.


Click here to access the full story from Respirology.

Vitamin D Deficiency Prevalent in Chronic Lung Patients

According to a recent study published in Thorax, a leading respiratory medicine journal, vitamin D deficiency is a frequent occurrence in chronic obstructive pulmonary disease (COPD) patients and has been found to correlate directly to the severity of the disease. With more than half of COPD and emphysema patients developing a vitamin D deficiency during their lifetime, understanding the importance of vitamin D and how to overcome this deficiency is an important step in managing the disease.


The Role of Vitamin D in Chronic Lung Disease

According to the U.S. Department of Health and Human Services, vitamin D is essential for the “formation, growth, and repair of bones and for normal calcium absorption and immune function.” However, for patients with chronic lung diseases, this important vitamin is thought to play a key role in preventing the loss of lung function over time.


“While there are still a lot of studies that need to be done on vitamin D and the lungs, it is thought that in patients with advanced disease the vitamin helps prevent the decline in lung function over time,” said Samuel A. Allen, D.O., pulmonologist, critical care specialist and director of the Pulmonary Hypertension Center at Beaumont Hospital in Troy, Michigan. “Vitamin D can also help people recover from infections. So patients with good levels of vitamin D will probably recover from an infection better than those dealing with a deficiency.”


In addition, low levels of vitamin D can result in osteoporosis and osteomalacia (softening of the bones), as vitamin D plays a critical role in calcium absorption, which is key to building strong bones.


The Cause of Vitamin D Deficiency

The cause of vitamin D deficiency in patients with chronic lung diseases is twofold. First, because eating requires a great deal of energy for people living with COPD and emphysema, many individuals do not consume enough foods that are rich in vitamin D.


“Because eating can often be physically exhausting, many people living with chronic lung conditions do not eat three meals a day,” said Dr. Allen. “In addition, most patients tend to eat foods that have a high volume of fat and protein because that is what their body needs as their condition worsens. However, these meals usually do not contain a good amount of vitamin D.”


Second, because patients with severe respiratory issues do not regularly participate in outdoor activities, they are not receiving the sunlight they need to absorb adequate amounts of vitamin D. These deficiencies are further complicated by the chronic steroid use included in many individual’s treatment plans.


“When taken in high doses over an extended period of time, steroids can inhibit the absorption of vitamin D and calcium in the intestines,” said Dr. Allen. “So the vitamin D that patients are able to take in through their diet and sunlight is impaired because they are chronically on steroids.”


Increasing Vitamin D Intake

To increase their intake of vitamin D, patients with chronic lung diseases can do a number of things, including adding vitamin D3 supplements to their daily regimen.


“I tell my patients first and foremost to take vitamin D3 supplements, rather than plain vitamin D or vitamin D with calcium. This seems to work better than others because vitamin D3 provides both the dietary and sunlight-activated vitamins in one supplement,” said Dr. Allen. “For all practical purposes, patients should be taking 1,000 IUs (international units] of vitamin D3 a day.”


In addition, individuals should get 20 to 30 minutes of sunlight each day, if possible. Eating five or six small meals a day rather than three large meals is also recommended, as eating smaller portions requires much less energy. These meals should also include foods that are rich in vitamin D, such as swordfish, tuna, sake salmon, and cod liver oil.


“I tell my patients to have sake salmon or tuna at least once a week. Then for breakfast, my recommendation would be to drink eight ounces of vitamin D-fortified orange juice and a yogurt that is also fortified with vitamin D,” said Dr. Allen. “However, the biggest thing patients can do is stop smoking, because smoking impairs vitamin D absorption, accelerates lung conditions and has been known to cause issues with bone loss.”


Note: Because exceeding dietary recommendations can result in vitamin D toxicity, it is important to speak with your physician before making these changes to your treatment plan.

Recent Study Uncovers Exacerbation Frequency Related to COPD Severity

Frequency of exacerbations such as dyspnea, cough, and sputum production in chronic obstructive pulmonary disease (COPD) patients may be related to the severity of the disease, according to recent study.

Researchers examined literature to identify randomized controlled trials and cohort studies that directly examined the exacerbation frequency in COPD patients receiving usual care or placebo. Thirty-seven relevant studies were identified, with 43 reports of total exacerbation frequency, including 19 event-based and 24 symptom-based, and 14 reports of frequency of severe exacerbations.

Researchers then determined annual frequencies for total exacerbations defined by an increased use of healthcare, total exacerbations defined by an increase of symptoms, and severe exacerbations defined by hospitalization.

Annual event-based exacerbation frequencies were estimated at 0.82 for mild COPD, 1.17 for moderate, 1.61 for severe, and 2.10 for very severe COPD. Annual symptom-based frequencies were 1.15, 1.44, 1.76, and 2.09, respectively. For severe exacerbations, annual frequencies were 0.11, 0.16, 0.22, and 0.28, respectively.

Researchers note that study duration or type of study did not significantly affect the outcomes.

Click here to access the full study from DovePress

CT Scans Reveal Changes in Lungs Associated with COPD Flare-Ups

Researchers have identified two types of structural changes associated with frequent exacerbations in the lungs of patients with chronic obstructive pulmonary disease (COPD), according to a recent study published in Radiology.

Researchers analyzed data from the COPDGene Study, an ongoing, multicenter study sponsored by the National Heart, Lung, and Blood Institute (NHLBI) and designed to identify genetic factors associated with COPD, selecting patients between the age of 45 and 80 with a history of cigarette smoking. Participants then underwent spirometry and whole-lung volumetric computed tomography (CT) examinations.

Researchers also studied the association between a patient’s bronchial wall thickness and the degree of air sac destruction shown on CT scans with frequency of exacerbations. The findings reveal that while many patients had a mixture of structural changes related to their COPD, two subgroups could be identified—those with emphysema and those with large airway disease—and both were associated with greater exacerbation frequency. This frequency was found to be independent of spirometric measures of lung function.

“Radiologic characterization of COPD patients has prognostic value in the selection of more homogeneous subgroups for clinical trials and possibly for identifying patients at risk of frequent exacerbations for targeted medical therapies,” said the study’s lead researcher, Meilan K. Han, M.D., M.S., assistant professor of medicine at the University of Michigan Health System in Ann Arbor, Mich., in a statement released by the Radiological Society of North America.

She adds that the research may suggest there may be different disease mechanisms causing inflammation in the two COPD subgroups and future studies may help determine if these patients should be treated differently.

According to the NHLBI, an estimated $49.9 billion was spent on COPD in the United States in 2010, the majority of which was related to exacerbations.

Click Here to Access the Full Story from Radiology (membership may be required)

Physician Groups Issue New Treatment Guidelines for COPD

New guidelines for chronic obstructive pulmonary disease (COPD) have been released, updating the previous guidelines that were set forth by the American College of Physicians (ACP) in 2007. The guidelines, which were published recently in the Annals of Internal Medicine, offer a number of updated recommendations for the diagnosis and treatment of COPD.

Overall, physicians made seven recommendations addressing diagnosis and treatment, noting that guidelines do not cover smoking cessation, surgical options, palliative care, end-of-life care or nocturnal ventilation.

In these guidelines, physicians are urged to use spirometry to diagnose airflow obstruction in patients with respiratory symptoms such as wheezing, shortness of breath and chronic cough. However, this screen should not be performed in asymptomatic people, because it could lead to unnecessary testing and increased health care costs, among other things.

Further, physicians now believe that patients with more sever COPD are best managed with inhaled monotherapy of either acting beta-agonists or anticholinergics. These patients can also be given combination therapy that includes inhaled corticosteroids, although there is less evidence for this recommendation.

Researchers also strongly recommended prescribing continuous oxygen therapy to patients with severe hypoxemia, as the “use of supplemental oxygen for 15 or more hours daily can help improve survival” in this population.

The recommendations were developed by the American College of Physicians, American College of Chest Physicians, American Thoracic Society and European Respiratory Society through a thorough review of studies published between 2007 and 2009.

Click Here to Access the Guidelines From the Annals of Internal Medicine

Emphysema Severity and Lung Thickness Tied to COPD Exacerbations

Percentage of lung affected by emphysema and bronchial wall thickness on quantitative computed tomography (CT) are associated with chronic obstructive pulmonary disease (COPD) exacerbations, independent of the severity of airflow obstruction. That is according to a recent study published in Radiology.

The study examined a total of 1,002 individuals, who fulfilled the Global Initiative for Chronic Obstructive Lung Disease criteria for COPD and had quantitative CT analyses. The mean wall thickness and mean wall area percentage in six segmental bronchi were measured by an automated program, while a questionnaire was used to determine the frequency of COPD exacerbations in the previous year.

Researchers found that after adjusting for lung function, total emphysema percentage and bronchial wall thickness correlated with COPD exacerbation frequency. The annual exacerbation rate increased significantly with each 1 mm increase in bronchial wall thickness. Further, each 5 percent increase in emphysema in patients with 35 percent or greater emphysema correlated with a 1.18-fold increase in the annual exacerbation rate.

"Our study results, obtained by using quantitative CT metrics, demonstrated that the frequency of COPD exacerbations is related to both emphysema severity and airway disease," the authors write.

Click Here to Access the Full Study From Radiology (Registration may be required)

Reduced Lung Function Increases Risk of Cardiovascular Disease

Individuals with reduced lung function, such as those suffering from chronic obstructive pulmonary disease (COPD), have a greater risk of developing cardiovascular disease. That is according to a recent study presented at the European Respiratory Society’s Annual Congress in Amsterdam.

Researchers, who analyzed the prevalence of both heart disease and nasal symptoms in lung patients, gathered data from 993 individuals with COPD and 993 without. The study revealed that 50.1% of individuals with COPD also had cardiovascular conditions, such as heart disease, stroke and hypertension. That is compared to 41% of individuals with normal lung function.

The study also found that nasal symptoms were common among patients who had both COPD and heart disease (53%), while those with normal lung function and heart disease were at less risk (35.8%). This is the first study to reveal that nasal symptoms and heart disease are common in individuals with COPD and may link the two conditions.

“Our findings are the first to shed light on the links between both nasal symptoms and cardiovascular condition, in relation to people with COPD and restrictive lung function,” said Dr. Anne Lindberg, from the Sunderby Hospital in Sweden, in a Medical News Today article. “This has important implications for clinicians who need to understand the potential overlaps of these conditions when they are treating people with COPD. In addition to raising awareness of these comorbidities, it will also be important to investigate these links further and look at the effect that comorbid conditions have on exacerbations and disease progression.”

Click Here to Access the Full Article From Medical News Today.

Loss of Small Airways Before Emphysema May Explain COPD

The narrowing and disappearance of small airways before the onset of emphysematous destruction, which is marked by the onset and spread of lesions and holes in the lung, may explain the increased peripheral airway resistance reported in chronic obstructive pulmonary disease (COPD), according to a recent study published in the New England Journal of Medicine.

The study used multidetector computed tomography (CT) to compare the number of small airways (measuring 2.0mm to 2.5mm in diameter) in patients with various stages of COPD, as judged by scoring on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) scale. MicroCT was used to measure the extent of emphysema, the number of terminal bronchioles per milliliter of lung volume and the minimum diameters and cross-sectional areas of terminal bronchioles. Both isolated lungs removed from patients with COPD who underwent transplantation and donor lungs were examined.

According to researchers, samples from the isolated lungs of patients with severe COPD who underwent lung transplantation showed significant reductions in the total cross-sectional area and numbers of terminal bronchioles. Furthermore, analysis revealed that the narrowing and loss of terminal bronchioles occurred before the onset of emphysematous destruction.

In samples from patients with COPD, as compared with control samples, the number of small airways was reduced for those participants who were categorized as GOLD stages one through four. Authors of the study note that they could not determine whether the reduction in the number of small airways that was observed by CT analysis was a true reduction or simply a narrowing to the point at which the airways were no longer visible.

They add: “Despite these limitations, the microCT results extend earlier reports by showing that there is both widespread narrowing and loss of smaller conducting airways before the onset of emphysematous destruction in both centrilobular and panlobular emphysema phenotypes of COPD.”

Research for this study was funded by the National Heart, Lung, and Blood Institute, the Canadian Institute of Health Research–Thoracic Imaging Network of Canada, the Canadian Collaborative Innovative Research Fund, GlaxoSmithKline, and the Lavin Family Supporting Foundation.

Click Here to Access the Full Study from the New England Journal of Medicine.

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