Putting the Brakes on Lung Disease

When an individual has emphysema, or chronic obstructive pulmonary disease (COPD), their lung tissues are destroyed by chronic inflammation, which is largely caused by specialized white blood cells known as neutrophils and macrophages. Although these cells can effectively combat lung infections, they can also attack the lung's elastic fibers leading to breathing difficulties and chest infections.

While a cure for COPD does not currently exist, a recent study published in The Journal of Clinical Investigation suggests that COPD and co-associated medical problems can be prevented by directly “blocking” the G-CSF protein that is known to commonly stimulate the production of white blood cells.

“We found elevated levels of G-CSF in mice with COPD, and when it was eliminated, the excessive numbers of white blood cells in their lungs were markedly reduced and the lungs themselves no longer became diseased,” said the senior author of the study, immunologist Associate Professor Margaret Hibbs.

Researchers discovered that by adjusting the dose of any eventual therapeutic, they may have the ability to maintain white blood cells' infection-fighting capabilities as well as prevent the damage that leads to COPD. The study could potentially provide the key for the first ever treatment that prevents the disease from progressing. It could also provide a new ‘biomarker’ to screen patients and identify COPD much earlier.

“When we blocked G-CSF, the effect was absolutely striking. It prevented not only the emphysema but also the wider medical problems, whether it be the heart, muscles or bone. We realized we had uncovered a potential pathway for treatments," said collaborator Professor Gary Anderson, director of the Lung Health Research Centre at the University of Melbourne. “We now have a very good case that we have indeed found a mechanism not just for preventing emphysema and chronic bronchitis in the lungs, but also for preventing the damaging medical conditions associated with it."

“This would be the first ever strategy that would not only treat the lung disease but the co-associated medical conditions at the same time. If successful, this has the potential to benefit the millions of people who suffer this terrible disease," said Hibbs.

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COPD More Prevalent in Rural Areas, CDC Analysis Finds

Based on the Center for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report, chronic obstructive pulmonary disease (COPD) appears to be more prevalent in “large rural areas compared with metropolitan areas.”

Researchers analyzed data from the 2015 Behavioral Risk Factor Surveillance System, as well as information collected from Medicare hospital records and National Vital Statistics System death certificates. Outcomes revealed that 15.5 million adults had received a COPD diagnosis, as well as discovered COPD was the underlying cause for 335,000 Medicare hospitalizations and 150,350 deaths.

It was also determined that COPD, along with COPD-related Medicare hospitalizations and deaths “were significantly higher among people in rural areas” than individuals based in micropolitan or metropolitan areas of the country.

Through their analysis, researchers also found that counties in the United States with the highest quartiles of COPD were located in the nonmetropolitan areas of seven states: Alabama, Arkansas, Indiana, Kentucky, Mississippi, Tennessee, and West Virginia. Out of these states, “Arkansas, Mississippi, and West Virginia were also in the highest quartile for percentage of rural residents.”

Researchers surmised that these rural populations had an increased risk of COPD due to the prevalence of individuals who smoked, an increased rate of individuals exposed to secondhand smoke and a lack of smoking cessation programs. These areas also had higher rates of residents who were uninsured or were from a lower socioeconomic status, which may have created challenges regarding limited access to “early diagnosis, treatment, and management of COPD.” Additional barriers may have also stemmed from “cultural perceptions about seeking care, distance to travel for care, a lack of services available, and financial burden.”

“Healthcare providers and community partners who serve rural residents can help adults with COPD increase access to and participation in healthcare interventions,” said the authors. “Federal agencies are promoting collaborative and coordinated efforts to educate the public, providers, patients, and caregivers about COPD and improve the prevention, diagnosis, and treatment of COPD.”

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Training on Proper Inhaler Use Key Predictor of Adherence in COPD

A study published in the International Journal of Chronic Obstructive Pulmonary Disease suggests that although age may be correlated to poor medication adherence among those with chronic obstructive pulmonary disease (COPD), there are additional areas that may predict poor adherence which healthcare providers should also address.

Researchers surveyed over 760 patients from nine countries, including Brazil, Canada, France, Germany, Italy, Japan, the Netherlands, the United Kingdom and the United States. Individuals who participated in the survey had been diagnosed with “mild to very severe COPD and were between the ages of 40 and 75 years.” The survey was designed to collect data regarding inhaler use, adherence, dosing accuracy and training, as well as additional elements that impact adherence.

“There is increasing evidence that suggests correct inhaler technique is fundamental for effective therapy and that inhaler device type and mastery play important roles in improving adherence, clinical outcomes, health-related quality of life, and use of health care resources in patients with asthma and/or COPD,” said the authors.

The survey revealed that nonadherence was higher in patients who were 65 years of age or younger when compared with older patients. However, despite this, there was no recorded “difference in adherence between genders, disease severity, or time since diagnosis.” Researchers also concluded that there was not a substantial change in patients’ “confidence of inhaling a full dose based on gender, age, disease severity, or time since diagnosis.”

In fact, patients whose healthcare providers offered them correct inhaler training were more confident that they received the correct dose. However, nearly 30 percent of those surveyed revealed that they “did not receive any training on inhaler use.”

It was also discovered that appropriate follow up regarding inhaler utilization was necessary to ensure patients were using their device correctly. Patients who had received a follow up from their clinician were documented to have achieved higher rates of adherence and felt more confident that they had taken the correct dose when using their inhaler than those who did not receive a follow up.

“The results presented are of significant importance as device attributes that lead to confidence of full dose received may improve treatment adherence by reducing the risk of overdosing or underdosing drug administration in patients,” said the authors.

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Emphysema Threshold on CT Imaging May Have Predictive Value for COPD

According to a recent study published in the American Journal of Respiratory and Critical Care Medicine, patients with chronic obstructive pulmonary disease (COPD) who have been diagnosed with ≥5% emphysema using “thoracic computed tomography (CT) imaging may be at greater risk for poor outcomes” than those with <5%. Researchers also suggested that these patients may find significant value in directed therapy.

To evaluate the correlation between an emphysema diagnosis resulting from the utilization of a CT scan “and patient outcomes, exacerbations, and mortality,” researchers studied data from the National Institutes of Health’s COPD and COPD Genetic Epidemiology studies, including that related to subpopulations and outcome measures. Ultimately, the purpose of the study was to provide clinicians with a set of appropriate directions to accurately interpret radiologic findings and enhance patient decision making.

Researchers examined patients between the ages 40 and 80 with documented histories of smoking. They also evaluated the “frequency of exacerbations, lung parenchyma on CT scan, and spirometry before and after receiving an administered dose of a short-acting bronchodilator.” Based on this data, researchers discovered a correlation between increased exacerbations and higher mortality rates among patients whose CT scans had released a threshold of approximately 5 percent emphysema.

Patients were then divided into two groups: those above the 5 percent emphysema threshold and those below it. Researchers discovered that patients with ≥5% emphysema had “significantly higher average exacerbation frequency,” as well as higher mortality rates.

Further, 26 percent and 15 percent of individuals that had ≥5% emphysema along with “forced expiratory volume in 1 second/forced vital capacity <0.70” were not diagnosed with COPD. Patients with <5% emphysema did not exhibit increased rates of symptoms or exacerbations, which signified that the CT scan findings “were likely related to airway disease.”

A significant link between “all-cause mortality and airflow obstruction” was also observed, supporting the need to use “combined criteria to identify” patients who have an increased risk of exacerbations and death. Based on this data, healthcare providers should address patients with COPD and CT results of ≥5% emphysema, as they may be more at risk for poor outcomes and could benefit from directed therapy.

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Remote Monitoring Could Help COPD Patients, But More Studies Are Needed

A report titled, “Impact of remote patient monitoring on clinical outcomes: an updated meta-analysis of randomized controlled trials” recently appeared in the NPJ Digital Medicine Journal. The study analyzed the impact of devices that remotely monitor patients with chronic obstructive pulmonary disease (COPD) to determine if these tools show promise in improving the condition.

The researchers from Cedars-Sinai Medical Center team analyzed twenty-seven clinical trials, which focused on various conditions conducted throughout thirteen countries. Four of these trials compared remote monitoring and traditional care methods to determine whether utilization of remote monitoring could enhance clinical outcomes among COPD patients.

For instance, one of the studies focused on a nurse who used remote monitoring capabilities to gain insight into “patients’ pulse oximeter and respiratory health sensor readings.” Although evidence did not suggest that the monitoring had an impact on lung function, hospital readmission rates or quality of life, remote monitoring did lead to increased patient engagement and self-management of their COPD.

An additional trial focused on the remote monitoring of COPD patients’ vital signs. Researchers concluded that these patients had “lower rates of hospitalization and emergency room visits and shorter hospital stays,” when compared with patients who had not been remotely monitored. Further, another study revealed that “remotely monitored patients saved an average of $2,931 in treatment costs compared with other patients.”

The third study also revealed a lower rate of hospital admissions and costs associated with remote patient monitoring. In a fourth study an association between “lower flare-up rates and flare-up-related hospitalizations among remotely monitored patients,” was also discovered. The Cedars-Sinai research team examined several measures among all four studies. It was concluded that remote monitoring did not impact “patients’ weight, body mass index, waist circumference, body fat percentage or blood pressure.”

The team also hypothesized that certain monitoring-related treatments appeared to be more effective than other types, such as treatments utilizing “established care guidelines, social science models or personalized coaching.”

“Future studies should be powered to analyze sub-populations to better understand when and for whom RPM (remote patient monitoring) is most effective,” said the researchers.

Click Here to Access the Full Article on Lung Disease News

Foods That Can Irritate COPD

Patients with chronic obstructive pulmonary disease (COPD) often suffer from irreversible lung damage due to its progressive nature. Currently there is not a cure for this condition, however, patients can take steps to manage their symptoms including smoking cessation and exercising. Diet can also play a significant role as certain foods can irritate the disease. It is recommended that patients should avoid or consume the following foods “in small quantities.”

Fried Foods
Not only does the grease in fried foods cause digestive issues, but “the breakdown of fats takes longer in the digestive system and a sensation of being bloating can occur in the abdomen.” In turn, these side effects cause patients to experience pain, breathing difficulties and also weight gain due to the additional fat that accumulates. Common fried foods that should be avoided include fried chicken, french fries and onion rings.

Aerated Beverages
Beverages that have been aerated with carbon dioxide, such as sodas and energy drinks, increase pressure in the middle of patients’ torsos which, in turn, impacts their ability to breathe. To avoid potential symptoms associated with aerated drinks, patients with COPD should instead drink water “and allow the body enough fluid to carry out all metabolic activities.”

Excess Salt
Although salt intake is critical to “maintain a healthy sodium balance in the body,” it is vital to avoid a high intake of it since it can result in water retention, also known as edema. If COPD patients continue to consume high quantities of salt, they will likely experience trouble breathing as the extra water acts similar to excess fat when located around the diaphragm.

Dairy Products
When individuals consume dairy products, “a product of the breakdown of milk digestion” known as casomorphine increases the amount of mucus and phlegm produced. To expel the excess mucus and phlegm, the body generally coughs it out. For patients with COPD, coughing and wheezing can lead to a significant amount of discomfort. Common foods and beverages containing dairy that should be consumed less frequently include milk, ice cream and cheese.

Cruciferous Vegetables
Cruciferous vegetables such as kale, broccoli and cabbage have numerous benefits, yet they also contain extra fiber that causes indigestion, bloating and breathing difficulties resulting from “extra gas generated in the system.” Although these vegetables do not need to be completely removed from patients’ diets, it is extremely helpful to limit consumption.

Cold Cuts and Cured Meats
Processed meats, including bacon, cold cuts and hot dogs contain preservatives to extend their shelf life. However, these additives are unhealthy to consume especially for those living with COPD. In fact, lung conditions may actually worsen if patients eat large portions of the nitrates contained in these foods.

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Moderate and Severe Exacerbations Accelerate Physical Activity Decline in COPD Patients

A new study published in the European Respiratory Journal, conducted by researchers from the Barcelona Institute for Global Health (ISGlobal), revealed that moderate and severe exacerbations among individuals with chronic obstructive pulmonary disease (COPD) have been linked to “a decline in their physical activity level.”

"Previous research showed an acute drop in physical activity during a COPD exacerbation. We now observed that this drop in physical activity has an important and lasting effect. Higher exacerbation frequencies were associated with more pronounced declines in physical activity," said Heleen Demeyer, first author of the study and researcher from KU Leuven and ISGlobal.

"An unexpected finding was that two or more moderate exacerbations (treated without hospital admission) resulted in a long-term decline in physical activity equivalent to that of a severe event (with hospitalization). This confirms the importance of prevention and early management of exacerbations regardless of the severity," added Demeyer.

Researchers analyzed data from 141 patients that received care from one of five European healthcare centers located throughout Greece, Scotland, England, Belgium and The Netherlands. Patients’ physical activity was measured and compared with the number and severity of exacerbations after one year. Researchers also evaluated each patient’s “perception of their physical activity.”

The researchers presented two hypotheses that explain the occurrence of patients’ decline in physical activity. The first hypothesis suggested that there may have been a decline resulting from patients’ loss of “functional exercise capacity.” The second hypothesis theorized that patients were continuously less active after “experiencing worsening of symptoms during an exacerbation.”

"Patients with frequent exacerbations constitute a specific disease phenotype with a worse prognosis, specifically a faster loss in lung function, a greater worsening of health status and a substantial reduction in the amount of physical activity," said Judith Garcia-Aymerich, ISGlobal researcher and coordinator of the study. "Our results support the promotion of interventions to increase physical activity after an exacerbation, such as behavioral programs combined, when needed, with pulmonary rehabilitation.”

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New Study Offers Insights on Genetic Indicators of COPD Risk

A recent study, titled “Human airway branch variation and chronic obstructive pulmonary diseaseappearing in the Proceedings of the National Academy of Sciences revealed that “genetic variations in the anatomy of the lungs could serve as indicators to help identify people who have low, but stable, lung function early in life.” These indicators may also help identify those who have a high risk of developing chronic obstructive pulmonary disease (COPD) to “smoke-induced decline in lung function.”

Although cigarette smoking most commonly causes COPD, some smokers never develop the condition while many non-smokers do. The study sheds light into the occurrence, as researchers have discovered a link between “genetically programmed airway tree variation” and an increased rate of COPD among older adults.

"This work raises many interesting questions for researchers. Understanding precisely why these genes influence the development of COPD may lead to entirely new and more effective ways of preventing or treating this disease," said James Kiley, M.D., director of the National Heart, Lung, and Blood Institute Division of Lung Diseases. "This novel study suggests that a Computerized Tomography (CT) scan, which is widely available, can be used to measure airway structure and predict who is at higher risk for smoke-induced lung injury."

Researchers initially believed that COPD develops later in life resulting from “prolonged exposure to cigarette smoke or air pollution, which accelerates the decline in lung function.” Yet, recent studies show that instead of experiencing an accelerated decline in lung function, “many older adults with COPD had low lung function early in life and experienced the normal lung function decline associated with aging.”

"In the current study, we found that central airway branches of the lungs, which are believed to form early in life, do not follow the textbook pattern in one quarter of the adult population and these non-textbook variations in airway branches are associated with higher COPD prevalence among older adults," said the study's first author Benjamin M. Smith, M.D. M.S., assistant professor at Columbia University Medical Center. "Interestingly, one of the airway branch variants was associated with COPD among smokers and non-smokers. The other was associated with COPD, but only among smokers."

The researchers suggest that more research is needed to confirm that patients’ outcomes can be improved with “preventive or therapeutic interventions based on the presence of airway tree variations.”

Although there may be developmental events involved that may occur within families, the team will continue to determine whether a genetic basis exists for this variant. If proven, it would “represent a novel mechanism of COPD among non-smokers." In the meantime, however, the researchers emphasized that smoking cessation remains the best measure to prevent the occurrence of COPD.

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What Can COPD Caregivers Do to Help Themselves and Their Loved Ones?

When an individual is diagnosed with a chronic disease, they will often need continuous care to remain as healthy as possible, visit doctor’s appointments and complete daily tasks. The caregiving responsibility frequently falls to a family member such as a spouse. Complicating matters, these caregivers are not usually equipped with the necessary healthcare training, which leads to a heavy burden.

“Caregiving is an important role for these individuals. Because COPD can be a really long-term illness, it can be a long-term commitment to care for a COPD patient,” said Dr. Philip Diaz, a pulmonary specialist at The Ohio State University Wexner Medical Center. “And because many COPD patients have comorbidities, or other diseases that require treatment, that can increase obligations on the caregiver even more.”

According to a study published in Respiratory Medicine, the average duration of a caregiving period is 7.2 years. This is an extensive period of time due to the fact that COPD is a progressive disease and the intensity of care is likely to increase throughout time.

“Caregiver stress is one of the most stressful situations there is,” said Diaz. “But there are ways to make caregiving a little easier, and that starts with understanding the disease and its treatments better.”

Education is Key

“When given the opportunity to [educate themselves], caregivers often go above and beyond and can actually find a deep sense of fulfillment in helping their loved one deal with this difficult disease,” said Scott Marlow, a respiratory therapist at the Cleveland Clinic.

By attending support group meetings, caregivers can not only educate themselves, but they can also feel like “they’re not alone in caring for a loved one with COPD.” Meetings often cover topics ranging from traveling and vacation tips to oxygen tank recommendations that will enable an increased quality of life. Discussions also focus on energy conservation and personal hygiene techniques. It can be helpful for caregivers to attend doctor’s visits with their loved one to better understand their condition and treatment protocols. It also provides caregivers with the opportunity to ask physicians questions regarding appropriate care.

Importance of Taking Care of Yourself

It’s vital that caregivers ensure that they take the necessary steps to remain healthy, well rested and active themselves. This can be a challenge due to the extreme stress associated with caring for a patient with COPD. To maintain a healthy mindset and reduce the pressure of their role, caregivers should dedicate time for exercise and hobbies, as well as consider having an additional caregiver that can provide a well-needed break.

Emphysema Treatment Market to Discern Steadfast Expansion During 2017 – 2025

Chronic obstructive pulmonary disease (COPD) occurs when a chronic obstruction of lung airflow interferes with a patient’s normal breathing. According to the Centers for Disease Control and Prevention (CDC), COPD is the third leading cause of death in the U.S.

Emphysema is one of the diseases that falls under the category of COPD, which causes patients’ inhalation and exhalation to slow or even stop for a period of time resulting from inflammation of the alveoli.

Patients with emphysema have a higher rate of mortality “due to respiratory failure, lung infection or heart attack.” However, if emphysema is effectively treated, hospitalizations are prevented, and patients can experience a reduced shortness of breath.

Emphysema treatments are critical due to the fact that nearly 3.1 million adults in U.S. developed emphysema due to cigarette smoking. Based on a survey, smokers are six-times as likely to develop emphysema compared to non-smokers.

Many of the treatments for emphysema have significant side effects. For instance, patients who use inhaled steroid medications may experience weakened bones and cardiovascular diseases. The use of oral steroid medications may also lead to high blood pressure and cardiovascular diseases.

Treatment Market Growth

Due to the prevalence of COPD, and emphysema in particular, as well as the need for improved treatments, it is expected that “the global market of emphysema treatment will show tremendous growth.” Currently, the treatment most preferred by patients with these conditions is smoking cessation. However, there is also a demand for treatment plans that include bronchodilators, corticosteroids and oxygen medications, as well as new medications, therapies and products.
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