A new study finds that popular smoking cessation drugs varenicline (Chantix) and bupropion (various brands), “show no significant increase in the risk for serious neuropsychiatric side effects in patients with or without psychiatric disorders”.
The largest to date study examined the “safety and efficacy of the two drugs in comparison with nicotine patch and placebo,” was taken on based on a request by the US Food and Drug Administration (FDA), which requires a black box warning on the two drugs, owing to concerns of neuropsychiatric side effects.
Published online in Lancet, the study was conducted between 2011 and 2015 and examined over 8000 smokers who were motivated to quit, from 16 different countries. Participants were grouped into those with current or past stable psychiatric disorders and those without such disorders.
Study participants were randomly assigned to “receive 12 weeks of treatment with either varenicline, bupropion nicotine patch, or placebo, with 12 weeks of non-treatment follow-up. It was also noted that participants also received cessation counseling at each visit.
Of those studied who had no previous psychiatric disorders, “there were no statistically significant differences between any of the treatment groups in rates of moderate and severe neuropsychiatric disorders.” For those participants who had been previously diagnosed with a psychiatric disorders or were currently dealing with any, “rates of moderate and severe neuropsychiatric adverse events were higher in general.”
What if you were told that there was a new, experimental treatment for severe emphysema? Would you try it? First, let’s take a look at what its benefits are and how it works.
According to a new study out of University of Groningen in the Netherlands, the treatment is designed to replace more risky surgeries, such as Lung Volume Reduction Surgery, and involves placing one-way valves in airways to alleviate damaged lung tissue by giving healthier areas of the lung more breathing room. These valves “help patients to breathe easier and exercise longer”, said lead study author Karin Klooster, which “can relieve symptoms [and act as] a workable therapy”.
So, what’s the catch? Researchers say the technique “only works in patients whose badly-damaged lung tissue is isolated”. If air is sneaking in from healthier tissue, the treatment is not effective. Klooster also noted that because of this limitation, “only about one in 10 patients with severe emphysema would be candidates for the implanted valves”. Klooster continues to emphasize that although the group of those qualified for the surgery would but small, “the benefit would be real”.
To compare, “with the valves in place, patients released 21 percent more air in the first second when they tried to exhale. With standard care the increase was just 3 percent”, according to the results in the New England Journal of Medicine, where the study was published.
While the valves have not yet been approved for use in the U.S., they are being tested at 21 U.S. centers as part of a separate study using valves.
According to a recent observational study, regular aspirin use is associated with a slowing of the progression of subclinical emphysema. The results, which still need to be confirmed by a prospective study, give hope to many suffering from emphysema as a potential treatment and, if confirmed, would be the only known treatment for the condition.
Carrie Aaron, MD, of Columbia University Medical Center in New York City led the study and noted “a number of animal studies showing that endothelial damage contributes to the development of emphysema, and there are lung biopsies in humans showing areas of emphysema where the capillaries are destroyed”. Aaron and her research team began their study in the hope that aspirin has the potential to counter emphysema by “inhibiting platelet activation, reducing inflammation, or altering blood flow in pulmonary capillaries”.
The team based their study on the already ongoing Multi-Ethnic Study of Atherosclerosis (MESA) study, which is designed to reveal the characteristics of subclinical cardiovascular disease and risk factors associated with disease progression. Aaron is hopeful that "something that is so widely used might help alleviate the cardiovascular side of things and the pulmonary side of things”.
A new report published in the Centers for Disease Control (CDC) journal Morbidity and Mortality Weekly Report has found that nearly one-quarter of Americans that suffer from chronic obstructive pulmonary disease, or COPD, are unable to work.
Using U.S. health data for 2013, the CDC team led by CDC investigator Anne Wheaton, found that just over 24 percent of adults with COPD reported that they cannot work compared to about 5 percent of adults in the general population.
Of those, about half said they also had some form of "activity limitation" linked to their condition, and more than 38 percent said they found it difficult to walk or climb stairs.
Due to the alarming results, the CDC advises people with the condition to quit smoking as soon as possible if they do. However, the report also found that “more than one-third of those with COPD continued to smoke.”
"Smoking cessation has been shown to slow the progression of COPD," the report said, and smoking raised the odds of activity limitations in patients. "This result reinforces the importance of smoking cessation by COPD patients," the experts said.
Another way COPD patients can combat the illness is engaging in a "pulmonary rehabilitation" program. This sometimes requires physical activity that may be challenging for some persons with COPD, but the CDC team insists that exercise training is an “essential part of helping the body maximize its respiratory potential.”
Wheaton also maintains that public health efforts should “focus on prevention, such as anti-smoking programs and treatment to slow the progression of the disease, manage [accompanying illnesses], and lessen symptoms.”
Researchers at the University of Alabama at Birmingham are investigating a one-way valve for its ability to improve lung function. The valve can be placed in the lungs of patients with severe emphysema and is being hailed as a method that can reduce lung volume without surgery.
Lung-volume-reduction surgery, in which over-inflated, diseased parts of the lung are surgically cut away, allowing the lung to return to a more normal size is a traditional path many take to combat damaging the lungs further. While the surgery is effective, it is not commonly performed in the United States due to the associated risks of pulmonary or cardiac complications.
Developed as a non-surgical option, the one-way valve, formerly known as the Zephyr endobronchial valve, is a minimally invasive procedure. Using a bronchoscope inserted in the airway, several small, one-way valves are placed in the lungs to block airflow to diseased regions. This allows healthy regions to expand and function more efficiently, enabling better breathing and improving quality of life.
"The idea behind all lung-volume-reduction procedures is to reduce the volume in the lung and allow the diaphragm to return to its normal shape and function," said Mark Dransfield, M.D., associate professor in the Division of Pulmonary, Allergy and Critical Care Medicine and medical director of the UAB Lung Health Center. "We're looking for a less invasive way to achieve that goal without the risks inherent in surgery."
So far the valves have been placed in four patients diagnosed with severe emphysema. Dransfield also adds that not all patients with severe emphysema are good candidates for the implantation, noting that “patients need to have enough healthy lung tissue so that blockage of the most diseased and damaged areas and the reduced lung volume will allow the healthier areas to function more normally.”
While there is no cure for emphysema, Dransfield insists that “clinical studies in Europe indicate majority of patients see a significant improvement in lung function, exercise tolerance and quality of life.”
With the release of Apple’s HealthKit, LifeMap Solutions, a digital therapeutics provider, and Mount Sinai partnered to create a self-management program called COPD Navigator. This iOS mobile health application that empowers patients to better monitor and manage chronic obstructive pulmonary disease (COPD) by “leverage[ing] evidence-based care guidelines, behavioral science, and patient data to deliver personalized, doctor-specified interventions with the goal of achieving better outcomes at lower cost”.
With over 24 million people affected, COPD is estimated to cost the United States over $50 billion dollars annually in treatment, surgery, and hospital re-admissions. If patients are able to recognize the signs of an impending exacerbation and take action immediately, they can potentially avoid costly treatments and hospital admissions. So how will COPD Navigator help to solve this problem?
The app is designed to enable patients and care teams to intervene earlier and help payers control the costs of chronic disease management while improving patient quality of life. To do this, COPD Navigator “tracks patient data that includes symptoms, medication and treatment adherence, and overall quality of life. This information is presented in an easy-to-understand and configurable graph that empowers the patient to recognize patterns in their own health history, as well as to send this information to their doctor”.
Additionally, the app also helps patients to “avoid environmental risk factors by providing real-time alerts about local air quality and extreme weather” and is equipped to accept inhaler usage information from any HealthKit-compliant, Bluetooth-enabled, “smart” inhaler device. This means that the app will know when the patient has used their inhaler and how often, helping the app track medication adherence.
COPD Navigator can help to avoid certain risk factors; it is only one part of a larger COPD platform that LifeMap has created. The larger platform includes a clinician dashboard for care providers, which is a HIPAA-compliant tool that shows the health status of patient populations. From the dashboard, clinicians can “flag high-risk patients, set rules for events-based alerts, and intervene early with the goal of reducing the risk of acute exacerbations”.
The COPD Navigator app is currently expected to be available to the public in the second half of 2015.
Blount Memorial Sleep Health Center has recently correlated advances in non-invasive ventilatory support with that of chronic obstructive pulmonary disease (COPD) treatment. Like continuous positive airway pressure (CPAP) devices, a treatment for obstructive sleep apnea,a new device calledbi-level positive airway pressure (BPAP),is showing significant decreases in a COPD patient’s chances of needing to be placed on an invasive lifesaving ventilator.
Dr. Jaber Hassan with the Blount Memorial Sleep Health Center explains that while many people don’t make a correlation between sleep apnea and COPD, the method of treatment is quite similar. “BPAP or BiPAP systems use a mask to deliver air pressure, rather than requiring a tube to be placed in the trachea. It’s very similar to a CPAP system, and has saved many lives, shortened hospital stays, reduced the costs incurred with using a ventilator, and has helped prevent the overall deterioration of quality of life,” he explained.
Operationally, the BPAP device helps in the relaxation of the breathing muscles at night. “These muscles usually are overworked to the point of exhaustion, causing shortness of breath and the retention of carbon dioxide in the lungs. With the right patient, use of a BPAP machine at night can improve carbon dioxide and oxygen levels during the day on a chronic basis,” said Hassan. “With careful monitoring, maximization of care, vaccination, screening for sleep apnea and consideration of home BPAP systems when appropriate, we potentially can make remarkable reductions in the effects of COPD.”
This past January, researchers from the University of Rochester were awarded $1.6 million to embark on a four year series of studies involving a group of compounds derived from omega-3 fatty acids and their ability to combat inflammation caused by cigarette smoking, which can lead to chronic obstructive pulmonary disease (COPD).
The research team will use their early data to illustrate that compounds, called pro-resolving lipid mediators, have anti-inflammatory effects on human lung cells and can stop cigarette smoke-induced lung damage that creates and exacerbates the disease. The team believes that the studies will showcase the compound’s ability to speed the repair of lung injury from short and long-term cigarette smoke exposure, as well as other forms of lung injury.
“These exciting new compounds have the potential to be one of the first-ever disease modifying therapies against smoking-induced inflammatory lung disease, including chronic bronchitis and emphysema, the two conditions that characterize COPD,” said Richard P. Phipps, Ph.D., research team leader and professor of Environmental Medicine and Director of the Lung Biology and Disease Program at the University of Rochester School of Medicine.
The research team explained that while current therapies, such as bronchodilators and steroids, can relieve symptoms, they are not cures. The team’s early data focuses solely on pro-resolving lipid mediators’ effect on the lungs. In previous studies, these compounds have shown the ability to turn off pro-inflammatory signals and promote the destruction of inflammatory cells that take over lung tissue following smoking.
Following the studies, researchers say they hope to develop a supplement, “likely from fish or certain plants like algae, which is highly enriched in pro-resolving mediators”.
For those individuals dealing with chronic obstructive pulmonary disease (COPD) or emphysema, difficulty breathing is an all too common daily experience. Some patients even find the ritual of eating food every day to be an exhausting and labor intensive task as difficulty breathing or wearing oxygen masks gets in the way of an enjoyable activity.
Those with emphysema or COPD who tend to have unwanted weight loss due to lack of proper nutrition intake become very thin, even cachectic looking, says Ilaria St. Florian, a clinical nutritionist at both Stamford Hospital in Connecticut and White Plains Hospital in New York. “It can start to affect your immune system, so that you’re more susceptible to infection. It affects your general strength – really, your muscles,” she says.
It is imperative that COPD and emphysema patients get the most out of every calorie consumed in order to keep up their strength and maintain the integrity of their immune system. St. Florian suggests the following to help maintain a normalized weight and diet:
Avoid large meals. Smaller, more frequent meals work better because you don’t have to work as hard or as long to eat.
Eat protein. When losing muscle due to lack of activity, dietary protein can synthesize new muscle.
Monosaturated fats are your friend. Canola oil, avocados and nuts are heart healthy and provide extra calories for patients who aren’t eating a lot.
Avoid dairy products, as these can create mucous, which can be uncomfortable and difficult to remove in COPD and emphysema patients.
Drink fluids between meals, not with meals, to avoid filling the stomach too quickly.
Eat slowly. Swallowing food quickly can increase the risk of pneumonia.
St. Florian also suggests eating more fish, grapefruits, bananas due to their abundance in antioxidants, which help to fight off damaging free radicals in the body caused by smoking. Using these tips can help COPD and emphysema patients plan condition suitable meals, that will help to maintain a healthy weight.
Usually irreversible and progressive, a late diagnosis of chronic obstructive pulmonary disease (COPD) poses a problem as the disease may be rather advanced before the cause of the patient’s respiratory problems are diagnosed. Access and use of primary care can play a significant role in determining an early diagnosis of COPD.
Begin by identifying possible risk factors. The most prevalent risk factors associated with a COPD diagnoses include:
Environmental air pollution
Occupational exposures (i.e. coal mine workers)
Childhood respiratory illness
Recurrent bronchopulmonary infections
Long-term oxygen therapy
If you are able to catch any of these signs and address them with your primary care doctor, you are more likely to receive an early diagnoses; helping to prevent advancement and exacerbations.
If you are diagnosed with COPD, it is important to know the severity of the condition. Familiarity with such indicators will help to identify any adverse or worsening symptoms. Knowing the severity will also help to determine which form(s) of treatment are right for you. Following are treatment methods to consider if diagnosed with COPD:
While each of these has shown to provide various forms of improvement in patients, they may not be right for your specific needs. It is always best to consult your primary care doctor and weigh your options based on your set and severity of symptoms.