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Study Challenges Provisions for End-of-Life Care in COPD Patients

A recent study published in the British Medical Journal has challenged the current assumptions supporting the provisions for end-of-life care for people with chronic obstructive pulmonary disease (COPD).

 

The study, titled “Living and Dying with Severe Chronic Obstructive Pulmonary Disease,” was developed to better understand the perspective of people with COPD as their illness progresses, as well as the perspectives of their professional and informal caretakers. Conducted through a number of qualitative interviews over an 18-month period, the study examined 21 patients, 13 informal caretakers (family members, friends, neighbors) and 18 professional caretakers nominated by the patients. During the study period, 11 patients died.

Through the interview process, researchers revealed that severe symptoms that caused major disruptions to normal life were often described as a “way of life” rather than an illness, and overall patients told a “chaos narrative” of their illness that was indistinguishable from their life story. Attitudes toward death were described as normal in an elderly population.

“People with very severe COPD have a well recognized burden of disabling physical symptoms (especially breathlessness), compounded by comorbidity, psychological distress, and social isolation,” wrote researchers. However, the chaos narrative has made it difficult for caretakers to define a point where palliative care might be appropriate.

Further, researchers believe that the policy focus on identifying a time to transition to palliative care has little resonance with patients based on the accounts described during the study. It may also be counterproductive if it distracts professional caretakers from timely consideration of providing much needed supportive care.

Click Here to Access the Full Study from Medscape

The National Association of Managed Care Physicians (NAMCP) Unveils COPD Resource Center

The National Association of Managed Care Physicians (NAMCP) has unveiled the Medical Directors COPD Resource Center, a resource designed to provide medical directors, practicing physicians and patients with up-to-date information on the diagnosis and treatment of chronic obstructive pulmonary disease (COPD).

The resource center was designed by a team of medical directors from various purchasers, plans and providers who saw a need for an unbiased information source on the various techniques currently used to help improve patient outcomes in the COPD patient population.

“We needed one spot to research new information on the diagnosis and treatment of COPD. The web-based Medical Directors COPD Resource Center is that place,” said Ron Hunt, MD, Medical Director of Blue Cross Blue Shield of Georgia, who was a member of the COPD Resource Center Advisory Board, in a statement released by the NAMCP.

The end result features a number of tools that can assist both physicians and patients in managing the disease. For example, the NAMCP COPD Physician Audit Tool, which is available in the resource center, can help physicians monitor the progress of their patients over the course of their treatment.

Further, the NAMCP COPD Patient Health Record can assist patients in determining if they have the signs and symptoms often associated with COPD. Once completed, this resource can be utilized during doctor appointments, where the physician and patient can review the results together.

The Medical Directors COPD Resource Center is the latest in a series of resource centers released by NAMCP. Other resource centers include bipolar disorder, diabetes, weight management and sleep disorders. For more information on these resources, visit www.namcp.org.

Click Here to Access the NAMCP COPD Resource Center

COPD Comorbidities Linked to Higher Risk for Death

A number of comorbidities commonly associated with chronic obstructive pulmonary disease (COPD) are independently associated with a higher likelihood of death. That is according to “Comorbidities and Risk of Mortality in Patients with COPD,” a study published in the American Journal of Respiratory and Critical Care Medicine on May 3.

A key cause of morbidity and mortality, COPD is commonly accompanied by comorbidities such as cardiovascular and cerebrovascular disease, cancer and diabetes. However, little research has been completed on the prognostic value of capturing the effects of these comorbidities in patients with COPD.

As part of the study, researchers followed 1,664 patients with COPD for a median of 51 months. During that time, 79 comorbidities were recorded. Mortality risk was then calculated and a COPD comorbidity index (COTE) was constructed based on the comorbidities that increase mortality risk using a multivariate analysis.

Of these comorbidities, 12 were associated with increased risk of death. These include cancers of the lung, pancreas, esophagus and breast, followed by pulmonary fibrosis, atrial fibrillation/flutter, congestive heart failure, coronary artery disease, gastric/duodenal ulcers, liver cirrhosis, diabetes with neuropathy and anxiety.

“These easily identifiable comorbidities could be screened by healthcare providers caring for COPD patients, as there may be effective interventions that may help decrease the risk of death,” said lead author Miguel Divo, MD, a physician in the Pulmonary and Critical Division at Brigham and Women’s Hospital and an instructor in medicine at Harvard Medical School, Boston, said in an American Thoracic Society news release.

Authors note that these findings raise the possibility of a close interaction among these diseases that may share common biological pathways.

Click Here to Access the Full Study From the American Journal of Respiratory and Critical Care Medicine.

Putting a Stop to Smokers’ Thinking

Whether you have been smoking for 2 years or 20 years, part of the difficulty of quitting is in breaking the habit of thinking like a smoker. When cravings hit, it is easy to revert back to this smokers’ thinking and rationalize the need for a cigarette. However, you must remember that the benefits of quitting far outweigh the benefits of that last cigarette.

When you’re faced with “smokers’ thinking,” it is important to defeat these thoughts and fight the urge to smoke. Smokefree.gov provides a number of useful rationalizations to smokers’ thinking that may help you in this process:

Smokers’ Thinking: I just need one cigarette to take the edge off my cravings.

Clear Thinking: With every day you do not smoke, cravings become weaker and less frequent. Even one puff of a cigarette will make cravings stronger.

Smokers’ Thinking: It’s been a long day; I deserve a cigarette.

Clear Thinking: You do deserve a reward after a long day, but there are better rewards than a cigarette. For instance, a good meal, a funny movie, or a hot shower will help you relax without compromising your attempt to quit smoking.

Smokers’ Thinking: The urge to smoke is too strong; I can’t stand it.

Clear Thinking: Even the strongest cravings will last less than three minutes. This urge will go away whether you smoke or not, and smoking will just make future cravings more frequent.

Smokers’ Thinking: I blew it; I smoked a cigarette.I might as well go ahead and finish the pack.

Clear Thinking: You are still learning how to be a nonsmoker. It’s normal to make mistakes, but you don’t have to smoke that next cigarette. You can learn from this mistake and keep going.

Smokers’ Thinking: I am doing really well. Just one cigarette won’t hurt.

Clear Thinking: You have never smoked just one cigarette before. One always leads to another, and you don’t want to undo my progress by smoking now.

Smokers’ Thinking: It’s too hard to quit smoking. I can’t do this.

Clear Thinking: Roughly 40,000 American have quit smoking. If other people can do it, so can you. It is too important to give up on.

For people living with chronic obstructive pulmonary disease (COPD) and other chronic lung conditions, the importance of quitting cannot be stressed enough. By arming yourself with these positive thoughts, you will ensure that cravings will be put to rest and you will be well on your way to being a nonsmoker.

For More Tips Like These, Visit Smokefree.gov.

Can Natural Remedies Help Treat COPD?

There is no shortage of natural remedies on the market today to treat, heal and cure our many ailments—chronic obstructive pulmonary disease (COPD) included. However, people living with COPD and other lung-related illnesses should be cautious when using these supplements to treat or manage their condition. That is according to a recent article published by Everyday Health.

Unlike prescription drugs, natural remedies are not regulated by the U.S. Food and Drug Administration and have not undergone the extensive research and scrutiny that prescription drugs receive before entering the marketplace. Therefore, many doctors and researchers are still uncertain about the effectiveness of these supplements, as well as their side effects.

Following are several natural supplements that have been said to remedy symptoms associated with COPD, as well as comments from experts on their effectiveness—or lack thereof.

  • Bromelain: A supplement created from the enzymes found in a pineapple’s stem and juice, bromelain is said to reduce inflammation associated with COPD. However, according to the National Institutes of Health, scientific evidence to support this claim is lacking.
  • Coenzyme Q10: An antioxidant that is naturally produced by the body, coenzyme Q10 has been said to increase cell activity and ease inflammation in people with COPD. Researchers have found that people living with COPD have especially low levels of coenzyme Q10; however, studies have not proven that taking the supplement improves conditions.
  • L-Carnitine: Typically produced by the body, L-carnitineis used to burn fat and boost energy. In COPD patients, this supplement appears to help strengthen muscles and improve endurance when exercising. Further, research has proven that those people who take L-carnitine supplements do significantly better during walking exercise programs.
  • N-acetylcysteine: An antioxidant available as an over-the-counter dietary supplement, N-acetylcysteine has been researched for its role in breaking down the mucus that can clog the lungs of people living with COPD. To date, research has showed mixed results on the supplement’s effectiveness.
  • Antioxidant vitamins: With properties of antioxidants, vitamins A, C and E have been said toimprove the lung function in people with COPD. Studies have shown that people living with COPD have low levels of these antioxidant-rich vitamins, and this deficiency can result in decreased pulmonary function. Further, studies have proven that COPD patients whose diets are rich in fruits and vegetables—a good source of vitamins A, C and E—saw improved lung function.

Note that natural remedies cannot serve as the sole source of COPD treatment. Consult with your physician before adding these supplements to your diet to ensure they do not interfere with current treatment methods.

Click Here for More Information on These and Other Natural Supplements.

Airway Bypass Procedure Fails Clinical Test

While early findings demonstrated promising results, recent studies have proven that patients with severe emphysema derive no significant benefits from a less-invasive alternative, known as airway bypass, to surgical lung-volume reduction, known as the sham procedure. That is according to a recent study published in The Lancet.

The study reports that airway bypass failed to improve lung function or dyspnea in comparison to the sham procedure, despite the successful release of trapped air in emphysematous lung tissue. Airway bypass was developed as an alternative to surgical lung-volume reduction, which was proven to improve breathing and reduce dyspnea. However, the surgery was the cause of substantial morbidity.

Performed by broncoscopy, airway bypass calls for the surgical creation of passages in bronchial airways, followed by the placement of paclitaxel-coated stents to maintain passages’ patency. Early studies demonstrated that airway bypass maintained efficacy for six months in patients with a residual volume/total lung capacity (RV/TLC) greater than 67 percent.

Encouraging early results led to the design of a randomized, controlled trial of airway bypass in patients with severe homogenous emphysema. Investigators at 38 centers across England, Germany, Brazil and the U.S. recruited 315 patients with severe hyperinflation. The patients were then randomized 2:1 to airway bypass or sham procedure.

At the end of the trial, 30 of 208 patients in the airway bypass group demonstrated improvements of 12% or greater in forced vital capacity (FVC) and at least a one-point decrease in dyspnea score, compared to 12 of 107 in the control group. Researchers reported that in the airway bypass group, mean FVC increased from baseline to day one but then returned to baseline over the next three months.

“Although our findings showed safety and transient improvements, no sustainable benefit was recorded with airway bypass in patients with severe homogeneous emphysema,” authors concluded.

Click Here to Access the Full Study From The Lancet

CT Scans May Be Helpful in Detecting COPD

Computed tomography (CT) scans may be helpful in identifying patients with chronic obstructive pulmonary disease (COPD), according to a recent study published in the Journal of the American Medical Association.

 

The study, which was conducted within an ongoing lung cancer screening trial, used prebronchodilator pulmonary function testing with inspiratory and expiratory CT scans to determine the accuracy of CT scans in identifying COPD. Both scans were performed on the same day on 1,140 male patients between July 2007 and September 2008. The average age of participants was 62.5 years.

Researchers then used the results of the pulmonary function tests to determine whether the CT scans accurately diagnosed patients with COPD. Data for self-reported respiratory symptoms was available for 1,085 participants, with 41% reporting physician-diagnosed emphysema and 93% reporting physician-diagnosed bronchitis. Based on the results of the pulmonary function testing, 38% of patients were classified as having COPD.

The final diagnostic model for the study included five independent factors associated with COPD: CT emphysema, CT air trapping, body mass index, pack-years (the number of packs of cigarettes smoked per day multiplied by the number of years the person has smoked) and smoking status. Using the point of optimal accuracy, the model identified 274 participants with COPD with 85 false-positives, a sensitivity of 63 percent, a specificity of 88 percent and a positive predictive value of 76 percent. This corresponds to a COPD-diagnosis for 63% of participants.

“If the results of this study are validated and confirmed and are found to be generalizable, it may be reasonable to consider adding an expiratory CT scan to the (baseline) inspiratory CT scan for additional evaluation of COPD because this would improve diagnostic accuracy,” the authors wrote. “[Further], the additional scan can be obtained within the five minutes needed for lung cancer screening, so a substantial amount of extra scan time is not required.”

The researchers note that quantitative CT scans cannot replace pulmonary function testing as a primary screening method for COPD.

Click Here to Access the Full Study from the Journal of the American Medical Association.

Early Detection of COPD Instrumental in Lung Cancer Diagnosis

While it is well-known that chronic obstructive pulmonary disease (COPD) is a significant risk factor for lung cancer, with approximately 1% of COPD patients developing the cancer each year, a recent study has shown that the early detection of COPD is instrumental in picking up more cases of lung cancer in COPD patients.

The study, which was published in the European Respiratory Journal, found that patients with COPD had a fivefold increased risk of developing lung cancer. Researchers discovered this increased risk through a review of medical evidence, with findings sufficient to justify CT screening for lung cancer among those diagnosed with COPD.

While low-dose computed tomography (LDCT) is an effective procedure for the early detection of lung cancer in high-risk patients, determining which patients should be screened for the cancer in a primary care setting is difficult. However, researchers now believe that patients who have been diagnosed with COPD should be screened by CT scan to detect lung cancer at an early stage. Further, the lung function of former and active smokers should be routinely tested to help identify COPD at an early stage.

Researchers propose that for the prevention of both diseases, COPD screening in smokers should be initiated as early as possible, so that they can stop smoking and candidates for an efficient lung cancer screening program can be identified.

“Both COPD and lung cancer have high mortality rates and a serious economic impact worldwide,” said study leader Yasuo Sekine, an associate profession at Tokyo Women’s Medical University. “The findings from our analysis suggest that early detection of COPD in addition to lung cancer screening for these patients could be an effective detection technique for lung cancer.”

Click Here to Access the Study from the European Respiratory Journal

Online Tool Allows Patients to Better Manage Chronic Illnesses

Individuals suffering from chronic illnesses, such as heart disease, asthma, arthritis, diabetes, bronchitis or emphysema, now have an online resource to help them learn how to better manage their disease and improve their health. The tool, Better Choices, Better Health™, is being offered free of charge by OASIS, a national education organization dedicated to enriching the lives of adults age 50 and older through health and wellness, education and enrichment programs.

Better Choices, Better Health is an online version of the internationally recognized Chronic Disease Self-Management Program (CDSMP), developed and tested at the Stanford University Patient Education Research Center. The six-week online workshop provides users with information on a broad range of topics, from an overview of self-management and chronic health conditions to action plans, how to deal with emotions, depression and fatigue, exercise and nutrition, medication management and how to work with healthcare professionals.

To complete the workshop, participants must log on to the website for two hours each week and complete readings and interactive learning exercises via the Better Choices, Better Health Learning Center. Included in the interactive learning plan are weekly action plans, problem solving and guided online exercises and other self-tests and activities. Participants are also encouraged to post their disease-related problems on the website’s bulletin board and help other group members with problems they encounter.

Trained peer facilitators moderate each workshop. They are available to facilitate discussions, monitor participation, answer questions, assist program participants with problem solving and ensure that individuals who are seeking specific medical advice turn to their healthcare provider.

For those individuals without Internet access or who prefer to attend a workshop in person, OASIS also offers a classroom version of the class, Living a Healthy Life.

For more information or to register for either of the OASIS programs, visit www.oasisnet.org/betterchoices.

Scans May Identify Patients at Increased Risk of COPD Complications

Quantitative CT scans may help identify chronic obstructive pulmonary disease (COPD) patients at a heightened risk of flare-ups more effectively than spirometry, according to a recent study published in the journal of Radiology.

The study, which was conducted by researchers from National Jewish Health and the COPDGene research consortium, identified a correlation between symptom exacerbations and the level of tissue destruction (emphysema) and thickness of the airway walls. Researchers note that the worse the emphysema and airway wall inflammation, the more likely the patient is to have a COPD exacerbation.

Because quantitative CT scans digitally measure lighter and darker areas of the scanned area to detect inflammation and tissue damage, doctors are able to better measure emphysema and airway wall inflammation using this method. This is not possible with spirometry tests because they only measure airflow obstruction.

“The findings also help us identify distinct phenotypes among the COPD patient population, who could benefit from individualized, targeted management of their disease,” James D. Crapo, MD, professor of medicine at National Jewish Health in Denver, Colo., and co-author of the paper, said in a release about the study.

COPD exacerbations can deplete lung function and often require hospitalization, which makes recognizing symptoms important in COPD management. Identifying at-risk patients before they experience exacerbations is a step toward better treatment, as doctors can ensure that those patients have flare-up medications on hand and can emphasize the importance of an exacerbation action plan so that patients know what to do when an exacerbation happens.

Click Here to Access the Full Story from the Journal of Radiology.

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