Research Pinpoints Role of Biomarker In COPD

A report suggests that people with chronic obstructive pulmonary disease (COPD) and asthma have a protein in their lungs that leaks a small molecule into their bloodstream which restricts their breathing instead of relaxing their airways.

Published in the American Journal of Respiratory Cell and Molecular Biology, the report says this discovery may help clinicians diagnose and determine the severity of chronic lung diseases and make current treatments more effective. A protein in the cell membranes of the lungs can leak cyclic adenosine monophosphate (cAMP), causing the airways to become constricted.

These cells control constriction of the airways in asthma. By losing cAMP, the cells are more apt to constrict and worsen asthma, researchers said. They defined cAMP in the bloodstream as a biomarker by analyzing blood samples from a well-defined cohort of asthma patients. They determined that cAMP blood levels are higher in asthma patients. 

The knowledge gained from this research allows for better diagnostics of the illness and forms the basis for new therapeutics that will plug the leak of cAMP into the protein.

Additional insights from Dr. Nair:  There is a certain “back to the future element” to cAMP and lung disease. Theophylline was used for asthma and COPD many years ago, but it fell out of favor due to side effects that would occur (high pulse, nausea, vomiting, insomnia, irritability) if it was not maintained at a certain level or therapeutic window. That level got thrown off easily by drug interactions, sometimes with common medications such as antibiotics and common conditions such as liver disease. At very high levels, cardiac rhythm abnormalities and seizures could occur. Also, it was not as effective as regular treatment. It is very rarely used anymore, except for people who have been on it a long time. 

There has been a search for a “cleaner version” of Theophylline. The closest we have come to is a medication called Daliresp (Roflumalast). It is more of an add on medication – sometimes it helps and sometimes it doesn’t. It is also limited by GI side effects.

To read more about the study, please visit AJMC.

COPD + OSA = OS

Obstructive sleep apnea (OSA) occurs when the breathing stops and starts repeatedly throughout the night. Chronic obstructive pulmonary disease (COPD) is a group of lung conditions that make breathing difficult by blocking airflow in the lungs. When the two conditions occur together – which they do about 13% of the time – it results in a condition called overlap syndrome (OS).

OS can be a cause for concern, as the combination of symptoms from COPD and OSA may make it hard for the body to get enough oxygen. Too, compared to people with COPD or OSA alone, someone with OS is more likely to experience:

• Nocturnal oxygen desaturation (NOD) – when blood oxygen levels decrease during sleep
• Hypercapnia – too much carbon dioxide in the blood
• Hypoxia – not enough oxygen in the blood

Lack of oxygen in the blood leads to oxidative stress. This then causes the release of “messengers” that cause an inflammatory response in cells and blood vessels called systemic inflammatory mediators, which can lead to the hardening of the arteries and a type of coronary artery disease called endothelial dysfunction. As a result, people with OS have a higher risk of developing high blood pressure and heart failure.

In terms of treating OS, the most effective option is noninvasive positive airway pressure (PAP) using a continuous PAP (CPAP) machine during sleep. A mask is worn over the mouth and nose to introduce pressured air into the lungs as a person sleeps by splinting open the collapsed upper airways. Lifestyle changes such as quitting smoking, maintaining a moderate body weight and pulmonary rehabilitation and a structured exercise program can also be beneficial for those with OS.

Other potential options, which may not be suitable for everyone with OS, include supplemental oxygen at night and use of bronchodilators and corticosteroids.

Additional comment from Dr. Nair: It is well known that there is an association between COPD and sleep apnea, although this can sometimes be missed because people with COPD do not have the body type commonly associated with sleep apnea (classically thought of as overweight). If you have any symptoms of sleep apnea, mention it to your doctor. In addition to quality-of-life issues, sleep apnea can magnify some of COPD’s bad effects, such as low oxygen and pulmonary hypertension. 

To read the complete article, visit Medical News Today. 

New Treatment Helps COPD, Emphysema Patients

A new procedure approved by the Food and Drug Administration (FDA) is helping certain patients diagnosed with chronic obstructive pulmonary disorder (COPD) and emphysema to breathe better. The procedure, endobronchial valves (EBV), involves placing valves in a patient’s lungs that can be moved or removed if needed. The results, so far, have been promising.

Some patients who’ve undergone it are moving forward with more breath, better endurance and have even been able to perform light work that they haven’t in years, in some cases. For example, one patient suffering with COPD since 1998 couldn’t catch her breath when moving about her house. Since undergoing the mostly painless procedure she has been able to resume yard work – something she hadn’t been able to do in years.

A good alternative to more invasive surgery options, which often involve removing portions of the patient’s lung and are painful, EBV is currently available to certain emphysema patients, who must pass heart, blood, and breathing tests to qualify.

Additional insight from Dr. Nair: “EBV therapy, as described here, may be on the verge of wider use. It is always good to add a new weapon to treat COPD and once again refute the notion emphysema is not reversible. EBV therapy is lung volume reduction therapy but does not require a full-blown surgery like true LVRS does. This therapy may seem ingenious, but it is not going to be successful in everyone. EBV therapy may be on the verge of wider use. It is always good to add a new weapon to treat COPD and once again refute the notion Emphysema “is not reversible.”

To read the complete article, click here.

New Study Finds Increased COPD Risk in “Metabolically Healthy” Obese People

A new study from the University of Glasgow’s Institute of Health and Wellbeing indicates that “healthy obesity” is a myth, as even those individuals who are considered metabolically healthy are at a higher risk of developing heart and respiratory diseases including COPD.

Metabolic health refers to things like whether a person has high blood pressure, insulin resistance, and high blood sugar, which are common issues that arrive in cases of obesity. Researchers found that metabolically healthy obese adults still had a 28% greater chance of developing a respiratory disease and 19% more likely to suffer COPD compared to their healthy non-obese counterparts.

The study, published in Diabetologia, looked at the association between metabolically healthy obese (MHO) and all-cause mortality, type 2 diabetes, heart attack and stroke, heart failure and respiratory diseases including COPD. The authors analyzed more than 11 years of data of 381,363 participants in the UK Biobank project who were classified as metabolically healthy non-obese (MHN), metabolically unhealthy non-obese (MUN) and MHO.

They found that MHO individuals were generally younger, watched less television, exercised more, had higher education level, lower deprivation index, higher red and processed meat intake, and were less likely to be male and non-white than participants who were MUO. Yet, when compared to MHN participants, they were 4.3 times more likely to have type 2 diabetes, 18% more likely to suffer heart attack or stroke, and had a 76% higher risk of heart failure.

Their findings led researchers to conclude that people with MHO “are not ‘healthy’ as they are at higher risk of heart attack and stroke, heart failure, and respiratory diseases compared with people without obesity who have a normal metabolic profile.”

“Weight management,” they add, “could be beneficial to all people with obesity irrespective of their metabolic profile. The term ‘metabolically healthy obesity’ should be avoided in clinical medicine as it is misleading, and different strategies for defining risk should be explored.”

Added Insights from Dr. Nair: As we saw with the COVID-19 pandemic, obesity can lead to some degree of immunocompromise, making one more susceptible to illness. Excessive weight can have negative effects on a patient’s overall health in many ways. Thus, controlling one’s weight can help improve quality of life for those with COPD.

Read more on the findings on Eureka Alert.

Poverty Impacts Respiratory Health

Despite dramatic reductions in adult smoking rates, vastly improved air quality, a plethora of safety mandates and other advances, low-income Americans continue to suffer from COPD and other respiratory illnesses at a disproportionately higher rate than their wealthier counterparts. The reason, according to a recent study in JAMA Internal Medicine, is likely socioeconomic.

Working with health examination survey data collected by the U.S. Centers for Disease Control and Prevention (CDC) over the past 60 years, researchers examined three types of pulmonary outcomes – respiratory symptoms, respiratory diagnoses, and spirometry results – in children ages 6-17 years and adults aged 18-74 years. They also assessed trends in current/former smoking prevalence. Socioeconomic status, this was defined by family income and (for adults) educational achievement, which was included in the CDC survey data.

What they found was that “many income-based gaps in indicators of lung health persisted or potentially worsened despite secular improvements in air quality, occupational safety, tobacco control, and medical care – and in average lung function – suggesting that the benefits of these advances have not been equitably enjoyed.”

Researchers noted that multiple factors likely contribute to these disparities. Among these are unequal exposure to cigarette smoke, air pollution, workplace hazards, pulmonary infections, in utero exposures, premature birth, nutritional deficiencies, and other factors. 

They concluded that, despite overall improvements in air quality and occupational exposures, individuals with lower socioeconomic status and racial/ethnic minorities still encounter more unhealthy exposures on the job and live in more polluted neighborhoods.

“Destitution also increases individuals’ susceptibility to air pollution, possibly owing to interaction with other harmful exposures or chronic illness. Finally, unequal access to health care may play a role; good medical treatment of airway disease can improve symptoms and lung function,” they wrote, noting that these disparities “are likely clinically significant…suggesting that the widening disparities we found could contribute to the growing income-based inequalities in US life-expectancy.”

Added Insights from Dr. Nair: Socioeconomic status is, on its own, just one of many factors that can affect one's ability to stay healthy. 

Read the full study in JAMA Internal Medicine and coverage in The New York Times.

Supporting A Loved One with COPD

Caring for a loved one struggle with chronic obstructive pulmonary disease (COPD) is an extremely difficult job – one that you may doubt that you can handle. But being there for your loved one, offering your support and encouragement, can go a long way toward improving their quality of life and easing some of their symptoms.

And while it can be hard to watch someone you love suffer with an uncurable disease, there are things you can do to make things a little bit easier on them.

• Get them to quit smoking — Tobacco smoke is the primary cause of COPD. If someone continues to smoke after they have been diagnosed, talk to them about quitting or research nicotine replacement therapies and local support groups on their behalf. If you smoke, set a good example by quitting, especially since secondhand smoke is equally harmful.
• Be their exercise buddy — Gentle exercise can improve a COPD sufferer’s breathing and strengthen their respiratory muscles. After clearing it with their doctor, invite your loved to take short walks around the neighborhood, gradually picking up the pace each time.
• Stay healthy —Respiratory infections can worsen COPD symptoms, so it is important to avoid spreading germs to a patient or loved one. Get an annual flu shot and keep your distance if you have a cold or any other illness. If you get sick while living with someone who has COPD, disinfect all surfaces, don’t prepare their food and always wear a mask.
• Keep indoor air clean — Reducing air pollution at home can help someone cope with their COPD. Avoid using strong-scented cleaning products and stay away from air fresheners or plug-ins. Also be aware of what you put on your body — strong perfumes, lotions or hairspray can trigger a COPD flare-up.
• Help make their house COPD-friendly — The simplest task can cause breathlessness in those living with COPD, so taking steps such as installing a shower chair can help a loved one conserve energy. Assisting with meal preparation and keeping their house free of any dust and debris that can make breathing difficult are also helpful.
• Accompany them to a doctor’s appointment — People with COPD have a lot on their mind, which can make it hard to remember everything a doctor tells them. Go along with them to appointments and take notes or bring along a tape recorder so nothing important is missed.
• Educate yourself — Learning more about COPD will help you better understand what a loved one is going through and their limitations. The more you know, the more encouraging and supportive you will be.
• Recognize signs of distress — No one wants to burden loved ones, which is why people with COPD aren’t always honest about how they feel. Teaching yourself to identify ailments such as heart problems, respiratory infections or depression lets you know when it’s time to encourage a loved one to seek medical attention.

Added Insights from Dr. Nair This article has some nice points but also some things with which I disagree. I don't like emphasizing that COPD is incurable. Aside from infections, diseases with surgical treatment (e.g., appendicitis) and many cancers, most diseases required some concession to be made to control them, whether it be taking medications, eating healthier or making lifestyle changes. COPD is no different. In fact, when you think about it, most ailments don't just disappear – they are, for all intents and purposes, uncurable. The key is you can live with them even if they aren’t curable. 

I particularly like the emphasis on the significant burden caregivers carry, and the importance of self-care. If you don't take care of yourself, you can't take care of others.

Read the complete Healthline story to learn more about taking care of a loved one living with COPD.

How Singing can help COPD Sufferers

There are several different medications and treatments that ease the symptoms of chronic obstructive pulmonary disease (COPD). But according to one English study, singing can help soothe this savage beast of a condition without a prescription.

Those who participated in the study, conducted by England’s Canterbury Christ Church University, sang in weekly 60-minute sessions for 12 weeks. At the end of the study, researchers found that participants’ lung function maintained or improved, and COPD didn’t progress.

Researchers theorize that singing allows COPD patients to inhale without anxiety and take deeper breaths that clear their lungs more efficiently. Participants also got an emotional boost, reporting that the sessions lifted their spirits, promoted relaxation and reduced anxiety and depression – all of which can be very helpful in coping with COPD.

Andrea Paul, MD, Chief Medical Officer at www.boardvitals.com, recommends COPD patients participate in 30-minute singing sessions a few times a week.

“It is truly fantastic to be able to offer these patients an option that is not only free, but also fun,” she Paul.

Added Insights from Dr. Nair: Singing involves controlling your breathing pattern, which is very important with this disease. The “O” in COPD stands for obstruction – especially airflow OUT of your lungs. The most important thing when short of breath is to remember to breathe out slowly because it allows more time for air to be exhaled. 

Read the complete blog on Philips for more information on how singing can help ease symptoms associated with COPD.

The Four Stages of COPD

It is estimated that 174 million people suffer from chronic obstructive pulmonary disease (COPD) and 3 million will die from it each year. Depending on how far it has progressed, COPD can be divided into four stages, ranging from Stage 1 (very mild) to Stage 4 (extremely severe).

These classifications are based on the Global Initiative for Chronic Obstructive Lung Disease, or GOLD, system, which is a program started by the National Heart, Lung, and Blood Institute and World Health Organization. GOLD grades COPD based on the results of a spirometry test, which measures the strength and speed each time a person exhales, combined with subjective measures of symptom severity.

Your doctor will look at two specific numbers from the spirometry test: 1) FVC, or force vital capacity, which is the total amount of air you breathe out, and 2) FEV1, or force expiration volume in one second, which is the amount you can breathe out in one second. A FEV/FVC ratio of less than 0.7 indicates COPD. Symptom severity is typically determined using either the British Medical Research Council (mMRC) questionnaire or the COPD Assessment Test (CAT).

It is the combination of these findings that determines the stage of COPD. Each stage has a unique set of symptoms and treatments, as outline below.

Stage 1: Symptoms are so mild that most people see no difference in their lung function. Your doctor may recommend a bronchodilator medication to open your airways. Lifestyle changes will also be encouraged, such as quitting smoking — the top cause of COPD — and avoiding secondhand smoke.

Stage 2: Symptoms worsen to the point where people typically seek medical attention. Coughing and mucus production become more severe, and you may experience shortness of breath when exercising or walking. Doctors will typically recommend pulmonary rehabilitation during this stage to learn how to better manage your COPD. Steroids and oxygen are also often prescribed to mitigate dangerous flare-ups.

Stage 3: Symptoms are so severe that patients may not be able to do simple chores and often can’t leave the house. Flare-ups will become more frequent. Shortness of breath and coughing will worsen. Additional symptoms in this stage include frequent colds, swollen ankles, and wheezing. Most patients will be prescribed an oxygen tank to assist with their breathing.

Stage 4: Oxygen blood levels are very low, and the risk of developing heart and lung failure is very high. Flare-ups are more frequent and can sometimes be fatal. Treatment includes surgical intervention such as a lung transplant or a bullectomy, where large areas of damaged air sacs in the lungs are removed.

Added Insights from Dr. Nair: Everyone’s disease trajectory will be unique, so don’t allow yourself to get pigeonholed into any particular category or defined by any number. The bottom line is to lead the best life you can, regardless of stage.

Read the complete story on Healthline to learn more about the stages of COPD.

The COPD-Lung Cancer Link

A recent study shows that people with chronic obstructive pulmonary disease (COPD) are twice as likely to get lung cancer, while another found that 77% of lung cancer patients with COPD lived five years post-cancer diagnosis compared to 91% of those without COPD.

Once you are diagnosed with COPD, it is important for you and your doctor to pay close to attention to any signs indicating lung cancer. Though the two conditions have similar symptoms, such as coughing and difficulty breathing, there are subtle difference. As such, if you are experiencing one or more of the following symptoms, you should call your physician as soon as possible:

• Fatigue
• Loss of appetite
• Unexplained weight loss
• Chest pain unrelated to coughing
• Hoarseness
• Bronchitis, pneumonia, and other recurring lung infections
• Coughing up blood or mucus marked with blood
• A nagging cough — even a dry one — that won’t go away

Read the complete Healthline story for more on COPD and its relationship to lung cancer.