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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COPD: Delving into Inhaler Adherence

To achieve optimal outcomes, it is essential that patients with chronic obstructive pulmonary disease (COPD) adhere to the long-term use of pharmacotherapies. Patients who follow their treatment plan are less likely to experience exacerbation, hospitalization and preventable death. Often, they also have fewer medical costs than those who are not adherent.  

According to a study, poor inhaler adherence increased the “risk of hospitalization by 58% and death by 40%.” Although most patients are aware that COPD is a progressive condition, overall medication adherence is significantly low. To reverse this trend, it is critical that healthcare teams collaborate to “ensure that patients with COPD use medications properly, consistently, and persistently.”

Inhalers are critical to successful COPD management. In recent years, researchers have discovered two approaches that can aid healthcare providers in assessing COPD patients’ medication use. The Morisky-Green test consists of four questions that clinicians should ask patients regarding their attitude toward their medication. Similarly, the Batalla test consists of two questions that clinicians can ask to assess a patient’s knowledge and understanding of their condition.

Improving Adherence

Patients who have received education regarding their COPD have confidence in their medication and hold realistic expectations about their treatment have a higher likelihood of faithful use. However, patients who doubt the effectiveness of both their medications and clinicians, and who smoke or have comorbid depressed, have a higher probability of nonadherence.

Patients’ attitudes towards their medications are a key determinant of how often and consistent the use. This supports the need for pharmacists to encourage adherence by explaining how a patient’s “medications work, when to use as-needed doses,” and what to expect.  

Getting the Medication and Inhaler Right

Pharmacists can also help to improve adherence through medication selection. Patients may be adherent to one inhaler, yet fail to use another for various reasons such as preferring a once-daily dose administration.

By considering each patient’s needs and preferences, including the patient’s medication use history and the individual inhaler’s characteristics, “pharmacists can help patients with COPD find the inhalers to which they are most likely to adhere.”

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What Are the Best Forms of Exercise for COPD Patients?

Although exercise cannot reverse chronic obstructive pulmonary disease (COPD), it is key to effectively manage the condition and enhance overall health. Despite the prevalence of lung damage that leads to COPD, exercise can also help to avoid deterioration of the condition that can result in increased breathlessness and a worsening prognosis.

A study published in the Annals of the American Thoracic Society reveals the “association between physical activity levels and hospitalizations among a large group of COPD patients.” The results showed that patients who participated in any level of consistent moderate to vigorous physical activity had a profoundly lower risk of 30-day hospital readmission.

Researchers noted that physical inactivity reflects a worsened state of the disease, and the results support the theory that “promoting and supporting physical activity is a promising strategy not only to reduce the risk of having the [initial] hospitalization but also to buffer the stresses of hospitalization…Our findings further support the importance of physical activity in the overall management of COPD across the care continuum, including care transition efforts to reduce 30-day readmissions.”

The following steps highlight the most beneficial exercises for COPD patients and how they can incorporate them into their daily routine.

Get Checked Out

It is essential for COPD patients to first speak with their doctor before beginning any exercise routine to ensure they can safely increase their levels of physical activity. As part of COPD management protocol, doctors will often prescribe a pulmonary rehabilitation program which can help patients learn the most effective exercises and how to accurately perform them.

Stretching and Relaxation

Stretching is an optimal practice to begin before an exercise session, as it can help to loosen muscles and prevent an injury from occurring. For COPD patients in particular, “loosening up the muscles around the neck, chest and upper back may offer more room for the lungs to expand,” effectively enabling individuals to breathe easier.

Additionally, practicing yoga or tai chi can help to loosen muscles and encourage relaxation. Finding effective stress reduction techniques is essential as COPD can induce anxiety due to breathing complications and worsen symptoms. Both pursed-lip and diaphragmatic breathing are effective techniques to help patients relax, since they can help to “reduce some of the hyperinflation of the lungs that can result from COPD.”

Strengthening

COPD patients can also benefit from strengthening exercises for both the upper and lower body, such as lifting light free weights, and using weight machines or stretchy resistance bands. Lower body resistance exercises may also incorporate “side leg lifts, heel-to-toe lifts and repetitions of rising from seated to standing positions.”

Upper Extremity Endurance

Improving and maintaining both upper extremity strength and endurance is essential, so patients can remain independent. Upper extremity endurance includes the ability to reach for items on high shelves or dress themselves. To build upper body endurance, many patients utilize an arm ergometer – “a small, tabletop bicycle that’s pedaled with the arms.” If patients don’t have access to this machine, they can also use resistance bands or practice arm exercises to facilitate upper extremity strength.

Lower Body Endurance

Lower body endurance exercises, such as walking and cycling, are recognized as the “cornerstone” of a pulmonary rehabilitation program and are essential for COPD patients to regularly practice. Without this endurance, patients are more likely to experience difficulty in completing daily tasks. Depending on the stage of their COPD, patients can also benefit from incorporating water aerobics and swimming into their exercise regimen.

Start Slowly and Build Gradually

It’s also important to note that if a patient has been mostly inactive for a significant period of time, they should steadily ease back into a regular exercise routine and build gradually allowing the body to adjust. Choosing an activity that is enjoyable can also help to create a long-term lifestyle change.

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Can Vitamin A Help With My CPOD?

Although a growing body of literature supports the fact that cigarette smoking is the top risk factor associated with developing chronic obstructive pulmonary disease (COPD), it is not the sole cause. In fact, scientists are still perplexed as to how exactly “cigarette smoke and other inhaled irritants can trigger the development of COPD.”

One theory is that smoking cigarettes may “deplete the body of vitamin A,” a nutrient that builds and repairs lung tissue. If lungs lack adequate amounts of vitamin A, it can lead to the development of lung infections or chronic diseases of the lungs.

“The connection between vitamin A and the lungs starts from the very beginning, while we're developing in utero and continues well into adulthood,” said Dr. Antonello Punturieri, program director for COPD at the National Heart, Lung and Blood Institute. "The lungs are still developing until age 25 or 30. This is why teen smoking is so bad. Having an adequate vitamin A intake throughout this developmental period is critical to developing and maintaining strong, healthy lungs.”

A study published in the journal Molecular Aspects of Medicine revealed that moderate vitamin A deficiency can significantly enhance the occurrence of respiratory tract-related diseases. In addition to vitamin A’s involvement in lung function, it is also critical to the development of various tissues and cells, and embryonic lung growth.

Another study published in the New England Journal of Medicine revealed that pregnant women who took vitamin A supplements throughout their pregnancy “had children with better lung health when the researchers followed up 9 to 13 years later.”

Researchers in Holland published a study in the Journal of Physiology and Pharmacology focusing on laboratory mice bred to have reduced levels of vitamin A. After exposing the mice to cigarette smoke, it was discovered that they developed emphysema in a total of three months. The study could signify a potential correlation between cigarette smoke, reduced levels of vitamin A and the development of chronic lung diseases. Ultimately, this could signify the ability to reverse or cure lung damage caused by COPD.

Although various studies and evidence exists, scientists must still preform additional studies to determine if the intake of vitamin A can truly reduce COPD symptoms and its progression.

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People with Severe Emphysema May Breathe Better after EBV Therapy, Study Shows

A trial published in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine reveals that a minimally invasive procedure may help patients with severe emphysema breathe better.

The study analyzes the use of a one-way valve that prevents air from entering diseased regions of the lung. This, in turn, enhances lung function and enables healthier areas of the lungs to expand.

Previous studies highlighting the placement of the valves using a bronchoscope found that this therapy can be used as an alternative to lung volume reduction surgery. Patients with severe emphysema that participate in endobronchial valve (EBV) therapy “appear to experience similar improvements in lung function, shortness of breath, exercise intolerance and quality of life,” yet do not experience the occurrences of morbidity and mortality which have been associated with surgery.

"EBVs have been shown to work in single center trials, but these studies tend to be performed at centers, and by physicians, with considerable experience, so the results may not be generalizable to other centers," said lead study author Samuel V. Kemp, MD, a respiratory physician and expert in interventional bronchoscopy at Royal Brompton Hospital. "What is interesting about this multicenter trial is that the results are at least as good as the single center studies, even though some of the investigators were new to the technique."

All study participants were ex-smokers over the age of 40 and had been diagnosed with severe heterogeneous emphysema. Out of the 97 participants, sixty-five received the valves and the remaining patients were provided with standard of care specific to each medical center's protocols for a patient that had received bronchoscopy.

Researchers discovered:

• After three months, 55.4 percent of the EBV group had a 12 percent improvement in FEV1, the amount of air that can be forcefully exhaled in one second, compared to 6.5 percent of controls.
• After six months, the percentage of those in the EBV group meeting the minimum FEV1 improvement was 56.3 percent, compared to 3.2 percent of controls.
• The average increase in FEV1 in the EBV group was nearly 30 percent.
• After six months, secondary endpoints among those in the EBV group were also clinically and statistically significant, including being able to walk nearly 80 meters longer in six minutes, retaining 750 fewer milliliters of air upon maximum expiratory effort, exhibiting less shortness of breath and reporting higher quality of life.
• The most common adverse event in the EBV group was a collapsed lung, which occurred in 29.2 percent of the patients.

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Bariatric Surgery in Obese COPD Patients Lowers Risk of Hospitalization, Study Finds

According to a recent study in the journal Chest, titled, “Reduced Risk of Acute Exacerbation of COPD After Bariatric Surgery: A Self-Controlled Case Series Study,” the risk of hospitalizations and emergency room (ER) visits caused by acute exacerbations related to chronic obstructive pulmonary disease (COPD) decreases among obese patients who underwent bariatric surgery.

Nearly 6 percent of adults in the United States have COPD, 35 percent of whom are considered obese. According to studies, obesity may be a risk factor as it results in higher rates of acute exacerbations.

Researchers found that patients with COPD who lost weight realized enhanced outcomes, such as clinical scores and exercise tolerance. Yet, there are few statistics available regarding the impact weight reduction can have on additional issues associated with COPD, including acute exacerbations.

The study, conducted by researchers at Massachusetts General Hospital, analyzed 481 obese patients who were diagnosed with COPD and had undergone bariatric surgery between the years 2005 and 2011. The analysis studied each patient’s risk of acute exacerbations in COPD (AECOPD) that resulted in ER visits and hospitalizations over a two-year period, which was “compared to the patient’s risk in the pre-surgery period.”

It was discovered that 28 percent of obese COPD patients were hospitalized or visited the ER due to AECOPD 13 to 24 months before their bariatric surgery. However, within 12 months of post-bariatric surgery, only 12 percent of patients were at risk of being hospitalized or visiting the ER.

Although the “mechanism behind weight loss and a decreased risk of AECOPD” has yet to be discovered, researchers suggest that weight loss may reverse the correlation between obesity and COPD. Lung function can be impaired due to obesity as it can alter gut bacteria and lung operations, create systemic inflammation caused by proinflammatory mediators, and increase the risk of infections and additional conditions.

It has been concluded that bariatric surgery among obese COPD patients can “reduce proinflammatory levels and decrease the incidence of obesity-related health problems”, and ultimately lower the risk of AECOPD, hospitalizations and ER visits.

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Tips for Avoiding Pneumonia and Other Exacerbations When You Have COPD

Various complications can arise when an individual has chronic obstructive pulmonary disease (COPD), including increased susceptibility to lung infections such as pneumonia.

Defining Pneumonia

Pneumonia is the eighth leading cause of death in the United States and most common among individuals over the age of 65, smokers, young children and those with lung conditions including COPD. The infection can present in one or both lungs and often results from the prevalence of bacteria or viruses. Although rare, the infection can develop when certain fungi are directly touched or breathed in. Further, pneumonia can occur as a result of another illness “such as flu, measles, pneumococcus, whooping cough and Haemophilus influenzae type b (Hib).”

Pneumonia Symptoms

It is vital to contact your healthcare team if you are experiencing the following symptoms, as signs of pneumonia “can often be mistaken for a COPD exacerbation.”

• Fever or shaking chills
• Rapid breathing or shortness of breath more severe than usual
• Excess coughing producing lots of mucus
• Change in color of mucus
• Increased heart rate
• Pain in a specific area or areas of the chest when breathing deeply
• Nausea or vomiting
• Diarrhea

Although it remains essential to recognize the signs of pneumonia and other exacerbations and receive timely care, the COPD Foundation recommends taking preventative steps to reduce the risk of infections.

These include attending regular appointments with your healthcare team, washing your hands, quitting smoking and receiving annual flu and pneumonia vaccinations. Additional preventative steps individuals can take are refraining from touching their eyes, nose and mouth, avoiding large crowds throughout flu and cold season, eating a balanced diet and carrying writing implements instead of using another individual’s.

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