Study Reveals How HIV Virus Destroys Lung Tissue

A recent study published in Cell Reports exposes the damage human immunodeficiency virus (HIV) has on lung tissue. Weill Cornell Medicine researchers discovered a mechanism that could explain why nearly “30 percent of HIV patients who are appropriately treated with antiretroviral therapies” are later diagnosed with emphysema. Further, the study reveals how HIV binds to and transforms basal cells lining airways. These altered cells then release enzymes that can “destroy lung tissue and poke holes in walls of air sacs.”

“This research is important because although antiretroviral agents have turned HIV into a chronic, rather than deadly, disease, the viral reservoirs that remain in the lungs and other tissue continue to cause serious side effects,” said senior author Dr. Ronald Crystal, chairman of the Department of Genetic Medicine and the Bruce Webster Professor of Internal Medicine at Weill Cornell Medicine, and a pulmonologist at New York-Presbyterian/Weill Cornell Medical Center. “Now that we have more information about how the HIV virus might cause emphysema, we can learn more about this potential enzyme target and work toward developing a therapy to prevent this lung damage from happening.”

Although antiretroviral agents have helped to extend the lives of HIV-positive patients, they develop “degenerative disorders of the brain, heart and lungs” significantly more often than the general population. There are various explanations for this occurrence, including the belief that the antiretroviral drugs may in fact lead to these outcomes.

To gain insight, researchers exposed normal human airways basal cells, acquired from the lungs of nonsmokers, to HIV. Under observation, it was discovered that the virus “bonded to the basal cell’s surface and reprogrammed them to start producing an enzyme.” This enzyme then began to deteriorate proteins as well as destroy tissues. This finding is significant as emphysema originates in the airways, when basal cells are transformed due to the virus they begin to destroy healthy lung tissue which ultimately leads to emphysema.

“Our next step is to conduct additional research to determine what the preventive therapeutic target might be,” Crystal said, “And then, since basal cells are so important to normal lung anatomy and lung function, determine the other side effects of this re-programming.”

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Using Apps to Persuade People with COPD to Increase Physical Activity

A study published in Journal of Medical Internet Research provides insight into how technology-based interventions could increase daily walking levels of people with COPD after they complete pulmonary rehabilitation to help them “experience a higher quality of life and fewer acute exacerbations. Researchers developed and implemented three prototype applications based on various persuasive technology design principles including “dialogue support, primary task support, and social support.”

“Our aim was to inform the choice of design principles and specific persuasive techniques in the design of an app that could be used to encourage physical activity in this population,” the researchers wrote.

The first prototype utilized dialogue support, along with a virtual coach that addressed the user by their name and instructed them through their goals. Users had the option to receive reminders and “audio encouragement while walking.” The application also “provided a suggested exercise plan with daily goals.”

The second prototype was based upon a primary task support approach. This approach enabled users to set goals and track activity on their mobile device. While engaging in exercise, users were “offered feedback with activity levels for each day.” In addition, the prototype allowed for users to pick their preferred music and highlighted “local exercise facilities on a map.”

The third prototype incorporated the social support approach to “build a community of similar users to support physical activity.” Participants could compete and collaborate with other users, as well as share tracked activity. The application also, “awarded points when users achieved their goals with the potential for both virtual and real-world rewards.”

The study found that out of all three prototypes, the first was the most persuasive and most likely to be used. The second prototype was deemed the most likely application to encourage, “participants to use a technology.” The third prototype was reported to be the least persuasive and inappropriate as the competitive component could “dishearten users.”

Highly ranked features included “features of tips and advice on performing activity,” as well as the ability to set customized goals and view graphed levels of activity. The lowest ranked features included the identification of local sporting facilities, achieving trophies based on the completion of goals and the display of points earned by other participants.

“The findings suggest that a system that supports dialogue between the user and the technology alongside supporting the primary task (here, walking) to promote the self-regulation of physical activity is likely to be acceptable to [people with COPD] and perceived as persuasive,” the researchers wrote.

Click Here to Access the Full Article on The American Journal of Managed Care

Have COPD? Exercise Helps Keep You Out of the Hospital

Flare-ups caused by chronic obstructive pulmonary disease (COPD) can lead to hospitalizations and emergency room visits. Common symptoms of COPD, such as shortness of breath, chest tightness and fatigue, can make it difficult to exercise, yet exercise can alleviate COPD symptoms and enhance quality of life. According to pulmonologist Kathrin Nicolacakis, MD, adhering to a weekly exercise routine will improve the health of individuals experiencing mild, moderate and severe COPD.

For those with mild COPD, Nicolacakis recommends individuals adhere to a, “light cardio program, such as walking or swimming.” Participating in exercise lowers resting heart rate and blood pressure to ensure lungs don’t work as hard. As chest muscles are strengthened and breathing improves, individuals become less susceptible to flare-ups. Exercise can also support weight loss, which helps lungs function more easily.

Pulmonary rehabilitation programs can also have a major impact on the lives of individuals with moderate and severe COPD. These programs equip individuals with a team of experts, including a respiratory therapist specialized in exercise physiology, who will test for exercise capacity. The team will then create a personalized pulmonary rehabilitation program that focuses on, “breathing exercises, cardio exercise and resistance training.”

Once the individual completes the program, the team will reassess their exercise capacity and help to “develop a year-long exercise plan to sustain” progress. The benefits of completing a pulmonary rehabilitation program include reduced rates of exacerbations, flare-ups, ER visits, anxiety, and instances of shortness of breath.

“Patients report feeling better at the end of the program. They also have fewer hospitalizations than patients who don’t complete rehabilitation,” Nicolacakis said. “If you’re interested in pulmonary rehabilitation, ask your doctor to refer you to a program that follows American Heart Association guidelines. Choose either a COPD program or one that is staffed by people experienced in COPD.”

Click Here to Access the Full Article on Cleveland Clinic

As the Thermostat Goes Up, COPD Symptoms May Worsen

A recent study, published in the Annals of the American Thoracic Society, revealed that chronic obstructive pulmonary disease (COPD) symptoms worsen when individuals are exposed to high indoor temperatures and air pollutants.

In the study, “Respiratory Effects of Indoor Heat and the Interaction with Air Pollution in COPD,” conducted by Meredith C. McCormack, MD, MHS, along with her John Hopkins University colleagues, 69 participants with moderate to severe COPD were analyzed throughout the hottest recorded days of the year.

A daily questionnaire was provided to participants that included the Breathlessness, Cough, and Sputum Scale (BCSS), “which provides a standardized rating of respiratory symptoms.” Lung function was analyzed through daily spirometry. Participants also documented their use of rescue inhalers.

Based on the questionnaire results, researchers discovered that “participants spent the overwhelming majority of their time indoors and that BCSS scores worsened with rising indoor temperatures and the use of rescue inhalers also increased. Additionally, the “effects of higher indoor temperatures were experienced immediately and continued for one to two days and although 86 percent of participants lived in a home with some form of air conditioning, they did not turn it on during 37 percent of study days.”

McCormack believes that rising temperatures attributed to global warming will provide healthcare professionals with “an opportunity for targeted interventions and policy makers with the need to develop mitigation strategies to protect those most vulnerable to heat.”

"Given that participants spent an overwhelming majority of their time indoors, which we believe is representative of patients with COPD generally, optimizing indoor climate and reducing indoor pollution represents a potential avenue for improving health outcomes," said McCormack.

Click Here to Access the Full Article on ScienceDaily

Depression Linked to Reduced COPD Medication Adherence

A recent study published in the Annals of Thoracic Society, found that older adults with chronic obstructive pulmonary disease (COPD) showed a lack of adherence of medications after being diagnosed with depression.

Coauthor of the study, Linda Simoni-Wastila, said, “with a prevalence of 17 to 44 percent, depression remains one of the most common, yet least recognized and under-treated, co-morbidities among patients with COPD."

Between 2006 and 2012, a random sample of Medicare claims were analyzed with a focus on a, “relationship between a new episode of depression and COPD medication adherence.” The beneficiaries that were examined had, “filled their COPD prescriptions at least twice in the 24 months after diagnosis in their analysis.” The study was then narrowed down to the 20% of those beneficiaries who had been diagnosed with depression, “within 24 months after a COPD diagnosis.”

The study also found that the, “average monthly adherence to medications for COPD was low among all of the patients, peaking at 57% 1 month after the first prescription and dropping to 35% within 6 months. Only 20% of patients with depression and COPD fell into the highest adherence category during the 24-month follow-up period compared with 22% of patients with COPD who did not have depression.”

Further investigations found that patients who were diagnosed with over three conditions had, “the highest risk for poor adherence.” This insinuates that, “patients may prioritize filling certain medications or may struggle to maintain complex regimens.”

The researchers hope that the study will raise awareness about the correlation between reduced medication adherence and patients with multiple medical conditions.

Click Here to Access the Full Article on Medscape

Free COPD, Asthma Resources Now Available for Physicians and Patients

The American Academy of Family Physicians (AAFP) is now providing updated resources, including a booklet and brochure, focusing on the differences and similarities between asthma and chronic obstructive pulmonary disease (COPD).

The booklet, "COPD and Asthma: Differential Diagnosis," was released for physicians, which contained information on the, “diagnostic differences between COPD and asthma, how to help patients self-manage their illness, and the importance of short- and long-term monitoring. It also provides guidance on how to maximize lung function and manage exacerbations and airflow limitations.”

The booklet highlights some of the more prominent differences in between COPD and asthma including:

• Asthma on-set occurance before the age of 20, while COPD on-set occurs after 40,
• Asthma symptoms generally vary over time, while COPD symptoms often persist with treatment,
• Asthma symptoms improve with bronchodilator treatment, while COPD symptoms may not respond to bronchodilator treatment.

The patient education handout, "COPD and Asthma: What You Need to Know", includes the definition of COPD and asthma. The handout also contains information about common symptoms and treatment options.

Both the booklet and brochure were sent to, “AAFP members and internal medicine physicians who subspecialize in pulmonology in the 14 states that have the highest prevalence of COPD.”

Clare Hawkins, a physician who helped develop the materials, explained, “The number of people who get ill and (are) hospitalized makes this a big public health priority, especially in disadvantaged populations.”

Both COPD and asthma are greatly impacting the health of Americans and may be underdiagnosed. Both conditions also appear alike, due to the symptoms.

“COPD is the third leading cause of death in the United States, according to the American Lung Association. An estimated 12.7 million Americans have been diagnosed with COPD, and 24 million U.S. adults have evidence of impaired lung function.”

Asthma is also a growing condition in the U.S., with 22.5 million Americans diagnosed. “The condition is responsible for nearly 440,000 hospitalizations, 1.8 million emergency department visits and 14.2 million physician office visits.”

The AAFP’s physician resources should aid physicians in selecting the best treatments for patients on an individual basis and focus on smoking cessation.

Click Here to Access the Full Story on American Academy of Family Physicians

Can COPD Patients Benefit From Music Therapy?

A recent study finds that music therapy benefits chronic obstructive pulmonary disease (COPD) patients. The disease, “affects a person’s lungs and breathing, and the study found that music therapy in conjunction with traditional therapies can help improve symptoms better than standard treatment alone.” COPD symptoms include tightness of the chest, shortness of breath, and an ongoing cough.

Sixty-eight individuals, “who were diagnosed with chronic disabling respiratory diseases, including COPD,” participated. The study was conducted over a six-week period while, “a randomized group underwent musical therapy involving live music, visualizations, wind instrument playing and singing, which incorporated breath control techniques.”

“Music therapy has emerged as an essential component to an integrated approach in the management of chronic respiratory disease. The results of this study provide a comprehensive foundation for the establishment of music therapy intervention as part of pulmonary rehabilitation care,” explained Dr. Jonathan Raskin.

COPD patients have treatment goals, which strive to, “relieve symptoms, slow progression of the disease, improve exercise tolerance, prevent and treat complications, and improve overall health. These goals can be met with medical intervention and treatment coupled with alternative methods.”

Alternative remedies for COPD include:

• Control your breathing: Speak with your doctor or breathing specialist to find ways to better control your breathing
• Clear your airways: Keep your airways clear of mucus by drinking water, using a humidifier, and controlling your coughs
• Exercise regularly: Regular exercise improves overall strength and respiratory muscles.
• Eat healthy foods: A healthy diet keeps your weight in check and maintains overall strength
• Avoid smoke and air pollution
• See your doctor regularly

One of the most effective ways to prevent COPD is to completely stop smoking, as COPD is strongly linked to smoking.

Click Here to Access the Full Article on Bel Marra Health

Why is Anxiety Common Among COPD Patients?

Findings from a recently released study from COPD: Journal of Chronic Obstructive Pulmonary Disease, illustrated that “levels of anxiety are up to three times higher in older adults with chronic obstructive pulmonary disease (COPD) than in patients without COPD.”

Why is this?

The study, conducted by researchers from the University of Toronto, sampled more than 11,000 adults (50 years of age or older), measuring for “sociodemographic factors, social support, health behaviors, sleep problems, pain, functional limitations and early childhood adversities.” Based on these factors, the research team determined that of the more than 700 adults that reported their COPD diagnosis, “one in 17 had anxiety within the past year, or about 5.8 percent.”

Lead study author, Professor Esme Fuller-Thomson, noted that “even after accounting for 18 possible risk factors for Generalized Anxiety Disorder (GAD), individuals with COPD still had 70 percent higher odds of GAD compared to those without COPD.”

So, what are the risk factors associated?

The study was able to determine that “lack of social support and exposure to parental domestic violence during the patients’ childhoods” was one of the leading factors. Additionally, “older adults without social support involved in their important decision making had more than seven times the odds of having anxiety in comparison with the patients who did have a friend or social support.” In participants who had been exposed to ten incidences or more of parental domestic violence, “their odds for anxiety in comparison to the adults without COPD rose to about five times the risk” of those patients without COPD.

The study’s aim was to highlight the need for healthcare provider’s participation in “identifying and providing promising interventions to reduce anxiety for individuals with COPD, in particular by screening for and addressing pain and functional limitations and targeting those most at risk.”

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Dealing With Declining Lungs: Weapons to Control COPD

Lung diseases like chronic obstructive pulmonary disease (COPD) and emphysema can often lead to increased and worsened health problems if left untreated. The most powerful treatments often come in the form of exercise, education, breathing methods and taking medications as prescribed.

It has been noted in several studies that a combination of these techniques can help slow the progression of such diseases and improve quality of life. Additional benefits have also been seen when COPD patients quit smoking, lower their blood pressure and properly manage their weight, as all these factors contribute to the progression of these diseases.

In effort to help patients some hospitals and medical centers have begun offering exercise classes like yoga as a form of therapy to increase stamina in the lungs. These programs are helping patients to lead more fulfilling lives by teaching them to adjust their daily activities.

In addition to these exercise programs, medical facilities are also supplyingpatients with information about their conditions and ways to cope. “Part of the education is about communication, communicating their needs and educating them so they know what to ask about,” said Bobbi Brown, LRH respiratory therapist, Lakeland Regional Health. Education is critical to proper treatment and symptom recognition is the condition worsens, so the disease can be managed accordingly.

These skills, combined with proper and regular medication and education, patients dealing with chronic lung conditions can improve daily life and increase physical endurance, helping them maintain a healthier, active lifestyle.

Click Here to Access the Full Story on The Ledger