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CDC Finds Nearly Half of Older Adults with Asthma, COPD Still Smoke
Although chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States, close to half of adults over 40 who have been diagnosed with asthma or COPD still continue to smoke – a leading cause of the disease – according to federal health officials. The findings highlight the difficulty in quitting smoking even for those whose condition is exacerbated by the habit.
The statistics released by the Centers for Disease Control and Prevention (CDC) used data from the U.S. National Health and Nutrition Survey for the years 2007-2012, which found “46 percent of adults aged 40 to 79 who had a lung-obstructing illness currently smoked. That number rose to 55 percent when the researchers looked only at cases involving ‘moderate or worse’ disease”. The researchers also noted that “rates of smoking for people with lung obstruction were more than double that of people without such illnesses -- about 20 percent.”
So why would people with an illness predominately caused and made worse by smoking continue to engage in the habit?
Researchers concluded that depression and anxiety, which is associated with about 40 percent of COPD patients, make it difficult to comply with necessary steps for quitting smoking.
Patricia Folan, director of the Center for Tobacco Control at North Shore-LIJ Health System in Great Neck, N.Y. suggests treating the depression before attempting to treat the habit. Folan added, “empathetic counseling, motivational interviewing, and ongoing support from professionals, family and friends” are other ways to help to treat and encourage quitting smoking, lessening exacerbations.
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Researchers Find New COPD Therapy Device Makes Breathing Easier
Millions of people suffering from chronic obstructive pulmonary disease (COPD) now have renewed hope, thanks to a new device that is demonstrated to improve breathlessness. The device, which moves mucous up and out of the lungs, promises to better a patient's quality of life while avoiding the use of prescription drugs during treatment.
The Aerobika Oscillating Positive Expiratory Pressure (OPEP) Therapy System recently won Gold at the Medical Design Excellence Awards, which recognizes cutting-edge innovations that are saving lives; improving patient healthcare; and transforming medical technology worldwide, with its ability to create airway clearance by engaging the cilia through oscillation generated by breathing into the device which aids in moving the mucous out of the airways. Treatments last from 10-20 minutes up to four times a day, depending on severity of symptoms.
“The overall goal of the device is to ensure the patients can maintain their treatments to control their symptoms, breathe easier, enjoy a better quality of life and ultimately, stay out of the hospital,” said Mitch Baran, CEO, Trudell.
The OPEP Therapy System was created by Trudell Medical International and tested by Dr. David McCormack and Grace Parraga from Western's Schulich School of Medicine & Dentistry and their team at Robarts Research Institute.
Video demonstration of the device can be seen here.
Treating COPD in the Elderly
The treatment of seniors (age 66 and older) who have both asthma and disease (COPD) has become increasingly difficult, as their younger counterparts are thought to experience less lung inflammation when receiving the same treatment. Thus, a study was undertaken to determine which medications work best for older adults with COPD.
Published in The Journal of American Medical Association, the study states that “knowing which prescription medications are the most effective in improving health outcomes for people with COPD is essential to maximizing health outcomes.”
It was determined that a combined treatment of long-acting beta agonists and inhaled corticosteroids is most effective treatment of COPD. Among seniors specifically, there were 8 percent fewer deaths and hospitalizations during the length of the study among those taking both medications. Even more striking was the 16 percent decrease in deaths and hospitalizations for those seniors with comorbidity who took only the long-acting beta agonists.
By singling out seniors aged 66 and older, researchers are able to emphasize the significance and potentially life-saving importance of personalized COPD treatment.
Diabetes More Prevalent in COPD Patients Without Emphysema
In a new study published in BMC Pulmonary Medicine, researchers aimed to determine the frequency of diabetes in those patients diagnosed with chronic obstructive pulmonary disease (COPD). The study, which consisted of 4,197 participants, found that those defined as non-emphysematous (without the symptoms of emphysema) had an increased prevalence of diabetes.
The method of the study “aimed to create a simplified distinction between emphysema-predominant and presumed airway-predominant COPD based on the presence or absence of emphysema on chest CT scan.” Based on this, researchers used two groups of participants, non-emphysematous and emphysema-predominant, to determine the prevalence of diabetes.
Although they were unable to determine the on-set of diabetes in the non-emphysematous participants, researchers were able to determine the prevalence of diabetes based on previous studies conducted, comprised of participant self-reporting.
Study authors suggest that “COPD patients without emphysema may warrant closer monitoring for diabetes, hypertension, and hyperlipidemia and vice versa.”
Asthma vs. COPD
Often times the signs and symptoms of asthma are confused with the symptoms of chronic obstructive pulmonary disease (COPD) by both the patient and physician; however the two are different and require different treatments.
A recent presentation at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting showed that “as many as 50 percent of older adults with obstructive airway disease have overlapping characteristics of asthma and COPD. And this percentage increases as people get older.”
Why is this?
Presenters determined that while the symptoms can be difficult to differentiate, the pathway to those symptoms is critical during the diagnosis stage. According to presenters, measurement of lung function, age of the patient, and smoking history are all good places to start when determining differences between asthma and COPD patients.
If a patient has already been diagnosed with one or the other and is not experiencing any symptom change, presenters recommend looking at the treatment the patient is receiving as they may have been misdiagnosed. This misdiagnoses and treatment can often lead to increased risk for exacerbations of both asthma and COPD.
"The primary treatment in COPD is bronchodilators. They help relax muscles around the airways in the lungs, allowing air to flow more freely," said allergist Michael Foggs, MD, ACAAI president. "They should not be given alone to people with asthma.”
Instead, asthma patients best respond to inhaled corticosteroids, however the use of inhaled corticosteroids in COPD patients has been associated with an “increased risk for pneumonia.”
Each patient’s signs and symptoms should be treated on a case-by-case basis, as personal triggers vary, but sharing all symptoms and medical history will help allergists to determine a correct diagnoses and treatment option.
"Lung Flute" Helps COPD Patients Breathe Easier
University of Buffalo (UB) researchers have created a device aimed at helping alleviate airflow restriction in patients diagnosed with chronic obstructive pulmonary disease (COPD) and chronic bronchitis. The device, when used over a period of six months, aims to clear mucus that can restrict airflow to the lungs, making it increasingly difficult to breathe.
During a trial study, 69 participants were instructed to blow twice into the Lung Flute “vigorously enough to make the reed oscillate, followed by 5 normal breaths. This was repeated 10 times, followed by 3 huff coughs to complete 1 cycle. Two such cycles were recommended twice a day.”
The goal, as described in a UB press release, was to use acoustic waves created by the device to loosen mucus within the lungs allowing for increased airflow.
The 26-week study “confirms that the Lung Flute improves symptoms and health status in COPD patients, decreasing the impact of the disease on patients and improving their quality of life,” said Sanjay Sethi, MD, principal author of the study and chief of the division of pulmonary, critical care, and sleep medicine in the Department of Medicine at the UB School of Medicine and Biomedical Sciences.
The positive results of this study are helping researchers to gain ground and credibility for treatments outside of medication and inhaled glucocorticoids. Medical Acoustics, the company enlisted to create the Lung Flute, plans to market the device, which recently received FDA clearance, through collaborations with the University of Buffalo team of researchers.
Click Here to Access Full Study from Clinical and Translational Medicine
COPD: Is Stepping Down Therapy Safe?
The results of a recent trial, published in The New England Journal of Medicine,that studied the gradual withdrawal of inhaled glucocorticoids and exacerbations of chronic obstructive pulmonary disease (COPD) found that there was a “significant decrease in lung function with completion of glucocorticoid withdrawal at week 18, which persisted to the end of the 12-month trial.”
The trial included 2,485 patients with a history of frequent COPD exacerbations on tiotropium (Spiriva), salmeterol (Serevent), and fluticasone for an initial 6-week period. Patients were randomly assigned to continued triple therapy or withdrawal of fluticasone over a 12-week period.
Those who continued withdrawal to week 18 saw a “greater decrease in lung function.” The results of those who continued triple therapy were “not clinically meaningful,” meaning the changes in exacerbations were not significant enough to count against the final results.
In an accompanying editorial, John J. Reilly, MD, University of Pittsburgh Pulmonary Division, concluded that "the results of this trial, taken together with the findings of other studies, suggest that the rationale for continuing glucocorticoid therapy in patients who are also taking long-acting bronchodilators should be based on symptomatic improvement attributable to the glucocorticoid rather on the prevention of exacerbations."
New Role for Medical Practitioners: COPD Patient Motivational Intervention
Patients with chronic obstructive pulmonary disease (COPD) often also suffer from psychosocial co-morbidity, the combination of multiple medical conditions at one time that affects the mental state. It’s a combination that makes it more difficult for patients to find motivation to engage in physical activities.
A study published in the October issue of BMC Family Practicehighlights the positive effects and “enduring motivational benefits” of psychological motivational intervention by liaison health workers (LHWs) to address the psychosocial needs of COPD patients. Because it requires long-term care and attention, COPD represents a serious challenge to health public services. Clinicians and providers are not available as long-term caregivers, leaving many patients to rely on self-management of the condition.
The study, described as a “short-term intervention”, involved 29 COPD patients and used 13 LHWs to assess the behavioral activation, cognitive restructuring and medication management of patients using liaison skills to adjust patient behavior to improve self-management.
The LHWs reported seeing a “positive impact on work targeting patients’ psychosocial requirements.” Based on these findings study authors suggest that “LHWs practices should be adopted to induce motivational changes in patients with COPD and other long-term conditions.”
Chronic Bronchitis, Pneumonia and Emphysema Associated with Lung Cancer Risk
In August, the American Journal of Respiratory and Critical Care Medicine released its findings that three common respiratory diseases--bronchitis, pneumonia and emphysema--are all linked to increased risk for developing lung cancer.
Based on findings of seven studies that included more than 25,000 people, researchers and investigators found that “people who had all three - chronic bronchitis, emphysema and pneumonia - had a higher risk of lung cancer than those with chronic bronchitis only.” The research also revealed that “there was no increased risk of lung cancer among those who had chronic bronchitis along with asthma or tuberculosis.”
Study author Ann Olsson, of the International Agency for Research in Cancer in Lyon, France, said the reason respiratory illnesses may affect lung cancer risk in different ways could have to do with underlying disease mechanisms. She also insisted that while the study did not show any cause and effect relationships, “having a better understanding of the links between respiratory ailments and lung cancer may help inform doctors on how best to monitor and help patients.”
The ABCs of COPD
Chronic obstructive pulmonary disease (COPD) has the job of acting as a catch-all term for bronchitis, emphysema and in some cases, chronic asthma, of which are all directly associated with airflow obstruction. While there is no cure for COPD, the goal is to slow the progression of the disease as much as possible to maintain quality of life and keep patients from getting worse.
Listed as the third leading cause of death in the United States, researchers and professionals have created an acronym to help COPD sufferers remember what factors affect their symptoms and quality of life.
“C” Is for Cigarettes
Millions of Americans live with the symptoms of COPD and may not even know they have it. However, for the more than 15 million Americans already diagnosed, it is important to know and understand the effects that smoking has on the body.
More than 80 percent of COPD patients are current or former smokers. While not all patients fall into this category, smoking is directly associated with increased exacerbations and a higher frequency for complications during treatment.
“O” is for Oxygen
As previously mentioned, COPD directly affects the airflow to the lungs, making it very difficult to breathe. While many COPD patients manage without oxygen therapy, or only use it as needed, others with severe COPD rely more heavily on oxygen.
Some sufferers must adjust travel arrangements or even avoid travel altogether in order to account for their oxygen tanks or the location they are traveling to.
If you are reliant on supplemental oxygen, physicians want you to know what options are available. Pressurized tanks are good for those less apt to travel. For those who do travel, favorable options include liquid oxygen, a portable solution and easily stowed and oxygen concentrators, which are also portable but require a constant source of electricity.
“P” is for Progressive
For sufferers of COPD, the difficulty of breathing is described as the equivalent of plugging your nose and then putting a straw in your mouth. The lungs of someone who has been diagnosed have lost their elasticity, making it difficult for them to expand and release carbon dioxide causing the airways to become “damaged, thick and inflamed.”
COPD is a slow moving disease and many of those diagnosed have no signs or symptoms until they have reached the moderate-to-severe phase. For example, for someone who starts smoking as a teen and persists into adulthood, damage can go on quietly for years. “Because you have two lungs and a lot of lung reserve, most lung diseases really don’t cause significant problems or symptoms until someone has lost 50 or 60 percent of their lung function,” according to Andrew Ries, a professor of family medicine and preventive medicine at the University of California–San Diego.
Ries suggests looking for signs and symptoms of breathlessness. Early prevention is often times the best way to slow the progression of COPD.
“D” is for Dealing With It
To some a COPD diagnoses seems bleak, but people living with COPD do have options including “taking prescription medications, keeping up with treatments, building endurance through exercise, accepting limitations and making adaptations in their homes, like rearranging kitchens so they can sit while preparing food.”
If none of these work, there are several other options including surgeries and physical therapies to increase lung capacity. If you are able to “build fitness and endurance” it is possible to reduce the likelihood of becoming sedentary, says Ries.
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