New Research Suggests COPD Treatment Should Include Surgery for Some

The treatment of chronic obstructive pulmonary disease (COPD), which is a major cause of disability and premature death for millions affected, now has renewed hope as a result of clinical trials performed by researchers at Imperial College London. The study, “Surgical approaches for lung volume reduction in emphysema” which was published in the April issue of Clinical Medicine, suggests that lung volume reduction surgery (LVRS) could reduce breathlessness and improve exercise capacity and survival for patients who have severe emphysema restricted to one part of the lung.

During LVRS, surgeons remove the most damaged area of the lung enabling the remaining parts of the lung to work more effectively.

The study, which reviewed patient outcomes from 2000 to 2012, showed that in a series of 81 patients who had undergone the procedure there were no deaths and only six percent were still in the hospital one month after the operation. Despite the benefits, historical concerns about the risks associated with LVRS have limited the number of procedures.

Lead author of the study, Dr. Nicholas Hopkinson from Imperial's National Heart and Lung Institute, supports this evidence stating that “these results suggest that concerns about the risks of surgery have been exaggerated and doctors looking after patients with COPD should be encouraged to identify people eligible for this procedure.”

Dr. Hopkinson also insists that based on evidence found “there are thousands more people with lung disease in the UK who could profit from this approach.”

Other treatments that have been found to aid in the treatment of COPD include stopping smoking, exercise programs and inhaled medications. However, many people with the condition remain extremely breathless.

Click Here to Access the Full Study from Clinical Medicine

Improved Kitchen Ventilation Shown to Improve Lung Function, Reduce Risk of COPD

Improving kitchen ventilation and switching cooking fuels may reduce the risk of chronic obstructive pulmonary disease (COPD) and improve lung function, according to a recent study published in the March online issue of PLOS Medicine, “Lung Function and Incidence of Chronic Obstructive Pulmonary Disease after Improved Cooking Fuels and Kitchen Ventilation: A 9-Year Prospective Cohort Study.”

The study examined nearly 1,000 eligible participants across 12 villages in southern China over a nine-year period, paying close attention to their choice of fuel and ventilation and the subsequent effects on their health. In addition, researchers provided participants with safer and healthier options for combustion fuels (biogas) used for cooking and improved kitchen ventilation in their homes. Questionnaire interviews and spirometry tests were performed in three-year intervals, while improved air quality was confirmed via measurements of indoor air pollutants in a randomly selected subset of the participants’ homes.

To determine the effect of the improved ventilation and cooking fuel, researchers compared annual declines in lung function and incidence of COPD between those participants who implemented one, both, or neither of the interventions. They found that the use of clean fuels and improved ventilation was associated with a reduced decline in lung function compared to those who took up neither intervention.

“These findings suggest that, among people living in rural southern China, the combined interventions of use of biogas instead of biomass and improved kitchen ventilation were associated with a reduced decline in lung function over time and with a reduced risk of COPD,” said the study authors.

However, due to the absence of a control or intervention group, a direct link between kitchen ventilation, cooking fuel and COPD could not be developed. Regardless, these findings suggest that “the use of biogas as a substitute for biomass for cooking and heating and improvements in kitchen ventilation might lead to a reduction in the global burden of COPD associated with biomass smoke.”

Click Here to Access the Full Study from PLOS Medicine.

COPD May Increase Risk of Mild Cognitive Impairment

Chronic obstructive pulmonary disease (COPD) may increase of the risk of contracting Mild Cognitive Impairment (MCI), an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia. That is according to a recent study published in the March issue of JAMA Neurology, “A Prospective Study of Chronic Obstructive Pulmonary Disease and the Risk for Mild Cognitive Impairment.”

The study, which followed 1,425 cognitively normal individuals aged 70 to 89, used interviews and neurologic exams to identify the incidence of two types of MCI: amnestic MCI (A-MCI) and non-amnestic MCI (NA-MCI). A baseline was established at the beginning of the study, with interviews and exams occurring every 15 months thereafter.

Researchers found that nearly 25% of the study group developed some incidence of MCI. However, a COPD diagnosis significantly increased the risk for NA-MCI by 83%. In addition, researchers discovered that those individuals with a long-term COPD diagnosis were at the greatest risk of developing MCI, with patients who have a diagnosis of five years or longer being at the greatest risk of developing either form.

While little research has been done around the effect of COPD on cognitive impairment, researchers now believe that the blockage of airflow in COPD patients can lead to MCI. A progressive and treatable disease characterized by chronic limitation of the air ducts, COPD eventually leads to the development of hypoxemia and hypercapnia, as well as serious complications for patients.

Researchers note that these findings “highlight the importance of COPD as a risk factor for MCI and may provide a substrate for early intervention to prevent or delay the onset and progression of MCI, particularly NA-MCI.”

Click Here to Access the Full Study from JAMA Neurology.

Depression May Worsen Symptoms of COPD

Depression and anxiety may worsen symptoms of chronic obstructive pulmonary disease (COPD) and result in exacerbations and hospitalizations. That is according to a study published in the American Journal of Respiratory and Critical Care Medicine, “Independent Effect of Depression and Anxiety on Chronic Obstructive Pulmonary Disease Exacerbations and Hospitalizations.”

The study, which examined nearly 500 patients with stable COPD in China, measured depression and anxiety using the Hospital Anxiety and Depression Scale (HADS) then monitored the occurrence and characteristics of event-based and symptom-based COPD exacerbations and hospitalization over a 12-month period.

During this period, 876 symptom-based and 450 event-based exacerbations were recorded, among which 183 led to hospitalization. Multivariate Poisson and linear regression analyses were then used to estimate adjusted incidence rate ratios (IRRs) and adjusted effects on duration of events.

What researchers found was that the depression was associated with an increased risk of symptom-based exacerbations, event-based exacerbations, and hospitalization compared with those individuals who were likely not depressed. In addition, event-based exacerbations for those with even probable anxiety were 1.92 times longer than those without anxiety.

While the study does not definitely link depression to worsening of COPD, researchers say that is it possible based on three distinct theories:

·         Depression may be linked to immune system changes that leave patients more vulnerable to environmental triggers.

·         Depressed patients may be more sensitive to their COPD symptoms and more likely to report those symptoms.

·         Depressed patients may not follow their treatment plans as well as other patients, making them more vulnerable to flare-ups.

The good news is that depression screening and treatment is available for those who need it. For more information on how depression and anxiety can affect your disease state, or to connect with a mental health counselor, contact your doctor or healthcare provider. 

Click Here to Access the Full Story from WebMD.

Bacteria in Lungs May Make COPD Patients Sicker

While the medical profession has long agreed that bacteria in the lungs of chronic obstructive pulmonary disease (COPD) patients are harmless when independent of flare-ups or exacerbations of respiratory symptoms, a new study may suggest otherwise.

The study, “Bacterial Colonization Increases Daily Symptoms in Patients with Chronic Obstructive Pulmonary Disease,” which was published in the January 2014 issue of the Annals of the American Thoracic Society, found that COPD patients do in fact experience more respiratory symptoms when their lungs are colonized by bacteria, even in the absence of an acute exacerbation.

The study examined41 elderly male veterans with smoking-related COPD in the COPD Study Clinic at the Buffalo VA, focusing on four common pathogens encountered in COPD – Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae and Pseudomonas aeruginosa. Researchers used sensitive molecular detection methods, as well as conventional laboratory cultures, to detect these bacterial pathogens, while patients used electronic diaries to record daily symptoms of breathlessness, cough and sputum.

“The lungs are constantly being exposed to microbes ‘with every breath you take’ as well as from aspiration of small amounts of secretions from the throat, especially during sleep,” said senior author Sanjay Sethi, MD, professor of medicine and chief of pulmonary, critical care and sleep medicine and staff physician with the Veterans Affairs Western New York Healthcare System. “If the persistence of these bacteria contributes to increased symptoms and inflammation in the lungs in stable COPD, we should regard this as a chronic infection, not innocuous colonization.”

For that reason, Dr. Sethi believes that more must be cone to reduce chronic infections in COPD patients.

“These findings demonstrate that it’s time for a paradigm shift in how we treat patients with stable COPD,” said Dr. Sethi. “We need to go beyond traditional approaches of bronchodilation and anti-inflammatory agents to reduce symptoms. We need to put more emphasis on developing therapies that can decrease bacterial colonization in COPD.”

Click Here to Access the Full Story from the University of Buffalo.

Preparing for Airline Travel

For sufferers of chronic lung conditions such as emphysema, chronic bronchitis and chronic obstructive pulmonary disease (COPD), the use of supplemental oxygen may be necessary at some point in your treatment plan. Yet, this does not mean that these individuals cannot travel via airline transportation. In fact, many people who require supplemental oxygen fly on a regular basis. However, additional planning is required.

Pre-Travel Planning

Once approved for air travel by your physician or care team, it is important to check with the airline regarding their supplemental oxygen guidelines. While many will allow passengers to travel with a portable oxygen tank, some will not, meaning checking with your specific carrier is imperative before booking any flights.

Once you have identified an airline carrier who will accommodate your portable oxygen needs, it is important to identify any additional information they may need. Included in this may be a letter from your physician, a brief medical history and a current oxygen prescription. Passengers should also check to ensure that their portable oxygen concentrator has been approved for in-flight use.

Security Screening

Depending on your reliance on a portable oxygen device, the manner in which you will be screened by the Transportation Security Administration (TSA) may vary.

For those individuals who have been advised by their physician that they can safely disconnect from the portable oxygen concentrator, screening will occur through the airport’s Advanced Imaging Technology. In addition, TSA recommends that the passenger check the equipment as checked baggage whenever possible. If you would prefer to bring your oxygen concentrator on the flight as a carry-on bag, the equipment will either undergo X-ray screening or inspection.

If you are unable to or would prefer not to disconnect from the portable oxygen device, TSA will conduct the screening through a pat-down procedure similar to those that are used to resolve any alarms or anomalies identified by the imaging technology. 

Please note that it is important for the passenger to inform the security officer whether he or she can disconnect from the oxygen supply before the screening process begins.

For more information on the screening process for travelers requiring portable oxygen, please visit the TSA website for Travelers with Disabilities and Medical Conditions.

Additional Information

For additional information on traveling with COPD or emphysema, including a checklist for airline travel and tips for travelers, visit the Cleveland Clinic’s website for COPD - Traveling Tips for People with COPD. If you are newly diagnosed with a chronic lung condition, you may also find it helpful to read the following travel information, which can be found on our website under “Living with COPD.”

Lung Diseases May Affect More than Lungs

Chronic lung conditions in adults, such as chronic obstructive pulmonary disease (COPD) and bronchiectasis, may lead to gastroesophageal reflux according to a recent study published in the August issue of Respirology, Proximal and distal gastro-oesophageal reflux in COPD and bronchiectasis.

The study, which examined patients with COPD or bronchiectasis against a control group, found that those living with these chronic lung conditions were twice as likely to have reflux problems as those without lung disease, leaving researchers to believe that gastroesophageal reflux— a condition in which acid from the stomach leaks back up into the esophagus – is a common side effect of these lung conditions.

To reach this conclusion, researchers at the Melbourne School of Health Sciences at The University of Melbourne studied 27 participants who had COPD, 27 participants with bronchiectasis and 17 control participants without lung disease. Of the participants, 17 with COPD and 16 with bronchiectasis had previously been prescribed anti-reflux therapy.

Each participant completed a questionnaire about their reflux symptoms, then had the level of acid in their esophagus measured for 24 hours. Those participants with lung disease also had their pepsin levels (the substance in the stomach that helps break down food) measured and the severity of their lung disease monitored. 

With this information, researchers used the data collected to determine the prevalence of gastroesophageal reflux in all participants. 

Of the participants without lung disease, 18 percent were diagnosed with gastroesophageal reflux. That is compared to 37 percent of patients who had COPD and 40 percent of patients who had bronchiectasis. Meaning those participants with chronic lung conditions were twice as likely to have reflux problems than those without lung disease.

Researchers note that the severity of the lung disease did not affect the participants’ likelihood of having gastroesophageal reflux. Further, many of those individuals diagnosed with gastroesophageal reflux did not exhibit any obvious symptoms.

These findings may affect the way that doctors look for reflux symptoms in patients with chronic lung conditions.

Click here to access the full story from Respirology.

Vitamin D Deficiency Prevalent in Chronic Lung Patients

According to a recent study published in Thorax, a leading respiratory medicine journal, vitamin D deficiency is a frequent occurrence in chronic obstructive pulmonary disease (COPD) patients and has been found to correlate directly to the severity of the disease. With more than half of COPD and emphysema patients developing a vitamin D deficiency during their lifetime, understanding the importance of vitamin D and how to overcome this deficiency is an important step in managing the disease.

The Role of Vitamin D in Chronic Lung Disease

According to the U.S. Department of Health and Human Services, vitamin D is essential for the “formation, growth, and repair of bones and for normal calcium absorption and immune function.” However, for patients with chronic lung diseases, this important vitamin is thought to play a key role in preventing the loss of lung function over time.

“While there are still a lot of studies that need to be done on vitamin D and the lungs, it is thought that in patients with advanced disease the vitamin helps prevent the decline in lung function over time,” said Samuel A. Allen, D.O., pulmonologist, critical care specialist and director of the Pulmonary Hypertension Center at Beaumont Hospital in Troy, Michigan. “Vitamin D can also help people recover from infections. So patients with good levels of vitamin D will probably recover from an infection better than those dealing with a deficiency.”

In addition, low levels of vitamin D can result in osteoporosis and osteomalacia (softening of the bones), as vitamin D plays a critical role in calcium absorption, which is key to building strong bones.

The Cause of Vitamin D Deficiency

The cause of vitamin D deficiency in patients with chronic lung diseases is twofold. First, because eating requires a great deal of energy for people living with COPD and emphysema, many individuals do not consume enough foods that are rich in vitamin D.

“Because eating can often be physically exhausting, many people living with chronic lung conditions do not eat three meals a day,” said Dr. Allen. “In addition, most patients tend to eat foods that have a high volume of fat and protein because that is what their body needs as their condition worsens. However, these meals usually do not contain a good amount of vitamin D.”

Second, because patients with severe respiratory issues do not regularly participate in outdoor activities, they are not receiving the sunlight they need to absorb adequate amounts of vitamin D. These deficiencies are further complicated by the chronic steroid use included in many individual’s treatment plans.

“When taken in high doses over an extended period of time, steroids can inhibit the absorption of vitamin D and calcium in the intestines,” said Dr. Allen. “So the vitamin D that patients are able to take in through their diet and sunlight is impaired because they are chronically on steroids.”

Increasing Vitamin D Intake

To increase their intake of vitamin D, patients with chronic lung diseases can do a number of things, including adding vitamin D3 supplements to their daily regimen.

“I tell my patients first and foremost to take vitamin D3 supplements, rather than plain vitamin D or vitamin D with calcium. This seems to work better than others because vitamin D3 provides both the dietary and sunlight-activated vitamins in one supplement,” said Dr. Allen. “For all practical purposes, patients should be taking 1,000 IUs (international units] of vitamin D3 a day.”

In addition, individuals should get 20 to 30 minutes of sunlight each day, if possible. Eating five or six small meals a day rather than three large meals is also recommended, as eating smaller portions requires much less energy. These meals should also include foods that are rich in vitamin D, such as swordfish, tuna, sake salmon, and cod liver oil.

“I tell my patients to have sake salmon or tuna at least once a week. Then for breakfast, my recommendation would be to drink eight ounces of vitamin D-fortified orange juice and a yogurt that is also fortified with vitamin D,” said Dr. Allen. “However, the biggest thing patients can do is stop smoking, because smoking impairs vitamin D absorption, accelerates lung conditions and has been known to cause issues with bone loss.”

Note: Because exceeding dietary recommendations can result in vitamin D toxicity, it is important to speak with your physician before making these changes to your treatment plan.

Recent Study Uncovers Exacerbation Frequency Related to COPD Severity

Frequency of exacerbations such as dyspnea, cough, and sputum production in chronic obstructive pulmonary disease (COPD) patients may be related to the severity of the disease, according to recent study.

Researchers examined literature to identify randomized controlled trials and cohort studies that directly examined the exacerbation frequency in COPD patients receiving usual care or placebo. Thirty-seven relevant studies were identified, with 43 reports of total exacerbation frequency, including 19 event-based and 24 symptom-based, and 14 reports of frequency of severe exacerbations.

Researchers then determined annual frequencies for total exacerbations defined by an increased use of healthcare, total exacerbations defined by an increase of symptoms, and severe exacerbations defined by hospitalization.

Annual event-based exacerbation frequencies were estimated at 0.82 for mild COPD, 1.17 for moderate, 1.61 for severe, and 2.10 for very severe COPD. Annual symptom-based frequencies were 1.15, 1.44, 1.76, and 2.09, respectively. For severe exacerbations, annual frequencies were 0.11, 0.16, 0.22, and 0.28, respectively.

Researchers note that study duration or type of study did not significantly affect the outcomes.

Click here to access the full study from DovePress