Physician Groups Issue New Treatment Guidelines for COPD

New guidelines for chronic obstructive pulmonary disease (COPD) have been released, updating the previous guidelines that were set forth by the American College of Physicians (ACP) in 2007. The guidelines, which were published recently in the Annals of Internal Medicine, offer a number of updated recommendations for the diagnosis and treatment of COPD.

Overall, physicians made seven recommendations addressing diagnosis and treatment, noting that guidelines do not cover smoking cessation, surgical options, palliative care, end-of-life care or nocturnal ventilation.

In these guidelines, physicians are urged to use spirometry to diagnose airflow obstruction in patients with respiratory symptoms such as wheezing, shortness of breath and chronic cough. However, this screen should not be performed in asymptomatic people, because it could lead to unnecessary testing and increased health care costs, among other things.

Further, physicians now believe that patients with more sever COPD are best managed with inhaled monotherapy of either acting beta-agonists or anticholinergics. These patients can also be given combination therapy that includes inhaled corticosteroids, although there is less evidence for this recommendation.

Researchers also strongly recommended prescribing continuous oxygen therapy to patients with severe hypoxemia, as the “use of supplemental oxygen for 15 or more hours daily can help improve survival” in this population.

The recommendations were developed by the American College of Physicians, American College of Chest Physicians, American Thoracic Society and European Respiratory Society through a thorough review of studies published between 2007 and 2009.

Click Here to Access the Guidelines From the Annals of Internal Medicine

Emphysema Severity and Lung Thickness Tied to COPD Exacerbations

Percentage of lung affected by emphysema and bronchial wall thickness on quantitative computed tomography (CT) are associated with chronic obstructive pulmonary disease (COPD) exacerbations, independent of the severity of airflow obstruction. That is according to a recent study published in Radiology.

The study examined a total of 1,002 individuals, who fulfilled the Global Initiative for Chronic Obstructive Lung Disease criteria for COPD and had quantitative CT analyses. The mean wall thickness and mean wall area percentage in six segmental bronchi were measured by an automated program, while a questionnaire was used to determine the frequency of COPD exacerbations in the previous year.

Researchers found that after adjusting for lung function, total emphysema percentage and bronchial wall thickness correlated with COPD exacerbation frequency. The annual exacerbation rate increased significantly with each 1 mm increase in bronchial wall thickness. Further, each 5 percent increase in emphysema in patients with 35 percent or greater emphysema correlated with a 1.18-fold increase in the annual exacerbation rate.

"Our study results, obtained by using quantitative CT metrics, demonstrated that the frequency of COPD exacerbations is related to both emphysema severity and airway disease," the authors write.

Click Here to Access the Full Study From Radiology (Registration may be required)

Reduced Lung Function Increases Risk of Cardiovascular Disease

Individuals with reduced lung function, such as those suffering from chronic obstructive pulmonary disease (COPD), have a greater risk of developing cardiovascular disease. That is according to a recent study presented at the European Respiratory Society’s Annual Congress in Amsterdam.

Researchers, who analyzed the prevalence of both heart disease and nasal symptoms in lung patients, gathered data from 993 individuals with COPD and 993 without. The study revealed that 50.1% of individuals with COPD also had cardiovascular conditions, such as heart disease, stroke and hypertension. That is compared to 41% of individuals with normal lung function.

The study also found that nasal symptoms were common among patients who had both COPD and heart disease (53%), while those with normal lung function and heart disease were at less risk (35.8%). This is the first study to reveal that nasal symptoms and heart disease are common in individuals with COPD and may link the two conditions.

“Our findings are the first to shed light on the links between both nasal symptoms and cardiovascular condition, in relation to people with COPD and restrictive lung function,” said Dr. Anne Lindberg, from the Sunderby Hospital in Sweden, in a Medical News Today article. “This has important implications for clinicians who need to understand the potential overlaps of these conditions when they are treating people with COPD. In addition to raising awareness of these comorbidities, it will also be important to investigate these links further and look at the effect that comorbid conditions have on exacerbations and disease progression.”

Click Here to Access the Full Article From Medical News Today.

Loss of Small Airways Before Emphysema May Explain COPD

The narrowing and disappearance of small airways before the onset of emphysematous destruction, which is marked by the onset and spread of lesions and holes in the lung, may explain the increased peripheral airway resistance reported in chronic obstructive pulmonary disease (COPD), according to a recent study published in the New England Journal of Medicine.

The study used multidetector computed tomography (CT) to compare the number of small airways (measuring 2.0mm to 2.5mm in diameter) in patients with various stages of COPD, as judged by scoring on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) scale. MicroCT was used to measure the extent of emphysema, the number of terminal bronchioles per milliliter of lung volume and the minimum diameters and cross-sectional areas of terminal bronchioles. Both isolated lungs removed from patients with COPD who underwent transplantation and donor lungs were examined.

According to researchers, samples from the isolated lungs of patients with severe COPD who underwent lung transplantation showed significant reductions in the total cross-sectional area and numbers of terminal bronchioles. Furthermore, analysis revealed that the narrowing and loss of terminal bronchioles occurred before the onset of emphysematous destruction.

In samples from patients with COPD, as compared with control samples, the number of small airways was reduced for those participants who were categorized as GOLD stages one through four. Authors of the study note that they could not determine whether the reduction in the number of small airways that was observed by CT analysis was a true reduction or simply a narrowing to the point at which the airways were no longer visible.

They add: “Despite these limitations, the microCT results extend earlier reports by showing that there is both widespread narrowing and loss of smaller conducting airways before the onset of emphysematous destruction in both centrilobular and panlobular emphysema phenotypes of COPD.”

Research for this study was funded by the National Heart, Lung, and Blood Institute, the Canadian Institute of Health Research–Thoracic Imaging Network of Canada, the Canadian Collaborative Innovative Research Fund, GlaxoSmithKline, and the Lavin Family Supporting Foundation.

Click Here to Access the Full Study from the New England Journal of Medicine.

DRIVE4COPD Unveils COPD Monument to Travel the Country

DRIVE4COPD, a multiyear public health initiative that aims to help people identify symptoms of chronic obstructive pulmonary disease (COPD) and take action, recently unveiled 24M: The DRIVE4COPD Monument, which will travel the country after its unveiling in New York.

The monument is a visual representation of the impact COPD has in the United States, with 24 large-scale pinwheels—the DRIVE4COPD symbol—to represent the 24 million Americans who may be living with COPD. Designed by artist and sculptor Michael Kalish, the monument reaches 14 feet high and spans half a football field.

“I travel the country collecting materials for my work, and many of the people I see on a daily basis are affected by COPD or are at risk for the disease,” said Kalish in a recent press release issued by DRIVE4COPD. “COPD affects people from all walks of life, and this is my opportunity to give them a voice.”

Kalish uses discarded everyday items such as car tires, boxing speed bags and recycled license plates to create his unique and highly sought-after works of art. A total of 2,400 license plates from all 50 states were used to construct the monument’s pinwheels, with the number of license plates reflecting the percentage of that state’s population affected by COPD. Each pinwheel is secured to a base shaped like one or more states, which together form the map of the United States. The monument also includes license plates from DRIVE4COPD spokespeople, NASCAR driver Danica Patrick and Grammy award-winning country music artist Patty Loveless, who have both lost loved ones to COPD.

Following its unveiling in New York, the monument will travel to those states with the highest prevalence and population of COPD, including Texas, Florida and California. The organization hopes that the monument will increase disease awareness and motivate people to recognize their risk. Visitors of 24M can follow a self-guide tour through the monument to learn about its creation, the impact of COPD and the DRIVE4COPD campaign.

The monument will be on display in Glendale, Calif., from December 9 to 18, 2011.

For more information about 24M and the DRIVE4COPD campaign, visit drive4copd.com.

COPD: The Basics

Chronic obstructive pulmonary disease (COPD) is the third-leading cause of death in the United States and one of the most common lung diseases in the world. According to the World Health Organization (WHO), nearly 210 million people across the world are currently suffering from COPD. That estimate includes nearly 12 million Americans living with COPD, while another 12 million may be left undiagnosed.

COPD is a combination of diseases, with most patients suffering from both chronic bronchitis and emphysema, making breathing more and more difficult for them. That is because emphysema destroys the air sacs in the lungs over time, reducing the surface area of the lungs and the amount of oxygen that enters the bloodstream. Further, chronic bronchitis leaves patients with inflamed bronchial tubes and a long-term cough with mucus.

Symptoms of COPD include shortness of breath, coughing with or without mucus, respiratory infections, tightness of the chest, wheezing and trouble catching one’s breath. However, most COPD patients do not experience symptoms from the disease until their lungs have been severely damaged, making it important for those people who are at risk for the disease to be screened regularly. Spirometry is the most commonly used test for diagnosing COPD, while X-rays, CT scans and lab tests can also be used.

While smoking is the main cause of COPD, inhaling irritants such as chemicals, dust and other fumes are also risk factors. COPD can also affect those who have never smoked or had any contact with harmful pollutants, as there is a genetic risk factor for developing emphysema. The most commonly known genetic risk factor for emphysema is called alpha-1 antitrypsin (AAT) deficiency, which leaves patients with little to no AAT protein in the bloodstream. This deficiency leaves room for white blood cells to damage the lungs. While AAT deficiency seems to be the main cause of COPD among nonsmokers, researchers believe that there are other genetic factors that may increase the risk of developing the disease.

While currently there is no cure for COPD, there are treatment options to relieve symptoms and keep the disease from progressing. These include medications such as inhalers and steroids, oxygen therapy, pulmonary rehabilitation and surgery. There are also steps that COPD patients can take on their own to improve their symptoms, including:

• Practicing controlled breathing and relaxation exercises
• Exercising regularly to strengthen respiratory muscles
• Maintaining a healthy diet and drinking plenty of water
• Avoiding crowds and cold air
• Getting vaccinated for respiratory infections
• Quitting smoking and avoiding places where smoking is permitted

While COPD cannot be cured, it can be prevented by avoiding smoking and by breathing clean, fresh air to keep lungs healthy.

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