COPD WEB SITE NEWS, INCLUDING SOUND ADVICE ON A NUMBER OF TOPICS AND DETAILS OF NEW UPDATES.

NOTE : Henceforward our policy on news items is to place them here only if they are of practical use and interest to COPD patients within a year or so. There are many plugs and hypes made for new devices and treatments that will hopefully be available five or ten years hence. Many of them are launched to try and get funding for ongoing research. Please write if you think we are wrong on this.

"3 Million UK patients to get Remote care for copd according to Rebecca Smith, Daily Telegraph.
Three million people with conditions such as lung disease, heart failure, arthritis and high blood pressure, will have special monitoring equipment is installed in their homes to send results electronically to qualified medical staff. This follows success of pilot schemes of 6000 patients which cut deaths by up to half as well as cutting hospital admissions and GP visits. Whilst claims of success are still based on small scale experiments, remote healthcare is expected to expand in the next 10 to 15 years. It marks a step change in the way the NHS looks after the long-term sick with more care delivered in their homes rather than in hospitals. Many copd patients view these moves as just one more cost saving measure at their expense, but only time will tell.
http://www.telegraph.co.uk/health/healthnews/8936038/Remote-healthcare-for-three-million-patients.html

Posted 23rd October. 2011 WORLD COPD DAY. This is an annual event organized by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) to improve awareness and care of COPD around the world. World COPD Day 2011 will take place on Wednesday, Nov.16, around the theme "Are you short of breath?
You may have COPD!" Ask your doctor about a simple breathing test called "spirometry."

23 August. Posted by David

STUDY CLAIMS TRIPLE COPD THERAPY REDUCES DEATH RISK BY 35%
Combination triple therapy reduces mortality, hospital admissions and exacerbations in patients with COPD, new U.K. research indicates. GPs commonly apply triple therapy with inhaled corticosteroids, beta-agonists and antimuscarinics for COPD, but there has been only limited scientific work to substantiate the value of such treatment. The new study supports the strategy. NICE guidance published in 2010 suggests a step approach to drug use for patients with COPD. First used are short-acting beta-agonists or short acting antimuscarinics. Inhaled steroids are used for exacerbations or persistent breathlessness for patients whose FEV1 is less than 50%. Long acting antimuscarinics are added where patients do not respond to the above. See Article: http://www.pulsetoday.co.uk/newsarticle-content/-/article_display_list/12535122/triple-copd-therapy-reduces-risk-of-death-by-35

August 5th. Posted by David

Just a line to warn you all that the NHS now has a policy of restricting the number of referrals they allow GPs to make. Their argument is that they have in place the necessary support to manage treatment at home for those with less critical problems. Of course we face inevitable cuts, but It would be fine if the support claims were true in all parts of the country. But from what we see and hear there are significant gaps in both quantity and quality of some home support teams. The usual postal lottery basis seems to apply. Perhaps it is best not to get ill for a while until things settle down. DB

People who drink hot tea or coffee are less likely to carry MRSA in their noses. Drinking either tea or coffee resulted in around 50 percent relative reduction in the odds of nasal MRSA carriage, and drinking both gave a bigger reduction of 67 percent, said Dr. Eric Matheson et al at Medical University of South Carolina in Charleston USA. Sadly the tea and coffee manufacturers involved are not specified in the article. Perhaps Hospitals will now force all visitors to drink hot tea before entering a ward??! http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/27525

CSC (An American medical company) has launched CSC eMEDlink, a pioneering telemedicine platform that enables clinicians in primary and secondary care to conduct secure, remote audio/visual consultations, and empower patients to take control of their personal care. Following a successful pilot at Frederiksberg Hospital in Copenhagen, Denmark, CSC is now taking the solution to the wider European and global market by starting a pilot at a hospital trust in the United Kingdom, where eMEDlink will initially be rolled out to 25 patients with COPD.

CSC eMEDlink® allows patients with long-term conditions (LTCs) and chronic diseases to be treated at home, receiving the same care and treatment as if they were admitted into the hospital. By following patients closely, with virtual ward rounds and ad hoc consultations, it helps reduce waiting times and costs associated with unplanned admissions, outpatient clinics and patient transport. Virtual monitoring also reduces the precedence of readmission following hospital discharge. See Story:
http://www.healthtechwire.com/The-Industry-s-News-unb.146+M5bc888fba55.0.html

There have been recent press puffs about Singulair and Montelo-10 and Accolate, a group of steroid-free anti-inflammatory pills- claimed to replace long-acting inhaled beta-agonists that also carry a steroid e.g. Serevent, Symbicort. As preventers they have been around a long time but are now being considered for wider use in asthma situations - including chronic asthma - because of the high number of patients who are unable to use inhalers effectively and because it does not include a steroid. Main side-effects include gastric problems, sleeplessness and suicidal tendencies - not an inviting combination, but risk levels are low. Now being rechecked by the FDA in America. Progress needs watching.

17th April posted by David for Katie. She is a good example of courage among copd patients.

"I am 64 years old ex smoker.
Diagnosed with COPD a couple of years ago, but sadly for me, I ignored it. However after several chest infections, pneumonia and pleurisy, MRI's, CT scans and a stint of pulmonary rehab, I have just been told that I am now functioning on just less than 1/2 a lung ( my left one) The right one is completely collapsed due to its emphysematous condition.
Basically its like breathing through a straw, I'm told, but strangely enough I don't feel too bad and do manage to get out and about even though I get extremely breathless after only walking say 10 metres, I have 3 inhalers as do most emphysema sufferers and I take mucodyne to help release the phlegm. Antibiotics have played havoc with my stomach which incidentally has never been a problem until now.
My Consultant is extremely good at explaining things and keeping me in the picture, but I failed to ask him, perhaps I was frightened to, I really don't know why, " what the long term prognosis is and what is my life expectancy ? but then again I suppose its one of those answers, how long is a piece of string and maybe its all about a positive mental attitude, which I think I have.

I just wondered if you had any similar stories and how these people have coped. Kind regards, Katie"

Dental floss can help reduce lung infections. It better that an interdental brush because a different piece of floss is used each time. Bacteria from a gum infection can easily slip into your airways when you inhale. And the warm, moist conditions in your lungs are the perfect breeding ground for trouble. See More:
http://www.dentistryiq.com/index/display/news-display/1395089327.html

TIOTROPIUM VS SALMETEROL FOR COPD
Guidelines recommend inhaled long-acting bronchodilators - either an anticholinergic (Spiriva) - or a ß2-agonist Salmeterol - to mitigate symptoms and reduce the frequency of exacerbations in patients with moderate to severe disease. Which one is more effective? A recently published study compared Spiriva to the ß2-agonist salmeterol and found that tiotropium may be about 12% more effective in preventing exacerbations.
http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=26729

9th March Posted by David

A new inhaler drug called Indacaterol from Novartis is available in the UK. Reportedly it is an equivalent to Spiriva, Bronchial dilation effects last for almost 24 hours. Delivered in 75 mg doses. As with Daxas (now reported reserved for severe patients), again the NHS Trusts appear wary.

7th March,

Reposted by David for Terry

Inhalers Linked to Higher Odds of Diabetes in Asthma, COPD Patients

Dec. 16 (HealthDay News) -- Asthma and chronic obstructive pulmonary disease (COPD) patients who are treated with inhaled corticosteroids may face a significantly higher relative risk for both the development and progression of diabetes, new Canadian research suggests.

http://www.healthfinder.gov/news/newsstory.aspx?docID=647538
The warning stems from an analysis of data involving more than 380,000 respiratory patients in Quebec. Inhaler use was associated with a 34 percent increase in the rate of new diabetes diagnoses and diabetes progression, the researchers found.

The latest detailed advice on oxygen if you are travelling by air is given at the foot of the page for OXYGEN. Up dated to September 2010.

There has been a lot of interest in the new drug Daxas in the UK and many patients are asking for it.

A UK doctor who was personally involved in an assessment of Daxas was approached. The response below is understood to be a personal opinion :

It was suggested that clinically it is not yet shown to have a major effect and as it is an oral tablet it has to go all round the body before it starts to work. For this reason there is said to an increased risk of side effects.

It is intended to reduce airway inflammation and in the two studies that showed good results, none of the patients involved were on maximum inhaled steroids, so it is unlikely that they were having frequent exacerbations.

[This latter point suggests that it is shown suitable so far only for milder levels of copd. DB]

Daxas has been licensed for use in UK and doctors may prescribe it, but it has not yet been assessed by NICE, the UK drug 'value for money' organization which advises our NHS The major hospital trusts and pharmacy groups are hesitant to stock and distribute it. [This suggests that it can be obtained privately but not yet free via the NHS. DB]

[It is reportedly not an expensive drug to produce so there is no reason to believe that cost cutting is a significant factor. The FDA has asked the manufacturer for more information and I suspect this is the reason behind the caution in the UK. DB]

November 3rd. Posted by Terry

MONTREAL — Montreal researchers have discovered that patients using inhaled steroids increase their chances of developing diabetes. Patients with lung disease should ask their physicians about treatment with the synthetic hormone medication because the higher the dose, the greater the risk, said Samy Suissa, director of the Centre for Clinical Epidemiology at the Lady Davis Institute for Medical Research of the Jewish General Hospital. Oral corticosteroids like prednisone have long been known to increase the risk of diabetes, but this is the first time the effect has been observed with the inhaled form, said Suissa, lead author of the study published in the American Journal of Medicine.
Read more: http://www.montrealgazette.com/health/Asthma+inhalers+increase+chances+diabetes+Researchers/3765021/story.html#ixzz14BSy7bsB

November 2nd Posted by David for MYoung2175@aol.com

Certain vitamin deficiencies may lead to decreased lung function in people with chronic obstructive pulmonary disorder (COPD), which includes emphysema and chronic bronchitis, says a new study.

For the study, 20 COPD patients (13 women, seven men) completed a questionnaire to assess their dietary intake of vitamins A, C, D, E and selenium, all of which contain cell-protecting antioxidants. A diet low in antioxidants -- as compared to national dietary intake requirements -- was common among the patients.

http://www.healthfinder.gov/news/newsstory.aspx?docID=644791

October 28th. Posted by David for Doris2

PUBLISHED BY American Thoracic Society's American Journal of Respiratory and
Critical Care Medicine. 20 Oct 2010

"Long term exposure to low-level air pollution may increase the risk of
severe chronic obstructive pulmonary disease."

"While acute exposure of several days to high level air pollution was known
to be a risk factor for exacerbation in pre-existing COPD, until now there
had been no studies linking long-term air pollution exposure to the
development or progression of the disease."

October 21st. 2010. Posted by David

This is about Daxas, the new drug for copd patients

The first drug to specifically target the causes of chronic obstructive pulmonary disease, known as Daxas, is now available as a prescription on the NHS but health trusts in the region have not given it approval and will only consider making it available if GPs ask for it.

October 1st. Posted by David

This could be important for copd - but sadly, only in the long term

Adult skin cells can be turned into pluripotent stem cells by dosing them with messenger RNA sequences corresponding to stem cell-related transcription factors, researchers found.

The manoeuvre allowed a team at the Harvard Stem Cell Institute in Cambridge, Mass., led by Derrick Rossi, PhD, to force reversion of adult fibroblasts to an immature stem-cell state without using viral vectors or other methods that potentially alter the cells' genomes.

http://www.medpagetoday.com/PublicHealthPolicy/StemCellResearch/22494?utm_content=GroupCL&utm_medium=email&impressionId=1285912760620&utm_campaign=DailyHeadlines&utm_source=mSpoke&userid=124707

August 14th Posted by David

This new ultrasound technology is forecast to replace the standard CT scan for looking at lung conditions and for prognosis. It is already approved by the US Federal Drugs Authority.

http://www.youtube.com/watch?v=3FcseDRyepA

IMPORTANT MESSAGE. This letter is in reply to Helen who had been told by her doctor to take the short-acting bronchodilator (Albuterol) before the long-acting one (Advair) "To open up the airways". Mark Mangus explains why this is not always good advice and can result in excessive drug usage. If it applies to you, talk to your doctor and show him a copy of this letter. The official NHS/NICE guidelines give no guidance on this issue. David

What your pulmonary doctor told you is what the vast majority of pulmonary doctors are saying. The same is true of other pulmonary health care professionals like respiratory therapists, pulmonary nurse practitioners and pulmonary physician's assistants.

There's a long story about how that recommendation came about. But, the truth is that it is based upon false assumptions and - more important, there is a complete lack of evidence to validate it. No one argues against the fact that fast/short-acting versions open up the airways quickly. Where the problem arises is that the fast/short-acting versions exert their action on the same receptors in the lungs as do the long-acting versions. So, when you use the fast-acting versions and then follow them immediately with the long-acting ones, there are few if any receptor sites within the lungs with which the long-acting version can bind because they've all been tied up by the short-acting medication.

Consequently, the long-acting medication floats around until it is sent to be disposed of from your body having never had the opportunity to do any work. As a result, folks who use the fast/short-acting versions first and then follow with the long-acting ones find they do not get the predicted benefit from the long-acting medications that they are supposed to expect. And worse, they end up taking twice as much medication, since they then have to use the short-acting medications more often than they would otherwise need to. This is because the long-acting ones are mostly lost in the body and never get a chance to work.

The other fallacy in the recommendation has to do with the notion that you have to take any of them "very deeply" into your lungs. The receptors for those medications are in the small to mid airways. Yes, they do require a good quality deep breath and hold, but they don't require the deepest breath you can take. For the amount of "opening up of the airways the short/fast-acting medications do, actually there is no real difference in the "amount" of opening. Actually, there is only a few minutes difference in how long it takes the long-acting drugs to reach 'comparable' dilation with the short-acting ones.

Finally, there has never been a study done to test the widely held belief and recommendation you have received. It came about because of incorrect use and introduction of the long-acting medications when they were introduced to us many years ago. While none of us on either side of the question has high-quality empirical evidence (evidence that has been shown to be "cause and effect-related" to the stated condition). I have at least gathered 'some' amount of prospective evidence from a significant number of subjects over several years - and I have discussed the question with pharmacokineticists who are expert in bronchopharmacology (how drugs act in the bronchial tubes) who back my contentions and rationale and dispute the validity of the popular and widespread, but erroneous notions in this regard.

Also, right here on our EFFORTS list there are many folks who can tell you their own experience with changing the order of taking their inhaled medications. Helen, you should take your Advair, followed in a few minutes by Spiriva. If after 30 more minutes, you are still having a hard time breathing, only then should you take additional Albuterol. The Albuterol should be no more than an "as needed"/back-up medication to use on occasion between doses of Advair.

Best Regards, Mark
Mark W Mangus, Sr. BSRC, RRT, RPFT, FAARC
San Antonio,Texas.