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BREATHLESS WEBSITE: This site was founded by John Kirtley. Sadly he died in 2008. |
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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. David July 20th Exposure to wood smoke may increase (nearly double) the risk of chronic obstructive pulmonary disease (COPD) -- particularly among current smokers, researchers have found.
July 12th
June 18th
In a cohort study of nearly 80,000 patients, 92% were given IV steroids and only 8% were initially treated with low-dose oral medications as guidelines urge, according to Peter Lindenauer, MD, of Baystate Medical Center in Springfield, Mass., and colleagues.
LINK HERE
Published Tue 27 Apr 2010 13:35, Last updated: 2010-04-27 by Anthony Harvison. A new wonder drug which eases emphysema and chronic bronchitis will be available from GPs within weeks after being developed by a Liverpool-based professor Daxas was proven to reduce the frequency and severity of attacks by almost 40 per cent following clinical trials among 4,500 patients in ten countries. Link here
From Terry
Date: Thu, 22 Apr 2010 13:52:01 -0700
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 good advice and results in excessive drug usage. If it applies to you, talk to your doctor and show him a copy of this letter.
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.
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
NEW ORLEANS -- Chronic obstructive pulmonary disease (COPD) patients treated with formoterol-containing treatments appear to significantly reverse airflow obstruction, even with severe cases of COPD. "Reversibility of airflow obstruction was achieved by a majority of patients after formoterol-containing treatment," Donald Tashkin, MD, emeritus professor of medicine at UCLA, said at the annual meeting of the American Academy of Allergy, Asthma & Immunology. LINK HERE (N.B. Symbicort contains formoterol, David )
Feb 4th 2010 The claim below was carried out solely by reviewing old paperwork covering emphysema patients – not the most reliable of sources. With due respect, after the admitted adjustments for age, gender, region, health plan capitation status, urban or rural residence, comorbidities, respiratory-related inpatient admission or emergency department use, flu and pneumonia vaccination, total medical costs, and presence of congestive heart failure or pneumonia - each adjustment having a significant error factor, it is very hard indeed to believe that the quoted results are meaningful. I know they suffered an early setback, but it does look as though the promoters of Spiriva are going overboard in dredging up peripheral and sometimes rather obscure data to advertise their product. David B
SAN DIEGO -- For patients with chronic obstructive pulmonary disease (COPD), the likelihood of being hospitalized appears to vary depending on the type of long-acting bronchodilator treatment they're receiving, a retrospective study showed. Monotherapy with tiotropium (Spiriva) resulted in the lowest risk of COPD-related hospitalization, Emily Durden, PhD, of Thomson Reuters in Austin, Tex., reported at the American College of Chest Physicians meeting here.
Jan 7th 2010 The NHS have been carrying out surveys on how they can save costs by discharging copd patients early after they have been admitted to hospital due to an exacerbation. The idea is that they receive care in their home via hospital-based staff who work under the direction of their specialist. The copd specialist would decide when such care can be handed over to the local surgery. This is the basic idea. It sounds reasonable, but there are many problems as yet unaddressed - particularly what happens in respect of a need for further rehab. I have been accepted as the UK patient representative on a European-based committee considering these matters. If you have any views or ideas, tell me by e-mail at Boscon@metronet.co.uk David
NOTE TO READERS. The software for managing this website is old and now appears frequently unstable when handling inputs from Outloook Express. All postings for mid-October through January have been lost. We apologise for this. David October 13th 2009
Patients taking tiotropium bromide (Spiriva) for chronic obstructive pulmonary disease (COPD) appear to be at decreased risk for death and cardiovascular events compared with placebo, researchers said. David October 2009 Childhood exposure to environmental tobacco smoke correlated with increased evidence of emphysema on lung scans of nonsmoking adults, data from a large cohort study showed. Structural and quantitative indices of emphysema differed significantly on CT lung scans of adults with a childhood history of secondhand smoke exposure compared with those with a negative exposure history, Gina S. Lovasi, PhD, of the Mailman School of Public Health of Columbia University in New York, and colleagues reported online in the American Journal of Epidemiology.
Dec 29 09.
[UPDATE 10/07/2008] FDA informed healthcare professionals that FDA has reviewed preliminary data from UPLIFT (Understanding the Potential Long-Term Impacts on Function with Tiotropium), a large, 4-year, placebo controlled clinical trial with Spiriva HandiHaler in approximately 6000 patients with chronic obstructive pulmonary disease. The preliminary results reported by Boehringer Ingelheim to the FDA showed that there was no increased risk of stroke with tiotropium bromide compared to placebo. Hi all,
Despite the justified warnings from Susie below, about M Young's posting, many people on line do report good results from the drug combination referred to. David From: MYoung2175@aol.com
Sent:
Friday, October 09, 2009 12:40 PM Subject: COPD Int'l - COPD: Triple Therapy Reduces COPD Exacerbations
For moderate-to-severe chronic obstructive pulmonary disease (COPD), a triple regimen of a long-acting ß-agonist (LABA), an inhaled corticosteroid, and an antimuscarinic agent substantially reduced exacerbations compared with monotherapy in a randomized trial. Severe exacerbations dropped 62% when combination budesonide and formoterol (Symbicort) was added to tiotropium (Spiriva), according to Tobias Welte, MD, of Hannover Medical School in Germany, and colleagues. Triple therapy also significantly improved lung function, COPD symptoms, and quality of life, they reported in the Oct. 15 American Journal of Respiratory and Critical Care Medicine.
Hi everyone, When I saw this story, my first reaction was to check the funding sources for this study. I do that on all studies to see if there is any conflict of interest. Well, this one has the following note at the bottom of the article: The trial was sponsored by AstraZeneca. Welte reported conflicts of interest with AstraZeneca, Boehringer Ingelheim, Novartis, MSD, and GlaxoSmithKline. Co-authors reported conflicts of interest, including stock ownership and patents, with AstraZeneca. They also reported conflicts of interest with Boehringer Ingelheim-Pfizer, GlaxoSmithKline, Almirall, Nycomed, Bayer Schering, Talecris, Actelion, Eli Lilly, and ZLB Behring. Jones reported that he has received consultancy fees from GlaxoSmithKline, AstraZeneca, Almirall, Boehringer Ingelheim, and Spiration and lecture fees from GlaxoSmithKline. His institution will receive funds from his time as a consultant to Novartis. This is first time I ever saw such a blatant conflict of interest actually noted. I would like to think the outcome of this study is unbiased, but the fact is we owe it to ourselves as informed patients to not take all these studies at face value, but check with unbiased sources on the efficiency of these drugs. Susie in Delaware 16 September 2009 Roflumilast Combined With Salmeterol or Tiotropium Is Safe and Effective in COPD: Presented at ERS VIENNA, Austria -- September 16, 2009 -- The phosphodiesterase-4 inhibitor roflumilast in combination with bronchodilators salmeterol or tiotropium shows significant benefit in COPD patients, according to study research reported at the 19th Annual Congress of the European Respiratory Society (ERS). Synergistic adverse events were not observed, allaying concerns over the use of combined therapies incorporating roflumilast. http://www.docguide.com/news/content.nsf/news/852576140048867A85257633007B09C4 Posted elsewhere by ednafiore@msn.com Getting nearer. David.
1st September 2009
Roflumilast There has been much cyber discussion about this new drug. It is not a direct replacement for Spiriva, but has the potential to go a long way towards reducing the need for steroid drugs such as Prednisolone. This is great news, but I have heard from a patient who took part in the early UK trials. This was in 2005. He says that immediately after the trials, instead of going straight for the preliminary approval procedure, there was a financial squabble between the drug companies involved and a gap of several years before more trials were started. If this was so, here was another shameful example of lack of care for patients by the drug companies. David
1st August 2009 Inhalation of 70 parts per billion ozone for 6.6 hours, a concentration below the current eight-hour National Ambient Air Quality Standard of 75 ppb, can induce significant reduction in FEV1 -- the volume of air a person can forcibly exhale in the first second -- according to a report in the Aug. 1 American Journal of Respiratory and Critical Care Medicine.
December 11th ROCKVILLE, Md. Dec. 10 -- A panel of FDA advisers reviewing the safety of long-acting beta agonist inhalers heard calls today from some agency staffers to recommend banning two of the four drugs for use in adolescents. 8 December In addition, the two other inhalers should be banned altogether because there is too high a mortality risk with them, the FDA staffers said. However FDA staffers viewed this as much too extreme a measure. Also, clinicians told the panel that banning the drugs would, on balance, be harmful to patients. The drugs are salmeterol/fluticasone (Advair), formoterol (Foradil), salmeterol (Serevent), and formoterol/budesonide (Symbicort). The FDA already has a black box warning on the labels of those drugs to ensure use with a steroid. But some patients are taking the long-acting beta agonists as a monotherapy, despite the black box warnings, said Andrew Mosholder, M.D., M.P.H., an epidemiologist with the FDA's Center for Drug Evaluation and Research http://www.medpagetoday.com/Pulmonary/Asthma/12117
Long-term Antibiotics Reduce COPD Exacerbations, Raise Questions
Thursday, December 4
Gilead starts pulmonary disease drug trial 17th November Alan Johnson, the Secretary of State for Health, has today announced that patients seeking additional treatment from the private sector will no longer lose their entitlement to NHS care. · he will work with the pharmaceutical industry to allow companies to supply drugs at cheaper prices until their worth has been proven · NICE will create more flexible arrangements for drugs for terminal illnesses · a new timetable will be created to fast track the NICE appraisal programme for new drugs, with guidance for most drugs available by six months · a set of core principles will be published and detailed guidance will be produced for PCTs in how to handle exceptional cases for drugs which do not yet have NICE approval November 15th NOTE. Today a well-meaning and important input to COPD International by Jackie Levigne about diffusion unfortunately may appear a bit confused and misleading for UK readers. There are also several errors of fact. As many of our visitors also use COPD Int and join their forums, with due respect I though it best to try and offer an edited and more precise version of her statements. David PFT means Pulmonary Function Test. It is a generic term that covers several different tests that check various aspects of lung f unction. An Oximeter can show how much O2 is in the blood stream and the pulse rate, but nothing more. Usually as the disease progresses doctors need to know more about the rate of O2 and CO2 gas exchange that occurs in the blood in the alveoli. This process is called Diffusion. It is said that if the membrane of the alveoli could be stretched out they would cover a tennis court. The more of this area in the lungs that is working well, the better the oxygen supply to the blood will be. An example Diffusion Test. The patient inhales a single breath of air containing a measured amount of Carbon Monoxide (CO). The patient holds their breath for 10 seconds and then exhales. The exhalation is captured and the amount of CO remaining in it is measured. The difference has been absorbed into the patient's bloodstream. That amount is used to indicate the rate at which the CO was absorbed into the blood during the 10 seconds. The greater the amount absorbed, the better the lung condition. The rate can be compared to that expected in a normal lung for a person of similar build and expressed as a percentage - the higher the better. The test using CO gives a useful indication of the state of the alveoli and their ability to get oxygen into the blood. An important part of physical lung function is the ability to inhale a quantity of air and then expel it - Spirometry measures amount you process and the rate of exhalation compared to what is normal for a person of your age, height and other factors. The basic "standard" for evaluating the severity of COPD has primarily been Spirometry. However, functional dyspnea (difficult or painful breathing), body mass index (BMI), and FEV1 from Spirometry, when evaluated collectively, offer better insight into outcomes such as survival. Most times, the Spirometry test results are the only referenced statistics.
Here are some common acronyms met in pulmonary testing:
DLCO is Diffusion capacity of the Lung for carbon monoxide (CO). FVC is Forced Vital Capacity - the volume of air which can be forcibly and maximally exhaled out of the lungs until no more can be expired. It is usually measured in litres FEV1 is Forced Expiation Value after 1 second - the volume of air which can be forcibly exhaled from the lungs in the first second of a forced expiratory maneuver. It too is measured in litres. FEV1/FVC is Forced Inspiration Value after 1 second as a Percentage of Forced Vital Capacity – indicates what percentage of the total FVC was expelled from the lungs during the first second of forced exhalation.
31st October PHILADELPHIA, Oct. 30 -- Chronic obstructive pulmonary disease patients taking either of two commonly used medications had similar changes in bone mineral density, a randomized, multicenter trial showed Patients given the long-acting beta2-agonist salmeterol (Serevent) or a combination of salmeterol and the corticosteroid fluticasone propionate (Advair) for three years had no consistent differences in bone mineral density at the lumbar spine or hip, Glenn Crater, M.D., director of clinical development of GlaxoSmithKline in Research Triangle Park, N.C., reported at the American College of Chest Physicians meeting here. GlaxoSmithKline funded the study and manufacture both medications. http://www.medpagetoday.com/MeetingCoverage/CHEST/11550 From Pauline 18th October BREAKING NEWS NEW HOPE FOR TREATMENT OF SEVERE EMPHYSEMA
Minimally Invasive Metal Implant Makes Its First Appearance At Berlin Congress. Forwarded by Dick/MO: A new type of implant for the treatment of severe emphysema, which can be placed using a simple, non-invasive procedure, has made its first appearance at the Annual Congress of the European Respiratory Society (ERS) in Berlin, to considerable acclaim. This device - though, to date, tested on only a handful of patients - could provide a viable alternative to the invasive treatments currently used, including lung volume reduction surgery and lung transplants. The new, revolutionary approach was presented to the Congress in three scientific communications that provided an assessment of the new device's feasibility and effectiveness. No surgery needed: This is the context in which the new device, presented to the ERS Congress by American and German teams, makes its promising debut. The implant, designed to restore or improve the patient's normal breathing mechanism, is made of super-elastic nitinol (a metal alloy). It aims to compress the lung tissue, restore its elasticity and reduce the excessive swelling of the emphysema-affected lung. Unlike the current invasive surgical procedures, placement of the implant is carried out using only a bronchoscope, a small, flexible tube inserted in the lungs through the mouth, without any need for surgery or incision. The end goal is the same as with the standard surgical treatment - to reduce lung volume - but without the need to excise areas of the lung, and without the mortality and morbidity risks that surgery involves. Furthermore, its effectiveness should not be undermined by air bypassing the treated area. The first triumph, as Herth and his colleagues told the Congress, was that the procedure was found to be safe, and was well tolerated by the patients, aged 61 on average, who were able to go home after three days. The study kept the patients in hospital for 72 hours so that their health could be comprehensively monitored. And the procedure proved highly effective, according to the figures announced in Berlin. Three-month follow-up showed, for all tests, an observed improvement in lung function, comfort and quality of life for the five patients. For example, in some patients FEV1 (forced expiratory volume in one second) rose by 18% and patients on average were able to walk an additional 38 metres in the traditional six-minute walking test. "This study is highly significant", the Congress was told by Armin Ernst of Beth Israel Deaconess Medical Center, Boston, who represented the American teams. "For the first time, a technology has been designed specifically to restore bronchiolar elasticity. In the future, this will help thousands of patients with emphysema." On the basis of the results presented in Berlin, other centres throughout Europe will now be able to undertake similar studies. http://www.medicalnewstoday.com/articles/124303.php
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