Friday’s COPD Newsletter from COPD Support, Inc.
Volume 9, Issue 40
September 4, 2009
Joan Costello, Editor
LUNG TRANSPLANT RULES HELP SOME, LEAVE OTHERS OUT
By Chris Emery, Contributing Writer, MedPage Today. New rules for lung allocation have increased the likelihood of patients receiving a transplant, but a new study showed that one group did not benefit from reduced mortality — those with idiopathic pulmonary arterial hypertension (IAPH). The likelihood of IAPH patients receiving a lung transplant within a year of being put on the U.S. transplant waiting list increased from 17% before the Lung Allocation Score was implemented in 2005 to 37% afterward, according to a report in the Sept. 1 edition of the American Journal of Respiratory and Critical Care Medicine. The likelihood of IPAH patients receiving a transplant within six months improved from 10% to 29% with the introduction of the scoring system, known as LAS.
However, while mortality rates improved for waiting list patients with other diagnoses — such as idiopathic pulmonary fibrosis, COPD and cystic fibrosis — the mortality rate for IAPH patients did not change significantly. “Our results indicate that although the LAS has been successful in improving the efficiency of lung allocation for the majority of patients, lung allocation remains an ongoing challenge especially for underrepresented diagnoses such as IPAH,” wrote Hubert Chen, MD, MPH, of the University of California, San Francisco, and colleagues.
Allocation of lungs in the U.S. is overseen by the Organ Procurement and Transplantation Network. That changed with the implementation of the LAS system, which bases priority on an estimate of the patient’s survival benefit from a lung transplant. The intention was to minimize waiting list mortality, maximize transplant benefit and ensure the efficient and equitable allocation of donor lungs, according to the paper.
http://tinyurl.com/l3947v
ALSO IN THIS ISSUE
-UPPER ARM EXERCISES IMPROVE VIGOR IN COPD PATIENTS
-TIRED? TELL SOMEONE ABOUT IT
-EXPERIMENTAL COPD DRUG FINDINGS
-TREATING COPD EARLY IMPROVES OUTCOMES
-LETS GET FIT
-THE DOWN SIDE OF ROMANTIC, CANDLE-LIT DINNERS
-MISCELLANEOUS
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SOURCES: News items summarized in The COPD-NEWS are taken from secondary sources believed to be reliable. However, the COPD Family of Services does not verify their accuracy.
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UPPER ARM EXERCISES IMPROVE VIGOR IN COPD PATIENTS
The benefits of exercises to strengthen muscles in the upper arms, shoulders, and chest of patients with COPD extend beyond the upper extremities, results of a clinical trial indicate. Unsupported upper extremity exercises “may ameliorate the patients’ general exercise capacity and autonomy, over and above standard pulmonary rehabilitation,” physical therapist Stefania Costi and associates in Italy report in the August issue of Chest.
The current guideline on pulmonary rehabilitation for COPD patients advocates exercise training targeted at the muscles of the upper extremities in COPD patients. The theoretical rationale for this advice involves the dual role of upper extremity muscles that sustain the upper girdle while also acting as accessory respiratory muscles. However, Dr. Costi, from the University of Modena and Reggio Emilia, and her team found that the quality of previous clinical trials has been so poor that there are no reliable data to support this type of training.
They therefore conducted their own randomized trial among patients with stable COPD who had been referred for inpatient pulmonary rehabilitation, to study the effects of 15 sessions of unsupported upper extremity exercise training. Twenty-five patients each (mean age 69 years) were randomly assigned to regular rehabilitation or rehabilitation plus the upper extremity training. All patients completed the trial.
The training consisted of five movements while holding dumbbells to activate the pectoralis, deltoids, triceps brachii, trapezius, and biceps brachii. The primary outcome was change in the 6-minute ring test, in which the total number of rings moved were counted and change in physiologic measures — heart rate, pulse oximetry, respiratory rate, perceived dyspnea and arm fatigue — were monitored. Secondary outcomes were an activities of daily living field test, the 6-minute walking test, and scales to assess the extent and effect of breathlessness on daily activities.
Evaluations carried out at the end of the study period indicated that patients in the intervention group improved significantly…At a 6-month follow-up, the intervention group maintained the greater improvement in the 6-minute ring test and in the degree of dyspnea experienced during daily activities.
Besides corroborating the efficacy of unsupported upper extremity exercise testing in improving exercise capacity, “this trial provides new and relevant data regarding the benefits of this specific training on clinically important outcomes, such as the ability to perform activities of daily living that involve the upper extremities and the fatigue related to those activities,” Costi and associates conclude.
Unexpected was the improvement of general exercise capacity, surpassing the minimal clinically important difference for patients with COPD.
http://www.medscape.com/viewarticle/708092
TIRED? TELL SOMEONE ABOUT IT
National Fatigue Survey Launched by The Fatigue Management Institute. The National Chronic Fatigue Survey, an internet-based survey of fatigue related to chronic illness, has been launched by the Fatigue Management Institute of Florida Institute of Technology. The survey is designed to gather information on the nature and impact of fatigue associated with chronic medical disorders. The survey findings will be used to better describe the experience and severity of fatigue related to chronic medical conditions and will contribute to the development of improved techniques for managing fatigue. Summaries of survey findings will be posted on our web site following the close of the survey.
The Survey is open to adults with a chronic medical condition, can be completed anonymously, and can be accessed at:
http://research.fit.edu/fmi
About the Fatigue Management Institute: The Fatigue Management Institute serves as a focal point for integrating emerging research findings with techniques for day-to-day management of fatigue. The Institute conducts research on fatigue and fatigue management interventions, provides fatigue management training, and disseminates summaries of research findings related to fatigue and its management in chronic medical conditions. The institute is part of the School of Psychology at Florida Institute of Technology and has no commercial interests. Forwarded by Carolyn.
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MEDICAL DECISIONS. Your physician should be consulted on all medical decisions. New procedures or drugs should not be started or stopped without such consultation. While we believe that our accumulated experience has value, and a unique perspective, you must accept it for what it is…the work of COPD patients. We vigorously encourage individuals with COPD to take an active part in the management of their disease. They do this through education and by sharing information and thoughts with their primary physician and pulmonologist. However, medical decisions are based on complex medical principles and should be left to the medical practitioner who has been trained to diagnose and advise.
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EXPERIMENTAL COPD DRUG FINDINGS
By Megan Johnson. Late-stage clinical trials show that Daxas, a drug developed to treat COPD reduced COPD attacks and improved breathing. The drug, from Nycomed and Forest Laboratories, reduced serious COPD attacks by 17 percent per patient per year when compared with a placebo; it also raised the volume of air patients could breathe out in one second by close to 50 milliliters, according to Reuters. If approved, the drug will most likely be used in combination with inhaled treatments already on the market. Despite the positive results, its approval by the Food and Drug Administration is not a sure thing. In an earlier clinical trial, the drug did not produce large enough benefits. The latest results are published in the journal Lancet.
http://health.usnews.com/articles/health/2009/08/28/health-buzz-experimental-copd-drug-findings-and-other-health-news.html
TREATING COPD EARLY IMPROVES OUTCOMES
Three reports published in the Aug. 29 issue of The Lancet, a special issue devoted to COPD, offer new insight into treatments, including a new anti-inflammatory drug that shows promise.
In the first report, patients who began treatment early with the inhaled drug tiotropium (Spiriva) had better outcomes compared with untreated patients.
“If you treat moderate disease with these anticholinergic drugs, you get clear improvements in lung function, health-related quality of life, exacerbations and even, maybe, in mortality, but that was not statistically significant, but there was a trend,” said lead researcher Dr. Marc Decramer. In addition, “you seem to reduce the rate at which the disease progresses,” he noted. For the study, Decramer’s group followed 2,376 patients with early COPD who took part in a study for four years. These patients were randomly assigned to receive Spiriva or a placebo. The researchers found that the rate of decline in lung function was 12 percent lower among patients receiving Spiriva than for patients receiving the placebo. In addition, patients taking Spiriva were healthier. Flare-ups of the disease were cut 18 percent, and hospitalizations resulting from flare-ups were reduced 26 percent, compared with patients taking the placebo, the researchers found. For the best outcomes, Decramer said, COPD needs to be diagnosed in its early stages, and aggressive therapy should begin as soon as possible.
Two other reports in the same edition of the journal show the benefit of the new drug roflumilast (Daxas) in treating COPD:
Daxas, an anti-inflammatory, is still going through the drug approval process in the United States and elsewhere. In one study, Dr. Leonardo Fabbri from the University of Modena in Italy and colleagues randomly assigned 3,091 patients with severe COPD to Daxas or a placebo. Over a year, patients taking Daxas experienced improved lung function and had 17 percent fewer flare-ups than patients taking a placebo.
In a second report, a research team led by Dr. Klaus F. Rabe, of Leiden University Medical Center in the Netherlands, tested the benefit of Daxas when added to standard COPD treatment with long-acting bronchodilators or anticholinergics. In this trial, 1,677 patients with moderate-to-severe COPD were randomly assigned to Daxas or a placebo for 24 weeks. Patients were also receiving the bronchodilator salmeterol (Serevent) or the anticholinergic Spiriva. The researchers found that adding Daxas to treatment with Serevent or Spiriva improved lung function over either drug alone. In addition, Daxas improved respiratory symptoms. In both studies, Daxas was associated with more adverse side effects, including nausea, diarrhea and weight loss, researchers note.
“Roflumilast improves lung function in patients with moderate-to-severe COPD who are already being treated with long-acting bronchodilators [beta-2 agonists or anticholinergic drugs], although with expected class-specific adverse events. Roflumilast could become an important, concomitant treatment for these patients.” “These effects are clinically important, but not terribly striking,” said Dr. Paul O’Byrne, a professor of medicine at McMaster University Medical Center in Ontario, Canada, and author of an accompanying journal editorial. One problem with these studies is that they don’t compare Daxas with inhaled corticosteroids, which are also anti-inflammatories, OByrne said. “We don’t know what advantage roflumilast has in patients already taking inhaled corticosteroids.”
http://health.usnews.com/articles/health/healthday/2009/08/27/treating-copd-early-improves-outcomes.html
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COMMERCIAL FREE: We do not accept any paid advertising. Any corporations, products, medicines (prescription or non) mentioned in this newsletter are for informational purposes only and not to be construed as an endorsement or condemnation of same.
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LETS GET FIT
Posted by Carolyn Krall: We are getting ready to start a new team for List subscribers who want to join the Lets Get Fit Program. You can read about the program at http://www.copd-support.com
Or at the Lets Get Fit website at
http://lgf.copd-support.info
We’re about exercising to help ourselves breathe better and to increase our strength and endurance. We have small groups of exercisers who email daily to report their exercise efforts and to share encouragement and support. We share lots of exercise information but we do not tell our members what exercises to do. All our members must rely on their medical advisors for guidance.
The new group will be starting after Labor Day!
Izzy Kuehl Director
Bruce Petro Assistant Director
LGF posts are from COPD patients or their caregivers. LGF staff and members are NOT medical professionals. Consult your doctor about your exercise & medical needs.
THE DOWN SIDE OF ROMANTIC, CANDLE-LIT DINNERS
Burning candles made from paraffin wax - the most common kind used to infuse rooms with romantic ambiance, warmth, light, and fragrance - is an unrecognized source of exposure to indoor air pollution, including the known human carcinogens, scientists report. Levels can build up in closed rooms, and be reduced by ventilation, they indicated in a study presented at the 238th National Meeting of the American Chemical Society (ACS). In the study, R. Massoudi Ph.D., and Amid Hamidi , Ph.D., said that candles made from bee’s wax or soy, although more expensive, apparently are healthier. They do not release potentially harmful amounts of indoor air pollutants while retaining all of the warmth, ambiance and fragrance of paraffin candles (which are made from petroleum).
“An occasional paraffin candle and its emissions will not likely affect you,” Hamidi said. “But lighting many paraffin candles every day for years or lighting them frequently in an un-ventilated bathroom around a tub, for example, may cause problems.” Besides the more serious risks, he also suggested that some people who believe they have an indoor allergy or respiratory irritation may in fact actually be reacting to air pollutants from burning candles.
http://www.medicalnewstoday.com/articles/161322.php
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JOIN US? Subscription to this Newsletter is free and we hope that it serves your needs. For more Newsletter information, go to:
http://copd-support.com/signup-news.html
The Newsletter, like all the other endeavors of the Family of COPD Support Programs, is provided to you by COPD-Support, Inc. a non-profit member organization with IRS designation 501(c)(3). If you would like to be involved and help us provide these programs to the individuals who benefit from them, please consider joining us as a member. Further information is available at:
http://copd-support.com/membership.html
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MISCELLANEOUS
Your age by Chocolate
Forwarded by Bobbie/UK
http://fminbox.com/interesting/your-age-by-chocolate-math/
Find The Nude Dude
Not x-rated, just for fun
http://www.angelfire.com/ak2/intelligencerreport/nude_dude.html
This is a most unusual PC illusion.
http://www.angelfire.com/ak2/intelligencerreport/christ1.html
Hidden Countries Word Puzzles
http://thinks.com/puzzles/hidden1.htm
Until next Friday,
Joan Costello, Editor
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September 4, 2009
Tags: COPD Support Inc., COPD Support newsletter, Friday COPD newsletter Posted in: Friday's COPD Newsletter
One Response
Corinne Russell - September 8, 2009
Thanks for posting information on our National Fatigue Survey, and thanks to all who have participated. We will break out results by types of medical disorders, such as rheumatoid arthritis and chronic fatigue syndrome, if we have a large enough response rate. Please encourage others to participate, as the Survey will be available through January 31, 2010, and we are not yet reaching as many of the individuals who deal with fatigue as we would have liked.
Corinne Russell
Dr. Thom Harrell
Fatigue Management Institute
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