Friday’s COPD Newsletter from COPD Support, Inc.

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Volume 9, Issue 46
October 16, 2009
Joan Costello, Editor

TRIPLE THERAPY HALVES EXACERBATIONS IN MODERATE-TO-SEVERE COPD

> From Richard NY. Before the ink was dry on the study that found “no benefit to the combo therapy,” this latest one appeared:

Patients with moderate to severe COPD can benefit from triple therapy that includes a long-acting ß-agonist (LABA), an inhaled corticosteroid (ICS) and an anti-muscarinic agent, according to researchers in Germany. In the study, which will appear in the October 15 issue of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine, researchers found that adding budesonide, an ICS, and formoterol, a LABA, to the anti-muscarinic agent, tiotropium, reduced the rate of severe exacerbations in COPD patients by 62 percent. Triple therapy also resulted in significant improvements on a number of outcome parameters in COPD patients, including lung function, signs and symptoms, and quality of life.

The researchers recruited more than 600 patients with moderate to severe COPD to participate in the randomized, double-blind, multi-center, parallel group trial. Prior to the beginning of the study, enrolled patients stopped their use of LABA and ICS medications for two and four weeks respectively. Two weeks prior to the start of the trial, every patient was given a tiotropium (18 µg) inhaler to use daily and as needed as a reliever medication. Patients were then randomized to use either tiotropium plus budesonide and formoterol or tiotropium plus placebo twice daily. They were assessed at the beginning of the run-in period, then at weeks zero, one, six and 12.

After one week, patients on triple therapy increased their pre-dose FEV1 clinic values by six percent over than patients on tiotropium alone. There was an even greater improvement in post-dose readings among triple-therapy patients, which were about 12 percent better than those on tiotropium alone. Onset of symptom relief was also significantly quicker in the triple therapy group. “In some cases, we found that patients experienced an almost immediate relief, whereas those who were treated with placebo had a greater lag time between dosing and relief.” The researchers also found significant improvements in morning activities in the triple therapy group, beginning at one week and sustained throughout. “Patients could easier wash themselves, get dressed, eat breakfast and walk around early in the morning,.”
http://www.medicalnewstoday.com/articles/166713.php

ALSO IN THIS ISSUE

WHAT IS CHRONIC BRONCHITIS?

SOME REALLY GOOD COPD VIDEOS

CHEST PAIN, WHAT YOU SHOULD KNOW

TO YOUR GOOD HEALTH

LINK BETWEEN PROTEIN AND LUNG DISEASE FOUND

HANDLING CREDIT CARD DEBT SHOULD YOUR SPOUSE PASS AWAY

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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WHAT IS CHRONIC BRONCHITIS?

Written by Amanda Wattson, MD. Chronic bronchitis is a type of chronic obstructive airway disease, or COPD. People with COPD have limitations in the flow of air through their airways. Chronic bronchitis is an ongoing inflammation of the breathing tubes.

What is going on in the body?

Chronic bronchitis results from long-term exposure of the airways to irritants. These irritants include tobacco smoke, air pollution, and chemicals. They cause the airways to secrete excess mucus and to become inflamed. With time, the inflammation becomes widespread. The cells lining the airways change. The glands that produce the mucus become enlarged. Inflammation and excess mucus combine to cause a cough that produces sputum, or phlegm, almost every day.

The World Health Organization, also known as WHO, has developed a classification system for the severity of chronic bronchitis and other forms of COPD. There are four stages of severity, as outlined below:

- Stage 0, or at risk for COPD. These people have chronic cough and sputum production. Their lung function tests are still normal.

- Stage I, or mild COPD. Individuals in this group have mild limitations in their airflow and changes in their lung function tests. They generally have chronic cough and sputum production.

- Stage II, or moderate COPD. People at this stage have worsening of airflow that leads to shortness of breath with exertion. Their lung function tests show marked limitations.

- Stage III, or severe COPD. Individuals at this stage have severe airflow limitations that impair their quality of life. Their lung function tests are markedly abnormal.

What are the causes and risks of the condition?
What are the treatments for the condition?
What are the side effects of the treatments?
What happens after treatment for the condition?
How is the condition monitored?
Answered at: http://www.24medica.com/content/view/843/2/

SOME REALLY GOOD COPD VIDEOS

Welcome to Health Nation
http://www.healthination.com/content/view/video_popup/234

CHEST PAIN, WHAT YOU SHOULD KNOW

Written by Glenn Rosenberg. The chest is the area where the heart and lungs are located. These organs are protected by the rib cage and breastbone. Many different conditions can cause pain in the chest. Chest pain is a common complaint. In adults, it is often a cause for concern because it can signal a heart attack. However, many conditions ranging from a pulled muscle to pneumonia can also cause chest pain.

The are many different causes for chest pain. These include:

- heart pain. This may be due to stable angina, unstable angina or a heart attack. It also may be caused by myocarditis, inflammation of the heart muscle, or pericarditis, which is inflammation of the membranes lining the heart.

- muscle strain in the chest. This can be brought on by lifting weights or other heavy items.

- injury to the chest

- bone or joint inflammation. This may include arthritis of the shoulder or spine, spinal disc problems in the neck, or costochondritis, an inflammation of the cartilage of the ribs.

- damage, irritation or inflammation of the lungs. This may be caused by acute bronchitis, chronic bronchitis, pneumonia, pleurisy, lung cancer, or a punctured or ruptured lung.

- blood vessel-related pain. This may be caused by aortic dissection or a blood clot known as a pulmonary embolus.

- gastrointestinal pain. This may be caused by peptic ulcers, gastroesophageal reflux, gas pockets, irritable bowel syndrome, esophageal spasm, achalasia, or a tear or ulcer in the esophagus.

- irritation of other organs in the abdomen. This may include gallbladder pain from cholecystitis, or pancreatitis.

- herpes zoster. This is a viral infection of the central nervous system. It is caused by the same virus as chickenpox.

- emotional or psychological conditions such as anxiety and panic disorders

Other causes are also possible. In some cases, the cause is never found. Chest pain can be a serious symptom and should not be ignored. Those with severe chest pain or known heart disease should go to the nearest hospital for evaluation of the pain.
http://www.24medica.com/content/view/865/2/

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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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TO YOUR GOOD HEALTH
By Paul G. Donohue M.D.

Dear Dr. Donohue: I am inquiring for a friend about COPD. I would like to know what to look for in the last stages of COPD. We are in prison, and my friend is having a hard time with his COPD. He is 60. I want to help him in any way I can. — K.S.

“COPD” stands for chronic obstructive pulmonary disease. “Chronic” indicates that it’s a permanent thing; “obstructive,” that there’s a blockage of air passing into the lungs and oxygen into the blood; “pulmonary,” that the lungs are the site of the trouble. The two main COPD illnesses are emphysema and chronic bronchitis. Usually, both are seen together, and cigarette smoking is the most common cause of them.

Emphysema indicates destruction of the lung’s air sacs, the millions of delicate, tiny, cellophane like structures through which oxygen passes into the blood from the lungs. Chronic bronchitis is inflammation of airways — bronchi, or breathing tubes. They’re filled with thick, yellow mucus, and they have narrowed. The signs of COPD are shortness of breath on activity and a cough that won’t stop.

The stages of COPD are best defined by lung tests. Symptoms are a rough guide to staging. In the advanced stages of COPD, a person struggles for air on taking only a few steps, and coughing is constantly present.

COPD isn’t curable. It is treatable. Medicines can expand the narrowed breathing tubes and can soothe their irritation. Oxygen is required in advanced stages.

There are two maneuvers that your friend can do for himself that might help him to breathe more easily. One is to exhale through pursed lips. He exhales through his mouth with his lips pursed in the whistling position. This helps keep airways opened. The other trick is to lean a bit forward at the waist when walking. That posture provides more room for the lungs to fill with air.
http://www.southcoasttoday.com/apps/pbcs.dll/article?AID=/20091012/LIFE/910120301/-1/ENTERTAIN

LINK BETWEEN PROTEIN AND LUNG DISEASE FOUND

In a development that could lead to a novel approach to the treatment of a devastating lung disease, biochemists at The University of Texas Health Science Center at Houston report they are the first to link the osteopontin (OPN) protein to COPD. Findings appear online and will be in the January 2010 print issue of The FASEB Journal, the journal of The Federation of American Societies for Experimental Biology.

The researchers were able to prevent COPD features in a mouse model by genetically removing osteopontin. To gauge the applicability of their findings to humans, the investigators analyzed the airways of people with COPD and found elevated levels of the protein. “This is an important crossover study,” said Michael Blackburn, Ph.D., the study’s senior author and professor in the Department of Biochemistry and Molecular Biology at The University of Texas Medical School at Houston. “Because we can show osteopontin is elevated in people with COPD, this suggests that osteopontin could serve as both an indicator of disease progression and a therapeutic target.” In the study, researchers induced COPD features in mice and then compared symptoms experienced by mice with osteopontin and those without.

The mice without the protein had less inflammation and lung disease. “The lack of osteopontin in the mice prevented the COPD features,” said Daniel Schneider, the study’s lead author and an M.D./Ph.D. candidate at the UT Health Science Center at Houston. With the new study linking osteopontin to COPD, Blackburn believes his laboratory may have uncovered a protein that could lead to a more targeted approach to treating emphysema. “As a physician scientist, one goal of drug development is to offer more specific drug targets to treat the disorder and osteopontin provides a specific target that may be associated with fewer side effects,” Schneider said.

“This paper adds a new element, osteopontin, to the mix by discovering its significant role in the development of COPD with emphysema
http://www.sciencedaily.com/releases/2009/09/090915140930.htm

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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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HANDLING CREDIT CARD DEBT SHOULD YOUR SPOUSE PASS AWAY

By Bill Hardekopf: What are you responsible for? And, what do you need to do? When is a surviving spouse not responsible for credit card debt?

If a credit card is only in your spouse’s name, the debt only belongs to your spouse (there are exceptions to this in community property states). Family members will not be responsible for the debt or forced to pay it. Even if you are a second cardholder on the account who has charging privileges, but it is not a joint account, you are not responsible for the remaining debt.

If the card is only in your spouse’s name, the estate is responsible for paying off the balance. The executor of the estate will use the assets to pay off the debts. If the estate doesn’t have the money to pay the bill, then credit card companies must write it off and the account is closed.

There are several instances when the surviving spouse is responsible for the credit card debt. If the card is a joint account, this means that your name is also listed on the account and the card is reported on your credit report. You will be responsible for the debt after your spouse dies.

In addition, if you live in a community property state, you could also be responsible for the debt. Assets that are gained together during marriage are classified as joint property in these states. This can also apply to debt. Debt gained together during marriage is considered joint debt and the surviving spouse is responsible. Rules vary by state. States that use common property laws include Alaska, Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington, and Wisconsin. Sometimes the surviving spouse will only have to pay the debts that he or she benefited from like food, utilities and health care.

After your spouse dies, either you or the executor of the estate must notify all creditors that the account holder has died (even if the account was only in your spouse’s name). Find out where to send a copy of the death certificate and include a note with the account number. Send it by certified mail so you have proof that it was sent. Keep a copy of the letter for your records.

Expect creditors or collection agencies to call. If there is money in the estate, they will go after it and may pressure you and attempt to bully you for payment. Refer all questions about payment to the executor. Don’t answer questions about this until you know what assets you have, what you are responsible for, and what bills must be paid. If collection agencies or credit card companies start calling, make sure the debt is valid, that you are responsible for it, and it is not past the statute of limitations (3-6 years, varies by state and situation).

Life is unpredictable, but there are a few things you can do to protect yourself and your spouse. If you have credit card and other debts, pay them off as quickly as possible. Make sure that both partners know about all credit accounts, the amount owed and help create a payment plan for these. It is also a good idea for each spouse to have a credit card in your own name so you each establish a strong credit record.
http://www.stretcher.com/stories/09/09mar09d.cfm

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MISCELLANEOUS

Allergy and Asthma Crossword
http://respiratory-care-sleep-medicine.advanceweb.com/Editorial/Content/Editorial.aspx?CC=208026

In a recent poll Advance Respiratory and Sleep Care Mag asked:
Is it ethical to refuse to treat smokers who do not follow physician advice?
22% said Yes
78% said No

Wise words from George Carlin
http://www.mamarocks.com/wise_words.htm

Imglish Glossary; speed up your texting
http://www.alphadictionary.com/articles/imglish/imglish_a.html

Play Monopoloy on Line
http://www.hasbro.com/monkeybartv/default.cfm?page=Entertainment/OnlineGames/GameSelect&game=2034

Until next Friday,
Joan Costello, Editor

Web version of the News: http://copd-support.com/news.html

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