COPD Information

The following statement has been provided to the COPD Foundation
by Senator Mike Crapo (R-ID), Co-Chair Congressional COPD Caucus

H.R. 6331 contained a number of positive provisions, including the cardiac and pulmonary rehabilitation language, but faced a veto threat from the White House. Accordingly, I chose to support a Senate bipartisan compromise between Chairman Baucus and Senator Grassley. This bill also contained the cardiac and pulmonary rehabilitation provisions and it could have been signed into law by the President, unlike H.R. 6331. Unfortunately, for political reasons, the Democrats refused to allow this compromise bill to come to a vote. If they had, it would have passed overwhelmingly and this issue would be behind us. I remain committed to the COPD community and am confident that Congress can agree on Medicare legislation that will contain these crucial provisions. I will continue to advocate on behalf of patients who need cardiac and pulmonary rehabilitation."

Senator Mike Crapo (R-ID), Co-Chair Congressional COPD Caucus

Additional Information on this bill at:
http://www.COPDFoundation.org

The FDA recommends that patients should NOT stop taking Spiriva, however that they should discuss the following preliminary trial results and the use of Spiriva with their medical professionals.

Based on data from 29 placebo-controlled trials of tiotropium (Spiriva), ongoing safety monitoring has identified a possible increased risk of stroke in patients who take Spiriva.

These studies indicate an increased risk factor of 2 per 1000 patients over a 1 year period. (2/10ths of a percent)

The FDA report also states that it is important to interpret these preliminary results with caution. More data is expected when the results of a large, four-year randomized trial called UPLIFT (Understanding the Potential Long-Term Impacts on Function with Tiotropium) is reported. These results are expected to be released in June 2008

The full Advisory:
http://www.fda.gov/cder/drug/early_comm/tiotropium.htm

A key reason why some smokers develop chronic bronchitis and others don't is that 40% of the risk for the condition is genetic, a study of twins revealed.

This study found that risk for developing chronic bronchitis has a moderate genetic cause and that only a small percentage of these genes also contribute to smoking risk.

Only 14% of the genetic factors for chronic bronchitis are also associated with smoking behavior,

The sturdy by Jenny Hallberg, M.Sc., of the Karolinska Institute, and colleagues appears in the March 1 issue of the American Journal of Respiratory and Critical Care Medicine.

Source:
http://www.medpagetoday.com/Pulmonary/SmokingCOPD/

Foradil (formoterol fumarate inhalation powder) Capsules

Audience: Pulmonologists, inhalation therapists, pharmacists, other healthcare professionals, patients

[Posted 02/29/2008] FDA informed healthcare professionals and consumers of the correct way to use Spiriva and Foradil inhalation powder capsules. FDA and the National Poison Control Center have received many reports of patients swallowing Spiriva and Foradil capsules rather than placing the capsules in the inhalation devices. Both products are to be used in the HandiHaler (Spiriva) and Aerolizer (Foradil) devices to deliver the medicine to the lungs to improve breathing in patients with asthma, and in individuals affected by chronic obstructive lung disease and bronchitis. Both products will not treat a patient's breathing condition if the contents of a capsule are swallowed rather than inhaled. Healthcare professionals should discuss with patients how to correctly use the Spiriva HandiHaler or Foradil Aerolizer. See the Public Health Advisory for important information on the correct use of both products.

[February 29, 2008 - Public Health Advisory - FDA]

University of Pittsburgh investigators state they have made a discovery in the fight against chronic obstructive pulmonary disease.

The Pitt pulmonary medical specialists report that they have discovered strong evidence that COPD is an autoimmune disease, and that it occurs when a person's immune system attacks the cells that line the lungs.

Patients are being recruited in a clinical trial of an inhaled immune-suppressant drug, called cyclosporine, that could lead to a better treatment.

Read the full article at:
http://www.pittsburghlive.com/x/pittsburghtrib/s_554721.html

Absract

Background
Snoring is more prevalent in patients with chronic bronchitis than in persons without it. Few studies have examined the effect of snoring on chronic bronchitis. We prospectively investigated the association between snoring and the incidence of chronic bronchitis.

Methods
The baseline study was conducted from June 25, 2001, to January 29, 2003. Members of the study cohort consisted of 5015 male and female Korean citizens aged 40 to 69 years at baseline who participated in a comprehensive health examination and on-site interviews at Korea University Ansan Hospital. Of these, 4270 participants (52% men and 48% women) entered the analysis for the first 2-year follow-up from April 17, 2003, to February 20, 2005, and those who met the same inclusion criteria remained in the analysis for a second 2-year follow-up period from February 21, 2005, to November 17, 2006. We collected information on snoring at baseline and identified incident cases of chronic bronchitis during a 4-year follow-up period. On the baseline questionnaire, we excluded participants who reported the presence of cough and sputum production on most days for at least 3 months a year.

Results
During 4 years of follow-up, we documented 314 cases of new-onset chronic bronchitis (27.1 cases per 1000 person-years). After taking into account age, smoking, and other risk factors for chronic bronchitis, the multivariate relative risks of chronic bronchitis were 1.25 (95% confidence interval [CI], 0.95-1.64) for persons snoring 5 times per week or less and 1.68 (95% CI, 1.17-2.42) for those snoring 6 to 7 times per week compared with never snorers (P for trend = .049). The analyses stratified by risk factors, including smoking, occupation, and body mass index, showed a stronger association among never smokers, house workers, and overweight persons. In analysis for the joint effect of smoking and snoring, the relative risks of chronic bronchitis were 1.39 (95% CI, 1.01-1.90) for nonsmoking and snoring, 2.31 (95% CI, 1.38-3.87) for smoking and never snoring, and 2.86 (95% CI, 1.91-4.27) for smoking and snoring compared with nonsmoking and never snoring.

Conclusions
This prospective study observed that snoring is associated with chronic bronchitis. Our findings provide support for the hypothesis that snoring influences the development of chronic bronchitis.

Full Article:
http://www.medwire-news.md/48/72610/Respiratory/Snoring_prevalent_in_chronic_bronchitis_patients.html

In the past, it has been common practice to exclude older
patients from receiving transplants because of limited donor supply and
lower survival rates. However, a new UCLA Medical Center study shows that
select patients age 65 and older can safely undergo lung transplantation and
have acceptable outcomes.

The findings are reported in the February issue of the peer-reviewed
Journal of Thoracic and Cardiovascular Surgery. Since 1999, UCLA
has been one of the few transplant centers in the country to offer lung
transplants to patients 65 and older who were otherwise healthy
candidates for the procedure.

The early survival rate of the older patients (over 65) was 95.7 percent,
compared with 95.9 percent for the younger cohort.

See Article: http://www.medicalnewstoday.com/articles/96249.php

On Novembar 20, 2007, The FDA (US Food and Drug Administration) first informed the public about the possibility of serious neuropsychiatric symptoms sssociated with the use of varenicline (Chantix), a prescription drug aimed at helping people give up smoking.

As FDA’s review of the issue has progressed, it appears increasingly likely that there is an association between Chantix and serious neuropsychiatric symptoms.

In the most recent FDA ALERT [2/1/2008], the FDA highlights important revisions to the WARNINGS and PRECAUTIONS sections of the full prescribing information for Chantix regarding serious neuropsychiatric symptoms. The recommendations and considerations for patients are as follows:

-- Tell the doctor about any history of psychiatric illness prior to starting Chantix. Patients taking Chantix have experienced worsening of current psychiatric illness, even if it is currently under control, and the reoccurrence of previous psychiatric illness.

-- Be alert to changes in mood and behavior. Symptoms include strange thoughts or behaviors, depressed mood, and thinking about or attempting suicide.

-- Immediately report changes in mood and behavior to the doctor.

-- Vivid, unusual, or strange dreams may occur while taking Chantix.

It was also noted that in most cases, neuropsychiatric symptoms developed during Chantix treatment, but in other instances, symptoms developed following withdrawal of Chantix therapy

Source: http://www.fda.gov/cder/drug/InfoSheets/HCP/vareniclineHCP.htm

Regular snoring was associated with a 25% to 68% increased frequency of new-onset chronic bronchitis compared with those who never snored, Chol Shin, M.D., Ph.D., of Korea University Ansan Hospital, and colleagues reported today in the Archives of Internal Medicine.

The combination of smoking and snoring almost tripled the likelihood of chronic bronchitis compared with those who did not smoke or snore.

An examination of the joint effect of snoring and smoking on chronic bronchitis revealed a relative risk versus nonsmoking-never-snorer of:

1.39 for nonsmoking and snoring (95% CI 1.01 to 1.90)
2.31 for smoking and never-snoring (95% CI 1.38 to 3.87)
2.86 for smoking and snoring (95% CI 1.91 to 4.27)

The authors acknowledged that information on chronic bronchitis was self-reported, not documented by medical records, and the information on snoring was not verified. They also acknowledged that they could not rule out potential confounding effects of unknown and uncontrolled factors.

Read the full article at:
http://www.medpagetoday.com/PrimaryCare/SleepDisorders/dh/8141

A study in a Wiley-Blackwell journal - Respirology - finds that the development of bullous lung disease occurs in marijuana smokers approximately 20 years earlier than tobacco smokers.

A condition often caused by exposure to toxic chemicals or long-term exposure to tobacco smoke, bullous lung disease (also known as bullae) is a condition where air trapped in the lungs causes obstruction to breathing and eventual destruction of the lungs.

Lead author Dr. Matthew Naughton says, "What is outstanding about this study is the relatively young ages of the lung disease patients, as well as the lack of abnormality on chest X-rays and lung functions in nearly half of the patients we tested."

Full Article: http://www.medicalnewstoday.com/articles/94896.php