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November 13, 2008

 New Survey Suggests Growing Awareness of COPD, Nation’s Fourth Leading Killer

Understanding of the Disease and its Risk Factors, Including Smoking, Remains Low

Awareness of COPD (chronic obstructive pulmonary disease) is growing, but few Americans have a thorough understanding of the disease, according to a new national survey released today. The new data show that 64 percent of survey respondents had heard of COPD, compared with 49 percent in a 2004 survey. Among those who reported hearing of COPD, only half recognized the disease as a leading cause of death, and just 44 percent understood it to be treatable.  

The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health analyzed results from the annual HealthStyles survey of American public health attitudes, knowledge, practices, and lifestyle habits, conducted each summer by Porter Novelli.

The fourth leading cause of death in the United States, COPD is a serious lung disease affecting an estimated 24 million Americans. More than 12 million people are currently diagnosed with COPD and another 12 million may have COPD but remain undiagnosed despite recognizable symptoms. COPD typically affects people over 45, especially those who smoke or have smoked, and those with risk factors associated with genetics or environmental exposures.  Symptoms include chronic cough, sometimes called “smoker’s cough,” shortness of breath, wheezing, not being able to take a deep breath, and excess sputum production.

“We are encouraged that people are becoming more aware of the term COPD,” said Elizabeth G. Nabel, M.D., director, NHLBI.  “But the survey also indicates that we as a public health community have much more work to do to promote greater understanding of the disease, its symptoms, and risk factors, so that we can improve rates of diagnosis and treatment.”

While 74 percent of survey respondents correctly identified shortness of breath as a symptom of COPD, only 5 percent recognized chronic cough as a symptom of the disease.  Smoking is attributed to as many as 9 out of ten COPD-related deaths, yet most survey respondents¾66 percent¾did not recognize smoking as a risk factor. This was especially true among the current smokers surveyed. Just 22 percent recognized that their smoking puts them at greater risk for COPD. 

“This is perhaps the most distressing information that the survey has brought to light,” said James P. Kiley, Ph.D., director of the Division of Lung Diseases, NHLBI. “While we applaud the millions of Americans who have heeded the public health community’s call to quit smoking, it’s important that both current and former smokers know that they remain at risk for COPD.”

COPD can be diagnosed with a simple breathing test called spirometry. Those at risk for COPD as well as those experiencing symptoms should talk to their doctor about the test.   Spirometry is not invasive and can be conducted in the doctor’s office.  It involves breathing out as hard and fast as possible into a tube connected to a machine that measures lung function. 

HealthStyles questionnaires were mailed in early summer of 2008 to a nationwide sample of 8,200 adults 18 years of age and older.  The results represent a sample of 5,399 households. The 2004 survey of COPD awareness was conducted by the National Women’s Health Resource Center and Russell Marketing Research. That survey was fielded in March, 2004 among 1,554 adults across the United States.

For those diagnosed with COPD, many treatments are available to reduce symptoms, improve breathing, and help patients get back to doing activities they used to do. 

NHLBI launched the COPD Learn More Breathe Better campaign in 2007 to increase awareness and understanding of COPD and its risk factors, and to underscore the benefits of early detection and treatment in slowing the disease and improving quality of life. The campaign is supported by more than 20 organizations including leading medical professional societies, patient advocacy groups, and corporate partners in facilitating this public health initiative. 

November is National COPD Awareness Month. Sponsored by the U.S. COPD Coalition, the observance is a time for organizations and communities across the country to increase the overall awareness of COPD. The COPD Learn More Breathe Better campaign is pleased to support ‘Learn About COPD Days’, November 13-16, 2008, in honor of COPD Awareness Month. 

# # # 

For more information on COPD, visit:  http://www.nhlbi.nih.gov/health/public/lung/copd/ or http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_WhatIs.html

NHLBI plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on COPD, women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at www.nhlbi.nih.gov.

The National Institutes of Health — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Source: http://www.medpagetoday.com/ProductAlert/Prescriptions/tb/11215

PRESS RELEASE

Landmark COPD Trial UPLIFT(R) Shows SPIRIVA(R) HandiHaler(R)
Sustained Lung Function Improvements Over Four Years

Sunday October 5, 8:01 am ET

Results published in New England Journal of Medicine reaffirm well-established efficacy and long-term safety profile of SPIRIVA® HandiHaler®

RIDGEFIELD, Conn., and NEW YORK, Oct. 5 /PRNewswire/ -- Results of the UPLIFT (Understanding Potential Long-term Impacts on Function with Tiotropium) trial, showed that SPIRIVA® HandiHaler® (tiotropium bromide inhalation powder), sustained improvements in lung function for up to 4 years as measured by FEV(1) (p<0.001) versus placebo in Chronic Obstructive Pulmonary Disease (COPD) patients. It did not significantly reduce the accelerated rate of decline in lung function, as measured by FEV(1), which was the primary endpoint of the study. The landmark study, published online today in the New England Journal of Medicine and presented at the European Respiratory Society (ERS) Annual Congress, also reaffirmed the well-established, long-term safety profile of SPIRIVA.

UPLIFT, one of the largest COPD trials ever undertaken, is a four-year multicenter (470 sites), multinational (37 countries), randomized, double-blind, placebo-controlled, parallel-group prospective trial. The study included 5993 male and female COPD patients. Patients were randomized 1:1 to receive either 18 micrograms tiotropium or placebo (control) once daily. In both arms, patients were allowed to use all other prescribed respiratory medications, except for inhaled anticholinergics.

Secondary Endpoints

UPLIFT showed that SPIRIVA produced a significant delay in time to first exacerbation by a median of 4.1 months (p<0.001) versus control, a significant reduction in the number of exacerbations per patient year (14 percent; p<0.001). In addition, it significantly reduced the risk of exacerbations leading to hospitalizations (Hazard Ratio 0.86; p<0.002) versus the control group. In the UPLIFT trial, a COPD exacerbation was defined as an increase or new onset of more than one of the following respiratory symptoms: cough, phlegm, change in the color of phlegm, wheezing, breathlessness with a duration of 3 or more days requiring treatment with antibiotics and/or systemic (oral, intramuscular or intravenous) steroids.

SPIRIVA provided statistically significant improvements at all time points in health-related quality of life, as measured by the St. George's Respiratory Questionnaire (SGRQ) total score (median 4.1, p<0.001).(1) SGRQ is a health-related quality of life measure, where a four-point decrease is considered to be a clinically meaningful improvement.

UPLIFT results showed no increased risk in mortality (all-cause). Specifically, a statistically significant 16 percent decrease in the risk of death (p=0.016) was observed in the SPIRIVA group, while patients received treatment. Within the four year trial period, the effect on survival was sustained, even when deaths occurring after early discontinuation of study medication were included in the analysis (p=0.034). Risk of mortality, assessed for the 30 days following the conclusion of the study, revealed an 11 percent reduction that did not meet statistical significance (p=0.086).

"With UPLIFT, the bar was set high, as patients were allowed treatment with all other respiratory medications, except for inhaled anticholinergics," said Dr. Donald Tashkin, lead investigator of the UPLIFT trial and professor at the David Geffen School of Medicine at the University of California at Los Angeles. "So the effects seen over the long term on lung function, exacerbation rates and patients' quality of life and safety are excellent news for patients and physicians."

The data also demonstrate that SPIRIVA provides important respiratory improvements in patients with moderate COPD (GOLD -Global Initiative for Chronic Obstructive Lung Disease- Stage II). Forty-six percent of the patients in the UPLIFT trial were GOLD Stage II. This is one of the largest COPD Stage II patient populations ever studied over four years. The results obtained for this patient group are especially relevant as this is the stage when patients normally first seek treatment for COPD symptoms and diagnosis.(1)

UPLIFT data suggest that SPIRIVA sustains positive effects for patients with COPD. "Importantly, the UPLIFT study highlights the well-established, long term safety profile of SPIRIVA. Almost 6,000 patients were followed for up to four years, adding to the more than 10 million patient years of market experience for SPIRIVA, commented Dr. Andreas Barner, vice chairman of the board of managing directors at Boehringer Ingelheim responsible for research, development and medicine. "This is the type of meaningful data that Boehringer Ingelheim and Pfizer are committed to bringing physicians and patients dealing with COPD. We are excited about these results and look forward to physicians incorporating these findings into clinical application."

About COPD

COPD is a progressive yet treatable disease that restricts patients' lives over time and is a major cause of death and disability throughout the world.(1) COPD is a disease primarily of current and former smokers. It is projected to become the third-leading fatal illness in the United States by 2020.(1) As many as 24 million Americans have impaired lung function,(2) yet fewer than 12.6 million have been diagnosed with COPD.(2) Symptoms include cough, sputum (mucus or phlegm) production, and breathlessness on exertion. Worsening of these symptoms often occurs and can restrict a patient's ability to perform normal daily activities.(1) Dyspnea (breathlessness), the main symptom of COPD, is characteristically persistent and progressive and has a serious impact on patients' quality of life.(1) At its most severe, it even limits a patient from simple tasks such as washing and dressing.

UPLIFT Study Design

The four-year study was a multicenter (470 sites), multinational (37 countries), randomized, double-blind, placebo-controlled, parallel-group trial. The study included 5993 male and female COPD patients. Patients were randomized 1:1 to receive either 18 micrograms tiotropium or placebo once daily. In both arms, patients were allowed to take all other respiratory medications usually prescribed for the treatment of COPD, except for inhaled anticholinergics.

About SPIRIVA® HandiHaler®

SPIRIVA HandiHaler is a once-daily inhaled maintenance prescription treatment for breathing problems (airway narrowing) associated with chronic obstructive pulmonary disease (COPD). COPD includes both chronic bronchitis and emphysema.

SPIRIVA does not replace fast-acting inhalers for sudden symptoms.

Do not swallow the SPIRIVA capsule. Only use the HandiHaler device to take the SPIRIVA capsule. Do not use the HandiHaler to take any other medications.

Do not get SPIRIVA powder in your eyes.

The most common side effect with SPIRIVA is dry mouth. Others include constipation and problems passing urine. For a complete list of reported side effects, ask your doctor or pharmacist.

Tell your doctor about your medicines, including eye drops, and illnesses like glaucoma and urinary or prostate problems. These may worsen with SPIRIVA.

If you have vision changes, eye pain, your breathing suddenly worsens, you get hives, or your throat or tongue swells, stop taking SPIRIVA and contact your doctor.

Do not use SPIRIVA if you are allergic to atropine, ipratropium, tiotropium bromide, or lactose. A lactose allergy is not the same as lactose intolerance.

Read the step-by-step Patient's Instructions for Use for SPIRIVA before you take your medicine.

For full prescribing information, please visit www.spiriva.com.

About Boehringer Ingelheim Pharmaceuticals, Inc.

Boehringer Ingelheim Pharmaceuticals, Inc., based in Ridgefield, CT, is the largest U.S. subsidiary of Boehringer Ingelheim Corporation (Ridgefield, CT) and a member of the Boehringer Ingelheim group of companies.

The Boehringer Ingelheim group is one of the world's 20 leading pharmaceutical companies. Headquartered in Ingelheim, Germany, it operates globally with 135 affiliates in 47 countries and approximately 39,800 employees. Since it was founded in 1885, the family-owned company has been committed to researching, developing, manufacturing and marketing novel products of high therapeutic value for human and veterinary medicine.

In 2007, Boehringer Ingelheim posted net sales of US $15.0 billion (10.9 billion euro) while spending approximately one-fifth of net sales in its largest business segment, Prescription Medicines, on research and development.

For more information, please visit http://us.boehringer-ingelheim.com.

About Pfizer

Founded in 1849, Pfizer is the world's largest research-based pharmaceutical company taking new approaches to better health. We discover, develop, manufacture and deliver quality, safe and effective prescription medicines to treat and help prevent disease for both people and animals. We also partner with healthcare providers, governments and local communities around the world to expand access to our medicines and to provide better quality health care and health system support. At Pfizer, more than 80,000 colleagues in more than 90 countries work every day to help people stay happier and healthier longer and to reduce the human and economic burden of disease worldwide.

References

(1) National Heart, Lung, and Blood Institute. Data Fact Sheet: Chronic Obstructive Pulmonary Disease (COPD). Available at www.nhlbi.nih.gov/health/public/lung/other/copd_fact.pdf. Accessed January 10, 2008.

(2) Centers for Disease Control. Summary health statistics for U.S. adults: National Health Interview Survey, 2003. National Center for Health Statistics. Vital Health Stat 10(225). 2005. Table 3.

Source: Boehringer Ingelheim Pharmaceuticals, Inc.; Pfizer

Sept 25,2008
On Wednesday, September 24^th, 2008, the COPD Foundation hosted a teleconference with Dr. Byron Thomashow, Chairman of the COPD Foundation, and Dr. Dave Balazar of Boehringer-Ingelheim Pharmaceuticals, whom were present to answer questions regarding the day’s release of a meta-analysis report in the Journal of the American Medical Association concerning inhaled tiotropium, marketed as Spiriva, which is a long acting inhaled anticholinergic agent used in managing COPD. Over 50 individuals representing various sectors of the COPD patient community were present in the conference, and asked several questions to the two experts.
 

In regards to the study released, the COPD Foundation issued a statement:
“Inhaled anticholinergic medications have been an important agent in COPD care for many years. All available guidelines stress the importance of maintenance therapy in COPD patients with moderate, severe, or very severe disease. Inhaled Tiotropium, a long acting inhaled anticholinergic agent has been a mainstay of COPD care. The meta-analysis published in JAMA on September 24^th raises concerns over cardiovascular risks. However meta-analysis of aggregated published data does have limitations and it must be stressed that COPD itself has been defined as a cardiovascular risk factor. UPLIFT, one of the largest trials ever done in COPD has recently been completed. While the results of this very large study will not be available until next month, the UPLIFT safety data released today report no increased cardiovascular risk.

 The COPD Foundation would suggest caution in potentially over-reacting to the JAMA study. COPD is almost always a preventable and treatable disease. Available data continues to suggest that Tiotropium is an important component of that therapy. We await with interest and hope the full results of UPLIFT.”  (By Dr. Byron Thomashow, Chairman of the COPD Foundation Board of Directors.)
 

An FAQ document is being developed with a list of questions asked during the teleconference. This FAQ will soon be posted on the COPD Foundation’s website and available for callers of the C.O.P.D. Information Line. For more information regarding the teleconference or the news, please contact the Information Line at 1-866-316-COPD (2673).

Jama Media release
Spiriva Safety Press Release

Q&A Regarding Meta-analysis Report Concerning Inhaled Tiotropium (Spiriva®)

Note: see also Foundation News

July 15.2008
The U.S. Senate and U.S. House of Representatives voted to overturn President Bush's veto of the Medicare Improvements for Patients and Providers Act of 2008 (HR 6331).

This bill will make life easier for the millions of Americans on Medicare who suffer from serious lung diseases, especially the many adults who have chronic obstructive pulmonary disease (COPD). The vote of 70 to 26 in the US Senate and 383-41 in the House of Representatives insures that older Americans in all states have access to pulmonary rehabilitation treatment as a covered benefit through Medicare, reducing the impact of COPD by helping to control or reduce breathlessness and recondition the body. It is well established that pulmonary rehabilitation helps people with COPD to develop less need for medications and experience fewer hospital stays, longer survival and a better quality of life.

This bill's passage also:

• Protects doctors from a 10.6 percent cut in their reimbursement rates when treating Medicare patients
• Repeals the title transfer oxygen equipment to patients after 36 months of Medicare payments for equipment
• Delays the implementation of the competitive bidding process for oxygen providers.

Lung diseases are the fourth-leading cause of death in Florida
Robyn Shelton | Sentinel Medical Writer
June 3, 2008

The average person takes more than 20,000 breaths on any given day. Imagine fighting for every one of them.

That's the reality for millions of Americans with emphysema, bronchitis, asthma and other lung diseases.

Though better treatments have improved many patients' lives, some of the conditions still defy modern medicine. Overall, chronic lung disease is the fourth-leading cause of death in Florida and across the nation.

Symptoms usually start with a nagging cough, then grow into shortness of breath during exertion. It only gets worse with time.

"Eventually, you get shortness of breath even when you're doing nothing at all," said Dr. Fortune Alabi, a Florida Hospital pulmonologist at Celebration Health in Osceola County. "By the time I see many patients they are so far along, there is very little I can do for them."

The state estimates nearly 9,000 Florida residents die from chronic lung disease each year. The best way to protect yourself is also the most obvious: Don't smoke. Other tips include staying indoors when pollution levels are high and avoiding triggers for breathing attacks if you have asthma.

COPD

The lungs are large, elastic organs that supply the body with fresh oxygen and rid it of carbon dioxide gas. Each lung holds a dense network of airways that culminate in tiny, sac-like clusters called alveoli.

Problems with the tubes and these little sacs make it harder to breathe.

One of the most deadly lung conditions is called COPD, a catchall term that stands for chronic obstructive pulmonary disease. The airways are inflamed, narrowed and often filled with secretions in COPD patients, who are diagnosed by their symptoms, personal risk factors (smoking history), lung function tests and chest X-rays.

Two conditions fall under the broader category of COPD: emphysema and chronic bronchitis. But doctors often don't distinguish between them because they are treated in the same way. Patients rely on multiple medications and breathing treatments with a nebulizer, which creates a medicated mist to open the airways.

Many have oxygen machines in their homes and use them frequently to get the fresh air that their lungs can no longer provide. They take small, portable oxygen tanks with them everywhere just in case. The loss of lung function is progressive -- though it's slow in some and faster in others.

Alabi said there is no cure for COPD and often, existing treatments are not very effective.

"There are medicines that can reduce the symptoms to have a better quality of life," he said. "But most of the medicines just make you feel a little bit better. Once the damage starts, it's irreversible; the disease is not going to go away."

About 12 million Americans have been diagnosed with the condition, and experts suspect that an equal number are developing the disease.

Dr. Adam Wanner is a pulmonologist and professor at the University of Miami's school of medicine. He said smoking is the major cause of COPD in western countries such as the United States, where about 80 percent of cases are linked to cigarettes. But that doesn't mean most smokers get COPD. Overall, about 20 percent develop the condition.

For the unlucky ones, it is a devastating diagnosis.

"It is a frustrating disease in terms of treatment, but if you can give the patient just a 10- to 15-percent improvement in lung function, that's a lot when every breath is an effort," said Wanner, who also works with the COPD Foundation based in Miami.

Cecilia Adams of Kissimmee has been living with lung disease for more than a decade. On a recent day, she managed to unfurl her garden hose and water the flowers beside her front porch. That's an accomplishment.

"Every year I can tell it gets a little bit worse," said Adams, 66, who has emphysema. "I'm just very careful. I know how far I can push myself, then I stop."

Asthma

Asthma is another major form of chronic lung disease. It differs from COPD in that asthma doesn't cause permanent damage to the lung tissue.

Instead, patients suffer from chronic inflammation and tightening of the airways. The condition can be controlled with medications and a solid treatment plan, said Dr. Jose R. Arias Jr., an Orlando doctor who specializes in allergies and asthma.

Even so, the disease is demanding. It affects an estimated 22 million Americans, often starting in childhood and requiring a complex daily regimen of medications that includes inhalers, pills and nebulizers.

Asthma can be connected to allergies that spark the sudden and life-threatening breathing attacks. Other triggers are exercise and cold weather.

Being overweight also makes asthma worse. Arias tells his patients that every 10 pounds of excess fat is like stacking a brick on the chest and trying to breathe.

He said asthma kills an estimated 4,000 Americans every year. It is a major cause of emergency-room visits and absenteeism at work and school.

"If your asthma is controlled, you have a normal life; if it's not controlled, you're going to be very limited," Arias said. "You're going to feel tired and irritable, and you're going to have a hard time doing anything. It can have a major, major impact" on a person's life.

More lung conditions

Here are other chronic lung diseases, as described by the American Lung Association:

*Pulmonary fibrosis occurs when tissue between the air sacs in the lungs becomes scarred, making the lungs thick and breathing difficult. The cause is often unknown, though some people develop pulmonary fibrosis after exposure to asbestos and other contaminants.

*Alpha-1 related emphysema is an inherited form of the disease in which people fail to make a protein that normally protects the lungs. Damage results and patients progressively lose lung function.

*Cystic fibrosis is a hereditary disease that causes a thick mucus to form in the lungs, blocking the airways. On average, CF patients live about 37 years, according to the Cystic Fibrosis Foundation.

Robyn Shelton can be reached at rshelton@orlandosentinel.com or 407-420-5487.

From the Orlando Sentinel -
http://www.orlandosentinel.com/features/lifestyle/orl-lung0308jun03,0,1355776.story

reprinted with permission
 

Gary Bain, President and founder of the volunteer COPD online support group EFFORTS, died of pulmonary failure Wednesday, April 30, at age 68.

Bain created EFFORTS (which stands for Emphysema Foundation For Our Right to Survive) with two other emphysema patients, Mick Wagner and Sharon Adkins, in late 1997 as a support and advocacy group for those with emphysema, now usually referred to as COPD (chronic obstructive pulmonary disease).

First diagnosed in 1986 by a doctor who told him he had about six years to live, Bain set out to learn everything he could and got involved in support groups, culminating in his own EFFORTS. “We started it in December of 1997 and it took off like gangbusters,” he said in the introduction to his website. EFFORTS now has more than 2,300 members.

"The COPD Foundation and the Alpha-1 Foundation wish to express our heartfelt condolences to the family of Gary Bain,” said John Walsh, President of the COPD Foundation and President and CEO of the Alpha-1 Foundation. "Gary was a pioneer in patient advocacy for individuals with COPD. He impacted thousands of lives through his dedication and commitment as the founder of EFFORTS and all the related activities, his psychosocial support, dissemination of information, and day-to-day inter-connectivity.

"Gary shall always remain an inspiration and example of the impact that an individual can make in helping others."

In an interview on the Alpha-1 Foundation’s website, he said the motive behind EFFORTS was the need to address many unanswered questions, and he felt the website helped to improve patient knowledge. “I think it’s great for any patient because the more you know, the better you’re armed. Once you learn to relate to the problem, you can learn how to control it.”

He was married for 43 years to Harriet Ann Bain, who predeceased him.

Ultimately, he outlived his doctor’s prediction by 16 years.

His obituary in the Kansas City Star: http://www.legacy.com/KansasCity/DeathNotices.asp?Page=Lifestory&PersonId=108796876

His feature in the Alpha-1 Foundation’s “Special Stories”http://www.alphaone.org/alphas/gary-and-his-efforts

This Senate resolution specifically mentions Chronic Obstructive Pulmonary Disease

SANDERS, BERNARD (I-VT) - Sponsor
Snowe, Olympia J. (R-ME) - Cosponsor
Kerry, John F. (D-MA) - Cosponsor
Clinton, Hillary (D-NY) - Cosponsor
Menendez, Bob (D-NJ) - Cosponsor
WHITEHOUSE, SHELDON (D-RI) - Cosponsor
Bingaman, Jeff (D-NM) - Cosponsor
Boxer, Barbara (D-CA) - Cosponsor
Leahy, Patrick J. (D-VT) - Cosponsor
Nelson, Bill (D-FL) - Cosponsor
Durbin, Richard J. (D-IL) - Cosponsor

110th CONGRESS

2d Session

S. RES. 509

Recognizing the week of April 7, 2008, to April 13, 2008, as 'National Public Health Week'.

IN THE SENATE OF THE UNITED STATES

April 9, 2008

Mr. SANDERS (for himself, Ms. SNOWE, Mr. KERRY, Mrs. CLINTON, Mr. MENENDEZ, Mr. WHITEHOUSE, Mr. BINGAMAN, Mrs. BOXER, Mr. LEAHY, and Mr. NELSON of Florida) submitted the following resolution; which was referred to the Committee on Health, Education, Labor, and Pensions

RESOLUTION

Recognizing the week of April 7, 2008, to April 13, 2008, as 'National Public Health Week'.

Whereas the week of April 7th, 2008, is National Public Health Week, and the theme is 'Climate Change: Our Health in the Balance';

Whereas, since 1996, the American Public Health Association, through its sponsorship of National Public Health Week, has educated the public, policy-makers, and public health professionals about issues important to improving the public's health;

Whereas, according to the World Health Organization (WHO), climate change is a significant and emerging threat to public health and the WHO estimates that human-induced changes in the Earth's climate lead to at least 5,000,000 cases of illness and more than 150,000 deaths each year;

Whereas, according to the Intergovernmental Panel on Climate Change (IPCC), climate change contributes to the global burden of disease, premature death, and other adverse health impacts due to extreme weather events and changes in infectious disease patterns, air quality, quality and quantity of water and food, ecosystem changes, and economic impacts;

Whereas, according to the IPCC, the United States will be challenged by increased heat waves, air pollution, and forest fires during the course of the century, with potential risk for adverse health impacts, such as heat stress and increases in asthma, allergies, and chronic obstructive pulmonary disease;

Whereas the Director of the United States Centers for Disease Control and Prevention, Dr. Julie Gerberding, testified, in October 2007, that, 'Climate change is anticipated to have a broad range of impacts on the health of Americans and the Nation's public health infrastructure';

Whereas, according to the World Health Organization, the negative public health impacts of climate change will likely disproportionately impact communities that are already vulnerable;

Whereas these communities include developing countries, young children, the elderly, people with chronic illnesses or otherwise compromised health, people in underserved communities, communities of color, traditional societies, subsistence farmers, and coastal populations;

Whereas it is estimated that more than 900,000,000 people worldwide live in slum-like conditions and are particularly vulnerable to the possible health impacts of climate change due to a lack of access to health care, sanitation, and vulnerability to displacement;

Whereas future vulnerability to the health impacts of climate change will depend not only on the degree of climate change the Earth experiences, but also on development and adaptation measures; and

Whereas the public health system will be a first-line responder to emergency conditions related to impacts of climate change and plays a key role in informing, educating, and empowering local communities: Now, therefore, be it

Resolved, That the Senate--

(1) recognizes 'National Public Health Week';

(2) recognizes the efforts of public health professionals, first responders, States, municipalities, and local communities to incorporate measures to adapt health care systems to address impacts of climate change;

(3) recognizes the role of adaptation in preventing impacts of climate change on vulnerable communities, the potential for improvement of health status and health equity through efforts to address climate change, and the need to include health policy in the development of climate responses;

(4) encourages further research, interdisciplinary partnership, and collaboration between stakeholders to understand and monitor the health impacts of climate change, for preparedness activities and for improvement of health care infrastructure; and

(5) encourages each and every American to learn about the impacts of climate change on health.

2008 Questionnaire for POC Users Experience by LTOT Network

As a followup to its 2004 survey on needs assessment of patients with lung disease,  NECA (The National Emphysema/COPD Association, previously known as the COPD Research Network) in conjunction with Innovative Health Solutions, Corp., is conducting a new 2 part survey.
 
     One part of the survey is for the person with COPD.
 
     The second part of the survey is for individuals who care about the person with COPD and provide valuable assistance to them (for example, a spouse, a child or other close relative). Households may complete in either or both surveys. Each survey should be completed independently, without input from anyone else.
 
 To take the Patient survey, click here.
 
 To take the other Household Member survey, click here.

There is a very comprehensive article appearing in the Nov 29th  issue of the New York Times. The research for this article was extensive, based on interviews with patients, as well as Healthcare professionals.  Included is input from patients  Jean Rommes, Grace Ann Dorney/Koppel, Diane Williams Hymons, and John Walsh.  Also interviewed from the medical profession and government;  Dr. James Crapo, Dr. Byron Thomashow, Dr. Neil Schachter, Pamela L. Moore and Dr. James Kiley

It is very well written,  bringing a much better picture of COPD to the forefront.
http://tinyurl.com/2fn9nt

The New York Times coverage also includes a video on COPD. http://video.on.nytimes.com/index.jsp?fr_story=39f9d444e3cdfaac1fcebdfa4b506cce31786094

There is Expert Q&A area where readers can ask questions about COPD.
Dr. Byron Thomashow, medical director of the The Jo-Ann LeBuhn Center for Chest Disease and Respiratory Failure at Columbia University Medical Center, is taking readers' questions about C.O.P.D.

Dr Thomashow is also a member of the Board of Directors of the COPD Foundation

New Bill Would Improve Services to Lung Patients
Treatment and device training could be provided in homes; covered by Medicare

 DALLAS (Oct. 26, 2007) – U.S. patients suffering from respiratory disease could be greatly helped if a bill introduced today by Congressman Mike Ross (D-AR) is passed, according to Toni Rodriguez, president of the American Association for Respiratory Care (AARC), the professional association for respiratory therapists.
     The new Medicare Respiratory Therapy Initiative, HR 3968, will help patients receive better access to health care services. The House bill will revise the Medicare law to permit qualified respiratory therapists to provide certain services, such as smoking cessation, asthma management, medication education, and inhaler training. These services will be provided to asthma and COPD (chronic obstructive pulmonary disease) patients under the general supervision of a physician, but without the doctor present.
      “This bill could literally open the door for many patients who haven't been able to get the care they deserve," said Rodriguez, a respiratory therapist for more than 35 years. “With this bill, they would have access to the services of a respiratory therapist in all of the places they might seek care - doctor's office, outpatient clinic, even their own home. And the expense will be covered by Medicare. This is a significant bill.”
      Congressman Ross is a member of the Health Subcommittee of the House Energy and Commerce Committee. The American Association for Respiratory Care began working with Congressman Ross to develop the initiative with the hope of increasing access to the services of certain respiratory therapists in settings outside of the acute care hospital
     “I am proud to introduce this important legislation on behalf of patients with respiratory and lung disease to ensure they have greater access to medical treatments for their conditions,” said Ross, emphasizing this bill will greatly help those in rural areas of America where access to medical care continues to be a major challenge.  “This legislation would help break down barriers that some patients currently experience in receiving these important treatments.”

A Serious Problem
     According to a new study by the American College of Chest Physicians, one out of three patients with asthma or COPD use their inhalers incorrectly. The study found that 32.1% of patients made at least one essential error while using a dry powder inhaler (DPI) and that the error rate increased with age and severity of airway obstruction. Additionally, the experts on a government asthma guidelines panel recommend training by health professionals to improve the cost-effectiveness and clinical benefit to patients. Stuart Stoloff, M.D., a member of the expert panel that wrote the asthma guidelines, believes this bill can help rectify that very serious problem.
      “Respiratory therapists are a vital part of the team for educating patients about the appropriate use of inhaled medications in respiratory disease,” said Stoloff, a family physician in Carson, Nevada who works closely with respiratory therapists at four hospitals in his region.  “Their knowledge of medications combined with their teaching expertise can facilitate improved care for patients with respiratory problems.”
     If passed, the law would revise current sections of the Medicare Part B Program, which governs specific services available to the Medicare beneficiary outside of the acute care hospital. This has been a major hurdle for many respiratory patients on fixed incomes. 
      “As an individual with COPD, I very much value the respiratory therapist as an asset to help me achieve a better quality of life,” said John Walsh, a COPD patient with Alpha-1, a genetic form of the lung disease. “Current reimbursement through Medicare does not provide the regular access or consistency in care that this initiative calls for. It would allow a respiratory therapist to be more readily available to COPD patients like myself."

About the AARC
     The American Association for Respiratory Care, headquartered in Dallas, is a professional association of respiratory therapists that focuses primarily on respiratory therapy education and research. The organization’s goals are to ensure that respiratory patients receive safe and effective care from qualified professionals as well as supporting respiratory health care providers. The association continues to advocate on behalf of pulmonary patients for appropriate access to respiratory services provided by qualified professionals.  Further information about the AARC and how to become a respiratory therapist are available at www.AARC.org.

Action Alert

ENSURE THAT PULMONARY REHABILITATION
WILL BE PROVIDED TO MEDICARE BENEFICIARIES
TAKE ACTION TODAY

 For over 20 years organizations supporting pulmonary health have requested clear and consistent Medicare policy for pulmonary rehabilitation.  Medicare statute currently does not specifically provide reimbursement for pulmonary or cardiac rehabilitation for beneficiaries.  Often pulmonary and cardiac rehabilitation programs ARE covered services by Medicare under the “incident to physician services” clause.  In an effort to ensure access to necessary care, Senator Mike Crapo (R-ID) and Senator Blanche Lincoln (D-AR) have introduced the Pulmonary and Cardiac Rehabilitation Act S 329 providing a national coverage policy that will ensure that individuals are not denied or limited access.  The House companion HR 552 was introduced by Congressman John Lewis (D-GA) and Congressman Chip Pickering (R-MS).  S 329 and HR 552 will end the debate between the Centers for Medicare and Medicaid Services (CMS), fiscal intermediaries and providers by clearly defining Pulmonary Rehabilitation for Medicare recipients.

The treatment of chronic lung diseases such as COPD are frequently complicated, confusing and frustrating for patients, family members and those who care for them.  As you know, pulmonary rehabilitation combines education with therapeutic exercise and functional activities to help individuals understand and cope with the disease and function more comfortably and independently.

This is an important opportunity to advocate for COPD and the lung disease community.  The COPD Foundation urges you to take ACTION by contacting your Senators and Representative and requesting co-sponsorship of this important legislation.  It is time to resolve this problem and improve the lives of those living with lung disease.

Why Medicare Should Define and Pay for Pulmonary Rehabilitation (PR)

• PR is a restorative and preventative process for patients with chronic respiratory disease;
• PR has been defined as a multi-disciplinary program of care for patients with chronic respiratory impairment that is individually tailored and designed to optimize physical and social performance and autonomy;
• PR improves the individuals ability to manage and cope with progressive lung disease;
• PR is often focused on those with COPD but is also appropriate for other lung diseases such as asthma, Alpha-1 Antitrypsin Deficiency, or before and after transplantation;
• PR includes critical components of assessment, physical reconditioning, skills training and psychological support;
• PR teaches individuals valuable skills that assist in managing and understanding their disease and improving health outcomes;
• PR is appropriately practiced in a variety of settings;

 What can I do?  Join the COPD Foundation by taking Action

• Call, Fax or Write to your Senator
• Request co-sponsorship of S 329 and HR 552 THE PULMONARY AND CARDIAC REHABILITATION ACT which clearly defines pulmonary rehabilitation benefits for eligible Medicare recipients
• Copy the Foundation on the action you take so that we may better represent our constituents on Capitol Hill
  ( moday@alpha1.org This e-mail address is being protected from spam bots, you need JavaScript enabled to view it or mail to Miriam O’Day at the address above)

CALL - Capitol switchboard 202-225-3121. 
FAX – Call your Senators and Representatives office and request the fax number. 
WRITE – Write a letter to your Senators and Representatives.
SEND A LETTER ONLINE – The professional society for respiratory therapists (American Association for Respiratory Care) has set up a section on their website for individuals to contact their members of congress online regarding co-sponsorship of S 329 and HR 552.  Surf to http://capwiz.com/aarc/home/

Report provided 3/19/07
     Today the Senate Appropriations Subcommittee on Labor, Health and Human Services, and Education held a hearing on the FY 2008 NIH budget.  Chairman Harkin and Senator Specter’s opening statements both detailed the FY 2008 cuts proposed by the Administration for NIH, the adverse impact of the cuts, and their intention of restoring the cuts and providing increases as possible to the FY 2008 NIH budget.
     Zerhouni’s testimony was followed by a panel presentation from four NIH funded researchers from the University of Texas at Austin (Brent Iverson), Harvard Medical School (Joan Brugge), Johns Hopkins (Robert Siliciano), and Yale (Stephen Strittmatter).
     Following the hearing a press conference was help to release a report titled “Within Our Grasp-Or Slipping Away?”  This report was prepared by twenty contributing scientists and is referred to as “a Statement by a Group of Concerned Universities and Research Institutions . 

Specter/Harkin Opening Statements
      FY 2008 is the fifth year in a row that the NIH budget has not kept pace with inflation.  The FY 2008 request represents a $529 million cut when compared to FY 2007 level when the transfer to the global AIDS fund is considered.  Harkin stated that “we will not let the cuts stand” and Specter stated that “the cuts are unacceptable”.

Zerhouni’s Testimony
     Dr. Zerhouni’s statement was identical to the statement he gave before the House Appropriations Subcommittee on March 6^th. Essentially his main point is that the per capita rate of increase in health expenditures can not be sustained and we must therefore change the way we practice medicine to focus on the preemption of diseases. 
     Harkin’s questioning on the Administration’s limitations on stem cell research solicited the comment from Zerhouni that:  “its time to move forward” and modify or change the Administration’s restrictions”.  Specter asked what it would cost to cure cancer. Zerhouni eventually indicated that he would submit something for the record but offered by way of response that the fastest way to find cures for all diseases is to maintain the historic approval rate of NIH grant applications.  Zerhouni felt that the current approval rate of less than 20% is insufficient over time to keep the biomedical research enterprise healthy.

The Panel of Researchers
    Each panel member talked about his or her specific area of research and the impact of current low success or approval rate of NIH grant applications on their field.  A common theme was that research representing new and creative ideas is not being funded and the low approval rate had a disproportionate negative impact on young faculty.  Several panel members indicate that we will lose a generation of investigators if the current low approval rate continues. One researcher stated that he now spends 60% of his time (up from 30%) applying for grants in order to stay afloat. They also stated that though the overall rate of grant awards is a dismal 20%, for young, first time investigators it is as low as 5% (down from 15% 5 years ago).
     Today the Senate Appropriations Subcommittee on Labor, Health and Human Services, and Education held a hearing on the FY 2008 NIH budget.  Chairman Harkin and Senator Specter’s opening statements both detailed the FY 2008 cuts proposed by the Administration for NIH, the adverse impact of the cuts, and their intention of restoring the cuts and providing increases as possible to the FY 2008 NIH budget.
     Zerhouni’s testimony was followed by a panel presentation from four NIH funded researchers from the University of Texas at Austin (Brent Iverson), Harvard Medical School (Joan Brugge), Johns Hopkins (Robert Siliciano), and Yale (Stephen Strittmatter).
     Following the hearing a press conference was help to release a report titled “Within Our Grasp-Or Slipping Away?”  This report was prepared by twenty contributing scientists and is referred to as “a Statement by a Group of Concerned Universities and Research Institutions (We have a copy of the report if interested.). 

Specter/Harkin Opening Statements
     FY 2008 is the fifth year in a row that the NIH budget has not kept pace with inflation.  The FY 2008 request represents a $529 million cut when compared to FY 2007 level when the transfer to the global AIDS fund is considered.  Harkin stated that “we will not let the cuts stand” and Specter stated that “the cuts are unacceptable”.

Zerhouni’s Testimony
      Dr. Zerhouni’s statement was identical to the statement he gave before the House Appropriations Subcommittee on March 6^th. Essentially his main point is that the per capita rate of increase in health expenditures can not be sustained and we must therefore change the way we practice medicine to focus on the preemption of diseases. 
     Harkin’s questioning on the Administration’s limitations on stem cell research solicited the comment from Zerhouni that:  “its time to move forward” and modify or change the Administration’s restrictions”.  Specter asked what it would cost to cure cancer. Zerhouni eventually indicated that he would submit something for the record but offered by way of response that the fastest way to find cures for all diseases is to maintain the historic approval rate of NIH grant applications.  Zerhouni felt that the current approval rate of less than 20% is insufficient over time to keep the biomedical research enterprise healthy.

The Panel of Researchers
     Each panel member talked about his or her specific area of research and the impact of current low success or approval rate of NIH grant applications on their field.  A common theme was that research representing new and creative ideas is not being funded and the low approval rate had a disproportionate negative impact on young faculty.  Several panel members indicate that we will lose a generation of investigators if the current low approval rate continues. One researcher stated that he now spends 60% of his time (up from 30%) applying for grants in order to stay afloat. They also stated that though the overall rate of grant awards is a dismal 20%, for young, first time investigators it is as low as 5% (down from 15% 5 years ago).

Report provided by: Madison Associates, L.L.C.,  300 Independence Avenue, SESuite 201,  Washington, D.C. 20003,  www.madisonassoc.com