Emphysema Might Increase Risk of Aneurysms

While the how’s and why’s of why aneurysms develop are not well understood, a recent study indicates that those with chronic obstructive pulmonary disease (COPD) are at higher risk. The study, published in the American Heart Association journal Stroke, found that the risk an aneurysm will rupture is much higher for those with COPD, and suggests that COPD may be a marker to determine if someone is at a heightened stroke risk.

Aneurysms develop on the wall of the aorta, which supplies blood to the abdomen, pelvis and legs. If one ruptures, it creates a life-threating situation. Researchers posit that the damage done by emphysema to the alveoli sacs in the lungs increase the risk for rupture. This conclusion was made after analyzing data for about 1.7 million Medicare beneficiaries over the age of 65, then following them for an additional four years. Of the more than 4,800 patients diagnosed with an aneurysm rupture, 433 had emphysema.

After accounting for other risk factors—hypertension, diabetes, tobacco use and alcohol abuse—researchers found that people with emphysema were more than twice as likely to experience a ruptured aortic aneurysm. They were also 50 percent more likely to have a subarachnoid hemorrhage caused by their aneurysm.

"We [should] tell patients with emphysema that they are at higher risk for aneurysm formation, screen them and work with them on modifiable risk factors like smoking and blood pressure control," said Dr. Ali Mahta, the study's lead author and an assistant professor of neurology in the Warren Alpert Medical School of Brown University in Providence, RI.

The study, which is the largest of its kind on the topic of aneurysm and emphysema, also suggests the two conditions may share a similar underlying pathology, accounting for their relationship, said Mahta.

The study doesn’t prove the correlation, of course, and there are limitations. For example, the study does not capture clinical variables such as severity, treatment or duration of a patient's emphysema or aneurysm, or the context in which the diagnosis was made. Even though smoking is a factor of both conditions, the data here did not show if those studies were smokers.

To read the full article on Health Day, click here.

Spreading Awareness of the Risk of Lung Cancer in Patients with COPD

Most patients with COPD require greater motivation to seek help when symptom changes occur and most people are unaware of their increased risk of developing lung cancer, according to new research.

In a UK-based qualitative interview study published in Psycho-Oncology, researchers explored how COPD affects patient response to changes in their symptoms and sought to explain their reluctance to seek help from medical professionals. The results showed that patients often disregarded early signs of lung cancer and instead believed they were COPD-related. They also showed that none of the patients knew about the link between their condition and the potential onset of lung cancer.

“Various factors were considered to explain why patients avoided seeking medical treatment,” the researchers said. “Researchers acknowledged awareness to the risk of lung cancer, prompt diagnosis, and early treatment could prolong survival rates.”

Between July 2016 and May 2017 interviews were completed with 40 patients with COPD aged 40 to 83 in Glasgow, Scotland. Questions were related to four different “circles of influence” regarding patient self-knowledge, his or her amount of social interaction, cultural attitudes and social structure.

Researchers were able to gather information on each patient’s symptom experience, interpretation, action, recognition, help-seeking tendencies, evaluation and re-evaluation. Likewise, cultural influences had a dramatic effect on individuals’ reluctance to seek professional help.

“Many participants wanted to be considered ‘good patients’,” researchers said.

For example, patients felt concern about wasting a physician’s time, which demonstrates mindfulness of a moral balance between responsible use of medical services and avoidance of needlessly sacrificing their health.

“Many patients emphasized they would only consult their physician in critical circumstances,” the research found.

Patients also were more likely to be fatalistic and were deterred from seeking care. In fact, a number of individuals interviewed said they felt pessimistic about the idea of achieving improved symptoms. Social interaction also was a key influence on an individual’s likelihood to seek treatment. For example, family members and friends noticed worsening coughs or physical changes when patients failed to recognize any change themselves. Those who had the support of family or friends had a greater chance of attaining help than those who expressed feelings of isolation.

Social capacity was also found to be a major influencer on a patient’s tendency to seek help. Many patients said they purposefully avoid social situations that could alert others to their condition because of their feelings of embarrassment about it. In addition to social isolation, other barriers to care included scheduling appointments beyond typical working hours and transportation or physical mobility issues.

The prevalence of lung cancer, which is among the most common forms of cancer, is four times higher in patients with COPD. Researchers indicated concern that informing patients of a link between COPD and cancer could be harmful and lead to increased fatalism, but also said that raising awareness of the relationship between “COPD and lung cancer will enlighten patients to the benefits of early diagnosis.”

“Healthcare professionals need to do more to educate those with COPD about their increased risk of developing lung cancer and be more vigilant when a patient with the illness presents changing symptoms,” said Kathyrn A. Robb, PhD, and senior lecturer at the University of Glasgow, in a statement.

Click here to read the full article on AJMC.

Know the Warning Signs of COPD

In the beginning stages of chronic obstructive pulmonary disease (COPD), patients may have no symptoms – or have only mild ones. But as the disease progresses, symptoms may include chest tightness, a cough with mucus, low fever, shortness of breath and wheezing. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) no longer emphasizes distinguishing chronic bronchitis from emphysema, the two main types of COPD. It instead focuses on the airflow-limited state.

That said, COPD is a disease that includes persistent respiratory symptoms accompanied by airflow limitation that is secondary to airway and/or alveolar abnormalities, often caused by significant exposure to noxious gases or particles. Chronic bronchitis is defined as the presence of cough and sputum production for at least three months a year in each of two consecutive years, according to GOLD’s 2019 report.

Patients with chronic bronchitis and emphysema may be differentiated by their presentation, including associated cardiac and lung assessment findings, sitting position in the office, type of cough and weight. Those with chronic bronchitis may be obese and experience frequent coughing with expectorant, coarse rhonchi and wheezing on lung exam, and edema and cyanosis that can be associated with right-sided heart failure. They also may be thin and have barrel chests.

Hyper-resonant lung sounds and wheezing may be heard, or they may have pursed lip-breathing accompanied by a tripod position and use of accessory muscles and little or no cough or expectorant reported.

COPD diagnosis is made with spirometry, when the ratio of forced expiratory volume in one second is less than 70 percent of a match control, signifies an obstructive defect. A high-resolution computed tomography can help diagnose emphysema, given that it has better sensitivity then a chest radiograph.

The six-minute walk test is part of the BODE index (Body-mass index, airflow Obstruction, Dyspnea, and Exercise) to predict mortality for patients with COPD. There are other tests, of course. Differential diagnosis of COPD can include asthma, bronchiectasis, congestive heart failure, diffuse pan bronchiolitis, and obliterative borchiolitis.

The key to managing COPD is a thorough assessment that includes spirometry testing, the nature and magnitude of the symptoms, history of moderate and severe exacerbations and future risk, and presence of comorbidities, such as diabetes, gastroesophageal reflux disease, heart failure and osteoporosis.

The GOLD (2019) refined ABCD assessment tool can then be used to guide treatment, the goals of which include improving exercise tolerance and health status, preventing disease progression, preventing and treating exacerbations, reducing mortality and relieving symptoms. Smoking cessation is key to managing chronic bronchitis and COPD.

Treatment includes medications, such as inhaled or oral corticosteroids, short- and long-acting bronchodilators, phosphodiesterase, inhibitors, respiratory anticholinergics and a combination medication and corticosteroids or anticholinergic inhalations. Treatment may also include improved diet, infection control, management of sputum viscosity and clearance, oxygen therapy, pulmonary rehab, smoking cessation, vaccinations and anti-trypsin deficiency treatment to aid the patient’s functional status and quality of life.

Chronic bronchitis is the beginning point of the progression of COPD. Research is being done to analyze mucin concentration and phlegm samples, as well as clinical trials for patients with chronic bronchitis by attempting to kill cells that produce mucus with low-level energy.

Click here to read the full article on Contemporary Clinic.

Researchers breathe new life into COPD research using mouse models

Researchers at Tokyo Medical and Dental University (TMDU) used mice to demonstrate that immune cells called basophils act to trigger a cascade of immune responses leading to airway degeneration resembling that in human chronic obstructive pulmonary disease (COPD).

In the study, published in the journal Proceedings of the National Academy of Sciences USA, researchers used a variety of mouse models to explain the developmental process behind COPD. The team showed that the immune cells basophils, previously believed to be mainly involved in fighting parasitic infections and inducing allergic responses, also induce the destruction of alveolar walls (emphysema).

“Earlier studies of COPD focused on mice as a suitable model for easily dissecting the mechanisms behind this disease, but encountered a range of difficulties in mimicking the features in humans,” the researchers noted.

Per reports on the study, the mice were first exposed to smoke, given the association between smoking and COPD, but there was no measurable “progressiveness of the disease in humans.” Next, researchers administered enzymes called proteases directly into the airway. Proteases break up proteins, producing more human COPD-like features.

They were able to induce emphysema in mice. Lead author, Sho Shibata, said the team then worked backwards one step at a time through the series of events causing this symptom to identify what started this cascade, using mice to knockout of each component of this cascade.

“The team started by revealing that the lung tissue destruction was caused by a molecule called MMP-12, which they found was released in excess from immune cells called interstitial macrophages when elastase was administered,” Science Daily reported.

By working backward, the researchers said they found “interstitial macrophages arose when the precursor immune cells called monocytes were induced by an immunity-regulating molecule called interleukin-4,” thus showing that this interleukin-4 was released by the immune cells basophils.

Ultimately, they were able to treat the mice that elicited emphysema.

"Our results are surprising because basophils have not previously been identified to be active in this kind of situation," said corresponding author Hajime Karasuyama. "It may be that basophils were previously overlooked because they only make up 1 percent of the white blood cells in the lungs."

The team hope that their discovery will lead to therapies targeting basophils or the interstitial macrophages that they create to slow down the progression of emphysema.

Click here to read the full article on Science Daily.

Diet for COPD sufferers

Living with chronic obstructive pulmonary disease (COPD) requires more than a few adjustments to help the afflicted conserve energy and optimize lung function. Two adjustments should be eating well and maintaining a healthy weight, which may help keep symptoms in check and let COPD suffers live a more high-quality and active life.

“If you're overweight, you have to carry more of your weight around, making you feel more short of breath,” Barry Make, MD, co-director of the COPD program at National Jewish Health in Denver and a professor of medicine at the University of Colorado Denver, School of Medicine, told Everyday Health.

Nutrition Tips

Before beginning any diet, speak with your medical team about the nutrition plan that is best for you related to your specific body and health factors. A nutritionist may be required, who can help develop a meal plan to best meet your needs and monitor progress along the way.

However, in general, people who have COPD should consider the following to maintain an optimal weight:

• Monitor calories: The American Lung Association (ALA) recommends that people with COPD who are overweight consume fewer calories. If the opposite is true and you need to focus on maintaining or increasing your body weight, talk with your medical team or nutritionist about the foods you should be eating to keep the weight on.

• Avoid fad diets: Fad diets are not appropriate for COPD patients. People with COPD appear to fare best with a varied diet that provides a good balance of whole grains, fruits, vegetables and lean proteins, according to research published the International Journal of Chronic Obstructive Pulmonary Disease.

• Focus on protein: Protein is particularly important for COPD patients who are exercising as part of their pulmonary rehabilitation plan. The ALA recommends milk, eggs, cheese, meat, fish, poultry, nuts and beans as good protein sources.

• Watch your portions: Consider eating small meals frequently, rather than fewer large meals. Eating throughout the day instead of two or three large meals can help lessen shortness of breath.

• Get balanced: Focus on consuming fruits, vegetables, dairy products, whole grains and lean proteins.

• Limit salt: Consuming excessive sodium can lead to fluid retention, which can worsen shortness of breath.

A healthy diet is an important part of a COPD treatment plan. It can also help manage symptoms, and make people feel better overall by potentially increasing their energy level and giving their body the fuel needed to fight infection.

Click here to read the full article on Everyday Health.

Self-Care COPD Program Lowered Hospital Re-admissions

Self-management of chronic obstructive pulmonary disease (COPD) could significantly reduce the number of hospital readmissions and increase patient quality of life, according to finding of a new study.

Researchers developed the study at Johns Hopkins Bayview Medical Center, which entailed a three-month BREATHE program combined with transition support and chronic disease self-management. The goal of the study was to determine I if it were possible to improve quality of life and acute care reduction for those suffering from COPD.

COPD encompasses a group of conditions, including emphysema and chronic bronchitis, that causes irreversible lung damage. More than 1 of every 10 seniors have COPD, and 1 of 5 people admitted into the hospital with a COPD exacerbation are re-hospitalized within a month.

According to lead author, Hanan Aboumatar, MD, MPH, associate professor of medicine at the Johns Hopkins University School of Medicine, people with COPD must maintain a “meticulous juggling act: learning about the various medications they must take, how to use multiple inhalers, maintaining the ability to do the activities they enjoy, and recognizing flare-ups early before they get serious enough to warrant a hospital admission.” 

In other words, COPD patients must learn extensively about their condition and how to best live with it throughout their daily lives, Aboumatar said. “Unfortunately, patients often report not receiving sufficient information about COPD and how to manage it. Many don’t know how to use their inhalers or how to get portable oxygen devices so they can still leave their home.”

Between March 2015 and May 2016, 240 patients were randomized to receive usual care or intervention care. Usual care patients were assigned a general transition coach who supported the patient for 30 days after discharge, providing guidance with a discharge plan and outpatient services. For intervention care, nurses with specialized training in supporting COPD patients, met with patients during their hospital stay and for three months after discharge.

Hospitalizations, emergency department visits, and the St. George’s Respiratory Questionnaire (SGRQ) quality of life score were monitored for six months after initial hospitalization. For the 203 patients who completed the study, the number of COPD-related acute events was 0.72 for the intervention group and 1.40 in the usual care group.

The SGRQ score for the intervention group decreased by only 1.53 points; however, the score for the usual care group showed a notable rise, at 5.44 points, researchers discovered.

Aboumatar said the COPD patients and caregivers that partnered with their research team to develop the BREATHE program were able to share important information about their needs and what areas healthcare providers needed to focus on. “We are planning to repeat this study in a wider variety of hospitals, including ones in rural settings and those serving patients who have more access to resources,” she added.

The study, “Effect of a Program Combining Transitional Care and Long-term Self-management Support on Outcomes of Hospitalized Patients with COPD," was originally published in JAMA.

Click here to read the full article on MD magazine.

Is There An Impact on Lung Cancer Survival because of COPD?

Lung cancer and chronic obstructive pulmonary disease (COPD) are both diseases that are heterogeneous and diverse, with different pathological changes, clinical manifestations and outcomes for those afflicted by them. So, as researchers investigated the association between COPD phenotypes -- characteristics of an individual resulting from the interaction of its genotype with the environment -- and the prognosis of different types of lung cancer, they found that COPD and emphysema were independent risk factors for squamous carcinoma only.

The researchers had speculated that the diverse nature of the two diseases played an “important role in the relationship between COPD and lung cancer prognosis,” the researchers found.

The study included individuals with a newly and pathologically confirmed diagnosis of lung cancer who were preparing for lung cancer surgery. These individuals also underwent a pulmonary function test and diagnosis of COPD was determined based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines.

Of the 2,222 lung cancer patients, 32.6 percent were found to also have COPD. After adjustment for age, sex, body mass index, smoking status and therapy method, COPD was significantly associated with the decreased overall survival of lung cancer. With the increased severity of COPD, the overall survival of lung cancer gradually worsened.

In terms of disease heterogeneity, emphysema was an independent prognostic risk factor for squamous carcinoma, and no significant relationship between COPD and lung cancer prognosis was observed among adenocarcinoma, small cell lung cancer, large cell lung cancer and other subtype patients.

According to AJMC, there have been conflicting results from previous studies about whether or not COPD affects lung cancer survival. The researchers involved with this latest study said that to their knowledge this current study is the largest to date that examines this specific issue.

Unfortunately, per the findings, the five-year overall survival rates of lung cancers with COPD were significantly lower than that of lung cancers without COPD. The results were higher than the overall five-year survival in overall lung cancer population,but were consistent with overall survival rates in patients undergoing surgery

Click here to read the whole article om the AJMC site.

Study Shows that Protein May Slow Emphysema

A protein generated as part of our body's immune response to intestinal worms could slow the progression of emphysema, Rutgers University found in a recent study, which was published in the journal Cell Reports.

Past studies have shown that inflammation associated with activated immune cells can contribute to the development of emphysema. The Rutgers study suggests that a protein, RELM-alpha, produced in response to an infection with parasitic worms can suppress the harmful inflammation linked to emphysema and control its progression.

"When the parasite first enters the lungs, it induces production of the inflammatory cytokine IL-17, which can cause emphysema," said William Gause, director of the Center for Immunity and Inflammation at Rutgers New Jersey Medical School, and lead author of the study. "But subsequently the parasite also triggers this specific component of the immune response that can reduce the IL-17 and thereby limit the severity of the emphysema."

Gause said the study is one of many currently examining the immune responses triggered by parasites, which scientists hope will help them identify new treatments to control inflammation and promote lung tissue repair. Studies such as these are looking to identify molecules that may hold potential for actually reducing lung tissue damage.

Future studies, he said, will continue examining whether or not direct administration of this molecule can reduce the severity of emphysema, as well as how harmful inflammation driven by IL-17 results in the immune-mediated tissue damage that contributes to this lung disorder.

"Harmful inflammation is such a serious problem in disease," Gause said. "This protein produced by immune cells during parasitic worm infections reveals the complexity of the immune response and indicates how we can unleash beneficial components of our own immune system to control the harmful inflammation that contributes to many chronic diseases."

Click here to read the whole article on Medical Xpress.

Impact of “Seasonal COPD” Reviewed

Patients with chronic obstructive pulmonary disease (COPD) often have a significant disease burden that is particularly associated with the peak incidence of exacerbation events during winter months. Per a review of several existing studies, researchers evaluated the impact of seasonality in COPD, and found that there is indeed important considerations for understanding how all factors of the disease might impact patients and where interventions can be targeted.

The review used the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines to define a COPD exacerbation as an acute event characterized by “the worsening of a patient’s respiratory symptoms that is beyond normal variation and leads to a change in medication,” the AJMC reports.

Of the studies reviewed, one study showed that its authors demonstrated that the “expression of anti-inflammatory genes was altered by the time of the year -- highly expressed in June, July and August in the northern hemisphere and raised in December, January and February in the southern hemisphere.” Thus, it seems there is a strong correlation for COPD flare ups and environmental factors found in each season.

Additionally, in regard to environmental factors, the authors of the review said that extremes in temperature are typically associated with an increase in morbidity and mortality in the general population. COPD, the reviewers discovered, showed inconsistencies among “a range of study results” in the sample reviewed, reflecting the “complexity of the associations among a variety of environmental factors,” as well as the immune response from the host.

In their review, the authors of the aggregate study said its findings emphasize the need for more research into seasonal CPOD and their effects on those suffering from the illness. In other words, “the biology of a patient in response to seasonality needs to be better understood to provide better treatment and prevention options,” according to the review.

“This seasonal variation in exacerbation incidence has a corresponding effect on hospital admissions in many different healthcare systems and is also associated with an increase in mortality,” the authors said in a statement. “Therefore, a greater understanding of the factors that contribute to these seasonal increases in exacerbation rates should provide opportunities to protect patients and reduce the burden on already-overstretched healthcare systems.

“Research should be undertaken with a clear knowledge of the changing environmental conditions that patients experience,” the authors added. “In this study, we have discussed the factors separately, although, they are all clearly interconnected; importantly, with growing climate extremes, there is a risk that this will impact on seasonal variations in exacerbations rates.”

Click here to read the entire article on AJMC.