New COPD And Smoking Research Presented At CHEST 2009

Main Category: Respiratory / Asthma
Also Included In: Water - Air Quality / Agriculture;  COPD;  Smoking / Quit Smoking
Article Date: 05 Nov 2009 - 4:00 PDT

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Air Pollution Major Factor in Fresno Health
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Air pollution is a major health risk for patients in Fresno, CA, who suffer from chronic lung diseases. Researchers from the University of California, San Francisco, Fresno compared the weekly rates of those admitted to the ER with asthma or chronic obstructive pulmonary disease (COPD) with air pollution indices for corresponding weeks. There were 1,184 ER visits in total, predominantly by female patients (60 percent). Of the total ER visits, 932 (79 percent) patients were admitted and 24 (2.0 percent) were ICU admissions. Results showed that an increased ambient particulate matter 2.5 (PM-2.5) level was associated with an increase in weekly ER visits; however, there was no association between ambient ozone level and weekly ER visits from respiratory illness. Researchers conclude that air pollution, as measured by particulate matter, has a greater impact on patients with chronic airway disease than ambient ozone level.

New Formula Calculates More Accurate 'Lung Age' in Smokers
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A new formula more accurately calculates a smoker's "lung age," which researchers hope will help persuade patients to quit the habit. A research team from Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, CA, developed and evaluated a new lung age formula based on %FEV1/FEV6 rather than the current lung age formulas based on height and FEV1 or FVC. They found that the new formula closely approximated actual lung ages in 5,800 never-smokers, while values using the earlier formulas were erratic. They also found that in 3,500 current smokers, mean increases in lung age progressed to more than 25 years by age 50 and above, much higher but less erratic than using lung ages based on earlier formulas. Researchers conclude that sharing physiological lung age with smokers may be more effective in smoking cessation than sharing spirometry results.

Pulmonary Rehab May Improve Smoking Cessation Rates
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New research shows that patients who smoke who participate in a structured pulmonary rehabilitation (PR) program achieve higher abstinence rates than those who receive usual care. A research team from Montreal compared smoking cessation rates among 413 patients with chronic obstructive lung disease (COPD). Of the patients, 27 subjects participated in a PR program, while 386 received standard care. After a follow-up of 31±24 months, 81.5 percent of patients in the PR group had at least a short-term abstinence compared with only 46.1 percent in the non-PR group. Additionally, 37 percent of patients in the PR group showed signs of sustained quitting, compared with 8 percent in the non-PR group. Researchers conclude that PR may play a role in smoking cessation in patients with COPD.

Indacaterol May Produce Better Outcomes Than Salmeterol in Patients With COPD
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Patients with COPD who received once-daily indacaterol had significantly better outcomes than patients treated with twice-daily salmeterol. Researchers from the University of California, Los Angeles and UBC Scientific Solutions in the United Kingdom compared the effectiveness and safety of these treatments in 998 patients with moderate to severe COPD who were assigned to take indacaterol 150 g every day, salmeterol 50 g twice daily, or placebo for 26 weeks. Trough FEV1 was significantly higher in patients treated with indacaterol than placebo and salmeterol after 12 and 26 weeks. Indacaterol-treated patients also reported improved scores in transition dyspnea index and health status, and experienced more rescue medication-free days over 26 weeks. The incidence of adverse events for indacaterol, salmeterol, and placebo, respectively, was 51 percent, 46 percent, and 47 percent. Five deaths were reported (one indacaterol, one salmeterol, three placebo), with none suspected to be related to study treatment. Researchers conclude that indacaterol will be a useful maintenance treatment for patients with moderate to severe COPD.

Varenicline Effective and Well Tolerated for Smoking Cessation
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New research shows that varenicline is an effective therapy for smoking cessation and is well tolerated among patients with chronic obstructive lung disease (COPD). In a 27-center, double-blind, multinational study, researchers from the University of California, Los Angeles and UBC Scientific Solutions in the United Kingdom assessed the efficacy and safety of varenicline in patients with mild to moderate COPD. Patients were randomized to receive either varenicline (n=248) or placebo (n=251) for 12 weeks, with a 40-week nontreatment follow-up. At weeks 9 and 12, the continuous abstinence rate (CAR) was significantly higher for varenicline (42.3 percent) vs placebo (8.8 percent). Greater varenicline efficacy also was maintained during weeks 9 and 52 (varenicline CAR, 18.6 percent vs placebo CAR, 5.6 percent). Serious events adverse occurred in 2.8 percent of patients receiving varenicline and 4.4 percent of patients receiving placebo. Two patients receiving varenicline died during the study, as did one patient receiving placebo. One suicidal ideation event was reported for placebo; no such event was reported for varenicline. Reports of depression, depressed mood, and depressive symptoms were similar for both treatment groups.

COPD Underdiagnosed in Mexico
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In Mexico, one in five primary health-care patients with risk factors for chronic obstructive pulmonary disease (COPD), actually have irreversible airflow obstruction. Researchers from the Universidad Autónoma de Baja California, Mexico, surveyed and administered pre- and postspirometry tests to 2,293 patients referred for evaluation, either with or without COPD symptoms. Of the patients, 472 had spirometry scores associated with COPD, with the rate significantly higher in men (24.1 percent) than in women (18.3 percent). COPD patients had smoked for a significantly higher number of years, smoked more cigarettes per day, and had a significantly more frequent history of exposure to biomass smoke than patients without COPD. Despite being symptomatic and/or having risk factors for COPD, only 256 patients (11.3 percent) had a spirometric test in the past, while only 9.3 percent of current smokers had received advice to quit smoking from their physician.

Telemedicine for COPD Reduces Hospital Visits
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A Louisiana-based telemedicine program for patients with chronic obstructive pulmonary disease (COPD) was associated with a reduction in exacerbations and unscheduled hospital visits. A research team at Overton Brooks VA Medical Center assessed the effect of a telemedicine program on the overall health and health-care utilization in 100 patients with COPD. During the intervention period, patients used an in-home electronic device that requests information on a participant's health and transmits responses to a registered nurse. Researchers found that patients tended to have fewer significant COPD exacerbations during the intervention period compared to the year prior, and unscheduled hospital visits for COPD fell from an average of 3.59 visits per year to 1.95 visits per year, a 46 percent relative reduction. The study authors speculate that automated telemedicine programs are useful in the management of advanced COPD and may reduce the cost, both personal and monetary, of this disease.

Source: Jennifer Stawarz
American College of Chest Physicians

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