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Draft guideline to improve asthma diagnosis

The draft guideline – NICE’s first on asthma – reinforces recommendations made in the 2014 BTS/SIGN asthma guideline, which also supports spirometry as the preferred initial test to assess the presence and severity of airflow obstruction.

A number of methods and assessments are available to determine the likelihood of asthma. These include measures of airflow obstruction, such as spirometry and peak flow, and measures of reversibility with bronchodilators, with both types of measure being widely used in current clinical practice.

This latest guideline aims to determine the most clinical and cost effective way to effectively diagnose people with asthma and determine the most effective monitoring strategy to ensure optimum asthma control.

The guideline stresses that to achieve an accurate diagnosis clinical tests should be used as well as checking for signs and symptoms. The process which the healthcare professional should follow in the initial assessment, and the tests to use, are presented in simple flow charts.

The draft guideline recommends spirometry as the first-line investigation for asthma in adults older than 16 and children aged 5–16 years. Healthcare professionals should regard a forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio of less than 70% as a positive test for obstructive airway disease.

Further breath tests should be carried out depending on the results from spirometry and the patient’s age.  For adults and young people over 5 years, healthcare professionals may need to check for levels of nitric oxide, a gas which is found in larger volumes in people with asthma, using the fractional exhaled nitric oxide (FeNO) test, and carry out a bronchodilator reversibility (BDR) test. The treatment of under-5s should be based on professional judgment and observation until the child is old enough to take clinical tests.

Around 1 in 10 of adults with asthma develops the condition because they are exposed to certain substances, such as chemicals or dust, in their workplace. The draft guideline also recommends that healthcare professionals should ask employed people how their symptoms are affected by work to check if they may have occupational asthma.
Professor Mark Baker, director of clinical practice at NICE said: “Asthma is a long-term incurable condition that affects millions of people of all ages. If left untreated asthma attacks can be life threatening.

However, with appropriate treatment...

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Take Action to Fight Against Lung Disease

Join the American Lung Association in its effort to eliminate tobacco-caused death and disease! By taking action to prevent and reduce tobacco use in your state, you are standing with the American Lung Association to advance the fight against lung disease. As part of the American Lung Association Action Network, you can also take action to reduce other lung diseases and support our efforts to make indoor and outdoor air safe to breathe. Thank you for taking action!

State Alerts
Help the American Lung Association implement its road map to eliminate tobacco-caused death and disease in the U.S. Elected officials must take action to pass the tobacco control policies called for in State of Tobacco Control 2015 to reduce smoking rates to 10 percent by 2024 and protect everyone from secondhand smoke. Choose a specific state alert you would like to take action on at the American Lung Association Tobacco Control by clicking here.

In this New Year it is truly time for you to get serious with your practice and your patients to stomp out smoking. What better way to do so then to implement a solid Smoking Cessation program.  Hold your patient’s hands, encourage them, and test them to ensure they are taking their health seriously.  Join us in supporting the American Lung Association and our efforts to help others to stop smoking once and for all. 

Our Smoking Cessation products can help support you in this New Year!

References:
http://mdspiro.com/breath-co 
http://mdspiro.com/smoke-check
http://www.stateoftobaccocontrol.org/take-action/

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Asthma, COPD Linked With More Inflammatory Bowel Disease

In this New Year, it is important for us to be educated about new studies that have come out in reference to airway management, asthma, COPD, and more.  A higher incidence of inflammatory bowel disease (IBD) has been found in persons with airway diseases, such as asthma and COPD, in a study published online ahead of print in European Respiratory Journal.

Lead author Paul Brassard, MD, and fellow investigators determined that the incidence of Crohn disease was 27% higher in persons with asthma and 55% higher in persons with COPD, and that incidence of ulcerative colitis was 30% higher in persons with COPD.

These percentages were determined in comparison with the general population of Québec, which the investigators noted is the province with the second-highest incidence of Crohn disease in Canada and a prevalence of asthma and COPD that is above the Canadian average.

"Although a link has previously been suggested, this is the first study to find significantly increased rates of IBD incidence in people with asthma and COPD," said Brassard in a statement from the European Lung Foundation. "If we can confirm a link between the two conditions it will help diagnose and treat people sooner, reducing their symptoms and improving their quality of life."

The researchers noted in their study that when patients with airway disease develop digestive symptoms, clinicians need to be aware of the possible occurrence of new cases of IBD, even in older age groups and regardless of smoking status.

Brassard's group identified 136,178 persons with asthma and 143,904 persons with COPD in the administrative health databases of Québec. Among those with asthma, there was an average incidence of 23.1 cases of Crohn disease and 8.8 cases of ulcerative colitis per 100,000 person-years.

Among persons with COPD, there were 26.2 cases of Crohn disease and 17 cases of ulcerative colitis per 100,000 person-years. The incidence of both Crohn disease and ulcerative colitis in elderly patients with COPD was significantly higher than in the general population.

Women with asthma were more likely than men to develop Crohn disease, and men with COPD were more likely than women to develop ulcerative colitis.

The researchers pointed out that immunologic dysfunctions triggered by environmental factors are a common element in the pathogenesis of both IBD and airway diseases such as asthma and COPD, and that pulmonary involvement is one of the extraintestinal...

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FIRS Mobilizes Members to Raise Awareness on COPD and Smoking Cessation

The Forum of International Respiratory Societies (FIRS) is continuing to mobilize its members to raise awareness of COPD and help prevent the risk factors that cause it.

210 million people have COPD worldwide, causing the death of at least 2.9 million people each year. It is the sixth major cause of death and disability in low- and middle-income countries and is projected to be the third most common cause of death by 2020.

World COPD Day, which is observed in November each year, was an opportunity to highlight the impact of COPD to governments, politicians, funding agencies, clinicians, public health personnel, and also the general public—but it can’t stop there.

FIRS is dedicated to raising awareness of the disease.  The alliance hopes to highlight some of the key risk factors, diagnosis, and essential management components of the disease.

Risk Factors for COPD
Risk factors for COPD other than smoking tobacco are being increasingly recognized. These include environmental exposures, such as occupational exposures to dusts and fumes, and indoor biomass fuel burning in many developing countries.

Epidemiological studies indicate that the most common risk factors for COPD are age, smoking, indoor exposure to coal and workplace exposure to dust.

Spirometry is Essential for COPD diagnosis
One possible explanation of the inaccurate diagnostic labelling of COPD is the underutilization of spirometry for COPD diagnosis. Only 20% of individuals surveyed in a population-based study had undergone spirometry sometime in their life. Spirometry training programs, as well as the availability of spirometers in the primary care setting, are still scarce—and that is where MD Spiro comes into play.

Treatment and Prevention of COPD
Patients should have access to comprehensive treatment including education for patients and family, smoking cessation programs, medication, pulmonary rehabilitation, and oxygen therapy as prescribed.

Prevention of smoking and exposure to pollutants, such as coal and dust, are the interventions most likely to succeed against COPD worldwide.

ATS President Tom Ferkol, MD said: "COPD is a global killer. It is a major cause of death and disability in low- and middle-income countries and is projected to be the third-leading cause of death by 2020. We have joined together with other members of the Forum to highlight the impact of COPD to the public and policymakers. Understanding the risk factors for COPD, raising...

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November Is COPD Awareness Month: The Third Leading Cause of Death in the U.S.

Try to imagine what it might feel like to take every breath through a straw. For many people with lung diseases like chronic obstructive pulmonary disease or COPD, they don't have to imagine because that's what breathing can feel like on many days, especially days when air pollution levels are high. With COPD it often becomes more and more difficult for people to breathe over time because the air sacs that carry air from the nose and mouth to the lungs become less elastic.

November is COPD Awareness Month and Wednesday, Nov. 19, was World COPD Day. If there's one thing that the American Lung Association of the Northeast wants the public to know as we shine the spotlight on this disease this month is that COPD can be treated.

When diagnosed early and properly managed, both COPD's progression and its severity can be minimized. That's why it is so important to be aware of the signs and symptoms of this disease so that if you notice symptoms in yourself or a loved one, you know to make an appointment to see your doctor right away.


Are your lungs trying to tell you something?

The most common symptoms of COPD include constant coughing, shortness of breath while performing everyday activities, excess sputum production, feeling unable to breathe or take a deep breath, and wheezing. COPD most often occurs in people age 40 and over who have a history of smoking, have had long-term exposure to lung irritants or have a rare genetic condition called alpha-1 antitrypsin (AAT) deficiency.

COPD is the third leading cause of death in the United States, claiming more than 120,000 American lives each year. More than 12 million people have been diagnosed, but another 12 million people are likely to have COPD and don't know it.

Particularly alarming is the rise of COPD in Women. Last year, the American Lung Association reissued its report Taking Her Breath Away, which found that the number of deaths among women from COPD has increased four-fold over the past three decades. Since 2000, more women than men in this country have died of this disease.

As we observe COPD Awareness Month, please spread the word to your loved ones that if they have trouble breathing they should see their doctor. Never assume that trouble breathing is a normal part of aging; it is not. Get yourself checked out. COPD is diagnosed using a simple test called spirometry. Spirometry is a noninvasive test that checks the amount of air you can blow out of your lungs and how fast you...

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Smoking Causes 14 Million Medical Conditions in U.S. Yearly, Study Finds

Smoking is to blame for about 14 million major medical conditions among American adults yearly, a new study shows.

That number is higher than the U.S. Centers for Disease Control and Prevention's (CDC) last estimate, in the year 2000, which found that American adults suffered from 12.7 million smoking-attributable conditions.

Chronic obstructive pulmonary disease (COPD) — which includes conditions like chronic bronchitis and emphysema — accounts for more than half of the medical cases attributable to smoking, the researchers found.

"The disease burden of cigarette smoking in the United States remains immense, and updated estimates indicate that COPD may be substantially underreported in health survey data," wrote the researchers, who published their findings on October 13, 2014 in the journal JAMA Internal Medicine.

Data from the CDC's National Health Interview Survey initially suggested that 6.9 million adults in the United States suffered from a combined 10.9 million smoking-attributable medical conditions, including COPD, cancers, heart attacks and diabetes. But the actual number of conditions is likely higher because this survey relies on people’s self-reports, and COPD is underreported, the researchers said.

To account for this gap, the researchers — led by Brian Rostron, of the U.S. Food and Drug Administration's Center for Tobacco Products — also looked at data from another CDC survey, the National Health and Nutrition Examination Survey. In this survey program, participants are not only interviewed, but they also undergo physical exams, including a lung function test called spirometry that is used to diagnose COPD.

Based on that data, Rostron and colleagues estimated that cases of COPD were 70 percent higher than the number of cases based on self-reported data. The researchers estimated that 14 million American adults had a smoking-related condition in 2009.

The lack of COPD diagnoses might be the result of current clinical guidelines, the researchers said. Physicians are advised to use spirometry to test patients who report symptoms such as wheezing and chronic cough. But doctors are advised not to screen patients who don't report these symptoms because of the economic and health care costs.

"Individuals with slowly declining respiratory function or individuals who have become accustomed to some degree of chronic airway obstruction may not report these conditions to physicians and consequently would not be...

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Childhood Trauma Linked to COPD Development Later in Life

There is a correlation between adverse childhood experiences (ACE) and chronic obstructive pulmonary disease (COPD) development, with a more pronounced association in women, Centers for Disease Control and Prevention (CDC) researchers found.  

In study results published in International Journal of Chronic Obstructive Pulmonary Disease, researchers examined the data of 26,546 women and 19,015 men in MN, MT, VT, WA, and WI. Occurrences of childhood abuse, household dysfunction, COPD diagnoses were recorded in addition to age, gender, race, marital status, education, and smoking status.  

their analysis, the investigators noted 12.7 percent and 4.4 percent of respondents were diagnosed with asthma and COPD, respectively. Overall, 63.1 percent of participants claimed they experienced one ACE prior to age 18.  

Specifically, the writers discovered that “men were significantly (P<0.05) more likely to report childhood verbal abuse,” while “women were significantly (P<0.05) more likely to report childhood sexual abuse; living with a substance  abusing household member; living with a mentally ill  household member; and to report 5 or more ACEs compared to men.”  

Weighing the prevalence of ACEs and COPD diagnoses among their patients, the authors found women who experienced an ACE were significantly more likely (P<0.05) to have COPD than women who didn’t. While the male sample had a higher rate of COPD development (P<0.05), the link between COPD and ACEs wasn’t as strong.   

“For women who were never smokers, there was still a higher likelihood of COPD associated with physical abuse (PR=1.81, 95% CI: 1.28, 2.58), sexual abuse (PR=2.18, 95% CI: 1.46, 3.24), and living with a substance abusing household member during childhood (PR=1.70, 95% CI: 1.18, 2.43),” the investigators wrote.   

While ACEs have been tied to other chronic conditions such as depression, heart disease, cancer, diabetes, and stroke, research on their relationship to COPD is limited. From their research, the investigators claimed while they have shown an association between COPD, ACEs, and gender, the mechanism behind the trend cannot be ascertained from their study alone.  

“Programs and policies that address the underlying problems caused by experiences of childhood maltreatment and household dysfunction may prove more effective than traditional smoking prevention and cessation strategies alone,” the writers penned. “Further research examining sex...

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Kids exposed to BPA before birth at risk of wheeze and asthma

Young kids who were exposed to Bisphenol A (BPA) before birth are more likely than others to have a wheeze before age five, according to a new study that found no connection to BPA exposure after birth.

Many plastic and aluminum consumer products contain BPA, and most Americans have detectable BPA concentrations in their urine, the authors write. Some studies have suggested that exposure to the chemical may contribute to the development of asthma.

Animal studies are still going on to clarify the association between BPA and lung function, said lead author Dr. Adam J. Spanier of the pediatrics department at the University of Maryland School of Medicine in Baltimore.

In 2012, the U.S. Food and Drug Administration banned BPA from baby bottles, but said there was not enough evidence for a more widespread ban.

Researchers began by testing urine samples from nearly 400 expectant mothers in the Cincinnati, Ohio area at 16 and 26 weeks into their pregnancies.

After the children were born, the researchers asked parents every six months for the next five years if the child had wheezing in his or her chest, and at ages four and five tested how much air the children could exhale during a forced breath at age.

Researchers also collected urine samples from the children annually.

The higher the BPA concentration in the mother’s urine during pregnancy, the lower the child’s lung function tended to be at age four, the researchers found. There was no association with lung function at age five.

For wheezing, the mother’s BPA concentrations at 16 weeks’ gestation was linked to the child’s risk of persistent wheeze.

The level of BPA in the children’s urine was not related to their own wheeze or lung capacity.

The results suggest a relationship between the exposure to BPA during early pregnancy and the likelihood of developing early wheeze, said Dr. Randall M. Goldblum, director of the Child Health Research Center Lab and Children’s Asthma Program at the University of Texas Medical Branch in Galveston.

He was not involved in the new study.

“It is difficult to say if this is the cause, because the development of asthma is complex and includes genetic predisposition as well as environmental exposures like the one documented,” he told Reuters Health by email.

If children get over their early wheeze by age five there is a good chance they will not have it again later in life, he noted.

“Some of the...

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