Patients with chronic obstructive pulmonary disease (COPD) who also have non-tuberculous mycobacterial pulmonary disease (NTM-PD) are more likely to be hospitalized and die, according to a German study that urges improved care for this particular disease.
The study, “Burden of non-tuberculous mycobacterial pulmonary disease in Germany,” appeared in the European Respiratory Journal in an article.
In the past decade, the incidence of infections caused by Mycobacterium tuberculosis have decreased in the industrialized world. However, infections caused by other Mycobacterium strains have started to be recognized worldwide.
Although over 150 different species are linked with NTM-PD, the disease is most commonly associated with Mycobacterium avium complex. Because it doesn’t always present signs of active infection and because its symptoms often overlap with those of other chronic pulmonary diseases, NTM-PD can be difficult to diagnose and even harder to eradicate — requiring prolonged therapy regimens with high risk of recurrence or relapse of infection.
In the present study, authors evaluated the real NTM-PD burden by comparing 125 newly diagnosed NTM-PD patients with 1,250 matched control patients over a 39 month-period. They found that although the incidence of NTM-PD was only 2.6 per 100,000, those with NTM-PD had a nearly fourfold increase in mortality (22.4 percent) than those in the control group (6 percent).
Among COPD patients with NTM-PD, the mortality rate was 41.5 percent, compared to 15.9 percent for COPD patients without the disease. In addition, hospitalization costs were three times higher for NTM-PD patients (accounting for 63 percent of total costs).
Even so, the authors noted discrepancies across individual treatments. Only 54 percent of the NTM-PD patients analyzed had received antibiotics on diagnosis, while 26 percent received no antibiotics at all. They also counted 29 different drug combinations across all treatments, suggesting a lack of treatment guidelines for this condition.
“Although NTM-PD is considered rare, these findings highlight that the burden of the disease is high,” the study’s author, Michael Loebinger, said in a press release. “Treatment can be hard to tolerate and may be unsuccessful, making treatment decisions complex. To help with this challenge, the British Thoracic Society will be releasing new guidelines this year.”
Globally, World Health Organization (WHO) estimates that 235 million people suffer from asthma. It also indicates that asthma is not just a public health problem for high income countries, but it occurs in all countries regardless of the level of development.
The study further shows that over 80 per cent of asthma deaths occur in low and lower-middle income countries.
In Rwanda, according to the WHO data published in May 2014, asthma deaths reached 267 or 0.39 per cent of total deaths. The age adjusted death rate was 5.62 per 100,000 of the population, ranking Rwanda 80 in the world.
Treatment should be a priority.
Prof Joseph Mucumbisti, a pediatrician at King Faisal Hospital, Kigali, and president of Rwanda Heart Foundation, says that with time, the rate of asthma cases can be unpredictable, or even higher in the future if awareness on its treatment and diagnosis isn’t put into effect.
“Asthma is quite a common health issue, it’s part of the non-communicable diseases (NCDs), which can’t be transmitted from one person to another. It’s part of the big four NCDs including cardiovascular diseases, diabetes, cancer and the group of chronic respiratory diseases,” he says.
Therefore, there is need for both medical practitioners and the whole public to be aware of the disease, as well as get the proper treatment required to get rid of it completely.
Mucumbisti explains that, in most cases, asthma tends to continue from childhood to adulthood, that’s if the patient doesn’t get proper treatment and management. However, this can be easily prevented if its cause is treated at a young stage.
“The challenge that we have is that most people tend to dwell on prescribing medicines that are meant to relieve the acute asthma attack,” he says.
He explains that these medicines are in form of inhalers which ensure healing within three to five days. Although this ensures relief, unfortunately, it doesn’t ensure its treatment completely which leads to the inflammation of the disease.
“When this happens, the patient will continue to have asthma even in their entire life. And the longer one has it, the more the impact on their life increases,” he adds.
Mucumbisti, however, notes that as a result of prolonged asthma, one is likely to suffer from chronic diseases of the lungs and the heart, therefore the earlier its detection, the earlier the treatment, thus the prevention of consequences later in life.
Risk factors Read more..
To shine a light on the link between chronic obstructive pulmonary disease (COPD) and depression, the Lung Institute is starting an initiative to help combat depression in COPD patients. It kicked off on World Health Day, April 7.
The initiative will seek to decrease the prevalence of depression in people with COPD by helping them improve their quality of life.
Depression affects an estimated 300 million people worldwide, including 16 million American adults, according to the National Institute of Mental Health. It’s particularly prevalent in COPD. About 40 percent of the 24 million Americans with the disease experience depression, according to the Lung Institute.
An article titled “Depression in COPD – management and quality of life considerations” spells out the problem. It was published in The International Journal of Chronic Obstructive Pulmonary Disease.
“Many of our COPD patients suffer from depression. It is what is known in medicine as a co-morbidity,” Jack Coleman, Jr., MD, senior medical director of the Lung Institute, said in a press release.
“When you suffer with COPD, life’s smallest activities like bathing and walking can be a daily struggle; leaving the house can be overwhelming, which may lead to isolated living conditions. You can become cut off from the things you enjoy and, too often, the ones you love.”
Depression can significantly worsen the physical burden of COPD. That makes it important for doctors and their patients to create a plan to deal with it.
The Lung Institute says COPD and depression don’t need to co-exist. Managing the depression that does exist can improve patients’ outlook, it adds.
The institute offers regenerative cell therapy to those with lung disease. This involves using a person’s stem cells, which can generate other cells types, to regenerate lung tissue. The ultimate goal is to improve the quality of life of COPD patients.
After treatment, many patients are ready to engage in the simple tasks they used to do, and pursue activities they once thought impossible, the institute says.
“I could barely leave the house and I couldn’t move. It was hard to get [up] out of a chair. I went into a depression of losing my life, the life I had and the life I loved,” said a patient at the Lung Institute, David V. “But [having] the stem cell [treatment] freed me up to be able to move again. That was the move that saved my life.”
Stem cell therapy involves...Read more..
It's never too late to quit smoking.
Even after heart surgery, research has shown that quitting smoking reduces the risk of a heart attack, stroke or death. Yet only about one-third of smokers hospitalized for heart attacks and other serious heart problems received proven smoking-cessation therapy while they were in the hospital, according to research scheduled for presentation at the American College of Cardiology's 66th Annual Scientific Session. Moreover, data showed that amid mounting evidence of the dangers of tobacco smoke, use of smoking-cessation treatments only increased by 10 percent in hospitals nationwide over the last decade.
"Hospitalization is usually a highly teachable moment, when patient motivation to quit smoking is really high," said Quinn R. Pack, MD, MSc, a preventive cardiologist at Baystate Medical Center in Springfield, Massachusetts, and lead author of the study.
"Yet our study suggests that two-thirds of these patients leave the hospital without having been given evidence-based smoking-cessation tools that we know can help them quit."
Pack and his colleagues examined diagnostic and billing data from 282 hospitals to determine how often smokers hospitalized for heart attacks or heart surgery received smoking-cessation counseling, nicotine replacement therapy (such as the nicotine patch, gum, lozenge or inhaler) or a smoking-cessation medication (varenicline or bupropion) during their hospital stay. The researchers reviewed data for 36,675 patients coded as active smokers at hospital discharge between 2004 and 2014. Nearly 70 percent were men, their average age was 58, and 63 percent of them were hospitalized for a heart attack. The hospitals were located across the country and ranged from medium-sized community hospitals to large university-affiliated medical centers. All of the hospitals had voluntarily submitted the data, stripped of information that might identify individual patients, to a large quality-improvement database.
Overall, about 30 percent of the patients received at least one smoking-cessation therapy during their hospital stay. Of those, about 20 percent were given the nicotine patch, which was the most commonly given treatment, and about 10 percent received professionally delivered smoking-cessation counseling. Few patients received medication or other forms of nicotine replacement therapy such as nicotine gum or lozenges. Smokers who had lung disease, used alcohol, were depressed or were...Read more..
Asthma affects hundreds of millions of people across the world. New research links the gut's microbes with the risk of developing asthma, and identifies a specific fungus in babies that might increase the risk of childhood asthma.
For the first time, a study links a yeast found in babies' guts with the risk of childhood asthma.
Historically, it was believed that asthma is a disease of high-income countries, but this theory is no longer valid as most people living with asthma are from low- and middle-income countries.
Across the world, asthma prevalence is distributed unevenly. The highest prevalence worldwide occurs in Latin America and in English-speaking countries (where over 20 percent of the population live with asthma), whereas the lowest prevalence (at less than 5 percent) was noted in India, Asia-Pacific, and the Eastern part of the Mediterranean, as well as Northern and Eastern Europe.
Countries such as Canada and Ecuador both have a significant incidence of the disease, with approximately 10 percent of the population living with asthma.
New research suggests that a yeast in the gut of Ecuador-born babies may be a strong predictor for childhood asthma. The study was carried out by a team of researchers from the University of British Columbia in Canada and was led by microbiologist Brett Finlay.
The findings were presented at the annual meeting for Association for the Advancement of Science in Boston, MA.
Pichia fungus increases risk of asthma
In the past, Finlay and his colleagues examined the gut microbiota of Canadian children and its connections to asthma. They found four gut bacteria that appeared to prevent the onset of asthma if they were present in the infants' guts within the first 3 months of life.
Now, in this follow-up study, Finlay and team replicated the experiment in an Ecuadorian village, in an attempt to investigate whether the beneficial role of the gut's microbiome is universal.
Using stool samples and health information from more than 100 children, scientists found that the gut's bacteria do play a key role in preventing asthma. However, among the early-life microbes, a yeast known as Pichia seems to increase the risk of asthma if present in the babies' early days of life.
The research further emphasizes the key role of the gut's...Read more..
A large-scale meta-analysis using more than 10,000 participants concludes that vitamin D supplementation may help to prevent a major cause of global death - acute respiratory tract infections.
Acute respiratory tract infections are responsible for 10 percent of ambulance and emergency room visits in the United States.
Including anything from the common cold to pneumonia and bronchitis, they were the cause of an estimated 2.65 million deaths globally in 2013.
Respiratory tract infections have a wide array of risk factors, including overcrowding, a damp living environment, air pollution, and parental smoking.
A number of observational studies have also reported a nutritional risk factor - vitamin D deficiency. Some researchers have concluded that vitamin D has the ability to trigger an immune response to certain viruses and bacteria.
However, the links between respiratory tract infections and vitamin D supplementation have remained controversial; some studies support the theory while others are inconclusive. To date, five meta-analyses have been conducted on existing data. Two of these reported significant positive effects, and three found no significant effect.
Diving into the vitamin D data
In an attempt to put this question to bed, the largest meta-analysis to date was published last week in the BMJ.
The analysis, carried out by an international group of researchers, is the first to use individual participant data (IPD), rather than the aggregate methodology that was used in earlier meta-analyses. In this way, changes measured at different points in time within each participant of each trial can be accounted for, rather than taking a summary (aggregate) of the data. IPD is considered the "gold standard" of systematic review.
The team used data from 25 randomized controlled trials investigating vitamin D supplementation. In total, data from 11,321 participants were analyzed.
After adjusting for potentially confounding variables, such as sex, age, and study duration, they found that vitamin D supplementation produced a 12 percent reduction in the proportion of individuals experiencing at least one acute respiratory tract infection.
In simple terms, if 33 people took vitamin D supplements, one acute respiratory tract infection would be prevented. If these results are confirmed, vitamin D supplementation could potentially prevent millions of respiratory infections each year.
Conclusions from the data
When the team drilled...
"What's the weather going to be today?" It's a frequent question that has larger implications for those with lung disease. Whether it's summer or winter, rainy or windy, people with lung disease should pay attention to the weather report as sudden changes in the weather as well as extreme weather conditions can provoke lung symptoms.
Hot and Humid
Hot weather can be especially hard on people with respiratory disorders. In a 2013 study from the Johns Hopkins University, researchers found a relationship between rising temperatures and the number of emergency hospital admissions for chronic obstructive pulmonary disease (COPD) and respiratory tract infections among people 65 and older. Although the reason behind this correlation is not clear, inhaling hot air is known to promote airway inflammation and exacerbate respiratory disorders like COPD. Hot weather can also be a trigger for people with asthma. Because people with asthma already have inflamed airways, weather is more likely to have an impact, as breathing in hot, humid air induces airway constriction in asthmatics. Air pollution can also be a factor impacting summer breathing in those with lung disease, as increased ozone from smog is often seen in the summer months.
Cold and Dry
Cold weather, and particularly cold air, can also play havoc with your lungs and health. Cold air is often dry air, and for many, especially those with chronic lung disease, that can spell trouble. Dry air can irritate the airways of people with lung diseases. This can lead to wheezing, coughing and shortness of breath.
Be Proactive and Be Prepared
While you can't control the weather, you can reduce the impact it has on your lung disease symptoms. Stay ahead of the curve by monitoring the weather forecasts and identifying your triggers before going outside. You can enjoy your favorite outdoor activities all year round by keeping the following tips in mind:
Israel's Teva Pharmaceutical Industries has won U.S. approval to market a copy of GlaxoSmithKline's best-selling Advair inhaler, although the real battle is still to come.
Teva's version of GSK's blockbuster medicine, called AirDuo RespiClick, is not directly substitutable for Advair and is only approved for asthma, while Advair is also widely used for chronic obstructive pulmonary disease (COPD).
Teva said on Monday it would launch AirDuo later this year. It has not said how much its product will cost.
AirDuo provides patients with the same two drugs as Advair, fluticasone propionate and salmeterol, but it delivers a lower dose of salmeterol. It also uses Teva's Respiclick inhaler rather than a copy of GSK's device.
Producing cut-price copies of Advair is a major opportunity for generics companies at a time when fewer blockbuster medicines are losing patent protection.
For GSK, it is a challenge since Advair has sold more than $1 billion annually since 2001. Global Advair sales were $5.6 billion in 2015, with half that generated in the United States, although sales are now shrinking.
Teva's product promises to grab some of this business in asthma but the bigger threat will come from fully substitutable generic copies of Advair, which are still pending approval.
The U.S. Food and Drug Administration is due to decide whether to approve the first of these, from Mylan, by March 28. A rival version from Hikma and Vectura is close behind, with an approval date of May 10.
GSK said that as Teva's product was not substitutable for or equivalent to Advair it did not "pose the same competitive dynamics as market entry of generic products in the U.S. would."
Advair is already available generically in Europe, but demand for copies is expected to take off more swiftly in the United States, where managers of prescription plans can quickly drive conversion to such cheaper products.
Investors are watching closely to see how GSK's Advair sales will fare in the face of new competitors. One big unknown is the scale of discounts that will be offered by generic companies.
Reporting by Ben Hirschler
Editing by Susan Fenton
Signage for GlaxoSmithKline is seen on its offices in London, Britain, March 30, 2016. REUTERS/Toby Melville/File PhotoRead more..