COPD Care at Home Rather Than Hospital Boosts Patient Outcomes, Canadian Study Finds

Moving chronic obstructive pulmonary disease (COPD) patients from hospitals to their homes could improve the sustainability of Canada’s health system while improving individual outcomes, says the Canadian Foundation for Healthcare Improvement (CFHI).

Data from health systems participating in the INSPIRED study conclude that offering Canadian COPD patients the right support services in their homes improved their quality of life while reducing hospital readmissions by 64 percent and emergency room visits by 52 percent.

“Too often, people with chronic diseases like COPD end up in hospital because the care they need is not available in the community,” CFHI President Maureen O’Neil said in a news release. “INSPIRED provides the services patients and their families tell us they need to manage their disease outside of hospital, and now we are expanding this innovative collaboration to benefit more patients.”

INSPIRED was developed at Capital Health in Halifax, Nova Scotia, to help patients manage their illness more effectively in their homes and communities. It is based on extensive input from patients and caregivers, and relied on specific healthcare teams that identified COPD patients who were able to participate in the program.

Those selected received written action plans for managing their COPD, phone calls after every discharge and at later intervals, at-home self-management education and psychosocial support, and advanced care planning when necessary. Patients were also given a phone number to call for support.

That approach has slashed emergency-room visits and hospital readmissions among more than 2,000 COPD patients in the provinces of Alberta, Manitoba, New Brunswick, Nova Scotia, Ontario and Prince Edward Island since the program’s establishment in 2014-15.

“These results are important because they show we can keep people with chronic disease out of the hospital by partnering with them to reinvent the way we deliver care so it meets their needs,” said Maria Judd, vice president of programs at CFHI. “All Canadians who use and pay for the healthcare system — not just those with a chronic disease — will benefit from the emergency department and hospital bed capacity this approach will free up as it spreads across the country.”

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Asthma in America Carries $82 Billion Price Tag

The economic cost of asthma in the United States is nearly $82 billion a year, federal health officials report.

That figure includes medical expenses and costs associated with work and school absences and deaths.
However, the true cost of asthma is probably underestimated because the U.S. Centers for Disease Control and Prevention study did not include people with untreated asthma.

The new analysis was based on federal government data, collected from 2008 to 2013. It showed that about 15.4 million people were treated for asthma each year. The annual per-person medical cost of asthma was $3,266.

Of that per-person amount, $1,830 was for prescriptions, $640 for office visits, $529 for hospitalizations, $176 for hospital outpatient visits and $105 for emergency room care.

Asthma-related deaths cost $29 billion a year, with an average of 3,168 deaths a year.

Asthma resulted in 8.7 million lost work days and 5.2 million lost school days a year, for a combined annual cost of $3 billion.

The findings were published online Jan. 12 in the Annals of the American Thoracic Society.

"The cost of asthma is one of the most important measures of the burden of the disease," study lead author Tursynbek Nurmagambetov, a health economist at the CDC, said in a journal news release. "Cost studies can influence health policy decisions and help decision makers understand the scale, seriousness and implications of asthma so that resources can be identified to improve disease management and reduce the burden of asthma."
The findings show "the critical need to support and further strengthen asthma control strategies," Nurmagambetov said.

The U.S. National Heart, Lung, and Blood Institute has more on asthma.
Annals of the American Thoracic Society, news release, Jan. 12, 2018


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Diet rich in apples, tomatoes may help repair lungs of ex-smokers, study suggests

The natural decline in lung function over a 10-year period was slower among former smokers with a diet high in tomatoes and fruits, especially apples, according to a study from the Johns Hopkins Bloomberg School of Public Health, suggesting certain components in these foods might help restore lung damage caused by smoking.

The researchers found that adults who on average ate more than two tomatoes or more than three portions of fresh fruit a day had a slower decline in lung function compared to those who ate less than one tomato or less than one portion of fruit a day, respectively. The researchers inquired about other dietary sources such as dishes and processed foods containing fruits and vegetables—such as tomato sauce—but the protective effect was only observed in fresh fruit and vegetables.

The paper, which is part of the Ageing Lungs in European Cohorts study funded by the European Commission and led by Imperial College London, also found a slower decline in lung function among all adults with the highest tomato consumption, including those who had never smoked or had stopped smoking. The findings appear in the December issue of the European Respiratory Journal.

"This study shows that diet might help repair lung damage in people who have stopped smoking. It also suggests that a diet rich in fruits can slow down the lung's natural aging process even if you have never smoked," says Vanessa Garcia-Larsen, assistant professor in the Bloomberg School's Department of International Health and the study's lead author. "The findings support the need for dietary recommendations, especially for people at risk of developing respiratory diseases such as COPD."

For the study, the research team assessed the diet and lung function of more than 650 adults in 2002, then repeated lung function tests on the same group of participants 10 years later. Participants from three European countries—Germany, Norway, and the United Kingdom—completed questionnaires assessing their diets and overall nutritional intake. They also underwent spirometry, a procedure that measures the capacity of lungs to take in oxygen.

The test collects two standard measurements of lung function: Forced Exhaled Volume in one second, which measures how much air a person can expel from their lungs in a second; and Forced Vital Capacity, the total amount of air a person can inhale in six seconds. The study controlled for factors such as age, height, sex, body mass index,...

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Drinking Soda While Pregnant Could Increase Your Child's Risk of Asthma, Study

We know moms aren't supposed to drink alcohol during pregnancy, but could soda be just as bad? Studies are pointing to new evidence that excessive consumption of sugary drinks during pregnancy could cause health problems for the child later in life.

New research published in the Annals of the American Thoracic Society suggests that children ages 7 to 9 are more likely to develop asthma if they consumed excessive amounts of sugary drinks in early childhood - or if their mother did the same during pregnancy.

"Previous studies have linked intake of high fructose corn syrup sweetened beverages with asthma in school children, but there is little information about when during early development exposure to fructose might influence later health," said lead study author Sheryl L. Rifas-Shiman, MPH. Scientists had yet to investigate the effects of exposure before birth.

During their third trimesters, 1,068 mothers completed questionnaires detailing their food and beverage consumption. The researchers looked closely at reports of drinking soda, fruit juice, and other sweetened drinks to determine their results. They analyzed this information in the context of overall fructose consumption - including sugar consumed from food - to determine whether sugary drinks had a significant effect.

Nineteen percent of children studied ended up with asthma. Mothers who consumed sugary drinks were 63 percent more likely to have a child with asthma, and mothers who consumed overall high levels of fructose were 61 percent more likely.

The researchers hypothesize that the correlation is due to fructose's potentially inflammatory effect on the lungs.

The study results note that since this is a purely observational study, it cannot prove that the sugary drinks caused the asthma - rather, only that there is a correlation.

Additionally, the correlation involved large amounts of fructose, rather than your occasional sugary drink. Your safest bet is still to avoid drinking soda daily, along with avoiding these other 8 foods and drinks while you're pregnant.


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The Great American Smokeout is Tomorrow!

Every year, on the third Thursday of November, smokers across the nation take part in the American Cancer Society Great American Smokeout event. Encourage someone you know to use the date to make a plan to quit, or plan in advance and then quit smoking that day. By quitting – even for 1 day – smokers will be taking an important step toward a healthier life and reducing their cancer risk.

Why We Need the Great American Smokeout

About 36.5 million Americans still smoke cigarettes, and tobacco use remains the single largest preventable cause of disease and premature death in the world. While cigarette smoking rates have dropped (from 42% in 1965 to 15.1% in 2015), cigar, pipe, and hookah – other dangerous and addictive ways to smoke tobacco – are very much on the rise. Smoking kills people – there’s no “safe” way to smoke tobacco.

Quitting smoking has immediate and long-term benefits at any age. Quitting is hard, but your patients and those that you love can increase their chances of success with help. Getting help through counseling or medications can double or triple the chances of quitting successfully.  And who better to help out with your smoking cessation program then MD Spiro.

You can read about the history of the Great Smokeout here.

For other resources to leverage with your patients, please check out the materials available to help assist your patients to quit smoking today.



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When It Pays to Quit, More People Do!

Financial rewards and personalized support can improve a smoker's chances of quitting, a new study finds.

"Our results show that a successful intervention to help [low-income] individuals quit smoking should be multifaceted and focus on both assisting with resources and, when possible, providing financial incentives," said lead author Dr. Karen Lasser. She's a general internist at Boston Medical Center and an associate professor of medicine at Boston University School of Medicine.

In the study of more than 350 adults, one group of smokers was provided a "patient navigator" to help them get prescriptions for nicotine replacement products and referrals for counseling. They were also offered a monetary reward ($250) if they quit within six months. They received an additional $500 if they were not smoking after 12 months.

Those who did not quit within six months were given a second chance to earn $250 if they quit within 12 months.

A control group of smokers was only given information about resources to help them quit smoking.

After six months, nearly 10 percent in the intervention group had quit smoking, compared with less than 1 percent in the control group. After 12 months, researchers found 12 percent of the intervention group had stopped smoking, compared with 2 percent who only received information about quitting.

"Most of the participants who quit smoking utilized patient navigation, but it's unclear whether navigation alone would achieve the rates of smoking cessation we observed," Lasser said in a medical center news release.

She and her colleagues said older smokers, women and nonwhites were most likely to benefit from the personal support and payments.

The study was published Oct. 30 in the journal JAMA Internal Medicine.

The American Cancer Society offers a guide to quitting smoking.



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Can Young People Get COPD?

Many chronic diseases have an age dimension. As we grow older, the body’s ability to repair itself changes, and damage can accumulate in various parts of the body. Cancer, arthritis, cardiovascular disease, Type 2 diabetes, osteoporosis and dementia are all diseases that tend to afflict older adults more frequently than younger adults.

Chronic obstructive pulmonary disease also has an age component. Because this incurable and progressive lung disease usually results from years of damage to the tissues of the lungs, it’s more common in older adults. The Mayo Clinic reports that “most people are at least 40 years old when symptoms begin.” These symptoms include shortness of breath, especially when engaging in physical activity, wheezing or chest tightness, a chronic cough, lack of energy and frequent respiratory infections. These symptoms may be mistaken for simple signs of aging, but over time they will increase to the point of requiring treatment. And if it’s COPD, it’s not just age – the symptoms are being caused by real damage to the lungs that can’t be reversed but can be managed to maintain a better quality of life.

A lengthy history of cigarette smoking is the biggest risk factor for developing COPD, but the National Heart, Blood and Lung Institute reports that about 15 percent of COPD patients have never smoked. These people may have encountered occupational hazards such as coal dust or other airborne particles that damaged the lungs, or had other exposures to inhaled irritants that did permanent damage to the inside of the lungs.

Although COPD can be considered a disease of aging, there are some other factors that can lead to COPD at a younger age in some people.

Genetic Susceptibility
One factor that can put nonsmokers and younger people at risk for developing COPD is a genetic condition called alpha-1 antitrypsin deficiency. Patients with this hereditary condition have a delivery problem with alpha-1 antitrypsin enzyme. The liver manufactures the enzyme, but it can’t exit the liver properly, so it’s not delivered to the lungs where it does most of its work. This can lead to problems with both the lungs and the liver.

“Alpha-1, for short, is primarily a genetic condition that increases the risk of things injuring the lung and liver that normally wouldn’t injure them,” says Dr. Robert Sandhaus, pulmonologist at National Jewish Health in Denver.

“People with this deficiency are 100 times more...

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The Looming Consequences of Breathing Mold

Flooding means health issues that unfold for years

The flooding of Texas and Florida is a health catastrophe unfolding publicly in slow motion. Much of the country is watching as gallons of water rise around the chairs of residents in nursing homes and submerge semi-trucks. Some 20+ trillion gallons of water are pouring onto the urban plain, where developers have paved over the wetlands that would drain the water.

The toll on human life and health so far has been small relative to what the images suggest. But the impact of hurricanes on health is not captured in the mortality and morbidity numbers in the days after the rain. This is typified by the inglorious problem of mold.

Submerging a city means introducing a new ecosystem of fungal growth that will change the health of the population in ways we are only beginning to understand. The same infrastructure and geography that have kept this water from dissipating created a uniquely prolonged period for fungal overgrowth to take hold, which can mean health effects that will bear out over years and lifetimes.

The documented dangers of excessive mold exposure are many. Guidelines issued by the World Health Organization note that living or working amid mold is associated with respiratory symptoms, allergies, asthma, and immunological reactions. The document cites a wide array of “inflammatory and toxic responses after exposure to microorganisms isolated from damp buildings, including their spores, metabolites, and components,” as well as evidence that mold exposure can increase risks of rare conditions like hypersensitivity pneumonitis, allergic alveolitis, and chronic sinusitis.

Twelve years ago in New Orleans, Katrina similarly rendered most homes unlivable, and it created a breeding ground for mosquitoes and the diseases they carry, and caused a shortage of potable water and food. But long after these threats to human health were addressed, the mold exposure, in low-income neighborhoods in particular, continued.

The same is true in parts of Brooklyn, where mold overgrowth has reportedly worsened in the years since Hurricane Sandy. In the Red Hook neighborhood, a community report last October found that a still-growing number of residents were living in moldy apartments.

The highly publicized “toxic mold”—meaning the varieties that send mycotoxins into the air, the inhaling of which can acutely sicken anyone—causes most concern right after a flood. In the wake of Hurricane...

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