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Friday’s COPD Newsletter from COPD Support, Inc.

Posted May 21 2010 7:04am

Volume 10, Issue 25
May 21, 2010
Joan Costello, Editor

By Martha A Simpson, DO: Q. I had a cold recently that traveled down into my chest. I went to the doctor and was told that I had bronchitis. My wife, however, argues that I must have pneumonia since I am coughing so much. Are bronchitis and pneumonia very different, and what are the distinguishing factors that tell them apart? Finally, it seems like both illnesses are treated the same way, so how much does it really matter which one you have?

A. …pneumonia and bronchitis are both illness that affect the lungs and bronchial tubes. Although many of the symptoms are similar, they are very different diseases.Bronchitis is an inflammation of the bronchi, the twin passages that connect the trachea to each lung. The symptoms can be quite severe and they can also persist in what we call chronic bronchitis. Chronic bronchitis is a type of ongoing obstructive lung disease…Acute bronchitis and pneumonia can both be caused by either viruses or bacteria, meaning that they often start out as a cold or flu, but not always. Both can also be caused by prolonged or intensive exposure to irritants such as cigarette smoke, chemicals or severe dust. Both illnesses can cause a persistent cough…both illnesses typically last for at least a week and sometimes to two.

The cough that stems from bronchitis is usually dry in the early days, but then you begin to cough up yellow or green mucus. The cough can be quite harsh and cause pain in the chest wall and, eventually, sore stomach muscles. Wheezing is usually prominent in acute bronchitis. Often, these symptoms accompany those of the cold that preceded it. Bronchitis patients do not usually have a fever, but they may experience mild shortness of breath.

It may surprise you that pneumonia may cause a cough: but not always. When it does, the coughing typically produces mucus from the onset. Also, pneumonia patients usually experience a fever of over 101 degrees Fahrenheit. They also have some difficulty taking a deep breath, and they are slightly short of breath.

Acute bronchitis and pneumonia can occur at any age, but both illnesses tend to be worse in smokers, elderly people, or people of any age who have other chronic diseases, such as heart disease and diabetes.

Blood tests and x-rays may be needed to differentiate between the two illnesses. If the infection is viral, usually supportive care is all that is needed for treatment of either. If the infection is bacterial, antibiotics are usually prescribed. Based on your specific medical history and illness, your physician will determine the right treatment plan for you.

Bacterial colonization in COPD contributes to airway inflammation and modulates exacerbations. We assessed risk factors for bacterial colonization in COPD.

Methods: Patients with stable COPD consecutively recruited over 1 year gave consent to provide a sputum sample for microbiologic analysis.

Bronchial colonization by potentially pathogenic microorganisms (PPMs) was defined as the isolation of PPMs at concentrations of [greater than or equal to] 102 colony-forming units (CFU)/mL on quantitative bacterial culture. Colonized patients were divided into high (>105 CFU/mL) or low (<105 CFU/mL) bacterial load.

Results: A total of 119 patients (92.5% men, mean age 68 years, mean forced expiratory volume in one second [FEV1] [% predicted] 46.4%) were evaluated.

Bacterial colonization was demonstrated in 58 (48.7%) patients. Patients with and without bacterial colonization showed significant differences in smoking history, cough, dyspnoea, COPD exacerbations and hospitalizations in the previous year, and sputum color.

Thirty-six patients (62% of those colonized) had a high bacterial load. More than 80% of the sputum samples with a dark yellow or greenish color yielded PPMs in culture.

In contrast, only 5.9% of white and 44.7% of light yellow sputum samples were positive (P <0.001).

Conclusions: Almost half of our population of ambulatory moderate to very severe COPD patients were colonized with PPMs. Patients colonized present more severe dyspnoea, and a darker color of sputum allows identification of individuals more likely to be colonized.


News items summarized in The COPD-NEWS are taken from secondary sources believed to be reliable. However, the COPD Family of Services does not verify their accuracy.

Obese patients with COPD stand to gain as much from pulmonary rehabilitation as their slimmer counterparts, even though as a group they have a lower exercise capacity, according to new research from the University Hospitals of Leicester in the UK.

“Like the healthy population, the prevalence of obesity is increasing in those with COPD,” said Neil Greening, M.B.B.S, M.R.C.P., who led the study. “There is evidence that obesity may lower exercise capacity but at the same time appears to confer a survival advantage, which is known as the obesity paradox. Pulmonary rehabilitation is effective in improving exercise capacity and health status in COPD but it is unclear whether these benefits accrue in patients with extreme obesity.

Researcher wanted to compare the outcomes of a pulmonary rehabilitation program in patients with obesity of varying severity and normal weight subjects. To compare the effects of pulmonary rehabilitation between obese and non-obese patients, researchers recruited patients with clinical and spirometric COPD and classified them according to their level of obesity, from normal weight to extreme obesity. The patients underwent pulmonary rehabilitation at a single center in the UK. The improvements in their exercise performance and endurance, as well as their health status (chronic respiratory questionnaire) and baseline characteristics were assessed.

“We found that obese people with COPD are more disabled in terms of exercise capacity, despite having less severe airflow obstruction (the measure used to quantify severity of COPD). However, they do just as well with rehab including those with extreme obesity,” said Dr. Greening. “There is no difference between obesity subgroups in the proportion of patients achieving a clinically significant improvement in the incremental shuttle walk test.”

“Patients with COPD, irrespective of body mass, improve following a pulmonary rehabilitation program. Therefore extremely obese patients with COPD should still be considered for enrollment,” said Dr. Greening, adding that although there are no weight limits for pulmonary rehabilitation programs, there is likely some discrimination by medical staff who may emphasize weight loss over exercise.

There remain questions about the disparity in obese patients with COPD. Obese patients do not have the same improvements in health status following pulmonary rehabilitation. In particular, fatigue does not improve, possibly due to co-existing medical problems, such as obstructive sleep apnea or obesity hypoventilation, according to Dr, Greening. However, the most puzzling question remains the survival benefit conferred by obesity. “As medical professionals, we know that obesity is linked with medical complications such as diabetes and heart disease, so how it can lead to a survival advantage in other diseases such as COPD or chronic kidney disease is puzzling. The reasons for this are currently unknown and further research is needed.” A larger study is planned to examine some of these issues.

An active lifestyle is crucial for day-to-day function in COPD patients, says a new study. Inactivity is known to be associated with a decrease in exercise tolerance, but it was unknown whether the reduced amount of physical activity alone was responsible for the reduction in functional exercise tolerance and maximal exercise capacity, or if the decreased intensity of the performed activities also played a role.

“We looked at the functional exercise tolerance in patients with COPDthat is, the distance they were able to walk during the six-minute walk testand related it to the amount of daily activity they were able to maintain. We found that patients with a higher amount of daily activities also had higher scores on the six-minute walk test,” said co-author Chris Burtin. In contrast, patients’ maximal exercise tolerance was unaffected by their daily activity, and more likely to be affected by disease severity, and the intensity, rather than the amount, of performed activities. “Knowledge of these relationships is of utmost importance when developing interventions aiming at improvement of functional or maximal exercise capacity.

…a diagnostic accuracy study. In COPD response of the forced expiratory volume in 1 second (FEV1) after bronchodilators is poor. Inspiratory parameters like forced inspiratory volume in 1 second (FIV1) and inspiratory capacity (IC) can be responsive to bronchodilators.

In an individual patient with COPD a significant bronchodilator response must exceed the random variation for that parameter. Therefore it is important that the type of scatter is *homoscedastic. If this is the case the chance of underestimating or overestimating the random variation for low or high parameter values is at its lowest. The aim of this study is to investigate the random variation (type and quantity) of inspiratory parameters and FEV1.

Methods: In 79 stable COPD patients spirometry that included inspiratory parameters was performed.FEV1, FIV1, IC, maximal inspiratory flow at 50% (MIF50) and peak inspiratory flow (PIF) were measured five times in one day and again within two weeks of the first measurement. The values of these parameters, within one hour, within one day and between two different days were compared. The coefficient of repeatability was calculated and, in addition, linear regression was performed to investigate the type of scatter (homo- or heteroscedastic) of the measured parameters.

Results: The type of scatter was unwanted *heteroscedastic for all the parameters when the differences were expressed as parameter values; however, when the differences were expressed as percent change from initial values we found a more homoscedastic scatter.

The coefficient of repeatability within one hour of each parameter expressed as percent change from initial value were respectively: FEV1:12%, IC: 19%, FIV1: 14%, PIF: 18%, MEF50: 21%.

Conclusions: Changes in FEV1, FIV1, IC, MIF50 and PIF are best expressed as percentage change from initial value because more homoscedastic scatter is found by this method.In an individual patient with COPD a significant improvement for a parameter must exceed the above-mentioned change.

homoscedastic ( statistics ) Pertaining to two or more distributions whose variances are equal.

Heteroscedasticity - In statistics, a sequence of random variables. guide Deborah Leader, RN, covers the subject pretty thoroughly. “Many people are bothered by this term and think it carelessly applied. This week, we talk about end stage COPD and what it really means. We will also find out more about the stages of COPD and treatment options available for patients in this phase of the disease.”

We do not accept any paid advertising. Any corporations, products, medicines (prescription or non) mentioned in this newsletter are for informational purposes only and not to be construed as an endorsement or condemnation of same.

Your doctor may prescribe medication that you breathe in using a metered-dose inhaler. You need to keep your inhaler clean. Keep track of how much medication is left in the canister, so you’ll never run out.

Keeping your Inhaler Clean

-Rinse the spacer and the inhaler jacket in warm water every day.
-Let them dry overnight on a paper towel.
-Disinfect them as necessary in a solution of vinegar and water.

When to Replace Your Inhaler

Each inhaler is good for only a certain number of puffs of medication. After those puffs are used up, any puffs remaining will not give you the amount of medication you need. To be sure you’ll get enough medication when you need it, keep track of how many puffs you use. Here’s a tip:

-Find the number on the canister that tells you how many puffs it contains.

-Divide this number by how many puffs you are told to use in one day. This gives you the number of days your medication should last.
-Use your calendar to find out what date your medication will run out. Mark it on the canister and on your calendar.
-Be sure to replace the inhaler before you run out of medication.

Sample for you to fill in:

Number of puffs in new canister÷ ______________
Number of puffs you use each day= ____________
Number of days medication will last ____________

Note: Be aware that your medication will run out sooner if you use your inhaler more often than planned.
For example, if your new canister holds 200 puffs and you’ve been told to use 4 puffs a day: 200 ÷ 4 = 50 days

Related Videos: Asthma Inhaler 1:22 minutes

Neuromuscular electrical stimulation (NMES) may reduce muscle atrophy in patients with severe COPD, according to Canadian researchers. NMES is the application of electrical stimulation to a group of muscles through electrodes placed on the skin. It is primarily used by physical therapists to help restore function to injured muscles. Isabelle Vivodtzev, Ph.D. and colleagues wanted to test whether NMES had the potential to address muscle wasting in COPD patients.

Muscle wasting is common in patients with severe COPD, and effective treatment has yet to be developed. The impact of muscle wasting and poor limb muscle endurance on survival and functional status in COPD has been clearly established. General physical reconditioning is currently the best treatment to improve limb muscle function in this disease, but there is a need to develop alternative tools to treat limb muscle dysfunction. Up to a third of patients with COPD undertaking exercise training do not show the expected gain in functional status or muscle function.

“Because it has little impact on ventilatory requirements and dyspnea, NMES appears as a promising alternative to general physical reconditioning in advanced COPD and its feasibility has been confirmed in this population.”

To investigate whether NMES could effectively reduce muscle wasting in COPD patients, the researchers recruited 20 patients with severe COPD (FEV1<50% expected) to be randomly assigned to receive home-based nmes or sham treatment (wherein electrical stimulation was applied, but at a very low frequency so as to induce tremor sensation without true muscle contraction) for 30 minutes, five days a week over six weeks, in a double-blind study. Training with NMES led to significant reduction in the level of Atrogin-1 protein which is involved in muscle protein degradation, and, maintenance of the level of p70S6K protein, which is involved in protein synthesis in the NMES-trained patients as compared with sham group. Furthermore, changes correlated with changes in intensity of stimulation during NMES training suggesting that changes at cellular level were modulated via a dose-response manner.

Your physician should be consulted on all medical decisions. New procedures or drugs should not be started or stopped without such consultation. While we believe that our accumulated experience has value, and a unique perspective, you must accept it for what it is…the work of COPD patients. We vigorously encourage individuals with COPD to take an active part in the management of their disease. They do this through education and by sharing information and thoughts with their primary physician and pulmonoligist. However, medical decisions are based on complex medical principles and should be left to the medical practitioner who has been trained to diagnose and advise.

Glenmark’s Phase II-B study for Oglemilast does not meet primary end point. The end has been officially signaled on Glenmark’s prospective asthma drug Oglemilast, the first to be licensed out by Glenmark to Forest Laboratories Inc. for further development. Oglemilast will now be shelved according to most analysts. Analysts had actually factored in the fact that Oglemilast is not going to show great results post its failure on COPD.

By Donna Young, Washington Editor: Forest Laboratories Inc. and Nycomed GmbH on May 17th received a complete response letter for their COPD drug Daxas (roflumilast). Although the FDA requested certain additional information and analyses, regulators are not seeking more patient trials, the firms said in a statement.

Even with the thumbs up on safety, many on the FDA’s committee had expressed concerns about neuropsychiatric events in Daxas study participants, including three suicides, and serious adverse gastrointestinal events, such as pancreatitis, which led to two deaths. Some panelists also were concerned about carcinogenicity observed in hamsters in preclinical studies, which regulators said may be relevant for humans. Forest also got stung when the FDA last month said Daxas provided only a modest improvement in lung function in COPD patients.

Given that range of issues, Piper Jaffray’s Amsellem said he doubted the FDA was leaning toward approval of Daxas. But, he added, even if regulators approve the drug for the U.S. market, “we believe that sales potential would be limited, given the likelihood of rigorous safety monitoring in the context of a modest clinical benefit.” The FDA’s absence of a request for new Daxas trials, said Baird & Co. analyst Thomas Russo, could suggest the agency did not take its panel’s suggestions seriously to consider requiring the drug to be studied on top of true standard of care for COPD prior to approval.

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The Newsletter, like all the other endeavors of the Family of COPD Support Programs , is provided to you by COPD-Support, Inc. a non-profit member organization with IRS designation 501(c)(3). If you would like to be involved and help us provide these programs to the individuals who benefit from them, please consider joining us as a member. Further information is available at

Some foods can trigger asthma attacks. Excess weight may exacerbate (or even lead to) asthma. Other research shows that anti-inflammatory foods and foods rich in antioxidants can help fight the inflammation that causes asthma symptoms. How do your eating habits shape up? A quiz

Don’t Gross Out The World, forwarded by John/MN: Sure, you know not to eat with your feet on the table at a restaurant. But what about eating at a fancy restaurant in Khartoum in Sudan. Should you bring your camel in with you, or leave him outside? How about ants in your soup? Rescue them or let them drown? Okay, maybe the following International Dining Etiquette Quiz questions aren’t that weird, but they’re close.

This puzzle has been around before but it didn’t move until it was completed. Now you have a chance to put it together while it’s moving. Forwarded by Pauline/UK.


You exercise your body to stay physically in shape, so why shouldn’t you exercise your brain to stay mentally fit? With these daily exercises you will learn how to flex your mind, improve your creativity and boost your memory. As with any exercise, repetition is necessary for you to see improvement, so pick your favorite exercises from the daily suggestions and repeat them as desired. Try to do some mentalrobics every single day!

-Mentalrobics Articles: Daily exercises and tips for improving memory, creativity, vocabulary and stress management.
-Memory Tests: The average person’s short-term memory can hold 7 things. How much can you remember?
-Flash Cards: When you are trying to memorize something, flash cards can be a very effective way to improve your memory.
-Vocab Builder: This vocabulary test is loaded with over 3000 of the most common words found on the SAT and GRE standardized tests.
-IQ Tests: Learn more about how intelligence is measured and calculate your own personal score., the preeminent Internet publisher of literature, reference and verse providing students, researchers and the intellectually curious with unlimited access to books and information on the web, free of charge. This week they are featuring Gray’s Anatomy of the Human Body among other well known books.

Editor’s note: If you are looking for a quote, Bartleby’s is the place.

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