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Friday’s COPD Newsletter from COPD Support, Inc.

Posted Jun 11 2010 6:22am

Volume 10, Issue 28
June 11, 2010
Joan Costello, Editor

The British group is developing a generic steroid treatment for asthma and two specialty products: an inhaled anti-fungal treatment for lung-disease sufferers and a product to tackle the rejection of implanted lungs after transplant. “We are confident we can go into the clinic with the (steroid treatment) and start to move it forward,” Chief Executive Chris Blackwell said in an interview on Monday.

“On VR461, an inhaled anti-fungal for underlying lung disease, we hope to start trials in calendar year 2011.” Vectura, which spends most of its revenues on research and development, ended the year to end-March with cash of 64.1 million pounds after upping its R&D spend by 13 percent. It said R&D costs would grow another 10 percent this year as key products, such as VR315, widely said to be a generic version of GlaxoSmithKline’s (GSK.L) lung drug Advair, approached commercialisation.

The group is also bullish on the prospects for its drugs NVA237 and QVA149 for the treatment of COPD, which have been licensed to Novartis and are in development for final-stage clinical trials.












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.

Dr. Manny has a couple of good videos on COPD Stents, Bronchoscopy and Breathing easy

I often get asked the question, “What is a hospitalist?” when patients and families have no idea who I am. Sometimes I introduce myself as an internist who specializes in hospital based medicine. Which then forces some people to ask me about being an internist. As an internist, I have chosen a field that has failed to identify itself by the name it has taken on. Internist. What does that mean? When I was a medical student, I had no idea what an internist did. I remembered thinking, “Why are these doctors called internists?”

Interns are medical doctors who have completed a medical school education and have begun their first year of residency training, the grueling year that separates doctors from all other providers of medical care. Intern programs generally exist for internal medicine, general surgery, pediatrics and family medicine. All other training programs and subspecialties begin with an intern who has completed one year in one of these field.

Internists do take care of the vast majority of conditions that affect the gut. But they don’t perform surgery on the belly.Internists have an identity crises. They are often lumped in with other primary care providers by a public who lacks an understanding of what it is we have been trained to do. I’m sure even my family questioned what I do before educating themselves. Internists are doctors of adult medicine. We manage the vast majority of all acute and chronic medical conditions, both stable and unstable, and for 90% or more of the adult population, we have the skills to manage these conditions independently without necessary referral for subspecialty evaluation.

I am trained to manage most chronic medical conditions that do not require procedural or surgical intervention….I will call another subspecialist when my skills to manage a condition are lacking. And because of that, they can rest assured they will only hear from me when I have a question that needs to be answered, not because I don’t want to deal with a problem.

For some docs, that might offend them. They want to be called on their patients. The problem is, I am qualified to manage their patient because the patient is my patient until I have a question that needs to be answered. If I don’t need help evaluating a patient, I won’t ask for that help. I respect their expertise. I would expect them to respect mine as well. I often get into these consulting issues with patients as well. In fact, some patients demand that subspecialists see them for conditions I am more than qualified to handle. Stroke patients, COPD and pneumonia patients, heart failure patients. They often ask why a neurologist or a lung doctor or the cardiologist hasn’t been around. After explaining to them what I do as a hospitalist most patients are perfectly happy with the care they receive from me.

The failure of patients to understand what I do is not their fault. It’s a failure of internists and our specialty societies to market our subspecialty to the lay public and to help them understand exactly what it is we do as internists. Patients should want an internist managing their illness. They should want a hospitalist leading their ship as the full service crew. They should demand it.

This is not primary care. This is internal medicine. What is an internist? An internist is not a primary care doctor. An internist is the doctor’s doctor. Just ask for us by name.

COPD affects independence and survival in the general population, but it is unknown to which extent this conclusion applies to elderly people with mild disease. The aim of this study was to verify whether mild COPD, defined according to different classification systems (ATS/ERS, BTS, GOLD) impacts independence and survival in elderly (aged 65 to 74 years) or very elderly (aged 75 years or older) patients.

Methods: We used data coming from the Respiratory Health in the Elderly study and compared the differences between the classification systems with regards to personal capabilities and 5-years survival, focusing on the mild stage of COPD.

Results: We analyzed data from 1,159 patients (49% women) with a mean age of 73.2 years. One third of participants were 75 years or older. Mild COPD, whichever was its definition, was not associated with worse personal capabilities or increased mortality after adjustment for potential confounders in both age groups.

Conclusions: Mild COPD may not affect survival or personal independence of patients over 65 years of age if the reference group consists of patients with a comparable burden of non respiratory diseases.

Comorbidity and age itself likely are main determinants of both outcomes.

(Editor’s note: While this study was conducted by sports’ participants the reported benefit of respiratory muscle training was interesting.) Daily breathing exercises for six weeks freed more oxygen for other muscles by cutting down on the amount required by breathing or inspiratory muscles during exercise. Louise Turner, researcher in kinesiology at the Indiana University, said just the act of breathing during an endurance activity such as running, swimming or cycling, performed at maximum intensity, can account for 10 to 15 percent of an athlete’s total oxygen consumption. ‘This study helps to provide further insight into the potential mechanisms responsible for the improved whole-body endurance performance previously reported following IMT (inspiratory muscle training),’ she said.

IMT involves the use of a hand-held device that provides resistance as one inhales through it, requiring greater use of inspiratory muscles. For half of the study participants, the IMT device was set to a level that provided resistance as the subjects took a fast forceful breath in. For six weeks they took 30 breaths at this setting twice a day. The cyclists in the control group did the same exercises with the IMT adjusted to a minimal level. After six weeks, when the study participants mimicked the breathing required for low, moderate and maximum intensity activities, the inspiratory muscles required around one percent less oxygen during the low intensity exercise and required 3 to 4 percent less during the high intensity exercise. Muscles need oxygen to produce energy. Turner’s research also is looking at the next component of this equation, whether more oxygen is actually available to other muscles, particularly those in the legs, because less oxygen is being used by the breathing muscles, says an Indiana University release.

IMT has been used as an intervention in pulmonary diseases and conditions, such as asthma, COPD cystic fibrosis, and also is marketed as a means for improving athletic performance in cyclists, runners and swimmers. Turner presented her study at the American College of Sports Medicine annual meeting.

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.

Three times as many women with advanced lung cancer were alive and had no progression of their cancer 12 months after taking the drug erlotinib (also known as Tarceva) compared to those who did not receive the drug according to new data being presented at the ASCO1 conference. The randomised trial - the largest of its kind - followed 670 UK men and women with advanced NSCLC, most of whom who were too ill to have standard chemotherapy treatment. More than half of patients were older than 77 years.

Nearly half of the 39, 750 UK lung cancer patients are estimated to be in this category for which there is little effective treatment, although the benefit from erlotinib was greatest in women.

Erlotinib targets a protein on the surface of lung cancer cells called EGFR. The drug interferes with cell division and stops the cancer cells growing. “Erlotinib should be recommended for women with NSCLC who are unsuitable for first-line chemotherapy.” Source: Cancer Research UK

CHICAGO – The targeted agent erlotinib (Tarceva) prolonged survival by 26% in older women with advanced non-small cell lung cancer but did not benefit men with the disease, a researcher said here. Full story

Continuous positive airway pressure therapy helps restore memory consolidation in adults with obstructive sleep apnea, suggests a research abstract presented in San Antonio, Texas, at SLEEP 2010, the 24th annual meeting of the Associated Professional Sleep Societies LLC. Results indicate that OSA patients being treated with CPAP therapy outperformed untreated OSA patients on an overnight picture memory consolidation task, suggesting that CPAP is effective at recouping memory abilities that are impaired by OSA. CPAP patients correctly identified more photographs after one night of sleep.

The researchers also made the intriguing discovery that OSA patients who were using CPAP therapy performed better on the memory task than a control group of people who did not have OSA. This important finding could provide direction for future research to study the effect of CPAP therapy on brain function and memory processes. The study involved a preliminary sample of 135 adults between the ages of 33 and 65 years who were divided into three groups.

San Antonio Long-term continuous positive airway pressure (CPAP) treatment is likely to prevent the development of cardiomyopathy and congestive heart failure in patients with severe obstructive sleep apnea, researchers found. Full story

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.

By Mike DeDoncker, GateHouse News Service: Long time COPD Support Member, Harry Brunner, a smoker for 50 years, gives an interview to The Aledo Times Record.

Harry Brunner says it takes him two days to do things another person can do in one. Brunner, a two-and-a-half-packs-a-day smoker for 20 years, lays the blame on his COPD chronic bronchitis with emphysema. Brunner said he considers himself a “medium” COPD patient because he doesn’t need oxygen therapy, but said his shortness of breath forces him to pace himself during two of his favorite pastimes working in his yard and playing golf. It also is responsible for Brunner’s high blood pressure and one of the worst winters he’s ever spent.

“I’m susceptible mostly to pneumonia,” said Brunner, who is in his 70s. “I had pneumonia this past February, and I was in the hospital for six days and then I had to go to a nursing home for five weeks. I’m also doing pulmonary rehabilitation, and that’s from the pneumonia also. That’s the worst I’ve ever had it.”

COPD is a progressive disease that develops slowly and makes it hard to breathe because air passages in the lungs become abnormally narrowed and clogged with mucus. Brunner takes five medications a day for COPD and two for the high blood pressure, one of which is a beta-blocker. Like most patients, Brunner didn’t suspect bronchitis or emphysema when he went to see his doctor in the late 1990s. He said he doesn’t recall being noticeably short of breath back then, either.

Dr. Jon Michel, a pulmonologist, intensivist and sleep doctor in the Heart Hospital at SwedishAmerican, said COPD is the fourth leading cause of death in the United States and is expected to become the third leading cause in the next five to 10 years. Because it is highly preventable and treatable, Michel said, it is frustrating when patients go undiagnosed or are diagnosed too late.

“I have many patients,” Michel said, “that feel their shortness of breath is due to getting older, getting heavier, being sedentary or being out of shape. The answer is that, oftentimes, if you are short of breath you could have COPD so it’s very important to bring up the concept with your doctor, get tested for it and get treated for it early.” He said a simple test in which the patient holds the tube of a measuring device called a spirometer in their mouth, inhales as much air as possible, and then exhales forcefully into the spirometer is the first step in diagnosing COPD.

Brunner said he quit smoking within two years of being diagnosed and said, “If I could tell someone with COPD one other thing, it would be to lose weight. I’ve lost 26 pounds since January and the reason is simple. It’s just easier to breathe.”

COPD patients often develop heart problems that, as with Brunner, may be treated with beta blockers. But doctors also may avoid beta blockers because of concerns about causing bronchospasms in the lungs.

A report in the May 24 issue of Archives of Internal Medicine, a part of the Journal of the American Medical Association, suggests that COPD patients may have fewer respiratory flare-ups and longer survival if they take beta blocker medications. The report and an accompanying editorial say more research is needed on the subject, but the editorial adds that the report “provides a rationale for the practicing clinicians to use beta blockers cautiously in their patients with COPD who also have a coexisting cardiovascular condition for which a beta-blocker is required.”

The Environmental Protection Agency is tightening health standards for sulfur dioxide emissions from power plants and other industrial sources. The agency said that the new standard, adopted under the Clean Air Act, would prevent 2,300 to 5,900 premature deaths and 54,000 asthma attacks a year. Sulfur dioxide is a major element of exhaust from coal-burning power plants and a component of acid rain. It has been linked to many breathing problems, including asthma, emphysema and bronchitis.

The new rule calls for concentrations of no more than 75 parts per billion of sulfur dioxide, measured hourly. The current standard is 140 parts per billion, averaged over 24 hours.

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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

National geographic free trial games.

Online gear games
Free Shockwave gear games and puzzles

For those who want to figure it out here’s some free challenger games from Top Gear.

Until next Friday,
Joan Costello, Editor

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