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Friday’s COPD Newsletter from COPD Support, Inc.

Posted Nov 05 2010 2:10pm

newspaper12
Volume 10, Issue 48
November 5, 2010
Richard D. Martin, Editor

Atrial fibrillation (AF) is the most common form of cardiac arrhythmia (abnormal heart rhythm). According to Wikipedia, it involves the two upper chambers of the heart (atria), that quiver (fibrillate) instead of producing a coordinated contraction. Terry, a COPD-Support member from Illinois, shares her story about recently being rushed to the hospital by ambulance when her heart rate reached 165. She was diagnosed with AF and told that it was common for people with COPD to have this condition. Shortly after her episode, she posted a message about her experience and asked if others had heard of a connection between AF and COPD. As a follow up to her post, a number of members quickly shared they too have AF. It turns out, what Terry was told appears to be true; people with COPD are at higher risk of AF.

The AF and COPD Connection
In a research article from 2003, published in the European Respiratory Journal, Danish researchers report that people with reduced lung function are twice as likely to develop AF than people with normal lung function. The researchers followed 13,400 people over a period of 13 years, and they explain that COPD is related to other cardiac conditions besides AF. Cor pulmonale and ischaemic (or ischemic) heart disease are two examples. Cor pulmonale, according to Wikipedia, is an enlargement of the right ventricle of the heart due to high blood pressure in the lungs, and ichaemic heart disease is a reduced supply of blood to the heart muscle. These conditions can lead to arrhythmia (AF is just one type of arrhythmia or abnormal heart beat). The investigators recommend that COPD patients be checked for AF annually. They say: “In conclusion, this study indicates that reduced forced expiratory volume in one second % predicted [often expressed as FEV1] is an independent predictor of new onset atrial fibrillation. Since atrial fibrillation, if untreated, causes high morbidity from stroke and is associated with increased mortality, this indicates the importance of routine electrocardiograms in patients with chronic obstructive pulmonary disease.”
http://tinyurl.com/292wrhc

Causes of Atrial Fibrillation
COPD is not the only risk factor in the development of AF. According to the National Institutes of Health (NIH), AF can also be triggered by thyroid dysfunction, heart disease or alcohol use. They explain that COPD causes changes in blood gases and other abnormalities in pulmonary function, and add that changes in the flow of blood resulting from pulmonary hypertension can also lead to the development of AF. Treatment, they maintain, has to be well coordinated, because treatment of either COPD or atrial fibrillation might complicate treatment of the other condition. The NIH abstract can be found at http://tinyurl.com/28attqt

Diagnosis and Treatment of Atrial Fibrillation
MedicineNet has a comprehensive article on the diagnosis and treatment of AF. Although they point out there are sometimes no symptoms of AF, the most common symptom is palpitations. Other symptoms might include, but are not limited to: dizziness, fainting, weakness, fatigue, shortness of breath and chest pain. They list the many risk factors for developing AF (besides COPD), and also delve into the various ways in which AF can be diagnosed and treated. They address not only treating the underlying cause of the fibrillations, but also review medication to treat the symptoms and prevent further problems. Treatments can consist of medications to normalize heart rhythms, surgery (pacemakers and defibrillators), and medications such as blood thinners to decrease the risk of a stroke. The MedicineNet article can be found at http://tinyurl.com/22q3aec

- PREVIEW MEDICARE PART D PRESCRIPTION DRUG PLANS BEFORE ENROLLMENT STARTS
- USING SPACERS WITH AN HFA METERED DOSE INHALER (MDI)
- LIFETIME LIMITS FOR MEDICARE COVERAGE OF PULMONARY REHABILITATION
- HHS AWARDS $727 MILLION TO COMMUNITY HEALTH CENTERS
- GENE THERAPY FOR PULMONARY HYPERTENSION
- NEW RESEARCH ON PROTECTION FROM STREPTOCOCCUS PNEUMONIAE
- APPLICATIONS FOR NEW COPD DRUG ACLIDINIUM BROMIDE TO BE FILED IN 2011
- GLASSIA BEING LAUNCHED IN THE U.S. FOR ALPHA-1 ANTITRYPSIN DEFICIENCY (AATD)
- AERISEAL LUNG VOLUME REDUCTION
- STUDY FINDS INHALED CORTICOSTEROIDS INCREASE RISK OF DIABETES
- MISCELLANEOUS
TODAY’S 70 YEAR OLDS SMARTER THAN THEY USED TO BE
ONLINE IQ TEST
ADRENALINE GAMES FOR THE YOUNG AT HEART
COMPUTER SCREEN MAGNIFIERS REVIEWED

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SOURCES:
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.
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With an average of 33 Medicare Part D Prescription Drug Plans (PDPs) per state from which to choose, those of us with Medicare Part D plans might want to start reviewing options before open enrollment starts on November 15, 2010 for 2011 coverage. The Kaiser Family Foundation (not related to the insurance company) has published, “Medicare Part D Spotlight,” a review of Part D plans and key changes since the drug program began in 2006. Here are some highlights of their report regarding 2011:

* The average beneficiary has between 28 (Hawaii) and 38 (Pennsylvania/West Virginia) stand-alone PDPs from which to choose
* The overall number of plans available for 2011 is fewer than in 2010 and most companies offer fewer plans from which to choose
* Average premiums are expected to be $40.72 per monthan increase of about 10 percent from last year. However, some plans will cost less than they did last year
* Part D enrollees with incomes over $85,000 (for individuals) or $170,000 (for couples), will be notified that they have to pay more
* About 58 percent of PDPs have a deductible
* The doughnut hole starts after $2,840 is spent on drugs (the doughnut hole is the gap between the initial coverage limit and the beginning of catastrophic coverage)
* During the doughnut hole, enrollees will get 7 percent off generic drugs and 50 percent off brand-name drugs
* Some drug plans offer additional coverage during the doughnut hole, but coverage is usually rather limited
* After $4,550 is spent out of pocket, enrollees will emerge from the doughnut hole, receive catastrophic coverage, and pay 5 percent of total drug costs
* There are 332 plans that have no premiums (25 more than last year) for low-income subsidized enrollees
* Some low-income beneficiaries will be reassigned to new plans
* Most low-income beneficiaries will receive letters from the Centers for Medicare and Medicaid Services (CMS) or their state’s pharmacy assistance program regarding changes and actions they can take

For a more thorough review of the changes, see the Kaiser Family Foundation report (in pdf format) at http://tinyurl.com/38×9wwt

Once you’ve securely braced yourself, you might want to proceed to Medicare’s “Plan Finder” to start your research. The “Plan Finder” is patiently waiting for you at http://tinyurl.com/2c6o5fh

If you are planning to stay with your current PDP, don’t forget to check for changes in the formulary for 2011!

Pat, a member from upstate New York, reports that she was given a spacer for her inhaler while in the hospital, and that they are “highly praised” by all the respiratory therapists in her area. A spacer, sometimes called a holding chamber, is a device that attaches to your MDI (metered dose inhaler) and is placed between your MDI and your mouth. It helps diffuse the medication so you get more of the medication into your lungs and less of it hitting the back of your throat. It can also compensate, somewhat, for less than perfect timing or technique. Some medical professionals, including doctors, recommend them, and some do not. According to National Jewish Health, spacers were developed in the 1950s when CFCs (chlorofluorocarbons) were used as the propellant in MDIs. Within the last few years, however, CFC propellants have been banned in the United States and other countries to protect the ozone layer. They have been replaced with HFA (hydrofluoroalkane) propellants. When using an HFC inhaler, National Jewish Health recommends only using spacers that are anti-static. A few of the brands that state they are anti-static (or non-electrostatic) are Invacare’s AeroChamber Plus, Mohegan Aerochamber, and Vortex. There are others. If you use an MDI, check with your physician to see if he or she recommends using a spacer. If they do suggest using one, you might ask if they prefer one brand over another. Physicians sometimes have a supply in their office, and your spacer may be covered by your insurance. If purchasing retail, expect to pay around $18 U.S. plus shipping. Don’t forget to follow the manufacturer’s recommendations for cleaning your spacer. For information on the proper use of spacers, the following National Jewish Health website provides good information http://tinyurl.com/aswtds

CMS (The Centers for Medicare and Medicaid Services) has strict guidelines for coverage of pulmonary rehabilitation. This new (2010) coverage of pulmonary rehabilitation under Medicare Part B requires providers follow detailed protocols regarding individualized evaluations, treatment plans, delivery parameters, and documentation of services. Although providers will usually ensure all the required components are followed carefully (because they want to get paid), Medicare recipients need to be aware that they are only entitled to 36 sessions in their lifetime. An additional 36 sessions can be requested but are not guaranteed. Being aware of these lifetime limits might help Medicare recipients plan more wisely. You can find additional information on these CMS announcements:

The following October 2010 CMS short announcement (5 pages in pdf format) is the latest release (from CMS) concerning pulmonary rehabilitation and provides a good overview http://tinyurl.com/2eat2jp
This longer announcement, with more detail, dates from May 2010 (16 pages in pdf format), also includes proposed changes noted in red http://tinyurl.com/aswtds

Awards totaling $727 million will go to 143 community health centers across the United States, according to an announcement by the U.S. Department of Health and Human Services (HHS). Community health centers serve 19 million people, 40 percent of whom have no insurance. Charges for services are set according to income, and individuals are served regardless of their ability to pay. To locate a community health center in your area, please visit http://tinyurl.com/2a7g5l8
For the HHS announcement of the awards, see http://tinyurl.com/3an8h7d

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COMMERCIAL FREE: We do not accept any paid advertising. Any corporations, products, medicines (prescription or over the counter) mentioned in this newsletter are for informational purposes only and not to be construed as an endorsement or condemnation of same.
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Heart and Stroke Foundation of Canada researchers have made a major breakthrough in the diagnosis and treatment of pulmonary hypertension, a common complication of COPD. Pulmonary hypertension is an abnormally high blood pressure in the pulmonary arteries that carry blood from the heart to the lungs. It can result in an enlargement of the heart, and can be life-threatening. Researchers have discovered a protein that is present in individuals with pulmonary hypertension, and it exists in a greater level in individuals with more severe pulmonary hypertension. According to researcher Dr. Bonnet, “We have found that using gene therapy to inhibit the inappropriate activation of this protein is a novel and effective therapy that can reverse the disease altogether.” It is still being studied, but you can read all about it at http://tinyurl.com/23ybg9r

From the American Society for Microbiology comes this study that finds that flagellin, a protein, can stimulate a natural response to streptococcal pneumonia, thereby increasing the resistance to this infection that is often a cause of pneumonia in infants and older people. This study has only been carried out in mice. Read about it at http://tinyurl.com/26onxpl

Two drug companies working together on a new compound aclidinium bromide have announced they will file applications for this new COPD drug in 2011. Aclidinium bromide has been touted as a replacement for tiotropium (Spiriva). Forest Labs in the United States and Almirall, the drug company with rights in the rest of the world, are moving forward even though they are not totally pleased with the outcome of the most recent trial of this twice daily medication. Here is a summary from the Genetic Engineering and Biotechnology News http://tinyurl.com/22uue4j

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MEDICAL DECISIONS. 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 pulmonologist. 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.
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GLASSIA BEING LAUNCHED IN THE U.S. FOR ALPHA-1 ANTITRYPSIN DEFICIENCY (AATD)

Drug manufacturer Baxter International Inc. announces that its drug Glassia will be launched commercially in the United States. Glassia was approved in July, 2010 by the U.S. Food and Drug Administration. It is an alpha-1 proteinase inhibitor for therapy of alpha-1 antitrypsin deficiency (AATD). AATD is a genetic condition that affects the production of alpha1-antitrypsin that can result in emphysema and liver disease. Glassia is the first available ready-to-use liquid alpha1-proteinase inhibitor to be marketed.
http://tinyurl.com/23w48z2

Aeris Therapeutics receives the CE Mark approval for its system of lung volume reduction. The CE Mark certifies that the product has met European Union consumer health, safety, and environmental requirements. It allows the company to move towards commercialization of their product. Briefly, their unique lung reduction procedure is accomplished by a minimally invasive procedure that delivers a proprietary foam sealant to targeted areas of the lung. The foam sealant collapses the targeted area(s) of the lungs, thereby allowing healthier areas of the lungs to expand. The news article can be found on The Medical News’ website at http://tinyurl.com/2943p5l
A full description of the procedure can be found on the manufacturer’s website http://tinyurl.com/2e6wvvh

Although it has been widely accepted that oral steroids increase the risk of developing diabetes, researchers at the Jewish General Hospital’s Lady Davis Institute for Medical Research in Montreal have found that inhaled corticosteroids also increase the risk as well. The article states, “They determined that inhaled corticosteroids increased the rate of onset of diabetes from 14 people per 1000 to 19 per 1000, or 34 percent, every year of use. In other words, 5 additional people for every 1000 users in the study - people who otherwise would not have been affected - developed diabetes from the use of the drug.” For more information, see http://tinyurl.com/2fc7ugj

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JOIN US?
Subscription to this Newsletter is free and we hope that it serves your needs. For more Newsletter information, go to: http://copd-support.com/signup-news.html

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: http://copd-support.com/membership.html
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TODAY’S 70 YEAR OLDS ARE SMARTER THAN THEY USED TO BE
This Swedish study finds that 70 year olds are doing better on IQ tests than in the past. Let’s hope these findings hold true outside of Sweden!
http://tinyurl.com/2er6goc

ONLINE IQ TEST
Feeling a bit smug about being smarter than your ancestors were a mere generation ago? Well, this should bring you back down to earth! This IQ test is not one of those silly types we often encounter; it actually seems to measure at least some reasoning ability. A good score, however, will probably not get you admitted to Mensa, but give it a shot anyway at http://tinyurl.com/2frzwep

ADRENALINE GAMES FOR THE YOUNG AT HEART
These games will wake you up, or have you climbing the walls!
http://tinyurl.com/yt4mko

COMPUTER SCREEN MAGNIFIERS REVIEWED
Old computers, small screens, “floaters,” cataracts, macular degeneration…the list goes on, and many of us have problems reading our computer screens. If you look in the “accessories” file on your computer, and then in the subfiles sometimes named “ease of access” or “accessibility tools,” you may discover ways to increase the size of print and images on your screen, sometimes with the use of a built in “magnifying glass.” Perhaps you even have a program on your computer, of which you are unaware, that will read print for you. If solutions built into your computer don’t work, you might want to consider an adaptive device for your computer. This site reviews screen magnifiers http://tinyurl.com/bhqu3l

For comments and questions, or to contact Richard D. Martin, please send your email to: newsletter@COPD-Support.com

Proofreading provided by: Jennifer, B.C. Canada

Until next Friday,

Richard D. Martin, Editor


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