“We followed 1,664 COPD patients recruited from five pulmonary clinics in the United States and Spain for a median of 51 months,” said lead author Miguel Divo, MD, a physician in the Pulmonary and Critical Division at Brigham and Women’s Hospital and Instructor in Medicine at Harvard Medical School. “Among the 79 comorbidites we observed in these patients, 12 were significantly and independently associated with an increased risk of death.”

The 12 comorbidities with the strongest association with an increased risk for death were lung cancer, pancreatic cancer, esophageal cancer, breast cancer, pulmonary fibrosis, atrial fibrillation/flutter, congestive heart failure, coronary artery disease, gastric/duodenal ulcers, liver cirrhosis, diabetes with neuropathy and anxiety.

“We used these 12 comorbidities to develop a new comorbidity risk index (the COPD specific CO-morbidity Test, or COTE),” Dr. Divo said. “After adjustment for age, gender, race, and BODE (Body Mass Index; FEV1; Dyspnea and Exercise capacity) index, an increased COTE index was a significant predictor of death in our cohort of COPD patients.”

The findings were published online ahead of print publication in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

The average number of comorbidities per subject in the cohort overall was 6.0 (±3.5), and the average number of comorbidities was significantly higher among non-survivors (6.5 ±3.8) compared with survivors (5.8 ±3.3).

“These easily identifiable comorbidities could be screened by health care providers caring for COPD patients, as there may be effective interventions that may help decrease the risk of death,” Dr. Divo said.

The study had some limitations. The proportion of women included in the study (11 percent) was low. Some patients were excluded at baseline because of comorbidities that might cause early death, including a recent myocardial infarction, severe congestive heart failure, and untreated cancer. Finally, patients were recruited from specialty clinics, and so might not represent all COPD patients.

“In this study we have confirmed earlier observations that patients with COPD frequently suffer from comorbidities, and have shown that 12 specific comorbidities are associated with an increased mortality risk in these patients,” Dr. Divo concluded. “The simple comorbidity risk index we developed based on these 12 comorbidities complements the BODE index and can be used to help predict an increased risk of death in COPD patients in both clinical and research settings.”

To read the article in full, please visit: http://www.thoracic.org/media/press-releases/resources/divo.pdf.
About the American Journal of Respiratory and Critical Care Medicine:

With an impact factor of 10.191, the AJRRCM is a peer-reviewed journal published by the American Thoracic Society. It aims to publish the most innovative science and the highest quality reviews, practice guidelines and statements in the pulmonary, critical care and sleep-related fields.

Founded in 1905, the American Thoracic Society is the world’s leading medical association dedicated to advancing pulmonary, critical care and sleep medicine. The Society’s 15,000 members prevent and fight respiratory disease around the globe through research, education, patient care and advocacy.

Source: American Thoracic Society (ATS)

COPD patients in particular should make sure they are staying on top of the best way to keep the air in their homes clean from allergens, irritants and chemicals.

Allergens such as dust mites are common on furniture and beds, and can cause lung damage if not dealt with regularly. In the bedrooms, keep pillows to a minimum, and wash your linens weekly. These items are significant dust collectors, as are rugs and carpets. If you have carpets, vacuum them regularly.

For overall home air quality, have the air ducts in your home cleared. This can help prevent stirring up more dirt and dust. Also, an air filtration system that circulates and cleans the air can make a tremendous difference in lung health.

Be careful when using household cleaning and other similar products. These chemicals can cause harm to your lungs if inhaled. Products like paints, varnishes, wax, cleaning and cosmetic supplies should be kept to a minimum, and bought in limited quantities.

Most importantly, cigarette smoke is a major irritant contributor to home air quality problems. For someone living with COPD, it is imperative that no one smoke in your home – ever.

The study shows that COPD appears to be partly driven by the action of immune cells circulating in the blood entering into the lungs. The fact that this process begins in blood vessels in the center of the lungs will open new doors to researchers.

Researchers were hoping to find out where the inflammation that destroys the balance of cells lining lung airways begins. Tests on rats showed that tobacco-smoke exposure causes neutrophil white blood cells to migrate out of bronchial blood vessels and accumulate in the lung tissues. When the cells accumulate, they release enzymes that kill other cells and accelerate inflammation.

Researchers hope new drugs can be developed to target the inflammatory process and reduce inflammation.

As temperatures rise, it’s important to keep your lungs and body from getting heat fatigue. Extreme temperatures can cause stress to the entire body as it works to keep a normal temperature. With COPD, shortness of breath can increase quickly and cause a rapid decrease in energy if you do not keep cool.

Furthermore, extreme temperatures can lead to bronchospasm, where the air passages from the lungs contract, causing difficulty in breathing and shortness of breath.

The CDC reports over 8,000 heat-related deaths in the U.S. since 1979, many of which could have been prevented with proper precautions taken.

This summer, doctors recommend the obvious for COPD sufferers:  drink plenty of fluids, wear sunscreen and stay indoors as much as possible.

It’s just as important to plan your day around opportunities to cool off. Running errands in the morning or at night can help you avoid the brutal summer heat, and finding that shady parking spot is worth a bit of extra effort. Make sure you are close enough to an air-conditioned structure in case you experience shortness of breath.

Staying in constant contact with loved ones also helps keep your schedule intact and allows friends and family to know immediately if something may be wrong.

Even short periods of extreme heat can lead to COPD complications and even death. Staying cool this summer is the most important thing you can do to keep yourself safe.

There are many reasons for not following the doctor’s instructions. For example, if you’re using multiple medications, it’s easy to lose track. In fact, you might be surprised to learn that the typical person with COPD takes an average of six different medications, three or four of which may be administered via inhaler. In many cases, the need for multiple medications increases the likelihood that something may fall through the cracks.

Why so many prescriptions? COPD and asthma are complex diseases, often requiring numerous medications from different drug classes, such as long- and short-acting bronchodilators and inhaled corticosteroids. Each class of drug attacks the underlying causes of lung disease in a slightly different way, and the drugs often work better, or in some cases more safely, when used together.

Potential solution: Switch to a combination product.

If you’re taking a long-acting beta2 agonist — formoterol (Foradil) or salmeterol (Serevent) — for asthma, it must be taken along with a controller medication, such as a corticosteroid, to reduce the risk of asthma-related death. Combination therapy may also be appropriate for some people with COPD. Although beta2 agonists and inhaled steroids may be prescribed individually, two combination products are also available: Advair, which contains salmeterol and the steroid fluticasone, and Symbicort, which contains formoterol and the steroid budesonide.
Alternatively, ask your doctor if a once-daily medication is an option. Currently, the only once-a-day bronchodilator available is tiotropium (Spiriva). Although it has been approved by the Food and Drug Administration (FDA) for the treatment of COPD, it has not been approved for asthma. Mometasone (Asmanex), the only FDA-approved once-daily inhaled corticosteroid, is approved for maintenance treatment of asthma.

Source: http://www.johnshopkinshealthalerts.com/eletter/profile/22/83391.html?ET=johnshopkins:e83391:530147a:&st=email&s=ELH_120510_001

The Food and Drug Administration has approved roflumilast (Daliresp), a pill taken daily to decrease the frequency of flare-ups or worsening of symptoms from severe chronic COPD.

Daliresp, the first in a new drug class for the treatment of COPD, is an inhibitor of an enzyme called phosphodiesterase type 4 (PDE-4). It is indicated for people with severe COPD to treat the symptoms of cough and excess mucus linked to bronchitis. It is not intended to treat emphysema.

The safety and effectiveness of Daliresp were demonstrated in two Phase 3 clinical studies that included more than 1,500 patients ages 40 and older who received the medication. Those treated had a history of COPD associated with chronic bronchitis and had experienced an exacerbation of COPD during the 12 months prior to beginning treatment.

The most common side effects reported by those receiving Daliresp included diarrhea, nausea, headache, insomnia, back pain, decreased appetite and dizziness. Other potential side effects include changes in mood, thinking or behavior, and unexplained weight loss.

Daliresp should be considered when first-line therapies for COPD are not tolerated or are not providing adequate benefit.

Source: John Hopkins Health Alerts

MyPlate shows the amount of space each food group should take up on your plate during a typical meal. Gone are the frustrating attempts to figure out ounces of chicken, cups of rice or “servings” of vegetables. Visualizing healthy food choices in a way that’s more practical and familiar should make it far easier to plan nutritious meals.

The USDA offers the following recommendations to “build your plate”:
•Half of your plate should be fruits and vegetables.
•The other half should be divided between grains and proteins. At least half of your grains should be whole grains.
•Proteins should come from a variety of sources. For instance, choose seafood twice a week, replace meat with beans some days and go for small portions of lean meat and poultry.
•Switch to skim or 1 percent milk and other low-fat dairy products, such as cheese and yogurt.
•Reduce your salt intake by checking food labels and choosing foods with the lowest sodium. Aim for less than 1,500 milligrams of sodium daily.
•Avoid foods and beverages containing added sugar. Drink water and choose fruit for dessert.
•Save foods high in saturated fats or solid fats, such as cakes, pizza and hot dogs, as an occasional treat.

The USDA stresses that a key component of good nutrition is to enjoy your food. But make sure when you do so to avoid oversized portions. Use a smaller plate and a smaller glass to make your serving sizes appear larger.

Other tips include:
•Pay attention to the calorie count. When dining out, check the calorie counts posted on the menu.
•Stop eating when you’re satisfied, before you’re uncomfortably full.
•Increase the amount of calories you expend through exercise. Exercise is still key to weight control.
•Find out your own, personal daily calorie limit and discover meal planners, recipes, tip sheets and other resources at ChooseMyPlate.gov.

Source: http://www.johnshopkinshealthalerts.com/alerts/healthy_living/MyPlate-food-guidance_6123-1.html

The study, by the Centre for Research in Environmental Epidemiology in Spain and published in the European Respiratory Journal, shows that any more than a slice of ham or so per day can lead to more instances that could send people back to the hospital.

In the study of 274 people with COPD, participants ate 23 grams of cured meat, or the equivalent to one slice of ham, per day. During the two-year follow-up period, about 35% of those studied had at least one hospital readmission. The study authors suggest that nitrites included in cured meats can damage lung tissue, but other researchers have argued that the high levels of salt in cured meats could be driving the results.

Because the results are not definitive, most researchers agree that more study into the affect of cured meats on COPD patients is needed.