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 COPD Support News June 18,2010
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Posted - Jun 18 2010 :  07:34:14 AM  Show Profile  Reply with Quote
Volume 10, Issue 29
June 18, 2010

James Thompson, MD, Board Certified Allergist and Asthma Specialist Twenty five years ago intranasal steroids (INS) were ushered into the market as a novel approach to treating allergic rhinitis. Nasalid (flunisolide) led the way. Vancenase (Beclomethasone) and Nasacort (Triamcinolone) nasal sprays soon followed. These sprays offered a class of topically active steroids that, unlike previous nasal steroid sprays, had minimal systemic impact. This means the majority of the spray worked on the inner surface of the nose with very little absorption into blood vessels.

At about the same time long-acting, non-drowsy, oral antihistamines came on the scene like gangbusters and immediately appealed to seasonal allergy sufferers nationwide. The sedation and fatigue experienced by so many people after taking older forms of antihistamines (Benadryl, for example) set the table for this new generation of allergy medication. The impact of terfenadine (brand name Seldane and Seldane -D) was unmatched by many previous, blockbuster drugs. But the jubilation over terfenadine didn't last long. Seldane was removed from the market in 1998 because of the potential for dangerous heart rhythm disturbances, especially when taken with certain other drugs or foods. Since that time, safer and more effective antihistamines have emerged which continue to be used, for example: loratadine (Claritin), cetirizine, (Zyrtec), fexofenadine (Allegra) and levocetirizine (Xyzal). Fexofenadine and levocetirazine require a prescription.

Present Day Dilemma
Allergists continue to see many adults and children who fail to respond to antihistamines (with or without decongestant) and INS. Many of these patients will be offered a course of allergy shots (if allergic) but this treatment often takes several months to work.

Three Nasal Sprays In A New Class
Three nasal sprays unique in mechanism of action (how they work) compared to the INS are: Astelin (azelastine HCL), Patanase (olopatadine HCL) and Astepro (a new formulation of azelastine).

These nasal sprays are topically effective antihistamines. They are in the same class as the oral antihistamine medications that have been around for decades. They block histamine, which is naturally released when an allergic person breathes in an allergy trigger (such as ragweed or grass pollen). Interestingly, their impact inside the nose goes beyond drying up drainage and reducing itching and sneezing. Nasal congestion may be reduced within 30 to 40 minutes. The nasal decongestant action has a faster onset of action compared to intranasal steroid sprays. Furthermore, these newer sprays can be used on an as needed basis, unlike the majority of INS sprays. INS sprays work more effectively when regularly used.

Potential adverse affects include nasal burning, nose bleeding, headache, and throat irritation (similar to INS). But unlike INS, sedation is also possible, although experienced by a small percentage of people.


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.

By Denise Mann, WebMD Health News: More than 90% of acutely ill people who are hospitalized for COPD receive high doses of IV steroids, even though lower-dose oral steroids may be just as effective, a study shows. The findings appear in the June 16 issue of The Journal of the American Medical Association.

COPD is a progressive, debilitating lung disease that makes it increasingly hard to breathe. Symptoms include coughing, wheezing, shortness of breath, and chest tightness. COPD is the fourth leading cause of death in the U.S., and one of the 10 leading causes of hospitalizations.

"In sharp contrast to the leading clinical guidelines, the vast majority of patients hospitalized for acute exacerbation of COPD were initially treated with high doses of corticosteroids administered intravenously," conclude study researchers led by Peter K. Lindenauer, MD, of Baystate Medical Center in Springfield, Mass. This practice is not associated with "any measurable benefit and at the same time exposes patients to the risks and inconvenience of an intravenous line, potentially unnecessarily high doses of steroids, greater hospital costs, and longer lengths of stay." Steroids are considered to be a beneficial way to treat acute exacerbations of COPD, but the best dosages and the best way to deliver them is not fully understood. Most clinical guidelines recommend treatment with 20 milligrams to 60 milligrams of prednisone (an oral steroid) once daily.

Researchers looked at how steroids were used among people hospitalized for COPD at more than 400 hospitals during 2006 and 2007. They then compared outcomes among patients treated with oral steroids and patients who received higher doses of IV steroids during the first two days of their hospitalization for COPD.

Fully 92% of 79,985 patients were treated with high-dose IV steroids, compared with 8% who received oral steroids, the study shows. Overall, 1.4% of people treated with IV steroids died while they were hospitalized, compared with 1% of those who received oral steroids. Researchers also developed a composite measure or a combination of several outcomes that together indicate treatment failure. This composite measure included mechanical ventilation after day two and death in the hospital or readmission within 30 days after discharge. The researchers found that 10.9% of patients in the IV group failed treatment, compared with 10.3% of people in the oral steroid group. Patients treated with oral steroids also had shorter hospital stays and less cost associated with treatment, compared to
patients who received IV steroids.

Bigger is not always better when it comes to COPD treatment, says Neil Schachter, MD, a professor of pulmonary medicine and medical director of the respiratory care department at Mount Sinai Center in New York City. "IV steroids have no benefit over the less expensive oral steroids in terms of hospital stays and mortality," he says. When asked by WebMD if this study could change practice, Schachter says "while I don't think that this study will immediately change how doctors treat exacerbations, it certainly puts the spotlight on the need to refine criteria for IV steroid therapy."

"I use inhaled and oral steroids in the patients I see in my office," Schachter says. "If someone is in severe distress in my office, I might give them an injection of steroids to rapidly relieve symptoms, knowing that there could be a significant delay if they have to go home and obtain oral medication from a pharmacy. Many of the patients with a COPD exacerbation come through the emergency room where they are given IV steroids as a reflex."

He says that one of the presumed criteria for admission to the hospital is that they need IV treatment. "Once they are on IV steroids, there may be an inertia to switch to oral medication as the exacerbation is brought under control," he says, adding that most of these individuals are already on oral steroids when they arrive at the emergency room.

by Richard Quinn" A report in this month’s Journal of Hospital Medicine shows macrolide and quinolone antibiotics are associated with similar rates of treatment failure in acute exacerbation of chronic pulmonary disease (AECOPD). The lead author says the study could be a precursor to, say, an intrepid HM researcher working on a randomized trial of the antibiotics’ effectiveness. "It’s a perfect thing for hospitalists to study because they’re the ones treating it," says Michael Rothberg, MD, MPH, associate professor of medicine at Tufts University School of Medicine in Boston, and lead author of "Comparative Effectiveness of Macrolides and Quinolones for Patients Hospitalized with Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD)."

The retrospective cohort review reported that out of nearly 20,000 patients, 6,139 (31%) were treated initially with a macrolide and 13,469 (69%) with a quinolone. "Those who received macrolides had a lower risk of treatment failure (6.8% vs. 8.1%, p<0.01), a finding that was attenuated after multivariable adjustment (OR=0.89, 95% CI 0.78-1.01), and disappeared in a grouped-treatment analysis (OR=1.01, 95% CI 0.75-1.35)," the authors wrote. The study found no differences in adjusted length of stay or cost. However, antibiotic-associated diarrhea was more common with quinolones (1.2% vs. 0.6%, p<0.001).

Dr. Rothberg, who is affiliated with the Center for Quality of Care Research at Baystate Medical Center in Springfield, Mass., says the data, while a point in the right direction, should be viewed as a first step in doing more search to determine the best treatment for AECOPD.

"If you look at the guidelines, the recommendations are all over the map," Dr. Rothberg says. "This is really because there are no randomized trials in COPD patientsThere are so many unanswered questions. Theree’s been so much focus on pneumonia, heart failure, and acute myocardial infarction. COPD kind of has a dearth of research." Dr. Rothberg hopes to further that research via the COPD Outcomes-Based Network for Clinical Effectiveness & Research Translation (CONCERT), a team of physicians and researchers from centers around the country who are advocating for improvements to COPD treatment. Baystate is one of CONCERT’s outposts.

COMMERCIAL FREE: 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.

The trial is designed as a double-blind, placebo controlled, randomized, cross-over study comprising up to 60 non-smoking patients with moderate to severe COPD. Each subject will receive nebulized Bimosiamose solution or vehicle for 28 consecutive days twice daily in two subsequent periods according to a randomization plan and separated by a wash-out phase (cross-over). Co-alternative primary endpoints will be the difference of neutrophils counts and interleukin-8 levels in induced sputum following Bimosiamose and Placebo; secondary variables cover lung function parameters as well as cellular and non-cellular biomarkers. The study is conducted at 10 centers in Germany. "Inhaled Bimosiamose solution previously demonstrated to be safe and anti-inflammatory in short-term trials with
healthy subjects (ozone challenge) and in patients with Asthma and COPD."

In contrast to oral PDE4 inhibitors, Bimosiamose is given locally by inhalation, directly targeting the inflammation in the lung. In recent assessments from regulatory authorities (e.g. IQWiG) inhalative treatment is preferred towards oral treatment in COPD, since better efficacy and faster onset may be achieved with less systemic side effects. Results are expected for the second quarter of 2011.",1338768.html

Ingen filed two more provisional patents; one for its new IngenThermo drug product, and the other for its new cannula technology. The IngenThermo uses polymer-crystal technology to keep insulin and other glass vile drugs cool and safe. Ingen's engineering team is working on the tooling and molds to manufacture this new product using medical-grade polycarbonate as an insulating material, along with polymer-crystals. The new cannula technology involves the use of special materials that are embedded within the PVC of the nasal cannula. As oxygen flows, it will change the color of the cannula which would indicate a specific flow rate.

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 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.

One of the most common lung disorders in adults is COPD a term used to include chronic bronchitis and emphysema. Obstruction due to airway inflammation and excess mucus occurs in the airways of the lung (called bronchi and bronchioles), leading to decreased air flow. This ultimately results in decreased amounts of oxygen delivered to the body's tissues. In emphysema, there is also destruction of the alveoli (tiny sacs where oxygen and carbon dioxide exchange takes place). Emphysema and chronic bronchitis may both be present in an individual at the same time. COPD is one of the leading causes of death in developed nations and affects both men and women. Smoking is the cause of COPD in most cases and accounts for 80% to 90% of COPD-related deaths. The June 16, 2010, issue of JAMA includes an article about treatment of COPD.

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Let NASA send your face into space;
NASA launched the first Space Shuttle in 1981. It made manned space flight safer and more regular than ever. And various Space Shuttles have flown more than 130 missions since. But the Space Shuttle program is about to come to an end. There are only two launches left before the spacecraft are officially retired. And for now, NASA has no plans for another manned space program. This will truly be the end of an era. This is a bittersweet moment in history. But it's historic nonetheless. And NASA wants you to be a part of it. It wants you to upload a picture of your face to this site. Your picture will then be flown on one of the last Space Shuttle missions. When the Space Shuttle returns, return to this site. You can print off your very own Flight Certificate. The actual Mission Commander will sign this commemorative certificate. How cool is that?

FotoSketcherFotoSketcher is a 100% free program which can help you convert your digital photos into art, automatically. If you want to turn a portrait, the photograph of your house or a beautiful landscape into a painting, a sketch or a drawing then look no further, FotoSketcher will do the job in just a few secondsThanks to FotoSketcher you can create stunning images to make original gifts for your friends or relatives. Create birthday cards, season's greetings stationery or simply print your work of art and hang it on the wall. Different styles are available: pencil sketch, pen and ink drawing, various painting renderings. You can also improve your original photo with simple tools (enhance contrast, sharpen, simplify image, increase luminosity, color saturation etc...).

FotoSketcher is completely free and does not contain any adware, spyware or virus. It runs on any version of Microsoft Windows (sorry, no Mac version available). Go to download page:

Find the NudeDude: This is a cartoon...not X-rated...when you find the nude dude-click on him...Check out Mardi Gras or the beach.

7th space has a bunch of free games

A couple of clams were eating chocolate bars while two fish watched.

"Did you see that?" one fish said, as the clams finished their treat. "They didn't offer us a single bite!"
"What do you expect?" asked the other fish. "They're two shellfish."
Until next Friday,

Joan Costello, Editor

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Please keep in mind that all posts are from COPD patients / caregivers
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