Posted - Mar 28 2008 : 11:17:13 AM
| Volume 8, Issue 17
March 28, 2008
WHAT TO TAKE WHEN YOU'RE SICK
Matt Rourke/AP. When your persnickety, purist doctor won't prescribe antibiotics for your cold/flu/sinus infection/ear infection/bronchitis, what should you take?
Whatever makes you comfortable while your immune system fights off the virus, which can take a couple of weeks. There are more than 800 over-the-counter cold remedies, and some of them have gone out of favor a bit, having been found not very effective, or worse. The cough suppressant dextromethorphan is being used by some kids to get high (turning them into "Robotards"--named after one of the more popular DM-containing products, Robitussin). And the popular decongestant sudefedrin is now being used to make methamphetamine. Guaifenesin is a useful treatment for cold/flu/sinus problems. It will thin out the mucus and encourage drainage and expectoration. Guaifenesin is in many over-the-counter products. The highest dose is in Mucinex.
Discussing this mundane subject of how to treat a cold at a recent medical conference, Dr. William J. Heuston of the Medical University of South Carolina veered toward the alternative. He recommended a saline nasal spray/rinse administered using a Neti pot or sprayer (but with a 3 percent solution instead of the usual 0.9 percent). He also noted that some studies have shown benefit from the herb echinacea, vitamin C and zinc lozenges. Another natural remedy is suggested by a study from Penn State College of Medicine: It showed the eons-old treatment of buckwheat honey to be superior to dextromethorphan as a cough suppressant. So there's a traditional, wholesome, safe alternative. One other pearl from Dr. Heuston is to "give your patients a realistic expectation" and let them know that after a bout of bronchitis, it is normal for the cough to linger for weeks or even months--especially if you are a smoker or work in a cold environment.
ALSO IN THIS ISSUE
-NEED TO KNOW
-SEWER GAS PUTS HEART AND LUNGS ON HOLD
-MECHANICAL VENTILATION WEAKENS THE LUNGS
-YOUR NOSE: THE GUARDIAN OF YOUR LUNGS
-EARLY CANCER STUDY FOUND FUNDED BY TOBACCO MONEY
-INHALED CORTISONE SPRAYS EASE SYMPTOMS OF COPD
-EXTENDRYL AND ENTENDRYL GCP
-SUN PHARMA SECURES FDA OK FOR GENERIC BENZONATATE CAPSULES
-NEW INHALER TO RESULT IN 40% COST SAVING: CIPLA
-SPRING CLEANING TIPS FOR ALLERGY SUFFERERS
-DIY MOLD REMOVAL
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.
NEED TO KNOW
From the UK: Q. Do GPs everywhere have to refer for a consultant opinion to decide which COPD patients should have home oxygen? How well has the home oxygen service bedded in?
A: Home oxygen therapy usually refers to the provision of long-term oxygen therapy (LTOT) at 15 hours per day for patients with evidence of arterial hypoxaemia - that is PaO2 less than 7.3kPa or between 7.3kPa and 8kPa in the presence of nocturnal hypoxia, pulmonary hypertension or secondary polycythaemia3. So all patients who are potential candidates for LTOT must have a clear diagnosis with arterial blood gas measurements performed. Oximetry is useful as screening for hypoxaemia, but not accurate enough for LTOT prescription and does not measure arterial carbon dioxide.
Q: How reliable an indicator of bacterial infection is sputum color?
A: It's broadly correct that patients with purulent sputum - either when stable or at exacerbation - are more likely to have bacterial infection, commonly Haemophilus influenzae or Streptococcus pneumoniae. So if an exacerbation is accompanied by clear sputum, antibiotics are not necessary but they are recommended for exacerbations with increase in sputum production and/or purulent sputum.
Q: What proportion of COPD patients will need to remain on a low maintenance dose of steroids?
A: After an exacerbation, most patients recover their lung function to their usual stable state within 14 days. However, some patients can develop more prolonged symptoms and even another or recurrent exacerbation. In this situation, treat first with another course of oral steroids with or without antibiotics as indicated.
Professor Wisia Wedzicha is professor of respiratory medicine at the Royal Free and University College Medical School, London Competing interests: Professor Wedzicha has received funding for research and honoraria for lectures and/or advisory boards from GlaxoSmithKline, Astra Zeneca and Boehringer Ingelheim.
More detailed answers to the above and other questions at:
SEWER GAS PUTS HEART AND LUNGS ON HOLD
By Crystal Phend. A whiff of the rotten-egg scented hydrogen sulfide gas may make people hold their breath, but longer, controlled doses could be used to put the lungs, heart, and metabolism into hibernation, researchers found. (...these findings came from an animal study and will need further confirmation before the gas could be used clinically. ) Low doses of hydrogen sulfide dropped the respiratory, metabolic, and heart rate of mice without reducing oxygen levels or blood pressure, reported Warren M. Zapol, M.D., of Massachusetts General Hospital, and colleagues in the April 2008 issue of the journal Anesthesiology.
Hydrogen sulfide, emitted by sewers, volcanoes, sulfur springs, and various sulfur-containing products, can be toxic at high concentrations. However, these findings suggest controlled doses could be used to preserve organ function when oxygen supply is limited, such as after a traumatic injury or cardiac arrest, the researchers said. Previous animal studies showed hydrogen sulfide lowered body temperature and metabolic rate and improved survival of mice with acute hypoxia.
As in the previous study, breathing the gas at room temperature progressively dropped body temperature of the mice...During exposure, the mice gradually became less active until they appeared asleep by three hours. However, they responded to tapping on their cage and painful stimulus, which suggested they were not anesthetized. The reason for these effects was likely a slowing of metabolic responses rather than changes in arterial blood gas levels or electrolyte concentrations, which were unaffected, the researchers said. Whole body carbon dioxide production and oxygen consumption rates fell significantly within 10 minutes of inhalation which preceded the reduction in body temperature. Less substantial but still significant reductions were seen even when body temperature was held constant by keeping mice in a hot environment . These effects were reversible by stopping hydrogen sulfide exposure. The findings offer "exciting" possibilities for treatment, but further study is needed. One important question is whether intravenous use would be required for humans or larger animals to prevent lung toxicity. (The study was supported in part by grants from the NIH and from Linde Gas Therapeutics through the Gas Enabled Medical Innovations Fund. The authors made no financial disclosures.)
MECHANICAL VENTILATION WEAKENS THE LUNGS
By Crystal Phend. A patient's diaphragm may atrophy quickly when mechanical ventilation takes all the pressure off the lungs, researchers found. Slow-twitch fibers used for breathing and fast-twitch fibers used for coughing shrank by more than half after a prolonged period on full ventilatory support, reported Sanford Levine, M.D., of the University of Pennsylvania, and colleagues in the March 27 issue of the New England Journal of Medicine. This effect had been seen in prior animal studies but never confirmed in humans, the researchers said. The findings argue against use of controlled mechanical ventilation as a protective strategy to "rest" the lungs and reverse diaphragm fatigue in the ICU, said Gary C. Sieck, Ph.D., and Carlos B. Mantilla, M.D., Ph.D., both of the Mayo Clinic in Rochester, Minn., in an accompanying editorial. (P)atients (should be cautioned) that the negative effects of mechanical ventilation on diaphragm strength may differ according to how much effort the ventilation protocol requires from the lungs. Their findings may help explain why some patients have so much trouble weaning off ventilation, Dr. Levine said.
However, the majority of patients go on assist-mode ventilation and synchronized intermittent mandatory ventilation with pressure support, which does require some work from the diaphragm, the editorialists noted. Animal studies suggest these types of ventilation largely eliminate diaphragm atrophy, but the effect for human patients is still unclear. To help mitigate weaning problems, the researchers suggested, blocking or attenuating the pathways of proteolysis in the diaphragm might work. The study was supported by grants from the National Heart, Lung, and Blood Institute and the Department of Veterans Affairs Merit Review Program. The researchers and editorialists reported no conflicts of interest relevant to the study.
YOUR NOSE: THE GUARDIAN OF YOUR LUNGS
Posted to the List by Maggi/Illinois. You might not think your nose is a "vital organ." To understand its importance, all that most people need to experience is a bad cold. Nasal congestion and a runny nose have a noticeable effect on quality of life, energy level, ability to breathe, ability to sleep, and ability to function in general.
It processes the air that you breathe before it enters your lungs. Most of this activity takes place in and on the turbinates, located on the sides of the nasal passages. In an adult, 18,000 to 20,000 liters of air pass through the nose each day.
Your Nose Protects Your Health By:
-Filtering all that air and retaining particles as small as a pollen grain with 100% efficiency.
-Humidifying the air that you breathe, adding moisture to the air to prevent dryness of the lining of the lungs and bronchial tubes.
-Warming cold air to body temperature before it arrives in your lungs.
-For these and many other reasons, normal nasal function is essential. Do your lungs a favor; take care of your nose. Because the connection between the nose and lungs is so important, paying attention to problems in the nose...can reduce or avoid problems in the lungs such as bronchitis and asthma. Ignoring nasal symptoms such as congestion, sneezing, runny nose, or thick nasal discharge can aggravate lung problems and lead to other problems:
Mouth breathing causes dry mouth, which increases the risk of mouth and throat infections and reduces the sense of taste. Mouth breathing also pulls all pollution and germs directly into the lungs; dry cold air in the lungs makes the secretions thick, slows the cleaning cilia, and slows down the passage of oxygen into the blood stream. Ignoring nasal allergies increases the chance that you will develop asthma; it also makes asthma worse if you already have it. So, it is important to treat nasal symptoms promptly to prevent worsening of lung problems.
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EARLY CANCER STUDY FOUND FUNDED BY TOBACCO MONEY
By Peggy Peck, MedPage Today. Tobacco-industry money has been revealed as the funding source of a widely publicized study that reported annual CT-screening of smokers and former smokers could save lives by detecting lung cancer at its earliest stage. The money, $3.6 million, was funneled through a charity called the Foundation for Lung Cancer: Early Detection, Prevention & Treatment, according to a front page article in (the) New York Times. Claudia I. Henschke, M.D., Ph.D., of Weill Cornell Medical Center who was principal investigator for the I-ELCAP (International Early Lung Cancer Action Program), served as president of the foundation. Her co-investigator, David Yankelevitz, M.D., was its secretary-treasurer, Antonio Gotto, M.D., dean of Weill Cornell, and Arthur J. Mahon, vice-chairman of the Weill Cornell board of overseers, were listed as directors. The tobacco money came in the form of four grants from the Vector Group, which is the parent company of the Liggett Group, maker of Liggett Select, Eve, Grand Prix, Quest, and Pyramid cigarettes.
Dr. Henschke said that the results suggested that annual screening could prevent 80% of lung cancer deaths, an extrapolation that was disputed almost as soon as it was published. The Times uncovered the tobacco link by investigating the tax records of the foundation. When told about the funding, Jeffrey M. Drazen, M.D., editor-in-chief of the NEJM, said that during his seven-year tenure, the journal had never knowingly published any tobacco-funded research. Otis Brawley, M.D., chief medical officer for the American Cancer Society, told the newspaper that the ACS would not have given Dr. Henschke more than $100,000 in research grants if it had known that she was "using blood money." The Times said Drs. Henschke and Yankelevitz denied any wrong-doing. In an email, the investigators pointed out that the grants were "announced publicly [and] the advocacy and public health community knew about it."
INHALED CORTISONE SPRAYS EASE SYMPTOMS OF COPD
By Paul G. Donohue, M.D.
Dear Dr. Donohue: I have COPD - chronic obstructive pulmonary disease - specifically, chronic bronchitis. I'd appreciate knowing why the impaired lungs are unable to thin the thick congestion.- R.L.
COPD consists of two lung illnesses - emphysema and chronic bronchitis. A person with COPD usually has a touch of both illnesses. Both give rise to breathing troubles.With chronic bronchitis, cough and the production of thick mucus are principal symptoms. Inflamed bronchi - air passages - are responsible for both. In this condition, the mucus glands of the bronchi increase in number and in size. That's why the thick mucus occurs. The mucus can be so thick that it obstructs air flow into the lungs. Inhaled medicines - not inhaled from a machine but from a handheld spray - can dilate the clogged airways and help people cough up mucus. Two examples are Spiriva and Atrovent. Inhaled cortisone sprays ease airway irritation and decrease mucus production. (Pulmonary rehabilitation) Therapists teach COPD patients proper breathing techniques, safe exercise and the ways to drain mucus out of the lungs.
EXTENDRYL AND ENTENDRYL GCP
Auriga Laboratories, Inc. a specialty pharmaceutical company, announced the launch of ExtendrylŽ PEM and ExtendrylŽ GCP. The two new products will be marketed under the Extendryl brand name which consists of prescription products to treat various cough, cold, and allergy symptoms. The prescription respiratory market is valued at more than 8 billion dollars in sales and more than 68 million prescriptions are written annually in the US. ExtendrylŽ PEM (phenylephrine HCl 30 mg; methscopolamine nitrate 1.25 mg) Tablets combine two compounds; a decongestant with an anticholinergic/drying agent in an extended release format to provide 8 to 12 hours of relief of symptoms for adults suffering from nasal congestion and mucosal drainage associated with respiratory tract infections and related conditions such as sinusitis, pharyngitis, bronchitis, and asthma. ExtendrylŽ GCP Oral Solution combines three compounds (100 mg/5 mL guaifenesin; 15 mg/5mL carbetapentane citrate; 5 mg/mL hydrochloride), and is indicated for temporary relief of non-productive cough accompanying respiratory tract congestion associated with the common cold, influenza, sinusitis, and bronchitis. ExtendrylŽ PEM and ExtendrylŽGCP will be launched in March 2008. For contraindications and prescribing dosages see:
SUN PHARMA SECURES FDA OK FOR GENERIC BENZONATATE CAPSULES
By Rumman Ahmed: The U.S. FDA has given it approval to make and sell Benzonatate capsules, a generic version of Forest Laboratories Inc.'s Tessalon. The capsules, which are available in doses of 100 milligram and 200 mg, have annual sales of about $40 million in the U.S., the company said Friday. It added that it will start selling the product shortly. Benzonatate is an antitussive, used to relieve cough caused by common cold, bronchitis, pneumonia or other lung infections.
NEW INHALER TO RESULT IN 40% COST SAVING: CIPLA
Cipla is set to launch the world's first triple drug combination inhaler for COPD patients in India. Cipla's brand, Triohale will have triotropium, formoterol and ciclesonide for asthma patients. The company is in the process of registering the drug for exports to semi-regulated markets. The inhaler drug would cost Rupees 570 ($14.20 American Dollars) per 120-metered doses in India. Amar Lulla, MD, Cipla said that patients will save about 40% as against buying the single component drug, this apart from not have to remember which one he has taken and which one he has not. Lulla added that the inhaler will be available in the market from this week (on).
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.
SPRING CLEANING TIPS FOR ALLERGY SUFFERERS
by Allison Janse. If you're one of the 40 million people who suffer from allergies, particularly dust or chemical sensitivities, spring cleaning can be more than unpleasant -- it can be downright dangerous, causing wheezing, sneezing, itchiness, and other allergic reactions. To avoid these problems, follow the general guidelines below before you begin to tackle the room-by-room checklist that follows.
-If you're allergic to pollen, do your spring cleaning early in the season, so you can keep all of your windows open for full ventilation. Once the pollen's out, you'll want your house closed up.
-Wear a mask, especially when vacuuming or dusting.
-Use electrostatically charged cleaning cloths or damp-dust so that you trap the dust instead of sending it airborne through your house.
-Likewise, if you're still turning on your heat, change your furnace filter regularly too, since dust and dander can accumulate if it's not changed regularly during the winter months.
Before You Begin:
Feel the urge to purge: Take a day to sort through any clutter, organizing it into boxes: to save, to store, to giveaway and to sell (eBay here I come). Less clutter means less dust and an easier time cleaning in general.
And a great tip...if you have something that can't be laundered in hot water, (decorative throw pillows, stuffed animals, etc.) put them in the freezer for a few hours. It helps get rid of the dust mites.
Lastly, once the inside of your home is clean, wash or replace the mats leading into your home, as any dirt and grime on them will likely be tracked into your home.
DIY MOLD REMOVAL
by Alina Bradford. An expert shares how to remove mold from your home: Mold is a big problem in the steamy South where the high humidity feeds its need for moisture. My home is constantly under attack it seems, and every member in my family is severally allergic to mold. Being frugal, I wanted to try getting rid of the mold without the help of a professional, which would cost me more than $1,000.
First, I tried scrubbing the walls with bleach. It seemed to work, but within days, it looked as if I hadn't done anything at all. Why? "Bleach does not kill mold," says Michael Dooley, the Vice President of the New Mexico chapter the American Society of Home Inspectors. I was shocked when I heard this, until I did some research and realized that the reason you use bleach on white clothes is to remove color. Essentially, I was just removing the color from the mold.
Dooley says that there are some great, inexpensive solutions to killing mold. One of them is using a cleaning product that contains at least 3% hydrogen peroxide for non-porous materials. Inspired, I made a solution that was one part hydrogen peroxide and three parts water and put it into a spray bottle. I applied the mixture to the mold in my house, and I have to say that it was very effective. "Another inexpensive alternative," says Dooley, "is to make a paste with borax and water. Use the paste to scrub the surface that is infected with mold and rinse." Wood with mold contamination can be sanded and/or wire-brushed, then sprayed with an anti-microbial agent, and refinished. I find that painting the walls in my bathroom with Kilz brand paint has slowed, if not gotten rid of my mold problem in that room. Many people think that Kilz kills mold. I haven't found any proof that it kills the mold. It works by blocking it. It seals out moisture, so the wall doesn't become infected with mold. Kilz can be found in Wal-Mart stores, and is cheaper than many regular paint brands. "Most porous materials such as sheetrock, carpeting, ceiling tiles, and so on, should be cut out and disposed of and replaced with new materials." More at:
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The Portion Quiz: Your supersized mentality just may be responsible for your supersized thighs. Test your knowledge of portion size. (Click on the answer phrase rather than the box next to it.)
Here's a test that probably shows why we shouldn't talk on cell phones and drive...
What happens when you overuse your mouse? This might be fun to play with for pattern.
Until next Friday,
Joan Costello, Editor
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