Pulmonary Disease

14 Jul Obesity, Lack of Exercise Linked to COPD

Posted at 13:08h in Author Interviews, CMAJ, Metabolic Syndrome, Pulmonary Disease, Weight Research

MedicalResearch.com Interview with: Dr Gundula Behrens Department of Epidemiology and Preventive Medicine University of Regensburg Franz-Josef-Strauss-Allee 11 93053 Regensburg, Germany Medical Research: What are the main findings of the study? Dr Behrens: We studied the relations of obesity and physical activity to the incidence of chronic obstructive pulmonary disease (COPD) among more than 100,000 middle-aged to elderly men and women living in the U.S. People with a large waist circumference (43.5 inches (110 cm) or over in women and 46.5 inches (118 cm) or over in men) had a 72% increased risk of COPD as compared to people with a normal waist circumference. In contrast, individuals who were physically active five times or more per week had a 29% decreased risk of COPD as compared to their physically inactive counter-parts.

27 Jun COPD: New BODE Index May Be Better Predictor of Mortality

Posted at 11:38h in Author Interviews, Pulmonary Disease

MedicalResearch.com Interview with: Dr. Juan P de Torres Pulmonary Department Clínica Universidad de Navarra Pamplona, Spain; MedicalResearch: What are the main findings of the study? Dr. Torres: The BODE Index (BMI, Obstruction, Dyspnea, Exercise ) predicts mortality better than the GOLD ABCD (The Global Obstructive Lung Disease) grading and adding the COTE (Copd cO-morbidity TEst ) comorbidity Index to the BODE Index is complementary and provides an excellent predictive capacity for all-cause mortality in COPD patients.

29 May Does Nebulized Hypertonic Saline Improve Pediatric Bronchiolitis ?

Posted at 11:05h in Author Interviews, JAMA, Pediatrics, Pulmonary Disease

MedicalResearch.com Interview with: Susan Wu MD Division of Hospital Medicine, Children's Hospital Los Angeles Assistant Professor of Clinical Pediatrics, Keck School of Medicine of the University of Southern California MedicalResearch: What are the main findings of the study? Dr. Wu: We performed a randomized trial at 2 urban free-standing children's hospitals, comparing inhaled 3% hypertonic saline to 0.9% normal saline in patients under 24 months with bronchiolitis. Patients with prematurity less than 34 weeks, cyanotic heart disease, chronic pulmonary disease, and previous episodes of wheezing or bronchodilator use were excluded. Patients were 4 mL of study medication nebulized up to 3 times in the emergency department; if admitted, patients continued to receive the assigned study medication three times a day until discharge. A total of 408 patients were analyzed. We found that 28.9% of patients treated with hypertonic saline required hospital admission, compared with 42.6% of patients in the normal saline group.

20 May Are Statins Effective In Reducing COPD Flares?

Posted at 01:57h in Author Interviews, NEJM, Pulmonary Disease, Statins

MedicalResearch Interview with: Dr. Gerard J. Criner MD, FACP, FACCP Professor, Medicine Director, Medical Intensive Care Unit and Ventilator Rehabilitation Unit Co-Director, Center for Inflammation, Translational and Clinical Lung Research, Temple University Hospital in Philadelphia, PA MedicalResearch: What are the main findings of the study? Dr. Criner: The STATCOPE Trial (Simvastatin in the Prevention of COPD Exacerbations) found that a statin drug commonly used to lower cholesterol is not effective in reducing the number and severity of flare ups from chronic obstructive pulmonary disease (COPD). The study rigorously tested the hypothesis that statin drugs may be beneficial to persons with COPD because of the drugs’ purported anti-inflammatory effect. However, researchers found that:

40 mg. of daily simvastatin (statin drug) added to usual care did not reduce exacerbation rate or prolong the time to exacerbation in patients with moderate to severe COPD.
Simvastatin had no effect on lung function, quality of life, severe adverse events or mortality.
The data do not demonstrate a therapeutic benefit from statins in patients with moderate to severe COPD.

19 May COPD: Benefits of high dose N-acetylcysteine

Posted at 09:49h in Author Interviews, CHEST, Pulmonary Disease

MedicalResearch.com Interview with: Dr. Hoi Nam Tse, FCCP, MRCP, MBChB Associate Consultant, Kwong Wah Hospital, Hong Kong Life member and Council member of Hong Kong Thoracic Society MedicalResearch: What are the main findings of the study? Dr. Hoi Nam Tse: N-acetylcysteine (NAC) is an oral mucolytic containing anti-oxidative and anti-inflammatory property. Our study demonstrated that long term use of high-dose : N-acetylcysteine (600 mg twice daily for 1 year) was a well-tolerated treatment, and it reduced exacerbations and prolonged time to first exacerbation in ‘high-risk’ COPD patients--which was defined as patients who had 2 or more exacerbations per year, FEV1<50% or both. Such beneficial effect was not obvious in the ‘low-risk’ COPD patients.

15 Apr Evaluating Pulmonary Nodules for Cancer: Patients May Receive Too Much, Too Little Care

Posted at 23:40h in Author Interviews, JAMA, Lung Cancer, Pulmonary Disease

MedicalResearch.com Interview with: Renda Soylemez Wiener, MD, MPH Assistant Professor of Medicine The Pulmonary Center Boston University School of Medicine Center for Healthcare Organization & Implementation Research Edith Nourse Rogers Memorial VA Hospital MedicalResearch.com: What are the main findings of the study? Dr. Soylemez Wiener: The main finding is that evaluation of pulmonary nodules to determine whether or not they are cancerous is inconsistent with clinical practice guideline recommendations in almost half of cases, suggesting there is room for improvement in clinical care of these patients. Patients with pulmonary nodules are sometimes evaluated more aggressively than they should be (18%), which can cause harms to patients from unnecessary invasive tests (biopsies or surgery) or unneeded radiation exposure from imaging studies. Still more patients (27%) are followed less aggressively than they should be, which in the worst case scenario could lead to delays in the diagnosis and treatment of cancer. It is particularly important to improve care of these patients now, because new guidelines from the US Preventive Services Task Force recommend CT screening for lung cancer screening, which often finds pulmonary nodules that require evaluation.

19 Mar COPD and Risk of Mild Cognitive Impairment

Posted at 11:57h in Cognitive Issues, JAMA, Mayo Clinic, Medical Research Centers, Pulmonary Disease

MedicalResearch.com Interview with: Michelle M. Mielke, Ph.D. Associate Professor Department of Health Sciences Research, Division of Epidemiology Department of Neurology Mayo Clinic Rochester, MN 55905 MedicalResearch.com: What are the main findings of the study? Dr. Mielke: Using a population-based sample of cognitively normal individuals, aged 70-89 at baseline, we found that a medical-record confirmed diagnosis of COPD was associated with an increased risk of mild cognitive impairment, specifically non-amnestic mild cognitive impairment. The risk of mild cognitive impairment increased with a longer duration of COPD such that individuals who had COPD for more than 5 years had a 2.5-fold increased risk of developing non-amnestic mild cognitive impairment.

09 Mar COPD: Using FEV6 to Identify More Affected Patients

Posted at 02:32h in Annals Thoracic Surgery, Author Interviews, NIH, Pulmonary Disease

MedicalResearch.com Interview with: Surya P Bhatt MD Assistant Professor Division of Pulmonary and Critical Care Medicine University of Alabama at Birmingham MedicalResearch.com: What are the main findings of the study? Dr. Bhatt: The forced vital capacity (FVC) maneuver is a difficult maneuver for many patients and the forced expiratory volume in the first 6 seconds (FEV₆) has been shown to be a reliable substitute. We used imaging findings on computed tomography, COPD questionnaires and tests of exercise capacity to compare these two spirometric measures (FEV₁/FVC and FEV/FEV₆) in the diagnosis of airflow obstruction, and showed that FEV₆ can be reliably substituted for FVC. Our findings suggest that using FEV₆ may in fact identify more patients with disease than by using FVC.

03 Mar Pneumonia Risk Increased From Sleep Apnea

Posted at 20:52h in Author Interviews, CMAJ, Pulmonary Disease, Respiratory, Sleep Disorders

MedicalResearch.com Interview with: Dr. Vincent Yi-Fong Su Department of Chest Medicine Taipei Veterans General Hospital Taipei, Taiwan MedicalResearch.com: What are the main findings of the study? Answer: We found interestingly that patients with sleep apnea experienced a 1.20-fold (95% CI, 1.10-1.31; p <0.001) increase in incident pneumonia compared to patients without sleep apnea. We also demonstrated an “exposure-response relationship,” in that the patients with more severe sleep apnea might have a higher risk for pneumonia than did those of milder severity.

23 Feb COPD: Risk from Chinese WaterPipe Smoking

Posted at 12:35h in Author Interviews, CHEST, Pulmonary Disease, Smoking

MedicalResearch.com Interview with: Chunxue Bai, MD & PhD Director, Shanghai Respiratory Research Institute Professor of Medicine, Chairman, Shanghai Leading academic discipline Chair, Chinese Alliance against Lung Cancer MedicalResearch.com: What are the main findings of the study? Dr. Bai: Recently, we found a dilemma phenomenon that the incidence of chronic obstructive pulmonary disease (COPD) and lung cancer has remained high in southwest China despite the 1976 National Stove Improvement Program for indoor air quality. However, little information is known to the public about a regional endemic related to Chinese waterpipe smoking, which is different from the Arabic waterpipe. The Chinese waterpipe has been traditionally misconceived as less harmful for three reasons:

(1) no charcoal was used in contrast to the Arabic waterpipe,
(2) tobacco smoke passed through the water as opposed to cigarette smoking and
(3) smoking through a large volume waterpipe could “improve lung function.”

In our study, we provide robust results that the large volume Chinese waterpipe use and exposure are associated with the elevated prevalence of COPD, which have been identified by epidemiologic, physiologic, radiology, and toxicologic findings for the first time.

19 Feb Pulmonary Fibrosis: High Resolution CT Diagnosis

Posted at 04:35h in Author Interviews, Lancet, Pulmonary Disease

MedicalResearch.com Interview with: Ganesh Raghu, M.D.,FCCP, FACP Professor of Medicine & Lab Medicine (Adjunct) Division of Pulmonary & Critical Care Medicine University of Washington(UW) Director,CENTER for Interstitial Lung Disease (ILD),UW Medicine, ILD, Sarcoid and Pulmonary Fibrosis Program Co-Director, Scleroderma Clinic, UW Medical center(UWMC) Seattle, WA 98195 MedicalResearch.com: What are the main findings of the study? Dr. Raghu: In a subgroup of patients with typical clinical features of Idiopathic pulmonary fibrosis ( IPF) , further evaluation by a thorough evlauation by regional experts experienced in management of idiopathic pulmonary fibrosis and related diseases may lead to a diagnosis of idiopathic pulmonary fibrosis without the need for surgical lung biopsy if the HRCT features have a Possible-UIP pattern AND if there are no suspicion for environmental factors or collagen vascular diseases to explain the pulmonary fibrosis .

14 Feb COPD: Treatment with twice daily N-acetylcysteine 600 mg

Posted at 20:42h in Author Interviews, Lancet, Pulmonary Disease

MedicalResearch.com Interview with: Jinping Zheng MD FACCP on behalf of Prof. Nanshan Zhong [caption id="attachment_3779" align="alignleft" width="113"]

Prof. Nanshan Zhong[/caption] --Jinping Zheng, MD, FCCP Guangzhou Institute of Respiratory Disease First Affiliated Hospital of Guangzhou Medical University 151 Yanjiang Rd. Guangzhou 510120, China MedicalResearch.com: What are the main findings of the study? Answer: PANTHEON is the largest, evidence-based study of long-term treatment with N-acetylcysteine (NAC) in COPD patients conducted to date. The main finding of this study is that 1-year of treatment with high dose NAC (600mg twice daily) was effective at reducing exacerbations in patients with COPD, especially in the earlier stage [GOLD II (moderate) of disease. NAC was well tolerated.

13 Feb COPD: Editorial Regarding Earlier Diagnosis by Primary Care

Posted at 23:48h in Author Interviews, BMJ, Primary Care, Pulmonary Disease

MedicalResearch.com: Interview with: Professor Chris van Weel Emeritus Professor of Family Medicine/General Practice Radboud University Nijmegen, The Netherlands Professor of Primary Health Care Research, Australian National University, Canberra Background from Professor Chris van Weel Thank you for the opportunity to respond to your questions. My paper was a commentary to the study of Jones and colleagues, Opportunities to diagnose chronic obstructive pulmonary disease in routine care in the UK: a retrospective study of a clinical cohort looking at the implications of the study findings. MedicalResearch.com: What are the main findings of the study? Answer: Jones and colleagues reported that in the UK, there are many missed opportunities to diagnose COPD. My comments are that this is not a unique UK problem, but a universal one: under-diagnosis or late diagnosis of COPD is a universal problem in most if not all countries in the world. To understand it, it is important to analyse more in-depth the diagnostic challenge in primary care, for general practitioners(GP)/family physicians (FP). The paper of Jones highlights this diagnostic problem - symptoms of COPD are initially insidious and may fluctuate over time. And from my earlier research it is also clear that patients 'adept' their daily activities (less physical activities) and therefore may underplay or even become unaware of, their symptoms. At the same time, this is a problem for the physician, when encountering these symptoms. As I highlighted in my commentary, GPs/FPs have to pay attention to other possible diseases that might cause these symptoms: pneumonia, heart failure, lung cancer. The 'low key symptoms' and the need of applying a broad diagnostic scope together cause what Jones and his colleagues called the 'missed opportunities' to diagnose COPD.

13 Feb COPD Diagnosis Often Delayed

Posted at 12:04h in Author Interviews, Pulmonary Disease

MedicalResearch.com Interview with: Erika J. Sims, PhD Senior Researcher Research in Real Life Ltd Cambridge, CB24 3BA Rupert C M Jones MD Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, UK Prof David Price MD Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK MedicalResearch.com: What are the main findings of the study? Authors: The main findings are that the majority of patients with COPD identified in our study, had visited their doctor with respiratory symptoms prior to the diagnosis being made, but that the underlying cause of their symptoms - COPD - wasn't diagnosed. Indeed, in the 5 years before being diagnosed with COPD, 85% of patients had visited their doctors with respiratory problems without the diagnosis being made. Furthermore, some patients repeatedly attended and received treatment and multiple chest X-rays before they had the diagnosis made. We also identified a large increase in the proportion of patients with comorbidity over the duration of the study, and that patients with comorbidity appear to be being diagnosed with COPD at any earlier stage. As this study includes data on 38,000 people with a diagnosis of COPD identified from two large general practice databases in the UK - Optimum Patient Care Research Database and Clinical Practice Research Datalink, we believe our findings are generalisable to UK and international primary and secondary care.

05 Jan ARDS: IV Interferon-beta-1a Effect on Mortality

Posted at 01:02h in Author Interviews, Lancet, Pulmonary Disease

MedicalResearch.com Interview with: Prof Sirpa Jalkanen MD, PhD MediCity Research Laboratory and Department of Medical Microbiology University of Turku Turku, Finland MedicalResearch.com: What are the main findings of the study? Answer: Pulmonary vascular leakage occurs early in acute lung injury/acute respiratory distress syndrome (ALI/ARDS). Mortality is high (35-45%), but no effective pharmacotherapy exists. Production of anti-inflammatory adenosine by ecto-5’-nucleotidase (CD73) maintains endothelial barrier function. Interferon-beta-1a (IFN-beta) increases CD73 synthesis and might thus reduce vascular leakage and mortality in ALI/ARDS. We tested this hypothesis and the findings were as follows: 1.IFN-beta increased the number of CD73-positive vessels in human lung culture (4- and 14.3-fold on days 1 and 4 respectively, p=0.04 and 0.004). 2. The optimal tolerated FP-1201 dose (a unique intravenous formulation of interferon-beta 10 μg /day for six days) caused a significant rise in serum MxA (a marker for interferon response) and CD73 levels and a fall in interleukin-6 (an inflammatory cytokine) concentration. 3. Most importantly, odds of 28-day mortality was 81% lower in the treated than untreated subjects (8% vs 32%, OR[95% CI]0.19[0.03 to 0.72], p=0.01).

03 Dec Stem Cells: Generating Lung Cells from PluriPotent Stem Cells

Posted at 12:04h in Author Interviews, Nature, Pulmonary Disease, Stem Cells

MedicalResearch.com Interview with: Hans-Willem Snoeck MD, PhD Columbia University Medical Center MedicalResearch.com: What are the main findings of the study? Dr. Snoeck: We were, for the first time, able to differentiate human embryonic stem cells and induced pluripotent stem cells into at least 6 different types of lung and airway epithelial cells. Furthermore, we could demonstrate function of surfactant-producing type II alveolar epithelial cells, and the lung progenitors we generated could generate airway after transplantation under the kidney capsule of immunodeficient mice.

25 Nov Asthma and COPD: Results of Clinical Trials of dual PDE3 and PDE4 inhibitor

Posted at 01:07h in Author Interviews, Lancet, Pulmonary Disease

MedicalResearch.com Interview with: Professor Clive Page Director, Sackler institute of Pulmonary Pharmacology Joint Head, Institute of Pharmaceutical Science King's College London 150 Stamford Street Waterloo Campus London SE1 9NH MedicalResearch.com: What are the main findings of the study? Prof. Page: RPL 554 was shown to cause bronchodilation and anti-inflammatory activity at the same dose. The drug showed benefit in both patients with COPD and asthma.

21 Nov Pulmonary Fibrosis: Strongly Associated with a Herpes Virus

Posted at 13:09h in Author Interviews, Herpes Viruses, Infections, Nature, Pulmonary Disease

MedicalResearch.com Interview with: Gerard Nuovo MD Professor College of Medicine, The Ohio State University Satellite Laboratory, Ohio State Univ Comprehensive Cancer Center Phylogeny Inc, Powell, Ohio MedicalResearch.com: What are the main findings of the study? Dr. Nuovo: The main finding of the study was that idiopathic pulmonary fibrosis was strongly associated with an infection by a herpesvirus. The data that supported this main finding included:

1) detection of the viral DNA by in situ hybridization in each case of idiopathic pulmonary fibrosis (IPF) and in none of the controls;
2) the localization of the viral DNA to the nucleus of the cell that orchestrates IPF, the regenerating epithelial cell (herpes viruses localize to the nucleus of the target cell);
3) the demonstration that the viral DNA co-localized with "pirated proteins" that the virus makes during productive infection (these were IL-17. cyclin D, dihydrofolate reductase, and thymidylate synthase); this combination of proteins are rarely if ever co-expressed in lung disease and their co-expression per se was highly suggestive of a viral infection;
4) the demonstration by RTPCR that the cyclin D RNA in IPF comes from the virus and not the human cells;
5) the recognition that this family of herpesviruses (called gammaherpesvirus) causes IPF in other animals including horses, mice, and donkeys;
6) the cloning of part of the gene of the virus from a clinical IPF sample that showed 100% homology to the published sequence of the likely viral pathogen - herpesvirus saimiri.

11 Sep COPD: Comparing Tiotropium Delivery Devices

Posted at 19:40h in Author Interviews, Johns Hopkins, NEJM, Pulmonary Disease

MedicalResearch.com Interview with: Dr. Robert A. Wise MD Professor of Medicine Johns Hopkins University School of Medicine 5501 Hopkins Bayview Circle Baltimore, MD 21224 MedicalResearch.com: What are the main findings of the study?  Dr. Wise: The TIOSPIR trial was a landmark study, one of the largest ever conducted for chronic obstructive pulmonary disease (COPD). It was designed to test the comparative safety and effectiveness of two delivery devices of tiotropium, a long-acting bronchodilator. One formulation is the Respimat multi-dose soft mist inhaler and the other formulation is the single dose HandiHaler dry powder inhaler. After following more than 17000 patients for an average of 2.3 years, TIOSPIR showed that there was no difference in either the safety in terms of mortality or adverse cardiovascular events between the two devices. Moreover, both devices showed similar effectiveness in terms of time to first COPD exacerbation. A lung function substudy in 1370 patients showed that the 5 microgram dose of Respimat was equivalent to the HandiHaler as a bronchodilator, but the 2.5 microgram dose was not quite as effective.

07 Aug COPD and Coronary Artery Bypass Surgery

Posted at 00:35h in Annals Thoracic Surgery, Author Interviews, Heart Disease, Pulmonary Disease

MedicalResearch.com Interview with: Hossein Almassi, MD Professor, Cardiothoracic Surgery Medical College of Wisconsin and Zablocki VA Medical Center Milwaukee, Wi, 53226 MedicalResearch.com: What are the main findings of the study? Answer: The main findings of this study were that off-pump coronary bypass grafting did not have a positive differential impact on outcome of patients with COPD as compared to the standard operation performed on cardiopulmonary bypass.

04 Jul Curcumin and Protection Against Long-Term Hyperoxic Lung Injury

Posted at 00:36h in Author Interviews, Nutrition, Pediatrics, Pulmonary Disease

MedicalResearch.com Interview with: Virender K. Rehan, MD Los Angeles Biomedical Research Institute (LA BioMed). MedicalResearch.com: What are the main findings of the study? Dr. Rehan: This is the first study to show that the active ingredient in Indian spice turmeric provides long term protection against neonatal lung damage that leads to chronic lung disease of prematurity.

17 Jun Vitamin C may alleviate exercise-induced Bronchoconstriction

Posted at 01:53h in Author Interviews, BMJ, Exercise - Fitness, Pulmonary Disease, Vitamin C

MedicalResearch.com: Interview with: Dr. Harri Hemila Department of Public Health, University of Helsinki, Helsinki, Finland MedicalResearch.com: What are the main findings of the study? HH: Vitamin C administration may halve the exercise-induced FEV1 decline in people who suffer from exercise-induced bronchoconstriction.