Author Interviews, Environmental Risks, JAMA, NIH, Pulmonary Disease / 13.08.2019

MedicalResearch.com Interview with: [caption id="attachment_50697" align="alignleft" width="150"]Joel Kaufman, MD, MPH, Professor   Environmental & Occupational Health Sciences, Medicine, and Epidemiology University of Washington Prof. Kaufman[/caption] Joel Kaufman, MD, MPH, Professor   Environmental & Occupational Health Sciences, Medicine, and Epidemiology University of Washington  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Increasingly, it is recognized that chronic lung diseases like emphysema occur in nonsmokers and rates of these diseases are continuing to increase.  We really need to understand what’s causing chronic lung disease. Air pollutants are known to make disease worse in people with prior lung disease, but little is known about whether long-term exposure to air pollutants can cause chronic lung disease. We found that higher residential concentrations of air pollutants—especially ozone and traffic-related air pollutants—are associated with changes in the lung—emphysema-like changes in the lung.  The associations were strong and suggest that air pollution may be an important contributor to chronic lung disease. 
Author Interviews, Biomarkers, NEJM, Pulmonary Disease / 11.07.2019

MedicalResearch.com Interview with: [caption id="attachment_50147" align="alignleft" width="200"]Dr. Chris Butler,, BA MBChB DCH CCH MD FRCGP (Hon)FFPH FMedSci Professor of Primary Care Nuffield Department of Primary Care Health Sciences, Professorial Fellow at Trinity College Clinical Director Primary Care Clinical Trials Unit University of Oxford Dr. Butler[/caption] Dr. Chris Butler,, BA MBChB DCH CCH MD FRCGP (Hon)FFPH FMedSci Professor of Primary Care Nuffield Department of Primary Care Health Sciences, Professorial Fellow at Trinity College Clinical Director Primary Care Clinical Trials Unit University of Oxford  MedicalResearch.com: What is the background for this study? Response: More than a million people in the UK have COPD, which is a lung condition associated with smoking and other environmental pollutants. People living with the condition often experience exacerbations, or flare-ups, and when this happens, three out of four are prescribed antibiotics. However, two-thirds of these flare-ups are not caused by bacterial infections and antibiotics often do not benefit patients. A simple finger-prick blood test could help prevent unnecessary prescribing of antibiotics for people with the lung condition chronic obstructive pulmonary disease (COPD).  The finger-prick test measures the amount of C- reactive protein (CRP) - a marker of inflammation that rises rapidly in the blood in response to serious infections. People with a COPD flare-up who have a low CRP level in the blood appear to receive little benefit from antibiotic treatment. The General Practitioner (GP) use of a C-Reactive Protein (CRP) Point of Care Test (POCT) to help target antibiotic prescribing to patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) who are most likely to benefit (The PACE Study) determined whether the using a POCT CRP to guide antibiotic treatment decisions for acute exacerbations of COPD reduced antibiotic use without harming patients.
Author Interviews, Columbia, JAMA, Pulmonary Disease / 28.06.2019

MedicalResearch.com Interview with: [caption id="attachment_49933" align="alignleft" width="198"]Elizabeth C. Oelsner, MD, MPH Irving Assistant Professor of Medicine Division of General Medicine New York Presbyterian Columbia University Dr. Oelsner[/caption] Elizabeth C. Oelsner, MD, MPH Irving Assistant Professor of Medicine Division of General Medicine New York Presbyterian Columbia University MedicalResearch.com: What is the background for this study? Response: Uncertainty regarding how to diagnose chronic obstructive pulmonary disease (COPD) has posed significant problems for early detection and treatment of this common disease. Simplifying and standardizing the diagnosis of COPD has the potential to improve diagnosis, clinical care, and clinical research for this common and under-diagnosed chronic lung disease. We therefore aimed to provide robust evidence for the best threshold to diagnose COPD by comparing how well various thresholds predict hospitalizations and deaths from COPD.
Author Interviews, Immunotherapy, NEJM, Pulmonary Disease / 22.05.2019

MedicalResearch.com Interview with: [caption id="attachment_49320" align="alignleft" width="148"]Gerard J. Criner, MD, FACP, FACCPChair and Professor, Thoracic Medicine and SurgeryLewis Katz School of MedicineTemple University Dr. Criner[/caption] Gerard J. Criner, MD, FACP, FACCP Chair and Professor, Thoracic Medicine and Surgery Lewis Katz School of Medicine Temple University  MedicalResearch.com: What is the background for this study? Response: An earlier, Phase II trial of benralizumab found a non-statistically significant reduction in COPD exacerbation rate for patients with eosinophilic inflammation in the airways. In this Phase III trial, the researchers sought to discover whether benralizumab's ability to deplete the airways of blood eosinophils in patients with eosinophilic inflammation would lead to a reduction in COPD exacerbations. The Phase III, randomized, double-blind, placebo-controlled, parallel-group clinical trials GALATHEA and TERRANOVA evaluated the efficacy and safety of benralizumab for the prevention of exacerbations in patients with moderate to very severe COPD, eosinophilic inflammation, and increased risk of exacerbations. Benralizumab is a type of drug called an interleukin-5 receptor alpha-directed cytolytic monoclonal antibody. It is approved by the FDA for the treatment of severe eosinophilic asthma.
Author Interviews, Heart Disease, JAMA, Johns Hopkins, Pulmonary Disease / 07.05.2019

MedicalResearch.com Interview with: [caption id="attachment_48985" align="alignleft" width="80"]Robert A. Wise, M.D.Professor of MedicinePulmonary and Critical CareJohns Hopkins University School of MedicineBaltimore, MD  Dr. Wise[/caption] Robert A. Wise, M.D. Professor of Medicine Pulmonary and Critical Care Johns Hopkins University School of Medicine Baltimore, MD MedicalResearch.com: What is the background for this study? What are the main findings? Response: There has been a lingering controversy about the safety of long-acting anti-muscarinic agents (LAMA) as maintenance treatment for COPD in patients who have increased cardiovascular risk.  This study enrolled participants with COPD who also had increased cardiovascular risk or known cardiovascular disease.  Participants were randomly treated with either aclidinium bromide (Tudorza Pressair) or placebo. Over 3 years of follow up there was no increased risk of adverse cardiovascular events.  Moreover, the medication had a significant benefit in terms of reducing exacerbations and COPD hospitalizations.
Author Interviews, Pulmonary Disease / 16.04.2019

MedicalResearch.com Interview with: [caption id="attachment_48572" align="alignleft" width="150"]Dr. Sameer Arbat, MBBS, MDInterventional Pulmonologist at Department of PulmonologyKRIMS Hospitals, Ramdaspeth, Nagpu  Dr. Arbat[/caption] Dr. Sameer Arbat, MBBS, MD Interventional Pulmonologist at Department of Pulmonology KRIMS Hospitals, Ramdaspeth, Nagpu  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Chronic obstructive pulmonary disease (COPD) is one of the major preventable chronic respiratory diseases. Worldwide chronic obstructive pulmonary disease (COPD) is the third leading cause of death. A retrospective data of non-smoker COPD patients coming to our tertiary health care centre-KRIMS Hospitals, India was collected from year 2016-2018. About 180 patients were found to be non-smokers who were diagnosed as COPD on their spirometry findings. Out of 180 non-smoker COPD patients, 54% were females. In our study 61% patients belonged to rural areas and 38% belonged to urban areas showing that rural region has higher majority of COPD patients than urban. Most people having this disease were housewives working on biomass wood smoke exposure and farmers working with toxic chemical sprays. 
Author Interviews, Infections, Pulmonary Disease, Stanford / 15.09.2018

MedicalResearch.com Interview with: [caption id="attachment_44541" align="alignleft" width="200"]Stephen J Ruoss MD Professor, Stanford University, Medicine, Division of Pulmonary and Cfritical Care Medicine Stanford, California Dr. Ruoss[/caption] Stephen J Ruoss MD Professor, Stanford University, Medicine, Division of Pulmonary and Cfritical Care Medicine Stanford, California MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by an atypical mycobacterial infection?  Response: Our interest in undertaking this study stems from three important clinical observations and issues. First, the use of inhaled steroid medications for a broad variety of respiratory complaints and diseases is increasing, including in clinical circumstances where there isn’t much strong supportive evidence for benefit to patients from using inhaled steroids. The second observation is that steroids can and do alter immune system responses, and can increase the risk for some infections. There are already data from studying patients on inhaled steroids where the incidence of bacterial respiratory infections has increased, supporting the concerns for infection risk from inhaled steroids. And the third issue is that steroids can more specifically alter immune system function that helps combat mycobacterial infections, and this means that the risk for, and incidence of mycobacterial infections could be increased in patients treated with inhaled steroids. The best known mycobacterial infection is of course tuberculosis, but there are other mycobacteria, called nontuberculous mycobacterial (or atypical mycobacterial) that are broadly found in the environment, and some of those nontuberculous mycobacteria (NTM) can cause lung infections. So our hypothesis was that the use of inhaled steroids might be associated with an increased frequency of NTM infections, and we designed the study to explore that hypothesis.
Author Interviews, Cannabis, McGill, Pulmonary Disease / 30.07.2018

MedicalResearch.com Interview with: [caption id="attachment_40908" align="alignleft" width="200"]“Cannabis sativa” by Manuel is licensed under CC BY 2.0 cannabis[/caption] Sara Abdallah, PhD Student, first author and Dennis Jensen, PhD Associate Professor, Department of Kinesiology and Physical Education Associate Dean – Infrastructure, Faculty of Education Director, McGill Research Center for Physical Activity and Health Canada Research Chair in Clinical Exercise & Respiratory Physiology Associate Member, Translational Research in Respiratory Diseases Program Research Institute of the McGill University Health Center MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Many patients with chronic obstructive pulmonary disease (COPD) suffer from severe breathlessness at rest and on minimal exertion despite receiving optimal drug therapy for their underlying disease (e.g., bronchodilators). In these patients, breathlessness significantly diminishes exercise capacity and quality of life. Thus, research focused on identifying adjunct therapies for management of breathlessness in patients with advanced COPD is clinically relevant. A series of studies conducted in the 1970’s found that smoked cannabis caused bronchodilation (i.e., improved airway function) in healthy individuals and in patients with asthma. More recently, it has been demonstrated that delta-9 (∆9)-tetrahydrocannabinol (THC, the major cannabinoid constituent of cannabis) inhibits cholinergic contractions in isolated human bronchi and that a positive association exists between measure of lung function (e.g., forced expiratory volume in 1-sec) and cannabis use in patients with COPD. These studies lead us to hypothesize that inhalation of vaporized cannabis may alleviate exertional breathlessness and improve exercise tolerance in patients with advanced COPD by improving airway function at rest and during exercise.
Author Interviews, Pulmonary Disease / 29.05.2018

MedicalResearch.com Interview with: [caption id="attachment_42008" align="alignleft" width="149"]Kenneth R. Chapman, MD MSc FRCPC FACP FCCP, FERS Director, Asthma & Airway Centre, University Health Network, Professor of Medicine, University of Toronto, GSK-CIHR Research Chair in Respiratory Health Care Delivery, Toronto, Ontario Dr. Chapman[/caption] Kenneth R. Chapman, MD MSc FRCPC FACP FCCP, FERS Director, Asthma & Airway Centre, University Health Network, Professor of Medicine, University of Toronto, GSK-CIHR Research Chair in Respiratory Health Care Delivery, Toronto, Ontario MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Guidelines regard inhaled bronchodilators as foundational pharmacotherapy in COPD while inhaled corticosteroids are to be used sparingly.  Inhaled corticosteroids are used to reduce exacerbation tendency but come with the added risk of pneumonia, osteoporosis and other corticosteroid related adverse effects.  Although only a minority of COPD patients are exacerbation prone, many patients with COPD are treated unnecessarily with inhaled corticosteroids alongside long-acting anticholinergic and beta2 agonist bronchodilators - so-called "triple therapy".  In patients who have minimal exacerbation histories, inhaled corticosteroid withdrawal is suggested to reduce side-effects. Although studies have suggested this is a reasonable strategy, study limitations have been noted.  The best known inhaled corticosteroid withdrawal study, the WISDOM trial, recruited only 39% of patients using triple therapy regularly before inhaled corticosteroid withdrawal; the remainder were placed on triple therapy solely for the purposes of the withdrawal study. In the SUNSET trial, long term triple therapy patients with no more than one exacerbation in the preceding year were randomized to continue triple therapy or to de-escalate to a second generation dual bronchodilator therapy - indacaterol/glycopyrronium 110/50 once daily.  This one step de-escalation better mirrored clinical practice than the gradual tapering approach of the WISDOM trial.  There was no increase in exacerbations after de-escalation and although average FEV1 decreased by 26 ml in the group that de-escalated, the decrease is so small as to be immeasureable in individuals.  In a post-hoc analysis, a subset of patients with persistently elevated blood eosinophil counts (greater than 300 cells per uL) were the ones most likely to have exacerbations in follow-up or to have changes in FEV1. 
Author Interviews, Primary Care, Pulmonary Disease / 15.12.2017

MedicalResearch.com Interview with: [caption id="attachment_38964" align="alignleft" width="107"]Dr Jennifer K Quint MSc PhD FHEA FRCP Clinical Senior Lecturer Respiratory Epidemiology Respiratory Epidemiology, Occupational Medicine and Public Health National Heart and Lung Institute Imperial College London Dr. Quint[/caption] Dr Jennifer K Quint MSc PhD FHEA FRCP Clinical Senior Lecturer Respiratory Epidemiology Respiratory Epidemiology, Occupational Medicine and Public Health National Heart and Lung Institute Imperial College London  MedicalResearch.com: What is the background for this study? What are the main findings? Response: We were commissioned by the Chartered Society of Physiotherapy in the UK to undertake a piece of work to show the value of pulmonary rehabilitation in reducing exacerbations in COPD patients so that they could create a web based tool that would show cost savings if GPs actually referred people for pulmonary rehabilitation. Previous systematic reviews have found that pulmonary rehab can reduce hospital admissions but those groups are often small and not very generalizable so we decided to look at what happens in a primary care COPD population. Our main finding is that people who are eligible for referral are not being referred  - less than 10% eligible were actually referred.
Author Interviews, NEJM, Pulmonary Disease / 10.09.2017

MedicalResearch.com Interview with: Dr Prof Nanshan Zhong, MD (Edin), FRCS (Edin), FRCP and Pixin Ran PhD National Center for Respiratory Diseases, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response:    According to the latest research, in 2015, 3.2 million people died from COPD globally, with an increase of 11.6% in mortality compared with that in 1990 (GBD 2015 Chronic Respiratory Disease Collaborators. Lancet Respir Med. 2017,5:691-706). COPD has now become the third leading cause of death worldwide and is estimated to become the disease with the seventh greatest burden worldwide in 2030. In China, the prevalence was 8.2% among people aged 40 years or greater, according to our epidemiological survey in 2007. Importantly, current international guidelines have been mainly focusing on the management of moderate-to-severe COPD. However, among this patient cohort, the severely impaired lung function can only be reversed to a very limited extent despite the most potent treatment combinations. Patients with more advanced COPD are frequently associated with a significantly higher mortality and incidence of re-hospitalization and disability, which cause tremendous economic burden for both the families and the society. However, more than 70% of COPD patients are currently categorized as having stage I to early stage II COPD, most of whom have no or very few respiratory symptoms (Zhong NS, et al. Am J Respir Crit Care Med. 2007, 176:753-760; Mapel DW, et al. Int J COPD 2011; 6: 573−581). The vast majority of these patients would have the “COPD assessment Test” (CAT) score of 10 or lower (range: 0 to 40, with higher scores indicating more severe COPD). Admittedly, no medication has been recommended for this patient cohort according to the latest international guidelines. In real-world practice, these patients are almost neglected by physicians and have received virtually no medication. Nonetheless, the annual lung function decline rates among these patients are the most rapid among all COPD patients. (Bhatt SP, et al. Am J Respir Crit Care Med 2015; 191: A2433). An important clinical question has been raised regarding whether an intervention strategy targeting at early stages of COPD can possibly make the airflow limitation more reversible or prevent from further deterioration.
Author Interviews, BMC, End of Life Care, Pulmonary Disease / 31.03.2017

MedicalResearch.com Interview with: [caption id="attachment_33567" align="alignleft" width="180"]Dr Sabrina Bajwah MBChB MRCGP MSc MA PhD Consultant Palliative Medicine, King’s College NHS Foundation Trust Honorary Senior Lecturer King's College London Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation London, UK Dr Sabrina Bajwah[/caption] Dr Sabrina Bajwah MBChB MRCGP MSc MA PhD Consultant Palliative Medicine, King’s College NHS Foundation Trust Honorary Senior Lecturer King's College London Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation London, UK  MedicalResearch.com: What is the background for this study? Response: Where people die is often important to them and their families, as well as being important for planning health care services. Most people want to die at home, but instead most die in hospital. While the trends have been studied in cancer, other diseases, such as respiratory, are rarely looked at even though they are common and increasing causes of death. Chronic Obstructive Pulmonary Disease (COPD) and Interstitial Pulmonary Diseases (IPD) are common respiratory conditions. Both conditions result in a high use of hospital services, especially among people in advanced stages. This leads to high healthcare costs.1 In the UK in 2010, it is estimated that IPD costs £16.2 million per year in hospitalisations.2 The NHS spends more than £810 million annually managing COPD, with inpatient stays accounting for around £250 million annually. Understanding which factors affect place of death is vital for planning services and improving care, especially given our ageing population, rising chronic diseases and the high costs of hospital admissions. Strategies in many countries have sought to improve palliative care and reduce hospital deaths for non-cancer patients, but their effects are not evaluated. We aimed to determine the trends and factors associated with dying in hospital in COPD and IPD, and the impact of a national end of life care (EoLC) strategy3 to reduce deaths in hospital. This study analysed a national data set of all deaths for COPD and IPD, covering 380,232 people over 14 years.
Author Interviews, JAMA, Mental Health Research, Pulmonary Disease / 06.01.2017

MedicalResearch.com Interview with: Meng-Ting Wang, PhD Associate Professor School of Pharmacy National Defense Medical Center Taipei, Taiwan MedicalResearch.com: What is the background for this study? Response: During the past decades, there have been multiple case reports about acute respiratory distress or acute respiratory failure (ARF) from the use of antipsychotics. Nevertheless, no population-based studies have been conducted to examine this potential drug safety issue. We aimed to investigate the association between use of antipsychotics and risk of ARF in a population of chronic obstructive pulmonary disease (COPD), who is vulnerable to ARF and frequently prescribed with antipsychotics.
Author Interviews, NEJM, Pulmonary Disease / 07.09.2016

MedicalResearch.com Interview with: Jørgen Vestbo DMSc FRCP FERS Professor of  Respiratory Medicine Division of Infection, Immunity and Respiratory Medicine University of Manchester Education and Research Centre University Hospital of South Manchester Manchester MedicalResearch.com: What is the background for this study? What are the main findings? Response: Efficacy studies are limited in their usefulness to clinicians as there are often restricted inclusion criteria, with many exclusion criteria and patients are followed closely with high adherence to study treatment. They therefore show what the drugs can do but not necessarily what they do do in the real world. Randomised studies in everyday practice, not limiting the entry (effectiveness trials) are therefore needed. In our study we showed that it is feasible to do randomised studies in the “real world”. Our study showed that a simple treatment with a once-daily combination of an inhaled corticosteroid and a long-acting beta-agonist (Breo/Relvar) was superior to the usual care chose by the patients’ general practitioners to manage their COPD.
Author Interviews, Biomarkers, Lancet, Pulmonary Disease / 25.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23751" align="alignleft" width="200"]Danny MvBryan, MD Vice president, Clinical Development & Medical Affairs, Respiratory Boehringer Ingelheim Pharmaceuticals, Inc. Dr. Danny MvBryan[/caption] Danny McBryan, MD Vice president, Clinical Development & Medical Affairs, Respiratory Boehringer Ingelheim Pharmaceuticals, Inc. MedicalResearch.com: What is the background for this study? What are the main findings? Dr. MvBryan: The new post-hoc analysis from the WISDOM study shows a routine blood test could help identify the small minority of patients with severe or very severe COPD who may benefit from the addition of inhaled corticosteroids (ICS). This post-hoc analysis was recently published online in The Lancet Respiratory Medicine. For 80 percent of patients in the WISDOM study, the use of ICS on top of SPIRIVA HANDIHALER (a long-acting muscarinic antagonist – LAMA) and salmeterol (a long-acting beta-agonist – LABA) had no additional benefit in reducing the risk of exacerbations, compared to SPIRIVA HANDIHALER and the LABA without ICS. The post-hoc analysis shows that these patients can be easily identified by measuring the level of white blood cells, called eosinophils. Patients with levels lower than 4 percent (300 cells/µL) were associated with a lack of response to ICS. The WISDOM study evaluated stepwise withdrawal of inhaled corticosteroids (ICS) in severe to very severe COPD patients with a history of exacerbation. WISDOM was a 12-month, double-blind, parallel-group, active-controlled study in which all patients received triple therapy (tiotropium 18 μg once daily, salmeterol 50 μg twice daily and fluticasone 500 μg twice daily) for a six-week run-in period. Patients were randomized 1:1 to continue triple therapy or stepwise withdrawal of ICS over 12 weeks (dose reduction every six weeks). The WISDOM data show that in patients with severe to very severe COPD, the risk of moderate/severe exacerbations during one year of follow-up was non-inferior between those patients who continued on inhaled corticosteroids and those where ICS therapy was withdrawn in a stepwise manner.
Author Interviews, Biomarkers, Lancet, Pulmonary Disease / 14.04.2016

MedicalResearch.com Interview with: Dr Henrik Watz MD Pulmonary Research Institute at Lung Clinic Grosshansdorf Airway Research Center North, German Center for Lung Research Grosshansdorf, Germany Medical Research: What is the background for this study? What are the main findings? Dr Watz : While bronchodilators are the mainstay therapy for all patients with COPD some patients benefit from the addition of inhaled corticosteroids in case of frequent exacerbations. So far only little data exist that help clinicians to better characterize those patients that may benefit from the continuation of inhaled corticosteroids on top of dual bronchodilation with a LABA and a LAMA. Post-hoc analyses of the WISDOM dataset suggest that those patients, who have blood eosinophil counts of 4 % or greater or 300 eosinophils per µL or more have less exacerbations, when inhaled corticosteroids are continued compared to patients, in whom inhaled corticosteroids are withdrawn. Patients with less than 4 % eosinophils or less than 300 eosinophils in peripheral blood, who represent 80 % of the study population in WISDOM, did not benefit from a continuation of inhaled corticosteroids.
Author Interviews, JAMA, Pulmonary Disease, Smoking / 07.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23256" align="alignleft" width="117"]Dr. William Phillips MD MPH USPSTF Task Force member and Theodore J. Phillips Endowed Professor in Family Medicine University of Washington, Seattle. Dr. Phillips is also a founder and senior associate editor of the Annals of Family Medicine Dr. William Phillips[/caption] Dr. William Phillips MD MPH USPSTF  Task Force member and Theodore J. Phillips Endowed Professor in Family Medicine University of Washington, Seattle. Dr. Phillips is also a founder and senior associate editor of the Annals of Family Medicine MedicalResearch.com: What is the background for this study? What are the main findings?  Dr. Phillips: Chronic obstructive respiratory disease, or COPD, is a serious, chronic condition that affects a person’s ability to breathe. It is the third leading cause of death in the United States. When the Task Force reviewed the research on screening adults for COPD in a primary care setting, we concluded with moderate certainty that screening has no net benefit, which is why we do not recommend screening for COPD in people who do not have symptoms.
Author Interviews, Pulmonary Disease / 30.03.2015

Gulshan Sharma, MD, MPH Division of Pulmonary Critical Care and Sleep Medicine University of Texas Medical Branch Galveston, TXMedicalResearch.com Interview with: Gulshan Sharma, MD, MPH Division of Pulmonary Critical Care and Sleep Medicine University of Texas Medical Branch Galveston, TX Medical Research: What is the background for this study? What are the main findings? Dr. Sharma: Thirty-five years ago, two multicenter trials reported substantial improvements in survival and quality of life with continuous oxygen therapy in the treatment of severe hypoxemia associated with chronic obstructive pulmonary disease (COPD). Notably, aside from smoking cessation, no other medical intervention therapy has been shown to improve survival for patients with COPD. It is estimated that upto a third of the patients who are prescribed oxygen continue to smoke. Using large claims data of Medicare beneficiaries with COPD, we found that patients with COPD who had a burn injury were more likely to have been prescribed oxygen therapy in the preceding 90 days compared to the control subjects. Patients with COPD on oxygen who had burn injury, the face, head and neck region were more commonly involved. In the U.S. oxygen is prescribed to an estimated one million Medicare beneficiaries, based on our estimates a physician would have to treat 1,421 patients with oxygen therapy for one year to cause one burn injury.
Author Interviews, BMJ, Nutrition, Pulmonary Disease / 05.02.2015

MedicalResearch.com Interview with: Raphaëlle Varraso INSERM U1168, VIMA (Aging and chronic diseases. Epidemiological and public health approaches), 16 avenue Paul Vaillant Couturier Villejuif, France MedicalResearch: What is the background for this study? What are the main findings? Response: Respiratory health and lung function, strongly predict general health status and all-cause mortality. Chronic obstructive pulmonary disease (COPD) is currently ranked the third leading cause of death worldwide. The predominant risk factor for COPD in the developed world is cigarette smoking, but up to one-third of COPD patients have never smoked, suggesting that other factors are involved. Besides smoking, relatively little attention has been paid to other modifiable risk factors that might decrease risk of developing COPD, including diet. The Alternate Healthy Eating Index (AHEI)-2010, a new measure of diet quality based on current scientific knowledge, has been linked to risk of major chronic diseases, such as cardiovascular disease, diabetes and cancer. However, the role of dietary scores on risk of COPD is unknown. We examined this issue among >120,000 US female and male health professionals (Nurses’ Health Study and Health Professionals Follow-up Study), and we reported that a high AHEI-2010 dietary score score (reflecting high intakes of whole grains, vegetables, fruit, polyunsaturated fatty acids, nuts and legumes, and long-chain omega-3 fats, a moderate intake of alcohol, and low intakes of red/processed meats, trans fat, sodium and sugar-sweetened beverages) was associated with a lower risk of COPD in both women and men. This novel finding supports the importance of diet in COPD pathogenesis.
Author Interviews, CHEST, Hospital Readmissions, Pulmonary Disease / 03.01.2015

Tina Shah, MD University of Chicago Medicine Department of Pulmonary and Critical Care University of ChicagoMedicalResearch.com Interview with: Tina Shah, MD University of Chicago Medicine Department of Pulmonary and Critical Care University of Chicago Medical Research: What is the background for this study? What are the main findings? Dr. Shah: The reason why we undertook this study is to better understand the Medicare COPD population that falls under the purview of the CMS Hospital Readmissions Reduction Program (HRRP). This program places up to a 3% penalty on all Medicare revenues for hospitals that take care of beneficiaries should a hospital exceed its “expected readmission rate.” Previously 30 day readmissions after index admissions for congestive heart failure, acute myocardial infarction and pneumonia fell subject to the HRRP. As of October 2014, COPD has been added to the list, despite minimal evidence to guide hospitals in how to curb COPD readmissions. The goal of this research was to provide an epidemiological background for this population and identify trends as a hypothesis generating first step to predict who is most likely to be readmitted and to identify targets for successful future interventions on this group. Our study population is unique in that we longitudinally look at about 1/2 of all Medicare admissions for COPD exacerbations, using the CMS guideline definition which is based on discharge ICD-9 codes. As described in previous literature, there is a large discrepancy between identification of COPD by provider versus coding algorithm, however since the Hospital Readmissions Reduction Program is based on discharge coding it is important to examine this particular group.
Author Interviews, CHEST, Nutrition, Pulmonary Disease / 26.11.2014

Refaat Hegazi, MD, PhD, MS, MPH Medical Director, Abbott Nutrition Affiliate Research Associate Professor, The Brody School of Medicine at East Carolina UniversityMedicalResearch.com Interview with: Refaat Hegazi, MD, PhD, MS, MPH Medical Director, Abbott Nutrition Affiliate Research Associate Professor, The Brody School of Medicine at East Carolina University Medical Research: What is the background for this study? What are the main findings? Dr. Hegazi: This study stems from the need to address the financial and health burdens that Chronic Obstructive Pulmonary Disease (COPD) places on the United States. It is the third leading cause of death in the U.S. and costs us about $50 billion a year. It’s a devastating and chronic condition that plagues patients on a daily basis, and previous studies have shown that proper nutrition is essential for proper pulmonary function and rehabilitation. In a retrospective study of inpatient medical records, we found that by ensuring the nutritional needs of COPD patients were met with oral nutritional supplements (ONS), we were able to tackle the issue of cost, as well as better health outcomes. Specifically, the COPD patients that received oral nutritional supplements, experienced reduced length of hospitalization, lower average hospital costs, and lower readmission rates within 30 days, compared to those that did not.
Author Interviews, Exercise - Fitness / 03.11.2014

Paul D. Loprinzi, PhD Center for Health Behavior Research Department of Health, Exercise Science and Recreation Management The University of Mississippi, University, MS.MedicalResearch.com Interview with: Paul D. Loprinzi, PhD Center for Health Behavior Research Department of Health, Exercise Science and Recreation Management The University of Mississippi, University, MS. Medical Research: What is the background for this study? What are the main findings? Dr. Loprinzi: COPD not only induces inflammation in the lung, but systemic inflammation as well.  Therefore, individuals with COPD are at an increased risk of cardiovascular and metabolic disease as a result of increased systemic inflammation.  Physical activity has been shown to reduce systemic inflammation in the general population, but the association between physical activity and systemic inflammation among those with COPD is less established.  Our study demonstrated that individuals with COPD who were more active had less systemic inflammation than those who were less active.
Author Interviews, CDC, JAMA, Tobacco / 15.10.2014

Dr. Brian Rostron PhD, MPH Center for Tobacco Products US Food and Drug Administration Silver Spring, MarylandMedicalResearch.com Interview with: Dr. Brian Rostron PhD, MPH Center for Tobacco Products US Food and Drug Administration Silver Spring, Maryland Medical Research: What are the main findings of the study? Dr. Rostron: We estimated that Americans in 2009 had had 14 million major medical conditions such as heart attack, stroke, lung cancer, and COPD that were attributable to smoking.  COPD was the leading cause of smoking-attributable morbidity, with over 7.5 million cases of COPD attributable to smoking.
Author Interviews, JAMA, Pulmonary Disease / 20.09.2014

Andrea Gershon MD, MSc, FRCP(C) Scientist, Institute for Clinical Evaluative Sciences Respirologist, Division of Respirology, Sunnybrook Health Sciences Centre Assistant Professor of Medicine, University of Toronto ICES Central Bayview Avenue, Toronto, OntarioMedicalResearch.com Interview with: Andrea Gershon MD, MSc, FRCP(C) Scientist, Institute for Clinical Evaluative Sciences Respirologist, Division of Respirology, Sunnybrook Health Sciences Centre Assistant Professor of Medicine, University of Toronto ICES Central Bayview Avenue, Toronto, Ontario Medical Research: What are the main findings of the study? Dr. Gershon: Within a large real world population of people with COPD, those who initiated combination long-acting beta-agonists (LABA) and inhaled corticosteroids (ICS) were less likely to die or be hospitalized for COPD than those who initiated LABA alone. Further those who initiated LABA/ICS combination therapy did not appear to have more pneumonia or osteoporotic fractures – side effects that have been associated with ICS use—than those initiating LABA alone. A second interesting finding was that people with a co-diagnosis of asthma experienced a greater incremental benefit of LABA/ICS over LABA than people without a co-diagnosis of asthma. Finally, we found that people who were not also taking an inhaled long-acting anticholinergic medication experienced a greater incremental benefit of LABA/ICS over LABA than people who were.
Author Interviews, CMAJ, Metabolic Syndrome, Pulmonary Disease, Weight Research / 14.07.2014

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.
Author Interviews, Pulmonary Disease / 27.06.2014

MedicalResearch.com Interview with: Dr. Juan P de Torres Pulmonary Department Clínica Universidad de Navarra Pamplona, Spain;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.
Author Interviews, CHEST, Pulmonary Disease / 19.05.2014

Dr. Hoi Nam Tse,  FCCP, MRCP, MBChB Associate Consultant, Kwong Wah Hospital, Hong Kong Life member and Council member of Hong Kong Thoracic SocietyMedicalResearch.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.
Cognitive Issues, JAMA, Mayo Clinic, Medical Research Centers, Pulmonary Disease / 19.03.2014

Michelle M. Mielke, Ph.D. Associate Professor Department of Health Sciences Research, Division of Epidemiology Department of Neurology Mayo Clinic Rochester, MN 55905MedicalResearch.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.
Annals Thoracic Surgery, Author Interviews, NIH, Pulmonary Disease / 09.03.2014

Surya P Bhatt MD Assistant Professor Division of Pulmonary and Critical Care Medicine University of Alabama at BirminghamMedicalResearch.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.
Author Interviews, CHEST, Pulmonary Disease, Smoking / 23.02.2014

Chunxue Bai, MD & PhD Director, Shanghai Respiratory Research Institute Professor of Medicine, Chairman, Shanghai Leading academic discipline Chair, Chinese Alliance against Lung Cancer Vice President of Respiratory Society, Chinese Medical Association Editor-in-Chief, Translational Respiratory Medicine (Springer) Editor-in-Chief, International journal of Respiration (China) Editor-in-Chief, Perspectives of Respiratory Medicine (China)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.