COPD

How diagnosing and treating asthma, COPD early can significantly improve quality of life

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Four lung scans are highlighted in blue
Experts say diagnosing asthma, COPD early is crucial.
  • Researchers report that as many as 70% of people with chronic obstructive pulmonary disease (COPD) or asthma could be undiagnosed.
  • They say that receiving a diagnosis and treatment can dramatically improve health and quality of life for a person with one of those conditions.
  • They add the people should take respiratory symptoms seriously and consult a physician and request a spirometry test if they’re concerned.

Next time you go to the doctor, maybe ask them to check your breathing — especially if you’ve been experiencing even minor trouble.

Nearly seven out of 10 people with asthma or chronic obstructive pulmonary disease (COPD) are undiagnosed, a situation that can lead to worse long-term health outcomes and lower quality of life than if a person had received diagnosis and treatment earlier, a new study published in the New England Journal of Medicine reports.

This research is the first of its kind to look at not only rates of diagnosis for asthma and COPD but also to detail the effects of early treatment and diagnosis on quality of life and health system burden.

“I’m a practicing pulmonologist and I see a lot of people who come to my office who’ve experienced symptoms of asthma or COPD for months to years, and the diagnosis hasn’t been made,” Dr. Shawn Aaron, a lead study author as well as a respirologist and senior scientist at the Ottawa Hospital Research Institute and a professor at the University of Ottawa in Canada, told Medical News Today.

“So we did this study where we looked at people who were who we diagnosed with no previous history of asthma or COPD and we diagnosed them,” he explained. “We found that compared to people their age, those who are undiagnosed with COPD or asthma have a much worse quality of life. They have impaired work performance and impaired work attendance because they’re taking days off because of their respiratory symptoms. These are people that are suffering sort of silently because they’re not they’re either not seeing their doctors or their doctors are not doing the proper diagnosis.”

Details from the asthma, COPD diagnosis study

Researchers surveyed more than 26,000 people about shortness of breath and lung function to find a group of 595 asthma and COPD diagnoses, which were confirmed using a gold-standard spirometry test.

Of this group, 508 agreed to participate in a clinical study where half received typical clinical care for these conditions and the other half had regular visits with a lung specialist.

Both groups received help with 92% of those seeing lung specialists receiving new medications to treat the conditions as well as 60% of those who received usual care.

Those who saw lung specialists took fewer trips to the doctor in the following year (0.53 compared to 1.12 per participant) and had larger improvements on the St. George’s Respiratory Questionnaire (10 point increase compared to less than 7) when compared to their counterparts receiving usual care.

Researchers reported that both groups also improved far more than if they had remained undiagnosed. They said a four-point improvement on the respiratory questionnaire represents a significant increase in health and quality of life, which each study group experienced.

“Overall, these results are inspiring,” said Dr. Robert Jasmer, a pulmonologist at Pulmonary Associates of Burlingame in California who was not involved in the research.

“Given the specialized training and experience that we as pulmonologists have with patients who have asthma and COPD, it was nice to see the benefits of diagnosis and early treatment confirmed in a community-based study published in a prestigious medical journal,” Jasmer told Medical News Today.

Why people with COPD and asthma go undiagnosed

On some level, the findings of this study are common sense. Of course, people with an undiagnosed medical condition do better after receiving a diagnosis.

However, beneath that is the more probing question of just why so many people go undiagnosed with serious respiratory illnesses.

The answer is multi-faceted, but one reason, especially where COPD is concerned, is that it tends to hit people later in life, which can make the symptoms easier to ignore until they progress to a state that’s undeniable, according to Aaron.

“You don’t usually start developing COPD until you’re in your sixties,” he said. “Many people who start developing COPD become more and more short of breath, and the shortness of breath is progressive, and they decline with more shortness of breath every month or two or three. Maybe they’re in denial or just figure that they’re getting older.”

Physicians can also perpetuate this dynamic.

“Sometimes the doctor will wave away the symptoms and the complaints and say, ‘Oh, yeah, well, you’re 65 now, we expect you to be a little short of breath,’” Aaron said. “Sometimes the doctor has good intentions but doesn’t make the diagnosis.”

How to talk to your doctor about COPD, asthma

Patient self-advocacy can help.

“If you’re experiencing prolonged cough, it doesn’t go away after eight weeks, or you’re experiencing wheezing or chest tightness — this is not normal. And you shouldn’t assume that everything is fine,” Aaron said. “You should go to your physician and you should insist on the physician ordering a spirometry test for you. What I would tell the public because we now know that if we find this and we treat it, you will get better.”

Jasmer echoed that sentiment.

“This study is important because there has been a lot of negativity for most of my education and career around COPD, especially as being an end-stage and hopeless disease for which treatment is not helpful-that is not correct, so COPD particularly suffers from a major PR problem,” he said. “Public perceptions about COPD being untreatable are not true and asthma is almost entirely treatable and usually completely reversible. While patients with COPD can help their symptoms with lifestyle changes such as quitting smoking and exercising, there are still many other effective medical treatments available that they can discuss with their doctor to further improve their symptoms, which will also improve their quality of life.”

High dietary niacin intake associated with decreased likelihood of COPD

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Key takeaways:

  • Preliminary results suggest vitamin B3 may protect against COPD.
  • More research is needed to determine the optimal dosage and timing of dietary niacin to enhance lung function and prevent COPD.

Higher dietary niacin intake was associated with reduced COPD prevalence in adults, according to a study published in Scientific Reports.

Wen-Wen Li, from Dongying People’s Hospital in China, and colleagues pointed to previous research showing “that certain vitamins, notably vitamins A, C, D and E, have a positive impact on COPD.”

PC0224Li_Graphic_01_WEB

“These vitamins can be ingested either as supplements or through a well-balanced diet,” they wrote, although the relationship between vitamin B3, or niacin — found in foods like meat, nuts and fish — and COPD “remains unexplored.”

The researchers assessed possible correlations between dietary niacin intake and COPD using data from adults enrolled the National Health and Nutrition Examination Survey between 2003 and 2012.

The adults were then divided into COPD (n = 243) or non-COPD (n = 6,812) groups.

Compared with the non-COPD group, those with COPD were older and had a lower daily mean dietary niacin intake (21.39±0.62 mg vs. 25.29±0.23 mg).

Li and colleagues found that those in the highest quartile of dietary niacin intake had decreased odds of COPD compared with those in the lowest quartile (OR = 0.55; 95% CI, 0.33-0.89).

The results “suggest that niacin could serve as a protective factor against the onset of COPD,” they said, although the mechanisms are still not fully understood.

“Research indicates that niacin and its primary metabolite have antioxidant and anti-inflammatory effects,” they wrote. “Given these properties, niacin is likely to aid in preventing COPD by reducing inflammation in the airways, protecting them from oxidative damage, and improving their overall functionality.”

The study had several limitations. For example, the researchers could not determine causality, and the food frequency questionnaire that patients completed may have been vulnerable to misclassification and recall bias.

Ultimately, “further research is required to ascertain whether niacin as an alternative therapy can enhance lung ventilation function and effectively prevent COPD,” Li and colleagues concluded. “Additionally, there is a need for more detailed studies to establish the optimal dosage and timing for niacin’s potential beneficial effects on COPD.”

COPD and the effect of low-dose cadmium, a highly toxic metal, on airway epithelial cells.

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cigarette smoking

Cigarette smoke exposure is associated with the development and severity of chronic obstructive pulmonary disease, or COPD, which is the third leading cause of death worldwide.

Cigarette smoke contains 2–3 micrograms of cadmium, a highly toxic metal and environmental pollutant, per cigarette. Burning tobacco releases cadmium oxide that can be adsorbed onto microparticles in smoke that travel deep into the lungs. Furthermore, the body is not able to remove cadmium, which accumulates in longtime smokers.

In a Scientific Reports study, University of Alabama at Birmingham researchers show how a low dose of cadmium produces a deleterious stress in lung epithelial cells, and their findings highlight potential therapeutic targets to be explored in cadmium-exposure and subsequent lung injury.

The research, led by Veena Antony, M.D., a professor in the UAB Department of Medicine, focuses on microRNA-381, and the expression of a chloride channel gene called ANO1 in lung tissue samples and airway epithelial cells. ANO1 helps produce mucus in the airway; but overproduction of mucus in chronic lung disease can lead to airway thickening and mucus blockage, adding to severity of the disease. Thus, overexpression of ANO1 can exacerbate COPD.

The UAB researchers compared lung tissue samples from nine “never” smokers, who had zero history of cigarette smoking, and lung tissue samples from 13 “ever” smokers with COPD who had a history of smoking that ranged from 15 to 25 pack years per person.

One pack year is generally defined as smoking one pack of cigarettes a day for one year. The researchers found that “ever” smokers, in contrast to “never” smokers, had upregulated ANO1 expression in airway epithelial cells.

Similarly, airway epithelial cells in a bronchoalveolar lavage fluid from one non-COPD subject and one smoker with COPD showed greater ANO1 expression in the COPD-subject cells.

The researchers next tested the direct effect of very low doses of cadmium on normal human airway epithelial cells. These cells were grown on an air-liquid interface that allows the airway cells to differentiate normally. Two weeks of exposure to 0.5 or 1.0 micromolar cadmium chloride in the liquid layer increased expression of ANO1 12 to 14 times.

MicroRNAs have the ability to downregulate expression of a gene by direct interaction with that gene’s mRNA sequence. The UAB team used computer software analysis to identify microRNA-381 as the microRNA with most interaction with ANO1 mRNAs, suggesting that microRNA-381 is a negative regulator of ANO1. Some heavy metals are known to negatively regulate microRNAs.

Antony and colleagues used a synthetic inhibitor for microRNA-381 to inhibit the expression of microRNA-381 in primary human airway epithelial cells from subjects with COPD, and found that ANO1 expression was upregulated significantly.

COPD Exacerbated by Gum Disease

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Severe gum disease has been linked to the progression of chronic obstructive pulmonary disease, or COPD. However, it is not fully understood how the connection plays out in the immune system. Now, a new study reveals immune system cells that play a key role in the microbial link between COPD and gum disease. Researchers from Sichuan University, in China, report that bacteria associated with gum disease promote COPD through the activation of two types of cells, γδ T cells and M2 macrophages.

The findings are published in mSystems in an article titled, “Periodontitis aggravates COPD through the activation of γδ T cell and M2 macrophage.”

“COPD is a chronic systemic inflammatory disease with high morbidity and mortality,” wrote the researchers. “Periodontitis exacerbates COPD progression; however, the immune mechanisms by which periodontitis affects COPD remain unclear. Here, by constructing periodontitis and COPD mouse models, we demonstrated that periodontitis and COPD could mutually aggravate disease progression. For the first time, we found that the progression was associated with the activation of γδ T cells and M2 macrophages, and M2 polarization of macrophages was affected by γδ T cells activation.”

“By enhancing periodontal therapy and targeting the inhibition of γδ T cells and M2 macrophages [we] may be able to help control the progression of COPD,” said microbiologist Boyu Tang, PhD, who led the study with microbiologist Yan Li, PhD.

Periodontitis is a chronic infectious disease, and previous studies have found that it’s a risk factor for a raft of diseases, including diabetes, hypertension, some cancers, cardiovascular disease, and COPD.

Previous studies, including some led by Li and Tang, have established that the oral bacteria Porphyromonas gingivalis plays an important role in gum disease. For the current study, Li, Tang, and their colleagues used mouse models to show how those bacteria could aggravate progression of COPD. In one experiment, they showed that mice infected with both periodontitis and COPD had worse progression of COPD than mice infected with COPD alone.

In another experiment, they observed that in mice orally infected with P. gingivalis, the bacteria migrated to and infected lung tissue, leading to a significant, observable change in the lung microbiota. Further observations using flow cytometry and immunofluorescence revealed that periodontitis promoted the expansion of the immune cells in the lung tissue. Finally, in experiments using mouse lung tissue, the group connected the dots by showing that P. gingivalis could activate the immune cells, promoting their ability to produce cytokines associated with worsening COPD.

The researchers noted that the decrease in lung function and increase in immune cells was more modest than they’d predicted, but that could be an artifact of the experimental setup. The team created COPD animal models using exposure to cigarette smoke. “If the cigarette smoke exposure could be extended for a longer period of time, these changes might be more pronounced,” Li said. In future studies, Li said that the group plans to investigate how increases in smoke exposure might affect the immune response.

“We’ll further carry out additional studies on human subjects to confirm the mechanism,” Li said. They plan to recruit patients with both conditions and offer periodontitis treatment, then compare lung function and immune cell counts before and after. “Our finding could lead to a potential new strategy for treating COPD.”

Gabapentinoids in COPD Patients May Raise Risk for Severe Exacerbations

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39% higher risk compared with nonusers, database study finds

A photo of a senior woman at home holding an oxygen mask to her face

Gabapentinoid use in patients with chronic obstructive pulmonary disease (COPD) was associated with a higher risk for severe exacerbations, a population-based cohort study from Canada indicated.

Among more than 27,000 COPD patients, those who started therapy with the anticonvulsant for either epilepsy, neuropathic pain, or some other form of chronic pain had a 39% greater risk for severe exacerbations compared with a matched group of nonusers (HR 1.39, 95% CI 1.29-1.50), reported Christel Renoux, MD, PhD, of the Lady Davis Institute and Jewish General Hospital in Montreal, and colleagues in Annals of Internal Medicineopens in a new tab or window.

The findings were consistent across age, sex, and COPD severity, and the increased risk for severe exacerbations remained consistent across the three subgroups studied:

  • Epilepsy: HR 1.58 (95% CI 1.08-2.30)
  • Neuropathic pain: HR 1.35 (95% CI 1.24-1.48)
  • Other chronic pain: HR 1.49 (95% CI 1.27-1.73)

“Public health agencies have released warnings of respiratory depressionopens in a new tab or window as a potentially serious adverse effect of gabapentinoids, including for patients with COPD,” wrote Renoux and co-authors. “However, these directives are yet to be echoed in clinical practice guidelines for the management of COPD and of neuropathic pain.”

“Several guidelines for the management of neuropathic pain recommend gabapentinoids as first-line pharmacotherapeutic options,” they continued. “Although one guideline noted gabapentinoids’ potential for misuse and dependence, none mentioned the potential for respiratory adverse effects. Thus, our findings may help inform the prescription of gabapentinoids in patients with COPD.”

On- and off-label gabapentinoid prescriptions are on the riseopens in a new tab or window across North America, partly in response to the opioid epidemic, the authors suggested, given that the class of drugs are often perceived as a safer alternative to opioidsopens in a new tab or window.

“These trends are of concern because gabapentinoids are not effective in many of these off-label indications, yet they expose patients to potentially serious adverse effects,” Renoux and co-authors noted. “In particular, their propensity to cause central nervous system depression leading to sedation and respiratory depression has been reported in both animal and human studies.”

The analysis used three digital health insurance databases in Quebec and included 13,504 COPD patients ages 55 and older exposed to gabapentinoid from 1994 to 2015 for either epilepsy (n=356), neuropathic pain (n=9,411), or other chronic pain (n=3,737). These patients were matched to an equal number of COPD patients with epilepsy, neuropathic pain, or other chronic pain but who were not exposed to gabapentinoids.

The study’s main outcome was a severe COPD exacerbation requiring hospital admission or resulting in death.

For secondary outcomes, gabapentinoid use was also associated with an increased risk for either moderate or severe exacerbations, as well as respiratory failure, in patients taking the drugs for neuropathic or other chronic pain. Precision was limited regarding this association in patients with epilepsy, the researchers reported.

COPD was defined by relevant medications for the condition based on ICD codes, which included the possibility of misclassification if patients were prescribed long-acting beta-agonist/inhaled corticosteroids for asthma.

Other limitations included that data on race/ethnicity were missing, as were details on smoking status, and that the study may have captured more patients ages 65 and older, “because all persons in this age group are insured for prescription medication in Quebec,” Renoux and colleagues said.

Could Inhaling a Statin Help Ease Asthma, COPD?

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News Picture: Could Inhaling a Statin Help Ease Asthma, COPD?By Ernie Mundell HealthDay Reporter

FRIDAY, Jan. 5, 2024

Drugs already used by millions to lower cholesterol might someday have a new role: Relieving asthma and COPD.

That’s the hope of a new line of research underway at the University of California, Davis.

A study funded by the U.S. National Institutes of Health is seeking to determine whether a “statin inhaler” might reduce the airway inflammation that makes breathing difficult for folks with illnesses like asthma or chronic obstructive pulmonary disease (COPD).

Taking a statin pill has no significant effect on the airways, but “delivering statins directly to the lung via inhalation might achieve better local tissue drug levels, and therefore, better clinical results,” theorized lead investigator Amir Zeki, a professor of internal medicine who specializes in pulmonary, critical care and sleep medicine at UC Davis.

This research is still in its early stages. However, if it pans out it might offer another treatment option to the more than 26.5 million Americans with asthma and the more than 16 million battling COPD.

Zeki’s team is focusing on what’s known as airway smooth muscle (ASM) — tissue which lies within each airway’s wall and helps control airflow.

The inflammation that drives asthma can trigger a tightening of smooth muscle, restricting airways. This “hyperactivity” of smooth muscle also plays a role in COPD, the researchers explained.

Treatments such as asthma bronchodilators already target receptors on specific smooth muscle cells, triggering a healthy relaxation of the muscle. But these meds aren’t always effective.

“Despite their widespread use, current inhaler therapies that treat asthma and COPD remain inadequate in controlling symptoms for many patients, especially those with moderate to severe disease,” Zeki said in a UC Davis news release. “For this reason, we need novel inhaled medications to treat obstructive airway diseases such as asthma via mechanisms of action different from current standard-of-care therapies.”

That’s where the anti-inflammatory properties of statins come in. Studies in the lab have shown that these drugs enhance the cellular function of airways in various ways.

“To our surprise, we have discovered that statins also work as a bronchodilator, in which they directly relax ASM tissue, leading to the opening of airways,” Zeki said.

Statins taken as pills have not shown any benefit against airway disease, however. That’s because the liver breaks down drugs taken as pills, minimizing any benefit that might accrue by the time the drug makes it to an airway.

Using an inhaler to deliver a statin directly to the airway bypasses that issue.

“This allows us to deliver significantly lower doses to the airways with hopefully greater potency,” Zeki said.

Phase 1 and phase 2 clinical trials are planned in which patients with asthma and COPD will try out statin inhalers for safety and effectiveness.

“We have successfully developed a proprietary formulation that is available and ready for first-in-human testing,” Zeki said. “Our aim is to begin with asthma, but we also have plans to investigate COPD as well.”

Nine controversial questions about augmentation therapy for alpha-1 antitrypsin deficiency: a viewpoint

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Abstract

Augmentation therapy with intravenous alpha-1 antitrypsin is the only specific treatment for alpha-1 antitrypsin deficiency (AATD)-associated emphysema. This treatment has been available and remained basically unchanged for more than 35 years, but many questions persist regarding its indications, regimen of administration and efficacy. Because AATD is a rare disease, it has not been possible to conduct randomised, placebo-controlled trials that are adequately powered for the usual outcomes analysed in non-AATD-related COPD, such as lung function decline, exacerbations, symptoms or quality of life. New outcomes such as lung densitometry measured by computed tomography are more sensitive for identifying emphysema progression but are not widely accepted by regulatory agencies. In addition, clinical manifestations, severity and the natural history of lung disease associated with AATD are very heterogeneous, which means that individual prediction of prognosis is challenging. Therefore, the indication for augmentation is sometimes a dilemma between initiating treatment in individuals who may not develop significant lung disease or in whom disease will not progress and delaying it in patients who will otherwise rapidly and irreversibly progress.

Other areas of debate are the possible indication for augmentation in patients with severe AATD and respiratory diseases other than emphysema, such as bronchiectasis or asthma, and the use of therapy after lung transplant in AATD patients. All these uncertainties imply that the indication for treatment must be personalised in expert reference centres after in-depth discussion of the pros and cons of augmentation with the patient.

Conclusions

Although AT has been in use for more than 30 years, there is large variability in its use and there are still several uncertainties regarding its indication. A personalised approach to the indication and treatment regimen seems to be the most adequate, but there is a lack of evidence about aspects, such as the right protective threshold for each patient, the efficacy of different treatment regimens and the right outcome for evaluating the evolution of emphysema. Currently, there is no evidence for the treatment of Pi*MZ or Pi*SZ heterozygotes, or patients with AATD and bronchiectasis or asthma without significant or progressive coexistent emphysema. In this context, individualised prescription in reference centres with a discussion between the patient and the healthcare provider on the pros and cons of AT is necessary.

10 supplements for COPD

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Chronic obstructive pulmonary disease (COPD) is a term for a group of chronic lung conditions including chronic bronchitis, refractory asthma, and emphysema. Several supplements and remedies may help ease COPD symptoms.

People with COPD find it increasingly difficult to breathe. Among other symptoms, they may experience coughing, wheezing, and a feeling of tightness in the chest.

Nutrition is very important for the 15.7 million peopleTrusted Source in the United States with a COPD diagnosis.

According to the COPD Foundation, people with COPD may need 430–720 more calories per day than other people due to the effort they need to exert breathing.

In fact, 25–40%Trusted Source of people with COPD are also dealing with malnutrition, which interferes with their long-term outlook.

At present, there is no cure for COPD. However, the American Lung Association suggests that eating a high fat, low carbohydrate diet can be helpful for people with breathing problems.

There are also several supplements and remedies people with COPD can try to support their medical treatment and help them manage their condition. Keep reading to learn more.

Vitamins

MoMo Productions/Getty Images

ResearchersTrusted Source have identified the following vitamins for COPD treatment and support:

1. Vitamin D

Many people with COPD have low vitamin D. Taking vitamin D supplements may help the lungs function better.

Taking vitamin D3 supplements for COPD can also protect against moderate or severe flare-ups.

2. Vitamin C

Low levels of vitamin C are linked to increases in shortness of breath, mucus, and wheezing.

3. Vitamin E

People experiencing a flare-up of COPD symptoms tend to have lower levels of vitamin E than people whose COPD is stable.

Other studies suggest that long-term use of vitamin E supplements may help prevent COPD.

4. Vitamin A

An older review notes one study found individuals with the highest intake of vitamin A had a 52%Trusted Source lower risk of COPD.

Minerals

Researchers have identified the following minerals for COPD treatment and support:

5. Magnesium

Magnesium supports lung function, but some COPD medications may interfere with the body’s ability to absorb it.

People should also exercise caution when taking magnesium supplements for COPD. It can interfere with some drugs and cause side effects.

6. Calcium

Calcium can help the lungs function, but some COPD medications may cause the body to lose calcium. This makes it even more important for people with COPD to consider increasing calcium-rich foods in their diet.

If a person cannot reach their calcium needs through diet, it may be necessary to take a calcium supplement.

Other supplements

Researchers have identified the following additional supplements for COPD treatment and support:

7. Omega-3 fatty acids

Increasing the intake of omega-3 fatty acids may reduce inflammation in people with COPD. Although omega-3s are present in fish, seeds, and nuts, some people take fish oil supplements to make sure they get enough of this nutrient.

8. Dietary fiber

Eating more dietary fiber may leadTrusted Source to a lower risk of COPD.

9. Herbal teas

Many people with COPD use the following teas to help reduce their symptoms:

  • green tea
  • chamomile tea
  • lemon balm tea
  • lime tea
  • linseed tea
  • sage tea
  • thyme tea
  • mallow tea
  • rosehip tea
  • mint tea

In fact, some research has shown that drinking green tea at least twice per day may reduce the risk of developing COPD.

10. Curcumin

Present in turmeric, curcumin is sometimes called a natural anti-inflammatory.

Some research suggests it may help treat the inflammation of the airways in COPD.

Read about some natural remedies for COPD here.

When to see a doctor

COPD is chronic and progressive, which means it does not go away and tends to get worse with time. People with COPD need to meet with their doctor regularly to monitor and manage their condition.

Even though prescription drugs cannot reverse the gradual decline in breathing capacity, they can help people with COPD manage their symptoms.

Also, getting regular flu shots can help people with COPD prevent illnesses that could cause serious complications. For these reasons, people with COPD need regular medical care.

Although taking supplements for COPD can be helpful, people with this condition need to speak with a doctor or other qualified healthcare professional about all the supplements they are taking or planning to take.

Vitamins, minerals, herbs, and other products may interact and interfere with COPD medications. They can also cause side effects.

Summary

COPD is a serious and chronic health condition.

Although there is currently no cure for this condition, medical treatment can help people manage their symptoms. Using herbal and nutritional supplements for COPD may also help with symptom management.

Before taking any supplements, a

Are Antibiotics Needed for Moderate Acute Exacerbations of COPD?

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Maybe not for one subgroup of patients, says study from Germany

The need for antibiotics in patients with chronic obstructive pulmonary disease (COPD) seeking treatment for moderate acute COPD exacerbations could not be ruled out in a randomized trial from Germany, except perhaps for one subgroup.

In the ABACOPD study of nearly 300 patients, the overall treatment failure rate among those receiving 5 days of sultamicillin was 15.3%, as compared to 25.0% for those who received placebo, falling outside the bounds of non-inferiority (9.97% between group difference, 95% CI 0.7-19.23), reported Gernot Rohde, MD, of Frankfurt University Hospital in Germany.

But in the subgroup of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1 or 2 patients, the failure rate — need for antibiotics during the treatment period or ahead of a test-of-cure visit at day 30 — was twice as high with the antibiotic (29.82% vs 14.29%).

“The trial failed to demonstrate that antibiotics [are] not needed for patients with acute moderate exacerbation of COPD across all stages of the disease,” Rohde said during a presentation at the European Respiratory Society annual meeting. “But we are very confident that at least we can say that this treatment is unnecessary in GOLD stages 1/2, and we have to say it cannot be withheld in GOLD stages 3/4.”

The role of antibiotics in treating COPD is debated, Rohde explained, as a large proportion of exacerbations are associated with viral infections. According to the AERIS study, as little as 37.7% of medical visits for COPD exacerbations were positive for bacterial infection on PCR testing.

But the reality, at least in German emergency rooms, said Rohde, is that most patients will arrive having already received antibiotics prescribed by general practitioners. This and recent hospitalizations were the reasons behind most of the exclusions in the present study.

From 2013 to 2019, the double-blind, multicenter ABACOPD trial randomized 294 patients presenting at 28 different sites in Germany to either 5 days of sultamicillin of placebo. Most (70%) of the patients were treated in the hospital setting while the remaining were outpatients. All participants received standard care, including 40 mg of prednisone for 7 to 10 days, oxygen if needed, and continuation of inhaled therapy.

Baseline characteristics were similar between groups. The average patient age was 66.5 years, and 62% were men. A third of the patients had GOLD stages 1 or 2 disease while the remaining had GOLD stage 3 or 4 disease. A majority (60.5%) reported having exacerbations in the prior year, and 58% were current smokers. Nearly all patients were on bronchodilators and about half were on concomitant corticosteroids.

The proportion of patients reporting at least one adverse event (AE) was higher in the antibiotic group compared with the placebo group (53% vs 42%, P=0.0453), said Rohde, though no differences were seen for serious AEs.

Patients were required to have moderate acute exacerbation of COPD but without respiratory failure or need for intermediate or intensive care. Other inclusion criteria were: age over 40, having a smoking history of 10 pack-years or more, the absence of community-acquired pneumonia or respiratory tract infection with a clear indication for antibiotics, and the absence of pulmonary infiltrates.

Patients were excluded if they had fever, impaired hepatic or renal function, tuberculosis, a methicillin-resistant Staphylococcus aureus (MRSA) infection, known bronchiectasis, an acute asthma exacerbation, or hypersensitivity or suspected serious adverse reaction to sultamicillin. Other exclusion criteria were antibiotic use within the last 30 days and use of immunosuppression therapies.

Dietary flavonoids may mitigate some risk for smoking-related COPD

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Higher intake of dietary flavonoids may mitigate some risk for COPD in current and former smokers, according to a study published in European Respiratory Journal.

“Fruit and vegetables, as well as tea, cocoa and other plant-based foods and beverages, are dietary sources of flavonoids, which are bioactive compounds that reduce oxidative stress and systemic inflammation,” Nicola P. Bondonno, PhD, apostdoctoral research fellow at the School of Medical Health Sciences at Edith Cowan University in Perth, Australia, and colleagues wrote. “… Although epidemiological studies investigating the association between flavonoid intakes specifically and COPD are missing, there is some evidence that flavonoid intakes are favorably associated with pulmonary function parameters and less age-related decline in lung function.”

High intake of dietary flavonoids was associated with
Data were derived from Bondonno NP, et al. Eur Respir J. 2022;doi:10.1183/13993003.02604-2021.

The prospective cohort study included 55,413 participants in Denmark without COPD aged 50 to 65 years at baseline (mean age, 56 years; 47.6% men). Flavonoid intakes were estimated using a food frequency questionnaire. Daily median flavonoid intake was 496 mg.

During a median follow-up of 21 years, 5,557 participants were diagnosed with COPD, of whom 4,013 were current smokers, 1,062 were former smokers and 482 were never smokers.

Participants with the highest total flavonoid intakes had a 20% lower risk for COPD compared with participants with the lowest intakes in multivariable analyses (HR = 0.8; 95% CI, 0.74-0.87). In addition, in each flavonoid subclass, researchers identified a 6% to 22% lower risk for COPD.

The researchers reported that the inverse association between flavonoid intake and risk for COPD remained among men and women, but only among current smokers (HR = 0.77; 95% CI, 0.7-0.84) and former smokers (HR = 0.82; 95% CI, 0.69-0.97), not never smokers. In addition, higher flavonoid intakes appear to have lessened the higher risk for COPD associated with smoking intensity, according to the researchers.

“While the findings of this study suggest an importance of dietary flavonoids in partially mitigating the risk of COPD in people who smoke, both current and former smokers remained at a substantially higher risk of COPD than nonsmokers, indicating that dietary modifications should be secondary to smoking cessation,” the researchers wrote.