To contact us Click HERE
New research shows that patients who are HIV positive may be at an increased risk for developing chronic obstructive pulmonary disease (COPD). Researchers from Yale University School of Medicine investigated the prevalence of COPD among 1,014 HIV-positive and 713 HIV-negative men enrolled in the Veterans Aging Cohort 5 Site Study. Results showed that the prevalence of COPD was 10 percent in HIV-positive and 9 percent in HIV-negative patients, as reported by ICD-9 codes, and 15 percent and 12 percent respectively, as indicated by patient self-report. However, after adjusting for age, race/ethnicity, pack-years of smoking, and injection drug use and alcohol abuse, HIV infection was an independent risk factor for COPD, with HIV-infected patients 50 to 60 percent more likely to have COPD than HIV-negative subjects. This study appears in the November issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
Newsbriefs from the journal Chest, November 2006
Contact: Jennifer Stawarz
American College of Chest Physicians
27 Haziran 2012 Çarşamba
Millions of Americans have COPD, some diagnosed, some not
To contact us Click HERE
Millions of Americans have already been diagnosed with chronic obstructive pulmonary disease (COPD). Millions more remain undiagnosed and are at serious risk for health complications. Questions, conversation, and education in the clinical setting facilitate early detection and improve outcomes.
Chronic obstructive pulmonary disease (COPD) is a slowly progressive condition of the airways characterized by a gradual loss of lung function. "The National Health and Nutrition Evaluation Survey III (NHANES III) estimated that 16 million people carry a diagnosis of COPD as diagnosed by physicians or healthcare workers, 2.2 million of which have emphysema while the rest have chronic obstructive bronchitis," says Dennis E. Doherty, MD, FCCP. "Some studies have suggested that millions more have the disease. Based on the data from NHANES III, it is estimated that between 45 and 50 million people have the disease, and that as many as two-thirds of those individuals are not yet diagnosed or do not know that they carry the diagnosis."
Dr. Doherty says patient-provider communication issues contribute to COPD underdiagnosis. Fears and misconceptions often make patients reluctant to discuss their symptoms. Physicians may need to seize the communication initiative.
"Over 85% of all COPD is caused by smoking tobacco, but many patients don't want to quit smoking and they won't tell their physician about their habit," he says. "But we need to be asking our patients questions about their habits. We also must remember to check for genetic predispositions. A deficiency of alpha- 1 antitrypsin places people at an increased risk to develop COPD."
Other research has indicated that COPD is misdiagnosed as asthma, especially in women, according to Dr. Doherty.
"Patients may feel less apprehensive about an asthma diagnosis because there isn't a stigma attached to it like COPD. Even though the majority of COPD cases tend to be mild rather than severe, patients still think it is a death sentence. The disease is partially reversible, especially during its earlier stages. Patients may not get back their normal lung function with treatment, but lung function, quality of life, and activities of daily living can improve with proper pharmacologic and non-pharmacologic therapies."
CONTINUES.........Physician's Weekly
Chronic obstructive pulmonary disease (COPD) is a slowly progressive condition of the airways characterized by a gradual loss of lung function. "The National Health and Nutrition Evaluation Survey III (NHANES III) estimated that 16 million people carry a diagnosis of COPD as diagnosed by physicians or healthcare workers, 2.2 million of which have emphysema while the rest have chronic obstructive bronchitis," says Dennis E. Doherty, MD, FCCP. "Some studies have suggested that millions more have the disease. Based on the data from NHANES III, it is estimated that between 45 and 50 million people have the disease, and that as many as two-thirds of those individuals are not yet diagnosed or do not know that they carry the diagnosis."
Dr. Doherty says patient-provider communication issues contribute to COPD underdiagnosis. Fears and misconceptions often make patients reluctant to discuss their symptoms. Physicians may need to seize the communication initiative.
"Over 85% of all COPD is caused by smoking tobacco, but many patients don't want to quit smoking and they won't tell their physician about their habit," he says. "But we need to be asking our patients questions about their habits. We also must remember to check for genetic predispositions. A deficiency of alpha- 1 antitrypsin places people at an increased risk to develop COPD."
Other research has indicated that COPD is misdiagnosed as asthma, especially in women, according to Dr. Doherty.
"Patients may feel less apprehensive about an asthma diagnosis because there isn't a stigma attached to it like COPD. Even though the majority of COPD cases tend to be mild rather than severe, patients still think it is a death sentence. The disease is partially reversible, especially during its earlier stages. Patients may not get back their normal lung function with treatment, but lung function, quality of life, and activities of daily living can improve with proper pharmacologic and non-pharmacologic therapies."
CONTINUES.........Physician's Weekly
COPD Patients Should Begin Treatment At An Earlier Stage
To contact us Click HERE
While the effectiveness of drug therapy for COPD patients at advanced stages of disease has been proven, little evidence exists regarding starting treatment at earlier stages. The findings of the UPLIFT study, published in an Article Online First to coincide with this week's COPD special issue of The Lancet, show that treatment with inhaled tiotropium at an earlier stage of COPD reduces decline of lung function-and thus treatment should begin at this earlier stage. The Article is written by Professor Marc Decramer, University Hospital, University of Leuven, Belgium, and colleagues.
Although the UPLIFT study investigated patients at all stages of the disease, the authors in this paper did a pre-specified subgroup analysis of patients specifically at GOLD stage II* (moderate disease). From a total of 5993 patients, 2739 had GOLD stage II COPD at randomisation, with a mean age of 64 years. Pre-bronchodilator spirometry was done prior to administration of study drug in the morning of a clinic visit (i.e. 24 hours after the last dose of study medication). Post-bronchodilator spirometry was performed after study drug and short-acting bronchodilators (ipratropium and salbutamol). The patients had a mean post-bronchodilator FEV1** volume of 1.63L, 59% of the predicted value. A total of 2376 patients qualified for the final analysis-of these, 1218 patients had received tiotropium and 1158 placebo over a period of four years.
The researchers found that the rate of decline of mean post-bronchodilator FEV1 per year was 12% lower in the tiotropium group than the placebo group (43 mL vs 49 mL). The rate of decline of mean pre-bronchodilator FEV1 did not differ significantly between groups (35 mL v 37 mL per year). Patients given tiotropium were also found to have better health status (measured by questionnaire) at all timepoints. The risk of an exacerbation (serious worsening of symptoms) was reduced by 18% for patients who received tiotropium, and patients receiving tiotropium also saw the risk of a hospital admission due to an exacerbation fall by 26%.
The authors conclude: "In patients with GOLD stage II COPD, long-term treatment with tiotropium seemed to reduce the rate of decline of post-bronchodilator FEV1 and the risk of exacerbations. Since we also found that lung function and health-related quality of life were better in the tiotropium group than in the control group throughout the trial, treatment of COPD should begin in symptomatic patients with moderate disease."
In an accompanying Comment, Dr Lisa Davies, Aintree Chest Centre, University Hospital Aintree, Liverpool, UK and Professor Peter M A Calverley, University of Liverpool, Liverpool, UK, say: "As the UPLIFT investigators comment, there are still substantial numbers of symptomatic patients in GOLD stage II without a clinical diagnosis. Their data should encourage those developing plans for the early identification of COPD, which includes the UK Department of Health, that identifying such patients is indeed worthwhile and can provide the patient with better symptomatic control of their condition and improvements in their overall wellbeing."
Link to article
Source
The Lancet
Although the UPLIFT study investigated patients at all stages of the disease, the authors in this paper did a pre-specified subgroup analysis of patients specifically at GOLD stage II* (moderate disease). From a total of 5993 patients, 2739 had GOLD stage II COPD at randomisation, with a mean age of 64 years. Pre-bronchodilator spirometry was done prior to administration of study drug in the morning of a clinic visit (i.e. 24 hours after the last dose of study medication). Post-bronchodilator spirometry was performed after study drug and short-acting bronchodilators (ipratropium and salbutamol). The patients had a mean post-bronchodilator FEV1** volume of 1.63L, 59% of the predicted value. A total of 2376 patients qualified for the final analysis-of these, 1218 patients had received tiotropium and 1158 placebo over a period of four years.
The researchers found that the rate of decline of mean post-bronchodilator FEV1 per year was 12% lower in the tiotropium group than the placebo group (43 mL vs 49 mL). The rate of decline of mean pre-bronchodilator FEV1 did not differ significantly between groups (35 mL v 37 mL per year). Patients given tiotropium were also found to have better health status (measured by questionnaire) at all timepoints. The risk of an exacerbation (serious worsening of symptoms) was reduced by 18% for patients who received tiotropium, and patients receiving tiotropium also saw the risk of a hospital admission due to an exacerbation fall by 26%.
The authors conclude: "In patients with GOLD stage II COPD, long-term treatment with tiotropium seemed to reduce the rate of decline of post-bronchodilator FEV1 and the risk of exacerbations. Since we also found that lung function and health-related quality of life were better in the tiotropium group than in the control group throughout the trial, treatment of COPD should begin in symptomatic patients with moderate disease."
In an accompanying Comment, Dr Lisa Davies, Aintree Chest Centre, University Hospital Aintree, Liverpool, UK and Professor Peter M A Calverley, University of Liverpool, Liverpool, UK, say: "As the UPLIFT investigators comment, there are still substantial numbers of symptomatic patients in GOLD stage II without a clinical diagnosis. Their data should encourage those developing plans for the early identification of COPD, which includes the UK Department of Health, that identifying such patients is indeed worthwhile and can provide the patient with better symptomatic control of their condition and improvements in their overall wellbeing."
Link to article
Source
The Lancet
Loss of Bone Density with Inhaled Corticosteroids
To contact us Click HERE
Study participants with mild to moderate chronic obstructive pulmonary disease (COPD) who used 1,200 micrograms per day
over 3 years of an inhaled corticosteroid, triamcinalon, in an attempt to slow lung function decline showed reduced bone
density in both the lumbar spine and neck of the femur (thigh).
The researchers investigated bone metabolism in COPD in 412 subgroup participants involved in Lung Health Study II. All
subjects, who were either current smokers or recent quitters, underwent bone mineral density scans of the hip and lumbar
spine with dual-energy X-ray absorptiometry at the start of the study, after 1 year, and at the end of year 3. (In COPD,
patients have persistent obstruction of the airways associated with either emphysema or chronic bronchitis, caused by years
of smoking.)
The reductions were 1.78 percent in femoral neck bone mass density and 1.33 percent in lumbar spine bone mass density. The
declines occurred in both the men and women patients who were from 55 to 57 years old. Good adherence to therapy (more than 9
puffs of inhaled corticosteroid per day over 3 years) was seen in almost 47 percent of the patients.
The authors said that there was little or no decline in bone mass density until after the first year of the study, but
reductions did occur during the second and third years of the trial. Since smoking prevalence is high in persons with COPD,
the authors urged doctors to encourage patients to quit. The study appears in the second issue for December 2004 of the
American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
American Thoracic Society Journal news tips for December 2004 (second issue)
For the complete text of these articles, please see the American Thoracic Society Online Web Site at atsjournals. For either contact information or to
request a complimentary journalist subscription to ATS journals online, or if you would like to add your name to the
Society's twice monthly journal news e-mail list, contact Cathy Carlomagno at 212-315-6442, or by e-mail at
ccarlomagnothoracic.
Contact: Cathy Carlomagno
ccarlomagnothoracic
212-315-6442
American Thoracic Society
over 3 years of an inhaled corticosteroid, triamcinalon, in an attempt to slow lung function decline showed reduced bone
density in both the lumbar spine and neck of the femur (thigh).
The researchers investigated bone metabolism in COPD in 412 subgroup participants involved in Lung Health Study II. All
subjects, who were either current smokers or recent quitters, underwent bone mineral density scans of the hip and lumbar
spine with dual-energy X-ray absorptiometry at the start of the study, after 1 year, and at the end of year 3. (In COPD,
patients have persistent obstruction of the airways associated with either emphysema or chronic bronchitis, caused by years
of smoking.)
The reductions were 1.78 percent in femoral neck bone mass density and 1.33 percent in lumbar spine bone mass density. The
declines occurred in both the men and women patients who were from 55 to 57 years old. Good adherence to therapy (more than 9
puffs of inhaled corticosteroid per day over 3 years) was seen in almost 47 percent of the patients.
The authors said that there was little or no decline in bone mass density until after the first year of the study, but
reductions did occur during the second and third years of the trial. Since smoking prevalence is high in persons with COPD,
the authors urged doctors to encourage patients to quit. The study appears in the second issue for December 2004 of the
American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
American Thoracic Society Journal news tips for December 2004 (second issue)
For the complete text of these articles, please see the American Thoracic Society Online Web Site at atsjournals. For either contact information or to
request a complimentary journalist subscription to ATS journals online, or if you would like to add your name to the
Society's twice monthly journal news e-mail list, contact Cathy Carlomagno at 212-315-6442, or by e-mail at
ccarlomagnothoracic.
Contact: Cathy Carlomagno
ccarlomagnothoracic
212-315-6442
American Thoracic Society
Education For Health And Other Leading Experts Call For National Strategies ToTackle COPD - An Emerging Epidemic In The Workforce
To contact us Click HERE
COPD Uncovered 2010, a new report issued today,
exposes the devastating economic, social and personal impact of COPD in the 40-65 years
age group - the mainstay of the global workforce1,2. These results have led respiratory
experts to call for the implementation of National Strategies to tackle this disease in the
working age population.
Authored by Education for Health and other leading specialists, the report uncovers the true
cost of COPD in the working age population and reveals its significant impact on work and
quality of life. The authors are appealing to policy makers, the medical community and other
stakeholders such as employers to create and implement tactics such as earlier diagnosis
and management, in order to keep people healthy and productive for longer3.
"It's an economic time-bomb" said Monica Fletcher, Chief Executive of Education for Health.
"The key generation driving the economy in most countries are people aged 40-65 years
and in this harsh economic climate, we need to ensure they stay active and productive. With
the incidence of COPD set to rise, with increasing numbers of women being affected than
previously thought, it can only mean that personal and societal cost will also increase."
"COPD is often considered a disease of old men, but there are far more people aged under
65 years with this condition than previously recognised. We are calling for policy makers to
prioritise the early diagnosis and integrated management of COPD in this population".
COPD has wide ranging implications not only for the affected individual, but also for the
wider community. According to the report, in the UK alone, the economic burden of disease
is UK??1.5 billion per annum5 a similar cost to that incurred by European airlines due to the
recent Icelandic ash cloud! This includes not only direct healthcare costs, but factors such as
lost income tax, payment of state benefits and productivity loss due to COPD. These
calculations are based on the current age of retirement, but as many people expect to have
to work beyond their official retirement date6, the economic impact will continue to rise.
COPD is rapidly becoming one of the world's most serious health issues, affecting 210
million people worldwide4, but only half of these people have been diagnosed. COPD can
dramatically impair the productivity of this population. However, it is preventable and
treatable and we encourage those with symptoms such as persistent cough with phlegm,
breathlessness or a wheezy chest to visit their healthcare provider for a lung function test.
Other Key Insights From The Report Include:
- Society Faces A Double Economic Impact From The Growing Copd Crisis - Patients are losing an
average of $1800 per year in lost income due to their COPD, which equates to lifetime
losses of nearly $20,0003. In addition, nearly 1 in 5 of 45-68 year olds are forced to retire
prematurely due to the condition, thereby incurring increased health costs and reducing
personal contribution from taxation3.
- COPD Places A Significant Cost Impact On Healthcare Systems - Individuals of working age are
most often managed within the primary care setting and this places increasing demands
on primary care services7. However, as COPD severity increases, so does the
requirement for patients to be seen in emergency departments or to require
hospitalization. It is these hospitalizations that are responsible for the majority of the
direct costs associated with COPD8.
- People With COPD Feel Unable To Confidently Plan For The Future - The impact of COPD on
people's earning power and overall household income makes them concerned about its
future impact on their lives, and those of their family, and their ability to maintain the
same lifestyle as they had before3.
- Smoking Rates Remain High Regardless Of Disease Severity - Although smoking cessation is
the only known intervention to alter progression and prognosis of COPD, the report
reveals that almost half of patients with mild disease continue to smoke9, and that even
if everyone did stop smoking today, the rates of COPD would still continue to increase
for the next 20 years10. People with COPD need to receive early and appropriate
management including access to pulmonary rehabilitation services along with
appropriate pharmacological intervention in order to keep the disease under control and
avoid exacerbations.
About COPD
COPD is a debilitating, life-threatening and progressive lung disease that interferes with
normal breathing11. Symptoms are often mistakenly attributed to ageing or other
respiratory diseases such as asthma, resulting in COPD being undetected in about 50% of
cases12 and misdiagnosed in about 23%13. A 30% increase in prevalence is expected by the
year 203014. The estimated prevalence of COPD includes approximately 4-13% of adults in
Europe15-19 and approximately 7% of adults in the United States20. While COPD was
previously more common in men, an increase in smoking among women has led to the
disease affecting men and women almost equally4. There is no cure for COPD but it can be
treated.
About COPD Uncovered
COPD Uncovered represents the combined efforts of a multi-disciplinary committee of
international experts, coming together to bring forward some of the most burning issues in
COPD today. Their aim is to highlight the impact of COPD in an understudied and ignored
patient segment between the ages of 40 and 65.
The COPD Uncovered initiative is a compendium of research and analysis undertaken by
experts in respiratory health. COPD Uncovered was first initiated by Education for Health
and Novartis Pharma AG. Novartis Pharma AG is providing financial support for this
initiative, including by commissioning a number of underlying studies. COPD is also
administered by a secretariat from Chandler Chicco Agency (CCA).
The first report from the initiative was published on World COPD Day 200921. It revealed
that more than two billion working hours are lost each week worldwide due to the
condition, and that if left unchecked, COPD could have significant global workforce and
economic implications on patients, families, employers and society as the disease escalates.
The report called for collaborative efforts from all stakeholders to advance our knowledge
of COPD, dispel some of the myths surrounding the condition, and ultimately improve
disease management for patients in this key population.
About the Authors
The COPD Uncovered Report, issued on World COPD Day 2010, is authored by the following
individuals, supported by Novartis with editorial assistance from medical education
specialists from CCA:
- Monica Fletcher, Chief Executive, Education for Health and National Respiratory Training
Center, principle lead for COPD Uncovered
- Dr Marianella Salapatas, President, European Federation of Allergy and Airways Diseases
Patients' Associations
- Professor Thys van derMolen, Department of General Practice, University of Groningen
- John Walsh, President and CEO, COPD Foundation
References
1. US Census Bureau. Current 2009 Population Survey, 2010 annual social and economic
supplement. Available online here. Accessed
October 2010.
2. Office for National Statistics. Annual survey of hours and earnings. Available online here.
Accessed October 2010.
3. Fletcher MJ et al. COPD has significant social and economic impact on a working-age
population of COPD sufferers; an international survey. Abstract and poster presented at
The American Thoracic Society Congress, 18 May 2010
4. World Health Organization. Chronic obstructive pulmonary disease. Available online here. Accessed October 2010.
5. Baldwin M et al A novel method to estimate the economic impact of COPD in patients of
working age. Poster presented at COPD7 International Multidisciplinary Conference, 2
July 2010.
6. MetLife Mature Market Institute. Boomer bookends. Insights into the oldest and
youngest boomers, February 2009. Available online here. Accessed October 2010.
7. Fletcher M et al. Health care utilization in COPD: the burden carried by primary care
practitioners. Primary Care Resp Journal 2010;19(2):A1.
8. Wouters EF. Economic analysis of the Confronting COPD survey: an overview of results.
Respir Med 2003;97(Suppl. C):S3-14.
9. Fletcher MJ et al. How much do COPD patients smoke? A global survey. Abstract and
poster presented at European Respiratory Society Congress, 2010.
10. Mannino DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future
trends. Lancet 2007;370:765-773.
11. Global initiative for chronic obstructive lung disease (GOLD). Global strategy for the
diagnosis, management, and prevention of chronic obstructive lung disease. Updated
2009. Available online here.. Accessed
October 2010.
12. Halbert RJ, et al. Global burden of COPD: systematic review and meta-analysis. Eur
Respir J 2006;28:523-532.
13. T??lamo C, et al. Diagnostic Labeling of COPD in Five Latin American Cities. CHEST
2007;131(1):60-67.
14. Fletcher MJ et al. Patients of working age with COPD have reduced quality of life in
comparison to available population norms; an international survey. Abstract and poster
presented at The American Thoracic Society Congress 18 May 2010
15. Stang P, Lydick E, Silberman C et al. The prevalence of COPD: using smoking rates to
estimate disease frequency in the general population. Chest 2000;117;354S-9S.
16. Buist AS, McBurnie MA, Vollmer WM, Gillespie S, Burney P, Mannino DM, et al.
International variation in the prevalence of COPD (the BOLD Study): a population-based
prevalence study. Lancet 2007;370(9589):741-50.
17. Viegi G, Pedreschi M, Pistelli F et al. Prevalence of Airways Obstruction in a General
Population:European Respiratory Society vs American Thoracic Society Definition. Chest
2000;117:339S-345S.
18. Pe??a VS, Miravitlles M, Gabriel R et al. Geographic variations in prevalence and
underdiagnosis of COPD: results of the IBERPOC multicenter epidemiological study.
Chest 2000;118:981-989.
19. Shahab L, Jarvis M, Britton J, West R. Prevalence, diagnosis and relation to tobacco
dependence of chronic obstructive pulmonary disease in a nationally representative
population sample. Thorax 2006;61:1043-1047.
20. Mannino DM, et al. Obstructive and restrictive lung disease and functional limitation:
data from the Third National Health and Nutrition Examination. Journal of Internal
Medicine 2003;254:540-547.
21. Fletcher M, van der Molen T, Salapatas M,Walsh J. COPD Uncovered: a Report. ISBN: 978-0-
9565537
exposes the devastating economic, social and personal impact of COPD in the 40-65 years
age group - the mainstay of the global workforce1,2. These results have led respiratory
experts to call for the implementation of National Strategies to tackle this disease in the
working age population.
Authored by Education for Health and other leading specialists, the report uncovers the true
cost of COPD in the working age population and reveals its significant impact on work and
quality of life. The authors are appealing to policy makers, the medical community and other
stakeholders such as employers to create and implement tactics such as earlier diagnosis
and management, in order to keep people healthy and productive for longer3.
"It's an economic time-bomb" said Monica Fletcher, Chief Executive of Education for Health.
"The key generation driving the economy in most countries are people aged 40-65 years
and in this harsh economic climate, we need to ensure they stay active and productive. With
the incidence of COPD set to rise, with increasing numbers of women being affected than
previously thought, it can only mean that personal and societal cost will also increase."
"COPD is often considered a disease of old men, but there are far more people aged under
65 years with this condition than previously recognised. We are calling for policy makers to
prioritise the early diagnosis and integrated management of COPD in this population".
COPD has wide ranging implications not only for the affected individual, but also for the
wider community. According to the report, in the UK alone, the economic burden of disease
is UK??1.5 billion per annum5 a similar cost to that incurred by European airlines due to the
recent Icelandic ash cloud! This includes not only direct healthcare costs, but factors such as
lost income tax, payment of state benefits and productivity loss due to COPD. These
calculations are based on the current age of retirement, but as many people expect to have
to work beyond their official retirement date6, the economic impact will continue to rise.
COPD is rapidly becoming one of the world's most serious health issues, affecting 210
million people worldwide4, but only half of these people have been diagnosed. COPD can
dramatically impair the productivity of this population. However, it is preventable and
treatable and we encourage those with symptoms such as persistent cough with phlegm,
breathlessness or a wheezy chest to visit their healthcare provider for a lung function test.
Other Key Insights From The Report Include:
- Society Faces A Double Economic Impact From The Growing Copd Crisis - Patients are losing an
average of $1800 per year in lost income due to their COPD, which equates to lifetime
losses of nearly $20,0003. In addition, nearly 1 in 5 of 45-68 year olds are forced to retire
prematurely due to the condition, thereby incurring increased health costs and reducing
personal contribution from taxation3.
- COPD Places A Significant Cost Impact On Healthcare Systems - Individuals of working age are
most often managed within the primary care setting and this places increasing demands
on primary care services7. However, as COPD severity increases, so does the
requirement for patients to be seen in emergency departments or to require
hospitalization. It is these hospitalizations that are responsible for the majority of the
direct costs associated with COPD8.
- People With COPD Feel Unable To Confidently Plan For The Future - The impact of COPD on
people's earning power and overall household income makes them concerned about its
future impact on their lives, and those of their family, and their ability to maintain the
same lifestyle as they had before3.
- Smoking Rates Remain High Regardless Of Disease Severity - Although smoking cessation is
the only known intervention to alter progression and prognosis of COPD, the report
reveals that almost half of patients with mild disease continue to smoke9, and that even
if everyone did stop smoking today, the rates of COPD would still continue to increase
for the next 20 years10. People with COPD need to receive early and appropriate
management including access to pulmonary rehabilitation services along with
appropriate pharmacological intervention in order to keep the disease under control and
avoid exacerbations.
About COPD
COPD is a debilitating, life-threatening and progressive lung disease that interferes with
normal breathing11. Symptoms are often mistakenly attributed to ageing or other
respiratory diseases such as asthma, resulting in COPD being undetected in about 50% of
cases12 and misdiagnosed in about 23%13. A 30% increase in prevalence is expected by the
year 203014. The estimated prevalence of COPD includes approximately 4-13% of adults in
Europe15-19 and approximately 7% of adults in the United States20. While COPD was
previously more common in men, an increase in smoking among women has led to the
disease affecting men and women almost equally4. There is no cure for COPD but it can be
treated.
About COPD Uncovered
COPD Uncovered represents the combined efforts of a multi-disciplinary committee of
international experts, coming together to bring forward some of the most burning issues in
COPD today. Their aim is to highlight the impact of COPD in an understudied and ignored
patient segment between the ages of 40 and 65.
The COPD Uncovered initiative is a compendium of research and analysis undertaken by
experts in respiratory health. COPD Uncovered was first initiated by Education for Health
and Novartis Pharma AG. Novartis Pharma AG is providing financial support for this
initiative, including by commissioning a number of underlying studies. COPD is also
administered by a secretariat from Chandler Chicco Agency (CCA).
The first report from the initiative was published on World COPD Day 200921. It revealed
that more than two billion working hours are lost each week worldwide due to the
condition, and that if left unchecked, COPD could have significant global workforce and
economic implications on patients, families, employers and society as the disease escalates.
The report called for collaborative efforts from all stakeholders to advance our knowledge
of COPD, dispel some of the myths surrounding the condition, and ultimately improve
disease management for patients in this key population.
About the Authors
The COPD Uncovered Report, issued on World COPD Day 2010, is authored by the following
individuals, supported by Novartis with editorial assistance from medical education
specialists from CCA:
- Monica Fletcher, Chief Executive, Education for Health and National Respiratory Training
Center, principle lead for COPD Uncovered
- Dr Marianella Salapatas, President, European Federation of Allergy and Airways Diseases
Patients' Associations
- Professor Thys van derMolen, Department of General Practice, University of Groningen
- John Walsh, President and CEO, COPD Foundation
References
1. US Census Bureau. Current 2009 Population Survey, 2010 annual social and economic
supplement. Available online here. Accessed
October 2010.
2. Office for National Statistics. Annual survey of hours and earnings. Available online here.
Accessed October 2010.
3. Fletcher MJ et al. COPD has significant social and economic impact on a working-age
population of COPD sufferers; an international survey. Abstract and poster presented at
The American Thoracic Society Congress, 18 May 2010
4. World Health Organization. Chronic obstructive pulmonary disease. Available online here. Accessed October 2010.
5. Baldwin M et al A novel method to estimate the economic impact of COPD in patients of
working age. Poster presented at COPD7 International Multidisciplinary Conference, 2
July 2010.
6. MetLife Mature Market Institute. Boomer bookends. Insights into the oldest and
youngest boomers, February 2009. Available online here. Accessed October 2010.
7. Fletcher M et al. Health care utilization in COPD: the burden carried by primary care
practitioners. Primary Care Resp Journal 2010;19(2):A1.
8. Wouters EF. Economic analysis of the Confronting COPD survey: an overview of results.
Respir Med 2003;97(Suppl. C):S3-14.
9. Fletcher MJ et al. How much do COPD patients smoke? A global survey. Abstract and
poster presented at European Respiratory Society Congress, 2010.
10. Mannino DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future
trends. Lancet 2007;370:765-773.
11. Global initiative for chronic obstructive lung disease (GOLD). Global strategy for the
diagnosis, management, and prevention of chronic obstructive lung disease. Updated
2009. Available online here.. Accessed
October 2010.
12. Halbert RJ, et al. Global burden of COPD: systematic review and meta-analysis. Eur
Respir J 2006;28:523-532.
13. T??lamo C, et al. Diagnostic Labeling of COPD in Five Latin American Cities. CHEST
2007;131(1):60-67.
14. Fletcher MJ et al. Patients of working age with COPD have reduced quality of life in
comparison to available population norms; an international survey. Abstract and poster
presented at The American Thoracic Society Congress 18 May 2010
15. Stang P, Lydick E, Silberman C et al. The prevalence of COPD: using smoking rates to
estimate disease frequency in the general population. Chest 2000;117;354S-9S.
16. Buist AS, McBurnie MA, Vollmer WM, Gillespie S, Burney P, Mannino DM, et al.
International variation in the prevalence of COPD (the BOLD Study): a population-based
prevalence study. Lancet 2007;370(9589):741-50.
17. Viegi G, Pedreschi M, Pistelli F et al. Prevalence of Airways Obstruction in a General
Population:European Respiratory Society vs American Thoracic Society Definition. Chest
2000;117:339S-345S.
18. Pe??a VS, Miravitlles M, Gabriel R et al. Geographic variations in prevalence and
underdiagnosis of COPD: results of the IBERPOC multicenter epidemiological study.
Chest 2000;118:981-989.
19. Shahab L, Jarvis M, Britton J, West R. Prevalence, diagnosis and relation to tobacco
dependence of chronic obstructive pulmonary disease in a nationally representative
population sample. Thorax 2006;61:1043-1047.
20. Mannino DM, et al. Obstructive and restrictive lung disease and functional limitation:
data from the Third National Health and Nutrition Examination. Journal of Internal
Medicine 2003;254:540-547.
21. Fletcher M, van der Molen T, Salapatas M,Walsh J. COPD Uncovered: a Report. ISBN: 978-0-
9565537
25 Haziran 2012 Pazartesi
Walsall And Hull Launch Mainstream Deployments Of Telehealth For People With COPD And Congestive Heart Failure, Using Tunstall Genesis Monitors, UK
To contact us Click HERE
Walsall and Hull have announced the launch of large mainstream deployments of telehealth to monitor people with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) in their own homes.
Both Primary Care Trusts are using Genesis monitors from leading telehealth and telecare specialist Tunstall to ensure best use of healthcare resources, reduce COPD and CHF related hospital admissions, support independent living and deliver an improved quality of life for patients.
COPD kills 30,000 people every year in England and Wales alone, making it the fifth biggest killer, and the cost to the NHS of treating COPD is high, at ??818 million per annum.
The cost to Walsall PCT for each patient admitted to Accident and Emergency can be as high as ??2,300, and it is hoped that the telehealth solutions from Tunstall will prevent hundreds of avoidable admissions. Previous research has shown that use of Genesis monitors can reduce the need for hospitalisation by over 50% and for emergency care visits by nearly two thirds.
Tony Diaram, Project Manager at Walsall Metropolitan Borough Council said: "This telehealth project will give patients truly person-centred care, helping them to manage their condition and avoid the constant cycle of hospitalisation. Tunstall Genesis units support greater independence and encourage better self-management of COPD, especially within hard-to-reach communities."
The telehealth programme being run by Hull PCT uses Tunstall Genesis units to let people monitor their weight and blood pressure, enabling daily accurate monitoring without needing the person to visit their GP. Patients' stress levels, which are a contributing factor to the condition, are also reduced, as it keeps them in a comfortable and familiar environment.
Clare Brown, Locality Manager for Hull City council's Community Care services and Telecare Project Lead commented: "Previously, during acute phases of CHF, we would often have to hospitalise patients for long periods to simply monitor their condition, when they were in fact well enough to be at home.
"The Tunstall Genesis monitors allow us to track a patient's condition closely while they remain in their home, which is proven to help their well-being, yet we can still react quickly if their condition worsens. It truly is a win-win situation for both patients and PCT."
tunstall.co.uk
Both Primary Care Trusts are using Genesis monitors from leading telehealth and telecare specialist Tunstall to ensure best use of healthcare resources, reduce COPD and CHF related hospital admissions, support independent living and deliver an improved quality of life for patients.
COPD kills 30,000 people every year in England and Wales alone, making it the fifth biggest killer, and the cost to the NHS of treating COPD is high, at ??818 million per annum.
The cost to Walsall PCT for each patient admitted to Accident and Emergency can be as high as ??2,300, and it is hoped that the telehealth solutions from Tunstall will prevent hundreds of avoidable admissions. Previous research has shown that use of Genesis monitors can reduce the need for hospitalisation by over 50% and for emergency care visits by nearly two thirds.
Tony Diaram, Project Manager at Walsall Metropolitan Borough Council said: "This telehealth project will give patients truly person-centred care, helping them to manage their condition and avoid the constant cycle of hospitalisation. Tunstall Genesis units support greater independence and encourage better self-management of COPD, especially within hard-to-reach communities."
The telehealth programme being run by Hull PCT uses Tunstall Genesis units to let people monitor their weight and blood pressure, enabling daily accurate monitoring without needing the person to visit their GP. Patients' stress levels, which are a contributing factor to the condition, are also reduced, as it keeps them in a comfortable and familiar environment.
Clare Brown, Locality Manager for Hull City council's Community Care services and Telecare Project Lead commented: "Previously, during acute phases of CHF, we would often have to hospitalise patients for long periods to simply monitor their condition, when they were in fact well enough to be at home.
"The Tunstall Genesis monitors allow us to track a patient's condition closely while they remain in their home, which is proven to help their well-being, yet we can still react quickly if their condition worsens. It truly is a win-win situation for both patients and PCT."
tunstall.co.uk
Pharmacists Reduce Hospital Visits For Respiratory Patients
To contact us Click HERE
Patients with chronic obstructive pulmonary disease (COPD) experience 55%
fewer hospital admissions and 50% less visits to accident and emergency
departments when clinical pharmacists intervene in their care, research
launched at the British Pharmaceutical Conference (BPC) in Manchester has
shown.
Six months into a year-long study on a pharmacy-led disease and medicine
management programme in patients with COPD (an umbrella term for serious
respiratory diseases like emphysema), pharmacy researchers in Belfast have
shown that the involvement of a clinical pharmacist improves patients'
health-related quality of life and results in greater cost-effectiveness for
the NHS.
Patients in the study group reported 81% adherence to medication regimes,
compared to only 60% in the control group.
The study maintained a strong focus on self-management because COPD
patients may benefit from the early intervention that comes from following
self-management plans(1),(2), which may prevent a crisis and possibly the
need for hospital admission.
Lead researcher, Maher Al-khdour, said: "This ongoing study indicates
that a management programme led by clinical pharmacists can improve
adherence, reduce the need for hospital care in patients with moderate to
severe COPD and improve their quality of life."
Through a separate study investigating inhaler treatments for patients
with asthma and COPD, John Moores University pharmacy researchers in
Liverpool found that switching inhaler medicines could result in NHS savings
of ??5,100 a year. Two similar and equally effective inhalers are available -
the newer Symbicort inhaler is not as well-known or prescribed as often as
the Seratide inhaler, but is much cheaper.
Head researcher, Lewis Brien, said: "This study indicates considerable
progress in the management of these chronic respiratory diseases. It also
highlights the fact that more detailed clinical interventions can result in
both health and cost benefits - a demonstration of the value and expertise of
pharmacists."
About Chronic Obstructive Pulmonary Disease (COPD)
COPD is an umbrella term covering a range of conditions including chronic
bronchitis and emphysema. It is a long term condition that leads to damaged
airways, causing them to become narrow, making it harder for air to get in
and out of the lungs. There is no cure for COPD, but it can be managed
through drug therapy.
The World Health Organisation estimates suggest that COPD will become the
third leading cause of death, world-wide, by 2030:
who.int/gard/news_events/World_Health_Statistics_2008/en/
About Asthma
Asthma affects the airways of the lungs (
nhsdirect.nhs.uk/glossary/#Lung ) (the bronchi) which causes the
airways to become inflamed and swollen. The bronchi are small tubes that
carry air in and out of the lungs. In asthmatics, bronchi are more sensitive
than normal and certain substances, or triggers, can irritate them.
Common triggers include house dust mites, animal fur, pollen, tobacco
smoke, cold air, and chest infections. When the bronchi are irritated, they
become narrow and the muscles around them tighten, which can increase the
production of sticky mucus, or phlegm. This makes it difficult to breathe,
and causes wheezing (nhsdirect.nhs.uk/glossary/#Wheezing),
coughing, and a feeling of tightness in the chest.
The United Kingdom has one of the highest incidences of asthma in the
world(3). Over 5 million people suffer from the condition(4), which causes
around 2000 deaths annually; approximately 90% of which are avoidable(3).
Despite better health care and medical advances, asthma is the only
disease in the UK still increasing in prevalence. In England, the mortality
rate from respiratory diseases is almost double the average for Europe(5).
About the British Pharmaceutical Conference 2008 (BPC)
BPC 2008: Pharmacy in the 21st Century: Adding years to life and life to
years. In 2008, as the NHS marks its 60th anniversary year, BPC will examine
how pharmacy and the pharmaceutical services are helping to add years to life
and life to the year of the UK population. The profession of pharmacy plays
an important role in meeting the healthcare challenges associated with the
UK's ageing population.
How can pharmacists contribute to caring for the population as well as
ensuring quality of life? Increasingly, scientists and practitioners have to
consider the cost implications of this conundrum, and the evidence base for
all interventions is becoming of paramount importance: BPC 2008 will debate
these issues and open up discussion on them.
bpc2008
The main sponsors of BPC 2008 are: Boots The Chemists (Lead Sponsor),
AstraZeneca (Associate Sponsor and BPC-PJ Careers Forum Platinum Sponsor),
Pharmacists' Defence Association (PDA) (Associate Sponsor) and GSK (BPC-PJ
Careers Forum Platinum Sponsor).
Research released at BPC is published in the International Journal of Pharmacy Practice (IJPP).
References
(1) Bourbeau J, et al. Reduction of hospital utilization in
patients with chronic obstructive pulmonary disease: a disease specific
self-management intervention. Arch Intern. Med. 2003; 163, 585 -591.
(2) Lorig KR, et al. Evidence suggesting that a chronic disease
self-management program can improve health status while reducing
hospitalization: a randomized trial. Medical care. 1999; 37, 5-14.
(3) Asthma UK. "Where do we stand? Asthma in the UK today" December
2004. p3 - 10.
(4) Prescribing Review. Drugs used in asthma and COPD. Prescription
Pricing Division. May 2007.
(5) It takes your breath away: The Impact of Chronic Obstructive
Pulmonary Disease. CMO Annual Report 2004. Pages 21 and 23.
British Pharmaceutical Conference
fewer hospital admissions and 50% less visits to accident and emergency
departments when clinical pharmacists intervene in their care, research
launched at the British Pharmaceutical Conference (BPC) in Manchester has
shown.
Six months into a year-long study on a pharmacy-led disease and medicine
management programme in patients with COPD (an umbrella term for serious
respiratory diseases like emphysema), pharmacy researchers in Belfast have
shown that the involvement of a clinical pharmacist improves patients'
health-related quality of life and results in greater cost-effectiveness for
the NHS.
Patients in the study group reported 81% adherence to medication regimes,
compared to only 60% in the control group.
The study maintained a strong focus on self-management because COPD
patients may benefit from the early intervention that comes from following
self-management plans(1),(2), which may prevent a crisis and possibly the
need for hospital admission.
Lead researcher, Maher Al-khdour, said: "This ongoing study indicates
that a management programme led by clinical pharmacists can improve
adherence, reduce the need for hospital care in patients with moderate to
severe COPD and improve their quality of life."
Through a separate study investigating inhaler treatments for patients
with asthma and COPD, John Moores University pharmacy researchers in
Liverpool found that switching inhaler medicines could result in NHS savings
of ??5,100 a year. Two similar and equally effective inhalers are available -
the newer Symbicort inhaler is not as well-known or prescribed as often as
the Seratide inhaler, but is much cheaper.
Head researcher, Lewis Brien, said: "This study indicates considerable
progress in the management of these chronic respiratory diseases. It also
highlights the fact that more detailed clinical interventions can result in
both health and cost benefits - a demonstration of the value and expertise of
pharmacists."
About Chronic Obstructive Pulmonary Disease (COPD)
COPD is an umbrella term covering a range of conditions including chronic
bronchitis and emphysema. It is a long term condition that leads to damaged
airways, causing them to become narrow, making it harder for air to get in
and out of the lungs. There is no cure for COPD, but it can be managed
through drug therapy.
The World Health Organisation estimates suggest that COPD will become the
third leading cause of death, world-wide, by 2030:
who.int/gard/news_events/World_Health_Statistics_2008/en/
About Asthma
Asthma affects the airways of the lungs (
nhsdirect.nhs.uk/glossary/#Lung ) (the bronchi) which causes the
airways to become inflamed and swollen. The bronchi are small tubes that
carry air in and out of the lungs. In asthmatics, bronchi are more sensitive
than normal and certain substances, or triggers, can irritate them.
Common triggers include house dust mites, animal fur, pollen, tobacco
smoke, cold air, and chest infections. When the bronchi are irritated, they
become narrow and the muscles around them tighten, which can increase the
production of sticky mucus, or phlegm. This makes it difficult to breathe,
and causes wheezing (nhsdirect.nhs.uk/glossary/#Wheezing),
coughing, and a feeling of tightness in the chest.
The United Kingdom has one of the highest incidences of asthma in the
world(3). Over 5 million people suffer from the condition(4), which causes
around 2000 deaths annually; approximately 90% of which are avoidable(3).
Despite better health care and medical advances, asthma is the only
disease in the UK still increasing in prevalence. In England, the mortality
rate from respiratory diseases is almost double the average for Europe(5).
About the British Pharmaceutical Conference 2008 (BPC)
BPC 2008: Pharmacy in the 21st Century: Adding years to life and life to
years. In 2008, as the NHS marks its 60th anniversary year, BPC will examine
how pharmacy and the pharmaceutical services are helping to add years to life
and life to the year of the UK population. The profession of pharmacy plays
an important role in meeting the healthcare challenges associated with the
UK's ageing population.
How can pharmacists contribute to caring for the population as well as
ensuring quality of life? Increasingly, scientists and practitioners have to
consider the cost implications of this conundrum, and the evidence base for
all interventions is becoming of paramount importance: BPC 2008 will debate
these issues and open up discussion on them.
bpc2008
The main sponsors of BPC 2008 are: Boots The Chemists (Lead Sponsor),
AstraZeneca (Associate Sponsor and BPC-PJ Careers Forum Platinum Sponsor),
Pharmacists' Defence Association (PDA) (Associate Sponsor) and GSK (BPC-PJ
Careers Forum Platinum Sponsor).
Research released at BPC is published in the International Journal of Pharmacy Practice (IJPP).
References
(1) Bourbeau J, et al. Reduction of hospital utilization in
patients with chronic obstructive pulmonary disease: a disease specific
self-management intervention. Arch Intern. Med. 2003; 163, 585 -591.
(2) Lorig KR, et al. Evidence suggesting that a chronic disease
self-management program can improve health status while reducing
hospitalization: a randomized trial. Medical care. 1999; 37, 5-14.
(3) Asthma UK. "Where do we stand? Asthma in the UK today" December
2004. p3 - 10.
(4) Prescribing Review. Drugs used in asthma and COPD. Prescription
Pricing Division. May 2007.
(5) It takes your breath away: The Impact of Chronic Obstructive
Pulmonary Disease. CMO Annual Report 2004. Pages 21 and 23.
British Pharmaceutical Conference
Advair Reduces Exacerbations In COPD Patients With A History Of Exacerbations
To contact us Click HERE
The use of Advair Diskus(R) 250/50 (fluticasone propionate and
salmeterol inhalation powder) demonstrated a 30% reduction in exacerbations
in patients with chronic obstructive pulmonary disease (COPD) who have a
history of exacerbations as compared with salmeterol alone, according to
new data presented today at the International Conference of the American
Thoracic Society meeting in Toronto.
COPD is a progressive, life-threatening lung disease that includes
chronic bronchitis, emphysema or both. Exacerbations are flare-ups or
episodes of worsening COPD symptoms that often require additional
treatment, such as antibiotics, oral corticosteroids and in some cases
hospitalization. Symptoms may include shortness of breath, or coughing up
excess mucus beyond normal day-to-day variations. Seventy-seven (77)
percent of patients with COPD report experiencing at least one exacerbation
within the past year.
The randomized study of 797 patients was a replicate study which found
that after a year of treatment, patients treated with Advair Diskus 250/50
had a 30% reduction in the rate of annual exacerbations compared to
salmeterol (p
About Advair in COPD
Advair Diskus 250/50 is indicated for the maintenance treatment of
airflow obstruction in patients with COPD, including chronic bronchitis
and/or emphysema. Advair Diskus 250/50 is also indicated to reduce
exacerbations in patients with a history of exacerbations. Advair Diskus
250/50 is the only approved strength for COPD because an efficacy advantage
of the higher strength Advair Diskus 500/50 over Advair Diskus 250/50 has
not been demonstrated.
Patients should only take one inhalation of Advair twice a day. People
with COPD taking Advair may have a higher chance of pneumonia. Patients
should call their doctor if they notice any of the following symptoms:
change in amount or color of sputum, fever, chills, increased cough, or
increased breathing problems. Advair may increase the risk of osteoporosis
and some eye problems (cataracts or glaucoma). Patients should have regular
eye exams. Thrush in the mouth and throat may occur. Patients should tell
their doctor if they have a heart condition or high blood pressure before
taking Advair. Do not use Advair with long-acting beta2-agonists for any
reason. Advair does not replace fast-acting inhalers for sudden symptoms.
For more information about Advair please visit gsk.
About GlaxoSmithKline (NYSE: GSK)
GlaxoSmithKline is one of the world's leading research-based
pharmaceutical and healthcare companies. GlaxoSmithKline is committed to
improving the quality of human life by enabling people to do more, feel
better and live longer. For company information visit gsk.
GlaxoSmithKline
gsk
salmeterol inhalation powder) demonstrated a 30% reduction in exacerbations
in patients with chronic obstructive pulmonary disease (COPD) who have a
history of exacerbations as compared with salmeterol alone, according to
new data presented today at the International Conference of the American
Thoracic Society meeting in Toronto.
COPD is a progressive, life-threatening lung disease that includes
chronic bronchitis, emphysema or both. Exacerbations are flare-ups or
episodes of worsening COPD symptoms that often require additional
treatment, such as antibiotics, oral corticosteroids and in some cases
hospitalization. Symptoms may include shortness of breath, or coughing up
excess mucus beyond normal day-to-day variations. Seventy-seven (77)
percent of patients with COPD report experiencing at least one exacerbation
within the past year.
The randomized study of 797 patients was a replicate study which found
that after a year of treatment, patients treated with Advair Diskus 250/50
had a 30% reduction in the rate of annual exacerbations compared to
salmeterol (p
About Advair in COPD
Advair Diskus 250/50 is indicated for the maintenance treatment of
airflow obstruction in patients with COPD, including chronic bronchitis
and/or emphysema. Advair Diskus 250/50 is also indicated to reduce
exacerbations in patients with a history of exacerbations. Advair Diskus
250/50 is the only approved strength for COPD because an efficacy advantage
of the higher strength Advair Diskus 500/50 over Advair Diskus 250/50 has
not been demonstrated.
Patients should only take one inhalation of Advair twice a day. People
with COPD taking Advair may have a higher chance of pneumonia. Patients
should call their doctor if they notice any of the following symptoms:
change in amount or color of sputum, fever, chills, increased cough, or
increased breathing problems. Advair may increase the risk of osteoporosis
and some eye problems (cataracts or glaucoma). Patients should have regular
eye exams. Thrush in the mouth and throat may occur. Patients should tell
their doctor if they have a heart condition or high blood pressure before
taking Advair. Do not use Advair with long-acting beta2-agonists for any
reason. Advair does not replace fast-acting inhalers for sudden symptoms.
For more information about Advair please visit gsk.
About GlaxoSmithKline (NYSE: GSK)
GlaxoSmithKline is one of the world's leading research-based
pharmaceutical and healthcare companies. GlaxoSmithKline is committed to
improving the quality of human life by enabling people to do more, feel
better and live longer. For company information visit gsk.
GlaxoSmithKline
gsk
Lungs Try To Repair Damaged Elastic Fibers
To contact us Click HERE
The lungs of patients suffering chronic obstructive pulmonary disease (COPD) attempt to repair damaged elastic fibers, a new finding that contradicts the conventional wisdom on the capabilities of the adult lung.
The study "Evidence for attempted regional elastic fiber repair in severe emphysema," was done by Jason Woods, Kristin Castillo, Alexander Patterson and Richard Pierce of Washington University, St. Louis, Mo.; Joel Cooper of the University of Pennsylvania, Philadelphia; and James Hogg of St. Paul's Hospital, Vancouver, British Columbia. The authors will be present their findings Nov. 3 at The American Physiological Society conference "Physiological Genomics and Proteomics of Lung Disease."
The researchers found that synthesis of elastin, a gene linked to elastic fiber growth, is increased in the moderately diseased tissue of COPD patients.
Elastic fibers allow the lung to expand and contract with breathing.
"We've found elastin synthesis to increase in the air sacs (alveoli) and airways of the lungs of patients suffering severe or end-stage COPD," Woods explained. "This shows that the lung may be attempting to repair itself."
The finding is important because it could pave the way to develop a drug to 'turn on' key genes to allow the lung to grow new alveoli, he said. Alveoli play a role in the exchange of oxygen and carbon dioxide between the lungs and the circulatory system.
A 2-year-old could do it
Very young children who suffer lung injuries increase elastin expression and produce new elastic fibers inside the alveoli, Woods said. Adults do not have that ability and that has led physiologists to conclude that the elastin gene must shut off after we reach a certain age, ending elastin fiber production.
Physiologists want to understand this process in the hope that it could be harnessed to repair the diseased adult lung. In particular, Woods and his colleagues looked at three genes associated with elastic fiber assembly:
Emilin-1, MFAP2 and elastin. They found the expression of elastin consistently increased in the diseased lungs they studied.
In a preliminary study, the researchers examined two diseased lungs removed from end-stage COPD patients undergoing lung transplants. COPD develops as a result of exposure to toxins such as cigarette smoke, resulting in inflammation to the small airways and destruction of elastic fibers within alveoli. The patients suffered from emphysema.
The team used hyperpolarized magnetic resonance imaging (MRI) to characterize the regions of the lung showing moderate emphysema and regions showing severe emphysema. They found that new elastin synthesis was initiated in moderately diseased specimens.
The researchers did a second study using 10 lungs from end-stage COPD patients who had undergone transplants. Again, they found the greatest amount of elastin gene expression in the moderately diseased areas of the lungs, Woods said. There was no variability in elastin levels within the control lungs.
Further, the team found that the increase in elastin expression occurred on the alveolar walls, the same area where elastin occurs during the lung's development in children. This shows the lung is attempting to repair the elastic fibers in end-stage emphysema, the authors concluded.
Funding
National Institutes of Health (Pierce) and the Barnes-Jewish Foundation
(Woods)
The American Physiological Society was founded in 1887 to foster basic and applied bioscience. The Bethesda, Maryland-based society has 10,500 members and publishes 14 peer-reviewed journals containing almost 4,000 articles annually.
APS provides a wide range of research, educational and career support and programming to further the contributions of physiology to understanding the mechanisms of diseased and healthy states. In 2004, APS received the Presidential Award for Excellence in Science, Mathematics and Engineering Mentoring.
American Physiological Society
The study "Evidence for attempted regional elastic fiber repair in severe emphysema," was done by Jason Woods, Kristin Castillo, Alexander Patterson and Richard Pierce of Washington University, St. Louis, Mo.; Joel Cooper of the University of Pennsylvania, Philadelphia; and James Hogg of St. Paul's Hospital, Vancouver, British Columbia. The authors will be present their findings Nov. 3 at The American Physiological Society conference "Physiological Genomics and Proteomics of Lung Disease."
The researchers found that synthesis of elastin, a gene linked to elastic fiber growth, is increased in the moderately diseased tissue of COPD patients.
Elastic fibers allow the lung to expand and contract with breathing.
"We've found elastin synthesis to increase in the air sacs (alveoli) and airways of the lungs of patients suffering severe or end-stage COPD," Woods explained. "This shows that the lung may be attempting to repair itself."
The finding is important because it could pave the way to develop a drug to 'turn on' key genes to allow the lung to grow new alveoli, he said. Alveoli play a role in the exchange of oxygen and carbon dioxide between the lungs and the circulatory system.
A 2-year-old could do it
Very young children who suffer lung injuries increase elastin expression and produce new elastic fibers inside the alveoli, Woods said. Adults do not have that ability and that has led physiologists to conclude that the elastin gene must shut off after we reach a certain age, ending elastin fiber production.
Physiologists want to understand this process in the hope that it could be harnessed to repair the diseased adult lung. In particular, Woods and his colleagues looked at three genes associated with elastic fiber assembly:
Emilin-1, MFAP2 and elastin. They found the expression of elastin consistently increased in the diseased lungs they studied.
In a preliminary study, the researchers examined two diseased lungs removed from end-stage COPD patients undergoing lung transplants. COPD develops as a result of exposure to toxins such as cigarette smoke, resulting in inflammation to the small airways and destruction of elastic fibers within alveoli. The patients suffered from emphysema.
The team used hyperpolarized magnetic resonance imaging (MRI) to characterize the regions of the lung showing moderate emphysema and regions showing severe emphysema. They found that new elastin synthesis was initiated in moderately diseased specimens.
The researchers did a second study using 10 lungs from end-stage COPD patients who had undergone transplants. Again, they found the greatest amount of elastin gene expression in the moderately diseased areas of the lungs, Woods said. There was no variability in elastin levels within the control lungs.
Further, the team found that the increase in elastin expression occurred on the alveolar walls, the same area where elastin occurs during the lung's development in children. This shows the lung is attempting to repair the elastic fibers in end-stage emphysema, the authors concluded.
Funding
National Institutes of Health (Pierce) and the Barnes-Jewish Foundation
(Woods)
The American Physiological Society was founded in 1887 to foster basic and applied bioscience. The Bethesda, Maryland-based society has 10,500 members and publishes 14 peer-reviewed journals containing almost 4,000 articles annually.
APS provides a wide range of research, educational and career support and programming to further the contributions of physiology to understanding the mechanisms of diseased and healthy states. In 2004, APS received the Presidential Award for Excellence in Science, Mathematics and Engineering Mentoring.
American Physiological Society
Complete Procidentia
To contact us Click HERE
Complete procidentia of the colon through the anus, while not a frequent phenomenon, sometimes tax the ingenuity of the most experienced surgeons. The collapse of this term is sometimes used to designate one of the two pathological conditions in which there is herniation of the mucous membrane colonone only, and the other in which the complete lower large intestine wall. In the interest of distinction, however, would seem procidentia of a better term for the latter condition. Dashed line is the mucosa, which is involved in both conditions. Procidentia including the submucosa, muscularis and serosa are determined by the solid line in the image below.
Mikulicz operation may be fraught with danger. And Mont Reid has a lot of common procedures. Anatomically, they produce the same results and both were done without laparotomy. Although the peritoneal cavity was opened Mikulicz procedure and the area around the operation area can be examined, but it can not be right to describe the vascular tree.
Complete Procidentia more likely than Mont Reid method, in which the sutures eroded surface agglutination causes inflammation of the peritoneum. Mont Reid procedure, it is not possible to determine the nature of the contents of the hernia sac was ligated.
Although related to the two cases reported here can be said that the patient's condition contraindicated celiotomy, with this increase in anesthetic and surgical techniques and advances in supportive therapy is spoken, "blind" operation carried out to avoid more extensive procedures can not be forgiven. No one replaces the direct examination.
Mikulicz operation may be fraught with danger. And Mont Reid has a lot of common procedures. Anatomically, they produce the same results and both were done without laparotomy. Although the peritoneal cavity was opened Mikulicz procedure and the area around the operation area can be examined, but it can not be right to describe the vascular tree.Complete Procidentia more likely than Mont Reid method, in which the sutures eroded surface agglutination causes inflammation of the peritoneum. Mont Reid procedure, it is not possible to determine the nature of the contents of the hernia sac was ligated.Although related to the two cases reported here can be said that the patient's condition contraindicated celiotomy, with this increase in anesthetic and surgical techniques and advances in supportive therapy is spoken, "blind" operation carried out to avoid more extensive procedures can not be forgiven. No one replaces the direct examination.
24 Haziran 2012 Pazar
State Of Colorado Expands Contract With Alere Medical To Include Medicaid Recipients With COPD
To contact us Click HERE
Alere Medical, Inc., a leading health management company, announced today that it has been chosen by the State of Colorado to manage its Medicaid recipients with chronic obstructive pulmonary disease (COPD) beginning in October 2007. This is the second expansion of the State of Colorado's contract with Alere Medical, which is also successfully managing the state's Medicaid heart failure and asthma patients.
"We believe that the success we've achieved with Alere's asthma program, combined with the preliminary positive experience in Alere's heart failure program, will result in similar results for our members with COPD," said Christy Hunter, Disease Management Coordinator for the state.
"Alere has been very pleased with the success of its Medicaid heart failure and asthma programs in Colorado," added Timothy J. Moore, MD, MS, executive vice president and chief medical officer for Alere. "We're confident that our COPD program, with its proven results, can improve the health of the state's members with COPD as well."
The Alere COPD program for the state of Colorado includes telephonic interaction with a specialized respiratory registered nurse, mailed educational materials, online education tools, and a toll-free number for members to call with questions or concerns. High-risk members will be eligible to receive a home monitor that will allow them to transmit symptoms to Alere's registered nurses daily. Moderate- and high-risk members will be eligible to participate in ongoing telephonic education sessions with Alere's registered nurses. Alere's registered nurses will provide intervention and send regular progress reports to the member's physician.
About Alere Medical Inc.
Alere Medical Incorporated is a leader in specialized health management services focusing on a patient-centric, programmatic approach to comprehensive personal health support. Alere's integrated care monitoring system identifies and monitors all medium- and high-risk patients, and prioritizes those patients to facilitate efficient workflow. With published outcomes that exceed those of any competitor, Alere Medical's health management programs improve clinical outcomes for patients, and maximize savings for clients.
Alere Medical has received NCQA Patient and Practitioner Full Accreditation of its disease management programs for heart failure, coronary artery disease, diabetes, asthma and COPD. For more information, visit alere.
"We believe that the success we've achieved with Alere's asthma program, combined with the preliminary positive experience in Alere's heart failure program, will result in similar results for our members with COPD," said Christy Hunter, Disease Management Coordinator for the state.
"Alere has been very pleased with the success of its Medicaid heart failure and asthma programs in Colorado," added Timothy J. Moore, MD, MS, executive vice president and chief medical officer for Alere. "We're confident that our COPD program, with its proven results, can improve the health of the state's members with COPD as well."
The Alere COPD program for the state of Colorado includes telephonic interaction with a specialized respiratory registered nurse, mailed educational materials, online education tools, and a toll-free number for members to call with questions or concerns. High-risk members will be eligible to receive a home monitor that will allow them to transmit symptoms to Alere's registered nurses daily. Moderate- and high-risk members will be eligible to participate in ongoing telephonic education sessions with Alere's registered nurses. Alere's registered nurses will provide intervention and send regular progress reports to the member's physician.
About Alere Medical Inc.
Alere Medical Incorporated is a leader in specialized health management services focusing on a patient-centric, programmatic approach to comprehensive personal health support. Alere's integrated care monitoring system identifies and monitors all medium- and high-risk patients, and prioritizes those patients to facilitate efficient workflow. With published outcomes that exceed those of any competitor, Alere Medical's health management programs improve clinical outcomes for patients, and maximize savings for clients.
Alere Medical has received NCQA Patient and Practitioner Full Accreditation of its disease management programs for heart failure, coronary artery disease, diabetes, asthma and COPD. For more information, visit alere.
News From The Annals Of Internal Medicine: Feb. 16, 2010
To contact us Click HERE
1. Early Release: Annals Readers Respond to USPSTF Mammography Guidelines
An editorial and a selection of reader responses to the November 17 article, "Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement," was published early online at annals on February 15.
2. Pipe and Cigar Smoking Strongly Associated with Decreased Lung Function, COPD
Pipe and cigar smoke may be more harmful than once thought. While some believe pipes and cigars are healthier than cigarettes, a major known cause of chronic obstructive pulmonary disease (COPD), a new study directly links pipe and cigar smoking to decreased lung function.
Researchers conducted a population-based study to determine whether pipe and cigar smoking was associated with elevated cotinine levels (the end product of tobacco, which can be detected in the urine), decrements in lung function, and increased odds of airflow obstruction. Among 3,528 participants, those who did not smoke cigarettes but did smoke pipes or cigars were more likely to have airflow obstruction than those who had never smoked.
While cotinine levels among current pipe and cigar smokers were lower than among current cigarette smokers, the relative differences in cotinine levels may reflect differences in nicotine absorption but not necessarily exposure to harmful products of tobacco smoke.
"Our study shows that pipe and cigar smoking is associated with decrements in lung function that are consistent with obstructive lung disease," said R. Graham Barr, MD, Dr.PH, Assistant Professor of Medicine and Assistant Professor of Epidemiology at Columbia Presbyterian and lead author of the study. "These findings, together with increased cotinine levels in current pipe and cigar smokers, suggest that long-term pipe and cigar smoking may damage the lungs and contribute to the development of COPD. Physicians should consider pipe and cigar smoking a risk factor for COPD and counsel their patients to quit."
In a related editorial, Michael B. Steinberg, MD, MPH, of the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, stresses the importance of educating the public, and expresses concern for the rising rate of tobacco use in the United States.
"We are now witnessing the concerning trend of increased use of other tobacco products," Dr. Steinberg writes. "As changes in public health policy have made cigarette smoking less socially acceptable, a distinct set of characteristics are associated with cigar and pipe use, such as sophistication, affluence, education, and celebration. These images, largely fostered by the tobacco industry, perpetuate the idea that these products play a suitable role in our society."
3. Slight Risk Increase for Heart Attack Persists Six Years After HRT Use
Postmenopausal women who take estrogen plus progestin hormone therapy have a greater risk for coronary heart disease (CHD) during the first few years after starting hormone therapy. To determine how long this risk persists, researchers randomly assigned 16,608 postmenopausal women to either a daily hormone regimen (n = 8,506) or placebo (n = 8,102). The researchers found a possible increased risk for CHD in the first two years in women who started hormone therapy within 10 years after menopause. The increase risk persisted for up to six years after use. Investigators conclude that most women who are considering short-term estrogen plus progestin hormone therapy for the relief of menopausal symptoms should not expect protection against CHD, and may need to worry about a possible slightly increased risk for heart attacks.
4. Superficial Venous Thrombosis Not So Superficial - Condition May Indicate More Serious Thromboembolic Risk
Superficial venous thrombosis (SVT) is a blood clot of the superficial vein of the limbs or chest. While the condition is painful and common, it is not considered life threatening. However, new evidence suggests that SVT can occur with deep venous thrombosis (DVT) or pulmonary embolism (venous thromboembolism), two more serious conditions. Researchers studied 844 consecutive patients with symptomatic SVT of the lower limbs that was at least 5 cm on compression ultrasonography. Of the patients studied, approximately 25 percent also had DVT and about 10 percent developed thromboembolic complications over the next three months. Researchers caution that symptomatic SVT of the lower limbs may be more serious than previously thought and may be a marker for more clinically significant thromboembolic risk. For patients presenting with symptomatic SVT, close follow up and evaluation through compression ultrasonography is suggested.
5. "Dead Fish" Odor May Cause Diabetics to Discontinue Treatment with Metformin
Metformin, an oral anti-diabetic drug, is considered the first line of treatment for type 2 diabetes. The drug is associated with few adverse effects, but gastrointestinal upset is common. While the gastrointestinal effects of metformin have been well documented, researchers uncovered one characteristic of the drug that had not been previously reported in medical literature - its strong and distinct fishy odor. After examining case files for two patients reporting a "dead fish" or "fishy" odor associated with the immediate release formulation of metformin, researchers searched medical literature for other documented cases. Although reaction to the odor of metformin had not been reported in medical literature, hundreds of postings to message boards on the Internet note the peculiar odor of the drug. In addition, an informal survey of pharmacists found that metformin was easily identified by its smell which was classified as "fishy" or "like old locker-room sweat socks." The researchers believe that the adverse reaction to metformin's odor may not be published because patients may report that the drug makes them nauseous, but they may not distinguish this as a visceral reaction to the smell of the medication. The authors recommend that physicians consider inquiring more closely about revulsion to the odor of the medication when patients stop taking it. Trial of a film-coated, extended release formulation may be a reasonable approach in such cases.
An editorial and a selection of reader responses to the November 17 article, "Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement," was published early online at annals on February 15.
2. Pipe and Cigar Smoking Strongly Associated with Decreased Lung Function, COPD
Pipe and cigar smoke may be more harmful than once thought. While some believe pipes and cigars are healthier than cigarettes, a major known cause of chronic obstructive pulmonary disease (COPD), a new study directly links pipe and cigar smoking to decreased lung function.
Researchers conducted a population-based study to determine whether pipe and cigar smoking was associated with elevated cotinine levels (the end product of tobacco, which can be detected in the urine), decrements in lung function, and increased odds of airflow obstruction. Among 3,528 participants, those who did not smoke cigarettes but did smoke pipes or cigars were more likely to have airflow obstruction than those who had never smoked.
While cotinine levels among current pipe and cigar smokers were lower than among current cigarette smokers, the relative differences in cotinine levels may reflect differences in nicotine absorption but not necessarily exposure to harmful products of tobacco smoke.
"Our study shows that pipe and cigar smoking is associated with decrements in lung function that are consistent with obstructive lung disease," said R. Graham Barr, MD, Dr.PH, Assistant Professor of Medicine and Assistant Professor of Epidemiology at Columbia Presbyterian and lead author of the study. "These findings, together with increased cotinine levels in current pipe and cigar smokers, suggest that long-term pipe and cigar smoking may damage the lungs and contribute to the development of COPD. Physicians should consider pipe and cigar smoking a risk factor for COPD and counsel their patients to quit."
In a related editorial, Michael B. Steinberg, MD, MPH, of the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, stresses the importance of educating the public, and expresses concern for the rising rate of tobacco use in the United States.
"We are now witnessing the concerning trend of increased use of other tobacco products," Dr. Steinberg writes. "As changes in public health policy have made cigarette smoking less socially acceptable, a distinct set of characteristics are associated with cigar and pipe use, such as sophistication, affluence, education, and celebration. These images, largely fostered by the tobacco industry, perpetuate the idea that these products play a suitable role in our society."
3. Slight Risk Increase for Heart Attack Persists Six Years After HRT Use
Postmenopausal women who take estrogen plus progestin hormone therapy have a greater risk for coronary heart disease (CHD) during the first few years after starting hormone therapy. To determine how long this risk persists, researchers randomly assigned 16,608 postmenopausal women to either a daily hormone regimen (n = 8,506) or placebo (n = 8,102). The researchers found a possible increased risk for CHD in the first two years in women who started hormone therapy within 10 years after menopause. The increase risk persisted for up to six years after use. Investigators conclude that most women who are considering short-term estrogen plus progestin hormone therapy for the relief of menopausal symptoms should not expect protection against CHD, and may need to worry about a possible slightly increased risk for heart attacks.
4. Superficial Venous Thrombosis Not So Superficial - Condition May Indicate More Serious Thromboembolic Risk
Superficial venous thrombosis (SVT) is a blood clot of the superficial vein of the limbs or chest. While the condition is painful and common, it is not considered life threatening. However, new evidence suggests that SVT can occur with deep venous thrombosis (DVT) or pulmonary embolism (venous thromboembolism), two more serious conditions. Researchers studied 844 consecutive patients with symptomatic SVT of the lower limbs that was at least 5 cm on compression ultrasonography. Of the patients studied, approximately 25 percent also had DVT and about 10 percent developed thromboembolic complications over the next three months. Researchers caution that symptomatic SVT of the lower limbs may be more serious than previously thought and may be a marker for more clinically significant thromboembolic risk. For patients presenting with symptomatic SVT, close follow up and evaluation through compression ultrasonography is suggested.
5. "Dead Fish" Odor May Cause Diabetics to Discontinue Treatment with Metformin
Metformin, an oral anti-diabetic drug, is considered the first line of treatment for type 2 diabetes. The drug is associated with few adverse effects, but gastrointestinal upset is common. While the gastrointestinal effects of metformin have been well documented, researchers uncovered one characteristic of the drug that had not been previously reported in medical literature - its strong and distinct fishy odor. After examining case files for two patients reporting a "dead fish" or "fishy" odor associated with the immediate release formulation of metformin, researchers searched medical literature for other documented cases. Although reaction to the odor of metformin had not been reported in medical literature, hundreds of postings to message boards on the Internet note the peculiar odor of the drug. In addition, an informal survey of pharmacists found that metformin was easily identified by its smell which was classified as "fishy" or "like old locker-room sweat socks." The researchers believe that the adverse reaction to metformin's odor may not be published because patients may report that the drug makes them nauseous, but they may not distinguish this as a visceral reaction to the smell of the medication. The authors recommend that physicians consider inquiring more closely about revulsion to the odor of the medication when patients stop taking it. Trial of a film-coated, extended release formulation may be a reasonable approach in such cases.
Noninvasive Ventilation: New Clinical Practice Guidelines
To contact us Click HERE
New clinical guidelines for use of noninvasive ventilation in critical care settings are published in CMAJ (Canadian Medical Association Journal).
The use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure by mask has increased significantly among acutely ill patients. A growing body of literature and variations in practice in recent years have necessitated the development of new clinical practical guidelines to help manage patients with acute respiratory distress or failure.
The guidelines were created by the Canadian Critical Care Trials Group/Canadian Critical Care Society Noninvasive Ventilation Guidelines Group. They address the use of noninvasive ventilation in the postoperative setting, in immunocompromised patients, in patients being weaned from conventional mechanical ventilation and in patients at high risk of respiratory failure after removal of breathing tube.
Noninvasive positive pressure ventilation should be the first choice in patients with chronic obstructive pulmonary disease (COPD) or cardiogenic pulmonary edema. It can be used postoperatively or in people with compromised immune systems.
"Implementation of these guidelines may require clinician education, additional health care personnel, organizational change or additional resources (equipment or beds with cardiopulmonary monitoring) to ensure safe and appropriate application of noninvasive positive-pressure ventilation and continuous positive airway pressure," writes Dr. Sean Keenan, Royal Columbian Hospital, with coauthors.
"Strategies for the implementation of these guidelines should be developed for each relevant clinician group (physicians in different clinical areas and with different levels of training and expertise, respiratory therapists and nurses)," they conclude.
In a related commentary, Dr. Andrew Bersten from Flinders Medical Centre in Adelaide, Australia, writes "many factors appear to influence the effective implementation of noninvasive ventilation. These factors include an experienced team of health care staff able to provide 24-hour service and detailed attention to mask interface and leaks, choice of equipment, ventilator settings, inspired oxygen levels, glottic function and clearance of secretions."
"For these guidelines to change clinical practice, they have to be supported by appropriate education, implementation and review. Helping clinicians know when and when not to use noninvasive ventilation is perhaps the most important role for these guidelines," he concludes.
The use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure by mask has increased significantly among acutely ill patients. A growing body of literature and variations in practice in recent years have necessitated the development of new clinical practical guidelines to help manage patients with acute respiratory distress or failure.
The guidelines were created by the Canadian Critical Care Trials Group/Canadian Critical Care Society Noninvasive Ventilation Guidelines Group. They address the use of noninvasive ventilation in the postoperative setting, in immunocompromised patients, in patients being weaned from conventional mechanical ventilation and in patients at high risk of respiratory failure after removal of breathing tube.
Noninvasive positive pressure ventilation should be the first choice in patients with chronic obstructive pulmonary disease (COPD) or cardiogenic pulmonary edema. It can be used postoperatively or in people with compromised immune systems.
"Implementation of these guidelines may require clinician education, additional health care personnel, organizational change or additional resources (equipment or beds with cardiopulmonary monitoring) to ensure safe and appropriate application of noninvasive positive-pressure ventilation and continuous positive airway pressure," writes Dr. Sean Keenan, Royal Columbian Hospital, with coauthors.
"Strategies for the implementation of these guidelines should be developed for each relevant clinician group (physicians in different clinical areas and with different levels of training and expertise, respiratory therapists and nurses)," they conclude.
In a related commentary, Dr. Andrew Bersten from Flinders Medical Centre in Adelaide, Australia, writes "many factors appear to influence the effective implementation of noninvasive ventilation. These factors include an experienced team of health care staff able to provide 24-hour service and detailed attention to mask interface and leaks, choice of equipment, ventilator settings, inspired oxygen levels, glottic function and clearance of secretions."
"For these guidelines to change clinical practice, they have to be supported by appropriate education, implementation and review. Helping clinicians know when and when not to use noninvasive ventilation is perhaps the most important role for these guidelines," he concludes.
News From The Journal Chest, January
To contact us Click HERE
COMPRESSION DEVICES EFFECTIVE FOR RESTLESS LEGS SYNDROME
Pharmacotherapy for restless legs syndrome (RLS) may be ineffective or complicated by side effects. However, new research shows that pneumatic compression devices, which apply air pressure to the leg at regular intervals, may be an alternative therapy for RLS. Researchers from Walter Reed Army Medical Center in Washington, DC, conducted a prospective, randomized, double-blinded trial of 35 patients with RLS. Patients wore either a therapeutic or subtherapeutic (sham) device prior to the usual onset of RLS symptoms for a minimum of 1 hour daily. Therapeutic compression devices significantly improved all measured variables compared with shams, including the RLS severity score and Johns Hopkins restless legs severity scale score. All quality of life domains also were improved, including daytime function, sleep quality, and emotional well-being. Researchers conclude that pneumatic compression devices may be an effective nonpharmacologic therapy for RLS. This study is published in the January issue of the journal CHEST.
COPD ASSOCIATED WITH HIGHER DEPRESSION RATES THAN DIABETES
Chronic disease has been associated with higher rates of depression; however, new research shows that patients with chronic obstructive pulmonary disease (COPD) are nearly two times as likely to suffer from depression compared with patients with diabetes. Researchers from The Netherlands compared the health characteristics of 999 patients with COPD, 978 patients with diabetes, and 2,494 healthy control subjects. Results showed that patients with COPD were diagnosed almost twice as often with depression compared with diabetic patients and control subjects. Furthermore, the mean time to a first diagnosis of depression was 7.7 years for patients with COPD, 5.9 years for patients with diabetes, and 7.3 years for control subjects. Researchers speculate that the increased risk of depression is not the result of having a chronic disease in general but specific to COPD. This study is published in the January issue of the journal CHEST.
SURVIVAL CONTINUES TO IMPROVE FOR PATIENTS WITH HIV
New research finds that the survival rate for critically ill patients with HIV continues to improve. Researchers from the University of California, San Francisco, conducted a retrospective study of 281 adults who were HIV-infected and admitted to the ICU during a 5-year study period, with a total of 311 admissions. During the study period, respiratory failure remained the most common indication for ICU admissions (42 percent overall); however, the proportion of patients with respiratory failure decreased each year from 52 percent to 34 percent. Hospital survival rates also increased during the study period. Administration of antiretroviral therapy (ART) at admission was not associated with survival, although ART was associated with predictors that were associated with survival. This study is published in the January issue of the journal CHEST.
Pharmacotherapy for restless legs syndrome (RLS) may be ineffective or complicated by side effects. However, new research shows that pneumatic compression devices, which apply air pressure to the leg at regular intervals, may be an alternative therapy for RLS. Researchers from Walter Reed Army Medical Center in Washington, DC, conducted a prospective, randomized, double-blinded trial of 35 patients with RLS. Patients wore either a therapeutic or subtherapeutic (sham) device prior to the usual onset of RLS symptoms for a minimum of 1 hour daily. Therapeutic compression devices significantly improved all measured variables compared with shams, including the RLS severity score and Johns Hopkins restless legs severity scale score. All quality of life domains also were improved, including daytime function, sleep quality, and emotional well-being. Researchers conclude that pneumatic compression devices may be an effective nonpharmacologic therapy for RLS. This study is published in the January issue of the journal CHEST.
COPD ASSOCIATED WITH HIGHER DEPRESSION RATES THAN DIABETES
Chronic disease has been associated with higher rates of depression; however, new research shows that patients with chronic obstructive pulmonary disease (COPD) are nearly two times as likely to suffer from depression compared with patients with diabetes. Researchers from The Netherlands compared the health characteristics of 999 patients with COPD, 978 patients with diabetes, and 2,494 healthy control subjects. Results showed that patients with COPD were diagnosed almost twice as often with depression compared with diabetic patients and control subjects. Furthermore, the mean time to a first diagnosis of depression was 7.7 years for patients with COPD, 5.9 years for patients with diabetes, and 7.3 years for control subjects. Researchers speculate that the increased risk of depression is not the result of having a chronic disease in general but specific to COPD. This study is published in the January issue of the journal CHEST.
SURVIVAL CONTINUES TO IMPROVE FOR PATIENTS WITH HIV
New research finds that the survival rate for critically ill patients with HIV continues to improve. Researchers from the University of California, San Francisco, conducted a retrospective study of 281 adults who were HIV-infected and admitted to the ICU during a 5-year study period, with a total of 311 admissions. During the study period, respiratory failure remained the most common indication for ICU admissions (42 percent overall); however, the proportion of patients with respiratory failure decreased each year from 52 percent to 34 percent. Hospital survival rates also increased during the study period. Administration of antiretroviral therapy (ART) at admission was not associated with survival, although ART was associated with predictors that were associated with survival. This study is published in the January issue of the journal CHEST.
Budesonide/formoterol Plus Tiotropium Improves The Quality Of Life Of Patients With Severe COPD
To contact us Click HERE
Preliminary results from a double-blind, randomised, multicentre trial among 660 patients with chronic obstructive pulmonary disease (COPD) show that budesonide/formoterol (Symbicort®: AstraZeneca) plus tiotropium (Spiriva™: Boehringer Ingelheim Limited) significantly improves disease control and patients' quality of life.1,2
The study known as CLIMB, compared 12 weeks treatment with budesonide/formoterol (400/12 mcg one inhalation twice-daily) plus tiotropium (18 ?µg one inhalation once daily) vs. tiotropium alone plus placebo.
"Combined inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) therapy with budesonide/formoterol (Symbicort®) is indicated for COPD patients with a forced expiratory volume in 1 second (FEV1) < 50% predicted normal and a history of repeated exacerbations",3 explained Professor Tobias Welte, the international coordinating investigator of the CLIMB study. "While budesonide/formoterol combination is commonly used together with tiotropium for the management of patients with severe COPD, CLIMB is the first study to evaluate the therapeutic effect of combining budesonide/formoterol with tiotropium. The results of the study confirmed that this triple therapy regimen has a key role to play in the management of patients with COPD," he continued.
CLIMB showed that tiotropium plus budesonide/formoterol combination versus tiotropium alone:
- reduced the rate of severe exacerbations by 62% (p
Full results of the CLIMB study are due to be published later in 2009.
Notes
An estimated 3.7 million people in the UK have COPD; COPD is the 5th biggest killer in the UK; around 30,000 people in the UK die from COPD each year, which is more than from bowel cancer, breast cancer or prostate cancer.6
References
1. Welte T, et al. Budesonide/formoterol added to tiotropium improves the management of COPD patients. American Thoracic Society International Conference, San Diego, USA, 15-20 May 2009; Abst 953775.
2. Welte T, et al. Budesonide/formoterol added to tiotropium is well tolerated and reduces the risk of severe exacerbations in COPD patients. American Thoracic Society International Conference, San Diego, USA, 15-20 May 2009; Abst 953763.
3. Symbicort 400/12® Summary of Product Characteristics, December 2008.
4. Miravitlles M et al. Patient's perception of exacerbations of COPD - The PERCEIVE study. Respir Med 2007; 101: 453-60.
5. 'Unleash the life within...' a patient's perspective of living with Chronic Obstructive Pulmonary Disease (COPD) Survey. Sponsored by AstraZeneca UK Ltd.
6. British Lung Foundation. Invisible Lives. Chronic Obstructive Pulmonary Disease (COPD) - finding the missing millions, November 2007.
Source
AstraZeneca
View drug information on Spiriva HandiHaler.
The study known as CLIMB, compared 12 weeks treatment with budesonide/formoterol (400/12 mcg one inhalation twice-daily) plus tiotropium (18 ?µg one inhalation once daily) vs. tiotropium alone plus placebo.
"Combined inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) therapy with budesonide/formoterol (Symbicort®) is indicated for COPD patients with a forced expiratory volume in 1 second (FEV1) < 50% predicted normal and a history of repeated exacerbations",3 explained Professor Tobias Welte, the international coordinating investigator of the CLIMB study. "While budesonide/formoterol combination is commonly used together with tiotropium for the management of patients with severe COPD, CLIMB is the first study to evaluate the therapeutic effect of combining budesonide/formoterol with tiotropium. The results of the study confirmed that this triple therapy regimen has a key role to play in the management of patients with COPD," he continued.
CLIMB showed that tiotropium plus budesonide/formoterol combination versus tiotropium alone:
- reduced the rate of severe exacerbations by 62% (p
Full results of the CLIMB study are due to be published later in 2009.
Notes
An estimated 3.7 million people in the UK have COPD; COPD is the 5th biggest killer in the UK; around 30,000 people in the UK die from COPD each year, which is more than from bowel cancer, breast cancer or prostate cancer.6
References
1. Welte T, et al. Budesonide/formoterol added to tiotropium improves the management of COPD patients. American Thoracic Society International Conference, San Diego, USA, 15-20 May 2009; Abst 953775.
2. Welte T, et al. Budesonide/formoterol added to tiotropium is well tolerated and reduces the risk of severe exacerbations in COPD patients. American Thoracic Society International Conference, San Diego, USA, 15-20 May 2009; Abst 953763.
3. Symbicort 400/12® Summary of Product Characteristics, December 2008.
4. Miravitlles M et al. Patient's perception of exacerbations of COPD - The PERCEIVE study. Respir Med 2007; 101: 453-60.
5. 'Unleash the life within...' a patient's perspective of living with Chronic Obstructive Pulmonary Disease (COPD) Survey. Sponsored by AstraZeneca UK Ltd.
6. British Lung Foundation. Invisible Lives. Chronic Obstructive Pulmonary Disease (COPD) - finding the missing millions, November 2007.
Source
AstraZeneca
View drug information on Spiriva HandiHaler.
23 Haziran 2012 Cumartesi
Wrinkled Middle-Aged Smokers At Higher Risk Of COPD
To contact us Click HERE
If you are middle-aged, have lots of wrinkles and smoke, you are five times more likely to develop CPOD (chronic obstructive pulmonary disease) than middle-aged smokers who are not very wrinkly, says a study from the Royal Devon and Exeter Hospital, UK.
You can read the report in the journal Thorax. The scientists said that the heavy lines on a smoker's face could provide a good indication of COPD risk. They studied 149 people and concluded that genetic propensity to wrinkles seems to come with a higher susceptibility of developing COPD.
Millions of people around the world have COPD and have not been diagnosed. It is caused mainly by smoking. WHO predicts it will become the third leading cause of death in the world within the next 14 years.
The study looked at 149 people who smoke, or used to smoke. They were aged 45-70 and all came from the Cambridge, UK, area. 68 of them had COPD. 25 of them had very wrinkly faces, of which 21 had COPD. The researchers found that after taking into account the people's age and how long they had been smokers, those with wrinkly faces had five times the probability of having COPD compared to smokers who did not have wrinkly faces. Severe emphysema was also linked to wrinkly faces, said the researchers.
Team leader, Dr Bipen Patel, said "We think there is a genetic susceptibility to COPD. What this research shows is that those who are prone to COPD are also prone to wrinkles. If there is a gene for COPD susceptibility, it may also increase the chance of someone developing wrinkles." He added that wrinkles may become a risk indicator for COPD.
As early diagnosis is an essential part of effective COPD treatment, perhaps doctors should look out for middle-aged smoking patients who have wrinkly skin.
You can read the report in the journal Thorax. The scientists said that the heavy lines on a smoker's face could provide a good indication of COPD risk. They studied 149 people and concluded that genetic propensity to wrinkles seems to come with a higher susceptibility of developing COPD.
Millions of people around the world have COPD and have not been diagnosed. It is caused mainly by smoking. WHO predicts it will become the third leading cause of death in the world within the next 14 years.
The study looked at 149 people who smoke, or used to smoke. They were aged 45-70 and all came from the Cambridge, UK, area. 68 of them had COPD. 25 of them had very wrinkly faces, of which 21 had COPD. The researchers found that after taking into account the people's age and how long they had been smokers, those with wrinkly faces had five times the probability of having COPD compared to smokers who did not have wrinkly faces. Severe emphysema was also linked to wrinkly faces, said the researchers.
Team leader, Dr Bipen Patel, said "We think there is a genetic susceptibility to COPD. What this research shows is that those who are prone to COPD are also prone to wrinkles. If there is a gene for COPD susceptibility, it may also increase the chance of someone developing wrinkles." He added that wrinkles may become a risk indicator for COPD.
As early diagnosis is an essential part of effective COPD treatment, perhaps doctors should look out for middle-aged smoking patients who have wrinkly skin.
Life Is A Journey Not A Destination
To contact us Click HERE
Just before I was about to begin writing this article,I went through my emails. There it is! An email with the following quote:
"Plenty of people miss their share of happiness, not because they never found it, but because they didn't stop to enjoy it." --William Feather, Writer.
Journey
Talk about Law of Attraction or synchronism, here I was thinking about what to write and this pops up on my screen.
While studying for certification as a life coach, Life is a Journey not a Destination was one of the "Empowerment Foundation Principles" that was taught at iPEC (Institute for Professional Empowerment Coaching). But why write about it? This principal has special meaning for me and is one I think many of us forget in our busy lives. But what does it really mean?
Life is a Journey not a Destination is about living in the present. It's not about not having goals but it is about working so hard to reach your goals or being so focused on "getting there" that you forget to enjoy today.
Are you so concerned about retirement that you're afraid to take a vacation and enjoy today? Is your next promotion so much on your mind that you forget to leave work for your child's preschool graduation.?
How come when we're visiting a new place we love to walk around and find those unusual stores or restaurants but at home we never notice? After getting my nails done recently, I was hungry and saw a sushi restaurant. It was so good that I asked how long they had been there -- 28 years -- and I never noticed because every time I went to that shopping center I was so intent on where I was going and what I was doing that I never looked around.
Sometimes when you lose a spouse, you suddenly think about all the things you never did. Some goals may not be realized -- you may not retire together -- but when I lost my husband after he had battled for years with cancer, I knew one thing. I knew that I had no regrets that I had put off the things that we could do while working to meet our goals. We traveled with our son, went camping, but most important we took the time to have fun.
Maybe because we knew we had a limited amount of time, we took advantage of it.
BUT WHY?
These things didn't distract us from working toward our goals but definitely enhanced the process.
The Next Thing On My List by was a book we read for our book club a few months ago. This book is about a girl who had a list of things she wanted to do before she turned 25. Unfortunately she was killed in a car accident. The woman who was in the car with her found the list and decided to complete it. Have you made your life list? Whether you're 20, 40 or 60, what haven't you done that you wish you had or that you say I will when...?
One more thought. Do you remember being 14? Were you as consumed with getting into college as today's kids are? Talk to a teenager today and almost everything they do is related to how a college admissions person will view it. We have to teach our kids today to work hard but enjoy life also.
Life is a Journey Not a Destination - plan your destination and please, enjoy the journey!
Life Is A Journey Not A Destination
In 2006 Fran Elster and Mary Caprio formed Your New World Coaching. Both widowed at early ages, they had to reinvent themselves. This process took time for each of them to discover who they were in their new worlds. As Life Purpose Coaches, they are now dedicating themselves to helping people move forward in their lives. Visit our website at http://www.yournewworldcoaching.com or contact us at info@yournewworldcoaching.com
Your New World Coaching -- Acknowledge The Past, Live In The Present, Embrace The Future.
Why Should You Have a Chemical Stress Test?
To contact us Click HERE
Stress is a common, but serious problem for a great many people in today's world. Everyone experiences stress at some point in their life, and a small amount of stress is natural, however when stress becomes a long term issue it can have a detrimental effect on your physical and mental well-being. A chemical stress test can help identify stress related health issues and help you combat them before they become a serious problem.
What Can a Chemical Stress Test Do For Me?
\"family Life\"
A chemical stress test is a helpful test which is used to determine how effective a person will be at handling different stressful conditions. The test also identifies the short and long term effects that stress may have on the person. Some of the physical effects that can be assessed by this test include increased heart rate, increased blood pressure, increased acidity, and increased bowel movements.
Chemical stress tests take images of a resting, and stressed heart, then inject a radioactive substance into the patient. This substance becomes concentrated around the heart, and when more images of the heart are taken using a gamma camera, the images can be analyzed to determine the how well the heart is functioning, and the structural integrity of the heart.
Getting Ready For The Test
Your doctor should give you some advice on how to prepare for a chemical stress test. Typically you should avoid eating and drinking prior to the procedure, and you may need to stop taking certain medicines, but your doctor will advise you in more detail about this - you should never cease taking prescription medicines without the advice of a doctor, as abruptly stopping medicines can often be dangerous.
A full Chemical stress test usually takes between two and four hours - the first part usually takes an hour, and the second part around the same length of time.
Looking To the Future
Do not worry about the results of your test, the test does not only identify problems it will help you find solutions to improve your health. You should try to avoid stressful situations, and take time out of your day to day routine to relax. Consider taking up meditation or yoga, or any other relaxing hobbies. Try to build a daily routine that gives you time to relax, and remember that looking after yourself will improve all aspects of your life, including your health, work life, and family life.
Why Should You Have a Chemical Stress Test?
Avoid stress and diet related illnesses in your family by finding out how stress management helps illness [http://www.i-choose-us.com/tips4moms.shtml]. Sign up for our FREE newsletter and make stress and health management [http://www.i-choose-us.com/tips4moms.shtml] a priority in your family.
How to Stop Panic Attacks
To contact us Click HERE
It has been a long time dream of medical professionals to put a halt to panic attacks by various means, some means have yielded good results while some haven't. Stopping the attack can not be achieved without knowing the causes and symptoms.
Basically, study has shown that 80% of panic attacks are more of psychological than medical, so, here are some possible causes of the attack.
\"life Style\"
- Alcohol
- Shock
- Stress
- Hereditary
ALCOHOLS
Taken of excess alcohols have shown to have much adverse effect to people than its benefits to the health. Research has shown that excess alcohols cause spots on the veins invariably disrupting the flow of blood to the heart and this cause a health disorder of persistent fear to the victim. These persistent fears otherwise known as anxiety translate into a state of persistent fear.
SHOCK
This is an unexpected, intense, and distressing experience that has a sudden and powerful effect on somebodies' emotions or physical reaction. Also, it can be said to be a physiological collapse, marked by weak pulse, coldness, sweating and irregular breathing, and resulting from situation such as blood loss, hearth failure, allergic reaction, lost of beloved one, suffer of defeat and divorce news.
STRESS
This is a mental, physical and emotional strain caused by putting a long period of time in work.
It has the ability of raising ones blood pressure and depression invariably causing a state of restless which usually leads to a constant state of shivery or dizziness.
HEREDITARY
The act of persistent fear in ones life which is the major cause of panic attack could be from gene which means that the cause of ailment can be transferred from parent to offspring even from generation to generation.
In summary, it is obvious that how to stop panic attack begins with knowing the causes and symptoms which are listed above. You will believe with me that little could be done medically to stop this problems rather a good life style and a prepared mind to absorb all forms shock is the best means of stopping panic attack.
How to Stop Panic Attacks
Izi Smith Has help thousands of people with the best health therapy on how to Cure anxiety and panic attacks permanently.
Click [http://www.overcomepanicattaks.com] for a guide.
Drug Half Life and Drug Testing
To contact us Click HERE
Every drug has its own unique half life which can be used to determine if a person has ingested the substance recently. Whether illicit or legally prescribed, a drugs half life is the amount of time which is required for the trace concentration of a drug within the red blood cells to be reduced by one half. Simply put, a half life is the duration of time it takes for half the amount of a drug to leave the body. Heavy or consistent substance abuse will increase the half life of the drug while infrequent users will expel the toxins from their body at a faster rate.
Half lives of the most commonly abused illicit drugs follows: Regular marijuana users retain a half life of 10 days while sporadic users have a THC life cycle (the active and traceable component in marijuana) of only 2 days. The half lives of Methamphetamines are 15-20 hours while cocaine is between 1-2 hours.
Life
The half lives of the most commonly abused prescription drugs follows: The painkiller opiates, such as Vicodin, hydrocodone, hydrocodeine, oxycontin, Percocet, and oxycodone all have a half life between 4 and 6 hours. Anti-anxiety benzodiazepines such as Xanax and Valium have a time frame between 14-18 hours. Drug testing for most pills ingested needs to occur quickly after consumption due to the bodies rapid rate of expulsion for most commonly prescribed drugs.
Understanding the differences between the half lives of drugs is essential when determining the best method for drug testing. Urinalysis and urine test strips work best for drugs with longer lives such as marijuana and opiates while hair follicle tests and saliva drug tests will still show traces of drug use amongst quickly expelled drugs such as cocaine and methamphetamine. When trying to uncover and stop substance use and abuse, considering the half lives of each drug will enable you to find the most precise drug testing kit for accurate results unique to your situation.
Drug Half Life and Drug Testing
Frank Shepard is a leading source and writer of information for drug testing kits and home drug tests.
21 Haziran 2012 Perşembe
How To Make Money With affiliate programs
To contact us Click HERE
it really pays to work well with others. Also known as referral programs, affiliate programs are normally commission based sales. You'll recommend a site to your visitors and then pick up a percentage of any sale that those visitors make. You'll benefit from the commission and the merchant benefits from the sales.
If you already have a website set up, you can run an affiliate program from it, or you can simply build a site to promote a particular product or service. As long as it brings in more cash than it takes to build or run it, you'll be fine.
With any marketing program, you'll need to be careful when you select an affiliate program. The benefit of an affiliate program will give you another way to make money from your users. Instead of selling them a product, you simply send them to a partner then take a cut of the profits.
Even though it may seem tempting to go for programs with the highest commissions, those programs won't pay you anything if your visitors don't buy them.
Below, you'll find some tips to help you select an affiliate program that's right for you:
1. Do not accept any less than 25% with commission. You can find many programs with great payment structures and high percentages of pay in just about any field.
2. Look for statistic pages that list the number of click throughs, sales, and earnings so you'll be able to see how you are doing.
3. Always look for programs that offer a wide variety of tools to put on your web site, including banners, text links, and of course graphics.
4. Find out hwo often you'll be paid and be sure that the payment schedule meets with your own expectations. Some programs will pay monthly, while others will pay quarterly.
5. Be sure that top level support is included. If they can't answer your questions in a quick and timely manner, you don't want to work with them.
Once you learn what you are doing with affiliate programs, you can make a lot of money. If you are just starting out, you should always use common sense and not rush into anything. As you become more familiar with how things work, you'll be well on your way to making a lot of money – and enjoying making it. If you have to work hard, you'll be glad you did.
For More Information Click Here
Source White Market
Goal Setting for Kids
To contact us Click HERE
Ever thought about Goal Setting for Kids? Goal setting is one of the most important skills that a person can learn, and the earlier this skill is learned, the more chances there are for successful outcomes in a person's life. Adults know that goal setting is all about planning, making progress with that plan and reaching final goals or achievements. Once a child learns how to do this, they can use this tool for more success in school and at home.
Goal setting for kids will help your children to do well on their school tests and in activities such as sports, music programs or outside academic or arts programs – even at home, and with their personal finances. Teaching your child how to be a goal setter will give them a sense that they are capable of whatever they want to do. That's valuable!
How to help your child be a goal setting child
Goal setting for children is basically the same as for adults, with a few caveats. Because they are young, and not as emotionally or cognitively developed, goals should be smaller and more tangible. The idea with goal setting for kids is to get them started in the life-long frame of mind for thinking, planning and taking action to achieve results. The basic premises of goal setting remain the same. You can help your child learn to set goals by working through these steps with him:
Ask, "What do you want to achieve?" – Help your child describe in specific terms something he would like to do that will take some work/planning (getting an A on his next math test, earning money to purchase a certain kind of bicycle).
Ask, "How will you get there?" – Help him plan out the steps to take and the mini-goals to reach on his way to the ultimate goal.
Establish accountability – Have your child write down what he wants to achieve and what his plan for getting there is. He can read it each day to help him with personal accountability, and he can share it with you, or another trusted adult to help him stay motivated, inspired and on-track.
Achieve – Achievement is not only for the final outcome, but also for the small goals that are met along the way.
Review plan/goals/outcomes – Throughout the process and at the end as well, review with your child the plan and how it is going. Do adjustments need to be made? How does he feel about his progress and where it is leading? How was the goal setting experience for him?
If your child does not reach his ultimate goal, talk to him about what he learned on the way. He still has learned valuable lessons about planning and goal setting, and he's probably learned about himself. Encourage him to not give up on dreams that are important to him, but that if one plan doesn't work, he has to revise the plan and try again.
For More Information Click Here
Source White Market
Lindsay Lohan's Crazy Week: Car Crash, Porn Star And Paramedics
To contact us Click HERE
If your week involved smashing a Porsche into an 18-wheeler, being linked in headlines to a porn star, and having the paramedics called to your hotel room, there's a pretty good chance you are probably James Bond. Or Lindsay Lohan.
Of course, one of those folks is fictional. The other is very much real — and just had a really crazy week. Yes, the Lind-sanity is still with us, as the actress wrapped an impressive seven-day stretch that began with a car wreck (and hospitalization), rolled right on with some salacious headlines and wrapped with some drama at the Ritz-Carlton (and a rumored hospitalization).
Reed Full Article Here
Free Php Mailer Script
To contact us Click HERE
Great script to send millions of emails to your list using your website
just upload phpmailer to your site using Ftp then call it in your Browser
Type your email , Your message , Your name and your mail list up to 20,000 emails in one time
Download Free Phpmailer From Here ( Direct Link )
Download Free Phpmailer From Here ( 4shared.com )
keywords: php mail script,send mail php script,php send mail,php send mail with attachment,send mail php,php mass mailer,php mass mailer script,mass mailing,mass mailer,mass email marketing,mass emailer,mass email sender,nbox php mailer,php inbox mailer,inbox mailer php,inbox mass mailer,inbox mailer,mailer inbox,inbox emails,inbox mass mailer php,emails inbox
php mail script,send mail php script,php send mail,php send mail with attachment,send mail php,php mass mailer,php mass mailer script,mass mailing,mass mailer,mass email marketing,mass emailer,mass email sender,nbox php mailer,php inbox mailer,inbox mailer php,inbox mass mailer,inbox mailer,mailer inbox,inbox emails,inbox mass mailer php,emails inbox
php mail script,send mail php script,php send mail,php send mail with attachment,send mail php,php mass mailer,php mass mailer script,mass mailing,mass mailer,mass email marketing,mass emailer,mass email sender,nbox php mailer,php inbox mailer,inbox mailer php,inbox mass mailer,inbox mailer,mailer inbox,inbox emails,inbox mass mailer php,emails inbox
php mail script,send mail php script,php send mail,php send mail with attachment,send mail php,php mass mailer,php mass mailer script,mass mailing,mass mailer,mass email marketing,mass emailer,mass email sender,nbox php mailer,php inbox mailer,inbox mailer php,inbox mass mailer,inbox mailer,mailer inbox,inbox emails,inbox mass mailer php,emails inbox
Kaydol:
Kayıtlar (Atom)