To contact us Click HERE
A study in Clinical and Experimental Pharmacology and Physiology published by Wiley-Blackwell has showed that the generation of oxidative stress increases pulmonary inflammation - thus encouraging the development of airway obstruction associated with chronic obstructive pulmonary disease (COPD).
The study "Oxidative Stress is an Important Component of Airway Inflammation in Mice Exposed to Cigarette Smoke or Lipopolysaccharide" investigates the inflammatory responses in oxidative stress-deficient mice exposed to cigarette smoke. The authors employ a cigarette smoke model to understand the role of oxidative stress in the pathogenesis of COPD, and suggested that further investigations of the efficacy of new compounds that may help treat respiratory disorders.
Cigarette smoking is the main cause of respiratory disorders such as chronic bronchitis, emphysema and COPD. Smokers and patients with COPD generally display an increased oxidative stress level as compared to healthy patients.
Lead author Vincent Lagente, Professor of Pharmacology at the University of Rennes 1 in France says, "Overwhelming evidence shows that- compared to non-smokers and healthy patients - smokers and patients with COPD display an increased level of oxidative stress, and suffer from an imbalance in oxidants in airway inflammation. As classic anti-inflammatory compounds are ineffective in treating respiratory disorders, and the effects of cigarette smoke on COPD are still not completely understood, we have developed a cigarette exposure protocol that results in airway inflammation to better understand the physiopathology of the inflammatory process."
In examining the response of mice exposed to cigarette smoke, researchers found that those with reduced oxidative stress showed lesser inflammatory symptoms - hence suggesting the association of oxidative stress with COPD and supporting the development of anti-oxidant therapy for smoking related-diseases.
About Clinical and Experimental Pharmacology and Physiology
Clinical and Experimental Pharmacology and Physiology provides a medium for the rapid publication of original research papers, short communications, rapid communications and theoretical articles (hypotheses) on the results of clinical and experimental work in pharmacology and physiology. Invited review articles are published occasionally.
About Wiley-Blackwell
Wiley-Blackwell was formed in February 2007 as a result of the acquisition of Blackwell Publishing Ltd. by John Wiley & Sons, Inc., and its merger with Wiley's Scientific, Technical, and Medical business. Together, the companies have created a global publishing business with deep strength in every major academic and professional field. Wiley-Blackwell publishes approximately 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal. For more information on Wiley-Blackwell, please visit blackwellpublishing or interscience.wiley.
About Wiley
Founded in 1807, John Wiley & Sons, Inc. has been a valued source of information and understanding for 200 years, helping people around the world meet their needs and fulfill their aspirations. Since 1901, Wiley and its acquired companies have published the works of more than 350 Nobel laureates in all categories: Literature, Economics, Physiology/Medicine, Chemistry and Peace.
Our core businesses include scientific, technical, medical and scholarly journals, encyclopedias, books, and online products and services; professional/trade publishes books, subscription products, training materials, and online applications and websites; and educational materials for undergraduate and graduate students and lifelong learners. Wiley's global headquarters are located in Hoboken, New Jersey, with operations in the U.S., Europe, Asia, Canada, and Australia. The Company's Web site can be accessed at wiley. The Company is listed on the New York Stock Exchange under the symbols JWa and JWb.
John Wiley & Sons, Inc.
4 Temmuz 2012 Çarşamba
Chronic Obstructive Pulmonary Disease (COPD) can prevention be improved?
To contact us Click HERE
To contribute to the improvement of COPD (Chronic Obstructive Pulmonary Disease) prevention, by identifying groups at risk for COPD, reseachers carried out a detailed analysis of the determinants of COPD using the Stepwise Target Group-Oriented Prevention (STOP) model.
Results had shown that, apart from smoking, other environmental determinants and host factors contribute to further lung function's rapid decline.
Target groups for early disease detection and appropriate interventions can be identified by the presence of one or more known risk factors and by identification of high-risk groups.
It was concluded that the STOP strategy is a step toward improvement in COPD prevention, by shifting the focus from symptomatic smokers aged 45+ years to much earlier and preventable stages of the disease, that is, from disease treatment to risk management.
M. H. Ghambarian et al., Preventive Medicine, Vol. 39 (2) 337-43, August 2004
sciencedirectsciencedirect
Results had shown that, apart from smoking, other environmental determinants and host factors contribute to further lung function's rapid decline.
Target groups for early disease detection and appropriate interventions can be identified by the presence of one or more known risk factors and by identification of high-risk groups.
It was concluded that the STOP strategy is a step toward improvement in COPD prevention, by shifting the focus from symptomatic smokers aged 45+ years to much earlier and preventable stages of the disease, that is, from disease treatment to risk management.
M. H. Ghambarian et al., Preventive Medicine, Vol. 39 (2) 337-43, August 2004
sciencedirectsciencedirect
New Research Shows Many Patients With Persistent Cough And Sputum Actually Had Airway Obstruction Consistent With COPD
To contact us Click HERE
GlaxoSmithKline (NYSE:
GSK) announced findings from a cross-sectional study which showed
that 26 percent of primary care patients 40 years of age and older with a
history of smoking and symptoms of chronic bronchitis actually had airway
obstruction consistent with chronic obstructive pulmonary disease (COPD) -
yet were not diagnosed with the disease.
The data also show that as age and smoking history increased the
percent of patients with COPD increased - roughly half (49%) of the
patients over 60 years of age with more than a 20-pack year history of
smoking had an FEV(1) (forced expiratory flow in one second)/FVC (forced
vital capacity) ratio consistent with COPD; 40 percent of patients over 50
years of age who had more than a 30-pack year history of smoking also had
FEV(1)/FVC consistent with COPD. For the group over 70 years of age with
more than a 40-pack year history, the percent increased to 72.
Overall, only 4 percent of patients in this study had been diagnosed
with COPD by their clinician. These data were presented in Philadelphia at
CHEST 2008, the annual meeting of the American College of Chest Physicians.
"Understanding the patients who are at greatest risk for having
undiagnosed COPD should help improve disease recognition, diagnosis and
management," said Barbara Yawn, M.D., lead author and director of research
at the Olmsted Medical Center, Rochester, MN. "Spirometry should be
considered in anyone with symptoms and a 10 or greater pack-year smoking
history - which is how we will improve recognition of COPD."
In the study, pre- and post-bronchodilatory spirometry was performed on
all patients. Albuterol was self-administered for determination of post-
bronchodilator FEV(1)/FVC ratio, post-albuterol FEV(1)% of predicted normal
and FEV(1) reversibility. All patients had self-reported symptoms of
chronic bronchitis and were current or previous cigarette smokers with a
history of cigarette smoking of > or = 10 pack-years. COPD was defined as a
post- bronchodilator FEV(1)/FVC < or = 0.7.
COPD is characterized by a progressive airflow limitation that is not
fully reversible and is associated with an abnormal inflammatory response
of the lungs, primarily caused by smoking. The range of conditions
described by COPD, which include chronic bronchitis and emphysema, has led
to confusion about disease terminology and difficulty with diagnosis
especially in the primary care setting. Despite the availability of
effective medicines to help manage the disease, many patients with COPD
remain undiagnosed and under- treated. This study aimed to characterize
airway obstruction, patient characteristics, and patient and provider
awareness and understanding of COPD in primary care patients with symptoms
of chronic bronchitis.
About the Study
This was a multi-center, cross-sectional study of more than 1,200
subjects 40 years of age and older with a minimum 10 pack-year smoking
history and symptoms of chronic bronchitis recruited from primary care
centers. There was no treatment intervention in the study. Each study
subject completed a single visit encompassing all study procedures, which
included two questionnaires completed by each study subject. One
questionnaire was a compilation of the medical research council (MRC)
dyspnea scale, the 12-item Short Form Health Survey (SF-12, version 2), a
modified American Thoracic Society (ATS) respiratory questionnaire, and
additional questions about disease and smoking history, work and non-work
activities missed due to breathing problems. The other questionnaire, The
Lung Function Questionnaire (LFQ), was comprised of seven questions related
to respiratory symptoms, smoking history and age.
About the Lung Function Questionnaire
Data was also presented at CHEST 2008 on the development of the Lung
Function Questionnaire (LFQ), a patient screening tool to help identify
patients at risk for airflow obstruction who are candidates for spirometry
and to help address undiagnosed COPD issues.
The LFQ is being developed in 3 phases: 1) Empirical phase: candidate
questionnaire items were identified and their accuracy evaluated using data
from NHANES III; 2) Qualitative phase: questions identified in phase 1 were
evaluated for clarity by patients/clinicians; 3) Quantitative phase:
ongoing validation study of the LFQ in screening for airway obstruction.
The LFQ contained age, wheeze, dyspnea, smoking and phlegm as questions
being predictive of airflow obstruction. LFQ demonstrates moderate
screening accuracy both in a chronic bronchitis population as well as in a
general population in NHANES. Additional validation studies are underway to
further evaluate LFQ in a general population.
Background on COPD
An estimated 24 million Americans suffer from COPD, which is the fourth
leading cause of death in the United States. COPD is a progressive, life-
threatening lung disease that includes chronic bronchitis and emphysema. It
is characterized by airflow obstruction, a limitation in lung function that
makes it difficult to breathe. Many patients have components of both
chronic bronchitis and emphysema. Symptoms of COPD include chronic cough,
chest tightness, shortness of breath, an increased effort to breathe and
increased mucus production. Typically, patients with COPD develop shortness
of breath during exertion, which continues and gradually worsens. Most
patients also develop a productive, chronic cough. Over time, many patients
suffer from shortness of breath so severe that it interferes with their
most basic daily activities including sleeping, talking, and even dressing.
The gradual loss of lung function, coupled with other symptoms and
exacerbations, often lead to hospitalization and can be disabling and
life-threatening.
GlaxoSmithKline - one of the world's leading research-based
pharmaceutical and healthcare companies - is committed to improving the
quality of human life by enabling people to do more, feel better and live
longer.
Cautionary statement regarding forward-looking statements
Under the safe harbor provisions of the U.S. Private Securities
Litigation Reform Act of 1995, GSK cautions investors that any
forward-looking statements or projections made by GSK, including those made
in this announcement, are subject to risks and uncertainties that may cause
actual results to differ materially from those projected. Factors that may
affect GSK's operations are described under 'Risk Factors' in the 'Business
Review' in the company's Annual Report on Form 20-F for 2007.
GlaxoSmithKline
gsk
GSK) announced findings from a cross-sectional study which showed
that 26 percent of primary care patients 40 years of age and older with a
history of smoking and symptoms of chronic bronchitis actually had airway
obstruction consistent with chronic obstructive pulmonary disease (COPD) -
yet were not diagnosed with the disease.
The data also show that as age and smoking history increased the
percent of patients with COPD increased - roughly half (49%) of the
patients over 60 years of age with more than a 20-pack year history of
smoking had an FEV(1) (forced expiratory flow in one second)/FVC (forced
vital capacity) ratio consistent with COPD; 40 percent of patients over 50
years of age who had more than a 30-pack year history of smoking also had
FEV(1)/FVC consistent with COPD. For the group over 70 years of age with
more than a 40-pack year history, the percent increased to 72.
Overall, only 4 percent of patients in this study had been diagnosed
with COPD by their clinician. These data were presented in Philadelphia at
CHEST 2008, the annual meeting of the American College of Chest Physicians.
"Understanding the patients who are at greatest risk for having
undiagnosed COPD should help improve disease recognition, diagnosis and
management," said Barbara Yawn, M.D., lead author and director of research
at the Olmsted Medical Center, Rochester, MN. "Spirometry should be
considered in anyone with symptoms and a 10 or greater pack-year smoking
history - which is how we will improve recognition of COPD."
In the study, pre- and post-bronchodilatory spirometry was performed on
all patients. Albuterol was self-administered for determination of post-
bronchodilator FEV(1)/FVC ratio, post-albuterol FEV(1)% of predicted normal
and FEV(1) reversibility. All patients had self-reported symptoms of
chronic bronchitis and were current or previous cigarette smokers with a
history of cigarette smoking of > or = 10 pack-years. COPD was defined as a
post- bronchodilator FEV(1)/FVC < or = 0.7.
COPD is characterized by a progressive airflow limitation that is not
fully reversible and is associated with an abnormal inflammatory response
of the lungs, primarily caused by smoking. The range of conditions
described by COPD, which include chronic bronchitis and emphysema, has led
to confusion about disease terminology and difficulty with diagnosis
especially in the primary care setting. Despite the availability of
effective medicines to help manage the disease, many patients with COPD
remain undiagnosed and under- treated. This study aimed to characterize
airway obstruction, patient characteristics, and patient and provider
awareness and understanding of COPD in primary care patients with symptoms
of chronic bronchitis.
About the Study
This was a multi-center, cross-sectional study of more than 1,200
subjects 40 years of age and older with a minimum 10 pack-year smoking
history and symptoms of chronic bronchitis recruited from primary care
centers. There was no treatment intervention in the study. Each study
subject completed a single visit encompassing all study procedures, which
included two questionnaires completed by each study subject. One
questionnaire was a compilation of the medical research council (MRC)
dyspnea scale, the 12-item Short Form Health Survey (SF-12, version 2), a
modified American Thoracic Society (ATS) respiratory questionnaire, and
additional questions about disease and smoking history, work and non-work
activities missed due to breathing problems. The other questionnaire, The
Lung Function Questionnaire (LFQ), was comprised of seven questions related
to respiratory symptoms, smoking history and age.
About the Lung Function Questionnaire
Data was also presented at CHEST 2008 on the development of the Lung
Function Questionnaire (LFQ), a patient screening tool to help identify
patients at risk for airflow obstruction who are candidates for spirometry
and to help address undiagnosed COPD issues.
The LFQ is being developed in 3 phases: 1) Empirical phase: candidate
questionnaire items were identified and their accuracy evaluated using data
from NHANES III; 2) Qualitative phase: questions identified in phase 1 were
evaluated for clarity by patients/clinicians; 3) Quantitative phase:
ongoing validation study of the LFQ in screening for airway obstruction.
The LFQ contained age, wheeze, dyspnea, smoking and phlegm as questions
being predictive of airflow obstruction. LFQ demonstrates moderate
screening accuracy both in a chronic bronchitis population as well as in a
general population in NHANES. Additional validation studies are underway to
further evaluate LFQ in a general population.
Background on COPD
An estimated 24 million Americans suffer from COPD, which is the fourth
leading cause of death in the United States. COPD is a progressive, life-
threatening lung disease that includes chronic bronchitis and emphysema. It
is characterized by airflow obstruction, a limitation in lung function that
makes it difficult to breathe. Many patients have components of both
chronic bronchitis and emphysema. Symptoms of COPD include chronic cough,
chest tightness, shortness of breath, an increased effort to breathe and
increased mucus production. Typically, patients with COPD develop shortness
of breath during exertion, which continues and gradually worsens. Most
patients also develop a productive, chronic cough. Over time, many patients
suffer from shortness of breath so severe that it interferes with their
most basic daily activities including sleeping, talking, and even dressing.
The gradual loss of lung function, coupled with other symptoms and
exacerbations, often lead to hospitalization and can be disabling and
life-threatening.
GlaxoSmithKline - one of the world's leading research-based
pharmaceutical and healthcare companies - is committed to improving the
quality of human life by enabling people to do more, feel better and live
longer.
Cautionary statement regarding forward-looking statements
Under the safe harbor provisions of the U.S. Private Securities
Litigation Reform Act of 1995, GSK cautions investors that any
forward-looking statements or projections made by GSK, including those made
in this announcement, are subject to risks and uncertainties that may cause
actual results to differ materially from those projected. Factors that may
affect GSK's operations are described under 'Risk Factors' in the 'Business
Review' in the company's Annual Report on Form 20-F for 2007.
GlaxoSmithKline
gsk
Almirall Strengthens Its Respiratory Franchise With A New Generation Of Chronic Obstructive Pulmonary Disease (COPD) Treatment
To contact us Click HERE
Almirall strengthens its position in the respiratory field with a positive development progress of another New Chemical Entity (NCE). LAS190792 is a new dual long-acting Muscarinic Antagonist ??2 Agonist (MABA), which combines two bronchodilator mechanisms in a single molecule for the treatment of COPD. This new class of inhaled long-acting bronchodilators is expected to provide additional symptom relief in patients living with COPD, and to form the basis of so called triple combinations together with ICS (inhaled corticosteroids). The MABA franchise (MABA and MABA/ICS combination) offer the convenience of different mechanisms of action in one inhaler therapy, and is envisaged to become a future block buster in COPD.
"Almirall's MABA (LAS190792) represents an exciting opportunity for the treatment of COPD and shows the strength of Almirall??s commitment to research in respiratory disease", said Dr Bertil Lindmark, MD, PhD, and Chief Scientific Officer at Almirall.
MABA compounds offer the advantage over the two-molecule bronchodilator combinations (LABA/LAMA), in that MABA/ICS combinations can be developed with a reasonable size development programme.
In preclinical models, LAS190792 has shown to have a long duration of action and high anti-muscarinic activity combined with ??2 agonism. The molecule shows very favourable drug properties and safety.
Almirall is planning to prioritize the finalization of the pre-clinical phase, aiming at starting clinical studies during first half of 2012.
LAS190792 will be developed in the Genuair® inhaler, a novel, state-of-the-art, multi-dose dry powder inhaler. It incorporates significant safety features, including one hand dosing, visible dose indicator, an anti-double dosing mechanism and an end-of-dose lock-out system to prevent use of an empty inhaler, as well as audio feedback to confirm successful dose intake. Genuair® is a registered trademark owned by Almirall, S.A.
After aclidinium bromide (monotherapy planned to be filed in mid 2011) and LAS100977 (LABA) + ICS (currently in phase II), this MABA is the third NCE developed by Almirall which will utilize the Genuair® inhaler system.
About COPD
The World Health Organisation (WHO) has described COPD as a global epidemic; an estimated 210 million people have COPD worldwide and more than 3 million people died of the condition in 2005, which is equal to 5% of all deaths globally that year. Total deaths from COPD are projected to increase by more than 30% in the next 10 years without interventions to cut risks, particularly exposure to tobacco smoke.
In patients with COPD the airways in the lungs typically lose their elasticity, produce excess mucus and become thick and inflamed, limiting the passage of air. The most common symptoms of COPD are breathlessness (or a "need for air"), abnormal sputum (a mix of saliva and mucus in the airway), and a chronic cough. Daily activities, such as walking up a short flight of stairs or carrying a suitcase, can become very difficult as the condition gradually worsens. There are significant unmet needs in the treatment of COPD including limited therapeutic options to improve lung function, reduce symptoms and control exacerbations.
"Almirall's MABA (LAS190792) represents an exciting opportunity for the treatment of COPD and shows the strength of Almirall??s commitment to research in respiratory disease", said Dr Bertil Lindmark, MD, PhD, and Chief Scientific Officer at Almirall.
MABA compounds offer the advantage over the two-molecule bronchodilator combinations (LABA/LAMA), in that MABA/ICS combinations can be developed with a reasonable size development programme.
In preclinical models, LAS190792 has shown to have a long duration of action and high anti-muscarinic activity combined with ??2 agonism. The molecule shows very favourable drug properties and safety.
Almirall is planning to prioritize the finalization of the pre-clinical phase, aiming at starting clinical studies during first half of 2012.
LAS190792 will be developed in the Genuair® inhaler, a novel, state-of-the-art, multi-dose dry powder inhaler. It incorporates significant safety features, including one hand dosing, visible dose indicator, an anti-double dosing mechanism and an end-of-dose lock-out system to prevent use of an empty inhaler, as well as audio feedback to confirm successful dose intake. Genuair® is a registered trademark owned by Almirall, S.A.
After aclidinium bromide (monotherapy planned to be filed in mid 2011) and LAS100977 (LABA) + ICS (currently in phase II), this MABA is the third NCE developed by Almirall which will utilize the Genuair® inhaler system.
About COPD
The World Health Organisation (WHO) has described COPD as a global epidemic; an estimated 210 million people have COPD worldwide and more than 3 million people died of the condition in 2005, which is equal to 5% of all deaths globally that year. Total deaths from COPD are projected to increase by more than 30% in the next 10 years without interventions to cut risks, particularly exposure to tobacco smoke.
In patients with COPD the airways in the lungs typically lose their elasticity, produce excess mucus and become thick and inflamed, limiting the passage of air. The most common symptoms of COPD are breathlessness (or a "need for air"), abnormal sputum (a mix of saliva and mucus in the airway), and a chronic cough. Daily activities, such as walking up a short flight of stairs or carrying a suitcase, can become very difficult as the condition gradually worsens. There are significant unmet needs in the treatment of COPD including limited therapeutic options to improve lung function, reduce symptoms and control exacerbations.
NICE Consults On New Chronic Obstructive Pulmonary Disease And Chronic Kidney Disease Draft Quality Standards
To contact us Click HERE
NICE has today (30 September) launched a consultation on its draft quality standards for chronic obstructive pulmonary disease (COPD)[1] and chronic kidney disease (CKD)[2] in adults. The consultation period will also include field testing during which NICE implementation consultants will visit service providers, GPs and Primary Care Trusts to explore how the standards can be effectively and successfully put into practice.
NICE quality standards reflect the very best in high quality patient care. They aim to help healthcare practitioners and commissioners of care deliver excellent services. They are the only standards in health and social care that apply nationally in England, and are derived from the best available evidence, usually NICE guidance or other sources that have been accredited by NHS Evidence[3].
NICE quality standards are aimed at:
- Patients and the public
- clinicians
- public health practitioners
- commissioners
- service providers.
The draft quality standard on COPD identifies a number of elements of high quality patient care, including:
- People receiving a clinical diagnosis of COPD have a record of one or more indicative symptoms.
- People with COPD who smoke are encouraged to stop and offered help to do so.
- People with COPD, meeting appropriate criteria, are offered an effective pulmonary rehabilitation programme.
The draft quality standard on CKD defines high quality patient care to include the following:
- People with CKD are assessed for disease progression and associated complications.
- People with CKD in defined at risk groups are referred for specialist assessment in accordance with NICE guidance.
- People with CKD are immunised against infection in accordance with current policy.
The draft quality standards are available on the NICE website until 5.00pm, Wednesday 10 November 2010, and allow stakeholders to comment on the drafts and help prioritise which statements are most important to support quality improvement.
Dr Fergus Macbeth, Centre for Clinical Practice Director at NICE said: "The draft NICE quality standards on COPD and CKD have been developed from a range of evidence sources such as published NICE guidance, and the UK Renal Association Clinical Practice Guidelines. The standards will set the benchmark for healthcare quality in these two disease areas, to enable healthcare commissioners and providers to deliver the best care locally. I would encourage all those with an interest in these areas to submit their comments via the NICE website."
These drafts have been issued for consultation;NICE has not yet published the final quality standards to the NHS.
The draft standards are available for consultation on the NICE website until 5.00pm on Wednesday 10 November here.
All eligible comments will be reviewed by the independent Topic Expert Group and the Programme Board and the standards will be refined in light of this information. The final quality standards for COPD and CKD are expected to be published in March 2010.
Notes
--The draft quality standards on COPD are derived from the following evidence sources:
- NICE (2010) Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care (partial update). NICE clinical guideline 101.
- Department of Health (2010) Consultation on a strategy for services for COPD in England.
--The UK Renal Association Clinical Practice Guidelines can be found here.
--The draft quality standards on CKD in adults are derived from the following evidence sources:
- NICE (2008) Chronic kidney disease: early identification and management of chronic kidney disease in adults in primary and secondary care. NICE clinical guideline 73.
- NICE (2006) Anaemia management in people with chronic kidney disease. NICE clinical guideline 39.
- UK Renal Association (2010) Clinical practice guidelines: Vascular access for haemodialysis.
- UK Renal Association (2010) Clinical practice guidelines: Peritoneal dialysis.
- UK Renal Association (2009) Clinical practice guidelines: Planning, initiating and withdrawal of renal replacement therapy.
- UK Renal Association (2009) Clinical practice guidelines: Peritoneal access.
- UK Renal Association (2009) Clinical practice guidelines: Blood borne virus infection.
- UK Renal Association (2009) Clinical practice guidelines: Haemodialysis.
- UK Renal Association (2008) Clinical practice guidelines: Assessment for renal transplantation.
- UK Renal Association (2008) Clinical practice guidelines: Acute kidney injury.
- Department of Health (2010) Immunisation against infectious disease - 'The Green Book'.
- Department of Health (2009) Achieving excellence in kidney care: Delivering the National Service Framework for Renal Services.
- Department of Health (2007) Second Progress Report on the Renal NSF.
-Department of Health (2004) National Service Framework for Renal Services: Part One - Dialysis and transplantation.
-Department of Health (2005) National Service Framework for Renal Services - Part Two: Chronic kidney disease, acute renal failure and end of life care.
- Transparency in outcomes - a framework for the NHS consultation can be found here.
[1] Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease.
[2] Chronic kidney disease (CKD) is a chronic (long-term) condition where the kidneys progressively lose their function.
[3] The recently announced Transparency in Outcomes framework for the NHS proposes using quality standards to produce more detailed commissioning guidance to meet the suggested outcome goals.
NICE quality standards reflect the very best in high quality patient care. They aim to help healthcare practitioners and commissioners of care deliver excellent services. They are the only standards in health and social care that apply nationally in England, and are derived from the best available evidence, usually NICE guidance or other sources that have been accredited by NHS Evidence[3].
NICE quality standards are aimed at:
- Patients and the public
- clinicians
- public health practitioners
- commissioners
- service providers.
The draft quality standard on COPD identifies a number of elements of high quality patient care, including:
- People receiving a clinical diagnosis of COPD have a record of one or more indicative symptoms.
- People with COPD who smoke are encouraged to stop and offered help to do so.
- People with COPD, meeting appropriate criteria, are offered an effective pulmonary rehabilitation programme.
The draft quality standard on CKD defines high quality patient care to include the following:
- People with CKD are assessed for disease progression and associated complications.
- People with CKD in defined at risk groups are referred for specialist assessment in accordance with NICE guidance.
- People with CKD are immunised against infection in accordance with current policy.
The draft quality standards are available on the NICE website until 5.00pm, Wednesday 10 November 2010, and allow stakeholders to comment on the drafts and help prioritise which statements are most important to support quality improvement.
Dr Fergus Macbeth, Centre for Clinical Practice Director at NICE said: "The draft NICE quality standards on COPD and CKD have been developed from a range of evidence sources such as published NICE guidance, and the UK Renal Association Clinical Practice Guidelines. The standards will set the benchmark for healthcare quality in these two disease areas, to enable healthcare commissioners and providers to deliver the best care locally. I would encourage all those with an interest in these areas to submit their comments via the NICE website."
These drafts have been issued for consultation;NICE has not yet published the final quality standards to the NHS.
The draft standards are available for consultation on the NICE website until 5.00pm on Wednesday 10 November here.
All eligible comments will be reviewed by the independent Topic Expert Group and the Programme Board and the standards will be refined in light of this information. The final quality standards for COPD and CKD are expected to be published in March 2010.
Notes
--The draft quality standards on COPD are derived from the following evidence sources:
- NICE (2010) Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care (partial update). NICE clinical guideline 101.
- Department of Health (2010) Consultation on a strategy for services for COPD in England.
--The UK Renal Association Clinical Practice Guidelines can be found here.
--The draft quality standards on CKD in adults are derived from the following evidence sources:
- NICE (2008) Chronic kidney disease: early identification and management of chronic kidney disease in adults in primary and secondary care. NICE clinical guideline 73.
- NICE (2006) Anaemia management in people with chronic kidney disease. NICE clinical guideline 39.
- UK Renal Association (2010) Clinical practice guidelines: Vascular access for haemodialysis.
- UK Renal Association (2010) Clinical practice guidelines: Peritoneal dialysis.
- UK Renal Association (2009) Clinical practice guidelines: Planning, initiating and withdrawal of renal replacement therapy.
- UK Renal Association (2009) Clinical practice guidelines: Peritoneal access.
- UK Renal Association (2009) Clinical practice guidelines: Blood borne virus infection.
- UK Renal Association (2009) Clinical practice guidelines: Haemodialysis.
- UK Renal Association (2008) Clinical practice guidelines: Assessment for renal transplantation.
- UK Renal Association (2008) Clinical practice guidelines: Acute kidney injury.
- Department of Health (2010) Immunisation against infectious disease - 'The Green Book'.
- Department of Health (2009) Achieving excellence in kidney care: Delivering the National Service Framework for Renal Services.
- Department of Health (2007) Second Progress Report on the Renal NSF.
-Department of Health (2004) National Service Framework for Renal Services: Part One - Dialysis and transplantation.
-Department of Health (2005) National Service Framework for Renal Services - Part Two: Chronic kidney disease, acute renal failure and end of life care.
- Transparency in outcomes - a framework for the NHS consultation can be found here.
[1] Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease.
[2] Chronic kidney disease (CKD) is a chronic (long-term) condition where the kidneys progressively lose their function.
[3] The recently announced Transparency in Outcomes framework for the NHS proposes using quality standards to produce more detailed commissioning guidance to meet the suggested outcome goals.
2 Temmuz 2012 Pazartesi
Possible Alternate Therapy For Adults With Poorly Controlled Asthma
To contact us Click HERE
A drug commonly used for the treatment of chronic obstructive pulmonary disease (COPD) successfully treats adults whose asthma is not well-controlled on low doses of inhaled corticosteroids, reported researchers supported by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.
"This study's results show that tiotropium bromide might provide an alternative to other asthma treatments, expanding options available to patients for controlling their asthma," said NHLBI Acting Director Susan B. Shurin, M.D. "The goal in managing asthma is to prevent symptoms so patients can pursue activities to the fullest."
According to the study, adding tiotropium bromide to low doses of inhaled corticosteroids is more effective at controlling asthma than doubling inhaled corticosteroids alone, and as effective as adding the long-acting beta agonist salmeterol. The results were published online today in the New England Journal of Medicine and presented at the Annual Congress of the European Respiratory Society in Barcelona, Spain.
Increasing inhaled corticosteroids or supplementing them with long-acting beta agonists like salmeterol are the two preferred treatment options available for adults whose asthma is poorly controlled on low doses of inhaled corticosteroids. However, higher doses of corticosteroids do not improve symptoms for all patients and can have significant side effects, while long-acting beta agonists have come under scrutiny for their risk of worsening asthma symptoms that could result in hospitalization and, rarely, death.
"Tiotropium relaxes smooth muscle in the airways through a different mechanism than beta agonists, and thus may help people who do not respond well to currently recommended treatments," said study lead Stephen Peters, M.D., Ph.D., of Wake Forest University Baptist Medical Center, Winston-Salem, N.C. "Further analysis of the study data will help us better understand which patients respond best to tiotropium. Then we will need to conduct longer-term studies to establish its safety for asthma patients and to determine its effect on the frequency and severity of asthma exacerbations."
Conducted by the NHLBI's Asthma Clinical Research Network, the study compared three treatment methods: doubling the dose of inhaled corticosteroids alone, supplementing a low dose of inhaled corticosteroids with a long-acting beta agonist (salmeterol), and supplementing a low dose of inhaled corticosteroids with a long-acting anticholinergic drug (tiotropium bromide). Anticholinergics block a part of the autonomic nervous system that can cause airway muscles to contract. The study followed 210 adults whose asthma was not well-controlled on low doses of inhaled corticosteroids alone. Participants received each treatment for 14 weeks with two-week breaks in between, for a total of 48 weeks.
Tiotropium bromide was shown to be effective using several asthma control measurements, including patients' day-to-day lung function as well as the number of days in which they had no asthma symptoms and did not need to use their albuterol rescue inhalers. When patients began the trial, their average number of such "asthma control days" was 77 per year (extrapolated from the treatment period). Doubling corticosteroids gave patients another 19 symptom-free days on average, while adding tiotropium to low-dose corticosteroids gave them another 48.
"Much research over the last century has explored the role of cholinergic mechanisms [which constrict the airways] and anticholinergic therapies in asthma. However, this is the first study to explore adding an anticholinergic inhaler to low-dose inhaled corticosteroids," said James Kiley, Ph.D., director of the NHLBI's Division of Lung Diseases. "The Asthma Clinical Research Network is designed to address exactly these kinds of practical and important management questions, with the ultimate goal of helping asthma patients."
More information about the trial - Tiotropium Bromide as an Alternative to Increased Inhaled Corticosteroid in Patients Inadequately Controlled on a Lower Dose of Inhaled Corticosteroid, or TALC (NCT00565266) - can be found at clinicaltrials.
Resources:
Asthma clinical practice guidelines
Asthma Clinical Research Network (ACRN)
"This study's results show that tiotropium bromide might provide an alternative to other asthma treatments, expanding options available to patients for controlling their asthma," said NHLBI Acting Director Susan B. Shurin, M.D. "The goal in managing asthma is to prevent symptoms so patients can pursue activities to the fullest."
According to the study, adding tiotropium bromide to low doses of inhaled corticosteroids is more effective at controlling asthma than doubling inhaled corticosteroids alone, and as effective as adding the long-acting beta agonist salmeterol. The results were published online today in the New England Journal of Medicine and presented at the Annual Congress of the European Respiratory Society in Barcelona, Spain.
Increasing inhaled corticosteroids or supplementing them with long-acting beta agonists like salmeterol are the two preferred treatment options available for adults whose asthma is poorly controlled on low doses of inhaled corticosteroids. However, higher doses of corticosteroids do not improve symptoms for all patients and can have significant side effects, while long-acting beta agonists have come under scrutiny for their risk of worsening asthma symptoms that could result in hospitalization and, rarely, death.
"Tiotropium relaxes smooth muscle in the airways through a different mechanism than beta agonists, and thus may help people who do not respond well to currently recommended treatments," said study lead Stephen Peters, M.D., Ph.D., of Wake Forest University Baptist Medical Center, Winston-Salem, N.C. "Further analysis of the study data will help us better understand which patients respond best to tiotropium. Then we will need to conduct longer-term studies to establish its safety for asthma patients and to determine its effect on the frequency and severity of asthma exacerbations."
Conducted by the NHLBI's Asthma Clinical Research Network, the study compared three treatment methods: doubling the dose of inhaled corticosteroids alone, supplementing a low dose of inhaled corticosteroids with a long-acting beta agonist (salmeterol), and supplementing a low dose of inhaled corticosteroids with a long-acting anticholinergic drug (tiotropium bromide). Anticholinergics block a part of the autonomic nervous system that can cause airway muscles to contract. The study followed 210 adults whose asthma was not well-controlled on low doses of inhaled corticosteroids alone. Participants received each treatment for 14 weeks with two-week breaks in between, for a total of 48 weeks.
Tiotropium bromide was shown to be effective using several asthma control measurements, including patients' day-to-day lung function as well as the number of days in which they had no asthma symptoms and did not need to use their albuterol rescue inhalers. When patients began the trial, their average number of such "asthma control days" was 77 per year (extrapolated from the treatment period). Doubling corticosteroids gave patients another 19 symptom-free days on average, while adding tiotropium to low-dose corticosteroids gave them another 48.
"Much research over the last century has explored the role of cholinergic mechanisms [which constrict the airways] and anticholinergic therapies in asthma. However, this is the first study to explore adding an anticholinergic inhaler to low-dose inhaled corticosteroids," said James Kiley, Ph.D., director of the NHLBI's Division of Lung Diseases. "The Asthma Clinical Research Network is designed to address exactly these kinds of practical and important management questions, with the ultimate goal of helping asthma patients."
More information about the trial - Tiotropium Bromide as an Alternative to Increased Inhaled Corticosteroid in Patients Inadequately Controlled on a Lower Dose of Inhaled Corticosteroid, or TALC (NCT00565266) - can be found at clinicaltrials.
Resources:
Asthma clinical practice guidelines
Asthma Clinical Research Network (ACRN)
Testing For COPD Inadequate, Study Finds
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Spirometry testing is a widely accepted and encouraged diagnostic method for chronic obstructive pulmonary disease (COPD), but new research shows that it is not used nearly enough. The study appears in the August issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP) and reports that only one-third of patients with a COPD diagnosis ever received spirometry testing.
"Without proper testing, both underdiagnosis and misdiagnosis may occur, which can lead to improper therapies being prescribed," said lead author MeiLan Han, MD, MS, University of Michigan, Division of Pulmonary and Critical Care Medicine. "This study shows that we have a lot of work ahead of us in terms of raising awareness among both patients and physicians."
Along with colleagues from Johns Hopkins University, the University of Washington, and the National Committee for Quality Assurance, Dr. Han identified patients with newly diagnosed COPD by data collected from five health plans. The study examined patients aged 40 years and older, and determined if patients with a new diagnosis of COPD had received spirometry in the preceeding 720 days. Of the 5,039 eligible patients identified, only 32% were found to have received spirometry testing. Furthermore, only half of those patients received follow-up bronchodilator testing to confirm their diagnosis.
"In order to distinguish COPD from other diseases, such as asthma, spirometry must be measured both before and after administration of medication that dilates the airways," Dr. Han explained. "As such, if COPD is suspected, initial spirometric testing should include bronchodilator testing too, in order for that patient to receive a truly diagnostic test."
In addition, the study notes that these numbers contradict previous findings in which over 70% of physicians reported using spirometry for establishing a COPD diagnosis. Given the contrast, Dr. Han suggests a possible difference between what physicians say and what they actually do. Also of particular concern was that, according to this study, spirometry testing in those patients who were 75 years and older was performed less frequently, with only 28% of patients in this population receiving spirometry. Researchers point to the issue of ageism and question whether or not a patient's age influences a physician's decision to order diagnostic testing.
"The bad news is that we have significant room for improvement. The good news is that we have to know a problem exists before we can fix it, and now we know," said Dr. Han. Other good news is that women and men fared virtually the same when it came to spirometry testing, despite previous reports suggesting women were tested less often.
"COPD is currently the fourth leading cause of death in the United States, and the economic burden of this disease is measured in the billions of dollars but, despite this, it is so often underdiagnosed or misclassified," said Dr. Han. "Prior to this study, I did not truly appreciate the magnitude of spirometry underutilization, but my hope is that this study will lead to more correct diagnoses and better care of patients."
"Spirometry testing is an inexpensive, quick, and painless procedure, which is necessary to confirm a COPD diagnosis," said Mark J. Rosen, MD, FCCP, President of the American College of Chest Physicians. "In order to make a shift in the underutilization of spirometry, physicians need to use all of the resources available to them, and patients need to actively inquire about their care."
The National Lung Health Education Program suggests that current and former smokers aged 45 years and older, as well as any patient who experiences cough, shortness of breath with exertion, or wheezing, ask their doctor about having a spirometry test performed.
CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at chestjournal. The journal's Web site also provides public access to thousands of archived studies, dating back to 1946 -- a newly added feature that is free of charge. The ACCP represents 16,600 members who provide clinical respiratory care, sleep medicine, critical care, and cardiothoracic patient care in the United States and throughout the world. The ACCP's mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. For more information about the ACCP, please visit the ACCP Web site at chestnet/.
"Without proper testing, both underdiagnosis and misdiagnosis may occur, which can lead to improper therapies being prescribed," said lead author MeiLan Han, MD, MS, University of Michigan, Division of Pulmonary and Critical Care Medicine. "This study shows that we have a lot of work ahead of us in terms of raising awareness among both patients and physicians."
Along with colleagues from Johns Hopkins University, the University of Washington, and the National Committee for Quality Assurance, Dr. Han identified patients with newly diagnosed COPD by data collected from five health plans. The study examined patients aged 40 years and older, and determined if patients with a new diagnosis of COPD had received spirometry in the preceeding 720 days. Of the 5,039 eligible patients identified, only 32% were found to have received spirometry testing. Furthermore, only half of those patients received follow-up bronchodilator testing to confirm their diagnosis.
"In order to distinguish COPD from other diseases, such as asthma, spirometry must be measured both before and after administration of medication that dilates the airways," Dr. Han explained. "As such, if COPD is suspected, initial spirometric testing should include bronchodilator testing too, in order for that patient to receive a truly diagnostic test."
In addition, the study notes that these numbers contradict previous findings in which over 70% of physicians reported using spirometry for establishing a COPD diagnosis. Given the contrast, Dr. Han suggests a possible difference between what physicians say and what they actually do. Also of particular concern was that, according to this study, spirometry testing in those patients who were 75 years and older was performed less frequently, with only 28% of patients in this population receiving spirometry. Researchers point to the issue of ageism and question whether or not a patient's age influences a physician's decision to order diagnostic testing.
"The bad news is that we have significant room for improvement. The good news is that we have to know a problem exists before we can fix it, and now we know," said Dr. Han. Other good news is that women and men fared virtually the same when it came to spirometry testing, despite previous reports suggesting women were tested less often.
"COPD is currently the fourth leading cause of death in the United States, and the economic burden of this disease is measured in the billions of dollars but, despite this, it is so often underdiagnosed or misclassified," said Dr. Han. "Prior to this study, I did not truly appreciate the magnitude of spirometry underutilization, but my hope is that this study will lead to more correct diagnoses and better care of patients."
"Spirometry testing is an inexpensive, quick, and painless procedure, which is necessary to confirm a COPD diagnosis," said Mark J. Rosen, MD, FCCP, President of the American College of Chest Physicians. "In order to make a shift in the underutilization of spirometry, physicians need to use all of the resources available to them, and patients need to actively inquire about their care."
The National Lung Health Education Program suggests that current and former smokers aged 45 years and older, as well as any patient who experiences cough, shortness of breath with exertion, or wheezing, ask their doctor about having a spirometry test performed.
CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at chestjournal. The journal's Web site also provides public access to thousands of archived studies, dating back to 1946 -- a newly added feature that is free of charge. The ACCP represents 16,600 members who provide clinical respiratory care, sleep medicine, critical care, and cardiothoracic patient care in the United States and throughout the world. The ACCP's mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. For more information about the ACCP, please visit the ACCP Web site at chestnet/.
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