Study: Inhaled Glucocorticoids Don’t Reduce COPD Exacerbations

An example of a valved holding chamber that helps patients inhale COPD and asthma medications. (Image courtesy Philips Respironics)

An example of a valved holding chamber that helps patients inhale COPD and asthma medications. (Image courtesy Philips Respironics)

European researchers are questioning the benefits of inhaled glucocorticoids in reducing the risk of exacerbations among patients with severe or very severe COPD. A double-blind study of nearly 2,500 patients found that glucocorticoids do not have a significant impact on reducing COPD exacerbations.

An inhaled glucocorticoid is commonly prescribed as an adjunct to LAMA (tiotropium) and LABA (salmeterol) combination therapy for patients with severe or very severe COPD with a history of exacerbations.

The study, published in the New England Journal of Medicine, found the patients that underwent a phased withdrawal of inhaled glucocorticoids over 18 weeks did not have a significantly greater risk of exacerbations.

All patients started out with 18 μg of tiotropium delivered once daily, 50 μg of salmeterol xinafoate twice daily and 500 μg of fluticasone propionate  twice daily by a metered-dose inhaler. Over 18 weeks, a group of patients, went from 1,000 μg of inhaled glucocorticoids to 500 μg, to 200 μg and then to 0 μg.

When the phased withdrawal was complete at week 18, those patients had a slight drop in FEV1 (38 mL) when compared to those who continued the inhaled glucocorticoid regimen. At the conclusion of the study, at 52 weeks, a similar difference (52 mL) was seen between the groups. However, the larger reduction of FEV1 from baseline “does not seem to be associated exacerbations,” the authors wrote.

Overall “the stepwise withdrawal of glucocorticoids was noninferior to the continuation of such therapy, with respect to the risk of moderate or severe exacerbations,” the authors concluded.


A chart of common types of asthma and COPD medications available in Australia as published by the National Asthma Council of Australia.

The study challenges current treatment guidelines which call for a triple therapy, including inhaled corticosteroids, for patients with severe COPD. It is unclear what immediate impact the European study might have on established therapies. (Learn more about the current recommended guidelines at the Global Initiative for Chronic Obstructive Lung Disease, or GOLD.

In a separate study of patients who were 66 years or older, Canadian researchers found that a combination therapy of long-acting β-agonists and inhaled corticosteroids (ICS) was associated with a modestly reduced risk of death (36.4% vs 37.3%) or COPD-related hospitalizations (27.8% vs. 30.1%).

The benefits of the LABA-ICS combination therapy was greater in patients with a comorbidity of asthma with a difference in composite outcome at 5 years reaching -6.5% (at 95% confidence internal, and a hazard ratio of 0.84 at 95% CI) and those who were not receiving inhaled long-acting anticholinergic (LAA) drugs (-8.4%, 95% CI with HR of 0.79 at 95% CI).

Dr. Andrea Gershon, at the Sunnybrook Health Sciences Centre and Institute for Clinical Evaluative Sciences in Toronto, and her colleagues followed nearly 12,000 patients over eight years for the real-world, population-based study.

“Our finding of an association between LABAs and ICSs and outcomes helps clarify the management of patients with COPD and asthma, as many studies of COPD medications have excluded people with asthma and vice versa,” Dr. Gershon was quoted as saying by the Journal of the American Medical Association.

“In addition, practice guidelines for COPD recommend that LABAs be considered first-line treatment while asthma guidelines warn against use of LABAs without ICSs. Our findings also offer insight into the optimal treatment of COPD patients without asthma—those who would not be considered especially corticosteroid responsive.”


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Karl Deisseroth Earns Keio Medical Science Prize for Optogenetics

Keio Prize Awarded to Karl DeisserothKarl Deisseroth was chosen as one of two recipients of this year’s prestigious Keio Medical Science Prize for his “enormous contributions towards the fundamental understanding of brain function in health and disease,” Keio University announced yesterday.

Keio University lauded his efforts in inventing optogenetics, which has been adopted rapidly as a tool to precisely target and demonstrate “causal relationship between neuronal circuits and behavior.”

Thus, Dr. Deisseroth first provided “a method by which all neurons of just one type could be activated or inactivated, leaving the others more or less unaltered” (Francis Crick, 1979), which had been a long-required task in the field of neuroscience.

Optogenetics has further permitted us to control intracellular signals such as calcium and cAMP signals, and thus it can be widely applied to biomedical and life science research. By making optogenetics a reality and leading this new field, Dr. Deisseroth has made enormous contributions towards the fundamental understanding of brain function in health and disease.

“It is a tremendous honor to receive the 2014 Keio Medical Science Prize, in recognition of our efforts to develop optogenetics,” Deisseroth told Keio University. “Prize is particularly meaningful because optogenetics originated as a tool to study the basic science of biology, not medical illness.”

But optogenetic investigations into forms of Parkinson’s in rodent models have already helped neurosurgeons better target implanted stimulating electrodes. Some Parkinson’s patients receive implanted electrodes as part of their treatment to reduce symptoms. However, the precise neuronal connections to target had been up for debate–until optogenetics helped pinpoint the wiring.

“Now neurosurgeons are finding that placing their electrical contacts to target connections gives better results in treating symptoms in people with Parkinson’s and many other conditions,” Deisseroth told Standord News Service in an interview.

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Spirometry Data Coming to Your iPhone

Apple's decision to add spirometry data types could herald a new era of portable spirometers.

Apple’s decision to add spirometry data types could herald a new era of portable spirometers.

The addition of three spirometry data types to Apple’s iOS 8 HealthKit, announced ahead of Apple’s iPhone 6 launch event next Tuesday, may herald a new era of personal medical devices designed for monitoring asthma, emphysema, chronic bronchitis and other respiratory conditions.

By offering recognition of data types that can be gathered from sleep monitors and portable spirometers, Apple’s HealthKit goes beyond common apps that track, calculate and store fitness- and nutrition-related data.

Spirometry, which measures your lung capacity as well as various functions, remains the gold standard in diagnosing and monitoring asthma, chronic bronchitis, emphysema and pulmonary fibrosis.

In the release notes of iOS 8 Beta 5, Apple announced that “Spirometry data types are now available in HealthKit.” An iPhone alone cannot measure your lung functions or diagnose COPD, for example. But the availability of spirometry data types allows software and medical device developers to design apps and portable spirometers that pass the data to an iPhone for recognition.

So far three basic spirometry data types have been added to HealthKit:

  • HKQuantityTypeIdentifierForcedExpiratoryVolume1
  • HKQuantityTypeIdentifierForcedVitalCapacity
  • HKQuantityTypeIdentifierPeakExpiratoryFlowRate
MySpiroo, a portable spirometer developed in Poland by Piotr Bajtala and Dr. Lukasz Koltowski, plugs into an iPhone. (Image courtesy MySpiroo)

MySpiroo, a portable spirometer developed in Poland by Piotr Bajtala and Dr. Lukasz Koltowski, plugs into an iPhone. (Image courtesy MySpiroo)

In a move seen as a push to develop a platform for health-related software and hardware, Apple has recently hired a team of medical device experts, including Roy Raymann, a sleep researcher and founder of the Philips Sleep Experience Lab, and Divya Nag, dubbed “a rising star in the medical device community” and an expert in regulatory affairs.

Even before Apple’s recognition of spirometry as an important diagnostic and monitoring tool, developers around the world have been looking for ways to turn an iPhone into a pocket-sized spirometer.

The Respi Project, a graduate of the DreamIt Health accelerator at Johns Hopkins University, wants to help patients monitor lung conditions constantly from anywhere.

The Respi Project, a graduate of the DreamIt Health accelerator at Johns Hopkins University, wants to help patients monitor lung conditions constantly from anywhere.

As mentioned here previously, researchers at University of Washington’s Ubiquitous Computing Lab created SpiroSmart, a software that measures FEV1, FVC and PEF using only a user’s lip reverberation.

In Poland, Piotr Bajtala and Dr. Lukasz Koltowski are wrapping up their development of MySpiroo, a portable spirometer designed to relay its spirometry data to an iPhone through the earphone jack. MySpiroo so far can measure FEV, FVC, PEF, MVV, SVC, TLC, FRC, RV, ERV and more.

The Respi Project, a graduate of the DreamIt Health accelerator at Johns Hopkins University, has also designed a portable spirometer for iPhones with the goal of allowing patients to monitor their lungs from anywhere at any time.

These personal, portable spirometers do not replace consultations with and diagnoses by a physician. However, Apple’s recognition of spirometry as an important tool in managing and monitoring chronic lung conditions is likely to help empower patients living with asthma and COPD.

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ACP Releases New Sleep Apnea Diagnosis Guidelines

Illustration of Obstructive Sleep Apnea (Courtesy Habib M’henni / Wikimedia Commons)

Sleep studies for the assessment of obstructive sleep apnea should be limited to patients with unexplained daytime sleepiness after other potential causes have been ruled out, according to new guidelines from the American College of Physicians.

The Clinical Guidelines Committee of the College also recommended that patients suspected of having obstructive sleep apnea (OSA) should undergo polysomnography (PSG). But those without serious comorbidities may use portable sleep monitors when a sleep study lab is not available to them.

The recommendations, however, were rated as weak and based on low- to medium-quality evidence, the Committee wrote in the paper published in the latest edition of the Annals of Internal Medicine.

Polysomnography performed at a sleep lab has been the gold standard in diagnosing obstructive sleep apnea, but it’s expensive, resource-intensive and requires patients to spend a night away from home.

Some portable sleep monitors, those designed for use at home, may help identify suspected OSA cases through the apnea-hypopnea indiex (AHI), the number of apnea or hypopnea events per sleeping hour. But their results vary widely across different types of portable monitors. And no study to date has directly compared different portable monitors.

There was insufficient evidence to determine if sleep questionnaires, like the Epworth Sleepiness Scale, phased testing and preoperative screening for OSA were useful, the authors noted.

OSA is caused by an obstruction of the upper respiratory tract which can partially (hypopnea) or completely (apnea) block the airflow. The most common risk factor for obstructive sleep apnea is obesity. And OSA may lead to daytime sleepiness, hypertension, heart attack, stroke, cognitive impairment and other serious conditions.

Learn more about OSA at the National Heart, Lung, and Blood Institute.


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Back-to-School Pollution Could Trigger Respiratory Problems

No Idle Zones are popping up across the United States. (Courtesy Mike Licht / flickr)

No Idle Zones are popping up across the United States. (Courtesy Mike Licht / flickr)

Returning to classes after a relaxing summer vacation could pose multiple challenges to school children with asthma and other respiratory conditions. A myriad triggers and factors may contribute to the challenges. But one factor has gained the attention of parents and health professional: health consequences of exhaust from excessive idling.

Many previous studies, including those done in Taiwan, the U.K. and the U.S., have linked traffic-related air pollution to the risk of developing or triggering asthma in children, but ‘No Idling Campaigns’ urge concrete steps to minimize the health impact of excessive idling on school grounds.

It is easier said than done especially when extreme temperatures can either melt or freeze you without an A.C. or a heater. Still some California air pollution control districts, including the one in San Joaquin Valley, are urging parents to turn off their engine while waiting for their children. In Seattle, CoolMom has partnered with the Puget Sound Clean Air Agency to promote “Idle-Free Elementary” schools and protect children’s health.

For its part, the U.S. Environmental Protection Agency has a “Turn Off Your Engine, Kids Breathe Here” campaign designed to educate school bus drivers. While air pollution, fuel, money and wear on the engine factor into their campaign, the impacts on human health is cited as a key reason for their push.

EPA has determined that diesel exhaust is a likely human carcinogen and can contribute to other acute and chronic health concerns (see EPA’s Health Assessment Document for Diesel Exhaust). People with existing heart or lung disease, asthma, bronchitis or other respiratory problems are most sensitive to the health effects of fine particles. The elderly and children are also at risk. Children are more susceptible to air pollution than healthy adults because their respiratory systems are still developing and they have a faster breathing rate.

What has been your experience with no-idling campaigns and state laws?


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ActualTrack Recognizes and Analyzes Common Animal Behavioral Tasks

ActualTrack automatically tracks, recognizes and analyzes the behaviors of experimental animal models from video you collect. Analyze all your trials with just a couple of clicks. Validated by behavioral neuroscientists, ActualTrack is designed to save you time, and priced to save you money.

The animal behavior analysis software was designed to support single- and multi-subject tracking in rodent, zebrafish and Drosophila models with simple graphical user interfaces. The software doesn’t require any hardware key or dongles and lets you work from the lab, your office, or even at home.

3 Steps to analyzing your video:: Capture, Analyse, Discover

  1. Capture
    • Record experiments using standard webcams or Firewire cameras
    • Upload your video using an easy import tool that accepts all common video file formats
  2. Analyze
    • Designed for all common experimental paradigms
    • Define any areas of interest with simple drawing tools
    • Single and Multi-subject tracking
    • Multi-point tracking
    • Three-point tracking (nose, center and tail-base): Rodent, Zebrafish and Drosophila larvae
    • Two-point tracking (nose and center): adult Drosophila
    • Manual coding solution to easily score non- automated behaviors
  3. Discover
    • Results in CSV and Microsoft Excel format
    • Export results to Excel, R, SPSS and other leading statistical packages to support further analysis
    • Includes basic locomotor and zonal statistics including: distances; times; zone entries and exits; velocities and latencies in SI units
    • Easily change configurations and re-analyze data
    • Statistical analysis of the data collected

Learn more about ActualTrack animal behavior tracking and analysis software. Check out the following tutorials to get a better idea of what ActualTrack can do for you:



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Study: Direct Medical Cost of COPD Set to Reach $49 Billion

Between 12 million and 15 million adults in the United States say they have been diagnosed with chronic obstructive pulmonary disease. But the actual number may be higher due to under-reporting. (Courtesy National Heart, Lung and Blood Institute)

Between 12 million and 15 million adults in the United States say they have been diagnosed with chronic obstructive pulmonary disease. But the actual number may be higher due to under-reporting. (Courtesy National Heart, Lung and Blood Institute)

Direct costs associated with chronic obstructive pulmonary disease in the United States totaled $32.1 billion in 2010 and is set to reach $49 billion by 2020, the CDC reported in a study published in journal Chest.

The study attributed another $3.9 billion to COPD-related absenteeism, bringing the total burden of the chronic disease to $36 billion in 2010. The latest estimate counts 16.4 million days of lost work annually due to COPD and related illnesses.

Private insurance paid 18% of the medical costs, Medicare 51%, and Medicaid 25%, according to the study, which was published online early.

About 15 million people in the United States say they have been diagnosed with COPD, often under-reported and under-diagnosed, though the actual number may be higher, according to the CDC.

In the developing world, poor indoor air quality is thought to play a key cause of COPD, but tobacco smoke remains the leading factor in the development of the chronic disease.

Dr. Earl Ford and his colleagues at the Centers for Disease Control and Prevention (CDC) used national surveys, medicare and medicaid data, and the 2010 census to compile their findings and project costs through 2020.

“Evidence-based interventions that prevent tobacco use and reduce clinical complications of COPD may result in potential decreased COPD-attributable costs,” the study concluded.

COPD Resources:

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3D-Printed CPAP Mask May Revolutionize Therapy

3D-Printed CPAP Face Mask by Metamason

Metamason hopes to revolutionize CPAP therapy by 3D-printing custom face masks for each patient. (Courtesy Metamason)

A small California-based start-up wants to dramatically boost CPAP therapy compliance and reduce quit rates by creating custom-molded, 3D-printed face masks. Each mask is designed to fit a person’s unique facial features, superficial as well as subcutaneous, to maximize comfort and flow, the start-up says.

“We personally know several people who struggle with sleep apnea and CPAP therapy (including some members of our team), and quickly identified the opportunity that parametric design could yield a perfectly customizable product if coupled with 3D scanning and printing.” says Leslie Oliver Karpas, founder of Metamason, told 3Ders in an interview.

Metamason first aggregates data from 3D face scans, sleep studies, and thermal imaging of facial and subcutaneous tissues. The scan data is compiled using proprietary algorithms in a computer software, where patients and clinicians can adjust settings to find the maximum flow and comfort. The custom masks are then 3D-printed in medical-grade silicone.

Once Metamason receives clearance from the F.D.A., Karpas promises the final cost of a custom-printed mask to be either on par or cheaper than conventional CPAP masks out in the market today.


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Thunderstorm Asthma, Slow Growth and Looking to the Nervous System for Answers

(Alexander / Flickr)

(Alexander / Flickr)

With more than 235 million asthma sufferers worldwide, researchers are working to understand rare triggers, such as thunderstorms, study the impact of common asthma drugs on children’s growth rate, and open new treatment approaches, including the nervous system responsible for putting the airway into overdrive.

Often under-diagnosed and under-treated, asthma is a public health problem worldwide and imposes a health burden on the individuals and their families, according to the World Health Organization. Risk factors include genetic predisposition and environmental exposure, such as allergens and pollution. But precise causes are not entirely understood.

Scientists have documented a relationship between thunderstorms and asthma attacks, but the mechanisms are still not well understood, the Washington Post reports. Thunderstorm asthma is highly unpredictable and not everyone with severe asthma is likely to experience an attack.

COPD-6 and other portable lung monitors can help manage asthma and COPD.

COPD-6 and other portable lung monitors can help manage asthma and COPD.

Anecdotal evidence suggests that even those with mild hay fever might suddenly experience respiratory distress following a thunderstorm, according to the Post. Dr. Joe Turbyville, an allergy specialist, told the Post that even some of his patients experienced heightened reactions to routine allergy shots after thunderstorms. He’s studying the link between thunderstorms and adverse reactions to immunotherapy.

Inhaled corticosteroids have been the first line of defense for adults and children with persistent asthma and have helped reduce mortality and hospital visits and improve their quality of life. But a restrospective study found that corticosteroids may suppress growth in children by 0.2 in., or 0.5 cm, on average.

“The evidence we reviewed suggests that children treated daily with inhaled corticosteroids may grow approximately half a centimeter less during the first year of treatment,” Dr. Linjie Zhang, who is based at the Faculty of Medicine at the Federal University of Rio Grande in Rio Grande, Brazil, said in a press release.

“But this effect is less pronounced in subsequent years, is not cumulative, and seems minor compared to the known benefits of the drugs for controlling asthma and ensuring full lung growth,” Dr. Zhang was quoted as saying.

Citing limitations of the study, Dr. Zhang recommended that the minimum effective dose be administered until further study can establish more definitive links between corticosteroids and growth rate.

Inhaled corticosteroids help counter an immune system response to an asthma trigger, but neuroscientists (and neurobiologists) have been looking into a completely different approach to limiting, and possibly silencing a group of sensory neurons that restrict the airway.

In the latest study, researchers have been able to systematically shut off a set of neurons in mice that were made sensitive to egg white and to confirm that the neurons that were shut down could not be activated by the immune system.

The study’s authors believe that innate genetic mutations are not likely to be the cause of severe airway constrictions. “Our guess is that instead, the immune system can permanently change these neurons during some initial immune response,” Dr. Dimitri Tränkner told Science.

The study, published online in the latest edition of the Proceedings of the National Academy of Sciences, confirms suspicions that neurons could become a target of treatment, but observers note that additional studies are needed.

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Now Available: CED Data Acquisition and Analysis System

Our new partnership with Cambridge Electronic Design allows us to offer our customers the full range of CED’s well known high-quality data acquisition and analysis products.  For over 40 years, CED has been offering laboratories around the world the latest in data acquisition tools.

They currently offer two different software programs (Spike2 and Signal) designed for users requiring continuous or episodic data acquisition, as well as two different hardware systems to support the programs.

All of their offerings are directly compatible with A-M Systems’ own amplifiers and stimulators.  Of note, CED’s innovative solution to Dynamic Patch Clamping is directly compatible with A-M Systems Model 2400 Patch Clamp Amplifier.

Check out the full line of CED’s data acquisition and analysis software and hardware.

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