Interventional Therapies for Acute Pulmonary Embolism: Current Status and Principles for the Development of Novel Evidence: A Scientific Statement From the American Heart Association
Interstitial Lung Abnormalities In Patients With COPD Linked To Cancer, Heart Failure Risks
Interstitial lung abnormalities (ILAs) in patients with chronic obstructive pulmonary disease (COPD) are linked to lower lung adenocarcinoma rates but higher rates of other cancers and heart failure.
Interstitial lung abnormalities (ILAs) are associated with various comorbidities in patients with chronic obstructive pulmonary disease (COPD), particularly lung cancer, according to a study published in BMC Pulmonary Medicine.1
Although COPD diagnoses typically rely on patient-reported symptoms and pulmonary function tests, chest computed tomography (CT) imaging is often used to further characterize the disease and associated comorbidities.2 COPD frequently coexists with various comorbidities, like cardiovascular disease, lung cancer, and diabetes.3
Chest CT scans can also detect and characterize ILAs, incidental non-dependent abnormalities that affect at least 5% of lung parenchyma in patients without suspected interstitial lung disease (ILD).4 Previous studies linked ILA with a heightened risk for various pulmonary morbidities, like COPD and lung cancer.1
Despite the well-established relationship between ILA and respiratory morbidities, its correlation with non-respiratory comorbidities remains unexplored. Consequently, the researchers aimed to assess the association between the presence of ILA in patients with COPD and their comorbidities, along with their clinical and laboratory characteristics.
Interstitial lung abnormalities (ILAs) in patients with chronic obstructive pulmonary disease (COPD) are linked to lower lung adenocarcinoma rates but higher rates of other cancers and heart failure.Image Credit: Peakstock - stock.Adobe.Com
They examined a retrospective cohort of patients hospitalized with COPD at the First Affiliated Hospital of Xiamen University. Eligible patients were those diagnosed with COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria and were hospitalized between January 2015 and August 2021.
The researchers extracted all data on eligible patients from their medical records. Next, they classified patients based on the presence or absence of ILA. Then, the researchers performed analyses to identify differences in demographic characteristics, clinical profiles, laboratory results, and comorbid conditions between the 2 groups.
The study population consisted of 1131 hospitalized patients with COPD, with males comprising 93.7%. Of these patients, 82.3% were hospitalized due to acute exacerbations, and 60% had respiratory infections; the median hospitalization duration was 8 days. Additionally, 85.6% (n = 962) had emphysema, and 14.6% (n = 165) exhibited ILAs. The 3 most prevalent comorbidities were lung cancer (19.3%), history of tuberculosis (12.7%), and coronary artery disease (9.9%).
After stratifying the study population into groups based on ILA presence, the researchers noted no statistically significant differences in clinical, demographic, or laboratory parameters. However, the one exception was circulating fibrinogen (FIB) and procalcitonin (PCT) levels. Compared with those without ILA, patients with ILA displayed significantly lower levels of FIB (3.82 g/L vs 4.34 g/L; P = .018) and PCT (0.046 ng/mL vs 0.064 ng/mL; P = .005).
Similarly, the researchers found significant differences in the prevalence of several comorbid conditions among patients with and without ILA. In particular, the incidence of lung cancer among those with ILA was about half that of those without ILA (11.5% vs 20.6%; OR, 0.50; 95% CI, 0.30-0.83; P = .006).
Of those with comorbid lung cancer, 198 were diagnosed during hospitalization, and 20 had a prior diagnosis. The researchers found that 8.6% (n = 17) of the patients diagnosed during hospitalization also had an ILA, a rate comparable to that observed in the group diagnosed before hospitalization (10%). Additionally, they further examined the association of ILA with 3 major lung cancer subtypes: adenocarcinoma (ADC), squamous cell carcinoma (SCC), and other lung cancers.
Compared with those without comorbid lung cancer, those with lung ADC exhibited a significantly lower ILA prevalence (OR, 0.32; 95% CI, 0.15-0.71; P = .005). The researchers found a similar trend among patients with COPD and comorbid lung SCC (OR, 0.48; 95% CI, 0.22-1.11; P = .09); however, this was not statistically significant. Conversely, the prevalence of ILA in patients with other lung cancer subtypes was comparable to that in patients without lung cancer.
Lastly, the researchers found that the prevalence of cancers other than lung cancers in the ILA group was significantly higher than in the non-ILA group (7.9% vs 3.6%; OR, 2.27; 95% CI, 1.16-4.39; P = .012). Similarly, they discovered heart failure was more prevalent in the ILA group (11.5% vs 6.9%; OR, 1.75; 95% CI, 1.04-3.00; P = .04).
The researchers acknowledged their limitations, including the study population consisting solely of hospitalized patients with COPD, potentially limiting the generalization of their findings. Because of the male predominance among smokers in China, most patients were male, meaning these findings may not be generalizable to female patients. However, they expressed confidence in their findings and suggested areas for further research.
"...Our study demonstrates that the presence of ILA in patients with COPD is associated with multiple comorbidities of the disease, particularly lung ADC," the authors concluded. "Further investigations are warranted to better understand these relationships and their clinical implications."
References
Annual Lung Screening Recommended For High-risk Individuals
Ganga Ranasuriya
One in 16 Americans will be diagnosed with lung cancer in their lifetime. As the leading cause of cancer deaths in the U.S., lung cancer is a serious threat, but early detection and treatment can save lives. Most early-stage cases of lung cancer are either asymptomatic or show minimal symptoms, so catching the disease at Stage 1 provides the best chance for a cure. Unfortunately, by the time symptoms appear, the cancer is often more advanced, making successful treatment more difficult.
Lung Cancer Screening Guidelines
The American Cancer Society recommends lung cancer screenings for individuals over the age of 50 with a history of smoking one pack a day for 20 or more years. This includes current smokers and those who have quit within the last 15 years. The primary screening method is low-dose computed tomography (LDCT), a type of CT scan that uses low-dose radiation to create detailed images of the lungs. The scan is quick, non-invasive and painless, and it is designed to detect pulmonary nodules — abnormal tissue growths that can increase the risk of lung cancer.
If a nodule or abnormality is found, doctors may recommend a lung biopsy. This procedure can be done using various methods, including a biopsy needle, endoscopy, video-assisted thoracic surgery (VATS) or robotic bronchoscopy. While most lung nodules are non-cancerous, regular monitoring is important to ensure they don't develop into lung cancer. A physician or pulmonary specialist can help assess the risk and decide on the best course of action.
Lung Cancer Types and Treatment
Lung cancer treatment varies depending on the type and stage of the disease. Options include surgery, chemotherapy, radiation therapy, targeted therapies and immunotherapy. It's important to work closely with your oncologist to understand your treatment choices and the potential side effects. Asking questions and staying informed can help you feel more in control of your treatment.
There are different types of lung cancer, with non-small cell lung cancer (NSCLC) being the most common, accounting for about 85% of cases. Small cell lung cancer (SCLC) is more aggressive and makes up about 15% of lung cancers, often located in the central areas of the lungs or chest, and is typically treated without surgery. A rare form of lung cancer is carcinoid tumors, which arise from neuroendocrine cells in the lungs and are usually treated surgically.
Why
Screening Matters
More people die from lung cancer every year than from breast, prostate and colorectal cancers combined. More than three-fourths of these deaths could have been prevented if the cancer had been caught at an early stage. Sadly, only 15 percent of lung cancer cases are being caught early enough. For those diagnosed with stage four lung cancer, the five-year survival rate is just around 5%.
Detecting cancer early helps ensure that it is still "localized," or contained to the lungs. Once it has spread outside the lungs, the survival rate is just three percent. As there are typically no symptoms until after the cancer has spread outside the lungs, proactive screening based on risk is the best tool in the fight against lung cancer. Talk to your primary care provider to determine your risk for lung cancer and eligibility for lung cancer screening.
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Ganga Ranasuriya, M.D., is with UPMC Pulmonology and sees patients at UPMC Williamsport, 700 High St., Williamsport. To make an appointment with Dr. Ranasuriya, call 570-321-3580. To learn more about UPMC Pulmonology services in northcentral Pa., go to UPMC.Com/LungNCPA.
COPD: More Than Just A Health Problem For The Homeless, Uninsured
Early diagnosis is key: cleaning a home is tough when breathing makes movement difficult. Open Airways is concerned about the number of their patients with COPD who are in need of more than just healthcare (Photograph supplied)
Chronic obstructive pulmonary disease is a serious, progressive illness that hits the homeless and underinsured the hardest. It's something Lindsay Bishop is seeing more and more of in her role as COPD educator for Open Airways. COPD is a chronic lung condition characterised by swollen, inflamed airways and excessive mucus which makes it difficult to breathe, especially when exhaling.
In severe cases, it can lead to oxygen dependence or leave people bedridden. It primarily affects smokers, but can also be hereditary or caused by workplace exposure to chemicals or dust.
Helping hand: Open Airways COPD educator Lindsay Bishop demonstrates the proper use of an inhaler (Photograph supplied)
Of real concern to Ms Bishop is that the charity has taken on an unsustainable role: caring not only for people's health needs, but also their entire wellbeing.
"Unfortunately, what I'm seeing more and more in the community, after 35 years of nursing, is more homeless people, more people living in cars, people living in squats, living wherever they can find shelter in town," she said.
Open Airways has typically paid for inhalers, oxygen and doctor's appointments for people that are not employed and not insured. A donor-funded programme gives added help, but only to people in desperate circumstances.
"We're finding more and more people fall into that category, and it almost becomes pointless paying for [medication] when they're sleeping rough and catching lots of colds; they're in dirtier environments, which is affecting the breathing, and they're getting pneumonia from being in contact with viruses and not being able to eat properly, sleep properly and be warm," Ms Bishop said.
"And for [COPD] patients, they're not going to get better and so our role is to educate them, so that they know how not to get worse, how to slow that deterioration down."
COPD health fair this month
Open Airways will host a COPD Health Fair on November 16 at St Paul's Church Hall in Paget.
The event is in observance of Chronic Obstructive Pulmonary Disease Awareness Month. There will also be a complimentary tea and flu shots and information on any and everything related to COPD.
"For anybody with COPD it would be wonderful if they came along – not just for the tea and the flu shots, there are going to be lots of people there with lots of good information," said Lindsay Bishop, the COPD educator for Open Airways.
Among the speakers will be a pharmacist from CG Pharmacy who will talk about the best medicines there are available in Bermuda; Maureen Ryan, a physiotherapist from Myotherapy Centre, will discuss breathing exercises and how to maximise lung capacity.
Pathways, the addiction rehabilitation centre, will discuss smoking cessation; Open Airways will provide nicotine patches for people who are "very keen to quit" but are not insured and don't have the means to pay.
Also on hand will be medical social workers, nurses from the Department of Health and representatives from Age Concern, who will offer help with any financial issues people might be facing.
Medical House will also be there, to show their supplies of oxygen and related items.
"Oxygen is not for everybody," Ms Bishop said. "It has to be prescribed by a doctor. It can be quite dangerous in COPD, but it also can be very helpful in COPD, so it has to be prescribed properly."
Ms Bishop asked that people who use inhalers bring them along "so we can show them how to best use them and check that they're on the right medications".
The COPD fair will run from 12pm to 3pm on November 16. To attend, RSVP on 536-6060 or nurse@openairways.Com
COPD health fair this month
Open Airways will host a COPD Health Fair on November 16 at St Paul's Church Hall in Paget.
The event is in observance of Chronic Obstructive Pulmonary Disease Awareness Month. There will also be a complimentary tea and flu shots and information on any and everything related to COPD.
"For anybody with COPD it would be wonderful if they came along – not just for the tea and the flu shots, there are going to be lots of people there with lots of good information," said Lindsay Bishop, the COPD educator for Open Airways.
Among the speakers will be a pharmacist from CG Pharmacy who will talk about the best medicines there are available in Bermuda; Maureen Ryan, a physiotherapist from Myotherapy Centre, will discuss breathing exercises and how to maximise lung capacity.
Pathways, the addiction rehabilitation centre, will discuss smoking cessation; Open Airways will provide nicotine patches for people who are "very keen to quit" but are not insured and don't have the means to pay.
Also on hand will be medical social workers, nurses from the Department of Health and representatives from Age Concern, who will offer help with any financial issues people might be facing.
Medical House will also be there, to show their supplies of oxygen and related items.
"Oxygen is not for everybody," Ms Bishop said. "It has to be prescribed by a doctor. It can be quite dangerous in COPD, but it also can be very helpful in COPD, so it has to be prescribed properly."
Ms Bishop asked that people who use inhalers bring them along "so we can show them how to best use them and check that they're on the right medications".
The COPD fair will run from 12pm to 3pm on November 16. To attend, RSVP on 536-6060 or nurse@openairways.Com
Three weeks ago the nurse was contacted by a COPD patient with a chest infection.
The man had been unable to call a doctor for help because he did not have a phone and he was too unwell to make his way to a pharmacy and fill a prescription.
"It was very simple for me to call the doctor and go pick up his meds, but it was going to take a week for that to improve how he was feeling," said Ms Bishop, who is raising the issue to draw attention to COPD Awareness Month observances.
"He'd been quite weak for a very long time and quite tired for a very long time and was on home oxygen.
"Because he lives alone and has no family, his house, you can imagine, was in a terrible state. It was quite dirty through no fault of his own.
"He was unable to push a mop around, unable to scrub the tub, unable to do dishes. He was pretty much bed-bound in the week before I saw him until a neighbour lent him a phone to call."
Another patient of hers lives "in the rough and has been in a squat for a while". Thanks to Open Airways his name is now on a housing list, but in the meantime he relies on others for food.
"We went to all the different helping services. He was a year too young for Ageing and Disability; Age Concern helped a little with a food card," Ms Bishop said.
"He was sleeping in a squat; the squat's now boarded up and locked with his possessions inside. So he's been sleeping outside on a wet porch, and we've been paying for inhalers for him."
The man was referred to Open Airways by the Emergency Department at King Edward VII Memorial Services after he had been admitted for treatment three times.
"We have managed to get him a card to help with some of his medications, not all, and he eats three times a week at a church. They would kindly give him more food, but he has nowhere to store it."
Open Airways is to host a mini health fair for people with COPD on November 16, between Noon and 3pm, at St Paul's Anglican Church, Paget (Photograph supplied)
An effort to get the man on financial assistance has "been a long process" because he didn't have the money to open a bank account or pay for the birth certificate he needed as proof of ID.
"So while I'd like to say that we were just helping with people's health, I'm finding more and more that this job is social work as well because we have to take care of the whole patient, not just the inhalers.
"Telling them how to use their inhaler properly is of no benefit if they can't eat or sleep," Ms Bishop said.
Also alarming to her is the rising number of individuals who are homeless because illness prevents them from working. It's a contrast with past decades, when most people were sleeping in the rough because of "alcohol, mental health, or drug issues".
"Often with COPD, patients get breathless. So if they were in a job painting or mowing grass, or doing something that required a lot of exertion, they can no longer do that job," Ms Bishop said.
Of the five patients she saw with COPD last week, three were new. It's a definite increase over what she has seen in her 30-odd years of nursing.
"The World Health Organisation says that COPD is the third leading cause of death in the world. It's a common umbrella term for diseases such as chronic bronchitis and emphysema. It's treatable, but it's not curable," she said.
Open Airways follows guidelines set by the Gold Initiative for Lung Disease and the medication that is available here is of a good quality however it's up to the patient to ensure a successful outcome.
"Best practice is that people need physio. Best practice is that people need to exercise, take the medicines properly and take care of themselves.
"Generally, it's hard to get people to increase their exercise. When they're short of breath they're very frightened [about doing that] so it's important to do that with an expert helping them, so they know how far to push themselves," Ms Bishop said.
Early diagnosis is key. Smokers and former smokers over the age of 40 should have a lung function test, which is free to anyone with insurance.
"We've got patients with COPD that are runners; we've got patients that are homebound and palliative, very end-stage and soon to die.
"So it runs the whole gamut, and not everybody reaches that oxygen homebound stage, but even for people that do, we can make sure they're very comfortable," she said.
"But it's also a case of knowing how to use the inhalers properly. And that's one of the things that our free home visits and consults do, teach you how to use these things properly."
• For more information on COPD, visitopenairways.Com
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