EFFORTS  NEWSLETTER
SEPTEMBER 2001

The following represents items that have been shown on our list by our members from time to time.  They contain information that might be of interest to some, but would normally be missed, as would other information, if one is not a regular subscriber of EFFORTS.  

The information shown, is not meant to include or omit any interested parties concepts or intent, but merely to inform.  In all cases, where possible, we have attempted to show the credits necessary in posting this information and apologize for the instances where this was accidentally omitted.  

The information included may be controversial to some, but is reported as information only.  It is our goal to help educate and inform folks, as much as possible, about what is being done specifically about research into COPD and related lung disease, as well as what could enhance discoveries about our disease through other seemingly unrelated research.  This includes drugs or resources  that might be discovered serendipitously or through "The faculty of making fortunate discoveries by accident."   

NEWSLETTER ARCHIVES:
AUGUST 2000 (YES, 1 YEAR AGO)
JULY 2001
AUGUST 2001

~~Word For September - "CONSIDERATE"~~

DR. RON KARPICK, M.D., F.A.C.P., F.C.C.P. is the official CONSULTING PULMONOLOGIST for EFFORTS and writes a monthly article for our Newsletter.  Click here to see his background.  Dr. Karpick also has a regular Questions and Answers page where he responds to member's and others questions about COPD.  Please visit
Dr. Karpick's Korner to view questions that may also be of importance to you.

ASK THE DOCTOR
Dr. Ron Karpick, M.D, F.A.C.P., F.C.C.P.

COPD/Anxiety/Depression 

            First a disclaimer, I am not a psychiatrist, I am a pulmonologist, thus take what I write as material to discuss with your personal physician.  Because anxiety and depression commonly occur in individuals with COPD, I thought it would be helpful to discuss these brain diseases.  However, these are big topics, so rather than write a very long article I decided to first write about the therapy of anxiety and depression, followed by the October article on anxiety and the November article on depression.  This backward approach will allow those who feel they have one or both of these disorders to initiate therapy.

            Surprisingly, although anxiety and depression are separate brain diseases their present treatment is very similar.  First line medication therapy is done with Selective Serotonin Reuptake Inhibitors (SSRI’s).  This family of medications increases the level of a drug, serotonin, in the brain, especially in the brainstem where the respiratory center resides.  Examples of these medications are fluoxetine (Prozac). fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft) and trazodone (Deseryl). Other antidepressants affect additional chemicals in the brain such as norepinephrine and dopamine.  Examples of these medications are mirtazipine (Remeron), nefazodone (Serzone) and venlafaxine (Effexor).  Some of these medications are broken down by the liver by the same mechanisms as other medications such as Theophylline, thus your physician has to know all of the medications you are taking and adjust the doses appropriately.  This usually means starting at low doses and checking theophylline blood levels.

            Another family of medications used is called tricyclic antidepressants. These older drugs have more side effects than the above-mentioned medications. They can cause dry mouth, constipation, sleepiness and low blood pressure. Nortriptyline (Pamelor) has been beneficial in small uncontrolled studies.  All of the drugs mentioned so far take several weeks to months to be effective, you have to be patient.

            Benzodiazepines, such as alprazolam (Xanax), and diazepam (Valium), have long been thought to be the drugs of first choice for anxiety and panic, but recently have been replaced by the SSRI’s.  Unfortunately they can be addicting and can suppress the respiratory drive.  In controlled studies the benzodiazepines did not show any improvement in the symptom of shortness of breath.  However, in small doses they can be quite helpful to rapidly decrease anxiety and panic.

            While the current psychotropic medications are very effective in improving the sometimes crippling symptoms of anxiety and depression, they should be coupled with support groups or individual counselors to learn coping skills.  There are a number of treatment modalities designed to address specific problems.  These modalities include 1) Cognitive Behavioral Therapy, 2) Stress Management, 3) Guided Imagery, 4) Biofeedback, 5) Relaxation Therapy, 6) Interpersonal Therapy and 7) Problem Solving. These approaches are usually not used by the primary care physician or pulmonologist.  Skilled clinicians such as psychiatrists, psychologists, social workers and licensed professional counselors spend time gathering information about the emotional and social aspects of ones life, stressing current difficulties so that goals can be developed while entering into a therapeutic relationship

            It is very important to acknowledge the existence of these brain diseases, anxiety and depression. They significantly impact the individuals and their family’s lives.  We are fortunate to live in a time when mental disorders are not a stigmatized as in the past.  Anxiety and depression are illnesses just like diabetes and congestive heart failure; there are medications and methods of treating them so that the individual can lead a full and productive life.
Dr. Ron   8/31/01

Mixed Messages: Antioxidants May in Some Cases Do More Harm Than Good

It used to be so simple, a battle between good and evil. Rogue chemicals called free radicals roam about the body like brazen street punks, the story went, smashing cellular walls and roughing up innocent DNA molecules, causing cancers and the diseases of middle and old age. Their flagrant disregard for the law would continue unchecked if it weren't for swashbuckling antioxidants swooping in on the wings of dietary supplements, disarming the free radicals of their menacing electrons and converting them into respectable molecular citizens.

http://washingtonpost.com/ac2/wp-dyn/A39716-2001Aug6?language=printer

*****

Three University of Chicago anesthesiolgists have expressed concerns that echinacea, ephedra, garlic, ginkgo, ginseng kava, St. Johns's wort, and valerian taken before or after surgery can cause a variety of adverse reactions. The direct effects include bleeding from garlic, ginkgo, and ginseng; cardiovascular effects from ephedra; low blood pressure from ginseng; and increased anesthetic effects from kava and valerian. [Ang-Lee MK and others. Herbal medicine and perioperative care. JAMA 286:208-216, 2001]

http://jama.ama-assn.org/issues/v286n2/abs/jrv10013.html

*****

Interactions Between Prescription Drugs and Natural Remedies -- 

After reading this article, you will be familiar with (1) How interactions between popular herbs and prescription medications can increase or decrease the pharmacological or toxicological effects of either component, (2) Chinese traditional medicines and their interactions with prescription drugs, and (3) Case reports and case series of herb-drug interactions...

http://www.internalmdlinx.com/thearts.cfm?artid=199901&specid=3

Completes Target Enrollment For Phase III Trial Of Actimmune For The Treatment Of Idiopathic Pulmonary Fibrosis

InterMune, Inc. today announced that it has completed enrollment in its Phase III clinical trial evaluating the safety and efficacy of Actimmune(R) (Interferon gamma-1b) for the treatment of idiopathic pulmonary fibrosis (IPF).

http://biospace.com/news_story.cfm?StoryID=6062015&full=1

*****

CILOMILAST HAS MAJOR AFFECT ON COPD Fred Amsden in "The Land of Smiles" Korat, Thailand

A DG Review of Cilomilast, a selective phosphodiesterase-4 inhibitor for treatment of patients with chronic obstructive pulmonary disease: a randomized, dose-ranging study" Based on findings by clinicians at 60 European centers, further trials are underway of cilomilast, an orally active, potent, selective phosphodiesterase type 4 inhibitor. In vitro, cilomilast appears to affect cells thought to be of clinical importance in chronic obstructive pulmonary disease (COPD). Lancet

http://asthma.about.com/library/blnews.htm

Are you or someone you know planning to file for disability benefits? There's a new tool to help. When an adult applies for disability benefits, we complete a Disability Report (SSA-3368). The form helps us obtain information about an applicant's condition, and is the key to obtaining medical records. Now you can get tips right over the Internet on how to best complete the 3368. Just click on any section of the form and you'll get a "plain language" explanation of what we're looking for, why we need the information, and how your answers help us decide if you can get disability benefits. This new tool is your key to having the Disability Report completed before your appointment. To take a look, visit http://www.ssa.gov/disabilityformhelp/

Compound For The Treatment And Prevention Of Pseudomonas Infections

InterMune, Inc. today announced that it has accepted a humanized monoclonal antibody targeted against the PcrV protein of the bacterium Pseudomonas aeruginosa. The monoclonal form of the antibody was developed by a team of researchers at the Medical College of Wisconsin in Milwaukee and the University of California, San Francisco, and was then humanized under an agreement with Protein Design Labs, Inc. "The successful humanization of the PcrV antibody marks a significant milestone in InterMune's development of a product to prevent Pseudomonas infections," said Woodruff Emlen, M.D., Vice President of Scientific Affairs at InterMune. "We are now prepared to begin manufacturing and toxicology testing and will work toward moving the program into the clinic by the end of next year."

http://biospace.com/news_story.cfm?StoryID=6027815&full=1

Sensaire Pocket Spirometer

The Sensaire Pocket Spirometer has received CE Mark approval to be marketed throughout the European Union, QRS DIAGNOSTIC LLC (Plymouth, MN) announced Monday.The portable device is capable of performing a complete lung function test to diagnose respiratory ailments such as chronic obstructive pulmonary disease and asthma. Spirometers measure respiratory gases to determine how well the lungs take in air, the volume of the air held by the lungs and how well the lungs exhale air. Sensaire received 510(k) clearance from the FDA in December 2000, as reported by Medical Industry Today. The device features apatented biodegradable mouthpiece sensor and a touch screen with real-time graphics. It even exceeds the American Thoracic Society's Standardization of Spirometry Guidelines for accuracy and precision, according to QRS. Sensaire is designed for use by physicians, nurses, hospital technicians and home care specialists.

http://www.medicaldata.com/mit/detail.asp?art=08210101&MITUID=208287

Appointment of New FDA General Counsel May Signal New Conservative Era WASHINGTON (Reuters Health) Aug 22 - The Bush Administration has appointed a new general counsel at the US Food and Drug Administration (FDA) in a move that eventually may prove more significant than the appointment of a new commissioner.

http://www.medscape.com/reuters/prof/2001/08/08.23/20010822rglt006.html

*****

FDA Approves First Pacemaker For Congestive Heart Failure

FDA today approved a new type of pacemaker that sends specially timed electrical impulses to the heart's lower chambers to treat the symptoms of moderate to severe congestive heart failure.

http://www.fda.gov/bbs/topics/ANSWERS/2001/ANS01100.html

*****

FDA Needs Your Help

You probably know that the U.S. Food and Drug Administration (FDA) is responsible for making sure that everything from medicines to foods to cosmetics are safe to use. But what do you do if you have trouble with a product? The FDA has several ways for you to report problems, depending on the product involved. And the agency says it needs your help because despite testing before products are approved, some problems aren't detected until a larger number of people use the product.

http://dailynews.yahoo.com/h/hsn/20010806/hl/fda_needs_your_help_1.html

New York Doctors Group Sues 6 HMOs

A state doctors group Wednesday sued six leading HMOs, alleging they harmed patients and breached contracts with doctors by denying medically necessary care, reducing reimbursements and denying claims.

http://www.internalmdlinx.com/thearts.cfm?artid=205464&specid=3

*****

Hmos Profitable in 2000

After losing money for three straight years, the US health maintenance organization (HMO) industry returned to profitability last year, earning nearly á billion, a study of 492 companies released Monday by Weiss Ratings Inc. showed.

http://dailynews.yahoo.com/h/nm/20010806/hl/hmos_1.html

*****

Choosing a Doctor

It's happened again: Your medical insurance plan has dropped your primary-care physician. Now you have to leaf through that telephone directory-size book looking for a new doctor.

http://dailynews.yahoo.com/h/hsn/20010807/hl/choosing_a_doctor_1.html

New U.S. Medicare Rules to Cut Benefits

The United States will issue new rules cutting payments for some hospital outpatient procedures within the next few days, the Los Angeles Times reported on Monday. Medicare is planning to slash its payments for some innovative and frequently used outpatient procedures, including the implanting of pacemakers, the newspaper reported, citing ''congressional and industry sources.''"

http://dailynews.yahoo.com/h/nm/20010820/ts/health_medicare_dc_1.html

NHLBI-Funded Emphysema Study Finds Certain Patients at High Risk for Death Following Lung Surgery

Emphysema patients who have severe lung obstruction with either limited ability to exchange gas when breathing or damage that is evenly distributed throughout their lungs receive little benefit from lung volume reduction surgery (LVRS) and are at high risk of death from the procedure, according to early results from the National Emphysema Treatment Trial (NETT). NETT is a five-year, multicenter, randomized study to evaluate the role of LVRS in the treatment of severe emphysema. This is the first time that researchers have identified scientifically based selection criteria for patients seeking LVRS as a potential treatment for advanced emphysema. As a result of the findings, patients with these high-risk characteristics are no longer being enrolled in NETT; however, the study will continue to recruit other eligible patients until its scheduled completion in 2002.

http://www.nhlbi.nih.gov/new/press/01-08-14.htm

MEMBER ROUNDUP

Texas Gathering!!!!
See the main Website.

October 13, 2001
Harris Southwest Methodist Hospital
6100 Harris Parkway
Fort Worth, Texas  76132
Time:  10 AM to 3 PM

 Sherry Elmore, Texas Chapter Leader

Withdrawn Bayer Drug Linked to 31 Deaths

WASHINGTON (Reuters) - Bayer AG's cholesterol drug Baycol, which the German drug giant pulled from the market Wednesday, is linked to 31 US deaths from a muscle-related side effect, according to the US Food and Drug Administration.

http://biz.yahoo.com/iw/010831/02031405.html

It doesn't take a scientist to tell you that too many snacks can make you fat, but now a new medical study says french fries, cookies, chips and the like may harm your vision.

http://dailynews.yahoo.com/htx/abc/20010816/hl/gma010815snacks_vision_1.html

For a free diabetes ID necklace for our diabetic members, see: http://www.diabeteswellness.net/NewFiles/alertidentification.html

*****

Coping With More Than One Disorder

In illness and health, the body's systems work together to achieve a state of healthy equilibrium called homeostasis. There are limits to what the body can do, however, and you must be actively vigilant to help your body. It's one thing to fight off the flu or a temporary spike in blood pressure. But for older individuals, who may already have five or six conditions at the same time, as well as having less reserve because of the aging process, the body's ability to restore homeostasis is seriously taxed. And multiple chronic medical conditions can complicate a new condition. If you have both diabetes and cardiovascular disease and have a heart attack, you're more at risk of a poor outcome. The effects of multiple conditions start to amplify each other, making it more important to carefully attend to your health when you are older. Adding to the mix are the effects of medications. People 65 and older take 25 percent of all prescription drugs. When you're taking three, five or eight different drugs a day, there is a higher risk of drug interactions and side effects, which may create symptoms interpreted as a problem with the heart, diabetes or vascular systems.

http://www.intelihealth.com/IH/ihtIH/WSIHW000/22030/22034/267340.html?d=dmtContent

Pulmonary Rehabilitation for The Elderly Client

Pulmonary rehabilitation (PR) is the standard of care for persons with disabling symptoms and deconditioning associated with chronic lung disease. PR includes exercise training, education, psychosocial/behavioral intervention, and outcome assessment. Outcomes of PR include improved respiratory symptom control, muscle function, exercise tolerance, and quality of life, as well as reduced respiratory hospitalizations and emergency room visits. The advanced practice nurse (APN) plays a key role in managing the patient with chronic lung disease. Interventions include establishing an accurate diagnosis, providing clinical management, teaching prevention strategies, strengthening patient partnership, and referring appropriate patients to PR. http://www.medscape.com/Medscape/Nurses/journal/public/archive/2001/toc_0102.html

Antioxidants and the Lung

Recent research suggests that oxygen and its related species (oxidants) may contribute to, play a role in, or mediate the pathogenesis of a number of important lung diseases. The lung exists in a high-oxygen environment and, together with its large surface area and blood supply, is susceptible to injury mediated by these oxidants. We shall briefly review oxidants and antioxidants, lung diseases with which they may be involved, data available so far, and how this information may lead to new approaches to managing oxidant-mediated lung diseases.

http://www.chestnet.org/education/pccu/vol13/lesson18.html

*****

Antibiotic-Resistant "Superbug"

One of the most widely disseminated strains of an antibiotic-resistant bacterium responsible for hundreds of infections in European hospitals can be traced back to the 1950s, according to researchers at The Rockefeller University.

http://biospace.com/linkto.cfm?link=www.sciencedaily.com/releases/2001/08/010809070109.htm

Benefits of Nicotine Gum 'May Be Placebo Effect'

Smokers who chew nicotine gum to help them quit may do just as well with ordinary chewing gum, a small new study suggests.Psychologists at the University of Glamorgan in Pontypridd, Wales have shown that conventional gum is just as good at reducing cigarette cravings. Their findings suggest much of the benefit from nicotine gum may be the so-called placebo effect--where smokers feel better simply because they expect the gum to have an effect.

http://dailynews.yahoo.com/htx/nm/20010815/hl/gum_1.html

*****

Passive Smoking at Work Damages Nonsmokers Lungs

LONDON (Reuters Health) - Exposure to cigarette smoke in the workplace is more likely to cause reduction in lung function than exposure at home or in public places, according to research published Thursday in the August issue of Occupational and Environmental Medicine.

http://news.healthcommunities.com/common/news/1/pul08152001_smoking.shtml

To Keep Fit, Keep Moving!

Doctors' Advice, Counseling Improves Fitness, Especially in Women.

http://webmd.chtah.com/a/aA7dBD1AFqBfYAFrDG7ACBJ9UJ9

*****

Lifestyle Changes Ward Off Type II Diabetes

Shedding just a few pounds and getting only a modicum of exercise can dramatically cut your chances of getting Type II diabetes, according to the largest-ever U.S. clinical trial on diabetes prevention. Americans at high risk for Type II (adult-onset) diabetes, which is now at epidemic levels in the United States, can decrease their risk of getting the disease by almost 60 percent if they lose only 15 pounds on a low-fat diet and exercise 30 minutes a day for five days a week.

http://dailynews.yahoo.com/h/hsn/20010809/hl/lifestyle_changes_ward_off_type_ii_diabetes_1.html

Table of Contents


08/31/01
Text and Images, this page: © 2001, EFFORTS
EMPHYSEMA FOUNDATION FOR OUR RIGHT TO SURVIVE
Contact EFFORTS