NEW ORLEANS—Since leaders of the American Thoracic Society (ATS) declared 2010 to be the Year of the Lung, it follows that much of the research presented at the organization's annual meeting, held in New Orleans in May, dealt with pulmonary disease.
The Year of the Lung designation is intended to draw attention to lung disease from people outside the world of thoracic experts, as pink ribbons and red dresses have done for breast cancer and heart disease, explained representatives of ATS and partnering international organizations at the meeting.
“The importance of chronic respiratory disease is being greatly underestimated,” said Norbert Berend, MD, president-elect of the Forum of International Respiratory Societies. COPD is projected to be the third most common cause of death by 2020, he noted.
Physicians, both specialist and generalist, can help get the word out by screening for lung disease, the experts suggested. ATS and its partners have declared October 14 World Spirometry Day, to be marked with free testing around the world.
“We want every patient to go to a doctor and say, ‘Can I have a breathing test?’” said Dr. Berend.
COPD's new attitude
There's already evidence of a new attitude toward COPD, reflected by the growing quantity of research on the disease, according to Richard Casaburi, MD, PhD, who moderated a press conference at the meeting. Whereas COPD patients used to be thought of as suffering the expected consequences of their bad habits, “We now have sympathy for them,” said Dr. Casaburi, of the University of California Los Angeles.
Physicians now also have some additional evidence on how to treat these patients, especially with regard to exercise. One trial presented at the meeting found that being active on a regular basis was more closely associated with COPD patients' functional status than their maximal exercise tolerance. This finding gets at a larger issue about whether the secret to health is peak fitness or just regular activity, according to Dr. Casaburi.
“This suspicion is growing that perhaps the most important factor is that people are active,” he said.
The value of exercise for all was confirmed by another study finding that obese COPD patients benefit as much from pulmonary rehabilitation as thinner patients do.
Although their exercise prescriptions may be similar, the differences among COPD patients were highlighted by a study finding that children who had severe asthma while growing up in the 1960s were at a significantly increased risk of developing COPD later in life.
“Traditionally, COPD has been regarded as a smoker's disease. There's growing evidence that there's a lot of non-smoking COPD,” said study author Colin Robertson, MD, of the Royal Children's Hospital in Melbourne, Australia. It is still unknown whether the better asthma therapies in use today will reduce this risk, he added.
Gender's role in asthma
Asthma is also turning out to be a more heterogeneous disease than physicians once thought, with the appearance of possible sex differences. New basic science presented at the meeting found that estrogen could have beneficial effects on function of the female lung, especially when combined with beta-agonists.
The research is still in early stages, but may explain a phenomenon that practicing physicians have already observed.
“There are some women who when estrogen is low in their menstrual cycle, asthma is worse,” said John Mastronarde, MD, director of the Asthma Center at Ohio State University and moderator of the asthma press conference.
The study gives a physiologic basis to some physicians' practice of giving women more beta-agonists when they have menstrual or pre-menstrual asthma, he added.
Another solution to the challenge of fine-tuning asthma care was offered by a study of an online self-management program.
“The biggest challenge we have in managing asthma is to find the balance [of] the lowest dose that will keep control of the disease while reducing side effects,” said study author Simone Hashimoto, MD, of the department of respiratory medicine at the University of Amsterdam.
Patients in the trial conducted daily monitoring of their exhaled nitric oxide levels, entered the data online, and then received modifications to their corticosteroid regimens from a nurse. Use of the Internet program was associated with a reduction in steroid use compared to controls.
“Not only for asthma, but also for other chronic diseases, [a program like this] might be a solution for the future,” said Dr. Hashimoto.
Asthma also turns out to be like many other chronic diseases in that it doesn't go well with high-fat fast food. Researchers in one study fed asthma patients either burgers and hash browns or low-fat yogurt and then looked at their airway inflammation and response to a bronchodilator. The people who ate the high-fat meal did worse on both measures.
More research is needed to tease out the possible roles of carbohydrates and overall calories in this finding, but in the meantime, it's useful evidence to convince patients to steer away from foods that are generally considered unhealthy anyway, noted Dr. Mastronarde. “I can say, ‘Look, it makes your asthma worse.’”