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Monthly Archives: November 2016

Too Many Meds May Be More Problem

arely a week goes by, it seems, without some company announcing a new pill designed to help you live a longer,healthier life.

Medication can, indeed, do a lot toward curing, preventing or easing many ills. But taking a fistful of pills each day creates its own set of medical risks, prompting concern among a growing number of physicians and pharmacists that people are simply taking too many medications for their own good.

“As you keep increasing the amount of prescriptions, that increases the chance of having a drug interaction or major side effect,” said Sophia De Monte, a pharmacist in Nesconset, N.Y., and a spokeswoman for the American Pharmacists Association. “It’s exponential. The more you add on, the more chance you’ll have something bad happen.”

It’s a concept called polypharmacy, the use of more medications than someone actually needs. And that means not just prescription drugs but also over-the-counter medications and dietary supplements.

The average American is prescribed medication about 13 times a year, according to a report last year by the Kaiser Family Foundation. But the likelihood of polypharmacy increases as people age. Studies have found that seniors make up 13 percent of the population but account for 30 percent of all drug prescriptions. When elderly patients transfer from hospitals to nursing homes for rehabilitation, it is common for caregivers to have to keep track of nine or more prescribed medications for each person, according to a long-term care report.

The more medications people take, the more likely it is that they’ll experience a problem in three key areas, said De Monte and Norman P. Tomaka, a pharmacist in Melbourne, Fla., including:

  • Drug interactions. Drugs can work against each other in strange ways, and the more medications added to a daily regimen, the greater the risk for an interaction that could affect the person’s health.
  • Drug compliance. Trying to keep track of multiple medications can become too much of a burden, causing people to give up trying to comply with the directions for medication use. “We’ve found that compliance drops 40 percent when you add a second drug to a patient’s regimen, even if they are both once a day,” Tomaka said. A lack of compliance to prescription directions can create a serious health risk. “For example, if you use blood pressure medication sporadically, you may set your blood pressure up to become drug resistant,” he said. Sporadic use of antibiotics can cause infectious bacteria to develop immunity to medications.
  • Side effects. Every medication a person takes comes with its own risk for side effects. Multiple prescriptions and remedies mean a multiplied risk. And once side effects occur, it can be more difficult to track down the problem. “Sometimes those drugs can mask each others’ symptoms,” Tomaka said. “If you get an adverse reaction, you don’t know which one caused it. Then you have a quandary.”

But though the trend has been toward more prescriptions, steps are being taken to safeguard patients’ health.

Doctors and pharmacists are working together to create systems by which patients’ prescription lists are reviewed, with an eye toward minimizing the medications they take, De Monte said.

“The whole goal is to try to fine-tune it,” she said, “working with the patient to get the best medication with the best effects at the minimal amount.”

Researchers also are working on ways to combine drugs that work well together into a single dose, reducing the number of pills people have to keep track of as well as the risk for drug interactions, Tomaka said.

New Drug Targets Underlying

A new drug that targets a faulty protein that causes cystic fibrosis led to improved lung function and fewer symptoms in people with the lung disease, researchers report.

The drug — ivacaftor — is the first to halt the underlying processes that cause the inherited disease, which causes thick, sticky mucus to build up in the lungs and the pancreas and can lead to life-threatening infections, experts said.

“It has a huge significance for the whole cystic fibrosis community,” said study author Dr. Bonnie Ramsey, director of the Center for Clinical and Translational Research at Seattle Children’s Hospital and a professor at the University of Washington School of Medicine. “It’s the first time we have developed a therapy directed at the abnormal proteins and showing that it can be corrected.”

Only 4 percent to 5 percent of cystic fibrosis patients have the particular genetic variant that the drug is being studied to treat, but for them, the results could mean a significant improvement in their health, said Robert Beall, president and CEO of the Cystic Fibrosis Foundation.

“We’re talking about adding decades to these people’s lives, that’s how profound this drug is,” Beall said.

But Beall and other experts say the drug may end up helping people with other cystic fibrosis genetic variants, including the most common one, D508, one copy of which is present in more than 90 percent of people with cystic fibrosis.

Though ivacaftor (previously known as VX-770) on its own didn’t work all that well in these patients, a trial looking at using ivacaftor in conjunction with another drug is currently under way. Results of that trial are expected in the fall of 2012, said Beall, whose organization has provided funding for VX-770 research.

In the study reported in the Nov. 3 issue of the New England Journal of Medicine, 161 patients aged 12 and older were randomly divided into two groups. One received the drug every 12 hours and the other received a placebo. All patients had at least one copy of the G551D mutation.

Researchers could tell the drug was working two weeks after people started taking it and the concentration of chloride in their sweat dropped, for some to levels seen in people without the disease. Very salty sweat is a telltale sign of the disease.

Patients also showed improved lung function, as measured by FEV1, or how much air they could blow out in one second.

“It’s not surprising you would see an effect in two weeks. By changing the hydration of the mucus, you can clear it out better and open up the airways,” Ramsey said. “We saw the improvement across all illness severities … That was very encouraging. We had been very worried once you had the lung damage or the infections you wouldn’t be able to reverse it. That’s not saying the lungs would return to normal, but there was more reversibility than we thought there would be.”

Patients also experienced an average relative change in their lung function of 17 percent. Relative change means relative to where they started. The absolute change was about a 10 percent improvement.

At 48 weeks, patients on the drug were 55 percent less likely to have experienced an exacerbation, or an infection that left them ill and unable to work or hospitalized.

Patients on the drug also gained an average of 7 pounds, a huge feat for someone with cystic fibrosis, experts said. The weight gain brought people who were nutritionally deficient and underweight closer to a normal body weight, Ramsey said.

The results stayed consistent through 48 weeks, and there were few side effects, according to the study.

One in 6 Cell Phones in Britain Contaminated With ‘Fecal Matter’

One in six cell phones in Britain may be contaminated with fecal matter that can spread E. coli, likely because so many people don’t wash their hands properly after using the toilet, a new study contends.

The findings also suggest that many people lie about their hygiene habits, according to the researchers at the London School of Hygiene & Tropical Medicine and Queen Mary, University of London.

The study authors went to 12 cities and collected 390 samples from the cell phones and hands of volunteers, who were also asked about their hand-washing habits.

Ninety-five percent of the participants told the researchers that they washed their hands with soap and water where possible. However, lab tests revealed that 92 percent of phones and 82 percent of hands had bacteria on them. The researchers also found that 16 percent of hands and 16 percent of cell phones harbored E. coli bacteria, which is found in feces and can cause serious illness.

The study was released to coincide with Global Handwashing Day on Oct. 15.

“This study provides more evidence that some people still don’t wash their hands properly, especially after going to the toilet. I hope the thought of having E. coli on their hands and phones encourages them to take more care in the bathroom — washing your hands with soap is such a simple thing to do but there is no doubt it saves lives,” Dr. Val Curtis, a hygiene expert at the London School of Hygiene & Tropical Medicine and U.K. campaign leader for Global Handwashing Day, said in a school news release.

“Our analysis revealed some interesting results from around the U.K. While some cities did much better than others, the fact that E. coli was present on phones and hands in every location shows this is a nationwide problem. People may claim they wash their hands regularly but the science shows otherwise,” Dr. Ron Cutler, of Queen Mary, University of London, said in the news release.

Hand-washing with soap can prevent a number of illnesses caused by bacteria and viruses.

The Best Diet for COPD

Finding the right diet can be tricky for people withchronic obstructive pulmonary disease (COPD), but critical. They need to eat a healthy diet and maintain their optimal weight to keep COPD symptoms in check.

COPD: The Impact of Body Weight

For COPD patients, maintaining a healthy weight is important for controlling symptoms.

“If you’re overweight, you have to carry more of that weight around, making you feel more short of breath,” says Barry Make, MD, co-director of the COPD program at National Jewish Health in Denver and a professor of medicine at National Jewish and the University of Colorado Denver School of Medicine. Having more weight to carry around can increase shortness of breath, which is one of the primary symptoms of COPD. Being overweight also increased your risk for heart disease and diabetes, chronic diseases that can undermine your efforts at COPD management.

That said, it’s even more crucial for COPD patients not to be underweight. “Being overweight is bad, but being underweight is even worse in COPD patients,” Dr. Make says. “A lot of COPD patients want to lose weight, but we tell them not to lose too much.” According to Make, a low body weight when you have COPD is associated with a poorer prognosis, meaning a worse long-term outlook. In addition, not weighing enough can zap your energy, making it difficult to adhere to your COPD management plan.

COPD: Nutrition Tips

Talk with your COPD medical team about the nutrition plan that is best for you. They may recommend that you see a nutritionist, who can work with you to develop a meal plan to best meet your needs and monitor your progress along the way.

In general, people who have COPD should consider the following for a healthy diet:

  • Monitor calories: The American Lung Association (ALA) recommends that people with COPD keep close tabs on their weight. If you are overweight, you can lose weight by eating fewer calories. But don’t eat so few calories that you feel fatigued and hungry all the time. If you need to focus on maintaining or increasing your body weight, talk with your medical team or nutritionist about the foods you should be eating to keep the weight on.
  • Avoid fad diets: “Fad diets are not appropriate for COPD patients,” Make says. People with COPD appear to fare best with a varied diet that provides a good balance of whole grains, fruits, vegetables, and lean proteins, according to research published in 2014 in the International Journal of Chronic Obstructive Pulmonary Disease. This helps ensure that you’re getting vitamins such as C, E, and D, which are among those tied to better outcomes with COPD.
  • Focus on protein: Work with your medical team or nutritionist to determine the amount of protein you need. “A lot of people do not get enough protein in their diet,” says Make. The ALA recommends milk, eggs, cheese, meat, fish, poultry, nuts, and beans as protein sources.
  • Get enough fiber: Aim for 20 to 30 grams of fiber daily, the ALA recommends. Sources of fiber include whole-grain breads and pastas, nuts, vegetables, and fruit.
  • Watch your portions: “We tell our COPD patients to eat small meals frequently, rather than large meals,” Make says. According to the ALA, this strategy can help lessen shortness of breath.
  • Limit salt: Consuming excessive sodium can lead to fluid retention, which can worsen your shortness of breath. The American Heart Association recommends eating less than 2,400 milligrams of salt daily.
  • Remember your oxygen: If your medical team recommends it, use supplemental oxygen during and after meals to reduce shortness of breath when eating.

A healthy diet is an important part of a COPD treatment plan. Eating the right foods can help manage your symptoms, make you feel better overall, increase your energy level, and give your body the fuel it needs to fight infection. It takes energy to breathe when you have COPD, so feed your body well.