‘ORGAN-ON-A-CHIP’ technology could be the future

A research team at the Wyss Institute for Biologically Inspired Engineering at Harvard University have used their new ‘organ-on-a-chip’ technology to develop a model of the human airway so that diseases such as COPD can be studied outside of the human body to allow researchers to gain new insights into the disease mechanisms, identify biomarkers and test new drugs.

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Diseases such as COPD and asthma are inflammatory reactions in the lungs whether to smoking, inhaled particles or bacterial/viral infections. It is already known that many of the disease processes occur in the alveoli however much less is known about how inflammation starts off these reactions and why these processes react in the way that they do. For example the reason why the body recruits white blood cells and the build-up of mucus, both of which compromises the patient’s lungs or the cause and reasoning behind exacerbations.

A new microfluidic model of the lung has been created of the lung’s small airways made with chips lined with cells from both normal donors and diseased patients. This model is like looking inside an actual patient and “recapitulates critical features of asthma and COPD with unprecedented fidelity and detail” explains Donald Ingber. Now with this micro-engineered human lung small airway lung inflammatory diseases over several weeks can be studied in order to gain better insight into disease mechanisms, as well as screen for new therapeutic drugs.

This device closely mimics the 3D cellular architecture of an actual human small airway and contains fully matured human small airway epithelium with different cell types and channels containing all the components that you have in your lungs including white blood cells and nutrients. The device can keep itself ‘alive’ for a few weeks before starting to deteriorate. Inflammatory situations such as asthma and COPD can be simulated by adding an asthma-inducing immune factor or by setting up the system with lung epithelial cells from a COPD patient and then researchers can observe the different ways that the airways react in different situations. In both cases, the team was not only able to observe highly disease- and cell type-specific changes but could also exacerbate them with agents simulating viral or bacterial infection.

Demand for such a device is high due to the fact that the inflammatory response is so complex and internalised that it cannot be adequately studied in humans or animals and there are no known drugs that can stop and start the inflammation processes so that you could potentially get a snap-shot of what was going on.

This new organ-on-a-chip technology has provided researchers with a window on a molecular scale to be able to observe the activities of living human tissue and allows them to break down the processes and interactions of specific cell types and immune system components so as to understand why the diseases progress in the way they do and ideas on how this could be prevented based on the interactions between the lung tissue and the immune system, whether this be by manipulating the immune system response or by developing new drugs to counteract the effects.

“This novel ability to build small airway chips with cells from individual patients with diseases like COPD positions us and others now to investigate the effects of genetic variability, specific immune cell populations, pharmaceutical candidates and even pandemic viruses in an entirely new and more personalized way; one that will hopefully increase the likelihood of success of future therapeutics,” said Ingber.

References: http://medicalxpress.com

How your cough can impact on your quality of life

The characteristic symptoms of COPD include a chronic and progressive cough and sputum production that can be variable from day to day; it may start off intermittently but towards the end will be frequent throughout the day.

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The cough itself is an important defence mechanism that helps to clear foreign bodies and excess mucus from the lungs to allow better breathing. However a chronic cough has been found to be associated with detrimental psychological and physical effects on the patient’s life.

Depression, muscle strain and fatigue, sleep deprivation, incontinence and vomiting are all directly associated with coughing. Other related symptoms are rib fractures, fatigue, embarrassment, unconsciousness, difficult conversations on the phone, hoarse sound, unable to stand close to the their relatives due to their cough, and an inability to work in school or elsewhere.

 

In this new study it has been shown that a lower cough-specific quality of life is associated with a lessened ability to carry out daily activities due to its negative effect on fatigue and lower abdominal muscle endurance, and higher depression levels are also usually observed in patients with COPD.

When coughing the contraction of abdominal muscles is required. However with a chronic cough this can lead to a decline in the endurance of these muscles due to repeated overuse and resulting in them working ineffectively and not being able to help aid the cough or mucus clearance.

In a study of COPD patients with chronic coughs 33% were identified as anxious while 16% experienced depression and approximately 48% of all coughers had moderate or high trait anxiety. Also in general patients were at a higher risk of suffering from phobic anxiety, obsessional tendencies and depression showing that this group of individuals suffered from an emotional and psychological impact on their lives from their chronic cough.

53% of the group attended a speciality centre to help treat their chronic cough and depressive symptoms and there was a statistical improvement in both cough severity and depression scores after three months. This reinforces the fact that quality of life and chronic cough are linked but also that there is treatment to help improve both.

If cough is an important part of COPD and contributes to deterioration in quality of life, the symptom should be controlled and see your doctor who can help to ease your cough which in turn will hopefully improve your quality of life whether physically, psychologically or both.

Ensuring that you follow your doctor’s advice regarding medications and oxygen therapy regime, exercising and eating correctly will help to ensure that you are easing the COPD symptoms as much as possible and therefore also the cough. If you find you are coughing more and gasping for breath maybe your medical oxygen requirements need altering; whether it be an increased flow rate or different machinery to fit your lifestyle. Ask your doctor straight away as anything that you can do to ease the coughing and breathlessness will not only instantly improve your medical condition but will indirectly improve your general quality of life.

 

References: http://www.dovepress.com

Stem cells and nanoparticles could be the future treatment for lung disease

Malaysian scientists are joining forces with Harvard University experts to help in seeking a safe, more effective way of tackling lung problems including chronic obstructive pulmonary disease (COPD), the progressive, irreversible obstruction of airways causing almost 1 in 10 deaths today and to revolutionize the treatment of lung diseases through the delivery of ‘nanomedicine.’

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Treatment of COPD and lung cancer commonly involves chemotherapeutics and corticosteroids which are misted into a fine spray and inhaled, enabling direct delivery to the lungs and a quick and effective medicinal effect. However, because the particles produced by today’s inhalers are large, most of the medicine is deposited in the upper respiratory tract and does not reach down to lower parts of the airways and lungs.

The Harvard team is working on “smart” nanoparticles, which are tiny particles that deliver the appropriate levels of a medication to the deepest, tiniest sacs of the lung and ensures an even distribution, through the use of magnetic fields.

Malaysia’s role is to help ensure the safety and improve the effectiveness of nanomedicine and in assessing how nanomedicine particles behave in the body, what attaches to them to form a coating, where the drug accumulates and how it interacts with different cells.

Inhaled nanomedicine holds the promise of helping doctors prevent and treat such problems in future, reaching the target area more swiftly than if administered orally or even intravenously. This is particularly true for COPD and lung cancer, says Dr. Brain. “Experiments have demonstrated that a drug dose administered directly to the respiratory tract achieves much higher local drug concentrations at the target site.”

“Nanotechnology is making a significant impact on health care by delivering improvements in disease diagnosis and monitoring, as well as enabling new approaches to regenerative medicine and drug delivery,” says Prof. Zakri Abdul Hamid, Science Advisor to the Prime Minister of Malaysia.

Lung regeneration is another key focal point as scientists have found that regardless of their stage in life, lung cells are able to regenerate themselves in order to repair missing or damaged tissue. The team behind the discovery hopes that they will one day be able to replicate this natural behavior in order to help repair tissue damage in patients with conditions such as COPD.

There are two main types of lung cells: type 1 cells, where oxygen and carbon dioxide are exchanged during breathing and type 2, which secrete surfactants, a type of lubricant essential to the breathing process. Type 2 cells have been previously observed to regenerate into type 1 cells in the presence of cell damage, but a team of scientists from the University of Pennsylvania School of Medicine and Duke University have shown that the opposite also occurs.

“We saw new cells growing back into these new areas of the lung. It’s as if the lung knows it has to grow back and can call into action some type 1 cells to help in that process,” explained cardiologist Rajan Jain and the observation suggests that there is much more flexibility in the pulmonary system than previously thought.

Understanding how and why these mature cells are regenerating into different types of lung tissue may be the key to treating certain types of lung damage caused by conditions such as chronic obstructive pulmonary disease. Although patients may somewhat control the condition, there is currently no cure. The ability to regrow damaged lung tissue on demand, then, could completely change treatment options and possibly offer a cure for COPD patients.

 

References: http://www.news-medical.net and http://www.medicaldaily

You soon could wear a blood oxygen sensor like a plaster

For many patients such as those with COPD it is important for your health to be able to constantly monitor your blood oxygen levels in order to avoid exacerbations and worsening health and breathing problems. There are many pulse oximeter devices already out there but many are cumbersome or difficult to use. These rely on LEDs that shoot infrared light and red light through a part of the body with a sensor waiting on the other side to receive the light that remains and detects how much has passed through. Oxygen-rich blood will absorb much more infrared light and low-oxygen blood will absorb more of the red light.

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Scientists at the University of California have a developed a much more simplified, easy to use and light weight device by developing a thin film-like sensor that can be worn around the finger much like a plaster. Instead of using infrared and red light this new device uses red and green light. These red and green LEDS are organically made and integrated onto a flexible piece of plastic.

Due to the organic components this electronic device is flexible and can easily conform to the body. It also means that the parts are cheaper to make, meaning that they can be thrown away after each use rather than having to disinfect the device each time. It is lightweight, more inconspicuous, cheap and disposable. The researchers tested the prototype alongside conventional pulse oximeters and found the readings to be equally as accurate.

Another device which is only the size of a post-it note is the Moxy-monitor, which has been designed to allow the user to monitor their body performance during workouts. It is a small black box worn against the skin that tracks blood oxygen levels in your muscles and it can display the data along with other fitness data in real time in third party devices and apps. It uses LEDS and light detectors to transmit near-infrared light though the skin and into the muscle tissue and back out again and extracts oxygen level readings from the results.

Although the device is geared more towards athletes, it is also beneficial for anyone with a medical condition such as COPD who want to exercise to help improve their condition but who need to monitor their oxygen levels closely to make sure they do not over do it and end up collapsing out of breath. The developers say that it is durable, even for rugby players and can even be used underwater. Its charge lasts for 3 hours and it transmits its data via a radio antenna or data can be retrieved via a USB port if the device has been out of signal or underwater.

There are other devices that have been developed such as a smart sock that monitors a baby’s vital signs and iPhone compatible oximeters. The future however is set to explode under the term ‘wearable.’ Much more than smart watches and fitness bands, the market is set to be filled with garments laden with sensors sewn into them which can track and monitor our every move.

These garments will at first be aimed at runners and sports professionals who want to track their performance, but will quickly spread to help anyone who wants to keep tabs on their health. Sensors sewn into clothing will scan for heart conditions, Smart socks will help those recovering from injury to restore their balance and alert family members when an elderly relative suffers a fall. The clothing manufacturers and fashion world are keen to weave these devices into their clothes so that users can be fashion conscious and advertise sponsors and brands as they move around .

Looking further ahead ‘wearables’ will become medical devices more than fitness trackers. When the data from them is accurate enough to be used to monitor someone’s heart over a period of time then their doctor could tell when the data is indicating a heart condition.

People in the industry believe that this will be a vast market and incredibly popular and that it will make such sensors cheap enough to sew into a whole range of clothes, and for them to be durable enough to be washed. They also forecast that these sensors could also be offered to users outside of retail such as with health insurance, gym membership and with diet plans.

 

 

References: http://www.gizmag.com and http://www.ibtimes.co.uk

Computers could help treat us 24/7

Normally your GP may see you for a few minutes a few times a year and take a handful of test results. What if a computer system was constantly monitoring you 24/7 and could compare your results with readings from thousands of other patients worldwide and use the knowledge from clinical guidelines and studies to treat you?

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In 2016 this idea is closer to becoming a reality. A machine in California has been designed by Sentrian, an early-stage machine learning and biosensor analytics company for remote patient management to be able to do this and is currently being trialed on patients. “We are trying to build a system that will enable us to listen to the lives and bodies of patients all the time, so we can make better, earlier and more personalised decisions.”

Currently one or two wireless ‘biosensors’ can collect simple data such as body temperature and heart rate as well as more complex information like oxygen saturation and potassium levels. If a patient could constantly wear several sensors at a time then the amount of data produced would be enormous.

Collecting all of this data and using learning algorithms to detect subtle patterns on chronic conditions such as heart disease and COPD can allow the machine to be able to detect early warning signs of an exacerbation or an attack and notify the doctor and patient when needed to warn them and allow more accurate treatment.

Many patients with COPD and similar chronic conditions will have symptoms a few days before an attack occurs but not feel ill until nearer the time. The computer could detect early signs of an upcoming attack and warn the doctor and patient so that medications could be altered, oxygen levels adjusted or warn the patient to eat or sleep more etc. It is currently being tested in the US and UK and early evidence has shown that the computer can spot early signs of a congestive heart failure exacerbations up to 10 days in advance. Early research is showing that even small things like heart rate change, sleep duration and body temperature may be indicators of an impending crisis and the system can even predict when someone may suffer a fall well in advance.

However the question being discussed is whether we should hand over all decision making to a computer when it comes to health-care? The profession itself is non-trusting of the results and of a computer being in control but Sentrian have suggested having joint control with humans. That doctors are notified of results and warning indicators and can use their judgment accordingly. The computer system would also be continually learning to know exactly which rules and interventions work best for which patients, and if a false alarm occurs the doctor can report this and the more feedback the system gets, the more it can learn and adapt.

Normally the human brain can remember the last 30 patients but the computer would be able to remember more than 30,000. Machine learning is also a lot faster than human learning. With the medical advances and research of the last 100 years medical knowledge has grown beyond belief and is becoming more difficult for the human brain to be able to intake and even during the course of a GP’s life medicine is constantly progressing and it is difficult for a GP to keep up-to-date. On average it can now take 17 years for new evidence-based findings to find their way to the GP and be clinically used.

What if a doctor was able to bring up every single case study and worldwide guidelines on a particular disorder to the forefront of their minds and instantaneously have all the possible data they need? The computer system can do this and therefore will you not be treating the patient with the most up-to-date knowledge possible? It could read all textbooks, medical databases of journals and literature, thousands of patients records and   be subject to 1000’s of hours of teaching sessions from clinicians. Things that can take scientists 30 years to uncover may take the computer only a month, especially when it comes to research.

It could assist your GP by analyzing a patient’s medical record in conjunction with all of it’s acquired knowledge and suggest potential treatment recommendations. It could also match patients to clinical trials which usually takes hours of a human’s time to trawl through patient’s notes to see if they match the criteria for a trial and eliminates human error.

In theory by wearing a few sensors a computer system can monitor and record your readings, recognize subtle patterns and differences in your results, use data collected from around the world and if there are indicators for different treatments, a warning sign of an attack or deterioration of your condition then it can alert your doctor and you. It may just require a slight alteration in your medication dosage or oxygen saturation levels or ask that you eat, exercise or sleep more; things that the patient can do themselves or it may require intervention from the GP or hospital.

“Sentrian’s system is currently undergoing several randomised controlled trials, which means that the data of thousands of patients will be added to the platform. While we wait on clinical evidence, it is just a matter of time before this sort of artificial intelligence becomes a regular occurrence in the doctor’s office.”

 

References: http://www.wired.co.uk

Stopping smoking will not only help your lungs, but also your brain!

For COPD patients and others that use supplemental oxygen to help them to breathe, quitting smoking is hugely important to stop further lung damage, help slow the disease down and reduces the danger of smoking near oxygen cylinders. 2016 is going to be the year to stop smoking as part of a new campaign to try and combat lung disease. However if you stop smoking it is not only your lungs that you will help but your brain will benefit too.

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It’s never too late to quit, even if you’re in your 70’s, there is still a chance for a noticeable recovery. For light smokers the damage can be reversed in a few weeks and for heavier long-term smokers it may take anywhere up to 25years for full recovery but every little helps.

The cerebral cortex, which is responsible for memory, attention, awareness and language naturally thins with age but this process is hugely accelerated by smoking. Scientists at the University of Edinburgh found that even though smoking thins the outer layer of the brain and increases the risk of memory problems and dementia, it is reversible. The damage that cigarettes cause to the brain can start reversing as soon as you give up the habit. Even when quitting later in life there is still a chance of reversing the harmful damage done to your brain.

In the study the thickness of the cerebral cortex was measured and important thinking skills were tested on smokers, non-smokers and ex-smokers. Those who had never smoked tended to have a thicker cortex than the smokers but ex-smokers also had a thicker cortex than those who had continued with the habit. Also more importantly those who had kicked the habit some time ago seemed to have a thicker cortex than more recent quitters, showing that there had been continuous recovery.

Professor James Goodwin from AgeUK talks about how we all know that smoking is bad for our heart and lungs but it is also important that we know it is also bad for our brain. Avoiding smoking offers the best protection against the risk of brain decline, dementia and other cognitive disease but this study gives smokers a new hope that by quitting smoking even later in life can still allow our bodies to start to heal itself.

“With research suggesting that older people’s fear of developing dementia outweighs that of cancer, it is important we inform people about the simple steps they can take to safeguard against this horrible and distressing disease.”

COPD patients already have many health issues related to their condition but the fear of cancer and dementia adding to them is concerning for patients. Knowing that by quitting smoking you can help to reverse damage to your brain, on top of preventing further damage to your heart and lungs, reduce the risk of combustion with oxygen cylinders and concentrators and halting progression of the respiratory disease you’re suffering from is a huge incentive for people to encourage them to give up smoking.
References: http://www.dailymail.co.uk

E-CIGS: Worth it?!

Smoking is the main factor in developing COPD and many patients struggle with giving up smoking. E-cigarettes could be the way to help COPD give up and to improve their lung function and slow down the progression of their disease. Using oxygen to help improve your breathing is highly beneficial in coping with the disease but if you are still smoking then it is counter-acting the good work of the oxygen and other medications prescribed for you. However what are the facts and are they actually safe?

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Electronic cigarettes are battery-powered devices filled with liquid nicotine that is dissolved in a solution of water and propylene glycol. They can look very similar to ordinary cigarettes or other designs are less conspicuous. Often termed as ‘vaping’ you take a puff, the battery heats up the nicotine which creates a vapour than you then inhale, resulting in a sensation similar to smoking but without the smoke.

You can smoke them indoors, they are closer to a nicorette inhaler than tobacco and there are many studies supporting the opinion that they do alleviate the desire to smoke. For those people that use them in conjunction with tobacco in order to cut down on their tobacco intake, they found that they managed to reduce their tobacco intake and not suffer from any withdrawal symptoms. They have worked for people who constantly fail at ceasing smoking via other conventional methods. An online survey revealed that 96% said that E-Cigarettes helped them to quit smoking, 92% said that it made them smoke less and the majority stated that they helped to fight cravings, cope with withdrawal symptoms and avoid relapsing.

However many feel that they are not regulated enough and lack essential health warnings, proper labeling and instructions and disposal methods. Some have been found to leak which may expose you to a toxic exposure of nicotine.

A study found that e-cigarettes caused accused pulmonary effects after smoking it for 5 mins. Healthy non-smokers were reported to suffer airway flow resistance and oxidative stress. The authors however also suggested that if they were only being used as a bridge to stop smoking then the benefits would outweigh the risks.

The FDA states that “E-cigarettes may contain ingredients that are known to be toxic to humans, and may contain other ingredients that may not be safe.” They also suggest that because e-cigarette manufacturers are not required to submit clinical study data to them, the public has no way of knowing “whether e-cigarettes are safe for their intended use, what types or concentrations of potentially harmful chemicals are found in these products, or how much nicotine they are inhaling when they use these products.” The FDA is also concerned that the marketing efforts of e-cigarettes may increase addiction to nicotine, especially in young people, encouraging them to experiment with real tobacco products.

It is important to stop smoking as a COPD patient, not only for your health but for your safety due to the use of supplemental oxygen and the dangers of smoking around oxygen tanks. However how you choose to quit is a matter of personal choice and everyone is different and will respond differently to the various methods that are available from nicotine gum/patches, quit smoking medications, support groups and educational materials as well as E-cigarettes. You have to decide what is safe and easiest for you and ask your doctor for help, advice and support.

 

References: http://www.jsonline.com and http://copd.about.com and http://www.dailymail.co.uk