COMMENTARY

Morning Report: COPD Guidance, Adult Vaccine Update, Cancer Prevention Awareness

Arefa Cassoobhoy, MD, MPH

Disclosures

February 17, 2017

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Hello. I'm Dr Arefa Cassoobhoy, a practicing internist and a medical editor for Medscape and WebMD. Welcome to our weekly brief on recent medical news and findings.

Updated COPD Guidelines

First, there is an update to the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (COPD). Known as the Global Initiative for Chronic Obstructive Lung Disease (GOLD), this report includes several key recommendations.

For example, assessments should focus on symptoms, including dyspnea, chronic cough, and sputum production. Also consider risk factors, such as tobacco, and the effect of the disease on overall health. Spirometry is required to make the diagnosis and to guide therapy. A postbronchodilator FEV1/FVC ratio < 0.70 confirms the presence of persistent airflow limitation.

The global strategy also provides a simpler and more practical definition of exacerbation, and places more emphasis on the use of combined bronchodilators as first-time therapies. In addition, it offers in-depth strategies for escalation and deescalation of therapy, while also presenting a thorough review of other treatment options. These include smoking cessation, pulmonary rehabilitation, and oxygen therapy, as well as treatments for comorbidities and palliative care.

The full report on COPD can be found on the GOLD website.

Changes to 2017 Adult Vaccination Recommendations

Next, the Advisory Committee on Immunization Practices (ACIP) and the Centers for Disease Control and Prevention have issued their final 2017 adult vaccination schedule. Here are a few of the key revisions.

First, it is now recommended that the hepatitis B vaccine be given to patients with chronic liver disease, as well as to those with hepatitis C. Another recommendation is that patients who didn't get the human papillomavirus (HPV) vaccine before age 15 still require three doses, not the two-dose regimen now recommended for children. That is the case for both men and women through age 26 years.

Adults considered at risk for meningococcal B disease, including those with HIV, should be immunized against meningococcal B. HIV-positive adults should also receive vaccination for meningococcal serotypes A, C, W, and Y. For specifics, see the ACIP's full report.

Crisis in Cancer Awareness

And finally, new data show how little Americans know about what does and doesn't increase the risk for cancer. The American Institute for Cancer Research's latest survey shows that most people blame cancer on factors beyond their control, when in reality, lifestyle is the key influencer of cancer risk. An overwhelming number of respondents blamed cancer on genetics, although actually, more than 90% of cancers develop in people who have no genetic link to the disease.

Fewer than one half of respondents were aware that they could affect their risk for cancer by changing the way they live. Lifestyle factors associated with cancer include inactivity, a diet low in vegetables and fruits, a diet high in red meat, and high consumption of processed meats.

Just 50% of those surveyed realized that obesity plays a role in cancer—even though, next to not smoking, a healthy body weight is the single greatest factor in lowering cancer risk. Also, 40% didn't know that alcohol use increases cancer risk.

As clinicians, we must educate our patients about how much their lifestyle affects their present and future health.

For Medscape and WebMD, I'm Dr Arefa Cassoobhoy.

Follow Dr Cassoobhoy on Twitter at @ArefaMD

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