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Acetaminophen May Boost Risk of COPD, Study Suggests

by John C. Martin
05-12-05 - A heightened use of the pain-reducing drug, acetaminophen, may increase the risk of developing asthma or chronic obstructive pulmonary disease (COPD), according to a study from a group of international researchers.1

One Theory: Oxidation?
The research did not conclude that acetaminophen was a direct cause of COPD, but that there was an association with the drug's daily use and incidence of the disease. Still, the investigators in the international study have a theory for the apparent link. "Oxidative stress may increase the risk of asthma, contribute to asthma progression, and decrease lung function," they wrote in the May 1 issue of the American Journal of Respiratory and Critical Care Medicine. "Previous research suggests that use of acetaminophen, which is hypothesized to reduce antioxidant capacity in the lung, is associated with an increased risk of asthma."

According to the study team, previous animal studies suggested that acetaminophen could deplete a beneficial antioxidant found in the airway of the lung, which could ultimately damage lung tissue.

Antioxidants are beneficial molecules in the body that may protect cells from damage caused by unstable molecules known as free radicals. Antioxidants can help stabilize oxidants (free radicals) and may prevent the damage they may have caused otherwise.2

Leading Cause of Death
Chronic obstructive pulmonary disease is the fourth leading cause of death in the United States. It's a lung disease that makes it hard to breathe because the airways are partially obstructed. As a result, the airways and air sacs of the lungs lose their shape and become floppy, causing airway restriction. The most common cause of COPD is cigarette smoking.3 However, it can evolve in people with pulmonary hypertension4 or co-exist in those with pulmonary fibrosis, for example.5

Acetaminophen/COPD Link Assessed
In the study, Tricia McKeever, PhD, a research fellow in the Division of Epidemiology and Public Health at the University of Nottingham in the UK and her colleagues gathered information from records of more than 13,000 patients who took part in the Third National Health and Nutrition Survey (NHAMES III), a U.S. study that ran from 1988 to 1994. Participants in the survey were asked about certain health habits, such as whether they had taken aspirin, acetaminophen, and ibuprofen during the previous month. They were then classified as "never users", "occasional users", "regular users", and "daily users".

After measuring the rate of acetaminophen usage in the NHAMES III study and comparing it to the incidence of COPD cases, McKeever and her colleagues found that "increased use of acetaminophen had a positive-dose-dependent association with COPD and an inverse association with lung function." (Lung function decreased with higher doses of acetaminophen).

Other Data
The investigators found that nearly 7 percent of the patients in the U.S. study had been diagnosed with asthma, and nearly 12 percent had contracted COPD. Almost 3 percent had both respiratory illnesses. In terms of acetaminophen use, about 4 percent of the study participants used the drug daily, more than 8 percent used aspirin, and about 2-and-a-half percent had used ibuprofen.

A small percentage reported using all three medications in the previous month; 16 percent reported using two types of medications.

McKeever's group determined that neither aspirin nor ibuprofen use were associated with the prevalence of asthma or COPD in the study population.

"This study provides further evidence that use of acetaminophen is associated with an increased risk of asthma and COPD, and with decreased lung function," the researchers wrote. They added that the findings confirm those of previous studies.

1. McKeever TM, Lewis SA, Smit HA, Burney P, Britton JR, Cassano PA. The association of acetaminophen, aspirin, and ibuprofen with respiratory disease and lung function. Am J Respir Crit Care Med 2005 May 1;171(9):966-71. Epub 2005 Feb 25.

2. National Cancer Institute. National Institutes of Health (NIH). Antioxidants and Cancer Prevention: Questions and Answers. Available at: http://www.cancer.gov/newscenter/pressreleases/antioxidants. Accessed May 12, 2005.

3. National Heart, Lung, and Blood Institute. National Institutes of Health (NIH). What is Chronic Obstructive Pulmonary Disease (COPD)? Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_WhatIs.html. Accessed May 12, 2005.

4. Barbera JA, Peinado VI, Santos S. Pulmonary hypertension in COPD: old and new concepts. Monaldi Arch Chest Dis 2000 Dec;55(6):445-9.

5. Ji R, He Q. The clinical study of pulmonary emphysema with pulmonary fibrosis. Zhonghua Jie He He Hu Xi Za Zhi 1999 Nov;22(11):666-8.

John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include coverage of health news for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.

What is Chronic Obstructive Pulmonary Disease (COPD)?

Chronic obstructive pulmonary disease (COPD) is a lung disease in which the lung is damaged, making it hard to breathe. In COPD, the airways-the tubes that carry air in and out of your lungs-are partly obstructed, making it difficult to get air in and out.

Cigarette smoking is the most common cause of COPD. Most people with COPD are smokers or former smokers. Breathing in other kinds of lung irritants, like pollution, dust, or chemicals over a long period of time may also cause or contribute to COPD.

The airways branch out like an upside-down tree, and at the end of each branch are many small, balloon-like air sacs. In healthy people, each airway is clear and open, the air sacs are small and dainty, and both are elastic and springy. When you breathe in, each air sac fills up with air, like a small balloon, and when you breathe out, the balloon deflates and the air goes out. (See the section, "How Do the Lungs Work," for details.) In COPD, the airways and air sacs lose their shape and become floppy. Less air gets in and less air goes out because:

* The airways and air sacs lose their elasticity (like an old rubber band)
* The walls between many of the air sacs are destroyed
* The walls of the airways become thick and inflamed (swollen)
* Cells in the airways make more mucus (sputum) than usual, which tends to clog the airways.

COPD develops slowly, and it may be many years before you notice symptoms like feeling short of breath. Most of the time, COPD is diagnosed in middle-aged or older people.

COPD is a major cause of death and illness throughout the world. It is the 4th leading cause of death in the U.S. and the world.

There is no cure for COPD. The damage to your airways and lungs cannot be reversed, but there are things you can do to feel better and slow the damage to your lungs.

COPD is not contagious-you cannot catch it from someone else.

Judge orders fen-phen lawyers to surrender $20 millon

BURLINGTON, Ky. -- A judge has ordered three Lexington attorneys to surrender $20 million taken from a 2001 fen-phen settlement and used to set up a charitable fund.

An order this week by Judge William Wehr of Fort Thomas said the attorneys have paid themselves and friends more than half of the $200 million settlement, and did not tell their clients about the charity fund.

"In reality, they were passing out money to themselves and others like it was theirs to do with as they wished," Wehr wrote in the order. The lawyers and other directors of the fund paid themselves more in fees during its first two years than they paid out in grants, Wehr wrote.

Wehr ruled that the lawyers _ Melbourne Mills Jr., William Gallion and Shirley Cunningham _ breached their duty to 431 clients for telling them that fees wouldn't surpass about 30 percent of the settlement total. By the lawyers' own accounting, $106 million went to attorney fees and other costs, according to the order, issued on Wednesday.

An attorney for the lawyers, William E. Johnson of Frankfort, could not be reached for comment.

Wehr ordered the lawyers to place the funds from the charity in escrow so it can be distributed to former clients if they win a suit against the attorneys.

The original suit was filed in 1998 in Boone Circuit Court by a group of people who suffered health problems after using the drug.

Last month, the Judicial Conduct Commission reprimanded the judge who presided in the fen-phen litigation, Senior Judge Joseph F. Bamberger. He resigned rather than face removal from office for approving huge fees for the attorneys and a close friend, trial consultant Mark Modlin.

Wehr wrote that documents turned over in discovery and found in Bamberger's chambers make it clear that some fen-phen victims were unhappy with their settlement amount from the start. One victim, for example, received just $29,500 after having a stroke while taking fen-phen.

The original lawsuit filed against American Home Products Corp., which made one of the drugs in fen-phen, was settled in 2001.

In December 2004, a group of plaintiffs filed suit after learning of the charitable fund, known as the Fund for Healthy Living. The plaintiffs, whose number has grown to about 200, now are asking that the lawyers be forced to give back excessive fees.

According to Wehr's accounting, Cunningham, Gallion and Mills paid themselves $20 million each. A fourth attorney, Stan Chesley of Cincinnati, who was counsel to the other attorneys, was paid another $20 million. The total in fees and other costs was $106 million, plus $20 million for the fund, which left $74 million for the plaintiffs to share.

Chesley was not included in Wehr's order because he has separate counsel who had requested a delay in ruling on his case.


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