Generic Propecia

Every person who is infected with the H1N1 swine flu puts 1.5 other people at risk over the three days before coughing, fever and other symptoms appear.

That’s the conclusion of a new study published in the journal Influenza and Other Respiratory Viruses.

Anyone showing early symptoms of the flu needs to contact their health-care provider immediately. In addition, anti-viral drugs will likely help slow transmission, the researchers said.

The currently circulating swine flu first appeared in the town of La Gloria in Veracruz state in Mexico apparently sometime in early March. By March 15, it had spread to Mexico City and, since then, to much of the world.

According to the latest World Health Organization (WHO) figures, more than 209,400 cases of swine flu have occurred globally, with at least 2,185 deaths. These numbers likely underestimate the outbreak, WHO noted.

The authors of the new study looked at Mexico City data on all suspected cases of H1N1 swine flu from April 15 to April 25, examining people they had been in contact with, and cross-referencing that information with the onset of symptoms, hospitalization and other factors.

Their conclusions: The 2009 H1N1 virus is spreading at a rate comparable to the 1957 and 1968 flu pandemics — the most recent pandemics prior to this year’s swine flu — and to the SARS (Sudden Acute Respiratory Syndrome) outbreak, which surprised the world in 2003.

“Even if flu has a reproduction only a little bit above 1 [in this case 1.5], it has its effect because, in a susceptible population, it can start jumping from person to person within one to two days,” said study co-author Dr. Nathaniel Hupert, co-director of Cornell University and Weill Cornell Medical College’s joint Institute for Disease and Disaster Preparedness. He is also director of the Centers for Disease Control and Prevention’s Preparedness Modeling Unit.

“What that means is, three days later, you’ve got an additional half a person infected. In three days, each of those new people have infected an additional half person, and it’s like compound interest. It’s the same calculation that lets you grow $1,000 into a $1 million 20 years later.”

But health officials stress that the H1N1 swine flu produces relatively mild infections, much like the annual seasonal flu, and patients recover quickly. And some people, mostly older ones, seem to have some immunity to the virus.

However, doctors around the world are reporting a very severe form of the disease in young and otherwise healthy people. “In these patients, the virus directly infects the lung, causing severe respiratory failure,” the WHO said. So, countries should anticipate a growing demand for treatment in intensive care units as they prepare for a second wave of the pandemic, the agency said, the Associated Press reported.

Dr. Peter Gross, chief medical officer at Hackensack University Medical Center in New Jersey, sees no reason for mass panic. “They’ve proven that the transmissibility is comparable to the seasonal flu and less than the horrendous 1918 pandemic,” he said. Also key, he said, is that “the mortality is no worse than the seasonal flu and, if anything, might be slightly less.”

Still, he and others agree that the potential for infection is significant.

“If each person were infecting less than one person, it would eventually die out on its own. If it was two people, the outbreak would cascade. If it was 10, it would be an explosive epidemic,” said Dr. Dean Blumberg, associate professor of pediatric infectious diseases at University of California, Davis Children’s Hospital. “The number they’ve come up with here is similar to what others have found, in the range of 1.3 to 1.4. The seasonal flu is about 1.3, so it’s right in the range.”

The 1918 pandemic was estimated at about 2 to 2.5, he said.

“In a sense, it’s kind of reassuring in that it is highly transmissible but not exceptionally transmissible,” Blumberg said. “On the other hand, we need to keep in mind that, unless you’re someone who has already been infected with the swine flu, everybody in the world is susceptible to it. That’s the scary part.”

Given this vulnerability, Blumberg said, it makes sense that hospitals and communities are taking some extra precautions, such as using N-95 respirator masks.

Authorities have tried various strategies to mitigate the current outbreak, including closing schools, although federal officials in the United States are leaving that decision to local jurisdictions.

Recommended precautions for preventing the spread of swine flu include avoiding contact with other people if you are sick, coughing into your sleeve rather than your hand, and copious hand washing.

But the study authors said larger-scale measures may still be needed.

The study is the first completed by the new Preparedness Modeling Unit at the U.S. Centers for Disease Control and Prevention.

Although there is no cure for chronic obstructive pulmonary disease (COPD), starting treatment early may slow progression of the illness and add years to the lives of sufferers, new research finds.

COPD is a progressive, destructive disease of the lungs that is usually brought on by years of smoking. Symptoms include restricted breathing, secretion of mucus, oxidative stress and airway inflammation. It is estimated that as many as 24 million Americans have COPD, and the number is rising.

Three reports published in the Aug. 29 issue of The Lancet, a special issue devoted to COPD, offer new insight into treatments, including a new anti-inflammatory drug that shows promise.

In the first report, patients who began treatment early with the inhaled drug tiotropium (Spiriva) had better outcomes compared with untreated patients.

“If you treat moderate disease with these anticholinergic drugs, you get clear improvements in lung function, health-related quality of life, exacerbations and even, maybe, in mortality, but that was not statistically significant, but there was a trend,” said lead researcher Dr. Marc Decramer, a professor in the department of pathophysiology at University Hospital of the University of Leuven in Belgium.

In addition, “you seem to reduce the rate at which the disease progresses,” he noted.

For the study, Decramer’s group followed 2,376 patients with early COPD who took part in a study for four years. These patients were randomly assigned to receive Spiriva or a placebo.

The researchers found that the rate of decline in lung function was 12 percent lower among patients receiving Spiriva than for patients receiving the placebo.

In addition, patients taking Spiriva were healthier. Flare-ups of the disease were cut 18 percent, and hospitalizations resulting from flare-ups were reduced 26 percent, compared with patients taking the placebo, the researchers found.

For the best outcomes, Decramer said, COPD needs to be diagnosed in its early stages, and aggressive therapy should begin as soon as possible.

“We need to treat these patients earlier than we presently do,” Decramer said.

Dr. Norman Edelman, chief medical officer of the American Lung Association, agreed that the findings highlight the need to start COPD treatment when the illness is still mild.

“The major new finding is the efficacy of an anticholinergic in patients with relatively mild COPD in improving lung function and quality of life,” Edelman said. “The effects were small but seem real. This is of significance because it points out the usefulness of case finding and treatment of relatively early COPD cases, a somewhat neglected area in clinical practice.”

Two other reports in the same edition of the journal show the benefit of the new drug roflumilast (Daxas) in treating COPD.

Daxas, an anti-inflammatory, is still going through the drug approval process in the United States and elsewhere.

In one study, Dr. Leonardo Fabbri from the University of Modena in Italy and colleagues randomly assigned 3,091 patients with severe COPD to Daxas or a placebo. Over a year, patients taking Daxas experienced improved lung function and had 17 percent fewer flare-ups than patients taking a placebo.

“These results suggest that different subsets of patients exist within the broad range of COPD, and that targeted specific therapies could improve disease management,” the researchers concluded.

In a second report, a research team led by Dr. Klaus F. Rabe, of Leiden University Medical Center in the Netherlands, tested the benefit of Daxas when added to standard COPD treatment with long-acting bronchodilators or anticholinergics.

In this trial, 1,677 patients with moderate-to-severe COPD were randomly assigned to Daxas or a placebo for 24 weeks. Patients were also receiving the bronchodilator salmeterol (Serevent) or the anticholinergic Spiriva.

The researchers found that adding Daxas to treatment with Serevent or Spiriva improved lung function over either drug alone. In addition, Daxas improved respiratory symptoms.

In both studies, Daxas was associated with more adverse side effects, including nausea, diarrhea and weight loss, researchers note.

“Roflumilast improves lung function in patients with moderate-to-severe COPD who are already being treated with long-acting bronchodilators [beta-2 agonists or anticholinergic drugs], although with expected class-specific adverse events. Roflumilast could become an important, concomitant treatment for these patients,” Rabe’s team wrote.

“These effects are clinically important, but not terribly striking,” said Dr. Paul O’Byrne, a professor of medicine at McMaster University Medical Center in Ontario, Canada, and author of an accompanying journal editorial.

For now, there is still no definitive treatment for COPD or treatment that stops the progression in the decrease in lung function.

One problem with these studies is that they don’t compare Daxas with inhaled corticosteroids, which are also anti-inflammatories, OByrne said. “We don’t know what advantage roflumilast has in patients already taking inhaled corticosteroids,” he said.

Dr. Neil Schachter, a professor of pulmonary medicine at Mount Sinai Medical Center in New York City, noted that with only three types of drugs available to treat COPD, something new would be beneficial.

“It’s good to have new compounds introduced for the treatment of COPD … because some patients won’t respond to the three [types of] drugs now available,” Schachter said.