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Welcome! Here we publish our views on new research and insights from the field of pulmonary medicine, most often focusing on topics related to exercise, nutrition, and other self-management techniques for those who suffer from chronic shortness of breath.

Whether you have COPD, currently smoke, or are just concerned about persistent shortness of breath and/or cough, read our articles to explore COPD treatment options and self-management techniques that can help you feel better NOW!



Thursday, December 31, 2009

Even a Simple Walking Program Can Improve Physical Conditioning for COPD Patients!

This month Portuguese researchers published the results of a study indicating that a pulmonary rehabilitation program built solely around a walking program (versus more intensive cardiovascular/strength training exercise typically found in rehab programs) produced improvements in several key measures of physical conditioning.

    For those who suffer from chronic shortness of breath and are not eligible for an outpatient pulmonary rehab program here in the United States and are reluctant to begin a cardiovascular/strength program on their own, this study highlights that conditioning benefits can be achieved by simply starting and maintaining a regular walking program.

The study, published in the Jornal brasileiro de pneumologia, took 16 COPD patients through a 7 week exercise program consisting of three 20 minute walking sessions each week (Ferreira SA, et al. Pulmonary Rehabilitation in COPD: from exercise training to "real life". J Bras Pneumol. 2009; (35) 11:1112-1115.) For those of you who are interested, the full text of the article can be viewed by clicking here.

Prior to the first walking session, researchers had each patient undergo a two separate 6 minute walk tests (known in pulmonary medicine circles as the 6MWT). Researchers also measured peak heart rate (pulse) during and after exercise, perceived breathlessness, aerterial blood gasses and patient self-reported changes in quality of life. The patients were all male with a mean age of 68. All had either Stage III or Stage IV COPD (moderate to severe, respectively), all were former smokers, and none were on home oxygen therapy.

A 6MWT is simply a mechanism used by physicians to establish a baseline and measure progress of a person's physical conditioning. During a 6MWT, patients simply walk as far as they can in a six minute period. Researchers measure the distance walked (known as the 6MWD) in either meters or yards.    

In this particular study, after the 7 week walking program was completed, researchers had the study subjects perform two additional 6WMT. The results? The mean distance walked by the 16 subjects rose on average 6-8%.

You might say that's not much of an improvement but consider the program only involved walking at a comfortable pace for 20 minutes 3 times a week for 7 weeks. Consider further that 31% of the patients reported an obvious improvement in their health (rising from moderate health status to good or very good health status). Further still, perceived breathlessness fell by an average of 11%. Heart rates measured during and after exercise also fell from the beginning of the study compared to the end.

The researchers concluded, "The exercise training protocol with walking resulted in improvement in quality of life and exercise capacity."

So, if nothing, get up and get walking! Your heart and lungs will thank you – even if you have COPD, even if you are an active or former smoker – exercise is powerful medicine!

Wednesday, December 2, 2009

New Hope For Smokers

Lung disease is pervasive - whether in America or in other countries around the globe. Smoking, environmental and workplace pollutants, poor diet and exercise habits, and in some cases genetic influences combine to make respiratory health a huge and growing issue just about in every society on our planet. And realistically, looking at the statistics and trends over the past few decades as well as future projections – the prognosis for combating compromised respiratory function is not promising. Despite all the valiant efforts of practitioners and researchers over the years, lung disease (including COPD, chronic bronchitis, asthma, emphysema and other more exotic conditions) continues to grow at alarming rates.

Contrast this picture to the inroads made by practitioners and researchers in the fields of cancer and heart disease and you get a clear sense of how bad things are now in the field of pulmonary medicine and how they are likely to worsen over time. The cost of not making significant progress in decreasing the incidence of pulmonary ailments is high and growing – not to mention frustrating for all concerned. One of the main reasons for this escalating cost cycle is that people with lung disease seem to land in hospitals over and over again. The solutions employed by physicians seem to lessen the immediate symptoms of these patients but candidly do very little to address the underlying problems that lead to this cycle.

Smoking cessation seems to be the first line of fire for addressing the largest contributing factor in the development of lung disease - understandably so given the clear benefits of stopping smoking at any age. But the data is clear – smoking cessation approaches of all stripes and combinations are not making much of a dent in the overall problem. Don't believe me? Last month, the Center for Disease Control issued a report stating that despite all the herculean efforts in marketing smoking cessation programs, new research and public service campaigns to reduce the incidence of smoking….smoking rates in the US have remained essentially flat over the past five years. http://www.cdc.gov/media/pressrel/2009/r091112.htm

I personally think a dramatic answer/solution to this problem is broad scale application of pulmonary rehabilitation. Specifically, I believe there would be significantly greater success in impacting long term smoking and lung disease trends if the $200 billion handed out to states over the past 10 years to combat smoking rates were instead applied to the following areas over the next 10 years:

  • Increasing awareness among smokers and those with lung disease about the power of pulmonary rehabilitation and how to incorporate its principles and practices into their daily lives.
  • Building more pulmonary rehabilitation programs around our country and making it easier for practitioners to offer and prospective patients to access
  • Introducing new, cost effective, innovative solutions to extend practitioners reach with this valuable treatment option

In my opinion, there is no doubt that the principles and practices of pulmonary rehabilitation persistently offered and maintained on a broader scale for anyone who is a smoker or suffers from any stage of nearly every lung disease could make a powerful impact on the direction of smoking cessation rates and overall lung disease in the U.S.

Will it happen? I don't know but I will continue to beat this drum and search for ways to get this wonderful treatment option in more people's hands.

Later this month comes my first stab at it – I will be introducing Breathe Better for Life™ - A Guide to the Secrets of Pulmonary Rehabilitation. It is my hope that I will be able to reach thousands (and even more hopefully, millions) of people in our country with this guide to educate them on the value of pulmonary rehabilitation and how to incorporate its principles and practices in their daily lives. I've read the research, been to several pulmonary rehab centers, talked to many of the leading practitioners & researchers, and visited with COPD patients who've been through such programs. And based on these experiences, I am convinced that a reprioritization of the standards of care for smokers and those with lung disease that puts pulmonary rehabilitation in front of smoking cessation could be the key to this elusive problem.