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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!



Saturday, March 27, 2010

How accurate is spirometry for diagnosing COPD?

A research article in this month’s issue of the journal Respiratory Medicine highlights the challenge practitioners face in accurately diagnosing COPD using the most reliable tool available today, spirometry. In fact, the Swedish researchers who conducted the study described in the article determined that only one third of COPD patients in their study population had prior spirometry results that were consistent with a COPD diagnosis. In other words, spirometry failed to detect COPD for nearly 70% of the study population. (Arne M, et al. How often is diagnosis of COPD confirmed with spirometry? Respiratory Medicine. 2010 April; 104(4): 550-556.)


This is somewhat troubling in that it means a significant portion of people in the study population likely experienced further lung function deterioration before they were diagnosed and prescribed treatment regimens for COPD. Some people might quibble with the study’s results as applicable to the U.S. since the study population was drawn from Sweden but we’ve seen enough “spirometry under-diagnosis” papers published in journals from across the globe to believe that the overall point raised by the study is valid even if the precise figures vary from country to country.

For a relatively brief (and hopefully not-too-technical) description of what a spirometry test involves and what results it produces, you can click here to be redirected to our Breathe Better for Life e-letter filing cabinet for an excerpt on spirometry from our Breathe Better for Life guide/CD.

What makes this study’s results noteworthy is it adds fuel to the fire in the long running debate within the medical community about how broadly to use spirometry to test people considered at risk for COPD (i.e. smokers, those who work in environments with heavy industrial air pollutants).

At one end of the pole, there is a group of physicians who believe that spirometry should be given early and often to people who fall into high risk categories so that doctors have a better chance to catch emerging COPD earlier and therefore prescribe treatment earlier in an effort to reduce the degree of lung function decline over time.

At the other end of the spectrum, there is another group of physicians who believe that over-prescribing spirometry tests is wasteful in that spirometry is unlikely to detect COPD in its early development and patients might be misdiagnosed with COPD based on poor spirometry results when they are otherwise asymptomatic (poor spirometry results may indicate lung conditions other than COPD).

For an excellent overview of the “damned if you, damned if you don’t” situation regarding spirometry as a diagnostic tool for COPD, there is an excellent paper authored by Dr. Neil MacIntyre, one of the leading pulmonary medicine researchers in the U.S., that was published last year in the journal Respiratory Care. You can view the full, free text of Dr. MacIntyre’s paper by clicking here.

From our perspective, the main takeaway for people who suffer from chronic shortness of breath is the following…if you are concerned that you might have emerging lung disease but your doctor says that your spirometry results don’t indicate COPD, ask to be tested again.

Alternatively, ask your doctor whether one or more of these other common lung function tests are appropriate for you - pulse oximeter readings, six minute walk test results, chest x-rays, CT scans, and/or arterial blood gas samplings. While none of these tests in and of themselves will confirm a COPD diagnosis, they may help your doctor identify or rule out COPD if your spirometry results are inconclusive. By the way, we published a previous post on pulse oximeters and how you can use one at home to keep tabs on your blood oxygen levels and gain some basic insight into the quality of your respiratory system. You can access that post by clicking here.

Friday, March 26, 2010

COPD – Statins versus Vitamin D

In the most recent issue of Chest, the journal of record for the American College of Chest Physicians, there appears a letter exchange between a group of physician researchers and the editors of the Chest regarding the use of statin drugs versus Vitamin D for anti-inflammatory purposes among COPD patients. We found the exchange interesting on a couple fronts and thought it was worthy of your attention.

At basic issue in the professional disagreement between the Chest editors and the physician researcher “letter writers” was whether Vitamin D might be a lower cost alternative to statin drugs and might yield fewer side effects and whether Vitamin D should be supplemented and its effects observed before prescribing statins. The letter writing researchers argued that, “Patients with COPD should be considered at high risk of Vitamin D insufficiency because of reduction of outdoor activity, increased glucocorticoids-induced catabolism, impaired activation as a consequence of renal dysfunction, and a lower storage capacity of in muscle and fat due to wasting.” Masticelli L, et al. Statins, Vitamin D and COPD. Chest. 2010 March; 137 (3): 742-743.

That’s a mouthful isn’t it! In non-doctor-speak, this statement means many people with COPD have depressed levels of Vitamin D as a result of lack of physical activity, poor diet, side effects from use of steroid-based bronchodilators and reduced exposure to sunlight (given the lack of regular outdoor physical activity).

This Vitamin D deficiency depresses immunity, contributes to inflammation that affects a person’s ability to breathe fully, and increases the risk of osteoporosis (decay of bone strength). In the letter writing researchers’ point of view, supplementing Vitamin D has been shown to positively impact these particular health concerns as well as reducing the risk of falling among elderly COPD patients. They further argue that the side effects of statin drugs include depressed muscle performance, and increase the risk of falling among elderly COPD patients.

Given the increased osteoporosis risk created by Vitamin D deficiency in COPD patients, the researchers’ point is that Vitamin D supplementation may provide the same kinds of anti-inflammatory benefits that statin drugs provide but without the risk of increasing the possibility of life-altering falls.

On the other side of the debate lie the Chest editors whose journal recently published the review of statin studies in COPD patients that the letter writing researchers had challenged. (Janda S, et al. Statins in COPD: a systematic review. Chest. 2009 Sep; 136(3): 734-43). While the editors acknowledged that Vitamin D supplementation might provide an “intriguing consideration” as an option to statin drugs, the editors held fast to the notion that more research is needed to prove the efficacy of Vitamin D in comparison to statin drugs for a number of health benefits COPD patients have evidenced in taking statin drugs (benefits identified in the review article Chest published as positively impacting exacerbation rates, pulmonary function, exercise capacity and COPD mortality).

The editors acknowledge that statins do have side effects and concede that the letter writing researchers have raised an interesting point that deserves more investigation and they further suggest that instead of viewing Vitamin D supplementation as a replacement to statins for elderly COPD patients, that more research should examine their complementary use.

This type of professional exchange between rival points of view occurs in medical research constantly but often the debate does not find its way to the very people who the research is intended to help. As you manage your condition (whether you have COPD or are simply concerned about chronic shortness of breath), it is valuable from our point of view to share such debates with you so that you can be better informed about your options.

In our view, whether you take statins or not, it is worth discussing Vitamin D supplementation with your doctor. To assist you in that conversation, we’ve previously written about Vitamin D supplementation for COPD patients (see our blog article of February 2, 2010 by clicking here). In that posting we identified the specific form and dosage levels of Vitamin D (Vitamin D3) that have been examined in COPD related studies. After talking with your doctor, if you are interested in adding or increasing supplemental Vitamin D to your daily healthy living routine, you can find Vitamin D3 in retail outlets and online for between $5-$20 per 30-day supply depending on the dosage level you desire and whether other ingredients have been added (such as Calcium or Vitamin K). In our Breathe Better Marketplace site, powered by Amazon.com, we’ve linked to an array of Vitamin D3 products offered through Amazon as a resource for your product research and price comparisons. You can access the Breathe Better Marketplace by clicking here.

Monday, March 22, 2010

Recent study shows 14% lower heart disease risk for those who quit smoking

At a recent meeting of the American College of Cardiology, a group of researchers from the University of Wisconsin led by Dr. JH Stein reported the results of a study that showed smokers who quit received a 14% decrease in heart disease risk within one year. The study paper itself has yet to find its way into the Journal of the American College of Cardiology that we could find but when it is we will pass along the abstract and information on where you can purchase the full text of the article. The results of their study have been encapsulated in a number of media outlets and we've provided a link here to a Milwaukee Journal-Sentinel article about the study that was published on March 15, 2010.

From reading a few other media reports regarding the research paper's presentation, there were two pieces of information that caught our attention. The first, related to the above mentioned 14% reduction in heart disease risk one year after quitting, is that the 14% reduction in risk was determined by an observed 1% improvement in arterial blood flow and artery dilation among those study subjects who had quit one year previously. It's amazing that such a small improvement in artery performance can yield such a large reduction in heart disease risk. It should also be noted that one of the study researchers believes that the heart disease risk reduction begins within days after quitting even though they evaluated the risk reduction at one year post-quitting.

As we highlighted in last week's posting of our e-letter article titled, Endurance Training Improves Arterial Stiffness in COPD patients (also posted on our blog page at www.breathebetterblog.blogspot.com), another recent study showed a whopping 10% improvement in arterial flexibility from an eight week aerobic exercise program - a level equivalent to the performance of statin medications - and that study did not exclude smokers.

We are not sure whether the studies evaluate the same measure of arterial performance but if so leads one to believe that beginning and maintaining an ongoing exercise program, whether you quit smoking or not, can yield significant heart disease risk benefits, and may be more powerful than smoking cessation's impact. When the full study is available for our review we will follow up on this potential comparison between the two studies' measures.

This is not to say that current smokers shouldn't consider quitting. We all know it is the most beneficial thing you can do for your long-term health and quality of life. But, understanding that many people are not ready or willing to quit, it is strongly recommended you consider beginning and maintaining an active exercise program even if you just walk 20-30 minutes a day, 3-5 days a week.

The second item of interest highlighted in the Milwaukee Journal-Sentinel story about the study was an observation by the researchers that the risk of diabetes among those who quit smoking rose significantly within the first two to three years after quitting (70% increased risk) but after ten years the risk of developing diabetes among former smokers dropped to nearly 0%. Why this happens was not explained in the article about the study but may be related to an observed weight gain by those in the study who quit smoking.

Thursday, March 18, 2010

Supplement N-Acetylcysteine (NAC) improves exercise tolerance in COPD patients

In our effort to keep you informed of strategies you can employ on your own to help support better breathing, we have brought to your attention nutritional supplements that are helpful to address nutrient depletion brought on by smoking/lung disease as well as supplements that have been shown to improve exercise tolerance/performance among people with COPD and other chronic conditions.

One such nutrient that we haven’t written about yet is an ingredient called N-Acetylcysteine (otherwise known as NAC). NAC is an amino acid that helps the human body produce a powerful antioxidant called glutathione and has antioxidant properties of its own. WebMD has a pretty decent overview of NAC including known medication interactions and side effects that you can view by clicking here.

In a study published in the August 2009 edition of Chest, the journal of record for the American College of Chest Physicians, a group of researchers reported significant improvements in exercise tolerance and lung function among COPD patients who received 1,200 mg of N-Acetylcysteine daily for 6 weeks. (Stav D, Raz M. Effect of N-acetylcysteine on air trapping in COPD: a randomized placebo-controlled study. Chest. 2009 Aug; 136(2):381-6)

The study involved 24 former smokers with COPD. These subjects were divided into two groups of 12. One group received a placebo for six weeks while the other received 1,200 mg daily of NAC. Both groups performed cycle ergonometer exercise capacity and lung function tests prior to the commencement of supplement use, and again at the end of the six week NAC dosing period. Both groups then underwent a 2 week flush out period where NAC was not used by any study subject before they reversed roles for another 6 week period (the group that had taken the placebo now took NAC and vice versa – in scientific terms this is called a crossover study).

The results were clear and unambiguous. Each group that used the NAC experienced increased exercise capacity post-dosage - whether expressed in terms of exercise endurance time, inspiratory capacity (IC), or forced vital capacity (FVC). These benefits were observed post-exercise and to a lesser extent when the patient was at rest prior to exercise.

The researchers surmise that NAC helps reduce a phenomenon known as “air trapping” in the lungs. In this way, the researchers suggest that NAC helps improve the performance of respiratory muscles and limbs (hence creating less demand for oxygen by these muscles) and in reducing inflammation (acting as an antioxidant to neutralize inflammation-producing free radicals created during exercise).

Air trapping occurs most often during vigorous effort and is common in COPD patients. Essentially, air trapping is when the lungs cannot expire forcefully enough of the air already used by your body and therefore cannot take in enough new air to provide the body with adequate oxygen for the increased level of activity. When air trapping occurs it creates an event in your body that doctors call dynamic hyperinflation that makes you feel like you can’t breathe in enough new air (but ironically, it is caused by the presence of too much old/used air in your lungs).

As an aside, another proven method respiratory care professionals use for reducing trapped air in your lungs is a breathing technique called pursed lip breathing. It’s highly effective and easy to learn. We’ve posted a pictorial demonstration of pursed lip breathing on our e-letter web site. Click here to view. You can also find a variety of text descriptions and pictorial/video demonstrations on the web by searching on the term “pursed lip breathing”.

For those of you with COPD or chronic shortness of breath who are engaged in an active exercise program or considering starting one, we suggest you consider the results of this research study and discuss with your doctor whether NAC might be helpful for you. NAC is available typically in 600 mg daily dosage levels in retail stores and online. If you decide to try NAC, remember the research study noted in this post was conducted using 1,200 mg/day. The researchers noted that previous studies that utilized 600 mg daily dosage did not show the same levels of improvement.

Wednesday, March 17, 2010

In your 50's or 60's? Double your odds for reaching 85

Last week, the Wall Street Journal published an article detailing the powerful benefits of staying physically active/fit in middle-age. The article titled, "Want to See 85? Get A Move On," highlighted that people who stay physically active/fit during their fifties double their chances of reaching the age of 85 compared people who are sedentary. You can view the full text of the article by clicking here.

Though the article focused on a cross-section of average U.S. adults (meaning they didn't just focus on COPD patients and smokers), we found one other eye-opening tidbit from the article that might interest COPD patients and current smokers - staying physically active/fit during middle-ages provided more health longevity benefits than smoking cessation.

Those of you who have purchased our Breathe Better for Life guide/CD, and those who read our blog and our e-letters know already we are strong advocates for beginning and maintaining an ongoing exercise program. For people with COPD and current/former smokers, following a program based on the practices and principles of pulmonary rehabilitation is strongly advised given that your conditioning starting point is not the same as the average middle-aged adult. In addition, it is advisable for people with COPD (and in our opinion, current/former smokers who have yet to develop lung disease as well) to follow a program that reasonably builds aerobic endurance and muscle strength without triggering shortness of breath attacks.

To get started, ask your primary care physician or pulmonologist to suggest an exercise program that takes into account your current physical condition. If you are unable or unwilling to ask your doctor, consider visiting a local fitness center and talking to a personal trainer/fitness instructor who is certified in exercise training for those with chronic cardiovascular/respiratory conditions (there are such certified trainers). If you'd like to educate yourself more about exercise programs designed specifically for COPD patients and those who suffer from chronic shortness of breath, consider purchasing our Breathe Better for Life guide at http://www.breathebetterforlife.com/. Our exercise program recommendations are based on a combination of guidelines established by the American Thoracic Society, the European Respiratory Society and the American College of Sports Medicine for those with COPD and other chronic respiratory conditions (such as emphysema and chronic bronchitis).

Regardless of which option you choose, please consider increasing your level of physical activity - even if you just start a walking program of 20-30 minutes a day, 3-5 days a week, you will find you not only feel better but per the Wall Street Journal article, you'll increase the likelihood of living a longer life. As the author of the article concluded, "...heroics aren't necessary to get fit. In fact, studies suggest the biggest benefit from exercise occurs when people go from a sedentary lifestyle to getting regular moderate exercise. 'The biggest bang for your buck is just getting off the couch,' Dr. Berry says."

Wednesday, March 10, 2010

Endurance training improves arterial stiffness in COPD patients

The March 21010 issue of Chest, a scientific journal published by the American College of Chest Physicians, includes an article detailing the study results of a team that examined the impact of endurance training on arterial stiffness in COPD patients. (Vivodtzev, I, et al. Significant Improvement in Arterial Stiffness After Endurance Training in Patients with COPD. Chest. 2010; 137(3): 585-592)

According to the article authors, arterial stiffness is considered an indicator of cardiovascular risk and has been shown to be elevated in COPD patients. Additionally, the authors note that the severity of emphysema is somewhat related to the degree of arterial stiffness.

The study involved 17 COPD moderate-to-severe patients who underwent a 4-week aerobic exercise program in which they performed cycling exercises 5 days a week for 18-30 minutes each session. Over the course of the program, intensity and duration of the cycling was increased based on individual COPD patient tolerance (determined by their self-reported shortness of breath) – the average intensity of exercise ranged from just under 40% of peak maximum exertion up to 65% of the same metric. The study’s 4 week program was similar in construction to regimens followed in pulmonary rehabilitation programs although it was shorter in duration but higher in intensity (pulmonary rehab programs are typically 8-12 weeks in duration and patients typically exercise 2-3 times a week, not 5 times as done in this study).

Interestingly, the average improvement in reduced arterial stiffness across the COPD patient population that participated in the exercise program was 10% - a comparable level to the reduction in arterial stiffness achieved by taking prescription statin drugs.

The researchers also evaluated whether the 4 week exercise program described above had positive impact on blood pressure among the COPD patients in the study. Guess what? Before the training program, 40% of the COPD patients who participated in the training program were diagnosed with hypertension (high blood pressure). After the 4 week program, only 20% of this group still had blood pressure levels considered consistent with a hypertension diagnosis.

Further still, the COPD patients who underwent the 4 week aerobic exercise program saw a 20% improvement in the distance they could walk in 6 minutes (a measure commonly used by pulmonologists to determine patient conditioning level), a 58% increase in quadriceps muscle endurance, and a 20% increase in peak work rate among other metrics evaluated.

In the end, the researchers concluded that, “Thus, the benefits of pulmonary rehabilitation in reducing arterial stiffness in patients with COPD is at least comparable in magnitude to what can be obtained with drug therapies.” Pretty amazing results and another excellent example of exercise as medicine for COPD patients (and smokers).

Tuesday, March 9, 2010

Physical inactivity and COPD – an inescapable connection

One of the “chicken versus egg” topics in the diagnosis and treatment of lung disease is whether physical inactivity contributes to the development of conditions such as COPD or whether these lung conditions instead lead to a decrease in physical activity.

Regardless of which comes first, most researchers agree that increasing physical activity in COPD patients is highly desirable and beneficial. Indeed, in one 2006 study, the researchers’ data suggested that COPD patients who were at least moderately physically active lived approximately 7 years longer than those who were highly inactive. (Garcia-Aymerich J, et al. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax. 2006: 61:772-778)

By the way, the same researchers reported in a different paper that active smokers who were more physically active exhibited better lung function and less incidence of COPD. To that end, the researchers noted, “It is plausible that regular physical activity could counteract the smoking effects through an anti-inflammatory and antioxidant mechanism.” (Garcia-Aymerich J, et al. Regular physical activity modifies smoking-related lung function decline and reduces risk of chronic obstructive pulmonary disease: a population based cohort study. Am J Respir Crit Care Med. 2007: 175: 458-463)

So even if you don’t have COPD yet, but you do smoke, regular physical activity can be a powerful form of medicine.

Another more recent study demonstrated that COPD patients’ level of physical activity was notably lower than healthy adults of the same relative age, weight and height. Further, the study concluded that physical activity levels of COPD patients declined in direct correlation with the severity of COPD (there are four levels of severity in COPD: Stage I – mild, Stage II – moderate, Stage III – severe, Stage IV – very severe). For example, study subjects with mild COPD engaged in 53% less moderate physical activity time as the study control subjects (healthy adults), whereas severe COPD patients devoted only 31% of the time healthy adults invested in moderate physical activity – which means the severe COPD patients were 41% less active than even mild COPD patients. (Troosters T, et al. Physical activity in patients with COPD, a controlled multi-center pilot study. Respiratory Medicine. 2010. doi:10.1016/j.med.2010.01.012)

So what’s the message here – get up, get moving. Whether you are enrolled in a pulmonary rehab program in your area, or participate in an exercise program on your own (we’d recommend you ask your doctor to recommend a suitable program for you or consider purchasing our Breathe Better for Life guide/CD for an exercise program patterned after those used in pulmonary rehab programs – http://www.breathebetterforlife.com/ ), or simply start a regular walking program, the dividends for being more active are significant and lasting. You’ll benefit more over time from increasing the intensity and duration of aerobic and strength training exercise, but even if you just start and maintain a regular walking program you will derive valuable conditioning benefits.

A rough rule of thumb for those interested in starting and maintaining a walking program is to take 10,000 steps each day (sounds like a lot of steps I know, but you’d be surprised how many steps you take already in a given day walking around your home, to/from your car, and at work). As a side note, in the above mentioned study from Respiratory Medicine, the average healthy adult in the study took 9,372 daily steps whereas moderate COPD patients took only 6,560 daily steps and severe COPD patients in the study took only 4,592 on average.

For those of you who decide to start a walking program on your own, we’d recommend you purchase a pedometer to measure the number of steps you take each day. Low cost pedometers are available online, in pharmacies, sporting goods stores and other retail locations. Simply activate the device by touch and keep the pedometer in your pocket or attached to your belt each day to record the number of steps you’ve taken and the distance you’ve traveled. Keep track of the daily steps you take for about a week to determine your baseline average daily steps. Then, as you institute your walking program, try building up to the 10,000 daily step level gradually over a period of 3-4 weeks. In other words, don’t try to vault from 4,000 average daily steps to 10,000 in one day - build your stamina over a reasonable amount of time.

What’s clear from many research studies is that the earlier in the development of lung disease you start and maintain a regular pattern of daily physical activity (whether in a structured exercise program or just getting up and walking more frequently and longer distances), the better your prognosis for a higher quality of life, better lung function, and decreased likelihood of developing severe COPD.

As one set of researchers concluded in a 2009 editorial on physical inactivity and COPD (forgive their penchant for doctor-speak, they mean well), “It is also well established that exercise capacity, whether measured on a field test, as in the BODE (body mass index, airflow obstruction, dyspnea, exercise capacity) score, or in the laboratory, is predictive of survival. Lastly, in large cohorts it is clear that self-reported physical activity predicts prognosis in COPD and may even impact on the rate of lung function decline.” (Polkey MI, Rabe KF. Chicken or egg: Physical activity in COPD revisited. Eur Respir J. 2009: 33; 227-229)

Saturday, March 6, 2010

Pulmonary rehabilitation – a powerful first step to improving health among smokers

It’s interesting that so many health organizations and physicians recommend smoking cessation as the primary way to improve the health of smokers when the success rates of these programs are so abysmal. More so, it’s amazing to me that physicians walk right by a proven, highly effective treatment option known as pulmonary rehabilitation as a way to improve the health of smokers (whether they give up smoking or not) until such time smokers have already developed serious lung disease. Why not offer it sooner rather than later?

Thousands of studies have been conducted on pulmonary rehabilitation over the past three decades (don’t believe me? Do a NIH Pubmed search by clicking here using the keyword pulmonary rehabilitation and see for yourself). It is highly effective in reducing shortness of breath, improving quality of life, improving physical conditioning, slowing the progression of lung disease for people with COPD (chronic obstructive pulmonary disease), and reducing health care costs (particularly costs associated with shortness of breath attacks which repeatedly land those with compromised lung function in hospitals repeatedly).

Pulmonary rehabilitation is essentially a structured 4-8 week program of which the cornerstone element is guided exercise intended to boost endurance, stamina and strength for those with compromised lung function. It also incorporates training regarding breathing and airway clearing techniques as well as patient education regarding nutrition support, proper use of medications, and psychological support among other topics. The ironic thing is that many of the principles and practices of pulmonary rehabilitation can be practiced at home or at fitness center and physicians expect COPD patients to do just that after graduating a clinical program.

But guess what? Hardly anyone knows anything about it, and for those who do, getting into a pulmonary rehab program in our country is close to impossible. In fact, only 1-2% of COPD patients in the US can gain access to a pulmonary rehab program due to limited availability. Given that over 100 million US adults have some form of compromise lung function (40% of the US population, a number that represents a cross section of 43 million current smokers, 47 million former smokers, 24 million diagnosed cases of various lung diseases, and 12 million Americans who can’t walk up more than one flight of stairs without stopping to rest because they can’t catch their breath).

If you are a smoker who has yet to develop serious lung disease but find yourself constantly short of breath, I would especially encourage you to take a harder look at pulmonary rehabilitation when you consider we’ve poured hundreds of billions of dollars into smoking cessation awareness and prevention programs over the past 10 years in the US and yet smoking rates are essentially unchanged. Further, the prevalence and growth of chronic obstructive pulmonary disease (COPD) is staggering and getting worse by the second – it’s already the fourth leading cause of death in the US and is expected to be the third leading cause of death worldwide by 2020. Further still, lung disease is the only major disease category in the US that is rising as a cause of death (heart disease, stroke, cancer are all on the decline) and smoking is the number one cause of COPD.

In my opinion, if smokers had access to the principles and practices of pulmonary rehabilitation and the medical community broadly advocated beginning/maintaining such a program sooner rather than later (even if smokers don’t quit, or at least prior to trying a smoking cessation program), we would see notable cost drops in treating the long term effects of smoking, improved smoking cessation rates, and an improvement in the morbidity of Americans who have lung disease.

Why won’t they consider it? From my perspective it’s because there are blinders on the vast majority of health care professionals who treat smokers and those with lung disease. The unchallenged mantras are - stop smoking first and then we’ll help you, or use this inhaler when you feel short of breath.

Both are valuable pieces of advice and treatment options but the cold, hard reality is that these solutions are doing very little to solve long term patient lung health issues. The reality is that pharmacotherapy solutions only relieve immediate short-term symptoms of shortness of breath - they do nothing to improve the long-term health of smokers/COPD patients. And smoking cessation awareness campaigns and smoking cessation programs, even for part-time smokers, are not making a meaningful difference in a reduction of smoking rates or prevalence of lung disease.

It’s time for a new approach to this growing and chronic issue worldwide and in my opinion a significant, proven solution is right under physicians’ noses if they would simply open their minds to the pursuit of healthier smokers using all available, proven means…and pulmonary rehabilitation is one such solution. It is the primary reason I created the Breathe Better for Life guide/CD (http://www.breathebetterforlife.com/ – to help smokers and people with COPD employ the principles and practices of pulmonary rehab at home or at a fitness center if they can’t get access to a clinical program through other means.

Thursday, March 4, 2010

What is a pulse oximeter and why do I need one?

If you’ve ever been admitted to a hospital, chances are you’ve had a nurse slip a little device onto your fingertip for a short time to take a diagnostic reading. This device is called a pulse oximeter, a device that uses a small light and sensor to detect your pulse (how many times your heart beats in one minute) and the level of oxygen present in your blood (otherwise known as oxygen saturation). If you have COPD or are concerned about persistent shortness of breath, it is worth considering purchasing a pulse oximeter of your own to use at home.

While pulse oximetry does not directly indicate your lung capacity nor evalu¬ate your specific level of breathlessness, it does provide insight into the quality of the functioning of your respiratory system. A low oximetry reading indicates that a low amount of oxygen has been transferred from your lungs into your bloodstream.

Most consumer-friendly pulse oximeters are fingertip devices. To use the device, you place the device directly over your fingertip. After a few seconds, the oximeter will display the saturation percent¬age of oxygen in your blood (on a scale of 0% to 100%) and your heart’s pulse rate. Just like a heart rate or blood pressure monitor, a pulse oximeter’s readings change from moment to moment depending on your activity level, so it often makes sense to take your readings at various points of the day (both at rest and during various physical activities including during exer¬cise sessions) to get a good sense of your typical blood oxygen saturation and pulse rate. It should be noted that those with circulatory problems may find fingertip devices do not produce accurate readings. In this case, a forehead, wrist or earlobe probe is typically recommended by respiratory care professionals.

At rest, a pulse oximeter reading of 94 to 98 percent is considered normal. During exercise, oxygen levels typically fall as you stress your respiratory system to keep up with the higher level of activity. Healthy adults generally should not see their oxygen level dip below 92 percent while exercising. Below this level, there is not enough oxygen in your lungs to enter red blood cells (which are the vehicles for transporting oxygen to the rest of your body). Therefore, you are in effect starving your body’s need for oxygen to operate your organs and muscles.

In COPD patients, oxygen levels typically fluctuate between 88 and 92 percent, whether at rest or during exercise. If you fall in this range and are experiencing breathlessness, this is a definite warning sign. If you use a pulse oximeter and receive multiple read¬ings below 90 percent, you should see your doctor immediately to determine whether your device is faulty or whether you need medical assistance. In more serious cases (typically when blood oxygen saturation levels fall below 88 percent), doctors will recommend oxygen therapy.

Aerobic exercise improves physical endurance and this is often noticeable in the reduction of your resting heart rate. Likewise, the better your aerobic conditioning, the more likely your blood oxygen levels over time will increase both during exercise and at rest. Further, the pursed lip breathing technique can also increase blood oxygen levels for COPD patients. For step by step instructions of the pursed lip breathing technique taken from our Breathe Better for Life CD-ROM, click here.

A number of things can affect a pulse oximetry reading. If you are smoking while taking an oximetry reading, the chemicals in cigarettes that find their way into your blood system can generate inaccurate readings. Additionally, if you wear heavy, dark fingernail pol¬ish, the fingernail polish can inhibit the transmission of the light signals used in pulse oximetry and generate inaccurate readings. Extremely cold fingertips can also generate inaccu¬rate readings due to reduction of blood flow to the fingertip.

Most pulse oximeters are only available by prescription. If you are interested in using one at home, ask your doctor to prescribe one for you. The only pulse oximeter we are aware of that is available with or without a pre¬scription is the Nonin GO2 Achieve Pulse Oximeter (people use pulse oximeters for other purposes that don’t require prescriptions, such as mountain climbers and other adventure enthusiasts who often use pulse oximeters to gauge the effects of high elevations on their oxygen levels). The GO2 Achieve is a relatively inexpensive device to use at home to help track your oxygen levels – it costs about the same as a good blood pressure monitor or heart rate monitor. If you are interested in learning more about the GO2 Achieve, click here.

Tuesday, March 2, 2010

Tai chi – an alternative form of exercise for COPD patients

In previous posts we’ve discussed the significant benefits of aerobic exercise and strength training for people who suffer from chronic shortness of breath. The scientific research is clear and unambiguous – an ongoing exercise program reduces shortness of breath, improves physical conditioning and mobility, and improves perceived quality of life.

But maybe you don’t have access to the appropriate exercise equipment to begin and maintain your own exercise program. Or maybe you have such limited mobility and balance it feels too challenging to step up on a treadmill to walk. Or possibly you become quickly bored by a traditional exercise program and find that you quit due to what feels like a tedious routine.

If any of the above reasons apply to you, then I have a fun and therapeutic form of low intensity exercise for you to consider – tai chi.

A recent article from the Mayo Clinic describes tai chi as “meditation in motion because it promotes serenity through gentle movements — connecting the mind and body. Originally developed in ancient China for self-defense, tai chi evolved into a graceful form of exercise that's now used for stress reduction and to help with a variety of other health conditions…Tai chi, also called tai chi chuan, is a noncompetitive, self-paced system of gentle physical exercise and stretching. To do tai chi, you perform a series of postures or movements in a slow, graceful manner. Each posture flows into the next without pause, ensuring that your body is in constant motion.” Click here for the full text of the article.

Interestingly, there has been a significant amount of research conducted on tai chi over the past few decades evaluating its health benefits for those with cardiovascular disease, hypertension (high blood pressure), diabetes, and arthritis among other conditions. However, one has to look back to 1995 to find any studies specifically examining tai chi for COPD as an alternative to aerobic exercise in pulmonary rehabilitation programs (Lai JS, et al. Two-year trends in cardiorespiratory function among older Tai Chi Chuan practitioners and sedentary subjects. J Am Geriatr Soc. 1995 Nov; 43(11):1222-7). Despite the dearth of recent pulmonary rehab/COPD studies related to tai chi, many of the studies related to heart disease have shown impressive results from an ongoing commitment to a tai chi program.

For example, one recent review article examining studies conducted on tai chi for those with cardiovascular disease concluded, “Given the existing evidence, tai chi exercise may be a reasonable adjunct to conventional care. It may be appropriate for those unable or unwilling to engage in other forms of physical activity or as a bridge to more rigorous exercise programs in frail or deconditioned patients. Patients with early detection of cardiovascular disease risk factors (e.g. borderline hypertension) may be reluctant to begin drug therapy and nonpharmacological approaches are often welcomed. These lifestyle interventions have been recognized as important and effective strategies for primary prevention. In addition, patients with either pre-hypertension or established hypertension, who otherwise feel well, may be less motivated and find it difficult to engage in and maintain a regular exercise regimen. Finding an appropriate, nonthreatening, easy-to-perform activity that patients will maintain is critical to therapeutic success. Clinical trials have reported excellent compliance with tai chi interventions and suggest that tai chi may promote exercise self-efficacy.

Likewise, exercise is a well-recognized and effective strategy for secondary prevention in patients with established cardiovascular disease.” (Yeh GY, et al. Tai Chi Exercise for Patients with Cardiovascular Conditions and Risk Factors. Journal of Cardiopulmonary Rehabilitation and Prevention. 2009; 29:152–160)

In Dr. Yeh’s review of 29 good-quality tai chi/cardiovascular studies, many of the reviewed studies showed statistically significant improvement in subject exercise capacity, reduction in resting heart rate (pulse), reduction in blood pressure levels, improvement in peak expiratory air flow, and improved pulmonary function.

Tai chi has been shown in other studies to promote balance among elderly patients and those who are primarily sedentary (by the way, tai chi movements can be done from a seated position for those who are concerned about their balance or mobility). It also has a strong track record for exercise program compliance (meaning people tend to stick with tai chi classes longer than traditional aerobic exercise regimens).

In our opinion, tai chi is worthy of your consideration as a complementary or alternative form of exercise even though there are not recent studies conducted on COPD patients in the context of pulmonary rehabilitation. There are many tai chi DVDs available for purchase online and many fitness centers, YMCA’s, and community centers offer low-cost (and in some cases, no cost) tai chi classes. Look for DVDs and/or classes that are tailored for either the elderly or those with limited mobility for these resources have adapted the traditional tai chi movements to help people who have some level of compromised physical condition.

Monday, March 1, 2010

Is your shortness of breath really from COPD?

Most people have no idea that lung disease, including emphysema, can also be caused by a rare genetic condition called alpha-1antitrypsin deficiency (AAT deficiency for short). In simple terms, AAT is a critical protein normally found in your lungs and bloodstream. It helps protect your lungs from diseases such as emphysema. But if you don’t have enough of it, you’re far more likely to develop lung disease.

If you haven't previously heard of alpha-1 antitrypsin deficiency (sometimes also referred to as AATD), you can read a good topic review published in January’s Canadian Family Physician (click here for the full free text of the review). It's a little technical in spots but overall provides a fairly understandable overview of the condition, causes, symptoms and treatment options.

People with alpha-1 antitrypsin deficiency develop the first signs and symptoms of lung disease at a younger age, usually between ages 20 and 50. The earliest symptoms are things like shortness of breath after doing mild activity, reduced ability to exercise, and wheezing. Other signs can include unintentional weight loss, recurring respiratory infections, fatigue, and rapid heartbeat upon standing.

It’s believed that up to 3% of patients with diagnosed COPD actually suffer with AAT deficiency instead – that’s 360,000 people. But only about 6% of people with this deficiency know they have it!

This also means you could be getting the WRONG treatment! Why? COPD medications that provide temporary relief from shortness of breath episodes simply mask the symptoms of AATD - so you get worse and don’t know why. In our opinion, if you suffer from chronic shortness of breath, you should ask your doctor to be tested for AATD. The simple blood test is reimbursable by most insurance companies and Medicare. And the good news is that an effective AATD treatment option exists - a blood plasma replacement therapy that essentially introduces elevated levels of the missing AAT protein into the bloodstream and can help halt the progression of further lung function deterioration.

To learn more about how to talk to your doctor about getting tested, you can visit http://www.testtodaychangetomorrow.com/. This site was created by one of the leading pharmaceutical companies that produce a plasma replacement therapy for AATD patients. It provides a checklist you can complete and print to take to your doctor to help you get tested. This checklist can be especially helpful if you are currently managing your breathlessness through your primary care physician instead of a pulmonologist given that many primary care doctors have little to no knowledge of AAT!