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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 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.

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