A recent study published in Medicine and Science in Sports and Exercise, the journal of record for the American College of Sports Medicine, revealed that men with at least a moderate level of physical fitness had 57% lower risk of lung cancer mortality and a 52% lower risk of developing lung cancer in the first place. (Xuemei S, et al. Influence of Cardiorespiratory Fitness on Lung Cancer Mortality. Medicine & Science in Sports & Exercise. May 2010: Vol. 42(5); 872-878)
The study examined the medical records of 38,000 adult men who completed preventative medical examinations including fitness testing at the Cooper Clinic in the Dallas, TX area between 1974 and 2002. The men agreed to provide follow up data from the date of their initial examination until their date of death or December 31, 2003 if still living. The research team reviewed the baseline cardiorespiratory fitness tests, follow up reports and mortality data to reach their conclusions.
In addition to looking at the overall connection between fitness level and lung cancer risk among men, the researchers also looked at whether there were differences between current smokers, former smokers and never smokers and lung cancer risk/mortality based on their respective fitness levels (low, moderate, high).
Interestingly, the study results showed that current smokers who had a moderate level of physical fitness had approximately 48% lower risk of lung cancer mortality than smokers who had low cardiorespiratory fitness while current smokers with high cardiorespiratory fitness had 58% lower lung cancer mortality risk.
Still, even current smokers with high cardiorespiratory fitness were 2.5 times more likely to die of lung cancer than those who never smoked and had low cardiorespiratory fitness, and 1.5 times more likely to die from lung cancer than moderately fit former smokers.
So, while exercise does provide substantial protective health benefits for current smokers, those benefits could be dramatically improved by quitting smoking. But the overarching theme of the study results is clear – higher levels of cardiovascular fitness (even for current smokers) dramatically lowers risk of developing and dying from lung cancer.
As the researchers conclude, “In summary, our data provide evidence that low levels of fitness may play a causal role in lung cancer mortality…If fitness does decrease the risk of lung cancer mortality as shown in our data, then there is something more than avoiding tobacco that can be done to lower risk of the leading cause of cancer death in the United States.”
Thursday, April 29, 2010
Tuesday, April 27, 2010
New study demonstrates pulmonary rehab effectiveness for current smokers
For many years, respiratory care professionals have excluded COPD patients who are current smokers from admission to pulmonary rehabilitation programs. The basis of this exclusion has been a belief that smokers will not stick with the rehab program due to a lack of desire to make positive changes in their lives. Additionally, respiratory care professionals believe that smoking dilutes the benefits gained in pulmonary rehab. Well, a new study published this month demonstrates that while both of these assumptions may be true – current smokers still significantly benefit from completing a traditional pulmonary rehab program.
The study, conducted by a research team in Brazil, included 41 moderate to severe COPD patients (18 former smokers and 23 current smokers). Both groups participated in a traditional pulmonary rehab program 3 days/week for 1 hour each session for a total of 3 months. In those sessions, both groups participated in observed cardiovascular and strength training exercise, and received counseling on topics such as breathing techniques and nutrition. Though the dangers of smoking were discussed with both groups, there was no formal smoking cessation program as part of the rehab program. (Santana VT, et al. Influence of current smoking on adherence and responses to pulmonary rehabilitation in patients with COPD. Rev Bras Fisioter. 2010 Feb; 14(1):16-23)
The results were eye opening. While more current smokers dropped out of the rehab program (7 of the 23 dropped out) during the study than former smokers (2 of 18 dropped out), the current smokers who completed the program experienced significant gains in physical conditioning and self-reported quality of life, and in most cases achieved gains similar to the former smokers.
More important, of the current smokers who completed the program, 19% stopped smoking by the end of the program, and over 50% of the remaining current smokers saw moderate drops in their nicotine dependence.
We’ve long argued that it is a mistake to exclude current smokers from pulmonary rehab. In doing so, we’ve argued that pulmonary rehab is a potentially powerful weapon to improve the health status of smokers whether they quit or not. We’ve also suggested that participating in an ongoing exercise program might improve smoking cessation success rates. This study’s results seem to support both positions (there have been a few other studies over the past couple of years with similar findings that have not garnered much attention).
As the Brazilian research team concluded, “The results of this study indicate that, although current smoking was negatively related to adherence to PR (pulmonary rehabilitation), the clinical and physiological gains were generally similar in ex-smokers and current smokers. In addition, the PR was associated with a significant reduction in nicotine dependence in current smokers. These results indicate that although a higher rate of withdrawal from PR can be antici¬pated in smokers with COPD, there seems to be no a priori clinical or physiological grounds to exclude such patients from PR programs.”
While this study’s findings are significant, it is unlikely to result in a broadening of access to pulmonary rehab programs for current smokers in the near term for two reasons. First, physicians will want to see studies involving larger COPD patient populations that confirm these results. Second, access to pulmonary rehab is still very limited and respiratory care professionals will likely opt to admit only those patients who have a high probability of completing the program and they continue to view current smokers as less likely to complete a full course of pulmonary rehab.
Still, if you have been diagnosed with COPD (stage II or stage III) and you are a current smoker, we recommend you ask your doctor for a referral to a pulmonary rehab program in your area anyway - even if you aren’t ready to stop smoking. If your doctor won’t make the referral until you complete a smoking cessation program or the pulmonary rehab program won’t admit you, consider purchasing our Breathe Better for Life guidebook and companion CD-ROM (www.breathebetterforlife.com). We have built a better breathing exercise and nutrition program based on pulmonary rehabilitation guidelines created by the American Thoracic Society and European Respiratory Society. We created the program specifically for people who can’t get access to a pulmonary rehab program but desire to find ways improve shortness of breath, physical conditioning and their quality of life. As always, you should consult your physician before pursuing our recommended program to make sure the program is appropriate for your circumstances.
The full free text of the Brazilian research study is available be clicking here.
The study, conducted by a research team in Brazil, included 41 moderate to severe COPD patients (18 former smokers and 23 current smokers). Both groups participated in a traditional pulmonary rehab program 3 days/week for 1 hour each session for a total of 3 months. In those sessions, both groups participated in observed cardiovascular and strength training exercise, and received counseling on topics such as breathing techniques and nutrition. Though the dangers of smoking were discussed with both groups, there was no formal smoking cessation program as part of the rehab program. (Santana VT, et al. Influence of current smoking on adherence and responses to pulmonary rehabilitation in patients with COPD. Rev Bras Fisioter. 2010 Feb; 14(1):16-23)
The results were eye opening. While more current smokers dropped out of the rehab program (7 of the 23 dropped out) during the study than former smokers (2 of 18 dropped out), the current smokers who completed the program experienced significant gains in physical conditioning and self-reported quality of life, and in most cases achieved gains similar to the former smokers.
More important, of the current smokers who completed the program, 19% stopped smoking by the end of the program, and over 50% of the remaining current smokers saw moderate drops in their nicotine dependence.
We’ve long argued that it is a mistake to exclude current smokers from pulmonary rehab. In doing so, we’ve argued that pulmonary rehab is a potentially powerful weapon to improve the health status of smokers whether they quit or not. We’ve also suggested that participating in an ongoing exercise program might improve smoking cessation success rates. This study’s results seem to support both positions (there have been a few other studies over the past couple of years with similar findings that have not garnered much attention).
As the Brazilian research team concluded, “The results of this study indicate that, although current smoking was negatively related to adherence to PR (pulmonary rehabilitation), the clinical and physiological gains were generally similar in ex-smokers and current smokers. In addition, the PR was associated with a significant reduction in nicotine dependence in current smokers. These results indicate that although a higher rate of withdrawal from PR can be antici¬pated in smokers with COPD, there seems to be no a priori clinical or physiological grounds to exclude such patients from PR programs.”
While this study’s findings are significant, it is unlikely to result in a broadening of access to pulmonary rehab programs for current smokers in the near term for two reasons. First, physicians will want to see studies involving larger COPD patient populations that confirm these results. Second, access to pulmonary rehab is still very limited and respiratory care professionals will likely opt to admit only those patients who have a high probability of completing the program and they continue to view current smokers as less likely to complete a full course of pulmonary rehab.
Still, if you have been diagnosed with COPD (stage II or stage III) and you are a current smoker, we recommend you ask your doctor for a referral to a pulmonary rehab program in your area anyway - even if you aren’t ready to stop smoking. If your doctor won’t make the referral until you complete a smoking cessation program or the pulmonary rehab program won’t admit you, consider purchasing our Breathe Better for Life guidebook and companion CD-ROM (www.breathebetterforlife.com). We have built a better breathing exercise and nutrition program based on pulmonary rehabilitation guidelines created by the American Thoracic Society and European Respiratory Society. We created the program specifically for people who can’t get access to a pulmonary rehab program but desire to find ways improve shortness of breath, physical conditioning and their quality of life. As always, you should consult your physician before pursuing our recommended program to make sure the program is appropriate for your circumstances.
The full free text of the Brazilian research study is available be clicking here.
Monday, April 26, 2010
New push by CDC to reduce smoking rates – wasted money?
This past week, the Centers for Disease Control (CDC) reported that a new initiative to curtail smoking rates could reduce the 400,000 annual U.S. tobacco related deaths. The core of the new initiative is a recommendation that states adopt tougher “tobacco control” programs. Click here for the CDC press release touting the report.
One small problem – the same CDC reported in November 2009 that U.S. smoking rates remained unchanged over the five year period between 2003 and 2008 despite states having received over $200 billion in tobacco control funding over the past decade. Click here for the CDC press release regarding the success rates of recent tobacco control programs.
We don’t disagree that stopping smoking is highly beneficial in terms of improving a person’s health and lowering overall health care costs, but it does seem rather wasteful to us to keep throwing money down a hole that has previously shown little return.
The classic assortment of methods employed by states to control tobacco distribution/use include taxing cigarette sales at high enough rates that it makes smoking a financially uncomfortable habit to continue, enacting smoke-free laws that limit/eliminate smoking in public places, limiting where and how often cigarettes can be marketed, investing in anti-smoking public service advertisements, and subsidizing smoking cessation programs for those who can’t afford to pay for such programs on their own. All of these are noble efforts but one wonders how successful they’ve been in reducing the number of people who smoke or the health care costs associated with tobacco use.
The CDC’s new report suggests that tightening the screws across all 50 states through more aggressive tobacco control programs will yield a breakthrough in smoking rates. They point to California as a success story example. The state of California has been one of the most aggressive states in employing tobacco control programs and has seen smoking rates fall from 23% of the adult population in 1988 to 13% in 2006. As a consequence, the CDC indicates that California has seen lung cancer rates decline at a substantially higher rate than other states.
That is indeed impressive, but if the overall level of smoking in the U.S. has remained unchanged over the past five years, California’s progress in recent years has either stalled or other states are experiencing offsetting increases in smoking rates - despite a significant increase in new tobacco control programs enacted in many states during that time period.
The gist of CDC’s position is that there is wide variability of enacted laws and money spent on tobacco control programs across the 50 states. If all states employed a higher/more aggressive set of tobacco control programs, the CDC is convinced smoking rates would decline and thereby cut tobacco related deaths and reduce overall healthcare costs.
But one has to ask - how realistic is it to assume a broad swath of states can afford to beef up their tobacco control program investments? Significant budgetary constraints already exist in most states due to the tenuous state of the U.S. economy and the recently enacted federal healthcare reform legislation imposes significant new healthcare cost obligations on most states that will dominate state funding agendas for an extended period of time.
Not mentioned in the CDC press release is the additional fact that commercial smoking cessation programs have terribly low success rates – another confounding circumstance impacting the ability of the medical community to lower smoking rates. The low levels of success among commercial smoking cessation programs and most state-funded tobacco control programs to reduce smoking rates points out the obvious – nicotine is a powerfully addictive substance and the habit of smoking is awfully difficult to break.
So what’s the solution then? In our view, it’s reframing the problem and then attacking the reframed problem from a different angle. The problem isn’t reducing smoking rates…the problem is improving the health status of our smokers.
From our perspective, if one refocused a good portion of the money and other resources spent on tobacco control programs and smoking cessation programs on a “healthy living for smokers” program patterned after the clinically affirmed therapy known as pulmonary rehabilitation, it is our bet that we would see lower healthcare costs, improved health status, and ultimately increased smoking cessation success among the U.S. smoking population.
To that end we ask whether it is a better pursuit to spend another $200 billion over the next ten years to reduce smoking rates by 2% (a level we’re betting the CDC would declare as good progress) or invest that same amount of money in opening up smoker access to pulmonary rehabilitation style programs?
If our 46 million smokers better understood the dramatic health benefits (i.e. improving physical conditioning, reducing shortness of breath, reducing hospital admissions, and improving quality of life) that accrue from an exercise program of moderate intensity tailored for those who have compromised respiratory function - would more than 2% be inclined to try one especially if they weren’t required to give up smoking as a prerequisite? We think so. And beyond these immediate health benefits there is evidence in recent studies that an active exercise program boosts smoking cessation program success rates. As a case in point, we refer you to our recent blog posting about a new research study supporting smoker access to pulmonary rehab: http://breathebetterblog.blogspot.com/2010/04/new-study-demonstrates-pulmonary-rehab.html
Look at it this way – if you took the $200 billion spent over the past decade on tobacco control programs and divided it by 46 million active U.S. smokers, it means that state & federal governments have spent approximately $4,350 per active smoker over that time period and achieved zero improvement in smoking rates.
By way of contrast, under recently improved Medicare reimbursement provisions, hospitals can achieve $50/hour reimbursement for up to 72 1-hour pulmonary rehab sessions per patient (sadly, Medicare and insurance reimbursement for pulmonary rehab is limited to moderate to severe COPD patients, and only 1-2% of COPD patients are admitted to pulmonary rehab programs annually). If the combined state and federal governments offered every active U.S. smoker access to a 24 week pulmonary rehab program (3 days/week, 1 hour per day) and reimbursed health care professionals at the same $50/hour Medicare reimbursement rate, the subsidized cost per smoker would be $3,600 and the overall subsidy would be $166 billion – nearly 20% lower than what has been spent on tobacco control programs over the past decade (a level, by the way, the CDC acknowledges was inadequate to reduce smoking rates in its November 2009 report). Now realistically not every U.S. smoker would be interested in such a program but we’re guessing more than 2% would – and we’re confident there would be a greater than zero return for those who did opt for pulmonary rehab given the three decades worth of published studies demonstrating its efficacy.
If one polled pulmonary rehab professionals and asked the question – do you think overall smoker health status and tobacco related healthcare costs would improve more from $200 billion additional investment in tobacco control programs over the next decade or from a $166 billion investment in an extended subsidized pulmonary rehab program for every U.S. smoker, we think you’d find a dominant majority would favor pulmonary rehab’s chances of delivering a more meaningful societal benefit.
Our position is that in order to achieve a breakthrough in improving the health of our smoking population, physicians and policymakers will have to do more than just ratchet up the intensity of “same old, same old” approaches. We believe offering active smokers subsidized access to pulmonary rehab (whether they give up smoking or not) is a novel approach worthy of serious investigation as a means of achieving improved health status among active smokers while at the same time lowering healthcare costs. And with all due respect to the CDC, we think it would cost far less than $200 billion and take less than a decade to prove it.
One small problem – the same CDC reported in November 2009 that U.S. smoking rates remained unchanged over the five year period between 2003 and 2008 despite states having received over $200 billion in tobacco control funding over the past decade. Click here for the CDC press release regarding the success rates of recent tobacco control programs.
We don’t disagree that stopping smoking is highly beneficial in terms of improving a person’s health and lowering overall health care costs, but it does seem rather wasteful to us to keep throwing money down a hole that has previously shown little return.
The classic assortment of methods employed by states to control tobacco distribution/use include taxing cigarette sales at high enough rates that it makes smoking a financially uncomfortable habit to continue, enacting smoke-free laws that limit/eliminate smoking in public places, limiting where and how often cigarettes can be marketed, investing in anti-smoking public service advertisements, and subsidizing smoking cessation programs for those who can’t afford to pay for such programs on their own. All of these are noble efforts but one wonders how successful they’ve been in reducing the number of people who smoke or the health care costs associated with tobacco use.
The CDC’s new report suggests that tightening the screws across all 50 states through more aggressive tobacco control programs will yield a breakthrough in smoking rates. They point to California as a success story example. The state of California has been one of the most aggressive states in employing tobacco control programs and has seen smoking rates fall from 23% of the adult population in 1988 to 13% in 2006. As a consequence, the CDC indicates that California has seen lung cancer rates decline at a substantially higher rate than other states.
That is indeed impressive, but if the overall level of smoking in the U.S. has remained unchanged over the past five years, California’s progress in recent years has either stalled or other states are experiencing offsetting increases in smoking rates - despite a significant increase in new tobacco control programs enacted in many states during that time period.
The gist of CDC’s position is that there is wide variability of enacted laws and money spent on tobacco control programs across the 50 states. If all states employed a higher/more aggressive set of tobacco control programs, the CDC is convinced smoking rates would decline and thereby cut tobacco related deaths and reduce overall healthcare costs.
But one has to ask - how realistic is it to assume a broad swath of states can afford to beef up their tobacco control program investments? Significant budgetary constraints already exist in most states due to the tenuous state of the U.S. economy and the recently enacted federal healthcare reform legislation imposes significant new healthcare cost obligations on most states that will dominate state funding agendas for an extended period of time.
Not mentioned in the CDC press release is the additional fact that commercial smoking cessation programs have terribly low success rates – another confounding circumstance impacting the ability of the medical community to lower smoking rates. The low levels of success among commercial smoking cessation programs and most state-funded tobacco control programs to reduce smoking rates points out the obvious – nicotine is a powerfully addictive substance and the habit of smoking is awfully difficult to break.
So what’s the solution then? In our view, it’s reframing the problem and then attacking the reframed problem from a different angle. The problem isn’t reducing smoking rates…the problem is improving the health status of our smokers.
From our perspective, if one refocused a good portion of the money and other resources spent on tobacco control programs and smoking cessation programs on a “healthy living for smokers” program patterned after the clinically affirmed therapy known as pulmonary rehabilitation, it is our bet that we would see lower healthcare costs, improved health status, and ultimately increased smoking cessation success among the U.S. smoking population.
To that end we ask whether it is a better pursuit to spend another $200 billion over the next ten years to reduce smoking rates by 2% (a level we’re betting the CDC would declare as good progress) or invest that same amount of money in opening up smoker access to pulmonary rehabilitation style programs?
If our 46 million smokers better understood the dramatic health benefits (i.e. improving physical conditioning, reducing shortness of breath, reducing hospital admissions, and improving quality of life) that accrue from an exercise program of moderate intensity tailored for those who have compromised respiratory function - would more than 2% be inclined to try one especially if they weren’t required to give up smoking as a prerequisite? We think so. And beyond these immediate health benefits there is evidence in recent studies that an active exercise program boosts smoking cessation program success rates. As a case in point, we refer you to our recent blog posting about a new research study supporting smoker access to pulmonary rehab: http://breathebetterblog.blogspot.com/2010/04/new-study-demonstrates-pulmonary-rehab.html
Look at it this way – if you took the $200 billion spent over the past decade on tobacco control programs and divided it by 46 million active U.S. smokers, it means that state & federal governments have spent approximately $4,350 per active smoker over that time period and achieved zero improvement in smoking rates.
By way of contrast, under recently improved Medicare reimbursement provisions, hospitals can achieve $50/hour reimbursement for up to 72 1-hour pulmonary rehab sessions per patient (sadly, Medicare and insurance reimbursement for pulmonary rehab is limited to moderate to severe COPD patients, and only 1-2% of COPD patients are admitted to pulmonary rehab programs annually). If the combined state and federal governments offered every active U.S. smoker access to a 24 week pulmonary rehab program (3 days/week, 1 hour per day) and reimbursed health care professionals at the same $50/hour Medicare reimbursement rate, the subsidized cost per smoker would be $3,600 and the overall subsidy would be $166 billion – nearly 20% lower than what has been spent on tobacco control programs over the past decade (a level, by the way, the CDC acknowledges was inadequate to reduce smoking rates in its November 2009 report). Now realistically not every U.S. smoker would be interested in such a program but we’re guessing more than 2% would – and we’re confident there would be a greater than zero return for those who did opt for pulmonary rehab given the three decades worth of published studies demonstrating its efficacy.
If one polled pulmonary rehab professionals and asked the question – do you think overall smoker health status and tobacco related healthcare costs would improve more from $200 billion additional investment in tobacco control programs over the next decade or from a $166 billion investment in an extended subsidized pulmonary rehab program for every U.S. smoker, we think you’d find a dominant majority would favor pulmonary rehab’s chances of delivering a more meaningful societal benefit.
Our position is that in order to achieve a breakthrough in improving the health of our smoking population, physicians and policymakers will have to do more than just ratchet up the intensity of “same old, same old” approaches. We believe offering active smokers subsidized access to pulmonary rehab (whether they give up smoking or not) is a novel approach worthy of serious investigation as a means of achieving improved health status among active smokers while at the same time lowering healthcare costs. And with all due respect to the CDC, we think it would cost far less than $200 billion and take less than a decade to prove it.
Friday, April 16, 2010
New study shows oral vaccine reduces severity of COPD exacerbations
A group of Australian researchers reported interesting findings in a recently published study regarding the efficacy of an oral influenza vaccine in reducing the severity of exacerbations in COPD patients. (Tandon MK, et al. Oral Immunotherapy With Inactivated Nontypeable Haemophilus infuenzae Reduces Severity of Acute Exacerbations in Severe COPD. Chest 2010; 137(4):805–811.)
The study, published in the April issue of Chest, the journal of record for the American College of Chest Physicians, was based on the premise that COPD exacerbations (severe shortness of breath attacks) are often caused by too much fluid/mucous in the lungs. The build-up of fluid/mucous is believed to be an inflammatory response to the presence of bacteria that COPD patient’s bodies own white blood cells do not recognize as a threat.
The researchers wondered whether oral administration of the Haemophilius Influenzae vaccine (known as HI-64OV) would trigger the body’s production of white blood cells that would recognize the bacteria colonization as a threat and act upon it. In doing so, they hoped to reduce the bacteria colonization which in turn would reduce mucous/fluid production in the lungs, and thereby reduce exacerbations.
The Australian research team discovered that the oral vaccine didn’t dramatically reduce the number of exacerbations (16% decline), but the COPD patients receiving the vaccine did experience a significant difference in the percentage of exacerbations that were categorized as moderate to severe (63% decline), the length of exacerbation events (37% reduction) and hospitalizations associated with the exacerbations declined 90%. Further, for those study subjects who did incur moderate to severe exacerbations the need for follow-on antibiotics dropped 56%. Overall, these are pretty impressive results.
A few caveats – the research team was funded by the folks who make the vaccine, so it would be beneficial if an independent research team confirmed these results in a subsequent study to ensure the absence of bias. Also, the study was conducted on severe COPD patients only, and the vaccines’ usefulness for less severe COPD patients remains to be determined. Finally, the study size was small (38 subjects) and therefore not likely to stand on its own as the basis for commercializing the experimental vaccine.
Nonetheless, the results of this study are encouraging from the standpoint of potentially providing a new weapon for respiratory care professionals to limit the number and severity of exacerbations in COPD patients. Further, if confirmed, the HI-64OV vaccine may also help reduce reliance on corticosteroids and antibiotics to manage exacerbations as well as potentially reducing the number of hospitalizations related to shortness of breath attacks (and the costs associated with such hospitalizations). Hopefully, other pulmonology researchers will pursue follow-on studies to confirm the Australian team’s results and make the vaccine available for COPD patients in the not-too-distant future.
The study, published in the April issue of Chest, the journal of record for the American College of Chest Physicians, was based on the premise that COPD exacerbations (severe shortness of breath attacks) are often caused by too much fluid/mucous in the lungs. The build-up of fluid/mucous is believed to be an inflammatory response to the presence of bacteria that COPD patient’s bodies own white blood cells do not recognize as a threat.
The researchers wondered whether oral administration of the Haemophilius Influenzae vaccine (known as HI-64OV) would trigger the body’s production of white blood cells that would recognize the bacteria colonization as a threat and act upon it. In doing so, they hoped to reduce the bacteria colonization which in turn would reduce mucous/fluid production in the lungs, and thereby reduce exacerbations.
The Australian research team discovered that the oral vaccine didn’t dramatically reduce the number of exacerbations (16% decline), but the COPD patients receiving the vaccine did experience a significant difference in the percentage of exacerbations that were categorized as moderate to severe (63% decline), the length of exacerbation events (37% reduction) and hospitalizations associated with the exacerbations declined 90%. Further, for those study subjects who did incur moderate to severe exacerbations the need for follow-on antibiotics dropped 56%. Overall, these are pretty impressive results.
A few caveats – the research team was funded by the folks who make the vaccine, so it would be beneficial if an independent research team confirmed these results in a subsequent study to ensure the absence of bias. Also, the study was conducted on severe COPD patients only, and the vaccines’ usefulness for less severe COPD patients remains to be determined. Finally, the study size was small (38 subjects) and therefore not likely to stand on its own as the basis for commercializing the experimental vaccine.
Nonetheless, the results of this study are encouraging from the standpoint of potentially providing a new weapon for respiratory care professionals to limit the number and severity of exacerbations in COPD patients. Further, if confirmed, the HI-64OV vaccine may also help reduce reliance on corticosteroids and antibiotics to manage exacerbations as well as potentially reducing the number of hospitalizations related to shortness of breath attacks (and the costs associated with such hospitalizations). Hopefully, other pulmonology researchers will pursue follow-on studies to confirm the Australian team’s results and make the vaccine available for COPD patients in the not-too-distant future.
Thursday, April 15, 2010
Tai chi for COPD – new study shows improvement in respiratory symptoms
A newly released study reported an 8% decline in self-recorded respiratory symptoms among study subjects with COPD who participated in a 3 month long tai chi program. By comparison, COPD participants in the study control group showed a 12% increase in self-reported respiratory symptoms over the same 3 month period - the control group subjects did not participate in a tai chi or other exercise program during the study duration. (Chan A, et al. Effectiveness of a Tai chi Qigong program in promoting health-related quality of life and perceived social support in chronic obstructive pulmonary disease clients. Quality of Life Research. 2010 Mar 15. [Epub ahead of print]).
While the research team concluded the comparative improvement in self-reported symptoms for the tai chi group was statistically significant, they would not go as far as to declare the results “clinically significant”. Apparently, the study results needed to show a 9% decline in self-reported symptoms in order to deem the results “clinically significant”. The main reason cited by the researchers for narrowly missing the “clinically significant” threshold was the short study duration of only 3 months (noting that other tai chi studies conducted over 6 month and 12 month periods demonstrated larger range of physical conditioning improvements).
As a result of falling short of the clinically significant milestone, you are unlikely to see this study’s results discussed widely elsewhere. But, in our view, given there was a significant improvement in self-reported symptoms between the control group and tai chi group, we think it is worth your exploration of tai chi as an alternative form of low intensity exercise for those with COPD. In fact, last month we wrote an article regarding the potential benefits of tai chi for COPD patients based on the strong and growing body of research surrounding tai chi for other chronic conditions such as heart disease, hypertension and arthritis. To read that article, click here.
In the Quality of Life Research study, the tai chi group practiced 13 movements of the 18 movements of the tai chi form known as qigong. The subjects met 2 times a week for 1 hour each session over the 3 month study period. The researchers selected the 13 movements used in the study based on those that are easy to learn and master in a short period of time. Study subjects were also asked to coordinate their breathing during each tai chi movement.
At the outset of the study, the control group and tai chi group were asked to rate their quality of life in three areas (distress caused by respiratory symptoms, how breathlessness limits their daily activities, and the overall psychological/social effects of COPD on their daily lives) using a survey tool known as the St. George’s Respiratory Questionnaire (SGRQ) – a widely used tool among respiratory care professionals to assess COPD patient quality of life. The study subjects then completed the SGRQ again at 6 weeks into the study and again at the end of the 3 month research project. Of the three areas probed in the SGRQ, the tai chi group showed significant improvement in the distress caused by respiratory symptoms section.
The Hong Kong based study team concluded, “During the 3-month TCQ (tai chi qigong) training, no exercise-related problems occurred; hence, this TCQ style appeared to be safe. In addition, the subjects enjoyed the training. Statistically, TCQ contributed toward improvements in health outcomes with respect to clients’ perception of their recent respiratory symptoms and decreased disturbances to their daily physical activities.”
In addition to tai chi’s known physical conditioning benefits, the ancient Chinese martial arts technique also promotes balance among the elderly and has been shown to improve exercise program compliance (i.e. tai chi is a lot less boring than walking on a treadmill so people are more inclined to continue a tai chi exercise program).
Many fitness and community centers offer tai chi classes – some particularly targeted to the elderly and people with limited mobility. There are also a wide range of DVD’s available online and in retail stores that demonstrate tai chi programs that can be practiced at home. We highlighted a few beginner oriented DVD’s on our Breathe Better Marketplace web site. To view our selections, click here. If you’d like to review a broader selection of tai chi DVD’s, we suggest you visit www.amazon.com and type in the search term “tai chi DVD”.
While the research team concluded the comparative improvement in self-reported symptoms for the tai chi group was statistically significant, they would not go as far as to declare the results “clinically significant”. Apparently, the study results needed to show a 9% decline in self-reported symptoms in order to deem the results “clinically significant”. The main reason cited by the researchers for narrowly missing the “clinically significant” threshold was the short study duration of only 3 months (noting that other tai chi studies conducted over 6 month and 12 month periods demonstrated larger range of physical conditioning improvements).
As a result of falling short of the clinically significant milestone, you are unlikely to see this study’s results discussed widely elsewhere. But, in our view, given there was a significant improvement in self-reported symptoms between the control group and tai chi group, we think it is worth your exploration of tai chi as an alternative form of low intensity exercise for those with COPD. In fact, last month we wrote an article regarding the potential benefits of tai chi for COPD patients based on the strong and growing body of research surrounding tai chi for other chronic conditions such as heart disease, hypertension and arthritis. To read that article, click here.
In the Quality of Life Research study, the tai chi group practiced 13 movements of the 18 movements of the tai chi form known as qigong. The subjects met 2 times a week for 1 hour each session over the 3 month study period. The researchers selected the 13 movements used in the study based on those that are easy to learn and master in a short period of time. Study subjects were also asked to coordinate their breathing during each tai chi movement.
At the outset of the study, the control group and tai chi group were asked to rate their quality of life in three areas (distress caused by respiratory symptoms, how breathlessness limits their daily activities, and the overall psychological/social effects of COPD on their daily lives) using a survey tool known as the St. George’s Respiratory Questionnaire (SGRQ) – a widely used tool among respiratory care professionals to assess COPD patient quality of life. The study subjects then completed the SGRQ again at 6 weeks into the study and again at the end of the 3 month research project. Of the three areas probed in the SGRQ, the tai chi group showed significant improvement in the distress caused by respiratory symptoms section.
The Hong Kong based study team concluded, “During the 3-month TCQ (tai chi qigong) training, no exercise-related problems occurred; hence, this TCQ style appeared to be safe. In addition, the subjects enjoyed the training. Statistically, TCQ contributed toward improvements in health outcomes with respect to clients’ perception of their recent respiratory symptoms and decreased disturbances to their daily physical activities.”
In addition to tai chi’s known physical conditioning benefits, the ancient Chinese martial arts technique also promotes balance among the elderly and has been shown to improve exercise program compliance (i.e. tai chi is a lot less boring than walking on a treadmill so people are more inclined to continue a tai chi exercise program).
Many fitness and community centers offer tai chi classes – some particularly targeted to the elderly and people with limited mobility. There are also a wide range of DVD’s available online and in retail stores that demonstrate tai chi programs that can be practiced at home. We highlighted a few beginner oriented DVD’s on our Breathe Better Marketplace web site. To view our selections, click here. If you’d like to review a broader selection of tai chi DVD’s, we suggest you visit www.amazon.com and type in the search term “tai chi DVD”.
Wednesday, April 14, 2010
The “Unaccounted” – the frustrating pursuit to diagnose those with COPD
Two recent published studies highlight the challenges faced by physicians to diagnose COPD among those who suffer from chronic shortness of breath. From past research studies and practical experience, pulmonology professionals believe there are as many as 12 million people in the U.S. who have COPD but have not been diagnosed – a group sometimes referred to among respiratory health professionals as the “unaccounted”.
For a frame of reference, there are approximately 12 million U.S. adults who have been already diagnosed with COPD – meaning that roughly 50% of all U.S. adults with COPD have no idea they have this degenerative, largely irreversible condition. Due to this substantial under-diagnosis, the “unaccounted” are not gaining access to the full range of treatment options that could help slow down and possibly halt the progression of lung disease.
Why are so many people that are suffering from chronic shortness of breath undiagnosed as COPD patients? In our view, the three most common reasons, in order of prevalence, seem to be as follows:
(1) Many people don’t visit their doctors to be evaluated and discover they have COPD only after an acute exacerbation (doctor-speak for a shortness of breath attack serious enough to land you in a hospital).
(2) Some people who do visit a doctor about their shortness of breath are evaluated only by their primary care physician, not a pulmonologist. Primary care physicians sometimes incorrectly diagnose the patient and/or don’t refer the patient to a pulmonologist to conduct respiratory function tests even if COPD risk factors are present.
(3) Some people who do undergo respiratory function tests (most notably spirometry) receive a false-negative diagnosis – meaning the tests do not confirm COPD even though later testing confirms a COPD diagnosis. This happens most often because the spirometry test was either poorly administered or interpreted.
Reason (1) is reinforced by a recent study published in Chronic Respiratory Disease. In this study, a group of U.K. researchers set out to examine the case records of people admitted to a London area hospital over a 1-year period. They wanted to determine the percentage of COPD patients who received their initial COPD diagnosis as a result of a first-time hospitalization related to an acute exacerbation event.
The research team discovered that 34% of the 41 patients admitted for the first time related to an acute exacerbation were previously undiagnosed with COPD. These patients received respiratory function tests during their hospitalization that confirmed a COPD diagnosis. More troubling, 57% of those who were previously undiagnosed presented severe COPD symptoms – meaning that the majority of the undiagnosed waited so long to seek help for their chronic shortness of breath that they were deep into lung disease before gaining access to treatment. (Bastin AJ, et al. High prevalence of undiagnosed and severe chronic obstructive pulmonary disease at first hospital admission with acute exacerbation. Chron Respir Dis. 2010: March 18. [Epub ahead of print])
Reason (2) is highlighted by the results of another recently published study, this one in the April 2010 Canadian Medical Association Journal. In this study, Canadian researchers surveyed a group of 1,003 COPD patients who were at least 40 years of age and had smoked for at least 20 years (the mean age of the group was approximately 60) and who had visited their primary care physician for any reason between April 2006 and February 2007. In particular, the researchers wanted to know whether COPD diagnosis was determined by the primary care physicians.
The study found that 21% of the surveyed patients had either Stage II (moderate) or Stage III/IV (severe to very severe) COPD but were not diagnosed by the primary care physician they visited. The research team further noted, “Although more than three-quarters of the patients with COPD reported at least one respiratory symptom, two-thirds were unaware of their diagnosis. These findings suggest that adults who attend a primary care practice with known risk factors for COPD are important targets for screening and early intervention.” (Hill K, et al. Prevalence and underdiagnosis of chronic obstructive pulmonary disease among patients at risk in primary care. CMAJ 2010. DOI: 10.1503/cmaj.091784).
Reason (3) is supported by a research study we wrote about last month. You can access that article by clicking here.
The bottom line for you – if you suspect that your shortness of breath is increasingly affecting your ability to participate in everyday activities you owe it to yourself to see your doctor ASAP. Yes, you’ll probably have to undergo some tests and you will likely hear an earful about stopping smoking, exercising more and/or changing your dietary habits (all excellent recommendations for making an immediate impact on your shortness of breath). When you visit your doctor, ask for a referral to a local pulmonologist and in turn ask the pulmonologist to order a spirometry test. You are far more apt to get a correct diagnosis by seeking an evaluation from a qualified pulmonologist trained to administer and interpret spirometry results than through any other means. In the end , you have a far better chance of limiting the ravaging effects of severe lung disease by seeking treatment sooner rather than later – even if some of the prescribed solutions mean altering your long practiced habits.
If you are unfamiliar with the treatment options available for COPD, we have detailed the full range of treatment options in our Breathe Better for Life guide and companion CD-ROM. We developed the guide and CD to provide people who suffer from chronic shortness of breath with self-management strategies for reducing shortness of breath, improving physical conditioning, and improving overall quality of life (whether you have COPD already or you are a current/former smoker and you'd simply like to breathe & feel better). However, our guide and CD describe the full range of COPD treatment options including pictorial demonstrations. To purchase the guide & CD, visit www.breathebetterforlife.com.
Alternatively, for a brief overview of COPD treatment options you can visit the COPD treatment options page on the American Lung Association web site by clicking here.
For a frame of reference, there are approximately 12 million U.S. adults who have been already diagnosed with COPD – meaning that roughly 50% of all U.S. adults with COPD have no idea they have this degenerative, largely irreversible condition. Due to this substantial under-diagnosis, the “unaccounted” are not gaining access to the full range of treatment options that could help slow down and possibly halt the progression of lung disease.
Why are so many people that are suffering from chronic shortness of breath undiagnosed as COPD patients? In our view, the three most common reasons, in order of prevalence, seem to be as follows:
(1) Many people don’t visit their doctors to be evaluated and discover they have COPD only after an acute exacerbation (doctor-speak for a shortness of breath attack serious enough to land you in a hospital).
(2) Some people who do visit a doctor about their shortness of breath are evaluated only by their primary care physician, not a pulmonologist. Primary care physicians sometimes incorrectly diagnose the patient and/or don’t refer the patient to a pulmonologist to conduct respiratory function tests even if COPD risk factors are present.
(3) Some people who do undergo respiratory function tests (most notably spirometry) receive a false-negative diagnosis – meaning the tests do not confirm COPD even though later testing confirms a COPD diagnosis. This happens most often because the spirometry test was either poorly administered or interpreted.
Reason (1) is reinforced by a recent study published in Chronic Respiratory Disease. In this study, a group of U.K. researchers set out to examine the case records of people admitted to a London area hospital over a 1-year period. They wanted to determine the percentage of COPD patients who received their initial COPD diagnosis as a result of a first-time hospitalization related to an acute exacerbation event.
The research team discovered that 34% of the 41 patients admitted for the first time related to an acute exacerbation were previously undiagnosed with COPD. These patients received respiratory function tests during their hospitalization that confirmed a COPD diagnosis. More troubling, 57% of those who were previously undiagnosed presented severe COPD symptoms – meaning that the majority of the undiagnosed waited so long to seek help for their chronic shortness of breath that they were deep into lung disease before gaining access to treatment. (Bastin AJ, et al. High prevalence of undiagnosed and severe chronic obstructive pulmonary disease at first hospital admission with acute exacerbation. Chron Respir Dis. 2010: March 18. [Epub ahead of print])
Reason (2) is highlighted by the results of another recently published study, this one in the April 2010 Canadian Medical Association Journal. In this study, Canadian researchers surveyed a group of 1,003 COPD patients who were at least 40 years of age and had smoked for at least 20 years (the mean age of the group was approximately 60) and who had visited their primary care physician for any reason between April 2006 and February 2007. In particular, the researchers wanted to know whether COPD diagnosis was determined by the primary care physicians.
The study found that 21% of the surveyed patients had either Stage II (moderate) or Stage III/IV (severe to very severe) COPD but were not diagnosed by the primary care physician they visited. The research team further noted, “Although more than three-quarters of the patients with COPD reported at least one respiratory symptom, two-thirds were unaware of their diagnosis. These findings suggest that adults who attend a primary care practice with known risk factors for COPD are important targets for screening and early intervention.” (Hill K, et al. Prevalence and underdiagnosis of chronic obstructive pulmonary disease among patients at risk in primary care. CMAJ 2010. DOI: 10.1503/cmaj.091784).
Reason (3) is supported by a research study we wrote about last month. You can access that article by clicking here.
The bottom line for you – if you suspect that your shortness of breath is increasingly affecting your ability to participate in everyday activities you owe it to yourself to see your doctor ASAP. Yes, you’ll probably have to undergo some tests and you will likely hear an earful about stopping smoking, exercising more and/or changing your dietary habits (all excellent recommendations for making an immediate impact on your shortness of breath). When you visit your doctor, ask for a referral to a local pulmonologist and in turn ask the pulmonologist to order a spirometry test. You are far more apt to get a correct diagnosis by seeking an evaluation from a qualified pulmonologist trained to administer and interpret spirometry results than through any other means. In the end , you have a far better chance of limiting the ravaging effects of severe lung disease by seeking treatment sooner rather than later – even if some of the prescribed solutions mean altering your long practiced habits.
If you are unfamiliar with the treatment options available for COPD, we have detailed the full range of treatment options in our Breathe Better for Life guide and companion CD-ROM. We developed the guide and CD to provide people who suffer from chronic shortness of breath with self-management strategies for reducing shortness of breath, improving physical conditioning, and improving overall quality of life (whether you have COPD already or you are a current/former smoker and you'd simply like to breathe & feel better). However, our guide and CD describe the full range of COPD treatment options including pictorial demonstrations. To purchase the guide & CD, visit www.breathebetterforlife.com.
Alternatively, for a brief overview of COPD treatment options you can visit the COPD treatment options page on the American Lung Association web site by clicking here.
Tuesday, April 13, 2010
Spring is Upon Us - Remember Your Pursed Lip Breathing!
Now that warmer (and more humid) weather is emerging across the U.S. pollen and other allergenic plant matter is exploding into our breatheable air. Most of us tend to increase our outdoor physical activity as temperatures become more temperate and the unwelcome allergens in the air can make it more challenging to breathe when we do so.
So this is a perfect time of year for you to reintroduce yourself to the breathing technique known as pursed lip breathing. It is a highly effective method for overcoming shortness of breath attacks. Though I am not personally a smoker nor do I have COPD I use pursed lip breathing regularly when I am pushing myself in a workout at the gym or if I am out on a run or if I am about to climb a significant number of steps. I can tell you categorically it is amazingly effective at improving my capacity to breathe when I am under cardiovascular stress. I have also introduced this valuable breathing technique to my 71 year-old father, who is a former smoker and does have COPD. Ironically, until he read my Breathe Better for Life guide/CD, he had never heard of pursed lip breathing from his pulmonologist nor ever tried it. Needless to say, he is a convert and regular practitioner now.
If you are unfamiliar with the technique, I've included a link to a printable step-by-step instruction sheet from our Breathe Better for Life CD. To access the instructions, click here . If you are interested in ordering the full Breathe Better for Life guide/CD, visit www.breathebetterforlife.com.
So this is a perfect time of year for you to reintroduce yourself to the breathing technique known as pursed lip breathing. It is a highly effective method for overcoming shortness of breath attacks. Though I am not personally a smoker nor do I have COPD I use pursed lip breathing regularly when I am pushing myself in a workout at the gym or if I am out on a run or if I am about to climb a significant number of steps. I can tell you categorically it is amazingly effective at improving my capacity to breathe when I am under cardiovascular stress. I have also introduced this valuable breathing technique to my 71 year-old father, who is a former smoker and does have COPD. Ironically, until he read my Breathe Better for Life guide/CD, he had never heard of pursed lip breathing from his pulmonologist nor ever tried it. Needless to say, he is a convert and regular practitioner now.
If you are unfamiliar with the technique, I've included a link to a printable step-by-step instruction sheet from our Breathe Better for Life CD. To access the instructions, click here . If you are interested in ordering the full Breathe Better for Life guide/CD, visit www.breathebetterforlife.com.
Friday, April 9, 2010
New Test May Reveal Early Signs of Emphysema Among Smokers
Earlier this week, WebMD.com posted an article describing a new test that may help identify smokers most at risk of developing emphysema. The test is a new type of "multidetector row CT" otherwise known as a MDCT. To read the article, click here. Though the new test does not appear to be commercially available at this point it is a potentially useful tool to help identify emphysema earlier in its development among smokers.
Genetic testing in general is a growing area of focus within pulmonary medicine (among other disciplines) as physicians seek to find ways to get in front of the curve of lung disease. There are at least two other genetic tests that are commercially available for those who are concerned about chronic shortness of breath. One we have written about a couple times before, alpha-1 antitrypsin deficiency (otherwise known as AATD, see our article by clicking here), and one for cystic fibrosis (a test known as a sweat chloride test).
Surprisingly, even though interest in genetic testing is rising in the medical profession, not many doctors are familiar with the emerging test methods as pointed out in a Chest editorial published in March 2010 (Chest is the journal of record for the American College of Chest Physicians). In that editorial, the authors pointed to a recent study that found 72% of clinicians not trained in genetics rated their knowledge of genetics as fair to poor. (Liss D, et al. Diagnosis of Adult Hereditary Pulmonary Disease and the Role of Genetic Testing. Chest 2010; 137: 748-750)
So, don't assume your doctor knows what tests are available. If you have been diagnosed with emphysema and haven't been tested for AATD, ask your doctor to be tested. If he/she doesn't know about the AATD test, suggest they visit the site www.testtodaychangetomorrow.com for more information. If you are experiencing chronic shortness of breath but you have yet to be diagnosed with a lung disease, ask your doctor to order the AATD test and the cystic fibrosis test to either help confirm or rule out these potential genetic disorders.
Genetic testing in general is a growing area of focus within pulmonary medicine (among other disciplines) as physicians seek to find ways to get in front of the curve of lung disease. There are at least two other genetic tests that are commercially available for those who are concerned about chronic shortness of breath. One we have written about a couple times before, alpha-1 antitrypsin deficiency (otherwise known as AATD, see our article by clicking here), and one for cystic fibrosis (a test known as a sweat chloride test).
Surprisingly, even though interest in genetic testing is rising in the medical profession, not many doctors are familiar with the emerging test methods as pointed out in a Chest editorial published in March 2010 (Chest is the journal of record for the American College of Chest Physicians). In that editorial, the authors pointed to a recent study that found 72% of clinicians not trained in genetics rated their knowledge of genetics as fair to poor. (Liss D, et al. Diagnosis of Adult Hereditary Pulmonary Disease and the Role of Genetic Testing. Chest 2010; 137: 748-750)
So, don't assume your doctor knows what tests are available. If you have been diagnosed with emphysema and haven't been tested for AATD, ask your doctor to be tested. If he/she doesn't know about the AATD test, suggest they visit the site www.testtodaychangetomorrow.com for more information. If you are experiencing chronic shortness of breath but you have yet to be diagnosed with a lung disease, ask your doctor to order the AATD test and the cystic fibrosis test to either help confirm or rule out these potential genetic disorders.
Thursday, April 8, 2010
Pulmonary rehab just as effective for elderly COPD patients as it is for younger patients
Over the years, there has been a bias in pulmonary rehab studies to exclude evaluating the impact of a pulmonary rehab program on elderly COPD patients (those 70+ years of age). A study just published in the March/April 2010 edition of the Journal of Cardiopulmonary Rehabilitation and Prevention demonstrates that pulmonary rehab for elderly COPD patients is just as effective in improving physical conditioning, reducing shortness of breath, improving quality of life and decreased hospital admissions. (Sundararajan, L. et al. Effectiveness of Outpatient Pulmonary Rehabilitation in Elderly Patients with Chronic Obstructive Pulmonary Disease. Journal of Cardiopulmonary Rehabilitation and Prevention 2010; 30: 116-120)
The U.K. based research team highlighted their belief as to why this bias exists as follows, “There have been suggestions that older patients are ‘too old,’ would not tolerate aggressive treatment, or would have limited ability to improve exercise capacity because of the physiological effects of aging and comorbid illness.”
So the team set out to investigate whether the basis of this bias was valid. They combed through two U.K. hospital pulmonary rehab records from 1998-2003 to select out a group of 70+ aged adults (yielding 102 patients with a mean age of 76) and another group of <70 aged adults (yielding 98 patients with a mean age of 61). The combined 200 patients had all been through the same 6 week pulmonary rehab program consisting of 2 days/week in-clinic endurance training (30 minutes each day) and 1 additional day per week on their own outside of the clinic. The researchers compared the two groups’ improvement in physical conditioning, perceived breathlessness, perceived quality of life, and subsequent hospital admissions.
The retrospective study’s results showed that both the under-70 and over-70 groups experienced notable improvements on all measurements. For example, in the shuttle-walk test, the over-70 group saw a 20% increase in distance walked while the under-70 group experienced a 33% increase – both significant jumps. The shuttle walk test is a standard test used by respiratory care professionals to measure physical conditioning whereby patients walk as far as possible within a specific period of time – the farther you walk in the time allotted, the better your physical conditioning. Both groups demonstrated very similar levels of improvement in the other measures examined including perceived breathlessness, quality of life, subsequent hospital admissions and length of subsequent hospital stays.
So, in effect, the researchers demonstrated that the bias among respiratory care professionals to exclude the elderly from pulmonary rehab research was misplaced. As the research team noted, “The physiological effects of aging, including worsening cardiovascular status with reduction in aerobic endurance, changes in body composition such as skeletal muscle atrophy and weakness, and bone loss, DO RESPOND TO EXERCISE TRAINING (our emphasis added). Thus, it should not be surprising that elderly patients are capable of similar improvements from PR (pulmonary rehab) as are younger patients.”
We wholeheartedly agree. In our opinion, COPD patients of any age can benefit from a pulmonary rehab-style exercise program. Whether you are 45 or 75, we recommend pursuing an ongoing exercise program. The best place to start is by asking your doctor to refer you to a pulmonary rehab program in your area. If your doctor won’t prescribe it or there is no such program in your area, go to your local fitness center or community center and ask to speak to a fitness instructor who is certified in structuring exercise programs for people with chronic health conditions.
We would also encourage you to consider purchasing our Breathe Better for Life guide (http://www.breathebetterforlife.com/) which, among other things, provides a detailed 8 week endurance and strength training exercise program that is tailored for those with breathing difficulties. The program we recommend is based on guidelines established by the American Thoracic Society, European Respiratory Society and the American College of Sports Medicine. Our program also explains how you can establish your baseline physical condition at home and how you can monitor your progress over time. Whether you choose to follow our recommended program or not, the guide may serve as a valuable resource for you to discuss an exercise program with your doctor.
If none of those options appeal to you, please consider at least starting and maintaining a regular walking program (3-5 days a week, 30 minutes to 60 minutes per walking session). A number of research studies have demonstrated that COPD patients and smokers can benefit from such a walking program. Though the conditioning benefits won’t be as great from a simple walking program as you can achieve from an endurance/strength training program of moderate to vigorous intensity you can still improve how you feel and breathe.
In the end, no matter your age or current physical condition, you have the capacity to make a meaningful difference in how you breathe and live. So don’t let physician bias stop you from at least trying!
The U.K. based research team highlighted their belief as to why this bias exists as follows, “There have been suggestions that older patients are ‘too old,’ would not tolerate aggressive treatment, or would have limited ability to improve exercise capacity because of the physiological effects of aging and comorbid illness.”
So the team set out to investigate whether the basis of this bias was valid. They combed through two U.K. hospital pulmonary rehab records from 1998-2003 to select out a group of 70+ aged adults (yielding 102 patients with a mean age of 76) and another group of <70 aged adults (yielding 98 patients with a mean age of 61). The combined 200 patients had all been through the same 6 week pulmonary rehab program consisting of 2 days/week in-clinic endurance training (30 minutes each day) and 1 additional day per week on their own outside of the clinic. The researchers compared the two groups’ improvement in physical conditioning, perceived breathlessness, perceived quality of life, and subsequent hospital admissions.
The retrospective study’s results showed that both the under-70 and over-70 groups experienced notable improvements on all measurements. For example, in the shuttle-walk test, the over-70 group saw a 20% increase in distance walked while the under-70 group experienced a 33% increase – both significant jumps. The shuttle walk test is a standard test used by respiratory care professionals to measure physical conditioning whereby patients walk as far as possible within a specific period of time – the farther you walk in the time allotted, the better your physical conditioning. Both groups demonstrated very similar levels of improvement in the other measures examined including perceived breathlessness, quality of life, subsequent hospital admissions and length of subsequent hospital stays.
So, in effect, the researchers demonstrated that the bias among respiratory care professionals to exclude the elderly from pulmonary rehab research was misplaced. As the research team noted, “The physiological effects of aging, including worsening cardiovascular status with reduction in aerobic endurance, changes in body composition such as skeletal muscle atrophy and weakness, and bone loss, DO RESPOND TO EXERCISE TRAINING (our emphasis added). Thus, it should not be surprising that elderly patients are capable of similar improvements from PR (pulmonary rehab) as are younger patients.”
We wholeheartedly agree. In our opinion, COPD patients of any age can benefit from a pulmonary rehab-style exercise program. Whether you are 45 or 75, we recommend pursuing an ongoing exercise program. The best place to start is by asking your doctor to refer you to a pulmonary rehab program in your area. If your doctor won’t prescribe it or there is no such program in your area, go to your local fitness center or community center and ask to speak to a fitness instructor who is certified in structuring exercise programs for people with chronic health conditions.
We would also encourage you to consider purchasing our Breathe Better for Life guide (http://www.breathebetterforlife.com/) which, among other things, provides a detailed 8 week endurance and strength training exercise program that is tailored for those with breathing difficulties. The program we recommend is based on guidelines established by the American Thoracic Society, European Respiratory Society and the American College of Sports Medicine. Our program also explains how you can establish your baseline physical condition at home and how you can monitor your progress over time. Whether you choose to follow our recommended program or not, the guide may serve as a valuable resource for you to discuss an exercise program with your doctor.
If none of those options appeal to you, please consider at least starting and maintaining a regular walking program (3-5 days a week, 30 minutes to 60 minutes per walking session). A number of research studies have demonstrated that COPD patients and smokers can benefit from such a walking program. Though the conditioning benefits won’t be as great from a simple walking program as you can achieve from an endurance/strength training program of moderate to vigorous intensity you can still improve how you feel and breathe.
In the end, no matter your age or current physical condition, you have the capacity to make a meaningful difference in how you breathe and live. So don’t let physician bias stop you from at least trying!
Monday, April 5, 2010
Resveratrol as an antioxidant for smokers and COPD patients
Both COPD and asthma are characterized by chronic airway inflammation that is caused in part by oxidative stress in the body. A new study review article published online ahead of print suggests that an antioxidant known as resveratrol may be a powerful antioxidant in moderating airway inflammation among smokers, COPD patients and asthmatics (Wood LG, Wark PA, Garg ML. Antioxidant and anti-inflammatory effects of resveratrol in airway disease. Antioxid Redox Signal. 2010 Mar 9. [Epub ahead of print]).
Resveratrol is a naturally occurring compound found in a variety of plants, most notably red grapes. However, it is also found in berries, peanuts and an herb known as hu zhang. It is actually a phytonutrient that plants produce as a defense mechanism to ward off parasites and other threatening microbes. Resveratrol is most often mentioned in relation to studies showing red wine’s protective effects against heart disease but has been studied for a wide range of potential health benefits.
In the Wood review article, the authors examined the body of studies conducted on resveratrol’s impact on COPD patients, smokers and asthmatics. They conclude that enough evidence exists of resveratrol’s benefits among these audiences to warrant further research investigation. In particular, a number of studies noted in the Wood article have shown resveratrol reduces airway inflammation, mucus hypersecretion, epithelial shedding (shedding of the protective layer of airway lining tissue), and vascular exudation (fluid secretion in the lungs).
To take a step back, airway inflammation in smokers and COPD patients is most often initiated by exposure to cigarette smoke. Cigarette smoke produces an enormous amount of oxidative chemicals - in fact, the Wood article authors note that a single puff of cigarette smoke contains approximately 10,000,000,000,000,000 oxidative particles known as free radicals!
Unchecked, free radicals damage human tissue (including the lungs). Normally, free radicals are offset in the body by compounds known as antioxidants. Antioxidants bind with free radicals and thereby neutralize the free radicals ability to inflame and damage tissue. But in smokers and COPD patients, free radicals inhaled in cigarette smoke typically far outnumber the body’s supply of stored antioxidants (partly because the volume of free radicals consumed through smoke is very high, and partly due to the fact that the majority of COPD patients and smokers do not consume an antioxidant rich diet – the highest concentration of antioxidants typically are found in colorful fruits and vegetables).
As a result, most respiratory care professionals recommend improving dietary intake of antioxidant rich foods and pursuing smoking cessation to reduce free radical damage among smokers and COPD patients (excellent advice to be sure). But from our perspective it is unlikely that smokers and COPD patients could consume enough antioxidant rich food to offset the effects of cigarette smoke, especially if they continue to smoke. Therefore, in our opinion it is worth COPD patients and smokers considering complementing an antioxidant rich diet with targeted antioxidant nutritional supplements.
Resveratrol is one such antioxidant (other common antioxidants that have been studied in relation to COPD patients and smokers include Vitamin C, Vitamin E, lycopene, beta-carotene, glutathione, and quercetin). That said there is no standard recommended daily amount of resveratrol that has been studied related to respiratory benefits in COPD patients and smokers. According to the Wood article authors, the daily dosages examined in the studies they reviewed ranged from 1 nanogram up to 1500 milligrams. It should also be noted that many of the published resveratrol studies have been conducted on human tissue in the laboratory and in mice and few have been conducted on human subjects.
As a result of these two factors (unclear dosage range and quality of past studies), many respiratory care professionals are skeptical of resveratrol’s benefits for COPD patients, smokers and asthmatics. However, the Wood article authors conclude based on their investigation of research literature, "In each of the models reviewed, effects of resveratrol on inflammation were similar or superior to, the effects of glucocorticoids (steroids).”
For more information on foods and beverages with high resveratrol content, we’ve provided a link to a good summary from the Linus Pauling Institute at Oregon State University here.
If you are interested in trying a resveratrol nutritional supplement, resveratrol is widely available online and through retail stores (sometimes sold as grape seed extract). As one might imagine given the Wood article authors findings mentioned above there is also a wide range of dosages to choose from. From our own investigation, most of the really high potency resveratrol supplements (200mg+) are associated with dubious anti-aging claims and therefore we would recommend looking at resveratrol supplements in the 10 mg to 100 mg range. Of the many resveratrol products on the market, there were two approved by ConsumerLab.com for purity and label potency accuracy that appeared to us to be particularly good values - Swanson’s Ultra Resveratrol (100mg) and Country Life Resveratrol Plus (100mg). We’ve added all the Resveratrol products offered through Amazon.com (including these two products) to our Breathe Better Marketplace for you to conduct your own research and price comparison if so inclined. To visit our Marketplace, please click here. As always, we recommend that you consult your physician about whether Resveratrol or any nutritional supplement is appropriate for you based on your individual situation and current medications prior to purchasing and ingesting.
Resveratrol is a naturally occurring compound found in a variety of plants, most notably red grapes. However, it is also found in berries, peanuts and an herb known as hu zhang. It is actually a phytonutrient that plants produce as a defense mechanism to ward off parasites and other threatening microbes. Resveratrol is most often mentioned in relation to studies showing red wine’s protective effects against heart disease but has been studied for a wide range of potential health benefits.
In the Wood review article, the authors examined the body of studies conducted on resveratrol’s impact on COPD patients, smokers and asthmatics. They conclude that enough evidence exists of resveratrol’s benefits among these audiences to warrant further research investigation. In particular, a number of studies noted in the Wood article have shown resveratrol reduces airway inflammation, mucus hypersecretion, epithelial shedding (shedding of the protective layer of airway lining tissue), and vascular exudation (fluid secretion in the lungs).
To take a step back, airway inflammation in smokers and COPD patients is most often initiated by exposure to cigarette smoke. Cigarette smoke produces an enormous amount of oxidative chemicals - in fact, the Wood article authors note that a single puff of cigarette smoke contains approximately 10,000,000,000,000,000 oxidative particles known as free radicals!
Unchecked, free radicals damage human tissue (including the lungs). Normally, free radicals are offset in the body by compounds known as antioxidants. Antioxidants bind with free radicals and thereby neutralize the free radicals ability to inflame and damage tissue. But in smokers and COPD patients, free radicals inhaled in cigarette smoke typically far outnumber the body’s supply of stored antioxidants (partly because the volume of free radicals consumed through smoke is very high, and partly due to the fact that the majority of COPD patients and smokers do not consume an antioxidant rich diet – the highest concentration of antioxidants typically are found in colorful fruits and vegetables).
As a result, most respiratory care professionals recommend improving dietary intake of antioxidant rich foods and pursuing smoking cessation to reduce free radical damage among smokers and COPD patients (excellent advice to be sure). But from our perspective it is unlikely that smokers and COPD patients could consume enough antioxidant rich food to offset the effects of cigarette smoke, especially if they continue to smoke. Therefore, in our opinion it is worth COPD patients and smokers considering complementing an antioxidant rich diet with targeted antioxidant nutritional supplements.
Resveratrol is one such antioxidant (other common antioxidants that have been studied in relation to COPD patients and smokers include Vitamin C, Vitamin E, lycopene, beta-carotene, glutathione, and quercetin). That said there is no standard recommended daily amount of resveratrol that has been studied related to respiratory benefits in COPD patients and smokers. According to the Wood article authors, the daily dosages examined in the studies they reviewed ranged from 1 nanogram up to 1500 milligrams. It should also be noted that many of the published resveratrol studies have been conducted on human tissue in the laboratory and in mice and few have been conducted on human subjects.
As a result of these two factors (unclear dosage range and quality of past studies), many respiratory care professionals are skeptical of resveratrol’s benefits for COPD patients, smokers and asthmatics. However, the Wood article authors conclude based on their investigation of research literature, "In each of the models reviewed, effects of resveratrol on inflammation were similar or superior to, the effects of glucocorticoids (steroids).”
For more information on foods and beverages with high resveratrol content, we’ve provided a link to a good summary from the Linus Pauling Institute at Oregon State University here.
If you are interested in trying a resveratrol nutritional supplement, resveratrol is widely available online and through retail stores (sometimes sold as grape seed extract). As one might imagine given the Wood article authors findings mentioned above there is also a wide range of dosages to choose from. From our own investigation, most of the really high potency resveratrol supplements (200mg+) are associated with dubious anti-aging claims and therefore we would recommend looking at resveratrol supplements in the 10 mg to 100 mg range. Of the many resveratrol products on the market, there were two approved by ConsumerLab.com for purity and label potency accuracy that appeared to us to be particularly good values - Swanson’s Ultra Resveratrol (100mg) and Country Life Resveratrol Plus (100mg). We’ve added all the Resveratrol products offered through Amazon.com (including these two products) to our Breathe Better Marketplace for you to conduct your own research and price comparison if so inclined. To visit our Marketplace, please click here. As always, we recommend that you consult your physician about whether Resveratrol or any nutritional supplement is appropriate for you based on your individual situation and current medications prior to purchasing and ingesting.
Subscribe to:
Posts (Atom)