Over the years, respiratory medicine researchers have found that underweight COPD patients seem to exhibit the worst dyspnea (shortness of breath), report the lowest quality of life and experience the highest mortality rate among the general COPD population.
Pulmonary rehabilitation (PR) has been shown in many studies to improve both dyspnea and quality of life in the general COPD population but most PR studies have not distinguished between low body weight patients and those considered either normal weight or obese in reporting their findings. This raises the question – are their differences in PR outcomes among these three body weight classifications and if so, should PR programs be adapted to address the differing outcomes?
With those questions in mind, two recently published studies provide some insight into PR’s effectiveness for low body weight COPD patients in comparison to those of either normal weight or those considered obese.
To take a step back, the cornerstone element of pulmonary rehabilitation is observed, guided exercise where patients start at modest levels of intensity and duration and over the course of 8-12 weeks increase both intensity and duration. The goal of the exercise program is to boost aerobic endurance/stamina and to build muscle strength. By doing so, research has convincingly shown that upon program completion, PR participants demonstrate improved physical conditioning, reduced shortness of breath, lower incidence of COPD exacerbations (shortness of breath attacks), fewer hospitalizations and higher self-reported quality of life. PR programs include other elements that support this mission including breathing training, nutrition counseling and other self-management techniques.
The first of two recent pulmonary rehab studies distinguishing outcomes based on body weight classifications showed notable differences in self-reported quality of life measures depending on whether a COPD patient was considered low weight, normal weight or overweight. In the study, the Brown University based researchers examined the records of 61 male veterans who completed a pulmonary rehabilitation program at a Rhode Island based Veterans Administration medical center between October 2006 and January 2008. Fourteen of the 61 patients were considered underweight (body mass index lower than 23), 30 patients were considered middle-weight (BMI 23-33), and the remaining 17 patients were considered obese (BMI over 33). (Velasco R, et al. Influence of Body Mass Index on Changes in Disease-Specific Quality of Life of Veterans Completing Pulmonary Rehabilitation. J Cardiopulm Rehab and Prev. 2010; 30; 334-339.)
To assess the differences in PR outcomes, the Brown University study team looked at quality of life survey answers provided by the study participants prior to starting the PR program and again at the end of the PR program. They found that all three BMI groups did report improvement on all categories (mastery, fatigue, emotion and dyspnea) as a result of participating in the PR program, but that COPD patients who were obese (those in the highest weight category) experienced the greatest absolute gains across the four rated categories. By contrast, low BMI patients in the study experienced the smallest absolute gains in quality of life measures post-rehab. This led the researchers to conclude that higher BMI patients got more out of the PR program than the lower BMI patients – even though both groups achieved improvements.
In the second recent study examining PR outcomes based on weight classifications, a China-based research team evaluated low and normal weight COPD patients with regard to exercise capacity as well as quality of life ratings.
One wrinkle in this study was that all the study subjects (both low weight and normal weight patients) received supplemental oxygen during their rehab exercise sessions (3 liters/minute). Since the Chinese researchers didn’t evaluate the study subjects exercise performance without supplemental oxygen it’s difficult to discern how much of the absolute benefits were derived from the rehab program versus the use of supplemental oxygen. However, since both low body weight and normal body weight COPD patients received supplemental oxygen their relative PR outcomes to one another can be evaluated.
The Chinese study involved 44 COPD patients (22 considered underweight with a BMI lower than 20, and 22 considered normal weight with BMI greater than 20 – note that the split between weight groups in this study was significantly different than in the Brown University study described above). All 44 patients underwent a 12 week hospital based pulmonary rehab program. Diagnostic readings of exercise capacity and lung function were taken at the outset of the program and again at the end, as were quality of life surveys. (Lin CC, et al. Pulmonary rehabilitation improves exercise capacity and quality of life in underweight patients with chronic obstructive pulmonary disease. Respirology. Accepted article published online ahead of print. doi:10.1111/j.1440-1843.2010.01895)
Their results showed the low BMI group started at lower levels of physical conditioning/exercise capacity on most measures compared to the normal BMI group, but that the low BMI group achieved greater percentage gains post-rehab on a number of the exercise performance measures. For example, the low BMI group achieved a 13% increase in peak exercise work load from readings taken at the beginning of the PR program. By comparison, the normal BMI group increased peak work load by 9%. Maximum oxygen uptake during peak exercise also increased by a greater percentage in the low BMI group (9%) compared to the normal weight group (6%). On most other exercise performance measures there was little difference in improvement levels between the two groups.
In the quality of life survey results, both groups showed marked improvement post-rehab in comparison with their pre-program ratings and there were no significant differences in quality of life improvements based on body weight. However, the low BMI group did report absolute quality of life scores (both pre and post rehab) that were notably lower than the normal weight group.
The results of these two studies seem to indicate that even though low BMI COPD patients enter rehab programs at lower levels of conditioning and perceived quality of life, they do achieve meaningful gains from PR and in some cases these gains are relatively higher in comparison with normal-to-overweight COPD patients.
Given that upwards of 40% of COPD patients are considered underweight, it seems worthwhile for researchers and practitioners to take a harder look at tailoring rehab program elements for COPD patients of different body weight classifications to improve the gains of all rehab participants. To learn more about pulmonary rehabilitation, please visit www.breathebetterforlife.com.
Friday, November 19, 2010
Wednesday, November 17, 2010
Four new studies show connection of antioxidant levels and respiratory function
Examine lung tissue and sputum samples from a COPD patient, current smoker or former smoker who reports chronic shortness of breath and compare them to people with healthy respiratory function and here is what you will find in the COPD/smoker samples:
1. Enlarged cells of the airway lining and surrounding muscles resulting in narrower airways
2. High concentrations of infection detecting/signaling proteins known as cytokines
3. High concentrations of infection fighting white blood cells known as macrophages
These are the classic indicators of what respiratory researchers call airway inflammation – believed to be a prime cause of shortness of breath.
Next, look at the chemical analysis of blood plasma from COPD patients, current smokers and former smokers who report chronic shortness of breath and compare them to people with normal respiratory function and here is what you will find in the COPD/smoker samples:
1. High concentrations of damaging pro-oxidant molecules known as free radicals
2. Low, deficient concentrations of protective anti-oxidant molecules that neutralize free radicals
These are the classic indicators of what scientists call oxidative stress – an imbalance between anti- and pro-oxidant molecules in the body. Oxidative stress is believed to be a prime cause of airway inflammation in COPD patients and smokers. Cigarette smoke and industrial pollutants are far and away the primary sources of pro-oxidative molecules consumed by those with poor respiratory health.
Four new studies published this month add to the growing number of previous studies which demonstrate the connection between antioxidant levels and healthy respiratory function:
1. A group of NIH researchers reported that of the 118 Buffalo, NY police officers evaluated in their study, those with higher blood plasma concentrations/consumption of Vitamin A and magnesium had better measures of forced vital capacity (FVC) compared to officers with low concentrations. Among police officers who are current/former smokers, the researchers found higher forced vital capacity and higher forced expiratory volume (FEV1) in those with increased intake of Vitamin E. FVC and FEV1 are common diagnostic measures of lung capacity and the quality of lung function. (Charles LE, et al. Antioxidants and Pulmonary Function Among Police Officers. J Occup Environ Med. 2010 Nov;52(11):1124-1131)
2. In Indonesia, a research team divided 108 COPD patients with upper respiratory infections into three groups. In one group, the patients received the antibiotic ciprofloxacin for 7 days. One group received cipro for 7 days and the herb Echinacea purpurea for a total of 14 days. The final group received cipro for 7 days and Echinacea plus the antioxidants zinc, selenium and Vitamin C for a total of 14 days. In particular, the researchers sought to understand if any of the three regimens were correlated with a reduced incidence and severity of post-infection COPD exacerbations (shortness of breath attacks which are strongly linked to inflammation). Their results showed significantly less severe and shorter exacerbation episodes following an upper respiratory infection among the group that received cipro/Echinacea/antioxidants compared with the other two groups. (Isbaniah F. Echinacea purpurea along with zinc, selenium and vitamin C to alleviate exacerbations of chronic obstructive pulmonary disease: results from a randomized controlled trial. J Clin Pharm Ther. 2010 Nov 10. doi: 10.1111/j.1365-2710.2010.01212.x. [Epub ahead of print])
3. In Taiwan, a study group desired to evaluate differences in blood plasma concentrations and dietary intake of antioxidants Vitamin A, C, E and carotenoids between 43 healthy Taiwanese subjects and 34 Taiwanese COPD patients. Further, the investigators examined the blood plasma concentrations of white blood cells that are markers of inflammation in the two groups. Their results definitively showed, “Compared to the healthy controls, COPD patients had significantly lower plasma concentrations of vitamins A, C, and E; alpha- and beta-carotene; and total carotenoids but significantly higher endogenous and H2O2-induced white blood cell DNA damage [inflammation]. Intakes of vitamin C and several carotenoids were lower in the COPD group, and COPD patients consumed significantly fewer vegetables and fruits than did the healthy controls. In conclusion, COPD patients in Taiwan have lower levels of antioxidative nutrients in their plasma and diet than do healthy people. Intakes of vitamin C and carotenoids are correlated with dietary habits.” (Lin YC, et al. Comparison of plasma and intake levels of antioxidant nutrients in patients with chronic obstructive pulmonary disease and healthy people in Taiwan: a case-control study. Asia Pac J Clin Nutr. 2010;19(3):393-401.)
4. At the annual conference of the American College of Chest Physicians earlier this month, a paper was presented by a group of researchers analyzing the dietary habits of 20 COPD patients for antioxidant content. They discovered that antioxidant deficiency was common (55% were deficient for Vitamin A, 45% for Vitamin C, 70% for Vitamin D, 90% for Vitamin E, and 25% were deficient in trace mineral selenium). The researchers further noted that the male COPD patients in the study who showed deficiencies in Vitamin A, C and D had poorer lung capacity than COPD patients who were not deficient in these antioxidants. (Khan MS, et al. The effect of antioxidant intake on pulmonary function in chronic disease is moderated by gender. Chest 2010; 138: 488A)
Many physicians recommend that COPD patients boost antioxidant levels through adding more antioxidant rich foods to their daily diet. Their primary concern with dietary supplements is that there are no consensus dosage recommendations for daily intake for respiratory support antioxidants at this time.
However, other researchers and practitioners recognize that the volume of pro-oxidant free radicals consumed through cigarette smoke is so significant that adding a few oranges to your daily diet is unlikely to make much of a dent in the imbalance of pro/anti oxidants. This latter group of physicians recommends complementing antioxidant rich foods with antioxidant dietary supplements. Since there are no standard recommended dosage guidelines for antioxidant consumption among those with poor respiratory health at this time, it is wise in our opinion from a safety and efficacy standpoint to consume a broad array of antioxidants in modest dosages rather than consume massive doses of one or two. This is why we incorporated a broad array of the antioxidants most studied in respiratory health studies in our Resplenish formula, www.resplenish.com.
For example, the above studied antioxidants may not be the most potent/effective for reducing inflammation/oxidative stress among those who have respiratory concerns. To wit, the most widely studied antioxidant related to airway inflammation is n-acetyl-cysteine (NAC). NAC is actually an essential amino acid that helps the body produce the most abundant antioxidant used in airway tissues, glutathione. Now you’d think that the simple solution would be to just consume glutathione directly but glutathione is not absorbed well as a stand-alone dietary ingredient. Therefore, respiratory researchers often utilize NAC to help the body boost its production of glutathione.
In our opinion, you have the power to rebalance your body’s supply of antioxidants and thereby alleviate oxidative stress and inflammation by:
1. Reduce pro-oxidant molecule intake (i.e. reduce or eliminate cigarette consumption – a massive source of pro-oxidant molecules)
2. Increase anti-oxidant molecule intake (through antioxidant rich foods such as vegetables, fruits, grain cereals, teas, legumes, and nuts - and/or dietary supplements containing antioxidants).
For more information about airway inflammation, food sources of antioxidants, and dietary supplement antioxidant ingredients that are supportive of healthy respiratory function, visit our Resplenish web site by clicking here.
1. Enlarged cells of the airway lining and surrounding muscles resulting in narrower airways
2. High concentrations of infection detecting/signaling proteins known as cytokines
3. High concentrations of infection fighting white blood cells known as macrophages
These are the classic indicators of what respiratory researchers call airway inflammation – believed to be a prime cause of shortness of breath.
Next, look at the chemical analysis of blood plasma from COPD patients, current smokers and former smokers who report chronic shortness of breath and compare them to people with normal respiratory function and here is what you will find in the COPD/smoker samples:
1. High concentrations of damaging pro-oxidant molecules known as free radicals
2. Low, deficient concentrations of protective anti-oxidant molecules that neutralize free radicals
These are the classic indicators of what scientists call oxidative stress – an imbalance between anti- and pro-oxidant molecules in the body. Oxidative stress is believed to be a prime cause of airway inflammation in COPD patients and smokers. Cigarette smoke and industrial pollutants are far and away the primary sources of pro-oxidative molecules consumed by those with poor respiratory health.
Four new studies published this month add to the growing number of previous studies which demonstrate the connection between antioxidant levels and healthy respiratory function:
1. A group of NIH researchers reported that of the 118 Buffalo, NY police officers evaluated in their study, those with higher blood plasma concentrations/consumption of Vitamin A and magnesium had better measures of forced vital capacity (FVC) compared to officers with low concentrations. Among police officers who are current/former smokers, the researchers found higher forced vital capacity and higher forced expiratory volume (FEV1) in those with increased intake of Vitamin E. FVC and FEV1 are common diagnostic measures of lung capacity and the quality of lung function. (Charles LE, et al. Antioxidants and Pulmonary Function Among Police Officers. J Occup Environ Med. 2010 Nov;52(11):1124-1131)
2. In Indonesia, a research team divided 108 COPD patients with upper respiratory infections into three groups. In one group, the patients received the antibiotic ciprofloxacin for 7 days. One group received cipro for 7 days and the herb Echinacea purpurea for a total of 14 days. The final group received cipro for 7 days and Echinacea plus the antioxidants zinc, selenium and Vitamin C for a total of 14 days. In particular, the researchers sought to understand if any of the three regimens were correlated with a reduced incidence and severity of post-infection COPD exacerbations (shortness of breath attacks which are strongly linked to inflammation). Their results showed significantly less severe and shorter exacerbation episodes following an upper respiratory infection among the group that received cipro/Echinacea/antioxidants compared with the other two groups. (Isbaniah F. Echinacea purpurea along with zinc, selenium and vitamin C to alleviate exacerbations of chronic obstructive pulmonary disease: results from a randomized controlled trial. J Clin Pharm Ther. 2010 Nov 10. doi: 10.1111/j.1365-2710.2010.01212.x. [Epub ahead of print])
3. In Taiwan, a study group desired to evaluate differences in blood plasma concentrations and dietary intake of antioxidants Vitamin A, C, E and carotenoids between 43 healthy Taiwanese subjects and 34 Taiwanese COPD patients. Further, the investigators examined the blood plasma concentrations of white blood cells that are markers of inflammation in the two groups. Their results definitively showed, “Compared to the healthy controls, COPD patients had significantly lower plasma concentrations of vitamins A, C, and E; alpha- and beta-carotene; and total carotenoids but significantly higher endogenous and H2O2-induced white blood cell DNA damage [inflammation]. Intakes of vitamin C and several carotenoids were lower in the COPD group, and COPD patients consumed significantly fewer vegetables and fruits than did the healthy controls. In conclusion, COPD patients in Taiwan have lower levels of antioxidative nutrients in their plasma and diet than do healthy people. Intakes of vitamin C and carotenoids are correlated with dietary habits.” (Lin YC, et al. Comparison of plasma and intake levels of antioxidant nutrients in patients with chronic obstructive pulmonary disease and healthy people in Taiwan: a case-control study. Asia Pac J Clin Nutr. 2010;19(3):393-401.)
4. At the annual conference of the American College of Chest Physicians earlier this month, a paper was presented by a group of researchers analyzing the dietary habits of 20 COPD patients for antioxidant content. They discovered that antioxidant deficiency was common (55% were deficient for Vitamin A, 45% for Vitamin C, 70% for Vitamin D, 90% for Vitamin E, and 25% were deficient in trace mineral selenium). The researchers further noted that the male COPD patients in the study who showed deficiencies in Vitamin A, C and D had poorer lung capacity than COPD patients who were not deficient in these antioxidants. (Khan MS, et al. The effect of antioxidant intake on pulmonary function in chronic disease is moderated by gender. Chest 2010; 138: 488A)
Many physicians recommend that COPD patients boost antioxidant levels through adding more antioxidant rich foods to their daily diet. Their primary concern with dietary supplements is that there are no consensus dosage recommendations for daily intake for respiratory support antioxidants at this time.
However, other researchers and practitioners recognize that the volume of pro-oxidant free radicals consumed through cigarette smoke is so significant that adding a few oranges to your daily diet is unlikely to make much of a dent in the imbalance of pro/anti oxidants. This latter group of physicians recommends complementing antioxidant rich foods with antioxidant dietary supplements. Since there are no standard recommended dosage guidelines for antioxidant consumption among those with poor respiratory health at this time, it is wise in our opinion from a safety and efficacy standpoint to consume a broad array of antioxidants in modest dosages rather than consume massive doses of one or two. This is why we incorporated a broad array of the antioxidants most studied in respiratory health studies in our Resplenish formula, www.resplenish.com.
For example, the above studied antioxidants may not be the most potent/effective for reducing inflammation/oxidative stress among those who have respiratory concerns. To wit, the most widely studied antioxidant related to airway inflammation is n-acetyl-cysteine (NAC). NAC is actually an essential amino acid that helps the body produce the most abundant antioxidant used in airway tissues, glutathione. Now you’d think that the simple solution would be to just consume glutathione directly but glutathione is not absorbed well as a stand-alone dietary ingredient. Therefore, respiratory researchers often utilize NAC to help the body boost its production of glutathione.
In our opinion, you have the power to rebalance your body’s supply of antioxidants and thereby alleviate oxidative stress and inflammation by:
1. Reduce pro-oxidant molecule intake (i.e. reduce or eliminate cigarette consumption – a massive source of pro-oxidant molecules)
2. Increase anti-oxidant molecule intake (through antioxidant rich foods such as vegetables, fruits, grain cereals, teas, legumes, and nuts - and/or dietary supplements containing antioxidants).
For more information about airway inflammation, food sources of antioxidants, and dietary supplement antioxidant ingredients that are supportive of healthy respiratory function, visit our Resplenish web site by clicking here.
Monday, November 15, 2010
Add tai chi to spice up your exercise program & improve your breathing
Over the past decade, tai chi, the ancient Chinese martial arts form that emphasizes gentle, flowing movements and meditative breathing techniques has received increasing research attention for a range of benefits including stress-relief, balance/coordination, and aerobic conditioning among people with various health conditions (91 studies published in 2010 alone).
While the amount of past tai chi research related to COPD is scant (less than a handful of studies in total), there are some intrepid researchers who continue to investigate tai chi for COPD patients for some very valid and specific reasons, including:
The study, conducted at a Boston area hospital, involved 10 COPD patients split into two groups (5 who participated in a 12-week group tai chi program, and 5 who did not participate in an exercise program of any kind). The researchers measured all 10 patients exercise capacity at the beginning of the study and again after the 12-week tai chi program had concluded. In addition, the study participants completed standard quality of life/respiratory symptom questionnaires at the outset of research effort and again at the end. The investigators then evaluated the changes between the baseline and end-of-study measures for each of these diagnostic tools in both groups.
The 12-week tai chi program took place twice each week for one hour each session and included warm-up exercises, 5 simplified tai chi movements, visualization techniques, and traditional breathing techniques. Tai chi participants were provided a 35 minute instructional video that outlined the exercises presented in class and patients were encouraged to practice the movements at home in between sessions (most did).
At the end of the study, the researchers reported that the most pronounced difference between the two groups was in their self-reported breathlessness ratings on the respiratory symptoms questionnaire. The tai chi group rated a 33% improvement in their sense of breathlessness at the end of the program compared to their pre-tai chi ratings. This was sharply higher than the 7% improvement in perceived breathlessness reported by the control/non-exercising group.
Further, while the research team did not comment on their findings related to balance and coordination, we found an intriguing result in their data that may point to balance/coordination benefits of tai chi for COPD patients. One of the quality of life/respiratory symptom questionnaire sections completed by study participants examines mastery of activities of daily living (an evaluation of how often COPD patients participate in every-day activities and how they feel about their ability to participate these activities). The tai chi group in the study reported a 54% jump in their mastery ratings at the end of the study while the control/non-exercising group registered a 5% drop in mastery. In our opinion, the perceived improvement in mastery ratings by the tai chi group is likely driven by greater confidence in moving around as a result of improved balance and coordination gained through the tai chi sessions.
With regard to exercise capacity, the researchers found a small improvement (6%) in the distance walked by study participants in 6 minutes (a standard diagnostic test to assess physical condition in respiratory health studies) in comparison to a 10% drop in distance walked for the non-exercising/control group. These variances were not considered statistically significant enough by the study authors to declare that tai chi improves exercise capacity but they do show some benefit. We reported a similar finding in an article we wrote about a March 2010 tai chi COPD study you can read by clicking here.
So for those of you seeking to start or spice up an exercise program, tai chi may be an option worth exploring. Tai chi classes are widely offered in health clubs and in community centers across the country and are likely available in your local area (many of these classes are geared specifically for elderly and less mobile participants). Additionally, there are a range of videos in DVD/CD format that demonstrate the basic movements that you can use to try tai chi at home. We’ve highlighted a few of these instructional videos in our Breathe Better Marketplace hosted by amazon.com. Click on the link titled tai chi DVDs in the right hand side bar of the Breathe Better Marketplace site to learn more about the titles we selected.
While the amount of past tai chi research related to COPD is scant (less than a handful of studies in total), there are some intrepid researchers who continue to investigate tai chi for COPD patients for some very valid and specific reasons, including:
- Long-term adherence to exercise programs is a significant problem among COPD patients. Past tai chi research studies related to other health conditions have shown that including tai chi as part of an ongoing exercise program notably lengthens the span of time an exercise program is maintained. The reigning thought behind why this happens is that over time traditional exercise programs become boring/tedious and that participating in group tai chi sessions keeps exercise fun/interesting and therefore improves adherence. Thus far, however, no studies have either explored or reported such exercise compliance improvements among COPD patients.
- Past studies among patients with poor heart health have shown that tai chi boosts exercise capacity and physical conditioning. While recent COPD studies have shown modest improvements in physical condition/exercise capacity among patients in a tai chi program, the improvements have not yet been shown to be clinically significant and certainly have not been tested yet head-to-head against the proven COPD treatment pulmonary rehabilitation.
- Past COPD studies have shown that those participating in a tai chi program report less severe breathlessness symptoms than COPD patients that don’t exercise. For those unwilling or unable to participate in a traditional exercise program, tai chi is viewed as a potential method of boosting physical activity and reducing perceived breathlessness. Researchers believe that the meditative breathing techniques taught/practiced in tai chi programs are the prime drivers of this effect.
- Poor balance and coordination is a common symptom of sedentary COPD patients. The less physically active a person is the weaker muscles and bones become. Over time, this weakness results in poor balance/coordination. Past tai chi studies among elderly patients and those with muscular dysfunction have shown a marked improvement in balance/coordination. Since one of the core principles of tai chi as a martial arts form is to maintain balance when defending oneself against an attacker, the tai chi movements taught and practiced are intended to explicitly improve balance.
The study, conducted at a Boston area hospital, involved 10 COPD patients split into two groups (5 who participated in a 12-week group tai chi program, and 5 who did not participate in an exercise program of any kind). The researchers measured all 10 patients exercise capacity at the beginning of the study and again after the 12-week tai chi program had concluded. In addition, the study participants completed standard quality of life/respiratory symptom questionnaires at the outset of research effort and again at the end. The investigators then evaluated the changes between the baseline and end-of-study measures for each of these diagnostic tools in both groups.
The 12-week tai chi program took place twice each week for one hour each session and included warm-up exercises, 5 simplified tai chi movements, visualization techniques, and traditional breathing techniques. Tai chi participants were provided a 35 minute instructional video that outlined the exercises presented in class and patients were encouraged to practice the movements at home in between sessions (most did).
At the end of the study, the researchers reported that the most pronounced difference between the two groups was in their self-reported breathlessness ratings on the respiratory symptoms questionnaire. The tai chi group rated a 33% improvement in their sense of breathlessness at the end of the program compared to their pre-tai chi ratings. This was sharply higher than the 7% improvement in perceived breathlessness reported by the control/non-exercising group.
Further, while the research team did not comment on their findings related to balance and coordination, we found an intriguing result in their data that may point to balance/coordination benefits of tai chi for COPD patients. One of the quality of life/respiratory symptom questionnaire sections completed by study participants examines mastery of activities of daily living (an evaluation of how often COPD patients participate in every-day activities and how they feel about their ability to participate these activities). The tai chi group in the study reported a 54% jump in their mastery ratings at the end of the study while the control/non-exercising group registered a 5% drop in mastery. In our opinion, the perceived improvement in mastery ratings by the tai chi group is likely driven by greater confidence in moving around as a result of improved balance and coordination gained through the tai chi sessions.
With regard to exercise capacity, the researchers found a small improvement (6%) in the distance walked by study participants in 6 minutes (a standard diagnostic test to assess physical condition in respiratory health studies) in comparison to a 10% drop in distance walked for the non-exercising/control group. These variances were not considered statistically significant enough by the study authors to declare that tai chi improves exercise capacity but they do show some benefit. We reported a similar finding in an article we wrote about a March 2010 tai chi COPD study you can read by clicking here.
So for those of you seeking to start or spice up an exercise program, tai chi may be an option worth exploring. Tai chi classes are widely offered in health clubs and in community centers across the country and are likely available in your local area (many of these classes are geared specifically for elderly and less mobile participants). Additionally, there are a range of videos in DVD/CD format that demonstrate the basic movements that you can use to try tai chi at home. We’ve highlighted a few of these instructional videos in our Breathe Better Marketplace hosted by amazon.com. Click on the link titled tai chi DVDs in the right hand side bar of the Breathe Better Marketplace site to learn more about the titles we selected.
Monday, November 8, 2010
Lung inflammation persists in ex-smoking COPD patients
For many years, smoking cessation advocates have extolled the short-term and long-term benefits associated with permanently quitting cigarettes. Some of these benefits happen quite quickly while others accrue over time. Indeed the American Lung Association and U.S. Surgeon General’s office have categorized a number of these benefits that you can view by clicking here.
One such benefit is the reduction of airway inflammation – inflammation is believed to be a prime cause of shortness of breath among those with poor respiratory health. However, a new study published in the journal Chest revealed that COPD study participants with confirmed emphysema still showed significant markers of inflammation even though they had quit smoking for an average 15 years. (Miller M, et al. Persistent airway inflammation and emphysema progression on CT in ex-smokers observed for 4 years. Chest. DOI 10.1378/chest.10-0705. Epub online ahead of print)
In the study, the research team recruited 10 ex-smoking COPD patients who had an emphysema diagnosis confirmed by a CT scan. As controls, the investigators also included 8 healthy non-smokers, and 7 healthy smokers (i.e. current smokers who showed no evidence of lung disease).
The researchers collected sputum samples from each group at the outset of the study (baseline measure) and then four years later collected sputum samples again. They examined the sputum samples for the content of certain proteins and white blood cells that are present in large numbers in patients with significant lung inflammation. The researchers also chemically verified that the ex-smokers and non-smokers in the study were not active smokers at the baseline or end-study measurements.
Upon comparing the baseline and end-of-study inflammation markers between the three groups, the researchers found that the COPD-Emphysema group still showed significantly higher counts of the inflammation related proteins and white blood cells than either the non-smoking group or the healthy smoking group. Indeed, the actual inflammation marker counts in the COPD-Emphysema group were relatively unchanged between the outset measures and the end-of-study measures.
As the research team concluded, “In summary, in this study we have demonstrated that in subjects with GOLD stage IIb COPD-E (moderate COPD with emphysema), even after at least 4 years of not smoking, airway inflammation persists and that this is associated with continued airspace destruction as revealed by increased emphysema on CT-scan. This continued inflammation and airspace destruction in ex-smokers with GOLD stage IIb COPD-E could likely be more extensive if these subjects continued to smoke and thus it remains important that smokers with COPD should quit smoking. However, this study provides further evidence that once tobacco smoke initiates and causes progression as far as GOLD Stage IIb COPD-E, discontinuing smoking may slow but not necessarily halt the persistent inflammation and progression of this severity of COPD-E.”
What’s the takeaway? While smoking cessation confers many benefits for COPD patients (both those with emphysema and chronic bronchitis), it does not necessarily lead to a reduction in inflammation among emphysema patients.
As we have written previously, there are other steps that COPD patients can take to reduce inflammation including engaging in a regular exercise program, increasing dietary intake of antioxidants, complementing food antioxidant intake with dietary supplements, and increasing direct exposure to sunlight. For more information about these valuable action steps, we recommend you consider reading our Feel Better NOW Plan.
One such benefit is the reduction of airway inflammation – inflammation is believed to be a prime cause of shortness of breath among those with poor respiratory health. However, a new study published in the journal Chest revealed that COPD study participants with confirmed emphysema still showed significant markers of inflammation even though they had quit smoking for an average 15 years. (Miller M, et al. Persistent airway inflammation and emphysema progression on CT in ex-smokers observed for 4 years. Chest. DOI 10.1378/chest.10-0705. Epub online ahead of print)
In the study, the research team recruited 10 ex-smoking COPD patients who had an emphysema diagnosis confirmed by a CT scan. As controls, the investigators also included 8 healthy non-smokers, and 7 healthy smokers (i.e. current smokers who showed no evidence of lung disease).
The researchers collected sputum samples from each group at the outset of the study (baseline measure) and then four years later collected sputum samples again. They examined the sputum samples for the content of certain proteins and white blood cells that are present in large numbers in patients with significant lung inflammation. The researchers also chemically verified that the ex-smokers and non-smokers in the study were not active smokers at the baseline or end-study measurements.
Upon comparing the baseline and end-of-study inflammation markers between the three groups, the researchers found that the COPD-Emphysema group still showed significantly higher counts of the inflammation related proteins and white blood cells than either the non-smoking group or the healthy smoking group. Indeed, the actual inflammation marker counts in the COPD-Emphysema group were relatively unchanged between the outset measures and the end-of-study measures.
As the research team concluded, “In summary, in this study we have demonstrated that in subjects with GOLD stage IIb COPD-E (moderate COPD with emphysema), even after at least 4 years of not smoking, airway inflammation persists and that this is associated with continued airspace destruction as revealed by increased emphysema on CT-scan. This continued inflammation and airspace destruction in ex-smokers with GOLD stage IIb COPD-E could likely be more extensive if these subjects continued to smoke and thus it remains important that smokers with COPD should quit smoking. However, this study provides further evidence that once tobacco smoke initiates and causes progression as far as GOLD Stage IIb COPD-E, discontinuing smoking may slow but not necessarily halt the persistent inflammation and progression of this severity of COPD-E.”
What’s the takeaway? While smoking cessation confers many benefits for COPD patients (both those with emphysema and chronic bronchitis), it does not necessarily lead to a reduction in inflammation among emphysema patients.
As we have written previously, there are other steps that COPD patients can take to reduce inflammation including engaging in a regular exercise program, increasing dietary intake of antioxidants, complementing food antioxidant intake with dietary supplements, and increasing direct exposure to sunlight. For more information about these valuable action steps, we recommend you consider reading our Feel Better NOW Plan.
Friday, November 5, 2010
Mediterranean diet combined with physical activity boosts antioxidant levels
In past articles we have extolled the benefits of regular exercise and antioxidant consumption (through food and nutritional supplementation) for COPD patients, smokers and others who experience chronic shortness of breath.
So we thought it worthwhile to bring to your attention a new study demonstrating the value of increased physical activity combined with a Mediterranean diet. While the study is not focused specifically on COPD patients or smokers, it is in our opinion relevant to anyone seeking to improve their respiratory and cardiovascular health.
In the study, the Greece based research team surveyed 3,042 Greek citizens about their daily physical activity levels, dietary consumption, and lifestyle behaviors. In addition, study participants received several diagnostic evaluations including blood pressure measurements, and blood draws to assess antioxidant levels and cholesterol levels.
The purpose of the study was to determine whether there was a positive correlation between physical activity level and the so-called “Mediterranean” diet on total antioxidant capacity (TAC). Total antioxidant capacity is a blood plasma measure of the combined antioxidant particles available to your body from all antioxidant nutrients consumed through diet or produced by the body.
Commenting on the Mediterranean diet, the study authors noted, “The dietary characteristics found in the olive growing areas of the Mediterranean region (i.e. Greece, Spain, Italy and France) have been…associated with lower incidence of cardiovascular diseases, metabolic disorders and several types of cancer.”
The foods that form the basis of a Mediterranean diet include whole grains, fruits, vegetables, olive oil, nuts and seeds combined with an emphasis on poultry and fish versus red meat. In addition, many proponents of the Mediterranean diet also suggest red wine for those who consume alcohol in moderation. For a more complete description of the Mediterranean diet, click here to read the Mayo Clinic summary.
In previous studies, it has been shown that people who regularly exercise have higher TAC levels than those who exercise less. Additionally, previous studies on the Mediterranean diet have shown that those closely following the Mediterranean diet have higher TAC levels compared to those consuming more of a Western diet (a diet that typically has higher levels of red meat versus fish/poultry, and a greater percentage of calories from refined foods with high sugar/salt content versus fruits, vegetables, and other plant based foods).
So the researchers in this investigation desired to know whether there was an additive effect on TAC from closely following a Mediterranean diet and engaging in regular physical activity as opposed to pursuing one of these two lifestyle options alone. (Kavouras SA, et al. Physical activity and Adherence to Mediterranean Diet Increase Total Antioxidant Capacity: The ATTICA Study. Cardiology Research and Practice. 2010 Oct 20;2011:248626).
Their results showed that those study participants who most closely followed the Mediterranean diet and exercised the most had mean TAC levels of 288 umol/L (umol/L is a measurement describing the total number of antioxidant molecules present in the blood plasma samples of the study participants).
Those who closely followed a Mediterranean diet but were physically inactive had mean TAC levels that were 11% lower than the combined high Med diet/high exercise group. Among study subjects who exercised heavily but did not follow a Mediterranean diet closely, TAC levels were 15% lower than the combined high Med diet/high exercise group.
By comparison, those who were the least physically active and did not consume a Mediterranean style diet had TAC levels of 230 umol/L , or 20% lower blood level concentration of antioxidants.
So the results clearly showed the additive benefit of a closely followed Mediterranean diet and high levels of regular physical activity on the body’s antioxidant reserves. It should be noted that the participants of this study were considered “healthy adults”, not people with advanced cardiovascular or respiratory conditions.
You might ask – so what?
Well, it is believed by scientists that an imbalance between pro-oxidative molecules known as free radicals and anti-oxidant molecules which neutralize the effects of pro-oxidants are significantly correlated with poor cardiovascular and respiratory health.
We’ve previously discussed such evidence related to the effects of cigarette smoke in depleting the body’s supply of antioxidants and in so doing contributing to airway inflammation. Chronic airway inflammation is believed to be the main cause of chronic shortness of breath.
As another recent dietary antioxidant study noted, “The imbalance of oxidant/antioxidant plays an important role in the development of chronic obstructive pulmonary disease (COPD). There is increasing evidence that individuals with high antioxidative nutrient levels in the diet or in blood tend to maintain better lung function.” (Lin YC, et al. Comparison of plasma and intake levels of antioxidant nutrients in patients with chronic obstructive pulmonary disease and healthy people in Taiwan: a case-control study. Asia Pac J Clin Nutr. 2010;19(3):393-401.)
Therefore, steps one can take to boost antioxidant levels in the body are beneficial to help protect the heart, lungs and other vital body organs from the damage exacted by an over-abundance of pro-oxidative molecules. This study confirms that closely following a Mediterranean diet and engaging in regular physical activity are powerful strategies that you can employ to boost your body’s supply of antioxidants.
So we thought it worthwhile to bring to your attention a new study demonstrating the value of increased physical activity combined with a Mediterranean diet. While the study is not focused specifically on COPD patients or smokers, it is in our opinion relevant to anyone seeking to improve their respiratory and cardiovascular health.
In the study, the Greece based research team surveyed 3,042 Greek citizens about their daily physical activity levels, dietary consumption, and lifestyle behaviors. In addition, study participants received several diagnostic evaluations including blood pressure measurements, and blood draws to assess antioxidant levels and cholesterol levels.
The purpose of the study was to determine whether there was a positive correlation between physical activity level and the so-called “Mediterranean” diet on total antioxidant capacity (TAC). Total antioxidant capacity is a blood plasma measure of the combined antioxidant particles available to your body from all antioxidant nutrients consumed through diet or produced by the body.
Commenting on the Mediterranean diet, the study authors noted, “The dietary characteristics found in the olive growing areas of the Mediterranean region (i.e. Greece, Spain, Italy and France) have been…associated with lower incidence of cardiovascular diseases, metabolic disorders and several types of cancer.”
The foods that form the basis of a Mediterranean diet include whole grains, fruits, vegetables, olive oil, nuts and seeds combined with an emphasis on poultry and fish versus red meat. In addition, many proponents of the Mediterranean diet also suggest red wine for those who consume alcohol in moderation. For a more complete description of the Mediterranean diet, click here to read the Mayo Clinic summary.
In previous studies, it has been shown that people who regularly exercise have higher TAC levels than those who exercise less. Additionally, previous studies on the Mediterranean diet have shown that those closely following the Mediterranean diet have higher TAC levels compared to those consuming more of a Western diet (a diet that typically has higher levels of red meat versus fish/poultry, and a greater percentage of calories from refined foods with high sugar/salt content versus fruits, vegetables, and other plant based foods).
So the researchers in this investigation desired to know whether there was an additive effect on TAC from closely following a Mediterranean diet and engaging in regular physical activity as opposed to pursuing one of these two lifestyle options alone. (Kavouras SA, et al. Physical activity and Adherence to Mediterranean Diet Increase Total Antioxidant Capacity: The ATTICA Study. Cardiology Research and Practice. 2010 Oct 20;2011:248626).
Their results showed that those study participants who most closely followed the Mediterranean diet and exercised the most had mean TAC levels of 288 umol/L (umol/L is a measurement describing the total number of antioxidant molecules present in the blood plasma samples of the study participants).
Those who closely followed a Mediterranean diet but were physically inactive had mean TAC levels that were 11% lower than the combined high Med diet/high exercise group. Among study subjects who exercised heavily but did not follow a Mediterranean diet closely, TAC levels were 15% lower than the combined high Med diet/high exercise group.
By comparison, those who were the least physically active and did not consume a Mediterranean style diet had TAC levels of 230 umol/L , or 20% lower blood level concentration of antioxidants.
So the results clearly showed the additive benefit of a closely followed Mediterranean diet and high levels of regular physical activity on the body’s antioxidant reserves. It should be noted that the participants of this study were considered “healthy adults”, not people with advanced cardiovascular or respiratory conditions.
You might ask – so what?
Well, it is believed by scientists that an imbalance between pro-oxidative molecules known as free radicals and anti-oxidant molecules which neutralize the effects of pro-oxidants are significantly correlated with poor cardiovascular and respiratory health.
We’ve previously discussed such evidence related to the effects of cigarette smoke in depleting the body’s supply of antioxidants and in so doing contributing to airway inflammation. Chronic airway inflammation is believed to be the main cause of chronic shortness of breath.
As another recent dietary antioxidant study noted, “The imbalance of oxidant/antioxidant plays an important role in the development of chronic obstructive pulmonary disease (COPD). There is increasing evidence that individuals with high antioxidative nutrient levels in the diet or in blood tend to maintain better lung function.” (Lin YC, et al. Comparison of plasma and intake levels of antioxidant nutrients in patients with chronic obstructive pulmonary disease and healthy people in Taiwan: a case-control study. Asia Pac J Clin Nutr. 2010;19(3):393-401.)
Therefore, steps one can take to boost antioxidant levels in the body are beneficial to help protect the heart, lungs and other vital body organs from the damage exacted by an over-abundance of pro-oxidative molecules. This study confirms that closely following a Mediterranean diet and engaging in regular physical activity are powerful strategies that you can employ to boost your body’s supply of antioxidants.
Monday, November 1, 2010
COPD and air travel
For those who contend with persistent shortness of breath, the prospect of air travel can be intimidating. In fact, many COPD patients opt not to travel by air for fear of experiencing a shortness of breath attack during the flight (known alternatively as “hypoxia”, “dyspnea” or “air hunger” among pulmonary medicine professionals).
According to a new research paper published in the journal Respiratory Medicine, this is an understandable concern given that “At maximal cruising altitude, the cabin pressure is allowed to decrease to the equivalent of 2438 meters altitude. This may cause a significant decrease in arterial oxygen tension in patients with respiratory disease, such as chronic obstructive pulmonary disease (COPD).”
However, despite the lower in-flight air pressure and anxiety regarding travel, this new study showed that a majority of COPD patients participating in the study did in fact travel by air (54%) and a minority of these flyers actually experienced dyspnea and air hunger in-flight (28%). (Edvardsen A, et al. High prevalence of respiratory symptoms during air travel in patients with COPD. Respiratory Medicine. Epub online ahead of print. Doi:10.1016/j.rmed.2010.10.006).
The Norway-based study sought to examine and compare the air travel behavior of 391 COPD patients and 184 control subjects who did not have COPD. In particular, the researchers desired to understand the prevalence of dyspnea/air hunger among COPD patients while traveling and whether there were any pre-flight factors that influenced who might experience hypoxia/air hunger.
Of the 54% of COPD patients who had traveled by air within the previous two years, 50% had flown at least twice and 33% reported having flown four or more times. The most common flight duration noted by flying COPD patients was 3-6 hours. Surprisingly, only 9% of the 46% non-flying COPD patients reported avoiding air travel due to their lung condition (the most common reason for not flying among this group was “no reason to travel” –noted by 79% of the non-flying COPD patients).
By comparison, 86% of the control subjects without COPD had flown within the previous two years with approximately 40% having flown at least two times and 55% having flown four or more times. The average flight duration was about the same for control subjects as for COPD patients.
As one can see from these findings, fewer COPD patients participating in the study traveled by air versus those without COPD, and those COPD patients who did fly took fewer flights. Further, as one will see below, COPD patients were more apt to report in-flight shortness of breath symptoms.
When looking at the percentage of both groups who experienced hypoxia-like symptoms such as air hunger, 28% of the flying COPD patients in the study reported such symptoms. By comparison, 16% of the flying non-COPD control subjects in the study reported in-flight shortness of breath symptoms. After adjusting for external influencing factors (referred to by researchers as confounders), the study team concluded that flying COPD patients were 3 times more likely to experience shortness of breath related symptoms than those without COPD.
But…
Of particular note to us were the findings that the COPD patients who reported the fewest hypoxia symptoms during flight were those patients who reported low levels of dyspnea pre-flight and/or those who walked longer distances on the 6 minute walk test pre-flight (a common diagnostic tool used by respiratory care professionals to assess overall physical condition of COPD patients).
In our view, these results seem to indicate that COPD patients who are in better pre-flight aerobic conditioning are less likely to experience significant shortness of breath when traveling by air.
While the researchers offered no recommendations for improving air travel experience for COPD patients in their paper, we think their results suggest a few proactive steps for those who would like to travel by air but have decided against it in the past because of anxiety related to a potential shortness of breath episode:
According to a new research paper published in the journal Respiratory Medicine, this is an understandable concern given that “At maximal cruising altitude, the cabin pressure is allowed to decrease to the equivalent of 2438 meters altitude. This may cause a significant decrease in arterial oxygen tension in patients with respiratory disease, such as chronic obstructive pulmonary disease (COPD).”
However, despite the lower in-flight air pressure and anxiety regarding travel, this new study showed that a majority of COPD patients participating in the study did in fact travel by air (54%) and a minority of these flyers actually experienced dyspnea and air hunger in-flight (28%). (Edvardsen A, et al. High prevalence of respiratory symptoms during air travel in patients with COPD. Respiratory Medicine. Epub online ahead of print. Doi:10.1016/j.rmed.2010.10.006).
The Norway-based study sought to examine and compare the air travel behavior of 391 COPD patients and 184 control subjects who did not have COPD. In particular, the researchers desired to understand the prevalence of dyspnea/air hunger among COPD patients while traveling and whether there were any pre-flight factors that influenced who might experience hypoxia/air hunger.
Of the 54% of COPD patients who had traveled by air within the previous two years, 50% had flown at least twice and 33% reported having flown four or more times. The most common flight duration noted by flying COPD patients was 3-6 hours. Surprisingly, only 9% of the 46% non-flying COPD patients reported avoiding air travel due to their lung condition (the most common reason for not flying among this group was “no reason to travel” –noted by 79% of the non-flying COPD patients).
By comparison, 86% of the control subjects without COPD had flown within the previous two years with approximately 40% having flown at least two times and 55% having flown four or more times. The average flight duration was about the same for control subjects as for COPD patients.
As one can see from these findings, fewer COPD patients participating in the study traveled by air versus those without COPD, and those COPD patients who did fly took fewer flights. Further, as one will see below, COPD patients were more apt to report in-flight shortness of breath symptoms.
When looking at the percentage of both groups who experienced hypoxia-like symptoms such as air hunger, 28% of the flying COPD patients in the study reported such symptoms. By comparison, 16% of the flying non-COPD control subjects in the study reported in-flight shortness of breath symptoms. After adjusting for external influencing factors (referred to by researchers as confounders), the study team concluded that flying COPD patients were 3 times more likely to experience shortness of breath related symptoms than those without COPD.
But…
Of particular note to us were the findings that the COPD patients who reported the fewest hypoxia symptoms during flight were those patients who reported low levels of dyspnea pre-flight and/or those who walked longer distances on the 6 minute walk test pre-flight (a common diagnostic tool used by respiratory care professionals to assess overall physical condition of COPD patients).
In our view, these results seem to indicate that COPD patients who are in better pre-flight aerobic conditioning are less likely to experience significant shortness of breath when traveling by air.
While the researchers offered no recommendations for improving air travel experience for COPD patients in their paper, we think their results suggest a few proactive steps for those who would like to travel by air but have decided against it in the past because of anxiety related to a potential shortness of breath episode:
- Begin and maintain an exercise program 6-8 weeks prior to flying. Many COPD research studies have conclusively demonstrated that a regular program of aerobic and strength training exercise (the foundations of the COPD treatment known as pulmonary rehabilitation) does reduce perceived shortness of breath and does improve physical stamina, strength and endurance. If you have Stage II or Stage III COPD, ask your doctor for a referral to a pulmonary rehabilitation program in your area. Alternatively, if you can’t gain entry to a pulmonary rehab program, ask your doctor to recommend an exercise program appropriate for your particular circumstance. To learn more about our recommended exercise program for COPD patients, smokers and those who suffer from chronic shortness of breath, consider purchasing our Breathe Better for Life guidebook and companion CD-ROM, www.breathebetterforlife.com. We’ve patterned our program based on guidelines published by the American Thoracic Society, European Respiratory Society and the American College of Sports Medicine.
- Learn and practice the pursed-lips breathing technique leading up to the flight – and use this helpful breathing technique in-flight if you start to feel uncomfortable. This technique helps you clear old/used air out of your lungs in order to accommodate more new, oxygenated air. While a more robust description of the pursed-lips breathing technique and narrated pictorial demonstration are included on our Breathe Better for Life CD-ROM, we have posted a brief description of the technique on our Resplenish web site that you can access by clicking here. Resplenish is our new respiratory support nutritional supplement intended to help reduce inflammation/oxidative stress and improve exercise tolerance.
- Consider increasing your intake of antioxidants for at least 6-8 weeks prior to traveling to help reduce inflammation/oxidative stress. Numerous respiratory health-focused studies have been published over the past decade examining the anti-inflammatory properties of a range of antioxidants given that inflammation is believed by pulmonary researchers to be caused by an imbalance between pro-oxidative and anti-oxidative molecules. To read more about what causes inflammation and how antioxidants can help, click here to read our inflammation-related article “War of the Worlds in your lungs” on our Resplenish web site.
- Review our checklist recommendations for other COPD patient pre-flight preparations excerpted from the Breathe Better for Life CD-ROM by clicking here. Though many of these recommendations are for COPD patients who utilize supplemental oxygen, a number of the checklist items are useful to non-oxygen using COPD patients.
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