In researching topics for the current edition of our e-letters, we ran across a review article examining the how to make pulmonary rehabilitation a greater success component of COPD disease management.
As readers of our blog, e-letters, and buyers of our Breathe Better for Life guide/CD know, we are emphatic supporters of the value of pulmonary rehabilitation. This treatment option has been shown in three decades worth of research studies to reduce breathlessness, improve physical conditioning, improve patient quality of life, reduce exacerbations and associated hospital stays/health care costs.
For those who are unaware, the cornerstone element of pulmonary rehabilitation is observed guided exercise (aerobic and strength training). Other elements of pulmonary rehab include training of breathing and airway clearing techniques, and counseling on nutrition, smoking cessation, and proper use of medications.
In any event, in describing ways to expand access to pulmonary rehabilitation for a wider range of COPD patients, and ways to encourage continued participation in an ongoing exercise program after rehab, the article author included a chart on self-management strategies for COPD patients (Bourbeau J, Making pulmonary rehabilitation a success in COPD. Swiss Medical Weekly. 2010;140:w13067)
We thought the chart was worth summarizing for you (see below). If your doctor has not discussed these strategies with you, or if you have not yet seen your doctor about your shortness of breath concerns, we recommend using this list as a guide to discuss your own “better breathing program” with your doctor. Alternatively, we suggest you consider purchasing our Breathe Better for Life guide/CD, www.breathebetterforlife.com, to find specific suggestions and strategies for many of the topics highlighted in the below list, including exercise, nutrition, breathing techniques, conserving energy, managing stress, and maintaining intimacy among others.
Self-management skills and healthy behaviors for COPD self-management (Table 3 in referenced review article):
1. Live in a smoke free environment - Quit smoking, remain non-smoker and avoid second-hand smoke.
2. Comply with your medication - Take medication as prescribed on a regular basis and use proper inhalation techniques.
3. Manage to maintain comfortable breathing, use according to directives:
– the pursed-lip breathing technique
– the forward body positions
4. Conserve your energy - Prioritize your activities, plan your schedule and pace yourself.
5. Manage your stress and anxiety - Use your relaxation and breathing techniques, try to solve one problem at a time, talk about your problems and do not hesitate to ask for help and maintain a positive attitude.
6. Prevention and early treatment of COPD exacerbations - Get your flu shot every year and your vaccine for pneumonia. Identify and avoid factors that can worsen your symptoms. Use your Plan of Action according to the directives (recognition of symptom deterioration and actions to perform).Contact your resource person when needed.
7. Maintain an active life style - Maintain physical activities (activities of daily living, walking, climbing stairs, etc.). Exercise regularly (according to a prescribed home exercise program).
8. Keep a healthy diet - Maintain a healthy weight, eat food high in protein and eat smaller meals more often (5–6 meals/day).
9. Have good sleep habits - Maintain a routine, avoid heavy meals and stimulants before bedtime and relax before bedtime.
10. Maintain a satisfying sex life - Use positions that require less energy. Share your feelings with your partner. Do not limit yourself to intercourse, create a romantic atmosphere. Use your breathing, relaxation and coughing techniques.
11. Get involved in leisure - Choose leisure activities that you enjoy.
12. Activities - choose environments where your symptoms will not be aggravated. Pace yourself through the activities while using your breathing techniques. Respect your strengths and limitations.
Thursday, September 23, 2010
Monday, September 20, 2010
Pedometer teamed with Internet a useful tool in boosting physical activity in COPD?
A significant challenge for respiratory care professionals in lifelong COPD disease management is ensuring that patients increase and maintain a higher level of daily physical activity.
The primary method for “kick-starting” physical activity in COPD patients is the treatment option known as pulmonary rehabilitation (PR). In a typical outpatient PR program, patients receive exercise training for 30-60 minutes, 2-3 days per week, over an 8-12 week period. The exercise training includes both aerobic/cardiovascular (i.e. walking on a treadmill, riding a stationary cycle or ergonometer) and strength training (lifting weights that strengthen upper and lower body muscles).
However, once a COPD patient completes a PR program, he/she is expected to self-manage an ongoing exercise program thereafter. Unfortunately, many COPD patients who’ve experienced significant gains in physical conditioning, reduced shortness of breath, and improved sense of well being during PR lose the benefits within one year because they don’t continue to exercise.
Why COPD patients who’ve experienced these health gains don’t maintain an exercise program is bedeviling to practitioners and researchers. It seems that in many cases exercise adherence falls as COPD patients leave PR because they lose their cheerleader/guider/motivator/feedback provider.
So practitioners and researchers continue to seek ways/methods to encourage exercise post-rehab and for those who are not eligible for rehab (which sadly, is about 99% of COPD patients). Researchers know it is not feasible from a cost or physical resource perspective to provide ongoing direct support ad infinitum, so they investigate ways to cost effectively provide feedback and motivation and thereby extend the length of home-based exercise programs.
One such way for encouraging greater daily physical activity might be to provide COPD patients with a pedometer to track their daily steps combined with an easy way to track progress and goals set by practitioners. That was the aim of a new research study reported in the Journal of Rehabilitation Research & Development.
In this study, the research team looked back at the results of a larger pedometer study to extract the experience of the 16 COPD patients who completed in the study (of the 205 people who completed the larger pedometer study, only 16 were identified as COPD patients).
To establish a baseline of steps taken in a given day, the study participants were asked to carry/wear a pedometer with the display screen covered during waking hours for a 7 day period. After the baseline was established, study participants were asked to carry/wear the pedometer during waking hours for 16 weeks, recording their steps taken at least once per week on an Internet-based tracking site. The Internet walking-tracking site provided feedback/motivational messages/goals for each patient based on their individual progress.
At the end of the study, COPD patients saw their daily steps taken rise by 988 over their baseline average of 3,596 (27% increase). By comparison, the non-COPD population of the larger study from which this data was extracted experienced a 60% gain in average daily steps taken over the 16 week period. (Moy ML, et al. Use of pedometer and Internet-mediated walking program in patients with chronic obstructive pulmonary disease. J Rehabil Res Dev. 2010;47(5):485-96)
While the COPD patients did indeed demonstrate a statistically significant rise in average daily steps taken, their increase was not as dramatic as the non-COPD participants. But from a practitioner perspective, a statistically significant rise in COPD patient daily activity is a huge step in the right direction.
It is not clear from the study whether the pedometer alone, or the pedometer combined with the Internet tracking service was responsible for the rise in steps taken since the study did not include test panels to evaluate the relative differences in steps taken between no intervention, pedometer alone, pedometer with Internet tracking service. However, understanding that a significant barrier to continued exercise among COPD patients is the lack of a feedback/motivation loop outside of the clinical environment, it would appear that the combination of live data from the pedometer teamed with the tracking/feedback Internet site is an interesting alternative to a traditional exercise program for COPD patients who are self-managing their disease.
If you are interested in starting a pedometer assisted walking program of your own, we’ve provided a link to our Breathe Better Marketplace where we’ve posted some of Consumer Reports top rated pedometers available through amazon.com. We’ve also included a link to Step Up To Better Health, the Internet-based walking tracking site used in the above mentioned study.
The primary method for “kick-starting” physical activity in COPD patients is the treatment option known as pulmonary rehabilitation (PR). In a typical outpatient PR program, patients receive exercise training for 30-60 minutes, 2-3 days per week, over an 8-12 week period. The exercise training includes both aerobic/cardiovascular (i.e. walking on a treadmill, riding a stationary cycle or ergonometer) and strength training (lifting weights that strengthen upper and lower body muscles).
However, once a COPD patient completes a PR program, he/she is expected to self-manage an ongoing exercise program thereafter. Unfortunately, many COPD patients who’ve experienced significant gains in physical conditioning, reduced shortness of breath, and improved sense of well being during PR lose the benefits within one year because they don’t continue to exercise.
Why COPD patients who’ve experienced these health gains don’t maintain an exercise program is bedeviling to practitioners and researchers. It seems that in many cases exercise adherence falls as COPD patients leave PR because they lose their cheerleader/guider/motivator/feedback provider.
So practitioners and researchers continue to seek ways/methods to encourage exercise post-rehab and for those who are not eligible for rehab (which sadly, is about 99% of COPD patients). Researchers know it is not feasible from a cost or physical resource perspective to provide ongoing direct support ad infinitum, so they investigate ways to cost effectively provide feedback and motivation and thereby extend the length of home-based exercise programs.
One such way for encouraging greater daily physical activity might be to provide COPD patients with a pedometer to track their daily steps combined with an easy way to track progress and goals set by practitioners. That was the aim of a new research study reported in the Journal of Rehabilitation Research & Development.
In this study, the research team looked back at the results of a larger pedometer study to extract the experience of the 16 COPD patients who completed in the study (of the 205 people who completed the larger pedometer study, only 16 were identified as COPD patients).
To establish a baseline of steps taken in a given day, the study participants were asked to carry/wear a pedometer with the display screen covered during waking hours for a 7 day period. After the baseline was established, study participants were asked to carry/wear the pedometer during waking hours for 16 weeks, recording their steps taken at least once per week on an Internet-based tracking site. The Internet walking-tracking site provided feedback/motivational messages/goals for each patient based on their individual progress.
At the end of the study, COPD patients saw their daily steps taken rise by 988 over their baseline average of 3,596 (27% increase). By comparison, the non-COPD population of the larger study from which this data was extracted experienced a 60% gain in average daily steps taken over the 16 week period. (Moy ML, et al. Use of pedometer and Internet-mediated walking program in patients with chronic obstructive pulmonary disease. J Rehabil Res Dev. 2010;47(5):485-96)
While the COPD patients did indeed demonstrate a statistically significant rise in average daily steps taken, their increase was not as dramatic as the non-COPD participants. But from a practitioner perspective, a statistically significant rise in COPD patient daily activity is a huge step in the right direction.
It is not clear from the study whether the pedometer alone, or the pedometer combined with the Internet tracking service was responsible for the rise in steps taken since the study did not include test panels to evaluate the relative differences in steps taken between no intervention, pedometer alone, pedometer with Internet tracking service. However, understanding that a significant barrier to continued exercise among COPD patients is the lack of a feedback/motivation loop outside of the clinical environment, it would appear that the combination of live data from the pedometer teamed with the tracking/feedback Internet site is an interesting alternative to a traditional exercise program for COPD patients who are self-managing their disease.
If you are interested in starting a pedometer assisted walking program of your own, we’ve provided a link to our Breathe Better Marketplace where we’ve posted some of Consumer Reports top rated pedometers available through amazon.com. We’ve also included a link to Step Up To Better Health, the Internet-based walking tracking site used in the above mentioned study.
Wednesday, September 15, 2010
Resveratrol vs. Steroids in smokers and COPD patients
A new German study published online ahead of print in the Journal of Pharmacology and Experimental Therapeutics showed that Resveratrol may be more effective in depressing inflammation in smokers and COPD patients than corticosteroids.
Resveratrol, a polyphenol compound produced in a range of plants, is a protective chemical secreted by plants to ward off infection from attacks of bacteria or fungi. Resveratrol has been studied for a wide range of health applications in humans and first garnered significant attention as the main factor behind the “French Paradox”.
The French Paradox refers to the puzzling circumstance of low heart disease prevalence in the French population despite a diet which includes significant amounts of calories from fats and oils. Given that red wine is a staple of many French diets, and Resveratrol is found in red grapes in relatively high concentration, some scientists have associated the Resveratrol with protective heart health benefits. What makes this a head scratcher is that the average glass of red wine contains only 1-2mg of Resveratrol – a dosage level which is way below dosage levels deemed effective in Resveratrol research studies. But the fact still remains that French citizens who consume red wine on a regular basis seem to have less incidence of heart disease.
Resveratrol has shown promising results in smokers and people with COPD as we described in a previous article (click here to read more). The new German study further explored Resveratrol as an antioxidant and anti-inflammatory agent for smokers and COPD specifically to understand whether it might be more effective than steroids in reducing inflammation.
It has been previously established in past research studies that corticosteroids, a common treatment option for airway inflammation in smokers and COPD patients, are not particularly effective over the long-term in relieving symptoms associated with inflammation. As the German research team noted, “The use of corticosteroids in COPD is disputed, since their anti-inflammatory properties are impaired in smoking-related COPD compared to other chronic inflammatory lung diseases such as asthma.” (Knobloch J, et al. Resveratrol impairs the release of steroid-resistant inflammatory cytokines from human airway smooth muscle cells in COPD. JPET. Epub ahead of print, DOI:10.1124/jpet.110.166843)
To understand why, it is important to understand what causes inflammation in the first place. The cycle operates like this – cigarette smoke damages the cells of the lungs lining and airway muscle cells. Over time, the volume of damage inflicted by cigarette smoke causes the affected cells to malfunction. The most notable way they malfunction is an inappropriately overwhelming response to the presence of bacteria or fungi in the lungs.
Normally, when the cells detect bacteria or fungi, they send out signals (in the form of proteins known as cytokines). These signals are intended to boost production of white blood cells (macrophages as an example) to attack and kill the invading bacteria or fungi.
In smokers and COPD patients, however, the cell response to the presence of bacteria or fungi is dramatically more intense. Huge amounts of cytokines are produced and an overwhelming number of white blood cells respond. The lung tissues fill up with both the proteins and white blood cells and swell. The combination of swelled tissue and extra fluid in the lungs is described as inflammation. This inflammation in turn makes it harder to breathe because the airways are narrowed and not as much oxygen can be inhaled.
Corticosteroids are widely prescribed for reducing inflammation as anyone who has bad knees, hips, or back can attest. They are effective in reducing the body’s response to a perceived threat or injury. However, in smokers and COPD patients, some of the proteins that signal production of white blood cells have shown to be resistant to steroid’s effects, thereby diluting their anti-inflammatory properties.
Antioxidants have been receiving greater focus as an alternative because a number of them have been shown to be effective in reducing the production of cytokines and in moderating the free radical damage inflicted by inhaling cigarette smoke.
In this study, the German research team sought to test Resveratrol versus Dexamethasone (corticosteroid) in reducing the presence of cytokines in human lung tissue samples (specifically, human airway smooth muscle cells or HASMC). They recruited 3 sets of 10 patients – 10 non-smokers, 10 smokers who were considered healthy and free of lung disease, and 10 smokers diagnosed with COPD.
The study subjects agreed to a biopsy of their lung tissue into which the research team introduced a cytokine known as TNF-alpha (tumor necrosis factor alpha). The presence of TNF-alpha in lung tissue in turn signals the cells to produce other cytokines (Interleukin-8, for example) and chemicals (GM-CSF, granulocyte macrophage-colony stimulating factor, for example) to pass the “alert…infection detected” signal on to produce white blood cells in response.
Then the researchers introduced Dexamethasone into one set of the lung tissue samples from each group (non-smokers, smokers, COPD), Resveratrol into another set of the samples, and maintained a control/baseline set of tissue samples that received no injections.
The results showed that Dexamethasone was effective in reducing the number of inflammation-related proteins and chemicals in non-smokers, and that its effectiveness by comparison in smokers and COPD patients was notably reduced. This was determined by counting the number of cytokines and other signaling chemicals in the cell samples before and after treatment with Dexamethasone.
By contrast, the smoker and COPD cells treated with Resveratrol showed significantly lower counts of cytokines and other white blood cell signaling chemicals. As the study team noted, “In contrast to dexamethasone, resveratrol reduced IL-8 release from TNFalpha-stimulated HASMCs down to baseline level in all three cohorts.” (researcher-speak meaning that Resveratrol eliminated nearly all the inflammation related protein IL-8, by the way, the same was true of the signaling chemical GM-CSF).
Further, the researchers’ results showed that repeated administration of Resveratrol at lower dosage levels provided similar benefits to a single, large dose. The reason this is interesting is related to the point discussed above related to the “French Paradox”. Red wine contains a low dosage of Resveratrol (1-2mg per glass) and so one wouldn’t think that such a low dose would provide health benefits given that past Resveratrol research studies typically have had to administer large dosage levels in order to generate statistically significant responses.
Scientists have theorized that repeated low to moderate dosage of Resveratrol over time may, in effect, improve the body’s response to the antioxidant in such a way as to provide similar benefits to single, large doses. This study seems to provide support for this point of view. That said there is no current guideline for appropriate dosage level of Resveratrol in humans for any health condition. What seems more important than the specific dosage is continually replenishing the body’s supply of it.
Resveratrol is widely available in dietary supplement form in daily dosages ranging from 20mg up to 1000mg – it is sometimes sold as Grape Seed Extract. If you decide to purchase and try Resveratrol, make sure though that you check the supplement facts box of the product you are interested in prior to purchasing. While a label might indicate that there is 200mg of Grape Seed Extract in the product, Resveratrol is typically found in concentrations of 8% to 20%. So if you bought a 200mg Grape Seed Extract thinking you were getting 200mg of Resveratrol, you might really be getting 16mg-40mg of Resveratrol. Reputable supplement marketers will clearly identify the concentration level of Resveratrol in their product – steer clear of those who don’t.
As always, please check with your doctor before consuming Resveratrol to ensure there are no counter-indications with your individual health status. If you don’t want to try a Resveratrol supplement, consider adding red grapes, peanuts and/or red wine to your diet. All three of these sources provide 1-2mg Resveratrol per serving.
Resveratrol, a polyphenol compound produced in a range of plants, is a protective chemical secreted by plants to ward off infection from attacks of bacteria or fungi. Resveratrol has been studied for a wide range of health applications in humans and first garnered significant attention as the main factor behind the “French Paradox”.
The French Paradox refers to the puzzling circumstance of low heart disease prevalence in the French population despite a diet which includes significant amounts of calories from fats and oils. Given that red wine is a staple of many French diets, and Resveratrol is found in red grapes in relatively high concentration, some scientists have associated the Resveratrol with protective heart health benefits. What makes this a head scratcher is that the average glass of red wine contains only 1-2mg of Resveratrol – a dosage level which is way below dosage levels deemed effective in Resveratrol research studies. But the fact still remains that French citizens who consume red wine on a regular basis seem to have less incidence of heart disease.
Resveratrol has shown promising results in smokers and people with COPD as we described in a previous article (click here to read more). The new German study further explored Resveratrol as an antioxidant and anti-inflammatory agent for smokers and COPD specifically to understand whether it might be more effective than steroids in reducing inflammation.
It has been previously established in past research studies that corticosteroids, a common treatment option for airway inflammation in smokers and COPD patients, are not particularly effective over the long-term in relieving symptoms associated with inflammation. As the German research team noted, “The use of corticosteroids in COPD is disputed, since their anti-inflammatory properties are impaired in smoking-related COPD compared to other chronic inflammatory lung diseases such as asthma.” (Knobloch J, et al. Resveratrol impairs the release of steroid-resistant inflammatory cytokines from human airway smooth muscle cells in COPD. JPET. Epub ahead of print, DOI:10.1124/jpet.110.166843)
To understand why, it is important to understand what causes inflammation in the first place. The cycle operates like this – cigarette smoke damages the cells of the lungs lining and airway muscle cells. Over time, the volume of damage inflicted by cigarette smoke causes the affected cells to malfunction. The most notable way they malfunction is an inappropriately overwhelming response to the presence of bacteria or fungi in the lungs.
Normally, when the cells detect bacteria or fungi, they send out signals (in the form of proteins known as cytokines). These signals are intended to boost production of white blood cells (macrophages as an example) to attack and kill the invading bacteria or fungi.
In smokers and COPD patients, however, the cell response to the presence of bacteria or fungi is dramatically more intense. Huge amounts of cytokines are produced and an overwhelming number of white blood cells respond. The lung tissues fill up with both the proteins and white blood cells and swell. The combination of swelled tissue and extra fluid in the lungs is described as inflammation. This inflammation in turn makes it harder to breathe because the airways are narrowed and not as much oxygen can be inhaled.
Corticosteroids are widely prescribed for reducing inflammation as anyone who has bad knees, hips, or back can attest. They are effective in reducing the body’s response to a perceived threat or injury. However, in smokers and COPD patients, some of the proteins that signal production of white blood cells have shown to be resistant to steroid’s effects, thereby diluting their anti-inflammatory properties.
Antioxidants have been receiving greater focus as an alternative because a number of them have been shown to be effective in reducing the production of cytokines and in moderating the free radical damage inflicted by inhaling cigarette smoke.
In this study, the German research team sought to test Resveratrol versus Dexamethasone (corticosteroid) in reducing the presence of cytokines in human lung tissue samples (specifically, human airway smooth muscle cells or HASMC). They recruited 3 sets of 10 patients – 10 non-smokers, 10 smokers who were considered healthy and free of lung disease, and 10 smokers diagnosed with COPD.
The study subjects agreed to a biopsy of their lung tissue into which the research team introduced a cytokine known as TNF-alpha (tumor necrosis factor alpha). The presence of TNF-alpha in lung tissue in turn signals the cells to produce other cytokines (Interleukin-8, for example) and chemicals (GM-CSF, granulocyte macrophage-colony stimulating factor, for example) to pass the “alert…infection detected” signal on to produce white blood cells in response.
Then the researchers introduced Dexamethasone into one set of the lung tissue samples from each group (non-smokers, smokers, COPD), Resveratrol into another set of the samples, and maintained a control/baseline set of tissue samples that received no injections.
The results showed that Dexamethasone was effective in reducing the number of inflammation-related proteins and chemicals in non-smokers, and that its effectiveness by comparison in smokers and COPD patients was notably reduced. This was determined by counting the number of cytokines and other signaling chemicals in the cell samples before and after treatment with Dexamethasone.
By contrast, the smoker and COPD cells treated with Resveratrol showed significantly lower counts of cytokines and other white blood cell signaling chemicals. As the study team noted, “In contrast to dexamethasone, resveratrol reduced IL-8 release from TNFalpha-stimulated HASMCs down to baseline level in all three cohorts.” (researcher-speak meaning that Resveratrol eliminated nearly all the inflammation related protein IL-8, by the way, the same was true of the signaling chemical GM-CSF).
Further, the researchers’ results showed that repeated administration of Resveratrol at lower dosage levels provided similar benefits to a single, large dose. The reason this is interesting is related to the point discussed above related to the “French Paradox”. Red wine contains a low dosage of Resveratrol (1-2mg per glass) and so one wouldn’t think that such a low dose would provide health benefits given that past Resveratrol research studies typically have had to administer large dosage levels in order to generate statistically significant responses.
Scientists have theorized that repeated low to moderate dosage of Resveratrol over time may, in effect, improve the body’s response to the antioxidant in such a way as to provide similar benefits to single, large doses. This study seems to provide support for this point of view. That said there is no current guideline for appropriate dosage level of Resveratrol in humans for any health condition. What seems more important than the specific dosage is continually replenishing the body’s supply of it.
Resveratrol is widely available in dietary supplement form in daily dosages ranging from 20mg up to 1000mg – it is sometimes sold as Grape Seed Extract. If you decide to purchase and try Resveratrol, make sure though that you check the supplement facts box of the product you are interested in prior to purchasing. While a label might indicate that there is 200mg of Grape Seed Extract in the product, Resveratrol is typically found in concentrations of 8% to 20%. So if you bought a 200mg Grape Seed Extract thinking you were getting 200mg of Resveratrol, you might really be getting 16mg-40mg of Resveratrol. Reputable supplement marketers will clearly identify the concentration level of Resveratrol in their product – steer clear of those who don’t.
As always, please check with your doctor before consuming Resveratrol to ensure there are no counter-indications with your individual health status. If you don’t want to try a Resveratrol supplement, consider adding red grapes, peanuts and/or red wine to your diet. All three of these sources provide 1-2mg Resveratrol per serving.
Wednesday, September 8, 2010
B Vitamins and Lung Cancer Risk
A recent study published recently in the Journal of the American Medical Association (JAMA) showed that people with higher blood levels of Vitamin B6, Folate (Vitamin B9), and the amino acid Methionine had a 67% lower odds-ratio of developing lung cancer compared to those with low levels of these nutrients.
According to the research team, the above odds ratio was largely the same among never smokers, former smokers and current smokers (meaning that in all three groups of smoking status, the odds ratio of developing lung cancer was about the same when comparing those who had high blood levels of these nutrients and those who had low levels). (Johansson M, et al. Serum B Vitamin Levels and Risk of Lung Cancer. JAMA. 010;303(23):2377-2385)
That said current smokers between the ages of 35 and 79 included in the research database analyzed by the study team had a much higher risk of lung cancer than either former smokers or never smokers. As a case in point, currently smoking men in the study with low levels of Vitamin B6 and Methionine had a 14.9% risk of developing lung cancer while currently smoking men with high levels of these two nutrients had only a 6.6% risk. On the other end of the spectrum, never smoking men in the study with low blood levels of Vitamin B6 and the amino acid Methionine had a 0.9% risk of developing lung cancer while those never smoking men with high levels of these two nutrients had a 0.3%.
To take a step back, the paper’s authors achieved their results by examining the medical records of over 500,000 Europeans who participate in a large, ongoing study (a generational study known as a cohort) called EPIC. They examined the EPIC database of patients to select those who had developed lung cancer after their initial blood draw (when their levels of B Vitamins and other nutrients were originally obtained). After eliminating some of the lung cancer patients for various confounding characteristics the researchers arrived at roughly 900 lung cancer patient records. They then selected approximately 1,800 control patient records from the database, attempting to find 2 cancer-free control patients of similar health/demographic characteristics for each of the lung cancer patients.
The researchers focused their study on B Vitamins and Methionine because, “B vitamins, including B6 and Folate (B9), as well as related enzymes in the 1-carbon pathway, are essential for DNA synthesis and methylation…Deficiencies in B vitamins may increase the probability of DNA damage and subsequent gene mutations, and may influence gene expression via aberrant methylation patterns. Given their involvement in maintaining DNA integrity and gene expression, these nutrients have a potentially important role in inhibiting cancer development, and offer the possibility of modifying cancer risk through dietary changes.”
In other words, these nutrients play a key role in healthy cell development and division. When low levels of these nutrients are present in the human body there is a greater likelihood of abnormal cell development and division (and abnormal cell development and division is at the root of cancer development).
For the paper’s authors, the puzzle arising out of the study results was the fact that there was less of a correlation between dietary intake levels of foods or nutritional supplements that contain these nutrients and lung cancer risk than there was with blood level amounts of the nutrients.
In other words, the study team did not find direct evidence to support the contention that consuming more foods and/or supplements with Vitamin B6, Folate and Methionine reduced lung cancer risk. Instead, the correlation discovered was based solely on blood levels of these nutrients.
But clearly, the main sources of these nutrients for humans are food and nutritional supplements that contain these ingredients. So if a person has higher blood levels of these nutrients it is logical to assume that they either consume more foods/supplements with these nutrients or their bodies better absorb the nutrients than people with low levels.
Despite the absence of proof that higher dietary intake of Vitamin B6, Folate and Methionine necessarily leads to higher blood levels of these nutrients, the study authors conclude, “Dietary sources of B6 are varied and include beans, grains, meats, poultry, fish, and some fruits and vegetables, whereas primary sources of methionine are from animal proteins, as well as some nuts and vegetable seeds.Given that serum levels of B vitamins and metabolites are at least partially determined by diet, and are clearly affected by vitamin supplements,low vitamin levels are therefore modifiable.” [Meaning, it seems to us, you can generate higher blood levels of these nutrients by consuming foods and supplements that contain them]
The study provided no guidance on specific dietary intake levels of Vitamin B6, Folate and Methionine. However, we have provided below links to fact sheets from the National Institutes Health’s Office of Dietary Supplements for Vitamin B6 and Folate that describe food sources and recommended daily dosage levels of dietary supplements for these nutrients. In addition, we’ve provided a link to a Wikipedia page with similar information for Methionine.
Vitamin B6
Folate
Methionine
According to the research team, the above odds ratio was largely the same among never smokers, former smokers and current smokers (meaning that in all three groups of smoking status, the odds ratio of developing lung cancer was about the same when comparing those who had high blood levels of these nutrients and those who had low levels). (Johansson M, et al. Serum B Vitamin Levels and Risk of Lung Cancer. JAMA. 010;303(23):2377-2385)
That said current smokers between the ages of 35 and 79 included in the research database analyzed by the study team had a much higher risk of lung cancer than either former smokers or never smokers. As a case in point, currently smoking men in the study with low levels of Vitamin B6 and Methionine had a 14.9% risk of developing lung cancer while currently smoking men with high levels of these two nutrients had only a 6.6% risk. On the other end of the spectrum, never smoking men in the study with low blood levels of Vitamin B6 and the amino acid Methionine had a 0.9% risk of developing lung cancer while those never smoking men with high levels of these two nutrients had a 0.3%.
To take a step back, the paper’s authors achieved their results by examining the medical records of over 500,000 Europeans who participate in a large, ongoing study (a generational study known as a cohort) called EPIC. They examined the EPIC database of patients to select those who had developed lung cancer after their initial blood draw (when their levels of B Vitamins and other nutrients were originally obtained). After eliminating some of the lung cancer patients for various confounding characteristics the researchers arrived at roughly 900 lung cancer patient records. They then selected approximately 1,800 control patient records from the database, attempting to find 2 cancer-free control patients of similar health/demographic characteristics for each of the lung cancer patients.
The researchers focused their study on B Vitamins and Methionine because, “B vitamins, including B6 and Folate (B9), as well as related enzymes in the 1-carbon pathway, are essential for DNA synthesis and methylation…Deficiencies in B vitamins may increase the probability of DNA damage and subsequent gene mutations, and may influence gene expression via aberrant methylation patterns. Given their involvement in maintaining DNA integrity and gene expression, these nutrients have a potentially important role in inhibiting cancer development, and offer the possibility of modifying cancer risk through dietary changes.”
In other words, these nutrients play a key role in healthy cell development and division. When low levels of these nutrients are present in the human body there is a greater likelihood of abnormal cell development and division (and abnormal cell development and division is at the root of cancer development).
For the paper’s authors, the puzzle arising out of the study results was the fact that there was less of a correlation between dietary intake levels of foods or nutritional supplements that contain these nutrients and lung cancer risk than there was with blood level amounts of the nutrients.
In other words, the study team did not find direct evidence to support the contention that consuming more foods and/or supplements with Vitamin B6, Folate and Methionine reduced lung cancer risk. Instead, the correlation discovered was based solely on blood levels of these nutrients.
But clearly, the main sources of these nutrients for humans are food and nutritional supplements that contain these ingredients. So if a person has higher blood levels of these nutrients it is logical to assume that they either consume more foods/supplements with these nutrients or their bodies better absorb the nutrients than people with low levels.
Despite the absence of proof that higher dietary intake of Vitamin B6, Folate and Methionine necessarily leads to higher blood levels of these nutrients, the study authors conclude, “Dietary sources of B6 are varied and include beans, grains, meats, poultry, fish, and some fruits and vegetables, whereas primary sources of methionine are from animal proteins, as well as some nuts and vegetable seeds.Given that serum levels of B vitamins and metabolites are at least partially determined by diet, and are clearly affected by vitamin supplements,low vitamin levels are therefore modifiable.” [Meaning, it seems to us, you can generate higher blood levels of these nutrients by consuming foods and supplements that contain them]
The study provided no guidance on specific dietary intake levels of Vitamin B6, Folate and Methionine. However, we have provided below links to fact sheets from the National Institutes Health’s Office of Dietary Supplements for Vitamin B6 and Folate that describe food sources and recommended daily dosage levels of dietary supplements for these nutrients. In addition, we’ve provided a link to a Wikipedia page with similar information for Methionine.
Vitamin B6
Folate
Methionine
Tuesday, September 7, 2010
What to do if you can’t or won’t stop smoking cigarettes?
A new paper in the Journal of Clinical Nursing highlighted some of the smoking cessation challenges/barriers that exist for COPD patients who continue to smoke cigarettes. The researchers identified six core reasons given by the study participants for why they continue to smoke even though they have advanced lung disease. The six reasons were as follows:
Comments like:
“The way I have suffered with my chest for the last two years, I say to myself is it worth it stopping now? It’s the only enjoyment I’ve got.”
“I cough and cough and I know rightly if I wasn’t smoking I would be able come up the stairs a bit better and feel a bit better. I know that for a fact like.”
“Emptiness in the house, nobody cares about me (pause) I don’t see anybody hardly… (I’m) just lonely.”
http://breathebetterblog.blogspot.com/2010/04/cardiorespiratory-fitness-reduces-lung.html
http://breathebetterblog.blogspot.com/2009/11/pulmonary-rehabilitation-as-precursor.html
http://breathebetterblog.blogspot.com/2010/04/new-study-demonstrates-pulmonary-rehab.html
Nutrition articles:
http://breathebetterblog.blogspot.com/2010/08/black-currant-shown-to-reduce-airway.html
http://breathebetterblog.blogspot.com/2010/07/n-acetyl-cysteine-reduces-airway.html
http://breathebetterblog.blogspot.com/2010/06/chinese-herb-dramatically-reduces.html
http://breathebetterblog.blogspot.com/2010/05/vitamin-c-supplementation-possible.html
Now I recognize that many smokers (especially COPD patients who smoke) find it hard to do any form of physical activity because they become breathless quickly. But guess what? Lack of physical activity actually makes breathlessness worse…greater physical activity reduces breathlessness! Exercise also lowers lung cancer risk (even if you continue to smoke) and has been shown in recent studies to improve success rates for smoking cessation.
No one expects a person who suffers from chronic breathlessness to leap up and run a marathon. One has to start slow, build a base level of conditioning, and slowly over time increase the intensity and duration of exercise. That is the core belief set behind the treatment option pulmonary rehabilitation and our Breathe Better for Life guide/CD, www.breathebetterforlife.com.
On the nutrition side, smoking seriously depletes protective nutrients in the body known as antioxidants. So much so, in my humble opinion, it is impossible for a pack-a-day-or-more smoker to consume enough antioxidant rich food to offset the effects of smoking. But, improving dietary intake and supplementing with vitamins and other dietary supplements that have good antioxidant content have been shown to reduce lung inflammation – the core cause of breathlessness in COPD patients according to the vast majority of practitioners and researchers.
Imagine then if you, as a current smoker who has not been successful in quitting, decided to start a modest exercise program and add antioxidant rich foods and/or dietary supplements to your daily routine (in consultation with your physician). Imagine then that the proactive acts each day of trying to do something healthy (while continuing to smoke) helped you feel better physically, helped you gain confidence in your ability to improve your quality of life, helped you get out and meet new people, and helped you accomplish more basic activities of normal every-day life like shopping, walking up stairs and preparing meals without pronounced breathlessness.
If you were able to do that for 8-12 weeks, wouldn’t you think that because of all of these positive changes you would be in a better frame of mind and better physical condition to attempt smoking cessation, therefore increasingly the likelihood of your success?
I think so, and from a COPD patient perspective I think it is a helluva lot better option than believing that nothing will help you feel better. From a physician standpoint, I think it’s a helluva lot better option than simply writing a prescription for a bronchodilator, providing a brochure about smoking cessation, and then waiting for the inevitable hospital admission call to come.
- Too late to stop now – health already compromised, can’t change it, why stop now
- Finding motivation – can’t muster the willpower to try again
- Guilt about continued smoking – led to depression which led to lack of desire to change
- Bargaining/contemplation – need to deal w/another life issue before quitting
- Need to stop – past failure at attempts to quit led to giving up trying again
- Reduced quality of life – smoking provided structure/social outlet – don’t want to lose
In all of these responses (and the candid snippets of comments from study participants included in the study), there is strong sense of loss of hope. There is also a strong current of a belief that no action a smoking COPD patient can take will help them feel better. (Wilson JS, et al. ‘It’s not worth stopping now’: why do smokers with chronic obstructive pulmonary disease continue to smoke? A qualitative study. J Clin Nurs. 2010 Aug 24. [Epub ahead of print])
“The way I have suffered with my chest for the last two years, I say to myself is it worth it stopping now? It’s the only enjoyment I’ve got.”
“I cough and cough and I know rightly if I wasn’t smoking I would be able come up the stairs a bit better and feel a bit better. I know that for a fact like.”
“Emptiness in the house, nobody cares about me (pause) I don’t see anybody hardly… (I’m) just lonely.”
I don’t think smokers (COPD patients included) should believe there is no hope of feeling better – whether they quit now or later. Yes, smoking cessation is difficult decision to make and a harder decision to see through. The physical habit of smoking and the addiction to nicotine are very powerful inhibitors. But there are steps you can take to feel better - even if you continue to smoke.
To be clear, I am not advocating the concept that one should continue to smoke. Quite the opposite – quitting smoking is so powerfully beneficial to your health (at any stage of lung disease) that it is always the best first option you can consider.
However, I am increasingly concerned that medical professionals are so focused on smoking cessation that they do not discuss with patients other steps a cigarette smoker can take in conjunction with smoking cessation or in lieu of smoking cessation (in the event one is not ready to quit but is ready to take steps to improve their health).
It is remarkable when I read in studies and articles (and hear at conferences and symposiums) physicians make comments along the lines of, “I am reluctant to share this information with patients who smoke because they will interpret my sharing this information as me granting permission for them to continue smoking.”
While I can understand the basic sentiment behind the comment, I think it is misguided. Knowing that smoking cessation success rates are very low in general, knowing that these rates are even lower for COPD patients, knowing that in the U.S. alone there are over 40 million currently smoking adults, doesn’t it make sense to provide smokers every available option to help improve their health – whether it involves smoking cessation or not?
Imagine if doctors said to obese patients - I want you to lose weight and so I want you to change your diet. But, I’m not going to tell you to exercise until you’ve lost the weight because I don’t want you to think you don’t need to change your diet. Weight loss programs are all about combining dietary changes with exercise to improve metabolism, burn calories and increase overall physical activity. Why not the same kind of approach for smokers?
From a societal standpoint, the main goal of medical professionals and public policy makers is to lower the societal burden of smoking (meaning reduce the health care costs associated with smoking). So shouldn’t we as a society provide smokers with every option available to improve their health (including smoking cessation) in pursuit of this goal?
Statistics from bodies like the American Lung Association and U.S. Surgeon General’s office tell us that approximately 70% of current smoking adults express a desire to quit each year. Of this 70%, only 40% actually try, and of this amount only about 15% are successful in quitting for 12 months or more if you take the most aggressive/optimistic range of success rates. That means that out of approximately 43 million current smoking adults, only about 2 million adults successfully quit for 12 months or more each year.
So what does society/medicine do for the 41 million people who can’t or won’t stop smoking in a given year? Other than barrage them with new laws that restrict smoking in public, passive smoking cessation discussions in doctor’s offices, and public service announcements that also push the smoking cessation message, the honest answer is…nearly nothing outside of prescribing rescue inhalers for shortness of breath (that is until lung disease is so advanced that more intensive medical intervention is required).
But did you know, for example, there have been a number of studies conducted that demonstrate health benefits for smokers from exercise and improving nutrition/dietary intake? We’ve written articles in the past that shed more light on recent studies in these areas (links to a sampling of these articles provided below):
Exercise articles:
http://breathebetterblog.blogspot.com/2009/11/pulmonary-rehabilitation-as-precursor.html
http://breathebetterblog.blogspot.com/2010/04/new-study-demonstrates-pulmonary-rehab.html
Nutrition articles:
http://breathebetterblog.blogspot.com/2010/08/black-currant-shown-to-reduce-airway.html
http://breathebetterblog.blogspot.com/2010/07/n-acetyl-cysteine-reduces-airway.html
http://breathebetterblog.blogspot.com/2010/06/chinese-herb-dramatically-reduces.html
http://breathebetterblog.blogspot.com/2010/05/vitamin-c-supplementation-possible.html
Now I recognize that many smokers (especially COPD patients who smoke) find it hard to do any form of physical activity because they become breathless quickly. But guess what? Lack of physical activity actually makes breathlessness worse…greater physical activity reduces breathlessness! Exercise also lowers lung cancer risk (even if you continue to smoke) and has been shown in recent studies to improve success rates for smoking cessation.
No one expects a person who suffers from chronic breathlessness to leap up and run a marathon. One has to start slow, build a base level of conditioning, and slowly over time increase the intensity and duration of exercise. That is the core belief set behind the treatment option pulmonary rehabilitation and our Breathe Better for Life guide/CD, www.breathebetterforlife.com.
On the nutrition side, smoking seriously depletes protective nutrients in the body known as antioxidants. So much so, in my humble opinion, it is impossible for a pack-a-day-or-more smoker to consume enough antioxidant rich food to offset the effects of smoking. But, improving dietary intake and supplementing with vitamins and other dietary supplements that have good antioxidant content have been shown to reduce lung inflammation – the core cause of breathlessness in COPD patients according to the vast majority of practitioners and researchers.
Imagine then if you, as a current smoker who has not been successful in quitting, decided to start a modest exercise program and add antioxidant rich foods and/or dietary supplements to your daily routine (in consultation with your physician). Imagine then that the proactive acts each day of trying to do something healthy (while continuing to smoke) helped you feel better physically, helped you gain confidence in your ability to improve your quality of life, helped you get out and meet new people, and helped you accomplish more basic activities of normal every-day life like shopping, walking up stairs and preparing meals without pronounced breathlessness.
If you were able to do that for 8-12 weeks, wouldn’t you think that because of all of these positive changes you would be in a better frame of mind and better physical condition to attempt smoking cessation, therefore increasingly the likelihood of your success?
I think so, and from a COPD patient perspective I think it is a helluva lot better option than believing that nothing will help you feel better. From a physician standpoint, I think it’s a helluva lot better option than simply writing a prescription for a bronchodilator, providing a brochure about smoking cessation, and then waiting for the inevitable hospital admission call to come.
Saturday, September 4, 2010
Misdiagnosis of COPD and the prescribing of inhaled therapies
A troubling study was recently published in the International Journal of Chronic Obstructive Pulmonary Disease which highlighted that only 14% of the study subjects over the age of 40 could be confirmed with a diagnosis of COPD based on the criteria of the Global Initiative for Chronic Obstructive Lung Disease (GOLD).
The problem: 51% of the study subjects over 40 were diagnosed with COPD by the primary care physicians participating in the study and were prescribed some combination of bronchodilators or corticosteroids. That’s a pretty alarming difference and means a significant percentage of the study subjects may have received prescription medication that may not be appropriate for their reported respiratory symptoms.
The study, conducted in Spain, involved approximately 9,500 patients who had visited one of approximately 1,400 primary care physicians in Spain between May and November of 2008 complaining of respiratory symptoms and who were prescribed an inhaled therapy as a result of the visit. The research team conducting the study gathered the medical records related to the visits from each of the physicians and then looked at both the quantitative diagnostic test results reported by the doctors and the qualitative survey responses provided by the patients. (Izquierdo JL, et al. Misdiagnosis of patients receiving inhaled therapies in primary care. International Journal of Chronic Obstructive Pulmonary Disease. 2010:5 241–249)
The study team then compared the combination of the quantitative and qualitative test results with the internationally accepted criteria for establishing a diagnosis of COPD (the GOLD guidelines mentioned above) and the internationally accepted criteria for determining an asthma diagnosis (GINA – Global Initiative for Asthma). Overall, the primary care physicians diagnosed 43% of the total study population with COPD, 43% with asthma, and the remaining 14% with disease of unknown origin. When the researchers further parsed the data to look specifically at the study population over 40 years of age, they determined that the primary care physicians had diagnosed COPD in 51% of the over-40 group.
However, when the researchers applied the GOLD criteria to the over-40 study population, they found that only 14% had met all of the criteria necessary to confirm a diagnosis of COPD, not 51%! The paper’s authors noted, “These data suggest that there could be a significant percentage of patients with an incorrect or unclear diagnosis.”
In other words, many of the people diagnosed with COPD in this study might actually be suffering from a different respiratory condition (asthma, for example). It means that bronchodilators and steroids commonly prescribed for relieving temporary airway obstruction in COPD patients may not be appropriate for a large percentage of the people diagnosed with COPD in this study. As a result of the misdiagnosis, it is possible that the prescribed inhaled therapies may be masking the real respiratory condition, or may be preventing the patient from receiving an inhaled therapy that is more effective for the undiagnosed condition.
So what were the primary care physicians basing their diagnoses on? The study authors seem to indicate that the diagnoses were largely made based on the subjective judgment of the physicians involved - not based on the GOLD or GINA guidelines.
For example, in this study, of the 100% of patients prescribed an inhaled therapy as a result of a respiratory disease diagnosis determined by the participating primary care physicians, only about 50% received spirometry as part of their office visit.
Spirometry is a standard diagnostic test to determine the degree of airflow obstruction. A poor spirometry test result is not conclusive alone for diagnosing COPD but is widely considered a significant leading indicator and is one of the criteria elements of the GOLD guidelines. Spirometry is typically only administered if a physician suspects COPD based on other symptoms (there is a sizeable group of physicians opposed to providing blanket spirometry to all people who report respiratory symptoms – they view it as wasteful - so it is typically limited to those patients where COPD is suspected).
According to the research paper, of the 50% who took the spirometry test, approximately 45% of them received a functional confirmation of COPD – meaning that only 23% of the total study population had a spirometry test that indicated COPD – 100% x 50% x 45%).
So presuming the primary care physicians were accurate in their subjective judgments of other symptoms in deciding spirometry was appropriate for only 50% of the total study population, the maximum percentage of the total study population that should have received a COPD diagnosis was 23%. Yet, as state above, the primary care physicians diagnosed and treated 43% of the total study population for COPD.
Now, we suspect that some of you reading this article might conclude this must be a problem only in Spain but sadly this issue exists worldwide. We’ve written several previous articles about the misdiagnosis of COPD that you can find by visiting the archives of our blog site, www.breathebetterblog.blogspot.com, or if you are one of our e-letter subscribers, by visiting the website for your particular e-letter.
The studies we’ve highlighted in the past have dealt with under-diagnosis of COPD where this study seems to also reveal problems with over-diagnosis. Either way, there are some real problems confronting the medical profession and its ability to accurately diagnose COPD. The research team in this study seems to agree, “In conclusion, the majority of patients in our study who were receiving inhaled therapy in primary care did not have an accurate diagnosis according to current international guidelines for COPD or asthma…More initiatives for improving diagnosis accuracy in respiratory diseases must be implemented in primary care, and focusing on use of spirometry. Improving the differential diagnosis in primary care will improve the management of these common respiratory diseases and ultimately improve the health care of affected patients.”
The problem: 51% of the study subjects over 40 were diagnosed with COPD by the primary care physicians participating in the study and were prescribed some combination of bronchodilators or corticosteroids. That’s a pretty alarming difference and means a significant percentage of the study subjects may have received prescription medication that may not be appropriate for their reported respiratory symptoms.
The study, conducted in Spain, involved approximately 9,500 patients who had visited one of approximately 1,400 primary care physicians in Spain between May and November of 2008 complaining of respiratory symptoms and who were prescribed an inhaled therapy as a result of the visit. The research team conducting the study gathered the medical records related to the visits from each of the physicians and then looked at both the quantitative diagnostic test results reported by the doctors and the qualitative survey responses provided by the patients. (Izquierdo JL, et al. Misdiagnosis of patients receiving inhaled therapies in primary care. International Journal of Chronic Obstructive Pulmonary Disease. 2010:5 241–249)
The study team then compared the combination of the quantitative and qualitative test results with the internationally accepted criteria for establishing a diagnosis of COPD (the GOLD guidelines mentioned above) and the internationally accepted criteria for determining an asthma diagnosis (GINA – Global Initiative for Asthma). Overall, the primary care physicians diagnosed 43% of the total study population with COPD, 43% with asthma, and the remaining 14% with disease of unknown origin. When the researchers further parsed the data to look specifically at the study population over 40 years of age, they determined that the primary care physicians had diagnosed COPD in 51% of the over-40 group.
However, when the researchers applied the GOLD criteria to the over-40 study population, they found that only 14% had met all of the criteria necessary to confirm a diagnosis of COPD, not 51%! The paper’s authors noted, “These data suggest that there could be a significant percentage of patients with an incorrect or unclear diagnosis.”
In other words, many of the people diagnosed with COPD in this study might actually be suffering from a different respiratory condition (asthma, for example). It means that bronchodilators and steroids commonly prescribed for relieving temporary airway obstruction in COPD patients may not be appropriate for a large percentage of the people diagnosed with COPD in this study. As a result of the misdiagnosis, it is possible that the prescribed inhaled therapies may be masking the real respiratory condition, or may be preventing the patient from receiving an inhaled therapy that is more effective for the undiagnosed condition.
So what were the primary care physicians basing their diagnoses on? The study authors seem to indicate that the diagnoses were largely made based on the subjective judgment of the physicians involved - not based on the GOLD or GINA guidelines.
For example, in this study, of the 100% of patients prescribed an inhaled therapy as a result of a respiratory disease diagnosis determined by the participating primary care physicians, only about 50% received spirometry as part of their office visit.
Spirometry is a standard diagnostic test to determine the degree of airflow obstruction. A poor spirometry test result is not conclusive alone for diagnosing COPD but is widely considered a significant leading indicator and is one of the criteria elements of the GOLD guidelines. Spirometry is typically only administered if a physician suspects COPD based on other symptoms (there is a sizeable group of physicians opposed to providing blanket spirometry to all people who report respiratory symptoms – they view it as wasteful - so it is typically limited to those patients where COPD is suspected).
According to the research paper, of the 50% who took the spirometry test, approximately 45% of them received a functional confirmation of COPD – meaning that only 23% of the total study population had a spirometry test that indicated COPD – 100% x 50% x 45%).
So presuming the primary care physicians were accurate in their subjective judgments of other symptoms in deciding spirometry was appropriate for only 50% of the total study population, the maximum percentage of the total study population that should have received a COPD diagnosis was 23%. Yet, as state above, the primary care physicians diagnosed and treated 43% of the total study population for COPD.
Now, we suspect that some of you reading this article might conclude this must be a problem only in Spain but sadly this issue exists worldwide. We’ve written several previous articles about the misdiagnosis of COPD that you can find by visiting the archives of our blog site, www.breathebetterblog.blogspot.com, or if you are one of our e-letter subscribers, by visiting the website for your particular e-letter.
The studies we’ve highlighted in the past have dealt with under-diagnosis of COPD where this study seems to also reveal problems with over-diagnosis. Either way, there are some real problems confronting the medical profession and its ability to accurately diagnose COPD. The research team in this study seems to agree, “In conclusion, the majority of patients in our study who were receiving inhaled therapy in primary care did not have an accurate diagnosis according to current international guidelines for COPD or asthma…More initiatives for improving diagnosis accuracy in respiratory diseases must be implemented in primary care, and focusing on use of spirometry. Improving the differential diagnosis in primary care will improve the management of these common respiratory diseases and ultimately improve the health care of affected patients.”
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