A new Japanese research study published in the Asia Pacific Journal of Clinical Nutrition points to dietary calcium deficiency as a risk factor for developing COPD. In particular, their research findings showed that study subjects who consumed the most dietary calcium had a 35% lower risk of developing COPD than those who consumed the least amount of calcium-rich food.
The goal of the study was to determine if there were correlations between the dietary consumption of certain key minerals and prevalence of COPD. To assess these correlations, the researchers analyzed the dietary habits of 278 Japanese COPD patients and 340 healthy Japanese adults. The researchers surveyed the study participants regarding their eating habits and then used standard nutritional content tables to calculate the mineral content of the foods consumed by study participants. (Hirayama F, et al. Dietary intake of six minerals in relation to the risk of chronic obstructive pulmonary disease. Asia Pac J Clin Nutr. 2010;19(4):572-7)
Of the six minerals examined, only two showed correlations between low mineral levels and high prevalence of COPD – calcium and iron. Of the two, calcium was the most pronounced.
Calcium deficiency is also a known contributor to the development of osteoporosis. We’ve previously written about the high incidence of osteoporosis among COPD patients (estimated to exist in 50-65% of COPD patients). In those previous articles we’ve highlighted the root causes as a combination of sedentary lifestyle, Vitamin D deficiency (from lack of exposure to direct sunlight), and prolonged exposure to cigarette smoke. Click here and here to read these previous articles. It is likely therefore that calcium deficiency plays a role in the development of osteoporosis among COPD patients as well.
Foods that are naturally rich in calcium content include certain fish such as salmon, tuna, sardines and mackerel. Additionally, soy beans and other soy based products (such as tofu) contain high levels of calcium. Dairy products such as milk, cheese, egg yolks, and yogurt are also good sources of calcium.
Wednesday, December 29, 2010
Tuesday, December 28, 2010
New study shows acai berry helpful for smokers
A novel study published online ahead of print in the journal Food and Chemical Toxicology explored injecting the extract of a potent antioxidant known as acai berry into cigarettes that were in turn inhaled by laboratory mice. The researchers discovered that the acai berry treated cigarettes produced far less inflammation in mice receiving the antioxidant compared to mice exposed to cigarette smoke alone.
The purpose of the study was to determine whether providing a powerful antioxidant along with cigarette smoke would lessen the likelihood of lung tissue damage and associated inflammation. The researchers chose acai berry extract (specifically the extract of the acai berry stone [seed]) because previous research studies involving plant-based antioxidants known as proanthocyanidins have shown similar anti-inflammatory effects.
In this study, the researchers divided the 60 mice in the study into three groups. One group, the control group, received neither exposure to cigarette smoke or acai berry extract. A second group, the cigarette group, was exposed to cigarette smoke from 12 cigarettes daily over a 60 day period. The third group, the acai group, was exposed to cigarette smoke in the same manner as the cigarette group but received the cigarette smoke from cigarettes injected with the acai berry extract. (de Moura RS, et al. Addition of acai (Euterpe oleracea) to cigarettes has a protective effects against emphysema in mice. Food Chem Toxicol. 2010 Dec 10. [Epub ahead of print])
At the end of the 60 day period, all mice were euthanized and lung tissue samples were extracted. The researchers viewed lung tissue samples via microscope to assess the size of alveolar spaces between the three groups (in emphysema, alveolar spaces enlarge). In addition, the lung tissue was analyzed for counts of proteins and white blood cells that are known to be present in large numbers in inflamed airway tissue.
The study team discovered that the cigarette group had 38% greater alteration to alveolar tissue in comparison to the control group. The acai group had 25% lower alteration compared to the cigarette group (meaning the acai group’s lung tissue samples showed less alteration than the cigarette group but more alteration in comparison with the control group).
When analyzing the inflammation markers, researchers found 400% more leukocytes in the cigarette group compared to the control group. The acai group had 65% fewer leukocytes than the cigarette group (again showing the acai group lessened the impact of cigarette smoke). Similar findings were found for other markers such as macrophages and neutrophils.
The study team concluded, “This study demonstrated for the first time that adding a hydro-alcoholic extract of acai stone to cigarettes significantly reduced pulmonary inflammation, oxidative stress, and CS-induced emphysema in mice… Because lung damage induced by CS is mainly due to inflammation and oxidative stress, it seems likely that acai’s anti-inflammatory and antioxidant properties underlie these protective effects…The present study demonstrated that acai extract in cigarettes has a preventive action; that is, the harmful effects of CS can be significantly reduced when the smoke also contains antioxidant compounds.”
Now, what to make of this finding? First, it is unlikely you will find acai-injected cigarettes offered by cigarette companies any time soon. The medical community will object vociferously to such additives because they fear such additives will give consumers the false impression that adding antioxidants to cigarettes reduces their negative health effects.
Second, the study results echo those of other recent studies on different antioxidant ingredients. There is a clear, growing body of evidence in pulmonology research that antioxidant supplementation (whether through consumption of antioxidant rich foods or from dietary supplements) confers significant anti-inflammatory benefits in smokers and people with COPD.
Currently, there is no consensus view as to what antioxidants are most appropriate for smokers and people with lung disease. Further, there is no consensus among researchers as to the appropriate human dosage levels to achieve significant inflammation reduction (most recent studies have been conducted on either human tissue samples or laboratory animals).
That said, the antioxidants that have received the most attention from pulmonology researchers over the past few years include Vitamin D, Vitamin A, Vitamin C, Vitamin E, N acetyl cysteine, reseveratrol, curcumin, quercetin, Chinese skull cap (baicalin), and now acai berry.
As an aside, all of the above antioxidants, with the exception of acai berry, are included in our respiratory support dietary supplement, Resplenish. To learn more about Resplenish, visit www.resplenish.com.
For more information about acai berry, click here for a WebMD.com summary.
For a sampling of dietary supplements that include acai berry, visit our Breathe Better Marketplace hosted by amazon.com.
The purpose of the study was to determine whether providing a powerful antioxidant along with cigarette smoke would lessen the likelihood of lung tissue damage and associated inflammation. The researchers chose acai berry extract (specifically the extract of the acai berry stone [seed]) because previous research studies involving plant-based antioxidants known as proanthocyanidins have shown similar anti-inflammatory effects.
In this study, the researchers divided the 60 mice in the study into three groups. One group, the control group, received neither exposure to cigarette smoke or acai berry extract. A second group, the cigarette group, was exposed to cigarette smoke from 12 cigarettes daily over a 60 day period. The third group, the acai group, was exposed to cigarette smoke in the same manner as the cigarette group but received the cigarette smoke from cigarettes injected with the acai berry extract. (de Moura RS, et al. Addition of acai (Euterpe oleracea) to cigarettes has a protective effects against emphysema in mice. Food Chem Toxicol. 2010 Dec 10. [Epub ahead of print])
At the end of the 60 day period, all mice were euthanized and lung tissue samples were extracted. The researchers viewed lung tissue samples via microscope to assess the size of alveolar spaces between the three groups (in emphysema, alveolar spaces enlarge). In addition, the lung tissue was analyzed for counts of proteins and white blood cells that are known to be present in large numbers in inflamed airway tissue.
The study team discovered that the cigarette group had 38% greater alteration to alveolar tissue in comparison to the control group. The acai group had 25% lower alteration compared to the cigarette group (meaning the acai group’s lung tissue samples showed less alteration than the cigarette group but more alteration in comparison with the control group).
When analyzing the inflammation markers, researchers found 400% more leukocytes in the cigarette group compared to the control group. The acai group had 65% fewer leukocytes than the cigarette group (again showing the acai group lessened the impact of cigarette smoke). Similar findings were found for other markers such as macrophages and neutrophils.
The study team concluded, “This study demonstrated for the first time that adding a hydro-alcoholic extract of acai stone to cigarettes significantly reduced pulmonary inflammation, oxidative stress, and CS-induced emphysema in mice… Because lung damage induced by CS is mainly due to inflammation and oxidative stress, it seems likely that acai’s anti-inflammatory and antioxidant properties underlie these protective effects…The present study demonstrated that acai extract in cigarettes has a preventive action; that is, the harmful effects of CS can be significantly reduced when the smoke also contains antioxidant compounds.”
Now, what to make of this finding? First, it is unlikely you will find acai-injected cigarettes offered by cigarette companies any time soon. The medical community will object vociferously to such additives because they fear such additives will give consumers the false impression that adding antioxidants to cigarettes reduces their negative health effects.
Second, the study results echo those of other recent studies on different antioxidant ingredients. There is a clear, growing body of evidence in pulmonology research that antioxidant supplementation (whether through consumption of antioxidant rich foods or from dietary supplements) confers significant anti-inflammatory benefits in smokers and people with COPD.
Currently, there is no consensus view as to what antioxidants are most appropriate for smokers and people with lung disease. Further, there is no consensus among researchers as to the appropriate human dosage levels to achieve significant inflammation reduction (most recent studies have been conducted on either human tissue samples or laboratory animals).
That said, the antioxidants that have received the most attention from pulmonology researchers over the past few years include Vitamin D, Vitamin A, Vitamin C, Vitamin E, N acetyl cysteine, reseveratrol, curcumin, quercetin, Chinese skull cap (baicalin), and now acai berry.
As an aside, all of the above antioxidants, with the exception of acai berry, are included in our respiratory support dietary supplement, Resplenish. To learn more about Resplenish, visit www.resplenish.com.
For more information about acai berry, click here for a WebMD.com summary.
For a sampling of dietary supplements that include acai berry, visit our Breathe Better Marketplace hosted by amazon.com.
Wednesday, December 22, 2010
Systemic inflammation in ex-smokers
A new research article reveals that 54% of ex-smoking COPD patients involved in a Chile based COPD study still exhibited signs of systemic inflammation despite their commitment to permanent smoking cessation.
These results echo the findings of another research study we wrote about last month that found airway inflammation persists for an extended period of time in ex-smoking COPD patients. Click here to read that article.
The new study examined 104 ex-smokers with mild to very severe COPD and 52 healthy non-smoking adults to see if there were differences in the blood serum levels of know inflammation markers. In particular, the research team evaluated counts of certain proteins and white blood cells that are typically found in large numbers in the presence of systemic inflammation (C-Reactive protein, Interleukin-6, fibrinogen, neutrophils).
The research investigators found notably higher counts of two of these inflammation markers among 54% of the COPD patients participating in the study (C-Reactive protein and interleukin-6). The counts of these two proteins were high enough for the researchers to conclude systemic inflammation still existed for 56 of the 104 ex-smoking COPD patients. (Morales SA, et al. Systemic inflammation among stable ex smokers with chronic obstructive pulmonary disease. Rev Med Chil. 2010 Aug;138(8):957-64. Epub 2010 Nov 26).
Why is inflammation such a big deal for smokers and COPD patients? In short, prolonged exposure to cigarette smoke alters the functioning of lung cells by disrupting the lungs normal response to the presence of bacteria and fungi. This disruption causes the body to produce massive amounts of fluid containing proteins and white blood cells seeking to counteract the presence of bacteria and fungi. The fluid build-up causes lung tissues to swell and harden, thus narrowing airways and resulting in persistent shortness of breath. For a more detailed description of inflammation and steps you can take to reduce inflammation, read our War of the Worlds In Your Lungs.
For many years, pulmonology researchers hypothesized that permanent smoking cessation would lead to a pronounced decline in airway inflammation. While that may be in the case for some smokers, it does not seem to be true in a majority of patients who’ve already been diagnosed with COPD.
In the interim, researchers and practitioners have focused the majority of their attention on corticosteroids, bronchodilator delivered prescription medication, and antibiotics as the main weapons to fight inflammation. While all three of these pharmaceutical solutions do offer relief for shortness of breath/inflammation related symptoms, the vast majority are short-acting in nature. In other words, they are band-aids for short-term relief. They offer no long-term cures for inflammation. Several exotic combinations of bronchodilating medications have shown increased promise for longer-term inflammation relief but their potential side effects concern some respiratory care professionals.
Therefore, COPD patients, current smokers and ex-smokers are wise to consider additional avenues to help combat inflammation. These other avenues include exercise, dietary changes, antioxidant supplementation and increased exposure to direct sunlight. To learn more about these inflammation fighting actions you can employ, read our 5 Steps to Feel Better NOW Plan.
These results echo the findings of another research study we wrote about last month that found airway inflammation persists for an extended period of time in ex-smoking COPD patients. Click here to read that article.
The new study examined 104 ex-smokers with mild to very severe COPD and 52 healthy non-smoking adults to see if there were differences in the blood serum levels of know inflammation markers. In particular, the research team evaluated counts of certain proteins and white blood cells that are typically found in large numbers in the presence of systemic inflammation (C-Reactive protein, Interleukin-6, fibrinogen, neutrophils).
The research investigators found notably higher counts of two of these inflammation markers among 54% of the COPD patients participating in the study (C-Reactive protein and interleukin-6). The counts of these two proteins were high enough for the researchers to conclude systemic inflammation still existed for 56 of the 104 ex-smoking COPD patients. (Morales SA, et al. Systemic inflammation among stable ex smokers with chronic obstructive pulmonary disease. Rev Med Chil. 2010 Aug;138(8):957-64. Epub 2010 Nov 26).
Why is inflammation such a big deal for smokers and COPD patients? In short, prolonged exposure to cigarette smoke alters the functioning of lung cells by disrupting the lungs normal response to the presence of bacteria and fungi. This disruption causes the body to produce massive amounts of fluid containing proteins and white blood cells seeking to counteract the presence of bacteria and fungi. The fluid build-up causes lung tissues to swell and harden, thus narrowing airways and resulting in persistent shortness of breath. For a more detailed description of inflammation and steps you can take to reduce inflammation, read our War of the Worlds In Your Lungs.
For many years, pulmonology researchers hypothesized that permanent smoking cessation would lead to a pronounced decline in airway inflammation. While that may be in the case for some smokers, it does not seem to be true in a majority of patients who’ve already been diagnosed with COPD.
In the interim, researchers and practitioners have focused the majority of their attention on corticosteroids, bronchodilator delivered prescription medication, and antibiotics as the main weapons to fight inflammation. While all three of these pharmaceutical solutions do offer relief for shortness of breath/inflammation related symptoms, the vast majority are short-acting in nature. In other words, they are band-aids for short-term relief. They offer no long-term cures for inflammation. Several exotic combinations of bronchodilating medications have shown increased promise for longer-term inflammation relief but their potential side effects concern some respiratory care professionals.
Therefore, COPD patients, current smokers and ex-smokers are wise to consider additional avenues to help combat inflammation. These other avenues include exercise, dietary changes, antioxidant supplementation and increased exposure to direct sunlight. To learn more about these inflammation fighting actions you can employ, read our 5 Steps to Feel Better NOW Plan.
Sunday, December 19, 2010
Cigarette smoking and a good night’s sleep
According to a new study published online ahead of print in the journal Sleep Medicine, current cigarette smokers are more than twice as likely to report insufficient sleep as non-smokers.
As the study authors explain, “The mechanism through which active smoking affects sleep has been established. Nicotine, the active component of cigarette smoke, stimulates the release of sleep regulating neurotransmitters including dopamine and serotonin, resulting in sleep disturbance. Cigarette smoking is associated with disturbances in sleep architecture including lighter sleep, long latency in sleep initiation, decreased sleep efficiency and increased daytime sleepiness. Nicotine dependence and nightly withdrawal are associated with anxiety and stress disorders. Further, cigarette smoking impacts sleep by exacerbating respiratory symptoms or contributing to sleep disordered breathing.”
In other words, nicotine disrupts the chemical processes in the brain that help us fall asleep and stay asleep. Further, during sleep smokers do not ingest nicotine at the same rate as they do when awake and so sleep is further compounded by anxiety and stress associated with nightly nicotine withdrawal symptoms. It’s a bit of damned if you do, damned if you don’t cycle every single night.
In the Sleep Medicine study, a group of West Virginia University researchers examined questionnaire results provided by over 80,000 respondents participating in the 2008 Behavioral Risk Factor Surveillance System - a large behavioral health study based on random, nation-wide phone surveys conducted in 2008. (Sabanayagam C, et al. The association between active smoking, smokeless tobacco, second-hand smoke exposure and insufficient sleep. Sleep Med. 2010 Dec 6. [Epub ahead of print])
Their particular aim was to confirm previous study results connecting insufficient sleep/chronic insomnia and current cigarette smokers, and to verify whether similar sleep disturbances were present in people who use smokeless tobacco and non-smokers regularly exposed to cigarette smoke.
The research team discovered that approximately 18% of current cigarette smokers suffered from insufficient sleep (defined by the researchers as not getting enough rest or sleep everyday in the preceding 30 days). By comparison, only 9% of non-smokers reported insufficient sleep when completing the survey. This led the researchers to conclude that current smokers have 100% higher odds of experiencing insufficient sleep compared to non-smokers.
With regard to smokeless tobacco, the study investigators found 67% higher incidence of insufficient sleep among current smokeless tobacco users compared to never smokeless tobacco users. While this level was lower than the odds ratio for current cigarette smokers, it is still statistically significant.
Among non-smokers exposed to second hand cigarette smoke, the study results showed 41% higher odds of insufficient sleep compared to non-smokers not exposed to second hand cigarette smoke.
It appears from these results that regardless of consumption source (inhaling cigarette smoke, chewing tobacco, inhaling snuff, or inhaling second hand cigarette smoke), nicotine exposure is disruptive to a good night’s sleep. As the article authors concluded, “Consistent with previous studies, active smoking was associated with insufficient rest/sleep in the current study. Effect of smokeless tobacco on sleep has not been studied before. To our knowledge this is the first study showing an association between smokeless tobacco and insufficient rest/sleep.”
So short of permanent smoking cessation, what can people regularly exposed to cigarette smoke do to improve their odds of a good (or at least better) night’s sleep?
From our reading of sleep related research, we have several suggestions to offer:
1. Exercise – multiple studies have shown that adults of various ages and physical condition enjoy better sleep latency (the amount of time it takes for one to fall asleep), sleep duration and self-reported sleep quality from engaging in a regular exercise program. In fact, a separate study published this month online ahead of print in the journal Sleep Medicine showed that elderly study subjects who engaged in 30-40 minutes of sub-maximal aerobic exercise 3-4 times each week over a 16 week period reported a 1.25 hour increase in sleep duration, a 21% drop in the time it took them to fall asleep, and a significant jump in self-reported sleep quality.
2. Caffeine – avoid consuming products with caffeine after 2 p.m. each day. Much like nicotine, caffeine is a brain chemical stimulant that disrupts the body’s normal sleep cycle. If you can’t give up nicotine, then at least avoid compounding the problem by eliminating caffeine after 2 p.m. each day in order to give your body a chance to flush the caffeine consumed earlier in the day before bedtime.
3. Alcohol – thought alcohol is not a stimulant (it’s considered a depressant), consuming too much alcohol does disrupt the normal release of sleep inducing chemicals in the brain. Research suggests that consuming more than 2-3 alcoholic beverages within 4 hours of attempting to sleep does affect the body’s ability to fall asleep.
4. Television/Internet usage – though many people unwind at night by watching television or surfing the web, research has shown that cutting off television viewing/Internet surfing 1 hour or more before bedtime enhances the body’s ability to drift off to sleep.
5. Snack – studies have shown that consuming a light snack prior to bedtime enhances the body’s ability to fall asleep and stay asleep. Note, we said light snack, not full meal.
6. Sleep environment – scientists have found that odds of a good night’s sleep are enhanced by sleeping under warm bedding in a dark, cold room. Further, retiring to your bed only when ready to sleep (versus reading a book or watching TV in bed for a prolonged period before sleep) has been shown to improve the time it takes one to fall asleep.
7. Wake-time – an effective way of shocking your body to accept sleep more readily is to set your alarm clock to wake 30 minutes before your current waking time for at least a week. When you combine this technique with avoiding naps during the day during the same reset period, you effectively reset your body’s sleep clock (meaning at night your body is more receptive to sleep).
While there are surely other techniques for improving the time it takes one to fall asleep, stay asleep and wake up feeling well rested and full of energy, these techniques are the ones most often cited by sleep advocates such as the American Academy of Sleep Medicine.
As the study authors explain, “The mechanism through which active smoking affects sleep has been established. Nicotine, the active component of cigarette smoke, stimulates the release of sleep regulating neurotransmitters including dopamine and serotonin, resulting in sleep disturbance. Cigarette smoking is associated with disturbances in sleep architecture including lighter sleep, long latency in sleep initiation, decreased sleep efficiency and increased daytime sleepiness. Nicotine dependence and nightly withdrawal are associated with anxiety and stress disorders. Further, cigarette smoking impacts sleep by exacerbating respiratory symptoms or contributing to sleep disordered breathing.”
In other words, nicotine disrupts the chemical processes in the brain that help us fall asleep and stay asleep. Further, during sleep smokers do not ingest nicotine at the same rate as they do when awake and so sleep is further compounded by anxiety and stress associated with nightly nicotine withdrawal symptoms. It’s a bit of damned if you do, damned if you don’t cycle every single night.
In the Sleep Medicine study, a group of West Virginia University researchers examined questionnaire results provided by over 80,000 respondents participating in the 2008 Behavioral Risk Factor Surveillance System - a large behavioral health study based on random, nation-wide phone surveys conducted in 2008. (Sabanayagam C, et al. The association between active smoking, smokeless tobacco, second-hand smoke exposure and insufficient sleep. Sleep Med. 2010 Dec 6. [Epub ahead of print])
Their particular aim was to confirm previous study results connecting insufficient sleep/chronic insomnia and current cigarette smokers, and to verify whether similar sleep disturbances were present in people who use smokeless tobacco and non-smokers regularly exposed to cigarette smoke.
The research team discovered that approximately 18% of current cigarette smokers suffered from insufficient sleep (defined by the researchers as not getting enough rest or sleep everyday in the preceding 30 days). By comparison, only 9% of non-smokers reported insufficient sleep when completing the survey. This led the researchers to conclude that current smokers have 100% higher odds of experiencing insufficient sleep compared to non-smokers.
With regard to smokeless tobacco, the study investigators found 67% higher incidence of insufficient sleep among current smokeless tobacco users compared to never smokeless tobacco users. While this level was lower than the odds ratio for current cigarette smokers, it is still statistically significant.
Among non-smokers exposed to second hand cigarette smoke, the study results showed 41% higher odds of insufficient sleep compared to non-smokers not exposed to second hand cigarette smoke.
It appears from these results that regardless of consumption source (inhaling cigarette smoke, chewing tobacco, inhaling snuff, or inhaling second hand cigarette smoke), nicotine exposure is disruptive to a good night’s sleep. As the article authors concluded, “Consistent with previous studies, active smoking was associated with insufficient rest/sleep in the current study. Effect of smokeless tobacco on sleep has not been studied before. To our knowledge this is the first study showing an association between smokeless tobacco and insufficient rest/sleep.”
So short of permanent smoking cessation, what can people regularly exposed to cigarette smoke do to improve their odds of a good (or at least better) night’s sleep?
From our reading of sleep related research, we have several suggestions to offer:
1. Exercise – multiple studies have shown that adults of various ages and physical condition enjoy better sleep latency (the amount of time it takes for one to fall asleep), sleep duration and self-reported sleep quality from engaging in a regular exercise program. In fact, a separate study published this month online ahead of print in the journal Sleep Medicine showed that elderly study subjects who engaged in 30-40 minutes of sub-maximal aerobic exercise 3-4 times each week over a 16 week period reported a 1.25 hour increase in sleep duration, a 21% drop in the time it took them to fall asleep, and a significant jump in self-reported sleep quality.
2. Caffeine – avoid consuming products with caffeine after 2 p.m. each day. Much like nicotine, caffeine is a brain chemical stimulant that disrupts the body’s normal sleep cycle. If you can’t give up nicotine, then at least avoid compounding the problem by eliminating caffeine after 2 p.m. each day in order to give your body a chance to flush the caffeine consumed earlier in the day before bedtime.
3. Alcohol – thought alcohol is not a stimulant (it’s considered a depressant), consuming too much alcohol does disrupt the normal release of sleep inducing chemicals in the brain. Research suggests that consuming more than 2-3 alcoholic beverages within 4 hours of attempting to sleep does affect the body’s ability to fall asleep.
4. Television/Internet usage – though many people unwind at night by watching television or surfing the web, research has shown that cutting off television viewing/Internet surfing 1 hour or more before bedtime enhances the body’s ability to drift off to sleep.
5. Snack – studies have shown that consuming a light snack prior to bedtime enhances the body’s ability to fall asleep and stay asleep. Note, we said light snack, not full meal.
6. Sleep environment – scientists have found that odds of a good night’s sleep are enhanced by sleeping under warm bedding in a dark, cold room. Further, retiring to your bed only when ready to sleep (versus reading a book or watching TV in bed for a prolonged period before sleep) has been shown to improve the time it takes one to fall asleep.
7. Wake-time – an effective way of shocking your body to accept sleep more readily is to set your alarm clock to wake 30 minutes before your current waking time for at least a week. When you combine this technique with avoiding naps during the day during the same reset period, you effectively reset your body’s sleep clock (meaning at night your body is more receptive to sleep).
While there are surely other techniques for improving the time it takes one to fall asleep, stay asleep and wake up feeling well rested and full of energy, these techniques are the ones most often cited by sleep advocates such as the American Academy of Sleep Medicine.
Wednesday, December 15, 2010
Perceived quality of life a strong predictor of COPD exacerbations
A COPD exacerbation is typically defined as a shortness of breath episode significant enough that a patient seeks physician intervention and can often lead to an emergency room visit or hospitalization. Exacerbations commonly occur in COPD patients as a result of significant airway inflammation most often caused by some combination of prolonged exposure to cigarette smoke, upper respiratory infections and/or dramatic increases in the production of sputum.
Many recent pulmonology research efforts have explored ways to treat exacerbations, reduce the number and severity of future exacerbations and to find ways to identify patients who are likely to be most susceptible to exacerbations (with an eye towards heading off the problem before it occurs).
The most common solutions prescribed by physicians to address exacerbation symptoms are in the form of antibiotics, corticosteroids, and bronchodilator medications. The antibiotics help suppress respiratory infections and clear sputum. The corticosteroids and bronchodilators typically help suppress airway inflammation. Sounds like an easy set of solutions, right? Well, it is true that these medications do help reduce exacerbation symptoms but unfortunately most are effective in relieving immediate symptoms and do not produce lasting benefit or protection against future exacerbations.
For those thinking proactively (i.e. trying to avoid future exacerbations) the treatment option that offers the best, longer-term protection is smoking cessation. Prolonged exposure to cigarette smoke damages the integrity of lung tissues over time as the pro-oxidant free radical molecules present in cigarette smoke in massive quantities nick away at the protective lining of the airways, exposing underlying cells to the toxic chemicals in cigarette smoke. Those toxic chemicals eventually disrupt the normal lung cell function and stimulate inflammation.
Beyond smoking cessation, another effective method for reducing exacerbations is a COPD treatment known as pulmonary rehabilitation. Pulmonary rehab is an exercise centered treatment program designed to build patient physical endurance and strength. Research studies have shown that an 8-12 week pulmonary rehab program is effective in reducing COPD patient shortness of breath, reducing the frequency and severity of exacerbations, reducing future hospitalizations, improving physical conditioning, and improving patient quality of life.
There is also growing research evidence that many COPD patients are deficient in vital nutrients known as antioxidants. In studies where certain antioxidants are supplemented (through food or dietary supplements) in human COPD patients and smokers, human lung tissue samples exposed to cigarette smoke, and laboratory animals exposed to cigarette smoke, there have been many published results showing a significant reduction in lung tissue inflammation. So there appears to be growing sentiment for supplementing antioxidants as a proactive ongoing measure against lung inflammation (and by extension future exacerbations).
But what about methods to predict or identify those most susceptible to COPD exacerbations? Well, a new research article examined several potential “leading indicators” and concluded that among the leading indicators self-reported quality of life ratings seem to be a strong potential predictor of those most likely to have frequent future exacerbations.
The study, published online ahead of print in The Clinical Respiratory Journal, followed 121 COPD patients in a year-long study. The Sweden based research team selected several potential “leading indicators” to measure at the outset of the study including previous 3-month corticosteroid use (signaling a recent previous exacerbation episode), self-reported quality of life survey ratings, inflammation-related markers in sputum samples, body-mass-index scores, and a set of diagnostic test measures of physical condition (6 minute walk test) and lung function (spirometry).
During the course of the 1 year study, the COPD patients and their physicians reported subsequent exacerbations to the study team. At the end of the study period, the researchers divided the 121 COPD patients into two groups. In one group, study subjects who had 2 or more exacerbations during the study were denoted as “frequent exacerbators”. The other group, those who experienced less than 2 exacerbations during the study period were classified as “infrequent exacerbators”.
Then the researchers examined the differences in the “leading indicators” measured at the outset of the study to determine which, if any, indicators were substantially different between the two groups. The only two indicators that delivered statistically significant differences were “past 3-month corticosteroid use” and low self-reported quality of life survey ratings. (Brusse-Kaizer MGJ, et al. Clinical predictors of exacerbation frequency in chronic obstructive pulmonary disease. The Clinical Respiratory Journal. Accepted Article; doi: 10.1111/j.1752-699X.2010.00234.x)
The past 3-month corticosteroid use makes intuitive sense. The steroids were most likely prescribed for a previous exacerbation event and therefore indicative of someone susceptible to future exacerbations.
The quality of life survey ratings were more intriguing as a potential predictor in our opinion (especially in alerting COPD patients of potential quality of life warning signs to keep an eye on). Two particular questions on the Health Quality of Life survey used in the study showed strong correlation as predictive of future exacerbations. As the researchers explained, “The factors “being in control of health”, “panic”, and “disturbance of daily life” could be worse in less stable patients and these patients could therefore be identified as being at higher risk of being frequent exacerbators, something that to our knowledge has not been analyzed in this way before. Indeed, the question “I feel that I am not in control of my chest problem” was answered positively more often by frequent (35.5%) than by infrequent exacerbators (12.2%). Similarly, the question “I get afraid or panic when I cannot get my breath” was answered positively more often by frequent (38.7%) than by infrequent exacerbators (22.2%)”.
In other words, COPD patients who are increasingly concerned that they are not in control of their chest problem and/or sense a increasing degree of panic when they can’t catch their breath are among those most likely to experience a COPD exacerbation within the year.
In our opinion, if you find yourself feeling this way about either issue and you want to take proactive steps to avoid a COPD exacerbation, you would be well served to discuss your concerns with your physician and to explore smoking cessation, pulmonary rehabilitation, and antioxidant supplementation.
Smoking cessation and antioxidant supplementation will help reduce inflammation. Pulmonary rehabilitation will help boost your physical condition, reduce shortness of breath, and promote a greater sense of control of your breathing. The combination of these three treatment options combined with medications prescribed by your doctor can significantly reduce the likelihood of future exacerbations and the severity of an exacerbation if one does occur.
To learn more about inflammation and what steps you can take to reduce it, we recommend reading our article, War of the Worlds in Your Lungs, and considering following our 5 Step Feel Better NOW Plan.
Many recent pulmonology research efforts have explored ways to treat exacerbations, reduce the number and severity of future exacerbations and to find ways to identify patients who are likely to be most susceptible to exacerbations (with an eye towards heading off the problem before it occurs).
The most common solutions prescribed by physicians to address exacerbation symptoms are in the form of antibiotics, corticosteroids, and bronchodilator medications. The antibiotics help suppress respiratory infections and clear sputum. The corticosteroids and bronchodilators typically help suppress airway inflammation. Sounds like an easy set of solutions, right? Well, it is true that these medications do help reduce exacerbation symptoms but unfortunately most are effective in relieving immediate symptoms and do not produce lasting benefit or protection against future exacerbations.
For those thinking proactively (i.e. trying to avoid future exacerbations) the treatment option that offers the best, longer-term protection is smoking cessation. Prolonged exposure to cigarette smoke damages the integrity of lung tissues over time as the pro-oxidant free radical molecules present in cigarette smoke in massive quantities nick away at the protective lining of the airways, exposing underlying cells to the toxic chemicals in cigarette smoke. Those toxic chemicals eventually disrupt the normal lung cell function and stimulate inflammation.
Beyond smoking cessation, another effective method for reducing exacerbations is a COPD treatment known as pulmonary rehabilitation. Pulmonary rehab is an exercise centered treatment program designed to build patient physical endurance and strength. Research studies have shown that an 8-12 week pulmonary rehab program is effective in reducing COPD patient shortness of breath, reducing the frequency and severity of exacerbations, reducing future hospitalizations, improving physical conditioning, and improving patient quality of life.
There is also growing research evidence that many COPD patients are deficient in vital nutrients known as antioxidants. In studies where certain antioxidants are supplemented (through food or dietary supplements) in human COPD patients and smokers, human lung tissue samples exposed to cigarette smoke, and laboratory animals exposed to cigarette smoke, there have been many published results showing a significant reduction in lung tissue inflammation. So there appears to be growing sentiment for supplementing antioxidants as a proactive ongoing measure against lung inflammation (and by extension future exacerbations).
But what about methods to predict or identify those most susceptible to COPD exacerbations? Well, a new research article examined several potential “leading indicators” and concluded that among the leading indicators self-reported quality of life ratings seem to be a strong potential predictor of those most likely to have frequent future exacerbations.
The study, published online ahead of print in The Clinical Respiratory Journal, followed 121 COPD patients in a year-long study. The Sweden based research team selected several potential “leading indicators” to measure at the outset of the study including previous 3-month corticosteroid use (signaling a recent previous exacerbation episode), self-reported quality of life survey ratings, inflammation-related markers in sputum samples, body-mass-index scores, and a set of diagnostic test measures of physical condition (6 minute walk test) and lung function (spirometry).
During the course of the 1 year study, the COPD patients and their physicians reported subsequent exacerbations to the study team. At the end of the study period, the researchers divided the 121 COPD patients into two groups. In one group, study subjects who had 2 or more exacerbations during the study were denoted as “frequent exacerbators”. The other group, those who experienced less than 2 exacerbations during the study period were classified as “infrequent exacerbators”.
Then the researchers examined the differences in the “leading indicators” measured at the outset of the study to determine which, if any, indicators were substantially different between the two groups. The only two indicators that delivered statistically significant differences were “past 3-month corticosteroid use” and low self-reported quality of life survey ratings. (Brusse-Kaizer MGJ, et al. Clinical predictors of exacerbation frequency in chronic obstructive pulmonary disease. The Clinical Respiratory Journal. Accepted Article; doi: 10.1111/j.1752-699X.2010.00234.x)
The past 3-month corticosteroid use makes intuitive sense. The steroids were most likely prescribed for a previous exacerbation event and therefore indicative of someone susceptible to future exacerbations.
The quality of life survey ratings were more intriguing as a potential predictor in our opinion (especially in alerting COPD patients of potential quality of life warning signs to keep an eye on). Two particular questions on the Health Quality of Life survey used in the study showed strong correlation as predictive of future exacerbations. As the researchers explained, “The factors “being in control of health”, “panic”, and “disturbance of daily life” could be worse in less stable patients and these patients could therefore be identified as being at higher risk of being frequent exacerbators, something that to our knowledge has not been analyzed in this way before. Indeed, the question “I feel that I am not in control of my chest problem” was answered positively more often by frequent (35.5%) than by infrequent exacerbators (12.2%). Similarly, the question “I get afraid or panic when I cannot get my breath” was answered positively more often by frequent (38.7%) than by infrequent exacerbators (22.2%)”.
In other words, COPD patients who are increasingly concerned that they are not in control of their chest problem and/or sense a increasing degree of panic when they can’t catch their breath are among those most likely to experience a COPD exacerbation within the year.
In our opinion, if you find yourself feeling this way about either issue and you want to take proactive steps to avoid a COPD exacerbation, you would be well served to discuss your concerns with your physician and to explore smoking cessation, pulmonary rehabilitation, and antioxidant supplementation.
Smoking cessation and antioxidant supplementation will help reduce inflammation. Pulmonary rehabilitation will help boost your physical condition, reduce shortness of breath, and promote a greater sense of control of your breathing. The combination of these three treatment options combined with medications prescribed by your doctor can significantly reduce the likelihood of future exacerbations and the severity of an exacerbation if one does occur.
To learn more about inflammation and what steps you can take to reduce it, we recommend reading our article, War of the Worlds in Your Lungs, and considering following our 5 Step Feel Better NOW Plan.
Monday, December 13, 2010
Pulmonary rehabilitation reduces depression in COPD patients
A new study published in the journal Chronic Respiratory Disease revealed that COPD patients who underwent an intensive 4-week inpatient pulmonary rehabilitation program reported significantly lower feelings of depression in addition to recording improved physical conditioning and higher self-reported quality of life.
This study confirms previous pulmonary rehabilitation research results with regard to its reported findings with a twist. Most past pulmonary rehab studies have examined the effectiveness of 8-12 week outpatient programs where COPD patients attend 2-3 one-hour sessions each week.
In this Norway based study, the 161 study subjects participated in a hospital-inpatient program for 4 weeks where patients attended pulmonary rehabilitation sessions 7.5 hours a day, 5 days a week over the 4 week period. The program components were similar to outpatient programs (guided/observed exercise, breathing & airway clearing training, and counseling regarding nutrition, medication use and other related health topics).
At the outset of the study, the COPD patients were tested for their exercise capacity using common a respiratory diagnostic tool known as the 6 minute walk test (where patients are asked to walk as far as they can within a 6 minute time limit – the resulting measure is called the 6-minute walk distance or 6MWD). Patients also completed health quality of life questionnaires and a depression/anxiety questionnaire commonly used by researchers to assess patient perceptions of well being (the St. George’s Respiratory Questionnaire and the Hospital Anxiety and Depression Scale, respectively). At the end of the 4 week period, the patients went through this battery of tests again and then researchers compared the pre and post study measures to judge if patients experienced improvement on some or all. (Bratas O, et al. Pulmonary rehabilitation reduces depression and enhances health-related quality of life in COPD patients - especially in patients with mild or moderate disease. Chron Respir Dis. 2010;7(4):229-37)
Not surprisingly, given past rehab study results, exercise capacity improved as measured by the 6 minute walk test. The mean improvement in 6MWD after the 4-week rehab program was 44 meters, or 12% (according to the study team, an increase of 35 meters or more is considered clinically significant).
On the Health Quality of Life survey, the COPD patients in the study showed statistically significant improvement between their pre and post study questionnaires in one particular component, the “psychosocial impact” component. According to the study team, the impact section, “measures aspects of social functioning and psychosocial disturbances caused by airway disease.” In other words, patients rate their perception of how COPD impacts their ability to interact with others.
It was in the depression/anxiety survey results where the biggest statistical improvement of the pulmonary rehab program was reported by study participants. At the outset of the study, 27% of the COPD patients in the study recorded scores on the anxiety/depression questionnaire that suggested a depression diagnosis. At the end of the 4-week pulmonary rehab program, only 16% showed results suggesting a depression diagnosis. This represented a 39% reduction in study participants with a possible depression diagnosis after completing the pulmonary rehab program.
Commenting on the improvements in the “psychosocial impact” and depression scores, the study authors commented, “In general, it is not clear which components of a pulmonary rehabilitation program specifically contribute to reduction of psychological distress. However, the components exercise, disease education and psychosocial support in the present rehabilitation program may have contributed, separately or combined to reducing depression.”
We suspect that in the process of improving physical condition through pulmonary rehabilitation-style exercise programs, COPD patients develop a greater sense of control over their breathing pattern and greater confidence in their ability to participate in everyday activities. The greater sense of control and improved confidence in turn help reduce depression (i.e. less sense of helplessness and greater participation/enjoyment of normal daily activities).
For COPD patients who haven’t tried pulmonary rehabilitation, we highly recommend you ask your physician to refer you to a program in your area. While it will not be as short/intensive as the program reported in this study, a traditional outpatient program confers many of the same benefits. For COPD patients who are unable to gain entry to a pulmonary rehab program (and sadly, that represents about 99% of COPD patients given the limited number of available programs and restrictive Medicare/insurance admission guidelines), you can achieve many of the same benefits by beginning and maintaining a regular exercise program.
Consult your physician for an exercise program that is appropriate for your individual circumstance. If your physician does not have a program to recommend, we suggest you consider purchasing our Breathe Better for Life guidebook and CD-ROM. We’ve developed an exercise program based on the principles of pulmonary rehabilitation as outlined by the American Thoracic Society and the European Respiratory Society. We’ve further tweaked these guidelines to include exercise recommendations from the American College of Sports Medicine for people with chronic respiratory conditions.
Whatever path you choose, we strongly believe that regular physical exercise is one of the best proactive steps a COPD patient (or anyone who suffers from chronic shortness of breath) can undertake. Not only will you likely benefit from improved physical conditioning and reduced shortness of breath, you may also see significant improvements in your perceived quality of life, mood and outlook.
This study confirms previous pulmonary rehabilitation research results with regard to its reported findings with a twist. Most past pulmonary rehab studies have examined the effectiveness of 8-12 week outpatient programs where COPD patients attend 2-3 one-hour sessions each week.
In this Norway based study, the 161 study subjects participated in a hospital-inpatient program for 4 weeks where patients attended pulmonary rehabilitation sessions 7.5 hours a day, 5 days a week over the 4 week period. The program components were similar to outpatient programs (guided/observed exercise, breathing & airway clearing training, and counseling regarding nutrition, medication use and other related health topics).
At the outset of the study, the COPD patients were tested for their exercise capacity using common a respiratory diagnostic tool known as the 6 minute walk test (where patients are asked to walk as far as they can within a 6 minute time limit – the resulting measure is called the 6-minute walk distance or 6MWD). Patients also completed health quality of life questionnaires and a depression/anxiety questionnaire commonly used by researchers to assess patient perceptions of well being (the St. George’s Respiratory Questionnaire and the Hospital Anxiety and Depression Scale, respectively). At the end of the 4 week period, the patients went through this battery of tests again and then researchers compared the pre and post study measures to judge if patients experienced improvement on some or all. (Bratas O, et al. Pulmonary rehabilitation reduces depression and enhances health-related quality of life in COPD patients - especially in patients with mild or moderate disease. Chron Respir Dis. 2010;7(4):229-37)
Not surprisingly, given past rehab study results, exercise capacity improved as measured by the 6 minute walk test. The mean improvement in 6MWD after the 4-week rehab program was 44 meters, or 12% (according to the study team, an increase of 35 meters or more is considered clinically significant).
On the Health Quality of Life survey, the COPD patients in the study showed statistically significant improvement between their pre and post study questionnaires in one particular component, the “psychosocial impact” component. According to the study team, the impact section, “measures aspects of social functioning and psychosocial disturbances caused by airway disease.” In other words, patients rate their perception of how COPD impacts their ability to interact with others.
It was in the depression/anxiety survey results where the biggest statistical improvement of the pulmonary rehab program was reported by study participants. At the outset of the study, 27% of the COPD patients in the study recorded scores on the anxiety/depression questionnaire that suggested a depression diagnosis. At the end of the 4-week pulmonary rehab program, only 16% showed results suggesting a depression diagnosis. This represented a 39% reduction in study participants with a possible depression diagnosis after completing the pulmonary rehab program.
Commenting on the improvements in the “psychosocial impact” and depression scores, the study authors commented, “In general, it is not clear which components of a pulmonary rehabilitation program specifically contribute to reduction of psychological distress. However, the components exercise, disease education and psychosocial support in the present rehabilitation program may have contributed, separately or combined to reducing depression.”
We suspect that in the process of improving physical condition through pulmonary rehabilitation-style exercise programs, COPD patients develop a greater sense of control over their breathing pattern and greater confidence in their ability to participate in everyday activities. The greater sense of control and improved confidence in turn help reduce depression (i.e. less sense of helplessness and greater participation/enjoyment of normal daily activities).
For COPD patients who haven’t tried pulmonary rehabilitation, we highly recommend you ask your physician to refer you to a program in your area. While it will not be as short/intensive as the program reported in this study, a traditional outpatient program confers many of the same benefits. For COPD patients who are unable to gain entry to a pulmonary rehab program (and sadly, that represents about 99% of COPD patients given the limited number of available programs and restrictive Medicare/insurance admission guidelines), you can achieve many of the same benefits by beginning and maintaining a regular exercise program.
Consult your physician for an exercise program that is appropriate for your individual circumstance. If your physician does not have a program to recommend, we suggest you consider purchasing our Breathe Better for Life guidebook and CD-ROM. We’ve developed an exercise program based on the principles of pulmonary rehabilitation as outlined by the American Thoracic Society and the European Respiratory Society. We’ve further tweaked these guidelines to include exercise recommendations from the American College of Sports Medicine for people with chronic respiratory conditions.
Whatever path you choose, we strongly believe that regular physical exercise is one of the best proactive steps a COPD patient (or anyone who suffers from chronic shortness of breath) can undertake. Not only will you likely benefit from improved physical conditioning and reduced shortness of breath, you may also see significant improvements in your perceived quality of life, mood and outlook.
Saturday, December 4, 2010
COPD patients & smokers – winter is almost here, are you ready???
For people who suffer from chronic shortness of breath, the winter months are the most trying. By way of example, previous studies have shown that COPD exacerbation events spike during the winter months often leading to increased emergency room visits and/or hospitalizations. This trend is most pronounced in northern latitude geographic locations where the combination of colder temperatures and reduced hours of sunlight lead people to pursue an unhealthy mix of lifestyle behaviors.
The cycle goes like this:
1. Colder temperatures and fewer hours of sunlight lead people to stay indoors more hours of every day during the winter.
2. While indoors, most people tend to be less physically active than when participating in outdoor activities. Lack of movement/activity weakens muscles and contributes to de-conditioning of cardiovascular function – especially in COPD patients.
3. Also while indoors, people receive less Vitamin D from exposure to direct sunlight. Vitamin D deficiency is believed a leading cause of lung inflammation (along with other antioxidant deficiencies).
4. For those who smoke cigarettes and/or those who regularly use wood burning heating sources, the toxic fumes from smoke linger in the air longer indoors given that the confined space traps smoke versus dissipating more quickly in outdoor environments (meaning more of the dangerous chemicals are inhaled while indoors).
5. Further, bacteria and viruses most often thrive in warm, moist environments and during winter months the most attractive environments for them to survive are found indoors. The more time spent indoors, the greater the exposure to bacteria and viruses that cause respiratory infections.
6. Episodes of depression are more pronounced during winter months due to prolonged confinement in indoor environments, lack of activity, and the persistent bleak inhospitable outdoor environment. Depression can lead people to smoke more, eat more and drink alcohol more.
So, winter’s nearly here (and if it hasn’t officially arrived in your area, we’re it sure feels like it already) – what can you do to improve your chances of having a healthier and happier season?
1. Increase your consumption of Vitamin D – from direct exposure to sunlight (20-30 minutes a day with multiple areas of your skin exposed and without applying sunscreen that blocks UV-B rays), foods fortified with Vitamin D (cereals, breads and dairy products are good sources of Vitamin D), and/or from Vitamin D dietary supplements (we recommend 2,000 IU’s for smokers and people with respiratory conditions). Vitamin D as a dietary supplement is inexpensive and is widely available both in retail stores and from online merchants (look for Vitamin D3 in the form of cholecalciferol). For those interested, we have included Vitamin D3 at 2,000 IU’s in our potent, antioxidant dietary supplement for respiratory support called Resplenish. To learn more about Resplenish, click here. Alternatively, we’ve listed a couple stand-alone Vitamin D products from supplement companies we find reputable on our Breathe Better Marketplace site hosted by amazon.com.
While increasing your Vitamin D consumption may sound too simple a solution for good respiratory health during the winter months it is honestly one of the most valuable steps you can take. It helps protect your immune function and reduces airway inflammation – both valuable benefits for those with respiratory health concerns, especially during winter months.
2. Exercise – 20-30 minutes of cardiovascular exercise and 20-30 minutes of strength training exercise 3-5 days a week has been shown to reduce shortness of breath, improve physical strength/stamina, improve participation in other activities, and improve sense of well being, reduce COPD exacerbations, and reduce hospitalizations related to respiratory health. These are the fundamental benefits of pulmonary rehabilitation, a highly effective COPD treatment.
If you are a COPD patient and don’t know where to start, ask your physician for a referral to a pulmonary rehab program in your area. If you cannot gain admission to a rehab program in your area (they are notoriously hard to get into), consider utilizing a fitness center in your community where you can find fitness instructors who can design an exercise program appropriate for your health circumstances. Alternatively, consider purchasing our Breathe Better for Life guidebook and CD-ROM for our recommended exercise program for those with respiratory conditions. Our program is based on pulmonary rehabilitation guidelines promulgated by the American Thoracic Society, European Respiratory Society, as well as guidelines for those who chronic respiratory conditions from the American College of Sports Medicine.
If none of those options appeal to you, consider a simple walking program of 30-60 minutes a day, 3-5 days a week. If you live in an area with snow and ice covered outdoor walkways, try walking at your local indoor mall or on a treadmill. If you live in an area where there isn’t a lot of snow or ice, it is ideal to walk outdoors to gain the additional benefit of exposure to direct sunlight. Whether indoors or outdoors, seek flat surfaces and walking courses/equipment with adequate handrail support if you suffer from poor balance. You might even consider Nordic walking (walking with ski-pole-like devices). We previously wrote about a recent research study regarding Nordic Walking for COPD patients that you can read by clicking here.
Not only is exercise beneficial for good respiratory health and physical conditioning, it also has been shown in many studies to reduce feelings of depression.
3. Join a tai chi or yoga class – these mediation based forms of exercise convey health benefits for COPD patients and others who suffer from chronic shortness of breath as we’ve previously reported. If you’re stuck indoors all winter, these classes are also great ways to get out, move around, and socialize with others. Many health clubs and community centers offer tai chi and yoga classes specifically designed for people with limited mobility or other health conditions. If you can’t or don’t want to attend a center-based tai chi or yoga class, consider buying a tai chi or yoga DVD to use at home. These videos offer step by step instructions and many are geared for people with limited mobility or other health conditions. We’ve listed a handful on our Breathe Better Marketplace hosted by amazon.com for those who are interested but tai chi and yoga DVD’s are widely available from retail and online merchants.
4. While the value of smoking cessation during winter months is particularly high given the increased exposure to smoke in confined indoor spaces, we understand the prospect of smoking cessation may feel like too much of a challenge for some. For those who can’t or won’t stop smoking, consider delaying your first cigarette of the day for 30-60 minutes after waking. Research studies have shown that smokers who light up their first cigarette within the first 5 minutes after waking have the highest level of depression among all smokers, while those who delay for at least 30 minutes after waking have the lowest depression among smokers. And the gap between the two is notable as we’ve previously reported.
5. If your primary heating and/or cooking source is a wood burning stove or fireplace, seriously consider replacing these options with electric or natural gas burning devices. Previous studies have shown that regular exposure to wood smoke can be as detrimental to respiratory health as cigarette smoke, and if you are exposed regularly to both, your chances of serious respiratory health issues are dramatically increased. Click here to read a related article.
In our opinion, you can significantly improve your chances of a healthier and happier winter season by following the above steps. The combination of increased Vitamin D consumption, regular exercise/physical activity, and reduced exposure to cigarette and wood smoke can make a world of difference for COPD patients, smokers and other who suffer from chronic shortness of breath.
The cycle goes like this:
1. Colder temperatures and fewer hours of sunlight lead people to stay indoors more hours of every day during the winter.
2. While indoors, most people tend to be less physically active than when participating in outdoor activities. Lack of movement/activity weakens muscles and contributes to de-conditioning of cardiovascular function – especially in COPD patients.
3. Also while indoors, people receive less Vitamin D from exposure to direct sunlight. Vitamin D deficiency is believed a leading cause of lung inflammation (along with other antioxidant deficiencies).
4. For those who smoke cigarettes and/or those who regularly use wood burning heating sources, the toxic fumes from smoke linger in the air longer indoors given that the confined space traps smoke versus dissipating more quickly in outdoor environments (meaning more of the dangerous chemicals are inhaled while indoors).
5. Further, bacteria and viruses most often thrive in warm, moist environments and during winter months the most attractive environments for them to survive are found indoors. The more time spent indoors, the greater the exposure to bacteria and viruses that cause respiratory infections.
6. Episodes of depression are more pronounced during winter months due to prolonged confinement in indoor environments, lack of activity, and the persistent bleak inhospitable outdoor environment. Depression can lead people to smoke more, eat more and drink alcohol more.
So, winter’s nearly here (and if it hasn’t officially arrived in your area, we’re it sure feels like it already) – what can you do to improve your chances of having a healthier and happier season?
1. Increase your consumption of Vitamin D – from direct exposure to sunlight (20-30 minutes a day with multiple areas of your skin exposed and without applying sunscreen that blocks UV-B rays), foods fortified with Vitamin D (cereals, breads and dairy products are good sources of Vitamin D), and/or from Vitamin D dietary supplements (we recommend 2,000 IU’s for smokers and people with respiratory conditions). Vitamin D as a dietary supplement is inexpensive and is widely available both in retail stores and from online merchants (look for Vitamin D3 in the form of cholecalciferol). For those interested, we have included Vitamin D3 at 2,000 IU’s in our potent, antioxidant dietary supplement for respiratory support called Resplenish. To learn more about Resplenish, click here. Alternatively, we’ve listed a couple stand-alone Vitamin D products from supplement companies we find reputable on our Breathe Better Marketplace site hosted by amazon.com.
While increasing your Vitamin D consumption may sound too simple a solution for good respiratory health during the winter months it is honestly one of the most valuable steps you can take. It helps protect your immune function and reduces airway inflammation – both valuable benefits for those with respiratory health concerns, especially during winter months.
2. Exercise – 20-30 minutes of cardiovascular exercise and 20-30 minutes of strength training exercise 3-5 days a week has been shown to reduce shortness of breath, improve physical strength/stamina, improve participation in other activities, and improve sense of well being, reduce COPD exacerbations, and reduce hospitalizations related to respiratory health. These are the fundamental benefits of pulmonary rehabilitation, a highly effective COPD treatment.
If you are a COPD patient and don’t know where to start, ask your physician for a referral to a pulmonary rehab program in your area. If you cannot gain admission to a rehab program in your area (they are notoriously hard to get into), consider utilizing a fitness center in your community where you can find fitness instructors who can design an exercise program appropriate for your health circumstances. Alternatively, consider purchasing our Breathe Better for Life guidebook and CD-ROM for our recommended exercise program for those with respiratory conditions. Our program is based on pulmonary rehabilitation guidelines promulgated by the American Thoracic Society, European Respiratory Society, as well as guidelines for those who chronic respiratory conditions from the American College of Sports Medicine.
If none of those options appeal to you, consider a simple walking program of 30-60 minutes a day, 3-5 days a week. If you live in an area with snow and ice covered outdoor walkways, try walking at your local indoor mall or on a treadmill. If you live in an area where there isn’t a lot of snow or ice, it is ideal to walk outdoors to gain the additional benefit of exposure to direct sunlight. Whether indoors or outdoors, seek flat surfaces and walking courses/equipment with adequate handrail support if you suffer from poor balance. You might even consider Nordic walking (walking with ski-pole-like devices). We previously wrote about a recent research study regarding Nordic Walking for COPD patients that you can read by clicking here.
Not only is exercise beneficial for good respiratory health and physical conditioning, it also has been shown in many studies to reduce feelings of depression.
3. Join a tai chi or yoga class – these mediation based forms of exercise convey health benefits for COPD patients and others who suffer from chronic shortness of breath as we’ve previously reported. If you’re stuck indoors all winter, these classes are also great ways to get out, move around, and socialize with others. Many health clubs and community centers offer tai chi and yoga classes specifically designed for people with limited mobility or other health conditions. If you can’t or don’t want to attend a center-based tai chi or yoga class, consider buying a tai chi or yoga DVD to use at home. These videos offer step by step instructions and many are geared for people with limited mobility or other health conditions. We’ve listed a handful on our Breathe Better Marketplace hosted by amazon.com for those who are interested but tai chi and yoga DVD’s are widely available from retail and online merchants.
4. While the value of smoking cessation during winter months is particularly high given the increased exposure to smoke in confined indoor spaces, we understand the prospect of smoking cessation may feel like too much of a challenge for some. For those who can’t or won’t stop smoking, consider delaying your first cigarette of the day for 30-60 minutes after waking. Research studies have shown that smokers who light up their first cigarette within the first 5 minutes after waking have the highest level of depression among all smokers, while those who delay for at least 30 minutes after waking have the lowest depression among smokers. And the gap between the two is notable as we’ve previously reported.
5. If your primary heating and/or cooking source is a wood burning stove or fireplace, seriously consider replacing these options with electric or natural gas burning devices. Previous studies have shown that regular exposure to wood smoke can be as detrimental to respiratory health as cigarette smoke, and if you are exposed regularly to both, your chances of serious respiratory health issues are dramatically increased. Click here to read a related article.
In our opinion, you can significantly improve your chances of a healthier and happier winter season by following the above steps. The combination of increased Vitamin D consumption, regular exercise/physical activity, and reduced exposure to cigarette and wood smoke can make a world of difference for COPD patients, smokers and other who suffer from chronic shortness of breath.
Wednesday, December 1, 2010
Yoga for COPD patients and smokers
Over the past year, we’ve published a few articles describing the benefits of tai chi for COPD patients. The combination of the slow, graceful tai chi movements with deep breathing/meditation exercises appears to hold promise for COPD patients in reducing shortness of breath, improving balance and coordination, and improving overall sense of well being. To view our past tai chi articles, visit www.breathebetterblog.blogspot.com and enter the search term “tai chi” in the search box provided in the left hand column of the page.
Tai chi has also been shown to help COPD patients extend the length of time they maintain an exercise program – an important element of successful long-term COPD self management. Researchers speculate the main factor driving this additional benefit is that many tai chi class participants find the sessions more interesting/enjoyable than limiting their exercise to stationary exercise equipment (such as walking on a treadmill). Therefore, because many COPD patients consider this form of exercise fun, they keep their programs going for longer periods of time.
Along similar lines, we recently read a new study published online ahead of print that showed interesting benefits for COPD patients from practicing another form of meditative exercise, yoga. Unlike tai chi which emphasizes balanced movement, yoga involves more stationary exercises where one sits or stands in specific positions while concentrating on deep breathing and clearing one’s mind through meditation.
In this particular study conducted by researchers at a Chicago based Veterans Administration hospital, the 22 male COPD patients who completed the study participated in yoga classes 1 hour per day, 3 days per week over a 6 week period. Patients were encouraged to practice the yoga exercises at home but were not required to do so. (Fulambarker A, et al. Effect of Yoga in Chronic Obstructive Pulmonary Disease. Am J Ther. 2010 Oct 22. [Epub ahead of print])
The researchers described the content of the yoga sessions as involving 6 specific yoga exercises, “Yoga exercises comprised pranayama, asanas, kapalabhati, sithali, and meditation during the 1-hour yoga session. The participants were encouraged to practice the same at home on a daily basis. Pranayama involves slow deep breathing, breathing through one nostril at a time, slow expiration, breath holding, and usage of abdominal muscles for expiration. Kapalabhati involves rapid abdominal contractions to force a volume of air out of the lungs. Sithali involves breathing through a curled tongue. Asanas comprise shoulder warm-ups, standing forward bend, cat and cow, downward dog with lunge, child pose, bridge, and seated twist. Meditation was done after the abovementioned exercises. Asana techniques were modified to accommodate the level of performance of the subjects with COPD.”
The researchers’ main goal in conducting the study was to understand whether yoga improved COPD patients’ sense of well being as measured by a common quality of life survey used to assess COPD patients (St. George’s Respiratory Questionnaire). The study participants completed the survey before the yoga program and again afterwards. The researchers tallied the self-reported ratings and compared the differences between the pre and post study surveys. The results showed a 19% improvement in self-reported quality of life among the COPD patients practicing yoga.
The more compelling/interesting outcomes of the COPD yoga study were statistically significant improvements in lung function. Specifically, study participants underwent diagnostic lung function tests at the beginning and end of the study. In particular the researchers tested the COPD patients for maximum inspiratory pressure, maximum expiratory pressure, forced vital capacity, and forced expiratory volume. On all of these measures, the yoga practicing COPD patients experienced statistically significant improvements. For example, maximum inspiratory pressure improved by 23% and maximum expiratory pressure improved by 14%. The improvements in forced vital capacity and forced expiratory volume were smaller but considered by the researchers to still be statistically significant.
The study authors speculated the reasons for the improvement in lung function as follows, “The beneficial effect of yoga observed in our study may be related to deep breathing (pranayama) and meditation causing a reduction in breathing frequency as in other studies. It may modulate airway reactivity, increase respiratory sensation through conditioning of the breathing pattern, reduce oxygen consumption, decrease hypoxic and hypercapnic responses with better blood oxygenation without increasing minute ventilation, increase respiratory endurance and muscle strength at least on a short-term basis, and modulate the autonomic function with a documented short-term decrease in resting heart rate and sympathetic reactivity. There is also evidence to suggest that it modulates the respiratory center and increases respiratory sensation through conditioning of the breathing pattern.”
We believe these research results show promising benefits for COPD patients participating in a yoga program and that those benefits may extend to smokers and others who suffer from chronic shortness of breath. Indeed, the yoga study authors noted that asthma patients participating in previous yoga studies have shown reduced shortness of breath symptoms and decreased use of bronchodilators (but no improvement in lung function).
Therefore, for those of you interested in adding a low impact and fun form of exercise to your weekly routine that also help relieve shortness of breath symptoms, tai chi or yoga are options worth exploring. Many community centers and health clubs offer tai chi and yoga classes specifically geared for people with chronic health conditions where the exercises are modified for people with limited mobility and other health issues. In addition, there are a wide range of videos available through retail outlets and online merchants that teach basic tai chi and yoga exercises. We’ve listed a handful of these videos on our Breathe Better Marketplace hosted by amazon.com for those who are interested.
Tai chi has also been shown to help COPD patients extend the length of time they maintain an exercise program – an important element of successful long-term COPD self management. Researchers speculate the main factor driving this additional benefit is that many tai chi class participants find the sessions more interesting/enjoyable than limiting their exercise to stationary exercise equipment (such as walking on a treadmill). Therefore, because many COPD patients consider this form of exercise fun, they keep their programs going for longer periods of time.
Along similar lines, we recently read a new study published online ahead of print that showed interesting benefits for COPD patients from practicing another form of meditative exercise, yoga. Unlike tai chi which emphasizes balanced movement, yoga involves more stationary exercises where one sits or stands in specific positions while concentrating on deep breathing and clearing one’s mind through meditation.
In this particular study conducted by researchers at a Chicago based Veterans Administration hospital, the 22 male COPD patients who completed the study participated in yoga classes 1 hour per day, 3 days per week over a 6 week period. Patients were encouraged to practice the yoga exercises at home but were not required to do so. (Fulambarker A, et al. Effect of Yoga in Chronic Obstructive Pulmonary Disease. Am J Ther. 2010 Oct 22. [Epub ahead of print])
The researchers described the content of the yoga sessions as involving 6 specific yoga exercises, “Yoga exercises comprised pranayama, asanas, kapalabhati, sithali, and meditation during the 1-hour yoga session. The participants were encouraged to practice the same at home on a daily basis. Pranayama involves slow deep breathing, breathing through one nostril at a time, slow expiration, breath holding, and usage of abdominal muscles for expiration. Kapalabhati involves rapid abdominal contractions to force a volume of air out of the lungs. Sithali involves breathing through a curled tongue. Asanas comprise shoulder warm-ups, standing forward bend, cat and cow, downward dog with lunge, child pose, bridge, and seated twist. Meditation was done after the abovementioned exercises. Asana techniques were modified to accommodate the level of performance of the subjects with COPD.”
The researchers’ main goal in conducting the study was to understand whether yoga improved COPD patients’ sense of well being as measured by a common quality of life survey used to assess COPD patients (St. George’s Respiratory Questionnaire). The study participants completed the survey before the yoga program and again afterwards. The researchers tallied the self-reported ratings and compared the differences between the pre and post study surveys. The results showed a 19% improvement in self-reported quality of life among the COPD patients practicing yoga.
The more compelling/interesting outcomes of the COPD yoga study were statistically significant improvements in lung function. Specifically, study participants underwent diagnostic lung function tests at the beginning and end of the study. In particular the researchers tested the COPD patients for maximum inspiratory pressure, maximum expiratory pressure, forced vital capacity, and forced expiratory volume. On all of these measures, the yoga practicing COPD patients experienced statistically significant improvements. For example, maximum inspiratory pressure improved by 23% and maximum expiratory pressure improved by 14%. The improvements in forced vital capacity and forced expiratory volume were smaller but considered by the researchers to still be statistically significant.
The study authors speculated the reasons for the improvement in lung function as follows, “The beneficial effect of yoga observed in our study may be related to deep breathing (pranayama) and meditation causing a reduction in breathing frequency as in other studies. It may modulate airway reactivity, increase respiratory sensation through conditioning of the breathing pattern, reduce oxygen consumption, decrease hypoxic and hypercapnic responses with better blood oxygenation without increasing minute ventilation, increase respiratory endurance and muscle strength at least on a short-term basis, and modulate the autonomic function with a documented short-term decrease in resting heart rate and sympathetic reactivity. There is also evidence to suggest that it modulates the respiratory center and increases respiratory sensation through conditioning of the breathing pattern.”
We believe these research results show promising benefits for COPD patients participating in a yoga program and that those benefits may extend to smokers and others who suffer from chronic shortness of breath. Indeed, the yoga study authors noted that asthma patients participating in previous yoga studies have shown reduced shortness of breath symptoms and decreased use of bronchodilators (but no improvement in lung function).
Therefore, for those of you interested in adding a low impact and fun form of exercise to your weekly routine that also help relieve shortness of breath symptoms, tai chi or yoga are options worth exploring. Many community centers and health clubs offer tai chi and yoga classes specifically geared for people with chronic health conditions where the exercises are modified for people with limited mobility and other health issues. In addition, there are a wide range of videos available through retail outlets and online merchants that teach basic tai chi and yoga exercises. We’ve listed a handful of these videos on our Breathe Better Marketplace hosted by amazon.com for those who are interested.
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