COPD: A Little Treatment Helps a Lot

A new study suggests people
with chronic obstructive pulmonary disease
can stay out of the hospital—and possibly
live longer--if they participate in a
low-level management program.



by Craig Stoltz


COPD is the medical name given to “smoker’s lung”: the persistent phlegmy cough and constricted breathing that’s nearly always caused by smoking.



So: A little treatment can go a long way. Let’s dig in.



Three things you need to know:



1. The patient support program studied wasn’t very intensive. Patients got an hour of group assessment and education; personalized medication recommendations; a basic self-management handout; and, to handle bad episodes, a refillable prescription for antibiotics and a steroid. A respiratory therapist called once a month, and patients were allowed to call when they needed to.


2.The program cut ER visit by more than half and hospitalizations by a third compared to similar people who got usual treatment from primary care docs. Fewer of the treated patients died, but the study lacked power to nail that down with specificity.



3. The study was small, hasn’t been published and obviously couldn’t be “blinded,” which is to say people knew they were getting engaged treatment so the placebo effect may be in operation. The study was presented May 21 at the American Thoracic Society's International Conference, in Toronto.



Still: If you have COPD, talk to your doctor or the hospital where you’re treated about participating in what’s usually called a “disease management” or “patient management” program for COPD. It can help keep you out of the ER.


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Ventilator Relieves Lung Cancer Pain in Final Hours

At end of life,
it may be better than
standard oxygen therapy,
study suggests

By Randy Dotinga







New research suggests that a mechanical ventilator can ease suffering and help lung cancer patients avoid sedation at the end of life.

A large percentage of these patients didn't want to have anything to do with a ventilator, which requires them to wear an oxygen mask. But those who were willing to try the treatment needed less morphine and had fewer symptoms in their final hours.

The findings could change the way doctors treat lung cancer patients in the end stages of their disease, said study author Dr. Stefano Nava, chief of the respiratory critical care unit at Istituto Scientifico di Pavia in Italy.

According to Nava, the ventilator approach could "provide some relief to patients and a better quality of dying."

At issue are lung cancer patients who typically only have a matter of hours or days to live. They often suffer from pain and difficulty breathing.

One approach is to help the patients breathe with the use of oxygen that reaches their lungs through nasal tubes. This approach, known as standard oxygen therapy, is used by many patients with lung conditions.

Another approach relies on mechanical ventilators, which use pressure to push oxygen into the lungs. The ventilators require the use of a face mask.

According to Nava, no studies have compared the two approaches in end-stage lung cancer patients.

Nava and his colleagues in Italy and Spain randomly assigned 92 patients to either of the two treatments. Eighteen other patients declined to accept the ventilator treatment after trying out the masks; another five declined after trying the standard oxygen treatment.

The findings were scheduled to be released Tuesday at the American Thoracic Society's International Conference, in Toronto.

The researchers found the ventilator treatment reduced discomfort and difficulty breathing at one, three and 24 hours. It took three hours for those on the standard oxygen therapy to experience improvement.

The patients on ventilators also needed much less morphine.

Dr. Neil Schachter, a professor of pulmonary medicine, said the findings could help doctors make better decisions. "There now appears to be an alternative way of making what is really a very horrible situation more comfortable for the person who is dying," said Schachter, medical director of the respiratory care department at Mount Sinai Medical Center in New York City.

The ventilator treatment appears to reduce the sensation of breathlessness in the patients. That, he said, could mean less need for sedation.

"By doing it in this way, you're not sedating them, making them go to sleep," he said. "They can presumably have a better interaction with their family in these last moments."

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COPD patients benefit more from pulmonary rehab in earlier stages

Patients with chronic obstructive
pulmonary disease (COPD)who are in
their final years of survival do not
get the same benefits from pulmonary
rehabilitation (PR) as patients who
have more years left to live—regardless
of their age, complicating illnesses or
lung function, according to new research
funded by the Veteran’s Administration,
which will be presented at the American
Thoracic Society’s 2008 International
Conference in Toronto on Tuesday, May 20.

The researchers recruited 106 patients with COPD who completed an eight-week course of PR. Each patient was evaluated at the beginning and the conclusion of the course for exercise capacity, dyspnea in daily activities, such as walking and carrying groceries, fatigue, quality of life, and other indices of health. The researchers then compared the results of patients who died within two years of the program to those who survived longer and found that even after controlling for potentially complicating factors—such as lung function, age and other present illnesses—patients who lived longer than two years were able to obtain more positive results from their PR program than those who had end-stage COPD (defined retrospectively as having died within two years of the program).

“Although people who died within two years after entering a pulmonary rehabilitation program improved their exercise capacity during the program, they improved less on this and other key variables than did those who lived longer,” said Bonnie Steele, A.R.N.P., Ph.D., a respiratory clinical nurse specialist at the VA Puget Sound Health Care System in Seattle. “The finding was independent of age, lung function and the number of other illnesses they had.”

The researchers anticipated that those with end-stage COPD would be more ill with lung or other diseases. “Previous work has taught us that even with severe obstructive lung disease based upon pulmonary function, people can derive significant benefits from PR,” said Dr. Steele, “but our limited findings suggest that other, presently unappreciated factors present at end of life may contribute to poorer outcomes in end-stage patients with respect to exercise capacity and quality of life.”

There are several possible explanations for the findings, including the possibility that patients in end-stage disease have overall poorer muscle function and greater levels of deconditioning and the possible specific impact of selected co-morbidities, such as heart failure.

“Our sample was too small to explicate this fully,” said Dr. Steele, “but it suggests that treatments for end-stage patients with COPD may still be effective and introducing exercise training sooner in the course of their disease results in more improvement.”

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When Asthma and COPD Coexist

by Brian A. Smart, MD

Asthma and COPD (Chronic Obstructive Pulmonary Disease), which includes emphysema and chronic bronchitis, are common respiratory ailments that can affect people for many years. Asthma can affect people at any point in their lives, whereas COPD more often impacts seniors. Asthma and COPD also can coexist in the same individual. It is important to understand the similarities and differences between the diagnosis, treatment and long-term outcome of asthma and COPD.

Blogger's Note: This Article discusses definitions, symptoms, smoking,
medical exams, medical tests, treatments and expected outcomes
when Asthma and COPD Coexist.

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Living With Chronic Illness Builds Courage

by Pauline Salvucci, Self Care Connection

The challenge of living with chronic illness isn't always apparent when you're first diagnosed. This is just the beginning. It takes time to understand your illness, the treatment options available, and how living with illness will affect your life and the lives of your partner and family.

Being sick is like being on a roller coaster -- you can be up and hopeful one minute and down and doubtful the next. Your illness can take unexpected and unpredictable turns. One disease can dispose you to or give rise to another. This can be frightening as well as exasperating. Finding medication that works, being committed to following a good treatment plan and maintaining honest, direct and open communication with your healthcare providers takes time, energy and skill. But this is only part of the picture. Living with illness affects every part of your life and every significant relationship you have.

If you're still able to work, you find yourself in the position of having to make decisions about what and how much you tell your employer and coworkers, especially if your illness requires you to make time adjustments to your work schedule. Responding to and dealing with coworker's responses or reactions can be a challenge. Saying too much makes you vulnerable to unwanted questions, saying too little may raise questions of 'special treatment' and elicit criticism or even jealousy. Yet, not being able to work means giving up your role in the workforce as a productive employee -- and facing the economic changes and problems of not being able to financially provide for yourself or your family.

When you live with chronic illness, every aspect of life takes on a new dimension. Your daily decisions and choices are examined through a new lens, and you often find yourself carefully weighing the ramifications and possible outcomes of your choices. But, wait. Wasn't this the way it always was? Isn't this something all intelligent and responsible adults do? Yes, of course. However, living with chronic illness broadens the scope of that decision making process. The question isn't only how will this decision or choice affect you, but also, how will it affect your illness which in turn affects you and the choices and decisions you continually make.

Obviously, this is a demanding aspect of living with chronic illness. It's also the measure of your courage. Living with illness affords ample opportunity to be courageous in living your life to the best of your ability. Why is this so? Because when limitations and diminished control over the effects of illness are part of your daily life, your choices and decisions become the stuff from which courage emerges.

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Lower Limb Activity and its Determinants in Chronic Obstructive Pulmonary Disease

Patients with COPD walk less
than healthy older people and
their self-reported activity
predicts exacerbation risk.









The relationship between
lower limb activity and
total daily activity is
not known nor is there
data relating objectively
assessed daily activity to
laboratory assessments made
before and after rehabilitation.





We measured lower limb activity
by leg actigraphy over 3 days
in 45 patients with moderate
to severe COPD and 18 similar
age controls.









Thirty-three COPD patients entered
an 8-week rehabilitation programme
where we measured the change in
leg activity and related this to
other outcomes.

In COPD patients mean
activity level measured
by whole body and leg
activity monitors was
closely related.





Total daily activity in COPD patients
is closely related to leg activity
which is reduced compared to similar
age controls. Individuals differ in
the time spent mobile during the day
but both subjective and objectively
assessed activity improves after
rehabilitation and is predicted by FEV1.
The change in activity is unrelated to
improvements in corridor walking and
health status.



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A healthier, fitter YOU — Simple strength training tips

"If you’ve never lifted weights in your life — and many people haven’t — why should you start now? The answer is simple: Muscle tissue, bone density, and strength all dwindle over the years. So, too, does muscle power. These changes open the door to accidents and injuries that can compromise your ability to lead an independent, active life. Strength training is the most effective way to slow and possibly reverse much of this decline.

Having smaller, weaker muscles doesn’t just change the way people look or move. Muscle loss affects the body in many ways. Strong muscles pluck oxygen and nutrients from the blood much more efficiently than weak ones. That means any activity requires less cardiac work and puts less strain on your heart. Strong muscles are better at sopping up sugar in the blood and helping the body stay sensitive to insulin (which helps cells remove sugar from the blood). In these ways, strong muscles can help keep blood sugar levels in check, which in turn helps prevent or control type 2 diabetes and is good for the heart. Strong muscles also enhance weight control.

On the other hand, weak muscles hasten the loss of independence as everyday activities — such as walking, cleaning, shopping, and even dressing — become more difficult. They also make it harder to balance your body properly when moving or even standing still, or to catch yourself if you trip. The loss of power compounds this. Perhaps it’s not so surprising that, by age 65, one in three people reports falls. Because bones also weaken over time, one out of every 20 of these falls ends in fracture, usually of the hip, wrist, or leg. The good news is that the risk of these problems can be reduced by an exercise and fitness routine that includes strength training.

Beginner’s simple strength boosting exercises

A sturdy chair with armrests and athletic shoes with non-skid soles are all you need for these simple strength building exercises.

Seated bridge


Sit slightly forward in a chair
with your hands on the armrests. Your feet should
be flat on the floor and slightly apart, and your
upper body should be upright (don’t lean forward).
Using your arms for balance only, slowly raise
your buttocks off the chair until nearly standing
with your knees bent. Pause. Slowly sit back down.
Aim for 8–12 repetitions. Rest and repeat the set.



Triceps dip

Put a chair with armrests up
against a wall. Sit in the chair and put your feet together
flat on the floor. Lean forward a bit while keeping your
shoulders and back straight. Bend your elbows and place
your hands on the armrests of the chair, so they are in
line with your torso. Pressing downward on your hands,
try to lift yourself up a few inches by straightening
out your arms. Raise your upper body and thighs, but keep
your feet in contact with the floor. Pause. Slowly release
until you’re sitting back down again. Aim for 8–12 repetitions.
Rest and repeat the set.


Standing calf raise


Stand with your feet flat
on the floor. Hold onto the back of your chair for balance.
Raise yourself up on tiptoe, as high as possible. Hold briefly,
then lower yourself. Aim for 8–12 repetitions. Rest and repeat
the set."







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