Let's Talk: Living Today With COPD

Drop Smoking Without Picking Up Weight

2008-07-26T09:23:00.005-05:00

Quitting smoking and weight gain have long been linked. But when you kick the butts, is it inevitable yours will expand?

True, four out of five people who smoke gain some weight. On average, people who quit gain between 4-10 pounds.

Most weight tends to be gained in the first six months after quitting.

The fear of weight gain is so great many smokers cite it as the reason they continue to puff away. Although the benefits of quitting far outweigh the possibility of extra pounds, few want to swap nicotine addiction for food addiction.

"I was an avid smoker for over 16 years -- at least a pack a day, the traditional coffee and cigarette Type-A personality -- who feared gaining weight if I quit," says Dawn Marie Fichera, director of special projects for a communications firm. In September, she celebrates two years being smoke-free. "I genuinely enjoyed it: the taste, the feel of it in my mouth, the sweet sting of nicotine as it traveled through my veins."

But smokers need not fear quitting will lead to weight gain, experts say. By combining diet and lifestyle changes with a smoking cessation program, you can throw away the cigarette pack and avoid packing on extra pounds.

Oral Fixation

Why do smokers seem to gain weight when they quit?

There are a couple of reasons. First, nicotine is known to raise metabolic rate. It increases the amount of calories used; a heavy smoker may burn as many as 200 calories daily. Nicotine also serves as an appetite suppressant ; after quitting it is normal for your appetite to increase.

Many people report that when they quit smoking their ability to taste and smell is enhanced, a temptation that can lead to increased eating. It is common for people to say that before quitting they never had much of a sweet tooth but now they find that they eat sweet foods. Studies show that people want more sweet and fatty foods after quitting.

Finally, smoking often provides a socially soothing activity for shy or anxious people. When the urge to light up hits, foods -- especially fattening, salty, or sweet snacks -- become a substitute for the physical and emotional comfort smoking provides.

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2008-07-25T10:35:00.001-05:00

Feeling sad is a common human experience. But when the cloak of sadness stretches for a long period, it may signal a bigger problem, especially when patients are dealing with chronic disease.

Unfortunately, the insidious transformation into depression often mirrors the adaptive inactivity that comes with chronic obstructive pulmonary disease (COPD). Sadly, this depression is often overlooked in patients with COPD because physicians only concentrate on managing breathing symptoms.

To ensure optimal outcomes, however, physicians need to understand and identify the high prevalence of depression in patients with COPD-and treat them accordingly.

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2008-07-24T06:51:00.006-05:00

Facts About

Chronic Bronchitis

By Deborah Trendel, RN, About.com

Chronic Bronchitis Defined

Like emphysema, chronic bronchitis is a common form of COPD. Chronic bronchitis causes inflammation and irritation of the airways, the tubes in your lungs where air passes through. These airways are also called bronchial tubes, hence the name bronchitis. When the air tubes are inflamed and irritated, thick mucus begins to form in them. Over time, this mucus plugs up the airways of the lungs and makes breathing difficult.

Unlike acute bronchitis, chronic bronchitis is irreversible and its path is one of frequent recurrences.

Statistics

According to the American Lung Association, in 2004, approximately 9 million people in the United States were diagnosed with chronic bronchitis. Chronic bronchitis can occur in all ages, but is more likely to affect those over 45 years. Unlike emphysema, chronic bronchitis affects women more than men. In 2004, 2.8 million males were diagnosed with chronic bronchitis compared to 6.3 million women.

Causes

Like other types of Chronic Obstructive Pulmonary Disease (COPD), chronic bronchitis is primarily caused by cigarette smoking, second hand smoke, and air pollution. Additionally, allergies, and infection are known factors that can cause exacerbation of chronic bronchitis. In fact, people who are diagnosed with chronic bronchitis are more likely to develop recurring infections in the lungs.

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Awareness: 2 Questions to Identify Future Smokers

2008-07-23T09:15:00.003-05:00

Want to know how likely
it is that sixth graders
will take up smoking?

Ask them how easy it would be
to get a cigarette.

By ERIC NAGOURNEY

If they say easy, a new study reported on Monday, they are more likely to become smokers by the time they are in high school. And if they also say they have friends who smoke, they are even more likely to start.

Writing in The Annals of Family Medicine, the researchers, led by Dr. Chyke A. Doubeni of the University of Massachusetts Medical School, said knowledge about which children fit this description might make antismoking interventions more effective.

For the study, the researchers interviewed 1,195 sixth graders about smoking, then spoke to them several more times over the next four years.

At the start of the study, 168 students said they had smoked, 21 percent said it would be easy for them get cigarettes and 9 percent said they had friends who smoked.

By 10th grade, 177 more students had tried it, with 109 becoming regular smokers. About a third of those interviewed said they knew at least one store that sold cigarettes to youths.

While knowing where to get cigarettes and knowing smokers increased the chances of tobacco use on their own, Dr. Doubeni said, the two traits combined were an especially strong risk factor.

Source

Menthol Levels Adjusted To Smokers' Age

2008-07-22T11:37:00.002-05:00

Tobacco companies deliberately changed the menthol levels in cigarettes depending upon who they were marketing them to - lower levels for young smokers who preferred the milder brands and higher levels to "lock in lifelong adult smokers," U.S. researchers at the Harvard School of Public Health found.

The researchers reviewed industry documents dating back decades on product development and on strategic plans for menthol products.

They said that the tobacco companies researched how controlling menthol levels could increase sales among specific groups. Milder brands with lower menthol levels appealed to younger smokers. The milder products were then marketed to young consumers.

One document from R.J. Reynolds noted that all three major menthol brands "built their franchise with YAS (younger adult smokers) ... using a low-menthol product strategy. However, as smokers acclimate to menthol, their demand for menthol increases over time."

In 1987, R.J. Reynolds marketed low-level menthol varieties to persuade consumers to switch from regular brands and to recruit new, young smokers, noting: "First-time smoker reaction is generally negative. ... Initial negatives can be alleviated with a low level of menthol."

Philip-Morris USA used a two-prong strategy to increase Marlboro's share in the menthol market by targeting young adults and older smokers, the researchers concluded. Marlboro Milds were introduced nationally in 2000 and became popular among young smokers. The entry of that product coincided with an increase in the menthol level of the regular Marlboro Menthol brand intended for older smokers. The milds were responsible for almost 80 percent of the company's menthol-category growth that year.

"For decades, the tobacco industry has carefully manipulated menthol content not only to lure youth but also to lock in lifelong adult customers," said Howard Koh, a co-author of the paper.

William Phelps, a spokesman for Philip Morris USA, the largest U.S. tobacco company, said the study's conclusions were not supported by the facts cited. He said the study includes excerpts from several marketing documents. None talked about targeting youth or adolescents.

"At our company, our marketing goal is to find way to effectively and responsibly connect brands with adults who smoke," Phelps said. "Those brands are designed to meet the diverse preferences of adults who smoke. What we disagree with are the authors' conclusion that menthol levels were manipulated to gain market share among adolescents."

Greg Connolly, one of the report's co-authors, said the tobacco industry was careful not to talk about adolescents in the documents he reviewed, mostly from the 1980s and 1990s.

"They talk about young smokers. For me, that's just a euphemism for going after adolescent, first-time smokers," Connolly said.

Congress is considering legislation to give the Food and Drug Administration the power to regulate tobacco. And while the bill would ban fruit and candy flavorings, it would allow the continued sale of menthol-flavored brands. That has led to sharp criticism from some smoking control advocates, who argue that menthol lures some people to try cigarettes and helps keep others from trying to quit. The advocates are pressing for an amendment to ban menthol.

But Phelps said that would be a mistake. "We don't believe it's right to ban a particular ingredient because some people prefer the flavor that ingredient provides," he argued.

Philip Morris is the only one of the major tobacco companies supporting FDA regulation, and its backing for the legislation is considered important in gaining passage.

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Lung Cancer Screening with CT Scans: Should You Be Having One?

2008-07-21T10:25:00.003-05:00

Unfortunately, many American's still continue to smoke. Smoking results in a 20-fold increase in the risk of lung cancer! The smoking rate in men has declined dramatically and the lung cancer death rate in men has correspondingly decreased 1.8% each year from 1991 to 2004, the last year of data that has been printed. Recently, the smoking rate in women has begun to reduce by 13%, indicating that the risk of lung cancer in 5 to 10 years will begin to decline in women as well.

If you have been a smoker, with a 20-fold increased risk of lung cancer, or if you have been a passive smoker (living in a family with a smoker, or working around people who are smoking), with a 3-fold increase in risk of lung cancer, what can you do to reduce the risk that a fatal lung cancer may occur?

There have been many reports, beginning in Japan, and then followed up in the United States, which indicate that spiral or multi-detector CT scans can increase the chances that if a lung cancer is to occur in your lungs, it will be only a Stage I cancer, with a cure rate of over 90%, rather than a Stage II, III, or even IV lung cancer with cure rates that are only 60%, 20%, or less than 1%, respectively. Is it important, therefore, for every smoker to have an annual CT scan of the lungs?

Unfortunately, medicine does not have the complete answer to this question. CT scans of the lung can give a slight radiation exposure which might, to a small degree, increase the risks of other illnesses such as breast cancer. The physician's who favor CT scanning of the chest point out that in smokers, the risk of lung cancer is so much higher than the risk of any slight side effects of radiation that annual CT scans are absolutely needed even if there are no symptoms. Those physicians who recommend annual CT scanning point out that if you have an exposure of over 20 pack years (number of packs smoked per day x number of years that you have smoked cigarettes), then you should be requesting annual CT scans from your doctor.

Physicians who recommend against annual CT scans point out that even though CT scans unquestionably diagnose early lung cancers more effectively, there is as yet no real data that the overall risk of lung cancer deaths in all of the screened patients is reduced. National studies are underway to determine if CT scans will definitely reduce the risk of fatal lung cancer as has been suggested in the earlier studies from Japan and in the earliest studies in the United States.

However, if you have been a smoker or a past smoker, and have even the very mildest of symptoms, a CT scan is absolutely required. If you have any shortness of breath, if you have any cough, if you have any chest pain, or if you have coughed up any sign of blood or brown colored phlegm (a small amount of old blood appears brown rather than red in the phlegm), then you should ask your physician if a CT scan of the chest is appropriate. Do not neglect even the slightest symptom if you have ever been a smoker or a passive smoker.

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2008-07-18T07:59:00.004-05:00

Stem Cell Research in Lung Disease:
How Far From Mice to Men?

by Katherine Wandersee, Editor, Reviews & Trends in COPD

Recent breakthroughs in animal research indicate that stem cell–based therapies may offer exciting potential for treating lung disease in humans. What remains a mystery, however, is how large a gap exists between successful experiments in mice and useful treatments for humans.

Stem cells' intrigue is based on their potential to divide and differentiate into virtually any other type of cell with various degrees of specialization. Embryonic stem cells, in particular, have engendered both intense research interest and heated controversy. At the 2007 European Respiratory Society (ERS) Annual Congress in Stockholm, Sweden, a breakthrough was announced in research involving embryonic stem cells from mice that were cultivated to express markers for epithelial and endothelial pulmonary cells.1 A research team from Imperial College in London injected 1 million modified stem cells into tail veins of mice—some with normal lungs and some with damage consistent with lung diseases, including COPD. By tagging the stem cells with a fluorescent marker, the researchers were able to show that the cells colonized the target areas of the lungs, including areas of the pulmonary epithelium where gas exchange occurs. The modified cells did not gravitate to any other organs. The frequency of labeled cell engraftment was noticeably greater in the lungs of the healthy mice, according to the research team,2 and the engrafted cells persisted longer in the healthy lungs. Lead investigator Síle Lane of Imperial College told the ERS audience, “This is the first time that researchers have injected lung cells produced from stem cells into laboratory animals and found them attached to the lungs. Our study shows that embryonic stem cells really do have the capacity to recolonize damaged lungs.”

While the results are intriguing and informative, human medical applications remain “a long way off,” the British researchers cautioned. The precise nature, function, and longevity of the grafted cells remain unknown. Before conducting research in humans, more information is needed about potential toxicities of these types of procedures, particularly whether the undifferentiated cells are capable of implanting in unintended locations. “The lung is a very difficult target for tissue engineering researchers,” Dr. Lane told ERS attendees, “especially since it is an extremely complex organ and contains a large variety of cells, some of which have a very slow renewal rate.”

True Stem Cell or Reparative Cell?

Use of human embryonic cells has been the primary source of controversy associated with stem cell research. Thus, much hope is being placed on cells derived from nonembryonic sources, including umbilical cord blood and adult bone marrow. This raises the question of exactly what constitutes a “stem cell.” Committee members at the 2005 National Heart, Lung, and Blood Institute/Cystic Fibrosis Foundation (NHLBI/CFF) workshop agreed that the terminology for stem and progenitor cells is “often loosely and erroneously applied.”3

The term “pluripotent embryonic stem cells” technically refers to mammalian embryonic stem cells that can self-renew and differentiate into almost any cellular phenotype. While human embryonic stem cells can differentiate into trophoblasts, mouse embryonic stem cells cannot. The term “progenitor cells” refers to immature or undifferentiated cells typically found in postnatal mammals. The general term “stem cells” often refers to cells with more restricted differentiation abilities than pluripotent cells, and includes hematopoietic stem cells (bone marrow), neural stem cells, and epithelial cells. Because “stem cell” tends to serve as a catch-all term describing cells from a variety of sources, the NHLBI/CFF workshop attendees agreed that a better term might be “reparative cells,” including any population of cell or cells that can participate in lung remodeling after injury. Further distinction must be made between endogenous reparative cells (those originating in the lung) and exogenous reparative cells (originating in bone marrow, fat, or other sources) that are recruited to the lung to participate in remodeling after injury. Defining the roles of these various cells and how they interact with other cells in the lung is an important goal for current and future investigation (Table).3

Nonembryonic Sources for Cell Research

In looking for nonembryonic sources for reparative cells to treat lung disease, bone marrow seems a logical place to start. We know that adult bone marrow cells act as precursors for hematopoietic stem cells (Figure). Yet, the role of adult marrow–derived cells in lung remodeling remains largely unclear.3 Research in rodents has shown that several types of bone marrow–derived cells (including hematopoietic cells, mesenchymal cells, and fibrocytes) can be recruited to and acquire the phenotypic and functional markers of mature lung tissue, as well as that of bone, liver, skin, muscle, and brain.3-5 Specific to the lung, both mouse transplant models and studies of tissue from bone marrow–transplant patients have shown that marrow-derived cells may be able to differentiate into airway and alveolar epithelium, vascular endothelium, and interstitial cell types.6,7 However, the degree and duration in which cells are able to achieve true chimerism, or bonding with the new neighbors, remains under debate and some research has suggested that the number of marrow–derived cells taken up by the lungs is small.

Studies of Regenerative Science in Lung Disease

Cystic fibrosis (CF) is one of the pulmonary diseases researchers hoped to conquer with the discovery of genes leading to the disease, but gene-based therapies in humans have as yet proved unsuccessful.8 Now investigators are also turning to cell-based approaches. A number of studies are exploring how cord blood–derived stem cell therapies may be used for CF, similar to the approaches used in the treatment of some leukemias. Last year, University of Minnesota researchers successfully demonstrated differentiation in vitro of stem cells derived from cord blood into type II alveolar cells,9 which are responsible for secreting surfactant. Meanwhile, preclinical studies are also ongoing using bone marrow–derived cells in mouse models of CF.10

Idiopathic pulmonary fibrosis is an interesting target for this line of research because of the potential role of stem cells in lung remodeling. University of Michigan scientists investigated the role of bone marrow–derived progenitor cells in the generation of fibrotic lesions in a mouse model of interstitial lung disease. These researchers showed that bone marrow–derived cells contribute to fibrogenesis via specific chemokine pathways.11

Likewise, the role of exogenous cells in lung remodeling—either in tissue repair or tissue damage—is an important distinction relating to the study of COPD. Using a mouse model of elastase-induced emphysema, University of Nebraska researchers established that bone marrow–derived cells (including hematopoietic cells and fibroblasts) are recruited to the lung in the presence of COPD.12 These investigators showed that recruitment of the marrow–derived cells was enhanced in mice treated with a combination of all-trans retinoic acid and granulocyte colony–stimulating factor (G-CSF), while a marker of alveolar destruction was significantly decreased.3 Reporting on the research at the NHLBI/CFF workshop, Stephen I. Rennard, MD, noted that the data suggest transfer or mobilization of endogenous stem cells may be feasible in the setting of COPD.3

The majority of ongoing studies of cell-based therapies in lung disease are still in the preclinical phase, but a few are eking their way toward small phase I trials in humans. University of Toronto researchers have investigated the use of adult bone–marrow derived cells to regenerate lung microvasculature in pulmonary hypertension in rats.13 Now, this team is undertaking a phase I clinical trial called Pulmonary Hypertension: Assessment of Cell Therapy (PHACeT), billed as the “world's first gene therapy study for fatal lung disease.”14 Begun in early 2006, the trial will involve up to 18 patients with refractory disease selected to receive infusions of a specific type of progenitor cell derived from bone marrow (genetically modified endothelial precursor cells) into the pulmonary artery via catheter. This small pilot study was designed mainly for dose-finding and to explore safety and tolerability of the procedure.14

While it's encouraging to see some trials involving humans with lung disease, there remains a huge gap from basic science to miracle cure. Many patients with lung disease are hoping for a cure based in stem-cell science during their lifetimes; for them, it's easy to lose track of the fact that this research is still in its infancy. “The reality of stem cell biology is overshadowed by the hype,” remarked biomedical ethicist Christopher Thomas Scott in his 2006 book, Stem Cell Now (Pi Press). “We've got a good distance to go before regenerative medicine . . . will help large numbers of patients,” added Scott, head of Stanford University's Program on Stem Cells in Society. “It is very possible that many diseases will have to wait for cures from other quarters of medicine.”

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2008-07-16T09:27:00.004-05:00

Johns Hopkins Health Alert

Talking About Social Phobia

In this excerpt from a recent Depression and Anxiety Bulletin,
psychiatrist Emily A. Bost-Baxeter, M.D. explains
social phobia and discusses treatments.

Q. Where do you draw the line between shyness and social phobia? I get overwhelmed with anxiety in many social situations. It has affected my career and my ability to socialize and date. I am wondering whether medication could help me. I'd appreciate your input. Seattle, WA

Please Follow This Link To Read The Answer To This Important Health Alert.

Multiple Chemical Sensitivity

2008-07-15T11:11:00.003-05:00

What Is Multiple Chemical Sensitivity?

Multiple chemical sensitivity (MCS) is the name given by some to a condition in which various symptoms reportedly appear after a person has been exposed to any of a wide range of chemicals. The exposure may occur as a major event, such as a chemical spill, or from long-term contact with low-levels of chemicals, such as in an office with poor ventilation.

As a result of exposure, people with MCS develop sensitivity and have reactions to the chemicals even at levels most people can tolerate.

Other names for this condition are "environmental illness" and "sick building syndrome."

Is MCS a Real Disorder?

Many recognized medical groups and societies, including the CDC, the American Medical Association and the American Academy of Allergy, Asthma and Immunology, do not consider MCS a distinct physical disorder. There are several reasons for this.

First, there is a lack of clinical evidence to support a physical cause for the symptoms. In addition, people with MCS do not develop antibodies in response to chemical exposure, as is the case with an immune system, or allergic reaction. Further, people with MCS also have high rates of mental health disorders, including depression, anxiety and somatoform disorders -- mental disorders that are expressed through physical symptoms. About 50% of people with MCS meet the criteria for depression and/or anxiety disorders. Much of the controversy, then, centers on whether the symptoms associated with MCS are caused by physical or psychological factors.

What Are the Symptoms of MCS?

People with MCS have reported a wide range of symptoms, including:

* Headache

* Fatigue

* Dizziness

* Nausea

* Irritability

* Confusion

* Difficulty concentrating

* Intolerance to heat or cold

* Earache

* Stuffy head or congestion

* Itching

* Sneezing

* Sore throat

* Memory problems

* Breathing problems

* Changes in heart rhythm

* Chest pain

* Muscle pain and/or stiffness

* Bloating or gas

* Diarrhea

* Skin rash or hives

* Mood changes

How Common Is MCS?

Many healthcare practitioners do not recognize MCS as a disorder and, therefore, do not make a diagnosis of MCS. For this reason, it is not possible to assess how many people actually suffer from MCS. One estimate suggests that 2%-10% of people suffer some disruption in their lives because of MCS, although other experts believe these estimates are too high. The U.S. Environmental Protection Agency reported that about one-third of people working in sealed buildings claimed to be sensitive to one or more common chemicals. More women than men claim to have MCS, and it appears to occur most often in people between the ages of 30 and 50 years.

What Causes MCS?

The cause of MCS is unknown. One theory suggests that chemicals traveling in the air enter the nose and affect an area of the brain called the limbic system. The limbic system plays a role in emotions, motivated behavior, and memory, which may make a person more sensitive to a chemical odor previously encountered, a condition called cacosmia. However, this theory has not been proven

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COPD: The Heat Is On

2008-07-14T08:56:00.003-05:00

How to Beat the Summer Heat

and
Avoid COPD Complications

By Deborah Trendel, RN,

For people with severe, chronic illnesses like COPD, summer heat is not only uncomfortable, it can lead to dangerous COPD complications.

If you have COPD, then you probably know all too well how dyspnea affects your quality of life. In extreme temperatures, especially during the hottest months of summer, your level of dyspnea can sometimes be far greater than normal.

While we cannot control the weather, we can control our environment. Here are some steps you can take to beat the heat this summer and breathe easier:

1. Drink Plenty of Fluids

During the hot summer months, you should increase your fluid intake regardless of your activity level or thirst.

2. Wear Appropriate Clothing and Sunscreen

During the hottest time of the year, cool summer clothes and sunscreen are where it is at. Choose lightweight, light-colored, loose fitting garments. When you have a sunburn, it is more difficult for your body to cool itself, so be sure to wear sunscreen every day, even if you are not planning to be in the direct sunlight.

3. Plan Your Activities Carefully

If you have to go outside, do so in the early morning hours or after the sun goes down. When driving, park in shady areas and choose places to go that are air conditioned. Place sun protectors in your car when it is parked.

4. Keep Your Cool Indoors

If it is possible, stay indoors in an air-conditioned building. If you don't have air conditioning, plan your day to involve going to places that do, for example the library, a shopping mall or a friend or family member's home that is air conditioned. Take a cool shower or bath to lower your body temperature. Avoid activities that involve utilizing extra energy. Call your local health department to see if they can recommend a heat-relief shelter in your area.

5. Use the Buddy System

During the hot summer months, make sure to have friends or family members call at least twice a day to make sure you are OK. If you don't have a phone, ask neighbors, friends or relative to stop by your home each day.

6. Avoid Rigorous Exercise or Excess Activity

You will be better able to tolerate the heat if you avoid strenuous physical activity or exercise during hot days. If you do enjoy exercising, join a gym where the temperature is controlled or use a treadmill or other exercise machine in an air-conditioned room. Remember to drink plenty of fluids.

7. Take Your Medications as Directed

Remember to take your medications as directed by your doctor. If you are oxygen dependent, talk to your doctor about your oxygen requirements during the summer months.

8. Pay Attention to Weather Reports

Make it a point to watch or listen to the daily weather report alerting you to current weather conditions. Plan your activities during times of more moderate weather, devoid of extreme weather advisories.

Even short periods of extreme temperatures can cause serious illness and/or COPD complications. Knowing what to do in cases of excessive heat will not only help you keep your cool this summer but will also keep you safe.

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The Cost Of Breathing

2008-07-11T10:24:00.003-05:00

It's a good time to be an asthma

patient - if you can afford it.

With asthma rates climbing worldwide, pharmaceutical companies are galloping light speed to find the cause and innovative therapies for this highly complex disease. The competition has led to drugs so effective they can treat 90 percent of asthma cases.

"Hardly a week goes by when something new shows up," said Alfred Munzer, MD, director of pulmonary medicine at Washington Adventist Hospital, Takoma Park, Md., and past president of the American Lung Association.

As of last year, 22.9 million Americans had asthma, of which 6.8 percent are children, according to the American Lung Association.1 This translates to a $13 billion to $14 billion industry in the U.S. alone.1,2 The yearly cost to treat an asthma patient in the U.S. is $1,102, according to the Agency for Healthcare Research and Quality (AHRQ), a division of the U.S. Department of Health and Human Services.2

The rising costs in asthma care are fueled largely by increases in prescription prices. The phaseout of chlorofluorocarbon (CFC) metered dose inhalers through the end of this year will raise some patients' co-pays for the medications from $5 to $45.

In addition, patients are shifting their perspectives. Asthma no longer is seen as an episodic, reversible condition. They are learning it is a chronic disease requiring long-term management, which means more medication and higher costs.

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2008-07-10T07:27:00.002-05:00

Healthy Eating When You're Sick

Nutrition tips to fight fatigue and boost strength.

By R. Morgan Griffin

Healthy eating when you're sick is a challenge -- especially when you have a chronic illness like cancer, arthritis, or even depression. Diseases and their treatment can sap your appetite or leave you nauseated. Cancer fatigue might leave you too worn out to cook. Arthritis can make it a lot harder to get out and shop for groceries.

It's natural to let good nutrition slide when coping with an illness. But it's also dangerous. Everyone needs to get enough vitamins and nutrients. And that's truer than ever when you're sick.

By learning what to look for, and making smart choices, you can get the nutrition you need without a lot of extra effort

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2008-07-09T11:00:00.003-05:00

Johns Hopkins Health Alert

Fitting Exercise into Your Life

Being physically active has so many health benefits. So if you are thinking you can't possible fit 30 minutes or more of exercise into your daily routine, these tips from Johns Hopkins can help.

If finding enough time to exercise seems too much to contemplate, remember that any exercise is better than no exercise and small steps are the key to eventually making larger changes in your habits. What this means is that you shouldn’t forgo exercise altogether just because you can’t find the time or energy to exercise for 60 minutes a day -- even 30 minutes of exercise on most days of the week offers significant health benefits. Here are some strategies you can try to increase your amount of physical activity:

Exercise tip 1 -- Replace sedentary activities with more active ones.
For example, instead of watching television while sitting on the couch, take a walk while listening to a book on tape or talking on your cell phone. Or at least try doing some calisthenics while watching your favorite show.

Exercise tip 2 -- Look for stolen moments throughout your day to add activity.
Climb the stairs instead of taking the escalator, walk instead of taking your car or public transportation, do a lap around the mall before you start shopping, and return your cart all the way back to the supermarket instead of leaving it in the nearby cart bay.

Exercise tip 3 -- Buy a pedometer.
This step counter will help you assess how many steps you’re taking per day. We and other experts recommend 10,000 steps a day (equivalent to about 5 miles), although most people walk much less than that. Start off by tracking the number of steps you take on a typical day. Then, try to increase your step count by 500–1,000 steps every 2–3 weeks. Keep a record of your step counts and reward yourself (not with food, of course) when you reach your goal.

Exercise tip 4 -- Consider activities such as tennis, golfing, fishing, and dancing.
These activities can be enjoyed well into later life and add a social element to exercise.

Exercise tip 5 -- Plan for exercise every day.
Mark out 30 minutes or more a day for physical activity and stick to it as if it’s an important meeting or appointment. Individuals who become habitual exercisers are those who make physical activity a priority.

Source

2008-07-08T12:05:00.005-05:00

Guidelines for the treatment

of older patients with

respiratory conditions

are routinely ignored.

Research published today in the open access journal
BMC Health Services Research shows that recommended
treatments are given to only a small minority of
eligible patients.

Benjamin Craig from the Moffitt Cancer Center, Tampa, USA, led a team who investigated the treatment of nearly 30,000 patients across the US. According to Craig, "Despite the proliferation of numerous guidelines for the management of adults with obstructive respiratory diseases, we found major disparities between the actual care given and that which is recommended".

Chronic Obstructive Pulmonary Disease (COPD) and asthma are leading causes of death in people over the age of 45 in the US. COPD claims the lives of around 30,000 people per year in the UK. Guidelines for treatment of these conditions have been available for a number of years. They emphasize the importance of lung function tests, access to inhalers, influenza vaccination and smoking cessation. However, as Craig reports, "Slightly less than 22% of older adults with asthma or COPD received bronchodilator inhalers. An even smaller minority received one or more lung function examinations during the year and 18% were not vaccinated against influenza".

A substantial portion (16%) of the patients were smokers and the majority (53%) were former smokers. The researchers found that current smokers were less likely to receive care than those who had never smoked or who had quit. Craig explained that, "The finding that smokers receive less care is both troubling and intriguing. There may be a group of patients with such a strong nicotine addiction that quitting would be very difficult. It might be that some of these patients withdraw from care to avoid uncomfortable encounters with physicians who urge smoking cessation. Alternatively, of course, some physicians may dismiss smokers because they have failed to change their behaviour."

The researchers conclude that the needs of older adults with obstructive respiratory disease and possible nicotine addiction deserve special attention and that guidelines require further development and much wider implementation.

Source

COPD and exercise

2008-07-07T10:15:00.003-05:00

If you have COPD,
you should not attempt
any exercise before
consulting your doctor.
Overexerting yourself
could be fatal. But this
does not mean that you
should not exercise at
all – on the contrary.
Mild and regular exercise
can be very beneficial to
someone who has COPD.

A for aerobics. Aerobic exercise, such a low impact aerobics, swimming and walking are the correct choices for those with COPD. Exercise that is too strenuous should be avoided, as the respiratory system could easily become distressed. Mild exercise is recommended, but should be discussed with your doctor.

Be a quitter. If your breathing becomes laboured during mild exercise, it is your body's way of telling you to stop what you are doing. Carrying on exercising when you have breathing problems, is not only unwise, it could be fatal.

Choose your time. If you want to do something a bit physically strenuous, it is a good idea to wait until at least an hour after you have eaten. Digestion draws blood and its oxygen away from the muscles, so that they cannot really cope with extra demands.

Breathing treatment boost. Soon after taking your medicine or having breathing treatment, you may feel at your most energetic. This is a good time to take on activities that would usually be too strenuous for you.

Purse those lips. If you should feel breathless, use pursed lip breathing. This does make it easier to get enough oxygen.

Do it with a friend. If you have COPD, it is never a good idea to exercise alone. If you should become distressed, there should always be someone with you, who could help you to take your medication or call for medical assistance.

Source

Happy 4th Of July

2008-07-04T08:26:00.002-05:00

If you suffer from COPD, among other COPD symptoms, you probably have poor activity tolerance. As a result, you may not be able to muster up the energy to go outside this year to watch the fireworks.

I thought I would try and brighten your day by bringing the fireworks to you!

Click here to enjoy the show.

To Read More From Deborah Trendel, RN at About.com: Click Here

2008-07-03T07:42:00.002-05:00

Johns Hopkins Health Alert

The Asthma-Cough Connection

Many people with asthma suffer from shortness of breath, wheezing, coughing, and tightness in the chest, but don't understand why these symptoms occur. In this Health Alert, Dr. Peter B. Terry, Professor of Medicine in the Division of Pulmonary and Critical Care Medicine at Johns Hopkins explains why asthma causes coughing.

Q. Why is my asthma making me cough?

A. Asthma can cause coughing in several ways. First, the airways of a person with asthma are more sensitive to any inhaled pollutants. Breathing in a pollutant can cause coughing. Also, breathing in cold, dry air can trigger a cough in some people with asthma. This happens most commonly when a person exercises.

Usually, you breathe in through your nose, which humidifies and warms the air before it gets to your airways. But when you exercise, you tend to breathe in through your mouth. That means if you’re exercising outdoors in the winter, you’re getting a blast of cold air directly into the airways, which can trigger a cough.

Gastroesophageal reflux disease (GERD) also can cause coughing in some people with asthma. Some studies suggest that more than half of people with asthma also have GERD. Doctors aren’t exactly sure what the connection is between GERD and asthma, but there are several theories. GERD may cause people to have a small amount of acid bathe their voice box, which can trigger spasms in the airways. It is also possible that the acid damages the lining, exposing segments of an underlying nerve and causing a reflex that makes your airways narrow.

Source

2008-07-02T10:35:00.003-05:00

Johns Hopkins Health Alert

What To Do When Your Antidepressant Doesn’t
Work

If you’re on an antidepressant and it’s not working, don’t give up on it: You may need a higher dose, a longer duration of therapy, a different antidepressant altogether, or a combination of medications. That’s the important lesson to learn from a large, six-year, four-step government study called the Sequenced Treatment Alternatives to Relieve Depression trial, or STAR*D. In fact, the researchers found that systematically trying these treatment options can lead to a remission in symptoms in up to half of severely depressed, treatment-resistant patients.

The STAR*D study, which looked at the use of popular antidepressants in people with chronic depression (lasting, in some cases, 15–16 years), is the first to provide "real world" scientific data on what to do when someone doesn't respond to a particular antidepressant, has severe depression, or suffers from multiple mental and physical ailments. These types of treatment-resistant patients are not typically included in antidepressant drug trials sponsored by pharmaceutical companies.

Here are nine important take-home messages from the STAR*D study:

One antidepressant treatment does not fit all. You may need to try several medications to find a drug regimen that works for you. What fits one person may not fit your particular biology.

Persevering through several different treatment attempts, as arduous as that may be, can improve results for many people.

At standard doses of the most commonly used class of antidepressants -- selective serotonin reuptake inhibitors (SSRIs) -- 30% of patients with severe depression achieve remission with the first medication prescribed.

It often takes 12 weeks to achieve an adequate response to an antidepressant, not the standard four to eight weeks that most doctors and mental health specialists were previously using to guide decisions.

If the first choice of antidepressant does not provide adequate symptom relief, switching to a new drug is effective about 25% of the time.

Switching from one SSRI to another is almost as effective as switching to a drug from another class.

If the first choice of an antidepressant does not provide adequate symptom relief, adding a new drug while continuing to take the first medication is effective in about one-third of people.

For people who don’t respond to first-line therapy with an SSRI, adding a second drug to the SSRI drug regimen appears to be slightly better than completely switching medications.

For those who don’t respond to switching to a new antidepressant or adding a second drug, trying a third medication can still help about one in five people.

Source

Anxiety Linked With A Higher Risk For Certain Chronic Conditions

2008-07-01T07:41:00.004-05:00

As an everyday emotion, anxiety can be a good thing, prompting us to take extra precautions. But when anxiety persists, it can undermine our physical health. Evidence suggests that people with anxiety disorders are at greater risk for some chronic medical conditions.
The July 2008 issue of Harvard Women's Health Watch describes several conditions affected by anxiety:

Gastrointestinal disorders: About 10% to 20% of Americans suffer from irritable bowel syndrome (IBS) or functional dyspepsia. In these disorders, the nerves regulating digestion appear to be hypersensitive to stimulation. There are no firm data on the prevalence of anxiety disorders in people with such digestive disorders, but a recent New Zealand study found an association between high anxiety levels and the development of IBS.

Chronic respiratory disorders: Although results vary, most studies have found a high rate of anxiety symptoms and panic attacks in patients who have chronic respiratory disorders such as asthma or chronic obstructive pulmonary disease (COPD), with women at greater risk than men. In several studies involving COPD patients, anxiety has been associated with more frequent hospitalization and with more severe distress at every level of lung function. So even if anxiety doesn't affect the progress of the disease, it takes a substantial toll on quality of life.

Heart disease: Anxiety disorders have also been linked to the development of heart disease and to heart attacks in people who already have heart disease. Two recent studies concluded that among people with heart disease, those suffering from an anxiety disorder were twice as likely to have a heart attack as those with no history of anxiety disorders.

Source

Exacerbations Lead To Depression In COPD

2008-06-30T08:57:00.006-05:00

Chronic obstructive pulmonary disease (COPD) causes limitation of airflow in the lungs that cannot be fully reversed, leading to symptoms of breathlessness, cough, wheeze and sputum production. The disease, although chronic, is interspersed with periods of acute symptomatic and functional deterioration known as exacerbations. Exacerbations have important consequences for patients and their healthcare providers.

It is not fully understood why some individuals with COPD are prone to frequent exacerbations (three or more per year), however, it is known that these individuals have worse quality of life, greater limitation of daily activity and faster disease progression than infrequent exacerbators (patients who have fewer than three exacerbations per year). Depression is a recognised complication of many chronic diseases, including COPD, and this also affects quality of life.

In this study, Jadwiga Wedzicha (Academic Unit of Respiratory Medicine, University College London, UK) and his colleagues prospectively investigated 169 patients over a one-year period and assessed whether depressive symptoms increased at the time of an exacerbation and whether depression was related to exacerbation frequency.

They find that depressive symptoms are significantly higher at exacerbation than at baseline. The authors also find that frequent exacerbators have significantly higher depression scores in the stable state compared to infrequent exacerbators.

Patients who are depressed have a poorer quality of life, increased breathlessness, spend less time outdoors, and are more likely to be female and live alone.

The British team concludes that lack of recognition of depression may have implications for uptake and completion of treatment, including pulmonary rehabilitation, and propose that frequent exacerbators should be screened routinely and treated for depression if appropriate. This may help maximise patient outcome and quality of life in COPD.

From Medical News Today; this article is available in it's entirety by following THIS LINK

On Vacation

2008-06-23T09:03:00.001-05:00

Suppliers Fight Plan to Cut Medicare's Equipment Costs

2008-06-20T07:33:00.001-05:00

By Christopher Lee

Medicare shells out $1,825 for the same home hospital bed that anyone can buy online for $754, according to government data. It pays $4,023 for a power wheelchair that retails for $2,174.

Outraged over such disparities, Congress in 2003 required the federal health insurance program for the elderly to phase out its outdated fee schedule in favor of a competitive bidding system that would bring its durable medical equipment costs more in line with market prices.

The new system, scheduled to begin in 10 metropolitan areas July 1, relies on bids by accredited suppliers to determine who can sell to Medicare beneficiaries. It promises to cut prices by an average of 26 percent, saving the government about $125 million over the next year, according to the Centers for Medicare and Medicaid Services. Taking it nationwide eventually would generate annual savings of $1 billion, officials say.

"We look forward to the beneficiary and the taxpayer being able to save money and to deal with high-quality accredited suppliers who meet our financial standards," said acting CMMS Administrator Kerry Weems.

But Weems may have to wait. An intensive industry lobbying campaign on Capitol Hill threatens to derail the new bidding system weeks before its start.

Suppliers contend that the changes will sever longstanding ties between Medicare beneficiaries and many of the businesses they depend on for oxygen, diabetic supplies, walkers, power wheelchairs and scooters. The new system has unfairly disqualified some suppliers, accepted bids from others with little experience and will lead to declining quality and service, they argue.

"Large numbers of small business in our industry will begin losing money and will be forced to reduce staff or ultimately close," Gary Gilberti, president of Baltimore-based Chesapeake Rehab Equipment, testified at a recent congressional hearing.

The industry's arguments are gaining traction in Congress. Only about 4 million households will be affected by the program's first phase, but all lawmakers count Medicare beneficiaries among their constituents. A lot of money is at stake: Medicare spends about $8.5 billion annually on durable medical equipment.

A bipartisan group of 132 lawmakers sent a letter this month urging House Ways and Means Committee leaders to pass legislation delaying the program for at least a year. Sens. George V. Voinovich (R-Ohio) and Debbie Stabenow (D-Mich.) are circulating a similar letter in the Senate this week.

"[W]e are hearing from our constituents that companies who won bids have no experience in delivering the product in which they were awarded a contract," the senators wrote. "We have concerns these situations will lead to poor service for our most vulnerable constituents."

Rep. Pete Stark (D-Calif.), chairman of the Ways and Means subcommittee on health, said he plans to introduce legislation as soon as this week to delay the program by 18 months. But his cooperation comes at a price: The industry must agree to cuts in current fees equivalent to the projected savings of the bidding program.

"I don't mind the fee schedule if we set the fees right," Stark said in an interview. "But when I can go on eBay and buy stuff for a third of what Medicare is paying for it, then I know something is wrong. . . . There's money to be saved there, but I don't know that you have to put people out of business to do it."

Officials with the American Association for Homecare, a trade association
that has contributed $138,490 to members of Congress since 2002, said many suppliers favor temporary fee cuts over the possibility of being excluded from the program. Most derive as much as half their revenue from Medicare, officials say.

Weems said the concerns are overstated.

The program allows oxygen and oxygen-equipment suppliers who were not low bidders to keep servicing their Medicare customers -- but only at the new, lower price, he said.

Similarly, wheelchair suppliers can still provide repairs and service on chairs they've sold, he said. For the first time, suppliers of equipment must be accredited and meet standards for quality and financial health. And lower prices will help beneficiaries, who typically pick up a share of the cost, he said.

"The statute contemplated losers," Weems said. "In fact, 60 percent of the bidders were priced outside of the competitive range."

Walter Gorski, vice president of government affairs for the Homecare Association, said many beneficiaries will lose, too.

"If Congress wants to create the Amazon.com model of DME [durable medical equipment], then competitive bidding may be the direction they want to go in," Gorski said. "What is lost many times is . . . it's more than just an equipment-based benefit."

To Read This Article In It's Entirety: Click Here

Health Complications of COPD

2008-06-19T09:44:00.002-05:00

Sleep Disorders, Heart Disease and Other Potential Health Issues

Health complications can develop as COPD damages the lungs and impairs breathing ability. Some, such as respiratory distress and an increased risk of lung infection, are complications most people would expect from lung disease. Others, such as heart disease and sleep disorders, are health concerns that at first glance seem to have little to do with the lungs.

Respiratory Insufficiency

Respiratory insufficiency
is perhaps the most obvious
health complication associated
with COPD. As breathing becomes
increasingly difficult, the body
loses the ability to balance the
amount of oxygen and carbon dioxide
in the blood. Other health concerns,
such as heart disease, can occur if
too little oxygen is available in the
blood. Respiratory insufficiency may
require permanently breathing through
an oxygen mask.

Heart Disease

As the lungs' ability to transport oxygen drops, COPD places increasing strain on the heart. Heart disease may occur if low oxygen levels develop in the blood. High blood pressure develops in the blood vessels between the heart and the lungs due to these low oxygen levels, making the heart work harder to pump blood. The strain ultimately leads to heart disease and heart attacks.

Sleep Disorders

COPD sufferers experience more sleep-related health problems than the average person. Sleep disorders, such as insomnia or nightmares, and chronic fatigue may develop. Why COPD causes sleep disorders is unclear. Several possible reasons have been suggested, including the possibility that breathing difficulties and a decrease in lung function disrupt sleep. Side effects of COPD medications may also be to blame for some sleep disorders.

More information on sleep and health concerns can be found at About Sleep Disorders.

Lung Cancer

Lung cancer is not a COPD health complication. However, the majority of COPD patients are long-term smokers, so are at higher risk of lung cancer. Follow the link for more Information on Lung Cancer.

Pneumonia and Infections

COPD places great strain on the lungs, increasing the possibility of infections and pneumonia. Infections of the lungs are a serious health risk for COPD patients, and should receive immediate medical attention.

Pneumothorax

Pneumothorax is a health condition that can occur due to COPD. A hole develops in the lung sac of one of the lungs, and air escapes into the area between the chest wall and the lungs. This causes the collapse of the affected lung and causes respiratory distress. Emergency medical treatment is required.

Polycythemia

Polycythemia is an imbalance in blood cells caused by low oxygen levels in the bloodstream. As the lungs ability to acquire oxygen lowers, the body produces more oxygen-carrying red blood cells in an attempt to better use the available oxygen. While this helps initially, excess amounts of red blood cells eventually clog small blood vessels.

COPD Stages

Stage 1: Lungs function at 50 percent of normal capacity or higher. Health is not greatly impaired.

Stage 2: Lungs function at 35 to 49 percent normal capacity. Health is significantly impacted.

Stage 3: Lungs function at less than 35 percent. Health is severely affected.

Source

A Big Thanks to Dee at BBLW for finding this very informative article.

Pulmonary Arterial Hypertension and Cardiovascular Mortality in Patients With Rheumatoid Arthritis

2008-06-18T09:58:00.003-05:00

Question

Does pulmonary arterial hypertension have an intermediary role in cardiovascular mortality in patients with rheumatoid arthritis?

Response from Joseph Shanahan, MD
Associate Consulting Professor of Medicine,
Duke University Medical Center,
Carolina Arthritis Associates,
Durham, North Carolina.

Pulmonary arterial hypertension (PAH) is a recognized but rare complication of rheumatoid arthritis (RA). Different pathologic lesions have been described, including inflammatory pulmonary vasculitis and the more classic plexiform vasculopathy with intimal hyperplasia and smooth muscle hypertrophy. Therefore, treatment of RA-associated PAH may require aggressive immunomodulatory therapy in addition to the standard PAH drugs. Case studies also report PAH resulting from chronic venous thromboembolic disease and occasionally complicating overlap syndromes, particularly in patients with coexisting clinical serologic characteristics of scleroderma. However, cross-sectional echocardiographic studies describe elevated right ventricular pressures in as many as 1 in 4 patients, often without primary cardiac or pulmonary disease to explain the finding. However, limitations of these studies, including the absence of right heart catheterization to corroborate echocardiographic observations and liberal definitions of abnormal right-sided pressures, increased the false-positive rate for diagnosis of pulmonary hypertension. Recall that the diagnosis of PAH requires hemodynamic measures: elevated pulmonary artery pressure and vascular resistance with left ventricular wedge pressure

Source

Expand-A-Lung Chosen as Top Choice for Respiratory Fitness Training by the L.A. Times

2008-06-17T07:15:00.003-05:00

by Valerie Gotten

The Expand-A-Lung(TM) Breathing Resistance Exerciser has been selected as the top choice for respiratory fitness training by the L.A. Times. Jorge Brouwer, inventor of the most compact (4-inches) breathing exerciser, manufactures and markets the easy to use “Expand-A-Lung.” When asked about how his product’s success, Mr. Brouwer said, “We’re finally creating awareness about the importance of respiratory fitness training for athletes and people who suffer from shortness of breath due to respiratory problems such as COPD. This exercise works the muscles involved in the breathing process (the diaphragm and intercostals muscles), and allows you to breath in more volume of air/oxygen deeper into your lungs.”

“It also helps you to expulse more carbon dioxide out of your lungs. The end result is deeper, easier and better breathing inhaling and exhaling (100% drug free).”

“Research supports that the condition of the respiratory system is very important for endurance sports, and that respiratory fitness training can improve performance significantly in competitive athletes. Furthermore, it can also be extremely efficient as an integral part of a pulmonary rehabilitation program for COPD patients.”

“In the past, this type of exercise was only available with bulky equipment in respiratory care facilities. The Expand-A-Lung’s size (4-inches) provides the portability to take it and use it anywhere. This is the feature that made it popular among athletes who most frequently use it outdoors.”

* COPD patients, visit http://www.copd-breather.com/

Source