Tag Archives: pulmonologists

University of Washington Medical Center Excellance v Danish Air Pollution Study

Ah HA!  Ah, YES!  Air pollution does matter – finally a study proving it.

I like teaching hospitals – the attitude, the open and curious mindset that the body is more than one organ and the friendly, hospitable attitude of the medical professionals and employees is key to a patients – THIS patient – sense of wellbeing..

One of the best teaching hospitals in the nation according to US News and World Report is the University of Washington Medical Center, right across the pond from us here in Kitsap County and where I go for several medical conditions.

In all the years I’ve gone there and parked in the underground parking garage, I’ve never had a reaction to the normal car emissions.  The air seems to flow and dissipate the normal car smells.  Not so at the UWMC’s Roosevelt Building 11.

Yesterday, I had an appointment at the UWMC’s Roosevelt Building 11 and for the first time did not park in the underground parking but asked my husband to drop me off at the street level front door.

The past odor of the warm choking toxic stench in the underground garage is so bad, my eyes water.  My husband says he has never noticed the poor air quality down there but I do.

What does an air quality test show?  I called to ask.

I didn’t call to complain about the warm choking smother and forced inhaled sting of the air toxins the first or even second time we parked there – after all it IS underground parking.  When I did finally call  and did get the right person to ask when they had their last air quality check, I was politely told no one else had ever complained about it but she would find out for me.

About a month later she called to tell me what I smell must be from the helicopter landing emissions and that sometimes she even smells it in her office.

Well, how about a better filter on the helicopter or the parking garage to protect the people who park there AND work in the offices who sometimes smell it…although once inside the building, I’ve never smelled those toxins.

***

Air Pollution Exposure Increases Risk of Severe COPD

ScienceDaily (Nov. 5, 2010) — Long term exposure to low-level air pollution may increase the risk of severe chronic obstructive pulmonary disease (COPD), according to researcher s in Denmark. While acute exposure of several days to high level air pollution was known to be a risk factor for exacerbation in pre-existing COPD, until now there had been no studies linking long-term air pollution exposure to the development or progression of the disease.

…

The research was published online ahead of the print edition of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

“Our findings have significance on a number of levels,” said lead researcher on the study, Zorana Andersen, Ph.D., post doctoral fellow at the Institute of Cancer Epidemiology of the Danish Cancer Society in Copenhagen. “Patients, primary care physicians, pulmonologists and public health officials should all take not of our findings.”

Dr. Andersen and colleagues used data from the Danish Diet, Cancer, and Health Study, which consisted of more than 57,000 individuals between the ages of 50 and 64 who lived in Copenhagen or Aarhus, the first and second largest cities in Denmark, between 1993 and 1997. A self-administered questionnaire provided data on smoking, dietary habits, education, occupational history and lifestyle. They then used the unique personal identifiers to link the cohort to the Danish Hospital Discharge Register to identify hospital admissions and discharges due to COPD, and estimated pollution exposure by linking residential addresses to outdoor levels of NO2 and NOx levels, which were used to approximate the overall level of traffic-related pollutants since 1971. They looked at exposures over 15-, 25- and 35-year periods to assess the effect of different exposure lengths on COPD incidence. Data for more than 52,000 were available from the start 1971 to the end of follow-up in 2006.

“We found significant positive associations between levels of all air pollution proxies and COPD incidence,” said Dr. Andersen. “When we adjusted for smoking status and other confounding factors, the association remained significant, indicating that long-term pollution exposure likely is a true risk factor for developing COPD.”

These associations were slightly stronger for men, obese patients and those eating less than 240 grams of fruit each day (approximately eight ounces, or just more than a single serving). But notably, the effect of air pollution on COPD was strongest in people with pre-existing diabetes and asthma.

“These results are in agreement with those of other cross-sectional studies on COPD and air pollution, and longitudinal studies of air pollution and lung function, and strengthen the conclusion that air pollution is a causal agent in development of COPD,” said Dr. Andersen.

Because the study used hospital admissions for COPD to assess incidence, it is likely that the true incidence was underestimated, and that the cases represented severe COPD, as mild and moderate COPD does not often require hospitalization. This means that the reported increase in risk associated with air pollution is probably an underestimate of the true increase in risk for COPD in general. Furthermore, while smoking is known to be the primary cause of COPD in developed countries, and majority of COPD cases were smokers or previous smokers, the effect of pollution exposure was also observed in the group of non-smokers. “This result refutes the possibility that the observed effect of air pollution was due to inadequate adjustment for smoking in our data and supports the idea that air pollution affects COPD risk, irrespective of smoking status,” said Dr. Andersen.

The enhanced association between increased risk of COPD and air pollution in asthmatics and diabetics suggests the possibility of an underlying link. “It is plausible that airflow obstruction and hyper-responsiveness in people with asthma, or systemic inflammation in people with diabetes, can lead to increased susceptibility of the lung to air pollution, resulting in airway inflammation and progression of COPD, but more research is needed in this area.” said Dr. Andersen.

“In any case, sufficient data, including the results of this study, provide evidence that traffic-related urban air pollution contributes to the burden of COPD and that reductions in traffic emissions would be beneficial to public health.”

…

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by American Thoracic Society, via EurekAlert!, a service of AAAS.

Journal Reference:

1. Z. J. Andersen, M. Hvidberg, S. S. Jensen, M. Ketzel, S. Loft, M. Sorensen, A. Tjonneland, K. Overvad, O. Raaschou-Nielsen. Chronic Obstructive Pulmonary Disease and Long-Term Exposure to Traffic-Related Air Pollution: A Cohort Study. American Journal of Respiratory and Critical Care Medicine, 2010; DOI: 10.1164/rccm.201006-0937OC

http://www.sciencedaily.com/releases/2010/10/101019111536.htm

More later (part 1 of 3 photo story of one patients Lymphedema)  Sharon O’Hara

Post to Twitter Tweet This Post

Dr. Tom Speaks … Like it or Not

If COPD has a living guru in this nation, it is Thomas L. Petty, MD.

The following message is important and can save lives through early detection. Dr. Tom’s comment, “COPD is associated with numerous co-morbidities, and indeed, the entire body may become involved” is spot on….believe it… YES!

Since COPD diagnosis, then landing in the hospital in 1997, I have gone from being healthy and fit into my fifties to COPD and another EIGHT medical conditions. Each has its own set of ‘rules’. If I take pain pills for the Cellulites, I know that my respiratory system will be adversely affected….not a good thing with two lung diseases. The latest medication, Diovan, adds to the mix.

The point is that a COPD diagnosis is only the beginning of a medical adventure that need not happen with early detection…the simple Spirometry test.

Please, read Dr. Tom’s comments.
*****************************************
COPD Progress and Challenges 2009

By Thomas L. Petty, MD
…
In the four decades I’ve devoted to lung health, chronic obstructive pulmonary disease has been slow to excite the practicing physician. Yet COPD should create great enthusiasm because we have made so many advances in identification and treatment. Many new therapies are available that are effective and favorably influence the disease.

COPD is associated with numerous co-morbidities, and indeed, the entire body may become involved.1It is now regarded as a systemic disease.2Traditionally; COPD has included emphysema (loss of alveolar walls and loss of elastic recoil), chronic bronchitis, inflammation in the small and large airways, and various degrees of lung inflammation throughout the lung parenchyma.

More recently, bronchiectasis has been added to this spectrum, although there are significant differences in manifestations and pathogenesis with repeated bacterial infections playing a more prominent role in bronchiectasis than with emphysema and chronic bronchitis.

Spirometry’s significance

COPD is characterized by irreversible airflow obstruction as judged by simple spirometry. Only the FEV1is needed to judge the severity of airflow obstruction, although a number of other measurements of airflow volume and gas transfer (diffusion test) are commonly undertaken to assess the disease states in more detail.

Spirometry is used to monitor the course of disease. All physicians who treat COPD should have immediate access to spirometers, including primary care practitioners because of their growing involvement in COPD managment.

The benefits and barriers to spirometry have been summarized.3For some reason, there appears to be an unfortunate bias against spirometry, particularly in the diagnosis and assessment of early disease. This is where treatment has the opportunity to do the most good. It is astonishing that only 37 percent of hospitalized patients had a spirometric diagnosis of COPD at the time of a hospitalization for an exacerbation.4

Established therapies

Early diagnosis can change outcome of disease through smoking cessation and the selective use of a growing body of pharmacologic agents.5The pathogenesis of COPD relates to interaction of a complex array of genetic abnormalities under current study, interacting with environmental factors, most notably smoking, other dusts, and volatile compounds involved in various industries on a worldwide basis. Treatment focuses on eliminating these environmental factors.

Medications that are most useful in COPD are comparable to those used in asthma with reversible airflow obstruction. Thus, inhaled beta-agonists, corticosteroids, and in selected cases, anticholinergics are widely used in achieving better scientific scaffolding. Oral corticosteroids seem particularly effective in slowing the progress of disease.6

Active patients

Oxygen is established as an effective method of increasing not only the length, but quality of life for patients with COPD. At least 140,000 people with COPD and related disorders benefit from oxygen therapy in the U.S. alone. Ambulatory oxygen systems allow full activity, and they should be equipped with a pulse oximeter in order to monitor therapy’s effectiveness.

Portable oxygen concentrators are now approved for air travel. Most weigh about 10 pounds and deliver oxygen only by the demand mode; however, one exception weighs 17 pounds and gives up to 1 to 3 Liters of continuous flow.

Pulmonary rehabilitation is established as improving the exercise tolerance of many with COPD. Controlled clinical trials show pulmonary rehabilitation improves depression, anxiety, and somatic preoccupation, which are particularly common in the early stages of disease.7Most pulmonologists can provide the necessary breathing training, assistance in graded exercise, and other components that are key to patient and family education.

The future involves increased awareness of COPD among patients, physicians, and other health care providers.

COPD is the only disease increasing in morbidity and mortality among the top five killers, and by 2010, it is expected to become the third most common cause of death in the U.S. It resulted in direct and indirect losses of $30.4 billion to the U.S. economy in 2001. Approximately 16 million adult Americans have COPD, and it is very likely that a similar number have asymptomatic or even symptomatic lung disease that is neither diagnosed nor treated.
…
Thomas L. Petty, MD, MACP, Master FCCP, is chairman emeritus of the National Lung Health Education Program, Denver.
http://respiratory-care-sleep-medicine.advanceweb.com/Article/COPD-Progress-and-Challenges-2009.aspx

My next blog post will put money where my mouth is in a challenge to join me to prove that patients educated about their disease/s WILL make whatever lifestyle changes needed for the best health possible.

More later… Sharon O’Hara

Post to Twitter Tweet This Post

Dr. Tom Speaks … Like it or Not

If COPD has a living guru in this nation, it is Thomas L. Petty, MD.

The following message is important and can save lives through early detection. Dr. Tom’s comment, “COPD is associated with numerous co-morbidities, and indeed, the entire body may become involved” is spot on….believe it… YES!

Since COPD diagnosis, then landing in the hospital in 1997, I have gone from being healthy and fit into my fifties to COPD and another EIGHT medical conditions. Each has its own set of ‘rules’. If I take pain pills for the Cellulites, I know that my respiratory system will be adversely affected….not a good thing with two lung diseases. The latest medication, Diovan, adds to the mix.

The point is that a COPD diagnosis is only the beginning of a medical adventure that need not happen with early detection…the simple Spirometry test.

Please, read Dr. Tom’s comments.
*****************************************
COPD Progress and Challenges 2009

By Thomas L. Petty, MD
…
In the four decades I’ve devoted to lung health, chronic obstructive pulmonary disease has been slow to excite the practicing physician. Yet COPD should create great enthusiasm because we have made so many advances in identification and treatment. Many new therapies are available that are effective and favorably influence the disease.

COPD is associated with numerous co-morbidities, and indeed, the entire body may become involved.1It is now regarded as a systemic disease.2Traditionally; COPD has included emphysema (loss of alveolar walls and loss of elastic recoil), chronic bronchitis, inflammation in the small and large airways, and various degrees of lung inflammation throughout the lung parenchyma.

More recently, bronchiectasis has been added to this spectrum, although there are significant differences in manifestations and pathogenesis with repeated bacterial infections playing a more prominent role in bronchiectasis than with emphysema and chronic bronchitis.

Spirometry’s significance

COPD is characterized by irreversible airflow obstruction as judged by simple spirometry. Only the FEV1is needed to judge the severity of airflow obstruction, although a number of other measurements of airflow volume and gas transfer (diffusion test) are commonly undertaken to assess the disease states in more detail.

Spirometry is used to monitor the course of disease. All physicians who treat COPD should have immediate access to spirometers, including primary care practitioners because of their growing involvement in COPD managment.

The benefits and barriers to spirometry have been summarized.3For some reason, there appears to be an unfortunate bias against spirometry, particularly in the diagnosis and assessment of early disease. This is where treatment has the opportunity to do the most good. It is astonishing that only 37 percent of hospitalized patients had a spirometric diagnosis of COPD at the time of a hospitalization for an exacerbation.4

Established therapies

Early diagnosis can change outcome of disease through smoking cessation and the selective use of a growing body of pharmacologic agents.5The pathogenesis of COPD relates to interaction of a complex array of genetic abnormalities under current study, interacting with environmental factors, most notably smoking, other dusts, and volatile compounds involved in various industries on a worldwide basis. Treatment focuses on eliminating these environmental factors.

Medications that are most useful in COPD are comparable to those used in asthma with reversible airflow obstruction. Thus, inhaled beta-agonists, corticosteroids, and in selected cases, anticholinergics are widely used in achieving better scientific scaffolding. Oral corticosteroids seem particularly effective in slowing the progress of disease.6

Active patients

Oxygen is established as an effective method of increasing not only the length, but quality of life for patients with COPD. At least 140,000 people with COPD and related disorders benefit from oxygen therapy in the U.S. alone. Ambulatory oxygen systems allow full activity, and they should be equipped with a pulse oximeter in order to monitor therapy’s effectiveness.

Portable oxygen concentrators are now approved for air travel. Most weigh about 10 pounds and deliver oxygen only by the demand mode; however, one exception weighs 17 pounds and gives up to 1 to 3 Liters of continuous flow.

Pulmonary rehabilitation is established as improving the exercise tolerance of many with COPD. Controlled clinical trials show pulmonary rehabilitation improves depression, anxiety, and somatic preoccupation, which are particularly common in the early stages of disease.7Most pulmonologists can provide the necessary breathing training, assistance in graded exercise, and other components that are key to patient and family education.

The future involves increased awareness of COPD among patients, physicians, and other health care providers.

COPD is the only disease increasing in morbidity and mortality among the top five killers, and by 2010, it is expected to become the third most common cause of death in the U.S. It resulted in direct and indirect losses of $30.4 billion to the U.S. economy in 2001. Approximately 16 million adult Americans have COPD, and it is very likely that a similar number have asymptomatic or even symptomatic lung disease that is neither diagnosed nor treated.
…
Thomas L. Petty, MD, MACP, Master FCCP, is chairman emeritus of the National Lung Health Education Program, Denver.
http://respiratory-care-sleep-medicine.advanceweb.com/Article/COPD-Progress-and-Challenges-2009.aspx

My next blog post will put money where my mouth is in a challenge to join me to prove that patients educated about their disease/s WILL make whatever lifestyle changes needed for the best health possible.

More later… Sharon O’Hara

Post to Twitter Tweet This Post