Tag Archives: smoking

What Does Bremerton, WA Have in Common with Karachi, Pakistan?

What does Bremerton’s Mayor, Patty Lent, have to do Aga Khan University and the National Alliance for Tobacco Control seminar?

Both honored World COPD Day on Wednesday, 16 November 2011.

Mayor Lent had Adam Brockus present the 2011 World COPD Day Proclamation at the Bremerton City Council meeting, Wednesday, 16 November 2011.

Thank you Mayor Lent, Adam Brockus and the city council members!  Karma Foley of Seabeck will get the actual certificate because she lost both parents to COPD and Asbestosis and I’ll treasure my copy of it.

See photos below another World COPD Day story from the other side of the world, Karachi, Pakistan.

““…(COPD) disease poses a major health hazard and unfortunately remains largely under-diagnosed and under-treated in Pakistan, said experts gathered at a collaborative seminar organised by the Aga Khan University and the National Alliance for Tobacco Control. The seminar was held at the Aga Khan University to commemorate World COPD Day.

COPD affects more than 340 million people and is one of the leading causes of death worldwide,” said Prof Nadeem Rizvi, president of the Pakistan Chest Society and the Head Department of Chest Diseases, JPMC, Karachi.

Elaborating on the risk factors, Professor Javaid Khan, Head, Section of Pulmonolgy, the AKU said that smoking was a major risk factor for the disease.

Significant societal and quality of life benefits could be achieved if greater steps are taken to prevent the condition, such as greater access to smoking cessation programmes, earlier diagnosis and appropriate management strategies to control the condition and slow down the spread of the disease,” explained Prof Khan.

He called for the implementation of clean air laws in the country similar to the Sindh Assembly resolution passed earlier this year banning the use of Shisha in restaurants.

The use of biomass fuel like wood and coal in cooking is another important cause for this disease, especially for women living in rural areas.

Unfortunately, most patients visit their doctors very late when severe damage to the lungs has already been done. Smokers should seek help from smoking cessation experts, who could not only share with them some practical tips on how to quit smoking, but also how best to utilize new medicine designed to help with quitting.

http://www.thenews.com.pk/TodaysPrintDetail.aspx?ID=78106&Cat=4

Thanks for reading…. Sharon O’Hara

Does a hospital’s right to hire smokers trump a patient’s right to breathe clean air?

I was recently in the hospital to get a head start on trying to control the leaky cellulitis/lymphedema/edema causing havoc and pain on my left leg and life.  For an entire day all my experiences in the hospital were incredibly good… until…

The new aide came closer to take vitals until she was close enough to smell cigarette smoke on her.  “Smoker”?  I asked – she said, “Yes” and continued to wrap the blood pressure cuff around my left arm and placed the thermometer into my mouth.

For whatever reason when she finished with the blood pressure, she held on to the handle of the thermometer and I smelled the smoke on her fingers held next to my nose.  My mouth was tight around the thermometer and now could not breathe without smelling her smoke and I pulled away and said, “Your fingers reek of cigarette smoke.”

She agreed and I suggested she wash her hands.  She said she did but the smoke smell did not come off.  I was trapped – a hospital patient forced to inhale cigarette smoke from a hospital worker.  She said she would get someone else to do my vitals.

Funny thing.  I was in that hospital because of a forty-year smoking habit and developed emphysema (COPD) due – probably – to smoking.

I stopped smoking in 1997 – a tough time that took me over two years to get over the gut wrenching addiction urge to smoke again…and here I was trapped in the hospital, forced to inhale smoke from a hospital employee reeking of cigarette smoke.  The irony of all their outside hospital signs proving they were a “Smoke-free” hospital and grounds was laughable.

I complained.  The hospital person I complained to told me they would get someone else to do my vitals…that I did not have to have a smoker helping me.  I asked about the other seniors – any patient – who would probably not complain of being forced to inhale the toxins of cigarette smoke from a hospital employee for fear of retaliation…no one seemed concerned about them.  Apparently, the issue is only an issue with me, an ex-smoker, as far as the hospital is concerned.

A few hours later, the RN came in with the vials of antibiotics and other meds that went directly into my veins.  He dropped one vial, hesitated, picked it up, hooked it into the devise going directly into my vein, and plunged the contents inside.  Neither of us said a word.  I remember thinking, isn’t this hospital floor dirty?  And hoped the contents of the vial stayed uncontaminated.

As an almost thirty year hairdresser, if I dropped a comb on the floor it was cleaned and re-sterilized before touching a patron.  Apparently, hospitals are different.

A while later it was time to hook up the oxygen tube to my bipap.  I pulled to get it for her but the end was stuck between the hospital bed wheel and the metal bedframe I’d just lowered.  I left to visit the bathroom and when I came back, the hospital employee had ‘fixed’ it.

I looked and she had placed the deformed tube end on my machine but had not pushed it on to secure it.  I did it and went to bed…wondering why an employee was allowed to reek of cigarette smoke and work around patients….wondered why an RN didn’t throw the vial away and get a new one for the patient when it dropped to the dirty floor…wondered why the tube end of the oxygen tube wasn’t replaced by a clean, sterile one when it had been lodged against the dirty hospital bed wheel.

To be clear…I do not care if the hospital person smokes.  I care when her/his right to smoke interferes with my right to breathe clean air – especially in a hospital.

I was discharged and came home the next day.

Am I overreacting and expecting too much from a hospital?

Thanks for reading… Sharon O’Hara

ALPHA-1 is coming to town and Harrison Silverdale’s BB has them!

Alpha-1 is coming to town!  Silverdale to be exact – in the Rose Room at Harrison Silverdale to be more exact – 1:00pm to 3:00pm and we are all excited.

Mark Wednesday, 21 September 2011 for Better Breather’s partnering with Alpha-1 and Free Testing for the Alpha-1, a genetic component of Emphysema (COPD)

“American Thoracic Society (ATS) Guidelines

ATS guidelines recommend testing a broad range of patients with lung conditions:1

All adults with symptomatic emphysema regardless of smoking history

All adults with symptomatic COPD regardless of smoking history

All adults with symptomatic asthma whose airflow obstruction is incompletely reversible after bronchodilator therapy

Asymptomatic patients with persistent obstruction on pulmonary function tests with identifiable risk factors (smoking, occupational exposure, etc.)

Consider testing of asymptomatic individuals with persistent airflow obstruction without risk factors (no smoking or no known occupational exposure, etc.)”

The speaker is Nancy Bartholomew, with Prolastin-C from Grifols Inc.

 

 

I have included this photo taken from ATS “Rare Lung Diseases” because seeing it broke my heart.  It shows a ‘mother and her baby poignantly illustrating the fact that young women can be the victim of rare lung diseases.”

If we do not test, we cannot know and could easily be misdiagnosed and medically treated for the wrong condition.

… taken from American Thoracic Society (ATS) online “Some of the most exciting discoveries in pulmonary medicine have come from studying rare diseases. Insights gained from uncommon lung diseases often shed light on more common lung diseases…”  http://www.thoracic.org/education/breathing-in-america/index.php

Web sites of interest

National Institutes of Health Rare Diseases Clinical Research Network

www.rarediseasesnetwork.org

Orphanet  – About Rare Diseases

www.orpha.net/consor/cgi-bin/Education_AboutRareDiseases.php?Ing=EN

LAM Foundation

www.thelamfoundation.org

Hermansky-Pudlak Syndrome Network

www.hermansky-pudlak.org

Tuberous Sclerosis Alliance

www.tsalliance.org

 

Look for a table and chairs set up and friendly Harrison folks…Joyce is the RRT Harrison volunteer Better Breathers liaison…we are lucky to have her.

Rose Room – Harrison Silverdale

1800 NW Myhre Road – Silverdale, WA 98383

Better Breathers Support Group

“Our Better Breathers support group encompasses community members and their caregivers who live with chronic respiratory disease and lung disease. Better Breathers is designed to provide support, education, networking, and tools to improve the daily lives of those living with these health conditions.

We welcome any community member with asthma, emphysema, chronic bronchitis, sarcoidosis, asbestosis, pulmonary hypertension, pulmonary fibrosis and the many more lung diseases affecting our population, pediatric or adult.

Please email or call if you will need assistance with parking at the meeting.”

Contact: Pamela O’Flynn   – 360-744-6687 – respiratorycare@harrisonmedical.org

 

If anyone needs a ride, contact me.

Thanks for reading… Sharon O’Hara

Bartenders Win! And Improve Their Health in Wisconsin by 36 Percent – Skol!

For what it’s worth: Smoking can lead to really bad stuff.  I know.  I smoked forty years and enjoyed every cigarette.  When I ended up hospitalized and non-smoking that enjoyment turned into a craving I’d never felt before and the craving for a cigarette became agony when I stopped smoking in 1997.  I learned what addiction really means to a drug addict.  Anyone who thinks smoking can’t become an addiction – talk to me.

This study from the University of Wisconsin showed bartenders (36 %) improved their health after the statewide ban on smoking in public places.

****

Study shows statewide law associated with improved bartender health.

March 14, 2011

Study shows decreases in secondhand smoke exposure and respiratory symptoms

The Impact of Wisconsin’s Statewide Smoke-Free Law on Bartender Health and Attitudes, a study of 531 Wisconsin bartenders before and after Wisconsin enacted its statewide smoking ban, shows eight smoking-related upper respiratory health symptoms were reduced by as much as 36 percent. A baseline survey was conducted two months before the ban went into effect, with a follow-up survey conducted three to six months after the state law. The study included urban and rural areas of Wisconsin and was limited to bartenders who worked in establishments that allowed smoking before the law and were smoke-free after the statewide ban.

Learn more about Tobacco Surveillance and Evaluation Research conducted by CUIR in collaboration with Wisconsin’s Tobacco Prevention and Control Program.

http://www4.uwm.edu/cuir/news/statewide-bartender-survey.cfm

…thanks for reading…. Sharon O’Hara

February Heart Month – 911 – CK Medics and Me

February is Heart Month…. And I called 911 for help.

I called 911 for myself early morning a couple of Saturdays ago.  I thought I was having a heart attack.  I’d migrated from bed to sit right here in this chair in what is loosely called my ‘office’ next to my computer and a wall phone and waited until the pain in my throat and down into my chest subsided.  Trouble is it got worse and tighter.  The pain exploded in my throat and chest with every cough.  Pursed lip breathing didn’t seem to help.  My airway felt like it was closing.

I dialed 911 and told them how to get where I was.  Afterward, still conscious, I called the Old Guy and told him company was coming.

I remember the relief when the paramedics put a C Pap mask on me and I could breathe easier – most comfortable mask I’ve ever had on… and remember the tough time they had getting me out of here –too many steps – to the unit parked in the driveway.

Thank you CK 911 responders!  You were efficient and lifesaving…same with Harrison when you got me there. I appreciate the professional help, but especially those really special nurses and staff who understood that I have to maintain whatever degree of independence I have.

The Progressive Care Unit was a new area for me with – again – outstanding care.  Without exception, they helped me maintain my independence even though it took longer.  From the cheery “Darlin’” nurse to the incredibly kind assistants who make things work well for patients to the MD’s, Barbora Volovarova, (Attending) and Dr. Irina Case –to the well-done discharge RN, Debra Clough Russell and to the cheery Rhonda who wheeled me on out the front door to await the Old Guy bringing the gas guzzler.

The diagnosis was Bronchitis and the pain was pleurisy – the exact diagnosis the Norwegian doctor gave when I got sick in Norway in 1997.  The prescribed meds in Norway 1997 allowed me to finish a tight schedule there and get me home.

Shortly after getting home in 1997 and running out of the medications,  I was in Harrison and life changed forever.  I stopped a 40 year smoking habit and learned the real meaning of the word “addiction” as I fought against the sudden gut wrenching cravings to smoke that continued over the following two years and occasional cravings to a lesser degree, even beyond.

I was scheduled for a stress test at Harrison, but I opted out after the tech helped me do a perfect first scan and we had several delays.  The cardiologist asked about my throat and I told him the pain was still there and he kindly suggested that it probably wasn’t my heart but that the stress test would give a good base – I already have Right Heart Failure.

What I didn’t think to mention is that with all the sitting my legs, Restless Leg Syndrome (RLS) began acting up and I doubt I could have held them still for the second scan.  The Mirapex I take for RLS doesn’t work like it used to.  The stress effort would have been wasted without a good second scan.  They planned to do the chemical stress test since it seemed unlikely I could do a treadmill testing.  Too bad they don’t do water stress testing where they can get the heart pumping hard as they want without the external problems popping up – such as RLS.

The bottom line for me about Harrison is that they do not treat their patients all alike – they help each patient maintain what they are able to do and encourage that independence.  For that, they are unique and a special place for patients like me fighting to maintain strength even as we are there for medical help.

I missed that Saturday’s swim session with Coach Marilyn but her lessons stayed with me in that I was able to swing both legs up on the bed and gurneys using my new found core strength and beginning muscle protection for my left hip.  And we were back on track for the following Monday hour session.

I’m including a scan of a great morning tool Harrison gave me on discharge to keep track of such things as heart, weight to catch a heart attack before it happens.  I’ve added a blood/oxygen check (Nonin) column and check the time too.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002347

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002347

I use the following sheet every morning to keep track of what is going on and will take it to my next doctor appointment.

The single one thing I will change on the sheets I see every day is to change the “Heart Failure Log” to Heart HEALTH Log.

As a patient, I do not want to see “Failure” before me every morning.  Heart HEALTH Log is more accurate.

More later…. Sharon O’Hara

Cannabis Linked To Psychosis – Not Good Health

I voted yes for the use of marijuana for medical purposes in our state – unknowing Federal law still made it illegal.  Today I would vote a resounding NO – not in a cigarette form anyway – not as long as we have a Federal law against it and now because of the following article connecting cannabis use to psychosis.

I know people smoke pot but not around me.  I might have tried it at a young age but it wasn’t around then and later, when it was hitting the Kitsap schools my children attended I was too busy and no one I knew smoked it.  The subject didn’t come up.

Let me be clear:  I don’t care what people do with their own lives.  I smoked 40 years and understand the connection and addiction to drugs.

Trouble is all these years later I’ve got health issues that seem to stem directly from my own 40 year smoking addiction and have gathered opinions about it to share here such as….get educated about it first.

If one is going to smoke, use cannabis and other illegal drugs, then learn about them, study all you can find out about them – then from the basis of full  knowledge what you might be getting into long term – make your decision.  It is your decision, not mine.  Just get educated about it.  And that is why I’ve posted the following new information here.

………………………………….

Cannabis Link To Psychosis

A new study has provided the first conclusive evidence that cannabis use significantly hastens the onset of psychotic illnesses during the critical years of brain development – with possible life-long consequences.

The first ever meta-analysis of more than 20,000 patients shows that smoking cannabis is associated with an earlier onset of psychotic illness by up to 2.7 years.

The analysis, by an international team including Dr Matthew Large, from the University of New South Wales (UNSW) School of Psychiatry and Sydney’s Prince of Wales Hospital, is published in the prestigious journal Archives of General Psychiatry.

In partnership with St Vincent’s Hospital and The George Washington University School of Medicine and Health Sciences, the study set out to establish the extent to which use of cannabis, alcohol and other psychoactive substances affects the age at onset of psychotic illnesses such as schizophrenia.

Cannabis is the most widely used illicit drug in Australia with 33.5% of the population reporting use at some time, according to the 2007 National Drug Household Survey. Some 18% of all secondary school students aged 12-17 reported using the drug at some time in their life, according to the 2004 Secondary School Survey. (UNSW’s National Cannabis Prevention and Information Centre.)

Building on several decades of research, the finding is an important breakthrough in the understanding of the relationship between cannabis use and psychosis, Dr Large said.

A number of previous studies have found an association between psychosis and the use of cannabis, alcohol and other psychoactive substances. However, the aim of this study was to specifically show the extent to which this is caused by cannabis use alone, he said.

The current findings support the view that cannabis use precipitates schizophrenia and other psychotic disorders, perhaps through an interaction between genetic and environmental disorders or by disrupting brain development, the team notes.

“The study re-analysed the results from 20,000 patients with schizophrenia or other psychotic illnesses from 83 previous studies. The study used meta-analysis – a modern statistical method – to show that an earlier onset of severe mental illness among substance users is a result of cannabis use, and cannot be explained by other factors such as alcohol use,” Dr Large said.

“Results of this study are conclusive and clarify previously conflicting evidence of a relationship between cannabis use and the earlier onset of a psychotic illness, with evidence supporting the theory that cannabis use plays a causal role in the development of psychosis in some patients.”

Dr Large said there was a high prevalence of substance use among individuals treated in mental health settings, and patients with schizophrenia were more likely to use substances than members of the wider community.

“The study raises the question of whether those substance users would still have gone on to develop psychosis a few years later.

“However, even if the onset of psychosis were inevitable, an extra two or three years of psychosis-free functioning could allow many patients to achieve important developmental milestones of late adolescence and early adulthood that could lower long-term disability arising from psychotic disorders,” Dr Large said.

“The results of this study confirm the need for an ongoing public health warning about the potentially harmful effects of cannabis.”

http://www.medicalnewstoday.com/articles/215998.php

More later…. Sharon O’Hara

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

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

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

Lung Cancer COPD Confusion

Lung cancer is almost entirely caused by smoking…just as in COPD and COPD kills more people per year than lung cancer and breast cancer combined.

A vast difference though is that COPD is a long slow smother without treatment other than inhaled steroids, several other inhalers, lung reduction and lung transplant while physical exercise beyond the shortness of breath and inhalers, is the single most important thing a COPDer can do to help them live a quality life

Lung cancer is usually faster from diagnosis to death since most lung cancer is not diagnosed until a late stage.

Why?
Because there is no proven screening process that can find it earlier while early detection is possible for COPDers with the simple Spirometry test …the only problem is finding a doctor willing to give the quick, inexpensive test….and the only opportunity to give the patient, if a smoker, a chance to change behavior knowing what lies ahead.

Keep in mind too, only about 20 % smokers develop COPD while about 80% COPDers were smokers. (Speaking of patient changing behaviors if the consequences and benefits are known…my next post here will challenge me to do what I preach and throw out a challenge)

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According to Jennifer Croswell, MD, of the National Institutes of Health…” Low-dose computed tomography — now under study in two large randomized trials — has delivered significantly more false positives than chest X-rays…”
The false positives can lead to “… more invasive diagnostic procedures among patients screened with the low-dose CT, Dr. Croswell said at the annual meeting of the American Society of Clinical Oncology and “”False-positive results may create increased psychological stress in patients and an increased burden on the healthcare system…”

“According to the American Cancer Society, the five-year survival rate for localized lung cancer is 49.5%, but that falls to 20.6% for disease that has spread outside the lung and 2.8% if there are distant metastases.

The authors of the current study “break a little bit of new ground” in that they are looking at a study with a comparison group, according to Peter B. Bach, M.D., of Memorial Sloan-Kettering Cancer Center in New York.

But it has been known for some time that CT screening uncovers a “very, very high” frequency of lung abnormalities — up to 50% in one study and usually in the same range found by Dr. Croswell and colleagues.
Such findings can be nerve-wracking for patients, he said, and can require invasive procedures to pin down the cause of the “abnormal thing in the lung.”

But “only very rarely is that thing a lung cancer,” he said. “

Complicating the issue, Dr. Bach said, is that for physicians, the results of a CT scan that showed a minor abnormality are rarely a Yes or No issue. Instead, he said, they may increase suspicion and lead a doctor to follow a patient more or less closely.

The work of Dr. Croswell and colleagues, he said, adds to the available information, but “nothing really changes here. There is no organization in the world that recommends screening for lung cancer with CT” or any other technique.
“The status of the science is that (screening is) unproven, no one has ever shown it’s beneficial, numerous studies have shown it causes harm, and no one should be doing screening until we have randomized trials that are completed and show a benefit that outweighs all the harms,” he said.

On the other hand, “there is no question that CT screening will detect many lung cancers,” said Martin Edelman, M.D., of the University of Maryland Greenebaum Cancer Center in Baltimore.

The question is whether the approach will reduce the risk of death and illness, while minimizing harm to patients, said Dr. Edelman, who is on the independent committee verifying the endpoints of the National Lung Screening Trial.
So far, there is still a “complete absence of evidence that this approach decreases mortality or morbidity due to lung cancer,” he said.

Advocates for screening “have long claimed that there is little or no risk of harm, Dr. Edelman said, but Dr. Croswell and colleagues “demonstrate that there is a small, but real potential for harm from screening.”
What’s more, he said, “the potential for false positivity is highest in those at greatest risk for lung cancer.” “

medpagetoday.com/MeetingCoverage/ASCO/14432?utm_source=WC&utm_medium=email&utm_campaign=Meeting_Roundup_ASCO

More later… Sharon O’Hara