Tag Archives: The Netherlands

COPDers Most Accurate Measurement of Disease Severity is the 6-Minute Walk According to Netherlands Study

COPDers (Chronic Obstructive Pulmonary Disease) are familiar with the 6-minute walking test but the following study presented recently at the American Thoracic Society ATS 2011 Denver is the best explanation I’ve seen of what the test result really means in the progression of the disease.

COPD is the 3rd leading cause of death in the US, 5th in the world.   For many of us it means don’t waste time.   Most of us already know we might be short timers based on other folk’s reactions – like my wonderful dentist doesn’t mention fixing my lower teeth – he just kindly replaced the upper teeth insert my dog, Dean chewed up.

Mr. Dean is a notorious thief of night guards (three) and now he is a pick pocket of false teeth inserts.  He can’t be trusted around teeth in an pocket or loose anywhere he can jump.  I thought he wanted petting – ha!  Seven tiny pieces were found scattered in his cushioned pad and carefully carried to Dr. Robinson.

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Harrison Medical Center, Silverdale Better Breather’s (American Lung Association) upcoming meeting is a super place to ask the questions – more about the meeting in Monday’s blog post.

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American Thoracic Society

‘Walking distance’ test an accurate indicator of disease severity in patients with COPD

ATS 2011, DENVER – The six-minute walking distance test (6MWD), a test that measures a patient’s ability to tolerate exercise and physical activity, is an effective tool for understanding disease severity in patients with chronic obstructive pulmonary disease (COPD), according to a three-year global study of patients with COPD sponsored by drug manufacturer GlaxoSmithKline.

“We found that baseline 6MWD was predictive of hospital admission with an acute COPD exacerbation, was relatively stable in milder COPD, and has a steady rate of decline in patients with severe disease,” said study author Martijn Spruit, PhD, scientific advisor and research leader at the Centre of Expertise for Chronic Organ Failure (CIRO+) in Horn, the Netherlands. “This confirms prior observations that the results of the 6MWD are related to the risk of death in patients with COPD, and that the test is a useful tool in understanding disease severity in patients with COPD.”

Researchers studied 2,110 patients with moderate to severe COPD who underwent a supervised 6MWD at study enrollment to provide a baseline value and annually for 3 years. Death and exacerbation-related hospitalization were recorded.

During 3 years of observation, 200 patients died and 650 were hospitalized for exacerbations. Mortality rates and exacerbation-related hospitalization were higher in COPD patients as baseline 6MWD decreased. Researchers found that a 6MWD threshold of 357 meters was optimal to predict increased risk of hospitalization; while a 6MWD threshold of 334 meters was optimal to predict an increased risk of death. The mean rate of deterioration of the 6MWD was 5.7 meters per year and was primarily limited by the ability of the patient to breathe easily.

“Exercise tolerance is an important clinical aspect of COPD which can be easily and reliably measured with the 6MWD test,” Dr. Spruit said. “These data confirm the power of the 6MWD to identify subsets of the COPD population at higher risk of exacerbation-related hospitalization or death.

“The ability to group COPD patients according to their functional status disease severity should enable healthcare providers to better tailor therapy for their patients and optimize use of medical resources,” he added. “Patient grouping is also useful for those designing interventional studies in COPD; for example, if the aim of an intervention were to reduce the rate of exacerbation related admission, then a study can be designed by including primarily patients at higher risk of that outcome.”

Dr. Spruit also noted that the 6MWD test offers benefits over a more traditional test of COPD disease severity, the FEV1 (forced expiratory volume in the first second) which measures a patient’s ability to forcefully exhale air in one second. “The FEV1 has limitations as a marker of disease severity in COPD because it fails to capture systemic manifestations of the disease,” he said. “This study was designed to determine if the 6MWD could be an additional measure of disease severity, and the results confirmed that it can.”

(I exhale to just this side of fainting to get the best results – results hinge on the patient’s effort)

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“Reduced 6MWD Is Associated With Increased Mortality And Exacerbation-Related Hospitalization In COPD: The Eclipse Study” (Session A93, Sunday, May 15, 2:00-4:30 p.m., Room 505-506-507 (Street Level), Colorado Convention Center; Abstract 17736)

* Please note that numbers in this release may differ slightly from those in the abstract. Many of these investigations are ongoing; the release represents the most up-to-date data available at press time.

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http://patients.thoracic.org/

http://www.thoracic.org/

Thanks for reading… Sharon O’Hara

Train the Brain? Reconsider the Pills?

The headline caught my eye…Anger amplifies clinical pain in women with and without fibromyalgia

I wondered if anger could choke off breathing as well. The researchers from Utrecht University in the Netherlands touched a chord…

Sensitizing effect of anger and sadness not limited to fibromyalgia patients

Researchers from Utrecht University who studied the effect of negative emotions on pain perception in women with and without fibromyalgia found that anger and sadness amplified pain equally in both groups…”

The other day I read a post causally commenting on the list of medications the poster takes.   When I read ‘antianxiety’ pills, I wondered how anyone could take a pill when they are virtually helpless – seemingly in the middle of an anxiety attack.

A few weeks ago, I could no more have reached for a pill than fly to the moon with or without gossamer wings.

Tuesday, 31 August I had a doctor appointment.  Already extremely short of breath a day or two – by the time I dressed and dragged myself up into the back seat of the roomy gas guzzler I was angry and disgusted.   Gasping for air, weak, unable to move beyond a slight shift in position and braced against the side of the car door and the back seat of the car, I didn’t have enough air to purse lip breathe.  (PLB) This was new stuff.

My husband had set up the stepper he’d made me to help get in the car and waited in the driver’s seat until I’d gotten myself in, pulled the stepper in and shut the car door.

The more I struggled to maneuver myself into the car, the angrier and more short of breathe.  Slumped inside and in trouble I couldn’t breathe or talk.

My husband sat in the driver’s seat and drove off.  I couldn’t tell him to take me to the hospital… I couldn’t talk. There was no way to communicate to him that I was in trouble.  The only thing I had that could move was my mind.

Physically helpless my brain raced to hang on to something – anything.  Touches of memory flitted by and were lost. I couldn’t hang on – until the memory of a toilet suspended over a ravine tickled my memory.  The toilet was off to the right of the trail I was riding on.  The memory touched my mind and.  I grabbed hold and felt again the feeling of surprise and absurdity of seeing a toilet high in the Cascades.

I grabbed that memory and felt again the warm and windless Cascade mountain afternoon.  I felt the warm sweat of Wixi’s neck and inhaled her sweet horse smell when I patted her and dismounted to take a closer look and a picture.

The halter rope felt pliable and soft coiled in my hand.  The worn smooth edges of the leather reins slid through my fingers until I had enough rein to loop the ends around the saddle horn of my old roping saddle.

My mind pulled to relive every feeling and sight of that toilet set on the edge of space off a trail high in the Cascade mountain range.  It sat out on the edge of a ravine overlooking space.  Across the ridge, you could see the trail as it came around a bend and then disappeared again off to the right.

Focusing around that memory allowed me to breathe again.

Whoever hauled that toilet in – thanks for the memory.

It is a twenty minute drive to my doctor’s office.  At some point during that drive, I began breathing again.

It is strange how desperation can pull past training up without conscious thought.

Focusing my mind to grab a memory and recall the sights, sound, smell in detail was something I’d learned during a week-end seminar more than thirty years ago.  Lou Tice’s, Pacific Institute affirmation training saved the day.

Thanks Lou.

If that experience was an anxiety attack, a pill couldn’t have helped.  I was helpless to move anything or to swallow if I had a pill to take.

Our minds are available year around.  Maybe we should be trained to use our brain.

September is Pain Awareness Month

What does anger and pain have to do with women?  Lots it seems, with or without fibromyalgia.

Part 1 of 2   More later… Sharon O’Hara

Lungs Win the Fight Against Fat

If we are in a boxing match, Fat in one corner, and Lungs in another, Fat wins every time.
Why?
Fat takes up the chest room Lungs need to expand and for lung patients, fat compromises our ability to breathe.

The fat v lungs slammed home to me a couple weeks ago when a granddaughter, taking a new class on her way to becoming an RN, told me she just learned that each pound of excess fat is fed by SEVEN MILES of blood vessels.

I went online that night and found an airport-scanned photo (Digg) of a 250-pound woman next to a 120-pound woman. Fat filled her stomach and chest crowding her lungs and heart. Heaven knows what all that fat is doing as it surrounds and crowds the kidneys, bladder and other organs….it cannot be good!

Look, fellow Tubby’ettes and join me. To date, I have lost 133 miles of excess blood vessels supporting nineteen pounds of excess fat.
Regular Tubby’ettes is lucky if their health is not yet compromised.

Lung patients, easing the fat surrounding our lungs will not change the PFT numbers, but we are bound to feel a sigh of relief from our lungs as the fat around them retreats and they can finally expand to capacity and add to our quality of life.

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Obesity and the lung: 5 • Obesity and COPD
Thorax 20 08;63:1110-1117 doi:10.1136/thx.2007.086827
Abstract
Chronic obstructive pulmonary disease (COPD) and obesity are common and disabling chronic health conditions with increasing prevalence worldwide. A relationship between COPD and obesity is increasingly recognized, although the nature of this association remains unknown. This review focuses on the epidemiology of obesity in COPD and the impact of excessive fat mass on lung function, exercise capacity and prognosis. The evidence for altered adipose tissue functions in obesity—including reduced lipid storage capacity, altered expression and secretion of inflammatory factors, adipose tissue hypoxia and macrophage infiltration in adipose tissue—is also reviewed. The interrelationship between these factors and their contribution to the development of insulin resistance in obesity is considered. It is proposed that, in patients with COPD, reduced oxidative capacity and systemic hypoxia may amplify these disturbances, not only in obese patients but also in subjects with hidden loss of fat-free mass. The potential interaction between abnormal adipose tissue function, systemic inflammation and COPD may provide more insight into the pathogenesis and reversibility of systemic pathology in this disease.”
• Review series
1. F M E Franssen1,
2. D E O’Donnell2,
3. G H Goossens3,
4. E E Blaak3,
5. A M W J Schols1
1. 1
Department of Respiratory Medicine, University Hospital Maastricht, Maastricht, The Netherlands
2. 2
Division of Respiratory and Critical Care Medicine, Department of Medicine, Queens University, Kingston, Ontario, Canada
3. 3
Department of Human Biology, Nutrition and Toxicology Research Institute (NUTRIM), Maastricht University, Maastricht, The Netherlands
1. Dr A M W J Schols, NUTRIM School for Nutrition, Toxicology and Metabolism, Department of Respiratory Medicine, University Hospital Maastricht, P O Box 5800, 6202 AZ Maastricht, The Netherlands; a.schols{at}pul.unimaas.nl
• Received 15 February 2008
• Accepted 30 April 2008
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• http://digg.com/health/Body_Scans_of_a_250_lbs_Woman_vs_120_lbs_Woman
More later… Sharon O’Hara

Fat Airport Scan