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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.

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

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