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
