Tag Archives: pulmonary rehabilitation

Mark Mangus Tells the COPDer How to Live – EXERCISE

Pulmonologists and COPDers – take note – patients really do WANT to be educated and too many physicians are shy about encouraging patients to exercise and WHY WE MUST EXERCISE to have a life.

Following is the noted exercise guru for the COPDer, Mark W. Mangus, Sr., BSRC, RRT, RPFT, FAARC of San Antonio, TX answer to a patients question about her FEV-1 and FVC decline.  Mark’s answer was posted on my online support group, EFFORTS.  www.emphysema.net.

A gentle reminder that Mark had to move beyond traditional COPD treatment because his daughter, Kim, born with Cystic Fibrosis was not helped by traditional medicine methods for lung patients.  Kim’s only hope was to stay alive until she was old enough for a lung transplant.  She has had double lung transplants now and currently works for Vanderbilt Medical Center.

Hi _ _ _,

First, let me say that there is nothing you can do to stop the decline you

are experiencing in your FVC and FEV-1, though you CAN slow the inevitable

progression to some (unknown) degree by exercising increasingly VIGOROUSLY

as you embark on your pulmonary rehabilitation effort.

**********

Your stress testing and echo tell a story of long developing pulmonary

hypertension which has advanced with poor intervention with regard to timely

detection of hypoxemia and earlier oxygen therapy support.  Your breast

cancer bout and treatment are potentially responsible for part of what you

are currently experiencing.  Radiation treatment is notorious for triggering

a process of radiation fibrosis, though it usually happens more profoundly

in treatment of lung cancer than more superficial cancers like breast

cancer.  But, if lymph nodes under your arm were irradiated – in other words

– the radiation was applied broadly over an area larger than simply the

breast tissue, chances are that you are seeing some effect from that.  A

high-resolution CT of your lungs, maybe with enhancement, if deemed helpful,

might better illuminate the presence of fibrosis and its extent and progression.

 

Your FVC has dropped disproportionately with your FEV-1, the FVC dropping by

almost double that of the FEV-1 during the same period.  This is also

suggestive of the possibility of fibrosis.  As well, your DLCO being reduced

to around 30 % of what it should be AND the confirmed and significant

hypoxia discovered with your walking and sleeping oximetry tests correlate

with the reduced DLCO and FVC.  The reduction in FVC is yet further

suggestion of a restrictive process being combined with your obstructive

lung disease process.

**********************************

I am disappointed that your 6 minute walk was conducted as it was, but,

unfortunately, not surprised, as it is one of the most variably conducted

tests done in this area of medicine.  You SHOULD have been allowed to

continue – hypoxia detected or not – as long as you were able to AND at a

pace that YOU chose.  If monitoring was to be done, then it should have done

no more than to document the extent of changes – NOT signal a point at which

the clinician decided to stop you and THEN to totally alter the validity of

your test by setting your pace!  So, the 620 feet you walked is meaningless

to determine anything with regard to the clinical state of your disease

and the limitations it imposes upon your ability to ambulate or to

extrapolate any determination of functional adequacy.  None of that is your

fault.  It is due to the poor understanding of the test purpose and method

on the part of the clinicians.

**************************

Your sleep saturations are very telling of significant hypoxemia that is

more likely associated with your fibrosis and pulmonary hypertension.

Pulmonary hypertension aggravates hypoxia, making it worse, which in turn

makes the hypertension worse, which in turn, makes the hypoxia worse . .

You can see where that is going. That is why you bottom out so low at 78 %

during sleep.

*************************************

First, I hope that 2 liters during sleep is keeping you saturated to at

least 88 % as a bottom low point.  If you have not had a follow-up sleep

study to determine the effect/benefit of the oxygen during sleep, you should

push for it to be done.   You should ALSO be using oxygen for ALL ambulation

and exertion – and possibly more like 4 to 6 liters – as I’m doubtful that

any less will saturate you adequately to counteract your pulmonary

hypertension.   Treatment of the pulmonary hypertension should be a point of

primary focus for you and your medical team.  Oxygen, at this point is the

most powerful and effective treatment you can use to slow the inevitable

progression towards profound heart failure you can expect if the pulmonary

hypertension is not controlled a LOT better than it has been over the recent

past.  That wll likely ‘do you in’ a whole lot sooner and with much interim

misery than the combined lung disease process that has caused it.

********

It is good that you are starting a pulmonary rehab program.  I am surprised

that they don’t have a pulmonologist directing the program.  Do you know

what kind of doctor is acting/serving as their medical director?  Make the

most of it.  Push hard to learn to work against the difficulties of the

breathing symptoms that accompany your disease, especially at this point.

Don’t let the staff hold you back because of hypoxia.  Push them to give you

all the oxygen you need to be able to push yourself to the maximum.  Short of

such an effort and you will be mostly spinning your wheels.  Working hard to

breathe and overcoming the difficulties and fear it can impose upon you are

not easy.  NEVERTHELESS, working hard to breathe – even when it makes others

uncomfortable to watch you work so hard – will NOT harm you, despite what

many might opine.  It may ‘feel’ like it’s gonna kill you.  HOWEVER, it will

NOT!  It is not an easy path you must travel.  But, others have traveled the

same path.  The good news is that you still have 29 % FEV-1.  That might

creep back up to 35% with hard work.  AND, it would be worth it because that

little 5 % raw change represents a 20 % change in your overall FEV-1.

*******

If you have further questions as you go along, I am happy to try to answer

them for you.       Best Wishes,                                  Mark

 

Mark W. Mangus, Sr., BSRC, RRT, RPFT, FAARC

San Antonio, TX

************************

COPDers, a new study indicating what I have shouted about for years – recumbent cycling (trike)…

“…This study showed that an eccentric cycling protocol based on progressive increases in workload is feasible in severe COPD, with no side effects and high compliance…”

COPD. 2011 Jul 5. [Epub ahead of print]

Eccentric Cycle Exercise in Severe COPD: Feasibility of Application.

Rocha Vieira DS, Baril J, Richard R, Perrault H, Bourbeau J, Taivassalo T.

Source

Respiratory Epidemiology and Clinical Research Unit (RECRU), Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada,1.

Abstract

Eccentric cycling may present an interesting alternative to traditional exercise rehabilitation for patients with advanced COPD, because of the low ventilatory cost associated with lengthening muscle actions. However, due to muscle damage and soreness typically associated with eccentric exercise, there has been reluctance in using this modality in clinical populations. This study assessed the feasibility of applying an eccentric cycling protocol, based on progressive muscle overload, in six severe COPD patients with the aim of minimizing side effects and maximizing compliance. Over 5 weeks, eccentric cycling power was progressively increased in all patients from a minimal 10-Watt workload to a target intensity of 60% peak oxygen consumption (attained in a concentric modality). By 5 weeks, patients were able to cycle on average at a 7-fold higher power output relative to baseline, with heart rate being maintained at ∼85% of peak. All patients complied with the protocol and presented tolerable dyspnea and leg fatigue throughout the study; muscle soreness was minimal and did not compromise increases in power; creatine kinase remained within normal range or was slightly elevated; and most patients showed a breathing reserve > 15 L.min(-1). At the target intensity, ventilation and breathing frequency during eccentric cycling were similar to concentric cycling while power was approximately five times higher (p = 0.02). This study showed that an eccentric cycling protocol based on progressive increases in workload is feasible in severe COPD, with no side effects and high compliance, thus warranting further study into its efficacy as a training intervention.”

PMID:     21728805

[PubMed – as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/21728805

 

COPDers–talk to your doctors- get educated and educate them to what patients CAN DO.

Thanks for reading… Sharon O’Hara

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COPD, Professor William MacNee Clicked for this COPDer

FLASH

Ref:  Early detection public COPD Spirometry,  World Spirometry Day and World COPD Day

I called our health district yesterday and spoke with  Cris Craig, Kitsap County Health District Public Information Officer.  She couldn’t answer my question about the health department offering free spirometry to the public.  She did say in a cheerful voice she would call in about three weeks with a response.  THAT is good news and she didn’t ask what COPD was – even better..  A hopeful sign and may mean that Spirometry will be offered and made available to the public.  I believe in miracles.

Professor William MacNee and the Royal Infirmary of Edinburgh Scotland, UK website has superb graphics – the best explanation of COPD (Chronic Obstructive Pulmonary Disease) I’ve seen in one place.  His ‘The Latest Trends in COPD Research’ graphically shows why early detection Spirometry is important.

For many of us COPD is an ongoing magnet for other disease, including some really difficult stuff.  COPD and lung disease can be the beginning of a long list of personal medical challenges expanding the patient’s medical disease library.  Whatever needs to happen to avoid COPD in your life get tested for early detection and do whatever is needed to get it done.

My son, Al and I were visiting family in Northern Norway  in1997.  I didn’t know then my 40 year smoking habit was almost over.  And so was I.   I was beginning to feel sick.  The day after this picture was taken, I had to see a Norwegian doctor.  She examined me and prescribed medications for Pleurisy and Chronic Bronchitis.  The medication worked, the pain receded and we were back on schedule.   Within a couple weeks after this picture was taken and five days after returning home, I was in the hospital.

Life as I’d known it was over.

COPD is a friendly disease.  For me, once Emphysema (COPD) got settled in my lungs and got comfortable, she began to invite her Other Stuff Disease buddies for a sleep over.  Trouble is, they stayed over and didn’t go home.  They joined COPD trying to play Havoc with my health and life.

Following COPD was an open lung biopsy and Sarcoidosis – Sleep Apnea – RLS – Psoriasis – Venous Stasis Dermatitis  – Cellulitis – High Blood Pressure – Lymphedema – and  bone-on-bone Arthritis, left hip followed – to name a few.

Early detection Spirometry can stop COPD early – before it’s too late.  Ask your doctor.

This is where it gets tricky.  Health care is a huge problem.  COPD generally  takes twenty years developing before a person mentions symptoms to the doctor and by then about fifty percent of the lungs are destroyed….leading the patient to a long slow smother and the taxpayer choking form the cost.

Offering free Spirometry testing for early COPD detection gives the individual  warning.  If the problem is not genetic, it can be turned around. Telling isn’t enough – SHOW people what COPD can do to them and their families.  Let them meet willing patients who can show and tell… a real reality show.

Exercise works and muscle utilizes oxygen better than flab.  We can breathe better and move easier.  Exercise and understanding COPD gives us a quality of life back – to be the best we can be.  The recumbent trike takes us places we couldn’t easily go without one – fun stuff,  building muscle at the same time. We must keep moving … ask your doctor.

I did not qualify for lung reduction surgery or I would have opted to get it ..not enough good lung and I heard rave reviews from patients who had had one.  One COPDer told me the lung reduction surgery restored his life back to ‘normal’ and lasted about five years before time and COPD danced ahead.  Ask your doctor about it.

Pursed lip breathing training is a must for COPDers – it keeps us out of the panic mode and out of the hospital.  It has for me…and I tested it with my oximeter.Talk to your doctor about pulmonary rehab.  It is never too late to get better through our own efforts…what does your doctor say?

Photo taken by the photographer who traveled with the Trek.  This photo shows me on my recumbent trike flying the  COPD/EFFORTS safety flag and pedaling over Deception Pass with the American Lung Association of Washington’s three day bike ride – the Trek Tri Island.

It was the first time I had been away overnight from my house in seven years – since Harrison Hospital in 1997.  A slow trike rider, it is thanks to the wonderful volunteers who hop scotched me and my trike ahead of the other 200 plus bike riders time after time that enabled me to pedal 50 miles of the 137 mile trip. I felt free again.

Key motivators were the Shortness of Breath Study at the University of Washington Medical Center that I was lucky enough to qualify for and my online support group, EFFORTS.  Proof to me that  educating COPD patients work.

Stroke patient, Mary Griffith and her butterfly and gold star fingernails caught my eye the other day – more about Mary and husband, Doug later)

Kitsap County Health District … Will you be the first county health district in the nation to see the fiscal benefit of early detection Spirometry to protect citizens of ALL ethnic background.

The Kitsap County taxpayer and COPD future could rest in your hands.

Thank you Professor William MacNee for a great COPD informational website and allowing me to use it here.

http://www.efanet.org/activities/documents/WMcNeeLatestTrendsinCOPDResearch. pdf

More later… Sharon O’Hara

Part 4 of 4

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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.
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

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