When World Chronic Obstructive Pulmonary Disease (COPD) Day was observed recently, the focus of attention was on a subject that is becoming an extremely urgent hearth issue to chest physicians across the world and in Sri Lanka: namely, the long and short term damage of Chronic Obstructive Pulmonary disease to a person’s body. While this common chronic lung disease affects men and women the good news is that it is both preventable and treatable chronic lung disease.

Consultant Respiratory Physician, District General Hospital and District Chest Clinic, Trincomalee Dr. Upul Pathirana shares his expertise on this important health issue with the Sunday Observer on preventable risk factors causing it especially smoking and inhaling impure indoor and outdoor air emissions. Most importantly he also shares some simple rules to avoid these risks.

Excerpts

Q: When World COPD (Chronic Obstructive Pulmonary Disease) Day. ( Nov 16) was observed recently) I understand this year’s theme was “Lungs for Life.” Could you explain its significance to persons afflicted by this chronic lung condition.?

A. “Your Lungs for life, “is the theme for World COPD day 2022. Its message to all those who are not afflicted with COPD or already afflicted by the condition, is that keeping lungs healthy is a vital part of one’s future health and well being.

It is a process that starts from early childhood when the lungs are still developing, to the time one reaches adulthood. In order to create awareness of the important role of the lungs in our well being that the Global Initiative for Chronic Lung Disease ( GOLD) has selected this as a theme for this year’s COPD Day.

Q: With reference to what you just pointed out, COPD is a common respiratory disease across the world and keeping one’s lungs healthy plays an important role in one’s well being. Unfortunately many people still lack even basic knowledge of this condition-. Could you explain what exactly COPD is , and its adverse effects on our health?

A. COPD is a disease, which affects lungs making it hard to breathe. In patients with COPD, the airways (the branching tubes that carry breathing air within the lungs) are narrowed and can be clogged with secretions called mucus. The air sacs are also damaged. These combinations make patients feel short of breath and tired.

Q: Is Emphysema or chronic bronchitis the same thing? What is the difference?

A. Emphysema means damaged air sacs and air gets trapped inside the lungs making it harder to breathe in again. Breathlessness is the main symptom of emphysema. Constant and long-lasting irritation and swelling of the airways is the hallmark of chronic bronchitis. It is characterized by coughing and increased production of secretions called mucus. These are two different components of COPD.

Q: How is COPD caused?

A. Smoking is the most common cause of COPD globally. The noxious particles in smoking induce an inflammatory (immune reaction to injurious agents) cascade within the lungs. The damage incurred by smoking is permanent and causes COPD.

Q: Can symptoms of its onset be detected early?

A. The patient may not feel any symptom until the lung is damaged to a certain extent. As the severity of illness is getting worse, you may experience breathlessness, mainly when you are engaged in physical activities like walking. Your breathing might be noisy (“wheezing”) similar to that of bronchial asthma. Chronic cough with phlegm may cause further trouble.

The clinical course could further complicate with infective exacerbations and COPD patients are at risk of developing lung cancer and heart diseases.

Q: Main risk factors- what are they?

A. Smoking is the commonest causative factor for COPD although exposure to other toxic gases and fumes may induce COPD. Untreated long-standing bronchial asthma patients may behave like COPD. Indoors and outdoors air pollution are well-known risk factors to develop COPD and these can precipitate COPD flares as well. Alpha 1-antitrypsin deficiency is a rare genetic disorder associated with COPD.

Q: Is there a test/s to confirm the diagnosis?

A. Yes. Spirometry will help to establish the diagnosis. During this test, you will be advised to take a deep breath and then blow out as fast as you can into a tube. The tube is attached to a computerised system so that it can measure how much air you can blow out of your lungs and how fast you can blow. If the result is abnormal, the test is repeated in 15-20 minutes after an inhaled or nebulised medication. The second test aids to decide whether the abnormal results are reversible with medication and make alternative diagnosis like bronchial asthma.

Q: Do you offer tests other than spirometry?

A. Testing other than spirometry is individualized. Imaging your lungs with chest X-ray can show changes compatible with COPD although computed tomography (CT) of the chest is more accurate at detecting and characterizing emphysema. CT has other advantages like detection of early stage lung cancers for which COPD patients are at high risk.

Q: Can COPD be cured?

A. It cannot be cured and can get worse over time. However, there are treatment options to control symptoms and disability in COPD. There are therapeutic measures that prolong survival

Q: Will early diagnosis and treatment help?

A. It is important as removal of causative factors and can slow down the progression.

Q: What are the complications of persistent COPD? Is pneumonia one?

A. COPD is a progressive disease, and the trajectory may complicate with flares of disease, which could be non-infective or infective (pneumonia). Patients may end up with respiratory failure (a state of low oxygen in blood) and the pressure within the lung may go up (called pulmonary hypertension). Then, your right heart ultimately fails.

Q: Will regular exercise, nutritious diets help?

A. Eating healthy foods with a balanced meal improves your overall health. Patients with COPD can lose body weight and muscle mass because of disease itself (chronic inflammation) and lack of physical activity. The result is a lean patient with low body mass index (BMI), which is associated with poor outcome in these patients. Supervised regular exercise plan is an essential component in COPD management to reduce disability.

Q: Treatment options?

A. Your physician will stage the disease based on your clinical characteristics and spirometry results. The main forms of medicinal treatment are inhalers, which help to open and dilate the closed or narrowed airways. Thereby, the inhalers enhance your exercise capacity. Additionally, the doctor might prescribe pills and capsules as required, especially in flares of symptoms.

As the disease progresses, your lung fails to oxygenate the blood for the demand necessitating home oxygen therapy. On rare occasions, surgeons can help COPD patients with surgical interventions as decided by a multidisciplinary team led by a respiratory physician. Finally, replacing your disease lung with a donor lung (lung transplantation) is going to be the last option.

Q: You referred to flare-ups. What are they?

A. The disease is marked by the progressive nature of the disease over time. There may be rapid worsening of symptoms precipitated by an infection, exposure to toxic gases or fumes or related to any other stressful event. These are called acute exacerbations or flares. The other complications such as pneumothorax, heart attack, blood clot within the blood vessels inside your lungs (pulmonary embolism) or rhythm changes in your heart may mimic flares.

The flares could be mild or severe enough requiring hospitalized management to save your life. You should seek medical advice early in flares.

Q: Are there vaccinations to reduce risks?

A. Infections like influenza, pneumonia, Covid-19 can be very hard on your lungs and can cause COPD symptoms to flare up. Getting a vaccine against these bugs can lower the risk of flares. These include the pneumococcal vaccine at least once, the flu shot every year and the Covid -19 vaccine and boosters.

Q: Pulmonary rehabilitation for COPD is included in the Package of Interventions for Rehabilitation, currently under development as part of this WHO initiative. Can you elaborate on this?

A. COPD patients are chronically breathless, limiting their mobility and physical activities, which subsequently causes muscle wasting.

Therefore, you feel tired and weak despite well-controlled COPD with your medications. Targeted exercise sessions in a specialised institution supervised by a respiratory physician and physiotherapists enable patients to engage in activities at home to regain lost muscle power. This type of training programes are coupled with nutritional assessment and appropriate advice, and also psychological support. The whole programe is named as pulmonary rehabilitation, is happening in respiratory units in Sri Lanka with encouraging feedback from participants. .

Q: It has now been universally accepted that reducing exposure to tobacco smoke is one of the most important primary prevention of COPD. Do you agree?

A. Prevention or minimisation of tobacco exposure is the best measure in COPD control as it primarily prevents disease occurrence and mortality, thereby reducing the health care burden and impact on the economy. Quitting smoking is the first and most important step in COPD management.

It not only helps in COPD but also reduces the other complications associated with smoking, for example lung cancer, heart attack or stroke. No matter how much and how long you smoked, you must cease smoking for a healthier life.

Q: Any suggestions as to how a habitual smoker can quit smoking ?

A. Following are several options we have for those who have difficulty complying with this most important intervention in COPD. They include :

a) Nicotine replacement therapy

b) Motivation and counselling for cessation of smoking at all the stages including even if you have not thought of quitting To help make this a reality, WHO introduced the following MPOWER measures.

1) Monitoring tobacco consumption and the effectiveness of preventive measures

2) Protect people from tobacco smoke

3) Offer help to quit tobacco use

4) Warn about the dangers of tobacco

5) Enforce bans on tobacco advertising, promotion and sponsorship

6) Raise taxes on tobacco

These measures are intended to assist in the country-level implementation of effective interventions to reduce the demand for tobacco, contained in the WHO FCTC

Q: Your message to readers?

A. You buy diseases such as COPD, cancers, vascular diseases (heart attack, stroke) each time you smoke tobacco.

You spread these diseases to your loving relations, parents, children and friends, as passive smoking is also associated with tobacco related health issues.

My first, second and third message is quit smoking today, do not postpone it for tomorrow.

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Trouble breathing in winter? Here's all about cold-induced asthma

Nov 25, 2022, 07:20 pm
2 min read

Trouble breathing in winter? Here's all about cold-induced asthma
The symptoms of cold-induced asthma are triggered when a person is exposed to cold and dry air

Feeling shortness of breath when you haven't even involved yourself in strenuous exercise?

Well, if you have asthma, the cold weather may trigger your asthma symptoms.

When the temperature dips, the air becomes dry, and this dryness can trigger asthma attacks.

Read on to know what causes cold-induced asthma, its symptoms and how to prevent the triggers during winter months.

What is cold-induced asthma?

Asthma is a chronic disease and is one of the major non-communicable diseases, according to the World Health Organization (WHO).

Several factors could trigger the symptoms of asthma.

One such trigger is inhaling cold, dry air during the winter season.

This is termed cold-induced asthma or winter asthma.

In this, airway muscles constrict and mucus accumulates, giving rise to breathing problems.

Common symptoms include shortness of breath, tightness in the chest, coughing, chest pain, and wheezing.

These symptoms vary from person to person. Some may experience long-lasting symptoms, while others for a short while.

The symptoms of cold-induced asthma are triggered when a person is exposed to cold and dry air.

In most cases, they subside when the affected person moves to a warmer place.

What causes winter asthma?

The cold, dry winter air is the leading cause of winter asthma.

The weather causes your airways to constrict, triggering asthma symptoms.

Exercising in the cold outdoor air can worsen the situation.

Also, the concentration level of outdoor pollutants that can trigger asthma symptoms can exacerbate asthma attacks.

Changes in the atmospheric nitrogen oxide and oxygen concentration can also worsen asthma symptoms.

When the temperature lowers down, the air becomes too dry, and it causes difficulty in breathing for people with asthma.

This happens because when we breathe cold air, the thin layer of fluid lined inside our airways evaporates. It evaporates faster than it is replaced.

When our airways are dry, they become irritated and swollen, which in turn triggers asthma symptoms.

The best way to prevent a cold-induced asthma attack is by staying indoors during winter.

Inhaling hot water steam can give instant relief from shortness of breath.

It is also crucial to take your asthma meds as prescribed by your doctor.

Wearing a warm scarf around your nose and mouth would help humidify and warm the air you breathe.

Also, keep your inhaler handy.



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This is a whole-time 10PA post for a Consultant Respiratory Medicine supporting our Acute Respiratory Infection Virtual Ward. The post will work in collaboration with our colleagues at Breathing Space who are our specialist Community Respiratory Facility. The post will also work in collaboration with our colleagues in the Acute Hospital based within Respiratory Medicine.

The post is integral to maintaining the quality and extent of the service provided by Therapies, Dietetics and Community Care and Respiratory Medicine, enabling the successful delivery of the strategic objectives. Our Division of Therapies, Dietetics and Community Care has an integrated care pathway across the acute and community setting. The service has a dedicated community respiratory outpatient unit - Breathing Space. Breathing Space is led by a Respiratory Nurse Consultant and hosts a number of differing healthcare services such as:

Outpatients - For respiratory diagnostic workup of asthma, COPD, Bronchiectasis and ILDs

Pulmonary rehabilitation

Respiratory Physiology (Limited to spirometry and FeNO)

Potential research opportunities

Provides domiciliary visits

Main duties of the job

The post holder will be expected to provide high quality management of Respiratory services to the population of Rotherham through:

Provision of a Community Respiratory Medicine Services on the Acute Respiratory Infection Virtual Ward, outpatients, residents in care homes and their own homes, participation in multidisciplinary working

Provision of Consultant delivered Community Respiratory Medicine services

Administrative duties to ensure the proper functioning of the department

Provision of cover for colleagues periods of leave

Participation in medical audit, clinical governance and continuing professional development relating to Community Respiratory Medicine

Management and supervision of medical, nursing and other professional staff within the multidisciplinary care team

Attendance at Divisional, Trust Wide and Regional meetings, as required, to represent the interests of the specialty, the department and the Trust

The provision of teaching duties and to take an active part in the education programme of trainee medical staff and medical undergraduate students from the University of Sheffield

The post holder will have full continuing clinical responsibility for patients under his or her care

Expectation and encouragement of the completion of research and clinical audit activities as an inherent part of normal clinical duties

For full details please see job pack attached

About us

The Rotherham NHS Foundation Trust is a combined acute and community provider delivering a range of health care services to people in Rotherham and across South Yorkshire.

We are ambitious about our future and the part we will play in meeting the health and social care needs of the local community and the wider region. Our innovative and forward thinking approach means we are at the forefront of care delivery for people at home, in the community and in hospital.

At the heart of the Trust are more than 4,500 members of staff who are working out of the main Rotherham Hospital site and a number of community locations. A range of specialist services are delivered across the South Yorkshire region and nationally.

The Rotherham NHS Foundation Trust is committed to diversity and inclusion and welcomes applications from everyone. The Trust seeks to establish a workforce as diverse as the population it serves. We will consider applications to work flexibly. If you are disabled and require reasonable adjustments to the application process, please contact the Medical Recruitment Team to discuss.

Job description

Job responsibilities

The Department

This is a whole-time 10PA post for a Consultant Respiratory Medicine supporting our Acute Respiratory Infection Virtual Ward. The post will work in collaboration with our colleagues at Breathing Space who are our specialist Community Respiratory Facility. The post will also work in collaboration with our colleagues in the Acute Hospital based within Respiratory Medicine.

The post is integral to maintaining the quality and extent of the service provided by Therapies, Dietetics and Community Care and Respiratory Medicine, enabling the successful delivery of the strategic objectives. Our Division of Therapies, Dietetics and Community Care has an integrated care pathway across the acute and community setting. The service has a dedicated community respiratory outpatient unit - Breathing Space. Breathing Space is led by a Respiratory Nurse Consultant and hosts a number of differing healthcare services such as:

Outpatients - For respiratory diagnostic workup of asthma, COPD, Bronchiectasis and ILDs

Pulmonary rehabilitation

Respiratory Physiology (Limited to spirometry and FeNO)

Potential research opportunities

Provides domiciliary visits

We have recently been awarded investment by NHS England to establish a Respiratory Physiology Service at Breathing Space in line with the ambitions for Community Diagnostic Services. Work is scheduled for completion in March 2023.

The role is intended to support the expansion of our community services and deliver the Acute Respiratory Infection component of the Virtual Ward also working in collaboration with the Frailty Virtual Ward and future plans for supporting other patients with acute dependencies in the community.

The Acute Respiratory Infection Virtual Ward will operate on a SystmOne Platform supported by the current Community Respiratory Exacerbation Nurse Specialist team in association with colleagues delivering the two-hour/two-day Urgent Community Response (UCR) and the new Discharge to Assess (D2A) pathway.

The post holder will be expected to work in partnership with all other members of the multidisciplinary team to deliver clinically effective, safe, high quality Community Respiratory Medicine Services to the population served.

The post holder is expected to undertake service development review and evaluation to improve & expand current practice. All appointees are required to participate in all divisional activities, including audit, sharing the administrative responsibilities and contributing to the further development of the divisions and the Trust

KEY RESULT AREAS / RESPONSIBILITIES

Clinical

The post holder will be expected to provide high quality management of Respiratory services to the population of Rotherham through:

Provision of a Community Respiratory Medicine Services on the Acute Respiratory Infection Virtual Ward, outpatients, residents in care homes and their own homes, participation in multidisciplinary working.

Provision of Consultant delivered Community Respiratory Medicine services as identified in the job plan.

Administrative duties to ensure the proper functioning of the department.

Provision of cover for colleagues periods of leave.

Teaching and Education

The Rotherham NHS Foundation Trust is committed to teaching and education, facilitating a wide variety of training opportunities to various staff groups, including Medical students, Nurse Students, qualified Nurses, junior doctors and other Allied Health Care professionals.

Consultants are directly responsible for appointment, supervision and appraisal of junior staff. It is therefore a requirement of Consultants to attend appropriate training courses (interviewing techniques, educational supervisors course, equal opportunities training etc.) to ensure the adequate experience and skills are gained.

The Dean regards specific training for educational supervision as mandatory for all Consultants and when new Consultants are appointed, it is expected that this training will be completed within 12 months of appointment.

Active learning is strongly encouraged, along with opportunities to research and present on topical issues of interest to the specialty.

The post holder will have an active role in clinical supervision of other staff and participate in Grand Rounds.

The department regularly accommodates undergraduate students and the post holder will support this activity.

The Trust has excellent established links with Sheffield Teaching Hospitals (STH). STH has excellent infrastructure for both teaching and research. It accommodates just fewer than 50% of undergraduate students of the University of Sheffield. The case mix is excellent for teaching and the facilities for undergraduates have been improved by the provision of a new Medical Education complex at the Northern General Hospital. There are excellent opportunities for research including collaborative research with colleagues.

Research, Audit and Development

The Trust has an exceptional Research and Development Department and has a committed research ethos. There are strong links with the Universities of Sheffield and Sheffield Hallam University. Research is encouraged within the department and trainees in particular are encouraged and mentored in their audit and research activities.

Participation in clinical audit is a professional and contractual requirement for all doctors within the Trust. The importance of clinical audit is recognised by the Trust and commissioning authorities and protected time for clinical audit is provided with dedicated sessions provided. The post holder is expected to attend and participate in these sessions.

The post holder will be expected to adhere to national and Trust clinical effectiveness guidance using the best information to direct their clinical practice.

Participation in national audit initiatives such as NCEPOD and CESDI is undertaken by the Trust and are regarded as compulsory for Consultant medical staff.

The post holder is encouraged to lead innovative methods of conducting audit and link this to education e.g. journal clubs and integrated care pathways.

Research is performed within the Trust by individual clinicians. Clinical research (subject to Local Ethical Committee approval and usual financial requirements) is encouraged. The post holder will be expected to comply with all principles of research governance.

Development of Service

The clinical lead will be expected to take a key role in development of the service in line with local and national strategy.

The post holder will be expected to develop and maintain collaborative working relationships within the Trust and local partner organisations i.e. Primary Care, community services, voluntary sector etc.

The post holder will be expected to work with the team to assure optimum utilisation of all clinical sessions in terms of quality of service provided and productivity.

The post holder will be expected to actively contribute towards the achievement of all targets agreed for the respective specialty areas and the wider Division.

Meeting Attendance and Participation

The post holder will be expected to attend and lead several meetings

Attendance at additional meetings will be agreed by negotiation with the post holder as and when required.

Person Specification

Management Skills

Essential

  • Demonstrate effective team working skills
  • Time management/organisational ability. An example may be they have developed and run training programmes.
  • Proven knowledge of systems and process of NHS or equivalent
  • Sense of understanding and commitment to corporate responsibility
  • Commitment to and understanding of their responsibility to the organisation. Examples may include previous involvement in management roles, management courses

Ability and Skills

Essential

  • Specific skills required to undertake the role above those required to achieve CCT.

Qualifications

Essential

  • Full registration and a licence to practise with the GMC
  • Please provide your GMC registration number
  • On the GMC Specialist Register or within 6 months of CCT from the date of interview
  • Must hold MRCP or qualification equivalent to overseas training in Respiratory Medicine

Desirable

Education and Training

Essential

  • Experience and interest in undergraduate and postgraduate teaching and training.

Experience

Essential

  • >3 Years of General Medicine years of post-qualification
  • Experience of General Medicine and management of Respiratory dis

BMJRef: BMJ-101777/165-C9165-22-11-039

 

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Aisha Hussain’s eldest son Justin, 16, has been prescribed steroids to help him breathe (Picture: SWNS)

An asthmatic teenager is ‘struggling to breathe’ because of the mould that has taken over his home, his mum claims.

Aisha Hussain’s eldest son Justin, 16, has been on steroids and ‘in and out of an asthma mask’ for three weeks to help him breathe.

The mum-of-three, 31, said there is thick black mould on their living room bedroom walls at their flat in Harlesden, north-west London.

It started showing up last November and has not cleared up, despite Aisha trying to use mould remover.

She has contacted the landlord who manages the property, but says she is ‘slowly giving up’ because there’s ‘no help’.

She said: ‘I ring the council every day for help, but nobody seems to be there to help me.

‘I have put in a disrepair claim for condensation and I have lost furniture and clothes due to the stains from the mould.

‘I am paying around £2,000 a month for a flat that is unliveable.

Mould started showing up in the flat in Harlesden, west London, last November (Picture: SWNS)
Aisha said she has been unable to get rid of the mould (Picture: SWNS)

‘It is not just the winter. In the summer you can’t breathe in this flat as there are three windows in total.’

Aisha believes the stress of the situation is the reason she ended up in hospital with breathing problems and heart palpitations on November 18.

She was kept in overnight for observations, given tablets to reduce stress and was kept on a drip to keep her hydrated.

Aisha is also worried about her two-year-old son Shahroz, especially after reading about how little Awaab Ishak, the same age, died in December 2020 from a respiratory condition caused by mould.

‘This mould is at the end of my baby’s bed where he sleeps,’ she said.

Aisha is worried about her two-year-old son Shahroz sleeping near the mould (Picture: SWNS)

She has started a fundraising page to replace clothes and other items damaged by the damp.

Aisha, who does not want to move into an Airbnb and be forced to share one room with her three children, feels abandoned by the council.

Brent Council said: ‘It is our aim for everyone in Brent to live in a safe and secure home.

‘We take concerns about poor quality or overcrowded private accommodation very seriously and inspect properties quickly whenever problems are raised.

‘As in all situations like this, we have offered the family temporary accommodation and have also served a notice to the landlord to address the safety concerns.

‘The welfare of the family is our upmost priority so we will continue to look for temporary accommodation that meets the family’s needs and work with the landlord to see that any safety concerns are resolved urgently.’

Get in touch with our news team by emailing us at [email protected].

For more stories like this, check our news page.



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New Delhi: The theme of this year's COPD day rightly proclaims "Healthy Lungs -Never More Important" as the COVID-19 infection has not only created havoc on the environment and human life but also compromised our lung health hence the time to fix them is most certainly now before it is too late. Every year the third Wednesday of November is observed as COPD Day, the day strives to raise awareness of the condition, risk factors and also on the importance of a pollution-free environment for healthy living.

Chronic Obstructive Pulmonary Disease (COPD) is a broad term for a range of progressive lung diseases. Any form of lung damage can result in a multitude of problems including chronic bronchitis and emphysema. The bad news is that lung deterioration is a condition that is non-reversible and also there is no treatment option available. Lifestyle changes and medical intervention can simply help the patient to avoid flare-ups and improve their quality of life.

Children especially premature kids and those with weak immune systems and asthma are more prone to develop COPD at a later stage in life. According to WHO, every day almost 93% of the world's children under the age of 15 years (1.8 billion children) breathe air that is so polluted it puts their health and development at serious risk. WHO estimates that in 2016, 600,000 children died from acute lower respiratory infections caused by polluted air. The Delhi government's recent order on the closure of primary schools in Delhi owing to the dangerous level that the AQI has dipped to, has brought the debate back to the environmental concern of cleaner and safer air and finding sustainable solutions to the pollution problem. Instead of opting for short-term knee-jerk solutions, it is imperative that we ensure long-term sustainable solutions to the ever-growing problem of pollution.

The adverse health impact of air pollution is an immediate public health concern in the country and the government should look for addressing the concern in the most effective manner. In India industrial emission is majorly responsible for air pollution, followed by combustion by vehicles and then household emissions and burning of crop waste in rural areas. With Indian metros topping the list of most polluted cities in the world, the problem can no longer be overlooked. The government has already taken noteworthy steps when it comes to environmental degradation - from promoting cleanliness drives of rivers to banning the usage of plastic, the government has time and again shown its commitment towards environmental causes. However, the issue of air pollution has not been redressed impactfully and the resultant damage is a threat to our lungs - an organ that processes life with every breath that we inhale. Hence healthy lungs are a non-negotiable aspect of a healthy body and non-toxic and safe air plays a key role in ensuring strong and healthy lungs.

Policy reforms should be initiated to ensure that environmental concerns are prioritized over financial and commercial gains. If the government is able to look for sustainable options in a well-planned and coordinated manner, the future would be able to take care of economic progress along with mitigating harmful pollution caused by industrialization. Also, civil society should play a proactive role in creating awareness on the negative impact of pollution on human health and also on other causes of COPD. Apart from air pollution smoking tobacco is the major cause of COPD and also results in levelling serious harm to the human body, especially, to the lungs.

Long-term exposure to air pollution has countless adverse effects on human health, patients with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma are especially vulnerable to the negative impact of air pollutants. Air pollution can also aggravate and trigger asthma thereby increasing respiratory disorders because of decreased lung health. Research indicates that women in developing countries are more prone to COPD because of household cooking smoke hence it is important that they keep their lung health good by switching to healthier fuel and prioritizing their health over family needs. It is also important that we break marketing myths related to the use of electronic cigarettes and vaping. People usually fall for such gimmicks and jeopardize their health just to follow the trend and appear stylish and fashionable.

It is quite evident that COPD, air pollution and lung health are inevitably linked to each other and hence a comprehensive approach that involves all relevant stakeholders should be initiated. The government needs to make sure that in policy matters on health and the environment they seek the participation of health professionals, and engage in inter-sectoral policy-making for better outcomes. The government also needs to popularise on the use of cleaner and greener sources of energy instead of using fossil fuels. Also, better waste management techniques in metros as well as for crop waste in rural areas need to be initiated. In order to minimize the risk of air pollution on kids, schools and playgrounds should be located away from busy roads, factories and power plants. Policy interventions in this regard can pave the way for better tackling of the problem of air pollution and a holistic approach can provide better results.

But the onus of this change should not be the responsibility of the government alone a preventive lifestyle is a must to keep away from lung disorders. The role of lifestyle modifications at the individual level can successfully combat air pollution and the resulting disorders including COPD. From limiting the use of fossil fuels by opting for greener vehicles to quitting smoking, small lifestyle modifications can go a long way in ensuring healthier and happier lungs. Indulging in breathing exercises as well as including some sort of physical activity in your daily routine can add vitality and strength not only to your lungs but to your mental-wellbeing also. It has been scientifically proven that people who have anxiety disorders or stress are more prone to trigger asthma and COPD. So emotional well-being is equally important when it comes to managing COPD, along with a healthy diet and non-sedentary lifestyle. Small steps in the right direction can play a major role in encouraging lung health and managing air pollution; car-pooling, using mosquito nets instead of dangerous repellents, keeping indoor plants and most importantly quitting any form of smoking, which is harmful for your family as well as the environment. In keeping with the WHO's vision of "a world in which all people breathe freely," let's strive to leave a safer and healthier planet for our future generations.

(Kamal Narayan Omer is the CEO of Integrated Health And Wellbeing Council.)

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Nose or mouth?

Breathing is automatic. We breathe in oxygen and breathe out carbon dioxide without having to think about it. But many people tell us we should think about it.

Breathwork includes many different practices like shamanic breathwork, Vivation, Transformational Breath, Holotropic Breathwork, Clarity Breathwork, and Rebirthing. There’s also circular breathing, box breathing, and 4-7-8 breathing.

And then there’s Buteyko breathing. Buteyko claimed it would cure 150 diseases! Joseph Albietz evaluated it for SBM in 2009 and not surprisingly found a lack of evidence.

Each method is supported by those who practice it, and each is supported by testimonials rather than credible evidence. There is no consensus as to which method works best, and there are no controlled studies comparing the outcomes from different methods.

All kinds of benefits are claimed for breathwork.

Proper breathing is said to decrease fatigue, reduce anxiety, reduce symptoms of asthma in children and adolescents, improve stress management, reduce blood pressure, reduce aggressive behavior in adolescent males, and improve migraine symptoms.

Dr. Andrew Weil thinks 4-7-8 breathing can help with reducing anxiety, helping a person get to sleep, managing cravings, and controlling or reducing anger responses.

Alleged potential benefits of deep breathing include:

  • Decreases stress, increases calm
  • Relieves pain
  • Stimulates the lymphatic system (detoxifies the body)
  • Improves immunity
  • Increases energy
  • Lowers blood pressure
  • Improves digestion.

I remember reading about a woman who always cut the end off a roast. When asked why she did it, she said it was because her mother had always done that. When finally prompted to inquire why she did it, her mother explained that it was the only way a large roast would fit into her small roasting pan.

The daughter assumed that her mother did it to somehow make the roast come out better. She was blindly following a practice she didn’t understand, just like those cargo cult natives in the South Seas who built imitation runways in the hope that planes would land and enrich them with valuable cargos.

I know a lot of the breathwork stuff is nonsense, but I started to wonder about the admonition to breathe in through the nose, out through the mouth. In almost every exercise video I looked at, the trainer had students breathe like that, and the exhalation was usually through pursed lips. Being a curious skeptic, I couldn’t help asking WHY. Was that practice based on science or superstition? I looked for evidence.

Everything I could find indicated that breathing through the nose (both in and out) was preferable. The nose filters out dust and allergens. It warms and humidifies the inspired air. Mouth breathing lacks these advantages and can dry out the mouth. A dry mouth may contribute to bad breath, gum inflammation, tooth decay, and other problems.

The American Lung Association says pursed lip exhalation is beneficial for patients with chronic obstructive lung disease (COPD) and asthma.

I consulted Paul Ingraham, an Assistant Editor Emeritus of Science-Based Medicine who now runs Pain Science, a science-based website for pain and musculoskeletal medicine. He is currently looking into common claims about breathing and plans to write an article on the subject. He has already looked at the claim that longer expirations are more sedative. He says, “It seems to have a credible rationale, but the evidence shows no effect.” He suspects that the mouth/nose/pursed lip claims are “a thing that a lot of people have learned to say without really having any idea why.” In other words, a sort of folk wisdom that people assume is based on physiology but that probably isn’t.

Effects of breathing mode on exercise

Can nose breathing improve athletic performance compared to mouth breathing? Two small studies found that it lowered the respiratory rate but increased the heart rate, which could increase cardiovascular stress. They concluded:

…breathing technique doesn’t affect athletic performance, and the mode of breathing during exercise should be decided by the individual.

So is the advice wrong?

I couldn’t find any scientific evidence to support the common advice to breathe “in through the nose, out through the mouth.” Unless you have asthma or COPD, the evidence seems to show that nose breathing is always best. Some people may subjectively find it more satisfying to breathe out through the mouth, but I suspect the advice originated with someone who misinterpreted the physiology and was blindly followed by others just as the cargo cults imitated practices they didn’t understand, and like the woman kept needlessly cutting the ends off her roasts.

Conclusion: Don’t think, just breathe

You don’t need to think about your breathing. It is automatic and effortless. The mantra “in through the nose, out through the mouth” is based on superstition, not science.

  • Harriet Hall, MD also known as The SkepDoc, is a retired family physician who writes about pseudoscience and questionable medical practices. She received her BA and MD from the University of Washington, did her internship in the Air Force (the second female ever to do so),  and was the first female graduate of the Air Force family practice residency at Eglin Air Force Base. During a long career as an Air Force physician, she held various positions from flight surgeon to DBMS (Director of Base Medical Services) and did everything from delivering babies to taking the controls of a B-52. She retired with the rank of Colonel.  In 2008 she published her memoirs, Women Aren't Supposed to Fly.

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Chronic Obstructive Pulmonary Disease (COPD) is broad term for a range of progressive lung diseases. Any form of lung damage can result in a multitude of problems including chronic bronchitis and emphysema. The bad news is that lung deterioration is a condition that is non-reversible and also there is no treatment option available. Lifestyle changes and medical intervention can simply help the patient to avoid flare ups and improve their quality of life.

Children especially premature kids, and those with weak immune system and asthma are more prone to develop COPD at a later stage in life. According to WHO, every day almost 93% of the world's children under the age of 15 years (1.8 billion children) breathe air that is so polluted it puts their health and development at serious risk. WHO estimates that in 2016, 600,000 children died from acute lower respiratory infections caused by polluted air. The Delhi government's recent order on the closure of primary schools in Delhi owing to the dangerous level that the AQI has dipped to, has brought the debate back to the environmental concern of cleaner and safer air and finding sustainable solutions to the pollution problem. Instead of opting for short -term knee jerk solutions it is imperative that we ensure long term sustainable solutions to the ever - growing problem of pollution.

The adverse health impact of air pollution is an immediate public health concern in the country and the government should look for addressing the concern in the most effective manner. In India industrial emission is majorly responsible for air pollution, followed by combustion by vehicles and then household emissions and burning of crop waste in rural areas. With Indian metros topping the list of most polluted cities in the world, the problem can no longer be overlooked. The government has already taken noteworthy steps when it comes to environmental degradation - from promoting cleanliness drives of rivers to banning the usage of plastic, the government has time and again shown its commitment towards environmental causes. However, the issue of air pollution has not been redressed impactfully and the resultant damage is a threat to our lungs - an organ that processes life with every breath that we inhale. Hence healthy lungs are a non-negotiable aspect of a healthy body and a non-toxic and safe air plays a key role in ensuring strong and healthy lungs.

Policy reforms should be initiated to ensure that environmental concerns are prioritized over financial and commercial gains. If the government is able to look for sustainable options in a well- planned and co-ordinated manner, the future would be able to take care of economic progress along with mitigating harmful pollution caused by industrialization. Also, the civil society should play a pro- active role in creating awareness on the negative impact of pollution on human health and also on other causes of COPD. Apart from air pollution smoking tobacco is the major cause of COPD and also results in levelling serious harm to human body especially to the lungs. Long term exposure to air pollution has countless adverse effects on human health, patients with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma are especially vulnerable to the negative impact of air pollutants. Air pollution can also aggravate and trigger asthma thereby increasing respiratory disorders because of decreased lung health. Many researches indicate that women in developing countries are more prone to COPD because of household cooking smoke hence it is important that they keep their lung health good by switching to healthier fuel and prioritizing their health over family needs. It is also important that we break marketing myths related to the use of electronic cigarettes and vaping. People usually fall for such gimmicks and jeopardize their health just to follow the trend and appear stylish and fashionable.

It is quite evident that COPD, air pollution and lung health are inevitably linked to each other and hence a comprehensive approach that involves all relevant stakeholders should be initiated. The government needs to make sure that in policy matters on health and environment they seek the participation of health professionals, and engage in inter-sectoral policy making for better outcomes. The government also needs to popularise on the use of cleaner and greener sources of energy instead of using fossil fuels. Also, better waste management techniques in metros as well as for crop waste in rural areas need to be initiated. In order to minimize the risk of air pollution on kids, schools and playgrounds should be located away from busy roads, factories and power plants. Policy interventions in this regard can pave the way for to better tackle the problem of air pollution and a holistic approach can provide better results.

But the onus of this change should not be the responsibility of the government alone a preventive lifestyle is a must to keep away from lung disorders. The role of lifestyle modifications at the individual level can successfully combat air pollution and the resulting disorders including COPD. From limiting the use of fossil fuels by opting for greener vehicles to quitting smoking, small lifestyle modifications can go a long way in ensuring healthier and happier lungs. Indulging in breathing exercises as well as including some sort of physical activity in your daily routine can add vitality and strength not only to your lungs but to your mental-wellbeing also. It has been scientifically proven that people who have anxiety disorders or stress are more prone to trigger asthma and COPD. So emotional wellbeing is equally important when it comes to managing COPD, along with a healthy diet and non-sedentary lifestyle. Small steps in the right direction can play a major role in encouraging lung health and managing air pollution; car-pooling, using mosquito nets instead of dangerous repellents, keeping indoor plants and most importantly quitting any form of smoking, which is harmful for your family as well as the environment. In keeping with the WHO's vision of "a world in which all people breathe freely," lets strive leaving a safer and healthier planet for our future generations.

(Kamal Narayan Omer is the CEO of IHW Council)

Disclaimer: This story is auto-aggregated by a computer program and has not been created or edited by FreshersLIVE.Publisher : IANS-Media

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Cindy McEvoy, M.D., professor of pediatrics in the OHSU School of Medicine, bottom, second from right, is the lead author of a study on the effect of vitamin C supplementation for pregnant smokers on their children. McEvoy and her team: Kelvin MacDonald, M.D., specializes in caring for children with breathing disorders; Mitzi Go, M.D., M.C.R., FAAP, associated professor of pediatrics; Diane Schilling, respiratory care; Matt Olson, researcher; Kristin Milner, research project manager; Julie Brownsberger, clinical research associate; Julia Harris, research assistant; Brittany Vuylsteke, senior clinical research assistant; Katy Rabe, clinical research assistant; Alec Martin, clinical research assistant; Anna Petrey, clinical research assistant; and Julianna Mazziotti, clinical research assistant.  (OHSU/Christine Torres Hicks)

Cindy McEvoy, M.D., professor of pediatrics in the OHSU School of Medicine, bottom, second from right, is the lead author of a study on the effect of vitamin C supplementation for pregnant smokers on their children. McEvoy and her team: Kelvin MacDonald, M.D., specializes in caring for children with breathing disorders; Mitzi Go, M.D., M.C.R., FAAP, associated professor of pediatrics; Diane Schilling, respiratory care; Matt Olson, researcher; Kristin Milner, research project manager; Julie Brownsberger, clinical research associate; Julia Harris, research assistant; Brittany Vuylsteke, senior clinical research assistant; Katy Rabe, clinical research assistant; Alec Martin, clinical research assistant; Anna Petrey, clinical research assistant; and Julianna Mazziotti, clinical research assistant. (OHSU/Christine Torres Hicks)

Researchers at Oregon Health & Science University found that vitamin C supplementation to pregnant women unable to quit smoking significantly improves airway function and respiratory health in their offspring at 5 years of age.

While previous studies have shown that vitamin C improves airway function in infants, this is the first study to demonstrate whether the improvement in airway function can be maintained through preschool age.

The study published this week in JAMA Pediatrics.

Despite anti-smoking efforts and a steady decrease of smoking among the adult population over the past decade, the addictive properties of tobacco products can make quitting smoking incredibly challenging for many individuals. Roughly 10% of American women continue to smoke in pregnancy, each year resulting in about 400,000 infants being exposed to smoke in-utero, or in the uterus.

Cindy McEvoy, M.D., outside Mackenzie Hall.

Cindy McEvoy, M.D. (OHSU)

“We know by now just how addictive tobacco products can be. For many individuals, it can take many attempts over a long period of time to quit smoking, if they are successful,” said Cindy McEvoy, M.D., professor of pediatrics in the OHSU School of Medicine and the study’s lead researcher. “It’s important that we have a way to protect the baby’s developing lungs, even if their parent is struggling to quit smoking. These findings have identified an accessible, effective way to ensure optimal respiratory health outcomes both in-utero and throughout a child’s young life.”

In-utero smoke exposure from maternal smoking during pregnancy can be dangerous for a developing baby and is linked to poor health outcomes, including impaired fetal lung development, decreased airway function and an increased risk for wheezing and asthma. Additionally, decreased airway growth early in life causes increased risk for serious lifelong conditions, such as chronic obstructive pulmonary disease, which is now the third leading cause of death worldwide.

For this study, researchers recruited pregnant women from three sites: OHSU, PeaceHealth Southwest Washington Medical Center and Indiana University. Participating women were enrolled in a double-blind, randomized controlled trial to receive either vitamin C (500 mg/day) or a placebo.

Statistical analyses showed that the effect of vitamin C supplementation to pregnant smokers prior to 23 weeks of gestation consistently resulted in significantly better airway function in their offspring at 5 years old.

While the findings may improve the health of the many children who face in-utero smoke exposure, these findings may have even broader implications: The results may potentially lead to better understanding of, and treatments for, the health impacts of other smoke exposures, including indoor and outdoor air pollution, vaping and wildfires.

McEvoy also notes further investigation is needed to understand the mechanisms for improvement, as well as to determine whether improved respiratory outcomes will persist throughout a child’s lifetime. Researchers are also interested in learning more about the optimum time of vitamin C treatment and steps needed to make this therapy part of standard medical treatment.

This work was supported by the following grants: NHLBI (R01 HL105447 and 406 R01 HL 105460) with co-funding from the Office of Dietary Supplements (ODS) and by 407 P51 OD011092565 and NIH UH3 OD023288. Additional support from the Oregon 408 Clinical Translational Research Institute funded by the National Center for Advancing 409 Translational Sciences (UL1TR000128).

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Imagine running a marathon while breathing through a small coffee stirrer straw. This is how many people living with advanced chronic obstructive pulmonary disease (COPD) describe how it feels to walk across a room.

Unfortunately, struggling to breathe, frequent coughing and wheezing, and difficulty doing once simple household tasks are problems people with COPD know all too well. And, according to the Centers for Disease Control and Prevention (CDC), 16 million Americans, who have been diagnosed, feel this way. However, this number should be much larger as there are millions of others with COPD who have not been diagnosed and are not being treated.

November is National COPD Awareness Month, and with one death due to COPD every four minutes, spreading awareness is crucial. To do this, Jeannie Deal, Director of Respiratory Care for Iredell Health System, shares more about the disease and the importance of early detection.

Though Deal frequently encounters COPD working in respiratory care, the disease has more of a personal, special importance to her than just of that through her profession.

“My grandmother had COPD when I was younger. Later in life, both my parents were diagnosed with COPD. My mother recently passed away from complications of end-stage COPD, and my father does daily home treatments for the maintenance of his COPD,” said Deal.

“There is no cure for COPD, only treatments and maintenance. Awareness of COPD helps the community understand the risks, signs, and symptoms. It may help people seek treatment sooner and live a healthier, more productive life,” she added.

Although COPD is irreversible, early detection and treatment can help alleviate symptoms and improve quality of life. So, what exactly is COPD, and how does a person get it?

What is COPD?
“COPD is an umbrella term used to describe many lung diseases, including emphysema, chronic bronchitis, and refractory (severe) asthma. COPD causes less air to flow in and out of the airways inside the lungs, which makes it difficult to breathe,” said Deal.

Many people with COPD have both emphysema and chronic bronchitis.

COPD is a progressive disease, meaning it gets worse over time. The disease can interfere with your ability to work, do chores, and sleep. It can also affect your heart, decreasing its ability to pump blood effectively. It is a major cause of disability and a leading cause of death in the United States.

“You can actually have COPD and not know it. It can develop slowly, and most are not aware they have it until they are in their late 40s or older,” said Deal.

Who is at risk?
The majority of COPD cases are caused by smoking. Even secondhand smoke can cause COPD or make it worse. In fact, according to the CDC, smoking accounts for 8 out of 10 COPD-related deaths.

Other risk factors include exposure to air pollution and working with chemicals, dust, and fumes.

“Those who work in jobs where they are exposed to chemicals, paint fumes, and dust, like furniture and hosiery workers, or those who work outside with chemicals and dust, should always wear a high-quality mask or designated respirator,” said Deal.

What are the symptoms?
According to Deal, common symptoms of COPD include:

  • Shortness of breath
  • Wheezing
  • Chronic cough (that frequently produces mucus)
  • Lack of energy
  • Chest tightness
  • Frequent respiratory infections

Initial signs and symptoms of COPD may be subtle. You may disregard your cough as a typical smoker’s cough or think your shortness of breath and lack of energy is due to being out of shape and growing older.

However, it’s important to report any symptoms of COPD to your provider, as early detection is vital to slow progression and begin treatment. You can ask your provider for a pulmonary function test to measure how well your lungs are working and check periodically for COPD. The respiratory department at Iredell Memorial Hospital can perform this test.

People with COPD may also experience occasional flare-ups where symptoms are more intense. These flare-ups are normally caused by respiratory infections or colds and could land you in the hospital.

What are the treatment options?
Though there is no cure for COPD, there are treatment options available to alleviate symptoms. Firstly, if you smoke, quit. Quitting smoking will help slow the disease progression. You may also consider changing jobs if you work in an area that exposes you to fumes or chemicals that irritate your lungs.

“Avoiding the amount of time an individual is exposed is always the best way to help prevent or manage COPD,” said Deal.

According to Deal, other treatment options for COPD may be prescribed by your provider. These treatments include:

  • Bronchodilators, such as albuterol, that you can take as an inhaler or nebulizer
  • Oral steroids
  • Inhaled steroids
  • Supplemental oxygen

You may also consider asking your provider about a referral to Iredell Health System’s cardiopulmonary rehabilitation program. Pulmonary rehab includes exercise and education that will help you take charge of your COPD so you can function better in daily life.

COPD can be very serious, even deadly, and early detection is key. If you are having symptoms of COPD, make sure to schedule an appointment with your primary care provider to discuss your concerns and get treatment early.

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A new guidebook for asthma prevention and treatment was launched by health.people.cn and health experts who are aiming to improve the prevention and treatment of the disease by promoting long term standardized disease management.

Asthma is a chronic inflammatory disease and only second to cancer in causing death or disability in the world.

The disease targets different age groups. About 45.7 million of the nation"s population aged above 20 are asthma patients and the morbidity rate of children in China increased by 53 percent between 2000 to 2010.

In the urban region of the country, however, the disease control rate for adults is only 28.7 percent, while less than 40 percent for children.

The guidebook is a piece of popular science readings about the disease to help patients understand the prevention and treatment system as a long term process.

Guo Yanfei, physician of the respiratory and critical disease medicine department of Beijing Hospital, said asthma patients need long term treatment and disease control under the supervision of a physician despite the possibility that symptoms may ease from time to time.

There are two types of asthma drugs: easing drugs and controlling ones. According to Li Wen, physician of the respiratory disease department of the the Second Affiliated Hospital Zhejiang University School of Medicine, effective treatment may control the disease clinically despite the fact that it can not be cured.

Retail pharmacies joined the campaign by pledging more efforts in popularizing the disease control at the community level.

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    The American Lung Association reports that chronic obstructive pulmonary disease (COPD) is the sixth leading direct cause of death overall and the fifth leading disease-related cause of death in the United States.

    In 2015, chronic lower respiratory diseases, including COPD, were the third most common cause of death, according to the Centers for Disease Control and Prevention (CDC). Despite the overall decrease, in late 2021, Mayo Clinic reported that an estimated 16 million Americans have a form of COPD. This disease has been linked to a number of life-threatening medical conditions.

    What COPD is

    COPD refers to several abnormal breathing conditions. These problems in the lungs cause problems for the heart and other organs throughout the body. Among the lung diseases that comprise the major types of COPD are progressive and chronic bronchitis, emphysema and non-reversible asthma, called refractory asthma.

    Sufferers of chronic bronchitis are subject to long-term, mucus-producing coughing. Emphysema is a long-term destruction of the lungs in which the lung tissue is gradually damaged over an extended period.

    AHA reports that people who develop late-onset asthma, or asthma that appears in adulthood, are 57% more likely to have cardiovascular issues than those without asthma. Asthma in adults can result in declining lung function that impedes proper breathing.

    Complications caused by COPD

    Among the causes of death to which COPD contributes are lung cancer, heart disease and coronary artery disease. Vascular Health Clinics lists COPD among the leading causes of chronic lung infections. Chronic lung infections exacerbated by COPD include pneumonia and bronchiectasis-related pneumonia, which is the inability to clear secretions. Bronchiectasis occurs by the widening of the airways in the lungs, creating difficulty for mucus to properly be expelled. The mucus becomes a breeding ground for bacteria, resulting in lung damage and inflammation.

    Other complications may include the necessity for oxygen devices, such as tanks; difficulty walking or using stairs; depression and other mental issues. Social activities may also become difficult, and visits to physicians and hospital emergency departments can become more frequent.

    Impact on various groups

    Statistics from 2020 show that the COPD death rate decreased among men by 32% in the preceding 20 years. The COPD death rate among women remained about the same during that period. However, since 2020, the COPD death rate for women has risen in the United States. The CDC says one reason the rate is rising for females is that women are usually diagnosed later in life when the disease is more advanced. Women may also be more susceptible to certain causes of COPD, such as tobacco smoke and indoor air pollution.

    While COPD deaths among those over age 65 have decreased in the past 20 years, that age group still accounts for 86% of COPD deaths.

    Beyond age, COPD risk is 70% higher among smokers and 50% higher among former smokers than among the overall population. The CDC states that in 2020, research showed that 14.1% of adult men and 11% of adult women are current smokers. Overall, 12.5% of all U.S. adults (those over age 18), or over 30 million Americans, are smokers. Smoking-related diseases, including COPD, affect more than 16 million U.S. citizens, and cigarette smoking is considered the leading preventable cause of death.

    In addition to cigarette smoking, genetics may play a role in a person’s risk for COPD. Exposure to dust and chemicals in work settings, as well as burning fumes and fuel, can also increase risk. While asthma and cigarette smoking are both risk factors, the combination of the two further intensifies COPD risk.

    Treatment, management and prevention

    After COPD is diagnosed, its severity may influence treatment options. For very mild cases, smoking cessation may be all that is necessary. For advanced cases, therapy options are numerous. They can include medications that may be prescribed as ongoing or as needed, and devices, including inhalers. Inhalers may dispense medications such as Albuterol, ipratropium or levalbuterol, all considered short-acting bronchodilators. Long-acting bronchodilators may be prescribed, as well as inhaled steroids, such as fluticasone. Other medications may include oral steroids and antibiotics.

    For severe cases of COPD, lung therapies including oxygen therapies and pulmonary rehabilitation may be required. Severe emphysema may require surgery.

    Measures that can be taken to reduce COPD risk include never starting smoking and eliminating smoking if one is a smoker. Avoiding second-hand smoke and maintaining regular flu vaccines also help.

    To learn more about a variety of health conditions, management and treatment, log on to vascularhealthclinics.org.

    Do you have questions about your heart health? Ask Dr. Haqqani.

    If you have questions about your cardiovascular health, including heart, blood pressure, stroke lifestyle and other issues, we want to answer them. Please submit your questions to Dr. Haqqani by email at [email protected] .

    Omar P. Haqqani is the Chief of Vascular and Endovascular Surgery at Vascular Health Clinics in Midland.

     

     

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    New Delhi: Setting one's needs first and making time for relaxation, meditation, or exercise are just a few of the straightforward self-care practices that can significantly improve a woman professional's quality of life. They communicate to the rest of the family that this is their "me" time and that they should not be disturbed by others by establishing personal boundaries. Only by beginning with such modest acts of self-care as yoga can women reclaim some of their own time for vital self-care.

    Some women have hormonal imbalances, which increase their risk for physical, psychological, and emotional issues. By forming a habit that enhances body strength, hormone balance, and self-acceptance, yoga helps women manage their life. 30-45 minutes of yoga, when combined with a breathing exercise like pranayama, can lower stress, increase the quality of sleep, and regulate vital bodily processes like heart rate, respiration, and blood pressure, among others. Simply carve out sometime in the morning or evening from their hectic schedules.

    Navasana (Boat pose)

    How to do:

    Begin by lying down on the floor on your back. Keep your hands at your side and your legs together. Now, slowly lift your legs without bending them. Also, lift your upper body off the floor and stretch your arms towards your legs. Hold this position for about three minutes and then return to the original position.

    Contraindications:

    Do not practice this yoga pose if you have low blood pressure, severe headache, or migraine, or if have suffered from some chronic diseases or spinal disorders in the recent past. Asthma and heart patients are also advised to avoid this pose.

    Vasisthasana (Side Plank)

    How to do:

    Start in a plank position, shift body weight into the right hand, wrist under shoulder, drop heels to the right side onto the mat, rotate the body to face left side, and lift left arm into the air at shoulder height and twist. Raise hips as high to the ceiling as possible.

    Contraindications:

    People with an injury to the wrists, elbows, shoulders, neck, hips, back, knees, or ankles should avoid the practice of the Side Plank Pose. Any injury to the muscles of the legs, back, and arms are contraindications, and people should avoid the same.

    Urdhva Mukha Svanasana (Upward-Facing Dog)

    How to do:

    Start by lying on a mat with legs extended straight behind the body, front of legs resting on the floor, and upper body propped up in the air by pressing palms down into the mat. Extend arms to straight and lift thighs and shins off of the floor.

    Contraindications:

    It is always safe to take practice this pose with ease if one is suffering from a slipped disc or better still with the guidance of an experienced teacher. The deep stretch at the upper back including the neck and head, may not suit people having spondylitis. It is safer to go slow or take guidance from an expert.

    Bhramari Pranayama

    How to do:

    Do preliminary conditioning in Sukhasana or any other meditative posture. Sit on a firm chair with an erect backrest, if unable to sit on the floor. Keep the body above the waist straight and the spine erect. Inhale fully and then exhale slowly, smoothly and continuously in a controlled manner from the nostrils with a little force, making a humming sound like the black bee. Keep your mouth closed throughout the practice. The sound need not be very loud but should create vibrations. Practice 5 rounds/session, with pause in-between rounds.

    Contraindications:

    Bhramari should not be practised by pregnant or menstruating women. It is also contraindicated for individuals with extremely high blood pressure, epilepsy, chest pain, or an active ear infection.

    Anulom-Vilom Pranayama

    How to do:

    Close your eyes and sit in Padmasana. Use the right thumb to close the right nostril. Inhale slowly through the left nostril, taking in as much air as you can to fill your lungs. Remove the thumb from your right nostril and exhale. While exhaling, use the middle finger to close your left nostril and inhale with your right nostril. Remove the thumb from the right nostril and exhale. Perform for 2-5 minutes.

    Contraindications:

    It should not be practised by those people who are under medication for blood pressure. The same can be done without holding the breath within, and immediately exhaling out.

    Ujjayi Pranayama

    How to do:

    Begin by inhaling and exhaling naturally. Bend down your head, blocking the free flow of air, and inhale as long as you can, making a sound from your throat. Hold for 2-5 seconds. Close your right nostril with your right thumb while exhaling, and breathe out through the left nostril. Repeat 10-12 times in as much time as you need.

    Contraindications:

    Do not practice this pranayama if you are constantly feeling tired, anxious and panicking because exertion can be harmful to the lungs and the heart. Always practice under a Professional Yoga Teacher. Beginners should not practice this breathing for more than five minutes a day.

    Kapalbhati Pranayama

    How to do:

    This breathing technique involves passive inhalation and active exhalation. So inhale normally, breathe in as much air as possible, and exhale forcefully. Try to pull your stomach muscles as closely as you can towards the backbone during exhalation. Perform for 2-5 minutes.

    Contraindications:

    Individuals with high or low blood pressure, heart disease, hernia, gastric ulcer, epilepsy, vertigo, migraine headaches, significant nosebleeds, detached retina, glaucoma and history of stroke should avoid this yoga pose. For anyone who has undergone recent abdominal surgery, it is recommended to practice this pose under the guidance of an expert.

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    New Delhi, November 19 (IANSlife) Setting one's needs first and making time for relaxation, meditation, or exercise are just a few of the straightforward self-care practises that can significantly improve a woman professional's quality of life. They communicate to the rest of the family that this is their "me" time and that they should not be disturbed by others by establishing personal boundaries. Only by beginning with such modest acts of self-care as yoga can women reclaim some of their own time for vital self-care.

    Some women have hormonal imbalances, which increase their risk for physical, psychological, and emotional issues. By forming a habit that enhances body strength, hormone balance, and self-acceptance, yoga helps women manage their life. 30-45 minutes of yoga, when combined with a breathing exercise like pranayama, can lower stress, increase the quality of sleep, and regulate vital bodily processes like the heart rate, respiration, and blood pressure, among others. Simply carve out sometime in the morning or evening from their hectic schedules.

    Navasana (Boat pose)

    How to do:

    Begin by lying down on the floor on your back. Keep your hands at your side and your legs together. Now, slowly lift your legs without bending them. Also, lift your upper body off the floor and stretch your arms towards your legs. Hold this position for about three minutes and then return to the original position.

    Contraindications:

    Do not practice this yoga pose if you have low blood pressure, severe headache, or migraine, or if have suffered from some chronic diseases or spinal disorders in the recent past. Asthma and heart patients are also advised to avoid this pose.

    Vasisthasana (Side Plank)

    How to do:

    Start in a plank position, shift body weight into the right hand, wrist under shoulder, drop heels to the right side onto the mat, rotate the body to face left side, and lift left arm into the air at shoulder height and twist. Raise hips as high to the ceiling as possible.

    Contraindications:

    People with an injury to the wrists, elbows, shoulders, neck, hips, back, knees, or ankles should avoid the practice of the Side Plank Pose. Any injury to the muscles of the legs, back, and arms are contraindications, and people should avoid the same.

    Urdhva Mukha Svanasana (Upward-Facing Dog)

    How to do:

    Start by lying on a mat with legs extended straight behind the body, front of legs resting on the floor, and upper body propped up in the air by pressing palms down into the mat. Extend arms to straight and lift thighs and shins off of the floor.

    Contraindications:

    It is always safe to take practice this pose with ease if one is suffering from a slipped disc or better still with the guidance of an experienced teacher. The deep stretch at the upper back including the neck and head, may not suit people having spondylitis. It is safer to go slow or take guidance from an expert.

    Bhramari Pranayama

    How to do:

    Do preliminary conditioning in Sukhasana or any other meditative posture. Sit on a firm chair with an erect backrest, if unable to sit on the floor. Keep the body above the waist straight and the spine erect. Inhale fully and then exhale slowly, smoothly and continuously in a controlled manner from the nostrils with a little force, making a humming sound like the black bee. Keep your mouth closed throughout the practice. The sound need not be very loud but should create vibrations. Practice 5 rounds/session, with pause in-between rounds.

    Contraindications:

    Bhramari should not be practised by pregnant or menstruating women. It is also contraindicated for individuals with extremely high blood pressure, epilepsy, chest pain, or an active ear infection.

    Anulom-Vilom Pranayama

    How to do:

    Close your eyes and sit in Padmasana. Use the right thumb to close the right nostril. Inhale slowly through the left nostril, taking in as much air as you can to fill your lungs. Remove the thumb from your right nostril and exhale. While exhaling, use the middle finger to close your left nostril and inhale with your right nostril. Remove the thumb from the right nostril and exhale. Perform for 2-5 minutes.

    Contraindications:

    It should not be practised by those people who are under medication for blood pressure. The same can be done without holding the breath within, and immediately exhaling out.

    Ujjayi Pranayama

    How to do:

    Begin by inhaling and exhaling naturally. Bend down your head, blocking the free flow of air, and inhale as long as you can, making a sound from your throat. Hold for 2-5 seconds. Close your right nostril with your right thumb while exhaling, and breathe out through the left nostril. Repeat 10-12 times in as much time as you need.

    Contraindications:

    Do not practice this pranayama if you are constantly feeling tired, anxious and panicking because exertion can be harmful to the lungs and the heart. Always practice under a Professional Yoga Teacher. Beginners should not practice this breathing for more than five minutes a day.

    Kapalbhati Pranayama

    How to do:

    This breathing technique involves passive inhalation and active exhalation. So inhale normally, breathe in as much air as possible, and exhale forcefully. Try to pull your stomach muscles as closely as you can towards the backbone during exhalation. Perform for 2-5 minutes.

    Contraindications:

    Individuals with high or low blood pressure, heart disease, hernia, gastric ulcer, epilepsy, vertigo, migraine headaches, significant nosebleeds, detached retina, glaucoma, history of stroke should avoid this yoga pose. For anyone who has undergone recent abdominal surgery, it is recommended to practice this pose under the guidance of an expert.

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    AirPhysio is an effective lung expansion and mucus clearance OPEP device that utilizes OPEP (Oscillating Positive Expiratory Pressure), an all-natural process. This device assists a person’s natural cleaning procedure. Additionally, it assists in maintaining optimal hygiene in people’s lungs and restores their lung capability. AirPhysio is hugely helpful in treating many respiratory conditions, such as COPD, bronchiectasis, cystic fibrosis, etc. When people suffer from these conditions, they obstruct the capability of their bodies to clear the dirtied mucus. Additionally, their lung capacity gets lessened by 5 to 25 milliliters per year for asthmatics, and it becomes 33 milliliters per year for those who smoke. It gives rise to breathlessness after people take a light jog or climb stairs.

    The capacity of the lungs and AirPhysio

    Besides doing regular exercises, people can increase their lung capacity when they utilize a drug-free and all-natural process known as OPEP. AirPhysio device works as an efficient airway physiotherapy device that utilizes the process of OPEP for opening semi-closed and closed airways. It puts positive expiratory pressure to improve airway clearance via airway vibrations. A person can feel this device immediately as people blow into this device.

    The versions of AirPhysio

    AirPhysio is found in three distinct versions for accommodating various lung conditions and capacities, and they are:

    • AirPhysio Children – AirPhysio children are ideal for children as well as people who have a lower lung capacity variation. It is also perfect for people who require airway physiotherapy to clear mucus. Hence, it helps in improving people’s lung capability and clears every kind of obstruction.
    • AirPhysio Sports – AirPhysio sports is ideal for individuals who have healthy lungs and require opening up their airways besides providing their airways a superb clean out before an event or a workout.
    • AirPhysio CleanMyLungs – This is perfect for individuals who have got average lung capability and require airway physiotherapy for clearing mucus. It also improves the lung capacity of people before their situation worsens.

    People use AirPhysio to increase their lung capability, lessen breathlessness at the time when they exercise, fasten up their recovery times, and enhance exercise tolerance after training or they have worked out. AirPhysio also helps people in clearing the airways for people who suffer from various issues, such as asthma, cystic fibrosis, COPDs (Chronic Obstructive Pulmonary Diseases), atelectasis, bronchiectasis, and various conditions that create retained secretions.

    The specifications of AirPhysio

    People find AirPhysio to be a groundbreaking breathing device that forms smooth pulses of positive pressure in their airways and lungs. AirPhysio is also regarded as a patented device that has a straightforward design that utilizes simple physics to create positive pressure in people’s airways and lungs. As AirPhysio is patented, it has been verified for having an exclusive design in comparison to different other OPEP systems that are available today.

    Some core elements of AirPhysio are:

    • Steel ball.
    • Protective cover.
    • Circular cone.

    The on-the-go design of AirPhysio turns it easier for people to carry it wherever they go. The remarkable thing is this device doesn’t comprise any chemical substances or medicine. Hence, even people who tend to be sensitive to some chemicals can use AirPhysio to keep botheration at bay. Again, people are not required to recharge or refill it, similar to other devices they use regularly. When people use AirPhysio, they can see the results within a couple of or three minutes. According to the manufacturers of this device, it is of high quality and safety. Several medical studies had affirmed the results of this device before it was made available to people in general. Every person can use AirPhysio easily, even when he does not have any earlier knowledge or skills.

    How can a person use AirPhysio?

    When you decide to use AirPhysio, you need to follow some simple steps:

    • 1st step – The very first thing you must do is uncap your AirPhysio because it has a shape similar to a common inhaler, and it weighs less than a regular inhaler.
    • 2nd step – You must take a deep breath and hold this device for only 2-3 seconds.
    • 3rd step – Blow the AirPhysio device for nearly 3-5 seconds until your lungs become empty of air.

    So, when you complete the above-mentioned procedure, you will be able to use AirPhysio effectively.

    Benefits of using AirPhysio

    There are several benefits of using AirPhysio, and they outweigh the advantages of traditional and customary treatments that are used to treat breathing issues. AirPhysio is considered the highest quality and most effective product that people can use to escape from snoring and breathing troubles. Some notable benefits of using AirPhysio are:

    • AirPhysio helps in clearing people’s lungs and airways using a very simple method.
    • This device does not contain chemical substances or medicines.
    • AirPhysio doesn’t cause people any hypersensitivity reactions.
    • People can get quick results in just 2-3 minutes.
    • AirPhysio is ideal for every person.
    • Prevents and lessens the chances of suffering from pulmonary diseases. So, AirPhysio lessens some life-threatening conditions.
    • AirPhysio can be used easily.
    • AirPhysio has been prepared in an FDA-sanctioned facility.
    • When people begin to use AirPhysio, they are not required to pay frequent visits to physicians.
    • Using this device, people can save themselves from expensive medicines to lessen their breathing troubles.
    • AirPhysio is found with a risk-free and 30-day money-back assurance.

    The most remarkable advantage of AirPhysio is that people do not report complaints against it. Hence, everyone can use it without hesitating. Even pulmonologists suggest the use of AirPhysio for all kinds of disease conditions having breathing difficulties.

    Conclusion

    AirPhysio is devoid of toxic or chemical substances. Again, it doesn’t contain any medicine either. Hence, this device is regarded as harmless for every person. Every person can use it anywhere without confronting any issues or support. If a person does not become happy using it, he can ask for 100 percent cashback along with a money-back guarantee. All these things prove that AirPhysio is nothing but a legitimate product that users can rely on. If you visit the official website of AirPhysio, you will find more than 250,000 people describing it as life-changing.

    So Don’t wait, Click here to Purchase AirPhysio today!

    m



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    Cases of RSV (respiratory syncytial virus) and other respiratory illnesses have been surging throughout the United States. While recent headlines have been focusing on how children infected with RSV have been filling hospitals to capacity, older adults are also being hospitalized at a rate that is unusually high compared with previous years.

    Latest data (as of the week ending November 5) from the Centers for Disease Control and Prevention (CDC) shows that seniors ages 65 and up with RSV are filling hospital beds at a weekly rate of 1.6 per 100,000. Since the 2014–2015 season, CDC figures show that this hospitalization rate had not risen above 1 per 100,000. In 2018 at this same time of year, seniors with RSV were being admitted to the hospital at a low 0.2 per 100,000 — 8 times lower than the current rate.

    Still, young children is the population most affected by RSV. Among infants ages 0 to 6 months, 145.2 per 100,000 are being hospitalized weekly, according to latest federal government numbers. For those ages 6 to 12 months with the virus, the rate is 63 per 100,000.

    The Yolo County Health Department in California is warning all residents that RSV can be serious, especially in infants and older adults, causing pneumonia (lung infection) and bronchiolitis (inflammation of the small airways in the lung).

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    Respiratory syncytial virus (RSV) has hit the US harder and earlier than usual this year, and while children have primarily been affected, older Americans are also seeing a rise in hospitalizations from the illness.


    As of the week ending Nov. 12, data from the Centers for Disease Control and Prevention (CDC) shows adults ages 65 and older are being hospitalized at a weekly rate of 2.4 per 100,000. During the same period in 2021, the weekly hospitalization rate for seniors was 1.5 per 100,000—and in pre-pandemic times, it was even lower than that.


    “COVID has not respected any of the traditional respiratory virus seasons and as a result, it has really turned RSV upside down,” John Sellick, DO, professor of medicine in the division of infectious diseases in the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo, told Health. “With that much RSV in the kiddie population, we’re seeing the spillover into the older population.” 


    So why are older adults also seeing RSV infections—and ultimately, hospitalizations—in higher numbers too? Here's what experts have to say about why that population may be more likely to experience severe illness, and how to manage and prevent the illness—without a vaccine or targeted treatments.





    During typical years, RSV still disproportionately affects children and, to some extent, older adults; but the virus usually peaks between late December and early February. The COVID pandemic, however, has altered the virus' normal patterns.


    “All bets are off this year,” Jonathan D. Grein, MD, infectious disease specialist and director of Hospital Epidemiology at Cedars-Sinai, told Health. “This is a unique experience we’re going through after two years of relatively low flu and RSV activity. Going into this season, with a lot of the precautions for COVID being taken away, it’s really going to be hard to predict how the season will pan out.”


    This has led to high RSV cases for all age groups, seniors included—RSV hospitalizations in general have more than tripled as compared to this point in 2021. 


    As for why cases are so high right now, experts said the answer likely lies in part with the fact that masking, social distancing, and hand washing measures have been largely deemphasized this fall, Dr. Grein said. People likely also have less “intrinsic immunity” to RSV now because they weren’t exposed to RSV during the worst months of the pandemic, he added. 


    For people over 65 specifically, they’re likely catching RSV from the younger people that have it. 


    “I think it has something to do with the kids also going back to school, because, as you know, RSV is traditionally considered a pediatric disease,” Daphne-Dominique Villanueva, MD, transplant infectious disease physician and assistant professor at West Virginia University Medicine, told Health. “But [they] can spread it to older adults, especially when they visit grandparents.” 


    And with cases as high as they are now, Dr. Sellick is concerned that the coming weeks could bring even more opportunities for sick children and adults to spread RSV. 


    “We tend to see a lot of RSV after the holidays and we've always presumed that this means that you've got multi-generational family events between Thanksgiving and the New Year,” said Dr. Sellick. “You’ve got little kids with RSV who are more than happy to share it with mom and dad and grandma and grandpa.”


    But there is somewhat of a silver lining: The high numbers of hospitalizations are more a reflection of how people are behaving, more so than the virus itself becoming more transmissible or deadly, according to experts.


    Though RNA viruses like RSV do mutate in minor ways fairly frequently, Drs. Sellick and Grein agreed that there’s no evidence to suggest that this year’s high number of hospitalizations and cases are linked to any new kind of RSV variant. 





    For the majority of people, RSV presents as a mild cold, with coughing, sneezing, a runny nose, and fever. But in some cases, particularly for older people, young infants, or the immunocompromised, the virus can become dangerous. 


    “It will usually start as flu-like symptoms,” said Dr. Villanueva. “However, their symptoms can progress to more severe pneumonia such as shortness of breath, wheezing, those other symptoms. So those are signs that they need to go to the hospital.”


    These more severe RSV symptoms can strike seniors especially hard because many may have underlying health conditions that make it more difficult for their bodies to recover from the virus.


    “As you age, your immune system weakens a bit. Also as we age, we tend to collect more medical comorbidities,” said Dr. Grein. “So with RSV we know, for example, people with underlying heart disease or chronic lung disease are certainly at high risk of poor outcomes.”


    RSV can make conditions like asthma, COPD, or congestive heart failure worse, and in some cases, can cause death. The CDC estimates that each year, between 60,000 and 120,000 older adults are hospitalized with RSV, and between 6,000 and 10,000 will die from it. 


    Treatment for RSV is yet another hurdle for those over 65. RSV care in general is supportive, Dr. Villanueva explained, and people of all ages will receive hydration, rest, and breathing assistance if they're hospitalized for RSV.


    Young infants who are at risk of developing severe RSV can be given a monoclonal antibody treatment called Synagis (palivizumab) to prevent serious symptoms, but no such medication exists for older children or adults. 





    Though researchers are making progress on a vaccine for RSV—and it could be available “within the next two years,” Dr. Sellick said—we’re not there yet. And in the face of high case numbers, prevention is the only tool available to stop RSV from increasing to even more dangerous levels. 


    “The good news is the pandemic has taught us all the tools we need to keep ourselves safe,” said Dr. Grien. “All of those measures like wearing masks, staying away from others who are ill—those things work very well for pretty much all respiratory viruses, including RSV.”


    This doesn’t necessarily mean the US needs to go back to full-scale preventative measures like we saw in 2020 and 2021. Instead, Dr. Villanueva said, it’s best to “evaluate your own risk,” and decide if masking up or other preventative tools are a good idea to implement. 


    It’s impossible to predict if this current RSV surge is an early peak, or if it’s a precursor to even more hospitalizations to come in the following weeks or months, experts said. But prevention is one sure way to keep seniors safe from RSV. 


    “Our main strategy is really to prevent people from getting it in the first place,” Dr. Villanueva said. “We know that it works, right—masking and hand hygiene works because RSV is basically transmitted the same way as COVID is.”

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    Breath is essential to life, and our lungs make it happen. These two spongy organs rest deep in either side of our chest. Every time we inhale, our lungs harvest oxygen from the air we breathe and deposit it into our blood, which carries it into each cell in our body. Meanwhile, our cells constantly release carbon dioxide, which is also carried by our blood, and exhaled out through our lungs.

    This incredibly complex yet undeniably critical mechanism is virtually effortless. The incessant inhalation and exhalation of our breath carries on night and day, whether we think about it or not.

    The exchange of gasses our lungs perform is so vital to our wellbeing, that breathing is an automatic, built-in function of our bodies. And yet, it’s also vulnerable to breakdown by the lifestyle we lead.

    Some habits clearly compromise our breathing, such as cigarette smoking. But much less is said about how our breathing suffers when we don’t move enough.

    The less you move, the weaker and more compromised your lungs may become. Decades of research shows that sedentary behavior is linked to a rising risk of respiratory disease.

    Fat and Breath

    First, consider the fat factor. Sedentary behavior contributes to obesity, which in turn contributes to breathing problems. This direction of research began with longitudinal studies showing that, both in adults and children, there is a correlation between obesity and asthma, particularly in women.

    Later, epidemiological studies confirmed this pattern, showing that a propensity for obesity predicted a tendency toward asthma.

    Obesity can impair breathing in two ways. One is that excess fat, particularly in the chest and abdomen, weighs heavily on the lungs as well as the  muscle that drives the bellows of your breath: the diaphragm.

    Found just below your lungs, your diaphragm is like a flexible dome that pushes up against the bottom of your lungs. When your diaphragm  contracts, your lungs fill with air. When it relaxes, the diaphragm expands and pushes the air out of your lungs.

    But a diaphragm in an obese body has a larger load to carry. It has to expend more energy because it must work against the burden of excess fat. This burden can reduce lung volume as well, which means you get less out of each breath you take.

    The other drawback to excess abdominal fat is that it tends to be highly inflammatory, increasing the cytokines and immune cells known to drive all forms of chronic disease.

    This inflammatory factor raises the risk of lung problems such as asthma and chronic obstructive pulmonary disease (COPD), and can even shorten your life. Data from a 2012 study in the American Journal of Clinical Nutrition suggest that excessive abdominal fat contributes to the increase of an inflammatory marker known as plasma IL-6. This marker was shown to be “strongly associated with all-cause and cause-specific mortality in older persons with obstructive lung disease.”

    It’s a vicious cycle, because breathing problems can also drive obesity. If you already struggle to breathe, you may be less likely to engage in strenuous physical activities that make you huff and puff. A British study found that almost 80 percent of teenagers report that the worst thing about asthma was not being able to participate in sports due to compromised breathing.

    Of course, not moving enough is not the only cause for breathing problems. And not everyone with asthma is obese. However, the relationship these two diseases share is nevertheless remarkable. A meta-analysis examining over 300,000 adults found obesity and asthma were related, and the risk of asthma increased with a greater body mass index (BMI). According to some estimates, about 250,000 new cases of asthma per year in the United States are related to obesity.

    If excess fat impairs breathing, losing fat improves it, regardless of the fat reduction method. One review of studies examining weight loss and asthma found that all research observed an improvement in breathing outcome when subjects slimmed down, whether the fat was removed surgically or through good old fashioned diet and exercise.

    Moving for Breath

    In addition to shedding the pounds that may compress your lungs and diaphragm, exercise also contributes other breathing benefits.

    When you physically exert yourself, your muscles demand more oxygen, and release more carbon dioxide in the process. This means your lungs have to work harder to keep up. This improves your oxygen intake, and makes your lungs progressively stronger.

    According to fitness expert Gerry Bernstone, stronger muscles make breathing easier.

    “Exercise has also been shown to help to increase the size of the airways, making it easier for air to move in and out. Additionally, exercise can help to improve the elasticity of the lungs, making them more efficient at exchanging oxygen and carbon dioxide,” Bernstone said.

    So how should you move if you hope to breathe better? Aerobic exercise is the form best known for its improvements to lung function, because it challenges our breathing by its very nature. With consistent aerobic practice of walking, jogging, or bicycling, improvements are easy to see. A pace and distance that would have winded you weeks or months before may become a piece of cake, forcing you to pick up the pace to make further progress.

    Aerobic exercise is certainly important for improving lung health. However, other forms of exercise can play a role.

    For people who suffer from asthma, COPD, cystic fibrosis, or lung cancer, the American Lung Association recommends a program called pulmonary rehabilitation. The program includes a combination of aerobics, stretching, and resistance training as part of its instruction. Stretching provides relaxation, and a chance to focus on your breath. Resistance exercises (like weight lifting) can make your muscles stronger, including the ones that work your lungs.

    This predominantly exercise-focused lung improvement program may also include nutritional and psychological counseling. Doctors prescribe the program, which can be tailored for each individual. An evaluation includes a stress test to measure things like blood pressure, heart rate, and oxygen level, as well as a test to see how far you can walk in six minutes. Patients are retested months later to monitor progress.

    The program also teaches the mechanics of breathing so patients have a better understanding of their condition and how to manage it. The goal is to learn how to become more active with less shortness of breath.

    But you need not be diagnosed with a breathing problem to find an excuse to improve your lungs. Cross country and swim coach turned personal trainer Bonnie Frankel (78) also recommends a combination of aerobics, resistance training, and stretching, as well deep breathing exercises to further enhance your lung capacity.

    Frankel says to start gradually if you’re new to exercise, but be sure to find moves that you enjoy performing, because you’re more likely to be consistent if you’re having fun. Regularity is key, but you also don’t want to overwhelm yourself  or cause an injury. To avoid becoming too easy or routine, try to mix it up.

    “Your exercise program should vary in your workouts. This includes time, pace, place, mediums, and rest day or days,” Frankel said. The more you move, the quality of your life will improve.”

     

     

    Conan Milner

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    Conan Milner is a health reporter for the Epoch Times. He graduated from Wayne State University with a Bachelor of Fine Arts and is a member of the American Herbalist Guild.

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    Introduction

    Chronic obstructive pulmonary disease (COPD) is a common, preventable, and irreversible respiratory disease accompanied by extra-pulmonary manifestations that significantly impact morbidity and mortality.1 Cachexia is prevalent in many chronic diseases (eg, cancer, chronic kidney disease, chronic heart failure)2 and is an important extra-pulmonary manifestation observed in patients with COPD.2–4 In COPD, cachexia is a multifactorial syndrome characterized by severe loss of body weight, muscle, and fat, as well as increased protein catabolism.5 An estimated 1.4 million patients with COPD in Europe suffer from cachexia;2,4 these patients have a 2- to 3-fold higher mortality risk3,4 and suffer from a greater disease burden (eg, reduced lung function3,6,7 or more emphysema)4 than those without cachexia. In addition to its impact on patients, cachexia poses an increased load on the healthcare system in terms of number, length, and cost of hospitalizations.8,9 The considerable impact of COPD cachexia on patients and the healthcare system highlights the clinical relevance of the COPD cachexia syndrome and underscores the need to improve prevention and treatment.

    In the past decade, several international working groups focusing on chronic diseases and cancer have proposed definitions of cachexia to facilitate diagnosis and management (Figure 1).5,10–12 However, scientific and clinical respiratory communities have not systematically incorporated the diagnosis and management of cachexia in patients with COPD in research and practice.3 This oversight has led to an underappreciation of the prevalence and a suboptimal or neglected clinical management of the COPD cachexia syndrome. Understanding the factors that contribute to COPD cachexia is necessary to conceptualize effective prevention and treatment strategies. Therefore, the primary objective of this narrative review is to provide an update on the current scientific evidence on COPD cachexia etiology, assessment, and management. In addition, recommendations for clinical practice and future directions for research are provided. Given the variability in the definition of cachexia (Figure 1), it is important to note that this review covers a wide spectrum of patients and is not limited to a single definition of COPD cachexia.

    Figure 1 Graphical overview of published criteria to diagnose cachexia in patients with COPD. Given the variability in the definition of cachexia, it is important to note that this review covers a wide spectrum of patients and is not limited to a single definition of COPD cachexia. For specific diagnostic criteria and cut off values, the authors refer to the publications from Evans (2008), Muscaritoli (2010), Schols (2014) and McDonald (2019). Pre-cachexia criteria = light; Cachexia criteria = dark. *In cases where weight loss cannot be documented, a body mass index (BMI) <20 kg/m2 is sufficient. Based on Evans (2008), fatigue is interpreted as physical and/or mental weariness resulting from exertion and an inability to continue exercise at the same intensity with a resultant deterioration in performance. Based on Evans (2008) and Muscaritoli (2010), anorexia or anorexia-related symptoms are interpreted as limited food intake or poor appetite. Based on Evans (2008) and Muscaritoli (2010), abnormal histochemistry is interpreted as increased inflammatory markers, though anemia or low serum albumin may also be present. Created with BioRender.com.

    Abbreviations: CRP, C-reactive protein; FFMI, fat-free mass index; BMI, body mass index; mo, months.

    COPD Cachexia

    Diagnosis and Clinical Phenotype

    In the 15 years since Evans et al published their consensus definition of cachexia,11 research on the diagnosis and presentation of cachexia in COPD, including the importance of treating comorbid conditions, has evolved significantly. However, COPD cachexia is still primarily characterized using cross-sectional anthropometric measurements that are readily available in clinical offices. Low body mass index (BMI) and low fat-free mass index (FFMI) have long been recognized as risk factors for increased mortality in patients with COPD;13,14 however, patients with COPD who are experiencing weight loss, even among those who are overweight or obese, have a higher risk of death in comparison to those with stable weight.4 So, it is important to recognize that, despite the classically cachectic patient being seen as severely underweight, cachexia can develop in patients with COPD across the BMI spectrum.4 For this reason, cross-sectional measurements of BMI and FFMI are often inferior to longitudinal measures of loss of body weight and fat-free mass (FFM) for predicting mortality.3

    Screening for COPD cachexia can be as straightforward as tracking a patient’s weight across clinical visits; active monitoring of weight trends over time is essential, even among patients with obesity. However, in obese patients, unintentional weight loss may be applauded instead of recognized as a harbinger of worsened outcomes. Two large studies have found that the BMI category (normal, overweight, or obese) is a modifier of the risk of mortality among patients with COPD cachexia.4,15 However, several other studies of COPD have shown no statistically significant increased mortality contribution from BMI category above that associated with weight-loss.3,14,16 Concurrent monitoring of the loss of FFM is essential as patients may lose FFM independent of BMI.16 Measurement of FFM typically requires techniques such as dual x-ray absorptiometry (DXA) and bioelectrical impedance (BIA), which are often used in research but not generally accessible in pulmonary clinics.17,18

    Routine body composition monitoring for cachexia is most evolved in cancer, where patients frequently receive whole body scans. Cancer cachexia studies typically rely on assessment of muscle mass at the L3 vertebrae which is not typically available on chest computed tomography (CT) scans in COPD designed to capture lung abnormalities. However, pectoralis muscle area (PMA) and first lumbar level (L1) muscle mass can be measured on chest CT scans, which are commonly acquired during acute hospitalizations or as part of a lung cancer screening program in patients with COPD.19 PMA is more highly correlated with COPD disease severity and functional outcomes than BMI,20 and loss of PMA is associated with increased mortality in patients with COPD.16 Research in patients with non-small cell lung cancer showed that L1 muscle mass correlates very strongly (r = 0.90) with L3 muscle mass, which is considered the reference but is often not evident on chest CT, and L1 muscle mass loss predicts overall survival.21 Screening for longitudinal changes in FFM based on PMA or L1 muscle mass on routine chest CT scans is feasible. A large study of longitudinal PMA in more than 10,000 current and former smokers demonstrated increased risk of mortality independent of baseline BMI and disease severity which indicates therapies targeting muscle maintenance may be of benefit early in the disease course.16

    Clinical studies indicate that patients with COPD cachexia suffer from more severe disease in terms of pulmonary and physical functioning outcomes compared to those without cachexia. More specifically, patients with COPD cachexia have worse airway obstruction3,4,7,13,14,22, and more severe impairment in exercise capacity3,23 and functional outcomes such as walk distance and handgrip strength.24,25 In addition, cachexia is more prevalent in patients with more extensive emphysema on CT imaging. However, it is important to note that cachexia can develop in patients with COPD without emphysema.26

    Further, the multifactorial components of COPD cachexia contribute to the increased likelihood of other extra-pulmonary manifestations in cachectic patients or those at risk of becoming cachectic. For example, metabolically, patients with COPD and cachexia have elevated inflammation and growth hormone resistance compared to non-cachectic patients,6,27,28 while the presence of insulin resistance in cachectic patients remains debatable.6,29 Additionally, low body weight (defined as BMI <21 kg/m2) has also been associated with a higher likelihood of reporting symptoms of depression in patients with COPD.30,31 In contrast, a higher risk of anxiety symptoms has not been reported.30,32

    Overall, patients with COPD and cachexia (defined as low muscle mass) appear to have a worse quality of life than patients without cachexia;20,24,33 however, some studies have not reported this association.3,32

    Pathophysiological Mechanisms and Etiology of COPD Cachexia

    Pathophysiological Mechanisms

    The molecular triggers and mechanisms contributing to weight loss and muscle mass loss in COPD cachexia have become increasingly evident in the last decade. We provide a brief summary here, as these mechanisms have been reviewed in detail elsewhere.27,34–36

    Inflammation and oxidative/nitrosative stress are well-established triggers of muscle wasting and dysfunction in cachexia27,37 that catalyze an imbalance in protein and myonuclear turnover, leading to weight and muscle loss (atrophy) in cachectic patients with COPD.27,34 Protein breakdown is increased,34 with a compensatory increase in protein synthesis.38 In addition, cachectic patients with COPD have a more pronounced loss of oxidative muscle capacity than patients without cachexia.34,39–41 Recent research has further demonstrated that sarcopenic patients with COPD have more endoplasmic reticulum stress (a possible driver of muscle atrophy) compared to non-sarcopenic patients.42 Additionally, cachectic patients with COPD have dysregulated micro-RNA expression related to muscle proliferation and differentiation during myogenesis compared to patients without cachexia.43

    The molecular and cellular mechanisms responsible for fat mass loss, mostly observed in patients with advanced COPD and particularly emphysematous COPD,26 have received less attention. Most scientific work has focused on the role of adipokines, cell-signaling molecules (cytokines), produced by the adipose tissue. For example, leptin, a major influencer of energy balance through its effects on regulation of appetite and food intake, was found to be lower in the circulation of emphysematous patients compared to chronic bronchitis patients.44 Further, an association was noted between reduced serum leptin levels, increased serum adiponectin levels, and increased resting energy expenditure in patients with COPD, though this analysis was not limited to patients with cachexia.45 More recent research has investigated other adipokines, including adiponectin and zinc alpha 2-glycoprotein (ZAG), and reported that serum levels of both adipokines were significantly higher in patients with COPD with cachexia compared to those without cachexia.46 Adiponectin and ZAG were also associated with weight loss.46 Brown adipose tissue (BAT) activity has been suggested as a possible mechanism leading to a hypermetabolic state in patients with emphysema;47 however, Sanders et al recently discovered that BAT activity was not different between hypermetabolic patients with COPD and age, sex, and BMI-matched healthy controls.48 Lastly, upregulation of inflammatory and proapoptotic adipose tissue markers has not been observed in cachectic patients with COPD.29

    Other proposed COPD cachexia triggers and mechanisms include altered brain responses to food stimuli, altered gut integrity, and reduced splanchnic extraction.34

    Etiology

    The etiology of COPD cachexia involves a complex interplay of non-modifiable and modifiable factors,49 depicted in Figure 2. Which factors cause, accelerate or impair the recovery of cachexia remains to be determined. Identifying modifiable factors, however, is crucial as it drives the development of therapeutic approaches and may permit early detection of cachexia and initiation of treatment.

    Figure 2 Conceptual framework of etiological factors involved in COPD cachexia. The complex interplay of these factors is depicted via the irregularly shaped black line that links all factors to each other. It illustrates that each factor possibly influences other factors. For every patient with COPD cachexia, the factors involved and their interplay (and consequently the shape of the black line) will be different. Wider space between dashed line = scientific evidence is not consistent or not currently available in patients with COPD. Created with BioRender.com.

    Non-Modifiable Factors

    Age and sex Neither age and sex have been reproducibly shown to differ between COPD patients with and without cachexia.3,4,7,9,14,25,32

    Genetics Genetic predisposition to COPD and/or addiction to tobacco smoking are well-established, including monogenic and complex genetic etiologies.50–54 Among the monogenic etiologies, individuals with alpha-1 antitrypsin deficiency (AATD), caused by genetic variation in the SERPINA1 gene, are at increased risk of developing COPD as well as cachexia. This emphasises the importance of early AATD diagnosis and counseling for smoking cessation.55 Yet the majority of AATD patients go undiagnosed: in a recent study of 458,164 European-ancestry participants from the UK Biobank, only 6.4% of subjects with the heterozygous recessive PIZZ genotype, the most common genetic variation causing AATD, had been diagnosed with AATD.56 In addition to being at high risk for worsened airway obstruction, carriers of the PIZZ genotype are more likely to have cachexia and have a higher mortality risk. One challenge in investigating and identifying genetic predictors of COPD cachexia is that genetic variants typically have low to moderate effect sizes, which requires large samples of patients with COPD with and without cachexia to achieve the necessary power to scan the genome. For this reason, early genetic studies focused on candidate genes in patients with COPD who were not thoroughly phenotyped for cachexia. Candidate genes with variants associated with cachexia traits in COPD include angiotensin-converting enzyme (ACE),57 bradykinin receptor,58 vitamin D receptor,59 and secretory phospholipase-A2,60 as well as genes responsible for initiating the inflammatory cascade such as interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α).60 The first genome-wide association study of longitudinal weight loss in 4308 patients with COPD identified significant gene-level associations with EFNA1 and BAIAP2.61 Interestingly, EFNA2 encodes the membrane-bound protein ephrin-A2, which is involved in regulating developmental processes and homeostasis in adult tissue such as skeletal muscle. BAIAP2 encodes the 53 kD insulin-responsive protein (IRSp53), a negative regulator of myogenic differentiation. At the single gene variant level, the rs35368512 variant, intergenic to GRXCR1 and LINC02383, was associated with an increased likelihood of weight loss but only among African-American patients with COPD. The study also used an integrative approach to mine the underlying proteome network and found that genetic variation associated with weight loss in COPD may influence skeletal muscle regeneration and tissue remodeling. However, additional genetic investigations in larger samples of patients of diverse ancestry with COPD with and without cachexia are needed.

    Modifiable Factors

    Smoking Chief among the modifiable risk factors for COPD cachexia is continued tobacco smoking. Even among adults without COPD, longitudinal fat mass and muscle mass loss patterns are associated with tobacco smoking.62 Among patients with COPD, low BMI and muscle wasting are frequently, but not universally, associated with active smoking.3,7,9,32,63,64 The cellular mechanisms of the effects of smoking on skeletal muscle are not completely clear, but greater tobacco smoke exposure is associated with greater evidence of mitochondrial DNA damage, and the muscle from patients with COPD show increased levels of cytochrome c oxidase (COX) deficiency and blunted compensatory transcriptional responses.65 There is also evidence to suggest that m. vastus lateralis fibers of patients with COPD cachexia may undergo repeated cycles of denervation suggestively caused by decades of tobacco smoke exposure,66 although studies on the m. rectus abdominis in patients with cancer-associated cachexia show no evidence of denervation.67 Degens et al previously reviewed the extensive literature regarding skeletal muscle dysfunction secondary to active smoking (human and animal model) and concluded that smoking contributes to the development of muscle dysfunction, and that future studies need to investigate whether smoking cessation restores muscle function in patients with COPD.68 Other studies have suggested that physical activity may modulate tobacco smoke’s effects on skeletal muscle in mouse models.69,70 There may also be a differential temporal association of tobacco smoking with wasting in different tissues, as recent mouse and tissue culture data indicate earlier onset of adipose tissue wasting when compared to wasting of skeletal muscle. Future in vivo studies characterizing longitudinal changes in body composition in response to tobacco smoke exposure could help to identify temporal heterogeneity in the wasting of various tissue types.71

    Hypoxemia Cachexia is more likely to be present in patients with COPD who demonstrate more severe airway obstruction and emphysema, which limits the body’s access to oxygen, contributing to alveolar hypoxia and consequent hypoxemia. For these reasons, hypoxia and hypoxemia are suspected to play a crucial role in the pathogenesis of COPD cachexia.49,72 Hypoxia influences relevant cachexia mechanisms such as appetite and maintenance of skeletal muscle mass and function.73 Hypoxemia can be monitored clinically, and lower resting oxygen saturation has been associated with lower body weight in patients with COPD.74,75 A study in healthy young male volunteers found that hypoxemia (14.1% inspired oxygen) and forced inactivity, compared with normoxic forced inactivity, resulted in more significant thigh muscle cross-sectional area (CSA) loss, a greater increase in the proportion of type IIx muscle fibers, and a greater decrease in the proportion of type I muscle fibers.76 A similar fiber type shift is seen in patients with COPD and is associated with greater disease severity.77

    Hypercapnia The chronic buildup of carbon dioxide in blood, called hypercapnia, is associated with worse nutritional status in COPD.74 Hypercapnia is found to be more likely among patients with COPD and BMI <20 kg/m2 with respiratory failure.78 Interestingly, after receiving non-invasive positive pressure ventilation (NPPV) overnight, those with BMI <20 kg/m2 experienced weight gain independent of changes in blood gas and lung function levels. The mechanisms behind this beneficial effect of NPPV on body weight remain unclear. A reduction in the energy requirements by nocturnal unloading of the respiratory musculature is a plausible hypothesis to explain this improvement.78 Recent data supports this hypothesis, indicated by weight gain in patients with severe COPD and BMI < 21 kg/m2 after undergoing bronchoscopic lung volume reduction.79,80 Further studies to replicate these results are merited.

    Physical inactivity Physical inactivity contributes to a decline in muscle mass and function, and indirectly contributes to cachexia. While physical inactivity is the strongest predictor of all-cause mortality in patients with COPD,81 its role in COPD cachexia is surprisingly scarcely investigated. Muscle dysfunction in patients with COPD, however, has been extensively characterized.36 Physical inactivity is seen as a major driver of muscle dysfunction in patients with COPD, with many muscle characteristics similar to those observed after immobilization (disuse of the muscles).36 Additionally, studies of exercise training interventions have reproducibly shown improvements in muscle mass in patients with COPD.82 However, the number of exercise training studies including cachectic patients with COPD is limited. Observational evidence investigating the relationship between physical inactivity and muscle mass loss leads to contradictory conclusions. A recent systematic review33 showed that patients with COPD and lower-limb sarcopenia had significantly lower levels of subjectively (self-reported)83–86 and objectively (accelerometry)83 measured physical activity. Further, Matkovic et al demonstrated that patients with COPD and poor physical activity have a lower FFMI and lean mass index; however, these were not independently associated with poor physical activity in a multivariate analysis.87 Observational cross-sectional evidence has shown weak positive associations between FFMI, rectus femoris CSA, and physical activity level (r = 0.134 to 0.286) in patients with COPD.88,89 Multivariate analysis showed that FFMI was not an independent predictor of physical activity in patients with COPD;90 however, in GOLD stage I patients, physical activity was associated (independently from airflow limitation) by rectus femoris CSA,91 suggesting that muscle wasting is present even in early disease. Until now, observational studies investigating physical inactivity in patients with COPD and cachexia have been limited by cross-sectional data and small sample sizes. Longitudinal observational studies of physical activity in patients with COPD with cachexia are needed to elaborate on the dynamic process of cachexia and the role of physical inactivity to address causation. For example, it is unclear whether inactive patients with COPD are more prone to develop cachexia or whether patients with cachexia are more likely to be inactive. Lastly, low physical activity is associated with increased systemic inflammation, an essential trigger of cachexia in patients with COPD.92–94 Conversely, improvements in systemic inflammation have been reported in patients with COPD who were able to increase their physical activity.95

    Energy imbalance Factors contributing to the observed energy imbalance (energy expenditure vs energy availability) in cachectic patients with COPD is described in a comprehensive review by Sanders et al.34 An increased resting energy expenditure is reported in patients with COPD cachexia.96,97 Additionally, cachectic patients with COPD have higher energy demands when performing physical activity in comparison to healthy controls.98,99 When combined with the observed respiratory mechanical inefficiency, due to hyperinflation, which increases the work of breathing, the higher energy demand might lead to increased activity-induced energy expenditure (AEE). Research regarding AEE in cachectic patients with COPD is, however, lacking. Compensation for the elevated energy expenditure is necessary to maintain energy balance and to avoid wasting of muscle and fat mass. Dietary intake in patients with COPD who are losing weight are reported to be comparable to weight-stable patients but insufficient to counterbalance the elevated energy expenditure.100 Unfortunately, extensive research focusing on dietary intake in patients with cachexia is currently scarce. In relation to dietary intake, nutrition impact symptoms (eg, constipation, changes in the taste of food, loss of appetite) can be assessed and those symptoms are more frequently reported in patients with low FFMI compared to patients with normal FFMI.6 Additionally, nutrition impact symptoms and reduced food intake (measured as <75% food intake compared to usual) have shown to be associated with involuntary weight loss in patients with COPD,101 suggesting that nutrition impact symptoms and reduced food intake could significantly contribute to the development of cachexia in this population.

    Alcohol consumption Excessive alcohol consumption might also contribute to COPD cachexia. Animal models of COPD102,103 and cancer,104,105 as well as human106,107 studies, have repeatedly shown that excessive alcohol consumption leads to muscle loss as protein synthesis is inhibited and protein breakdown is enhanced.103,108 In addition, patients with COPD may have increased rates of excessive alcohol use compared to age-matched controls,109 suggesting that excessive alcohol consumption could contribute to the development of COPD cachexia. However, this hypothesis has not been tested, and future research is needed to explore the contribution of alcohol consumption to COPD cachexia.

    Exacerbations The number of COPD exacerbations a patient has experienced in the prior year is associated with an increased risk of cachexia (defined as unintentional weight loss of >5% over the preceding 6 months and with reduced FFMI).3 Gene expression studies on muscle tissue from the m. vastus lateralis of patients with COPD during acute exacerbation versus those with stable disease showed increased expression of genes associated with ubiquitin-dependent protein catabolism, one of the leading culprits in the pathophysiology of COPD cachexia, and down-regulation of genes in the mitochondrial respiratory chain.110 The proximal cause of these changes is uncertain as corticosteroids are frequently prescribed for acute exacerbations, and systemic corticosteroid exposure has been directly linked to reduced quadriceps strength after a COPD exacerbation111 and during stable disease.112

    Social-demographic factors Social factors such as access to care, ability to afford medication and food, proximity to environmental pathogens, and other social determinants of health show significant effects across the medical spectrum.113 Little data is available to describe the impact of these factors on the development and prognosis of cachexia in patients with COPD. Attaway et al used a national database in the United States to demonstrate increased prevalence of COPD in more rural and economically deprived areas; however, geographic differences between COPD patients with and without a muscle loss phenotype were relatively minor.9

    Multimorbidity Finally, it is important to conceptualize cachexia within a broader context of multimorbidity in patients with COPD. Vanfleteren et al described a pattern of comorbidity clustering in 215 patients with COPD, including a cluster of cachectic patients that showed associations with osteoporosis and renal disease.32 These associations were not borne out in a later clustering analysis conducted by the same group.7 Within the scientific community, there is a movement towards recognizing extra-pulmonary manifestations of COPD as related symptoms of an overarching systemic disease centered in the lungs but inextricably linked to the function of many other organs.114,115 Recognizing the burden of multimorbidity in COPD, and screening patients for these extra-pulmonary manifestations, could allow for earlier identification and treatment of comorbidities and more holistic care for the patient.115

    Therapeutic Approaches to COPD Cachexia

    The deleterious effects of cachexia on morbidity and mortality in patients with COPD underscore the importance of identifying effective therapeutic approaches. After cachexia is diagnosed in a patient with COPD, an initial structured nutritional assessment is required, which is ideally repeated regularly along with longitudinal measurements of body weight, body composition, and nutritional intake impact symptoms. These nutritional assessments should prompt multimodal intervention strategies encompassing nutritional support, muscle activation by exercise training, and/or targeted pharmacological interventions in select subpopulations.

    Nutritional Therapy

    Poor dietary quality may accelerate disturbances in body composition in patients with COPD and contribute to the development of cachexia. In terms of caloric content, patients with COPD generally have a normal dietary intake compared with healthy individuals.116 Nevertheless, this intake may be inadequate for meeting the elevated energy requirements of patients with COPD.117–119 Exacerbation of COPD may further impair energy balance due to decreased dietary intake combined with increased resting energy expenditure during acute illness.120 To compensate for increased energy requirements and prevent weight loss, patients with COPD may need to adapt their dietary intake to an energy-enriched diet. However, since a high caloric load may stress the impaired ventilatory capacity, smaller meals spread throughout the day should be recommended.121 In addition, muscle protein synthesis should be stimulated to maintain muscle mass. Muscle protein synthesis depends on the availability of amino acids in the bloodstream. Therefore, a diet with sufficient proteins amounting to at least 1.2 g per kg body weight might be necessary to achieve an anabolic response.122 High-quality proteins, such as casein, leucine, and whey protein, elicit an increased anabolic response after acute or short-term ingestion in patients with COPD.123–126 However, the long-term benefits of high-quality protein ingestion and the beneficial effects of its metabolites (eg, beta-hydroxy-beta-methylbutyrate) still need to be investigated.127

    Nutritional supplementation – To treat cachexia, oral nutritional supplements (medical drinks/snacks) could supplement the diet when nutrient requirements cannot be satisfied through habitual dietary intake or when a temporary boost is needed. A recent Cochrane review on supplementation with medical nutrition in patients with COPD showed moderate-quality evidence that nutritional supplementation promotes weight gain among patients with COPD, especially if malnourished.128 With high-quality proteins to stimulate the regenerative response of muscles, these supplements might need to be enriched with additional vitamins, minerals, and trace elements to combat nutrient deficiencies. Vitamin D deficiency, measured as serum levels of 25-hydroxyvitamin D, is frequently reported in patients with COPD and worsens with disease severity.129 Supplementing vitamin D in patients with COPD may positively affect bone health and improve muscle strength by regulating mitochondrial dynamics and enzyme production;130,131 however, the specific effects of vitamin D in the cachectic patient with COPD remain unclear. Low intake of omega-3 polyunsaturated fatty acids (n-3 PUFAs) is also reported in patients with COPD.132 In addition to their anti-inflammatory effects, PUFAs are the natural ligands of peroxisome proliferator-activated receptors (PPARs) and may potentially boost muscle mitochondrial metabolism by stimulating PPAR and PPAR gamma coactivator-1 alpha (PGC-1α) signaling or inhibiting classic nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling. In addition, a placebo-controlled randomized controlled trial (RCT) in cachectic patients with COPD showed decreased exercise fatigue and dyspnea after 12 weeks of a targeted medical nutrition therapy133 enriched with whey protein, n-3 PUFAs, and vitamin D. Nutrition therapy was compared with an isocaloric diet including milk protein instead of whey protein and sunflower oil instead of fish oil with high levels of n-3 PUFAs.

    Nutrition supplementation combined with exercise – Combining nutritional supplementation with pulmonary rehabilitation (PR) might enhance the beneficial effects of PR. For example, PUFA supplementation during an 8-week rehabilitation program significantly improved endurance exercise capacity in comparison to placebo in patients with COPD, even after adjustment for FFM.134 A more recent RCT—the NUTRAIN trial—investigated whether targeted nutritional supplementation enhances outcomes of exercise training in patients with COPD with low muscle mass.135 In the trial, a multimodal drink enriched with leucine, vitamin D, and n-3 PUFAs significantly improved or maintained body weight, inspiratory muscle strength, and physical activity but did not enhance the effects of a 12-week rehabilitation program on muscle mass, muscle strength, and physical performance.

    Opportunities for nutritional therapeutics – While most studies of nutritional interventions for COPD cachexia have focused on short-term efficacy (1–3 months) in clinically stable disease or as an adjunct to PR, only a few studies have investigated the benefits of nutritional supplementation during the maintenance phase after PR. For example, the NUTRAIN trial and the INTERCOM trial showed that during the 12- to 24-month maintenance phase after PR, nutritional interventions did not seem to enhance the long-term outcome of exercise training on physical capacity but did improve plasma levels of the supplemented nutrients, total body weight, physical activity, and generic health status. Notably, these outcomes were achieved at an acceptable cost for patients with high disease burden.136,137 Lastly, the effect of nutrition therapy during and after an acute exacerbation still is a wholly neglected area of research. This is noteworthy as, during an acute exacerbation, disease-related factors such as inflammation, hypoxia, inactivity, and glucocorticosteroid treatment converge and intensify.138 Additionally, the gap between energy intake and energy expenditure becomes wider during acute exacerbations, then slowly decreases upon recovery.120,139,140 Only one study has proven the feasibility and efficacy of nutritional supplementation in maintaining energy balance and increasing protein intake in hospitalized patients with COPD.139 Still, the therapeutic window of opportunity after an acute exacerbation warrants further investigation.

    Exercise Training

    Exercise training is recommended in many diseases associated with skeletal muscle wasting.141 Exercise should be routinely offered to patients with COPD as part of PR, supported by a significant and robust evidence base in both stable and acute COPD populations. The established benefits of PR in general COPD populations include improved exercise capacity, symptom burden, and health status, and, in the post-acute setting, a lower risk of hospital admission.142 Exercise training also clearly improves skeletal muscle function and morphology in patients with COPD36,82,142,143 through upregulation of factors governing skeletal muscle hypertrophy and regeneration, with a variable effect on systemic or local muscle inflammation.144,145 Increased fiber CSA, reduced proportion of type IIx fibers, increased oxidative capacity, and reduced exercise-induced lactic acid production are also observed after exercise training in patients with COPD.36,146 Notably, independent of the exercise modality used, programs using training at higher intensity or with longer duration produce greater physiological training effects.

    Endurance training modalities While the optimal program length is unknown, 8 weeks of endurance training, with at least 2–3 one-hour sessions per week, at >40% of maximal work rate (cycling) is recommended to achieve meaningful benefits.36,142 The goal should be to provide a potent training stimulus at the limit of the patient’s capacity.147 Many patients with COPD, including those with cachexia, find it challenging to sustain a moderate-to-high-intensity training load for the target training duration, for example due to intolerable breathlessness. Different training strategies can allow symptomatic patients to better tolerate training loads that offer an effective stimulus for adaptation. These include interval training, where repeated bouts of high-intensity exercise are interspersed with recovery periods (passive or active recovery)148, and partitioned training, where exercising a smaller muscle mass (eg, single-leg cycling or knee extension) reduces the load on the respiratory system.149–152

    Resistance training modalities A systematic review of resistance training in patients with COPD found increases in muscle strength and mass after short-term programs; typically, these programs involved 12 weeks of training, with at least 2–3 sessions each week, at progressive loads of 30–90% of one-repetition maximum.153–155 Catabolic, anabolic and transcription factor protein expression responses to resistance training are blunted in patients with COPD compared to healthy controls, but these seem not tightly coupled to gains in lean mass.156 Hypoxemia has been suggested to play a role in the variable adaptive response of the skeletal muscle in patients with COPD.157 As with endurance training, limiting symptoms may prevent patients with COPD from undertaking planned training protocols, and alternative training modalities can be helpful to increase the total work done. Neuromuscular electrical stimulation offers an effective form of resistance training,158 where an external current is applied over the target muscles to induce contractions.159 It places a low metabolic load on the respiratory system, and is thus particularly suited to severely breathless patients.

    Combined exercise modalities In practice, combining endurance and resistance training would optimize overall gains, eg, in functional capacity, along with increases in muscle mass and function to counteract the adverse effects of cachexia. Careful tailoring of the exercise prescription with attention paid to exercise modality can improve patient outcomes, including the most severe cases.160 A recent case report in a patient with very severe COPD, chronic respiratory failure, and cachexia showed impressive gains in weight (including lean mass), function (strength, exercise capacity, mobility), health status, and psychological well-being from comprehensive and personalized PR.161 The effects of exercise, anabolic and beyond, rapidly wane once the training stimulus is stopped,162 so attention to behavior changes and/or maintenance strategies is paramount. This requires a consideration of exercise program features that may improve longer-term access, adherence, and efficacy. Low-cost, home-based and telerehabilitation models may have a role; however, these models also have a smaller evidence base and lack the well-defined process and outcomes of center-based PR.163 Finally, as described previously exercise should be combined with nutritional intervention in a multimodal approach, as exemplified in the NUTRAIN and INTERCOM trials,136,137 to target the wide range of etiological factors involved in cachexia, including energy imbalance and low nutrient availability.34

    Exercise responses in COPD cachexia Despite the impressive gains in the abovementioned case report,161 individual responses to exercise training in COPD are variable and cannot be readily predicted by any clinical phenotype.83,164 Some, but not all, cachectic patients with COPD retain the capacity to improve functional exercise performance with exercise training. In an in-depth physiological study, Vogiatzis et al compared 10 cachectic and 19 non-cachectic patients with COPD before and after high-intensity cycling training (45 min, 3x weekly) over 10 weeks.165 The endurance, high-intensity interval program improved peak work rate and 6-min walk distance (6MWD) in both groups. Mean muscle fiber CSA also increased in both groups, though significantly less in cachectic patients. A blunted muscle remodeling response was found at the group level, with less reduction in the proportion of type IIb fibers, less increased muscle capillary/fiber ratio, and less increased insulin-like growth factor I (IGF-I) protein levels in the cachectic group.165 This blunted response to high-intensity endurance exercise in COPD cachexia supports the inclusion of resistance training in managing COPD cachexia. Indeed, combined endurance and resistance training approaches seem highly relevant and should focus on the critical features of the cachexia syndrome (eg, reduced muscle mass, reduced FFMI, and/or reduced muscle strength).16,58,166

    Pharmacological Intervention

    In addition to nutritional support and exercise training, pharmacological agents have been identified as potential therapeutic options for cachectic patients with COPD. Even though research is sparse,167–171 the efficacy of different pharmacological agents has been investigated and is listed below.

    Ghrelin A 28-amino acid peptide hormone,36 ghrelin, has received specific attention as a pharmacologic agent in COPD cachexia. Studies show that ghrelin has potential benefits in reversing the breakdown of proteins and weight loss in catabolic states like cancer cachexia172,173 and it is thought to affect several vital pathways in the regulation of appetite and body composition. However, less is known about the effects of ghrelin in COPD cachexia, and available study results are conflicting. In a small sample of 7 cachectic individuals with COPD, Nagaya et al168 found that a 3-week treatment with exogenously administered ghrelin resulted in improvements in body weight, food intake, lean body mass, peripheral and respiratory muscle strength, and clinically relevant improvement in 6MWD. In contrast, in a multicenter, randomized, double-blind, placebo-controlled trial, the same research group167 evaluated a similar intravenous treatment of high-dose ghrelin (2 µg/kg) twice daily for 3 weeks but did not see any significant difference in 6MWD, quality of life, symptoms, body weight, food intake, or peripheral muscle strength when compared to placebo. Nevertheless, ghrelin analogues are regarded as a novel potential therapeutic option in COPD cachexia that warrants further investigation despite the somewhat conflicting and limited findings reported in the literature.34,167,168

    Megestrol acetate and testosterone Another potentially relevant pharmacological agent for COPD cachexia is megestrol acetate, a progestational appetite stimulant with anti-inflammatory effects.36,174 In a large RCT including 145 individuals with COPD, megestrol acetate administration improved appetite, body weight, and body image but not exercise tolerance as measured by 6MWD.169 In a 12-week pilot trial in 2015, Casaburi et al171 treated 9 cachectic patients with COPD with oral megestrol acetate (800 mg/day) plus weekly testosterone injections (initially 125 mg in men and 40 mg in women). They found that the treatment reversed weight loss trajectories and resulted in significant gains in both lean and fat mass. Though the small sample size and lack of a control group should be noted when interpreting these findings, the promising findings warrant further research. Moreover, adding testosterone supplementation to men with COPD with low serum testosterone levels during a resistance training intervention have, when compared to resistance training alone, enabled more profound abundances of all major myosine heavy chain (MyHC) isoforms, enhanced expression of muscle IGF-1 and other components of the muscle IGF system, as well as improved maximal leg muscle strength and lean body mass.175,176

    Roflumilast Recent research shows that the phosphodiesterase (PDE)-4 inhibitor roflumilast may revert proteolysis and increase the antioxidant defense in cultured myotubes obtained from cachectic patients with COPD.177 As this PDE-4 inhibitor is available for treating systemic inflammation and exacerbations in patients with COPD, these findings have potential clinical implications for treating muscle wasting in cachectic patients with COPD.

    Targeting key pathways Sanders et al34 emphasizes that muscle wasting may result from protein and myonuclear turnover alterations;27,34 therefore, targeting key pathways in these processes (eg, ubiquitin-proteasome system) will likely be required to combat muscle wasting in cachectic patients with COPD.34 In 2019, Polkey et al178 investigated the effect of 2 doses of intravenously administered bimagrumab, a novel and fully human monoclonal antibody that inhibits myostatin (a negative skeletal muscle regulator), in patients with COPD with reduced skeletal muscle mass (without documented recent weight loss). Although the patients in the study were not diagnosed with cachexia, treatment led to increased thigh muscle volume over 24 months but had no effect on 6MWD.

    In summary, the benefit of single modality pharmacological interventions for the cachectic patient with COPD is unclear, research is sparse, and the results are mixed.167–171 Therefore, cachexia cannot be managed entirely by any single modality treatment intervention, including current pharmacological options. Still, pharmacological interventions may be relevant as part of a multimodal approach for some, but not all, cachectic patients with COPD, although the latter requires further investigation.170,179

    Recommendations for Practice

    Diagnosing (Pre-)Cachexia in Patients with COPD

    Longitudinal assessment of weight in patients with COPD meets Wilson and Jungner’s principles of screening.180 Though weight measurements are routinely collected, they require the clinician’s close attention in order to spark recognition and therapeutic action. In addition to weight, information from routine clinical imaging, such as lung screening CTs or DXA scans, present opportunities for monitoring muscle mass or FFM over time, generating longitudinal assessments of a patient’s body composition. If clinical imaging is not available, improving clinical access to other reliable and validated body composition assessment tools (eg BIA) is advised. Additionally, protocolized inquiries about weight loss or changes in strength or functional status could be incorporated into a disease-specific review of systems, along with more classical questions about sputum production and recent exacerbations. Automated generation of alerts by the electronic medical record could help augment the vigilance of clinicians and highlight weight loss when it is first evident. Future clinical studies should quantify the effects of heightened clinical attention and novel information technology solutions for early recognition of cachexia in patients with COPD to facilitate early therapeutic intervention.

    Minimizing Modifiable Etiological Factors and Improving Patient Referral to PR

    In theory, the prevention and management of COPD cachexia should start with minimizing modifiable etiological factors (Box 1). Generally, a multidisciplinary and holistic PR program considers all proposed minimization steps.181 Unfortunately, PR programs are not equally extensive worldwide, and poor healthcare professional awareness and knowledge about PR is a significant barrier to patient referral.182,183 In practice, therapeutic nihilism about the role of PR in the management of cachexia may prevent some healthcare professionals not recommending it to patients. Given the physiological and psychosocial benefits of PR for patients with stable and acute COPD, clinicians need to engage with patients to talk about barriers and enablers and support the uptake of PR.

    Box 1 Ways to Minimize Modifiable Etiological Factors

    Moving Towards Multimodal Therapeutic Approaches

    There is a clear consensus that single therapies are insufficient to stabilize or reverse cachexia.170,179 Considering the significant etiologic complexities of COPD cachexia, a multimodal approach that combines nutritional, exercise, and (possibly) pharmacological components is likely necessary. A recent review170 summarized the effect of multimodal treatment strategies tested in 5 individual studies in cachectic patients with COPD.133,136,184–186 All studies that combined exercise with an oral nutritional supplement reported significant improvements in favor of the treatment groups. Thus, building on current evidence, oral nutritional supplementation combined with exercise should be the primary multimodal approach to treating the cachectic patient with COPD. Adding a pharmacological agent might be considered in some, but not all, cachectic patients with COPD170 (Box 2).

    Box 2 Multimodal Interventions for Cachexia in COPD

    Future Directions for Research

    While acknowledging the challenges in COPD cachexia research studies, the following steps are recommended when designing future research studies to investigate the etiology, assessment, and management of COPD cachexia.

    Enable/Facilitate Comparisons Between Studies

    A key challenge in interpreting and comparing the results of observational and interventional studies is the use of different definitions of cachexia across studies, resulting in somewhat diverse patient groups. Therefore, we propose that researchers use a longitudinal definition of cachexia and recognize that cross-sectional measurements are not optimal. Furthermore, more detailed phenotyping of patients included in studies will assist in comparing patient cohorts between studies.

    Provide Stronger Scientific Evidence

    Observational studies on the etiology of COPD cachexia are often cross-sectional and retrospective. Instead, large-scale prospective and longitudinal studies should be conducted to provide more robust etiological evidence. In addition, multi-arm RCTs are needed to fully establish the efficacy of a specific or multimodal intervention.

    Select the “Right” Outcome(s)

    In previous work on COPD cachexia, functional outcomes, such as 6MWD, are commonly used, but does not seem to be responsive to cachexia interventions, including resistance training.167,169,178,187 The latter, thought to have a particular role in managing COPD cachexia considering the known consequences of the disease (eg, reduced muscle mass, reduced FFMI and/or reduced muscle strength).16,58,166 However, the efficacy of resistance training (at least when designed to improve muscle mass and strength)188,189 would not be reflected in the functional outcome of walking distance on the 6MWT.187 Instead, to evaluate resistance training intervention effects in the cachectic patient with COPD, muscle-related outcomes, including direct measurements of strength and power properties of the quadriceps, should be used due to their relevance to muscle mass; these measurements are particularly responsive to resistance training interventions.82,190–192 If a functional outcome measure is desirable, a sit-to-stand test would be more relevant, considering the requirements of this test compared to the 6MWT. For example, strength and muscle mass properties which often are affected in the cachectic patient with COPD are more closely linked to 5-time sit-to-stand performance than to 6MWT performance.193,194 Sit-to-stand tests also respond to resistance training interventions designed to increase muscle mass and strength.153

    Lastly, although selecting the proper functional test, and focusing on muscle-specific outcome measures is essential to capture treatment adaptations, multidimensional outcome assessment including objective and patient-centered outcomes such as quality of life should not be neglected. For example, quality of life is often worsened in patients with COPD cachexia compared to patients without cachexia.24,33 Additionally, although it remains to be determined in the cachectic patient COPD, it is likely that specialized nutrition and exercise can restore muscle mass and strength through metabolic crosstalk between body organs,195 highlighting the need of multidimensional outcome assessments to fully capture the treatment response in the cachectic patient with COPD.

    Evaluate Exacerbations

    Only limited studies have focused on the role of cachexia during and after severe exacerbations. Disease-related detrimental factors such as systemic inflammation, hypoxia, physical inactivity, malnutrition, and glucocorticosteroid treatment converge and intensify during a severe exacerbation. Therefore, the period of an exacerbation and the recovery phase immediately following might be an excellent opportunity to intervene to prevent or treat cachexia. More studies are needed to investigate the potential and optimal therapeutic strategies for the period around COPD exacerbations.

    Discover New Biomarkers Prognostic of Cachexia Development

    A major challenge with cachexia is that it remains largely discovered in end-stage COPD. By the time a patient with COPD exhibits weight loss the ideal interventional window for reversing cachexia’s course may have already been missed. Additional research is needed to identify biomarkers of pre-cachexia to guide cachexia risk stratification and/or serve as sensitive endpoints in clinical trials.

    Next to future steps described above, the scoping review by Orsso et al also provides excellent recommendations for future trials investigating nutrition or multimodal interventions to prevent or treat cachexia in clinical and non-clinical conditions.196

    Acknowledgments

    The authors greatly acknowledge Stacey Tobin for editing and improving the English language of the work.

    Author Contributions

    All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

    Funding

    Jana De Brandt is funded by the Swedish Heart and Lung Foundation (20200139 and 20210146). Joe Chiles is funded by the NIH NHLBI T32HL105346. Matthew Maddocks is funded by a National Institute for Health and Care Research (NIHR) Career Development Fellowship (CDF-2017-10-009) and NIHR Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. The views expressed in this article are those of the authors and not necessarily those of the NIHR, or the Department of Health and Social Care. Merry-Lynn N. McDonald is funded by the National Institutes for Health (NIH), National Heart, Lung and Blood Institute (NHLBI), R01HL153460. André Nyberg is funded by the Swedish Research Council (2020-01296) and the Swedish Heart and Lung Foundation (20210146).

    Disclosure

    The authors report no conflicts of interest in this work.

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    The COPD Therapeutics Market was valued at US$ 11,668.8 million in 2022 and is anticipated to reach US$ 20,127.7 million by 2032, growing at a CAGR of 5.1% during the projected period.

    Chronic Obstructive Pulmonary Disease is a broad term used for defining progressive lung diseases like emphysema, refractory asthma, chronic bronchitis and some other forms of bronchiectasis. The symptoms of Chronic Obstructive Pulmonary Disease are so common that sometimes people fail to understand that they are suffering from Chronic Obstructive Pulmonary Disease and consider it as normal cold, cough and symptoms of aging. Symptoms are sometimes not even visible in the early stages of disease and the disease remains undiagnosed for a long time.

    The symptoms of Chronic Obstructive Pulmonary Disease include wheezing, tightness in the chest, frequent coughing and increased breathlessness. Chronic Obstructive Pulmonary Disease can be treated using different types of drugs and therapies including oxygen therapy and pulmonary rehabilitation programs. In case of extreme severity of Chronic Obstructive Pulmonary Disease surgery is recommended which includes lung volume reduction surgery, lung transplant and bullectomy.

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    According to the data of British Lung Foundation approximately 1.2 billion people were suffering from Chronic Obstructive Pulmonary Disease in the U.K. alone in 2011. Also according to the COPD Foundation approximately 30million Americans were suffering from Chronic Obstructive Pulmonary Disease in 2013.

    Chronic Obstructive Pulmonary Disease is one of the leading causes of death worldwide. This data demonstrates the ever increasing demand of Chronic Obstructive Pulmonary Disease treatment worldwide and hence also shows the potential that the Chronic Obstructive Pulmonary Disease therapeutics market holds.

    Chronic Obstructive Pulmonary Disease Therapeutics Market: Overview

    Chronic Obstructive Pulmonary Disease therapeutics market is a growing market and is expected to see an even higher growth in the forecast period. Factors such as increase in the population suffering from Chronic Obstructive Pulmonary Disease worldwide and increasing awareness about Chronic Obstructive Pulmonary Disease are responsible for fueling the growth of the Chronic Obstructive Pulmonary Disease therapeutics market.

    Betterment of the healthcare infrastructure in Asia Pacific and Middle East and Africa is also responsible for the revenue growth of the Chronic Obstructive Pulmonary Disease therapeutics market in the forecast period.

    Chronic Obstructive Pulmonary Disease Therapeutics Market: Drivers and Restraints

    The most important factors that are expected to drive the growth of the Chronic Obstructive Pulmonary Disease market includes the ever increasing number of cases of Chronic Obstructive Pulmonary Disease globally. Also the change in the lifestyle is responsible for increasing the habits like smoking and increase in the number of genetic disorders which in turn are responsible for raising the number of Chronic Obstructive Pulmonary Disease patients.

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    Other factors that can boost the revenue from the Chronic Obstructive Pulmonary Disease therapeutics market are rising expenditures on healthcare that is leading to the adoption of Chronic Obstructive Pulmonary Disease treatments in the emerging economies. Increase in the level of awareness has also lead to the early diagnosis of the Chronic Obstructive Pulmonary Disease so that people can go for the treatment of the disease.

    Factors that can limit the growth of the therapeutic enzymes in the forecast period include the fact that not all the patients who are suffering from Chronic Obstructive Pulmonary Disease are aware of the fact that they are suffering from the disease and therefore do not go for the treatment of the disease.

    Also sometimes people get to know about their disease when the disease can’t be cured by only medication and therapies and surgery becomes mandatory. This factor can also lead to a slow growth in the revenue from the Chronic Obstructive Pulmonary Disease therapeutics market.

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    Chronic Obstructive Pulmonary Disease Therapeutics Market: Region-wise Outlook

    Chronic Obstructive Pulmonary Disease therapeutics market is in its growth phase and hence this market is expected to see very high growth in the emerging economies like Latin America and Asia Pacific due to high population growth in these regions. North America Chronic Obstructive Pulmonary Disease therapeutics market is the most developed market in terms of revenue, followed by Europe. Middle East and Africa are also expected to see higher growth due to growing advancement in the healthcare infrastructure.

    Chronic Obstructive Pulmonary Disease Therapeutics Market: Key Market Participants

    Some of the key participants of Chronic Obstructive Pulmonary Disease therapeutics market include: Pfizer Inc, Adamis Laboratories Inc., GlaxoSmithKline plc.

    The report is a compilation of first-hand information, qualitative and quantitative assessment by industry analysts, inputs from industry experts and industry participants across the value chain. The report provides in-depth analysis of parent market trends, macro-economic indicators and governing factors along with market attractiveness as per segments. The report also maps the qualitative impact of various market factors on market segments and geographies.

    Chronic Obstructive Pulmonary Disease Therapeutics Market: Segmentation

    Chronic Obstructive Pulmonary Disease therapeutics market can be segmented on the basis of components and end user.

    On the basis of component

    • Drug Class
    • Bronchodilators
    • Steroids
    • Phosphodiesterase-4 inhibitors
    • Theophylline
    • Antibiotics
    • Delivery Systems
    • Oral
    • Inhalation

    On the basis of end user

    • Hospitals
    • Private clinics
    • Out-patients

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