What is COPD?

“Chronic obstructive pulmonary disease (COPD) is a term used to describe chronic lung diseases, including emphysema and chronic bronchitis, and is characterized by breathlessness. Some people with COPD also experience tiredness and chronic cough with or without mucus,” said Army Maj. (Dr.) Nikhil Huprikar, chief of Pulmonary and Critical Care Medicine Service at Walter Reed National Military Medical Center (WRNMMC).

“COPD makes breathing difficult for the 16 million Americans who have this disease. Millions more people suffer from COPD but have not been diagnosed and are not being treated. Although there is no cure for COPD, it can be treated,” according to the Centers for Disease Control and Prevention (CDC).

To draw greater attention to COPD and educate the public about the disease, November is annually observed as National COPD Awareness Month.

Huprikar, and Army Maj. (Dr.) Arthur Holtzclaw, a pulmonologist and chief of Medicine at WRNMMC, explained symptoms of COPD can vary, but typically include decreased exercise tolerance, cough, and increased sputum production, in addition to breathlessness.

“COPD is usually diagnosed through lung function testing such as spirometry, which measures how well the lungs are working,” Huprikar explained. “A person may have COPD but not notice symptoms until it is in the moderate stage. Therefore, it’s important to ask your doctor about testing for COPD,” the CDC states.

Testing for COPD is especially recommended if a person is a current or former smoker, has been exposed to harmful lung irritants for long periods of time, or has a family history of COPD, Holtzclaw furthered. In many cases, COPD may also be caused by inhaling air pollutants, including tobacco smoking (cigarettes, pipes, cigars, etc.) and second-hand smoke.

Work-related environmental factors, such as fumes, chemicals, and dust have also been linked to COPD.

“Genetics has also played a role in the development of COPD, even if the person has never smoked or been exposed to strong lung irritants in the workplace,” the CDC adds.

There is no cure for COPD, but some treatments can decrease breathlessness and increase a person’s ability to do activities, while other treatments may reduce the risk of exacerbations of the disease, Huprikar explained.

Treatments include inhaled medications called bronchodilators, as well as pulmonary rehabilitation, which can include exercise and oxygen therapy, according to health care providers.

Breathing from the diaphragm is an exercise for COPD. Also called abdominal or belly breathing, the abdomen should rise when you breathe in, and lower as you breathe out when doing diaphragmatic breathing. The diaphragm, the muscle separating the chest cavity from the stomach, is the main muscle for breathing. When the diaphragm tightens, the lungs expand. The diaphragm is designed to do most of the work of breathing. When a person has COPD, the diaphragm doesn’t work as well and muscles in the neck, shoulders, and back are used. These muscles don’t do much to move your air, according to the CDC.

“Training your diaphragm to take over more work of breathing can help,” the CDC adds.

Diaphragmatic breathing is not as easy to do as pursed-lip breathing, so health care providers recommend people get instructions from a respiratory health care professional or physical therapist experienced in teaching it.

For more information about COPD and its treatment, visit the CDC website at www.cdc.gov/copd/features/copd-symptoms-diagnosis-treatment.html.

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As per World Health Organization (WHO), Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable, and treatable chronic lung disease that affects men and women globally. COPD at the same time is called emphysema (destruction of tiny air sacs at the end of airways in the lungs) or chronic bronchitis (chronic cough with phlegm) for common people.  Approximately 90 per cent of COPD deaths in those under 70 years of age occur in low- and middle-income countries. COPD is the third leading cause of death worldwide, causing 3.23 million deaths in 2019. 

During the winter season, as AQI gets deteriorates, it leads to exacerbation of COPD problems. Environmental exposure to tobacco smoke, indoor air pollution, and occupational dust, fumes, Biomass Fuel and chemicals are major risk factors. COPD should be considered in any patient with the following clinical features- breathlessness progressive over time, characteristically worse with exercise, and persistent Chronic cough, which may be intermittent and may be unproductive but is associated with recurrent wheezing. As COPD progresses, people find it more difficult to carry out their daily activities, often due to breathlessness.  

Diagnosis of COPD is made by considering three points of a triangle. The three points that are required to sum up the diagnosis of COPD are- 1) symptoms (shortness of breath, chronic cough, sputum), 2) risk factors (host factors, Tobacco, occupational exposure, indoor/outdoor pollution), 3)Pulmonary Function Test (to establish the diagnosis). Apart from these, the patient suspected of COPD is also subjected to other investigations like sputum examination, chest X-ray, and several other investigations to rule out co morbidities that play an important role in the management of COPD. 

Management of COPD can be divided into two parts non-pharmacotherapy measures and pharmacotherapy measures. Non-pharmacological therapy includes- smoking cessation (it has the greatest capacity to influence the natural history of COPD), avoidance of air pollution, avoidance of biomass exposure(use of clean energy resources), vaccination(pneumococcal influenza, Covid etc ), and pulmonary rehabilitation (which also includes, Yoga, Pranayam and Breathing Exercises).

In addition to this, various pharmacological therapies are used in the management of COPD. Out of these, the mainstay is the bronchodilators via inhaled route. Advanced cases of COPD, mainly emphysema or bulla, are subjected to surgical interventions. 

Uncontrolled symptoms of COPD make the patient vulnerable to COVID-19 infection. Hence COPD should be managed properly to reduce the chances of COVID-19 infection. The use of masks not only prevents COVID-19 infection but also helps in preventing people from air pollution. 

                                                                                                                                                              The Global Initiative for Chronic Obstructive Lung Disease (GOLD) releases COPD guidelines annually. The first gold guideline was propounded in 2001, and the GOLD report has been updated every year. As per new guidelines released for the year 2023,  the global prevalence of COPD is 10.3 per cent. According to GOLD's new guidelines, COPD is increasing rapidly worldwide due to increased smoking in developing countries and the elderly population in rich countries.

The new report estimates that by 2060, the number of deaths from COPD due to increasing smoking (in poor countries) and elderly persons (in rich countries) could exceed 5.4 million. COPD is higher in ex-smokers (who have smoked for at least one year) and smokers (people who smoke) than nonsmokers (who do not smoke). Smoking is the major risk factor for COPD.

 According to the new report, 50 per cent of smoking and 50 per cent of non-smoking factors are responsible for COPD. Three billion people in the globe utilize biomass fuels (coal, cow dung, wood, fireplaces, earthen stoves, etc.) for cooking, heating, and other purposes. It is referred to as biomass fuel exposure. All of these individuals are also at elevated risk for COPD. 

COPD patients should talk to their doctors about getting flu, corona, pneumonia, Pertussis and Varicella vaccines. There are new rules about COPD and Covid-19, updated reports for telemedicine, and rules about spirometry. Lung cancer is usually the cause of death for many COPD patients. Because of this, people with COPD who got it from smoking should get a low-dose CT scan once a year as a screening tool for Lung Cancer. Both lung cancer and COPD can be treated better this way. 

Bone illnesses, depression, and anxiety disorders are frequently neglected in COPD patients. These disorders should be adequately investigated and treated in COPD patients. In addition to this, COPD patients should also be treated for their other diseases while receiving COPD treatment (heart disease, diabetes, etc.). 

Apart from this, innovation has been incorporated into the new COPD guidelines by modifying some new definitions, diagnostic procedures, treatment strategies, inhaler devices, investigation methodologies, etc. 



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What is COPD?

“Chronic obstructive pulmonary disease (COPD) is a term used to describe chronic lung diseases, including emphysema and chronic bronchitis, and is characterized by breathlessness. Some people with COPD also experience tiredness and chronic cough with or without mucus,” said Army Maj. (Dr.) Nikhil Huprikar, chief of Pulmonary and Critical Care Medicine Service at Walter Reed National Military Medical Center (WRNMMC).

“COPD makes breathing difficult for the 16 million Americans who have this disease. Millions more people suffer from COPD but have not been diagnosed and are not being treated. Although there is no cure for COPD, it can be treated,” according to the Centers for Disease Control and Prevention (CDC).

To draw greater attention to COPD and educate the public about the disease, November is annually observed as National COPD Awareness Month.

Huprikar, and Army Maj. (Dr.) Arthur Holtzclaw, a pulmonologist and chief of Medicine at WRNMMC, explained symptoms of COPD can vary, but typically include decreased exercise tolerance, cough, and increased sputum production, in addition to breathlessness.

“COPD is usually diagnosed through lung function testing such as spirometry, which measures how well the lungs are working,” Huprikar explained. “A person may have COPD but not notice symptoms until it is in the moderate stage. Therefore, it’s important to ask your doctor about testing for COPD,” the CDC states.

Testing for COPD is especially recommended if a person is a current or former smoker, has been exposed to harmful lung irritants for long periods of time, or has a family history of COPD, Holtzclaw furthered. In many cases, COPD may also be caused by inhaling air pollutants, including tobacco smoking (cigarettes, pipes, cigars, etc.) and second-hand smoke.

Work-related environmental factors, such as fumes, chemicals, and dust have also been linked to COPD.

“Genetics has also played a role in the development of COPD, even if the person has never smoked or been exposed to strong lung irritants in the workplace,” the CDC adds.

There is no cure for COPD, but some treatments can decrease breathlessness and increase a person’s ability to do activities, while other treatments may reduce the risk of exacerbations of the disease, Huprikar explained.

Treatments include inhaled medications called bronchodilators, as well as pulmonary rehabilitation, which can include exercise and oxygen therapy, according to health care providers.

Breathing from the diaphragm is an exercise for COPD. Also called abdominal or belly breathing, the abdomen should rise when you breathe in, and lower as you breathe out when doing diaphragmatic breathing. The diaphragm, the muscle separating the chest cavity from the stomach, is the main muscle for breathing. When the diaphragm tightens, the lungs expand. The diaphragm is designed to do most of the work of breathing. When a person has COPD, the diaphragm doesn’t work as well and muscles in the neck, shoulders, and back are used. These muscles don’t do much to move your air, according to the CDC.

“Training your diaphragm to take over more work of breathing can help,” the CDC adds.

Diaphragmatic breathing is not as easy to do as pursed-lip breathing, so health care providers recommend people get instructions from a respiratory health care professional or physical therapist experienced in teaching it.

For more information about COPD and its treatment, visit the CDC website at www.cdc.gov/copd/features/copd-symptoms-diagnosis-treatment.html.







Date Taken: 11.28.2022
Date Posted: 11.28.2022 12:34
Story ID: 434031
Location: US






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COPD Chronic Obstructive Pulmonary disorder is a respiratory disease which has no cure so it can be treated and prevented. India has seen an alarming number of patients, about 63 million with COPD in the past 10 years, leading to the need for COPD awareness. 

Image Source: Sakra world Hospital

COPD (Chronic Obstructive Pulmonary Disorder) is a respiratory disease which has no cure of it can be treated and prevented. India has seen an alarming number of patients, about 63 million with this disease in the past 10 years, leading to the need for its awareness.

COPD involves a bunch of lung disorders which are caused by the blockage in the airflow in the lungs. It is usually the combined condition of Chronic Bronchitis, swelling of bronchial tubes causing mucus accumulation in the walls and Emphysema, weakened walls of alveoli leading to inadequate supply of oxygen in areas of lungs. These conditions lead to wheezing, chronic cough and shortness in breath that can’t be reversed however can be managed via inhalers and medications.

COPD -India’s Silent Killer Disease

COPD is mainly caused by inhalation of smoke in various forms. India moving towards becoming a developed economically stable country racing in industrialization and urbanization has also lured deadly disease, health crisis and mortality rate. It is a respiratory burden among Indians due to the air pollution caused by vehicles, environmental management and lifestyle changes of smoking from a very young age has elevated its occurrence among the society. It is also prevailing in rural areas due to the usage of mud stoves and their traditional practices.

Lack of COPD awareness

COPD is commonly mistaken as a chronic cough condition and underestimating their effects in the early stages thus resulting in very poor treatment and lifestyle in the later stages. This misconception is spread among many, preventing them from taking medical attention in the beginning. Access to hospitals and doctors and timely checkup routine is being impossible in rural areas as a result of inadequate healthcare professionals and equipment to provide right diagnosis and monitoring the patients through their track records of visits.

risk factors of silent killer copd
Risk Factors of COPD Image source: LifeSource by A&D medical

Need of the Hour Change in COPD management

Awareness of COPD causes, risk factors and treatment should be addressed to the masses. The people should be educated on the severity of COPD and the difference between various respiratory distress and their necessary medical intervention. Skilled and qualified medical officers to be accessible nationwide especially to remote areas of the country.

Deployment of medical instruments for Point of Care Testing devices along with the temperature, SpO2 levels (oxygen saturation levels), blood pressure monitor and pulse rate to be carried by patients. These devices are easy to be trained and taught to people and integrating these tools with AI technology for diagnosis with precision is achieved and coupling them to mobile applications is easier for patients getting in touch with doctors and keeps their records stored 24/7 to aptly manage the COPD condition of patients.

TT (Treatable Trait) management methods in patients exposed to high levels of smoke can help in predicting the COPD incidence in early stages. It is a clinical phenotypic analysis in which the presence of the TT or biomarkers to cause its condition in an individual is screened. This may be passed on hereditary or may be developed due to the damage sustained by a person.

Thus, COPD in India contributes to 32% of the world’s cases. It is high time to precisely follow the prevention and treatment measures meticulously across nations to reduce the mortality rate and improve the patient burden in later stages.

READ MORE:AIIMS RUNNING ON MANUAL MODE FOR 5 DAYS NOW

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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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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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Job description

We are seeking to appoint a Research Assistant as maternity cover to work on a national clinical trial using lay health workers to improve the uptake and completion of pulmonary rehabilitation (PR) by people with chronic obstructive pulmonary disease (COPD). The IMPROVE trial – improvetrial.co.uk 

 

The successful candidate will join a team that has developed a ‘train the trainers’ package for respiratory physiotherapy teams. The physiotherapy teams will recruit, and train lay health workers. The lay health workers are people with COPD, the most common lung disease caused by smoking. They have completed pulmonary rehabilitation themselves and will be trained by the physiotherapists to support COPD patients newly referred for the treatment. We call the lay health workers PR-buddies.  

 

The Research Assistant will work in a multidisciplinary health research team with experts in community trials of innovative treatments and behaviour change techniques. The Research Assistant will work on the recruitment, liaison and support of participating sites, recruitment of participants, and all stages of data collection and analysis.  

 

The post offers the opportunity to work in a dynamic and supportive academic environment that will invest in the appointee’s personal development as a researcher. There will be opportunities to learn both quantitative and qualitative skills during the course of this research.  

 

About us

The trial team includes clinical trialists, a qualitative research expert, a health psychologist, a health economist, a statistician, and a trial manager. We developed the intervention in a feasibility study described in the publications linked here. The team is part of the Primary Care Research Group in the School.   

 

Applicants should hold a first degree and/or a health-related professional qualification. Research experience in a health or social care setting and familiarity with working with the public would be an advantage.

 

KCL Reporting Line: Patrick White, Chief investigator and Professor of Primary Care Respiratory Medicine, King’s College, London 

 

We consider all applications on merit and have a strong commitment to enhancing the diversity of our staff.  

 

This post will be offered on a fixed term contract until 12th February 2024 or on return of the substantive postholder 

This is a full-time post - 100% full time equivalent

 

Key responsibilities

•       Work closely with the research team to deliver the IMPROVE trial - Improving life quality in chronic obstructive pulmonary disease (COPD) by increasing uptake and completion of pulmonary rehabilitation with lay health workers: a cluster randomised controlled trial  

•        Support the trial sites in participant recruitment and delivery of the intervention including visiting trial sites and participants 

•        Contribute to data collection and entry and data quality assurance  

•        Assist with qualitative and questionnaire data collection  

•        Undertake on-going training and personal development as agreed with the chief investigator  

•        Show a commitment to enhancing Equality and Diversity, as well as commitment to the principles of the Athena Swan Charter.  

•        Contributing to reports to the funder and to scientific papers resulting from the trial 

 

The above list of responsibilities may not be exhaustive, and the post holder will be required to undertake such tasks and responsibilities as may reasonably be expected within the scope and grading of the post.  

Skills, knowledge, and experience 

Essential criteria  

1.      Undergraduate degree or health-related professional qualification at degree level 

2.      Demonstrable experience in clinical research 

3.      Demonstrable experience of working with members of the public in a research capacity 

4.      Confident conducting interviews alone in the field  

5.      Committed to equality, diversity, and inclusion, and to actively addressing areas of potential bias 

6.      Willing to travel within the UK to visit trial sites and patient participants

 

Desirable criteria

7.      Research experience in a health or social care setting working with patients/service users 

8.      Previous experience of working with volunteers 

9.      Ability to deliver information effectively through presentations 

 

Candidates are strongly encouraged to specifically address the essential criteria outlined in the Person Specification in their covering letter. 

Further information

The selection process will include a panel interview and written task or presentation.  

 

The School of Life Course & Population Sciences is one of five Schools that make up the Faculty of Life Sciences & Medicine at King’s College London. The School unites over 400 experts in women and children’s health, nutritional sciences, population health and the molecular genetics of human disease. Our research links the causes of common health problems to life’s landmark stages, treating life, disease and healthcare as a continuum. We are interdisciplinary by nature and this innovative approach works: 91 per cent of our research submitted to the Subjects Allied to Medicine (Pharmacy, Nutritional Sciences and Women's Health cluster) for REF was rated as world-leading or internationally excellent. We use this expertise to teach the next generation of health professionals and research scientists. Based across King’s Denmark Hill, Guy’s, St Thomas’ and Waterloo campuses, our academic programme of teaching, research and clinical practice is embedded across five Departments. 

 

More information:   www.kcl.ac.uk/slcps

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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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New research was presented at CHEST 2022, the American College of Chest Physicians 2022 annual meeting, from October 16-19 in Nashville. The features below highlight some of the studies emerging from the conference.

Home-Based COPD Rehab Shows Positive Outcomes

A home-based rehabilitation program for patients with COPD showed highly positive outcomes, according to Roberto P. Benzo, MD, and colleagues. For the study, 375 patients (median age, 69; 59% female) with COPD were randomly assigned to a home healthcare regimen delivered by an app with remote coaching or to a wait list and usual care. The median FEV1 at enrollment was 45% of predicted. Through the app, patients had access to their data to monitor their progress at any time. Patients rated how they felt generally, their level of energy, and their progress toward accomplishing daily goals. They could review and discuss this information with the coach at an appointed time. Improvement in physical and emotional domains of the Chronic Respiratory Questionnaire (CRQ) was the primary outcome of the study. Secondary outcomes included symptoms of depression, physical activity, and sleep quality; healthcare utilization was also examined. Patients randomly assigned to the program had a considerable and clinically meaningful improvement in all areas of the CRQ, including emotional well-being and activity levels at the end of 12 weeks. The study was conducted during the COVID-19 pandemic, when hospital visits for non-COVID-related issues were lower than usual. Combined with the other findings, Dr. Benzo hypothesizes that a drop in healthcare utilization could also be demonstrated in more conventional circumstances.

Racial Disparities Endure in Pulse Oximetry Use

For patients with acute hypoxemic respiratory failure (AHRF) who require high levels of oxygen support, racial biases continue to exist in the use of pulse oximetry devices, according to Amitha Avasarala, MD. This finding, she added, supports well-documented race-based disparities within medicine and further reveals the racial bias in pulse
oximetry. For the study, 112 White patients and 32 Black patients with AHRF treated in an ICU were included. Black patients had a significantly higher oxygen saturation (SpO2) average compared with White patients (97±4 vs 95±4; P=0.041) in comparing direct arterial blood gas readings versus pulse oximetry readings. Race was shown to be a considerable predictor for SpO2 (P=0.019) in regression analysis of arterial oxygen saturation (SaO2). Compared with readings taken from White patients, SpO2 readings from Black patients overestimated oxygen saturation by 0.814%. SpO2 was the only significant predictor of flow rate in regression analysis that included SpO2, SaO2, PaO2, and race. When analyzing for fraction of inspired oxygen—including SaO2, SpO2, PaO2, and race—SaO2 and PaO2 were meaningful. During the COVID-19 pandemic, a greater reliance on pulse oximetry led to an enhanced awareness of race-based inaccuracies in pulse oximetry measurements, the study authors noted. Patients with darker skin are more inclined to experience occult hypoxemia, they explained.

Sepsis Transition May Lessen Mortality in Patients Discharged to Post-Acute Care

Nicholas Colucci Ello, MD, and colleagues presented the results of a study comparing the Sepsis Transition and Recovery (STAR) program to usual care (UC) alone on 30-day mortality and hospital readmission among sepsis
survivors discharged to post-acute care. STAR uses nurse navigators to deliver best-practice post sepsis care during and after hospitalization. The investigation was a secondary analysis of patients from the IMPACTS (Improving Morbidity During Post-Acute Care Transitions for Sepsis) trial, which focused solely on patients who were discharged to a post-acute care facility. The STAR intervention data, Dr. Colucci Ello said, indicate that the
program may lead to decreased 30-day mortality and readmission rates in this patient population. Patients hospitalized with sepsis believed to be at high risk for post-discharge readmission or mortality were randomized to STAR or UC. Among IMPACTS patients discharged to post-acute care facilities, 82% were placed in skilled nursing facilities, whereas 7% were admitted to long-term acute care hospitals; the remaining 11% were admitted to inpatient rehabilitation. The composite 30- day all-cause mortality and readmission endpoint occurred in 30.6% of patients in the UC group versus 20.7% patients in the STAR group, for a risk difference of -9.9% (95% CI, -22.9 to 3.1). As
individual factors, 30-day all-cause mortality was 8.2% in the UC group, compared with 5.8% in the STAR group, for a risk difference of -2.5%, and the 30-day all-cause readmission rate was 27.1% in the UC group, compared with 17.2% in the STAR program. Patients receiving UC experienced, on average, 26.5 hospital-free days, compared
with 27.4 in the STAR group.

Research Backs Extended Criteria for ECMO on Individual Basis

Worse survival was not linked with the inclusion of older and sicker patients in the selection criteria for extra-corporeal membrane oxygenation (ECMO) as a bridge to lung transplant, according to Abdul Wahab, MBBS. The growing need for ECMO support for patients with respiratory failure has put a burden on ECMO resources, Dr.
Waab and colleagues explained. For patients seeking ECMO as a bridge to lung transplant or lung transplant decision (ECMO-BTT), this has created increased scrutiny and limited access. The investigators sought to assess whether ECMO-BTT outcomes are affected by expanded versus standard patient selection criteria. They conducted a retrospective cohort study of adults (N=45) who were placed on ECMO as a bridge to lung transplant procedure, bridge to ECMO-BTT, or who received consultation for lung transplant after being placed on ECMO. Outcomes were compared between two groups: 1) candidates placed on ECMO meeting standard candidate selection criteria and 2)
those who did not. For standard ECMO-BTT criteria, 67.7% of patients met extended criteria, and 33.3% met institutional guidelines. Age older than 55 (26.7%), performing a 6-minute walk distance of less than 180 meters at time of transplant listing (26.7%), and obesity (20.0%) where the main reasons patients did not meet standard or institutional selection criteria. Of total patients, 60.0% survived to hospital discharge, three without lung transplantation. Nearly all (96.0%) patients who received a lung transplant survived to hospital discharge and 1-year post-transplant. Between those who met standard ECMO-BTT selection criteria and those who did not, the study team observed no differences in the odds of receiving a transplant (OR, 1.2), surviving to 1-year post-transplant (OR, 2.1), or surviving to hospital discharge (OR, 1.5), or being delisted or dying on the waitlist (OR, 0.6).

Pulmonary Rehab Hastens Return to Normalcy for Some With COVID

“Pulmonary rehabilitation is an effective intervention in patients with chronic lung disease who have significant dyspnea, poor exercise tolerance, and diminished QOL,” said Pavanjit Singh Dumra, MBBS. He sought to “evaluate the effect of pulmonary rehabilitation in the patients [with] post-COVID-19 lung disease who had similar disabilities.” Dr. Dumra and Aviral R. Tripathi conducted a retrospective observational study, analyzing the data of patients with post-COVID-19 lung disease (N=57) enrolled in pulmonary rehabilitation. Participants underwent an 8-week supervised pulmonary rehabilitation protocol consisting of endurance training, strength training for upper
and lower limb muscle groups, breathing strategies, and balance and coordination training. A 30-second wall push-up test, 30-second sit-to-stand test (STST), Modified Borgs Scale, and St. George’s Respiratory Questionnaire (SGRQ) were performed as outcome measures at the beginning and after completion of rehabilitation. On Borg’s
scale, median post-rehab improvement was 5 points (IQR, 3). Dr. Dumra noted that most patients rated their breathlessness during activity as severe to maximal prior to rehab. After rehab, only 13 patients reported their activity breathlessness as more than very slight (>1 point). Following pulmonary rehabilitation, the median change in SGRQ was 40.04 (IQR, 22.92), the median difference in 30-second wall push-up was 8 (IQR, 5), and the median change in 30-second STST was 7 (IQR, 4). Extremely sick patients, some barely able to speak or exercise prior to rehab, showed considerable improvement after the program.

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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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Chronic obstructive pulmonary disease (COPD) refers to disorders that cause airflow blockage and breathing-related issues. The classic symptoms of COPD include wheezing, coughing, shortness of breath and trouble taking deep breaths. The signs of COPD getting worse could mean you are having a COPD exacerbation.

A COPD exacerbation is sometimes called a flare-up. When symptoms of COPD become worse quickly, it might be an exacerbation. Exacerbations may be triggered by severe allergies, a common cold or a sinus infection.

“If your symptoms become severe, even for a short time, it’s a good idea to tell your health care provider as soon as possible,” said Josephine Mei, M.D., pulmonologist with Norton Pulmonary Specialists.

6 signs COPD is getting worse

  1. Shortness of breath: Of course COPD includes difficulty breathing, but if you are having shortness of breath after climbing stairs or walking up a gentle incline, that is a potential cause for concern.
  2. Wheezing: Inflammation causes narrowing of the airway and can cause wheezing. Not everyone with COPD wheezes, but a study suggested that wheezing is typical in more severe COPD symptoms, more frequent exacerbations and decreased lung function. “Wheezing that comes on quickly or stays constant is a sign to seek medical attention,” Dr. Mei said.
  3. Changes in mucus: Mucus, also called sputum or phlegm, is the sticky material that lines your nose, lungs and sinuses. When you cough or sneeze, you may spit out some of this mucus. The color of the mucus you produce is important.
    “Typically, we see clear or slightly cloudy sputum, but during an exacerbation, it may turn yellow or even green,” Dr. Mei said. “That could mean an infection in the lungs.”
  4. Changes in cough: Coughing is a typical symptom of COPD, but a cough that gets worse or persists for several weeks — or if it is accompanied by chest pain — should be investigated by your health care provider.
  5. Fatigue: “Feeling tired or worn out is a common symptom of COPD, because your body has to work harder to get oxygen to the cells,” Dr. Mei said. If you’re feeling extra worn out or fatigued, it is wise to call the doctor. You also may be groggy in the morning as a result of a lack of oxygen or sleep apnea.
  6. Swelling: Also known as edema, swelling occurs in the legs, ankles and feet.
    “You can gain anywhere from 5 to 15 pounds from the fluid retained,” Dr. Mei said.
    Other conditions such as pulmonary hypertension and congestive heart failure may contribute to swelling.

Norton Pulmonary Specialists

Chronic obstructive pulmonary disease (COPD) is treatable, especially when diagnosed early. If you experience shortness of breath, frequent cough or wheezing, talk to your health care provider.

How to prevent COPD flare-ups

“Stopping smoking is the most important step if you have COPD,” Dr. Mei said. “That includes staying away from other people who are smoking.” Dr. Mei also advises monitoring weather alerts so you can reduce exposure to the outdoors on poor air quality days.

Some genetic reasons contribute to developing COPD. Be sure to give your health care provider a full health history, in case those genetic conditions can be caught early and possibly slow or stop the onset of COPD.

You also should stay current on your vaccinations such as flu, pneumonia and COVID-19. Talk to your health care provider about medications and exercise programs that can help you stay healthier longer.

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KUALA LUMPUR, Nov 23 – Chronic obstructive pulmonary disease (COPD) is associated with substantial humanistic and socioeconomic burden on patients and the society. It has risen to be one of the top three causes of death worldwide; 90 per cent of these deaths occur in low- and middle-income countries.

Although it is preventable and treatable, it is still a major cause of disability and death throughout the world.

COPD is characterised by persistent respiratory symptoms such as cough and shortness of breath. These symptoms are brought about by disease to the airway and the lungs that are usually caused by exposure to noxious particles and gasses. 

Smoking is the primary risk factor, while others include environmental pollution, exposures to occupational hazards, and burning of fossil/ wood-based fuels.

World COPD day is observed on every third Wednesday of November and this year, it falls on November 16, 2022. The theme for this year, “Your Lungs for Life”, aims to highlight the importance of educating the public about the risks associated with COPD to promote lifelong lung health and to protect vulnerable populations.

The rise in smoking, urbanisation, industrialisation, environmental pollutants and an ageing population is resulting in a marked increase in the number of COPD cases. It currently affects more than 10 per cent of the world’s population and is responsible for three million deaths annually.

A high prevalence of smoking among the Malaysian adult population means that they are at a higher risk for developing COPD. This causes a huge economic burden on our health care as COPD is the fourth leading cause of hospitalisation in Malaysia. 

In 2010 alone, 448,000 cases were reported with an estimated treatment cost of a staggering RM2.8 billion.

Most of the admissions are due to sudden attacks of breathlessness (acute exacerbations). On top of that, individuals with COPD are also at risk to develop other associated medical conditions such as coronary artery disease, irregular heart rhythm (atrial fibrillation), lung cancer, depression, and anxiety. Treatments of these conditions further add to the economic burden of COPD.

In conjunction with World COPD Day, the Pulmonology Department of Serdang Hospital, a Ministry of Health facility in Selangor, organised an open event at the main lobby of Serdang Hospital, where booths were set up that display the services and treatments provided with emphasis on educating the public as well as health care workers, regarding COPD, including the treatments available. 

The event featured booths from the rehabilitation department and pharmacy to give the public a unique insight into the various treatment options available, from medications to various therapies provided.

Prevention is always key when it comes to treatment and prevention of COPD. Smoking cessation is of utmost importance not only for those suffering from COPD, but the general public as well. 

Access to the latest treatments is limited in most low- and moderate-income countries due to the cost factor, so prevention goes a long way.

Pulmonary rehabilitation can also be offered to patients with COPD to enhance their self-care ability and to help them stay as active as possible within safe limits of their capabilities. 

It is a programme that helps introduce and gradually increase a patient’s level of exercise in order to improve breathing and ability to perform daily or recreational activities and live a fulfilling life.

If a patient fails to improve with medications and pulmonary rehabilitation, more invasive treatments like bronchoscopic lung volume reduction (BLVR), i.e. inserting one-way valves into the airways, can be done for selected COPD patients with emphysema phenotype, and in certain cases, they can be evaluated for lung transplant. 

BLVR is offered at Serdang Hospital, while lung transplant assessment is done by the hospital’s Lung Transplant Unit. The lung transplant surgery is done at Institut Jantung Negara (IJN).

The World COPD day event aims to highlight the serious burden of COPD not only to patients, but to their family and the economy. 

Knowing the risks associated with the development of COPD brings to light the importance of public education regarding the dangers of smoking, environmental protection and adequate protective gear in working environments with high rates of exposure to noxious substances. 

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Among patients with chronic obstructive pulmonary disease (COPD) and severe chronic breathlessness, short-term daily treatment with low doses of extended-release morphine did not significantly reduce the intensity of worst breathlessness, a randomized trial showed.

At 1 week, change in the intensity of worst breathlessness was not significantly different between patients who received 8 mg/day of morphine and those who received placebo (mean difference -0.3, 95% CI -0.9 to 0.4) or between those who received 16 mg/day of morphine and the placebo group (mean difference -0.3, 95% CI -1.0 to 0.4), reported Magnus Ekström, MD, PhD, of Blekinge Hospital in Karlskrona, Sweden, and colleagues.

"The lack of efficacy was consistent across severities of breathlessness (modified MRC [Medical Research Council] breathlessness scale score of 3 or 4)," they wrote in JAMA.

After 3 weeks, the secondary outcome of change in mean daily step count was not significantly different between any of the following morphine groups versus placebo:

  • 8 mg: mean difference -1,453 (95% CI -3,310 to 405)
  • 16 mg: mean difference -1,312 (95% CI -3,220 to 596)
  • 24 mg: mean difference -692 (95% CI -2,553 to 1,170)
  • 32 mg: mean difference -1,924 (95% CI -47,699 to 921)

That these physiological variables were not altered by the study intervention "indicat[es] that the fear of significant respiratory depression associated with use of opiates at these doses in patients with COPD is unwarranted," noted Richard M. Schwartzstein, MD, of Harvard Medical School in Boston, in an accompanying editorial.

Among ambulatory COPD patients, chronic breathlessness is well known to lead to decreased physical activity and muscular and cardiovascular deconditioning, which may explain why "the symptom of dyspnea is a better predictor of mortality than forced expiratory volume in the first second of expiration, a measure of the severity of airway resistance on spirometry in patients with COPD," he wrote.

He pointed out that "extended-release opiates are typically reserved for patients with dyspnea at rest, often in the setting of palliative care at the end of life," but this study did not "specifically comment on dyspnea at rest."

"The absence of dyspnea at rest would call into question the premise for use of daily long-acting opiates instead of rapid-onset, short-acting opiates as needed prior to planned exertion ... [which] would minimize the adverse events associated with opiate use," he added.

Schwartzstein noted that pulmonary rehabilitation improves exercise capacity and reduces dyspnea in patients with COPD, even though their lung function is not altered. The absence of any improvement in activity may be explained by habitual avoidance of activities that may provoke dyspnea, and reduced activity due to muscular fatigue as opposed to breathing capacity, "both of which may improve with pulmonary rehabilitation."

Other benefits of pulmonary rehabilitation include breathing training to minimize dynamic hyperinflation and to provide a sense of control during activity, "which may reduce the fear and anxiety associated with the breathing discomfort" and help desensitize patients to dyspnea, he wrote.

This multicenter double-blind trial enrolled 156 people with COPD and chronic breathlessness from 20 centers in Australia between September 2016 to mid-November 2019. Median age was 72 years, and 48% were women.

Participants were randomized 1:1:1 to 8 mg or 16 mg of oral extended-release morphine or placebo during week 1. At the start of weeks 2 and 3, they were randomized 1:1 to 8 mg, which was added to the prior week's dose, or placebo.

At follow-up through Dec. 26, 2019, 88% of patients completed treatment at week 1 (48 in the 8 mg group, 43 in the 16 mg group, and 47 in the placebo group).

The primary outcome of severe chronic breathlessness was defined as a modified MRC breathlessness scale score of 3 or 4 (score range 0-10), corresponding to patients' reports of being "too breathless to leave the house," or "breathless when dressing," despite optimal treatment for underlying causes, Ekström and team noted.

Treatment-emergent adverse events (TEAEs), including constipation, fatigue, dizziness, nausea, and vomiting, occurred in 64% of the 8-mg group, 78% of the 16-mg group, and 48% of the placebo group during week 1, and "did not appear to be associated with study drug adherence," the group wrote.

Serious TEAEs included increased breathlessness, infections, morphine-related adverse events, hospitalizations, and deaths, and occurred in 33% of those who received any dose of morphine compared with 12% of those taking placebo.

Ekström and colleagues acknowledged that only 42% of patients completed treatment at week 3, which was a limitation to the study. Other limitations included assessment of breathlessness in daily life and not during standardized exercise testing, and potential underdosing of long-acting morphine due to the 24-hour dosing interval.

"Further research is needed to determine if specific groups of people with COPD are more likely to experience a reduction in breathlessness with morphine, if some may benefit from higher doses of morphine, and to clarify the role of short-acting opioids for severe episodes of breathlessness," Ekström and colleagues wrote.

  • author['full_name']

    Kate Kneisel is a freelance medical journalist based in Belleville, Ontario.

Disclosures

This study was funded by a grant from the National Health and Medical Research Council of Australia and sponsored by Flinders University, Adelaide, Australia.

Ekström reported receiving a grant from the Swedish Research Council.

Co-authors reported multiple relationships with government entities and foundations, as well as pharmaceutical companies.

Schwartzstein reported serving as a medical education consultant to a law firm.

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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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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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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!

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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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