Wellinks is investigating whether its chronic obstructive pulmonary disease (COPD) virtual management program — which offers health coaching, lung rehabilitation, and monitoring through connected devices and a mobile app — can reduce hospital readmission among people with COPD.

To test the platform, the healthcare company has teamed up with Hartford HealthCare to launch a clinical trial involving about 150 adults with COPD who have been hospitalized due to an exacerbation, or a sudden worsening of their symptoms.

The goal of the trial, called the “Prospective, Observational Study of Wellinks Effect on COPD Hospital Readmissions” — POWER — is to determine if the online platform can cut the number of hospital readmissions needed for these patients.

“COPD is a complex medical condition that requires a multidisciplinary team approach. When patients are recovering from hospitalization, care gaps are difficult to close and can have a negative impact on outcomes,” Abi Sundaramoorthy, MD, chief medical officer at Wellinks, said in a press release.

“Wellinks is designed to bridge these gaps to engage and empower patients regardless of their access to traditional in-person resources. We are eager to work with Hartford HealthCare to advance the clinical evidence for virtual-first COPD care while helping more patients live fully and breathe freely,” added Sundaramoorthy.

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COPD patients may experience acute exacerbations, which are characterized by severe shortness of breath, persistent cough, fatigue, and swelling of the legs or ankles. Such exacerbations often lead to hospitalization and prolonged care, and are generally associated with poor outcomes.

“Although COPD is the third leading cause of death by disease in the United States, estimated to cost $49 billion in care annually, innovation in COPD care has trailed other disease states,” said Syed Hadi, MD, a Hartford HealthCare hospitalist.

“Acute exacerbations of COPD often result in hospitalization, and a quarter of patients will be readmitted to the hospital within 30 days,” Hadi said.

In the POWER trial (NCT05330507), participants will be provided with 16 weeks (about four months) of the Wellinks platform. This includes a connected spirometer to measure the volume of inhaled and exhaled air, a pulse oximeter to measure blood oxygen levels, virtual respiratory therapist sessions with lung rehabilitation, and coaching sessions. All participants will receive mobile application access and COPD-related education.

The four-month period consists of a 30-day post-discharge period, followed by a three-month intensive program. During the first month, participants will receive virtual respiratory therapist sessions twice a week, along with simultaneous lung rehabilitation. In the three-month period, patients will have virtual health coaching sessions once every two weeks, and the lung rehabilitation program will no longer be held at the same time.

In both phases, participants will have at-home access and use of the connected spirometer, pulse oximeter, and mobile app.

Primary study goals will be to determine the rate of hospital readmission, changes in quality of life, and exercise capacity. The trial also will evaluate patients for shortness of breath and the program’s impact on their daily activities.

Other objectives include assessing mobile app use, as well as the use of the other devices throughout the study period. Participant-reported satisfaction with the management program also will be determined.

According to Wellinks, integrated COPD care can significantly reduce 30-day hospital readmission, as well as the associated costs. Additionally, a small pilot study conducted by the company showed that older adults with COPD found the Wellinks health mobile app useful and valuable for managing the disease.

In collaboration with the COPD Foundation’s COPD Patient-Powered Research Network (COPD PPRN), Wellinks also is conducting a 24-week study. That trial, called ASPIRE (NCT05259280), is assessing the platform’s impact on health-related quality of life, healthcare resource utilization, and lung function.

The trial is currently only enrolling by invitation.

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Black lung is a type of lung disease that’s caused by long-term inhalation of coal mine dust. The condition is also known as coal workers’ pneumoconiosis (CWP) or miner’s lung.

The disease has a long history as a work-related illness. That’s because inhaling coal mine dust commonly happens in those who work in mines. It rarely occurs in the general environment.

Black lung is still prevalent in coal workers today. Additionally, without treatment, black lung can cause serious complications such as heart failure, tuberculosis, and lung cancer.

Read on to learn more about the causes, symptoms, and treatment options for black lung, plus how to reduce your risk.

The type and severity of black lung symptoms depend on the level of coal mine dust exposure.

The symptoms can develop over many years. As a result, most people don’t start showing signs of black lung disease until they’re closer to retirement age.

Common symptoms of black lung include:

In some cases, black lung might not cause obvious symptoms.

The main cause of black lung is inhaling coal dust over time. It primarily affects people who work in coal mines. Black lung rarely occurs in people not regularly exposed to coal dust.

Coal dust consists of carbon-containing particles that are harmful to the lungs. In some cases, coal workers might also inhale silica-containing particles.

When you inhale coal dust, the particles settle into the alveoli in your lungs. Alveoli are small air sacs that help your lungs take in oxygen. If coal dust gets into your alveoli, your lung tissue attempts to fight and remove the particles. This results in chronic lung inflammation, which can cause scarring over time.

Black lung is classified as:

  • Simple: This type involves small amounts of scarring in lung tissue. It appears as small circular bumps on a chest X-ray or CT scan.
  • Complicated: Also known as progressive massive fibrosis, this type involves severe scarring. It also affects a more widespread area of the lung.

People who work in coal mines of all sizes can develop black lung. Specifically, the following jobs present a higher risk:

  • continuous miner operators
  • shuttle car operators
  • surface drillers and blasters
  • high wall and thin seam miners

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Normal lung vs black lung disease
Photo credit: National Institute for Occupational Safety and Health – NIOSH

A healthy lung looks pink. A black lung, which has been exposed to coal mine dust, has black nodules due to scarring. The black area will get bigger as the scarring becomes more severe.

There’s no test for diagnosing black lung. Your doctor will use different methods to determine if you have the disease. This will likely include the following:

  • Medical history: Since black lung is associated with certain careers, your doctor will want to learn more about your job history. They’ll also ask questions about your symptoms.
  • Physical exam: A physical exam allows your doctor to examine your chest area and listen to your breathing.
  • Breathing tests: These tests will measure how well your lungs can inhale oxygen.
  • Imaging tests: A chest X-ray or CT scan will allow your doctor to see inside your lungs. They’ll look for scarring and inflammation.

Black lung affects about 16 percent of coal workers, both old and young miners alike.

There’s no cure for this disease. As such, the goal of treatment is to ease symptoms and reduce the risk of complications.

This can be done by using:

  • Medication: Your doctor will likely prescribe medication that reduces inflammation in your lungs and supports breathing.
  • Pulmonary rehabilitation: During pulmonary rehabilitation, you’ll learn exercises to improve your lung strength and breathing abilities This can help you stay active and breathe more effectively.
  • Supplemental oxygen: Also called oxygen therapy, this treatment uses a device that delivers extra oxygen into your lungs. It’s used for severe cases of black lung disease.
  • Lung transplant: In this procedure, one or both of your lungs is replaced by lungs from a donor. It’s only used in very severe cases.

Without symptom management, black lung can lead to complications like:

In 2016, the Centers for Disease Control and Prevention (CDC) reported that black lung decreases life expectancy by 12.6 years.

Not all coal workers develop black lung. However, it’s a preventable disease, and certain methods may help reduce the risk.

For coal miners, prevention strategies include:

  • wearing an appropriate respirator while working
  • washing skin that’s exposed to coal dust
  • safely removing coal mine dust from clothing
  • washing your hands and face before eating or drinking

If you work in or near a coal mine, it’s also a good idea to get regular physical checkups. This will allow your doctor to monitor your lung function and breathing and to notice any warning signs in the early stages.

Black lung, or coal workers’ pneumoconiosis, is caused by inhaling coal dust over a long period of time. The condition is most common in coal workers.

Symptoms include coughing, difficulty breathing, and producing black mucus. Over time, the condition can lead to complications like tuberculosis, COPD, and lung cancer. It can also reduce life expectancy and cause premature death.

There’s no cure for black lung, but treatment can help relieve symptoms and reduce the risk of complications. Treatment usually includes medication, oxygen therapy, and pulmonary rehabilitation.

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A recent study found that pulmonary rehabilitation after hospitalization for chronic obstructive pulmonary disease (COPD) resulted in a net cost savings.

A study published in JAMA Network Open found that pulmonary rehabilitation (PR) was effective at reducing costs for patients with chronic obstructive pulmonary disease (COPD) after a hospitalization. They also found improvements in quality-adjusted life expectancy (QALE) for patients who went to PR.

The researchers created a Markov microsimulation model of outcomes after a hospital discharge for a COPD-related hospitalization. They compared a situation with universal PR vs no PR in the US health care system, and they used a lifetime time horizon but assumed that PR would occur within 90 days of index admission, PR would not continue after the first year, and PR would have no cost outcomes beyond the first year.

Data came from literature published between October 1, 2001, and April 1, 2021. The primary data source for this study was an analysis of Medicare beneficiaries who were living with COPD between January 1, 2014, and December 31, 2015; patients in this study had a mean age of 76.9 years and 58.6% of them were women.

Model parameters were taken from 2 analyses of fee-for service Medicare enrollees who were 65 years or older and hospitalized for COPD in 2014. Estimates from the propensity-matched cohorts were used for 1-year mortality, hospital readmission, and number of days per person-year in the hospital calculations. All costs were represented in 2020 US$.

PR was demonstrated as having a lifetime net cost savings of $5721 (95% prediction interval, $3307-$8388) per patient and an improved QALE (gain of 0.53 years; 95% prediction interval, 0.43-0.63) due to reductions in number of days in the hospital or skilled nursing facility.

Researchers found that the savings in the first year after hospitalization were $8226 (95% prediction interval, $5348-10,873); mean savings in the first year were $8667 per patient for the health system perspective.

PR remained cost saving even if it only prevented readmissions and didn’t improve quality of life or mortality (mean savings, $7607 per patient) unless the HR for readmission was less than 0.89. Incremental quality-adjusted life-years would decrease to 0.41 (compared with 0.43) if PR did not improve quality of life but reduced rehospitalizations and mortality.

There were some limitations to this study. The results of this study depend on the validity of the model; validity, precision, and applicability of the data used for parameters; and the extent of plausible scenarios being explored. The study’s primary source used propensity weighting to account for differences between patients who used PR and did not use PR. However, estimates of the distribution of Global Initiative for Obstructive Lung Disease stages came from European studies that may not be generalizable.

The analysis used the distribution of attended PR visits rather than a completed PR course, which may underestimate cost and effectiveness. Costs vary by region, which may have led to an underestimation of cost of PR in specific locations. The results of the study were also not validated.

The researchers concluded that their study suggests that PR was effective in saving money in patients who had been hospitalized with COPD. QALE was also improved in patients with COPD who underwent PR after hospitalization.

“Given these findings, payers­—particularly Medicare—would identify policies that would increase access and adherence to PR programs for patients living with COPD,” the authors wrote.


Mosher CL, Nanna MG, Jawitz OK, et al. Cost-effectiveness of pulmonary rehabilitation among US adults with chronic obstructive pulmonary disease. JAMA Netw Open. 2022;5(6):e2218189. doi:10.1001/jamanetworkopen.2022.18189

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Pulmonary rehabilitation refers to a medical program that aims to help people with lung conditions breathe better and maintain a higher quality of life. There are many benefits to enrolling in these programs.

Chronic obstructive pulmonary disease (COPD) is a group of long-term conditions that cause airflow blockages and breathing problems. It affects 16 million people in the United States.

A person with COPD can get many benefits from participating in a pulmonary rehabilitation program. These include building strength, reducing anxiety or depression symptoms, and making daily tasks easier.

Other components of these programs include education and counseling. A participant can learn how to cope better with their condition and feel their best.

Keep reading to learn more about pulmonary rehabilitation programs, including their various components, the enrollment process, and how they can help individuals with COPD.

Pulmonary rehabilitation is a comprehensive outpatient program of exercise and education for people with COPD. It involves training people on the following aspects: exercise, breathing techniques, education, and counseling.

It consists of two to three weekly sessions that continue for several weeks or months. The program provides the tools and knowledge that people living with lung diseases need to manage their symptoms and improve their quality of life.

A rehabilitation team administers the program. Its members include:

  • doctors
  • nurses
  • respiratory therapists
  • physical therapists
  • dietitians
  • exercise specialists

The team works together to customize the program to a person’s particular needs.

Although the program has the potential to offer several benefits, some aspects of the training may come with a few risks. However, a healthcare professional supervises the exercise sessions, which means that if a participant does encounter a serious problem, they can receive treatment immediately.

Pulmonary rehabilitation involves several components:

Exercise training

The goal of exercise training is to strengthen the muscles that play a role in breathing and other muscles in the body, such as those in the arms, legs, and back. Exercise also increases flexibility and endurance, which can make it easier to perform everyday tasks.

When engaging in physical activity, a person may need to adjust their oxygen therapy and use medications that open the airways. Additionally, before a healthcare team designs a customized program, it may be necessary for an individual to undergo the following tests:

  • Stress test: This test measures heart rate, oxygen, and blood pressure during exercise.
  • 6-minute walk test: Healthcare professionals use this test to determine how far someone can walk in a short time.
  • Breathing tests: These tests evaluate lung function.

Breathing training

Breathing training may involve teaching people how to use the following techniques:

These techniques may help a person control their breathing and avoid feeling out of breath, particularly when they are experiencing stress or engaging in physical activity.

People may also find that these techniques help clear mucus from the lungs.

Nutritional counseling

Nutritional counseling involves teaching people what foods to eat and how to prepare them. It helps ensure that a person gets enough essential nutrients in their diet.

For some individuals, a dietitian may also advise taking certain dietary supplements, sticking to a weight loss plan, or taking certain medications to meet the goals of the program.

Psychological counseling

As people with long-term lung conditions may experience depression, anxiety, or other emotional problems, pulmonary rehabilitation provides psychological counseling.

This may also include stress management training.


The delivery of the educational aspect of the program may take place in individual or group sessions. Healthcare professionals offer guidance on various topics relating to the relevant lung condition and answer participants’ questions.

Through the program, people may learn how the lungs work and develop a better understanding of:

  • taking medications for lung conditions
  • quitting smoking
  • recognizing and managing a flare-up
  • performing everyday tasks in a way that conserves energy
  • avoiding lifting, reaching, and bending

According to the COPD Foundation, pulmonary rehab can benefit people with lung conditions by:

  • increasing exercise capacity
  • decreasing breathlessness and shortness of breath
  • reducing depression and anxiety
  • boosting stamina and energy levels
  • enhancing feelings of well-being
  • improving the ability to do everyday tasks
  • increasing the ability to manage the lung condition
  • promoting active communication with healthcare teams
  • allowing people with similar concerns to connect and share ideas

Research indicates that the program is effective and provides several benefits.

Impact on survival rates

A 2020 study looked into the effects of pulmonary rehabilitation following hospitalization for COPD. The researchers compared the effects of enrollment in a program with those of no enrollment. They looked at enrollment within 3 months of hospital discharge and at a later stage.

Although enrollment within 3 months was rare, it was associated with significantly higher 1-year survival rates than enrollment after 3 months or no enrollment.

However, the study had several limitations. For instance, the participants who started a pulmonary rehab program within 3 months were younger and less frail than those in the other groups.

Beneficial for people with COPD

An older 2013 review looked at research that explored the value of pulmonary rehabilitation for COPD. The authors report that pulmonary rehabilitation can have the following benefits:

  • reducing breathlessness
  • improving endurance and strength
  • enhancing psychological health
  • decreasing the rate of hospital admissions
  • increasing the ability to perform everyday activities
  • improving a person’s quality of life

Yes, although people attend the sessions in a hospital or clinic, they can do some exercises of the program at home.

Research from 2015 evaluated the effectiveness of the exercise component of home-based pulmonary rehabilitation. A total of 29 individuals participated in an exercise program while a control group of 15 people did not exercise. The intervention involved sessions 5 days per week for a total of 24 sessions. The researchers concluded that home-based pulmonary rehabilitation improved exercise tolerance, decreased shortness of breath, and enhanced quality of life.

Below is information on enrollment costs and finding a program:


The cost depends on the program, its location in the country, and insurance coverage. A person can ask their insurance provider if, and to what extent, it offers coverage.

Also, if a person with COPD meets certain criteria, Medicare covers the program.

The coordinator of the program can provide information on what cost to expect.

Finding a program

People interested in enrolling themselves should start by contacting a doctor, who can give them a referral.

Health agencies are another resource for help with locating a program. People can contact the American Lung Association Lung HelpLine at 800-LUNGUSA (800-586-4872).

Alternatively, they can reach the American Association of Cardiovascular and Pulmonary Rehabilitation by dialing 312-321-5146.

If a pulmonary rehabilitation program is not available in a person’s area, they can still benefit from an exercise routine. Before starting, they should ask a doctor to suggest one that is appropriate for them. One of the most important exercises for a person with a lung condition is walking, but a doctor can make specific recommendations regarding the duration and frequency.

Pulmonary rehabilitation is a program that offers exercise training, breathing training, education, and counseling. It provides multiple benefits for people with COPD, including increased exercise capacity, the ability to perform everyday activities, and a reduction in breathlessness and negative emotions.

If a program is unavailable in a person’s area, they can still benefit from participating in a home exercise routine. However, it is best to talk with a doctor before starting.

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The global respiratory care devices market has been gaining traction in the last few years. A significant rise in the geriatric population is one of the major factors estimated to encourage the growth of the overall market in the next few years. The growing prevalence of respiratory diseases and the growing incidence of preterm births are further predicted to accelerate the overall growth of the market in the coming years. In addition to this, the changing lifestyle of consumers and the rising prevalence of tobacco smoking are further estimated to accelerate the growth of the market in the coming years.

Furthermore, the high rate of urbanization and the rising pollution levels are likely to generate promising growth opportunities for the market players in the next few years. On the flip side, the rising concerns related to the reimbursement and the availability of low-cost products from the local manufacturers are some of the key factors that are likely to restrict the growth of the global respiratory care devices market in the next few years. In addition to this, the harmful effects of several devices on neonates and the lack of awareness and the large undertreated and underdiagnosed population are some of the other factors that are predicted to restrict the growth of the overall market in the near future.

The rising demand for home care therapeutics devices and the high growth in several emerging nations across Latin America and Asia Pacific are predicted to enhance the growth of the global market in the coming years. Furthermore, a substantial rise in the demand for multimodal ventilators and the growing demand for enhanced portable devices are estimated to generate promising growth opportunities for the market players in the next few years. Thanks to these factors, several new players are estimated to enter the global respiratory care devices market in the coming years.

Global Respiratory Care Devices Market: Overview

Respiratory care devices are medical devices focusing on the diagnostics, treatment, control, and management of patients suffering from disorder in cardiopulmonary system. These devices are known to be reliable in providing enhanced care to patients suffering from acute and chronic respiratory abnormalities. They are primarily used as therapeutic devices, diagnostic devices, monitoring devices, and consumables and accessories. Their demand is high among end users such as hospitals, ambulatory care, and home care.


Global Respiratory Care Devices Market: Key Trends

The increasing prevalence of chronic obstructive pulmonary diseases (COPD) and other respiratory diseases such as asthma and tuberculosis is the primary factor augmenting the global respiratory care devices. The growing global population of aged people is creating a staggering demand for respiratory care devices owing to the fact that they are more susceptible to respiratory disorders. Moreover, skyrocketing pollution levels and rising incidence of tobacco smoking are working in favor of the market.

However, the lack of reimbursement policies is limiting the widespread adoption of respiratory care devices. The low-cost products offered by local manufacturers are creating pricing pressure on international players. As a result, large manufacturers are selling their products at competitive pricing, which in turn is adversely affecting the overall revenue generation of the market

Global Respiratory Care Devices Market: Market Potential

Various studies indicate that over 1 billion people across the world suffer from respiratory challenges such as CHF (congestive heart failure), COPD (chronic obstructive pulmonary disease), and asthma, with about 80 million cases in the U.S. alone. The high prevalence is creating a pressing need for reliable breathing monitoring, training, and therapeutic devices for these patients in the hospitals and at home. This is prompting players to develop technologically advanced devices that can be cost-effective and improve patient outcomes across the continuum of care at home and hospitals. For instance, in November 2016, ADM Tronics Unlimited Inc. entered into a strategic agreement with QOL Devices Inc., regarding new respiratory training and therapy platform trademarked "Alvio™" by QOL. Alvio is based on cloud technology and will be designed for use in non-regulated respiratory training applications and medical respiratory indications. Therefore, the birthing of advanced products in the near future is likely to revolutionize the global respiratory devices market.


Global Respiratory Care Devices Market: Geographical Segmentation

North America and Europe will account for a substantial cumulative share in the market throughout the review period. The presence of highly developed healthcare infrastructure and high technical acumen among end users to operate technologically advanced respiratory devices are contributing to the growth of the market in the regions. The widening base of patients suffering from respiratory diseases due to the increasing adoption of smoking and drinking habits is also fuelling the growth of these regions.

Moreover, the growing geriatric population and rising funding by governments in the healthcare sectors are supplementing the growth of Europe and North America. On the other hand, Asia Pacific is expected to rise at a tremendous CAGR during the same period. The robust growth of the healthcare sector along with increasing expenditure on healthcare is one of the primary factors propelling the growth of the region. The rising per capita income and burgeoning demand for cutting-edge technologies are translating into the greater uptake of respiratory care devices in the region.

Global Respiratory Care Devices Market: Competitive Landscape

The majority of players in the global respiratory care devices market are focusing towards expanding their shares through product launches and technological advancements. The trend is likely to render the market a highly competitive arena in the near future. Some of the prominent companies operating in the market are Philips Healthcare, Medtronic Plc., Fisher and Paykel Healthcare Limited, Drägerwerk AG & Co. KGaA, CareFusion Corporation, Becton, Dickinson and Company, and Hamilton Medical AG.


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Bananas may be beneficial for people with chronic obstructive pulmonary disease (COPD). They are potassium-rich and contain antioxidants and fiber. Other sources of these nutrients are berries and whole grains.

COPD is a group of diseases, including emphysema and chronic bronchitis. These conditions cause a blockage to the airflow and difficulty breathing.

COPD affects millions of Americans and is the third leading cause of disease-related death in the United States.

Depending on the severity, people can make lifestyle and dietary changes to manage the condition.

This article looks at how bananas may benefit COPD and what the research says. We also discuss other fruits and foods to eat for optimal lung function. Finally, we provide general dietary tips for managing COPD.

Bananas are a healthy food containing vitamins, minerals, and fiber. The studies below demonstrate the nutritional benefits of bananas for COPD.

May improve lung function

An older study examining over 2,000 participants with COPD in a specific cohort found those who ate bananas had better lung function measures over a 3-year period. The research associated bananas with better clinical outcomes, including less emphysema, walking scores, and forced expiratory volume — how much air a person can exhale during a forced breath.

Potassium may prevent exacerbation of COPD

Bananas are a good source of potassium, which may be beneficial in COPD.

A 2020 study of 81 patients with acute exacerbations of COPD found that potassium levels are lower in these people compared to controls. The study also associated lower potassium levels with higher death rates in COPD patients.

According to a 2022 study, 16% of patients presenting to the emergency room with exacerbation of COPD have low potassium, which doctors call hypokalemia. However, the study authors did not find an association between hypokalemia and adverse outcomes in patients presenting with an acute exacerbation of COPD.

Therefore, including bananas in the diet may be helpful. One banana contains 375 milligrams of potassium, providing 8% of the Daily Value (DV) of potassium — how much a nutrient in one serving of food contributes to the recommended DV of the nutrient.

However, another 2019 study indicates high potassium levels (hyperkalemia) were only present in 6.7% of all people with COPD. Although some of these cases may be due to the medications which raised potassium levels, it may be sensible not to overeat bananas.

41% of COPD patients with hyperkalemia were taking medications that may potentially have raised potassium levels. Therefore, it may be sensible to eat bananas in moderation, as with all other foods.

People with COPD and kidney disease may need to limit their potassium intake, so it is important to check with their healthcare professional before adding high potassium foods such as bananas into their diet.

Everyone should include fruit as part of a balanced diet. The Dietary Guidelines for Americans 2020–2025 recommends that a person eating 2,000 calories a day, consumes 2 cups of fruit.

A study from 2021 suggests that people who eat an antioxidant-rich diet have higher lung function scores. Therefore, eating fruits high in antioxidants, such as blueberries and strawberries, may help reduce symptoms.

For example, a 2020 study found that participants with COPD who ate grapefruit had better lung function than those who did not. The authors comment that the effects may be due to the anti-inflammatory and antioxidant properties of the fruit.

2021 research associates the following antioxidant-rich fruits and vegetables with a lower risk of chronic disease:

High antioxidant-rich fruits

Some examples of fruits with a high concentration of antioxidants include:

High antioxidant-rich vegetables

Certain vegetables to include in an antioxidant-rich diet are:

A person can also speak with a dietitian to help them plan which fruits and vegetables to eat as part of their diet.

Read more about antioxidant foods.

The American Lung Association advises that the right mix of nutrients can help someone with COPD breathe easier. It explains that the metabolism of carbohydrates produces the most carbon dioxide for the amount of oxygen used. Conversely, the metabolism of fat produces the least. Therefore, for some people with COPD, eating a diet with fewer carbohydrates and more fat helps them breathe easier.

Additionally, the association has the following dietary tips:

  • choose complex carbohydrates, such as whole grain bread and pasta, fresh fruits and vegetables
  • limit simple carbohydrates such as:
    • table sugar
    • candy and cake
  • eat 25–30 grams of fiber each day by consuming food such as:
    • nuts and seeds
    • whole grains
    • legumes
    • fruits and vegetables
  • choose plant sources of fats and oils such as:
  • limit trans fats and saturated fats in:
  • stay hydrated by drinking 6–8 glasses of water per day
  • drinking water 1 hour after meals to avoid feeling too full
  • avoid consuming too much salt
  • try eating 4–6 smaller meals per day to allow the diaphragm to move more freely
  • avoid foods that cause gas or bloating

As a rich source of potassium, eating bananas may help someone avoid low potassium levels, which could exacerbate symptoms of COPD. In addition, bananas are a fiber-rich complex carbohydrate and contain several other vitamins and minerals that contribute to overall health and well-being.

Many fruits contain antioxidants with higher levels in berries and other foods such as whole grains, seeds, and nuts. Therefore, including these foods in the everyday diet could help people with COPD manage their condition.

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Using best is class healthcare technology can literally mean the difference between life and death for many patients.

A case in point is the rapidly expanding, $1.4bn portable oxygen concentrator (POC) market, devices which also offer considerable quality of care, treatment, out-of-hospital and mobility benefits.

Here industry disruptor Belluscura (BELL Follow | BELL) is setting the pace. Since launching only 9 months ago, its next generation POCs - which help patients with severe respiratory conditions such as COPD, pneumonia, long Covid – have enjoyed considerable interest. In fact, demand has been so strong that house broker Dowgate has already upgraded its forecasts on several occasions.

Additionally, Belluscura announced today that it’s flagship X-PLOR machine has been further improved, with the latest version the first in the industry to add mobile app functionality that adds Bluetooth to connect with smartphones, tablets, pulse oximeters and wearables.

This means that patients can now track their own oxygen usage, breathing rates, blood oxygen saturation levels, heart rate, sleep and other important biometric and environmental data. Patients will also have the option to share the information with their healthcare providers & doctors, to further personalise treatment regimes in order to meet their specific needs.

Ultimately, by aggregating the data across potentially 10ks of patients across the world, there will be significant analytics and artifical intelligence (AI) opportunities too, which will help X-PLOR stays further ahead of the pack as it builds scale. 

CEO Bob Rauker commented: “I am very excited about the launch of the next generation X-PLOR with the Nomad Health App. Our goal is to not only provide cutting edge medical devices, but to also improve patient outcomes with every new product we launch. We believe putting more health & environmental information in the hands of our patients will result in greatly improved long-term patient outcomes.”

In terms of the numbers, house broker Dowgate is forecasting tha Belluscura will be profit neutral in H223, cashflow positive by 2024 and deliver normalised EPS of 28.5c on revenues of $140.6m in 2025.

I would value the company on a 2025 12x-15x EV/EBIT multiple, which - discounting back at 12% and adjusting for $9.3m of estimated Dec'22 net cash - would give a theoretical valuation of 200p-240p per fully diluted share. In comparison Dowgate have a 200p target price.

And with many of Belluscura's's larger rivals either selling inferior products or still struggling with supply chain issues, there’s an immediate near-term opportunity to win even greater market share. Follow | BELL

Stock Chart | BELL

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Improved monitoring on low-acuity wards needs to be practised in a structured way. This article provides an example of how standardised monitoring platforms can aid the application of clinical judgement


The National Early Warning Score 2 (NEWS2) is a robust, evidence-based tool that enables health professionals to recognise deterioration in a patient and understand when it is appropriate to escalate their care. This article reminds nurses of the synonymous relationship between the NEWS2 chart and the airway, breathing, circulation, disability, exposure (ABCDE) approach to assessing and treating patients who are acutely unwell, illustrating how both can work together to enable early recognition in a patient who is suspected of deteriorating, despite a low-risk aggregate score. The article uses a fictitious clinical scenario to demonstrate this approach to assessment.

Citation: Eakins F (2022) Preventing deterioration before a NEWS2 score is triggered. Nursing Times [online]; 118, 7.

Author: Freya Eakins is intensive care nurse, Hywel Dda University Health Board.

  • This article has been double-blind peer reviewed
  • Scroll down to read the article or download a print-friendly PDF here (if the PDF fails to fully download please try again using a different browser)


A fundamental requirement of all competent nurses is the ability to recognise deterioration in a patient and understand when it is appropriate to escalate. The universal ‘track-and-trigger’ system of the National Early Warning Score (NEWS) – whereby a score is allocated to six physiological measurements – is widely used as a robust, evidence-based tool to aid health professionals in this process. In December 2017, NEWS was updated to National Early Warning Score 2 (NEWS2) to address shortfalls identified in its original model. A prescribed scale for safe oxygen use for patients with hypercapnic (type-2) respiratory failure was added; this and other refinements aimed to identify people at risk of new serious deterioration (Royal College of Physicians (RCP), 2017). Through standardisation of NEWS2, it is estimated that more than 1,800 patient lives are saved each year (NHS, nd).

Despite these encouraging statistics, it is worth asking whether the emphasis on clinical judgement has been lost along the way. In the UK, all registered nurses are expected to conduct a whole-body systems assessment, as well as interpret these findings, as part of the requirement for the Nursing and Midwifery Council (NMC)’s (2018) proficiency standards for registered nurses. In 2019, Jensen et al’s qualitative study of hospital nurses’ perceptions of, and reactions to, track-and-trigger systems identified four central barriers to their use; these were problems with:

  • Community of practice;
  • Rules and compliance;
  • Division of labour;
  • Using standardised tools and misrepresentation of clinical judgement.

These barriers invariably affect nurses’ compliance and competence in using track-and-trigger systems appropriately.

This article challenges perspectives on NEWS2, by highlighting how practitioners can use their comprehensive knowledge of physiology and assessment in partnership with patient collaboration – through interaction, observation, intervention and employed technology – to improve clinical accuracy and patient outcomes.

Standards and frameworks

In the UK, the National Institute for Health and Care Excellence (NICE), the Care Quality Commission (CQC), and the National Patient Safety Agency recognise the need to ensure patients are safe, and prioritise the development of standards and frameworks that prompt recognition of deterioration. The use of NEWS2 as a quality indicator has been recorded by the CQC during hospital inspections and evaluated to improve both patient outcomes and mortality rates (RCP, 2017). Despite these provisions, evidence suggests the response to the deteriorating patient is still of ongoing concern (Burke et al, 2020). Irrespective of widespread implementation of track-and-trigger systems, in 2019, 63.7% of avoidable deaths were attributed to preventable conditions in England; the figure was 62.8% for Wales (Office for National Statistics, 2021). Clinical research shows patient deterioration is often detected late or missed completely, contributing to the development of serious adverse events (Petersen Tym et al, 2017).

Although much research has sought to explore the nurse’s role in recognising clinical deterioration, there has been little exploration of the causes of failure-to-rescue rates; in the qualitative data that does exist, the causes that emerge are a lack of knowledge and educational resources available to registered nurses predominantly working in level-1 inpatient settings (Chua et al, 2019). The implementation of early-warning scoring systems is only effective if nurses can recognise and act on clinical deterioration in a timely manner. Evidence shows that physiological knowledge, clinical judgement and person-centred decision-making are needed to improve in-hospital mortality rates (Chua et al, 2019).

The main aim of NEWS2 is to embed a cultural shift in the NHS by making health professionals more aware of when it is appropriate to respond, escalate and transfer to a higher dependency of care. This approach to deterioration – sometimes referred to as the ‘three Rs’ – recognise, relay, react – has been found effective in reducing failure-to-rescue rates (Burke et al, 2020). Adopting a complication-management approach can mitigate unidentified deterioration by creating an intuitional competence in this context.

A NEWS2 score of ≥5 is:

  • Classified as a key threshold for urgent response;
  • Associated with mortality rates three times higher than those of a NEWS2 score of 0-4 (RCP, 2017).

Translating the aggregate scoring system into patient outcomes sets a clear precedent for the importance of using independent thought and clinical reasoning when performing observational checks. If each NEWS2, irrespective of the level of risk, was used in conjunction with a subjective and qualitative tool – such as the Resuscitation Council UK’s (RCUK) airway, breathing, circulation, disability and exposure (ABCDE) approach to the assessment of critically ill patients – nurses would be able to predict early deterioration hours before abnormal vital signs (Table 1) are displayed.

What can be missed using NEWS2?

The RCP (2017) highlighted that track-and-trigger systems carry many contentions so should not be a substitute for competent clinical assessment. Irrespective of the NEWS2 score, any concern about the stability of a patient’s condition should prompt thorough clinical assessment and review. Taking observations is not just about generating numbers and activating the specific escalation pathway according to the aggregate score; it is knowing the patient’s diagnosis, comorbidities, associated complications and management plan. A clinical reasoning checklist is given in Table 2.

Box 1 details a fictitious scenario of a patient (Mr Jones) whose deterioration could have been identified earlier if a focused bedside-assessment tool, such as the ABCDE approach, had been used. Understanding the associated risks and cardinal signs of each individual patient’s comorbidities can help with the direction and emphasis of the clinical assessment.

Box 1. Sample scenario

Mr Jones, aged 76 years, was admitted to a general medical ward three days after presenting to the emergency department with fatigue, chest pain and exertional breathlessness. An electrocardiogram showed he was in AF so he was admitted for further investigations and heart rate control. He has a past medical history of ischaemic heart disease, chronic obstructive pulmonary disease and hypertension. Since starting treatment for the AF, his heart rate has been controlled and, reportedly, his symptoms have improved.

On arrival at the ward, Mr Jones is alert and orientated, but reports having had a restless night due to breathlessness. These are his vital signs:

  • Respiratory rate: 20 breaths per minute
  • Oxygen saturation: 93% on room air
  • Heart rate: 89 beats per minute
  • Blood pressure: 137/73
  • Temperature: 36.5°C

His NEWS2 score at 9am is 0 and he is classified as low risk. A lower target of 88-92% oxygen saturation is indicated for his hypercapnic respiratory failure on the NEWS2 chart for scoring oxygen saturation; this decision should be made by a competent clinical physician – usually the specialty registrar – and recorded in the patient’s medical notes.

At midday, Mr Jones calls his bell for attention; he is only able to speak in short sentences and is extremely dyspnoeic. These are now his vital signs:

  • Respiratory rate: 28 breaths per minute
  • Oxygen saturation: 86% on room air
  • Heart rate: 120 beats per minute
  • Blood pressure: 168/78
  • Temperature: 36.7°C

His NEWS2 score is now 6 and requires an urgent response. This means commencing hourly monitoring of vital signs (as a minimum) and immediately requesting a review by a clinician or team competent in acutely ill patients.

AF = atrial fibrillation; NEWS2 = National Early Warning Score 2

The following sections explore an integrated, patient-specific assessment based on the NEWS2 chart and Mr Jones’ presenting complaint.


The assessment of Mr Jones’ airway is patent and secure; this is confirmed by his ability to speak in sentences with normal tone. However, the ‘look, listen, feel’ assessment tool is paramount when identifying risk factors of a potentially unprotected airway. The aim of the airway assessment is to identify any obstruction, whether complete or partial.

In partial obstruction, the patient may look agitated, have increased accessory muscle use and be gasping for air. Noisy breath sounds, particularly gurgling sounds, are indicative of a partially occluded airway (Sampson, 2021). The character of the noise provides an indication of the location and cause of the obstruction; in complete airway obstruction there are no breath sounds at the mouth or nose. Looking at the patient, you may see a paradoxical (‘see-saw’) breathing pattern; use of the accessory muscles, pallor or cyanosis are late signs.

The main causes of airway obstruction are:

  • Foreign bodies;
  • Allergic reaction;
  • Laryngeal oedema;
  • Pooled secretions;
  • Tongue displacement;
  • Reduced consciousness (Webb et al, 2016).

If a completely obstructed airway is suspected, look inside the mouth for signs of airway obstruction, observe the chest for adequate rise and fall and bilateral chest expansion, and listen for the presence of breath sounds; no air entry at auscultation or high-pitched breathing noises (stridor) are all signs of complete airway obstruction (Heuer, 2021).

Airway obstruction is an emergency. Expert help should be sought immediately, and the airway should be opened using the head-tilt/chin-lift manoeuvre. Untreated, airway obstruction causes hypoxia and risks damage to the brain, kidneys and heart, as well as cardiac arrest and death (RCUK, nd).

Mr Jones has a history of type-2 respiratory failure; this means a target saturation must be prescribed to determine the most appropriate scale on the oximetry section of the NEWS2 chart. Consider referring to previous records for a last-recorded oxygen saturation and asking the patient what is normal for them. Is 93% consistent with what has previously been recorded? Best practice is prescribing a target range for all hospital patients at the time of admission, so that appropriate oxygen therapy can be started in the event of unexpected clinical deterioration (O’Driscoll et al, 2017).

In the event of hypoxaemia, where a target saturation has not been prescribed and the patient’s history is unknown, acute respiratory failure should be assumed and 15L oxygen should be provided via a high-flow, non-rebreather reservoir mask (RCUK, nd).

If new hypoxaemia is suspected in Mr Jones, the airway should be assessed for partial obstruction. This would cause air entry to be diminished and often noisy; simple methods of airway clearance and suctioning can remove pooled secretions (Peate and Dutton, 2021).

The British Thoracic Society’s emergency-oxygen guideline – O’Driscoll et al (2017) – recommends oxygen saturations of 88-92% in patients admitted with exacerbations of chronic obstructive pulmonary disease (COPD). This must be confirmed following the guidance of a clinician, based on the NEWS2 guidelines (RCP, 2017). Some patients with chronic lung disease carry an oxygen alert card that documents their target saturation. High concentrations may depress breathing in a subgroup of patients with COPD, leading to an increased risk of airway obstruction (RCUK, nd).


The respiratory system adapts readily to demands placed on it, and early identification of changes in respiratory rate can facilitate prompt treatment. The RCUK (nd) recommends that respiratory assessment follows a logical, structured approach. There are four main components to comprehensive respiratory assessment:

  • Inspection;
  • Palpation;
  • Percussion;
  • Auscultation (Morgan, 2021).

To assess the stability of respiratory function, it is important to observe the patient’s work of breathing from a distance. Observation should include pattern, depth and regularity of breathing, as well as checking whether there is use of the sternocleidomastoid, scalene or pectoralis minor muscles and whether the patient is pursing their lips or flaring their nostrils (Wheatley, 2018).

Assessing Mr Jones’ colour and checking his skin, nail beds and mucous membranes for pallor or cyanosis would provide information about his perfusion (Gulanick and Myers, 2011). Observing the position he is in could also indicate his respiratory effort; for example, a high Fowler’s position allows for increased respiratory capacity and full descent of the diaphragm. Simply asking Mr Jones how well he slept or observing the number of pillows used could reveal an early precursor to the change in his condition from baseline (Cooper and Gosnell, 2019).

When Mr Jones’ respiratory effort increases from baseline, checking the trend from previous recordings would indicate whether a respiratory rate of 20 is normal for him; a subtle change might be noticed. While counting a patient’s respiratory rate over one minute, you should be assessing the depth of each breath, the pattern, the rhythm of respiration and whether chest expansion is equal on both sides. When the rate of breathing has been determined, consider whether this is normal for the patient and use their trend as a guide to aid your clinical judgement. Patients adapt their breathing pattern over time to facilitate gas exchange. In the early stages of compensation, there is a mild increase in respiratory rate and, as the underlying cause progresses, so does the dyspnoea.

After gaining consent, a physical examination of the chest wall can also help identify any abnormalities in respiratory function that may have been missed. Note whether there are any anterior or posterior chest wall deformities. To feel for symmetry, place your hands on either side of the patient’s anterior chest with your thumbs touching at the second intercostal space and ask the patient to inhale deeply; your thumbs should separate equally, several centimetres away from the sternum (Potter, 2021).

If asymmetry is suspected, palpate the patient’s trachea for deviation; the trachea should be anatomically medial to the ends of the clavicle and central to the suprasternal notch. If a trachea deviates, it will deviate to the direction of less pressure, away from a collapsed lung (Lister et al, 2020). Asymmetrical chest movement and tracheal deviation can indicate underlying conditions such as large pneumothorax, pleural effusion and rib fractures (Innes, 2018). New tracheal deviation is an emergency: help must be summoned immediately. Asymmetrical chest movements require an urgent review by the medical team.

When feeling for symmetry and observing work of breathing, listen to the patient’s breath sounds and note the pattern. Signs requiring further assessment in palpation include:

  • A paradoxical (see-saw) breathing pattern;
  • Hyperinflation on chest expansion;
  • Adventitious or abnormal breath sounds, such as a wheeze.

If these signs are present, you could palpate for tactile or vocal fremitus by feeling the vibrations produced when the patient speaks or uses percussion. Dullness indicates fluid or consolidation in lung fields; hyperresonance indicates air in the pleural cavity, suggesting a pneumothorax (Crouch et al, 2016).

If the health professional is competent in performing auscultation, the procedure can provide further clinical evidence to support the findings of an abnormal breathing assessment. Normal breath sounds are tracheal, bronchial, bronchovesicular and vesicular, depending on where they are heard (Ball et al, 2021). Patients with noisy breath sounds should be assessed for their ability to expectorate: assess what their sputum load is, along with its colour and consistency if they have a productive cough.


Cardiovascular disease remains one of the leading causes of death worldwide (Mladenka et al, 2018), so it is essential that nurses possess a comprehensive understanding of cardiovascular anatomy and physiology. The cardiovascular system is complex, comprising the heart and an extensive network of blood vessels that extend into two anatomically separate systems:

  • Pulmonary circulation system (lungs);
  • Systemic circulation system (body).

Each subordinate organ has a multifaceted role in regulating homeostasis (Creed and Spiers, 2020).

The heart is a unique organ because it is autorhythmic (Colman and Holden, 2019): its specialist conduction system means it self-regulates and produces no downtime. The limitation of this circuit means multiple problems – for example, cardiovascular pathologies, physiological disturbances or drug-induced cardiotoxicity – can impair it or threaten its electrophysiology (Mladenka et al, 2018). The rate, rhythm and strength of the pulse indicate how well the heart is working.

Assessing the regularity of pulsations helps determine the presence of cardiac arrythmias (Peate et al, 2014). Mr Jones’ atrial fibrillation (AF) provides a baseline rate, strength and rhythm. In all known cardiac arrhythmias, the pulse should be assessed manually, rather than via a pulse oximeter, as an abnormal heart rhythm such as with AF will provide an inaccurate reflection in ventricular rate, regularity and strength (Alagappan, 2018). The rhythm should be assessed and noted to prevent unidentified change; abnormally weak or strong pulses suggest abnormal stroke volumes (Hajar, 2018).

If a weak and thready pulse is palpated, observe the patient’s colour, digit temperature and capillary refill time for prolongation (>2 seconds). Each of these observations can reveal a lack of perfusion. The body initially compensates for the reduced cardiac output through subtle changes, usually only identifiable by a prolonged capillary refill time, pallor and changes in skin temperature. Pale, cyanosed or mottled peripheries are poorly perfused; abnormally warm or flushed peripheries indicate excessive dilation from distributive shock (Hariri et al, 2019).

When observing limbs, assess for the presence of peripheral oedema by palpating the areas over the tibia, ankles and feet. If peripheral oedema is present, documenting the level to which it extends on admission will allow the assessor to see whether things improve. The development of peripheral oedema in heart failure is related to fluid excess: as the heart fails, renal perfusion diminishes, which is followed by sodium and water retention (Pellicori et al, 2015).

If fluid retention is suspected, check for an accurate record of fluid intake and output over the previous 24 hours and calculate the fluid deficit. If the patient is showing positive signs of fluid retention, their current weight should be compared with their admission weight; body weight is a more sensitive indicator of fluid retention (Davies et al, 2015).


An initial assessment of disability should be measured by the patient’s level of consciousness, using the alert, confusion, voice, pain, unresponsive (ACVPU) scale. This scale is quick, simple and helpful for making a rapid assessment of a person’s gross level of consciousness or mental state (Romanelli and Farrell, 2021). The assessment is completed in sequence and the person’s response is recorded in order of appropriateness, based on the nurses’ initial awareness of the patient’s consciousness:

  • A – the patient is fully alert with eyes open and cognisant;
  • Cconfusion and changes in neurological state: these are significant and often indicate signs of deterioration well before other parameters change;
  • V – the patient responds to voice, then closes their eyes again until next stimulated by verbal stimuli with evident drowsiness;
  • P – the patient only responses when pain is inflicted (trapezium pinch or sternal rub);
  • Uunresponsive to pain (Barker, 2019).

Any deviation from alert (A) should prompt a more in-depth assessment to be performed. The Glasgow Coma Scale (GCS) is considered the gold standard in the UK and is the tool generally used by nurses to assess neurological function (Steen et al, 2021). Similar to the ABCDE approach, it requires nurses to establish whether the level of consciousness and cognitive state are normal for the patient. A normal GCS score is 15/15, but the GCS baseline may be lower in some patients with dementia, underlying chronic neurological disorders or learning disabilities. This should always be confirmed by someone who is involved in the patient’s care and competent to make this decision (NICE, 2014).

A patient with a GCS score of <15 on initial assessment should be reviewed for indicators of neurological compromise. Look for pupil size, equality and reaction to light. Normal pupil size is 2-5mm and reaction to light should be brisk. Following removal of the light source, the pupil should return to its original size; this response should be consensual in both eyes (Jevon, 2016). Pupillary reaction assesses the third cranial nerve (oculomotor nerve) – an abnormal pupil reaction, size or shape is an indicator of raised intracranial pressure (Goulden and Clarke, 2016).

A patient who scores P or U on the ACVPU scale is considered to have a GCS score of ≤8 and, therefore, the airway is unprotected (Romanelli and Farrell, 2021). These patients should always be nursed in a lateral position to maintain patency before urgent review by the medical team or anaesthetist. Causes of the change in mental status should always be investigated, as these may be multifactorial.

If medication changes have recently been made, the medication chart should be reviewed for drugs such as opioids, benzodiazepines, neuroleptic drugs or over-oxygenation in hypercapnic respiratory failure. The blood–glucose level should also be measured to exclude hypoglycaemia. If capillary blood sugars are <4mmol/L, follow local protocols for the treatment of hypoglycaemia (RCUK, nd).


The exposure assessment is the final process and can help solidify a nursing diagnosis or identify a cause of deterioration. In Mr Jones’ case, his temperature should first be recorded to make sure it is in the normal range; the accepted value for NEWS2 is 36.1-38.0°C. A thorough head-to-toe examination should then be undertaken to identify any:

  • Broken areas to skin;
  • Injuries;
  • Oedema;
  • Venous thromboembolism;
  • Evidence of external and/or internal bleeding.

The site of any indwelling catheters, drains and peripheral vascular-access devices should also be checked for clinical signs of infection, such as rashes, skin changes or phlebitis, using the visual infusion phlebitis score (Dutton and Finch, 2018).

When assessing exposure, it is important to consider skin integrity. The risk of pressure sores is greater because of Mr Jones’ reduced exercise tolerance. Skin integrity should be considered using tools related to organisation and, depending on the level of risk and professional discretion, the appropriate interventions should be undertaken.


Nurses have a fiduciary responsibility and are under increasing pressure to keep up to date with changes in society and healthcare. What patients require from nurses is becoming more complex, as new proficiencies, standards and autonomous roles in nursing arise, so it is important to make quality of care more efficient and timely. Early identification of patient deterioration can be achieved without increasing nurses’ workload by combining two effective assessments. Incorporating a whole-body assessment into routine standardised framework tools will improve failure-to-rescue rates. In-hospital mortality rates can be reduced by making use of physiological knowledge, clinical judgement and person-centred decision-making; the application of all three must be integrated into staff recruitment, training and the institutional culture to improve patient outcomes.

Key points

  • Incorporating a whole-body assessment into standardised framework tools will improve failure-to-rescue rates
  • Early identification of patient deterioration can be achieved by combining two systematic assessments: the National Early Warning Score 2 and the airway, breathing, circulation, disability, exposure (ABCDE) approach
  • It is important to use independent thought and clinical reasoning when performing observational checks
  • A person-centred approach to care of the deteriorating patient is vital

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Patients who are hospitalized with chronic obstructive pulmonary disease rarely receive post-acute pulmonary rehabilitation. But greater participation in rehab would improve these patients’ health and longevity. It could also result in net cost savings for healthcare systems, investigators contend.

The researchers used an economic simulation model to estimate the cost-effectiveness of participation in pulmonary rehab after COPD hospitalization compared with no rehab, and quality-adjusted life expectancy (QALE). To do so, they examined research data published between 2001 and 2021. They found net cost savings and improvement in QALE across a range of probability and cost parameters. 

At an estimated savings of $5,700 per patient per year, “universal utilization of pulmonary rehabilitation could result in savings for Medicare of $1 to $1.25 billion annually,” they reported.

“These findings suggest that stakeholders should identify policies to increase access and adherence to pulmonary rehabilitation for patients with COPD,” the authors wrote.

Low use, despite coverage

Yet rehab participation is low in this patient group. 

Medicare began providing coverage for pulmonary rehab in 2010. Yet as of 2012, the utilization rate for pulmonary rehab among Medicare beneficiaries was only 4%, the researchers noted. The disease is a huge burden on the healthcare system, affects about 16 million Americans and is a leading cause of death. 

“Given these findings, payers — particularly Medicare — should identify policies that would increase access and adherence to pulmonary rehabilitation programs for patients living with COPD,” the authors of the current study concluded.

Readmission common

COPD, an umbrella term for a group of lung diseases that obstruct air flow, is estimated to affect 24 million people in the United States, according to the researchers. More than a quarter of costs associated with the condition can be attributed to hospitalization for acute exacerbation. What’s more, fully one quarter of these patients are readmitted to the hospital within 30 days, they reported.

The study was published in JAMA Network Open.

Related articles:

40 percent of US older adults with COPD have poor access to pulmonary rehabilitation

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Pneumonia is a lung infection most commonly caused by bacterial or viral infections and less by fungal infections or aspiration, inhaling a substance into the lungs.

Pneumonia leads to airway inflammation and the alveoli (air sacs) may fill with fluid.

The severity of your symptoms can range from mild to life-threatening, underscoring the importance of prevention, early diagnosis, and prompt treatment.

This article will discuss ways to prevent pneumonia so you can avoid this potentially life-threatening condition. 

ljubaphoto / Getty Images


Symptoms vary among children, adults, and older adults, but in most cases, you will experience one or more of the following symptoms:

  • Fever
  • Chills
  • Shortness of breath
  • Chest pain on deep inspiration
  • Cough (often with phlegm)
  • Night sweats
  • Nausea
  • Vomiting
  • Muscle aches
  • Rapid breathing and heartbeat
  • Confusion
  • Weight loss

Risk Factors

Your age is the biggest risk factor for pneumonia. To be clear, pneumonia can affect anyone at any age, but the two age groups at the highest risk for contracting it and for having more severe cases are children under age 2 and adults older than 65.

But age isn’t the only factor that can increase your risk of pneumonia. A host of lifestyle and health risk factors may also increase your risk, including:

  • Being immunocompromised: Having a weakened immune system, often caused by HIV/AIDS, alcohol abuse, organ transplantation, or long-term cancer or autoimmune treatment (such as chemotherapy or long-term treatment with steroids or other immunosuppressant drugs), can decrease your body’s ability to fight infections, making you more susceptible to pneumonia.
  • Being hospitalized or being on a ventilator: This raises your risk of hospital-acquired bacterial infections and aspiration pneumonia.
  • Having a chronic condition including asthma, chronic obstructive pulmonary disease, structural lung disease, and heart disease: Damaged lungs are more vulnerable to lung infections. 
  • Smoking: The chemicals in cigarettes compromise the immune system, lowering its ability to defend itself from the organisms that make you sick.

Environmental factors, such as jobs that involve working with toxic substances, indoor air pollution, secondhand smoke, and living in a crowded home, can increase your susceptibility to pneumonia.


These tips can help prevent you from getting pneumonia.

Get a Pneumonia Vaccine

Vaccines help prevent pneumonia by boosting your immunity against some of the common bacteria and viruses that cause illness. Taking all of the following vaccines can safeguard you against pneumonia:

Vaccines are incredibly safe and effective, but they can have side effects. Speak to a healthcare provider so you know what to expect with each vaccine.

Of note, the Centers for Disease Control and Prevention (CDC) recommends infants younger than age 2 take four doses of the pneumonia shot at 2 months, 4 months, 6 months, and then a booster between 12 to 15 months; and that all adults older than 65 be given pneumococcal vaccines.

Exercising Proper Hygiene

One of the best ways to prevent respiratory infections is to practice proper hygiene. Some useful techniques include:

  • Washing your hands regularly with soap and warm water for at least 20 seconds
  • Cleaning and disinfecting surfaces that are touched a lot (with alcohol based products)
  • Coughing or sneezing into a tissue or into your elbow or sleeve
  • Limiting contact with cigarette smoke or quitting smoking
  • Taking good care of medical conditions, such as asthma, diabetes, or heart disease

Avoiding Sick Contacts

If possible it’s best to avoid people who are sick. This is even more important for young children and older adults who are at the highest risk of getting sick. If you are sick, stay away from others as much as possible to keep from getting them sick, especially those in your family or friend circle who are most susceptible to illness.

Don’t Smoke or Abuse Alcohol

As previously mentioned, the chemicals in cigarettes can compromise the immune system, lowering its ability to defend itself from the organisms that make you sick.

Chronic alcohol use increases your risk of hospitalization and damages alveolar macrophages and phagocytic cells that ingest and clear inhaled microbes as the first line of defense in lung cellular immunity.

Chronic alcohol exposure significantly interferes with alveolar macrophage function, making your lungs more vulnerable to infections that they could otherwise defend themselves against.

Maintain Good Overall Health

Having a pre-existing health condition like obesity, diabetes, asthma, COPD, or heart disease greatly increases your risk of pneumonia, hospitalization, and even death.

Preventing these conditions via a combination of vaccination, healthy eating, regular exercise, and routine visits to your healthcare provider are key to preventing pneumonia.


There’s no one size fits all recovery from pneumonia. Some people recover in a week, returning to their normal routines, while others take much longer.

If you are diagnosed with pneumonia, follow your healthcare provider's instructions, take antibiotics as prescribed, monitor your symptoms, and allow yourself time to fully recover.

Avoiding situations that may put you into close contact with molds and getting vaccinated are also important steps that you can take to prevent infection.

When to See a Healthcare Provider

If you are having trouble breathing or experiencing a high fever that is not going down with over-the-counter (OTC) medication, seek immediate medical attention.

Remember that infants and small children, older adults over the age of 65, smokers, and people with chronic conditions such as COPD, asthma, and heart disease are at high risk of developing pneumonia and should not wait to see a healthcare provider if they are experiencing pneumonia-like symptoms.


You can take steps to prevent pneumonia, including avoiding getting sick in the first place by practicing proper hygiene, not smoking, and getting vaccinated.

A Word From Verywell

Pneumonia can be incredibly taxing and some people may take weeks or months to recover.

Following your healthcare provider's recommendations is important to recovery, but preventing pneumonia is the best way to avoid serious medical complications.

The best way to do this is to get vaccinated and avoid crowded spaces where germs are easily spread. While it is not definite that you will develop pneumonia if exposed to the germs that cause it, being aware of your risk factors and safeguarding yourself against infection dramatically lowers your risk. 

Frequently Asked Questions

  • Is pneumonia contagious?

    Pneumonia is most commonly caused by bacteria and viruses, which can be transmitted to others via aerosolized particles that form in the lungs and are transmitted to others through coughing or sneezing.

  • What causes pneumonia?

    Pneumonia is a lung infection most commonly caused by bacteria and viruses. Still, less commonly, it can be caused by fungus and via aspirated substances in the stomach, especially in those who are immunocompromised or hospitalized.

  • How do you get pneumonia?

    Pneumonia is caused by germs that are passed from person to person via direct transmission when a person coughs or sneezes. If you breathe some of these germs directly into your lungs, they may potentially replicate and cause symptoms. Aspiration, or inhaling food, liquids, vomit, or fluids from the mouth into your lungs, called aspiration pneumonia, is also another way you may develop a lung infection.

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Wildfire season is upon us and coupled with the extreme drought that much of the United States is experiencing, we have a recipe for a disastrous 2022 wildfire season.

In fact, according to the CDC wildfires are starting earlier, spreading faster, and burning longer than ever experienced in recorded history. If that isn’t enough to keep us up at night, wildfires have also been linked to multiple health concerns including trauma and PTSD, cardiovascular ailments, respiratory illnesses, cancers, and poor sleep. Inadequate sleep, caused by the poor air quality that wildfires create, leaves us even less able to cope with the acute dangers of the wildfires and with managing life itself.

According to the CDC, insufficient sleep has been linked to type 2 diabetes, obesity, cardiovascular disease and depression. (1) A case study on the deadliest wildfires in California shows the negative impact that this type of climate change extreme has on mental health. It also illustrates that mental health outcomes, specifically PTSD, anxiety and depression are dependent on the extent of fire exposure to the individual, as well as pre-existing adversities (especially due to childhood exposures), and general quality of sleep. (2)

In a recent systematic review of multiple sleep studies, ranging over a 9-year period from 2012-2021, sleep disturbances are shown to be highly prevalent with wildfire survivors, and the proximity and the severity of traumatic exposure of the survivor creates an even stronger link. (3)

The case can surely be made that poor sleep and sleep disorders have overwhelming effects on human health. Apart from the errors in judgments when sleep is lacking, the less obvious ramifications are actually more frequent and include accidents, injuries, lower functioning and lessened quality of life, and diminished family well-being. (4)

Insomnia and nightmares rate as the most common sleep issues that affect between 63-72% and 33-46% of survivors respectively. (3) Meanwhile, behavioral changes in children after experiencing a wildfire can include changes in concentration, elevated irritability, sleep changes, and a decline in academic performance. (5)

“Some studies indicate that air pollution increases sleep disturbances by affecting the airways and the brain and the emotional impact caused by wildfires,” explains Dr. Carleara Weiss, a sleep science advisor at Aeroflow Sleep. “In addition, individuals with respiratory difficulties, such as those with obstructive sleep apnea, may have more difficulty sleeping with air pollution. In general, increasing air quality via filtration systems and air cleaners should contribute to better sleep,” Dr. Weiss says.

While we can all understand the environmental impact of wildfires, some of us have also experienced, first-hand, the devastating impact of wildfires physically, emotionally, and economically.

In my recent conversation with retired Federal Smoke Jumper for the US Department of Interior Bureau of Land Management, Todd Jinkins (disclosure: my older brother), I asked him if he ever experienced sleep disturbances as a direct consequence of the smoke pollution that he was exposed to while fighting wildfires.

He responded, “over the course of my twenty-three-year career, I often experienced sleep disturbance from wildfires for a myriad of reasons.” When I asked Jinkins if he was ever given any training on how to improve sleep while on the job, he responded emphatically, “no, nothing, no training or talk of anything like that.”Jinkins went on to describe that, “while we received considerable training about wildland firefighting, fire safety, and parachuting as a smokejumper, we received no training about maintaining our health as a wildland firefighter.” Elaborating, he said, “maintaining your physical health is critical for peak performance as a smokejumper, but mental health is also of critical importance. Recent recognition of high suicide rates among firefights and first responders is bringing this issue into focus.”

PTSD, insomnia and sleep disturbances can continue for a long period after living through a wildfire. Wildfires have been shown to correlate with increased rates of PTSD, depression and generalized anxiety (GAD) and these psychological issues can continue for years after the initial event.

A study on survivors of a wildfire in llia, Greece, concluded that the presence of insomnia was identified in 63% of the survivors, and the majority of them were older females, who had also developed PTSD. Over 50% of the participants also experienced what was described as “fear of imminent death.” (6)

Recent Surge in Wildfires

The hot summer months are projected to be a very dangerous fire season and 2022 continues to be an exceptionally dry year. Typically, wildfire season lasts for a 4 to 5-month period from June to October, but the season has recently extended to a now more common 7 to 8-month period throughout much of the South and Western United States. Along with the intensifying and widening of the fire season in places like California, Idaho, Oregon, Arizona, Nevada, New Mexico, Colorado, Utah and Florida, we are also seeing more intense wildfires as climate change progresses.

In fact, more than half of the 20 largest fires in California’s history took place in the last 5 years. (7) The average amount of acres burned annually by wildfires has been steadily increasing since the 1950’s. In the 1950s, experts recorded 3000 acres burning. The number today is more like 300,000 acres. Prior to 1970, there were no megafires (fires that burned more than 100,000 acres). (8)

The current extreme dry weather pattern is also intensifying across parts of the West in California, Nevada, Utah, New Mexico, Texas, Oklahoma and Colorado. (9) California has had the driest January-April on record and Nevada and Utah rank this same period the 3rd driest in a four-month period since records began. (10) As of May 17, 2022, more than half of the lower 50 States were experiencing drought.Rong Fu, UCLA professor of atmospheric and oceanic sciences, paints a grim picture of what is to be expected with wildfires in the coming years, saying, “I am afraid that the record fire seasons in recent years are only the beginning of what will come.” (11)

We saw more large-scale fires in some regions around the world in 2021 than we have ever seen according to Copernicus Atmosphere Monitoring Service (CAMS) Senior Scientist and wildfire expert, Mark Parrington. As a result, several regions also experienced their highest emissions ever, as specified by data tracked by the Global Fire Assimilation System (GFAS) data that goes back as far as 2003. (12)

Extreme weather, including dangerous lightning storms, strong winds, and high temperatures are all the effects of climate change, and these events are creating an ideal situation for wildfires to start. Although sometimes wildfires occur naturally either by lightning strikes or by spontaneous combustion of dry fuel like sawdust and leaves and the sun’s heat.

North Carolina State University professor Joseph Roise points out that a majority of fires occur because of “human involvement,” such as by castoff cigarettes, arson or neglected campfires. Roise explains, “Human carelessness is the biggest factor contributing to wildfires.” (13)

Tips To Reduce Wildfire Pollution and Improve Sleep

1. Invest in a good quality air filter, and a cleaned and updated HVAC system

When we are talking about improving interior air quality (IAQ), we can filter the air through portable air filters or inside the central heating, ventilation and HVAC systems of a home. Many studies have found a beneficial impact on indoor air pollutants by using a high-efficiency particulate air (HEPA) filter that provides the highest efficiency in reducing pollutants during wildfires.

According to the US Department of Energy, a true HEPA filter should be able to remove 99.97% of airborne particles. Remember that clogged filters cannot do the job that they are intended to do, so be sure to check your filters and replace them more often during prolonged smoke events. Air cleaners should filter at least two to three times the room volume per hour. Using an air purifier for just a few hours can be beneficial because it has been shown to reduce PM2.5 concentration in IAQ by 57%, which also produced a reduction in serum levels of inflammatory markers. And we know how beneficial lowering inflammatory markers is for many health markers, including cardiovascular health. (14)

2. Seal the windows and stay indoors, until air quality is safe

Dr. Weiss recommended staying indoors and closing windows, saying, “use an air cleaner and filtration system and keep the windows closed in your home to improve the air quality and stay indoors.” Once the air quality outside improves in the area, be sure to take the opportunity to air out your home, open the windows and doors, and use fans to help change the air inside the home.

3. Keep your home clean

Reduce chemicals, particulate matter (PM) and volatile organic compounds (VOC) in your home by cleaning your home often and using natural cleaning products when possible.

We know the IAQ is greatly improved when we reduce pollutants in our homes which are often hidden in common household items like beds, rugs, furniture, paint and in household cleaning products. These pollutants include particular matter (PM), (VOC) and chemicals. Prolonged exposure to these substances is associated with cardiovascular disease, respiratory diseases, lung cancer and COPD, (15) and short term exposure can have a negative impact on our sleep. (16)Consider using an organic mattress that is free from harmful allergens and chemicals, and use natural cleaning solutions which can both help to minimize the added chemicals in IAQ. Keeping dust to a minimum by cleaning the floors often with a damp cloth and by using a wet cloth instead of a feather duster can also help reduce the fine particular matter (PM2.5) from dispersing in the air.

4. Make your bedroom a “Clean Room”

If you can’t afford to buy multiple air filters for your entire home, focus on your bedroom for added sleep benefits.

Mary Prunicki, director of air pollution and health research at the Sean N. Parker Center for allergy and & asthma research at Stanford University, recommends creating a single room within a home that can be the “clean room.” (17) Also, be sure to place the air filters away from doors, windows and foot traffic, but don’t put them too close to walls or in the corners of a room where air less readily reaches the unit. (18)

5. Keep added pollution in your home low

Avoid using anything in your home that burns, such as your fireplace, gas logs, candles and incense.

During a period when the air index quality is diminished, only use your vacuum if it has a HEPA filter because vacuuming can actually heighten the particulate matter load in your home, according to Linda Smith, Ph.D. Branch Chief of the California Air Resources Board, because vacuuming can stir up particles that are already in your home and disperse them in the air.

6. Don’t exercise

During episodes of dangerous air index quality, you may want to restrict your strenuous activity and your exercise routine. Most of us breathe through the mouth, not the nose, during exercise or demanding activity. Research shows that nose breathing can be more effective in preventing water-soluble gases, particles and vapors from reaching the lung (19), than mouth breathing. Breathing through the mouth has been shown to increase the dose of pollutants that reach our lower respiratory system.

An experimental study of healthy adults showed that the total respiratory tract deposition of ultrafine particles (diameter <100 nm) was about 5 times greater during moderate exercise than at rest. (20) So you shouldn’t feel guilty about not exercising during this stressful time and instead try some meditation, or simple breath work. You can do that seated with your mouth closed while you gently inhale and exhale through the nose and focus your mind’s attention on gentle breathing.

7. Seek medical attention when in doubt

Dr. Weiss says, “recognize warning signs from your body. Identify signs of intense or dangerous smoke levels, such as sinus congestion, burning eyes, coughing, chest pain, fatigue, and difficulty breathing. Those signs should prompt you to seek medical assistance.”

The Impact of Wildfires on Well-Being

Air quality:

Wildfire smoke is a mix of fine particles (PM2.5) and gases from the burning plants, trees, buildings and other materials. Particulate matter (PM) is one major component of air pollution and is a key term that is often used to describe wildfire smoke. PM consists of both liquid and solid matter that is suspended in the air and is measured by size rather than the chemicals it contains.

According to the EPA, PM2.5 or less pose the greatest threat to health because these fine particles can penetrate the human respiratory tract, enter the bloodstream and impair vital organs. These particles travel into the deeper surface of the lungs while PM10 tends to be larger and coarser particles and are more likely to deposit on the surface of the upper lung area. Both PM2.5 and PM 10 can be inhaled, and both of the deposit sites can induce tissue damage and lung inflammation.

The CDC maintains that wildfire smoke can make anyone sick, but people with asthma, COPD, emphysema, heart disease, and children, pregnant women and responders are especially at risk for the ill effect of wildfires which include:

  • Trouble breathing
  • Asthma attacks
  • Tiredness
  • Headaches
  • Chest pain
  • Increased heart rate
  • Runny nose
  • Wheezing
  • Coughing
  • Stinging eyes
  • Scratchy throat

All of these issues can also affect one’s sleep. Along with the multiple studies that show PM2.5-10 can have a harmful effect on anyone’s sleep, one study looked specifically at how children’s sleep was affected when they were exposed to PM10 or below, and it showed that there were negative effects that included increased sweating while sleeping and trouble initiating or maintaining sleep. (21)

A randomized controlled study on sleep and bedroom air quality shows that when the air quality was improved, with lower CO2 levels, subjects were found to have improved performance on logical thinking the next day and they reported improved sleep quality, less grogginess, greater ability to concentrate, and overall felt better. (22)

Smokejumper Jinkins also cautioned, “most of these causal factors could be experienced by anyone who is in close proximity to a wildfire, but increasingly frequent large wildfire smoke dispersal can affect individuals hundreds or even thousands of miles away from an uncontrolled wildfire.”

When asked about the bill that The House of Representatives recently passed called the Federal Firefighters Fairness Act that creates the presumption that federal firefighters who become disabled with specific diseases (such as heart disease, lung disease, certain cancers, and other infectious diseases) contracted the illness on the job, and will be covered under workers’ compensation and disability retirement if this legislation becomes law, Jinkins said, “although this bill has only been passed by the House, it is encouraging that Congress has recognized the hazards that wildland firefighters face on a daily basis. I am hopeful that this bill becomes law soon to provide critical necessary health treatment.”


Along with physical responses to wildfires, we also have common mental responses to the extreme stress that exposure to wildfires creates that include sleep problems, nightmares, anger, lack of concentration, general anxiety, PTSD and grief, to name just a few.

In a recent study of general anxiety disorder (GAD), six months after the Fort McMurray Wildfire in Alberta, Canada, findings show a prevalence between GAD symptoms after a natural disaster like wildfires. These risk factors increased in folks who had experienced any of the following: witnessing the burning of homes during a wildfire, pre-existing anxiety disorder, relocation, and exposure to media coverage of wildfires.

This study also shows that increased problematic substance abuse was associated with elevated GAD symptoms. (23)

Lifestyle Tips for Protecting Against Wildfire Pollution

1. Be like a river: stay hydrated

Drink plenty of water. Water helps the body process and clear harmful chemicals and gunk in our bloodstream and digestive track. It’s helpful to think of our body as a river. Ideally, we want the water to be clear and to move along quickly. If our body’s elimination systems slow down, our river can become a stagnant pond. Our goal is to keep the river moving smoothly so that the water doesn’t stagnate and collect stuff that shouldn’t be there. Staying hydrated is the single most important way to achieve this so that our internal river doesn’t dry up or become stagnant and get clogged up with garbage.

2. Get adequate sleep

Make sleep a top priority in your life as a way to keep your immune system strong and inflammation markers low. (24) Be sure you have a bedroom that is conducive to sleep with good air quality, a bed with a chemical-free and comfortable mattress, a cool environment (67 degrees Fahrenheit or below) and blackout blinds that keep light out so that your circadian rhythms can stay in sync with the sun.

3. Do meditation and breathing exercises regularly

Resiliency has been shown to improve the effects on mental health after experiencing the stress of a wildfire. (2) We know that both mindful meditation and intentional breathing techniques can improve resiliency and increase vagal tone.

Breathing methods like the 4,7,8 method, and resonance breathing, have been shown to help reduce anxiety both over the long term and in more acute stressful situations. (25) Both of these breathing techniques have been studied for their ability to help quell stress and anxiety, and to help us fall asleep or stay asleep.

Full abdominal breathing stimulates full oxygen exchange, which means the productive exchange of outgoing carbon dioxide with incoming oxygen. This action controls the breathing rate and can slow the heart rate and help stabilize blood pressure. It has also been shown that people who suffer from insomnia may have autonomic dysfunction and practicing slow, paced breathing techniques can help enable vagal activity which improves sleep quality. (26)

4. Exercise to improve HRV

When the AQI is good in your area, grab your running shoes and go for a walk, jog or hike to help improve heart rate variability (HRV). HRV is the amount of time between heartbeats and is associated with overall health. As a rule, when we are relaxed and resting the heartbeat is slower and when we are active, stressed or in danger, the heart rate increases. Our breathing correlates to this by increased inhalation signaling action or stress and exhalation signaling rest and repair.

Studies show that the positive influence that exercise has on HRV happens through increased vagal tone and downregulating of the sympathetic nervous system response. This improved HRV corresponds with decreased health problems such as heart conditions, and mental health issues such as depression and anxiety. A study with residents of a nursing home in Mexico City showed that exposure to increased concentration on PM2.5 was associated with autonomic nervous system (ANS) dysfunction in elderly. There was a significant decrease in HRV for every 10ug/m3 increase in same day PM2.5 exposure, and participants who already suffered hypertension were more susceptible to the reduction in HRV induced by the PM2.5. (27)

5. Eat the rainbow

Using food as medicine is always a good option for health since eating is something that we do daily, and food has the ability to affect change in our bodies and minds. Vitamins B (28), C, E (29), D and Omega 3 polyunsaturated fatty acid (PUFA) (30), have all been shown to be protective against damage caused by PM; specifically pulmonary illness and cardiovascular diseases. (31)

Also, an important fact to note is that vitamin D does not naturally appear in optimal amounts in many foods (apart from in eggs, salmon or other fatty fish, and cod liver oil). There are, however, a few foods that have been fortified with vitamin D such as milk, yogurt and cereal. Getting enough sun (our body can itself produce Vitamin D from sunlight) on a daily basis is often the most reliable way to ensure that you are getting the appropriate amount of vitamin D daily. Remember, however, that the fairer-skinned people and those under 50 are better at converting sunshine into vitamin D. Also, if you happen to live in the more northern parts of the world, where the sun’s rays are not strong enough in winter, you’ll want to be sure to supplement your food with vitamin D3, and eat foods like salmon—which has 66% of the daily value for vitamin D, or alternatively consume milk that is fortified with vitamin D.

We know that many fruits and cruciferous vegetables contain high levels of vitamin C, but leafy greens are also a great choice for getting adequate amounts of vitamins C and E, and they are also rich in some B vitamins. So eat plenty of salad, or sauté some bokchoy with garlic and lemon for a dinner.

We can ensure our vitamin E intake is optimal by eating a handful of nuts or seeds daily. Meanwhile cold water, fatty fish and seeds like flax, chia seeds and walnuts all contain good amounts omega 3.

6. Use the Firewise community’s principles of Ready, Set, Go

The Firewise USA program is a national movement that advises homeowners on how to prepare their homes to survive the effects of wildfires. It is part of California’s effort to ensure communities are prepared against wildfire. Ready, Set, Go is the three-step plan that Firewise recommends for all at-risk property owners and residents to follow in order to be ready for wildfires.

  • Be Ready: Create and maintain defensible space and harden your home against flying embers.
  • Get Set: Prepare your family and home ahead of time for the possibility of having to evacuate. Ensure that you have a plan of what to take and where to go
  • GO!: When wildfire strikes, go early for your safety. Take the evacuation steps necessary to give your family and home the best chance of surviving a wildfire.

Jinkins recommended the Firewise principles, saying, “it is critical that homeowners abide by these principles. Over the course of my career I often witnessed situations where residents waited too long to evacuate or refused to evacuate. This puts firefighters and residents in hazardous situations as late fleeing residents often clog access routes for fire responders. Residents who refuse to evacuate can find themselves in situations that quickly overwhelm them, requiring firefighters to endanger themselves in attempting to rescue these people.”

Jinkins’ final words on wildfire preparation were, “don’t put yourself or firefighters at risk by trying to “ride out” an approaching wildfire.”

State-Wide Resources






New Mexico





North East

Other Resources

Last Word From Sleepopolis

Just a reminder that we are not medical experts. Anyone who is experiencing profound sleep problems associated with poor air quality from wildfires (or for any other reason) should seek medical advice.

Sleep is an essential ingredient of a healthful lifestyle and is the third pillar of health (32). When the quality of sleep is impaired, there are a multitude of health consequences that often follow. Be proactive when considering how to set up your home for wildfire season and stay informed as to what your local air quality index is so that you can stay prepared and safe during wildfire season.


  1. Sleep and Sleep Disorders. CDC, USA Center for Disease Control, www.cdc.gov/sleep/about_sleep/chronic_disease.html
  2. Silveira, Sarita et al. “Chronic Mental Health Sequelae of Climate Change Extremes: A Case Study of the Deadliest Californian Wildfire.” International journal of environmental research and public health. Feb. 2021.
  3. Ravinder Jerath et al. Self-Regulation of Breathing as a Primary Treatment for Anxiety. Applied Psychophysiology and Biofeedback. June 2015.
  4. Institute of Medicine (US) Committee on Sleep Medicine and Research; Colten HR, Altevogt BM, editors. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. National Academies Press (US). 2006. 3, Extent and Health Consequences of Chronic Sleep Loss and Sleep Disorders. www.ncbi.nlm.nih.gov/books/NBK19961/
  5. To, Patricia et al. “The Impact of Wildfires on Mental Health: A Scoping Review.” Behavioral sciences (Basel, Switzerland). Sep. 21, 2021.
  6. Psarros, Constantin, et al. Insomnia and PTSD one month after wildfires: Evidence for an independent role of the “fear of imminent death”. International Journal of Psychiatry in Clinical Practice. 2017.
  7. NASA Earth Observatory (September, 2021). What’s Behind California’s Surge of Large Fires. earthobservatory.nasa.gov/images/148908/whats-behind-californias-surge-of-large-fires
  8. Kasha Patel, Nasa Earth Observatory (December, 2018). Six trends to know about the season in the Western U.S. climate.nasa.gov/ask-nasa-climate/2830/six-trends-to-know-about-fire-season-in-the-western-us/
  9. The National Center for Environmental Information (May 17, 2022). US Drought Monitor Update. droughtmonitor.unl.edu
  10. The National Center for Environmental Information (April,2022). Assessing the USA climate in April 2022, www.ncei.noaa.gov/news/national-climate-202204
  11. Rong Fu, UCLA professor of Atmospheric and Oceanic Sciences. newsroom.ucla.edu/releases/frequent-wildfires-human-caused-climate-change
  12. Copernicus Atmosphere Monitoring System (December,2021). atmosphere.copernicus.eu/wildfires-wreaked-havoc-2021-cams-tracked-their-impact
  13. Andrew Moore. (December,2021). NC State University College of Natural Resources. cnr.ncsu.edu/news/2021/12/explainer-how-wildfires-start-and-spread/
  14. Chen, Renjie et al. “Cardiopulmonary benefits of reducing indoor particles of outdoor origin: a randomized, double-blind crossover trial of air purifiers.” Journal of the American College of Cardiology. 2015.
  15. Li, Tao et al. “Fine particulate matter (PM2.5): The culprit for chronic lung diseases in China.” Chronic diseases and translational medicine. Aug. 28, 2018.
  16. Liu, Jianghong et al. “Air pollution exposure and adverse sleep health across the life course: A systematic review.” Environmental pollution (Barking, Essex : 1987). 2020.
  17. Stanford researchers offer practical tips to mitigate harm from wildfire smoke, (July,2021) news.stanford.edu/2021/07/07/tips-protect-wildfire-smoke/
  18. Washington State Department of Health, Improving Ventilation and Indoor Air quality during Wildfire Smoke Events (August,2015). doh.wa.gov/sites/default/files/legacy/Documents/Pubs//333-208.pdf
  19. Lizal, Frantisek et al. “The effect of oral and nasal breathing on the deposition of inhaled particles in upper and tracheobronchial airways.” Journal of aerosol science. 2020.
  20. Daigle, Christopher C et al. “Ultrafine particle deposition in humans during rest and exercise.” Inhalation toxicology. 2003.
  21. Abou-Khadra, Maha K. “Association between PM₁₀ exposure and sleep of Egyptian school children.” Sleep & breathing = Schlaf & Atmung. 2013.
  22. Strøm-Tejsen, P et al. “The effects of bedroom air quality on sleep and next-day performance.” Indoor air. 2016.
  23. Agyapong, Vincent I. O., et al. “Prevalence Rates and Predictors of Generalized Anxiety Disorder Symptoms in Residents of Fort McMurray Six Months After a Wildfire.” Frontiers in Psychiatry. 2018.
  24. Mullington, Janet M et al. “Sleep loss and inflammation.” Best practice & research. Clinical endocrinology & metabolism. 2010.
  25. Jerath, Ravinder et al. “Self-regulation of breathing as a primary treatment for anxiety.” Applied psychophysiology and biofeedback. 2015.
  26. Tsai, H J et al. “Efficacy of paced breathing for insomnia: enhances vagal activity and improves sleep quality.” Psychophysiology. 2015.
  27. Holguín, Fernando et al. “Air pollution and heart rate variability among the elderly in Mexico City.” Epidemiology (Cambridge, Mass.) 2003.
  28. Fiorito, G et al. “B-vitamins intake, DNA-methylation of One Carbon Metabolism and homocysteine pathway genes and myocardial infarction risk: the EPICOR study.” Nutrition, metabolism, and cardiovascular diseases. 2014.
  29. Possamai, Fabricio Pagani et al. “Antioxidant intervention compensates oxidative stress in blood of subjects exposed to emissions from a coal electric-power plant in South Brazil.” Environmental toxicology and pharmacology. 2010.
  30. Romieu, Isabelle et al. “The effect of supplementation with omega-3 polyunsaturated fatty acids on markers of oxidative stress in elderly exposed to PM(2.5).” Environmental health perspectives. 2008.
  31. Mozaffarian, Dariush et al. “Effect of fish oil on heart rate in humans: a meta-analysis of randomized controlled trials.” Circulation. 2005.
  32. Castillo, M. “The 3 pillars of health.” AJNR. American journal of neuroradiology. 2015.
Karri Jinkins

I’m Karri Jinkins; freelance writer, certified Ayurvedic Medicine Health Counselor, and a co-founder of the Brains & Bellies podcast, based in New York City.

I work with people using the techniques of Ayurveda, nutrition, yoga and meditation to help them improve their health and live a better connected life. I am a contributing author of the book, Yoga Sadhana for Mothers, and I have written for various online publications, including the Huffington Post.

When I’m not working, you can find me boogie boarding with my husband and son while we try to coax our bird dog into the water with us.

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What Is ProAir HFA?

ProAir HFA (albuterol) is used to prevent and treat wheezing, shortness of breath, coughing, and chest tightness caused by breathing problems that may be associated with certain lung diseases. It’s a quick-relief medication and a beta-agonist. It works by relaxing the airway muscles to open air passages to the lungs to make breathing easier. Albuterol also inhibits the release of immediate hypersensitivity mediators from mast cells.

ProAir is available in three different types of ProAir inhalers:

  • ProAir HFA: metered-dose inhaler that releases the drug as a fine mist
  • ProAir RespiClick: a dry powder inhaler that releases the drug as a powder
  • ProAir Digihaler: a dry powder inhaler that connects the inhaler to a mobile app on your phone to tell you how well you’re inhaling the medication

All three forms of ProAir inhalers come in a strength of 90 micrograms (mcg) per puff. It’s a prescription drug and must be used as prescribed by your healthcare provider.

Drug Facts

Generic Name: Albuterol

Brand Name(s): ProAir HFA

Drug Availability: Prescription

Therapeutic Classification: Beta-agonist

Available Generically: Yes

Controlled Substance: N/A

Administration Route: Inhalation

Active Ingredient: Albuterol sulfate

Dosage Form(s): Inhalation aerosol

What Is ProAir HFA Used For?

ProAir is indicated to:

According to the Centers for Disease Control (CDC), around 25 million people have asthma in the U.S. It is a leading chronic disease in children. Black children are almost three times more likely to have asthma in comparison with white children.

ProAir is a rescue inhaler and comes in different forms. Your healthcare provider will decide the frequency and type of inhaler when you need to ease trouble breathing.

How to Take ProAir HFA

Follow the instructions on your prescription label and use the medicine exactly as directed.

  1. Remove the protective cap from the mouthpiece and ensure that the canister is inserted into the mouthpiece properly.
  2. If you’re using a new inhaler or have not used it in more than 14 days, prime it. Shake it well and press to release four sprays into the air, away from your face. Avoid contact with your eyes. 
  3. Breathe out through your mouth. Hold the canister to place the open end of the mouthpiece in your mouth and close your lips.
  4. Breathe in through the mouthpiece and press down on the container to spray the medication into your mouth.
  5. Hold your breath for about 10 seconds or as long as you comfortably can; remove the inhaler, and breathe out slowly.
  6. If you are prescribed to have two puffs, wait for one to five minutes and then repeat to inhale.
  7. Replace the protective cap on the inhaler. Keep your inhaler clean.

Other directions to keep in mind:

  • Help a young child use ProAir HFA.
  • Take your puffs 15 to 30 minutes before exercising to prevent exercise-induced bronchospasm. 
  • Shake ProAir HFA well before each use.
  • Always use the inhaler device provided.
  • Don't change your dose or the prescribed dosing schedule without asking your healthcare provider.


Store your ProAir HFA inhaler at room temperature between 59 and 77 degrees F (15 and 25 degrees C). Keep your device away from heat, direct light, and humidity. Do not puncture the canister or expose it to open flame. ProAir HFA canisters can burst if exposed to extreme temperatures. Don’t store your device in the bathroom. Store your inhaler with the mouthpiece down. Different brands of Albuterol have different storage needs. Ask your pharmacist how to store the brand you use if you have questions.

Keep your medications out of reach of children and pets, ideally locked in a cabinet or closet.

If you plan to travel with ProAir HFA, get familiar with your final destination's regulations. In general, be sure to make a copy of your ProAir HFA prescription. If possible, keep your medication in its original container from your pharmacy with your name on the label. If you have any questions about traveling with your medicine, be sure to ask your pharmacist or healthcare provider.

Discard all unused and expired drugs, but do not pour them down the drain or into the toilet. Ask your pharmacist or healthcare provider about the best ways to dispose of this medicine. And check out drug take-back programs in your area.

How Long Does ProAir HFA Take to Work?

ProAir HFA works immediately to help relieve the symptoms of bronchospasm as soon as you inhale it.

Off-Label Uses

Inhaled albuterol is also used to treat or improve muscle paralysis (inability to move parts of the body) in people with high blood levels of potassium (a condition that causes paralysis attacks).

Healthcare providers also prescribe albuterol for some respiratory problems, such as chronic obstructive pulmonary disease (COPD).

What Are the Side Effects of ProAir HFA?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Some common side effects of Albuterol include:

  • Heart palpitations/increased heart rate
  • Nervousness
  • Headache
  • Nausea
  • Vomiting
  • Throat irritation
  • Muscle aches
  • Bones or back pain
  • Uncontrollable shaking of body parts
  • Cough

Call your healthcare provider if any of the side effects become severe.

Severe Side Effects

Albuterol can cause some severe side effects, such as:

  • Allergic reactions such as rash, hives, itching, swelling of the face, throat, tongue, lips or extremities, difficulty breathing or swallowing, and hoarseness
  • Wheezing, choking, or other breathing problems
  • Chest pain, irregular heart rate, pounding heartbeats, or fluttering in the chest
  • Pounding in the neck or ears
  • Pain or burning sensation during urination
  • High blood sugar
  • Low potassium levels

Get emergency medical help if you have any of the new or worsening severe symptoms.

Long-Term Side Effects

Long-term side effects are not available for ProAir HFA.

Report Side Effects

ProAir HFA may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much ProAir HFA Should I Take?

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IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For inhalation aerosol dosage form (inhaler):

    • For treatment or prevention of bronchospasm:

      • Adults and children 4 years of age and older—Two puffs every 4 to 6 hours as needed.
      • Children younger than 4 years of age—Use and dose must be determined by your child's doctor.
    • For prevention of exercise-induced bronchospasm:

      • Adults and children 4 years of age and older—Two puffs taken 15 to 30 minutes before exercise.
      • Children younger than 4 years of age—Use and dose must be determined by your child's doctor.
  • For inhalation powder dosage form (inhaler):

    • For treatment or prevention of bronchospasm:

      • Adults and children 4 years of age and older—Two puffs every 4 to 6 hours as needed.
      • Children younger than 4 years of age—Use and dose must be determined by your child's doctor.
    • For prevention of exercise-induced bronchospasm:

      • Adults and children 4 years of age and older—Two puffs taken 15 to 30 minutes before exercise.
      • Children younger than 4 years of age—Use and dose must be determined by your child's doctor.
  • For inhalation solution dosage form (used with a nebulizer):

    • For prevention of bronchospasm:

      • Adults and children older than 12 years of age—2.5 milligrams (mg) in the nebulizer 3 or 4 times per day as needed.
      • Children 2 to 12 years of age—0.63 to 1.25 mg in the nebulizer 3 or 4 times per day as needed.
      • Children younger than 2 years of age—Use and dose must be determined by your child's doctor.


The following modifications (changes) should be kept in mind when using ProAir HFA:

Severe allergic reaction: Avoid using ProAir HFA if you have a known allergy to it or any of its ingredients. Ask your pharmacist for a complete list of the ingredients if you're unsure.

Pregnancy and breastfeeding: Discuss with your healthcare provider if you plan to become pregnant or are pregnant, and weigh the benefits and risks of taking ProAir HFA during your pregnancy or breastfeeding.

Children: The safety of ProAir HFA has not been established for people under age 4.

Adults over the age of 65 years: The dose may need to be started at the lower side of the dosing range if the individual has reduced renal (kidney) or hepatic (liver) functions.

Kidney problems: Individuals with kidney problems may not be able to clear medication from their bodies as easily. This means the medicine stays in the body longer and can have increased side effects. Albuterol and other beta-adrenergic drugs are eliminated from the kidneys. People with renal (kidney) impairment may require a different dose to avoid toxic effects.

Missed Dose

If you miss a dose of ProAir HFA on a prescribed schedule or if you forget to take it before exercise, take it as soon as you remember. If it’s almost the time of the next dose, skip the missed dose. Inhale your next dose at the regular time. Do not double the dose to make up for the missed dose.

Try to find ways that work for you to help yourself remember to routinely take your medication. If you miss too many doses, ProAir HFA might be less effective at preventing and/or treating your condition.

Overdose: What Happens If I Take Too Much ProAir HFA?

An overdose of albuterol may be fatal. If someone has overdosed on the drug, immediately seek medical help. Call 911 right away if the victim has collapsed or has difficulty breathing.

Symptoms of overdose are:

  • Chest pains
  • Dizziness
  • Dry mouth
  • Fainting or feeling light-headed
  • Fast heartbeat
  • Headache
  • General illness or extreme tiredness
  • Nervousness
  • Uncontrollable shaking of a body part
  • Seizures

What Happens if I Overdose on ProAir HFA?

If you think you or someone else may have overdosed on ProAir HFA, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking ProAir HFA, call 911 immediately.


Drug Content Provided and Reviewed by

IBM Micromedex®

It is very important that your doctor check your or your child's progress at regular visits. This will allow your doctor to see if the medicine is working properly and to check for any unwanted effects.

Do not use this medicine together with other similar inhaled medicines, including isoproterenol (Isuprel®), levalbuterol (Xopenex™), metaproterenol (Alupent®), pirbuterol (Maxair®), or terbutaline (Brethaire®).

This medicine may cause paradoxical bronchospasm, which means your breathing or wheezing will get worse. This may be life-threatening. Check with your doctor right away if you or your child have coughing, difficulty breathing, or wheezing after using this medicine.

Talk to your doctor or get medical help right away if:

  • Your symptoms do not improve or they become worse after using this medicine.
  • Your inhaler does not seem to be working as well as usual and you need to use it more often.

You or your child may also be taking an antiinflammatory medicine, including steroid (cortisone-like medicine), together with this medicine. Do not stop taking the antiinflammatory medicine, even if your asthma seems better, unless your doctor tells you to.

Albuterol may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and require immediate medical attention. Check with your doctor right away if you or your child develop a skin rash, hives, itching, trouble breathing or swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.

Hypokalemia (low potassium in the blood) may occur while you are using this medicine. Check with your doctor right away if you or your child have decreased urine, dry mouth, increased thirst, irregular heartbeat, loss of appetite, mood changes, muscle pain or cramps, nausea, vomiting, numbness or tingling in the hands, feet, or lips, trouble breathing, seizures, or unusual tiredness or weakness.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take ProAir HFA?

ProAir HFA is contraindicated in people with a history of an allergic reaction to albuterol or any other inhalation aerosol ingredients.

Avoid using ProAir HFA if you're hypersensitive to milk protein.

The safety of ProAir HFA has not been established for people under age 4.

There is no clinical data on the safety of ProAir HFA in pregnancy and breastfeeding. Consult your healthcare provider if you are pregnant or breastfeeding.

What Other Medications Interact With ProAir HFA?

Beta-blockers may not work effectively if taken with ProAir. Examples of beta-blockers are:

  • Tenormin (atenolol)
  • Coreg (carvedilol)
  • Toprol XL, Lopressor (metoprolol)
  • Bystolic (nebivolol)
  • Inderal LA (propranolol)

Diuretics may cause lower potassium levels in the body when taken with ProAir HFA, such as:

  • Bumex (bumetanide)
  • Thalitone (chlorthalidone)
  • Lasix (furosemide)
  • Microzide (hydrochlorothiazide)

When taken with albuterol, blood levels of digoxin (Lanoxin) may decrease and become less effective in treating heart disease. Your healthcare provider may need to monitor the level closely to find the effectiveness of the digoxin. 

Monoamine oxidase inhibitors (MAOIs) and ProAir combined can lead to an increased risk of heart problems. Albuterol should NOT be used at least two weeks before starting or two weeks after stopping MAOIs such as:

  • Nardil (phenelzine)
  • Azilect (rasagiline)
  • Marplan (isocarboxazid)
  • Emsam, Zelapar (selegiline)
  • Parnate (tranylcypromine)

Tricyclic antidepressants can increase the risk of heart problems when used with ProAir. ProAir should be used at least two weeks after stopping taking tricyclic antidepressants such as:

  • Elavil (amitriptyline)
  • Norpramin (desipramine)
  • Silenor (doxepin)
  • Pamelor (nortriptyline)

Your healthcare provider may need to adjust the dose of your medications or monitor you closely for side effects.

What Medications Are Similar?

Albuterol, a bronchodilator, is also available in other brand names prescribed for the same conditions. These are:

  • Ventolin HFA
  • Proventil HFA

The following are both short-acting beta-agonists, like albuterol, but are different (metaproterenol).

These medicines are approved to prevent and treat bronchospasm in people with asthma. They’re also each approved for use as needed to avoid exercise-induced bronchospasm. They are used in adults and children ages 4 and older.

Ventolin HFA comes in canisters that hold either 60 or 200 inhalations of medicine. ProAir HFA and Proventil HFA come in canisters with 200 inhalations of medicine.

Frequently Asked Questions

  • What is ProAir HFA used for?

    ProAir HFA (albuterol) is a short-acting bronchodilator used to relieve lung problems such as bronchospasm from asthma and reversible obstructive airway disease.

  • How does ProAir HFA work?

    ProAir HFA (albuterol) relaxes the airway muscles so they remain open. This helps ease breathing and relieve other symptoms of lung diseases.

  • What drugs should not be taken with ProAir HFA?

    Beta-blockers, diuretics, digoxin, monoaminoxidase inhibitors (MAOIs), and tricyclic antidepressants cannot be taken with ProAir HFA.

How Can I Stay Healthy While Taking ProAir HFA?

Albuterol is meant to be a rescue treatment for symptoms of bronchospasm. Short-acting albuterol and other beta-agonists should not be used regularly to control asthma or other lung problems. However, your healthcare provider will determine the need, safety, and effectiveness of the medicine for you. 

Use your inhaler appropriately and always keep a backup to avoid any problem from accidental loss or a nonfunctioning inhaler, as this can be life-threatening. It's essential to regularly keep appointments with your healthcare provider to continue monitoring and talking about your symptoms and see if you may need to change treatment.

It's common for the ProAir inhaler to become clogged with powder residue. People may think the inhaler is broken when the delivery device simply needs to be cleaned/rinsed out. Ask your pharmacist or healthcare provider about how best to clean your ProAir inhaler.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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Hartford (Conn.) HealthCare partnered June 23 with digital health company Wellinks to see if the tech platform can improve the health of patients being treated for chronic obstructive pulmonary disease.

After leaving the hospital, participants in the study will have 16 weeks of access to Wellinks' virtual pulmonary rehabilitation program that includes personalized health coaching and remote monitoring through connected devices. The research will compare their hospital readmission rates and other outcomes to a control data set from Hartford's EHR.

"Although COPD is the third leading cause of death by disease in the United States, estimated to cost $49 billion in care annually, innovation in COPD care has trailed other disease states," said Syed Hadi, MD, a Hartford HealthCare hospitalist, in a Wellinks news release. "Acute exacerbations of COPD often result in hospitalization, and a quarter of patients will be readmitted to the hospital within 30 days."

Dr. Hadi added: "This is an important step, as together, we can reduce readmissions and move healthcare forward."

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Thrive's short-term pulmonary rehab program leverages technology, like the OmniFlow™, for improving pulmonary endurance and respiratory function.

NAPERVILLE, Ill., June 22, 2022 /PRNewswire/ -- Thrive Personalized Medical Rehabilitation offers a robust short-term pulmonary rehab care program at two of its skilled nursing facilities located in Lisle and Aurora: Thrive of Lisle and Thrive of Fox Valley.

Thrive of Lisle and Thrive of Fox Valley's short-term pulmonary rehab program consists of clinical teams and technology for improving pulmonary endurance and respiratory function. Their teams of professionals have specialized skills and work closely together to develop and implement each patient's pulmonary rehab care plan. Thrive of Lisle and Thrive of Fox Valley's clinical team members include in-house physical and occupational therapists, respiratory therapist, internal medicine physician, nurse practitioner, pulmonary nurse practitioner, registered nurse (RN), psychologist and registered dietitian.

Thrive of Lisle and Thrive of Fox Valley's short-term pulmonary rehab care program treats patients facing pulmonary conditions such as COPD, asthma, emphysema, chronic Bronchitis, pneumonia, and post COVID-19 syndrome.

Thrive of Lisle and Thrive of Fox Valley's short-term pulmonary rehab program also incorporates the latest in therapy technology like the OmniFlow™ and LiteGait©. OmniFlow, developed by Accelerated Care Plus, is a breathing therapy biofeedback system that conducts exercises using visual feedback in a virtual experience. In the following video, a Thrive rehab guest demonstrates the OmniFlow: www.youtube.com/watch?v=bWpHZR9hWaE. The LiteGait is another therapy technology that helps patients with weight bearing restrictions maintain constant support while working on gait therapy exercises.

For more information on Thrive Personalized Medical Rehabilitation and their short-term pulmonary rehab care program and skilled nursing facilities near Naperville—Thrive of Lisle and Thrive of Fox Valley—visit www.ThriveAhead.com.

Media Contact:

Lisa Henderson



Cision View original content to download multimedia:www.prnewswire.com/news-releases/naperville-pulmonary-rehab-care-301572639.html

SOURCE Thrive Personalized Medical Rehabilitation

Source link

Thrive's short-term pulmonary rehab program leverages technology, like the OmniFlow™, for improving pulmonary endurance and respiratory function.

NAPERVILLE, Ill., June 22, 2022 /PRNewswire/ -- Thrive Personalized Medical Rehabilitation offers a robust short-term pulmonary rehab care program at two of its skilled nursing facilities located in Lisle and Aurora: Thrive of Lisle and Thrive of Fox Valley.

Thrive of Lisle and Thrive of Fox Valley's short-term pulmonary rehab program consists of clinical teams and technology for improving pulmonary endurance and respiratory function. Their teams of professionals have specialized skills and work closely together to develop and implement each patient's pulmonary rehab care plan. Thrive of Lisle and Thrive of Fox Valley's clinical team members include in-house physical and occupational therapists, respiratory therapist, internal medicine physician, nurse practitioner, pulmonary nurse practitioner, registered nurse (RN), psychologist and registered dietitian.

Thrive of Lisle and Thrive of Fox Valley's short-term pulmonary rehab care program treats patients facing pulmonary conditions such as COPD, asthma, emphysema, chronic Bronchitis, pneumonia, and post COVID-19 syndrome.

Thrive of Lisle and Thrive of Fox Valley's short-term pulmonary rehab program also incorporates the latest in therapy technology like the OmniFlow™ and LiteGait©. OmniFlow, developed by Accelerated Care Plus, is a breathing therapy biofeedback system that conducts exercises using visual feedback in a virtual experience. In the following video, a Thrive rehab guest demonstrates the OmniFlow: www.youtube.com/watch?v=bWpHZR9hWaE. The LiteGait is another therapy technology that helps patients with weight bearing restrictions maintain constant support while working on gait therapy exercises.

For more information on Thrive Personalized Medical Rehabilitation and their short-term pulmonary rehab care program and skilled nursing facilities near Naperville—Thrive of Lisle and Thrive of Fox Valley—visit www.ThriveAhead.com.

Media Contact:
Lisa Henderson
[email protected]

SOURCE Thrive Personalized Medical Rehabilitation

Source link

Background: Most of the acute exacerbations of chronic obstructive pulmonary disease (COPD) are due to infections, mostly due to bacteria and viruses. There is a need to study the outcome of microbe-induced airway inflammation.

Materials and methods: It is an observational follow-up study from the pulmonary medicine department of Kalinga Institute of Medical Sciences with the participation of the Regional Medical Research Center, Bhubaneswar, from October 2018 to February 2022. Patients who were admitted with acute exacerbation of COPD and treated as per GOLD (Global Initiative for Chronic Obstructive Lung Disease) 2021 guidelines were included in the study. Those patients in the severe category, who had clinically recovered, had undergone pulmonary physiotherapy, were on prescribed medications and home oxygen therapy after discharge, were followed up every three months by telephone calls. Any exacerbation, clinical stability, or mortality information was recorded.

Results: Out of 197 cases, the majority were elderly, males, smokers, and belonged to urban areas; in total, 102 (51.8%) microbes were isolated as etiological agents of infective exacerbation in which 19.79% were viruses and 23.35% were bacteria, while coinfection was found in 8.62% cases. Among the viruses, rhinovirus, influenza virus, and respiratory syncytial virus were the major isolates. Among the bacteria, mostly gram-negative organisms such as Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa were isolated. Readmission was more among patients with coinfection.

Conclusion: Acute exacerbation of COPD was mostly seen in males in the age group of 61-80 years. Rhinovirus and influenza A virus were the two most common viral isolates, and among the bacterial isolates, Acinetobacter baumannii and Klebsiella pneumoniae were predominantly detected. Poor clinical outcomes were noticed more among the coinfection group.


Worldwide, COPD is one of the major causes of illness and the sixth highest cause of death. According to research on the Global Burden of Diseases in 2017, it contributed to 50% of all chronic respiratory diseases. It is currently the third leading cause of death worldwide, accounting for nearly 3.23 million deaths, with nearly 80% of deaths occurring in the middle- and low-income countries, and is expected to rise from the 12th leading cause of disability-adjusted life-years (DALYs) in 1990 to the fifth leading cause in 2020 [1,2].

Acute exacerbations of COPD are significant events in the course of illness because they have a negative influence on health status, hospitalization rate, and disease progression. It is believed that respiratory infections are an important risk factor for COPD exacerbations, with viruses accounting for 22%-64% [3]. The increased exposure to viruses in winter has been correlated to an increase in the frequency of exacerbations in winter in some areas of the world [4]. Co-infections have also been linked to an increase in the severity of COPD exacerbations. The simultaneous discovery of bacteria and viruses in patients with acute exacerbation of COPD is responsible for the worsening lung function, prolonged hospital stay, and risk of recurrence of a similar event [5,6].

This study analyses the prevalence and pattern of viral and bacterial infections in patients presenting with acute exacerbation of COPD, correlates the type of infection with the severity of exacerbation among the patients, and finds out the long-term outcome of the severe follow-up cases after discharge in terms of readmission, clinical stability, or death.

Materials & Methods

The study was conducted from October 2018 to February 2022 among the patients admitted to critical care, Respiratory and General Medicine unit of Kalinga Institute of Medical Sciences, Bhubaneswar, in collaboration with Regional Medical Research Centre (ICMR), Bhubaneswar.

The sample size was calculated by using the formula: 

n = Z2 P(1−P)/d2

where n is the sample size; Z is the statistic corresponding to a 95% level of confidence, which is equal to 1.96; P is the expected prevalence (proportion of COPD patients with infectious etiology = 78.3% in a study conducted by Jahan et al.) [7]; d is the absolute precision (it has been taken as 6%). The sample size was found to be 179; adding a 10% non-response rate, the final sample size was 179 + 18 = 197.

Admitted cases underwent clinical assessment and other routine investigations. Empirical treatment was given as per standard treatment guidelines. The nasopharyngeal swab was taken and transported in a viral transport medium within 24 hours to the Regional Medical Research Centre (RMRC) for the detection of respiratory viruses. Samples were tested by real-time reverse transcription-polymerase chain reaction (RT-PCR). The test was done using recommended commercial kit (FTD, UK) following the manufacturer’s instructions on Applied Biosystems-7500 (ABI-7500) equipment (ABI, USA). After thorough rinsing of the oral cavity, respiratory secretions were sent in a sterile container to our institute laboratory for bacterial culture and sensitivity study by VITEK 2 compact instrument (bioMérieux, France).

Apart from the procedural guidelines, depending on the severity of the cases, patients were treated with microbe-targeted antibiotics, oxygen support, either parenteral or oral, nebulized corticosteroid, and bronchodilator and were classified as mild, moderate, and severe as per the GOLD guidelines. The severe cases underwent pulmonary physiotherapy (diaphragm strengthening, pursed-lip breathing, lower limb muscle training, and chest percussion) session one week after clinical stability.

The patients were contacted over telephonic/telemedicine services every three months (due to the COVID pandemic, physical follow-up was not done) to ensure that they were continuing to perform the exercises at home and consuming medications, and any clarifications sought were addressed. Outcome data were collected with respect to clinical stability, worsening of clinical symptoms requiring admission, or mortality at the end of one year of follow-up.

This is an observational follow-up study conducted in the pulmonary medicine department of the Kalinga Institute of Medical Sciences. Ethical clearance was obtained from Institutional Ethics Committee (vide letter no.: KIIT/KIMS/113). All patients (including those on ventilation) with acute exacerbation of COPD (based on acute onset of cough, increased sputum with or without purulence, and breathing difficulty) admitted to the pulmonary medicine department were included in the study. Patients with pulmonary tuberculosis (TB), bronchiectasis, bronchial asthma, pneumonia, and acute lung injury (based on history and evaluation) and patients unwilling to give consent were excluded from the study.

Statistical analysis

Descriptive statistics were done after the collection of data. Frequency distributions of categorical variables (occupation, gender, place of residence, smoking status, type of pathogens found, clinical features, comorbidities, and follow-up data) were calculated. For continuous data (age, total leukocyte count [TLC], and duration of hospital stays), mean and standard deviations were calculated. These were presented in tables using SPSS version 20.0 (IBM Corp., Armonk, NY) and Microsoft Excel 2007 (Microsoft Corporation, New Mexico, USA).

Type of infection, isolated organisms, and clinical outcomes after one year were identified. Chi-square and p-values were calculated to measure the associations between the type of infection and isolated organisms, type of infection, and readmission after one year.


A total of 197 subjects were included in the study, out of which 138 (70.06%) were males and 59 (29.94%) were females. The maximum number of subjects (130 [65.9%]) were within the age group of 61-80 years. The total number of patients more than 80 years of age was 25 (12.69%). The mean age of the patients was 69.24 ± 11.08 years (Table 1).

Age group (years) Male Female Total
40-60 25 17 42
61-80 92 38 130
>80 21 4 25
Total 138 59 197

The total number of patients who had a smoking history was 126 (63.95%). Most of the study subjects were farmers (37.06%), and the least belonged to the category of laborer (2.54%). Out of the total subjects, only 83 (42.13%) patients were from rural areas (Table 2).

Variables Frequency Percentage (%)
Smoking history
Smoker 126 63.96
Non-smoker 71 36.04
Teacher 16 8.12
Businessmen 21 10.66
Laborer 5 2.54
Farmer 73 37.06
Housewife 47 23.86
Unemployed 35 17.77
Area of residence
Urban 114 57.87
Rural 83 42.13

Out of 197 patients,102 (51.78%) had been isolated with bacteria or viruses, or both. Isolated viral infection was seen in 39 (19.79%) cases, while 46 (23.35%) had only bacterial exacerbations. In another 17 (8.62%) cases, both bacteria and viruses were detected. No etiology for exacerbation could be detected in 95 (48.2%) cases (Table 3).

Infection detected No. of cases Percentage (%)
Virus only 39 19.79
Bacteria only 46 23.35
Coinfection with both 17 8.62
No pathogen found 95 48.24
Total no. of patients 197 100

Out of 56 cases, in three cases of viral exacerbations, more than one virus (i.e., two) was detected, and in one case of viral exacerbation, more than one virus (i.e., three) was detected. A total of 62 viruses were isolated. Rhinovirus and Flu-A (H3N2) were isolated most frequently (30.35% and 25%, respectively) followed by respiratory syncytial virus (RSV) and parainfluenza virus 3 (PIV-3) (10.71% each; Table 4).

List of viruses No. of cases with viral infection (N = 56) % of patients with the isolated virus
Rhinovirus 17 30.35
Flu-A (H3N2) 14 25.0
RSV-B 6 10.71
Flu-B 4 7.14
PIV-3 6 10.71
Flu-A/PDM 09 4 7.14
HMPV 3 5.35
Adenovirus 2 3.57
RSV-A 2 3.57
COVID-19 4 7.14

A total of 63 bacteria were isolated in which gram-negative bacilli were most common, which include Acinetobacter baumanniiKlebsiella pneumoniae, and Pseudomonas aeruginosa. Among the gram positives, Staphylococcus aureus was the most common.

Rhinovirus was most commonly associated with bacterial coinfection in four cases (2.03%) followed by Flu-A and COVID-19. Acinetobacter baumannii was associated with a viral infection in most cases (five cases; 2.53%). This was followed by the detection of Pseudomonas aeruginosa and Klebsiella pneumoniae in two cases each (Table 5).

List of bacteria No. of cases with bacterial infection (N = 63) % of total bacteria isolated
Acinetobacter baumannii 14 22.22
Klebsiella pneumoniae 14 22.22
Pseudomonas aeruginosa 12 19.05
Staphylococcus aureus 5 7.94
Escherichia coli 8 12.70
Enterobacter cloacae complex 5 7.94
Serratia marcescens 2 3.17
Enterococcus faecium 1 1.59
Streptococcus pneumoniae 1 1.59
Staphylococcus haemolyticus 1 1.59
Sphingomonas paucimobilis 1 1.59

Breathlessness and cough were the most frequent complaints at the time of presentation. In cases with isolated viral exacerbation, 38 out of 39 cases (97.4%) had a shortness of breath, while 34 out of 39 (87.2%) cases had a cough. Fever was present in 14 out of 39 (32%) cases. However, sore throat was reported only in patients with isolated viral exacerbation, and chest pain was reported in patients with isolated bacterial exacerbations. Hypertension was the most common comorbidity reported in both bacterial and viral infections. Diabetes mellitus was mostly seen in patients who had a coinfection (Table 6).

Clinical feature Type of infection
Isolated viral Isolated bacterial Coinfection
Fever 14 19 6
Cough 34 36 13
Expectoration 9 10 4
Breathlessness 38 43 17
Chest pain 0 2 0
Sore throat 9 0 0
Altered sensorium 2 0 0
Hypertension 11 16 4
Diabetes mellitus 5 5 6
Parkinson’s disease 0 2 0
Coronary artery disease 0 4 0
Cerebrovascular accident 1 2 0
Chronic kidney disease 1 1 0
Cushing syndrome 1 0 0
Chronic liver disease 1 0 0
Carcinoma larynx 0 1 0
Alzheimer’s disease 0 1 0
Congenital heart disease 0 0 1

Among the 102 patients with infective exacerbations, patients with viral exacerbation had relatively lower mean TLC, while patients with exacerbation due to coinfection had the highest mean TLC. However, the results were not significant (p = 0.641). Among the patients with infective exacerbations, those with viral exacerbation had the least mean duration of hospital stay (7.33 ± 4.8 days), while patients with bacterial exacerbation spent the highest number of days in the hospital (10.082 ± 5.89 days). The 17 patients with coinfection had a mean duration of hospitalization of 6.8 ± 5.03 days. The results were not statistically significant (p = 0.071). Ten (26%) patients with viral exacerbation, 24 (52%) with bacterial exacerbation, and nine (53%) patients with a coinfection required respiratory support and hence needed admission to ICU. Severity was most commonly noticed in coinfection cases (p = 0.020). Two deaths were reported in viral infections, four in bacterial exacerbation, and three in coinfections (Table 7).

Parameters Mean Value P-value
  Isolated viral infection (n = 39) Isolated bacterial infection (n = 46) Coinfection (n = 17)
Mean age (years ± SD) 68.36 ± 3.45 71.8 ± 11.73 73 ± 8.33 0.084NS
Total leukocyte count (cells/mm3) 11.139 ± 4.8 12.49 ± 5.435 12.66 ± 7.3 0.641NS
Mean duration of hospital stay (in days) 7.33 ± 4.8 10.052 ± 5.89 6.8 ± 5.03 0.071NS
Type of cases
Mild 12 (31%) 0 (0%) 0 (0%) 0.041S
Moderate 17 (43%) 22 (48%) 8 (47%) 0.062NS
Severe 10 (26%) 24 (52%) 9 (53%) 0.020S
No. of deaths among the severe cases 2 4 3 NA

The number of patients who had a severe disease was 43 (Table 7). Out of them, nine died. The rest 34 cases were advised pulmonary rehabilitation, oxygen therapy, inhaler-based medication as self-management home-based delivery, and were on telehealth monitoring. Five cases were lost to follow-up. In the rest 29 cases, information was documented after follow-up for one year that consisted of six viral infection, 17 bacterial infection, and six coinfection cases (Table 8).

Condition of the patients after one year of follow-up Viral infection (6 cases) Bacterial infections (17 cases) Coinfections (6 cases) P-value
Clinically stable 6 (100%) 16 (94%) 2 (33%) 0.034s
Exacerbation (admission) 0 1 (6%) 4 (67%)

All viral infection cases were clinically stable and did not require admission. Out of 17 bacterial infection cases, 16 (94%) were clinically stable and only one (6%) required hospital admission due to exacerbation. But in the six coinfection cases, two (33%) were clinically stable and the rest four (67%) cases required hospital admission, and the data was found to be statistically significant (p = 0.034). This shows most of the coinfection cases required rehospitalization during the period of follow-up (Table 8).


Acute exacerbation of COPD results in deterioration of pulmonary function, morbidity, and death. In our study, the mean age of the patients was 69.24 ± 11.08 years with a majority of the patients belonging to the age group of 61-80 years (Table 1). In a recent study conducted at the All India Institute of Medical Sciences (AIIMS), Bhubaneswar, the mean age was 65.49 ± 10.40 years [7]. As per another Indian study by Mood et al., the mean age of patients was 66.8 ± 11.4 years and the maximum prevalence was observed in the age group 70-79 years [8]. In another study that involved both European and American subjects, the proportion of females was 36.7% among Europeans and 33.3% among Americans, which is in accordance with our findings [9]. A study by Hajare et al. reported a male-to-female ratio of 2.3:1 [10]. The preponderance of males being affected can be attributed to the fact that males are more involved in outdoor activities and hence are more exposed to environmental pollutants [8]. Smoking is a risk factor for COPD and also its exacerbation as it decreases mucociliary clearance, which is amply proved in our study where smoking as a risk factor was noticed among 64% of patients [11]. In our study, the two main occupations that had increased the prevalence of COPD were farmers and housewives (Table 2). In a study published in 2016, occupations that were at COPD risk were seafarers, coalmine operatives, and cleaners [12]. In a study in Bangladesh, occupational exposures in farmers, hazardous exposures in tanners, and cotton dust exposures in garments were among the most prominent risk factors for the development of COPD [13]. In our study, the urban population comprised the majority (57.8%, Table 2), which correlates well with a study done in India where the prevalence of COPD was more in the urban areas. But there has been a significant increase in the prevalence in rural areas where it was reported to be 8.8% in a study done in India, whereas in our study, the prevalence is around 22% [14]. The disparity in the urban-rural divide is reversed in the United States, where the prevalence of COPD in rural communities is nearly double that in urban areas [15].

The complex interactions between environment, host, and microbes are responsible for exacerbations in COPD and increased morbidity and mortality [16]. As per studies, the major cause of acute exacerbations is infections [7]. In our study, infection was detected in 51.7% of cases (Table 3). In an Indian study, around 78.3% of cases had a respiratory infection [7]. Our study illustrates that only bacterial infection was found in 23.35% of cases; only viral etiology was found in 19.79% of cases, and bacterial and viral coinfection was found in 8.62% of cases. Other studies have reported bacterial infection in around 42%-49% of cases, viral infections in around 20%-64% of cases, and bacterial-viral coinfection in 27% of cases [7,17,18]. There has been an increased report of respiratory viruses as a causative agent in the acute exacerbation of COPD. With the application of molecular techniques in patients’ samples, viruses have been implicated in around 47%-66% of cases [11]. A total of 56 viruses were isolated (Tables 3, 4). The most common viruses isolated were rhinovirus, followed by Flu-A and RSV-B. Human rhinovirus (HRV) has been reported as a common viral isolate in various studies [18]. The study by Koul et al. also reported rhinovirus and influenza virus as the most common virus causing acute exacerbation of COPD [19]. The high rate of isolation of influenza virus may be attributed to the transmission of the influenza virus in the community and the need to have immunization [20]. In our study, more than one virus was isolated in three cases. Similar results have been found in a recent study in India [7]. The most common bacterial isolates in our study are Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa making up around 21.9% (for both Acinetobacter and Klebsiella) and 18.8%, respectively. Among the gram-positive bacteria, Staphylococcus aureus (7.8%), Enterococcus faecium (1.6%), and Streptococcus pneumoniae (1.6%) were the most common isolates. In the study by Jahan et al., the most common bacteria isolated were Pseudomonas aeruginosa (28%), followed by Acinetobacter baumannii and Klebsiella pneumoniae in seven cases each (21%) [7]. In another study, the most common bacterial isolates were P. aeruginosa (30.7%) followed by K. pneumoniae (20.3%) and S. pneumoniae (8.6%) [8].

It is to be noted that most of the studies implicate Pseudomonas aeruginosa as the most common bacteria causing exacerbation, whereas Acinetobacter baumannii and Klebsiella pneumoniae are the most common bacteria causing exacerbations as per (Table 5) of our study [21]. The predominance of Acinetobacter spp. in our study is a novel finding, and further studies are needed to know if this is the emerging trend in acute exacerbation of COPD as MDR (multidrug-resistant). Acinetobacter baumannii is implicated in the etiology of various other infections [22]. Jahan et al. reported coinfection with virus and bacteria in 24.9% of cases of acute exacerbations of COPD [7]. In our study, coinfection was detected in 9.63% of cases (Table 3). However, this may not represent a natural course as many patients are chronically infected with multiple pathogenic bacteria before a viral pathogen is detected. Conversely, viruses have been shown to be frequently followed by secondary bacterial infection. Most of the coinfections were seen to be associated with rhinovirus and influenza A virus, whereas it was mostly associated with both influenza A and influenza B in another study by Jahan et al. [7]. In another study, the viruses implicated alone or as coinfections are picornaviruses (especially rhinovirus), influenza virus, and respiratory syncytial virus [23]. Comorbidities were associated with eight cases of viral exacerbation with hypertension being the most common (Table 6). Similar findings were also reported by Koul et al. where hypertension was seen in 60.52% of cases followed by heart ailments (14.16%) [19]. No significant correlation was observed between the various subgroups. Breathlessness and cough were the most common clinical presentation in cases of exacerbation in our study. Sore throat, however, was reported only in viral exacerbation and not in bacterial or coinfection (Table 6). The outcome of viral exacerbation has improved over time, owing to an increase in adult vaccination and early treatment. Among the etiological agents, in our study, we noticed poor outcomes among the coinfection group probably as a consequence of systemic inflammation (Table 7). As per a study in Japan, gram-negative bacilli were significantly associated with prolonged hospitalization [24].

The severe category of patients who were discharged was put on telemedicine advice on pulmonary physiotherapy, medications, and home oxygen. Among them, the coinfection group had exacerbation that needed admission, and the rest of the cases were clinically stable (Table 8). There are not many studies that correlate the long-term outcome of acute exacerbation of COPD with infective causes. As per a review by Wang et al., it is observed that in cases where there is coinfection with bacteria and virus, the lung function impairment is greater and the duration of hospitalization is also longer [25]. In another study published in Lung India, where the outcomes were followed up for readmission for two years, 12% mortality was observed; readmission was seen in 54% of cases, and two or more readmissions were seen in 45% of cases [26].

Thus, a proportion of patients appear to be more susceptible to exacerbation. Hence, prevention and mitigation should be the key goals. The application of technological advancement in communication during the COVID pandemic enabled us to overcome the challenge through tailored prescription and telemedicine intervention.


The clinical course of COPD is punctuated by exacerbation. These events are associated with accelerated loss of lung function, poor quality of life, increased health care costs, and mortality. Infection is the most important cause of exacerbation. Klebsiella pneumoniae and Acinetobacter baumannii among the bacterial isolates and rhino and influenza A viruses among the viral isolates were predominantly detected. During the telehealth follow-up, it was observed that those patients who had co-infections were more prone to readmission, whereas those who had isolated bacterial or viral etiology had better clinical stability. Pulmonary physiotherapy and appropriate medical measures for the mitigation of exacerbation can prevent further decline of disease progression.

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Lung scraping, or thoracentesis, involves the removal of fluid or air from the space between the chest wall and the lungs. In some cases, doctors may perform the procedure on people who have chronic obstructive pulmonary disease (COPD).

It is not a standard treatment for COPD, but it may be necessary if a person has pleural effusion or empyema.

This article looks at COPD and lung scraping in more detail. It explains who may need the procedure and discusses the risks, preparation, and aftercare. It also outlines other procedures for COPD.

Lung scraping involves removing air or excess fluid from the pleural space. The pleural space is the area between the lungs and the chest wall. The medical term for lung scraping is thoracentesis. Doctors perform the procedure for therapeutic reasons or diagnostic purposes.

Therapeutic thoracentesis helps decrease the shortness of breath and pain that result from the pressure of the fluid on the lungs. It typically involves the removal of a large volume of fluid. It is not unusual for a healthcare professional to remove multiple liters of fluid.

Diagnostic thoracentesis helps doctors determine the cause of pleural effusion, which is a buildup of fluid in the pleural space. Healthcare professionals remove less fluid during diagnostic thoracentesis.

Doctors may use thoracentesis to treat pleural effusion. Usually, the pleural space contains a small amount of fluid, but a pleural effusion involves excess fluid. The excess fluid causes respiratory problems.

Thoracentesis is not generally a primary treatment for COPD. However, doctors may suggest thoracentesis for a person with COPD who develops pleural effusion or empyema.

An empyema involves an accumulation of pus in the pleural space. In the U.S., there are about 32,000 cases of empyema each year.

A 2018 study involving 72,085 people found that the individuals with COPD were more likely to develop empyema than those without COPD.

Thoracentesis is an option for people with COPD who develop an empyema. It is also a treatment option for pleural effusion that is not related to COPD. According to 2019 research, common causes of pleural effusion include:

It is important to emphasize that thoracentesis is not a treatment for COPD. Rather, it is a procedure for draining fluid from the pleural space.

As with any medical procedure, thoracentesis has risks. According to the American Thoracic Society, possible risks include:

The risks of complications may vary based on several individual factors, including the amount of fluid in the pleural space.

The researchers behind a recent study investigated the complication rate of thoracentesis over a 5-year period. They looked at a total of 685 thoracentesis procedures and found a complication rate of 4.1%, equating to 28 complications.

A 2016 study also found that major complications from thoracentesis are not common.

To prepare for thoracentesis, doctors may instruct a person to stop eating and drinking for a specific number of hours before the procedure. A person may also be unable to take certain medications on the day of the procedure.

Healthcare professionals may give different preparation instructions to each individual depending on their circumstances.

Typically, doctors will perform an imaging test before the procedure to determine how much excess fluid is in the pleural space. A doctor may use one of the following imaging tests:

Usually, people remain awake during thoracentesis. Sometimes, a doctor may give a person sedative medication to help them relax.

After cleaning a person’s skin with a disinfectant, the healthcare professional will inject a numbing medication into the skin.

To perform the procedure, the doctor will insert a thin tube or needle through the skin and the chest wall into the pleural space. They will then remove the excess fluid through the tube and remove the tube when all the fluid has drained.

The procedure usually takes 10–15 minutes. However, in some cases, the tube stays in place for longer to allow fluid to continue to drain.

After removing the tube, the doctor will apply a bandage to the insertion site wound. The small wound should close by itself without the need for stitches.

Anyone who takes sedative medication to help them relax during the procedure will need someone else to drive them home.

The aftercare guidelines for thoracentesis include monitoring for complications, such as excessive bleeding or a collapsed lung. If doctors suspect complications, they may order a chest X-ray to check the lungs.

Healthcare professionals may recommend avoiding or doing certain things to avoid infection and other complications. Their recommendations may include:

  • showering rather than taking a bath until the puncture site has healed
  • avoiding strenuous activity
  • resting when tired
  • checking when to resume regular medications
  • taking antibiotics if a doctor has prescribed them and completing the full course
  • keeping the puncture site clean and dry

Typically, COPD treatment includes medications, oxygen therapy, and lifestyle changes. Doctors may also suggest surgery.

In certain circumstances, a doctor may recommend thoracentesis for pleural effusion or empyema related to COPD.

However, healthcare professionals use other surgical procedures to treat COPD. According to the ALA, the following surgical procedures may be an option for people with COPD:

  • Bullectomy: In this procedure, a doctor will remove bullae, or large air sacs, from the lungs. The bullae may block or interfere with functioning lung space and cause difficulty breathing.
  • Lung volume reduction surgery: This may help in cases of severe COPD that affects the upper lobes of the lungs. A healthcare professional will remove about 30% of the damaged lung tissue. This allows the healthier portion of the lung to work better.
  • Lung transplant: In cases of severe COPD, lung transplantation may be an option. A doctor will remove the damaged lung and replace it with a donor’s lung.

Lung scraping is a medical procedure in which a doctor removes excess fluid from the space between the chest wall and the lungs. Healthcare professionals will likely refer to lung scraping as thoracentesis.

Thoracentesis is not a standard treatment for COPD. However, doctors may use thoracentesis to treat pleural effusion or empyema, which may occur in people with COPD.

A person with COPD should discuss their treatment options in detail with a doctor.

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At Airofit, we want to bring better breathing to the world. The beauty of Airofit is that it can and should be used by anyone – from Olympic athletes to the everyday person who just want to become a better version of their current self. Airofit is here to enhance your quality of life. Whether you do sports, run out of breath taking the stairs or suffer from asthma or COPD, we do it for you.

The Airofit Breathing Trainer provides resistance to your breathing muscles, allowing you to train your Respiratory Strength, Accessible Lung Capacity, Anaerobic Threshold, and other areas of your breathing. Airofit training is simple and easy, done separately from any exercise in just 5-10 minutes a day, sitting down in the comfort of your home.

Visit: www.airofit.co.za

Competition closes Thursday, 30 June 2021 2021 at midnight.

Ts&Cs apply. Competition will run online only. By entering the competition, you accept The Citizen’s standard terms and conditionsPremium members will not be automatically entered for this competition due to the nature of the competition.


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Hamakawa reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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In a new study, a non-respiratory symptom-dominant elevation in the COPD assessment test total score was associated with depression in adults with COPD, researchers reported in Respiratory Medicine.

The researchers aimed to evaluate characteristics of the COPD assessment test to determine whether non-respiratory symptom-dominant status is linked with depression status in patients with COPD. They noted that “there is no established method to distinguish patients whose [COPD assessment test] scores are high because of their depressive symptoms from patients whose [COPD assessment test] scores are high because they have severe respiratory symptoms caused by COPD.


Source: Adobe Stock.

The researchers analyzed data from 226 patients in the KYOTO cohort (mean age, 71.6 years; 93.8% men) in Japan and 924 patients in the Korea COPD Subgroup Study (KOCOSS) cohort (mean age, 69.2 years; 98.1% men).

Nearly one-quarter (23.5%) of patients in the KYOTO cohort and 11.2% in the KOCOSS cohort had a depression diagnosis (Patient Health Questionnaire-9 score 5 or Beck Depression Inventory-II score 17, respectively).

Non-respiratory symptom dominance was observed among 24.3% of patients in the KYOTO cohort and 26.9% of patients in the KOCOSS cohort. Patients in both cohorts had a significantly higher prevalence of depression compared with patients with respiratory symptom dominance, according to the researchers.

Researchers reported that both the COPD assessment test score and non-respiratory symptom dominance were significantly associated with depression in both cohorts. In addition, symptomatic patients with a COPD assessment test score of 10 or more also experienced preserved and significant associations, the researchers wrote.

“Patients with COPD and depression had a higher sum score for the last 4 items (Q5-Q8; Q5678, non-respiratory symptoms) than they did for the first four items (Q1-Q4; Q1234, respiratory symptoms). This ‘non-respiratory symptom-dominant’ status, Q1234 Q5678, could be a significant suspicious feature for depression in patients with COPD,” Yoko Hamakawa, MD, from the department of respiratory medicine at the Graduate School of Medicine at Kyoto University, Japan, and colleagues wrote.

The researchers noted that screening tools that are easy to administer are “essential for detecting depression” in this patient population.

Depression negatively affects the course of COPD, and regular treatment for COPD using bronchodilators and/or inhaled corticosteroids cannot always relieve depressive symptoms,” Hamakawa and colleagues wrote. “Therefore, determining and providing adequate treatment is vital. Treatment for depression is important for mental health but is a ‘treatable trait’ for patients with COPD.”

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Anxiety and depressive symptoms, although common in patients with COPD, are not frequently assessed, identified, and treated in this patient population.

“Comorbid anxiety and depressive symptoms increase  the risk of elevated morbidity, disability, and premature mortality in patients with COPD,” explains Abebaw M. Yohannes, PhD, MSc, FCCP, ATSF. “They are a frequent causes of emergency care utilization and hospital admissions in this patient group. In addition, they exert significant burden, misery, social isolation and impaired QOL on patients and their caregivers and contribute to poor treatment compliance, and heighten the dropout rate from a pulmonary rehabilitation program. Therefore, it is important to identify these comorbid symptoms and treat them adequately.”

For a study published in Respiratory Medicine, Dr. Yohannes and colleagues identified the pathways between symptoms of COPD, depression, and anxiety. They used a network analysis, a new method for determining the pathophysiology of mental health disorders, in patients with COPD.

Interconnection of COPD & Depressive Symptoms Illustrated

Using data from the COPDGene study, 1,587 patients with COPD from were included. The Bayesian Gaussian Graphical Model was used to emphasize the correlations between symptoms of COPD (measured via the COPD Assessment Test [CAT]) and depression and anxiety (Hospital Anxiety and Depression Scale [HADS)]). The researchers also assessed the role of sociodemographic characteristics, health status, and lung function.

A rendering was created that depicted five interconnected pathways in the network analysis from patients with COPD and comorbid symptoms of anxiety and depression, notes Dr. Yohannes. Based on their redundancy, 14 HADS items were combined into six variables. “The analysis, illustrated by nodes and communities, show how anxiety relates to tension, worry, fear, and panic,” he says.  “Depressive symptoms are tied to sadness and lack of pleasure in life. Physical impairment relates to low energy and breathlessness. Also, the impact of respiratory problems correlated with lack of confidence, sleep problems, and chest tightness (Figure).

These points, he says, are highly relevant for clinicians when interacting with their patients with COPD.  “We found that nodes and communities representative of characteristic COPD symptoms were highly interconnected. For example, cough and phlegm are closely related to chest tightness, sleep problems, and breathlessness, which in turn are linked to items related to physical and activity limitations.”

Anxiety & Depression Are Not Frequently Assessed in COPD

 The key takeaway from this study, according to Dr. Yohannes and colleagues, is that anxiety and depressive symptoms are not frequently assessed, identified, and treated in patients with COPD.  “We suggest identifying these symptoms in routine clinical practice,” Dr. Yohannes says. “Clinicians need to use a validated anxiety and depressive symptoms scale, such as HADS or the Anxiety Inventory for Respiratory Disease (AIR).

Patients with COPD identified with high levels of anxiety and depressive symptoms should be referred to a psychiatrist for further assessment, who may prescribe antidepressant drug therapy for major depression or anxiety, and mild to moderate  symptoms exercise therapy, and/or cognitive behavioral therapy are worthy of consideration.”

Following acute exacerbations, patients with COPD should be referred to a pulmonary rehabilitation program, he adds. “Pulmonary rehabilitation has been shown to be effective in ameliorating anxiety and depressive symptoms, improve exercise capacity and quality of life in patients with COPD.”

For future research, the study team concurred that prospective, randomized controlled trials with large sample sizes are needed to show the efficacy of antidepressant drug therapy in patients with COPD with comorbid symptoms of anxiety and depression. “Where appropriate and available, clinicians should consider a collaborative care model approach to treat these symptoms in patients with COPD,” Dr. Yohannes says.


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