A never-before seen medical ailment has evolved in the world over the last few years as a result of the worldwide COVID-19 epidemic.

The condition, called “Long COVID-19,” is still so novel that intervention research is only beginning to emerge.

But La Mesa Rehab has already used all available data at hand to create a new, intensive program for those suffering from its symptoms. La Mesa Rehab will reportedly continue to refine its protocols as scientists and doctors learn more about the disease’s etiology.

Long COVID-19 is a condition defined as the continuation, recurrence of, or emergence of virus symptoms lasting more than four weeks after recovery from the initial, acute phase of the disease. Some patients’ symptoms last up to two years. As of the June 2022 report from the Centers for Disease Control (CDC,) 1 in 13 adults in the U.S. (7.5%) had Long COVID-19 symptoms.

La Mesa Rehab’s new Long COVID-19 program is offering continuity of care, working as a total network for patients with the condition. It’s a team approach, with pulmonologists, respiratory therapists, and physical therapists working together for the betterment of “long haulers,” as they’ve come to be known.

Treatment plans unique to each patient

Each patient gets a new treatment plan that differs from that of any other patient because of the widely-varying symptoms across the population, as well as symptoms that change over time within an individual.

These may include: difficulty breathing or shortness of breath, chest tightness or pain, stomach pain, headache, low stamina, fatigue or weakness. And with these sensations comes fear. One patient at the clinic described their plight “You take for granted, that you’re going to breathe…it’s such a natural thing. And when that gets taken away, it’s very scary!”

According to Tami Peavy, MBA, DPT, and founder of La Mesa Rehab, what makes their treatments so unique is that “We design individual protocols, with respiratory therapy and physical therapy at the center of the program. We identify patients’ symptoms and address them systematically and adjust their protocols accordingly.”

Respiratory and physical therapists work closely with referring physicians, together designing individually-tailored programs that reduce shortness of breath, eliminate mucus, and increase lung capacity through exercise, postural strengthening, and breathing techniques. Specialized equipment and techniques are employed in order to more quickly and effectively achieve results. A few of these treatments include: vest therapy, bubble breathing, oxygen therapy, nebulizer treatments, gas exchange analysis, and balloon therapy.

Salt chamber therapy is the newest tool in the arsenal

Salt chamber therapy involves the inhalation by patients of dry salt in the form of a mist to clear lung mucus. Saline solution is placed in a nebulizer, a device that facilitates the inhalation of the mist into the lungs. Compressed oxygen or ultrasonic power breaks up the medicinal liquid into small aerosol droplets that are inhaled from a mouthpiece. Corticosteroids or bronchodilators can be added to the nebulizer to extend the effectiveness.

This procedure is administered within a specially designed salt chamber. The process, also called halotherapy, is quite remarkable, especially considering that it’s derived from a naturally-occurring substance. Dry salt particles shrink and liquefy lung mucus plugs that obstruct airways and aggravate breathing issues. The particles accelerate mucus transport and allow for enhanced cough efficiency. Coughs are more “productive” and the lungs are relived of mucus.

Peavy, a practicing clinician and innovative thinker, came up with the novel methodology. The lofty goal, which she successfully achieved, was to enhance the benefits of pulmonary rehabilitation, and minimize patients’ reliance on prescriptions. Previously, patients would have had to undergo bronchoscopies to remove such mucus plugs.

La Mesa Rehab’s new Long COVID-19 program is based on the clinic’s experience with other lung impairments and diseases. These include chronic obstructive pulmonary disease (COPD,) emphysema, chronic bronchitis, pulmonary hypertension, pulmonary fibrosis, and bronchiectasis. Therapists share their knowledge of these conditions with each other and with those who come to them for help. Patient education is provided to help get people with Long COVID-19 back to work more quickly, which is more important than ever during these times of economic difficulty and diminished workplace numbers.

Most lung diseases are treated with drug therapies, including steroids and inhalers. However, numerous published medical reports have shown that pulmonary rehabilitation is much more effective at easing symptoms, and results in a superior quality of life. It has also been documented that improved lung function leads to greater longevity, strength, and endurance, and reduces the number of hospitalizations and readmissions.

For more information, call (619) 466-6077 or view their website at: lamesarehab.com.

The facility is located at: 8380 Center Drive, Suite E, La Mesa.

Editor’s note: This article was provided by Carol Holland Lifshitz.

Photo credit: Pixabay.com

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Lungs are the main organ of the body’s respiratory system. When we breathe, our lungs absorb oxygen which is transported to and the all parts of our body, harmful carbon dioxide is removed from our system, keeping our body healthy and running. In recent years, due to several lifestyle and environmental changes, our respiratory health is suffering greatly, giving rise to a many acute as well as chronic and long-term lung diseases.

Chronic obstructive pulmonary disease (COPD), asthma, occupational lung diseases, bronchitis, and pulmonary hypertension are among the most common chronic lung diseases. Children, the elderly, and those with weak immune system are especially vulnerable to the chronic lung diseases. Globally asthma affected approximately 339 million  people, according to the World Health Organization. Even the number of people with chronic obstructive pulmonary disease is also increasing. It has affected 384 million  people worldwide.

There are several factors contributing to the increased risk of developing chronic lung diseases. Some of them are:

  • Smoking: Smoking causes damage to the airways and the small air sacs in the lungs which can cause lung disease. People who do not smoke but are exposed to secondhand smoke inhale many of the same poisonous substances and can develop chronic lung disease.
  • Air pollution: According to the World Health Organization, air pollution is second tobacco epidemic and is responsible for 7 million  deaths worldwide each year. Exposure to harmful air pollutants not only damages the lung function and causes chronic lung diseases but also causes inflammation.
  • Burning fuel: People who are exposed to fumes from burning fuel for cooking in poorly ventilated homes are more likely to develop chronic lung diseases.
  • Genetics: People with genetic conditions are also at the risk of developing lung diseases. For example: Alpha-1 antitrypsin (AAT) deficiency effects the lungs and can cause COPD.

Warning signs of chronic lung disease

Chronic lung diseases can be extremely dangerous to one’s health, so understanding the symptoms is critical. Though symptoms may vary in different chronic lung disease but there are certain symptoms which are commonly seen in all the patients are persistent breathlessness, cough, wheeze, chest infections, chest pain, mucus production, and fatigue.

Anybody experiencing any of the warning signs should immediately visit a doctor.

What are the preventive measures against chronic long term lung disease?

  • Eat right- Diet has a significant impact on lung health and can aid in its maintenance. To protect the lungs people should consume citrus fruits, vegetables, and antioxidant-rich foods.
  • Strengthen the lungs-People are advised to do breathing exercises because they help to improve the capacity of the lungs and increase the oxygen in the blood. All of this protects the lungs from developing chronic lung diseases.
  • Regular health checkups- As lung diseases can go unnoticed until they are severe, regular health checkups can help prevent them.
  • Quit smoking- As smoking is a major risk factor for developing chronic lung diseases. So, to protect the lungs, it is best to avoid smoking.
  • Proper ventilation- As exposure to fumes from burning cooking fuel in poorly ventilated areas increases the risk, it is critical to ensure that a place is well ventilated before burning cooking fuels.
  • Reduce exposure to outdoor pollution- Unless necessary, avoid going outside because prolonged exposure to air pollution is harmful to lung health.

Treatment options available for chronic long- term lung disease

  • Medications- A variety of medications can be used to treat the symptoms and complications of long-term lung disease. People suffering from early-stage lung diseases (COPD, pulmonary fibrosis, cystic fibrosis, and pulmonary arterial hypertension) are often prescribed long term medications daily to control and manage their symptoms, thereby preventing the progression of the disease. Combination medications, inhaled steroids and short-acting bronchodilator inhalers are some of the common medications, however they should only be taken after consulting adoctor.
  • Therapy- Along with an appropriate medical treatment plan, additional therapies may provide relief to people suffering from chronic lung disease. For example, oxygen therapy, where extra oxygen is provided to the body, can be helpful for patients with lung disease.
  • Lung transplant- Lung transplantation remains the pivotal treatment option once all the possible conservative treatments are exhausted and disease is irreversible. It involves a surgical procedure that helps replace a diseased or failing lung with a healthy one from a deceased donor. Aside from the underlying pulmonary or cardiopulmonary disease, the main selection criteria for transplant candidates are age, mobility, nutritional and muscular condition, and concurrent extrapulmonary disease.

People who have tried medications or other treatments, but whose conditions have not improved sufficiently are candidates for a lung transplant. Depending on the criteria, a lung transplantation is performed and can successfully improve the patient’s quality of life (e.g., in COPD or emphysema) and/or prolong life expectancy (e.g., in cystic fibrosis, pulmonary fibrosis, and pulmonary arterial hypertension).

The treatment protocol for each chronic lung disease varies depending on its type and spread, therefore patients are advised to work closely with doctor to determine what treatment works best for them. The best way to manage symptoms is to monitor lung disease and collaborate with the doctor.



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What Is Tyvaso?

Tyvaso (treprostinil) is a prescription-only medication used to help improve the symptoms of a medical condition known as pulmonary arterial hypertension (PAH).

Pulmonary hypertension means you have high blood pressure in the arteries that carry blood to your lungs. This is a serious medical condition that is accompanied by bothersome symptoms.

When high blood pressure is in these arteries, the blood vessels are narrowed, meaning less blood and oxygen can get to the lungs. As the disease progresses, it leads to symptoms such as shortness of breath, tiredness, and difficulty breathing upon exertion.

Treprostinil widens the blood vessels, lowering the pressure in the arteries for the lungs and helping to alleviate the symptoms of PAH.

Tyvaso is taken as an inhalation that you breathe into your lungs. You will use an inhalation system to administer the medication, which comes as an inhalation solution (liquid) or a powder.

Drug Facts

Generic Name: Treprostinil

Brand Name(s): Tyvaso, Tyvaso DPI

Drug Availability: Prescription

Administration Route: Inhalation

Therapeutic Classification: Vasodilator

Available Generically: No

Controlled Substance: N/A

Active Ingredient: Treprostinil

Dosage Form(s): Inhalation solution, powder

What Is Tyvaso Used For?

The Food and Drug Administration (FDA) approved Tyvaso to improve symptoms of high blood pressure in the arteries that carry blood to the lungs. This condition is known as pulmonary arterial hypertension.

How to Take Tyvaso

You should always follow directions given to you by your healthcare provider on how to take your medication.

Tyvaso comes as a solution intended to be inhaled by mouth that requires a device to deliver the medication, known as the Tyvaso Inhalation System. Make sure you get rid of any drug left in the chamber after your last dose, so it is ready for the next day.

It also comes as an inhalant powder used in a dry powder inhaler (DPI) under the brand name Tyvaso DPI. Your healthcare provider will train you on how to use the inhaler.

Unless instructed by your healthcare provider, do not mix other drugs in the nebulizer (inhaler). If this drug accidentally gets in the eyes or on the skin, rinse with water immediately.

Storage

Tyvaso is supplied as four individual vials packaged in a foil pouch.

Store Tyvaso according to the following guidelines:

  • Keep it in a cool, dry place at room temperature (68 F to 77 F).
  • Do not store it in the bathroom or your refrigerator, and do not freeze it.
  • Once the foil pouch is opened, use the vials that contain Tyvaso within seven days.
  • Tyvaso is a light-sensitive medication, meaning exposure to light can affect how the drug works and how long the medication is good. Due to this reason, unopened vials should be stored in the original foil pouch.
  • When a vial of Tyvaso is opened and transferred to your medicine cup, the solution should remain in the Tyvaso Inhalation System for no more than 24 hours. Any remaining solution should be discarded by the end of the day.

Tyvaso DPI inhalation powder comes in cartridges contained in blister strips. Store them according to the following guidelines:

  • Sealed blister strips: Store in the refrigerator to keep them until their expiration date. If you store them at room temperature, you must use them within five weeks.
  • Opened blister strips: Don't put an open blister card or strip back into the refrigerator after opening it or storing it at room temperature. Use opened strips within three days.

You can store the Tyvaso DPI inhaler in the refrigerator. However, leave it at room temperature for 10 minutes before using it. You can use the inhaler for up to seven days from its first use. After seven days, discard the inhaler and replace it with a new one.

Keep all your medications out of reach of children and pets.

Tyvaso is only available through a specialty pharmacy. When running low on the medication, it is important to contact your pharmacy before you run out to ensure you don't miss a dose of your medication. 

Off-Label Uses

There are currently no off-label uses for Tyvaso. It is important to make sure you are taking Tyvaso only as it is intended, as instructed by your healthcare provider.

How Long Does Tyvaso Take to Work?

Tyvaso takes about 10 minutes to reach its maximum level in your body. Tyvaso is typically taken four times a day, spaced four hours apart, with each dose increasing how much of the drug is in your body. Contact your healthcare provider if it has been a while since you started treatment and you are not noticing any improvements.

What Are the Side Effects of Tyvaso?

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 FDA at www.fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

The following are the most common side effects that have been observed with Tyvaso:

Severe Side Effects

Notify your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Swelling under the skin (angioedema)
  • Symptomatic hypotension (low blood pressure), with symptoms including lightheadedness or dizziness and syncope
  • Bronchospasm (narrowing of the airways), which can cause difficulty breathing and may be more likely in people with a history of a hyperreactive airway

Long-Term Side Effects

Tyvaso does not have any documented side effects that have occurred after it has been stopped.

Report Side Effects

Tyvaso 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 Tyvaso Should I Take?


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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 pulmonary arterial hypertension and pulmonary hypertension with interstitial lung disease:

    • For inhalation dosage form (powder):

      • Adults—At first, 16 micrograms (mcg) per treatment session at least 4 hours apart, 4 times a day. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 64 mcg per treatment session, 4 times a day.
      • Children—Use and dose must be determined by your doctor.
    • For inhalation dosage form (solution):

      • Adults—At first, 18 micrograms (mcg) or three breaths, per treatment session at least 4 hours apart, 4 times a day. Each treatment session will take 2 to 3 minutes. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 12 breaths per treatment session, 4 times a day.
      • Children—Use and dose must be determined by your doctor.

Modifications

The following factors can sometimes affect how medications are taken. Here's how they impact treatment with Tyvaso.

Pregnancy

There is currently limited information on Tyvaso and how it may affect the fetus if used during pregnancy. However, pulmonary hypertension is linked to increased risks for the pregnant individual and the fetus. Before starting treatment, let your healthcare provider know if you are pregnant or planning to become pregnant.


Breastfeeding

There is no information on the presence of Tyvaso in breast milk, its effects on the breastfed infant, or its effects on milk production. Talk to your healthcare provider with any questions or concerns.


Children

The safety and efficacy of Tyvaso in children under 18 have not been established.


Advanced Age

The safety and efficacy of Tyvaso observed in older adults (65 and older) were similar to younger adults. Caution should still be exercised due to an increased likelihood of liver or kidney damage in older people and possible interactions with other medications.

Missed Dose

If you miss a dose of Tyvaso, take it as soon as you remember. Therapy should be resumed as soon as possible at the usual dose. Do not take an increased dose to account for the missed dose.

Overdose: What Happens If I Take Too Much Tyvaso?

If you overdose on Tyvaso, you may experience the following:

  • Flushing
  • Headache
  • Low blood pressure
  • Nausea or vomiting
  • Diarrhea

Immediately seek medical advice if you think you've overdosed on your medication. You may receive general supportive care until the symptoms of the overdose resolve.

What Happens If I Overdose on Tyvaso?

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

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

Precautions


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It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.

It is very important that your doctor check your blood pressure regularly while you are taking this medicine. You may also need to monitor your blood pressure at home. If you notice any changes to your recommended blood pressure, call your doctor right away.

This medicine may increase the risk of bleeding. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Brush and floss your teeth gently. Be careful when using sharp objects, including razors and fingernail clippers.

This medicine may make you dizzy, lightheaded, or faint. Do not drive or do anything else that could be dangerous until you know how this medicine affects you. Standing up slowly from a sitting or lying position can help.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements. Your doctor may adjust the doses of all the medicines you are taking or monitor you carefully for side effects.

What Are Reasons I Shouldn’t Take Tyvaso?

It is not recommended to take Tyvaso if you have severe liver damage. However, this recommendation is based on the oral administration of treprostinil. There is not enough data on the use of inhaled treprostinil in liver impairment. Therefore, caution should still be exercised.

If you have mild to moderate liver damage, it is difficult to eliminate the medication from your body, so special care must be taken when your dose is increased.

You should also not take this medication if you develop a severe allergic reaction when taking this medication.

What Other Medications Interact With Tyvaso?

Because certain medications can affect the way treprostinil works, it is essential to tell your healthcare provider about any other medicines you take or plan to take, including over-the-counter (OTC) nonprescription products, vitamins, herbs, supplements, and plant-based medicines.

Tyvaso is further broken down in the body by specific proteins made by the liver called CYP2C8 enzymes. Any medication that decreases the production of these proteins can increase the amount of Tyvaso in your body. These include:

  • Lopid (gemfibrozil)
  • Nardil (phenelzine)

Ask your healthcare provider or pharmacist if you are unsure whether you are taking a medication that inhibits CYP2C8.

Tyvaso can enhance the effects of blood pressure-lowering medications. Medications that are used to decrease blood pressure include: 

This is not a complete list of medications that may interact with Tyvaso. Talk with your pharmacist or healthcare provider for more detailed information about potential interactions.

What Medications Are Similar?

Tyvaso belongs to a class of medications known as prostacyclin analogues. The following medications are also part of this drug class:

  • Flolan (epoprostenol)
  • Ventavis (iloprost)

The following are other drugs that the FDA has also approved to treat high blood pressure in the arteries of the lungs:

This is a list of drugs commonly used to treat pulmonary hypertension. It is NOT a list of drugs recommended to take with Tyvaso. Talk to your pharmacist or healthcare provider if you have any questions.

Frequently Asked Questions

  • What is Tyvaso used for?

    Tyvaso is used to improve symptoms if you have high blood pressure in the arteries for the lungs, also known as pulmonary arterial hypertension.

  • How does Tyvaso work?

    In pulmonary arterial hypertension, the blood vessels are narrowed, decreasing the oxygen carried to the lungs. This gives you the feeling of shortness of breath.

    Tyvaso widens the blood vessels, lowering the blood pressure in the arteries to the lungs.

  • Should I still exercise if I am taking Tyvaso?

    It is important to maintain a healthy lifestyle, especially if you have pulmonary hypertension. Tyvaso helps with your ability to exercise, but you should not overwork yourself. Talk to your healthcare provider to determine an appropriate exercise regimen for you and your goals. 

How Can I Stay Healthy While Taking Tyvaso?

To stay healthy while taking Tyvaso, it is important to take this medication every day as directed by your healthcare provider. Maintaining a healthy lifestyle is also essential and may include improving your diet or exercising regularly.

With your condition, exercise may be challenging to achieve at first. Still, you should try to remain active. Pulmonary hypertension is a chronic disease that worsens over time. Recent literature has shown that light exercises under expert supervision have helped improve quality of life. While there are benefits associated with physical activity, it is also important not to overdo it. You should only do light exercise if you can tolerate it and with your healthcare provider's approval.

Talk to your healthcare provider to help you develop an exercise regimen specific to you.

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.

I would like to recognize and thank Cody Ryan Thomas for contributing to this article.

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What Is Noxivent?

Noxivent is an inhaled medication used to treat infants with respiratory failure caused by pulmonary hypertension—a condition that occurs when blood vessels in the lungs don't open wide enough. This reduces how much oxygen is delivered to the brain and other organs.

Noxivent belongs to a group of drugs called vasodilators. It works by helping to expand blood vessels in the lungs and improves oxygen delivery throughout the body.

Drug Facts

Generic Name: Nitric oxide

Brand Name(s): Noxivent, Inomax, Genosyl

Drug Availability: Prescription

Therapeutic Classification: Vasodilator

Available Generically: No

Controlled Substance: No

Administration Route: Inhalation

Active Ingredient: Nitric oxide

Dosage Form(s): Inhalation gas

What Is Noxivent Used For?

Noxivent is an inhaled medication used to treat respiratory failure in babies with persistent pulmonary hypertension of the newborn (PPHN). This severe condition can cause a baby not to get enough oxygen after birth.

PPHM affects approximately 2 out of every 1,000 live births and is one of the most common critical illnesses affecting babies in the neonatal intensive care unit (NICU). PPHM occurs when blood vessels in the lungs don't expand wide enough after birth. This reduces blood flow to the lungs and decreases oxygen delivery to the brain and other parts of the body.

Signs of PPHM include:

  • Rapid breathing
  • Retractions (the skin under and in between the ribs pulls in with each breath)
  • Grunting
  • Blue color of the lips, skin, or nails (cyanosis)
  • Low oxygen levels in the blood

Healthcare providers may administer Noxivent, mechanical ventilation (a breathing machine), and other therapies to treat PPHM.

How to Take Noxivent

Noxivent is an inhaled gas administered by healthcare providers in the NICU. A special machine attaches to a ventilator (breathing machine) and pumps the Noxivent gas through the ventilator tubes and into the baby's lungs.

Noxivent is typically administered for up to 14 days or until oxygen levels improve.

Storage

Your baby's healthcare provider will administer and store this medication.

Off-Label Uses

Healthcare providers may prescribe medicines for conditions not approved by the Food and Drug Administration (FDA). This is called off-label use. Healthcare providers may prescribe Noxivent off-label to treat:

How Long Does Noxivent Take to Work?

Noxivent starts to improve oxygen levels within 30 minutes. Healthcare providers typically continue Noxivent for up to 14 days.

What Are the Side Effects of Noxivent?

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 healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

A common side effect of Noxivent is low blood pressure (hypotension).

Severe Side Effects

Healthcare providers in the NICU will monitor your baby continuously for any reactions to Noxivent.

Severe side effects of Noxivent may include but are not be limited to:

  • Methemoglobinemia  (a condition that makes some red blood cells unable to transport oxygen)
  • Lung tissue damage and airway inflammation

Long-Term Side Effects

Abruptly stopping Noxivent can lead to rebound pulmonary hypertension syndrome, causing oxygen levels and pulmonary hypertension to worsen. Your child's healthcare provider will slowly decrease Noxivent to avoid this reaction.

Report Side Effects

Noxivent 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 provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Noxivent Should I Take?

Your baby's healthcare provider will determine and administer (give) the proper dosage of Noxivent to your baby.

Modifications

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

Adults: Noxivent is not normally used to treat adults. However, it can be prescribed off-label by a healthcare provider who has completed a special training program.

Pregnancy: Not enough is known about the safety and effectiveness of Noxivent in pregnant people and their unborn fetuses. Noxivent is not normally used to treat adults.

Breastfeeding: When a nursing person takes a medicine, it can get into the breast milk. This means the nursing baby may be exposed to those medicines. This exposure can have negative effects on the baby. However, not enough is known about the safety of Noxivent in human breast milk and nursing babies.

Talk with your and/or your child's healthcare provider to discuss your questions or concerns.

Adults over 65: Noxivent is not normally used to treat adults. However, it can be prescribed off-label by a healthcare provider who has completed a comprehensive training program.

Children: Noxivent is approved to treat babies born to term and near term (greater than 34 weeks' gestation) with respiratory failure (trouble breathing) caused by pulmonary hypertension (high blood pressure in the lungs). Further studies were done to see if Noxivent could prevent bronchopulmonary dysplasia (a chronic lung disease) in premature babies.

However, it was found to be ineffective (it didn't work). Insufficient information is available on treating premature babies with conditions other than pulmonary hypertension with Noxivent.

Missed Dose

Healthcare providers in the neonatal intensive care unit (NICU) will administer (give) Noxivent continuously to your baby.

Overdose: What Happens If I Take Too Much Noxivent?

The symptoms of a suspected Noxivent overdose include:

Your baby's healthcare provider will monitor for any reactions and decrease the dose or discontinue Noxivent if appropriate.

What Happens If I Overdose on Noxivent?

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

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

Precautions


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It is very important that your baby's doctor check your baby closely while receiving this medicine. This will allow the doctor to see if the medicine is working properly and to decide if your baby should continue to receive it. Blood tests may be needed to check for unwanted effects.

Your baby's doctor also needs to monitor your baby's breathing, oxygen levels, and other vital signs while receiving this medicine.

Stopping this medicine suddenly may increase your baby's risk to have rebound pulmonary hypertension syndrome. Symptoms include: bluish lips or skin, slow heartbeat, lightheadedness, dizziness, or fainting, or decreased cardiac output.

This medicine may cause a rare, but serious blood problem called methemoglobinemia. Your baby's doctor will measure how much methemoglobin is in your baby's blood while receiving this medicine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Noxivent?

Babies with the following conditions should not receive Noxivent:

What Other Medications Interact With Noxivent?

Use caution when taking Noxivent with the following medications:

What Medications Are Similar?

Noxivent is a vasodilator that works by expanding blood vessels in the lungs. Another medicine that works similarly to treat babies with respiratory failure caused by pulmonary hypertension is Revatio (sildenafil).

Oral or intravenous (IV) Revatio may be considered if there is suboptimal (not the best) or no response to Noxivent or if Noxivent is unavailable.

Frequently Asked Questions

  • What is Noxivent used for?

    Noxivent is used to improve breathing in newborns with respiratory failure caused by pulmonary hypertension.

  • How does Noxivent work?

    Noxivent is an inhaled gas administered through a ventilator (breathing machine). It expands blood vessels in the lungs and improves oxygen delivery throughout the body.

  • How long does it take for Noxivent to work?

    Noxivent may start to improve oxygen levels within 30 minutes. Healthcare providers may administer Noxivent for up to 14 days.

  • What are the side effects of Noxivent?


How Can I Stay Healthy While Taking Noxivent

If your baby is receiving Noxivent, it means they're in the NICU, which can be a stressful, overwhelming, and exhausting situation for any parent. Consider some of these tips to help you get through this emotional time:

  • Review the NICU's visitations guidelines: Be sure to know how many people can visit at one time, the rules on vaccination status of visitors, and if there are age-based restrictions, such as for young siblings.
  • Participate in rounds: Each day, your baby's healthcare providers will discuss your baby's condition and care plan. Find out when rounds take place—times when the medical team visits patients to review their status and plan of care—and attend if possible. This is a great time to hear about your baby's health and for you to bring up your questions or concerns.
  • Help with your baby's care: With healthcare providers taking care of your baby around the clock, it's easy to feel like your role as a parent has been diminished. Let your baby's healthcare team know you'd like to be involved as much as possible. Depending on your baby's condition, you may be able to change diapers, feed, and bathe them.
  • Consider joining a parent support group: Ask what resources are available at the hospital and in the community. Talking with other parents in a similar situation can help you feel less alone.
  • Don't forget to take care of yourself: It may seem impossible, but getting a good night's sleep and eating a nutritious diet are essential for managing the stress associated with having a child in the NICU. Ask for help when you need it. If you feel guilty—or have other feelings—for taking some time for yourself, consider reaching out to a mental healthcare provider or other options like self-compassion meditation practices.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for 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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  1. DailyMed. Noxivent 101 - noxivent 101 gas.

  2. Singh Y, Lakshminrusimha S. Pathophysiology and management of persistent pulmonary hypertension of the newbornClin Perinatol. 2021;48(3):595-618. doi:10.1016/j.clp.2021.05.009

  3. Sherlock LG, Wright CJ, Kinsella JP, Delaney C. Inhaled nitric oxide use in neonates: balancing what is evidence-based and what is physiologically soundNitric Oxide. 2020;95:12-16. doi:10.1016/j.niox.2019.12.001

  4. Chandrasekharan P, Lakshminrusimha S, Abman SH. When to say no to inhaled nitric oxide in neonates?Semin Fetal Neonatal Med. 2021;26(2):101200. doi:10.1016/j.siny.2021.101200


By Christina Varvatsis, PharmD

Christina Varvatsis is a hospital pharmacist and freelance medical writer. She is passionate about helping individuals make informed healthcare choices by understanding the benefits and risks of their treatment options.

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Lung health

Lung diseases, excluding lung cancer, cause an estimated 235,000 deaths each year

New Delhi: Like other parts of the body, the lungs are an extremely important organ, which needs utmost care.

According to the National Heart, Blood and Lung Insititute, chronic lower respiratory diseases, including obstructive pulmonary disease (COPD) and asthma are the leading causes of death globally, every year.

Lung diseases, excluding lung cancer, cause an estimated 235,000 deaths each year.

Lungs age faster than other parts of the body since we breathe in toxic air, pollution, and dust, involve in smoking, and other things that deteriorate the organ. With time, the lungs lose their strength, which can make it more difficult to breathe.

But by adopting certain healthy habits, you can better maintain the health of your lungs, and keep them working optimally even into your senior years.

Your body relies on your respiratory system to supply the oxygen necessary for your organs to function. And if you struggle to breathe, your body may not get enough oxygen, and without enough oxygen, other critical organs may shut down.

Warning signs of respiratory distress

It is very important to learn to recognise the signs and symptoms of respiratory problems that may help you protect your life. If you notice any of these symptoms, you must contact your doctor immediately.

Breathlessness

Many people suffer from chronic breathlessness which means they are short of breath and the lungs are not able to get enough oxygen to breathe.

Even though it is normal to get breathless occasionally when you exert more than normal, sudden and regular shortness can be a sign of impending danger.

According to health experts, the lungs are involved in transporting oxygen to your tissues and removing carbon dioxide, and problems with either of these processes affect your breathing. Causes of breathlessness can be due to:

  • Asthma
  • Carbon monoxide poisoning
  • Excess fluid in the lungs
  • COPD
  • Covid-19
  • Lung collapse
  • Pulmonary embolism
  • Tuberculosis
  • Pulmonary fibrosis
  • Lung cancer
  • Croup
  • Anaphylaxis

Change in skin colour or Cyanosis

Health experts say that people who have less oxygen in their blood have a bluish colour to their skin. The condition is known as cyanosis, and it develops along with breathlessness and other symptoms. Cyanosis is caused due to lung problems and is a slow-progressing ailment, which needs immediate attention.

Causes of cyanosis in the lungs include:

  • High altitudes
  • Asthma
  • Respiratory tract infection
  • Blood clots in the arteries of the lungs
  • COPD
  • Pulmonary hypertension
  • Pneumonia

Hemoptysis

Hemoptysis is the coughing up of blood from the respiratory tract. Massive hemoptysis can cause the production of more than 600 ml of blood within 24 hours, and lead to lung collapse.

Doctors say in hemoptysis, the blood arises from this bronchial circulation when there is a trauma causing damage to pulmonary arteries because of a tumour caused by lung cancer. Hemoptysis is also caused by:

  • Severe pneumonia
  • Tuberculosis
  • Severe respiratory tract infection
  • Bronchitis

Wheezing

If you are constantly wheezing or breathing noisily, it could be an indication that your airways have become obstructed and there is a problem with the functioning of the lungs.

Doctors say it is important to report the first sign of experiencing wheezing. It is a result of inflammation and narrowing of the airway in any location from your throat to the lungs.

The most common causes of wheezing are:

Chest pain

If you suffer from lingering chest pain, you must contact your doctor immediately, as it can be due to:

  • A blood clot in the lung is known as a pulmonary embolism, where the artery can block blood flow to lung tissue.
  • Inflammation of the membrane covering the lungs, known as pleurisy in which chest pain, worsens when you inhale or cough.
  • A collapsed lung when air leaks into the space between the lung and the ribs.
  • High blood pressure in the lung arteries is known as pulmonary hypertension. This condition affects the arteries carrying blood to the lungs and can produce chest pain.

Disclaimer: Tips and suggestions mentioned in the article are for general information purposes only and should not be construed as professional medical advice. Always consult your doctor or a dietician before starting any fitness programme or making any changes to your diet.

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Mumbai: A 46-year-old woman from Seychelles has been breathing easy for the last one month after being on oxygen therapy for around five years.

Elaine Desnousse, a finance professional, was diagnosed with a genetic disorder called cystic fibrosis, developed pulmonary hypertension and had a rare anomaly in the structure of her blood vessels. Despite all these challenges, both her lungs were replaced with those received from an Indian donor.

Desnousse got in touch with doctors at Parel-based Global Hospital early last year and has been living in Mumbai since June. Her primary concern was fibrosis, a genetic condition that makes a person prone to several lung infections which get progressively worse with time. The only solution was lung transplant.

While the woman was undergoing basic screening before the procedure, the doctors noticed she had a rare birth defect wherein both her lungs had a single vein connecting them to the heart. Known as anomalous pulmonary venous connection, it is seen among 2.5% children with congenital heart defects, which affects one in 1,000 live births.

“While the anomaly itself is not life threatening, it certainly made the transplant difficult. And the genetic difference between the donor and recipient was the other challenge,” Dr Samir Garde, director of interventional pulmonology and lung transplant department of the hospital, said.

Once Desnousse was in India, she was registered as a recipient with the Zonal Transplant Coordination Committee (ZTCC). It took six months to find a pair of lungs for her as the committee puts Indian nationals needing an organ higher up on the waiting list of recipients of an organ transplantation. A pair of lungs was flown in from Ahmedabad.

Dr Chandrashekhar Kulkarni, lead lung transplant surgeon of the hospital, said that the first order of business was to prevent organ rejection. “As the patient had fought many infections earlier, her antibody profile had to be cleansed. We scavenged all antibodies in her system through plasma therapy. We took an antibody profile of the donor and ensured that the two of them were compatible,” he said.

The final surgery took place on December 18. While Desnousse had only one pulmonary vein, the donor had two veins. To resolve this, the doctors had to create a funnel-like system with the help of tissue enhancers while also increasing the width of the area where the vein connected with the heart.

Being able to move around freely, albeit with an N95 mask, Desnousse is looking forward to trekking again, a hobby she had to let go of due to her health condition. “I am grateful to the doctors and the family of the donor. The surgery seems nothing short of a miracle to me,” she added. She is still getting used to her strict diet post-surgery as well as readapting to the daily routine.

“We ensured that the patient received support from a multidisciplinary team of specialists in pulmonology, cardiovascular and thoracic surgery, immunology, infectious diseases, dedicated nursing staff and other support staff,” Dr Vivek Talaulikar, chief executive officer, Global Hospital, said.

Cardiac transplant surgeon from Fortis Hospital, Dr Sanjeev Jadhav, applauded the team for managing the complications in the case, given the rarity of the congenital defect.

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A 33-year-old Seychelles woman, who was on oxygen therapy for the last five years due to cystic fibrosis and pulmonary hypertension, got a new lease of life after Mumbai doctors performed a complicated and complex bilateral lung transplantation.

The patient had a very rare congenital variation, where a single vein in her blood vessels connected her lungs to the heart. She experienced breathlessness and was rushed to a local hospital back in 2018 and had been on oxygen therapy since then. She was diagnosed to have cystic fibrosis, a condition which affects the lungs the most. As the disease progresses, people have shortness of breath, chronic cough, wheezing, digital clubbing, cyanosis and end up coughing up blood. Then they develop pulmonary heart disease that ultimately leads to a collapsed lung. To complicate matters, she was also detected with pulmonary hypertension (a type of high blood pressure impacting the arteries in the lungs and the right side of the heart). In such cases, one needs both heart and lung transplant as both organs are dysfunctional.

The woman was referred to the team at Global Hospitals, Mumbai, where she was registered for a bilateral lung transplant after undergoing several tests. Her treating doctor, Dr Samir Garde, Director of Pulmonology, Interventional Pulmonology and Lung Transplant said, “She came to us with severe breathlessness. At a young age, she was unable to do anything because of her clinical condition. Lung transplantation in such cases not only is life-saving but improves the quality of life dramatically. Lung transplantation is the most challenging transplant to manage as the organ is exposed to an external environment immediately after the surgery. Additionally, as the patient is of African origin, transplanting Indian lungs posed an additional immunological challenge.”

Dr Chandrashekhar Kulkarni, Senior Consultant CVTS and Lead Lung Transplant Surgeon at Global Hospital, mentioned that the transplant performed on December 18, 2022 was challenging as the patient had a congenital variation in her blood vessels connecting the lungs to the heart. “Normally each lung is connected to the upper chamber of the heart by two veins which are each around 1 to 1.5 cm in size. In our patient, we had a single vein of approximately 2 cm placed in an abnormal position, a congenital variation. The donor had standard two veins and the main challenge of the surgery was to conform the two veins to the single vein in such a way that the flow was not obstructed. A slight aberration and it could have led to immediate graft failure as both the site and size were a major deviation from the normal.”

“I am happy to stand on my feet again, walk and breathe freely now. Organ donation is a noble act and everyone should donate organs. I thank the family of the donor for saving my life,” said the patient.



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The 2023 report from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) — “Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease” (COPD)1 — details “an expanded range of therapies for COPD that now can be considered to improve mortality,” according to Gerard J. Criner, MD, FACP, FACCP, an author of the 2023 GOLD Report and director of the 2022 GOLD COPD Day conference, held in November, where the updated 5th version of the GOLD report was released and the scientific underpinnings of the updates were discussed.

The expanded range of COPD therapies discussed in the 2023 report includes “an expanded role of triple inhaled therapy in select patient populations, as well as noninvasive ventilation, which also may have a role in improving exacerbation in select patient groups with COPD,” said Dr Criner, who is Chair and Professor of Thoracic Medicine and Surgery at the Lewis Katz School of Medicine at Temple University in Philadelphia, which hosts the annual GOLD COPD Day conference.

The 2023 GOLD report contains numerous other important updates as well. Among these are a reconsideration of the definitions and taxonomy of COPD and symptomatic exacerbations; new material on chronic bronchitis; and an increased focus on genetic and environmental causal factors in COPD aside from tobacco smoking.

Definitions, Heterogeneity, and Exacerbations

An important change in the 2023 GOLD report involves “clarifications and suggestions on the definition of COPD,” said Dr Criner. Related to this, the updated report also has expanded the discussion of how an exacerbation is defined, he added. “We’ve integrated newer work on codifying the onset of an exacerbation and defining the severity of an exacerbation by using not only symptoms but also physiologic criteria in grading the exacerbation as mild, moderate, or severe. Now that’s more a hypothesis than something with data wrapped around it, but is meant to fuel thought into how we can do a better job of assessing exacerbations.”

The revised definition of COPD in the 2023 report “now describes symptoms clearly and underscores the heterogeneity of COPD,” said Fernando J. Martinez, MD, MS, another coauthor of the 2023 GOLD Report. “GOLD has now embraced the concept of both early COPD and pre-COPD, and this now is incorporated into the GOLD document,” explained Dr Martinez, who is also Chief of the Pulmonary and Critical Care Medicine Division at Weill Cornell Medicine in New York City.

“There’s a lot of interest right now regarding the heterogeneity of COPD,” added Dr Martinez. “Two very relevant articles recently advocated for highlighting that heterogeneity in the definition of COPD.2,3 Exactly what implication that’s going to have for patient management and therapeutics, no one yet knows. But that level of heterogeneity is now something that’s very clearly seen as an important component of COPD in general,” he stressed.

With regard to defining exacerbations and their severity, Dr Martinez added, “the science committee recommended adopting the ’Rome Proposal,4 which suggested that the definition of severity should evolve away from what therapies are used, and rather toward a series of objective parameters: how bad the symptoms are, whether there’s evidence of inflammation or an oxygen saturation problem, and so on. So that is a recommendation that was made for consideration only at this time, because it is not yet clear whether it has any therapeutic implications,” said Dr Martinez.

Assessment Schema and Pharmacotherapy

The evolution of GOLD’s approach to pharmacotherapeutic assessment for COPD — one of the topics “of greatest interest” at the 2022 COPD Day conference, according to Dr Martinez — is covered at length in the 2023 GOLD report.

Until the release of the 2023 report, it was recommended that clinicians determine a patient’s initial COPD pharmacologic regimen using the “ABCD Assessment Tool,” said Dr Criner, who described the tool as “a sort of ‘four squared’ algorithm…based on symptoms and exacerbation history.” First presented in the 2011 GOLD report and later refined in the 2017 GOLD report, the ABCD Assessment Tool was “based on the patient’s level of symptoms, future risk of exacerbations, the extent of airflow limitation, the spirometric abnormality, and the identification of comorbidities” and was “a major advance from the simple spirometric grading system” used previously, the 2018 GOLD report stated.5

Based on recent evidence, however, the 2023 GOLD report has further revised this tool, which is now called the “ABE Assessment Tool.”1 According to the 2023 report, this change recognizes the clinical relevance of exacerbations, independent of the level of symptoms, in making assessments. As Dr Martinez explains it, “This year we got rid of the ‘C’ [ie, less symptomatic, high-exacerbation-risk] and ‘D’ [ie, more symptomatic, high-risk] groups in the ABCD tool, and merged them into one ‘E’ group, representing exacerbation-prone patients. This was partly because the ‘C’ group was so uncommon in large population studies, and partly because the exacerbation component is such a crucial issue to address.”

The 2023 GOLD report also included significant changes in COPD pharmacotherapeutic strategy, said Dr Martinez. The first change is in line with the American Thoracic Society/European Respiratory Society (ATS/ERS) statement that combination bronchodilator therapy — a long-acting beta agonist (LABA) and a long-acting muscarinic antagonist (LAMA) together — is better than LABA or LAMA as monotherapy,6,7 he explained. “We now recommend dual bronchodilator therapy up front for symptomatic patients. There was advocacy for this for many years, and we finally made that change.”

“There is increasing awareness that dual bronchodilator therapy is initially indicated in people who are symptomatic or have exacerbations,” said Dr Criner. “This includes people who have COPD exacerbations and have peripheral blood eosinophilia.”

Yet more discussion on this topic seems inevitable; as Dr Martinez noted, “implementation of dual bronchodilator therapy and quantitative cutoff values for eosinophilia in treatment selection” were the subject of “spirited debates,” at the recent COPD Day Conference.

Another significant change in COPD pharmacotherapeutic strategy in the 2023 GOLD report is the recommendation to use inhaled triple therapy rather than inhaled corticosteroid (ICS)-plus-LABA for higher-risk patients who are more symptomatic and exacerbation prone. After much debate, the GOLD science committee concluded that for these patients, “triple therapy beats ICS/LABA in every category,” said Dr Martinez, who was involved with 2 or 3 major studies of these therapies. 8,9  As a result, said Dr Martinez, “ICS/LABA has been dropped from the therapeutic recommendations in GOLD. That is a major change. ICS/LABA remains one of those commonly used regimens globally. There are various generic formulations, and payers love it, because it’s cheap; but now it’s dropped off the GOLD therapeutic strategy. So it will be interesting to see how payers interpret that.”

To support this change, the 2023 report highlights “very convincing data that triple therapy, in a particular population of patients, can improve all-cause mortality.10,11 We included a tabular representation of all of the studies that have shown improvements in mortality, for pharmacotherapy and nonpharmacotherapy, and we recommend that be incorporated into therapeutic decision-making for individual patients,” Dr Martinez noted. “So the management recommendations for stable COPD have now changed to emphasize dual bronchodilators and triple therapy, and also with a strong emphasis on the eosinophil as a circulating biomarker that can be used to guide response.”

Chronic Bronchitis and Mucus Hypersecretion

The burden of mucus hypersecretion in patients with COPD is also covered in the 2023 report, said Dr Criner. In particular, chronic bronchitis is discussed at greater length, with a review of some of its pathobiology and epidemiology, as well as a discussion of new medical and interventional treatments.

“There is a lot of interest in particular symptoms such as cough and sputum production. But it’s only recently that the clinical implications of those symptoms have become evident,” said Dr Martinez. He added that “the effort to target a particular symptomatic expression of COPD, such as cough and sputum production, is now a very active area, with practical implications for patients. Interventional studies are ongoing; and oral pharmacotherapeutic approaches, including cystic fibrosis transmembrane conductance regulator (CFTR) potentiators,12 are under evaluation right now.”

Vascular Disease and Other Updates

The 2023 report also discusses pulmonary vascular diseases, both secondary pulmonary hypertension and pulmonary embolism. The latter has been the focus of more recent studies, including a large French study published in JAMA.13 As Dr Criner explained, “In that study, about 6% of patients who presented with an acute exacerbation of COPD were found to have a pulmonary embolism at the time of presentation.” This study “highlights the fact that some people with COPD exacerbations actually have COPD with exacerbation of symptoms that are due to another cause, such as pulmonary embolism, heart failure, or ischemic heart disease” — a topic of interest that was discussed during the conference, said Dr Criner. Accordingly, he noted, the importance of screening patients with COPD for comorbid conditions like pulmonary embolism and other diseases is reflected in the 2023 GOLD report.

Certain sections of the new report have some degree of updated information but were not exhaustively revised, said Dr Criner. “We discuss imaging more than previously, particularly the role of computed tomography (CT) scanning — both its current role and the role we think it will have in the future. We have also expanded and revised the discussion of surgical and interventional treatments for COPD. This includes indications for bullectomy or lung reduction surgery; bronchoscopic treatments for lung reduction, an evolving field both in and outside the US; and interventional treatments that are currently being studied for chronic bronchitis. There is also a more comprehensive discussion of the role, benefits, and complications of lung transplantation. Finally, we revised and updated chapters on comorbidities and on COVID-19.”

Interstitial Lung Abnormalities: A Future Topic

Interstitial lung abnormalities in patients with COPD was a topic of interest at the GOLD conference that was not exhaustively covered in the 2023 GOLD report, said Dr Criner. Interstitial lung abnormalities “have been reported in several epidemiologic studies, mainly imaging studies characterizing patients who have been exposed to smoke, and also studies of lung cancer screening data. These studies demonstrate that patients with COPD have some interstitial changes that could be related to smoke exposure, or occupational exposure, or smoking in people who also are predisposed to interstitial lung diseases,” said Dr Criner. This topic is likely to be a focus in the future, he added.

Disclosures:Dr Criner reports receiving grants from AstraZeneca, Boehringer Ingelheim, Broncus, Chiesi, Corvus, Genentech, Gilead, GlaxoSmithKline, Fisher-Paykel Healthcare, Lilly, NIH-NHLBI, Novartis, Olympus, PA-DOH, Pfizer, Pearl, PneumRx, Pulmonx, Regeneron, Roche and Spiration; consultant fees from Almirall, AstraZeneca, Broncus, BTG, CSA Medical, GlaxoSmithKline, EOLO, Intuitive, Ion, Mereo, Nuvaira, PneumRx, Pulmonx, Regeneron and Sanofi; and an equity interest in Free Flow Medical and Pleural Dynamics. Dr Martinez reports receiving fees for consulting and/or speaker roles with AstraZeneca, Boehringer Ingelheim, Chiesi, Sanofi/Regeneron, CSL, Behring, GlaxoSmithKline, Medtronic, Novartis, Polarean, Pulmatrix, Pulmonx, and Theravance/Viatris.

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Weekend Doctor Column

Sherrie Schreck, RRT

Pulmonary Rehab

Blanchard Valley Hospital

Is difficulty breathing making it harder to do the things you want to do? Has it become harder to get the mail, do simple cleaning, or get groceries? If you have chronic obstructive pulmonary disease
(COPD), interstitial lung disease, asthma, cystic fibrosis, pulmonary
hypertension, recovering from lung surgery or other breathing-related
problems, pulmonary rehabilitation is a program that can improve your quality of life. For many patients diagnosed with chronic lung conditions, attending pulmonary rehabilitation can be a lifesaver.

What is pulmonary rehabilitation?

Pulmonary rehabilitation is a gradual exercise and education program to help people

with chronic (long-term) lung diseases. It will not cure your lung disease, but you may

notice fewer breathing problems, more strength and improved quality of life.

Your pulmonary rehabilitation may be overseen by respiratory therapists, nurses,

exercise physiologists and physicians. They will help design a personal program for

you. Your program will include an initial assessment with a walk test to monitor oxygen

levels, blood pressure, heart rate, and the distance you are able to walk in six minutes.

During your pulmonary rehab program, you will learn everything you need to know

about your specific chronic lung disease, including symptoms, medications and oxygen.

You will receive education on how to deal with your chronic lung condition, learn exercises to

help you feel better and do more, and you will learn ways to cope mentally and

emotionally with your lung condition.

You will attend supervised exercise classes that include stretching, strength exercises,

and cardiovascular exercise like walking, using a bike or recumbent stepper. Because

of breathing challenges, people with chronic lung disease tend to avoid exercise. The

right amount and type of exercise can help improve your strength, increase energy

levels and help you use oxygen more efficiently.

Where is pulmonary rehabilitation done? How often do I have to go?

Most pulmonary rehabilitation programs will be done at your local hospital or outpatient

health center. Pulmonary rehabilitation is usually two to three times a week for 12

or more weeks. You will need to try to attend every session to get the most out of the

program. It may be hard and take some time, but, it will be worth the benefits in the end.

How does pulmonary rehabilitation work?

Chronic lung disease can cause your muscles to become weak. The muscles involved

in breathing and in moving must be re-strengthened. You will have your own exercise

program designed to improve your strength and endurance.

All pulmonary rehab patients are taught pursed lip breathing to help increase oxygen

levels
and better manage symptoms. You will be taught to check your oxygen
level and take preventative measures to increase your oxygen level
before it gets too low.

How effective is pulmonary rehabilitation?

Pulmonary rehabilitation is effective if you put effort into it. You will get the best results

if you continue to exercise after completing your pulmonary rehabilitation program.

Insurance and Medicare usually pay for some or all of the cost of pulmonary rehab.

Contact your healthcare provider if you have questions or think that pulmonary rehab

might be right for you.

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By Sherrie Schreck, RRT
Pulmonary Rehab, Blanchard Valley Hospital

Is difficulty breathing making it harder to do the things you want to do? Has it become harder to get the mail, do simple cleaning, or get groceries? If you have chronic obstructive pulmonary disease (COPD), interstitial lung disease, asthma, cystic fibrosis, pulmonary hypertension, recovering from lung surgery or other breathing-related problems, pulmonary rehabilitation is a program that can improve your quality of life. For many patients diagnosed with chronic lung conditions, attending pulmonary rehabilitation can be a lifesaver.

What is pulmonary rehabilitation?

Pulmonary rehabilitation is a gradual exercise and education program to help people with chronic (long-term) lung diseases. It will not cure your lung disease, but you may notice fewer breathing problems, more strength and improved quality of life. Your pulmonary rehabilitation may be overseen by respiratory therapists, nurses, exercise physiologists and physicians. They will help design a personal program for you. Your program will include an initial assessment with a walk test to monitor oxygen levels, blood pressure, heart rate, and the distance you are able to walk in six minutes.

During your pulmonary rehab program, you will learn everything you need to know about your specific chronic lung disease, including symptoms, medications and oxygen. You will receive education on how to deal with your chronic lung condition, learn exercises to help you feel better and do more, and you will learn ways to cope mentally and emotionally with your lung condition.

You will attend supervised exercise classes that include stretching, strength exercises, and cardiovascular exercise like walking, using a bike or recumbent stepper. Because of breathing challenges, people with chronic lung disease tend to avoid exercise. The right amount and type of exercise can help improve your strength, increase energy levels and help you use oxygen more efficiently.

Where is pulmonary rehabilitation done? How often do I have to go?

Most pulmonary rehabilitation programs will be done at your local hospital or outpatient health center. Pulmonary rehabilitation is usually two to three times a week for 12 or more weeks. You will need to try to attend every session to get the most out of the program. It may be hard and take some time, but, it will be worth the benefits in the end.

How does pulmonary rehabilitation work?

Chronic lung disease can cause your muscles to become weak. The muscles involved in breathing and in moving must be re-strengthened. You will have your own exercise program designed to improve your strength and endurance.

All pulmonary rehab patients are taught pursed lip breathing to help increase oxygen levels and better manage symptoms. You will be taught to check your oxygen level and take preventative measures to increase your oxygen level before it gets too low.

How effective is pulmonary rehabilitation?

Pulmonary rehabilitation is effective if you put effort into it. You will get the best results if you continue to exercise after completing your pulmonary rehabilitation program. Insurance and Medicare usually pay for some or all of the cost of pulmonary rehab. Contact your healthcare provider if you have questions or think that pulmonary rehab might be right for you.

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Low activity levels in a small RNA molecule called miR126 may be implicated in vascular remodeling — a hallmark feature of pulmonary hypertension (PH) — in the lungs of chronic obstructive pulmonary disease (COPD) patients regardless of whether or not they also have PH, a study reported.

This finding indicates that PH is not a determining factor in the blood vessel remodeling seen in people with COPD, according to the researchers.

The study, “Characterization of pulmonary vascular remodeling and MicroRNA-126-targets in COPD-pulmonary hypertension,” was published in the journal Respiratory Research.

Recommended Reading

An assortment of foods from every food group.

miR126 works to regulate the migration of endothelial cells in lungs vessels

COPD is characterized by chronic inflammation that blocks the airways, causing cough with mucus, wheezing, and difficulty breathing.

PH, or increased blood pressure in the blood vessels that supply the lungs, can result from having COPD. Although the two diseases have similar features regarding alterations in pulmonary lung vessels and smooth muscle cells, COPD-PH lungs do not show the abnormal growth of endothelial cells — which line blood vessels — that form specific blood vessel lesions in pulmonary arterial hypertension.

The remodeling features of lung vessels in COPD-PH patients may be caused by the response of endothelial cells to chronic cigarette smoking. However, the underlying mechanisms are still unclear.

MicroRNAs, small RNA molecules that help to regulate the activity of genes, have been shown to play a key regulatory role in endothelial cells. In particular, miR126 is crucial for endothelial cell migration.

This miRNA has opposite functions depending on the size of the blood vessels. In large vessels, miR126 supports endothelial cells survival — in part by inhibiting the activity of a protein called SPRED1 — and in small vessels, it prevents the proliferation of these cells by blocking a protein called LAT1.

Previous studies have shown that cigarette smoke decreases the expression (activity) of miR126 in endothelial cells of the small vessels of the lungs. Additional research reported that miR126 targets a protein called ADAM9 that is involved in lung inflammation and damage in COPD.

Researchers in the U.S. conducted a study to characterize blood vessel remodeling in the lungs of people with COPD or COPD-PH and a history of tobacco smoking, and its association with miR126 and ADAM9 levels.

Lung tissue from COPD patients with and without PH was collected and compared with that of non-smokers and smokers without either of these diseases, both serving as controls.

Remodeling was analyzed according to pulmonary artery size and was measured by the levels of alpha-smooth muscle actin (alpha-SMA), a marker of smooth muscle cells and of myofibroblasts, cells important in tissue scarring.

The study also quantified the activity levels of miR126 and its targets, namely the genes that provide instructions for making the SPRED1, LAT1, and ADAM9 proteins.

Significantly higher levels of alpha-SMA were seen in the pulmonary arteries of people with COPD and COPD-PH compared with controls. Alpha-SMA levels particularly were increased in small pulmonary arteries and the lung’s smallest vessels.

Remodeling not linked to rise in mean pulmonary artery pressure

Researchers also found that greater remodeling in these blood vessels was not related to an increase in mean pulmonary artery pressure, a PH hallmark.

These findings “indicate that significant remodeling of the pulmonary vascular bed of small and microvascular size occurs before or independent of the clinical development of PH,” the scientists wrote.

Results also “highlight the importance of defining the mechanisms of pulmonary vascular injury and dysfunction which are associated with chronic smoking and COPD, rather than focusing solely on established COPD-PH,” they added.

In pulmonary vessels, people with COPD or COPD-PH also had significantly lower levels of endothelial cell markers and greater levels of ceramide, a mediator of programmed cell death. “These findings suggest endothelial cell and pulmonary arterial injury in COPD and COPD-PH,” the investigators wrote.

A significant reduction of miR126 expression also was found in lungs of COPD patients.

“Although miR126, by playing a key role in pulmonary vascular endothelial cell survival and repair is an attractive target for COPD-PH, other miRNAs may also be involved in the development of COPD and COPD-PH,” the scientists noted.

miR126 levels also decreased as ADAM9 gene expression increased, “suggesting it [ADAM9] is a direct target,” the team added.

ADAM9 levels were significantly higher in lungs of people with severe COPD, who are likely to have PH, as well as in individuals with confirmed COPD-PH when compared with controls. This was seen in small pulmonary arteries and in the smallest blood vessels.

“Decreased miR126 expression with reciprocal increase in ADAM9 may regulate endothelial cell survival and vascular remodeling in small pulmonary arteries and lung microvasculature in COPD and COPD-PH,” the investigators wrote.

Future studies are needed “to elucidate the role of cell-specific and intercellular communication between miR126 and ADAM9 in pulmonary vascular remodeling,” they added.

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The COVID-19 pandemic disrupted the delivery of health care to patients with pulmonary hypertension (PH), primarily with respect to obtaining diagnostic testing, with aerosolized and invasive testing being the most seriously impacted, according to survey findings published in the journal Respiratory Medicine.

Patients with PH are at especially high risk from care disruptions because of their extensive health care needs and highly specialized care teams. Current guidelines for pulmonary arterial hypertension (PAH), in particular, recommend updated risk evaluation with such tools as the REVEAL 2.0 calculator at every clinical visit. Moreover, it is well known that individuals with PH have a high risk for increased mortality and morbidity from COVID-19.  Investigators therefore conducted a survey of providers to assess their perceptions of how the care of patients with PH was affected during the COVID-19 pandemic.

The survey, which comprised 47 questions associated with the care of patients with PH, was developed by the American College of Chest Physicians 2020-2021 Pulmonary Vascular Disease (PVD) NetWork Steering Committee. The survey was sent to all members of the PVD NetWork and to providers connected with many other professional networks for PH. All responses to the survey, which were collected between November 2020 and February 2021, were anonymous. A total of 95 providers responded to the survey.

Results of the study showed that 93% of respondents believed that care of patients with PH had been affected by the pandemic, with 67% observing decreased referrals for PH assessment during this period.

Adapting to the challenges that COVID-19 has presented will ultimately simplify the care of patients with PH by necessity, thereby increasing accessibility and hopefully improving patient outcomes.

A dramatic shift to using telemedicine also occurred with this patient population. Before the COVID-19 pandemic, only 15% of providers had utilized telemedicine for the management of their patients with PH, compared with 84% during the pandemic. Telemedicine was used most often for follow-up of selected low-risk patients (49% overall). Willingness to prescribe new treatment for PAH via telemedicine varied among survey respondents, with 22% indicating they were completely willing to prescribe new treatment via telemedicine and 11% indicating they were completely unwilling. Notably, providers’ comfort level varied according to the type of medication being prescribed.

With respect to other care disruptions, more than 90% of providers surveyed reported disruptions in obtaining testing, and 31% reported disruptions in renewal or approval of medications.

Survey limitations include: selection bias, a preponderance of respondents from the US, and unanswered questions by some respondents.

The authors concluded that “Adapting to the challenges that COVID-19 has presented will ultimately simplify the care of patients with PH by necessity, thereby increasing accessibility and hopefully improving patient outcomes.

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Research Report

Breathing Disorder Treatment Market | DataM Intelligence

Breathing Disorder Treatment Market Expected to reach a high CAGR of 4.8% By 2030:

Breathing Disorder Treatment Market Expected to reach a high CAGR of 4.8% By 2030:”

— DataM Intelligence

CLEVELAND, OHIO, USA, December 27, 2022 /EINPresswire.com/ -- Market Overview:

Several products, such as antimicrobials, corticosteroids, bronchodilators, antihistamines, respiratory stimulants and others, are being used widely by patients with chronic respiratory disorders such as asthma, lung cancer, cystic fibrosis and idiopathic pulmonary fibrosis. The breathing disorder treatment drug is in high demand due to huge investments in research and development and a high rate of product launches.

Market Size Growth Rate:

According to the research report published by DataM Intelligence, the global breathing disorder treatment market size was valued at USD YY billion in 2021; it is projected to reach USD YY billion by 2029, with growth at a CAGR of 4.8% over the forecast period 2022-2029.

Breathing disorder drugs are medicines that are utilized for several respiratory or breathing disorders treatments, such as cystic fibrosis, COPD and asthma. These drugs help breathe easier as they reduce inflammation. High exposure to dust, air pollution and increased smoking enhance the adoption of these medications. Along with novel product launches and technological advances, the rising demand for breathing disorder treatment, owing to rising breathing disorders, will further support market trends for breathing disorder treatment through 2029.

Market Drivers:

The market has experienced significant growth, ascribed to the growing incidences of respiratory disorders globally and rising research and development. The healthcare infrastructure modernization in emerging nations is funded by their governments, which will expand access to healthcare. There is a high need for breathing disorder treatment for COPD, asthma or cystic fibrosis patients for improvement in treatment. The global market for breathing disorder treatment has attractive potential due to the rise in the frequency of novel product launches and high investment in research and development in emerging nations.

Download Free Sample: www.datamintelligence.com/download-sample/breathing-disorder-treatment-market

Market Restraints:

The market for global breathing disorder treatment is hampered by the side effects associated with drugs for breathing disorder treatment. Side effects include nervous tension, dizziness, muscle cramps, dry mouth, runny nose, tremors, irritated or scratchy throat, trembling, upset stomach and palpitations. Several stringent regulations are applied for the approval of respiratory disorders treatment drugs.

Market Opportunities:

Research and medical experts are developing advanced approaches to improve the outcomes of breathing disorder treatment. The major area of research is the latest technological advancements, such as improved technologies providing better results or improvements and fewer side effects and new product launches. Increasing government organization funding in healthcare sectors is boosting the market. Growing investments is helping distribution channels use novel technologies.

Infrastructure development and rising investments are expected to provide huge opportunities for the breathing disorder treatment market. This will provide a lucrative opportunity for the growth of the market.

COVID-19 Impact Analysis:

The health system is under extreme strain due to the COVID-19 pandemic. Prioritizing treating patients with disabilities or several chronic disorders, increasing the use of suitable breathing disorder treatment drugs for better treatment and positive results, enhancing the number of products with more efficacy, and advancing technology for better treatment are a few ways that need to be reorganized in terms of priorities.

Recent Developments in the Industry:

1. In May 15, 2022, AstraZeneca announced positive results from the MANDALA Phase III trial, which showed that PT027 (albuterol/budesonide), an inhaled corticosteroid (ICS), is utilized as a rescue medicine that demonstrate a significant reduction in the severe exacerbation risk versus albuterol rescue in patients having moderate to severe asthma.

2. In July 24, 2020, AstraZeneca announced the approval of the triple-therapy Breztri Aerosphere as a COPD maintenance treatment. Breztri Aerosphere shows a statistically-significant reduction in moderate or severe exacerbations rate compared with dual-combination therapies.

Market Segmentation:

According to the research analysis, the global breathing disorder treatment market is segmented by drug class as antimicrobial, corticosteroid, bronchodilator, antihistamines, respiratory stimulants and others. By indication, the market is further segmented into asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, pulmonary hypertension, lung cancer, allergic rhinitis, idiopathic pulmonary fibrosis and others. By distribution channel, the market is divided into hospital pharmacies, retail pharmacies and online pharmacies.

1. Based on the indication, the chronic obstructive pulmonary disease (COPD) segment accounted for the largest market share of around XX% in 2021 and is expected to grow at a CAGR of 4.8% during the forecast period (2022-2029). Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease causing obstructed airflow from the lungs. Its symptoms are cough, breathing difficulty, mucus (sputum) production and wheezing. According to the Office of Disease Prevention and Health Promotion (ODPHP), about 14.8 million adults in the United States suffered from chronic obstructive pulmonary disease (COPD) in 2020. Major key players are researching and developing several advanced novel technologies and product launches. Additionally, it is anticipated that rising chronic disease incidences and rising FDA product approvals will fuel the global market expansion.

Geographical Classification:

The global breathing disorder treatment market is segmented into major regions: North America, South America, Europe, Asia Pacific, and the Middle East & Africa.

North America Breathing Disorder Treatment Market:

This large revenue share is mainly due to the rising investments in research and development and the abundance of highly qualified surgeons, among other things. North America is one of the biggest markets for breathing disorder treatment. This region showcases a significant CAGR owing to the rising adoption and awareness regarding drugs for breathing disorder treatment, the increasing prevalence of several respiratory diseases such as COPD and asthma, and the growing geriatric population combined with the increasing demand for breathing disorder treatment medications. The significant market share is attributable to the high disorder knowledge in the area and the numerous programs initiated to increase awareness about chronic obstructive pulmonary disease (COPD), which have expanded the market for these novels and advanced breathing disorder treatments.

Due to the region's growing geriatric population and chronic respiratory disorders, which is driving up demand for breathing disorder treatment in patients with asthma, cystic fibrosis or chronic obstructive pulmonary disorder (COPD), Asia Pacific is predicted to have the quickest increase throughout the analyzed period. By 2029, Japan’s market for breathing disorder treatment is anticipated to be worth over xx million dollars. Due to numerous aspiring industry players in the area, the China breathing disorder treatment market is predicted to provide a CAGR of around xx percent, accounting for revenue generation of over USD xx billion by the conclusion of the projected year.

Competitive Analysis:

However, it is expected to grow rapidly in the next couple of years with intense competition among the players and a rising number of cases. A few key players are already being observed adopting strategies, such as collaboration for developing novel technologically advanced products, which may make the market crowded with new products in the next couple of years.

Major Companies:

Major key companies contributing to the market’s growth include F. Hoffmann-La Roche, AstraZeneca, GSK plc, Abbott Laboratories, Amgen Inc., Novartis AG, Medtronic plc, Dr. Reddy’s Laboratories Ltd., Bayer AG and Biogen.

View Full Report: www.datamintelligence.com/research-report/breathing-disorder-treatment-market

Additional Benefits Post Purchase:

1) Unlimited Analyst support for a period of 1 year.

2) Any query concerning the scope offered will be addressed within 24- 48 hours.

3) An excel sheet with market numbers will be provided separately.

The Full Report has the following insights:

• The report comprehensively evaluates the market in terms of Market Value (US $) and Y-o-Y Growth Rates (%). It does so via in-depth qualitative insights, historical data (2020-2021), and verifiable projections about market size during the forecast period (2022-2029).

• Visualize the composition of the global breathing disorder treatment market segmentation drug class, indication, distribution channel, and region, highlighting the key commercial assets and players.

o By Drug Class: Antimicrobial, Corticosteroid, Bronchodilator, Antihistamines, Respiratory Stimulants and Others

o By Indication: Asthma, Chronic Obstructive Pulmonary Disease (COPD), Cystic Fibrosis, Pulmonary Hypertension, Lung Cancer, Allergic Rhinitis, Idiopathic Pulmonary Fibrosis and Others

o By Distribution Channel: Hospital Pharmacies, Retail Pharmacies and Online Pharmacies.

o By Region: North America, South America, Europe, Asia Pacific, and the Middle East & Africa

• Identify global breathing disorder treatment market commercial opportunities by analyzing trends and co-development deals.

• The report also covers data insights on various industry forces such as porter's five forces analysis, supply chain analysis, and pricing analysis.

• Excel data sheet with thousands of global breathing disorder treatment market-level 4/5 segmentation data points.

• PDF report with the most relevant analysis cogently put together after exhaustive qualitative interviews and in-depth market study.

• Product mapping in excel for the key product of all major market players

• The report will provide access to approximately 61 market data tables, 64 figures, and close to 180 pages.

About Us:

DataM Intelligence 4Market Research is a market intelligence platform that gives access to syndicated, customized reports and consulting to its clients in one place. As a firm with rich experience in research and consulting across multiple domains, we are a one-stop solution that will cater to clients’ needs in key business areas. DataM Intelligence has an online platform whose coverage includes industries such as chemicals and products, agriculture, health care services, animal feed, and food & beverages, among others. Our platform has Insights on markets that uncover the latest market research data that are distinct from the competition. With coverage across ten major industries in the marketplace research, DataM Intelligence benefits thousands of companies by helping them take their innovations early to the market by providing a complete view of the market with statistical forecasts. Our strategy-centric framework and value-added services will let individuals and corporates ease access and custom personalization to research and markets.

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Get to know Pulmonologist Dr. Ka Ling (Karin) Cheung, who serves patients in California.

(The Magazine Plus Editorial):- New York City, New York Dec 13, 2022 (Issuewire.com) – Dr. Cheung serves as a pulmonary and sleep medicine specialist with Bass Medical Group. She sees patients of all ages out of the office in Walnut Creek, California. 

At the John Muir Health Walnut Creek Medical Center, she is the current Medical Director for Respiratory Care and Pulmonary Rehabilitation Services. She is also affiliated with Concord Medical Center.

Her current interests include sleep disorders, sleep studies, interstitial lung disease, advances in COPD/asthma, and pulmonary hypertension.

Throughout her academic career, Dr. Cheung received her undergraduate education and medical school training at Erasmus University, Rotterdam, in the Netherlands. She then completed her medical residency at the Graduate Hospital of the University of Pennsylvania and her pulmonary, critical care, and sleep fellowship at Yale. 

From 1997 until 2001, Dr. Cheung began working in pulmonary and sleep medicine at Nanticoke Memorial Hospital in Seaford, Delaware. There, she directed the Pulmonary Function Lab and Respiratory Care Department.

From 2001 until 2003, she was a pulmonologist/intensivist/sleep physician with Abington Pulmonary and Critical Care Associates in Abington, Pennsylvania. She then relocated to California, where she joined the Respiratory Medical Group (now part of Bass Medical Group) and the John Muir medical staff. 

With a commitment to her profession, Dr. Cheung is board-certified in internal medicine, pulmonary diseases, critical care medicine, and sleep medicine. 

In addition, she is a Fellow of the American College of Chest Physicians, a Fellow of the  American Academy of Sleep Medicine, a member of the American Thoracic Society, and a member of the Society of Critical Care Medicine.

Pulmonology is a medical specialty that deals with diseases involving the respiratory tract. A pulmonologist is an internal medicine physician who specializes in preventing, diagnosing, and treating conditions and diseases that affect the lungs, bronchial tubes, and the respiratory system, including the nose, pharynx, and throat.

Outside of practicing medicine, Dr. Cheung enjoys playing golf, hiking, reading, nature photography, traveling, as well as listening to modern jazz and classical music. She speaks many languages, including English, Dutch, Chinese, German, and French. 

Learn More about Dr. Ka Ling (Karin) Cheung:
Through her findatopdoc profile, www.findatopdoc.com/doctor/2532400-Ka-Ling-Cheung-Sleep-Medicine-Specialist or through Bass Medical Group, www.bassmedicalgroup.com/doctors/ka-ling-karin-cheung 

About FindaTopDoc.com
FindaTopDoc is a digital health information company that helps connect patients with local physicians and specialists who accept your insurance. Our goal is to help guide you on your journey toward optimal health by providing you with the know-how to make informed decisions for you and your family.

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COPD, or chronic obstructive pulmonary disease, is a leading cause of disability and death in the U.S., according to the American Lung Association.

More than 12.5 million people have been diagnosed with COPD, but millions more may have the disease without knowing it.

COPD is a chronic inflammatory lung disease caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke.

People with COPD are at increased risk of developing respiratory infections, heart disease, lung cancer, pulmonary hypertension and depression.

Also, if you have a chronic lung disease such as COPD, you may be at greater risk of severe illness and complications from COVID-19.

Symptoms of COPD often don’t appear until significant lung damage has occurred, and they usually worsen over time, particularly if cigarette smoke exposure continues.

Signs and symptoms of COPD can include:

• Shortness of breath.

• Wheezing.

• Chest tightness.

• Chronic cough that may produce clear, white, yellow or green mucus.

• Frequent respiratory infections.

• Lack of energy.

• Unintended weight loss.

• Swelling in the ankles, feet or legs.

Treatment

If you’ve been diagnosed with COPD and you smoke, it is important that you quit. Most cases of COPD in the U.S. are directedly related to long-term cigarette smoking, and stopping smoking can keep COPD from getting worse and reducing your ability to breathe.

Many people with COPD have mild forms of the disease for which little therapy is needed other than smoking cessation.

Even for more advanced stages of disease, effective therapy is available that can control symptoms, slow progression, reduce your risk of complications and exacerbations, and improve your ability to lead an active life.

Treatment for COPD can include:

• Medications: Several kinds of medications are used to treat the symptoms and complications of COPD. You may take some medications on a regular basis and others as needed. These medications can include bronchodilators, inhaled steroids, combination inhalers, oral steroids, phosphodiesterase-4 inhibitors, theophylline and antibiotics.

• Lung therapies: Lung therapies for people with moderate or severe COPD can include oxygen therapy and pulmonary rehabilitation.

• In-home noninvasive ventilation therapy: A noninvasive ventilation therapy machine with a mask helps to improve breathing and decrease retention of carbon dioxide that may lead to acute respiratory failure and hospitalization. More research is needed to determine the best ways to use this therapy.

• Managing exacerbations: Even with ongoing treatment, you may experience times when symptoms become worse for days or weeks. This is called an acute exacerbation, and it may lead to lung failure if you don’t receive prompt treatment. When exacerbations occur, you may need additional medications, such as antibiotics, steroids or both; supplemental oxygen; or treatment in the hospital. Once symptoms improve, your health care team can talk with you about measures to prevent future exacerbations, such as quitting smoking; taking inhaled steroids, long-acting bronchodilators or other medications; getting your annual flu vaccine; and avoiding air pollution whenever possible.

• Surgery: Surgery is an option for some people with some forms of severe emphysema, a type of COPD, who aren’t helped sufficiently by medications alone. Surgical options can include lung volume reduction, lung transplant and bullectomy.

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Heart disease has some really unfortunate statistics when it comes to deaths in the US. It’s the leading cause of death in the country. 

What’s less known is that chronic lower respiratory disease is also high on the list. It’s in the third spot.

Alarming. 

Among the chronic lower respiratory diseases that kill many Americans is COPD. It stands for chronic obstructive pulmonary disease. 

Here’s something that not everyone realizes. 

Heart disease and COPD may look very similar to the untrained eye

person in pain in the bed

Shortness of breath is something you’ll experience whether you have one condition or the next. It’s a hallmark sign that shows something might be wrong. 

Let’s take a closer look at the individual components so you can hopefully help stay in better health. 

What is COPD?

woman coughing

Did you know that COPD is a chronic inflammatory lung disease? The inflammation causes issues as the airways are obstructed, and the airflow has a harder time getting from the long.

Breathing difficulties, coughing, wheezing, and mucus stems from your being affected by this disease. 

What’s unfortunate about COPD is that it worsens over time, with breathing increasingly difficult. It happens as less air flows in and out, affecting 15 million American adults. Yes, it’s no party living with the condition. 

Lots can be done to avoid getting it, which we’ll get into later. 

Types of COPD

Two main conditions cover COPD in the United States, including Chronic bronchitis and Emphysema. 

The former is caused when there’s damage to the walls between air sacs in the lungs. These sacs fill up with air as oxygen is breathed in and are stretchy without the condition. Deflation happens as the air leaves the sacks. Emphysema makes it harder for air to leave. 

Repeated inflammation is what causes Chronic bronchitis, more specifically in the lining of the airways. You probably know how mucus can be annoying with the common cold. With bronchitis, more mucus makes breathing difficult. 

COPD is often caused b a mixture of the two diseases. The severity of each will vary. 

man who is coughing

What causes COPD & what are the risk factors?

One of the biggest things causing COPD is smoking. However, it’s not the only thing that’s causing it. 30% of people that get the condition never smoked. 

Another thing causing it is alpha-1 antitrypsin (AAT) deficiency. 

Symptoms of COPD

Excessive mucus is a consequence of COPD, created when coughing happens. Shortness of breath, difficulty breathing, and chest tightness are other symptoms. Routine activities become a chore as the condition worsens. By the time it progresses, taking care of yourself becomes tedious. Activities like walking or cooking will take your breath away. 

Oxygen levels are diminished, and life gets far harder as it progresses. 

Shortness of Breath from Heart Failure

man feeling his heart

Congestive heart failure causes the heart to weaken. It means blood is no longer pumped around the body as it should. Backing up fluid levels causes issues for the heart and lungs. The consequence of that – is shortness of breath.

Small amounts of exercise or activity cause exertion, making it hard to function. 

Shortness of Breath from COPD

Physical activity in those with COPD causes shortness of breath. Shortness of breath arises as oxygen and carbon dioxide are not leaving the body as intended. As the air sacs aren’t working properly, someone exhaling with COPD gets shortness of breath.

COPD and heart failure

woman holding up a heart

The symptoms may largely look the same regarding congestive heart failure and COPD. Heart failure comes in two shapes, though. One’s left-sided, and the other one is right-sided. Heart failure can either be related to or worsened by COPD. 

Right-sided heart failure

COPD can cause right-sided heart failure in extreme cases. A rise in blood pressure in the lungs’ arteries happens as the body struggles with low oxygen levels. The condition is called pulmonary hypertension.

Additional strain is put on the ventricle, which is responsible for pushing blood through the lungs. Heart failure can occur as the muscle becomes weaker over time. 

Left-sided heart failure

COPD and left-sided heart failure are not directly caused by one another. An exacerbation can happen if a patient suffers from both. Additional stress is placed on the heart due to lower oxygen levels. Worsening symptoms can be expected as a consequence. 

Fluid buildup happens in the lung, which makes the COPD worse. 

Understanding the connection

The connection between heart failure and COPD is important to keep in mind. The risk of heart failure is increased in people with COPD, and continuing to smoke will only worsen the symptoms. Smokers are at risk of COPD and heart failure due to their lifestyles. 

Seeking the medical guidance of a cardiologist can monitor your health, especially if you’re looking to make a change.

Understanding the differences

It can be hard to tell whether your shortness of breath is caused by one or the other. 

The difference between the two is often investigated through a physical examination. It includes listening to both your heart and lungs. The veins in your neck are explored to see if it’s one or the other. 

Fluid buildup in your lungs can be seen using a chest x-ray. It’s a sign of heart failure. On the other hand, COPD does not flood the lungs with additional fluids. However, over-inflation is a sign of COPD.

Brain natriuretic peptide is studied in the blood. Higher-than-usual levels indicate heart failure.

Cardiac enzymes are examined in a blood test. These can help see if it’s a heart condition. Issues there will put additional strain on the heart.

An echocardiogram is an ultrasound test to evaluate your various organs. Looking at the valves, pumping strength, and heart, it’s determined whether it’s a heart issue.

COPD treatment

asian woman in pain

It’s important to make sure you start changing your habits when COPD is discovered. The biggest improvement you can make is to put the cigarettes away and start including healthier life choices daily. 

It also helps if you start becoming more active to help slow down the progression. 

Pulmonary rehabilitation, oxygen therapy, and medicines are other options that can help you deal with the situation you’re in. 

Oxygen therapy

To increase your oxygen levels, oxygen therapy is used. Oxygen is delivered in myriad ways, including a face mask or tube placed in your trachea. 

It can be delivered both at the hospital and at home. However, it’s important to know that oxygen deficiency causes certain issues. However, introducing additional oxygen increases the fire risk. 

For that reason, flammable materials need to be kept far away from oxygen sources. 

It’s common to experience a range of side effects with this treatment. They include:

  • Morning headaches
  • Tiredness
  • Bloody & dry nose.

Medicines

Medicines usually come in two forms, steroids and bronchodilators. It’s administered through an inhaler, ensuring it can easily reach your lungs. While some inhalers are slightly different, they typically work largely the same way. It’s important that you follow your doctor’s recommendation if you’re put on such medicine. 

The medicine that’s prescribed will depend on the severity of the condition. Long-acting bronchodilators are administered in more severe cases. When flaring up happens, the steroid can be given in addition. 

Steroids can reduce inflammation, whereby airways are partially cleared up. A doctor will often work with you over an extended period to figure out what solution works in your given situation. 

Pulmonary rehabilitation

Pulmonary rehabilitation is a broader approach that seeks to tackle unhealthy aspects of your life. It includes exercise training and an improvement to your overall health. Breathing techniques are taught to best cope with your condition. 

Surgery

Some people with COPD benefit from surgery. However, it’s not a desirable approach if other treatments prove effective. It’s usually done to people experiencing severe symptoms. 

Surgery can include lung volume reduction surgery, one-way endobronchial valves that are implanted, or bullectomy. 

Lung transplant

A lung transplant is a big, invasive measure. It includes replacing the diseased lung. Severe or chronic lung cases can improve their quality of life through this procedure. It can also be done when other options have been tried without success.

Recovery is extensive, and you can expect to spend 1 to 3 weeks at the hospital following the surgery. Special medication is administered to ensure your body does not reject the new organ. Additional changes are important to ensure the safekeeping of your body following such an invasive measure. 

COPD exacerbation

Patients with COPD will go through episodes of exacerbation where symptoms worsen. Morbidity and mortality increase, and the quality of life decreases. Additional inflammation caused worsened breathing. Flare-ups cause respiratory symptoms to become more severe. 

Viruses and bacteria can cause these exacerbations, infecting the airway. Faster disease progression is often seen in patients prone to flare-ups. Stronger medication is often given to help keep flare-ups at bay.

However, patients are encouraged to take additional measures to avoid excessive inflammation.

Is COPD curable?

Unfortunately, there is no cure for COPD, only treatment. Patients are encouraged to work with doctors and consider lifestyle choices to ensure the best possible quality of life. 

What do lungs with COPD look like?

Lungs with COPD will often look hyperinflated on an x-ray. A flatter diaphragm is common, and the lungs will appear larger than normal, as will the heart.

COPD life expectancy

Milder cases of COPD can live into their 90s. Other health problems can shorten your life, and pneumonia and respiratory failure are definite options. 

COPD breath sounds

Patients with COPD will experience their breath clicking or crackling as they breathe in. The sounds can make either sound particularly coarse or fine. 

Oxygen saturation in COPD

Healthy individuals will have oxygen levels ranging from 95% to 100%. However, oxygen saturation in COPD is generally around 88% to 92%. An oximeter can tell you where your readings are at. 

FAQ

Is COPD hereditary?

The tendency for COPD to be hereditary is very low, with only 1 in 100% being predisposed with alpha-1-antitrypsin deficiency. The most common reason for the condition involves smoking. 

How do you get COPD?

Tobacco smoke is the most common cause. However, Respiratory infections and increased air pollution can contribute to the likelihood. 

Can COPD be reversed?

Curing or reversing it is not possible. 

Can you die from COPD?

Yes.

Can a person with COPD get better?

Treatment can be provided to keep the symptoms at bay. Additionally, a patient can make lifestyle choices to improve their COPD.

Is COPD a disability?

Yes, it is considered a disability. 

Is COPD a death sentence?

It is not a death sentence. Many people live past the overall life expectancy with the condition. However, it can significantly decrease the quality of life for those affected.

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COPD
Micrograph showing emphysema (left – large empty spaces) and lung tissue with relative preservation of the alveoli (right). Credit: Wikipedia, CC-BY-SA 3.0

COPD, or chronic obstructive pulmonary disease, is a leading cause of disability and death in the U.S., according to the American Lung Association. More than 12.5 million people have been diagnosed with COPD, but millions more may have the disease without knowing it.

COPD is a chronic inflammatory lung disease caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. People with COPD are at increased risk of developing respiratory infections, heart disease, lung cancer, pulmonary hypertension and depression. Also, if you have a chronic lung disease such as COPD, you may be at greater risk of severe illness and complications from COVID-19.

Symptoms of COPD often don't appear until significant lung damage has occurred, and they usually worsen over time, particularly if cigarette smoke exposure continues.

Signs and symptoms of COPD can include:

—Shortness of breath.
—Wheezing.
—Chest tightness.
—Chronic cough that may produce clear, white, yellow or green mucus.
—Frequent respiratory infections.
—Lack of energy.
—Unintended weight loss.
—Swelling in the ankles, feet or legs.

Treatment

If you've been diagnosed with COPD and you smoke, it is important that you quit. Most cases of COPD in the U.S. are directedly related to long-term cigarette smoking, and stopping smoking can keep COPD from getting worse and reducing your ability to breathe.

Many people with COPD have mild forms of the disease for which little therapy is needed other than smoking cessation. Even for more advanced stages of disease, effective therapy is available that can control symptoms, slow progression, reduce your risk of complications and exacerbations, and improve your ability to lead an active life.

Treatment for COPD can include:

—Medications: Several kinds of medications are used to treat the symptoms and complications of COPD. You may take some medications on a regular basis and others as needed. These medications can include bronchodilators, inhaled steroids, combination inhalers, oral steroids, phosphodiesterase-4 inhibitors, theophylline and antibiotics.

—Lung therapies: Lung therapies for people with moderate or severe COPD can include oxygen therapy and pulmonary rehabilitation.

—In-home noninvasive ventilation therapy: A noninvasive ventilation therapy machine with a mask helps to improve breathing and decrease retention of carbon dioxide that may lead to acute respiratory failure and hospitalization. More research is needed to determine the best ways to use this therapy.

—Managing exacerbations: Even with ongoing treatment, you may experience times when symptoms become worse for days or weeks. This is called an acute exacerbation, and it may lead to lung failure if you don't receive prompt treatment. When exacerbations occur, you may need additional medications, such as antibiotics, steroids or both; supplemental oxygen; or treatment in the hospital. Once symptoms improve, your health care team can talk with you about measures to prevent future exacerbations, such as quitting smoking; taking inhaled steroids, long-acting bronchodilators or other medications; getting your annual flu vaccine; and avoiding air pollution whenever possible.

—Surgery: Surgery is an option for some people with some forms of severe emphysema, a type of COPD, who aren't helped sufficiently by medications alone. Surgical options can include lung volume reduction, lung transplant and bullectomy.

©2022 Mayo Clinic News Network.
Distributed by Tribune Content Agency, LLC.

Citation:
Treating COPD (2022, November 29)
retrieved 29 November 2022
from medicalxpress.com/news/2022-11-copd.html

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

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

Excerpts

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

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

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

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

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

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

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

Q: How is COPD caused?

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

Q: Can symptoms of its onset be detected early?

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

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

Q: Main risk factors- what are they?

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

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

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

Q: Do you offer tests other than spirometry?

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

Q: Can COPD be cured?

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

Q: Will early diagnosis and treatment help?

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

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

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

Q: Will regular exercise, nutritious diets help?

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

Q: Treatment options?

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

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

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

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

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

Q: Are there vaccinations to reduce risks?

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

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

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

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

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

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

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

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

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

a) Nicotine replacement therapy

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

1) Monitoring tobacco consumption and the effectiveness of preventive measures

2) Protect people from tobacco smoke

3) Offer help to quit tobacco use

4) Warn about the dangers of tobacco

5) Enforce bans on tobacco advertising, promotion and sponsorship

6) Raise taxes on tobacco

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

Q: Your message to readers?

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

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

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

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

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

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

6 signs COPD is getting worse

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

Norton Pulmonary Specialists

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

How to prevent COPD flare-ups

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

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

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

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Chronic obstructive lung disease (COPD) has been reported as the third leading cause of death globally. The main risk factor for a significant portion of emphysema patients is tobacco use. Additionally, occupational exposure to wood dust enhances the risk of acquiring respiratory disorders, since the respirable wood dust settles into the bronchioles and alveoli and causes lung irritation which presents symptoms like mucus hypersecretion and breathlessness. A secondary complication, emphysema-induced pneumothorax, in the elderly requires the medical intervention of intercostal drainage (ICD) to allow the leak of air out of the thoracic cavity. In this article, we present a case of a 65-year-old male who visited the respiratory department with complaints of breathlessness, fever, and cough with expectoration for four days. He reports a history of tobacco smoking for 30 years with prior hospitalization seven years ago with similar complaints. The patient was initially diagnosed with pulmonary emphysema, which later progressed to spontaneous pneumothorax. He underwent medical management with ICD, which was successful. Following this, an integrated rehabilitation program using various breathing strategies was established in order to get the patient back to his regular daily activities with minimal signs of exhaustion or dyspnea. This protocol proved to be successful in enhancing the patient's respiratory condition.

Introduction

Emphysema is defined as an abnormal permanent enlargement of the air space distal to the terminal bronchioles, accompanied by degradation of the alveolar walls [1]. Based on the pathologic pattern, emphysema is typically categorized into three categories: centrilobular, panlobular, and paraseptal. The secondary lobule's central airways enlarge with normal distal alveolar ducts and sacs in centrilobular emphysema (CLE), a smoking-related condition that frequently affects the higher lobes [2]. In 2019, 3.23 million people perished since chronic obstructive pulmonary disease (COPD) emerged as the third leading cause of death worldwide. About 90% of fatalities occur due to COPD under the age of 70 years especially in low and middle-income countries [3]. Presenting features of emphysema are cough associated with expectoration, dyspnea, reduced chest expansion, declining lung volumes, etc. [4].

Pneumothorax, which can occur spontaneously or as a result of iatrogenic injury or trauma to the lung or chest wall, is the collapse of the lung when air builds between the parietal and visceral pleura inside the chest. The air is outside the lung but inside the thoracic cavity. Consequently, the lung is under pressure, which increases the risk of its collapse and causes the mediastinum to migrate [5]. The migration of air from the lung into the pleural cavity without trauma is known as a spontaneous pneumothorax (SP). Secondary spontaneous pneumothorax (SSP), as opposed to primary spontaneous pneumothorax (PSP), is the term used to describe an SP in a patient with an underlying chronic lung pathology, such as COPD [6]. Spontaneous pneumothorax shows a bimodal age distribution, with the secondary peak including patients aged ≥50 years The most prevalent underlying condition linked to spontaneous pneumothorax in the aged population is pulmonary emphysema [7].

The clinical features of a pneumothorax are sudden onset of dyspnea and pleuritic chest pain, reduced chest excursion on the affected side, an expanded hemithorax on the affected side, diminished breath sounds, no tactile or vocal fremitus, hyper-resonant percussion, etc. [8]. We provide a case of a patient who had an emphysema-induced pneumothorax and underwent medical care, intercostal drainage (ICD), and collateral physiotherapeutic rehabilitation. Intercostal drainage tube insertion and antibiotic chemotherapy continue to be the main treatments for pneumothorax. In order to collect the fluid, blood, and air and for the underlying lung to expand, intercostal tube drainage is employed. It is inserted into the pleural space through the chest wall and is made of flexible plastic. As a result of the accumulation of air, greater respiratory demands appear in the form of dyspnea, a decrease in chest expansion, and faster breathing. Breathing exercises prescribed by a physical therapist are advised because they help with fluid drainage, maintain chest expansion, and reduce dyspnea. Physiotherapists use a range of strategies to increase ventilation for patients with respiratory diseases. Reduced bronchospasm, clearing of lung secretions, regaining full lung expansion, and optimal functional recovery were the objectives of the treatment [9].

Case Presentation

Patient Information

A 65-year-old male, a carpenter by occupation, visited the respiratory department of tertiary care rural hospital with complaints of breathlessness, fever, and cough associated with expectoration that was mucoid in quality for four days. The patient was prior hospitalized seven years ago in a private hospital in Nagpur, India, due to an acute episode of breathlessness suddenly during work and has been experiencing dyspnea since then. X-ray reports showed hyperinflated lungs bilaterally suggestive of pulmonary emphysema. Previous reports suggest dyspnea of grade I-II on Modified Medical Research Council (MMRC) scale. He has a positive history of dust allergy with seasonal variation, exaggerated during winters. The patient claims consuming tobacco products for 20 years and smoking cigarettes for 30 years. The patient consumed 3-4 cigarettes per day. The patient was admitted to our hospital on August 14, 2022, due to acute exacerbation of dyspnea that was evaluated as grade IV on MMRC. Chest X-ray (posterior-anterior view) investigations showed hyperinflated lungs bilaterally along with hyperlucent lung fields. The patient was diagnosed with ipsilateral left-sided pneumothorax secondary to bilateral centrilobular emphysema. ICD was inserted in the left infra axillary in the fourth intercostal space, the air was drained and underwater seal was placed. After the removal of intercostal drainage, post-operative day four, the patient was further referred to the cardiorespiratory physiotherapy department for the removal of excessive secretions, to reduce dyspnea and improve exercise tolerance.

Clinical findings

Informed consent was taken from the patient, which was done prior to the physical examination after the removal of ICD. On inspection, the patient was found in a sitting position and was cooperative, with orientation to time, place, and person. Pallor was present, and clubbing grade II was observed with a positive Schamroth window test as shown in Figure 1. From the lateral view, barrel-shaped chest was inspected as shown in Figure 2. The use of accessory muscles was present. On palpation, the trachea was deviated to the right side, chest excursion was found to be reduced bilaterally, and tactile vocal fremitus was diminished in the upper and middle zones. Chest expansion findings were 1cm, 1.5cm, and 2cm at axillary, nipple, and xiphisternal levels, respectively. On percussion, hyper-resonant note was present on the left side, mammary region. On auscultation, breath sounds were diminished in the upper and lower zones on the left side of the thorax.

Diagnostic assessment

The patient’s high-resolution CT (HRCT) thorax scan findings revealed ICD with the tip in the left pleural space and a few small areas of fibrotic changes in bilateral lung fields with subsegmental atelectasis. Bilateral lungs appear hyperinflated with centrilobular emphysematous changes, extending superiorly to the ipsilateral axilla, shoulder, and suprascapular region as shown in Figure 3. X-ray findings of the chest revealed hyper lucent lung fields bilaterally, with deviation towards the right side and flattening of the left hemidiaphragm as presented in Figure 4.

Physiotherapy management

Table 1 presents the data of the physiotherapy management strategy that was planned and applied as per the patient's limitations. It enlists the problems faced by the patient, goals, and interventions specific to the problems displayed.

Serial no. Problems faced by the patient Goals Description of interventions
1. Pain at the ICD insertion site To reduce pain 1. TENS: Transcutaneous Electrical Nerve Stimulation was used with the following parameters: Mode: Conventional mode Frequency: 100-150 Hz Duration: 10-15 minutes Site of electrode placement at the site of tube insertion.  2. Splinting technique: The patient was instructed to use a towel pad to support the incision site while coughing, sneezing, laughing etc. 3. Breath stacking exercise (after removal of ICD): The patient was encouraged to breathe in slowly, stacking one breath on top of the other, with five seconds hold; three sessions per day with five repetitions were advised (Mohamed et al., 2021).    
2. Exertional dyspnea To reduce dyspnea while working Ventilatory strategies with activity: The patient was explained to breathe through the nostrils and exhale through pursed lips as in blowing a candle. The breathing pattern was synchronized with the activity. For example, explaining to the patient to take two steps and simultaneously inhale and exhale once while walking.
3. Use of accessory muscles Provide relaxation to muscles Dyspnea relieving position with PLB: The patient was instructed to do bedside sitting, place a pillow over both thighs and was asked to lean on it with elbows extended over the pillow. While doing that, the patient was explained to inhale through the nostrils and exhale through pursed lips (five repetitions). Other positions such as sitting on a chair and leaning on the table in front were taught.  
4. Reduced Chest Expansion To improve chest mobility Chest Mobility exercises with breathing strategies: 3 different exercises were demonstrated to the patient. He was instructed to sit in a chair and perform pectoral stretch with hold and pectoral stretch while performing trunk rotations. The patient was explained to stand and perform side bends avoiding overstretching with pursed lip breathing. The effectiveness of chest wall mobility lies in its ability to increase ventilation on that side of the chest, emphasize the depth of inspiration, and regulate expiration. [9].  
5. Accumulation of secretions Clearance of secretions Active Cycle of Breathing Technique (ACBT): The mechanism of ACBT comprises three exercises- breathing control x3, thoracic expansion exercise x3, forced expiratory exercise consisting of coughing and huffing x2, with breathing control thrice after each exercise. The patient is asked to initiate inhaling and exhaling through nostrils three times, then perform thoracic expansion, with an interval of breathing control, followed by coughing and huffing along with breathing control. This procedure helps the movement of secretions from peripheral to central airways and further to the mouth. Oscillatory positive expiratory pressure (OPEP) device: The patient was given a mechanical hand-held OPEP device, and was told to breathe through it. This device had an inhaling valve and a linear track for the patient to follow. Positive pressure oscillations are caused by a one-way valve opening and closing sporadically during exhale. The patient then coughed and huffed a couple of times. Ten to 20 blows into the device were administered four times per day [10].  
6. Reduced cardiovascular endurance To improve exercise tolerance The patient was provided with a well-monitored graded exercise program that started with bedside limb mobility exercises, involved walking, and stair climbing for 10 minutes three to four times per day and was gradually increased in accordance with the patient's hemodynamic response and rate of perceived exertion. Home Exercise Program (HEP): The physiotherapy protocol was designed for two weeks with six sessions a week in the hospital inpatient set-up. Once improvements in his endurance were seen, he was discharged with a well-explained home program. The patient was provided with a plan of exercises that included deep breathing exercises, pursed lip breathing exercise, brisk walking, and stair climbing with symptoms in check and chest mobility exercises.

Outcome measures

Table 2 lists the results that were utilized to evaluate the patient's progress on the day of referral, on the day of discharge, and on the day of follow-up. The patient was given a set of training regimens to follow at home in order to restore strength and increase endurance, including instructions for self-monitoring vital signs and spotting warning signs. Along with this routine, he was also instructed to practice breathing retraining and cleanliness every day, as well as to use relaxation and dyspnea-relieving techniques as needed. Additionally, he was told to follow up after two weeks and contacted by phone if he had any questions about the medication or his health. Positive rehabilitation outcomes were reported by the patient with great satisfaction.

Outcome First day of referral On the day of discharge At the time of Follow-up
Functional Independence Measure  (FIM)   4 6 7
Six-Minute Walk Distance (6 MWD) 230 m  with rest pause 260 m with rest pause 290 m
St. George Respiratory Questionnaire (SGRQ) 50 30 20

Timeline of all the events

Table 3 presents the duration of all the events such as the date of admission, date of surgery, date of physiotherapy referral, date of discharge, and date of the last follow-up.

Events Dates
Date of Admission August 10, 2022
Date of Surgery August 13, 2022
Date of Physiotherapy Referral August 17, 2022
Date of Discharge August 30, 2022
Date of the last follow-up September 28, 20/22

Discussion

Chronic respiratory diseases impact an individual’s breathing and ventilation capacities negatively. A deadly disease, COPD, leads to functional impairments and secondary complications like pneumothorax, pulmonary hypertension, pneumonia, and chronic atelectasis following emphysema, the most common form of COPD to prevail. This case study describes a case of an elderly male patient who developed pneumothorax secondary to pulmonary emphysema. He underwent ICD insertion following which intensive physiotherapy care was required to improve the oxygenation and ventilation capacities of the lungs. Breathing exercises include diaphragmatic breathing and segmental expansion as well as pursed lip breathing that creates back pressure over the alveoli, hence allowing prolonged perfusion and the development of collateral channels for ventilation. Conclusion derived from a study on two groups of COPD participants using flutter as well as active cycle of breathing technique (ACBT) for two weeks showed drastic results, by increasing mucus clearance and improving the viscoelasticity of lungs. An increase in peak expiratory flow rate (PEFR) and forced expiratory volume/forced vital capacity (FEV1/FVC) was observed simultaneously [11].

Dimitrova’s research developed a pulmonary rehabilitation protocol to assess the severity of symptoms of COPD pre- and post-intervention using indicators such as six-minute walk test and modified medical research council (MMRC) scale. Aerobic exercises such as walking, slow running, cycling, etc., along with breathing exercises, forced exhalation, and coughing manoeuvres caused symptoms to be less pronounced [12]. To clear out the secretions, the patient in this case study was provided with an oscillatory expiratory pressure device, which he was instructed to blow in 10-20 times, four times each day. Chest recovery was faster and reflected a reduction in symptoms of dyspnea as well. By the outcome measures, improvement was seen in the six-minute walk test, indicating improvement in exercise tolerance. As observed in the findings of a study by Sarah et al., in COPD patients, oscillatory expiratory positive pressure (OPEP) medication significantly improved forced vital capacity (FVC), six-minute walk distance (6MWD), and symptoms in sputum-producers. It also became easier to cough up sputum. Additionally, significant improvements in the St. George respiratory questionnaire (SGRQ), forced expiratory volume (FEV1), 6MWD, and ventilation-perfusion deficit (VDP) were seen in half of those who generated sputum [10]. Nutsupa et al. in their study showed that patients underwent light exercise training to become acquainted with breathing regulation while doing activities of daily life after ventilatory feedback and exercise training that demonstrated a positive impact on ventilation [13].

Conclusions

The goal of this study was to plan a management structure for a patient of pneumothorax secondary to emphysema in aspects of pulmonary rehabilitation. Prior to the initiation of physiotherapy management, the patient had reduced oxygen saturation and poor mucus clearance. However, our approach with an integrated and comprehensive rehabilitation regimen showed positive changes in the severity of symptoms of dyspnea, cough, mucus clearance, pulmonary capacities, weakness, and overall quality of life. It is vital for these parameters to resolve in elderly patients so that they can get back to their pre-disease state and spend the rest of the years of their lives in peace and prosperity.



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