The Impact of Exercise on Sleep and Respiratory Symptoms in Men with COPD

Living with chronic obstructive pulmonary disease (COPD) presents numerous challenges, with patients often experiencing chronic cough, sputum production, and inadequate sleep. While aerobic moderate-to-vigorous physical activity (MVPA) has been recommended for individuals with chronic diseases, the role of resistance training alongside MVPA in managing COPD symptoms hasn't been extensively explored.

Researchers from South Korea sought to change that with a population-based cross-sectional study that appeared in Scientific Reports.

Study Overview

A recent nationwide population-based study conducted in South Korea sought to investigate the association between resistance training in addition to MVPA and clinical outcomes in men with airflow limitation. The study utilized data from the Korea National Health and Nutrition Examination Survey between 2014 and 2019, focusing on individuals with COPD who engaged in aerobic MVPA. The participants were categorized based on whether they also performed resistance training.

Researchers found that the combination of MVPA and resistance training:

1. Improved Sleep Duration: Men with airflow limitation who engaged in aerobic MVPA alongside resistance training experienced more adequate sleep duration compared to those who only performed aerobic MVPA. The association was particularly significant in individuals with a forced expiratory volume of less than 80% of the predicted value.

2. Reduced Respiratory Symptoms: The combination of aerobic MVPA and resistance training was associated with decreased odds of chronic cough and sputum production in men with airflow limitation, compared to those who engaged in aerobic MVPA alone.

These findings highlight the potential benefits of incorporating resistance training alongside aerobic MVPA in the management of COPD symptoms. By improving sleep duration and reducing respiratory symptoms, such as chronic cough and sputum production, individuals with COPD may experience enhanced quality of life and better overall health outcomes.

A Holistic Approach

While the study provides valuable insights, it's important to acknowledge that its cross-sectional design prevents establishing causal relationships. Future longitudinal studies are warranted to validate these findings and explore the long-term impact of resistance training on sleep and respiratory symptoms in COPD patients.

This study underscores the importance of adopting a holistic approach to exercise in COPD management, emphasizing the inclusion of resistance training alongside aerobic MVPA. By addressing both physical activity and strength training, individuals with airflow limitation may experience improvements in sleep quality and respiratory symptoms, ultimately enhancing their overall well-being and quality of life.

To read the full study, visit Scientific Reports.

Breathing Easier and Living Longer: The Promise of Bronchoscopic Lung Volume Reduction

 Living with severe chronic obstructive pulmonary disease (COPD) can be a daily struggle, affecting not only breathing but also quality of life. For those who have been on this challenging journey, any glimmer of hope is a breath of fresh air. Recently, a groundbreaking study has shed light on a potential game-changer in the management of severe COPD: Bronchoscopic Lung Volume Reduction (BLVR).

COPD is a chronic lung condition characterized by airflow limitation, making it increasingly difficult to breathe over time. It's a condition that has far-reaching effects on daily life, and until recently, the options for treatment have been limited. Enter BLVR—a promising treatment option that involves using coils or endobronchial valves to reduce hyperinflated lung volumes and improve lung function.

A Ray of Hope

Researchers sought to investigate the impact of BLVR on survival rates for patients with severe COPD. It included 1,471 patients who visited the hospital for consultations to evaluate their eligibility for BLVR treatment and underwent pulmonary function tests. These patients were referred from various physicians across the Netherlands.

The study’s three primary findings were remarkable:

1. Extended Survival: The median survival time for patients considered for BLVR treatment was approximately 7.4 years.

2. Survival Benefit: Patients who underwent BLVR treatment had a significantly longer median survival time compared to those who did not receive the treatment. Specifically, the BLVR-treated group had a median survival time of approximately 8.6 years, compared to around 6.9 years for the non-treated group.

3. Independent Predictor: BLVR treatment was found to be an independent predictor of survival, even after adjusting for other factors that influence survival, such as age, gender, and disease severity.

These findings indicate that BLVR treatment has the potential to not only improve lung function and quality of life but also extend life expectancy. While this treatment may not be suitable for everyone, it represents a significant advancement in the management of COPD, especially for those with severe hyperinflation and limited life expectancy.

In the world of COPD management, every breath is precious. The results of this study underscore the potential of BLVR as a life-extending treatment option for individuals with severe COPD. While more research is needed to fully understand the long-term effects and to identify the most suitable candidates, these findings offer a ray of hope for those living with this challenging condition.

Additional Insights from Dr. Nair: BLVR is a good option for the patients who qualify, but many patients will not. One problem is the target lobe of the lung to be blocked by a one-way valve should only get oxygen via the main bronchial airways not by “collateral ventilation.” This occurs when the neighboring lung helps inflate adjacent tissue. The proposed area to be closed off to air (though phlegm can get out) must only fill through the main airways for the procedure to be effective.

Read the study in Respiratory Medicine.

Empowering COPD Patients through Smartphone Apps

Chronic obstructive pulmonary disease (COPD) is a global health concern, impacting millions of lives and straining healthcare systems worldwide. One of the key challenges faced by individuals living with COPD is maintaining adequate levels of physical activity. Low physical activity not only worsens COPD symptoms but also leads to numerous health complications, including increased hospitalizations and mortality.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recognizes the potential of technology-based interventions to enhance physical activity in COPD patients, especially in today's digital age where smartphone apps have emerged as a promising solution to address the physical inactivity crisis in COPD patients. These apps offer a convenient and accessible means to promote physical activity, leveraging the ubiquity of smartphones in daily life. However, their effectiveness hinges on patient adherence, which, in turn, is influenced by the technological features of these apps.

To shed light on this critical aspect, a recent systematic review delved into the technological features of smartphone apps designed to promote physical activity in COPD patients. The review analyzed 23 relevant studies, offering valuable insights into the state of technology-driven solutions for COPD patients' physical activity promotion.

The Technological Landscape

The review identified 19 distinct smartphone apps specifically designed to enhance physical activity in people living with COPD. These apps served various purposes, including promoting daily physical activity, structured exercises, and self-management, which encompassed educational content, symptom monitoring, alerts, chat functionalities, and even smoking cessation support.

One striking feature was the integration of wearable devices into eight of these apps. This allowed patients to collect and transmit essential health data, enhancing the personalization and effectiveness of interventions. Wearables like activity trackers and oximeters played a crucial role in tracking physical activity and vital signs, enabling those with COPD to monitor their health proactively.

Key Technological Features

The review categorized the technological features into six distinct categories, with varying degrees of implementation across the apps:

1. Measuring and Monitoring: This category was present in all apps, focusing on tracking and recording physical activity data. It provided patients with valuable insights into their progress.

2. Information and Analysis: Apps frequently offered visual representations of user data, helping patients understand their achievements. “Data in visual format” and “progress in visual format” features were particularly common, allowing patients to visualize their journey toward better health.

3. Support and Feedback: Offering advice on physical activity was a prevalent feature, emphasizing the importance of education and motivation in promoting physical activity. However, social features and expert contact options were rarely implemented, highlighting potential areas for improvement.

4. Adaptation: Personalization and goal-setting features were frequently integrated, recognizing the value of tailoring interventions to individual behavior and needs. These features aimed to boost patients' engagement and motivation.

5. Social: Surprisingly, only three apps included social features, which could leverage the power of social support networks to motivate patients further. Given the documented importance of social support in people with COPD, this represents an area ripe for development.

6. Other: Features like weather forecast integration and calendar integration were notably absent from all apps. These features could help patients overcome barriers like inclement weather and establish a routine.

The systematic review of smartphone apps designed for those living with COPD highlights the potential of technology to promote physical activity and improve the quality of life for those living with this chronic condition. However, it also underscores the need for further development and refinement.

While these apps offer valuable features related to measuring, monitoring, and providing feedback on physical activity, there is room for improvement. Incorporating social elements and enhancing personalization could significantly enhance patient engagement and adherence.

Moreover, the absence of features like weather forecast integration and calendar integration represents missed opportunities to address common barriers to physical activity. The field of mobile health apps for people with COPD is evolving, and researchers and developers should consider these findings to create more effective and comprehensive solutions.

As we navigate the challenges posed by COPD, the integration of technology into healthcare becomes increasingly vital. Smartphone apps have the potential to empower patients, enabling them to take control of their health and improve their physical activity levels. However, continued research and innovation are essential to maximize the impact of these tools on COPD management and overall well-being.

Read the study in Pulmonology.

GETomics: Unlocking the Secrets of COPD, Aging, and Exercise

Recent research into “GETomics” and its implications for people with chronic obstructive pulmonary disease (COPD) has shed new light on the complex interplay between genetics, the environment, aging, and the potential role of exercise in managing COPD.

GETomics is a concept that emphasizes the importance of dynamic and cumulative gene (G) - environment (E) interactions throughout an individual's lifetime (T). It recognizes that human health and disease are shaped by these interactions, with outcomes influenced by the timing of these interactions and an individual's history of previous encounters.

In the study, researchers discussed how a GETomics approach to COPD may open new perspectives to better understand its relationship with exercise limitation and the aging process in five areas.

1. Changing the Understanding of COPD

Traditionally, COPD was seen as a disease primarily caused by tobacco smoking, affecting older men and leading to accelerated lung function decline with age. However, recent research has challenged this perspective. We now know that COPD has multiple risk factors, occurs in both genders, affects young individuals, and has diverse lung function trajectories. This evolving understanding of COPD has significant implications for diagnosis and treatment.

2. The 12 Hallmarks of Aging

Researchers have identified 12 hallmarks of aging, which encompass various levels of biological organization, from molecular to systemic. These hallmarks are interconnected and play a role in both aging and age-related diseases. One of these hallmarks is cellular senescence, which contributes to both aging and COPD by limiting cell renewal and promoting inflammation.

3. Exercise as a Polypill for Aging and Health

Exercise is a well-established environmental factor that can positively impact aging and health. Regular exercise has been linked to increased longevity and several other health benefits. However, the relationship between exercise and health is not linear, with excessive exercise potentially having detrimental effects. For COPD patients, exercise is encouraged as part of their management, but its role in lung regeneration remains an area of active research.

4. GETomics, Aging, and COPD

GETomics offers a new perspective on the complex relationships between genetics, the environment, aging, and COPD. This approach recognizes that different people age differently due to genetic and environmental factors. While aging is inevitable, the rate and quality of aging can vary significantly. COPD, often accompanied by multimorbidity, is influenced by these factors.

5. Exercise to Manage COPD

Exercise may hold promise as a therapeutic approach for COPD patients. While the evidence for its regenerative effects on the lungs is still emerging, exercise has been shown to positively impact several hallmarks of aging. Importantly, exercise's potential to improve lung function, reduce inflammation, and promote overall health makes it a valuable tool in the management of COPD.

GETomics provides a fresh perspective on the complex relationship between aging, COPD, and exercise. It emphasizes the importance of genetic and environmental factors in shaping an individual's health and disease risk. For COPD patients, understanding these dynamics can open new doors to prevention, early diagnosis, and improved management.

While exercise may not be a cure for COPD, its potential to positively influence various hallmarks of aging and health underscores its importance as part of a comprehensive COPD management plan. As research continues, exercise may become an increasingly valuable tool in the fight against COPD and the quest for healthier aging.

Read the study on Respiratory Medicine

Motivating Conversations About COPD: What Patients Prefer

Living with a chronic condition like chronic obstructive pulmonary disease (COPD) can be challenging. Early diagnosis and timely clinical conversations are crucial for managing this condition effectively. A recent study delved into understanding what motivates patients to initiate conversations about COPD with their healthcare providers, revealing valuable insights into message features that can encourage these vital discussions.

In a quest to identify effective message features, researchers conducted a discrete choice experiment involving 928 participants, primarily non-Hispanic white adults with some college experience. Their goal was to determine which messages would inspire them to talk to a clinician about COPD. Key findings were:

1. COPD Susceptibility Matters (25.53% preference): Messages focusing on COPD susceptibility, such as signs and symptoms, were the most influential in motivating patients to discuss COPD, highlighting the importance of raising awareness about the early warning signs of the disease.

2. Message Source Counts (19.32% preference): Patients placed a significant emphasis on the source of the message. Those from medical authorities including clinicians and COPD organizations were highly preferred, demonstrating that trust in the messenger plays a vital role in encouraging dialogue.

3. Supportive Call-to-Action (14.12% preference): Participants responded positively to messages that supported their autonomy in decision-making regarding COPD screening. Empowering patients to take control of their health decisions is essential.

4. Emotional Frame (13.24% preference): Messages that conveyed hope for living a healthy life with COPD and boosted self-efficacy in seeking screening garnered attention, showing that emotions can be powerful motivators in healthcare discussions.

5. Efficacy Matters (8.65% preference): While less influential than other factors, messages that conveyed efficacy in getting screened still played a role. Patients need to believe that taking action will make a difference.

6. Preference for Susceptibility Over Risk Behaviors: Interestingly, patients favored messages about COPD signs and symptoms over those related to risk behaviors like smoking and environmental exposures. This suggests that emphasizing early detection and symptom awareness might be more effective.

7. Variation in Message Preferences: The study also revealed that message preferences varied based on age, gender, race, ethnicity, education level, and smoking status. Tailoring messages to specific patient demographics could enhance their effectiveness.

These findings offer valuable guidance for healthcare professionals and organizations in promoting COPD awareness and early diagnosis. By crafting messages that focus on susceptibility, come from credible sources, empower patients, and evoke hope, clinicians can encourage more patients to discuss COPD during their appointments.

COPD is a challenging condition, but initiating clinical conversations about it is a crucial step toward effective management. Understanding what motivates patients to discuss COPD is vital. This study's findings shed light on the message features that can inspire these conversations, ultimately improving the early detection and management of COPD.

By tailoring messages to patient preferences, healthcare providers can play a pivotal role in reducing the burden of this disease, particularly among at-risk populations.

Read the full study in PEC Innovations.

Research Uncovers Why Viral Infections are Worse for People with COPD

New research has identified the cells responsible for exacerbating viral infections in people with chronic obstructive pulmonary disease (COPD) – tissue-resident natural killer (trNK) cells that are abnormally active in people with COPD. When exposed to viral infections in COPD-affected lungs, these trNK cells respond too aggressively and, as a result, fail to produce the necessary cytokine, or signaling protein, to fight the infection.

The findings, discovered by researchers from the Hunter Medical Research Institute and the University of Newcastle in collaboration with Grace Cooper from University of Southampton, were published in the American Journal of Respiratory and Critical Care Medicine.

In the study, mice were exposed to cigarette smoke for 12 weeks to induce COPD-like lung disease, after which their lung trNK cell phenotypes and function were analyzed. That analysis showed that when the natural killer (NK) cells were exposed to viral infections, they became overactive and ultimately stopped working. This overly aggressive immune response meant the NK cells could not produce the necessary signaling protein, or cytokine, and could not fight the infection. 

“Collectively,” researchers concluded, “these results demonstrate that trNK cell function is altered in cigarette smoke-induced disease and suggests that smoke exposure may aberrantly prime trNK cell responsiveness to viral infection. This may contribute to excess inflammation during viral exacerbations of COPD.”

Read the original article in Medical Xpress.

Emphysema is More Common in Cannabis Smokers

According to the Centers for Disease Control and Prevention (CDC), marijuana is used by more than 48 million people, making it the most used federally illegal drug in the U.S. It affects the part of the brain responsible for memory, learning, attention, decision-making, coordination, emotion, and reaction time and has been linked to increased risk of psychosis or schizophrenia in some users.

If those facts aren’t sobering enough, new research has also linked it to higher rates of chronic obstructive pulmonary disease (COPD).

According to a study in Radiology, COPD is more common in cannabis smokers than cigarette smokers, likely because it enters the lungs unfiltered. The study involved chest CT scans of 56 marijuana smokers, 33 tobacco-only smokers and 57 nonsmokers. It found higher rates of emphysema among the marijuana smokers (42 out of 56) than nonsmokers (three out of 57) but not tobacco-only smokers (22 out of 33). 

The scans also found higher rates of bronchial thickening – inflammation of the lining of the bronchial tubes – among cannabis smokers, as well as bronchiectasis (widened, damaged airways) and mucoid impaction. The study also found that paraseptal emphysema was the predominant subtype in marijuana smokers. The rarest form of emphysema, paraseptal emphysema damages tiny ducts that connect air sacs in the lungs, usually affecting the upper part of the lung with fluid-filled sacs called bullae forming on the surface.

The study’s findings align with other research that associates marijuana smoking with large airway inflammation, increased airway resistance, and lung hyperinflation, and more prevalent symptoms of chronic bronchitis. Another study found that frequent marijuana smokers had more outpatient medical visits for respiratory problems than those who do not smoke.

To read the full study, visit Radiology.

Study: COPD-related Anxiety is Misunderstood and Under-Addressed

Anxiety related to chronic obstructive pulmonary diseases (COPD) is triggered initially by specific events in the illness trajectory and thereafter maintained by COPD-related internal, external, and behavioral factors. That is according to new research designed to improve identification and management of COPD-related anxiety, a prevalent but often unidentified issue that is not typically managed adequately.

Researchers in Denmark synthesized the findings of 41 qualitative studies of patients’ experiences of COPD-related anxiety. They identified four themes related to the disorder – initial events, internal maintaining factors, external maintaining factors, and behavioral maintaining factors – and used them to create a conceptual model of COPD-related anxiety from the patient perspective. 

“According to the model, specific initial events can trigger COPD-related anxiety, i.e., realizing the diagnosis and/or prognosis, experiencing exacerbation/symptom progression for the first time, and loss of function and/or abilities due to COPD,” they wrote, noting that despite multiple studies exploring the psychological effect of other illnesses including cancer, the same cannot be said for COPD. “One possible explanation for this lack of focus might be related to the consideration that smokers should expect to be ill from smoking, which is a widespread understanding of COPD, despite also being the case for certain cancers and cardiovascular disease. Another explanation may be the relatively slow progression of the disease, often resulting in several visits to the doctor with symptoms and declining lung function before the diagnosis is confirmed by the physician and disclosed to the patient.”

Results of the study, published in the June 2023 issue of International Journal of Chronic Obstructive Pulmonary Disease, suggest that, once triggered, COPD-related anxiety was maintained and potentially worsened over time by internal, external, and behavioral maintaining factors. For example, the review showed that patients were troubled by thoughts of death and the process of dying. They further expressed that, even shortly after being diagnosed with COPD and understanding the prognosis, death became a near reality, which affected their internal processes. 

“In spite of being aware of patient needs, many health-care providers feel inadequately prepared for discussing end-of-life issues and might therefore tend to avoid bringing up the subject. Moreover, appropriate timing of these conversations can be challenging, due to the unpredictability of the general illness trajectory in COPD compared to cancer.”

The study also suggests that patients suppress information about mental health, believing that their healthcare providers and caregivers could not understand or comprehend their situation. As such, they refrained from requesting help with their anxiety and initiated avoidance and social distancing which worsened symptoms. 

“With the purpose of strengthening the identification of COPD-related anxiety in the future, there are a number of potential barriers among health-care providers that need to be overcome, such as not recognizing the scale of the problem, not considering anxiety as part of the remit, and lack of knowledge about or access to appropriate interventions. Both health-care providers and patients can benefit from implementing systematic, psychological screening processes, because it can potentially increase confidence in assessing and managing psychological symptoms,” the researchers wrote.

Additional insights from Dr. Nair:  The need to breathe is so fundamental that if one chronically has trouble doing it, it will predispose them to anxiety. Anxiety also causes one to hyperventilate, which actually leads the body to emphasize the main defect in COPD – impairment to getting the breath out of your lungs. The “obstruction” in COPD is getting air out (exhalation) rather than in (inhalation). It takes longer to empty your lungs than it does to fill them, so the more times you breathe in the less time you have to breathe out. Thus, anxiety is an important symptom for a doctor to address when treating a person with COPD in a comprehensive manner.

Read the full study in International Journal of Chronic Obstructive Pulmonary Disease

Hitting the Road Safely

Summer is here, bringing with it thoughts of vacations and quick getaways. But for people with chronic obstructive pulmonary disease (COPD), getting where they need or want to be – whether it’s for appointments, errands, a trip across country, or just getting out of the house for the day – can be stressful.

There are ways to safely get from here to there, including having a plan, checking the weather, avoiding secondhand smoke, and being prepared with any supplies he or she may need while on the road. Following are suggestions to make leaving home safer and less challenging from the COPD Caregiver’s Toolkit, published by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health (NIH).

Have a Plan

Knowing what to do in advance makes leaving the house easier for everyone. Allow enough preparation time, and check with the person with COPD about their energy levels and level of ambition so you both have a clear understanding of the goals and ambition level for the outing. This will also help you both be mentally prepared for what needs to come next.

Check the Weather

Check the forecast and pay close attention to any predicted weather changes (e.g., intense humidity or cold) that might trigger a COPD flare-up. Pack the right weather protection and consider whether the car should be started in advance to get it warmed up or cooled down before getting in.

Avoid Secondhand Smoke

Not only is secondhand smoke an irritant, but it can change how the lungs and airways work. Thus, it’s important to avoid public smoking areas or anywhere that runs the risk of exposure.

Be Prepared

Ensure you have all necessary supplies, including any medications, oxygen supplies, etc., and make sure you have emergency phone numbers and contacts. If air travel is involved, contact the airline in advance to verify that the oxygen delivery device you plan to take is approved for use on the airplane.

If You’re Staying Behind

If someone else is taking the person with COPD to their appointment, establish a plan for them to use when making transportation arrangements. Make sure whoever is providing transportation understands any special needs and/or limitations. Many areas also offer senior or medical transportation services or check to see if any available public transportation is ADA-compliant.

Traveling with Oxygen

Preparation is particularly critical when traveling with oxygen. Answer these questions before leaving the house or during trip planning:

1. Do we have enough oxygen to travel with?
2. Do we have all the oxygen supplies we need?
3. Have we reviewed tank safety for traveling?
4. If flying, have we assessed what is needed for in-flight oxygen and oxygen at our destination?

NHLBI also shares the following outdoor safety checklist in its COPD Caregiver’s Toolkit:

• Sign up for air quality alerts from airnow.gov.
• Get outdoor allergen levels from your local news or weather websites.
• When outdoor air quality is poor or allergen levels are high, keep windows and doors closed and use air conditioning whenever possible.
• Avoid outdoor activities, especially during peak poor outdoor air quality hours from 1:00-4:00 pm.
• If you live in an area where wildfires are common, talk to your healthcare provider about ways to protect the person you care for against wildfire smoke.

More travel safety information can be found in NHLBI’s COPD Caregiver’s Toolkit, available here.