What Are the Best Forms of Exercise for COPD Patients?

Although exercise cannot reverse chronic obstructive pulmonary disease (COPD), it is key to effectively manage the condition and enhance overall health. Despite the prevalence of lung damage that leads to COPD, exercise can also help to avoid deterioration of the condition that can result in increased breathlessness and a worsening prognosis.

A study published in the Annals of the American Thoracic Society reveals the “association between physical activity levels and hospitalizations among a large group of COPD patients.” The results showed that patients who participated in any level of consistent moderate to vigorous physical activity had a profoundly lower risk of 30-day hospital readmission.

Researchers noted that physical inactivity reflects a worsened state of the disease, and the results support the theory that “promoting and supporting physical activity is a promising strategy not only to reduce the risk of having the [initial] hospitalization but also to buffer the stresses of hospitalization…Our findings further support the importance of physical activity in the overall management of COPD across the care continuum, including care transition efforts to reduce 30-day readmissions.”

The following steps highlight the most beneficial exercises for COPD patients and how they can incorporate them into their daily routine.

Get Checked Out

It is essential for COPD patients to first speak with their doctor before beginning any exercise routine to ensure they can safely increase their levels of physical activity. As part of COPD management protocol, doctors will often prescribe a pulmonary rehabilitation program which can help patients learn the most effective exercises and how to accurately perform them.

Stretching and Relaxation

Stretching is an optimal practice to begin before an exercise session, as it can help to loosen muscles and prevent an injury from occurring. For COPD patients in particular, “loosening up the muscles around the neck, chest and upper back may offer more room for the lungs to expand,” effectively enabling individuals to breathe easier.

Additionally, practicing yoga or tai chi can help to loosen muscles and encourage relaxation. Finding effective stress reduction techniques is essential as COPD can induce anxiety due to breathing complications and worsen symptoms. Both pursed-lip and diaphragmatic breathing are effective techniques to help patients relax, since they can help to “reduce some of the hyperinflation of the lungs that can result from COPD.”

Strengthening

COPD patients can also benefit from strengthening exercises for both the upper and lower body, such as lifting light free weights, and using weight machines or stretchy resistance bands. Lower body resistance exercises may also incorporate “side leg lifts, heel-to-toe lifts and repetitions of rising from seated to standing positions.”

Upper Extremity Endurance

Improving and maintaining both upper extremity strength and endurance is essential, so patients can remain independent. Upper extremity endurance includes the ability to reach for items on high shelves or dress themselves. To build upper body endurance, many patients utilize an arm ergometer – “a small, tabletop bicycle that’s pedaled with the arms.” If patients don’t have access to this machine, they can also use resistance bands or practice arm exercises to facilitate upper extremity strength.

Lower Body Endurance

Lower body endurance exercises, such as walking and cycling, are recognized as the “cornerstone” of a pulmonary rehabilitation program and are essential for COPD patients to regularly practice. Without this endurance, patients are more likely to experience difficulty in completing daily tasks. Depending on the stage of their COPD, patients can also benefit from incorporating water aerobics and swimming into their exercise regimen.

Start Slowly and Build Gradually

It’s also important to note that if a patient has been mostly inactive for a significant period of time, they should steadily ease back into a regular exercise routine and build gradually allowing the body to adjust. Choosing an activity that is enjoyable can also help to create a long-term lifestyle change.

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Can Vitamin A Help With My CPOD?

Although a growing body of literature supports the fact that cigarette smoking is the top risk factor associated with developing chronic obstructive pulmonary disease (COPD), it is not the sole cause. In fact, scientists are still perplexed as to how exactly “cigarette smoke and other inhaled irritants can trigger the development of COPD.”

One theory is that smoking cigarettes may “deplete the body of vitamin A,” a nutrient that builds and repairs lung tissue. If lungs lack adequate amounts of vitamin A, it can lead to the development of lung infections or chronic diseases of the lungs.

“The connection between vitamin A and the lungs starts from the very beginning, while we're developing in utero and continues well into adulthood,” said Dr. Antonello Punturieri, program director for COPD at the National Heart, Lung and Blood Institute. "The lungs are still developing until age 25 or 30. This is why teen smoking is so bad. Having an adequate vitamin A intake throughout this developmental period is critical to developing and maintaining strong, healthy lungs.”

A study published in the journal Molecular Aspects of Medicine revealed that moderate vitamin A deficiency can significantly enhance the occurrence of respiratory tract-related diseases. In addition to vitamin A’s involvement in lung function, it is also critical to the development of various tissues and cells, and embryonic lung growth.

Another study published in the New England Journal of Medicine revealed that pregnant women who took vitamin A supplements throughout their pregnancy “had children with better lung health when the researchers followed up 9 to 13 years later.”

Researchers in Holland published a study in the Journal of Physiology and Pharmacology focusing on laboratory mice bred to have reduced levels of vitamin A. After exposing the mice to cigarette smoke, it was discovered that they developed emphysema in a total of three months. The study could signify a potential correlation between cigarette smoke, reduced levels of vitamin A and the development of chronic lung diseases. Ultimately, this could signify the ability to reverse or cure lung damage caused by COPD.

Although various studies and evidence exists, scientists must still preform additional studies to determine if the intake of vitamin A can truly reduce COPD symptoms and its progression.

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People with Severe Emphysema May Breathe Better after EBV Therapy, Study Shows

A trial published in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine reveals that a minimally invasive procedure may help patients with severe emphysema breathe better.

The study analyzes the use of a one-way valve that prevents air from entering diseased regions of the lung. This, in turn, enhances lung function and enables healthier areas of the lungs to expand.

Previous studies highlighting the placement of the valves using a bronchoscope found that this therapy can be used as an alternative to lung volume reduction surgery. Patients with severe emphysema that participate in endobronchial valve (EBV) therapy “appear to experience similar improvements in lung function, shortness of breath, exercise intolerance and quality of life,” yet do not experience the occurrences of morbidity and mortality which have been associated with surgery.

"EBVs have been shown to work in single center trials, but these studies tend to be performed at centers, and by physicians, with considerable experience, so the results may not be generalizable to other centers," said lead study author Samuel V. Kemp, MD, a respiratory physician and expert in interventional bronchoscopy at Royal Brompton Hospital. "What is interesting about this multicenter trial is that the results are at least as good as the single center studies, even though some of the investigators were new to the technique."

All study participants were ex-smokers over the age of 40 and had been diagnosed with severe heterogeneous emphysema. Out of the 97 participants, sixty-five received the valves and the remaining patients were provided with standard of care specific to each medical center's protocols for a patient that had received bronchoscopy.

Researchers discovered:

• After three months, 55.4 percent of the EBV group had a 12 percent improvement in FEV1, the amount of air that can be forcefully exhaled in one second, compared to 6.5 percent of controls.
• After six months, the percentage of those in the EBV group meeting the minimum FEV1 improvement was 56.3 percent, compared to 3.2 percent of controls.
• The average increase in FEV1 in the EBV group was nearly 30 percent.
• After six months, secondary endpoints among those in the EBV group were also clinically and statistically significant, including being able to walk nearly 80 meters longer in six minutes, retaining 750 fewer milliliters of air upon maximum expiratory effort, exhibiting less shortness of breath and reporting higher quality of life.
• The most common adverse event in the EBV group was a collapsed lung, which occurred in 29.2 percent of the patients.

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Bariatric Surgery in Obese COPD Patients Lowers Risk of Hospitalization, Study Finds

According to a recent study in the journal Chest, titled, “Reduced Risk of Acute Exacerbation of COPD After Bariatric Surgery: A Self-Controlled Case Series Study,” the risk of hospitalizations and emergency room (ER) visits caused by acute exacerbations related to chronic obstructive pulmonary disease (COPD) decreases among obese patients who underwent bariatric surgery.

Nearly 6 percent of adults in the United States have COPD, 35 percent of whom are considered obese. According to studies, obesity may be a risk factor as it results in higher rates of acute exacerbations.

Researchers found that patients with COPD who lost weight realized enhanced outcomes, such as clinical scores and exercise tolerance. Yet, there are few statistics available regarding the impact weight reduction can have on additional issues associated with COPD, including acute exacerbations.

The study, conducted by researchers at Massachusetts General Hospital, analyzed 481 obese patients who were diagnosed with COPD and had undergone bariatric surgery between the years 2005 and 2011. The analysis studied each patient’s risk of acute exacerbations in COPD (AECOPD) that resulted in ER visits and hospitalizations over a two-year period, which was “compared to the patient’s risk in the pre-surgery period.”

It was discovered that 28 percent of obese COPD patients were hospitalized or visited the ER due to AECOPD 13 to 24 months before their bariatric surgery. However, within 12 months of post-bariatric surgery, only 12 percent of patients were at risk of being hospitalized or visiting the ER.

Although the “mechanism behind weight loss and a decreased risk of AECOPD” has yet to be discovered, researchers suggest that weight loss may reverse the correlation between obesity and COPD. Lung function can be impaired due to obesity as it can alter gut bacteria and lung operations, create systemic inflammation caused by proinflammatory mediators, and increase the risk of infections and additional conditions.

It has been concluded that bariatric surgery among obese COPD patients can “reduce proinflammatory levels and decrease the incidence of obesity-related health problems”, and ultimately lower the risk of AECOPD, hospitalizations and ER visits.

Click Here to Access the Full Article on COPD News Today

Tips for Avoiding Pneumonia and Other Exacerbations When You Have COPD

Various complications can arise when an individual has chronic obstructive pulmonary disease (COPD), including increased susceptibility to lung infections such as pneumonia.

Defining Pneumonia

Pneumonia is the eighth leading cause of death in the United States and most common among individuals over the age of 65, smokers, young children and those with lung conditions including COPD. The infection can present in one or both lungs and often results from the prevalence of bacteria or viruses. Although rare, the infection can develop when certain fungi are directly touched or breathed in. Further, pneumonia can occur as a result of another illness “such as flu, measles, pneumococcus, whooping cough and Haemophilus influenzae type b (Hib).”

Pneumonia Symptoms

It is vital to contact your healthcare team if you are experiencing the following symptoms, as signs of pneumonia “can often be mistaken for a COPD exacerbation.”

• Fever or shaking chills
• Rapid breathing or shortness of breath more severe than usual
• Excess coughing producing lots of mucus
• Change in color of mucus
• Increased heart rate
• Pain in a specific area or areas of the chest when breathing deeply
• Nausea or vomiting
• Diarrhea

Although it remains essential to recognize the signs of pneumonia and other exacerbations and receive timely care, the COPD Foundation recommends taking preventative steps to reduce the risk of infections.

These include attending regular appointments with your healthcare team, washing your hands, quitting smoking and receiving annual flu and pneumonia vaccinations. Additional preventative steps individuals can take are refraining from touching their eyes, nose and mouth, avoiding large crowds throughout flu and cold season, eating a balanced diet and carrying writing implements instead of using another individual’s.

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COPD Self-Care Appears to Improve with Social Support

According to the recent study, “Association between Social Support and Self-Care Behaviors in Adults with Chronic Pulmonary Disease,” published in the Annals of the American Thoracic Society, individuals with COPD who live with others and have a caregiver have a higher rate of participating in pulmonary rehabilitation and being active.

The study focused on 282 patients with COPD to determine if the prevalence of social support impacts the decision to participate in healthy behaviors.

"Patient engagement in self-care is the crux of COPD management," said senior study author Huong Q. Nguyen, PhD, RN, a research scientist at Kaiser Permanente Southern California and an affiliate associate professor at the University of Washington. "Our goal with this study was to identify factors associated with self-care activities, including physical activity, quitting smoking, participating in a pulmonary rehabilitation program, adherence to medications, and getting influenza and pneumococcal vaccinations."

Researchers recruited participants from two Veterans Administration hospitals, as well as two academic medical center who had been diagnosed with moderate to severe COPD. The study focused on the correlation between healthy behaviors and two social supports: “structural, the type of social network a person has such as being married or living with a partner or caregiver, and functional, the support a person perceives his/her social network provides.”

Based upon the findings, researchers discovered that participants who lived with other individuals reported having enhanced functional support. The higher their functional support was, the higher likelihood that they had a pneumococcal vaccination and were less inclined to smoke. Further, participants that lived with someone took more than 900 steps more than those who lived alone. Participants with a spouse, partner or caregiver were also 11 times more likely to receive pulmonary rehabilitation.

“Clinicians should assess whether their patients have the necessary social support to do all they can do to remain healthy, “said Nguyen. “When social support is lacking, the health care team should assist patients in marshalling social support. Similarly, health and social policies should acknowledge and consider ways to support the nearly 45 million unpaid family caregivers in the United States who are responsible for the vast majority of the day-to-day care of their loved ones."

Click Here to Access the Full Article on ScienceDaily

Stem Cells Offer New Solutions for Lung Disease

As the fourth leading cause of death, projected to be the third by 2020, chronic obstructive pulmonary disease (COPD) is a major and growing health concern. In fact, COPD impacts more than 5% of the population in most countries, with a $600 billion financial toll. The disease causesexaggerated chronic inflammatory response leading to airway irregularities. As lung function declines, patients will begin to experiencesymptoms of the disease progression such as increase of cough, shortness of breath and mucus production. Additional indicators of COPD include extra-pulmonary complications including cardiovascular disease and depression.

There is no current cure for the disease, yet recent studies suggest that adult stem cells may have the ability to reverse the effects of diseases involving inflammatory or degenerative parts, like COPD. The primary function of adult stem cells is to heal and maintain the health of the tissues they are found in. Existing throughout the body, stem cells can renew themselves through cell division, as well as differentiate into specialized cell types. They can also be harvested from an individual’s own tissues, with the most plentiful source found in adipose (fat) tissue. “In fact, approximately 500 times more stem cells can be obtained from fat than bone marrow.”

Stromal vascular fraction (SVF), a mixed population of cells containing most cellular elements of fat, can be isolated and obtained from fat tissue in 30-90 minutes in an out-patient clinic setting. This process can be completed using a mini-lipoaspirate technique, in which “tens to hundreds of millions of adipose-derived stem cells (ADSCs) can be obtained.” After the procedure and preparation of ADSC, patients can be provided with either an infusion or injection.

After having been exposed to stem cell therapy, many COPD patients are often willing “to receive additional cell infusions if possible, due to a feeling of well-being associated with the injection.” Previous studies have also shown that intravenous infusion of these cultured adipose stem cells can significantly improve smoke exposure-induced emphysema onset and progression.

Utilizing stem cells for regenerative purposes shows limitless potential. Patients now have access to innovate treatments that are compliant, effective and, importantly, safe. The research group involved with the studies have successfully and safely treated more than 7,000 patients. Stem cell treatments have increasing potential to become the optimal form of care concerning most degenerative diseases to truly enhance outcomes and quality of life for millions of individuals around the globe.

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How Can Pharmacists Improve Flu Vaccination Rates in Patients with COPD?

Although individuals living with chronic obstructive pulmonary disease (COPD) have a significantly higher risk of morbidity and mortality if they acquire influenza, most do not receive the annual influenza vaccination. To improve vaccination rates among this group, pharmacists must prioritize the promotion of the flu vaccination by maintaining an awareness of the characteristics present in those who generally do not receive vaccinations. 

Despite best attempts of Healthy People 2010 to achieve a 60% coverage rate for high-risk adults, less than 40% of individuals with COPD were vaccinated. Although Healthy People 2020’s goal has increased to 90% coverage, “vaccination rates among these patients rarely exceed 50%.” Concerning is the fact that unvaccinated patients with COPD have substantially higher risks of experiencing “exacerbations, greater pulmonary function impairment, reduced quality of life, and economic burden if they develop the flu.”

Researchers from the University of New Mexico have recently published a study, which appeared in the journal titled, “Research in Social and Administrative Pharmacy.” The study analyzed COPD patients who responded to the 2012 Behavioral Risk Factor Surveillance System in order to determine influenza vaccination rates. This data was then used “to identify predisposing, enabling, and need factors that influence the decision to be vaccinated.”

The findings revealed that 53% of respondents had been vaccinated. Data also suggested that the older the individual, the more likely they were to have been vaccinated. Patients who were never married had a significantly lower likelihood of being vaccinated in comparison to those who were married, divorced, widowed or separated. Additionally, participants who were current smokers or who had not seen a healthcare provider for a checkup in a year or more were also less likely to be vaccinated.

It was also discovered that unemployed individuals, as well as those who received care from a primary physician or were insured also had a higher likelihood of vaccination. Increased rates were associated with the prevalence “of a pharmacist immunizer on the staff of centers that serve the medically underserved.”

Although certain individuals may be less likely to receive the flu vaccination, sometimes a simple encouragement can make all the difference. Pharmacists can make an impact by screening for patients with COPD, determining which factors they may have that are associated poor vaccination rates, and providing encouragement to patients who are less likely to receive the vaccination.

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9 Tips to Lower Your Risk of Lung Disease

Second only to heart disease, lung disease remains one of the leading causes of death in the United States. Although various lung diseases stem from genetics, many of them can be avoided by adhering to a “healthy lifestyle and avoiding lung irritants.” Adhere to the following tips to lower your risk of developing a lung disease.

Choose a Healthy Diet and Consider Vaccines
Healthy foods might not heal lung damage, but a balanced diet will enhance your overall health and wellbeing and help to lower the risk of lung disease. It may also be helpful to receive an annual flue or pneumonia vaccination, particularly “if you have compromised health”.

Stop Smoking
The most effective way to prevent lung disease is to quit smoking. Although this might present challenges to heavy smokers, it is a feasible goal that will improve your overall health. In addition to cigarette smoke, marijuana, pipe and cigar smoke are also harmful. Avoiding secondhand smoke and smoky atmospheres is also equally as important.

Test for Radon
Radon, a radioactive gas, can exist in “homes and public buildings, particularly in small areas and in basements.” Invest in a radon testing kit, which can be purchased from your local hardware store. If positive results for radon are found, it is essential to ensure the building is appropriately ventilated and all cracks where the gas could flow through are sealed.

Avoid Asbestos
Being exposed to asbestos can have serious ramification on your lung health. Those working in certain construction-related industries can have a higher risk of being exposed and should regularly receive health and safety training. It is also vital to have your home inspected for asbestos as “asbestos is still contained in many public and private buildings”.

Stay Away from Dust and Chemical Fumes
Common household spray cans, such as hair spray, air fresheners and house paints, “can irritate lungs so use them sparingly in well-ventilated areas.” Also avoid dust inhalation by wearing a face mask.

Receive a Spirometry Test
In the case that you might feel your lungs may be compromised or you have “an increased risk of developing a lung disease due to your work history or lifestyle choices,” schedule an annual spirometry test. This can help to detect potential problems before they cause serious damage.

Contact Your Physician
Chronic cough that persists after several weeks could signify a medical issue with your lungs. It is vital that you schedule an appointment with your doctor to determine the cause. Additionally, it is essential to contact a medical provider if you are experiencing shortness of breath or chest pains.

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