Importance of Pulmonary Rehabilitation

If your doctor has prescribed pulmonary rehabilitation as part of your COPD treatment plan, don't be surprised. First theorized about nearly 60 years ago, pulmonary rehabilitation is becoming part of the gold standard of treatment for people suffering from COPD.

By way of a multidisciplinary team, pulmonary rehabilitation covers all aspects of COPD management including education, exercise and relaxation and breathing techniques. It also includes nutritional advice, emotional support and coping skills.

By combining these treatments and techniques, pulmonary rehabilitation allows COPD patients to:

• Lead a more active life
• Reduce symptoms
• Improve quality of life
• Be an active participation in treatment
• Limit visits to the doctor’s office and hospital

Consider this: After you are diagnosed with COPD, you may be worried or experience loneliness and lack the motivation and self-esteem you once had. While these feelings are completely normal, a pulmonary rehabilitation team would be able to refer you to counseling services, teach you relaxation techniques and allow you to share your feelings in a safe environment.

Pulmonary rehabilitation is generally supervised and structured and can be completed both in and out of the hospital setting. Typically rehabilitation includes an evaluation of your symptoms and treatment, short-term and long-term goal setting, education, support, and supervised therapy programs.

Though pulmonary rehabilitation will not reverse the damage to your lungs from COPD, it will help you cope with the symptoms and complete daily tasks, such as dressing, shopping and walking, more easily.

Coping With COPD: Taking Care of Your Emotional Health

With your diagnosis of chronic obstructive pulmonary disease (COPD), your life has likely altered. Adjusting to this new way of life is a process and will not happen overnight. Your symptoms, changes in energy, and concern for the future might cause you and your loved ones to feel angry, depressed or worried— this is normal.

An important aspect of living and coping with COPD is learning how to deal with the emotions that come along with the disease. You may have been active all of your life, and now you may not do the things you once enjoyed. You most likely feel slowed down and incapable of spontaneity since toting around oxygen and living with sleep problems and fatigue make it difficult to just pick up and go. Many people may find limitations in doing the things that once filled their lives, like traveling, dancing and gardening.

These are all important losses that may be felt.. It is normal to feel angry, afraid, sad, depressed, guilty, stressed and frustrated with all of the changes your life has seen. However, it is critical that you allow yourself to feel these things, even when it is uncomfortable. This not only benefits your emotional health but also your physical health, as people with COPD who also suffer from depression and/or anxiety are at a higher risk for COPD exacerbations.

The following tips can help you deal with some of these emotions:

• Get dressed every day.
• Go out and walk whenever possible.
• Keep up with activities or hobbies you enjoy.
• Stay involved with others, and involve your friends and family in your healthcare appointments.
• Share your feelings with your spouse, a friend or a clergy member.
• Get a good night’s sleep.
• Follow your treatment plan.
• Set and follow a realistic daily schedule.
• Join a support group for people with your condition.

As you begin to take charge of your health and make positive changes, you might find that the negative feelings start to fade. However, if negative feelings continue to interfere with your ability to enjoy life, consult with your healthcare provider. Joining a support group or seeking professional counseling may help you feel better. But remember to be patient with yourself as you learn about coping with your emotions. Change does not occur overnight.

(Information in this article was compiled from sources including the Cleveland Clinic and various CPOD support groups.)

COPD Patients May Be Over-Treated With Steroids

Bigger is not always better when it comes to the treatment of chronic obstructive pulmonary disease (COPD). That is according to a new study published in The Journal of the American Medical Association, which found that more than 90% of acutely ill patients hospitalized for COPD receive high doses of steroids when lower-dose oral steroids may be just as effective.

Considered a beneficial way to treat acute exacerbations of COPD, the proper administration of steroids is still not fully understood by many healthcare providers. And though most clinical guidelines recommend treatment with 20-60 mg of an oral steroid daily, dosage and administration varies between hospitals.

“In sharp contrast to the leading clinical guidelines, the vast majority of patients hospitalized for acute exacerbation of COPD were initially treated with high doses of corticosteroids administered intravenously,” conclude study researchers led by Dr. Peter K. Lindenauer of Baystate Medical Center in Springfield, Mass.

However, this practice is not associated with any measurable benefits. It also exposes patients to the risks and inconvenience of an intravenous line, potentially unnecessarily high doses of steroids, greater hospital costs and longer lengths of stay.

The study looked at the use of steroids among COPD patients hospitalized at more than 400 hospitals during 2006 and 2007. Findings include 92% of patients being treated with high-dose IV steroids, with 1.4% of those patients dying during hospitalization. Comparatively, only 1% of patients receiving oral steroids died. Patients treated with oral steroids also had shorter hospital stays and fewer costs associated with treatment, compared to patients who received IV steroids.

“IV steroids have no benefit over the less-expensive oral steroids in terms of hospital stays and mortality,” says Dr. Neil Schachter, a professor of pulmonary medicine and medical director of the respiratory care department at Mount Sinai Center in New York City. “[And] while I don’t think that this study will immediately change how doctors treat exacerbations, it certainly puts the spotlight on the need to refine criteria for IV steroid therapy.”

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Wireless Monitoring Offers More Accurate Assessment of COPD

The use of wireless monitors enables healthcare professionals to observe patients suffering from debilitating conditions such as chronic obstructive pulmonary disease (COPD) under normal living conditions, providing a more accurate assessment of patient health. That is according to a report in the International Journal of Biomedical Engineering and Technology.

The assessment of debilitating diseases under normal living conditions has become increasingly important in improving treatment by allowing healthcare professionals to follow the progression of the condition. This, in turn, can keep costs down by avoiding unnecessary medical costs and hospital visits.

For their assessment, researchers from Kalasalingam University in India created a real-time monitoring system with vital signs sensors, a sensor network, electronic patient records and web portable technology that calls on medical personnel when life-threatening events occur. This system was said to be effective for “ambulatory investigation,” offering data collection and knowledge discovery capabilities not previously available outside a hospital or clinic.

Through recent advances in sensor technology the team created miniature movement, temperature, blood pressure and heart rate sensors to monitor various signals. These signals send out data, which can then be processed and integrated with the wireless network. The sensors were programmed to send out alert signals above a certain unhealthy body temperature, below a specific heart rate, or blood pressure changes of more than 10%.

The system works in conjunction with standard wireless networking technology with a 750-meter range. It hooks into a previously available web-based information portal to provide an effective emergency response information system to support the need for multiple parties to share information about the patients’ status and location.

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Long-Term use of Vitamin E May Prevent COPD in Women

Regular long-term use of vitamin E may protect women against chronic lung disease, according to a recent study out of Cornell University and Brigham and Women’s Hospital in Boston.

The findings, presented at the American Thoracic Society (ATS) 2010 International Conference, suggest that the use of vitamin E supplements reduces the incidence of chronic lung disease, such as emphysema and chronic bronchitis, by 10%. This would make it the first definitive findings on the effect of vitamin E in the prevention of lung diseases.

The study randomized 39,876 female patients without chronic lung disease to receive vitamin E or a placebo for approximately 10 years. All other health and lifestyle characteristics were balanced between groups to ensure that any effects were, in fact, a result of vitamin E.

The difference in diagnoses was significant after cigarette smoking, aspirin assignment, randomization age, multivitamin use, body mass index, preexisting asthma, diabetes, hypercholesterolemia, hypertension, inflammatory disease and dietary intake of vitamin C or non-study-assigned vitamin E were taken into account.

Researchers believe that the positive outcome is due to the contributing role the oxidant/antioxidant balance in lung tissues play in the risk of COPD. Previous observational studies have shown that higher antioxidant status is associated with a lower risk for COPD, but those studies were conducted only in men and only looked at a reduction in symptoms.

Anne Hermetet Agler, a doctoral candidate at Cornell's Division of Nutritional Sciences, presented the findings at the ATS. She explained that as lung disease develops, tissue damage occurs through several processes, including inflammation and exposure to free radicals. Vitamin E may protect the lung against this kind of damage.

Researchers are not yet ready to recommend the widespread adoption of vitamin E for the prevention of chronic lung disease on the basis of these findings alone, since very high doses of vitamin E have been associated with congestive heart failure and increased mortality in other studies.

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Use of Antibiotics Best for COPD Flare-Ups

Patients hospitalized due to chronic obstructive pulmonary disease (COPD) may do better receiving antibiotics without delay, according to a new study published in the Journal of the American Medical Association. Researchers found that patients who were given antibiotics early in their stay were less likely to require mechanical ventilation and less likely to be readmitted to the hospital.

These findings may have implications for routine treatment, which currently utilizes antibiotics only for CPOD patients who have an increase in sputum or purulent (pus-bearing) sputum. They do not mean that all patients will benefit from antibiotics, however, as only about half of COPD exacerbations are thought to be caused by infection.

Researchers are unsure as to which half of COPD patients will benefit from this treatment—those with exacerbations caused by infection, or those without.

According to researchers, exacerbations of COPD are responsible for more than 600,000 hospitalizations each year and result in direct costs of more than $20 billion. The research team studied the outcomes of almost 85,000 patients hospitalized in more than 400 U.S. hospitals over a period of almost two years.

Although 79% of patients received antibiotics for at least two days, the timing of treatment was critical to their outcome. Researchers found that fewer patients whose antibiotic therapy started in the first two days after admission needed to be put on a mechanical ventilator than patients whose treatment started later. In addition, fewer patients who received early treatment saw fatal outcomes or treatment failures. They also saw a lower rate of hospital readmission for acute exacerbations of COPD.

Though further study is needed, researchers expect that all patients requiring hospitalization due to COPD exacerbations will benefit from early administration of antibiotics.

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