PERF, The Pulmonary Education and Research Foundation, is a small but vigorous non-profit foundation.  We are dedicated to providing help for those with chronic respiratory disease through education, research, and information.  We hope this newsletter is worthy of our efforts.

Do you sometimes wonder if there is enough interest in pulmonary rehabilitation and in helping those with pulmonary disease?  If so, being at the April 5th-6th annual conference of  CSPR, the California Society for Pulmonary Rehabilitation would have lifted your spirits.  About 130 health care professionals gathered at Long Beach Memorial Hospital to exchange ideas, look at new products, and listen to cutting edge lectures designed to help them understand and better se\rve their patients.

     Kicking off the conference was internationally known Dr. Andy Ries giving an Update on the NETT.  As you may recall, NETT stands for the National Emphysema Treatment Trial which is studying the effects of pulmonary rehab and surgery for emphysema vs. only pulmonary rehabilitation.  In January, we published an article by Dr. Reis about the study, to which you can refer.  The results so far highlight the effectiveness of pulmonary rehabilitation as practiced widely in the medical community, not just at selected clinical and/or research sites.  It is believed that rehabilitation is also an important adjunct to a surgical program like lung volume reduction surgery and plays an important role in assisting with patient selection as well as in helping patients prepare for, and recover from surgery.  Enrollment for the study ends at the end of this May so if you want to take advantage of this opportunity, act today!  It will be March of next year before the first paper about the results will be published, which is record time for such a study.

     Patrick Dunnne, Med, RRT, MPH gave a lecture on New Advances in Aerosol Therapeutics, the science that allows delivery of drugs by inhalation.  This lecture was so packed with technical information that we can’t begin to summarize it.  We plan to have an article written by Patrick, specific for our readers, on this important topic in the near future.

     Dr. Kenneth Landis spoke on “Update on Foregoing Treatment”, in other words, the bioethics of end of life treatment.  You may not realize how much attitudes have changed and improved over the last 10 years, though we still have away to go.  Dr. Landis discussed some of the landmark cases that have helped clarify ethical and legal issues surrounding this subject of concern to all of us.  He told us also that the Advanced Health Care Directive replaces the Durable Power of Attorney for Health Care here in California.  Your existing Durable Power remains legal in California.  However, it is wise for everyone in all states to check the legal status of their Living Wills, or other such documents, to make sure they will be honored.  Laws vary from state to state.  All of us wish to have some say in our own care and having one of these documents is the way to do it.  Perhaps in the future we can have Dr. Landis write a longer article just for us but, in the meantime, there is good news for the future.  California again leads the way.  By the year 2006, in order to get a license renewal, a physician must have taken a 12-hour course in pain management and end of life care of the patient.  This requirement is long over due and we hope to see other states emulate it.

     Jim Barnett, RRT gave a very well received talk on “Planting the Seeds of a Successful Support Group” which stimulated a lot of questions and discussion with the audience.  He showed some great slides of his group on cruises and on his many trips to Laughlin where upper extremity exercises were practiced on the slot machines.  Unfortunately, none of these hour-long talks were recorded.  We can’t reproduce the slides that Jim showed of his active support group, but, should you wish detailed information on starting or improving your own support group, we do have a suggestion.  Mary Burns has written several chapters on this subject.  The medical librarian at your local hospital should be able to get the following references for you. 

• Burns M. Continuing Care Programs. In: Casaburi R, Petty TL; eds. Principles and Practices of Pulmonary Rehabilitation.  Philadelphia: Saunders, 1993;pp 398-404.)

• Burns M. Social and recreational support of the pulmonary patient. In: Hodgkin J, Connors G, eds. Pulmonary Rehabilitation: Guidelines to Success, 3^rd ed. Philadelphia: JB Lippincott, 2000

• For further information you can also call Jim at (877) 280-2777 or Mary at (310) 539-8390.  Support groups are very important!

     Margareta Emtner, PT, Ph.D. told us about “Supplemental Oxygen in Rehabilitative Exercise Training in Non-hypoxemic COPD Patients”.  What does that mean?  In lay terms, this study found out what happens when patients whose lowest saturations with exercise are above 88% participate in an exercise-training program while receiving supplemental oxygen.  In theory, these people don’t “need” oxygen.  This is a study that was recently completed and the data is still being worked on.

Margareta, who did this research at Harbor-UCLA as a Fulbright Scholar last year, will present the completed data at the European Respiratory Society annual meeting in Stockholm next September.  We’ll give you more of the details then, but in the meantime, it may not surprise you to learn that yes, oxygen does help COPD patients exercise harder and longer even though they don’t “need” oxygen.  Interestingly enough, a previous study showed that people without COPD don’t improve their exercise ability with oxygen, in spite of what those football players may think!

What does this mean for you?  Maybe in the future rehab programs will start their patients exercising the first few weeks of rehab with oxygen, even if they don’t “need” it, to give them a jump-start, making it easier to achieve a routine of exercise.  Stay posted and we’ll give you more information on this interesting subject later.

     Dr. Rich Casaburi gave a companion lecture to Margareta’s titled “The Scientific Foundations of Long Term Oxygen Therapy” in which he gave a wonderful lecture on the physiological effects of oxygen, what determines an exercise training response in COPD, and how oxygen supplementation affects this.  Rich made the point that oxygen is a miraculous “drug”, providing a number of beneficial effects.  He discussed in detail the benefits of high intensity exercise, and how oxygen supplementation would be expected to allow higher exercise intensity.

     Janos Porszasz, MD, Ph.D., our web master, spoke on Clinical Exercise Testing.  Using case studies as examples, he explained how the heart and lung often interact to cause shortness of breath, low oxygen levels, abnormal blood pressure and various cardiac responses.  Knowing all of these interactions can help the pulmonologist to better evaluate a patient's shortness of breath.

Christopher Cooper, MD and Tom Storer, Ph.D. gave companion talks about exercising patients with COPD.  Dr. Storer focused on strength training, which is just beginning to be stressed in rehab programs.  It is important to start out slowly and very gradually to build up endurance and strength.  While he did not discuss it in his lecture, Dr. Storer has developed a very successful exercise maintenance program for pulmonary patients at El Camino Community College, in Torrance, CA.  If you would like more information on how to get such a program started at your community college, or would like to discuss this further with Dr. Storer, he can be reached at (310) 660-3667 or by e-mail at tstorer@elcamino.cc.ca.us.

• Or, if you would like to read their lectures in full, ask the medical librarian at your hospital for the supplement to Medicine & Science in Sports and Exercise, Volume 33, number 7, July 2001.
  To access these articles on-line, click on the links below:
  C.B.Cooper Exercise in Chronic Pulmonary Disease: Aerobic Exercise Prescription
  T.W.Storer Exercise in Chronic Pulmonary Disease: Resistance Exercise Prescription

     Dr. Paul Selecky gave his usual informative speech on “Sleep in Patients with Lung Disease” that had everyone doubled over laughing.  A talk by Dr. Selecky is best of all worlds when you are approaching the end of 2 days crammed full of information!  We feel that this is such an important topic that we have asked Dr. Selecky to write an article on this subject for a future Second Wind rather than just give you the brief synopsis space would allow today.  It is worth mentioning that, later that same day, Dr. Selecky was presented an award as Man-of-the-Year by the American Lung Association of Orange County.  Congratulations, Dr. Selecky!  That is a well-deserved award!

     This CSPR Conference was a smashing success!  Plans are already underway for a repeat performance next April in Sacramento.  While several states outside of California were represented at Long Beach, it is hoped to make this a truly regional conference, specific to pulmonary rehabilitation, next year.

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