• News In Pulmonary Rehabilitation
  • COPD is the 4th leading cause of death. More disturbing is the fact that there has been a 163% increase between 1965 and 1998 while every other major disease has shown a significant decline. In 2020, COPD is expected to be the 3rd leading cause of death in the US and in the world. More serious, the number of people with diagnosed COPD is thought to represent only one half to 1/4 of those who actually have this condition.
  • There is a misperception that only 15% of those who smoke get COPD. Smokers whose lungs are damaged by smoking lose lung function at 2 times the rate of those who do not smoke. Many of these people fall into the category of undiagnosed COPD.
  • One of the problems of COPD is the lack of recognition by the patient. Many people with COPD so severe that they get short of breath with talking still feel that they only have a mild case!
  • Undeniable symptoms of shortness of breath with activity often do not occur until lung function goes down to 40% of predicted. The problem is, people will stop the activity that makes them short of breath. When you ask them if they are short of breath with activity they say, "No.". But, they no longer are active! With these people, improving lung function doesn't help. You need rehab and exercise also.
  • Muscle abnormalities in COPD are not just due to inactivity. There definitely are skeletal muscle abnormalities in COPD. To lose weight and muscle mass is not a good prognostic sign.
  • We also need to separate smoking and COPD. Smoking is an epidemic, as is COPD, but they are different from each other. About 20% of people who die of COPD have never smoked. Even if we considered only this 20%, COPD would still be a huge health problem. Other non-smoking causes of COPD are Alpha-1 antitrypsin defect, frequent lung infections, and some forms of asthma. Babies born with a low birth weight are also born with smaller lungs and fewer alveoli. They statistically have a larger chance of getting COPD, but NOT of getting lung cancer.
  • There are multiple theories about the many possible causes of COPD. While we once thought that the lung has no capacity for repair, we now know that is not true. 5% of lung collagen turns over every day just like cells in the skin and bone. Excessive or abnormal repair leads to interstitial pulmonary fibrosis or emphysema. Possibly multiple cells are involved in repair. We do know that cigarette smoke alters cell response and prevents repair, as does starvation when food intake is down to 40% of what it should be. Starvation also makes emphysema worse.
  • The future will be to restore lung function and alleviate the suffering of our patients. Retinoic acid works in rats and grows alveoli in their lungs, but how to get it to work in people is the question now faced. The lung cells stimulated to grow in rats are not identical to the ones that are in people. And alveolar repair is different according to location in the lung. One technique now being researched is stem cell transplants from bone marrow cells to help make retinoic acid and other such drugs work better. There are lots of hurdles but they are amenable to the efforts of dedicated researchers!
  • The LVRS (Lung volume reduction surgery) study proved the value of pulmonary rehab. In the long run, this may have been more important than the value of LVRS.
  • COPD is a very exciting field because of the promise of what can be done to help our patients with this debilitating disease.

  • Are you a health care professional interested in a seminar on pulmonary rehabilitation?
  • Join us at the California Society for Pulmonary Rehabilitation (CSPR) annual meeting April 22-23 at the Long Beach Hilton, in Long Beach, California. You will hear internationally renowned physicians like our Dr. Rich Casaburi, but also meet physicians from Norway, Russia, Japan and Hungary, who will be joining us for an exchange of ideas. For fun mixed with science, don't miss Dr. Greg Mason's talk on "Pulmonary Pachyderm Mysteries, TB or not TB". Brian Whipp, PhD, DSc will educate us on "The Ventilatory Demands of Exercise in COPD". Get 12 CEU's, or CME's, enjoy all the fine lectures we have lined up for you during the day, and socialize with this friendly group in the evening. Be sure to tell the medical director of your rehab program about this bargain! At only $185 for members, or $260 for non-members (join CSPR for $55 and save money), it is the best educational bargain of the year. For more information, call Jim Barnett toll free at (877) 280-2777 or check the PERF website at http://www.perf2ndwind.org for the brochure.
  • Come network with a great group devoted to pulmonary rehab. Don't miss this meeting!

  • Do you have a question about respiratory disease that has been bothering you? If so, feel free to write and ask us, either through our web site or by mail. We answer all of your letters.