• Further News
  • The recommendations of the 6th Long-Term Oxygen Therapy Consensus Conference were published in Respiratory Care May 2006 Vol. 51 No 5. Your pulmonary rehab team may be interested in reading it. (Access to the articles is restricted, however AARC Members have free access to the full text of the articles).
  • The recent American Thoracic Society (ATS) position paper on pulmonary rehabilitation can now be read in English or Spanish on the ATS website, http://www.thoracic.org.
  • Essentials of Pulmonary Rehabilitation by Dr. Tom Petty, Dr. Brian Tiep and Mary Burns can now also be found on the ATS website. It first hit the Internet on our own PERF website www.perf2ndwind.org and has been widely copied since then. We are very pleased and honored!
  • Altidue and Oxygen
    More email questions of general interest
  • Altitude and oxygen I Live in Colorado Springs, more than 5,200 ft above sea level. I am on oxygen 24/7 at 2 liters per minute (lpm). If I spend 3 months near the coast in Southern California is it possible I might not need to wear oxygen this summer? Sure it's possible. But only your pulmonologist will be able to tell you for sure. First get the highest altitude at which you will be staying in California. Even the foothills are minor compared with anything near Colorado Springs, but your doctor will want that information. He may be able to give you a yes or no answer right away, depending on your condition and your blood gases, or he may want to do a HAST study. This is a simple High Altitude Simulation Test to see what your oxygen level is at a certain altitude. Usually it is done for patients going UP to the mountains but there is no reason why you wouldn't have one for the opposite reason. Medicare and private insurance should pay for it, but ask in advance.
  • If you get the okay for being without oxygen where you will be staying this summer, be sure you consider altitudes you encounter coming and going while in transit or during your visit. If the doctor decides that you just need oxygen while sleeping; it should be easy for you to arrange to have a concentrator delivered to where you are staying before you get there. If you have a national company your regular insurance should smoothly take care of expenses but ask! You don't want any surprises. Have a great vacation!

  • Did you know that 100 years ago the average age for American men was only 46 while for women it was only 48?

  • New information from ATS
  • Smoking is the stimulant that starts an inflammatory process in everyone who smokes. There is an almost 3 fold increase in the white blood cells in the lung tissues. This process is still not understood. It is suspected that there is some sort of cellular defense in those that do not develop COPD with smoking. However it is also believed that this inflammatory process causes many diseases other than COPD such as cancer of the lung, atherosclerosis and cardiovascular disease, among others. As you have read before, COPD is not just a disease of the lungs but also a systemic disease. A lowered FEV1 (the amount of air you can force out of your lungs in one second) is a strong predictor for all sources of mortality, not just a sign of pulmonary disease. In fact it is probably a better predictor of cardiovascular disease than of pulmonary disease. Co-morbidities are increased when COPD is present. That means there may be other systems besides the lungs damaged when we have COPD.
  • COPD is a syndrome rather than a single disease. When a patient has COPD, the whole patient should be treated and examined to make sure there are no other problems present. Physicians should have a patient-centered approach and treat the whole patient, not just the disease of COPD.
  • While the FEV1 is still a disease marker used to evaluate the severity of COPD, exercise capacity and distance walked in the 6-minute walk are probably more significant markers. Why is that good news? Because you CAN improve your exercise capacity! Physical activity is a behavior and behaviors can be learned. Do you have exertional dyspnea? Dyspnea can be controlled with pacing and breathing techniques. Remember that physical exertion is one of the keys to improving yourself!
  • An acute exacerbation in COPD is the equivalent of the MI (myocardial infarction) in cardiac disease. It is to be taken very seriously and prevented with all means possible. Everyone should learn the early warning signs of exacerbation such as increased fatigue, increased sputum and increased cough. We usually think exacerbations are infections, but 52% are non-bacterial and not responsive to antibiotics. Besides viral infections it is now thought other causes may be possible, such as an autoimmune component among others.
  • If hospitalization is required, it is essential that activity be started again as soon as possible. Some resistance exercises, at the very least, should be started while still in the hospital. Muscular atrophy is very serious and needs to be prevented as much as possible.
  • It is a myth that that there is no effective treatment for COPD other than smoking cessation. Pulmonary rehabilitation is being seen as the treatment of choice, in that it helps to prevent exacerbations and increase exercise tolerance. Dr. Barry Make also added that he never uses anti-depressants for his COPD patients. He said (and we agree) that pulmonary rehab is the most effective treatment for depression and far more effective than any medication.
  • And don't forget that other great new study we reported last month. It is worth repeating. We all know that pacing and breathing techniques learned in pulmonary rehab help to control shortness of breath and make exercising easier. Pursed lip breathing combined with slow respirations, and breathing out longer than breathing in are what you should aim for.
  • By slow we mean 16 breaths or less a minute. (Many patients average 12) Research now shows that even 20 breaths a minute can cause a marked increase in air trapping, which causes increased shortness of breath and feelings of suffocation.
  • We now have proof for what we have been telling you in rehab for many years. This is one time when you can't trust your instincts. When you feel most short of breath is when it is most important for you to slow your respiratory rate! Nice slow breaths, concentrating on breathing out two or three times longer than you breathe in, can relieve that sense of shortness of breath and prevent panic attacks. Many of you already know this. But if you don't, please give this a try. Pass the word on to all of your friends and let us know it this information has been of help. We really care.
  • Have a nice summer and stay well!