• News
  • National Respiratory Care week is from October 20-26.
  • November has been designated by President Bush as National COPD Awareness Month.
  • Very special thanks to Kevin and Judy Hettich, for their donation to the Chair in honor of Mary, who is very honored by this tribute.
  • Evelyn Gould made a donation to PERF in memory of Glenn Gould while Barbara Borak made one in memory of Dianna Reynolds.
  • Thanks to John Boynton for yet another donation for the Chair.
  • Thanks also for donations made to PERF by Freda Standeford, and Edith & James Winning.
  • European Respiratory Society Meeting in Stockholm
  • When Dr. Brian Tiep was asked about his impressions of the ERS conference he reported, "There was a lot of good information, discussion and cross-fertilization on subjects that I consider important. Examples include the early recognition of exacerbations and the use of specific antibiotics and steroids to bring rapid relief. Also, there is some interesting, and I think fruitful, work in the area of interstitial pulmonary fibrosis (IPF). They are now treating it as an active process rather than simply scar tissue. The benefit of that approach is that its inevitable progression may not be inevitable. Treatment protocols are going after an active process of inflammatory pathways. (The way I describe inflammation to my patients is a repair process gone awry, or an inappropriate repair process.) Also, lung biopsy may not be necessary in making the diagnosis of IPF. The HRCT scan and clinical history will be adequate in most cases. There is a greater understanding of oxygen deprivation and its impact on muscles. Cor Pulmonale may relate to the kidneys as much as the heart and lungs."
  • Thanks, Brian. We hope to hear more detail on some of these subjects in future newsletters. What was my favorite session at ERS? Without a doubt, it was the presentation by Margareta Emtner, PT, PhD on "Benefits of Supplemental Oxygen in Rehabilitative Exercise Training in Non-Hypoxemic COPD Patients". This was the study that Margareta did as a Fulbright Scholar in her 1-1/2 years at the Rehabilitation Clinical Trials Center at Harbor-UCLA. Translated into everyday English what does this mean? It means that unlike people without lung damage, patients with COPD benefit from using oxygen with exercise, even if they don't "need" it, according to Medicare standards in the United States. In other words, even with vigorous exercise, their oxygen saturations stayed above 88% without supplemental oxygen.
  • On this picture a crowd is viewing Margareta's poster, including Audhild Hjaimarsen, MD, Phd of Tromso, Norway and Mary Burns. This study showed that giving oxygen during exercise training enabled them to exercise more vigorously and improve faster than the patients who received room air as their "placebo". Does that mean that we think that all COPD patients should be on oxygen even if they don't seem to need it according to their tests? No, we do not. What we do speculate however, is that using oxygen in exercise training during rehab would give patients a jump-start. They would be able to exercise harder and also increase their exercise tolerance.
  • Some of you may have had the fun of participating in this study and should feel justifiably proud of your contribution to our knowledge treatment options in COPD. It received a great deal of international interest since many countries, including Sweden, do not give oxygen even to patients who desaturate with exercise. Learning that oxygen will benefit those who do not desaturate, created a stir and a rethinking of attitudes. Other studies will be done to validate her results. This was an important research project and we thank all of you who participated.
  • Other important thoughts we took away from ERS included remarks by Dr. Bart Celli, of Boston. A summary of his talk said, "COPD has been associated with a nihilistic attitude. Based on current evidence, this nihilistic attitude is totally unjustified. The disease has to be viewed under a new paradigm - one that accepts COPD not only as a pulmonary disease, but also one with important measurable systemic consequences. COPD is not only preventable but also treatable. Caregivers should familiarize themselves with the multiple complementary forms of treatment and individualize the therapy to each patient's particular situation. The future for patients with this disease in bright." And at another time he said, "The concept that COPD is a disease that progresses over time and for which there is little treatment is incorrect. COPD is a preventable and treatable disease - one where more research and the application of currently available and rational treatment can not only prolong the life of the patients afflicted with the disease but also improve the quality of their life."
  • "COPD is the one respiratory disease where multiple randomized trials have resulted in strong evidence of improvement in other outcomes. The administration of oxygen prolongs the survival of patients with hypoxemia and supplemental oxygen to patients with less degree of hypoxemia not only improves exercise endurance but also improves dyspnea and respiratory breathing pattern.
  • Pulmonary rehabilitation with exercise training has not only resulted in improvement in dyspnea, but also in quality of life, and utilization of health care resources. The evidence supporting pulmonary rehabilitation is so overwhelming, that it has become the gold standard against which new therapies such as pneumoplasty is being compared."
  • Other speakers echoed the sentiments of Dr. Celli. Pulmonary rehab is accepted as the standard of care around the world. There is new optimism about available treatments of COPD, as well as other treatments still in the research stage.
  • We have given you a lot of heavy-duty information in this newsletter. What we hope you have gotten out of it is a sense of the good news about increased interest in COPD and increased optimism of medical professionals around the world. There are exciting new medications about to come on the market in the United States (some are already being used in other countries) with others still in clinical trial stage. There are new advances in oxygen therapy that we should see within the year and, best of all, an acceptance of pulmonary rehabilitation as the gold standard in the care of COPD. Watch future issues of the Second Wind for more positive news. Until then, get your flu shots, and keep exercising!