• Flu shots. More on this next month, but we did want to remind you to make an appointment with your physicians NOW. The shortage won't be as bad as last year though supplies may still be late if the office didn't order early enough. Check on the status of supplies so that you can be sure of being protected during the flu season.
  • Results from an ongoing clinical trial conducted by Medicare and the National Heart Lung and Blood Institute at the National Institutes of Health indicate that a subgroup of patients with very severe emphysema who undergo a surgical treatment called Lung Volume Reduction Surgery (LVRS), are four times more likely to die than patients receiving medical therapy only. The results are so alarming, that federal officials monitoring the clinical trial have stopped allowing certain patients with very severe emphysema to take part in the trial.
  • "These study results mean that patients and providers should be cautious in evaluating the risks and benefits of LVRS in patients with severe emphysema," says ATS President Adam Wanner, MD. LVRS is a procedure whereby chest surgeons remove emphysematous lung tissue. The rationale for the procedure is that removal of emphysematous lung tissue would reduce the volume of the over-inflated lung, thereby increasing its elasticity and improving the patients' ability to breathe.
  • However, early results from the clinical trial have shown high mortality rates for some patients with very severe emphysema. Dr. Wanner comments, "The early data generated by the clinical trial indicates that LVRS may be a dangerous procedure for patients with severe emphysema. I appreciate the decision of the Medicare and the National Health Lung and Blood Institute to release the study results early. The study results show just how valuable joint clinical trials sponsored by Medicare and the National Institutes of Health can be." It is worth noting that the preliminary results of this trial (and of other studies of lung volume reduction surgery) have been encouraging. It seems likely that the procedure will eventually be shown to be of some benefit to selected patients with emphysema.
  • Helen writes from Walnut Creek, CA "Dr. Petty's letter always says "Check your lungs, Know your numbers." Is this in reference to spirometry tests and FEV1 or something else?"
  • Good question. Yes, Dr Petty is referring to your FEV1 which is measured during your spirometry or pulmonary function tests. What is your FEV1 ? Literally, it is the volume of air that you can force out of your lungs in one second after having inhaled maximally. In other words, as much as you can.
  • We measure FEV1 during the time you are asked to "blow out as hard as you can". The individual without lung disease will be able to blow out 80% or more of the air in the lungs in one second. An FEV1 below 80% of predicted is considered abnormal.
  • If you have pulmonary disease you may only be able to blow out 40% or 30% or even only 20% in one second. That would mean that your FEV1 is 40% or 30% or 20% of predicted. Why do we prefer a percent rather than actual numbers? It is because a man who is 6 feet 5 inches tall will have bigger lungs, and therefore more milliliters, than a lady who may only be 5 feet tall. So, while your doctor wants to know your FEV1 in milliliters, for more practical purposes the percentage may be more informative to you.
  • And speaking of practical, what does all this mean? The FEV1 is a very important measure of your lung health and also seems to be a measure in other areas of health. When your FEV1 (as a percent of predicted) decreases it shows that your lungs are aging faster than you are. Not so good. It may take you an additional three, or four or even five seconds to get all of the air out of your lungs, depending on what the decreased percentage of your lungs may be may be. This is why it is so important to concentrate on breathing out when you have COPD and why we tell you to do so at least 2 or 3 times as long as you breathe in. If you don't get that old air out, there is no room for the new, oxygen rich air to get in. That is why, if you breathe in and out too rapidly, you get short of breath rather than feeling more comfortable.
  • Why does it take you longer to get air out of your lungs when you have COPD? It is because of a loss of elasticity causes air trapping to take place. Instead of having air rush out easily, the way it would from a full balloon, it sits there and needs to be pushed out of the lungs, the way you need to flatten a bag to get all of the air out of it.
  • When you go to the doctor does he or she let you know what your blood pressure is? Does your physician tell you what your cholesterol level is? Of course! It is just as important to have a measure of your lung function known to you. To scare you? Of course not. Rather, to encourage you to do something about it. As an example, if your blood pressure is 160/96 would you ignore it? NO! You would probably be counseled to go on a low sodium diet and lose weight, if appropriate. You would be told to start an exercise program and then use medications, if necessary, to lower your blood pressure and prevent further problems with your health.
  • What do you do if your FEV1 is low? It depends on the numbers, of course. Most people aren't even aware that they have a problem until they get below 40% or 50% of predicted.
  • Some of the things to do at that stage would be to consider getting into a pulmonary rehab program, to start an exercise program, to use the medications (inhalers especially), recommended by your physician, and, most important of all, stop smoking! You would do all you can to protect you lungs from further damage. That includes pneumonia and flu shots. So make that appointment today for your flu shot and to discuss with your physician what else you can do to help your respiratory condition.