An example Diffusion Test. The patient inhales a single breath of air containing a measured amount of Carbon Monoxide (CO). The patient holds their breath for 10 seconds and then exhales. The exhalation is captured and the amount of CO remaining in it is measured. The difference has been absorbed into the patient's bloodstream. That amount is used to indicate the rate at which the CO was absorbed into the blood during the 10 seconds. The greater the amount absorbed, the better the lung condition. The rate can be compared to that expected in a normal lung for a person of similar build and expressed as a percentage - the higher the better. The test using CO gives a useful indication of the state of the alveoli and their ability to get oxygen into the blood.

An important part of physical lung function is the ability to inhale a quantity of air and then expel it - Spirometry measures amount you process and the rate of exhalation compared to what is normal for a person of your age, height and other factors.

The basic "standard" for evaluating the severity of COPD has primarily been Spirometry. However, functional dyspnea (difficult or painful breathing), body mass index (BMI), and  FEV1 from Spirometry, when evaluated collectively, offer better insight into outcomes such as survival.  Most times, the Spirometry test results are the only referenced statistics.

Here are some common acronyms met in pulmonary testing:

DLCO is Diffusion capacity of the Lung for carbon monoxide (CO).                                                                      FVC is Forced Vital Capacity - the volume of air which can be forcibly and maximally exhaled out of the lungs until no more can be expired. It is usually measured in litres                                                                                                     FEV1 is Forced Expiation Value after 1 second - the volume of air which can be forcibly exhaled from the lungs in the first second of a forced expiratory maneuver. It too is measured in litres.                                                        FEV1/FVC is Forced Expiration Value after 1 second as a Percentage of Forced Vital Capacity – indicates what percentage of the total FVC was expelled from the lungs during the first second of forced exhalation.

BREAKING NEWS NEW HOPE FOR TREATMENT OF SEVERE EMPHYSEMA Minimally Invasive Metal Implant Makes Its First Appearance At Berlin Congress. Forwarded by Dick/MO: A new type of implant for the treatment of severe emphysema, which can be placed using a simple, non-invasive procedure, has made its first appearance at the Annual Congress of the European Respiratory Society (ERS) in Berlin, to considerable acclaim. This device - though, to date, tested on only a handful of patients - could provide a viable alternative to the invasive treatments currently used, including lung volume reduction surgery and lung transplants. The new, revolutionary approach was presented to the Congress in three scientific communications that provided an assessment of the new device's feasibility and effectiveness. No surgery needed: This is the context in which the new device, presented to the ERS Congress by American and German teams, makes its promising debut. The implant, designed to restore or improve the patient's normal breathing mechanism, is made of super-elastic nitinol (a metal alloy). It aims to compress the lung tissue, restore its elasticity and reduce the excessive swelling of the emphysema-affected lung. Unlike the current invasive surgical procedures, placement of the implant is carried out using only a bronchoscope, a small, flexible tube inserted in the lungs through the mouth, without any need for surgery or incision. The end goal is the same as with the standard surgical treatment - to reduce lung volume - but without the need to excise areas of the lung, and without the mortality and morbidity risks that surgery involves. Furthermore, its effectiveness should not be undermined by air bypassing the treated area. The first triumph, as Herth and his colleagues told the Congress, was that the procedure was found to be safe, and was well tolerated by the patients, aged 61 on average, who were able to go home after three days. The study kept the patients in hospital for 72 hours so that their health could be comprehensively monitored. And the procedure proved highly effective, according to the figures announced in Berlin. Three-month follow-up showed, for all tests, an observed improvement in lung function, comfort and quality of life for the five patients. For example, in some patients FEV1 (forced expiratory volume in one second) rose by 18% and patients on average were able to walk an additional 38 metres in the traditional six-minute walking test. "This study is highly significant", the Congress was told by Armin Ernst of Beth Israel Deaconess Medical Center, Boston, who represented the American teams. "For the first time, a technology has been designed specifically to restore bronchiolar elasticity. In the future, this will help thousands of patients with emphysema." On the basis of the results presented in Berlin, other centres throughout Europe will now be able to undertake similar studies. http://www.medicalnewstoday.com/articles/124303.php

From Terry  10th October

Tiotropium (marketed as Spiriva HandiHaler)
Audience: Pulmonary care health professionals and patients

FDA informed healthcare professionals that FDA has reviewed preliminary data from UPLIFT (Understanding the Potential Long-Term Impacts on Function with Tiotropium), a large, 4-year, placebo controlled clinical trial with Spiriva HandiHaler in approximately 6000 patients with chronic obstructive pulmonary disease. The preliminary results reported by Boehringer Ingelheim to the FDA showed that there was no increased risk of stroke with tiotropium bromide compared to placebo. 

Two recent publications reported increased risk for mortality and/or cardiovascular events in patients who received tiotropium or inhaled anticholinergics. Both studies examined cardiovascular outcomes. 

FDA expects to receive the complete report for UPLIFT in November 2008.  Results from this trial will also help to address some issues raised about tiotropium in the two recent publications. Due to the amount of data collected in UPLIFT, a complete review of the results could take several months, at which time FDA will update this communication with the final results of the UPLIFT analysis, as well as all the available data regarding tiotropium and stroke risk. 

Read the complete MedWatch 2008 Safety summary, including a link both today's update and the original March 18th Early Communication, at:http://www.fda.gov/medwatch/safety/2008/safety08.htm#Tiotropium

From Pauline 10th october

NEW NATIONAL GUIDELINES ON EMERGENCY OXYGEN USE, UK The first national guideline for the emergency use of oxygen in adults has been published, with the aim of simplifying oxygen delivery and better protecting acutely ill patients. The guideline is published in the October
2008 issue of Thorax, the journal of the British Thoracic Society.
Until now, most healthcare professionals have followed their own institution's customary practice when administering oxygen therapy...Oxygen is one of the most widely used drugs, and is used across the whole range of healthcare specialties. Oxygen is an extremely important drug because hypoxaemia can cause death during many medical emergencies and it is essential to protect patients from this risk by the rapid recognition of acute illness and hypoxaemia followed by the immediate provision of oxygen to hypoxaemic and critically ill patients.
The guideline recommends that oxygen is administered to patients whose oxygen saturation falls below the target saturation ranges (94-98% for most acutely ill patients and 88-92% for those at risk of type 2 respiratory failure with raised carbon dioxide level in the blood), and that those who administer oxygen therapy should monitor the patient and keep within those specified target saturation ranges.
Despite a widespread belief amongst medical staff, and patients, that oxygen relieves breathlessness, there is no evidence that oxygen has an effect on breathlessness if the blood oxygen level is normal. The guideline group advised that too much oxygen can prove harmful in patients with chronic lung diseases such as COPD and 'blind' oxygen therapy outside of critical illness might actually delay recognition of a patient's deterioration by providing a false sense of reassurance based on high oximetry measurements.
The biggest changes that people will notice are as follows:
- Oxygen therapy will be adjusted to achieve target saturations rather than giving a fixed dose to all patients with the same disease.
- Nurses will make these adjustments without requiring a change to the prescription on each occasion.
- Most oxygen therapy will be from nasal cannulae rather than masks.
- Oxygen will not be given to patients who are not hypoxaemic (except during critical illness)
- Pulse oximetry must be available at all locations where emergency oxygen therapy is used.
- Oxygen will require a prescription in all situations except for the immediate management of critical illness.
More information and an abbreviated copy of the British Thoracic Society's Guideline for Emergency Oxygen Use in Adult Patients for download are available on http://www.brit-thoracic.org.uk.
The British Thoracic Society is the United Kingdom's professional body of respiratory specialists http://www.medicalnewstoday.com/articles/123424.php
 
KEY COMPONENT OF COPD IDENTIFIED
Researchers have demonstrated a close correlation between the decline in a key component of the lung's antioxidant defense system and the progression of COPD in humans. COPD is a degenerative condition that decreases the flow of air through the lungs as the lung's air sacs are damaged. A study of lung tissue samples from COPD patients by scientists at the Johns Hopkins Bloomberg School of Public Health found that expression of the regulating gene NRF2 was significantly decreased in smokers with advanced COPD compared to smokers without COPD. The study is published in the September 15, 2008, edition of the American Journal of Respiratory and Critical Care Medicine.
"This work clearly demonstrates that decline in our antioxidant system is involved in progression of COPD, which could also be the case for other environmental diseases. There is no treatment of COPD, but NRF2 could be a novel target for the development of new drug therapies. As we learn how the protective actions of NRF2 are decreased in the course of a lifetime of exposure to cigarette smoke, it opens new venues for the development of novel drugs fitted for individual patients in specific stages of the disease."
http://www.news-medical.net/?id=41425
 
From David. 4th October

Paracetemol use linked to asthma.  More to come later.

New from Pauline. 20 September

KEY COMPONENT OF DEBILITATING LUNG DISEASE IDENTIFIED Antioxidant defense system could be new target for potential therapies for COPD. For the first time, researchers have demonstrated a close correlation between the decline in a key component of the lung’s antioxidant defense system and the progression of COPD in humans. COPD is a degenerative condition that decreases the flow of air through the lungs as the lung’s air sacs are damaged. A study of lung tissue samples from COPD patients by scientists at the Johns Hopkins Bloomberg School of Public Health found that expression of the regulating gene NRF2 was significantly decreased in smokers with advanced COPD compared to smokers without COPD. The study is published in the September 15, 2008, edition of the American Journal of Respiratory and Critical Care Medicine.
....disruption of NRF2 expression in mice caused early onset and severe emphysema, which is a major component of COPD in human. However, the status of this critical pathway in humans with COPD was unclear. "This work clearly demonstrates that decline in our antioxidant system is involved in progression of COPD, which could also be the case for other environmental diseases."
 
http://www.newswise.com/articles/view/544185/
HOW BRONCHODILATORS WORK IN YOUR LUNGS
Bronchodilators are drugs that relax your airways. The muscles around the airways become less tight. When your airways relax, they open up and allow air to flow more easily. As a result, you can exhale more completely. People with COPD have trouble getting the old air out. This makes it harder to get new air in...getting the air out better will let the new air come in better.
Bronchodilators widen the airways. Three main types are:
Anticholinergics: Drugs that affect the muscles around the large airways (bronchi). They work by stopping the muscles from tightening.
Beta-agonists: Drugs that affect the muscles around the airways (bronchi and bronchioles). They work by relaxing the muscles of the airways. They also widen the airways.
Theophyllines: Drugs that affects the muscles in the breathing tubes. It may help to decrease swelling in the lungs. Theophylline is taken in pill form.
The high risk of side effects limits its use. It is not a first choice treatment for COPD.
These types of drugs have similar effect, but work in different ways. Thus, sometimes your doctor may have you take more than one type of bronchodilator.
Most bronchodilators are taken with an inhaler. Some are available as pills, liquids, or nebulized liquids. (A nebulizer is a device that converts liquid medication into a mist that can be inhaled thorough a mask.)
> From Volume 12, Number 1 of Breathe Well publication, a joint effort of Boehringer Ingelheim and Pfizer. For a free subscription call (800) 231-6584.
~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<
 
~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<>~<
RHINITIS: FRAGRANCES AND WHAT YOU CAN DO TO AVOID THEM By James Thompson, MD:
In recent years the number of consumer products containing fragrances has skyrocketed. Thousands of fragrances have invaded our air space and become a part of our daily routine. But some people with respiratory problems might say that their homes and work places have turned into virtual gas chambers..
Fragrances are not limited to perfumes and colognes. Where else can they be found? Hair spray, bar soap, body and facial lotion, shampoo, cosmetics, deodorant and aftershave often contain fragrance. Clothing and linen are frequently washed in fragrances that have been added to soap powder or liquid. Fabric softener and dryer sheets (that reduce static cling) may contain fragrance.
The makers of some brands of chlorine bleach have recently added fragrance.
Floor soaps, wood cleansers, carpet cleaners, window cleaners, tile cleaners, dish washing liquids, bathroom cleaners and aerosols for dusting often contain fragrance. Air fresheners, aerosols, potpourri, scented candles and incense.
Work place exposure to fragrance is very frustrating for millions of rhinitis and asthma patients. Some businesses have established fragrance free policies.
This is not enough for jobs that serve the public or have clients who wear fragrance. Fragrances may trigger symptoms that mimic allergy, including runny nose, nasal congestion, sneezing, post-nasal drip, cough, headache and watery burning or itchy eyes.
Asthma control may worsen after inhaling certain fragrances, leading to more cough, wheezing, and shortness of breath. The most common skin reaction to fragrance is a rash caused by direct contact (contact dermatitis). Severe reactions to fragrance can be life-threatening and may encompass all of the above symptoms.
Fragrances Rarely Cause Allergic Reactions. While people often assume they are allergic to fragrance, they are usually mistaken. Allergic reactions are typically triggered by organic substances - pollen, food, mold spores, dust mites, animal and cockroach dander, feathers -- capable of inducing white blood cells to make IgE antibody. That is what makes them allergic trigger factors. Fragrances, in contrast, usually are synthetic chemicals that, generally, do not stimulate IgE antibody production. Thus, they are not allergens, but irritants. Irritants (which also include smoke, odors, fumes and other chemicals) irritate the inner surface of the nose, eyes, throat, or lung. They will not cause anaphylaxis. There are no allergy skin prick tests available for fragrances. There are exceptions. There are a few chemicals involved with plastics and paints that may cause allergic sensitivity (TDI and TMA, specifically). Contact dermatitis (often erroneously called "contact
allergy") is a delayed immune reaction that DOES NOT involve IgE.
The author suggests ways to reduce your level of exposure to fragrances at home and work place:
http://www.healthcentral.com/allergy/c/3989/26134/rhinitis-fragrances?ic=6101
 
New 19 September

An antioxidant found in broccoli may reduce oxidative stress that leads to lung damage in chronic obstructive pulmonary disease (COPD), researchers said.

Sulforaphane restored antioxidant gene expression in a human bronchial epithelial cell line model of COPD, Shyam Biswal, Ph.D., of Johns Hopkins University, and colleagues reported in the Sept. 15 issue of the American Journal of Respiratory and Critical Care Medicine.  In their series of experiments, lungs of COPD patients showed markedly decreased levels of key anti-inflammatory antioxidants and the protein that stabilizes these nuclear factor erythroid 2-related factor 2 (NRF2)-dependent antioxidants against degradation. Since both factors were linked to COPD severity, the findings suggest that these compounds could be developed to halt COPD, the researchers said. http://www.medpagetoday.com/Pulmonary/SmokingCOPD/tb/10945

Yes that sounds good news. we eat a lot of Broccoli - 3 times a week on average. I am wondering whether this is the reason my COPD has stabilised over the past year and I have been able to reduce my Symbicort dosage by 25%. But have a care, some heart patients are advised not to eat it because they are told it thickens the blood.  David

Can anyone help Lawrence ?

Hello

New 16th September

From Debbie

Patients Endorse Home Oxygen Service UK
95% of patients in England and Wales are happy with the service they receive from the Home Oxygen Service, the Department of Health announced today. The first annual National Patient Satisfaction Survey of the Home Oxygen Service, published today, was commissioned jointly by the Department of Health and oxygen suppliers and is an important measure of the quality of care patients receive to show satisfaction with the service. 14 Sept 2008 article located at: http://www.medicalnewstoday.com/articles/121322.php
5% unhappy patients is far too many. Nothing to crow about. David

NEW 13th September

From Pauline Elliott

 1.  This may bring hope to a lot of people and pray God they will master it soon :  Most of us will be unable to go to meetings like this but the concept of stem cell treatments is so exciting!!
 
September 12, 2008
ANYONE IN THE BOSTON U AREA?
Forwarded by Dick/MO: Lung Regeneration: New Approaches to the Treatment of Lung Disease. Symposium to focus on new approaches to the treatment of lung disease: Current treatment of lung diseases is focused on halting disease progression and on ameliorating symptoms. Recent research in embryogenesis and stem cell biology along with a deeper understanding of tissue regeneration in other organs and animals suggest, for the first time, the exciting possibility of treatments that could actually regenerate new lung tissue. If successful, this would provide a completely new approach to lung disease treatment. With this in mind, a new program, the Lung Regeneration Initiative, within the Boston University Pulmonary Center has been established, which will focus on understanding the basic biology of lung stem cells in the adult and embryonic lungs.
 
Speakers include lung biologists, along with distinguished scientists from other fields. Among them are CAS Biology Professor Horacio Frydman (Drosophia Stem (on Lung Stem Cells); Phillip Newmark, Ph.D., University of Illinois (Planarian Regeneration); Darrell Kotton, MD, BU Pulmonary Center (Modeling Lung Development with Embryonic Stem Cells); and Dario Fauza, MD, Children’s Hospital Boston (Use of Stem Cells to Repair Congenital Lung Defects).
 
A unique feature of this symposium is that along with a discussion of current research in lung stem cells, we also will discuss what is known in other better-defined model systems and how that knowledge can be applied to lung research. A major goal is to formulate strategies and concepts to advance lung research.
When: Friday, Sep 19, 2008 at 9:00am until 3:30pm
Where: 72 East Concord Street (BUMC L-110)
Who: Open to General Public, Admission is free Contact BU Pulmonary Center Alan Fine, MD afine@bu.edu 617-638-4860
 
2.  A good idea and worth members looking at this :  It could equally work well for neighbours and friends close by or even our own members working together and taking turns in monitoring other members .........
 
21st Century Wake Up Call
 
Since I live alone and am quite a distance from family, I give my married children a "good morning" email to let them know I'm up. This way, if they haven't heard from me after a certain time, they are on the phone to find out if I'm OK. This eases my mind to know that if I fell and couldn't get to a phone, someone would be checking up on me daily.
 
 
3.  A friend got me this book and it is fantastic - make a great Xmas Present too.  I would heartedly recommend it and dont wait until Xmas:
 
'COPD for Dummies' by Kevin Felner, MD Board Certified, Internal Medicine, Pulmonary Disease NYU School of Medicine and Meg Schneider - Award - winning journalist. 
 
The idea behind the book is for you to understand COPD, its causes and effects - you are shown how your lungs work and how COPD interferes with your lung function and differences between COPD and other lung diseases like asthma and t.b.  There is coverage of nutrician and exercises and even a section for your loved ones to read in order for them to understand your physical, mental and emotional needs and our constantly changing moods.   There is so much in this book far too much for me to tell you here - you can buy the book from Amazon here in the UK - I feel it could be a COPD bible as it contains so many answers to our questions and you will get a thorough knowledge of this disease.
 
Hope this is useful for you and not too much but I search a lot for things like this and like to share :)
 
People who use paracetamol at least once a week are almost three times more likely to suffer from asthma than infrequent users, according to new research.

One of the authors of the study, Dr Seif Shaheen of Imperial College London told the Daily Mail: ‘Epidemiological evidence is growing that shows a link between paracetamol and asthma,’ adding: ‘We have also shown that asthma prevalence is higher in children and adults in countries with higher paracetamol sales. Considering asthma is a common disease and paracetamol use is frequent, it is now important to find out if the association is really a causal one.’
The researchers believe that regular use of paracetamol decreases levels of the antioxidant glutathione, which protects the lungs from air pollution and tobacco smoke.
Leanne Male, Asthma UK’s Assistant Director of Research, said: ‘Now there is data from across the world suggesting a link between paracetamol use and an increased risk of developing asthma, we need to carry out further studies to identify whether  paracetamol actually plays a role in causing the condition.
'This is particularly important because, if proven, it could potentially enable us reduce the number  of people developing asthma in a way that other causes, for example genetic  factors, may not be as easy to do.'More than five million Britons, 1.4 million of whom are children, suffer from asthma, a condition which leads to 70,000 hospital admissions and 1,400 deaths a year in the UK.

IF you are wanting more information go to FINDING OUT and BOOKS AND LINKS. We get many letters from carers who want to know what to expect when their loved ones are in the so called "end stage". I have descibed some of those things on the prognosis page. However, it is difficult to describe end stage copd since many patients live on for years with appalling lung function.

For example although John's FEV1 had now dropped to 15% and he was on oxygen 24/7 he did not consider himself at death's door!!! "If I was in my 80s, with a very low BM1 and heart disease and on 5 litres a minute of oxygen (per minute) and showing signs of pneumonia I might. But even so nobody can predict within a week of someone's death".

If one was caring for someone with a recognised heart problem or just elderly, say with COPD, one should be aware of the following signs of a stroke.

THERE ARE 3 STEPS - REMEMBER THE FIRST THREE LETTERS...S.T.R S

S- ASK THE INDIVIDUAL TO SMILE                                                       

T- ASK THE PERSON TO SPEAK A SIMPLE SENTENCE COHERENTLY i.e it is sunny today.                                                                                    

R- ASK HIM OR HER TO RAISE BOTH ARMS. 

ALSO YOU CAN ASK THE PERSON TO "STICK" OUT THEIR TONGUE. IF IT IS CROOKED GOING TO ONE SIDE OR THE OTHER THIS IS ALSO A SIGN OF A STROKE

FAILURE IN ANY ONE OF THESE TESTS THEN YOU MUST CALL 999 AT ONCE describing the symptoms. A NEUROLOGIST CAN REVERSE THE DAMAGE OF A STROKE IF HE CAN RECEIVE THE PATIENT WITHIN 3 HOURS.

MAJOR HEALTH TOPIC - aimed at professionals and patients.

On June 18th The Times reported that 1 in 4 Primary care Trusts were failing targets on cleanliness and tackling superbug infections. In 2006 there were 55,681 cases of C. difficile in patients in England (up 8%) and between October and December 1,540 cases of MRSA (down 7% on previous quarter) - so that means nearly 6000 cases per annum compared to NONE in the Netherlands.

C. difficile can cause diarrhoea, ranging from a mild disturbance to a very severe illness with ulceration and bleeding from the colon (colitis) and, at worst, perforation of the intestine leading to peritonitis. It can be fatal. Generally, it is only able to do this when the normal, healthy intestinal bacteria have been killed off by antibiotics. When not held back by the normal bacteria, it multiplies in the intestine and produces two toxins (A and B) that damage the cells lining the intestine. The result is diarrhoea.

The term MRSA or methicillin resistant Staphylococcus aureus is used to describe those examples of this organism that are resistant to commonly used antibiotics. Methicillin was an antibiotic used many years ago to treat patients with Staphylococcus aureus infections. It is now no longer used except as a means of identifying this particular type of antibiotic resistance. Individuals can become carriers of MRSA in the same way that they can become a carrier of ordinary Staphylococcus aureus which is by physical contact with the organism. If the organism is on the skin then it can be passed around by physical contact. If the organism is in the nose or is associated with the lungs rather than the skin then it may be passed around by droplet spread from the mouth and nose.  A significant death rate is associated with thiis disease amongst the ill and elderly patients in hospital.

HOW DO HOSPITALS PREVENT THESE INFECTIONS?

Here are some basic guides. All patients and visitors should be tested by a simple swab. Is your local hospital doing this? Nurses should throw away gloves after dealing with each patient or use the hand gel for MRSA & wash their hands with soap for C.Difficile. Ideally, anybody with MRSA should be placed in an isolation room but few hospitals have these. Stainless steel surfaces and door handles should be replaced with copper which kills off MRSA after a few minutes. 

Ideally floors and door should be washed thoroughly, not just swept.  

People who use paracetamol at least once a week are almost three times more likely to suffer from asthma than infrequent users, according to new research.

One of the authors of the study, Dr Seif Shaheen of Imperial College London told the Daily Mail: ‘Epidemiological evidence is growing that shows a link between paracetamol and asthma,’ adding: ‘We have also shown that asthma prevalence is higher in children and adults in countries with higher paracetamol sales. Considering asthma is a common disease and paracetamol use is frequent, it is now important to find out if the association is really a causal one.’
The researchers believe that regular use of paracetamol decreases levels of the antioxidant glutathione, which protects the lungs from air pollution and tobacco smoke.
Leanne Male, Asthma UK’s Assistant Director of Research, said: ‘Now there is data from across the world suggesting a link between paracetamol use and an increased risk of developing asthma, we need to carry out further studies to identify whether  paracetamol actually plays a role in causing the condition.
'This is particularly important because, if proven, it could potentially enable us reduce the number  of people developing asthma in a way that other causes, for example genetic  factors, may not be as easy to do.'More than five million Britons, 1.4 million of whom are children, suffer from asthma, a condition which leads to 70,000 hospital admissions and 1,400 deaths a year in the UK.