3 Ways to Boost Your Lung Power

By David Blyweiss, M.D., Advanced Natural Medicine

Take a deep breath.
For most people, it’s not a big deal. But if you suffer from chronic obstructive lung disease (COPD), breathing may be one of the most difficult things you do.

COPD is a group of conditions that includes emphysema, chronic bronchitis and asthma. Smoking is the most common cause of COPD. But pollution and chemical fumes can also set you up for respiratory problems later in life.

COPD Blog: Inhaled Medications for COPD: Are the Steroids Dangerous?

Robert T. Schreiber, MD, an American Lung Association in New York expert

Many patients with COPD are prescribed inhaled medications to help treat symptoms of coughing, wheezing, and shortness of breath. However, some patients are reluctant to take them because they mistakenly think that all inhaled medications are steroids, and they’re afraid of the side effects. A patient might hear from family or friends that these medications have many adverse reactions — but they’re usually wrong.

Inhaled medications for COPD include short-acting and long-acting bronchodilators, and neither of them are corticosteroids. Patients with mild COPD and only intermittent symptoms are prescribed a short-acting bronchodilator, or short-acting beta agonist (SABA), to use when symptoms occur. Typically, these come in a metered dose inhaler and contain a quick onset medication (for example, albuterol). These medications are sympathomimetics (distant cousins of adrenalin), and work to open up the bronchial tubes quickly. A dose from a short-acting bronchodilator works rapidly and then leaves the body quickly, wearing off between four and six hours. The side effects are temporary, and may include nervousness, shakiness, increased heart rate or blood pressure, and insomnia. They do not have long-term consequences if used as directed.

Patients who have advanced COPD and persistent symptoms may be prescribed a long-acting bronchodilator as the next step in their treatment. Long-acting beta agonists (LABA) help to keep the bronchial tubes open for up to 12 hours. They are similar to SABAs in their action and side effects, and are also part of the sympathomimetics family. Salmeterol and formoterol are both LABA bronchodilators. Another type of long-acting bronchodilator is in the anticholinergic family. Tiotropium is the only long-acting inhaled anticholinergic currently available in the U.S. The most common side effects from this type of medication are dry mouth, constipation, and problems with urination, and they should be taken with caution by patients with glaucoma.

Recent medical research has shown that patients with moderate to severe COPD who took a combination of a LABA and an inhaled corticosteroid (ICS) had fewer exacerbations of their COPD in the course of one year. These combined medications (fluticasone plus salmeterol; budesonide plus formoterol) contain an extremely tiny dose of the corticosteroid, which is measured in micrograms. For comparison, oral doses of corticosteroids given to patients with COPD exacerbations typically contain 100 to 1000 times the amount found in the inhaled doses, and they’re measured in milligrams. In addition, most of the corticosteroid that is inhaled doesn’t travel beyond the lungs — very little gets into the blood stream and travels to the rest of the body.

While COPD medications are generally considered safe, there are some short- and long-term side effects that you should be aware of. When taken for many years, an ICS may increase the chance of osteoporosis, cataract formation, and skin bruising. It has also been suggested that the LABA-ICS combination may increase the chance of getting pneumonia. However, in medical practice, we typically don’t see the side effects from an ICS that people taking corticosteroid pills or shots may experience, such as face swelling, fluid retention, elevated blood sugar and blood pressure, and bone thinning.

So, most inhaled medications prescribed for COPD do not contain steroids. But even combined medications that have an ICS contain only small amounts and are usually safe for most people. Of course, everyone is different, and you may react differently than someone else to a medication. Therefore, you should always discuss the potential benefits and risks of a new treatment with your doctor before you start to take it.

Dr. Schreiber is board certified in internal medicine and pulmonary diseases by the American Board of Internal Medicine. He is a member of Nassau Chest Physicians, P.C., who are actively involved with the American Lung Association in New York. Schreiber is director of the SICU at St. Francis Hospital, medical director of the Oyster Bay Cove Village Police Department, and a member of the Nassau County Medical Reserve Corps. He is on the professional staffs of St. Francis Hospital, North Shore University Hospital (Manhasset and Plainview), and St. Joseph Hospital.

http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-disease/inhaled-medications-for-blog.aspx

How Weather Can Affect Your COPD

Weather and temperature changes can trigger COPD symptoms. Here's what you can do.

By Krisha McCoy

Medically reviewed by Cynthia Haines, MD

Weather changes are one of many factors that can trigger your COPD symptoms. Symptoms of COPD, which include shortness of breath, cough, and phlegm production, tend to get worse for some people when the air is very cold and when it is hot and humid.

"Weather extremes are not good," says Barry Make, MD, co-director of the COPD program at National Jewish Health and professor of medicine at the University of Colorado in Denver. Dr. Make says that temperatures below freezing or above 90 degrees Fahrenheit tend to cause COPD symptoms to flare up.

COPD and Weather: When It's Cold and Windy

Cold air and strong winds are known triggers for the worsening of COPD symptoms. Many people with COPD find that cold air can make it harder to breathe, leading to shortness of breath and wheezing. Frigid temperatures can also cause fatigue. "COPD patients just feel like they are more tired after they've been in the cold," explains Make.

Windy days can be practically problematic. "If COPD patients go out when it is windy and have to walk against the wind, there is more resistance," says Make. Therefore, it requires more exertion to walk, which can be difficult for someone with COPD.

If cold and windy climates bother you, try wearing a scarf or face mask loosely over your nose and mouth, and breathe through your nose on wintry days. The winter muffler and breathing through your nose warms the air before it enters your lungs, which can help prevent your symptoms from worsening.

Dealing With Hot, Humid Air

While there are a few people whose COPD symptoms improve in humid weather, most people's symptoms flare up on days of high heat, humidity, or smog. This can especially be an issue when a front moves in that brings humidity, says Make. "A lot of people with COPD tell you that they know when a front is going to come because of a change in their symptoms," he says.

To prevent a flare-up on the hottest and most humid days of the year, stay indoors in an air-conditioned room. "If it is a high-pollution day, we suggest that our COPD patients stay inside and limit their activities," notes Make. "If it is really hot or really cold, we would say the same."

Should You Move?

Seasonal exacerbations of COPD symptoms can be so bad that people will move across the country in an effort to manage their condition. "One of the most common questions we get is what part of the country is best to live in because of the weather," says Make.

In the past, physicians commonly recommended moving to the western United States, where the air is less humid. But it is now known that the COPD-weather connection is very individualized. "It is variable from person to person," says Make. "Some people prefer more humidity and some less."

It is usually not necessary to move when you have COPD, but if you live in a climate with extreme weather changes and moving is an option for you, talk with your doctor. If you decide to move, spend an extended vacation in the new area before you permanently relocate there.

"If people are going to think about moving somewhere for the weather," Make says, "be there during each season of the year." That way you will know if the move will provide year-round improvement of your symptoms.

The best advice for people with COPD is to pay attention to your symptoms during different weather conditions. With help from your doctor, you can learn how to minimize weather-related flare-ups.

http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-disease/weather-and-copd.aspx

COPD Blog: Is It COPD or Asthma?

Robert T. Schreiber, MD, an American Lung Association in New York Expert

A middle-aged woman sits across the desk from me looking somewhat nervous. She’s been sent to my office by her primary care physician for a pulmonary evaluation. As a lung specialist, I’m being asked to determine the cause of her chronic cough and episodes of wheezing. Is it asthma or COPD?

I evaluate and treat patients like this all the time. To give an accurate diagnosis and treatment plan, I take a full history, do a physician examination, and order a few tests.

First I ask about her symptoms and medical history:

• Are the symptoms chronic (meaning long-standing) or did they start recently?
• Was there a sudden change that could have triggered the symptoms, such as an exposure to an allergen or toxic substance, an acute respiratory infection, or a new pet in the home?
• Is there a prior history of childhood asthma or recurrent coughing and wheezing as an adult?
• Is there a history of allergies?
• Does she smoke or has she smoked in the past?
• Do any family members have asthma or COPD?
• What level of physical activity is she able to do? Has her exercise tolerance been declining?

The answers to these and other questions are the strongest clues I have to diagnose a patient’s condition.

Smoking is the most common cause of COPD. The risk of COPD from smoking is determined by pack years (number of packs per day multiplied by the numbers of years of smoking). COPD is more likely in people who have a history of 20 or more pack years. If the patient’s symptoms have been present for a long time and slowly worsening, it is more likely to be from COPD than asthma.

However, my patient’s symptoms could be a sign of asthma. In people with a history of allergies and childhood asthma, their asthma can reactivate as an adult. People who never had asthma can develop “non-allergic” asthma after an acute respiratory infection.

Both asthma and COPD can produce chronic coughing and wheezing, but the symptoms appear differently: People with COPD tend to have a chronic morning “smokers cough” as a sign of chronic bronchitis; most asthmatics have coughing and wheezing only during flare-ups.

The woman who came in today was a pack-a-day smoker for 25 years, and a casual smoker for five years before that. She quit smoking a few years ago, but has had a morning cough and recently started wheezing in cold weather and when she has a cold. She also gets short of breath easily walking up stairs, particularly if carrying packages.

In the examining room, I check her vital signs and do a head and neck exam, looking for evidence of chronic nasal or sinus swelling or nasal polyps (seen more commonly in asthma and allergies). I listen to her heart and breathing with my stethoscope; I hear mild wheezing in both lungs. Her heart sounds normal. I check the extremities for cyanosis (a blue color that might indicate a low oxygen level) and feet for swelling (which might indicate heart strain).

Next I order a chest x-ray. It looks for signs of cancer, “water on the lungs” and other problems that might cause her symptoms. Luckily, her test doesn’t show any of these.

Pulmonary function tests (PFT’s) are done next; these are breathing tests that measure lung capacity and flow rates. My patient’s PFT’s show that she can’t blow out as much air as she should in one second (her FEV1 is reduced). The next step is to give her a quick-acting bronchodilator and repeat the test. Most asthmatics have normal results after a bronchodilator, but when people have COPD, their tests do not normalize. My patient’s FEV1 is still low and for me, this clinches the diagnosis of COPD.

When I sit down with my patient to review the findings, I tell her she has COPD from years of smoking. Although she quit several years ago, most smoking damage is permanent. It’s common for patients to lose over half of their lung function before they realize it. Some of her loss of lung function is also a part of aging.

I outline a treatment regimen for her which includes taking an inhaled bronchodilator to control her symptoms. I also tell her to:

• Eat a healthy diet to strengthen her immune system.
• Get regular exercise to improve functional capacity.
• Avoid inhaled irritants and, of course, never smoke again.
• Take steps to prevent respiratory infections, such as getting immunizations for influenza and pneumonia, avoiding sick people, and frequent hand cleansing.

Her treatment also requires regular checkups with me to monitor her progress and adjust her medicines. As my new patient leaves, she isn’t happy that she has a chronic condition, but she seems satisfied that she has the right diagnosis and a plan of action.

Dr. Schreiber is board certified in internal medicine and pulmonary diseases by the American Board of Internal Medicine. He is a member of Nassau Chest Physicians, P.C., who are actively involved with the American Lung Association in New York. Schreiber is director of the SICU at St. Francis Hospital, medical director of the Oyster Bay Cove Village Police Department, and a member of the Nassau County Medical Reserve Corps. He is on the professional staffs of St. Francis Hospital, North Shore University Hospital (Manhasset and Plainview), and St. Joseph Hospital.

gotquestions  http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-disease/copd-blog-copd-or-asthma.aspx

Is It Asthma, COPD, or Both?

By Lisa D. Ellis

Reviewed by QualityHealth's Medical Advisory Board

Have you noticed that your fast-acting relief inhaler isn't providing as much relief as you'd expect? If you're an older person who smoked, it's possible that in addition to asthma, you could have another ailment called Chronic Obstructive Pulmonary Disease (COPD).

What is COPD?

COPD refers to a variety of respiratory conditions that cause symptoms that are quite similar to asthma, except that while asthma can be reversed with proper treatment, COPD causes more permanent damage.

Long-term smoking most often leads to COPD, and smokers are also more likely to have both asthma and COPD.

Is It Asthma or COPD?

Because asthma and COPD look similar, causing symptoms such as coughing, wheezing, and difficulty breathing, it's often challenging to differentiate between the two illnesses, especially when they co-occur. Yet there are some subtle differences. For instance, asthma episodes often occur at night and after exposure to allergens, while people with COPD commonly experience coughing and mucus in the mornings, along with chest symptoms that can linger throughout the day. But using symptoms alone may not be enough to accurately identify the conditions and determine how best to treat them.

Diagnosing Asthma and COPD

One way doctors assess a patient's respiratory condition is through a pulmonary function test (PFT) to reveal obstruction in the airways. In asthmatics, a bronchodilator usually improves lung function, while in people who have COPD alone, the medicine usually won't make a significant difference. People who have both asthma and COPD together usually get some benefits from the inhaler, however the effects aren't as efficient as when it's used for asthma alone.

Using Biomarkers to Identify Asthma or COPD

To help make it easier for doctors to diagnosis asthma and COPD, researchers from Australia recently tried to identify some of the common characteristics in the cells that occur with asthma and with COPD. They examined the blood of people with asthma, those with COPD, and those with no respiratory disease in order to understand the proteins that exist in these different scenarios. They were able to identify four biomarkers in the blood that help regulate inflammation in the cells and can be indicative of asthma or COPD. In the future, these markers may help doctors to properly identify asthma and COPD, or a combination of the two conditions, at an earlier stage. These findings appeared in the American Journal of Respiratory and Critical Care Medicine in summer 2011.

Treating Asthma and COPD

If you're grappling with respiratory symptoms and you believe that asthma, COPD, or both conditions may be to blame for your ailments, it's important to see a specialist who can confirm the diagnosis. While testing to identify the biomarkers may not be available yet for the general public, your doctor can still use more conventional methods to assess the health of your respiratory system, determine what's causing your symptoms, and ways to best to treat them.

Smoke Triggers Asthma and COPD

Regardless of what ails you, if you smoke, you'll need to kick the bad habit. Smoking can worsen both asthma and COPD and can also lead to many other serious health problems. You should also avoid second-hand smoke, too, since someone else's smoke can be enough to trigger your symptoms.

Treating Asthma and COPD

Asthma and COPD are usually both treated with bronchodilators and inhaled corticosteroids. In addition, many people with asthma and COPD will need a flu shot and pneumonia shot each year to help avoid illnesses that can make the conditions worse. If you do get sick, people with COPD often need an antibiotic to prevent an infection from taking root. Finally, for both conditions it's best to avoid dry air and pollutants, since these can irritate sensitive airways and can make you feel worse.

While you can't make asthma and COPD go away completely, with proper diagnosis, you can effectively manage the symptoms and breathe more easily.

Sources:

Chronic Obstructive Pulmonary Disease (COPD) American Academy of Asthma, Allergy, and Immunology. AAAAI, n.d. Web. 21 Aug. 2011.

"COPD." American Lung Association. LungUSA.org, n.d. Web, 25 Aug. 2011.

Verrills, Nicole M. "Identification of Novel Diagnostic Biomarkers for Asthma and Chronic Obstructive Pulmonary Disease." American Journal of Respiratory Critical Care Medicine, 183 (Jun 2011) 1633 - 1643.

got questions  http://www.qualityhealth.com/asthma-articles/it-asthma-copd-both