By Ed Susman, Contributing Writer, MedPage Today. NEW ORLEANS – Doctors and patients with COPD agree that shortness of breath is the condition’s most debilitating symptom, but on other issues patients and clinicians are not on the same page, a survey reported here shows.
For example, “patients and physicians are both aware of the prevalence of morning symptoms, but physicians are less aware of the prevalence and importance of symptoms in the afternoon and evening,” Ronald Balkissoon, MD, of the University of Colorado Health Sciences Center in Denver, wrote in his poster presentation at the 2010 American Thoracic Society annual meeting. And patients “worry most about symptoms worsening over time, whereas physicians thought their patients worried most about being put on oxygen,” Balkissoon reported. The largest group of patients about 62% expressed concern about worsening symptoms. About 63% of doctors thought that was a major concern as well, although doctors believed other symptoms were more of a problem.
Among the significant differences between physicians and patients:
75% of physicians thought that their patients most feared being put on oxygen, but only about 47% of patients considered that their major concern.
73% of the doctors thought that losing independence was a major fear of patients, but just 55% of patients expressed that concern.
17% of doctors thought patients were fearful of not seeing friends and family more often, but that concern was mentioned by about 40% of the patients.
25% of doctors thought the ability to handle aspects of personal hygiene was feared by patients, an underestimation as 40% of patients said that was a concern.
46% of doctors thought that the possibility of having to leave their home would be fearful for patients, but just 36% of the patients agreed.
46% of doctors believed that patients would be fearful about their ability to continue working, but just 22% of the patients expressed that same concern.
“Increasing physician awareness of the gaps that exist between patients’ and physicians’ perceptions of the burden of COPD may make counseling efforts more effective,” Balkissoon wrote.
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By Steven Reinberg, HealthDay Reporter: People hospitalized with…COPD do better when they receive antibiotics without delay, a new study shows. COPD patients who were given antibiotics early in their hospital stay were less likely to need mechanical ventilation and less likely to have to be readmitted to the hospital, the researchers said. The finding could have implications for routine treatment, since “current guidelines for treating COPD exacerbations recommend antibiotics only for patients who have an increase in sputum or purulent [pus-bearing] sputum.” said lead researcher Dr. Michael B. Rothberg, from Baystate Medical Center in Springfield, Mass.
“We looked to see if we could identify a group of patients who would not benefit from antibiotics, but we couldn’t find one,” Rothberg said. This is not to say that all COPD patients will benefit from antibiotics…”At present, we only think that about half of COPD exacerbations are caused by infection, so probably only half of patients can benefit from this therapy. The problem is that we don’t know which half,” he said. The findings were published in the May 26 issue of the Journal of the American Medical Association.
By Ed Susman, Contributing Writer, MedPage Today: Treatment of COPD with either of the two leading inhaled corticosteroid formulations appears to give patients similar results in controlling their conditions, researchers reported at the 2010 American Thoracic Society annual meeting. In a comparison of outcomes in 3385 patients taking budesonide/formoterol fumarate dehydrate (Symbicort) with outcomes in 3385 patients taking fluticasone/propionate/salmeterol (Advair), there were no statistical differences in medical services utilization for either treatment. For example, 140 of the budesonide cohort required hospitalization for COPD (4.1%) compared with 117 of the fluticasone patients (3.5%), but that was not statistically different. In addition, 60 of the budesonide patients (1.8%) required pneumonia-related hospitalization compared with 65 of the fluticasone patients (1.9%), also not significant.”Budesonide/formoterol fumarate dehydrate combination and fluticasone propionate/salmeterol combination demonstrated comparable real-world effectiveness as measured by number of exacerbation and pneumonia events during the evaluation period,” the researchers wrote.The study was funded by AstraZeneca. Blanchette did not have disclosures. A co-author of the paper is an employee of AstraZeneca.
By Peter M. Gott, M.D. Newspaper Enterprise Association: Dear Dr. Gott: My breathing is shallow, and I often count 20 or more intakes per minute. I quit smoking 24 years ago, and the problem was not there then. My wife often hears my breath from another room, and my camcorder microphone picks it up easily. I have had a series of laboratory tests that all say there is nothing, but this condition can’t be right. My doctor says I definitely don’t have asthma, and he doubts that it’s pulmonary hypertension.
I work at a plastics plant that often “cooks” the plastic, which smells and tastes nasty, but no one else there about 700 employees has had this trouble. I also operate an EDM machine that uses chemicals known to cause skin irritations, but again, no other person has had this breathing disorder. I am active for a 60-year-old. I swim and hike regularly but now have to stop more frequently to catch my breath.
Dear Reader: A normal breathing rate for healthy adults is between eight and 16 breaths per minute. At a rate of 20, this is slightly abnormal, but given your claim that it is progressing, I believe you need further examination and testing. Rapid, shallow breathing is known as tachypnea and is associated with several pulmonary disorders, including asthma, pneumonia and other lung infections, pulmonary embolism (blood clot) and COPD.
Pulmonary hypertension is high blood pressure that affects the arteries in the lungs and the right side of the heart only. It causes the heart to weaken over time and eventually causes it to fail completely. Request a referral to a pulmonologist (lung specialist), who can examine you and order further testing, which may include a chest X-ray, CT scan or MRI of your lungs. You may also need additional blood testing.
Dear Dr. Donohue: I quit smoking one year ago. I had a cough when I was smoking, and I still have it, but it’s much milder. I saw a doctor, who tells me I have COPD. I do pant when I have to climb stairs or do chores around the house. The doctor put me on a medicine that I inhale. How is that helping me? What else can I do? H.G.
COPD, is something that happens to many smokers. It happens to nonsmokers too, but not in the numbers that it strikes smokers. Emphysema and chronic bronchitis are the two COPD illnesses, and both usually develop together. Emphysema destroys the air sacs, the tiny, delicate, bubblelike structures through which oxygen passes into the blood. Chronic bronchitis is perpetual inflammation of the bronchi, the airways. Symptoms of COPD are breathlessness on exertion, cough, production of thick sputum and wheezing. The degree of COPD is best assessed through breathing tests spirometry. Those tests guide the doctor in prescribing medicines and advising patients how they can best cope with COPD.
Your inhaler medicine is one that expands the airways and reduces inflammation and mucus production. Often the inhaler contains both a bronchodilator (airway expander) and a cortisone drug (inflammation fighter). Taken as an inhalant, little cortisone gets into the blood, so its side effects are not great. Some simple tips make breathing easier for COPD patients. When you walk, bend slightly forward at the waist. That gives the lungs more room to expand, and it facilitates the action of the diaphragm, the chief breathing muscle. Practice pursed-lip breathing. Inhale through your nose and exhale through lips that are puckered, as they are put together when a person whistles. If you’re into precision, inhalation ought to take four seconds, and exhalation six. Pursed-lip breathing keeps the airways opened.
DEAR Dr. Donohue: Since I can’t go out in cold weather for sunlight and its production of vitamin D, will sunlight shining beautifully through my window have the same effect? Or is it better to take a vitamin D pill? M.F.
In summer or winter, window glass filters out ultraviolet-B rays, the sun rays that convert a precursor chemical in the skin into vitamin D. Therefore, the answer to your question is that you do not stimulate vitamin D production by sitting in front of a window through which sunlight shines.You live in the North. In winter, Northerners deplete their vitamin D stores because winter sun is less intense and because people are exposed to too little sunlight. It’s better to take a vitamin D supplement. The suggested dose is 1,000 IU. Don’t forget calcium. Vitamin D enhances calcium absorption.
Rajiv Dhand, MD, FCCP. Inhaler technology has advanced rapidly in recent years. This has led to the availability of a plethora of delivery devices and an impressive array of innovative clinical applications, both for local respiratory effects and for systemic therapy. Pressurized metered-dose inhalers (pMDIs) used with or without a spacer device, dry powder inhalers (DPIs), nebulizers, and soft mist inhalers are employed for aerosol delivery. New developments have focused on incorporating features to improve aerosol dispersion, produce aerosols with high fine particle fraction, and target specific areas of the lung. Moreover, the devices’ delivery efficiency has improved while maintaining their portability and ease of use. Several factors must be considered when selecting an appropriate aerosol delivery device. If the selected delivery device fails to provide satisfactory treatment or results in unacceptable side effects, other equally effective options are available.
Our airways are a lot like a highway system with major roads and side streets that branch off. In certain diseases and conditions, thick mucus causes a traffic jam, which can lead to repeated infections, trouble breathing, and other health issues. Along with inhaled bronchodilators and antibiotics, various airway clearance techniques can get the mucus moving smoothly again. These are standard treatments for cystic fibrosis (CF), but they can help with many other diseases and conditions too.
How do you know when you’re too sick to exercise? There are lots of articles out there with lots of opinions. The bottom line: If your symptoms are above the neck, exercise is probably OK. If they’re below the neck – like in your stomach or in your lungs – then take a few days off.
But fellow exercise avoiders, let’s not kid ourselves. We don’t need an article to tell us the difference between “sick” and “looking for an excuse not to exercise.” Many of us use mild headaches, slight muscle soreness or general malaise as a reason to give ourselves a pass. yes” I said “us” because I do it, too. Rationalization is my middle name. But not this week. I woke up Monday morning feeling crappy, and my exercise regime has suffered because of it. Still I wondered: Am I just being lazy, or am I really too sick to get off my duff? A trip to the doctor today made it official. I’ve got bronchitis, not laziness. At least this time.
Kara Domonick, (WWLP) - The Center for Quality of Care Research at Baystate Medical Center (Masachusetts) has been awarded one the largest grants in the hospital’s history. According to a release sent to 22News, the hospital is receiving nearly $829,264 in federal grants to fund research into the effectiveness of care for COPD.
Clare Ansberry, (The Wall Street Journal) “Home health care funded largely by Medicaid generally costs less money than institutionalizing developmentally disabled people…But the political reality is that it’s easier to cut back home services than to close a 24-hour facility, which can leave people with nowhere to go. Thus, some of the biggest cuts around the country are happening in the basic services that help the disabled cope at home.”
Across the country, budget-strapped states are focusing on Medicaid. Created in 1965, it is now a $379 billion program, including state and federal funds. But states don’t have much flexibility when it comes to what they can and can’t cut inside Medicaid. Although it is a state-managed system, the federal government pays a percentage of each state’s total costs and makes many of the Medicaid rules. Under federal Medicaid law, states must offer inpatient and outpatient hospital care, X-rays and lab services. They also have to cover nursing-home services and meet certain standards, such as staffing ratios. There are further constraints this year. States can’t reduce Medicaid eligibility this year because of a condition attached to federal stimulus money, and under health-care reform, they can’t eliminate existing programs.
But many in-home services, though critical to those receiving them, are optional. Furthermore, there aren’t many minimum standards set for in-home services, so it’s easier to cut them without violating funding requirements. There are fewer immediate consequences for the state when it cuts those services because families won’t generally abandoned disabled relatives and leave states on the hook for housing. Cutting home care could ultimately prove penny-wise and pound-foolish. It could push more people into institutions or large group homes because that is where services are guaranteed, even though institutional care is more expensive.
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