Former First Lady Barbara Bush died on April 17, 2018, two days after spokespeople said that she had decided not to seek additional medical treatment. CNN had reported that Barbara Bush had COPD.
Beginning of interview:
I am a respiratory disease physician and professor at the University of Pittsburgh School of Medicine, and I direct the COPD clinical and research programs. My research has been inspired by real clinical problems when facing my lung disease patients whom I have worked with over the past 30 years.
COPD is a chronic respiratory condition that results in cough and shortness of breath. It often gets worse. It affects up to 16 million people and is the third-leading cause of death in the United States behind heart disease and stroke. It further results in 6 percent of all deaths worldwide.
The disease is most commonly caused by tobacco smoking and is thus often preventable. Mrs. Bush smoked cigarettes for decades, she wrote in her biography, but quit in 1968. One-fourth of cases occur in nonsmokers, in part due to other environmental exposures. COPD is often undiagnosed because of its slow onset. Also, people often assume that their coughing is “smokers’ cough,” or old age. Women are more likely than men to be diagnosed with COPD.
COPD includes several different conditions, including emphysema and chronic bronchitis. They can occur separately or together.
Normal lungs have bronchial tubes that branch like a tree into smaller and smaller tubes, which end in tiny elastic air sacs called alveoli. These fill up as we breathe in and snap back empty when we exhale.
In COPD, the airway tubes narrow due to inflammation, increased mucous production and, eventually, scarring, which is known as chronic bronchitis. Further, the walls of the alveoli can break down, as do small bubbles coalesce to form larger bubbles. This is known as emphysema. As a result, they do not snap back as easily when a person exhales. They have less ability to transfer oxygen into, and remove carbon dioxide from, the blood.
These different processes result in a prolonged and incomplete exhalation, and air remains trapped in the lungs when the next breath begins. As the condition progresses, it becomes increasingly hard to breathe. This results in more fatigue, a decreasing ability to exercise, declining activity and a lower quality of life.
Many COPD patients develop recurrent chest colds, often requiring hospitalization and rising medical...Read more..
According to the study, long-term exposure to traffic and ozone significantly increases the risk of asthma attacks, and also increases the need for asthma medication and treatment.
“It is very well known that short-term exposure to air pollution is associated with increased asthma symptoms, hospitalizations and use of asthma medication, but studies on the associations between long-term exposure to outdoor air pollution and asthma among adults are still scarce,” explained lead author Anaïs Havet.
“We wanted to try and better understand the underlying biological mechanisms associated with outdoor air pollution and increased asthma symptoms, asthma attacks or medication use, as up to now they were largely unknown.”
For their investigation, the experts obtained cohort study information on 608 French adults, including 240 individuals who had asthma with respiratory symptoms, asthma attacks, or increased medication use in the previous 12 months. The research team used this data to estimate the impact of long-term exposure to heavy traffic, particulate matter, and ozone.
The researchers also examined the link between asthma, exhaled 8-iso, and outdoor air pollution. A high concentration of 8-iso can cause contraction of the airway muscles, which makes it hard to breathe.
The study revealed that 8-iso concentration, high traffic intensity, and ozone exposure increased the risk factors in individuals who currently had asthma. Furthermore, the risk of future asthma was significantly increased by 8-iso levels and particulate matter.
“For the first time in adults, we found associations between long-term exposures to outdoor air pollution, exhaled 8-iso concentration and current asthma,” explained Havet.
“Based on this, we think that 8-iso is a marker related to one of the underlying biological mechanisms by which outdoor air pollution increases the risk of experiencing asthma symptoms, asthma attacks or the need for use of asthma medications.”
Even though air pollution is much lower in western Europe than in regions of Latin America or Asia, the levels are still threatening to respiratory and lung health.
“Efforts should be made to limit air pollution emissions, with more emphasis on moving towards cleaner cities with fewer cars and more efficient public...Read more..
Regular aspirin use was associated with a more than 50% reduction in emphysema/chronic obstructive pulmonary disease (COPD) progression in an elderly cohort over a decade in a longitudinal analysis of data from a large lung study.
The association was seen across aspirin doses and was greatest in older study participants with significant airflow obstruction.
"These findings, along with supportive results in animals, suggest that further study of aspirin and platelet activation in emphysema may be warranted," Carrie Aaron, MD, of Columbia University, New York City, and colleagues wrote in the journal CHEST.
They noted that platelet activation reduces pulmonary microvascular blood flow and contributes to inflammation, which has been shown to be important in the pathogenesis of COPD/emphysema.
"We hypothesized that regular use of aspirin, a platelet-inhibitor, would be associated with slower progression of emphysema-like lung on computed tomography (CT), and slower decline in lung function," the researchers wrote.
To test the theory, they examined data from the Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study, which assessed the percentage of emphysema-like lung below-950 Hounsfield units ("percent emphysema") on cardiac and full-lung CT.
Spirometry was conducted during 2004-2007 and repeated in 2010-2012 in accordance with American Thoracic Society-European Respiratory Society guidelines following the MESA Lung protocol; all exams were reviewed by one investigator.
At the time of the participants' first spirometry measurement, airflow obstruction was defined as pre-bronchodilator FEV1/FVC <0.70 and restrictive ventilatory defect as FVC<lower limit of normal and FEV1/FVC≥0.7.
Regular aspirin use was defined as 3 or more days per week and mixed effects models adjusted for demographics, anthropometry, smoking, hypertension, ACE-inhibitor use, C-reactive protein, sphingomyelins, and scanner factors.
The analysis included 4,257 participants from the MESA Lung Study. Their mean (±SD) age was 61±10 years, 54% were ever-smokers, and 22% used aspirin regularly.
Among the main findings:
On average percent emphysema increased 0.60 percentage points over 10 years (95% CI 0.35 to 0.94).
Progression of percent emphysema was slower among regular aspirin users compared to non-aspirin users (fully adjusted model: -0.34% per 10 years, 95% CI -0.60 to -0.08; P=0.01).
Results were similar in ever-smokers and for doses of 81 mg and...Read more..
The journey to better women's heart health starts with having more data, said Nanette Kass Wenger, MD, MACC, MACP, FAHA, professor of cardiology at Emory University School of Medicine, during the Simon Dack Keynote Lecture, which opened the 67th Scientific Session of the American College of Cardiology.
Years before “Go Red for Women” and the red dress pin became symbols of the campaign to end heart disease and stroke in women, Nanette Kass Wenger, MD, MACC, MACP, FAHA, wasn’t going red. For the Emory University professor of cardiology, it was more like seeing it.
Wenger, founding consultant of the Emory Women’s Heart Center, gave the Simon Dack Keynote Lecture to open the 67th Scientific Session of the American College of Cardiology, and her talk, “Understanding the Journey: the Past, Present, and Future of CVD in Women,” revealed the uncomfortable truth: recent declines in cardiovascular death (CV) for women have been possible because science is finally paying attention to them.
Back in the 1970s, when Wenger began educating the public about women’s vulnerability to heart attacks—and the effects of alcohol, smoking, and some medications—CV disease was seen as “man’s disease.” For example, the first conference for women on coronary heart disease by the Oregon Heart Association in 1964 had been about men, specifically husbands, and what wives could do to keep them healthy.
But the data didn’t lie. Starting in early the 1980s and peaking in 2000, the gap in CV deaths between men and women kept getting wider—as the new millennium started, about 500,000 women died each year, compared with about 440,000 men. Since then, numbers for both have fallen, and in 2013, the death total for women from CV causes fell below that of men, with both below 428,000. “We are delighted to be in second place, and we hope to stay there,” Wenger said.
It took a “paradigm shift,” Wenger said, and it started with the idea that medical research had to include women as research subjects to see if outcomes would be different in women. “This change in mindset—the advent of gender-specific medicine—has had a stunning outcome,” she said. Too often, Wenger said, the only studies specific to women were what she calls “bikini medicine,” those limited to the breast, ovaries, or the female genital area.
Conference Identifies Gaps
A breakthrough came in January 1992, when the National Heart, Lung, and Blood Institute...Read more..
But it's not really clear where the advantage comes from.
From cross-country skiing to speed skating, the Winter Olympics is full of breathless feats of endurance. And for a large number of Olympic athletes, the breathlessness isn’t just over who will win the next medal—it’s from asthma.
But if you think the condition could hold Olympians back, think again: Athletes with asthma are more likely to win medals than their competitors.
Up to one in four winter Olympians have asthma, a condition that constricts the airways and makes it difficult to breathe normally. That’s no surprise to John Dickinson, a professor at the University of Kent’s School of Sport and Exercise Sciences. He’s studied asthma in elite competitors for years and says that the number of athletes with the condition can skew even higher in endurance sports: up to 70 percent in swimmers and 50 percent in cross-country skiers.
Endurance sports might attract athletes who have asthma, he says, but they can also cause breathing problems in and of themselves. Normally, people breathe through their nose, which warms and humidifies the air, filtering out gnarly particles and noxious chemicals along the way. But during endurance events, says Dickinson, most athletes temporarily turn into mouth-breathers.
“You get unconditioned air going into the airway,” he says. This, in turn, wreaks havoc on the lungs, drying out their air sacs and fueling inflammation. Asthma can result—and as his research with athletes shows, it often does.
These athletes manage to make it to the Olympics despite all that wheezing and coughing, and even outperform challengers without asthma. That’s especially true during the Winter Games.
In a 2012 literature review, asthma expert Kenneth D. Fitch crunched the numbers. He found that during the Salt Lake City Winter Games in 2002, 5.2 percent of athletes had asthma, but that group won 15.6 percent of the medals. He observed the same effect in Torino in 2006 (7.7 percent of athletes with asthma won 14.4 percent of the medals) and Vancouver in 2010 (7.1 percent of athletes with asthma won 11.8 percent of the medals).
Could athletes’ asthma inhalers explain their dominance? Dickinson has spent years trying to find out.
Consider a salbutamol inhaler, one of the most common types. (You may know it as albuterol or Ventolin.) It’s a beta-2 agonist inhaler that relaxes the bronchial passages, making it easier for people with asthma to...Read more..
Your heart (and your patient’s hearts), one of the most important organs in your body, receives recognition this month. Not for all of the hard work it does each and every day pumping blood throughout your body, but to raise awareness of heart disease.
The American Heart Association reports that 1 in 3 Americans die from heart disease with 92.1 million adults living with some form of it. Show your heart some love this month by learning the risk factors and what you can do to lower risk.
While some factors, like genetics, aren’t modifiable or controllable, it’s important to protect yourself against heart disease by identifying your risks and assessing your health status.
“Being overweight, inactive, smoking, high stress, and family history increase the risk of heart disease and heart attack,” said George Waters, board certified cardiologist at Sturdy Cardiology Associates.
If you have an unhealthy diet chock full of saturated fat, salt and cholesterol, you’re putting yourself at risk for the development of heart disease and obesity. Even more so, if you don’t engage in physical exercise, you have an increased risk of high blood pressure, high cholesterol, risk of blood clots and heart disease.
It is incredibly important to embrace the goal of encouraging your patients to quit smoking and we can help. MD Spiro is here to work with you on your smoking cessation programs to help assist in having your patients quit for good this time!
Knowing the symptoms of a heart attack and identifying your risk are the first steps in prevention.
“You must also work to incorporate healthy lifestyle habits,” Waters said. “Eating a healthy low-saturated fat diet, getting regular exercise, quitting smoking, and seeing your doctor on a regular basis are all important steps in prevention.”
Be sure to include fresh fruits, vegetables, fish, whole grains, nuts and legumes into your diet while limiting sodium, sugar-sweetened beverages, processed meats and saturated fats.
Commit to a small goal of physical exercise each day — 30 minutes of aerobic exercise a day as well as strength and stretching workouts can improve heart health.
If you are a smoker, quit. Quitting smoking reduces your risk for heart attack each year you remain a nonsmoker.
As a primary care provider, it is important to market to your patients to schedule their annual exam and provide them the tools to quit smoking. These exams will provide the monitoring...Read more..
Moving chronic obstructive pulmonary disease (COPD) patients from hospitals to their homes could improve the sustainability of Canada’s health system while improving individual outcomes, says the Canadian Foundation for Healthcare Improvement (CFHI).
Data from health systems participating in the INSPIRED study conclude that offering Canadian COPD patients the right support services in their homes improved their quality of life while reducing hospital readmissions by 64 percent and emergency room visits by 52 percent.
“Too often, people with chronic diseases like COPD end up in hospital because the care they need is not available in the community,” CFHI President Maureen O’Neil said in a news release. “INSPIRED provides the services patients and their families tell us they need to manage their disease outside of hospital, and now we are expanding this innovative collaboration to benefit more patients.”
INSPIRED was developed at Capital Health in Halifax, Nova Scotia, to help patients manage their illness more effectively in their homes and communities. It is based on extensive input from patients and caregivers, and relied on specific healthcare teams that identified COPD patients who were able to participate in the program.
Those selected received written action plans for managing their COPD, phone calls after every discharge and at later intervals, at-home self-management education and psychosocial support, and advanced care planning when necessary. Patients were also given a phone number to call for support.
That approach has slashed emergency-room visits and hospital readmissions among more than 2,000 COPD patients in the provinces of Alberta, Manitoba, New Brunswick, Nova Scotia, Ontario and Prince Edward Island since the program’s establishment in 2014-15.
“These results are important because they show we can keep people with chronic disease out of the hospital by partnering with them to reinvent the way we deliver care so it meets their needs,” said Maria Judd, vice president of programs at CFHI. “All Canadians who use and pay for the healthcare system — not just those with a chronic disease — will benefit from the emergency department and hospital bed capacity this approach will free up as it spreads across the country.”
The economic cost of asthma in the United States is nearly $82 billion a year, federal health officials report.
That figure includes medical expenses and costs associated with work and school absences and deaths.
However, the true cost of asthma is probably underestimated because the U.S. Centers for Disease Control and Prevention study did not include people with untreated asthma.
The new analysis was based on federal government data, collected from 2008 to 2013. It showed that about 15.4 million people were treated for asthma each year. The annual per-person medical cost of asthma was $3,266.
Of that per-person amount, $1,830 was for prescriptions, $640 for office visits, $529 for hospitalizations, $176 for hospital outpatient visits and $105 for emergency room care.
Asthma-related deaths cost $29 billion a year, with an average of 3,168 deaths a year.
Asthma resulted in 8.7 million lost work days and 5.2 million lost school days a year, for a combined annual cost of $3 billion.
The findings were published online Jan. 12 in the Annals of the American Thoracic Society.
"The cost of asthma is one of the most important measures of the burden of the disease," study lead author Tursynbek Nurmagambetov, a health economist at the CDC, said in a journal news release. "Cost studies can influence health policy decisions and help decision makers understand the scale, seriousness and implications of asthma so that resources can be identified to improve disease management and reduce the burden of asthma."
The findings show "the critical need to support and further strengthen asthma control strategies," Nurmagambetov said.
The U.S. National Heart, Lung, and Blood Institute has more on asthma.
Annals of the American Thoracic Society, news release, Jan. 12, 2018