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Monday, April 25, 2016

Wood Smoke Linked to COPD and Asthma

The following was originally published at healthcentral.com/asthma. 

Wood fires have been used for heating and cooking for most of history. Even today they continue to be used, sometimes for fun and entertainment, although often as a much needed source of heating and cooking. The problem, though, lies in the smoke created, which has now been linked to asthma and COPD.

What is wood smoke?  

Well, most poeple know what wood smoke is.  Still, the technical name for wood smoke is biomass smoke.  Biomass is fuel created from living or recently living organisms, such as trees, plants, animal dung, charcoal and coal. Biomass smoke comes from wood stoves, fireplaces, campfires, wildfires, and leaf burning.  It also comes from cigarettes and cigars.

Biomass contains carbon, hydrogen and oxygen. Biomass burning, called combustion, results in a series of chemical reactions that turn carbon, hydrogen and oxygen into carbon dioxide, water and heat. However, due to incomplete combustion, the reaction also releases pollutants into the smoke created.

These include:
  • Harmful Chemicals.  These include carbon monoxide, formaldehyde, benzene, toluene, acrolein, methane, and methyl chloride.  These may irritate cells lining your respiratory tract to trigger asthma attacks and COPD flare-ups.
  • Particulate Matter.  These are solid and liquid particles of incompletely burned wood, many of which are small enough to be inhaled deep into airways. Like chemicals, they may also irritate cells lining your respiratory track to trigger attacks and flare-ups. 
What do the studies show?  

A great deal of studies have pretty much confirmed the link between wood smoke and respiratory diseases like asthma and COPD. As a matter of fact, wood smoke may trigger asthma attacks and COPD flare-ups, and it may also cause asthma and COPD, just like cigarette smoke does.

Studies have also linked inhaling wood smoke with:
  • Small birth weight, which has also been linked to asthma and to COPD
  • Respiratory infections like pneumonia, which may trigger asthma and COPD
  • Lower respiratory tract infections in children, including pneumonia and bronchiolitis, which are also linked with the development of lung disease later in life
  • Increased incidence of strokes and heart problems
  • Eye disease, as smoke also irritates cells lining your eyes
  • Cancer, such as lung cancer
  • Headaches
How does wood smoke cause respiratory complications?

Acute Exposure. Inhalation of certain chemicals and particulate matter may irritate airways, triggering an immune response.  This sets off a series of chemical reactions that cause cells lining airways to become inflamed.  This irritation results in asthma and COPD symptoms like wheezing, coughing, and shortness of breath.

Chronic Exposure.  Exposure to biomass smoke day after day after day may cause this inflammation to become chronic, such as what occurs in asthmatic airways. Chronically inflamed airways may also cause scarring that makes airways thicker.  It may also result in loss of lung tissue. These are patterns that result in airflow limitation, or COPD.

What circumstances increase your risk for developing health problems due to smoke inhalation?  

Cold Weather.  Molecules in hot air are farther apart, and so warm air tends to rise. This makes it so smoke created from a campfire on a warm summer day is likely to rise away from people, and therefore is less likely to cause problems. Molecules in cold air are bundled together, and so cold air tends to stick near the ground. So smoke on a cold day tends to linger near the ground and is more likely to be inhaled. So, if you have a lung disease, some alternative source of heat may be beneficial.

Enclosed Spaces. During winter months, when it’s cold outside, people tend to keep their windows and doors shut. This makes it so wood smoke lingers inside homes, increasing the likelihood of it being inhaled. One study actually showed that women who spent years cooking over wood fires had an elevated incidence of respiratory complications. So it’s best to avoid using wood stoves and fireplaces, although if you must use them, keep a window open to improve ventilation.

Neighborhoods.  Of course if you have a wood stove or fireplace in your home, you are at the greatest risk of inhaling wood smoke.  However, if you do not burn wood in your home and your neighbor does, smoke may enter your home even with closed windows and doors.  This may be especially true on cold days. Some neighborhoods may solve this problem with bans on wood stoves and fire pits.

Poverty.  Wood heat is convenient and it’s also relatively inexpensive. This is nice for people in poverty, and it’s also nice for people in underdeveloped countries. Unfortunately, this also leads to indoor air pollution and an increased incidence of the complications of inhaling it. About three billion people continue to heat and cook using biomass fuel.

What does this mean?  Surely this may be difficult for some people, although it basically shows the need to limit exposure to wood smoke, especially if you have a family history of respiratory diseases, and especially if you already have a diagnosis of asthma or COPD. Alternative sources of heat, include gas, electricity, and heating oil. 

References and further reading:

Saturday, April 23, 2016

My theory why small, regional hospitals are disappearing

During the course of the past ten years many smaller hospitals have either closed their doors or merged with larger hospitals. There are various reasons for this, but I think one of the main reasons is corporate cronyism. It's always existed to a certain degree, but it has been put on steroids since during the Obama administration. This is not a criticism of Obama, it's just an observation.

Okay, so money has always played a significant role in politics. You will always have corporations that make a lot of money, everybody always wants more (I don't care who you are) and the lure of making more money is always seductive. 

Now, I don't have a problem with corporations making lots of money, and I never will.  I believe there is plenty of money to go around, enough so that every person, every corporation, in the world could be rich if they made the effort; if they sacrificed their time, and took the risks.  I mean, that's what American Exceptionalism is all about. 

So you have corporate cronyism, or socialist cronyism, or capitalist cronyism, or whatever you want to call it.  This is where large corporations, those with a lot of money like Walmart, send lobbyists or consultants to Washington to make sure laws are passed that benefit them; laws that might help them make more money. 

It is in this regard that Walmart supported a higher minimum wage.  Walmart executives know that they can afford the higher wages, while many of their smaller competitors may not be able to afford it.  In this way, Walmart is able to beat their competitors without having to beat them in the marketplace.

In other words, even if Walmart competitors have a better product, Walmart can beat them because it can afford to make deals with politicians, while their competitors cannot. (Ironically, Walmart's profits have stagnated, and they are now blaming the minimum wage hike.  Go figure!)

This is the same in healthcare.  You have large hospital groups that can afford to send lobbyists and consultants to Washington. They can afford to make deals with politicians. They give thousands of dollars to this politician, or that politician.  They even support laws that they otherwise would not support because they know they can afford it.  

For instance, Obamacare has required hospitals to hire 20 or 30 new people just to make sure they are in compliance with all the new regulations. They can afford to make all the changes that are required, while their competitors cannot.

Not helping here is that Obamacare made it easier for hospitals to merge, almost encourages it.

Because they cannot afford it, smaller hospitals have had to make decisions to either close shop or be bought our or to merge.  It is by this means that large hospitals have become larger, and smaller, regional hospitals have become a thing of the past.

I'm not saying here that I agree with Obamacare or not, this is just what is happening, or has happened. Money is important to get elected and re-elected. Money is important to get your agenda passed, and right now, like it or now, Obama is selling. 

Buying laws is important to benefiting your business.  So, so long as this is legal, it will continue to occur. And, like it or not, it has occurred under the Obama administration more so than in the past.

Further reading:

Thursday, April 21, 2016

Why healthcare costs have increased since 2010

So large hospital groups have succeeded in beating out the competition by supporting big government, which in turn creates laws that create regulations that smaller hospitals cannot afford. This, in turn, causes their competitors to either close their doors, or they have no choice but to merge with the larger groups. This, in turn, has resulted in higher healthcare costs.

This is contrary to the promise that healthcare costs would go down under Obamacare. Yet Obamacare has made it easier to merge, and easier to charge high prices. In fact, Obamacare almost encourages it through incentives. Check out here some quotes from Forbes.com.

This has had a great impact on the healthcare industry.  This is how larger hospitals have beat out their competition -- gobbled up the competition -- without even having a better product, or regardless of having a better product.

Here's a quote from Forbes:
The average day spent in a U.S. hospital costs five times as much as it does in other industrialized countries. That’s not because U.S. hospitals use higher technology or better care. It’s because they charge more for the same technology and the same care. Because they can get away with it.
Making matters worse, as I noted above, is that Obamacare encourages hospitals to merge, giving hospitals an even greater incentive to charge higher prices. This is due to less competition. According to Forbes:
The next thing Obamacare does is it encourages hospitals to merge, thereby giving hospitals even more market power to charge even higher prices. A study by Jamie Robinson of the University of California found that highly concentrated hospital markets–where one or two hospitals controlled most of the patient volume—hospitals charged an average of 41 percent more for common procedures than they did in more competitive markets.
Furthermore, as noted by Forbes, since Obamacare there has been a spike in hospital mergers. Forbes noted:
The spike in hospital mergers is being driven by two things. The first is that Obamacare expands government-sponsored insurance, like Medicaid. Government insurance pays less than private insurance pays, so hospitals seek to merge so they can gain more leverage on private insurers to charge whatever they want. In 1993, for example, Harvard’s two main hospitals—Massachusetts General and Brigham and Women’s—merged, and immediately began jacking up prices to the privately insured and uninsured populations.
The second is that Obamacare creates a government program, called Accountable Care Organizations, whose explicit goal is to encourage hospitals to consolidate the provider industry, thereby giving them more leverage to charge higher prices. In 2011, a Federal Trade Commissioner called attention to this problem, noting that “the net result” of ACOs “may therefore be higher costs and lower quality health care.”
Some say that the best way to bring down prices is for Obamacare to add price controls. Although all that would do is cause hospitals to stop offering services that are under priced offer procedures that are over priced.

The real resolution to this problem is to try increasing competition, something that has never been tried in healthcare. This would entail breaking up the large hospital groups with antitrust proceedings, loosening up restrictions on hospitals, repealing Obamacare, and allowing the sale of health insurance and hospital services across state lines. This would get hospitals and insurance groups to compete with one another, and the ones that offered the best quality service at the lowest price would prevail.

Further reading:

Monday, April 18, 2016

Fetal Origins Hypothesis: Mother’s Environment May Cause COPD

Originally published at healthcentral.com/copd

Researchers are working overtime to learn what causes COPD. The Fetal Origins Hypothesis suggests it all begins in the uterus as the fetus adjusts to its environment. Such adjustments may predispose the fetus to chronic diseases like asthma and COPD later in life.  

During the 1950s and 1960s, physicians thought the placenta was a natural barrier that protected unborn babies from the mother’s environment; that it protected the fetus from anything bad ingested or inhaled; that it only allowed good substances, such as essential nutrients, to get to the fetus.

It was based on this old theory that caused physicians, or at least many of them, to remain indifferent to a mother’s nutritional status.  If anything, it was prefered they didn’t gain too much weight. Physicians also remained unconcerned about mothers having a few drinks or inhaling cigarette smoke. In fact, during the 1960s, about half of expectant mothers reported smoking cigarettes.

However, by the 1990s an abounding amount of evidence started to show that this theory was probably poppycock, that the placenta was not a natural barrier, and that anything the mother inhaled or ingested could have a major impact on the growth and development of the fetus, especially during the first trimester.  

In 1992, Dr. David J. Barker became the first person to seriously consider this new evidence. He postulated that undernourished infants tended to have small birth weights and were likely to have trouble with obesity later in life. This became known as Barker’s Hypothesis. This hypothesis was later expanded upon to include other chronic diseases, and is now referred to as the Fetal Origins Hypothesis.  

Barker believed inadequate nutrition programmed the fetus’s to develop metabolic changes that would predispose the unborn baby to chronic diseases later in life. Others suspected gene mutations leading to physiologic and metabolic changes that prevent the child from reaching a healthy birth weight.  

A good example here is COPD. The hypothesis suggest that changes made in utero as fetus’s attempt to adapt to their mother’s environments cause airway changes that prevent these children from obtaining peak lung function by early adulthood.  It is these children who are most likely to develop COPD when chronically exposed to harmful substances in the air.

Subsequent studies have linked small birth weights with decreased lung function and increased risk for respiratory symptoms (wheezing, shortness of breath) in childhood.  Other studies have small birth weights with the development of asthma later in life. It should also be understood here that researchers suspect up to 15 links between asthma and COPD.

There exist other interesting facets of this hypothesis. For instance, it suggests that the nine months in utero are the most critical in a person’s life.  It suggests that the mother’s environment may have a significant impact not just on the development of chronic diseases later in life, but also on a child’s future life, maybe even determining the child’s level of intelligence and future abilities.  

While it’s just one hypothesis, it seems to be well accepted by the scientific and medical communities. It shows the importance of ingesting a healthy diet and inhaling healthy air on the future health and abilities of unborn babies. Perhaps future research in this regard will lead to an end to diseases like asthma and COPD.

Here are my references and some further reading you may enjoy:

Here’s 10 Potential Causes of COPD

The following was originally published at healthcentral.com/copd. 

Studies suggest that about 95% of people who develop COPD are current or former cigarette smokers. Still, evidence suggests that smoking is not the only risk factor, and that people who have never smoked may still develop COPD. Here are ten risk factors for developing COPD.

1  Smoking Cigarettes.  It’s not so much the nicotine, but the 5,000 chemicals in cigarette smoke that cause all the harmful effects of smoking, including the destruction of lung tissue and the loss of lung function. In fact, studies show smoking is harmful to the smoker and anyone else who happens to inhale it -- including children, and even fetuses.

2   Genetics.  I previously discussed the impact of genetics on COPD.  The general idea is that repeated exposure to certain substances in the air, such as chemicals in cigarette smoke, may cause airway changes that result in COPD. Certain genes may also increase the risk of developing COPD, especially when exposed to environmental triggers like cigarette smoke.

3.  Aging.  Some people develop senile emphysema, which is the slow but natural breakdown of lung tissue as one gets older. Studies suggest this is probably caused by increased air spaces in the lungs due to natural causes, and not due to inflammation caused by chronic exposure to pollutants.

4.  Gender. Older studies showed that men were more susceptible to COPD than women, although this may have been due to the fact men were more likely to smoke.  Modern evidence may actually suggest that women are more likely to develop COPD than men. You can learn more by reading our post Why Women Are at Higher Risk for COPD Than Men.

5.  Lung Maturity.  Studies seem to suggest that anything that negatively impacts lung growth at or near birth may contribute to the development of asthma or COPD later in life. Premature birth, small birth weight, and severe lung infections have all been linked with the development of asthma and COPD. Generally, small birth weight is considered less than five pounds.

6.  Wood Smoke.  Smoke produced from wood stoves, fire places, wildfires, campfires, and cigarettes contains microscopic particles and toxic chemicals that can easily be inhaled deep into the lungs. These particles are believed to damage airways leading to loss of lung function over time. 

7.  Chemicals.  Chemicals from common household cleaners, or those produced at work, may easily be inhaled deep into airways.  Chronic exposure may result in airway changes that cause a gradual loss of lung funciton. Harmful chemicals are also in cigarette and wood smoke.  

8.  Poverty.  Some studies show an inverse relationship between income and COPD, with those in poverty more likely to develop it. No one knows the exact reason, although exposure to outdoor and indoor air pollution at home or work may be a contributing factor. Stress may result in risky behavors, such as smoking cigarettes and taking high risk jobs, both of which increase exposure to high risk chemicals that are linked to lung disease. To learn more, read our post “7 Links Between Poverty and COPD.”

9.  Asthma. Asthmatic airways are chronically inflamed and over-sensitive to asthma triggers, such as dust mites, mold spores, pollens, cockroach urine, and other microscopic substances that get into the air inhaled.  Studies suggest that repeated and uncontrolled asthma may lead to airway changes and the development of the Asthma COPD Overlap Syndrome, otherwise known as Severe Asthma.  Other studies suggests those diagnosed with asthma have a 10% greater chance of developing COPD than those without asthma.

10.  Chronic Bronchitis. This is defined as chronic cough and increased sputum production at least three months a year for two straight years. It may exist without loss of lung function, and without the presence of emphysema.   Still, evidence exists that the accumulation of mucus may obstruct airways leading to loss of lung function and shortness of breath. Evidence suggests that those who continue to smoke after a diagnosis of chronic bronchitis are at increased risk for developing COPD.  

10.  Infections.  Severe lung infections early in life may cause airway changes that  lead to loss of lung function and increased shortness of breath later in life. Actually, various studies have linked severe lung infections early in life with asthma and COPD.

Continuing Education.  As researchers learn more, there may be more added to this list of things that might potentially cause one to develop COPD. Such knowledge may be key to preventing chronic lung disease in the future.

You may also enjoy reading:

Tuesday, April 12, 2016

Studying Asthma: You'll Be Impressed What Researchers Are Learning

Originally published at healtahcentral.com/asthma

Researchers are working overtime in their quest to find better treatment options for asthmatics. Here are some of the latest discoveries. We think you'll be impressed!

Key protein discovered.  Researchers at the University of Leipzig believe they found a “key molecule” responsible for allergic asthma. The molecule is called protein syndecan-4, and is found in the cell membrane of antigen presenting cells. The hope is further research in this regard will lead to better medicines or cures for allergies and asthma.  

Root cause of asthma discovered. Using mouse models of asthma and human airway tissue, researchers at Cardiff University believe the calcium sensing receptor (CaSR) is the "potential root cause of asthma."  

It was already known that asthma triggers release chemicals that activate sensory neuro airways leading to airway twitchiness, inflammation, and narrowing. This leads to asthma symptoms such as wheezing, coughing, and shortness of breath. Missing was the link between triggers and inflammation. 

Activation of CaSR appears to be the missing link. They believe drugs already exist, called calcilytics, to manipulate CaSR proteins to reverse the asthma response. They believe this should prevent asthma symptoms, preventing the need for rescue inhalers. 

It appears the only thing standing in the way of this treatment option is funding for research. Once funding is locked down, researchers believe calcilitics may be an option for asthmatics in about five years. 


Asthma cells move.  Epithelial cells are the cells lining airways. Normal epithelial cells “are pentagon-shaped and are jammed -- they hardly move at all.”  Up until now researchers believed asthmatic epithelial cells were the same.  However, the results of a study conducted at Harvard T.H. Chan School of Public Health show asthmatic epithelial cells are “unusually shaped and scramble around like there’s a fire drill going on.”  

Does the asthma process cause cells to become jammed, or does the jamming cause asthma? Hopefully, the quest to answer these questions will lead to better asthma wisdom and treatment. 

Source: Harvard Gazette: Asthma Cells Scramble Like ‘There’s a Fire Drill.’ (Check out this link to see asthma cells scramble)

Exercise key to good asthma control. Researchers in Montreal, Canada, studied 66 adults with poorly controlled asthma. They were divided into two groups: those who participated in supervised aerobic activities, and those who did not.

The results showed that those who exercised at least 30 minutes per day had better asthma control compared to those who failed to exercise. Dr. Salter might be smiling down upon us, as he was the first to recommend exercise to control asthma way back in 1860.


Asthma controller medicine safe for baby. Most asthma experts teach that the risks of uncontrolled asthma on a fetus are far greater than the risks of the medicines used to treat and control asthma. A study released in July, 2015, seems to confirm that asthma controller medicines are safe for baby.


Learning the impact of severe asthma. Severe asthma is a subtype of asthma that has been studied extensively in recent years. It’s a subtype of asthma that affects 5-15 percent of asthmatics.  It consists of airways that are chronically narrowed and less responsive to asthma controller medicines, like inhaled corticosteroids.

Results of a survey released in September showed the true impact of this disease on those who have it. Of 850 severe asthmatics in Europe surveyed, 25 percent reported symptoms on a daily basis, and 71 percent reported symptoms at least weekly. Likewise, 32 percent said it affected their social life, 23 percent said it affected their working life, 18 percent said it affected their family life, and 17 percent said it affected their sex life.

This spotlights the ongoing need to continue the quest to learn more about this asthma subtype. 


What can we take away from all this?  As an asthmatic myself, it’s neat to see that researchers are learning so much about our disease. If any of these can eliminate to carry rescue inhalers, that would be a major plus for asthmatics. We'll keep you posted as we learn more. In the meantime, the future for asthmatics looks bright.

You may also enjoy reading:


7 Reasons Childhood Asthma Seems To Go Away

Originally published at healthcentral.com/asthma

Many childhood asthmatics seem to get better with age.  Sometimes asthma attacks come less often, or are less severe.  In some cases asthma may seem to go away altogether, or to go into remission.  Here are seven reasons to explain this phenomenon.

1  Testosterone.  Asthma in boys often improves during teenage years. One theory for this suggests this may be due to an increase in testosterone levels. Testosterone (or one of its metabolites) may have an influence over the abnormal immune response that causes asthma.

2  Communication. Because you cannot see how other people feel, some parents have a hard time recognizing asthma in children. Making this worse, children are often poor communicators of how they feel.  As they grow older and mature, children become better communicators, and this makes asthma easier to both diagnose and treat.  

3  Medicine. For liability reasons, few studies are done to show the impact of asthma medications on children under the age of 12.  For this reason, some physicians are afraid to prescribe some medicines for children.  For instance, Advair helps many adults obtain optimal asthma control, although pediatricians may be hesitant to allow their patients to try it. Once children get older, this becomes less of a problem.

4  Compliance.  Let’s face it, it’s not easy to get children, especially smaller children, to take medicine. In fact, it’s hard to get kids to take medicine when they feel sick, let alone when they feel well.  Since asthma controller medicines must be taken every day, this may pose a problem for many childhood asthmatics.  As children mature, they learn the importance of taking their medicine the right way every day.

5.  Triggers.  Children are more likely to hang out in places where asthma triggers are most likely to be.  For instance, children play in musty basements, on dirty floors, in forests, in the weeds, etc. As children mature they are more likely to get away and stay away from their asthma triggers.

6.  Airways. Children tend to have smaller, more sensitive airways. This canmake them more brittle, or more likely to become obstructed. As children go through puberty their airways become larger and less sensitive to asthma triggers.  Surely asthma attacks may still occur, but they may tend to be less severe than during childhood.

7.  Sensitivity.  Asthmatic airways tend to be chronically inflamed, making them hypersensitive to asthma triggers.  Even a slight exposure a trigger (such as dust mites) may cause an asthma attack.  As lungs mature, this inflammation may lesson to such a degree that airways become less sensitive.  This may make asthma episodes so minor, or so non-existent, that asthma may appear to go into remission, or to go away altogether.

7.  Maturity.  As children mature they are better able to communicate how they feel, more likely to be compliant with their medicine, and to avoid their asthma triggers.  This alone may result in better asthma control.  As children mature they also become better capable of communicating with their asthma doctors, something that is essential to good asthma control.

It’s important to understandthat asthma never really goes away.  Even if it seems you no longer have it, you still do.  So it’s essential to continue seeing your asthma doctor at least once a year, and to never stop taking your asthma controller lmedicines without your doctor's approval. 

Further reading: