COPD often associated with muscle wasting

Because of their limited ability to move about, it is fairly common for patients with chronic obstructive pulmonary disease (COPD), particularly those with end stage COPD, to develop muscle wasting, further compounding the ability to live a normal life with this disease.

Muscles of the upper and lower bodies, such as those of the arms, shoulders and legs, become atrophied because many of these patients are required to adapt to a sedentary lifestyle in order to reduce or prevent dyspnea.

When the muscles of the lower limbs become atrophied, this impairs the ability to walk or climb stairs.  It also limits the ability to gain the exercise necessary to make the heart and lungs stronger, thus diminishing dyspnea with exertion.

Muscle wasting also increases fatigue, making it difficult to even do simple tasks. The bottom line here is that patients with COPD should, from the time of diagnosis, make an effort to stay as physically active as possible in order to prevent muscle wasting, or to slow the process thereof.

References:

1. Foschini Miranda, Eduardo, Carla Malaguiti, Paulo Henrique Marchetti, and Simone Dal Corso, "Upper and Lower Limb Muscles in Patients With COPD: Similarities in Muscle Efficiency But Differences in Fatigue Resistance," Respiratory Care, January, 2014, volume 59, number 1, pages 62-69

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The latest wisdom on mucolytics

We don't see much mucomyst being ordered anymore here at Shoreline. Of all the days I've worked, I can only remember one patient since January who was ordered to get 1cc of Mucomyst with every other breathing treatment.

This observation of mine makes sence, considering a recent review of Mucomyst, according to this Medscape.com, "Best Evidence Review: Mucolytics -- An Update on Their Use in COPD: Discussion," notes that the rate of Mucolytic (such as Mucomyst) has declined by as much as 50% since a previous review in 1996.

The reason for this, as the article notes, "Two significant factors may have contributed to the apparent decrease in efficacy of mucolytics over the years. First, the quality of the studies has improved, with larger trials completed recently. Second, the routine use of inhaled corticosteroids may have blunted the effect of mucolytics in improving COPD outcomes."

Still, studies have consistently shown that the use of mucolytics may reduce the risk of COPD exacerbations by as much as 56%, and "significantly effective in reducing patient symptoms," according to the review.

The article concludes that, "Nonetheless, mucolytics can be a safe, effective, and inexpensive option to improve chronic bronchitis and COPD. The collective research suggests that mucolytics do not need to be used year-round. They might be most effective among more symptomatic patients and used in anticipation of more exacerbations during the winter. Mucolytics might also be particularly helpful for patients who are intolerant of inhaled corticosteroids or have difficulty with handheld inhalers. Overall, mucolytics deserve consideration to improve the lives of patients with COPD and chronic bronchitis."

I know we RTs tend to complain when the pulmonary toilet is ordered, yet there continues to be supportive evidence that at least Mucomyst shows some merit as an effective therapy for treating COPD patients.

Vitamin E shown to reduce risk of COPD

Of all the patients we RTs care for in the hospital setting, a majority are COPD patients. That's not a coincidence, as in the year 2000 it was responsible for the deaths of 2.74 million people, and by the year 2020 the World Health Organization predicts COPD to be the leading cause of death in the World.

While smoking is a leading cause of COPD, many are being diagnosed with this disease, or asthma, due to the high amounts of air pollution, both man made and natural occurring. So while the number of people who smoke is declining, the number of those being diagnosed with some type of COPD is still increasing.

Yet new research shows that "supplementing" your diet with Vitamin E may reduce your risk of developing COPD or of your COPD worsening with time. In fact, a recent randomly controlled study showed this reduction was as much as 10%.

This article from NaturalNews.com, notes that it's not easy to get enough Vitamin E from our normal diet, so taking a Vitamin E supplement is essential. Likewise, the post notes you can get Vitamin E from the following food sources:

• Almonds
• Apples
• Broccoli
• Carrots
• Kiwi
• Peanuts
• Spinach
• Sunflower Seeds
• Vegetable and Seed/Nut Oils (sunflower oil, almond oil, olive oil, palm oil, peanut oil, etc.)

Vitamin E is essential to our bodies because free radicals get into our bodies via cigarette smoke and pollution in the air, such as "burning fuels in smokestacks, car exhaust pipes or house chimneys or from the formation of ground level ozone during hot weather," according to fellow asthma expert. Kathi MacNaughton in her post, "Are We at Risk From Free Radicals in Our Air?"

A free radical is any electron that has a single unpaired electron in its outer shell, and when it gets into our body it does whatever it needs to do to get what it needs. This can often result in disease formation in the human body, such as asthma or COPD.

Kathi notes our bodies don't have a defense mechanism against free radicals. Although antioxidents are known to interact safely with free radicals and "stop their action before vital cells are damaged." And, she notes a major source of antioxidents is vitamin E, C and beta carotene.

So while this new wisdom is still in the study phase, if you have a family history of lung disease, you may want to think about supplementing your diet with vitamin E.

COPDers should avoid wood smoke

A new study shows that patients who inhale both cigarette smoke and wood smoke have their risk for developing worsening COPD by a fourfold amount.

The study was first released in the online version of American Journal of Respiratory and Critical Care Medicine and reported on again at m medicalnewstoday.com, "Wood Smoke Exposure Multiplies Damage From Smoking increases Risk of COPD."

Inhaled smoke can be first or second hand, and wood smoke can be used for home heating or cooking or can be inhaled in the ambient air from other homes or businesses in the area. Either way, science already shows that the chemicals of cigarette smoke can damage the lungs and cause COPD.

Yet science now shows that inhaling wood smoke is "likely to (cause) epigenetic changes in the DNA that further increase their risk of COPD and related pulmonary problems," the medicalnewstoday.com article notes.

Dr. Yohannes Tesfaigzi and his colleagues studied sputum samples of over 1800 COPD patients and used their smoking and demographic information to come to their conclusion. They studied the eight genes known to be associate with lung cancer.

The medline article notes "They found that wood smoke exposure was significantly and independently associated with an increased risk of respiratory disease, especially among current smokers, non-Hispanic whites and men. Furthermore, wood smoke exposure was associated with specific COPD outcomes in people who had aberrantly methylated p16 or GATA4 genes, and both factors together increased the risk more than the additive of the two risk factors together. They also found that people with more than two of the eight genes analyzed showing methylation were also significantly more likely to have a lower than predicted FEV1 than those with fewer than two methylated genes."

This study is significant because not only does it prove there is a genetic link to developing COPD, it likewise provides evidence to COPD patients that if they smoke they should avoid heating their homes with wood. Likewise, it's evidence physicians and COPD experts can use to convince their patients to not heat their homes with wood, especially if the patient is a smoker.

Other studies also showed that inhaling cigarette smoke and wood smoke together increased the risk for worsening COPD as compared to inhaling just cigarette smoke or inhaling just wood smoke.

"We observed increased inflammatory response in mice that were exposed to both cigarette smoke and low concentrations of wood smoke compared to those exposed to cigarette smoke only. We would like to use this animal model to determine the mechanisms underlying this exacerbation," said Dr. Tesfaigzi.

COPD Wisdom

Sources for COPD Wisdom:

1. COPD blogs and resources
2. Related blogs and recommended links
3. COPD Connection.com
4. COPD Lexicon
5. COPD FAQ
6. The Sputum Lexicon
7. The PFT Lexicon

Medicine:

1. Lung Medicine Lexicon (coming soon)
2. MDIs: Priming the pump
3. How heart failure is treated
   

Basic COPD Wisdom:

1. What causes COPD? .
2. What is COPD? (Click here for more)
3. Early warning signs of COPD
4. Signs of COPD related anxiety and depression
5. The COPD Action Plan
6. COPD FAQ
7. What causes COPD exacerbations?
8. Severe or end stage COPD
9. What is heart failure (CHF)
10. Tips for living with end stage COPD
11. How should COPD be treated?
12. Here are signs of worsening COPD
13. Life expectancy of COPDers
14. Life expectancy of CHF
15. COPD medicines
16. What is a blue bloater
17. COPD more common that previously thought
18. Most people who smoke are not evil

Facts and tips about smoking:

1. 20 Reasons to quit smoking
2. More good reasons to quit smoking
3. Smoking is no longer the IN thing
4. 20 reasons to quit smoking if you have asthma

Interesting facts about COPD:

1. Are bronchodilators safe: a q&a about Ventolin and Atrovent
2. How do I know how much lung damage I have?
3. Some basic facts about COPD you should know
4. Asthma or COPD: Which one do you have?
5. Types of airflow obstruction (Asthma, emphysema, bronchitis, or a combination)
   
6. The link between asthma and COPD
7. Myth busted: Influenza does not cause nausea!
8. Everything RTs need to know about pneumonia
9. What is CPAP and BIPAP?
10. Asthma/COPDers should avoid pop & beer
11. The hypoxic drive theory: Why do we breathe?
12. The hypoxic drive theory: debunked
13. The Hypoxic Drive Theory: completely debunked
14. The hypoxic drive theory: Should be still taught
15. The hypoxic drive theory: The CO2 retainer
16. The hypoxic drive theory: reality or simply a hoax?
17. Furosimide nebs may decrease COPD dyspnea
18. "I'm not sorry I have COPD," she said
19. Pneumonia: Here's how you can prevent it
20. New drug combo may greatly benefit COPDers
21. It's time to excercise!!! (COPDers should exercise too!)
22. Bronchospasms don't always wheeze
23. I'm featured on COPD News of the Day
24. My Q&A with Roxlyn Cole, a COPD patient
25. New hope for those who want to quit smoking
26. Are we prolonging life, or delaying death???
27. No Vent, DNR, or full code: what's your choice?
28. What's it like to be intubated?
29. Inhaled steroids don't cause pneumonia
30. COPD associated with anxiety, depression
31. Types of airflow obstruction
32. CTs may lead to early COPD intervention
    

Types of COPDers and Inspsirational stories:

1. The 5 types of COPD patients
2. Mrs. Flowers and her quilt
3. Neil Cavuto chooses to enjoy life, despite illnessess
4. The God fearing patient