The primary cause of chronic obstructive pulmonary disease or COPD is smoking tobacco. Studies continue to show that people who suffer from COPD have a much more difficult time with smoking cessation. Smoking cessation is the only real way of slowing down the progression of the disease. The sooner someone stops smoking, the slower their disease will progress.
A recent study out of Nicotine and Tobacco Research looked at the ability of certain front line smoking cessation aids to meet with this COPD challenge. The primary outcome measured was continuous abstinence rates from 9 - 24 weeks, or between 2 and 6 months of smoking cessation. They found that severe and very severe COPD patients were primarily male. Interestingly, this large subgroup of the study population had a very high physical addiction to nicotine.
The results show a continuous abstinence rate between weeks 9-24 to be 48.5%. So just slightly less than half were able to stay nicotine free between the study period of 9-24 weeks. The abstinence rate differed according to type of stop smoking aid utilized.
Nicotine replacement therapy (NRT) had a 38.2% cessation rate. It also had the fewest recorded side effects. However, the dreaded psychiatric symptoms sometimes reported were rare in all stop smoking methods studied and evenly distributed across all groups. Bupropion (Zyban) had a quit rate of 55.6%, while varenicline (Chantix) had the highest cessation rate of 58.3%.
This study only points out the difficulty associated with smoking cessation in someone who is afflicted with a multi-dimensional disease like COPD. This disease carries with it many other complicatiang diseases which affect the physical, emotional and psychiatric status of the sufferer. It is no surprise that something more than simple nicotine replacement was needed to help these people break the cycle of nicotine dependence.
People often ask, " is nicotine bad for you?" I think the answer is pretty evident. The dependence creates a continuous assault on the health of your body. Then you suddenly wake up 30-40 years later with a disease, or more than likely, a mix of diseases, that affects everything from how you breathe, to how far you can walk each day.
According to this study though, it's not too late. You can still quit, despite your disease status. So get some help and do the right thing, for yourself and for your family.
Showing posts with label COPD. Show all posts
Showing posts with label COPD. Show all posts
COPD Medications Help
A recent study seemed to actually connect the dots between healthcare practice and preventive medicine. This one looked at pharmacists. Seems about right since pharmacists have an opportunity to speak with just about every patient with just about every disease known. They are a one stop shop for healthcare information. As it turns out, some of them take advantage of that interaction.
The study found that pharmacists with greater than 20 years experience took advantage of this patient interaction more than those with 10 years. The patient population evaluated was COPD patients. When the patient came in to get their inhaled steroid medication filled, some pharmacists actually asked the patient if they knew that smoking caused their COPD and that continuing to smoke would only exacerbate their symptoms. Surprisingly, many of the patients didn't make this connection, which makes you wonder what their doctors are telling them.
So the next time you go to CVS, Walgreens, Rite Aid, or some other pharmacy, maybe, just maybe, your pharmacist will ask you if you are still smoking.
The study found that pharmacists with greater than 20 years experience took advantage of this patient interaction more than those with 10 years. The patient population evaluated was COPD patients. When the patient came in to get their inhaled steroid medication filled, some pharmacists actually asked the patient if they knew that smoking caused their COPD and that continuing to smoke would only exacerbate their symptoms. Surprisingly, many of the patients didn't make this connection, which makes you wonder what their doctors are telling them.
So the next time you go to CVS, Walgreens, Rite Aid, or some other pharmacy, maybe, just maybe, your pharmacist will ask you if you are still smoking.
Early Detection of COPD
Chronic Obstructive Pulmonary Disease (COPD) is largely an avoidable disease. There is a genetic form of the disease, but the lion-share is brought on by smoking tobacco. I have treated thousands of patients who have or had COPD. Every one of them smoked cigarettes. They all told me how much they regretted smoking and wished someone had told them the truth about it long ago when they first started the habit.
There is an idea in medicine, where physicians and clinics hope to catch patients early, before COPD becomes the debilitating, progressive disease that it is. One thought, is to have general practitioners or family doctors, screen patients for COPD. This is a double sided coin, because if they test a smoking patient and they don't show signs of damage, then they might not think they're at risk and continue to smoke. On the other hand, if they are tested and show disease, they might think it's too late for them and throw their hands up in the air and keep right on smoking. Sometimes, you never know how people will react to information.
The International Journal of Chronic Obstructive Pulmonary Disease looked at this very question in their article, "Early detection of COPD in general practice" by Ulrik, et al. They recruited subjects who did not have a previous diagnosis of COPD, >35 years of exposure and they had to have at least 1 respiratory symptom, like shortness of breath, cough, wheezing, recurrent respiratory infections, or sputum. More than a third of the participants had airway obstruction.
The researchers conclude that it is not difficult to screen patients for airway obstruction if you have sound prescreening criteria. The question then becomes, will those patients listen to the physician and will this information be enough motivation to get them to stop smoking? Only time will tell, as this type of initiative has strong support within the pulmonary and critical care community.
Hopefully these type of screening programs will have an enormous influence on reducing the morbidity/mortality of COPD.
There is an idea in medicine, where physicians and clinics hope to catch patients early, before COPD becomes the debilitating, progressive disease that it is. One thought, is to have general practitioners or family doctors, screen patients for COPD. This is a double sided coin, because if they test a smoking patient and they don't show signs of damage, then they might not think they're at risk and continue to smoke. On the other hand, if they are tested and show disease, they might think it's too late for them and throw their hands up in the air and keep right on smoking. Sometimes, you never know how people will react to information.
The International Journal of Chronic Obstructive Pulmonary Disease looked at this very question in their article, "Early detection of COPD in general practice" by Ulrik, et al. They recruited subjects who did not have a previous diagnosis of COPD, >35 years of exposure and they had to have at least 1 respiratory symptom, like shortness of breath, cough, wheezing, recurrent respiratory infections, or sputum. More than a third of the participants had airway obstruction.
The researchers conclude that it is not difficult to screen patients for airway obstruction if you have sound prescreening criteria. The question then becomes, will those patients listen to the physician and will this information be enough motivation to get them to stop smoking? Only time will tell, as this type of initiative has strong support within the pulmonary and critical care community.
Hopefully these type of screening programs will have an enormous influence on reducing the morbidity/mortality of COPD.
Pulmonary Case Studies
I have been asked by many to start including actual case studies from my personal hospital experience. I will limit these cases to those that just involve patients who had smoking related diseases, although, I may venture off every once in a while to talk about very unusual to interesting cases. I may even ask questions to see if you can figure out what may have happened to the patient.
Here's a quick case study off the top of my mind. We had a 58 y/o white male present with shortness of breath. His lung sounds included lots of crackles and wheezing, with a prolonged expiratory phase. His respiratory rate was > 25. He quit smoking 1 year prior to this admission, but had smoked 1 - 1.5 packs of cigarettes per day for 40 years. He had spiked a temperature at 101.4 F the night before. His ankles had 1+ edema (swelling). He had a history of 2 previous heart attacks (AMI). He was not a candidate for heart surgery, due to his poor baseline respiratory status. He was diagnosed with Stage 4 emphysema and was dependent on a multiple of inhalers, as well as, continuous nocturnal bipap.
This gentleman was the nicest guy around. We loved seeing him in the hospital but were sad because we only saw him as a patient, rather than a visitor. He is what you call a "frequent flyer". In other words, he found himself in our ER frequently throughout the year with the same old symptoms. His hospital stays would typically last about 10 days. His diagnosis was always the same:
1) COPD (emphysema)
2) Community acquired pneumonia
3) Congetive heart failure
4) Ischemic heart disease
5) Hypertension (high blood pressure)
6) Acute respiratory failure
7) Chronic respiratory failure
Here is an example of someone's body not tolerating the effects of a 40 pack year smoking history very well. I could also give you an example of someone who smoked just as much, but didn't have nearly the physiological devastation that this man had.
But the point is, you never know how your body will respond over time to the smoking. Which person will you turn into? Patient A who needed a machine at night to ensure he didn't stop breathing when he was asleep and continuous oxygen the rest of the time, or the other patient whose body faired a little better?
Hard core smokers are quick to point out lots of patient B examples, and tend to ignore or even deny the existence of the over couple hundred thousand patients a year that die due to smoking related illnesses. It's important to drive home the realism of smoking related disease, as often times, this is the only thing people will listen to.
I hope to share even more real life case studies in the future to offset the hum-drum nature of literature review.
Here's a quick case study off the top of my mind. We had a 58 y/o white male present with shortness of breath. His lung sounds included lots of crackles and wheezing, with a prolonged expiratory phase. His respiratory rate was > 25. He quit smoking 1 year prior to this admission, but had smoked 1 - 1.5 packs of cigarettes per day for 40 years. He had spiked a temperature at 101.4 F the night before. His ankles had 1+ edema (swelling). He had a history of 2 previous heart attacks (AMI). He was not a candidate for heart surgery, due to his poor baseline respiratory status. He was diagnosed with Stage 4 emphysema and was dependent on a multiple of inhalers, as well as, continuous nocturnal bipap.
This gentleman was the nicest guy around. We loved seeing him in the hospital but were sad because we only saw him as a patient, rather than a visitor. He is what you call a "frequent flyer". In other words, he found himself in our ER frequently throughout the year with the same old symptoms. His hospital stays would typically last about 10 days. His diagnosis was always the same:
1) COPD (emphysema)
2) Community acquired pneumonia
3) Congetive heart failure
4) Ischemic heart disease
5) Hypertension (high blood pressure)
6) Acute respiratory failure
7) Chronic respiratory failure
Here is an example of someone's body not tolerating the effects of a 40 pack year smoking history very well. I could also give you an example of someone who smoked just as much, but didn't have nearly the physiological devastation that this man had.
But the point is, you never know how your body will respond over time to the smoking. Which person will you turn into? Patient A who needed a machine at night to ensure he didn't stop breathing when he was asleep and continuous oxygen the rest of the time, or the other patient whose body faired a little better?
Hard core smokers are quick to point out lots of patient B examples, and tend to ignore or even deny the existence of the over couple hundred thousand patients a year that die due to smoking related illnesses. It's important to drive home the realism of smoking related disease, as often times, this is the only thing people will listen to.
I hope to share even more real life case studies in the future to offset the hum-drum nature of literature review.
Smokers Lungs
I couldn't find any good research articles today to bring to you, so I dug into my article bag. I found this article I wrote detailing the negative effects smoking has on your lungs. I call it, "Smokers Lungs" - enjoy.
Smokers Lungs
Twenty percent of all Americans smoke. The World Health Organization describes smoking as an epidemic around the world. Smoking has become a blight on those in the lower socio-economic cultures of the world. Tobacco companies have revenues in the billions. All this without advertisement on television or radio. So why?
This type of economic juggernaut must not impose very bad side-effects on its customers, right? If smoking were bad for you, then why do so many people do it?
All these are pretty good questions. The tobacco business goes all the way back to our founding fathers. Remember from history class what a cash crop was? That's right: tobacco was the king of cash crops. It wove it's way throughout the economic fabric of our bourgeoning country and it hasn’t looked back.
So here we are, 200 plus years later and we’re having to answer the question of whether tobacco is really that bad for you. Physicians and healthcare professionals can tell you the answer to the question. Yes, smoking is bad for you. Lets look at the statistics for a moment.
Roughly 90% of all lung cancers are attributable to smoking. Emphysema (COPD) is the fourth leading cause of death in the US. Smoking is listed as a primary risk factor in over 70 diseases. It’s also a contributing risk factor in hundreds more. But what about the smokers’ lungs.
COPD is the single largest preventable disease, they just have to quit smoking. COPD stands for chronic obstructive pulmonary disease. There is no cure. It is chronic and progressive which means the symptoms will begin to worsen over time. The only way to slow it down, is to stop smoking.
Lets go over 3 physiologic changes that take place in the lung after someone smokes.
1. The fine cilia in the throat begin to die off
2. The muscle that forms the airways loose their rigidity and spasm or narrow
3. The cellular walls in the tiny air sacs of the lung begin to tear apart
These 3 changes then result in the following symptoms:
1. Chronic coughing
2. Difficulty in removing secretions
3. Elevated risk of pneumonia
4. Shortness of breath
5. Wheezing
6. Poor oxygenation
These symptoms then need to be treated with medicines like expectorants, anti-biotics, inhalers, nebulizers and supplemental oxygen. Not quite the glamorous retirement you envisioned for yourself is it? Relying on inhaled steroids, nebulizers and oxygen can really put a damper on your visit with the grandkids.
So take smoking seriously. You know it’s bad for you. There are just so many great stop smoking benefits available to you if you’d only take a look. You’re a smart person and you can make this decision. But get the valuable stop smoking information you need, so you can be informed. The more educated you are, the better your chances of success.
Smokers Lungs
Twenty percent of all Americans smoke. The World Health Organization describes smoking as an epidemic around the world. Smoking has become a blight on those in the lower socio-economic cultures of the world. Tobacco companies have revenues in the billions. All this without advertisement on television or radio. So why?
This type of economic juggernaut must not impose very bad side-effects on its customers, right? If smoking were bad for you, then why do so many people do it?
All these are pretty good questions. The tobacco business goes all the way back to our founding fathers. Remember from history class what a cash crop was? That's right: tobacco was the king of cash crops. It wove it's way throughout the economic fabric of our bourgeoning country and it hasn’t looked back.
So here we are, 200 plus years later and we’re having to answer the question of whether tobacco is really that bad for you. Physicians and healthcare professionals can tell you the answer to the question. Yes, smoking is bad for you. Lets look at the statistics for a moment.
Roughly 90% of all lung cancers are attributable to smoking. Emphysema (COPD) is the fourth leading cause of death in the US. Smoking is listed as a primary risk factor in over 70 diseases. It’s also a contributing risk factor in hundreds more. But what about the smokers’ lungs.
COPD is the single largest preventable disease, they just have to quit smoking. COPD stands for chronic obstructive pulmonary disease. There is no cure. It is chronic and progressive which means the symptoms will begin to worsen over time. The only way to slow it down, is to stop smoking.
Lets go over 3 physiologic changes that take place in the lung after someone smokes.
1. The fine cilia in the throat begin to die off
2. The muscle that forms the airways loose their rigidity and spasm or narrow
3. The cellular walls in the tiny air sacs of the lung begin to tear apart
These 3 changes then result in the following symptoms:
1. Chronic coughing
2. Difficulty in removing secretions
3. Elevated risk of pneumonia
4. Shortness of breath
5. Wheezing
6. Poor oxygenation
These symptoms then need to be treated with medicines like expectorants, anti-biotics, inhalers, nebulizers and supplemental oxygen. Not quite the glamorous retirement you envisioned for yourself is it? Relying on inhaled steroids, nebulizers and oxygen can really put a damper on your visit with the grandkids.
So take smoking seriously. You know it’s bad for you. There are just so many great stop smoking benefits available to you if you’d only take a look. You’re a smart person and you can make this decision. But get the valuable stop smoking information you need, so you can be informed. The more educated you are, the better your chances of success.
Do Patients with COPD Want to Stop Smoking?
A recent study in the Journal of Clinical Nursing (Wilson, et al) looked at the experience of tobacco/cigarette smokers who had been diagnosed with chronic obstructive pulmonary disease, better known as COPD. The lion-share of those with this diagnosis are people who suffer from emphysema. Perhaps many COPD diagnosed individuals think it is too late for them to quit smoking. Perhaps, they just don't care. It has been my experience that people with COPD fall into three categories: 1) they feel it's too late for them; 2) they already stopped smoking, but still suffer the consequences of COPD; or 3) they want to quit, but they're not yet convinced that they're really bad off yet.
In fact, previous studies show that people who have COPD are less likely to quit smoking, as their smoking cessation rates are fairly low compared to the remaining population at large. Interestingly, the number one treatment outlined in the GOLD guidelines is to remove the cause of the disease, or in other words, quit smoking. COPD is the single most preventable disease. Simply quit smoking and sit back and watch the disease rates melt to insignificance.
In the past, nobody really knew why their smoking cessation rates were so low. This study was a randomized controlled trial and evaluated the national smoking cessation guidelines and conducted interviews to distinguish why COPD patients were unsuccessful at quitting smoking. They questioned the participants and identified 6 themes listed as follows:
1 - Too late to stop now2 - Finding motivation
3 - Guilt about continued smoking
4 - Bargaining/contemplation
5 - Need to stop
6 - Reduced quality of life
What they found in this population is that a complex pattern of thought and behavior is at work, in spite of the rather obvious connection between cigarette smoking and poor or declining health. For many with COPD, cigarettes are regarded as "friends". It clearly helps us understand the old expression that says, "with friends like these, who needs enemies". Additionally, these people also avoid healthcare opportunities which contributes to their continuing disability.
So as we first said in the beginning, many with COPD associate smoking cessation with ambivalence. Sadly, this is all too prevalent a problem in many who smoke, regardless of their disease state(s). They either misunderstand the hazardous health affects of smoking or don't feel it will happen to them. As was demonstrated in this particular study, they may also feel it's simply too late for them. But the catch is, it isn't too late for many with COPD. Remember, COPD is a progressive disease that can be slowed through avoidance. The continuation of the disease will lessen once smoking cessation occurs.
We as healthcare workers need to get this message out to those with COPD. We need to let them know that they too can reap many benefits when they stop smoking - and the earlier the better.
Stop Smoking Anytime and Reap the Benefits
As a respiratory therapist, I get to have lots of conversations with patients about their smoking habits. They ask me all sorts of questions. 1. Am I too old to quit smoking?
2. I already have a smoking disease, so why should I quit?
3. It's too late for me, isn't it?
When patients are in the hospital because they smoked, it's hard to be brutally honest with them, because they already feel bad. The last thing they need is a guilt trip from some young whipper-snapper in a white lab jacket about their smoking habit. So I carefully answer their questions as best I can without making them feel too bad about their poor choices in life.
But they do ask some good questions, don't they? Are they too old or sick to even think about quitting? Lets look at these for a moment.
Stop smoking benefits are great. They're even greater if you stop smoking at a young age. But just because you are getting a little long in the tooth, doesn't mean there are no benefits for you. Consider this for a moment.
Roughly 90% of all lung cancers are brought on by smoking. Let that sink in for a moment. If people stopped smoking, 90% of all lung cancers would just go extinct, like the dinosaurs. But how long do you run the risk of lung cancer after you stop smoking? For those who quit smoking for 10 years, the risk is 30-50% less than current smokers. Also, if you have quit for 15 years, the risk may be 80-90% less than current smokers. What does this mean in real terms? Lets say you quit at age 55. That mean by age 70, you have approximately the same risk of lung cancer as a non-smoker. So when you are about to enjoy those grandchildren, you'll have a greater chance to do so. What if you quit when you're 40? Then you can enjoy your retirement without as much concern for that dreaded disease.
Now we turn our attention to COPD, popularly known as emphysema. Many smokers have some sort of COPD as they age. They simply can't help it. Smoking does what smoking does, it damages the lungs. So people more, some less, but the damage is there. The question is, how much damage do you want to risk? So when my patients ask me if stopping smoking will help their COPD, the answer is of course it will. The less you smoke the less damage you have. Studies show the progression of COPD slows after smoking cessation. The amount of obstruction in the airways to airflow continues to occur, but at slower rates of decline.
So "yes Virginia, their are benefits for the elderly and sick who want to stop smoking". We haven't even touched on the other health benefits seen in people when they stop smoking. There is an even more comprehensive list of stop smoking benefits available. There are also many more risks that smokers expose themselves to by continuing to smoke.
Similar Stories, Similar Results
After 20+ years experience in healthcare, I've come across what could only be described as some very nice case studies for why people shouldn't smoke. I'd like to say these case studies are few and far between, but in fact, they're all too commonplace. Everyday in the hospital, I was one of about 10 therapists who would see on average 30 patients in 12 hours. Of these 30 patients, more than 20 were there due to a smoking related illness.
Now multiply this scenario out by the other 20-30 metropolitan hospitals in the metroplex and then again by all the long term care facilities and nursing homes found in our fair city. Now multiply this number by everyday of the year, year after year, after year. So it's safe to say, I've seen my share of pain that smoking can cause. I would like to talk about one such case today.
This was a 68 year old man who smoked on average one and a half packs of cigarettes per day for over 30 years, but he quit when he was 49. He first came to our hospital when he was 53 years old, 4 years after he stopped smoking. His symptoms began with shortness of breath and a cough that wouldn't go away with over the counter medications. Over the 15 years he spent coming to our hospital, he was diagnosed with the following diseases: emphysema (COPD), respiratory failure requiring mechanical ventilation (life support machine) three times, congestive heart failure (CHF), pneumonia (multiple times), coronary artery disease, CVA (stroke), renal insufficiency, chronic bronchitis, acute myocardial infarction (heart attack) and several more maladies related to the above diseases.
He was prescribed home oxygen at age 58 and was dependent on respiratory inhalers and cardiac medications for the duration of the time he first came to us at age 53. He eventually died at the ripe old age of 68 in our emergency room from respiratory failure. The wife decided he had been through enough and chose not to revive him.
This is just one example out of literally millions, of what smoking can do. I did not add any hype to this story for dramatic affect, it simply is what it is. I shudder to think what his life would have been like if he hadn't stopped smoking when he did. But, imagine what would have happened if he had quit when he was 30 years old. He might have been able to enjoy life a little more, maybe travel and see the world. He might have been able to see his grandchildren and his friends more frequently, but as it turns out, he couldn't. You see, he couldn't leave his house. He would simply get too short of breath.
This tragic tale plays out everyday in every city. Hey, I know the world is made up of a million other sad stories. My mom has Alzheimer's disease, so I know that sadness comes in many forms, both within and out of our control. But the thing about smoking is, you can choose to stop. You can rewrite the ending of your life story. It doesn't have to end with a breathing tube stuck in your throat, attached to a ventilator pushing oxygen into your lungs until your family decides you've had enough.
You have so little control over what happens to you in life, but you can control whether you pick up that next cigarette - or does the nicotine have that control? Go ahead and fight back. Get some stop smoking help and take your life back. You won't regret it and neither will those who care most about you.
Now multiply this scenario out by the other 20-30 metropolitan hospitals in the metroplex and then again by all the long term care facilities and nursing homes found in our fair city. Now multiply this number by everyday of the year, year after year, after year. So it's safe to say, I've seen my share of pain that smoking can cause. I would like to talk about one such case today.
This was a 68 year old man who smoked on average one and a half packs of cigarettes per day for over 30 years, but he quit when he was 49. He first came to our hospital when he was 53 years old, 4 years after he stopped smoking. His symptoms began with shortness of breath and a cough that wouldn't go away with over the counter medications. Over the 15 years he spent coming to our hospital, he was diagnosed with the following diseases: emphysema (COPD), respiratory failure requiring mechanical ventilation (life support machine) three times, congestive heart failure (CHF), pneumonia (multiple times), coronary artery disease, CVA (stroke), renal insufficiency, chronic bronchitis, acute myocardial infarction (heart attack) and several more maladies related to the above diseases.
He was prescribed home oxygen at age 58 and was dependent on respiratory inhalers and cardiac medications for the duration of the time he first came to us at age 53. He eventually died at the ripe old age of 68 in our emergency room from respiratory failure. The wife decided he had been through enough and chose not to revive him.
This is just one example out of literally millions, of what smoking can do. I did not add any hype to this story for dramatic affect, it simply is what it is. I shudder to think what his life would have been like if he hadn't stopped smoking when he did. But, imagine what would have happened if he had quit when he was 30 years old. He might have been able to enjoy life a little more, maybe travel and see the world. He might have been able to see his grandchildren and his friends more frequently, but as it turns out, he couldn't. You see, he couldn't leave his house. He would simply get too short of breath.
This tragic tale plays out everyday in every city. Hey, I know the world is made up of a million other sad stories. My mom has Alzheimer's disease, so I know that sadness comes in many forms, both within and out of our control. But the thing about smoking is, you can choose to stop. You can rewrite the ending of your life story. It doesn't have to end with a breathing tube stuck in your throat, attached to a ventilator pushing oxygen into your lungs until your family decides you've had enough.
You have so little control over what happens to you in life, but you can control whether you pick up that next cigarette - or does the nicotine have that control? Go ahead and fight back. Get some stop smoking help and take your life back. You won't regret it and neither will those who care most about you.
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