Taking the breath of life

People with a lung condition can get short of breath but The British Lung Foundation have set out the following tips for breathing exercises to help the shortness of breath and breathe more easily each day.

  • relaxed slow deep breathing: breathe in gently through your nose and breathe out through your nose and mouth. Try to feel relaxed and calm each time you breathe out.
  • pursed-lips breathing: breathe in gently through your nose and breathe out with your lips pursed as if you are whistling.
  • blow as you go: use this when you’re doing something that makes you breathless, such as standing up. Breathe in before you make the effort. Then breathe out while making the effort. Try using pursed lips as you breathe out.
  • paced breathing: this is useful when you’re active, such as climbing stairs. You pace your steps to your breathing. For example, breathe in when on the stair, and breathe out as you go up a stair.

Try to practise them every day. They can also help if you get out of breath suddenly. Being in control of your breathing means breathing gently, using the least effort, with your shoulders supported and relaxed.
Great advice!

Trying to avoid lung disease

People used to speak of emphysema or chronic bronchitis, but Chronic Obstructive Pulmonary Disease (or COPD as it is generally referred to) is a collective term used to describe several chronic lung diseases, which limit airflow to and from the lungs.

COPD is much more than a so-called “smoker’s cough”. It’s a serious, progressive life-threatening disease, which causes ongoing breathing difficulties – and, according to the World Health Organization (WHO), in 2015 it killed more than three million people worldwide.
A large international study established that the highest prevalence of Stage 2 or higher COPD was among people in Cape Town, South Africa, and it surmised that both smoking and occupational dust were responsible.
The causes of COPD
Tobacco smoke (this includes second hand exposure), pollution (especially indoor air pollution from cooking fuels in low-income contries) and fumes, as well as frequent lower respiratory infections during childhood can all be causes of COPD. Many people are exposed to fumes, dust and pollution while at work.
Required lifestyle changes if you have COPD
It is essential that you stop smoking, and also avoid spaces where other people smoke. Also avoid polluted or dusty areas. A healthy diet and regular exercise are both also essential to maintain your health and manage your COPD.
To people with COPD, even a common cold can easily lead to a more serious lower respiratory tract infection, making it even more difficult to breathe than usual. People with COPD need to alert their doctor if their COPD symptoms get worse. Treatment may include inhaled medications, oxygen and antibiotics. It is important to note that antibiotics can help to treat a bacterial infection, but not any condition (like the common cold) caused by a virus.
reference: http://www.health24.com/Medical/Asthma/From-our-sponsors/how-to-avoid-chronic-lung-diseases-20170704

Possible cure for PAM and other rare lung diseases?

Pulmonary Alveolar Microlithiasis (PAM) is a rare lung disorder where small stones form and accumulate in the air sacs of the lung. These stones cause inflammation, scarring of lung tissue and reduced respiratory ability resulting in the patient requiring supplemental oxygen.
New research from a team at the University of Cincinnati has uncovered and identified key bio-markers and a potential new therapeutic approach that could be the key in treating this rare lung disease.
A few years ago a team discovered that DNA mutations in the gene SLC34A2 caused a loss of a cellular pump which would normally remove phosphate from the air spaces in the lungs.  As a result calcium and phosphate levels rise in the alveolar sacs and cause the formation of stones or microliths that invoke inflammation.  Patients find that by middle-age this chronic inflammation has caused scarring and damage to the lungs and experience respiratory failure.
The team collected samples from people all over the world with help from the RDCRN programme who’s goals are to advance medical research on rare diseases by providing support for clinical studies and to facilitate collaboration and data sharing. This enables scientists from multiple disciplines at hundreds of clinical sites around the world to work together to help study more than 200 rare diseases.
They found that those with mutations in this specific gene also had elevated levels of certain serum markers.  Certain cytokines and surfactant proteins were raised in line with the presence of stones in the lung, suggesting that by testing and monitoring these levels it could be a useful tool in following the disease progression and treatment responses in patients.
They also discovered that the stones dissolved easily in EDTA, a molecule used in many detergents as it binds to calcium.  “Washing the lungs with an EDTA-containing solution reduced the burden of stones in air spaces,” says Dr McCormack. “This finding could translate into a therapy for humans if toxicity studies demonstrate that the approach is safe.”
A low-phosphate diet was found to prevent stone development and to even reverse lung calcification. However low phosphate levels can cause other medical problems and this approach will need to be tested in clinical trials first. Although another strategy is to utilise gene therapy and to insert a gene for a working phosphate pump back into the cells using viral vectors.
“This study demonstrates how discovering the causes of these rare lung diseases not only can inform us how the lung normally functions, but can also lead us to potential therapeutic interventions for these rare and often lethal lung diseases,” says James Kiley, PhD, Director of the Division of Lung Diseases at NHLBI.
McCormack says rare disease research can reveal surprising insights into the fundamental biology of the lung. “Studies of the PAM.. model have already revealed a potential role for phosphate in the regulation of surfactant balance in the lung and have attracted the interest of cystic fibrosis scientists interested in exploring the possible interaction between [the phosphate pump] and the defective chloride channel in that disease,” explains McCormack.
Although human trials are a few years way, UC’s research offers some hope to patients who suffer from this rare disease. Kathleen Falco, 65 from Riverhead in America shares a similar story with other patients. She was misdiagnosed with Sarcoidosis in 1977 until 2000 when they diagnosed PAM. It started to take its toll in her 40’s and a few years ago her symptoms intensified and she has shortness of breath, reduced mobility and dependency on supplemental oxygen. She cant walk, take part in outdoor activities, has lost weight and finds it hard to breathe when its hot or cold. She felt isolated, with little information and no support network or forums and eventually sort out help through the internet and was put into contact with Dr McCormack. She’s hoping that the trials will be a success and that she may be able to live out her retirement years being able to breathe a bit easier and enjoy a much improved quality of life.
References: http://medicalxpress.com and https://www.sciencedaily.com

Avoiding a lung infection may have become easier with new drug

Many COPD patients suffer from acute exacerbations where their symptoms suddenly get a lot worse and can result in hospitalisation.  75% of the time it is due to a lung infection whether bacterial or viral. The most common culprits are the influenza virus and Streptociccus pneumoniae, which cause the flu and pneumonia.
Bacteria and viruses cause infections in different parts of the lung and cause bronchitis if it occurs in the larger bronchial tubes or cause bronchiolitis if in the smaller bronchial tubes. An infection in the alveoli or air sacs of the lungs can cause pneumonia. Antibiotics are only effective against bacterial infections and viruses are more difficult to treat. Often a patient will acquire a secondary bacterial infection from having a viral one. This is due to the build up of mucus and inflammation in the lungs which create the perfect breeding ground for bacteria. This is why antibiotics are normally prescribed whether the infection is viral or bacterial as to protect from a secondary bacterial infection from occurring.
The other common causes of exacerbations are sinus infections, air pollution, heat failure and blood clots.  It is so important that COPD patients try to avoid any of these triggers and try to prevent picking up any viruses or bacteria in order to prevent exacerbations.
The disease compromises the lung’s ability to defend against bacteria and a new study has shown that even when a patient isn’t experiencing an exacerbation, the bacteria that are colonized in their lungs are causing respiratory symptoms for them.  Having bacteria in the lungs increases the inflammation and significantly increases the shortness of breath, cough and sputum in COPD patients.  Doctors are aware that most stable patients experience daily fluctuations in respiratory symptoms but the reason why has never been understood until now.  These fluctuations can sometimes be fairly intense and often qualify as exacerbations but go unreported to their doctor.
The study shows that medicine needs to alter its approach to treating stable COPD patients and not to focus on just the flare-ups but to understand that COPD is based around a chronic infection and treat accordingly.
“The lungs are constantly being exposed to microbes ‘with every breath you take’ as well as from aspiration of small amounts of secretions from the throat, especially during sleep,” Dr Sethi says. “If the persistence of these bacteria contributes to increased symptoms and inflammation in the lungs in stable COPD, we should regard this as a chronic infection, not innocuous colonization. For that reason, more must be done to reduce chronic infections in COPD.”
However due to resistance, long-term antibiotic treatment is not the way forward and “we need to put more emphasis on developing therapies that can decrease bacterial colonization in COPD.”
At the end of last year a company announced that the drug AB569 had been successful in trials and appears to be able to treat lung infections caused by Pseudomonas aeruginosa, a common culprit of lung infections in COPD and CF patients.  This bacteria is common however it is also difficult to treat as it survives without oxygen and it has the ability to develop resistance against antibiotics as it holds a lot of resistant genes.  It causes 40% of infections in children with CF and up to 75% of cases in adults with CF as well as a high percentage of COPD infections. If this drug can treat this bacteria and passes human trials then perhaps it can be used to help dramatically cut the number of infections and the resulting exacerbations suffered by COPD and CF patients and also ease their daily fluctuations of respiratory distress.
Here are eight tips that can help you reduce your risk of developing an infection:

  • Wash your hands. Regular hand-washing is one of the most important things you can do to reduce your risk of infection.
  • Avoid infections. Ask people who are sick not to visit until they are well again, and wear a face mask if you do have to come in contact with someone who has an infection.
  • Clear your airways. It is important to keep airways free from mucus. Your doctor can give you devices and teach you manoeuvres to ensure your coughing is productive at shifting the mucus.
  • Stay hydrated.
  • Clean your equipment. All equipment that you use, including humidifiers, oxygen masks, and flutter valves, should be properly cleaned and maintained to ensure that they don’t harbour infectious organisms.
  • Get vaccinated. Talk with your doctor about which vaccines you should get. In general, people with COPD should get a pneumococcal vaccine once, as well as a flu vaccine every year.
  • Stay away from crowds. When possible, avoid large crowds, especially during cold and flu season.
  • Treat infections as early as possible. Call your doctor at the first sign of infection, so it can be treated before it progresses to a more serious infection of your lungs.
  • Breathe clean air if possible. Breathing in air from your supplemental oxygen unit and air that has been filtered in your home will be a lot cleaner and free from irritants such as pollen, dust and germs and will help to reduce the risk of an exacerbation.

References: www.webmd.com and www.buffalo.edu and http://lungdiseasnews.com and www.everydayhealth.com