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The Star Online: Lifestyle: Health

When the lungs are squeezed

Posted: 01 Feb 2014 08:00 AM PST

COPD is a progressive life-threatening disease that is often misdiagnosed.

CHRONIC Obstructive Pulmonary Disease (COPD) is an umbrella term to describe chronic lung diseases that result in limitations to lung airflow.

The more familiar terms chronic bronchitis and emphysema are no longer used.

The most common symptoms of COPD are breathlessness, excessive sputum production, and a chronic cough. COPD is not just simply a "smoker's cough", but an under-diagnosed, life-threatening lung disease that may progressively lead to death.

The main risk factors for COPD include:

·Tobacco smoking

·Indoor air pollution (such as biomass fuel used for cooking and heating)

·Outdoor air pollution

·Occupational dusts and chemicals (vapours, irritants, and fumes)

COPD can be fatal, but if it doesn't take your life, the damage is irreversible and burdensome.

There is no cure, but it is treatable and even preventable.

Caused primarily by smoking, it affects 210 million people worldwide. It is now the fourth-leading cause of death behind heart disease, cancer and stroke, and it is predicted to be number three unless urgent action is taken to reduce risk factors, according to the World Health Organization (WHO),

In Malaysia, where an estimated 10,000 die of smoking-related diseases annually, the healthcare bill for COPD was an estimated RM2.8bil in 2010.

Dr David Price, an international authority on COPD, says the rising global death rate is alarming. On an optimistic note, he says the respiratory expert community is very excited that current research is yielding new therapies with increased efficacies that can help doctors better manage COPD and give patients a new lease of life.

The Professor of Primary Care Respiratory Medicine at the University of Aberdeen, United Kingdom, was in Kuala Lumpur recently for a COPD seminar to exchange views and discuss new therapies with the local medical fraternity.

He shares his take on this progressive life-threatening disease, why it is often misdiagnosed, and his message to smokers to kick the habit, the sooner the better.

WHO has predicted deaths from COPD will increase by over 30% in the next 10 years. How alarming is this?

The death rate in COPD is very alarming. Whilst many diseases are becoming less common and more treatable, COPD incidence is rising. This is sad because it's preventable with the right public health measures, smoking cessation and practices at workplaces to curb pollution.

When I say smoking, it includes cigarettes, secondary smoking and shisha smoking.

64-slice CT scan of the lungs

People with COPD suffer obstructed breathing. Generally, they have relatively well maintained volume in their lungs, but they cannot get the air in and out fast. – Filepic

Across Asia, COPD is becoming more common because of this. Generally, there is a 20% chance of a smoker developing COPD, and in the over 40 age group, one in five smokers will have it.

What is behind the increase in cases?

There are several reasons. One is the increase in cigarette smoking. In particular, we are starting to see more women smokers in society.

Smokers are also starting at a much younger age. Our lungs develop until we are in the mid-20s. If you damage your lungs at that stage in your life, you also damage the primal lung function and end up with "stunted" lungs.

People are also living longer. Your lungs age with time, and if you smoke, the deterioration is much faster.

Why is COPD often misdiagnosed and what are the symptoms?

It can be challenging to diagnose COPD because the symptoms are not always immediately obvious.

Breathlessness is a key symptom. And there is cough and wheeze. Anybody who has a cough for more than six weeks must always be fully investigated.

Wheeze is classically thought to be an asthma symptom, but it appears in COPD as well.

Family history is another risk factor. If I have someone telling me they have family members who have lung disease or COPD in their 40s and 50s, that's really worrying. They may not even call it COPD – they may say it is chronic bronchitis (inflammation of the bronchial tubes that carries air to and from the lungs) or emphysema (damaged lungs).

The most important thing is to compare if you are more breathless doing activities with people your own age. A study done in Australia a few years ago showed smokers who didn't yet have COPD were much more breathless compared to others in the same age group who never smoked. So, even before the disease fully starts, they are getting breathless already.

A new study has found that people who have chest infections and prescribed antibiotics repeatedly actually had COPD, and each time, the flare-up or exacerbation causes them to lose lung function. So, someone getting repeated chest infections should ask for a test to diagnose COPD.

How is COPD diagnosed?

With a simple painless test called spirometry. It measures how fast and how much you can blow air out of your lungs.

People with COPD suffer obstructed breathing. Generally, they have relatively well maintained volume in their lungs, but they cannot get the air in and out fast. Obstruction also happens in asthma, but in asthma, it is reversible.

What is the difference between COPD and asthma?

Asthma tends to start at a younger age. If you start to get breathless after 40, then you need to be thinking it is COPD. If you have been smoking for 15 or 20 years, then it's very likely to be COPD.

It can still be asthma because the symptoms are similar – breathlessness, cough and wheeze.

The little difference is that COPD symptoms tend to stay and progress over time, whereas asthma may come and go. About one in six people with COPD have some degree of asthma-like illness. So, it is important to ascertain whether a patient has just COPD or COPD and asthma.

The treatments are quite different. Asthma requires anti-inflammatory therapy whereas the main treatment for COPD is bronchodilators to open up the lungs.

What is it like to be a COPD sufferer?

A good way to imagine is to breathe in once, twice, three times, and keep breathing in to completely fill the lungs up, but you cannot empty the air out.

The worst time of the day for a patient is first thing in the morning because you have been lying flat. Even for normal people, getting ready for the day is pretty tough – get out of bed, take a shower and dress. COPD patients can't do these all in one go, they have to stop and rest frequently. Mornings are really very, very tough times for them.

Some patients may stop exercising and give up work prematurely.

What are the treatments currently available for COPD?

There is no cure for COPD, but early intervention works much better because in the early stage, the deterioration occurs faster. We can help patients to stop smoking, get them physically active again and start them on the right treatment.

In this way, they end up with normal lives.

With drug treatment, the most effective therapy is long-acting bronchodilators to open up the lungs. COPD patients really should be on long-acting drugs because they do reduce the number of flare-ups, and there is a study that shows they can potentially reduce mortality too.

Short-acting drugs are the least effective and do not prevent exacerbation.

Long acting drugs come in two groups. One is the lama and the other is called the laba. Lama unblocks the airways while laba works on the muscles to relax the airways.

The drugs are taken separately in the morning and last for 24 hours. Some patients may require only one drug, but others need the two together to get the best effect.

Why the excitement over current research on COPD treatments?

We are quite excited that some drugs being researched might help to slow down the development of the disease. What we are going to see in the next few years is that new therapies will target both lama and laba in one inhaler. We are seeing results – improvements in the way the lungs function that is comparable to what we see in sthma.

Can you share the UK's experience in the diagnosis and management of COPD?

The major awareness has been in the last five years. One of the things the UK government did, after a lot of pressure, was to set up a clinical strategy to help recognise the symptoms early, help doctors to diagnose early and therefore manage it better.

The strategy was drawn up by a group of primary and secondary care providers, patient representatives, government, public health, pharmacists and nurses.

We incentivise doctors to do proper spirometry. There is also a movement started by GPs called the Primary Care Respiratory Society that is very much focused on improving respiratory management in general practice. So, there has been a push from both the government and also from GPs.

We also do a lot of work on rehabilitation, helping patients make the best of their bodies. We do two things – advocacy and how to manage breathlessness and get them fit again with exercise programmes. We get patients to work together as a group.

My aim is to keep them fit, healthy and enable them to live their lives with less flare ups. I'm less focused on the mortality because what I really want is for the patients to live life to the fullest.

Come on Malaysians, get moving!

Posted: 01 Feb 2014 08:00 AM PST

Implementing a community sports programme can be challenging, but the rewards are aplenty.

WE'RE becoming a nation of heavyweights. Our priorities are to work, eat and sleep, in no particular order. Everything else is secondary. We'd rather double-park our cars and pay the summons than walk a mere 50m. Small wonder then that we're the most "cherubic" nation in Southeast Asia.

Although there is no fitness data among Malaysians, indulging in physical activity or sports has yet to become part of our culture.

According to the World Health Organisa-tion, physical inactivity accounts for almost 3.2 million deaths per year. This figure is alarming, especially since non-communicable diseases (cardiovascular diseases, cancer, mental health problems, diabetes mellitus, chronic respiratory disease and musculoskeletal conditions) have taken over from infectious diseases as the major cause of death.

To introduce sports as part of our lifestyle and to create healthier individuals, the International Olympic Council (IOC) has come up with an informative book called Get Moving! – The IOC's Guide to Managing Sports for All Programmes.

Staying active goes a long way towards good health.

Staying active is universally recognised as an effective way towards cultivating good health.

Published by the IOC last September, the guide is designed to be an informative platform for organisations and interested individuals to create a sports-for-all programme in the community. The IOC wants to ensure that sport activities can be pursued by all ages, whatever their social or economic circumstances may be.

In line with this, IOC's local chapter, the Olympic Council of Malaysia (OCM), has mooted a Move Malaysia programme to get Malaysians to move. But how?

"There are four components in the programme," says OCM secretary Datuk Sieh Kok Chi. "First, exercise is medicine. We are working with the Academy of Family Physicians of Malaysia to train doctors to give 'exercise prescription'. Right now, doctors don't know what kind of exercises to recommend to the patient. We also have to train more fitness professionals."

Secondly, the intention is to include a course in the undergraduate medical curriculum, so that future doctors understand the value of sports for better health.

The third component is introducing community activities, and lastly, methods to make the programme sustainable.

The proposal has received a US$250,000 (RM800,000) grant from Coca Cola International. While OCM's primary objective is to send elite athletes to international tournaments, the secondary objective is to strengthen the second line. This programme is part of their plan to have another avenue to scout for more talents, as well as to create a stronger society and a sustainable sports movement.

At 75, the secretary of the Olympic Council Malaysia, Datuk Sieh Kok Chi continues to be an active hasher.

Datuk Sieh... We have to inculcate the fitness culture as a family activity so that the nation can reap the benefits in future.

A healthier, fitter society also means greatly reduced health costs. Encouraging people to be involved in physical activity at all levels is an investment, and the returns are substantial.

In the past, the Government has started many sports and fitness programmes for the community, but most of it has slid into oblivion. For example, what has happened to the National Fitness Council, which started out aggressively promoting the value of cardiovascular endurance and strength training? Their objective was to create a pool of certified fitness instructors, but it has since "died a natural death".

Sieh refrains from commenting on the matter, but points out that our culture just doesn't value exercise. Yet. The seeds need to be planted from young so that it can become a lifestyle.

"We have to inculcate the fitness culture as a family activity so that the nation can reap the benefits in future."

He clarifies that OCM is not running or creating any programmes for the general public.

"We are just a funding agency. We're not training anyone. We need your ideas and dedicated community leaders and organisations to make the programme successful. We have a task force comprising academicians, athletes, fitness trainers and doctors who will sieve the proposals.

"You don't have to be a sportsman to lead a programme. We're targeting young individuals and sports enthusiasts who can start such a programme, irrespective of sports. It can eventually become a business.

"Just look at the taekwondo schools. Many of them started small and have since grown into a lucrative business," explains Sieh, who at 75, remains an active Hasher and walks all over town for meetings.

He cites the example of community aerobic and tai chi programmes conducted at public parks. These are usually well-attended by senior citizens who pay a token sum to the instructor, if they wish.

Sieh says there is a need for more such programmes to cater for different age groups. But someone has to initiate and take the lead.

All over the world, there have been successful cases of sports-for-all programme in many age groups. For example, the IOC guide tells of the Segundo Tempo programme that was created by the Brazilian Sports Ministry with the aim of promoting the practice and benefits of sports in schools.

Aquatics classes like this are beneficial for seniors.

Aquatics classes like this are beneficial for seniors.

The programme focuses on the development of life skills in children, adolescents and youths with the aim of improving their quality of life. It primarily targets groups located in socially vulnerable areas.

Since 2003, the programme has reached over six million people across Brazil.

The Trinidad and Tobago Olympic Committee has started an elderly aquatic programme for those over 55. Too often, this age group is neglected by the community because of false beliefs and misconceptions about their age and abilities, and not enough emphasis is placed on maintaining healthy lifestyles.

The programme has seen great physical and psychological enhancement among this community.

Sieh says, "There is no one-size-fits-all. There are different needs for urban and city dwellers, so we need different programmes. For condo dwellers, they have the facilities, but for others, accessibility to a venue might be a problem."

> The OCM will be conducting a free workshop on 'Managing Sport for All Programmes' based on the IOC guidebook, on Feb 27 from 9am to 4.30pm. The venue is at Level 2C, OCM Indoor Sports Complex, Wisma OCM, Kuala Lumpur. The objective of the workshop is to brainstorm, share experiences and views on how such a programme can be planned and implemented. For more details and to register, please contact Joshua Edgar, the Project Manager of Move Malaysia programme at edgar.jos@gmail.com or 012-203 3010.

Lower the thermostat to boost weight loss

Posted: 01 Feb 2014 04:09 PM PST

TACKLING weight loss could be as simple – or uncomfortable – as lowering the thermostat and living in chillier conditions.

In fact, overheated homes and offices during the cold winter months could be partly responsible for our expanding waistlines, researchers say.

It's a notion that stems from the fact that most people spend 90% of their time indoors, where the knee-jerk reaction is to pump up the thermostat as soon as the mercury dips outside, pointed out lead researcher
Wouter van Marken Lichtenbelt. 

But what would happen if people were forced to regulate their own body temperatures without the miracle of indoor heating?

According to Lichtenbelt and his team, prolonged and frequent exposure to mild cold – between 15°C (59°F) and 17°C (62.6°F) – was seen to help activate brown fat in adults, the type of heat-generating fat that
burns calories instead of storing them.

The study builds on previous research out of Japan that showed a decrease in body fat when subjects were forced to endure indoor temperatures of 17°C for two hours a day over six weeks.

Furthermore, though uncomfortable at first, it seems people are able to get used to the cold over frequent, prolonged exposure, says the Dutch team.

When subjects were exposed to colder temperatures for six hours a day over 10 days, scientists found they had increased their brown fat. Participants also reported feeling more comfortable and shivered less at 15°C.

Really keen to lose those last few pounds? Lower the thermostat enough to provoke a good shiver, as a good cold-induced palpitation can increase heat burning and calorie expenditure by as much as five-fold above the resting metabolic rate. 

"...rethinking our indoor climate by allowing ambient temperatures to drift may protect both health and bank account," concludes the study.

The research was published out of Maastricht University Medical Centre in the journal Trends in Endocrinology &
Metabolism. – AFP Relaxnews 

Kredit: www.thestar.com.my

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