The Star Online: Lifestyle: Health
The Star Online: Lifestyle: Health |
| Posted: 19 Nov 2011 04:36 PM PST COPD is greatly underdiagnosed, with recent studies indicating that 25% to 50% of people with clinically significant COPD don't know they have the disease. SHORTNESS of breath (dyspnoea) is difficult or laboured breathing, which feels like you cannot get enough air. One common cause of shortness of breath is chronic obstructive pulmonary disease (COPD), which refers to a group of lung diseases that cause damage to your lungs and makes it difficult for you to breathe. Cigarette smoking is the leading cause of COPD. Long-term exposure to other lung irritants, such as air pollution, chemical fumes or dust, also may contribute to COPD. Secondary smoke (exposure to people who smoke) is also a risk factor. Incidence According to the World Health Organization, COPD is most common in countries where cigarette smoking is very widespread. It afflicts some 50 million people around the world, and kills nearly three million every year. COPD is the fourth leading cause of death worldwide and is greatly under-diagnosed, with recent studies indicating that 25% to 50% of people with clinically significant COPD don't know they have the disease. In Malaysia, respiratory illness is the primary cause of visits to health clinics and outpatient hospital clinics. The burden of COPD in males is almost three times that of females. Chronic respiratory disease, including COPD, in Malaysia is ranked fifth among the leading cause of disease burden. The two most common conditions of COPD are: ·Chronic bronchitis: The inflammation of the lining of the bronchial tubes which carry air to and from your lungs. Acute bronchitis is very common and develops from a cold or other respiratory infection. Chronic bronchitis caused by smoking is due to the constant irritation or inflammation of the lining of the bronchial tubes. Acute bronchitis usually improves within a few days; however, repeated bouts of bronchitis may be suggestive of chronic bronchitis and will require medical attention. ·Emphysema: The tiny air sacs in the lungs are gradually destroyed and there is progressive shortness of breath. Smoking is the leading cause of emphysema. Are smokers with COPD more likely to develop pneumonia? Yes! Smoking increases mucous production and impairs the clearing action in the airway. Bacteria and inflammatory and damaged lung cells accumulate, making the secretions thick and difficult to clear. The stagnant mucous causes bacteria to flourish and cause infection of the lung (pneumonia). Furthermore, even the inflammatory cells are damaged by tobacco smoke, so their ability to fight infections is diminished and there is limitation in the oxygen-carbon dioxide diffusion. Pneumonia is often also more severe in smokers with COPD than in non-smokers without COPD. Symptoms of COPD do not appear until significant lung damage has occurred. People with COPD are also likely to experience episodes called an exacerbation, which is an increase in the severity of the disease. Red flags to watch out for include: ·Chronic cough (often the first symptom of COPD), and later, with chronic sputum production. ·Wheezing. ·Tightness of the chest. ·Shortness of breath (dyspnoea) is the hallmark symptom of COPD. COPD and asthma have similar symptoms of coughing and wheezing, but differ in that the onset of asthma typically occurs during childhood or adolescence, while COPD often develops in smokers and former smokers who are in their mid-40s. Exacerbations of asthma often have identifiable triggers such as allergens, cold air or exercise. Exacerbations of COPD are commonly caused by infections. With treatment, asthma patients can be symptom-free between exacerbations. COPD patients rarely experience a day without symptoms. How a doctor decides to manage a patient's COPD is based on spirometry results, severity of dyspnoea and disability, which can be assessed using the Modified Medical Research Council (MMRC) dyspnoea scale. Spirometry is the most common and important lung function test in diagnosing COPD and its stage. You'll be asked to blow into a large tube connected to a spirometer. This measures how much air your lungs can hold and how fast you can blow the air out of your lungs. Spirometry can detect COPD even before you have symptoms of the disease. There are four stages of COPD, ranging from mild (stage 1) to very severe (stage 4). Mild COPD is when there is shortness of breath when hurrying on level ground or walking up a slight hill, progressing to severe COPD where the person gets breathless just getting dressed. A COPD patient is in stage 4 when there are signs of respiratory failure. Such patients are usually bed-bound. Treatment There's no cure for COPD, and you can't undo the damage to your lungs. But COPD treatments can control symptoms, reduce your risk of complications and exacerbations, and improve your ability to lead an active life. Bronchodilators are drugs that can open the airways, usually administered via an inhaler. Bronchodilators include beta agonists and can be either short-acting (salbutamol) or long-acting (salmeterol). Anti-cholinergics such as iptratroprium bromide, which have good bronchodilator effects, can also be added. Occasionally, theophylline is used if the patient's symptoms are not controlled with the usual bronchodilators. A broad-spectrum antibiotic acts against a wide range of disease-causing bacteria and should be given to COPD patients with acute exacerbations who have at least two out of three cardinal symptoms, which are yellow-green phlegm, increased phlegm volume and/or increased dyspnoea Antibiotic treatment can be effective for such cases and is directed at the common causative bacteria such as Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. Initial outpatient treatment may include orally administered antibiotics such as doxycycline, amoxicillin-clavulanate potassium or moxifloxacin. Patients who are older than 65 years of age or have more frequent exacerbations (four or more episodes per year), and have had several antibiotic treatments in a short span of time may need an augmented penicillin such as amoxicillin-clavulanate potassium or respiratory quinolone such as moxifloxacin. Oral moxifloxacin for the treatment of exacerbated COPD with once-daily dosing and is as effective as its intravenous form. Effective initial antibiotic treatment of exacerbations may be able to prevent admission to hospital, or at the very least, shorten the stay in hospital if admission is necessary. In some cases, the selection of the correct antibiotic together with adequate supportive care can prevent death in a COPD patient experiencing an exacerbation The management of chronic stable COPD always includes smoking cessation and oxygen therapy. Inhaled beta 2 agonists, inhaled anticholinergics, and systemic corticosteroids provide short-term benefits in patients with chronic stable disease. Inhaled corticosteroids reduce airway inflammation and will help you breathe better. Preventing acute exacerbations helps to reduce long-term complications. Long-term oxygen therapy, regular monitoring of pulmonary function and referral for pulmonary rehabilitation are often indicated. Get your influenza and pneumococcal vaccination, exercise regularly, eat healthy and avoid smoke, crowds and cold air. Patients who do not respond to standard therapies may benefit from surgery. If you find yourself often short of breath, ask yourself if you may have COPD. Ask your doctor about a simple breathing test called spirometry. This simple test may safeguard your lung health. Further to that, if you smoke, quit now. The power is in your hands. > This article is contributed by Dr Kalpana Nayar, medical advisor with Bayer HealthCare. This information is provided for educational purposes only and should not be taken in place of a consultation with your doctor. Bayer HealthCare disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article. Related story |
| Posted: 19 Nov 2011 03:50 PM PST Looking at nutritional alternatives in cholesterol control. WE already know from the third National Health and Morbidity Survey (NHMS III 2006) that five years ago, about 43% of adult Malaysians (30 years and above) were overweight (29%) or obese (14%); 43% had hypertension; and 15% had diabetes. Since Malaysians continue to lead unhealthy lifestyles and indulge in high-calorie unhealthy foods, the situation is definitely worse now. If we concentrate only on those 40 and above, then the figures will be more worrying; and figures for those 50 and above will be really alarming, because the survey figures were somewhat "diluted" by the relatively healthy 30-39 age group. I hope that in the future, the Government will release figures that will indicate these differences so that we realise that the problem is bigger than what the NHMS seems to show. However, the survey on younger Malaysians should continue because unhealthy trends begin in childhood and continue through adult life, resulting in early onset of non-communicable diseases (or chronic lifestyle diseases as I prefer to call them) like obesity, hypertension, heart disease, diabetes and cancer. A survey involving 10,000 students showed that 24% of those aged between six and 12 were either overweight or obese. Another survey showed that about 38% of youngsters between 12 and 18 were overweight. Most adults have high cholesterol It is not surprising that we doctors see so many patients who have dyslipidaemia (abnormal lipid/fat levels – particularly high total cholesterol and LDL-cholesterol; high triglycerides; and low HDL-cholesterol). And many of these patients are on cholesterol-lowering drugs, which are mainly statin drugs. I estimate that over 50% of the patients above 50 years have high total and "bad"/LDL-cholesterol levels, and most of them have been prescribed statins by their doctors. While diet is a factor in raising our cholesterol levels, it must be remembered that it contributes only 10-15% to the total cholesterol. The bulk of it is what is produced by our liver, and this is influenced by our general health, many hormones (especially the metabolic and sex hormones), exercise, and fitness. So if you are not healthy, your cholesterol levels may be abnormal even if you are not overweight and do not consume much animal products. Children with high cholesterol More worrying is the increasing prevalence of abnormal lipid levels in children and young adults. Recently, the US National Heart, Lung, and Blood Institute (NHLBI) recommended that all children be screened for high cholesterol at least once between the ages of nine and 11 years, and again between ages 17 and 21 years. This is because 30-60% of children already have high cholesterol levels! This correlates with the rising incidence of obesity and atherosclerosis (which causes heart attacks and stroke) in children and young adults in the last two decades. Since Malaysian children are also living similar "Western" lifestyles, eating similar unhealthy junk food and getting fat/obese, we should also consider this so that we can monitor and advice those children and young adults who are at risk much earlier, and help them avoid getting heart disease or stroke later in their lives. Statin therapy While there is no doubt that many studies have shown the benefits of normalising lipid levels (to reduce the risk of heart attacks, stroke and peripheral arterial disease), my concern is that most patients are put on the statin drugs without recourse to basic and safer alternatives first. The statin drugs are known to have side effects, the most common of which are myopathy (many patients complain of muscle cramps) and liver stress (many patients have high levels of liver enzymes). The first and most important step is always a reversion to a healthy lifestyle and diet, maintaining an ideal weight, and doing sufficient exercise. In addition, I would prescribe nutritional therapies. To be fair to the doctors, the problem is that most patients are not disciplined and committed to adopt the lifestyle/diet/exercise that would enable them to achieve their ideal weights and normalise their cholesterol levels. However, it is my observation (especially feedback from the patients who come to me for nutritional therapy advice) that our doctors are too quick in prescribing the statin drugs without considering the alternatives. So I end up "weaning off" these patients who come to me from statin drugs to nutritional alternatives. Here are some nutritional therapies that have been proven to reduce bad cholesterol. Some may even raise the good HDL-cholesterol. Soluble fibre Soluble fibre can reduce the absorption of dietary cholesterol. Animal products are the sources of cholesterol in our diet, but plant products that contain much saturated fat can also cause the blood cholesterol level to rise. You will need at least 5g of soluble fibre a day to decrease your total and LDL-cholesterol. The more you ingest, the better the results. We all know through the local campaigns that oatmeal is effective in lowering cholesterol. That is because one bowl of oatmeal or oat bran provides more than 5g of soluble fibre, and therefore, daily consumption can reduce and maintain healthy cholesterol levels. Other sources of soluble fibre include apples, bananas, barley, kidney beans, pears and prunes. Omega-3 essential fatty acids Omega-3 fatty acids can reduce total and bad cholesterol, triglycerides, as well as raise good cholesterol. They also reduce inflammation and may help lower the risk of chronic lifestyle diseases (eg hypertension, heart disease, stroke, cancer, and arthritis). They are important for cognitive functions (eg memory). Deficiency may cause fatigue, poor memory, dry skin, heart problems and mood swings. Developing foetuses, babies and children need enough omega-3 fatty acids for healthy nerve, eye and brain development. Omega-3 fatty acids can be found in deep-sea fish such as salmon, tuna, mackerel, trout, herring, sardines and halibut; other seafood including algae and krill; some plants; and nut oils. It is recommended that we eat omega-3 rich fish at least twice a week, but there is also concern that most of the fish are now contaminated by heavy metals, which can cause toxicity problems and increase cancer risk. So in order to get higher doses of omega-3 fatty acids to lower cholesterol (or for other benefits) without having the risk of contamination, it is better to rely on omega-3 supplements for therapy. I use purified molecular-distilled omega-3, which are guaranteed to be free of contaminants. Tocotrienols (super vitamin E) We are the world's leading producer and exporter of tocotrienols – the family of vitamin E that are far superior in many aspects compared to the more widely available form of vitamin E (tocopherols). Our palm oil is the richest commercial source of tocotrienols, while the common vitamin E supplements (alpha-tocopherol) is extracted from soy. Clinical research has shown that tocotrienols can reduce total and LDL-cholesterol, dissolve existing cholesterol plaques while also having brain-protective and skin-protective effects against ageing. Tocotrienols may also be helpful against some forms of cancer. Combined therapy There are other nutritional therapies which have been shown to be effective, though not necessarily having as much evidence as the above methods (eg red yeast rice, guggul lipids, berry extracts, mangosteen extracts, etc). When any of the above nutritional therapies fail, I combine two or more methods until I achieve the desired results. In fact, the patients benefit from the multiple health-enhancing effects of the nutrients. > Dr Amir Farid Isahak is a medical specialist who practises holistic, aesthetic and anti-ageing medicine. He is a qigong master and founder of SuperQigong. For further information, e-mail starhealth@thestar.com.my. The views expressed are those of the writer and readers are advised to always consult expert advice before undertaking any changes to their lifestyles. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information. Full content generated by Get Full RSS. |
| Posted: 19 Nov 2011 03:49 PM PST Studies show that stem cells from fat tissue demonstrate early success in reconstructive surgery. STEM cells derived from human fat tissue were recently reported to demonstrate early success in reconstructive surgeries in over 30 patients in Japan who underwent facial and breast procedures. Innovative treatment The results from an investigator-initiated study by Dr Kotaro Yoshimura of Tokyo University in Japan were presented at the 4th annual meeting for the International Fat Applied Technology Society that took place in Baton Rouge, Louisiana, US. Dr Yoshimura performed an innovative stem cell treatment on 39 patients who underwent procedures ranging from repair of congenital facial and breast defects, and aesthetic enhancements to breast reconstruction following partial mastectomy. The procedure is similar to a conventional lipo-injection. Dr Yoshimura's team lipo-suctioned fat from patients, concentrated stem cells found in the fat, then injected the fat and stem cells into the areas of damaged tissue. Each patient received his or her own fat and stem cells. Until now, doctors have injected fat into damaged tissue to give physical or mechanical support. However, eventual loss of that fat, called atrophy, is a common occurrence in patients who have had injected fat therapy. Dr Yoshimura observed minimal atrophy in his patients, and believes the stem cells were key to keeping the fat healthy and allowing it to rejuvenate. Stem cells derived from fat tissue appear to act through the promotion of blood vessels as a way to increase the survival of the transplanted tissue, as well as continuing tissue turnover after transplantation by forming new fat cells, helping to preserve tissue volume, stated Dr Yoshimura. These are early findings for which more research is required prior to making such a treatment broadly available. However, these clinical results demonstrate the potential for stem cells derived from fat tissue. Dr Yoshimura also said that 70% of all complications arising from cosmetic surgery are linked to the use of artificial materials. Stem cell enriched-fat, therefore, holds the promise of eliminating such complications. Stem cells from adipose tissue (fat) is a rich source of stem cells, as well as other cell types that contribute to the natural healing process in humans. Referred to by the medical community as adipose-derived stem cells, researchers have "prompted" such cells to convert to fat, bone, cartilage and muscle, and believe these cells could help treat heart conditions, heal broken bones, and even be used in reconstructive surgery. According to Dr Jeffrey Gimble of the Pennington Biomedical Research Center in Louisiana, fat is considered to be much more than just those extra pounds we carry around. Unlocking the potential of stem cells found in fat tissue is just the beginning. Additional applications A separate research team, led by Dr Lorenza Lazzari, also released work that supports the thought that fat stem cells within transplanted fat can improve lipo-injection therapy. Dr Lazzari's team extracted fat from the abdomens and thighs (lipo-suction) of 12 patients, and then injected the fat into the patient's vocal folds. This therapy is used following damage due to disease or anatomical defect. Until now, the team believed the injected fat offered only mechanical or structural support of the vocal folds. Prior to injection, however, the team also sampled the fat for laboratory analysis. Dr Lazzari's team found that this procedure gave vocal abilities and normal speech to their patients for the long-term – one to two years, so far. The injected fat remained healthy and demonstrated rejuvenation. To determine why, the team analysed the fat tissue used for injection and found the presence of stem cells. Dr Lazzari believes that adult stem cells (ASCs) residing naturally in fat tissue may enhance the rejuvenation of damaged vocal folds. Sample analysis indicated that ASCs in fat samples were present and able to differentiate into various cell types, and may act as a source to provide regenerative abilities in vocal fold tissue. Local scenario Aesthetic physician and cosmetic surgeon Dr Alice Prethima Michael says this technology can be used for skin rejuvenation and anti-ageing therapy through the CHA-Station™ procedure. With CHA-Station™, undesired fat is aspirated from another part of the body and infused with stem cells, then injected into body parts such as the breasts, buttocks or even the hollow contours of the face. "I'm a firm believer in educating patients and the general public about the latest medical treatments and technologies," says Dr Alice. "Introducing the CHA-Station™ to the public is part of my mission to educate them on this safer and longer lasting option to aesthetic enhancement." Full content generated by Get Full RSS. |
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