A NEW REPORT FROM THE CENTERS FOR DISEASE CONROL AND PREVENTION AND THE NATIONAL INSTITUTES OF HEALTH PROVIDES THE FIRST REPORT OF STATE LEVEL CHRONIC OBSTRUCTIVE PULMONARY DISEASE PREVALENCE AS WELL AS ASSOCIATED HEALTHCARE RESOURSE USE. THE FINDINGS WERE PUBLISHED IN THE NOVEMBER 23 ISSUE OF THE MORBIDITY AND MORTALITY REPORT.

The researchers found that the age-adjusted prevalence of COPD is considerably variable from state to state, ranging from less than 4% prevalence in Puerto Rico, Washington state, and Minnesota to more than 9% prevalence in Alabama and Kentucky. The overall prevalence among US adults is 6.3% (an estimated 15 million people) and appears to increase with age, with a higher than 11.6% prevalence seen in adults aged 65 years or older compared with a prevalence rate of 3.2% in those aged 18 to 44 years.
COPD was reported more commonly among non-Hispanic whites and blacks than among Hispanics (6.3% and 6.1% compared with 4.0%, respectively), and women were more likely to report COPD than men (6.7% vs 5.2%). Prevalence decreased with increasing income, “from 9.9% among those reporting a household income <$25,000 annually to 2.8% among those reporting ≥ $75,000,” and respondents with a history of asthma were more likely to have been diagnosed with COPD than those without (20.3% vs 3.8%, respectively).”Continued surveillance for COPD, particularly at state and local levels, is critical to 1) identify communities that likely will benefit most from awareness and outreach campaigns and 2) evaluate the effectiveness of public health efforts related to the prevention, treatment, and control of the disease,” lead epidemiologist Nicole Kosacz, MPH, from Oak Ridge Institute for Science and Education in Tennessee, and colleagues write.Data from the 2011 Behavioral Risk Factor Surveillance System, which collects information via telephone survey of noninstitutionalized individuals aged 18 years or older, was used for the analysis. The survey is administered annually by state health departments in collaboration with the CDC, and data are collected from all 50 states, the District of Columbia, and Puerto Rico. In 2011, nearly 500,000 people responded to the survey. Median response rates ranged in different states from 33.8% to 64.1%.All respondents were asked: “Have you ever been told by a doctor or health professional that you have COPD, emphysema, or chronic bronchitis?” Surveys administered in 21 states, the District of Columbia, and Puerto Rico included additional questions for those who responded “yes” to this initial question.

Additional Data From 21 States
Data from 21 states, the District of Columbia, and Puerto Rico documented that 64.2% (95% confidence interval [CI], 62.4% – 66.0%) of respondents felt that shortness of breath had a negative effect on their quality of life; 55.6% (95% CI, 53.7% – 57.5%) were taking at least 1 medication a day to manage their COPD, with rates of medication usage increasing with age; and 76.0% (95% CI, 74.4% – 77.6%) had been given a diagnostic breathing test (spirometry).

“The overall prevalence of COPD and its associations with health-care utilization and quality of life make it a serious public health burden that needs to be addressed, especially in areas where the prevalence remains well above the national average,” the authors write.

Of the respondents from this subset, 43.2% (95% CI, 41.4% – 45.1%) reported seeing a physician for COPD-related symptoms in the past 12 months. Visits to a hospital or emergency room in the preceding 12 months were lowest in Tennessee (11.7%; 95% CI, 7.3% – 18.3%) and highest in Puerto Rico (27.1%; 95% CI, 18.1% – 38.5%), with a collective prevalence of 17.7% (95% CI, 10.3% – 26.8%) for the 21 states together with Puerto Rico and the District of Columbia.

The report authors note that spirometry for the diagnosis of COPD is a simple test that can be performed in the office setting; however, nearly 20% of respondents who reported having COPD were not diagnosed with a breathing test. “Access to health care and insurance coverage are possible issues, given that wide geographic variation was observed in the reporting of spirometry and medication use in this study,” Kosacz and colleagues write.

The authors also note possible limitations of the report, such as the exclusion of institutionalized individuals (eg, those living in nursing homes or assisted care facilities), which may have resulted in the underestimation of prevalence. In addition, data regarding the diagnosis of COPD, medical tests performed, and medications administered were based on self-report and may have affected prevalence data.

“This analysis provides an important starting point for states to quantify the burden of COPD locally and target their resources, as well as to evaluate the effectiveness of education and awareness programs such as the National Heart, Lung, and Blood Institute’s ‘Learn More, Breathe Better’ campaign in those states,” the authors conclude.

By Charlotte Libov, via WebMD

Denise McVey knows holiday stress all too well. To be sure, she loves the holidays: going caroling, shopping, buying cards, enjoying the first snow, and, most of all, loving the look of delight on her toddler’s face on Christmas morning. But as the days until the holidays dwindle and the lines at the mall get longer, McVey is so beset by season-induced stress that, when the New Year rolls around, she’s spent. “Colds, flu, you name it, every year I get it; I’ve had shingles eight times,” says the 40-year-old owner of a creative agency in Boonton, N.J.

Why do many people feel so much more stress at this time of year? We tend to blame worsening traffic, crowded malls, and incessant commercials pushing holiday consumption, but a key culprit is our own memories, according to Ronald Nathan, PhD, clinical professor at Albany Medical College in New York. “When we think about the holidays, we dwell on the past and what went wrong, or we romanticize it and make it impossible to re-create,” he says.

He counsels people to carefully examine their thoughts and expectations, and not drive themselves crazy finding “the perfect gift” or planning “the perfect party.” “Instead,” he says, “lower your expectations, and overestimate — rather than underestimate — your time.”

STRESS AND THE IMMUNE SYSTEM

Easing up on yourself over the holidays is important because the connection between stress and illness is real, says Simon A. Rego, PsyD, an assistant professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine and associate director of psychology training at Montefiore Medical Center in Bronx, N.Y.

“The controversy that stress causes disease is pretty much over. We’re now teasing out how stress does it,” he says. In fact, a new study explains how stress may weaken the immune system. Each cell contains a tiny “clock” called a telomere, which shortens each time the cell divides. To counter this effect, the body also produces an enzyme, telomerase, which protects the cell and prevents further shortening by adding more DNA to the end of the telomere.

So far, so good — but under stress, the body pumps out cortisol, a hormone that suppresses this protective enzyme. The study found that people under chronic stress have shorter telomeres, which, researchers say, means they are more vulnerable to a host of ailments.

HEALTH EFFECTS OF STRESS

How to reduce the wear, tear, and misery that holiday stress can inflict? When your holiday to-do list stretches longer than Santa Claus’s beard, eliminate whatever is unnecessary. Doing so may reduce your risk of:

-Heart disease, including heart attacks

-Skin conditions, including psoriasis and shingles

-Digestive disorder flare-ups, such as symptoms of irritable bowel syndrome, ulcerative colitis, and Crohn’s disease

-Immune disorders, including flare-ups of multiple sclerosis and lupus

-Anxiety, depression, and insomnia

-Worsening pain, if you already have a pain disorder such as arthritis, back pain, and muscle spasms

As for McVey, she’s paring down her holiday expectations. “I’m planning to take a day off, head into Manhattan, and enjoy the Christmas atmosphere.”

I found this article researching this morning, and thought you all might be interested in it. It is about a study done on which methods are most effective in measuring exercise tolerance and improvement in COPD. Might not be a bad bit of information for you to have in your back pocket to speak to your physician or therapist about performing with you when the time is right.

Borel B, Provencher S, Saey D, Maltais F.

Source

Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, QC, Canada.

Abstract

Exercise intolerance is a key element in the pathophysiology and course of Chronic Obstructive Pulmonary Disease (COPD).

As such, evaluating exercise tolerance has become an important part of the management of COPD.

A wide variety of exercise-testing protocols is currently available, each protocol having its own strengths and weaknesses relative to their discriminative, methodological, and evaluative characteristics.

This paper aims to review the responsiveness of several exercise-testing protocols used to evaluate the efficacy of pharmacological and nonpharmacological interventions to improve exercise tolerance in COPD.

This will be done taking into account the minimally important difference, an important concept in the interpretation of the findings about responsiveness of exercise testing protocols.

Among the currently available exercise-testing protocols (incremental, constant work rate, or self-paced), constant work rate exercise tests (cycle endurance test and endurance shuttle walking test) emerge as the most responsive ones for detecting and quantifying changes in exercise capacity after an intervention in COPD.