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Asthma

5 Common Myths Associated with Asthma 

Asthma is a chronic condition that affects the airways in the lungs. Among children, asthma is a common condition however it affects people of all ages ranging from infants to the elderly.

While there are many things that can cause asthma such as genetics, environmental factors, and occupational exposures,  sometimes the exact cause cannot be determined. If you or someone you know has recently been diagnosed with asthma, it can be overwhelming.

Your healthcare provider can provide you with some great resources, and while the internet is a great source of information, take caution regarding some common myths associated with asthma. Read on to learn the truth to these common myths.

Myth #1: Asthmatics Should Avoid Exercise.

While many asthmatics experience exercise induced asthma, it does not mean that it should be avoided all together. This, in fact, is a myth. It is important to assess your individual risk factors and determine if your asthma is well controlled with an asthma-action plan. If your asthma is well controlled, you may enjoy activities such as a brisk walk, leisure biking, swimming, and hiking. Avoid exercising outdoors in colder weather months to avoid an asthma flare-up.

Myth #2: Asthmas Goes Away after Childhood.

While some children will experience asthma only in the early years of life, asthma does not just go away. A common misconception, but, in fact, a myth. A clear answer to this myth would be that, for some children, asthma can go into a hibernation state and never return. This is due to a person’s lungs growing and maturing and the lungs becoming less affected by triggers. Its important to know that while your asthma may not ever truly go away, your attacks can be well controlled if you are aware of your triggers.

Myth #3: No One Dies from Asthma.

This is alarmingly false. According to the World Health Organization (WHO), in 2016 there were 417,918 deaths globally due to asthma. Asthma is one of the major noncommunicable diseases, this means that asthma is not transmissible directly from one person to another. While asthma can be controlled with medication, it can cause deaths. It is important to seek treatment and not allow your symptoms to get worse. Ensure you continue your medications and asthma action plan set by your healthcare provider.

Myth #4 All You Need is Albuterol.

Albuterol sulfate is a common bronchodilator, which works by relaxing the muscles in the lungs, and makes it easier to breathe. The truth is albuterol is not the only medication available to treat asthma. Also, everyone with asthma does not take the same medication. Asthma can be treated with two types or medications: a quick-relief and long-term controller. A quick relief will control the symptoms of an asthma flare-up. A long-term medication will work by helping you have fewer and milder flare-ups.

Myth #5: Asthma is Easy to Diagnose and Treat.

The truth is asthma can be difficult to diagnose. The reason being that asthma mimics other diseases and often there are similar symptoms, making it difficult to make the diagnosis. Asthma is underdiagnosed and undertreated which creates a substantial health burden globally and to individuals and their families. If you suffer from asthma, and you have a long family history of asthma, it may be easier to diagnose. For some, a series of test may be needed to make the diagnosis.

Takeaway

Asthma is estimated to have affected more than 339 million people in 2016 according to WHO. It is a common condition, and it is important to have facts and understand the misconceptions and myths associated with it. Asthma can be treated and controlled so that a person can enjoy their day-to-day life!

Sources:

https://www.cdc.gov/asthma/faqs.htm

https://www.nhlbi.nih.gov/health-topics/asthma

https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653

https://www.who.int/news-room/fact-sheets/detail/asthma

COPD Awareness: Understanding the Diagnosis and Stages

Awareness

COPD Day

November 18, 2020 – World COPD Day

Being told you have chronic obstructive pulmonary disease (COPD) can be overwhelming. COPD is a progressive disease that obstructs the airflow, making it difficult to breathe and get enough oxygen into your lungs. According to the Chest Foundation, COPD is the third leading cause of death in the US and impacts roughly 24 million Americans.

COPD is made up of two diseases; emphysema accounts for 33 percent, and chronic bronchitis accounts for the remaining 64 percent of diagnosed cases. Emphysema occurs due to the damage that happens to the air sacs in the lungs. These air sacs overfill with air and lose their elasticity which makes it hard to exhale the excess air. In chronic bronchitis, the airways become swollen and inflamed and produce large amounts of mucus. The increased production of mucus obstructs the airways, narrows them, and makes it hard to breathe.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has classified four stages in which your healthcare provider will determine what stage of COPD you are in. This will help them determine the best treatment plan for you.

Symptoms

The first part of diagnosing your condition will consist of assessing symptoms. It will be important to provide your healthcare provider with the symptoms you have been having that have led you to seek medical attention. Common COPD symptoms include:

  • Shortness of breath
  • Chronic cough
  • New or increased wheezing
  • Coughing up phlegm or and increase in phlegm

Risk Factors

It will be important for your healthcare provider to know if you have had or are currently exposed to any risk factors. Risk factors could include things such as:

  • Genetic factors
  • Abnormalities from birth
  • Tobacco smoke
  • Smoke from cooking/heating fuels
  • Dust
  • Vapor
  • Fumes or other inhaled chemicals

Spirometry

Spirometry will play a large role in your COPD diagnosis. Once you have sought medical care for COPD related symptoms and you have discussed your risk factors, the next step will be for your healthcare provider to order spirometry.

Spirometry is a common breathing test used to see how well your lungs are working by taking a few test measurements while you breathe into a machine. Spirometry will measure the air you breathe in, the air you breathe out, and how quickly you breathe out.

One of the initial spirometry tests that will be performed is called the Forced Vital Capacity (FVC) measurement or the amount of forced air that you can exhale and inhale into the machine. An equally important measurement is the calculation based on the Forced Expiratory Volume in One Second (FEV1). This is the amount of air you can breathe out of the lungs in the first one second of forced expiration.

Your FEV1 is based on factors including your age, sex, height, and ethnicity.  Your healthcare provider will compare your results to a healthy individual and any deviations in measurements are what will lead to a sign of what might be causing your problems.

You will be given a breathing treatment with medication to help open your lungs such as a bronchodilator before you start the test. This is to ensure your lungs are performing at their best.

After your test is completed, your healthcare provider will review the measurements and see which of the four GOLD stages of COPD you fall into based on your results. This testing will serve as a follow-up assessment to determine what other therapies can work for you and to monitor you as the disease progresses.

Four Stages of GOLD

Your spirometry results, particularly your FEV1, will fall into one of the four GOLD classifications of severity which is how your COPD stage will be determined.

COPD Fast Facts

GOLD 1
  • Mild Stage, Stage I COPD
  • FEV1  greater than/or equal to 80% of predicted test results compared to a healthy individual
  • In this stage, you will likely experience very mild symptoms
GOLD 2
  • Moderate Stage, Stage II COPD
  • FEV1 between 50 – 79% of predicted test results compared to a healthy individual
  • Symptoms include shortness of breath with activity, cough, and sputum production
GOLD 3
  • Severe Stage, Stage III COPD
  • FEV1  between 30 – 49% of predicted test results compared to a healthy individual
  • In this stage, you may experience shortness of breath, fatigue, and a lower tolerance to physical as well as more frequent COPD exacerbations
GOLD 4
  • Very Severe, Stage III COPD sometimes referred to as End-Stage COPD
  • FEV1 less than 30 % of predicted test results compared to a healthy individual
  • In this stage, you may find that your quality of life is significantly decreased, and you may experience severe and life-threatening exacerbations

Takeaway

COPD is a chronic disease that cannot be cured and as time goes on, the disease progresses. Certain treatments and lifestyle changes can help you manage your symptoms and improve your quality of life. It is important to seek out a healthcare provider who will work with you to improve your breathing.

Sources:

https://foundation.chestnet.org/lung-health-a-z/chronic-obstructive-pulmonary-disease-copd/

https://www.who.int/respiratory/copd/burden/en/

https://goldcopd.org/

Face Masks and Your Oxygen Levels

Face Masks

As we approach the fall and winter months, it is imperative we continue the use of face masks to slow the spread of COVID-19 and follow the recommendations set by the Centers for Disease Control and Prevention (CDC). Misinformation about their effectiveness to slow the spread of COVID-19 as well as the misconception that their use deprives a wearer’s oxygen level will only lead to adverse impacts on individuals who follow inaccurate information.

An infodemic, that has recently accompanied the COVID-19 pandemic, is an overabundance of information, some information is accurate, and some is not. This makes it difficult for people to find trustworthy sources and reliable guidance when they need it the most.

Face Mask

Misinformation regarding the use of masks could impact the spread of COVID-19.

Oxygen Levels

For most adults, wearing a face mask will not lead to the wearer developing hypoxemia. There are a few exceptions, including the use among very young children and people with certain pre-existing pulmonary or cardiac issues. Hypoxemia is a condition in which the supply of oxygen is inadequate for normal organ function and levels of oxygen are extremely low at the tissue level. Hypoxemia is determined by measuring the oxygen level in a blood sample, the artery, or it can be estimated by measuring the oxygen saturation of your blood by using a pulse oximeter.

Normal arterial oxygen is approximately 75 to 100 millimeters of mercury (mm Hg). For healthy individuals, a pulse oximeter reading of 95 to 100 percent is normal however for those with chronic respiratory conditions such as chronic obstructive pulmonary disease (COPD), an acceptable pulse oximeter reading is 88 to 92 percent. Pulse oximetry levels among COVID-19 patients vary as the condition evolves.

In a press release from earlier this year, CDC Director Dr. Robert R. Redfield shared, “Cloth face coverings are one of the most powerful weapons we have to slow and stop the spread of the virus, particularly when used universally within a community setting. All Americans have a responsibility to protect themselves, their families, and their communities.”

Stay safe and stay informed with good sources of information. Research shows masks are effective in spreading COVID-19 and they will not cause oxygen deprivation.

Read more about this topic at https://www.reuters.com/article/uk-factcheck-oxygen/fact-check-face-masks-do-not-cause-terrible-damage-to-the-brain-by-depriving-it-of-oxygen-idUSKBN2761ZW

Our fact-check sources:

The CDCs Recommendations

Questions and Answers regarding Face Coverings

True Hypoxia and Hypoxemia Facts

Frontline Workers & The Truth About Masks

Respiratory Health Among First Responders

This year marks the 19th Anniversary of the September 11th attacks of 2001. Immediate deaths involved those at the World Trade Center (WTC) in New York City (NYC), the Pentagon, and the passengers on board the four aircrafts, which included Shanksville, Pennsylvania, and Arlington County, Virginia. Of the 2,977 lives lost that day, 343 firefighters and 71 law enforcement officers perished. As the day approaches, we pause to remember the victims, the families, and survivors affected by this horrific event.

New York City Firefighters

Firefighters work at the site of the World Trade Center terrorist attack in New York City on September 11, 2001.
Photo: Mark Lennihan/Associated Press

With specific regard to the WTC and ground zero, the information provided by the NYC Commissioners office states that the rescue and recovery clean-up of the 1.8 million tons of wreckage took 9 months to complete. Firefighters, Emergency Medical Technician (EMT), law enforcement officers, and volunteers joined in the effort to recover and rebuild, putting their respiratory health at risk in the process.

Firefighters are regularly at an increased risk of developing respiratory conditions due to occupational exposures. In fact, researchers have found an increased prevalence of chronic obstructive pulmonary disease (COPD) among nonsmoking workers. According to the Centers for Disease Control and Prevention (CDC), nonsmokers account for an estimated 26 -53% of COPD cases attributed to occupational exposures. Inhalation of occupational elements can lead to short- and long-term effects on the respiratory system. During the “knockdown” phase, firefighters are actively fighting the fire. During the “overhaul” phase, firefighters have extinguished the fire, and embers and smoldering flames have subsided. Consequently,  both lead to exposure to toxins and respiratory irritants such as sulfur dioxide, aldehydes, and hydrogen chloride.

The World Trade Center Health Program was implemented to manage the ongoing health effects of the 9/11 attacks. As of December 2017, the program has reported asthma, COPD, various cancers, and gastroesophageal reflux disease (GERD) to be the most common conditions they treat. Air pollution experts suggest that along with pulverized building materials and electronic equipment, first responders were also inhaling things such as burning jet fuel, plastics, metal, and fiberglass. Under normal circumstances, firefighters are not exposed to this magnitude of inhaled pollutants.

The events of 9/11 highlight the essential need for firefighters to use self-contained breathing apparatus (SCBA). The use of an SCBA can prevent or slow the progression of developing respiratory conditions such as asthma and COPD, prevent inhalation of pulmonary irritants, and reduce the risk of smoke inhalation injuries. The significance of COPD among firefighters is like that of a problem in developing countries where household air pollution is a concern. According to the World Health Organization (WHO), 25% of deaths attributed to COPD involve low- and middle-income countries and are due to the exposure to household air pollution. Women who are exposed to high levels of indoor smoke and are twice as likely to develop COPD as compared to women that use cleaner fuels and technologies.

Lung disease among firefighters is studied routinely. Schermer TR, et al. set out to compare occupational exposures, use of respiratory protective devices, and their association with health-related quality of life among metropolitan firefighters. A cross-sectional cohort analysis of the South Australian metropolitan fire-fighter was performed. The questionnaire involved 570 participants and analyzed respiratory symptoms, medical conditions, occupational tasks and exposures, and the consistency of respiratory protection. Of the results reported, 91% of firefighters that participated reported relevant occupational exposures in the last year. Asthma accounted for 4% and COPD for 7% as a diagnosis based on criteria answered in the questionnaire. Firefighters with asthma reported they had been sick due to occupational exposures twice as often as those with COPD, emphysema, or chronic bronchitis.

Our medical textbooks teach us that asthma and COPD are two distinct disorders however there is increasing evidence that many patients may have features of both, now referred to as Asthma-COPD overlap (ACO).  Asthma is classified by having intermittent symptoms early on and has an effective response to inhaled medication therapy. COPD however is generally is associated with a late-onset, a patient typically has a slow progression of symptoms, poor response to inhaled therapy, and often associated with long-term smoking. COPD patients are prescribed long term oxygen therapy (LTOT) manage their symptoms whereas most asthma patients are not. Patients with ACO have a decline in the quality of life and higher mortality compared with patients who have either isolated-COPD or isolated asthma.

Firefighters at ground zero after the attacks at the World Trade Center

Firefighters at ground zero in New York City shortly after the attacks on the World Trade Center (WTC). September 11, 2001.

In a similar 2016 study by Aldrich TK et al., lung function trajectories in WTC firefighters over the course of 13 years were observed. Information was collected from 10,641 WTC-exposed NYC firefighters. Significant findings revealed that on average, firefighters lost 10% of their lung function after 9/11, and >10% developed new obstructive airway disease. The data also revealed that there was a little recovery in lung function over a span of the first 6 years. First responders, those arriving at ground zero the morning of 9/11 had a significant pulmonary function test (PFT) results, having an FEV1 < lower limit of normal as compared to those that arrived toward the end of the day. Of those studied, Aldrich et al. did separate the subjects into never smokers, current smokers, and previous smokers. Current smokers had existing lung function damage, but the significance of the findings is that 65% of the firefighters never smoked yet make up the 10% of those who have a new diagnosis of obstructive disease. Smoking cessation plays a significant role in any patient population however extremely imperative in the firefighter population. While the damage caused by the WTC exposure is immutable, focusing on improving PFT metrics can monitor the progression of the long-term respiratory conditions.

The National Institute for Occupational Safety and Health (NIOSH) is a federal agency and organization that conducts research and makes recommendations to prevent work-related injuries and illnesses. According to NIOSH, mortality from lung cancer, heart disease, and COPD are three diseases traditionally associated with firefighting. Based on previous research collected, current smokers may tend to overlook signs and symptoms of COPD which could lead to delay in care and treatment of lung damage. As with our current COVID-19 pandemic, great importance is placed on the use of personal protective equipment (PPE). NIOSH Respiratory Protection Week is September 8-11, 2020. Their focus for the last 101 years has been to compile resources and determine proper respiratory protection and maximize the availability of respiratory protection in addition to designing innovative respirators.  

The International Association of Fire Fighters (IAFF) is another key organization among firefighters. Information provided by the IAFF suggests that depending on when a diagnosis is made of COPD and how aggressively firefighters can change exposures and behaviors, further decline in lung function can be decreased with appropriate PPE. As mentioned before from what we know with the events of the 9/11 attacks, the use of SCBA equipment by firefighters can slow the progression of respiratory diseases by preventing inhalation of pulmonary irritants and reduce the risk of smoke inhalation injuries. Beyond that, specific attention to the consistent use of respiratory protection devices in employees who have underlying chronic respiratory conditions is equally important.

Among the common respiratory conditions firefighters face, cancer is among the highest diagnosed within the profession. In 2010, NIOSH published a study that included nearly 30,000 firefighters who were employed from 1950 – 2009. Findings suggested that compared to U.S. population rates, firefighters had a 9% increase in cancer diagnosis and a 14% increase in cancer-related deaths. This information is consistent with a cancer diagnosis that has been trended from the WTC Health Program. Each year more firefighters have lost their life due to various types of cancer, linked back to the exposure of the 9/11 attacks.

The dedication and bravery the multitude of first responders from 9/11 and all firefighters today exhibit should never be forgotten. Integrity, respect, and compassion are qualities these men and women display daily all while risking their lives and health. Let us pause to commemorate the lives of those we lost that day and join in the effort to bring safety awareness to this vulnerable population who is at increased risk of developing respiratory health issues and fatal conditions.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289858/

https://www.sciencedirect.com/science/article/abs/pii/S0091743511003616

http://postprint.nivel.nl/PPpp6792.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4686342/

https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health

https://www.cdc.gov/niosh/index.htm

https://www.iaff.org/asthma-copd/