Coronary heart disease (CHD) remains a significant cause of death, accounting for 1 in 10 deaths worldwide.
International guidelines recommend improving or decreasing the cardiac workload using a combination of therapies known as MONA: morphine, oxygen, nitrates, and aspirin.
Oxygen, via face mask or nasal cannula, is often administered to patients with suspected AMI.
According to Dion Stub, MBBS, PhD, from The Alfred Hospital in Melbourne, Australia, treating AMI with oxygen has its roots in practices dating back more than a century. “Oxygen was first administered to patients with suspected ACS in 1900, and to this day is given to [more than] 90% of patients with cardiac emergencies. Whilst other medical practices from the early 1900s — such as starvation diets for aneurysms and mercury as a treatment for infections — were quickly discarded, the routine use of oxygen in cardiac emergencies has remained a pervasive component of first medical response,” Dr Stub told Cardiology Advisor.
Oxygen therapy may decrease cardiac blood flow and perfusion, reduce cardiac output, and increase coronary vascular resistance.
In 2010, Juan Cabello, MD, PhD, from Hospital General Universitario de Alicante in Spain, and colleagues published a review of the literature for oxygen therapy in AMI conducted to determine whether this practice is helpful or harmful. They found that robust evidence to support the use of oxygen to treat AMI was lacking.
The uncertainty of whether oxygen therapy in AMI is beneficial or harmful has stimulated the development of clinical trials examining this question.
According to Dr Cabello, no firm recommendation can be made regarding oxygen therapy for AMI given the low quality and scarcity of the available clinical trial evidence. “The message for clinicians is that we still do not know if oxygen is helpful, harmful, or useless,” he said. “There are theoretical reasons why it could help and also why it could do harm.”
“This updated Cochrane Review further emphasizes the message that oxygen should be treated like all other medical therapies, in which efficacy needs to be balanced with the side effect profile,” Dr Stub said.
Christmas is a time for friends, family and a lot of preparing gifts, journeys, cards to send but most of all do not get too stressed and rushed and forget to look after yourself or your family’s health over the festive period.
- Order any repeat prescriptions you may need especially if you are going away for the festive season.
- Check that you have enough oxygen supply for the Christmas period.
- If you are going away make sure you make arrangements for any oxygen that you need.
- Also look out for lonely, vulnerable neighbours and friends during the winter period, that may need your help or even conversation.
- Stay warm during the festive time – make sure you pre-programme your heating for when you are going to be in and set your thermostat to a suitable temperature.
- If you are ordering a supply of oxygen make sure you have registered with OxygenWorldwide so any concerns whilst away can be dealt with 24/7
- Have a lovely Christmas!!!!
Rheumatoid arthritis is a well-known disease for causing damage to joints, however the disease can also affect your lungs. It can cause damage to the tissue around the joints as well as your eyes, heart and lungs.
“We call it rheumatoid arthritis, but we should really call it rheumatoid disease,” says Elinor Mody, MD, director of the Brigham and Women’s Hospital Women’s Orthopaedic and Joint Disease Centre in Boston. Besides the joints, the “heart and lungs are the most commonly affected,” Mody says. Doctors aren’t sure how or why rheumatoid arthritis causes other organs to suffer, but lung complications of rheumatoid arthritis can be serious and even cause death.
Interstitial Lung Disease
Rheumatoid arthritis-associated interstitial lung disease, or RA-ILD, is the most serious lung complication for people with rheumatoid arthritis. This illness can be hard to detect, but occurs when lung tissue becomes inflamed and eventually scarred.
* Smoking increases the risk of developing it but non-smokers do develop RA-ILD.
* It causes breathlessness and a dry cough, but in many cases it is symptomless making it difficult to be able to detect it early enough to try and treat it.
* There are trials going on at the moment trialling new drugs to try and treat it but nothing has been very successful so far making the disease difficult to treat, other than treating the symptoms.
The inflammation and scarring caused by RA-ILD can lead to pulmonary fibrosis and permanent scarring of the lung tissues. The air sacs are gradually replaced by scar tissue reducing the respiratory capability of the lungs and resulting in shortness of breath.
* Supplemental oxygen can be used to help make breathing easier but it cannot reverse the dame done by pulmonary fibrosis.
* Methotrexate is a drug commonly used to treat rheumatoid arthritis, however this drug also causes pulmonary fibrosis. If you are on this drug then your
respiratory status needs to be carefully monitored.
Rheumatoid arthritis can also cause nodules to form in the throat and on the vocal cords, causing complications like hoarseness and other changes. Nodules can develop in the lungs as well, but usually don’t cause symptoms and patients may never notice them.
Prevention of Respiratory Issues
Because of the high risk of complications due to rheumatoid arthritis-associated lung disease and the fact that there is little treatment available, prevention is key. To help reduce your risk:
* Don’t smoke. If you do, ask your doctor for suggestions about how to quit smoking immediately. Chemicals found in cigarettes can irritate already delicate lung tissue, leading to further complications.
* Have regular check-ups. Your doctor should listen to your lungs and monitor your breathing at each visit as lung problems that are detected early can be easier to treat. Talk to your doctor about any shortness of breath you’re experiencing and ask about changing medications or starting supplemental oxygen therapy to help ease symptoms.
COPD patients are often prescribed opioids such as codeine, oxycodone and morphine to provide relief from common symptoms such as muscoskeletal pain, insomnia and respiratory issues. However it has been shown by researchers in Toronto, Canada that opioids can induce additional respiratory side effects and that new opioid users have 5 times a greater risk of death compared to non-opioid users. These results raise serious safety concerns about the use of opioids for older adults with COPD.
“This is a population that has a chronic lung disease, with symptoms that can sometimes be challenging to manage,” said Dr. Nicholas Vozoris, lead author of the study. “This class of drugs may offer some relief; however, there is also evidence suggesting that opioids can adversely affect breathing and lung health in people who already have chronically compromised lungs.”
Previous studies reported that opioids were safe for patients with advanced COPD but the results were not reliable due to study limitations.
In this new study over 130,000 patient records were examined from multiple healthcare databases to try to ensure the results were more generally applicable and reliable.
“Previous research has shown about three-quarters of older adults with COPD have been prescribed opioids, which is an incredibly high rate of new use in a population that is potentially more sensitive to narcotics,” Vozoris said. “Our new findings show there are not only increased risks for respiratory-related death associated with new opioid use, but also increased risk of visits to emergency rooms, hospitalizations and needing antibiotics or steroid pills.”
The team found that those who used opioids had an increased risk of 14% or ending up in the emergency department and nearly 3 times the risk of COPD or pneumonia-related mortality. They even have an overall mortality risk of 76% compared to non-opioid users. Opioids were however found to decrease the risk of respiratory exacerbations by 12%.
The higher risks were found in patients using stronger or higher dosage opioids however many risks were unaffected by dosage if you were a new user.
Opioids can impact COPD patients in several ways such as respiratory depression, reduced mucous clearance from cough suppression, and immunosuppressive effect.
To lower the risks of adverse events doctors may prescribe less potent or lower dosage opioids but the results of the current study showed increased risk of complications and even death regardless of dose amount among new opioid users. Vosoriz said the finding is important because lower doses were long considered safe.
“Sometimes patients are looking for a quick fix for chronic pain or breathing issues and physicians may believe opioids can offer them some relief,” he added. “The trade-off becomes explaining that there are risks to patients and making sure they understand that potentially alleviating their symptoms could come at a higher cost to their health.”
An individual multi-disciplinary approach is better as a treatment plan rather than just prescribing opioids. Making use of pulmonary rehabilitation, supplemental oxygen therapy, exercise and lifestyle changes in conjunction with medication is best way forward for COPD patients.
Despite there being excellent medications for COPD patients, such as bronchodilators which are continually improving in both potency and in delivery there is still a huge proportion of the COPD patient population who continue to experience deterioration in their symptoms and poor quality of life. There are however many non-pharmalogical treatments that can provide huge relief for many patients. They may work alongside your pharmalogical treatment or you may decide that they are better used instead of, but always consult with your doctor.
Smoking cessation is the most important of these. It has been shown and still being proved in continuous research how cigarette smoke harms not just your lungs but also the rest of your body. It the primary cause of COPD and the chemicals have been shown to affect your cells right down to its DNA and causes abnormalities, inflammation and permanent damage which greatly worsens your symptoms and respiratory ability. There are lots of different ways you can be aided in stopping, with patches, gum and electronic cigarettes. Its always best to support your method with counselling or support groups.
Telemedicine allows patients with COPD to connect electronically with a specialized care consultant. Telemedicine can be used to collect information from the patient and track his or her progress on a daily basis, if necessary. It has been used to alert the medical team to the early onset of acute exacerbation of COPD thereby avoiding emergency department visits and hospital admissions. However, more evidence is needed as some studies state that “telemonitoring for COPD is not yet proven and further work is required.” There are many devices already out in the market which are easy to use and allows the user to feel more in control and to monitor their respiratory vitals on a daily basis and adjust their regime quickly when alerted to avoid unnecessary attacks and deterioration.
Pulmonary rehabilitation is important in order to sustain your mobility and quality of life. It aims to counteract the loss of skeletal muscle that is common in COPD and to improve exercise tolerance. There are a variety of methods including exercise training, nutritional supplementation, and psychosocial support. Although it is not yet proven to have direct links to increased survival or lung function, there have been improvements in health-related quality of life, dyspnea, and exercise tolerance. There has also been a tendency for any accumulated improvements to deteriorate with time unless the methods are continued.
Long-term oxygen therapy is also an option for some patients with COPD. Short-term use of oxygen during exercise or strenuous activities in patients with any degree of hypoxemia has long been known to improve dyspnea and increase exercise tolerance, although is not proven to extend survival. For patients who are chronically hypoxemic long-term oxygen therapy where the patient uses it constantly through the day, not only improves exercise performance and quality of life but also improves survival rates. There are many different devices depending upon your lifestyle and requirements and can be obtained via the NHS or from private companies. They are much more compact, lightweight, discrete and portable than ever and still allows the patient to move around easily both in their home and outdoors so as to allow the patient to have a significantly increased quality of life and eliviate respiratory symptoms.
Noninvasive positive pressure ventilation (NIV) has been effective when treating COPD patients that suffer from acute exacerbations. Gas exchange and respiratory abilityes are improved, resulting in decreases in intubation rates, shortening hospitalizations, and improving mortality. However, its long-term role in managing COPD has not been demonstrated and its unclear as to whether nocturnal NIV will signoificantly improve lung function, gas exchange, or sleep efficiency.
Patients with severe emphysema typically have bullae. These are growing air spaces that occupy space within the thorax but do not provide much gas exchange. They are more likely to impair the function of less diseased lungs by occupying dead space within the thorax and contributing to air trapping and ventilation/perfusion problems. The aim of surgical lung volume reduction is to remove nonfunctional lung and thus improve lung physiology and symptoms. A large study showed that this treatment is only truely beneficial to patients with predominantly upper lobe disease and low prior exercise tolerance. Other subjects tended to have higher mortality. The procedure is rarely performed today, but there are attempts to achieve a similar outcome, by less invasive methods. These employ the placement of one-way valves in the lung airways that allow gas to leave bullae but not return. The valves are placed bronchoscopically into the lungs. In general, some improvement in lung function, less dyspnea, and improvements in exercise capacity have been obtained, but there has usually been an increase in adverse effects, including acute exacerbations of COPD and pneumothorax, sometimes requiring removal of the valve(s). Lung coils are another method proven to be very succesful. Doctors insert special flexible scopes through the patient’s mouth to place metal coils into the damaged tissue of the patient’s lung. The coils return elasticity to the diseased tissue, allowing the lungs to work in a more normal way. Other experimental lung procedures with the same aim have attempted to collapse the most emphysematous lung regions by closing the airways to those regions by other means, but development of these methods is incomplete.
Lung transplantation has been an option for patients with severe COPD since 2000, with 50% survival being in the region of 5 years and steadily improving. It should be considered only in patients with end-stage COPD, only when all other therapies have been tried and failed to provide relief. Primary graft failure, chronic rejection, and infection are common problems, however, there can be successes where lung function and quality of life can markedly improve, and outcomes are improving with time.
A company in California has invented biosensors that can be injected into the body and not be rejected by the body’s immune system. They could well replace traditional clinical laboratory testing and make our bodies continually accessible 24/7 so that we know exactly whats going on in our bodies and improve our health. The capability for these new biosensors to provide long-term, continuous streams of live data about the levels of various molecules in our body could completely alter the relationship we have with our bodies as well as transforming the healthcare system.
We rarely get the chance to see whats happening inside our body unless we see an x-ray or have specific tests done; we rely on our doctors to take some blood or perform other one-ff tests in order to get a single snap shot of whats going on and interpreting it for us.
If we could see the data for ourselves continuously in real time, then we can make timely choices to prevent symptoms getting worse and have a continuous conversation with our own bodies to keep it within healthy parameters.
These new biosensors will have uses not only for healthy individuals wishing to remain so and monitor their health and fitness but also could be used in the management of chronic diseases such as diabetes and COPD.
“Our tissue-integrated biosensor technology meets three key criteria for continuous monitoring: First, the data needs to be clinical-grade so that you and your healthcare provider can make medical decisions about your health and wellbeing. Second, the user experience needs to be seamless so adoption can fit into any workflow environment. And finally, the technology needs to be accessible at a reasonable cost in a form function that’s easy to use,” explained Dr Hwang.
The biggest hurdle of biosensor development has been how to overcome the effects of the foreign body response and to stop the body from rejecting what it thinks are foreign objects. The biosensors are placed under the skin with a specially designed injector. Each biosensor is a flexible fibre of 3-5mm long and 500 microns in diameter. Rather than being isolated from the body these sensors are fully integrated into the tissue of the body. There are no metal devices or electronics involved and therefore overcomes the effect of the foreign body response.
Each biosensor is comprised of a bio-engineered ‘smart hydrogel’ which is similar to contact lens material which forms a porous, tissue-integrating scaffold that also induces blood vessel growth and cell growth in the surrounding tissue. The smart gel is linked to a florescent light-emitting molecule that continuously signals the presence of a body chemical like oxygen or glucose.
Adhered to the skin’s surface or held by hand, a separate optical reader is used to read the fluorescent signal from the embedded biosensor. The reader sends excitation signals through the skin to the biosensor, which then emits light proportional to the concentration of molecules being tracked. The data can be relayed to a smart phone for an encrypted personal record and historical tracking.
Their oxygen sensing system that the company has developed is a single biomarker sensor designed to measure dissolved oxygen in the tissue. It is the only long-term monitoring technology that guides therapeutic action and measures tissue oxygen levels during the treatment and healing process for peripheral artery disease (PAD). It will be available in Europe this year to be used by vascular surgeons and wound-healing specialists. Other respiratory disease patients can also benefit from using this technology such as those who suffer with COPD. They can continuously measure their oxygen levels using real time data in order to be able to adapt and alter medications and supplemental oxygen flow rates in order to prevent exacerbations and hospital admissions. It would help respiratory disease patients to continuously monitor their condition and provide real data for their healthcare provider to monitor and aid in their long-term treatment. It could help prevent exacerbations and help to prolong quality of life and increase survival rates.
In the future we would be able to monitor practically every biomarker in our body and would not need blood tests and some other clinical monitoring tests at hospital to be performed and would reduce the burden upon on the healthcare system. Results could be sent wirelessly to the doctor who could monitor from afar and would change the way medicine is practiced and put the responsibility and control into the hands of the patient.