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By Angela C.C. Wang, MD, CTS President
"To put it still more plainly: the desire for security and the feeling of insecurity are the same thing. To hold your breath is to lose your breath…" Alan Watts
Toddlers do it. They exist completely in the moment — even as they ricochet from joy to tears to joy again in a single breath. As our maturing brains simultaneously learn to remember the past and imagine the future, we become increasingly distracted from the present and in extreme cases, oblivious to our own body's cues and processes. Hence, the "asymptomatic" patient sitting in the exam room — tachypneic, her breathing shallow and labored — insisting that she is NOT short of breath. Or, the anxious patient, paralyzed by indecision, for whom any possibility of happiness is consumed by fear about future "what ifs." We see it in ourselves, as frontline clinicians, paying more attention to our screens, guidelines and data than the living, breathing patient in front of us.
That we can breathe and not forget our dreams entirely...
From Paris Winter, by Howard Altman
Some readers will undoubtedly roll their eyes at an article with "mindfulness" in the title. However, mindfulness is a state of awareness that can be a powerful tool for patients and their providers to not just manage their symptoms and mental health, but also embrace the lives they have now and live it to the fullest. We learn early on that life is not fair. But we also need to learn that we have the ability to choose how we will react to life's misfortunes, and that how we choose to do so — with grace and determination, with dignity and love — is not just a weapon against pain and despair but perhaps the ultimate expression of what it means to be fully human.
By Ni-Cheng Liang, MD, Assistant Clinical Professor, Medical Director, Pulmonary Services; University of California San Diego, Center for Pulmonary and Sleep Medicine
- Self-management programs empower patients with COPD to learn and enact care plans, promote change for healthier lifestyles, and provide psychosocial support to cope with disease.
- In a Cochrane Review, self-management interventions in those with COPD were found to be associated with less dyspnea, improvement in quality of life, and a reduction in respiratory-related admissions (1).
- Anxiety and depression are important comorbidities of patients with COPD. Depression is associated with readmission due to acute exacerbation of COPD (8).
- Self-management interventions using mindfulness, are not well studied in COPD, but improve patients' ability to become self-aware of their breath and body sensations which can lead to an improvement in quality of life. However, mindfulness based interventions have been shown to improve depressive symptoms, anxiety and quality of life in multiple studies (9).
- Mindfulness is intentional non-judgmental awareness.
- Mindfulness Based Stress Reduction (MBSR), a well-established 8 week program initially developed for those with chronic pain, improves other chronic health conditions such as those with cardiovascular disease, and as an adjunctive treatment for patients with cancer (9). MBSR traditionally consists of eight weekly 2-2.5 hour classes that consist of formal mindfulness based meditation practices such as the body scan, awareness of breath, mindful movement with walking, group support and discussion. Through these classes, skills promoting awareness and acceptance of the present moment are fostered and lead to greater appreciation of life inclusive of hardships, development of self- compassion and the sense of interconnectedness with others providing a catalyst for positive lifestyle changes, and a greater sense of well-being (2).
- Pilot studies using MBSR and adaptations of MBSR for patients with COPD are few in number and have shown inconclusive results (3-5). There remains a paucity of data on the use of mindfulness in patients with chronic lung disease, but MBSR has shown benefits in patients with asthma (7) and for smoking cessation (6).
- There remains a lack of standardization in research focused on self-management for patients with COPD, inclusive of mindfulness based programs due to intervention, study population and outcome measure heterogeneity and thus recommendations regarding the most effective form and content of self-management programs in COPD remain unknown (1).
- In today's burgeoning climate of healthcare change and accountability with penalties incurred for readmissions, promotion of self-management interventions and its rigorous study, along with increased emphasis on treatment of psychological comorbidities such as anxiety and depression are priorities.
By Angela C.C. Wang, MD, CTS President
With what a glory comes and goes the year!
From Autumn by Henry Wadsworth Longfellow
It's been an amazing year for CTS, and I am acutely aware of how much I and CTS have to be grateful for. A special thanks to my fellow Executive Committee members: Chris Garvey and George Chaux, whose selfless wisdom and fierce commitment to excellence were vital to the successful launching of several new endeavors this year, including this newsletter. Chris has done an outstanding job shepherding the publication through its infancy. The quality of its articles continues to amaze and delight. Our final 2015 edition will be published in two weeks and will feature a "greatest hits" review of articles from the past few months and I am eager to see what our readers have been most interested in, to help us improve for 2016. The essence of a professional organization such as CTS is its members. People like Chris, George and our Executive Director Shannon Jamieson are what make CTS unique. CTS is not just a place to share ideas or find a mentor and get advice; it's not just about learning about the latest in medicine or jobs and research opportunities. CTS is a place where you can thrive by connecting with people who bring out the best in you.
We've always been proud of the quality of our educational events. Our fall symposium continues to grow and this year's event set another attendance record. The room full of smiling, wide awake faces during the last lecture at 4 p.m. on a Saturday afternoon in October was proof of another successful conference! And now we've taken our flagship annual Carmel Conference and made it even better. One of the things I love most about this meeting is its size. Big enough to be stimulating, small enough so that I am not overwhelmed trying to decide between multiple talks being held at the same time in separate venues. The intimacy encourage questions and spontaneous discussion and you can sit close enough to see the speakers without the use of a video screen!
Two new pre-meeting courses — a fluoroscopy/radiation safety course and a multidisciplinary COPD symposium are being held on Friday Jan. 29. The Welcome Reception will be Friday evening, followed by the long-running annual Western Respiratory Club dinner. If you've never attend the WRC dinner, this year is a great time to start! This year's WRC speaker is Dr. Denny Amundson who will be describing his experiences on the frontline of the Ebola epidemic in Liberia. You can get a preview of his talk here. Finally, the main program on Saturday Jan. 30 features its own stellar lineup of faculty discussing the latest in ARDS, post ICU care and chronic lung infections.
Early Bird Registration ends TOMORROW 12/11. Don't wait, click here to register now! And while you're at it, please consider joining our organization, if you haven't done so already. As I've mentioned in several previous columns, CTS offers invigorating opportunities for professional and personal growth. And don't be shy about volunteering for a committee. Clinical Practice, Education, Advocacy are just a few ways to become more involved with this great organization.
CTS Membership $125 (one year active physician)
Collegiality and Camaraderie $Priceless
Advances in Pulmonary and Critical Care Medicine:
ARDS, ECMO and Chronic Lung Infections
Mycobacteria, Bronchiectasis & the Airway Microbiome
Featuring special guest faculty:
Chuck Daley, MD, National Jewish Health
and Atul Malhotra, MD, UCSD and ATS President
PLUS – TWO NEW pre conference Friday programs:
COPD Today: A Team Approach (Symposium)
Fluoroscopy Safety for the Medical Provider (State Recognized CME Course)
Full Conference Details
Early Bird Registration (EXPIRES TOMORROW, Dec. 11)
People who have occasional migraines and asthma are twice as likely as those without the breathing condition to develop chronic migraine attacks, according to a new study. Researchers explored the link between migraines and asthma because they are similarly caused by inflammation, either of the blood vessels or airways.
Los Angeles Times
California would target certain harmful emissions under new legislation being introduced by state Sen. Ricardo Lara in an effort to boost public health while battling global warming. Known as short-lived climate pollutants, the emissions include diesel exhaust and methane from agriculture.
Lung Disease News
A recent study of an endoscopic technique called flexible bronchoscopy in patients with chronic obstructive pulmonary disease and pulmonary hypertension has found these patients have an elevated risk of lower blood-oxygen levels than COPD patients undergoing the procedure. The paper was published in the International Journal of COPD.
The Washington Post
It was just a tiny bump behind Corey Wood's right eye, but her doctor was concerned. The college senior and marathon runner felt fine, but a full-body scan revealed that she had Stage 4 lung cancer. The diagnosis was stunning, both because of Wood's age and the fact that she has never smoked. Every year, though, a couple thousand Americans under 40 receive the same mind-bending news, despite having none of the usual risk factors for the disease.
A new study suggests that kids with asthma or allergies like hay fever may face as much as a doubling of their risk of high blood pressure and high cholesterol — even if they aren't overweight. However, the risk to any one child remains low, experts stressed, and it's not clear whether allergic diseases directly cause these problems. It's possible that another factor — such as a lack of exercise — could play a role.
Many electronic cigarettes contain flavoring chemicals that may cause lung disease, researchers say. A team of researchers tested 51 types of flavored e-cigarettes and liquids. The investigators found that 47 (more than 75 percent) of them contained diacetyl. The chemical has been linked to a severe lung disease called bronchiolitis obliterans.
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