|
Re: Phlebotomy For COPD
From: teamtanner@hotmail.com (ironjustice)
On Jun 12, 9:31 pm, ironjustice <teamtan...@hotmail.com> wrote:
"Phlebotomy decreases blood volume and viscosity, increases cardiac
output and improves exercise tolerance in patients"
"Improvement was dramatic" <<
Chest 1990 Nov;98(5):1073-7
Exercise performance of polycythemic chronic obstructive pulmonary
disease
patients. Effect of phlebotomies.
Chetty KG, Light RW, Stansbury DW, Milne N
Department of Medicine, VA Medical Center, Long Beach, CA 90822.
The purpose of this study was to determine the effects of phlebotomy
on the exercise tolerance and right and left ventricular ejection
fraction of polycythemic patients with chronic obstructive pulmonary
disease. Ten patients with COPD (mean FEV1 = 1.32 +/- 0.55 L) and
polycythemia (mean Hct = 62 +/- 3 percent) were studied before and
after their hematocrits had been reduced to approximately 50 percent.
Post-phlebotomy the maximal oxygen consumption increased from 1.09 +/-
0.34 L/min to 1.26 +/- 0.43 L/min (p less than 0.05) and the maximum
workload increased from 56.5 +/- 32.6 watts to 74.5 +/- 23.4 watts (p
less than 0.05). The increase in the exercise tolerance appeared to be
primarily due to an increased cardiac output at Emax. There was no
relationship between the increases in the upright exercise capacity
and changes in the supine ejection fractions of the right or left
ventricular either at rest or during exercise.
PMID: 2225946, UI: 91030710
__________________________________________________ _______________
Respiration 1979;38(6):305-13
Phlebotomy improves pulmonary gas exchange in chronic mountain
polycythemia.
Cruz JC, Diaz C, Marticorena E, Hilario V
There is not unanimous agreement in the literature regarding the
effects of bleeding on pulmonary gas exchange in polycythemic
patients. Spirometry, alveolar arterial O2 and CO2 tension
differences, PaO2 breathing 100% oxygen and carbon monoxide-diffusing
capacity were measured before and after 1 week of chronic phlebotomy
in 4 chronic mountain polycythemic patients. Studies were carried out
at 3,700 m above sea level (PB = 491 mm Hg). Before phlebotomy, 2
patients showed abnormal spirometry and gas exchange. Only 1 patient
had high PaCO2 and all of them showed low values of PaO2 breathing
oxygen. Phlebotomy improved both spirometry and gas exchange.
Improvement in arterial oxygen saturation and PaO2 could not be
attributed to changes in alveolar ventilation, but rather to better
distribution of VA/Qc ratios since physiological dead space decreased.
Our results are similar to those reported in polycythemia vera
patients. A significant correlation between the changes in PaO2 with
phlebotomy and the control PaO2 have been found from 45 polycythemic
patients with chronic obstructive pulmonary disease collected from the
literature. It is concluded that excessive polycythemia worsened
hypoxemia and that phlebotomy improved gas exchange.
PMID: 538338, UI: 80146854
__________________________________________________ _______________
Am J Med 1983 Mar;74(3):415-20
Improved exercise tolerance of the polycythemic lung patient following
phlebotomy.
Chetty KG, Brown SE, Light RW
The present study evaluated the effects of therapeutic phlebotomy on
the exercise tolerance and the maximal carbon dioxide output of
polycythemic patients with chronic obstructive pulmonary disease.
Fifteen maximal exercise studies were performed before and after
phlebotomy in patients with moderate to severe chronic obstructive
pulmonary disease (mean forced expiratory volume in one second [FEV1]970 ml). After phlebotomy there were no significant differences in
pulmonary function, blood gases, oxygen consumption, or carbon dioxide
production at rest. However, after phlebotomy there was a significant
increase in the exercise tolerance of the patients. The mean workload,
the duration of exercise, the maximal oxygen consumption, the maximal
carbon dioxide production, and the ventilation at maximal exercise all
increased significantly. The improved exercise tolerance after
phlebotomy appeared due to an increased cardiac output generated
mainly through an increased stroke volume. We hypothesize that the
increased stroke volume was due to a higher ejection fraction of the
right ventricle secondary to a lower pulmonary artery pressure. This
study provides further evidence that patients with chronic obstructive
pulmonary disease who have polycythemia benefit by therapeutic
interventions that maintain their hematocrits below 55 percent.
PMID: 6402930, UI: 83149913
Who loves ya.
Tom
Jesus Was A Vegetarian!
People Pictures">Man Is A Herbivore!
DEAD PEOPLE WALKING
Phlebotomy for rapid weaning and extubation in COPD patient with
secondary polycythemia and respiratory failure.
Tripathy S, Panda SS, Rath B.
Lung India. 2010 Jan;27(1):24-6.
Department of Kalinga Institute of Medical Sciences, Bhubaneswar,
India.
Abstract
The increased incidence of ventilator-associated complications in
patients
with chronic obstructive pulmonary disease (COPD) necessitates rapid
weaning and extubation.
The presence of secondary polycythemia in this subgroup increases the
incidence of stroke and myocardial infarction due to hyperviscosity
and
tissue hypoxia.
We present a 58-year-old male patient of COPD with secondary
polycythemia
(hematocrit 64%) who had possible hyperviscosity-related complications
leading
to cardiac arrest after a minor surgical procedure.
The patient developed ventilator dependence after recovery.
Phlebotomy was done to remove 10% of total blood volume.
Symptomatic improvement was dramatic.
Improvement in weaning indices like rapid shallow breathing index and
PaO(2)/PAO(2) was observed facilitating rapid weaning and early
extubation.
Monitored, acute phlebotomy is safe and cost-effective.
It decreases blood volume and viscosity, increases cardiac output and
improves exercise tolerance in patients.
PMID: 20539767
------
Half of COPD Patients Were Misdiagnosed as Having Asthma
70% of those with this leading cause of disability are senior
citizens.
COPD (chronic obstructive pulmonary disease) - a progressive
condition
that leads to a worsening of respiratory symptoms, a decline in lung
function and increased disability - tends to be under-diagnosed and
under-treated. More than half of patients with COPD, for example, may
be misdiagnosed as having asthma. Estimates are that almost
three-fourths of COPD patients are senior citizens.
The new study results, published in the Journal of Asthma, are from
the
most recent prospective, patient-reported, objectively documented
COPD
study to examine COPD misdiagnosis.
COPD, which includes chronic bronchitis and emphysema, is
characterized
by a loss of lung function over time.(2) Primarily a disease of
current
and former smokers, COPD affects nearly 12 million Americans.(3)
Unlike
asthma, COPD is associated with a cascade of decline that leads to a
diminished quality of life over time.(7)
Most people with COPD are at least 40 years old or around middle age
when symptoms start. It is unusual, but possible, for people younger
than 40 years of age to have COPD.
"Millions of people live with COPD for years, so their inability to
do
the things they enjoy because they simply can't breathe is
devastating," said the study's lead author, David G. Tinkelman, M.D.,
Vice President for Health Initiatives, National Jewish Medical and
Research Center, Denver.
"We need to clarify the differences between COPD and asthma so
patients
get the right diagnosis early and the appropriate interventions
needed
to change the course of this growing health crisis."
The study, conducted in Denver and Aberdeen, Scotland, and sponsored
by
Boehringer Ingelheim Pharmaceuticals, Inc. and Pfizer Inc, analyzed
data from 597 patients age 40 and older with a history of lung
disease
or recent treatment with respiratory medications.(1) Patients were
then
screened using spirometry, a lung function test, to confirm their
diagnosis of COPD.(1)
In this study, a COPD diagnosis was defined in agreement with
American
Thoracic Society and European Respiratory Society guidelines as the
presence of obstruction -- inability to get air out of the lungs --
based on spirometry results.(1)
Of the 235 patients diagnosed with COPD by spirometry (measuring the
capacity of the lungs), 51.5 percent reported a prior diagnosis of
asthma only.(1) Only 37.9 percent of participants diagnosed with COPD
based on the study tests reported a previous diagnosis of the
disease,(1) while 10.6 percent reported no prior diagnosis of COPD or
asthma.(1)
"These findings are surprising given the availability of credible
diagnosis and treatment guidelines specifically for COPD," noted Dr.
Tinkelman. "Only through proper diagnosis and treatment will COPD
patients fully benefit. Patients can benefit from lifestyle
modifications, pulmonary rehabilitation and proper pharmaco therapy
that may help them breathe better and return to the activities they
enjoy."
About COPD
COPD is second-leading cause of disability (5) and the fourth-leading
cause of death in the U.S.(2) While COPD is primarily caused by
cigarette smoking, other causes of COPD include exposure to
occupational dusts and chemicals.(2) Researchers have also found a
link
between COPD and a rare genetic disorder involving a deficiency in
the
enzyme alpha1-antitrypsin (AAT) that normally prevents loss of
elasticity in the lungs' fibers.(7)
The most common COPD symptoms include shortness of breath, chronic
cough (sometimes with phlegm), and wheezing.(2) In mild COPD,
patients
experience breathlessness during high-energy activities, such as
exercise.(4) As the disease worsens to the moderate and severe
stages,
patients become breathless more frequently, avoiding activities that
cause shortness of breath.(4) This can lead to physical
deconditioning
-- loss of muscle strength -- and disability.(4) Patients eventually
become breathless, even at rest.
COPD accounts for a high proportion of health-care costs -- nearly
$40
billion in the U.S.(8) In the last 20 years, COPD was also
responsible
for nearly 50 million hospital visits nationwide.(9)
COPD is, however, a manageable disease.(7) According to diagnosis and
treatment guidelines set by the Global Initiative for Chronic
Obstructive Lung Disease (GOLD), intervention can help improve and
prevent some of the symptoms of COPD and improve health status and
patient outcomes.(7)
About National Jewish Medical and Research Center
National Jewish Medical and Research Center is the only medical and
research center in the United States devoted entirely to respiratory,
allergic and immune system diseases, including asthma, tuberculosis,
emphysema, severe allergies, lupus and other autoimmune diseases.
Founded in 1899, this nonprofit and nonsectarian institution is
dedicated to enhancing prevention, treatment and cures through
research, and to developing and providing innovative clinical
programs
for treating patients regardless of age, religion, race or ability to
pay. Website -.
References:
(1) Tinkelman DG, Price D, Nordyke RJ, Halbert RJ. Misdiagnosis of
COPD
and asthma in primary care patients 40 years of age and over. Journal
of Asthma. 43:1-6. 2006.
(2) National Heart, Lung, and Blood Institute. Data Fact Sheet:
Chronic
Obstructive Pulmonary Disease (COPD). Available at.
Accessed June 25, 2004.
(3) Centers for Disease Control. Summary health statistics for
U.S.adults: National Health Interview Survey, 2003.National Center
for
Health Statistics. Vital Health Stat 10(225).2005. Table 3. Available
at:.
(4) National Heart, Lung, and Blood Institute. Education Strategy
Development Workshop: Chronic Obstructive Pulmonary Disease. U.S.
Department of Health and Human Services. December 2005.
(5) Beers MH, ed. The Merck Manual-Second Home Edition. Chronic
obstructive pulmonary disease. Available at:.
(7) Global Initiative for Chronic Obstructive Lung Disease. Global
Strategy for the Diagnosis, Management and Prevention of Chronic
Obstructive Pulmonary Disease. NHLBI/WHO workshop report. Bethesda,
National Heart, Lung and Blood Institute, April 2001; Updated
September
2005. Available at.
(8) National Institutes of Health. NHLBI Morbidity & Mortality: 2004
Chart Book on Cardiovascular, Lung * Blood Diseases. May 2004.
Available at:.
(9) Holguin F, Folch E, Redd SC, Mannino DM. Comorbidity and
mortality
in COPD-related Hospitalizations in the United States, 1979-2001*.
Chest ,October 2005. 2005-2011.
(10) National Health Interview Survey
SOURCE: National Jewish Medical and Research Center
Who loves ya.
Tom
Jesus Was A Vegetarian!
Man Is A Herbivore!
DEAD PEOPLE WALKING
|
