الرغبة في التقاط صورة للمكان الذي أنت فيه وإرسالها إلى صديقك أو الإنسان الـذي تحبه؛ هو شكل أيضًا مـن أشكـال الحـب، الجمال الـذي تُبصره عـينـاك تُـريـد أن تُبصره عيناه هو الآخر ..

Coffee Hour

COPD, 11/13/2023

I have a mild form of COPD that was aggravated by Covid. I'd never needed anything to treat it, but a few months ago was given a prescription for a non-rescue inhaler. I'm on my second unit, and frankly, it sucks. It never delivers a consistent dose. Each puff looks and sound different. I honestly don't know if it is helping at all. The pharmacist says there's nothing he can do. Contact the manufacturer. I contacted the manufacturer and they tell me there's nothing wrong, but I can rinse out the delivery puffer if I wish. I think that's supposed to make me feel better; I don't think it fixes the delivery mechanism.

My Stunt Double du Jour suggests holding my breath for a minute. It won't do anything for my COPD or inhaler issue, but I'll feel better when I take my next breath. He's much more helpful than my pharmacist. Or at least he's better looking.

shout-out to anyone with a preventable disability. shout-out to the frustration and the pain and the grief and the rage. if your disability was caused by ignorance or negligence or malice or chance i see you. if someone else had made a difference choice or if you could have made different choices i see you. i see your pain. you are no less entitled to feel that grief even if you could have done something. you shouldn’t be in pain even if you caused it. i forgive you, i see you. if someone else caused your disability i see you. you’re entitled to rage and grief and confusion. to everyone who sees people ignoring the same advice that could have prevented your own suffering, i see you. i see your sorrow, your indignation, your desperation. It’s frustrating when people don’t take your advice because they can’t see the looming outcome. Even when you’re right there.

Struggling to breathe / having dyspnea is so insanely scary and traumatic. So honestly, this is a shoutout post to those who know what it's like and those who deal with it on a regular basis and everyone in between those two spectrums. I actually become so exhausted and stay up incredibly late sometimes soley due to my breathing. I become terrified that if I fall asleep or even lay back down, something will happen. I often spend a wild amount of time distracting myself on my laptop .

idc if they can’t breathe, I desperately need them

Getting help when chronically ill is a full-time job with constant overtime, and instead of getting paid, they take your money.

Also, you're very ill and tired but have to do the work or you die 🙃

I was recently diagnosed with "mild COPD". That's what the doctor called it, but then I was called back in cause my alpha-one tests results came back abnormal. That is not a good thing, it turns out. When your alpha-ones are abnormal it means that at best you're a carrier for lung disease or cancer, and at worst you have lung disease or cancer. So we ran more tests and I got a call from the doctors' office saying they wanted to go over those tests.

That is not good news.

You ever hear the phrase no news is good news? Well, that's almost always applied to medical testing. So the fact that I'm being called in so my doctor can go over my test results is probably not good fucking news.

Trying really hard not to freak out.

MMWR Booster #14: Chronic Obstructive Pulmonary Disease Mortality by Industry and Occupation — United States, 2020

Top 5 Takeaways

COPD as a Leading Cause of Death: Chronic obstructive pulmonary disease (COPD) was the sixth leading cause of death in the United States in 2020.

Mortality Data Analysis: In 2020, 316,023 deaths (10.3%) among ever-employed persons were associated with COPD, with data analyzed from 46 states and New York City.

High-Risk Industries and Occupations: The highest COPD proportionate mortality ratios (PMRs) were observed in the mining industry and food preparation and serving-related occupations.

Demographic Variations: The highest age-adjusted COPD death rates were noted in females, White persons, and non-Hispanic persons.

Public Health Implications: The findings emphasize the need for targeted interventions in high-risk industries and occupations, including workplace smoke-free policies and reduction of COPD-related risk factors.

Full summary link: BroadlyEpi.com

Enjoying these summaries? Check back every day at 8am and 4pm Pacific Time (UTC - 8) for a new MMWR Booster. A reblog would also be greatly appreciated, and thanks to everyone who already has! BroadlyEpi hopes to make Epidemiology and Public Health more approachable to anyone who's interested.

crutches

I need

smoke

in my lungs

pure

oxygen

just kills me

he is like

oxygen

in a container

made of

shiny

metal

I just want

to melt down

and turn into

something

new.

My body:

"I'm going to give u the most emergency room ass symptoms except you're actually completely fine you just have to suffer ooo ouchie"

صَباحُ الخَير ..

”لو كنتُ أعجَبُ مِن شيءٍ لأعجبَني

سَعيُ الفتى وهوَ مَخبوءٌ لهُ القدَرُ.“..

كعب بن زهير

COPD:GOLD

WHO: smoking is the main cause of chronic obstructive pulmonary disease

A recent global report on Chronic Obstructive Pulmonary Disease (COPD) reveals that, despite advances in awareness about the risks of smoking, it remains one of the main causes of this deadly disease that affects more than 392 million people all over the world.

COPD, a common lung disease that causes breathing problems, claims the lives of more than 3 million people each year, according to data collected by respiratory health experts.

Highlighting the magnitude of the problem, research indicates that smoking accounts for more than 70% of COPD cases in high-income countries, while in low- and middle-income nations, this figure ranges between 30% and 40%. %, with domestic air pollution as another significant risk factor.

The risks associated with tobacco are not only limited to COPD but also increase the likelihood of developing lung cancer, cardiovascular disease, and type 2 diabetes.

Prof. David MG Halpin, consultant physician and professor of respiratory medicine, warns of the growing smoking epidemic in low- and middle-income countries, driven by the aggressive marketing strategies of tobacco companies.

“About 80% of the world’s 1.3 billion tobacco users currently live in low- and middle-income countries. “This will undoubtedly lead to a huge increase in the global burden of COPD in the coming decades,” warns the professor. Read more

Going through questions:

The U.S. Preventive Services Task Force (USPSTF) recommends exercise interventions to prevent falls in community-dwelling adults ≥65 years of age who are at increased risk for falls (B recommendation). Falls occur at least once annually in approximately 30% of community-dwelling adults 65 years or older, and the USPSTF recommendation is based on studies that demonstrated improved fall-related outcomes for patients who participated in exercise programs.

Most evidence included group exercise, but supervised individual interventions also appeared to be of benefit. Gait, balance, and functional training; resistance training; flexibility work; and endurance training all appeared to be effective for reducing falls.

Other interventions associated with a reduction in falls or fall-related fractures include an annual fall risk assessment, assistive devices such as grab bars or walkers, and environmental assessment and modifications such as the removal of trip hazards from the home. However, the evidence for in-home assessment of environmental hazards is less robust.

There is no evidence for psychological evaluation in the prevention of falls. The USPSTF recommends against vitamin D supplementation to prevent falls in community-dwelling adults ≥65 years of age in those who are not known to have osteoporosis or vitamin D deficiency (D recommendation).

Above image:

The pearly, papular appearance of this patient’s growth and the overlying telangiectasia makes the most likely diagnosis a nodular basal cell carcinoma. Basal cell carcinoma is the most common cutaneous malignancy. The incidence increases with age and occurs most commonly in Fitzpatrick skin types 1 and 2. The tumors appear most frequently on the face, scalp, ears, and neck, and less frequently on the torso and extremities. In-office dermoscopy may make the branching blood vessels or telangiectasias characteristic of basal cell carcinoma easier to see. In pigmented basal cell carcinomas, dermoscopy can highlight pigmented globules or other areas of abnormal deposition not easily seen without a dermatoscope. Basal cell carcinoma can be locally destructive but rarely metastasizes.

A 55-year-old male with a 40-pack-year smoking history comes to your office with the results of spirometry he had at a health fair. He quit smoking 1 year ago. He does not have any cough, dyspnea, wheezing, or sputum production, but he is concerned that the spirometry results show an FEV1/FVC ratio of 0.65 and an FEV1 of 70% of predicted, which indicates mild to moderate airflow obstruction.

Based on the best available evidence, which one of the following should you recommend in order to prevent the development of symptomatic airflow obstruction?

Answer: No treatment

There is no evidence from randomized, controlled trials to show that treating asymptomatic individuals who have mild to moderate airflow obstruction on spirometry prevents future respiratory symptoms or reduces subsequent declines in lung function. Partly for this reason, the U.S. Preventive Services Task Force and joint guidelines issued by the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society recommend against screening for COPD in asymptomatic adults. Regardless of the results of this patient’s spirometry testing, treatment should not be initiated in the absence of symptoms. Detailed history-taking would be appropriate to detect patients who have limited their activity in order to avoid symptoms. A long-acting anticholinergic, a long-acting β-agonist (LABA), an inhaled corticosteroid (ICS), and combination therapy with an ICS and a LABA would not be recommended for this patient.

Family physicians are often required to manage dyspnea and evaluate common office spirometry results. The American Thoracic Society recommends complete pulmonary function testing with diffusing capacity of the lungs for carbon monoxide (DLCO) measurement when office spirometry suggests a restrictive pattern, which is defined as an FVC less than 80% of predicted. This level of pulmonary function testing gives further information about gas exchange and lung volumes, allowing a more definitive diagnosis.

The 6-minute walk test is used to evaluate the treatment response for known cardiopulmonary disease. Bronchoprovocation testing helps identify asthma triggered by allergens or exercise when office spirometry is normal.

Pearly papules of the penis are a benign, normal anatomic variant and are not sexually transmitted. They are dome-shaped, skin-colored papules 1–4 mm in size with a ring-like distribution around the corona of the glans penis, more commonly found along the dorsal side of the corona. They are present in up to 15%–40% of males. They most commonly occur in late puberty and early adulthood. Circumcised males have a lower incidence. The differential diagnosis includes condyloma acuminata; Tyson glands, which are modified sebaceous glands in a parafrenular distribution; or molluscum contagiosum.

Angiokeratomas are well-circumscribed red or blue papules that are 1–6 mm in size. Genital warts are raised masses that can be pearly and smooth or have a rough, cauliflower-like appearance, and are not confined to the penile corona. Lichen nitidus consists of discrete, hypopigmented, 1-mm papules that are not confined to the corona and can also occur on the upper extremities and abdomen. Squamous cell carcinoma may be endophytic (ulcerated) or exophytic (thickened skin or wart-like growths that can progress to a large, irregularly shaped, fungating mass).

Adhesive capsulitis is characterized by worsening shoulder pain that is hard to localize. The underlying pathology is contraction of the glenohumeral capsule resulting in decreased active and passive range of motion. It is an idiopathic condition but has an increased prevalence in patients with diabetes mellitus and hypothyroidism. Adhesive capsulitis is often self-limited but can persist for years in some patients. Nonsurgical treatment options include physical therapy, oral or intra-articular corticosteroids, acupuncture, and hydrodilatation.

Osteoarthritis is more common among older patients and typically develops more chronically than the subacute presentation of adhesive capsulitis. There is often a history of trauma, previous surgery, or repetitive work. Superior labrum anterior to posterior (SLAP) lesions can be acute (e.g., sustained during a fall on an outstretched hand) or chronic (e.g., in throwing athletes or other high-risk professions). Passive range of motion may be sustained. Infraspinatus tendinopathy may show pain with resisted external rotation. It may also arise due to acute injury or chronic repetitive overuse. Supraspinatus tendinopathy may present with normal strength but positive impingement testing as well as a positive Jobe test or empty can test.

COPD meets COVID

Persistent wheezing, coughing and breathlessness. These are all symptoms of chronic obstructive pulmonary disease (COPD). Add a lung infection on top of COPD and these symptoms worsen. To better investigate how COPD affects lung infection at an individual level, researchers created organoids – lab-grown tissues that mimic organs – using tissue samples collected from the airways (bronchi) and nasopharyngeal areas of healthy and COPD patients. Fluorescence microscopy of nasopharyngeal (pictured, left) and bronchial (right) organoids from healthy (top) and COPD (bottom) individuals revealed more goblet cells (magenta) in COPD organoids – this mimics what's seen in COPD patients. SARS-CoV-2 infection of COPD organoids showed that viruses replicated more in bronchial than in nasopharyngeal organoids. This is also in line with real-life disease, where the bronchi are the main site of infection in severe COVID-19 cases. This lab-grown system may therefore prove useful in modelling lung disease and infection in individual cases.

Written by Lux Fatimathas

Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore and Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore

Image originally published with a Creative Commons Attribution 4.0 International (CC BY 4.0)

Published in Nature Communications, December 2022

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I love COPD or asthma commercials that show a classic blue inhaler with a piece of tape labeling it "rescue inhaler". Totally necessary. I personally can't find my inhaler if it's not labeled correct.