Medical Myths about Chronic Obstructive Pulmonary Disease (COPD)

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From Medical News Today

Dr. Neil Schachter is a professor of medicine — pulmonary, critical care, environmental medicine, and public health — at the Icahn School of Medicine at Mount Sinai in New York. He is also medical director of pulmonary rehabilitation at the Mount Sinai Health System.

Dr. Shahryar Yadegar is a critical care medicine specialist, pulmonologist, and medical director of the ICU at Providence Cedars-Sinai Tarzana Medical Center, CA.

 

  1. COPD is rare

According to the World Health Organization (WHO), COPD caused 3.23 million deaths in 2019, making it the third leading cause of death worldwide.

 

Dr. Schachter explained that in the United States, COPD “is the fourth leading cause of death. More than 16 million Americans are diagnosed.”

 

Additionally, as Dr. Yadegar said, “millions more people may be undiagnosed.”

 

The American Lung Association (ALA) recommends that anyone who is “experiencing COPD symptoms — chronic cough, shortness of breath, frequent respiratory infections, significant mucus production (also called phlegm or sputum), and/or wheezing — speak with [a] doctor about obtaining a breathing test called ‘spirometry,’ which can help diagnose COPD.”

 

  1. Only smokers develop COPD

It is true that smoking tobacco is the leading cause of COPD, but Dr. Schachter said, “There are many other risk factors that contribute to the development of the disease, including air pollution, work-related pollution, infection, and some forms of asthma.”

Dr. Yadegar:

“Approximately 10–20% of COPD patients never smoked. Some of these never-smokers include significant secondhand smoke exposure; genetic predisposition, primarily through alpha-1 antitrypsin deficiency; or substantial exposure to air pollution.”

Alpha-1 antitrypsin is an enzyme that protects the body from an immune attack. Some people have a mutation in the gene that codes for this enzyme; this causes alpha-1 antitrypsin deficiency.

Deficiency of alpha-1 antitrypsin increases the risk of developing COPD and other conditions that affect a range of bodily systems.

 

  1. Only older adults develop COPD

COPD is certainly more common in older adults than in younger people, but younger people are not immune to the condition.

For instance, in the U.S., between 2007 and 2009, COPD affected 2% of males and 4.1% of females aged 24–44 years. Similarly, the condition affected 2% of males and 3% of females aged 18–24 years.

Dr. Schachter said that a “significant proportion of those individuals diagnosed before the age of 50” have a hereditary form of the disease that causes a deficiency of alpha-1 antitrypsin.

 

  1. COPD only affects the lungs

“False,” said Dr. Schachter. “COPD coexists with many comorbidities, including heart disease, lung cancer, hypertension, osteoporosis, and diabetes. The association may be due to common causative factors, as well as ‘systemic inflammation.’”

In other words, some of these conditions share risk factors, which makes them more likely to occur with COPD. For instance, smoking is a risk factor for both COPD and heart disease.

At the same time, health experts associate COPD with systemic inflammation, which can also independently increase the risk of other conditions.

 

  1. People with COPD cannot exercise

According to Dr. Yadegar, “Without proper guidance, patients with COPD may have difficulty completing physical exercises.”

However, he also explained that doctors recommend people with COPD do exercise, as it can help “increase their breathing capacity and improve their daily symptoms.”

“Pulmonary rehabilitation programs typically offer guided breathing techniques in conjunction with physical exercise in order to maximize better patient outcomes,” he continued.

In a nutshell, Dr. Schachter said that “exercise is therapeutic for COPD, reducing the number of exacerbations and improving quality of life.”

 

“You might feel like it is not safe or even possible to exercise, but the right amount and type of exercise has many benefits. Be sure to ask your doctor before you start or make changes to your exercise routine.”

 

  1. There are no treatments for COPD

This, thankfully, is a myth. “There are numerous therapies and strategies that improve the course of the disease,” Dr. Schachter said, “including medications, rehabilitation, diet, and vaccines that protect against respiratory infections that accelerate the course of the disease.”

Dr. Yadegar said, “With a spectrum of presentations, patients may benefit from inhaled bronchodilators, anticholinergics, corticosteroids, and supplemental oxygen.” These, he said, can be tailored uniquely to each person.

“Certain patients may also benefit from alpha-1 antitrypsin augmentation or even lung transplants,” he added.

 

  1. COPD is the same as asthma

“While both diseases are considered obstructive lung diseases, there are several differences between COPD and asthma,” Dr. Yadegar explained.

“Asthma most commonly begins in childhood, where it is frequently associated with allergies and problems of inflammation. COPD usually begins in the 60s and is associated with smoking. There is, however, an overlap syndrome, which has features of both.”

Dr. Yadegar dove into the details: “COPD is a disease of the alveoli, mostly a result of elasticity loss induced primarily by smoking. Asthma is a disease of the airways, primarily a result of chronic airway inflammation.”

“While clinical symptoms may overlap between the two diseases,” he continued, “treatments vary in order to best help patients in the short and long term.”

 

  1. Body weight does not affect COPD

This is not true. Dr. Schachter told us that carrying excess body weight can increase the disability associated with COPD.

Conversely, if people have a body weight that is below moderate, it can be “a sign of emphysema and also indicates a poor prognosis.”

 

  1. If you have COPD, there is no point quitting smoking

This is another myth. As Dr. Schachter said, “It is never too late to quit.”

He explained that “smoking accelerates the loss of lung function that accompanies COPD.” He also said that smoking tobacco can promote exacerbations of the symptoms.

 

  1. Shortness of breath is the only symptom of COPD

“Shortness of breath is a major presenting symptom but hardly the only one,” according to Dr. Schachter.

“Cough, excess phlegm production, respiratory infections, and all the symptoms of the comorbidities are often signs of progressing COPD.”

Other symptoms can include sleep problems, anxiety, depression, pain, and cognitive decline.

  1. A healthy diet cannot help with COPD

As a matter of fact, a healthy diet can make a difference for people living with COPD. Dr. Schachter said that a healthy diet promotes “general health and can protect against exacerbations of COPD itself and its comorbidities.”

For example, a 2020 meta-analysis of eight observational studies investigated the role of diet in COPD. The authors conclude that “healthy dietary patterns are associated with a lower prevalence of COPD, while unhealthy dietary patterns are not.”

Similarly, the data generated in another review suggest that “a higher intake of fruits, probably dietary fiber, and fish reduce the risk of COPD.”

In summary, although there is no cure for COPD, treatments are available, and lifestyle changes can reduce symptom severity. For more information on the causes, diagnosis, symptoms, and treatment of COPD.

Anti-Inflammatory Diet May Reduce Risk for Dementia

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From Medical News Today

Some foods linked to high rates of inflammation include:

Processed foods

Sugar

Unhealthy oils

Excess amounts of red meat

Alcohol

Some foods that are known for their anti-inflammatory properties include:

Fish

Fruits

Vegetables

Nuts and seeds

Tea

Legumes, such as lentils

Being able to measure the inflammatory potential of different diets may help clinicians recommend dietary interventions for cognitive health.

The researchers found that those with the most inflammatory diets were 3.43 times more likely than those with the least inflammatory diets to develop dementia.

To explain the results, the researchers say that after around 40 years of age, the immune system starts to decline, called “inflammaging.”

“Inflammaging” is also linked to oxidative stress and the induction of apoptosis, or programmed cell death. These effects, note the researchers, make up some of the main neuroinflammatory and neurodegenerative pathways involved in dementia.

Although “inflammaging” is a common factor of aging, research suggests that food components could exacerbate it.

One researcher said “We need to have a serious look at pro-inflammatory foods that we consume in Western diets. There has recently been a lot of attention paid to research on Mediterranean diets, which are anti-inflammatory and seem to have positive effects against cognitive decline and dementia risk.”

Dr. Birken likes Dr. Andrew Weil’s anti-inflammatory diet recommendations.

“There are two restaurants that follow his guidelines,” Dr. Birken said.  “True Food and Flower Child.  But reading about anti-inflammatory foods and diet and utilizing these concepts at home is the essential approach.  And I highly recommend the antioxidant supplement, Mitothera, that we carry in the office.”

 

 

Medical Myths About Irritable Bowel Disease

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From Medical News Today

Dr. Abhik Bhattacharya, assistant professor of medicine in the Division of Gastroenterology at the Icahn School of Medicine at Mount Sinai discusses myths surrounding IBD.

 

  1. IBD is the same as IBS

IBD and irritable bowel syndrome (IBS) both affect the digestive system and have similar acronyms. This, perhaps, explains some of the confusion. However, the two conditions are not the same.

 

Dr. Bhattacharya explained that IDB “is a disorder of the interaction between the gut and brain, leading to diarrhea, constipation, or both, along with bloating and pain. [It] can be worsened or precipitated by stress and anxiety.”

 

Conversely, he continued, IBD “is a disease of a dysregulated immune system, wherein the immune system starts attacking your own gastrointestinal system, leading to damage.”

 

“The disease can lead to stress, worsening anxiety, depression, and loss of sleep because of the devastating consequences it can have on a person’s daily functioning,” he said. “Symptoms can include bleeding in stools, diarrhea, severe belly pain, unintentional weight loss, fevers, chills, rectal pain, fatigue, and more.”

 

  1. Stress causes IBD

IBD is driven by the immune system, so stress is not the direct cause. However, as Dr. Bhattacharya explained, it “can make life very stressful.”

 

Stress can trigger IBD flares and exacerbate the symptoms in some people, which might help explain the confusion. However, stress does not cause IBD.

 

  1. IBD is linked to a personality type

Some small, decades-old studies have investigated the links between personality traits and IBD. However, when asked Dr. Bhattacharya whether there are any links between a person’s character and IBD, he put it succinctly: “There are none that we know about.”

 

  1. Some people have both Crohn’s and ulcerative colitis

Crohn’s and ulcerative colitis are the most common forms of IBD. However, they are distinct conditions, and people cannot have both.

“You can either have Crohn’s disease or ulcerative colitis,” said Dr. Bhattacharya. “However, in a very small subset of patients, it is hard to determine whether they have Crohn’s or ulcerative colitis. The disease, however, does reveal itself over the course of a patient’s lifetime.”

 

  1. No treatments can relieve IBD

Thankfully, this is untrue. “There are many treatments that are extremely effective for IBD. Depending on what you have and how severe the disease is, we have a plethora of options for medical treatment,” explained Dr. Bhattacharya. He then outlined some of the available interventions:

 

“These include, but are not limited to, biologic medications, such as Remicade [infliximab], Humira [adalimumab], Cimzia [certolizumab pegol], Simponi [golimumab], Entyvio [vedolizumab], and Stelara [ustekinumab], or small molecules like Zeposia [ozanimod] and Xeljanz [tofacitinib]. These are potent immunosuppressant medications, and we are constantly developing new medications through clinical trials.”

 

  1. Everyone with IBD needs surgery

“No, everyone does not need surgery,” Dr. Bhattacharya said. He explained that in the past, a majority of people with IBD would have undergone surgery.

 

However, “with the advent of very effective and safe immunosuppressant medications,” rates of surgery have dropped significantly over the past 20 years.

 

According to Crohn’s & Colitis UK, about 15% of people with ulcerative colitis will need surgery 10 years after diagnosis. However, in agreement with Dr. Bhattacharya, the organization notes that the improved treatments available mean that this percentage is reducing.

 

“The goal of treatment,” Dr. Bhattacharya said, “is to prevent surgery due to complications of bowel damage.” He advocates for early treatment with potent medications soon after diagnosis. This, he explained, prevents damage, thereby removing the need for surgery.

 

  1. People should not take IBD medications during pregnancy

This is not true. “Most IBD medications are very safe during pregnancy,” said Dr. Bhattacharya.

 

He explained that the goal is to keep people with IBD in remission during pregnancy “because the worst thing to happen for both baby and mother is for the disease to be active.”

 

“We have gathered, and continue to gather, a large amount of data regarding the safety of medications during pregnancy.”

There is an important exception, though: methotrexate. Dr. Bhattacharya told us that methotrexate “is stopped even when women with IBD are planning to get pregnant.”

 

  1. If your symptoms go, you can stop medication

Once drugs for IBD take effect and the symptoms disappear, it can be tempting to stop taking the medication. However, this is not what doctors recommend. Dr. Bhattacharya said:

 

“At this moment, we don’t have a good way of stopping medications for patients with IBD in remission. […] We don’t recommend stopping medications.”

 

He explained that ending treatment can have serious consequences. For instance, the symptoms might come back, and if the person restarts on the same treatments, these may not work.

 

“While we do have options when it comes to treatment,” he said, “those options are not limitless, and we don’t want to run through medications. There is good data to support that when […] one set of IBD medications [fails], your response to another type may be less likely.”

 

  1. A gluten-free diet cures IBD

As Dr. Bhattacharya said, a “gluten-free diet works for [people with] celiac disease and non-celiac gluten sensitivity,” but it will not benefit those with IBD.

 

  1. IBD only affects the gut

Although, as the name suggests, IBD significantly affects the bowel, the disease can also have ramifications on many other parts of the body.

 

“Apart from the gastrointestinal system, which includes the mouth to the anus, IBD can have extraintestinal manifestations like affecting the skin, eyes, and joints, to name a few,” said Dr. Bhattacharya.

 

According to a review of extraintestinal manifestations of IBD, they “can involve nearly any organ system […] and can cause a significant challenge to physicians managing IBD patients.”

 

For instance, IBD can affect the musculoskeletal system, as well as the eyes, kidneys, and lungs. It may also damage the hepatopancreatobiliary system, which includes the pancreas, liver, gallbladder, and bile duct.

 

  1. IBD is curable

At this time, there is no cure for IBD. However, as Dr. Bhattacharya said, “this is a work in progress.”

 

Researchers are working tirelessly to understand the condition better so that they can design better treatments and, perhaps one day, a cure.

 

  1. People with IBD cannot lead a normal life

This, thankfully, is a myth. “They absolutely can,” confirmed Dr. Bhattacharya. “With proper medical management and, sometimes, surgeries, IBD patients can live a completely normal life.”