Other Lung Conditions
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New Developments in Hormone Replacement Therapy
In July 2002, the government halted a major study of hormone therapy
three years early because of a slight but significant increase in the
risk of invasive breast cancer. Researchers concluded that the long-term
risks of taking hormones outweigh the benefits for a woman who still
has her uterus.
More than 16,000 women took part in the study, known as the Women's
Health Initiative, the largest to compare postmenopausal hormones with
a placebo. The therapy was a combination of estrogen and progestin (Prempro),
a treatment used by an estimated six million women to replace the declining
levels of hormones at menopause.
The study sought to determine whether this combination hormone therapy
could prevent such ailments as osteoporosis and heart disease. But while
there were small decreases in hip fractures and colorectal cancer, the
increases in breast cancer, heart attacks, strokes, and blood clots were
The data suggested that for every 10,000 women on the estrogen-progestin
combination, an additional 8 will develop invasive breast cancer, when
compared with women not taking the therapy. An additional 7 will have
cardiovascular disease, 8 will have a stroke, and 8 will have blood clots
in the lungs (pulmonary embolism).
In the aftermath of the trial, it seems that many doctors will be reconsidering
prescribing estrogen and progestin. Some women may want to lower their
doses or limit the duration of the use of these combinations, while others
will elect to try other treatments to combat their hot flashes, vaginal
dryness, and other menopausal symptoms.
However, it is important for women already on hormone replacement therapy
(HRT) to know that there is no urgency to stop, and waiting until an
annual exam to discuss it with a doctor is fine. There is also no harm
in stopping immediately, if a woman is more comfortable doing so.
It's important to remember that only combination therapy appears to
have these effects. Estrogen alone taken by women who have had a hysterectomy
has not displayed such risks. A separate trial, with 10,000 women who
have had a hysterectomy randomly assigned to either estrogen or a placebo,
has not indicated an increased breast cancer risk. The trial is scheduled
to go until 2005.
The full report on the Women's Health Initiative appeared in the Journal
of the American Medical Association on July 17, 2002.
July 2002 Update
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Reducing Your Risk of Deep Vein Thrombosis During
Deep vein thrombosis (DVT), recently featured in the news as "economy
class syndrome," is the formation of a blood clot in the deep veins
of the legs while sitting particularly in the cramped seats of
an airplane (be it economy class or first class), car, bus, or train
for long periods. You move less in tight quarters, causing circulation
to decrease and allowing blood to collect and form a clot. The blood
clot may cause pain and swelling in the legs. Serious, even fatal complications
can occur if the blood clot breaks loose in the blood stream and travels
to the heart or lungs. Older people, and those who are obese or have
a family history of DVT tend to be at the highest risk.
While a blood clot can result from a number of causes, some studies suggest
an association between blood clots and airplane travel. Many doctors
believe this connection is simply a result of being unable to move around,
and not from sitting in economy class seats or in an airplane, per
se. However, it is possible that pressurized air and dehydration
may also play a role in the connection between air travel and blood clots.
Many airlines have already begun to address this health issue by preparing
warning pamphlets for their passengers, including articles in their in-flight
magazines, posting notices on their Websites, or creating in-flight videos
offering exercises aimed at prevention. A member of the parliament in
Australia has even called for treadmills to be installed in airplanes
that carry passengers for six or more hours.
While treadmills may or may not appear on airplanes in the near future,
you can address this issue on your next lengthy flight by taking a few
simple measures to help prevent blood clotting.
- Wear loose-fitting, comfortable clothing during the flight.
- Eat a small meal and drink plenty of fluids to help increase blood
circulation. Avoid alcohol and caffeine, as these contribute to dehydration.
- Do not cross your legs while seated and make sure you adjust your
position every half hour.
- You may want to wear elastic support hose to increase circulation
in your legs.
- Most importantly, try to walk up and down the aisle at least once
an hour. Even standing in front of your seat and gently shaking out
your legs or slowly rising up on your toes can help.
- If you cant get out of your seat, you can do the following
exercises in your seat to increase blood circulation. Perform each
exercise for 15 seconds, once an hour.
- Ankle rotations: Draw a circle with your toes, rotating
clockwise and then counterclockwise with both feet.
- Foot pumps: Slowly alternate between flexing and pointing
- Leg lifts: With your knee bent, lift your leg up off
the seat and hold for a few seconds. Alternate legs.
- Head and shoulder rotations: Gently roll your head
clockwise and then counterclockwise, keeping your shoulders
relaxed. Then gently roll your shoulders forwards and
- Toe reach: Slowly bend forward and extend your arms
down towards your toes and then gently sit back up.
- People who are at high risk for blood clotting due to other conditions
should speak with their physician for additional advice before traveling.
Studies do not agree on how long a flight needs to be to pose a risk
of blood clotting. A few studies even suggest that there is no association
between blood clots and air travel. Clearly, more research is necessary.
However, while we wait for a definitive answer to these questions, heeding
these simple instructions may help prevent problems.
March 2001 Update
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Lung Volume Reduction Surgery for Patients
with Severe Emphysema
In recent years, thousands of patients with severe emphysema have undergone
lung volume reduction surgery even though private insurers and governmental
organizations have questioned the benefits of the treatment. Physicians
believe, however, that removal of the most damaged areas of the lung
allows the rest of the lung to work more efficiently. Now, the results
of a clinical study confirm the benefits of the treatment.
The study, performed in the U.K., involved 48 patients with severe emphysema
who received either a continuation of medical treatment or the lung volume
reduction surgery. After six months, most patients in the surgical group
showed improvements in the amount of air they were able to exhale in
one second (called the forced expiratory volume, FEV1). In contrast,
the FEV1 of patients in the standard medical treatment group dropped.
Most patients in the surgical group also performed better on a walking
test and scored higher on a quality-of-life questionnaire than they had
prior to treatment. Patients in the medical treatment group, on the other
hand, experienced declining health, as witnessed by lower scores on both
the walking test and quality-of-life questionnaire.
Deaths occurred in both treatment groups, five among the group receiving
the surgical treatment and three in the medical-care only group. The
researchers believe this relatively high mortality was a result of inexperience
of the surgical team and severity of the patients emphysema. In
any case, because of the small number of patients in the trial, investigators
could not draw any conclusions on whether surgery reduces the number
of deaths from emphysema. A larger United States study, which is now
underway may answer this question and might offer insight into which
patients benefit most from surgery.
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