Thinking Beyond NUTRITION EXERCISE KNOWLEDGE Health and Human - PowerPoint PPT Presentation

QUALITY SLEEP MEDICINE GOOD OXYGEN HABITS Undergraduate Research “Thinking Beyond” NUTRITION EXERCISE KNOWLEDGE

Health and Human Performance: Disease Detection, Intervention, Prevention and Beyond Rick Carter Lamar University

Aging and Declining Function Carter & Nicotra 1986, Seminars in Respir Med 8:113-123

Inactivity, Weightlessness & Aging • Inactivi tivity ty • Wei eight ghtles lessnes sness – Muscle cle Wasting ting – Muscle cle Wasting ting – Bone ne Loss – Bone ne Loss – Change ange in Body y – Change ange in Body y Fluids ids Fluids ids – Immune mune System em – Immune mune System em Altere tered Altere tered – Decr creas eased ed Wor ork k – Decr creas eased ed Wor ork k Perf rfor orma mance nce Perf rfor orma mance nce – Dys yspnea pnea on – Dys yspnea pnea on Exertio rtion Exertio rtion

 Exercise Intolerance ↓ Respiratory ↓ Nutritional ↓ Cardiac ↓Skeletal ↓ Gas ↑ Dyspnea Function Status Function Function Exchange O 2 transport O 2 utilization Aging, COPD, Healthy Heart Disease, Decreasing Function Cancer, etc.

Borg Dyspnea & VAS Scales for Assessment of Dyspnea 0 Nothing at All  0.5 Very, Very Slight  1 Very Slight  2 Slight (light)  3 Moderate  MILD 4 Somewhat Severe  5 Severe (Heavy)  6  MODERATE 7 Very Severe  8  9  10 Very, Very Severe  (Almost Max) SEVERE * Maximal

Presentation Outline • Respiratory Physiology/Patient Assessment • Behavioral/Public Health • Disease Prevention • Human Performance

From: Tiep,B and Carter R http://www.thoracic.org/clinical/copd-guidelines/resources/copddoc.pdf

Mouth Protective cells Alveolus with Enzyme Supply Enzyme damaging alveolar walls while trying to kill bacteria Enzyme Bacteria being eaten by protective cell Mechanisms of Lung Injury: Protiase-antiprotiase activity Oxidant Mediated lung injury

Lung Destruction Schema • Process – Lung Insult Mouth – Inflammatory Process, Enzymes, Protective cells Alveolus with Enzyme Supply Cellular Debris and Enzyme damaging alveolar wlaa while trying to kill Biomarkers released bacteria or used Enzyme – Repair process Bacteria being eaten by protective cell – Ongoing Biomarker load in the lung

Typical lung parenchyma showing A. Erythrocytes, E. capillaries & Type II pneumocyte and II alveolar surface. Higher Magnification demonstrating pathway 2400x Pictures from Carter. The Physiological Principles of Oxygen Delivery, Futura Publishing, 1991. A. Alveolus, E. Erythrocyte, EN Endothelial Cells. 600x

Mechanisms of Proteinase Mechanisms of Oxidant- Mediated Lung Injury Mediated Lung Injury Owen Proc Am Thoracic Society: vol. 2, pp 373-385, 2005

Respiratory Physiology Tests • Spirometry – Flow – Volume Loop (FVL) • AKA; MEFV Curve

Respiratory Physiology

 Effort-Independent  Assessment is conducted during normal tidal breathing  Applicable to a more diverse cohort as compared to spirometry  Suitable for all age ranges and patient limitations  Can be used in animals and people  Lacks normal reference data -- Our Present Focus  Equipment not widely available at this time  Several technologies for oscillometry  Not directly comparable to Spirometry  How the Measurements Detect Under different Conditions/Disease States — Where we are heading  Can it be used with Exercise???

Master’s Thesis Allan Sexton, BS , MS, Lamar University, 2014,  Impulse Oscillometry Normative Data for the Assessment of Airway Resistance, Reactance and Capacitance , Carter, R. Faculty Advisor. Paper in Preparation. Spirometry Testing: From Occupational Screening to Disease Management, RT For Decision Makers in Respiratory Care Published on October 17, 2011, Rick Carter, PhD, MBA, Brittnee Rodriguez , Brian Tiep, MD, and Rebecca Tiep, BS Comparison of Airways Response to Methacholine by Spirometry and Impulse Oscillometry in Adolescents with Severe Asthma and in Adolescent Controls Federico MJ, Larsen GL, Brugman S, Carter R, Wamboldt MZ Impulse oscillometry (IOS) is an important measure of respiratory mechanics in children that requires only quiet tidal breathing for short periods of time. Unfortunately, information on its use in assessing methacholine responsiveness in pediatric patients with severe asthma is limited. The objective of this study was to correlate the findings of IOS with the most commonly assessed measure of lung function for a methacholine challenge: forced expiratory volume in one second (FEV 1 ). Twenty-one severe asthmatic and fourteen non-asthmatic control adolescents, ages 12-18 years underwent a methacholine challenge with IOS and spirometry. Methacholine was delivered using a dosimeter. The response to methacholine was assessed using the Jaeger system for spirometry and IOS. IOS measures included: resistance(R), reactance (X), resonant frequency, and the area function AX. Multivariate analysis demonstrated that the percent change in FEV 1 from baseline to PC20 significantly correlated with the percent change in reactance at 5 Hz (r=0.68, p=0.0082) and with the absolute change in AX (r=0.64, p=0.0361). Further analysis showed a tight correlation between the absolute value of FEV 1 with X5 (r=0.81, p<0.0001) and AX (r=0.79, p<0.0001). Therefore, X5 and AX from IOS may be useful tools for assessing lung function in children with asthma.

Single-cycle lavage provides estimates of solute concentrations in the epithelial lining fluid of specific regions of the lungs. D. Griffith, W. Blevins, B. Girard, R. Carter, A. Kurdowska, S. Fields, and B. Peterson. Presentation for Europ. Resp. Soc. Meeting Glasgow, Scotland, Sept 5, 2004 Background of Single-cycle Lavage 5. Lung Lavage METHODS Standard Serial Lavage Obtained 133 Xenon scans of 12 healthy subjects. 1. All subjects inhaled an aerosol of 99m Tc-sulfur colloid to 2. -5 washes of 20 ml each “label” -all 5 aliquots pooled (68ml) central vs. peripheral regions (Alexis, et al, Am. J. Respir. Crit . Care Med 164: 1964-1970, 2001) - 6 subjects used rapid shallow breathing (central deposition) - 6 subjects used slow deep breathing (peripheral deposition) 3. Obtained gamma images of the lungs to verify deposition sites of Urea correction for dilution of ELF with saline: solute ( 99m Tc-sulfur colloid) relative to airway volume ( 133 Xe) 4. Performed 2 single-cycle 80 ml lavages--5 fractions/lavage [Protein] ELF = [Protein] lavage x [urea] plasma [urea] lavage Compared distribution of 99m Tc-sulfur colloid in lavage 5. fractions Rennard, et al. J. Appl. Physiol . 60:532, 1986 to distribution in gamma images

Central Deposition of 99m Tc-sulfur colloid 5 regions identified from 133 Xe scan Peripheral Deposition of 99m Tc-sulfur colloid

Conclusions 1. The single-cycle (SC) lavage provides estimates of solute concentrations in the ELF from different regions of the airways. 2. SC lavage can detect a gradient (large airways to alveoli) in solute concentrations in the ELF 3. There is no measurable gradient in albumin concentration in ELF. 4. Comparison with gamma imaging suggests that SC lavage may underestimate the gradient due to… A. …contamination of distal (alveolar) ELF samples as the lavage sample is withdrawn through the upper airways or B. …failure to sample the most peripheral regions of the lungs or C. …both.

Presentation Outline • Respiratory Physiology/Patient Assessment • Behavioral/Public Health • Disease Prevention • Human Performance

Psychol Med. 2008 Mar;38(3):385-96. Epub 2007 Oct 9. COPD education and cognitive behavioral therapy group treatment for clinically significant symptoms of depression and anxiety in COPD patients: a randomized controlled trial. Kunik ME 1 , Veazey C, Cully JA, Souchek J, Graham DP, Hopko D, Carter R, Sharafkhaneh A, Goepfert EJ, Wray N, Stanley MA. J Asthma. 2008 Mar;45(2):135-9. doi: 10.1080/02770900701840246. Frequency and correlates of overweight status in adolescent asthma. Abramson NW 1 , Wamboldt FS, Mansell AL, Carter R, Federico MJ, Wamboldt MZ. Pediatr Pulmonol. 2006 May;41(5):434-40. Effect of body mass index on response to methacholine bronchial provocation in healthy and asthmatic adolescents. Mansell AL 1 , Walders N, Wamboldt MZ, Carter R, Steele DW, Devin JA, Monica TH, Miller AL, Wamboldt FS.

Health Behaviors • Exercise Behaviors • Eating Behaviors Chest. 2003 May;123(5):1408-15. • OUTCOMES 6-minute walk work for assessment of functional capacity in patients with COPD. Carter R 1 , Holiday DB, Nwasuruba C, Stocks J, Grothues C, – Obesity Tiep B. – Diabetes – Cardiovascular J Cardiopulm Rehabil. 2002 Jul-Aug;22(4):298-308. Criterion validity of the Duke Activity Status Index for – Pulmonary assessing functional capacity in patients with chronic obstructive pulmonary disease. – Asthma Carter R 1 , Holiday DB, Grothues C, Nwasuruba C, Stocks J, Tiep B. – Etc.

Dyspnea Dyspnea pnea u Afferent • Dysp spnea nea is is Information – Upper Airway mult ltifac ifactoria torial – Lung • Dif ifferent ferent – Chest Wall u Efferent under erlying lying Information mechani me chanisms sms – Motor cortex to sensory cortex • The e u Brain Stem – Changes in la langua guage ge ABGs change anges

Potential for Improving Breathing following Training-Areas of Impact