Quote

涂鸦-卡通

Q: I've lost 95 pounds. Although I exercise every other day, my weight loss seems to be slowing down. My doctor says I still need to lose another 30 pounds, though. What can I do?

A: You don't mention how long it's taken to lose nearly 100 pounds, but that's a considerable amount of weight and your body may simply be "shocked" and trying to adjust to the changes. It's natural for the body to reach a plateau, often after around six months of steady weight loss.

Even though you may want to continue losing, at this point it's probably a good idea to change strategies. You're in danger of gaining the weight back that you've lost. When the body senses that fat stores have fallen below a (theoretically estimated) set-point, its fat-preservation mechanisms kick in and try to help it regain the lost fat. Fat is stored energy, after all, and the body seems to be hard-wired to favor storing energy rather than letting it go. As a result of your weight loss, a host of biological signals may be making you more inclined to eat more and exercise less in order to return to what the body senses is its "normal" fat level. These triggers might make you get hungrier sooner in between meals, crave more snacks, or take longer to feel full when you do eat, for example.

For now, it may be a better idea to shift into weight-maintenance mode to allow your body to stabilize.

Exercise is a key weapon for weight loss, especially during the maintenance phase. You don't mention what type of exercise you're doing, but it should include a combination of cardio workouts such as walking, swimming or cycling, along with weight training to target muscles.

When you lose weight, you also lose lean body mass, a proportion of which is muscle tissue. The faster and greater your weight loss, the more muscle tissue is lost. Weight training has been shown to decrease the amount of lean body tissue that's lost during periods of weight loss. So if you haven't already, include weight training in your routine, along with performing cardio (aim to accumulate 60 to 90 minutes per day on most days of the week). Try to target all your major muscles in your upper and lower body on two to three days per week. You can get ideas for specific workouts and exercises from the MSN Fit Zone.

As far as diet goes, rather than trying to deprive yourself further to encourage more weight loss, aim for a caloric intake that keeps your weight stable. Instead of "dieting," use this period as a time to improve the quality of what you eat. Rather than just counting calories or portion sizes, look at the nutrient intake. Are you getting all the vitamins and nutrients and other beneficial compounds found in foods that you need?

You can keep a diet diary, tracking everything you eat and then entering the information into a nutrition database to get an estimated nutrient breakdown. Try the U.S. Department of Agriculture's MyPyramid Tracker, or check out My Wellness Center on MSN Health & Fitness.

An easy way to improve the quality of what you eat is to make sure you are meeting the recommended servings of different types of foods recommended in the USDA's Dietary Guidelines for Americans. Once you know your nutritional status and what you should aim for, experiment with new ways to improve how you eat.

You may find that you need to eat more fiber, or that you are low in certain vitamins. An easy fix might be to snack on nuts or to throw more veggies into your salads. You may need to increase the amount of unsaturated fat you eat and decrease the amount of "bad" saturated and trans fats. One way to do this would be to eat fewer animal products like meat, butter, and cheese, and add more plant oils such as walnut oil or olive oil to foods.

Other easy ways to boost the nutrient values or your everyday foods: Add an extra fresh or frozen vegetable or fruit to every single snack and meal. For example, throw some roasted peppers on your morning omelet, add spinach leaves to your sandwich, snack on fruit, and eat a fresh-fruit-and-ice smoothie for dessert. By eating more nutrient-dense foods, you'll be improving your health dramatically.

Use your plateau/maintenance phase as a time to keep weight stable, improve the nutrients that you eat and to get stronger and develop more stamina from exercise.After three to six months, you can aim for weight loss again.

--
Wei
xiaokanye atsign gmail dot com

Beijing Marathon, 10/18/2009
"When we are confident, we can rationalize away any potential problems; without confidence, even slight threats become magnified." - Hal Higdon

10 Interview Questions Decoded

Auld lang syne is a phrase that literally means "old long since" or "old long ago" and became famous in Robert Burns's 1788 song:

The germ phrase has been traced back to an anonymous ballad in the Bannatyne Manuscript of 1568, "Auld Kyndnes foryett."

Champagne is the name of a province in eastern France and the varieties of still or sparkling wine made from the grapes there. As defined by French law, only sparkling wine from Champagne can be called "champagne." It must be fermented in the bottle and varies from brut, the driest, to sweeter doux champagnes. Champagne is sometimes called "the wine of love."

Resolution is from the Latin resolutio, resolution- from resolvere meaning "to loosen or dissolve again," (re- + solvere) which was the original meaning of resolve. The meaning "to determine or decide upon a course of action, etc." was first used in English around 1523.

The practice of drinking a toast started in the 17th century with the naming of a lady at a banquet to whose health the others present were requested to drink. Pieces of spiced toast were once placed in wine and the idea of this practice was that the lady's name flavored the drink as pieces of spiced toast once would have.
== unquote ==

the original is at http://dictionary.reference.com/features/newyears.html

--
Wei
xiaokanye atsign gmail dot com

Beijing Marathon, 10/19/2008
"When we are confident, we can rationalize away any potential problems; without confidence, even slight threats become magnified." - Hal Higdon

Regular exercise or physical activity can do everyone a world of good. It helps prevent heart disease, diabetes, osteoporosis, and a host of other diseases, and is a key ingredient for losing weight or maintaining a healthy weight ( 1).

With all these good things going for it, it's mind boggling that only a minority of Americans get enough exercise or leisure-time physical activity to benefit.( 2)

Body-wide benefits

Studies that have followed the health of large groups of people for many years, as well as short-term studies of the physiologic effects of exercise, all point in the same direction: A sedentary (inactive) lifestyle increases the chances of becoming overweight and developing a number of chronic diseases. Exercise or regular physical activity helps many of the body's systems function better and keeps a host of diseases at bay. According to the US Surgeon General's report, Physical Activity and Health ( 1), regular physical activity:

• improves your chances of living longer and living healthier

• helps protect you from developing heart disease or its precursors, high blood pressure and high cholesterol

• helps protect you from developing certain cancers, including colon and breast cancer

• helps prevent or control type 2 diabetes (what was once called adult-onset diabetes)

• helps prevent arthritis and may help relieve pain and stiffness in people with this condition

• helps prevent the insidious loss of bone known as osteoporosis

• reduces the risk of falling among older adults

• relieves symptoms of depression and anxiety and improves mood

• controls weight
  

The cost of inactivity

If exercise and regular physical activity benefit the body, a sedentary lifestyle does the opposite. According to analyses by Graham Colditz, a professor of epidemiology at the Harvard School of Public Health, the direct medical cost of inactivity is at least $24 billion a year.( 3) An analysis of health-care costs by a team from the federal Centers for Disease Control and Prevention suggests that because individuals who are physically active have significantly lower annual direct medical costs than those who are inactive, getting people to become more active could cut yearly medical costs in the U.S. by more than $70 billion.(4)

Reaping the benefits

A wealth of studies have established the benefits of exercise. Yet two related - and very practical - questions remain: What is the best kind of exercise? and How much exercise do we need each day?

Cardiovascular Exercise

If you don't currently exercise and aren't very active during the day, any increase in exercise or physical activity is good for you. Some studies show that walking briskly for even one to two hours a week (15 to 20 minutes a day) starts to decrease the chances of having a heart attack or stroke, developing diabetes, or dying prematurely.

The U.S. Surgeon General,(1) along with the Centers for Disease Control and Prevention and the American College of Sports Medicine,( 5) recommend getting a minimum of 30 minutes of moderate-intensity physical activity on most days of the week. You can do all 30 minutes at once or break it up into 10- or 15-minute periods.

Moderate intensity exercise or physical activity is activity that causes a slight but noticeable increase in breathing and heart rate. One way to gauge moderate activity is with the "talk test" - exercising hard enough to break a sweat but not so hard you can't comfortably carry on a conversation.

Exercise experts measure activity a different way. They talk about metabolic equivalents, or METs. One MET is defined as the energy it takes to sit quietly. For the average adult, this is about one calorie per every 2.2 pounds of body weight per hour someone who weighs 160 pounds would burn approximately 70 calories an hour while sitting or sleeping.

Moderate intensity activities are those that get you moving fast enough or strenuously enough to burn off three to six times as much energy per minute as you do when you are sitting quietly, or exercises that clock in at 3-6 METs.

Brisk walking fills the bill for moderate-intensity activity. How fast is brisk? For the average person, it means walking 3-4 miles an hour, or about as fast as you'd walk if you were late for an important appointment. Walking is an ideal exercise for many people - it doesn't require any special equipment, can be done any time and any place, and is generally very safe.

What's more, studies such as the Nurses' Health Study,(6 , 7) Health Professionals Follow-up Study,( 8) Women's Health Study,(9) Harvard Alumni Health Study,( 10) National Health Interview Survey,(11) Women's Health Initiative,( 12) Honolulu Heart Program,(13) and others have demonstrated that this simple form of exercise substantially reduces the chances of developing heart disease, stroke, and diabetes in different populations.

If you don't like walking, any activity that makes your heart work harder will suffice, as long as you do it long enough and often enough.

Keep in mind that 30 minutes of moderate-intensity activity a day is an excellent starting point, not an upper limit. Exercising longer, harder, or both can bring even greater health benefits.

If you are exercising mainly to lose weight or maintain a healthy weight, 30 minutes or so a day will work if you're careful about how much you eat.( 14) But you may need to exercise more, or more vigorously. A report from the Institute of Medicine concluded that it takes 60 minutes a day of moderate-intensity activity to maintain a healthy weight.( 15)

Among the 3,000 men and women who are part of the National Weight Control Registry, a select club that includes only people who lost more than 30 pounds and kept them off for at least a year, the average participant burns an average of 400 calories per day in physical activity. That's the equivalent of about an hour of brisk walking.( 16)

Feeling what's right

The current recommendations for exercise and physical activity call for moderate intensity activities, or those measured at 3-6 METs (see table). Keep in mind that these are general recommendations aimed at the general population.

The problem with guidelines is that they try to cover as many people as possible. In other words, they aren't right for everyone. How much exercise you need depends on your genes, your diet, how much muscle and fat you carry on your frame, how fit you are, and your capacity for exercise.

A study of more 7,000 men who graduated from Harvard before 1950 suggests that older people, those who are out of shape, or those with disabilities may get as much benefit from 30 minutes of slower walking or other exercise as younger, more fit people get from the same amount of more intense activity.( 17)

In other words, if an exercise or physical activity feels hard, then it is probably doing your heart - and the rest of you - some good, even if it doesn't fall into the "moderate" category.

Don't get stuck in a rut, though. As your body adapts to exercise, you'll need to push yourself more and more to get the same cardiovascular workout. Another way to know that it's time to pick up the pace is if you see your weight or waist size start creeping up on you.

Beyond the heart

When talking about the benefits of exercise, keeping the heart and blood vessels healthy usually gets most of the attention. For many older individuals, though, stretching and strength training exercises that barely raise the heart rate - and so aren't considered moderate at all - may be just as important. Such exercises can maintain or improve balance, muscle strength, and overall function.

Resistance Training

Resistance training or weight training is probably the most neglected component of fitness programs but one of the most beneficial. Our body can basically be divided into 2 components. Fat mass consists of the body's fat store, while fat free mass is a combination of non-fat tissue such as muscle, bone, internal organs etc. An important part of fat free mass is lean body mass, which is essentially muscle.

Muscle is metabolically active tissue. This means that it utilizes calories to work, repair and refuel itself. Fat requires very few calories, it just kind of sits there. As we enter our mid to late twenties, we slowly start to lose muscle as part of the natural aging process. This means that the amount of calories we need each day starts to decrease and it becomes easier to gain weight. By engaging in regular strength training exercise, it is possible to decrease this loss of lean muscle tissue and even replace some that has been lost already. Studies have shown strength training to increase lean body mass, decrease fat mass and increase resting metabolic rate (a measurement of the amount of calories burned per day) ( 19,20 ,21). These effects may make it easier to manage one's weight.

Another beneficial effect of resistance training pertains to bone health. In addition to weight bearing cardiovascular exercise, weight training has been shown to help fight osteoporosis. For example, in postmenopausal women, 2 strength training sessions a week for one year increased bone mineral density by 1%. A sedentary control group lost 2% in the same time period ( 22).

Finally, in older populations, resistance training can help maintain the ability to perform functional tasks such as walking, rising from a chair, climbing stairs and even carrying their own groceries.

Many people are intimidated by the idea of resistance training or are afraid of injury. They need not be. A great idea is to consult an expert. Consider hiring an exercise physiologist or personal trainer for a few sessions until you have the confidence to branch out on you own. For more information and to locate a trainer contact, The American Council on Exercise. ( www.acefitness.org)

Flexibility Training

Flexibility training or stretching exercise is another important part of overall fitness. It has been shown to increase range of motion, decrease muscle soreness associated with exercise and may decrease exercise related injury.

Tips for Getting Exercise Into Your Life

1. Get off a stop or 2 earlier during your bus or subway commute; walk the rest of the way.
2. Purposefully park you car a little further from the mall or store. It may not seem like much, but over weeks and months, these minutes of exercise add up.
3. Use the stairs instead of elevators and escalators whenever possible.
4. Consider buying a piece of cardiovascular equipment for your home (e.g. treadmill, bike, elliptical machine). Home models can be more reasonable than you think and you can't beat the convenience.
5. When you get busy, try to combine your cardiovascular exercise with something that you do already. Hop on that piece of home equipment while watching TV, reading the newspaper or returning phone calls.
6. Make it fun! Try a new sport like tennis or rollerblading. The more that you enjoy exercise the more likely you are to stick to it.
7. Make it social. Walk with a friend, your spouse, or your family in the morning or evening.
8. Keep an exercise log. It will help to make you more accountable.
9. Take a walk for 20 minutes of your lunch hour.
10. Hire a personal trainer for a session or 2 to help you with your weight training and flexibility training. Then you'll have the confidence to branch out on your own.

References

1. Physical Activity and Health: A report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (1996) http://www.cdc.gov/nccdphp/sgr/sgr.htm

2. Healthy People 2010: Understanding and Improving Health. U.S. Department of Health and Human Services. http://www.healthypeople.gov/

3. Colditz GA. Economic costs of obesity and inactivity. Med Sci Sports Exerc 1999; 31:S663-7.

4. Pratt M, Macera CA, Wang G. Higher direct medical costs associated with physical inactivity. Phys Sportsmed 2000; 28:63-70.

5. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995; 273:402-7.

6. Manson JE, Hu FB, Rich-Edwards JW, et al. A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. N Engl J Med 1999; 341:650-8.

7. Hu FB, Sigal RJ, Rich-Edwards JW, et al. Walking compared with vigorous physical activity and risk of type 2 diabetes in women: a prospective study. JAMA 1999; 282:1433-9.

8. Tanasescu M, Leitzmann MF, Rimm EB, Willett WC, Stampfer MJ, Hu FB. Exercise type and intensity in relation to coronary heart disease in men. JAMA 2002; 288:1994-2000.

9. Lee IM, Rexrode KM, Cook NR, Manson JE, Buring JE. Physical activity and coronary heart disease in women: is "no pain, no gain" passe? JAMA 2001; 285:1447-54.

10. Sesso HD, Paffenbarger RS, Jr., Lee IM. Physical activity and coronary heart disease in men: The Harvard Alumni Health Study. Circulation 2000; 102:975-80.

11. Gregg EW, Gerzoff RB, Caspersen CJ, Williamson DF, Narayan KM. Relationship of walking to mortality among US adults with diabetes. Arch Intern Med 2003; 163:1440-7.

12. Manson JE, Greenland P, LaCroix AZ, et al. Walking compared with vigorous exercise for the prevention of cardiovascular events in women. N Engl J Med 2002; 347:716-25.

13. Hakim AA, Curb JD, Petrovitch H, et al. Effects of walking on coronary heart disease in elderly men: the Honolulu Heart Program. Circulation 1999; 100:9-13.

14. Jakicic JM, Marcus BH, Gallagher KI, Napolitano M, Lang W. Effect of exercise duration and intensity on weight loss in overweight, sedentary women: a randomized trial. JAMA 2003; 290:1323-30.

15. Institute of Medicine. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington, DC: National Academies Press, 2002.

16. Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr 2001; 21:323-41.

17. Lee IM, Sesso HD, Oguma Y, Paffenbarger RS, Jr. Relative intensity of physical activity and risk of coronary heart disease. Circulation 2003; 107:1110-6.

18. Fletcher GF, Balady GJ, Amsterdam EA, et al. Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation 2001; 104:1694-740.

19. Ballor D, Poehlman E, Resting Metabolic Rate and coronary heart risk in aerobically and resistance trained women. Amercian Journal of Clinical Nutrition 1992; 56:968-74.

20. Broeder C, Burrhus K, et al. The effects of either high intensity resistance or endurance training on resting metabolic rate. American Journal of Clinical Nutrition 1992; 55:802-810.

21. Campbell W, Crim M, et al. Increased energy requirements and changes in body composition with resistance training in older adults. American Journal of Clinical Nutrition 1994; 60:167-75.

22. Nelson ME, Fiatarone CM, et al. Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. A randomized controlled trial. JAMA 1994; 272:1909-14

 

--
Wei
xiaokanye atsign gmail dot com

Beijing Marathon, 10/19/2008
"When we are confident, we can rationalize away any potential problems; without confidence, even slight threats become magnified." - Hal Higdon

1. Run 08' Beijing Marathon in 3 hours and 30 minutes
   
2. Drop my 10K time below 40 minutes
3. Drop my 10 Mile time below 1 hour and 15 minutes
4. Drop my HM below 1 hour and 30 minutes
   
5. Shred 2-4 # of fat and weigh at 162#
6. Keep my BF to 11% - 12%
7. Run 50 mpw
8. get laid more! ;)
   

A YEAR OF EATING SEASONALLY

How to get produce at its nutritious best

http://www.runnersworld.com/article/0,7120,s6-238-267-269-12331-0,00.html

RUN AND RACE WELL IN THE COLD

Winter Running Safety

Runners, especially those that are new to running in cold weather, may not think of the safety hazards that winter can bring. Some of the dangers of winter running include: frostbite, hypothermia, aggravation of bronchial difficulties, poor traction, and poor visibility. Frostbite and hypothermia are serious dangers, but can be prevented by wearing the right clothes and staying inside when temperatures dip too low -- as in below freezing. Bronchial problems, poor traction, and poor visibility are much more prevalent and are harder to prevent.

Bronchial Problems

• Wearing a scarf or handkerchief (made from a wicking material, if possible) over your nose and mouth
• Staying hydrated because often the problem is just that your throat and mouth get dried out, which causes other problems.
• Not running outside, at least if you are experiencing bronchial difficulties like a bad cough

Poor Traction

• Choose to run on snow instead of over icy roads or sidewalks
• Shorten your running stride
• Run slower than you would in fair conditions
• Be aware of your path, and where you are going
• Invest in trail shoes or another traction option (like do-it-yourself screw shoes or store-bought ice cleats)

Poor Visibility

This isn't so much about you being able to see, but rather about other people being able to see you. Because of shorter winter days, more runners are forced to run in the dark (mornings or nights). This alone causes a host of problems for visibility, but if it is also bad weather, drivers may have a hard time staying on the road, let alone seeing a runner. Remember these simple tips to improve your visibility:

• Avoid running in the dark, especially in bad weather, when possible
• Wear reflective gear
• Wear light-colored clothing if it's dark
• Wear bright colors if it is snowy

It's also important to take an active role in your safety. Be aware of cars and other vehicles around you. Don't run in the road in bad weather; that's just asking for an accident. Don't just assume that people see you. Be especially careful when crossing streets; even if a car should stop or is starting to stop, they may not stop in time in icy or wet winter weather.

1st Layer:

• ID
• A wicking hat, with a brim if it's snowing or raining
• Wicking, light-weight, snug running shirt, long-sleeved if it's cold out, short-sleeved if it's cool
• Light-weight running gloves
• Light-weight running tights
• Wicking undergarments, especially important for men
• Thick, absorbent socks
• Running shoes, of course
• Moisturizer and/or sunscreen

2nd Layer:

• Polypropylene (Coolmax or Thermax) long-sleeved shirt and/or a light-weight windbreaker jacket
• Mittens
• heavy tights, replacing the light-weight tights from the first layer
• For the guys, insulated underwear may be worn to prevent cold-related injuries in especially sensitive areas

3rd Layer:

• Balaclava or similar ski mask
• Vaseline covering all exposed skin
• Long-sleeved shirt AND windbreaker jacket (Goretex is a good option)
• Lined, waterproof mittens
• Fleece pant linings

  Lung cancer is a disease of uncontrolled cell growth in tissues of the
  lung.  This may lead to metastasis, invasion of adjacent tissue and
  infiltration beyond the lungs.  Lung cancer, the most common cause of
  cancer-related death in men and the second most common in women, is
  responsible for 1.3 million deaths worldwide annually.  The most common
  symptoms are shortness of breath, coughing (including coughing up
  blood), and weight loss.  The main types of lung cancer are small cell
  lung carcinoma and non-small cell lung carcinoma.  This distinction is
  important because the treatment varies; non-small cell lung carcinoma
  (NSCLC) is sometimes treated with surgery, while small cell lung
  carcinoma (SCLC) usually responds better to chemotherapy.  The most
  common cause of lung cancer is exposure to tobacco smoke.  The
  occurrence of lung cancer in non-smokers, who account for fewer than
  10% of cases, appears to be due to a combination of genetic factors.
  Radon gas, asbestos, and air pollution may also contribute to lung
  cancer.  Treatment and prognosis depend upon the histological type of
  cancer, the stage (degree of spread), and the patient's performance
  status.  Possible treatments include surgery, chemotherapy, and
  radiotherapy.  With treatment, the five-year survival rate is 14%.

Read the rest of this article:
  http://en.wikipedia.org/wiki/Lung_cancer


_______________________________
Today's selected anniversaries:

1307:
  William Tell, a legendary marksman in Switzerland, is said to have
  successfully shot an apple on the head of his son with a single bolt
  from his crossbow.
  (http://en.wikipedia.org/wiki/William_Tell)

1626:
  St.  Peter's Basilica, one of four major basilicas of Rome, was
  consecrated on the anniversary of that of the previous church in 326.
  (http://en.wikipedia.org/wiki/St._Peter%27s_Basilica)

1905:
  Prince Carl of Denmark became Haakon VII, the first King of Norway
  after the personal union between Sweden and Norway was dissolved.
  (http://en.wikipedia.org/wiki/Haakon_VII_of_Norway)

1928:
  Walt Disney's Steamboat Willie, the first completely post-produced
  synchronized sound animated cartoon, was released.
  (http://en.wikipedia.org/wiki/Steamboat_Willie)

1985:
  Calvin and Hobbes, a comic strip by Bill Watterson featuring
  six-year old Calvin and his stuffed tiger Hobbes, was first published.
  (http://en.wikipedia.org/wiki/Calvin_and_Hobbes)

1987:
  An underground fire kills 31 people at London's busiest underground
  station at King's Cross St Pancras.
  (http://en.wikipedia.org/wiki/King%27s_Cross_fire)

1991:
  Croatian War of Independence: Republic of Serbian Krajina forces
  captured the Croatian city of Vukovar, ending an 87-day siege.
  (http://en.wikipedia.org/wiki/Battle_of_Vukovar)


_____________________
Wiktionary's Word of the day:

  prurient: Uneasy with desire; having a lascivious anxiety or
  propensity.
  (http://en.wiktionary.org/wiki/prurient)


_____________________
Wikiquote of the day:

  Whatever the scientists may come up with, writers and artists will
  continue to portray altered mental states, simply because few aspects
  of our nature fascinate people so much.  The so-called mad person will
  always represent a possible future for every member of the audience —
  who knows when such a malady may strike? -- Margaret Atwood
  (http://en.wikiquote.org/wiki/Margaret_Atwood)


_______________________________________________
Wikipedia Daily Article mailing list.
To unsubscribe, visit:
http://lists.wikimedia.org/mailman/listinfo/daily-article-l
Questions or comments? Contact dal-feedback@wikimedia.org

(Chronic Bronchitis and Emphysema)

August 2006

Chronic obstructive pulmonary disease (COPD) is a term referring to two lung diseases, chronic bronchitis and emphysema, that are characterized by obstruction to airflow that interferes with normal breathing.  Both of these conditions frequently co-exist, hence physicians prefer the term COPD. It does not include other obstructive diseases such as asthma.

• COPD is the fourth leading cause of death in America, claiming the lives of 122,283 Americans in 2003 and the number of women dying from the disease has surpassed the number seen in men.¹ 
• This is the fourth consecutive year in which women have exceeded men in the number of deaths attributable to COPD.  In 2003, over 63,000 females died compared to 59,000 males.²
• Smoking is the primary risk factor for COPD. Approximately 80 to 90 percent of COPD deaths are caused by smoking. Female smokers are nearly 13 times as likely to die from COPD as women who have never smoked.  Male smokers are nearly 12 times as likely to die from COPD as men who have never smoked.³
• Other risk factors of COPD include air pollution, second-hand smoke, history of childhood respiratory infections and heredity.  Occupational exposure to certain industrial pollutants also increases the odds for COPD.  A recent study found that the fraction of COPD attributed to work was estimated as 19.2% overall and 31.1% among never smokers.⁴
• In 2004, 11.4 million U.S. adults (aged 18 and over) were estimated to have COPD.⁵ However, close to 24 million U.S. adults have evidence of impaired lung function, indicating an under diagnosis of COPD.⁶
• An estimated 638,000 hospital discharges were reported; a discharge rate of 21.8 per 100,000 population. COPD is an important cause of hospitalization in our aged population. Approximately 65% of discharges were in the 65 years and older population in 2004.⁷
• In 2004, the cost to the nation for COPD was approximately $37.2 billion, including healthcare expenditures of $20.9 billion in direct health care expenditures, $7.4 billion in indirect morbidity costs and $8.9 billion in indirect mortality costs.⁸
• Chronic bronchitis is the inflammation and eventual scarring of the lining of the bronchial tubes. When the bronchi are inflamed and/or infected, less air is able to flow to and from the lungs and a heavy mucus or phlegm is coughed up. The condition is defined by the presence of a mucus-producing cough most days of the month, three months of a year for two successive years without other underlying disease to explain the cough.
• This inflammation eventually leads to scarring of the lining of the bronchial tubes. Once the bronchial tubes have been irritated over a long period of time, excessive mucus is produced constantly, the lining of the bronchial tubes becomes thickened, an irritating cough develops, and air flow may be hampered, the lungs become scarred. The bronchial tubes then make an ideal breeding place for bacterial infections within the airways, which eventually impedes airflow.⁹
• In 2004, an estimated 9 million Americans reported a physician diagnosis of chronic bronchitis. Chronic bronchitis affects people of all ages, but is higher in those over 45 years old.¹⁰
• Females are more than twice as likely to be diagnosed with chronic bronchitis as males. In 2004, 2.8 million males had a diagnosis of chronic bronchitis compared to 6.3 million females.¹¹
• Symptoms of chronic bronchitis include chronic cough, increased mucus, frequent clearing of the throat and shortness of breath.¹²
• Chronic bronchitis doesn't strike suddenly and is often neglected by individuals until it is in an advanced state, because people mistakenly believe that the disease is not life-threatening. By the time a patient goes to his or her doctor the lungs have frequently been seriously injured. Then the patient may be in danger of developing serious respiratory problems or heart failure.
• Emphysema begins with the destruction of air sacs (alveoli) in the lungs where oxygen from the air is exchanged for carbon dioxide in the blood. The walls of the air sacs are thin and fragile. Damage to the air sacs is irreversible and results in permanent "holes" in the tissues of the lower lungs.  As air sacs are destroyed, the lungs are able to transfer less and less oxygen to the bloodstream, causing shortness of breath. The lungs also lose their elasticity, which is important to keep airways open.  The patient experiences great difficulty exhaling.¹³
• Emphysema doesn't develop suddenly.  It comes on very gradually. Years of exposure to the irritation of cigarette smoke usually precede the development of emphysema. Of the estimated 3.6 million Americans ever diagnosed with emphysema, 91 percent were 45 or older.¹⁴
• Of the emphysema sufferers, 54.8 percent are male and 45.2 percent are female. However, within in the past year, the prevalence rate for women has seen a 20 percent increase where as men have seen a decreased of 19 percent.¹⁵
• Symptoms of emphysema include cough, shortness of breath and a limited exercise tolerance. Diagnosis  is made by pulmonary function tests, along with the patient's history, examination and other tests.¹⁶ 
• Alpha1 antitrypsin deficiency-related (AAT) emphysema is caused by the inherited deficiency of a protein called alpha1-antitrypsin (AAT) or alpha1-protease inhibitor. AAT, produced by the liver, is a "lung protector." In the absence of AAT, emphysema is almost inevitable. It is responsible for 5% or less of the emphysema in the United States.¹⁷
• An estimated 100,000 Americans, primarily of northern European descent, have AAT deficiency emphysema. Another 25 million Americans carry a single deficient gene that causes Alpha-1 and may pass the gene onto their children.¹⁸
• Symptoms of AAT deficiency emphysema usually begin between 32 and 41 years of age and include shortness of breath and decreased exercise capacity.  Smoking significantly increases the severity of emphysema in AAT-deficient individuals.¹⁹
• Blood screening is primarily used to diagnose whether a person is a carrier or AAT-deficient. If children are diagnosed as AAT-deficient through blood screening, they may undergo a liver transplant.²⁰ In addition, a DNA-based cheek swab test has been recently developed for the diagnosis of AAT-deficiency.²¹
• A recent study suggested that there are at least 116 million carriers among all racial groups, worldwide.²²

COPD Treatment

• The quality of life for a person suffering from COPD diminishes as the disease progresses. At the onset, there is minimal shortness of breath.  People with COPD may eventually require supplemental oxygen and may have to rely on mechanical respiratory assistance.²³
• A recent American Lung Association survey revealed that half of all COPD patients (51%) say their condition limits their ability to work.  It also limits them in normal physical exertion (70%), household chores (56%), social activities (53%), sleeping (50%) and family activities (46%).²⁴
• None of the existing medications for COPD has been shown to modify the long-term decline in lung function that is the hallmark of this disease.  Therefore, the goal of pharmacotherapy for COPD is to provide relief of symptoms and prevent complications and/or progression of the disease with a minimum of side effects.²⁵
• Bronchodilator medications (prescription drugs that relax and open air passages in the lungs) are central to the symptomatic management of COPD.  They can be inhaled as aerosol sprays or taken orally.²⁶
• Additional treatment includes antibiotics, oxygen therapy, and systemic glucocorticosteroids. The efficacy of inhaled glucocorticosteroids continues to be under study, however short-term benefit has been demonstrated.  Chronic treatment with systemic steroids involves the risk of serious side effects; therefore these are used mostly for acute exacerbations.²⁷
• Pneumonia and influenza vaccines should be given to COPD patients.²⁸  Those with COPD should also live a healthy lifestyle by exercising, avoiding cigarette smoke and other air pollutants, and eating well.²⁹
• Pulmonary rehabilitation is a preventive health-care program provided by a team of health professionals to help people cope physically, psychologically, and socially with COPD.³⁰
• Lung transplantation is being performed in increasing numbers and may be an option for people who suffer from severe emphysema. Additionally, lung volume reduction surgery (LVRS) has shown promise and is being performed with increasing frequency. However, a recent study found that emphysema patients who have severe lung obstruction with either limited ability to exchange gas when breathing or damage that is evenly distributed throughout their lungs are at high risk of death from the procedure.³¹
• In August 2003, the Centers for Medicare and Medicaid Services (CMS) announced that they intend to cover LVRS for people with non-high risk severe emphysema, who meet the criteria stated in the National Emphysema Treatment Trial (NETT). In addition, CMS has decided that LVRS is "reasonable and necessary" only for qualified patients that undergo therapy before and after the surgery.  CMS is currently composing accreditation standards for LVRS facilities and will use these standards to determine where the surgery will be covered.³²
• Treatments for AAT deficiency emphysema including AAT replacement therapy (a life-long process) and gene therapy are currently being evaluated.  It is hoped that a clinical trial on gene therapy will take place within the decade.³³

For help with treatment decisions online, click through the COPD Lung Profiler™.

For more information on COPD, please review the Chronic Bronchitis and Emphysema Morbidity and Mortality Trend Report in the  Data and Statistics section of our website or call the American Lung Association at 1-800-LUNG-USA (1-800-586-4872).
 
Sources:
1.  National Center for Health Statistics. Report of Final Mortality Statistics, 2003.
2.  Ibid.
3.  U.S. Department of Health and Human Services. The Health Consequences of Smoking. A Report
 of the Surgeon General, 2004.
4.  Hnizdo E., Sullivan, PA, Bang KM and G. Wagner.  Association between COPD and Employment by Industry and Occupation in the US Population: A Study of Data from the Third National Health and Nutrition Examination Survey.  American Journal of Epidemiology. Vol. 156 (8), 2002.
5.  National Center for Health Statistics. Raw Data from the National Health Interview Survey, U.S., 2003.  (Analysis by the American Lung Association, Using SPSS and SUDAAN software).
6.   Mannino DM, Homa DM, Akinbami L, et al. Chronic Obstructive Pulmonary Disease Surveillance - U.S., 1997-2000.  Morbidity and Mortality Weekly Report. Vol. 51 (SS06); 1-16.
7. National Center for Health Statistics. National Health Interview Survey, 2004.
8.  National Heart Lung and Blood Institute, Morbidity and Mortality Chartbook, 2004.
9.  American Thoracic Society. Standards for Diagnosis and Care of Patients with COPD. American Journal of Respiratory Care Medicine. Vol. 152 pp. S77-S120, 1995.
10.  National Center for Health Statistics. Raw Data from the National Health Interview Survey, U.S., 2003.  (Analysis by the American Lung Association, Using SPSS and SUDAAN software).
11. Ibid.
12. American Thoracic Society. Standards for Diagnosis and Care of Patients with COPD. American Journal of Respiratory Care Medicine. Vol. 152 pp. S77-S120, 1995.
13.  Ibid.
14. National Center for Health Statistics. Raw Data from the National Health Interview Survey, U.S., 2003.  (Analysis by the American Lung Association, Using SPSS and SUDAAN software).
15. Ibid.
16. American Thoracic Society. Standards for Diagnosis and Care of Patients with COPD.    American Journal of Respiratory Care Medicine. Vol. 152 pp. S77-S120, 1995.
17. American Thoracic Society.  Standards for the Diagnosis and Management of Individuals  with Alpha-1 Antitrypsin Deficiency. American Journal of Respiratory Care Medicine. Vol. 168 pp. 818-900, 2003.
18. Alpha1 Network. What is Alpha-1? Available at: www.alphaone.org. Accessed on 8/16/06.
19. American Thoracic Society.  Standards for the Diagnosis and Management of Individuals    with Alpha-1 Antitrypsin Deficiency. American Journal of Respiratory Care Medicine. Vol. 168 pp. 818-900, 2003.
20. Ibid.
21. Alpha 1 Network. Press Release: LabCorp Announces New Non-invasive Swab Test for Alpha1-Antitrypsin Deficiency. May 2004.
22. Frederick J. de Serres. Worldwide Racial and Ethnic Distribution of  1-Antitrypsin Deficiency: Summary of an Analysis of Published Genetic Epidemiologic Surveys. Chest. Vol. 122  pp. 1818-1829, 2002.
23.Global Initiative for Chronic Obstructive Pulmonary Disease.Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease, 2003. www.goldcopd.com
24. Confronting COPD in America, 2000. Schulman, Ronca and Bucuvalas, Inc. (SRBI) Funded by Glaxo Smith Kline.
25-30. Global Initiative for Chronic Obstructive Pulmonary Disease.  Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease, 2003. www.goldcopd.com
31. National Emphysema Treatment Trial Research Group. Patients at High Risk of Death after Lung-Volume-Reduction Surgery. New England Journal of Medicine. Vol. 345(15) pp. 1075-1083, 2001
32. Centers for Medicare and Medicaid Services. Decision Memo for Lung Volume Reduction Surgery (CAG00115R) www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=96..
33. American Thoracic Society.  Standards for the Diagnosis and Management of Individuals    with Alpha-1 Antitrypsin Deficiency. American Journal of Respiratory Care Medicine. Vol. 168 pp. 818-900, 2003.

*Racial and ethnic minority terminology reflects those terms used by the Centers For Disease Control.