Tag Archive for: lungs

Finding the Cause of Death

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Last week, I left you with a question about a hypothetical situation: What if my grandmother’s bedsores had become infected to the degree that it spread throughout her body; she still had congestive heart failure but didn’t have pulmonary effusion at that time. What would be the primary cause of death?

With so many health experts and influencers that get a lot of attention in social media, causes of death appear to be misunderstood. Let’s cover it as simply as I can, based on the definitions from the CDC, WHO, and other agencies around the world.

  • The primary cause of death is the situation or condition that started the chain of events resulting in death.
  • The secondary cause(s) of death are any conditions that may have contributed to the death.

In the case of the hypothetical situation, the cause of death was the systemic infection from the bedsores. The congestive heart failure was a secondary cause of death. We can’t know for certain, but the infection probably took away the ability to fight back due to the weakened condition of the cardiovascular system.

I’ll give some examples of misinformation in Saturday’s Memo—which is May 10. Long time readers will understand the significance of that day.

What are you prepared to do today?

        Dr. Chet

Why My Grandmother Died

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You may be wondering why the TAP-IT study created that stop-in-my-tracks moment. In the mid-1980s, my grandmother Frances was 80 years old and was always my biggest fan. She had congestive heart failure, so doctors tried the needle procedure, which drained close to 20 lbs. of fluid from around her lungs; you can imagine the pressure that caused on her heart. But congestive heart failure is an unforgiving disease—at least it was back then. Without a real treatment other than thoracentesis, there’s no cure.

Months later, the pulmonary effusion happened again, but she refused treatment because the procedure had hurt too much the first time. She died a couple of weeks later. The study prompted my realization that a medication like a diuretic might have prevented a rather difficult death with multiple bedsores.

The fact that there was never a randomized controlled trial to compare the two approaches until 45 years later just absolutely astounds me. At least now there are treatment options for people with the same condition without the same type of complications.

Just to be clear: there was no coming back from advanced congestive heart failure as my grandmother had. Using either procedure would not have cured her—it would have eventually killed her anyway. But the difference was really in her quality of life. She may have lived longer and certainly less painfully using the diuretic, which as I said was available even back then. But there was no research to support it.

What Was the Cause of Death?

There appears to be a lot of misinformation today about cause of death. I’m going to use my grandmother as an example. I mentioned that she had severe pulmonary effusion due to the congestive heart failure. But she also had bedsores. If they had gone septic, resulting in a whole-body infection, what would have been the official cause of death? That’s what we’ll explore next week. Please share your thoughts.

What are you prepared to do today?

        Dr. Chet

Reference: Circulation. 2025 Apr 1;151(16):1150–1161

TAP-IT to Stop It

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Have you ever had a moment where you were reading something, listening to an audio, or watching a video where you just had a moment of realization and absolutely stopped in your tracks? The reason is that you got hit with a discovery of some fact that you didn’t know. More than that, you realized what it meant. That’s what happened to me while listening to a podcast from a cardiologist about pulmonary effusion and how to treat it.  Let’s start there.

Pulmonary effusion (PE) is the buildup of fluids in the connective tissue surrounding the lungs and the chest cavity.  If enough fluid builds, it’s going to push on the lungs and ultimately push on the heart and make it very hard to breathe. To restore function, the fluid has to be removed. This happens to people who have congestive heart failure.

The TAP-IT study, formally called Thoracentesis to Alleviate Cardiac Pleural Effusion–Interventional Trial, was recently published in a leading heart journal. The researchers selected subjects who were 80+ years of age with less than a 25% ejection fraction. This population was chosen because they are the ones most likely to suffer from pleural effusion. They compared subjects who took diuretics to alleviate the fluid with subjects who got thoracentesis. The goal was to determine if there were any differences in outcomes as assessed by the number of days lived after beginning treatment.

The results? There were no differences in outcomes between the two groups. That’s amazing! Both reduced the pleural effusion, but there were differences in patient comfort and quality of life. As you might imagine, sticking a 2- to 5-inch needle through the rib space and into the pleural cavity to drain the fluid is going to be uncomfortable if not downright painful. There were also 20 out of 80 pneumothoraxes with the needle approach, while there were no complications noted in the group that took the medication.

The realization? This was the first randomized controlled trial that compared thoracentesis with diuretics, even though diuretics have been available for 75 years and thoracentesis for 175 years! Why did that matter to me? I’ll tell you on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Circulation. 2025 Apr 1;151(16):1150–1161

Research Update: Omega-3s and Lung Function

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Lung function declines as we age; depending on how we treat our lungs, our habits can determine the rate of decline. Working in toxic situations (or even worse, smoking cigarettes) can accelerate the decline. That’s why a recent study that examined blood levels of omega-3 fatty acids and measures of lung function found that our diet has an impact on lung function. Let’s look at this study.

Increases in Omega-3 Levels Prevent Decline

Of the two studies reported in the paper, I’ll stick to the longitudinal study, although both demonstrated the positive impact of omega-3s on lung function. A couple definitions first.

  • Forced expiratory volume 1 (FEV1) is the amount of air that one can forcefully breathe out in one second. The normal range is 2,500 to 3,250 milliliters.
  • Forced vital capacity (FVC) is the amount breathed out after a normal exhalation. The normal range is 3,700 ml to 4,800 ml.

One more thing: in this study, the mean rate of lung function decline was 36.8 mL per year for FEV1 and 35.8 mL per year for FVC.

Researchers examined a pooled group of studies that were part of the National Heart, Lung, and Blood Institute Pooled Cohorts Study. Studies were chosen because of the repeated measurements of both lung function and plasma phospholipid omega-3 fatty acids. The study found that higher omega-3 fatty acid levels were associated with less decline in lung function for 15,063 participants. The omega-3 that provided the most benefit was the omega-3 fatty acid DHA. In plain English, the more the DHA levels increased over time, the more the decline in lung function was prevented. I know that sounds funny to say it “prevented decline” but to say that it improved lung function would be incorrect.

The Questions

In both studies, nutritional information wasn’t collected, or if it was collected, it wasn’t used in the statistical analyses performed. The assumption seems to be that seafood and plants were the primary sources of omega-3 fatty acids, and that may be true. But it raises a question about the potential for using omega-3s in dietary supplements. Would the same response occur in reducing the risk of chronic kidney disease as it did for the loss of lung function?

It also raises another question. Many studies on the benefits of omega-3 supplements on heart health and other organs are often less than overwhelming. Could it be that there is a nutrient or nutrients in fish that, together with omega-3s, could contribute to benefits? Or could it be there’s a factor that helps with digestion, absorption, and utilization in the actual form of omega-3s used as supplements? We don’t know at this time.

The Bottom Line

While the benefits of omega-3s, specifically DHA, were small, the fact that they prevented decline over years contributes to aging with a vengeance. I think having a diet that includes the regular intake of fatty fish is the key to a healthy lifestyle, and I still think regular use of fish oil supplements may prove to be beneficial as the research continues. I’ll keep you posted.

What are you prepared to do today?

        Dr. Chet

References:
1. Am J Respir Crit Care Med. 2023 Jul 20. doi: 10.1164/rccm.202301-0074OC
2. BMJ 2023;380:e072909. doi: 10.1136/bmj-2022-0729092

Does Exercise Reduce COVID-19?

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I’ve written about fitness and COVID-19 before, but a recent post by a colleague got my attention. I had never been able to find any research that suggested people who are fitter would have less serious cases of COVID-19 or any upper respiratory infection for that matter. I thought maybe the scientific paper he used might provide an update. In addition, there were a couple of statements in the paper that caught me by surprise. Here’s what I found.

Exercise and Fatty Lungs

The paper suggested that if a person were overweight or obese, there could be an increase in fat cells in the lungs. As such, that could increase the available components such as fatty acids that could contribute to the cytokine storm in extreme cases of infection. I’d never heard that fat cells were found in the lungs, so I decided to dig deeper.

The paper referenced an article that talked about risk factors for severe cases of the COVID-19. They cited two studies. The first was a study on overweight diabetic rats. However, we’re not rats so we can’t assume the same applies to humans. The other article dealt only with obesity. The paper said that in a small study on humans, fat cells were found in the lung parenchyma where gas exchanges occur in the lung tissue.

I decided to check out that paper as well. It was a post-mortem examination of the lungs of normal-weight and overweight subjects who died from asthma and non-respiratory conditions. Researchers found fat cells in the cell walls of large structures greater than 6 mm in diameter but none in smaller areas. There was an increase in the fat cells and immune response cells in the fatal asthma cases in obese subjects. While interesting, it does not support the original article indicating fat cells in the lungs to any significant degree, because some obese subjects had none in their lung tissue.

Exercise and COVID-19

The rest of the paper discussed the benefits of exercise as it relates to weight loss, reducing cardiovascular disease, and improving metabolic systems, especially as related to type 2 diabetes. They talked about how every type of exercise improves the body enough to reduce comorbidities, and reducing comorbidities may lead to a better outcome if you get COVID-19.

The only misstatement was that exercise is a way to reduce a significant amount of body fat. It’s not; you also have to reduce your caloric intake to do that. But exercise can improve every organ system to respond better to challenges. That may help if one catches a severe case of COVID-19, so they got that right.

The Bottom Line

Exercise has been described this way: it would be the most prescribed medication in the world if it were in pill form. Based on this paper and the sum total of all the research on exercise and health, exercise can help you reduce your risk of a severe case of this or any virus, maybe not directly, but in helping you reduce your comorbidities. Move more and start today!

What are you prepared to do today?

        Dr. Chet

References:
1. Front. Physiol. doi.org/10.3389/fphys.2020.572718
2. Diabetes Metabolism. 2020. https://doi.org/10.1002/dmrr.3325.
3. Eur Resp J. 2019. 54:1900857; DOI: 10.1183/13993003.00857-2019

The Bottom Line on Vaping Today

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Recent reports indicate that in addition to fruit juices and flavors such as menthol and bubble gum, two natural products may be contributing to the issues with vaping: vitamin E and CBD oil. Vitamin E has been found in some vaping cartridges that contain CBD oil. CBD, short for cannabidiol, is the second most abundant cannabinoid found in the cannabis plant. It has levels of THC (tetrahydrocannabinol) below the legal limit and is often used for pain relief and psychological distress such as anxiety. I can’t comment on CBD oil; it’s not my area of expertise.

What I do know is that while cannabis is typically inhaled, CBD oil can be administered orally or topically and that’s probably a better delivery system. When any oil is produced, vitamin E is typically added so the oil doesn’t go rancid. In addition, there may be other additives so the CBD doesn’t break down. There’s no research to suggest that the oil or the vitamin E are safe when incinerated. Even if a cold aerosolized process is used, the ingredients are not designed to be administered that way.

Lung tissue is very sensitive. Think of the aerosolized droplets thousands of times larger than individual molecules of vitamin E or omega-3 fatty acids that would be found in blood. Those droplets would create a barrier, making it tough to breathe, whether natural or not. The benefit relies on the absorption and while some would be absorbed quickly, how long would the residue remain? Could it even be removed?

The Bottom Line Today

As I said in the Tuesday Memo, the governor of Michigan banned the sale of flavored vaping products; I think she made the right decision even though she is taking political heat for it. Business interests have interfered in public health initiatives for too long. Do I even have to mention the tobacco industry? And that it has heavily invested in the vaping industry? With the health of a generation at stake, I think taking time to examine the safety and marketing of these products is warranted.

I wish I could say this is the last word on vaping, but this is a rapidly changing health topic. The only vaping that should be allowed is as a method for quitting smoking—not to replace smoking, but as part of a strategy to quit smoking. It should be regulated by the Food and Drug Administration because nicotine is a drug.

As for the rest of what’s being used in vaping products, I think everyone should take a pass. If the industry actually conducts safety testing to discover any health issues for vapers, maybe, but I just don’t see that happening. The burden shouldn’t be on the health industry to prove vaping is bad; the burden should be on the vaping industry to prove it’s safe. We do enough to ourselves already to impair our health. We don’t need to add any more habits that we’ll need to break in the future. If you smoke, there’s no question you should quit. Talk with your doctor about the best way to accomplish that before you start vaping.

What are you prepared to do today?

        Dr. Chet

Is Vaping Healthy?

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Two years ago, I wrote this about vaping’s potential negative effects: “We won’t know how harmful it is for years, possibly decades, when those who began vaping years ago are tested and found to have higher rates of lung disorders.”

I was wrong; we’re seeing serious lung issues now and even a few deaths. Reports of respiratory illnesses include pneumonia and asthma-like symptoms that impede breathing. Another issue appears to be seizures in some cases. The problem is that no one can identify what’s causing the problem.

One cause might be heavy metals that are aerosolized from the vaping devices as well as metal juice cartridges such as chromium, nickel, and lead. They may be irritants to lung tissue. Lead could also explain seizures in some vapers.

I think that the juices targeting young vapers could be a major source of contaminants. Juices may be natural or synthetically produced, and we might point the finger at synthetic flavors. However, there’s no research on what incinerating natural juices would produce. Phytonutrients are meant to be eaten; what could happen to them when they’re burned? They may end up being toxic due to the change in chemical structure caused by exceeding normal cooking temperatures.

There are still other possibilities so I’ll finish this up on Saturday.

What are you prepared to do today?

        Dr. Chet

Vaping: The Spit Test

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The use of e-cigarettes, also known as vaping, is gaining in popularity, especially among young adults. I wouldn’t recommend it because the research is incomplete; here’s the latest study.

Researchers recruited subjects for three groups: 15 non-smokers, 14 e-cigarette users, and 15 cigarette smokers. The researchers had the subjects spit into sterile containers. Then they examined the sputum for abnormalities between the groups.

E-cigarette users had increases in stress proteins usually associated with cigarette smoking. Defense proteins that are generally associated with chronic obstructive pulmonary disease (COPD) were elevated in e-cigarette uses as well. Vapers also had an increase in sputum components associated with an immune response typically found in cigarette smokers. Finally, proteins generally associated with thicker sputum similar to that found in cigarette smokers were also found in e-cigarette users.

Reduced antioxidant levels. COPD. Alterations in immune function. Thicker spit. Yes, this was a small study. Yes, these are only factors associated with serious lung disorders, not the disorders themselves. But do you see anything that seems to indicate vaping doesn’t have serious risks? You can wait until the research shows the hazards or you can quit vaping now. Your lungs. Your body. Your choice.

What are you prepared to do today?

Dr. Chet

P.S. Get all the info on vaping in one place on the Health Info page under Basic Health Info: “Should You Vape?”

 

Reference: https://doi.org/10.1164/rccm.201708-1590OC.

 

Update: E-Cigarettes Put Lungs at Risk

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The second study presented at the European Respiratory Conference on e-cigarettes that caught my attention was a study done in Sweden. Researchers questioned over 30,000 people, randomly selected from the Swedish population. The purpose was to ask the subjects about smoking: did they smoke, what did they smoke, and what type of respiratory symptoms did they have? Here’s what they found.

Only 12.6% of those surveyed said they smoked, and the numbers broke down this way: 11% smoked only conventional cigarettes, 0.6% vaped only, and 1.2% said they used both. Researchers speculated they smoked cigarettes when allowed and vaped in public or other settings.

What about respiratory conditions? As you might expect, the highest percentage of respiratory issues came from those subjects who smoked both conventional and e-cigarettes at 56%; 46% of those who smoked only cigarettes had respiratory issues, and 34% of those who exclusively used e-cigarettes. How many non-smokers had respiratory conditions? Only 24%. The results clearly show that vaping causes the same respiratory issues such as wheezing or productive coughs as might be found in tobacco cigarettes.

What might be contributing to the issues with e-cigarettes? I’ll cover that on Saturday. One thing is clear so far: vaping is not innocuous as has been sold to consumers.

What are you prepared to do today?

Dr. Chet

 

Reference: ERS 2017. Abstract PA4485

 

The Microbiome of Your Lungs

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When we think of the microbiome, it’s logical to think only of the digestive system and our skin. In reality, the microbiome includes every microbe in and on our entire body, including our lungs. At one time, the lungs were thought to be microbe free; that certainly seemed to be the case for newborns. As babies are exposed to various bacteria and other microbes, a microbiome develops in the lungs much as it does throughout the body. It seems to have the same balance of good and bad microbes, although not as extensive as the gut.

Research has shown that in serious lung conditions such as cystic fibrosis as well as chronic lung conditions such as asthma and allergies there’s a dysbiosis of the lung microbiome. In other words, the lung microbiome is out of balance.

What can be done to restore the balance? Nothing other than traditional treatments for now, but this is an area of great research interest. I believe that focusing on eating foods with probiotics as well as prebiotics can help our entire microbiome, not just our gut.

Vegetables, beans, yogurt, fermented foods, and fruit should still be the foundation of our diet. Whether it helps the lung microbiome is not known, but it will help the gut microbiome. As we know, what helps the gut microbiome can influence other parts of the body; it’s reasonable to believe that it just may help the lung microbiome as well.

What are you prepared to do today?

Dr. Chet
References:
1. JAMA. 2017;317(17):1713-1714. doi:10.1001/jama.2017.3023
2. http://www.news-medical.net/life-sciences/Lung-microbiome.aspx