First ever world spirometry day

On Thursday October 14^th, free spirometry will be offered world wide. This event will be one of the top opportunities to raise awareness about lung health through the public and the media. The European Respiratory Society and the European Lung Foundation will coordinate the organizing of the event.

Spirometry is the most common method for testing lung function. It is simple, quick and non invasive. The test specifically measures the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled by the lungs. Spirometry is an important tool and is helpful in assessing conditions such as asthma and pulmonary fibrosis and perhaps most importantly chronic obstructive pulmonary disease.

These spirometry events have a dual purpose. On the one hand they have a public health impact enabling many people who have not been tested previously to have their lung function measured. In Berlin approximately 20% of people tested were advised to visit their doctor for further examination. On the other hand, these events provide a focus on lung health and lung disease, facilitating increased public awareness.

The results of six of these events in summary found that in over 12,500 people tested, nearly 20% has some degree of airway obstruction, nearly 50% were smokers and 5% had asthma.

The organizers of these events conclude that spirometry testing is a useful way to detect airway obstruction at an early stage in life, in a large proportion of residents.

On World Spirometry Day, Manse Medical will organize and run an event to offering free spirometry. CareFusion and Bird Heath Care have generously offered support in the way of filters and noseclips for the event.

More details will be posted nearer to the date.

Vanessa

WHAT ARE YOU EATING FOR A GOOD NIGHTS SLEEP?

I recently read a magazine article which focused on sleep and what factors affect our ability to get a good nights rest. We all know that there are many things in our daily life which will have an impact on this area – stress, anxiety, work hours, illness, drugs, exercise, social habits, babies, pain, body temperature, diet, and the list goes on….

I am going to focus in part on food. Research tells us that there are certain foods that can help you get to sleep. This list includes foods such as bananas, nuts and peanut butter, milk, apples, fish, yogurt, cheese (particularly cheddar, Swiss, gruyere), soy products, lettuce (think The Tale of Peter Rabbit and the Flopsy Bunnies – soporific effect) and there are certainly others that I have missed. Why are these foods recommended over others?

The thing that these foods have in common is that they are high in something called tryptophan. Tryptophan is an amino acid which the body cannot make itself but is needed by our nerve cells to make serotonin. Serotonin is a brain neurotransmitter that helps promote feelings of relaxation, calmness and sleepiness. We need enough of this hormone serotonin in our system to get to sleep and this in turn is dependent on our tryptophan levels. Tryptophan is also in competition with other amino acids to reach the brain.

Interestingly, it is NOT recommended that we load ourselves up with these magic sleep inducing foods.

It is important to understand that studies have shown that tryptophan helps with only one phase of our sleep cycle – that of getting to sleep. It won’t necessarily keep you asleep.

Our typical sleep cycle is divided into REM and non- REM sleep. REM (or rapid eye movement) is the stage of sleep when we dream. Non-REM sleep is divided into four stages of sleep – stage 1 being lighter sleep through to progressively deeper stage 4 sleep, followed by REM. This cycle usually takes about 90 - 120 minutes, and we have about 4 or 5 of these cycles a night, with the amount of REM increasing in length with each cycle.

Excess tryptophan has in fact been shown to increase the amount non-REM sleep and actually decrease REM sleep time. Deep sleep is an important time for the body to renew itself and REM sleep an important time for the brain to process and sort information. It is linked to both memory and production of certain neurotransmitters like serotonin and dopamine which directly affect our day time mood.

From my research, there seems to be a general consensus about meals for sleep.
It is recommended that you eat a lighter rather than heavier evening meal about 4 hours prior to your usual bed time so that you body is not working overtime at active digestion.

Evidence shows that eating a small carbohydrate rich snack with tryptophan containing foods (a protein) 1 -2 hours prior to bed to be beneficial. Carbohydrate consumption stimulates the release of insulin which assists in transporting those competing amino acids from the bloodstream, making tryptophan more readily available.
Select your proteins (and portions) wisely as many animal foods high in tryptophan are also high in other amino acids (like tyrosine) which potentially stimulate the brain with the release of adrenalin for example and can have the opposite desired effect.

So that warm glass of milk as a snack before bedtime is a good idea to help you get to sleep but only if you are taking a considered approach to your overall dietary habits (not just focusing on specific foods) and addressing any other potential sleep stressors.
For more information on setting yourself up for a good nights sleep and creating healthy sleep habits, you can download our sleep hygiene recommendations available on our website.

Lisa

A chest x-ray for sore ankles?

A young male patient presents with painful, inflamed ankles and is ordered a chest x-ray. He thinks maybe the doc didn’t quite hear him right.

But possibly his doctor is right on to what is happening and suspects Lofgren’s syndrome (named after Swedish Researcher Sven Lofgren 1910-1978).

This is a type of sub acute sarcoidosis which may present with erythema nodosum (tender red nodules), bilateral hilar adenopathy (enlarged lymph nodes on the border of the lungs), arthritis and fever.

The cause is unknown but environmental triggers have been implicated, combined with a genetic susceptibility. There is variable instances of this disease around the world but you may be more vulnerable if you are Irish, Scandinavian, African or Puerto Rican and less prone if Japanese. There has also been some association with those working in specific professions including health care workers, school teachers, agricultural workers exposed to agricultural dust, insecticides, pesticides and moulds, suppliers of building materials, hardware or gardening materials and firefighters.

Other risk factors are being female (85%), being young to middle age (mean age of disease is 35) and seasonal considerations, with the disease being more common in the spring in the Northern Hemisphere.

The patient may present with arthralgia, cough or shortness of breath, fever or malaise along with erythema nodosum (more likely if female) and bilateral ankle inflammation (more likely if male).

The diagnosis can be made with the assistance of a chest x-ray which will show mediastinal lymphadenopathy or pulmonary infiltration, lung function tests which may indicate decreased forced vital capacity, as well as elevated serum calcium and ACE levels. A lymph node biopsy may also confirm the diagnosis.

Generally the disease has a good prognosis and is usually benign and self limiting over a 6 month to 2 year period. Normal serum ACE levels at diagnosis and a particular HLA type (DRB1*03 positive as opposed to negative which points to a non resolving disease) are good prognostic markers

Management is supportive, with use of non steroidal anti inflammatories and short term bed rest. Occasionally corticosteroids will be given for severe symptoms such as severe arthritis.

Differential diagnoses may include infection, cellulitis, osteomyelitis, gout, polyarthritis, lymphoma, fungal infections, tuberculosis and bronchiogenic carcinoma to name a few.

But just remember that chest x-ray for anyone presenting with inflammatory ankle symptoms.

Irene