Donald A. Mahler, MD, Claremont, NH (2025)

01/26/2024

Screening For Lung Cancer: Should I Do It? Dear Dr. Mahler: I am 64 years old and my new physician's assistant recommended a CT scan to screen for lung cancer. Does this make sense? I take two different inhalers in the morning for my COPD and use albuterol puffer at least once most days. Each winter I seem to get a chest infection that requires an antibtiotic and a course of prednisone....

Screening for lung cancer is recommended for those 50-80 years of age, have smoked at least 20 pack-years, and are current or past smokers.

01/11/2024

Regular Physical Activity Reduced Mortality And Severe Flare-ups In COPD Background: Physical inactivity (being sedentary) is more common in those with COPD compared with age-matched healthy adults without COPD. One reason for this difference is that individuals with COPD expereince shortness of breath with various activities and are thereby less active in order to avoid unpleasant breathing. This scenario creates a downward cycle and leads to reduced quality of life and a higher risk of flare-ups (exacerbations)....

Starting moderate to vigorous physical activity can potentially reduce mortality and severe exacerbations in those with COPD.

12/15/2023

Effectiveness of Influenza Vaccine in COPD: Results from 2018-2020 Seasons Background: Information about the effectivenss of the flu (influenza) vaccine is limited in preventing flu-related hospitalizations in older adults and those with high-risk conditions such as COPD. Study: Ashley Tippett, MPH, and colleagues from Emory University School of Medicine in Atlanta, Georgia, recorded information on adults 50 years of age or older admitted to two hospitals in the United States for an acute respiratory illness and adults admitted for congestive heart failure or COPD flare-ups (exacerbations)....

The adjusted effectiveness of the vaccine in preventing influenza-related hospitalization for COPD/congestive heart failure flare-up was 80%.

11/10/2023

Augmentation Therapy Improves Survival In Alpha-1 Antitrypsin Deficiency Background: Alpha-1 antitrypsin deficiency (A1AD) is a rare inherited type of COPD with predominant emphysema. Weekly intravenous infusions of alpha-1 protein (called augmentation therapy) is "standard of care" for those with this condition living in the United States. However, some countries with socialized healthcare systems (like Ireland) do not pay for augmentation therapy because their regulatory agencies do not believe that clinical trials have shown efficacy (that it works!)....

Augmentation therapy improves survival: comparison of patients receiving therapy (Austria and Switzerland) versus no therapy (Ireland)

11/05/2023

Omega-3 Slows Decline In Lung Function In Adults Background: After about 50 years of age, lung function declines gradually in healthy adults. In those with COPD who continue to smoke, there is a faster rate of decline. Quitting smoking is important as it slows down this progression. Patients with COPD who have quit smoking as well as health care professionals are also interested in whether diet and/or exercise can also slow down any worsening in lung function....

Omega-3 slows decline in lung function in adults and has beneficial effects, especially DHA, on lung health.

10/29/2023

Improving Shortness Of Breath In COPD With Weight Loss Through Health Coaching Background: Shortness of breath (medical word is dyspnea) is the leading symptom of those with COPD. People who are overweight report more shortness of breath, have poorer quality of life, and use health care more frequently than those who are not obese. Overall, obesity is increasing in the general population as well as in those with COPD....

Improving shortness of breath in individuals with COPD and severe obesity was associated with weight loss and health coaching.

09/07/2023

RSV Vaccines in COPD: Should I Get The New Vaccine? What Is RSV? RSV is an abbreviation for Respiratory Syncthial Virus - a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious. Infants and older adults are more likely to develop severe RSV and need hospitalization. People infected with RSV usually show symptoms within 4 to 6 days after getting infected....

RSV Vaccines in COPD. There are two new vaccines that are more than 80% effective in in preventing RSV infection.

08/11/2023

Are You Taking The Right Inhaler? A Personalized Approach Background: For a variety of reasons information on treatment of COPD has focused primarily on the inhaled medication with only limited consideration of the actual delivery system (type of inhaler). Clearly, both the type of medication (two different types of bronchodilators and inhaled corticosteroids) and the different types of inhaled delivery systems are BOTH important....

Your health care professional should personalize the selection of inhaled medication delivery system so that you use the right inhaler.

07/10/2023

Increased Risk Of Pneumonia Related to Long-term Air Pollution Background: Pneumonia is a global infectious disease associated with high morbidity (illness) and mortality among all age groups. COPD is one of the risk factors for pneumonia along with age > 65 years and excess alcohol use. It is increasing recognized that air pollution poses a substantial effect on public health and leads to an increased risk of respiratory diseases including asthma and COPD....

Long-term exposure to air pollution was associated with an increased risk of pneumonia, especially in individuals who smoke.

07/02/2023

Promising New Treatment For COPD: Ensifentrine Has Bronchodilator And Anti-inflammatory Effects Background: Current treatments for COPD include the same classes of inhaled therapy for over 40 years These three classes are inhaled short- and long-acting bronchodilators and inhaled corticosteroids. Ensifentrine - a dual inhibitor of phosphodiesterase (PDE) 3 and PDE4 - is a novel treatment for those with COPD. A PDE3 inhibitor relaxes bronchial smooth muscle providing bronchodilator effect (opening the airways), while PDE4 has anti-inflammatory effect (reduces redness & swelling)....

Ensifentrine is a promising new treatment for those with COPD because it works by different mechanisms than existing medications.

06/19/2023

Natural Disasters And COPD: How Should I Prepare? Dear Dr. Mahler: My COPD was diagnosed about four years and I live on the Gulf Coast of Florida. I am worried about the upcoming hurricane season and wanted to know y0ur thoughts about being prepared for a possible natural disaster. I try to keep active playing shuffle board and cards each once a week with others in park where I live....

Preparing for Natural Disasters And COPD includes youir personal safety, a plan for loss of electricity, and having medications available.

06/04/2023

What Causes A COPD Flare-up? Background: Many, if not most, indiviudals with COPD have experienced a flare-up or worsening of shortness of breath and/or cough which may be productive of mucus or phlegm. The medical word for a flare-up is an exacerbation. Generally, the causes of a flare-up include a respiratory infection, either viral or bacterial, and environmental - such as inhaling pollutants in the air....

By understanding the possible causes of a COPD flare-up, you are able to provide important information to assist the health care professional.

04/28/2023

Cooking With Gas And COPD: Is It Safe? What Can I Do? Dear Dr. Mahler: I have been reading a lot about climate change and want to know your thoughts on cooking with natural gas. My COPD was diagnosed five years ago and my breathing seems to be slowly getting worse. I completed the 36 sessions of pulmonary rehabilitation before COVID, and have restarted walking on the treadmill at the community fitness center....

Cooking with gas and COPD: Using a stove range hood and/or an air filter system can reduce airborne irritants in your home.

04/11/2023

Tele-Pulmonary Rehabilitation Reduces Hospital Admissions And Emergency Department Visits Background: Although the benefits of pumlmonary rehabilitation (PR) are clear and substantial, unfortunately many patients with COPD do not have access to local pulmonary rehabilitation programs. Tele-pulmonary rehabilitation is defined as the use of information and technologies to provide rehabilitation services remotely to people in their homes, and has the potential to improve use of and access to PR....

Long-term tele-pulmonary rehabilitation and unsupervised treadmill walking in patients with COPD reduced hospital admissions.

03/24/2023

Air Cleaners For COPD Have Health Benefits Background: In a previous study evaluating air cleaners for COPD, it was shown that a household air cleaner reduced indoor pollution and improved respiratory health and reduced the risk of an exacerbation. Now, these same investigators evaluated the effects of an air cleaner on heart disease as it is one of the leading causes of death in those with COPD....

Air cleaners with high-efficiency particulate and carbon filters improve cardiovascular health in those with COPD.

03/03/2023

Red Tide And Breathing: What To Know Dear Dr. Mahler: I wanted to know if you are familiar with red tide. We have been in Boca Grande, FL, since the beginning of Nov. we live right on the beach. We have had red tide off and on since then. When the wind comes out of the west, which it does 90% of the time, it makes ...

Red tide produces toxic chemicals that can cause respiratory irritation and lead to difficulty breathing, coughing, and sneezing.

02/24/2023

Benefits Of HIIT Exercise In COPD: Less Shortness of Breath And Better Fitness Background: HIIT means High Intensity Interval Training. HIIT exercise in COPD is an alternative approach to training than the lower intensity, longer duration exertion used in many pulmonary rehabilitation programs. It is a popular type of a cardio work-out - could be walking on a treadmill, cycling on a stationary bike, using a stair climbing machine, rowing, jumping rope, etc....

HIIT increases exercise capacity, reduces shortness of breath, and improves quality of life in those with COPD.

02/05/2023

Breathlessness And Expectations Of Breathlessness By Brain Activity Background: Breathlessness, also called shortness of breath, is a key feature of COPD that may persist despite maximal medical therapy. Pulmonary rehabilitation is one of the most effective therapies to relieve the troubling symptom of breathing difficulty. Despite considerable research, it is still unknown which patient characteristics predict improvements with pulmonary rehabiliation....

Breathlessness and expectations of breathlessness by brain activity in response to the cue "climbing stairs" predicts improvement

Donald A. Mahler, MD