Negin Hajizadeh, MD, MPH, associate professor of medicine in the division of pulmonary, critical care and sleep medicine with Northwell Health's Department of Medicine, is studying the effects of exercise science on a population whose every breath can be a struggle - while also paying special attention to treatment disparities found predominantly among African American and Hispanic populations with end-stage lung disease.
Dr. Hajizadeh, also the director of decision science in the Feinstein Institute for Medical Research's new Center for Health Innovations and Outcomes Research, says the evidence shows that patients with chronic obstructive pulmonary disease (COPD) – including chronic bronchitis and emphysema - can improve their quality of life through exercise and rehabilitation. However, many patients, in particular underserved, disparity populations are unable to access this life-altering resource. Disparities, can result from patients' lack of access to transportation needed to get to a rehabilitation facility, limited education or communication problems with their providers, and lack of physician referral to rehabilitation programs because of perceptions that patients will not comply.
Northwell's Chronic Pulmonary Disease Management Program (CPDMP) is attempting to overcome some of the barriers facing underserved populations, starting with African-American and Hispanic patients with COPD. The CPDMP brings the pulmonary rehabilitation program in to their homes or local community centers so that they can work remotely with a dedicated respiratory therapist and a pulmonologist (Dr. Hajizadeh) on an exercise regimen and care plan to better cope with this debilitating disease. The program also includes regular follow up by a social worker to facilitate the transition out of the hospital and obtaining follow up appointments, and prescribed medications.
"There is no cure for COPD or emphysema but there are things that can be done to improve the quality of breathing and by extension the quality of a patient's life," said Dr. Hajizadeh. It starts with education and improved decision-making that can improve quality of life during its final phases. "For example, the idea of training people with COPD to purse their lips when they exhale to take pressure off the lungs is a relatively simple adjustment that has significant ramifications. One of the characteristics of COPD is that it causes the lungs to close up when people breathe out. Pursed lip breathing for people with COPD acts as the release of a pressure valve.
That's just one element of educating patients to help them understand the breathing anxiety cycle. "When you feel you can't breathe, you naturally tend to breathe faster, but the faster you breathe, the more air gets trapped," Dr. Hajizadeh said. "By slowing down one's breathing and learning to push one's belly out, you are controlling the breathing process. It's counterintuitive to what patients feel when they struggle for breath. Many believe they need to quicken their rate of breathing to bring more air into the lungs which only makes the sensation of feeling like they are suffocating worse."
She said patients can use the other muscles in their bodies to help lessen the struggle as well. "The goal is to put less stress on the lungs by exercising and properly using the diaphragm and intercostal muscles. If we develop the muscles throughout the body, including those surrounding the ribcage, patients will feel less pressure on their lungs to do all of the work of breathing. It increases overall strength so other parts of the body can do the work, not to mention the general well-being and self-efficacy that comes from working out and moving the body."