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New Approach to an Old Goal: Better Breathing

October 07, 1986|URSULA VILS | Times Staff Writer

The tradition of helping those with breathing problems reaches back to 1913 when the City of Hope was founded as a tuberculosis sanitarium in then smog-free Duarte.

In August of this year, the medical center, now perhaps best known for research and for treatment of catastrophic diseases at no charge to qualified patients, reemphasized its original commitment by reorganizing its department of respiratory diseases to become the Lung Institute at the City of Hope.

Dr. Michael J. Belman, institute director, heads a program set up 17 years ago for two purposes: to improve the quality of life for people with breathing disorders and to conduct research.

While the Lung Institute encompasses research, its clinical work focuses on a pulmonary rehabilitation program for about 120 patients a year with chronic emphysema, asthma and lung cancer and any combination of those, as well as other maladies such as bronchitis, lung infection, interstitial fibrosis (scarring of lung tissue that affects breathing) and sarcoidosis (chronic inflammation of the lungs usually seen in younger people).

The rehab program recently shifted emphasis from hospitalization to treatment on an out-patient basis five days a week.

Started in 1972, the rehabilitation program begins with an evaluation of the patient's condition to measure the extent of breathing impairment and to check for problems with the heart and blood, Belman said.

"We can monitor the oxygen in a patient's blood," he said, "to see if the patient needs (additional) oxygen all the time, some of the time, while walking or, in some cases, not at all."

Rehabilitation includes physical therapy to strengthen legs and arms, walking exercises, occupational therapy and learning breathing and energy techniques, proper use of medication and respiratory equipment (oxygen, sprays to relieve asthma) and educational sessions for both patients and their caretakers, usually spouses.

"Motivation is important," Belman said. "If they come with a negative attitude, we try to work on that."

The institute uses the team approach.

"We combine the talents of physicians and occupational therapists, social workers, dietitians," he said. "For example, many lung cancer patients are treated also by pulmonary internists, radiologists, surgeons, oncologists and psychologists.

"Prescriptions do not work for emphysema patients because medications are of limited benefit. With other patients, we work with pharmacists on medication, correct doses and side effects.

"Sprays are a good example. Most come in an easy-to-squeeze device, partly because many who need them are older--the average age of emphysema patients is 65--and have arthritis in their hands. It has been shown that most people use these sprays incorrectly--some too much, some too little. We teach them coordination, to squirt and breathe at the same time, how far from the mouth to hold the spray device. It makes a great deal of difference because it changes the dose."

Two Experimental Areas

The Lung Institute's research centers around two experimental areas, one of which is oxygen conservation, the other the breathing muscles and diaphragm. Among physicians working with Belman is Dr. Brian L. Tiep, a doctor with a flair for mechanical design.

A significant number of emphysema patients get oxygen on a continuous basis, Belman said, and Tiep has developed a device that measures the costly oxygen and doles it out efficiently.

"About 70% of the oxygen is wasted during use now," Tiep said. "Medicare pays about $1 billion a year for in-home oxygen. I think we can save about half of that. In some cases the patient gets the same benefit using a quarter of the amount of oxygen previously expended, and my 'Oxymizer' is much lighter and can be carried around more easily."

Another area of research is into what Belman calls "the last undiscovered area of the human body: the respiratory muscles." Here again Tiep's knack for invention is being utilized with a kazoo-like device that monitors resistance to breathing and permits doctors to find out how much resistance the patient has to overcome to inhale.

Training the 'Pump'

"Just because emphysema is irreversible," Belman said, "we can still do much for the 'pump,' the diaphragm that pumps air into the lungs. This is training geared to the muscles; let the muscles make up for the deficiencies of the lungs."

Belman is quick to note that other Southland hospitals have similar rehabilitation programs, mentioning specifically Loma Linda, Hoag Memorial, the Little Company of Mary in Torrance and Barlow, affiliated with the USC School of Medicine. Many also have formed follow-up groups like the City of Hope's Strollers, through which rehab program graduates meet to walk together and for social events.

On completion of the rehab regimen, patients are instructed to continue their exercises and to walk at least an hour each day.

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