Caring Comes Naturally to BREATHE LA Researcher

Coughing doesn't bother Margaret Nield. Perhaps that's why she has devoted her professional life to caring for patients with COPD.

COPD is most often characterized by shortness of breath and a persistent cough. Those over the age of 40 with a history of smoking are particularly at risk, however 1 in 6 people with COPD have never smoked. COPD is the number four cause of death in the United States, it cannot be cured, but it can be treated.

"There are 12 million Americans diagnosed with COPD, and we estimate that another 12 million people have the disease and don't even know it," says James Kiley, Ph.D., Director, Division of Lung Diseases, National Heart, Lung, and Blood Institute (NHLBI). "NHLBI really appreciates the work of the partners who have joined our campaign to educate the public and patients about this devastating lung disease."

In honor of COPD Awareness Month BREATHE California of Los Angeles County (BREATHE LA) invites you to sit down with Dr Margaret Nield, R.N., PhD., one of our BREATHE LA researchers, whose nursing background brings a caring-focused approach to living with COPD.

BREATHE LA Center for Healthy Lungs funds research designed to identify interventions that improve quality of life for those suffering with lung disease. Funding is also targeted for research that promotes clean air and develops technology. The first award of research funding was made in 2007 to Arnold Platzker, MD, Children's Hospital of Los Angeles, for his research titled "Childhood Asthma, Inflammatory Markers and Environmental Tobacco Smoke Exposure"

2007 BREATHE LA Center for Healthy Lungs research funding awards have been announced for :

Chris B. Cooper, MD, "Controlled Feasibility Study of Community Based Exercise Program in Patients with Moderate COPD." (Chronic Obstructive Pulmonary Disease; including emphysema and chronic bronchitis )And

Margaret Nield, RN, PhD, "Implementation of a Breathing Pattern Retraining Protocol with Interactive Telecommunications System in Los Angeles County Better Breathers' Clubs."

COPD is a serious lung disease, sometimes called by other names, like emphysema or chronic bronchitis. In fact COPD is a multi-system combination of lung diseases that require subtle differences in treatment and present patients with a range of symptoms that share a common, and frightening aspect, inability to breathe. "With emphysema," Dr. Neild explains, "air trapping occurs. It's called ‘dynamic hyperinflation.'Air comes in and cant get out." People with COPD and Asthma can have similar symptoms, coughing, wheezing and difficulty breathing. "Inflamation of airway is common to asthma and COPD, but treatments are different"

Long term effects of COPD can include Cognition Deficits, lack of oxygen can affect cognitive function, and Muscle Wasting (which can be caused by a lack of exercise due to in ability to breathe. But the most difficult symptom is the inability to take a breath. "Patients not only struggle with the disease in general, they have the very frightening and very immediate experience of not being able to breathe. That produces anxiety."

But there are ways to cope with the disease and with the challenges it presents. "With a chronic disease, you change your expectations," says Dr. Nield, leaning back in her chair reflectively. Tall and slender, with a shock of white hair and a ready smile, Dr. Nield's demeanor is calm and caring. Not the stereotypical scientific researcher, although her stylist black rimmed spectacles lend an air of seriousness to her otherwise utterly gentle features, "Are you going to say woe is me because I can't do as much or am I going to find a way to live with the disease on my own terms? Each of us is different in how the disease presents and we can come to terms with a change in our lifestyle that allows us to accommodate the disease."

"It's a matter of knowing who you are and how your body copes with any long term disease. I see it as ‘health within illness,' not focusing on the disease, but on what your life can be in spite of the disease," Dr Nield says with a gentle smile.

Indeed, Dr Nield's BREATHE LA Center for Healthy Lungs study, despite it's unwieldly title ("Implementation of a Breathing Pattern Retraining Protocol with Interactive Telecommunications System in Los Angeles County Better Breathers' Clubs" )seeks to do just that by allowing patients to remain in the comfort of their homes while receiving personalized face to face care from a health professional over the internet. Dr Nield's study plans to demonstrate the efficacy of e-health care specific to COPD patients drawn from Los Angeles Area Veterans served by the VA hospital in Los Angeles. The potential for long term benefits of this type of health care for other remote or home-bound patients, using internet access, skype and web cam technology, and humanizing the experience with personalized care excites Dr. Nield,

"As a nurse, I approach this with a different level of care. CARE vs CURE - nursing approach to health within disease. COPD can also be affected by environmental factors. Air pollution, pollen, smoke from seasonal wildfires can all make it even more difficult for COPD and Asthma patients to breathe. In California, and in other warm and tropical locations, increased warmth leads to more blooming and this can lead to lung irritation triggers. Dr Nield shakes her head in agreement at the suggestion of a connection between Global Warming and the rise in the incidence of asthma in children, "It is a global issue. The increase in warming and blooming of plants are part of the reason for increase in asthma cases. Focusing on environmental issues is only natural. There is a link to the natural in lung health and disease. In terms of COPD, primary causes include smoking, and second hand smoke, but the whole other point is environmental. Global warming is the new AIDS."

Dr Nield, a nurse trained at Abbott Hospital School of Nursing in Minneapolis and McAllister College in St Paul found her way to her life's work in COPD when she took on a fateful summer job while living in Arizona while her late husband completed a PhD in physics. "I decided to go to school to get Masters in a federally funded public health program. I worked during my masters degree studies in a Demonstration Clinic of INPBB. Intermittant - Positive - Pressure - Breathing which was a system of delivering mechanized medication for COPD patients. The device was a mouthpiece that forced the patient to take deep breaths. It was a key treatment at the time, that and nebulizers. And now, patients are trained to take deep breaths on their own."

After she finished her masters degree, she continued her work at Pima General Hospital in Pima Arizona as Directorof Respiratory Therapy and Nurse Clinician Expert on Pulmonary care and Pulmonary Gases. "Imagine that! I had so much energy in those days, and with a husband and two kids." Her children are now grown, and both live in Chicago.

Dr Margaret Nield served the first Presidency of the Chicago Area Nursing Assembly in the 1970's and served again as President of the National Nursing Assembly in the 1980's after earning her doctorate. She has worked with the American Lung Association of Chicago, "which was very active in pollution at the time," and later, the California Thoractic Society. After completing her PhD at UCLA, Dr Nield started the Phyisical Medical Rehabilitation program and Smoking Cessation program at the Los Angeles Veterns Administration Hospital.

"Smoking in the United States is down to only 21% of the population. But the 2010 Health target was to bring the smoking population down to 12% but it appears the goal will not be met. And the whole other piece of the puzzle in COPD is second hand smoke."

Dr. Nield's specialty is Pulmonary and Chronic Lung Disease Symptom Management and Patient Self Care "My niche is as a nurse," she says, returning to her roots allows her to approach her research and her interaction with patients with a focus on quality of life, "COPD is a multi-system disease, similar to diabetes. Complex biochemistry is at play in the disease. Patients with COPD cope with anxiety. COPD is a psycho social disease. Exertion causes not only physical symptoms but creates a psychological change in the patient. People can't take their next breath they get scared that they can't breath. So in the treatment process they learn to pace themselves, to understand the levels of exertion they can tolerate and learn how to limit themselves, or pace themselves. They can retrain themselves to breathe at a controlled rate and can improve their health-related quality of life."

Her goals for her patients are simple, "You focus on how you can manage the disease. It doesn't go away but there are many things you can do to slow the progression of the disease and to develop quality of life."

For more information about lung health and clean air issues related to BREATHE LA visit www.breathela.org or for more information about COPD Awareness Month activities taking place across the country and to learn more about the COPD Learn More Breathe Better campaign, visit www.LearnAboutCOPD.org.

BREATHE LA is an independent, non-profit organization dedicated to serving the lung health needs of Los Angeles County. BREATHE LA promotes clean air and healthy lungs through advocacy, education, and funding of research and technology.

BREATHE LA was established in 1903 and has over a century of accomplishments protecting the breath of life in Los Angeles County. BREATHE LA's public information, advocacy, and services address lung disease (asthma, emphysema, tuberculosis) environmental education, tobacco, and access to services.