Respiratory,parameters,termina health Respiratory parameters of terminal cancer patients predicted

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Physiological state of terminally ill cancer patients is characterised by dozens of parameters that are outside of the normal range. Among the simplest cardio-respiratory parameters used by modern oncologists are pulse and respiratory rate at rest (Chiang et al, 2009; de Miguel Sanchez et al, 2006; Groeger et al, 1998). After investigating several parameters and characteristics in 100 terminally ill cancer patients, Dudgeon and Lertzman (1998) concluded that “spirometry was abnormal in 93% of patients”.While most formulas, which could predict survival of cancer patients, involve blood analysis and other complicated procedures, a group of Spanish doctors suggested only 3 simple parameters reflected in the title of their study: “Palliative Performance Status, Heart Rate and Respiratory Rate as Predictive Factors of Survival Time in Terminally Ill Cancer Patients” (de Miguel Sanchez et al, 2006). Ninety-eight patients were studied, whose median survival was 32 days. In abstract these doctors noted, “In the multivariate analysis, three independent variables were identified: Palliative Performance Score of 50 or under, heart rate of 100/minute or more, and respiratory rate of 24/minute or more.”In the 1960s, when Doctor Konstantin Buteyko was the head of the classified respiratory project devoted to first Soviet spaceship missions (Soviets wanted to define ideal air composition in a space rocket and ideal respiratory parameters of astronauts for their maximum performance and body oxygenation), he analyzed results of thousands of healthy and sick people (mostly with heart disease and asthma) and suggested the Buteyko Table of health zones. Several books (e.g., Buteyko & Buteyko, 2005) and websites have this table. The discovery of health zones was so important for Dr/ Buteyko that he filled a patent application with the title “Method for assessment of human health” Application No.: 99114075/14 from 23.06.1999 (Russian Federal Service for Intellectual Property, Patents and Trademarks). The Buteyko Table links together several fundamental physiological characteristics of the human body, including heart rate, respiratory frequency, CO2 concentration in the alveoli of the lungs, automatic pause (a natural pause of total rest or no breathing after their usual exhalation), and the Control Pause (or body oxygenation index). The CP is the breath holding time measured after usual exhalation, but only until the signs of initial discomfort or stress.    The normal parameters according to his table are: 60 beats per min for pulse; 8 breaths per min for breathing frequency; 6.5% CO2 in the alveoli; 4 s for automatic pause during unconscious breathing and 60 s of oxygen in the body for breath holding time. Such parameters were normal for many ordinary people about 100-120 years ago. Modern people breathe faster and deeper, CO2 is less, heart rate is higher, and body oxygenation is less than 30 s. The most severe or last stage of the disease (7th stage of the disease) corresponds to critically and terminally ill patients. Terminal cancer patients, according to Buteyko Table, should have less than 5 s CP, when the immune system offer no resistance to pathogenic bacteria, viruses, and malignant cells even in the blood due to severe tissue hypoxia and suppressed immune system. At this stage, they are likely to be bed-ridden, unable to work, have problems with self-care, etc. With around 3-5 s for body oxygenation, these people may need to be fed and can loose consciousness. These were the observations of Dr. Buteyko and his colleagues, who studied breathing parameters of terminally ill heart and asthma patients in the 1960s before these patients were able to learn the Buteyko breathing retraining method.Hence, the Palliative Performance Status at 3-10 s CP would be very low because it includes 5 characteristics (Ambulation; Activity Level /Evidence of Disease; Self-Care ability; Food Intake; Level of Consciousness). In order to find the exact numbers, let us consider the last row of this Table (for 5 s CP or the terminal stage of disease). It corresponds to the heart rate of 100 and the breathing frequency of 30 breaths per minute for early morning numbers (epidemiological studies found that critically ill patients are likely to die from about 4 to 7 am). During day time, their parameters would be better. According to the table, less than 10 s CP (body oxygenation) means over 90 beats per minute for pulse and over 26 for respiratory frequency. Spanish doctors  (de Miguel Sanchez et al, 2006) found the pulse over 100 and respiratory rate over 24 are very poor predictors of survival and these parameters are close to Buteyko observations, considering huge deviations from the norms (about 2 times). Therefore, there is almost no difference, from the cardio-respiratory viewpoint and body oxygenation state, in parameters of terminally ill patients with these seemingly different conditions: heart disease, asthma, and cancer.ReferencesButeyko VK, Buteyko MM, The Buteyko theory about a key role of breathing for human health, Scientific introduction to the Buteyko therapy for experts, Buteyko Co LTD, Voronezh, 2005.Chiang JK, Lai NS, Wang MH, Chen SC, Kao YH, A proposed prognostic 7-day survival formula for patients with terminal cancer, BMC Public Health. 2009 Sep 29; 9(1): p.365.de Miguel Sanchez C, Elustondo SG, Estirado A, Sanchez FV, de la Rasilla Cooper CG, Romero AL, Otero A, Olmos LG, Palliative Performance Status, Heart Rate and Respiratory Rate as Predictive Factors of Survival Time in Terminally Ill Cancer Patients, J Pain Symptom Managem. June 2006; 31(6), p. 485-492.Dudgeon DJ, Lertzman M, Dyspnea in the advanced cancer patient, J Pain Symptom Management 1998 Oct; 16(4): p.212-219. Groeger JS, Lemeshow S, Price K, Nierman DM, White P Jr, Klar J, Granovsky S, Horak D, Kish SK, Multicenter outcome study of cancer patients admitted to the intensive care unit: a probability of mortality model, J Clin Oncol. 1998 Feb; 16(2): p.761-770.