Column by Dr. Vivek Murari
Original Article

Breathe easy. It’s the phrase that tells us not to worry. And nothing measures our wellbeing quite like breathing, the body’s rhythmic act of taking fresh air in and sending out the used-up breath.

Diseases that name the opposite of free breathing fit under the title “chronic obstructive pulmonary disease,” or COPD. The label encompasses a number of lung disorders, including emphysema and chronic bronchitis, that are characterized by obstruction of the airways.

In COPD, the obstruction predominantly affects the ability to breathe air out. This leads to stagnation of the air in the lungs and poor air exchange. COPD is the fourth leading cause of death in the United States, with 100,000 people dying from it every year.

To better understand this disease, let’s review the process of air exchange.

The lungs are inside the chest cavity. When you take in a breath, the diaphragm (the muscle between the chest and abdomen) and chest muscles contract, or draw tighter. As they do, the chest cavity enlarges and a negative pressure is created in the cavity, which causes air to rush in and flow into the lungs.

As that air is carried into the lungs, it gets delivered to air sacs (alveoli) by a branching system of tubes (bronchi and bronchioles). The alveoli are surrounded by small, thin-walled blood vessels, or capillaries, and this is where oxygen passes into the blood and is carried thoughout the body.

The flow of air out of the lungs, however, is a passive process. It occurs as the lungs recoil due to their inherent elasticity. Any disease, like emphysema, which causes destruction of the alveoli and elastic fibers and decreases the elastic recoil of the lungs, leads to trapping of air and slow expelling of air from the lungs.

Diseases like chronic bronchitis cause inflammation and swelling of the airways along with excess mucus production, and those conditions also lead to obstruction of the airways.

Smoking is by far the most common cause of lung damage and COPD.

Fortunately, it takes many years of heavy smoking before there is irreversible damage.

Chronic exposure to fumes, vapors, dusts and pollutants can also lead to COPD. And a rare genetic disorder, “alpha 1 antitrypsin deficiency, can lead to COPD earlier in life.

Common symptoms of chronic obstructive pulmonary diseases include cough, phlegm production, shortness of breath and wheezing.

Patients slowly develop symptoms with progressive lung injury over the years. Sometimes a respiratory infection causes rapid deterioration of the patient’s condition, with severe shortness of breath.

A test of the lung function, “spirometry,” helps diagnose COPD. In this test, a patient blows out air into a tube, which is connected to a machine that calculates the rate of airflow and determines whether there is significant obstruction to diagnose COPD.

Your doctor may order a chest X-ray, CT scan of the chest, sputum exam and blood gases to evaluate your lung condition.

Nothing can reverse lung damage or cure this disease. But there is some relief available.

• Smokers who stop in time can prevent further lung damage.

• People can us bronchodilators to help dilate, or open, the airways, and those medications may be helpful.

• Inhaled corticosteroids are medications that may help with airway swelling.

• Antibiotics and corticoseroids are often used in treatment of COPD exacerbations

• Oxygen is helpful for patients who have low oxygen levels in blood and can prolong life.

• Pulmonary rehabilitation programs may help improve quality of life. And lung volume reduction surgery and lung transplantation may be considered in a few patients.

Preventive measures include a pneumonia vaccine and influenza vaccine, which ward off respiratory infections that can be lethal in COPD patients.

Just the work of breathing can be so difficult for some patients that they lose weight and become malnourished especially if they are unable to eat adequately. Eating well and taking supplements may help. And in overweight patients, losing weight by paying attention to diet will help breathing.

We know you have heard this before, but it’s important to repeat: Since COPD is incurable, the best strategy is to prevent this disease by stopping smoking.

This entry was posted on Wednesday, November 12th, 2008 at 11:13 am and is filed under Be Well. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.