COPD
Overview
Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases. It makes it difficult to breathe. There are two main forms of COPD:
· Chronic bronchitis, defined by a long-term cough with mucus
· Emphysema, defined by destruction of the lungs over time
Most people with COPD have a combination of both conditions.
Alternative Names
COPD; Chronic obstructive airways disease; Chronic obstructive lung disease; Chronic bronchitis; Emphysema; Bronchitis – chronic
Causes
Smoking is the leading cause of COPD. The more a person smokes, the more likely that person will develop COPD although some people smoke for years and never get COPD.
In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema.
Other risk factors for COPD are:
· Exposure to certain gases or fumes in the workplace
· Exposure to heavy amounts of secondhand smoke and pollution
· Frequent use of cooking gas without proper ventilation
Symptoms
· Cough with mucus
· Shortness of breath (dyspnea) that gets worse with mild activity
· Fatigue
· Frequent respiratory infections
· Wheezing
Since the symptoms of COPD develop slowly, some people may be unaware that they are sick.
Tests & diagnosis
The best test for COPD is a simple lung function test called spirometry. This involves blowing out as hard as one can into a small machine that tests lung capacity. The test can be interpreted immediately and does not involve exercising, drawing blood, or exposure to radiation.
Using a stethoscope to listen to the lungs can also be helpful, although sometimes the lungs sound normal even when COPD is present.
Pictures of the lungs (such as X-rays and CT scans) can be helpful but sometimes look normal even when a person has COPD.
Sometimes it is necessary to do a blood test (call a “blood gas”) to measure the amounts of oxygen and carbon dioxide in the blood.
Treatment
There is no cure for COPD. However, there are many things you can do to relieve symptoms and keep the disease from getting worse.
Persons with COPD must stop smoking. This is the best way to slow down the lung damage.
Medications used to treat COPD include:
· Inhalers (bronchodilators) to open the airways, such as ipratropium (Atrovent), tiotropium (Spiriva), salmeterol (Serevent), or formoterol (Foradil)
· Inhaled steroids to reduce lung inflammation
In severe cases or during flare-ups, you may need to receive steroids by mouth or through a vein (intravenously).
Antibiotics are prescribed during symptom flare ups, because infections can make COPD worse.
Oxygen therapy at home may be needed if a person has a low level of oxygen in their blood. Pulmonary rehabilitation does not cure the lung disease, but it can teach you to breathe in a different way so you can stay active. Exercise programs such as pulmonary rehabilitation are also important to help maintain muscle strength in the legs so less demand is placed on the lungs when walking. These programs also teach people how to use their medicines most effectively.
Things you can do to make it easier for yourself around the home include:
· Avoiding very cold air
· Making sure no one smokes in your home
· Reducing air pollution by eliminating fireplace smoke and other irritants
Eat a healthy diet with fish, poultry, or lean meat, as well as fruits and vegetables. If it is hard to keep your weight up, talk to a doctor or dietitian about getting foods with more calories.
Surgical treatments may include:
· Surgery to remove parts of the diseased lung, for some patients with emphysema
· Lung transplant for severe cases
Prognosis
This condition is a long-term (chronic) illness. The disease will get worse more quickly if one continues to smoke.
Patients with severe COPD will be short of breath with most activities and will be admitted to the hospital more often. These patients should talk with their doctor about the use of breathing machines and end-of-life care.
Complications
· Irregular heart beats (arrhythmias)
· Need for breathing machine and oxygen therapy
· Right-sided heart failure or cor pulmonale (heart swelling and heart failure due to chronic lung disease)
· Pneumonia
· Pneumothorax
· Severe weight loss and malnutrition
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EMPHYSEMA
Emphysema is a factor in the progression of chronic obstructive pulmonary disease (COPD), a condition that limits the flow of air when you breathe out. Emphysema occurs when the air sacs at the ends of your smallest air passages (bronchioles) are gradually destroyed. Smoking is the leading cause of emphysema.
As it worsens, emphysema turns the spherical air sacs — clustered like bunches of grapes — into large, irregular pockets with gaping holes in their inner walls. This reduces the number of air sacs and keeps some of the oxygen entering your lungs from reaching your bloodstream. In addition, the elastic fibers that hold open the small airways leading to the air sacs are slowly destroyed, so that they collapse when you breathe out, not letting the air in your lungs escape.
Airway obstruction, another feature of COPD, contributes to emphysema. The combination of emphysema and obstructed airways makes breathing increasingly difficult. Treatment often slows, but doesn't reverse, the process.
SYMPTOMS:
Emphysema symptoms are mild to begin with but steadily get worse as the disease progresses. The main emphysema symptoms are:
§ Shortness of breath
§ Wheezing
§ Chest tightness
§ Reduced capacity for physical activity
§ Chronic coughing, which could also indicate chronic bronchitis
§ Loss of appetite and weight
§ Fatigue
CAUSES:
§ Smoking. Cigarette smoke is by far the most common cause of emphysema. There are more than 4,000 chemicals in tobacco smoke, including secondhand smoke. These chemical irritants slowly destroy the small peripheral airways, the elastic air sacs and their supporting elastic fibers.
§ Protein deficiency. Approximately 1 to 2 percent of people with emphysema have an inherited deficiency of a protein called AAt, which protects the elastic structures in the lungs. Without this protein, enzymes can cause progressive lung damage, eventually resulting in emphysema. If you're a smoker with a lack of AAt, emphysema can begin in your 30s and 40s. The progression and severity of the disease are greatly accelerated by smoking.
Treatments and drugs
Emphysema can't be cured, but treatments can help relieve symptoms and slow the progression of the disease.
Medications
Smoking cessation drugs. Prescription medications, such as bupropion hydrochloride (Zyban) and varenicline (Chantix), can help you quit smoking.
Bronchodilators. These drugs can help relieve coughing, shortness of breath and trouble breathing by relaxing constricted airways, but they're not as effective in treating emphysema as they are in treating asthma or chronic bronchitis.
Inhaled steroids. Corticosteroid drugs inhaled as aerosol sprays may help relieve shortness of breath. But prolonged use can weaken your bones and increase your risk of high blood pressure, cataracts and diabetes.
Antibiotics. If you develop a bacterial infection, like acute bronchitis or pneumonia, antibiotics are appropriate.
Therapy
Pulmonary rehabilitation. A pulmonary rehabilitation program can teach you breathing exercises and techniques that may help reduce your breathlessness and improve your ability to exercise. You'll also receive advice about proper nutrition. In the early stages of emphysema, many people need to lose weight, while people with late-stage emphysema often need to gain weight.
Supplemental oxygen. If you have severe emphysema with low blood oxygen levels, using oxygen regularly at home and when you exercise may provide some relief. Many people use oxygen 24 hours a day. It's usually administered via narrow tubing that fits into your nostrils.
Surgery
Depending on the severity of your emphysema, your doctor may suggest one or more different types of surgery, including:
Lung volume reduction. In this procedure, surgeons remove small wedges of damaged lung tissue. Removing the diseased tissue helps the remaining lung tissue work more efficiently and helps improve breathing.
Lung transplant. Lung transplantation is an option if you have severe emphysema and other options have failed.
PROGNOSIS
Emphysema is a disease that affects quality of life and not necessarily the quantity of life. The goal for treatment of emphysema is to prevent further lung damage, and to maximize the function of the remaining healthy lung tissue.
Symptoms of emphysema occur because the body is not being supplied with adequate oxygen, and because it takes significant effort to take deeper breaths. These both contribute to the very miserable sensation of constantly feeling short of breath.
BRONCHITIS
OverviewBronchitis is inflammation of the main air passages to the lungs. Bronchitis may be short-lived (acute) or chronic, meaning that it lasts a long time and often recurs.
See also: Chronic obstructive pulmonary disease (COPD)
Alternative Names
Inflammation - bronchi; Acute bronchitis
Causes
Acute bronchitis generally follows a viral respiratory infection. At first, it affects your nose, sinuses, and throat and then spreads to the lungs. Sometimes, you may get another (secondary) bacterial infection in the airways.This means that bacteria infect the airways, in addition to the virus.
People at risk for acute bronchitis include:
· The elderly, infants, and young children
· Persons with heart or lung disease
· Smokers
Chronic bronchitis is a long-term condition. People have a cough that produces excessive mucus. To be diagnosed with chronic bronchitis, you must have a cough with mucus most days of the month for at least 3 months.
Chronic bronchitis is one type of chronic obstructive pulmonary disease, or COPD for short. (Emphysema is another type of COPD.)
The following things can make bronchitis worse:
· Air pollution
· Allergies
· Certain occupations (such as coal mining, textile manufacturing, or grain handling)
· Infections
Symptoms
The symptoms of either type of bronchitis may include:
· Chest discomfort
· Cough that produces mucus; if it's yellow-green, you are more likely to have a bacterial infection
· Fatigue
· Fever -- usually low
· Shortness of breath worsened by exertion or mild activity
· Wheezing
Even after acute bronchitis has cleared, you may have a dry, nagging cough that lingers for several weeks.
Additional symptoms of chronic bronchitis include:
· Ankle, feet, and leg swelling
· Blue-colored lips from low levels of oxygen
· Frequent respiratory infections (such as colds or the flu)
Treatment
You DO NOT need antibiotics for acute bronchitis caused by a virus. The infection will generally go away on its own within 1 week. Take the following steps for some relief:
· Do not smoke
· Drink plenty of fluids
· Rest
· Take aspirin or acetaminophen (Tylenol) if you have a fever. DO NOT give aspirin to children
· Use a humidifier or steam in the bathroom
If your symptoms do not improve, your doctor may prescribe an inhaler to open your airways if you are wheezing. If your doctor thinks that you have a secondary bacterial infection, antibiotics may be prescribed. Most of the time, antibiotics are not needed or recommended.
For any bronchitis, the most important step you can take is to QUIT smoking. If bronchitis is caught early enough, you can prevent the damage to your lungs.
Prognosis
For acute bronchitis, symptoms usually go away within 7 to 10 days if you do not have an underlying lung disorder. However, a dry, hacking cough can linger for a number of months.
The chance for recovery is poor for persons with advanced chronic bronchitis. Early recognition and treatment, combined with smoking cessation, significantly improve the chance of a good outcome.
Complications
Pneumonia can develop from either acute or chronic bronchitis. If you have chronic bronchitis, you are more likely to develop recurrent respiratory infections. You may also develop:
· Emphysema
· Right-sided heart failure or cor pulmonale
· Pulmonary hypertension
ASTHMA
OverviewAsthma is an inflammatory disorder of the airways, which causes attacks of wheezing, shortness of breath, chest tightness, and coughing.
Causes
Asthma is caused by inflammation in the airways. When an asthma attack occurs, the muscles surrounding the airways become tight and the lining of the air passages swell. This reduces the amount of air that can pass by, and can lead to wheezing sounds.
Most people with asthma have wheezing attacks separated by symptom-free periods. Some patients have long-term shortness of breath with episodes of increased shortness of breath. In others, a cough may be the main symptom. Asthma attacks can last minutes to days and can become dangerous if the airflow becomes severely restricted.
In sensitive individuals, asthma symptoms can be triggered by breathing in allergy-causing substances (called allergens or triggers).
Common asthma triggers include:
· Animals (pet hair or dander)
· Dust
· Changes in weather (most often cold weather)
· Chemicals in the air or in food
· Exercise
· Mold
· Pollen
· Respiratory infections, such as the common cold
· Strong emotions (stress)
· Tobacco smoke
Symptoms
· Cough with or without sputum (phlegm) production
· Pulling in of the skin between the ribs when breathing (intercostal retractions)
· Shortness of breath that gets worse with exercise or activity
· Wheezing
o Comes in episodes
o May be worse at night or in early morning
o May go away on its own
o Gets better when using drugs that open the airways (bronchodilators)
o Gets worse when breathing in cold air
o Gets worse with exercise
o Gets worse with heartburn (reflux)
o Usually begins suddenly
Treatment
The goal of treatment is to avoid the substances that trigger your symptoms and to control airway inflammation. You and your doctor should work together as a team to develop and carry out a plan for eliminating asthma triggers and monitoring symptoms.
There are two basic kinds of medication for the treatment of asthma:
· Long-acting medications to prevent attacks
· Quick-relief medications for use during attacks
Long-term control medications are used on a regular basis to prevent attacks, not to treat them. Such medicines include:
· Inhaled corticosteroids (such as Azmacort, Vanceril, AeroBid, Flovent) prevent inflammation