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CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Chronic obstructive pulmonary disease (COPD) is the name given to a of group of lung diseases in which airflow from the lungs is obstructed. Lung diseases such as asthma, chronic bronchitis, and emphysema are included in this category. COPD causes damage to your lungs that cannot be reversed. Usually COPD is some combination of two of these entities (ie emphysema + chronic bronchitis).

Symptoms of COPD can include a persistent cough that may or may not produce mucus, wheezing, shortness of breath, weight loss, and frequent lung infections. You may also notice swelling of the legs or ankles and more rapid breathing than is normal for you.

COPD is diagnosed with a physical exam by your physician and pulmonary function tests. Chest x-rays are notoriously inaccurate in diagnosing COPD. Your physician may also order blood tests, electrocardiograms, CT scans, or lab tests of your sputum. If COPD is not treated, or progresses, it can cause strain and enlarge your heart, (cor pulmonale) and increase blood pressure in your lungs (pulmonary hypertension).

Treatment aims are to relieve symptoms and to prevent your condition from getting worse. Medications that relax and open the airways, called bronchodilators, are usually prescribed. Other medications used include inhaled or oral steroids to decrease inflammation, antibiotics to treat bacterial infections, and medicines called expectorants that loosen the mucus and allow you to cough it up. You may be prescribed breathing treatments with a nebulizer or a medicine called a diuretic, to rid your body of extra fluid. Lastly, the most important treatment must be cessation of cigarette smoking.

For more information about COPD, check the following web sites:

http://www.copd-support.com, or http://www.nhlbi.nih.gov

ASTHMA

Asthma is a chronic lung condition that causes wheezing, coughing, and shortness of breath. It is caused by inflammation (swelling) of the lining of the airways in your lungs. When you have asthma, the airways in your lungs are more easily irritated, even when you don’t have any symptoms. When your airways are exposed to irritants or allergens, the airways become more swollen and make more mucus. The tiny muscles in the walls of the airways contract, causing the airway openings to become smaller, and making it harder for air to more in and out of your lungs. Wheezing is the sound of air moving through the narrowed air passages. The extra mucus in the airways causes coughing. Allergies are often associated with, but not necessary for the diagnosis of asthma.

Symptoms of asthma are wheezing, cough, shortness of breath, and chest tightness. A single attach of wheezing does not mean you have asthma. Some infections and chemicals can cause temporary wheezing that does not recur.

Your physician will ask about your history of breathing problems, give you a physical exam, and perform breathing tests. If your examination and breathing tests are normal, the physician may order a test called a methacholine challenge. This is a very specific test used to diagnose asthma. Pulmonary function tests are performed. You will then breathe in a dilute solution of the chemical, methacholine. If there is no change in your breathing tests, a slightly more concentrated solution of methacholine is inhaled, and pulmonary function tests are again repeated. This sequence is repeated up to 5 times, each time with a more concentrated methacholine solution. If you become short of breath, or have a change in your pulmonary function tests, the test is stopped. A breathing treatment is given after the test to relieve any shortness of breath you may feel. Methacholine will not cause any type of a reaction in those without asthma.

The goals of asthma treatment are to allow you to live a normal, active life, and to prevent attacks. There are several types of medications available to treat asthma that can be divided into two basic categories. Quick-acting, or rescue medications, and stabilization medications. Preventive medicine is designed to prevent asthma attacks and the chronic symptoms associated with asthma. Generally this includes a long-acting bronchodilator and inhaled steroids. Your physician may also prescribe other medications to control allergy symptoms that may contribute to your asthma. Quick-acting bronchodilators are designed to relax the muscles in the airways. This allows the airways to become larger, so there is more room for air to move in and out of the lungs. This type of medication should be used when you first have symptoms. If you have asthma attacks often, you should keep an inhaler with you.

Asthma can be a life-threatening condition. If your medicines do not seem to be working to keep you breathing comfortably, contact your health care provider. If you are having an asthma attack and your rescue inhaler is not relieving your symptoms, get medical care right away. This may mean going to the emergency room or calling 911. Newer medications to prevent asthma “attacks” include the medications Singulair and Accolate as well as the novel, injectable medicine Xolair. See the “what’s new” section in this website. Singulair has been approved to treat allergic symptoms as well as asthma.

For more information about asthma, check the following web sites:

http://pulmonarychannel.com, http://www.nhlbi.nih.gov, or http://www.aafa.org

CHRONIC BRONCHITIS

Bronchitis is swelling and irritation of the larger airways (bronchi), that connect the windpipe to the lungs. Chronic means the symptoms occur year after year for months at a time.

Chronic bronchitis can be caused by cigarette smoking, repeated exposure to other irritants such as dust, chemicals, or other pollutants, or frequent bacterial infections of the upper respiratory system. After coming into contact with the irritant, the airways swell and produce mucus. When the airways swell, the air passages become narrower and partially blocked by the mucus, making it hard for air to pass in and out of your lungs. This can cause wheezing and trouble breathing.

Symptoms of chronic bronchitis may include a deep cough, which produces a lot of mucus every day for weeks or months, frequent lung infections, or wheezing and shortness of breath.

Treatment may include medication that relaxes and opens the airways. This medication may be provided by inhalers or with inhaled medication administered through a nebulizer. Antibiotics may be prescribed to treat bacterial infections. Regular checkups with your physician are recommended to prevent complications.

EMPHYSEMA

Emphysema is a chronic disease that gradually enlarges and destroys the air sacs in your lungs. When the air sacs are damaged, the oxygen you breathe cannot be absorbed into your bloodstream easily. It becomes harder to breathe out carbon dioxide, as well. Carbon dioxide becomes trapped in the air sacs, leaving less room for oxygen to be breathed in. The lungs become hyperinflated, or very large. This is extremely uncomfortable creating shortness of breath.

Cigarette smoking is the main cause of emphysema. An inherited disorder called alpha-1 antitrypsin deficiency can also cause emphysema. The main symptom of emphysema is shortness of breath, however, you may also have wheezing and coughing. Early in the disease, you may not have any physical symptoms, and x-rays and lab tests may be normal. Symptoms first occur with exercise or exertion, but as the disease progresses, shortness of breath will increase with minimal exertion and daily activities. In generally, symptoms of shortness of breath develop when the lung function deteriorates to approximately 50% of normal or less.

Your doctor will use a variety of tests to determine if you have emphysema. He will take an extensive medical history, examine your heart and lungs, and check pulmonary function tests and x-rays. Your physician may also order blood tests. The diagnosis is oftentimes made by a combination of pulmonary function abnormalities and CT scanning.

There is no cure for emphysema, but treatment can help control the disease. The goals of treatment are to relieve the symptoms and keep you as active as possible, and to avoid things that make emphysema worse, such as smoking and lung infections.

Medications such as bronchodilators, (open the airways), and steroids, (decrease inflammation) are used for symptom control. You may be prescribed medication to use in a nebulizer to help keep your airways open. It is possible that you will need oxygen at some point.

New surgical procedures for emphysema can be found in the “what’s new” section of this website.

The most important part of treatment is to stop smoking. Check with your physician to see if it might be helpful to join a stop-smoking program, or if he advises using nicotine patches or gum. Prescription medication is also available to help you be successful in your decision to stop smoking. With cigarette smoking cessation, the lung function stabilies. This means that no matter how severe your disease is, quit smoking and it will not get any worse.

For more information about emphysema, check the following web sites:

http://www.lungusa.org, http://www.nhlbi.nih.gov , or http://emphysemafoundation.org