A Breath In The Right Direction Fights Symptoms Of COPD

By Jan Howard

Chronic Obstructive Pulmonary Disease (COPD) is the fourth highest cause of death in the United States, following cancer, heart disease, and stroke.

Lisa Mariani of Trumbull, a certified respiratory therapist with St Vincent’s Medical Center in Bridgeport, presented a program, “A Breath in the Right Direction,” on October 2 at St Rose School on chronic bronchitis and emphysema, their symptoms, treatment options, and how to live effectively with COPD. The Parish Nurse Ministry of St Rose of Lima sponsored the program.

COPD affects more men than women, and more men in their 50s than women in their 50s, Ms Mariani said. In all, 16.4 million Americans suffer from either bronchitis or emphysema, or both, she noted. COPD is responsible for $30.9 billion dollars in medical costs.

Asthma, once considered as a chronic pulmonary disease, is no longer included under this category because it is considered reversible.

“Chronic Obstructive Pulmonary Disease comes on gradually and worsens as you get older,” she said.

Ms Mariani explained that the lungs take in oxygen when you inhale fresh air and push out carbon dioxide, a gas produced as waste, when you exhale. With COPD, movement of air into and out of the lungs is limited, and breathing becomes difficult.

The primary role of your lungs is to get oxygen to your blood. “The lungs are the main organ for gas exchange,” she said. When a person has COPD, the normal flow of air is blocked by excess mucus and inflammation in chronic bronchitis or by collapsed airways in emphysema. As a result, a person feels short of breath. He/she may cough, wheeze, or feel weak.

“The obstruction of air flow to the lungs causes decreased oxygen and increased carbon dioxide,” Ms Mariani said.

In healthy lungs, when you breathe, you take air in through your nose or mouth. The air passes through your throat into the trachea and then into the lungs. The diaphragm, a dome-shaped muscle, lies below the lungs and flattens to draw air in as you exhale, then rises as you exhale.

Air passes from the trachea into the bronchial tubes. These tubes branch, like a tree, into smaller and smaller passages, or airways, which are wrapped by bands of muscle. Air travels through these branches, eventually reaching the smallest airways (bronchioles), which end in balloon-like air sacs called alveoli. Blood vessels surrounding the alveoli absorb oxygen into the bloodstream. At the same time, the alveoli remove carbon dioxide from the blood. The carbon dioxide is then exhaled.

 Emphysema

Emphysema destroys the alveoli, making it difficult for the lungs to absorb enough oxygen or expel enough carbon dioxide. The walls of the alveoli lose their elasticity and enlarge. As they enlarge, the diaphragm flattens, making it harder for the lungs to move air in and out. The bronchioles also become less elastic, and narrow or collapse when you exhale. As a result, carbon dioxide gets trapped in the airways and prevents oxygen from getting to the blood.

Emphysema affects 1.8 million Americans, Ms Mariani said.

Smoking is a major cause of emphysema. It creates a chemical imbalance that causes the walls of the alveoli to break down. However, she said, “Not every smoker has lung disease.”

Signs and symptoms of emphysema include shortness of breath, particularly on exercise or exertion, rapid, shallow breathing, and defined muscles in the neck, among others.

Diagnosis includes a pulmonary function test, chest x-ray to check for a flattened diaphragm, and a test for arterial blood levels and carbon dioxide levels. Pulmonary function testing should be repeated each year, Ms Mariani said.

Chronic Bronchitis

Chronic bronchitis is diagnosed when you cough up mucus and feel short of breath three months or more each year for at least two years. These symptoms occur when the lining of the bronchioles becomes inflamed and produces too much mucus. The swelling and excess mucus narrow the airways and restrict airflow into and out of the lungs, causing shortness of breath. The cilia are also damaged, so they are unable to remove the excess mucus.

Chronic bronchitis is long term, Ms Mariani said, with constant inflammation of the air passageway, an over production of mucus, and chronic cough. “Air can’t get in and out,” she said.

Chronic bronchitis is caused mostly by smoking or through exposure to air pollution, Ms Mariani said.

Treatment is through the use of broncho-dilators, which make breathing easier for up to six hours, or rescue medications that open up airways immediately. They can bring relief from three to eight hours. Other medications might include steroids that reduce inflammation, decrease effects of irritants, and cut down on mucus production; antibiotics to combat infection; and oxygen. Anti-inflammatories also may be used to reduce inflammation and swelling in airways.

Preventive Management

To manage COPD, Ms Mariani said to quit smoking; reduce exposure to environmental hazards, such as using a mask when using cleaning products; get a flu vaccination; reduce weight; treat symptoms early; and use inhalers or other respiratory devices properly.

COPD patients should control their breathing through two breathing techniques, pursed-lip breathing and diaphragmatic breathing; cough up mucus; exercise regularly; and eat a well balanced diet to feel better.

“Rely on your symptoms,” Ms Mariani said, to help you cope with COPD.