Loss of breath troubles many
We’ve all had the experience of running out of breath. What if that feeling came on just trying to get up to go to the bathroom? What if you couldn’t sleep, simply because you couldn’t catch your breath? Unfortunately, that’s the experience of many patients who come to the hospital with Chronic Obstructive Pulmonary Disease, or COPD.
COPD is a common condition, affecting up to one out of 13 people in the US. Most of these people have not been formally diagnosed. A simple breathing test in your doctor’s office can detect it. COPD includes the diagnoses of Chronic Bronchitis and Emphysema and is the 4th leading cause of death in the U.S.
The misery and disability COPD causes is substantial. The leading cause is cigarette smoking, although secondhand smoke and chronic dust exposure (mining, farming) can also cause it.
COPD results from destruction of lung tissue and increased mucous production, causing great difficulty expelling air. This leads to difficulty breathing and low oxygen levels. People become short of breath doing minimal activity, are fatigued, and are more susceptible to lung infections.
Quality of life suffers as the amount of activity one can do becomes more restricted. Oxygen often becomes necessary, and hospital visits become frequent. Minimal exertion can make you feel like you are drowning, causing a great deal of fear and anxiety.
We are all born with a certain amount of lung tissue, and past childhood, we make no more lung tissue. Every one of us, smoking or not, loses a small amount of lung function every year. This irreversible decline eventually causes problems.
Most people have enough lung tissue to live long lives without problems. People who smoke lose more of their lung function per year than those who do not.
This can lead to problems developing at 50 years of age, instead of 100. Quitting smoking slows the decline to the pace of someone who has never smoked. The lung tissue that is lost is not regained, however. This is why it is important to quit smoking early on in life, because quitting smoking then has a tremendous benefit. Quitting smoking is always beneficial, but less so over time.
COPD treatment begins with smoking cessation and avoidance of known triggers such as dust or pollutants. It also includes vaccination against pneumococcus (a type of bacteria that causes pneumonia) every five years and influenza yearly.
Medications include Albuterol, Salmeterol (Serevent), Formoterol (Foradil), Ipratropium (Atrovent), Tiotropium (Spiriva), and Theophylline (Theodur). All but the last are inhaled medications. Tiotropium seems to have a benefit over many other drugs in the treatment of COPD, and it is dosed once daily. Tiotropium and Ipratropium should not be used together. Steroids such as Prednisone can be used for attacks of COPD, and antibiotics are used when bacterial triggers are present. Inhaled steroids such as Advair and Flovent are sometimes used in COPD. Oxygen is frequently necessary and is in fact the only medication that has been shown to prolong life in COPD.
Oxygen is prescribed when oxygen levels in the blood fall below 88 percent. While COPD is not the only medical condition that causes a need for oxygen, the following advice applies to all medical conditions where oxygen is necessary.
Blood vessels in the lungs constrict when oxygen levels are low. When blood vessels constrict, the pressure inside them rises. The right side of the heart pumps blood to the lungs, and normally works at low pressure. It is not designed to work at high pressures. High right-sided pressures cause shortness of breath, leg swelling, blood clots, and can cause sudden death.
Oxygen causes the blood vessels in the lungs to dilate, reducing the pressure placed on the right side of the heart, prolonging life. Unfortunately, one cannot simply take a breath of oxygen and have it last all day – it needs to be continuously administered. If you need oxygen, ideally you should wear it all of the time. The less you wear it, the less benefit.
Pulmonary rehabilitation classes increase quality of life for patients with COPD. Your doctor can refer you to Sierra Nevada Memorial Hospital’s Pulmonary Rehabilitation program, but you must quit smoking to be eligible. A referral to a Pulmonologist can be helpful for the care of patients with COPD, and your doctor can refer you to one if necessary. Other treatments such as lung surgery, lung transplantation, transtracheal oxygen, and assisted ventilation are available but require careful patient selection.
Quitting smoking now – today – is the single best thing you can do for your overall health and to reduce your chances of developing COPD. If you have COPD, quitting smoking now will help you live longer and better.
Dr. Nicholas Browning is a hospitalist at Sierra Nevada Memorial Hospital.
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