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Chronic Obstructive Pulmonary Disease

more about Chronic Obstructive Pulmonary Disease


Emphysema or COPD

  • Air is brought into the lungs when the muscles of the diaphragm and chest descend outward and downward. This creates a vacuum effect, causing the lungs to expand and take in air. Air is expelled from the lungs because the lung tissue is elastic and it relaxes -- similar to the way a rubber band "snaps back" to normal size after being released. In Emphysema, the tissue in the lung that makes it elastic is damaged. Thus, once air is brought into the lungs, it is very difficult to expel the "old air" because the lungs do not "snap back" after being expanded.
  • The most common cause of this damage is cigarette smoking. There is also a rare syndrome called Alpha-1 antiproteinase deficiency. It is a genetic disease in which an enzyme needed by the lungs is not being made. It results in Emphysema at an early age (30s), especially in smokers.

  • Shortness of breath -- initially on exertion

  • Cigarette smoking
  • Alpha --1 antiproteinase deficiency

  • Examination 

- Decreased breath sounds in the lungs

  • Blood count may show polycythemia
  • Arterial blood gas shows decreased oxygenation and respiratory acidosis -- usually present in advanced disease only
  • Spirometry shows obstruction (decreased flow volume, i.e. FEV1 and FEV1/FVC ratio)
  • Chest X-Ray may show hyperinflation or lung blebs

    1. Atrovent inhaler
    2. Albuterol or serevent inhalers
    3. Oral theophylline
    4. Oral corticosteroids if severe
  • Oxygen given by nasal prongs may be needed
  • Special exercise programs
  • CPAP machines -- provide continuous airway pressures.  Usually used during sleep.
  • Alpha --1 antiproteinase inhibitor for those with the rare syndrome listed above
  • Lung transplantation may be a consideration
  • Removal of lung bulla (blebs) should be considered, and now can be done with laser surgery.

  • Cor pulmonale -- also known as right Heart Failure.  Since the lungs are damaged, it is difficult for the right side of the heart to pump blood through them.  Over time, the right side of the heart becomes overworked and damaged.  Common symptoms include leg swelling and swelling of the abdomen with fluid.

  • Spontaneous Pneumothorax -- commonly known as a collapsed lung.  The blebs that sometimes form in emphysema can "pop", resulting in a Collapsed Lung.  This can be a life-threatening emergency.


  • Avoid or Quit Smoking. The medication Zyban has been very effective in helping people quit. Any smoking cessation plan or program should be considered. Other options include Nicotine patches and hypnosis.




more about Chronic Obstructive Pulmonary Disease


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