What is Chronic Obstructive Pulmonary Disease

COPD (Chronic Obstructive Pulmonary Disease) is a chronic disease of the lung that covers several conditions including Chronic Bronchitis or Emphysema.

Chronic Bronchitis results from an inflammation of the airways of the lung. The term chronic refers to the fact that the condition is present for a long time and bronchitis means inflammation of the bronchi or air passages of the lung. You can find the anatomy of the lung on any well-researched website, but I will give a brief summary here.

The air passages begin with the trachea in the neck which branches into the left and right main stem bronchi. These bronchi continue to branch into smaller bronchi or bronchioles until they end up in the microscopic air sacs or alveoli. It is the alveoli that oxygen and carbon dioxide are exchanged with a rich network of small blood vessels or capillaries. The bronchioles and bronchi are responsible for delivering the oxygen to the alveoli and for carrying the carbon dioxide from the alveoli to the outside. These air passages are more than just tubes — the linings are composed of cells and structures that serve many functions for lubricating the airways and removing debris from the airways. These cells can be damaged by infections or toxins like inhaled poisons or smoking. When these cells are irritated by various stimuli, they form mucus which can plug up the airways and make air movement difficult. In addition, the airways have muscles in the walls and these muscles will contract or dilate the airway depending on what kind of pressure is placed on them.

When we breathe in, our diaphragmas act like an accordion and pull air into the airways. When we breathe out, we squeeze our chests and the airways by pushing our diaphragms up to force the air out. This pressure to force the air out causes the bronchi to become narrow and slows down the speed of the air escaping from the lungs. If the airways are already partially blocked by mucus, or if the muscles are contracting due to irritation, the air cannot escape from the lungs as well, and we feel short of breath or you will hear a wheezing sound as the air tries to escape through narrow tubes.

Emphysema, on the other hand is a disease of the alveoli or air sacs, where the lining of the sacs become destroyed by specific enzymes or infections, and the small air sacs become larger and larger as the walls or membranes between them become destroyed. They tend to lose their elasticity and are unable to squeeze the air out of them as effectively. In addition, the walls or membranes contain the capillaries or small blood vessels that carry the oxygen to the tissues and remove the carbon dioxide from the tissues, so air exchange becomes compromised and we feel short of breath, because not enough oxygen is being delivered to our tissues. In severe cases we can actually see our fingernails turn blue from lack of sufficient oxygen. When there is not enough oxygen in the blood, the blood becomes dark or blue, like in our veins. When there is enough oxygen in the blood the blood becomes a bright red, like in the arteries.

Chronic Obstructive Pulmonary Disease or COPD is a combination of Chronic Bronchitis and Emphysema. The treatment is therefore three fold.

* Remove the toxins from the lungs. This is done by avoiding irritants like smoke, perfumes, dust, or allergens from the environment. In addition, direct toxins like cigarette, cigar or pipe tobacco smoke should be immediately discontinued.

* Treat the constriction of the airways with medicines that can open up the airways. These are called bronchodilators and are usually in inhalers or nebulizers, but can also be in cough medicine, or pills.

* Treat the inflammation of the airways with inhaled anti-inflammatory medications, or by pills or injections. These medications are derivatives of cortisone. Frequently in severe episodes you will be treated with doses of Prednisone tablets for short period of time, or injections of cortisone.

The treatment of COPD is therefore a combination of bronchodilators and cortisone as well as discontinuing smoking, treating any infections and avoiding an environment of smoke.

The prognosis varies depending on the severity of the condition, and this can be determined by doing pulmonary function tests to see how well you can breathe. A simple test that can be done in the office is the PEFR (Peak Expiratory Flow Rate). This is a simple flow meter that patients with COPD can obtain from the pharmacy to test the amount of airway restriction that is present. A more detailed test can be done by a pulmonary specialist, which we do have here in Nassau.

If caught early enough, like any other disease, the prognosis is excellent. I have seen patients with severe COPD who require oxygen all the time, still smoke even with the oxygen being administered. Those are extreme cases but, as you can see, the prognosis can vary widely depending on the severity of the disease and the compliance of the patient with prescribed treatment.

P.S. boost your asthma immunity by eating Vitamin C and Vitamin D rich foods and fruits.

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H1N1, asthma can be a dire combination in children

The day before Halloween, T.J. Berndsen had what his parents believed was a little asthma flare-up. By Halloween night, he felt lousy enough to cut trick-or-treating short.

A week later, the 9-year-old was straining to breathe in the emergency room at Cincinnati Children's Hospital Medical Center because of complications from an H1N1 influenza infection.

"By Sunday, Nov. 8, his cough turned into a croupy bark, and he started running a fever. It got to 102.9. I knew it had gotten to be more than we could handle at home," says his mother, Jennifer Berndsen. She had suspected flu but wasn't sure. His school had had significant numbers of children out, but his classroom hadn't seemed to be hit hard, she says.

While H1N1's effects in a healthy child can range anywhere from mild congestion and sore throat to serious respiratory illness, and even death, the 7 million American kids who have asthma are at a higher risk for complications and death if they contract the novel flu virus, says Tom Skinner of the Centers for Disease Control and Prevention.

"We're seeing underlying health problems, including asthma, in about two-thirds of the estimated 540 children who have died from H1N1 complications," he says.

But the CDC and pediatric asthma experts say there are steps you can take to prevent H1N1, or swine flu, as well as seasonal flu, and ways to treat it if an infection does occur.

Prevention is best

"In children with asthma, the key issue is anticipation rather than reacting," says Erwin Gelfand, chair of pediatrics at National Jewish Health in Denver, a hospital that specializes in treating children with respiratory conditions.

Gelfand says a parent can ensure two things: vaccination and making sure a child's asthma is in control.

The advice goes even for children who get asthma only intermittently, says Tyra Bryant-Stephens, medical director of the Community Asthma Prevention Program at Children's Hospital of Philadelphia.

"Children who only get asthma during exercise, with a cold, or during allergy season can also have serious complications from flu," Bryant-Stephens says.

T.J.'s parents gave him what asthma experts call "maintenance medications" every day: an oral Zyrtec (cetirizine) for allergies and the inhaled corticosteroid Flovent (fluticasone), which reduces inflammation in the lungs. They knew he needed the H1N1 vaccine, says T.J.'s mom, but it hadn't become available in their area yet.

Unlike T.J., many asthmatic children do not take medications as prescribed, sometimes because of cost or parental concerns about side effects, Gelfand says.

"I'd say to any parent, this is not a time to relax compliance. The drugs we have for asthma are as a rule not effective if taken on an intermittent basis, except in possibly the mildest of cases," Gelfand says.

As for vaccines, the CDC recommends that children with breathing issues get the shot form of the vaccine – two doses spread out by a month in those under age 9 – instead of the nasal mist.

If a child does get flulike symptoms, there are steps caregivers should take, says Carolyn Kercsmar, director of the Asthma Center at Cincinnati Children's.

She says if a child develops a fever, is feeling poorly, has chest pain, a bad cough or extreme fatigue, see a doctor right away.

Rough night, quick comeback

T.J.'s parents took the correct steps, Kercsmar says. After additional home albuterol treatments didn't budge his symptoms, they scooted fast to the pediatrician, who sent him on to the ER. There, Jennifer Berndsen says, "they did three back-to-back albuterol treatments – continuous for about an hour. He was so sick by then, poor thing."

He then received a cornucopia of drugs: Motrin to help reduce fever, antibiotics for atypical pneumonia that a chest X-ray revealed, and an intravenous line of magnesium sulfate to help further open up his airways. They dosed him with the steroid prednisone to simmer down inflammation, and he received pure oxygen through a nose mask, Berndsen says.

After he was moved to a room well after midnight and an H1N1 swab came up positive, he was given Tamiflu (oseltamivir).

"These are the children who can benefit from starting Tamiflu right away. It can turn a very nasty disease into one that's tolerable," says Kercsmar, who adds that it works best started within 48 hours, but even within 72 hours can help.

Berndsen reports that though her son's night in the hospital was rough, the turnaround was fast.

"By noon the next day, Tuesday, Nov. 10, T.J. was feeling well enough to eat a chili dog and a pretzel with cheese," she says. He went home that night.


P.S. Boost your immune system by eating Vitamin C and Vitamin D rich foods and fruits.



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Children with asthma more vulnerable to H1N1 virus

Secretary of Health Kathleen Sebelius met with students and their parents at Thurgood Marshall Elementary, one of 16 schools in Philadelphia that partners with the Merck Childhood Asthma Network, Inc. (MCAN). The program works to help students better manage their asthma. She talked about the importance of education and creating healthy habits to avoid missing school.

"Nothing is more important than keeping our children healthy, in school and ready to learn as we start the new school year," said Dr. Floyd Malveaux, Executive Director of MCAN and former Dean of the College of Medicine at Howard University. "We applaud Secretary Sebelius for recognizing that staying healthy can be a challenge for students with asthma – a factor that is even further complicated with the possibility of being exposed to the H1N1 virus, which can increase the severity of asthma symptoms, leading to possible hospitalizations."

During the meeting, Secretary Sebelius highlighted the work of the Philadelphia MCAN project as a model for inner-city childhood asthma management. Launched in 2005, the Philadelphia MCAN project has improved asthma outcomes for children and reduced school absenteeism by using a community-based approach that integrates families, community agencies, schools and health care providers to implement scientifically proven asthma interventions.

The Philadelphia program brings hope into communities that shoulder a disproportionate share of the childhood asthma burden. Screening conducted with the Philadelphia MCAN project in partnership with The School District of Philadelphia found that one out of four students in the West, Southwest, Olney, Logan and Germantown communities – target communities for the program – have been diagnosed with asthma or have been admitted to the hospital for wheezing, compared to one out of ten nationwide. The Philadelphia program provides children with asthma and their families access to three key services: Community Asthma Prevention Program (CAPP) classes that educate parents, other caretakers and children with asthma; CAPP home visits where community health workers help families eliminate or control allergens and irritants within the home; and Health Promotion Council (HPC) Link Line services that connect families to asthma care coordinators.

"The unique structure of our program allows us to bring multiple stakeholders to the table to create a successful team that can get children to care and services for better long-term and immediate asthma management," said Dr. Michael Rosenthal of Thomas Jefferson University and co-lead investigator of the Philadelphia MCAN program. "By collaborating with specific schools to identify children that have asthma, the Philadelphia MCAN project has armed school nurses with essential information to assist students who are at higher risk for complications with H1N1 and seasonal flu virus, allowing them to be better prepared to manage these children at school."

Nationally, MCAN, a non-profit organization funded by the Merck Company Foundation, provides funding to four other local programs that target low-income, urban populations with high rates of pediatric asthma in Chicago, Los Angeles, New York and Puerto Rico. The goal is to evaluate the effectiveness of these programs and use the findings to develop model programs that can be replicated and tailored in communities across the country.

"The Philadelphia MCAN program has shown that we can help children manage their asthma and that means improved quality of life, significantly fewer trips to the ER or stays in the hospital, and best of all, more days in school," said Dr. Tyra Bryant-Stephens from The Children's Hospital of Philadelphia and co-lead investigator of the Philadelphia MCAN project. "Empowering caregivers and children with this knowledge has helped to greatly decrease the school days missed by children in Philadelphia, a segment of the nearly 13 million schools days missed each year by the millions of children nationwide that have been diagnosed with asthma."

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