A Simple Guide to Chronic Obstructive Lung Disease

A Simple Guide to Chronic Obstructive Lung Disease
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What is Chronic Obstructive Lung Disease?
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Chronic Obstructive Lung Disease (COLD) is a disease of the lungs characterised by the obstruction to the air flow in the airways of the lungs.

The narrowing of the airways together with distension of the air sacs beyond the terminal bronchioles with destruction of the alveolar walls over the course of many years damages the air sacs reducing the surface area left for the exchange of oxygen and carbon dioxide.

As a result the patient become increasingly short of breath.

What is the cause of Chronic Obstructive Lung Disease?
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Chronic Obstructive Lung Disease is associated with
1.Chronic bronchitis .
Chronic bronchitis is an ongoing inflammation of the lining of the breathing tubes (the bronchi), which is caused by bacterial infection or cigarette smoke irritation.

As the inflammation progresses, the bronchi fill up with mucus resulting in a chronic cough, as the body attempts to rid itself of the excess mucus that is irritating the lungs. The excess mucus in the bronchi also makes the diameter of the bronchi narrower and reduces the amount of air that can pass through. There is obstruction to air flow and hence breathlessness.

Smoking is the main culprit here.

2.Chronic asthma-
the narrowing of the airtubes caused by spasm of the muscles of the lining the airtubes triggered off by the allergens can cause permanent damage to the airtubes causing obstruction to airflow and hence difficulty in breathing.

3.Emphysema -
here the narrowing of the airway extends to the smaller airways or bronchioles with damage and overdistension of the air sacs resulting in obstruction and less air getting through to the lungs.

4.Chronic infection of the lungs like pneumoconiosis and tuberculosis may cause damage to the lungs with difficulty in breathing and poor air flow.

In all cases of the above conditions air flow is impeded and there is hyper inflation of the lungs.

What are the Symptoms of Chronic Obstructive Lung Disease?
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Symptoms include:
1.Cough is usually the first symptom to develop.
It is usually a wet cough with phlegm(sputum).
Initially the cough is intermittent but becomes persistent as the condition progresses.

2. Excessive sputum or mucus is produced by the damaged airways.
This results in excessive production of phlegm

3.Chronic shortness of breath or shortness of breath occurs with mild exertion.
As the illness continues, breathlessness occurs even when sitting and can be very distressing to the patient.

4.There may even be breathing difficulty when lying down.

5.Wheezing may occur due to the sound of the air trying to squeeze through narrow airways.

6.Bluish coloration of the skin due to lack of oxygen

7.Dizziness can occur if the brain does not receive enough oxygen

8.Fatigue also occur when the body does not receive enough oxygen

Besides these main symptoms, other symptoms are:
1. Nasal flaring and bulging eyes

2.Vision abnormalities

3.Anxiety, stress, and tension

4.Ankle, feet, and leg swelling

5.Unintentional weight loss

6.Headache (especially in the morning)

7.Excessive daytime sleepiness

8.Insomnia

How is the diagnosis of Chronic Obstructive Lung Disease made?
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1. medical history of cough, excessive sputum, breathlessness and their duration.
Any history of smoking,asthma, exposure to environmental toxins.

2. Physical examination for barrel-shaped chest and flattened diaphragm.

3. Pulmonary (lung) Function Testing-
this is a very important tool used to confirm COLD.
The patient is asked to into a machine called the spirometer which measures the amount of air the patient is able to blow out from his lungs.
The readings from the spirometer will confirm the diagnosis of COLD and assess the severity.
It is also used to monitor the patient's progress.

4. Chest X-ray is useful as an aid in the diagnosis of COLD(hyperinflated lungs and depressed diaphragm is typical).
It is also useful to rule out other conditions besides COLD.
It also detects any complications of COLD.

What is the Treatment of Chronic Obstructive Lung Disease?
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There is no cure for COLD.

Medications and lifestyle changes may help in the relief of symptoms and preventing the progression of the disease.

Lifestyle Changes:
1.Stop Smoking is the most important step for a COLD sufferer.
While the damage to to the lungs cannot be reversed, stopping smoking will help prevent the progression of the condition.

2. Avoid air pollution and second hand smoke in the workplace and wear a mask if the air pollution index is high

3.Pulmonary Rehabilation- this involved a structured programme which includes education, exercise training,psychosocial support and instruction proper breathing techniques.
Benefits include improvement in the ability to exercise, reduced breathlessness and fatigue resulting in improvement in the quality of life.

4.Nutrition- eat a well balanced diet.
If chewing and swallowing interfere withbreathing, take small frequent meals.

5. Rest, meditation,adequate sleep are factors which will help improve your quality of life.

Medications:
1.Bronchodilators are medicines that relax the muscles aound the airways in your lungs, It opens the airways allowing air flow in and out of the lungs to improve. Bronchodilators may be taken orally or in inhalers.

2. Corticosteroids helps reduce airway inflammation and decrease the mucus production. Again these medicines can be taken orally or in inhalers.
Side effects are less with inhalers.

3. Antibiotics are taken to treat any underlying infection.

4. Vaccinations:
a.Yearly influenza vaccination is given if there is a higher risk of pneunomia if you suffer from influenza.
b.Pneumoccal vaccination for protection against pneumococcal infection.

Oxygen Therapy:Those wth severe symptoms may benefit from a regime of oxygen therapy for at least 15 hours a day.

Surgery:
Sometime removal of section of lung which has collapsed may improve symptoms. Sometimes a few may be considered for lung transplantation.

What are the Complications of Chronic Obstructive Lung Disease?
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Most patients ends up with pneumonia and death because of the chronic progression of the disease.

Many if treated are able to live a long time before succumbing to pneumonia.

Other advice:

Air travel may be possible if the doctor deem that you are fit to travel.

Sometimes arrangement for oxygen and medications during the air flight may be necessary.

A Simple Guide to Asthma

A Simple Guide to Asthma
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What is asthma?
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Asthma is a common long-lasting (chronic) inflammatory disease of the lungs and airways (bronchi) that affects 5 % adults and 20% children and causes narrowing of the airtubes.

What happens during an asthma attack?
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When your airtubes are exposed to trigger factors, inflammation of the airway results.
The breathing tubes become narrowed and clogged up with mucus making breathing difficult. Inflammation may continue even though there is minimal or no symptom of asthma.

What are the symptoms of Asthma?
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Asthma is characterised by attacks of

1. breathlessness,

2.tight chest,

3.wheezing sounds and

4.coughing

These symptoms are caused by the airways becoming narrowed and inflamed.
Some people may have these symptoms all of the time.

Others may be normal between attacks.

Who is at risk of developing asthma?
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Anybody can get it at any age but it tends to run in families.
They also have an inherited tendency to develop other allergic conditions such as eczema and allergic rhinitis.
Most children, particularly those with mild asthma will be attack free by adolescence.
A small number continue to have symptoms as adults.
Yet others have their asthma symptoms reappearing only when they reach adulthood.

What causes asthma attacks?
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Asthma results from sensitive airways that react to certain trigger factors.
These triggers may be different for different people.
Avoidance of trigger factors is important.

Some common triggers are:
1.Allergens such as house-dust mites, cockroaches, animal danders, pollen, indoor moulds and foods particularly those containing sulphite.
2.Infections such as the common cold and sinus infection

3.Weather changes due to change in temperature or humidity
4.Air pollution e.g. from tobacco smoke and haze
5.Strong odours or sprays e.g. paints, varnishes, cleaning solvent fumes, perfumes, cooking fumes
6.cold air,
7.vigorous exercise
8.stress.

Attacks may be more frequent or severe in people who have a chest infection.

Avoidance of trigger factors
1.Animal dander (fur, skin of cats or dogs) Give away pet if possible. If not, prevent pet from entering the bedroom. Bathe pet weekly.
2.House-dust mites Use protective air-tight mattress covers and pillow cases. Wash bedsheets and pillow cases weekly in hot water
3.Cockroaches Do not leave garbage uncovered. Use poison baits. Use pesticide spray only when the asthmatic is out of the house.
4.Indoor moulds Reduce dampness in the house.
5.Outdoor pollens Close doors and windows and stay indoors when pollen count is highest in the afternoon.
6.Tobacco smoke and haze Avoid tobacco smoke and haze as far as possible.
7.Medication Aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) and beta-blockers should be avoided.
8.Food Certain foods containing sulphites should be avoided such as shellfish and preserved foods.

What to do during an asthma attack?
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1.Stay calm. Family members or caregivers should be calm, positive and encouraging.
2.Use 2 puffs of your reliever inhaler immediately as previously instructed by your doctor.
If asthma symptoms are not relieved or wheezing returns within 4 hours, give another 2 puffs of the reliever.

3. take your asthma medications with warm water.

4. consult your family doctor if there is no improvement.
If necessary, go to the nearest hospital for help.

How serious is Asthma?
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Asthma is not generally considered by doctors to be a serious illness in most people who have it, mainly due to the mildness of symptoms and the range of very effective medicines that control these symptoms and stop asthma worsening.
Asthma does, however, have an effect on quality of life because attacks can be unpleasant and distressing and can restrict activity. Whilst most sufferers learn to live with and manage their condition, for some it can be disabling.
In exceptional cases, asthma can be life-threatening, particularly if it is not treated adequately or promptly. For some of these, an attack is so severe that it results in death.

How long does Asthma last?
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Asthma attacks come and go, with wide variation in the symptoms at different times.
Many people with asthma have problems only occasionally but others struggle with it every day. Modern medicines control and relieve symptoms and so attacks may only last a few hours or minutes, but without treatment this may go on for several days.
Some children grow out of asthma and some people are only affected at different times of the year.
However, the period of time during which people may have asthma attacks can last for many years or throughout life.

How is Asthma treated?
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There is no cure for asthma, but there are different types of medicines that will help to keep it under control and relieve symptoms.
1.Most sufferers must be given a type of medicine called a preventer, which is usually an anti-inflammatory steroid (of the glucocorticosteroid type) that treats the underlying causes of the asthma. These are usually given from an inhaler.
Even if symptoms are not present, sufferers should keep taking the preventer medicines, as this will greatly decrease the risk of suffering asthma attacks. This will help many asthmatics to live a normal active life.
Steroids can also be taken as tablets but have many side effects.
2.Another sort of medicine is called a reliever that is used during an asthma attack and may be contained in an inhaler. This contains a bronchodilator medicine that opens up the bronchial tubes of the lungs and works in a few minutes. It can also be taken as tablets. Side effects may be rapid heart beats and tremors of hands.

Can asthma be cured?
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No, there is currently no known cure for asthma.

The good news is that modern medicine is extremely effective in controlling symptoms.

You can lead a relatively normal life if you seek to understand how to control your asthma and prevent attacks from occurring.

Asthma attacks may be prevented at a reasonable cost.
It usually requires long term treatment with 'preventer medication'.

What you can do to control asthma?
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ASTHMA MANAGEMENT PLAN
Asthma is a chronic disease requiring continuous management and appropriate treatment.
If you follow your prescribed asthma management plan, you can expect to live an active, normal lifestyle.

Successful treatment of asthma is a partnership between you and your doctor.

You and your doctor should work out an asthma management plan.
This should include:
1.understanding what asthma is all about
2. having clear goals of management
3. knowing the severity of your asthma;
patients with mild asthma can do with just reliever medications to stop the attacks.
On the other hand, patients with severe asthma or those with frequent attacks should go on regular medications to prevent attacks
4.being able to recognise symptoms suggesting worsening of asthma
5.knowing your medicines (preventers and relievers) and how to use them correctly
6.using the right inhaler technique and practicing it until you get it right
7..recognising and avoiding trigger factors
8.knowing what to do during an asthma attack
9..arranging regular follow-up visits with your doctor