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Chronic Obstructive Pulmonary Disease
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- 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.
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-
Shortness
of breath -- initially on
exertion
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- Cigarette smoking
- Alpha --1 antiproteinase
deficiency
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- 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
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- Atrovent inhaler
- Albuterol or serevent inhalers
- Oral theophylline
- 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.
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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.
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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.
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- 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.
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