What do the lungs do?

The main function of the lungs is (rapid) gas exchange. This is accomplished by a well-coordinated interaction of the lungs with the central nervous system, the diaphragm and chest wall musculature, and the circulatory system.

Gas exchange occurs in the alveolus where the thin laminar blood flow and inspired air are separated only by a thin tissue layer. Gas exchange takes 0.25 seconds or 1/3 of the total transit time of a red cell. The entire blood volume of the body passes through the lungs each minute in the resting state, that is 5 liters per minute. The total surface area of the lung is about 80 meters square, equivalent to the size of a tennis court. 

Only about 10% of the lung is occupied by solid tissue, whereas the remainder is filled with air and blood. Supporting structures of the lung must be delicate to allow gas exchange, yet strong enough to maintain architectural integrity, that is sustain alveolar structure. The functional structure of the lung can be divided into (1) the conducting airways (dead air space), and (2) the gas exchange portions. The two plumbing systems are: airways for ventilation, and the circulatory system for perfusion. Both are under low pressure.

Respiratory infection - Can be caused by anything from the rhinovirus, parainfluenza virus, respiratory syncytial virus, influenza virus, and multiple other viruses. Mild cases are known as the common cold, severe cases become Pneumonia, and can be life threatening. 

Chronic obstructive pulmonary disease (COPD), also called chronic obstructive lung disease, is a
term that is used for two closely related diseases of the respiratory system: chronic bronchitis and emphysema.  In many patients these diseases occur together, although there may be more symptoms of one than the other. Most patients with these diseases have a long history of heavy cigarette smoking. 

Commonly called "the flu," is caused by the influenza virus, which infects the respiratory tract. The virus
generally spreads from person-to-person when an infected person coughs or sneezes. 

Compared with other respiratory infections like the common cold, the flu can cause severe illness and lead
to serious, and life-threatening complications in all age groups. 

Typical flu symptoms include fever, dry cough, sore throat, runny or stuffy nose, headache, muscle aches, and extreme
fatigue. Children may experience gastrointestinal problems like nausea, vomiting, and diarrhea but such symptoms are not common in adults. Although the term "stomach flu" is sometimes used to describe gastrointestinal illnesses, this is caused
by other organisms and is not related to “true” flu. 

Sarcoidosis:

Also known as Sarcoid or Boeck's disease, is a multi-system auto-immune disease. It is a systemic 
granulomatous disease especially involving the lungs with resulting fibrosis but can also effect skin, liver, spleen, eyes, 
bones, brain, parotid glands and other soft tissue organs. Sarcoidosis is not contagious, it's onset may appear without any symptoms and it can cause lifelong ailments. At this time there is no cause or cure for sarcoidosis. 

Pulmonary fibrosis:

Shortness of breath is the main symptom possibly first appearing during exercise. The condition
then may progress to the point where any exertion is impossible. If the disease progresses, the person may be short of breath even at rest. This happens because scarring occurs in the tissue between the air sacs, with the lung becoming stiff. 

Pulmonary hypertension:

A rare and incurable disease. It most often strikes young women in the prime of their lives,
causing high blood pressure in the lungs, which produces progressive breathlessness and ultimately death. 

Pulmonary embolism:

An obstruction of a blood vessel in the lungs, usually due to a blood clot, which blocks a coronary artery. Symptoms include chest pain, chest wall tenderness, back pain, shoulder pain, upper abdominal pain, syncope, hemoptysis, shortness of breath, painful respiration or new onset of wheezing. 

Dyspnea:

Shortness of breath, or dyspnea, is a feeling of difficult or labored breathing that is out of proportion to the level of physical activity. It is a symptom of a variety of different diseases or disorders and may be either acute or chronic. It results from a combination of impulses relayed to the brain from nerve endings in the lungs, rib cage, chest muscles, or diaphragm, combined with the patient's perception and interpretation of
the sensation. 

Patients can feel an unpleasant shortness of breath, increased tiredness in the chest muscles, a panicky feeling of being smothered, or tightness and cramping in the chest wall. 

                        Sources:

             Cornell University Medical College
                 Sarcoidosis Online Sites
                American Lung Association
            Pulmonary Hypertension Association eMedicine
        Blue Cross and Blue Shield of Massachusetts

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"Primary care physicians frequently made decisions without discussing the intervention with the patient or seeking their involvement," the researchers reported in the Dec. 22, 1999, issue of the Journal of the American Medical Association. 

Do you frequently have unexplained shortness of breath?
Do you sometimes have coughing or breathing attacks when exerting yourself-- for instance, when walking up stairs?
Do you smoke?
Do you have frequent bouts with bronchitis? (If you're not sure, it could be Chronic Bronchitis 
Do you have morning coughing fits?
Do you cough up greenish-yellow sputum (mucus or phlegm)?

If you answered YES more than two times...see your doctor and ask for a COPD evaluation.
Every time you take a breath, air travels down your windpipe, or trachea, into the bronchial tubes. The bronchial tubes branch like a tree into smaller and smaller airways as they go further into the lungs. All along the breathing passages, tiny protective hairs called cilia help keep dust and other pollutants from entering your lungs.  The airways end in tiny air sacs called alveoli. The alveoli transfer oxygen from the air you inhale directly into the bloodstream.

Beneath your lungs is a large, thick muscle called the diaphragm. When you inhale, it flattens out. At the same time, your chest muscles pull your ribs outwards. These two actions expand your chest like a bellows, so that air is sucked deep into your lungs.

Measuring lung function
Lung function is measured using a machine called a spirometer. You blow into it and it measures how much air you exhale and how hard and fast you can do it.

Lung function naturally decreases with age. The spirometer can tell you how your lungs compare with the lungs of an average person your age. (The No Smoking Section includes a graph that will give you a visual sense of how smoking -- and  quitting smoking -- affect lung function over the years.)

Blood tests
If you have breathing problems, your doctor may want to know how well your lungs exchange oxygen for carbon dioxide
(a waste gas you exhale). This involves taking blood from an artery to find out how much oxygen it contains.
.

Most people don't realize they have a problem until they're 40 or older. Then they start noticing that they're short of breath. They may also have a morning cough that produces sputum (mucus or phlegm). It might be mistaken for smoker's cough.  Many people don't find out that they have COPD until they have a serious attack of bronchitis.

If you have any of the following symptoms  (especially if you are or were a smoker), you may have COPD:

There is no doubt that shortness of breath causes difficulty when a patient attempts certain types of physical activity. The reason for this is quite simple. Your damaged lungs may not allow sufficient oxygen to be available to support the increased activity.  Many patients tend to do as little as possible in order to avoid the uncomfortable feelings of breathlessness.  But stop and think for a moment.  What happens if you don't use muscles. They become weak!  So will the muscles that control breathing.  It takes more oxygen to make a weak muscle work than it does to make a strong muscle work. The weaker you become, the less you do, and the less you do, the weaker you become. Many times patients will develop a great deal if  dependency that can become quite burdensome for family members. Lets look at the problem psychologically, as well as, physiologically. A large number of emphysema patients feel overwhelmed by their present life circumstances, and they feel immobilized.  They realize that they are physically unable to accomplish some things previously handled without any effort.
A point is reached where a major impact on their self confidence and self esteem is experienced. Out of concern, family members begin to undertake activities previouly performed by the patient.  They are trying to "help" the patient.  However, removing these activities from the patient often results in negative ends. The patient may experience feelings of guilt because "someone else has to do things for them". They may experience lowered self esteem and further withdraw from
responsibilities. The distress can be great for people who led active lives and now find that they cannot do
the things they used to do.  Some patients may seek nuturing from spouse and family members. They display the "poor me" attitude. If they display helplessness, they are likely to get the nurturing and protection they seek. The family members, who take on the activities that the patient has given up, feel sympathetic, useful, stronger and quite competent, so they tend to do more and more for the patient. It makes them feel as though they are able to help. If however, there is too much for them to do, they eventually become angry and resentful. I remember one spouse who was so angry because her husband made her rinse his false teeth because he wouldn't go to the sink. Let me give you some examples of what I have heard people say:
"Look at me! There's no way I'll ever be able to do that again. Could you do that for me?" "I'm not breathing well today. Before you go out to the store, would you please.....tie my shoes....take out the garbage...turn on the television.....get me a drink of water.....etc., etc., etc." "Oh! How I wish I could be independent again."

1. You and your family should have a reasonable understanding of what your true physical limitations are. Consult with your doctor! Make your doctor be specific as to activities you should avoid.

2. Set reasonable expectations! You will probably not be out running a marathon or doing heavy physical work. But you can use controlled brathing techniques to help you do many normal activities. Remember, shortness of breath is not harmful, It is a symptom of the underlying problem. It's not comfortable and you may to work slower, but you can accomplish much. Remember the famous tortoise and his race with hare.

3. Family members need to stop doing things that the doctor feels the patient is capable of doing for him/herself. Do not mistake love for for assuming their responsibilities. Assisting the patient to be less dependent on you will take time. Don't be discouraged. Remember you are helping them to regain or maintain their self esteem, as well as, providing an opportunity to exercise and use their muscles. This helps keep the patient fit and lowers their oxygen demand. As a result, patients begin to feel better.

4. You may need to make some physical changes in your surroundings to maximize patient functioning. For example, a shower seat might help to make it easier to shower. It's definitely safer too! Placement of everyday items like dishes for instance, should be made so as to limit bending and stooping or having to reach up real high. Thes types of changes will 
help the patient be able to do more for him/herself. Try some of these suggestions and see if they improve the situation.
William Jaeckle

Most of us know that our COPD is, at least one or two aspects, unique to us. One has a productive cough, another doesn't; some are candidates for LVRS, most aren't; many have emphysema, chronic bronchitis, and asthma, others have "only" the alpha form. We also know that each of our treatment programs must be personalized, not generalized, even though some may suffer from "only" one of these illnesses.  I suggest that it is time to insist upon applying "COPD" as THE definitive term to includes all chronic obstructive pulmonary diseases, and to preach the efficacy of aggressive treatment by qualified pulmonolgists, including early detection and customized multidisciplinary pulmonary rehabilitation programs.  There have been several allusions to the traditional wordings of obituaries, and I thought it appropriate to remind you that published statistics are based upon similar vague or misleading descriptions.

Many deaths reported as "congestive heart failure" or "coronary arrest" are so recorded, despite the fact that the cardiac problem was only the ultimate result of many years of living with COPD.

The reported number of cases of people suffering from a given illness is based upon the diagnoses of our doctors and are accurate only to the extent that : 1) there is a diagnosis, and 2) the diagnosis is correct. {Think of those with Alpha-1 who were misdiagnosed for years; those who might have been diagnosed earlier {and treated earlier}, and; those, like me, who were incorrectly diagnosed as cardiac patients because our low o2 levels caused angina pains.

The American Lung Association and the National Emphysema Foundation say that COPD is the fourth most common cause of death, that it is the third leading cause of disability, and that 30,000.000 Americans have the disease.How good are these statistics, since they are based upon the "reported" data, which we know to be inaccurate?
You can bet the farm that there are at least 50,000,000 COPD patients in the US, and that it ranks at least third in cause of death.

Bill Horden..........................http://members.aol.com/SOBnSA/home.index.html

You will frequently in the management of your illness be asked to undergo pulmonary function testing. Spirometry measures how much air a patient can blow out in one second and also with a full exhalation. This will be decreased if the lungs have a significant amount of fibrosis.  As the lung gets progressively scarred, less air can be drawn into the lungs and therefore less can be blown out. Lung volumes are another set of tests done inside what is called a "body box". This examines essentially how large or how much volume of air the lungs can hold. With interstitial fibrosis, the lungs may shrink or contract down and the lung volumes will then be smaller. Diffusing capacity is the test which looks at how well oxygen moves into your bloodstream and the diffusing capacity will be measured to be less. The last test usually done is an arterial blood gas. Blood is drawn from an artery (the blood vessels which take blood away from the heart) rather than a vein (the blood vessels which bring blood back to the heart) for this because blood in the arteries has just passed through the lungs.
Usually the artery in the wrist is used. This blood is analyzed for oxygen level and carbon dioxide level. The better the lungs function, the
more oxygen and less carbon dioxide there is in arterial blood. Pulmonary function tests are quick, easy, and safe to perform and can easily be compared from one physician visit to the next. They are the most
commonly used tests to monitor the course of interstitial lung disease.
"Concerning your Doctor"
If any General Practitioner, Internist, or Family Practitioner, acting as a "Primary Care Physician" (or "Gatekeeper," as HMOs like to consider
them) EVER reuses to refer you to a Pulmonologist for a consult, you should insist upon a Spirometry Test to justify the contention that your
condition isn't serious enough to warrant the services of a specialist. If the doctor won't perform it, or order it, contact the HMO (or insurer)
and insist upon it.  It's relatively inexpensive and available at any hospital or pulmonary clinic in the world.
Then find a new Primary Care Physician. Take control of your life.
My Pulmonologist, my Cardiologist, and my Urologist each take all the time required to explain my condition, answer my questions, allay my
wife's fears, and personally return my phone calls. They are Physicians.
It took some work to find doctors like this, but they are still out there. The results are quite worth the effort.
Those of you who get poor service from your doctors should reexamine your attitude ... you wouldn't keep taking your car back to a mechanic
who couldn't do the job, was always late, spoke to you like you're an idiot, and then charged you for his mistakes. Is your health not as valuable
There are other differences in doctors' attitudes and one of them is the implications of the word "chronic." Patients with "chronic" diseases aren't
in need of immediate, aggressive treatment; those with "acute" problems are. "Acute" problems are interesting: "chronic" problems aren't.
This is why I keep saying "be aggressive."

Bill Horden..........................http://members.aol.com/SOBnSA/home.index.html

Some of us COPD'ers  just can't manage out there, at all,  in excessive heat, but many of us could if we approached  it
from a problem solving perspective.

After my first summer in Texas  after being diagnosed with COPD, I decided I had to develop tools & techniques to help me to handle the heat better.  I wanted to be able to do things outdoors (shopping, fishing, restaurants, etc) and not become a total recluse.. . I felt it would be really important to my overall state of mind & consequently my health  I figured I wasn't necessarily put on this earth to be comfortable 24 hours a day. There maybe some of you twho feel the same way & could some tips to help you out..

SOB is no picnic but 6 years after being diagnosed,  I still  haven't had as many SOB hours as I did when I was a 20 year old in Marine Corps training in the hot summer in North Carolina..

Last summer in Houston, we were experiencing, excruciating, record breaking 100+ degree days.  I would like to share a short article I wrote, which was published in the Houston Chronicle, on "Coping with the Steamy Days of Summer"

Coping with Steamy Days of Summer A Very Very Hot Weather Survival Kit submitted by Lou Ledda (281) 326-3261 / wop5@aol.com

These tools & techniques are especially useful to the elderly, and people with heart & respiratory problems.  Could turn out to be a life saver

A - CLOTHING- The right clothing makes a big difference. Clothes do make the man (or woman)---  COOL-that is.

1) A Moistened Thin Cotton Baseball Cap will  reduce your overall body temperature.  Most of the body heat enters the body through the head,  just as it leaves the body through the head during cold weather.  A thick polyester cap with "Eat at Joe's" on it, will probably make you hotter.  I wear an ultra light aussie looking hat with a combo of cotton /nylon with a
very wide brim.  The nylon causes any sweat to dry faster. I can actually ball it up & put it in my pocket.  A straw panama type hat is also good, but don't try to ball it up & put it in your pocket..  There's a French Foriegn Legion type hat I see many Texas fishermen wearing lately.  It completely covers the back of the neck & most of the shoulders.  If you don't look a little dorky in what you are wearing it probably isn't effective.

2) Thick, tight. short sleeve polo or tee shirts are out--- & Loose, Lightweight All Cotton Shirts,or a combo of cotton / nylon  are in (with or with out sleeves).  Some say searsucker is good because it allows air to circulate.  I, however do not like the way it feels------ too crispy-- I like soft..

3) Tight thick jeans or polyester pants are out & loose Lightweight Cotton Khaki-Type Pants are in, preferrably shorts when possible.

4) Weight or Thickness of Fabric - look for 3.5 to 4.5 oz's. per sq. foot.  If you are wearing clothes with higher weights than that; you are  wearing cold weather gear & are not dressed comfortably for hot weather.

B - ACCESSORIES
Carry the following items ,in  a small soft  ice chest (e.g. 6"w X 8"l X 5"d), containing ice cubes in a zip lock bag & a small ice pack::

1) Two Cool Wraps, which can be purchased in most sporting goods stores. A Cool Wrap will stay very cold for at least 1/2 a day, wrapped around your neck (John Wayne style).  It will minimize your breathlessness and keep your body temperature lower.  Carry two, so that you can switch.

2) A Cool Moistened Face Mask is really useful when you have triple digit temperatures.  It reduces the extreme air temperature you would be breathing into your lungs.  Carry 2 so you can switch.  I put an ice cube in it sometimes.   Someone I know breathes in the cool air from a cup of ice until the car air conditioner kicks in.

3) A Small Plastic Squirt Bottle filled with cold water can be sprayed on the face at intervals,  again reducing body temperature. The one I use emits a very fine spray, that when sprayed at the mouth causes a definite reduction in my SOB.

4) Sometimes the protection & shade  provided by An Umbrella is a necessary adjunct to a hat to keep you comfortable & safe.  Use the dry pocket of the soft ice chest to carry the miniature umbrella.

5) A Car Front  Windshield Shade will keep the car temperature 20 degrees lower.

6) A small personal battery operated Mini Fan worn around the neck will help (for example), when getting into a hot car.  Is that dorky enough for you?

I hope you can use some of these ideas,  Essentially it is like creating a new climate.