Chronic Obstructive Pulmonary Disease

COPD affects twice as many Americans as diabetes. Yet many affected by COPD know little about it.
21.7 Million Americans Sufferers
15.2 Million undiagnosed
6.5 Million diagnosed
$32 Billion in annual cost


Breath of Fresh Air









It's easy to smile when you're winning, when fortune is going your way -
but character comes from the struggles of fighting life's battles each day
Lung or Respiratory Disease:

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.

Lung conditions and terms:
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. 
Obstructive pulmonary disease:
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. 


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. 


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. 


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

Ground-level ozone

This page is intended for educational purposes only and should not be used as a
substitute for consulting with a Medical Professional of your choice. 
Most of the contributors are not health care professionals; this page in part is a
collection of personal experiences, suggestions, and practical information mainly
from myself and other COPD patients. 
Please remember when reading this that every Person with COPD responds
What is true for one COPD patient may or may not be true for you. 
Although every effort is made to keep this information accurate, 
This should NOT be used as an authoritative reference.
"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. 

When you get a diagnosis of
It does not necessarily mean the end of the world.
How you spend the rest of your life is up to you and no one else.

Listed below are things you can and should do to insure a better Quality of Life foryourself.
Your quality and quanity of life from here on are mainly up to you. Not your mate or your parent or
your doctor or health care professional.  You are responsible for what you make of the rest of your life.
The things you can do for yourself to help you prolong your life and give it better quality are not lister in the
order of their importance.  As one needs to incorporate all of these things to obtained the desired results.
OK, You have COPD ! You heard the doctor say it, now what does it mean? What can I do? What are my
options? What does all this mean to me?  How will I live with this?  Can I livee with this?
Have a million questions do you?
I will attempt to answer from a patients point of view what it means to be "Living with COPD."
The American guidelines however state the severity of COPD as:
1.   FEV1>=      50% predicted : Stage I
 2.   FEV1>=35-49% predicted : Stage II
  3.   FEV1>=   <35% predicted : Stage III

Quotes from the Emphysema category of the "Emergency Medicine"site for medical personnel.
"Frequency:  In the U.S.: Two-thirds of adult males and one-fourth of females will have emphysema at death."

The American Lung Association and the National Emphysema Foundation say, in various publications, that some 25 to 30 million Americans suffer from emphysema and that it is the No. 3 killer in the US Unfortunately, they fail to publish the sources of their research, so we are unable to know whether the 25 to 30,000,000 represents only those DIAGNOSED with emphysema, or has a fudge factor for the (probable) equal number with mild-to-moderate cases who are walking around, SOB, but undiagnosed. They also fail to support the death count, to clarify whether it includes only those whose death certificates specifically said "emphysema" or "COPD," or also considered those labeled "pulmonary distress, pneumonia, or congestive heat failure," that were direct and immediate consequences on years of living with COPD.

MIAMI (September 25, 2001) - A Cabinet Resolution signed by Governor Jeb Bush proclaimed October to be National Chronic Obstructive Pulmonary Disease (COPD) Awareness Month in Florida. COPD, a group of respiratory diseases, is the fourth leading cause of death in America, affecting an estimated 16 million people, resulting in 110,000 deaths yearly. The Florida Society for Respiratory Care (FSRC), the Alpha-1 Foundation, and the American Lung Association (ALA) of Florida are spearheading COPD Awareness Month activities throughout the state of Florida. "COPD is a serious public health issue. Over 780,000 Florida citizens are
estimated to have COPD," said Sandra Kessler, executive director of the ALA of Florida.  The most common symptoms of COPD include shortness of breath, chronic coughing, chest tightness, greater effort to breathe, increased mucus production and frequent clearing of the throat. COPD is progressive and irreversible, and there is no cure. "Proper treatment of COPD can yield significant benefits," said Lynn Haines, MS, RRT, President of the FSRC. Alpha1-Antitryspin Deficiency (Alpha-1) is the number one genetic risk factor for developing COPD. "Approximately 1 in 25 individuals with COPD are estimated to have Alpha-1, a genetic disorder that can cause lung and liver disease," said John W. Walsh, CEO and President of the Alpha-1
Foundation. In addition to supporting COPD Awareness Month efforts, the Alpha-1 Foundation -- a not-for-profit foundation -- is launching a state-sponsored, free Alpha-1 screening and detection program for individuals with COPD in Florida.  Recognition of the prevalence and severity of COPD is critical to help
improve health outcomes for residents in Florida. This is why the ALA, the FSRC and the Alpha-1 Foundation are on the forefront of this awareness effort. For more information on COPD, call the American Lung Association at 1-800-LUNG USA or Florida Society for Respiratory Care at 1-800-447-3772.
For more information on Alpha-1, call 1- 877-2-CURE-A1 (877-228-7321).

Just because it's published, Internet or elsewhere, doesn't make it true.
The American Lung Association and the National Emphysema Foundation say, in various publications, that some 25 to 30 million Americans suffer from emphysema and that it is the No. 3 killer in the US.  Unfortunately, they fail to publish the sources of their research, so we are unable to know whether the 25 to 30,000,000 represents only those DIAGNOSED with emphysema, or has a fudge factor for the (probable) equal number with mild-to-moderate cases who are walking around, sob but undiagnosed. They also fail to support the death count, to clarify whether it includes only those whose death certificates specifically said "emphysema" or "COPD," or also considered those labeled "pulmonary distress, pneumonia, or congestive heat failure," that were direct and immediate consequences on years of living with COPD.

I am convinced that, all things considered, COPD is our third-ranked killer and our second- or third-ranked crippler.

I think it was Mark Twain who wrote, "There are liars, damned liars, and then there are statisticians."

Bill Horden

Subject:  Re: [COPD] Confused about asthma
   Date: Mon, 1 May 2000 11:56:42 EDT
   From: Bill Horden <SOBnSA@AOL.COM>
Both emphysema and asthma come in differing degrees of severity and from different causes.

Asthma may be reversible or irreversible, bronchial or systemic, induced by allergies, emotions, physical stresses, etc, etc.

Emphysema is always considered irreversible but may be induced by a number of causes, including smoking and/or air pollutants. It is usually accompanied by "chronic bronchitis," a convenient catch-all for frequent, productive or nonproductive coughing that the doctor can't attribute to anything else.

Seldom do two people have exactly the same combinations of these diseases, at the same levels of severity (and the same emotional approach to handling them) so the doctors call such combinations COPD.

Many of the drugs developed for asthma help the emphysema component and, often, the reverse is true. It often develops that patients who quit smoking get great relief from the chronic bronchitis (like this is a coincidence), and almost all of us get a bronchodilator for good measure.

A dedicated, assertive pulmonologist will run a PFT, explain your specific disease, adjust your meds, and prescribe treatment/exercise.

Yes, it seems asthma and emphysema are similar, but they are definitely not. They respond to some similar meds and treatments, but not all. Any doctor who says differently is not one you should see again.

Bill Horden

FROM 1979 TO 1997

1.  Heart disease decreased 35%
2.  Cancer decreased 4%
3.  Stroke  decreased 38%
5.  Accidents  decreased 30%

Definitely, there is a way to distinguish between asthma, chronic bronchitis and Emphysema.

Complete PFT tests done in a hospital (pulmonary lab) will easily diagnose the severeness of asthma, but not emphysema.  However, a High Resolution CAT (CTscan) will show how much damage there is from emphysema and where the damage is located.  A CTscan scans your lungs and takes pictures in dozens of slices and clearly shows all the damaged areas caused from emphysema.  A CTscan clearly shows the many, holes caused from burst alveoli in all zones of both lungs.  A regular xray won't show something like that and isn't much help for a definite diagnoses.  People need a definite diagnosis of their lung disease, not guesses without something definite to back it up.  Having a  CT scan is the only way to accurately diagnose emphysema.

I believe you will find several schools of thought on the subject. In the first place, there are now several clearly defined types of asthma and absolutely no real consensus amongst medical specialties about COPD.

Not only do doctors differ on what diseases should be included under the COPD umbrella, they can't agree upon early detection, treatment, or exercise. The same is true for "stand-alone" asthma.

Each of us should be constantly wary of blindly accepting, as true, everything they read on the Internet.  The person who authored the stuff on the website you're reading may be no smarter than I am. Then, who are you going to believe.

"COPD" is medical shorthand for Chronic Obstructive Pulmonary Disease and is used to describe the problems of any patient with any combination of two or more obstructive maladies. Every specific obstructive pulmonary ailment, including asthma, should be considered a component of COPD and should be included in the treatment program developed.

Bill Horden

Chronic Bronchitis And Emphysema


The Merck Manual of diagnosis of Cor Pulmonale

COR PULMONALE(Pulmonary Hypertension)

Cor pulmonaledefination

Dr. Koop - Medical Encycloepodia - Cor pulmonale - Causes and Risks:

An abstract on ILOPROST's  use in Pulmonary Hypertenstion


Starting point for finding caregiving:

Paying for that care:

Guide to navigating . . . Legal Planning

Support to help the caregiver, in day-to-day activities.

Support groups for caregivers

Welcome to CareGuide's Resource Center

LVRS in COPD Patients
Live Presentation: from March 14, 2000
Is Lung Reduction Right for You?
If you have emphysematous COPD, you've probably heard of lung reduction surgery.  First developed in the 1950s, it
has only become a viable treatment option in the past few years.  But although it has proved beneficial in many cases, it is
still a difficult and uncertain procedure that does not always have positive results. Our panel will discuss lung reduction
surgery, standard treatment options for COPD, and describe the process through which candidates for lung reduction
surgery are selected. Topics will include:
How successful are oxygen therapy and pulmonary rehabilitation in treating emphysematous COPD?
What is lung reduction surgery?
What sorts of patients should -- and should not -- be considered for lung reduction?
What are the risks associated with the procedure?
Host: Paul Moniz
Participants: Byron Thomashaw, MD; New York Presbyterian Hospital, Columbia University
Michael Argenziano, MD; New York Presbyterian Hospital, Columbia University

  >>>>>O<<<<<>>>>>O<<<<<>>>>>O<<<<<>>>>>O<<<<<  CLD Information Resource  New England Journal of Medicine Search  The Lancet Publishing Group  BMJ Information  Primary Immune Deficiencies Amer Med Assn  health & fitness  Harvard Meb Web  Resp. Disease (Notes)  Harvard medical School Info  On Health!  Mayo Clinic Search  MedScape Today  disability links  Amer w/Disability Docs Amer w/Disability Act  Explains PFT Results  find a person  Learning Lungs
Breathing, Health tips and Exercise
Emphysema is one of the lung disorders classified as chronic obstructive pulmonary disease (COPD)

Effects of Increased Partial Pressure of co2
The Role of CO2
Respiratory Acidosis
How the Body Uses O2
The Monitoring of  Blood Gas
Use of pulse oximeter
Viscosity of Pulmonary Mucous Secretions
Hyperbaric Oxygen Therapy
Smoking and Diving
The Respiratory Tract Infection Alert is the first system available directly to consumers and healthcare professionals
to track new cases of respiratory tract infections nationwide.  It can forecast the likelihood of an outbreak of infections and predict when they are expected to peak in a given area.  Based on information gleaned from approximately 30,000
Physicians across the country, the RTIalert is updated each week. For information on your area, CLICK HERE and
enter your zip code below. On a scale of 0 to 10, with ten being the highest, the RTIalert reading tells you the current
level of respiratory tract infections in your area and lets you know if levels are expected to peak soon.
International Classification of Diseases
New blood test rapidly pinpoints cardiac risk
LVRS and the NETT Program
List of Diseases and Discussion
blood test for toxic hepatitis
Blood Test Reveals Cancer Spread
Made for Walking
ALT Blood Test
National Emphysema Treatment Trial (NETT)
Inhaled corticosteroids reduce exacerbations in chronic obstructive pulmonary disease
 COPD Around the clock
Chronic Bronchitis: Primary Care Management
 Chronic Bronchitis
COPD across the USA
 COPD Dictionary
ALA on Living with COPD
 COPD Early identification and intervention
 COPD Early-Onset
 Audio Tape about Copd
COPD: New Treatments for an Old Disease
 COPD The Impact
Pulmonary Hypertension Require Different Strategies
 Cystic Fibrosis linked to COPD
Chronic Obstructive Pulmonary Disease & Emphysema
 COPD Screening and Early Intervention
 Flu Risks For Women With Chronic Illness
 Doctors can treat - but not cure - Emphysema
 National Emphysema Foundation

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Evalulating Your Breathing

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.

What Is COPD?

COPD stands for "chronic obstructive pulmonary disease":
"Chronic" means long-term.  "Obstructive" refers to the fact that breathing is partially blocked.  "Pulmonary" indicates that the disease affects the lungs.
If you have COPD, you're not alone. In fact almost 16 million Americans have it. It's even more common than asthma.
The term COPD refers to a disease that generally includes both chronic bronchitis and emphysema (see the sections below). Usually it occurs in people who are heavy smokers and have been smoking for a long time.

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:

A severe cough that persists between colds.
Spitting up mucus.
Difficulty breathing.
Frequent bad colds.
Shortness of breath on exertion.

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."



Sure, there are limits to what you can do physically. But, there are also many things that you can do for yourself. The following tips for you and your family members will help you feel better about yourself and will help keep you as active and independent as possible. Also, the additional activity will help keep your muscles from deteriorating.

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


What is COPD ?
This subject keeps cropping up. It appears that doctors have lots of opinions about what diseases belong in "COPD." I've even read some doctors say that "bronchial" asthma may be a component of COPD but other forms, such as "exercise-induced" don't belong there. I suspect these doctors spend hours, each Sunday, debating the number of angels seated on the head of a pin. The picture isn't made any clearer by the allergists who insist that, though it is an obstructive disease, it can't be a COPD component because it is reversible. I've never heard it called "curable," but that doesn't mean someone hasn't so labeled it.  Since it may decrease over time, or appear only late in life, be caused by any one (or more)
of hundreds of allergens, or by physical or emotional stress, and vary widely in severity and duration, I'm inclined to believe that asthma:
1...   is a generic term used by the medical profession to cover any of many different diseases with similar symptoms..
2.     is a Chronic disease; is an Obstructive disease; is a Pulmonary Disease, and; therefore IS a COPD...................
3.     is often mistreated (or maltreated) by PCPs and Allergists who have no pulmonary training and, therefore, don't
refer the patient to Respiratory or Pulmonary Therapy until there is an Emergency Room-level problem.....

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..........................


Pulmonary Function Testing

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..........................


A Second Opinion
Nancy Snyderman, M.D., F.A.C.S.

It is hard to know exactly why, but it is a simple fact. People who know more about their health conditions, tests and treatments tend to have better health outcomes than those who remain passive, uninformed and uninvolved in their
own care. This is true whether you’re talking about medications, surgery or cancer therapies. And one of the most important parts of informed medical decision-making is getting a second opinion.
Before seeking a second opinion, discuss your situation thoroughly with your doctor. Ask why he or she is recommending this test or treatment, and what are the other alternatives. Find out the risks, costs and possible side effects.  What kind of results can you expect, and what might happen if you decline the procedure or treatment?
When to Seek a Second Opinion
You have your doctor’s recommendation in hand. When do you need a second opinion?
Not for minor conditions and procedures.
When your health plan requires it.
Prior to major elective surgery.
When there are other options, but your doctor favors just one, and you don’t necessarily agree.
When your diagnosis is uncertain, or you just have doubts about how to proceed. This doesn’t mean you have a bad
doctor. Medicine is not always a matter of starkly clear choices. Two radiologists, for example, might interpret a mammogram differently, or doctors may have varying clinical experience that affects their preferences regarding treatments.
What is Next?
Once you have decided to obtain a second opinion, tell your doctor. Don’t be hesitant about this! A good doctor will support you and may offer a referral.  Have your doctor send a copy of your file and tests to the second doctor.
In his book "Examining Your Doctor," Dr. Timothy B. McCall suggests that you see a doctor unaffiliated with the first. You may want to choose someone with a different specialty, but still experienced in treating your condition. If surgery’s the issue, Dr. McCall says it may be a good idea to go to a non-surgeon, just to get a different perspective.
The Final Decision is Yours ... With Some Help After all this, the second opinion may only
the first, and that is fine.  You will feel greater confidence going into the procedure or treatment.  If there is disagreement, make a decision that is in line with your own philosophy and inclinations. In the case of two wildly divergent opinions, you may need to do some additional research of your own and perhaps seek a third opinion.

The heat and humidity are my worst triggers... I doubt if I'll willingly set foot outside my bedroom for the rest of the summer-just leave for appointments. I always hated the heat, anyway. It was similar to that here-low 90s, humid. Ick! Thanks goodness for A/C! I know a lot of people are put into a bad mood by this weather, and are made sort of mopey-but those of us with lung disease are affected the worst.

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 /

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.

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.

National Emphysema Foundation
 Lung Slides
Pulmonary Function Testing
 Smoking Doubles your risk for Alzheimer's
Guidelines - Assessment - Management of COPD







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edited on 3-30-2003