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Tuesday, Mar 31, 2015

Taking your breath away

Hernando Today Correspondent


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When Joe DeFibro put his Spring Hill home on the market, he planned to move into a smaller duplex in a retirement community. But his ailing health and a recent diagnosis of chronic obstructive pulmonary disease, COPD, helped jumpstart a new plan.

DeFibro was told by his doctor that moving out of Florida and into a drier climate might be his best defense against the challenges he was facing with his breathing. His COPD was smoking-related and wasn't being managed the way he had hoped with medications and changes in habit. He considered a more drastic solution. So he called his real estate agent, negotiated a lower price on his home and prepared to move to Arizona.

Less than a month later, and just days before the scheduled closing on his house, DeFibro succumbed to his disease. His adult children were left to pack up their father's life, wishing they'd pushed him a little sooner to relocate. That was 10 years ago.

Today, research on COPD, which encompasses many lung diseases including chronic bronchitis and emphysema, has come a long way. But the American Lung Association is worried that awareness still isn't where it needs to be to save lives.

COPD, according to the American Thoracic Association, describes a group of lung conditions that cause difficulty when emptying air out of the lungs. Conditions like emphysema, which DeFibro had due to years as a heavy smoker, and chronic bronchitis fall under the umbrella of COPD.

Emphysema is a condition that affects the ability of the alveoli, or air sacs, inside the lungs to completely empty of air. The lungs have more than 300 million alveoli, which stretch and spring like little balloons. In healthy lungs, it takes energy to blow up the alveoli but little to no effort to empty them since they "spring" back into shape. In diseased lungs, the alveoli become stretched, more like a paper bag, and cannot empty without help.

The result often leads to trapped air inside the alveoli since the lungs are not fully emptying. When combined with the added energy it now takes to deflate the damaged alveoli, an obstruction becomes the result and symptoms described as shortness of breath appear.

With emphysema, the "obstruction" of air causes the breathing tubes to collapse on exhalation, preventing the necessary amount of air from getting into the lungs. The airway becomes obstructed.

With chronic bronchitis, the breathing tubes, called bronchi or bronchioles, constantly swell and become irritated. This results in increased mucus. Chronic bronchitis is diagnosed when the patient reports coughing and mucus on most days for three months during two consecutive years and other lung conditions have been eliminated as the cause.

The airways become obstructed when swelling and excessive mucus production causes the inside of the breathing tubes to be narrower than normal. The narrowing of the airways prevents adequate amounts of air from reaching the lungs.

Bronchiectasis is a permanent enlargement of the bronchi and bronchioles, which then produce abnormal amounts of mucus. Bronchiectasis may occur after severe pneumonia and is sometimes thought to be COPD. Yet once diagnosed the treatments are different.

Asthma, a condition of chronic swelling of the airways, may produce an obstruction of the airways. Asthma is similar to COPD and some who suffer from COPD also have asthma.

Causes of COPD are still under investigation, but many believe it has as much to do with environment as it does with behavior. Smoking, as in the case of DeFibro, often leads to emphysema and chronic bronchitis, and quitting smoking is usually the first step in controlling symptoms and further damage.

But recently the American Lung Association compiled research that indicates as many as 400,000 Americans die each year from COPD from causes including the inhaling of particles, gases, fumes and smoke at home and in the workplace.

"Studies by the ALA reveal nearly 132 million people live in counties where monitors show unhealthy levels of ozone and particle pollution, which underlines an urgent need for policy makers to understand that indoor air pollution is as widespread and dangerous as pesticides or global warming," the study states.

The American Lung Association ranks ozone, particle pollution, carbon monoxide, lead, nitrogen dioxide and sulfur dioxide in addition to mercury, arsenic, benzene, formaldehyde and acid gases. Therefore, it is necessary to initiate higher public awareness about the quality of indoor air.

COPD is usually suspected when breathlessness is experienced that doesn't go away. These signs and a history of smoking will usually indicate the need for a test called spirometry to measure the airway. The test will determine whether or not there is an obstruction.

COPD, once diagnosed, is chronic, meaning the patient will have the disease for life. But certain treatments are used to help with symptoms including anti-inflammatory medications to help reduce swelling in the breathing tubes or antibiotics to treat an infection. Most medications will need to be taken every day to stabilize breathing.

There is currently no treatment available to restore damaged bronchi from bronchitis or alveoli from emphysema.

For more information about COPD, contact the American Lung Association at or the American Thoracic Association at www.thoracic .org.

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