EPOC: ¿Qué determina la susceptibilidad a las exposiciones ambientales que conducen a la EPOC?

"Michael: About 3 years ago, I called and got you on the phone.  I was beside myself with fear. I thought I had COPD and the doctors were wanting me to go on different puffers for a few months.  I instinctively knew that was the wrong thing to do!  The respiration tests I failed. I want to thank you from the bottom of my heart for your very kind and positive words that helped and boosted me  past this difficult stage. I bought the videos and breathing equipment and straps and applied them diligently every day for at least 6 months.  I want to let you know that I am doing fine today.  I don't have the breathing difficulties that I had back then.  I owe all of this to you and the amazing knowledge that you have passed on for those of us who are willing to participate and reclaim back our health.  I thank you from the bottom of my heart.  Sincerely,  Beth Palmer""

Many people mistake their increased breathlessness and coughing as a normal part of aging. In the early stages of the disease, you may not notice the symptoms. COPD can develop for years without noticeable shortness of breath.

William Bailey, MD, FCCP, a renowned COPD expert who works with the U.S. COPD Coalition emphasizes, “Given that more than half of the estimated number of COPD patients are not diagnosed, we need to bring greater awareness to this disease and its symptoms and encourage patients to seek lung function testing from their physicians (or maybe better yet). If diagnosed, there are effective treatments that can help improve patients' lung function and quality of life.”

If you have chronic obstructive pulmonary disease (COPD), you may be a lot more focused on your lungs than on your heart. Yet these two organ systems are intimately connected and the health of one system can significantly affect the health of the other. 

Researchers have long known that advanced COPD can harm the heart. Now, a study in The New England Journal of Medicine indicates that even mild cases of COPD can be associated with diminished heart function. 

While that may not sound like good news, there is an upside. You can take steps to help your lungs and your heart -- and the sooner you take them the better. 

The heart and lungs work together to deliver oxygen to and remove carbon dioxide from the body's tissues. When you inhale, oxygen enters the blood via little sacs in the lungs called alveoli. The oxygenated blood travels through the pulmonary veins to the left side of the heart, where it is pumped throughout the body. The deoxygenated blood then returns to the right side of the heart and is pumped through the pulmonary arteries to the lungs. When you exhale, carbon dioxide exits your body and the cycle starts again. 

But this process can go awry in people with COPD. Low oxygen levels in the alveoli cause the pulmonary arteries to constrict (narrow) and the normally low pressure in the arteries to rise. If the pressure in the pulmonary arteries rises to a sufficiently high level, a condition called secondary pulmonary hypertension develops. 

In pulmonary hypertension, the right side of the heart must work harder to push blood through the pulmonary arteries into the lungs. Over time, the heart's right ventricle becomes thick and enlarged and the heart's pumping action may deteriorate. The result of this damage may be heart failure. 

In a person with left heart failure, fluid builds up in the lungs and other organs as well as in the arms and legs, causing fatigue and breathlessness on exertion. The condition also increases the risk of pulmonary emboli (blood clots in the lung), which can further block blood vessels in the lungs. When right-sided heart failure results from a lung disorder, fluid builds up in the legs and arms but less so in the lungs, and it is referred to as cor pulmonale. 

Just like many of us use only a small portion of our brain power, MOST people  have some degree of lung dysfunction or arrested lung development; it is just undetected. they are classified as "normal". These "normal" people worry me.

More than 16 million Americans have COPD, and the COPD coalition states there are more than 15 million more who are not yet diagnosed.

"Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality throughout the world.^[1,2] In 1990, COPD was ranked 12th in terms of overall burden of disease; the World Health Organization (WHO) projects that, by the year 2020, it will be fifth.^[3] COPD ranks fourth as a cause of death in the United States, following only heart disease, cancer, and cerebrovascular disease. Unlike these other conditions, the death rate for COPD continues to increase.^[4] As the population of the United States ages, we can expect the burden of COPD to increase even more".  Stephen C. Lazarus MD   Lecture at CHEST 2001: 67th Annual Scientific Assembly of the American College of Chest Physicians

COPD affects approximately 30 million Americans and is the fourth leading cause of death in the United States. The direct costs associated with COPD care are more than twice those attributable to asthma. 65

Within the past several years, the results of 4 long-term (3 to 4 years) studies of the role of inhaled corticosteroids in COPD have been published. The EUROSCOP, ISOLDE, Copenhagen City Health Study, and the Lung Health Study II were all designed to examine the effect of long-term inhaled corticosteroids on the natural history of COPD. Although these studies, individually and collectively, show convincingly that inhaled corticosteroids do not modify the long-term decline in lung function in COPD, some of the data suggest that they may reduce the frequency and severity of exacerbations. This has generated significant controversy regarding when, and in whom, inhaled corticosteroids should be used.

"Approximately 90% of patients with COPD have a history of significant cigarette smoking, but only 15% to 20% of smokers develop COPD. The obvious question, therefore, is "what determines the susceptibility to environmental exposures that leads to COPD?"   

From Mike: I suggest they look at how they are breathing, their internal breathing coordination. Free Breathing Test

From Mike: I have taken an article and inserted bold comments, as I often do to show people that there is much more to understand then many are aware of.

Chronic morning cough and shortness of breath are the two leading indicators of COPD.

COPD is the 4th leading cause of death in the United States, killing more than 112,000 people each year, according to the lung association. 

There are many more patients out there with COPD than carry a firm diagnosis from a doctor.

Millions of people in the United States are suffering from chronic obstructive pulmonary disease (COPD) and don't even know it, according to a new study. "It's the Rodney Dangerfield of chronic diseases," said Dr. Sam Giordano, executive director of American Association for Respiratory Care (AARC). But he believes better public screenings and better education for both doctors and patients will help.   

Encouraging

AARC is joining the American Lung Association (ALA), the National Lung Health Education Program (NLHEP) and the American College of Chest Physicians and in a national education campaign to raise awareness of the condition. 

From Mike: This is largely a drug oriented approach. There are some exercises that can help but my experience is that they do not approach exercise or breathing exercises in an optimal fashion to maximize breathing development.

The groups want to "let people know about the very great impact COPD is having on American lives," explained Dr. Norman Edelman, a scientific consultant and spokesman for the ALA.  

From Mike: Due to oxygen relationships to cellular function and detoxification as well as breathing's impact on nervous system balance and blood pH and then add the impact of respiratory dysfunction to all other illnesses you may well re-rank respiratory problems as public health enemy #1 ahead of heart attack and cancer.

The study, funded by pharmaceutical giant GlaxoSmithKline, highlights two points, said Dr. Jill Ohar, a professor of medicine at St. Louis University and a consultant on the survey. "First, there are many more patients out there with COPD than carry a firm diagnosis from a doctor and, secondly, patients are more symptomatic than they tell. "Researchers interviewed 573 patients who were either diagnosed with COPD, emphysema or chronic bronchitis or had symptoms of chronic bronchitis and were at least 45 years old. They also interviewed 203 physicians in a national sample, with some surprising results, according to Ohar.

When asked about their frequency of symptoms  79% had shortness of breath at least a few days a week, while 58% suffered from the condition daily. 76% brought up phlegm a few days a week -- 48% did so every day. 28% had difficulty breathing while lying down or sitting. 32% were short of breath when talking. 44% had shortness of breath while washing or dressing. What is COPD?  COPD is an umbrella term for diseases that restrict the flow of air out of the lungs. If there is too much "used" air in the lungs, there's not enough room for oxygen-rich air to enter. Emphysema and chronic bronchitis are the primary COPD diseases.

Patients suffering from chronic bronchitis produce excess phlegm in their lungs, which clogs air passages. Symptoms include coughing up excess mucus, shortness of breath and frequent infections. Some 14.2 million people in the United States suffer from chronic bronchitis, according to the lung association. Emphysema affects fewer people -- about 3 million, according to ALA. It is characterized by shortness of breath and coughing. Lung damage from emphysema is irreversible, because the disease destroys small air sacs  in the lungs.  

From Mike: I have demonstrable evidence that a significant aspect of emphysema is reversible and that alveoli before  believed to be unrecoverable is in fact in MANY instances recoverable.

COPD often goes untreated because patients often don't tell their doctors about their symptoms or how severe those symptoms are. "One gets a sense that people are too accepting of their disease," explained the lung association's Edelman. That's especially true of smokers, who tend to cough more and bring up more phlegm. "It is common for smokers to get up in the morning, wash their face, brush their teeth, cough and spit up phlegm," said consultant Ohar, so they tend not to report it to their doctor.

Also, because most patients are 45 or older, many think shortness of breath is a common part of the aging process. A study conducted by the Centers for Disease Control and Prevention found that at least two thirds of the population of patients with lung disease don't know they have it. On the other hand, doctors aren't asking patients about these symptoms and aren't testing patients enough, experts said. Testing in the past has been difficult -- the machines used were very complicated and the data had to be evaluated by an outside laboratory. But now there are simple computers that doctors can use in their offices to evaluate test results and the cost has gone down significantly. "Patients should have the lung function tested at some point in their life," 

From Mike: how about daily or weekly on their own as well? 

said Dr. David Mannino, a medical epidemiologist with the CDC. "To know what your lung function is can be an indicator of overall health." Early diagnosis and earlier treatment can significantly improve the quality of life for patients, said Dr. Tom Petty, chairman of the NLHEP. "The average age for a COPD patient is 53 years -- that's too old," he added.

Smoking is a primary cause

While there is no cure for COPD (From Mike: may not be true in MANY if not MOST instances), there are many ways to alleviate symptoms. Medications, such as bronchodilators, can help open clogged air passages. Antibiotics and anti-inflammatory agents may also be prescribed, along with a healthy diet and exercise to strengthen muscles. But doctors say the best way to avoid COPD is to stop smoking.

From Mike: TOO easy an answer. COPD includes bronchitis which invites its own return due to dysfunctional breathing balance/coordination/nutrition/internal cleansing. 

Smokers are times more likely to have COPD than non-smokers, according to the American Lung Association. "Ninety percent of COPD that we see in the United States is caused directly by smoking -- there's no argument about it," agreed Dr. Gerald W. Staton Jr., a professor at the Emory University School of Medicine. 

In the United States, there are more than 47 million people over 18 who smoke and nearly 45 million former smokers, according to CDC statistics. After the age of 30, lungs stop growing and lung function begins to diminish. Non-smokers lose lung function at a rate of about 20 cubic centimeters per year. Smokers lose about 4-5 times that much and can exhale about 100 cubic centimeters less air.  

From Mike: Definitely not true. People can develop lungs long after age thirty. 

"If you smoke and stop, you can expect to regain 60 (cubic centimeters) of lung function per year after two years -- then you could go back to normal aging lung function loss," explained Ohar.   From Mike: These "normal" people worry me. 

From Mike: This refutes the earlier statement that it is lost.  It has been my experience that this "60 cubic centimeters" can be greatly increased. I smoked a pack and a half of Camels unfiltered in my teens and twenties and now at age 70 the Voldynne 5000 says I have the lung volume of a 6'4" twenty year old.

Nicotine patches, gums, inhalers or sprays -- coupled with the prescription smoking cessation drug Zyban -- have been successful in helping patients quit smoking, according to a 1998 study published in the New England Journal of Medicine.   
From Mike: Most people I have spoken with that quit smoking just suddenly decided to quit and then QUIT. When one does not breathe properly one gets much of the sense of deeper relaxing and energizing breathing from the way they breathe while inhaling and the nicotine.   

But doctors need to do more, one expert said. "Doctors need to tailor their message to their patient," said Ohar. "If you're talking to a teenage boy, tell him smoking will make him impotent. If you're talking to a teenage girl, tell her smoking causes periodontal disease and will ruin her smile. If you're talking to a middle-aged woman, tell her how smoking will cause premature wrinkles and contribute to osteoporosis."  Tell them also that it can be beaten

From Mike: MANAGING COPD
Primary goals are . (1)improvement of  intrinsic mechanical loading (elastic and resistive) of the inspiratory muscles; (2) improved mechanical (volume) restriction during exercise; (3) decreasing functional inspiratory muscle weakness; (4) decreased ventilatory demands relative to capacity; (5) improving gas exchange abnormalities; (6) improve dynamic airway compression; (7) cardiovascular factors; and (8) Extending height and rise of the diaphragm  (9) any combination of the above.  

There are several good things you can learn about managing COPD. They unfortunately include drugs and do not seek to rehabilitate the breathing. There is a HUGE difference between helping and rehabilitation. 

Clearly, early detection and smoking cessation can have a significant impact on the natural history of COPD. There are, however, numerous barriers to success. Many clinicians have negative attitudes about COPD because there are few therapeutic options, and because it is a "self-inflicted" disease. Many patients are embarrassed about their inability to stop smoking, and delay seeking medical attention because they are unwilling to be lectured about smoking cessation. Nevertheless, simple programs using objective criteria for airflow obstruction can be implemented at minimal cost. The recognition that chronic cough and sputum are not normal, and that our free breathing tests can go a long way toward identifying individuals early in the course of COPD, when intervention can be effective.

1. Thom TJ. International comparisons in COPD mortality. Am Rev Respir Dis. 1989;140:27-34.
2. Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: global burden of disease study. Lancet. 1997;349:1269-1276.
3. Murray CJL, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: global burden of disease study. Lancet. 1997349:1498-1504.
4. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med. 2001;163:1256-1276.
5. Fletcher C, Peto R. The natural history of chronic airflow obstruction. BMJ. 1977;1:1645-1648.
6. Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV₁. The Lung Health Study. JAMA. 1994;272:1497-1505.
7. Petty TL. Early diagnosis of COPD: National Lung Health Program in the United States. Program and abstracts of CHEST 2001: 67th Annual Scientific Assembly of the American College of Chest Physicians; November 4-8, 2001; Philadelphia, Pennsylvania.
8. Strategies in preserving lung health and preventing COPD and associated diseases. The National Lung Health Education Program. Chest. 1998;113(2 suppl):123S-163S.
9. Zielinski J. Early diagnosis of COPD: national program of early diagnosis of COPD in Poland. Program and abstracts of CHEST 2001: 67th Annual Scientific Assembly of the American College of Chest Physicians; November 4-8, 2001; Philadelphia, Pennsylvania.

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Pink Puffers and Blue Bloaters

Singing helps COPD   Singing and Speaking Program

Do you possibly have some measure of undetected COPD or tendency towards that?.

Summarizing the SEVEN basic areas that can be changed to improve lung function

MEDICAL. Pulmonary patients need FOUR doctors: Internist, pulmonologist, cardiologist,  or Integrative MD, Naturopath, family chiropractor or osteopath.

EXERCISE. The body must be challenged but intelligently. This includes our approach to breathing exercises.

PREVENTION OF INFECTION. Allergies and bad air need to be protected against. Lung bugs need to be curtailed.

INTERNAL CLEANSING. In addition to killing bad lung bacteria one must remove the debris that invites them to proliferate.

NUTRITION. Most Naturopaths know a lot about this.

STRESS AND ANXIETY MANAGEMENT. This includes our approach to breathing exercises that improves lung function while calming.

AWARENESS
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