Wednesday, November 19, 2014

What causes COPD flare-ups

The following was originally published at healthcentral.com/copd on March 30, 2014.

COPD Flare-Up Causes

Chronic Obstructive Pulmonary Disease (COPD) is one of those diseases, like asthma, that flares up from time to time. When this happens your breathing and coughing symptoms suddenly get worse. What causes them and what exactly happens?

There are essentially four things that might cause a COPD flare-up, or what many refer to as COPD exacerbations.

1. Common COPD triggers

COPD lungs tend to be very sensitive due to chronically inflamed air passages, and for this reason they tend to be very sensitive to things that are innocuous (harmless) to other people, such as air pollution, strong smells, temperature changes, gastrointestinal reflux, grasses, trees, pollen, dust, mold, and cold and dry air.

Generally, what happens is the chronically inflamed air passages become even more inflamed, and this causes them to spasm or constrict, thus resulting in narrowed air passages. This causes air to become trapped inside your lungs, making it hard to breathe. Medicines like albuterol, xopenex and duoneb can open up air passages, and systemic corticosteroids may reduce inflammation, both of which may make breathing easier.

2. Lung Infections

Especially if you have chronic bronchitis, large amounts of secretions often become trapped in your lungs. This can make it easy for common viruses and bacteria to collect in your lungs. Some infections may lead to pneumonia, which may make breathing even worse. Lung infections are the most common cause of COPD flare-ups. While antibiotics may help resolve bacterial infections, most infections are caused by viruses.

3. Heart failure

Especially during the end stages of the disease, the heart can become pooped out from working so hard to pump blood through diseased lungs, thus becoming a weak pump. A pooped out heart is unable to keep up with the bodies demands. This causes fluid (blood) to back up into the lungs, thus making it hard to breathe. Various medicine can help remove fluid from your lungs, and strengthen your heart, to make breathing easier.

4. Unknown

Sometimes the cause is never learned; it remains a mystery. Sometimes the cause is all three of the above, or any combination. Because it's unknown, treatment may involve assuming all three causes and treating them all. When this happens, it may also never be known which medicine worked.

So you can see that there are four basic causes of COPD flare-ups. Which treatment your doctor prescribes may depend on which one they presume to be the cause.
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Tuesday, November 18, 2014

Good reading material for asthmatics

The following was originally published at healthcentral.com/asthma on August 13, 2013.

8 Great Reading Materials for Asthmatics

If you have asthma, or if you take care of an asthmatic, you may be interested in learning what people think about it or how it affects their lives. There is a ton of reading material — from books to websites to articles — about asthma.

Here is some reading I highly recommend you check out (besides, you may find them quite entertaining):

1. Asthma: The biography: Mark Jackson recounts the history of asthma, beginning from ancient China to the present.

2. On Asthma: This is a book by fellow asthmatic and doctor Henry Hyde Salter, who details what it's like to both be an asthmatic and treat asthmatics during the 19th century. Dr. Salter was among the first to clearly define asthma as both spasmotic and nervous (yes, it's all in your head). There are also several chapters with old asthma remedies. This was the asthma book for reference during the second half of the 19th century.

3. Breathing Space: How allergies shape our lives and landscapes: This book was written by Gregg Mitman. He grew up with allergies, and through his book traces the ailment through space and time. I think this is essential reading because many people with asthma also have allergies. And, for the record, he provides a great history of asthma medicine.

4. Lord of the Flies: William Golding creates a character named Piggy, an asthmatic, who becomes isolated from the rest of the kids on an island. It kind of highlights how any asthmatic kid is forced to live and think differently.

5. Mornings on Horseback: One of the chapters in this book by David McCullough highlights how Teddy Roosevelt lived and survived asthma in an age where there were no efficient asthma medicines. Dr. Salter (noted above) was his physician, so clearly Teddy's asthma was all in his head.

6. Inhalatorium.com: OK, so this isn't a book. But it's a website compiled by Mark Sanders filled with pictures of his wonderful antique inhalers and nebulizers collection that you must see. He also displays a variety of antique ads for many of these older products as well. Beware: Once you enter you may never want to leave. It's like a good book you can't put down.

7. Asthma for Dummies: This is an asthma 101 book. This is a mandatory read for anyone new to asthma. It's also a great review for the rest of us.

8. "Divine Stramonium": The rise and fall of smoking for asthma: This is actually an article published in a 2010 issue of Medical History by our friend Mark Jackson. It describes the history of smoking for asthma. Yes, believe it or not, for several thousands of years before the invention of the inhaler in the 1950s, the best way of inhaling asthma medicine was via smoke.

If there is any asthma or asthma-related material you'd like to recommend, please list it in the comments below!
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Saturday, November 15, 2014

870 B.C.: The first description of artificial resuscitation

Elijah resuscitating a child 
Similar to other ancient civilizations, the Jews believed life and death, health and sickness, was the result of the desires of their God, the Lord.  Likewise, in the rare cases when a person was believed to be dead and then brought back to life, this was due to the wishes of their God, the Lord.

No one knows what they called it, although by the 18th century it was referred to as reanimation, and by the mid 20th century it was referred to as resuscitation.

Both terms work equally well, as animate comes from the Latin term anamatus which comes from anima, meaning "to give life to" or to breathe. It may also come from the Greek word anemos for wind.  Likewise, suscitate is a Latin term for "to stir up or rouse." (1)

The first description of an animation or a suscitation was when, through Adam, God created Eve: 
Adam was all alone in the garden with no one to help him. So, God put Adam into a deep sleep and took one of his ribs and formed it into a woman to be Adam's wife. Adam named her "Eve."
The work of the Lord could also be done through a prophet.  The Lord God had many prophets over the years covered in the Bible, among the first was a prophet named Elijah.  He is believed to have lived in the Northern Kingdom of Israel sometimes around 870 or 850 years before the birth of Christ.  

He is described as performing many miracles through the assistance of the Lord. In the First Book of Kings he is described as resuscitating (or reanimating).  A Sidonian widow woman was taking care of him during a drought when her son fell ill and became apparently dead.  She approached Elijah with the body of her son: 
Some time later the son of the woman who owned the house became ill. He grew worse and worse, and finally stopped breathing. 18 She said to Elijah, “What do you have against me, man of God? Did you come to remind me of my sin and kill my son?”
“Give me your son,” Elijah replied. He took him from her arms, carried him to the upper room where he was staying, and laid him on his bed. 20 Then he cried out to the Lord, “Lord my God, have you brought tragedy even on this widow I am staying with, by causing her son to die?” Then he stretched himself out on the boy three times and cried out to the Lord, “Lord my God, let this boy’s life return to him!”
The Lord heard Elijah’s cry, and the boy’s life returned to him, and he lived. 23 Elijah picked up the child and carried him down from the room into the house. He gave him to his mother and said, “Look, your son is alive!”
Then the woman said to Elijah, “Now I know that you are a man of God and that the word of the Lord from your mouth is the truth.” (Kings 1: 17-24)
The Sidonian widow at first appears to be angry at Elijah and his God for allowing her child to become sick and to die. Perhaps she doubts Elijah because she is a Sidonian widow and not an Israelite. Once the miracle is performed, however, she no longer has any doubts that he is a prophet of the Lord.

Elijah "stretched himself out on the boy three times." Why is this such a vague description?  It was because the authors of the Bible were not concerned with what Elijah did, as all the Jewish people needed to know about medicine was that the Lord brings sickness and health.  By obeying the Lord, the Lord will heal.  By disobeying the Lord, the Lord will not heal.  That's all people needed to know.

They did not need to know that Elijah was educated in all the wisdom of the land. They did not need to know that among his education involved knowledge of physics, chemistry, philosophy, mathematics, and medicine.  They did not need to know that the procedure he performed on the boy was a method of artificial resuscitation.   What he did, the method he used, was only eluded to because it did not matter. 

References:
  1. Definitions come from merriam-webster.com,  http://www.merriam-webster.com/dictionary/animate and http://www.merriam-webster.com/dictionary/suscitate, accessed 9/26/2013
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Thursday, November 13, 2014

Tips to quit smoking

The following was originally published at healthcentral.com on March 11, 2014.

6 tips to quit smoking

Once diagnosed with chronic obstructive pulmonary disease (COPD), the first thing your doctor will suggest is for you to quit smoking.  While quitting won’t reverse any damage already done, it will prevent further damage.  So a wise move is for you to start quitting, and to start quitting today.  Here are six tips to help you get started.  

1.  Learn what’s in a cigarette.  Did you ever consider what you are inhaling each time you puff on a cigarette?  If you knew, it might gross you out, maybe even make you cringe, and hopefully increase your desire to quit.  Surely you knew about the nicotine, but all it does is get you hooked.  

Every cigarette also contains over 5,000 chemicals, many of which you would never even think about putting in your body.  Here, I’ll name a few:   Acetone (paint thinner), ammonia (household cleaner), arsenic (rat poison), butane (lighter fluid), carbon monoxide (car exhaust), cadmium (used in batteries), cyanide (deadly poison), hydrogen cyanide (poison used in gas chambers), lead (a heavy metal),naphthalene (used in mothballs), polonium (cancer causing radioactive element), tar (used to fill potholes), and DDT (banned insecticide).

There are 36 more known cancer-causing agents in every cigarette.

2.  Learn what health problems smoking causes. Cigarette smoking has been proven to cause allergies, heart disease, asthma, cancers, emphysema, chronic bronchitis, heart disease, osteoporosis, raynaud’s syndrome, stroke, ulcers, pneumonia, infertility, bad breath, and diminished sense of smell.  Some studies have also linked it with dementia and alzheimer's disease.  You’re also at an increased risk of getting colds and flus.

3.  Learn the short-term benefits of quitting. Now for the good: As soon as you quit, changes start to occur in your body that set you on a path to improved health.

Within 20 minutes your blood pressure and pulse rate will already begin to return to normal, circulation to your hands and feet improves, and fibers in your bronchial tree begin to move again, removing irritants and bacteria.  Within eight hours carbon monoxide and oxygen levels in your blood returns to normal.

Within 24 hours your risk of heart disease already starts to decrease.  Within 48 hours your nerve endings begin to regrow.  Within 72 hours your breathing becomes easier as your lung capacity begins to increase.

In two weeks your circulation starts to improve, and your lung function may increase by as much as 30 percent.  

4. Learn the long-term benefits of quitting.  Within 1-9 months your energy will increase, and your breathing greatly improves due to the regeneration of your bronchial tree.  Your ability to spit up mucus greatly improves, thus improving your ability to clean out your lungs, thus diminishing your risk of developing pneumonia.  

After quitting for 3-5 years, your risk of dying of a heart attack decreases to that of a nonsmoker.  In 10 years, your risk of dying of lung cancer decreases to that of a nonsmoker.  Your risk of developing other cancers that cigarette smoke has been proven to cause (mouth, throat, esophagus, bladder, kidney, etc.) also greatly diminish after 10 years of nonsmoking.  

5.  Ask your doctor for help.  Surely you can quit on your own, but you don’t have to.  There are a ton of nicotine products that your doctor can prescribe so you can be slowly weaned off nicotine, and there are even some over-the-counter products. There are gums, fake cigarettes, lozenges, inhalers,  patches, and all sorts of options designed to help you.

There are also medicines such as Zyban and Chantix to help you deal with the withdrawal symptoms and the urge to smoke. Studies also show that a combination of a nicotine substitute and a medicine like Zyban and Chantix have the best success rate.

Every person is different, so what works for you may not work for others. Ideally, you should work with your doctor to find a method to help you quit, and then stick with it.  

6.  Know other people will support you.  Talk to your spouse, your children, and your friends.  Talk to others who have already quit.  There are also many support groups both online and in your community.

You can call numbers like 1-800-NY-QUITS or 1-800-QUIT-NOW.  You can alsoclick here for a variety of other options.  There are many people who want to help you quit, and who will do whatever they can to help.  

Bottom Line:  Quitting smoking is one of those things you should do for yourself because it’s the right thing to do.  The best way to quit is to make the decision today, and then set a stop smoking date.  When that date comes up, you’ll wake up a nonsmoker, and set yourself on a course to a healthier you.  

References:
  1. “Smoking Cessation Educational Kit,” University of Pittsburgh, Smoking Cessation: Practical Skills for Healthcare Professionals Training Program, 2001, 2006, ashp.org,https://www.ashp.org/DocLibrary/Policy/Tobacco/Educational-Kit.aspx, accessed on 4/13/14
  2. “Changes your body goes through when you quit smoking,” University of Michigan Health Sstem, Tobacco Consultation Service, 2005,http://hr.umich.edu/mhealthy/programs/tobacco/consultation/pdf/changes.pdf, accessed 2/23/14
  3. “Quitting Assistance,” newyorksmokefree.com,http://www.nysmokefree.com/default.aspx, accessed 2/14/14 
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Wednesday, November 12, 2014

The sixth period of respiratory therapy: The RRP?

So if -- WHEN -- the respiratory therapy profession survives the fifth period of respiratory therapy, what will our profession be like.  Chances are we will not be the neb jockey's and ventilator button pushers that we are today.  Chances are we will have more responsibility, and therefore improved respect and probably better wages.

Am I dreaming here? Chances are that I'm not.  I think there is too much pressure on hospital administrators to find ways to cut costs, and surely there's no better way than to quit doing procedures that there's simply no need for.  This would include about 80 percent of breathing treatment orders, incentive spirometer orders, electrocardiogram orders, and a variety of other respiratory therapy related orders.

Surely we won't want to cut our way out of jobs, and surely those working for the AARC and NBRC don't want to lose their jobs either.  And surely hospital administrators, physicians, nurses, and respiratory therapists alike know that respiratory therapists are an integral part of the patient care team. So efforts will be made to keep us.  The question that remains is: what will be the scope of practice for the respiratory therapist.

First of all, I think all attempts at deregulating respiratory therapy will fail. What will happen is there will be a gradual shift from the respiratory therapist to the respiratory therapy practitioner. The first step will be offering a bachelor's degree in respiratory therapy, and this process has already begun. At the present time therapists may continue their education on a voluntary basis.

However, as is the case for many hospitals, as more therapist obtain their bachelor's degrees, there will be a push to hire only therapists with bachelors.  Or, perhaps, the incentive to obtain a bachelor's degree will be that only those with bachelors will be able to decide who gets what and when.  RTs with bachelor's will be, in essence, the team leaders, while all other RTs will be the educated button pushers.  

Eventually all therapists will have bachelor's degrees, and more respect.  The gradual next step will be the gradual assimilation of Respiratory Therapy Practitioners (RTPs).  They will be on the same level of respect as nurse practitioners (NPs), physician's assistants (PAs), and the nurse anesthetist. Our profession will finally obtain full the respect it deserves.

Monday, November 10, 2014

Common COPD co-morbidities

Helping patients with chronic obstructive pulmonary disease (COPD) is a difficult task in and of itself. Making this task more difficult is the fact that the disease is frequently associated with various co-morbidities.

A morbidity is a medical condition that makes a person not perfectly healthy. In this way, pretty much any disease process is referred to as a morbidity. A co-morbidity is the term used to describe a medical condition that typically exists side-by-side with another medical condition.

Some examples of COPD co-morbidities are:

Cancer. The most common cause of COPD is cigarette smoke. It’s also the number one cause of various cancers, such as lung cancer. So it’s not uncommon for physicians to have to treat the two conditions together.

Pulmonary infections, like pneumonia. The disease process often creates excessive goblet cells that increase mucus secretion. Chronic bronchitis also depresses the ability to bring up and spit up these secretions. Making this worse is the inability to take in a deep enough breath to cough. Secretions that stack up in diseased lungs may become breeding grounds for infectious materials, including viruses and bacterium.

Osteoporosis. This is a disease that causes bones to become weak or brittle. It can be caused due to long-term systemic corticosteroid use, medicines commonly used to treat COPD.

Depression. Those diagnosed with this disease are often forced to make lifestyle changes as the disease progresses in order to cope. Over time this can lead wear on a person’s overall well-being leading to a gloomy outlook.

Anxiety. This may be caused by COPD flare-ups or the feeling you can’t catch your breath. It may also be caused by fear of the unknown, such as not knowing what might set off a flare-up, or fear of emergency rooms. It may also be caused by fear of what might happen if help is not sought. It may also be caused by medicines used to treat COPD.

Confusion and dementia. No one really knows for sure what would cause this, although some studies have linked them with cigarette smoke. They also might be the result of hypoxia (low oxygen levels) that may occur during flare-ups or as the disease progresses.

Metabolic Syndrome. Risk factors such as a sedentary life, obesity, smoking, and poor diet might increase the risk of developing heart disease, stroke, and diabetes.  

Coronary Artery Disease. This is when a waxy substance called plaque develops in arteries, causing them to become hard and narrow. This increases the risk for heart attack and stroke. Since a poor diet and cigarette smoking are causes of both diseases, they often exist side by side.  

Pulmonary Vascular Disease. As the disease progresses, less oxygen may get to certain areas inside the lungs. When this occurs, the body tries to compensate by constricting arteries to speed up the flow of blood, hoping to pick up more oxygen molecules. The end result here is that more oxygen is not picked up and, as these diseased areas take over more of the lungs, the heart eventually poops out and fails.

Congested Heart Failure (CHF). After years of working hard to pump blood through diseased lungs, the heart may simply become too pooped to keep up with the demands of the body. This causes fluid to back up into the lungs resulting in COPD flare-ups that may come upon fast and may result in severe dyspnea. A doctor will have to determine if the flare-up is caused by COPD or CHF, as both are treated differently.

Hypertension. Many things that cause COPD may also cause high blood pressure, including poor diet, obesity, stress, depression, genetics, and smoking. Progression of COPD itself may also cause it. So it’s not uncommon for COPD patients to also be on some form of blood pressure medicine. Likewise, systemic corticosteroids used to treat and prevent chronic inflammation in COPD airways may cause fluid retention that results in hypertension. This may be treated with diuretics, and prevented by low dose and short duration steroid therapy only when needed

Diabetes. Again, many things that cause COPD may also cause diabetes, including poor diet, stress, sedentary living, and smoking. Chronic inflammation associated with COPD may also cause it. Systemic corticosteroids used to treat and prevent COPD flare-ups may compound the issue of diabetes, making these patients very difficult to treat. So doctors may be forced to prescribe low dose steroids when high doses are needed. Regular glucose checks will be required for these patients.

Atrial Fibrillation. This is an irregular heartbeat that may be caused by high blood pressure, heart attacks, medicine, and smoking. It may increase the risk of stroke, and may be treated. However, it may also become chronic.

Skeletal muscle wasting. Some COPD patients become increasingly sedentary in order to prevent dyspnea (air hunger) that may occur with exertion. When muscles aren’t used, they become weak and shrink. This may result in weak arm and leg muscles, making it difficult to walk or do simple tasks. In severe cases, it may result in weak muscles of inspiration, making it difficult to take a deep breath and cough to clear secretions, something that is essential to prevent lung infections, such as pneumonia.

Cachexia. This is wasting away that occurs due to skeletal muscle wasting, loss of appetite, and weakness. These patients often present with a weak, frail, thin, and sickly deportment.

Normocytic Anemia. This is a type of anemia (loss of blood volume) associated with chronic disease. It’s possibly caused by the inflammation associated with COPD, although the exact cause is unknown. 

These COPD co-morbidities do not appear equally in all COPD patients. Some may have none and some may have them all. But, in all actuality, most probably have at least one or two. Often, as the disease progresses, co-morbidities gradually develop, further complicating care.

The good news is that many of them can be prevented, or at least more easily controlled, simply by quitting smoking immediately and working with your physician to control your disease and to live an active life with COPD.

Saturday, November 8, 2014

Old terms no longer used

Listed here are diagnosis's that were commonly seen by nurses during the 19th and 20th century that have since been replaced by more specific terms.

1. Catarrh: It was a generic term meaning inflammation of the respiratory tract that results in increased secretions, such as a runny nose. This term was commonly used in the 16th to mid 20th centuries. In some cases, it was used so generically that it could be used to descripe just about any disease process, as catarrh, or inflammation, is present in nearly every disease state in every organ. It was replaced with more specific terms such as hay fever, allergies, rhititis, influenza, bronchitis, asthma, emphysema, colds, etc.

2. Coryza: Catarrh of the nose. It was replaced by more specific terms such as allergies, rhinitis, colds, etc, but mainly rhinitis.

3. Dyspepsia: Upset stomach, bad digestion, indigestion. It was replaced due to the fact that it was simply a generic symptom. It means chronic or recurrent pain in the upper portion of the abdomen. It means feeling full or bloated. It may be accompanied by blotation, nausea, burping, heart burn, chest pain, etc.

4. Phthisis: This is an ancient term for tuberculosis of the lungs, and basically means wasting away. Phthisis was a generic term used to describe patietns who appeared to be wasting away. It has gone through many name changes, most notably consumption and then tuberculosis. Once tubercles were discovered in the lungs of phthisis patients, the name tuberculosis stuck.

5. Dropsy: Inflammation or swelling of tissue or organ. It's an abnormal accumulation of fluid in a tissue or organ. It has been replaced with terms like edema. For instance, in the old days someone with ankle edema would be diagnosed with dropsy.

6. Hydrops pulmonalis: Similar to dropsy, it's a generic term to describe an abnormal accumulation of fluid in the lungs. A more specific term replaced it: pulmonary edema.

7.  Asthma:  For most of history asthma was a generic term that covered shortness of breath, regardless of the cause, and mainly because the cause was not known). Yet beginning in the 18th century, as physicians started comparing symptoms observed with what was observed on autopsy, more was learned about pathophysiological processes.  As physicians learned about different diseases processes they were extricated from the rubric term asthma to become disease entities of their own with their own names and their own cures.  Examples include cardiac asthma, which we now refer to as heart failure, and kidney asthma, which we now refer to as kidney failure.  Other examples include emphysema and chronic bronchitis.   Actually, even phthisis, dropsy, and hydrops were once considered to be inside this rubric term.  Homer even used asthma to describe dyspnea from exertion and dyspnea from being stabbed in the chest.  

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