Dr. Vikas Maurya

COPD, also known as Chronic Obstructive Pulmonary Disease is a chronic medical condition that triggers extensive damage to the lungs, interfering with its functioning. In COPD, the lungs and the air sacs or the alveoli undergo severe inflammation that gives rise to a host of complications including wheezing, shortness of breath and other related breathing troubles. While an early medical assistance is instrumental in proper management and treatment of COPD, in most cases, the associated symptoms and discomfort appear at a later stage (when the lungs have already undergone damage and inflammation). Thus, a proper awareness about COPD is necessary. In this article, we will discuss some important points related to COPD to help people understand the condition better.

While there can be a plethora of triggers, two of the medical conditions that elevate the incidence of COPD are Chronic Bronchitis and Emphysema. The bronchial tubules functions as a carrier transporting the air (oxygenated and deoxygenated) from the lungs to the different body parts and vice versa.

• In case of Chronic Bronchitis, the lining of these tubules undergo severe inflammation. 
• In the case of Emphysema, the inner walls of the alveoli may rupture resulting in deleterious consequences including breathlessness.

For long people were of the opinion that COPD only affects people who smoke. However, various surveys suggest that COPD does affect non-smokers as well. While smoking does make a person more susceptible to the condition (COPD as well as Chronic Bronchitis and Emphysema), other factors such as chronic and severe neonatal lung ailments or prolonged exposure to the harmful gases and lung irritants can also act as triggers.

Though the incidences of COPD are relatively higher in people above 45 years, the young adults or the middle-aged can also be affected. Also, COPD is not limited to males and can affect females as well. Some of the symptoms associated with COPD include chest tightness, wheezing, breathlessness, chronic cough (often with mucus). These symptoms are quite similar to those of Asthma with people often confusing between the conditions. Thus, a proper diagnosis is vital. Spirometry is a lung test used in the diagnosis of COPD. This test evaluates the functioning of the lungs by measuring the amount of air inhaled and exhaled.

When we talk about the treatment or management of COPD, quitting smoking does improve the condition. For people with breathing troubles and chronic cough, the Bronchodilators (can be long-acting or short-acting Bronchodilators depending on the extent of the discomfort) comes as a great relief. The use of corticosteroids (inhaled) can go a long way to alleviate the inflammation of the airways.

In extreme cases with reduced oxygen reaching the blood, a person may need Oxygen Therapy to improve the condition. Of late the Pulmonary rehabilitation program have been benefiting people in dealing with COPD better. The program involves an amalgamation of counselling sessions to educate the people about the diet and nutrition, precautions to be followed along with some healthy lifestyle changes.

Lungs are part of the respiratory system, and their main job is to bring fresh air into the body and remove waste gases from the body.

What do the Lungs do?

• Lungs have a basic function of maintaining the process of gaseous exchange. The blood vessels in the lungs carry oxygen (O2) in the air we breathe to the cells and exchange it for the waste gas carbon dioxide (CO2). This exchange is needed for all our body cells to live.
• Lungs help to bring air we inhale to the proper body temperature and moisturizes it to the right humidity level.
• By coughing, sneezing, filtering or swallowing them, lungs protect our body from infections, pollutants and other harmful substances.
• Lungs also support our sense of smell.

Now that we know the major role of our lungs play in keeping us healthy, it is important that we know the ways to keep them in best of health to lead a problem-free life.

1. Do not smoke: Smoking increases the risk of lung cancer. Every time one smokes (cigarette, cigar, beedi) toxins like nicotine, carbon monoxide, and tar cause damage to the lungs. Over time these toxins irritate and inflame tissues leading to narrow airways which make it difficult to breathe. Smoking is also related to COPD (chronic obstructive pulmonary disease), pulmonary fibrosis and asthma. It is also advised to avoid passive smoking as it may damage the lungs as well.
2. Exercise more: Exercising will make the heart beat faster and lungs work harder, making them more efficient. During aerobic exercise, our breathing increases from 15 times a minute to about 40 - 60 times a minute, thus stepping up the exchange of O2 and CO2
3. Avoid exposure to pollutants: air pollutants can damage the lungs and accelerate aging. Reduce your exposure by avoiding:
   • Exercising near heavy traffic, as one tends to inhale the exhaust.
   • Pollutants at work by taking appropriate precautions.
   • Keeping indoor spaces well ventilated, clean (free from molds, dust, pet dander) and appropriately humid 30-50% relative humidity also helps.
4. Deep breething: Breathing deeply helps the lung to reach its full capacity.
5. Wash your hands regularly: Washing hands properly can help prevent a majority of infectious respiratory diseases like cold and flu.

Importance of diet in maintaining lungs health:
Eat right and keep yourself hydrated is essential for keeping your lungs healthy. Mentioned below are a few foods that are great for the lungs:

• Cruciferous vegetables like cauliflower, cabbage, broccoli, kale. A review by Lam TK in 2009 stated that cruciferous vegetable intake may reduce lung cancer incidence.
• Bright orange and red vegetables-like carrots, sweet potato, pumpkin, are rich in carotenoids, known to reduce the risk of developing cancer in the lungs.
• Foods rich in omega-3 fatty acids have beneficial anti-inflammatory effects on human lung cells.
• Spices like turmeric, ginger and garlic contain antioxidants and anti-inflammatory properties which are good for lung health.
• Water keeps the blood flowing to and from the lungs. It also keeps mucous flowing and the lungs hydrated.

If you are facing difficulties in breathing, especially in the process of exhaling, you are suffering from emphysema. Emphysema is a condition in which the air sacs of the lungs are damaged and enlarged, causing breathlessness. It occurs as a result of several triggers, smoking being the most common one. Emphysema is a type of chronic obstructive pulmonary disease. People with this condition struggle to exhale, which implies that there is some obstruction in the air flow. This disease has no permanent cure but by quitting smoking, you can stop it from getting worse.

Stages
The progression and severity of emphysema occurs with the staging systems. The staging of the condition can help in developing a prognosis.

The Gold emphysema staging system
Gold is a major emphysema staging system created by a group known as the Global Initiative for Chronic Obstructive Lung Disease. The amount of air a patient can exhale forcefully in one second is determined during this stage. It is also referred to as the forced expiratory volume or FEV1.

The staging is as follows:

• Stage 1: Mild emphysema (FEV1 greater than 80% of normal)
• Stage 2: Moderate emphysema (FEV less than 80%, but more than 50% normal)
• Stage 3: Severe emphysema (FEV lesser than 50%, but more than 30% normal)
• Stage 4: Extremely severe emphysema. (FEV lesser than 30% of normal or lesser than 50% normal, with low levels of oxygen in the blood.

The BODE emphysema staging system
The condition affects several abilities. The BODE index, an acronym for BMI (body mass index), obstruction, dyspnea (breathlessness), exercise capacity (health index) is another staging system for emphysema in which the emphysema’s impact on several areas of life are measured. They include the following:

1. Body mass index (B)
2. Airflow limitation or obstruction (O), which is measured by pulmonary function tests
3. Breathless or dyspnea (D), which is assessed thoroughly via a questionnaire
4. Exercise capacity (E), which is measured to check how long a person with emphysema can walk in a span of six minutes

Life expectancy
The prognosis of emphysema is impossible to be determined in any person individually. The staging system helps to identify the severity of the condition, but the future cannot be predicted. Not many studies have been undertaken for the determination of the effects of emphysema on life expectancy. The best research that has been carried out included around 100 people, which is very less. The condition varies largely among people, even if they are in the same stage.

The statistics available on emphysema are not reliable enough for individuals who wish to know their life expectancy. It is considered that if a patient falls in a higher stage, his/her long-term life expectancy is less.

The air that we breathe in has become a cauldron of harmful and poisonous gases, particulate matter, chemical fumes and a host of similar toxic substances. Pollution, especially of the air is at an all-time rise. The quality of air is deteriorating with each passing day, triggering a plethora of health problems. Chronic and severe lung and respiratory disorders (such as COPD, Chronic Bronchitis, Asthma, Emphysema), heart and kidney problems, headache, burning eyes, are affecting people (irrespective of their age and sex) like never before. As per WHO, nearly 6.5 million premature deaths worldwide are reported yearly due to pollution, a depressing statistics indeed! Thus, necessary preventive measures should be followed to keep ourselves and our loved ones protected from the deleterious effects of pollution.

The use of Anti-pollution masks to deal with pollution

• The anti-pollution masks come as a blessing for millions of desperate souls who have been frantically looking for a solution to tackle pollution.
• The anti-pollution masks act as a shield against the harmful pollutants that often finds its way into our bodies.
• The different face masks work by filtering out the hazardous particulate matter from the air.
• Though industrial air masks and the surgical masks are available, most people prefer to go with the more superior quality anti-pollution masks such as N95, N99, and P95 masks.
• The surgical masks seldom provide any protection from the air pollution as toxic air can pass through the masks without any difficulty.

N95, N99 and P25 Air Masks

• The particulate matter (PM) in the air can be PM 2.5 or PM 10. PM 2.5 implies that the diameter of the particulate matter is 2.5 micrometers or less.
• Increased exposure to PM10 (the diameter of the particulate matter is 10 micrometers or less) can result in severe bronchial and respiratory problems (coughing, wheezing, breathing problems, asthma), heart ailments and stroke, a shoot in the blood pressure.
• As compared to PM 10, PM 2.5 remains suspended in the air for a longer time and can adversely affect the lungs (lung irritation and inflammation), heart (result in plaque formation in the arteries), throat and nose.
• As indicative of the name, the N95 Air Masks come with superior grade filtration technology that can filter about 95% of the PM 2.5 from the inhaled air. However, when it comes to oil-based pollutants, the effectiveness of N95 air masks takes a downslide.
• The N99 Air Masks comes with a better filtration rate and can filter out the PM 2.5 from the air with close to 99% efficiency. As seen in N95, the N99 air masks also fail to deliver against oil-based pollutants.
• The P25 masks come with an added benefit. Unlike the N95 and N99 air masks, the P25 masks are effective against oil-based pollutants and are used to remove PM 2.5 with 95% efficiency.
• However, be it N95, N99 or P25, one cannot use the masks for more than 40-42 hours (the filter loses its efficiency).

The inflammations of the lining in the bronchial tubes, which are responsible for carrying air from and to your lungs are known as bronchitis. It is a respiratory disease and more than a million cases are reported each year. Bronchitis requires medical diagnosis by your healthcare provider and can be chronic or acute. Cold or other respiratory infections can cause acute bronchitis whereas smoking leads to chronic bronchitis. Acute bronchitis usually lasts for few days but with persistent cough. Whereas, chronic bronchitis can be responsible for chronic obstructive pulmonary disease.

Symptoms of bronchitis:
The symptoms common to both acute and chronic bronchitis are given below:

1. Cough which may form mucus
2. Body aches and breathlessness
3. Headaches, blocked nose and sinuses
4. Fever with chills
5. Wheezing

The diagnosis of bronchitis is done by your doctor who will ask you about your cough. Some other questions may include your medical history, about smoking or whether you have had cases of flu or cold recently.

Treatment for bronchitis:
Your doctor will mainly recommend pain relievers and cough syrup along with warm air to breathe mainly at indoors. However your doctor may prescribe the following medications in cases of severe bronchitis:

1. Cough medicine: These medicines will help to remove mucus and irritants from your lungs. Medicines may not be able to suppress the symptoms completely but will give you relief from pain.
2. Bronchodilators: Which clears out the mucus by opening your bronchial tubes.
3. Mucolytics: These helps loosen mucus in the airways and help to cough up sputum.
4. Oxygen therapy: It will help to improve the oxygen intake when you face difficulty in breathing.
5. Therapy: Pulmonary program will include a therapist who would work to improve your breathing.
6. Medicines: Using anti inflammatory medicines to reduce damage to your lungs tissue and to also avoid chronic inflammation.

Prevention of bronchitis:

Acute and chronic bronchitis can be reduced by the following measures; however, they cannot be completely prevented:

1. Avoiding dust, smoke, and air pollution. You can always wear a mask when you are on the road or in traffic.
2. Washing your hands often to avoid germs and infections.
3. Avoiding smoking as it can cause harmful damage to your lungs.

Lungs are the most important organ of our body that has the responsibility of taking in the oxygen and releasing out carbon dioxide. When cancer develops in it, the entire body gets imbalanced. Lung cancer leads to more death than any other type of cancer, which is why identifying the symptoms and knowing the causes are instrumental in obtaining a timely diagnosis as well as in prevention of this disease.

Symptoms of Lung Cancer

In the early stages:

1. Persistent coughing
2. Chest pain
3. Bleeding
4. Fatigue
5. Loss of appetite
6. Sudden weight loss
7. Headaches
8. Coughing up blood

In the later stages:

1. Bone pain
2. Joint pain
3. Facial paralysis
4. Neck swelling
5. Blood clotting
6. Weakness
7. Severe chest pain

Causes of Lung Cancer

Smoking: People who smoke are more prone to lung cancer. With the increase in the number of cigarettes you smoke, your chances of getting lung cancer increase too. People who don't smoke but are surrounded by the smokers also have high chances of being affected by this form of cancer.

Exposure to Asbestos: Asbestos is a group of mineral, which is present naturally in the environment. Lung cancer can occur due to the inhalation and ingestion of asbestos fibers.

Exposure to Ranon Gas: Ranon is a radioactive gas, which is formed naturally on decaying of radioactive elements. It is found in low levels in the air that we breathe and the water that we drink. Consumption of air and water having this gas leads to lung cancer.

High Levels of Air Pollution: Presence of high levels of dust particles and pollutants in the air that we breathe can cause lung cancer. 1-2% of lung cancer is caused because of it.

High Levels of Arsenic in Drinking Water: Consuming water with arsenic content is harmful as it directly affects the lungs and when the arsenic content is too high, it may lead to lung cancer.

Exposure to Chemicals: Exposure to certain chemicals like uranium, coal products, gasoline, diesel exhaust and mustard gas can also cause lung cancer.

Family History of Lung Cancer: Chances of getting lung cancer increase if your parents, child or siblings are already prone to lung cancer.

Living with asthma can be tough, but not necessarily unmanageable to the point that it interferes living your life to the fullest. It all boils down to being aware of the triggers, signs and all the other relevant details and taking the necessary precautions to keep the asthma attack at arm’s length.

Here is an insight.

1. Keep your home dust free: Dust which contains irritants like dust mite collect in your beddings, old rugs, and curtains and they cause severe allergic reactions. Wash your bedspreads and pillow covers weekly once with hot water to kill the dust mites. Wear a mask and gloves while dusting the interior of your home. Keep the interior of your house dry so that molds do not form in the dark and damp places like faucets and toilets.
2. Keep your pets at bay: Pet dander triggers problems of asthma when they enter your respiratory system through breathing. If you have any asthma patient in your home, it is best to keep your home free from pets. You can make a separate accommodation outside your home for your pets. They should not be allowed inside the room of the family member with the asthma problem.
3. Be aware of your warning signs: Signs such as nose block, running nose, wheezing, coughing and shortness of breath are the common symptoms which trigger an asthma attack. You can measure your peak airflow with the help of a meter right at home. Thus, you can have an assessment of your lung function and take necessary precautions to prevent an attack. Keep your anti-allergic medicines and inhalers during the season you are susceptible to asthma attacks.
4. A healthy diet keeps the doctor away: Your diet is directly related to your asthma problem as certain foods have an immediate allergic reaction in our body even before we understand clearly. Also, there are certain foods that have a magical effect on the prevention of asthma. Recent studies have shown Vitamins C& E, Beta-carotene, magnesium, selenium, flavonoids and Omega 3 fatty acids play a vital role in improving lung function and preventing asthma. Eat as much fresh fruits and vegetables as possible.
5. A strict no-no to sulphites: Foods that are rich in potassium bisulphite or sodium sulphite may trigger your asthma attack. Both these ingredients are the used for preserving foods for a long time e.g., wine, beer, pickles, tinned or frozen berries, shrimps, etc. Due to the presence of potassium bisulphite, an asthmatic patient may suffer from bronchospasm and other symptoms of asthma attack. Dried fruits like raisins or apricots are also on the list.

Apart from the preventive measures mentioned above, regular exercises and yoga will strengthen the capacity of lungs and help you fight asthma with ease. A healthy diet and stress-free lifestyle is the key to keep this problem at miles away from you!

The lungs are made of tubes through, which air passes in and out for exchange of gases, taking in alveoli. It is a disease of alveoli to which finer air conducting tubes are attached. Over a period of time, with age and exposure to various agents, these tubules get obstructed. The amount of air that can pass through these is reduced, leading to reduced oxygen supply to the lungs and thereby the various body organs.

Symptoms
The symptoms of COPD can be easily understood if we realize how COPD is caused. The progressive blockage of the air tubes causes less oxygen to reach the tissues, which is the most essential agent for all tissues and organs to function. Reduced supply produces a generalized limitation in physical activity. There are two main components to COPD - chronic bronchitis and emphysema. The symptoms indicative of COPD are as follows:

1. Chronic cough: Also referred to as smoker's cough, the cough is relentless and does not subside with regular cough treatment. This is one of the first indications of COPD.
2. Mucus buildup: There is constant buildup of mucus which gets expelled during coughing. The person never feels completely clear of mucus, and the regular cough expectorants do not help relieve the symptoms.
3. Fatigue associated with limited activity: As noted earlier, the reduced capacity of the organs limits their activities. Therefore, regular activities like walking short distances or climbing stairs can induce fatigue.
4. Shortness of breath: The above fatigue is associated with shortness of breath, even with small physical exertion. A person with COPD will see marked tiredness and reduced ability to perform routine chores and feel a tightness in the chest.
5. Wheezing: Passage of air through the obstructed air tubes produces a whistling sound or wheezing. It is more pronounced when there is mucus accumulation in the airways.

Rarely, Frequent respiratory infections, more frequent flu attacks, swelling of the feet and ankles, cardiovascular disease, weight loss, and morning headaches.

Treatment
While there is no cure for COPD, once it sets, the following are some ways to slow its progression and reduce severity of the symptoms:

1. Bronchodilators: Dilate the air tubes and ease flow of air
2. Corticosteroids: Help reduce inflammation and thereby improve airflow through the tubes
3. Flu vaccination: Helps curb the frequent flu attacks
4. Antibiotics: To contain infections
5. Pulmonary rehabilitation: A combination of breathing exercise and patient education to improve lung function.
6. Oxygen therapy: In very severe cases, oxygen may be required.
7. Lifestyle changes: Eating healthy foods, preventing exposure to dust and smoke, quitting smoking, breathing exercises, bi-annual medical check-ups to monitor lung functions are essential.

Knowing that you have COPD is the first step towards managing COPD, which can be managed effectively.

Upper respiratory infection (URI) is a condition, which involves illness, mainly caused by critical infection in the upper respiratory tract. This region includes the pharynx, larynx, nose and sinus. This infection causes diseases, such as tonsillitis (tonsils get inflamed), pharyngitis (causes sore throat) sinusitis (nasal passage becomes inflamed), laryngitis (voice box in your throat gets inflamed) and common cold.

Causes of upper respiratory infection (URI):

1. Both virus and bacteria cause upper respiratory infection (URI). The most common form of virus causing this infection is known as 'rhinovirus.'
2. The immune system of young adults and children are often very vulnerable. Hence, they are more likely to develop upper respiratory tract infection.
3. URI is also contagious and airborne in nature. So if a person comes in contact with an infected person suffering from URI, he/she is likely to develop this infection.
4. Not washing hands before meals can also cause upper respiratory infection because the virus can be transferred easily to the mouth and can travel into your system.
5. If you have any lung problem or heart disease, you are more likely to be susceptible to upper respiratory infection.
6. Those who already have inflamed tonsils can trigger tonsillitis by drinking any cold or spicy beverage like ice-creams or cold milkshakes.
7. Exposure to some flu or cold can cause pharyngitis. It can also be caused by second hand smoking.
8. Birth defects or structural defects in the nasal cavity or nasal polyps can cause sinusitis. Sometimes the inside part of the nose may get swollen due to common cold and block your ducts. This is a common cause for sinusitis.

Symptoms of acute upper respiratory infection:

1. Congestion in the lungs or nasal area.
2. Whooping cough
3. Running nose due to common cold.
4. Feelings of fatigue and lethargy throughout the day.
5. Your body will start aching without engaging in any physical exercise.
6. You can also lose consciousness in severe respiratory tract infections.
7. Difficulty in breathing.
8. Oxygen levels in blood drop down drastically.

Sometimes in worse cases, acute upper respiratory tract infection (URI) can also cause respiratory failure, respiratory arrest and congestive heart failure. Therefore, it is necessary to book an appointment with a doctor as soon as you start experiencing the above symptoms.

The term pollution means introduction of harmful and unwanted contaminants into our environment. Due to the borderless nature of our atmosphere and oceans, contamination at a small level can have a huge impact that to in places which are nearby and one of the best examples of this is crop stubble burning in Punjab and Haryana which is a major contributor to Delhi smog. Pollution is a slow poison and is deleterious to the life of all beings, including plants, animals, and humans. With the rise in the pollution levels, no one can escape the harmful effects of the same on health. Though pollution poses a great threat to everyone, it is the children who are most effected, let us read on to know the reasons

Why are children more susceptible to pollution?

• The lung function, immune system, and metabolic systems in children are not fully developed and functional which makes it difficult for the body to fight these pollutants.
• Children breathe in more air per kilogram of their body weight than adults, so they take in more pollutants per breath.
• Children are not only more active but also have a faster breathing rate than that of adults. This means that they take in more environmental toxins and at a much faster rate.

Understanding the effects of pollution on children’s health

• Exposure of pregnant women to polluted air is strongly associated with premature birth, low birth weight, and intrauterine growth retardation. Low birth weight babies and premature infants are more prone to developmental delays and other disorders.
• Exposure to certain pollutants like carbon monoxide and ozone are linked with septal and valvular defects in the heart of a child.
• There is a strong association between particulate pollution and symptoms like wheezing and bronchitis in both adults and children. This is the main reason why there is an increased prevalence of Asthma in children in urban areas. Research has shown that high level of pollutants in air cause deficits in lung function growth.
• The immune system which protects the body from infections and germs is not fully developed in children. Pollutants are known to cause suppression of immunity in small children making them more prone to infections.
• Children need sufficient Vitamin D for strong and healthy bones. Vitamin D is known as sunshine vitamin and is synthesized in the body on exposure to UVB rays of the sun. Increased particulate components in the air reduce the amount of UVB radiation reaching the ground level. More than 60% children are Vitamin D deficient and require supplements orally.
• The exhaust of gasoline and diesel is known to emit carcinogens which are thought to play a role in the development of leukemia (blood cancer) in children.
• The nervous system is a target for many environmental pollutants. Exposure to these pollutants can lead to neurological deficits and delays in development. Some of these effects are irreversible and long-lasting.

Unfortunately, with urbanization and increased population, the levels of particulate pollutants in the air are increasing at an alarming rate. The problem of pollution needs to be addressed immediately, until then it is best to keep the children indoor and take necessary precautions and keep children safe from exposure to the pollutants.