COPD as the New Normal, a Caregiver's Plea

The next time your loved one annoys you with the nagging about your smoking, take a moment to fast forward in time before you impatiently snap and tell that person to mind their own business.

Take a moment to consider who you will rely upon to help with the simplest of everyday tasks. Who will you call in the middle of the night or first thing in the morning when your shortness of breath causes anxiety ridden panic?  To whom will you vent when your doctor sends you home with an arsonal of inhalers, supplemental oxygen, anti-anxiety medication, and a pat on the shoulder? Who will you cry with when it fully sinks in that you will be tethered to an oxygen tank and there is no magic pill to fix it? Where will you go when you fear being left alone, can no longer drive and totally lose your independence? Which of your children will be the one with the brunt of the responsibility, who loves you dearly yet silently simmers with guilt ridden anger over this unwelcome disruption in their own busy lives? How will your loved ones handle the additional burden on their own busy schedules while maintaining their health and marital relationships?

COPD, chronic obstructive pulmonary disease, is the fourth major cause of death in the USA.
The early symptoms of chronic obstructive pulmonary disease (COPD) may be confused with asthma or acute bronchitis. They have common symptoms that many people may have felt at one time or another.
But, while the symptoms of a cold or acute bronchitis usually go away in a few days or weeks, COPD symptoms last a long time. They can make you feel as though there was a heavy weight on your chest that just won't let up.
People with COPD may experience:

• Chest tightness
• Shortness of breath, especially during activity
• Persistent cough
• Excessive mucus (phlegm)
• Wheezing, whistling, or squeaking when you breathe
• Trouble keeping up with your normal activities
• Lung infections more than once a year

 When you have COPD associated with chronic bronchitis, your airways are both inflamed and constricted. The inflammation produces extra-thick mucus and narrows your airways, making it difficult to breathe. Most of the time, this is the result of a long history of smoking or breathing in other irritants such as pollutants, dust, or chemicals.

 To understand COPD it is necessary to know how the lungs work. When you breathe in, the air goes down your windpipe into tubes in your lungs - these tubes are called bronchial tubes or airways. The airways look like upside down trees or broccoli, with several branches. At the end of the branches are tiny air sacs called alveoli.

The airways and alveoli are flexible (elastic). When you breathe in they fill up with air like a balloon, when you breath out they deflate. Over time irreversible damage is done to the lungs and it becomes harder to get air into and out of the lungs.
Free radicals are produced through normal metabolism in the body, but with exposure  to the toxic chemicals in cigarettes free radicals steal healthy electrons from the lining of the lungs, thereby oxidizing lung tissue. When lung tissue is oxidized, cells break down and die.

• The airways and alveoli become less elastic
• The walls between many of the alveoli are destroyed
• The walls of the airways swell up (they become inflamed)
• The airways become clogged up with excess mucus
• The walls between many alveoli are damaged when a patient has emphysema. This causes them to lose their shape and become floppy. As the walls become totally destroyed, the patient ends up with a few large alveoli instead of many small ones
• In chronic obstructive bronchitis, the patient's airway lining is permanently irritated and inflamed. The lining consequently thickens. Thick mucus builds up in the airways, making it harder for the patient to breathe.
• The majority of COPD patients suffer from both chronic obstructive bronchitis and emphysema. In such cases the term COPD is more accurate.

 If you're 40 or older with a history of smoking and have any of these symptoms for more than a few weeks, it's time to talk to your doctor about taking a breathing test for COPD. It's called spirometry and it measures the breathing capacity of the lungs.

There is no cure for COPD, but there are methods to deal with an irreversible condition that will become a person's "new normal". A progressive disease, treatment begins with various inhalers to use when needed. Eventually, it may be necessary to have home oxygen in order to keep the blood oxygen at an acceptable level. During COPD flares, steroids such as prednisone may be prescribed in an attempt to alleviate the inflammation. Continuous use of steroids carry their own risks but eventually a person has to choose between the plus side of one drug with the down side of another. We do have to breathe, which puts the focus on the now rather than worry about the long haul.
 
 As with many medical issues, people often don't change their lifestyles until faced with their own mortality by losing their health. So what is in tobacco anyway? Tobacco plants evolved the ability to make a nerve gas against insects. That ability is called nicotine, an alkaloid pesticide that plants evolved to defend themselves against insect pests.

Cigarettes are the source of many irritants and poisons such as: reactive metal fragments, ammonia fumes, the paint stripper chemical acetone, hydrogen sulfide, methane, hydrogen cyanide, nitric oxide and formaldehyde. That certainly is not an inclusive list. According to David Bodanis in his book, "The Secret House", the reason cigarettes are the source of all these is because once lit the cigarette makes them itself.  During inhalation the glowing tip of the cigarette can reach 1,700 degrees F. That heat rips the tobacco and paper compounds into their constituent parts and from those basic parts, builds them up again into the poisonous, complex chemicals we started with. This is possible because under the intense heat hydrogen and oxygen come together to form water, which then superheats into steam and condenses as it cools. The chemicals have time to form in between the puffs on the cigarette which starts that process again and again. All that is going on just inside the cigarette, the dim glow behind the red hot tip.

Now imagine what is really in that smoke stream anyone around you has no choice but to breathe. The newly created chemicals of poison clot together in extremely small balls. By the time the cigarette is burned half-way down those little hydrogen cyanide balls are falling, ready to stick to whatever or whomever they land. In addition to that, the exhalation from the smoker is spewing out ammonia, cyanide, formaldehyde and mucus constituents from the nasal lining.

According to Dr. Mehmet Oz, "Nicotine is one of the most toxic addictions-especially because of its physiological effect on the rest of the body. But the addiction itself is manifested in not only an emotional need for the drug but also a physical need; your brain tells your body it needs nicotine to prevent the symptoms of withdrawal. One reason that nicotine is addictive is that it creates pleasure in the brain, causing a feeling of relaxation. Over time, nicotine keeps your brain from supplying these chemicals that create these good feelings, and you end up craving more nicotine and the feeling it produces."

Dr. Rachel Norwood of the National Jewish Medical and Research Center in Denver, states that depression is more prevalent in people with COPD than in those with other chronic conditions. 
Aside from the understandable anxiety, and hopelessness felt in dealing with the daily fear of not being able to breath, it has been found that there is a connection between depression and smoking. That component is the nicotine. It is called the "double-barreled situation". Depressed and anxious people tend to smoke to better handle whatever is going on in their lives, smoking can cause COPD,  the damage and impairment from the disease makes a person even more depressed, which can lead to more smoking. The body craves the nicotine and a person seeking relief from the "blues" feels relief by smoking. Yet smoking only aggravates the COPD and the vicious cycle goes round and round. Once diagnosed with COPD, those people who do manage to give up the smoking habit, not only suffer from the depressing reality of their future, but also suffer from the symptoms of withdrawal.

Controlling one's anxiety is the key to dealing with life with COPD. The fear of suffocating is very real and it is so easy to go into a panic when short of breath. Patients are instructed on Pursed Lip Breathing which is to breathe through the nose and exhale slowly through pursed lips to fully empty the lungs and avoid the tendency to hyperventilate. But even so, anti-anxiety and anti-depressant medications are very often part of the treatment program. These medications have their own side effects and strain on already overburdened bodily systems, but in many situations, they are necessary just to cope.

Everyone is told not to smoke. So why do people continue with such a harmful habit?  In his book, "The Secret Family", David Bodanis claims that nicotine works on the limbic system cells in the brain. By giving a boost in self-confidence many people crave, they soon think they need the stress relief cigarettes appear to offer.  Another reason that people, especially girls, enjoy their smokes is because the nicotine slows the stomach's usual movements which diminishes an appetite. Supposedly ideal for anyone trying to stay slim or lose weight. Women don't seem to realize that their idealistic body image could become an oxygen starved, wrinkled figure with thinning bones prone to fracture. Little is more harmful for maintaining a youthful facial complexion than the damage from free radicals caused by cigarettes.

The tobacco industry understands human nature. Young people vulnerable to peer pressure and normal insecurities are at a higher risk for poor decision making. Once the addictive properties of nicotine take hold, often people smoke for years until they can finally break the habit. Truth be told, many smokers claim to actually enjoy their cigarettes. Reaching for a cigarette while under emotional stress can be like having a good friend. Only true friends don't haunt you down the road.