COPD IS THE MOST DEADLIEST DISEASE OF THE SMOKERS …….

Smoking kills

WAT IS COPD ???

Chronic Obstructive Pulmonary Disease is a serious lung disease that over time, makes it hard to breathe. You may also have heard COPD called other names, like emphysema or chronic bronchitis. In people who have COPD, the airways—tubes that carry air in and out of your lungs—are partially blocked, which makes it hard to get air in and out.

WHY IS IS NOT GOOD TO HAVE COPD??

When COPD is severe, shortness of breath and other symptoms of COPD can get in the way of even the most basic tasks, such as doing light housework, taking a walk, even washing and dressing.

WAT ARE THE SIGNS ????

Barrel chest

When the lungs become enlarged, the diaphragm is displaced downward and is unable to contract efficiently. Furthermore, the chest wall is enlarged, making accessory breathing muscles (muscles in the neck, upper chest, and between the ribs) less efficient as well. These changes contribute to shortness of breath.

Pursed lips breathing

Because airflow out of the lungs becomes limited, exhalation takes longer. Because the alveoli lose their elasticity, one tries to shorten the time needed for exhalation by forcefully exhaling. Unfortunately, forced exhalation increases pressure on the lungs and causes structurally weakened airways to collapse.

Productive cough

Cyanosis

WAT ARE THE SYMPTOMS

Shortness of breath

Chronic cough

Wheezing

Hemoptysis

edema
weightloss

WAT ARE THE RISK FACTORS ??

Cigarette Smoking

The most important risk factor for COPD is cigarette smoking. Between 80% and 90% of COPD cases are caused by cigarette smoking. Although most cases of COPD are related to smoking, not all smokers develop COPD. This suggests that other factors in your environment or genetic make-up also contribute to the development of COPD. New research also suggests that people who are chronically exposed to second-hand smoke have an increased risk of developing COPD.

Genetic Factors

Although COPD usually develops in older persons with a long history of cigarette smoking, one form of emphysema has a genetic component, runs in families, and is more common in persons of northern European descent. Persons with this form of COPD have a hereditary deficiency of a blood component, known as alpha-1-protease inhibitor (alpha-1-antitrypsin, AAT). About 70,000 Americans are thought to have this genetic deficiency, and it accounts for 1%-3% of COPD cases. People with this defect can develop COPD by early middle age. If you have close relatives who developed COPD in their thirties or forties, your risk of this type of COPD may be elevated. A deficiency of AAT can be detected by blood tests available at medical laboratories.

Age

You are more likely to develop COPD as you get older, but this is partly related to the number of years of cigarette smoking.

Medical Conditions

A history of frequent childhood lung infections increases your risk of developing COPD. Frequent infections can lead to scarring of lung tissues, which reduces their elasticity and can lead to COPD.

Gender

COPD is much more common in men than in women, but this may be largely related to the higher rate of smoking among men. As the number of women who have significant smoking histories has increased, the number of COPD-related deaths among women has also risen.

Ethnic Background

COPD is more common in whites, despite high rates of smoking among blacks and other racial and ethnic groups. This suggests that genetic factors that increase the risk of COPD may be more common in whites than in other racial and ethnics groups.

Exposure to Environmental and Occupational Pollutants

Chronic exposure to dust, ozone, and gases or chemicals, such as traffic exhaust fumes and sulfur dioxide, increase your risk of developing COPD and can worsen symptoms of the disease. Although second-hand smoke has not been found to increase the risk of COPD, it can cause other problems and should be avoided.

WAT IS THE PATHOGENESIS ??

Chronic obstructive pulmonary disease (COPD) is characterized and defined by limitation of expiratory airflow. This can result from several types of anatomical lesions, including loss of lung elastic recoil and fibrosis and narrowing of small airways. Inflammation, edema, and secretions also contribute variably to airflow limitation. Smoking can cause COPD through several mechanisms. First, smoke is a powerful inducer of an inflammatory response. Inflammatory mediators, including oxidants and proteases, are believed to play a major role in causing lung damage. Smoke can also alter lung repair responses in several ways. Inhibition of repair may lead to tissue destruction that characterizes emphysema, whereas abnormal repair can lead to the peribronchiolar fibrosis that causes airflow limitation in small airways. Genetic factors likely play a major role and probably account for much of the heterogeneity susceptibility to smoke and other factors. Many factors may play a role, but to date, only alpha-1 protease inhibitor deficiency has been unambiguously identified. Exposures other than cigarette smoke can contribute to the development of COPD. Inflammation of the lower respiratory tract that results from asthma or other chronic disorders may also contribute to the development of fixed airway obstruction. COPD is not only a disease of the lungs but is also a systemic inflammatory disorder. Muscular weakness, increased risk for atherosclerotic vascular disease, depression, osteoporosis, and abnormalities in fluids and electrolyte balance may all be consequences of COPD. Advances in understanding the pathogenesis of COPD have the potential for identifying new therapeutic targets that could alter the natural history of this devastating disorder.

DO WE HAVE A TREATMENT ???

COPD HAS NO TREATMENT AND THERE ARE ONLY METHODS TO IMPROVE THE QUALITY AND LIFETIME OF THE PATIENT ……..

Its a irreversible disorder of the pulmonary system … While many medications are available to treat COPD, no drug has demonstrated effectiveness in halting the progression of the disease. Rather, the goal of drug therapy at this time is to maintain control of symptoms and prevent COPD exacerbation.

1) Quitting Smoking

In order to prevent or slow the progression of the disease, smoking cessation is the most essential and yet most commonly overlooked aspect of COPD management. In previous years, no drug has rendered itself of benefit to those who had a desire to quit smoking. Thankfully, however, that has changed, and medications are now available to assist people who want to stop.

2) Nicotine Replacement Therapy – Including gum, inhalers, tablets, patches and nasal spray. These aids help reduce cravings, making it easier to quit.

3) Clonidine – Used primarily to treat high blood pressure, this drug is thought to be helpful in treating nicotine withdrawal symptoms for those trying to quit smoking.

4) Antimicrobials

Those who have infection associated with COPD are commonly treated with antimicrobials. Prescribing antibiotics for conditions that are not associated with a bacterial infection, however, is a thing of the past. Most doctors will verify the presence of an infection with a blood or sputum culture. Common antimicrobials prescribed by doctors are:

• Tetracyclines
• Ampicillin
• Amoxicillin
• Bactrim

If you have been prescribed a course of antibiotics from your doctor, make sure you take the entire prescription and don’t stop just because you are feeling better. Not finishing your prescription can increase the risk of resistance to the infectious organism.

5) Bronchodilators

Drugs in this class relax the airway wall muscles allowing you to breathe better. The following are some common bronchodilators that your doctor may prescribe:

• Albuterol
• Atrovent
• Combivent
• Spiriva
• Terbutaline
• Theophylline
• Xopenex

6) Corticosteroids

According to the Global Initiative for Obstructive Lung Disease (GOLD), the role that corticosteroids play in the management of stable COPD is limited to specific indications due to the risk of potentially dangerous side effects. Oral corticosteroids on the other hand, are beneficial in the management of acute exacerbations of COPD as they shorten recovery time, improve lung function (FEV1), and hypoxemia. They may also decrease the possibility of early relapse, treatment failure and length of hospital stay. The following lists some common corticosteroids that your doctor may presribe during your treatment for COPD:

• Flovent
• Solumedrol
• Prednisone

7) Aerosol Therapy

Aerosol therapy is the process of dispensing particles of medication in a fine spray or mist by way of a nebulizer. The medications frequently used during this process are bronchodilators. Nebulized aerosols work by relieving spasms in the lungs, decreasing swelling, and making your secretions easier to cough up.

Pulmonary Rehabilitation

Pulmonary rehabilitation offers a unique intervention for patients with COPD. It is most beneficial for those who have debilitating symptoms and whose daily activities are impaired due to the disease. Through assessment, exercise, education and psychological support, pulmonary rehabilitation can help reduce symptoms, increase participation in daily activities and reduce overall healthcare costs in the COPD population.

CAN WE PREVENT COPD ?????

Prevent COPD Before It Starts

The best way to prevent COPD is to not start smoking or to quit smoking before you develop the disease. Smoking is the leading cause of COPD.

If you smoke, talk to your doctor about programs and products that can help you quit. Many hospitals have programs that help people quit smoking, or hospital staff can refer you to a program. The National Heart, Lung, and Blood Institute’s “Your Guide to a Healthy Heart” booklet has more information about how to quit smoking. Also, try to avoid secondhand smoke and other lung irritants that can contribute to COPD, such as air pollution, chemical fumes, and dust.

Prevent Complications and Slow the Progress of COPD

If you have COPD, the most important step you can take is to quit smoking. This can help prevent complications and slow the progress of the disease. You also should avoid exposure to the lung irritants mentioned above. Follow your treatments for COPD exactly as your doctor prescribes. They can help you breathe easier, stay more active, and avoid or manage severe symptoms. Talk with your doctor about whether and when you should get flu and pneumonia vaccines. These vaccines can lower your chances of getting these illnesses, which are major health risks for people who have COPD.

Living With COPD…….

COPD has no cure yet. However, you can take steps to manage your symptoms and slow the progress of the disease. You can:

• Avoid lung irritants
• Get ongoing care
• Manage the disease and its symptoms
• Prepare for emergencies

The appendix is a small, finger-shaped pouch that sticks out from your colon on the right side, at the junction of the small and large intestines. The appendix has no known function; however, it can be a source of problems. Every year, about 7 percent of Americans develop appendicitis, a condition in which the appendix becomes inflamed and filled with pus.

Appendicitis can occur at any age, but it most often affects people between the ages of 10 and 30, and is one of the most common reasons for emergency abdominal surgery in children. Males are slightly more affected than females.

Signs and Symptoms

The main symptom of appendicitis is pain that begins around the belly button and later shifts to the right side of the abdomen–more specifically, the right lower quadrant of the abdomen. On rare occasions, the pain can be felt in the left lower quadrant; this can be due to a rare condition in which the appendix lies on the left side.

The pain usually increases over a period of about 6 to 10 hours, but this can vary, and eventually the pain may be very severe. The location of your pain may also vary, depending on your age. Young children may have appendicitis pain in different places. In addition to pain, you may have one or more of the following symptoms:

Loss of appetite

Nausea (and sometimes vomiting)

A fever that starts after other symptoms appear

Diagnosis

The diagnosis of appendicitis is best based on a history of the symptoms and a physical exam. When pressure on the painful area is suddenly released, appendicitis pain will often feel worse. Blood tests may show an elevation in the white blood cell count.

An X-ray of the abdomen, ultrasound or CAT scan may be helpful in certain cases. Other diseases can mimic symptoms of appendicitis. Some of these include: pelvic inflammatory disease (PID), kidney stones, an ovarian cyst or an ectopic pregnancy. As you can see, it’s important to know what’s really causing the pain, and that’s what the scans will help the physician determine. If you’re female, a pelvic exam will be done to determine the exact location of your pain and to rule out PID, an ovarian cyst or an ectopic pregnancy (a pregnancy outside of the uterus, usually in the fallopian tube).

Complications

The most serious complication of appendicitis is an infection of the lining of your abdominal cavity. This is called peritonitis. Peritonitis is a medical emergency! If you or a family member develops signs of this abdominal infection, go to an emergency room right away. Even with prompt treatment, peritonitis can be extremely serious.

Treatment

If you have acute appendicitis, you’ll need to have your appendix surgically removed (an appendectomy). Your surgeon may perform traditional open surgery using a single abdominal incision, or choose laparoscopic surgery, which requires only a few small abdominal incisions. It often depends on how soon the diagnosis is made. In general, laparoscopic surgery will allow you to recover faster and heal with less scarring.

If your appendix has ruptured and infection has spread beyond the appendix, a larger incision will be needed, so your surgeon can clean the abdominal cavity. You’ll receive intravenous antibiotics to treat the infection, and you will need to stay in the hospital during your recovery. Don’t worry about pain after your surgery: You’ll be given medication to control any postoperative pain.

Also see http://medind.nic.in/maa/t03/i3/maat03i3p212.pdf

This is a medical blog for all the medicos started by Dr.Logarangan.Any Medical Professional who wants to blog here can mail me at drlokku@gmail.com

There was this day i started to help My Mother Dr.Inbamani a Gynaec and Obstetrics specialist for the past 25 years ….She has made a Vast Practice in the past and still suffering from Diabetes for past 22 years and Bilateral radiculopathy of the legs for the past 5 years ….stilll i feel for her poor health and management and still love her a lot ………there started my first day of private practice wit my mother …just to help her serve ……..But it was one funny xperience ………I wud love 2 share always ….huh ??????
wait not that soon

Slowly i started to gain confidence and started to ask qns to them …..Since a lot a patients females and that too all private queries for the first day it was tuff …………….I felt bad and sad for me being judged like a bad male in the garden of a bunch of girls ………….Till date i had no idea about my mother’s practice …..i know she is a roaring practitioner the place where we live but not did i xpect her to do this to me ………..But slowly the  older group made up wit me and all patients started listening to me …it is a miracle ….ithought it first then realized dont take it easy show ur self simple and elegant that one always never wants to be …………I asked all funny qns they gigled ..There started the secret of my Practice …..first make them easy …then make ur qns ……they will sure answer all of it ……
First Task