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Alveolus Arterial Blood Gas Asthma Blood Pressure Bronchiolitis Obliterans Bullae Chronic Bronchitis COPD - Chronic Obstructive Pulmonary Disease Cor Pumonale Emphysema Forced Expiratory Volume in One Second - FEV1 Heart Rate Hypertension Plyethsmography or Body Box Pulmonary Fibrosis Pulmonary Function Studies Pulse Oximeter Pursed Lip Breathing Residual Volume Tachycardia Target Heart Rate Tidal Volume Tracheostomy Vital Capacity Alveolus (singular), Alveoli (plural) are the air sacs in the lung, located at the ends of your smallest airways. The alveoli are surrounded by capillaries, which are blood vessels bringing blood to the lung that is depleted in oxygen. The exchange of oxygen and carbon dioxide takes place through a membrane separating the alveoli and capillaries. This is the test that tells the health professional how your lungs are working. It is very sensitive to changes in breathing patterns and is used to establish treatment for your condition and qualify you for home oxygen therapy. The main function of the lung is to bring fresh oxygen to the body tissues and get rid of carbon dioxide. The arterial oxygen and carbon dioxide pressure levels are measured in millimeters of mercury. The percent of oxygen that is carried in your blood is also measured. The pH tells us if your blood has too much of the acid component (carbon dioxide) or too much base (bicarbonate.) As expected, it hurts to have any blood drawn, but the information is invaluable.
Your airways are very sensitive and many things can bring on an attack, such as irritants in the air, allergies and emotions. Once you can identify those things that will trigger your airways to go into spasm, you will be able to avoid them! Agonist Drug that stimulates a nerve receptor to produce a desired reaction.Beta2 Agonist Medications derived from epinenphrine that specifically cause bronchodilation. Beta2 nerve receptors are in the muscles that surround the airway. When you take a beta2-agonist, it stimulates the muscle to relax and loosen its grip on the airway so it is no longer constricted. The following Beta2 agonists are considered short acting, lasting approximately 3 to 6 hours. (Generic name given with brand names in parentheses.) Albuterol (Proventil, Ventolin); Bitolterol (Tornalate); Isoetharine (Bronkosol); Isoproterenol (Isuprel); Metaproterenol (Alupent, Metaprel); Pirbuterol (Maxair); and Terbutaline (Brethaire) Bronchodilators can be taken by metered-dose inhalers (MDI); nebulized aerosols; dry powder inhalers; tablets and syrup. The difference between them is potency, how fast they begin to work and when their peak effect is reached. If you are using these medications by MDIs, it is essential that you use proper technique when inhaling the mist. It has been estimated that 50% of people with COPD do not take their medication appropriately. You should: • Shake the inhaler. • Breathe out as far as you can through pursed lips. • With the inhaler upright and about an inch or two away from your open mouth, begin to inhale slowly and deeply. • Do not stop inhaling. After about 3 seconds (half of your inspiratory time) depress the canister and continue inhaling. • Hold your breath for about ten seconds and exhale through pursed lips. • Repeat for the prescribed number of inhalations. If you put the inhaler all the way in your mouth, the medication is likely to hit the back of your throat and never get deposited in your lungs. Using a device called a spacer allows you to take your MDI medication without timing your inhalation. Side effects of beta2 bronchodilators may include increased heart rate, palpitations, nervousness, sleeplessness, headache, nausea, vomiting and/or tremors. Salmeterol (Serevent) is a longer acting Beta2-agonist, whose bronchodilating effect lasts up to 12 hours. This drug is not given for immediate relief of bronchoconstriction because it does not produce relief for 30 to 45 minutes. Serevent Diskus, is a new dry powder preparation. With dry powder, you do not have to coordinate your breathing as you do with a MDI. is the force your blood is exerting on the walls of the blood vessels. Normal blood pressure is considered to be 120/80 and read in millimeters of mercury. When your heart contracts, the top number (or systolic reading) is taken; when your heart relaxes, the bottom number (or diastolic reading) is read. Lower readings than 120/80 are usually nothing to worry about. If your blood vessels are narrowed, your heart has to work harder to pump the blood through. is a chronic scarring and obstruction process involving the lung’s small airways. It may become so diffuse, the entire airway may become filled with fibrotic scar tissue. When the small airways are destroyed, the larger airways become dilated and chronically inflamed. It may occur after a bout of pneumonia or with lung transplantation. Bronchoconstriction Your airways are constricted and difficult to get air through. BronchodilationAirways dilate or open up allowing more air through. Medications that accomplish this are called bronchodilators. Your airways are in the process of closing down; the terms bronchoconstriction and bronchospasm are generally considered the same. are large air-containing spaces within the lungs caused by the destruction of walls of neighboring alveoli that emphysema causes. Once present, they are not very effective in the oxygen-carbon dioxide exchange. is an obstructive lung disease where chronic airway inflammation is present with an abnormally large amount of secretions produced. You will be diagnosed with chronic bronchitis if you cough up secretions on most days for at least 3 months of the year; for at least 2 consecutive years. Because the secretions block your airways, it blocks oxygen from getting into your blood stream. The respiratory muscles have to work harder to get air in and out of your lungs. COPD - Chronic Obstructive Pulmonary Disease This diagnosis is often used as a catch-all phrase to include emphysema, chronic bronchitis and asthma. You may have only one component or a portion of all three states. The main problem is the ability for air to flow out of your lung is diminished or obstructed. In emphysema, the air sacs in your lung become floppy and are unable to snap back on exhalation to push the air out. In chronic bronchitis, secretions are blocking your airways. In asthma, the airways themselves are narrowed. It is often very hard for your physician to say you have only one diagnosis. Diagnosis of COPD How does your doctor decide if you have Chronic Obstructive Lung Disease? If they follow the American Thoracic Society standards they will first look at your history: Smoking: Age when started, quantity smoked per day, whether or not still smoker; Environmental (chronological) data: May disclose important risk factors, as occupational exposure; Cough: frequency and duration, chronic and whether or not it is a productive cough; Wheezing; Acute chest illnesses: Frequency, productive cough, wheezing, shortness of breath, fever During the physical examination the doctors are looking for symptoms of airflow obstruction such as prolonged forced expiratory time. Severe emphysema is indicated by overdistention of your lungs in a stable state with your diapraghm sitting very low. You may be using pursed lip breathing and/or using your neck muscles to help you breathe. Pulmonary function studies (spirometry) is essential to confirm the presence and reversibility of airflow obstruction and to quantify the maximum level your lung is functioning at. Indepth lung testing is usually not necessary except in special instances. A Chest X-ray is diagnostic only of severe emphysema but is essential data to rule out other lung diseases. Arterial blood gas is an essential test in people whose flow rate are 50% or less. (This tells our oxygen and carbon dioxide levels.) Pharmacologic Therapy for COPD You have the diagnosis, now what? If you have mild, intermittent symptoms, you will most likely use a beta agonist bronchodilator inhaler (such as ventolin, proventil) 1 to 2 puffs every 2 to 6 hours, not to exceed 8 to 12 puffs every 24 hours. This will open up your airways to ease shortness of breath. If your symptoms occur every day and are mild to moderate in nature, your beta agonist will be prescribed to be taken 1-4 puffs as required 4 times per day along with using Ipratropium Inhaler to decrease chronic inflammation. This inhaler is used 2 to 6 puffs every 6 to 8 hours. If the mild to moderate symptoms are not controlled by these two inhalers, sustained release theophylline is considered for use. 200-400 mg. is the usual dosage twice daily or 400-800 mg. at bedtime for control of nocturnal bronchospasm. Sustained release albuterol 4-8 mg. twice daily or at night. Oral steroids are used as a last choice. If secretions are very thick and difficult to raise, an agent may be given to help break it up. If you are having an acute episode or infection, the beta agonist dosage is increased to 6 to 8 puffs every one half to two hours or given through a nebulizer instead of an inhaler. You may need an injection of epinephrine or terbutaline to get you back on track. The ipratropium inhaler is also increased to 6 to 8 puffs every 3 to 4 hours or again, given by nebulizer. Theophylline and an antibiotic may be started by IV. is defined as right sided heart failure. Blood is returned to the right side of the heart low in oxygen and is pumped up to the lungs to replenish the oxygen supply. In lung disease, there may be high pressure in the lungs, making it difficult to pump against. After time, the right ventricle of the heart may balloon out and become ineffective.The blood could back up in your system and you may note swelling in your ankles. is a chronic obstructive lung disease that destroys alveoli walls. The alveoli can be compared to a balloon that has been blown up and the air has been let out. It no longer snaps back into place when stretched but lies floppy. When fresh air enters a lung with emphysema, it enters the alveoli because of changes in pressure. The fresh air now in the alveoli should give off oxygen and take on carbon dioxide to exhale and rid it from the body. However, instead of being exhaled, the air becomes trapped and unable to be pushed out because of the lack of elasticity of the alveoli. Stale air mixes with fresh air on the next breath. Emphysema is most commonly caused by smoking. A genetic form called alpha 1-antitrypysin deficiency emphysema is caused by the lack of an enzyme. This emphysema strikes at a younger age (by 35 in those who smoke; in the 40s in a nonsmoker) than the emphysema caused by smoking (usually by 60s). Forced Expiratory Volume in One Second - FEV1 is a measurement of flow rate; this is the amount of air that can be exhaled in the first second after you take the deepest breath that you can. In obstructive lung disease, this measurement is as basic as taking your temperature. You should know what your FEV1 is on a normal day. Asthmatics who take their FEV1 with a peak flowmeter on a daily basis can tell when an attack is beginning before the person even feels symptoms. is your pulse or reading of how many times your heart beats per minute. You can count your heart rate by locating your your radial pulse on the inside of your wrist, just below your thumb. Lightly feel the pulse (pressing too hard may dampen it) and count the beats for 30 seconds and then double the number to find your heart rate. You may find it easier to use your carotid pulse, located at the top of your neck underneath your jaw. is elevated blood pressure
above 140/90. Your physician worries about smaller changes in the bottom number, since
this means your heart does not have a chance to relax. It is very easy to ignore high
blood pressure since it usually produces no symptoms. If gone untreated, hypertension can
result in heart attack, stroke, vision loss and kidney problems. You may be at high risk
if high blood pressure runs in your family, are Africian American, are overweight, on
medications that may have the side effect of raising blood pressure, eat too much salt
and/or are in stressful situations. Your physician may order medication to lower your
pressure which is very important to take as directed! Plyethsmography or Body Box is a five foot box with clear doors that you sit in to have your lung values measured. You breathe through a mouthpiece and even the part of your lung that you can't exhale can be calculated. Pulmonary Fibrosis differs from other lung diseases, because problems occur from the lung muscle itself becoming stiff, rather than problems with the airways. You will not be able to expand your lung and the volume of air that you can hold will decrease. Because scarring occurs, it actsas a barrier for the oxygen-carbon dioxide exchange. It is known as a restrictive lung disease, rather than obstructive. Many times the cause is unknown, it could begin as a result of an industrial exposure, drugs used to fight cancer, after a bout of pneumonia or from allergic disorders. A measurement of your ability to move air in and out of your lungs. They tell physicians if lung deficiencies exist, even at early stages, what type of defect is present and the degree of involvement. They are also used to follow the progression of the disease. People free of lung problems of your same age, sex and height went through the same testing, these results were averaged and considered "normal." The taller you are, the more air your lung can hold and the older you are, the more slack you get! Your values that are reported are in percents and represent the percent of your normal you reached! Below eighty percent usually will raise your physician's eyebrows. This device uses a light to estimate the oxygen saturation of your arterial blood. A sensor that looks like a clothes pin, is put on your finger and a light passes through from one side to the other. The percentage of oxygen and your pulse rate are displayed. If the main concern of your treatment is to monitor your oxygen levels, the pulse oximeter gives a percentage that is not as reliable as one determined by arterial blood gas, but helpful in determining approximate values. The values are dependent on the person's blood flow, and other factors that may affect readings. It doesn't hurt a bit and does not incur the laboratory costs. Pursed
Lip Breathing is one of
the most effective tools people with COPD have to use. When you
breathe in through your nose, it helps to distribute the air more evenly in your
lungs. Instead of passively exhaling, purse your lips, as if you are ready to kiss, This is the amount you can't blow out after forceful exhalation. In obstructive diseases, as emphysema and asthma, this value may increase due to air trapped in the lung behind blocked airways. That is when the exchange of oxygen and carbon dioxide is hampered. is an abnormally high heart rate.
Normal pulse rate is 60-100 beats/minute; over 100 is considered high. Your pulse is
normally high after exercise, but various parts of your heart can stimulate the heart
muscle to beat fast. In lung disease, your heart will beat faster in response to decreased
oxygen levels thinking it can get the same amount of oxygen around the body, if it just
goes a little faster! When you exercise, your physician may
instruct you to reach a specific heart rate and stay within a range to avoid putting too
much strain on your heart. To determine you target heart rate, subtract your age from 220
- this is your maximal heart rate. Then multiply that number by 60% (or .60), 70% (or.70)
and 80% (or .80) to give you a range. The amount of air you breathe in and out each breath you take normally without even thinking about it. This is a tube that is inserted in the base of your neck through your trachea, for the purpose of establishing an airway. This procedure is done usually when a long term or prolonged problem is expected to be present. Because it passes through your larynx, you will not be able to speak unless you cover the opening of the tube. It is also important to maintain humidity to your airway, since you have bypassed your nose. The volume of your lung measured when you maximally exhale after the deepest possible breath you can take in. This represents 80% of your entire lung capacity - there is 20% that you can't exhale or your lung will collapse. When your lung muscle becomes stiff, as in pulmonary fibrosis, the vital capacity will decrease due to the lung not being able to expand to get air in. It will also decrease in people who are obese, since the lung has to work harder to move the excess weight on the chest with every breath.
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The Pulmonary Paper 
Asthma is
an obstructive lung disease that is characterized by airway narrowing and spasm.
Wheezing is often heard as the air tries to move through constricted airways. In
between asthma attacks, a person may have perfectly normal lung function values. Once
an attack starts, flow rate values (speed at which air moves through the lung) will be
greatly reduced. Peak flow meters can monitor your flow rate daily so you will be
warned of any decrease in flow rates before you feel symptoms. 
and slowly breathe out. You want to exhale twice as long as
you took a breath in. This helps push the air out of the damaged alveoli in emphysema
and around the secretions that fill the airway of chronic bronchitis. Inhale for
2 seconds; exhale for 4 seconds; inhale for 3 seconds, exhale for 6 seconds and
so on. Remember this technique when you become short of breath. Many people are
afraid to become short of breath and do anything to avoid it (that is, they simply do
nothing.) You are in control if you know pursed lip breathing. You might go up a
flight a stairs a little to fast or walk too quickly to catch a bus. Instead of
gasping, breathe in through your nose quickly, pucker up and blow out, again and
again until you can slow your breathing down and regain control. It truly does work!
(It will help if you pucker up and blow out as you lift your leg to climb the stairs!)