Respiratory Diseases

Respiratory Diseases

Working toward Breathing Free

You hike along a path that leads to a snow-covered peak in the Austrian Alps. Below is the Mozart-mad town of Salzburg; above is silent, glacier-cold rock and sky.

Drawing the crisp mountain air deep into your lungs, you hold it, exhale as long as you can, then repeat the process over and over again until every cell in your body is flooded with fresh, clean air.

If you had the flu, a cold or emphysema, you couldn't do this. You'd have to suck air on every hill as though you were 100 years old. You'd cough every time you took a deep breath. And you'd wheeze.

But if you keep your lungs healthy, you won't have to, says Robert Bethel, M.D., a staff physician at the National Jewish Center for Immunology and Respiratory Medicine in Denver.

Our lungs are made to last through any workout we hand them well into our seventies. Smoking, of course, can change that scenario, clogging up the lungs and making us gasp for air. Colds, flu, pneumonia and other infectious diseases can do the same, but only temporarily. Other diseases can also affect the lungs, but these are less common.

Strengthening Your Natural Defenses

Every day, your respiratory system draws in approximately 9,500 quarts of air and mixes it with up to 10,600 quarts of blood pumped by the heart into the lungs. Your lungs send oxygen through arterial highways to support the rest of the body and to provide an exhaust system for gaseous metabolic garbage such as carbon dioxide.

Since your lungs are internal organs that draw in the microorganisms of the outside world with every breath, the strength of their natural defense system is particularly important in maintaining oxygen flow to and from the rest of your body. Fortunately for most of us, the lungs' defensive players, including mucus and hairlike filaments called cilia, can sweep pollens, dust, viruses and bacteria out of the airway.

Most of the time they do a great job. But sometimes they're undermined by irritants such as cigarette smoke or overwhelmed by invading microbes.

More than 14 million men and women suffer from chronic obstructive pulmonary disease, which includes both chronic bronchitis and emphysema. And in one year alone, 7 to 8 million men and women had asthma, 129 million had the flu, 4 million had pneumonia, and practically every one of us had some kind of cold virus.

How can you protect your lungs from the diseases and irritants that can slow you down? Here's what experts say.

Keep your cilia sober. Drinking interferes with the cleansing mechanisms that keep your lungs free of disease-causing germs, says Steven R. Mostow, M.D., chairman of the American Thoracic Society's Committee on the Prevention of Pneumonia and Influenza and professor of medicine at the University of Colorado at Denver. "The respiratory system's cilia get drunk right along with the rest of you," he explains. If you're used to having one or two drinks on a daily basis, your cilia will be okay. But if you suddenly decide to drink more than you usually do, your cilia won't be able to do their job.

Use ultrasound. To keep your respiratory system in fighting trim, humidify your environment in winter with an ultrasonic humidifier, says Dr. Mostow. The increased moisture will help the cilia sweep out dust, viruses, bacteria and pollens.

Work your lungs. Don't just work your biceps. Get into an aerobic exercise program that works your heart and lungs, says Dr. Mostow. It will help keep your lungs functioning at peak efficiency. Walking, running and swimming for 20 minutes at least three times a week will certainly do the job, but check with your doctor before you start, so she can tailor your exercise prescription specifically to your needs.

Smother smokes. Smoking a cigarette or even being in a room where others are smoking can damage your lungs, says Dr. Bethel. The smoke may cause your body's natural defense system to release an enzyme that, in trying to attack the smoke's chemicals, literally digests the lung. Not only does this set the stage for future diseases, but breathing can be immediately impaired.

Smothering Cold Symptoms

Colds, upper respiratory infections and bronchitis can be caused by any one of numerous microorganisms that can make you feel as though you lost the ability to breathe.

You get these diseases by inhaling somebody else's germs or touching someone that has a virus, then touching your eyes or nose, allowing the germs to enter your body.

Once the virus has invaded, it sets up shop in your throat and begins churning out baby viruses by the hundreds. These viruses spread throughout your body and trigger those beloved cold symptoms: a stuffy, drippy nose, sore throat, aches and pains and cough.

There's no way to cure a cold as yet, but here's how you can deal with its
symptoms.

Eat five-alarm chili and curry. Hot peppers and spices such as curry and chili powder cause mucous membrane secretions. The extra fluid can thin out thick phlegm in your nasal passages and lubricate a sore, itchy throat.

Steam and sip. Sip chicken soup or linger in a steamy shower, suggests Thomas A. Gossel, Ph.D., dean of the College of Pharmacy and professor of pharmacology and toxicology at Ohio Northern University in Ada. The fluids you drink or inhale dilute the mucus in your nose and upper throat to help make breathing easier. Use decongestant sprays at bedtime for no more than five days to avoid inflaming tissues.

Try the big D. The D in many over-the-counter cough suppressants (such as Robitussin DM) is dextromethorphan. Doctors swear by it. Just make sure you follow package directions.

Suck on zinc. Zinc's ability to zap a cold has been suspected for years. And at least one study, at Dartmouth College in Hanover, New Hampshire, indicates that zinc tablets can cut the duration of a cold by 42 percent. But not any zinc tablet will do. You need those marked "zinc gluconate with glycine." They're fairly new on the market, so you may need to ask your druggist for help in tracking them down. If your druggist can't help, write the Quigley Corporation at 10 South Clinton Street, Doylestown, PA 18901.

Numb your throat. Suck on over-the-counter throat lozenges to numb and soothe your throat, suggests Dr. Gossel. Or aim a medicated spray at the back of your throat, hold your breath and squirt. Follow package directions for both lozenges and sprays.

Purge pain. Try aspirin, acetaminophen or ibuprofen to relieve the aches and pains of a cold, says Dr. Gossel.

Fight malaise. The too-tired-to-move feeling that usually accompanies a cold is often caused by dehydration, according to Dr. Gossel. Try drinking at least six glasses of water a day to prevent it.

Chill out. A study at Carnegie Mellon University in Pittsburgh indicates that the more stress you're under, the more likely you are to get a visit from any cold bug in the vicinity.

The researchers asked 394 men and women between the ages of 18 and 54 about any stress in their lives--recent bereavement, going on a diet, changing jobs, losing money, little sleep and arguing with family members--and then divided them into five groups. Each group received custom-made nose drops containing one of five viruses known to cause colds.

The result? Those who had the most stress in their lives were five times more likely to get colds than those who had the least.

Coping with Emphysema and Bronchitis

One disease likely to send your respiratory system into an early retirement is chronic obstructive pulmonary disease. It includes chronic bronchitis, a condition in which the air sacs of the lungs are destroyed, and emphysema, a condition in which lung elasticity is lost and air is unable to flow freely in and out through the airway. It does not include the common bronchitis you might get with a cold--that's simply an irritation of the bronchial tubes that causes a few days of coughing and then goes away.

Both chronic bronchitis--roughly defined as a daily wet cough that lasts for three months or more--and emphysema are usually caused by smoking. Both have early symptoms of shortness of breath, limited ability to exert yourself, hacking up mucus and coughing, and both conditions are on the rise. The number of people who have these diseases has increased 41 percent in the last ten years, and chronic bronchitis and emphysema make up the largest number of respiratory illnesses (other than colds) in people between the ages of 30 and 45. Because more men than women smoke, men are nearly twice as likely as women to get emphysema, but women are rapidly catching up. When it comes to chronic bronchitis, women are more likely to get it. Emphysema and chronic bronchitis together kill approximately 75,000 people a year.

There's no cure for chronic bronchitis or emphysema, but the following strategies can lessen the shortness of breath that eventually comes from an obstructed airway and make life with the diseases a little easier.

Avoid people who sneeze. Any type of respiratory infection can make emphysema and chronic bronchitis worse, says Dr. Bethel. As much as possible, avoid crowded areas or people who have infections. See your doctor if an illness such as a cold or flu is aggravating your breathing problems.

Get shot. Prevent the complications of influenza and bacterial pneumonia by getting immunized against both flu and pneumonia, says Dr. Bethel.

Learn to save your breath. If you have emphysema, ask your doctor to recommend both an occupational therapist and a physical therapist in your local area.

"An occupational therapist can work with people who are short of breath and who are limited in their day-to-day activities," says Dr. Bethel. "The therapist can teach people more energy-efficient ways of doing those activities."

A physical therapist can develop an exercise program that will train your body to use its available oxygen more efficiently. The result will be that the little oxygen you have will go farther.

Dilate your airway. Your doctor may prescribe medications to dilate your airway to its fullest, says Dr. Bethel. Use them according to directions.

Asthma: An Increasingly Deadly Disease

Asthma is different from chronic bronchitis and emphysema in that its obstruction of the airway is both intermittent and reversible.

During an asthma attack, the airway constricts, the airway walls thicken with inflammation, and mucus accumulates within the airway. The result is an obstructed airway that makes you feel as though you were choking to death. But after an attack, the airway usually returns to normal. Unfortunately, years of these attacks can lead to permanent airway damage.

If you've never had asthma before, breathe easy. Once you're past age 30, you're unlikely to develop it, says Harold S. Nelson, M.D., senior staff physician at the National Jewish Center for Immunology and Respiratory Medicine and a member of the National Asthma Education Expert Panel of the National Heart, Lung and Blood Institute.

"Asthma tends to run in families," says Dr. Bethel. "There may be a predisposition in some people, but we think that asthma is caused by an inflammation of the airway.

"All the mechanisms aren't clear," he adds. "Sometimes the inflammation is caused by allergens that people inhale. Sometimes it's workplace exposures. Exposure to a large number of agents--solder used in the electronics industry or fumes from the making of plastics--may sensitize the airway and make someone asthmatic. And many times people develop asthma, and it's not clear what caused it."

What is clear, doctors agree, is that asthma, which affects about 12 million Americans, is becoming more prevalent and more deadly every year. About 5,000 people die from it each year--and the death rate climbs with age.

What's behind the increase in asthma numbers and deaths is still a mystery, reports the American Lung Association. Any number of things can trigger an asthma attack, including allergies, cigarette smoke and other irritants, a viral infection in your respiratory system and heartburn, which can result in coughing and spasms in your lungs. Even strong emotions and hard exercise--especially in cold weather--can cause troubles, Dr. Nelson says.

New or recurring cases of asthma can start off feeling like regular respiratory tract infections, Dr. Nelson says. If you begin to develop wheezing, tightness in your chest or shortness of breath, see a doctor immediately.

If you're diagnosed with asthma, doctors can prescribe medication to ease the symptoms. Inhalers containing corticosteroids are the most effective way of reducing swelling and helping you breathe easier. Over-the-counter drugs rarely have much effect, Dr. Nelson says.

"This is not something you should treat by yourself," he says. "Asthma is much too serious for that." Here's what experts suggest to handle the disease.

Fight pollution. "There's evidence that living in polluted environments increases the incidence of lung diseases such as asthma," says Dr. Bethel. That's why you should try to avoid heavily polluted areas such as industrial districts and urban highways.

Air quality is frequently monitored by various agencies to see if it complies with federal and state standards. To find out how badly the area in which you live or work is polluted, call your state's environmental agency. The people there have the information at hand or can refer you to someone who does.

Breathe through a scarf. Breathing in cold, dry air can constrict the airway and induce wheezing, coughing and shortness of breath. The solution? Wear a scarf that you can draw up over your mouth and nose to breathe through during cold spells. And try to breathe mostly through your nose. Breathing through your nose warms and humidifies the air before it reaches the lungs.

Head for the kitchen. A review of what 9,000 adults eat every day revealed that higher vitamin C and niacin intakes were associated with fewer cases of wheezing. Good sources of vitamin C include black currants, guava, orange juice and red bell peppers. Good sources of niacin include chicken breast, water-packed tuna and swordfish.

Use an early warning system. The home peak-flow meter, a device that measures your breathing capacity, can help identify what's a normal flow and what's not, says Dr. Nelson. Since airflow sometimes drops a couple of hours or days before an attack, the peak-flow meter can give you an early warning that lets you ward off the attack with medication prescribed by your doctor.

Ask your doctor about where to get a peak-flow meter and how to use it.

Take the right medication. Prescription medications that treat asthma include anti-inflammatory drugs that suppress airway inflammation, such as steroids, as well as bronchodilators that dilate the airway itself.

But noting that some people use only bronchodilators, Dr. Nelson adds, "Anyone with more than the mildest occasional asthma needs to be on anti-inflammatory treatment rather than just bronchodilators. Together, they will decrease symptoms, probably decrease the number of acute episodes that would otherwise need hospital treatment, decrease the need for bronchodilators and, doctors hope, prevent the long-term development of irreversible obstruction."

Surviving Flu and Pneumonia

Neither flu nor the most common forms of pneumonia are likely to damage your lungs, but they can make you so short of breath that you feel you can't even make it up a flight of stairs.

Flu, which generally causes fever, headache, sore throat, nasal congestion, muscle aches and a feeling of exhaustion, typically strikes between December and March. It's caused by one of two virus strains, A or B, that usually manage to infect anywhere from 33 to 52 percent of Americans each year. Because flu affects older folks so severely, it is the sixth leading cause of death in the United States.

Pneumonia, which is generally characterized by coughing, phlegm, fever, chills and chest pain, can be caused by a variety of infectious agents, including viruses, mycoplasma parasites and bacteria. It occurs in 80 percent of those who have AIDS. Called Pneumocystis carinii pneumonia, it is triggered by a parasite and is seen only rarely in people without AIDS.

Fortunately, both flu and the most deadly and common types of pneumonia can frequently be prevented or successfully be treated without permanently damaging your lungs. Here's how.

Be alert for signs of danger. Some types of pneumonia, such as staph or klebsiella, can seriously damage the lung, says Dr. Mostow, and "your lung is never the same afterward." So see your doctor quickly if you have a fever, breathlessness or a nagging cough that won't go away.

Defend yourself against pneumonia. The pneumonia vaccine doesn't prevent pneumonia, says Dr. Mostow, but it can prevent you from dying when pneumonia strikes. The vaccine is effective against 23 different types of bacterial germ--the kinds that are responsible for 90 percent of pneumonia deaths. You need to get it only once in your life.

Protect against flu. The flu vaccine is highly effective, says Dr. Mostow.

Anyone with chronic lung or heart disease, diabetes, impaired immunity, kidney disease, anemia or another blood problem should get the vaccine every year in the fall, as should anyone over age 65 and anyone who's involved in the care of patients.

Who should not get the shot? Since the vaccine is incubated in eggs, those who are allergic to eggs should avoid it. In general, if you can eat eggs, you can safely receive a flu shot.

Visit your family physician. If you forget to get your flu shot, there are two prescription antiviral drugs that can stop flu in its tracks, says Dr. Mostow. One is amantadine (Symmetrel), and the other is rimantadine (Flumadine). These two compounds are active against influenza A, the only flu virus that kills. Just one caveat: You must get them from your doctor within 48 hours of when you come down with the flu.

If you forget to get the pneumonia vaccine--or if you're unlucky enough to run into one of the pneumonias that's not in the vaccine--your doctor will prescribe an antibiotic that is specifically designed to kill the virus or bacteria that have attacked, says Dr. Mostow. If you have the form of pneumonia that affects those with AIDS, P. carinii, then your doctor will prescribe trimethoprim sulfate (Polytrim), a drug that won't cure it but will keep the disease under control.