By: Fernando Neto – Massage Therapist
BREATHLESSNESS (or dyspnoea) is described as the feeling of shortness of breath. It is a very common complaint associated with various medical conditions affecting the heart, lungs and other systems.
Obstruction of the air passages in the nose, mouth, throat or lungs themselves (such as with a pulmonary embolus), can cause breathing difficulties as well as abnormalities of the chest wall or musculature thereof. This occurs because the heart is unable to pump enough blood to supply adequate oxygen to the rest of the body. In addition, heart problems can cause pooling of blood and fluid in the lungs (pulmonary oedema), which further limits gas exchange in the lungs.
First, heart diseases usually cause shortness of breath during exertion, but later they develop the characteristic types of breathlessness called orthopnoea, breathlessness while lying flat, you may find it more comfortable sleeping on several pillows and paroxysmal nocturnal dyspnoea (PND), breathlessness that wakes you up from sleep. Anxiety, anaemia and even cancer are some of the other common causes of breathlessness.
How many of you have noticed that you cannot walk as fast or as far without getting breathless? How many have started using buggies on the golf course because of shortness of breath, wheezing and coughing? How many have stopped going to the gym or doing sports because your “stamina” is just not what it used to be? And how many have put this down to your age creeping up on you?
Well, we have some news for you. These might be the first signs of Chronic Obstructive Pulmonary Disease (COPD) and, as a few of our patients recently found out, if diagnosed and treated early it can have some seriously beneficial effects on your activities of daily living.
What is COPD?
COPD is characterised by limitation of airflow in the lungs as a result of obstruction that is no longer fully reversible and is usually progressive, causing interference with normal breathing.
The obstruction is caused by chronic inflammation, tissue destruction and eventual scarring of the airways, which then lose their elasticity and make breathing more of an effort than usual. This happens in smokers (past and/or present), people with chronic bronchitis, emphysema and even long-standing asthma, any condition which causes chronic inflammation of the airways and which had progressed to a basically irreversible condition.
The signs and symptoms of COPD include:
• Sputum (mucus) production.
• Shortness of breath, especially when exercising.
• Wheezing (a whistling or squeaky sound when you breathe).
• Chest tightness.
Symptoms often occur years before the flow of air in and out of the lungs is reduced. However, not everyone with a cough and sputum production goes on to develop COPD, not everyone with COPD has a cough and not every breathless person has COPD! There are many other causes.
To determine whether you have COPD or not, a lung function test must be done and possibly a chest X-ray, as well as a full assessment of the past medical history, family history, the onset of symptoms and the current general condition.
Smoking is the primary risk factor for COPD, causing approximately 80 to 90 per cent of COPD deaths. But, for those of you who immediately say, “I’ve never smoked! How can I have COPD?” other risk factors include air pollution, second-hand smoke, history of childhood respiratory infections and heredity. People with a family history of COPD are more likely to get the disease if they smoke. Occupational exposure to certain industrial pollutants like chemical fumes, vapours, as well as long-term dust exposure – on building sites, in the carpentry business and breeders of certain types of birds – also increases the odds for COPD.
Most people with COPD are at least 40 years old or around middle age when symptoms start. It is unusual, but possible, for people younger than 40 years of age to have COPD.
According to the American Lung Association’s fact sheet, COPD is the fourth leading cause of death in America. In 2003, it claimed the lives of 122,283 Americans. It is estimated that there are currently 14 million people in the US diagnosed with COPD. An additional 14 million are still undiagnosed. It is the second leading cause of missed workdays and the only major health problem in which mortality has been increasing over the last 20 years. This confirms my findings in practice and is why I often insist on doing further assessments, even for those with minimal symptoms.
Surprising little has actually been learned over the years about COPD. Studies have been very limited; however things do seem to be improving with some encouraging studies and clinical trials under way for medications and treatments, some of which are already available on the market and have had the most positive results.
However, there is a long way to go, thus in 1998, in an effort to bring more attention to COPD, its management and prevention, a committed group of scientists encouraged the US National Heart, Lung, and Blood Institute and the World Health Organisation to form the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Among the important objectives of GOLD are to increase awareness of COPD and to help the millions of people who suffer from this disease and die prematurely from it or its complications.
The good news is that COPD, though considered a chronic, debilitating and sometimes fatal disease, can be managed, controlled and slowed down, as long as the diagnosis is made early enough and treated appropriately.
The goals of COPD treatment are to:
• Relieve your symptoms with no or minimal side effects.
• Slow the progress of the disease.
• Improve exercise tolerance (your ability to stay active).
• Prevent and treat complications and sudden onset of problems.
• Improve overall health.
The basis of COPD treatment is bronchodilators (drugs that help open up the small airways in the lungs). These are usually administered as inhalers, but in severe cases tablets are taken in addition. Corticosteroids are only used during acute attacks and as prophylaxis in moderate/severe cases.
The most important element of treatment is to prevent infections, as the build up of mucous in the lungs is a perfect breeding ground for nasty bugs. Each infection causes further inflammation, further scarring of the tissues and worsens the overall condition of the lungs with a consequent deterioration in symptoms. Regular vaccinations for flu and pneumonia are also essential.
Breathlessness can be distressing and frightening for both the person having the symptoms as well as the one observing them.
All problems with breathing, whether of sudden onset or long-term and, regardless of other symptoms, should be considered seriously. Although many of the possible causes are harmless and easily treated, you should still see your doctor for a thorough medical evaluation.
So the next time you think that that “breathless feeling” is just old age, think twice.
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