Q: I would like to know what can be done to relieve my breathing problems and how low an oxygen level has to be before a person needs oxygen 24 hours a day. I have COPD and about two years ago I had a staph infection in my lungs. My breathing hasn’t been the same since. I would be very grateful if you could give me some kind of answer. I read your good answers every day. Thank you.
A: Chronic obstructive pulmonary disease (COPD) is a group of lung diseases that block air flow, making breathing difficult. The two most common conditions that make up COPD are chronic bronchitis and emphysema. Chronic bronchitis represents inflammation and narrowing of the lining of the bronchial tubes that carries air in and out of the lungs. Emphysema occurs when the alveoli, the air sacs at the ends of a person’s air passages, ultimately collapse. Generally speaking, symptoms don’t present until significant damage to the lungs has occurred but can include chronic cough, shortness of breath, wheezing, cyanosis (a blue tinge) of the lips and fingertips, frequent respiratory infections, and tightness of the chest.
The most common cause is a history of tobacco use that affects about 20% of all smoking patients, followed by exposure to other lung irritants at home or in the workplace. There is also a minimal percentage of COPD cases that result from a genetic order that causes low levels of a specific protein known as alpha-1-antitrypsin (Aat), made in the liver and secreted into the bloodstream to help protect the lungs. AAt deficiency may be treated with replacement of the protein to prevent progression of further lung damage.
Individuals with COPD are at increased risk for respiratory infections including pneumonia, colds and the flu, all which make it more difficult to breathe. COPD may also cause pulmonary hypertension in those arteries responsible for bringing blood to the lungs and may place a person at higher risk for coronary issues, as well. Diagnosis can be made through chest X-ray, CT scan, pulmonary function testing, and arterial blood gas analysis.
There is help and hope for COPD which begins with the individual discontinuing smoking, preventing others from smoking within the same living quarters because of inhalation of second-hand smoke, using a bronchodilator (perhaps in combination with inhaled steroids), oral steroids, antibiotics, medication to decrease airway inflammation, the use of oxygen, and more. The amount of oxygen and extent of usage depends on each individual case and must be considered along with other possible medical problems. When all else fails, lung transplant or lung volume reduction surgery may be appropriate but wouldn’t be considered without all other possibilities attempted first.
Long-term therapy should be used at least from 15 to 24 hours a day but before instituted, arterial blood gasses (ABGs) should be done to determine how bad your lungs are. Generally speaking, Medicare and other insurance companies will not reimburse an individual for home therapy without ABG results that must meet the following guidelines: an arterial partial pressure less than or equal to 55 mg Hg, or between 56 and 59 mm Hg or the oxygen saturation is 89% with evidence of right-sided heart failure due to breathing problems, heart failure, or there are an increased number of red blood cells present; an arterial oxygen saturation less than or equal to 88%, or when arterial oxygen saturation is greater than 88% at rest but becomes less than or equal to 88% at rest or awake. Oxygen therapy is generally prescribed to raise the partial pressure of oxygen to between 60 and 65 mg Hb or the saturations from 90 to 92%. Higher rates don’t generally help and may even be dangerous. Keep in mind that oxygen is a fire hazard.
Protect your lungs. Avoid pollutants, eat a well-balanced diet, exercise as much as possible under your doctor’s direction, and consult a respiratory therapist who can help you with relaxation techniques that may be beneficial during a period of exacerbation. COPD is a serious disease but it is both treatable and often preventable.
Readers who are interested in learning more can order Dr. Gott’s Health Report “Pulmonary Disease” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order payable to Dr. Peter Gott Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
