Friday, June 6, 2014

Eyes....Soul's mirror.












                                                                         


Compare and contrast the properties of rod and cone vision

As we open our eyes and look around, we see a panorama of light images with the help of the retina - a light-sensitive tissue at the back of each eye which converts light energy into neural signals and then transfers these signals to the brain. This is done through the photoreceptor cells, which are in control of detecting attributes like colour and  light intensity. These photoreceptor cells are of two types: rods and cones. We are now going to look deeper into each of their individual functions and differences.

Rods and cones differ in their construction, size and shape. The basic difference, as the name suggests, is that the outer structure of rods is straight and narrower whereas that of cones is of a conical shape and wider. Not only that but they differ in their arrangement, as well. Rods contain disks and cytoplasmic space whereas cones have invaginations of cell membranes. The pigments of rods are located in these disks and the pigments of cones situated in the infoldings of the cell membrane.

Both rods and cones are sites of the transduction of light energy into neuronal signals but they, in essence, work in opposite ways. Rods respond to low levels of light at all wavelengths to generate neuronal signals but cones require high levels of light for the very same signals. This happens because cones have lesser pigments than rods and need more light to detect images.





                                                                           Rod


                                                                            Cone

The most important distinguishing factor between rods and cones is that rods are not responsible for discriminating colours and work in conditions of low light (such as dusk and nighttime) but cones are certainly in charge of colour vision and work best during the daytime. In other words, rods are generate nocturnal vision and cones create high resolution diurnal vision.

You can also say, cones have high visual sharpness, whereas rods do not. But it is due to high sensitivity of rods to dimmest illumination, that enables vision .possible
Cones are less sensitive than rods. This is because rods are receptive enough to respond to a single photon of light whereas cones require tens to hundreds of photons to get triggered. However, rods are 6 to 15 times less sensitive than cones when it comes to light increment.

To make it clearer, rods are sensitive to scattered light and saturate only in daylight, while cones are sensitive to direct axial rays and saturate only in intense light.

Rods are comparatively abundant than cones and there are about 110 to 130 million present in the human eye. Cones, on the other hand, are known to be approximately 5 to 7 million.

Cones, being narrower, are concerned with the direction of light reaching them, whereas rods are not so bothered and respond well to dispersed light.

Rods also have only one kind of photosensitive pigment, which is completely responsible for night vision and seeing black, white and shades of gray. They allow us to see when it’s very dark. In contrast, cones sense mixtures of light waves and have to do with colour vision. They have three types of pigments: red (64%), green (32%) and blue (2%). Together, all three type of these cones enable us to see a spectrum of colours.

Every cone is served by one neuron while in contrast, sets of rods are served by a single common neuron. Rods are also known to have highly-convergent retinal pathways while cones have less convergent retinal pathways.

The density of the rods is a lot higher than that of cones all over the retina but in the fovea, cone density reaches 200-fold and beats rods by miles. Moreover, cones are concentrated in the centre of the retina in the fovea while rods are located everywhere in the retina except in and around the fovea. The foveola, in fact, is entirely free of rods. Rods are also more easily procured than cones and their parts are comparatively easier to separate than the parts of cones.

Due to the fact that the sensitivity of the rod system is lesser than that of cones for higher illumination, rods do not recover quickly from bleaching lights - unlike cones. This has to do with two chemicals: iodopsin (in the cones) and rhodopsin (in the rods). Being in the light bleaches these chemicals. When you go into the dark, the bleaching stops and the chemicals restore their original levels. This is also known as dark adaptation.

Similarly, when we move from a dark area to a well-lit area, the glare gets too much to handle and it takes a bit of time for our eyes to adjust. This is because the visual inception in the cones increases due to the bleaching of iodopsin. It takes about five minutes for the eyes to acclimate. This is known as light adaptation.

The central field of vision is solely performed by cones, under high illumination, producing visual acuity of sharpest image with perfect color sensitivity. It is as much as ten times better than peripheral vision. Whereas peripheral field of vision performed by rods is highly sensitive to fading illumination, has insignificant color identification and lacks shape formation feature.

Since we have concluded that rods are responsible for night vision, the loss of rods causes night blindness, while, similarly, the loss of cones causes legal blindness. Both of these photoreceptors together work towards normal eye vision and make for the perfect visual system.

Why We Need Two Systems

The human eye is basically a specialized transducer, with the capability of converting signals of light with varying wavelengths into visual images. In order to act on electromagnetic radiations emitted from the surrounding spectrum, eye’s visual system converts such signals into visible images. For carrying out such highly specialized functions, the structure of the eye is studded with immensely delicate units of rods and cones. Both these specialized optical units perform the delicate function of converting light impulses from surrounding objects and illuminant surfaces into chemically mediated nervous signals, ultimately sending those signals to the visual cortex of brain.

Rods and cones are the basic and most vital units of the visual system. It is only these rods and cones which have the capability to catch electromagnetic impulses (photons) reaching our retina, and converting them into visual signals. The location of rods and cones is on outer retinal layer. The processing and perception of signals is done by the middle neuronal layer of retina. That only takes place when the light signals have been generated by rods and cones, after trapping photons from illuminant surfaces.

The normal visual capability of a human eye goes through a two-way processes. At first it needs to perceive strength of illuminant surface, and secondly it requires to assess strength of information of image signals. This dual role is effectively carried out by the two different systems within rods and cones. Of the two, rods have the specific function for dark vision, because of their lower electromagnetic perception threshold. Whereas cones fulfill a wide range of electromagnetic frequencies’ analysis and thus performing varied or non-specific visual activities particularly daytime visual perceptions.

The more concentrated central location of cones system at fovea, enables retina to create a more sharp and focused image with the best visual acuity. Where there is a decline in the number of cone receptors more peripherally, it makes it impossible to receive lower wavelength electromagnetic signals. It is at this region away from fovea, rods’ receptors are more abundant. So when eyes move sideways, the lower threshold for wavelength of light stimulus enables dimmer objects to be visualized easily. This is clear indication of such a delicate advantage of the dual optical system of retina.

It is these two systems of rods and cones, with stimuli from surrounding illuminant objects, that helps the retina to create sharpest of images at given time of day. The rods, with pigment rhodopsin inside enables the eye to see shades of gray, white and black. They also assist in making out the shape of electromagnetic photons, hence form surrounding objects and surfaces.

The cones system in retina is needed to perform the function of identifying colors around the focus of eyes and plays a major role for visual acuity. They work best with higher wavelength electromagnetic stimulus, hence they are meant for bright light vision. With three different types of blue, red and green color receptor cones, it becomes easier to recognize different color image stimuli.

It is quite clear that rods enable the retina of the eye to adapt to nighttime or dim illumination vision (scotopic). The limitation of rods to discriminate only in shades of white to black becomes obvious at twilight, when it is not possible to make out different colors.  The cones function in good illumination, performing color vision and resolution of finer details (photopic vision) of surrounding objects. They are so tuned up for each specific role, so no intermingling or wrong signals are transmitted for brain cortex during creation of an image.

The range between photopic and scotopic vision of the two systems of the eye is so wide that it allows remarkable working space for the human eye to changes in electromagnetic wavelength (brightness) to almost 1000,000,000 times. Having said that, unprotected exposure to laser or sun may cause severe damage to retina.

It will be relevant here to point out, that there are certain conditions, either congenital or acquired which may cause poor night time or dim light vision. Retinitis pigmentosa is one such congenital (by birth), where rod receptors are abnormal or damaged. In some cases cones are damaged. Consequently there is poor or no dark adaptation, loss of peripheral vision and in severe situation loss of central vision.

Similarly there are conditions, not uncommon, in which eyes are unable to distinguish different color spectrums. As we know that it is cones system which enables us to perceive a wide range of colors from illuminant surfaces. The three types of cones, blue, red and green, have different sensitivity to electromagnetic wavelengths. Light entering cones cells stimulates them simultaneously, sending signals to visual cortex. Here the brain cortex interprets signals into a wide range of colors. As rods have a very limited color sensitivity, the three-color cones system performs this remarkable function of recognizing the beautiful colorful world of ours.

Color blindness, as we call it, can either be due to abnormal cones or fault in the signal pathway from cones to visual cortex. This further emphasizes the existence vitality of the dual system rods and cones inside retina. Most color blind people are unable to perceive and distinguish shades of red and green.

Although rods and cones function between wide range of light wavelengths (498nm for rods and 555nm for cones) where both these receptors work independent. Still some misconception needs to cleared. There are intermediate illumination levels at which they perform the function of photon receptors simultaneously. This level of wavelength at which photopic (cones function) and scotopic (rods function) is at transition level of illumination of twilight (dusk) is known as mesopic vision. At the illumination level of dusk, both rods and cones system are not working at full potential, still they are active in visual perception. When these two systems are active together, it plays significant role during night aviation.

The range of intensities of perception from illuminant surfaces between scotopic (rods system) and photopic (cones system) becomes evident when light starts fading. At this level of photon (electromagnetic impulses) the color discrimination becomes impossible. Still, due to higher sensitivity of rods, even to dimmest of light sources, retina can perceive signals and send them to visual cortex in dim gray shades for image build up. This clearly shows the vitality of two systems vision in human retina.

Both these photoreceptors, so vital structures located inside retina, function to compliment and not weaken human vision. The structure, pigments and concentration of rods and cones in retina allows each to perform specific visual response. Rods furnishing dim light information and object movements, whereas cones giving sharp details and color patterns of surroundings

The manner in which both systems work is in perfect sequence and harmony. They never intermingle under specific daytime or night time conditions but adjunct each other at one particular time of day.


Friday, May 23, 2014

Polio.The disease, virus, prevention and management









Introduction

The Polio virus is an organism,smaller than a bacteria which effects human nervous system cells. It multiplies inside the motor neuron cells of nervous system and totally destroys motor neuron cells. The destruction of motor neurons ultimately causes paralysis of various groups of muscles in human body. The virus gains entry into motor neuron cells by attaching itself to the cell receptors.After gaining access it multiplies into thousands in very short span of time, destroys the cell identity and takes the fucntion of parent cell.The polio virus has three variants, type 1,2 and 3.










What are the major muscles effected?

When polio virus attacks the spinal cord motor nerve cells, it results in paralysis or loss of abilty to move different muscles of arms, legs and respiration.This is medically termed as spinal polio.

When it infects motor neurons of eyes, taste, swallowing and breathing, it is known as bulbar polio. 
In certain cases it involves both spinal and bulbar elements of paralysis.

How Polio presents?

Polio virus infection  occurs in majority cases without any obvious sign or symtom of sickness.

Non-paralytic polio, is a form of polio virus infection where symptoms of flu appear, which last from few days to weeks. These signs and symptoms include fever, sore throat vomitting and headaches. Pain in neck, back and limbs with muscle spasms and tenderness may be predominating complains in some cases. Few of non-paralytic cases of polio develope meningitis, when infection spreads to membrane covering brain and spinal cord.

Paralytic polio has few of symptoms overlaping like non-paralytic variant. But it gets severe and causes impairment of motor functions. It usually is unilateral. There is pain in muscles of limbs, diminished or total loss of reflexes, spasm and ultimate flaccidity of limbs or muscles effected by polio viral infection. When muscles of respiration are infected, severe difficulty in breathing occurs, making survival more difficult. According to WHO every 1 in 200 cases with polio virus developes irreversable muscle paralysis.




Who is hit most by poliomyelitis?

Polio virus has prediliction for infecting children under 5 years of age. Of the % effected by polio virus, 99.5% do not get paralytic polio, only .5% progress to show signs of flaccidity of muscle/groups Other group most susceptable are pregnant women and individual with compromised immune system due to some disease process.

The mode of enterance of polio virus is through mouth. Contaminated water is biggest source of polio virus, which is excreted in faeces of polio infected individuals.

What are the risk factors?

Travelling to regions where polio virus infection is endemic.
Living in close contact with polio virus infected case.
Working in lab which handles live polio virus.
Tonsilectomized individuals.

How Polio virus infection is detected?

During first 3-10 days of illness polio virus can be isolated from oral scrapings.
Major diagnostic specimen is stool sample from individual showing acute signs of illness.
It is very rarely diagnosed from blood or CSF fluid exams.

Can polio be treated?

There is no known cure for any of variant of polio. When it is established that an individual has poliomyelitis, paralytic or non-paralytic, only supportive measure can substantially improve quality of life. For non-paralytic polio anti-pyretic analgesics help to control fever, headaches and associated muscle pains. That does not rid of polio virus from intestine of effected person.

Respiratory infection and breathing difficulty are the major problems to manage when respiratory muscle paralysis has occured. It may require instituting anti-biotics for chest infection and ventilator for maintaing respiration.







When paralysis is at earliest stage, applying plaster splints or sandbags for hip support at angle less than 10 degrees may significantly relieve  pain and prevent development of limb deformity.









 Physiotherapy is the core treatment strategy of paralytic polio. It involves hydrotheray,electrical stimulation of effected muscle/group and exercises.



Orthostatic appliances are placed over region effected, particularly upper leg to below the knee, to prevent angulation or deformities.




Prevention of polio

The standard oral polio vaccination is programmed to prevent infection from polio virus. Oral polio vaccine drops are given to kids from age 2,4 and 6 months with booster doses at age of 18 months and 6 years.Adults who have complete vaccination documentation during chidhood are considered polio virus immunized or free from virus and carry a life long immunity.












Sunday, May 18, 2014

COPD, Life style,Support and Prevention












Life style factors, Support and Prevention

Your COPD (chronic obstructive pulmonary disease) has already jeopardized your well being. It has caused enough damage to your lung’s structure and function, which is irreversible. Now is the time to bring stability in your overall general health and pulmonary functions. This can be achieved by giving up habits and surroundings that have played a major role in causing your COPD. Following measure can help you halt the progress and improve your lung capacity and working.

Ÿ  Quit smoking, as it will stop further damage and help the medical treatment have its maximum effects. It will also reduce the effects of carbon monoxide in smoke on oxygen carrying of your blood. This toxic gas in smoke decreases red cells oxygen carrying capacity to your vital organs like brain and heart. The quicker you stop smoking the more faster your COPD disability starts stabilizing. If you find it difficult to stop smoking your health care provider may advise nicotine replacement substances (nicotine gums, patches, nasal sprays).

Ÿ  Avoid getting exhausted by resting when you feel out of breath or tired. Learn to exhale slow and longer, don’t put force into it. Your doctor will guide you some good breathing techniques to improve your early exhaustion and easy intake of fresh air. Pursed lip breathing is one such way to have better air entry which increases your lung capacity. Inhale deep and close your lips. Slowly exhale evenly through your pursed lips making whistling sound. Repeating the procedure 4-5 times will relieve your shortness of breath. This alone will gradually minimize breathing hardship. Learn to breath by using your diaphragm muscle. Inhale slow while you lie down, inflate your abdomen outwards. That brings your diaphragm down, making more room for your lung expansion. These techniques of breathing will increase your exercise tolerance as well as improve air entry in your lungs.

Ÿ  Eat well balanced and nutritious diet. This should have more fresh fruits and vegetables. Diet rich in legumes, nuts, meats will supply proteins. They will help you maintain good repair speed from COPD and make your muscle more stronger.

Ÿ  Fluids should be taken liberally. They keep a good hydration and make mucus in your airways less viscous. Less viscous mucus is easy to be coughed up and expelled to clear your airways.
Ÿ  Getting vaccinated will reduced the risk of further damage to your COPD effected lungs from viral and bacterial infections. Flu and pneumococcal vaccination generally help avoiding most common infection.

Ÿ  Keep yourself active socially by visiting friends and family members. This will lift up your mood which may generally get depressed by COPD handicap.

Ÿ  Avoid triggers like indoor or outdoor pollution. Cold dry weather and high altitude will make your breathing effort more tiring, keep away from such triggers. If your work has been with exposure to fumes and dust related industry, changing occupation will stabilized your COPD.

Ÿ  Good hygiene is best way to keep you clean and protected from common bacteria and viruses. Common liquid dish wash should be used, which has been proved to kill RSV(respiratory syncytial virus) very effectively, know cause of pneumonia.

Ÿ  Keep a lean and healthy weight. Obesity has negative impact on general health. It may further increase burden your compromised breathing and lung capacity. Reduce weight if obese or over weight.

Ÿ  Eat small and frequent meals. As eating large meals at one time is not possible due to breathing difficulty and general weakness of COPD. That will surely keep your nutritional status at healthy levels.








Coping and support

You should not let your suffering from COPD get the best of you. Since you are now under care of your doctor. Take it as a challenge and with his guidance you must learn to live with situation. You may at times feel severely depressed and disabled by COPD. But things like caring for your safety, communicating with your loved ones, joining groups with same problem. Share your thought and get to know anything on new treatment methods for COPD that may have beneficial effects. Knowing that you may get short of breath, take rest between chores. Don’t push yourself for hard tasks. Take physical therapist advise on degree of physical exertion you should be taking at a given pace and time.






Prevention

Smoking is the major cause of your COPD. It is also a well established fact that keeping away from smoking will not only prevent respiratory illnesses but many other health problems. Quitting smoking will bring some normalcy to your life if you have COPD. Quitting smoking is the single most benefit factor for your COPD, as it is the major cause of your health disability. Don’t smoke if you haven’t started, is the clear message you will get from your healthcare provider. As there may be some other reasons involved. Smoking will aggravate your disease.
Ÿ  Avoid fumes and dust and occupation place by taking standard safety measures. That includes wearing mask all the time while at work. Avoid second hand smoke by keeping non-smokers company.
Ÿ  If you have any sibling with history of COPD or alpha-1 antitrypsin  deficiency, you have greater risk of COPD development later in life. Get timely shots of deficient enzyme. Weekly I/V infusion alpha1-antitrypsin protein will bring its concentration in alveoli to normal. This will help in preventing development of COPD along with keeping away from smoking all your life.

6.0     Natural treatment
Acetyl-L-Carnitine.  

Acetyl-L-Carnitine, also called MRM, is an anti-oxidant with a basic form of L-Carnitine. Carnitine plays a major role in the conversion of body fat into energy. Beef is the highest source for carnitine, though there is no major dietary requirement as carnitine is essentially manufactured by the body itself. Carnitine helps improve the tissues ability to produce energy, thus theoretically supplemental carnitine can improve muscular efficiency. Due to this, carnitine is linked to treatments for angina, Alzheimer disease and COPD. A research conducted on 49 individuals in a blinded placebo-controlled study showed visible improvement in COPD tolerance(Dal Negro R, 1986). 

Boswellia

Arising from a family of trees in the Sapindales order, Boswellia is a plant used in many medications due to its anti-inflammatory properties. Trials on humans have revealed the effectiveness of Boswellia extracts for the treatment of patients suffering from rheumatoid arthritis, ulcerative colitis and COPD (Ammon HP, 2002). Compelling data shows that the boswellia extracts successfully inhibit 5-lipoxygenase, which is an enzyme that causes an inflammatory response in the body. On a long term treatment basis, Boswellia has not been shown to cause any adverse reactions as opposed to non-steroidal anti-inflammatory drugs (NSAIDs). Though future studies are needed to gauge the safety and efficacy of Boswellia with other remedies.

CoQ10 

Also known as vitamin Q10 and ubiquinone, CoQ10 is a co-enzyme, similar to a vitamin. It functions as an anti-oxidant helping the cells in the production of energy and also for cell maintenance. Supplements of CoQ10 help in improving your general cardiovascular health. Studies conducted on the efficacy of CoQ10 on smokers and patients with COPD has shown positive results. Patients suffering from hypertension and heart disease have markedly improved their exercise tolerance on the consumption of CoQ10 supplements. A study conducted concludes, “Oral administration of co-enzyme Q10 improved subjective fatigue sensation and physical performance during fatigue-inducing workload trials and might prevent unfavorable conditions as a result of physical fatigue” (Mizuno K., 2008).

Ginseng

Panax Ginseng is a perennial plant whose roots are used to treat various illnesses including COPD. When administered in patients during a study, ginseng was shown to have no side effects hence it is recommendable (Monaldi Arch Chest Dis. 2002 Oct-Dec;57(5-6):242-6). Since coughing and shortness of breath are the symptoms of COPD, the tonic made from the roots of ginseng is beneficial for the lungs and helps relieve them (collaborative study carried out by RMIT University, the Box Hill Hospital and Austin Health).

Omega-3

Found in oily fish such as mackerel and salmon, flaxseeds and flaxseed oil, omega-3 is acknowledged to improve the symptoms of COPD (Kagoshima University Hospital). Though COPD cannot be cured entirely, research proves that considerable relief can be provided to patients with COPD with the administration of omega-3. A diet rich in omega-3 lowers inflammatory cytokine levels  (Chest. 2005 Dec;128(6):3817-27).

Resveratrol

Chronic obstructive pulmonary disease (COPD) is mainly characterized by airway inflammation, which occurs due to oxidative strain in the body (Antioxid Redox Signal. 2010 Mar 9). Here, the role of resveratrol, being the antioxidant, becomes quite clear. Found in red grapes, berries and peanuts, resveratrol reduces inflammation and is known to be far more effective than corticosteriods in COPD treatment (J Pharmacol Exp Ther. 2010 Dec;335(3):788-98. Epub 2010 Aug 26). It also eliminates the production of interleukin in smokers with COPD by 94% (Thorax, October 2003).

Sulforaphane
Found in broccoli sprouts, Brussels sprouts and cabbage, sulforaphane contains disease-fighting compounds. It restores “antioxidant gene expression” in COPD (American Journal of Respiratory and Critical Care Medicine, September 2012). It is also known to reduce inflammation (Clinical Immunology, 2009). The supplementation of sulforaphane improves the macrophage phagocytic function of the lungs.

Vitamin D

Vitamin D is commonly found in tuna, salmon, sardines and milk but the easiest way to obtain it is to spend at least fifteen minutes in the sun daily. This vitamin is known to improve breathing for COPD patients (Thorax, 2010). Although vitamin D is commonly known to strengthen the bones, researchers believe it toughens the muscles too - thus, making it easy for patients with COPD to breathe. A study shows that high doses of the vitamin keep COPD patients’ health from worsening (Ann Intern Med. 2012 Jan 17;156(2):105-14).

Vitamin E

Since it has been established COPD is caused due to oxidative stress, vitamin E helps relieve the lungs of that stress because it is a natural antioxidant. Obtained from spinach, almonds, sunflower seeds, turnip greens, mustard greens, collard greens and bell peppers, vitamin E has been found to reduce the risk of COPD especially in women 45 years and older (researchers at Cornell University and Brigham and Womens' Hospital, April issue of Thorax, Vol. 66: 4). It improves the endurance capacity of DNA in the blood against COPD oxidation (Int J Vitam Nutr Res. 2007 Jul;77(4):272-9).

Zinc

Zinc is found in oysters, toasted wheat germ, veal liver, roast beef, watermelon seeds, pumpkin seeds, squash seeds, dark chocolate and crab. This mineral has anti-oxidative properties and promotes the betterment of a COPD patient’s health (Respir Med. 2008 Jun;102(6):840-4. Epub 2008 Mar 4). One study has concluded that supplementing zinc to COPD patients is helpful to counter the inflammation and airways restriction of this illness. It is based on finding of low serum levels, plasma levels and in hairs in patients with COPD. Zinc has been shown to keep a good balance between oxidant and anti-oxidant in your cells (Lang CJ, Bimetals published on 29 August 2010, sub. Of  dietry zinc and effects on inflammation).

Your COPD like so many other diseases is more preventable than treatable.The positive impact of quitting smoking or not smoking at all, getting alpha-1 anti-trypsin for compensating its lack, maintaining diet rich in vitamin sources and in case of any deficiency using supplements, are all measures which can help you prevent this debilitating illness.


Friday, May 16, 2014

COPD, complications and pharmaceutical therapies.











Complication

Chronic obstructive pulmonary disease is serious and debilitating health problem. It runs a long course to cause severe damage to your lungs. Its diagnosis and treatment usually starts when it has already caused secondary complication to your cardio respiratory system. Your lung capacity is markedly diminished as well as life routine compromised. The complication can be life threatening if exposure to causative agents is not avoided and supportive treatment not taken. Following secondary effects of  COPD may endanger your life;

Ÿ  Pulmonary hypertension arises when your lungs loose elasticity along with constriction and hardening of its blood vessels as result of COPD. Heart faces greater resistance to push blood into pulmonary artery, through your lung vessels. Ultimately oxygenation of blood is reduced.

Ÿ  Pneumonia of both viral and bacterial cause may readily effect you in COPD. The dual effect of reduced oxygenation and excessive mucus in airways makes your lungs more susceptible to infection by such organisms. Deterioration in your health due to COPD hampers or minimizes your immunity. Pneumonia further damages your lung tissue which is already facing restrictive effects of COPD, thereby creating a vicious cycle.

Ÿ  Cor Pulmonale is failure of right side of your heart due to chronic obstructive pulmonary disease. There is increased resistance faced by right ventricle of your heart in pumping blood through lungs. Pulmonary artery pressure rises and ultimately results slow pumping, lesser blood flow to lungs and breathing strain. Right ventricle enlarges and fail to work efficiently.

Ÿ  Polycythemia (increased red cells in blood) occurs due to reduced oxygen saturation of blood. It stimulates your bone marrow to produce increased number of red blood cells. This is mediated via erythropoietin(hormone for red cell production) release from your kidneys. The objective is to compensate reduced oxygen supply to your body cells as complication of COPD sets in.

Ÿ  Malnutrition and weight loss is very common when you have established COPD. The dyspnea (difficulty in breathing) is so troublesome that will make it hard for you to complete a meal. You may gradually start loosing weight. This further effects your body strength to carry out routine life activities.

Ÿ  Pneumothorax is presence of air between your lungs and chest wall. The over inflated air sacs in emphysema (COPD variant) may burst with result in escape of trapped air into chest cavity. This complicates into collapse of your lung if that air is not immediately removed from you chest wall through intubation.


Pharmaceutical therapies

The damage your smoking has caused during long term is irreversible. Any treatment at this stage will be supportive and not curative. The medicine and other modalities will halt progression of damage, enhance your strength needed for daily life activities to better extent. Following are medication that will be prescribed when you are diagnosed with COPD.



                                                                            Bronchodilator inhalers
                                                  

Ÿ  Bronchodilators,  are group of drugs that will relax and expand the constricted and narrowed respiratory passages. They can be taken orally, by injections or as aerosols/inhalers. The inhalation route of bronchodilators is much preferred as it effectively reaches the narrowed airways directly with immediate effects. Also the side effects associated with drugs are minimal. A combination inhaler of fluticasone and salmeterol is one of popular inhalers for COPD. Another inhaler to be prescribed contains formotorol and budesonide. They all have corticosteroids and long acting b agaonist bronchodilator. You may be given oral long or short acting beta agonist like albuterol, turbutaline, salmeterol, bambuterol, formoterol.
Ÿ  Side effects of beta agonist agents include ; tachycardia(rapid heart rate), tremors, premature ventricular contractions, sleep disturbances, lowering of serum potassium.

Ÿ         Anti-cholinergic inhaler may also be given. Ipratopium is one of such kind. They all have proven efficacy in your COPD maintenance treatment. They also relax the smooth muscles of your airways and reduce mucus secretions. These agents improve your exercise tolerance and forced expiratory volume in one second. They are prescribed to you if you have some underlying cardiac problem. Side effects of anti-cholinergic are, dryness of mouth, increased intraocular pressure.

Ÿ  Methylxanthines are group of drugs that have some bronchodilator effect. They also make mucus expulsion easy and strengthen airways in some way. Theophyline(oral) and aminophyline(inject able) are two agents of this group used.
Ÿ  Side effects of methylxanthines are, irregular heart beats, convulsions, headache, nausea, vomiting, diarrhea and heart burns.






                                                       

Ÿ  Corticosteroids,   such as prednisone and prednisone are very effective anti-inflammatory group of drugs for your COPD. They bring satisfactory improvement in lung function in 30%-40% of COPD patients. They reduce inflammatory reaction, hall mark of swollen respiratory passages and excessive mucus.
Ÿ  Side effects are, osteoporosis( thinning of bones), raised blood pressure, disturbed sugar levels leading to diabetes on long term use, weight gain, loss of sleep.

Ÿ  Vaccination, to minimize risk of flu and pneumonia. Flu shots are better to be taken with full consultation of your healthcare provider as they have shown aggravation of COPD. Pneumoccocal vaccine also decreases you risk of pneumonia, which may complicate your COPD easily.






Ÿ  Oxygen therapy,  may be needed to bring improvement in its concentration in your airways. This is highly reduced in COPD. It can benefit in your daily activity. Also it will be preventing heart strain and damage to vital organs. It brings about improvement in your sleep and keeps your energy level high.

Ÿ  Anti-biotics,  also have an important role to play in controlling infection in your COPD. These infections easily can harm your lungs. In acute flare ups of your COPD, the number one choice is tromethoprim-sulphamethaxazole combination for five days. Other group also effective are ampicillin and tetracyclines for same duration. Azithromycin has also shown promising results in dealing infection in COPD.
Ÿ  Side effects of anti-biotics are common with gastrointestinal upsets, skin rashes, vomiting , nausea, abdominal pains. Some of them may cause anaphylaxis, a sudden and possible life threatening reaction drug.



Thursday, May 15, 2014

Chronic obstructive pulmonary disease (COPD)



                                                                              Emphysema


 Chronic Bronchitis

Introduction

Chronic obstructive pulmonary disease also know as COPD, is chronic debilitating disease of your lungs. The condition is characterized by difficulty in your breathing associated with constant cough productive of thick mucus. It is caused most commonly by smoking and continues to progress in severity with more and more difficulty in your breathing ability and reduction in lung capacity. Chronic bronchitis and emphysema are two condition which mainly come under same definition of COPD, along with asthma. The common feature is reduced oxygen intake and carbon dioxide expulsion. This makes you  breathless or short of breath most of the time.

In chronic bronchitis there is distortion of your bronchial passages.Whereas in emphysema the alveoli of your lungs are enlarged with loss of their expandable quality. Other than smoking, your exposure to any irritant dust, chemicals can cause such damage leading to COPD. The damage to your lung tissues in both condition, chronic bronchitis and emphysema is irreversible. But if the insulting or the causative irritant is removed, further damage can be controlled. You may develop features of chronic bronchitis and emphysema at same time, if you continue smoking for longer duration.

Ÿ  Incidence; COPD worldwide is 4th most common cause of death. Whereas in US alone ,it is 3rd most common cause of death in both males and females. An estimated 16 million individuals are presently effected in US with chronic obstructive pulmonary disease (COPD). COPD is mostly encountered in smokers of 60 years and above age.
Ÿ  About $33 billions have been spend on healthcare of patients with COPD in US. More females are hospitalized than males due to this debilitating pulmonary disease.


-           Major symptoms that may effect you in COPD are, long standing cough with thick productive sputum, increasing difficulty in your breathing efforts, which is more marked when you indulge in exercise. With progress of COPD even exertion of simple nature like changing cloths or cooking. You may start loosing weight.


Causes and Risk factors

The principal/major cause of your COPD is extended or long term exposure to smoke or smoking. If you are involved in occupation which exposes you to irritant dust or fumes, you will have changes in your bronchial passages and smaller airways. These will lead to chronic obstructive pulmonary disease. The conditions of chronic bronchitis, chronic asthma and emphysema are grouped as COPD. They may co-exist in same individual. The morphological changes in your lungs, caused by smoking or getting exposed to second or passive smoke or chemical fumes are, loss of elasticity of your airways(bronchi) and air sacs (alveoli). Air  passages get swollen and inflamed filled with mucus, walls between air sacs are destroyed with loss of surface area of ventilation. These all will lead to reduction in oxygen intake and exertional effort for breathing to compensate.

Ÿ  Chronic bronchitis with or without asthma may lead to narrowing of your bronchial passages. This condition is further aggravated by excessive secretion of mucus due inflammation caused by smoke and other irritants reaching your airways. Asthma ,if it is not well controlled may lead to COPD with remodeling of lung tissues. Although the precise mechanism in both condition is quite different. In COPD, there is more of neutrophilic reaction involved, whereas asthma is characterized by eosinophilic response. Wheezing is common in both the conditions. The major difference between asthma and chronic bronchitis causing COPD is, the reversible narrowing of airways in your asthma.

Ÿ  Emphysema is another condition causing chronic obstructive pulmonary disease. Your lungs exposed for years to smoking or secondary smoke cause damage to smaller air sacs called alveoli in your lungs. Walls separating adjacent alveoli breaks down due to inflammatory damage and accompanying cough. Larger sacs are created which trap the air in them. The loss of exchange of oxygen and carbon dioxide results in your breathlessness. This situation over period of time becomes severe and irreversible. Your smoking and other irritants cause activation of macrophages in your alveolar cells. The macrophage response causes neutrophilic chemotactic factors release. Which in turn release protease, that breaks down alveolar tissue, resulting in your emphysema.


Risk factors

Your chronic obstructive pulmonary disease is one of world’s top five leading cause of death. The most difficult aspect of getting this debilitating illness treated early is, its slow and camouflage (hidden) progress to severity. With this fact in consideration the risk factors may guide in  preventing your ongoing lung insult and progress to COPD.

Ÿ  Smoking is one major risk for your respiratory handicap due to chronic bronchitis, emphysema, and chronic asthma (COPD). The earlier you start smoking and longer you have continued, is a major determinant risk for COPD. Even as passive smoker, how long you have been exposed to second smoke will put you in risk for either one of COPD variants. In as much as 80% to 85% of diagnosed COPD effected individuals, smoking is sole causative factor found. The number of cigarettes you smoke daily also determines your severity of COPD. In addition to cigarettes, cigar, pipes, and marijuana also increase the risk in your lung disability due to COPD.
Ÿ  Pollutant exposure will also play risk factor for COPD. If place of your work or residence is close to industrial unit’s the fumes and dust will increase your COPD risk. Exposure to biomass fuel in cooking enhances your chances for COPD development greatly if care is not taken.

Ÿ  Genetics may also make you more susceptible to get any of COPD conditions. COPD runs in families who have shown deficiency in a-anti-trypsin deficiency. This enzyme factor is produced by liver and it protects your lungs from damaging effect protease enzyme. Its deficiency may cause alveolar wall destruction specially in smokers, resulting in emphysema. When you have any of first blood relative with COPD, your smoking adds to greater risk.

Ÿ  Gender risk now has shifted towards females in COPD occurrence. Women are now shown to be more effected by negative influences of smoking on their lungs than men.

Ÿ  Lower socioeconomic status is more risk for development of COPD for obvious reasons. Lack of safety measure during using biomass fuel cooking methods, failure of early treatment of chronic respiratory illness. All will contribute to COPD at later age of life.

Ÿ  Preterm birth history means that after birth you must have received oxygen therapy. This method of artificial oxygenation will damage your lungs and increase COPD at advance age of your life.
Ÿ  Asthma has been linked to COPD, as it may cause permanent bronchial restriction to breathing. This may result if you are non-compliant to treatment and preventive measures.