MEDICAL MINUTE: IT’S NOT EASY BEING WHEEZY
This week, our paramedic students have been studying their unit on diseases of the pulmonary (lungs) system. This is an intensive unit because one of the most common 911 calls that they will encounter involves shortness of breath. Specifically, Chronic Obstructive Pulmonary Disease (COPD) patients. They are so named because, in one form or another, the diseases interrupt the normal flow of air from the nose/mouth into the lungs for gas exchange. COPD is a general name given to a family of disease including chronic bronchitis, asthma, and emphysema. One of the most common preventable ones is the last mentioned, emphysema.
First, let’s look at how the work of breathing actually takes place. The air we are surrounded by is 21% oxygen; this will be important later on in our discussion. As we breathe in, the air rushes through our nose/mouth and into our trachea. From the trachea, the air moves down through that windpipe and into our bronchi. The bronchi begin when the trachea splits at the base of our neck. These bronchi continue splitting thousands of times until they can’t be seen by the naked eye. At the end of the bronchi, the air reaches the alveoli. These are small, soccer ball like sacs and are the only place that it is possible for the oxygen in the air to move over into our blood. They also work to get rid of the expended carbon dioxide that we breathe out with each breath.
Now, think about that process of breathing from the eyes of someone with a COPD illness: If something happens to block or reduce the amount of air that is traveling towards the alveoli, the end result will be less air and oxygen that is available for gas exchange. In emphysema, this is done through damage of the lung tissue in those smaller bronchi. The extremely small bronchi, sometimes called bronchioles, collapses and make it extremely difficult to get new air in or old air out of the alveoli.
The most common symptom of emphysema is shortness of breath. Sometimes this is accompanied by a cough which is caused by an overproduction of mucus that cannot be cleared away. There can also be wheezes, or high-pitch, musical notes, at the end of each breath. You should know that the collapsed bronchioles and other damaged areas decrease the size of the air passages. This makes the whistling sound that is common with wheezes. Furthermore, you might notice that your tolerance for exercise decreases over time. This is because as we expend energy, our need for fresh oxygen increases. A person with emphysema cannot replenish their amount of oxygen fast enough due to the damaged lung tissue. During this time of exercise or other shortness of breath moments, you might find that you are “pursed-lips” breathing, or breathing through lips that look as if you are puckering up for a kiss. This is a self-defense mechanism that is aimed to increase the force in which you take air into your body.
You should seek medical care from your personal physician if you suspect that you have emphysema or if you have noticed any hint of blue beginning to form around your lips, tongue, or fingernails. This is called cyanosis and can indicate a worsening of COPD. If you experience periods of shortness of breath that have increased in frequency or duration, make that appointment. You should call 911 or go to an Emergency Room if you become suddenly and severely cyanotic or begin to become light-headed or disoriented due to your respiratory problems. Many people in emergency situations will also sit in the “tripod” position which is upright with hands on the knees in an effort to bring in more air with each breath.
Cigarette smoking is the number one cause of emphysema. It is never too late to quit. Smoking directly affects the cells in the bronchioles ability to clear mucus which leads to the decreased air reaching the alveoli. Without constant clearing, the mucus is allowed to build up, severely reducing your ability to breath. Although there are other, less common causes, smoking is the one that is most easily fixed. Remember, you are shorting your life by an average of seven minutes with each cigarette smoked. Do yourself a favor, a kick those butts! If you think you can’t, remember, it isn’t easy being wheezy. Stay safe out there.
M. Eric Williams, MS, NR-P is a syndicated columnist and the Assistant Director of Emergency Medical Technology Education at Jones County Junior College. He is a current Doctoral researcher at Delta State University and has 15 years’ experience in healthcare. If you have questions or comments, you may contact him at eric.williams@jcjc.edu
