MÜKAM KARÔTI VACÁLAM

PANGUM LANGHAYATÄ GIRIM

YATKRIPÁ TAMAHAM VANDÄ

PARAMÁNANDA SÁGARAM

PRAYER

Name of the disease & terminologiesEtiologyHistory, signs and symptomsPhysical examination InvestigationTreatment according to allopathic medicineOther therapiesYoga practicesBooks and journals for reference

INTRODUCTION

COPD is a general term for a group of diseases that cause progressive damage to the lungs.

Include Chronic bronchitis, Asthma and Emphysema.

Of the more than 16 million Americans with COPD, nearly 3 million have symptomatic emphysema and millions more are in the early stages of the disease before signs and symptoms appear.

Unlike asthma, which occurs when the muscles in the airways tighten, emphysema causes a loss of elasticity in the walls of the small air sacs in the lungs.

Eventually, the walls stretch and break, creating larger, less efficient air sacs that aren't able to handle the normal exchange of oxygen and carbon dioxide.

When emphysema is advanced, lungs must work so hard to expel air that breathing can consume up to 20 % of the resting energy.

Emphysema develops gradually over many years, may not experience symptoms such as shortness of breath until irreversible damage has already occurred.

Treatments focuses on relieving symptoms and avoiding complications.

SIGNS AND SYMPTOMS

The main symptoms of emphysema are shortness of breath and a reduced capacity for physical activity, both of which are likely to become worse as the disease progresses.

In time, patients may have trouble breathing even when lying down, and it may be especially hard to breathe during and after respiratory infections, such as colds or flu.

Other signs and symptoms of emphysema include:

Chronic, mild cough. Produces sputum while coughing.

Loss of appetite and weight loss. It's a vicious cycle. Emphysema can make eating more difficult, and the act of eating robs the breath.

Fatigue. Feels tired because it's more difficult to breathe and body is getting less oxygen.

In emphysema, inflammation damages the fibers around the walls of the alveoli, causing them to lose their natural elasticity and eventually to rupture. This creates one large air space instead of many small ones.

CAUSES When the patient inhales, air travels to the lungs

through two major airways called bronchi. Inside the lungs, the bronchi subdivide like the

roots of a tree into a million smaller airways (bronchioles) that finally end in clusters of tiny air sacs (alveoli).

There are about 300 million air sacs in each lung. Within the walls of the air sacs are tiny blood vessels (capillaries) where oxygen is added to blood and carbon dioxide – a waste product of metabolism – is removed.

What happens in emphysema Inflammation destroys these fragile walls of the air

sacs, causing them to lose their elasticity. As a result, the bronchioles collapse, and air becomes

trapped in the air sacs, which overstretches them and interferes with ability to exhale (hyperinflation).

In time, this overstretching may cause several air sacs to rupture, forming one larger air space instead of many small ones.

Because the larger, less-elastic sacs aren't able to force air completely out of lungs when exhale, patient breathes harder to take in enough oxygen and to eliminate carbon dioxide.

The process works something like this: Normally, exhalation in two ways, actively and passively.

Body needs more oxygen, chest muscles contract, forcing air out rapidly.

On the other hand, when sitting quietly, the diaphragm contracts and chest muscles expand to take air in, but muscles don't actively contract to let the air out. Instead, the elastic tissue around air sacs contracts, and lungs passively shrink.

In emphysema, many of these elastic fibers have been destroyed.

Forced exhalation compresses many of the small airways, making expelling air even more difficult.

Most common cause is smoking Cigarette smoke is by far the most common

cause of emphysema. The damage begins when tobacco smoke

temporarily paralyzes the microscopic hairs (cilia) that line bronchial tubes.

Normally, these hairs sweep irritants and germs out of airways.

But when smoke interferes with this sweeping movement, irritants remain in bronchial tubes and infiltrate the alveoli, inflaming the tissue and eventually breaking down elastic fibers.

Protein deficiency plays a role

In a small percentage of people, emphysema results from low levels of a protein called alpha-1-antitrypsin (AAt), which protects the elastic structures in lungs from the destructive effects of certain enzymes.

A lack of AAt can lead to progressive lung damage that eventually results in emphysema.

AAt deficiency is a hereditary condition that occurs when patient inherits two defective genes, one from each parent.

Although severe AAt deficiency is rare, millions of people carry a single defective AAt gene.

Some of these people have mild to moderate symptoms; others have no symptoms at all.

Carriers are at increased risk of lung and liver problems and can pass the defect to their children.

People with two defective genes have a high likelihood of developing emphysema, usually between the ages of 30 and 40.

The progression and severity of the disease are greatly exacerbated by smoking.

Experts recommend that people with early-onset emphysema – especially those who don't smoke or have other risk factors for the disease or who have a family history of AAt deficiency – be tested for the defective gene.

People who are found to have a genetic predisposition for AAt deficiency may want to consider having close family members tested as well.

RISK FACTORS

The single greatest risk factor for emphysema is smoking.

Emphysema is most likely to develop in cigarette smokers, but cigar and pipe smokers also are susceptible, and the risk for all types of smokers increases with the number of years and amount of tobacco smoked.

Men are affected more often than women are, but this statistic is changing as more women take up smoking.

Other risk factors include:

Age. Although the lung damage that occurs in emphysema develops gradually, most people with tobacco-related emphysema begin to experience symptoms of the disease between the ages of 50 and 60.

Exposure to secondhand smoke known as passive or environmental tobacco smoke, which is inadvertently inhaled from someone else's cigarette, pipe or cigar.

Occupational exposure to chemical fumes. From certain chemicals or dust from grain, cotton, wood or mining products may lead to emphysema. The risk is even greater if patient smokes.

Exposure to indoor and outdoor pollution. Breathing indoor pollutants such as fumes from heating fuel as well as outdoor pollutants – car exhaust, for instance – increases the risk of emphysema.

Heredity. A rare, inherited deficiency of the protein, alpha-1-antitrypsin (AAt) can cause emphysema, especially before age 50, and even earlier if patient smokes.

HIV infection. Smokers living with HIV are at greater risk of emphysema – and of developing the disease at a relatively young age – than are smokers who don't have HIV infection.

Connective tissue disorders. Some conditions that affect connective tissue – the fibers that provide the framework and support for the body – are associated with emphysema. These conditions include cutis laxa, a rare disease that causes premature aging, and Marfan syndrome, a disorder that affects many different organs, especially the heart, eyes, skeleton and lungs.

WHEN TO SEEK MEDICAL ADVICE

Short of breath most of the time. Cannot breathe well enough to tolerate even

moderate exercise. Frequently cough up sputum that's colored and

possibly infected.

SCREENING AND DIAGNOSIS

These noninvasive tests can detect emphysema before symptoms.

They measure how much air lungs can hold and the flow of air in and out of lungs.

They can also measure the amount of gases exchanged across the membrane between alveolar wall and capillary membrane.

During the test, patient is asked to blow into a simple instrument called a spirometer.

Pulmonary function tests (PFTs)

PFTs may be done before and after the use of inhaled medications to test response to them.

In smokers or a former smoker, tests are done frequently.

Chest X-ray

Chest x-ray is performed to evaluate the lungs, heart and chest wall.

Physicians use the examination to diagnose or monitor treatment for conditions such as:

Pneumonia. Heart failure and

other heart problems. Emphysema. Lung cancer.

Arterial blood gases (ABG) analysis These blood tests measure how the lungs

transfer oxygen to bloodstream and how effectively they remove carbon dioxide.

Pulse oximetry This test involves use of a small device that

attaches to the fingertip. The oximeter measures the amount of oxygen in

the blood differently from the way it's measured in blood gas analysis.

To help determine whether patient needs supplemental oxygen, the test may be performed at rest, during exercise and overnight.

Sputum examination Analysis of cells in sputum can help determine

the cause of some lung problems.Computerized tomography (CT) scan

A CT scan allows to see the organs in two-dimensional images or "slices."

Split-second computer processing creates these images as a series of very thin X-ray beams are passed through the body.

A CT scan can detect emphysema sooner than an X-ray can, but it can't assess the severity of emphysema as accurately as can a pulmonary function test.

TREATMENT

The most essential step in any treatment plan for smokers with emphysema is stopping smoking; it's the only way to stop the damage to lungs from becoming worse.

But quitting is never easy, and people often need the help of a comprehensive smoking cessation plan, which may include:

A target date to quit Relapse prevention Advice for healthy lifestyle changes Social support systems Nicotine gum or patches and sometimes use of

the antidepressant bupropion hydrochloride (Zyban) to help curb the irritability, depression and sleep problems that can occur in the first few weeks after quitting smoking

Other treatments, which focus on relieving symptoms and preventing complications, include:

Bronchodilators. These drugs can help relieve coughing, shortness of breath and trouble breathing by opening constricted airways, but they're not as effective in treating emphysema as they are in treating asthma.

Inhaled steroids. Corticosteroid drugs inhaled as aerosol sprays may relieve symptoms of emphysema associated with asthma and bronchitis. Although inhaled steroids have fewer side effects than oral steroids do, prolonged use can weaken bones and increase the risk of high blood pressure, cataracts and diabetes.

Supplemental oxygen. Severe emphysema with low blood oxygen levels, using oxygen at home may provide some relief. Various forms of oxygen are available as well as different devices to deliver them to the lungs.

Protein therapy. Infusions of AAt may help slow lung damage in people with an inherited deficiency of the protein.

Antibiotics. Respiratory infections such as acute bronchitis, pneumonia and influenza are a leading complication of emphysema, increasing the amount of sputum produced and making breathing problems worse. Broad-spectrum antibiotics may help relieve these symptoms, but should be used with caution to avoid the serious and growing problem of antibiotic-resistant bacteria.

Inoculations against influenza and pneumonia, COPD, experts recommend an influenza (flu) shot annually and a pneumonia shot every five to seven years.

Tests to monitor

Pulmonary Function Tests (PFT) Peak Expiratory Flow Rate (PEFR) Forced Expiratory Volume (FEV) Forced Vital Capacity (FVC) Vital Capacity (VC)

SURGERY

In a procedure called lung volume reduction surgery (LVRS), surgeons remove small wedges of damaged lung tissue.

Although it seems counterintuitive to treat diminished lung capacity by further reducing the size of the lungs, the extra space that's created in the chest cavity help the remaining lung tissue and diaphragm work more efficiently.

LVRS, first tried in the 1950s, fell out of favor because of little success and a high death rate.

The procedure received renewed attention 40 years later when the results of a large clinical trial called the National Emphysema Treatment Trial showed that LVRS could improve the lung function of certain people with severe emphysema.

Those who benefited had emphysema in the upper lobes of their lungs and a low exercise capacity even after undergoing several weeks of pulmonary rehabilitation.

People who didn't have emphysema in the upper lobes of their lungs and who had a greater exercise capacity after a program of pulmonary rehabilitation did not respond well to the surgery.

For those who were helped, improvement was greatest the first six months after the procedure.

After that, lung function gradually declined. People began having more difficulty breathing, and performance in the pulmonary function tests decreased.

By the two-year mark, the lung function in many people was about the same as it was before surgery.

On the other hand, eligible people who didn't have LVRS declined continuously over the two-year period.

TRANSPLANT

Lung transplantation is an option in severe emphysema and other options have failed.

Usually just one lung is transplanted because the survival rate has proved to be higher for people with single-lung transplants than for people with double-lung transplants.

PULMONARY REHABILITATION PROGRAM A key part of treatment involves a pulmonary

rehabilitation program, which combines education, exercise training and behavioral intervention to help restore patient to the highest possible level of independent living.

Smoking cessation, nutritional needs, special breathing techniques and ways to conserve energy is useful.

Exercise program. Aerobic exercises such as walking, riding an

exercise bike and special exercises for arms and legs.

PREVENTION Most cases of emphysema are due to smoking. If

patient smokes cigarettes, cigars or a pipe – chance of developing emphysema is much greater than for nonsmokers.

The best way to prevent emphysema is to not smoke or to stop smoking.

In addition, try to limit exposure to secondhand smoke.

Although smoking is the most common cause of emphysema, occupational exposure to chemical fumes and dust also is a risk factor.

Wearing a dust mask for protection during work in such an environment.

SELF-CARE

Stop smoking. Avoid other respiratory irritants. Exercise regularly. Clear airways. Protect from cold air. Avoid respiratory infections. Maintain good nutrition. Express feelings and share emotions. Consider a support group.

COPING SKILLS

Some simple exercises can improve breathing. They help control the emptying of the lungs

by using abdominal muscles. Do them two to four times daily.

Diaphragmatic breathing Lie on the back with head and knees supported by

pillows. Begin by breathing in and out slowly and smoothly in a rhythmic pattern. Relax.

Place the fingertips on the abdomen, just below the base of the rib cage. As you inhale slowly, should feel the diaphragm lifting the hand.

Practice pushing the abdomen against your hand as your chest becomes filled with air. Make sure the chest remains motionless. Try this while inhaling through the mouth and counting slowly to three. Then purse the lips and exhale through the mouth while counting slowly to six.

Pursed-lip breathing Try the diaphragmatic breathing exercises

with the lips pursed as exhale, that is, with the lips puckered – the flow of air should make a soft "sssss" sound. Inhale deeply through the mouth and exhale.

Repeat 10 times at each session.

Deep-breathing exercise While sitting or standing, pull the elbows

firmly backward as you inhale deeply. Hold the breath in, with the chest arched, for a

count to five, and then force the air out by contracting the abdominal muscles.

Repeat the exercise 10 times.

YOGA PRACTICES

YOGA IS BALANCE (SAMATVAM)

I A Y T CORRECTS IMBALANCES

AIMS :

• STRESS REDUCTION

• RELIEF OF PAIN

• MEDICATION REDUCTION

Ánandamaya KôùaÁnandamaya KôùaVijòanánmaya Vijòanánmaya

KôùaKôùa

PERFECTPERFECTHEALTHHEALTH

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Panchakosa concept

INTEGRATED YOGA MODULE FORCOPD

Breathing practices Hands in and out breathing Ankle stretch breathing Tiger breathing Rabbit breathing Dog breathing (eyes closed) Straight leg raise breathing Back stretch Tiger stretch Yoga chair breathingSithilikarana Vyayama (loosening exercises) Pavanamuktasana kriya Suryanamaskar

Yogasanas Ardhakati cakrasana Padahastasana Ardha cakrasana Vakrasana/ Ardha-Matsyendrasana Bhujangasana Salabhasana Sarvangasana Matsyasana Deep relaxation technique (DRT)

Pranayama Kapalabhati Vibhaga pranayama (Sectional breathing) Surya Anuloma Nadi suddhi BhramariMeditation (Dhyana Dharana) Nadanusandhana OM meditationKriyas Jala Neti Sutra Neti Vaman Dhouti

SPECIFIC PRACTICES

Baddha padmasana Pranayama Sarvangasana Sirshasana Suptavajrasana Surya namaskara Sasankasana Viparita karani mudra Vrukshasana Yogamudrasana