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Lungs



Lungs

As a kid you probably tried holding your breath to see how long you could go without exhaling. Maybe you were throwing a temper tantrum and wanted to give Mom and Dad a good scare. Or you were just trying to show your friends that you had the toughest lungs on the block. Your face probably started turning purple, and your lungs were probably about to explode before you finally gave up and breathed in a bountiful blast of fresh air.

Just in time, too, since your survival depends on lung inflation. These two football-size organs are made of elastic tissue filled with interlacing networks of tubes and sacs carrying air and with blood vessels carrying blood. They''re the body''s inhalers, filters and vacuum cleaners. The lungs supply oxygen to the body, dispose of carbon dioxide in the blood, filter and store blood and defend against invading agents of infection.

Air Travel

Unless you''re winded by exercise, breathing is something most of us don''t think about. Believe it or not, you take 20,000 breaths a day--that''s more than seven million breaths per year! But it''s all highly automated--unless you happen to be in a who-can-hold-their-breath-longer contest.

Wheezing on the Run

Although exercise is recommended for many people who have asthma, some people find that they start to wheeze when they''re active. For people who get exercise-induced asthma (EIA), here''s what doctors recommend.

Ease into it. Warm-ups are very important, according to Phillip Corsello, M.D., staff physician at the National Jewish Center of Immunology and Respiratory Medicine in Denver. "About ten minutes of walking at a gradual pace or other gentle aerobic exercise may help prevent or reduce the severity of EIA," he says. "Also, don''t exercise in cold or polluted air."

Spray before you play. If you use an inhaler before you exercise, it might help prevent an attack. "It''s good to use your inhaler about five to ten minutes before you start," says Garrison Ayars, M.D., allergist and clinical associate professor at the University of Washington in Seattle. "With exercise-induced asthma, if you premedicate, you''ll do fine."

Shape up. With regular aerobic exercise, you may find that you have asthma less often. "If you get into better aerobic condition, you''ll eventually have less of a problem with exercise-induced asthma," says Dr. Ayars.

What comes automatically is actually a complex process that starts when you take in air through your nose or mouth. The air travels through your trachea, or windpipe, which divides at mid-chest into two ducts, called bronchi, that carry air to your lungs.

It''s like a tree, with the windpipe being the trunk, leading to ever-tinier roots. At the end of each of these "roots" are the little sacs called alveoli. There are some 300 million alveoli, tiny air sacs where gases such as oxygen and carbon dioxide diffuse into or out of the blood.

Diaphragm Work

Some ways of breathing are better than others. And most of us are on the wrong track when it comes to the simple procedure of inhaling and exhaling.

Actually, most of us breathed better when we came into the world than we do now. As a baby, you automatically used your diaphragm, which is the largest and most efficient breathing muscle. Located beneath your lungs and forming a dome on top of your intestinal cavity, your diaphragm muscle flattens out into a saucer shape when you breathe in. That muscle action creates a vacuum inside your chest area, and air rushes into your lungs to fill the vacuum.

But when we get older, easy breathing tends to go out the window--replaced by short, shallow puffs that are activated by tensed-up chest muscles rather than the leisure-loving diaphragm. Most of us take shallow breaths between 10 and 16 times per minute, and none of those little, tense puffs really fills the lungs to capacity. With slower, relaxed, diaphragmatic breathing you can fill your lungs about 8 to 10 times per minute--with breaths that fill all the far-flung sacs of your alveoli.

Sucking It In

Deep breathing is an important technique for reducing stress, so it can become a tool to help you reduce the health problems often associated with stress--from cancer to heart disease. And the stronger your lungs, the more you increase your endurance, whether for doing aerobics, climbing stairs or swimming laps.

Here''s what experts recommend to help you improve your relaxed breathing and expand your capacity.

Press your stomach. To expand your lung capacity, practice abdominal breathing, which forces you to use your diaphragm instead of your smaller, weaker chest muscles. Here''s how it''s done, as described in Take a Deep Breath by James E. Loehr, Ed.D., and Jeffrey Migdow, M.D., yoga teacher and director of the Kripalu Yoga Teacher Training Program at Kripalu Center for Yoga and Health in Lenox, Massachusetts.

* First, lie on your back and place one hand on your stomach.

* Breathe in, pushing your stomach against your hand.

* Breathe out, lowering your stomach down toward the floor as far as possible.

Ideally, you should begin by practicing this breathing for a couple of minutes each hour with a longer session in the morning and at night, notes Dr. Migdow. "If you can do that consistently for six to eight weeks, more and more during the day you''ll start breathing that way automatically," Dr. Migdow says.

Hang your arms. If you spend a lot of time sitting, your muscles are likely to get stiff, and that makes breathing more difficult. To help yourself relax, do the following quick relaxation exercise while seated: As you inhale, clench your fists, shrug your shoulders, and then tighten your arms. As you exhale, let your shoulders fall. Now open your hands and let your arms hang straight down.

You can do a similar exercise with your legs and feet--first tightening them as you inhale and then relaxing them as you exhale. By the time you''re finished your whole body will be more relaxed (especially your upper body), and you''ll be able to breathe without tensing your chest and upper-body muscles.

Hang a thread. If you automatically sit or stand with hunched shoulders, you''re keeping a lid on the best kind of breathing. When your shoulders are pulled forward, you constrict your breathing muscles. To stop the strain, try this exercise from Miracle Healing from China . . . Qigong by Charles T. McGee and Effie Poy Yew Chow, R.N., Ph.D., president of the East West Academy of the Healing Arts/Qigong Institute in San Francisco. While standing or sitting, visualize a straight thread extending from the ground, up your spine and to the top of your head. As you imagine the thread pulling you up, allow it to stretch your spine.

Have a roll. While standing erect, roll your shoulders back and down--away from your neck. That will make your shoulder blades drop down and allow your muscles to relax, according to Dr. Chow.

When Breathing Isn''t Easy

Even if your breathing technique isn''t quite up to snuff, be grateful that you''re not one of those fashion victims of the nineteenth century. Back then, a woman''s waist was often squished into a tightly laced corset. A 15- to 18-inch waist was the norm. Unfortunately, so was fainting--a result of the lungs being severely restricted.

While we no longer have corsets holding us back (and in), there''s a breathtaking array of substances out there that can also shorten your breath. Pollen, dust, viruses, bacteria, animal dander, tobacco smoke, radon, indoor and outdoor air pollution--any of these alien agents known as allergens can find their way into your lungs.

Some people can shrug off such irritants, but for the 12.4 million Americans with asthma, they''re a daily curse. Asthma results from hyperactive bronchial tubes, which can be sent into spasms by outside substances. Allergens are a big factor with children who have asthma, triggering 90 percent of their asthma attacks. But asthma-prone adults are susceptible to allergens, too, since half of adult asthma cases are allergy-related.

Other factors that can trigger an asthma attack include cold air and exercise, says Diana DeCosimo, M.D., director of the Division of General Medicine and Geriatrics in the Department of Medicine at the New Jersey Medical School and medical director of the Women''s Wellness Center in Newark.

As anyone with asthma knows, having an attack can be terrifying. When muscles in the walls of the bronchial tubes go into spasms, the air passages narrow, which constricts the free flow of air. To force air through the narrow passage, someone who is having an asthma attack needs to breathe faster and harder--literally panting. The result is wheezing, coughing and breathlessness.

What''s Attacking You?

How do you know if your wheezing is the allergic kind? "If you have attacks around dogs or cats, or just in the fall or spring, that strongly suggests allergies," says Garrison Ayars, M.D., allergist and clinical associate professor at the University of Washington in Seattle. You''ll need to visit an allergist for tests to see if there''s a substance you can avoid or eliminate. But your attacks might also be caused by nonallergen irritants, such as strong colognes, perfumes, newsprint or any strong odors, notes Dr. Ayars.

What makes one person more susceptible than another to asthma is a mystery, although it''s largely inherited, says Leonard Bielory, M.D., director of the Division of Allergy and Immunology and director of the Asthma and Allergy Center at the New Jersey Medical School.

If you have one parent with asthma or allergies, you have a 30 percent chance of having the same. If both of your parents have asthma, your chances jump to 60 percent, says Dr. Bielory.

In any case, the best way to control this chronic condition is with inhaled medication such as bronchodilators and corticosteroids that reduce inflammation. Both need a doctor''s prescription. "It''s a reversible disease. If you think you may have asthma because of symptoms of wheezing, tightness in the chest or shortness of breath with exertion, it is always best to see your doctor rather than depending on over-the-counter medications," says Gary N. Gross, M.D., clinical professor of internal medicine at Southwestern Medical School in Dallas, Texas. "With the right medications from your doctor, you can do whatever you want," he says. "Frequent use of over-the-counter asthma sprays may be dangerous and certainly are not the best treatment."

The Best Defense

Asthma is a lifelong challenge for some people. But along with taking prescribed medications there are many other things you can do to help yourself breathe easier. Here''s some advice from top doctors.

Ditch your triggers. The best way to ease your breathing is to avoid allergens, notes Dr. DeCosimo. "If you''re allergic to the cat, get rid of the cat," she says. The dust mite, which feeds on shed skin cells, is another top allergen. Because these critters thrive in humidity, keep your home as dry as possible. Also, wash bedsheets in the hottest water possible to help kill the dust mites. And since all rugs and carpets are favorite mite hangouts, go for the spare look in your home--with bare floors.

Dust off for prevention. Apart from dust mites, dust itself is another big culprit. It paralyzes the clearance mechanism in the lungs, says Robert Sandhaus, M.D., director of clinical development at Cortech, a biotech firm in Denver.

Since vacuuming kicks up a dust storm in your house, you might consider a special filtered vacuum cleaner--such as the kind made by Miele Vacuum--if you have a major reaction to dust. Call Miele at 1-800-694-4868 to be connected with your local dealer. If there isn''t one nearby, you''ll be connected with someone at the national mail-order headquarters.

Another way to beat the dust enemy is with high-efficiency particulate absorption bags. These bags have microscopic holes that don''t allow dust particles to escape, says Dr. Sandhaus. Each vacuum cleaner manufacturer makes its own version of these. But some bags can only be used with specially designed vacuum cleaners, so there may be some expense in getting the whole system.

Do brew. Because caffeine helps dilate the bronchial passages, strong black coffee can have a beneficial effect. "It releases bronchial spasms," notes Dr. Bielory. "But it''s no substitute for medication."

Air out your office. With an ever-increasing number of offices being filled with recycled air, you should be aware of workplace pollution, says Dr. Sandhaus.

Because you can''t open windows in most offices, chemicals from cleaning products stay in the air. "If it''s a chemical that causes an odor, talk to your building manager about adding fresh air to the ventilation system. If you only have breathing problems when you''re at work, you might even have to request a different office--or even consider changing jobs," he notes.

Work it out. Aerobic exercise improves asthma by opening up your airways and working out your diaphragm and chest wall muscles, which open your lungs, says Dr. Gross. He recommends a 30-minute walk or stationary bike ride three to five times a week. Don''t be afraid that asthma equals inactivity. Remember, more than 10 percent of America''s 1984 Olympic athletes had asthma!

Know how to inhale. Using an inhaler takes appropriate aim and timing, notes Dr. Ayars. Just before spraying you should blow out all your air. Then start to take a deep breath, and while you''re breathing in deeply, activate the inhaler. Continue to breathe in deeply and slowly until your lungs are full, says Dr. Ayars. Hold your breath as long as you can so the drug can reach all the nooks and crannies of your lungs, he says.

You can also use spacers, which are three- to five-inch tubes or chambers that you put between the inhaler and your mouth. Because the spray first goes into the chamber, less spray jets onto and sticks to the back of your throat, he explains. Check with your doctor or allergist about using spacers.

Don''t smoke. Smoking is bad because it irritates the airways, and people with asthma are more sensitive to irritants anyway, says Dr. Gross. "The combination of asthma and smoke makes your breathing function worsen more quickly," says Dr. Gross. "So instead of a mild course of the problem, you''ll have long-term breathing problems."

Peek at your peak. To get a handle on your breathing status, use a peak flow meter, which is a thermometer-like instrument that you breathe into to measure your breathing, says Dr. Bielory. "It measures the amount of air flowing out of your lungs," he notes. "It''s portable and inexpensive. Many people use them when they get up and when they go to bed. It helps you coordinate treatment so you don''t end up in the emergency room."

Getting the Better of Bronchitis

If it were physically possible to cough up a lung, it would probably happen during a bout of bronchitis.

This inflammation of the airways connecting the trachea to the lungs is to coughing what chicken pox is to spots. And unfortunately, all that hacking produces loads of green or yellow phlegm. Not a real pleasant way to spend three or four days.

The usual form is called acute bronchitis, which develops suddenly and often clears up in a few days. It''s usually a complication of a viral infection.

If you have a bronchitis cough that doesn''t clear up after a week, you should see your doctor. "If it''s not going away, it may be a bacterial infection, in which case you''ll need antibiotics," says Dr. Sandhaus.

But if you battle bronchitis at the onset, it might clear up. Here''s how to hold your own.

Relieve the pain. One of the things that''ll make you feel better is ibuprofen, which helps ease general malaise, says Dr. DeCosimo.

Quiet your (a.m.) cough. Use over-the-counter cough medications, which are as effective as prescription medicine, says Dr. Sandhaus. But only take the medication at night, he adds. That''s because a productive cough is actually good, since you''re bringing up some of that germ-laden phlegm every time you cough. "If someone has a productive cough, it''s the body''s way of getting rid of infectious agents; you don''t want to suppress that entirely," says Dr. Sandhaus.

Dr. Sandhaus recommends cough medicine such as Robitussin DM, with a secretion-loosening ingredient such as dextromethorphan or guaifenesin.

Flu or Bronchitis--What''s the Difference?

Bronchitis is commonly caused by a virus, and so is the flu. So how do you find out which culprit has you bedridden--hacking, sniffling and exhausted?

If you''ve been bitten by the flu bug, you''ll have fever and muscle aches along with the coughing, according to Diana DeCosimo, M.D., director of the Division of General Medicine and Geriatrics in the Department of Medicine at the New Jersey Medical School and medical director of the Women''s Wellness Center in Newark. Flu has become a generic term for any kind of viral infection, while bronchitis is an inflammation of your airways--it specifically refers to a lower respiratory infection.

Get steamed. Using a cool-mist vaporizer helps moisten the already too-dry air irritating your airways, says Dr. Sandhaus. But if you are prone to asthma, the cold mist can irritate your lungs and spur an attack, Dr. Sandhaus notes. So here''s an alternative bronchitis treatment: Go in the bathroom, turn on a hot shower, let the room fill with mist and fill your lungs with it.

Flood your phlegm. Drinking clear liquids helps make that thick mucus just a bit easier to cough up, says Dr. DeCosimo. She especially recommends hot fluids such as soup or tea.

Kick the butts. It''s vital for anyone with bronchitis to avoid smoking, especially while you''re still coughing, notes Dr. Sandhaus. "It prolongs the illness by irritating the airways, which induces more coughing." There could be another bonus as well: When some people lay off nicotine because of bronchitis, they end up quitting for good, Dr. Sandhaus says.

Lung Cancer

Air meets blood. Breath after breath, heartbeat by heartbeat, that''s what happens all day and all night. While you''re awake or sleeping, a staggering 8,000 to 9,000 liters of breathed-in air meet 8,000 to 10,000 liters of blood. All that breathing is hard, steady work.

But imagine trying to perform such vital chores for someone who smokes. The lungs have to labor for breath through ever-blackening lung tissue--the result of tar deposits nestling between the air sacs.

This carcinogenic tar can later lead to lung cancer--the leading killer cancer among women. To make matters worse, smoke particles irritate the lungs'' airways--causing excess mucus production and chronic irritation that result in the labored breathing of emphysema and chronic bronchitis, also known as smoker''s cough.

No doubt about it--smoking is to blame for most adult lung cancers, says Dr. DeCosimo.

"Smoking is a really serious health problem for women," says Dr. DeCosimo. "Some 2,000 girls start smoking every day. It''s so tied up with looking good and staying slim; it''s very seductive."

The most deadly of smoking-related illnesses is lung cancer, which strikes more than 74,000 women and 96,000 men in a typical year. The vast majority--about 90 percent--of the cases are linked with smoking, says Peter Greenwald, M.D., director of the Division of Cancer Prevention and Control at the National Cancer Institute in Bethesda, Maryland.

Lung cancer is a killer mainly because early detection is difficult. Often the only symptom is a persistent cough, and by then it could have spread, says Dr. Greenwald.

"The most common cancer in women is breast cancer, and the five-year survival rate is more than 50 percent," says Dr. Greenwald. "But only 15 percent of women survive that long with lung cancer."

Even if you''ve never lit up, you could still be at risk. Some 3,000 people a year are estimated to die from secondhand smoke, notes Dr. Greenwald. Although critics say the danger of environmental tobacco smoke has been blown out of proportion, a 1990 study in which Dr. Greenwald took part shows otherwise.

The study compared 191 nonsmokers who developed lung cancer with 191 nonsmokers without lung cancer and looked at the frequency with which their parents smoked. Those who''d been exposed to smoke during the first two decades of life had twice the risk of developing lung cancer.

A No-Tar Life

Despite the grim findings about lung cancer, there''s one thing to be said for it--this is one of the most preventable cancers. Here are a few tips to help keep this cancer out of your lungs and life.

Don''t smoke, don''t smoke and don''t smoke. It''s absolutely never too late, and if one stop-smoking effort doesn''t work, just try again. Not smoking is the best insurance against lung cancer. Even if you''re smoking two or three packs a day, there are many methods to help you kick the habit. (See "Ditching the Butts for Good.")

Eat your fruits and veggies. People who get very little beta-carotene in their diets have two times more lung cancer than people who get plenty of it, says Harvey Simon, M.D., associate professor of medicine at Harvard Medical School, founding member of the Harvard Cardiovascular Health Center and author of Conquering Heart Disease. The best sources of beta-carotene are brightly colored fruits and vegetables such as carrots and red peppers, as well as dark green, leafy vegetables. "Every little bit helps, so munch away," says Dr. Simon.

Check for radon. Test your house for radon, a colorless, odorless gas that''s found in rocks and soil and is responsible for some 16,000 lung cancer deaths a year, says Dr. Simon. You can test your house for excessive radon levels with a low-priced kit available at hardware and department stores.

Beating Obstructive Diseases

If smoking wages war on your lungs, then emphysema and chronic bronchitis are the battle scars. These diseases, which fall under the category of chronic obstructive pulmonary disease (COPD), kill 87,000 people a year.

About 6 out of every 1,000 American women can be expected to get emphysema. It develops after many years of assault on the lungs--almost always by smoking. Over the years the walls between the tiniest air sacs within the lungs break down, and those compartments become enlarged, causing the lung tissue to lose its elasticity and the lungs to become distended. After that they''re unable to fill and empty normally.

Eventually, breathing gets more difficult, and the person with emphysema grows weaker--at first, she''ll feel breathless and, after a while, unable to do physical activity. Although the effects of emphysema can be controlled somewhat with drugs, people who have it may end up needing oxygen, even when resting.

Chronic bronchitis--also known as smoker''s cough--is almost always the forerunner or companion of emphysema. It''s caused by chronic irritation from tobacco smoke, which causes periodic attacks of obstructed breathing. The lungs become inflamed and clogged with mucus.

Get Your Skin Pricked

If you''re wondering whether you have asthma, allergies or a little bit of both, the best way to find out is with skin prick tests, says Garrison Ayars, M.D., allergist and clinical associate professor at the University of Washington in Seattle. Various allergens are pricked into the skin, and if a hive develops, you''re allergic to that substance.

The doctor may also test your lung function with a machine called a spirometer that measures the total amount of air you breathe and how fast.

People who have chronic bronchitis never really shake the cough. If your cough produces phlegm, and it continues to bother you every day for a couple of months, it''s likely that you have chronic bronchitis. Your doctor will be able to confirm this.

Aside from quitting smoking--the very best way to avoid COPD--doctors recommend a few other ways to cope.

Work out. Although nothing can reverse damaged lung tissue, aerobic exercise helps work out respiratory muscles such as the diaphragm, which strain to work when you have COPD, says Thomas Clanton, M.D., associate professor of physiology, internal medicine and allied medical professions at Ohio State University in Columbus. Dr. Clanton recommends walking or biking 20 to 30 minutes three times a week.

Lift those arms. Because simple arm exercises such as toothbrushing and drying dishes can wind folks with COPD, exercising the arm and shoulder muscles can reduce shortness of breath, says Dr. Clanton. Take an empty liter-size plastic bottle in each hand and lift them straight out to your sides. Repeat 10 to 15 times. As you get stronger, pour a little water in the bottles. Increase the measure of water in small increments as you get stronger.

Commit to C and E. Folks with smoking-induced COPD should take vitamins C and E daily, says Dr. Sandhaus. That''s because cigarette smoke contains oxidants--substances that tend to attack healthy cells--while vitamins C and E are antioxidants that help counteract these effects. The recommended minimum dose of vitamin C is 250 milligrams twice a day. For vitamin E the recommended amount is 800 units twice a day, says Dr. Sandhaus. Since vitamin C can be toxic above levels of 1,200 milligrams a day, and E can become toxic above 600 IU, the high doses of vitamins C and E should be approved by your doctor.

Pucker up. To improve your breathing, try doing it with pursed lips, suggests Thomas Petty, M.D., professor of medicine at the University of Colorado Health Sciences Center and consultant to HealthONE in Denver.

"Pursed-lip breathing causes people to breathe slower and deeper, which is more efficient for good gas transfer and relieves shortness of breath," he notes. Pucker your lips as if you''re whistling, then breathe in through your nose and out your pursed lips for five to ten minutes. Repeat this breathing exercise two to four times a day. Then use the technique while exercising to fend off breathing problems.

Pneumonia

It sort of feels like the flu, what with the fever, chills and cough it produces. In fact, it often begins as the flu. But pneumonia is in a league of its own, sickness-wise.

Usually caused by bacteria, and sometimes by a virus, pneumonia differs from the common flu in that its effects on the lungs are much worse. Those who suffer from pneumonia often produce large amounts of thick, gray-green or bloody mucus when they cough. And pneumonia frequently causes chest pain.

Ditching the Butts for Good

It''s been linked to heart disease; cancer of the lung, bladder, mouth, lip and throat; premature births; lower survival rates for babies and wrinkled skin--not to mention bad breath, yellow teeth and smelly clothes.

Yet despite all these bad marks against cigarettes, a startling 46 million Americans keep on smoking.

Most smokers are not hardheaded or ignorant of health facts--they''re simply addicted, both physically and psychologically.

In fact, a 1988 surgeon general''s report compared the mechanics of nicotine addiction with those of heroin or cocaine addiction. The conclusions: "It''s often more difficult to withdraw from nicotine than any of the others," says Thomas Glynn, Ph.D., chief of the cancer prevention and control research branch at the National Cancer Institute in Bethesda, Maryland.

In fact, of the 15 million Americans who quit smoking each year, only 3 percent stay off cigarettes. Dr. Glynn says you should realize that you are likely to relapse while trying to quit, since most people have to make three or four attempts. Don''t give up, he urges; each attempt is actually a learning experience. "You know what to do better next time. It''s a six-month to two-year process."

Here are a few of Dr. Glynn''s top tips.

Go cold turkey. Cutting down doesn''t seem to work. When most people get down near eight or ten cigarettes a day, they resume again.

Prepare yourself mentally. You should be adamant about wanting to quit and know exactly why. Some people like to write down their reasons for stopping and ask friends and family to help them. It''s also good to pick a specific date--particularly a birthday or anniversary--as Quit Day.

Ditch cig "souvenirs." Get rid of all cigarettes, matches, lighters and ashtrays in your home and office. Also, have smoky clothes cleaned professionally or