Doctors At War

war against disease in UK

For tens of millions of people across the United Kingdom, the ability to breathe normally has been slowly and silently stolen away. These individuals suffer from Pulmonary Disease or Chronic Obstructive Pulmonary Disease. Pulmonary Disease is the fifth leading cause of death in the United States. Current estimates suggest that 16 million Americans have been diagnosed with some form of Pulmonary Disease and as many as 16 million more are undiagnosed.

The main function of the lungs is to provide oxygen to and remove carbon dioxide from the blood. Pulmonary Disease, a term used to describe conditions such as emphysema, chronic bronchitis, and asthma, inhibits the body’s ability to perform this function. The reasons for this inhibition vary by disease.

  • Emphysema. In the lungs there are very small tubes called bronchioles. The smallest bronchioles end in tiny elastic air sacs called alveoli. Blood vessels in the alveoli walls allow the exchange of oxygen and carbon dioxide to take place. With emphysema, the walls of the alveoli are damaged by inflammation. They can lose their natural elasticity, become overstretched, and rupture. When several adjacent alveoli rupture, a large space forms causing bronchioles to collapse, and trapping air that needs to be exhaled.
  • Chronic bronchitis. This condition refers to long-term inflammation and thickening of the walls of the main entryways into the lungs, the bronchial tubes. This thickening narrows the bronchial tubes thus allowing less air to enter and often leading to coughing spells. In addition, the glands of the bronchial tubes may produce excessive mucous, increasing the congestion in the lungs and further impeding the breathing process.
  • Asthma. Asthma is a chronic inflammation of the airways resulting from swelling and excessive mucous. The airways may become further blocked when an irritant, or trigger, causes spasms of the bronchial passages and results in coughing, wheezing, and difficulty breathing.

Pulmonary Hypertension and Heart Failure
High blood pressure in the arteries transporting blood from the heart to the lungs, the pulmonary arteries, is referred to as pulmonary hypertension. As the blood is pumped through the arteries in the lungs it receives oxygen; this oxygenated blood returns to the heart where it is then transported to the rest of the body through the aorta and other arteries. Injury or changes to the pulmonary artery can cause the artery to tighten, limiting the passage of blood, and increasing the pressure in the artery. If you suspect that you or any of your loved ones have pulmonary disease then get it checked by your doctor. You can also buy a good pulse oximeter for COPD.

Pulmonary hypertension may occur without symptoms making it difficult to diagnose. Pulmonary hypertension is often not diagnosed until symptoms of congestive heart failure appear.

What is Pulse Oximeter

Pulse oximetry is a technology used to measure the oxygen level in your blood and your heart rate. A clip-like device called a probe is placed on a body part, such as a finger or ear lobe. Regardless of the reading, one should treat the patient first. The device passes two wavelengths of light through the body part to a photodetector. A finger pulse oximeter is equipped with technology to rapidly detect changes in your blood oxygen level.

The probe uses light to measure how much oxygen is in the blood. The reading is only one of several important assessment criterions. It measures the changing absorbance at each of the wavelengths, allowing it to determine the absorbances due to the pulsing arterial blood alone, excluding venous blood, skin, bone, muscle, fat, and (in most cases) nail polish. It can help give you the knowledge you need to take control of your condition. This information helps the healthcare provider decide if a person needs extra oxygen.

Watch for symptoms of hypoxia or hypoxemia. A pulse oximeter is a handy medical device that uses two frequencies of light – red and infrared – to determine the percentage of hemoglobin in the blood that is saturated with oxygen, or your oxygen saturation level. A finger pulse oximeter is easy to use – just clip it on your fingertip to get a blood oxygen reading. If you work in healthcare (or have been patient !) you are very likely to have come across pulse oximeters. Furthermore, pulse oximeter measures oxygen saturation, not breathing and does not indicate the removal of carbon dioxide from blood.

You can find them in areas such as operating rooms, recovery, critical care, wards, and ambulances. Along with SpO2, one needs to record the respiratory rate to get an indication on breathing. If a finger is placed in between the light source and the light detector, the light will now have to pass through the finger to reach the detector. Part of the light will be absorbed by the finger and the part not absorbed reaches the light detector.

Pulmonary Hypertension and Cor Pulmonale
When the pulmonary arteries have been compromised, increasing pressure is needed to get blood to the lungs. Normal pulmonary artery pressure is 14 mmHg (millimeters quicksilver). In PH, pressures can exceed 25 mmHg. o compensate for the increased pumping pressure, the heart muscle changes in size. An enlarged heart is a sign that the heart is working very hard to circulate blood and oxygen to the body. The right side of the heart, which is not accustomed to high blood pressure, may also weaken. Right-sided heart failure that occurs as a result of pulmonary hypertension is known as cor pulmonale.

Primary Pulmonary Hypertension: In some cases, no underlying cause for pulmonary hypertension can be determined; this is called primary pulmonary hypertension, or PPH. Up to ten percent of primary pulmonary hypertension cases are hereditary, that is, they occur in more than one family member.

Pulmonary Arterial Hypertension

Another type of pulmonary hypertension, secondary pulmonary hypertension, or SPH, occurs as a result of other diseases. Diseases associated with SPH include chronic obstructive pulmonary disease (COPD), collagen vascular diseases like scleroderma, systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), congenital heart disease, and ongoing liver disease. SPH is also associated with illicit drug use. Long-term exposure to high altitudes may also be responsible for some cases of pulmonary arterial hypertension.

Secondary Causes of Pulmonary Arterial Hypertension

The most common type of pulmonary hypertension (PH, or PAH) is known as secondary pulmonary arterial hypertension. Because this form of PH occurs as the result of other existing diseases or factors, such as COPD or the use of weight loss pills, it is called a secondary disease.

PH and Breathing Disorders

Chronic bronchitis and emphysema, which are chronic obstructive pulmonary diseases (COPD), are common causes of secondary PH. Interstitial lung disease and sleep apnea can also contribute to the development of SPH. Neonatal lung disease, a condition that can affect premature newborns whose lungs have not had a chance to develop completely, may contribute to pulmonary arterial hypertension. Pulmonary sarcoidosis, a chronic inflammation of the lung tissue that limits lung volume and makes the lungs “stiff” is also a risk factor for PH

These respiratory diseases can prevent the transfer of adequate levels of oxygen from the lungs to the blood. Over time, as the blood vessels are deprived of oxygen, they begin to constrict. This chronic constriction can lead to pulmonary hypertension as well as congestive heart failure. Long exposures to high altitude can produce the same

PH and Blood Disorders

Other diseases such as sickle cell disease, pulmonary embolism, or blood clotting disorders can also result in secondary pulmonary hypertension. In these diseases vessels are blocked creating an increase in pressure in the pulmonary arteries and a lack of oxygenation to the blood.

PH and Sclerosis

Systemic sclerosis, or scleroderma, is a disease that can scar the blood vessel walls. Sclerosis can affect the entire body (“systemic”) including the heart, lung, kidneys, skin, digestive tract, and extremities. People with sclerosis may experience decreased blood flow to the fingers and toes when they are cold (Raynaud’s disease), painful joints, heartburn, and difficulty swallowing.

Women are four times more likely than men to get systemic sclerosis. Up to fifteen percent of patients with systemic sclerosis develop pulmonary hypertension and PH is the main cause of mortality in patients with sclerosis.


Weight Loss Pills and PH
Studies show a strong link between pulmonary hypertension and elevated serotonin levels. Serotonin levels are increased with weight loss pills containing the appetite suppressant drug dexfenfluramine-phentermine (“fen-phen”). Increased serotonin levels may result in sensitivity or injury to the blood vessels, a key component in the onset of PH. In September 1997, the FDA banned the weight loss drugs fenfluramine, phentermine, and dexfenfluramine because of their strong connection with pulmonary hypertension and valvular regurgitation.

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