Friday Quiz: COPD and CO2 Retainers   (February 12, 2009)

What Is COPD?

COPD, or chronic obstructive pulmonary (PULL-mun-ary) disease, is a progressive disease that makes it hard to breathe. "Progressive" means the disease gets worse over time.

COPD can cause coughing that produces large amounts of mucus (a slimy substance), wheezing, shortness of breath, chest tightness, and other symptoms.

Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke or used to smoke. Long-term exposure to other lung irritants, such as air pollution, chemical fumes, or dust, also may contribute to COPD.

In the United States, the term "COPD" includes two main conditions—emphysema (em-fi-SE-ma) and chronic obstructive bronchitis (bron-KI-tis).

In emphysema, the walls between many of the air sacs are damaged, causing them to lose their shape and become floppy. This damage also can destroy the walls of the air sacs, leading to fewer and larger air sacs instead of many tiny ones.

In chronic obstructive bronchitis, the lining of the airways is constantly irritated and inflamed. This causes the lining to thicken. Lots of thick mucus forms in the airways, making it hard to breathe.

Most people who have COPD have both emphysema and chronic obstructive bronchitis. Thus, the general term "COPD" is more accurate.

COPD is a major cause of disability, and it's the fourth leading cause of death in the United States. More than 12 million people are currently diagnosed with COPD. An additional 12 million likely have the disease and don't even know it.

Bonus question: What is a "CO2 Retainer"?

A CO2 retainer is a person who has become conditioned to chronically high levels of CO2.

The hypoxic drive theory: The CO2 retainer

Usually, increases and decreases in carbon dioxide levels detected by the central chemo receptors is what causes people to breathe. When a person is in respiratory failure, and the carbon dioxide level is high, decreasing levels of oxygen as detected by the peripheral chemo receptors then takes over as the drive to breathe.

Thus, if a person has a chronically high carbon dioxide level, and you give this person 100% oxygen, you knock out their drive to breathe. This, my friends, is what we call the hypoxic drive theory. Actually, this is the gold standard of respiratory care. It is what helped to establish us as a profession.

This is what happened to my father when he was admitted to the hospital with a suspected case of bacterial pneumonia. Since he was having trouble breathing, the attendants gave him 100% oxygen.

Unbeknownst to them, he was a "CO2 retainer," and so the 100% oxygen, rather than aid his breathing, essentially signalled his body to stop breathing.

As I understand it, it works like this in CO2 retainers: when levels of CO2 reach a certain high level, then the lungs are signaled to rid the body of excess CO2 by exhaling and inhaling, i.e. breathing. If CO2 levels are very low, as is the case when a patient is breathing 100% oxygen (recall that normal air is only 20% oxygen), then the body never gets a signal to breathe because, well, there's apparently no need to as CO2 levels are low.

Apparently not everyone buys into this theory; but in any event, my father basically stopped breathing, which triggered a reaction by the emergency room staff. Since it was late at night, my stepmother had gone home, so we don't know exactly what happened, but it seems a breathing tube was inserted down my Dad's throat to restore normal breathing.

My Dad is 82 and suffers from a host of chronic illnesses. He never smoked, so we surmise he contracted COPD as a result of living his entire life in the smog-laden Los Angeles basin. He has multiple myeloma and severe osteoporosis as well as COPD. Since he'd already had pneumonia last year, my stepmother was very worried, so his surviving offspring rallied round, my brother flying in from France and my sister and I making the much-less arduous 400-mile trek to their house.

My Dad was released from the hospital and is recovering pretty well at home, but all the issues of at-home assisted care are now on the table. My sister researched the Medicare coverage, and well, most of you middle-aged and elderly folk can fill in the blanks.

What can I say but the obvious: try to keep whatever health you currently possess by whatever preventative measures are still within reach.

"This guy is THE leading visionary on reality. He routinely discusses things which no one else has talked about, yet, turn out to be quite relevant months later."
--An anonymous comment about CHS posted on another blog.

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