NOT AGAIN – When Your Having A Bad Day – a bad air day?


I decided to write this post after I started experiencing a worsening of my symptoms for no apparent reason on Friday night; driving my car to the chip shop. I knew instinctively that a bad day was on the way! Anyone who has stage three or four COPD will be familiar with these days. You feel like there is just not enough air to go round and everything takes so much more effort and it’s exhausting.

Like many people, when I was first diagnosed with COPD it was already quite severe and these days were very frequent and puzzling to me. Back then I used to get many more bad days than good days. Since I have adjusted my life a bit I do not have so many but when I do it always annoys and frustrates me. I run through all the reasons in my head why this day has come on me, such as, am Idownload (1) starting with a virus, have I eaten, drank something too sugary, is the air pressure low, that can cause poor oxygen in the atmosphere or have I been in contact with any allergens, maybe I have done too much. The answer isn’t always obvious sometimes there is no reason and any plans I have made for a shopping trip, visiting friends etc has to be put on hold. More frustrating, is my immediate family don’t seem to understand this anomaly at all. I’m sure they think I am malingering at times – you know, as if I really enjoy those days not being able to breath? They make comments like you are always breathless what’s the difference or your always ill as if it’s just another day! Then I try to explain yes, but its the degree of breathlessness! It is almost impossible to explain it.

So what do I do about it? Well, I find a lot of patience comes in handy especially if this daydownload (2) or days, I forgot to mention it can last for a couple of days, falls on a cleaning day or a shopping day or a day I had plans or especially if someone else is relying on me, (that can be tricky). Firstly, I hunt out my emergency antibiotics and steroids and try to decide if they will be needed. I take my peak flow and measure my oxygen levels, am I wheezing more? This usually tells me if steroids are needed and if I start coughing up gunk then there may be an infection on the way so I add on the antibiotics. If it is an infection, then it will turn into as full blown exacerbation and won’t be gone in a day or two. But if as often is the case it’s nothing like that then I will get my nebuliser out and  make myself comfortable on the settee and put 110_E2BFposter_zcatch up TV on and have a nice cup of tea (thats if I am well enough to make one). This is where exercising has really come to benefit me. These mini flare ups are not as bad when they come and I am able to get my food and drinks. Whereas in the past pre exercise me, well, I went for hours without even having a cup of tea and these mini flare ups could go on for longer and the chance of them developing into an infection were higher. Keeping fit and eating nutritious food is really important to keep in control of your symptoms. Below is a video where a respiratory nurse explains about keeping a journal helps.


Collateral Ventilation Explained Simply!!

Below is an explanation of Collateral Ventilation, this came up on one of my visits to Jimmy’s. The surgeon mentioned that I would not be able to have endobronchial valves if the lobes of my lungs affected had ‘collateral ventilation’. I went home and straight away tried to find an easy explanation for it. I am now sharing my knowledge with you –

Collateral Ventilation Explained

In the lungs of a normal, healthy person, there is one single route inwards and out again for each of the alveoli (alveoli are the tiny cavities at the end of the airways where the gas exchange with the blood happens). Think in terms of a bunch of grapes. Alveoli are the grapes, the airways are the stalks.

When the lungs get damaged, whether through disease or pollution or irritation, if the membrane suffers extensive damage, then some of that membrane is replaced, as part of the healing process, with scar tissue. If there are repeated episodes of disease, or sustained exposure to pollution or other causes of irritation, then the amount of scarring can become significant.

Scar tissue is not as elastic as the original membrane. It also does not permit gasimages (1) exchange. As our lungs expand and contract, if the sites where scarring has occurred have become a significant size, then some tearing can happen. This tearing is minute, and is no cause for concern in terms of day to day wear and tear. It is the long term combined effect over years that is the problem. This is where we now jump to, several year down the line. Imagine that two adjacent alveoli have a lot of scarring, and another inflaming infection takes hold, and one particular breath is deeper and heavier than normal, and it causes a tear that goes through the tissue between the alveoli. You now have a hole that will not close. The tissue will heal, but leaves an enlarged cavity because that requires less stretching than the original formation. For the bunch of grapes, two grapes have been replaced by one damson fed by two stalks. After several more years, a number of damsons have formed, and some of those have merged into much larger plums. This is now advanced Emphysema, with some large cavities (called bullae), and we are at the point where medical intervention is required. This is what has happened to me on my upper left lobe I have just got one large bullae. It is filled with too much air, imagine it as been blown up like a balloon but there is no way out for the air because the valve letting air in and pushing air out is no longer working. Air gets trapped taking up vital lung space so any good parts of your lung are compromised by this shortage of space taken up by this massive balloon.  One of the things that has to be considered to determine which operation is best to go for is how this damage presents itself.

The structure of the lungs is that they are divided into zones called lobes, three in theDiagram of lungs right, and two in the left. Thinking in terms of the bunches of grapes, consider that each lobe is home to one complete bunch whose only contact normally is through the main stem (the main airway). If the damage within the lungs is confined within the individual bunches, in other words, does not cross the boundaries between the lobes, then there is no collateral ventilation. Collateral ventilation occurs when the the tissue damage permits the passage of air between the lobes through holes between the lobes.

As the damage progresses, as the cavities form, so the internal support structure of the lungs gets reduced. This allows the lungs to become longer and they over inflate because of the loss of elasticity. They sit on the diaphragm, the bottom lobe of each lung gets compressed and generally cannot continue to work properly. The diaphragm now has to lift this extra weight with each breath taken. Through a day, that adds up to a lot of extra hard work. Taken with the loss of alveoli, and the presence of frequent infections etc, the lungs are now operating at maybe as low as 15% of their full capability when in good condition. The patient is permanently fatigued and needs lots of medication to keep the airways open. Often oxygen is needed. At this point, the consultant decides that surgical intervention is required. The first choice at the moment for most consultants is to use pulmonary valves. They are easy to fit, they allow the blocked off part of the lung to continue to pass CO2 and the lungs natural secretions out. Most importantly, they are reversible (if need be, they can be removed easily). The biggest deciding factor in choice for or against valves is whether or not there is collateral ventilation. If there is none, or is very minor, then valves could be considered. If there is collateral ventilation, then the usual decision is to go for lung reduction surgery. I had to have a lung ventilation scan  (see link for details of this), it was found from the scan that the divisions in my lobes are not ok and have scar tissue so I am not suitable for the valves in that area, it will collapse too much of my lungs.  This is all the damaged caused from Chronic Bronchitis which I have had through smoking. Dr Kemp in London explained that I have emphysema all over my lungs but it is pretty bad at the top of the right lung  so that is where they will start by cutting it off. He said he might consider valves for the other side.

As you can see, at the stage where there needs to be a choice made, the presence or not of collateral ventilation is important. Links to some videos that may help follow:……