COPD Lung Symptoms, Diagnosis, Treatment, E T C

What is COPD?

COPD is the abbreviation for chronic obstructive pulmonary disease. COPD is a lung disease that results from obstructions in the airways of the lungs that lead to breathing problems. Although COPD is a progressive disease, early diagnosis and treatment may slow its progression. COPD may be complicated by chronic bronchitis or emphysema; some patients develop both problems that lead to additional breathing problems. Some clinicians consider chronic bronchitis and emphysema as simply further manifestations of COPD.

How Does COPD Affect the Lungs?

Damage to the lung tissue over time causes physical changes in the lungs and the airways become clogged with thick mucus. Compliance (the ability of the lung tissue to expand) becomes weakened because of this lung tissue damage. This weakened compliance or elasticity of the lungs means that oxygen cannot get to the air spaces where oxygen and carbon dioxide exchange occurs in the lung. This all leads to coughing to remove the thick mucus and eventually, difficulty in breathing.

COPD Symptoms

Shortness of breath is the primary symptom of COPD. It occurs with daily activities and is caused by blocked or clogged airways and damaged or destroyed alveoli where oxygen is absorbed and carbon dioxide is released. Other COPD symptoms may include wheezing, chest tightness, and a chronic cough. The affected individual may tire easily, have frequent colds and flu infections, and produce excessive mucus or sputum. Symptoms of COPD slowly worsen and people with advanced symptoms of COPD may:

• Be obese from lack of exercise
• Have muscle loss and declining endurance
• Have morning headaches
• Have a bluish or greyish color underneath the fingernails due to decreased oxygen levels in the blood
• Conversely, some patients with COPD and emphysema may lose weight

COPD Causes

Smoking and secondhand smoke play a significant role in causing COPD. About 85% to 90% of all COPD deaths are related to smoking. The other causes are related to environmental irritants (pollution), and a rare few are genetically passed through family members (for example, people with Alpha-1 antitrypsin deficiency [AAT] are likely to develop COPD symptoms).

COPD Triggers: What Makes COPD Worse?

Half of all COPD exacerbations are triggered by bacterial or viral infections, whereas the rest of the triggers are caused by environmental factors. Minimizing exacerbations and avoiding COPD triggers can slow the progression of COPD. The following are common indoor and outdoor COPD triggers:

• Tobacco smoke
• Dust
• Pet dander
• Pollen
• Stronger odors- perfumes, scented candles, and air fresheners
• Chemical fumes- cleaning products, paints, and solvents
• Pollution-outdoor pollution (vehicle exhaust, gas station fumes) indoor pollutants (fumes and odors from cooking, fireplace, dirty air filters
• Extremes in temperatures- extreme heat or cold

COPD: Chronic Bronchitis

Many patients with COPD also develop chronic bronchitis. Chronic bronchitis is a cough that occurs every day and causes inflammation of the airways, mucus overproduction, and frequent viral or bacterial infections. Since smoking is often the cause of chronic bronchitis, the "smoker's cough" is a likely sign of COPD and chronic bronchitis. Treatment for chronic bronchitis can include bronchodilators, steroids, and oxygen therapy. Quitting smoking and avoiding air-borne bronchial irritants is also suggested.

COPD: Emphysema

Emphysema is a disease of the lung. In emphysema, the alveoli (small air sacs in the lungs that facilitate the exchange of carbon dioxide and oxygen) are damaged and die. Carbon dioxide and oxygen are not exchanged, and eventually, the alveoli die leaving holes in the lungs that result in lost lung tissue and increased symptoms of COPD. Symptoms of emphysema usually include shortness of breath and sometimes cough and wheezing. Treatment for emphysema may include bronchodilating medications, steroids, antibiotics, and oxygen. Quitting smoking is also strongly suggested.

COPD Diagnosis: Physical Exam

An important part of the diagnosis of COPD is the physical exam, the patient's breathing history, smoking history, and family history of COPD. The first simple, non-invasive test performed is usually with a pulse oximeter (shown in the picture on this slide). Oximetry measures the amount (% saturation) of oxygen in your blood. It is a way to test how much oxygen is being sent to parts of your body furthest from your heart, such as the arms and legs. The pulse oximeter is placed on a body part (finger, ear lobe) and uses light to measure the oxygen levels.

COPD Diagnosis: Spirometry Breath Test

Spirometry is a test that measures how much air you can move in and out of your lungs over a short period, and is used to test for COPD. Spirometry involves breathing into a large hose connected to a machine, called a spirometer. The test can identify early COPD, and even help determine the stage of COPD in the patient. The test also shows how well certain medicines affect a person's COPD symptoms.

COPD Diagnosis: Chest X-Ray

A chest X-ray may be able to show enlarged lungs that can occur in some patients with COPD (due to hyperinflation). However, X-ray is more useful to help rule out or rule in other problems that may cause symptoms similar to COPD, such as pneumonia.

COPD Treatment: Bronchodilators

Bronchodilators are medications that are commonly used to treat COPD by relaxing bronchial muscles. By relaxing these muscles, the airway becomes larger and allows air to pass through the lungs easier. Some are short-acting (4 to 6 hours) and are used when symptoms increase sharply, while longer-acting bronchodilators are used daily to treat more chronic COPD symptoms. People with COPD may use both types, depending on their symptoms.

COPD Treatment: Once-Daily Inhaler

There are at least 10 different inhalers available; they may contain one or more medications that may reduce COPD symptoms (bronchodilators, corticosteroids or combinations of both medications). For example, Spiriva contains tiotropium while Stiolto Respimat contains tiotropium bromide and olodaterol and is a once-daily inhaler available to COPD patients. This treatment relaxes muscles in the airways to improve breathing, but it should not be used to treat asthma. Stiolto Respimat is proven to be more effective than Spiriva or collateral alone.

Before utilizing a once-daily inhaler, check with your doctor to help you choose the inhaler that is the best choice for your condition.

COPD Treatment: Corticosteroids

Corticosteroids reduce the inflammation in airway tissues and thus allow the airway to open. This medicine is often taken by inhaler, but also may be administered by pills and/or injection. Oral corticosteroids are used to treat COPD when symptoms get rapidly worse. Inhaled corticosteroids are used to treat stable symptoms of COPD or COPD symptoms that are slowly getting worse. Both corticosteroids and bronchodilators are often prescribed to patients with COPD.

COPD Treatment: Lung Training

It is possible to significantly slow COPD progression and to improve breathing with pulmonary rehabilitation classes. Part of this rehabilitation includes stress management and breathing control techniques. Pulmonary rehabilitation classes are taught by specialists who help improve one’s physical condition as well as how to manage COPD after completing the course. Pulmonary rehabilitation will educate clients on breathing techniques, medications, nutrition, relaxation, oxygen, travel, and how to stay healthy and avoid COPD exacerbations.

Breathing Exercises for COPD

Having COPD makes it harder to breathe, which can lead to avoiding activities that leave you breathless. Here are some breathing exercises for people living with COPD:

1. Pursed-Lips Breathing
   
   This exercise involves breathing in through the nose (as if smelling something) for about two seconds. Then, purse the lips (like you are whistling or kissing) for two to three times longer than when you inhaled. Repeat as needed. This exercise makes exhaling easier for the person, and they also can extend exhalation, which provides improved oxygen and carbon dioxide gas exchange.
   Pursed-lips breathing offers the following benefits:
   • Slows down breathing
   • Keeps airways open longer so your lungs can get rid of more stale, trapped air
   • Reduces the work of breathing
   • Increases the amount of time you can exercise to perform an activity
   • Improves the exchange of oxygen and carbon dioxide
2. Diaphragmatic (Abdominal/Belly) Breathing
   
   The diaphragm is supposed to do most of the work when breathing, but COPD prevents the diaphragm from working properly. Instead, the neck, shoulders, and back are used while breathing. Diaphragmatic breathing may seem more difficult than pursed-lip breathing and seeking help from a health care professional is recommended.
   Begin by sitting back or lying down. Relax your shoulders and place one hand on your chest and the other on your belly. Inhale through the nose for two seconds. During inhalation, your belly should move outward and more than your chest. Exhale slowly through pursed-lips and gently press on your belly. This helps get the air out by pushing on the diaphragm. Repeat as needed.
   Diaphragmatic breathing offers the following benefits:
   • Increases total air volume exchange
   • Trains the diaphragm
   • Easier breathing
3. Coordinated Breathing
   
   Shortness of breath may cause you anxiety and you might hold your breath. Coordinated breathing helps to prevent this from happening. Before you can begin an exercise, inhale through the nose. Exhale, through pursed-lips, during the most strenuous part of the exercise. Coordinated breathing can be practiced during exercise or when feeling anxious.
4. Deep Breathing
   
   Shortness of breath can be caused by air getting trapped in your lungs and deep breathing can prevent this from happening. This exercise will also allow you to breathe in the more fresh air. Begin by sitting or standing with your elbows slightly back, allowing your chest to expand more. Inhale deeply and hold your breath for a count of five. Exhale slowly and deeply until all the air has been released. Repeat as needed.
5. Huff Cough
   
   The huff cough helps you cough up mucus that had built up in your lungs. COPD can make it difficult to cough without getting tired, but the huff cough makes it easier to cough up mucus. Begin by sitting in a comfortable position and inhale slightly deeper than normal. Exhale while making a “ha, ha, ha” sound, as if you are trying to steam up a mirror. This allows you to become less tired when coughing up mucus. Repeat as needed.

COPD Treatment: Oxygen Therapy

COPD lowers oxygen in the blood. As COPD progresses, many people have oxygen levels so low that they get very short of breath doing simple everyday tasks like walking a few steps or just standing up for a few minutes. These people with COPD usually get some relief with supplemental oxygen administered through nasal tubing. Using oxygen at home for more than 15 hours a day can increase the quality of life and help COPD patients live longer. Care must be taken when near someone using supplemental oxygen because it is flammable. Smoking, lit candles, or other open flames or sparking items (such as sparklers or gas cooking flames) should not be near someone using supplemental oxygen.

COPD Treatment: Antibiotics

Unfortunately, partially or completely blocked airways full of mucus are good places for pathogens (agents that cause diseases such as a virus or bacterium) to occupy and multiply. People with COPD are at a higher risk for infections because they have partially or completely blocked airways. If fever accompanies an increase in shortness of breath, people with COPD should see their doctor avoid serious infections. Antibiotics may be prescribed for bacterial infections.

COPD Treatment: Surgery

Surgery is not often used to treat people with COPD, but some people may benefit from certain procedures.

Surgical Procedures for COPD

Bullectomy
Typically, a bullectomy is meant for patients with COPD related to emphysema. When the air sac walls are destroyed, larger air spaces (bullae) will form. A bullectomy will remove the bullae and allow some lung expansion.

Lung Volume Reduction
Lung volume reduction surgery (LVRS) takes place in patients who suffer from COPD related to emphysema. This procedure reduces lung size by removing damaged tissues. The remaining lung and surrounding muscles can work more efficiently and allow functional airways to do the better gas exchange.

Lung Transplant
A lung transplant is typically performed in patients with very severe COPD. During a lung transplant, the damaged lung is removed and replaced with a healthy lung. The procedure improves COPD symptoms and the quality of life for some select patients (average survival is about 5 years after transplant). However, a lung transplant can cause infections and possibly death if the body rejects the new lung.

COPD and Exercise

All people with COPD are usually advised to exercise, even those on supplemental oxygen. Walking is considered by most clinicians as the best form of exercise, to begin with, and to develop endurance. Patients can start slowly and gradually increase their endurance.

Types of Exercises for COPD Patients

• Stretching- start by stretching the arms and legs before and after exercising to prepare the muscles for activity and prevent injury and muscle strain
• Cardiovascular or aerobic- walking, jogging, jumping rope, bicycling, cross-country skiing, skating, rowing, and low-impact aerobics
• Strengthening- repeated muscle contractions until the muscle becomes tired

Benefits of Exercise with COPD

• Improve circulation and help the body better use oxygen
• Improve COPD symptoms
• Build energy levels so you can do more activities without becoming tired or short of breath
• Strengthen the heart and cardiovascular system
• Increase endurance
• Lower blood pressure
• Improve muscle tone and strength; improve balance and joint flexibility
• Strengthen bones
• Help reduce body fat
• Help reduce stress, tension, anxiety, and depression
• Boost self-image and self-esteem
• Improve sleep
• Make you feel more relaxed and rested

Check with your doctor about exercising before you begin any exercise program.

COPD Prognosis

The prognosis for people with mild COPD is very good, but the prognosis may worsen as the severity of staging increases. The average life expectancy of a COPD patient who undergoes a lung transplant is about five years. Patients diagnosed with COPD have a much better outlook if they quit smoking. COPD prognosis is dependent on the stage of the illness and the health of the patient.

The BODE Index

The BODE Index is a way to measure a patient’s COPD prognosis. This test takes into account the patient’s body mass index (BMI), airway obstruction (measured by FEV1), dyspnea (measured by the MMRC dyspnea scale), and exercise tolerance (measured by a 6-minute walk). The BODE Index can assess a COPD patient’s life expectancy.

COPD Stages

There are four stages of COPD and each stage has different symptoms. Patients will usually participate in a pulmonary function test (PFTS) when being diagnosed with their stage of COPD.

Stage I (Mild COPD) Symptoms

• Shortness of breath when hurrying or walking on a slight incline
• No cough or mucus
• PFT results are usually 80% or more

Stage II (Moderate COPD) Symptoms

• Walking slower
• Become breathless when walking
• Possible cough or mucus
• PFT results are 50%-80%

Stage III (Severe COPD) Symptoms

• Stopping to regain breath after a few minutes of walking
• Possible cough and/or mucus
• Increased fatigue
• PFT results are 30%-50%

Stage IV (Very Severe COPD) Symptoms

• Too breathless to leave the house
• Breathless during everyday tasks
• Reduced quality of life
• PFT results are less than 30%

COPD and Diet

A healthy diet can help lessen symptoms of COPD. Obesity can make breathing and daily chores more difficult, while being too thin may cause weakness. Your doctor or a nutritionist can give you some guidance about a healthy diet for you. The following are some general dietary suggestions:

• Avoid under and overeating
• Monitor calories
• Limit salt intake
• Drink water, not caffeinated or carbonated drinks
• Eat high fiber foods (bran, fresh fruit)
• Avoid gas-producing foods (fried foods, beans)
• Eat small meals (3) with healthy snacks (2-3) every day

COPD: Smoking and Cancer

As mentioned previously, smoking, the leading cause of lung cancer, is also a major cause of COPD. Consequently, it is not surprising that many people with COPD also develop lung cancer. What is the best thing you can do to prevent COPD and lung cancer? Stop smoking, now. People who are diagnosed with COPD and who continue to smoke will have COPD progress faster. Smokers who quit will have COPD progress slower. Smoking causes airway tissues to become damaged or destroyed. Besides, the many toxins in cigarette smoke can increase blood pressure, heart rate, and increase the risk of lung cancer.

Living With COPD

Living with COPD can be very difficult, but some ways can help you diminish symptoms and slow the progression of COPD. Although several have been described in the preceding slides, here is a list of ways to improve your daily life:

• Stop smoking
• Eat a healthy diet
• Stay active (exercise to improve your endurance)
• Use your medications as directed
• Get the flu vaccine every year and get vaccinated against pneumococcal pneumonia
• Use sanitary hand washing techniques and avoid people with respiratory infections or those that have symptoms (cough, sneezing, nasal drip)

Contact your doctor immediately if you develop increasing symptoms of COPD and develop a fever.

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25 Effects of Smoking on Your Looks and Life

• Reviewed By: JAMES E. GERACE, MD

Reviewed on 5/3/2016

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Which Twin Smokes?

There are no proven ways to reverse the clock, but there is one known way to look older than your years: start smoking. Smoking can change your appearance by altering your teeth, hair, and skin. Aside from your appearance, smoking weakens your heart, lungs, and bones; and reduces fertility. Look at these two photos. One of these identical twins is a smoker; the other is not. Can you spot the difference?

Signs of a Tobacco Smoker

The twin on the right smoked for 14 years (a half-pack a day); her counterpart on the left is a nonsmoker. One of the characteristic signs is the looseness of the undereye skin, making her appear years older than her twin sister. This is one sign of skin damaged by smoking. The twin on the right further damaged her skin over time by repeated sun exposure.

Uneven Skin Tone

Smoking affects the blood vessels, which deliver oxygen and nutrients to the entire body. When the skin is deprived of these essential nutrients, changes begin to develop, even at an early age. Smokers can appear pale or have uneven skin tone as a result of their nicotine habit.

Sagging Skin and Wrinkles

Tobacco smoke contains over 4,000 chemicals, many of which are carcinogenic (known to cause cancer). Others are known to damage collagen and elastin, two components of the skin. Even exposure to secondhand smoke can result in skin damage. Sagging of the skin and deeper wrinkles are two consequences.

Sagging Arms and Breasts

Smoking can affect the skin elsewhere on the body as well. Damage to elastin fibers can cause sagging and drooping. Vulnerable areas include the breasts and upper arms.

Lines and Wrinkles Around the Lips

The damage to elastin in the skin is just one way that cigarette smoke affects the skin around the mouth. Another way is the development of wrinkles around the mouth from the act of smoking. These two factors together lead to early aging signs around the mouth.

Age Spots

This picture again shows identical twins, with half of the photo coming from each individual. The twin on the right had a long history of both smoking and sunbathing, in contrast to her sister. The difference is obvious. Age spots can develop in anyone after prolonged and repeated sun exposure, but studies suggest that smokers are more susceptible to the development of age spots.

Damaged Gums and Teeth

Yellow teeth are an obvious sign of smoking. But smokers experience other oral and dental problems as well. Gum disease, bad breath, and tooth loss are all more common in people who smoke.

Stained Nails and Fingers

Tobacco stains the skin of the nails and hands. This can be a telltale sign of a chronic smoker. Fortunately, this discoloration usually fades after you have stopped smoking.

Hair Loss

Smoking can worsen the natural process of hair thinning that occurs as we age. Some research shows that baldness is more common in men who smoke; studies from Taiwan show that male-pattern baldness risk increases in Asian men who smoke.

Cataracts

Cataracts are opaque areas on the lens of the eye that interfere with vision. Effective treatment can mean that surgery is required. Smoking increases the likelihood that you will develop cataracts.

Psoriasis

Smokers also have an increased risk of getting psoriasis, an unsightly and often uncomfortable skin condition. Psoriasis is characterized by thick, scaly skin patches that are most commonly seen on the elbows, scalp, hands, back, or feet.

Eye Wrinkles (Crow's Feet)

The outside eye wrinkles affectionately termed "crow's feet" develop earlier in smokers than in nonsmokers. These wrinkles also tend to be deeper in those who smoke. Squinting to keep smoke out of your eyes only worsens the tendency to develop wrinkles around the eyes. On top of all this, there is damage to the internal skin components because of the lack of nutrient and oxygen delivery to the skin.

Improve Your Looks By Quitting

After you quit smoking, blood flow improves. Consequently, your skin starts to receive more oxygen and begins to look healthier than before. Your teeth may get whiter and tobacco stains should disappear from your fingers and nails.

Battling Skin Damage: Creams

Any time you quit smoking, you've taken a healthy step toward resisting the signs of skin aging. Topical retinoids and antioxidants are among the products you can use to improve the appearance of your skin. Wearing sunscreen every time you are outdoors also helping prevent further damage.

Battling Skin Damage: Procedures

Some ex-smokers opt for cosmetic procedures to improve their damaged skin. Laser skin resurfacing and chemical peels can remove outer skin layers where damage is most obvious. Some doctors recommend that patients treat themselves to this type of procedure after quitting, suggesting that it provides strong motivation to stay tobacco-free.

Brittle Bones

While the effects of smoking on the lungs are widely understood, it might surprise some smokers to know that they are also damaging their bones. Smoking raises the risk of osteoporosis and fractures. Fractures of the spine can cause an abnormal curvature and "hunchback" appearance.

Heart Disease and ED

Narrowing of the coronary arteries of the heart is one of the most dangerous consequences of smoking. Since smoking also raises blood pressure and makes blood more likely to clot, the risk of a heart attack is dramatically increased. Smoking can also affect blood flow in other ways. Erectile dysfunction is one consequence of altered blood flow in men who smoke.

Reduced Athletic Ability

With all its effects on the heart and circulation, it's obvious that smoking and athletics don't mix. Increased shortness of breath and poor circulation isn't going to boost athletic performance. Quitting smoking is one way to ensure performance improvement in any sport.

Reproductive Issues

Not only do female smokers have a harder time conceiving, but their risk of problems in pregnancy also increases. Women who smoke have a greater than normal chance of miscarriage, premature birth, or having a baby with low birth weight.

Early Menopause

Women who smoke also reach menopause earlier than women who don't, according to researchers. Studies show that smokers reach menopause about 1 1/2 years earlier, on average than nonsmokers. This is particularly true of women who smoked heavily for a long time.

Oral Cancer

Oral cancer risk is also elevated in people who smoke or use smokeless tobacco. Adding alcohol to the mix intensifies this risk; those who smoke and are heavy drinkers have a 15-fold increased risk of oral cancer. Oral cancer usually starts as a sore inside the mouth that won't go away. Quitting smoking lowers the risk of oral cancer.

Lung Cancer

Nine out of every 10 deaths from lung cancer are due to smoking, meaning that 90% of lung cancer deaths could be prevented. Smoking causes other lung problems, like emphysema, and increases the risk of contracting pneumonia.

How Quitting Improves Your Health

Blood pressure and heart rate reduce to normal levels within 20 minutes of stopping smoking! Heart attack risk begins to lower after the first 24 hours. Within the first weeks, the lungs begin to heal, and the tiny cilia (seen in this enlarged photo) start to rid the lungs of pollutants. Your risk of developing heart disease drops to half that of current smokers after just one year of quitting. After ten years, your risk of dying from lung cancer is the same as that of a nonsmoker.

Cigarette Stench

Quitting smoking has cosmetic effects, too. The smell of cigarettes is removed from your hair and clothes. Just the smell attached to a smoker can be harmful to others. Others can be exposed to the toxins that cause your hair and clothes to smell. This has been termed "third-hand smoke" and is believed to be particularly harmful to children.

Can You Quit?

Of course, giving up any addiction is difficult, but quitting smoking is possible. There are more former smokers (48 million) than current smokers (45 million) in the US. This means that quitting has worked for 48 million people! Your doctor can help recommend medications and other quitting strategies to help you succeed.

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Smoking: How E-cigarettes and Vaping Affect Your Body

• Reviewed By: Melinda Ratini, DO

Reviewed on 9/28/2019

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What Is Vaping?

It's when you use a handheld tube, or tank, attached to a mouthpiece that makes a vapor you inhale. There are different types, such as vape pens, e-cigarettes, e-hookahs, and mods. But they all heat liquid chemicals ("e-juice") into a mist you breathe in like a cigarette or pipe.

Is Vaping Safe?

We don't know all the risks. But in the U.S., several people have died and hundreds had lung injuries linked to vaping. Many used marijuana products, but not all. Until we have the answers, the CDC says:

• Youths, young adults, and pregnant women shouldn't vape.
• If you don't vape, don't start.
• If you vape, don't buy devices or liquids off the street.
• Don't change a vaping device or add anything to it that the maker didn’t intend.

What's in the E-Liquid?

The FDA regulates e-liquids sold in stores, but not ones you buy on the street. The liquid or "e-juice" can contain marijuana or other drugs. But nicotine, which is known to be addictive, is the most common active ingredient. The liquid has other chemicals that may be dangerous. Two of them -- diacetyl and formaldehyde -- are linked to lung disease and cancer. Researchers are looking at the health effects of other e-juice ingredients.

Flavoring

Some e-juice is flavored. Even without nicotine, these flavorings can cause DNA damage or kill cells that line your blood vessels. One study showed that cinnamon and menthol flavors were especially harmful. Young people may be drawn to vaping by sweet, candy-like flavors and smells. To help stop this, several U.S. states have banned the sale of flavored vaping liquid. The federal government also plans to ban its sale nationwide.

Toxic Metals: Surprising Byproduct

Besides chemicals, researchers have found levels of metals in e-cig vapor that may not be safe. These include lead, chromium, and nickel, as well as the metal-like element arsenic. Studies suggest that most of these metals are released by the coils inside the device that heat the liquid. Breathing them in is linked to lung, liver, immune system, and brain damage, as well as several cancers.

Nicotine and Your Body

Nicotine in e-liquid goes quickly from your lungs to your bloodstream. It causes your body to release adrenaline, a hormone that raises your pulse, blood pressure, and breathing rate. This could play a role in raising your heart attack odds. You may also feel more alert and need to cough. If you vape marijuana, the high will be stronger than if you smoke the same amount. You may feel more anxious. Your eyes and mouth will be drier, too.

Is Vaping Addictive?

Nicotine is highly addictive. So you're likely to get hooked if you vape regularly. Young people are especially at risk of becoming addicted. Because their brains are growing so quickly, new habits take root very fast, and they "learn" to be dependent easily. Nicotine can also wire the brain for addiction to other drugs, like cocaine and alcohol.

Vaping and Your Heart

Studies show vaping may make heart disease more likely. Nicotine boosts plaque buildup in your arteries, which makes it harder for blood to reach your vital organs. This can lead to a heart attack or stroke. Smoking marijuana raises your heart rate, which makes your ticker work harder. Vaping the drug strengthens this effect. Just being around people who are vaping is a risk because you can breathe in the vapor.

Vaping and Your Lungs

You might cough and wheeze. If you have asthma, vaping can make it worse. Scientists think the chemicals often found in e-juice can cause other serious lung problems. A chemical called acrolein, for example, is mainly used to kill weeds. It can cause sudden lung injury and trigger serious respiratory illnesses like COPD and lung cancer.

Vaping and Your Brain

Your brain continues to grow until age 25. Before then, it's highly sensitive to the effects of e-cigarette chemicals, especially nicotine. It can disrupt your brain growth, with lasting effects on your learning and thinking skills. It's also linked to depression and schizophrenia.

Vaping and Your Immune System

Scientists already know that nicotine and marijuana can weaken your body's ability to fight germs. Research shows that vaping is especially bad for your immune system.

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Smoking: See What Happens to Your Body When You Quit

• Reviewed By: Jennifer Robinson, MD

Reviewed on 6/25/2019

Coronavirus COVID-19: Latest News and Information

20 Minutes: Pulse and Blood Pressure

Within half an hour of your last cigarette, your heart rate and blood pressure typically drop to normal levels. That's good because high blood pressure is known as "the silent killer" for its dangerous effects that often have no symptoms. These include heart attack, stroke, loss of vision, and more. A pulse that's too fast is harder on your heart. It can cause tiredness, dizziness, chest pain, and breathing problems.

12 Hours: Carbon Monoxide

When you smoke, you have 3 to 15 times more of this toxic chemical in your blood than someone who doesn't smoke. At higher levels, you might have a headache, faster pulse, dizziness, or nausea. That level drops to normal less than a day after you quit. That makes room for more oxygen in your red blood cells that you need for your heart, brain, and other organs.

24 Hours: Heart Attack Risk

Smoking is the top cause of heart attacks. Your risk goes down after just 1 day without cigarettes and continues to drop after that. If you've already had a heart attack and cut out cigarettes, you cut your chance of having another one in half.

48 Hours: Sense of Smell and Taste

Toxins in cigarette smoke kill the cells that help you taste and smell. Fortunately, these cells seem to grow back quickly when you stop smoking.

72 Hours: Bronchial Tubes

Cigarette smoke inflames these pathways through which air moves in and out of your lungs. That can make it harder to breathe. But it starts to get much better just 72 hours after you quit as the tubes start to relax. You might notice a boost in energy, too.

2 to 12 Weeks: Blood Circulation

It should start to improve almost immediately, but after a couple of weeks or more you might notice even bigger improvements. You may start to feel sensations more easily, and your hands and feet will be warmer as well. Good circulation is also linked to healthier blood pressure, pulse, and blood-oxygen levels.

1 to 9 months: Lung Function

Here's where you really might start to feel like you have more energy. You'll start to cough less and breathe better. Tiny hairs in your lungs called cilia to start to grow back. This helps cleans out your lungs and lessen infection. Your lung function could go up by as much as 10%.

1 year: Heart Health

Your risk of both heart disease and heart attack drops to about half that of a smoker. Nothing else you can do has such a dramatic effect on heart health.

2 to 5 Years: Cancer

Smoking raises your risk for certain cancers. You can help lower it again if you quit. After 5 years, your risk of mouth, throat, esophageal, and bladder cancers will be just half of what it was when you smoked. Your risk of cervical cancer will fall to that of a nonsmoker.

5 Years: Stroke

Smoking speeds up the formation of blood clots that can lead to a stroke. But in as few as 5 years after you quit, your risk of stroke could fall to the same as that of someone who doesn't smoke.

10 Years: Lung Cancer

That's how long it takes to cut your lung cancer risk to half that of a person who still smokes. At this time, your risk of cancer of the larynx and of the pancreas also goes down.

15 Years: Heart Disease

Congratulations! You've done much to reverse the damage that cigarette smoking causes. Your risk of both heart disease and heart attack is now the same as someone who has never smoked.

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How to Quit Smoking: 13 Tips to End Addiction

• Reviewed By: JAMES E. GERACE, MD

Reviewed on 7/27/2016

Coronavirus COVID-19: Latest News and Information

No. 1: Know Why You Want to Quit

Quitting smoking is a perfect idea! Get a powerful, motivating reason and do it now! Do it for yourself: to feel better and look younger, and to reduce your chance of getting lung cancer. Do it for your family: protect your loved ones from secondhand smoke.

No. 2: Don't Go Cold Turkey

It's not common to successfully quit smoking by stopping immediately. Most people who quit "cold turkey" end up smoking again. Nicotine addiction can require gradual tapering to avoid withdrawal symptoms.

No. 3: Try Nicotine-Replacement Therapy

Nicotine withdrawal can cause restlessness, depression, and can lead to frustration. Cravings can be overwhelming. Nicotine replacement treatments including nicotine gum, patches, and lozenges can help. Do not smoke while using nicotine replacements.

No. 4: Ask About Prescription Pills

Discuss nicotine replacement with your doctor. There are prescription medications that can reduce the craving for cigarettes and reduce withdrawal symptoms.

No. 5: Don't Go It Alone

Friends and family can encourage and support you while you are quitting smoking. Some find support groups and/or counselors helpful. Behavioral therapy is often used with success. When these methods are combined with nicotine replacement therapy, your odds of success in quitting can increase.

No. 6: Manage Stress

Stress reduction techniques are helpful when quitting smoking. Helpful methods can include yoga, tai chi, music, massage, and exercise.

No. 7: Avoid Alcohol, Other Triggers

Alcohol can be a trigger that causes people to return to smoking. Similarly, coffee and meals can cause relapses. Find your triggers, and replace them with other activities. Some find it helpful to brush teeth or chew gum after eating.

No. 8: Clean House

Clear your home of anything that reminds you of smoking. Remove ashtrays and lighters from your home and wash your clothes, upholstery, draperies, and carpets. Air fresheners will also help to eliminate that familiar smell.

No. 9: Try and Try Again

Relapses are common. If you relapse into smoking, analyze your situation and what might have triggered you to smoke again. Redefine your commitment and set a "quit date" and do it!

No. 10: Get Moving

Exercise activity can reduce nicotine cravings and withdrawal symptoms. When you feel like smoking, go move and find an activity you enjoy. This can also help to keep your weight optimal.

No. 11: Eat Fruits and Veggies

Don't worry about dieting during the early stages of quitting smoking. Focus on eating healthy foods. Of note, vegetables, fruits, and low-fat dairy products tend to make cigarettes taste poorly, according to a Duke University study.

No. 12: Choose Your Reward

Another benefit of stopping smoking is financial. Reward yourself by spending your extra money on something that you enjoy or saving for something you really want!

No. 13: Do It for Your Health

The real reward in stopping smoking is improved health. Stopping smoking lowers your blood pressure, decreases your risk of heart attack and stroke, as well as lung and other forms of cancer.

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How to Quit Smoking Without Weight Gain

• Reviewed By: Physicians' Review Network (PRN)

Reviewed on 6/21/2016

Coronavirus COVID-19: Latest News and Information

Congratulations!

Give yourself a round of applause: you have quit smoking and taken steps to better health. One of the biggest concerns of smokers who quit is weight gain, but your first priority should remain to stop smoking. After that, you can continue on your path to healthy living by reaching and maintaining a healthy weight.

Health Risks of Smoking

We all know smoking is the number one risk factor for lung cancer, which is the leading cause of cancer death in the U.S. Smoking is also a risk factor for cancer of the mouth, nose, throat, larynx, esophagus, liver, bladder, kidney, pancreas, colon, rectum, cervix, stomach, blood, and bone marrow. It increases the risk of other lung diseases as well as heart disease. Pregnant women who smoke risk their babies being born prematurely, having delivery complications, and babies with low birth weight.

Will I Gain Weight if I Stop Smoking?

It's not guaranteed you will gain weight when you quit smoking. For those who do gain weight, the gain is only about 6 to 8 pounds. Only about 10% of people who quit smoking gain 30 pounds or more.

What Causes Weight Gain After Quitting Smoking?

There are several reasons you may gain weight when you stop smoking, including:

• Hunger. When you first quit you may feel hungrier than you used to. This feeling will usually disappear after several weeks.
• More snacking and drinking alcohol. Many people turn to snacks or alcohol when they quit smoking.
• Calorie burn returns to normal levels. When you smoke, your body burns calories faster because your heart rate rises. However, this is a temporary effect that is damaging to your heart. When you quit smoking, this short-term calorie burn goes away and you will burn slightly fewer calories.

Can I Avoid Weight Gain After I Quit Smoking?

It's always a good idea to exercise and eat a balanced and healthy diet. However, when you are quitting smoking, focus on that goal first and foremost. Once you are smoke-free you can concentrate on weight loss efforts. The following slides discuss some ways to prevent weight gain when you quit smoking.

Accept Yourself

Don't dwell on weight gain, if any. Quitting smoking will improve your health in so many ways. You will notice:

• More energy
• Whiter teeth
• Fresh breath
• Clothes and hair smell cleaner
• Fewer wrinkles
• Skin looks healthier
• Voice is more clear

Get Regular, Moderate-Intensity Physical Activity

Regular exercise is one of the best ways to prevent large weight gain when you stop smoking. Exercise also gives you energy and can act as a mood-booster. Once you quit smoking, you will likely find you can breathe more easily during physical activity.

Aim for about 30 minutes of moderate-intensity exercise nearly every day to prevent weight gain. It doesn't have to be all at once – you can break it up into shorter sessions. You may need more than 30 minutes of exercise daily to lose weight.

Ideas for Being Active Every Day

There are ways you can incorporate physical activity into each day without it being a long exercise session. Try these simple steps:

• Take a walk during lunch breaks or after dinner.
• If you take the bus or subway get off one stop early and walk home (if you live where it is safe to do so).
• Park your car further away from the entrance to stores so you can walk.
• Take the stairs instead of the elevator.
• Sign up for fun classes such as dance or yoga.
• Ask a friend to join you when you exercise.

Limit Snacking and Alcohol

In addition to moving more, you must watch what you eat to avoid weight gain when you quit smoking. Many former smokers turn to high-fat, high-sugar snacks or alcoholic beverages when they quit. Don't fall into that trap of replacing one bad habit with another. Follow these steps to make healthier choices about what you eat and drink:

• Eat frequent, smaller meals.
• Eat enough to satisfy you, but don't overindulge.
• Eat slowly to pick up on your body's signals that you are full – it usually takes about 20 minutes from the first bite for your body to start registering you have had enough.
• Choose healthy snacks such as fruit, air-popped popcorn, or fat-free yogurt.
• If you want an occasional treat, have a small serving.
• Choose beverages that are sugar-free and fat-free instead of alcohol or soda.

Consider Using Medication to Help You Quit

In some cases, medications may help you quit smoking, and also to gain less weight when you do so. Talk to your doctor about the medications available, including nicotine replacement therapy (the patch, gum, nasal spray, and inhaler), or antidepressant medication. Nicotine patches and gum are usually available without a prescription.

Consider Getting Professional Advice about Weight Control

It may be easier to prevent weight gain or to lose weight with some extra help from a professional. Look into seeing a registered dietitian, nutritionist, or personal trainer to help with your diet and exercise goals.

Will Weight Gain Hurt My Health?

Most of us don't like to gain weight, but the overall benefits of quitting smoking far outweigh the risks of a few extra pounds. When you quit smoking you lower your risk for numerous types of cancers and other illnesses such as heart disease. When you embark on a smoking cessation program focus first on quitting. Once you have quit for good, then turn your energy to becoming physically active and eating a balanced diet to reach your desired weight.

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Effects of Secondhand Smoke: Facts

• Reviewed By: JAMES E. GERACE, MD

Reviewed on 7/27/2016

Coronavirus COVID-19: Latest News and Information

What Is Secondhand Smoke?

Secondhand smoke (also called environmental tobacco smoke, involuntary smoke, and passive smoke) is the combination of tobacco smoke and exhaled smoke from the smoker. Nonsmokers can inhale secondhand smoke, exposing themselves to the same chemicals, such as nicotine and carbon monoxide, as the smoker.

Secondhand Smoke and Children

Secondhand smoke exposure puts children at risk for health problems including severe asthma, breathing problems, and ear infections. Babies born to mothers who inhaled secondhand smoke are often lower birth weight and are more likely to die from SIDS (sudden infant death syndrome). Chemicals in cigarette smoke are also passed through breast milk.

What Causes Secondhand Smoke?

The most common source of secondhand smoke is cigarette smoke. Cigars and pipes are also a source. Secondhand smoke can occur anywhere, at home, at work, and in public spaces.

What Are the Health Risks of Secondhand Smoke?

More than 7,000 different chemicals have been identified in secondhand smoke. Of those, 250 have been identified as harmful, and 69 of those are known to cause cancer (carcinogenic). Some of the toxic chemicals include arsenic, benzene, the toxic metal beryllium, cadmium, ethylene oxide, formaldehyde, toluene, and vinyl chloride.

Secondhand smoke causes cancer. The U.S. Environmental Protection Agency, the U.S. National Toxicology Program, the U.S. Surgeon General, and the International Agency for Research on Cancer have all classified secondhand smoke as a known human carcinogen (a cancer-causing agent).

In addition to cancer, secondhand smoke causes serious cardiovascular and respiratory diseases and other illnesses.

Lung Cancer

Living with a smoker and inhaling secondhand smoke can increase the risk of developing lung cancer by 20% to 30%, according to the U.S. Surgeon general. There are approximately 3,000 lung cancer deaths in adult nonsmokers that result from exposure to secondhand smoke.

Heart Disease (Cardiovascular Disease)

Inhaling secondhand smoke can harm the cardiovascular system and can increase the risk for heart attack, particularly in those who already have heart disease. Nonsmokers exposed to secondhand smoke have a 25-30% higher risk of developing heart disease. Exposure to secondhand smoke causes an estimated 46,000 heart disease deaths each year. The risk of stroke is increased as well when secondhand smoke is inhaled.

Other Lung Diseases and Respiratory Illnesses

Secondhand smoke can irritate the lungs and can cause respiratory illnesses and breathing difficulties. Cough, chest congestion (phlegm), wheezing, shortness of breath, and even decreased lung function are all traceable to secondhand smoke exposure. In the U.S., among children 18 months and younger, secondhand smoke exposure is responsible for 150,000 to 300,000 cases of bronchitis and pneumonia, and 7,500 to 15,000 hospitalizations each year.

Other Effects on Children

In addition to serious reparatory infections, children who are exposed to secondhand smoke are at higher risk for ear infections, have fluid in their ears more often, and more frequently need operations to put in ear tubes for drainage. In children with asthma, even a small exposure to secondhand can trigger an asthma attack.

Effects on Pregnant Women

Babies born to mothers who inhaled secondhand smoke are often lower birth weight and are more likely to die from SIDS (sudden infant death syndrome).

Possible Link to Breast Cancer

Secondhand smoke is thought to possibly increase the risk of breast cancer. Research is still underway, and results have been mixed. Because secondhand smoke contains known carcinogens this may account for the increased risk.

Is There A Safe Level of Secondhand Smoke?

There is no safe level of secondhand smoke. Even inhaling small amounts can be harmful, and extensive or long-term exposure increases the risk of medical problems. Avoiding secondhand smoke is the best way to reduce the health risk.

What Can Be Done About Secondhand Smoke Exposure?

Nationally, numerous laws restrict smoking in public places such as airlines and Federal buildings. State and local laws routinely prohibit smoking in public places such as schools, hospitals, airports, and beaches. Many workplaces, restaurants, and bars also ban smoking on the premises. To find the laws in your state, the American Lung Association has a listing of regulations grouped by U.S. state: http://www.lungusa2.org/slati/

The U.S. Department of Health and Human Services Healthy People 2020 is a nationwide initiative aimed at reducing illness and death related to smoking and secondhand smoke. For more information on Healthy People 2020 visit http://www.healthypeople.gov/.

If You're A Smoker…

If you smoke, quit. Your family and friends will no longer be exposed to your secondhand smoke if you are not smoking. Find support at smokefree.gov.

How to Protect Yourself If You're A Non-Smoker

Avoid secondhand smoke to protect yourself from the health risks associated with inhaling it. If you don't smoke, don't allow others to smoke in your home or car. Make sure smoking restrictions are enforced where you work such as proper ventilation and smoking areas at least 25 feet away from entrances. Find smoke-free bars and restaurants, and let the owners know that you come there because they are smoke-free. Don't allow anyone who is smoking near your child, as children are particularly vulnerable to the effects of passive smoke.

What Is Thirdhand Smoke?

Thirdhand smoke is a recent term that refers to the smoke residue that is left behind after being around people who are smoking. The smell in your clothes, curtains, carpet, furniture, and other items has an odor because of the tobacco toxins that remain. These toxins can be absorbed through the skin and mucus membranes of non-smokers, particularly infants and children. To prevent thirdhand smoke, you need to prevent secondhand smoke.

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Dehydration: Causes, Symptoms & Tips to Stay Hydrated

• Reviewed By: Physicians' Review Network (PRN)

Reviewed on 6/21/2016

Coronavirus COVID-19: Latest News and Information

Our Body of Water

The majority of the body is made up of water with up to 75% of the body's weight due to H2O. Most of the water is found within the cells of the body (intracellular space). The rest is found in the extracellular space, which consists of the blood vessels (intravascular space) and the spaces between cells (interstitial space).

What is Dehydration?

Dehydration occurs when the amount of water leaving the body is greater than the amount being taken in. The body is very dynamic and always changing. This is especially true with water levels in the body. We lose water routinely when we:

• breathe and humidified air leaves the body;
• sweat to cool the body; and
• urinate or have a bowel movement to rid the body of waste products.

On a normal day, a person has to drink a significant amount of water to replace this routine loss.

Causes of Dehydration: Diarrhea

Diarrhea is the most common reason a person loses excess water. Diarrhea consists of unusually frequent or unusually liquid bowel movements and excessive watery evacuations of fecal material. Persistent diarrhea is both uncomfortable and dangerous, as a significant amount of water can be lost with each bowel movement. Worldwide, more than four million children die each year because of dehydration from diarrhea.

Causes of Dehydration: Vomiting

Vomiting is the act of forcible emptying of the stomach, in which the stomach has to overcome the pressures that are normally in place to keep food and secretions within the stomach. The stomach almost turns itself inside out - forcing itself into the lower portion of the esophagus (the tube that connects the mouth to the stomach) during a vomiting episode. Constant vomiting can be a serious cause of fluid loss and it is difficult for a person to replace the water if they are unable to tolerate liquids.

Causes of Dehydration: Sweat

The body can lose significant amounts of water when it tries to cool itself by sweating. Whether the body is hot because of the environment (for example, working in a warm environment), intense exercising in a hot environment, or because a fever is present due to an infection; the body uses a significant amount of water in the form of sweat to cool itself. Depending upon weather conditions, a brisk walk will generate up to 16 ounces of sweat (one pound of water).

Causes of Dehydration: Diabetes

In people with diabetes, elevated blood sugar levels cause sugar to spill into the urine, and water then follows, which can cause significant dehydration. For this reason, frequent urination and excessive thirst are among the symptoms of diabetes.

Causes of Dehydration: Burns

The skin has an important role to play in the fluid and temperature regulation of the body. If enough skin area is injured, the ability to maintain that control can be lost. Burn victims become dehydrated because water seeps into the damaged skin. Other inflammatory diseases of the skin are also associated with fluid loss.

Causes of Dehydration: Inability to Drink Fluids

The inability to drink adequately is another potential cause of dehydration. Whether it is the lack of availability of water or the lack of strength to drink adequate amounts, this, coupled with routine or excessive amounts of water loss can compound the degree of dehydration.

What Are the Signs and Symptoms of Dehydration?

The body's initial responses to dehydration are thirst to increase water intake along with decreased urine output to try to conserve water. The urine will become concentrated and more yellow in color. As the level of water loss increases, more symptoms can become apparent, such as increased thirst, dry mouth, cessation of tear production by the eyes, cessation of sweating, muscle cramps, nausea and vomiting, heart palpitations, and lightheadedness (especially when standing). With severe dehydration, confusion and weakness will occur as the brain and other body organs receive less blood. Finally, coma and organ failure will occur if the dehydration remains untreated.

How is Dehydration Diagnosed?

Dehydration is often a clinical diagnosis. Aside from diagnosing the reason for dehydration, the health care professional's examination of the patient will assess the level of dehydration. Initial evaluations may include:

• Mental status tests to evaluate whether the patient is awake, alert, and oriented.
• Vital sign assessments may include postural readings (blood pressure and pulse rate are taken lying down and standing). With dehydration, the pulse rate may increase and the blood pressure may drop because the intravascular space is depleted of water.
• The temperature may be measured to assess fever.
• Skin will be checked to see if sweat is present and to assess the degree of elasticity. As dehydration progresses, the skin loses its water content and becomes less elastic.
• Infant evaluation: infants may have additional evaluations performed, including checking for a soft spot on the skull (sunken fontanelle), assessing the sucking mechanism, muscle tone, or loss of sweat in the armpits and groin.
• Pediatric patients are often weighed during routine visits, thus a bodyweight measurement may help assess how much water has been lost with the acute illness.

In some cases, blood tests to measure potential electrolyte abnormalities and urinalysis may be ordered to determine the level of dehydration in the patient.

How Is Dehydration Treated?

Fluid replacement is the treatment for dehydration. This may be attempted by replacing fluid by mouth, but if this fails, intravenous fluid (IV) may be required. Should oral rehydration be attempted, frequent small amounts of clear fluids should be used.

Clear fluids include:

• water,
• clear broths,
• popsicles,
• Jell-O, and
• other replacement fluids that may contain electrolytes (Pedialyte, Gatorade, Powerade, etc.)

Can Dehydration Be Treated at Home?

Dehydration occurs over time. If it can be recognized in its earliest stages, and if its cause can be addressed, then home treatment may be adequate. Steps a person can take at home to prevent severe dehydration include:

• People with vomiting and diarrhea can try to alter their diet and use medications to control symptoms to minimize water loss.
• Acetaminophen or ibuprofen may be used to control fever. Ibuprofen may irritate the stomach and cause nausea and vomiting, so it should be used with caution in individuals who already have these symptoms.
• Fluid replacements may be attempted by replacing fluid by mouth with frequent small amounts of clear fluids.

If the individual becomes confused or lethargic; if it is persistent, uncontrolled fever, vomiting, or diarrhea; or if there are any other specific concerns, then medical care should be accessed. EMS or 911 should be activated for any person with altered mental status.