For people suffering from Chronic Obstructive Pulmonary Disease (COPD), breathing in and out is anything but easy. Normal breathing is a two-step process starting with contractions of the diaphragm creating a vacuum in the lungs. This results in air moving passively into the lungs (inhale). When enough air has been inhaled, the diaphragm stops contracting and the lungs passively allow air to move out (exhale).

This process is impaired or altered in people with COPD. The diaphragm does not work as well, lungs become hyperinflated from air trapped in the lungs, and exhalation becomes an active process, resulting in increased work of breathing.

COPD is an umbrella term used to describe the co-existence of emphysema and chronic bronchitis.

Emphysema destroys the air sacs and/or the smallest breathing tubes in the lungs. Lungs lose their elasticity, much like an overused rubber band, and air sacs become enlarged, trapping air in the sacs and impairing the exchange of oxygen and carbon dioxide. Symptoms include a cough, shortness of breath, and limited exercise tolerance.

Emphysema is a progressive disease that develops after years of exposure to smoking or pollution. Cigarette smoking is the primary cause.

Several treatments are available to help minimize the symptoms of emphysema and potentially decrease the rate of progression, but one of the most important treatments is one you can do -- stop smoking. Stopping at any point in the development of the disease will provide some benefit.

Chronic bronchitis is an inflammation, and eventual scarring, of the lining of the bronchial tubes. Long-time irritation of the bronchial tubes causes the formation of excessive mucus and the lining of the bronchial tubes becomes thickened, an irritating cough develops, air flow may be hampered, and the lungs are endangered. The bronchial tubes then make an ideal breeding place for infections.

Initially patients with early chronic bronchitis look normal in appearance, but as time passes the lips and skin may appear blue (from decreased oxygenation of tissues), feet swell, and there may be abnormal sounds in the lungs.

The treatment of chronic bronchitis is aimed at reducing irritation in the bronchial tubes. The discovery of antibiotic drugs has been helpful in treating acute infection associated with chronic bronchitis. Cigarette smoking is by far the most common cause of chronic bronchitis.

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• COPD is the fourth leading cause of death in the U.S. for people between the ages of 65 to 84.
• More than 122,000 Americans died of COPD in 2000.
• The annual cost to the nation is approximately $30.4 million.
• An estimated 8.8 million Americans were diagnosed with chronic bronchitis in 1999.
• An estimated 2.2 million Americans have been diagnosed with emphysema.
• Women have higher rates of chronic bronchitis while men have higher rates of emphysema.
• Approximately 80 to 90 percent of COPD cases are caused by smoking.
• A smoker is 10 times more likely than a nonsmoker to die of COPD.

*Figures from the American Lung Association.

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UI Health Care's Pulmonary Rehabilitation Program is a comprehensive, multi-disciplinary program tailored to meet the needs of each patient. The goal of the program is to help each patient achieve the maximum level of disease management/health and physical functioning.

The program includes:

• Patient assessment
• Training in all aspects of self care/disease management
• Psychosocial support
• Monitored progressive exercise

"The Pulmonary Rehabilitation Program provides patients with an opportunity to learn how to better care for themselves to maximize their health and level of independent physical functioning," says Kim Nielsen, UI Hospitals and Clinics physical therapist. "As a result, a person may have improved overall quality of life. Pulmonary rehabilitation helps patients with lung disease strive to reach their potential for health and fitness."

For more information about the program, call UI Health Access, 319-384-8442, ext. 403, or 800-777-8442, ext. 403, or visit www.uihealthcare.com/rehabtherapies.

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Nationally, smoking results in more than 5.6 million years of potential life lost each year.

Tobacco use remains the leading preventable cause of death.

Smoking causes more than 440,000 deaths each year, resulting in an annual cost of more than $75 billion in direct medical costs.

Every day, nearly 5,000 young people under the age of 18 try their first cigarette.

More than 6.4 million children living today will die prematurely because of a decision they will make as adolescents -- the decision to smoke cigarettes.

According to the 2000 National Health Interview Survey, 70 percent of adult smokers wanted to quit smoking.

In 2000, 41 percent of adult smokers stopped smoking for at least one day because they were trying to quit.

Interested in quitting? Call UI Health Access, 319-384-8442,

ext. 403, or 800-777-8442, ext. 403, for information about UI Health Care's Counseling and Health Promotion smoking cessation classes, or the UI Department of Rehabilitation Therapies Stop Smoking Clinic, www.uihealthcare.com/rehabtherapies.

*Figures from American Lung Association and Centers for Disease Control and Prevention.

All figures are for U.S.

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• National Lung Health Education Program
  Save Your Breath, America! Prevent Emphysema Now!

Listed above are several Web sites that offer additional information on this topic. University of Iowa Health Care does not sponsor or endorse these sites, or guarantee the accuracy of the information contained on these sites. These links are here for general information only, and should not be used for personal diagnosis or treatment. If you have any questions, please contact UI Health Access.

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