Symptoms lead diagnosis of COPD and emphysema

Ask Dr. Keith Roach M.D

DEAR DR. ROACH: What tests check for emphysema? Are they the same tests for COPD? My age is 80. — P.T. ANSWER: There are two main forms of chronic obstructive pulmonary disease: chronic bronchitis and emphysema. The main risk factor is cigarette smoking, but there are other risk factors, including a genetic condition, alpha- 1-antitrypsin deficiency. COPD is the fourth-leading cause of death in the U.S., and it gets a shockingly low amount of research money for such an important condition. Diagnosing COPD early is important in order to relieve symptoms, prevent hospitalizations and improve the quality of life and survival rates. The diagnosis of COPD should be suspected when there are classic symptoms. Shortness of breath, chronic cough (sometimes productive), wheezing and fatigue all may be present. Some people with COPD reduce their activities without realizing the degree to which they have become limited. The diagnosis of COPD is usually confirmed by tests of lung function; spirometry may be done in the physician’s office, but formal pulmonary function testing in the lab gives a definitive answer. Testing is done only to confirm a clinical diagnosis. Pulmonary function testing is expensive and time-consuming and can lead to inappropriate diagnoses if done indiscriminately. *** DEAR DR. ROACH: I often see advertisements for various arm, leg and body wraps that have copper infused in them. The ads claim they help with lack of energy and other problems. Are any of these claims real? I have my doubts. — H.I. ANSWER: You are wise to have doubts. There’s no good evidence that these wraps are effective, and the copper is a clever marketing gimmick with neither clinical evidence nor a good physiological reason to back it up. One manufacturer has had to pay a large fine for deceptive marketing. Save your money. *** DEAR DR. ROACH: Four years ago, I had a second heart operation, for constrictive pericarditis. I was advised not to strain when having a bowel movement. Do I still need to worry about this? How does having a bowel movement affect your heart? — G.H. ANSWER: The pericardium is the lining of the heart, and it consists of two layers, one thin and adjacent to the heart. The thick, outside layer can become scarred and then is unable to stretch to allow normal movement of the heart. There are several causes of constrictive pericarditis, but since this was your second heart surgery, it’s possible that the previous heart surgery was the cause. This doesn’t mean the surgeon did anything wrong; sometimes the pericardium has that reaction after surgery. In many cases, the cause is unknown. Straining for a bowel movement involves closing the glottis to prevent the air in the lungs from coming out, and constricting the chest and stomach muscles to increase the pressure in the chest and abdomen. This pressure is felt by the heart, which needs to beat more forcefully. In the period after surgery, where the pericardium and chest wall have just been repaired, this can damage or even tear the healing tissue. Four years later, you are in no danger of that. Still, forceful straining is never a good idea. That pressure is felt by the colon as well, and can lead to diverticulosis. A diet friendlier to the colon or a stool softener is appropriate if you feel the need to strain routinely. A lower toilet or a toilet footrest can also make your anatomy more efficient so you don’t need to strain.