Health Services

Your Lungs and You

Respiratory care is the treatment and care given to people who have problems with their lungs and breathing. Respiratory therapists and technicians provide therapy and treatment to help you with your breathing. Their role also includes education, which can help prevent or control the occurrence of respiratory difficulties in the future. You can help yourself by learning how your lungs function and by asking questions.

How Do Your Lungs Work?

The lungs are remarkable parts of the anatomy that function even when you don't think about it.

Air comes into your body when you breathe in through your nose and mouth. It then goes through your windpipe into two bronchial tubes – one going to each lung. These tubes branch out into even smaller tubes, called bronchioles. The bronchi are lined with tiny hairlike projections, called cilia.

The cilia are responsible for sweeping mucus, or phlegm, and dust particles upward to the throat where they can be coughed out. The bronchioles end in tiny air sacs called alveoli. Carbon dioxide is exchanged for oxygen through the thin walls of these sacs. Oxygen can readily enter the blood to be pumped through the body by the heart, and carbon dioxide can escape from the blood back into the lungs to be exhaled.

There is a large muscle located below the lungs called the diaphragm. The diaphragm normally does most of the work of breathing. Your lungs provide oxygen to the blood, and the heart pumps it throughout the body. Your lungs remove carbon dioxide, which is a waste product from the blood.

If the lungs become diseased or damaged, breathing can become difficult and even painful. Mucus can block the airways. The walls of the tiny alveoli sacs can break down and cause trapped air. Infections and irritants can cause tissues to swell and air tubes to become plugged.

 

Lung Diseases

There are many lung diseases and conditions. They include:

Colds and influenza (flu) – These are caused by viruses that affect all age groups and are easily spread. They can lead to more serious conditions, such as bronchitis and pneumonia. You can help prevent colds and flu by avoiding infected people and keeping yourself healthy through proper diet, exercise and rest. Keep your lungs clear of mucus as infections grow easily in old mucus.
Pneumonia – This acute lung infection fills the alveoli with fluid. When this happens, oxygen cannot get into the blood. Bacteria, viruses or fungus causes pneumonia -- organisms that affect both young and old. People with pneumonia usually receive respiratory treatments and antibiotics.
Tuberculosis (TB) – TB is an infectious disease caused by bacteria called mycobacterium tuberculosis. It most commonly affects people who have low resistance and live in close contact with someone who has TB. You can be tested for tuberculosis through a Mantoux skin test. People with TB usually are prescribed a combination of drugs and respiratory treatment.
Asthma – Asthma is a lung disease that causes episodes of wheezing, coughing, rapid breathing and gasping for air. These episodes can be serious. During an asthma attack, the bronchial tubes narrow due to muscle spasms or swelling of airway tissues. Mucus then plugs the small tubes, and air becomes trapped in the alveoli. As a result, breathing in and out becomes difficult. Asthma may be caused by a number of things, but usually is due to oversensitive lung tissue reacting to one or more of the following:
Allergic reactions to various allergens. Examples of allergens include animals, dust, pollen, mold and feathers. Allergic reactions are most common during the summer and fall. There frequently is a family history of allergens.
Emotional stress that causes the nervous system to become upset
Environment (occupation, climate, etc.)
Infection (colds, flu)
Smoke and air pollution that irritate lungs
Vigorous exercise resulting in bronchial spasms

Asthma usually affects children and some adults. It cannot be cured, but can be treated and controlled. Treatment may be individualized, but usually consist of medications (bronchodilators) that relax and widen the airways so more oxygen can get in, allowing breathing to become easier. These medications may be given through various means, including respiratory-therapy treatments.

Clearing the airways of mucus and breathing moist air helps make breathing easier. This can be accomplished with breathing treatments. Injections are sometimes given to help reduce sensitivity to allergens. Proper treatment and understanding make asthma easier to live with.

Chronic bronchitis -- This is an inflammation of the lining of the bronchi. The first symptoms are a persistent cough and excessive production of mucus, followed by shortness of breath. Chronic bronchitis develops over time, after prolonged and repeated irritation to the airways as a result of smoking or air pollutants. Respiratory treatments are given to open the bronchioles, allowing more air to get in and make breathing easier. Treatments help liquify and loosen mucus so it can be coughed up and spit out. Treatment also may include eliminating smoking and treating respiratory infections promptly.
Emphysema – This is a change occurring in the alveoli. The alveoli break down, lose their elasticity and remain partly filled with stale oxygen. The first symptom usually is shortness of breath, especially when any type of physical activity is involved. Later, coughing develops. Due to air remaining trapped in the alveoli, exhaling can be a problem. As the disease progresses, breathing becomes more difficult. Emphysema develops over time. Constant exposure to cigarette smoke and air pollutants makes emphysema worse.

Emphysema cannot be cured. However, it can be treated with medication and respiratory treatments, which help reduce breathing difficulties. Learning how to cough effectively and using proper breathing techniques are necessary for easier breathing. But the best prevention of emphysema is not smoking.

Bronchial asthma – This is an allergic disease of the lungs in which the airways narrow and constrict when exposed to an allergic substance. This causes difficulty in breathing, wheezing, tightness of the chest, coughing and excessive mucus. Treatment includes medications to help relax and enlarge the airways. Avoiding allergic substances is helpful.
Pneumoconiosis – This is an occupational lung disease caused by inhaling dust, such as fine particles of asbestos, silica, coal, etc. The lungs shrink and stiffen due to scarring tissue. Treatment consists of eliminating exposure to the material causing the disease process and then treating the symptoms.
Lung cancer -- This is the uncontrolled growth of abnormal cells, usually starting in the bronchial tubes. The primary cause is cigarette smoking. Exposure to asbestos dust and other materials also are contributing factors. Treatment is individualized, but may include surgery, radiation and/or drug therapy.

Bronchodilators

Bronchodilators are medications that help open your airways when they are tight or congested. By opening your airways, more oxygen can get to your lungs, thus making breathing easier. They also help shrink swollen tissues.

There are many widely used bronchodilators, including Ventolin® (albuterol), Alupent® (metaproterenol), Terbutaline® (Bricanyl), Bronkosol® (isoetharine) and Isuprel® (isoproterenol). These bronchodilators usually are mixed with normal saline to dilute the medication and moisten the mucus, which will help loosen the mucus so you can cough it up.

Bronchodilators can be given through several respiratory treatments, which will be covered later in this booklet. The respiratory therapist/technician will check your pulse to make sure there is no increase in you heart rate, which could be a side effect of the medication. Other side effects include anxiety, feelings of restlessness following treatment, tremors and palpitations. If you experience any of these reactions, notify the respiratory therapist or your nurse. A medication change may be necessary to eliminate the side effects.

Other respiratory medications may include Mucomyst®, which is given to break up very thick mucus that may be blocking the bronchial tubes. When this mucus is thinner, it can be coughed up and out more easily. Adverse reactions are minimal, but a bad smell and/or bad taste in the mouth can be relieved by brushing your teeth and/or using mouthwash after treatment.

Treatments to Deliver Medications

Handheld nebulizers

Nebulizers are aerosol devices used to deliver medication that moistens the airways so mucus can be coughed out. Equipment consists of a nebulizer, mouthpiece and tubing from the nebulizer to compressed air.

You need to breathe through the mouthpiece, taking slow, deep breaths until the medication is gone. This usually takes about 10 minutes. About every third or fourth breath, breathe deeply and hold it so that the medication stays in the airway system. If you must cough or rest during this time, lay the nebulizer on its side until you are ready to resume the treatment.

Intermittent positive pressure breathing (IPPB)

IPPB aids in deep breathing. The purpose of IPPB treatments is to:

Aid in clearing bronchial secretions from the lungs
Decrease the work of breathing
Prevent or correct the collapse of a lung or lobe of the lung by periodic deep breaths

You must inhale gently through the mouthpiece. The machine starts as you inhale. Allow the machine to fill your lungs slowly and deeply, with the machine doing the work for you. Do not take shallow, fast breaths, as this will cause feelings of dizziness, tiredness and possibly numbness in the extremities. The machine will shut off as you exhale. Water for humidification and medications are carried to the lungs. The treatment lasts about 10 minutes.

Incentive spirometry

This breathing exercise is designed to help keep the lungs open and expanded. It frequently is used after surgery to prevent lung complications. It is necessary to take a slow, deep breath through the mouthpiece while a flow guide rises. There will be a set goal for you to reach on the spirometer, which is a measured volume in cubic centimeters.

Inhale slowly and deeply. Hold your breath for 4 to 6 seconds, allowing for even expansion of the lungs, and exhale normally. Repeat 15 times, resting if needed.

Chest physiotherapy (CPPD)

CPPD involves having the patient assume different lung drainage positions while the respiratory therapist/technician performs chest tapping to loosen mucus from the bronchial tubes and lungs. With a good, effective cough, the mucus can then be expelled. CPPD also helps expand areas of the lungs. The chest tapping consists of the therapist/technician clapping with cupped hands on the chest wall over specific areas of the lung. This procedure is similar to tapping on an inverted ketchup bottle.

How to Help Yourself

Our environment, especially heat and humidity, affects all of us. These changes have an even greater effect on anyone with breathing problems. Follow these tips:

Avoid breathing in smoke.
Avoid getting a cold or other infections. Do not get close to people if you know they have a cold or other infections. If you do get a cold or other infection, treat it promptly. Your physician may advise a flu or pneumonia vaccine.
Do not use aerosol sprays or strong chemicals.
Some patients need to limit their fluid intake, so be sure to check with your physician.
Try to stay indoors when the air is heavy and air-pollution levels are high.
You especially need to avoid sudden changes in temperature. You should wear a mask when outside during the winter months, which also will help warm the air. These masks are available at most drug stores. Breathing in through your nose also helps warm the air.
You may have to use a humidifier if the air is dry in your home during the winter months. Humidifiers can be a source for bacterial growth, so be sure to clean the humidifier according to instructions. When refilling, dump out remaining water and add all new water. Moisture in the air, along with good fluid intake, keeps your mucus thinner.

Signs of Infection

Contact your physician if you have any of the following symptoms:

Fever, chills
Increase in the frequency of your coughing
Increased shortness of breath and/or wheezing
Increased weakness, chest discomfort
More mucus than usual
Mucus has changed color or is blood-tinged

Smoking

Ultimately, the choice of smoking is yours, but you should be aware that any foreign substance you breathe into your lungs might do serious damage. Cigarette smoke contains carbon monoxide, a poisonous gas, which paralyzes the cilia. Mucus builds up when the cilia do not work. Old mucus is a breeding ground for infections.

Carbon dioxide also cuts down on your oxygen supply, leaving you feeling run down and short of breath. When you stop smoking, your airway condition begins to improve. Your cough lessens, although this may take weeks to occur. You will breathe easier and be less susceptible to infections. Your senses of smell and taste will improve.

Stopping smoking is not easy. But you can do it. Determination and willpower is a must. Quitting smoking is the most important thing you can do to help yourself breath better. Your physician can offer suggestions, and there are support groups in the community that also can be of help. In addition, Great River Medical Center offers a smoking cessation class. For more information, please call the Center for Rehabilitation at (319) 768-4100.

Nutrition

Good nutrition is important for all of us. We need daily supplies of protein, milk products, fruits, vegetables, breads and cereals. Being overweight will add to your breathing difficulties. The weight from the abdomen pushes up on the diaphragm, making it difficult to take a deeper breath. Be sure to talk with your physician before starting any weight-reduction program.

You burn less calories in the evening hours, so a light evening meal may be helpful. Gas-forming foods may bloat your abdomen, causing more difficulty in breathing. Some of these types of foods are broccoli, cucumbers, onions, corn, melons, cabbage, cauliflower and Brussels sprouts.

If shortness of breath makes meals difficult, here are some things to try:

Eat slowly, and chew your food well.
Eat smaller, more-frequent meals. Less oxygen will be needed to chew and digest food.
If needed, rest during your meal and take deep breaths.

Plenty of fluids are needed to keep mucus thinner, making it easier to cough up and out. Mucus builds up in the lungs and airways as you sleep. A hot drink after you wake up in the morning may help cough up secretions. Be sure to check with your physician on fluid intake.

Exercise

You should not stop your activities just because you have a breathing problem. You want to keep your muscles at their fittest level, especially those that affect your breathing (the chest and diaphragm). You also do not want to overdo it so that you use up your oxygen supply. The key is to pace yourself. It may be necessary to do things at a slower pace, but at least you will be doing them.

You and your physician should work as a team to evaluate what levels of activity are best. Walking is one of the best exercises. Start with a short daily walk. Increase the length gradually each day, and practice breathing properly, which is discussed in the following section.

How to Breathe Effectively

Breathing effectively is just as important as food and exercise. Learn how to breathe correctly so that you do not waste energy and tire yourself.

When a person has difficulty breathing, there is a tendency to get excited and breathe more rapidly. This does not allow time for the lungs to empty. The first thing you must do is relax. You need to learn how to do diaphragmatic, or belly, breathing. The diaphragm does most of the work of breathing. As it moves down, the chest cavity enlarges, and when it moves up, the chest cavity becomes smaller.

By using the diaphragm for breathing, it helps ease the work of the chest muscles. Try this exercise:

Lie flat on your back, either on a bed or the floor. Do not use a pillow.
Put one hand on your abdomen, with your thumb just above your navel.
Keeping your mouth closed, breathe in through your nose and feel your abdomen get larger. Rather than expanding your chest, let your abdomen expand as you breathe in.
Breath out slowly through pursed lips, leaving only a small opening between your lips as if to make a soft whistling sound. This helps keep your bronchial tubes open and improves the distribution of air and oxygen in your lungs. It takes longer to empty the lungs than to fill them, so breathe out completely. Take at leas twice as long to breathe out as it takes to breathe in.
Remember: Breathe in slowly and deeply through your nose. Feel your abdomen enlarge and then exhale completely through pursed lips.

Practice this exercise until you feel comfortable with it. You can do this exercise while sitting or standing. Use this exercise as you work, walk or exercise.

Do not let yourself get excited when having an episode of shortness of breath. Remember to relax, use your diaphragm to breathe by taking in slow deep breaths through your nose, and exhale through a small opening between your lips.

Sit upright, so you can get better lung expansion. Take any medications or breathing treatments your physician has prescribed at these times. Call your physician if shortness of breath increases, chest discomfort develops or there is no improvement.

Coughing Effectively

Coughing is a necessary means of cleaning mucus from the bronchial tubes and lungs. There is a proper way to cough:

Sit with your head slightly forward.
Inhale through your nose, slowly and deeply.
Hold your breath for a few seconds.
Cough in succession two times. The first time helps loosen mucus so that it can be coughed up and out with the second cough.
After coughing, breathe in slowly as if to sniffle. This keeps mucus from being taken back into the lungs.

Do not try to suppress coughing. If you try to keep from coughing and swallow mucus, it could cause an upset stomach. Also, check with your physician before using cough syrups. If you have had surgery, your cough may be painful. It will help if you support your incision with a pillow.

It’s very important for you to breathe properly (filling your lungs completely) and cough correctly (ridding your lungs of mucus). You should try to clear your airways at least four times a day, including early morning and before bedtime. During sleep, mucus can build up in the lungs and airways. A hot drink the first thing in the morning may help get this mucus up and out.

Home Equipment

Your physician must prescribe oxygen equipment. There are oxygen tanks and oxygen concentrators available for rent from durable medical equipment dealers. Oxygen concentrators run on electricity and make oxygen right in the home.

Handheld nebulizers and portable compressors for treatments also require a physician’s prescription. The company you do business with should provide you with instructions for proper care and use. Keeping your equipment clean, especially the nebulizer, is the most important aspect of home treatments.

Please follow these general cleaning guidelines:

All equipment should be cleaned each day of use.
Wash the equipment in hot, soapy water and rinse well.
Mix one part white vinegar in three parts water. Soak the disassembled nebulizer parts in this mixture for 30 minutes. Rinse well, shake the water off each part and dry with a clean towel.
Cover your equipment until the next time it is to be used.

Oxygen

Your physician may prescribe oxygen if there is too little oxygen in your blood. Treat oxygen as a medication and take it as prescribed.

Be sure you understand how your equipment works, how to take care of it, when to know to call for more and how to set the flow rate. Do not use more than your physician prescribes. Too much oxygen can be worse than not enough. Be sure to post no-smoking signs in your home. Oxygen helps things burn.

Home Medications

Take all medications as prescribed by your physician. Try to take your medications on time. Take only as much as prescribed. If you feel you need more or less medication, call your physician. Do not self-medicate.

Do not take over-the-counter medications (such as cough syrups, aspirin, antacid, vitamins, sprays) without first consulting your physician. Some medications react to one another, causing unwanted side effects.

Have your medications laid out in a system so you know what you take and when. If you need to come to the hospital or emergency room, bring you medications (or a list) with you.

Know your medications, how they should help you, what side effects are possible and when to take them. Your medications help you manage your breathing problems. Your physician will work with you to determine which medications are best for you to use. Take them as directed.

Using Unit-Dose Inhalers

Follow these general guidelines for using a unit-dose inhaler:

Blow out slowly to clear as much air from your lungs as you can.
Put the opening of the inhaler to your mouth as you are about to breathe in. Keep your mouth open around the mouthpiece.
As you breathe in, squeeze the inhaler, keeping your mouth open, and take a deep breath. Hold it for 4 to 6 seconds. Holding your breath helps retain medication in the lungs.
Exhale slowly.
Repeat, as directed by your physician.
Rinse your mouth with water. Do not swallow the water as it may upset your stomach.

Some inhalers may be designed with a posterior opening on the mouthpiece apparatus. This opening allows you to place your mouth on the mouthpiece.

Keeping your inhaler clean is just as important as using it correctly. If you don’t keep the inhaler clean, bacteria can grow inside the mouthpiece, which means that each time you inhale medicine you also inhale bacteria.

Glossary of Terms

Aerosol — A fine mist that can be inhaled; medication can be given as aerosol.
Airways — The pathway air travels in and out of the lungs; bronchial tube system.
Allergy — A sensitivity to a substance.
Alveoli — Small air sacs at the end of the bronchial tubes.
Asthma — A lung condition in which the bronchi narrow, causing wheezing, coughing and chest tightness.
Belly-breathing — Breathing with the use of the abdominal muscles and diaphragm.
Bronchi — The larger tubes of the airway, branching off of the windpipe into the lungs.
Bronchodilator — Medication to relax and enlarge the airways; airway muscle relaxant.
Chronic — Long-lasting or continuous
Diaphragm — A dome-shaped muscle located below the lungs; main muscle of respiration.
Diaphragmatic-breathing — Same as belly-breathing; breathing by using the diaphragm, not the chest muscles.
Exhale or expiration — To breathe out
Expectorate — To cough mucus up and spit it out
Hyperventilate — To breathe too rapidly, causing dizziness, tiredness and numbness of extremities. May also cause lips to feel numb or tingly.
Inhale — To breathe in
Inspiration — The act of breathing in
Lobes — Sections of the lung. The right lung has three sections; the left has two.
Mucus — Fluid produced in the bronchial tubes; normally clear in color
Nasal cannula — A two-pronged plastic tube to the nose and nostrils that delivers oxygen from the source to your lungs
Nebulizer — Means of getting a spray of fluid, usually medication, into the lungs
Oxygen — A colorless, odorless gas in the air
Phlegm — Same as mucus; secretions
Pneumonia — Inflammation of the lung
Respiration — The act of breathing; gas exchange in the lung
Respiratory tract — Involves nose, throat, windpipe, bronchial tubes and alveoli
Secretions — Fluids in the lungs; mucus, phlegm
Sputum — Liquid sample from lungs brought up by coughing
Sputum specimen — Secretions coughed up from your lungs that are sent to the laboratory in a special container where they are tested to see what organisms may be causing infection.
Trachea — The windpipe
Ventilation — Mechanical movement of air in and out of the lungs