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    Respiratory Tract

    You know, we often talk about trauma and infection, but less so about chronic diseases. We have to face the fact that, without modern medicine’s miracle technology, some people with long-term issues may end up having life spans similar to those of their ancestors a hundred or  more years ago.

    In normal times, many conditions have a clear path to proper diagnosis and various options regarding treatment. Off the grid, many of these options don’t exist and those that have lost, for example, lung or heart function due to chronic disease.

    Take someone with a history of a heart attack. In this serious an event, a portion of heart muscle has died due to blocked arteries. You don’t grow this muscle back, and it leaves you with less capacity to function in good times or bad. It certainly would affect your ability to perform activities of daily survival.

    (Note: Today, research is ongoing to create heart tissue artificially. For more information, see this link:

    https://www.sciencedirect.com/science/article/pii/S0022522302000417)

    You could say the same thing for chronic lung disease like COPD. COPD stands for Chronic Obstructive Pulmonary Disease, a chronic inflammatory lung disease that causes decreased flow of air and, thus, oxygen to the body.

    Emphysema and Chronic Bronchitis

    Chronic Bronchitis

    Emphysema and chronic bronchitis are two most common consequences of COPD:

    Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (called alveoli) of the lungs. It’s characterized by daily cough and mucus (sputum) production for a least three months in two consecutive years.

    “dead” air space in emphysema

    Emphysema is a condition in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke or other irritating gases and particulate matter.

    COPD causes your lungs to lose their elasticity and overexpand, which leaves some air trapped in your lungs when you exhale. As time goes on, you might have spaces of trapped air replacing areas of what were once functioning lung tissue. This is essentially dead space, robbing you of the ability to absorb oxygen into your body.

    Signs And Symptoms Of COPD

    Image of typical COPD patient by
    Frank Netter MD

    Signs and symptoms of COPD are most obvious after the age of 40 and may include:

    • Daily cough with mucus that may be anywhere from clear to white to yellow
    • Shortness of breath, especially during physical activities
    • Wheezing
    • Chest tightness
    • Having to clear your throat upon waking up, due to excess mucus in your lungs
    • Later on, you may notice
    • Frequent respiratory infections
    • A Lack of energy
    • Unintended weight loss (in later stages)
    • Swelling in the ankles, feet or legs
    • Blueness of the lips or fingernail beds (caused by a lack of oxygen known as cyanosis)

    COPD symptoms often don’t appear until significant lung damage has occurred, and they usually worsen over time, particularly if smoking exposure continues.

    Progressive disease in those with COPD causes episodes of symptoms that becomes worse than usual day-to-day variation and persist for at least several days.

    Emphysema, chronic bronchitis, and other COPD issues are thought to be caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. People with COPD are at increased risk of developing heart disease, lung cancer, and a variety of other conditions.

    COPD and Smoking

    You might be skeptical about smoking causing certain health issues, but it’s pretty well established scientifically that the main cause of COPD in developed countries is tobacco smoking.

    Having said that, Only about 20 to 30 percent of chronic smokers may develop physical ailments due to  COPD. That doesn’t mean their lungs haven’t been affected, just that it doesn’t seem to affect their ability to function, at least at present.

    In underdeveloped countries, COPD often occurs in people exposed to fumes from cooking and heating fuel and poor ventilation. I consider this to be a similar situation to what we might experience if we’re knocked off the grid due to some long-term disaster.

    In about 1 percent of people with COPD, the disease results from a genetic disorder that causes low levels of a protein called alpha-1-antitrypsin. In normal times, this is treated by replacing it intravenously (with mixed results).

    COPD complications

    Lung Cancer

    The damage that COPD does to your lungs is bad enough, but it can cause many other complications, including:

    • Respiratory infections. People with COPD are more likely to catch infections like the common cold, influenza, and even pneumonia. Any of these will worsen respiratory difficulty and exhaust the patient. Although not 100% protective, flu (and pneumococcal pneumonia in those over 65) vaccines can prevent some infections.
    • Lung cancer. People with COPD are more likely to get lung cancer. Quitting smoking helps to reduce this risk.
    • Elevated pressure in lung arteries. COPD may cause elevated pressures in the arteries that bring blood to your lungs. This is known as “pulmonary hypertension” and is a major medical problem.
    • Depression. The energy spent breathing in those with COPD has an ill effect on mood. Losing the ability to perform activities of daily living (not to mention survival) can cause deep depression.
    • Heart problems. COPD statistically increases your risk of heart attack.

    Prevention of COPD

    If you’re not a smoker, you can best prevent COPD by never starting. If you do smoke, stop now. The effects on your stamina alone will decrease your chances of survival in long-term disasters.

    If your profession causes unavoidable exposure to fumes and dust, wear appropriate masks to protect yourself and use respiratory protective equipment.

    Modern tests for COPD usually include pulmonary function tests, chest x rays, and CAT scans of the chest. Most of these aren’t options off the grid, but you can test lung function with a simple piece of equipment called an inspirometer, which gives a rough idea of how deep a breath you can take and measure progress or deterioration over time. A simple battery-powered item called a pulse oximeter can measure how saturated your blood is with oxygen.

    Typical pulse oximeter measure oxygen saturation and pulse

    In normal times, COPD is treatable. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions. Although you may run out of inhalers and prescription drugs that open airways, you can still help yourself:

    Of course, the first step is to stop smoking. For smokers, it’s the only way to keep COPD from getting worse and reduce your ability to breathe. It isn’t easy, though, and you may need to use nicotine replacements products if you can’t go cold turkey. Whatever you do, get off cigarettes before the you-know-what hits the fan.

    Some hospitals have pulmonary rehab, but, if you’re off the grid, they won’t be an option. That means, If you already have COPD, that you’ve got to stockpile inhalers, which will lose potency over time, and oral meds like steroids which may last longer. Having a supply of oxygen cannisters may be useful, but if you’re at the point that you need it daily, your supplies won’t last long.

    One inexpensive med you might be able to stockpile if you have a sympathetic physician, is theophylline, an old asthma drug. Coffee or the caffeine in it, is actually similar from a chemical standpoint. Antibiotics, which I talk about in Alton’s Antibiotics and Infectious Disease, should also be accumulated as COPD patients have a tendency to be prone to infections. Remember that antibiotics only work against bacteria, not viruses.

    Other strategies include staying well-hydrated, controlled coughing, humidifiers, light exercise, and more. You may have your opinions about vaccines, but they’re probably a good idea in people at risk from lung complications, like the COPD sufferer.

    Controlled Coughing

    Ok, this is a sneeze, not a cough

    Notice I mentioned controlled coughing. What am I talking about?

    Not all coughs are effective in clearing excess mucus from the lungs. Explosive or uncontrolled coughing may cause airways to collapse and constrict. This traps mucus and makes it even harder to breathe.

    Controlled coughing helps a COPD patient use only enough force to loosen and expel mucus without causing them to collapse and constrict. this saves energy, the lack of which is a major problem in those with COPD. In these sufferers, more energy is required just to keep the body oxygenated.

    As a low-tech technique, controlled coughing may be very useful in survival settings. So How can you teach controlled coughing to those with chronic lung disease in situations where you’re off the grid?

    Method of Controlled Coughing

    To cough effectively:

    Have your patient relaxed on a chair or on the edge of a bed (or on a log for that matter), in a position where he is leaning somewhat forward. Both feet should be on the floor.

    Fold his arms across his abdomen and have him breathe in slowly through his nose. The power of the cough, remember, will come from air movement

    To exhale: the patient leans forward, pressing their arms against their abdomen. Cough 2-3 times through a slightly open mouth. Coughs should be short and sharp. The first cough loosens the mucus and moves it through the air passages. Successive coughs help enable you to cough the mucus out.

    Then, have you patient inhale again by “sniffing” slowly through his nose. This gentle breath helps prevent mucus from moving back down. Quick inhalations, on the other hand, can interfere with the exit of mucus from the lungs, and may start a coughing fit.

    Your patient should then rest and perform the technique again if more mucus needs to come out. If your patient uses and has a supply of inhalers, use the controlled coughing technique after they use their medicine. If the drug expands the airways, mucus will come out more easily.

    Other Ways of Managing Patients with COPD

    Other simple strategies that might help the COPD patient off the grid: Stay well-hydrated. Six to Eight glasses of water a day thins out mucus. This makes it easier to move out of the lungs. Of course, some sufferers might have other medical conditions that make drinking this much dangerous. Always know the full medical history of your patients.

    There are also mucus-clearing mechanical devices that might be useful in austere settings. These use pulses of resistance in exhaled breath to clear mucus. These devices include the Flutter device, the Acapella® (known as the ‘pickle’), the RC Cornet®, Lung Flute (lungflute®), and the Aerobika®.

    Aerobika mucus-clearing device

    To use these devices, place the mouthpiece in your mouth, seal your lips around it, and take a deep breath using your diaphragm. Breathe out slowly with a moderate force through the device for as long as you can. The increased pressure in the airways and the oscillations created by the device will give you the feeling to cough. When you feel the urge to cough, take a deep breath in, hold for 1-3 seconds and cough to loosen the mucus.

    To find out more information about simple mucus-clearing devices, here’s a useful video about one:

    Some medical issues are difficult to overcome in long-term disaster settings. COPD is one of them. We must be realistic about what can be accomplished in these patients, but never stop trying to help them.

    Joe Alton MD

    Joe Alton MD

    Chronic illnesses like COPD are just one of the many medical topics covered in our award-winning Third Edition of the Survival Medicine Handbook. Also, don’t forget to check out our kits, books, and other supplies at Nurse Amy’s store at store.doomandbloom.net. You’ll be glad you did.

    Find our book on Amazon or at our store!

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