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| How To Save Your Lungs Before It's Too Late |
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| Date: 24-Sep-2012 |
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As a society, my feeling is that we don't put enough emphasis on protecting our lungs against harmful macro and microscopic particles; this is a huge mistake, as reduced lung capacity is, in my mind, more damaging to quality of life than say, sub-optimal digestion, mild to moderate liver dysfunction, or even reduced cardiac output.
If you strongly disagree with this opinion, I'm willing to bet that you'll change your mind if you spend some time in any intensive care unit and sit by a few patients who are unable to properly oxygenate their blood because of reduced lung capacity - this is a heart-wrenching scenario, one that I don't wish upon the grouchiest people I know.
Why are healthy lungs so vital to the rest of your organs and body parts? It's within the very thinnest branches of tissue that line the base of your lungs where your body accepts oxygen from your environment and expels carbon dioxide. Without this ongoing exchange of gases, you can't adequately convert nutrients from food into usable energy.
As a part of every routine physical evaluation, I look for signs of lung dysfunction with the following measures:
Inspection
I look for signs of strained breathing; sometimes, it's as subtle as seeing overuse of smaller muscles in the neck region in an effort to assist ribcage expansion during laboured inhalation. Other obvious signs of lung dysfunction are slightly purple/blue lips or fingernails, and audible distress with breathing.
Palpation
Placing my hands symmetrically on both sides of the posterior aspect of a person's ribcage, I want to see my hands move about the same amount during deep inhalation. Assymetrical movement might indicate abnormal presence of fluid or air in the space between the lungs and the chest wall.
I also want to feel the transmission of the person's voice as vibration (called tactile fremitus) against my palms as they're pressed up against his chest wall - physicians will typically ask you to repeat a phrase like "ninety-nine" while assessing tactile fremitus. Abnormally strong vibration can indicate fluid accumulation within lung tissue, while decreased fremitus might mean that there is fluid build-up between the lungs and chest wall.
Percussion
To help confirm palpatory findings, percussion is used, whereby I use my hands to steadily percuss against the chest wall while listening to how hollow or full the chest cavity sounds along different points. This is much like tapping a wall to detect the presence of a stud - where there is a hollow sound on percussion, I know there is air; where there is a full, deadened sound on tapping, I know that there is something substantial behind the chest wall that is absorbing my percussive force, likely fluid associated with inflammation.
Basically, I'm hoping for a slightly hollow sound on percussion to indicate normal presence of air in the lungs - I don't want the feedback to be too resonate, which is characteristic of chronic obstructive pulmonary disease, or too dead, which usually means that there is unwanted fluid in the area.
Auscultation
Auscultation is the process of listening to lung sounds with a stethoscope. During auscultation, I'm hoping to hear what we call "vesicular breath sounds," which is to describe a mild influx of air with inhalation, and little sound during exhalation.
Whistling-type noises, scratchy sounds, noise that resembles what you hear when breathing through a snorkel, gurgling, and an abnormally quiet lung field all indicate some form of distress.
Here's the thing: you don't want to wait for your doctor to stumble upon an abnormal finding before becoming mindful of what you're breathing in during everyday activities. In most cases, by the time I come upon a significant finding using the screening procedures described above, chances are that dysfunction and disease have been at play for a good while. |
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| Source: Dr. Ben Kim |
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