Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD)encompasses a group of lung disorders that include chronic bronchitis, emphysema, chronic obstructive airways disease and chronic asthma. COPD affects millions of people worldwide and this disease is mostly attributed to smoking. Air pollution, working in an environment with harmful effluents and passive smoking are also likely causes for Chronic Obstructive Pulmonary Disease. Sometimes a patient may suffer an inherited form of emphysema due to a deficiency of alpha-1-antitrypsin. With chronic bronchitis, the air passages and mucus glands are enlarged thereby leading to severe cough. Over time, the enlargement can lead to reduced oxygen supply to the lungs. Elevated blood pressure is noticed. This condition is more predominant in those who smoke or have a history of respiratory illness. While some patients develop wheezing and shortness of breath, others notice mucus while coughing. Chronic bronchitis is noticed with symptoms such as continuous cough, rapid breathing and cyanosis (bluish tint to the lips and nails). Morning headaches may be noticed on account of inability to remove carbon dioxide from the blood. Patients with severe case of COPD may face hemoptysis (alternatively haemoptysis) (blood while coughing). Emphysema occurs when the tiny alveoli in the lungs are destroyed thereby hampering efficiency of the lungs. It leads to labored breathing and the patient often feels out of breath. Other symptoms are loss of weight, disturbed sleep and tight constriction in the chest.

Diagnostic tests for COPD include blood tests and pulmonary function test. The pulmonary function test is an indicator of the extent of blockage of the lungs. Chest x-rays help in identifying damaged areas of the lungs and areas of fluid collection as well as any masses in the lungs. Sputum culture can identify any respiratory infection. A spirometry test measures the amount of air a person can blow in a second. Arterial blood gas analysis indicates how efficiently the lungs bring oxygen into the blood and remove carbon dioxide.

Antibiotics can help in tackling the bacterial infections in the lungs. Bronchodilators open up the air passages in the lungs thereby alleviating some of the symptoms of Chronic Obstructive Pulmonary Disease. Inhaled corticosteroids will reduce airway inflammation. In severe cases, oxygen is administered. In addition, some lifestyle changes must be followed:

• Avoid smoking
  
• Avoid exposure to secondhand tobacco smoke
  
• Adopt physical fitness regime to maintain good lung health
  
• As far as possible, avoid environmental irritants, hazardous inhaled substances such as paints, chemicals and cleaning agents
  
• Balanced diet
  
• Plenty of water and fluids
  
• Steam inhalation
  

Chronic Inflammation

Inflammation is a generalized response of the body when affected by a trauma or an infection. Inflammatory response is a significant indication of the body's immune system reaction. A cascade of events usually follow inflammation based on which the form of inflammation is determined as acute or chronic. Acute inflammatory response is short lived but chronic inflammation is a progressive form.

Inflammatory response cascade consists of tissue necrosis, fibrous granulation, lymphocyte aggregation and collagen damage. Although the body's natural response with respect to tissue damage is activated; a dormant stage can also occur in some cases of chronic inflammation such as the stalemate stage in which the balance between damaged tissue and fresh tissue is not neutralized. In some cases chronic inflammatory diseases can also be caused as result of autoimmune diseases.

Clinical manifestations

Chronic inflammatory disease can occur in various parts of the body. It activates the production of macrophages and T- Cell immune response to prevent apoptosis of the healthy tissue. In most cases the diseases associated with chronic inflammatory responses are asymptomatic in the acute phase. The chronic form infectious diseases primarily occurs because of immune comprised status of the host.

Inflammatory response is also caused by irritants such as uric acid crystals, which are endogenous materials and other irritants such as silica, asbestos and prosthetic materials. Other clinical manifestations of chronic inflammatory disease are associated with underlying medical conditions such as organ specific like Hashimoto's Thyroiditis and non organ specific such as rheumatoid arthritis, Crohn's disease and inflammatory bowel disease.

Anti-inflammatory drugs are recommended in most cases for chronic inflammation. One of the most successful ways to treat persistent inflammation is to include foods that have high anti-inflammatory properties. Fruits and vegetables such as broccoli, pineapple, avocados and diary products such as yoghurt have potent anti-inflammatory properties.

Dermatoses

Dermatoses are conditions affecting the skin, nails, hair or glands. Dermatoses may be acute or chronic; acute conditions last from days to weeks and chronic conditions last from months to years. Treatment for dermatoses depends on whether the condition is acute or chronic. Most dermatoses respond to treatment with topical corticosteroids.

Dermatosis types and symptoms

Acute dermatoses: Occur suddenly and symptoms include redness, itching and swelling which may further progress to blisters, oozing, scratch marks etc. But usually the symptoms subside in a few days.

Chronic dermatoses: There are small oozing blisters and crusts that may appear thickened discolored and scaly. The skin is cracked and painful.

Subacute dermatoses: Symptoms include scaliness, scratch marks, redness and may peel off. The affected areas do not ooze and do not have blisters.

Dermatosis classification

Dermatosis may be described through the following terms

Lichenification: Thickening and discoloration of skin like the lichen on a tree.

Lesion: Abnormal area of the skin.

Macule: Change in color or consistency of the skin.

Nodule: a bump in the skin that may measure larger than a centimeter in diameter.

Papule: a bump in the skin that may measure smaller than a centimeter in diameter.

Plaque: A large area of affected skin that may flake or peel, it generally has defined edges.

Pustules: A bump that is filled with pus and may have resulted due to an infection.

Rash: A variety of conditions that may show up as red raised up area from the skin and involves inflammation.

Vesicles and bullae: Raised bumps that are filled with fluid.

Various Dermatosis conditions

Acute febrile neutrophilic dermatosis (Sweet's syndrome): Sweet's syndrome is characterized by skin lesions, sore eyes, ache in joints and fever. Red, swollen rashes and papules that are tender. Neutrophilic dermatosis can be caused due to many infections such as IBD, rheumatoid arthritis or upper respiratory tract infections. Rarely it can be a sign of an underlying blood disorder or cancer.

Contagious pustular dermatosis: Also called Contagious pustular dermatitis, it can be contracted from sheep affected with sheep pox, it shows up as papules.

Digitate dermatosis: Finger shaped psoriatic rash at the side of waist.

Dermatosis cinecienta: Symmetrical patches of thickened skin that are ash colored and is generally common in individuals under 40 years.

Dermatosis neglecta: Appears like warts, is a type of plaque caused due to inadequate washing of skin in a particular area. Dermatosis neglecta surfaces in the form of localized scaling and hyperpigmentation.

Dermatosis papulosa nigra: Often seen in dark skin toned people, many small, benign, dark skin lesions are seen on the face.

Linear lichenoid dermatosis: Small and scaly papule, often seen in children.

Transient acantholytic dermatosis or Grover's disease: Chronic, itchy blistering that is usually triggered by heat or sweating. It appears suddenly as itchy red spots on the trunk. It lasts for weeks to months, but resolves spontaneously.

Juvenile plantar dermatosis: Cracking and peeling of the weight-bearing soles of the juvenile plantar dermatosis: cracking and peeling of the weight-bearing soles of the feet in children.

Rheumatoid neutrophilic dermatosis: Skin manifestation of . It manifests as reddish palms and brittle split nails. The skin on the hands might become translucent and wrinkled.