Heart Disease: Types, Prevention &

Treatments
By Joe Brownstein | January 14, 2015 10:19pm ET
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Credit: Dreamstime.com

As can be expected from an organ responsible for getting blood throughout the body, the root of
heart disease is when that blood flow is blocked.

Heart disease, or cardiovascular disease, encompasses a range of conditions, including blood

vessel diseases such as coronary artery disease, problems with heart rhythm (arrhythmias) and
congenital heart defects, according to the Mayo Clinic.
Symptoms and types
Coronary artery disease is the most common type of heart disease in the United States, according
to the CDC. It occurs when cholesterol builds up in arteries — called plaque — narrowing the
space blood can flow through, a condition called atherosclerosis.

In other words, "anything that blocks the vessel," said Lawrence Phillips, a cardiologist and
assistant professor at NYU Langone Medical Center, in New York.

Ultimately, the narrowing can build up enough to cause chest pain and shortness of breath —
called angina, or it can block the vessel completely, causing a heart attack. Heart attacks can also
be caused by the rupture of a plaque that causes a blockage of the blood vessels, Phillips said.
Over 1 million Americans suffer heart attacks each year, according to the American Heart
Association.
Another cause of heart disease is an arrhythmia, a condition where the heart beats too quickly
(tachycardia), too slowly (bradycardia) or irregularly. Symptoms can include a fluttering feeling
in the chest, racing heartbeat, slow heartbeat, chest pain or discomfort, shortness of breath,
lightheadedness, dizziness, fainting (syncope) or near fainting, according to the Mayo Clinic.

Heart disease may also be caused by problems a person is born with, known as congenital heart
defects. Symptoms of heart defects in children can include pale gray or blue skin (cyanosis),
swelling in the legs, abdomen or around the eyes, and shortness of breath during feeding in
infants (causing poor weight gain), according to the Mayo Clinic.

Less serious congenital heart defects may not be diagnosed until late childhood or adulthood.
These defects are not immediately life threatening, and symptoms include becoming short of
breath or tired easily during exercise or activity, as well as swelling in the hands, ankles or feet.

Other forms of heart disease can be caused by weak heart muscle, heart infections, or diseases of
the heart valves.

Diagnosis and tests

Five symptoms can indicate when someone is having a heart attack and requires immediate
emergency care. These include pain in the jaw, neck or back; pain in the arms or shoulder; chest
pain; lightheadedness or weakness; and shortness of breath, Phillips said.
Heart disease symptoms may differ for men and women, according to the Mayo Clinic. Men are
more likely to have chest pain, while women are more likely to have shortness of breath, nausea
and extreme fatigue.

A number of factors play a role in heart disease risk. Some include family history and age (if
your relatives have heart disease or you are older, your risk goes up), but others you have more
control over.

Much of the advice to avoid heart disease is the same health advice given for other conditions:
stop smoking, exercise and eat a diet that is low in cholesterol and salt — cholesterol being the
source of blockage and salt contributing to higher blood pressure. Other things to avoid in the
diet include saturated fats, which typically come from animal fats and oils, and trans fats, which
occur in vegetable oil, but have largely been removed from the marketplace because of consumer
demand.

According to the NIH, diabetes can increase heart disease risk by as much as 100 percent, as the
higher levels of glucose in the blood that are characteristic of diabetes can leave fatty deposits in
blood vessels, which, like cholesterol plaques, can cause blockage of the heart.

Prevention
In addition to lifestyle changes, some treatments are available to help avoid heart disease. Many
of these medications are designed to lower cholesterol.

There are two types of cholesterol. The first, LDL, is called “bad cholesterol” because it is the
type that can build up and block blood vessels. The other, HDL, is called “good cholesterol”
because it is responsible for transporting LDL to the liver, ultimately removing it from the blood
stream.

Optimally, HDL cholesterol levels should be above 40 (measured in milligrams per deciliter of
blood) and LDL cholesterol should be below 100, according to the CDC.

The FDA has approved a number of drugs for improving cholesterol levels. Perhaps the best-
known are statins. They slow cholesterol production by the liver and speed up how fast it
removed LDL cholesterol from the bloodstream.

Another class of drug to lower cholesterol is called bile acid sequestrants. These drugs remove
bile acids from the body. Because the body produces these acids from LDL cholesterol, more
LDL cholesterol will be broken down to replace them.

Niacin and fibrates are other drug classes for improving cholesterol levels. Both increase HDL
cholesterol, and niacin lowers LDL cholesterol.

Treatment
Surgical options can also treat heart disease. Coronary angioplasty is performed over one million
times each year on patients in the United States, according to the NIH. In this procedure, a
balloon is threaded into the affected blood vessel and inflated, pushing the plaque blocking the
artery to the sides of the vessel. Sometimes, this procedure is accompanied by placement of a
stent — a mesh tube designed to hold the blood vessel open.

Despite all that is known about it, heart disease is the leading cause of death in both men and
women in the United States, according to the CDC, claiming over 630,000 lives in 2006 — more
than a quarter of all deaths.

Everything you need to know

about cirrhosis
Last updated Tue 5 December 2017
By Christian Nordqvist
Reviewed by Daniel Murrell, MD

1. Symptoms

2. Treatment

3. Outlook

4. Stages

5. Causes

6. Complications

7. Prevention
Cirrhosis of the liver describes a condition where scar tissue gradually
replaces healthy liver cells.
It is a progressive disease, developing slowly over many years. If it is allowed
to continue, the buildup of scar tissue can eventually stop liver function.
For cirrhosis to develop, long-term, continuous damage to the liver needs to
occur. When healthy liver tissue is destroyed and replaced by scar tissue, the
condition becomes serious, because it can start blocking the flow of blood
through the liver.

This MNT Knowledge Center article explains the symptoms, causes, and
treatments of liver cirrhosis, including information about complications.

Symptoms
One of the primary methods of diagnosis is through a blood test.

Symptoms are not common during the early stages of cirrhosis.

 However, as scar tissue accumulates, the ability of the liver to function
properly is undermined. The following signs and symptoms may occur:

 blood capillaries become visible on the skin on the upper abdomen.

 fatigue

 insomnia

 itchy skin

 loss of appetite

 loss of bodyweight

 nausea

 pain or tenderness in the area where the liver is located

 red or blotchy palms

 weakness
The following signs and symptoms may appear as liver cirrhosis progresses:

 accelerated heartbeat

 personality changes

 bleeding gums

 lost mass in the body and upper arms

 difficulties processing drugs and alcohol

 confusion

 dizziness

 fluid buildup on ankles, feet, and legs, known as edema

 hair loss

 higher susceptibility to bruising

 jaundice, or yellowing of the skin, whites of the eyes, and tongue

 loss of sex drive

 memory problems

 more frequent fevers and increased risk of infection

 muscle cramps

 nosebleeds

 pain in the right shoulder

 breathlessness

 stools become black and tarry, or very pale.

 urine becomes darker.

 vomiting blood

 problems with walking and mobility

The liver tissue is replaced by fibrous scar tissue. Regenerative nodules may
also form. These are lumps that appear as the liver tries to heal the damage.

Treatment
If the cirrhosis is diagnosed early enough, damage can be minimized by
treating the underlying cause or the various complications that arise.

Treatment for alcohol dependency: It is important for the patient to stop

drinking if their cirrhosis was caused by long-term, regular heavy alcohol
consumption. In many cases, the doctor will recommend a treatment program
for treating alcohol dependency.

Medications: The patient may be prescribed drugs to control liver cell

damage caused by hepatitis B or C.

Controlling pressure in the portal vein: Blood can "back up" in the portal
vein that supplies the liver with blood, causing high blood pressure in the
portal vein. Drugs are usually prescribed to control the increasing pressure in
other blood vessels. The aim is to prevent severe bleeding. Signs of bleeding
can be detected via an endoscopy.

If the patient vomits blood or passes bloody stools, they probably have
esophageal varices. Urgent medical attention is required. The following
procedures may help:

Banding: A small band is placed around the base of the varices to control
bleeding.

Injection sclerotherapy: After an endoscopy, a substance is injected into the

varices, which triggers a blood clot and scar tissue to form. This helps stem
the bleeding.

A Sengstaken-Blakemore tube with a balloon: A balloon is placed at the

end of the tube. If endoscopy does not stop the bleeding, the tube goes down
the patient's throat and into their stomach. The balloon is inflated. This places
pressure on the varices and stops the bleeding.

Transjugular intrahepatic portosystemic stent shunt (TIPSS): If the

therapies mentioned above do not stem the bleeding, a metal tube is passed
across the liver to join the portal and hepatic veins, creating a new route for
the blood to flow through. This reduces the pressure that was causing the
varices.
Other complications are handled in different ways:

Infections: The patient will be given antibiotics for any infections that arise.

Screening for liver cancer: Patients with cirrhosis have a much higher risk of
developing liver cancer. The doctor may recommend regular blood tests and
imaging scans.

Hepatic encephalopathy, or high blood toxin levels: Drugs can help treat
excessive blood toxin levels.

In some cases, the damage caused by cirrhosis covers most of the liver and
cannot be reversed. In these cases, the person may need a new, transplanted
liver. It can take time to find a suitable donor, and this procedure is often
advised only as a last resort.

Outlook
The survival rate of a person with liver cirrhosis depends on the severity of the
scarring.

A 15-year follow-up study of 100 people in Norway with severe alcoholic

cirrhosis showed that 71 percent of the people in the study lived for 5 years
after diagnosis, and 90 percent lived for 15 years.

Continued alcohol consumption and advanced age were linked to a higher

mortality rate in people with cirrhosis.

This is a limited study, but it shows that cirrhosis is a serious condition that
severely reduces life expectancy and impairs quality of living.

Cirrhosis is responsible for 12 deaths in every 100,000 members of the United

States population.
 Stages
Cirrhosis is graded on a scale called the Childs-Pugh score as follows:

 A: Relatively mild

 B: Moderate

 C: Severe
Doctors also classify cirrhosis as either compensated or decompensated.
Compensated cirrhosis means that the liver can function normally despite the
damage. A liver with decompensated cirrhosis cannot perform its functions
correctly and usually causes severe symptoms.

Rather than being viewed in terms of its own stages, cirrhosis is often seen as
a final stage of liver disease.

Causes
 Frequent heavy drinking is a cause of cirrhosis.

Common causes of cirrhosis are:

 long-term alcohol abuse

 hepatitis B and C infection

 fatty liver disease

 toxic metals

 genetic diseases
Hepatitis B and C together are said to be the leading causes of cirrhosis.
Other causes include:

Regularly drinking too much alcohol

Toxins, including alcohol, are broken down by the liver. However, if the
amount of alcohol is too high, the liver will be overworked, and liver cells can
eventually become damaged.

Heavy, regular, long-term drinkers are much more likely to develop cirrhosis,
compared with other, healthy people. Typically, heavy drinking needs to be
sustained for at least 10 years for cirrhosis to develop.

There are generally three stages of alcohol-induced liver disease:

 Fatty liver: This involves a build-up of fat in the liver.

 Alcoholic hepatitis: This occurs when the cells of the liver swell.

 Approximately 10 to 15 percent of heavy drinkers will subsequently

develop cirrhosis.

Hepatitis
Hepatitis C, a blood-borne infection, can damage the liver and eventually lead
to cirrhosis. Hepatitis C is a common cause of cirrhosis in Western Europe,
North America, and many other parts of the world. Cirrhosis can also be
caused by hepatitis B and D.
 Non-alcoholic steatohepatitis (NASH)
NASH, in its early stages, begins with the accumulation of too much fat in the
liver. The fat causes inflammation and scarring, resulting in possible cirrhosis
later on.

NASH is more likely to occur in people who are obese, diabetes patients,
those with high fat levels in the blood, and people with high blood pressure.

Autoimmune hepatitis
The person's own immune system attacks healthy organs in the body as
though they were foreign substances. Sometimes the liver is attacked.
Eventually, the patient can develop cirrhosis.

Some genetic conditions

There are some inherited conditions that can lead to cirrhosis, including:

 Hemochromatosis: Iron accumulates in the liver and other parts of the body.

 Wilson's disease: Copper accumulates in the liver and other parts of the
body.

Blockage of the bile ducts

Some conditions and diseases, such as cancer of the bile ducts, or cancer of
the pancreas, can block the bile ducts, increasing the risk of cirrhosis.

Budd-Chiari syndrome
This condition causes blood clots in the hepatic vein, the blood vessel that
carries blood from the liver. This leads to liver enlargement and the
development of collateral vessels.
 Other diseases and conditions that can contribute to cirrhosis include:

 cystic fibrosis

 primary sclerosing cholangitis, or hardening and scarring of the bile ducts

 galactosemia, or inability to process sugars in milk.

 schistosomiasis, a parasite commonly found in some developing countries

 biliary atresia, or badly formed bile ducts in babies

 glycogen storage disease, or problems in the storage and energy release

vital for cell function

Diagnosis
Because there are rarely symptoms early on in the condition, cirrhosis is often
diagnosed when the patient is being tested for some other condition or
disease.

Anybody who has the following symptoms should see their doctor
immediately:

 fever with shivering

 shortness of breath

 vomiting blood

 dark or tarry stools

 episodes of drowsiness or confusion

A doctor will examine the patient and feel around the liver area to determine
whether it is enlarged. The patient will be asked about their medical history
and lifestyle, including drinking.
 The following tests may also be ordered:

 Blood test: These measure how well the liver is functioning. If levels of
alanine transaminase (ALT) and aspartate transaminase (AST) are high, the
patient may have hepatitis.

 Imaging tests: Ultrasound, CT, or MRI scans can be used to see whether
the liver is enlarged and detect any scarring or nodules.

 Biopsy: A small sample of liver cells is extracted and examined under a

microscope. The biopsy can confirm cirrhosis and its cause.

 Endoscopy: The doctor inserts a long, thin tube with a light and video
camera at the end goes through the esophagus and into the stomach. The
doctor looks out for swollen blood vessels called varices than can be a sign
of cirrhosis.

Complications
Cirrhosis can lead to several other conditions, some of which are life-
threatening. These include:

Ascites or edema: Ascites is a buildup of fluid in the abdomen, and edema is

a buildup of fluid in the legs. They can be treated with a low-salt diet and
water pills. In severe cases, the fluid may have to be drained repeatedly.
Surgery is sometimes needed.

Varices and portal hypertension: These are large, swollen veins in the
esophagus and stomach. They can increase pressure in a blood vessel called
the portal vein that carries blood from the spleen and bowel to the liver.
Varices can rupture, causing severe blood loss and clots.

Hepatic encephalopathy: This refers to high levels of toxins in the blood

where the liver is no longer successfully filtering them all.
 Hepatocellular carcinoma: This is the most common type of liver cancer. It
is the third-leading cause of cancer mortality across the globe.

Hepatopulmonary syndrome (HPS): Doctors define HPS as a combination

of liver disease, dilated blood vessels in the lungs, and abnormalities in the
exchange of gases. It is linked to an increase in the mortality rate of people
waiting for a liver transplant.

Coagulation disorders: Cirrhosis can cause problems with blood clotting,

leading to potentially fatal bleeds and clots.

Prevention
Staying within recommended daily and weekly alcohol limits is highly
recommended to avoid cirrhosis. Please refer to the following helpful
information from the Centers for Disease Control and Prevention (CDC)
about drinking in moderation.

Individuals who have cirrhosis should avoid alcohol completely. Alcohol

accelerates the progression of the disease.

To avoid contracting hepatitis B and C, be sure to take the following

precautions:

 Use a condom when having sex.

 Do not share needles when injecting drugs.

 People at risk of becoming infected with hepatitis B, such as healthcare

workers, social care workers, and police personnel, can be vaccinated
As cirrhosis cannot be reversed or repaired once it reaches a certain stage,
prevention is often considered the best form of treatment.
Metabolic Syndrome
Metabolic syndrome is a collection of heart disease risk factors that increase your chance of
developing heart disease, stroke, and diabetes.
 SHARE Facebook Twitter LinkedinEmail

Print Full Article

What is metabolic syndrome?

Metabolic syndrome is a collection of heart disease risk factors that increase your chance of
developing heart disease, stroke, and diabetes. The condition is also known by other names
including Syndrome X, insulin resistance syndrome, and dysmetabolic syndrome. According to a
national health survey, more than one in five Americans has metabolic syndrome. The number of
people with metabolic syndrome increases with age, affecting more than 40 percent of people in
their 60s and 70s.

How is metabolic syndrome diagnosed?

You are diagnosed with metabolic syndrome if you have three or more of the following:

 A waistline of 40 inches or more for men and 35 inches or more for women (measured
across the belly)
 A blood pressure of 130/85 mm Hg or higher or are taking blood pressure medications
 A triglyceride level above 150 mg/dl
 A fasting blood glucose (sugar) level greater than 100 mg/dl or are taking glucose-
lowering medications
 A high density lipoprotein level (HDL) less than 40 mg/dl (men) or under 50 mg/dl
(women)

Who typically has metabolic syndrome?

 People with central obesity (increased fat in the abdomen/waist)

 People with diabetes mellitus or a strong family history of diabetes mellitus
 People with other clinical features of "insulin resistance" including skin changes of
acanthosis nigricans ("darkened skin" on the back of the neck or underarms) or skin tags
(usually on the neck)
 Certain ethnic backgrounds are at a higher risk of developing metabolic syndrome.

As you grow older, your risk of developing metabolic syndrome increases.

What are the symptoms of metabolic syndrome?

Usually, there are no immediate physical symptoms. Medical problems associated with the
metabolic syndrome develop over time. If you are unsure if you have metabolic syndrome, see
your health care provider. He or she will be able to make the diagnosis by obtaining the
necessary tests, including blood pressure, lipid profile (triglycerides and HDL), and blood
glucose.

What causes metabolic syndrome?

The exact cause of metabolic syndrome is not known. Many features of the metabolic syndrome
are associated with "insulin resistance." Insulin resistance means that the body does not use
insulin efficiently to lower glucose and triglyceride levels. Insulin resistance is a combination of
genetic and lifestyle factors. Lifestyle factors include diet, activity and perhaps interrupted sleep
patterns (such as sleep apnea).
If I have metabolic syndrome, what health problems might develop?

Consistently high levels of insulin and glucose are linked to many harmful changes to the body,
including:

 Damage to the lining of coronary and other arteries, a key step toward the development of
heart disease or stroke
 Changes in the kidneys' ability to remove salt, leading to high blood pressure, heart
disease and stroke
 An increase in triglyceride levels, resulting in an increased risk of developing
cardiovascular disease
 An increased risk of blood clot formation, which can block arteries and cause heart
attacks and strokes
 A slowing of insulin production, which can signal the start of type 2 diabetes, a disease
that is in itself associated with an increased risk for a heart attack or stroke. Uncontrolled
diabetes is also associated with complications of the eyes, nerves, and kidneys.

How do I prevent or reverse metabolic syndrome?

Since physical inactivity and excess weight are the main underlying contributors to the
development of metabolic syndrome, getting more exercise and losing weight can help reduce or
prevent the complications associated with this condition. Your doctor may also prescribe
medications to manage some of your underlying problems. Some of the ways you can reduce
your risk:

 Lose weight - Moderate weight loss, in the range of 5 percent to 10 percent of body
weight, can help restore your body’s ability to recognize insulin and greatly reduce the
chance that the syndrome will evolve into a more serious illness. This can be done via
diet, exercise, or even with help from certain weight-loss medications if recommended by
your doctor.
 Exercise - Increased activity alone can improve your insulin levels. Aerobic exercise
such as a brisk 30-minute daily walk can result in a weight loss, improved blood pressure,
improved cholesterol levels and a reduced risk of developing diabetes. Most health care
providers recommend 150 minutes of aerobic exercise each week. Exercise may reduce
the risk for heart disease even without accompanying weight loss.
 Consider dietary changes - Maintain a diet that keeps carbohydrates to no more than 50
percent of total calories. Eat foods defined as complex carbohydrates, such as whole
grain bread (instead of white), brown rice (instead of white), and sugars that are unrefined
(instead of refined; for example cookies, crackers). Increase your fiber consumption by
eating legumes (for example, beans), whole grains, fruits and vegetables. Reduce your
intake of red meats and poultry. Thirty percent of your daily calories should come from
fat. Consume healthy fats such as those in canola oil, olive oil, flaxseed oil and nuts.

Chronic kidney disease

 Symptoms & causes
 Diagnosis & treatment
 Doctors & departments
 Care at Mayo Clinic

Print

Overview

Chronic kidney disease, also called chronic kidney failure, describes the gradual loss of
kidney function. Your kidneys filter wastes and excess fluids from your blood, which are
then excreted in your urine. When chronic kidney disease reaches an advanced stage,
dangerous levels of fluid, electrolytes and wastes can build up in your body.

In the early stages of chronic kidney disease, you may have few signs or symptoms.
Chronic kidney disease may not become apparent until your kidney function is
significantly impaired.

Treatment for chronic kidney disease focuses on slowing the progression of the kidney
damage, usually by controlling the underlying cause. Chronic kidney disease can
progress to end-stage kidney failure, which is fatal without artificial filtering (dialysis) or
a kidney transplant.

Chronic kidney disease care at Mayo Clinic

Symptoms

Signs and symptoms of chronic kidney disease develop over time if kidney damage
progresses slowly. Signs and symptoms of kidney disease may include:

 Nausea

 Vomiting

 Loss of appetite

 Fatigue and weakness

 Sleep problems
  Changes in how much you urinate

 Decreased mental sharpness

 Muscle twitches and cramps

 Swelling of feet and ankles

 Persistent itching

 Chest pain, if fluid builds up around the lining of the heart

 Shortness of breath, if fluid builds up in the lungs

 High blood pressure (hypertension) that's difficult to control

Signs and symptoms of kidney disease are often nonspecific, meaning they can also be
caused by other illnesses. Because your kidneys are highly adaptable and able to
compensate for lost function, signs and symptoms may not appear until irreversible
damage has occurred.

When to see a doctor

Make an appointment with your doctor if you have any signs or symptoms of kidney
disease.

If you have a medical condition that increases your risk of kidney disease, your doctor is
likely to monitor your blood pressure and kidney function with urine and blood tests
during regular office visits. Ask your doctor whether these tests are necessary for you.

Request an Appointment at Mayo Clinic

Causes


Normal kidney vs. diseased kidney



Polycystic kidney
Chronic kidney disease occurs when a disease or condition impairs kidney function,
causing kidney damage to worsen over several months or years.

Diseases and conditions that cause chronic kidney disease include:

 Type 1 or type 2 diabetes

 High blood pressure

 Glomerulonephritis (gloe-mer-u-low-nuh-FRY-tis), an inflammation of the kidney's

filtering units (glomeruli)
  Interstitial nephritis (in-tur-STISH-ul nuh-FRY-tis), an inflammation of the kidney's
tubules and surrounding structures

 Polycystic kidney disease

 Prolonged obstruction of the urinary tract, from conditions such as enlarged

prostate, kidney stones and some cancers

 Vesicoureteral (ves-ih-koe-yoo-REE-tur-ul) reflux, a condition that causes urine to

back up into your kidneys

 Recurrent kidney infection, also called pyelonephritis (pie-uh-low-nuh-FRY-tis)

Risk factors

Factors that may increase your risk of chronic kidney disease include:

 Diabetes

 High blood pressure

 Heart and blood vessel (cardiovascular) disease

 Smoking

 Obesity

 Being African-American, Native American or Asian-American

 Family history of kidney disease

 Abnormal kidney structure

 Older age
Complications

Chronic kidney disease can affect almost every part of your body. Potential
complications may include:

 Fluid retention, which could lead to swelling in your arms and legs, high blood
pressure, or fluid in your lungs (pulmonary edema)

 A sudden rise in potassium levels in your blood (hyperkalemia), which could impair
your heart's ability to function and may be life-threatening
  Heart and blood vessel (cardiovascular) disease

 Weak bones and an increased risk of bone fractures

 Anemia

 Decreased sex drive, erectile dysfunction or reduced fertility

 Damage to your central nervous system, which can cause difficulty concentrating,
personality changes or seizures

 Decreased immune response, which makes you more vulnerable to infection

 Pericarditis, an inflammation of the saclike membrane that envelops your heart

(pericardium)

 Pregnancy complications that carry risks for the mother and the developing fetus

 Irreversible damage to your kidneys (end-stage kidney disease), eventually

requiring either dialysis or a kidney transplant for survival
Prevention

To reduce your risk of developing kidney disease:

 Follow instructions on over-the-counter medications. When using

nonprescription pain relievers, such as aspirin, ibuprofen (Advil, Motrin IB, others)
and acetaminophen (Tylenol, others), follow the instructions on the package.
Taking too many pain relievers could lead to kidney damage and generally should
be avoided if you have kidney disease. Ask your doctor whether these drugs are
safe for you.

 Maintain a healthy weight. If you're at a healthy weight, work to maintain it by

being physically active most days of the week. If you need to lose weight, talk with
your doctor about strategies for healthy weight loss. Often this involves increasing
daily physical activity and reducing calories.

 Don't smoke. Cigarette smoking can damage your kidneys and make existing
kidney damage worse. If you're a smoker, talk to your doctor about strategies for
quitting smoking. Support groups, counseling and medications can all help you to
stop.
  Manage your medical conditions with your doctor's help. If you have diseases
or conditions that increase your risk of kidney disease, work with your doctor to
control them. Ask your doctor about tests to look for signs of kidney damage.

Diagnosis

Kidney biopsy
As a first step toward diagnosis of kidney disease, your doctor discusses your personal
and family history with you. Among other things, your doctor might ask questions about
whether you've been diagnosed with high blood pressure, if you've taken a medication
that might affect kidney function, if you've noticed changes in your urinary habits, and
whether you have any family members who have kidney disease.

Next, your doctor performs a physical exam, also checking for signs of problems with
your heart or blood vessels, and conducts a neurological exam.

For kidney disease diagnosis, you may also need certain tests and procedures, such
as:
  Blood tests. Kidney function tests look for the level of waste products, such as
creatinine and urea, in your blood.

 Urine tests. Analyzing a sample of your urine may reveal abnormalities that point
to chronic kidney failure and help identify the cause of chronic kidney disease.

 Imaging tests. Your doctor may use ultrasound to assess your kidneys' structure
and size. Other imaging tests may be used in some cases.

 Removing a sample of kidney tissue for testing. Your doctor may recommend a
kidney biopsy to remove a sample of kidney tissue. Kidney biopsy is often done
with local anesthesia using a long, thin needle that's inserted through your skin and
into your kidney. The biopsy sample is sent to a lab for testing to help determine
what's causing your kidney problem.
Treatment

Health History Questionnaire

Interested in being a living kidney or liver donor? Start the process by completing a
Health History Questionnaire.


Kidney transplant
Depending on the underlying cause, some types of kidney disease can be treated.
Often, though, chronic kidney disease has no cure.

Treatment usually consists of measures to help control signs and symptoms, reduce
complications, and slow progression of the disease. If your kidneys become severely
damaged, you may need treatment for end-stage kidney disease.

Treating the cause

Your doctor will work to slow or control the cause of your kidney disease. Treatment
options vary, depending on the cause. But kidney damage can continue to worsen even
when an underlying condition, such as high blood pressure, has been controlled.

Treating complications
Kidney disease complications can be controlled to make you more comfortable.
Treatments may include:

 High blood pressure medications. People with kidney disease may experience
worsening high blood pressure. Your doctor may recommend medications to lower
your blood pressure — commonly angiotensin-converting enzyme (ACE) inhibitors
or angiotensin II receptor blockers — and to preserve kidney function. High blood
pressure medications can initially decrease kidney function and change electrolyte
levels, so you may need frequent blood tests to monitor your condition. Your doctor
will likely also recommend a water pill (diuretic) and a low-salt diet.

 Medications to lower cholesterol levels. Your doctor may recommend

medications called statins to lower your cholesterol. People with chronic kidney
disease often experience high levels of bad cholesterol, which can increase the
risk of heart disease.

 Medications to treat anemia. In certain situations, your doctor may recommend

supplements of the hormone erythropoietin (uh-rith-roe-POI-uh-tin), sometimes
with added iron. Erythropoietin supplements aid in production of more red blood
cells, which may relieve fatigue and weakness associated with anemia.

 Medications to relieve swelling. People with chronic kidney disease may retain
fluids. This can lead to swelling in the legs, as well as high blood pressure.
Medications called diuretics can help maintain the balance of fluids in your body.

 Medications to protect your bones. Your doctor may prescribe calcium and
vitamin D supplements to prevent weak bones and lower your risk of fracture. You
may also take medication known as a phosphate binder to lower the amount of
phosphate in your blood, and protect your blood vessels from damage by calcium
deposits (calcification).

 A lower protein diet to minimize waste products in your blood. As your body
processes protein from foods, it creates waste products that your kidneys must
filter from your blood. To reduce the amount of work your kidneys must do, your
doctor may recommend eating less protein. Your doctor may also ask you to meet
with a dietitian who can suggest ways to lower your protein intake while still eating
a healthy diet.
Your doctor may recommend follow-up testing at regular intervals to see whether your
kidney disease remains stable or progresses.
Treatment for end-stage kidney disease

If your kidneys can't keep up with waste and fluid clearance on their own and you
develop complete or near-complete kidney failure, you have end-stage kidney disease.
At that point, you need dialysis or a kidney transplant.

 Dialysis. Dialysis artificially removes waste products and extra fluid from your
blood when your kidneys can no longer do this. In hemodialysis, a machine filters
waste and excess fluids from your blood. In peritoneal dialysis, a thin tube
(catheter) inserted into your abdomen fills your abdominal cavity with a dialysis
solution that absorbs waste and excess fluids. After a period of time, the dialysis
solution drains from your body, carrying the waste with it.

 Kidney transplant. A kidney transplant involves surgically placing a healthy

kidney from a donor into your body. Transplanted kidneys can come from
deceased or living donors. You'll need to take medications for the rest of your life
to keep your body from rejecting the new organ. You don't need to be on dialysis to
have a kidney transplant.
For some who choose not to have dialysis or a kidney transplant, a third option is to
treat kidney failure with conservative measures. However, once you have complete
kidney failure, your life expectancy generally would be only a few months.

Potential future treatments

Regenerative medicine holds the potential to fully heal damaged tissues and organs,
offering solutions and hope for people who have conditions that today are beyond
repair.

Regenerative medicine approaches include:

 Boosting the body's natural ability to heal itself

 Using healthy cells, tissues or organs from a living or deceased donor to replace
damaged ones

 Delivering specific types of cells or cell products to diseased tissues or organs to

restore tissue and organ function
For people with chronic kidney disease, regenerative medicine approaches may be
developed in the future to help slow progression of the disease.

Request an Appointment at Mayo Clinic

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means
to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

As part of your treatment for chronic kidney disease, your doctor may recommend a
special diet to help support your kidneys and limit the work they must do. Ask your
doctor for a referral to a dietitian who can analyze your current diet and suggest ways to
make your diet easier on your kidneys.

Depending on your situation, kidney function and overall health, your dietitian may
recommend that you:

 Avoid products with added salt. Lower the amount of sodium you eat each day
by avoiding products with added salt, including many convenience foods, such as
frozen dinners, canned soups and fast foods. Other foods with added salt include
salty snack foods, canned vegetables, and processed meats and cheeses.

 Choose lower potassium foods. Your dietitian may recommend that you choose
lower potassium foods at each meal. High-potassium foods include bananas,
oranges, potatoes, spinach and tomatoes. Examples of low-potassium foods
 include apples, cabbage, carrots, green beans, grapes and strawberries. Be aware
that many salt substitutes contain potassium, so you generally should avoid them if
you have kidney failure.

 Limit the amount of protein you eat. Your dietitian will estimate the appropriate
number of grams of protein you need each day and make recommendations based
on that amount. High-protein foods include lean meats, eggs, milk, cheese and
beans. Low-protein foods include vegetables, fruits, breads and cereals.
Coping and support

Receiving a diagnosis of chronic kidney disease can be worrisome. You may be

concerned about what your diagnosis means for your future health. To help you cope
with your feelings, consider trying to:

 Connect with other people who have kidney disease. Other people with chronic
kidney disease understand what you're feeling and can offer unique support. Ask
your doctor about support groups in your area. Or contact organizations such as
the American Association of Kidney Patients, the National Kidney Foundation or
the American Kidney Fund for groups in your area.

 Maintain your normal routine, when possible. Try to maintain a normal routine,
doing the activities you enjoy and continuing to work, if your condition allows. This
may help you cope with feelings of sadness or loss that you may experience after
your diagnosis.

 Be active most days of the week. With your doctor's advice, aim for at least 30
minutes of physical activity most days of the week. This can help you cope with
fatigue and stress.

 Talk with a person you trust. Living with chronic kidney disease can be stressful,
and it may help to talk about your feelings. You may have a friend or family
member who is a good listener. Or you may find it helpful to talk with a faith leader
or someone else you trust. Ask your doctor for a referral to a social worker or
counselor.

Type 2 Diabetes: The Basics

Listen
 ARTICLES ONTYPE 2 DIABETES

 What Is Type 2 Diabetes?

 Causes
 Symptoms
 Prevention
 Risk Factors
 Screening
 Treatments
 Natural Remedies
 Ask Your Doctor
Diabetes is a life-long disease that affects the way your
body handles glucose, a kind of sugar, in your blood.
Most people with the condition have type 2. There are
about 27 million people in the U.S. with it. Another 86
million have prediabetes: Their blood glucose is not
normal, but not high enough to be diabetes yet.

What Causes Diabetes?

Your pancreas makes a hormone called insulin. It's what
lets your cells turn glucose from the food you eat into
energy. People with type 2 diabetes make insulin, but their
cells don't use it as well as they should. Doctors call this
insulin resistance.
At first, the pancreas makes more insulin to try to get
glucose into the cells. But eventually it can't keep up, and
the sugar builds up in your blood instead.
Usually a combination of things cause type 2 diabetes,
including:
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Genes. Scientists have found different bits of DNA that

affect how your body makes insulin.
Extra weight. Being overweight or obese can cause
insulin resistance, especially if you carry your extra pounds
around the middle. Now type 2 diabetes affects kids and
teens as well as adults, mainly because of childhood
obesity.
Metabolic syndrome. People with insulin resistance often
have a group of conditions including high blood glucose,
extra fat around the waist, high blood pressure, and high
cholesterol and triglycerides.
Too much glucose from your liver. When your blood
sugar is low, your liver makes and sends out glucose. After
you eat, your blood sugar goes up, and usually
the liver will slow down and store its glucose for later. But
some people's livers don't. They keep cranking out sugar.
Bad communication between cells. Sometimes cells
send the wrong signals or don't pick up messages
correctly. When these problems affect how your cells make
and use insulin or glucose, a chain reaction can lead to
diabetes.
Broken beta cells. If the cells that make the insulin send
out the wrong amount of insulin at the wrong time,
your blood sugar gets thrown off. High blood glucose can
damage these cells, too.

Risk Factors and Prevention

While certain things make getting diabetes more likely, they won't give
you the disease. But the more that apply to you, the higher your chances of
getting it are.
Some things you can't control.

 Age: 45 or older
 Family: A parent, sister, or brother with diabetes
 Ethnicity: African-American, Alaska Native, Native American,
Asian-American, Hispanic or Latino, or Pacific Islander-American

Some things are related to your health and medical history. Your doctor
may be able to help.

 Prediabetes
 Heart and blood vessel disease
 High blood pressure, even if it's treated and under control
 Low HDL ("good") cholesterol
 High triglycerides
 Being overweight or obese
 Having a baby that weighed more than 9 pounds
 Having gestational diabetes while you were pregnant
 Polycystic ovary syndrome (PCOS)
 Acanthosis nigricans, a skin condition with dark rashes around your
neck or armpits
 Depression
Other risk factors have to do with your daily habits and lifestyle. These are
the ones you can really do something about.

 Getting little or no exercise

 Smoking
 Stress
 Sleeping too little or too much

Because you can't change what happened in the past, focus on what you
can do now and going forward. Take medications and follow your doctor's
suggestions to be healthy. Simple changes at home can make a big
difference, too.
Lose weight. Dropping just 7% to 10% of your weight can cut your risk of
type 2 diabetes in half.
Get active. Moving muscles use insulin. Thirty minutes of brisk walking a
day will cut your risk by almost a third.
Eat right. Avoid highly processed carbs, sugary drinks, and trans
and saturated fats. Limit red and processed meats.
Quit smoking. Work with your doctor to avoid gaining weight, so you
don't create one problem by solving another.

Symptoms
The symptoms of type 2 diabetes can be so mild you don't notice them. In
fact, about 8 million people who have it don't know it.

 Being very thirsty

 Peeing a lot
 Blurry vision
 Being irritable
 Tingling or numbness in your hands or feet
 Feeling worn out
 Wounds that don't heal
 Yeast infections that keep coming back
Getting a Diagnosis
Your doctor can test your blood for signs of diabetes. Usually doctors will
test you on two different days to confirm the diagnosis. But if your blood
glucose is very high or you have a lot of symptoms, one test may be all
you need.
A1C: It's like an average of your blood glucose over the past 2 or 3
months.
Fasting plasma glucose: This measures your blood sugar on an empty
stomach. You won't be able to eat or drink anything except water for 8
hours before the test.
Oral glucose tolerance test (OGTT): This checks your blood glucose
before and 2 hours after you drink a sweet drink to see how your body
handles the sugar.

Long-Term Effects
Over time, high blood sugar can damage and cause problems with your:

 Heart and blood vessels

 Kidneys
 Eyes
 Nerves, which can lead to trouble with digestion, the feeling in your
feet, and your sexual response
 Wound healing
 Pregnancy

The best way to avoid these complications is to manage your diabetes well.

 Take your diabetes medications or insulin on time.

 Check your blood glucose.
 Eat right, and don't skip meals.
 See your doctor regularly to check for early signs of trouble.
Stroke - symptoms, diagnosis,
treatment, prevention

A stroke is a disruption of blood flow to a part of the brain, which causes brains cells to be damaged
or die because of a lack of oxygen. A stroke is a medical emergency that requires immediate
treatment. Symptoms usually occur suddenly but will vary depending on the part of the brain that is
affected.

Approximately 9000 New Zealanders have a stroke each year – it is the second biggest killer
(approximately 2500 deaths per year) and a major cause of disability in New Zealand . The best
means to prevent a stroke are to manage related medical conditions (notably high blood pressure)
and lifestyle factors.

Types of stroke
Ischaemic strokes:
Ischaemic strokes occur when a blood clot completely blocks an artery in or to the brain. They are
the most common type of stroke, occurring in about 85% of cases. Ischaemic strokes can be either
thrombotic or embolic. Thrombotic strokes occur when a blood clot (thrombus) blocks an artery that
supplies blood to the brain, which has been narrowed by the build-up of fatty deposits (plaques)
during a process known as atherosclerosis. Embolic strokes are due to a clot that has formed
outside the brain and travels to the brain in the blood stream. When this occurs the clot is known as
an embolus (plural = emboli).

Haemorrhagic Strokes:
Haemorrhagic strokes occur when an artery within the brain ruptures (bursts) and leaks blood into
the brain. The presence of this extra blood causes pressure to build within the area of the brain
 where the bleed has occurred. This causes damage to the brain tissue in that area. Haemorrhagic
strokes are less common than ischaemic strokes but their effects are generally more severe.
Rupture of an artery can be due to factors such as an aneurysm (where a weakened section of an
artery balloons out), a congenitally abnormal connection of blood vessels, or extremely high blood
pressure.

Mini stroke (transient ischaemic attack):

Mini strokes, or transient ischaemic attacks (TIA), occur when there is a temporary disruption in the
blood flow to the brain. This can be due to a narrowing in an artery in or to the brain, or as a result of
a blood clot that quickly dislodges itself allowing blood to flow again.

Symptoms of a TIA can be similar to those of a stroke and can include sudden weakness and/or
numbness of face, arm and/or leg, sudden blurred or loss of vision in one or both eyes, sudden
difficulty speaking or understanding what others are saying, sudden dizziness, loss of balance or
difficulty controlling movements. Symptoms may last for only a few minutes or up to a few hours and
resolve within 24 hours. If symptoms last longer than 24 hours the condition is diagnosed as a
stroke.

Suffering a TIA increases the risk of having a full-blown stroke and having a TIA should be a clear
warning that a more severe stroke might follow. Immediate medical attention should be sought if a
TIA is suspected as they can be a warning sign that a more severe stroke might follow.

The Stroke Foundation recommends a person with a suspected TIA should go directly to hospital for
medical assessment.

Stroke risk
People of all ages and genders can suffer a stroke. In New Zealand, approximately 24 people have
a stroke each day.
Risk factors multiply and the greater the number, the greater the chance of a stroke. High blood
pressure (hypertension) is the leading risk factor for stroke.

Seventy-five percent of strokes occur in people over 65 years of age. Ischaemic strokes make up the
majority of strokes in older people while younger people are more likely to suffer a haemorrhagic
stroke.
Ethnicity is a factor and Maori and Pacific Island New Zealanders are more likely to suffer a stroke
than European New Zealanders. Men are more likely to suffer a stroke than women. Pregnant
women also have a slightly increased risk of haemorrhagic stroke.

There are controllable and uncontrollable factors that increase the risk of stroke. Uncontrollable risk
factors (ie: risks you cannot reduce through treatment or lifestyle changes) include:

 Age
 Male gender
 Family history
 Ethnicity
 Previous TIA.

Early detection and effective management of controllable stroke risk factors can greatly reduce the
possibility of stroke. Controllable risk factors for TIA and stroke include:

 High blood pressure

 Heart disease
 Heart rhythm disorders eg: atrial fibrillation
 Smoking
 Diabetes
 High blood cholesterol levels
 Oral contraceptives
 Excessive alcohol intake
 Obesity.

Signs and symptoms

Signs and symptoms of a stroke usually occur suddenly. The type of symptoms experienced will
depend on what area of the brain is affected. The areas of the brain that control function on one side
of the body are often located in the opposite side of the brain. Therefore, lack of blood to one side of
the brain can often result in signs and symptoms on the opposite side of the body. Common initial
symptoms of a stroke include:

 Severe headache
 Impairment or loss of vision
 Memory loss
 Confusion
 Loss of balance or co-ordination
 Poor balance and dizziness
 Sudden numbness, paralysis or weakness of an arm, leg or side of the face
 Slurred or abnormal speech
 Loss of consciousness
 Incontinence.

Complications
A stroke can cause permanent loss of function. The type and degree of this loss of function is
determined by which area of the brain has been affected and the speed and success of treatment
given. Permanent effects of a stroke can include:

 Impaired vision
 Difficulty understanding or forming speech
 Severe weakness or paralysis of the affected side (hemiplegia)
 Numbness, strange sensations or pain - sometimes made worse by movement or temperature
change
 Swallowing difficulties
 Depression
 Emotional problems, such as difficulty controlling emotions or expressing inappropriate emotions.

Stoke may also cause problems with thinking, awareness, attention, learning, judgement and
memory.

Diagnosis
To diagnose a stroke a doctor will usually make an assessment using several of the following:

 Examination of current signs and symptoms

 Review of medical history (including current medications being taken, and head injuries)
 Review of personal and family history of heart disease, stroke and TIA
 Electrocardiogram (ECG) - measures electrical activity in the heart
 Echocardiogram - to assess for any abnormalities in heart function and structure
 Electroencephalogram (EEG) - measures electrical activity in the brain
 Cerebral angiogram - provides a detailed view of the arteries in the brain
 Ultrasound scanning of the neck arteries (carotids)
 Computerised tomography (CT) scan - specialised x-rays that can provide detailed cross-sectional
images of the brain
 Magnetic resonance imaging (MRI) - a specialised scan that produces a detailed image of the brain
 Blood tests
 Chest x-rays.

Treatment
Stroke is a medical emergency requiring immediate treatment. Prompt treatment improves the
chances of survival and increases the degree of recovery that might be expected. The treatment
given will depend on the type of stroke suffered.

INITIAL TREATMENT

Immediate treatment is aimed at limiting the size of the stroke and preventing further stroke. Acute
stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot causing
an ischaemic stroke or by stopping the bleeding of a haemorrhagic stroke. This will involve
administering medications and may involve surgery in some cases.

Medications

 Thrombolytic therapy: These medications dissolve blood clots allowing blood flow to be re-
established
 Anti-platelet drugs (eg: aspirin) and anticoagulants (eg: heparin): These medications help to prevent
blot clots getting bigger and prevent new blood clots from forming
 Antihypertensives: In cases of haemorrhagic stroke these medications may be prescribed to help
lower high blood pressure
 Medications to reduce swelling in the brain and medications to treat underlying causes for the stroke
eg: heart rhythm disorders may also be given.

Surgery
Surgery may be needed to repair blocked or ruptured arteries. For a haemorrhagic stroke this may
involve repairing a bleeding aneurysm or AVM. Where an ischaemic stroke has been caused by a
blockage in a neck artery surgery to remove the blockage may be performed. This is known as a
carotid endarterectomy.

Supportive treatment
Providing adequate fluid and nutrition intake after a stroke is vital, particularly if swallowing has been
affected. This may require the insertion of an intravenous drip into a vein in the hand or arm, or it
may involve inserting a feeding tube via the nose into the stomach. Preventing complications that
can occur as a result of immobility eg: pneumonia and bed sores, is also important.

LONGER TERM TREATMENT:

 Brain cells do not generally regenerate (regrow). Following a stroke, surviving brain cells can take
over the function of areas that are dead or damaged, but only to a certain degree. The adaptive
ability of the brain requires the relearning of various skills.

As each person who suffers a stroke is affected differently, individual rehabilitation plans are
developed in conjunction with the patient, family and healthcare team. These aim to teach skills and
maximise function so that the person can achieve maximum independence.

Rehabilitation may involve:

 Physiotherapy - to improve mobility

 Speech therapy - to improve communication
 Occupational therapy - to improve daily functions such as eating, cooking, toileting and washing.

Recovery can take months and it may be several days or weeks after the stroke before doctors are
able to give an accurate prediction for recovery.

Long term treatment with medications to treat the underlying cause of the stroke and to minimise the
risk of further stroke may be required. This includes long term use of medications to treat high blood
pressure, heart rhythm disorders, high cholesterol, heart disease and blood clotting disorders.
Common long-term medications prescribed for people who have had a stroke include warfarin and
aspirin - both of which aim to prevent the formation of blood clots.

Surgery to treat the underlying cause of the stroke may also be recommended. This can include
surgery to damaged heart valve, heart rhythm problems (may involve the insertion of a pacemaker)
or carotid endarterectomy.

Prevention
Reducing the number of controllable risk factors is the best way to prevent a stroke. This can
include:

 Stopping smoking
 Losing weight
 Eating a balanced diet low in sodium and saturated and trans fat
 Moderating alcohol intake (no more than 2 small drinks per day)
 Exercising regularly in order to stay physically fit
 Maintaining good control of existing medical conditions such as diabetes, high blood pressure and
high cholesterol.

If discovered prior to a stroke, some medical conditions may be repaired surgically in order to
prevent a stroke occurring in the first place eg: aneurysms, narrowed arteries, heart rhythm
disorders, heart valve problems.
Medications (eg: aspirin or warfarin) may be recommended to help prevent another ischaemic stroke
or TIA.

Overview
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease
that causes obstructed airflow from the lungs. Symptoms include breathing difficulty,
cough, mucus (sputum) production and wheezing. It's 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.

Emphysema and chronic bronchitis are the two most common conditions that contribute
to COPD. Chronic bronchitis is inflammation of the lining of the bronchial tubes, which
carry air to and from the air sacs (alveoli) of the lungs. It's characterized by daily cough
and mucus (sputum) production.

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 and other irritating gases and particulate matter.

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.

COPD care at Mayo Clinic

Symptoms

COPD symptoms often don't appear until significant lung damage has occurred, and
they usually worsen over time, particularly if smoking exposure continues. For chronic
bronchitis, the main symptom is a daily cough and mucus (sputum) production at least
three months a year for two consecutive years.

Other signs and symptoms of COPD may include:

 Shortness of breath, especially during physical activities

 Wheezing

 Chest tightness
  Having to clear your throat first thing in the morning, due to excess mucus in your
lungs

 A chronic cough that may produce mucus (sputum) that may be clear, white,
yellow or greenish

 Blueness of the lips or fingernail beds (cyanosis)

 Frequent respiratory infections

 Lack of energy

 Unintended weight loss (in later stages)

 Swelling in ankles, feet or legs

People with COPD are also likely to experience episodes called exacerbations, during
which their symptoms become worse than usual day-to-day variation and persist for at
least several days.

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Causes

The main cause of COPD in developed countries is tobacco smoking. In the developing
world, COPD often occurs in people exposed to fumes from burning fuel for cooking and
heating in poorly ventilated homes.

Only about 20 to 30 percent of chronic smokers may develop clinically apparent COPD,
although many smokers with long smoking histories may develop reduced lung function.
Some smokers develop less common lung conditions. They may be misdiagnosed as
having COPD until a more thorough evaluation is performed.

How your lungs are affected

Air travels down your windpipe (trachea) and into your lungs through two large tubes
(bronchi). Inside your lungs, these tubes divide many times — like the branches of a
tree — into many smaller tubes (bronchioles) that end in clusters of tiny air sacs
(alveoli).
The air sacs have very thin walls full of tiny blood vessels (capillaries). The oxygen in
the air you inhale passes into these blood vessels and enters your bloodstream. At the
same time, carbon dioxide — a gas that is a waste product of metabolism — is exhaled.

Your lungs rely on the natural elasticity of the bronchial tubes and air sacs to force air
out of your body. COPD causes them to lose their elasticity and overexpand, which
leaves some air trapped in your lungs when you exhale.

Emphysema


Bronchitis
Causes of airway obstruction

Causes of airway obstruction include:

  Emphysema. This lung disease causes destruction of the fragile walls and elastic
fibers of the alveoli. Small airways collapse when you exhale, impairing airflow out
of your lungs.

 Chronic bronchitis. In this condition, your bronchial tubes become inflamed and
narrowed and your lungs produce more mucus, which can further block the
narrowed tubes. You develop a chronic cough trying to clear your airways.
Cigarette smoke and other irritants

In the vast majority of cases, the lung damage that leads to COPD is caused by long-
term cigarette smoking. But there are likely other factors at play in the development
of COPD, such as a genetic susceptibility to the disease, because only about 20 to 30
percent of smokers may develop COPD.

Other irritants can cause COPD, including cigar smoke, secondhand smoke, pipe
smoke, air pollution and workplace exposure to dust, smoke or fumes.

Alpha-1-antitrypsin deficiency

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. Alpha-1-antitrypsin (AAt) is
made in the liver and secreted into the bloodstream to help protect the lungs. Alpha-1-
antitrypsin deficiency can affect the liver as well as the lungs. Damage to the lung can
occur in infants and children, not only adults with long smoking histories.

For adults with COPD related to AAt deficiency, treatment options include those used
for people with more-common types of COPD. In addition, some people can be treated
by replacing the missing AAt protein, which may prevent further damage to the lungs.

Risk factors

Risk factors for COPD include:

 Exposure to tobacco smoke. The most significant risk factor for COPD is long-
term cigarette smoking. The more years you smoke and the more packs you
smoke, the greater your risk. Pipe smokers, cigar smokers and marijuana smokers
 also may be at risk, as well as people exposed to large amounts of secondhand
smoke.

 People with asthma who smoke. The combination of asthma, a chronic

inflammatory airway disease, and smoking increases the risk of COPD even more.

 Occupational exposure to dusts and chemicals. Long-term exposure to

chemical fumes, vapors and dusts in the workplace can irritate and inflame your
lungs.

 Exposure to fumes from burning fuel. In the developing world, people exposed
to fumes from burning fuel for cooking and heating in poorly ventilated homes are
at higher risk of developing COPD.

 Age. COPD develops slowly over years, so most people are at least 40 years old
when symptoms begin.

 Genetics. The uncommon genetic disorder alpha-1-antitrypsin deficiency is the

cause of some cases of COPD. Other genetic factors likely make certain smokers
more susceptible to the disease.
Complications

COPD can cause many complications, including:

 Respiratory infections. People with COPD are more likely to catch colds, the flu
and pneumonia. Any respiratory infection can make it much more difficult to
breathe and could cause further damage to lung tissue. An annual flu vaccination
and regular vaccination against pneumococcal pneumonia can prevent some
infections.

 Heart problems. For reasons that aren't fully understood, COPD can increase
your risk of heart disease, including heart attack. Quitting smoking may reduce this
risk.

 Lung cancer. People with COPD have a higher risk of developing lung cancer.
Quitting smoking may reduce this risk.

 High blood pressure in lung arteries. COPD may cause high blood pressure in
the arteries that bring blood to your lungs (pulmonary hypertension).

 Depression. Difficulty breathing can keep you from doing activities that you enjoy.
And dealing with serious illness can contribute to development of depression. Talk
 to your doctor if you feel sad or helpless or think that you may be experiencing
depression.
Prevention

Unlike some diseases, COPD has a clear cause and a clear path of prevention. The
majority of cases are directly related to cigarette smoking, and the best way to
prevent COPD is to never smoke — or to stop smoking now.

If you're a longtime smoker, these simple statements may not seem so simple,
especially if you've tried quitting — once, twice or many times before. But keep trying to
quit. It's critical to find a tobacco cessation program that can help you quit for good. It's
your best chance for preventing damage to your lungs.

Occupational exposure to chemical fumes and dust is another risk factor for COPD. If
you work with this type of lung irritant, talk to your supervisor about the best ways to
protect yourself, such as using respiratory protective equipment.

Diagnosis


Spirometer
COPD is commonly misdiagnosed — former smokers may sometimes be told they
have COPD, when in reality they may have simple deconditioning or another less
common lung condition. Likewise, many people who have COPD may not be diagnosed
until the disease is advanced and interventions are less effective.

To diagnose your condition, your doctor will review your signs and symptoms, discuss
your family and medical history, and discuss any exposure you've had to lung irritants
— especially cigarette smoke. Your doctor may order several tests to diagnose your
condition.

Tests may include:

  Lung (pulmonary) function tests. Pulmonary function tests measure the amount
of air you can inhale and exhale, and if your lungs are delivering enough oxygen to
your blood.

Spirometry is the most common lung function test. During this test, you'll be asked
to blow into a large tube connected to a small machine called a spirometer. This
machine measures how much air your lungs can hold and how fast you can blow
the air out of your lungs.

Spirometry can detect COPD even before you have symptoms of the disease. It
can also be used to track the progression of disease and to monitor how well
treatment is working. Spirometry often includes measurement of the effect of
bronchodilator administration. Other lung function tests include measurement of
lung volumes, diffusing capacity and pulse oximetry.

 Chest X-ray. A chest X-ray can show emphysema, one of the main causes
of COPD. An X-ray can also rule out other lung problems or heart failure.

 CT scan. A CT scan of your lungs can help detect emphysema and help determine
if you might benefit from surgery for COPD. CT scans can also be used to screen
for lung cancer.

 Arterial blood gas analysis. This blood test measures how well your lungs are
bringing oxygen into your blood and removing carbon dioxide.

 Laboratory tests. Laboratory tests aren't used to diagnose COPD, but they may
be used to determine the cause of your symptoms or rule out other conditions. For
example, laboratory tests may be used to determine if you have the genetic
disorder alpha-1-antitrypsin (AAt) deficiency, which may be the cause of some
cases of COPD. This test may be done if you have a family history of COPD and
develop COPD at a young age, such as under age 45.
Treatment

A diagnosis of COPD is not the end of the world. Most people have mild forms of the
disease for which little therapy is needed other than smoking cessation. Even for more
advanced stages of disease, effective therapy is available that can control symptoms,
reduce your risk of complications and exacerbations, and improve your ability to lead an
active life.
Smoking cessation

The most essential step in any treatment plan for COPD is to stop all smoking. It's the
only way to keep COPD from getting worse — which can eventually reduce your ability
to breathe. But quitting smoking isn't easy. And this task may seem particularly daunting
if you've tried to quit and have been unsuccessful.

Talk to your doctor about nicotine replacement products and medications that might
help, as well as how to handle relapses. Your doctor may also recommend a support
group for people who want to quit smoking. It's also a good idea to avoid secondhand
smoke exposure whenever possible.

Medications

Doctors use several kinds of medications to treat the symptoms and complications
of COPD. You may take some medications on a regular basis and others as needed.

Bronchodilators

These medications — which usually come in an inhaler — relax the muscles around
your airways. This can help relieve coughing and shortness of breath and make
breathing easier. Depending on the severity of your disease, you may need a short-
acting bronchodilator before activities, a long-acting bronchodilator that you use every
day or both.

Short-acting bronchodilators include albuterol (ProAir HFA, Ventolin HFA, others),

levalbuterol (Xopenex HFA), and ipratropium (Atrovent). The long-acting
bronchodilators include tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil,
Perforomist), arformoterol (Brovana), indacaterol (Arcapta) and aclidinium (Tudorza).

Inhaled steroids

Inhaled corticosteroid medications can reduce airway inflammation and help prevent
exacerbations. Side effects may include bruising, oral infections and hoarseness. These
medications are useful for people with frequent exacerbations of COPD. Fluticasone
(Flovent HFA, Flonase, others) and budesonide (Pulmicort Flexhaler, Uceris, others)
are examples of inhaled steroids.

Combination inhalers

Some medications combine bronchodilators and inhaled steroids. Salmeterol and

fluticasone (Advair) and formoterol and budesonide (Symbicort) are examples of
combination inhalers.

Oral steroids

For people who have a moderate or severe acute exacerbation, short courses (for
example, five days) of oral corticosteroids prevent further worsening of COPD.
However, long-term use of these medications can have serious side effects, such as
weight gain, diabetes, osteoporosis, cataracts and an increased risk of infection.

Phosphodiesterase-4 inhibitors

A new type of medication approved for people with severe COPD and symptoms of
chronic bronchitis is roflumilast (Daliresp), a phosphodiesterase-4 inhibitor. This drug
decreases airway inflammation and relaxes the airways. Common side effects include
diarrhea and weight loss.

Theophylline

This very inexpensive medication may help improve breathing and prevent
exacerbations. Side effects may include nausea, headache, fast heartbeat and tremor.
Side effects are dose related, and low doses are recommended.

Antibiotics

Respiratory infections, such as acute bronchitis, pneumonia and influenza, can

aggravate COPD symptoms. Antibiotics help treat acute exacerbations, but they aren't
generally recommended for prevention. However, a recent study shows that the
antibiotic azithromycin prevents exacerbations, but it isn't clear whether this is due to its
antibiotic effect or its anti-inflammatory properties.
Lung therapies

Doctors often use these additional therapies for people with moderate or severe COPD:

 Oxygen therapy. If there isn't enough oxygen in your blood, you may need
supplemental oxygen. There are several devices to deliver oxygen to your lungs,
including lightweight, portable units that you can take with you to run errands and
get around town.

Some people with COPD use oxygen only during activities or while sleeping.
Others use oxygen all the time. Oxygen therapy can improve quality of life and is
the only COPD therapy proven to extend life. Talk to your doctor about your needs
and options.

 Pulmonary rehabilitation program. These programs generally combine

education, exercise training, nutrition advice and counseling. You'll work with a
variety of specialists, who can tailor your rehabilitation program to meet your
needs.

Pulmonary rehabilitation may shorten hospitalizations, increase your ability to

participate in everyday activities and improve your quality of life. Talk to your
doctor about referral to a program.

Managing exacerbations

Even with ongoing treatment, you may experience times when symptoms become
worse for days or weeks. This is called an acute exacerbation, and it may lead to lung
failure if you don't receive prompt treatment.

Exacerbations may be caused by a respiratory infection, air pollution or other triggers of

inflammation. Whatever the cause, it's important to seek prompt medical help if you
notice a sustained increase in coughing, a change in your mucus or if you have a harder
time breathing.

When exacerbations occur, you may need additional medications (such as antibiotics,
steroids or both), supplemental oxygen or treatment in the hospital. Once symptoms
improve, your doctor will talk with you about measures to prevent future exacerbations,
such as quitting smoking, taking inhaled steroids, long-acting bronchodilators or other
medications, getting your annual flu vaccine, and avoiding air pollution whenever
possible.

Surgery

Surgery is an option for some people with some forms of severe emphysema who aren't
helped sufficiently by medications alone. Surgical options include:

 Lung volume reduction surgery. In this surgery, your surgeon removes small
wedges of damaged lung tissue from the upper lungs. This creates extra space in
your chest cavity so that the remaining healthier lung tissue can expand and the
diaphragm can work more efficiently. In some people, this surgery can improve
quality of life and prolong survival.

 Lung transplant. Lung transplantation may be an option for certain people who
meet specific criteria. Transplantation can improve your ability to breathe and to be
active. However, it's a major operation that has significant risks, such as organ
rejection, and it's necessary to take lifelong immune-suppressing medications.

 Bullectomy. Large air spaces (bullae) form in the lungs when the walls of the air
sacs are destroyed. These bullae can become very large and cause breathing
problems. In a bullectomy, doctors remove bullae from the lungs to help improve
air flow.