This is an article by a patient. I may talk about asthma myself at a later date.

Is this a nightmare; crossing the border? (Apologies to W H Auden)

What have I got?

Your doctor may tell you that your asthma has developed into COPD (Chronic Obstructive Pulmonary Disease). You ask him what that means and he finds it difficult to explain precisely. "Well", he says, "It’s a chronic condition of what you've already got…..".

"Does it mean my wheezes will never go away", I ask? "Oh, not necessarily. It's just that your lungs have become damaged over the years and are now more likely to give problems if you have an infection"

Question : Crossing the border - when does Asthma really become COPD? 

COPD is a comparatively recently invented medical term that came from America, a catch-all phrase used to describe a multitude of chest disease conditions, of which asthma is but one. emphysema and chronic bronchitis are others.  Ignore the medical semantics; in this case the word to take on board is 'chronic' – the bottom line from this term means that :

a) whatever your condition, you are going to have to live with it permanently. This does not necessarily mean your wheezing is continuous; you may well feel fine in between exacerbations.

b) it might get steadily worse as time goes on, but the process can be slowed down.

c) forget asking your doctor how long you have got – he cannot tell and neither can you. It will depend greatly on how many exacerbations and complications you have along the road – the fewer the better. How long is a piece of string? It is no more a death sentence than is old age. I am 83 and have had asthma since I was 18 and probably COPD for nearly twelve years.

d) there are many things you can do and take to help you cope with the problems it brings.

e) a positive attitude and keeping as fit as possible within one’s limitations will help improve your lifetime expectancy.

The point at which your doctor may decide to tell you that you have COPD depends on his medical judgement and also on that of any specialist you may have seen. In other words, there is no hard and fast borderline; but it seems to be less of a variable feast than it used to be. Interestingly, the NHS has now issued a different set of treatment guidelines for those with Asthma and those with COPD.

Interviewing several doctors and a specialist on the 'dividing line' issue, showed general agreement that lung damage is the key factor. If asthmatics have periodic attacks and recover without subsequent damage, they would not be described as having COPD. If they do have damage and the lungs recover from that, they are coming in and out of a COPD condition. An asthmatic may recover from an attack and sustain permanent damage - but although now classified as having COPD, can feel perfectly normal between attacks. X-rays are crucial to the decision.

For me it became a firm ruling when I told my GP that the Ventolin inhaler no longer provided relief. There is a simple spirometer test used to detect this – you blow into a machine which records your rapid exhaling performance and, as expected, the result is worse than the norm. Then you take a reliever spray and try again. If the performance is no better after that, the word COPD may definitely be applied.

Eventually my own was classed as 'severe', but only when, a few years on, it became apparent that the nebuliser no longer helped either. For others the term may be applied earlier or hopefully later, depending on the nature of the problem.

Conclusion

Crossing the border is definitely not a nightmare. You have asthma and may end up with a COPD version of the same thing. Personally I regarded it as just another minor point along the road at which adjustments were needed; living sensibly within my current physical abilities. Between exacerbations I mow the lawn (OK, slowly), trim the hedges (OK, bit by bit), saw logs (OK, small ones), open the new jam pot lids (even big ones!) and carry the shopping. With luck, good sense and skill, my GP says I still have a considerable number of miles on the clock available. I may as well try and make the rest of my journey as helpful to others as I can and, for myself, seek not to indulge in too many misery-making noises. From time to time it could be a tough ride, so I have to try and be tough too. 

DAVID (SURNAME PREFERED NOT GIVEN)

You may contact DAVID through me (John Kirtley!) and then it will be up to him whether he replies or not. This is his article not mine.

My name is Stephen G ( aka  " baycitywalker" or "breathinstephen"),

      I'm 52 years old and live in San Francisco, California, USA  . I'm also a retired Respiratory Therapist  , so please excuse me if the medical descriptions I use seem too technical.

          I was first diagnosed with asthma at the age of two months and have lived with the disease continuously, ever since.  After a lifetime of frequent and often severe exacerbations, my lungs have gradually undergone extensive remodelling, in many ways resembling those of a person with moderate to severe COPD ( FEV1 36%).     

  I receive all of my medical care at the clinical airway research centre at UCSF medical centre in San Francisco.   I am currently labelled a   "Severe Persistent, Type II brittle Asthmatic".  Fancy title, but all it means, is that I have continuous symptoms with a tendency to become really sick... really fast!

 I have what is known as   "FIXED ASTHMA" .

There are actually two components to my lung disease, asthma and COPD.

 The asthma component:   I have super sensitive airways .When they get irritated, they start narrowing and spasming, eventually they narrow so much that I can't breathe. This is called bronchiolitis . These attacks usually comes on fast , sometimes in just a matter of minutes, and sometimes without warning. The good thing is that it usually reverses if treated quickly with medication (bronchodilators), but NOT ALWAYS.

 The COPD  ( chromic obstructive pulmonary disease ) component arises  because I’ve had asthma  for so long, the little air sacks ( alveoli) and the tiny airways that supply them,  have lost most of their elasticity.  They no longer function the way they were designed. Much like a person with emphysema, I'm unable to empty my lungs the way a normal person can. My lungs constantly fluctuate between a state of mild hyperinflation (my green zone), to a state of severe hyperinflation (my yellow zone), and sometimes a combination of both severe hyperinflation AND bronchospasm (my red zone).    Most of the medications I take , prevent the asthma component from occurring, but there's not much that can be done about the elasticity (COPD ) problem. The damage is permanent, and only gets worse.

       When I'm having mild to moderate shortness of breath (my yellow zone), its usually related to the COPD aspect of my disease.    If I attempt to walk or exercise when I'm hyper inflated, it's not so much the distance, as it is the intensity that makes things worse.    The more intense the workout, the more exertion required. The more exertion required, the faster I have to breathe. The faster I have to breathe, the more my lungs hyper inflate. The more l hyper inflate, well, you get the idea!  Eventually, I can get so hyper inflated, that there is literally no room to take another breath. The pressure in my chest can get so high, that it compresses the blood vessels that supply that heart and lungs themselves. I have actually blacked out because of this phenomenon.

       While there are many similarities between my “fixed asthma" and that of full blown Emphysema , there are also major differences. In my case for example , my diffusion studies are normal, I don't require supplemental O2 unless I'm sick,  my airways still have some degree of reversibility, and I still have a significant number of "good breathing days".

      Anyway, by the year 2004, I was spending more time as a patient in the hospital , than I was as an employee.  Eventually, I was forced to give up my 27 year position as a Respiratory Therapist and applied for long term disability. On 8-1-2005 , I was found to be  "permanently disabled" by  the Social Security Administration .

      As soon as the reality set in, that I would no longer be able to work ( at least not on a full time basis) , I decided that instead of laying around the house , getting fat and feeling sorry for myself , that I would  try to develop a pulmonary rehab program for myself.  I figured at the very least, it would give me something to occupy my time.   I had often preached to my patients about the importance of exercise, but now I was about to see if it really worked.

      After looking at various sports .ie cycling, swimming, tennis  I decided to take up fitness walking. What easier to do than walk, right?   Well, it wasn't as easy as I thought it would be.  I was only 49 years old, but I was in terrible shape. I had very little endurance and got winded very easily.

      Too make a very long story short, I started by walking just a few blocks at a time, and then very gradually increased the distance.

      Within a few months, I was walking several miles a day.  I eventually got bored of the same old routine, so I decided to set some goals for myself. My very first goal was to walk a half marathon. 12 months later.... I  did.

      Finishing that first race gave me the confidence to tackle even greater challenges. I signed up with various walking clubs and organizations in hopes of improving my walking skills and my speed, and in October 2006 , I finished my first full marathon . In the past 2 years, I have accomplished what most of my doctors said would be in possible .Now I am sometimes labelled a medical oddity by the medical establishment, because they can't figure out how I do it.

        I went from walking 2 blocks, to walking 26 miles!  Not once ....but TWICE! .

       My next race will be the Portland Marathon in PortlandOregon , and I was recently invited to walk   the Rome marathon, in RomeItaly, in March of 2008.

      I want to stress, that I while I may seem to make endurance walking look easy,  It's not!,  and it didn't come easy for me. There we're a lot of bumps along the way.  I train very hard, AND I have an incredibly high tolerance for breathing discomfort.   It took me TWO years to build the endurance I needed to finish my first full marathon.  During that time, I had still had my share of exacerbations which made an exercise schedule very difficult to maintain.  On many occasions I was so SOB that it was a real struggle to finish a walk, and on many days, I was too sick to walk at all.  After a hospitalization, it would take me weeks to regain the progress I had made in the preceding months.  It's like starting from scratch. It very frustrating, But I keep at it.

      What I'm try to say, is that you have to keep on trying.  If you're having a bad breathing day, you cut back a little and resume when you're feeling better.  BUT YOU NEVER GIVE UP!

  Whether you have asthma, emphysema, chronic bronchitis...   the important thing is that you maintain some sort daily exercise program. You don't have to walk marathons, but you need to do something.

      Good luck and I wish you always.....easy breathing!

      Stephen G  aka   BreathinStephen

      www.Baycitywalker.blogspot.com