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Monday, December 6, 2021
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    The mysterious mechanics of COPD


    Dear Dr. Roach: I have COPD, and my doctor explains that the trouble is that my lungs do not expel the full amount of the breath I take in. This prevents the full oxygen intake from my breath. My question is, Do commercial oxygen generators serve any purpose if the full amount of oxygen supplied by them cannot fully enter the lungs?

    J.H.

    Dear J.H.: Chronic obstructive pulmonary disease (COPD) is a complex condition that can be caused several different ways, and the explanation of how people with COPD become breathless is complicated. Part of it is what your doctor said, that there is obstruction to breathing, and particularly when expelling air, the airways can collapse from loss of stiffness. No matter how hard someone tries to blow, the air is slow to come out, and eventually, the person needs to breathe in again. This leads to hyperexpanded lungs and the “barrel chest” that many people with COPD will develop.

    Damage to the deepest part of the lungs, the alveoli, is another part of COPD, particularly in those with emphysema. In this case, gas exchange (oxygen in and carbon dioxide out) is impaired because there is inadequate lung surface area. People with more advanced COPD will often have low oxygen and high carbon dioxide levels in the blood.

    Supplemental oxygen helps, but it doesn’t completely solve the problem in either case. For those who have a low oxygen level (89% or lower breathing room air), supplemental oxygen improves both symptoms and life expectancy. The oxygen does diffuse into the lung when breathed regularly and almost always can correct the oxygen deficiency of COPD to at least 90%. Oxygen does nothing for the obstruction component, and does not lower the level of CO2 in the blood.

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