Smoking is the biggest risk factor for COPD. About a quarter of all smokers will ultimately develop the disease. COPD can be caused by the following: Smoking Second hand smoking Environmental irritants Pollution Poor ventilated home Poorly treated previous infections Multiple viral infections

The diagnosis of COPD is most often based off of symptoms, spirometry, lab work and imaging.  Spirometry is a measurement of how deeply you breathe and the amount of air you can force out of your lungs after one second. Spirometry A spirometer reading is most often used to identify COPD.  It involves breathing into a tube attached to a device that measures the amount of air expired on forced expiration in 1 second (FEV1), the total amount of air expired (FEV), and the total lung capacity (FVC). This may be abnormal even when there are few symptoms of the disease. In COPD you will see FEV 1:FVC ratio of less than <0.7 FEV1 less than <80% Chest X-ray Sometimes a chest x-ray can be used to make the diagnosis of COPD.  This will show hyperinflated lungs and an increase in the darkness of the lungs due to the increase in the size of the alveoli. Lab work In many cases there will be an increase of red blood cells Decreased oxygen entering the blood stream means more red blood cells are produced to carry the oxygen that is entering. Sputum culture to detect inflammation and/or infection ABG (arterial blood gas) To detect the ratio of oxygen versus carbon dioxide in the blood Stages of COPD according to American Thoracic Society Stage 1:

The best treatment for COPD is to stop smoking and/or avoid exposures. Medications help with symptoms, but avoiding exposure to offending agents like smoke and toxic chemicals at work are need to prevent further lung damage. Inhaled Anticholinergics Atrovent, Spiriva, etc Typically the medication most patients start with, will be given in an inhaler and taken daily Helps to reduce inflammation and improve shortness of breath Bronchodilators Bronchodilators are often started is anticholinergic medications are not enough Are inhalers containing beta adrenergic blockers (such as albuterol) that can be used for acute exacerbations of the disease as well as maintenance. Used to open the airways in the lungs Short acting used for rescue (taken only when having extreme difficulty breathing) Albuterol Long acting used for maintenance (will be taken daily) Salmeterol, formoterol, etc Inhaled Corticosteroids can be given to reduce inflammation of the airways. Flovent, Beclovent, Pulmicort, etc Reduced inflammation improves airflow and oxygen exchange Inhaled steroids are not typically used until the patient is more advanced in the disease Inhaled steroids in combo with bronchodilators are often needed later in the disease Oral steroids Prednisone In severe cases, oral corticosteroids can be used for short periods of times. Oral steroids have many side effects, which is why they are not typically given for long periods of time Side effects Weight gain Abnormal hair growth Is important not to stop oral steroids abruptly if have been on them for more than 10 days.

Introduction to Diabetes Diabetes is a collection of metabolic disorders that result in high amounts of sugar in the blood.  Elevated blood sugar is known as hyperglycemia and is the key element in the diagnosis of Diabetes. The main forms of diabetes include type 1, type 2, and gestational. Some forms of diabetes can be cured or prevented with lifestyle changes such as early stage type 2, while others are chronic such as type 1. Diabetes occurs either due to lack of insulin being produced by the pancreas or lack of the body’s response to insulin. Glucose, which is a form of sugar that is used as energy by the body, cannot enter the cell without insulin. Thus when insulin is not being used or produced properly the sugar stays in the blood stream causing high blood sugar. Chronic elevations in blood sugar over time lead to complications in the vascular systems of the kidneys, heart, eye, feet, nerves, and significantly increases risk for heart disease and stroke. Metabolic disorder: A condition that occurs due to a dysfunction in one or many of the pathways that control metabolism. Metabolic pathways control the ways in which the body produces energy and eliminates waste.

Type I Diabetes Type I Diabetes is much less common than type II, accounting for only 5-10% of diabetes cases. Diabetes type 1 is typically diagnosed before the age of 30. Type I Diabetes is an autoimmune disease in which the beta cells (insulin producing cells) located in the pancreas are destroyed over a period of time. The more beta cells are destroyed the less insulin that can be made. This results in a lifelong deficiency of insulin and dependency on insulin from external sources. Autoimmune refers to a condition in which the body mistakes its own cells (the beta cells) for invader cells and destroys them. While the exact cause is unknown, the autoimmune process is thought to be the result of genetic predisposition and an environmental trigger. This event sets off a chain reaction that causes the B cells of the immune system to creates proteins called antibodies that mark the beta cells and signal for their destruction by other parts of the immune response team. The CD4 and CD8T Cells are the soldiers who sniff out and destroy the tagged beta cells Progression of Type I Diabetes Pre-Diabetes: The hallmark of pre-diabetes is the presence of GAD, ICA, IAA antibodies. In addition there will be evidence of beta cell injury and a decrease in the amount of insulin being produced.