Pretend it is your birthday and there is a beautifully decorated cake in front of you with candles lit and glowing. Friends and family gather around to root as you take the deepest breath you can to blow them all out. This act of blowing out birthday candles actually represents a real maneuver that is used to measure lung function.

When a patient takes a deep breath and blows as hard and fast as he or she can into a machine called a Spirometer, the machine measures the volume of air exhaled within the first second. It can also measure the entire volume of air exhaled until that point where you think you have blown out every last drop of breath you have and you gasp for the next breath. The first measurement is known as FEV1, or Forced Expiratory Volume in 1 Second and the second measurement is FVC, or Forced Vital Capacity.

These measurements are extremely important if you are a patient suffering from a condition commonly known as COPD, or chronic obstructive lung (pulmonary) disease. We know how much air a normal, healthy pair of lungs can hold and how much these healthy lungs can exhale in one second. Since we know that, we can rate the degree of impairment for someone with COPD. For example, a patient with an FEV1 of 30 percent of that predicted for a normal patient would have a more serious case of COPD than another patient whose FEV1 was 75 percent of predicted.

The take-home message really should be the fact that people with chronic lung disease suffer from obstructed airflow that leaves them in various degrees of breathlessness. Cigarette smoking, undoubtedly, is the No. 1 culprit responsible for this situation. Inhaled cigarette smoke (even second-hand smoke to a certain extent) initiates a cascade of inflammatory events that involves macrophages, neutrophils, nuclear factor-B, interleukin-8, tumor necrosis factor-alpha, elastase/antielastase imbalance, proteinase mucus stimulants ... need I say more? The net result is a vicious cycle of inflammation in which the bronchial walls thicken narrowing the airways. Blowing out birthday candles just isn’t fun anymore.

Fortunately, there are some very good medicines that are delivered directly to the lungs via inhalers. But again, wouldn’t it be better to stop the process before it even begins?

If you smoke, do whatever you can to stop. It’s never too late to quit. If you have never smoked, why start? COPD is the fourth leading cause of death in the United States with related health care costs estimated to be about $23 billion a year. I know we will never eradicate death; but maybe we could eradicate COPD as one of the causes.


Agnes Oblas is a nurse practitioner with a private practice and residence in Ahwatukee Foothills. For questions, or if there is a topic you would like addressed, call her at (602) 405-6320 or e-mail Her Web site is

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