“Some tips on things you can do post thanksgiving with your Turkey:

• Remember the Two-Hour Rule: Refrigerate perishable items within two hours of coming out of the oven or refrigerator. After two hours, perishable food enters the “Danger Zone” (between 40 F and 140 F), where bacteria can multiply quickly and cause food to become unsafe. Perishable food should be discarded if left out for longer than two hours, so refrigerate or freeze items to prevent food waste.
• Use Shallow Containers: After you break down your Thanksgiving meal into smaller portions, store leftover food in shallow containers in the refrigerator until the Monday after Thanksgiving, or in the freezer for later use.
• Freeze or Consume Within Four Days: Use the Monday after Thanksgiving as a reminder that it is the last day you can safely eat leftovers. If you want to keep leftovers longer, freeze them within that four-day period. Frozen food stays safe indefinitely, though the quality may decrease over time (best quality if eaten within six months).
• Reheat to 165 F: Make sure your reheated leftovers reach 165 F as measured with a food thermometer. Reheat sauces, soups and gravies safely by bringing them to a rolling boil.
• Microwave Food Safely: When reheating in the microwave, cover and rotate the food for even heating. Arrange food items evenly in a covered microwave safe glass or ceramic dish and add some liquid, if needed. Because microwaves have cold spots, check the internal temperature of the food in several places with a food thermometer after allowing a resting time.”

USDA (https://www.usda.gov/media/blog/2021/11/22/leftovers-lets-keep-best-part-thanksgiving-safe)

The NY post 2018 states, “The fascinating new statistic emerged in a new survey of 2,000 Americans around all things concerning Thanksgiving, which also crowned ham (60 percent), chicken (41 percent) and roast beef (37 percent) as the most popular alternatives to turkey.

The new study, conducted by Omaha Steaks, also revealed nearly half (44 percent) of Thanksgiving hosts will be serving a new main dish this year.

Thanksgiving is a delicate occasion that expects near perfection all across the board or else you risk ending up with hungry and unhappy guests.

Unfortunately, according to the study, the average Thanksgiving dinner only goes 64 percent as planned.

So what usually goes wrong? The biggest “Thanksgiving fail” is not having all the food cooked on time — with 41 percent of Americans saying they’ve been left hungry and waiting at dinner.”

Well check out about White Meat vs. Red Meat

White Meat

White meat is best known as meat that is lean, especially in comparison with red meat. The big point about white meat is that its fat content is less in comparison with red meat. Meats traditionally thought of as white (such as veal and even lamb) have been reclassified as red meats. Another advantage to eating white meat over red meat, which is also why health experts recommend it over red meat, is the lower number of calories that it contains. However, the difference in calories between white meat and red meat is not so great that it will absolutely ruin your waistline if you choose to eat some red meat once in a while.

Red Meat

Red meat is the victim of stereotypes that have been exaggerated to the point where it is today somewhat stigmatized as a food that is linked to cancer and higher fat and caloric content. While the cancer issue depends on what studies you look at and the higher caloric content is not that much over white meat, red meat does have benefits that white meat simply lacks. For example, the nutrients zinc, iron, thiamine and riboflavin (in addition to vitamins B12 and B6) appear in much greater abundance in red meat. Moreover, red meat is a great source of muscle-building protein as well as being the best source of the antioxidant called alpha lipoic acid. Still, red meat has been the subject of a lot of studies that connect it to health problems beyond cancer, like cardiovascular disease and even arthritis and hypertension.

Which One to Choose

The bottom line is that no matter which meat you eat, you can guard yourself against health problems if you eat in moderation. While white meat is not tied to as many health problems as red meat is, it does not feature many of the benefits that you get in red meat, such as the vitamins and minerals. So if you want to get a dose of said nutrients, you should eat more red meat, but do so in a way that is only moderate

HERE IS SOME FACTS ABOUT TURKEY

Because most cuts of turkey provide valuable amounts of protein, turkey is often regarded as a high-protein food. Skinned turkey breast will provide the most protein per serving, at 34 grams in 4 ounces. But you will still get 31 grams from 4 ounces of turkey leg and 21 grams from 4 ounces of turkey thigh.

In addition to protein, however, turkey is also rich in other nutrients. All B vitamins are present in turkey meat, including B1, B2, B3, B5, B6, B12, folate, biotin, and choline. (Because the biotin content of turkey meat is sensitive to the turkey’s dietary intake, the amount of this vitamin can vary greatly, with an approximate average of 0.8 micrograms in 4 ounces of turkey breast.) Turkey is a very good source for vitamin B3 and provides about 8.5 milligram in 4 ounces, or over 40% of the Daily Value (DV). It’s also a very good source of vitamin B6, at 0.64 milligrams in 4 ounces (32% DV). By providing 22%DV for choline in 4 ounces, turkey also ranks as a good source of this B vitamin.

In terms of minerals, turkey is richest in selenium and provides over 50% of the DV in a single 4-ounce serving. Zinc, copper, phosphorus, magnesium, potassium, and iron are also provided by this food in amounts varying from 5-15% DV.

All cuts of turkey contain omega-3 fats. However, the content of omega-3s in turkey can vary widely, depending on the turkey’s diet. One of the reasons we recommend pasture-raised turkey is the ability of turkeys to enjoy omega-3 containing plants and insects in natural pasture settings. As a general rule, the most favorable ratio of omega-6 to omega-3 fats is found in skinned turkey breast, where the ratio in non-pasture-raised turkey is approximately 10:1. This same ratio is about 13:1 in non-pasture-raised turkey leg or turkey thigh with skin. While there are only a few studies documenting the omega-6 to omega-3 ratio in pasture-raised turkey, those studies suggest that pasture feeding can lower the ratio to approximately 7:1. (There are some studies on pasture-raised chickens that show similar results.) Within the omega-3 family of fats, it is possible to get 10-60 milligrams of DHA (docosahexaenoic acid) from a 4-ounce serving of turkey, depending on the cut and diet consumed by the turkey. DHA is a unique omega-3 fat in terms of its ability to support healthy nerve function.

Protein Richness

When we rank all of our 100+ WHFoods based on their protein richness (how much protein they provide in comparison with their calorie content), turkey ranks first among all of our foods. A 4-ounce serving of skinned baked turkey breast provides about 34 grams of protein and over two-thirds of the Daily Value (DV). With 4 ounces of turkey leg, this number drops just slightly to 31-32 grams of protein. With 4 ounces of turkey thigh, it drops to about 21 grams. In these examples, the protein values are changing from cut-to-cut partly because of the way the turkey moves and uses its muscles, and partly because of the fat content of the various cuts. If the health benefit you are seeking from turkey is focused on protein richness, you’ll probably want to stick with skinned turkey breast as your preferred cut.

 Other Health Benefits

Unfortunately, there is not as much research on turkey as there is on chicken, its fellow bird in the poultry category. Several preliminary studies show the protein richness of turkey to be of potential benefit in regulating blood sugar levels as well as insulin metabolism. These findings make sense since adequate protein intake in a balanced way throughout the day can be very helpful in managing blood sugar. In the area of cancer prevention, turkey shows that intake of it is not associated with increased cancer risk in the same way as red meats. However,they simply show that turkey intake does not raise this risk which is still a plus compared to some other foods.

Description

Like chicken, turkey belongs to the bird (Aves) class of animals, and to the family of birds called Phasianidae. While there are many different breeds of turkeys, most of them belong to the same genus and species of bird, namely Meleagris gallopavo. Turkeys are truly native to North and South America – they were not brought to the “New World” by European settlers but were instead discovered to be already present and intimately involved with Native American cultures. Turkeys are relatively large birds that can reach about 30-35 pounds in weight. They can fly short distances at speeds of about 50-55 miles per hour and run at approximately 20-25 miles per hour.

History

At 2.5 million tons of turkey meat per year, the U.S. is by far the world’s largest producer of turkey. (All countries in the European Union combined produce 1.75 million tons.) Smaller amounts of turkey are produced in Africa, Asia, and the Mediterranean. At about 450,000 tons, Brazil is the largest turkey producer in South America.

In the U.S., we consume an average of 16.5 pounds of turkey per person per year. That about is about one-quarter of our chicken consumption.

According to the National Turkey Federation, about 20% of all turkey (just over three pounds per person) is consumed on Thanksgiving Day, Gobble Gobble Day.

How to Select and Store

It’s worth taking special care in the selection of turkey! Several aspects of turkey selection will help you maximize your health benefits from this World’s Healthiest Food. First, we recommend the purchase of fresh turkey. Technically, the U.S. Department of Agriculture (USDA) guidelines allow use of the word “fresh” only when turkey has never been stored a temperature below 26°F (-3°C). (Otherwise, the term “frozen” or “previously frozen” would be required.) Additives like sodium erythorbate, MSG, and salt are not allowed on fresh turkey, and that’s a major health advantage for you.

“While Thanksgiving can be the perfect time for gathering around the table, this beloved American tradition can also play havoc with your heart health. Here are heart health habits to incorporate into your holiday tradition.

1. Downsize Your Plate

Be mindful of portions, try using a smaller plate so it appears full, and avoid heading over to Thanksgiving dinner on a completely empty stomach. To fill up a little, eat a high-protein snack, such as nonfat yogurt.

2. Stay Hydrated

Because the same part of your brain (the hypothalamus) is responsible for interpreting both hunger and thirst signals, mixed messages often lead us to believe we are craving food when all our body really wants, is fluids. Drinking a cup or two of water about a half-hour before your Thanksgiving meal can help you to feel full without overeating, aid in digestion and help your heart to work more efficiently.

3. Keep Stress in Check

Chronic stress is associated with an increased risk of heart attacks and stroke and that feeling of, “I can’t get it all done,” can really take a toll.

• Avoid over-committing. Prioritize yourself and make an investment in your physical and mental health.
• Take some downtime and head outdoors. Research suggests that a 10-minute walk may be just as good as a 45-minute workout in relieving anxiety symptoms.
•  Try to get enough rest and a good night’s ZZZs.

4. Ready, Set, Move

In addition to relieving anxiety, exercise not only lowers levels of a hormone (ghrelin) that stimulates appetite and raises levels of a hormone (peptide YY) that suppresses appetite, it also boosts your ‘good’ cholesterol, lowers your blood pressure, keeps your weight down and is a kind of one-stop-shopping for your overall well-being. During the holidays — and, in fact, all year round — aim for 30 minutes a day of brisk movement at least five days a week. Spread out the 30 minutes into more bite-sized 10-minute chunks and still reap the benefits. Be sure to talk with your doctor first if you are starting a new exercise program.

5. “Holiday Heart”

Alcohol can affect your heart health. Drinking too much and/or too quickly can result in an irregular heartbeat. Moderation is key. Binge drinking can produce disturbances in cardiac rhythm, even in people without underlying heart disease. Anyone can be at risk for “holiday heart syndrome,” a term that is applied to an irregular heart rhythm called atrial fibrillation, which is commonly triggered by excessive alcohol intake.”

Stony Brook Heart Institute (https://heart.stonybrookmedicine.edu/Thanksgiving)

It’s the holiday season—cardiac patients not careful in eating but indulging in junk food may put you at high risk for a bomb to go off in the heart=heart attack.

While colder weather may play a role, studies have shown that the spike in heart events during the holiday season occurs even in It’s no secret that holiday celebrations offer many temptations to overindulge. Many holiday foods are high in saturated fats or sodium. Overindulgence in these foods can increase cholesterol levels or blood pressure, making it more difficult for blood to flow through arteries and upping the chance of a blockage. What you may not know is that eating a heavy holiday meal may affect you even after you’ve pushed away from the table. “Research shows that anyone with coronary-artery disease or high cholesterol has a heightened risk for heart attack for up to one day after eating a heavy meal,” said Mittleman. Mittleman participated in a study, “Heavy Meals May Trigger Heart Attacks,” led by Francisco Lopez-Jimenez, MD, currently the Director of the Cardio-metabolic Program at the Mayo Clinic. This study, which focused on nearly 2,000 former heart attack patients, found that 10 percent of them suffered a coronary within 26 hours of eating a heavy meal.

“People often change their eating habits during the holidays,” said Dr. Anne Riley, a cardiologist at BIDMC. “For those with congestive heart failure [CHF], salty foods can cause fluid retention and high blood pressure, which place added stress on an already weakened heart.”

Your heart may leap with delight on the couch after Thanksgiving or at the electronic gizmo or emerald bracelet that you’ve just unwrapped from under the Christmas tree. But you can’t say the same for that nasty holiday surprise known as the “Happy Thanksgining” or “Merry Christmas coronary” or “Happy Hanukkah heart attack.”

For many years, researchers have been intrigued by a disturbing pattern: Deadly heart attacks increase during the winter holiday season. One study even found distinct spikes around Christmas and New Year’s Day.

Recommended Related to Heart Health

Read Amazing Facts About Heart Health and Heart Disease:

You can feel your heart thudding away every time you put your hand to your chest, but do you have any idea what’s really going on in there or what keeps your heart ticking as it should? WebMD the Magazine asked Richard Krasuski, MD, director of Adult Congenital Heart Disease Services and a staff cardiologist at the Cleveland Clinic, to help explain some amazing and little-known facts about the human heart.

“We certainly know that there are certain risk factors for coronary artery disease. There’s obviously smoking, hypertension, dyslipidemia [high cholesterol], diabetes, lack of exercise, and age,” says Robert A. Kloner, MD, PhD, a researcher at Good Samaritan Hospital in Los Angeles and a professor at the Keck School of Medicine at the University of Southern California.

“But we’re also learning that there are certain triggers for cardiovascular events,” he adds, “including time of the year and seasons. If we can get a true handle on the seasonal variation, we could knock down death from coronary disease.”

Coronary artery disease stems from atherosclerosis, a condition in which fatty plaques narrow the arteries to the heart. When a plaque ruptures, it can trigger a blood clot that leads to a heart attack.

In a national 2004 study published in Circulation, researchers at the University of California, San Diego, and Tufts University School of Medicine examined 53 million U.S. death certificates from 1973 to 2001. They discovered an overall increase of 5% more heart-related deaths during the holiday season. When researchers looked at individual years, they found varying increases in cardiac deaths for every holiday period they studied, except two.

Doctors have long known that cold weather is hard on the heart. Blood vessels constrict, which raises blood pressure. Blood also clots more readily. Frigid temperatures increase strain on the heart, and too much physical exertion can worsen the burden and trigger a heart attack. For example, doctors have treated many patients whose heart attacks followed strenuous snow shoveling.

Not to put a damper on holiday frivolity, but heart attacks increase during winter. For one reason, cold weather is tough on the heart. Blood vessels constrict, which causes blood pressure to rise. Additionally, blood clots more easily. (I’m getting this info, by the way, from the boldface link a sentence or two ago).

“People tend to consume much more fat, salt, sugar, and alcohol during the holiday season,”.   “Also, people tend to be less active due to the cooler weather. Overindulgence of food and alcohol along with inactivity raises the blood pressure and cholesterol levels. These risk factors combined increase your chances of having congestive heart failure, a stroke, or even a heart attack.” says Roberto Wayhs, MD, chief of cardiology at Methodist Charlton Medical Center.

To put a stop to that, or at least decrease your chances, he offers these tips:

Limit foods and beverages that are salty and/or rich. Blood pressure tends to go up the more salt you intake. Rich and sugary foods raise blood sugar levels.

Be consistent in taking your daily medications. You need them at all times of the year to maintain good health.

Get enough sleep. Sleep loss is related to weight gain, which also can affect the heart. Aim for at least seven hours.

Control your stress. “Holiday sadness adds stress,” Wayhs says. “Don’t be afraid to seek professional help if you need it.”

Limit alcohol intake.  “High alcohol intake has been linked to irregular and rapid heartbeats (atrial fibrillation) and congestive heart failure,” says Dr. Wayhs.

Maintain your normal exercise routine. “Don’t place your healthy habits on the back burner,” he says.

If you don’t have time for your usual workouts, try a shorter one.

Oh and, of course, stop smoking. But you knew that already.

“This is a great opportunity to come up with mindful strategies on how to avoid the overindulgence of those oh-so-good but oh-so-unhealthy foods. While it is important to enjoy ourselves and our families, it doesn’t have to mean we throw away all of our good habits.  One of the best strategies to prepare for the holiday feast is to get moving before your big meal. While you might think it makes sense to save up calories for the big meal, experts say eating a small meal in the morning can give you more control over your appetite. Start your day with a small but satisfying breakfast — such as an egg with a slice of whole-wheat toast, or a bowl of whole-grain cereal with low-fat milk — so you won’t be starving when you arrive at the gathering.  Whether you are hosting Thanksgiving dinner or bringing a few dishes to share, make your recipes healthier with less fat, sugar, and calories. There is more sugar and fat in most recipes than is needed, and no one will notice the difference if you skim calories by using lower calorie ingredients.

• Use fat-free chicken broth to baste the turkey and make gravy.
• Use sugar substitutes in place of sugar and/or fruit purees instead of oil in baked goods.
• Reduce oil and butter wherever you can.
• Try plain yogurt or fat-free sour cream in creamy dips, mashed potatoes, and casseroles.

Try to resist the temptation to go back for second helpings. Leftovers are much better the next day, and if you limit yourself to one plate, you are less likely to overeat and have more room for a delectable dessert.

Slowly savor and eat slowly on one plateful and no refills to have a nice healthy desert.

Remember, Thanksgiving is not just about the delicious bounty of food. It’s a time to celebrate relationships with family and friends.”

Texas Southern University (https://hr.tsu.edu/tips-for-having-a-healthy-thanksgiving/)

“Often COPD can be hard to diagnose because symptoms can be the same as those of other lung conditions. Many people who have COPD may not be diagnosed until the disease is advanced.  There are tests a GP or pulmonologist can order. Treatment is based on how severe your symptoms are and whether you often have bouts when symptoms get worse. These bouts are called exacerbations. Effective therapy can control symptoms, slow how fast the condition worsens, lower the risk of complications and improve your ability to lead an active life.

The most essential step in any treatment plan for COPD is to quit all smoking. Stopping smoking can keep COPD from getting worse and making it harder to breathe. But quitting smoking isn’t easy, especially if you’ve tried to quit and haven’t been successful.

Talk with your healthcare professional about stop-smoking programs, nicotine replacement products and medicines that might help.”

MAYO Clinic (https://www.mayoclinic.org/diseases-conditions/copd/diagnosis-treatment/drc-20353685)

If you have COPD, you may have symptoms such as:

• trouble breathing
• cough
• wheezing
• tightness in your chest

Smoking often causes COPD, but in some cases, breathing in toxins from the environment is the cause.

There’s currently no cure for COPD, and the damage to the lungs and airways is permanent.

However, several medications can help reduce inflammation and open your airways to help you breathe easier with COPD.

Short Acting Bronchodilators:

Bronchodilators help open your airways to make breathing easier. Your doctor may prescribe short-acting bronchodilators for an emergency situation or for quick relief as needed.

You take them using an inhaler or nebulizer.

Examples of short-acting bronchodilators include:

• albuterol (Proair HFA, Ventolin HFA)
• levalbuterol (Xopenex)
• ipratropium (Atrovent HFA)
• albuterol/ipratropium (Combivent Respimat)

Short-acting bronchodilators can cause side effects such as:

• dry mouth
• headache
• cough

These effects should go away over time.

Other side effects include:

• tremors (shaking)
• nervousness
• a fast heartbeat

If you have a heart condition, tell your doctor before taking a short-acting bronchodilator.

Corticosteroids:

With COPD, your airways can be inflamed, causing them to become swollen and irritated. Inflammation makes it harder to breathe.

Corticosteroids are a type of medication that reduces inflammation in the body, making air flow easier in the lungs.

Several types of corticosteroids are available. Some are inhalable and should be used every day as directed. They’re usually prescribed in combination with a long-acting COPD drug.

Other corticosteroids are injected or taken by mouth. These forms are used on a short-term basis when your COPD suddenly gets worse.

The corticosteroids that doctors most often prescribe for COPD are:

• Fluticasone (Flovent). This comes as an inhaler you use twice daily. Side effects can include headache, sore throat, voice changes, nausea, cold-like symptoms, and thrush.
• Budesonide (Pulmicort). This comes as a handheld inhaler or for use in a nebulizer. Side effects can include colds and thrush.
• Prednisolone. This comes as a pill, liquid, or shot. It’s usually given for emergency rescue treatment. Side effects can include headache, muscle weakness, upset stomach, and weight gain.

Methylxanthines:

For some people with severe COPD, the typical first-line treatments, such as fast-acting bronchodilators and corticosteroids, don’t seem to help when used on their own.

When this happens, some doctors prescribe a drug called theophylline along with a bronchodilator.

Theophylline works as an anti-inflammatory drug and relaxes the muscles in the airways. It comes as a pill or liquid you take daily.

Side effects of theophylline can include:

• nausea or vomiting
• tremors
• headache
• trouble sleeping

Long Acting Bronchodilators:

Long-acting bronchodilators are medications that are used to treat COPD over a longer period of time. They’re usually taken once or twice daily using inhalers or nebulizers.

Because these drugs work gradually to help ease breathing, they don’t act as quickly as rescue medication. They’re not meant to be used in an emergency situation.

The long-acting bronchodilators currently available are:

• aclidinium (Tudorza)
• arformoterol (Brovana)
• formoterol (Foradil, Perforomist)
• glycopyrrolate (Seebri Neohaler, Lonhala Magnair)
• indacaterol (Arcapta)
• olodaterol (Striverdi Respimat)
• revefenacin (Yupelri)
• salmeterol (Serevent)
• tiotropium (Spiriva)
• umeclidinium (Incruse Ellipta)

Side effects of long-acting bronchodilators can include:

• dry mouth
• dizziness
• tremors
• runny nose
• irritated or scratchy throat
• upset stomach

More serious side effects include:

• blurry vision
• rapid or irregular heart rate
• an allergic reaction with rash or swelling

Combination Drugs:

Several COPD drugs come as combination medications. These are mainly combinations of either two long-acting bronchodilators or an inhaled corticosteroid and a long-acting bronchodilator.

For people with COPD who experience shortness of breath or trouble breathing during exercise, the American Thoracic Society strongly recommends a long-acting beta agonist (LABA) combined with a long- acting muscarinic antagonist (LAMA).

Triple therapy, a combination of an inhaled corticosteroid and two long-acting bronchodilators, is recommended for those who continue to have shortness of breath or trouble breathing and are currently using LABA and LAMA combination therapy.

Recommended LABA/LAMA combination bronchodilator therapies include:

• aclidinium/formoterol (Duaklir)
• glycopyrrolate/formoterol (Bevespi Aerosphere)
• tiotropium/olodaterol (Stiolto Respimat)
• umeclidinium/vilanterol (Anoro Ellipta)

Combinations of an inhaled corticosteroid and a long-acting bronchodilator include:

• budesonide/formoterol (Symbicort)
• fluticasone/salmeterol (Advair)
• fluticasone/vilanterol (Breo Ellipta)

Combinations of an inhaled corticosteroid and two long-acting bronchodilators, called triple therapy, include fluticasone/vilanterol/umeclidinium (Trelegy Ellipta).

A 2018 research reviewTrusted Source found that triple therapy reduced flare-ups and improved lung function in people with advanced COPD.

According to current guidelines, the inhaled corticosteroid may be withdrawn if you have not had a flare-up in the past year.

However, it also indicated that pneumonia was more likely to develop with triple therapy than with a combination of two medications.

Antibiotics:

Regular treatment with antibiotics like azithromycin and erythromycin may help manage COPD.

Long term antibiotic therapy needs further research studies.

Cancer Medications for COPD:

Several cancer drugs could possibly help reduce inflammation and limit damage from COPD.

A 2019 study found that the drug tyrphostin AG825 helped lower inflammation levels in zebrafish.

The medication also sped up the rate of death of neutrophils, which are cells that promote inflammation, in mice with inflamed lungs similar to COPD.

Research is still limited on using tyrphostin AG825 and similar drugs for COPD and other inflammatory conditions. Eventually, they may become a treatment option for COPD.

Different types of medications treat different aspects and symptoms of COPD. Your doctor will prescribe medications that will best treat your particular condition.

Types of surgery for COPD:

Some considerations for surgery candidates include:

• You must be strong enough to have the surgery.
• You must participate in a pulmonary rehabilitation program.
• You cannot be a current smoker.

Some lung surgeries require that the lung damage must be in an area that is localized (a specific area) and can be removed. The decision for surgery is based on the results of many tests. Talk to your doctor to find out if lung surgery is right for you.

There are two types of lung surgery performed to address COPD:

• Bullectomy is a procedure where doctors remove one or more of the very large bullae or blebs from the lungs. Bullae are large air sacs that form from hundreds of destroyed alveoli. These air spaces can become so large that they crowd out the better functioning lung and interfere with breathing. For those people, removing the destroyed air sacs improves breathing.
• Lung Volume Reduction Surgery (LVRS) is a procedure to help people with severe emphysema affecting the upper lung lobes. LVRS is not a cure for COPD but can improve one’s exercise capacity and quality of life. The goal of the surgery is to reduce the size of the lungs by removing about 30 percent of the most diseased lung tissues so that the remaining healthier portion can perform better. LVRS also can allow the diaphragm to return to its normal shape, helping you breathe more efficiently. The surgery has been shown to help improve breathing ability, lung capacity and overall quality of life among those who qualify for it.

Surgery Transplantation for patients who are candidates:

Lung transplantation can prolong and dramatically improve quality of life for patients with advanced lung diseases. The Center for Advanced Lung Disease and Lung Transplantation at NewYork-Presbyterian/Columbia University Irving Medical Center is one of the oldest in the United States, having performed more than 1,300 lung and heart-lung transplants since 1988. Between 2001 and 2019, with the launch of new program leadership, they performed over 1,000 lung transplants.

Their patient survival rates are much higher than the national average — even though they treat sicker patients than most U.S. centers. We’ve also worked to expand the pool of donor lungs through innovative technologies. Over the years, they have earned a reputation for our clinical expertise and rigorous commitment to excellence.

“Chronic obstructive pulmonary disease (COPD) is characterised by poorly reversible airflow obstruction and an abnormal inflammatory response in the lungs. The latter represents the innate and adaptive immune responses to long term exposure to noxious particles and gases, particularly cigarette smoke. All cigarette smokers have some inflammation in their lungs, but those who develop COPD have an enhanced or abnormal response to inhaling toxic agents. This amplified response may result in mucous hypersecretion (chronic bronchitis), tissue destruction (emphysema), and disruption of normal repair and defence mechanisms causing small airway inflammation and fibrosis (bronchiolitis).

These pathological changes result in increased resistance to airflow in the small conducting airways, increased compliance of the lungs, air trapping, and progressive airflow obstruction—all characteristic features of COPD. We have good understanding of the cellular and molecular mechanisms underlying the pathological changes found in COPD.”

National Library of Medicine (https://pmc.ncbi.nlm.nih.gov/articles/PMC1463976/)

The normal lung is capable of receiving and distributing a large flow of air and blood to its alveoli. In emphysema, the elastic recoil of the lung decreases with loss of alveolar septa, presumably because the reduced alveolar surface area exerts a lower surface tension. Inspiration lowers alveolar pressure, allowing air to flow into the lungs; the bronchiole dilates when the pressure in the surrounding alveoli is less than that within the lumen of the bronchiole. Conversely, in expiration, the airways are compressed because the alveolar pressure surrounding the bronchiole exceeds that within the bronchiolar lumen. There is a greater tendency for airflow obstruction during expiration. In emphysema, bronchiolar obstruction due to loss of alveolar structure is irreversible.

The bronchial glands and goblet cells may be hypertrophied, producing excessive amounts of mucus, which frequently obstructs bronchiolar lumina. One aspect of therapy focuses on increasing the fluidity and mobility of mucus. Submucosal edema and cellular infiltration cause a thickening of the bronchiolar wall and narrowing of the lumen. Because vasodilatation often leads to edema, another aspect of treatment is to cause vasoconstriction by means of alpha-adrenergics. The smooth muscle may be hypertrophied in bronchitis or asthma, narrowing the lumen. Adrenergic drugs are used to smooth the muscle. COPD is usually insidious, existing in an asymptomatic unrecognized form for years prior to the appearance of noticeable dyspnea on exertion. With mild to moderate COPD, bronchiolar obstruction is found in a patchy distribution throughout the lungs. This results in uneven ventilation/perfusion ratios, which will be discussed at the end of this section. The less involved, better-ventilated lung units become insufficient to compensate for the more involved, poorly ventilated units in cases of advanced COPD or superimposed viral or bacterial infections.

Severe arterial hypoxemia is likely to increase production of erythropoietin, which stimulates the bone marrow causing erythrocytosis. This erythrocytosis may be either useful or harmful. The higher hemoglobin associated with increased O₂ capacity is good; but the increased blood volume in the presence of a failing heart is not. Increased blood viscosity causes a harmful resistance to blood flow through the lungs and coronary vessels. Early medicine utilized phlebotomies to treat hypoxia instead of O₂. This resulted in a stimulus for increased erythropoiesis causing a snowball effect.

Patients with severe bronchitis have mismatched ventilation/­perfusion. This leads to arterial hypoxemia, secondary erythrocytosis, and cor pulmonale with congestive heart failure. They are called blue bloaters due to their cyanosis and edema, or anasarca. A patient with severe emphysema may have decreased cardiac output and a relatively small heart, but as long as he/she can effectively hyperventilate and match ventilation/perfusion, he/she will not develop hypoxemia. They are called pink puffers because they maintain a near normal PaO₂ and are hyperpneic.

Auscultation

Auscultation of the lungs provides information about the airflow through the tracheobronchial tree and the presence of fluid, mucus or obstruction of the airway. Vesicular breath sounds are normally heard over the chest. They are soft and low in pitch. Bronchovesicular breath sounds are medium in intensity and pitch and heard over the large, main stem bronchi. Bronchial breath sounds are loud and high in pitch and normally heard over the trachea. One type of bronchial breath sound rarely heard is the amphoric breath sound heard over a thick walled cavity that communicates freely with a large sized bronchus. The sound resembles blowing over the top of a wine bottle. Vesicular breath sounds last longest on inspiration and when airflow to an area is diminished, they may be decreased or absent. Bronchial breath sounds are longest on expiration. Consolidation of lung tissue, as occurs in pneumonia, blocks the passage of air through the affected area and prevents the exchange of sound quality.

Remember that a patient with particularly severe asthma may have a rather quiet chest on auscultation. This is probably because airflow is so slow that it can no longer generate much sound. Breath sounds will also be absent or decreased in COPD. This is caused by lung distention and poor transmission of sound to the chest wall.

Abnormal breath sounds (adventitious or “added”) include rales, rhonchi, wheezes and pleural friction rubs. Rales are noisy murmurs caused by passage of air through liquid. Moisture causes a sound like soda fizzing, cellophane crinkling, or the sound you hear when you roll your hair between your fingers near your ears. Rales are usually heard on inspiration. Coarse rales may clear after a cough but fine rales near the bases of long fields rarely do. Rales are sometimes called “crackles.” The crackles of interstitial lung disease, such as fibrosing alveolitis, are typically heard on late inspiration as opposed to crackles from secretions.

Rhonchi are rumbling, snoring or rattling sounds caused by obstruction of a large bronchus or the collection of secretions in a large bronchus. They are most prominent on expiration. Another name for rhonchus is a “wheeze.” Snoring sounds are called sonorous rhonchi, and high-pitched musical sounds are called sibilant rhonchi. Wheezes may be audible without a stethoscope.

Pleural friction rubs occur when the pleural fluid that normally lubricates the pleura is decreased or absent. The membranes rub together causing a loud creak or a soft click that resembles a grating sound. They are heard on inspiration and expiration and are associated with pain and splinting.

Ventilation/Perfusion (V/Q) Ratio

Effective gas exchange depends on uniform distribution of function throughout the lung. Ventilation must be distributed to 300 million alveoli through 23 generations of branching airways along with blood distribution through a myriad of capillaries. Even in normal lung function, distribution is not uniform. There is a gravity-dependent gradient of pleural pressure in the upright lung of about 0.3 cm H2O pressure/cm vertical distance. The pleural pressure over a normal adult lung 30 cm in height is about 9 cm H2O more negative at the apex than at the base. Lung units near the lung apex are distended by a greater trans­pulmonary pressure and are more fully inflated than those at the base.

Blood flow, like ventilation, is least at the apex and increases down the lung. However, alveolar ventilation and perfusion are not evenly matched, so the gradient of perfusion is steeper than that of ventilation. The average V/Q (Ventilation-Perfusion Ratio) is 0.8.

In regions of the lung where the V/Q ratio is increased above normal, wasted ventilation occurs. This has the effect of adding a space that is ventilated but does not participate adequately in gas exchange. An extreme example can occur when perfusion is virtually eliminated, by a blood clot or following ligation of a pulmonary artery.

Ventilation of regions of the lung with high V/Q ratios is partly wasted and contributes to alveolar dead space ventilation. In decreased states, this is not uncommon. It results in hyperventilation and increased work of breathing.

When ventilation is impaired without decreased blood flow or when perfusion continues to non-ventilated regions of the lung, as in atelectasis, there is a decreased V/Q. Gas exchange is extremely impaired or absent and perfusing blood is poorly oxygenated. Hyperventilation can help hypercapnia, but not hypoxemia. The addition of poorly oxygenated blood from areas of low V/Q to normally oxygenated blood acts like a shunt. This “physiologic shunting” must be differentiated from true venous admixture produced by an “anatomic” shunt.

A shunt study can be performed by having the patient breathe 100% O₂ for 20 minutes and then obtaining arterial blood gases. True venous admixture will not be changed by breathing 100% O₂. Use extreme caution in some patients, however, making sure hypoxic drive is what is keeping them ventilated.

Clinical Features of COPD:

History & Physical Findings

Patients with COPD have at least one symptom in common: undue breathlessness on exertion. Chronic bronchitis is unusual in nonsmokers and is more common in men than in women. Cough is often worse on arising due to accumulation of secretions while sleeping. Wheezing and exercise intolerance are often present and tend to worsen during acute infections of the lower respiratory tract. The sputum may become mucopurulent or purulent. Unless the patient has a hobby or job that requires strenuous exertion, the disease may go unnoticed until quite extensive.

In general, the COPDer appears anxious and malnourished, and complains of lost appetite, use of accessory muscles, muscle atrophy, jugular engorgement, cyanosis, and digital clubbing.

The COPDer’s chest will have increased AP diameter, barrel chest, or hyper-resonant chest, with decreased breath sounds and adventitious breath sounds. Their ventilatory pattern may include paradoxical movement of the abdomen, prolonged expiratory time, active exhalation and pursed lip breathing. In advanced disease, peripheral edema may be present.

Asthmatics who show some degree of persistent airway obstruction and exertional dyspnea are classified as COPD. The accompanying cough is often paroxysmal, and wheezing is severe. Asthma can be brought on by intrinsic or extrinsic factors. An example of an intrinsic factor would be an emotional upset that brings on an attack; extrinsic factors would include specific allergens, etc. Usually by the time an emphysema patient reaches the fifth decade, dyspnea is the primary complaint. Hyperventilation may be present if the patient becomes anxious, but true orthopnea is uncommon unless heart failure is present.

The history may be helpful to distinguish other conditions like chronic pulmonary fibrosis, recurrent pulmonary thromboembolism, polycythemia vera, the diseases of hypoventilation, and myxedema. Aerophagia with gastric distension causes early satiety. Patients often complain of upper abdominal soreness, distention, and fullness, or even epigastric pain. It is important to note that 20 to 25% of emphysema patients develop ulcers at some stage of their disease.

With deteriorating blood gases, there will be gradual impairment of mental acuity, memory, and judgment, along with headache and insomnia. Patients with cor pulmonale complain of easy fatigability, and may have anterior chest pain and palpitation on exertion. With right heart failure, ankle edema appears and liver enlargement with or without ascites develops.

Clinical features of bronchiectasis principally include a chronic, loose cough with mucopurulent, foul-smelling sputum. In advanced cases, the mucus settles out into three layers: cloudy on top, clear saliva in the middle, and cloudy, purulent material on the bottom. It is frequently associated with chronic paranasal sinusitis. Hemoptysis, occasionally severe, occurs in at least a half of all cases. Advanced cases result in chronic malnutrition, sinusitis, clubbing, cor pulmonale and right heart failure. Physical signs are variable; rales may be present at times. A plain chest film may not be helpful if dilatations of air fluid levels are not present.

Often the diagnosis of the disease can be made from history alone. It is confirmed by bronchography after vigorous treatment for at least one week. A lung resection may be indicated. Iodized oil and iodine in water have been the standard contrast media for many years. Powdered tantalum appears to offer a reliable substitute without the risk of iodine sensitivity. (We will be learning more about roentgenologic features in the next section.) Bronchoscopy in bronchiectasis often reveals a deep velvety red mucosa with pus swelling up from areas of involvement. Gram stains may show fusospirochetal organisms and cultures will reveal common mouth flora and anaerobic streptococci or others. Microscopic exam of sputum may show necrotic tissue, muscle fibers and epithelial debris.

Roentgenologic Features

Correlation among symptoms, physical findings, and the appearance of chest x-rays is often poor in COPD. Films of moderately advanced disease can be read “essentially normal,” but at least they can be used to rule out other complications. In acute asthma, hyperlucency may mask emphysema, but will clear after attack. Emphysema patients will show attenuation of the peripheral pulmonary vasculature. Those with alpha-1-antitrypsin will have scarcity of vascular markings in bases, and hilar shadows present.

“By far the best ways to treat COPD are to catch it early and to stop smoking.”

Increased prominence of the basal vascular markings is often seen in patients with severe chronic bronchitis or bronchiectasis, with or without emphysema. In patients with pulmonary hypertension and right ventricular enlargement, classically there is prominence of the main pulmonary artery segment, bulging of the anterior cardiac contour into the retrosternal space, and enlargement of the right and left pulmonary artery shadows. In combined right and left ventricular failure, the transverse diameter of the heart is widened, and the basal vascular markings show increased prominence. Comparison with x-rays previously taken may show progressive flattening of the diaphragm, increased radiolucency of the lung fields, increased size of bullous areas, and increased heart size.

The best radiologic criteria for the presence of emphysema is a flattened diaphragm, as seen in lateral view, and an increased depth of the retrosternal space of more than 3 cm between the anterior wall of the origin of the ascending aorta and the sternum. Fluoroscopy in COPD may be helpful because radiolucency of the lung bases tend to persist during forced expiration, in contrast to the increased density seen in normal subjects. Expiratory films should be obtained four or five seconds after the command to exhale is given, to allow time for the full effects of airway obstruction to be registered. CT Scans and modern MRI’s have replaced most need for older lung laminagrams to demonstrate size and location of bullae. Lung photoscans following intravenous injection of macroaggregated particles of serum albumin tagged with iodine are helpful in demonstrating areas of non-perfused or under-perfused areas. Occasionally, Xenon scans are used for this purpose. Pulmonary arteriograms may be indicated to rule out embolism.

EKG Aspects

The electrocardiogram is often normal in early or moderate emphysema. One of the most frequent changes in COPD is a shift of the P wave axis toward the right, often greater than +80 degrees in the frontal plane. Observing the P wave in a VL easily assesses this; it is isoelectric at the +60 degree axis and becomes increasingly negative as its axis moves further to the right, greater than +60 degrees. The P waves frequently are symmetrically peaked in leads II, III, and a VF; and when their height is 2.5 mm or more they are classified as “P pulmonale.”

The QRS complexes often show low voltage in both the limb leads and the precordial leads, especially leads V5- 6. The mean QRS axis is displaced posteriorly and superiorly and shifted toward the left (clockwise rotation). The frontal electrical axis is often vertical, frequently more than +70 degrees. Superior rotation of the electrical vector manifested by a late R wave in a VR ABG gives rise to a SI, SII, SIII pattern with an indeterminate mean axis. With more severe rotation, axes greater than -30 degrees (left axis deviation) may be seen.

When right ventricular hypertrophy develops as a result of increased pulmonary vascular resistance and pulmonary hypertension, the QRS vector shift anteriorly and to the right. R waves then appear in the right precordial leads. Complete right bundle branch block is occasionally observed.

The QRS abnormalities may sometimes simulate those of myocardial infarction, particularly of the inferior portion of the heart. The presence of abnormal pulmonale-type P Ò26 waves suggests that emphysema is the sole cause of the EKG abnormality.