Learning About COPD Begins By Asking Questions
I have a nine-year-old son. He is constantly thinking. He comes up with some of the most amazing questions ever. Sometimes the answer comes easily. Sometimes there are no answers. Today’s question was: “If we don’t inhale carbon dioxide, how do we exhale it?”
Like, how do kids think of these questions? This one I actually had to stop and think. I mean, I know the answer, sort of. But, how do I simplify it so that a 9-year-old can understand it? Then a thought occurred in response to my son’s great question.
A test of my intelligence
I said, “Now, how is it that a 9-year old boy even knows about carbon dioxide.”
He said, “Oh, we learned about CO2 in school, dad.”
“Oh,” I said. I decided if he knew about CO2 to begin with, then I don’t need to simplify it too much. So, I attempted an answer. I said:
“Well, in the air around us are oxygen molecules. Each oxygen molecule has two oxygen atoms. You inhale an oxygen molecule. It goes deep into your lungs. It travels to the ends of the airways. It comes into contact with your bloodstream. Your blood then takes it to cells of your body. There, oxygen is broken down to make energy. The energy is used for the cell to do whatever its job is. A waste product of this is CO2. This CO2 then enters your bloodstream. Your blood takes it to your lungs. It then jumps out of your bloodstream into your lungs. You then exhale it.”
Whew! A test of my intelligence. If I didn’t know the answer as a respiratory therapist, there's definitely something wrong with me.
So, how did my son respond?
He said, “Oh, that makes sense.”
As he knows, right? Haha.
This made me think of my COPD patients. Often we find ourselves explaining about CO2. And so often I wonder if they even know what CO2 is. And rarely do they ever ask what it is. I have never heard a question as simple as my son's.
It’s actually a lot more complex than how I explained it. In school, we learn about the dreaded Krebs Cycle. This explains the process of how oxygen is broken down by cells to make energy. If I showed you it, you might think, “Yikes!" As I think of it now, I think, “Yikes!" And I ask myself, “How did I ever memorize it?"
And I had to memorize it more than once too. There were two, maybe three, classes that required me to memorize it. And each time I pretty much had to start from scratch.
What does CO2 have to do with COPD?
Well, some people with COPD may retain CO2. And this is when we find ourselves explaining about CO2. Sometimes, the disease makes it so the lungs have a hard time getting enough oxygen into your blood and getting all of the CO2 out of your blood.
When this happens your oxygen levels may drop. Thankfully, most people with COPD respond well to just a low flow of oxygen. This is why most people who need oxygen only need 2-3 LPM via a comfortable nasal cannula. This usually works just fine to resolve this issue.
Hypercarbia and its treatment
CO2 retention is another issue. And, for the record, the term for a low oxygen level is hypoxemia. This means you have a low blood oxygen level. The term for an elevated carbon dioxide level is hypercarbia. Those are medical terms you may hear from time to time.
Damage to the lungs may cause hypercarbia. Also, some people with COPD breathe more shallow than normal. This is most likely to occur at night while we are sleeping. At night, healthy people breathe more shallow but this may be exaggerated in some people with COPD. You don’t breathe deep enough to blow off enough CO2. So, CO2 levels may rise.
Hypercarbia can occur during flare-ups. So, it can happen during acute exacerbations of COPD. However, it may also occur gradually over time. In this case, your body compensates for this. The human body is good at compensating. So, for some people with COPD, hypercarbia becomes normal.
A treatment for hypercarbia is BiPAP. There are complex BiPAP machines we use in hospitals. These are the kinds that come with many bells and whistles. There are also some medicines your doctor can prescribe too. Plus, top-line COPD medicines can also help.
The power of questions
It's neat what can come of simple questions. It can sometimes spark neat conversations or articles such as this. Asking questions is something researchers do all the time too. It’s how they postulate educated guesses. Then they perform research in attempts to learn about our disease.
I will end this with another question posed by my son. I did not have an answer for this one. If you do, please share it in the comments below. As we were walking along Lake Michigan one pleasant evening, he humbly asked: “Dad, if humans can see water and can’t see air, can fish see air but not be able to see water?”
Do you have a COPD exacerbation tool kit?