Health and Psychology

I often evaluate people requiring oxygen for psychological issues of memory problems, anxiety or depression.  So I want to talk about how memory problems, anxiety and depression are related to lung function.  The chest contains two lungs.  One on the right side and one on the left side.  Each is made up of four parts called lobes.  Lungs are protected by the ribcage.  The lungs are like balloons and are soft and inflate and expand with breathing.  The function of the lungs is to bring oxygen into the bloodstream where it is carried by red blood cells to all organs and tissues in the body, and to remove carbon dioxide (a waste product produced after oxygen is circulated). 

After entering the nose or mouth, air travels down the trachea or windpipe. The trachea is the tube inside the neck. Behind the trachea is the esophagus. When we inhale, air moves down the trachea and when we eat food moves down the esophagus. The path air and food take is controlled by the epiglottis, a issue that functions like a gate that prevents food from entering the trachea. Occasionally, food or liquid may enter the trachea resulting in choking and coughing spasms.  The trachea divides into one left and one right breathing tube, and these are termed bronchi. The left bronchus leads to the left lung and the right bronchus leads to the right lung. These breathing tubes continue to divide into smaller and smaller tubes called bronchioles. The bronchioles end in tiny air sacs called alveoli.

Oxygen runs the brain and body.  Major lung problems have to do with problems of the lungs in bringing in oxygen.  This can happen in infections like pneumonia, where the lungs fill with fluid, limiting the ability of the lung to expand.  It can happen with space occupying lesions like tumors or granulomas, or changes in lung tissue like in cystic fibrosis.  It can happen with inflammation of the lungs in diseases like asthma, sarcoidosis, COPD, and pleursy, where the lung's ability to inflate to pull in oxygen or to deflate and expell carbon dioxide is compromised.  Sometimes lungs can deflate spontaneously or due to injury causing problems with bringing in air.  There are other diseases like chronic bronchitis, or emphysema that limit the ability of the lungs to move oxygen.  Oxygen is used more with exertion, like exercise, and when lying down than when seated or not moving.  So lung symptoms are more likely to be noticed when lying down or with exertion.

Lung function is measured in several ways.  A peak flow meter is used to evaluate how air is pushed out of the body with exhallation. Spirometry is a test that measures the efficiengy of air being brought into the lungs.  Plethysmography measures the volume of air in the lungs.

There are several symptoms of lung problems.  

• Shortness of breath. This is a feeling of breathlessness or not getting enough air.  The person will often arch their neck and use chest muscles to attempt to gain air.  The feeling of breathlessness may be accompanied by an increase in heart rate.  These physical symptoms closely mimic symptoms of anxiety and the feeling of not being able to breath may be accompanied by a sensation of panic.  
• Noisy Breathing.  Wheezing, whistling, gurgling, bubbling, or rattling sounds suggest there may be an obstruction of the lungs, bronchi, or fluid or mucus in the lungs or airways.
• Chest breathing.  Most breathing is done with the diaphram.  When air is not circulating adequately, accessory muscles in the chest may be used to increase oxygen.  
• Coughing or choking.  Coughing is a reflex used by the body to clear the airway.  In inflammatory conditions, or conditions that produce excess mucus, coughing may increase to attempt to clear the airway.  If the airway is not able to be cleared the coughing will be increased.  Exertion or laying down to sleep may increase coughing.  
• Early morning headaches.  Conditions like sleep apnea or other illness that limit oxygen can result in headaches from not having enough oxygen for a prolonged period like overnight.
• A bluish or darkened tint to nails, lips or skin.  Changes in color can show problems with oxygen transportation.  Red blood cells carry oxygen. These cells lend a pinkish tint to the skin.  When there aren't enough of these cells or if oxygen supplies drop the skin develops a bluish or darkened tint.  In darker skinned individuals it's sometimes easier to see the loss of color on the gums or inside the eyelids.  The skin overall can look pale and the person may seem listless.  This listlessness can be mistaken for depression.  
• Increasing fatigue and long muscle pain.  The lungs carry oxygen.  If muscles do not get enough oxygen to operate efficiently, they produce lactic acid.  This can happen with exercise, but can happen without much exercise if the lungs are not working adequately.  This can be mistaken for depression.  
• Difficulty in sleeping and limited interest in eating.  Sleeping and eating are activities that require oxygen.  Initially with lung problems people may eat more and sleep more.  As problems worsen, they stop most activities, have problems sleeping and stop eating.
• Concentration problems.  Oxygen is required by the brain to think.  Often mistaken for memory problems, concentration difficulties occur when there is a limitation in oxygen.  The difference between concentration and memory, is that concentration is forgetting where you put your keys, memory is forgetting what your keys are for.  I describe memory to people as having a file cabinet.  Information comes in and the information needs to be stored and later retrived.  Concentration problems are the trash bin next to the filing cabinet.  The information never gets into storage and therefore can not be retrieved later.  Since lung problems are common in peole over 40, many people believe these concentration difficulties may be the start of a dementing illness.  An assessment can help differentiate these problems.
• Swelling in the ankles or leg or calf pain.  Lung problems may be present for quite awhile before they are noticed.  The brain and the heart are two major oxygen users in the body.  Over time the heart will enlarge to meet the body's demand for oxygen.  The chest size may expand and it's shape may become more rounded or barrel shaped.  Swelling of the ankles or leg or calf pain may indicate the heart is working overtime and is producing fluid to help it work.  This fluid pools around the ankles causing swelling.