Chronic Obstructive Pulmonary Disease
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SYMPTOMS Debilitating fatigue is the hallmark of this syndrome. Daily functioning is often impaired. Aside from those symptoms required for diagnosis, other symptoms of CFS include alcohol intolerance, bloating, chest pain, chronic cough, diarrhea, dizziness, dry eyes or mouth, earaches, irregular heartbeat, jaw pain, morning stiffness, nausea, night sweats, shortness of breath, skin sensations, tingling sensations, and weight loss. The onset of CFS is often associated with a viral-like syndrome consisting of extreme fatigue, lung and sinus ailments, fever, and swollen glands. Stresses such as physical exertion, headache, and sore throat tend to make the fatigue worse.
DIAGNOSIS Since fatigue is a common symptom in many diseases, a search for the cause of the fatigue needs to be considered. However, avoiding unnecessary and expensive tests is also important. Before diagnosing CFS, a complete history and physical examination should be performed on all patients to exclude another illness. Laboratory tests should be limited to complete blood cell counts and tests specific for the patient’s symptoms. Depending on the results of the history and physical examination, illnesses that may need to be ruled out include fibromyalgia, chronic mononucleosis, Lyme disease, psychiatric disorders, sleep disorders, myalgic encephalomyelitis, irritable bowel syndrome, hormonal disorders, neurasthenia, chronic sinusitis, anemia, occult celiac disease, rheumatic disease, alcohol abuse, substance abuse, sick building syndrome, multiple
chemical sensitivities, reactions to prescribed medications, eating disorders, cancer, autoimmune disease, obesity, and other conditions.
TREATMENT Patients with CFS should not expect a quick fix. Sometimes using ineffective and unnecessary treatments does more harm. The best treatment strategy includes education, pain control, exercise, optimal diet, appropriate sleep schedule and antidepressants (both for mood and for chronic pain), combined with cognitive-behavioral therapy. Treatment for allergies and stress reduction may improve the quality of life for persons with CFS. A multidisciplinary approach involving medical, psychiatric, behavioral, and psychological evaluation and therapy has demonstrated effective results by restoring the ability to work and keep a job. SEE ALSO: Autoimmune disorders, Chronic pain, Sleep disorders
Suggested Reading The Merck manual of diagnosis and therapy (17th ed.). (1999). Also at www.merck.com/pubs/mmanual/
Suggested Resources Centers for Disease Control/National Center for Infectious Diseases. Chronic fatigue syndrome website: www.cdc.gov/ncidod/diseases/cfs/ National Institutes of Health/National Institute of Allergy and Infectious Diseases. Chronic fatigue syndrome website: www.niaid.nih.gov/publications/cfs.htm
GINA BELL LORI B. SIEGEL
Chronic Obstructive Pulmonary Disease Chronic obstructive pulmonary disease (COPD), the fourth leading cause of death in the United States, is a chronic, progressive disease encompassing both emphysema and chronic bronchitis t
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