It's a slow and surreptitious process within the lung tissue. At first, few patients notice the subtle changes -- the shallow, uneven breathing; the trapped air; the uncomfortable suffocation. Even when they do, they rationalize: "I'm getting older," they say, or "I need to lose some weight."

Without intervention, the devastation continues -- sometimes a result of cigarette smoke or inhaled toxins, sometimes for no known reason. Over time, the alveoli appear almost moth-eaten, unable to do their jobs. The silhouette of the heart shrinks because of hyperinflated lungs, the diaphragm flattens and the bronchi become floppy and narrow. Other symptoms -- the chronic cough, the mucus, the shortness of breath, the difficulty blowing air out, the inability to do physical activities -- become more pronounced.

Often, more than half of lung functioning is lost before a diagnosis of chronic obstructive pulmonary disease is made. Partly because the condition's patient profile has changed -- it's no longer considered a disease of old men -- and partly because it is fraught with other misconceptions, COPD remains overlooked, even though it is the fourth leading U.S. cause of death.

More than 12 million people are diagnosed with COPD, but at least 12 million more unknowingly have it. "It's absolutely not on anybody's front burner," says Barbara Yawn, MD, a family physician who directs research at Olmstead Medical Center in Rochester, Minn. She also co-chairs the U.S. COPD Coalition, a nonprofit network of organizations dedicated to public education and research. "The primary care physician is focusing on two or three other chronic conditions, and they don't get around to questions of COPD."

Thus, the National Institutes of Health's National Heart, Lung and Blood Institute launched in early 2007 the Learn More, Breathe Better Campaign in an attempt to raise awareness and communicate a key message of early detection. "We are updating attitudes and concepts. We now have more tools to diagnose and treat," says James P. Kiley, PhD, director of the NHLBI's division of lung diseases. "The awareness program is a wake-up call. This disease is on the rise, and we need to get our hands on it. There is a role for primary care physicians, and spirometry is key."

Nonetheless, as Dr. Yawn explains, doctors still ask why they should test for a disease they can't help. "Our first job is to let doctors know this is not hopeless, and if we diagnose earlier we can help patients return to work and to normal activities," she says. "We need to show this is worth identifying. Treating this condition can give doctors, patients and families the same satisfaction and hope that treating other chronic diseases can, especially if we find it earlier when treatments make more difference."

MYTH: Spirometry is cumbersome

"We found that almost 40% of COPD is missed by primary care physicians," says Frederic D. Seifer, MD, clinical associate professor at East Tennessee University Quillen College of Medicine and director of the Erlanger Center for Better Health in Chattanooga. "How can you help these patients without identifying them?"

Two of the biggest reasons COPD gets missed in the primary care setting, Dr. Seifer says, are that most physicians believe it can be diagnosed clinically without spirometry and that it primarily affects men older than 65. "Wrong sex and wrong age," he says, adding that spirometry is essential.

More than 12 million people have chronic obstructive pulmonary disease.

But primary care doctors often recall the expensive, cumbersome, hard-to-calibrate equipment of their medical school days. As a result, barely 20% of their offices have spirometers. "Of 20,000 newly diagnosed COPD patients," says Aaron Milstone, MD, the director of the lung transplant program at Vanderbilt University in Nashville, Tenn., "less than 2% had testing."

Today, spirometers cost less than $1,000. They're small, about the size of a smart phone; they are easy to use; and they are reimbursable. "It's much easier than an EKG," says Stephen Rennard, MD, professor of internal medicine at the University of Nebraska Medical Center in Omaha. "It's like measuring blood pressure."

These newer machines generate a computer report, and Dr. Seifer has been teaching local physicians how to interpret the results. "Physicians are intelligent, and they want to be able to read the reports," he says. "They are less likely to use it if they can't read it."

Additionally, the COPD Foundation sponsors a mobile spirometry unit. "Since Jan. 14, [2007], we've been in 21 cities and tested almost 10,152 [people]" says John Walsh, founder and president, who himself has the alpha-1 form of COPD.

MYTH: Alpha-1 COPD is untreatable

Since she was a child, Melissa Biggs was chronically ill with colds, sore throats and upper respiratory conditions. But it wasn't until the 34-year-old former "Bay Watch" actress had her second bout of pneumonia that she went to an allergy specialist for help.

"She drew nine vials of blood, did scratch tests," Biggs says. "She said I was severely allergic and diagnosed me as a stoic asthmatic." Weeks later, after further testing, the allergist diagnosed Biggs with an alpha-1 antitrypsin deficiency, the only known genetic cause of COPD.

Almost 40% of COPD is missed by primary care physicians.

Biggs was referred to a critical care specialist. "He said, 'I don't know much, but what I do know [is that] it is rare and it is fatal. I give you two years.'" Biggs, a single mother, says she went into a depression, but she also found out more. "I learned that my doctor was grossly misinformed. It's treatable and it's not rare. It's rarely diagnosed."

The average alpha-1 deficient patient has symptoms for 7.2 years and sees three different doctors before getting a correct diagnosis, says D. Kyle Hogarth, MD, assistant professor of medicine at the University of Chicago Medical Center. He also directs its Alpha-1 Antitrypsin Deficiency Clinical Resource Center.

Alpha-1 antitrypsin is an anti-inflammatory protein that shields the lung's delicate tissues by binding to neutrophil elastase -- a normal lung enzyme that digests bacteria and other foreign substances. Without alpha-1, this digestion goes unchecked, eventually damaging healthy lung tissue. According to a study by the Respiratory & Allergic Disease Foundation, alpha-1 is estimated to affect up to 100,000 Americans, but nearly 95% are undiagnosed or misdiagnosed.

Knowing whom to screen appears to be one of the missing links.

"Our surveillance study found that physicians cannot depend on typical patient profiles to assess whether AAT deficiency screening is necessary," says Dr. Hogarth, the lead author of a study presented at the annual meeting of the American College of Chest Physicians in October 2007. A number of patients who normally would not be screened based on suggested guidelines turned out to be positive for AAT deficiency. "In the real-world setting, this suggests that thousands of patients who have been diagnosed with COPD or severe asthma may actually have alpha-1."

Study findings suggest that all patients with moderate or severe persistent asthma and/or COPD should be tested for AAT deficiency, says Gary Rachelefsky, MD, one of the investigators and a professor of allergy and immunology and director of the Executive Care Center for Asthma, Allergy and Respiratory Diseases at California's UCLA School of Medicine. "It is imperative that clinicians become more vigilant about alpha-1 testing."

MYTH: It's a hopeless condition

It's the "pumpkin pie" talk that helps his COPD patients grasp what they are facing, Dr. Seifer explains.

He draws a circle on the back of the patient's spirometry reading. If the patient has lost one-third of his or her lung function, that's a one-third sized slice of the pie. "This much of your pie is gone. You'll never get it back," he tells them. "We're going to help you quit smoking, because you can't take any more bites out of this pie. For the first time they say they understand their disease."

COPD is the 4th leading cause of death in the U.S.

Understanding is an important part of the treatment equation, as is pulmonary rehabilitation, nutrition and exercise. "This improves quality of life," Nebraska's Dr. Rennard says.

Long-acting bronchodilators and inhaled corticosteroids added to bronchodilators are helping and, in some cases, slowing progression, he said. In the TORCH (TOward a Revolution in COPD Health) study, presented at the American Thoracic Society meeting in May, patients treated with salmeterol/fluticasone propionate had a slower rate of lung function decline over three years compared with patients receiving a placebo. In addition, advances in smoking cessation give primary care physicians new tools.

A previous therapy -- lung volume reduction surgery, originally used in the 1950s -- has re-emerged for patients with upper lobe damage. Surgeons remove the most damaged portion, hoping to restore lung elasticity. And it seems a small umbrella might hold an answer for some patients. Known as the IBV Valve System, these one-way devices are placed inside the lung's upper lobe to redirect airflow to healthier portions of the lung.

"This is just the tip of the iceberg," Dr. Milstone says.

The Global Initiative for Chronic Obstructive Lung Disease, an initiative of NHLBI and the World Health Organization, has developed evidence-based guidelines for COPD management and staging criteria from spirometry. Yet, on average, physicians estimate that only 12% of their patients have COPD. And although 55% of doctors are aware of major COPD guidelines, only 25% use them to guide decision-making.

"We are in a Columbus-like era for the treatment of COPD. We are going forward with great impact," Dr. Milstone says. "We now need to focus on primary care physicians and internists, to let our colleagues know the future is really quite bright, that we have great optimism."

A parasite that is the leading cause of heart failure in Latin American countries appears to be far more common here than previously thought. Public health officials and physicians are now struggling to devise strategies for detecting, treating and preventing transmission, according to a series of papers published over the past year and symposiums at recent infectious disease meetings.

"This is really a neglected disease, but Chagas is more and more on the radar screen in the U.S.," said Caryn Bern, MD, MPH, medical epidemiologist at the Centers for Disease Control and Prevention's division of parasitic diseases.

Chagas disease, caused by the Trypanosoma cruzi parasite and carried by the triatomine or "kissing bug," has always been here in a very limited way. Many mammals are infected. The first indigenous human case was noted more than a half century ago in the Oct. 15, 1955, Journal of the American Medical Association, but its incidence in humans has been considered rare.

Widespread testing of the blood supply as of January 2007 triggered by cases of transmission through transplanted organs and transfused blood -- in some cases causing death -- has enabled the detection of many more infections. Most are in people who have spent significant time in Latin America or, because this parasite can be transmitted to a fetus, are children of immigrants from endemic regions. A handful of cases, though, seem to have been contracted on this side of the border.

Data from the American Red Cross presented at the American Society of Tropical Medicine and Hygiene meeting in Philadelphia in November 2007 show that one in 30,000 donors tested positive for the parasite. This number is much higher in some regions of the country with large numbers of Latin American immigrants.

Not everyone who tests positive on the initial screen will actually carry it, but at least 317 people in 30 states were confirmed as infected last year by AABB, an association which represents organizations that collect about 65% of the U.S. blood supply. Experts say more than 100,000 people may have Chagas without knowing it.

More than 100,000 people may have Chagas without knowing it.

"We're just seeing the tip of the iceberg," said Patricia Dorn, PhD, associate professor of biological sciences at Loyola University New Orleans. She was the lead author on a paper in the April 2007 Emerging Infectious Diseases that documented the first locally acquired case of Chagas in Louisiana.

In order to facilitate treatment, JAMA published a review of data by leading experts in this field. In addition, the first U.S. clinic devoted to it, the Center of Excellence for the Diagnosis and Treatment of Chagas Disease at Olive View-UCLA Medical Center in Los Angeles, opened last month.

"We want to treat these patients, and we want to follow them long term because this has not been looked at before in the U.S.," said Sheba Meymandi, MD, center director and associate professor of medicine at UCLA.

But with all this activity comes a growing awareness of the complexity of dealing with Chagas.

Experts urge physicians to test those who may be infected, but determining who that may be is difficult. Dr. Meymandi is running a trial to evaluate the effectiveness of screening all Latin American patients with heart conduction abnormalities and unexplained cardiomyopathy. She is also testing close relatives of those known to carry the parasite.

Until the results are available, the categories of those who potentially carry this -- including those who have spent significant time in Latin America -- are too broad to allow targeted testing. This infection is also, for the most part, asymptomatic for decades until heart or gastrointestinal trouble appears.

Not all infants born to mothers infected with Chagas will acquire the disease.

"The most important thing for physicians is to keep Chagas disease on the differential," said Dr. Bern.

There's also not yet an easy way to detect this parasite. Two different tests, at minimum, are needed, and even those whose results are negative may still be infected.

"There is not one single test that is considered the gold standard, and we may be missing some people," Dr. Bern said.

And then there's the question of what to do with a positive result. Drug treatment is most effective in those who are newly infected and those who are younger than 18.

Limited evidence suggests that treating those who are older can have some benefit, and one of the more contentious debates is whether adults should be given these medications. They can be hard to take, and they're not always effective.

Moreover, the majority of those infected will never develop the major heart or gastrointestinal problems that drug treatment seeks to prevent. The estimated 20% to 30% of patients who do can be monitored and managed symptomatically.

"The bottom line is that there are no properly structured, double-blinded trials that demonstrate that giving a full course of the drug to those with long-standing infection is beneficial," said Louis V. Kirchhoff, MD, MPH, professor in the division of infectious diseases at the University of Iowa. Dr. Kirchhoff has been studying Chagas disease for more than 20 years.

A randomized clinical trial that may answer this question of drug treatment for long-term infections is under way, but there is also the challenge of getting patients access to treatment. The drugs are not approved by the Food and Drug Administration, even though they have been used in Latin America for decades. They are only available in the United States from the CDC, which provides them at no charge.

Despite these challenges, experts hope that all this testing will not only protect the blood and organ supply, but also ensure that more babies who contract the parasite congenitally will be treated.

Not all infants born to mothers who are infected will acquire Chagas. But some will -- and treatment is most effective in this group soon after birth.

Have you heard about the Raw Food Diet? Also known as Living Foods Diet is gaining popularity and a buzz, The power of raw foods is not only one of the most well-known "rejuvenation" secrets of celebrities and Hollywood stars like Demi Moore, Pierce Brosnan, Sting, and many others, it is also a concept that has the potential of giving you what you're looking for: incredible health, increased energy, and a youthful and slim body, A diet for a long and healthy life.

We eat so much in the way of processed food that we don’t even stop to think about what we’re putting into our bodies, and how far we’ve come nutritionally from our ancestral, agrarian roots.

A raw food diet means consuming food in its natural, unprocessed form. There are several common-sense rationales for why this is a good idea. Processing and cooking food can take so much of the basic nutritional value away. Think of some of the conventional wisdom you’ve heard about for years, such as: If you cook pasta just to the al dente (or medium) stage, it will have more calories, yes, but it will have more the nutritional value in it than if you cooked it to a well-done stage. Or you probably remember hearing not to peel carrots or potatoes too deeply, because most of the nutrients and values are just under the surface.

The raw food diet means eating unprocessed, uncooked, organic, whole foods, such as fruits, vegetables, nuts, seeds, legumes, dried fruits, seaweeds, etc. It means a diet that is at least 75% uncooked! Cooking takes out flavour and nutrition from vegetables and fruits. It also destroys the enzymes we need to live and slow the ageing process when they are heated to temperatures in excess of 116*F.

A raw food diet means eating more the way our ancient ancestors did. Our healthier, more fit ancestors. They cooked very little, and certainly didn’t cook or process fruits and vegetables. They ate them RAW. Their water wasn’t from a tap; it was natural, spring water. Maybe they drank some coconut milk on occasion.

Doesn’t it just make sense that this is how our bodies were meant to eat? It’s a way of eating that’s in harmony with the planet and in harmony with our own metabolisms. Our bodies were meant to work, and need to work to be efficient. That means exercise, certainly, but it also means eating natural, raw foods that require more energy to digest them.

Of course exercise is going to help with weight loss, and so will counting calories. These are hardly "tips" or ground-breaking news. But do you know what else can make you healthier from the inside out?

Everyone has heard the old adage "You are what you eat." This saying exists for a reason. It doesn't, however, just mean that you should eat low calorie foods or watch your junk food intake, both of which are critical to maintain a healthy weight. It also means eating foods that are both nutritionally dense and powerful in every way they can be. How can these foods be powerful, you ask? Food can make your moods improve almost as much as exercise. It can make your skin appear more youthful. In short, it can make you more beautiful and healthy from the inside out! Some foods to consume freely are almonds, salmon, broccoli and berries.

Almonds are high in the "good" fats, or the kind that lower cholesterol. They are also filling, so you won't be tempted to binge on the sugary, salty stuff if you have a handful of almonds. They are high in Vitamin E, and make a great-tasting natural snack. Salmon is also full of the good kind of fats. Although its high fat content makes some people shy away, it is actually quite healthy to eat a good amount of salmon a week. The Omega-3 fatty acids found in salmon are good for your heart, your hair skin and nails and your complexion. Again, they are not problematic for your cholesterol. Try substituting your chicken meal once a week with salmon, and having grilled salmon in your salad for lunch. There is good evidence out there that fish such as salmon improves and elevates your mood as well, as does getting in a good workout! Broccoli is just one of the most potent foods around. It is chock full of vitamins, fiber, protein and antioxidants. Your body would benefit greatly if you ate your broccoli! Berries, too, are a powerhouse in antioxidants. Vitamins and antioxidants like the kind found in broccoli and berries are great for your complexion, heart, stress, and overall health.

Other than eating better, more healthfully, and exercising, what else can one do to stay fit and healthy? Go to the doctor!

Immediately, you may be thinking "I am healthy and fit. Why do I need to see a doctor?" Not because anything is wrong, but because you should get various check-ups that you may just be missing. In other words, you should see certain professionals for preventative reasons. If you are over 40 and female, for example, you should be having a mammogram annually. If you have had breast cancer in your family, you may want to check with your doctor about having your first one at 35. Your dentist - twice annually - can stave off periodontal problems and other health concerns. Believe it or not, diseased gums have been linked to serious conditions such as heart disease and stroke! Even if you feel you are not at risk for such things, the health of your mouth is important. You want those natural choppers for as long as you can keep them, so when you are elderly you don't miss out on the pleasures of food! While we're on the topic of pleasures, what about the pleasure of the warm, summer sun? There is no reason you can't still enjoy the sunshine so long as you wear protective sunscreen. However, most people don't think to go to the dermatologist at least once a year and get an all-over skin screening. The dermatologist is another doctor to keep on your regular calendar of appointments so that he or she can check for unusual moles, skin discolorations, and any other pre-cancerous causes for concern. You don't just need a dermatologist for acne, you know! Regular checkups with your general practitioner can also be beneficial, for blood pressure screens, checking your thyroid, and just over-all health checks once a year.

A more fun visit to a health care professional could involve the alternative therapies, such as chiropractic or massage. Both of these tools for health have proven beneficial in healing back or neck pain, or other pain not easily corrected by anything other than surgery. If you have muscle or joint issues that don't seem to be resolved with rest, but you are not prepared for or in need of surgery, a visit to the chiropractor may be just what the doctor ordered, so to speak. Spine alignment has been shown to greatly improve back and neck pain, shoulder pain, hip pain and even headaches or sinus problems. And who doesn't enjoy a good massage? A qualified massage therapist can lift your spirits, ease muscle tension, and relieve stress - all of which help to produce a happier, healthier you!

You have done it! You've lost fifteen pounds over the last six months and you know you are on your way to where you want to be. However (and it's a big “however”!), you can't seem to rid yourself of the last stubborn ten that seems intent on sticking to your thighs and rear end. Your weight loss goal was twenty five pounds, and you know other people have done it-so how do you do it? What is the best way to lose those last, stubborn ten pounds?

You have sacrificed many a chocolate chip cookie and watched beads of sweat turn into pools on the floor in your spinning class week after week. So why won't those last ten pounds move? There could be a number of reasons. The body reaches a set point, or a given weight beyond which it's not so willing to budge. Sometimes, we have to trick it into moving along anyway. If you are already in a committed exercise program and you have changed your chicken from KFC to baked at home in the oven, here are some tips to go one step further:

1. Watch the processed foods. Just because something is labeled low-calorie or low-fat doesn't mean it's good for you to eat. Marketers for the food industry have the extremely lucrative and misleading ability to make even the most junky of junk food seem healthy. Foods that are found in the chips and crackers and cookies aisles are not going to be good for you, no matter how many times you read that each serving only has 100 calories! What's the harm, you ask? Well, it's not necessarily harmful, but with the last ten pounds every little step counts. When you consume processed foods, you are consuming a lot of extra ingredients that are made in a lab and a lot less whole food in its natural state. Some of these ingredients are merely binding in nature, and some can rob you of vitamins. Either way, the closer you stay to “real” food the better. When you consume real, whole foods in their natural state (think fruits, vegetables, fresh meats, and simple dairy) you get the benefit of food energy that you do not get from processed foods. Not only can this push you through your day and energize you, you can actually eat more of these ‘clean' foods for fewer calories. With greater healthy food consumption you will feel fuller and will not want to eat as much. After a while, your cravings for the processed foods will lessen.

2. Watch the white! Hand in hand with processed foods go ‘white' foods. Literally, you should try to cut down on any white-colored foods that don't come from nature if you want to shed the last ten pounds. Sugar is white and horrible for your body. Sodium (or salt) is white and can make you hold water weight, feel bloated, and increase blood pressure in high doses. Many people are surprised to find how much sodium is in certain foods when they start actually reading the labels to notice these amounts. Soups, for example, contain a very high level of sodium. In fact, the low fat or low calorie soups tend to contain more salt than the creamy ones! Try making your own fresh soups instead of buying the canned variety. White flour - the likes of which cookies, cakes, and pies are made of - is completely robbed of the nutrients it used to contain before it was turned into such a refined grain. Try to eat wheat breads instead of white breads. Even white rice has higher sugars in it than brown rice; it's higher on the glycemic index, which measures sugar conversion of food. Of course, white foods found in nature are perfectly fine in moderation. Milk, potatoes, and other natural white foods will not significantly add to your waistline so long as you're not eating a pound of potatoes or drinking a gallon of milk!

3. Fifteen minutes a day … Sounds simple, right? No matter what it is, you can do something for fifteen minutes a day, right? It is simple! Try adding just fifteen extra minutes each day to your exercise routine. If you work out five days a week, that's an extra hour and fifteen minutes a week and it adds up! By doing fifteen extra minutes of cardio you can actually end up burning an extra 100 calories per exercise session. By adding an extra 15 minutes of weight training, you can tear down and rebuild that much more muscle each time, which lean muscle mass will enable you to burn more calories throughout the day when you're doing nothing at all! It's a great investment - 15 simple minutes. If this seems like too much at first, start with an extra five minutes and build up to fifteen over the next few weeks.

By taking on these three simple changes, you will be able to stoke your metabolism just enough to push you into that ten pound deficit. It may be gradual, like the first fifteen you lost, but it will be long-lasting.