Diseases

Asthma

More than 15 million Americans have asthma, most with an onset before 20 years of age. A layer of smooth muscle surrounds the airways inside your lungs. Inflammation of the airways and constriction make the airway much smaller in individuals with asthma. Individuals with asthma are much more sensitive to certain triggers. Smoke, allergens, exercise, cold air, and infection are some triggers of asthma. Your doctor can diagnose asthma by evaluating your symptoms, performing a thorough physical examination, and ordering pulmonary function tests, blood tests, skin tests, and sensitivity tests. Pulmonary function tests look at how well you are breathing and how reactive your airways are. For those with allergic asthma, skin tests may help to identify some of the substances that aggravate it.

Symptoms of asthma include a sudden shortness of breath that is caused by a specific trigger. Patients with adult-onset asthma may not have a specific trigger that causes an attack; other symptoms include wheezing and a dry or productive cough. The disease can cause significant changes in lifestyle. Symptoms are usually worse at night and may cause disturbances in sleeping.

Your doctor will prescribe certain drugs depending on the severity of your asthma. Many of these drugs will be inhalers. An acute bronchodilating inhaler will provide immediate relief of most asthma attacks. Inhaled steroids offer more long-term effects but do not relieve an attack immediately. All inhalers prescribed to you must be inhaled properly, with a spacer for optimal benefit, to work properly. Your doctor may recommend that you receive an influenza and pneumococcal pneumonia vaccine. A peak flow meter is sometimes useful in monitoring your asthma. Asthma is a chronic disease which can often be controlled and allow for a normal lifestyle as evidence by many olympic and professional athletes who suffer the disease.

Bronchiectasis

The airways are surrounded by cartilage and muscle that provide support and maintain the shape of the airways. Constant irritation to the muscle and cartilage can result in their destruction, causing the airways to enlarge. This inflammation and permanent widening of the airways within the lungs is called bronchiectasis. Severe infections with a virus or bacteria, blockage of an airway, or a defect clearing secretions are common causes of bronchiectasis.

Your doctor can detect this disease by evaluating the symptoms of your underlying lung disease and ordering specific tests. Common tests include a sputum sample, a chest x-ray, and a CT scan. Common features of bronchiectasis often include constant cough with discolored sputum, wheezing, shortness of breath, and changes in the nails. Many patients often find blood in their sputum. Bronchiectasis is not contagious.

Treatment for bronchiectasis may involve chest physiotherapy, inhalers, and antibiotics. Chest physiotherapy involves postural changes that allow for better drainage of secretions from the lungs. The inhalers allow for increased airflow through the lungs, and help clear the secretions. Antibiotics reduce some of the inflammation by killing bacteria that have infected the airways. Your doctor may recommend that you be vaccinated against pneumococcal pneumonia and influenza. Most patients tolerate treatment very well.

Bronchitis, Acute

Bronchitis generally refers to an acute inflammation of the central airways which is usually self-limited and associated with near-complete healing within 4-8 weeks. Viral infections are a common cause, especially in the winter, but other factors such as air pollution, irritant fumes, and some bacteria may also produce bronchitis. The infectious causes are often spread by aerosol inhalation to other close contacts.

An acute change in cough, especially with colored sputum production, in addition to upper airway symptoms such as sore throat and nasal congestion may be seen. Muscle aches, low-grade fever, and wheezing are also common. Complications of bronchitis include bronchopneumonia, cough-related chest wall pain, and sleep deprivation. The severity of the symptoms also depends on the underlying state of the heart and lungs; for example, breathing may be greatly worsened in patients who have severe chronic obstructive disease.

Rest, oral fluids, cough suppressants and suppression of fever are usually adequate to treat most viral infectious flares of bronchitis. However, antibiotics may be necessary in patients with concomitant chronic lung disease who have increased volume of colored sputum and fever, or in patients who require hospitalization. If antibiotics are prescribed, they should be taken for a full course, even if you feel better after two or three days.

Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD) is characterized by the inability of your lungs to ventilate properly. The spectrum of COPD encompasses emphysema, Chronic Bronchitis, and reactive airways disease. Reactive airways disease is similar to asthma and Bronchitis. Most cases of COPD are a mixture of these diseases. Chronic bronchitis is defined as excessive mucous production on at least three months of two consecutive years. Emphysema is caused by destruction of the air sacs (alveoli) in the lungs. These diseases cause inhaled air to remain trapped in the lungs. Therefore, effective air exchange does not take place. COPD is not a contagious disease. It is most often the result of long-time smoking, but some cases of emphysema may be hereditary. Other less common causes include air pollution, childhood infections, and inhalation injury.

Your doctor can diagnose COPD by evaluating your symptoms, performing a complete physical examination, and ordering pulmonary function tests, a chest x-ray, and arterial blood gases. In emphysema, pulmonary function tests may show large lung volumes and difficulties expiring air. This disease is associated with shortness of breath and little cough or sputum production. Patients with chronic bronchitis may have the same features but also have a chronic, productive cough. This disease may cause disturbances in sleep due to mucous collection in the airways. The chest x-ray allows the doctor to look at changes in the lung because of the disease. Arterial blood gases measure how much oxygen and carbon dioxide is carried in your blood. Abnormal arterial blood gas values are often found in these diseases. These diseases are progressive and can lead to increased strain on your heart.

Treatment includes smoking cessation and oxygen in people who are found to have a deficiency in oxygen in their blood. It may often include broncho dialation, antibiotics, decongestion and exercise. Vaccinations may decrease the number and type of infection you acquire and your doctor may recommend an influenza vaccine and a pneumococcal pneumonia vaccine. The inherited form of emphysema may require monthly intravenous injection to replace the enzyme which is deficient. Medical treatment and occasional lung transplant may be useful in the treatment of emphysema and bronchitis.

Gastroesophageal Reflux Disease (GERD)

Gastroesophageal Reflux Disease (GERD) is more commonly known as acid indigestion or heartburn. It can be characterized by a burning feeling behind the breastbone which can move up into the throat and give a sour or bitter taste in the mouth. GERD is caused by stomach acid moving from your stomach up into your esophagus (the tube that connects the mouth to the stomach). This may happen if the muscle between the stomach and esophagus is weak. There are conditions that may aggravate this and they include diabetes, pregnancy, and medications used to treat high blood pressure and heart conditions. GERD is very common. About 5% of individuals have symptoms every day. About 15% have symptoms every week. Almost half of all individuals have symptoms at least once a month.

GERD is diagnosed most commonly by history. The most common symptom of GERD is heartburn. The burning, pressure or pain of GERD can last as long as 1 or 2 hours and is often worse after eating. Lying down or bending over can also make the pain worse. The pain associated with heartburn can be mistaken for the pain of a heart attack or angina. It is sometimes difficult to determine the difference and tests may be necessary to determine this.

In most cases, GERD can be relieved through diet and lifestyle modifications. For immediate relief, antacids can neutralize the acid and stop heartburn. However, there are side effects with the long-term use of antacids.< These include diarrhea, altered calcium metabolism, and excess magnesium buildup in the body. Over-the-counter and prescription strength histamine-2 (H2) blockers such as Pepcid, Tagament, and Zantac are available. These medications inhibit the secretion of acid by the stomach. Prevacid and Prilosec are another type of prescription drug called proton pump inhibitors. These drugs inhibit an enzyme needed for acid secretion. Other drugs are available to strengthen the muscle and quicken stomach emptying. A small number of individuals may need surgery because of severe GERD or poor response to medications. The surgical procedure increases the pressure in the lower esophagus, preventing acid from backing up from the stomach.

Influenza

Influenza is a common, acute, and highly contagious respiratory tract infection caused by a virus. Symptoms usually appear 24-48 hours after exposure. It is spread by contact with infected individuals. It affects individuals of all ages, but is especially dangerous for the very young, the elderly, and anyone with a chronic illness. The entire respiratory tract is affected. Influenza cannot be cured, but symptoms can be controlled with medications. The flu vaccine, which is offered yearly in the fall, is the best way to prevent influenza, although there can be cases of influenza in patients who did receive the vaccine. A common myth about the vaccine is that it causes the flu. The headaches & low grade fevers that people sometimes get after receiving the vaccine is due to the activation of the immune system, which produces antibodies against the flu. These symptoms are usually mild and much less severe than the actual flu virus. The flu vaccine does not contain live viruses.

Signs and symptoms include sudden onset of chills and fever (a temperature of 101 F to 104 F), muscle aches, cough, sore throat, runny nose, headache, fatigue, and weakness. These symptoms usually last 3-5 days, with the cough and fatigue lasting longer. Complications of Influenza may include middle ear infections, sinus infection, bronchitis, pneumonia, and Reye’s syndrome. Reye's syndrome is a life threatening illness.

The best treatment is rest. For discomfort, your doctor may prescribe analgesics & antipyretcs, as well as cough syrups and decongestants. It is recommended that you do not give aspirin to a child younger than 16 years because research has shown a link between using aspirin for a viral infection and the development of Reye's syndrome. Some cough medications and decongestants may cause drowsiness. Warm baths or a heating pad may help relieve the muscle aches. A cool-mist vaporizer may help thin secretions, but remember to change the water and clean the unit daily. Gargling with warm salt water or mouthwash may ease the sore throat. There are prescription anti-viral medications available, but these must be taken within the first 48 hours of onset of symptoms in order to be effective.

Idiopathic Pulmonary Fribrosis

Pulmonary Fibrosis is a disease of the lower respiratory tract that leads to a decreased ability of the alveoli to transfer oxygen from the air to the blood. There is widespread inflammation and deposition of scar tissue within the lung tissue. Damage to the lung tissue occurs from a response of the immune system of unknown cause. The disease is more common in men than in women.

Symptoms of pulmonary fibrosis include shortness of breath on exertion that lasts for months or years and eventually is present at rest, decreased tolerance for activity, cough, and chest pain. Your doctor can detect pulmonary fibrosis by physical examination, which could show finger clubbing (abnormal enlargement of the tips of the fingers). Dry, crackling breath sounds may be heard by stethoscope examination of the chest. Other diagnostic test that could be performed to detect pulmonary fibrosis includes chest x-ray, pulmonary function tests, blood work, high resolution CT Scan, or lung biopsy.

There is no prevention or cure for Idiopathic pulmonary fibrosis. The objective of treatment is supportive therapy. Medications such as corticosteroids and bronchodialators may be prescribed to improve breathing; and cytotoxic drugs may be prescribed to suppress the immune system. A lung transplant may be indicated for highly selected patients with end-stage pulmonary fibrosis.

Pleural Effusion

Pleural fluid is normally formed in small amounts between the surfaces of the pleura, the thin membrane that surrounds the lungs and chest wall. A pleural effusion is an abnormal collection of this fluid.

Symptoms of pleural effusions are shortness of breath, chest pain, cough, hiccups, rapid breathing, abdominal pain, and joint stiffness. It can be detected by listening to the chest with a stethoscope, which reveals decreased breath sounds. This is usually confirmed by having a chest x-ray, chest cat scan, or chest MRI.

Treatment depends on the cause of pleural effusion. The cause and type of pleural effusion can usually be determined by taking a sample of the fluid by thoracentesis (removing fluid through a needle inserted between the ribs into the chest cavity). The cause of the effusion (the underlying disease) must be treated as well.

Pleural Effusion can be caused by disease of the lung or heart or as well as diseases in other organs much as the liver or kidney.

The symptoms of pleural effusion can be very non specific and include shortness of breath, chest pain or cough. It can usually be suspected by physical exam which reveals decreased breathing or breath sounds out of the area where the fluid is. The presence of fluid is often confirmed by chest X-Rays.

The treatment of the effusion often depends upon the carrier. This is often determined by taking a sample of fluid and transporting it to the laboratory for evaluation.

Pneumonia

Pneumonia is a term that often refers to infection of the lung. Bacterial pneumonia means that inflammation is causes by a bacterial infection. Bacteria gain access to the lungs either through inhalation or via the bloodstream. Infections occur when the bacteria overwhelm the defense mechanisms. The following conditions may weaken the defense mechanisms and thus increase the risks for bacterial pneumonia: old age, smoking chronic alcohol use, chronic lung disease, congestive heart failure, diabetes, chronic kidney failure, HIV infection, use of drugs that lower the bodies immune system (anti cancer agents, prednisone), and recent viral respiratory tract infections.

Tests are performed to determine the cause and severity of pneumonia, including chest x-rays, and blood and sputum cultures. Common symptoms are fever, cough, chest pain, and shortness of breath. Phlegm may be yellow or green and contain blood. With some types of pneumonia, muscle aches, nausea/ vomiting, fatigue, and weakness are prominent. Complications of pneumonia include inflammation and infection of the pleura (the layer of cells lining the outside of the lung), lung abscess, and lung failure.

Antibiotics are the main treatment and should be started as soon as pneumonia is suspected. Duration of antibiotic therapy ranges from 7 to 10 days in most cases. Therapy for 14-21 days or longer may be necessary for certain types of bacteria and in those individuals with other chronic medical conditions. A pneumococcal pneumonia vaccine is helpful in the prevention of this type of pneumonia.

Pulmonary Embolism

Pulmonary emboli are caused by clots from the venous circulation, from the right side of the heart, from tumors that have invaded the circulatory system, or from other sources such as amniotic fluid, air, fat, bone marrow, and foreign substances. These clots travel in the blood stream & get caught in the lung. A pulmonary embolism affects as many as 5 out of 10,000 people in the United States each year, and sudden death can occur as a result of pulmonary embolism. The risk factors include prolonged bed rest or inactivity, oral contraceptive use, surgery, childbirth, cancer, stroke, heart attack, heart surgery, and fractures of the hips or femur. Most clots originate in the lower extremities as a result of inflamation & damage. This is often called deep vein thrombores of the legs (DVT). The prevention of DVT is early detection and treament may help prevent Pulmonary Embolism. DVT may be prevented by none deep like leg pain or having as well as some mechanical means.

There are many symptoms of pulmonary embolus and most are more specific. They include: cough which begins suddenly and may produce bloody sputum; sudden onset of shortness of breath at rest or with exertion; splinting of ribs with breathing (bending over or holding the chest); lightheadedness; fainting; dizziness; chest pain under the breastbone or on one side; a sharp, stabbing, burning, aching or dull, heavy sensation which may be worse at night, may radiate to the shoulder, arm, neck, jaw, or other area, or may be worsened by breathing deeply, coughing, eating, bending, or stooping; sweating; anxiety; rapid breathing or heart rate (tachycardia). Additional symptoms that may be associated with this disease are: wheezing, clammy skin, bluish skin discoloration, weak or absent pulse, nasal flaring, joint pain, pelvis pain, leg pain in one or both legs, low blood pressure, swelling in the legs (lower extremities), lump associated with a vein near the surface of the body (superficial vein).

Rhinitis, Allergic

In patients with allergic rhinits, the nasal passages are much more sensitive to environmental irritants or allergic triggers. Allergic rhinits is also known as “hay fever.” In patients with more constant or long-term problems, sinus changes, nasal polyps, loss of sense of smell, and itchy red eyes may also be present. Common triggers of allergic rhinits are smoke, smog, pollens, mold, or dust. This condition is not contagious or curable but may require medication and other forms of allergy treatment for control.

Symptoms may be seasonal (especially in the spring and/or fall) or perennial (continuous). Sneezing, runny nose, nasal congestion, scratchy throat, is the most common symptoms. In severe cases, frontal headaches, sinus involvement, and sleep deprivation caused by nighttime symptoms are seen.

The best treatment usually involves reducing or avoiding exposure to the potential allergens, in combination with the use of antihistamines and topical intranasal steroids. In more severe cases, a short course of oral corticosteroids and nasal decongestants may be required. Finally, allergy injections for specific types of allergic rhinits may be considered for individuals who have a poor response to drug therapy. Possible side effects of treatment may include excessive sleepiness, palpitations, or changes in blood pressure control, and occasional thinning of the nasal mucosa.

Sinusitis

Sinusitis is an infection of sinuses (the air pockets in the facial bones that are connected to the nose). It can be an acute or chronic infection often caused by bacteria. Sinusitis sometimes occurs after a viral infection such as a cold.

Signs and symptoms include pain over the sinuses infected, such as the cheek, upper teeth, behind the eyes, or over the eyebrows; a dry cough; low-grade fever; nasal congestion with a thick green-yellow discharge; a severe headache that is worse in the morning; and fatigue.

The treatment of sinusitis usually represses antibiotics and antihistamines. Nasal sprays and decongestants may help to decrease the congestion. Increasing you fluid intake may help to thin the secretions. Resting with the head elevated slightly may help promote drainage. For minor pain, your doctor may recommend analgesics. An acute bout of sinusitis will usually clear completely in 2-3 weeks with treatment. Surgical therapy is sometimes required for the more difficult congestion.

Sleep Apnea

Sleep apnea refers to a condition of repetitive episodes of breathing cessation during sleep. Apneas are often classified as one of three types. Obstructive, Central and Mixed Apneas. Obstructive Apnea is characterized by the closure of airway, preventing airflow while an individual is still making efforts to breathe. When an individual is making no effort to breathe this is called Central Apnea, that is, there is a brief time period where no signal is coming from the brain to initiate breathing. Mixed Apnea is a combination of the two, starting with a Central Apnea and progressing into an Obstructive Apnea.

Symptoms of Sleep Apnea include loud snoring and /or pauses in breathing during sleep with loud snorts /gasps as breathing resumes. Daytime sleepiness, irritability & difficulty concentrating are noticed during the waking hours. Diagnosis is made by a sleep study conducted overnight is a sleep laboratory or center. During the tests, brain activity, breathing patterns, oxygen level, and heart rate are some of the parameters recorded. The technician conducting the study may ask the patient to turn during sleep to see whether position affects the frequency of snoring and apneic episodes. Despite all the recording equipment, most individuals manage to sleep during the study. Detecting and treating sleep apnea is vital for good health. Untreated sleep apnea increases the risk for high blood pressure, stroke, diabetes and heart disease.

Treatment varies depending on the severity of the situation. Weight loss, avoidance of alcohol and sleeping pills, use of nasal decongestants, and not sleeping on the back may be recommended for these who stop breathing infrequently during sleep. A 10% reduction in body weight is a reasonable initial weight loss goal and can improve breathing while asleep.

For many patients, continuous positive airway pressure (CPAP) is prescribed. This system consists of a mask or interface for the nose connected to a bedside airflow generator (CPAP machine) via a flexible hose. Air from the CPAP machine travels under pressure through the hose and mask and into the throat, splinting the airway open. The appropriate level of CPAP pressure for each patient is discovered during the overnight CPAP titration. This overnight study is a follow-up to the baseline or diagnostic sleep study which reveals if the patient has sleep apnea and how severe it is. The CPAP pressure is adjusted by the technician during the overnight titration to find the optimal level for each individual patient. CPAP is very effective when used on a nightly basis and is the most widely prescribed form of therapy. If a patient requires high levels of CPAP or has problems tolerating CPAP then an alternate mode called BiPAP (Bi-level Positive Airway Pressure) may be prescribed.