Pulmonary Diseases

Asthma

Asthma is a chronic lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning.

Asthma affects people of all ages, but it most often starts during childhood. In the United States, more than 25 million people are known to have asthma. About 7 million of these people are children.

To understand asthma, it helps to know how the airways work. The airways are tubes that carry air into and out of your lungs. People who have asthma have inflamed airways. The inflammation makes the airways swollen and very sensitive. The airways tend to react strongly to certain inhaled substances.

When the airways react, the muscles around them tighten. This narrows the airways, causing less air to flow into the lungs. The swelling also can worsen, making the airways even narrower. Cells in the airways might make more mucus than usual. Mucus is a sticky, thick liquid that can further narrow the airways.

This chain reaction can result in asthma symptoms. Symptoms can happen each time the airways are inflamed.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sometimes asthma symptoms are mild and go away on their own or after minimal treatment with asthma medicine. Other times, symptoms continue to get worse.

When symptoms get more intense and/or more symptoms occur, you're having an asthma attack. Asthma attacks also are called flareups or exacerbations.

Treating symptoms when you first notice them is important. This will help prevent the symptoms from worsening and causing a severe asthma attack. Severe asthma attacks may require emergency care, and they can be fatal.

Asthma has no cure. Even when you feel fine, you still have the disease and it can flare up at any time.

However, with today's knowledge and treatments, most people who have asthma are able to manage the disease. They have few, if any, symptoms. They can live normal, active lives and sleep through the night without interruption from asthma.

 

If you have asthma, you can take an active role in managing the disease. For successful, thorough, and ongoing treatment, build strong partnerships with your doctor and other health care providers.

For more information on asthma, please click this link to learn more.

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COPD

COPD

Also known as chronic obstructive pulmonary disease; chronic bronchitis; or emphysema.

 

COPD, or chronic obstructive pulmonary disease, is a progressive disease that makes it hard to breathe. Progressive means the disease gets worse over time.

COPD can cause coughing that produces large amounts of a slimy substance called mucus, wheezing, shortness of breath, chest tightness, and other symptoms.

Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke or used to smoke. However, up to 25 percent of people with COPD never smoked. Long-term exposure to other lung irritants—such as air pollution, chemical fumes, or dusts—also may contribute to COPD. A rare genetic condition called alpha-1 antitrypsin (AAT) deficiency can also cause the disease.

To understand COPD, it helps to understand how the lungs work. The air that you breathe goes down your windpipe into tubes in your lungs called bronchial tubes or airways.

Within the lungs, your bronchial tubes branch many times into thousands of smaller, thinner tubes called bronchioles. These tubes end in bunches of tiny round air sacs called alveoli.

Small blood vessels called capillaries run along the walls of the air sacs. When air reaches the air sacs, oxygen passes through the air sac walls into the blood in the capillaries. At the same time, a waste product, called carbon dioxide (CO2) gas, moves from the capillaries into the air sacs. This process, called gas exchange, brings in oxygen for the body to use for vital functions and removes the CO2.

The airways and air sacs are elastic or stretchy. When you breathe in, each air sac fills up with air, like a small balloon. When you breathe out, the air sacs deflate and the air goes out.

In COPD, less air flows in and out of the airways because of one or more of the following:

  • The airways and air sacs lose their elastic quality.

  • The walls between many of the air sacs are destroyed.

  • The walls of the airways become thick and inflamed.

  • The airways make more mucus than usual and can become clogged.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In the United States, the term COPD includes two main conditions—emphysema and chronic bronchitis. In emphysema, the walls between many of the air sacs are damaged. As a result, the air sacs lose their shape and become floppy. This damage also can destroy the walls of the air sacs, leading to fewer and larger air sacs instead of many tiny ones. If this happens, the amount of gas exchange in the lungs is reduced.

In chronic bronchitis, the lining of the airways stays constantly irritated and inflamed, and this causes the lining to swell. Lots of thick mucus forms in the airways, making it hard to breathe.

Most people who have COPD have both emphysema and chronic bronchitis, but the severity of each condition varies from person to person. Thus, the general term COPD is more accurate.

COPD is a major cause of disability, and it is the fourth leading cause of death in the United States. Currently, 16 million people are diagnosed with COPD. Many more people may have the disease and not even know it.

COPD develops slowly. Symptoms often worsen over time and can limit your ability to do routine activities. Severe COPD may prevent you from doing even basic activities like walking, cooking, or taking care of yourself.

Most of the time, COPD is diagnosed in middle-aged or older adults. The disease is not contagious, meaning it cannot be passed from person to person.

COPD has no cure yet, and doctors do not know how to reverse the damage to the lungs. However, treatments and lifestyle changes can help you feel better, stay more active, and slow the progress of the disease.

For more information on COPD, please click this link to learn more.

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Cough

Cough

A cough is your body’s natural reflex to help clear your airways of irritants and prevent infection.

Common irritants include smoke, mucus, or allergens such as pollen, mold, or dust. Some medical conditions or medicines irritate the nerve endings in your airways and cause coughing.

A cough may be acute, subacute, or chronic depending on how long it lasts. Acute coughs last less than three weeks and usually are caused by the common cold or other infections such as sinusitis or pneumonia. Subacute coughs last three to eight weeks and remain after the initial cold or respiratory infection is over. Chronic coughs last more than eight weeks and can be caused by gastroesophageal reflux disease (GERD), postnasal drip from sinus infections or allergies, or chronic lung conditions such as asthma, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, and interstitial lung diseases.

Your doctor will consider your medical history, physical exam, and test results when diagnosing and treating cough. Quitting smoking and avoiding smoke, other irritants, or certain medicines may help relieve your cough. Medicines to control coughing are usually used only for coughs that cause extreme discomfort or interfere with sleep. Talk to your doctor about how to treat your child’s cough.

For more information on cough, please click this link to learn more.

Pneumonia

Pneumonia is a bacterial, viral, or fungal infection of one or both sides of the lungs that causes the air sacs, or alveoli, of the lungs to fill up with fluid or pus. Symptoms can be mild or severe and may include a cough with phlegm (a slimy substance), fever, chills, and trouble breathing. Many factors affect how serious pneumonia is, such as the type of germ causing the lung infection, your age, and your overall health. Pneumonia tends to be more serious for children under the age of five, adults over the age of 65, people with certain conditions such as heart failure, diabetes, or COPD (chronic obstructive pulmonary disease), or people who have weak immune systems due to HIV/AIDS, chemotherapy (a treatment for cancer), or organ or blood and marrow stem cell transplant procedures.

To diagnose pneumonia, your doctor will review your medical history, perform a physical exam, and order diagnostic tests. This information can help your doctor determine what type of pneumonia you have. If your doctor suspects you got your infection while in a hospital, you may be diagnosed with hospital-acquired pneumonia. If you have been on a ventilator to help you breathe, you may have ventilator-associated pneumonia. The most common form of pneumonia is community-acquired pneumonia, which is when you get an infection outside of a hospital.

Treatment depends on whether bacteria, viruses, or fungi are causing your pneumonia. If bacteria are causing your pneumonia, you usually are treated at home with oral antibiotics. Most people respond quickly to treatment. If your symptoms worsen you should see a doctor right away. If you have severe symptoms or underlying health problems, you may need to be treated in a hospital. It may take several weeks to recover from pneumonia.

For more information on pneumonia, please click this link to learn more.

Bronchitis

Bronchitis is a condition in which the airways in the lungs, called bronchial tubes, become inflamed and cause coughing, often with mucus. Bronchitis can be acute or chronic.

Most people with acute bronchitis recover after a few days or weeks. Viral infections, such as the cold or flu, are usually the cause of acute bronchitis. Occasionally, acute bronchitis can be caused by a bacterial infection.

Chronic bronchitis is an ongoing cough that lasts for several months and comes back two or more years in a row. In chronic bronchitis, the lining of the airways stays constantly inflamed. This causes the lining to swell and produce more mucus, which can make it hard to breathe. Chronic bronchitis is often part of a serious condition called chronic obstructive pulmonary disease (COPD).

Your risk for either type of bronchitis is higher if you smoke cigarettes or have asthma or allergies. Chronic bronchitis is most often caused by smoking cigarettes, but it can occur in non-smokers as well. Women who smoke may be more at risk than men. Those who are older, have been exposed to fumes or secondhand smoke, have a family history of lung disease, have a history of childhood respiratory diseases, or have gastroesophageal reflux disease (GERD), are also at higher risk of getting chronic bronchitis.

The most common symptom of bronchitis is coughing associated with mucus production. Other symptoms include wheezing or shortness of breath, chest pain, or a low fever. To diagnose bronchitis, your doctor will do a physical exam and ask about your medical history and symptoms. The doctor may also order a blood test to look for signs of infection or a chest X-ray to see if your lungs and bronchial tubes look normal and rule out pneumonia.

Usually, acute bronchitis goes away on its own, without treatment. Sometimes over-the-counter medicines that loosen mucus or a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen can help manage acute bronchitis. Taking a couple of teaspoons of honey or using a humidifier may also reduce the symptoms and help with comfort. Doctors typically prescribe antibiotics only if they find that you have a bacterial infection, which is more common in young children. To prevent acute bronchitis from recurring, your doctor may recommend that you get a seasonal flu vaccine, quit smoking, and avoid being around secondhand smoke.

 

The goal of treatment for chronic bronchitis is to help you breathe better and control your symptoms. Your doctor may recommend healthy lifestyle changes such as quitting smoking; taking medicines to help clear your airways or to prevent symptoms from getting worse; or, in some cases, getting oxygen therapy to help you breathe better. Pulmonary rehabilitation can teach you breathing techniques such as pursed-lip breathing and help you prevent symptoms from worsening.

For more information on acute bronchitis, please click this link to learn more.

For more information on chronic bronchitis, please click this link to learn more.

Pulmonary Embolism

Pulmonary embolism, or PE, is a sudden blockage in a lung artery. The blockage usually is caused by a blood clot that travels to the lung from a vein in the leg.

A clot that forms in one part of the body and travels in the bloodstream to another part of the body is called an embolus (EM-bo-lus).

PE is a serious condition that can:

  • Damage part of your lung because of a lack of blood flow to your lung tissue. This damage may lead to pulmonary hypertension (increased pressure in the pulmonary arteries).

  • Cause low oxygen levels in your blood.

  • Damage other organs in your body because of a lack of oxygen.

 

If a blood clot is large, or if there are many clots, PE can cause death.

PE most often is a complication of a condition called deep vein thrombosis (DVT). In DVT, blood clots form in the deep veins of the body—most often in the legs

Interstitial lung disease (ILD) is a group of lung disorders in which the lung tissues become inflamed and then damaged.

 

The lungs contain tiny air sacs (alveoli), which is where oxygen is absorbed. These air sacs expand with each breath.

The tissue around these air sacs is called the interstitium. In people with interstitial lung disease, this tissue becomes stiff or scarred, and the air sacs are not able to expand as much. As a result, not as much oxygen can get to the body.

ILD can occur without a known cause. This is called idiopathic ILD. Idiopathic pulmonary fibrosis (IPF) is the most common disease of this type.

There are also dozens of known causes of ILD, including:

  • Autoimmune diseases (in which the immune system attacks the body) such as lupus, rheumatoid arthritis, sarcoidosis, and scleroderma

  • Lung inflammation due to breathing in a foreign substance such as certain types of dust, fungus, or mold (hypersensitivity pneumonitis)

  • Medicines (such as nitrofurantoin, sulfonamides, bleomycin, amiodarone, methotrexate, gold, infliximab, and etanercept)

  • Radiation treatment to the chest

  • Working with or around asbestos, coal dust, cotton dust, and silica dust (called occupational lung disease) 

 

Cigarette smoking may increase the risk of developing some forms of ILD and may cause the disease to be more severe.

 

Shortness of breath is a main symptom of ILD. You may breathe faster or need to take deep breaths:

  • At first, shortness of breath may not be severe and is only noticed with exercise, climbing stairs, and other activities.

  • Over time, it can occur with less strenuous activity such as bathing or dressing, and as the disease worsens, even with eating or talking. 

 

Most people with this condition also have a dry cough. A dry cough means you do not cough up any mucus or sputum.

 

Over time, weight loss, fatigue, and muscle and joint pain are also present.

 

People with more advanced ILD may have:

  • Abnormal enlargement of the base of the fingernails (clubbing)

  • Blue color of the lips, skin, or fingernails due to low blood oxygen levels (cyanosis) 

  • Symptoms of the other diseases such as arthritis or trouble swallowing (scleroderma), associated with ILD

 

The health care provider will perform a physical exam. Dry, crackling breath sounds may be heard when listening to the chest with a stethoscope. 

The following tests may be done:

  • Blood tests to check for autoimmune diseases

  • Bronchoscopy with or without biopsy

  • Chest x-ray

  • High resolution CT (HRCT) scan of the chest

  • MRI chest

  • Echocardiogram

  • Open lung biopsy

  • Measurement of the blood oxygen level at rest or when active

  • Blood gases

  • Pulmonary function tests

  • Six minute walk test (checks how far you can walk in 6 minutes and how many times you need to stop to catch your breath) 

 

People who are heavily exposed to known causes of lung disease in the workplace are usually routinely screened for lung disease. These jobs include coal mining, sand blasting, and working on a ship.

 

Treatment depends on the cause and duration of the disease. Medicines that suppress the immune system and reduce swelling in the lungs are prescribed if an autoimmune disease is causing the problem. For some people who have IPF, pirfenidone and nintedanib are two medicines that may be used to slow the disease. If there is no specific treatment for the condition, the aim is to make you more comfortable and support lung function:

  • If you smoke, ask your provider about how to stop smoking.

  • People with low blood oxygen levels will receive oxygen therapy in their home. A respiratory therapist will help you set up the oxygen. Families need to learn proper oxygen storage and safety. 

Lung rehabilitation can provide support, and help you learn:

  • Different breathing methods

  • How to set up your home to save energy

  • How to eat enough calories and nutrients

  • How to stay active and strong 

Some people with advanced ILD may need a lung transplant.

 

You can ease the stress of illness by joining a support group. Sharing with others who have common experiences and problems can help you not feel alone.

 

The chance of recovering or ILD getting worse depends on the cause and how severe the disease was when it was first diagnosed.

Some people with ILD develop heart failure and high blood pressure in the blood vessels of their lungs.

 

Idiopathic pulmonary fibrosis has a poor outlook.

Pulmonary hypertension, or PH, is increased pressure in the pulmonary arteries. These arteries carry blood from your heart to your lungs to pick up oxygen.

PH causes symptoms such as shortness of breath during routine activity (for example, climbing two flights of stairs), tiredness, chest pain, and a racing heartbeat. As the condition worsens, its symptoms may limit all physical activity.

To understand PH, it helps to understand how your heart and lungs work. Your heart has two sides, separated by an inner wall called the septum.

Each side of your heart has an upper and lower chamber. The lower right chamber of your heart, the right ventricle, pumps blood to your pulmonary arteries. The blood then travels to your lungs, where it picks up oxygen.

The upper left chamber of your heart, the left atrium, receives the oxygen-rich blood from your lungs. The blood is then pumped into the lower left chamber of your heart, the left ventricle. From the left ventricle, the blood is pumped to the rest of your body through an artery called the aorta.

PH begins with inflammation and changes in the cells that line your pulmonary arteries. Other factors also can affect the pulmonary arteries and cause PH. For example, the condition may develop if:

  • The walls of the arteries tighten.

  • The walls of the arteries are stiff at birth or become stiff from an overgrowth of cells.

  • Blood clots form in the arteries.

 

These changes make it hard for your heart to push blood through your pulmonary arteries and into your lungs. As a result, the pressure in your arteries rises. Also, because your heart is working harder than normal, your right ventricle becomes strained and weak.

Your heart may become so weak that it can't pump enough blood to your lungs. This causes heart failure. Heart failure is the most common cause of death in people who have PH.

PH is divided into five groups based on its causes. In all groups, the average pressure in the pulmonary arteries is higher than 25 mmHg at rest or 30 mmHg during physical activity. The pressure in normal pulmonary arteries is 8–20 mmHg at rest. (The mmHg is millimeters of mercury—the units used to measure blood pressure.)

Other diseases or conditions, such as heart and lung diseases or blood clots, usually cause PH. Some people inherit the condition (that is, their parents pass the genes for PH on to them). In some cases, the cause isn't known.

PH has no cure. However, research for new treatments is ongoing. The earlier PH is treated, the easier it is to control.

Treatments include medicines, procedures, and other therapies. These treatments can relieve PH symptoms and slow the progress of the disease. Lifestyle changes also can help control symptoms.

Content provided by the National Heart, Lung, and Blood Institute. and MedlinePlus.

Interstitial Lung Disease

Pulmonary Hypertension