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Asbestos injures the lungs and surrounding tissues in several
different ways. Just the mere exposure to asbestos causes inflammation
in the lining around the lungs (pleural space) and on the surface
of the diaphragm, which is the muscle that assists us to breathe
in and out. Doctors can detect evidence of prior asbestos contact
by examining x-rays and CT scans of the chest. In people with prior
asbestos exposure these studies reveal calcification along the diaphragm
and the lining of the lungs. In itself, the calcification of the
diaphragm and pleural space is not harmful; it only serves as a
marker of the exposure.
Exposure to asbestos increases the risk of lung cancer and mesothelioma,
a malignancy of the lining around the lungs. Mesothelioma occurs
almost exclusively in people with prior asbestos exposure.
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Some individuals with prior exposure to asbestos suffer from a
disease called asbestosis. Asbestosis describes the scarring and
destruction of the lungs, which results from inhaling asbestos fibers.
Asbestosis usually develops many years after the initial exposure
to asbestos; in some cases the delay between exposure and the onset
of asbestosis can be as long as twenty to twenty-five years. Some
patients have no symptoms from asbestosis, but others suffer from
severe shortness of breath, fatigue and cough. |
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Asthma is the intermittent inflammation and narrowing of bronchial
tubes, which provide the passageway for air movement. It may occur
in almost any age group ranging from infancy to old age. The main
distinction between asthma and emphysema or chronic bronchitis is
the reversibility. Asthma occurs episodically in the form of “attacks.”
In between these attacks, many patients experience no symptoms and
go about their business uninterrupted. Jackie Joyner, an Olympic
athlete, suffered from asthma, took medications on a regular basis,
and still competed in the Olympics in track and field. With effective
management of the disease, people can live relatively normal lives.
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A variety of environmental exposures and other health problems
may trigger attacks. Many asthmatics suffer from severe symptoms
related to allergies. The various allergens capable of triggering
asthma attacks include dog, cat, and other animal hair, as well
as dust mites, weeds, grasses, molds, trees and even cockroaches.
Upper respiratory tract infections, acid indigestion and sinus infections
may also provoke asthma attacks in some people along with exercise
or physical exertion.
People suffering from asthma attacks usually complain of shortness
of breath, coughing and wheezing. The wheezing sounds like a high-pitched
noise similar to a flute and frequently worsens at night. The classic
dry cough of asthma intensifies during the night as well. |
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Chronic bronchitis prevents the complete exhalation of old, stagnant
air of the lungs through inflamed and narrowed passageways of the
bronchial tubes. The air passes through the much narrower tubes
at a slower rate and not enough time exists between breaths for
all the old air to escape. Imagine a liquid or gas flowing through
a pipe. If the force pushing the liquid through the pipe does not
change and the diameter of the pipe shrinks, the liquid will flow
slower and require more time to transverse the length of the pipe.
Since our bodies naturally initiate a new breath every four or five
seconds, people with chronic bronchitis lack sufficient time to
exhale completely before starting a new breath.
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The inflammation of the airways associated with chronic bronchitis
also produces mucus. People who suffer from chronic bronchitis cough
frequently in order to clear this mucus from their airway.
The word chronic means persistent. Chronic bronchitis does not
go away easily or quickly. This “chronic” component
distinguishes it from the routine bronchitis most people associate
with chest congestion and transient coughing. This more common “acute
bronchitis” lasts only a week or two before disappearing with
antibiotic treatment.
The symptoms of chronic bronchitis wax and wan. Any upper respiratory
congestion, viral or bacterial infection of the bronchial tubes
can worsen the symptoms. Exposure to smoke, high levels of pollution,
cold air or perfumes aggravates chronic bronchitis as well.
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Emphysema refers to the destruction of the tiny air sacks on the
perimeter of the lungs. Damage of these tiny air sacks or alveoli
decreases the elasticity of the lungs and prevents the lungs from
recoiling naturally. Imagine a balloon. When it fills with air it
expands and inflates. If one unties the knot keeping the balloon
closed, the air escapes and the balloon flattens back to its previous
small size.
The lungs function in a similar manner. When we exhale, the lungs
deflate and shrink back to their natural size. Emphysema destroys
this natural ability of the lungs to recoil to their small, natural
size. Consequently, patients with emphysema cannot exhale all the
old air in their lungs before initiating a new breath. A small amount
of air remains in the lungs after each breath and the lungs gradually
increase in size due to accumulating amounts of retained air. Doctors
label this gradual expansion of the lungs “hyperinflation.”
Patients with pure emphysema usually do not cough or expectorate
phlegm. Their main complaints consist of persistent fatigue and
shortness of breath.
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Distinguishing between emphysema and chronic bronchitis is often
difficult. Most patients suffer from what is referred to as overlapping
symptoms. For example, people often are adversely affected from
the destruction of the tiny air sacks in the lungs (alveoli) and
the associated loss of elasticity characteristic of emphysema as
well as the chronic inflammation of the airways common in chronic
bronchitis. Sometimes patients may also experience attacks of wheezing
mimicking asthma. Therefore, doctors often use the diagnosis of
chronic obstructive pulmonary disease (COPD) to avoid making arbitrary
distinctions, which can change from time to time.
Patients with chronic obstructive pulmonary disease (COPD) usually
experience the symptoms of emphysema and chronic bronchitis. They
have symptoms of a productive cough and mucus production characteristic
of chronic bronchitis coupled with the shortness of breath and fatigue
commonly present with emphysema.
Doctors usually confirm the presence of chronic obstructive pulmonary
disease based on a variety of factors. A “history” is
taken of any previous illnesses, symptoms, and other information
to get a clearer picture and facilitate an accurate diagnosis. If
you describe feeling short of breath, coughing up phlegm on a long
term basis and fatigue, one of the first disorders to surface in
your doctor’s mind will be chronic obstructive pulmonary disease.
Your physician will also ask about smoking cigarettes and any possible
toxic exposures in your work place.
Next, a chest x-ray is usually performed. In severe cases of COPD
the results will show some abnormalities including flattening of
the diaphragm (the large muscle separating the chest from the abdomen),
abnormally large lungs and lucent air sacks at the top of your lungs
technically called bullae. In milder cases of COPD the chest x-ray
may be completely normal.
The most important tests in diagnosing and evaluating COPD are
the pulmonary function tests. These tests consist of three major
parts: spirometry, lung volumes and diffusion capacity. The spirometry
measures the amount of air a person can exhale from his or her lungs
in a single breath. Patients with obstructive lung diseases cannot
exhale air as quickly from their lungs as normal people. More than
any other tool available in modern medicine spirometry quantifies
the severity of lung disease. How much air a person can exhale in
a single breath determines the severity of the obstructive lung
disease.
Pulmonary function tests also measure the ability of the lungs
to extract oxygen from the surrounding air (the diffusion capacity)
and measure the size of the lungs (the lung volumes). For patients
with obstructive lung disease the measurement of the lung size will
reveal an increase in the total lung size and residual air trapped
inside the lungs. Patients with emphysema will also not extract
oxygen from the air normally due to the destruction of the tiny
air sacks in the lungs (the alveoli).
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If the heart fails to contract normally, blood will not circulate
effectively through the lungs. When the heart malfunctions, fluid
and blood often accumulate in the lungs. This build-up in the lungs
is congestive heart failure and can often be detected on a chest
x-ray.
A wide assortment of heart problems can cause congestive heart
failure and breathing difficulty. Previous heart attacks or diseases
of the heart muscle may prevent normal circulation of blood into
the lungs, leading to accumulation of fluid in the lungs. Narrowing
or leakage of the valves of the heart may also prevent blood from
flowing normally, which results in trouble catching one’s
breath. Blockage and narrowing of the arteries supplying blood to
the muscle of the heart (coronary artery disease) may also impair
the heart’s ability to contract resulting in poor blood flow
and the accumulation of fluid in the lungs (congestive heart failure).
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Thrombophlebitis or deep vein thrombosis (DVT) results from the
formation of a blood clot in the veins of the leg. Any period of
prolonged immobility such as surgery, a long car ride or a lengthy
airplane trip decreases the blood flow in the legs and increases
the risk of blood clots. Smoking, obesity, pregnancy and birth control
pills also increase the risk of DVT.
Patients with this condition usually complain of swelling in one
leg, but they may complain of pain and difficulty walking as well.
The leg can become permanently swollen from damage to the valves
if left untreated for a prolonged period of time. This phenomenon
is post-phlebitic syndrome.
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However, the greatest risk with deep vein thrombosis is not to
the leg itself; a much larger threat is the development of an embolism.
When this occurs, a portion of the clot dislodges from the leg and
travels through the bloodstream to the lungs. If a blood clot (embolism)
lodges in the lungs, a person can experience severe shortness of
breath, chest pain and anxiety. In some cases, pulmonary emboli
kill people.
Due to the risk of pulmonary embolism, all patients with a deep
vein thrombosis extending above the knee require therapy with anticoagulants.
The drug of choice for initial treatment is Heparin. This fast acting
anticoagulant is administered intravenously for five to seven days
before gradually being replaced by the oral medication Coumadin.
For a period of three to six months patients take Coumadin to thin
the blood and prevent new clots from forming in the legs or lungs.
Taking Coumadin increases a person’s susceptibility to bleeding.
Consequently, patients on this drug are more likely to bleed from
an ulcer, hemorrhoids or wounds. While on Coumadin, patients should
avoid activities with a high risk of injury such as horseback riding,
working on ladders or contact sports. In addition, patients on coumadin
must adhere to scheduled appointments with their doctor and close
monitoring through lab work. This close monitoring decreases the
risk of unwanted bleeding.
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Idiopathic pulmonary fibrosis causes inflammation and scarring
of the lower part of the lungs. It generally affects males in their
6th through 8th decades of life. Patients usually experience persistent
coughing, shortness of breath and fatigue. The disease worsens at
variable rates; in the most unfortunate individuals the illness
could advance quickly to a terminal, end stage condition in a matter
of months, but in most cases the progression is slower. Although
no true cure exists for idiopathic pulmonary fibrosis, doctors prescribe
drugs to alleviate the symptoms of the disease. |
The “flu” describes a viral infection of the upper
respiratory tract and lungs caused by the virus influenza. Patients
with influenza usually complain of fevers, body aches, cough and
an overwhelming feeling of fatigue. These symptoms commonly last
for seven to ten days, although many new anti-viral medications
have helped decrease the duration. In elderly or more debilitated
patients the “flu” may have more serious consequences.
These patients can progress to more serious illnesses including
pneumonia (infection of the lungs). Two varieties of pneumonia complicating
the flu exist: a direct infection of the influenza virus itself
into the lungs or a secondary bacterial pneumonia.
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Individuals with pneumonia will notice a sudden worsening of their
symptoms marked by high fevers, phlegm production and absolute exhaustion.
The complications of pneumonia account for the majority of the deaths
reported in influenza epidemics.
If you or your physician suspects influenza, laboratories can confirm
the diagnosis of influenza easily by analyzing a specimen obtained
with a nasal swab. The swab tests for microscopic particles attached
to the virus itself. Laboratories usually offer same day results.
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Pneumonia means infection of the lungs. The majority of pneumonias
come from bacteria (bacterial pneumonia) and around ten percent
result from other microorganisms, including viruses and fungi. Contrary
to some common misperceptions, going outside with wet hair or leaving
your house without a jacket does not cause pneumonia. The majority
of pneumonias result from bacteria normally living in our mouth
and nose, which inadvertently pass down the trachea (windpipe) into
the lungs. Once the bacteria reach the lungs, they proliferate and
cause fever, cough and chest pain.
Some pneumonias may be transmitted from person to person through
respiratory droplets. A small percentage also comes from birds living
in the house (psitacosis), sheep (Q fever), or wild animals (tularemia).
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Pulmonary emboli are small blood clots, which lodge in the circulation
between the heart and lungs and prevent blood from flowing normally
through the lungs. These emboli usually begin as clots in the veins
of the legs or pelvis (deep vein thrombosis). Patients with cancer,
inherited problems with blood clotting, and cigarette smoking are
more likely to develop deep vein thrombi and eventual pulmonary
emboli. Pregnancy, the use of birth control bills or prolonged immobilization
associated with surgeries or long trips also increase a person’s
risk of developing deep vein thrombosis and eventual pulmonary emboli.
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Physicians generally treat pulmonary emboli with blood thinners
called anti-coagulants. Treatment requires initial therapy with
a short acting anticoagulant called Heparin. Doctors administer
it intravenously so it begins acting immediately. Patients usually
require a full week of Heparin therapy. During these seven days
the physician will also initiate treatment with an oral anti-coagulant
called Coumadin. This drug takes effect over several days and experts
recommend continuing the Coumadin for six months. During this therapy,
patients must check their clotting times every two to four weeks
in order to monitor the medication.
Coumadin also increases the risk of bleeding. Consequently, patients
with prior histories of internal bleeding or an intracranial hemorrhage
may not be candidates for Coumadin. In these cases, we recommend
the insertion of a titanium filter in the large vein in the abdomen
(the vena cava). This filter catches any pieces of clot dislodging
from the legs and migrating toward the lungs, thereby preventing
pulmonary emboli.
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Sarcoidosis causes inflammation and scar formation in the lymph
nodes at the center of the chest near the lungs. Although no one
knows for certain what causes sarcoidosis, it affects women more
often than men and occurs more frequently in certain racial minorities.
In more severe cases, the inflammation and scarring in sarcoidosis
may spread to the lungs themselves causing shortness of breath,
cough and fatigue. |
Tuberculosis is a slowly progressive bacterial infection of the
lungs. Although public health officials have made significant headway
in decreasing the incidence of tuberculosis in the United States,
it remains common in inner cities, patients infected with the AIDS
virus and immigrants from Latin America and Southeast Asia.
Tuberculosis often lacks symptoms and physicians frequently discover
early tuberculosis on screening chest x-rays or skin tests designed
to detect tuberculosis. In its later stages, this disease often
causes fevers, sputum production, weight loss and shortness of breath.
With modern treatments, tuberculosis is usually curable. Most
standard drug therapies require a combination of four different
medications given for varying durations and in different doses over
a period of six months. If patients suffer from a more resistant
form of tuberculosis, longer, more intense treatment may be required.
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