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Pulmonology

Pulmonology is the study and science of the anatomy, physiology, and pathology of the lungs. It is considered as a subspecialty of internal medicine as it deals with the study and treatment of the diseases of the lungs and respiratory tract.

Pulmonology is also known in other countries as Pneumology, Respiratory medicine, Chest medicine and Pulmonary medicine. This branch of medicine is also closely related to intensive care medicine as it deals with patients that require mechanical ventilation.

Chest medicine is not a specialty by itself but it is a term used to describe the treatment of chest ailments and it also includes the fields of pulmonology, intensive care medicine and thoracic surgery.

The primary focus of the Pulmonology is the treatment of lung diseases including the handling and prevention of tuberculosis. Medical experts specializing in Pulmonology are called pulmonologists.

Pulmonologists are physicians that have received a medical degree MD or had completed residency training in internal medicine for three years and followed it by at least another two years of subspecialty fellowship training in pulmonology.

With the various clinical problems in relation to lungs and respiratory tracts, pulmonologists are expected to possess medical knowledge of internal medicine and other specialties that deal with lung conditions. The common diseases under pulmonology are asthma, pneumonia, tuberculosis, cystic fibrosis and lung cancer.

ASTHMA

Asthma, also known as Reactive Airway Disease is a chronic disease that renders it hard to breathe. At its most terrible, asthma can be fatal. Case in point, in 2003, asthma took the lives of 287 Canadians. Asthma can't be cured, but it can be managed. With appropriate treatment, people with asthma can lead ordinary, active lives.

Asthmatic people have airways (breathing passages) that are extra sensitive. When they are around certain things, the ultra-sensitive airways can become:

• Red and swollen, as the airways get inflamed inside and fill up with mucus. The swelling and mucus make the airways more constricted, so it's more difficult for the air to pass through.
• "twitchy" and go into seizures. The muscles around the airways press together and constrict. This causes the airways to tighten, leaving less space for the air to pass through.
  

The more red and inflamed the airways are, the more “twitchy” they become.

Several different things can activate asthma symptoms. Every person with asthma has hi/her own group of asthma inducers and asthma activators. Asthma inducers are things one is allergic to that are breathed, for example, pollen or dust. Asthma activators are things that trigger asthma like smoke or cold air.

CAUSES
Asthma is almost certainly due to a mixture of environmental and genetic aspects. A person is more likely to acquire asthma if it runs in his/her family and if one is sensitive to allergens or irritants in the environment. Initial, recurrent infections and constant exposure to secondhand smoke or specific allergens may boost the probability of developing asthma.

Exposure to a range of allergens and irritants may set off asthma symptoms. The following are common things that activate asthma symptoms:

• Allergens (pollen, animal dander or mold)
• Air pollutants, irritants
• Cockroaches, dust mites
• Strong odors, scented products, chemicals
• Smoke
• Physical hard work, including exercise
• Respiratory infections (for example, the common cold)
• Cold air
• Intense emotions and stress
• Sinusitis
• Sulfites, preservatives put in some perishable foods
• Specific medications (beta blockers, aspirin and other non-steroidal anti-inflammatory drugs)

Gastroesophageal Reflux Disease (GERD)--a state in which stomach acids reverse into the esophagus. GERD may set off an asthma attack or make an attack worse.

DIAGNOSIS & SYMPTOMS

Diagnosis

A doctor deduces asthma based principally on a person's report of typical symptoms. A diagnosis of asthma can be established by means of spirometry tests.

For the duration of an asthma attack, the test divulges reduced airflow, but for more than hours or days, narrowing advances and is consequently reversible.

More frequently, the doctor carries out spirometry or pulmonary function tests prior to and after giving the patient an inhaled beta-adrenergic agonist. If outcomes are considerably better after the person gets the beta-adrenergic agonist, asthma is believed to be present. If the airways are not constricted at the moment of the first test, a diagnosis can be established by a test in which the person breathes in a chemical (generally methacholine but histamine may be utilized also) in doses very low to distress a normal person but which causes airway contraction in a person who has asthma.

Symptoms
Asthma signs and symptoms can vary from mild to severe. One may have only sporadic asthma episodes with mild, brief symptoms such as wheezing. Amid episodes, one may feel normal and have no trouble breathing. Some people with asthma have persistent coughing and wheezing combined with harsh asthma attacks.

A good number of asthma attacks are led by warning signs. Identifying these warning signs and dealing with symptoms early on can help thwart attacks or keep them from becoming worse.

Adults must be conscious of some warning signs and symptoms of asthma including:

• Troubled sleep caused by coughing, shortness of breath, or wheezing
• Heightened shortness of breath or wheezing
• Bigger need to use bronchodilators or drugs that open up airways by soothing the surrounding muscles
• Chest rigidity or pain
• A drop in peak flow rates as gauged by a peak flow meter, a simple and low-cost device that lets one monitor his/her own lung function
• Children frequently have an audible whistling or wheezing sound when exhaling and recurrent coughing spasms.

TESTS & TREATMENT

Test

• Spirometry—The most accurate breathing test for asthma where an instrument called a spirometer is used.
  

Doctors use spirometry to:

• help spot if a patient has asthma
• help work out how serious the asthma is
• see if the asthma is getting worse
• see if the asthma is getting better with treatment

Spirometry perfectly measures and documents the quantity of air inhaled and exhaled out of the lungs. The results illustrate how constricted the airways in the lungs are. Spirometry also helps the doctor to choose what drugs to recommend to the patient or whether the amount of the present medication needs to be increased or decreased.

• Peak flow meter—This provides an image of how narrow the airways are by computing the highest (or peak) rate at which one can blow air into it. Peak flow aids one to see how much one’s airways are changing.

If a patient has asthma medications every day, the doctor may advise him/her to use a peak flow meter to assist in checking one’s asthma at home. Normally children over the age of seven are adept at learning how to use a peak flow meter properly.

Peak flow measurement is most often employed to help one identify:

• when the asthma is getting worse
• when one may need to increase medication     

Treatment
Most people use a mixture of long-term control medicines and fast relief medications. A doctor must be consulted to decide which option is best for the patient based on age and the seriousness of symptoms. In general, the major types of asthma medications are:

• Long-term-control medications—These are taken daily on a long-term basis to manage chronic symptoms and foil asthma attacks.
  
  
  1. Inhaled corticosteroids—anti-inflammatory drugs that stop blood vessels from leaking fluid into the airway tissues.
  2. Long-acting beta-2 agonists (LABAs)—part of a set of medications called bronchodilators, which open up tight airways. Salmeterol (Serevent Diskus) and formoterol (Foradil), which last at least 12 hours, are used to control average and serious asthma and to stop nighttime symptoms.
  3. Leukotriene modifiers—lessen the production or obstruct the action of leukotrienes--substances discharged by cells in the lungs during an asthma attack
  4. Cromolyn and nedocromil—though not helpful for everyone, everyday use of nedocromil (Tilade) or inhaled cromolyn (Intal) may help put off attacks of mild to moderate asthma as well as asthma prompted by exercise.
  5. Theophylline—a bronchodilator in pill form to be taken every day. It relieves nighttime symptoms of asthma.
     
• Quick-relief medications—Short-acting bronchodilators, which are often, called "rescue" or "quick-relief" drugs to stop the symptoms of an asthma attack in progress.
  
  
  1. Short-acting beta-2 agonists—bronchodilators which begin acting within minutes and last 4-6 hours.
  2. Ipratropium (Atrovent).
  3. Oral and intravenous corticosteroids for asthma attacks—Prednisone, methylprednisolone, hydrocortisone and others may be taken to deal with acute asthma attacks or very serious asthma.

COMPLICATIONS

• Pneumonia
• Pneumothorax or pneumomediastinum
• Respiratory failure needing intubation in severe aggravation of the condition

Complications associated with most medications used for asthma are relatively rare. Those found in patients on long-term corticosteroid use includes:

• Osteoporosis
• Cataracts
• Immunosuppression
• Weight gain
• Myopathy
• Thinning of skin
• Addisonian crisis
• Avascular necrosis
• Easy bruising
• Psychiatric disorders
• Diabetes

PREVENTIONS

• Reduce exposure to environmental activators, such as molds, pollens, animal dander and secondhand tobacco smoke by:
  
  
  1. Keeping the home cooled to 68-72 degrees Fahrenheit
  2. Providing excellent ventilation with HEPA (high-efficiency particulate air) filters, fans and other devices
  3. Maintain humidity between 40 and 50 percent
  4. Put on a mask when cleaning the house or doing yard work, or better yet, hand over these tasks to others
  5. Combine mold inhibitor to paint, particularly in damp places like the bathroom
  6. Replace carpets with hard flooring
  7. Closely stay on the asthma action plan suggested by the doctor. Be sure to take all asthma medications as ordered.
  8. Keep a healthy lifestyle that includes good nutrition, enough rest, and regular exercise.
  9. Keep a healthy weight. Obese persons who lose weight often get rid of symptoms of asthma as well.

INCIDENCE AND STATISTICS
Frequency in the US:

Five to ten percent of the population or an estimated 14-15 million persons, including 5 million children. The rate of exercise-caused symptoms in persons with asthma has been reported to fluctuate from 40-90%.

Frequency in other nations:

Asthma is common in industrialized countries such as Canada, Australia, England, New Zealand, and Germany where factors such as urbanization, passive smoking, air pollution, and change in exposure to environmental allergens are greater. The occurrence rate of acute asthma in industrialized countries varies from two to ten percent. Recent trends suggest an increase in the prevalence of the disease, particularly in children younger than six years

PNEUMONIA

Pneumonia is a disease of the lungs and respiratory system in which the alveoli (microscopic air-filled sacs of the lung accountable for taking in oxygen from the environment) become swollen and inundated with fluid.

Pneumonia can result from a range of causes, including infection with viruses, bacteria, fungi, or parasites. Pneumonia may also crop up from chemical or physical injury to the lungs, or indirectly due to a different medical disease, such as alcohol abuse or lung cancer. 

Characteristic symptoms related to pneumonia include cough, fever, chest pain, and problem with breathing. Tools in diagnosing pneumonia include x-rays and examination of the sputum. Treatment relies upon the cause of pneumonia. Bacterial pneumonia, for example is treated with antibiotics.

Pneumonia is a common sickness, arises in all age groups, and is a top cause of death among the elderly and people who are persistently ill. Vaccines to put off specific types of pneumonia are accessible. The diagnosis for an individual rests on the kind of pneumonia, the proper treatment, any complications, and the person's health.

CAUSES
Pneumonia is caused by a lot of factors. Though, bacteria are the most common causes of pneumonia.

The most common bacterium that sets off pneumonia is Streptococcus pneumonia--20% to 60% community-acquired pneumonias in adults and 13% to 38% in children.

Staphylococcus aureus explains for 10% to 15% of hospital-acquired pneumonias. It is most frequently linked with viral influenza and patients with a dwindling immune system. Streptococcus pyogenes (Group A Streptococcus) can also cause pneumonia.

Atypical pneumonias, such as Walking Pneumonia, are caused by bacterial organisms and come with mild symptoms such as a dry cough. They usually do not call for hospital care.

Viral Causes of Pneumonia:

• Influenza
• Severe Acute Respiratory Distress Syndrome (SARS)
• Respiratory Syncytial Virus (RSV)
• Adenoviruses
• Human Parainfluenza Virus (HPV)
• Herpesviruses

COMPLICATIONS

Bacteria in the bloodstream.
Pneumonia can turn fatal when inflammation from the disease fills up the air sacs in the lungs and impedes with the capacity to breathe. In several cases the infection may attack the bloodstream (bacteremia). It can then extend rapidly to other organs.

Lung abscess.
A cavity holding pus (abscess) that develops within the area distressed by pneumonia is one more possible complication. Abscesses frequently are treated with antibiotics, but in unusual cases they may need to be eliminated surgically.

Fluid buildup and infection around the lungs.
At times fluid builds up between the thin, clear membrane (pleura) enveloping the lungs and the membrane that coats the inner surface of the chest wall—a state known as pleural effusion.

PREVENTION

• Get a pneumonococcal vaccine. Those who stand to gain most from vaccination are people over the age 65; anyone with persistent health problems (heart disease, diabetes, kidney disease, etc.); anyone who has had their spleen taken out; anyone staying in a nursing home or chronic care facility; healthcare workers or family caregivers; children with persistent respiratory diseases (such as asthma), and anyone who has had pneumonia in the past (because of the increased risk of reinfection). The pneumonococcal vaccine is 90 percent helpful against the bacteria and defends against infection for five to ten years.
• Follow good hygiene.
• Get an influenza shot every fall.
• Apply good preventive measures by eating a proper diet, getting regular exercise and lots of sleep.
• Do not smoke.
  
  

INCIDENCE AND STATISTICS
(Data are for U.S.)

Mortality

Number of deaths: 64,954 (2002)

Deaths per 100,000 population: 22.5 (2002)

Percent of hospital inpatient deaths from pneumonia: 8.1 (2000)

Health Care

Number of discharges: 1.3 million (2002)

Average length of stay: 5.7 days (2002)

Home health care

Number of current patients with pneumonia as primary diagnosis: 20,300 (2000)

Percent of current patients with pneumonia as primary diagnosis: 1.5 (2000)

Survey

Nursing home care:

Number of residents with pneumonia: 46,000 (1999)

Percent of residents with pneumonia: 2.5 (1999)

Average length of stay for discharges with pneumonia as primary diagnosis: 124 days (1999