Asbestos Related Lung Disease
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.

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.
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.

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.
Chronic Bronchitis
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.

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.

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.

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).

Congestive Heart Failure
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).

Deep Vein Thrombosis
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.

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.

Idiopathic Pulmonary Fibrosis
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.

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.

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).

Pulmonary Emboli
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.

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.

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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