Respiratory Diseases: Asthma

Common Respiratory Diseases

• Pathological conditions affect organs and tissues, making gas exchange difficult in air-breathing animals.
• Conditions include those of the respiratory tract, such as the trachea, bronchi, bronchioles, alveoli, pleurae, pleural cavity, as well as the nerves and muscles of respiration.
• Common respiratory diseases include: Asthma, COPD, Chronic Bronchitis, Emphysema, Lung Cancer, Cystic Fibrosis/Bronchiectasis, Pleural Effusion, Pneumonia, Tuberculosis, and COVID-19.

Asthma

• A common, chronic respiratory condition causing breathing difficulty due to airway inflammation.
• Asthma symptoms: Dry cough, wheezing, chest tightness, and shortness of breath.
• Environmental allergies, allergic reactions, infections, and pollution can trigger attacks.
• Anti-inflammatory medication can improve the quality of life, and rescue inhalers open airways quickly.
• Asthma often starts in childhood, progressing into adulthood, can also develop in older adults (60s-80s).
• It is a reversible obstructive lung disease, patients can improve breathing flow rates better than with COPD.

Chronic Obstructive Pulmonary Disease (COPD)

• An umbrella term for respiratory illnesses causing breathlessness or the inability to exhale normally.
• Symptoms include shortness of breath and coughing up sputum.
• COPD can be difficult to identify as symptoms can be mistaken for aging or body deterioration, and can develop over several years.
• COPD often goes undetected for long periods, begins in people's 30s or 40s, and peaks in their 50s-70s.
• It is generally associated with cigarette smoking, and people experience varying severity levels.
• Treatment includes smoking cessation, bronchodilator therapy, and pulmonary rehabilitation.
• COPD is not reversible, and it continues to worsen, even with smoking cessation.

Chronic Bronchitis

• A form of COPD emphasized by a chronic cough.
• People usually cough up sputum, especially in the morning.
• Mucus glands in the airways increase output, patients must cough to remove extra secretion.
• Chronic Bronchitis is treated the same way as COPD.
• Acute bronchitis is not a long-term disease, is caused by an infection, and can be treated with antibiotics.

Emphysema

• A serious respiratory disease and a form of COPD.
• The most common cause is smoking.
• Those who suffer from emphysema have difficulty exhaling air from their lungs.
• Cigarette smoke damages the air sacs in the lungs, making them irreparable.
• Emphysema commonly leads to respiratory failure, requires extra oxygen to meet breathing needs, evolves slowly, and has no cure.
• The disease's progression slows when quitting smoking.

Lung Cancer

• Difficult to detect, can develop in any part of the lungs, most often in the main part of the lungs near the air sacs.
• DNA mutations in the lungs cause irregular cells to multiply and create an uncontrolled growth of abnormal cells, or a tumor.
• Tumors interfere with the functions of the lungs.
• The most common risk factor is cigarette smoke, other risk factors: radon, workplace exposure, secondhand smoke, air pollution, and radiation exposure from frequent CT scans.
• Symptoms can take years to appear, and include chronic coughing, changes in voice, harsh breathing sounds, and coughing up blood.

Cystic Fibrosis/Bronchiectasis

• Cystic fibrosis is a genetic respiratory disease caused by a defective gene that creates thick, sticky mucus.
• Mucus clogs tubes and passageways causing repeat and dangerous lung infections, and obstructions in the pancreas preventing enzymes that break down nutrients.
• According to the Cystic Fibrosis Foundation, the disease affects 30,000 people in the U.S., and 75% were diagnosed by the age of 2.
• Symptoms of cystic fibrosis include salty-tasting skin, chronic coughing, frequent lung infections, and a poor growth rate in children.
• Bronchiectasis is a condition in which patients develop abnormally dilated bronchial tubes.
• This allows mucus to pool, causing frequent respiratory tract infections, wheezing and shortness of breath.
• Bronchiectasis develops besides cystic fibrosis, including other infections, develops later in life and is more common in women than men.

Pleural Effusion

• A collection of fluid between the lung and the chest wall in the pleural space.
• The fluid can collect due to pneumonia, cancer, or congestive heart failure.
• Symptoms of increasing chest discomfort and shortness of breath.
• A procedure is used to remove the fluid, allowing the lung to re-expand, a treatment plan is formed after the fluid is tested to determine its cause.

Tuberculosis

• Caused by a type of bacteria called Mycobacterium tuberculosis.
• Contagious infection that attacks the lungs, affects other parts of the body like brain and spine.
• A TB infection doesn't always mean a person will get sick, there are two forms of the disease:
• Latent TB, the germs are in the body, the immune system keeps them from spreading, there aren't any symptoms, and aren't contagious, but the infection can become active.
• Active TB, the germs multiply and cause sickness and can be spread. 90% of active cases in adults come from latent TB.
• A latent or active TB infection can also be drug-resistant.

Tuberculosis Signs and Symptoms

• Latent TB has no symptoms, a skin or blood test can tell.
• Signs of active TB disease include: A cough that lasts longer than 3 weeks, chest pain, coughing up blood, feeling tired, night sweats, chills, fever, loss of appetite, and weight loss.

Tuberculosis Risk Factors

• Likelihood of getting TB increases if a friend, co-worker, or family member has active TB; traveling to an area where TB is common; and working or living with someone more likely to spread TB such as homeless people, people who have HIV, and drug users.
• Working or living in a hospital or nursing home; being a health care worker for patients at high risk of TB; and being a smoker, are also risk factors.
• A healthy immune system fights TB bacteria, but may not be able to fend off active TB disease if a person has HIV, diabetes, severe kidney disease, head and neck cancers, cancer treatments such as chemotherapy, low body weight and poor nutrition, medications for organ transplants, or certain drugs to treat rheumatoid arthritis, Crohn's disease, and psoriasis.
• Babies and young children also have higher chances of getting it because their immune systems aren't fully formed.

Tuberculosis Transmission

• TB spreads, when someone who has TB coughs, sneezes, talks, laughs, or sings, and releases tiny droplets that contain the germs.
• It usually requires spending a long time around someone who has a lot of the bacteria in their lungs, most likely to occur with co-workers, friends, and family members.
• Tuberculosis germs don't thrive on surfaces and aren't spread by shaking hands or sharing food and drinks.

Tuberculosis Tests and Diagnosis

There are two common tests for tuberculosis:

• Skin test (Mantoux tuberculin skin test), a technician injects a small amount of fluid into the skin of the lower arm, checks for swelling after 2 or 3 days.
• Blood tests (interferon-gamma release assays or IGRAs), measure the response when TB proteins are mixed with a small amount of blood.
• In order to determine whether a TB infection is latent of active: a chest X-ray or CT scan looks for changes to the lungs, and acid-fast bacillus (AFB) tests for TB bacteria in the sputum, the mucus that comes up when you cough.

Tuberculosis Treatment

• Treatment is dependent on type of infection:
  • Latent TB is treated with medication such as isoniazid, rifapentine, or rifampin, either alone or combined to kill the bacteria so the infection doesnt become active, and lasts up to 9 months.
  • Active TB is treated with a combination of medicines such as ethambutol, isoniazid, pyrazinamide, and rifampin, lasting about 6-12 months.
  • Drug-resistant TB is treated with one or more medications for a much longer time, up to 30 months, that can cause more side effects.
• It is important to finish medication to prevent bacteria from becoming resistant to the drugs.

Tuberculosis Medication Side Effects

• TB drugs can have side effects.
• Tuberculosis infection can cause complications such as: joint damage, Lung damage, infection or damage of bones/spinal cord/brain/or lymph nodes, liver or kidney problems, and inflammation of tissues around your heart.

Tuberculosis Prevention

To help stop the spread of TB:

• Take all of your medication for latent cases so it doesn't become active and contagious.
• Limit contact with other people if you have active TB, cover your mouth when you cough, laugh, or sneeze. wear a surgical mask when around other people during the first weeks of treatment.
• Avoid spending a lot of time in crowded places with sick people if traveling where TB is common.
• Stay home and ventilate the room during first weeks of treatment.
• Finish entire course of medication.
• Get Tuberculosis vaccine. Children in countries where TB is common often get the BCG vaccine. (bacillus Calmette-Guerin (BCG) vaccine).

Pneumonia

• A bacterial or viral infection of the lungs, it can be treated with antibiotics at home, but can require hospitalization that can result in death.

Pneumonia Causes

• Infection of the air sacs in the lungs caused by bacteria, viruses or, rarely, fungi.
• Most cases caused by bacteria, usually Streptococcus pneumonia, it is more common in children.
• Pneumonia may affect one lobe or be widespread in the lungs.

Pneumonia Risk Factors

• Anyone can develop pneumonia, but some groups are at greater risk: babies, people with recent viral infections, smokers, people with chronic lung conditions, people with suppressed or weak immune systems, people who have poor diets or are undernourished, people who drink excessive alcohol, patients in hospitals, people with swallowing/coughing problems, and people 65+
• Pneumonia can develop when a person breathes in small droplets that contain pneumonia-causing organisms, or when bacteria/viruses that are normally present in mouth/nose/throat enter the lungs.

Pneumonia Signs and Symptoms

• Viral pneumonia tends to develop more slowly, bacterial tends to develop quickly and often over a day.
• Symptoms include fever, chills, shortness of breath, rapid breathing, a worsening cough that may produce yellow/green or bloody mucus, and chest pain when breathing/coughing - caused by inflammation of the membrane that lines the lungs.
• Babies and children show less specific symptoms, and have a fever, appear unwell/lethargic, possibly have noisy or rattly breathing, difficulty with feeding, and make a grunting sound with breathing.
• People 65+ may show signs of confusion or reduced mental awareness.
• It is also possible for the skin, lips and nail beds to become dusky or bluish - this signals not enough oxygen in the body.

Pneumonia Diagnosis and Treatment

• Diagnosis is done by seeking medical attention as soon as symptoms arise.
• Doctors will take a medical history and conduct a physical exam, listen to the chest with a stethoscope in order to analyze coarse breathing, crackling sounds, wheezing, and reduced breath sounds in a particular part of the lungs.
• A chest x-ray and blood/sputum tests are also generally conducted.
• Treatment includes antibiotics (for bacterial cases), pain relief medications, paracetamol (to reduce fever), drinking plenty of fluids, rest for at-home cases; and antibiotics (given intravenously), oxygen therapy, intravenous fluids, and physiotherapy (to help clear the sputum from the lungs) for hospitalization.

Pneumonia Recovery and Prevention

• Recovery may take several weeks (coughing will persist until the mucus has been cleared from lungs/fatigue and a reduced ability to exercise.)
• If cough gets worse or recovery is taking longer, see a doctor (smokers should have a chest x-ray after six weeks to confirm complete clearance of the lungs.)
• The steps that can be taken to reduce the risk of contracting pneumonia include: breastfeeding your baby (4+ months), quit smoking, keep home warm/well-ventilated, get vaccinated (pneumococcal disease, whooping cough, Hib, and influenza) , wash hands, and avoid contact with people with colds, etc.
• Vaccines against pneumococcal disease may not always prevent pneumonia, but they may prevent serious complications of pneumonia should infection occur.