Topic 1

Pneumonia
Pneumonia is an infection of the lungs caused by bacteria, viruses, fungi
and other microorganisms. The air sacs may fill with fluid or pus
(purulent material), causing cough with phlegm or pus, fever, chills, and
difficulty breathing. Pneumonia can range in seriousness from mild to
life-threatening. It is most serious for infants and young children, people
older than age 65, and people with health problems or weakened
immune systems.

Causes
Many germs can cause pneumonia. The most common are bacteria and
viruses in the air we breathe. Your body usually prevents these germs
from infecting your lungs. But sometimes these germs can overpower
your immune system, even if your health is generally good.
Pneumonia is classified according to the types of germs that cause it and
where you got the infection.
Community-acquired pneumonia
Pneumonia that develops in the outpatient setting or within 48 hours of
admission to a hospital. Community-acquired pneumonia is the most
common type of pneumonia. It occurs outside of hospitals or other
health care facilities. It may be caused by:
 Bacteria. Streptococcus pneumoniae, haemophilus influeanze and
Moraxella catarrhalis
 Bacteria-like organisms. Mycoplasma pneumoniae and chlamydia
species
 Fungi.  Candida species
 Viruses.  Influenza A and B, Rhinovirus, Herpes simplex
 Parasites involve toxoplasma Gondi, Ascaris lumbricoides and
Schistosoma species
Hospital-acquired pneumonia
Pneumonia that develops at least 48 hours after admission to a hospital
and is characterized by increased risk of exposure to multidrug-resistant
(MDR) organisms, some people catch pneumonia during a hospital stay
for another illness. Hospital-acquired pneumonia can be serious because
the bacteria causing it may be more resistant to antibiotics and because
the people who get it are already sick. People who are on breathing
machines (ventilators), often used in intensive care units, are at higher
risk of this type of pneumonia.
Health care-acquired pneumonia
Health care-acquired pneumonia is a bacterial infection that occurs in
people who live in long-term care facilities or who receive care in
outpatient clinics, including kidney dialysis centers. Like hospital-
acquired pneumonia, health care-acquired pneumonia can be caused by
bacteria that are more resistant to antibiotics.
Aspiration pneumonia
Aspiration pneumonia occurs when you inhale food, drink, vomit or
saliva into your lungs. Aspiration is more likely if something disturbs your
normal gag reflex, such as a brain injury or swallowing problem, or
excessive use of alcohol or drugs. Because the episode of aspiration is
usually not witnessed, the diagnosis is inferred when a patient at risk of
aspiration develops evidence of a radiographic infiltrate in characteristic
anatomic pulmonary locations
The classic findings are in the right lower lobe
Parasitic pneumonia
The most common parasites involve toxoplasma Gondi, Ascaris
lumbricoides and Schistosoma species

Symptoms
The signs and symptoms of pneumonia vary from mild to severe,
depending on factors such as the type of germ causing the infection, and
your age and overall health. Mild signs and symptoms often are similar
to those of a cold or flu, but they last longer.
Signs and symptoms of pneumonia may include:
  Chest pain
 Dyspnea - Shortness of breath
 Cough, is it productive or not?
 Sputum, if it is colored its evidence of bacterial infection, and if its
smelly it’s an indication of anaerobic infection and of course if
there is blood in the sputum
Nonspecific symptoms
 Fatigue
 Tachycardia
 Confusion or changes in mental awareness (in adults age 65 and
older)
 Fever, sweating and shaking chills (more than 4 days)
 Lower than normal body temperature (in adults older than age 65
and people with weak immune systems)
 Nausea, vomiting or diarrhea
 Throat pain
Newborns and infants may not show any sign of the infection. Or they
may vomit, have a fever and cough, appear restless or tired and without
energy, or have difficulty breathing and eating.

Risk factors-medical history

Pneumonia can affect anyone. But the two age groups at highest risk
are:
 Children who are 2 years old or younger
 People who are age 65 or older
Other risk factors include:
 Facilities. You're at greater risk of pneumonia if you're in a
hospital intensive care unit, especially if you're on a machine that
 helps you breathe, also if you are in the jail, contaminated air
condition system mainly about legionella species. Exposure to a
variety of animals because of the C burneti
 Family. Is there someone that is or was sick?
 Chronic disease. You're more likely to get pneumonia if you have
asthma, chronic obstructive pulmonary disease (COPD) or heart
disease.
 Smoking. Smoking damages your body's natural defenses against
the bacteria and viruses that cause pneumonia.
 Weakened or suppressed immune system. People who
have HIV/AIDS, who've had an organ transplant, or who receive
chemotherapy or long-term steroids are at risk, drugs, also
alcoholism, diabetes, chronic kidney or liver disease

Complications
Even with treatment, some people with pneumonia, especially those in
high-risk groups, may experience complications, including:
 Bacteria in the bloodstream (bacteremia). Bacteria that enter the
bloodstream from your lungs can spread the infection to other
organs, potentially causing organ failure.
 Difficulty breathing or even respiratory failure. If your
pneumonia is severe or you have chronic underlying lung diseases,
you may have trouble breathing in enough oxygen. You may need
to be hospitalized and use a breathing machine (ventilator) while
your lung heals.
 Fluid accumulation around the lungs (pleural effusion)-
Empyema Pneumonia may cause fluid to build up in the thin space
between layers of tissue that line the lungs and chest cavity
(pleura). If the fluid becomes infected, you may need to have it
drained through a chest tube or removed with surgery.
 Lung abscess (necrotizing pneumonia). An abscess occurs if pus
forms in a cavity in the lung. An abscess is usually treated with
antibiotics. Sometimes, surgery or drainage with a long needle or
tube placed into the abscess is needed to remove the pus.
Prevention
To help prevent pneumonia:
 Get vaccinated. Vaccines are available to prevent some types of
pneumonia and the flu. Talk with your doctor about getting these
shots. The vaccination guidelines have changed over time so make
sure to review your vaccination status with your doctor even if
you recall previously receiving a pneumonia vaccine.
 Make sure children get vaccinated. Doctors recommend a
different pneumonia vaccine for children younger than age 2 and
for children ages 2 to 5 years who are at particular risk of
pneumococcal disease. Children who attend a group childcare
center should also get the vaccine. Doctors also recommend flu
shots for children older than 6 months.
 Practice good hygiene. To protect yourself against respiratory
infections that sometimes lead to pneumonia, wash your hands
regularly or use an alcohol-based hand sanitizer.
 Don't smoke. Smoking damages your lungs' natural defenses
against respiratory infections.
 Keep your immune system strong. Get enough sleep, exercise
regularly and eat a healthy diet.

Diagnosis
Your doctor will start by asking about your medical history and doing a
physical exam, including listening to your lungs with a stethoscope to check
for abnormal bubbling or crackling sounds that suggest pneumonia.

First, we perform physical examination- We must try to notice

a) Crackles, rhonchi or wheezes

b) Decreased breath sound
c) Bronchophony
d) Dullness to percussion
If pneumonia is suspected, your doctor may recommend the following tests:

 Blood tests. Blood tests are used to confirm an infection and to try to

identify the type of organism causing the infection. However, precise
identification isn't always possible.

 Chest X-ray. This helps your doctor diagnose pneumonia and

determine the extent and location of the infection. However, it can't tell
your doctor what kind of germ is causing the pneumonia.

 Pulse oximetry. This measures the oxygen level in your blood.

Pneumonia can prevent your lungs from moving enough oxygen into
your bloodstream.

 Sputum test. A sample of fluid from your lungs (sputum) is taken after
a deep cough and analyzed to help pinpoint the cause of the infection.

Your doctor might order additional tests if you're older than age 65, are in the
hospital, or have serious symptoms or health conditions. These may include:

 CT scan. If your pneumonia isn't clearing as quickly as expected, your

doctor may recommend a chest CT scan to obtain a more detailed image
of your lungs.

 Pleural fluid culture. A fluid sample is taken by putting a needle

between your ribs from the pleural area and analyzed to help determine
the type of infection.

 Immunological test- In order to detect LgM antibodies

Treatment

First of all, we have to decide which is the severity of the case, if its mild he
can stay home, mild needs hospitalization and wild needs ICU. Also, the
changes of mortality, 0 to 1 rank is less than 3%, 2 is 3 to 15% and 3 to 5
more than 15%. Treatment for pneumonia involves curing the infection and
preventing complications. Although most symptoms ease in a few days or
weeks, the feeling of tiredness can persist for a month or more.

Specific treatments depend on the type and severity of your pneumonia, your
age and your overall health. The options include:
 Antibiotics. Amoxicillin and tetracycline should be used as the
antibiotics of the first choice. Macrolide antibiotics are used in countries
with low resistance to them for alternative. The duration of the use it
depends from the case it can last from around 10 days to 2-3 weeks. If
the diagnosis is right, there must be a response to them in 48-72 hours.

 Cough medicine. This medicine may be used to calm your cough so

that you can rest. Because coughing helps loosen and move fluid from
your lungs, it's a good idea not to eliminate your cough completely. In
addition, you should know that very few studies have looked at whether
over-the-counter cough medicines lessen coughing caused by
pneumonia. If you want to try a cough suppressant, use the lowest dose
that helps you rest.

 antipyretics/pain relievers. You may take these as needed for fever

and discomfort. These include drugs such as aspirin, ibuprofen (Advil,
Motrin IB, others) and acetaminophen (Tylenol, others).

 Oxygen supplementation

 Steroids is not used except in the case of sepsis!

 Rest and good food

Topic 2
Asthma
Asthma is a heterogenous disease usually characterized by chronic
airway inflammation. This can make breathing difficult and trigger
coughing, wheezing and shortness of breath. Chronically inflamed
airways are hyperresponsive; they become obstructed and airflow is
limited (by bronchoconstriction, mucus plugs, and increased
inflammation) when airways are exposed to various risk factors. It’s one
of the most common chronic diseases worldwide affecting 300 million
people, especially in kids, but the majority of deaths due to it are in the
older ages, almost 200.000 people die every year due to it. For some
people, asthma is a minor nuisance. For others, it can be a major
problem that interferes with daily activities and may lead to a life-
threatening asthma attack. Asthma can't be cured, but its symptoms can
be controlled. Because asthma often changes over time, it's important
that you work with your doctor to track your signs and symptoms and
adjust treatment as needed. Patients colds “go to the chest” or take
more than 10 days to clear up.

Symptoms
Asthma symptoms vary from person to person. You may have infrequent
asthma attacks, have symptoms only at certain times — such as when
exercising — or have symptoms all the time.
Asthma signs and symptoms include:
 Shortness of breath
 Chest tightness or pain
 Trouble sleeping caused by shortness of breath, coughing or
wheezing
 A whistling or wheezing sound when exhaling (wheezing is a
common sign of asthma in children)
 Coughing or wheezing attacks that are worsened by a respiratory
virus, such as a cold or the flu
  Symptoms occur or worsen in a seasonal pattern
 The patient also has eczema, hay fever, or a family history of
asthma or atopic diseases
Signs that your asthma is probably worsening include:
 Asthma signs and symptoms that are more frequent and
bothersome
 Increasing difficulty breathing (measurable with a peak flow
meter, a device used to check how well your lungs are working)
 The need to use a quick-relief inhaler more often
For some people, asthma signs and symptoms flare up in certain
situations:
 Exercise-induced asthma, which may be worse when the air is
cold and dry
 Occupational asthma, triggered by workplace irritants such as
chemical fumes, gases or dust
 Allergy-induced asthma, triggered by airborne substances, such
as pollen, mold spores, cockroach waste or particles of skin and
dried saliva shed by pets (pet dander)

Causes
It isn't clear why some people get asthma and others don't, but it's
probably due to a combination of environmental and genetic (inherited)
factors.
Asthma triggers
Exposure to various irritants and substances that trigger allergies
(allergens) can trigger signs and symptoms of asthma. Asthma triggers
are different from person to person and can include:
 Airborne substances, such as pollen, dust mites, mold spores, pet
dander or particles of cockroach waste
 Respiratory infections, such as the common cold
 Physical activity (exercise-induced asthma)
  Cold air
 Air pollutants and irritants, such as smoke
 Certain medications, including beta blockers, aspirin, ibuprofen
(Advil, Motrin IB, others) and naproxen (Aleve)
 Strong emotions and stress
 Sulfites and preservatives added to some types of foods and
beverages, including shrimp, dried fruit, processed potatoes, beer
and wine
 Gastroesophageal reflux disease (GERD), a condition in which
stomach acids back up into your throat

Risk factors
A number of factors are thought to increase your chances of developing
asthma. These include:
 Having a blood relative (such as a parent or sibling) with asthma
 Having another allergic condition, such as atopic dermatitis or
allergic rhinitis (hay fever)
 Being overweight
 Being a smoker
 Exposure to secondhand smoke
 Exposure to exhaust fumes or other types of pollution
 Exposure to occupational triggers, such as chemicals used in
farming, hairdressing and manufacturing

Complications
Asthma complications include:
 Signs and symptoms that interfere with sleep, work or
recreational activities
 Sick days from work or school during asthma flare-ups
  Permanent narrowing of the bronchial tubes (airway remodeling)
that affects how well you can breathe
 Emergency room visits and hospitalizations for severe asthma
attacks
 Side effects from long-term use of some medications used to
stabilize severe asthma
Proper treatment makes a big difference in preventing both short-term
and long-term complications caused by asthma.

Prevention
While there's no way to prevent asthma, by working together, you and
your doctor can design a step-by-step plan for living with your condition
and preventing asthma attacks.
 Follow your asthma action plan. 
 Get vaccinated for influenza and pneumonia. Staying current
with vaccinations can prevent flu and pneumonia from triggering
asthma flare-ups.
 Identify and avoid asthma triggers. 
 Identify and treat attacks early.
 Take your medication as prescribed.
 Pay attention to increasing quick-relief inhaler use. If you find
yourself relying on your quick-relief inhaler, such as albuterol,
your asthma isn't under control. See your doctor about adjusting
your treatment.

Diagnosis
Physical exam
To rule out other possible conditions — such as a respiratory infection or
chronic obstructive pulmonary disease (COPD) — your doctor will do a
physical exam and ask you questions about your signs and symptoms
and about any other health problems.
Physical examination in people with asthma
- Often normal
-The most frequent finding is wheezing on auscultation, especially on
forced expiration
But Wheezing is also found in other conditions
Tests to measure lung function
You may also be given lung (pulmonary) function tests to determine how
much air moves in and out as you breathe. These tests may include:
 Spirometry. This test estimates the narrowing of your bronchial
tubes by checking how much air you can exhale after a deep
breath and how fast you can breathe out.
 Peak flow. A peak flow meter is a simple device that measures
how hard you can breathe out. Lower than usual peak flow
readings are a sign your lungs may not be working as well and that
your asthma may be getting worse. Your doctor will give you
instructions on how to track and deal with low peak flow readings.
Lung function tests often are done before and after taking a medication
called a bronchodilator such as albuterol, to open your airways. If your
lung function improves with use of a bronchodilator, it's likely you have
asthma.
Additional tests
Other tests to diagnose asthma include:
 Methacholine challenge. Methacholine is a known asthma trigger
that, when inhaled, will cause mild constriction of your airways. If
you react to the methacholine, you likely have asthma. This test
may be used even if your initial lung function test is normal.
 Nitric oxide test. This test, though not widely available, measures
the amount of the gas, nitric oxide, that you have in your breath.
When your airways are inflamed — a sign of asthma — you may
have higher than normal nitric oxide levels.
 Imaging tests. A chest X-ray and high-resolution computerized
tomography (CT) scan of your lungs and nose cavities (sinuses) can
 identify any structural abnormalities or diseases (such as
infection) that can cause or aggravate breathing problems.
 Allergy testing. This can be performed by a skin test or blood test.
Allergy tests can identify allergy to pets, dust, mold and pollen. If
important allergy triggers are identified, this can lead to a
recommendation for allergen immunotherapy.
 Sputum eosinophils. This test looks for certain white blood cells
(eosinophils) in the mixture of saliva and mucus (sputum) you
discharge during coughing. Eosinophils are present when
symptoms develop and become visible when stained with a rose-
colored dye (eosin).
 Provocative testing for exercise and cold-induced asthma. In
these tests, your doctor measures your airway obstruction before
and after you perform vigorous physical activity or take several
breaths of cold air.
 LgE levels
How asthma is classified
To classify your asthma severity, your doctor considers your answers to
questions about symptoms (such as how often you have asthma attacks
and how bad they are), along with the results of your physical exam and
diagnostic tests.
Determining your asthma severity helps your doctor choose the best
treatment. Asthma severity often changes over time, requiring
treatment adjustments.

Asthma is classified into four general categories:

Asthma Signs and symptoms

classification

Mild intermittent Mild symptoms up to two days a week and up to two

 nights a month

Mild persistent Symptoms more than twice a week, but no more than
once in a single day

Moderate Symptoms once a day and more than one night a week
persistent

Severe persistent Symptoms throughout the day on most days and

frequently at night

Treatment
Prevention and long-term control are key in stopping asthma attacks
before they start. Treatment usually involves learning to recognize your
triggers, taking steps to avoid them and tracking your breathing to make
sure your daily asthma medications are keeping symptoms under
control. In case of an asthma flare-up, you may need to use a quick-relief
inhaler, such as albuterol.
Medications
The right medications for you depend on a number of things — your age,
symptoms, asthma triggers and what works best to keep your asthma
under control.
Preventive, long-term control medications reduce the inflammation in
your airways that leads to symptoms. Quick-relief inhalers
(bronchodilators) quickly open swollen airways that are limiting
breathing. In some cases, allergy medications are necessary.
Long-term asthma control medications, generally taken daily, are the
cornerstone of asthma treatment. These medications keep asthma
under control on a day-to-day basis and make it less likely you'll have an
asthma attack. Types of Long-term control medications include:
 Inhaled corticosteroids. 
 Leukotriene modifiers. 
  Long-acting beta agonists. 
 Combination inhalers. 
Quick-relief (rescue) medications are used as needed for rapid, short-
term symptom relief during an asthma attack — or before exercise if
your doctor recommends it. Types of quick-relief medications include:
 Short-acting beta agonists. 
 Ipratropium (Atrovent). 
 Oral and intravenous corticosteroids.
 Theophylline.
Allergy medications may help if your asthma is triggered or worsened by
allergies. These include:
 Allergy shots (immunotherapy). Over time, allergy shots gradually
reduce your immune system reaction to specific allergens. You
generally receive shots once a week for a few months, then once a
month for a period of three to five years.
 Omalizumab (Xolair). This medication, given as an injection every
two to four weeks, is specifically for people who have allergies and
severe asthma. It acts by altering the immune system.
Avoid your triggers
Stay healthy
Topic 3
COPD
Chronic Obstructive Pulmonary Disease (COPD) is a common,
preventable and treatable disease that is characterized by persistent
respiratory symptoms and airflow limitation that is due to airway and/or
alveolar abnormalities usually caused by significant exposure to noxious
particles or gases. Symptoms include breathing difficulty, cough, mucus
(sputum) production and wheezing. It's caused by long-term exposure to
irritating gases or particulate matter, most often from cigarette smoke.
People with COPD are at increased risk of developing heart disease, lung
cancer and a variety of other conditions. Almost 3 million people die
every year due to it and is increasing. Emphysema and chronic bronchitis
are the two most common conditions that contribute to COPD.
Emphysema slowly destroys air sacs in your lungs, which interferes with
outward air flow. Bronchitis causes inflammation and narrowing of the
bronchial tubes, which allows mucus to build up. COPD is treatable. With
proper management, most people with COPD can achieve good
symptom control and quality of life, as well as reduced risk of other
associated conditions.

Symptoms
COPD symptoms often don't appear until significant lung damage has
occurred, and they usually worsen over time, particularly if smoking
exposure continues. For chronic bronchitis, the main symptom is a daily
cough and mucus (sputum) production at least three months a year for
two consecutive years.
Other signs and symptoms of COPD may include:
 Shortness of breath, especially during physical activities
 Wheezing
 Chest tightness
  Having to clear your throat first thing in the morning, due to
excess mucus in your lungs
 A chronic cough that may produce mucus (sputum) that may be
clear, white, yellow or greenish
 Blueness of the lips or fingernail beds (cyanosis)
 Frequent respiratory infections
 Lack of energy
 Unintended weight loss (in later stages)
 Swelling in ankles, feet or legs
People with COPD are also likely to experience episodes called
exacerbations, during which their symptoms become worse than usual
day-to-day variation and persist for at least several days.

Causes
The main cause of COPD in developed countries is tobacco smoking. In
the developing world, COPD often occurs in people exposed to fumes
from burning fuel for cooking and heating in poorly ventilated homes.
Only about 20 to 30 percent of chronic smokers may develop clinically
apparent COPD, although many smokers with long smoking histories
may develop reduced lung function. Some smokers develop less
common lung conditions. They may be misdiagnosed as
having COPD until a more thorough evaluation is performed.
How your lungs are affected
Air travels down your windpipe (trachea) and into your lungs through
two large tubes (bronchi). Inside your lungs, these tubes divide many
times — like the branches of a tree — into many smaller tubes
(bronchioles) that end in clusters of tiny air sacs (alveoli). The air sacs
have very thin walls full of tiny blood vessels (capillaries). The oxygen in
the air you inhale passes into these blood vessels and enters your
bloodstream. At the same time, carbon dioxide — a gas that is a waste
product of metabolism — is exhaled. Your lungs rely on the natural
elasticity of the bronchial tubes and air sacs to force air out of your
body. COPD causes them to lose their elasticity and overexpand, which
leaves some air trapped in your lungs when you exhale.

Causes of airway obstruction

Causes of airway obstruction include:
 Emphysema. This lung disease causes destruction of the fragile
walls and elastic fibers of the alveoli. Small airways collapse when
you exhale, impairing airflow out of your lungs.
 Chronic bronchitis. In this condition, your bronchial tubes become
inflamed and narrowed and your lungs produce more mucus,
which can further block the narrowed tubes. You develop a
chronic cough trying to clear your airways.
Cigarette smoke and other irritants
In the vast majority of cases, the lung damage that leads to COPD is
caused by long-term cigarette smoking. But there are likely other factors
at play in the development of COPD, such as a genetic susceptibility to
the disease, because only about 20 to 30 percent of smokers may
develop COPD. Other irritants can cause COPD, including cigar smoke,
secondhand smoke, pipe smoke, air pollution and workplace exposure to
dust, smoke or fumes.
Alpha-1-antitrypsin deficiency
In about 1 percent of people with COPD, the disease results from a
genetic disorder that causes low levels of a protein called alpha-1-
antitrypsin. Alpha-1-antitrypsin (AAt) is made in the liver and secreted
into the bloodstream to help protect the lungs. Alpha-1-antitrypsin
deficiency can affect the liver as well as the lungs. Damage to the lung
can occur in infants and children, not only adults with long smoking
histories. For adults with COPD related to AAt deficiency, treatment
options include those used for people with more-common types
of COPD. In addition, some people can be treated by replacing the
missing AAt protein, which may prevent further damage to the lungs.

Risk factors
Risk factors for COPD include:
 Exposure to tobacco smoke. The most significant risk factor
for COPD is long-term cigarette smoking. The more years you
smoke and the more packs you smoke, the greater your risk. Pipe
smokers, cigar smokers and marijuana smokers also may be at
risk, as well as people exposed to large amounts of secondhand
smoke.
 People with asthma who smoke. The combination of asthma, a
chronic inflammatory airway disease, and smoking increases the
risk of COPD even more.
 Occupational exposure to dusts and chemicals. Long-term
exposure to chemical fumes, vapors and dusts in the workplace
can irritate and inflame your lungs.
 Exposure to fumes from burning fuel. In the developing world,
people exposed to fumes from burning fuel for cooking and
heating in poorly ventilated homes are at higher risk of
developing COPD.
 Age. COPD develops slowly over years, so most people are at least
40 years old when symptoms begin.
 Genetics. The uncommon genetic disorder alpha-1-antitrypsin
deficiency is the cause of some cases of COPD. Other genetic
factors likely make certain smokers more susceptible to the
disease.

Complications
COPD can cause many complications, including:
 Respiratory infections. People with COPD are more likely to catch
colds, the flu and pneumonia. Any respiratory infection can make
it much more difficult to breathe and could cause further damage
to lung tissue. An annual flu vaccination and regular vaccination
against pneumococcal pneumonia can prevent some infections.
 Heart problems. For reasons that aren't fully
understood, COPD can increase your risk of heart disease,
including heart attack. Quitting smoking may reduce this risk.
  Lung cancer. People with COPD have a higher risk of developing
lung cancer. Quitting smoking may reduce this risk.
 High blood pressure in lung arteries. COPD may cause high blood
pressure in the arteries that bring blood to your lungs (pulmonary
hypertension).
 Depression. Difficulty breathing can keep you from doing activities
that you enjoy. And dealing with serious illness can contribute to
development of depression. Talk to your doctor if you feel sad or
helpless or think that you may be experiencing depression.

Prevention
Unlike some diseases, COPD has a clear cause and a clear path of
prevention. The majority of cases are directly related to cigarette
smoking, and the best way to prevent COPD is to never smoke — or to
stop smoking now.
If you're a longtime smoker, these simple statements may not seem so
simple, especially if you've tried quitting — once, twice or many times
before. But keep trying to quit. It's critical to find a tobacco cessation
program that can help you quit for good. It's your best chance for
preventing damage to your lungs.
Occupational exposure to chemical fumes and dust is another risk factor
for COPD. If you work with this type of lung irritant, talk to your
supervisor about the best ways to protect yourself, such as using
respiratory protective equipment.

Diagnosis
COPD is commonly misdiagnosed — former smokers may sometimes be
told they have COPD, when in reality they may have simple
deconditioning or another less common lung condition. Likewise, many
people who have COPD may not be diagnosed until the disease is
advanced and interventions are less effective. To diagnose your
condition, your doctor will review your signs and symptoms, discuss your
family and medical history, and discuss any exposure you've had to lung
irritants — especially cigarette smoke. Your doctor may order several
tests to diagnose your condition.
COPD should be considered in any patient who has dyspnea, chronic
cough or sputum production, and/or history of exposure to risk factors
for the disease. A detailed medical history of a new patient who is
known, or suspected, to have COPD is essential.
Spirometry is required to make the diagnosis in this clinical context; the
presence of a post- bronchodilator FEV1/FVC < 0.70 confirms the
presence of persistent airflow limitation and thus of COPD in patients
with appropriate symptoms and significant exposures to noxious stimuli.
Tests may include:
 Lung (pulmonary) function tests. Pulmonary function tests
measure the amount of air you can inhale and exhale, and if your
lungs are delivering enough oxygen to your blood. Spirometry is
the most common lung function test. During this test, you'll be
asked to blow into a large tube connected to a small machine
called a spirometer. This machine measures how much air your
lungs can hold and how fast you can blow the air out of your
lungs. Spirometry can detect COPD even before you have
symptoms of the disease. It can also be used to track the
progression of disease and to monitor how well treatment is
working. Spirometry often includes measurement of the effect of
bronchodilator administration. Other lung function tests include
measurement of lung volumes, diffusing capacity and pulse
oximetry.
 Chest X-ray. A chest X-ray can show emphysema, one of the main
causes of COPD. An X-ray can also rule out other lung problems or
heart failure.
 CT scan. A CT scan of your lungs can help detect emphysema and
help determine if you might benefit from surgery
for COPD. CT scans can also be used to screen for lung cancer.
 Arterial blood gas analysis. This blood test measures how well
your lungs are bringing oxygen into your blood and removing
carbon dioxide.
 Laboratory tests. Laboratory tests aren't used to diagnose COPD,
but they may be used to determine the cause of your symptoms
 or rule out other conditions. For example, laboratory tests may be
used to determine if you have the genetic disorder alpha-1-
antitrypsin (AAt) deficiency, which may be the cause of some
cases of COPD. This test may be done if you have a family history
of COPD and develop COPD at a young age, such as under age 45.
In general, the case of a patient with chronic bronchitis is characterized
by daily productive cough for 3 months for at least past two years, he is
obese, cyanotic, rhonchi, wheezes, elevated hemoglobin and peripheral
edema, in the other hand a patient with emphysema will be older age
and thin, barrel chest, with severe dyspnea, and the x ray will saw the
difference.

Treatment
A diagnosis of COPD is not the end of the world. Most people have mild
forms of the disease for which little therapy is needed other than
smoking cessation. Even for more advanced stages of disease, effective
therapy is available that can control symptoms, reduce your risk of
complications and exacerbations, and improve your ability to lead an
active life.
Smoking cessation
Bronchodilators
Inhaled steroids
Combination inhalers
Oral steroids
Phosphodiesterase-4 inhibitors
Theophylline
Antibiotics
Lung therapies
Doctors often use these additional therapies for people with moderate
or severe COPD:
 Oxygen therapy. If there isn't enough oxygen in your blood, you
may need supplemental oxygen. There are several devices to
 deliver oxygen to your lungs, including lightweight, portable units
that you can take with you to run errands and get around town.
Some people with COPD use oxygen only during activities or while
sleeping. Others use oxygen all the time. Oxygen therapy can
improve quality of life and is the only COPD therapy proven to
extend life. Talk to your doctor about your needs and options.
 Pulmonary rehabilitation program. These programs generally
combine education, exercise training, nutrition advice and
counseling. You'll work with a variety of specialists, who can tailor
your rehabilitation program to meet your needs. Pulmonary
rehabilitation may shorten hospitalizations, increase your ability
to participate in everyday activities and improve your quality of
life. Talk to your doctor about referral to a program.
Surgery
Surgery is an option for some people with some forms of severe
emphysema who aren't helped sufficiently by medications alone.
Surgical options include:
 Lung volume reduction surgery. In this surgery, your surgeon
removes small wedges of damaged lung tissue from the upper
lungs. This creates extra space in your chest cavity so that the
remaining healthier lung tissue can expand, and the diaphragm
can work more efficiently. In some people, this surgery can
improve quality of life and prolong survival.
 Lung transplant. Lung transplantation may be an option for
certain people who meet specific criteria. Transplantation can
improve your ability to breathe and to be active. However, it's a
major operation that has significant risks, such as organ rejection,
and it's necessary to take lifelong immune-suppressing
medications.
 Bullectomy. Large air spaces (bullae) form in the lungs when the
walls of the air sacs are destroyed. These bullae can become very
large and cause breathing problems. In a bullectomy, doctors
remove bullae from the lungs to help improve air flow.

Lifestyle and home remedies

If you have COPD, you can take steps to feel better and slow the damage to
your lungs:

 Control your breathing. Talk to your doctor or respiratory therapist

about techniques for breathing more efficiently throughout the day. Also
be sure to discuss breathing positions and relaxation techniques that you
can use when you're short of breath.

 Clear your airways. With COPD, mucus tends to collect in your air

passages and can be difficult to clear. Controlled coughing, drinking
plenty of water and using a humidifier may help.

 Exercise regularly. It may seem difficult to exercise when you have

trouble breathing, but regular exercise can improve your overall strength
and endurance and strengthen your respiratory muscles. Discuss with
your doctor which activities are appropriate for you.

 Eat healthy foods. A healthy diet can help you maintain your strength.
If you're underweight, your doctor may recommend nutritional
supplements. If you're overweight, losing weight can significantly help
your breathing, especially during times of exertion.

 Avoid smoke and air pollution. In addition to quitting smoking, it's

important to avoid places where others smoke. Secondhand smoke may
contribute to further lung damage. Other types of air pollution also can
irritate your lungs.

 See your doctor regularly. Stick to your appointment schedule, even

if you're feeling fine. It's important to steadily monitor your lung function.
Topic 4
Lung cancer
Lung cancer is a type of cancer that begins in the lungs. Your lungs are
two spongy organs in your chest that take in oxygen when you inhale
and release carbon dioxide when you exhale. Lung cancer is the leading
cause of cancer deaths, among both men and women, but its more
among men. Lung cancer claims more lives each year than do colon,
prostate, ovarian and breast cancers combined. People who smoke have
the greatest risk of lung cancer, though lung cancer can also occur in
people who have never smoked. The risk of lung cancer increases with
the length of time and number of cigarettes you've smoked. If you quit
smoking, even after smoking for many years, you can significantly reduce
your chances of developing lung cancer.

Symptoms
Lung cancer typically doesn't cause signs and symptoms in its earliest
stages. Signs and symptoms of lung cancer typically occur only when the
disease is advanced. Unfortunately, there is 5% of the cases that are
asymptomatic with just a simple cough even when is too late.
Signs and symptoms of lung cancer may include:
 A new cough that doesn't go away
 Coughing up blood, even a small amount
 Shortness of breath
 Chest pain
 Hoarseness
 Losing weight without trying
  Bone pain
 Headache

Causes
Smoking causes the majority of lung cancers — both in smokers and in
people exposed to secondhand smoke. But lung cancer also occurs in
people who never smoked and in those who never had prolonged
exposure to secondhand smoke. In these cases, there may be no clear
cause of lung cancer.
How smoking causes lung cancer
Doctors believe smoking causes lung cancer by damaging the cells that
line the lungs. When you inhale cigarette smoke, which is full of cancer-
causing substances (carcinogens), changes in the lung tissue begin
almost immediately. At first your body may be able to repair this
damage. But with each repeated exposure, normal cells that line your
lungs are increasingly damaged. Over time, the damage causes cells to
act abnormally and eventually cancer may develop.
Types of lung cancer
Doctors divide lung cancer into two major types based on the
appearance of lung cancer cells under the microscope. Your doctor
makes treatment decisions based on which major type of lung cancer
you have.
The two general types of lung cancer include:
 Small cell lung cancer. Small cell lung cancer occurs almost
exclusively in heavy smokers and is less common than non-small
cell lung cancer. Its strongly related to smoking and is often
aggressive metastatic cancer.
 Non-small cell lung cancer. Non-small cell lung cancer is an
umbrella term for several types of lung cancers that behave in a
similar way, like adenocarcinoma, squamous cell carcinoma and
large cell carcinoma. 85-90% of the cases are non-small cell.

Risk factors
A number of factors may increase your risk of lung cancer. Some risk
factors can be controlled, for instance, by quitting smoking. And other
factors can't be controlled, such as your family history.
Risk factors for lung cancer include:
 Smoking. Your risk of lung cancer increases with the number of
cigarettes you smoke each day and the number of years you have
smoked. Quitting at any age can significantly lower your risk of
developing lung cancer. In most cases 80-90% of the lung cancer
cases is relating directly to smoking.
 Exposure to secondhand smoke. Even if you don't smoke, your
risk of lung cancer increases if you're exposed to secondhand
smoke.
 Exposure to radon gas. Radon is produced by the natural
breakdown of uranium in soil, rock and water that eventually
becomes part of the air you breathe. Unsafe levels of radon can
accumulate in any building, including homes.
 Exposure to asbestos and other carcinogens. Workplace exposure
to asbestos and other substances known to cause cancer — such
as arsenic, chromium and nickel — also can increase your risk of
developing lung cancer, especially if you're a smoker.
 Family history of lung cancer-genetics. People with a parent,
sibling or child with lung cancer have an increased risk of the
disease
 Lung diseases like TB or COPD

Complications
Lung cancer can cause complications, such as:
 Shortness of breath. People with lung cancer can experience
shortness of breath if cancer grows to block the major airways.
Lung cancer can also cause fluid to accumulate around the lungs,
making it harder for the affected lung to expand fully when you
inhale.
  Coughing up blood. Lung cancer can cause bleeding in the airway,
which can cause you to cough up blood (hemoptysis). Sometimes
bleeding can become severe. Treatments are available to control
bleeding.
 Pain. Advanced lung cancer that spreads to the lining of a lung or
to another area of the body, such as a bone, can cause pain. Tell
your doctor if you experience pain, as many treatments are
available to control pain.
 Fluid in the chest (pleural effusion). Lung cancer can cause fluid
to accumulate in the space that surrounds the affected lung in the
chest cavity (pleural space). Fluid accumulating in the chest can
cause shortness of breath. Treatments are available to drain the
fluid from your chest and reduce the risk that pleural effusion will
occur again.
 Cancer that spreads to other parts of the body (metastasis). Lung
cancer often spreads (metastasizes) to other parts of the body,
such as the brain and the bones. Cancer that spreads can cause
pain, nausea, headaches, or other signs and symptoms depending
on what organ is affected. Once lung cancer has spread beyond
the lungs, it's generally not curable. Treatments are available to
decrease signs and symptoms and to help you live longer.

Diagnosis
Testing healthy people for lung cancer
People with an increased risk of lung cancer may consider annual lung
cancer screening using low-dose CT scans. Lung cancer screening is
generally offered to people 55 and older who smoked heavily for many
years and are otherwise healthy.
Tests to diagnose lung cancer
If there's reason to think that you may have lung cancer, your doctor can
order a number of tests to look for cancerous cells and to rule out other
conditions.
Tests may include:
  Imaging tests. An X-ray image of your lungs may reveal an
abnormal mass or nodule. A CT scan can reveal small lesions in
your lungs that might not be detected on an X-ray.
 Bronchoscopy or VATS
 Sputum cytology. If you have a cough and are producing sputum,
looking at the sputum under the microscope can sometimes
reveal the presence of lung cancer cells.
 Tissue sample (biopsy). A sample of abnormal cells may be
removed in a procedure called a biopsy.
Your doctor can perform a biopsy in a number of ways, including
bronchoscopy, in which your doctor examines abnormal areas of your
lungs using a lighted tube that's passed down your throat and into your
lungs; mediastinoscopy, in which an incision is made at the base of your
neck and surgical tools are inserted behind your breastbone to take
tissue samples from lymph nodes; and needle biopsy, in which your
doctor uses X-ray or CT images to guide a needle through your chest wall
and into the lung tissue to collect suspicious cells.
A biopsy sample may also be taken from lymph nodes or other areas
where cancer has spread, such as your liver.
Careful analysis of your cancer cells in a lab will reveal what type of lung
cancer you have. Results of sophisticated testing can tell your doctor the
specific characteristics of your cells that can help determine your
prognosis and guide your treatment.
Tests to determine the extent of the cancer
Once your lung cancer has been diagnosed, your doctor will work to
determine the extent (stage) of your cancer. Your cancer's stage helps
you and your doctor decide what treatment is most appropriate.
Staging tests may include imaging procedures that allow your doctor to
look for evidence that cancer has spread beyond your lungs. These tests
include CT, MRI, positron emission tomography (PET) and bone scans.
Not every test is appropriate for every person, so talk with your doctor
about which procedures are right for you.
The stages of lung cancer are indicated by Roman numerals that range
from 0 to IV, with the lowest stages indicating cancer that is limited to
the lung. By stage IV, the cancer is considered advanced and has spread
to other areas of the body.

Treatment
You and your doctor choose a cancer treatment plan based on a number
of factors, such as your overall health, the type and stage of your cancer,
and your preferences.
Surgery
During surgery your surgeon works to remove the lung cancer and a
margin of healthy tissue. Procedures to remove lung cancer include:
 Wedge resection to remove a small section of lung that contains
the tumor along with a margin of healthy tissue
 Segmental resection to remove a larger portion of lung, but not
an entire lobe
 Lobectomy to remove the entire lobe of one lung
 Pneumonectomy to remove an entire lung
Radiation therapy

Radiation therapy uses high-powered energy beams from sources such

as X-rays and protons to kill cancer cells. During radiation therapy, you
lie on a table while a machine moves around you, directing radiation to
precise points on your body.

For people with locally advanced lung cancer, radiation may be used
before surgery or after surgery. It's often combined with chemotherapy
treatments. If surgery isn't an option, combined chemotherapy and
radiation therapy may be your primary treatment.

For advanced lung cancers and those that have spread to other areas of
the body, radiation therapy may help relieve symptoms, such as pain.
Chemotherapy

Chemotherapy uses drugs to kill cancer cells. One or more

chemotherapy drugs may be given through a vein in your arm
(intravenously) or taken orally. A combination of drugs usually is given in
a series of treatments over a period of weeks or months, with breaks in
between so that you can recover. Chemotherapy is often used after
surgery to kill any cancer cells that may remain. It can be used alone or
combined with radiation therapy. Chemotherapy may also be used
before surgery to shrink cancers and make them easier to remove. In
people with advanced lung cancer, chemotherapy can be used to relieve
pain and other symptoms.

Targeted drug therapy

Targeted drug treatments focus on specific abnormalities present within

cancer cells. By blocking these abnormalities, targeted drug treatments
can cause cancer cells to die. Many targeted therapy drugs are used to
treat lung cancer, though most are reserved for people with advanced or
recurrent cancer. Some targeted therapies only work in people whose
cancer cells have certain genetic mutations. Your cancer cells may be
tested in a laboratory to see if these drugs might help you.

Immunotherapy

Immunotherapy uses your immune system to fight cancer. Your body's

disease-fighting immune system may not attack your cancer because the
cancer cells produce proteins that blind the immune system cells.
Immunotherapy works by interfering with that process. Immunotherapy
treatments are generally reserved for people with advanced lung cancer.
Topic 5
Pleural effusion
Pleural effusion, sometimes referred to as “water on the lungs,” is the
build-up of excess fluid between the layers of the pleura outside the
lungs. The pleura are thin membranes that line the lungs and the inside
of the chest cavity and act to lubricate and facilitate breathing.
Normally, a small amount of fluid is present in the pleura.
The seriousness of the condition depends on the primary cause of
pleural effusion, whether breathing is affected, and whether it can be
treated effectively. Causes of pleural effusion that can be effectively
treated or controlled include an infection due to a virus, pneumonia or
heart failure. Two factors that must be considered are treatment for
associated mechanical problems as well as treatment of the underlying
cause of the pleural effusion.
Some patients with pleural effusion have no symptoms, with the
condition discovered on a chest x-ray that is performed for another
reason. The patient may have unrelated symptoms due to the disease or
condition that has caused the effusion. Symptoms of pleural effusion
include:
 Chest pain
 Dry, nonproductive cough
 Dyspnea (shortness of breath, or difficult, labored breathing)
 Orthopnea (the inability to breathe easily unless the person is
sitting up straight or standing erect)
Pleural effusions are very common, with approximately 100,000 cases
diagnosed in the United States each year, according to the National
Cancer Institute.
Depending on the cause, the excess fluid may be either protein-poor
(transudative) or protein-rich (exudative). These two categories help
physicians determine the cause of the pleural effusion.
The most common causes of transudative (watery fluid) pleural
effusions include:
 Heart failure
 Pulmonary embolism
 Cirrhosis
 Post open heart surgery
Exudative (protein-rich fluid) pleural effusions are most commonly
caused by:
 Pneumonia
 Cancer
 Pulmonary embolism
 Kidney disease
 Inflammatory disease
Other less common causes of pleural effusion include:
 Tuberculosis
 Autoimmune disease
 Bleeding (due to chest trauma)
 Chylothorax (due to trauma)
 Rare chest and abdominal infections
 Asbestos pleural effusion (due to exposure to asbestos)
 Meig’s syndrome (due to a benign ovarian tumor)
 Ovarian hyperstimulation syndrome
Certain medications, abdominal surgery and radiation therapy may also
cause pleural effusions. Pleural effusion may occur with several types of
cancer including lung cancer, breast cancer and lymphoma. In some
cases, the fluid itself may be malignant (cancerous), or may be a direct
result of chemotherapy.
The tests most commonly used to diagnose and evaluate pleural
effusion include:
 Chest x-ray
 Computed tomography (CT) scan of the chest
 Ultrasound of the chest
 Thoracentesis (a needle is inserted between the ribs to remove
a biopsy, or sample of fluid)
 Pleural fluid analysis (an examination of the fluid removed from
the pleura space)
When the pleural effusion has remained undiagnosed despite previous,
less-invasive tests, thoracoscopy may be performed. Thoracoscopy is a
minimally invasive technique, also known as video-assisted
thoracoscopic surgery, or VATS, performed under general anesthesia
that allows for a visual evaluation of the pleura). Often, treatment of the
effusion is combined with diagnosis in these cases.
How is pleural effusion treated?
 Treatment of pleural effusion is based on the underlying condition
and whether the effusion is causing severe respiratory symptoms,
such as shortness of breath or difficulty breathing.
 Diuretics and other heart failure medications are used to treat
pleural effusion caused by congestive heart failure or other
medical causes. A malignant effusion may also require treatment
with chemotherapy, radiation therapy or a medication infusion
within the chest.
 A pleural effusion that is causing respiratory symptoms may be
drained using therapeutic thoracentesis or through a chest tube
(called tube thoracostomy).
  For patients with pleural effusions that are uncontrollable or recur
due to a malignancy despite drainage, a sclerosing agent (a type of
drug that deliberately induces scarring) occasionally may be
instilled into the pleural cavity through a tube thoracostomy to
create a fibrosis (excessive fibrous tissue) of the pleura (pleural
sclerosis).
 Pleural sclerosis performed with sclerosing agents (such as talc,
doxycycline, and tetracycline) is 50 percent successful in
preventing the recurrence of pleural effusions.
Surgery
Pleural effusions that cannot be managed through drainage or pleural
sclerosis may require surgical treatment.
The two types of surgery include:
Video-assisted thoracoscopic surgery (VATS)
A minimally invasive approach that is completed through 1 to 3 small
(approximately ½ -inch) incisions in the chest. Also known as
thoracoscopic surgery, this procedure is effective in managing pleural
effusions that are difficult to drain or recur due to malignancy. Sterile
talc or an antibiotic may be inserted at the time of surgery to prevent
the recurrence of fluid build-up.
Thoracotomy (Also referred to as traditional, “open” thoracic surgery)
A thoracotomy is performed through a 6- to 8-inch incision in the chest
and is recommended for pleural effusions when infection is present. A
thoracotomy is performed to remove all of the fibrous tissue and aids in
evacuating the infection from the pleural space. Patients will require
chest tubes for 2 days to 2 weeks after surgery to continue draining
fluid.
Your surgeon will carefully evaluate you to determine the safest
treatment option and will discuss the possible risks and benefits of each
treatment option.
Topic 6
Pulmonary embolism
Pulmonary embolism is a blockage in one of the pulmonary arteries in
your lungs. In most cases, pulmonary embolism is caused by blood clots
that travel to the lungs from the legs or, rarely, other parts of the body
(deep vein thrombosis). Because the clots block blood flow to the lungs,
pulmonary embolism can be life-threatening. However, prompt
treatment greatly reduces the risk of death. Taking measures to prevent
blood clots in your legs will help protect you against pulmonary
embolism.

Symptoms
Common signs and symptoms include:
 Shortness of breath. This symptom typically appears suddenly and
always gets worse with exertion.
 Chest pain. You may feel like you're having a heart attack. The
pain may become worse when you breathe deeply (pleurisy),
cough, eat, bend or stoop. The pain will get worse with exertion
but won't go away when you rest.
 Cough. The cough may produce bloody or blood-streaked sputum.
Other signs and symptoms that can occur with pulmonary embolism
include:
  Leg pain or swelling, or both, usually in the calf
 Clammy or discolored skin (cyanosis)
 Fever
 Excessive sweating
 Rapid or irregular heartbeat
 Lightheadedness or dizziness

Causes
Occasionally, blockages in the blood vessels are caused by substances
other than blood clots, such as:
 Fat from the marrow of a broken long bone
 Collagen or other tissue
 Part of a tumor
 Air bubbles

Risk factors
Although anyone can develop blood clots and subsequent pulmonary
embolism, certain factors can increase your risk.
In addition, some medical conditions and treatments put you at risk,
such as:
 Heart disease. Cardiovascular disease, specifically heart failure,
makes clot formation more likely.
 Cancer. Certain cancers — especially pancreatic, ovarian and lung
cancers, and many cancers with metastasis — can increase levels
of substances that help blood clot, and chemotherapy further
increases the risk. Women with a personal or family history of
breast cancer who are taking tamoxifen or raloxifene also are at
higher risk of blood clots.
 Surgery. Surgery is one of the leading causes of problem blood
clots. For this reason, medication to prevent clots may be given
before and after major surgery such as joint replacement.
Other risk factors

 Smoking. For reasons that aren't well-understood, tobacco use

predisposes some people to blood clot formation, especially when
combined with other risk factors.
 Being overweight. Excess weight increases the risk of blood clots
— particularly in women who smoke or have high blood pressure.
 Supplemental estrogen. The estrogen in birth control pills and in
hormone replacement therapy can increase clotting factors in your
blood, especially if you smoke or are overweight.
 Pregnancy. The weight of the baby pressing on veins in the pelvis
can slow blood return from the legs. Clots are more likely to form
when blood slows or pools.

Complications
Pulmonary embolism can be life-threatening. About one-third of people
with undiagnosed and untreated pulmonary embolism don't survive.
When the condition is diagnosed and treated promptly, however, that
number drops dramatically.

Pulmonary embolism can also lead to pulmonary hypertension, a

condition in which the blood pressure in your lungs and in the right side
of the heart is too high. When you have obstructions in the arteries
inside your lungs, your heart must work harder to push blood through
those vessels. This increases the blood pressure within these vessels and
the right side of the heart, which can weaken your heart.

In rare cases, small emboli occur frequently and develop over time,
resulting in chronic pulmonary hypertension, also known as chronic
thromboembolic pulmonary hypertension.

Diagnosis
CT
X-ray
Blood test
Pulmonary angiogram
MRI

Treatment
Treatment is aimed at keeping the blood clot from getting bigger and
preventing new clots from forming. Prompt treatment is essential to
prevent serious complications or death.
Medications
 Blood thinners (anticoagulants). These drugs prevent new clots
from forming while your body works to break up the clots.
Heparin is a frequently used anticoagulant that can be given
through the vein or injected under the skin. It acts quickly and is
often overlapped for several days with an oral anticoagulant, such
as warfarin, until it becomes effective, which can take days. A
newer class of anticoagulants, referred to as novel oral
anticoagulants (NOACs), has been tested and approved for
treatment of venous thromboembolism, including pulmonary
embolism. These medications work quickly and have fewer
interactions with other medications. Some NOACs have the
advantage of being given by mouth, without the need for overlap
with heparin. However, all anticoagulants have side effects, with
bleeding being the most common.
 Clot dissolvers (thrombolytics). While clots usually dissolve on
their own, there are medications given through the vein that can
dissolve clots quickly. Because these clot-busting drugs can cause
sudden and severe bleeding, they usually are reserved for life-
threatening situations.
Surgical and other procedures
 Clot removal. If you have a very large, life-threatening clot in your
lung, your doctor may suggest removing it via a thin, flexible tube
(catheter) threaded through your blood vessels.
 Vein filter. A catheter can also be used to position a filter in the
body's main vein — called the inferior vena cava — that leads
from your legs to the right side of your heart. This filter can help
 keep clots from being carried into your lungs. This procedure is
typically reserved for people who can't take anticoagulant drugs
or when anticoagulant drugs don't work well enough or fast
enough. Some filters can be removed when they are no longer
needed.

Topic 7
Lung abscess
A lung abscess is a bacterial infection that occurs in the lung tissue. The
infection causes tissue to die, and pus collects in that space. A lung
abscess can be challenging to treat, and it can be life-threatening.

Causes
Lung abscesses can be classified as primary or secondary. They develop
from different strains of bacteria and have different causes. Primary
abscesses are caused by an infection, pneumonia, within your
lung. Aspiration pneumonia is an infection that develops after food or
secretions from your mouth, stomach, or sinuses are inhaled into your
lungs instead of going into your esophagus. It’s a very common cause of
primary abscesses. The most common Trusted Source illness that makes
a person susceptible to developing a lung abscess is alcoholism. Those
who misuse alcohol often experience bouts of vomiting and altered
levels of consciousness. These conditions increase the likelihood of
inhaling stomach contents and bacteria into the lungs, which can cause
an infection. People who misuse alcohol often have weakened immune
systems due to poor overall health and nutrition, which also makes it
easier to develop an infection. Secondary abscesses are caused by
anything other than an infection that starts in your lung. This can be an
obstruction of the large airways in your lung, coexisting disease in your
lungs, or infections from other parts of your body that spread to your
lungs.

Symptoms
The most noticeable symptom of a lung abscess is a productive cough.
The contents that are coughed up may be bloody or pus-like, with a foul
odor.
Other symptoms include:
 bad breath
 fever of 101°F or higher
 chest pain
 shortness of breath
 sweating or night sweats
 weight loss
 fatigue

Complications
In rare cases, a lung abscess can rupture. This is a serious medical
concern. Potential complications following rupture or surgical treatment
of an abscess are:
 Empyema. This is a large collection of infected fluid around the
lung that occurs where the abscess is. It can be life-threatening
and requires immediate medical attention so it can be removed.
 Bronchopleural fistula. This is when a connection develops
between a large airway inside your lung and the space in the lining
around the outside of your lung. It’s corrected through a scope or
surgery.
 Bleeding from your lung or chest wall. This can be a small amount
of blood or a lot of blood, which is life-threatening.
 Infection spreading to other parts of the body. If the infection
leaves your lung, it can then produce abscesses in other parts of
your body including your brain.
Diagnosis
To diagnose a lung abscess, your doctor will first look at your health
history. Your doctor will review recent operations where anesthesia was
used. If an abscess is suspected, your doctor will analyze the sputum or
pus. Your doctor might also use imaging tools, such as an X-ray or CT
scan, to look at where the infection is in the lungs and rule out other
conditions, such as cancer or emphysema. For more serious infections,
your doctor might perform a procedure to take a sample from the
abscess.

Treatment
The primary treatment for a lung abscess is antibiotics. Long-term use of
medication might be necessary for up to six months. Lifestyle changes
such as not smoking and drinking more fluids may also be suggested.
In some cases, more invasive procedures or surgery may be necessary. A
tube can be inserted into the lungs to drain pus from the abscess, or a
surgical procedure may be required to remove infected or damaged lung
tissue.
Topic 8
Respiratory failure
Respiratory failure is a condition in which not enough oxygen passes
from your lungs into your blood. Your body's organs, such as your heart
and brain, need oxygen-rich blood to work well.
Respiratory failure also can occur if your lungs can't properly remove
carbon dioxide (a waste gas) from your blood. Too much carbon dioxide
in your blood can harm your body's organs.
Both of these problems—a low oxygen level and a high carbon dioxide
level in the blood—can occur at the same time.
Respiratory failure can occur as a result of:
 Conditions that affect the nerves and muscles that control
breathing. Examples include muscular dystrophy, amyotrophic
lateral sclerosis (ALS), spinal cord injuries, and stroke.
 Damage to the tissues and ribs around the lungs. An injury to the
chest can cause this damage.
 Problems with the spine, such as scoliosis (a curve in the spine).
This condition can affect the bones and muscles used for
breathing.
  Drug or alcohol overdose. An overdose affects the area of the
brain that controls breathing. During an overdose, breathing
becomes slow and shallow.
 Lung diseases and conditions, such as COPD (chronic obstructive
pulmonary disease), pneumonia, ARDS (acute respiratory distress
syndrome), pulmonary embolism, and cystic fibrosis. These
diseases and conditions can affect the flow of air and blood into
and out of your lungs. ARDS and pneumonia affect gas exchange
in the air sacs.
 Acute lung injuries. For example, inhaling harmful fumes or smoke
can injure your lungs.

The signs and symptoms of respiratory failure depend on its underlying

cause and the levels of oxygen and carbon dioxide in the blood. A low
oxygen level in the blood can cause shortness of breath and air hunger
(feeling like you can't breathe in enough air). If the level of oxygen is
very low, it also can cause a bluish color on the skin, lips, and fingernails.
A high carbon dioxide level can cause rapid breathing and confusion.

Treatment for respiratory failure depends on whether the condition is

acute (short-term) or chronic (ongoing) and its severity. Treatment also
depends on the condition's underlying cause. Acute respiratory failure
can be a medical emergency. It often is treated in an intensive care unit
at a hospital. Chronic respiratory failure often can be treated at home. If
chronic respiratory failure is severe, your doctor may recommend
treatment in a long-term care center. One of the main goals of treating
respiratory failure is to get oxygen to your lungs and other organs and
remove carbon dioxide from your body. Another goal is to treat the
underlying cause of the condition. In general, include Oxygen Therapy,
Tracheostomy, Ventilator.