Tracheal Deviation: The trachea, more commonly known as windpipe is one of the most important parts of the body as it is used for breathing. Its structure is like a tube which is about 1 inch in diameter and 4 to 6 inches in length. It is vertically located in front of the esophagus having 16-20 cartilage rings that prevent it from collapsing.

The trachea is a membrane suppurated by cartilage rings having an opening at the back. It is connected by a band of muscles which in return helps the trachea to expand and contract whenever we breathe in and out.  It also acts as a defense mechanism whenever it is exposed to various environment irritants. While coughing, the mucous membrane that is lined on the inside becomes very sensitive, stimulates reflex action and coughs up the foreign body which enters the body.

Causes of Tracheal Deviation

• In a relatively high negative pressure, the tracheal shifts on either of the sides resulting in tracheal deviation.
• Situated in a vertical position in a straight manner starting from the neck area to the chest area, a deviation in its position will highly affect the area
• Pneumothorax as it is said to be the most dangerous condition that causes it

Tracheal Deviation in Infants

Tracheal deviation in infants is not a major issue and has no medical concern. Infants up to the age of five years are prone to have a tracheal deviation that has no link to medical conditions. It happens because the infants have short neck relatively to trachea which resolves itself and outgrows afterward.

• Atelectasis: Collapsed lung in medical terms is considered as atelectasis that happens due to an obstruction or blockage that restricts its capacity to inflate adequately.
• Pleural Fibrosis: The pleura (the lining of the chest cavity) gets so thickened that it results in chronic inflammation to calcification.
• Pleural Effusion: It is a condition when fluid gets trapped in the chest wall and lungs. Although tracheal deviation is a prominent researched case, its symptoms can only be seen once there is a huge amount of fluid collected.
• Tumors: Either of the benign or malignant can cause tracheal deviation. A large mass found in the lung, bronchi or pleural cavity can displace the trachea to the side.
• Pneumothorax: It may arise when there is an injury to the lungs. Due to the large quantity of air entering the pleural space, the lung may collapse. During respiration, this air gets compressed and restricts the expansion of the lungs which in turn leads to other life threatening problems.

Signs and Symptoms

Respiratory symptoms

• Respiratory distress or respiratory arrest also related to cardinal finding
• Increase in the rate of respiration
• Lung expansion Asymmetry
• Decrease in breathing sound or complete absence of it
• Breathing sounds Wheezes or crackles (also called adventitious breath sounds)
• Difficulty in breathing (dyspnea)

Cardiac Findings

• Tachycardia increase in cardiac rate
• Hypotension decrease in blood pressure
• Dented Jugular vein

Other Findings

• Anxiety
• Epigastric Pain (rare)
• Fatigue

Detection of Tracheal Deviation & other Signs

Grossly examining or a mere palpation will easily detect the deviation of tracheal. Even a mere x-ray report will reveal the following:

• Dyspnea (difficulty in breathing)
• Cough
• Abnormal breath sounds

Treatments for Tracheal Deviation

Tracheal deviation by itself does not cause any major health issue. But its causes and symptoms are the underlying problems that need to be addressed. Moreover, it is always treated with many precautions to avoid risks that may even lead to death.

• Needle Thoracostomy: 14-16 cannulas that are inserted on the second intercostals space which is advanced until the air can be released through the syringe connected to the cannula. As soon as it is set in place, a guiding needle will be removed to let the air trapped inside to escape.

• Chest Drain Placement: It is one of the most popular and common treatments used for pneumothorax and are surgically done. A tube is placed on the pleura that allow the air to escape. This process is considered to be safer since this is done visually compared to the needle thoracostomy

Tracheal Deviation Pictures

Tracheal Deviation image

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Bronchiectasis refers to an abnormal widening of one or more air passages causing them to become scarred and flabby.

The disorder is also referred to by other names, like:

• Acquired bronchiectasis
• Congenital bronchiectasis

The condition can arise at any age.

Bronchiectasis ICD9 Code

The ICD9 Codes for this disorder are 494 and 748.61.

Bronchiectasis Incidence

Global data about the exact incidence of this disease is not known. The condition is relatively uncommon in the U.S, with a prevalence of around 100,000 cases – based on data available from the 1980s.

Bronchiectasis Symptoms

The symptoms of this disease arise gradually. They may develop months or years after the event that gives rise to Bronchiectasis. The signs and symptoms may include the following:

Picture 1 – Bronchiectasis

• Fatigue
• Breath odor
• Bluish skin color
• Coughing up blood
• Paleness
• Wheezing
• Weight loss
• Clubbing of fingers
• Cough that gets worse when lying on one side
• Shortness of breath that gets worse with exercise
• Chronic cough with large amounts of foul-smelling sputum

Over a period of time, sufferers may experience symptoms of a more severe nature. They may feel extremely tired and may cough up bloody mucus or even blood. Children affected by this disease may not be able to lose weight or develop at a normal pace.

Bronchiectasis Causes

The condition usually arises as a result of damage to the walls of the air passages. This damage can occur due to infectious conditions of the lung, such as:

• Fungal infections
• Tuberculosis
• Acute pneumonia
• Measles or whooping cough (rare disorders in the U.S as a result of vaccination)

The disease can also originate due to conditions that damage the air passages and elevate the risk of lung infections, including:

• Conditions that can cause the obstruction of airways, such as inhalation of small objects or development of a growth or benign tumor.
• Malformation of the lungs in the fetal stage (known as Congenital Bronchiectasis).
• Chronic pulmonary aspiration, Allergic bronchopulmonary aspergillosis, cystic fibrosis and immunodeficiency disorders that can increase the risk of lung infections.

Bronchiectasis Risk Factors

The risk factors for this condition include:

Being female

Females are supposed to be more susceptible to this condition. Two-thirds of all sufferers of this disorder are found to be women. However, the disease is more common in boys than in girls in children population.

Certain disorders

Some conditions that increase the risk of lung infections and damage the lungs can make sufferers susceptible to Bronchiectasis. Such diseases include:

• Immunodeficiency disorders like common variable immunodeficiency and rarely HIV and AIDS
• Cystic fibrosis, which is the cause of 50% of all cases of Bronchiectasis in the U.S
• Conditions that affect functioning of the cilia, such as Primary Ciliary Dyskinesia
• Allergic bronchopulmonary aspergillosis, which is an allergic response to a type of fungus known as Aspergillus. This response results in an inflammation of the air passages.

Bronchiectasis Diagnosis

Doctors may suspect the condition if patients suffer from a daily cough that is characterized by large amounts of sputum. To determine the presence of this disease, doctors may recommend tests in order to rule out other causes of the symptoms, determine the extent of damage to the airways and detect any underlying causes that need treatment.

The diagnostic tests for this disease include the following:

Chest x-ray

It is a painless exam that creates pictures of chest structures, such as the lungs or the heart. It can also reveal abnormal regions of the lung and irregular, thickened walls of the airways.

Chest CT scan

It is the most common diagnostic test for this disease and is painless for sufferers. This imaging exam produces accurate images of the airways as well as other structures in the chest. It can also determine the location and extent of lung damage and renders more detailed images than a standard x-ray of the chest.

Bronchoscopy

This is carried out if the condition fails to respond to standard treatment options. Physicians use this technique to view the inside of the air passages. In this test, a flexible tube fitted with a light at one end (bronchoscope) is inserted into the airways through the mouth or the nose.

Bronchoscope renders a video image of the airways. Before conducting the test, medications are administered to patients to induce numbness into their upper air passages to help them relax during the technique. The process can show a possible obstruction in the airways and also reveal any source of bleeding in the airways.

Other tests

Doctors may also recommend certain other exams, such as:

• Lung function tests
• Sputum culture
• Sweat tests
• Blood tests
• Serum immunoglobulin electrophoresis
• Genetic testing, including sweat test for cystic fibrosis
• PPD skin test, in order to detect a prior tuberculosis infection
• Aspergillosis precipitin test (to check for signs of the aspergillosis fungus)

Initially, however, doctors may listen to the lungs of patients with a stethoscope to hear abnormal lung sounds.

Bronchiectasis Differential Diagnosis

The differential diagnosis of this disease includes telling its symptoms apart from those of other conditions that produce similar symptoms. These include:

• Primary Ciliary Dyskinesia
• Cystic fibrosis
• Respiratory failure

Physicians should make sure that patients are not suffering from any of these conditions and actually exhibiting the signs of Bronchiectasis.

Bronchiectasis Treatment

The condition is often cured with the aid of hydration, medications and chest physical therapy (CPT).

Medicines

These include:

Antibiotics

This class of drugs is the main treatment option for recurring lung infections caused by Bronchiectasis. Oral antibiotics are often used to cure such infections. Physicians may prescribe intravenous (IV) antibiotics to cure infections that are hard to treat. Such drugs are administered through an IV line inserted into the arm.

For persisting cases, doctors may help arrange for a care provider at home to administer antibiotic medicines.

Bronchodilators

This helps relax the muscles around the air passages and open the airways, making breathing easier. The majority of Bronchodilators are medicines to be inhaled. In this technique, patients have to use a nebulizer or an inhaler to breathe in a fine mist of medicine. Inhaled Bronchodilators work rapidly as the medication goes straightly to the lungs. Physicians may recommend sufferers to use a bronchodilator just prior to CPT.

Mucus-thinners or expectorants

These are used to help patients cough up mucus. Expectorants can help loosen the mucus present in the lungs. These are often used along with decongestants to provide patients with additional relief. Mucus thinners like Acetylcysteine help loosen the mucus and make it easier for sufferers to cough up.

Hydration

Drinking lots of fluids, particularly water, can help prevent mucus in the airways from becoming thick and sticky in nature. Proper hydration can help make mucus moist and slippery in form, making it easier for sufferers to cough up.

Chest Physical Therapy (CPT)

Also referred to as Percussion or Chest Clapping or Physiotherapy, this process includes using hands or a specialized device to pound the chest and back again and again. This technique can help loosen the mucus from the lungs so that sufferers can cough it up.

While CPT is being carried out, patients can sit or lie on their stomach with their head in a tilted down posture. Gravity and force can help drain the mucus from the lungs.

Bronchiectasis Prognosis

The outcome of this disorder is based on the particular underlying cause of the disorder. In the majority of affected individuals, the symptoms do not worsen. The condition takes a turn for the worse in certain cases and patients may suffer from respiratory problems. In a small number of sufferers, the disease gradually becomes worse as more and more air passages are affected. In rare cases, a life-threatening bleeding from a damaged air passage may also occur.

With proper and timely treatment, however, the majority of sufferers can lead normal lives without suffering from a major disability.

Bronchiectasis Complications

Acute cases of this disease may result in serious health disorders, like:

Picture 2 – Bronchiectasis Image

Atelectasis

In this condition, one or more regions of the lungs fail to inflate properly or even collapse. Due to this reason, sufferers may experience shortness of breath. The breathing rate and heart rate may increase, and there can also be blue discoloration of the lips and skin.

Respiratory Failure

In this condition, there is a deficiency of oxygen passing into the blood from the lungs. The disease can also develop if the lungs cannot properly remove carbon dioxide (CO2) from the bloodstream. The condition can result in problems like rapid breathing, shortness of breath and air hunger (sensation of lacking enough air for respiration). In acute cases, the symptoms may involve sleepiness, confusion and a bluish discoloration of the fingernails, lips and skin.

Heart failure

If Bronchiectasis is severe enough to affect all parts of the air passages, it may result in cardiac failure – a condition in which the heart is unable to pump enough blood to satisfy the needs of the body. This may be characterized by problems like fatigue, shortness of breath and inflammation of the abdomen, legs, feet, ankles and neck veins.

Other possible complications include:

• Coughing up blood
• Cor pulmonale
• Recurrent pneumonia
• Low oxygen levels (in severe cases)

Bronchiectasis Prevention

It is necessary to prevent lung damage, and lung infections that may arise as a consequence, in order to prevent Bronchiectasis. Childhood vaccines for whooping cough and measles can prevent infections associated to such disorders. These vaccines also decrease complications from these infections, like Bronchiectasis.

Proper medical treatment of lung infections in children may also help prevent lung damage (that can cause this disorder) and preserve lung function.

Avoiding smoke, gases, toxic fumes and other harmful materials can also help protect the lungs. Children as well as adults should be stopped from inhaling small materials that might enter and obstruct the small air passages. In case of accidental inhalation of such materials, medical attention should be sought on a prompt basis.

In case you or any of your family members is suffering from difficulties like respiratory shortness, chest pain or change in phlegm color, you should contact a professional medical care provider on an immediate basis. Prompt medical treatment can help achieve a faster recovery and avoid all possible complications.

References:

http://www.nhlbi.nih.gov/health/health-topics/topics/brn/treatment.html#

http://www.wisegeek.com/what-is-bronchiectasis.htm

http://en.wikipedia.org/wiki/Bronchiectasis

http://emedicine.medscape.com/article/296961-overview

The post Bronchiectasis appeared first on Prime Health Channel.

Bronchopulmonary Dysplasia Definition

Bronchopulmonary Dysplasia (BPD) is an acute lung disorder that affects infants, especially premature ones who require oxygen therapy. It is one of the most common chronic lung disorders in children, along with cystic fibrosis and asthma.

The condition was earlier referred to as “Chronic Lung Disease of Infancy.” It is now also known as “Chronic Lung Disease (CLD) of prematurity.”

Bronchopulmonary Dysplasia ICD9 Code

The ICD9 Code of this disease is 770.7.

Bronchopulmonary Dysplasia Etymology

The name of this disorder comes from a fusion of three terms “Broncho”, “Pulmonary” and “Dysplasia.” Brocho refers to the bronchial tubes or airways through which oxygen goes to the lungs. The word “Pulmonary” stands for the tiny air sacs in the lungs known as alveoli where carbon dioxide and oxygen are exchanged. “Dysplasia” refers to abnormal changes in the organization or structure of a cluster of cells.

Bronchopulmonary Dysplasia Incidence

Every year, around 5,000 to 10,000 babies born in the U.S suffer from this disease. Today, the condition is found to affect more babies than were affected 30 years ago. This has been made possible by advances in medicine and medical technology due to which more premature babies can survive now. The overall incidence of this disorder is reported at 20% in newborns who are provided ventilator support.

Bronchopulmonary Dysplasia Symptoms

BPD usually arises as a complication in premature infants who are treated for Respiratory Distress Syndrome (RDS), a condition characterized by improper development of the lungs of a baby which makes it difficult for it to inhale as much air as required.

Babies affected with this disorder suffer from scarring and inflammation in the lungs. Some other typical signs and symptoms of this disease include:

• Coughing
• Wheezing
• Sucked-in chest and ribs
• Blue coloration of nails and lips due to lack of enough oxygen in the bloodstream
• Rapid, shallow breathing
• Poor posture of the shoulders, neck and trunk

Many babies affected with BPD exhibit the symptoms of Respiratory Distress Syndrome, which include:

• Tachycardia, or abnormally rapid heartbeat (more than 100 beats every minute)
• Tachypnea
• Frequent desaturations
• Increased efforts at respiration (with grunting, nasal flaring and retractions)

Infants with BPD are often very immature. They have a very low birth weight and suffer from severe loss of weight during the first fortnight of life. During the period between the second and fourth weeks of life, both ventilator support and oxygen supplementation are often increased to maintain oxygenation and proper ventilation.

Bronchopulmonary Dysplasia Causes

The exact causes of BPD are not known. However, most cases of the disease are found to arise after infants are put on ventilators. Due to this reason, doctors believe that forced administration of air damages developing lung tissue.

The disorder most commonly arises as a complication of respiratory therapy in infants who are premature and affected with RDS. Babies with RDS must get adequate amounts of oxygen. An apparatus is often required to help them breathe and prevent brain damage in sufferers and save their lives. However, administration of oxygen in premature infants can damage their lungs and result in inflammation. This can damage the airways. Excessive amounts of oxygen can also reduce the normal pace of development of the lungs in babies who are extremely premature.

Administration of oxygen into the lungs of premature babies by breathing equipments, like respirators or ventilators, may further aggravate the condition. Such machines make use of pressure to push air into the lungs. However, the use of pressure can irritate the lungs and make them swell even more. This problem can be avoided by the use of a simple measure. Oxygen may be administered to babies through the nose with a CPAP (Continuous Positive Airway Pressure) machine.

BPD may also arise due to infection in the lungs of premature babies. The infections may cause swelling and result in the narrowing of respiratory passages.

Bronchopulmonary Dysplasia Risk Factors

The condition is seen most in infants who are born extremely premature, more than 10 weeks prior to their date of delivery. The risk of BPD is also great in newborns with low birth-weight (less than 1,000 grams or 2.2 pounds).

Bronchopulmonary Dysplasia Diagnosis

The diagnosis of BPD can include the following techniques:

Laboratory tests

Lab tests are used to assess and monitor infants affected with BPD and include:

• Pulmonary function tests
• Arterial blood gas (ABG) levels, to determine the presence of acidosis, hypoxia (with elevated oxygen requirements) and hypercarbia
• Transcutaneous or end-tidal carbon dioxide levels, which are used to determine trends, particularly whether the results have a correlation with ABG levels

Doctors may use Pulse oximetry to monitor oxygenation of blood constantly due to frequent desaturations. Blood pressure should also be monitored on a routine basis as infants affected with BPD may also develop Systemic hypertension.

Imaging studies

Doctors may use the following radiographic studies to assess the condition of infants suspected with BPD:

• Chest magnetic resonance imaging (Chest MRI)
• High-resolution chest CT (Computed Tomography) scan
• Chest radiography, to assess the acuteness of BPD and differentiate the disease from air leak syndrome, pneumonia and atelectasis

Lung biopsy

Other procedures such as Lung biopsy in preterm infants with BPD may demonstrate results from pathologic stages like:

• Acute lung injury
• Proliferative bronchiolitis
• Exudative bronchiolitis
• Obliterative fibroproliferative bronchiolitis

However, the condition is generally detected by an X-ray examination of the chest of affected infants when they are still recovering from RDS. X-rays may reveal spongy appearance of lungs in babies with BPD.

Bronchopulmonary Dysplasia Differential Diagnosis

The differential diagnosis of BPD involves isolating its symptoms from those of other disorders, such as:

• Pneumonia
• Pulmonary atelectasis
• Cystic fibrosis
• Patent ductus arteriosus
• Obliterative bronchiolitis
• Postinfective bronchiectasis
• Subglottic stenosis or tracheomalacia
• Poorly responsive infant respiratory distress syndrome (RDS)
• Air leak syndromes (including pneumoperitoneum, pneumomediastinum, pulmonary interstitial emphysema, pneumopericardium, pneumothorax and subcutaneous emphysema)

Doctors should confirm that the symptoms reported by sufferers are those of BPD and not of any of the above-mentioned conditions.

Bronchopulmonary Dysplasia Treatment

Infants affected with BPD are generally treated in the neonatal intensive care unit (NICU) in hospitals until they are able to breathe properly on their own, without the aid of a ventilator. A suffering infant can spend anytime between several weeks to several months in the NICU.

While in the NICU, infants with BPD are kept warm with the aid of an incubator or a radiant warmer. Fluids and nutrients are administered to them in an intravenous manner. The heart rate, blood pressure, temperature, fluid intake and respiration are monitored.

Babies affected with BPD are usually cured with medicines like:

Diuretics

Diuretics like Furosemide are used to reduce the accumulation of fluid in the lungs

Bronchodilators

Bronchodilators like Albuterol are used to help keep the respiratory passages in sufferers open.

Antibiotics

These are sometimes required to combat bacterial infections as infants with BPD are more likely to suffer from Pneumonia.

Steroids

Acute cases of BPD might be cured with the aid of a short course of steroids. However, steroids are only used after discussions with parents of sufferers as these are strong anti-inflammatory medications that have some serious short and long term side effects.

High-calorie formulas

In infants with BPD, who are sick enough to be hospitalized, a gastric tube may be inserted into the stomach. High-calorie formulas may be fed to them to ensure that they receive enough nutrients and calories to grow about as normally as other children.

Bronchopulmonary Dysplasia Prognosis

Many infants with BPD manage to recover and many of them are able to lead active, normal lives. The process of recovery may be slow. Suffering babies may need to continue medicines and breathing therapy or even oxygen administration at home even after leaving hospital. Oxygen supplementation may be stopped in the majority of infants by the end of the first year after their birth. A few babies with acute cases of BPD may require a breathing apparatus known as a ventilator for a number of years. In rare cases, they may need it as long as they live.

Bronchopulmonary Dysplasia Complications

During the first two years of their life, babies affected with BPD may suffer from multiple cases of lung infections. Parents with premature babies suffering from cough, cold, fever or runny nose should take them to a doctor for proper check-ups and treatment.

Majority of BPD sufferers have few respiratory problems within one or two years. They do not require any specific medical treatment and are not restricted in their daily activities.

Although most infants eventually outgrow the acute signs and symptoms of BPD, the condition along with other complications involved with prematurity can be life-threatening in rare cases.

Bronchopulmonary Dysplasia Prevention

The occurrence or aggravation of this condition can be prevented by the following measures:

• Regularly visiting a healthcare provider during pregnancy
• Adhering to a healthy diet
• Avoiding consumption of alcohol, smoking and illegal medicines
• Washing hands regularly and avoiding patients of flu or colds in order to prevent infection
• Taking steps to properly manage any health issues that might be present

In women who have a history of premature delivery, physicians may administer medications to help delay delivery. If a doctor suspects that a baby is premature, he may administer its pregnant mother with medicines (in an injected form) to help hasten the development of the lungs as well as various other organs. Medications can also help lower the risk of development of Respiratory Distress Syndrome (RDS) in affected babies.

Bronchopulmonary Dysplasia Pictures

The following images show the physical appearance of infants suffering from BPD.

Picture 1 – Bronchopulmonary Dysplasia

Picture 2 – Bronchopulmonary Dysplasia Image

Parents of preterm newborns should not ignore any health problem exhibited by their children and report all issues to concerned doctors on an immediate basis. Although the majority of BPD sufferers survive the stage of infancy, they tend to be susceptible to infections, growth delay, cardiac and neurological dysfunction and asthma. Hence, it is imperative for parents to report health problems immediately.

References:

http://en.wikipedia.org/wiki/Bronchopulmonary_dysplasia

http://reference.medscape.com/article/973717-overview#showall

http://www.patient.co.uk/doctor/Bronchopulmonary-Dysplasia.htm

http://kidshealth.org/parent/medical/lungs/bpd.html

The post Bronchopulmonary Dysplasia appeared first on Prime Health Channel.

Bronchopneumonia Definition

Bronchopneumonia refers to a severe inflammation or swelling of the walls of the bronchioles. Although it us similar to ordinary pneumonia, is can be more acute in nature and need different type of medical treatment. This inflammatory condition of the lungs spreads from and after bronchial infection.

The condition is also known by other names like:

• Bronchogenic pneumonia
• Bronchial pneumonia

The disorder is bilateral and affects a single lobe or multiple lobes.

Bronchopneumonia ICD9 Code

The ICD9 code for this disease is 485.

Bronchopneumonia Incidence

Pneumonia, including Bronchopneumonia, is fairly common in nature and affects millions of individuals only in the United States. Globally, it affects many more people with the disorder having a greater prevalence in third world nations.

Bronchopneumonia Symptoms

The typical signs and symptoms of this disorder include:

• Chest pain
• Chills
• Cough
• Fatigue
• Fever

People suffering from this type of pneumonia may cough up yellow or blood-streaked mucus.

The disorder is more common in older individuals and arises along with other viral respiratory conditions such as Bronchitis. It develops as a complication of asthma.

The early symptoms of the disorder resemble that of flu. In the later stages, the condition can show a progression with patients suffering from problems like:

• Fluctuating chest pain
• Muscle pain
• Shortness of breath
• Unexplained fatigue

In the event of any of these symptoms, sufferers should get in touch with a professional medical care provider on an immediate basis.

In bronchopneumonia, there is an accumulation of liquids such as pus in both the lungs of patients. This can result in reduced supply of oxygen to all the vital organs of the body and acute respiratory difficulties for sufferers. If left without treatment, it can obviously lead to death.

If Bronchopneumonia arises 2-3 days after acute bronchitis, the following health issues are usually experienced:

• Breathlessness
• Central cyanosis
• Increase in pulse rate
• Increase in rate of respiration
• Rise in body temperature

Usually, there is an acute cough with purulent sputum. In this condition, unlike in pneumococcal pneumonia, pleural pain is rare.

Bronchopneumonia Vs Lobular Pneumonia

Bronchopneumonia is different from Lobular Pneumonia. Only one of the two lobes is affected in lobar pneumonia, whereas both lobes suffer from an inflammation in bronchial pneumonia. In Lobular pneumonia, a subdivision or an entire section of the lung may be swollen. In Bronchopneumonia, only patches in and around the tiny passages and airways are inflamed.

However, the external symptoms of both types of Pneumonia are similar in nature, such as fever, chest pain, blood-streaked mucus, respiratory difficulties and chills.

Bronchopneumonia Causes

The disorder may arise as a secondary complication of some other disorder, such as:

• Malnutrition
• Some major operation
• Vomiting or aspiration of food
• Viral infection, such as measles or influenza
• Blockage of bronchus by some neoplasm or foreign body
• Inhalation of poisonous gases
• Hipostatics, lying long after suffering a stroke
• Acute chronic disorders such as Tuberculosis

In the majority of cases, the condition develops due to descending infection of the bronchi. Inflammatory foci of varying sizes develop in the lung parenchyma, which comprise of purulent exudates when bacteria is the cause. These sections are firm and grayish in appearance. They could be great in number or merge between each other (Confluent pneumonia).

Bronchopneumonia Pathophysiology

Bacteria are responsible for the transmission of Bronchopneumonia. The disorder arises when bacteria enters the lungs. Pseudomonas aeruginosa and Staphylococcus aureus are the most common forms of bacteria that lead to the development of bronchial pneumonia. When the pulmonary lobes are infected by bacteria, mucus produced by the lungs fills the alveolar sacs. This in turn results in a condition known as consolidation which happens when the air space is reduced due to the buildup of mucus inside the lungs. Reduced air space leads to respiratory difficulties such as causes shallow (labored) breathing or shortness of breath.

Bronchopneumonia Risk Factors

Senior citizens over the age of 65 years are most susceptible to this disorder. Individuals with long-term ailments that weaken the natural immunity of the body are also prone to this form of pneumonia. Impaired defense capability of the respiratory tract and low body resistance are the main reasons for the development of the condition in such people.

Is Bronchopneumonia Contagious?

This condition is caused by microbial organisms, such as bacteria. Naturally, it is contagious in nature and can be passed on from one person to another.

Bronchopneumonia Diagnosis

Physicians usually diagnose this condition by listening to the breathing sounds of sufferers with a stethoscope. In some cases, the following exams are also used to detect this disorder:

• Complete blood count (CBC)
• Sputum culture test
• Chest x-ray

In some individuals, a CT scan may be conducted. A pleural fluid culture of the fluid around the lungs may be taken.

In case the diagnosis is unclear, lung x-rays should be conducted. It must be remembered that auscultation and lung percussion penetrates up to a depth of 5 cm. Due to this reason, a negative result in an examination does not exclude atypical pneumonia.

In bronchopneumonia patients, an x-ray examination of the chest often helps show a scattering of heterogenous opacities, as opposed to the homogenous opacity that characterizes lobar pneumonia. This happens as a result of involvement of more than one area in the lungs.

Bronchopneumonia Differential Diagnosis

The differential diagnosis of Bronchopneumonia aims at distinguishing its symptoms from those of similar disorders, such as:

• Asthma
• Bronchiectasis
• Chronic Obstructive Pulmonary Disorder (COPD)
• Lung cancer
• Pulmonary edema
• Pulmonary emboli

Doctors should make sure that the symptoms experienced by sufferers are those of Bronchopneumonia and not of any of the conditions mentioned above. A misdiagnosis can jeopardize the health of sufferers and complicate the condition to a severe extent. Due to this reason, patients should always get themselves diagnosed by professional healthcare providers.

Bronchopneumonia Treatment

Upon diagnosis, most sufferers are treated with antibiotics at home. As Bronchopneumonia is an infection caused by bacteria, antibiotics like erythromycin or amoxicillin may used to hasten recovery. Apart from being administered antibiotic medications, patients are advised to consume lots of fluids and have enough rest.

Hospitalization is not deemed as necessary unless the symptoms are acute in nature or there are underlying health issues or other complications such as increased age.

Bronchopneumonia Complications

The typical complications associated with this disorder include the following:

• Acute renal insufficiency in dehydration
• Recurrent pneumonia, that affects other lung sections
• Pleura damage, caused by Pleural empyema, Pleural effusion or Pleurisy
• Cardiovascular disease
• Chronic pneumonia
• Respiratory deficiency
• Thromboembolic complications, due to bed rest
• Septic distribution to the pneumonia agents in blood along with the occurrence of endocarditis, otitis, brain abscess and meningitis.

Bronchopneumonia Prognosis

On strict adherence to the treatment plan prescribed by doctors, the disorder usually resolves within a period of 4-6 weeks. However, individual cases tend to vary on factors like:

• Acuteness of the infection
• The overall health of sufferers
• Age of sufferers

Sufferers may begin to feel better within 3-4 days after the initiation of medical treatment. However, they should follow the orders of their physicians for resuming work and day to day activities.

If an individual has an acute case of Bronchopneumonia or suffers from dehydration, he or she may be hospitalized. In a hospital setting, the condition can be monitored more closely. With proper treatment, the majority of patients manage to recover completely in around 2 weeks. Very elderly or infirm individuals who do not receive proper treatment can die as a result of the disorder.

Bronchopneumonia and Mortality

The rate of mortality is higher at the extremes of life particularly in cases where the condition supervenes or emphysema, chronic bronchitis or any debilitating disorder.

Bronchopneumonia Prevention

Certain vaccines are available that can help prevent bacteria and disorders that can act as causative factors for Bronchopneumonia. The Flu vaccine prevents pneumonia and other viral conditions caused by influenza viruses. A Pneumococcal vaccine like Prevnar and Pneumovax prevents Streptococcus pneumoniae. In children, the Hib vaccine helps prevent pneumonia from the Haemophilus influenza type b.

The best way to prevent the disorder involves washing the hands frequently with soap and water, particularly after coming back from public places or after using the bathroom. Cessation of smoking can also help lower the risk of suffering from pneumonia. Proper amounts of rest and a healthy diet can keep the immune system strong and help in fighting off bacteria and germs that can lead to pneumonia.

Famous People with Bronchopneumonia

The condition has been reported in many famous individuals. Those who have died due to this disorder include famous names such as:

• King Edward VI
• Gregory Peck
• Devin McKinnon
• Rosalind Franklin

Bronchopneumonia in Dogs

In dogs, the disorder occurs as a result of inflammation of the lungs and the bronchi – the large passages that help move air into the lungs. The condition generally occurs due to bacterial infection spread by inhalation. The form of pneumonia that is spread through blood contact is less common and frequently more difficult to cure.

Bronchopneumonia Pictures

The following images show the appearance of lungs affected by this condition.

Picture 1 – Bronchopneumonia

Picture 2 – Bronchopneumonia Image

If you suspect yourself or any member of your family to be affected by this disorder, get in touch with a doctor immediately and seek medical treatment promptly. Early diagnosis and treatment will not only ensure a faster recovery from the disease but also help avoid any possible complications that may arise at at any time in future.

References:

http://www.wisegeek.com/what-is-bronchopneumonia.htm

http://voices.yahoo.com/what-bronchopneumonia-111767.html?cat=70

http://nikon2.magnet.fsu.edu/galleries/pathology/bronchopneumonialarge.html

http://en.wikipedia.org/wiki/Bronchopneumonia

The post Bronchopneumonia appeared first on Prime Health Channel.

Silicosis Definition

It is a respiratory disease that occurs due to inhalation of crystalline silica dust. It is a type of Occupational Lung Disease.

The disorder is also referred to by the following names:

• Miner’s Phthisis
• Potter’s Rot
• Grinder’s Asthma

Silicosis ICD9 Code

The ICD9 Code for this disorder is 502.

Silicosis Incidence

According to a report published by the Center for Disease Control and Prevention (CDC) in 1996, as many as 1 million workers are exposed every year to crystalline silica. Of this population, over 250 people die from Silicosis.

As a result of greater awareness about the disease, enforcement of laws regarding maximum permitted dust levels in industry and use of protective wear, the incidence of new cases of the disorder is reducing in the U.S every year. Since regulations about the use of protective equipment have been implemented by the Occupational Safety and Health Administration (OSHA), the amount of silica dust inhaled by workers has been limited.

Silicosis Types

The disorder is classified into the following three types:

Simple Chronic Silicosis

It occurs as a result of prolonged exposure to low amounts of silica dust, generally for about 20 years. The dust of silica leads to an inflammation in the lymph nodes of the chest and in the lungs. This is the most common type of Silicosis. It is usually restricted to round, small spots in the lungs that can be seen in X-ray images.

Patients of this form of the disease may experience problems in breathing. Generally, sufferers are asymptomatic. The condition is found to be non-progressive once the exposure ends.

Accelerated Silicosis

It arises after exposure to high amounts of silica over a shorter duration, generally 5 to 15 years of time. In this form, the symptoms such as lung inflammation occur at a faster pace than in the simple form of the disorder.

Acute Silicosis

It arises as a result of short-term exposure to extremely high quantities of silica. The lungs get highly swollen and can be filled with fluid, resulting in low levels of oxygen in bloodstream and acute shortness of breath.

As per another classification, the disorder can be categorized into four types:

Chronic Simple Silicosis

It generally arises after 10-12 years of exposure to silica dust and is non-progressive after patients are not exposed to the irritant.

Chronic Complicated Silicosis

It occurs after 20 years or more of exposure to Silica dust. There is a progressive worsening of symptoms and damaged lung regions continue to grow in size even after there is an end to exposure.

Subacute Silicosis

It tends to arise after 3-6 years of acute exposure to silica and resembles the signs of Chronic Complicated Silicosis.

Acute Silicosis

It may arise after less than 2 years of heavy exposure to silica dust and is clinically different from the other forms.

Silicosis Causes

The condition, as already mentioned, arises as a result of exposure to silica – a crystalline substance that can be commonly found in natural surroundings. It is found in most rock beds. It forms dust which can come in contact with people who work in mines, tunnels and quarries or those who work with numerous metal ores. As Silica is the major constituent of sand, sand-blasters and glass workers are also exposed to the substance.

Silicosis Symptoms

The disorder generally gives rise to the following signs and symptoms in sufferers:

• Cough
• Weight loss
• Shortness of breath

Intense exposure to silica dust can result in disorders within a year. However, it generally takes a minimum period of 10-15 years of exposure prior to the development of the symptoms.

Silicosis and Progressive Massive Fibrosis

Progressive Massive Fibrosis is a pathological disorder of the lungs. The condition is characterized by acute scarring of lungs and destruction of normal lung structures. This condition may arise in either simple or accelerated forms of Silicosis, although it is more common in the accelerated type.

Progressive Massive Fibrosis is often compounded by chronic infection, especially Tuberculosis.

Silicosis Risk Factors

The risk factors for this disease involve the following:

Being in certain occupations

Some people are a higher risk of developing Silicosis due to constant exposure to silca dust, as a result of being involved in certain professions like:

• Blasting
• Road construction
• Building construction
• Tunnel construction
• Quartz mining
• Pottery
• Sandblasting
• Metal mining
• Foundries
• Stonecutting
• Abrasive manufacturing

Being of certain age

The disorder is generally identified in workers who are aged between 40 and 75 years of age.

Being male

Men have a tendency to develop the condition more than women as they are more involved in high-risk professions.

Silicosis Diagnosis

The diagnosis of this disorder involves a consideration of the medical history of sufferers. Doctors ask many questions to sufferers about their professions, hobbies and other activities that may have exposed them to silica dust. Physicians may also carry out a physical examination. It involves listening to sounds of breath with the aid of a stethoscope which may indicate blockage in the upper lobes of the lungs.

Additional tests to confirm the presence of the disorder and ruling out similar conditions include:

• Chest CT scan
• Chest X-ray
• Pulmonary function tests
• Serologic tests for connective tissue disorders
• Purified protein derivative (PPD) skin test (for Tuberculosis)

Some other tests for the condition, conducted in less common cases, may include:

• Pulmonary function tests, including lung volume measurement and Spirometry
• Arterial blood gases, to determine the efficiency of gaseous exchange in the lungs by the determination of levels of carbon dioxide (CO2) and oxygen in arterial blood
• Sputum culture, to detect the possible presence of any causative organisms and also for ruling out Tuberculosis

Silicosis Differential Diagnosis

The differential diagnosis of Silicosis includes isolating its symptoms from those of other similar disorders like:

• Sarcoidosis
• Tuberculosis
• Alveolar proteinosis
• Asbestosis
• Siderosis
• Stannosis
• Fungal pneumonia
• Lung cancer
• Lymphoma
• Metastatic carcinoma
• Lung diseases such as Pneumoconiosis
• Coal worker’s Pneumoconiosis
• Talcosis, caused by exposure to irritants

Silicosis Treatment

The disorder does not have any particular treatment. It is important to remove the source of Silica to prevent the worsening of the disorder. Cure mainly involves supportive treatment, which includes:

• Bronchodilators
• Cough medications
• Oxygen, if required

Antibiotic medications are prescribed for respiratory infections, as required. Other kinds of drugs used for the treatment of this disease involve anti-inflammatory medications (to decrease inflammation) and medications to widen the lung airways (Bronchodilators).

Treatment also involves reducing exposure to irritants, cessation of smoking and undergoing routine Tuberculosis (TB) skin tests.

Those with Silicosis are greatly susceptible to TB. Silica is supposed to interfere with the immune response of the body to the bacteria that is the causative agent of TB. Silicosis sufferers should undergo skin tests to help physicians determine the exposure to TB. Patients with a positive skin test should be cured with anti-TB medicines. Any alteration in the appearance of Chest x-ray may be an indication of TB.

People affected with severe cases of Silicosis may require a lung transplant.

Silicosis Management

The condition can be managed by the following measures:

Sleeping in a semi-upright position

It helps decrease the shortness of breath experienced by sufferers.

Stopping smoking

Smoking can worsen the symptoms of Silicosis and elevate the risk of lung cancer. Due to this reason, people suffering from Silicosis are urged to quit smoking.

Silicosis Prognosis

The outcome of this disease tends to vary on the basis of the amount of damage suffered by the lungs. Outcome is also dependent on other factors, such as:

• Duration of dust exposure
• Concentration of dust
• Size of silica dust particles that patients have been exposed to

If lung damage that is already present is permanent, the condition can cause permanent disability. The outcome tends to be less positive if complications occur or if Silicosis arises at any early age.

Although drugs cannot cure the underlying disorders, they can help give relief from the symptoms and let patients attain a complete recovery from Silicosis.

Drug therapy may help in recovery in cases where complications do occur. The amount of recovery, however, depends on the severity and the nature of the complications. Specific work restrictions, if any, are associated to the symptoms of affected individuals, particular work requirements and the presence of complications.

Silicosis Complications

The complications of the disorder may involve:

• Emphysema
• Lung cancer
• Stomach cancer
• Pneumothorax
• Other lung infections
• Respiratory failure
• Right-side heart failure (cor pulmonale)
• Increased risk for Tuberculosis (Silicotuberculosis)
• Progressive massive fibrosis (a variant of Silicosis)
• Connective tissue disease, including Systemic lupus erythematosus, scleroderma (also referred to as Progressive systemic sclerosis) and Rheumatoid arthritis

In some cases, the disorder can even result in the death of sufferers.

Silicosis Prevention

People who are involved in high-risk occupations should wear dust-masks and stop smoking. They should also use respirators and other protective devices recommended by OSHA. In well-developed nations, individuals engaged in professions that cause them to be exposed to silica dust use special respirators that prevent the entry of dust into their lungs. If possible, individuals who are already affected should make some changes in workplace to reduce or even obliterate exposure to silica dust. If that is not possible, they should wear protective equipment and clothing to prevent further exposure. In extreme cases, a complete change of profession may be required.

Today dry mining has been made infrequent. Special filters have been developed for drilling equipment. Any substance that can lower the amount of silica dust in the air, especially the use of water, is employed to introduce more safety in the working conditions.

Desert Lung Disease

It is a non-occupational type of Silicosis that results from prolonged exposure to sand dust in desert regions. Cases of this disease have been reported from the Libyan desert, Negev and Sahara. The condition occurs as a result of accumulation of sand dust in the lungs. The disorder may be associated to Al Eskan disease, a lung disorder that is supposed to arise due to exposure to sand dust which contains organic antigens. Al Eskan disease was diagnosed for the first time after the Gulf War of 1990.

Silicosis Support Groups

Those suffering from Silicosis and their family members should get in touch with one of the many support groups available for providing guidance, information and assistance regarding the disorder.

Silicosis Pictures

The images underneath would help you understand the appearance of lungs exposed to silica dust.

Picture 1 – Silicosis

Picture 2 – Silicosis Image

If you have been exposed to Silica dust regularly at work, or already have symptoms of the disorder, contact a health care provider. The earlier you recover from this disorder, the better it is for you.

References:

http://www.nlm.nih.gov/medlineplus/ency/article/000134.htm

http://www.mdguidelines.com/silicosis

http://www.wisegeek.com/what-is-silicosis.htm

http://en.wikipedia.org/wiki/Silicosis

The post Silicosis appeared first on Prime Health Channel.

Obstructive Sleep Apnea (OSA), also referred to as Obstructive Sleep Apnea Syndrome or Obstructive sleep apnea-hypopnea (OSAH), is a condition that is characterized by repetitive cessations of breathing during sleep in spite of persistent efforts to breathe in. It is the most commonly occurring form of sleep apnea.

Obstructive Sleep Apnea ICD-9 Code

The ICD-9 code for OSA is 327.23.

Obstructive Sleep Apnea Epidemiology

It is the most common sleep disorder related to difficulty in breathing. Although occurring in various areas throughout the world, it has a higher prevalence in western countries. During mid-90s, around 6% to 7% of men and 3% to 4% of women were believed to be affected by this disorder.

Obstructive Sleep Apnea Causes

An obstruction of the upper airway is the main cause for this syndrome and the condition is generally associated with reduction in the blood oxygen saturation. The pauses in breathing are known as apneas, which means “without breath,” and they generally last for about 20-40 seconds. Individuals having OSA are rarely aware that they are having breathing-related difficulties, even when they are awake. However, people around OSA-affected individuals can recognize this as a problem by witnessing them during such episodes or by noticing the effects of these apneas on the patients’ bodies. This syndrome is also commonly followed by snoring. Obstructive sleep apnea can be normal, mild, moderate or chronic and severe, based on the degree of intensity.

The following causes are believed to be responsible for most cases of OSA:

• Decreased muscle tone
• Old age (premature or natural)
• Brain injury (permanent or temporary)
• Structural features which give rise to narrowed airway
• An increase in soft tissue around airway (occasionally due to obesity)

A decrease in the muscle tone may occur due to alcohol or drugs, or it can occur due to neurological problems or some other disorders. Certain individuals might have more than one of the above-mentioned issues. According to a theory, long-term snoring can give rise to local nerve lesions within the pharynx in the same way as prolonged exposure to vibrations might give rise to nerve lesions in the other areas of the body.

Certain craniofacial syndromes may give rise to abnormal facial features. Some of these syndromes are genetic, while others develop due to unknown causes. Such conditions may involve the nose, the mouth and jaw, as well as the resting muscle tone and increase the risks for OSA. A condition known as Down syndrome may lead to the development of low muscle tone, a narrow nasopharynx as well as a large tongue, which greatly increases the chances of obstructive sleep apnea. In fact, more than 50% of people having Down syndrome eventually get affected by this sleep disorder. Other factors include obesity, adenoids and enlarged tonsils. In cases of certain other craniofacial conditions, the abnormal features associated with them may even improve the airway. However, corrective surgeries to rectify such craniofacial problems may increase the risks of development of OSA. An example of such a craniofacial condition includes cleft palate. Other craniofacial difficulties include Pierre Robin sequence and Treacher Collins syndrome.

Obstructive sleep apnea may also develop as a major post-operative complication of pharyngeal flap surgery which is used to treat velopharyngeal inadequacy (VPI). Surgical treatment for curing Velopalatal insufficiency may also give rise to this sleep disorder.

Obstructive Sleep Apnea Risk Factors

A number of factors can increase the risk of development of this syndrome. One of this is old age, which is frequently accompanied by a muscular as well as neurological loss of the muscle tone of upper airway. Reduced muscle tone can also be temporarily caused by alcoholic drinks, sedative medications and chemical depressants. Permanent premature loss of muscle tone in upper airway can occur due to neuromuscular disorders, traumatic brain injury, or a lack of adherence to chemical and/or speech-therapy treatments. People having reduced muscle tone, an increase in soft tissues around the airway as well as structural features giving rise to narrowed airway are more prone to develop this sleep disorder. Men having increased mass around torso and neck make up a vulnerable group especially during the middle ages or later. Women are more inclined to develop OSA during pregnancy.

Obstructive sleep apnea may also have a genetic aspect to it, with more people having a family history of this condition getting affected by it. Habits such as smoking can also increase the risk of development of this condition. Consuming alcohol, sedatives, or other sleep-inducing medications can also act as potent risk factors because most of these substances also act as muscle relaxants. People with hypertension, chronic nasal congestion, and diabetes forms a high risk group for this disorder. The condition can also develop in individuals suffering from severe infectious mononucleosis caused by the Epstein-Barr virus.

Obstructive Sleep Apnea Pathophysiology

Normal sleep/wake cycle in the adult population can be divided into three states:

• Rapid eye movement (REM) sleep
• Non-REM (NREM) sleep
• Consciousness

The NREM sleep can be further divided into Stage 1, 2 and 3. The stage 3 of non-REM is the deepest stage which is needed for attaining the physically restorative influence of sleep. It is also the stage where the human growth hormone is released in pre-adolescents. The non-REM Stage 2 and the REM together make up 70% of the total sleep time of an average person, and are essentially associated with the mental recovery as well as maintenance of the individual. During REM sleep, the muscle tone of throat and neck and most of the skeletal muscles are almost entirely attenuated, which allows the tongue and the soft palate/oropharynx to completely relax. In sleep apnea patients, it also impedes flow of air that may differ in degrees, ranging from light snoring to a complete collapse. If the airflow gets reduced to a state where the levels of blood oxygen fall or the effort to breathe is great, the neurological mechanisms elicit a sudden disruption of sleep known as a neurological arousal. Such arousals rarely lead to complete awakening, but may weaken the restorative effects of sleep. This leads to sleep deprivation caused by repetitive disruption and continuation of sleep activity. Interruption of sleep during the stage 3, or the slow-wave sleep as well as in the REM sleep stage can greatly interfere with the normal growth patterns, the healing abilities, and immune response, mainly in children or young adults.

Obstructive Sleep Apnea Symptoms

The most common signs and symptoms of OSA include:

• Anxiety
• Insomnia
• Irritability
• Depression
• Mood swings
• Forgetfulness
• Restless sleep
• Heavy night sweats
• Decreased sex drive
• Morning headaches
• Unexplained weight gain
• Difficulty in concentration
• Unexplained daytime sleepiness
• Increased urination and nocturia
• Increased heart rate and blood pressure
• Sore throat or dry mouth upon awakening
• Frequent instances of heartburn or gastroesophageal reflux disease
• Loud snoring, accompanied by periods of silence that are followed by gasps

Adults with OSA frequently suffer from obesity, especially gaining heaviness around the neck and face. However, many adults having normal BMIs (body mass indices) have reduced muscle tone leading to sleep apnea and airway collapse. Excessive daytime sleepiness is the hallmark of OSA in adults. Individuals having severe long-standing OSA might fall asleep for short periods during daytime provided they get any opportunity to rest or sit. This tendency can be quite dramatic, even occurring during conversations at social gatherings. Absence of oxygen or hypoxia can cause changes in neurons of hippocampus and right frontal cortex. Hippocampal atrophy can also occur in some extreme cases. Some individuals have been found to have problems with mental manipulation of non-verbal information as well as in executive function.

Although excessive sleepiness or hypersomnolence can also be noticed in children, it is not typical of all young children affected by sleep apnea. Signs of overexhaustion or hyperactivity may be observed in children and toddlers (pediatric cases) with OSA. Poor growth is observed in these children due to intense breathing which leads to faster burning of calories as well as obstruction of nose and throat which makes consumption of food a physically uncomfortable experience. Learning difficulties and memory deficits can also be observed in these children, leading to low IQ scores. Other symptoms may include bedwetting, drooling or choking and teeth grinding.

Obstructive Sleep Apnea Diagnosis

OSA is diagnosed by taking into consideration the medical history of patients as well as conducting lab or home-based tests.

Polysomnography

In this test, the activities of the heart, brain and lungs, breathing patterns, leg and arm movements as well as the blood oxygen levels of OSA patients are monitored as they sleep. It may involve an Electroencephalogram (EEG), 2 electro-oculograms (EOGs) and an Electromyogram. At the end of this diagnostic test, the total number of apnea/hypopnea episodes recorded per hour is presented as apnea-hypopnea index or AHI. The results of this test are interpreted in the following manner:

• AHI less than 5 – Normal sleep apnea
• AHI between 5 and 15 – Mild sleep apnea
• AHI between 15 and 30 – Moderate sleep apnea
• AHI greater than 30 – Severe sleep apnea

Home Oximetry Test

A home Oximetry test is a non-invasive technique of monitoring one’s blood oxygenation which can be easier to acquire than a formal polysomnography. Patients scoring 10 or more in an Epworth Sleepiness Scale (ESS) and/or 15 or more in a Sleep Apnea Clinical Score (SACS) are considered to be affected by OSA. The Oximetry test does not measure respiratory arousals or apneic events and so doesn’t give an AHI value.

Other tests may include:

• Nasolaryngoscopy
• Arterial blood gases
• Thyroid function tests

Obstructive Sleep Apnea Differential Diagnosis

A number of conditions show signs and symptoms similar to that of Obstructive Sleep Apnea (OSA). Hence, while determining the presence of OSA, doctors should differentiate it from such similar disorders in order to determine the best treatment plan. The differential diagnoses of OSA include conditions such as:

• Asthma
• Depression
• Narcolepsy
• Parkinsonism
• Drug reactions
• Simple snoring
• Hypothyroidism
• Central Sleep Apnea
• Dystrophica myotonica
• Idiopathic hypersomnia
• Nocturnal panic attacks
• Chronic insufficient sleep
• Gastroesophageal reflux disease
• Periodic limb movement disorder
• Dyspnea caused by pulmonary edema
• Chronic obstructive pulmonary disease
• Non-obstructive alveolar hypoventilation
• Obstructive sleep apnea-hypopnea syndrome
• Previous instances of encephalitis or head injury
• Obesity-hypoventilation syndrome or Pickwickian syndrome

Obstructive Sleep Apnea Treatment

OSA can be treated in a number of ways, depending on the medical history of patients, severity of the condition as well as the specific cause responsible for the obstruction.

Physical intervention

Positive airway pressure is the most prevalently used method of therapeutic intervention in which a breathing machine is employed to pump a controlled mass of air through the mask that is worn over the mouth, nose, or both. The additional pressure holds open or splints the relaxed muscles. There are numerous variants to these:

Continuous positive airway pressure or CPAP

In this method, a computer-controlled airflow generator gives out an airstream at constant pressure, which is prescribed by the doctor based on the results of an overnight test or a titration. Newer CPAP models allow more comfort and compliance for patients. CPAP is by far the most prevalently used treatment method for OSA.

Variable positive airway pressure or VPAP

This variant is also referred to as BiPAP or bilevel. It makes use of an electronic circuit for monitoring a patient’s breathing, and produces 2 different pressures – a higher pressure during inhalation as well as a lower one during exhalation. This is a more expensive option, and is often used for patients having other co-existing respiratory problems or who feel uncomfortable to breathe out against increased pressure.

Automatic positive airway pressure or APAP

APAP machines are connected to a computer and pressure sensors to continuously monitor the breathing performance of patients. These adjust the pressure continuously, thereby increasing it when a patient is trying to breathe but cannot and reducing it when pressure is more than necessary.

Another method of physical intervention is sometimes used for patients of moderate or mild sleep apnea. The mandibular advancement splint (MAS) includes a mouthguard that is similar to the ones that are used as a teeth-protecting device in sports. It helps in holding slightly down and forward the lower jaw compared to its natural position which may allow improving breathing in some apnea patients. Oral appliance therapy is also sometimes used despite its side effects, and continues to be popular due to being user friendly.

Pharmaceuticals

Although currently there are no such effective medication-based treatments for OSA that bears FDA approval, treatment with mirtazapine has shown some promise in some studies. Oral doses of theophylline, a methylxanthine drug has been proven effective to reduce the spells of apnea, but is also known to produce side effects like insomnia and heart palpitations. Drugs such as amphetamines and anti-narcoleptic medications are sometimes prescribed to cure the symptoms of somnolence or daytime sleepiness. Loss of weight can be brought about by medications, which can greatly reduce the frequency and intensity of the apnea episodes.

Neurostimulation

Some researchers are of the opinion that OSA occurs due to some neurological difficulty. Experimens have been carried out to study the effectiveness of using pacemakers and other devices that may encourage neurostimulation. This form of treatment is still under active research.

Surgery

Numerous surgical procedures are used to treat OSA. These include:

• Tonsillectomy
• Tracheostomy
• Adenoidectomy
• Hyoid suspension
• Genioglossus advancement
• Uvulopalatopharyngoplasty (UPPP)
• Laser-assisted uvulopalatoplasty (LAUP)
• Maxillomandibular advancement (MMA)
• Nasal surgery, such as turbinectomy and/or straightening of nasal septum
• Reduction of tongue base, either by using radiofrequency ablation or laser excision

Compression Stockings

Research has shown that use of compression stockings has been able to reduce number of apnea and hypopnea.

Oropharyngeal Muscle Exercises

Performing oropharyngeal muscle exercises like playing the didgeridoo can improve the symptoms of apnea by exercising the muscles of the throat and removing hypotonicity.

Positional Treatments

People might also benefit from lying or sleeping at 30° elevation of upper body or even higher, like in a recliner. This helps to prevent gravitational collapse of airway. Patients are also recommended to try out lateral positions as a treatment for OSA.

Behavioral Interventions

OSA patients are also recommended to avoid intake of alcohol in the evenings, give up smoking as well as trying to lose weight as these behavioral measures can greatly accentuate the chances of an individual for recovering from this sleep disorder.

Obstructive Sleep Apnea Complications

OSA patients can experience the following health complications:

• Stroke
• Asthma
• Obesity
• Diabetes
• Weight gain
• Clinical depression
• High blood pressure
• Ocular (eye) problems
• Metabolic disturbances
• Psychological problems
• Cardiovascular diseases
• Complications related to surgery and medications

Obstructive Sleep Apnea Prognosis

The prognosis for OSA following a regular treatment on a short term is good. Long-term outcome for the condition is not known due to a lack of sufficient data. Death can sometimes occur from the complications that might occur from this sleep disorder. Generally the outcome of treatment for Obstructive sleep apnea is mostly positive, and sufferers tend to live a healthy, well-rounded life.

References:

http://en.wikipedia.org/wiki/Obstructive_sleep_apnea

http://www.patient.co.uk/doctor/obstructive-sleep-apnoea

http://www.mayoclinic.com/health/obstructive-sleep-apnea/DS00968

http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/

The post Obstructive Sleep Apnea appeared first on Prime Health Channel.

Collapsed lung Definition

It is a condition caused by the buildup of air in the space surrounding the lungs. This accumulated air exerts pressure on the lungs, making its unable to expand normally while breathing. Patients find it painful to respire as a result.

The disorder is medically referred to as “Pneumothorax.”However, the term is also used sometimes to refer to Atelectasis, a collapse of the lung sacs that contain air.

The disorder is also known by various other names, such as:

• Air around the lung
• Air outside the lung
• Spontaneous pneumothorax

Collapsed lung ICD9 Code

The ICD9 Code for this disorder is 518.0.

Collapsed lung Symptoms

The condition is typically manifested by the following problems:

• Respiratory shortness
• Acute chest pain, worsened due to coughs or deep breathing
• Nasal flaring (rare)

Patients may also experience various other symptoms in case of a large pneumothorax, such as:

• Tightness of chest
• Tiredness, even without much exertion
• Rapid heart rate
• Bluish discoloration of skin, resulting from oxygen deficiency

In most cases of this condition, only one lung is found to be affected.

What Causes a Collapsed lung?

The condition arises when air escapes from the lungs and gets accumulated in the space external to the lungs but within the chest. This may result from any of the following factors:

• Rib fracture
• Damage caused by an underlying lung disorder
• A chest wound caused by a knife or gunshot
• Certain medical techniques

In some individuals, the condition may arise even in the absence of any visible causes. This is known as a spontaneous Pneumothorax. In this type of the condition, a small, air-filled lung area can suffer a rupture and send air into the space surrounding the lungs.

What is Partial Pneumothorax?

Also known as Partial Lung Collapse, it is a condition caused by part of a lung due to obstruction of the air passages or as a result of extremely shallow breathing. In adults, small areas of a partially collapsed lung are not generally life-threatening. This is due to the reason that the unaffected lung regions tend to compensate for the lack of function in the affected area. However, large-scale collapse of this type may be fatal – particularly in individuals who have another lung disorder or suffer from some other ailment. In infants and small children, lung collapse occurring as a result of mucus obstruction or some other factors may give rise to life-threatening problems. The condition may also lead to the development of Pneumonia.

A partial collapse of lung is also referred to as Atelectasis.

What is Tension Pneumothorax?

It is a particular form of Lung collapse in which air gets inside the space around the lungs and fails to escape the region completely. With each breath, greater amount of air is inhaled. In such conditions, patients suffer from severe chest pain and respiratory shortness which may worsen rapidly as the contents of the chest and the lung are compressed. This is a medical emergency and needs to be treated on an urgent basis.

What is Traumatic Pneumothorax?

In this form of the disorder, air may also enter the pleural space from outside the body. This may occur as a result of injuries marked by penetration of the chest by stabbing, broken ribs or surgeries performed on the chest.

What is Spontaneous Pneumothorax?

In this type of Pneumothorax, air commonly enters the space around the lungs when a bulla (a small air sac located on the lung surface) that is present from birth suffers a tear. The rupture may be caused by vigorous exercise, letting air escape into the lungs.

Collapsed lung Risk Factors

The condition has been found to affect certain people more than others. This at-risk group includes smokers and individuals having a tall, thin build.

The risk of having the condition is also elevated for people suffering from any of the following disorders:

• Whooping cough
• Asthma
• COPD
• Tuberculosis

Other risk factors for the disorder include:

Being male

Men are at greater risk of developing this disorder than women.

Being young

People aged between 20 and 40 years are more susceptible to rupture of air blisters, which can result in Pneumothorax.

History of the disorder

Those with a history of the condition, generally within 1-2 years of the first episode, are more likely to suffer from a recurrence of the disease. The condition may affect the same or the opposite lung.

Heredity

The disorder is also found to run in members or generations of same families.

Having certain lung disorders

The presence of an underlying disorder, particularly cystic fibrosis, sarcoidosis, pulmonary fibrosis or emphysema can make an individual more likely to suffer from a lung collapse.

Mechanical ventilation

Individuals who require mechanical ventilation for effective respiration are at an elevated risk of having thois condition.

Collapsed lung Diagnosis

A physical examination is often enough to detect this condition. A stethoscope exam helps reveal absence or reduction of breathing sounds on the side of the chest that is affected. Patients may also suffer from low blood pressure due to the condition. This happens due to the reason that the high pressure caused by trapped air prevents return of blood to the heart from the lungs.

Other diagnostic tests for the disorder include:

• Chest x-ray
• Arterial blood gases

A chest x-ray is usually the first medical test that is used to detect a Pneumothorax. In certain cases, CT (Computerized Tomography) scans may be required to obtain more detailed images of the lung space. CT scans are a combination of X-ray images taken from various directions to create cross-sectional views of the internal structures.

Collapsed lung Differential Diagnosis

The differential diagnosis of this condition involves distinguishing its signs from similar symptoms produced by other disorders, such as:

• Asbestosis
• Ascites
• Acute or chronic lung disease
• Blunt chest trauma
• Diaphragmatic paralysis
• Cancer or abscess of the lung
• Pneumothorax
• Pleural effusion
• Pneumonia
• Pulmonary embolism

Collapsed lung Treatment

A small pneumothorax may resolve after a certain period of time. Patients may only require rest and oxygen support to recover. A physician with expertise in handling such conditions may pull the extra air out from the region around the lungs so that it can fully expand. Some patients need additional oxygen support to deal with the problem.

In patients with a large pneumothorax, a chest tube is inserted and kept in position between the ribs and into the space surrounding the lungs. This helps drain air and allow re-expansion of the lungs. He tube may be left in position for a number of days. Sufferers might need hospital stay for a few days. However, a short stay might be required if a small chest tube is inserted.

In some cases, doctors may find it imperative to carry out a lung surgery to cure the problem or prevent recurrences of the disorder. Surgery involves repairing the lung area where the leak occurred. In some individuals, a special chemical is poured into the collapsed region of the lung which leads to the formation of a scar. The process is known as Pleurodesis.

Lung collapse associated with malignancy may need radiation and chemotherapy, apart from surgery. It can lead to prolonged disability for sufferers.

Collapsed lung Prognosis

The outcome of this condition actually depends on how well the underlying disorder or problem has been treated. The recurrence of the disease depends on your build (whether you are tall and thin), whether you are continuing smoking even after treatment and whether or not you have suffered two lung collapses in the past.

The factors on which recovery depends also include:

• Whether the collapse was partial or complete
• The severity of the symptoms
• The form of treatment that has been used
• The response of the individual to treatment
• The condition of the other, unaffected lung
• The presence of any other complications

Collapsed lung Recovery

After recovery, patients usually do not need to follow any special medical recommendations and make any changes in workplace for added comfort. Work restrictions actually differ from one patient to another and must be assessed on an individual basis. Restrictions usually apply when a sufferer returns to professional activity before the resolution of his or her symptoms.

Collapsed lung Rehabilitation

The rehabilitation for this condition depends on its underlying cause. The duration and frequency of rehabilitation may be dependent on the severity of lung collapse assessed at the time of diagnosis. If the condition is found to occur as a result of mucus or secretions, rehabilitation measures place emphasis on breathing exercises as well as strategies to expectorate secretions, such as:

• Postural drainage
• Chest clapping

Following treatment for conditions such as lung cancer, patients may need physical therapy and nutritional support.

Collapsed lung Complications

The possible complications of this disorder include:

• Shock
• Another episode of lung collapse in the future
• Continuance of air leakage, in case the lung opening fails to close (possibly requiring surgical cure)

In case of a severe Pneumothorax, patients might suffer from one or more of the following complications:

• Respiratory failure
• Cardiac arrest
• Shock
• Low oxygen level in blood (Hypoxemia)

Many individuals who have had one episode of Pneumothorax usually suffer from another within three years of the occurrence of the first.

Collapsed lung Prevention

As of now, doctors and medical researchers are still trying to find a way to prevent a lung collapse. However, the risk of occurrence of this condition can be reduced by abstaining from smoking.

Collapsed lung Pictures

Check out these images that show how a collapsed lung looks like.

Picture 1 – Collapsed lung

Picture 2 – Collapsed lung Image

If you are suffering from the symptoms of a lung collapse, it is essential for you to get in touch with a medical professional on an immediate basis. This is particularly important if you have already suffered from an episode of lung collapse earlier. Timely diagnosis and treatment would help you recover from the condition and avoid occurrence of any complication in future.

References:

http://www.nlm.nih.gov/medlineplus/ency/article/000087.htm

http://www.mayoclinic.com/health/pneumothorax/DS00943

http://en.wikipedia.org/wiki/Pneumothorax

http://www.emedicinehealth.com/collapsed_lung/article_em.htm

The post Collapsed lung appeared first on Prime Health Channel.

Pleural effusion Definition

It refers to a fluid accumulation between the tissue layers lining the chest cavity and the lungs.

Pleural effusion ICD9 Code

The ICD9 Code for this condition is 511.9.

Pleural effusion Incidence

The statistics regarding the rate of incidence for the condition tends to vary. However, the disorder is considered to affect as many as 1 million individuals per year in the United States.

Pleural effusion Symptoms

The disorder is characterized by a range of signs and symptoms, such as:

• Fever
• Cough
• Rapid rate of respiration
• Respiratory shortness
• Chest pain, generally acute and intensifying with deep breathing and coughs
• Hiccoughs

Some affected individuals are asymptomatic. In other words, they do not exhibit any abnormalities that are typically associated with this condition.

Pleural effusion Types

The condition is generally classified into the following two types:

• Transudative Pleural effusion
• Exudative Pleural effusion

Pleural effusion Causes

The human body produces small amounts of pleural fluid in order to lubricate the surfaces of the pleura, the thin layer of tissue surrounding the lungs and lining the chest cavity. The term “Pleural effusion” indicates an abnormal accumulation of this fluid in excessive amounts.

The cause of the condition differs according to the type of Pleural effusion that one suffers from.

Transudative Pleural effusion Causes

It results from leakage of fluid into the pleural space, caused by a low protein count in bloodstream or increased pressure within the blood vessels.

Exudative Pleural effusion Causes

It is caused by various factors, such as:

• Swelling
• Tumors
• Obstruction of lymph or blood vessels
• Injury (trauma) to the lungs

This type of condition most commonly results from Congestive heart failure.

Pleural effusion Diagnosis

The diagnosis of the condition usually begins with a physical examination and physicians using a stethoscope to listen to the lungs of sufferers. In the majority of cases where an effusion is suspected in the pleural cavity, physicians may use maneuvers like percussion (tapping on the chest) or auscultation (listening with a stethoscope).

Further tests may include:

• Chest x-ray
• CT scan of the chest
• Chest and heart ultrasounds
• Blood tests to check functioning of the kidneys and the liver
• Thoracentesis (In this test, a needle is inserted within the ribs to draw out a fluid sample)
• Pleural fluid analysis (microscopic examination of the fluid to detect protein amount and possible presence of bacteria and cancerous cells)

Pleural effusion Differential Diagnosis

The differential diagnosis of Pleural effusion involves telling the symptoms of its types apart from those of other similar conditions.

Differential Diagnosis of Transudative Pleural effusion

It involves taking into account the symptoms of the following conditions:

• Congestive heart failure (most common)
• Nephrotic syndrome
• Peritoneal dialysis/continuous ambulatory peritoneal dialysis
• Cirrhosis with hepatic hydrothorax
• Hypoproteinemia
• CSF leak to the pleural space
• Glomerulonephritis
• Fontan procedure
• Urinothorax
• Superior vena cava obstruction

Differential Diagnosis of Exudative Pleural effusion

It includes taking into considerations the symptoms of the following disorders:

• Asbestos pleural effusion
• Acute respiratory distress syndrome
• Malignancy
• Pneumonia
• Tuberculosis
• Pulmonary embolism
• Fungal infection
• Postcardiac injury syndrome
• Pericardial disease
• Meigs syndrome
• Pancreatic pseudocyst
• Intra-abdominal abscess
• Ovarian hyperstimulation syndrome
• Uremia
• Trapped lung
• Chylothorax
• Rheumatoid pleuritis
• Lupus erythematosus
• Pseudochylothorax
• Drug-induced pleural disease
• Chronic pleural thickening
• Malignant mesothelioma
• Yellow nail syndrome

Pleural effusion Treatment

The aim of treatment for this disorder is threefold:

• To remove the accumulated fluid from the pleural space
• Detecting and treating the cause of fluid accumulation
• Preventing the accumulation of fluid in the pleural space

Thoracentesis, or removal of the fluid, may be needed if a lot of fluid has been accumulated and leads to:

• Shortness of breath
• Respiratory problems, such as low levels of oxygen
• Chest pressure

Removal of fluid lets the lungs expand and makes respiration easier.

The plan and approach for treatment depends on the underlying causative factor for the condition. In case of congestive heart failure, patients may be prescribed medications such as (diuretics) water pills to cure heart failure. Antibiotics are used if infections are found to result in Pleural effusions.

In individuals suffering from infections or cancer, a chest tube is kept for several days to drain the fluid and treat the effusion.

In some cases, physicians may consider leaving small tubes in place within the pleural cavity for a long time. This would allow drainage of the fluid.

In certain cases, the following treatment measures may be used:

• Radiation therapy
• Surgery
• Chemotherapy
• Using medications to prevent accumulation of fluid after drainage

Pleural effusion and Surgery

The operative treatment for this condition requires any of the following surgical methods:

Thoracotomy

In case of extremely large types of Pleural effusions, where physicians suspect an infection as the underlying cause, a surgical technique known as Thoracotomy may be carried out. This operative procedure involves removal of fluid from the pleural cavity as well as ablation of any infected tissue. In this technique, a 6-8 inch incision is made in the chest. Thoracotomy helps remove all fibrous tissue and evacuate the infection from the region known as the pleural space. Following surgery, chest tubes need to be kept in place for about 2 weeks to continue drainage of fluid.

The process is also known as Open Thoracic Surgery or Traditional Thoracic Surgery.

VATS (Video-assisted thoracoscopic surgery)

This is a mimimally-invasive operation that involves making 1 to 3 tiny incisions in the chest. The process is quite effective in the management of pleural effusions that recur as a result of malignancy or are hard to drain. During surgery, antibiotic or sterile talc may be inserted to prevent the recurrence of fluid accumulation in the pleural space.

The technique is also simply referred to as Thoracoscopic surgery.

Pleural effusion Prognosis

The outcome of this disorder is based on the underlying cause. The prognosis tends to be extremely poor in case malignancy is the underlying factor.

Pleural effusion Complications

The complications of the disease may include:

• Pneumothorax (air in chest cavity) following thoracentesis
• Lung damage
• Infection leading to an absecess (known as Empyema) that need to be drained with the aid of a chest tube

Pleural effusion Risk Factors

Pleural effusion is often a symptom of another condition. Hence, its risk factors are same as that of its underlying conditions. Usually, the disorder is found to affect adults more. It is less common in children.

Malignant Pleural effusion

It is a complication arising in 30% of all cases of lung cancers. In this condition, an abnormal amount of fluid gets collected within the pleural lining due to a cancerous condition. Around 50-65% cases of this disorder results from cancerous conditions of the breast or the lungs. Lymphoma and pleural mesothelioma are other common factors responsible for the disorder.

The treatment approach for this condition aims at alleviating associated symptoms such as breathlessness and occasionally, curing the underlying cause for the disease.

Loculated Pleural effusion

It is marked by the development of pus-filled sacs. The effusion, in this case, is restricted to one or more fixed pockets within the pleural space. The pleural fluid may loculate between the visceral and parietal pleura (when there is partial fusion of the pleural layers) or within the fissures.

Bilateral Pleural effusion

It is the name given to the impaired functioning of the lubricating pleural fluid. Some cases of the disorder result from common ailments like arthritis, bacterial infections, tuberculosis and pneumonia. Antibiotic medications are very useful in eliminating the causes of the effusion as well as the effusion itself in such cases. These are easier cases of effusion and can be easier to diagnose and treat than other forms of the disorder.

Left Pleural effusion

It results from the accumulation of excess fluid in the left side of the pleural cavity. It can occur as a consequence of a variety of medical problems. The fluid accumulation can occur due to a chronic condition, such as congestive heart failure. However, it may also be associated with trauma, cancers, acute infection and respiratory disorders such as tuberculosis.

In some cases, the disorder has a sudden onset. In other cases, the buildup of fluid may gradually occur over a period of time. The fluid build-up may put more pressure over the lungs and make comfortable respiration more and more difficult for sufferers.

Can Pleural effusions Recur?

There can be a recurrence of this disorder for multiple times. This can be prevented by the use of sclerosing agents which induce scarring, such as tetracycline or talc. Operative techniques may be needed in cases where sclerosing agents fail to yield benefits.

Is Pleural effusion Serious?

The severity of this condition actually depends on the main underlying cause of the effusion. If effusion results from a viral infection, heart failure or pneumonia, it can be controlled. During treatment, physicians should consider curing problems associated to the disorder as well as curing the underlying condition.

Pleural effusion Prevention

The disorder results from a number of ailments and conditions. Preventing the underlying cause can help reduce the possibility of development of an effusion.

Pleural effusion Pictures

The following pictures show how the pleural fluid accumulates inside the body of individuals affected by this condition.

Picture 1 – Pleural effusion

Picture 2 – Pleural effusion Image

If you, or any of your family members, are suffering from symptoms similar to that of Pleural effusion, do not delay treatment. Delay in diagnosis and medical treatment can give rise to a range of complications and jeopardize health. Seeking medical attention on an immediate basis can ensure faster cure of the disease and a quicker recovery.

References:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001150/

http://www.webmd.com/lung/pleural-effusion-symptoms-causes-treatments

http://emedicine.medscape.com/article/299959-overview

http://www.medicinenet.com/pleural_effusion/article.htm#what_is_pleural_effusion

The post Pleural effusion appeared first on Prime Health Channel.

What is Pleurisy?

It refers to a swelling of the pleura or the lining of the chest and the lungs that usually gives rise to a piercing pain when sufferers cough or even breathe.

The condition is also known as “Pleuritis” or “Pleuritic chest pain.”

Pleurisy ICD 9 Code

The ICD 9 Code for this disorder is 511.

Pleurisy Symptoms

The condition mainly gives rise to painful sensations in the chest of patients. Sufferers usually experience aches while coughing or while taking a deep breath. Some patients experience painful symptoms in the shoulder. The aches may get worse with coughs, deeper breaths (due to exertion) and chest movement.

Picture 1 – Pleurisy

The disease may also lead to the accumulation of fluid inside the chest cavity. This can cause difficulties while breathing and may give rise to the following health issues:

• Coughing
• Cyanosis or bluish discoloration of skin
• Tachypnea or rapid breathing
• Chills, fever and loss of appetite (based on the cause)
• Respiratory shortness

In case of a fluid accumulation (referred to as Pleural effusion), the aches generally resolve as the fluid acts as a lubricant. However, accumulation of too much fluid can exert pressure over the lungs and compress it – thereby impairing its normal functioning. This leads to a shortness of breath. In case the fluid gets infected (Empyema or infected Pleural effusion), various discomforting symptoms such as chills, fever and dry cough may occur.

Certain sufferers experience relief from pain when they apply pressure over the aching region or hold their breath.

What Causes Pleurisy?

The pleura (a double layer of membranes) separate the lungs from the chest wall. One layer of this membrane lies over each lung while the other layer lines the inner wall of the chest. The layers appear as two smooth satin strips rubbing against each other, not causing any friction. This allows the lungs to expand and contract while breathing without any resistance from the chest wall.

When they suffer an inflammation, the two pleural membrane layers in the impacted side of the chest rub against one another like two strips of sandpaper. This can cause aches when a person breathes in and out.

This inflammation of the pleural membranes may occur due to a number of factors, such as:

• Infectious disorders, such as Tuberculosis
• Influenza and other severe viral infections
• A clot in a lung artery (Pulmonary embolism)
• Pneumonia, in cases where the infected lung region involves the pleural surface

Pleuritis may also result from:

• Cardiac surgery
• Chest trauma
• Lupus
• Rib fractures, such as those occurring due to severe cough
• Lung cancer (in rare cases)
• Rheumatoid arthritis
• Conditions related to Asbestos-exposure

Smoking has not been stated as a direct cause of the disorder. However, “smoker’s cough” has been found to worsen the painful sensations associated to the disorder. Some cases of Pleuritis are idiopathic, meaning their underlying causes are not known.

Pleurisy and Lupus

Systemic lupus erythematosus (SLE) is the name given to an autoimmune condition that attacks the immune system of the body and affects everything from the joints to the skin of patients. It can frequently trigger an inflammation in the pleura (lining around the lungs) and give rise to Pleurisy. Pleuritis is common in patients of Lupus. Around 30-60% of all Lupus sufferers are estimated to suffer from a pleural inflammation at some time in their lives.

Pleurisy Diagnosis and Testing

The pleura that line the lungs are normally smooth in appearance. In patients of Pleuritis, the surface of this lining becomes rough. The membranes rub together with each inhalation of the sufferer and mar produce a grating noise known as ‘friction rub.’ A doctor investigating Pleurisy places his stethoscope or his ear against the chest of his patient to listen to this sound. The presence of this sound confirms the condition. However, this ‘friction rub’ or ‘snow crunching’ sound is not always present. It is due to this reason that various diagnostic tests are recommended to patients of the condition. These include:

Thoracentesis

It involves injecting a local anesthetic into the area between the ribs where a fluid accumulation has occurred. A needle is then inserted into the region to extract some of the fluid and send it for laboratory analysis. In cases where only a small amount of fluid is present, the needle may be guided with ultrasound.

Pleural biopsy

This is usually recommended if a physician suspects lung cancer or tuberculosis to be the underlying cause. It includes removal of a sample of tissue with the aid of a hooked needle and using it for pathological analysis in a laboratory setting. Like in Thoracentesis, ultrasound may be used in this technique too for better diagnosis.

Thoracoscopy

It is carried out when patients are under the effects of a general anesthetic. The process involves observing the inner region of the chest and obtaining a sample of pleural tissue. A surgeon makes a single or multiple incisions between the ribs and inserts a tube fitted with a small video camera. The technique is sometimes referred to as Video-assisted Thoracoscopic Surgery (VATS).

CT scan of the chest

Computerized Tomography (CT) scan is usually the first imaging exam used by physicians for diagnosing this disorder. It helps doctors look for any abnormality in the thin chest sections. In this exam, a computer renders highly detailed images of the chest sections – thus helping doctors detect and analyze abnormalities more easily.

Chest X-ray

It helps reveal a swollen region of the lungs that suggests Pneumonia. In some cases, a special type of chest X-ray is used. Patients are made to lie on the side of the Pleurisy to check whether any fluid, that is not apparent on a standard chest X-ray, is present. This is known as “Decubitus chest x-ray.”

Chest ultrasound exam

In this imaging examination, high-frequency audio waves are used to render accurate images of internal structures. A physician may use this process to find out whether there is a pleural effusion.

CBC (Complete Blood Count)

A blood test helps doctors know whether a patient is suffering from an infection, and in case he is – what type of an infection it is. Blood exams may also reveal whether there is an underlying autoimmune condition, such as lupus or rheumatoid arthritis. Pleuritis is often an initial sign of such disorders.

The medical history of a patient is also taken into consideration. It is noteworthy that Pleuritis is often diagnosed only when a doctor has ruled out other causes of a more acute nature.

Pleurisy Differential Diagnosis

The differential diagnosis of Pleuritis involves ruling out other possible causes of chest pain, such as Angina. Such diagnoses are often deemed as necessary to confirm detection. This is because even with advanced x-ray exams, it is not always easy to visualize Pleurisy.

Pleurisy Treatment

It is necessary to seek treatment on an emergency basis in case of respiratory difficulties, acute pain or violent coughs. Some cases of chest pain are dangerous and even experienced physicians are sometimes unable to detect the exact cause for pain.

Picture 2 – Pleurisy Image

The treatment of this disease depends on its underlying cause. While antibiotics are used for treating bacterial infections, an operative technique may be needed to drain infected fluid from the affected lungs of a patient. Viral infections generally subside without the use of medicines. Anti-inflammatory drugs (like Ibuprofen) or Acetaminophen are often used by patients themselves to control the painful symptoms associated with this disorder. Prescription or over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs) may provide relief from certain symptoms of the disease. Painful symptoms and coughs may be controlled with the aid of a prescription Codeine.

In case of accumulation of large amounts of fluid, patients may require a hospital stay. During this period, a tube is usually inserted into the chest to let the fluid drain away constantly. Hospitalization is often required to keep a close watch on the respiratory stability of sufferers.

Pleurisy Home Remedies

Unfortunately, the disorder cannot be cured with the aid of simple home remedies. However, adopting certain steps for lifestyle management can help sufferers get relief from the symptoms associated with the disease. These include:

• Using over-the-counter medicines, such as Motrin and Advil, to get relief from associated inflammation and pain
• Taking a lot of rest, even while feeling better. Proper rest and restricting activities can promote healing
• Lying on the painful side, which can actually reduce the aches

Pleurisy Complications

The disorder does not usually give rise to any severities other than acute pain, as reported by some patients. However, the pain can be quite severe and debilitating for patients. Such intense aches may limit activities and the ability to work. Patients may even find themselves unable to perform even simple jobs.

It is only in rare cases that complications are found to occur. The usual problems arising due to this syndrome involve those arising from the original cause as well as other associated problems like:

• Respiratory difficulties
• Lung collapse, as a result of Thoracentesis

Pleurisy Prognosis

The outcome of the condition and recovery from it actually depends on its underlying cause. Prognosis also depends on the severity of the disorder. Unfortunately, individuals affected by the condition take several months to recover. When viral infections are the cause, the disorder generally resolves after a week. However, the condition may continue for an indefinite period of time if it arises due to cancerous syndromes. Even with proper treatment, the disease may persist for a few months and become difficult to be treated successfully. It may cause much pain to affected individuals.

Pleurisy Follow-Up and Monitoring

The condition gives rise to acute discomfort. Unless the painful symptoms are properly managed, patients may develop Pneumonia. This is due to their inability to breathe and cough in a proper manner. If the painful sensations turn worse after a week, despite use of proper medications, it is necessary to go for a reevaluation. A physician should promptly reevaluate a patient in the event of development of health issues like:

• Severe chills and shaking (rigors)
• High fever
• Coughing up more phlegm
• Respiratory shortness (shortness of breath)

Prognosis Prevention

Treating the bacterial infections of the respiratory system in the early stages can prevent the development of this disorder. Timely diagnosis and treatment with the aid of anti-inflammatory drugs can help you prevent acute Pleuritic chest pain. However, it must be remembered that most cases of Pleuritis result from infection and are therefore unavoidable. Patients should avoid exercising too hard or exerting themselves too much which can cause them to breathe hard and worsen the pain and the condition in general.

It is necessary to contact your doctor and seek immediate medical treatment if you are suffering from high fever, respiratory shortness or sudden, acute chest pain. Early diagnosis and treatment will help you get away with little complications by curing the condition in time, thus ensuring a faster and smoother recovery for you.

References:

Celli BR. Diseases of the diaphragm, chest wall, pleura, and mediastinum. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 100.

Lee-Chiong T, Gebhart GF, Matthay RA. Chest pain. In: Mason RJ, Broaddus VC, Martin TR, et al, eds. Murray and Nadel’s Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 30.

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What is Kennel cough?

It is the name given to a severely contagious infection of the upper respiratory tract in dogs, caused by a virus or bacteria. It is quite similar to a chest cold in humans. The condition infects a varied number of hosts, including cats. In some cases, the condition also affects humans – especially if they have an impaired immunity.

The medical name for this disorder is Tracheobronchitis. It is also known as Canine Bronchitis.

Kennel cough Incidence

This is one of the most common infectious respiratory condition affecting canines. The name of the disease is a reference to the fact that is most prevalent among dogs that live in a kennel, hospital or any other similar shelter. However, that is not always the case. The disorder is prevalent across the world.

Kennel cough Causes

The condition is most commonly caused due to an infection by the bacteria known as Bordetella bronchiseptica. The disease may also arise due to infection by Adenovirus-2 and Parainfluenza. Some other microbes that might be involved with the disorder may include:

• Coliforms
• Mycoplasma
• Pasteurella
• Pseudomonas
• Streptococcus

Kennel cough Symptoms

The disease mainly affects the upper respiratory tract. The symptoms of this disease typically arise 4-7 days after exposure to the causative microbe. The condition is initially manifested through loud and paroxysmal coughing, that is often described as the honk of a goose. Some other prominent early signs of this disorder include:

• Clear nasal discharge
• Retching, indicated by the production of a white frothy fluid

The secondary symptoms of the disease are:

• Lethargy, which shows that the dog is sick
• Fever, which is exhibited through dry cough and rise in body temperature
• Anorexia or loss of appetite
• Ocular discharge, or discharge from the eye

In a few dogs, conjunctivitis and flu-like symptoms may also be noted.

Hacking cough is one of the earliest and most notable symptoms of this disease. It seems as if an affected dog is about to vomit and the sound is reverberating throughout its body. The phlegm expelled from the mouth of the dog is yellowish in appearance. The sound of coughing often seems as if the dog is being gagged. If the dog is suffering from dry cough, there is reduced production of phlegm in their body.

How do Dogs Get Kennel cough?

This is an extremely contagious disease. It can spread from one dog to another through direct contact with soiled bowls or beddings. It also spreads through the air via the cough droplets from infected canines. It is due to this reason that the disease has the ability to spread quickly among dogs housed in hospitals, kennels or similar shelters.

Is Kennel cough Contagious to Humans?

Although the risk of transmission from dogs to humans is rare, one should exercise caution as infants and elderly individuals with a weak immunity are susceptible to the condition.

Kennel cough Diagnosis

The condition is typically detected through a physical examination, observation of clinical signs, history of exposure to microbial agents and response to therapy. Important diagnostic tests associated with this disease involve:

• Bacterial culture
• Blood work
• Tracheal wash
• Virus isolation

Kennel cough Differential Diagnosis

The differential diagnosis for this disorder involves telling its symptoms apart from those of other conditions that produce similar signs, such as Canine influenza and Canine distemper.

Kennel cough Treatment

In most cases, the condition is treated on an outpatient basis. This reduces the risk of transmission of the infection to other animals. Most mild and uncomplicated cases of this disease ted to resolve on their own. The symptoms take approximately 1-2 weeks to subside. If the condition tends to persist, one may need to take an affected dog to a vet who would provide medicines and cough suppressants to provide symptomatic relief. Severe episodes of coughing can be relieved with the aid of cough suppressants. Short term steroids and nebulizers might also be used. If the condition is found to result from a bacterial infection, antibiotics like Clavamox and trimethoprim-sulfonamide combination might be recommended.

An affected dog should be provided with as much rest as possible at home. Broad-spectrum antibiotics, such as Amoxicillin, are often found to be effective. A warm blanket should be provided to it to give more comfort. A dog collar should not be used for a few days. The canine should be fed soft, mushy foods and given lots of clean, fresh water to drink. A vaporizer or humidifier should be placed around the area where the dog sleeps to allow it more comfort.

Acute cases of the condition should be cured by a veterinarian. Otherwise, these may give rise to more serious disorders – including Bronchitis and Pneumonia.

Kennel cough Vaccines

The condition can be effectively                cured by using the intranasal Bordetella vaccine, although patients may require it to be administered twice every day. The intranasal vaccine immunizes a dog within 72 hours. In some cases, intramuscular Bordetella vaccine may also be used. Addition of CAV-2 and CPI vaccines into routine vaccines would reduce the incidence and severity of the coughs associated with this disease. The Bordetella vaccination is an optional preventive measure that may be beneficial for boarded dogs, show dogs and canines that frequently visit grooming salons.

Kennel cough Home Remedies

Dog owners often wonder whether there is any home remedy for the condition. There are indeed certain home treatment options that allow people to cure simple cases of the disorder in their canine companions. In more serious cases, these home remedies may act as supportive treatment alongside conventional medical curative options:

• Over-the-counter cough syrups
• Peppermint tea
• Vitamin C supplements
• Raw honey mixed with warm water
• Yerba Santa, an expectorant
• Bitter herb, also known as wild cherry bark
• Homeopathic medications, such as Bryonia C6 Echinacea purpurea and Plantago lanceolata

Kennel cough Prognosis

In most dogs affected with simple forms of this disease, the outcome is generally very good. Vets often advise people to keep their affected dogs in rest for a few weeks. With proper treatment, uncomplicated cases of this condition are likely to go away in about two weeks.

Kennel cough Prevention

The best way to avoid this disease is to stay aware about the latest vaccines. There are various vaccines that can protect dogs against a lot of potential causes of this condition. It may also be a good idea to acquire a booster immunization approximately a week prior to boarding or showing a dog. Try to maintain hygienic living conditions for your canine companion, as much as possible. Regularly clean the kennel and ventilate all closed spaces lived in or frequented by your dog. Wash your hands and clothes before feeding or interacting with your pet, to avoid infecting it.

It is recommended that you vaccinate your dog once or twice every year with the help of your vet. A number of dog boarding facilities do not allow canines that have not been vaccinated for Kennel cough. Make sure that you vaccinate your dog a few weeks prior to sending it to a boarding. This would provide it with some time to build up its immunity.

Kennel cough Risk Factors

The disorder affects canines of all ages, breeds and sexes. No predilection of any type has yet been detected. However, certain conditions have been found to increase the susceptibility to this disease. These include:

• Living in crowded kennels
• Low temperature
• Poor ventilation
• Stress, due to excessive traveling or exposure to cigarette smoke and dust

Dogs frequenting animal hospitals, dog grooming centers and canine shows are also at risk. In short, dogs that regularly visit places frequented or crowded by lots of other canines are at great risk of contracting this infectious disorder.

If your dog is coughing incessantly or suffering from uneasiness or rapid breathing, get in touch with a vet immediately. Timely diagnosis and treatment would help affected dogs to recover faster and also prevent the risk of transmission of the disease to other dogs or humans (who are immunocompromised).

References:

1. Ford, Richard Canine Infectious Tracheobronchitis In: Greene CE, Ed. Infectious Diseases of the Dog and Cat 3rd Ed. W.B. Saunders Elsevier 2006; 54-61.
2. Ettinger, Stephen J.;Feldman, Edward C. (1995). Textbook of Veterinary Internal Medicine (4th ed. ed.). W.B. Saunders Company. ISBN 0-7216-6795-3.

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