Introduction
Lung disease is common among both men and women. It is more frequent in smokers than in non-smokers.
The death rate from these diseases is on 4th place (after heart disease, cancer and stroke) and is increasing in women as a group versus men.
This is because women as a group are smoking more now than men and the associated lung diseases such as lung cancer, pneumonia, emphysema and chronic obstructive pulmonary disease (=COPD) lead to premature death. In the following review I will concentrate on the more common lung problems, their symptoms, how they are diagnosed and how they can be treated. It goes without saying that prevention measures such as stop smoking, wearing protective masks in industrial high risk areas, moving away from smog infested environments etc. will always be the most powerful tool (Ref.1).
Symptoms of lung disease
The most common symptoms associated with lung disease are coughing, shortness of breath (=dyspnea), wheezing, stridor, coughing up blood (=hemoptysis), chest pain, blue skin discoloration (=cyanosis) and clubbing. Some of these symptoms are due to narrowing of the airways, such as wheezing in asthma, others are due to chronic oxygen deficiency, such as cyanosis and clubbing.
Diagnostic tests
The simplest way for the practicing physician to come to a diagnosis regarding lung diseases is to take a thorough history, to do a careful examination with auscultation (=listening to the lungs with a stethoscope) and to order a chest X-ray. Often diagnoses such as asthma, pneumonia, emphysema, COPD and others can be accurately diagnosed this way. However, the physician today, particularly the lung specialist, (=respirologist or pneumologist) has a number of other tools that can be useful. This is depicted in this table. The links lead to images where the items are depicted.
Special procedures for lung diseases
_____________________________________________________
Allergy testing
Skin testing for a battery of allergens, important in many asthma and recurrent or chronic ear and nose infections
Arterial blood gases
Done by obtaining blood sample through arterial puncture to measure oxygen content.
Bronchoscopy
With a fiberoptic instrument the specialist can see the inside of the airways (trachea, bronchial tubes)
Chest imaging
X-rays, CT (arrows pointing to lung cancer in right lung), MRI scan and PET scan.
Chest tube insertion
A chest tube can save the patient’s life as the collapsed lung is reexpanded with a vacuum or a large pleural effusion is drained.
Establishing an airway
If asthma is severe or there is a foreign body in the airways, intubation may be life saving
Invasive investigations
Mediastinoscopy and percutaneous transthoracic needle aspiration
Postural drainage
Drowning victims are positioned upside down to drain the lungs
Pulmonary rehabilitation
Chest physiotherapy with pounding on chest and showing deep breathing exercises can make a big difference in COPD patients, helping with proper breathing and removing mucous
Pulmonary function testing
peak flow meter, spirometry, pulmonary function testing.
Thoracotomy
A cut through the chest wall to access the lung tissue
Tracheal aspiration and nasal aspiration
A procedure where secretions are sampled through a thin suction hose. Using a small suction pump with a longer hose nasotracheal suctioning is done
Tracheostomy
Emergency procedure where the trachea is opened to provide an emergency air entry into the lungs
_____________________________________________________
Lung Disease
Common lung diseases
Adult respiratory distress syndrome (ARDS)
Usually viral in origin, the acute shortness of breath is very similar to the RSD of premature babies
Atelectasis
A collapse of a segment of the lower lung, usually in the lower lung area
ASTHMA
An important lung disease that affects a lot of people. It is an inflammatory condition of the small bronchial tubes (bronchioles) with wheezing and spasm, often associated with allergies.
Bronchiectasis
Chronic bronchitis leads to this lung condition where small air sacs melt together forming larger pockets filled with pus
Bronchitis
Acute bronchitis due to viruses or bacteria; chronic bronchitis often due to smoker’s lung with chronic infection and scarring
COPD
Chronic obstructive pulmonary disease leads to chronic cough, many infections and evtl. respiratory failure
Cystic fibrosis
Congenital lung abnormality with very viscous mucous in airways; leads to COPD, bronchiectasis
Emphysema
Chronic asthma, COPD and chronic bronchitis can all lead to this end stage lung disease
Hypersensitivity pneumonitis
Farmer’s lung is one example, red cedar asthma another
Lung abscess
Acute localized infection/pus in one lung segment
Lung cancer
Bronchogenic carcinoma is the most common cancer in smokers
Occupational lung disease
Examples are silicosis, asbestosis or coal worker pneumoconiosis
Pleural disorders
Lung diseases of the lining of the lungs in the chest cavity leading to pleural effusions
Pneumonia
Infection of the lung tissue, often bacterial
Pulmonary emboli
Clots in the lung vessels lead to this life threatening disease, often originating from clots in the deep veins of the legs (after surgery etc.)
Pneumothorax
Collapse of part or of all of a lung leads to this life threatening condition
Respiratory failure (life support)
A terminal condition of many lung diseases when not enough oxygen can enter the bloodstream because of advanced chronic lung disease such as severe asthma, COPD or chronic bronchitis
Sleep apnea
A sleep disorder where the patient stops breathing intermittently for more than 10 seconds and blood oxygen drops.
References
1. Noble: Textbook of Primary Care Medicine, 3rd ed., Copyright © 2001 Mosby, Inc.
2. National Asthma Education and Prevention Program. Expert Panel Report II. National Heart, Lung and Blood Institute, 1997.
3. Rakel: Conn’s Current Therapy 2002, 54th ed., Copyright © 2002 W. B. Saunders Company
4. Murray & Nadel: Textbook of Respiratory Medicine, 3rd ed., Copyright © 2000 W. B. Saunders Company
5. Behrman: Nelson Textbook of Pediatrics, 16th ed., Copyright © 2000 W. B. Saunders Company
6. Merck Manual: Pulmonary disorders
7. Goldman: Cecil Textbook of Medicine, 21st ed., Copyright © 2000 W. B. Saunders Company
8. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
9. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
