Allergic rhinitis is an allergic reaction to airborne allergens. The immune system overreacts to allergens in the air causing inflammation in the nose. Allergic rhinitis is sometimes called “hay fever,” especially when caused by seasonal allergens.
Types of Allergic Rhinitis:
1) Seasonal (a.k.a Hay Fever):
Symptoms can occur in spring, summer, and early fall.
Triggers: outdoor allergens such as mold spores or pollen from trees, grass, and weeds.
2) Perennial:
Symptoms occur year-round.
Triggers: dust mites, pet hair or dander, cockroaches or indoor mold spores. Underlying or hidden food allergies rarely cause perennial nasal symptoms.
Symptoms also may be triggered by common irritants such as:
Cigarette smoke
Strong odours (perfume, hair spray and fumes)
Cleaning solutions, pool chlorine, car exhaust and other air pollutants (i.e., ozone)
Air fresheners
Symptoms of Allergic Rhinitis:
Symptom onset is often within minutes following allergen exposure and can affect sleep, and the ability to work or study
Stuffy nose due to blockage or congestion
Runny nose or post nasal drainage (clear discharge)
Sneezing
Cough
Red, itchy and watery eyes
Puffy, swollen eyelids.
Diagnosing Allergic Rhinitis:
1) Skin Testing
A small amount of suspected allergens are introduced into your skin. Skin testing is the easiest, most sensitive, and generally least expensive way of identifying allergens.
Types of Skin Tests: Prick or scratch test: A tiny drop of a possible allergen is pricked or scratched into the skin. This is the most common type of skin test. The results are known within 10 to 20 minutes. Intradermal test: A small amount of a possible allergen is injected under the skin using a thin needle. The site is checked for a reaction after about 20 minutes. This test is typically more sensitive than the prick or scratch test.
A condition that causes chronic airway inflammation and recurrent, reversible airway obstruction. Airway inflammation also leads to airway hyperreactivity which causes airways to narrow in response to various stimuli.
Main Symptoms of Asthma:
Wheezing (a squealing or whistling sound made when you breathe)
Coughing (especially at night, when laughing, or during exercise)
Chest tightness
Shortness of breath
Other symptoms of Asthma include difficulty talking, anxiety, fatigue.
Types of Asthma:
Allergic Asthma (Extrinsic Asthma): Aallergens trigger this common type of asthma. These might include pet dander from animals like cats and dogs, food, mold, pollen, dust mites. Allergic asthma is often seasonal because it often goes hand-in-hand with seasonal allergies.
Nonallergic Asthma (Intrinsic Asthma): This is brought on by factors such as stress, exercise, viral illness, extreme weather, irritants in the air not related to allergies (e.g. burning wood, cigarette smoke, air fresheners, perfumes, household cleaning products) and certain medications.
Occupational asthma This type of asthma is induced by triggers in the workplace (e.g., dust, dyes, gases and fumes, industrial chemicals, animal proteins, rubber latex).
Exercise-Induced Bronchoconstriction (EIB) Exercise-induced bronchoconstriction (EIB) usually affects people within a few minutes of starting exercise and up to 10–15 minutes after physical activity. This condition was previously known as exercise-induced asthma (EIA).
Asthma Triggers:
Allergens such as ragweed, pollen, dust mites, cockroaches, molds and animal dander
Irritants in the air such as smoke, air pollution, chemical fumes and strong odors
Medications (e.g., aspirin and acetaminophen)
Extreme weather conditions
Exercise
Stress / Illness
Testing in Asthma
Spirometry with reversibility
Skin Prick Test (gold standard for allergy testing)
Blood tests
Chest x-ray
Asthma Treatment
There are many effective medicines to treat asthma. Most people with asthma need two kinds: quick-relief medicines and long-term control medicines. Other treatments such as immunotherapy (allergy shots) and biologics are also be helpful.
Quick-relief medicines:
Are taken at the first sign of symptoms for immediate relief
They do not control the airway inflammation that cause the symptoms Examples:
Short-acting inhaled beta2-agonists (Ventolin, Asthalin, Albuterol)
Short- acting anticholinergics (Atrovent/Ipravent)
Both types of drugs are bronchodilators, meaning that they expand the passageways into the lungs (the bronchi), allowing more air in and out and improving breathing. They also help to clear mucus from the lungs by enabling the mucus to move more freely and get coughed out more easily.
If you find that you need your quick-relief medicine to treat asthma symptoms more than twice a week, or two or more nights a month, then your asthma is not well controlled.
If you have exercise-induced bronchoconstriction (EIB) it may be recommended that you use these medicines before exercise or other strenuous physical activity.
Long-term control medicines:
Taken every day to prevent symptoms and attacks (even if you do not have symptoms)
Two types of immunotherapy are available: allergy shots and sublingual (under the tongue) tablets.
Allergy shots:If your asthma is triggered by an allergy, you should consider allergy shots, which are very effective in relieving allergy symptoms and in some cases can actually cure your allergy. The treatment, which can take several years, builds up immunity to your offending allergens (pollens, dust mite, pets, mold). It works by injecting small amounts of the allergen in gradually increasing amounts over time. As the shots help the body build up a tolerance to the effects of the allergen, they eventually reduce and can even eliminate your allergy symptoms.
Sublingual tablets: This type of immunotherapy was approved by the Food and Drug Administration in 2014. Starting several months before allergy season begins, patients dissolve a tablet under the tongue daily. Treatment can continue for as long as three years. These medications should not be used in patients with severe or uncontrolled asthma. Only a few allergens (certain grass and ragweed pollens) can be treated now with this method but it is a promising therapy for the future.
Biologics
There are currently five biologic drugs approved by the Food and Drug Administration for use in treating severe uncontrolled asthma: reslizumab (Cinqair), mepolizumab (Nucala), omalizumab (Xolair), benralizumab (Fasenra) and dupilumab (Dupixent). Your allergist will do blood tests to determine which biologic would be the most effective for your severe uncontrolled asthma. Depending on the biologic recommended, you may receive it intravenously or subcutaneously (under the skin) every two to eight weeks.
Lung condition characterized by abnormal dilatation and loss of the architecture of the airway/bronchi (the tubing within the lungs in charge of transporting oxygen into the lungs and carbon dioxide out of the lungs). These changes in the airways are caused by chronic inflammation and infections.
Symptoms of Bronchiectasis
Chronic daily cough.
Coughing up large amounts of thick mucus.
Shortness of breath.
Wheezing (Whistling sound when you breathe).
Chest pain.
Weight loss.
Fatigue.
Frequent respiratory infections.
Clubbing (change in the structure of fingernails and toenails).
Causes of Bronchiectasis
Past severe lung infections that damage the lungs.
The prognosis for patients with bronchiectasis continues to improve. Most patients are able to have a normal lifespan. The goals of treatment are to reduce the number of exacerbations and to slow the decline of the lung function. Patients that continue to progress despite aggressive medical management can be referred and considered for lung transplant.
Bronchitis is inflammation of the bronchial tubes which carry air to the lungs.
Types of Bronchitis
Acute Bronchitis Generally caused by a virus. Lasts up to about three weeks. Clears up with simple at-home-care.
Chronic Bronchitis There is a daily cough that produces sputum (mucus) for at least three consecutive months, two years in a row. It is a form of COPD (Chronic Obstructive Pulmonary Disease).
Symptoms of Acute and Chronic Bronchitis
Cough with mucus (clear/white/yellow/green) or without mucus
Shortness of breath
Wheezing
Chest congestion (chest feels full) Symptoms of Acute Bronchitis may also include:
Low-grade fever
Muscle aches
Chills
Sore throat
Runny/stuffy nose
Fatigue
Diagnosing Bronchitis
Thorough medical history taking and comprehensive physical examination
Chest x-ray
Lung function testing (pulmonary function test)
Check oxygen saturation levels
Blood tests
Sputum Culture
Acute Bronchitis Treatment
Increase water intake
Plenty of rest
Take over-the-counter pain killers (acetaminophen, ibuprofen or naproxen)
Use a humidifier or steam
Mucolytic cough medicines (if needed).
Antibiotics (rarely) – only if a bacterial infection is suspected
Inhalers – if you have asthma or allergies and you are wheezing
Chronic Obstructive Pulmonary Disease is a chronic inflammatory lung disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. It is often preventable and treatable
COPD is an umbrella term for a combination of two conditions:
Emphysema:
Chronic lung condition in which the alveoli (air sacs in the lungs) may be destroyed, narrowed, collapsed, stretched or over-inflated resulting in a decrease in respiratory function and breathlessness. Damage to the air sacs is irreversible and results in permanent “holes” in the lung tissue.
Chronic Bronchitis:
Long term inflammation of the bronchi (breathing passages in the lungs) which results in increased production of mucus as well as other changes which may result in breathing problems, frequent infections, cough and disability.
What Causes COPD?
Smoking (main cause but non-smokers can also get COPD).
Air pollutants (second-hand smoke, organic and inorganic dusts, fumes and chemicals which are often work-related).
Genetic factors (Alpha-1 Antitrypsin Deficiency) A rare form of COPD which is related to emphysema. This form of COPD affects the
body's ability to produce a protein (Alpha-1) that protects the lungs.
COPD Risk Factors
Tobacco smoke
Exposure to air pollution (indoor and outdoor)
Breathing second-hand smoke
Working with chemicals, dust and fumes
A genetic condition called Alpha-1 Antitrypsin deficiency
A history of childhood respiratory infection
What Are the Symptoms Of COPD?
Chronic cough
Shortness of breath (dyspnoea) (especially with exertion)
Frequent respiratory infections
Blueness of the lips or fingernail beds (cyanosis)
Fatigue
Producing a lot of mucus (also called phlegm or sputum)
Wheezing
Chest tightness
Losing weight without trying (in later stages)
Diagnosing COPD
Complete medical history and physical examination
Spirometry (most common test)
Other lung function tests (gas transfer, lung volumes)
Chest x-ray
CT Scan chest
Arterial blood gas test
Laboratory tests (to rule out other conditions like alpha-1-antitrypsin deficiency).
What Are the Treatments for COPD?
There is no cure so the goal of treatment is to ease your symptoms and slow the disease.
Medical treatment:
Bronchodilator inhalers
Corticosteroids (oral or inhalers)
Combination inhalers (steroids and a bronchodilator)
Antibiotics
Roflumilast (Daliresp) - This drug stops an enzyme called PDE4. It prevents flare-ups in people whose COPD is linked to chronic bronchitis.
Flu or pneumonia vaccines
Pulmonary rehabilitation (this program includes exercise, disease management, and counselling to help you stay as healthy and active as possible).
Oxygen therapy
Surgery:
In severe cases of COPD your doctor may suggest:
Bullectomy (removes bullae, large air spaces that form when air sacs collapse)
Lung volume reduction surgery (removes diseased lung tissue)
Lung transplant (replaces a diseased lung with a healthy one)
Hay fever is another name for allergic rhinitis, most commonly used to describe a seasonal allergic reaction to pollen such as ragweed. The term is often used to refer to nasal allergies caused by any inhaled allergen. Despite the name, hay fever is not necessarily a reaction to hay, and it does not cause a fever.
Hay Fever Symptoms
Runny nose
Itchy eyes, mouth or skin
Sneezing
Stuffy nose due to blockage or congestion
Fatigue (often reported due to poor quality sleep as a result of nasal obstruction)
Hay Fever Triggers
Outdoor allergens (pollens from trees, grass, weeds, and mold spores)
Indoor allergens (pet hair or dander, dust mites and mold)
A large group of lung diseases and disorders that affect the tissues of the lungs (i.e., Interstitium) generally causing progressive scarring of lung tissue, often resulting in permanent loss of that tissue’s ability to breathe and carry oxygen into the bloodstream. ILD is a long-term (chronic) lung disease.
Symptoms of Interstitial Lung Disease
The symptoms and course of these diseases may vary from person to person, but the common link between the many forms of ILD is that they all begin with an inflammation.
Bronchiolitis. Inflammation that involves the bronchioles (small airways).
Alveolitis. Inflammation that involves the alveoli (air sacs).
Vasculitis. Inflammation that involves the small blood vessels (capillaries).
The following are the most common symptoms for interstitial lung diseases:
Shortness of breath (especially with exertion)
Fatigue and weakness
Loss of appetite
Loss of weight
Dry cough that does not produce phlegm
Discomfort in the chest
Laboured breathing
Haemorrhage in the lungs
How Does Interstitial Lung Disease Occur?
In ILD the lung is affected in three ways:
Lung tissue is damaged in some known or unknown way.
The walls of the air sacs in the lungs become inflamed.
Scarring (fibrosis) begins in the interstitium.
Fibrosis results in permanent loss of that tissue's ability to breathe and carry oxygen. Air sacs, as well as the lung tissue between and surrounding the air sacs, and the lung capillaries, are destroyed by the formation of scar tissue.
What Causes Interstitial Lung Diseases?
The cause of ILD is unknown. The contributing factors however can be placed into five broad categories:
Exposure or occupational related: asbestosis, silicosis, hypersensitivity pneumonitis, bird protein exposure (e.g., chickens, pigeons, exotic birds)
Autoimmune or connective tissue diseases: lupus, scleroderma, poly or dermatomyositis, rheumatoid arthritis-related ILD
Sarcoidosis
Idiopathic ILDs
Some Types of Interstitial Lung Disease
Interstitial Pneumonia (bacteria, viruses or fungi affect the interstitium)
Idiopathic Pulmonary Fibrosis (scar tissue grows in the interstitium)
Nonspecific Interstitial Pneumonitis (associated with people with autoimmune conditions)
Hypersensitivity Pneumonitis (associated with dust, mold or other airborne irritants)
Cryptogenic Organizing Pneumonia (COP) – (this is a pneumonia-like interstitial lung disease without an infection). Also referred to as Bronchiolitis Obliterans with Organizing Pneumonia (BOOP)
Acute Interstitial Pneumonitis (sudden severe interstitial lung disease associated with ventilator use)
Desquamative Interstitial Pneumonitis (partly results from smoking)
Sarcoidosis
Asbestosis (associated with breathing in asbestos, a fiber used in building materials)
Silicosis (associated with breathing in silica dust)
Histiocytosis X
Chronic Eosinophilic Pneumonia
How are Interstitial Lung Diseases Diagnosed?
In addition to a complete medical history and physical examination, the following tests may be requested:
Pulmonary function test (lung function test)
Chest x-ray
Blood tests
High-resolution computed tomography scan (also called an HRCT, CT, or CAT scan)
Lung biopsy - lung tissue can be collected via Bronchoscopy, Video-assisted Thoracoscopic Surgery [VATS] or Thoracotomy [open lung biopsy].
An inflammatory condition of the lung affecting primarily the microscopic air sacs known as alveoli, usually caused by infection with viruses or bacteria and less commonly other microorganisms, certain drugs and other condition such as autoimmune diseases.
The sudden blockage of a major blood vessel (artery) in the lung, usually by a blood clot. In most cases, the clots are small and are not deadly but they can damage the lung. However, if the clot is large and stops blood flow to the lung, it can be deadly.
Symptoms of Pulmonary Embolism
Most Common:
Sudden shortness of breath.
Sudden, sharp chest pain that is worse when you cough or take a deep breath.
Hemoptysis (a cough that brings up blood or pink foamy mucus).
More General Symptoms:
Increased sweating.
Feeling lightheaded.
Rapid breathing.
Heart racing / palpitations.
Feeling anxious.
Signs of shock.
What Causes Pulmonary Embolism
Blood clots that form in deep leg veins (most common) or the deep veins of the arms or pelvis.
Small masses of infectious material.
Fat released into the bloodstream after some type of bone fracture, surgery, trauma or severe burns.
Air bubbles or substances that get into the blood from trauma, surgery or medical procedures.
Tumours caused by rapidly growing cancer cells.
Amniotic fluid.
How is Pulmonary Embolism Diagnosed
Chest x-ray
Electrocardiogram (ECG/EKG)
D-Dimer blood test
CT Chest – Pulmonary Angiogram
MRI Chest
Ventilation-Perfusion Scan
Doppler Ultrasound of legs
Echocardiogram
How is Pulmonary Embolism Treated
Anticoagulants (blood thinners)
They help prevent new clots and keep existing clots from growing.
It may be used for a few months (low risk of blood clots) or lifelong (high risk of blood clots).
Thrombolytics (clot-busting drugs)
Dissolve clots quickly. Are used if symptoms are severe and life-threatening.
May increase the risk of serious bleeding
Embolectomy (surgical removal of the clot)
Placement of a Vena Cava Filter
A filter is placed into the large vein (Vena Cava) that carries blood from the lower body to the heart. Helps keep blood clots from reaching the lung.
May be used if you have problems using an anticoagulant.
There is no formal staging system for pulmonary fibrosis. Physicians use different factors like the ones listed below, to describe the disease as mild, moderate, severe or very severe.
Symptoms (frequency of symptoms and worsening of symptoms)
Pulmonary Function Tests (PFTs) (assess the amount of air the lungs can hold and how forcefully you can empty air from the lungs)
Six-Minute Walk Test (measures your exercise capacity)
High-Resolution CT Scan (shows how much scarring is in the lungs)
Treatment of Pulmonary Fibrosis
Lung scarring that occurs in pulmonary fibrosis cannot be reversed. Treatments may improve symptoms temporarily, slow disease progression and improve quality of life.
Medications
Pirfenidone (Esbriet) and Nintedanib (Ofev) – slow the progression of Idiopathic Pulmonary Fibrosis
Oxygen Therapy
Makes breathing and exercise easier
Prevent or lessen complications from low blood oxygen levels
Reduce blood pressure in the right side of your heart
Improve your sleep and sense of well-being
Pulmonary Rehabilitation (reduces the impact of chronic lung disease)
Physical exercise to improve your endurance
Breathing techniques that may improve lung efficiency
Nutritional counsellin
Counselling and support
Education about your condition
Lung Transplant
Can improve your quality of life and allow you to live a longer life. However, it can involve complications such as rejection and infection.
Complications of Pulmonary Fibrosis
Pulmonary Hypertension (high blood pressure in your lungs)
Pulmonary Hypertension (PHT) is high blood pressure in the heart-to-lung system that delivers fresh (oxygenated) blood to the heart while returning used (oxygen-depleted) blood back to the lungs. Pulmonary hypertension affects the arteries in your lungs and the right side of your heart. Pulmonary blood pressure is normally lower than systemic blood pressure. Normal pulmonary artery pressure is 8-20 mm Hg at rest. If the pressure in the pulmonary artery is greater than 25 mm Hg at rest or 30 mmHg during physical activity, it is abnormally high and is called pulmonary hypertension.
Symptoms of Pulmonary Hypertension
The signs and symptoms of pulmonary hypertension develop slowly. You may not notice them for months or even years. Symptoms get worse as the disease progresses.
Early symptoms include:
Shortness of breath during routine activity
Fatigue
Chest pain
Racing heartbeat
Pain in upper right side of abdomen
Decreased appetite
Later symptoms include:
Feeling light-headed, especially during physical activity
Fainting
Swelling in the ankles or legs
Bluish lips or skin
Types of Pulmonary Hypertension (PAH):
Group 1 PAH
Includes pulmonary hypertension that has no known cause (Idiopathic Pulmonary Arterial Hypertension), inherited (Heritable Pulmonary Arterial Hypertension), caused by drugs (methamphetamines) or toxins, caused by conditions such as connective tissue disease (lupus, scleroderma etc.), HIV infection, chronic liver disease (cirrhosis), congenital heart disease, sickle cell disease, or schistosomiasis or is caused by conditions that affect the veins and small blood vessels of the lungs.
Group 2 PAH
This is often associated with left-sided heart valve disease (mitral valve disease or aortic valve disease) or long-term high blood pressure. Left heart disease is the most common cause of pulmonary hypertension.
Group 3 PAH
This group is related to lung problems like chronic obstructive pulmonary disease (COPD), pulmonary fibrosis (a condition that causes scarring in the tissue between the lungs' air sacs), sleep apnea and other sleep-related breathing disorders.
Group 4 PAH
This includes pulmonary hypertension caused by chronic blood clots in the lungs (pulmonary emboli) or general clotting disorders
Group 5 PAH
This is triggered by other health conditions such as blood disorders (polycythemia vera and essential thrombocythemia; systemic disorders such as sarcoidosis and vasculitis; metabolic disorders such as thyroid and glycogen storage disease; and other conditions such as kidney disease and tumours that press on the pulmonary arteries.
Risks Factors for Pulmonary Hypertension
The condition is more often diagnosed in people ages 30 to 60. However, Idiopathic PAH is more common in younger adults
Other things that can raise your risk of pulmonary hypertension include:
A family history of the condition
Being overweight
Blood-clotting disorders or a family history of blood clots in the lungs
Exposure to asbestos
Genetic disorders, including congenital heart disease
Living at a high altitude
Use of certain weight-loss drugs
Use of illegal drugs such as cocaine
Use of selective serotonin reuptake inhibitors (SSRIs), used to treat depression and anxiety
Diagnosing Pulmonary Hypertension
Blood tests
Chest X-ray
Electrocardiogram (ECG)
Echocardiogram
Right heart catheterization.
Your doctor might also order one or more of the following tests to check the condition of your lungs and pulmonary arteries and further determine the cause of pulmonary hypertension:
Computerized tomography (CT)
Magnetic resonance imaging (MRI)
Pulmonary function test (Lung Function Test)
Polysomnogram
Ventilation/perfusion (V/Q)
Open-lung biopsy
Genetic tests
Pulmonary Hypertension Classifications
Once you have been diagnosed with pulmonary hypertension your doctor might classify the severity of your disease into one of several classes including:
Class I. You have no symptoms with normal activity.
Class II. You do not have symptoms at rest, but you have symptoms such as fatigue, shortness of breath or chest pain with normal activity.
Class III. You are comfortable at rest, but have symptoms when you are physically active.
Class IV. You have symptoms while at rest and during physical activity.
Treatment of Pulmonary Hypertension
There is no cure for pulmonary hypertension but your doctors can prescribe treatments to help you manage your condition. Treatment may help improve your symptoms and slow the progress of pulmonary hypertension. When pulmonary hypertension is caused by another condition, your doctor will treat the underlying cause whenever possible.
Medications:
Blood vessel dilators (vasodilators). Vasodilators relax and open narrowed blood vessels, improving blood flow. One of the most commonly prescribed vasodilators for pulmonary hypertension is epoprostenol (Flolan, Veletri). Other types of vasodilators, including treprostinil (Tyvaso, Remodulin, Orenitram), can be inhaled, injected, or taken by mouth. The drug iloprost (Ventavis) is given while you breathe in through a nebulizer, a machine that vaporizes your medication.
Guanylate cyclase (GSC) stimulators. Riociguat (Adempas) increases nitric oxide in the body, which relaxes the pulmonary arteries and lowers pressure within them. You should not take GSC stimulators if you're pregnant.
Endothelin receptor antagonists. These medications reverse the effect of endothelin, a substance in the walls of blood vessels that causes them to narrow. Such drugs include bosentan (Tracleer), macitentan (Opsumit), and ambrisentan (Letairis). These drugs may improve your energy level and symptoms. However, they can damage your liver. You may need monthly blood tests to check your liver function. Endothelin receptor antagonists shouldn't be taken if you're pregnant.
Sildenafil and tadalafil. Sildenafil (Revatio, Viagra) and tadalafil (Adcirca, Cialis) are commonly used to treat erectile dysfunction. But they also open the blood vessels in the lungs and allow blood to flow through more easily.
High-dose calcium channel blockers. These drugs help relax the muscles in the walls of your blood vessels. They include amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and nifedipine (Procardia, others). Although calcium channel blockers can be effective, only a small number of people with pulmonary hypertension improve while taking them.
Warfarin. Warfarin is a type of drug called an anticoagulant (blood thinner). Your doctor is likely to prescribe warfarin (Coumadin, Jantoven) to help prevent blood clots in the lung's arteries. This medication delays the clotting process and might put you at risk of bleeding, especially if you're having surgery or an invasive procedure.
Digoxin. Digoxin (Lanoxin) helps the heartbeat stronger and pump more blood. It can help control the heart rate if you have arrhythmias.
Diuretics. Commonly known as water pills, these medications help your kidneys remove excess fluid from the body. This reduces the amount of work your heart has to do. They may also be used to limit fluid build-up in your lungs, legs and abdomen.
Oxygen therapy. Your doctor might suggest that you sometimes breathe pure oxygen to help treat pulmonary hypertension, especially if you live at a high altitude or have sleep apnea. Some people who have pulmonary hypertension eventually need continuous oxygen therapy.
Surgery:
Atrial septostomy. If medications don't control your pulmonary hypertension, this open-heart surgery might be an option. In an atrial septostomy, a surgeon creates an opening between the upper left and right chambers of your heart (atria) to relieve the pressure on the right side of your heart. Atrial septostomy can have serious complications, including heart rhythm problems (arrhythmias).
Transplantation. In some cases, a lung or heart-lung transplant might be an option, especially for younger people who have idiopathic pulmonary arterial hypertension. Major risks of any type of transplantation include rejection of the transplanted organ and serious infection. You must take immunosuppressant drugs for life to help reduce the chance of rejection.
Complications of Pulmonary Hypertension
Right-sided heart enlargement and heart failure (cor pulmonale)
Sarcoidosis is an Interstitial Lung Disease which generates inflammation that primarily affects the lungs and breathing, although any organ in the body may be involved. Inflammation from sarcoidosis can lead to scarring or thickening of the walls of the lungs, making it difficult to move oxygen into (and carbon dioxide out of) the bloodstream.
What causes Sarcoidosis?
The exact cause is unknown. It may be a type of autoimmune disease associated with an abnormal immune response, but what triggers this response is uncertain. How Sarcoidosis spreads from one part of the body to another is still being studied.
Symptoms of Sarcoidosis
These vary widely depending on the organs involved:
Lungs: persistent dry cough, chest pain, shortness of breath (most common symptoms), fatigue
Skin: rashes, skin discoloration
Brain: Bell’s Palsy, numbness or tingling in the arm or leg
Eye: blurry vision, painful red eyes
Bones: bone pain
Bone marrow: fatigue, anemia
Heart: abnormal heart rhythm (can cause sudden death)
Diagnosing Sarcoidosis
Comprehensive history and physical examination
Chest x-ray / CT Scan of chest
Bronchoscopy with biopsy to look for granulomas in the affected area
Pulmonary Function Tests
Blood tests (to determine various organ involvement)
Sarcoidosis Treatment
There is no cure for Sarcoidosis but the disease may get better on its own over time. Many people with Sarcoidosis have mild symptoms and do not require any treatment. Treatment if needed generally fall into two categories:
A common sleep disorder characterized by brief interruptions of breathing during sleep. These episodes usually last 10 seconds or more and occur repeatedly throughout the night. People with sleep apnea will partially awaken as they struggle to breathe, but in the morning, they will not be aware of the disturbances in their sleep. Undiagnosed moderate to severe sleep apnea can take years off of your life.
Types of Sleep Apnea
Obstructive Sleep Apnea (OSA)
Most common type of apnea.
Caused by relaxation of soft tissue in the back of the throat that blocks the passage of air.
Central Sleep Apnea (CSA)
Caused by irregularities in the brain’s normal signals to breathe.
Mixed Sleep Apnea
Combination of both obstructive and central apnea
Sleep Apnea Symptoms
Snoring
Excessive tiredness during the day
You have been told you stop breathing during sleep (a.k.a Witnessed Apnea)
Hypertension
Early morning headaches
Weight gain
Insomnia
Acid reflux
Anxiety / Depression
Complications of Sleep Apnea
Excessive daytime sleepiness can cause people to fall asleep at inappropriate times such as while driving.
Risk of stroke and transient ischemic attacks (TIAs – a.k.a Mini Strokes).
Associated with coronary heart disease, heart failure, irregular heartbeat and heart attacks.
Tobacco use can lead to nicotine dependence and serious health problems. Cessation can significantly reduce the risk of suffering from smoking-related diseases.
Tobacco dependence is a chronic condition that often requires repeated interventions, but effective treatments and helpful measures exist. Smokers can and do quit smoking. In fact, today there are more former smokers than current smokers.
Nicotine Dependence
Nicotine is the psychoactive drug in tobacco products that produces dependence, Most smokers are dependent on nicotine.
Nicotine dependence is the most common form of chemical dependence in the United States. Research suggests that nicotine may be as addictive as heroin, cocaine or alcohol.
Quitting smoking is difficult and may require multiple attempts. Users often relaps because of stress, weight gain and withdrawal symptoms.
Examples of nicotine withdrawal symptoms include irritability, anxiety, difficulty concentrating and increased appetite.
Health Benefits of Cessation
Breaking free from nicotine dependence is not the only reason to quit smoking. Gigarette smoke contains a deadly mix of more than 7,000 chemicals; hundreds are toxic and about 70 can cause cancer. Cigarette smoke can cause serious health problems, numerous diseases and death.
Fortunately, people who stop smoking greatly reduce their risk for disease and premature death. Although the health benefits are greater for people who stop at earlier ages, cessation is beneficial at all ages.
Our Method to Quit Smoking
The majority of cigarette smokers quit without sing evidence-based cesssation treatments. However, our clinic offers the following assistance for smokers who want help to quit:
Brief clinical interventions (i.e., when a doctor takes 10 minutes or less to deliver advice and assistance about quitting)
Counseling (e.g., individual, group or telephone)
Behavioral cessation therapies (e.g., training in problem solving)
Treatments with more person-to-person contact and intensity (i.e., more time with counselors)
Use of cessation medications which have been found to be effective for treating tobacco dependence
Breathe Well Sleep Well and Live Lung Clinic knows that the combination of medication and counseling is more effective for smoking cessation than either medication or counseling alone and thus uses a multidisciplinary approach to achieve its FABULOUS 100% success rate for Smoking CESSATION.
Tuberculosis (TB) is a disease caused by a bacteria called Mycobacterium Tuberculosis. The bacteria usually attack the lungs but they can also damage other parts of the body including the brain, kidney and spine.
Types of Tuberculosis
Active Tuberculosis
This can occur weeks or years after becoming infected. Symptoms develop based on the area affected and you can spread the disease.
Latent Tuberculosis
You become infected with the bacteria however, your immune system is able to keep you from getting sick. You do not develop symptoms and cannot spread the disease. It is possible for latent tuberculosis to turn into active tuberculosis years later.
Mechanism of Transfer
TB spreads through the air when a person with tuberculosis of the lungs or throat coughs, sneezes or talks. The disease is not spread by shaking hands, kissing, using public toilets or sharing food and drink.
Symptoms of TB in the Lungs
Cough (which last 3 weeks or longer), fever, night sweats, loss of appetite, unexplained weight loss, weakness, tiredness, chest pain, coughing up bloody mucus (hemoptysis) and rapid heartbeat.
If other parts of the body are affected the symptoms differ and may include back pain if the disease attacks the spine or blood in the urine if you have tuberculosis in your kidneys.
Chest x-ray (helps determine latent or active tuberculosis)
Sputum samples (helps determine latent or active tuberculosis)
Blood tests (QuantiFERON - TB Gold Test or the T-SPOT – TB Test). *TB blood tests are the preferred TB test for people who have received the TB vaccine and those who have difficulty returning for a follow up visit to review the skin test.*
Treating Tuberculosis
Duration of treatment varies between 6 – 9 months, sometimes longer.
Latent TB usually requires one antibiotic taken for 9 months.
Active TB requires a combination of four antibiotics, usually taken for 6 months.
Drug-Resistant TB (a form of TB where the bacteria are resistant to some or all of the antibiotics used to treat the disease) have less effective treatment options.