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ASPIRATION

Aspiration is the medical term used to describe a condition where contents from the stomach or mouth enter the trachea and lungs. Aspiration is not considered a disease in and of itself, but can be a symptom of other medical problems, or can cause medical problems.

Aspiration may occur discreetly, or "silently" while sleeping, or may be very obvious, associated with coughing when swallowing food or drinks. If the muscles associated with speech and swallowing are affected by a stroke, aspiration may occur. Swallow studies done in a radiology department can assist with diagnosis of aspiration. EGD (esophagogastroduodenoscopy) may also be used to assist with diagnosis. Many times a physician may suspect aspiration based on the history given by the patient and physical exam.

Silent aspiration is fairly common, and contributes to many pulmonary problems. During sleep, the muscles at the top of the stomach relax, allowing fluid and acid to leak back up into the esophagus. Aspiration occurs when this fluid spills over from the esophagus into the trachea. This causes irritation and burning of the lung tissue. The result is chronically inflamed airways. Symptoms of asthma and chronic bronchitis can be worsened by silent aspiration. In some cases, pneumonia may develop from aspiration. Sleep apnea can cause aspiration to worsen.

Aspiration can be treated with medications that reduce the amount of acid produced by the stomach. Other medications given before bedtime assist with emptying the stomach more quickly, reducing the amount of stomach contents. Sleeping with the head of the bed elevated and refraining from eating for 2-3 hours prior to going to bed may also reduce the likelihood of aspiration.

ACUTE BRONCHITIS

Acute bronchitis describes a condition where the larger airways of the lungs are inflamed. The term "acute" indicates the bronchitis has developed quickly, and is not a condition that has been present for a long period of time. Acute bronchitis may develop after an upper respiratory infection. People with pre-existing lung diseases are more likely to develop the symptoms of bronchitis than those with healthy lungs, and the symptoms they experience may be more severe.

Acute bronchitis may be caused by bacteria or viruses. If your physician suspects a bacterial cause, antibiotics will be prescribed. Antibiotics are not effective against most viruses. Fluids and rest will be recommended. If the inflammation in the airways is severe enough, it may be treated with oral steroids.

FUNGAL PNEUMONIA

In North America, the most common types of fungal pneumonia are Aspergillosis, Histoplasmosis, Blastomycosis, and Coccidioidomycosis. Most fungal pneumonias are self-limiting. More severe or recurrent disease is more common in patients whose immune systems are suppressed.

Symptoms of fungal pneumonia may include flu-like symptoms, lymph node enlargement, fever, chills, sweats, cough (with or without sputum), pleuritic chest pain, and weakness. Symptoms may appear a few weeks after becoming infected, last a week or 2, then go away without intervention, or may be more severe. Chest x-ray may show infiltrates of varying density and lymph node enlargement. Granulomas may also be present on x-ray.

The fungi that can cause pneumonia are generally found in the soil, or in soil containing bird droppings. Spores become airborne and are inhaled. Diagnosis of fungal pneumonia occurs with positive cultures from a sputum specimen grown in the lab. Fungi are slow-growing, so results from this test may take up to 6 weeks.

When treatment is indicated, amphotericin B is the most effective medication for most fungal infections. A number of new medications, such as itraconazole, voriconazole, and caspofungin are now available. These medications may be easier to use and better tolerated than amphotericin B. Your physician will determine the best medications to treat your specific situation.

COUGH

Cough is a very common symptom, experienced by, virtually every person at some point in their life. The significance of a cough is dependent on a number of things, including the length of time it has been present, when it occurs, the severity of the cough, or if it is accompanied by other symptoms (such as fever, chills, weight loss, or sputum production). A cough that does not go away should be evaluated by a physician.

A cough may be a symptom of an infectious process such as pneumonia or tuberculosis, or a non-infectious process such as asthma, allergies, or lung cancer. Cough may be a result of chronic airway irritation, as seen in those who smoke, or the result of post-nasal drainage. During your visit to the physician's office, your health care provider will obtain an extensive history. This will assist him in determining the significance of your cough.

Treatment of a cough is usually directed at eliminating the cause of the cough. If the cough interferes with sleep or the ability to perform daily functions, a cough suppressant may be ordered.

SARCOIDOSIS

Sarcoidosis is a disease that affects multiple organ systems in the body, including the lungs. The cause of sarcoidosis is unknown. One of the principal findings of sarcoidosis is the presence of noncaseating granulomas in the organs that are affected. Because sarcoidosis is a multi-system disease, the presenting symptoms may vary considerably, depending on the organ systems primarily affected.

The most common symptoms of pulmonary sarcoidosis are shortness of breath, cough, and chest discomfort. Shortness of breath is most pronounced with exertion, but may progress if untreated. Cough can vary greatly in severity. Chest tightness and wheezing may be present.

Diagnosis is determined by history and physical exam, chest x-ray, chest CT and a biopsy of lung tissue. Biopsy is generally obtained through a bronchoscopy. If the diagnosis is not confirmed with bronchoscopy, a mediastinoscopy may be performed. Pulmonary function testing will assist with determining the extent of damage to the lungs.

The main treatment for pulmonary sarcoidosis is corticosteroids taken in tapering doses over a period of months. Chemotherapy agents may be prescribed in specific situations. For severe sarcoidosis, oxygen may be prescribed.

Sarcoidosis is a life-long illness. Symptom control and preventing the progression of the illness are the primary foci of treatment.

PULMONARY NODULE

A pulmonary nodule describes a rounded density seen on chest x-ray. Nodules may be very small or large. There may be many nodules, more than one, or a single nodule present. Pulmonary nodules may be an incidental finding on a routine chest x-ray associated with no respiratory symptoms. The size of the nodule(s), the location of the nodule(s), smoking history and presence of other symptoms will determine the extent of follow-up recommended.

Nodules may indicate old infection or scarring, a current infectious or fungal process, or lung cancer. Your physician will take an extensive history and perform a physical exam. Pulmonary function testing will be done to assess lung function. Other testing that may be ordered is a CT scan of the chest, to further evaluate the nodule. If indicated, your physician may order CT scans to be done at every 3-6 month intervals to monitor the nodule for changes in size, or for the appearance of new nodules. A bronchoscopy may be ordered to check the airways for abnormal cells with a washing, brushing, or biopsy, and visually inspect the airways. A PET scan may be ordered to check for increased metabolic activity in the lung nodule, or in other parts of the body. Your physician may want to biopsy your lung nodule. Depending on the size and location of the nodule, this may be done with a bronchoscopy, or using a CT scan to guide a radiologist to insert a needle into the nodule. In some situations a mediastinoscopy may be needed for an adequate specimen.

The treatment for pulmonary nodules depends on the cause of the nodule. After your physician determines your diagnosis, your treatment plan will be formulated.

PULMONARY EMBOLISM

Pulmonary embolism is the medical term for the presence of blood clots in the circulation of the lungs. The blood clots originate in the venous circulation somewhere else in the body; usually the legs.

Normally, blood flows from the right side of the heart to the lungs, where it receives oxygen. When blood clots are present in the circulation, the flow of blood is prevented in the areas where clots are present. This causes lower oxygen levels in the blood, and increased pressure in the right side of the heart.

Symptoms of pulmonary emboli are an unexplained sudden onset of shortness of breath, rapid breathing, and chest discomfort in the middle of the chest. These symptoms may be mild or severe depending on how much of the lung is affected.

Several things can make a person more likely to develop blood clots. Pre-existing medical conditions such as left-sided heart failure or immobilization after surgery will increase the risk of clot development. Females experience a higher risk of blood clot development in the month after delivering a baby and if they take oral contraceptives or hormone replacement therapy. Inherited risk factors that affect the clotting process also predispose a person to the development of blood clots.

Diagnosis is established by combining the information from the history and physical exam, blood tests, such as ABG's, and radiology studies designed to look at the circulation in the lungs.

Recognizing risk factors and implementing measures to prevent blood clots from developing are important. After pulmonary embolism has been identified, treatment consists of minimizing the damage caused by clots and preventing recurrance. Blood thinners such as heparin or Lovenox may be prescribed. Long-term treatment with warfarin will be necessary. Blood tests to check the protime and INR will be done at frequent intervals to determine the dose of warfarin needed.