Symptoms and Diagnosis of Stage 4 Lung Cancer

To assist physicians in deciding what type of treatment is more appropriate for lung cancer, there is a recognized numerical staging system that creates benchmarks. At Stage I, the cancer is small and localized in a specific area of ​​the lung. During phases 2 and 3, the cancer grows and spreads to the surrounding tissue and possibly the lymph nodes.

Stage 4 lung cancer is when the cancer has spread, or metastised, from the lungs to other parts of the body. Typically, the cancer spreads to the liver, bones, brain or adrenal glands. This is commonly known as secondary or advanced cancer. About 40% of lung cancer patients are diagnosed at stage 4, mainly because the symptoms of lung cancer could include symptoms of other diseases. In Stage 4, the cancer is not curable, but it can be treated. These are some of the symptoms that may help your doctor to diagnose stage 4 lung cancer.

Breathing problems

Lung cancer patients often present with shortness of breath, wheezing and hoarseness. It is often a persistent cough, and the patient can cough up blood. Sometimes, a chronic cough that the patient may suddenly change for some time may be natural. Because these symptoms may also affect other conditions, they are not sufficient to suggest a diagnosis of lung cancer. However, if a smoker presents with these symptoms, a diagnosis of stage 4 lung cancer is likely to be considered by the doctor.

Pain

Patients may experience pain in various areas of the upper body, including the back, chest, arms, ribs and hips. Deep breathing often intensifies the pain that can be felt in the tissues or bones depending on the spread of the cancer. It can also be pain when swallowing. Some people suffer from frequent headaches, which is an indication that the cancer could be affecting the brain.

Weight Loss

With stage 4 lung cancer, there is often a sudden, unexplained weight loss that is often accompanied by loss of appetite and a general feeling of weakness and fatigue. If this weight loss is significant and you do not have a diet, it should be investigated.

“Clubbing”

The nails on the fingers and toes can bulge, and the ends of the fingers change shape. This symptom usually develops in the latter stages of lung cancer, so it is a good indicator of diagnosis.

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Diagnosis

The diagnostic process for stage 4 lung cancer is usually some form of imaging, such as computed tomography (CAT) or magnetic resonance imaging (MRI). These scans give a detailed picture of the spread of the cancer as X-rays, allowing the doctor to determine the cancerous stage. A radionuclide scan can detect if the cancer has spread to other organs, while a bone scan will show if the bones are affected.

The doctor may also conduct tests to determine if the cancer has spread to the lymph nodes. This involves removing a tissue sample for testing under general anesthesia. This process is called medias or mediastinotomy, depending on whether the tissue is absorbed by the neck or the chest.

While all these symptoms refer to other conditions, if you experience one or more of them for two weeks or more, you should consult your doctor. Lung cancer is particularly dangerous because it metastises to other parts of the body relatively quickly, making it one of the most life-threatening cancers there is. As with most conditions, the earlier the diagnosis, the more likely that the treatment will succeed. During treatment for stage 4 lung cancer, the condition will not heal, it can prolong life and improve quality of life, so it is important to seek medical advice as soon as possible.

Different Types Of Lung Cancer

Lung cancer is a malignant tissue proliferation in the lungs, mainly from the mucous membranes of the bronchi. The medical term bronchial carcinoma hides numerous tumors with different cell types and therefore different forms of therapy and prognosis.

In the case of bronchial carcinoma, a distinction is made between small cell and non-small cell tumors

Non-Small Cell Lung Cancer (NSCLC) includes squamous cell carcinoma, which accounts for half of all lung cancers. The tumor cells do not grow as fast as e.g. in small cell bronchial carcinoma. It can usually be operated on well because it is predominantly located centrally in the lungs and more distinct than the small cell lung cancer. Also, the cancer cells grow less quickly, but also do not respond so well to a chemo or radiation therapy.

Adenocarcinoma also belongs to the group of non-small cell lung carcinomas. It has some special status, as it occurs mainly in non-smoking middle-aged women. Otherwise, it can be said that about every tenth cell-type lung cancer is an adenocarcinoma.

The third representative of this group is the rarely occurring large-cell bronchial carcinoma, which accounts for five to ten percent of all malignant lung tumors. All three tumor types grow more slowly compared to small cell bronchial carcinoma and do not form metastases (secondary tumors) as quickly.

Small Cell Lung Cancer (SCLC) is also referred to as oat cell cancer because the tumor cells are very similar to oat grains. This type of lung cancer is extremely fast and invasive and early causes metastases in the lymph nodes, liver, kidneys, brain and skeletal system (predominantly spine). As a form of treatment, a chemotherapy or radiation therapy is available here, under which the tumor size can greatly reduce or reduce due to the cell specificity. Surgery is performed if the cancer is found only in one lung and near lymph nodes. However, as this type of cancer does not usually occur in just one area, surgery as a single treatment is not useful. Often there are also recurrences.

Small cell bronchial carcinomas also have as a special feature the formation of a paraneoplastic syndrome, i. The tumor cells produce hormone-like substances that can lead to a variety of endocrinological symptoms. Since 80% of all patients already have metastasis at the time of first diagnosis, this tumor has the worst prognosis.

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Special shapes :

    • Pancoast tumor

The tumor sits at a certain point in the lung tip and has just through this situation a typical symptoms. The most common symptoms here are unilateral shoulder pain radiating to the arm, ribs, neck and back. This symptomatology is due to the ingrowth of the tumor into surrounding nerve tracts. Often a Horner syndrome also occurs. Horner’s syndrome is the combination of drooping eyelid, narrowing of the pupil, withdrawal of the eyeball and reversed perspiration on one side. As a therapy, a combined chemo and radiation therapy followed by surgery is recommended if the condition of the patient allows it and there are no metastases in adjacent lymph nodes or other organs.

    • Pleural Mesothelioma

This rather rare malignant tumor starts from the pleura, which covers the lungs. Although it can greatly affect the function of the lungs and lead to severe breathing difficulties, it does not formally belong to the group of different types of lung cancer. Causes of the pleural mesothelioma are mostly asbestos contacts. Asbestos is the most important risk factor for this type of cancer. Since 1977, pleural mesothelioma has been recognized as an occupational disease in recent occupational asbestos exposure. It grows quite slowly compared to other tumors. Decades may pass between the inhalation of asbestos-containing dusts and the manifestation of a pleural mesothelioma.

In the end, however, it destroys and displaces other organs such as the lungs, heart, and diaphragm and forms metastases. It also comes very often to a pleural effusion. This is an accumulation of often purulent, often bloody fluid in the chest. In the treatment of pleural mesothelioma, the affected tissues are removed and replaced if necessary by artificial sculptures. Accompanying radiation and / or chemotherapy can be used.

Does Beta-Carotene Cause Lung Cancer?

Many years ago, a study was published in which smokers were given beta-carotene – for the prevention of lung cancer. But then they did not get sick less often, but even more often with lung cancer. Once this unpleasant side effect was noticed, the study was stopped immediately and smokers were advised to stop taking beta-carotene. Meanwhile, however, it has come to the point where some people believe that dietary beta carotene (such as carrots) is harmful and can cause lung cancer. We explain how it behaves.

What is beta-carotene?

Beta carotene is a phytochemical in the carotenoid family. Carotenoids in turn are fat-soluble plant substances with yellow to red coloring. A diet rich in carotenoids is therefore used when the diet contains a high proportion of yellow and orange or even red vegetables.

Beta carotene is the best known carotenoid. Hardly any other food is as rich as it is in carrots and kale. Although green cabbage is green and not yellow or orange, the green of chlorophyll covers the orange tones of beta-carotene.

Which carotenoids are there?

Other carotenoids are, for example

    • the alpha carotene (eg in pumpkin and carrots),
    • Lycopene (especially in tomatoes),
    • the betacryptoxanthin (eg in pumpkin and red pepper),
    • lutein (eg in savoy cabbage, parsley and kale),
    • Astaxanthin (produced by algae) and
    • the zeaxanthin (eg in red pepper).

All of them are considered to be powerful antioxidants that fight free radicals and oxidative stress and can thus prevent many diseases, such as cardiovascular diseases, rheumatic diseases, eye diseases, as well as Alzheimer’s and Parkinson’s and cancer.

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Does beta carotene protect against lung cancer?

As late as the 1980s, beta carotene was considered very healthy by all people – whether they were smokers or not. In 1986, even a study on this topic appeared (1,266 participants). They found that smokers who did not eat carrots had a three-fold higher risk of lung cancer than smokers who ate carrots at least once a week. A significantly increased risk of lung cancer also existed for those who only liked a little green leafy vegetables. Liver and cheese (vitamin A) did not appear to have a protective effect because those who did not have either had no increased risk of ever developing lung cancer.

Another study (1,663 participants) in the same year showed similar, namely that a carotenoid-rich diet, in particular smokers protected against lung cancer.

But who wants to bother with all the vegetables? So at least the thought of many smokers, who on the whole rather seldom eat health-conscious. However, since lung cancer is a desirable target for her and smoking cessation is rarely up for debate, the obvious solution was: why not simply take a beta-carotene pill every day? Because it was known that a high level of beta-carotene in the blood reduced the risk of lung cancer. So you could safely take the beta carotene in pill form.

Betacarotin in pill form increases the risk of lung cancer

In 1996, a study on beta-carotene pills, published in the Journal of the National Cancer Institute, was quickly launched. More than 29,000 men between the ages of 50 and 69 who smoked more than 5 cigarettes a day took 50 mg of vitamin E (alpha-tocopherol ), 20 mg beta carotene, or both, or a placebo supplement for an average of 6 years.

Regarding vitamin E, there was no effect on lung cancer risk. Beta-carotene, however, appeared to increase lung cancer risk (but only slightly), especially in heavy smokers (more than 20 cigarettes per day) compared to smokers who smoked less. Even in men who also indulged in a higher alcohol consumption, was due to the beta carotene intake an increased risk of lung cancer.

Study stop because of frequent lung cancer cases

Similar results were obtained by the so-called CARET study, which was published in the same year. Here, over 18,000 participants were given 30 mg beta-carotene daily and 25,000 IU vitamin A or placebo. The study had to be stopped after just 21 months, as the beta carotene group had 28 percent more lung cancers and 17 percent more deaths. The participants of the study were smokers, former smokers or asbestos workers, ie all those with a high risk of lung cancer.

At the same time there were also studies that did not show any disadvantages after taking beta-carotene, such as the study that also appeared in 1996 (in the New England Journal of Medicine) and found that:

Beta-carotene in pill form does not always harm

More than 22,000 healthy men between the ages of 40 and 84 took 50 mg beta-carotene or placebo every other day for 12 years. These included smokers as well as former smokers and non-smokers. At the end of the 12 years, however, no significant differences in cancer risk, cardiovascular or mortality risk could be identified. In the beta-nicotine group even fewer men had lung cancer than the placebo group (82 versus 88), which was not statistically significant.

Three years later (1999), a study of nearly 40,000 healthy women – whether smokers or non-smokers – found that dietary supplementation with 50 mg beta-carotene every other day for an average of 2.1 years does not affect the risk of cancer or cardiovascular disease even the mortality had.

Problematic: The long-term use of carotenoids in pill form

But in 2009, another study with a negative outcome emerged: researchers from the University of North Carolina at Chapel Hill found that the long-term use (up to 10 years) of beta-carotene supplements and other carotenoids or vitamins was based on data from more than 77,000 participants -A-containing supplements (retinol and lutein) may increase lung cancer risk, especially in smokers. The study knowledge appeared in the American Journal of Epidemiology.

 

The scientists were able to observe that the longer they took the supplements, the higher the risk of lung cancer from smokers. The dose of supplements was secondary, even mediocre doses increased the risk of long-term supplementation.

Whether taking these supplements increases the risk of lung cancer in non-smokers was not apparent, since hardly any of the non-smokers became ill with lung cancer.

Dr. Jessie Satia, Professor of Epidemiology and Nutrition at the UNC Gillings School of Global Public Health said:

“We believe that the antioxidant beta-carotene at too high a dose has oxidative effects, which then increases the risk of cancer.”

High-carotenoids from carotenoids reduce the risk of lung cancer

More recently, it has been sensible to focus increasingly on the effects of a carotenoid-rich diet rich in vegetables. For example, in Cancer Science in 2014, a study of over 10,000 participants found that high carotenoid levels in the blood (alpha carotene and betacryptoxanthin) were significantly associated with a lower risk of lung cancer death.

Smokers’ lung cancer risk also decreased significantly by 46 percent for high levels of alpha carotene and 61 percent for high levels of beta-cryptoxanthin.

Even more recent is the study from the University of Montreal / Canada Research Center in 2017. Here, too, increased intake of carotenoid-rich vegetables has been shown to protect against lung cancer (squamous cell carcinoma and adenocarcinoma) – including heavy smokers.

Conclusion: Vegetables protect against lung cancer, carotenoid pills do not do this

Isolated beta-carotene and vitamin A supplements should not be taken by smokers for an extended period of time. In non-smokers, however, they have no harmful effect.

A carotenoid-rich diet consisting of plenty of carrots, squash, peppers, tomatoes, sweet potatoes, herbs (parsley, dill, etc.), kale, spinach, and other green leafy vegetables should be practiced by everyone, as it has been shown to reduce the risk of lung cancer although both non-smokers and smokers (including heavy smokers).

Note: For the sake of completeness, we would like to point out that in a carotenoid-rich diet no vitamin A overdose is to be feared, no matter how many carrots you like to eat. Although some carotenoids can be converted to vitamin A in the body, they can only be produced in the amount required by the body.

It would be quite different if you take cod liver oil or like to eat liver, both of which are very rich in vitamin A. Here, a vitamin A overdose is possible, which should be avoided at all costs – especially in pregnancy, as it can lead to malformations and brain damage in the embryo.

Fluid in the Lungs – Causes and Treatment

Fluid in the lungs is a broad term to describe two possible states that can give characteristic symptoms, such as a bubbling noise in the lungs (rattling) when breathing. Fluid accumulation may be in the lungs (pulmonary edema) or outside the lungs (pleural effusion), in the space between the lungs and the chest wall. The term fluid in the lungs is also used in the lungs to refer to mucus. Mucus or phlegm is really a thick, sticky secretion even though lung water is a thin fluid. Other fluid accumulation can be the result of blood or pus.

The lungs enter the thorax (chest) and lie on either side of the heart. Air travels through the air passages that surround the nose, throat (neck), trachea (trachea) and bronchi. The lung tissue is made up of small air sacs, known as alveoli, which is thin and surrounded by blood capillaries. The structure of the respiratory system allows an exchange of gases, so that essential oxygen is taken into the body and waste products, along with gases, are excreted by the exhaled air. The lung is enclosed in an airtight pleural cavity, with a small pleural space separating the lungs from the chest wall. This cavity is lined by the pleural lining, which also creates a small pleural fluid to reduce the friction between the chest wall and lungs while breathing.

Fluid in the lungs

The most common cause of fluid in the lungs is mucus or mucous produced by the lining of the airways. The airway is lined with a mucous membrane that produces a specialized tissue that produces smucus. This mucus lubricates the lining, which can dry out due to the movement of air and out of the channels as well as stopping dust or microorganisms in the air. However, under certain conditions, the mucous membranes of the respiratory tract can generate excessive amounts of mucus and this can slowly sink down the air ducts until it settles in the lungs. The cough reflex or even spontaneous coughing will usually expel most mucus through the mouth (sputum), but in cases of excessive mucus production, obstructive airway disease or diminished cough, the build up of mucus will quickly settle in the lungs.

Lung water or water in the lungs usually results from the interstitial fluid or blood plasma and may be an indication of a serious underlying condition, usually cardiovascular disease. This fluid in the lungs is known as pulmonary edema and may be accompanied by shortness of breath or shortness of breath (dyspnoea), a feeling of suffocation, anxiety and restlessness. Abnormal breathing sounds are also present, especially crackling. Pulmonary edema could be considered a medical emergency and really immediate medical intervention is necessary.

Blood can also fill in the lungs, but this usually happens as a result of severe trauma and the cause is evident, as in a shot or puncture wound. In most trauma cases, where blood can fill the lungs, the lungs collapse and the blood in the lungs collects in the chest cavity (hematothorax). Infections such as tuberculosis (TB) or lung cancer can also lead to blood accumulation in the lungs. Depending on the severity of the trauma, blood in the lungs will cause drowning and requires immediate medical attention. Pus can also occur in the lungs due to a lung abscess and also requires immediate urgent medical attention.

Causes of the fluid inside the lung
    • Bronchitis is the most common cause of mucus in the lungs and is often characterized by persistent cough. This respiratory disease can develop after the common cold or flu (seasonal influenza). often as a result of a secondary bacterial infection, but may also be more chronic and non-infectious as in the case of smokers.
    • Infections may cause hypersecretion of mucus in the respiratory tract and / or pulmonary edema and this includes viral (eg H1N1 swine flu, SARS severe acute respiratory distress syndrome), bacteria (eg tuberculosis, streptococci or pneumococcal pneumonia), fungi (eg histoplasmosis, aspergillosis, candidiasis) and parasitic (example toxoplasmosis) infectious agents.
    • Pneumonia can also cause lung water or fluid with a thinner viscosity. This can only occur on the affected lung lobe due to inflammation of the lung tissue. Pneumonia is not only caused by infection, but may be due to gastric contents being aspirated from the stomach into the lungs.
    • Allergy symptoms typically lead to increased mucus production, however, in specific acute cases there might be pulmonary edema. Retronasal can often cause phlegm collection in the lungs and allergies can cause inflammation of the bronchi and mucus in the chest of the asthmatic.
    • Near drowning results in fluid in the lungs and even if all the fluid is drained from the lungs, it is important to monitor the patient in the hospital to prevent dry drowning.
    • Many cardiovascular conditions may cause pulmonary edema, including hypertension (high blood pressure), myocardial infarction (heart attack), valvular heart disease or cardiomyopathy (damaged heart muscle).
    • Hypoalbuminemia can be caused by kidney failure, liver disease, malnutrition or protein enteropathy.
    • Kidney failure pulmonary edema, as the kidneys may not be able to filter out toxins in the blood.
    • Smoke inhalation can cause severe inflammation of the lung tissue, which leads to fluid accumulation in the lungs.
    • Lymphatic insufficiency lead to inadequate drainage of lymphatic fluid.
    • Side effects of drugs in a pulmonary edema may result and this includes OTC (over-the-counter) or prescription drugs. Narcotics or anesthetics. This may also occur after the application of the drug, when the effect of the drug appear to have worn out.
    • Inhalation, Ingestion or Injection Toxins or toxins may increase the permeability of the vessel walls, resulting in pulmonary edema. Some toxins can also increase mucus production in the lining of the lungs.
    • Autoimmune diseases such as sarcoidosis can cause fluid in the lungs due to the inflammation of the lung tissue.
    • The lack of oxygen due to high altitude can cause pulmonary edema, COPD (chronic obstructive pulmonary disease) and suffocation.

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Fluid outside the lungs

Pleural effusion is when the fluid around the lungs accumulates in the pleural space. Blood (hematothorax), fatty lymph fluid (chylothorax) or pus (empyema) can also fill the pleural space, although this occurs less frequently. Any fluid accumulation in the lungs should be taken seriously and require immediate medical attention. The fluid accumulation in the lungs compressing the lungs and this prevents normal breathing, which results in inadequate gas exchange. The types and causes of pleural effusions are discussed extensively with fluid in the lungs.

Some causes of fluid around the lung

    • Congestive heart failure is probably the most typical brings about of pleural effusion. This fluid is thicker (transudative) due to protein that is forced out of the blood vessels and into the pleural space.
    • Exudative effusion is an aqueous fluid accumulation due to inflammation caused by lung cancer such as pleural mesothelioma infections such as TB or pneumonia. Lung diseases such as asbestosis or drug reactions.
    • Hematothorax may be unusual in that a result of trauma or rupture of the large blood vessels in the case of an aortic aneurysm although the latter is caused by a pleural effusion.
    • Empyema is often due to the accumulation of pus in the pleural space to a lung abscess.
    • Chylothorax is the accumulation of lymph fluid, which has a high concentration of fat, and occurs in certain cancers, such as lymphoma.
    • Some of the causes of lung fluid accumulation can also cause pleural effusion, including kidney failure and liver disease.
The diagnosis of fluid in the lungs

During physical examination, your doctor will be able to identify unusual sounds, such as bubbling or crackling (rattling) with a stethoscope on your breathing. A whistling sound (Stridor) as well as clearly audible when you exhale. Percussion is a knocking motion done against the chest wall and will help your doctor identify with areas of the lungs that might be affected. Typically fluid accumulation causes a muffled sound compared to the normal hollow sound of the air filled lungs. Based on clinical findings and other signs and symptoms, your doctor may request further diagnostic tests that may include the following steps.

    • X-ray of the thorax is one of the most important diagnostic examinations performed to identify the severity and region that is affected. For further imaging, a thorax CT scan or chest ultrasound can be performed.
    • Due to the frequency of cardiovascular in the lungs fluid-related disorders, your doctor may perform an ECG (electrocardiogram), ultrasound of the heart (echocardiography) and other cardiac examinations.
    • Fluid may be aspirated from the pleural cavity, known as thoracocentesis, but this has been done carefully to prevent pneumothorax (accumulation of air into the pleural cavity). A pleural fluid analysis is then performed to identify the type of exudate or any microorganisms.
    • Sputum culture may be necessary to identify the cause of the infection.
    • Number of blood tests can be requested from your doctor to check kidney and liver function, proper gas exchange and heart disease.
The treatment of fluid in the lungs

Treatment depends on the cause of the fluid in the lungs. Some of the treatment options may include:

    • Antibiotics, antiviral or antifungals may be required in the event of infection.
    • Diuretics assist with additional fluid passing, but should be used cautiously in the case of heart disease.
    • Antihistamines may require allergic reactions, and these must be continued on a chronic basis to prevent exacerbations.
    • Corticosteroids can be useful for controlling inflammation and mucus production, as in asthma, and this can be used over the long term to prevent acute attacks.
    • Chest tube with a tube may be necessary for a empyema or a therapeutic pleural function, required for a pleural effusion.
    • Antihypertensives can be given in cases of hypertension.
    • Oxygen is administered in serious cases of fluid within the lungs, in which appropriate gas exchange is impaired. While this does not immediately treat the cause of the fluid in the lungs, except in a lack of oxygen, it helps with adequate gas exchange.
    • Physiotherapy could possibly be important to help with mucus drainage.

Pulmonary Embolism – Pulmonary Blood Clots / Thrombosis

Definition

Pulmonary embolism refers to the obstruction or fixing of blood clots (thromboses) in blood vessels of the lungs. Of the entrained blood clots, which are usually transported by the leg veins through the heart, the lungs are often affected. The blood clots in the arterial blood vessels (blood arterial embolism) of the lungs lead to blood and nutrient deficits in the affected blood vessels.

Root Cause

Risk groups, such as people with congenital blood clotting system disorders or people who are immobile, as well as those who are freshly operated, tend to thromboses and thus to embolisms. Obesity, smoking, birth control pills and certain medications can increase the risk of thrombosis. In some cases, blood clots that have formed in the heart may be responsible for pulmonary embolism.

Symptoms

Depending on the size of the blood clot, different symptoms may appear at different intervals. If the blood clot is small, it usually comes only to atypical cough. Severe pulmonary embolism may include chest pain, shortness of breath, coughing (blood), sweating or anxiety. Also typical are the bluish discoloration of the skin, fingernails or lips, due to the lack of oxygen.

pulmonary-embolism

Diagnosis

After a detailed conversation on the history of the disease, special clinical and technical examinations can be carried out, i.a. Blood and oxygen saturation tests, ECG, X-ray and ultrasound examinations, computed tomography and magnetic resonance tomography and nuclear medicine examinations (scintigraphy).

Therapy

The treatment of pulmonary embolism is usually to be initiated immediately after diagnosis, as this can be life-threatening. Depending on the form of the disease, conservative or surgical therapies may be initiated. Mostly anti-coagulant drugs are used, oxygen therapies initiated and bed rest prescribed. Within the so-called “lysis therapy” special lysis drugs can promote the dissolution of the blood clot. In congenital deficits, such as blood coagulation system damage, the therapy can be used for life or special operations performed.

Prevention

General preventive measures include early mobilization after surgery, avoiding too much bed rest, a healthy diet and lots of exercise. Especially on longer flights you should make sure that you move the legs (feet) regularly, so that it can come to no thrombosis. The airlines are usually familiar with the thrombosis risks on flights and provide information and suggestions. People with an increased risk of thrombosis will find comprehensive advice and preventative treatment at the doctor.

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Frequent Infections And Inflammation Of The Lungs

Respiratory Diseases As the days get shorter again and autumn and winter bring down cold, wind and rain, our immune system is under heavy strain. Added to this is dry heating air, which irritates and dehydrates our mucous membranes.

In the winter, many people bustle together in warm, closed rooms, buses and subways, which increases the risk of infection.

So bacteria and viruses are particularly easy to penetrate our body. When many people gather in warm, closed rooms, buses and subways in winter, the risk of infection is also increased: winter time is therefore also the time of acute respiratory infections. The spectrum ranges from a simple cold over the real flu to acute bronchitis or adult pneumonia.

The most harmless form of respiratory infections is a cold. Incidentally, it is sometimes referred to as a flu infection. Compared to the real flu but it runs harmless. Predominantly, a cold is triggered by viruses that affect the upper respiratory tract. Therefore, treatment with bactericidal antibiotics does not help here either. Usually, the disease begins two to four days after infection by droplet infection and usually lasts at most one week.

Typical signs of real influenza, influenza, are sudden high fever, dry cough, muscle and headache, and fatigue. The flu outbreaks that pass through Germany every winter are caused by influenza viruses. A vaccine can protect against infection. However, you should get vaccinated again every year against the flu, because the viruses are very versatile and the vaccine must be adjusted regularly. The Robert Koch Institute recommends vaccinations especially for pregnant women, elderly people and people with chronic illnesses.

If the pathogen penetrates deeper into the respiratory tract, as a result of a cold or flu, the mucous membranes of the bronchi can also become acutely inflamed. One speaks then of an acute bronchitis. In more than 90 percent of cases, viruses are the trigger, rarely bacteria. Since acute bronchitis can also become chronic, it is important to treat this condition properly and adequately.

One of the most serious respiratory infections is pneumonia. The most common causes of the disease are bacteria of the species Streptococcus pneumoniae. But other bacteria, viruses or fungi can lead to inflammation of the lung tissue. The treachery of pneumococcal pneumonia is that it can often lead to very severe symptoms without warning. It is also possible to get vaccinated against pneumococci, as in the case of influenza, people from risk groups are recommended to have a vaccine.

In recent years, the number of whooping cough cases increased again. This is mainly due to the fact that the vaccine against this highly infectious infectious disease gradually decreases and adults would have to refresh him. Pertussis, as the whooping cough in technical language is called, is a bacterial infection. The disease can be very tedious and life threatening especially for small children. It begins like a harmless cold with a cold and cough, but changes in the course of the typical bouts of attacks of coughing that occur especially at night.

The bacterial infectious disease that still causes most deaths worldwide is tuberculosis. In 2014, about 9.6 million people worldwide fell ill. In Germany, the rate of newly diagnosed tuberculosis infections is comparatively low, but in 2015 the Robert Koch Institute observed an increase to 5,865 cases compared to 4,533 cases in the previous year. Above all, people whose immune system is weakened are at risk. Contagion occurs through close contact with patients, usually by droplet infection via the lungs. In most cases, the body succeeds in successfully controlling the bacteria or isolating them. These inflammatory sites (tubercles), which are enclosed by the immune system, can be visualized on the x-ray and also give their name to the disease. An infection can now be treated well with a combination of antibiotics, however, multidrug-resistant tuberculosis pathogens have been a growing problem in recent years.

Inflammation in the lungs naturally also plays a central role in chronic lung diseases such as asthma or Chronic Obstructive Pulmonary Disease (COPD).

Lungs, Pneumonia and Respiratory Diseases

Anyone who is healthy breathes automatically – without thinking about what the lungs do. Some even blame the vital organ for exertions such as smoking. This can lead to mortal danger in diseases of the lungs and respiratory tract.

The human lungs: every day in adults, around 10 000 liters of air flow through.

Without realizing it, adult, healthy people breathe at rest about 12 to 16 times a minute. Each time, about half a liter of air flows through the airways into the lungs and out again.

Construction and location

Physicians refer to all parts of the body, which are traversed by the inhalation and exhalation of air as airways: Through the mouth and nose, the air passes through the throat into the trachea. The trachea lies behind the breastbone and divides in the thorax into a left and a right main bronchus. These lead together with the respective pulmonary vessels to the left or right lung.

The lung (Latin: Pulmo) is in fact paired. Each of the two lungs is supplied with its own blood vessels and, with the respective main bronchus, also has its own air supply, which enters the lungs together with the veins and arteries at the so-called pulmonary hilum. The left lung is slightly smaller than the right and consists of only two instead of three lobes, because in its vicinity the heart is located and thus less space available. Each main bronchus divides according to the number of lung lobes in so-called lobe bronchi and then branches out into Segementbronchien and ever smaller bronchi and bronchioli until at the end of the small alveoli, the so-called alveoli.

respiratory-diseases

They are the place where the lung performs its most important function, the gas exchange, giving the lung tissue its spongy appearance.

What is the job of the lungs and respiratory system?

The airways not only carry air into the lungs, cilia on their walls also purify the air. Foreign matter such as bacteria and dust particles remain hanging in it and are transported along with the lying on the cilia on the pharynx throat direction. He is either swallowed unnoticed or – for example, if the cilia are unable to afford the transport – coughed off.

The most important task of the lung is the gas exchange. Since our body needs a lot of oxygen and has to excrete corresponding amounts of carbon dioxide, a large area is necessary for this. These provide the alveoli. They have very thin walls that almost directly border the blood vessels. This makes it possible for the oxygen from the respiratory air to pass through these walls into the oxygen-poor blood of the pulmonary vessels, while the carbon dioxide passes from the blood into the alveoli.

Pulmonary and respiratory diseases

If the lungs become infected, it can hinder breathing and even have life-threatening consequences. It is not for nothing that lung and bronchial cancers, chronic obstructive pulmonary diseases and pneumonia are among the ten leading causes of death in Germany. One of the most important risk factors for lung disease is smoking. Because tobacco smoke not only favors the development of malignant diseases such as lung cancer, but also damages, among other things, the cilia, which transport phlegm and pathogens outside. This increases the risk of infection. Certain lung diseases such as Chronic Obstructive Pulmonary Disease (COPD) are very often the result of many years of smoking. If you want to do something good for your lungs, then you should do without cigarettes and similar tobacco products.

Everything You Should Know About Chronic Bronchitis, Causes, Symptoms And Therapy

Persistent coughing with sputum indicates chronic bronchitis. Smoking is the most important risk factor. Those who ignore the signs risk serious lung disease.

In short, what is chronic bronchitis?

Chronic bronchitis means that the bronchi are permanently inflamed. According to the World Health Organization (WHO), bronchitis is considered to be chronic if the symptoms of cough and sputum persist for two consecutive years for at least three months each year.

The bronchi are the continuation of the trachea. It divides into two main bronchi at the lower end. These lead the breathing air into the two lungs. There, the bronchi branch out ever finer until they end in the microscopic small alveoli, where the actual gas exchange, ie the vital intake of oxygen and release of carbon dioxide takes place.

Approximately ten percent of the population suffer from chronic bronchitis during their lifetime. Smoking is considered the biggest risk factor (colloquially “smoker’s cough”), but there are also many other triggers, which is why a reduction in smoking behavior falls short.

The most important therapy measure for smokers is the smoke stop. Various medications, adapted sports and special breathing techniques can help additionally.

Chronic bronchitis can lead to COPD – a chronic obstructive pulmonary disease. The airways are then permanently constricted and alveoli are broken down (emphysema). Read more about it in the COPD guidebook and in the guide to emphysema.

Everything-About-Chronic-Bronchitis

Causes and risk factors: How does chronic bronchitis develop?

Risk of tobacco smoke: Smoking is the leading cause of chronic bronchitis. Tobacco smoke damages the respiratory tract in different ways: First, it destroys the cilia in the bronchial mucosa. These normally transport mucus and pollutant particles contained therein and thus exercise a cleaning function. On the other hand, tobacco smoke promotes inflammatory processes, weakens the immune system and causes more mucus to be formed in the bronchi. Especially at night while lying down secretions accumulate, which leads to morning cough with sputum. Passive smoking also increases the risk of chronic bronchitis.

Air pollutants: Certain gases, dusts and vapors pollute some people in the workplace. These pollutants can also cause lung problems and cause chronic bronchitis.

Common respiratory infections: Bacterial and viral infections are more common in chronic bronchitis. It often remains unclear whether they are the cause or the consequence of the respiratory disease.

Genetic causes: A certain genetic component can be identified in chronic bronchitis and its consequences. Alpha-1-antitrypsin deficiency, which increases the risk of pulmonary emphysema and may be associated with symptoms of chronic bronchitis, cystic fibrosis, where lung involvement often begins as chronic bronchitis, and ciliary disorder, in which mutations are either missing or defective, are well characterized Formation of the cilia on the bronchial mucosa leads.

Other underlying diseases: Certain diseases are associated with chronic bronchitis. It is usually hard to recognize cause and impact. Examples are asthma, chronic sinusitis and pulmonary tuberculosis. A hyperreactive bronchial system, as is typical in people with an allergy, may in rare cases favor chronic bronchitis.

Is chronic bronchitis contagious?

Chronic bronchitis is not intrinsically contagious – unlike acute bronchitis, which is often the case. If respiratory tract infections occur as part of chronic bronchitis, they can be contagious.

Symptoms: How is chronic bronchitis noticeable?

The classic symptom of chronic bronchitis is coughing with expectoration of viscous mucus. The cough occurs especially in the morning.

Chronic bronchitis often begins insidiously and may initially go unnoticed. Because a clogged cough that lasts for a long time, sufferers often lead back to a supposedly harmless, perhaps “abducted” cold. They do not take the symptom seriously.

Chronic bronchitis can be fluent in COPD. If there is shortness of breath and tightness of the chest during physical exertion, this is a possible sign that COPD has already developed. However, there may be other causes behind such symptoms, such as angina pectoris.

When is a bronchitis chronic?

According to the WHO definition, it is a chronic bronchitis if the symptoms of coughing and expectoration occur for two consecutive years for at least three months a year most days of the week.

What is an exacerbation?

Doctors speak of an exacerbation when the patient’s complaints suddenly worsen. This occurs especially in advanced disease and during the cold season. In the majority of cases respiratory infections are the trigger. If very severe COPD is present, an exacerbation can be life-threatening.

Important: Take respiratory symptoms seriously. See the doctor if symptoms persist like coughing persistently or if shortness of breath occurs.

Chronic bronchitis: What are the consequences of the disease?

If chronic bronchitis progresses, this can have negative consequences:

Pulmonary emphysema: Pulmonary emphysema mainly affects the pulmonary alveoli of the lungs. They are indispensable for the absorption of oxygen. In pulmonary emphysema, they gradually merge into larger bubbles, the walls of the alveoli are degraded. Air remains trapped in the lungs. In addition, the inner surface of the lung continues to decrease. Although the respiratory muscles become more active, the gas exchange remains insufficient. This creates the feeling of shortness of breath or shortness of breath. Emphysema can not be undone. Read more in the guide Counselor Lungenemphysem.

Right heart failure (weakness of the right ventricle): In pulmonary emphysema, the blood vessels in the lungs are partly degraded, sometimes narrow. The blood must flow through fewer and narrower vessels. This is only possible by increased pressure, a pulmonary hypertension arises. The right ventricle of the heart needs to apply more force to pump the blood into the lungs. The heart enlarges, the muscle mass increases, it does not work more efficiently. This leads to right heart failure with symptoms such as shortness of breath and swollen legs.

Diagnosis: How to recognize a chronic bronchitis?

Information on complaints, medical history and lifestyle of the person concerned provide the doctor with first clues. Next, he listens and pats the patient’s chest. Under certain circumstances, a whistling or humming noise can be heard when exhaling, with secretion in the bronchi you can hear rattling breath sounds even during inhalation.

The diagnosis of chronic bronchitis is essentially based on the information provided by the patient. However, the doctor must rule out other diseases as a possible cause of the symptoms, for example, asthma, pneumonia, pulmonary embolism, lung cancer, tuberculosis or heart disease. Different investigations may be required. Chronic cough can also be a side effect of certain medications (antihypertensive drugs: ACE inhibitors) and is often associated with heartburn and reflux. More in the guidebook gastroesophageal reflux disease.

It is important to recognize the onset of bronchoconstriction as early as possible so that the disease is still treatable. Therefore, the doctor checks the lung function with a lung function test, spirometry. The patient blows with maximum force into a meter, after he has inhaled deeply. Among other things, this method is used to determine the characteristic value “FEV1”: the forced exhaled (exhaled) volume in the first second. The FEV1 value in relation to the total exhaled air (so-called expiratory, forced vital capacity, FVC) provides information on whether the airways are narrowed or how much the breathing is impaired. Read more in the text Spirometry. With the help of whole-body plethysmography, the bronchial constriction and the extent of pulmonary hyperinflation can be recorded more accurately and also during quiet, normal breathing. A whole body plethysmography is usually performed only by the lung specialist.

A blood gas analysis can be used by the doctor to check the oxygenation of the organism and the exhalation of the carbon dioxide.

Exercise tests (bicycle or treadmill ergometry, spiroergometry) often show changes in lung function more clearly and earlier than at rest.

If an infection is suspected, the doctor can also have a sample of the morning sputum (sputum sample) examined for germs and make an X-ray of the lung – the latter can also make a bronchial carcinoma visible.

Furthermore, if necessary, diagnostic procedures such as a blood sample, a bronchoscopy (lung reflection) or an ECG (electrocardiogram) are eligible.

respiratory-diseases

Therapy: What helps with chronic bronchitis?

Stop Smoking / Exposure Stop: Anyone who stops smoking can slow the progression of chronic bronchitis. Already three days after the last cigarette, the lung function improves. Over time, coughing subsides, the bronchi make less mucus. The lung cancer risk is reduced significantly. Those exposed to other pollutants in the air should try to avoid them in the future.

Medications: They do not fight the cause of chronic bronchitis. But they can alleviate symptoms and improve well-being. The exact therapy depends, among other things, on the severity of the disease. With a low severity of COPD, the doctor prescribes short-acting bronchodilating drugs (beta-sympathomimetics or anticholinergics). The patient can take them if necessary when he feels a need for air. If the disease progresses, usually long-acting bronchial dilating sprays are added, which the patient uses regularly. In addition, the doctor may prescribe a cortisone preparation. Cortisone has anti-inflammatory effects. You can read more about the treatment of COPD in the guidebook COPD.

Further measures

Respiratory Physiotherapy: Special breathing techniques (such as the so-called “lip brake”) and a posture that facilitates breathing contribute to maintaining quality of life and resilience despite impaired lung function.

Exercise: Physical training is a central part of the therapy. Anyone who practices adapted sport – for example in a lung sports group – can best maintain the resilience and functionality of their body. Regular physical activity also reduces the risk of exacerbation, ie a sudden worsening of bronchitis symptoms. The sport should take place under medical supervision, so that the patient is not overwhelmed.

Diet: Overweight influences the course of the disease as well as underweight. Especially the latter is accompanied by an unfavorable prognosis. An adapted diet should be done in collaboration with a nutrition expert.

Healing chances: is a chronic bronchitis curable?

Chronic bronchitis can completely recede in the early stages. Thus a cure is possible in principle. The decisive factor is that those affected eliminate smoking or other inhaled pollutants. However, if the bronchi are already constricted, so that a COPD has developed, the disease can no longer be completely cured. However, the course and the life expectancy can be positively influenced – by a consistent therapy.

How Does The Doctor Diagnose Pulmonary Edema?

Pulmonary Edema can be manifested by sudden onset of severe breathlessness, rattling breath and coughing attacks.

Causes: What causes pulmonary edema?

The cause of pulmonary edema is either an increase in pressure within the pulmonary vessels or an increase in the permeability of the pulmonary vascular walls. Sometimes combinations of both causes are present.

Cardiac Pulmonary Edema

When the pressure within the vessels increases, it is mostly due to heart disease. One speaks of a cardial pulmonary edema. For example, a heart attack, an inflammation of the heart muscle, a disease of the coronary vessels or too high a blood pressure in pre-existing heart failure underlying.

These diseases weaken the left ventricle. As a result, they can not pump the oxygen-rich blood provided by the lungs fast enough into the body. The blood builds up in the pulmonary vein. The congestion increases the pressure on the blood vessels. As a result, blood fluid escapes from the vessels and is forced into the lung tissue. The walls of the blood vessels work like filters and allow only the liquid to pass.

The remaining blood components, such as red blood cells or other cells, are held back. The fluid first accumulates in the interstices of the cells and can then penetrate into the interior of the alveoli. As a result, they can perform their task increasingly poorly and oxygen uptake is becoming increasingly difficult.

diagnose-pulmonary-edema

Altitude Pulmonary Edema

A special feature of the pulmonary edema was the so-called high-altitude edema. It is triggered in mountain climbing at high altitude in the first two to three days by a combination of oxygen deficiency and low air pressure. The vessels contract and cause an increase in blood pressure, which overloads the left ventricle and creates a backlog.

Non-cardiac pulmonary edema

In non-cardiac pulmonary edema, the most common cause is damage to the membranes of the fine pulmonary capillaries. As a result, they lose part of their barrier function; blood fluid, together with smaller cell components, can penetrate into the tissue of the lung. The more effective the lymphatic vessels can initially remove the excess fluid, the slower the development of symptoms.

In most cases, ARDS (Acute Respiratory Distress Syndrome) is the cause of membrane damage. In this case, the lungs react to massive damage, for example from infections with viruses, inhalation of toxic gases, medication, severe burns, serious cardiovascular shock or blood poisoning. Rarely, pulmonary embolism, overdose in anesthesia, or stroke can increase membrane permeability.

“Another cause is damage to the liver and kidneys, which leads to a drop in albumin in the blood – a specific blood protein,” says Köhler. Due to the lack of protein, the blood fluid can not be kept in the necessary amount in the blood vessels and thus reaches the cell gap to the outside.

Diagnosis

For diagnosis, the doctor asks questions about the underlying and concomitant diseases of the heart, lungs and other organs. When listening to the lungs with the stethoscope rattling noises fall on, which sometimes are already audible with the naked ear. An x-ray examination can be used to determine whether water is actually in the lungs. Important indications for pulmonary edema include accelerated breathing, increased heart rate and blueing of the skin and mucous membranes. An ECG, echocardiography and other examinations target the underlying cause.

Therapy: How is pulmonary edema treated?

Pulmonary edema is a serious, potentially life-threatening condition requiring intensive medical treatment. Patients should be transported to the hospital as soon as possible. As a first measure, an upper body and lower legs are helpful. As a result, the blood flows back to the heart slower, so this is relieved.

Breathing can be assisted by the delivery of oxygen via a nasogastric tube or a mask. In an advanced stage, positive pressure ventilation, in some cases artificial respiration is necessary. Most patients are supplied with painkillers and tranquillizers.

Dehydrating medications (diuretics) ensure that the water drains from the tissue. This not only improves the oxygen exchange at the alveoli, but also relieves the blood pressure by reducing the volume of fluid and thus reduces the burden on the heart. Drugs that dilate the vessels lower the pressure on the heart, improving the oxygen supply.

All other measures depend on the underlying cause. In case of height elevation edema sufferers should descend as soon as possible. In addition, oxygen delivery, vasodilating drugs, and positive pressure ventilation may help.

Bronchoscopy: Reflection Of The Lungs

The doctor can use the bronchoscope to examine the lungs and airways. In addition, the method helps in the treatment, for example, to extract viscous mucus. During lung reflection, the doctor introduces a bronchoscope into the airway via the mouth or nose. Modern bronchoscopes consist of a soft, flexible tube with a diameter of two to six millimeters. At the top of the tube sits a camera with light source. This camera sends its images in real time to a monitor on which the doctor examines the patient’s airways.

In addition, the bronchoscope can inject and aspirate liquid and thereby perform a so-called bronchial lavage. In addition, very small pliers or brushes can be advanced through the tube and tissue samples taken. These biopsy specimens will be examined later by the doctor under a microscope. In addition, a miniature ultrasound head can image the environment of the airways.

For what reasons does the doctor perform a bronchoscopy?

A bronchoscopy may be necessary for both treatment and diagnosis, for example if there is suspicion of lung cancer in the room or if treatment is to be scheduled for a known lung tumor. Doctors can also use this method to introduce radioactive substances into the lungs in order to irradiate tumors locally. Restrictions of the respiratory tract can be clarified by bronchoscopy. Similarly, the doctor can investigate reduced ventilation of partial areas of the lung, so-called atelectasis. With the lung reflection and bronchial lavage cells and germs can also be extracted from the lungs.

bronchoscope-to-examine-the-lungs

Doctors also use lung plasmas to look for and remove foreign bodies. In ventilated patients, the position of the breathing tube can also be corrected with it. In addition, secretions such as mucus plugs can be washed away with the bronchoscope and inserted so-called stents, which seemed to the airways from the inside and keep them open.

How is an examination with the bronchoscope going?

On the day of the examination the patient comes sober. He receives a spray that stuns the throat and suppresses the gagging. Then, the patient is virtually always injected with a short narcotic into the vein, so that he feels nothing at all from the examination. If necessary, sedatives are also used.

The doctor introduces the bronchoscope through the mouth or nose into the trachea. Afterwards, he examines the mucous membrane of the airways, which can be imagined as a “bronchial tree” with more and more ramifications. The doctor examines all bronchi to a maximum of the third or fourth diversion. This usually takes 10 to 15 minutes. The airways themselves are insensitive to pain.

If a bronchial lavage is needed, the doctor injects about 20-100 milliliters of sterile fluid into the lower respiratory tract and then sucks it off. It extracts bacteria and cells from the surface of the respiratory tract and subsequently examines them in the laboratory.

After the examination, the patient should abstain from eating and drinking for about two hours until the anesthetic of the throat has subsided. Otherwise there is a risk of swallowing. If the patient has been given tranquilisers or anesthesia, they are not allowed to drive the same day.

What other types of bronchoscopy are there?

In addition to the lung reflection with a flexible tube, there is still the investigation with a rigid tube. This tube can, for example, better remove foreign matter from the lungs. Even if a tumor severely restricts the airways, rigid bronchoscopy has advantages. Sometimes the doctor can remove tumors directly using laser devices or argon bombers. Argon beamer are coagulation devices that transfer energy via argon gas and soil the tissue two to three millimeters deep. The doctor uses them to destroy tissue and stop bleeding. If he has to use stents to stretch a constriction, it works better with the rigid bronchoscope.

Is a bronchoscopy dangerous?

The bronchoscope may cause nosebleeds or sore throat with difficulty swallowing, hoarseness or coughing, and very rarely injure the larynx. Even short-term fever sometimes occurs afterwards, especially in lavages. Severe incidents are very rare in bronchoscopy.

Removing the tissue samples may cause slight bleeding. Therefore, one should expect in the first two days that you abhustet blood to a small extent. Every now and then, the bleeding is so severe that they have to be breastfed by the endoscope.

In some cases, injury to the alveoli causes the lungs to leak and form a so-called pneumothorax. This means that air flows into the space between the lungs and the surrounding lung cavity and causes the feeling of being short of air. Then, if necessary, the application of a chest tube is necessary: ​​This plastic tube through the chest wall conveys the infiltrated air to the outside.

Possible exclusion reasons

A bronchoscopy can be problematic in generally very poor condition or serious comorbidities: If a heart failure or an acute myocardial infarction present, the function of the lungs massively reduced or the blood clotting are disturbed, you should consider the need for the investigation carefully and together with the doctor benefits and consider possible disadvantages.

Possible exclusion reasons

A bronchoscopy can be problematic in generally very poor condition or serious comorbidities: If a heart failure or an acute myocardial infarction present, the function of the lungs massively reduced or the blood clotting are disturbed, you should consider the need for the investigation carefully and together with the doctor benefits and consider possible disadvantages.