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Symptoms

The signs and symptoms vary depending on the cause and severity of the condition. The common symptoms associated with ARDS are;

• Severe shortness of breath
• Unusual rapid breathing
• Low blood pressure
• Fatigue (extreme tiredness)
• Confusion

Medications

Your doctor would prescribe you medications such as:

• Antibiotics
• Sedatives
• Pain relievers
• Anticoagulants
• Anti-acid reflux drugs

Lifestyle modifications

Your doctor would advise you to:

• Quit alcohol: Smoking can aggravate the symptoms
• Quit smoking: Alcohol makes you more prone to aspirate foreign material. So avoid it
• Get vaccinated: Yearly influenza shot and pneumonia vaccine every five years can reduce the risk of lung infections.

When to call a doctor?

ARDS mostly occurs when you are affected by other health conditions. In some instances, a healthy person who has severe pneumonia can develop ARDS. So, if you have any discomfort in breathing, you must call your local doctor.

Causes

You may develop respiratory distress directly or indirectly. But the most common causes include:

• Trauma
• Pneumonia
• Septic shock
• Inhaling chemicals
• Aspiring vomit into the lungs

Factors that predispose to ARDS

People who develop ARDS are usually hospitalised for any other condition. If you have an infection in your bloodstream, then you are at risk of developing ARDS. Alcohol consumption makes you susceptible to ARDS.

What are the other possible complications of ARDS?

The common complications of ARDS are:

• Lung damage
• Multi-organ failure
• Pulmonary fibrosis

Ventilator-associated pneumonia

Diagnosis

Treatment

The main goal in the treatment of ARDS is to improve the levels of oxygen that reach your bloodstream:

Oxygen therapy: Supplemental oxygen: Your doctor may deliver oxygen with the help of fixing an oxygen mask to your nose and mouth. But this can be useful if the symptoms are mild. Mechanical ventilation: in more severe conditions, your doctor would arrange mechanical ventilation for you. This helps force the air into your lungs and lets the fluid out of the alveoli.

Fluids: Your doctor will carefully give you the determined amounts of intravenous fluids because too much fluid can increase fluid buildup in the lungs. Too little fluid puts a strain on your heart, which may lead to shock.

Warning signs

The warning signs of an asthma attack you should look out for are:

• Wheezing
• Coughing
• Peak flow 50% less than personal best
• Chest tightness
• Itchy neck
• Eyes with dark circles
• Fatigue
• Irritability
• Anxiety
• Stuffy nose
• Peak flow reading in the yellow zone
• Stomachache
• Fever
• Headache

Treatment of Asthma 

Though asthma cannot be cured, it can be controlled or managed by taking proper medications. The right medications depend on numerous factors such as your age, symptoms and asthma triggers. Asthma medicines are classified into two kinds. Medicines that stop symptoms of asthma are called quick-relief medicines or rescue medicines and the other kinds of medicines are those that prevent the occurrence of asthma which are termed long-term control medicines or controller medicines. Quick relief medicines provide quick relief of the swollen airways that cause breathing problems and controller medicines decrease the inflammation of the airways causing symptoms of asthma.

Get help for worsening asthma

If your asthma is worsening you will have signs like extreme breathing problems, difficulty talking, difficulty in walking, fingernails and lips turning blue in colour, symptoms in the night time, rapid heartbeat, Nostrils flaring when breathing, peak flow drop and the need to use more rescue medication. You have to call 911 right away as it is a medical emergency.

Allergens and Trigger Factors

Asthma attacks can occur due to pollen dust and mold. You can avoid them from entering into the house by closing all the windows and doors and using the air conditioning system. Mould grows in areas that are humid like bathrooms and kitchens. You must keep these areas clean, and it is recommended to use a dehumidifier to keep the humidity at 50%. Dust and dust mites also trigger asthma. You must clean all your bed sheets and curtains in hot water that is above 130 F, every week. Pillows and mattresses should be covered in air-tight covers. Carpets should be treated with chemicals to reduce dust mites. Keep all soft toys and other objects that can catch dust away. Keep pets out of your room as pet dander can also trigger asthma. Smoking should be strictly prohibited in the vicinity as it is also a trigger factor.

The other trigger factors are exercise, change in temperature, food preservatives, Aspirin, Sinus infections, emotional situations, certain perfumes and deodorants.

Asthma controller medicines

Controller medicines need to be taken regularly every day to prevent asthma symptoms from being manifested. There are various types of controller medicines and each type works uniquely and specially to prevent asthma symptoms. These include:

• Inhaled corticosteroids (ICS): These medications are synthetic steroid hormones that have anti-inflammatory properties. They are effective, and safe, and are mainly prescribed for children and adults suffering from asthma. Some of these medications are beclomethasone, fluticasone, budesonide, mometasone, flunisolide and others. These medications need to be used for a long term to obtain maximum results.
• Leukotriene antagonists: Lieukotrien is a fatty substance produced by the immune system that causes inflammation and swelling of the airways. These drugs block leukotrienes from causing inflammation and are used along with corticosteroids to relieve the symptoms of moderate to severe asthma. These include medications such as montelukast, zafirlukast and zileuton.
• Long-acting beta agonists (LABAs): These medications cause relaxation and dilation of the smooth muscles that encircle airways and allow free passage of the airflow. These inhaled medications include salmeterol and formoterol
• Immunomodulators: These medications bring about changes in the responses of the immune system to asthma triggers by reducing the response of antibody IgE (antibodies are various types of substances produced by the white blood cells) responsible for the asthmatic episode. An example of this immunomodulator is omalizumab (brand name Xolair).

Asthma rescue medicines

These are also termed quick-relief medicines and are used for immediate and quick relief of symptoms during episodes of asthma or maybe before you resort to exercise as advised by your doctor. With quick-relief medicines, you may feel better or relieved for a shorter period. These medications may stop the episodes. If you use quick-relief medications every day, it means that you need medications for long-term control of asthma.

These medications include:

• Short-acting beta agonists: These medications dilate the bronchi and when inhaled provide immediate symptomatic relief. These include albuterol, levalbuterol and pirbuterol. These medications act within minutes of inhalation and effects last for many hours.
• Ipratropium: Ipratropium dilates the bronchi, making breathing easier. Your doctor may prescribe this inhaled medication for quick relief of your symptoms. This medication is used in cases of inflammation of the bronchi, and emphysema (obstructive lung disease) and to treat episodes of asthma.
• Oral and intravenous corticosteroids: These include synthetic steroid hormones, prednisone and methylprednisolone. These medications alleviate inflammation of the airways induced by severe asthma. As these cause severe side effects if used for a long time, these are only prescribed for short-term relief of asthma symptoms.

Using a Spray Inhaler

Asthma medicines may be taken through inhalers. Following are the basic steps as to how you can use spray inhalers.

• Hold the inhaler upright after removing the cap
• Shake the inhaler
• Bend your head backwards and exhale
• Keep the inhaler 1 or 2 inches away if you are not using a spacer. If you are using a spacer then put the exposed end of the spacer into your mouth, and wrap your lips around it.
• Push the inhaler down to release the medicine as gently as possible for 3 to 5 seconds
• Once you inhale the medicine, hold your breath for 10 seconds so that the medicine can reach your lungs
• Repeat as many times as recommended by your doctor

Asthma emergency

If you do not get better, inform your doctor and if needed get emergency help. In case of the following signals and signs, call for emergency medical care right away.

• When you fail to get a response from taking your quick-relief medicine.
• Breathing becomes suddenly difficult, hard and fast
• If you exert increased efforts to talk or walk
• If your face, lips or fingernails turn blue
• When you breathe, if your nose opens wide
• If the skin around your rib cage and neck gets tightened when you breath
• If your heartbeat and pulse are elevated.

Managing Asthma

You can manage asthma attacks by following simple steps. Make a plan. As asthma is an ongoing disease, consult your doctor and medical team, formulate an action plan as to what you should do in case of an asthmatic attack and strictly adhere to the plan. Revise the plan in case of any shortcomings. Exposure to various asthma triggers such as pollens, dust, fumes, polluted air, moulds and various allergens and irritants can result in an asthmatic attack. Hence, you need to identify these triggers first and take the necessary steps to avoid them as far as possible.

Monitor your breathing and take note of whether you have any breathing problems such as wheezing, coughing or breathlessness. These initial symptoms may indicate an impending attack of severe asthma. Maybe sometimes you need to use a peak airflow meter. When you identify an impending attack of asthma, act fast to take quick-relief medicines to get prompt relief. If possible, keep yourself away from any exposure to the irritant that caused the asthma attack. Even if you feel that the symptoms have improved, you must continue to follow the instructions of your doctor and take the controller medicines as advised in the correct dosage and frequency. If you are increasingly using quick-relief medicines or relying more on them, you must see your doctor as you may need to take medicines for long-term prevention.

Learning about Asthma

Breathing is a complex process. The air we inhale travels through our nose and mouth and passes through the wind pipe also called as trachea. The trachea then divides into two branches called bronchi or airways or bronchial tubes. These bronchi pass through the lungs and divide into smaller tubes called bronchioles. These bronchioles further divide and end in sac-like balloons called alveoli. Your body has around 300 million alveoli. These alveoli are surrounded by mesh-like blood vessels called capillaries where oxygen from the air is passed on to the blood and waste gases such as carbon dioxide and water vapor are collected and passed out when you exhale. The oxygen is carried to all the cells of the tissues and organs in the body through blood.

Asthma is an incurable, long-lasting disease of the lungs affecting the bronchial tubes or the airways. During normal breathing, the bands of the muscles that enclose the airways are relaxed and facilitate the free flow of the air. The following changes take place during the episode or attack of asthma.

• Bronchospasm: The muscular bands that encase the airways become constricted and tighten the airways obstructing the free flow of the air. This is called bronchospasm.
• Inflammation: The inside layer of the airways becomes inflamed and swollen.
• Mucus: The cells of the inner layer of the airways produce sticky, thicker than normal and more mucus.

All of the above issues namely bronchospasm, inflammation, and mucus production can result in breathing problems such as breathlessness, panting, coughing, wheezing (whistling sound during breathing), intolerance of daily activities and sometimes fatality.

Symptoms

Below mentioned are a few symptoms of bronchitis. They are:

• shortness of breath
• wheezing
• cough with yellow or green-coloured mucus
• heart burns
• fatigue
• sore throat
• fever

Respiration: The basics

The air we inhale travels through our nose and mouth and passes through the windpipe also called the trachea. The trachea then divides into two branches called bronchi or airways or bronchial tubes. These bronchi pass through the lungs and divide into smaller tubes called bronchioles. These bronchioles further divide and end in a sac-like balloon called the alveoli. Your body has around 300 million alveoli. These alveoli are surrounded by mesh blood vessels called capillaries, where oxygen from the air in the alveoli is passed on to the blood and waste gases such as carbon dioxide and water vapour are passed on to the alveoli, from where it is exhaled out. The oxygen is carried to all the cells of the tissues and organs in the body through blood.

Outlook

Acute bronchitis is a severe but short form of bronchitis. If the cough persists for a long time and your regular sleep is disturbed or if you have other problems such as diabetes or heart problems, you need to consult your doctor.

You can prevent acute bronchitis by taking proper sanitary precautions and avoiding coming into contact with people who suffer from cold or flu.

Prevention of acute bronchitis

Following are the measures that may help you to prevent acute bronchitis.

• Refrain yourself, if possible, from coming in touch with people suffering from cold or flu. Stay away from crowds during flu season.
• Usually, acute bronchitis is caused by influenza virus. Taking an annual flu shot protects you from getting the flu and reduces the risk of acute bronchitis.
• Keep proper sanitization by washing your hands regularly.
• If you need to spend time among people who sneeze and cough, be sure to wear a mask to cover your nose and mouth so that you can reduce the risk of viral or bacterial infections.

Understanding bronchitis

Bronchitis is the inflammation of the lining of the airways. Bronchitis often results in a cough with phlegm (slimy mucus substance produced by the lining of the bronchial tubes), wheezing, chest pain, fever or shortness of breath.

Causes

Acute bronchitis is caused by viruses that infect and produce inflammation of the lining of the airways. In response to the infection, airways become swollen and more sputum is produced. It takes some time for your body to fight against these viruses and to heal the damage inflicted on the bronchial tubes. The same viruses that cause cold and flu also cause acute bronchitis. The other causes of bronchitis include smoke, dust, fumes or other pollutants in the air.

Tests & Diagnosis

It is hard to distinguish the difference between the signs and symptoms of bronchitis, with that of the common cold at the beginning of the illness. During a physical examination, the doctor places the stethoscope on the chest to carefully listen to the lungs while you breathe.

In some cases, the doctor may suggest you undergo certain tests to diagnose the disease.

• A chest X-ray produces images of the lungs to determine if you are suffering from pneumonia or any other condition which explains the reason for your cough.
• A sputum test is performed to check if you have whooping cough or other illnesses which could be treated using antibiotics. Sputum is the mucus found when you cough from your lungs.
• A pulmonary function test is done to determine the condition of your lungs. This test is performed using a device called the spirometer, which measures the amount of air the lungs can withhold. Pulmonary function tests are carried out to check for signs of asthma.

Treatment

The treatment for acute bronchitis aims to relieve the person suffering from the symptoms and to help him breathe normally. To recover from acute bronchitis, the following are advised.

The following types of surgeries are considered:

• Avoid exertion and rest
• Drink a lot of water and fluids
• Breathe in warm and moist air by using humidifiers
• Take over-the-counter (OTC) pain and fever medications such as ibuprofen, naproxen, paracetamol or aspirin or if you have a dry cough, OTC cough suppressants.

In some circumstances, your doctor may prescribe medications. As acute bronchitis is caused by viral infections, antibiotics are not effective. Suppressing a productive cough is not advised as it helps your body to clear the irritants from your airways. If your cough keeps you from sleeping, you may need OTC cough medicines and if your sleep disturbs your sleep, your doctor may prescribe cough suppressants.

At times, the cough from acute bronchitis may last for several weeks or months. This is because your body is healing up the damage caused by the infection and needs time to completely heal. If the cough persists, then maybe you are suffering from another serious problem such as asthma or pneumonia, which may need other treatment approaches.

Types of bronchitis

There are two types of bronchitis: Acute bronchitis and chronic bronchitis.

Acute bronchitis usually lasts for a short period ranging from a few days to 10 days. But the cough may persist for several weeks even after the infection is gone. Acute bronchitis is caused by infections or other irritating factors, such as smoke, air pollution, dust, and fumes. The same viruses that cause cold and flu may cause acute bronchitis. Bacteria also can cause acute bronchitis. These viral and bacterial infections spread through the air and physical contact. Usually, acute bronchitis goes away within a few days.
Chronic bronchitis is a long-term, more severe condition and occurs when the lining of the airways is continuously irritated or inflamed. When you suffer from chronic bronchitis, you experience a cough with mucus at least for three months in a year, and for two years continuously. Smoking is the principal cause of chronic bronchitis. The inhaled smoke irritates the lining of the lungs, which produces mucus. People with chronic bronchitis can also be infected by viruses and bacteria worsening the symptoms further. There are many different kinds of respiratory illnesses and one such kind of illness.
Allergic bronchitis In this condition the airway and the bronchi are inflamed due to foreign particles or irritants. The person suffers from allergic bronchitis as long as he is exposed to allergens. Allergic bronchitis is also called allergic asthma. Allergic treatment of bronchitis can be effective if the particular allergen causing the problem is identified.

About COPD

COPD is a serious lung disease that gets worse over some time if proper treatment is not given. COPD is not a single disease, it includes two main diseases: Chronic bronchitis and emphysema.

The lungs, the organ of respiration, have two main parts – the bronchial tubes and the alveoli (the air sac in the lungs). The air that you breathe enters your lungs through the bronchial tube and reaches the alveoli, from the alveoli oxygen mixes with the blood and carbon dioxide is sent out. But if you are suffering from chronic bronchitis your bronchial tubes may be red, swollen and filled with mucus that blocks the bronchial tube thereby causing difficulty in breathing. Similarly, if your alveoli are stiffened and irritated, they lose the capacity to hold air in them, making it difficult for your body to get enough oxygen and send out carbon dioxide, a condition called emphysema.

COPD is the 4th leading cause of death in the US. It is estimated that about 120,000 Americans die due to COPD every year. In some, it causes serious long-term disability. More than 12 million people are suffering from COPD and the number might increase shortly as many with COPD are still undiagnosed.

Symptoms of COPD

A few symptoms of COPD that you should not ignore are

• Continuous coughing is sometimes called “smoker’s cough”
• Increase sputum production
• Shortness of breath while doing activities
• Feeling like you can’t breathe
• The problem with taking a deep breath
• Wheezing
• Tightness of chest

The symptoms of COPD develop over some time. It is not necessary that everyone with the above-mentioned signs is suffering from COPD and not every COPD patient shows the same symptoms. COPD is often accompanied by cold or flu.

In severe conditions, COPD may have the following symptoms

• Swelling in ankle, feet, and leg
• Difficulty in breathing even while sitting quietly or talking
• Due to low oxygen, your lips and nails may turn blue or grey
• Rapid heartbeat
• Mentally disturbed or not alert
• Treatment for symptoms isn’t working

Causes

Most people suffering from COPD don’t even know that they have been affected.

The main thing that tops the list of causes for COPD is smoking. COPD often affects people above 40 years of age and who have a long history of smoking. Smoking causes COPD in 9 out of 10 COPD-related deaths. But it is also found that 1 out of 6 people affected with COPD have never smoked.

Long-term exposure to chemicals in the workplace that harm or irritate your lungs may cause COPD. Dust, fumes, air pollution, gases, vapour, mist, and long-term exposure to second-hand smoke result in COPD.

Many people who have never smoked and never have been exposed to harmful chemicals also get COPD, the reason is a genetic condition called Alpha-1 antitrypsin deficiency (AAT deficiency). As many as 100,000 Americans are AAT deficient.

Preventing COPD

There are many things you can do to help yourself if you are diagnosed with COPD and also to prevent COPD.

• Quit smoking
• Avoid being exposed to pollutants and harmful chemicals
• Take flu and pneumonia shots every year

Diagnosis

If you have the above-said symptoms and suspect that you might be suffering from COPD, do not delay talking to your doctor, he will ask for your smoking history and the type of environment you work in every day. He might recommend a breathing test called Spirometry to confirm whether it’s COPD or any other disease.

Spirometry is a simple, non-invasive breathing test that detects the amount of air that you can blow out of your lungs and how fast you can blow it out. Depending on the test readings your doctor can say whether you have COPD or not. A spirometry test can detect COPD before the symptoms become worse. Spirometry also shows the severity of COPD and the best treatment option.

A chest X-ray is also taken to see the signs of COPD. An arterial blood gas test helps to find the amount of oxygen present in the blood.

Using inhaled medicine

Inhaled medicine delivers a specific amount of medicine into your lungs using a handheld canister or a nebulizer machine. People with severe COPD who find it difficult to use a handheld canister can use a nebulizer as it converts liquid medicine into a vapour that you can be inhaled easily. After use, rinse and gargle your mouth with plain water to avoid side effects. Follow your doctor’s instructions to take the right amount of medicine.

Complications of COPD

COPD results in frequent colds and flu. You might also suffer from high blood pressure.

Treatment

After being diagnosed with COPD, the first thing you should do to slow down the damage caused to your lungs is to quit smoking. Your doctor might suggest ways to quit smoking. COPD cannot be cured completely but medicines and a healthy lifestyle can help you feel better. Your doctor will suggest treatment according to your condition.

Bronchodilators may be prescribed to dilate the shrunken or blocked airway or bronchia making breathing easy. Inhaled steroids are used to treat the inflammation caused in the airways. This is prescribed when your COPD symptoms are worse. You may be asked to use a steroid inhaler for 3 months depending on your condition.

If your blood oxygen level is very low, then oxygen therapy is suggested to help you breathe easily. Oxygen will be given through tubes that are put into your mouth and nose or a mask that covers your mouth and nose.

In rare severe cases, where medicines do not help, surgery is the only option. Surgery for COPD includes bullectomy (removal of the thick-walled airways) and Lung Volume Reduction Surgery (LVRS). In very severe cases, lung transplantation may be done.

Vaccines like flu shots and pneumococcal vaccines can be given to lower the risk of flu and pneumonia.

Conclusion

Many times you might have ignored COPD as a simple cough or cold. It usually develops mildly but the complications are serious and might prove fatal in many. Therefore it is necessary that you know the basic difference between COPD and other diseases with similar symptoms. If you suspect that you might have COPD, talk to your doctor and get a simple breathing test done. Take steps at the earliest to prevent or to reduce the severity of the disease. Early detection will help you live a longer and lead a more active life.

About Croup

Croup is a viral respiratory infection that affects the upper airways - the trachea (windpipe) and the larynx (voice box), and causes them to swell resulting in a harsh “barking” cough and difficulty to breath.

Croup affects children who are below 5 years of age. The infection usually lasts for more than 5-6 days and is very common in the winter and early spring seasons.

The symptoms often worsen at night and improve in the daytime. The risk of croup infection increases if the child is prematurely born.

Causes

TCroup is caused mostly by a viral infection. The viruses involved in croup infection are parainfluenza virus (mostly), adenovirus, and respiratory syncytial virus.

Other causes of croup include bacterial infection, allergy, and inhaled irritants.

A baby gets the infection when he/she comes in direct contact with a person or the secretion of an infected person.

The infection starts in the upper respiratory tract and slowly spreads down resulting in swelling of the trachea and the larynx.

Young children are affected mostly because they have a small airway, and a mild infection and swelling are enough to block the airway.

Symptoms

A few symptoms of croup are:

• Common cold with stuffy and runny nose
• Fever
• Inflammation of the trachea and larynx
• Harsh, loud, barking cough
• A high-pitched squeaking noise is made while breathing
• Difficulty in breathing
• Fast breathing
• Retraction of the chest

In severe conditions, the lips and the region around the mouth may turn blue due to lack of oxygen. The symptoms of croup usually worsen at night or when the baby is crying.

Babies with croup usually are:

• Irritable
• Sleepy
• Low appetite
• Choking
• Vomiting
• Spasmodic cough

Complications

Children with croup usually do not develop any complications and they recover completely. Very rarely they develop complications like

• Bacterial infection of the upper respiratory tract or pneumonia
• Ear infection
• Dehydration due to less fluid intake
• Respiratory arrest (slow down or stop breathing due to any reason)
• Epiglottitis – inflammation of the cartilage covering the trachea
• Atelectasis (collapse of part of the lung)

Prevention

Though preventing croup is very close to impossible, parents can try a few hygiene tips to avoid the infection as much as possible.

Take care to wash your hands frequently and avoid contact with any infected person.

Getting vaccination for diphtheria, Haemophilus influenza (Hib), and measles can prevent the various dangerous forms of croup.

Home remedies

The moment parents discover that their baby has croup they can start a few home remedies. Home remedies treat most mild cases of croup effectively.

• The baby should be allowed to take complete rest and should be given plenty of fluid to drink.
• The parents should try to keep the baby calm and quiet, as crying can worsen the situation.
• Quiet play is better as running can make cough even worse.
• Giving any type of cough syrup is not recommended, especially if the child is below 2 years of age.
• For chest discomfort and discomfort caused by fever, parents can try giving acetaminophen.
• For a stuffy nose, parents can try clearing it with salt-water drops (1 teaspoon of table salt in a cup of water).
• The baby should be made to sit upright rather than lying down.
• No one should be allowed to smoke near the baby.
• A moist environment helps the child breathe easily, parents can turn on the humidifier or make their child breathe through a wet cloth placed over his mouth and nose
• Try running hot water in the bathtub, and once the room is steamy sit with the baby in the bathroom for 10 minutes.
• The child should be made to breathe fresh, cool air.
• Parents can wrap the baby in a blanket and take the baby for a walk in a cool environment.

In case home remedies do not work

Even after trying most of the home remedies if the baby doesn’t seem to respond, then it’s time to consult a doctor. The doctor may prescribe a few medicines or treatments for croup to bring down the symptoms. Most of the time doctors prescribe steroids to reduce the swelling.

In case of severe croup and blocking of airways, doctors may recommend aerosolized racemic epinephrine (adrenalin) such as dexamethasone and prednisone, which should be taken orally, inhaled or injected forms of corticosteroids may also be prescribed.

Corticosteroids rapidly reduce the swelling in the airways.

In case of difficulty in breathing, oxygen may be given and the child is kept under continuous monitoring overnight.

In case of bacterial infection, an antibiotic may be required.

Severe cases of airway obstruction may require intubation, a process where a tube is passed through the nose, mouth, and larynx straight into the airway that reaches the lungs.

Intravenous fluids may be given in case of dehydration.

Causes

Diphtheria occurs due to an infection by the Corynebacterium diphtheria bacterium. It is highly contagious and spreads through direct contact with contaminated objects. Diphtheria can also be transmitted if you are in contact with the infected person while they are sneezing, coughing, or blowing their nose.

Sometimes, the condition remains asymptomatic. However, the bacteria are still able to transmit the infection for up to six weeks to non-immunized people.

Once you are infected with the bacterium, they release certain toxic substances called exotoxins that destroy the tissue lining of your throat, nose, tongue, and airway.

Diagnosis

Your doctor might suspect diphtheria by looking at the signs and symptoms. A sore throat and grey membrane that covers the tonsils and throat are the primary symptoms. Your doctor may suggest a culture test in which a swab is collected from your throat and examined for the presence of bacteria. Sometimes, a sample of tissue is collected from the infected area on the skin to identify the type of bacteria.

Risk factors

The following are the factors that increase the risk of diphtheria:

• Non-immunized children or adults
• People living in poor sanitary conditions
• History of immune disorders such as HIV/AIDS
• Visiting a place where the diphtheria is endemic

Complications

If you’re not vaccinated or the infection is left untreated, you may have the following complications.

• Airway blockage
• Damage to the heart muscle causing myocarditis
• Nerve damage (polyneuropathy)
• Inability to move (paralysis)
• Lung infection (respiratory failure or pneumonia)

Prevention

The most efficient way to prevent diphtheria is vaccination. DTaP is the vaccine approved for the prevention of diphtheria. Your doctor may recommend a single shot of the vaccine. DTaP is a combination of vaccines for diphtheria, tetanus, and pertussis. Usually, it is administered in a series of five shots. In children, it is recommended at the age of two months, four months, six months, 12 to 18 months, and 4 to 6 years. For adults, the booster dose of Td (tetanus-diphtheria) is suggested.

Diphtheria Symptoms

The toxins released by the bacterium lead to the formation of a thick, grey-coloured coating in the infected area called pseudomembrane. The symptoms of diphtheria include:

• Fever
• Chills
• Drooling
• Loud, barking cough
• Sore throat
• Bluish discoloration of the skin
• Discomfort
• Swollen glands in the neck

In severe conditions, it may cause difficulty breathing or swallowing, vision changes, and slurred speech.

Treatment

Diphtheria is treated aggressively and immediately to avoid life-threatening complications. Your doctor may suggest the following medications for diphtheria treatment.

• Antitoxins: Administration of antitoxins is the initial step to act immediately against the exotoxin produced by the bacterium. You must notify your doctor if you’re allergic to diphtheria antitoxin. At times, your doctor will start the antitoxin therapy with smaller doses to prevent an allergic reaction.
• Antibiotics: According to the CDC guidelines, your doctor may prescribe antibiotics such as penicillin or erythromycin for at least two weeks.

Based on your symptoms, disease progression, and immunization status, your doctor may suggest antibiotic therapy alone or antibiotics plus antitoxin therapy in combination.

Symptoms

The classic symptom of emphysema is shortness of breath that begins gradually. Coughing is also the first among the symptoms of emphysema. These symptoms especially increase during exercise or high physical activity. Shortness of breath eventually occurs during rest as the disease progresses. Other COPD symptoms or emphysema symptoms include weight loss, tachycardia, and bluish discolouration of lips and fingernails (because of lack of oxygen).

Reach out to your doctor immediately if you have shortness of breath, difficulty climbing stairs, or if you do not feel mentally alert.

Causes

The main emphysema causes are:

Chronic irritation of the respiratory tract by irritants such as tobacco smoke, marijuana smoke, or air pollution.

Emphysema may also be caused by the deficiency of alpha-1 antitrypsin protein that protects the lungs.

Risk factors

Smoking tobacco or marijuana is the main risk factor for emphysema. Individuals who are aged between 40 and 60 years, exposed to secondhand smoking, and exposed to outdoor and indoor pollution are at increased risk for emphysema.

Complications

Emphysema can lead to pneumothorax (collapsed lung) and heart problems such as cor pulmonale. These conditions are rare but serious and life-threatening.

Diagnosis

The diagnosis of emphysema includes a physical examination and a review of medical history. Other tests include:

Chest X-ray helps to diagnose emphysema and to rule out other conditions. In some cases, an X-ray appears to be normal even though emphysema is present. A Computed Tomography (CT) Scan is also recommended to confirm the diagnosis.

Lung function tests are performed to determine the airflow in and out of the lungs. These tests are performed using a device called a spirometer.

Self-management

Following some tips may help to prevent emphysema:

• Avoid smoking
• Avoid smoking
• Avoid exposure to irritants such as air pollution
• Exercise regularly
• Wear a mask if you are exposed to dust or chemical fumes

Treatment

Emphysema can’t be cured, but the goal of emphysema treatment (COPD treatment) is to relieve the symptoms and slow down the progression of the disease.

Below are the options for the treatment of COPD

Medications: Bronchodilators help to treat shortness of breath and coughing. Corticosteroids in the form of aerosols are given to treat shortness of breath. Corticosteroids can cause the weakening of bones, and increase the risk of hypertension, and diabetes.
Surgery: Lung volume reduction surgery is performed to remove the diseased tissue. If the disease is more severe, your doctor may prefer lung transplantation based on your physical condition.
Other therapies: Pulmonary rehabilitation that includes breathing exercises and relaxation techniques to reduce breathlessness are also used to treat emphysema. Supplemental oxygen is given to treat lower oxygen levels.
Nutrition: It is essential to have proper nutrition to maintain adequate weight during the therapy.

Signs & Symptoms

Shortness of breath and dry cough is the most common symptom. These are progressive symptoms and exacerbate with time. Patients may have shortness of breath at rest or with physical exertion. Weight loss, fatigue, muscle and joint pain can also occur depending on the cause.

Patients with advanced ILD may have:

• Clubbing of nails: Abnormal enlargement of the nail bed and softening of nails.
• Cyanosis: Bluish discolouration of the nails, lips and skin due to low oxygen concentration.
• Abnormal chest sounds
• Symptoms of the associated disease or underlying cause are also present.

Risk factors

Factors that may increase the risk of ILD are:

• Age: Predominantly affects adults; infants and children are less commonly affected.
• Family history
• Smoking: This may increase the likelihood of having some forms of ILD.

Lung Transplantation

If the other treatment options fail to limit the progression of the disease and improve symptoms, a lung transplant is seen as the last resort. A successful lung transplant depends on a variety of factors such as age and general health of the patient.

Immunosuppressive drugs such as Azathioprine, are given to increase the body’s acceptability of the transplant.

Recent research states that the survival rate for one year after lung transplantation is 79 per cent, and for five years it is 53 per cent. The survival rate for 10 years is 30 per cent.

Oxygen Therapy

Oxygen levels may fall as the disease progresses and may warrant oxygen therapy. The requirement for oxygen depends from patient to patient. Some may require it round-the-clock; some may need it during sleep or physical work. It relieves the pressure on the lungs improving symptoms like breathlessness and cough.

Pulmonary Rehabilitation

This programme primarily focuses on improving the quality of life by reducing symptoms of the disease, promoting self-management, improving exercise tolerance, decreasing hospital stay, and managing the emotional well-being of the patient.

It includes:

• A physical exercise programme designed specifically for the patient
• Patient Education
• Breathing techniques to manage breathlessness
• Psychosocial support

Self-Management

This is a chronic disease which can cause physical and emotional challenges. Follow the below steps to manage the condition effectively:

• Stop smoking
• Eat a well-balanced diet
• Take emotional support from family, friends and disease groups
• Consider rehabilitation program

Diagnosis

The most common complaint of ILD patients is shortness of breath. A detailed history is crucial to identify the underlying cause. It involves medical and occupational history to rule out infections, autoimmune diseases, environmental pollutants and occupational exposures.

A complete physical examination is done to find any abnormal chest sounds and crackling sounds in the lungs, and changes in nails, skin, fingers and joints. An exercise tolerance test is done, which may include a six-minute walk on a treadmill, where the patient’s oxygen levels are monitored.

The following tests are done after the preliminary examination:

Blood tests: to examine blood cell counts and autoimmune diseases and other disorders

Imaging tests

• Chest X-rays: Done to assess the severity of the disease. In the early stages of the disease, this can be normal in up to 10% of the patients. Distinctive patterns such as “honeycomb” patterns or “bubbles” can also be seen on the X-rays depending on the cause.
• Computed tomography (CT) scan: It involves multiple X-rays of the chest, and a computer creates detailed images of the lungs and surrounding structures. Interstitial lung disease can usually be seen on a CT scan. A high-resolution CT scan is helpful to assess the distribution and progression of the disease.
• Echocardiography: To evaluate cardiac functions and abnormal pressures on the left and right sides of the heart.

Pulmonary function tests (PFT): Lung volume and breathing capacity are measured by forcefully exhaling into a device called a spirometer.

Diffusion capacity is also measured to assess the gaseous exchange in the lungs and how effectively oxygen passes into the bloodstream.

Biopsy: It is a test in which small samples of the lung tissues are taken and examined to assess the type of ILD. It can be:

• Bronchoscopic biopsy: In this test, a narrow tube is inserted through the mouth or nose into the lungs and samples are taken. Side effects may include a sore throat and hoarseness. Occasionally, bleeding occurs which may require treatment.
• Surgical biopsy: It is performed under general anaesthesia. Two or three small incisions are made between the ribs to take a sample of the lung tissue.

Video-assisted thoracoscopic surgery (VATS): A tube equipped with a video camera at its end is inserted into the chest to visually examine the lungs and take multiple samples of the lung tissue.

Treatment

Treatment of ILD depends upon the cause. Interstitial lung disease treatment options include:

Medications

• Antibiotics: mainly prescribed for any bacterial infection such as pneumonia. Azithromycin and levofloxacin are the popular drugs of choice for bacterial pneumococcal infection. Fungal pneumonia can be treated with antifungal agents.
• Corticosteroids: Prednisolone is given to decrease inflammation of the lungs. These are often combined with immunosuppressive drugs like Mycophenolate and Azathioprine. Immunosuppressive agents prevent the body’s immune system from attacking its cells to prevent further scarring.

Causes

The exact reason for ILD is still not known. However, scientists believe it to be caused by a few factors:

Environmental and occupational factors such as metals like silica dust, coal dust, asbestos, beryllium and gasses, fumes, moulds

Infections like pneumonia

Medications

• Cancer chemotherapeutic agents such as methotrexate
• Antibiotics, such as nitrofurantoin and sulfasalazine
• Heart medication, such as amiodarone

Auto-immune and Connective tissue diseases like rheumatoid arthritis, sarcoidosis, scleroderma, systemic lupus erythematosus, pulmonary vasculitis and radiation.

Signs and Symptoms

The symptoms appear two to ten days after being exposed to bacteria, and in some patients, it may take up to two weeks. Call your doctor immediately when you experience the below symptoms.

In the first few days, you may experience symptoms like a headache, muscle pain, chills, and fever.

By the second or third day, you will develop symptoms like cough, shortness of breath, chest pain, and gastrointestinal symptoms like nausea, and vomiting.

Risk factors

All the patients with bacterial infection may not get the infection. But the risk increases in these conditions:

• If you are habituated to smoke
• If you have chronic diseases due to weak immune system
• If you have chronic lung disease such as emphysema, or cancer
• If you are 50 years old or more

Treatment

Legionnaire’s disease treatment involves the use of antibiotics. If the condition is diagnosed and therapy is given in the early stages, the chance of developing complications will be low. If the symptoms are not managed, the patient will be hospitalized.

Prevention

The infection cannot be prevented but the risk can be prevented by avoiding smoking.

Causes

The bacterium called Legionella pneumophila is the main cause of the disease.

The bacterium lives in soil and water, and people get infected when they inhale water droplets containing the bacterium. Some of the sources of infection are:

• Hot tubes
• Air conditioning systems
• Swimming pools and other water systems

It can also be spread through aspiration and soil.

Complications

If the condition is not treated on time, you may develop several life-threatening complications like respiratory failure, septic shock, and acute kidney failure.

Diagnosis

First, the doctor would ask about the symptoms and asses your family and medical history. Then the doctor would suggest you go for the following tests:

Chest X-ray – to check for the extent of infection in the lungs

Urine test – to check for Legionella antigens

CT scan of the brain – it is done if you have symptoms related to a psychological disorder

A sample of your sputum or lung tissue is also tested to check for the presence of the bacterium.

Types of Lung Cancer

Lung Cancer is categorized into two types based on its appearance under the microscope. The types of lung cancer include:

Small Cell Lung Cancer: It occurs in heavy smokers and is less common than non-small cell lung cancer.
Non-Small Cell Lung Cancer: It is a common term for several types of lung cancers that behave similarly. These types of cancers include squamous cell carcinoma, adenocarcinoma and large cell carcinoma.

Causes of Lung Cancer

Smoking is the main and major cause of lung cancer. Cigarette smoke consists of cancer-causing substances that damage the cell line in the lungs. Repeated exposure to the carcinogens leads to lung damage over time. Passive smokers are also at a greater risk of developing lung cancer due to inhalation of carcinogens. People who are repeatedly exposed to radiation, radon gas, asbestos and pollution have a chance of developing lung cancer. Familial histories of lung cancer can also be a cause of lung cancer.

Signs and Symptoms of Lung Cancer

Lung Cancer does not show any symptoms in the early stages; the symptoms are developed only at the advanced stage. The symptoms of Lung Cancer include:

• Cough (blood in cough)
• Shortness of breath and chest pain
• Wheezing
• Hoarseness
• Unintentional weight loss due to loss of appetite
• Bone pain, chest pain
• Bronchitis
• Swelling of face and neck
• Headache
• Pneumonia
• Difficulty in swallowing
• Shoulder pain
• Weakness
• Depression, mood changes

Diagnosis of Lung Cancer

The diagnosis of lung cancer involves an initial physical examination which helps to identify the signs and symptoms of lung cancer. Different diagnostic tests used for lung cancer diagnosis are:

X-ray: An X-ray image of the lungs reveals an abnormal mass or nodule.
CT scan: A CT scan reveals small lesions in the lungs. These lesions may not be detected on an X-ray.
PET scan: Positron emission tomography scan produces three-dimensional coloured images of the lungs. It helps in identifying the abnormal cells.
MRI: High-frequency radio waves and strong magnetic fields are used to detect tiny changes in the structure of the lungs.
Sputum Cytology: The sputum is studied under the microscope several times to identify the presence of cancerous cells in the lungs.
Low-Dose Helical CT scan: It is used to identify cancerous cells in the lungs. It is mostly used for patients who are current and former smokers.
Biopsy: A tissue sample of abnormal cells is removed from the lungs for testing in the laboratory.
Bronchoscopy: Bronchoscopy: It is the examination of the airways to visualize the airways through a thin, fiberoptic probe inserted through the nose or mouth. It reveals the areas of the tumour. These tumour cells are diagnosed by biopsy. It helps to determine the extent of lung cancer.
Thoracentesis: Patients with lung cancer may develop fluid between their lungs and chest wall. Thoracentesis is the procedure which helps to remove the fluid and diagnose lung cancer.
Mediastinoscopy: In this technique, an incision is made at the base of the neck, and surgical tools are inserted behind the breastbone to take samples of tissues from lymph nodes. It is guided by an X-ray or CT image.

Staging of Lung Cancer

After the diagnosis of lung cancer, the staging of lung cancer is done by the doctors to identify the level of cancerous growth. The stages include:

Stage I. The size of the tumour is smaller than 2 inches. The cancer is limited to the lung.
Stage II. The size of the tumour is larger than 2 inches. The cancer may also have spread to the nearby lymph nodes or it may be a smaller tumor that is spread to nearby structures, such as the chest wall, the diaphragm or the lining around the lungs.
Stage III. The tumour size at this stage may be very large. It invades other organs near the lungs. This stage may also indicate a smaller tumour that has spread to lymph nodes that are farther away from the lungs.
Stage IV. At this stage, cancer will spread beyond the affected lung to the other lung or distant areas of the body.

Treatment of Lung Cancer

The treatment for lung cancer is based on the overall health condition of the patient and the stage of the cancer. The treatment options include surgeries to remove the area of the lung that is affected by cancerous cells.

The different procedures to remove lung tissue are

• Wedge resection - a small section of the lung containing the tumour along with a margin of healthy tissue is removed
• Segmental resection - a larger portion of the lung is removed
• Lobectomy - removal of the entire lobe of one lung
• Pneumonectomy - an entire lung is removed

During surgery, lymph nodes will also be removed to check the signs of cancer. After the surgical procedure, patients may experience difficulty breathing, shortness of breath, pain, and weakness. Bleeding, infections, and complications of general anaesthesia are the risks associated with surgery.

Chemotherapy: Chemotherapy treatment is given through intravenous route or oral route. Combinations of drugs are given in a series of treatments. Chemotherapy usually lasts for a few weeks to months with breaks in between for recovery from adverse effects of chemotherapy. Chemotherapy is often suggested after surgery to kill any cancer cells that may remain. Sometimes, it is also suggested before surgery to shrink tumours and make them easier to remove from the lung.

Radiation therapy: In high-powered energy beams from sources such as X-rays and protons are used to kill cancer cells. Radiation therapy is directed on the cancer site by an external beam radiation. Sometimes needles, seeds or catheters and placed inside the body near the cancer site to pass the radiation (brachytherapy).
Radiation therapy is used after surgery to kill any cancer cells that may remain. It is also used as the first treatment for lung cancers that may not be removed during surgery. Radiation therapy may also be used to relieve pain and other symptoms of advanced lung cancer. In cases of very small cancer tumours, stereotactic body radiotherapy is useful. This passes beams of radiation from different angles at the lung cancer.

Targeted Drug Therapy: Targeted therapies are newer cancer treatments. These work by targeting the specific abnormalities in cancer cells. Targeted therapy drugs are used in combination with chemotherapy drugs. Some targeted therapies work effectively in patients whose cancer cells have certain genetic mutations. Targeted therapy options for treating lung cancer include Afatinib, Ceritinib, Erlotinib, Crizotinib, Nivolumab, Bevacizumab Ramucirumab.

Understanding pneumonia

The lungs are the main organs of the respiratory system and they are made up of airways called bronchial tubules and air sacs known as alveoli. When you inhale, air goes into your airways and then reaches the alveolar sacs. From the air in the alveolar sacs blood takes in oxygen and releases carbondioxide.

In pneumonia, the alveoli get inflamed resulting in them filling up with fluid making it difficult for you to breathe. Pneumonia can be mild or severe in nature and is treatable.

Walking pneumonia

Walking pneumonia is caused by a virus known as Mycoplasma pneumonia and it is a mild form of pneumonia. The symptoms are not severe and it does not last for long.

The body can cure itself when it is affected by this walking pneumonia and the person may not even know that he is affected and continues to do his work normally, hence the interesting name ‘walking’ is attached to it.

Even though it is mild in nature, you must not neglect it as it may have uncomfortable symptoms that can include nausea, headache, fever, chills, chest pain, sore throat, lump in the neck, ear pain, rashes and an increase in the rate of respiration.

You will need bed rest even though hospitalization is not required. Antibiotics that may be prescribed are clarithromycin, erythromycin and tetracyclines.

Prevention of Pneumonia

• To prevent pneumonia you have to maintain good hygiene.
• It is very important to wash your hands after you use the restroom and before eating food.
• You are likely to pick up germs from places like door handles or the keyboard. You must wash your hands with soap or a sanitizer with alcohol base, as often as possible to keep germs away.
• You can develop Pneumonia even after a bout of flu.
• You can avoid the flu by taking preventive flu shots every year. The shot gives you protection from 3 to 4 dangerous strains of flu. It is important to have a strong immune system to prevent pneumonia.
• To build a strong immune system eating nutritious balanced food, exercising regularly and getting adequate rest is essential.
• It is important to avoid smoking and keep away from sick people.

Symptoms

The symptoms of pneumonia are:

• Fever
• Cough with mucus
• Breathing difficulty
• Chest pain
• Chills
• Muscle pain
• Headache
• Fatigue
• Sweating

These pneumonia symptoms can be mild to severe in nature and can often be mistaken for flu.

Vaccination for Pneumonia

Vaccination for pneumonia is recommended in people with risk factors like smoking, alcohol abuse, age above 65 years, heart disease, diabetes, asthma, lung disease, cirrhosis, kidney failure, removal or damage of spleen, AIDS, sickle cell disease, immunity suppressant drugs, people with cochlear implants, and those who are receiving chemotherapy.

The available vaccinations are the Pneumococcal conjugate vaccine (PCV) which is recommended for children less than 5 years of age and the Pneumococcal polysaccharide vaccine (PPSV) which is recommended for children who are 2 years and above. The vaccination cannot protect people from all strains of pneumonia, but it can certainly protect people from experiencing complications that can be life-threatening.

The Pneumococcal polysaccharide vaccine (PPSV) may cause some side effects including muscle soreness, slight fever, pain and redness at the site of injection. Side effects of the Pneumococcal conjugate vaccine (PCV) are irritability, loss of appetite, fever, and redness and tenderness at the site of injection.

Diagnosis

The physician would perform a physical examination in which he may look for any abnormal crackling sounds or rumblings coming from your lung. These abnormal sounds are an indication of fluid buildup in the lungs. To locate the infection and its extent in the lungs, a chest X-ray is taken.

A blood test is also conducted to check for the presence of microbes like bacteria and viruses. A blood test is needed to measure the count of white blood cells.

Mucus testing is done to identify the particular microbe that is causing pneumonia. In severe cases, a lung biopsy may be done where a sample of lung tissue is taken for testing.

A procedure known as Thoracentesis is done in which fluid from the pleura which is the thin membrane lining that covers the chest cavity and lungs, is taken for analysis.

To check the functioning of the lungs, a test called spirometry is done in which the patient is asked to breathe into an instrument called a spirometer that helps you measure the amount of air you breathe.

In a procedure known as bronchoscopy, the doctor passes a tube with a scope (camera) at its end through the nose to check for any abnormal mucus, pus and other infections in the airway of the lungs.

Treatment

The treatment for pneumonia depends on the type and severity of pneumonia present. For pneumonia that occurs due to bacteria, antibiotics are given.

Once you start taking the medications you will feel better, but do not stop the antibiotics midway as it may result in pneumonia returning, and there is the risk of developing antibiotic-resistant strains of bacteria.

To treat pneumonia caused by viruses, antiviral drugs are given and the patient is advised to take complete rest, and drink a lot of fluids.

For pneumonia that occurs due to mycoplasma, antibiotics are given. Antifungal medications are given to treat fungal pneumonia.

In cases of severe pneumonia, hospitalization is required. After treatment is over the doctor will call you for a follow-up visit and will take a follow-up chest X-ray.

Types of Pneumonia

• Community-acquired pneumonia: This type of pneumonia is the most common type of all and is caused due to bacteria known as streptococcus pneumonia. This occurs due to bacteria, fungi, viruses or any other irritants in the air that you can easily get infected with when you move into public places like grocery stores, gyms, schools, malls and workplaces.
• Aspiration pneumonia: At times when you vomit, small particles enter the lungs and you cannot cough them out and this in turn causes aspiration pneumonia.
• Hospital-acquired pneumonia: This is a dangerous form of pneumonia that can occur in people with weak immune systems, older people, and young children. This type of pneumonia occurs if you have to stay in the intensive care unit in a hospital where you have to use the ventilator for respiration. This can also occur if you have undergone chest surgery or if you had to stay in chronic care centres or received treatment at a kidney dialysis centre.
• Opportunistic Pneumonia: This occurs in people whose immune system has been weakened by conditions like acquired immune deficiency syndrome (AIDS), organ transplant cases or chronic obstructive pulmonary disease (COPD).

Symptoms

The pulmonary embolism symptoms include:

• Shortness of breath that develops suddenly or gradually
• Sharp and stabbing chest pain
• Coughing with blood in sputum
• Dizziness

Prevention

To prevent the formation of clots:

• Walk for at least 5 minutes every hour during travelling or long periods of inactivity
• Drink fluids regularly
• To prevent recurrence:
• Use anticoagulant medications regularly
• Wear compression stockings if you are at high risk for deep vein thrombosis

Complications

Pulmonary embolism if left untreated can lead to death. Evidence suggests that about one-third of people who are left undiagnosed do not survive. However, with early detection and prompt treatment, the survival rate has increased.

Pulmonary embolism can also cause pulmonary hypertension. In this condition, blood pressure will be high in the lungs and right side of the heart. This can lead to an increase in the workload of the heart, thereby weakening the heart.

Causes and Risk Factors

A pulmonary embolism occurs when a blood clot (which can form due to many reasons) blocks the pulmonary artery. Deep vein thrombosis or pulmonary thrombosis is a condition in which clots form in the legs and is a risk factor for pulmonary embolism. The clots formed in the legs move to the lungs and block the artery. The clot formed in the pelvis can also block the pulmonary artery. Acute pulmonary embolism is a condition that interferes with both circulation and gas exchange.

The risk factors for pulmonary embolism are age over 60 years, cardiovascular diseases, certain cancers like ovarian, breast, and lung, previous surgery, immobilization (risk of clot formation in legs), sedentary lifestyle, smoking, obesity, and trauma or injury to the legs (damage to the blood vessel). Hypercoagulable state or genetic blood clotting disorders also increase the risk of pulmonary embolism. All these factors increase the formation of clots, ultimately resulting in pulmonary embolism.

Diagnosis

The symptoms of pulmonary embolism resemble many other conditions of the heart and lungs. So, it is difficult to diagnose pulmonary embolism. The diagnosis of pulmonary embolism includes:

• Blood tests: to detect the levels of clot-dissolving substance, D-dimer; also to detect levels of oxygen and carbon dioxide (clot in lungs decrease the levels of oxygen)
• Chest X-ray: to rule out conditions that have similar symptoms; to study heart and lungs in detail
• Electrocardiography (ECG): to detect abnormalities of heart
• Ultrasound scan: to visualize the blood flow and check for blood clots in your legs
• CT and MRI scans: to detect abnormalities of arteries in the lungs
• Pulmonary angiogram: to detect the abnormalities of blood flow in lungs; most reliable test to diagnose pulmonary embolism

Treatment

Your doctor chooses the treatment depending on the size and location of the clot. The pulmonary embolism treatment includes:

Medication: Your doctor prescribes medication if the clots are small. Anticoagulants or blood thinners are given to prevent clot formation. Thrombolytics are given to break down the clot.
Surgery: Surgery is recommended if your clot is bigger and more problematic. Surgery is performed through different procedures such as:

• Vein filter – A small incision is made and your doctor inserts a small filter into the inferior vena cava (the vein that passes from the legs to the right side of the heart). This filter prevents the passage of clots from the lungs to the heart.
• Clot removal – With the help of a catheter, your doctor suctions the clot out of the artery. However, this is not an effective method because of the difficulty involved in the procedure.
• Open surgery – Your doctor chooses this method in emergencies and when medication doesn’t work.

Symptoms

In the case of latent TB, the bacteria remain dormant in the body, causing no symptoms, and hence this form is not contagious.

In active TB, symptoms include:

• Fatigue
• Unexplained weight loss
• Fever and chills
• Night sweats
• Loss of appetite

When the lungs are affected, symptoms include:

• Chronic cough lasting several weeks
• Coughing up blood or mucus
• Chest pain

At times, symptoms may go unnoticed, or the affected person may go into a state of remission (reduction and stoppage of symptoms). When tuberculosis spreads to other areas of the body, the symptoms vary as per the organ affected.

TB of the spine can result in back pain, TB of the kidney or bladder can cause blood in urine, and that of the brain shows symptoms of headache or nausea.

Causes

The exact cause of the salivary gland cancer is not clear. However, scientists believe that it occurs as a result of DNA mutation in the cells. These mutated cells kill the healthy cells, grow and spread to other body parts.

Risk factors

A person is at a higher risk of developing TB disease, if there has been recent exposure to the bacterial infection or if the immune system of the person is compromised due to some medical condition.

Exposure to Tuberculosis bacteria occurs when a person is in close contact with someone having active TB, or exposure to people coming from areas with high rates of TB, working at facilities like old-age homes, prisons, and shelters, where there is overcrowding or poor ventilation.

Malnutrition and lack of medical care also increase the risk of developing the disease.

A healthy immune system can successfully defend the body from infection, but certain pre-existing conditions like HIV infection, diabetes, and lung cancer weaken the immune system and increase the risk of contracting the disease.

Other factors that may compromise the immune system include:

• Substance abuse
• Severe kidney disease
• Organ transplant
• Low body weight
• Head and neck cancer
• Treatment for rheumatoid arthritis

Diagnosis

Common tests for diagnosis include a skin test and blood tests. The skin test (also known as the Mantoux test or PPD for purified protein derivative) involves injecting the PPD substance just below the skin of the inside forearm.

After 48 to 72 hours, any signs of reaction or swelling at the injection site in the form of a hard raised red bump (induration) are positive, indicating a TB infection.

The skin test isn’t always accurate and can result in false-positive tests, especially when a different type of Mycobacterium is present, or there has been recent vaccination with the bacillus Calmette-Guerin (BCG) vaccine.

There are also cases, where people infected do not react, show a delayed response to the skin test, as seen in children, older people or people with AIDS.

A positive TB skin test only tells that a person has been infected with the bacteria and does not tell whether there is latent or active TB. A chest X-ray and sputum sample will help determine this.

An X-ray showing white spots in the lungs (walled-off TB bacteria) shows a latent infection, while nodules or cavities in the lungs show active TB. Culture tests by taking sputum samples are also tested for the presence of the disease.

Blood tests are done to confirm or rule out latent or active TB. Here, the immune system’s reaction to Mycobacterium tuberculosis is measured.

Only one visit to draw blood is required, and the results will be ready in 24 to 48 hours.

Blood tests are more accurate than skin tests and at the same time more useful when the risk of infection is higher.

Outcome and course of action

Not all people who test positive are likely to develop the disease. There is an overall chance that 5 to 10 percent of infected people who do not receive timely treatment for latent infection, to develop active TB at some point in time.

Healthy people who get infected are mostly able to fight off the infection and the doctor will recommend taking an antibiotic for around 6 to 9 months to kill the infection. This is a preventive drug therapy approach, where germs that might become harmful in future get killed.

A common medication prescribed is isoniazid (commonly called INH) taken orally as a daily dosage or twice-a-week dose. Long–term use of isoniazid can result in side effects (liver damage, skin rash), hence close monitoring will be done. Taking acetaminophen and alcohol is contraindicated with this treatment.

There is a minor chance of developing active TB despite taking the medication regularly for the stipulated period. This is because certain bacteria are resistant to the medicine.

Active TB is treated by taking a combination of four medications – isoniazid, rifampin, ethambutol and pyrazinamide for 6 to 12 months.

Taking the medication and recovery is very important as becoming sick again will be harder to treat and cure. Multi-drug resistant TB can result as a consequence, which can be very dangerous.

Living with TB

TB in general is preventable, but once infected, it is important to take care of yourself and others around you. Below mentioned are a few points for tuberculosis prevention.

Maintaining a healthy immune system, getting regular tests done and ensuring adequate hygiene and ventilation can prevent a latent infection from turning active.

Ensure that the medication is working, and get help from a healthcare worker to stick to the correct treatment program.

The infection does not spread by sharing food or drink, shaking hands or touching.

Remember that even if you get infected, there is a cure, at the same time to develop active TB; you need to be in contact with such a person for a long time.