5 MOST COMMON DISEASES OF THE RESPIRATORY SYSTEM

EMPHYSEMA Emphysema occurs when the air sacs in your lungs are gradually destroyed, making you progressively more short of breath. Emphysema is one of several diseases known collectively as chronic obstructive pulmonary disease (COPD). Smoking is the leading cause of emphysema. As it worsens, emphysema turns the spherical air sacs clustered like bunches of grapes into large, irregular pockets with gaping holes in their inner walls. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream. Emphysema also slowly destroys the elastic fibers that hold open the small airways leading to the air sacs. This allows these airways to collapse when you breathe out, so the air in your lungs can't escape. Treatment may slow the progression of emphysema, but it can't reverse the damage. Emphysema is a destructive disease of the lung in which the alveoli (small sacs) that promote oxygen exchange between the air and the bloodstream are destroyed. Smoking is the primary cause of emphysema, which makes it a preventable illness. There are also less common genetic causes of emphysema including alpha-1 antitrypsin deficiency Shortness of breath is the primary symptom of emphysema. It is a progressive complaint, worsening over time. Early in the disease, shortness of breath may occur with exercise and activity but symptoms gradually worsen and may occur at rest. Diagnosis of emphysema is based upon history, physical examination, and pulmonary function studies. Once present, emphysema is not curable, but its symptoms are controllable. Medication regimens are available to preserve function for daily activities and quality of life for an individual with emphysema. Oxygen supplementation may be required for a person with emphysema. Exercise training and education are essential components of emphysema therapy and pulmonary rehabilitation. Surgical options for individuals with emphysema have been developed and but are not expected to be available for widespread use. Emphysema does not affect quantity of life, but rather quality of life. There are no studies that can predict life-expectancy in individuals with emphysema. Symptoms: You can have emphysema for many years without noticing any signs or symptoms. The main symptom of emphysema is shortness of breath, which usually begins gradually. You may start avoiding activities that cause you to be short of breath, so the symptom doesn't become a problem until it starts interfering with daily tasks. Emphysema eventually causes shortness of breath even while you're at rest. When to see a doctor: See your doctor if you've had shortness of breath for several months, especially if it's getting worse or it's interfering with your daily activities. Don't try to attribute it to your deconditioning or age or weight. Seek immediate medical attention if: 1. You're so short of breath, you can't talk 2. Your lips or fingernails turn blue or gray 3. You're not mentally alert 4. Your heartbeat is very fast Causes: The main cause of emphysema is long-term exposure to airborne irritants, including: Tobacco smoke Marijuana smoke Air pollution Manufacturing fumes Coal and silica dust Rarely, emphysema is caused by an inherited deficiency of a protein that protects the elastic structures in the lungs. It is called Alpha-1 antitrypsin deficiency emphysema. Risk factors: Factors that increase your risk of developing emphysema include: Smoking. Emphysema is most likely to develop in cigarette smokers, but cigar and pipe smokers also are susceptible. The risk for all types of smokers increases with the number of years and amount of tobacco smoked. Age. Although the lung damage that occurs in emphysema develops gradually, most people with tobacco-related emphysema begin to experience symptoms of the disease between the ages of 40 and 60. Exposure to secondhand smoke. Secondhand smoke, also known as passive or environmental tobacco smoke, is smoke that you inadvertently inhale from someone else's cigarette, pipe or cigar. Being around secondhand smoke increases your risk of emphysema. Occupational exposure to fumes or dust. If you breathe fumes from certain chemicals or dust from grain, cotton, wood or mining products, you're more likely to develop emphysema. This risk is even greater if you smoke. Exposure to indoor and outdoor pollution . Breathing indoor pollutants, such as fumes from heating fuel, as well as outdoor pollutants car exhaust, for instance increases your risk of emphysema. Complications: People who have emphysema are also more likely to develop: Collapsed lung (pneumothorax). A collapsed lung can be life-threatening in people who have severe emphysema, because the function of their lungs is already so compromised. Heart problems. Emphysema can increase the pressure in the arteries that connect the heart and lungs. This can cause a condition called cor pulmonale, in which a section of the heart expands and weakens.

Large holes in the lungs (giant bullae). Some people with emphysema develop empty spaces in the lungs called bullae. Giant bullae can be as large as half the lung. In addition to reducing the amount of space available for the lung to expand, giant bullae can become infected and are more prone to causing a collapsed lung (pneumothorax). Treatment and drugs: Emphysema can't be cured, but treatments can help relieve symptoms and slow the progression of the disease. Medications Smoking cessation drugs. Prescription medications, such as bupropion hydrochloride (Zyban) and varenicline (Chantix), can help you quit smoking. Bronchodilators. These drugs can help relieve coughing, shortness of breath and trouble breathing by relaxing constricted airways, but they're not as effective in treating emphysema as they are in treating asthma or chronic bronchitis. Inhaled steroids. Corticosteroid drugs inhaled as aerosol sprays may help relieve shortness of breath. But prolonged use can weaken your bones and increase your risk of high blood pressure, cataracts and diabetes. Antibiotics. If you develop a bacterial infection, like acute bronchitis or pneumonia, antibiotics are appropriate. Therapy Pulmonary rehabilitation. A pulmonary rehabilitation program can teach you breathing exercises and techniques that may help reduce your breathlessness and improve your ability to exercise. You'll also receive advice about proper nutrition. In the early stages of emphysema, many people need to lose weight, while people with late-stage emphysema often need to gain weight. Supplemental oxygen. If you have severe emphysema with low blood oxygen levels, using oxygen regularly at home and when you exercise may provide some relief. Many people use oxygen 24 hours a day. It's usually administered via narrow tubing that fits into your nostrils. Surgery Depending on the severity of your emphysema, your doctor may suggest one or more different types of surgery, including: Lung volume reduction. In this procedure, surgeons remove small wedges of damaged lung tissue. Removing the diseased tissue helps the remaining lung tissue work more efficiently and helps improve breathing. Lung transplant. Lung transplantation is an option if you have severe emphysema and other options have failed. BRONCHITIS Bronchitis is an inflammation of the lining of your bronchial tubes, which carry air to and from your lungs. Bronchitis may be either acute or chronic. Often developing from a cold or other respiratory infection, acute bronchitis is very common. Chronic bronchitis, a more serious condition, is a constant irritation or inflammation of the lining of the bronchial tubes, often due to smoking. Acute bronchitis usually improves within a few days without lasting effects, although you may continue to cough for weeks. However, if you have repeated bouts of bronchitis, you may have chronic bronchitis, which requires medical attention. Chronic bronchitis is one of the conditions included in chronic obstructive pulmonary disease (COPD). Treatment for bronchitis focuses on relieving your symptoms and easing your breathing. Symptoms: For either acute bronchitis or chronic bronchitis, signs and symptoms may include: 1. Cough 2. Production of mucus (sputum), which can be clear, white, yellowish-gray or green in color 3. Fatigue 4. Slight fever and chills 5. Chest discomfort If you have acute bronchitis, you may have a nagging cough that lingers for several weeks after the bronchitis resolves. Chronic bronchitis is defined as a productive cough that lasts at least three months for two consecutive years. If you have chronic bronchitis, you're likely to have periods when your signs and symptoms worsen. At those times, you may have acute bronchitis on top of your chronic bronchitis. In some cases, the cough may disappear only to reappear later. When to see a doctor: See your doctor if your cough: Lasts more than three weeks Prevents you from sleeping Is accompanied by fever over 100.4 F (38 C) Produces discolored mucus Produces blood (hemoptysis) Is associated with wheezing or shortness of breath Causes: Acute bronchitis is usually caused by viruses, typically the same viruses that cause colds and influenza. Antibiotics don't kill viruses, so this type of medication isn't useful in most cases of bronchitis. The most common cause of chronic bronchitis is smoking cigarettes. Air pollution and dust or toxic gases in the environment or workplace also can contribute to the condition. Risk Factors: Factors that increase your risk of bronchitis include: Cigarette smoke. People who smoke or who live with a smoker are at higher risk of both acute bronchitis and chronic bronchitis. Low resistance. This may result from another acute illness, such as a cold, or from a chronic condition that compromises your immune system. Older adults, infants and young children have greater vulnerability to infection. Exposure to irritants on the job. Your risk of developing bronchitis is greater if you work around certain lung irritants, such as grains or textiles, or are exposed to chemical fumes. Complications: Although a single episode of bronchitis usually isn't cause for concern, it can lead to pneumonia in some people. Repeated bouts of bronchitis may signal: 1. Chronic bronchitis

2. 3. 4. 5. 6.

Asthma Bronchiectasis Cystic fibrosis Tuberculosis Sinusitis

Treatments and drugs: The goal of treatment for bronchitis is to relieve symptoms and ease breathing. In most cases, acute bronchitis requires only self-care treatments such as: Getting more rest Taking over-the-counter pain medications Drinking fluids Breathing in warm, moist air Medications In some circumstances, your doctor may prescribe medications, including: Antibiotics. Bronchitis usually results from a viral infection, so antibiotics aren't effective. However, your doctor may prescribe an antibiotic if he or she suspects that you have a bacterial infection. If you have a chronic lung disorder or if you smoke, your doctor may also prescribe antibiotics to reduce your risk of a serious, secondary infection. Cough medicine. It's best not to suppress a cough that brings up mucus, because coughing helps remove irritants from your lungs and air passages. Over-the-counter cough medicine may help if your cough keeps you from sleeping. Other medications. If you have asthma or chronic obstructive pulmonary disease (COPD), your doctor may recommend an inhaler and other medications to reduce inflammation and open narrowed passages in your lungs. Therapies If you have chronic bronchitis, you may benefit from pulmonary rehabilitation a breathing exercise program in which a respiratory therapist teaches you how to breathe more easily and increase your ability to exercise. COMMON COLD The common cold is a viral infection of your upper respiratory tract your nose and throat. A common cold is usually harmless, although it may not feel that way at the time. If it's not a runny nose, sore throat and cough, it's the watery eyes, sneezing and congestion or maybe all of the above. In fact, because any one of more than 100 viruses can cause a common cold, signs and symptoms tend to vary greatly. Preschool children are at greatest risk of frequent colds, but even healthy adults can expect to have a few colds each year. Most people recover from a common cold in about a week or two. If symptoms don't improve, see your doctor. Symptoms: Symptoms of a common cold usually appear about one to three days after exposure to a cold-causing virus. Signs and symptoms of a common cold may include: Runny or stuffy nose Slight body aches or a mild Low-grade fever headache Itchy or sore throat Mild fatigue Sneezing Cough Watery eyes Congestion The discharge from your nose may become thicker and yellow or green in color as a common cold runs its course. What makes a cold different from other viral infections is that you generally won't have a high fever. You're also unlikely to experience significant fatigue from a common cold. When to see a doctor: For adults seek medical attention if you have: Fever of 103 F (39.4 C) or higher Significantly swollen glands Fever accompanied by sweating, chills and a cough Severe sinus pain with colored phlegm For children in general, children are sicker with a common cold than adults are and often develop complications, such as ear infections. Your child doesn't need to see the doctor for a routine common cold. But seek medical attention right away if your child has any of the following signs or symptoms: Fever of 100.4 F (38 C) in newborns up to 12 weeks Vomiting or abdominal pain Fever that rises repeatedly above 104 F (40 C) in a Unusual sleepiness child of any age Severe headache Signs of dehydration, such as urinating less often Stiff neck than usual Difficulty breathing Not drinking adequate fluids Persistent crying Fever that lasts more than 24 hours in a child Ear pain younger than 2 Persistent cough Fever that lasts more than three days in a child older than 2 Causes: Although more than 100 viruses can cause a common cold, the rhinovirus is the most common culprit, and it's highly contagious. A cold virus enters your body through your mouth, eyes or nose. The virus can spread through droplets in the air when someone who is sick coughs, sneezes or talks. But it also spreads by hand-to-hand contact with someone who has a cold or by sharing contaminated objects, such as utensils, towels, toys or telephones. If you touch your eyes, nose or mouth after such contact or exposure, you're likely to catch a cold. Risk Factors: Cold viruses are almost always present in the environment. But the following factors can increase your chances of getting a cold: Age. Infants and preschool children are especially susceptible to common colds because they haven't yet developed resistance to most of the viruses that cause them. But an immature immune system isn't the only thing that makes kids vulnerable. They also

tend to spend lots of time with other children and frequently aren't careful about washing their hands and covering their mouths and noses when they cough and sneeze. Colds in newborns can be problematic if they interfere with nursing or breathing through the nose. Immunity. As you age, you develop immunity to many of the viruses that cause common colds. You'll have colds less frequently than you did as a child. However, you can still come down with a cold when you are exposed to cold viruses or have a weakened immune system. All of these factors increase your risk of a cold. Time of year. Both children and adults are more susceptible to colds in fall and winter. That's because children are in school and most people spend a lot of time indoors. In warmer climates where cold weather doesn't keep people inside, colds are more frequent in the rainy season.

Complications: Acute ear infection (otitis media). Ear infection occurs when bacteria or viruses infiltrate the space behind the eardrum. It's a frequent complication of common colds in children. Typical signs and symptoms include earaches and, in some cases, a green or yellow discharge from the nose or the return of a fever following a common cold. Children who are too young to verbalize their distress may simply cry or sleep restlessly. Ear pulling is not a reliable sign. Wheezing. A cold can trigger wheezing in children with asthma. Sinusitis. In adults or children, a common cold that doesn't resolve may lead to sinusitis inflammation and infection of the sinuses. Other secondary infections. These include strep throat (streptococcal pharyngitis), pneumonia, and croup or bronchiolitis in children. These infections need to be treated by a doctor. Treatments and drugs: There's no cure for the common cold. Antibiotics are of no use against cold viruses. Over-the-counter (OTC) cold preparations won't cure a common cold or make it go away any sooner, and most have side effects. Here's a look at the pros and cons of some common cold remedies. Pain relievers. For fever, sore throat and headache, many people turn to acetaminophen (Tylenol, others) or other mild pain relievers. Keep in mind that acetaminophen can cause liver damage, especially if taken frequently or in larger than recommended doses. Don't give acetaminophen to children under 3 months of age, and be especially careful when giving acetaminophen to older babies and children because the dosing guidelines can be confusing. For instance, the infant-drop formulation is much more concentrated than the syrup commonly used in older children. Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children. Decongestant nasal sprays. Adults shouldn't use decongestant drops or sprays for more than a few days because prolonged use can cause chronic rebound inflammation of mucous membranes. And children shouldn't use decongestant drops or sprays at all. There's little evidence that they work in young children, and they may cause side effects. Cough syrups. The Food and Drug Administration (FDA) and the American Academy of Pediatrics strongly recommend against giving OTC cough and cold medicines to children younger than age 2. Over-the-counter cough and cold medicines don't effectively treat the underlying cause of a child's cold, and won't cure a child's cold or make it go away any sooner. These medications also have potential side effects, including rapid heart rate and convulsions. FDA experts are studying the safety of cough and cold medicines for children older than age 2. In the meantime, remember that cough and cold medicines won't make a cold go away any sooner and side effects are still possible. If you give cough or cold medicines to an older child, carefully follow the label directions. Don't give your child two medicines with the same active ingredient, such as an antihistamine, decongestant or pain reliever. Too much of a single ingredient could lead to an accidental overdose. ASTHMA Asthma is a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath. For some people, asthma is a minor nuisance. For others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack. Asthma can't be cured, but its symptoms can be controlled. Because asthma often changes over time, it's important that you work with your doctor to track your signs and symptoms and adjust treatment as needed. Symptoms: Asthma symptoms range from minor to severe and vary from person to person. You may have infrequent asthma attacks, have symptoms only at certain times such as when exercising or have symptoms all the time. Asthma signs and symptoms include: Shortness of breath Chest tightness or pain Trouble sleeping caused by shortness of breath, coughing or wheezing A whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children) Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu Signs that your asthma is probably worsening include: Asthma signs and symptoms that are more frequent and bothersome Increasing difficulty breathing (measurable with a peak flow meter, a device used to check how well your lungs are working) The need to use a quick-relief inhaler more often For some people, asthma symptoms flare up in certain situations: Exercise-induced asthma, which may be worse when the air is cold and dry Occupational asthma, triggered by workplace irritants such as chemical fumes, gases or dust Allergy-induced asthma, triggered by particular allergens, such as pet dander, cockroaches or pollen When to see a doctor: Seek emergency treatment

Severe asthma attacks can be life-threatening. Work with your doctor ahead of time to determine what to do when your signs and symptoms worsen and when you need emergency treatment. Signs of an asthma emergency include: Rapid worsening of shortness of breath or wheezing No improvement even after using a quick-relief inhaler, such as albuterol Shortness of breath when you are doing minimal physical activity Contact your doctor If you think you have asthma. If you have frequent coughing or wheezing that lasts more than a few days or any other signs or symptoms of asthma, see your doctor. Treating asthma early may prevent long-term lung damage and help keep the condition from worsening over time. To monitor your asthma after diagnosis. If you know you have asthma, work with your doctor to keep it under control. Good longterm control helps you feel better on a daily basis and can prevent a life-threatening asthma attack. If your asthma symptoms get worse. Contact your doctor right away if your medication doesn't seem to ease your symptoms or if you need to use your quick-relief inhaler more often. Don't try to solve the problem by taking more medication without consulting your doctor. Overusing asthma medication can cause side effects and may make your asthma worse. To review your treatment. Asthma often changes over time. Meet with your doctor on a regular basis to discuss your symptoms and make any needed treatment adjustments. Causes: It isn't clear why some people get asthma and others don't, but it's probably due to a combination of environmental and genetic (inherited) factors. Asthma triggers Exposure to various substances that trigger allergies (allergens) and irritants can trigger signs and symptoms of asthma. Asthma triggers are different from person to person and can include: Airborne allergens, such as pollen, animal dander, mold, cockroaches and dust mites Allergic reactions to some foods, such as peanuts or shellfish Respiratory infections, such as the common cold Physical activity (exercise-induced asthma) Cold air Air pollutants and irritants, such as smoke Certain medications, including beta blockers, aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve) Strong emotions and stress Sulfites and preservatives added to some types of foods and beverages Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat Menstrual cycle in some women Risk Factors: A number of factors are thought to increase your chances of developing asthma. These include: Having a blood relative (such as a parent or sibling) with asthma Having another allergic condition, such as atopic dermatitis or allergic rhinitis (hay fever) Being overweight Being a smoker Exposure to secondhand smoke Having a mother who smoked while pregnant Exposure to exhaust fumes or other types of pollution Exposure to occupational triggers, such as chemicals used in farming, hairdressing and manufacturing Low birth weight Exposure to allergens, exposure to certain germs or parasites, and having some types of bacterial or viral infections also may be risk factors. However, more research is needed to determine what role they may play in developing asthma. Complications: Asthma complications include: Symptoms that interfere with sleep, work or recreational activities Sick days from work or school during asthma flare-ups Permanent narrowing of the bronchial tubes (airway remodeling) that affects how well you can breathe Emergency room visits and hospitalizations for severe asthma attacks Side effects from long-term use of some medications used to stabilize severe asthma Proper treatment makes a big difference in preventing both short-term and long-term complications caused by asthma. Treatments and drugs: Prevention and long-term control are key in stopping asthma attacks before they start. Treatment usually involves learning to recognize your triggers and taking steps to avoid them, and tracking your breathing to make sure your daily asthma medications are keeping symptoms under control. In case of an asthma flare-up, you may need to use a quick-relief inhaler, such as albuterol. Medications The right medications for you depend on a number of things, including your age, your symptoms, your asthma triggers and what seems to work best to keep your asthma under control. Preventive, long-term control medications reduce the inflammation in your airways that leads to symptoms. Quick-relief inhalers (bronchodilators) quickly open swollen airways that are limiting breathing. In some cases, allergy medications are necessary. Long-term asthma control medications, generally taken daily, are the cornerstone of asthma treatment. These medications keep asthma under control on a day-to-day basis and make it less likely you'll have an asthma attack. Types of long-term control medications include: Inhaled corticosteroids. These medications include fluticasone (Flovent Diskus, Flonase), budesonide (Pulmicort, Rhinocort), mometasone (Nasonex, Asmanex Twisthaler), ciclesonide (Alvesco, Omnaris), flunisolide (Aerobid, Aerospan HFA), beclomethasone (Qvar, Qnasl) and others. You may need to use these medications for several days to weeks before they reach

their maximum benefit. Unlike oral corticosteroids, these corticosteroid medications have a relatively low risk of side effects and are generally safe for long-term use. Leukotriene modifiers. These oral medications including montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo) help relieve asthma symptoms for up to 24 hours. In rare cases, these medications have been linked to psychological reactions, such as agitation, aggression, hallucinations, depression and suicidal thinking. Seek medical advice right away for any unusual reaction. Long-acting beta agonists. These inhaled medications, which include salmeterol (Serevent) and formoterol (Foradil, Perforomist), open the airways. Some research shows that they may increase the risk of a severe asthma attack, so take them only in combination with an inhaled corticosteroid. And because these drugs can mask asthma deterioration, don't use them for an acute asthma attack. Combination inhalers. These medications such as fluticasone-salmeterol (Advair Diskus), budesonide-formoterol (Symbicort) and mometasone-formoterol (Dulera) contain a long-acting beta agonist along with a corticosteroid. Because these combination inhalers contain long-acting beta agonists, they may increase your risk of having a severe asthma attack. Theophylline. Theophylline (Theo-24, Elixophyllin, others) is a daily pill that helps keep the airways open (bronchodilator) by relaxing the muscles around the airways. It's not used as often now as in past years. Quick-relief (rescue) medications are used as needed for rapid, short-term symptom relief during an asthma attack or before exercise if your doctor recommends it. Types of quick-relief medications include: Short-acting beta agonists. These inhaled, quick-relief bronchodilators act within minutes to rapidly ease symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex HFA) and pirbuterol (Maxair). Short-acting beta agonists can be taken using a portable, hand-held inhaler or a nebulizer a machine that converts asthma medications to a fine mist, so they can be inhaled through a face mask or a mouthpiece. Ipratropium (Atrovent). Like other bronchodilators, ipratropium acts quickly to immediately relax your airways, making it easier to breathe. Ipratropium is mostly used for emphysema and chronic bronchitis, but it's sometimes used to treat asthma attacks. Oral and intravenous corticosteroids. These medications which include prednisone and methylprednisolone relieve airway inflammation caused by severe asthma. They can cause serious side effects when used long term, so they're used only on a shortterm basis to treat severe asthma symptoms. If you have an asthma flare-up, a quick-relief inhaler can ease your symptoms right away. But if your long-term control medications are working properly, you shouldn't need to use your quick-relief inhaler very often. Keep a record of how many puffs you use each week. If you need to use your quick-relief inhaler more often than your doctor recommends, see your doctor. You probably need to adjust your long-term control medication. Allergy medications may help if your asthma is triggered or worsened by allergies. These include: Allergy shots (immunotherapy). Over time, allergy shots gradually reduce your immune system reaction to specific allergens. You generally receive shots once a week for a few months, then once a month for a period of three to five years. Omalizumab (Xolair). This medication, given as an injection every two to four weeks, is specifically for people who have allergies and severe asthma. It acts by altering the immune system. Allergy medications. These include oral and nasal spray antihistamines and decongestants as well as corticosteroid and cromolyn nasal sprays. Bronchial thermoplasty This treatment which isn't widely available nor right for everyone is used for severe asthma that doesn't improve with inhaled corticosteroids or other long-term asthma medications. Generally, over the span of three outpatient visits, bronchial thermoplasty heats the insides of the airways in the lungs with an electrode, reducing the smooth muscle inside the airways. This limits the ability of the airways to tighten, making breathing easier and possibly reducing asthma attacks. Treat by severity for better control: A stepwise approach Your treatment should be flexible and based on changes in your symptoms, which should be assessed thoroughly each time you see your doctor. Then, your doctor can adjust your treatment accordingly. For example, if your asthma is well controlled, your doctor may prescribe less medicine. If your asthma isn't well controlled or is getting worse, your doctor may increase your medication and recommend morefrequent visits. Asthma action plan Work with your doctor to create an asthma action plan that outlines in writing when to take certain medications, or when to increase or decrease the dose of your medications based on your symptoms. Also include a list of your triggers and the steps you need to take to avoid them. Your doctor may also recommend tracking your asthma symptoms or using a peak flow meter on a regular basis to monitor how well your treatment is controlling your asthma. PNEUMONIA Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus, causing cough with phlegm or pus, fever, chills and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia. Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants and young children, people older than age 65, and people with underlying health problems or weakened immune systems. Antibiotics and antiviral medications can treat many common forms of pneumonia. Symptoms: The signs and symptoms of pneumonia vary from mild to severe, depending upon factors such as the type of germ causing the infection and your age and overall health. Mild signs and symptoms often are similar to those of a cold or flu, but they last longer. Signs and symptoms of pneumonia include: Fever, sweating and shaking chills Lower than normal body temperature in people older than age 65, and in people with poor overall health or weakened immune systems Cough, which may produce thick, sticky fluid Chest pain when you breathe deeply or cough Shortness of breath

 Fatigue and muscle aches Nausea, vomiting or diarrhea Headache Newborns and infants may not show any sign of the infection. Or they may vomit, have a fever and cough, appear restless or tired and without energy, or have difficulty breathing and eating. Older people who have pneumonia sometimes have sudden changes in mental awareness. When to see a doctor See your doctor if you have difficulty breathing, chest pain, persistent fever of 102 F (39 C) or higher or persistent cough, especially if you are coughing up pus. It's especially important to see a doctor if: A child with signs and symptoms is younger than age 2 You are older than age 65 You have an underlying health condition or weakened immune system You're having chemotherapy or taking medication that suppresses your immune system For some older adults and people with heart failure or lung ailments, pneumonia can quickly become a life-threatening condition. Causes: Pneumonia has many possible causes. The most common are bacteria and viruses in the air we breathe. Your body usually prevents these germs from infecting your lungs. But sometimes these germs can overpower your immune system, even if your health is generally good. Pneumonia is classified according to the types of germs that cause it, and where you acquired the infection. Community-acquired pneumonia Community-acquired pneumonia is the most common type of pneumonia. It occurs outside of hospitals and other health care facilities, and may be caused by: Bacteria, such as Streptococcus pneumoniae. Bacterial community-acquired pneumonia can occur on its own or after you have a cold or respiratory flu. This type of pneumonia often affects one area (lobe) of the lung, a condition called lobar pneumonia. Bacteria-like organisms, such as Mycoplasma pneumoniae, which typically produce milder signs and symptoms than do other types of pneumonia. "Walking pneumonia," a term used to describe pneumonia that isn't severe enough to require bed rest, may result from Mycoplasma pneumoniae. Viruses, including some that are the same type of viruses that cause colds and flu. Viruses are the most common cause of pneumonia in children younger than 2 years. Viral pneumonia is usually mild. But viral pneumonia caused by certain influenza viruses, such as sudden acute respiratory syndrome (SARS), can become very serious. Fungi, which can be found in soil and in bird droppings. This type of pneumonia is most common in people with an underlying health problem or weakened immune system and in people who have inhaled a large dose of the organisms. Hospital-acquired pneumonia Hospital-acquired pneumonia is a bacterial infection that occurs in people 48 hours or more after being hospitalized for another condition. Hospital-acquired pneumonia can be serious because the bacteria causing it may be more resistant to antibiotics. People who are on a breathing machine (ventilator), often used in intensive care units, are at higher risk of this type of pneumonia. Health care-acquired pneumonia Health care-acquired pneumonia is a bacterial infection that occurs in people who are living in long-term care facilities or have been treated in outpatient clinics, including kidney dialysis centers. Like hospital-acquired pneumonia, health care-acquired pneumonia can be caused by bacteria more resistant to antibiotics. Aspiration pneumonia Aspiration pneumonia occurs when you inhale food, drink, vomit or saliva into your lungs. This aspiration may happen if something disturbs your normal gag reflex, such as a brain injury, swallowing problem, or excessive use of alcohol or drugs. Risk Factors: Pneumonia can affect anyone. But the two age groups at highest risk are: Infants and children younger than age 2 years, because their immune systems are still developing People older than age 65 Other risk factors include: Certain chronic diseases, such as asthma, chronic obstructive pulmonary disease and heart disease Weakened or suppressed immune system, due to factors such as HIV/AIDS, organ transplant, chemotherapy for cancer or longterm steroid use Smoking, which damages your body's natural defenses against the bacteria and viruses that cause pneumonia Being placed on a ventilator while hospitalized Complications: Often, people who have pneumonia can be treated successfully with medication. But some people, especially those in highrisk groups, may experience complications, including: Bacteria in the bloodstream (bacteremia). Bacteria that enter the bloodstream from your lungs can spread the infection to other organs, potentially causing organ failure. Lung abscess. An abscess occurs if pus forms in a cavity in the lung. An abscess is usually treated with antibiotics. Sometimes, surgery or drainage with a long needle or tube placed into the abscess is needed to remove the pus. Fluid accumulation around your lungs (pleural effusion).Pneumonia may cause fluid to build up in the thin space between layers of tissue that line the lungs and chest cavity (pleura). If the fluid becomes infected, you may need to have it drained through a chest tube or removed with surgery. Difficulty breathing. If your pneumonia is severe or you have chronic underlying lung diseases, you may have trouble breathing in enough oxygen. You may need to be hospitalized and use a mechanical ventilator while your lung heals. Treatments and drugs: Your doctor will start by asking about your medical history and doing a physical exam, including listening to your lungs with a stethoscope to check for abnormal bubbling or crackling sounds that indicate the presence of thick liquid.

If pneumonia is suspected, your doctor may recommend: Chest X-rays, to confirm the presence of pneumonia and determine the extent and location of the infection. Blood tests, to confirm the presence of infection and to try to identify the type of organism causing the infection. Precise identification occurs in only about half of people with pneumonia. Pulse oximetry, to measure the oxygen level in your blood. Pneumonia can prevent your lungs from moving enough oxygen into your bloodstream. Sputum test. A sample of fluid from yours lungs (sputum) is taken after a deep cough, and analyzed to pinpoint the type of infection. If you are older than age 65, are in the hospital or have serious symptoms or an underlying health condition, your doctor may recommend: Pleural fluid culture. A fluid sample is taken from the pleural area and analyzed to help determine the type of infection. Bronchoscopy. A thin, flexible tube with a camera is inserted down your throat and through your airways to check whether something is blocking the airways or whether something else is contributing to your pneumonia. If your pneumonia isn't clearing as quickly as expected, your doctor may recommend a chest CT scan to obtain a more detailed image of your lungs. LUNG CANCER Lung cancer is a type of cancer that begins in the lungs. Your lungs are two spongy organs in your chest that take in oxygen when you inhale and release carbon dioxide when you exhale. Lung cancer is the leading cause of cancer deaths in the United States, among both men and women. Lung cancer claims more lives each year than do colon, prostate, ovarian and breast cancers combined. People who smoke have the greatest risk of lung cancer. The risk of lung cancer increases with the length of time and number of cigarettes you've smoked. If you quit smoking, even after smoking for many years, you can significantly reduce your chances of developing lung cancer. Symptoms: Lung cancer typically doesn't cause signs and symptoms in its earliest stages. Signs and symptoms of lung cancer typically occur only when the disease is advanced. Signs and symptoms of lung cancer may include: A new cough that doesn't go away Changes in a chronic cough or "smoker's cough" Coughing up blood, even a small amount Shortness of breath Chest pain Wheezing Hoarseness Losing weight without trying Bone pain Headache When to see a doctor Make an appointment with your doctor if you have any signs or symptoms that worry you. If you smoke and have been unable to quit, make an appointment with your doctor. Your doctor can recommend strategies for quitting smoking, such as counseling, medications and nicotine replacement products. Causes: Smoking causes the majority of lung cancers both in smokers and in people exposed to secondhand smoke. But lung cancer also occurs in people who never smoked and in those who never had prolonged exposure to secondhand smoke. In these cases, there may be no clear cause of lung cancer. How smoking causes lung cancer Doctors believe smoking causes lung cancer by damaging the cells that line the lungs. When you inhale cigarette smoke, which is full of cancer-causing substances (carcinogens), changes in the lung tissue begin almost immediately. At first your body may be able to repair this damage. But with each repeated exposure, normal cells that line your lungs are increasingly damaged. Over time, the damage causes cells to act abnormally and eventually cancer may develop. Types of lung cancer Doctors divide lung cancer into two major types based on the appearance of lung cancer cells under the microscope. Your doctor makes treatment decisions based on which major type of lung cancer you have. The two general types of lung cancer include: Small cell lung cancer. Small cell lung cancer occurs almost exclusively in heavy smokers and is less common than non-small cell lung cancer. Non-small cell lung cancer. Non-small cell lung cancer is an umbrella term for several types of lung cancers that behave in a similar way. Non-small cell lung cancers include squamous cell carcinoma, adenocarcinoma and large cell carcinoma. Risk Factors: A number of factors may increase your risk of lung cancer. Some risk factors can be controlled, for instance, by quitting smoking. And other factors can't be controlled, such as your family history. Risk factors for lung cancer include: Smoking. Smoking remains the greatest risk factor for lung cancer. Your risk of lung cancer increases with the number of cigarettes you smoke each day and the number of years you have smoked. Quitting at any age can significantly lower your risk of developing lung cancer. Exposure to secondhand smoke. Even if you don't smoke, your risk of lung cancer increases if you're exposed to secondhand smoke. Exposure to radon gas. Radon is produced by the natural breakdown of uranium in soil, rock and water that eventually becomes part of the air you breathe. Unsafe levels of radon can accumulate in any building, including homes. Radon testing kits, which can be purchased at home improvement stores, can determine whether levels are safe. If unsafe levels are discovered, remedies are available. Exposure to asbestos and other chemicals. Workplace exposure to asbestos and other substances known to cause cancer such as arsenic, chromium and nickel also can increase your risk of developing lung cancer, especially if you're a smoker.

Family history of lung cancer. People with a parent, sibling or child with lung cancer have an increased risk of the disease. Excessive alcohol use. Drinking more than a moderate amount of alcohol no more than one drink a day for women or two drinks a day for men may increase your risk of lung cancer. Certain smoking-related lung diseases. Smokers with certain lung diseases, such as emphysema, may have an increased risk of lung cancer.

Complications: Lung cancer can cause complications, such as: Shortness of breath. People with lung cancer can experience shortness of breath if cancer grows to block the major airways. Lung cancer can also cause fluid to accumulate around the lungs, making it harder for the affected lung to expand fully when you inhale. Coughing up blood. Lung cancer can cause bleeding in the airway, which can cause you to cough up blood (hemoptysis). Sometimes bleeding can become severe. Treatments are available to control bleeding. Pain. Advanced lung cancer that spreads to the lining of a lung or to another area of the body, such as a bone, can cause pain. Tell your doctor if you experience pain. Pain may initially be mild and intermittent, but can become constant. Medications, radiation therapy and other treatments may help make you more comfortable. Fluid in the chest (pleural effusion). Lung cancer can cause fluid to accumulate in the space that surrounds the affected lung in the chest cavity (pleural space). Pleural effusion can result from cancer spreading outside the lungs or in reaction to lung cancer inside the lungs. Fluid accumulating in the chest can cause shortness of breath. Treatments are available to drain the fluid from your chest and reduce the risk that pleural effusion will occur again. Cancer that spreads to other parts of the body (metastasis). Lung cancer often spreads (metastasizes) to other parts of the body most commonly the brain, bones, liver and adrenal glands. Cancer that spreads can cause pain, nausea, headaches, or other signs and symptoms depending on what organ is affected. In some cases, treatments are available for isolated metastasis, but in most cases, the goal of treatment for metastasis is only to relieve signs and symptoms. Death. Unfortunately, survival rates for people diagnosed with lung cancer are very low. In most cases, the disease is fatal. People diagnosed at the earliest stages have the greatest chances for a cure. Your doctor can discuss your chances for survival with you. Treatments and drugs: Testing healthy people for lung cancer Doctors aren't sure whether people with no signs or symptoms of lung cancer should undergo screening for the disease. Some studies show that lung cancer screening may save lives by finding cancer earlier, when it may be treated more successfully. But other studies find that lung cancer screening often reveals more benign conditions that require invasive testing and expose people to unnecessary risks. Screening for lung cancer is controversial among doctors. Studies are ongoing to determine what types of tests may be helpful and who would benefit from lung cancer screening. In the meantime, talk with your doctor if you're concerned about your risk of lung cancer. Together you can determine strategies to reduce your risk and decide whether screening tests are appropriate for you. Tests to diagnose lung cancer If there's reason to think that you may have lung cancer, your doctor can order a number of tests to look for cancerous cells and to rule out other conditions. In order to diagnose lung cancer, your doctor may recommend: Imaging tests. An X-ray image of your lungs may reveal an abnormal mass or nodule. A CT scan can reveal small lesions in your lungs that might not be detected on an X-ray. Sputum cytology. If you have a cough and are producing sputum, looking at the sputum under the microscope can sometimes reveal the presence of lung cancer cells. Tissue sample (biopsy). A sample of abnormal cells may be removed in a procedure called a biopsy. Your doctor can perform a biopsy in a number of ways, including bronchoscopy, in which your doctor examines abnormal areas of your lungs using a lighted tube that's passed down your throat and into your lungs; mediastinoscopy, in which an incision is made at the base of your neck and surgical tools are inserted behind your breastbone to take tissue samples from lymph nodes; and needle biopsy, in which your doctor uses X-ray or CT images to guide a needle through your chest wall and into the lung tissue to collect suspicious cells. A biopsy sample may also be taken from lymph nodes or other areas where cancer has spread, such as your liver. Lung cancer staging Once your lung cancer has been diagnosed, your doctor will work to determine the extent, or stage, of your cancer. Your cancer's stage helps you and your doctor decide what treatment is most appropriate. Staging tests may include imaging procedures that allow your doctor to look for evidence that cancer has spread beyond your lungs. These tests include CT scans, magnetic resonance imaging (MRI), positron emission tomography (PET) and bone scans. Not every test is appropriate for every person, so talk with your doctor about which procedures are right for you. Stages of lung cancer Stage I. Cancer is limited to the lung and hasn't spread to the lymph nodes. The tumor is generally smaller than 2 inches (5 centimeters) across. Stage II. The tumor at this stage may have grown larger than 2 inches, or it may be a smaller tumor that involves nearby structures, such as the chest wall, the diaphragm or the lining around the lungs (pleura). Cancer may also have spread to the nearby lymph nodes. Stage III. The tumor at this stage may have grown very large and invaded other organs near the lungs. Or this stage may indicate a smaller tumor accompanied by cancer cells in lymph nodes farther away from the lungs. Stage IV. Cancer has spread beyond the affected lung to the other lung or to distant areas of the body. Small cell lung cancer is sometimes described as being limited or extensive. Limited indicates cancer is limited to one lung. Extensive indicates cancer has spread beyond the one lung.