Pulmonology

Asthma is a condition in which your airways narrow and swell and may produce extra mucus. This can make breathing difficult and trigger coughing, a whistling sound (wheezing) when you breathe out and shortness of breath.

Symptoms include:

• Shortness of breath
• Chest tightness or pain
• Wheezing when exhaling
• Trouble sleeping caused by shortness of breath, coughing, or wheezing
• Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu

A chronic cough is a cough that lasts eight weeks or longer in adults. A chronic cough is more than just an annoyance. A chronic cough can interrupt your sleep and leave you feeling exhausted. Severe cases of chronic cough can cause vomiting, lightheadedness and even rib fractures. While it can sometimes be difficult to pinpoint the problem that's triggering a chronic cough, the most common causes are tobacco use, postnasal drip, asthma and acid reflux. Fortunately, chronic cough typically disappears once the underlying problem is treated.

A chronic cough can occur with other signs and symptoms, which may include:

• A runny or stuffy nose
• A feeling of liquid running down the back of your throat (postnasal drip)
• Hoarseness
• Wheezing and shortness of breath
• Heartburn or a sour taste in your mouth
• In rare cases, coughing up blood

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. It's typically caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. People with CPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions. Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD. These two conditions usually occur together and can vary in severity among individuals with COPD.

COPD symptoms often don't appear until significant lung damage has occurred, and they usually worsen over time, particularly if smoking exposure continues. Signs and symptoms of COPD may include:

• Shortness of breath, especially during physical activities
• Wheezing
• Chest tightness
• Chronic cough that may produce mucus (sputum) that may be clear, white, yellow, or greenish
• Frequent respiratory infections
• Lack of energy
• Unintended weight loss (in later stages)
• Swelling in ankles, feet or legs

Emphysema is a lung condition that causes shortness of breath. In people with emphysema, the air sacs in the lungs (alveoli) are damaged. Over time, the inner walls of the air sacs weaken and rupture - creating larger air spaces instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream. When you exhale, the damaged alveoli don't work properly and old air becomes trapped, leaving no room for fresh, oxygen-rich air to enter. Most people with emphysema also have chronic bronchitis. Chronic bronchitis is inflammation of the tubes that carry air to your lungs (bronchial tubes), which leads to a persistent cough. Emphysema and chronic bronchitis are two conditions that make up chronic obstructive pulmonary disease (COPD). Smoking is the leading cause of COPD. Treatment may slow the progression of COPD, but it can't reverse the damage.

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 are at rest.

Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), 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 65, and people with health problems or weakened immune systems.

The signs and symptoms of pneumonia vary from mild to severe, depending on 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:

• Chest pain when you breath or cough
• Confusion or changes in mental awareness (in adults age 65 and older)
• Cough, which may produce phlegm
• Fatigue
• Fever, sweating and shaking chills
• Lower than normal body temperature (in adults older than 65 and people with weak immune systems)
• Nausea, vomiting or diarrhea
• Shortness of breath

Pulmonary edema is a condition caused by excess fluid in the lungs. This fluid collects in the numerous air sacs in the lungs, making it difficult to breathe. In most cases, heart problems cause pulmonary edema. But fluid can accumulate for other reasons, including pneumonia, exposure to certain toxins and medications, trauma to the chest wall, and visiting or exercising at high elevations.

Pulmonary edema that develops suddenly (acute pulmonary edema) is a medical emergency requiring immediate care. Pulmonary edema can sometimes be fatal, but the outlook improves if you get treated quickly. Treatment for pulmonary edema varies depending on the cause but generally includes supplemental oxygen and medications.

Depending on the cause, pulmonary edema signs and symptoms may appear suddenly or develop over time. Sudden (acute) pulmonary edema signs and symptoms:

• Extreme shortness of breath or difficulty breathing (dyspnea) that worsens with activity or when lying down
• A feeling of suffocating or drowning that worsens when lying down
• Wheezing or gasping for breath
• Cold, clammy skin
• Anxiety, restlessness or a sense of apprehension
• A cough that produces frothy sputum that may be tinged with blood
• Blue-tinged lips
• A rapid, irregular heartbeat (palpitations)

Pulmonary embolism is a blockage in one of the pulmonary arteries in your lungs. In most cases, pulmonary embolism is caused by blood clots that travel to the lungs from deep veins in the legs or, rarely, from veins in other parts of the body (deep vein thrombosis). Because the clots block blood flow to the lungs, pulmonary embolism can be life-threatening. However, prompt treatment greatly reduces the risk of death. Taking measures to prevent blood clots in your legs will help protect you against pulmonary embolism.

Pulmonary embolism symptoms can vary greatly, depending on how much of your lung is involved, the size of the clots, and whether you have underlying lung or heart disease. Common signs and symptoms include:

Shortness of breath. This symptom typically appears suddenly and always gets worse with exertion.

Chest pain. You may feel like you're having a heart attack. The pain is often sharp and felt when you breathe in deeply, often stopping you from being able to take a deep breath. It can also be felt when you cough, bend or stoop.

Cough. The cough may produce bloody or blood-streaked sputum.

Other signs and symptoms that can occur with pulmonary embolism include:

• Rapid or irregular heartbeat
• Lightheadedness or dizziness
• Excessive sweating
• Fever
• Leg pain or swelling, or both, usually in the calf caused by a deep vein thrombosis
• Clammy or discolored skin (cyanosis)

Pulmonary hypertension is a type of high blood pressure that affects the arteries in your lungs and the right side of your heart. In one form of pulmonary hypertension, called pulmonary arterial hypertension (PAH), blood vessels in your lungs are narrowed, blocked or destroyed. The damage slows blood flow through your lungs, and blood pressure in the lung arteries rises. Your heart must work harder to pump blood through your lungs. The extra effort eventually causes your heart muscle to become weak and fail. In some people, pulmonary hypertension slowly gets worse and can be life-threatening. Although there's no cure for some types of pulmonary hypertension, treatment can help reduce symptoms and improve your quality of life.

The signs and symptoms of pulmonary hypertension develop slowly. You may not notice them for months or even years. Symptoms get worse as the disease progresses. Pulmonary hypertension symptoms include:

• Shortness of breath (dyspnea), initially while exercising and eventually while at rest
• Fatigue
• Dizziness or fainting spells (syncope)
• Chest pressure or pain
• Swelling (edema) in your ankles, legs and eventually in your abdomen (ascites)
• Bluish color to your lips and skin (cyanosis)
• Racing pulse or heart palpitations

Few sensations are as frightening as not being able to get enough air. Shortness of breath — known medically as dyspnea — is often described as an intense tightening in the chest, air hunger, difficulty breathing, breathlessness or a feeling of suffocation.

Very strenuous exercise, extreme temperatures, obesity and higher altitude all can cause shortness of breath in a healthy person. Outside of these examples, shortness of breath is likely a sign of a medical problem. If you have unexplained shortness of breath, especially if it comes on suddenly and is severe, see your doctor as soon as possible.

Obstructive sleep apnea is a potentially serious sleep disorder. It causes breathing to repeatedly stop and start during sleep. There are several types of sleep apnea, but the most common is obstructive sleep apnea. This type of apnea occurs when your throat muscles intermittently relax and block your airway during sleep. A noticeable sign of obstructive sleep apnea is snoring. Treatments for obstructive sleep apnea are available. One treatment involves using a device that uses positive pressure to keep your airway open while you sleep. Another option is a mouthpiece to thrust your lower jaw forward during sleep. In some cases, surgery may be an option too.

Signs and symptoms of obstructive sleep apnea include:

• Excessive daytime sleepiness
• Loud snoring
• Observed episodes of stopped breathing during sleep
• Abrupt awakenings accompanied by gasping or choking
• Awakening with a dry mouth or sore throat
• Morning headache
• Difficulty concentrating during the day
• Experiencing mood changes, such as depression or irritability
• High blood pressure
• Nighttime sweating
• Decreased libido

Sarcoidosis is an inflammatory disease in which the immune system overreacts, causing groups of cells to form clusters of inflamed tissue called "granulomas" in one or more organs of the body.

• Sarcoidosis most commonly affects the lungs and lymph nodes, but it can affect any organ including the eyes, skin, heart and nervous system.
• Sarcoidosis is a rare disease with 150,000-200,000 cases in the United States per year and approximately 27,000 new cases per year.
• Lofgren's syndrome is an acute, milder form of sarcoidosis that usually goes away within six months to two years after diagnosis.
• Black women are three times more likely to be diagnosed with sarcoidosis than White women, tend to have more severe disease, are more likely to be hospitalized and have a higher mortality rate.
• In severe cases, sarcoidosis can be life-threatening if it progresses to heart or severe lung disease.
• Severe fatigue can impact up to 70% of patients with sarcoidosis even when inflammation is controlled with medication. Fatigue can be disabling, and lead to loss of work.

The main goals of treatment for sarcoidosis are managing symptoms, decreasing the risk of organ damage, and improving quality of life. You may go into remission, meaning that the condition is no longer causing any complications. If you have no symptoms or they are mild, you may not require treatment, however, it is important for you to continue to see a specialist to be monitored.

Specialists often use medications that will lower your immune system's activity. Immune lowering medications can increase your risk of infection, so it is important to talk to your healthcare provider about the benefits and risks of each medication.