Cystic fibrosis is a progressive inherited disorder most often associated with lung damage that limits breathing. It can also affect the pancreas and digestive tract. Most people with this disorder develop lung complications and frequent infections. Over time, this can lead to severe health consequences, like pneumonia, and even death.

This article discusses the link between cystic fibrosis and pneumonia as well as symptoms, causes, diagnosis, and treatment.

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What’s the Link Between Cystic Fibrosis and Pneumonia?

Cystic fibrosis is an inherited disorder that affects many organ systems, but its damage to the lungs is the most concerning problem. People develop frequent episodes of pneumonia or bronchitis, which can lead to severe complications and early death. 

The faulty gene causing cystic fibrosis disrupts the movement of salts and water in the body, which leads to a buildup of mucus in places that can damage organ systems. The buildup of thick mucus is most prominent in the lungs, making it difficult for a person to clear bacteria that enter the lungs. Thus, people with cystic fibrosis frequently develop bacterial pneumonia.

Over time, repeated episodes of pneumonia lead to chronic (long-term) lung damage. Additionally, the overuse of antibiotics to treat frequent infections leads to antibiotic resistance. Eventually, the lung damage is so severe and the treatments no longer effective that a person cannot survive.

How Many People Have Cystic Fibrosis?

Cystic fibrosis affects approximately 30,000 people in the United States.

Symptoms of Lung Infections

Cystic fibrosis affects many different organ systems. Often, the initial symptoms of the disease are due to problems in the pancreas and intestines. People with cystic fibrosis cannot digest food because of a lack of digestive enzymes from the pancreas, which leads to malnutrition.

Since cystic fibrosis is an inherited disorder, the symptoms can start when a person is a baby. The initial symptoms of lung disease are nonspecific and include:

Newborns in the United States are screened for cystic fibrosis so the illness can be detected and symptoms treated as early as possible. However, in places without neonatal screening for cystic fibrosis, these nonspecific lung symptoms are initially misdiagnosed as asthma, mild bronchitis, or pneumonia not related to an underlying lung problem.

Which Organs Are Affected by Cystic Fibrosis?

The two central organ systems affected by cystic fibrosis are the lungs and pancreas. However, two other common problems that people with cystic fibrosis develop include recurrent episodes of sinusitis and diabetes.

Causes of Pneumonia and Other Lung Infections

Bacteria and viruses constantly circulate in the environment, and they can be passed from one person to another through respiratory droplets, such as by coughing or sneezing. Most people can clear their lungs of these invaders by producing mucus that can be coughed up and expelled.

However, people with cystic fibrosis are unable to clear mucus from their lungs. When mucus mixed with bacteria sits for a long time in a part of the lung, the area becomes inflamed and the person develops pneumonia.

Bacterial Causes

Early in life, the bacterial organisms that usually lead to pneumonia in people with cystic fibrosis are:

  • Staphylococcus aureus
  • Haemophilus influenzae

As a person’s lungs become repeatedly damaged from recurrent infections, other, more unusual and dangerous bacteria cause pneumonia, including:

  • Pseudomonas aeruginosa
  • Burkholderia cepacia 
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • Stenotrophomonas maltophilia
  • Achromobacter xylosoxidans 

Once a person has been infected and has lived with Pseudomonas aeruginosa for a while, they develop severe lung infections more frequently, have a more rapid decline in lung function, and are at higher risk for death. 

Most Common Causes of Bacterial Pneumonia

Staphylococcus aureus is the most common bacterial organism found in children and adolescents with cystic fibrosis. The most common bacterium found in adults with cystic fibrosis is Pseudomonas aeruginosa.

Viral Causes

Like people without cystic fibrosis, people with cystic fibrosis can develop viral infections of the lungs, such as influenza and respiratory syncytial virus (RSV). People with cystic fibrosis are not more likely to develop a viral infection. Instead, they are sicker when a viral infection occurs compared with people who do not have cystic fibrosis. 

Fungal Causes

People with cystic fibrosis can also develop pneumonia caused by a fungus instead of a bacteria. The most common fungal organism that leads to pneumonia in patients with cystic fibrosis is Aspergillus fumigatus.

Diagnosis

In the United States, there is a nationwide program that screens newborn infants for cystic fibrosis. The screening is performed in the first few days of life from a few drops of blood. Different states use different screening tests to confirm the diagnosis.

Newborn screening tests are vital because they help parents and healthcare providers know when to begin specialized cystic fibrosis treatments. Initiating treatment early extends the time without complications. 

If an infant or a person suspected of having cystic fibrosis tests positive during the initial screening test, they are given an additional test. This definitive diagnostic test is called a sweat test. It measures the amount of electrolytes in a person's sweat.

What Are Autosomal Recessive Carriers?

Testing for cystic fibrosis involves looking for the gene responsible for the disease. Some people are carriers of the gene but do not develop the disease. This is because the gene is autosomal recessive (passing from both parents to a child). If you are one of these people, speak with your healthcare provider about what this means.

Treatment

When people are treated for pneumonia several times over several years, they eventually develop antibiotic resistance. When a particular bacteria is resistant to many different antibiotics, the organism is called a multidrug-resistant bacterium. Infections from these types of bacteria are complicated to treat and can lead to death from pneumonia in a person with cystic fibrosis.

Healthcare providers need to treat Pseudomonas aeruginosa colonization or pneumonia early to help clear the infection. People chronically infected with the specific bacteria are treated regularly with inhaled antibiotics, such as tobramycin, which helps prevent severe infection.

What to Do About Pseudomonas aeruginosa

People with cystic fibrosis do not develop Pseudomonas aeruginosa lung infections until they are older children, young adults, or adults. Research has shown that if a person is treated early for this bacterium and the organism is destroyed completely, people live longer.

Antibiotics and Antifungals

Treatment of acute lung infections requires antibiotics. The choice of antibiotic depends on the bacterial organism in the lungs and whether a person has developed resistance to antibiotics needed to kill it.

If a person develops fungal pneumonia, treatment involves an antifungal agent and corticosteroids.

Airway Clearance Techniques 

Since people with cystic fibrosis cannot clear mucus out of their lungs, other treatments include airway clearance techniques. Examples include:

These techniques help move the mucus up and out of the airway. Airway clearance techniques are recommended daily for people with cystic fibrosis.

Regular aerobic exercise is also recommended for patients with cystic fibrosis because it stabilizes lung function.

Inhaled Therapy

People with cystic fibrosis are also encouraged to use inhalers that rehydrate and break up the mucus so that it can be coughed up and expelled. The inhaled medications are called mucolytics and options include:

  • 7% hypertonic saline solution
  • Mannitol
  • Dornase alfa

Transplant

People with end-stage lung disease with cystic fibrosis are eligible for lung transplantation. People can often live an additional ten years after a lung transplant.

How to Prevent a Lung Infection

People with cystic fibrosis who are infected with Pseudomonas aeruginosa are started on chronic preventive therapy. Patients are treated with inhaled and oral antibiotics to prevent future bacterial pneumonia. The most commonly used antibiotics include:

Other general preventative measures recommended for anyone with respiratory symptoms include:

  • Handwashing
  • Using masks when in healthcare facilities or close contact with someone with a respiratory illness
  • Social distancing when needed
  • Cleaning and disinfecting nebulizers and other tools used by the cystic fibrosis patient

Summary

Cystic fibrosis is a chronic, inherited disorder that leads to frequent lung infections. Symptoms of a lung infection include cough, wheezing, and shortness of breath. People with cystic fibrosis can develop various types of pneumonia, but bacterial pneumonia is the most common.

In the United States, treatment for cystic fibrosis usually starts early because of widespread neonatal screening programs used to detect it. Treatments aim to prevent infections, treat acute infections, and rid the lungs of mucus. 

A Word From Verywell

Living with cystic fibrosis can be extremely difficult because of the number of lung infections people develop, even in childhood. However, scientists have come a long way in improving life expectancy for people with cystic fibrosis through new treatments and preventive strategies.

If you are expecting a baby, make sure you participate in cystic fibrosis screening programs for your child. If you have cystic fibrosis, follow your healthcare provider's recommendations in trying to prevent frequent lung infections. 

Frequently Asked Questions

  • What is the most common cause of pneumonia in people with cystic fibrosis?

    The most common cause of pneumonia in a child with cystic fibrosis is Staphylococcus aureus. The most common cause of pneumonia in an adult with cystic fibrosis is Pseudomonas aeruginosa.

  • What is the risk of getting pneumonia if you have cystic fibrosis?

    Due to a buildup of mucus in the lungs, patients with cystic fibrosis are at risk of developing lung infections early in life. Sometimes the first episode develops as a baby.

  • Is pneumonia a symptom of cystic fibrosis?

    A single episode of pneumonia is not a symptom of cystic fibrosis. A diagnosis of cystic fibrosis would not be suspected in a person unless they had recurrent episodes of pneumonia. Cystic fibrosis is an inherited disorder, so it usually presents early in life.

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Respiration provides a constant supply of oxygen to the lungs, where this gas diffuses through the alveolar-capillary membrane into the blood (external respiration).

The circulatory system then distributes the oxygenated blood to various vascular beds, where oxygen is supplied to the various tissues (internal respiration).

In addition to providing oxygenation of the blood, the lungs also serve to rid the body of carbon dioxide (CO2), a residual product of metabolism.

Carbon dioxide, carried by venous blood, diffuses into the alveoli and is subsequently exhaled into the atmosphere.

Various diseases of medical interest can lead to inadequate gas exchange and thus respiratory insufficiency, which can be ventilatory (hypercapnia) or oxygenation (hypoxaemia).

The amounts of oxygen consumed and carbon dioxide produced each minute are determined by the extent of the patient’s metabolism.

Exercise and fever are examples of factors that increase the body’s metabolism and place greater demands on the respiratory system.

When the cardio-pulmonary reserve is limited by the presence of a pathological process, fever can represent an additional stress that can precipitate respiratory failure and thus tissue hypoxia.

STRETCHERS, LUNG VENTILATORS, EVACUATION CHAIRS: SPENCER PRODUCTS ON THE DOUBLE BOOTH AT EMERGENCY EXPO

Ventilatory failure (hypercapnia)

In ventilatory insufficiency there is inadequate ventilation between the lungs and the atmosphere which ultimately results in an inappropriate elevation of the partial pressure of carbon dioxide in arterial blood (PaCO2) to values above 45 mmHg (hypercapnia).

Ventilatory failure (hypercapnia) is generally considered to be

  • mild with PCO2 between 45 and 60 mmHg;
  • moderate with PCO2 between 60 and 90 mmHg;
  • severe with PCO2 above 90 mmHg.

When PCO2 exceeds 100 mmHg, coma may occur and, above 120 mmHg, death.

PCO2 is measured by haemogasanalysis.

We remind the reader that the ability to inhale requires the full efficiency of the nervous system, which must stimulate the respiratory muscles.

The contraction of the diaphragm reduces intra-thoracic pressure and causes gas to penetrate the lungs.

Minimal effort is required for this activity if the rib cage is intact, the airways pervious and the lungs distensible.

The ability to exhale, on the other hand, requires patency of the airways and lung parenchyma, which has sufficient elasticity to keep the bronchioles open until exhalation is complete.

Hypercapnia, causes and risk factors

Causes of ventilatory insufficiency include: depression of respiratory centres by pharmacological substances, brain diseases, spinal cord abnormalities, muscle diseases, rib cage abnormalities and upper and lower airway obstructions.

Upper airway obstruction can occur during acute infections and during sleep, when muscle tone is reduced.

Numerous factors can contribute to inspiratory muscle weakness and tip the balance in favour of acute ventilatory failure.

Malnutrition and electrolyte disorders can weaken the ventilatory muscles, while pulmonary hyperinflation (e.g. from pulmonary emphysema) can make the diaphragm less efficient.

Lung hyperinflation forces the diaphragm to assume an abnormally low position, which in turn leads to a mechanical disadvantage.

These problems are common in patients with acute and chronic obstructive pulmonary disease (bronchial asthma, chronic bronchitis and pulmonary emphysema).

Pathophysiology

An acute increase in PaC02 leads to a decrease in arterial blood pH.

The combination of elevated PaC02 and acidosis can have marked effects on the organism, especially when ventilatory failure is severe.

Severe acute respiratory acidosis results in impaired cognitive function due to depression of the central nervous system.

Cerebral and peripheral vessels dilate in response to hypercapnia.

Symptoms and signs

There are few clinical signs suggestive of elevated PaCO2.

Clinical signs suggestive of ventilatory failure include:

  • headache;
  • decreased vigilance;
  • warm flushed skin;
  • hypersyphilic peripheral pulses.

These findings are, however, extremely non-specific as they appear in numerous conditions other than ventilatory failure.

Since hypoxaemia is often present in a patient with ventilatory failure, it is common to observe the simultaneous appearance of signs of inadequate peripheral oxygenation.

Hypothermia and loss of consciousness are common findings, on the other hand, when ventilatory failure is the result of an overdose of substances with a sedative pharmacological effect. Sedatives and tricyclic antidepressants often result in pupillary dilation and fixation.

Tricyclic antidepressants also increase heart rate and blood pressure.

In the case of drug overdose, respiratory sounds are often evident despite the fact that aspiration has occurred.

This is more likely with sedative and alcohol abuse (as a result of the diminished swallowing reflex) and may result in rales in the right lower lobe.

Clinical signs of diaphragmatic fatigue are an early warning finding of respiratory failure in a patient with respiratory distress.

Such signs are, in fact, strongly suggestive of the need for immediate ventilatory assistance of the patient.

Diaphragm fatigue initially causes the appearance of tachypnoea, followed by periods of respiratory alternation or paradoxical abdominal breathing.

Respiratory alternation consists of the appearance of alternating for short periods of time between breathing with the accessory muscles and with the diaphragm.

Paradoxical abdominal breathing, on the other hand, is recognised on the basis of inward movement of the abdomen with each respiratory effort.

This phenomenon is due to the flaccidity of the diaphragm causing it to pull upwards whenever the accessory muscles of respiration create negative intrathoracic pressure.

Diagnosis of ventilatory failure (hypercapnia)

Anamnesis and objective examination are obviously the first steps in diagnosis.

Measurement of blood gas values is very important in assessing patients with ventilatory failure.

The severity of ventilatory failure is indicated by the extent of the increase in paCOz.

The assessment of blood pH identifies the degree of respiratory acidosis present and suggests the urgency of treatment.

The patient requires immediate treatment if the pH falls below 7.2.

Treatment

Acute elevation of arterial PCO2 indicates that the patient is unable to maintain adequate alveolar ventilation and may require ventilatory assistance.

PaCO2 does not have to exceed normal values for there to be an indication for ventilatory assistance.

For example, if the PaCO2 is 30 mmHg and then, due to respiratory muscle fatigue rises to 40 mmHg, the patient may benefit considerably from immediate intubation and mechanical ventilation.

This example therefore clearly illustrates how documenting the trend (“trending”) of arterial PaCO2 values can help in giving an indication for assisted ventilation.

Once the patient has been intubated, the set tidal volume should be 10-15 cc/Kg of ideal body weight (e.g. in obese patients a huge tidal volume is not necessary).

Current volumes below this tend to result in collapse of the more peripheral lung units (atelectasis), while current volumes above 10-15 cc/kg tend to overdistend the lungs and can cause barotrauma (pneumothorax or pneumomediastinum).

The ventilatory rate needed by the patient depends on his metabolism, although

  • adult subjects usually require 8-15 respiratory acts/minute. However, ventilation is modified in most patients to maintain PaCO2 values between 35 and 45 mmHg. An exception is the patient with cerebral oedema, in whom lower PaCO2 values may prove useful in reducing intracranial pressure
  • Another exception is patients with chronically high PaCO values in whom the aim of mechanical ventilation is to bring the pH back within normal limits and the patient’s PCO2 back to its baseline values. If the patient with chronic hypoventilation and CO2 retention is ventilated vigorously enough until a normal PCO2 is achieved, the problem of respiratory alkalosis arises in the short term and weaning the patient off mechanical ventilation in the long term.

The doctor should however determine the cause of the ventilatory failure before starting symptomatic treatment.

In the case of drug overdose, efforts should be made to identify the compound responsible, the amount of drug ingested, the length of time since ingestion and the presence or absence of traumatic injury.

Since hypoxaemia is often present in a patient with ventilatory failure, it is common to observe the simultaneous appearance of signs of inadequate peripheral oxygenation.

Hypothermia and loss of consciousness are common findings, on the other hand, when ventilatory failure is the result of an overdose of substances with a sedative pharmacological effect. Sedatives and tricyclic antidepressants often result in pupillary dilation and fixation.

Tricyclic antidepressants also increase heart rate and blood pressure.

In the case of drug overdose, respiratory sounds are often evident despite the fact that aspiration has occurred.

This is more likely with sedative and alcohol abuse (as a result of the diminished swallowing reflex) and may result in rales in the right lower lobe.

Clinical signs of diaphragmatic fatigue are an early warning finding of respiratory failure in a patient with respiratory distress.

Such signs are, in fact, strongly suggestive of the need for immediate ventilatory assistance of the patient.

Diaphragm fatigue initially causes the appearance of tachypnoea, followed by periods of respiratory alternation or paradoxical abdominal breathing.

Respiratory alternation consists of the appearance of alternating for short periods of time between breathing with the accessory muscles and with the diaphragm.

Paradoxical abdominal breathing, on the other hand, is recognised on the basis of inward movement of the abdomen with each respiratory effort.

This phenomenon is due to the flaccidity of the diaphragm causing it to pull upwards whenever the accessory muscles of respiration create negative intrathoracic pressure.

Diagnosis of ventilatory failure (hypercapnia)

Anamnesis and objective examination are obviously the first steps in diagnosis.

Measurement of blood gas values is very important in assessing patients with ventilatory failure.

The severity of ventilatory failure is indicated by the extent of the increase in paCOz.

The assessment of blood pH identifies the degree of respiratory acidosis present and suggests the urgency of treatment.

The patient requires immediate treatment if the pH falls below 7.2.

Treatment

Acute elevation of arterial PCO2 indicates that the patient is unable to maintain adequate alveolar ventilation and may require ventilatory assistance.

PaCO2 does not have to exceed normal values for there to be an indication for ventilatory assistance.

For example, if the PaCO2 is 30 mmHg and then, due to respiratory muscle fatigue rises to 40 mmHg, the patient may benefit considerably from immediate intubation and mechanical ventilation.

This example therefore clearly illustrates how documenting the trend (“trending”) of arterial PaCO2 values can help in giving an indication for assisted ventilation.

Once the patient has been intubated, the set tidal volume should be 10-15 cc/Kg of ideal body weight (e.g. in obese patients a huge tidal volume is not necessary).

Current volumes below this tend to result in collapse of the more peripheral lung units (atelectasis), while current volumes above 10-15 cc/kg tend to overdistend the lungs and can cause barotrauma (pneumothorax or pneumomediastinum).

The ventilatory rate needed by the patient depends on his metabolism, although

  • adult subjects usually require 8-15 respiratory acts/minute. However, ventilation is modified in most patients to maintain PaCO2 values between 35 and 45 mmHg. An exception is the patient with cerebral oedema, in whom lower PaCO2 values may prove useful in reducing intracranial pressure
  • Another exception is patients with chronically high PaCO values in whom the aim of mechanical ventilation is to bring the pH back within normal limits and the patient’s PCO2 back to its baseline values. If the patient with chronic hypoventilation and CO2 retention is ventilated vigorously enough until a normal PCO2 is achieved, the problem of respiratory alkalosis arises in the short term and weaning the patient off mechanical ventilation in the long term.

The doctor should however determine the cause of the ventilatory failure before starting symptomatic treatment.

In the case of drug overdose, efforts should be made to identify the compound responsible, the amount of drug ingested, the length of time since ingestion and the presence or absence of traumatic injury.

General objectives in the treatment of logical drug overdose are to prevent absorption of the toxin (gastric lavage or stimulation of the vomiting reflex and use of activated charcoal), to increase excretion of the drug (dialysis) and to prevent accumulation of the toxic metabolic products (e.g. acetylcysteine is the antidote of choice for acetaminophen overdose).

Weaning the patient off mechanical ventilation can begin as soon as the cause of the respiratory failure has been corrected and the medically relevant clinical condition stabilised.

Weaning parameters help to define when weaning has a consistent probability of success.

Physicians should use several parameters to decide when to start weaning from ventilation, as any one of them alone can be confusing. In adult patients, the combination of a spontaneous tidal volume of more than 325 cc and a spontaneous respiratory rate of less than 38 acts/minute seems to be a good indicator of success in weaning.

Methods used in weaning include IMV, pressure support and the ‘T’ tube.

Each of these methods has advantages and disadvantages, but each should be able to effectively wean most patients as soon as possible.

Each of the methods is based on the gradual reduction of ventilatory support under controlled conditions during close monitoring of the patient.

Finally, extubation can be performed when the swallowing reflex is intact and the endotracheal tube is no longer needed.

Weaning to IMV is carried out by reducing the number of respiratory acts per minute to an interval of a few hours, until the patient no longer requires mechanical support or demonstrates poor tolerance to weaning (e.g. 20% changes in heart rate and blood pressure).

The main disadvantage of IMV is the potential increase in respiratory work imposed on the patient during spontaneous breathing (13).

This increase in work is mainly due to the excessive resistance placed on the demand valve. More recently developed ventilators, however, attempt to correct this problem.

Pressure support helps to overcome the work imposed by the resistance of the artificial circuit by administering a predetermined positive pressure during inspiration.

Weaning with pressure support requires reducing the pressure support gradually with constant monitoring of the patient’s clinical condition.

Once the patient is able to tolerate low levels of pressure support (e.g. less than 5 cm H2O) ventilatory assistance can be discontinued.

T-tube weaning is, on the other hand, performed by suspending mechanical ventilation for a short period of time and placing the patient under a continuous flow of air at a pre-determined FiO2.

The time during which the patient is allowed to breathe spontaneously is gradually extended until signs of stress appear or the subject requires mechanical ventilatory support again.

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Tracheostomy during intubation in COVID-19 patients: a survey on current clinical practice

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Clinical Review: Acute Respiratory Distress Syndrome

Stress And Distress During Pregnancy: How To Protect Both Mother And Child

Respiratory Distress: What Are The Signs Of Respiratory Distress In Newborns?

Respiratory Distress Syndrome (ARDS): Therapy, Mechanical Ventilation, Monitoring

Tracheal Intubation: When, How And Why To Create An Artificial Airway For The Patient

What Is Transient Tachypnoea Of The Newborn, Or Neonatal Wet Lung Syndrome?

Traumatic Pneumothorax: Symptoms, Diagnosis And Treatment

Diagnosis Of Tension Pneumothorax In The Field: Suction Or Blowing?

Pneumothorax And Pneumomediastinum: Rescuing The Patient With Pulmonary Barotrauma

ABC, ABCD And ABCDE Rule In Emergency Medicine: What The Rescuer Must Do

Multiple Rib Fracture, Flail Chest (Rib Volet) And Pneumothorax: An Overview

Internal Haemorrhage: Definition, Causes, Symptoms, Diagnosis, Severity, Treatment

Difference Between AMBU Balloon And Breathing Ball Emergency: Advantages And Disadvantages Of Two Essential Devices

Cervical Collar In Trauma Patients In Emergency Medicine: When To Use It, Why It Is Important

KED Extrication Device For Trauma Extraction: What It Is And How To Use It

How Is Triage Carried Out In The Emergency Department? The START And CESIRA Methods

Chest Trauma: Clinical Aspects, Therapy, Airway And Ventilatory Assistance

Source:

Medicina Online



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Acute chest syndrome (ACS) is a potential complication of sickle cell disease (SCD). It involves the sudden onset of respiratory symptoms, which may lead to lung injury.

SCD is an inherited disorder that affects red blood cells. In people with SCD, red blood cells are crescent- or sickle-shaped instead of disc-shaped. This impairs their ability to carry oxygen and causes them to stick together.

A person with SCD may develop ACS if sickle cells stick together to form a blood clot in the small blood vessels within the lungs. Other possible causes include viral and bacterial lung infections and postsurgical complications.

The article below takes an in-depth look at ACS, including its causes, treatment, and prevention.

ACS is a serious and potentially life threatening condition involving sudden, severe respiratory symptoms and reduced blood oxygen levels. The condition is a potential complication of SCD.

According to the Centers for Disease Control and Prevention (CDC), the most common symptoms of ACS include:

Red blood cells contain a protein called hemoglobin, which binds to oxygen. Healthy red blood cells are disc-shaped, allowing them to move freely through blood vessels to deliver oxygen to the body’s tissues and organs.

In those with SCD, the hemoglobin inside red blood cells is abnormal and causes the cells to take on a characteristic sickle shape. These cells do not move through the blood vessels in the typical way and have a tendency to clump together.

A person with SCD may develop ACS as a result of sickle cells blocking a pulmonary blood vessel within the lungs. The Sickle Cell Disease Association of America notes that oxygen deprivation within the lungs can result in permanent lung damage. In some cases, ACS is life threatening.

Various factors can cause or contribute to ACS in SCD. Examples include:

In children, doctors are able to identify the cause of ACS in about 40% of cases. In the other cases, the triggering event is unclear.

According to the National Heart, Lung, and Blood Institute, more than 100,000 people in the United States have SCD. There are several types of SCD, each of which involves different gene mutations. According to a 2022 literature review, people with certain genotypes — hemoglobin SS (Hb SS) and Hb S-beta0-thalassemia — have an increased risk of developing ACS.

Some additional factors that may increase a person’s risk of developing ACS include:

  • asthma
  • respiratory infections
  • smoking or exposure to secondhand smoke
  • cold temperatures

A diagnosis of ACS relies on both clinical symptoms and imaging tests.

Clinical symptoms that may indicate a diagnosis of ACS include:

  • chest pain
  • increased breathing effort
  • chest sounds, such as coughing, wheezing, or rales
  • fever above 38.5°C
  • hypoxemia

Doctors may perform several tests to help rule out other illnesses and confirm a diagnosis of ACS. Examples include:

  • Chest X-ray: This imaging test can help doctors identify pulmonary infiltrates, which are substances within the lungs, such as pus, blood, or protein.
  • CT scan: Doctors can also use this test to look for the presence of new pulmonary infiltrates, which must be in at least one lung segment for a person to receive a diagnosis of ACS.
  • Blood gas analysis: This test measures oxygen levels in the blood. It can help doctors detect hypoxemia.

Without treatment, ACS may progress rapidly. Early treatment reduces the risk of complications and death.

Most people with ACS require hospitalization for careful respiratory monitoring and treatment. According to a 2017 review, treatment may include the following:

An individual cannot eliminate all risk factors for ACS. For example, people with certain genotypes of SCD have an increased risk of developing ACS. This is a nonpreventable risk factor.

However, people can take steps to reduce their risk of developing ACS. These include:

  • taking precautions to reduce the risk of lung infections, such as staying up to date on vaccinations for pneumonia and influenza
  • working with a doctor to develop an effective treatment plan for preventing asthma attacks, if asthma is present
  • using an incentive spirometry device during hospitalization

A 2017 study notes that almost half of all ACS cases develop during hospitalization. In this study, the frequency of an ACS diagnosis decreased from 22% to 12% after implementing a protocol for using incentive spirometry during hospital stays.

Among people with SCD, ACS is the second most common cause of hospitalization and one of the most common causes of death. The condition has a mortality rate of 4.3% in adults and 1.1% in children.

The outlook for people with ACS varies according to the nature and extent of any complications. Possible complications include:

The condition can also be fatal.

According to the British Society for Haematology (BSH), a person who develops ACS will require follow-up treatment, which may include blood transfusions or the chemotherapy agent hydroxycarbamide, which is also known as hydroxyurea.

Acute chest syndrome is a complication of sickle cell disease. People with ACS develop sudden respiratory symptoms, including chest pain and breathing difficulties, along with coughing, wheezing, or rales.

A person with SCD may develop ACS as a result of sickle cells sticking together and forming a blood clot within a pulmonary blood vessel. The condition can also occur due to a viral or bacterial infection, asthma, or complications following surgery.

ACS is a severe and potentially life threatening condition. However, people who receive prompt treatment tend to have a much more favorable outlook. As such, it is important that people with SCD familiarize themselves with the symptoms of ACS so that they can recognize and act on the warning signs, should they occur.

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The global respiratory care devices market has been gaining traction in the last few years. A significant rise in the geriatric population is one of the major factors estimated to encourage the growth of the overall market in the next few years. The growing prevalence of respiratory diseases and the growing incidence of preterm births are further predicted to accelerate the overall growth of the market in the coming years. In addition to this, the changing lifestyle of consumers and the rising prevalence of tobacco smoking are further estimated to accelerate the growth of the market in the coming years.

Furthermore, the high rate of urbanization and the rising pollution levels are likely to generate promising growth opportunities for the market players in the next few years. On the flip side, the rising concerns related to the reimbursement and the availability of low-cost products from the local manufacturers are some of the key factors that are likely to restrict the growth of the global respiratory care devices market in the next few years. In addition to this, the harmful effects of several devices on neonates and the lack of awareness and the large undertreated and underdiagnosed population are some of the other factors that are predicted to restrict the growth of the overall market in the near future.

The rising demand for home care therapeutics devices and the high growth in several emerging nations across Latin America and Asia Pacific are predicted to enhance the growth of the global market in the coming years. Furthermore, a substantial rise in the demand for multimodal ventilators and the growing demand for enhanced portable devices are estimated to generate promising growth opportunities for the market players in the next few years. Thanks to these factors, several new players are estimated to enter the global respiratory care devices market in the coming years.

Global Respiratory Care Devices Market: Overview

Respiratory care devices are medical devices focusing on the diagnostics, treatment, control, and management of patients suffering from disorder in cardiopulmonary system. These devices are known to be reliable in providing enhanced care to patients suffering from acute and chronic respiratory abnormalities. They are primarily used as therapeutic devices, diagnostic devices, monitoring devices, and consumables and accessories. Their demand is high among end users such as hospitals, ambulatory care, and home care.

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Global Respiratory Care Devices Market: Key Trends

The increasing prevalence of chronic obstructive pulmonary diseases (COPD) and other respiratory diseases such as asthma and tuberculosis is the primary factor augmenting the global respiratory care devices. The growing global population of aged people is creating a staggering demand for respiratory care devices owing to the fact that they are more susceptible to respiratory disorders. Moreover, skyrocketing pollution levels and rising incidence of tobacco smoking are working in favor of the market.

However, the lack of reimbursement policies is limiting the widespread adoption of respiratory care devices. The low-cost products offered by local manufacturers are creating pricing pressure on international players. As a result, large manufacturers are selling their products at competitive pricing, which in turn is adversely affecting the overall revenue generation of the market

Global Respiratory Care Devices Market: Market Potential

Various studies indicate that over 1 billion people across the world suffer from respiratory challenges such as CHF (congestive heart failure), COPD (chronic obstructive pulmonary disease), and asthma, with about 80 million cases in the U.S. alone. The high prevalence is creating a pressing need for reliable breathing monitoring, training, and therapeutic devices for these patients in the hospitals and at home. This is prompting players to develop technologically advanced devices that can be cost-effective and improve patient outcomes across the continuum of care at home and hospitals. For instance, in November 2016, ADM Tronics Unlimited Inc. entered into a strategic agreement with QOL Devices Inc., regarding new respiratory training and therapy platform trademarked "Alvio™" by QOL. Alvio is based on cloud technology and will be designed for use in non-regulated respiratory training applications and medical respiratory indications. Therefore, the birthing of advanced products in the near future is likely to revolutionize the global respiratory devices market.

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Global Respiratory Care Devices Market: Geographical Segmentation

North America and Europe will account for a substantial cumulative share in the market throughout the review period. The presence of highly developed healthcare infrastructure and high technical acumen among end users to operate technologically advanced respiratory devices are contributing to the growth of the market in the regions. The widening base of patients suffering from respiratory diseases due to the increasing adoption of smoking and drinking habits is also fuelling the growth of these regions.

Moreover, the growing geriatric population and rising funding by governments in the healthcare sectors are supplementing the growth of Europe and North America. On the other hand, Asia Pacific is expected to rise at a tremendous CAGR during the same period. The robust growth of the healthcare sector along with increasing expenditure on healthcare is one of the primary factors propelling the growth of the region. The rising per capita income and burgeoning demand for cutting-edge technologies are translating into the greater uptake of respiratory care devices in the region.

Global Respiratory Care Devices Market: Competitive Landscape

The majority of players in the global respiratory care devices market are focusing towards expanding their shares through product launches and technological advancements. The trend is likely to render the market a highly competitive arena in the near future. Some of the prominent companies operating in the market are Philips Healthcare, Medtronic Plc., Fisher and Paykel Healthcare Limited, Drägerwerk AG & Co. KGaA, CareFusion Corporation, Becton, Dickinson and Company, and Hamilton Medical AG.

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5-Point Growth Formula

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The 5-point growth formula includes the following points:

  • Current and Future Threats

Current and Future Threats

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  • How has COVID-19 affected the market?

  • What will be the post-pandemic scenario of the market?
  • What are the major threats that will dent the growth prospects of the market?

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As someone who doesn’t like to meditate, I’m always on the lookout for simple stress-management techniques that can lead to a calmer mind and a healthier body—preferably right now! (Not that I’m impatient about it....)

One-minute stress relief—too good to be true?

Unbelievably, there really are a few easy relaxation techniques that don’t require hard work or hours of commitment and practice. For example, I’ve previously written about the amazing “Inner Smile” technique. I’ve now found another quick-fix relaxation technique in “three-by-five breathing,” suggested by author Brad Stulberg in his book, The Practice of Groundedness. This technique sounded easy enough that I was willing to give it a try. It's effective enough that I find myself still using it on a daily basis after about six months.

The technique is as simple as the name—take five deep breaths three times a day. Sounds like a doctor’s prescription, doesn’t it? Except that you don’t need a prescription for this method of stress relief.

But why do you need relief from stress in the first place?

Why stress about stress?

The unpleasant sensations of being “stressed out”—tension, shallow breathing, anxious or worried thought patterns, clenched hands—are reason enough to stock up on stress-management tools. But there is an increasing body of research that also points to the damaging effects of low-grade, chronic stress on the mind and body.

For example, everyday stress can increase the risk of certain health conditions, such as asthma, heart attack, stroke, ulcers, and higher blood pressure. As reported by Hannah Seo in the New York Times, new research indicates that stress is also implicated in the aging of the immune system. Moreover, chronic stress contributes to inflammation, a culprit in numerous chronic illnesses. For many people, chronic stress also can increase the risk for mental health problems, such as depression and anxiety.

For balance, I’d like to point out that some types of stress have a positive side. For example, nervousness can pump you up before a performance, giving you a boost of energy to meet the challenge. Stress can also contribute to your personal growth by giving you confidence that you have the resources to cope with life’s demands. The “fight-or-flight” response is a stress reaction that Mother Nature has given us to save life and limb in a genuine emergency. Unfortunately, many of us interpret the annoying events of modern life as an emergency, keeping us in a constant state of high tension.

But whether you are experiencing “good stress” or harmful stress, your brain still needs breaks from the low-level stress that can leave you mentally frazzled and physically worn out. The “relaxation response” can counter the stress response, according to decades of research by stress pioneers like Herbert Benson. That’s why brief relaxation techniques can be so helpful. And that’s where the “three-by-five” comes in.

How:

Take one slow, deep breath. Repeat four more times. Continue as desired.

That's it! That's the exercise. But to make it even more effective, try these tips:

1. Pause a little at the “top” of the inhale. Exhale. Pause slightly at the “bottom” of the exhale.

2. Check yourself to make sure you are breathing from your abdomen as well as from your lungs—“belly breathing” is more likely to trigger the relaxation response.

3. To help yourself slow down, count mentally from one to five for each inhale and do the same for each exhale.

4. Try "five-finger breathing." If like me, you might get distracted and forget what breath you are on, a great option is to let your fingers do the counting. One helpful method is "five-finger breathing," described here:

“Hold one hand in front of you, fingers spread. Now, slowly trace the outside of your hand with the index finger on your other hand, breathing in when you trace up a finger, and out when you trace down. Move up and down all five fingers. When you’ve traced your whole hand, reverse direction and do it again.”

Before you know it, you’ve done two rounds of breathing. This practice has been popularized by Dr. Judson Brewer, author of Unwinding Anxiety. The reason it works, he says, is that using your sight, your sense of touch, and your mind all at once leaves little room in your brain for anxiety and for negative thoughts.

When:

A few ideas:

1. Tie three-by-five breathing to established habits. For example, Stulberg practices it before breakfast, lunch, and dinner.

2. Teach yourself to use your emotional tension as a trigger to practice three-by-five breathing. Catch yourself getting tense, stop what you are doing, and use the technique. Just one minute to a more relaxed you.

3. Use a combination of 1 and 2. I have a long-standing habit of starting my workday in my old easy chair. I make a to-do list and think about my priorities for the day. To this routine, I’ve added one round of three-by-five breathing (technique 1). When I find myself plagued by my own annoying mental chatter either during the day or night, I start another round of three-by-five breathing (technique 2).

Where:

Anywhere. The waiting room of a doctor’s office. Washing dishes. Walking. On hold with customer service. Anywhere.

In a nutshell: Small technique, big benefits

One to five-minute brain breaks like three-by-five breathing may not seem like much. But stress has a full-body impact. So, even toning down your reaction to stress just a little could have powerful effects, including these: slower aging of the immune system, a sharper mind, lower blood pressure, less anxiety or depression, more relaxation, better sleep, and less risk of chronic illness.

Maybe the best benefit is knowing that you can pause, breathe, and regain a sense of well-being in just one minute.

© Meg Selig, 2022. All rights reserved.

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We are delighted to announce the 8th Biennial Seminar in Paediatric Respiratory Medicine at the Sydney Children’s Hospital, Randwick.

For the first time, we will also be introducing our interactive short course scheduled for 1/2 day on 24 September. The short course offers three engaging modules with practical workshops to provide you with insights, tools and updates on Spirometry (Lung Function), Chest Physiotherapy techniques and Asthma Inhaler Devices.

The seminar and short course cover face to face presentations, practical activities, engaging discussions with industry leaders, and online course materials.

Over a period of 1 ½ days, you will have the opportunity to join thought-provoking debates and deep dive discussions from some of the world’s brightest minds in paediatric respiratory medicine!

So, mark your calendars and register to join us! We look forward to seeing you there!

About the seminar

The seminar aims to give you insights, practical tools and updates on best practice in paediatric respiratory medicine on a day-to-day basis.

Brought to you by UNSW Medicine & Health and the Sydney Children's Hospitals Network (SCHN), the seminar offers a series of interactive face to face presentations, engaging discussions, practical short course modules, and online course materials by leading experts in children's respiratory medicine in Australia and New Zealand.

Who should attend this seminar?

Paediatricians, GPs, junior doctors, nursing staff, allied health professionals and other interested health workers who are involved in the care of children with acute and chronic respiratory conditions.

About the short course

The short course is a collaboration between the UNSW Medicine & Health and the Sydney Children’s Hospitals Network (SCHN). Brief descriptions of the 3 modules are below:

  1. Spirometry (Lung Function): covering how do you interpret lung function (good quality vs uninterpretable lung function), how to approach a breathless child - exploring the techniques of exhaled nitric oxide (FeNO), provocation test such as mannitol challenge, and cardiopulmonary exercise testing (CPET).
  2. Chest Physiotherapy: covering who to refer and who doesn’t need referral (inpatient vs outpatient), what improvement you can expect from chest physiotherapy, new vs old techniques.
  3. Asthma Inhaler Devices: covering why do we need asthma education and how to provide education, advice on improving breathing including indoor air quality, house dust mite minimisation, how to provide a green asthma management plan (including new vs old devices and techniques).

Delegates are expected to attend the short course on 24 September which will be delivered sequentially one after another. An assessment consisting of 25 multiple choice questions (MCQs) will be available for credentialing.

What are the course credentials?

Upon successful completion of the assessment, you will be issued with a UNSW Medicine & Health verifiable credential badge. The credential provides formal recognition of professional development and reflects 1.5 days of learning inclusive of the 1 day seminar and 1/2 day short course.

The 1.5 days of learning and verifiable credential may be counted towards your continuing professional development (CPD). Please check with your college as the credential provides documentary evidence which may substantite activities claimed under your college program.

 

Q&A questions

Please feel free to send your questions ahead of time to shortcourses.health@unsw.edu.au.

Event registration

Early registration is recommended as places are limited.

Registration Price (GST inc.) For online price use discount code at checkout
Seminar & Short Course (in person) $500.00  
Seminar & Short Course (online) $450.00 PRMSONLINE

Inclusions

Price is inclusive of 1 ½ day seminar covering deep insights, practical tools and updates on best practice in paediatric respiratory medicine on a day-to-day basis, our short course (in person and online), professional learning and development materials, online learning resources, evidence-based research, practical tools and techniques, courses completion assessment, digital badging, and networking.

Morning tea, lunch and afternoon tea will be provided on Day 1 and morning tea will be provided on Day 2. All are covered in the price for attending the seminar in person.

Seminar program: Friday 23 September (full day)

Time Topic Speakers
8:00 - 8:50 Registration  
8:50 - 9:00 Welcome and Introduction Cathryn Cox, Chief Executive, SCHN
Session 1: Upper Airways
9:00 - 9:30 I can’t breathe - causes of shortness of breath on exercise dyspnoea Professor Hiran Selvadurai
9:30 - 10:00 The importance of sinuses in respiratiry health Dr Catherine Banks
10:00 - 10:30 Screening and managing children with obstructive sleep disordered breathing Dr Mimi Lu
10:30 - 11.00  Morning Tea  
Session 2: Respiratory Hot Topics
11:00 - 11.30 Improving asthma outcomes Dr Nusrat Homaira 
11.30 - 12:00 Virtual care in children with chronic respiratory condition Michael Doumit
12:00 - 12.30 Latest advances in therapeutics for respiratory disease in CF and SMA Dr Sandra Chuang
12:30 - 13:00 To eat or not eat peanut Dr Brynn Wainstein
13:00 - 14:00 Lunch  
Session 3: Latest Guidelines
14:00 - 14:30 Update on Tracheo-oesophageal fistula management guideline Dr Yvonne Belessis
14:30 - 15:00 Improving outcomes for non-CF bronchiectasis Dr Bernadette Prentice
15:00 - 15:30 Respiratory guidelines for Cerebral Palsy Prof Adam Jaffe
15:30 - 15:50 Afternoon Tea  
Session 4: Challenges in breathing
15:50 - 16:20 3 challenging cases Dr Louisa Owens
16:20 - 16:50 Promoting health in adolescents: vaping and tobacco control Alecia Brooks
16:50 - 17:20 John Beveridge Oration – Lessons learnt from the health system in COVID A/Prof Lucy Morgan
17:20 - 17:30 Program Evaluation QR code here

Short course program: Saturday 24 September (½ day)

Time Topic Presenters
8:30 - 9:00 Registration  
9:00 - 9:40

Chest Physiotherapy: covering who to refer and who doesn’t need referral (inpatient vs outpatient), what improvement you can expect from chest physiotherapy, new vs old techniques

Michael Doumit
9:40 - 10:20

Asthma Inhaler Devices: covering why do we need asthma education and how to provide education, advice on improving breathing including indoor air quality, house dust mite minimisation, how to provide a green asthma management plan (including new vs old devices and techniques)

Melinda Gray
10:20 - 10:50 Morning tea  
10:50 - 11:30

Spirometry (Lung Function): covering how do you interpret lung function (good quality vs uninterpretable lung function), how to approach a breathless child - exploring the techniques of exhaled nitric oxide (FeNO), provocation test such as mannitol challenge, and cardiopulmonary exercise testing (CPET)

Jamie McBride
11:30 - 12:00pm Assessment: consisting of 25 multiple choice questions (MCQs) Dr Sandra Chuang
12:00 - 12:30pm Q&A and Closure Dr Sandra Chuang

Speakers & presenters

Listed in order of speaker and presenter appearance.

Day 1

 
Cathryn Cox PSM – Chief Executive, Sydney Children’s Hospitals Network (SCHN)
Professor Hiran Selvadurai – Head of Respiratory Medicine Department, The Children’s Hospital at Westmead
Dr Catherine Banks –  Ear, Nose and Throat Surgeon, Sydney Children’s Hospital Randwick and Prince of Wales Hospital
Dr Mimi Lu – Respiratory and Sleep Physician, Sydney Children’s Hospital Randwick and Children’s Hospital Westmead, Woolcock Clinic
Dr Nusrat Homaira – Respiratory Epidemiologist, Early Career Fellow of National Health and Medicla Research Council, Senior Lecturer with Discipline of Paediatrics UNSW, honorary research scientist SCH Randwick
Michael Doumit – Senior Physiotherapist, SCH Randwick, Conjoint Associate Lecturer Discipline of Paediatrics UNSW, Lecturer in Physiotherapy, Department of Health Sciences Macquarie University
Dr Sandra Chuang – Respiratory Clinical Academic SCH Randwick, Lecturer Discipline of Paediatrics UNSW
Brynn Wainstein – Paediatric Immunologist and Allergist SCH Randwick, Conjoint Senior Lecturer Discipline of Paediatrics UNSW, President of the Australasian Society of Clinical Immunology and Allergy (ASCIA)
Dr Yvonne Belessis – Respiratory Physician SCH Randwick, Conjoint Senior Lecturer Discipline of Paediatrics SCH
Dr Bernadette Prentice – Respiratory Physician, SCH Randwick
Prof Adam Jaffe – Respiratory Clinical Academic SCH Randwick, John Beveridge Chair of Paediatrics
Dr Louisa Owens – Head of Respiratory Medicine Department, SCH Randwick; Conjoint Lecturer Discipline of Paediatrics UNSW
Alecia Brooks – Manager, Tobacco Control, Cancer Council NSW
A/Prof Lucy Morgan – Clinical Associate Professor, Concord Clinical School

Day 2

 
Michael Doumit – Senior Physiotherapist, SCH Randwick, Conjoint Associate Lecturer Discipline of Paediatrics UNSW, Lecturer in Physiotherapy, Department of Health Sciences Macquarie University
Ms Melinda Gray – Respiratory Clinical Nurse Consultant, Department of Respiratory Medicine, Sydney Children’s Hospital Randwick
Jamie McBride – Senior Respiratory Scientist, SCH Randwick

Venue & transport

Venue

John Beveridge Lecture Theatre, Level 1
Sydney Children’s Hospital
High St, Randwick NSW 2031

Map

Parking

Street parking is very limited. All-day parking is available at the Prince of Wales Hospital Car Park, via Barker St, Randwick (Maximum daily rate: $31.20).

Drop-off zone

There is a drop-off zone in the driveway of the Sydney Children’s Hospital on High St, Randwick.

Public Transport

For timetable information call the Transport Infoline on 131500 or see www.transportnsw.info

Cancellations & Refunds

Cancellation must be provided in writing to UNSW in which case the following terms and conditions apply:

  • If written notice is received by UNSW more than 10 working days prior to the seminar commencement date, 80% of the fees and charges will be refunded.
  • If written notice is received by UNSW less than 10 working days prior to the seminar commencement date, 50% of the fees and charges will be refunded.
  • No refund of the fees and charges will be made if written notice is received on or after the seminar commencement date or in the case of non-attendance at the seminar.

Accommodation

Delegates are advised to make their own arrangements for accommodation, if required.

Seminar, short course and course materials

Seminar, short course and course materials will be available in the UNSW Medicine & Health Canvas learning management system.  

Liability

The program is correct at the time of issuing. However, the organisers reserve the right to alter the program without notice due to unforeseen circumstances. The seminar organisers accept no responsibility for any loss incurred by registrants resulting from their attendance at the seminar.

The Inaugural John Beveridge Lecture

The John Beveridge Lecture recognises the life, contribution and commitment of Professor John Beveridge, to the health and welfare of children.

John Beveridge was the Foundation Professor of Paediatrics at the University of NSW and the Director of the Prince of Wales Children’s Hospital (now the Sydney Children’s Hospital, Randwick) from its inception in 1962 until 1991.

During his early career, he realised that paediatrics was his passion, and he is remembered for his high standards of service and care. Professor Beveridge was a strong, passionate and determined advocate for the Hospital specifically, and for children’s health more widely.

His clinical interest in respiratory conditions, like cystic fibrosis, provides a poignant connection to the respiratory presentations which will be delivered at this forum.

Reach us for further information about this seminar and the short course. We continuously improve our short courses, education and training, seminars and bespoke programs to reflect the needs of our learners and their employers. If you are interested in connecting with us to explore bespoke program for your organisation or team, please contact us.

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Pneumonia is a lung infection most commonly caused by bacterial or viral infections and less by fungal infections or aspiration, inhaling a substance into the lungs.

Pneumonia leads to airway inflammation and the alveoli (air sacs) may fill with fluid.

The severity of your symptoms can range from mild to life-threatening, underscoring the importance of prevention, early diagnosis, and prompt treatment.

This article will discuss ways to prevent pneumonia so you can avoid this potentially life-threatening condition. 

ljubaphoto / Getty Images


Symptoms

Symptoms vary among children, adults, and older adults, but in most cases, you will experience one or more of the following symptoms:

  • Fever
  • Chills
  • Shortness of breath
  • Chest pain on deep inspiration
  • Cough (often with phlegm)
  • Night sweats
  • Nausea
  • Vomiting
  • Muscle aches
  • Rapid breathing and heartbeat
  • Confusion
  • Weight loss

Risk Factors

Your age is the biggest risk factor for pneumonia. To be clear, pneumonia can affect anyone at any age, but the two age groups at the highest risk for contracting it and for having more severe cases are children under age 2 and adults older than 65.

But age isn’t the only factor that can increase your risk of pneumonia. A host of lifestyle and health risk factors may also increase your risk, including:

  • Being immunocompromised: Having a weakened immune system, often caused by HIV/AIDS, alcohol abuse, organ transplantation, or long-term cancer or autoimmune treatment (such as chemotherapy or long-term treatment with steroids or other immunosuppressant drugs), can decrease your body’s ability to fight infections, making you more susceptible to pneumonia.
  • Being hospitalized or being on a ventilator: This raises your risk of hospital-acquired bacterial infections and aspiration pneumonia.
  • Having a chronic condition including asthma, chronic obstructive pulmonary disease, structural lung disease, and heart disease: Damaged lungs are more vulnerable to lung infections. 
  • Smoking: The chemicals in cigarettes compromise the immune system, lowering its ability to defend itself from the organisms that make you sick.

Environmental factors, such as jobs that involve working with toxic substances, indoor air pollution, secondhand smoke, and living in a crowded home, can increase your susceptibility to pneumonia.

Prevention

These tips can help prevent you from getting pneumonia.

Get a Pneumonia Vaccine

Vaccines help prevent pneumonia by boosting your immunity against some of the common bacteria and viruses that cause illness. Taking all of the following vaccines can safeguard you against pneumonia:

Vaccines are incredibly safe and effective, but they can have side effects. Speak to a healthcare provider so you know what to expect with each vaccine.

Of note, the Centers for Disease Control and Prevention (CDC) recommends infants younger than age 2 take four doses of the pneumonia shot at 2 months, 4 months, 6 months, and then a booster between 12 to 15 months; and that all adults older than 65 be given pneumococcal vaccines.

Exercising Proper Hygiene

One of the best ways to prevent respiratory infections is to practice proper hygiene. Some useful techniques include:

  • Washing your hands regularly with soap and warm water for at least 20 seconds
  • Cleaning and disinfecting surfaces that are touched a lot (with alcohol based products)
  • Coughing or sneezing into a tissue or into your elbow or sleeve
  • Limiting contact with cigarette smoke or quitting smoking
  • Taking good care of medical conditions, such as asthma, diabetes, or heart disease

Avoiding Sick Contacts

If possible it’s best to avoid people who are sick. This is even more important for young children and older adults who are at the highest risk of getting sick. If you are sick, stay away from others as much as possible to keep from getting them sick, especially those in your family or friend circle who are most susceptible to illness.

Don’t Smoke or Abuse Alcohol

As previously mentioned, the chemicals in cigarettes can compromise the immune system, lowering its ability to defend itself from the organisms that make you sick.

Chronic alcohol use increases your risk of hospitalization and damages alveolar macrophages and phagocytic cells that ingest and clear inhaled microbes as the first line of defense in lung cellular immunity.

Chronic alcohol exposure significantly interferes with alveolar macrophage function, making your lungs more vulnerable to infections that they could otherwise defend themselves against.

Maintain Good Overall Health

Having a pre-existing health condition like obesity, diabetes, asthma, COPD, or heart disease greatly increases your risk of pneumonia, hospitalization, and even death.

Preventing these conditions via a combination of vaccination, healthy eating, regular exercise, and routine visits to your healthcare provider are key to preventing pneumonia.

Recovery

There’s no one size fits all recovery from pneumonia. Some people recover in a week, returning to their normal routines, while others take much longer.

If you are diagnosed with pneumonia, follow your healthcare provider's instructions, take antibiotics as prescribed, monitor your symptoms, and allow yourself time to fully recover.

Avoiding situations that may put you into close contact with molds and getting vaccinated are also important steps that you can take to prevent infection.

When to See a Healthcare Provider

If you are having trouble breathing or experiencing a high fever that is not going down with over-the-counter (OTC) medication, seek immediate medical attention.

Remember that infants and small children, older adults over the age of 65, smokers, and people with chronic conditions such as COPD, asthma, and heart disease are at high risk of developing pneumonia and should not wait to see a healthcare provider if they are experiencing pneumonia-like symptoms.

Summary

You can take steps to prevent pneumonia, including avoiding getting sick in the first place by practicing proper hygiene, not smoking, and getting vaccinated.

A Word From Verywell

Pneumonia can be incredibly taxing and some people may take weeks or months to recover.

Following your healthcare provider's recommendations is important to recovery, but preventing pneumonia is the best way to avoid serious medical complications.

The best way to do this is to get vaccinated and avoid crowded spaces where germs are easily spread. While it is not definite that you will develop pneumonia if exposed to the germs that cause it, being aware of your risk factors and safeguarding yourself against infection dramatically lowers your risk. 

Frequently Asked Questions

  • Is pneumonia contagious?

    Pneumonia is most commonly caused by bacteria and viruses, which can be transmitted to others via aerosolized particles that form in the lungs and are transmitted to others through coughing or sneezing.

  • What causes pneumonia?

    Pneumonia is a lung infection most commonly caused by bacteria and viruses. Still, less commonly, it can be caused by fungus and via aspirated substances in the stomach, especially in those who are immunocompromised or hospitalized.

  • How do you get pneumonia?

    Pneumonia is caused by germs that are passed from person to person via direct transmission when a person coughs or sneezes. If you breathe some of these germs directly into your lungs, they may potentially replicate and cause symptoms. Aspiration, or inhaling food, liquids, vomit, or fluids from the mouth into your lungs, called aspiration pneumonia, is also another way you may develop a lung infection.

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Wildfire season is upon us and coupled with the extreme drought that much of the United States is experiencing, we have a recipe for a disastrous 2022 wildfire season.

In fact, according to the CDC wildfires are starting earlier, spreading faster, and burning longer than ever experienced in recorded history. If that isn’t enough to keep us up at night, wildfires have also been linked to multiple health concerns including trauma and PTSD, cardiovascular ailments, respiratory illnesses, cancers, and poor sleep. Inadequate sleep, caused by the poor air quality that wildfires create, leaves us even less able to cope with the acute dangers of the wildfires and with managing life itself.

According to the CDC, insufficient sleep has been linked to type 2 diabetes, obesity, cardiovascular disease and depression. (1) A case study on the deadliest wildfires in California shows the negative impact that this type of climate change extreme has on mental health. It also illustrates that mental health outcomes, specifically PTSD, anxiety and depression are dependent on the extent of fire exposure to the individual, as well as pre-existing adversities (especially due to childhood exposures), and general quality of sleep. (2)

In a recent systematic review of multiple sleep studies, ranging over a 9-year period from 2012-2021, sleep disturbances are shown to be highly prevalent with wildfire survivors, and the proximity and the severity of traumatic exposure of the survivor creates an even stronger link. (3)

The case can surely be made that poor sleep and sleep disorders have overwhelming effects on human health. Apart from the errors in judgments when sleep is lacking, the less obvious ramifications are actually more frequent and include accidents, injuries, lower functioning and lessened quality of life, and diminished family well-being. (4)

Insomnia and nightmares rate as the most common sleep issues that affect between 63-72% and 33-46% of survivors respectively. (3) Meanwhile, behavioral changes in children after experiencing a wildfire can include changes in concentration, elevated irritability, sleep changes, and a decline in academic performance. (5)

“Some studies indicate that air pollution increases sleep disturbances by affecting the airways and the brain and the emotional impact caused by wildfires,” explains Dr. Carleara Weiss, a sleep science advisor at Aeroflow Sleep. “In addition, individuals with respiratory difficulties, such as those with obstructive sleep apnea, may have more difficulty sleeping with air pollution. In general, increasing air quality via filtration systems and air cleaners should contribute to better sleep,” Dr. Weiss says.

While we can all understand the environmental impact of wildfires, some of us have also experienced, first-hand, the devastating impact of wildfires physically, emotionally, and economically.

In my recent conversation with retired Federal Smoke Jumper for the US Department of Interior Bureau of Land Management, Todd Jinkins (disclosure: my older brother), I asked him if he ever experienced sleep disturbances as a direct consequence of the smoke pollution that he was exposed to while fighting wildfires.

He responded, “over the course of my twenty-three-year career, I often experienced sleep disturbance from wildfires for a myriad of reasons.” When I asked Jinkins if he was ever given any training on how to improve sleep while on the job, he responded emphatically, “no, nothing, no training or talk of anything like that.”Jinkins went on to describe that, “while we received considerable training about wildland firefighting, fire safety, and parachuting as a smokejumper, we received no training about maintaining our health as a wildland firefighter.” Elaborating, he said, “maintaining your physical health is critical for peak performance as a smokejumper, but mental health is also of critical importance. Recent recognition of high suicide rates among firefights and first responders is bringing this issue into focus.”

PTSD, insomnia and sleep disturbances can continue for a long period after living through a wildfire. Wildfires have been shown to correlate with increased rates of PTSD, depression and generalized anxiety (GAD) and these psychological issues can continue for years after the initial event.

A study on survivors of a wildfire in llia, Greece, concluded that the presence of insomnia was identified in 63% of the survivors, and the majority of them were older females, who had also developed PTSD. Over 50% of the participants also experienced what was described as “fear of imminent death.” (6)

Recent Surge in Wildfires

The hot summer months are projected to be a very dangerous fire season and 2022 continues to be an exceptionally dry year. Typically, wildfire season lasts for a 4 to 5-month period from June to October, but the season has recently extended to a now more common 7 to 8-month period throughout much of the South and Western United States. Along with the intensifying and widening of the fire season in places like California, Idaho, Oregon, Arizona, Nevada, New Mexico, Colorado, Utah and Florida, we are also seeing more intense wildfires as climate change progresses.

In fact, more than half of the 20 largest fires in California’s history took place in the last 5 years. (7) The average amount of acres burned annually by wildfires has been steadily increasing since the 1950’s. In the 1950s, experts recorded 3000 acres burning. The number today is more like 300,000 acres. Prior to 1970, there were no megafires (fires that burned more than 100,000 acres). (8)

The current extreme dry weather pattern is also intensifying across parts of the West in California, Nevada, Utah, New Mexico, Texas, Oklahoma and Colorado. (9) California has had the driest January-April on record and Nevada and Utah rank this same period the 3rd driest in a four-month period since records began. (10) As of May 17, 2022, more than half of the lower 50 States were experiencing drought.Rong Fu, UCLA professor of atmospheric and oceanic sciences, paints a grim picture of what is to be expected with wildfires in the coming years, saying, “I am afraid that the record fire seasons in recent years are only the beginning of what will come.” (11)

We saw more large-scale fires in some regions around the world in 2021 than we have ever seen according to Copernicus Atmosphere Monitoring Service (CAMS) Senior Scientist and wildfire expert, Mark Parrington. As a result, several regions also experienced their highest emissions ever, as specified by data tracked by the Global Fire Assimilation System (GFAS) data that goes back as far as 2003. (12)

Extreme weather, including dangerous lightning storms, strong winds, and high temperatures are all the effects of climate change, and these events are creating an ideal situation for wildfires to start. Although sometimes wildfires occur naturally either by lightning strikes or by spontaneous combustion of dry fuel like sawdust and leaves and the sun’s heat.

North Carolina State University professor Joseph Roise points out that a majority of fires occur because of “human involvement,” such as by castoff cigarettes, arson or neglected campfires. Roise explains, “Human carelessness is the biggest factor contributing to wildfires.” (13)

Tips To Reduce Wildfire Pollution and Improve Sleep

1. Invest in a good quality air filter, and a cleaned and updated HVAC system

When we are talking about improving interior air quality (IAQ), we can filter the air through portable air filters or inside the central heating, ventilation and HVAC systems of a home. Many studies have found a beneficial impact on indoor air pollutants by using a high-efficiency particulate air (HEPA) filter that provides the highest efficiency in reducing pollutants during wildfires.

According to the US Department of Energy, a true HEPA filter should be able to remove 99.97% of airborne particles. Remember that clogged filters cannot do the job that they are intended to do, so be sure to check your filters and replace them more often during prolonged smoke events. Air cleaners should filter at least two to three times the room volume per hour. Using an air purifier for just a few hours can be beneficial because it has been shown to reduce PM2.5 concentration in IAQ by 57%, which also produced a reduction in serum levels of inflammatory markers. And we know how beneficial lowering inflammatory markers is for many health markers, including cardiovascular health. (14)

2. Seal the windows and stay indoors, until air quality is safe

Dr. Weiss recommended staying indoors and closing windows, saying, “use an air cleaner and filtration system and keep the windows closed in your home to improve the air quality and stay indoors.” Once the air quality outside improves in the area, be sure to take the opportunity to air out your home, open the windows and doors, and use fans to help change the air inside the home.

3. Keep your home clean

Reduce chemicals, particulate matter (PM) and volatile organic compounds (VOC) in your home by cleaning your home often and using natural cleaning products when possible.

We know the IAQ is greatly improved when we reduce pollutants in our homes which are often hidden in common household items like beds, rugs, furniture, paint and in household cleaning products. These pollutants include particular matter (PM), (VOC) and chemicals. Prolonged exposure to these substances is associated with cardiovascular disease, respiratory diseases, lung cancer and COPD, (15) and short term exposure can have a negative impact on our sleep. (16)Consider using an organic mattress that is free from harmful allergens and chemicals, and use natural cleaning solutions which can both help to minimize the added chemicals in IAQ. Keeping dust to a minimum by cleaning the floors often with a damp cloth and by using a wet cloth instead of a feather duster can also help reduce the fine particular matter (PM2.5) from dispersing in the air.

4. Make your bedroom a “Clean Room”

If you can’t afford to buy multiple air filters for your entire home, focus on your bedroom for added sleep benefits.

Mary Prunicki, director of air pollution and health research at the Sean N. Parker Center for allergy and & asthma research at Stanford University, recommends creating a single room within a home that can be the “clean room.” (17) Also, be sure to place the air filters away from doors, windows and foot traffic, but don’t put them too close to walls or in the corners of a room where air less readily reaches the unit. (18)

5. Keep added pollution in your home low

Avoid using anything in your home that burns, such as your fireplace, gas logs, candles and incense.

During a period when the air index quality is diminished, only use your vacuum if it has a HEPA filter because vacuuming can actually heighten the particulate matter load in your home, according to Linda Smith, Ph.D. Branch Chief of the California Air Resources Board, because vacuuming can stir up particles that are already in your home and disperse them in the air.

6. Don’t exercise

During episodes of dangerous air index quality, you may want to restrict your strenuous activity and your exercise routine. Most of us breathe through the mouth, not the nose, during exercise or demanding activity. Research shows that nose breathing can be more effective in preventing water-soluble gases, particles and vapors from reaching the lung (19), than mouth breathing. Breathing through the mouth has been shown to increase the dose of pollutants that reach our lower respiratory system.

An experimental study of healthy adults showed that the total respiratory tract deposition of ultrafine particles (diameter <100 nm) was about 5 times greater during moderate exercise than at rest. (20) So you shouldn’t feel guilty about not exercising during this stressful time and instead try some meditation, or simple breath work. You can do that seated with your mouth closed while you gently inhale and exhale through the nose and focus your mind’s attention on gentle breathing.

7. Seek medical attention when in doubt

Dr. Weiss says, “recognize warning signs from your body. Identify signs of intense or dangerous smoke levels, such as sinus congestion, burning eyes, coughing, chest pain, fatigue, and difficulty breathing. Those signs should prompt you to seek medical assistance.”

The Impact of Wildfires on Well-Being

Air quality:

Wildfire smoke is a mix of fine particles (PM2.5) and gases from the burning plants, trees, buildings and other materials. Particulate matter (PM) is one major component of air pollution and is a key term that is often used to describe wildfire smoke. PM consists of both liquid and solid matter that is suspended in the air and is measured by size rather than the chemicals it contains.

According to the EPA, PM2.5 or less pose the greatest threat to health because these fine particles can penetrate the human respiratory tract, enter the bloodstream and impair vital organs. These particles travel into the deeper surface of the lungs while PM10 tends to be larger and coarser particles and are more likely to deposit on the surface of the upper lung area. Both PM2.5 and PM 10 can be inhaled, and both of the deposit sites can induce tissue damage and lung inflammation.

The CDC maintains that wildfire smoke can make anyone sick, but people with asthma, COPD, emphysema, heart disease, and children, pregnant women and responders are especially at risk for the ill effect of wildfires which include:

  • Trouble breathing
  • Asthma attacks
  • Tiredness
  • Headaches
  • Chest pain
  • Increased heart rate
  • Runny nose
  • Wheezing
  • Coughing
  • Stinging eyes
  • Scratchy throat

All of these issues can also affect one’s sleep. Along with the multiple studies that show PM2.5-10 can have a harmful effect on anyone’s sleep, one study looked specifically at how children’s sleep was affected when they were exposed to PM10 or below, and it showed that there were negative effects that included increased sweating while sleeping and trouble initiating or maintaining sleep. (21)

A randomized controlled study on sleep and bedroom air quality shows that when the air quality was improved, with lower CO2 levels, subjects were found to have improved performance on logical thinking the next day and they reported improved sleep quality, less grogginess, greater ability to concentrate, and overall felt better. (22)

Smokejumper Jinkins also cautioned, “most of these causal factors could be experienced by anyone who is in close proximity to a wildfire, but increasingly frequent large wildfire smoke dispersal can affect individuals hundreds or even thousands of miles away from an uncontrolled wildfire.”

When asked about the bill that The House of Representatives recently passed called the Federal Firefighters Fairness Act that creates the presumption that federal firefighters who become disabled with specific diseases (such as heart disease, lung disease, certain cancers, and other infectious diseases) contracted the illness on the job, and will be covered under workers’ compensation and disability retirement if this legislation becomes law, Jinkins said, “although this bill has only been passed by the House, it is encouraging that Congress has recognized the hazards that wildland firefighters face on a daily basis. I am hopeful that this bill becomes law soon to provide critical necessary health treatment.”

Stress:

Along with physical responses to wildfires, we also have common mental responses to the extreme stress that exposure to wildfires creates that include sleep problems, nightmares, anger, lack of concentration, general anxiety, PTSD and grief, to name just a few.

In a recent study of general anxiety disorder (GAD), six months after the Fort McMurray Wildfire in Alberta, Canada, findings show a prevalence between GAD symptoms after a natural disaster like wildfires. These risk factors increased in folks who had experienced any of the following: witnessing the burning of homes during a wildfire, pre-existing anxiety disorder, relocation, and exposure to media coverage of wildfires.

This study also shows that increased problematic substance abuse was associated with elevated GAD symptoms. (23)

Lifestyle Tips for Protecting Against Wildfire Pollution

1. Be like a river: stay hydrated

Drink plenty of water. Water helps the body process and clear harmful chemicals and gunk in our bloodstream and digestive track. It’s helpful to think of our body as a river. Ideally, we want the water to be clear and to move along quickly. If our body’s elimination systems slow down, our river can become a stagnant pond. Our goal is to keep the river moving smoothly so that the water doesn’t stagnate and collect stuff that shouldn’t be there. Staying hydrated is the single most important way to achieve this so that our internal river doesn’t dry up or become stagnant and get clogged up with garbage.

2. Get adequate sleep

Make sleep a top priority in your life as a way to keep your immune system strong and inflammation markers low. (24) Be sure you have a bedroom that is conducive to sleep with good air quality, a bed with a chemical-free and comfortable mattress, a cool environment (67 degrees Fahrenheit or below) and blackout blinds that keep light out so that your circadian rhythms can stay in sync with the sun.

3. Do meditation and breathing exercises regularly

Resiliency has been shown to improve the effects on mental health after experiencing the stress of a wildfire. (2) We know that both mindful meditation and intentional breathing techniques can improve resiliency and increase vagal tone.

Breathing methods like the 4,7,8 method, and resonance breathing, have been shown to help reduce anxiety both over the long term and in more acute stressful situations. (25) Both of these breathing techniques have been studied for their ability to help quell stress and anxiety, and to help us fall asleep or stay asleep.

Full abdominal breathing stimulates full oxygen exchange, which means the productive exchange of outgoing carbon dioxide with incoming oxygen. This action controls the breathing rate and can slow the heart rate and help stabilize blood pressure. It has also been shown that people who suffer from insomnia may have autonomic dysfunction and practicing slow, paced breathing techniques can help enable vagal activity which improves sleep quality. (26)

4. Exercise to improve HRV

When the AQI is good in your area, grab your running shoes and go for a walk, jog or hike to help improve heart rate variability (HRV). HRV is the amount of time between heartbeats and is associated with overall health. As a rule, when we are relaxed and resting the heartbeat is slower and when we are active, stressed or in danger, the heart rate increases. Our breathing correlates to this by increased inhalation signaling action or stress and exhalation signaling rest and repair.

Studies show that the positive influence that exercise has on HRV happens through increased vagal tone and downregulating of the sympathetic nervous system response. This improved HRV corresponds with decreased health problems such as heart conditions, and mental health issues such as depression and anxiety. A study with residents of a nursing home in Mexico City showed that exposure to increased concentration on PM2.5 was associated with autonomic nervous system (ANS) dysfunction in elderly. There was a significant decrease in HRV for every 10ug/m3 increase in same day PM2.5 exposure, and participants who already suffered hypertension were more susceptible to the reduction in HRV induced by the PM2.5. (27)

5. Eat the rainbow

Using food as medicine is always a good option for health since eating is something that we do daily, and food has the ability to affect change in our bodies and minds. Vitamins B (28), C, E (29), D and Omega 3 polyunsaturated fatty acid (PUFA) (30), have all been shown to be protective against damage caused by PM; specifically pulmonary illness and cardiovascular diseases. (31)

Also, an important fact to note is that vitamin D does not naturally appear in optimal amounts in many foods (apart from in eggs, salmon or other fatty fish, and cod liver oil). There are, however, a few foods that have been fortified with vitamin D such as milk, yogurt and cereal. Getting enough sun (our body can itself produce Vitamin D from sunlight) on a daily basis is often the most reliable way to ensure that you are getting the appropriate amount of vitamin D daily. Remember, however, that the fairer-skinned people and those under 50 are better at converting sunshine into vitamin D. Also, if you happen to live in the more northern parts of the world, where the sun’s rays are not strong enough in winter, you’ll want to be sure to supplement your food with vitamin D3, and eat foods like salmon—which has 66% of the daily value for vitamin D, or alternatively consume milk that is fortified with vitamin D.

We know that many fruits and cruciferous vegetables contain high levels of vitamin C, but leafy greens are also a great choice for getting adequate amounts of vitamins C and E, and they are also rich in some B vitamins. So eat plenty of salad, or sauté some bokchoy with garlic and lemon for a dinner.

We can ensure our vitamin E intake is optimal by eating a handful of nuts or seeds daily. Meanwhile cold water, fatty fish and seeds like flax, chia seeds and walnuts all contain good amounts omega 3.

6. Use the Firewise community’s principles of Ready, Set, Go

The Firewise USA program is a national movement that advises homeowners on how to prepare their homes to survive the effects of wildfires. It is part of California’s effort to ensure communities are prepared against wildfire. Ready, Set, Go is the three-step plan that Firewise recommends for all at-risk property owners and residents to follow in order to be ready for wildfires.

  • Be Ready: Create and maintain defensible space and harden your home against flying embers.
  • Get Set: Prepare your family and home ahead of time for the possibility of having to evacuate. Ensure that you have a plan of what to take and where to go
  • GO!: When wildfire strikes, go early for your safety. Take the evacuation steps necessary to give your family and home the best chance of surviving a wildfire.

Jinkins recommended the Firewise principles, saying, “it is critical that homeowners abide by these principles. Over the course of my career I often witnessed situations where residents waited too long to evacuate or refused to evacuate. This puts firefighters and residents in hazardous situations as late fleeing residents often clog access routes for fire responders. Residents who refuse to evacuate can find themselves in situations that quickly overwhelm them, requiring firefighters to endanger themselves in attempting to rescue these people.”

Jinkins’ final words on wildfire preparation were, “don’t put yourself or firefighters at risk by trying to “ride out” an approaching wildfire.”

State-Wide Resources

California

Colorado

Florida

Idaho

Nevada

New Mexico

Oklahoma

Oregon

Texas

Utah

North East

Other Resources

Last Word From Sleepopolis

Just a reminder that we are not medical experts. Anyone who is experiencing profound sleep problems associated with poor air quality from wildfires (or for any other reason) should seek medical advice.

Sleep is an essential ingredient of a healthful lifestyle and is the third pillar of health (32). When the quality of sleep is impaired, there are a multitude of health consequences that often follow. Be proactive when considering how to set up your home for wildfire season and stay informed as to what your local air quality index is so that you can stay prepared and safe during wildfire season.

References

  1. Sleep and Sleep Disorders. CDC, USA Center for Disease Control, www.cdc.gov/sleep/about_sleep/chronic_disease.html
  2. Silveira, Sarita et al. “Chronic Mental Health Sequelae of Climate Change Extremes: A Case Study of the Deadliest Californian Wildfire.” International journal of environmental research and public health. Feb. 2021.
  3. Ravinder Jerath et al. Self-Regulation of Breathing as a Primary Treatment for Anxiety. Applied Psychophysiology and Biofeedback. June 2015.
  4. Institute of Medicine (US) Committee on Sleep Medicine and Research; Colten HR, Altevogt BM, editors. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. National Academies Press (US). 2006. 3, Extent and Health Consequences of Chronic Sleep Loss and Sleep Disorders. www.ncbi.nlm.nih.gov/books/NBK19961/
  5. To, Patricia et al. “The Impact of Wildfires on Mental Health: A Scoping Review.” Behavioral sciences (Basel, Switzerland). Sep. 21, 2021.
  6. Psarros, Constantin, et al. Insomnia and PTSD one month after wildfires: Evidence for an independent role of the “fear of imminent death”. International Journal of Psychiatry in Clinical Practice. 2017.
  7. NASA Earth Observatory (September, 2021). What’s Behind California’s Surge of Large Fires. earthobservatory.nasa.gov/images/148908/whats-behind-californias-surge-of-large-fires
  8. Kasha Patel, Nasa Earth Observatory (December, 2018). Six trends to know about the season in the Western U.S. climate.nasa.gov/ask-nasa-climate/2830/six-trends-to-know-about-fire-season-in-the-western-us/
  9. The National Center for Environmental Information (May 17, 2022). US Drought Monitor Update. droughtmonitor.unl.edu
  10. The National Center for Environmental Information (April,2022). Assessing the USA climate in April 2022, www.ncei.noaa.gov/news/national-climate-202204
  11. Rong Fu, UCLA professor of Atmospheric and Oceanic Sciences. newsroom.ucla.edu/releases/frequent-wildfires-human-caused-climate-change
  12. Copernicus Atmosphere Monitoring System (December,2021). atmosphere.copernicus.eu/wildfires-wreaked-havoc-2021-cams-tracked-their-impact
  13. Andrew Moore. (December,2021). NC State University College of Natural Resources. cnr.ncsu.edu/news/2021/12/explainer-how-wildfires-start-and-spread/
  14. Chen, Renjie et al. “Cardiopulmonary benefits of reducing indoor particles of outdoor origin: a randomized, double-blind crossover trial of air purifiers.” Journal of the American College of Cardiology. 2015.
  15. Li, Tao et al. “Fine particulate matter (PM2.5): The culprit for chronic lung diseases in China.” Chronic diseases and translational medicine. Aug. 28, 2018.
  16. Liu, Jianghong et al. “Air pollution exposure and adverse sleep health across the life course: A systematic review.” Environmental pollution (Barking, Essex : 1987). 2020.
  17. Stanford researchers offer practical tips to mitigate harm from wildfire smoke, (July,2021) news.stanford.edu/2021/07/07/tips-protect-wildfire-smoke/
  18. Washington State Department of Health, Improving Ventilation and Indoor Air quality during Wildfire Smoke Events (August,2015). doh.wa.gov/sites/default/files/legacy/Documents/Pubs//333-208.pdf
  19. Lizal, Frantisek et al. “The effect of oral and nasal breathing on the deposition of inhaled particles in upper and tracheobronchial airways.” Journal of aerosol science. 2020.
  20. Daigle, Christopher C et al. “Ultrafine particle deposition in humans during rest and exercise.” Inhalation toxicology. 2003.
  21. Abou-Khadra, Maha K. “Association between PM₁₀ exposure and sleep of Egyptian school children.” Sleep & breathing = Schlaf & Atmung. 2013.
  22. Strøm-Tejsen, P et al. “The effects of bedroom air quality on sleep and next-day performance.” Indoor air. 2016.
  23. Agyapong, Vincent I. O., et al. “Prevalence Rates and Predictors of Generalized Anxiety Disorder Symptoms in Residents of Fort McMurray Six Months After a Wildfire.” Frontiers in Psychiatry. 2018.
  24. Mullington, Janet M et al. “Sleep loss and inflammation.” Best practice & research. Clinical endocrinology & metabolism. 2010.
  25. Jerath, Ravinder et al. “Self-regulation of breathing as a primary treatment for anxiety.” Applied psychophysiology and biofeedback. 2015.
  26. Tsai, H J et al. “Efficacy of paced breathing for insomnia: enhances vagal activity and improves sleep quality.” Psychophysiology. 2015.
  27. Holguín, Fernando et al. “Air pollution and heart rate variability among the elderly in Mexico City.” Epidemiology (Cambridge, Mass.) 2003.
  28. Fiorito, G et al. “B-vitamins intake, DNA-methylation of One Carbon Metabolism and homocysteine pathway genes and myocardial infarction risk: the EPICOR study.” Nutrition, metabolism, and cardiovascular diseases. 2014.
  29. Possamai, Fabricio Pagani et al. “Antioxidant intervention compensates oxidative stress in blood of subjects exposed to emissions from a coal electric-power plant in South Brazil.” Environmental toxicology and pharmacology. 2010.
  30. Romieu, Isabelle et al. “The effect of supplementation with omega-3 polyunsaturated fatty acids on markers of oxidative stress in elderly exposed to PM(2.5).” Environmental health perspectives. 2008.
  31. Mozaffarian, Dariush et al. “Effect of fish oil on heart rate in humans: a meta-analysis of randomized controlled trials.” Circulation. 2005.
  32. Castillo, M. “The 3 pillars of health.” AJNR. American journal of neuroradiology. 2015.
Karri Jinkins

I’m Karri Jinkins; freelance writer, certified Ayurvedic Medicine Health Counselor, and a co-founder of the Brains & Bellies podcast, based in New York City.

I work with people using the techniques of Ayurveda, nutrition, yoga and meditation to help them improve their health and live a better connected life. I am a contributing author of the book, Yoga Sadhana for Mothers, and I have written for various online publications, including the Huffington Post.

When I’m not working, you can find me boogie boarding with my husband and son while we try to coax our bird dog into the water with us.



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An immunologist, also called an allergist-immunologist, is a medical doctor specializing in allergies and other immune system disorders. Immunology is a subspecialty of internal medicine (care for adults) or pediatrics (care for infants through teens). 

Immunologists help diagnose, treat, and manage immune system conditions. Your primary healthcare provider might refer you to an immunologist if they suspect you have an allergy or other condition related to the immune system, such as asthma (a condition that inflames, swells, and narrows the airways, making breathing difficult).

This article will take a closer look at what an immunologist does, what specialties they may have, and what to expect from an appointment with an immunologist. 

FatCamera / Getty Images


Concentrations 

Immunologists are trained to diagnose, treat, and manage conditions involving the immune system.

This includes:

  • Allergic reactions to drugs, food, insect stings or bites, or other things
  • Asthma and other respiratory conditions like sinusitis and allergic rhinitis (hay fever)
  • Eye conditions stemming from allergies
  • Skin conditions like eczema (a type of atopic dermatitis, a condition of red, itchy, inflamed skin), hives (itchy welts that form on the skin), and contact dermatitis (itchy rash that forms from direct contact with an allergen)
  • Immune-related digestive conditions such as eosinophilic esophagitis (allergic condition in which the food tube does not contract properly)
  • Autoimmune conditions (conditions in which the immune system attacks healthy cells by mistake)
  • Stem cell (bone marrow) transplantation or organ transplantion

Not all immunologists work directly with patients. Some work in a lab setting and do research to advance the study of immunology. They may work on vaccine development research or antirejection research for organ transplantation.

Procedural Expertise 

Immunologists diagnose, treat, and help manage conditions involving the immune system. 

Many clinical immunologists who work directly with people seeking care have their own medical practice and work out of an office. They may work with children or adults, depending on their background. For example, an immunologist with a pediatrics background will work with children, while an immunologist with an internal medicine background will work with adults. 

Often, your first interaction with an immunologist will be to help diagnose a condition your primary care provider suspects is an allergy- or immune-related condition. 

An immunologist can order tests to help diagnose allergies and other immune system conditions. These tests may include:

  • Antibody tests: These tests check the levels of antibodies in your blood. When your immune system detects a foreign invader, like a virus, it produces antibodies to help combat the invading pathogen. Sometimes, the immune system produces antibodies in response to specific food products or other allergens. The body may also produce antibodies because of autoimmune disorders, directing them against the body's own cells.
  • Patch tests: A patch test can help pinpoint the cause of skin-related allergic reactions. It involves putting a patch on the skin that contains potential allergens. After about two days, your doctor will examine the area to check for a reaction.
  • T-cell tests. This test measures the levels of T cells, specialized immune cells, in your blood. Your doctor will order this test to check your immune system's health.
  • Skin prick test. Immunologists may recommend this test to help identify potential food or environmental allergens like pollen or mold. A medical professional will scratch the allergen onto the skin of your back or forearm. If you experience symptoms like redness, swelling, or itching, it’s a sign you have an allergy to the particular substance. 

After making a diagnosis, your immunologist will be able to recommend treatment options for your condition. The treatment course will depend on your diagnosis but may involve:

  • Medications, oral or topical, depending on your condition
  • Lifestyle changes 
  • Dietary changes 
  • A prescription for an epinephrine injector, such as EpiPen, for severe allergic reactions 
  • Stem cell or immunoglobulin therapy 
  • Complementary therapies to manage symptoms 

Subspecialties

Immunology is a subspecialty of pediatrics or internal medicine, and some immunologists may choose to further specialize in the following:

  • Organ transplant surgery
  • Specific infectious diseases, like human immunodeficiency virus (HIV)
  • Cancer

Training and Certification

Immunologists are doctors who have gone through medical school. After medical school, residency training for internal medicine or pediatrics takes three to four years.

Before becoming a board-certified physician, they must be certified in internal medicine (American Board of Internal Medicine) or pediatrics (American Board of Pediatrics) and go through two years of training in allergy and immunology.

After a two-year fellowship in allergy and immunology, prospective immunologists need to pass the certification exam with the American Board of Allergy and Immunology.

Appointment Tips

You’ll likely need a referral to make an appointment with an immunologist. While your regular healthcare provider can treat mild allergies, you’ll want to see a specialist for moderate to severe allergies. 

Before your appointment, you may want to consider logging your symptoms. It can be tough to pinpoint the cause of an allergy. If you or your healthcare provider suspects an allergy is causing your symptoms, keeping track of potential triggers may help with your diagnosis.

While an immunologist can order tests to help diagnose allergies, logging your symptoms and situations that may have led up to them may speed up the diagnostic process. 

When making an appointment, you’ll likely be told whether to expect testing that day and whether you need to avoid eating or drinking beforehand. 

Summary

An immunologist or allergist-immunologist is a doctor who specializes in treating immune-related conditions, including allergies. Some immunologists work directly with people seeking care, while others work in a research setting. 

A Word From Verywell 

Diagnosing immune-related conditions (allergies included) can be an arduous process. Working with a qualified allergist-immunologist can help streamline the process. 

Don’t hesitate to ask about treatments and their side effects. Your allergist-immunologist should be able to walk you through the pros and cons of treatment options and provide you with information about what to expect throughout the treatment process. 

Need help finding a qualified immunologist in your area? Use the American Academy of Allergy, Asthma, and Immunology’s (AAAAI) Find an Allergist/Immunologist tool.  

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What Is ProAir HFA?

ProAir HFA (albuterol) is used to prevent and treat wheezing, shortness of breath, coughing, and chest tightness caused by breathing problems that may be associated with certain lung diseases. It’s a quick-relief medication and a beta-agonist. It works by relaxing the airway muscles to open air passages to the lungs to make breathing easier. Albuterol also inhibits the release of immediate hypersensitivity mediators from mast cells.

ProAir is available in three different types of ProAir inhalers:

  • ProAir HFA: metered-dose inhaler that releases the drug as a fine mist
  • ProAir RespiClick: a dry powder inhaler that releases the drug as a powder
  • ProAir Digihaler: a dry powder inhaler that connects the inhaler to a mobile app on your phone to tell you how well you’re inhaling the medication

All three forms of ProAir inhalers come in a strength of 90 micrograms (mcg) per puff. It’s a prescription drug and must be used as prescribed by your healthcare provider.

Drug Facts

Generic Name: Albuterol

Brand Name(s): ProAir HFA

Drug Availability: Prescription

Therapeutic Classification: Beta-agonist

Available Generically: Yes

Controlled Substance: N/A

Administration Route: Inhalation

Active Ingredient: Albuterol sulfate

Dosage Form(s): Inhalation aerosol

What Is ProAir HFA Used For?

ProAir is indicated to:

According to the Centers for Disease Control (CDC), around 25 million people have asthma in the U.S. It is a leading chronic disease in children. Black children are almost three times more likely to have asthma in comparison with white children.

ProAir is a rescue inhaler and comes in different forms. Your healthcare provider will decide the frequency and type of inhaler when you need to ease trouble breathing.

How to Take ProAir HFA

Follow the instructions on your prescription label and use the medicine exactly as directed.

  1. Remove the protective cap from the mouthpiece and ensure that the canister is inserted into the mouthpiece properly.
  2. If you’re using a new inhaler or have not used it in more than 14 days, prime it. Shake it well and press to release four sprays into the air, away from your face. Avoid contact with your eyes. 
  3. Breathe out through your mouth. Hold the canister to place the open end of the mouthpiece in your mouth and close your lips.
  4. Breathe in through the mouthpiece and press down on the container to spray the medication into your mouth.
  5. Hold your breath for about 10 seconds or as long as you comfortably can; remove the inhaler, and breathe out slowly.
  6. If you are prescribed to have two puffs, wait for one to five minutes and then repeat to inhale.
  7. Replace the protective cap on the inhaler. Keep your inhaler clean.

Other directions to keep in mind:

  • Help a young child use ProAir HFA.
  • Take your puffs 15 to 30 minutes before exercising to prevent exercise-induced bronchospasm. 
  • Shake ProAir HFA well before each use.
  • Always use the inhaler device provided.
  • Don't change your dose or the prescribed dosing schedule without asking your healthcare provider.

Storage

Store your ProAir HFA inhaler at room temperature between 59 and 77 degrees F (15 and 25 degrees C). Keep your device away from heat, direct light, and humidity. Do not puncture the canister or expose it to open flame. ProAir HFA canisters can burst if exposed to extreme temperatures. Don’t store your device in the bathroom. Store your inhaler with the mouthpiece down. Different brands of Albuterol have different storage needs. Ask your pharmacist how to store the brand you use if you have questions.

Keep your medications out of reach of children and pets, ideally locked in a cabinet or closet.

If you plan to travel with ProAir HFA, get familiar with your final destination's regulations. In general, be sure to make a copy of your ProAir HFA prescription. If possible, keep your medication in its original container from your pharmacy with your name on the label. If you have any questions about traveling with your medicine, be sure to ask your pharmacist or healthcare provider.

Discard all unused and expired drugs, but do not pour them down the drain or into the toilet. Ask your pharmacist or healthcare provider about the best ways to dispose of this medicine. And check out drug take-back programs in your area.

How Long Does ProAir HFA Take to Work?

ProAir HFA works immediately to help relieve the symptoms of bronchospasm as soon as you inhale it.

Off-Label Uses

Inhaled albuterol is also used to treat or improve muscle paralysis (inability to move parts of the body) in people with high blood levels of potassium (a condition that causes paralysis attacks).

Healthcare providers also prescribe albuterol for some respiratory problems, such as chronic obstructive pulmonary disease (COPD).

What Are the Side Effects of ProAir HFA?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Some common side effects of Albuterol include:

  • Heart palpitations/increased heart rate
  • Nervousness
  • Headache
  • Nausea
  • Vomiting
  • Throat irritation
  • Muscle aches
  • Bones or back pain
  • Uncontrollable shaking of body parts
  • Cough

Call your healthcare provider if any of the side effects become severe.

Severe Side Effects

Albuterol can cause some severe side effects, such as:

  • Allergic reactions such as rash, hives, itching, swelling of the face, throat, tongue, lips or extremities, difficulty breathing or swallowing, and hoarseness
  • Wheezing, choking, or other breathing problems
  • Chest pain, irregular heart rate, pounding heartbeats, or fluttering in the chest
  • Pounding in the neck or ears
  • Pain or burning sensation during urination
  • High blood sugar
  • Low potassium levels

Get emergency medical help if you have any of the new or worsening severe symptoms.

Long-Term Side Effects

Long-term side effects are not available for ProAir HFA.

Report Side Effects

ProAir HFA may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much ProAir HFA Should I Take?


Drug Content Provided and Reviewed by


IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For inhalation aerosol dosage form (inhaler):

    • For treatment or prevention of bronchospasm:

      • Adults and children 4 years of age and older—Two puffs every 4 to 6 hours as needed.
      • Children younger than 4 years of age—Use and dose must be determined by your child's doctor.
    • For prevention of exercise-induced bronchospasm:

      • Adults and children 4 years of age and older—Two puffs taken 15 to 30 minutes before exercise.
      • Children younger than 4 years of age—Use and dose must be determined by your child's doctor.
  • For inhalation powder dosage form (inhaler):

    • For treatment or prevention of bronchospasm:

      • Adults and children 4 years of age and older—Two puffs every 4 to 6 hours as needed.
      • Children younger than 4 years of age—Use and dose must be determined by your child's doctor.
    • For prevention of exercise-induced bronchospasm:

      • Adults and children 4 years of age and older—Two puffs taken 15 to 30 minutes before exercise.
      • Children younger than 4 years of age—Use and dose must be determined by your child's doctor.
  • For inhalation solution dosage form (used with a nebulizer):

    • For prevention of bronchospasm:

      • Adults and children older than 12 years of age—2.5 milligrams (mg) in the nebulizer 3 or 4 times per day as needed.
      • Children 2 to 12 years of age—0.63 to 1.25 mg in the nebulizer 3 or 4 times per day as needed.
      • Children younger than 2 years of age—Use and dose must be determined by your child's doctor.

Modifications

The following modifications (changes) should be kept in mind when using ProAir HFA:

Severe allergic reaction: Avoid using ProAir HFA if you have a known allergy to it or any of its ingredients. Ask your pharmacist for a complete list of the ingredients if you're unsure.

Pregnancy and breastfeeding: Discuss with your healthcare provider if you plan to become pregnant or are pregnant, and weigh the benefits and risks of taking ProAir HFA during your pregnancy or breastfeeding.

Children: The safety of ProAir HFA has not been established for people under age 4.

Adults over the age of 65 years: The dose may need to be started at the lower side of the dosing range if the individual has reduced renal (kidney) or hepatic (liver) functions.

Kidney problems: Individuals with kidney problems may not be able to clear medication from their bodies as easily. This means the medicine stays in the body longer and can have increased side effects. Albuterol and other beta-adrenergic drugs are eliminated from the kidneys. People with renal (kidney) impairment may require a different dose to avoid toxic effects.

Missed Dose

If you miss a dose of ProAir HFA on a prescribed schedule or if you forget to take it before exercise, take it as soon as you remember. If it’s almost the time of the next dose, skip the missed dose. Inhale your next dose at the regular time. Do not double the dose to make up for the missed dose.

Try to find ways that work for you to help yourself remember to routinely take your medication. If you miss too many doses, ProAir HFA might be less effective at preventing and/or treating your condition.

Overdose: What Happens If I Take Too Much ProAir HFA?

An overdose of albuterol may be fatal. If someone has overdosed on the drug, immediately seek medical help. Call 911 right away if the victim has collapsed or has difficulty breathing.

Symptoms of overdose are:

  • Chest pains
  • Dizziness
  • Dry mouth
  • Fainting or feeling light-headed
  • Fast heartbeat
  • Headache
  • General illness or extreme tiredness
  • Nervousness
  • Uncontrollable shaking of a body part
  • Seizures

What Happens if I Overdose on ProAir HFA?

If you think you or someone else may have overdosed on ProAir HFA, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking ProAir HFA, call 911 immediately.

Precautions


Drug Content Provided and Reviewed by


IBM Micromedex®

It is very important that your doctor check your or your child's progress at regular visits. This will allow your doctor to see if the medicine is working properly and to check for any unwanted effects.

Do not use this medicine together with other similar inhaled medicines, including isoproterenol (Isuprel®), levalbuterol (Xopenex™), metaproterenol (Alupent®), pirbuterol (Maxair®), or terbutaline (Brethaire®).

This medicine may cause paradoxical bronchospasm, which means your breathing or wheezing will get worse. This may be life-threatening. Check with your doctor right away if you or your child have coughing, difficulty breathing, or wheezing after using this medicine.

Talk to your doctor or get medical help right away if:

  • Your symptoms do not improve or they become worse after using this medicine.
  • Your inhaler does not seem to be working as well as usual and you need to use it more often.

You or your child may also be taking an antiinflammatory medicine, including steroid (cortisone-like medicine), together with this medicine. Do not stop taking the antiinflammatory medicine, even if your asthma seems better, unless your doctor tells you to.

Albuterol may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and require immediate medical attention. Check with your doctor right away if you or your child develop a skin rash, hives, itching, trouble breathing or swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.

Hypokalemia (low potassium in the blood) may occur while you are using this medicine. Check with your doctor right away if you or your child have decreased urine, dry mouth, increased thirst, irregular heartbeat, loss of appetite, mood changes, muscle pain or cramps, nausea, vomiting, numbness or tingling in the hands, feet, or lips, trouble breathing, seizures, or unusual tiredness or weakness.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take ProAir HFA?

ProAir HFA is contraindicated in people with a history of an allergic reaction to albuterol or any other inhalation aerosol ingredients.

Avoid using ProAir HFA if you're hypersensitive to milk protein.

The safety of ProAir HFA has not been established for people under age 4.

There is no clinical data on the safety of ProAir HFA in pregnancy and breastfeeding. Consult your healthcare provider if you are pregnant or breastfeeding.

What Other Medications Interact With ProAir HFA?

Beta-blockers may not work effectively if taken with ProAir. Examples of beta-blockers are:

  • Tenormin (atenolol)
  • Coreg (carvedilol)
  • Toprol XL, Lopressor (metoprolol)
  • Bystolic (nebivolol)
  • Inderal LA (propranolol)

Diuretics may cause lower potassium levels in the body when taken with ProAir HFA, such as:

  • Bumex (bumetanide)
  • Thalitone (chlorthalidone)
  • Lasix (furosemide)
  • Microzide (hydrochlorothiazide)

When taken with albuterol, blood levels of digoxin (Lanoxin) may decrease and become less effective in treating heart disease. Your healthcare provider may need to monitor the level closely to find the effectiveness of the digoxin. 

Monoamine oxidase inhibitors (MAOIs) and ProAir combined can lead to an increased risk of heart problems. Albuterol should NOT be used at least two weeks before starting or two weeks after stopping MAOIs such as:

  • Nardil (phenelzine)
  • Azilect (rasagiline)
  • Marplan (isocarboxazid)
  • Emsam, Zelapar (selegiline)
  • Parnate (tranylcypromine)

Tricyclic antidepressants can increase the risk of heart problems when used with ProAir. ProAir should be used at least two weeks after stopping taking tricyclic antidepressants such as:

  • Elavil (amitriptyline)
  • Norpramin (desipramine)
  • Silenor (doxepin)
  • Pamelor (nortriptyline)

Your healthcare provider may need to adjust the dose of your medications or monitor you closely for side effects.

What Medications Are Similar?

Albuterol, a bronchodilator, is also available in other brand names prescribed for the same conditions. These are:

  • Ventolin HFA
  • Proventil HFA

The following are both short-acting beta-agonists, like albuterol, but are different (metaproterenol).

These medicines are approved to prevent and treat bronchospasm in people with asthma. They’re also each approved for use as needed to avoid exercise-induced bronchospasm. They are used in adults and children ages 4 and older.

Ventolin HFA comes in canisters that hold either 60 or 200 inhalations of medicine. ProAir HFA and Proventil HFA come in canisters with 200 inhalations of medicine.

Frequently Asked Questions

  • What is ProAir HFA used for?

    ProAir HFA (albuterol) is a short-acting bronchodilator used to relieve lung problems such as bronchospasm from asthma and reversible obstructive airway disease.

  • How does ProAir HFA work?

    ProAir HFA (albuterol) relaxes the airway muscles so they remain open. This helps ease breathing and relieve other symptoms of lung diseases.

  • What drugs should not be taken with ProAir HFA?

    Beta-blockers, diuretics, digoxin, monoaminoxidase inhibitors (MAOIs), and tricyclic antidepressants cannot be taken with ProAir HFA.

How Can I Stay Healthy While Taking ProAir HFA?

Albuterol is meant to be a rescue treatment for symptoms of bronchospasm. Short-acting albuterol and other beta-agonists should not be used regularly to control asthma or other lung problems. However, your healthcare provider will determine the need, safety, and effectiveness of the medicine for you. 

Use your inhaler appropriately and always keep a backup to avoid any problem from accidental loss or a nonfunctioning inhaler, as this can be life-threatening. It's essential to regularly keep appointments with your healthcare provider to continue monitoring and talking about your symptoms and see if you may need to change treatment.

It's common for the ProAir inhaler to become clogged with powder residue. People may think the inhaler is broken when the delivery device simply needs to be cleaned/rinsed out. Ask your pharmacist or healthcare provider about how best to clean your ProAir inhaler.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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BreatheEasy (BE) Eastbourne is a support group which encourages good health and wellbeing for people who are suffering from asthma/chronic lung diseases.

Activities run by the group include monthly support meetings, pulmonary rehabilitation exercise programmes, social activities and fitness classes.

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On Tuesday (June 21) BE held an open day at the Deerfold Centre in Seaside which is used for monthly meetings, volunteer offices, and will soon be home to the new drop-in centre.

Behind the scenes with BreathEasy Eastbourne (Pic by Jon Rigby)

BE was set up by Kim Cole eight years ago and has been an independent charity for three years. She said by being independent, the money raised can go back into the Eastbourne community.

Kim said, “I organised BreatheEasy because I have a chronic lung disease myself and there is a gap for support, especially for rehabilitation. The charity is run with the help of a team of dedicated and hard working volunteers who themselves all suffer from lung disease".

BE member Richard Harbourne said, “I was left in the dark really with no assistance – that's when I found BreathEasy.”

Kim said people can lose motivation after the NHS rehabilitation, and that's where BE fits in.

Behind the scenes with BreathEasy Eastbourne (Pic by Jon Rigby)

The charity currently supports around 150 people but is in need of more volunteers. There are only four volunteers as three died in the last year from their own lung conditions.

Kim has been praised by people in the community for her work.

BE member Graham May joined the group five years ago after speaking to his GP – Dr Stephen Lytton.

He said he attends the monthly meetings for useful advice given, but it's also a good social event to meet people in a similar situation.

Behind the scenes with BreathEasy Eastbourne (Pic by Jon Rigby)

Graham said, “Kim is very dedicated, she's done a cracking job.”

Dr Lytton, who is the GP lead for respiratory care in East Sussex, said, “When it comes to respiratory problems, you can't see it and there's huge suffering that goes with it.”

Dr Lytton said people with lung conditions are often 'frightened' of exercise because of the fear of being breathless, but the right type of exercise is actually very good for patients.

He said, “I'm a great supporter of this group. This is a place where you've got the group, activities, social interaction and the sharing of knowledge. This fulfils so many of the important aspects of managing people who are breathless.

Behind the scenes with BreathEasy Eastbourne (Pic by Jon Rigby)

“This group is breaking boundaries and making a huge difference.”

Sarah Crouch, head of the CCG, said, “We're so impressed with what they've been doing and we want to support them. It's a massive input for the community.

“There are BreatheEasy networks across the country, but in Eastbourne it's people like Kim that galvanize that. It's so unique what they do here.”

Alex Hough, a respiratory physiotherapist, is the one to run pulmonary rehabilitation sessions and has been involved with BE for four years.

She said when it comes to her role, it often gets overlooked, but people with lung conditions need to see a respiratory physio.

Alex said, “Breathlessness is a frightening thing, but we're turning that fear around. You can control it with the right help. If you don't exercise it gets worse.”

Alex runs the sessions alongside students from the University of Brighton, a partnership that was formed by working with university lecturer Hazel Horobin.

Hazel said, “There is no cure for these things but there is making the best of it, and the single best thing is exercise – that's where pulmonary rehabilitation comes in and that's why we work with BreatheEasy.

Exercise is a medicine, we're a branch of that.”

Hazel said less than 20 per cent of people that could get rehab actually use it which is why charities like BE are so important.

Mayor Pat Rodohan attended the BE open day and said, “One more charity doing a wonderful job. There's real support here, the charity is working with the doctors hand in hand – it's lovely to see.”If you want to get in touch with BE Eastbourne call 079498111599, email [email protected] or visit www.breatheasyeastbourne.org

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The latest study released on the Global Breathing Filter Market by AMA Research evaluates market size, trend, and forecast to 2027. The Breathing Filter market study covers significant research data and proofs to be a handy resource document for managers, analysts, industry experts and other key people to have ready-to-access and self-analyzed study to help understand market trends, growth drivers, opportunities and upcoming challenges and about the competitors.

Key Players in This Report Include:

Medtronic (United States), Smiths Medical (United States), 3M (United States), Honeywell (United States), Draeger (Germany), Armstrong Medical (United Kingdom), Intersurgical (United Kingdom), Flexicare (United Kingdom), Matisec (France), Teleflex (United States), Danaher (United States), GE Healthcare (United States), GVS Group (Italy)

Download Sample Report PDF (Including Full TOC, Table & Figures) @ www.advancemarketanalytics.com/sample-report/131242-global-breathing-filter-market

Definition:

Breathing system filters are intended to replace the filtering function of the nasopharynx and may also replace its warming and humidifying functions. Filters decrease the risk of the inner of breathing systems, equipment and the ambient air becoming contaminated by patients. Inspiratory and expiratory gases are separated in the breathing systems used in intensive care and ‘open’ breathing systems used during anesthesia, although there is a partial common pathway in the latter. The use of filters is not free of risk. They increase total resistance to gas flow and work of breathing. They may affect the triggering of some ventilators.

Market Trends:

  • Huge Demand for Diagnostic Tools to Deliver a Reliable Diagnosis of Asthma in Young Children
  • Technological Advancements in the Healthcare Sector

Market Drivers:

  • Increasing Prevalence of Respiratory Diseases
  • Rising Demand for Home Care Respiratory Devices

Market Opportunities:

  • Increasing Awareness and Improvement in the Healthcare Infrastructure in Emerging Economies

The Global Breathing Filter Market segments and Market Data Break Down are illuminated below:

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Global Breathing Filter market report highlights information regarding the current and future industry trends, growth patterns, as well as it offers business strategies to helps the stakeholders in making sound decisions that may help to ensure the profit trajectory over the forecast years.

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Geographically, the detailed analysis of consumption, revenue, market share, and growth rate of the following regions:

  • The Middle East and Africa (South Africa, Saudi Arabia, UAE, Israel, Egypt, etc.)
  • North America (United States, Mexico & Canada)
  • South America (Brazil, Venezuela, Argentina, Ecuador, Peru, Colombia, etc.)
  • Europe (Turkey, Spain, Turkey, Netherlands Denmark, Belgium, Switzerland, Germany, Russia UK, Italy, France, etc.)
  • Asia-Pacific (Taiwan, Hong Kong, Singapore, Vietnam, China, Malaysia, Japan, Philippines, Korea, Thailand, India, Indonesia, and Australia).

Objectives of the Report

  • -To carefully analyze and forecast the size of the Breathing Filter market by value and volume.
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Points Covered in Table of Content of Global Breathing Filter Market:

Chapter 01 – Breathing Filter Executive Summary

Chapter 02 – Market Overview

Chapter 03 – Key Success Factors

Chapter 04 – Covid-19 Crisis Analysis on Global Breathing Filter Market

Chapter 05 – Global Breathing Filter Market – Pricing Analysis

Chapter 06 – Global Breathing Filter Market Background

Chapter 07 — Global Breathing Filter Market Segmentation

Chapter 08 – Key and Emerging Countries Analysis in Global Breathing Filter Market

Chapter 09 – Global Breathing Filter Market Structure Analysis

Chapter 10 – Global Breathing Filter Market Competitive Analysis

Chapter 11 – Assumptions and Acronyms

Chapter 12 – Breathing Filter Market Research Methodology

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Thanks for reading this article; you can also get individual chapter wise section or region wise report version like North America, Middle East, Africa, Europe or LATAM, Asia.

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Craig Francis (PR & Marketing Manager)
AMA Research & Media LLP
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New Jersey USA – 08837
Phone: +1 (206) 317 1218
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A younger man uses an inhaler for asthmaShare on Pinterest
Experts say overusing or underutilizing asthma inhalers can lead to other health issues. MixMedia/Getty Images
  • About 25 million people in the United States have asthma.
  • Researchers say about one-fourth of them overuse their rescue inhalers.
  • They say another one-fourth underuse their preventive inhalers.
  • Experts say people with asthma need to be better informed about when to use inhalers.

More than one-fourth of people with asthma overuse SABA (or rescue) inhalers.

Another one-fourth of underuse corticosteroid (or preventive) inhalers, leading to an increased risk of severe asthma attacks.

That’s according to a new study by researchers at the Clinical Effectiveness Group at Queen Mary University in London who analyzed more than 700,000 patient records from 117 general medical practices.

They found that:

  • 26 percent of people with asthma were overprescribed SABA inhalers
  • 25 percent of those people were underusing preventive corticosteroid inhalers

The researchers calculated that helping people who use more than 12 SABA inhalers per year reduce their use to less than 12 could result in 70 percent fewer asthma-related hospital admissions for that group.

“This is an interesting study and seems to bring to light an important issue,” Dr. David Erstein, an allergist and immunologist working with Advanced Dermatology PC in New York, told Healthline. “I think people tend to not think about their breathing until they develop symptoms. Because the preventative inhalers don’t offer immediate help, they turn to their rescue inhaler.”

SABAs are short-acting beta-agonists for use as needed, such as during an acute asthma attack.

“They work by relaxing the airway muscles and allowing the airway to dilate, relieving shortness of breath,” Dr. Fady Youssef, a pulmonologist, internist, and critical care specialist at MemorialCare Long Beach Medical Center in California. “They don’t provide long-term disease control, just immediate symptomatic relief. Inhaled corticosteroids are a cornerstone in treating asthma and provide symptom relief as well as long-term control and reduction in the rate of exacerbations.”

Past studies have also looked at this issue.

The 2008-2010 Medical Expenditure Panel Survey, for example, found that nearly 15 percent of the asthma population in the United States used more than one SABA per month. About 60 percent used daily long-term control medications but still required significant use of quick-relief inhalers.

“When asthma is well controlled, the frequency of SABAs should be two or fewer days per week,” Joyce Baker, MBS, RRT, a fellow of the American Association for Respiratory Care, told Healthline.

Asthma affects the lungs when the airways can become inflamed, narrowing the airflow pathway in and out of the lungs.

Other changes during an asthma attack include excess mucus in the airways. In addition, muscles surrounding the airways can tighten, reducing the ability to breathe.

About 25 million people in the United States have asthma. It often starts in childhood.

“Asthma is a common, chronic condition with variable and recurrent symptoms, including bronchospasms, inflammation, and hyperactivity,” says Baker. “Poorly controlled asthma can limit daily activities and increase the number of missed school or workdays. It is associated with increased hospitalizations, emergency department visits, and oral steroid use.”

Many people experience an asthma attack or worsening symptoms because of a trigger. Common triggers include:

  • Pollen
  • Exercise
  • Viral infections
  • Cold air

There is currently no cure for asthma. However, with proper medical care, it is manageable.

Experts say people who learn to control their asthma can lead a full and active life.

There are several treatments available for asthma:

  • Quick-relief inhalers, sometimes called rescue inhalers, are used when you experience sudden symptoms. They are most effective when used at the first sign of symptoms.
  • Controller inhalers are used daily to prevent asthma symptoms by reducing swelling and excess mucus in the airways.
  • Biologic medicines are given via injection or infusion. They target a cell or protein to prevent swelling in the airways. People with certain types of persistent asthma might benefit from biologics.

A fourth option, which combines the quick-relief and controller inhalers, helps with short-term relief and long-term control.

The Asthma and Allergy Foundation of America includes these in its treatment guidelines. However, the Food and Drug Administration has not yet approved them for this purpose.

The researchers in the recent study believe medical professionals should support and educate patients on the proper use and dangers of overuse of SABA inhalers.

Primary physicians, specialists such as allergists, and pharmacists have tools to help people reduce their SABA use and increase preventive measures, they noted.

“In the United States, reasons for noncompliance with corticosteroid inhalers include the cost, inadequate education regarding the inflammatory origins of asthma, and oral side effects, which can include oral discomfort,” Dr. Jooby Babu, a pulmonologist in Southern California, told Healthline. “The LABA/ICS combination is inhaled corticosteroids and a long-acting beta-agonist. Patients who use this combination have noticeably decreased episodes of asthma and decreased hospitalizations.”

“During my patient clinic visits, I often ask about how often they use their SABA,” he added. “If it is more than once a week, I place them on inhaled corticosteroids in addition to their SABA. If the exacerbations are still not controlled, I prescribe a long-acting beta-agonist with an inhaled corticosteroid.”

There isn’t a one-size-fits-all way to address SABA overuse. Experts say education should be customized for each person.

“People learn and retain information differently, so it is important to start with having them show me how they use their inhalers. Then I can educate on any gaps in technique or understanding,” explained Baker. “There are many different inhalers on the market today, and technique will vary based on the device. In some cases, specific inhaler devices may not be ideal for the individual based on age and cognitive abilities, leading to overuse. It is also essential to use different teaching mechanisms to best meet the learner’s needs, such as demonstration, teach-back, videos, and handouts.”

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Thrive's short-term pulmonary rehab program leverages technology, like the OmniFlow™, for improving pulmonary endurance and respiratory function.

NAPERVILLE, Ill., June 22, 2022 /PRNewswire/ -- Thrive Personalized Medical Rehabilitation offers a robust short-term pulmonary rehab care program at two of its skilled nursing facilities located in Lisle and Aurora: Thrive of Lisle and Thrive of Fox Valley.

Thrive of Lisle and Thrive of Fox Valley's short-term pulmonary rehab program consists of clinical teams and technology for improving pulmonary endurance and respiratory function. Their teams of professionals have specialized skills and work closely together to develop and implement each patient's pulmonary rehab care plan. Thrive of Lisle and Thrive of Fox Valley's clinical team members include in-house physical and occupational therapists, respiratory therapist, internal medicine physician, nurse practitioner, pulmonary nurse practitioner, registered nurse (RN), psychologist and registered dietitian.

Thrive of Lisle and Thrive of Fox Valley's short-term pulmonary rehab care program treats patients facing pulmonary conditions such as COPD, asthma, emphysema, chronic Bronchitis, pneumonia, and post COVID-19 syndrome.

Thrive of Lisle and Thrive of Fox Valley's short-term pulmonary rehab program also incorporates the latest in therapy technology like the OmniFlow™ and LiteGait©. OmniFlow, developed by Accelerated Care Plus, is a breathing therapy biofeedback system that conducts exercises using visual feedback in a virtual experience. In the following video, a Thrive rehab guest demonstrates the OmniFlow: www.youtube.com/watch?v=bWpHZR9hWaE. The LiteGait is another therapy technology that helps patients with weight bearing restrictions maintain constant support while working on gait therapy exercises.

For more information on Thrive Personalized Medical Rehabilitation and their short-term pulmonary rehab care program and skilled nursing facilities near Naperville—Thrive of Lisle and Thrive of Fox Valley—visit www.ThriveAhead.com.

Media Contact:

Lisa Henderson

339155@email4pr.com

773-875-5956

Cision View original content to download multimedia:www.prnewswire.com/news-releases/naperville-pulmonary-rehab-care-301572639.html

SOURCE Thrive Personalized Medical Rehabilitation



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Thrive's short-term pulmonary rehab program leverages technology, like the OmniFlow™, for improving pulmonary endurance and respiratory function.

NAPERVILLE, Ill., June 22, 2022 /PRNewswire/ -- Thrive Personalized Medical Rehabilitation offers a robust short-term pulmonary rehab care program at two of its skilled nursing facilities located in Lisle and Aurora: Thrive of Lisle and Thrive of Fox Valley.

Thrive of Lisle and Thrive of Fox Valley's short-term pulmonary rehab program consists of clinical teams and technology for improving pulmonary endurance and respiratory function. Their teams of professionals have specialized skills and work closely together to develop and implement each patient's pulmonary rehab care plan. Thrive of Lisle and Thrive of Fox Valley's clinical team members include in-house physical and occupational therapists, respiratory therapist, internal medicine physician, nurse practitioner, pulmonary nurse practitioner, registered nurse (RN), psychologist and registered dietitian.

Thrive of Lisle and Thrive of Fox Valley's short-term pulmonary rehab care program treats patients facing pulmonary conditions such as COPD, asthma, emphysema, chronic Bronchitis, pneumonia, and post COVID-19 syndrome.

Thrive of Lisle and Thrive of Fox Valley's short-term pulmonary rehab program also incorporates the latest in therapy technology like the OmniFlow™ and LiteGait©. OmniFlow, developed by Accelerated Care Plus, is a breathing therapy biofeedback system that conducts exercises using visual feedback in a virtual experience. In the following video, a Thrive rehab guest demonstrates the OmniFlow: www.youtube.com/watch?v=bWpHZR9hWaE. The LiteGait is another therapy technology that helps patients with weight bearing restrictions maintain constant support while working on gait therapy exercises.

For more information on Thrive Personalized Medical Rehabilitation and their short-term pulmonary rehab care program and skilled nursing facilities near Naperville—Thrive of Lisle and Thrive of Fox Valley—visit www.ThriveAhead.com.

Media Contact:
Lisa Henderson
[email protected]
773-875-5956

SOURCE Thrive Personalized Medical Rehabilitation

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Background: Most of the acute exacerbations of chronic obstructive pulmonary disease (COPD) are due to infections, mostly due to bacteria and viruses. There is a need to study the outcome of microbe-induced airway inflammation.

Materials and methods: It is an observational follow-up study from the pulmonary medicine department of Kalinga Institute of Medical Sciences with the participation of the Regional Medical Research Center, Bhubaneswar, from October 2018 to February 2022. Patients who were admitted with acute exacerbation of COPD and treated as per GOLD (Global Initiative for Chronic Obstructive Lung Disease) 2021 guidelines were included in the study. Those patients in the severe category, who had clinically recovered, had undergone pulmonary physiotherapy, were on prescribed medications and home oxygen therapy after discharge, were followed up every three months by telephone calls. Any exacerbation, clinical stability, or mortality information was recorded.

Results: Out of 197 cases, the majority were elderly, males, smokers, and belonged to urban areas; in total, 102 (51.8%) microbes were isolated as etiological agents of infective exacerbation in which 19.79% were viruses and 23.35% were bacteria, while coinfection was found in 8.62% cases. Among the viruses, rhinovirus, influenza virus, and respiratory syncytial virus were the major isolates. Among the bacteria, mostly gram-negative organisms such as Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa were isolated. Readmission was more among patients with coinfection.

Conclusion: Acute exacerbation of COPD was mostly seen in males in the age group of 61-80 years. Rhinovirus and influenza A virus were the two most common viral isolates, and among the bacterial isolates, Acinetobacter baumannii and Klebsiella pneumoniae were predominantly detected. Poor clinical outcomes were noticed more among the coinfection group.

Introduction

Worldwide, COPD is one of the major causes of illness and the sixth highest cause of death. According to research on the Global Burden of Diseases in 2017, it contributed to 50% of all chronic respiratory diseases. It is currently the third leading cause of death worldwide, accounting for nearly 3.23 million deaths, with nearly 80% of deaths occurring in the middle- and low-income countries, and is expected to rise from the 12th leading cause of disability-adjusted life-years (DALYs) in 1990 to the fifth leading cause in 2020 [1,2].

Acute exacerbations of COPD are significant events in the course of illness because they have a negative influence on health status, hospitalization rate, and disease progression. It is believed that respiratory infections are an important risk factor for COPD exacerbations, with viruses accounting for 22%-64% [3]. The increased exposure to viruses in winter has been correlated to an increase in the frequency of exacerbations in winter in some areas of the world [4]. Co-infections have also been linked to an increase in the severity of COPD exacerbations. The simultaneous discovery of bacteria and viruses in patients with acute exacerbation of COPD is responsible for the worsening lung function, prolonged hospital stay, and risk of recurrence of a similar event [5,6].

This study analyses the prevalence and pattern of viral and bacterial infections in patients presenting with acute exacerbation of COPD, correlates the type of infection with the severity of exacerbation among the patients, and finds out the long-term outcome of the severe follow-up cases after discharge in terms of readmission, clinical stability, or death.

Materials & Methods

The study was conducted from October 2018 to February 2022 among the patients admitted to critical care, Respiratory and General Medicine unit of Kalinga Institute of Medical Sciences, Bhubaneswar, in collaboration with Regional Medical Research Centre (ICMR), Bhubaneswar.

The sample size was calculated by using the formula: 

n = Z2 P(1−P)/d2

where n is the sample size; Z is the statistic corresponding to a 95% level of confidence, which is equal to 1.96; P is the expected prevalence (proportion of COPD patients with infectious etiology = 78.3% in a study conducted by Jahan et al.) [7]; d is the absolute precision (it has been taken as 6%). The sample size was found to be 179; adding a 10% non-response rate, the final sample size was 179 + 18 = 197.

Admitted cases underwent clinical assessment and other routine investigations. Empirical treatment was given as per standard treatment guidelines. The nasopharyngeal swab was taken and transported in a viral transport medium within 24 hours to the Regional Medical Research Centre (RMRC) for the detection of respiratory viruses. Samples were tested by real-time reverse transcription-polymerase chain reaction (RT-PCR). The test was done using recommended commercial kit (FTD, UK) following the manufacturer’s instructions on Applied Biosystems-7500 (ABI-7500) equipment (ABI, USA). After thorough rinsing of the oral cavity, respiratory secretions were sent in a sterile container to our institute laboratory for bacterial culture and sensitivity study by VITEK 2 compact instrument (bioMérieux, France).

Apart from the procedural guidelines, depending on the severity of the cases, patients were treated with microbe-targeted antibiotics, oxygen support, either parenteral or oral, nebulized corticosteroid, and bronchodilator and were classified as mild, moderate, and severe as per the GOLD guidelines. The severe cases underwent pulmonary physiotherapy (diaphragm strengthening, pursed-lip breathing, lower limb muscle training, and chest percussion) session one week after clinical stability.

The patients were contacted over telephonic/telemedicine services every three months (due to the COVID pandemic, physical follow-up was not done) to ensure that they were continuing to perform the exercises at home and consuming medications, and any clarifications sought were addressed. Outcome data were collected with respect to clinical stability, worsening of clinical symptoms requiring admission, or mortality at the end of one year of follow-up.

This is an observational follow-up study conducted in the pulmonary medicine department of the Kalinga Institute of Medical Sciences. Ethical clearance was obtained from Institutional Ethics Committee (vide letter no.: KIIT/KIMS/113). All patients (including those on ventilation) with acute exacerbation of COPD (based on acute onset of cough, increased sputum with or without purulence, and breathing difficulty) admitted to the pulmonary medicine department were included in the study. Patients with pulmonary tuberculosis (TB), bronchiectasis, bronchial asthma, pneumonia, and acute lung injury (based on history and evaluation) and patients unwilling to give consent were excluded from the study.

Statistical analysis

Descriptive statistics were done after the collection of data. Frequency distributions of categorical variables (occupation, gender, place of residence, smoking status, type of pathogens found, clinical features, comorbidities, and follow-up data) were calculated. For continuous data (age, total leukocyte count [TLC], and duration of hospital stays), mean and standard deviations were calculated. These were presented in tables using SPSS version 20.0 (IBM Corp., Armonk, NY) and Microsoft Excel 2007 (Microsoft Corporation, New Mexico, USA).

Type of infection, isolated organisms, and clinical outcomes after one year were identified. Chi-square and p-values were calculated to measure the associations between the type of infection and isolated organisms, type of infection, and readmission after one year.

Results

A total of 197 subjects were included in the study, out of which 138 (70.06%) were males and 59 (29.94%) were females. The maximum number of subjects (130 [65.9%]) were within the age group of 61-80 years. The total number of patients more than 80 years of age was 25 (12.69%). The mean age of the patients was 69.24 ± 11.08 years (Table 1).

Age group (years) Male Female Total
40-60 25 17 42
61-80 92 38 130
>80 21 4 25
Total 138 59 197

The total number of patients who had a smoking history was 126 (63.95%). Most of the study subjects were farmers (37.06%), and the least belonged to the category of laborer (2.54%). Out of the total subjects, only 83 (42.13%) patients were from rural areas (Table 2).

Variables Frequency Percentage (%)
Smoking history
Smoker 126 63.96
Non-smoker 71 36.04
Occupation
Teacher 16 8.12
Businessmen 21 10.66
Laborer 5 2.54
Farmer 73 37.06
Housewife 47 23.86
Unemployed 35 17.77
Area of residence
Urban 114 57.87
Rural 83 42.13

Out of 197 patients,102 (51.78%) had been isolated with bacteria or viruses, or both. Isolated viral infection was seen in 39 (19.79%) cases, while 46 (23.35%) had only bacterial exacerbations. In another 17 (8.62%) cases, both bacteria and viruses were detected. No etiology for exacerbation could be detected in 95 (48.2%) cases (Table 3).

Infection detected No. of cases Percentage (%)
Virus only 39 19.79
Bacteria only 46 23.35
Coinfection with both 17 8.62
No pathogen found 95 48.24
Total no. of patients 197 100

Out of 56 cases, in three cases of viral exacerbations, more than one virus (i.e., two) was detected, and in one case of viral exacerbation, more than one virus (i.e., three) was detected. A total of 62 viruses were isolated. Rhinovirus and Flu-A (H3N2) were isolated most frequently (30.35% and 25%, respectively) followed by respiratory syncytial virus (RSV) and parainfluenza virus 3 (PIV-3) (10.71% each; Table 4).

List of viruses No. of cases with viral infection (N = 56) % of patients with the isolated virus
Rhinovirus 17 30.35
Flu-A (H3N2) 14 25.0
RSV-B 6 10.71
Flu-B 4 7.14
PIV-3 6 10.71
Flu-A/PDM 09 4 7.14
HMPV 3 5.35
Adenovirus 2 3.57
RSV-A 2 3.57
COVID-19 4 7.14

A total of 63 bacteria were isolated in which gram-negative bacilli were most common, which include Acinetobacter baumanniiKlebsiella pneumoniae, and Pseudomonas aeruginosa. Among the gram positives, Staphylococcus aureus was the most common.

Rhinovirus was most commonly associated with bacterial coinfection in four cases (2.03%) followed by Flu-A and COVID-19. Acinetobacter baumannii was associated with a viral infection in most cases (five cases; 2.53%). This was followed by the detection of Pseudomonas aeruginosa and Klebsiella pneumoniae in two cases each (Table 5).

List of bacteria No. of cases with bacterial infection (N = 63) % of total bacteria isolated
Acinetobacter baumannii 14 22.22
Klebsiella pneumoniae 14 22.22
Pseudomonas aeruginosa 12 19.05
Staphylococcus aureus 5 7.94
Escherichia coli 8 12.70
Enterobacter cloacae complex 5 7.94
Serratia marcescens 2 3.17
Enterococcus faecium 1 1.59
Streptococcus pneumoniae 1 1.59
Staphylococcus haemolyticus 1 1.59
Sphingomonas paucimobilis 1 1.59

Breathlessness and cough were the most frequent complaints at the time of presentation. In cases with isolated viral exacerbation, 38 out of 39 cases (97.4%) had a shortness of breath, while 34 out of 39 (87.2%) cases had a cough. Fever was present in 14 out of 39 (32%) cases. However, sore throat was reported only in patients with isolated viral exacerbation, and chest pain was reported in patients with isolated bacterial exacerbations. Hypertension was the most common comorbidity reported in both bacterial and viral infections. Diabetes mellitus was mostly seen in patients who had a coinfection (Table 6).

Clinical feature Type of infection
Isolated viral Isolated bacterial Coinfection
Fever 14 19 6
Cough 34 36 13
Expectoration 9 10 4
Breathlessness 38 43 17
Chest pain 0 2 0
Sore throat 9 0 0
Altered sensorium 2 0 0
Comorbidities
Hypertension 11 16 4
Diabetes mellitus 5 5 6
Parkinson’s disease 0 2 0
Coronary artery disease 0 4 0
Cerebrovascular accident 1 2 0
Chronic kidney disease 1 1 0
Cushing syndrome 1 0 0
Chronic liver disease 1 0 0
Carcinoma larynx 0 1 0
Alzheimer’s disease 0 1 0
Congenital heart disease 0 0 1

Among the 102 patients with infective exacerbations, patients with viral exacerbation had relatively lower mean TLC, while patients with exacerbation due to coinfection had the highest mean TLC. However, the results were not significant (p = 0.641). Among the patients with infective exacerbations, those with viral exacerbation had the least mean duration of hospital stay (7.33 ± 4.8 days), while patients with bacterial exacerbation spent the highest number of days in the hospital (10.082 ± 5.89 days). The 17 patients with coinfection had a mean duration of hospitalization of 6.8 ± 5.03 days. The results were not statistically significant (p = 0.071). Ten (26%) patients with viral exacerbation, 24 (52%) with bacterial exacerbation, and nine (53%) patients with a coinfection required respiratory support and hence needed admission to ICU. Severity was most commonly noticed in coinfection cases (p = 0.020). Two deaths were reported in viral infections, four in bacterial exacerbation, and three in coinfections (Table 7).

Parameters Mean Value P-value
  Isolated viral infection (n = 39) Isolated bacterial infection (n = 46) Coinfection (n = 17)
Mean age (years ± SD) 68.36 ± 3.45 71.8 ± 11.73 73 ± 8.33 0.084NS
Total leukocyte count (cells/mm3) 11.139 ± 4.8 12.49 ± 5.435 12.66 ± 7.3 0.641NS
Mean duration of hospital stay (in days) 7.33 ± 4.8 10.052 ± 5.89 6.8 ± 5.03 0.071NS
Type of cases
Mild 12 (31%) 0 (0%) 0 (0%) 0.041S
Moderate 17 (43%) 22 (48%) 8 (47%) 0.062NS
Severe 10 (26%) 24 (52%) 9 (53%) 0.020S
No. of deaths among the severe cases 2 4 3 NA

The number of patients who had a severe disease was 43 (Table 7). Out of them, nine died. The rest 34 cases were advised pulmonary rehabilitation, oxygen therapy, inhaler-based medication as self-management home-based delivery, and were on telehealth monitoring. Five cases were lost to follow-up. In the rest 29 cases, information was documented after follow-up for one year that consisted of six viral infection, 17 bacterial infection, and six coinfection cases (Table 8).

Condition of the patients after one year of follow-up Viral infection (6 cases) Bacterial infections (17 cases) Coinfections (6 cases) P-value
Clinically stable 6 (100%) 16 (94%) 2 (33%) 0.034s
Exacerbation (admission) 0 1 (6%) 4 (67%)

All viral infection cases were clinically stable and did not require admission. Out of 17 bacterial infection cases, 16 (94%) were clinically stable and only one (6%) required hospital admission due to exacerbation. But in the six coinfection cases, two (33%) were clinically stable and the rest four (67%) cases required hospital admission, and the data was found to be statistically significant (p = 0.034). This shows most of the coinfection cases required rehospitalization during the period of follow-up (Table 8).

Discussion

Acute exacerbation of COPD results in deterioration of pulmonary function, morbidity, and death. In our study, the mean age of the patients was 69.24 ± 11.08 years with a majority of the patients belonging to the age group of 61-80 years (Table 1). In a recent study conducted at the All India Institute of Medical Sciences (AIIMS), Bhubaneswar, the mean age was 65.49 ± 10.40 years [7]. As per another Indian study by Mood et al., the mean age of patients was 66.8 ± 11.4 years and the maximum prevalence was observed in the age group 70-79 years [8]. In another study that involved both European and American subjects, the proportion of females was 36.7% among Europeans and 33.3% among Americans, which is in accordance with our findings [9]. A study by Hajare et al. reported a male-to-female ratio of 2.3:1 [10]. The preponderance of males being affected can be attributed to the fact that males are more involved in outdoor activities and hence are more exposed to environmental pollutants [8]. Smoking is a risk factor for COPD and also its exacerbation as it decreases mucociliary clearance, which is amply proved in our study where smoking as a risk factor was noticed among 64% of patients [11]. In our study, the two main occupations that had increased the prevalence of COPD were farmers and housewives (Table 2). In a study published in 2016, occupations that were at COPD risk were seafarers, coalmine operatives, and cleaners [12]. In a study in Bangladesh, occupational exposures in farmers, hazardous exposures in tanners, and cotton dust exposures in garments were among the most prominent risk factors for the development of COPD [13]. In our study, the urban population comprised the majority (57.8%, Table 2), which correlates well with a study done in India where the prevalence of COPD was more in the urban areas. But there has been a significant increase in the prevalence in rural areas where it was reported to be 8.8% in a study done in India, whereas in our study, the prevalence is around 22% [14]. The disparity in the urban-rural divide is reversed in the United States, where the prevalence of COPD in rural communities is nearly double that in urban areas [15].

The complex interactions between environment, host, and microbes are responsible for exacerbations in COPD and increased morbidity and mortality [16]. As per studies, the major cause of acute exacerbations is infections [7]. In our study, infection was detected in 51.7% of cases (Table 3). In an Indian study, around 78.3% of cases had a respiratory infection [7]. Our study illustrates that only bacterial infection was found in 23.35% of cases; only viral etiology was found in 19.79% of cases, and bacterial and viral coinfection was found in 8.62% of cases. Other studies have reported bacterial infection in around 42%-49% of cases, viral infections in around 20%-64% of cases, and bacterial-viral coinfection in 27% of cases [7,17,18]. There has been an increased report of respiratory viruses as a causative agent in the acute exacerbation of COPD. With the application of molecular techniques in patients’ samples, viruses have been implicated in around 47%-66% of cases [11]. A total of 56 viruses were isolated (Tables 3, 4). The most common viruses isolated were rhinovirus, followed by Flu-A and RSV-B. Human rhinovirus (HRV) has been reported as a common viral isolate in various studies [18]. The study by Koul et al. also reported rhinovirus and influenza virus as the most common virus causing acute exacerbation of COPD [19]. The high rate of isolation of influenza virus may be attributed to the transmission of the influenza virus in the community and the need to have immunization [20]. In our study, more than one virus was isolated in three cases. Similar results have been found in a recent study in India [7]. The most common bacterial isolates in our study are Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa making up around 21.9% (for both Acinetobacter and Klebsiella) and 18.8%, respectively. Among the gram-positive bacteria, Staphylococcus aureus (7.8%), Enterococcus faecium (1.6%), and Streptococcus pneumoniae (1.6%) were the most common isolates. In the study by Jahan et al., the most common bacteria isolated were Pseudomonas aeruginosa (28%), followed by Acinetobacter baumannii and Klebsiella pneumoniae in seven cases each (21%) [7]. In another study, the most common bacterial isolates were P. aeruginosa (30.7%) followed by K. pneumoniae (20.3%) and S. pneumoniae (8.6%) [8].

It is to be noted that most of the studies implicate Pseudomonas aeruginosa as the most common bacteria causing exacerbation, whereas Acinetobacter baumannii and Klebsiella pneumoniae are the most common bacteria causing exacerbations as per (Table 5) of our study [21]. The predominance of Acinetobacter spp. in our study is a novel finding, and further studies are needed to know if this is the emerging trend in acute exacerbation of COPD as MDR (multidrug-resistant). Acinetobacter baumannii is implicated in the etiology of various other infections [22]. Jahan et al. reported coinfection with virus and bacteria in 24.9% of cases of acute exacerbations of COPD [7]. In our study, coinfection was detected in 9.63% of cases (Table 3). However, this may not represent a natural course as many patients are chronically infected with multiple pathogenic bacteria before a viral pathogen is detected. Conversely, viruses have been shown to be frequently followed by secondary bacterial infection. Most of the coinfections were seen to be associated with rhinovirus and influenza A virus, whereas it was mostly associated with both influenza A and influenza B in another study by Jahan et al. [7]. In another study, the viruses implicated alone or as coinfections are picornaviruses (especially rhinovirus), influenza virus, and respiratory syncytial virus [23]. Comorbidities were associated with eight cases of viral exacerbation with hypertension being the most common (Table 6). Similar findings were also reported by Koul et al. where hypertension was seen in 60.52% of cases followed by heart ailments (14.16%) [19]. No significant correlation was observed between the various subgroups. Breathlessness and cough were the most common clinical presentation in cases of exacerbation in our study. Sore throat, however, was reported only in viral exacerbation and not in bacterial or coinfection (Table 6). The outcome of viral exacerbation has improved over time, owing to an increase in adult vaccination and early treatment. Among the etiological agents, in our study, we noticed poor outcomes among the coinfection group probably as a consequence of systemic inflammation (Table 7). As per a study in Japan, gram-negative bacilli were significantly associated with prolonged hospitalization [24].

The severe category of patients who were discharged was put on telemedicine advice on pulmonary physiotherapy, medications, and home oxygen. Among them, the coinfection group had exacerbation that needed admission, and the rest of the cases were clinically stable (Table 8). There are not many studies that correlate the long-term outcome of acute exacerbation of COPD with infective causes. As per a review by Wang et al., it is observed that in cases where there is coinfection with bacteria and virus, the lung function impairment is greater and the duration of hospitalization is also longer [25]. In another study published in Lung India, where the outcomes were followed up for readmission for two years, 12% mortality was observed; readmission was seen in 54% of cases, and two or more readmissions were seen in 45% of cases [26].

Thus, a proportion of patients appear to be more susceptible to exacerbation. Hence, prevention and mitigation should be the key goals. The application of technological advancement in communication during the COVID pandemic enabled us to overcome the challenge through tailored prescription and telemedicine intervention.

Conclusions

The clinical course of COPD is punctuated by exacerbation. These events are associated with accelerated loss of lung function, poor quality of life, increased health care costs, and mortality. Infection is the most important cause of exacerbation. Klebsiella pneumoniae and Acinetobacter baumannii among the bacterial isolates and rhino and influenza A viruses among the viral isolates were predominantly detected. During the telehealth follow-up, it was observed that those patients who had co-infections were more prone to readmission, whereas those who had isolated bacterial or viral etiology had better clinical stability. Pulmonary physiotherapy and appropriate medical measures for the mitigation of exacerbation can prevent further decline of disease progression.



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The world is no stranger to yoga and the endless health benefits it offers. Staying fit doesn’t mean you have to be an expert in yoga and know all the difficult asanas. One of the most common and easy asanas to perform is Anulom Vilom Pranayama.

Anulom Vilom Pranayama or alternate nostril breathing exercise is a remarkable breathing exercise that involves holding one nostril closed while inhaling, and then the other nostril closed while exhaling. Anulom Vilom is the perfect addition to any sort of meditation practice. It is also reported that alternate nostril breathing has a positive impact on cardiovascular function. This form of pranayama is said to bring several physical and psychological benefits.

Here are the 10 benefits of the Anulom Vilom Pranayama.

  1. It helps to relieve depression, stress, and anxiety.
  2. When you breathe with more awareness, you allow your body to become fully oxygenated which helps your respiratory system.
  3. Anulom Vilom, if practised daily, can be very helpful in treating respiratory disorders such as asthma and bronchitis.
  4. This exercise helps to focus, improves concentration level, increases patience and helps in decision-making ability and inventiveness.
  5. The exercise helps to overcome negative thoughts and negative emotions like anger, uneasiness, frustrations and forgetfulness.
  6. Who doesn’t love naturally glowing skin without any pimples and marks? This is an excellent workout for glowing skin.
  7. It also may help you to lose those extra kilos from the body.
  8. Daily exercise can allay common problems like constipation, acidity, allergic problems, asthma and snoring.
  9. This exercise balances out the three doshas of the body that are- Vata(energy of movement), Kapha (energy of lubrication and structure) and Pitta(energy of digestion or metabolism).
  10. Alternate nostril breathing can improve respiratory and cardiovascular health and also reportedly keeps diabetes at bay.

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At Airofit, we want to bring better breathing to the world. The beauty of Airofit is that it can and should be used by anyone – from Olympic athletes to the everyday person who just want to become a better version of their current self. Airofit is here to enhance your quality of life. Whether you do sports, run out of breath taking the stairs or suffer from asthma or COPD, we do it for you.

The Airofit Breathing Trainer provides resistance to your breathing muscles, allowing you to train your Respiratory Strength, Accessible Lung Capacity, Anaerobic Threshold, and other areas of your breathing. Airofit training is simple and easy, done separately from any exercise in just 5-10 minutes a day, sitting down in the comfort of your home.

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Sitali Pranayama, often known as 'cooling breath', is a breathing technique that cools the body and calms the nervous system.

Sitali Pranayama is recommended by Ayurveda throughout the summer months and during the hottest parts of the day to relieve the heat that builds up in your body.

This breath is supposed to relieve weariness, bad breath, fever and high blood pressure, as well as quench thirst and hunger and promote a love of solitude. It can also help with concentration and reduce rage, anxiety and agitation.

Sitali is frequently suggested in Ayurvedic therapies for patients with a pitta dosha imbalance. Pitta energy frequently requires assistance to cool and quieten down.

Also known as Sheetali in Hindi, Sitali is derived from the root word 'Sheet', a Sanskrit root word that means 'cold' or 'frigid.' The term 'Sheetal' can be considered a noun, meaning 'something that has a cooling or calming effect.'


How to do Sitali pranayama properly?

Sitali Pranayama cools the body, gives moisture to the system and calms the pitta imbalance, which is frequent during the summer months, according to Ayurveda.

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Here's a step-by-step guide on how to perform the Sitali Pranayama properly:

  • Sit in a relaxed position that aligns with your head, neck and spine.
  • Close your eyes, and breathe diaphragmatically for a few minutes before opening your mouth and forming an 'O' with your lips.
  • Fold the tongue lengthwise, and protrude it from the mouth (approximately 3/4 inches).
  • As if drinking via a straw, breathe deeply across the tongue and into the throat.
  • As the stomach and lower ribs expand, concentrate on the soothing sensation of the breath.
  • Exhale thoroughly through the nostrils while drawing the tongue back and closing the mouth.

Benefits of doing Sitali pranayama regularly

Many distinct Sitali Pranayama benefits have been found over the years by scientists and medical professionals. Regular Pranayama practice can help you reap the following benefits:

1) For anxiety: Sitali Pranayama can assist in quietening your body's stress response, allowing you to recover to a state of relaxation and functioning.

2) Lower blood pressure: Lowering blood pressure is one of the top advantages of Sitali Pranayama. That is especially beneficial if your blood pressure builds frequently when you're stressed.

3) Strengthening respiratory muscles: Try the Sitali Pranayama for asthma or for targeting the abdomen muscles. It can improve and strengthen your lung capacity.

4) Improved cognitive function: The Sitali Pranayama is designed to help the mind focus more clearly, help quieten anxious thoughts and improve awareness about the present.

5) Mangaging addictions: Regularly practising the Sitali Pranayama can help develop a sense of serenity, which can aid in the management of addictions. It can also assist you in becoming more conscious of and in control of your urges.

6) Improves digestion: It improves the digestive system's ability to function properly by increasing blood flow throughout the body.

7) Boosts immunity: Practicing this pranayama daily can help you improve your breathing, allowing your body to filter the air you breathe in more effectively.

8) Aids in treatment of PTSD symptoms: Pranayama is a technique for relaxing the body and mind, which aids in the relief of PTSD symptoms. It's very useful when dealing with trauma triggers or stressful situations.


Tips to remember while doing Sitali Pranayama

While performing the Sitali Pranayama, you should be aware of the following precautions:

  • It's preferable to do this breathing exercise on an empty stomach for the best results.
  • Make sure your back and neck aren't bowed or curved, as that will prevent Prana from flowing freely through your subtle body.
  • Avoid doing the Sitali Pranayama during the winter and very cold weather, unlike other pranayamas, as it can cause respiratory difficulties.
  • Before attempting the Sitali Pranayama, anyone with a cardiac condition should visit a doctor or an experienced yoga instructor.
  • This pose is not recommended for people with normal blood pressure and chronic illnesses such as migraines or chronic constipation.
  • It's also not recommended for people who have asthma, cough, cold or congestion, as it can worsen their condition.

Key Takeaway

The Sitali Pranayama is ideally practised in hot weather or after a rigorous asana or heating pranayama practice, as it lowers the body temperature (like bhastrika).

Overall, the Sitali Pranayama is an excellent yoga exercise that can be performed at any time and in any location to offer relief and relaxation to the body and mind. It also aids in the reduction of body heat and fever, as well as tension and worry.

It's a breathing technique that can be done while at work to help relax the mind and soothe the body. You can even perform it while at home, taking a 10–15-minute break. It aids in the reduction of rage.


Q. Have you tried Sitali Pranayama?



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International Yoga Day 2022: 5 Yoga poses to relieve stress and rejuvenate mind
Image Source : FREEPIK

International Yoga Day 2022: 5 Yoga poses to relieve stress and rejuvenate mind

Annually International Yoga Day 2022 is celebrated on June 21 to educate people about Yoga's importance and the pivotal role it plays in leading towards a healthier lifestyle by rejuvenating our mind and body. In recent years, mental diseases of various kinds have become a serious worldwide health burden. An increase in the incidence of anxiety and depression is being attributed to unhealthy lifestyles, poor eating habits, and increased work-related stress. People with poor mental health can reap rich and long term benefits by practicing Yoga into their everyday life.

Yoga is beneficial to both mental and physical wellness. It balances our emotions and harmonizes our body and mind. It's evident that yoga can help people with depression, anxiety, and Attention-Deficit/Hyperactivity Disorder (ADHD). Stress leads to most lifestyle diseases. Yoga is a scientific approach that helps people cope up with stress & anxiety. Yoga also helps senior people with minor memory loss, it improves their memory, sleep, and overall quality of life.

Below are the best Yoga Asanas to help deal with mental health, stress & anxiety:

Balasana

Excellent for relieving stress and anxiety, this pose involves curling up into a ball with your knees tucked under you and your chest near the mat. Keep your arms out in front of you and rest your forehead on the mat. Stay in that position for at least 10 deep breaths.

Anulom Vilom

It's a specific type of pranayama, or controlled breathing, in yoga. It involves holding one nostril closed while inhaling, then holding the other nostril closed while exhaling. The process is then reversed and repeated. Doing this can bring better balance to your nervous system and less stress response and activity over time.

Vriksasana

Take one foot and place it above the thigh of the supporting leg. Vriksasana is an advanced mountain pose, intended to improve the yogi's balance and concentration. It also helps in strengthening the balancing muscles of our legs.

Shashankasana or Child’s Pose:

This asana re-energises your entire body by stimulating your neurological system. This asana is essentially a resting position that resembles a fetal position for a child. It's done by bending forward till the chest reaches the thighs and the forehead contacts the ground while sitting on the knees. Forward-stretching arms The performer will feel a sense of mental, bodily, and emotional comfort come upon him or her if executed with precision on a regular basis. This asana, like the majority of yoga asanas, should be done on an empty stomach or at least six hours after eating. This asana should be avoided by persons who have high blood pressure or back pain.

Bhujangasana

It is a reclining back-bending asana in hatha yoga. Begin by lying flat in your stomach and lift your upper body. Bhujangasana is said to help relieve stress and it strengthens your arms, shoulders, and upper back.

Savasana

Even if you want to opt-out of every other pose, please don't miss out on this one as it simply involves laying down on your mat with your eyes closed. But from this small, deliberate movement come big changes for your stress levels. 

Hasta Utthanasana:

People with high blood pressure, asthma, sinusitis, infertility, and osteoporosis are said to benefit from this yoga position. As a relaxation method, it also aids in the relief of mild depression and the treatment of insomnia. To do this stance, keep your back straight. As you inhale slowly, raise your hands from the front to over your head. Bend backwards from the upper back and hold the position while breathing normally.

Vipareetakaraniasana:

One of the best yoga asanas for boosting blood circulation to the head is this inverted stance. It aids in the reduction of anxiety, the treatment of depression, and the prevention of sleeplessness, as well as the regulation of blood flow. You can accomplish this stance by resting flat on your back. Keep your legs together as much as possible. Raise the legs, buttocks, and trunk while breathing, and support the hips on the palm. The trunk is angled to the ground at a 45-degree angle. In this position, breathe normally. Exhale while lowering the legs over the head and keeping the hands down. Bring the spine and legs down to the floor.

-With inputs from Dr. K. Shanmugam, Asst Chief Medical Officer, Jindal Naturecure Institute



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