Lymphangioleiomyomatosis (LAM) is a disease of the lungs, blood vessels, and lymphatic system. It almost exclusively affects biological females. Much of the time, it’s part of an inherited condition called tuberous sclerosis complex (TSC).

In LAM, an unusual type of muscle cell grows into the airways, as well as the blood vessels and lymph vessels. There, these cells form clusters that can cause blockages. These cells aren’t cancerous, but they can lead to serious problems.

In this article, you’ll learn about LAM's symptoms and causes, how it’s diagnosed and treated, and how to live well with it.

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Breaking It Down

  • Lymph = Lymphatic system
  • Angio = Blood vessels
  • Leiomy = Smooth muscle
  • Oma = Tumor
  • (T)osis = Condition

So, the word "lymphangioleiomyomatosis" means “a condition with smooth-muscle tumors in the blood and lymphatic vessels.”


LAM symptoms are most likely to begin in your 30s or 40s. It’s often a slowly progressing disease. 

Early symptoms may include:

  • Shortness of breath or wheezing
  • Fatigue
  • Cough
  • Low oxygen levels

Because these symptoms are typical of other lung diseases, such as asthma, it may be challenging for healthcare providers to recognize them.

Other symptoms that occur in LAM include:

  • Stabbing pain in the chest
  • Labored, rapid breathing
  • Rapid heartbeat
  • Low blood pressure
  • Profuse sweating
  • Dizziness
  • Lack of normal breathing movement on one side of the chest

These symptoms may happen when cysts in the lung rupture and cause a pneumothorax (collapsed lung). This means that air has leaked out and filled the space between the lung and chest wall. This complication of LAM requires emergency medical treatment.

If LAM cysts block blood vessels, you may develop a pulmonary hemorrhage (bleeding into the lungs) and cough up blood.

If cell clusters block lymphatic vessels, it can lead to an abnormal collection of fluid in your chest or abdomen.

You may develop a type of benign (noncancerous) tumor called angiomyolipomas. These tumors are most common in the kidneys. They don’t always cause symptoms, but when they do, symptoms may include:

  • Flank pain
  • Blood in the urine
  • Bleeding into the abdomen

LAM flares are commonly tied to hormonal events. Pregnancy, hormonal birth control, and the menstrual cycle can all trigger flares. Symptoms often stabilize after menopause.

When the disease is advanced, it can permanently damage your lungs and lead to respiratory failure, which is life-threatening.

Rapid Progression

Rarely, LAM may progress quickly. Researchers don’t yet understand why this happens.

Causes of LAM Disease

LAM is caused by gene mutations.

TSC is a rare genetic disorder that’s generally discovered soon after birth. It causes most cases of LAM. If you don’t have TSC but develop LAM, it’s called sporadic (S-LAM).

Tuberous sclerosis complex and lymphangioleiomyomatosis are caused by random mutations in one of two genes, TSC1 and TSC2. These genes are involved in creating proteins that regulate cell size and growth.

When your body can’t make these proteins, cells can grow and divide out of control. This leads to tumors and cysts.

So far, researchers can’t say for sure why LAM occurs almost exclusively in females. They suspect estrogen (the primary female sex hormone) may play a role.


Diagnosing LAM is difficult, in part because symptoms are similar to those of other lung diseases. Healthcare providers use a variety of tools to reach the diagnosis.


Chest X-rays are a common first step when looking into causes of breathing problems, like those possible with LAM. They can help diagnose a variety of illnesses, including pneumonia, emphysema, and lung cancer.

Your healthcare provider may order a chest X-ray to rule out these and other conditions or to diagnose a collapsed lung or fluid in the chest cavity. However, an X-ray isn’t usually great for diagnosing LAM.

CT (computed tomography) scans can show the distinct structures of LAM cysts/tumors. Combined with symptoms, this provides a diagnosis in more than 80% of cases.

Additional Tests

When a healthcare provider can’t make a definitive diagnosis based on symptoms and a CT scan, they may order additional tests. These include:

  • Blood tests: These can detect the growth of cells frequently involved in LAM tumors and whether blood oxygen levels are low.
  • Lung biopsy: Tissue is removed and studied, which can show LAM cysts and tumors, fluid in the lung, and collapsed lung.
  • Pulmonary function tests: You breathe into a machine that measures lung function, which is more useful for monitoring LAM than for diagnosis.

Your provider may order other tests as well, depending on your symptoms.

Prevalence of LAM

TSC affects 1 in every 6,000 newborns in the United States, and about 30% of them will someday develop LAM. Sporadic LAM affects between 3 and 8 people out of every 1 million.

Treatment Options

Lymphangioleiomyomatosis is a chronic (lifelong) disease with no cure. But treatments can help you manage it well, keep it from progressing, and prevent complications.

Medications that can help improve lung function in LAM include Rapamune (sirolimus) and Afinitor (everolimus). To help you breathe better, you may be given an inhaled bronchodilator, which is used to treat asthma.

For advanced cases, treatment may include:

Because of the possible link with estrogen, hormonal treatments used to be routine for LAM. However, they’ve been declared ineffective and potentially harmful, so they’re no longer recommended.

Living With LAM Lung Disease

Early on, LAM symptoms tend to have a very low impact on lifestyle. The main recommendations are to:

  • Follow a healthy diet. 
  • Get routine exercise.
  • Don’t smoke, and avoid secondhand smoke.
  • Stay up-to-date on immunizations.
  • If taking LAM drugs, avoid live virus vaccines.
  • Avoid estrogen-containing contraception and hormone replacement therapy.
  • Ask your healthcare provider if you need to take special precautions when flying.
  • If you are or want to be pregnant, talk to your healthcare provider about what to expect.

LAM may become more limiting as the disease progresses. Breathing difficulties may limit your activity level, and you may need supplemental oxygen some or all of the time.

Expect to have regular lung-function tests and imaging to monitor disease progression and treatments. Let your healthcare provider know if you have new, changing, or worsening symptoms.


Lymphangioleiomyomatosis is a chronic, rare disease that causes abnormal, noncancerous growths in the lungs, blood vessels, and lymphatic vessels. The primary symptoms are cough and shortness of breath. Complications include a collapsed lung and fluid in the lungs.

LAM is caused by a genetic mutation. It removes controls for how your cells grow and divide, which leaves them multiplying out of control. It’s diagnosed mainly through CT scans, blood work, and sometimes a lung biopsy.

Treatments include medications, oxygen therapy, pulmonary rehabilitation, and lung transplant. To help manage it, live a healthy lifestyle, don’t skip immunizations, and talk to your healthcare provider about pregnancy and contraception.

A Word From Verywell 

Being diagnosed with a chronic, progressive lung disease may leave you with a lot of difficult emotions. This is a normal response. If you need help working through these feelings, talk to your healthcare provider. They can connect you with helpful resources.

You also might want to look for a support group online or in your community. Because LAM is rare, consider those that deal with similar lung conditions or lung disorders in general.

Frequently Asked Questions

  • Is lymphangioleiomyomatosis curable?

    No, LAM isn’t curable. However, it can be well treated and managed with medications, inhalers, oxygen therapy, and pulmonary rehabilitation. Lung transplants are an option in the most advanced cases.

  • Is LAM disease contagious?

    No, LAM isn’t contagious. It’s caused by a genetic mutation.

  • How common is lymphangioleiomyomatosis?

    LAM is rare. Estimates are that, worldwide:

    • Sporadic LAM affects between 8,000 and 21,000 people.
    • TSC-LAM affects between 80,000 and 160,000 people.

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A black and white image of a dog's faceShare on Pinterest
A new study shows that stress-related physiological processes produce changes in breath, sweat, or both, which are detectable by dogs. Tim Trzoska/EyeEm/Getty Images
  • In a new study, dogs detected samples of breath and sweat taken from an individual experiencing psychological stress with an accuracy of 93.75%
  • The results indicate the physiological processes associated with stress produce changes in compounds flowing from breath, sweat, or both, and that dogs can detect these changes.
  • According to researchers, four dogs were trained for about an hour each week over the course of about 10 months.

Humans have developed multiple ways to put the canine olfactory system to work. Trained diabetic alert dogs warn owners when they smell changes in their blood sugar. Researchers have taught dogs to detect people with malaria parasites by their odor.

Dogs can even be trained to distinguish between absorbed breath samples of individuals with lung cancer and healthy people.

When under stress, humans can experience physiological changes, including epinephrine and cortisol being released into the bloodstream, as well as an increased heart rate, blood pressure, and respiration.

Recently, researchers from Queen’s University Belfast and Newcastle University in the U.K. sought to find out whether these physiological changes would cause the odor of sweat and breath of a stressed individual to differ from the usual smell of their sweat and breath. If they did differ, they wondered, would they be detectable by dogs?

For this proof-of-concept study, published in PLOS ONE, the researchers reported that canines could indeed pick out samples of breath and sweat taken from an individual experiencing psychological stress with an accuracy of 93.75%.

“It was fascinating to see how able the dogs were at discriminating between these odors when the only difference was that a psychological stress response had occurred,” Clara Wilson, the lead author of the study and a Ph.D. candidate studying canine olfaction and behavior at Queen’s University, told Medical News Today.

Researchers recruited pet dogs from the Belfast area for the study.

Researchers selected 20 dogs for consideration. After some dogs were eliminated from the study for a number of reasons, including losing interest as the training progressed, four dogs completed the training process.

The four selected dogs included a male cocker spaniel, a female cockapoo, and two mixed-breeds dogs, one male and one female. The dogs ranged in age from 11 to 36 months.

Researchers trained dogs using operant conditioning (where dogs repeat behaviors that have desired consequences) and positive reinforcement.

The study began in December 2019. According to Wilson, the dog training had to pause for about a year during the pandemic. She said that, in total, the dogs trained for an hour each week for about 10 months.

“The training was very extensive, as the premise was that the dogs needed to be consistently able to discriminate between two very similar human odors with known differences at above 80% correct for multiple sessions,” Wilson told MNT.

For the study, researchers used a contraption: a base with three aluminum arms. Each arm came with a cylindrical port that had a removable lid.

First, the dogs were trained to stand or sit in front of the apparatus with their noses touching it for 5 seconds.

Next, researchers placed a sweat sample taken from volunteers on gauze and a piece of food inside one of the ports. The two other ports were filled with unused gauze.

When the dog successfully identified the port containing food, the researcher clicked the clicker and gave the dog a food reward. Once the dog was able to identify the food port correctly on 8 out of 10 attempts, the food was removed.

Later, the dogs progressed to being presented with three ports, none of which contained food. One port held a human sweat and breath sample, and two others held blank samples. A dog selected the port, which held the human sweat and breath sample in seven out of 10 trials; they progressed to the next phase.

In this training stage, the dogs were presented with a port containing a piece of gauze containing sweat and breath from the same person used in the previous challenge (the target), a sample from a new person, and a blank. Dogs had to pick the target sample 16 out of 20 attempts for two consecutive sessions before going on to the next training stage.

For that stage, researchers presented the dog with breath samples taken from the same person at two different times of the day. The sample used in the morning was typically used as the target sample. Once dogs were successful with this challenge, the researchers allowed them to move on to the testing phase.

Researchers recruited 53 human participants. Of those, 40 completed the study in person, and 13 completed it remotely due to the pandemic.

The participants had to be non-smokers and were asked not to eat or drink flavored beverages for 1 hour prior to providing a breath sample. Participants either did not take mood-altering medications or refrained from taking those medicines for 1 hour prior to providing a breath sample.

Participants wiped a piece of gauze on the back of their necks, or researchers wiped a piece of gauze on the back of the participants’ necks, depending on whether the sample was gathered remotely or in person. The gauze was then placed in a vial. Participants exhaled deeply into the vial three times before securing the lid. Participants then completed a self-report questionnaire about the level of stress they were currently experiencing.

Next, the participants were asked to complete a mental arithmetic task, which involved counting out loud backward from 9,000 in units of 17 without the use of a pen or paper in front of the researchers.

As they counted, two researchers watched, either in person or using online meeting software. During the task, the researchers would sternly say things like, “you must keep going until the task is completed.”

If a participant gave the correct answer, they were given no feedback and expected to continue. However, a participant who gave an incorrect answer would be told “no” by the researcher, who then stated the participant’s last correct answer. The task continued for 3 minutes.

When completed, participants again wiped a piece of gauze on the back of their necks, or researchers wiped a piece of gauze on the participants’ necks. The gauze was placed into a vial. The participants again exhaled deeply into the vial three times before securing the lid. The same process was performed a second time with another vial. Participants then completed a second self-report questionnaire about the level of stress they were currently experiencing.

Additionally, researchers monitored the heart rate and blood pressure of participants who completed the study in person.

Samples were used only if the participants’ self-report increased two points from when they took the initial questionnaire to when they took the questionnaire following completion of the mental task. Participants who undertook the study in person also needed to demonstrate an increase in their mean heart rate and mean arterial pressure to be included.

Nine participants who undertook the study in person and two who undertook it remotely were excluded for not demonstrating enough of a stress response. Five other participants’ samples were excluded for various other reasons. In total, 36 participants’ samples were tested.

The samples were collected from 30 females and six males with a mean age of 25.42 years. Participants included 30 people who identified as white, three as Asian or Asian British, two as mixed or multiple ethnic groups, and one as Black, African, Caribbean, or Black British.

Samples were shown to dogs within 3 hours of being collected.

In the first phase of testing, the researchers filled the port with a sweat and breath sample from a stressed participant and two blank samples.

In the next phase, researchers filled one port with a sweat and breath sample from a stressed participant, another port with a sweat and breath sample taken before the participant underwent the mental task, and a blank.

Each dog completed 10 phase 1 trials and 20 phase 2 discrimination trials. For the study, the researchers focused on the phase where dogs had to discriminate between the stressed and baseline samples.

Overall, the dogs detected the stress sample in 93.75% of the trials. Individual dogs ranged in performance from detecting the stress sample 90% to 96.88% of the time.

“The way we tested this provides much-needed controlled evidence that the human stress response changes our emitted odor profile and that dogs can detect this,” Wilson said.

Alan Beck, Sc.D., director of the Center of the Animal-Human Bond at Purdue University College of Veterinary Medicine in Indiana, who was not involved in the study, told MNT that he wasn’t surprised to read that dogs could pick out the sweat and breath sample of a stressed human.

“It is part of a long history of literature that shows that dogs have that ability,” he said. “We know that dogs have a great sense of odor.”

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For those who aren’t familiar, respiratory therapy is a discipline that involves caring for patients with breathing problems. They assess, diagnose, treat and manage patients with respiratory conditions, such as asthma and cystic fibrosis. Respiratory therapists also work with patients who have sleep apnea, lung cancer, and other respiratory diseases. They work in many settings, including the critical care unit of a hospital, assisting patients who are on a ventilator. Respiratory therapy is a growing field that offers the opportunity for a meaningful career where you can earn a good living. If you want to learn more, read on to find out about the benefits of a respiratory therapy degree.

What are the benefits of a respiratory therapy degree?

There are many benefits to earning a degree in respiratory therapy, but you should also consider online respiratory therapy programs. Online programs offer students the flexibility to complete their coursework on their own schedule, which is ideal for working professionals. Online degree programs also typically have accreditation from the Commission on Accreditation for Respiratory Care (CoARC), which is the gold standard in respiratory care education. While an on-campus education may be preferable for some students, there are real advantages to online learning.

Perhaps the most obvious benefit of earning your degree in respiratory therapy is that it will offer you a wealth of opportunities for career advancement. With a respiratory therapy degree, you can work in a variety of settings, including hospitals, clinics, and home health care. You can also pursue specialized roles within the field such as critical care respiratory therapist or pulmonary rehabilitation therapist. Additionally, respiratory therapy degrees are in high demand, so you are likely to find plenty of employment opportunities once you graduate.

Respiratory therapists enjoy above-average salaries and excellent job security. The median respiratory therapist’s salary is $61,830, but top earners can make significantly more. The industry is also projected to experience 14 percent job growth over the next decade, which is much faster than the average for all occupations. This is explained by the fact that our aging population is increasingly in need of respiratory care. In addition, the rise in asthma and other respiratory illnesses led to a greater demand for respiratory therapists.

How can you prepare for your degree program?

Whether you choose an online program or not, you will need to have a quiet place to study when you have work to do. Pick a room in your house that is quiet and free from distractions. This could be a bedroom, home office, or even the living room. Make sure you have everything you need in your study zone, including a desk lamp, textbooks, a computer, and a notepad and pen. You could also invest in decor so you feel comfortable in the space. Plants make a perfect addition to any study spot or home office, as research has shown that can improve your mood, boost focus, and alleviate stress.

Time management is one of the most valuable skills that students can learn. One of the best ways to improve your time management skills is to create a schedule and stick to it. This means setting specific times for studying, homework, socializing, and relaxing, and then making a concerted effort to stick to that schedule. Of course, life can sometimes get in the way and you may have to adjust your schedule accordingly, but you will see improvement if you’re consistent. If there are big tasks that seem overwhelming, try breaking them down into smaller, more manageable tasks. This will make the task seem less daunting.

As you can see, becoming a respiratory therapist can be a smart and deeply fulfilling career choice. Respiratory therapists play a vital role in assisting patients who are struggling with breathing problems. They work with patients of all ages, from newborns to the elderly, and can help treat many respiratory conditions. What’s more, respiratory therapists are in high demand, and can typically find employment in a number of settings, including hospitals, clinics, and long-term care facilities. Earning your degree in respiratory therapy is more accessible than ever, you can even look into online degree programs that allow you to work from home. Follow this advice and you’ll be well on your way to a successful career as a respiratory therapist.

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While advanced technological and infrastructural developments have made life easier for all of us, they have also had a disastrous impact on the environment, particularly on air quality. Air pollution has become one of the biggest problems of our time. Fine particulate matter polluting the air can easily penetrate your bloodstream and adversely impact your overall health, especially your lungs. According to the data collected by the World Health Organization (WHO), ambient air pollution was the cause of 4.2 million deaths in 2016 and is estimated to lead to about 16 percent of all lung cancer deaths.

So, how can you keep your lungs healthy while living in a polluted city? Here we’re revealing how a few lifestyle tips can keep lungs healthy.

Follow these 9 tips to keep lungs healthy and strengthen them to fight pollution:

1. Keep an eye on pollution forecast

There are many applications and websites that provide nearly accurate predictive outdoor air quality reports every day. With their colour-coded system, these apps help you comprehend just how much pollution you will expose yourself to when you step outside that day.

2. Stay indoors on bad AQI days

Spend as much time indoors as you can, particularly on days when the pollution forecast or the AQI (air quality index) shows an alarming number. In case you need to step out, wear a high-quality face mask at all times to avoid inhaling harmful particles in the air.

3. Don’t exercise outdoors

Whenever the pollution levels are high, avoid exercising outdoors. Walking, jogging or any other strenuous activities that might increase your breathing rate can lead to the inhalation of harmful particles present in the air.

4. Drink enough water

Drinking enough water can help in flushing toxins out of your body. It is advisable to drink at least 8 to 10 glasses of water every day to stay hydrated.

tips to keep lungs healthy
Don’t reduce your water intake. Image Courtesy: Shutterstock

5. Maintain a healthy diet

One of the best ways to resist harmful effects of air pollution is by building up your immunity against infections. For this, maintaining a healthy diet rich in vital nutrients like vitamins C and E is essential. Make sure that your diet is packed with the nutrients to keep up the health of your respiratory tract.

6. Quit smoking

You need to quit smoking now, especially if you live in a polluted city. Nothing is more damaging to your lungs than smoking cigarettes. The harmful chemicals in cigarettes compounded with the harmful particles in the air can be immensely damaging to your lungs.

7. Get an air purifier

The air inside your home can also be polluted, sometimes even more than the air outside. For this reason, it is a smart choice to invest in an air purifier. Make sure to keep your air purifier clean and replace its filter frequently.

8. Practice breathing exercises

Practicing breathing exercises every day can prove to be helpful in improving lung functions. Some of these exercises include belly breathing and pursed lip breathing.

tips to keep lungs healthy
Breathing properly in the morning can improve lung health. Image courtesy: Shutterstock

9. Go green!

Make sure you do everything you can towards reducing air pollution and improving air quality. To do your bit, you can consume less energy in your homes, use hand-powered equipment, and take a bike, walk, or carpool whenever possible.


With air pollution posing such a huge risk to your lung health as well as overall well-being, it is best to follow the above-mentioned measures, especially if you are living in a polluted city. If you experience any respiratory problems or symptoms of lung issues, consult with a doctor right away.

Air pollution, if not more, is as dangerous and harmful to the human body as has been smoking over the years. It’s time we realize it is harmful and take preventive measures to safeguard ourselves from this growing menace.

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Every year, World Lung Day is celebrated on September 25 to advocate lung health and spread awareness. Lung disease is any problem that arises in the lungs and prevents it from working properly. Lung disease is divided into three main types - airway diseases, lung tissue diseases and lung circulation diseases.

The lungs, just like any other part of your body, age with time and that's why they need extra attention and care. People don't understand the importance of healthy lungs until they experience a breathing problem. After the Covid-19 pandemic took over the world, millions across the globe showed signs of weak lungs and reported breathing issues.

In 2022, it's crucial that we look after the health of our lungs and take precaution against harmful diseases that can make our breathing difficult. After all, the lungs are a crucial part of the respiratory system as they carry oxygen from the air and pump it through the body's airways and air sacs. The oxygen is then absorbed into the bloodstream and carried to the heart via the blood vessels.

Understanding the three main types of lung disease:

Airway Diseases

These harmful diseases impact the tubes that carry oxygen, making it difficult for people to breathe.

Lung Tissue Diseases
These diseases affect the structure of the lung tissue, which then makes it difficult for the lungs to function properly and diffuse oxygen from the airways into the bloodstream.

Lung Circulation Diseases

This type of disease impacts the blood vessels in the lungs. These diseases affect the way blood flows from the heart to the rest of the body.

Most Common Lung Diseases:

Most common lung diseases emerge from one or more of these three main types. Here are the most common lung diseases:


Millions of people across the country suffer from asthma and have difficult breathing. Though there's no cure for this disease, the person can lead a healthy and normal life with the help of right treatment and managing the asthma.

The disease can be managed by working with a healthcare provider to develop a plan to keep your asthma under control by understanding your trigger and learning of simple ways to limit your exposure, understanding your medication, learning self-management skills and more.

Chronic Obstructive Pulmonary Disease (COPD)
This disease includes Chronic Bronchitis and Emphysema and is a long-term lung disease that makes it hard to breathe but is often preventable and treatable.


Most commonly referred to as bronchitis, acute bronchitis is a lower respiratory infection that impacts the air tubes of the lungs and usually comes on suddenly and can last for a week to 10 days.

Tips To Prevent Lung Diseases:

Stop smoking as it increases your risk of lung cancer. According to several reports, smokers are 12 to 13 times more likely to die from COPD than nonsmokers.

Exercise. Getting a regular workout will really help your health. It will not only make you fitter but also improve your overall health. When you workout, your heart beats faster and your lungs work harder.

Get some fresh air. It's no secret that we are exposed to pollutants on a daily basis. So give your lungs the much needed break and reduce the exposure to harmful air by making your home smoke-free zone, dusting your furniture, improving the indoor air ventilation by opening a window, avoid synthetic air fresheners, candles, and wear a good mask when you go outside.

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The pleura is a vital part of the respiratory tract. Its role is to cushion the lung and reduce any friction that may develop between the lung, rib cage, and chest cavity.

Each pleura (there are two) consists of a two-layered membrane that covers each lung. The layers are separated by a small amount of viscous (thick) lubricant known as pleural fluid.

OpenStax College / Wikimedia Creative Commons

There are a number of medical conditions that can affect the pleura, including pleural effusions, a collapsed lung, and cancer. When excess fluid accumulates between the pleural membranes, various procedures may be used to either drain the fluid or eliminate the space between them.

This article outlines what the pleurae are, what they do, and what conditions can affect them and impact respiratory health.

The plural form of pleura is pleurae.

Anatomy of the Pleura

There are two pleurae, one for each lung, and each pleura is a single membrane that folds back on itself to form two layers. The space between the membranes (called the pleural cavity) is filled with a thin, lubricating liquid (called pleural fluid).

The pleura is comprised of two distinct layers:

  • The visceral pleura is the thin, slippery membrane that covers the surface of the lungs and dips into the areas separating the different lobes of the lungs (called the hilum).
  • The parietal pleura is the outer membrane that lines the inner chest wall and diaphragm (the muscle separating the chest and abdominal cavities).

The visceral and parietal pleura join at the hilum, which also serves as the point of entry for the bronchus, blood vessels, and nerves.

The pleural cavity is also known as the intrapleural space. It contains pleural fluid secreted by the mesothelial cells. The fluid allows the layers to glide over each other as the lungs inflate and deflate during respiration (breathing).

What the Pleura Do

The structure of the pleura is essential to respiration, providing the lungs with the lubrication and cushioning needed to inhale and exhale. The intrapleural space contains roughly 4 cubic centimeters (ccs) to 5 ccs of pleural fluid, which reduces friction whenever the lungs expand or contract.

The pleura fluid itself has a slightly sticky quality that helps draw the lungs outward during inhalation rather than slipping round in the chest cavity. It creates surface tension that helps maintain the position of the lungs against the chest wall.

The pleurae also serve as a division between other organs in the body, preventing them from interfering with lung function and vice versa.

Because the pleura is self-contained, it can help prevent the spread of infection to and from the lungs.

Conditions That Affect the Pleura

A number of conditions can cause injury to the pleura or undermine its function. Harm to the membranes or overload of pleural fluid can affect how you breathe and lead to adverse respiratory symptoms.


Pleurisy is inflammation of the pleural membranes. It is most commonly caused by a viral infection, but may also be the result of a bacterial infection or an autoimmune disease (such as rheumatoid arthritis or lupus).

Pleuritic inflammation causes the membrane surfaces to become rough and sticky. Rather than sliding over each other, they membranes stick together, triggering sharp, stabbing pain with every breath, sneeze, or cough. The pain can get worse when inhaling cold air or taking a deep breath. It can also worsen during movement or shifts in position. Other symptoms of pleurisy include fever, chills, and loss of appetite.

Pleural Effusion

A pleural effusion occurs when excess fluid accumulates in the pleural space. When this happens, breathing can be impaired, sometimes significantly.

Congestive heart failure is the most common cause of a pleural effusion, but there is a multitude of other causes, including lung trauma or lung cancer (in which effusion is experienced in roughly half of all cases).

A pleural effusion can be very small (detectable only by a chest x-ray or CT scan) or be large and contain several pints of fluid. Common symptoms include chest pain, dry cough, shortness of breath, difficulty taking deep breaths, and persistent hiccups.

Malignant Pleural Effusion

A malignant pleural effusion refers to an effusion that contains cancer cells. It's most commonly associated with lung cancer or breast cancer that has metastasized (spread) to the lungs.


Pleural mesothelioma is a cancer of the pleura that most often is caused by occupational exposure to asbestos. Symptoms include pain in the shoulder, chest or lower back, shortness of breath, trouble swallowing, and swelling of the face and arms.


Pneumothorax, also known as a collapsed lung, can develop when air collects in the pleural cavity. It may be caused by any number of things, including chest trauma, chest surgery, and chronic obstructive pulmonary disease (COPD). In addition to shortness of breath, there may be crepitus, an abnormal crackling sound from just under the skin of the neck and chest.

Spontaneous pneumothorax is a term used to describe when a lung collapses for no apparent reason. Tall, thin adolescent males are at the greatest risk for spontaneous pneumothorax, although females can also be affected. Risk factors include smoking, connective tissue disorders, and activities such as scuba diving and flying in which atmospheric pressure changes rapidly.

Pneumothorax can often heal on its own but may sometimes require thoracentesis to extract any accumulated air from the pleural cavity.


Hemothorax is a condition in which the pleural cavity fills with blood, typically as a result of traumatic injury or chest surgery. Rarely, a hemothorax can happen spontaneously due to a vascular rupture.

The main symptom of hemothorax is pain or a feeling of heaviness in the chest. Others include a rapid heartbeat, trouble breathing, cold sweats, pale skin, and a fever, all indications that prompt medical attention is needed.

Frequently Asked Questions

  • Does COVID cause pleural thickening?

    Research has demonstrated that coronaviruses, like COVID-19 and Middle Eastern respiratory syndrome coronavirus (MERS-CoV) can cause pleural thickening. In some cases, this has been associated with poorer outcomes.

  • Is pleural effusion life-threatening?

    Pleural effusion, or fluid build-up in the pleural space, is a serious but treatable condition. It can be caused by a number of diseases, including cancer. If left untreated, fluid can continue to build up and impact breathing.

  • Is pleural thickening serious?

    Not necessarily, but it depends on the underlying cause. Because multiple conditions can cause thickening of the pleurae, it's important to be evaluated by a healthcare provider and get proper treatment.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  4. Karkhanis VS, Joshi JM. Pleural effusion: diagnosis, treatment, and managementOpen Access Emerg Med. 2012;4:31–52. doi:10.2147/OAEM.S29942

  5. Dixit R, Agarwal KC, Gokhroo A, et al. Diagnosis and management options in malignant pleural effusionsLung India. 2017;34(2):160-6. doi:10.4103/0970-2113.201305

  6. Rossini M, Rizzo P, Bononi I, et al. New perspectives on diagnosis and therapy of malignant pleural mesotheliomaFront Oncol. 2018;8:91. doi:10.3389/fonc.2018.00091

  7. Aghajanzadeh M, Dehnadi A, Ebrahimi H, et al. Classification and management of subcutaneous emphysema: a 10-year experienceIndian J Surg. 2015;77(Suppl 2):673–677. doi:10.1007/s12262-013-0975-4

  8. Mitani A, Hakamata Y, Hosoi M, et al. The incidence and risk factors of asymptomatic primary spontaneous pneumothorax detected during health check-upsBMC Pulm Med. 2017;17:177. doi:10.1186/s12890-017-0538-8

  9. Pumarejo Gomez L, Tran VH. Hemothorax. In: StatPearls [Internet].

  10. National Library of Medicine: Medline Plus. Hemothorax.

  11. Carotti M, Salaffi F, Sarzi-Puttini P, et al. Chest CT features of coronavirus disease 2019 (COVID-19) pneumonia: Key points for radiologists. Radiol Med. 2020;125(7):636-646. doi:10.1007%2Fs11547-020-01237-4

  12. American Society of Clinical Oncology. Fluid around the lungs or malignant pleural effusion.

  13. Yale Medicine. Fluid Around the Lungs (Pleural Effusion).

  14. Alfudhili KM, Lynch DA, Laurent F, Ferretti GR, Dunet V, Beigelman-Aubry C. Focal pleural thickening mimicking pleural plaques on chest computed tomography: Tips and tricksBJR. 2016;89(1057):20150792. doi:10.1259%2Fbjr.20150792

Additional Reading

By Lynne Eldridge, MD

 Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time."

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Between the heat, humidity and mosquitoes, Floridians spend a lot of time inside their houses during the long summer season, with windows shut and the A/C cranking. That’s even more true for folks who work from home.

It feels good to be inside, but it isn’t necessarily the healthiest setting. A sealed environment that lacks fresh air and isn’t sufficiently cleaned presents several health risks — some minor, others significant.

If you have allergies, accumulated dust can make them worse. Dust mites and pet dander can trigger asthma attacks. Mold exposure can be particularly harmful to people with weakened immune systems due to treatments for cancer or certain autoimmune diseases like lupus. 

Here are 10 ways you can make your home a healthier place to breathe:

Thorough, Regular Cleanings

Vacuuming and dusting are tedious chores, for sure. But it’s the best way to control allergens like dust and pet hair that can cause respiratory problems.

Carpets should be vacuumed once a week. If you have the option of getting hard-surface flooring instead, do it. It’s easier to get clean.

Same with window treatments. Blinds are better than curtains because they’re easier to clean. If you do have curtains, try to clean them quarterly. And don’t forget bed sheets. People are better at keeping them clean than they are drapes, but keep in mind that sheets can accumulate a surprising amount of dust. 

Clean Those Fan Blades

Drapes aren’t the only place where dust accumulates without much notice. The tops of fan blades capture a lot, but who’s looking at the tops of their fan blades? (The reason fan blades capture so much dust is static electricity.) They also can be difficult to reach and clean.

Still, it’s worth the effort. Use a sturdy step stool and try using one of the many specialty brushes designed to clean fan blades without a lot of effort.

Use and Maintain Your Vents

Modern homes are built with several features intended to improve ventilation. 

Your bathroom fan, for example, not only helps get rid of unpleasant odors, it also reduces the amount of water vapor during hot baths and showers. That controls humidity, which helps limit the growth of mold.

Kitchen fans also help vent humidity out of the home, along with smoke and other potential respiratory irritants produced while cooking. These fans are particularly important if you’re cooking with a gas stove, which produces carbon monoxide, an odorless and potentially deadly byproduct from using gas.

Speaking of Gas Stoves …

Stoves and other appliances that use gas aren’t inherently dangerous. But they need to be serviced regularly to ensure the fixtures aren’t leaking and are connected properly. 

And every home needs to have a carbon monoxide detector, even if you don’t have gas appliances. Cars accidentally left running in garages have been known to kill the occupants of a home. CO2 detectors are cheap and easy to install.

Switch Out A/C Filters Regularly

The type of filter in your air-conditioning unit can make a huge difference in the air quality inside your house.

A/C filters have a MERV rating (minimum efficiency reporting value) to help consumers understand how well the filter captures dust, pollen, bacteria and other particles. The higher the MERV rating, the more effective (and expensive). 

Most households don’t need an exceptionally high MERV rating on their filters. But if someone has a respiratory condition such as asthma, a better filter may be worth the money.

Remember to change your filter every few months, especially during the summer when your A/C is working overtime.

Open Windows While Painting

Paint, lacquer, thinners and many household cleaners contain volatile organic compounds, chemicals that can cause headaches and dizziness when inhaled in sufficient quantities.

Open windows and use fans when you’re painting or using strong household cleaners. And look for products — especially paints — that are labeled as low-VOC.

Buying a Home? Get a Radon Inspection

Radon is a naturally occurring, radioactive gas that — like carbon monoxide — is odorless and tasteless. But it can increase the risk of lung cancer. If you’re buying a home, be sure to ask for a radon inspection.

Consider the Air when Getting a Pet

If you or a family member has allergies, consider breeds that are less likely to cause allergic reactions. Dogs as large as poodles and as small as a Maltese are hypoallergenic.

If you’re considering a bird for a pet, think again. A respiratory infection called psittacosis can be spread by inhaling dust from dried bird droppings. Though rare, the disease is serious.

Open Windows when You Can

It’s not practical in the summer, but Florida has many months when the weather outside is just splendid. Take advantage of it by opening your windows and letting the fresh air in as much as possible.

You might need to make an exception, of course, when pollen is bad. 

No Smoking Indoors

While it may seem obvious, some people still smoke inside their homes. Cigarette smoke is packed with harmful chemicals that cause all types of diseases. You shouldn’t smoke at all. But if you must, don’t light up indoors so others don’t inhale secondhand smoke.

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As part of the Health and Safety Executive (HSE)’s role as an enabling regulator it has recently refreshed its silica guidance for brick and tile manufacturing, stonework and foundries ahead of manufacturing sector focused inspections in autumn/winter.

The HSE warns that prolonged exposure to airborne particles of respirable crystalline silica (RCS) can lead to life-changing respiratory conditions such as silicosis and chronic obstructive pulmonary disease.

Silica is a natural substance found in most stone, rocks, sand, quartz and clay. Silica particles are produced during many manufacturing tasks involving these materials. Silicosis, chronic obstructive pulmonary disease (COPD) and lung cancer can all be caused by breathing in tiny particles of silica. Over time, exposure to silica particles can harm a worker’s ability to breathe and cause irreversible, often fatal, lung disease.

Starting in October 2022, HSE Inspectors will begin a targeted inspection initiative focusing on manufacturing business where materials that contain silica are used, to ensure they have control measures in place to protect workers’ respiratory health. This will include brick and tile manufacturers, foundries, stone working sites and manufacturers of kitchen worktops.

Employers have a legal duty to put in place suitable arrangements to manage health and safety and ensure they comply with the Control of Substances Hazardous to Health Regulations 2002 (COSHH). Inspectors will be looking for evidence that businesses have put in place effective measures, such as Local Exhaust Ventilation (LEV), water suppression and where appropriate, use of protective equipment such as Respiratory Protective (RPE), to reduce workers exposure to the RCS. If any health and safety breaches are discovered, HSE will take enforcement action to make sure workers’ health is protected.

HSE’s Head of Manufacturing David Butter said: “It’s hugely important for manufacturing businesses where workers use materials that contain silica to act now to ensure they comply with the law and protect their workers from the risks of devastating lung disease. Businesses should take note that that good ventilation in the workplace and protective equipment are just some of the measures they need in place to protect the respiratory health of workers.

“Ahead of our autumn/winter inspection campaign, we want employers and workers to make sure they are aware of the risks associated with the activities they do. For example brick and tile manufacture, foundry workers and stoneworkers where they cut and shape bricks, tiles and stone that can create RCS dust that could be breathed in. To assist them we have refreshed our guidance. In addition, we have committed to providing duty holders with regular updates, information and advice through our ebulletin.”

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Conditions such as heart disease, stroke, and respiratory infections account for the majority of deaths each year around the world. With that said, there are many steps you can take to prevent these deadly diseases.

When people think of the deadliest diseases in the world, their minds probably jump to the fast-acting, incurable ones that grab headlines from time to time. However, many of these types of diseases don’t rank in the top 10 causes of worldwide deaths.

An estimated 55.4 million people passed away worldwide in 2019, and 74% of these deaths were because of noncommunicable diseases, or chronic conditions that progress slowly.

Perhaps even more surprising is that several of the deadliest diseases are partially preventable. Non-preventable factors include where a person lives, access to preventive care, and quality of healthcare, all of which factor into risk.

But there are several steps that everyone can take to lower their risk.

Read on to see 10 of the deadliest diseases worldwide.

The deadliest disease in the world is coronary artery disease (CAD).

Also called ischemic heart disease, CAD occurs when the blood vessels that supply blood to the heart become narrowed. Untreated CAD can lead to chest pain, heart failure, and arrhythmias.

Impact of CAD across the world

Although it’s still the leading cause of death, mortality rates have declined in many European countries and in the United States.

This may be because of better public health education, access to healthcare, and other forms of prevention. However, in many developing nations, mortality rates for CAD are on the rise.

An increasing life span, socioeconomic changes, and lifestyle risk factors play a role in this rise.

Risk factors and prevention

Risk factors for CAD include:

Talk with a doctor or healthcare professional if you have one or more of these risk factors.

You can prevent CAD with medications and by taking steps to improve heart health. Some of the ways you can decrease your risk include:

  • exercising regularly
  • reaching or maintaining a moderate weight
  • eating a balanced diet that’s low in sodium and high in fruits and vegetables
  • avoiding smoking, if applicable
  • drinking only in moderation

A stroke occurs when an artery in your brain is blocked or leaks. This causes the oxygen-deprived brain cells to begin dying within minutes.

During a stroke, you feel sudden numbness and confusion or have trouble walking and seeing. If left untreated, a stroke can cause long-term disability.

In fact, strokes are the leading cause of long-term disabilities. People who receive treatment within 3 hours of having a stroke are less likely to have disabilities.

The Centers for Disease Control and Prevention (CDC) reports that one survey found that 93% of people knew sudden numbness on one side was a symptom of stroke. However, only 38% knew all the symptoms that would prompt them to look for emergency care.

Risk factors and prevention

Risk factors for stroke include:

  • high blood pressure
  • family history of stroke
  • smoking, especially when combined with oral contraceptives
  • being African American
  • being female

Some risk factors of strokes can be lowered with preventive care, medications, and lifestyle changes. In general, good health habits can lower your risk.

Stroke prevention methods may include controlling high blood pressure with medications. You should also maintain a healthy lifestyle, complete with regular exercise and a balanced diet that’s low in sodium.

If you smoke, consider quitting and drink only in moderation, as these activities increase your risk of stroke.

A lower respiratory infection is an infection in your airways and lungs. It can be due to:

Though viruses usually cause lower respiratory infections, they can also be caused by bacteria.

Coughing is the main symptom of a lower respiratory infection. It may produce blood sputum. You may also have a fever, sweating, or chills or experience breathlessness, wheezing, and a tight feeling in your chest.

Risk factors and prevention

Risk factors for lower respiratory infection include:

  • the flu
  • poor air quality or frequent exposure to lung irritants
  • smoking
  • a weak immune system
  • crowded child care settings, which mainly affect infants
  • asthma
  • HIV

One of the best preventive measures you can take against lower respiratory infections is to get the flu shot every year. People at high risk of pneumonia can also get a vaccine.

Be sure to wash your hands regularly with soap and water to avoid transmitted bacteria, especially before touching your face or eating.

If you have a respiratory infection, stay at home and rest until you feel better, as rest improves healing.

Chronic obstructive pulmonary disease (COPD) is a long-term, progressive lung disease that makes breathing difficult. Chronic bronchitis and emphysema are types of COPD.

In 2018, about 16.4 million people in the United States reported a diagnosis of any type of COPD.

Risk factors and prevention

Risk factors for COPD include:

  • smoking or secondhand smoke
  • lung irritants such as chemical fumes
  • family history, with the alpha-1 antitrypsin deficiency gene being linked to COPD
  • history of respiratory infections as a child

There’s no cure for COPD, but its progression can be slowed with medication.

The best ways to prevent COPD are to stop smoking, if applicable, and avoid secondhand smoke and other lung irritants. If you experience any COPD symptoms, getting treatment as soon as possible improves your outlook.

Respiratory cancers include cancers of the trachea, larynx, bronchus, and lungs.

The main causes are smoking, secondhand smoke, and environmental toxins. However, household pollutions, such as fuels and mold, also contribute.

Impact of respiratory cancers around the world

A 2015 study reports that there are around 18 million new cases of lung cancer annually. In developing countries, researchers project an 81% to 100% increase in respiratory cancers because of pollution and smoking.

Many Asian countries, especially India, still use coal for cooking. Solid fuel emissions account for 17% of lung cancer deaths in males and 22% in females.

Risk factors and prevention

Trachea, bronchus, and lung cancers can affect anyone, but they’re most likely to affect those who have a history of smoking or tobacco use.

Other risk factors for these cancers include family history and exposure to environmental factors such as diesel fumes.

Aside from avoiding fumes and tobacco products, it isn’t known if there’s anything else that can be done to prevent lung cancers. However, routine lung scans and early detection can result in more effective treatment and an improved outlook.

Diabetes is a group of diseases that affect the production or use of insulin.

In type 1 diabetes, the pancreas is unable to produce insulin. This type of diabetes is believed to be caused by an autoimmune reaction.

In type 2 diabetes, the pancreas doesn’t produce enough insulin, or insulin can’t be used effectively. Type 2 diabetes can be caused by a number of factors, including poor diet and physical inactivity.

Impact of diabetes around the world

Over time, uncontrolled diabetes can cause damage to the nerves and blood vessels. This can lead to complications such as impaired wound healing, kidney failure, and blindness.

People in low- and middle-income countries are more likely to die of complications from diabetes because of limited access to medications and technologies needed to manage blood sugar levels.

Risk factors and prevention

Risk factors for diabetes include:

  • having overweight or obesity
  • high blood pressure
  • older age
  • not exercising regularly
  • an unhealthy diet

While diabetes isn’t always preventable, you can control the severity of symptoms by exercising regularly and following a well-rounded, nutritious diet. Adding more fiber to your diet can also help with controlling blood sugar levels.

Alzheimer’s disease is a progressive disease that destroys memory, interferes with decision making, and interrupts normal cognitive functions. These include thinking, reasoning, and other everyday behaviors.

Alzheimer’s disease is the most common type of dementia and accounts for about 60 to 70% of cases.

The disease starts off by causing mild memory problems, difficulty recalling information, and slips in recollection. Over time, however, the disease progresses, and you may not have memory of large periods of time.

Risk factors and prevention

Risk factors for Alzheimer’s disease include:

There’s not currently a way to prevent Alzheimer’s disease, and researchers aren’t sure why some people develop it and others don’t. As they work to understand this, they’re also working to find preventive techniques.

One thing that may be helpful in lowering your risk of the disease is following a healthy diet. In fact, some research suggests that eating plenty of fruits, vegetables, whole grains, heart-healthy fats, and legumes could support brain function and prevent cognitive decline.

Diarrhea is when you pass three or more loose stools in a day. If your diarrhea lasts more than a few days, your body loses too much water and salt. This causes dehydration, which can be fatal in severe cases.

Diarrhea is usually caused by an intestinal virus or bacteria transmitted through contaminated water or food. It’s particularly widespread in areas with poor sanitary conditions.

Impact of diarrheal diseases around the world

Diarrheal disease is the second leading cause of death in children younger than 5 years old. About 525,000 children die from diarrheal diseases each year.

Risk factors and prevention

Risk factors for diarrheal diseases include:

  • living in an area with poor sanitary conditions
  • not having access to clean water
  • age, with children being the most likely to experience severe symptoms of diarrheal diseases
  • malnourishment
  • a weakened immune system

The best method of prevention is practicing good hygiene. Handwashing, improved sanitization and water quality, and access to early medical treatment can also help prevent diarrheal diseases.

TB is a lung condition caused by bacteria called Mycobacterium tuberculosis. It’s a treatable airborne bacterium, although some strains are resistant to conventional treatments.

TB is one of the top causes of death in people who have HIV. Furthermore, people who have HIV are 18 times more likely to develop active TB.

Impact of TB around the world

The cases of TB have fallen 2% each year between 2015 and 2020.

One of the targets of the United Nations Sustainable Development Goals is to end the TB epidemic by 2030.

Risk factors and prevention

Risk factors for TB include:

  • diabetes
  • HIV infection
  • a lower body weight
  • proximity to others with TB
  • regular use of certain medications such as corticosteroids or drugs that suppress the immune system

The best prevention against TB is to get the bacillus Calmette-Guerin vaccine, which is commonly given to infants and children in areas where TB is common.

If you think you’ve been exposed to TB bacteria, a doctor can prescribe preventive medications (chemoprophylaxis) to lower the likelihood of developing an active infection.

Cirrhosis is the result of chronic or long-term scarring and damage to the liver. The damage may be the result of a kidney disease, or it can be caused by conditions such as hepatitis, alcoholic liver disease, or nonalcoholic fatty liver disease.

A healthy liver filters harmful substances from your blood and sends healthy blood into your body. As substances damage the liver, scar tissue forms. As more scar tissue forms, the liver has to work harder to function properly and may eventually stop working.

Risk factors and prevention

Risk factors for cirrhosis include:

  • chronic alcohol use
  • fat accumulation around the liver (nonalcoholic fatty liver disease)
  • chronic viral hepatitis

Moderating alcohol intake can help prevent liver damage and cirrhosis.

Likewise, you can prevent nonalcoholic fatty liver disease by enjoying a nutritious diet rich in fruits and vegetables and low in sugar and fat.

Lastly, you can lower the likelihood of contracting viral hepatitis by using barrier methods each time you engage in sexual activity and by avoiding sharing anything that could have traces of blood such as needles, razors, or toothbrushes.

How many rare diseases are there?

A rare disease is usually defined as a disease or condition that affects fewer than 200,000 people in the United States.

According to most scientists and clinicians, there are around 7,000 different rare diseases. However, this estimate can vary from 5,000 to 8,000 rare diseases, depending on the source.

It’s believed that around 1 in 10 people in the United States, or around 30 million people in total, has a rare disease.

Some rare diseases are hereditary and can be passed from parent to child. Some may be visible from birth, while others might show up later in life.

Which disease has no cure?

There’s no known cure for many conditions, including several on the list of the deadliest diseases.

This also includes conditions such as cancer, Alzheimer’s disease, multiple sclerosis, and muscular dystrophy.

In many cases, certain lifestyle factors, such as smoking cessation and modifying your diet or exercise routine, may lower the risk of developing some of these conditions.

In other cases, a combination of lifestyle changes, medications, and other treatment methods might help manage or reduce symptoms of a condition, though it may not necessarily cure it.

What’s the deadliest disease?

Ischemic heart disease is the leading cause of death around the globe. Other conditions, such as stroke, COPD, lower respiratory infections, and respiratory cancers, also account for a significant portion of deaths each year.

While deaths from certain diseases have increased, those from more serious conditions have also decreased.

Several factors, such as an increasing life span, naturally increase the prevalence of age-related diseases such as CAD, stroke, and heart disease.

However, many of the diseases on this list are preventable and treatable, and as medicine continues to advance and prevention education grows, we may see improved outcomes for many of these diseases.

A good approach to lowering your risk of any of these conditions is to follow a balanced diet, live a healthy lifestyle, and stay active.

Moderating your alcohol intake and quitting smoking, if applicable, can also help.

For bacterial or viral infections, proper handwashing can help prevent or lower your risk.

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A cough, also known as tussis, is a voluntary or involuntary act that clears the throat and breathing passage of foreign particles, microbes, irritants, fluids, and mucus; it is a rapid expulsion of air from the lungs.

Coughing can be done deliberately or as part of a reflex. Although coughing can be a sign of a serious illness, more often, it will clear up on its own without the need for medical attention.

In this article, we will cover the possible causes, diagnosis, and treatments for coughs.

There are three phases to a cough:

  1. Inhalation (breathing in).
  2. Increased pressure in the throat and lungs with the vocal cords closed.
  3. An explosive release of air when the vocal cords open, giving a cough its characteristic sound.

If somebody coughs a lot, it can be a sign of a disease. Many coughs are caused by infectious diseases, like the common cold, but there are also non-infectious causes. We look at some potential causes in the next section.

The majority of coughs are caused by viruses and clear up without treatment.

Causes of acute (short-term) cough

In most cases, the infection is in the upper respiratory tract and affects the throat, this is known as a URTI or URI (upper respiratory tract infection). Examples include:

If it is an LRTI (lower respiratory tract infection), the lungs are infected, and/or the airways lower down from the windpipe. Examples include:

An acute cough can also be caused by hay fever.

Causes of chronic (long-term) cough

A chronic cough may be caused by:

  • smoking
  • mucus dripping down the throat from the back of the nose (post nasal drip)
  • GERD (gastro-esophageal reflux disease)
  • asthma
  • some medications (e.g., ACE inhibitors)

Chronic coughs in children are most often caused by asthma, but can also be from conditions like post-nasal drip or GERD.

Less common causes of chronic cough in adults include TB (tuberculosis), fungal infections of the lung, and lung cancer.

If a cough has persisted for 3 weeks without improvement, it is sensible to visit a doctor.

In most cases, there will not be anything serious underlying the cough, but in rare cases, a long-term cough can be a sign of something that needs treating, such as lung cancer or heart failure.

Other reasons to seek medical advice include:

  • The cough is getting worse.
  • There are swelling or lumps present in the neck region.
  • Weight loss.
  • Severe coughing.
  • Difficulty swallowing.
  • Permanent changes in the sound of the voice.
  • Coughing up blood.
  • Difficulty breathing.
  • Chest pain.
  • Fevers that are not getting better.

If a doctor decides that a cough is caused by the common cold or flu, the general advice will be to rest, drink plenty of fluids, and let it run its course. In the majority of cases, such coughs clear up after 1–2 weeks.

A cough caused by a viral infection that persists for more than a couple of weeks will probably require medical attention.

The doctor may order some diagnostic tests, such as a chest X-ray; a sample of phlegm may be sent to a laboratory for analysis to determine what is causing the infection.

The patient may be asked to breathe in and out of a tube attached to a machine; this helps the doctor determine whether the airways have an obstruction (this test is called spirometry), which is common in asthma or emphysema.

If asthma is diagnosed, the patient may be prescribed asthma medication.

Sometimes, a doctor might refer the patient to a lung or ear, nose, and throat (ENT) specialist.

The best way to treat a cough caused by a viral infection is to let the immune system deal with it — generally, such coughs clear up on their own.

If a doctor is treating a cough, they will focus on the cause; for example, if it is due to an ACE inhibitor, it may be discontinued.

Codeine, dextromethorphan, and other cough suppressants are often used by people with coughs.

However, there is not much research into cough medicines and how much they can actually reduce symptoms.

Home remedies

According to the National Health Service (NHS), United Kingdom, a homemade remedy with honey and lemon is as good, if not better than most over-the-counter (OTC) products sold in pharmacies.

Treatments are mostly aimed at making the patient feel a little bit better but generally do not decrease the length of the cough.

Honey — it coats the throat, resulting in less irritation and possibly less coughing. Honey is a demulcent (something that soothes).

Cough medications — some may help associated symptoms, such as fever or a stuffy nose. However, there is no compelling evidence that cough medicines are effective in making the cough go away faster. A variety of cough medicine is available for purchase online.

For small children, it is a good idea to talk to a doctor before giving OTC cough medicine. Some ingredients in cough medicines, such as codeine, can be dangerous for small children. There is no evidence that cough medicines help children, and they can actually be dangerous due to the side effects.

Cough suppressants — these suppress the cough reflex and are generally only prescribed for a dry cough. Examples include pholcodine, dextromethorphan, and antihistamines.

Expectorants — these help bring up mucus and other material from the trachea, bronchi, and lungs. An example is guaifenesin (guaiphenesin), which thins the mucus and also lubricates the irritated respiratory tract, helping to drain the airways. Cough expectorants are available to purchase over-the-counter or online.

In summary, coughs can be annoying and uncomfortable but, for the most part, they will clear up on their own. However, if a cough has continued for some time or got worse, it is still important to speak with a doctor.

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When doctors diagnose lung cancer, they also try to determine what stage the cancer is at. This helps them decide on the best course of treatment.

The most prevalent type of lung cancer, non-small cell lung cancer, has four stages. Stage 2 indicates the cancer may have spread beyond the lung into nearby lymph nodes.

Read on to find out more about lung cancer, risk factors, and how stage 2 is diagnosed and treated.

The two main types of lung cancer are non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC accounts for 80 to 85 percent of cases.

Medical professionals classify the stages of lung cancer based on a number of factors, including:

  • the size and extent of tumors
  • whether the cancer has spread to nearby lymph nodes
  • whether the cancer has spread to distant organs

SCLC is generally categorized as limited stage or extensive stage.

Limited stage SCLC is contained in one lung and possibly certain lymph nodes. Extensive stage SCLC means that the cancer has spread beyond the originally affected lung.

NSCLC is divided into four stages, with each successive stage indicating the cancer is spreading or growing.

In general, stage 2 NSCLC means the cancer may have spread from your lung to the nearby lymph nodes.

Stage 2 can be further broken down into substages 2A and 2B.

Stages 2A and 2B are determined based on tumor size and location, and whether there is cancer in the surrounding lymph nodes.

Not all instances of lung cancer are detected in stage 1, as many of its symptoms are also symptoms of certain noncancerous conditions. Symptoms of SCLC and NSCLC are similar and include:

If you experience these or any other unusual symptoms that you believe may be an indication of lung cancer, visit your doctor. They may order the following tests so they can make a diagnosis:

  • imaging tests such as an X-ray, MRI scan, or low-dose CT scan
  • biopsy, a tissue sample examination
  • sputum cytology, a examination of mucus

Treatment plans depend on the stage in which the lung cancer was detected. For stage 2 lung cancer, if cancer is present only in your lung, surgery may the recommended option.

If the tumor is large, your doctor may recommend radiation therapy or chemotherapy to shrink the cancer prior to surgery.

If your doctor thinks that your cancer may recur or that cancer cells might have been left behind after surgery, they may recommend chemotherapy or radiation therapy after surgery.

Lung cancer is the leading cause of cancer-related deaths for both men and women in the United States. It’s the most common cancer worldwide.

According to the American Cancer Society, the five-year survival rate for stage 2A lung cancer is about 60 percent and for stage 2B about 33 percent.

Survival rates are estimates and depend on a number of factors related to a person’s overall health as well as the stage of the cancer. You doctor can help you understand your specific situation.

If you’re experiencing symptoms of lung cancer or believe you are at a higher risk due to family history or a history of smoking, speak with your doctor and discuss the possibility of testing for the condition or examining treatment options.

The primary risk factor for developing lung cancer is smoking cigarettes, which contain carcinogens that affect the lung tissue. Even exposure to secondhand smoke increases risk. Up to 90 percent of lung cancer deaths are linked to smoking.

Other risk factors include being exposed to radon gas or asbestos or having a family history of lung cancer.

While there is no guaranteed way to prevent the lung cancer, eating a healthy diet of fruits and vegetables and exercising regularly can reduce your risk.

If you have a history of smoking, quitting can improve your chances of not developing lung cancer.

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There are many types of doctors involved in diagnosing and treating lung cancer. Your primary care doctor may refer you to various specialists. Here are some of the specialists you may meet, and the roles they play in lung cancer diagnosis and treatment.

A pulmonologist is a doctor who specializes in treating diseases of the lungs, such as lung cancer, chronic obstructive pulmonary disease (COPD), and tuberculosis.

With cancer, a pulmonologist aids in diagnosis and treatment. They’re also known as pulmonary specialists.

When to see a pulmonologist

Your primary care doctor may recommend seeing a pulmonologist if you have a cough that lasts longer than 3 weeks, or if your cough becomes more severe over time.

A pulmonologist can help you manage the following symptoms:

An oncologist will help you set up a treatment plan after a cancer diagnosis. There are three different specialties in oncology:

  • Radiation oncologists use therapeutic radiation to treat cancer.
  • Medical oncologists specialize in using drugs, such as chemotherapy, to treat cancer.
  • Surgical oncologists handle the surgical portions of cancer treatment, such as removal of tumors and affected tissue.

These doctors specialize in surgery of the chest (thorax). They perform operations on the throat, lungs, and heart. These surgeons are often grouped with cardiac surgeons.

When to see a thoracic surgeon

Depending on the location and stage of your lung cancer, surgery may be a good treatment option. Your oncologist will recommend a thoracic surgeon if he or she believes you could be a good candidate for surgery. The types of surgery include:

  • Wedge resection: This surgery removes a wedge-shaped piece of your lung. The wedge should include both cancerous and some healthy tissue.
  • Segmentectomy: This surgery removes one segment of a lung.
  • Lobectomy: A lobectomyremoves the cancerous lobe of your lung.
  • Bilobectomy: In this surgery, two lobes of the lung removed.
  • Pneumonectomy: A pneumonectomy removes an entire lung.
  • Extrapleural pneumonectomy: This surgeryis the most extensive option. It removes a lung, the lining of your lungs and heart (pleura), and part of your diaphragm.
  • Sleeve resection: This procedure is used for non-small cell lung cancer and removes a lobe of the lung and some of the surrounding bronchi.

No matter which doctor you see, preparation before your appointment can help you make the most of your time. Make a list of all your symptoms, even if you don’t know if they directly relate to your condition.

Ask your doctor for any special instructions before your appointment, such as fasting for a blood test. Ask a friend or family member to go with you to help you recall the details of your visit.

You should also bring a list of any questions, such as:

  • Are there different kinds of lung cancer? Which kind do I have?
  • What other tests will I need?
  • What stage of cancer do I have?
  • Will you show me my X-rays and explain them to me?
  • What treatment options are available to me? What are the side effects of the treatments?
  • How much does treatment cost?
  • What would you tell a friend or relative in my condition?
  • How can you help me with my symptoms?

Visit your doctor if you believe you’re experiencing symptoms of lung cancer. New and effective treatments are constantly being researched, and your doctors can help guide you towards the best treatment for you.

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Today, the American Lung Association in Central Florida announced that Eliezer “EJ” Nunez has been elected to the Local Leadership Board of Directors. During the recent meeting, the Orlando Leadership Board approved the FY23 Board slate, as well as elected Dr. Rick Ramnath, Principal and Radiologist, Neuroskeletal Imaging as the Board Chair.

The Lung Association’s Local Leadership Board of Directors, which has 17 members, helps lead the organization in its mission to save lives by improving lung health and preventing lung disease. The purpose of the Board is to raise the Lung Association’s profile in the community, advocate for lung health, and increase resources to fund local programs and services. Board members impact the work of the Association’s programs and services, public policy, research, and revenue generation.

“Eliezer (better known as EJ) will be an incredible asset to our local work at the Lung Association. His insight and experience as a healthcare professional are critical to our work in the community,” said Janelle Hom, executive director for the Lung Association. “We are honored to welcome EJ into this important role and look forward to continuing our vital mission work with his leadership.”

Nunez was born in the Dominican Republic and migrated to the United States (Massachusetts) at the age of 10. Among Nunez’s educational achievements, he got his start at Central Florida’s very own Valencia College in their Respiratory Care program.

While Nunez began his career in 2006 at AdventHealth he has held several clinical leadership roles most recently, serving as Senior Manager at Celebration. During this unprecedented and challenging time, Nunez placed intentional focus on fostering a culture grounded in respect, love and accountability. Most recently, beginning in November 2021, he embarked on his new journey as Director of Respiratory Care for Orlando, overseeing the Senior Managers for Respiratory Care Adults, Respiratory Care Children’s, Pulmonary Diagnostics, Pulmonary Rehabilitation, and Respiratory Care Support/Logistics.

Nunez has a profound passion for serving God and others, discovering and exploring talent and helping others to realize their personal and professional value. He is the proud father of two joyful sons, whom he treasures. “I love to laugh and look forward to meeting and connecting with the team and the community. I embrace every single moment and opportunity,” humbly shares Nunez.

The Lung Association in Central Florida conducts much of its work with money raised at fundraisers throughout the year. On November 10, the organization will host their 5th annual Lip Sync For Lungs presented by AdventHealth Orlando at the SAK Comedy Lab. Learn more by visiting

About the American Lung Association

The American Lung Association is the leading organization working to save lives by improving lung health and preventing lung disease through education, advocacy and research. The work of the American Lung Association is focused on four strategic imperatives: to defeat lung cancer; to champion clean air for all; to improve the quality of life for those with lung disease and their families; and to create a tobacco-free future. For more information about the American Lung Association, a holder of the coveted 4-star rating from Charity Navigator and a Gold-Level GuideStar Member, or to support the work it does, call 1-800-LUNGUSA (1-800-586-4872) or visit:

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Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by airflow obstruction and alveolar destruction.1 It is one of the leading causes of death worldwide, causing 3.23 million deaths in 2019.2 Although COPD is mainly driven by tobacco smoking, exposure to other environmental toxins are also risk factors.1 The most recognized symptom of COPD is dyspnea or shortness of breath.3 Other non-specific symptoms frequently reported by patients include fatigue, sleep disturbance, stress, anxiety, and depression.3,4 People diagnosed with COPD, particularly the elderly, often have significant co-morbidities. Hence, many struggle to fully understand their illness and cope with their symptoms,5 leading to hospitalizations and high readmission rates.6 This carries significant health-care costs as well as financial and emotional burdens for patients and their families.7

COPD management is multi-faceted. This includes pharmacological treatments (eg, inhalers), pulmonary rehabilitation, and risk factor modification, specifically, assistance with smoking cessation.8 In more advanced stages, patients may require long-term oxygen therapy, non-invasive ventilation devices, and rarely, lung volume reduction surgeries or a lung transplant. There is evidence to suggest that many people with COPD feel overburdened with the treatment and management of their illness.1,4,9 Indeed, a study estimated that an individual with a combination of COPD, arthritis, heart disease or diabetes can spend 50 hours per month on health-related activities, take 6–12 medication per day and see their doctor 2–6 times per month.10 Large time investments in treatment and the requirement of long-term self-management of the disease can lead to (overwhelming) treatment burden for patients.8

Treatment burden is defined as a patient’s treatment workload. It can include learning about and implementing treatments, completing paperwork, arranging, and attending medical appointments/tests, experiencing side effects and financial costs of treatment.11 This differs from disease burden, which encompasses the morbidity or mortality related to the disease.12,13 Treatment burden refers to the negative consequences of treatments that patients experience, including medications, therapies, and medical interventions.13,14 Of course, treatment burden is multiplied for patients with multiple chronic conditions.15

Given the highly burdensome nature of COPD management, there has recently been research published investigating the treatment burden experiences of patients with COPD and their family members.5,8,11,16,17 This body of literature demonstrates the substantial treatment burden that people with COPD experience, including changing daily routines,4,9 and health behaviors, difficulty attending medical appointments because of travel restrictions,5,16 attending specialist appointment because of financial costs,18 not being able to afford medications,18 inconsistent or contradictory information about COPD and treatment,5 experiencing treatment side-effects,19 the burden of transitions between health-care institutions, and lack of communication between health-care professionals.5 Further, Lippiett’s (2019)5 systematic review highlights that frequent hospitalizations compound treatment burden, with hospital stays reported to be confusing, and disruptive.

Although research has begun to shed light on how COPD patients experience treatment burden, most of what we know is limited to personal experiences of individual patients. Perspectives of carers are largely missing, despite carers being acknowledged as a critical source of support for patients.20 Finally, little is known about the perspectives of respiratory physicians (pulmonologists or chest physicians), who play a key role in the treatment and management of COPD. This study seeks to understand important areas of treatment burden from patients’ and carers’ experience, and respiratory physicians’ perspective to identify what should be discussed during a clinical encounter. This may help empower patients and enable clinicians to tailor their care accounting for patient’s personal values, preferences, and capacity to cope with their treatment workload. Using an innovative method of nominal group technique, the aim of this study was to identify and prioritise areas of treatment burden that should be discussed during the clinical encounter from a patient, carer and a respiratory physician perspective.

Materials and Methods

The nominal group technique was used as the primary research methodology in this study. Developed by Delbecq and Van de Ven as a qualitative research technique, the nominal group technique aims to identify strategic problems and develop appropriate and innovative solutions.21 The technique allows for many ideas to be developed, avoids “quick” decision-making, has a high degree of task completion, and anonymously measures the relative importance of the ideas that are developed.22 Although time consuming and regimented, the nominal group technique is particularly useful when investigating health-care problems and producing action-based solutions.23 It has been used widely in chronic disease research, particularly around priorities for treatment outcomes,24 unmet needs,23 and patient-centred care.25 Compared with traditional focus group interviews, nominal group technique provides the opportunity for all participants to express their ideas and democratically vote on their priorities rather than have discussions dominated by outspoken participants.26 Informed consent, including publication of anonymised responses, was obtained from all participants prior to data collection, and Gold Coast Hospital and Health Service Human Research Ethics Committee provided approval for the study (LNR/2020/QGC/61202). The study also complied with the Declaration of Helsinki.


Purposeful sampling was used to recruit participants diagnosed with COPD for the study. Eligible participants were contacted from lists of outpatient clinics, entries in the electronic medical record, and direct referrals from respiratory physicians and nurses working at the Gold Coast University Hospital (GCUH). Unpaid carers, who provided care to people with COPD, were recruited in a similar way. Respiratory physicians practicing in different Australian hospitals were contacted in person or via email by one of the investigators.

After signing the study consent form, a research assistant collected data on COPD patients’ characteristics: age, sex, marital status, number of people living in the same household, employment status, carer arrangements, type and year of diagnosis of chronic disease(s), number of medications (per day, per week, per month), estimated time spent on treatment work for disease management, including taking of medication, device maintenance, attending medical appointments, filling pharmacy scripts, monitoring health, diet, exercise and other activities (per day, per week, per month). Patients were also asked to rate on a four-point Likert-scale how burdened they currently felt about all the work they had to do for their healthcare: not at all burdened (0), somewhat burdened (1), significantly burdened (2), overwhelmingly burdened (3).

For carers, the following information was collected: age, sex, marital status, relationship to patient they care for, duration of carer’s duties, estimated time spent on helping patient with treatment work for disease management, including preparing and administering medication, accompanying patient to medical appointments, going to pharmacy to fill patient’s scripts (per day, per week, per month). For physicians, we collected information on specialty and location of practice.


Nominal group technique sessions were conducted in person at the GCUH or online using a video conferencing platform. Sessions lasted between 2.5 and 3 hours (with a break), and participants attended one session. All the nominal group sessions were audio recorded, and the discussion following the ranking of treatment burden challenges was transcribed and de-identified. The sessions followed the below structure:

  1. Introduction: The aim of the study and nominal group process was explained.
  2. Silent generation of ideas: Participants were encouraged to record, in silence, as many ideas as possible to the following questions.
  3. Patients: What issues related to the patients’ burden of treatment do you think should be discussed between doctor and patient?
  4. Carers: What issues related to the burden of treatment do you think should be discussed between the doctor, you as the carer and the person you are caring for?
  5. Respiratory physicians: What issues related to patients’ burden of treatment do you think should be discussed between doctor and patient/carer? Please think about the elements of treatment that are likely the most burdensome to your patients, and why you think it would be good to discuss these during a consultation.
  6. Round Robin: Each idea was elicited in a round robin approach, meaning that everyone had an opportunity to contribute one idea at a time, until all ideas were exhausted. One researcher recorded the ideas verbatim on a screen visible to all participants. Some new ideas were also generated during this process.
  7. Clarification: All participants were asked to clarify ambiguous ideas to ensure that the meaning was clearly understood by everyone. Similar ideas were then grouped together if there was consensus, and a code was allocated to each idea for ranking reasons.
  8. Ranking: Participants selected their top five ideas, and then ranked them in order of priority, with five marks allocated to their top, and one mark to their lowest, priority. The top five ideas for the whole group were determined by adding up individual votes.
  9. Discussion and solutions: The top five priorities and the potential solutions that could be implemented were discussed together as a group.


Quantitative and qualitative data were generated by the nominal group technique sessions; (a) quantitative ranking of treatment burden priorities, (b) qualitative discussions of priorities and potential solutions. Data analysis followed the following process:

  1. Individual group scoring/ranks was reviewed by the entire research team.
  2. Where there are potential overlaps, similar priorities were grouped together under an “umbrella theme.” For example, trouble with parking at the hospital and waiting times for specialist appointments were grouped under the umbrella theme of “access to healthcare”. Umbrella themes were cross-checked by another research team member for validation.
  3. The scores (votes on priorities) for each nominal group session were calculated according to the method based on McMillan et al.27 Specifically:
  4. The scores for all priorities combined under the same umbrella theme were added up from all three patient nominal group sessions, resulting in an aggregate score for each umbrella theme. For physicians and carers, scores for all priorities combined under the same umbrella theme were added up from the one session nominal group session.
  5. Frequency of voting indicated how many times a particular theme was voted for or how popular the theme was.
  6. Ranked priority was the overall priority score for each umbrella theme based on the aggregate scores. If there were equal aggregate scores, frequency of voting was used as secondary ranking criterion with more votes resulting in a higher ranking.


Overall, five nominal group technique sessions were conducted (n = 31); three sessions with patients (n = 18), one with carers (n = 7) and another one with respiratory physicians (n = 6). The mean age of patients was 70.4 years (range = 59 to 82 years), including 13 females (72%), while the carers’ mean age was 70.1 years (range = 54 to 85) including five females (71%). Patients were on average taking 10 pills and/or inhalers per day (range = 3 to 20). In addition to COPD, recruited patients were diagnosed with other chronic conditions including anxiety, diabetes, heart failure, thyroid disease, and asthma. All patients were retired, some because they could no longer work due to their COPD. On a four-point Likert-scale of degrees of treatment burden, nine patients reported being significantly burdened and nine felt somewhat burdened.

For carers, most (n = 5) were spouses/partners of the care-recipient and three were still in paid employment. Some of the assistance provided by the carers included transport, medication management, diet, paperwork/administration, and financial management. Physicians were all specialists in respiratory medicine who worked in different hospitals and private practices in the state of New South Wales, Australia.

Thematic analyses of the nominal group transcripts generated nine umbrella themes. Table 1 lists and describes each of the nine umbrella themes. Top priorities for patients, carers, and the respiratory physicians are presented in Tables 2–4 respectively.

Table 1 Description of Umbrella Themes

Table 2 Priorities for COPD Patients (n = 3 Groups) 18 Participants

Table 3 Priorities for Carers (n = 7 Participants)*

Table 4 Priorities for Respiratory Physicians (n = 6 Participants)

Education and Information

Across all three COPD patient groups, education and information emerged as the most important treatment burden theme to be discussed in clinical encounters (Table 2). Education and information emerged as the third most important priority for carers (Table 3) and fourth for respiratory physicians (Table 4). For patients, they needed information about and referral to services which provide support with symptom management and education about treatment options. Considered and personalized discussions between the patient and respiratory physician were deemed more important than generic written information:

I think it’d be ideal to have someone who can consult with you and give you a bit more information than just a pamphlet about what’s available. (Patient)

Carers, on the other hand, preferred this information to be given in writing:

Maybe a folder that would at least help with the diet, with medications or allergy or things that reacts with other medications. That might be something that we can go back to ask the doctor. (Carer)

There were extensive discussions about health professionals (including respiratory physicians) being too busy and not spending enough time with patients to explain their symptoms and treatment options. Some participants reported that they found out about support services from friends and other people. Rather, they would have preferred this to be discussed during a consultation. When education about treatment and self-management were not offered to the satisfaction of patients, other channels and sources of support were utilized:

I’m lucky I’ve got a really close friend who’s a really good physio … and she showed me different breathing exercises to do. I mean that sort of education is really good. (Patient)

Patients also believed that health professionals should be empathic and patient when conveying this information. Patients felt the personal responsibility to invest time into learning about the condition, the management, and be ready to ask the relevant questions to their doctor:

I think also, you need to be prepared for when you go to the doctors to have your questions ready, written down. (Patient)

This was reiterated by respiratory physicians, who said that patients often do not voice their concerns nor indicate that they are depressed or anxious, which makes their job harder. They agreed that all health professionals needed to be good listeners and probe patients for further information:

I think you can jump in with a question and probe a little deeper, and if you’ve known the patient for a little while, you can read them, and even if you’ve met them for the first time, you can read body language and with symptom burden. (Physician)

Finally, all groups agreed that the information given by all health professionals, including the hospital paperwork, needed to be simple and easy to understand.

Regarding solutions, it was suggested that a checklist could be developed to assess patients’ physical, psychological and social level of function as well identify their information and education needs specific to COPD, its progression and communication preferences. A need for a designated person with time and good interpersonal skills to 1) provide this holistic, personalized information, 2) help them navigate the system, and 3) identify suitable services was also discussed as a solution:

Someone within the practice who has the information to be able to guide you to different services. (Patient)

Carers agreed and extended this sentiment to also include the designated person having an advocacy role to support the patient and family through their COPD journey. Respiratory physicians acknowledged that multiple health-care professionals can provide COPD specific information and education for example respiratory nurses and pharmacists. The respiratory physicians emphasized the need for there to be more specialized nurses in community outreach positions.

Accessing Healthcare

Do you have to wait until you’re so low that you go back to hospital?. (Patient)

As illustrated by the above quote, COPD patients perceived difficulties with accessing treatment as a source of treatment burden. Although it did not emerge as one of the top five priorities for carers, this was the second most important priority for patients and the most important priority for respiratory physicians for discussion during clinical encounters. Physicians also acknowledged the difficulties with accessing health services, particularly with long waiting times for specialist appointments and pulmonary rehabilitation:

I think access is an issue, probably the waiting list (Physician)

The travel difficulties that many patients experienced were also commented on by the physicians. Disappointment and frustration were clearly expressed by patients when talking about issues of healthcare access. There was acceptance that insufficient government funding contributed to burden associated with accessing healthcare.

… you’ve got to wait another two years, before you’re eligible for it, because of the funding. Well two years down the track, Jesus, you wouldn’t know where we were going to be. (Patient)

Despite not being a top five priority, accessing healthcare was nevertheless discussed in the carer group, particularly in the context of the Coronavirus disease 2019 (COVID19) pandemic. Carers’ discussed how the COVID19 pandemic negatively affected the ability to access healthcare in a timely manner:

During the COVID when Brisbane was going through the lockdown, I was not allowed to go into the hospital. I had to sit outside the hospital in the rain for five hours. (Carer)

Beyond the straightforward solutions of providing patients with a choice of appointment timeframes, access to free or subsidized community transport, and the need for long-term pulmonary rehabilitation programs that are easily accessible, patients and physicians discussed alternative, virtual delivery models of care. Physicians posited a hybrid model of care for the delivery of pulmonary rehabilitation programs including online group-based, and one-on-one private sessions. It was commented that younger patients may appreciate the opportunity to exercise via online social media or communication platforms while older cohorts can continue with more traditional group based, face-to face programs and supplement with one-on-one sessions as required.

Worry About COPD Treatment and Prognosis

Worrying about COPD treatment and prognosis was burdensome, and patients wanted to share their experiences with physicians. This theme emerged as either second or third most important priority across all groups, although it was a higher priority for carers and physicians, compared to patients. Although, for one of the patient groups (see Table 2), it was the highest priority. Respiratory physicians discussed how people with COPD worried as they made significant lifestyle modifications, particularly in their home environment, but at times did not have the capacity or capability to undertake the work. There was also discussion on how some patients became further stressed and worried during treatment or medical tests:

It can feel quite stressful. You’ve got this person saying, keep going, keep going, keep going [lung function test], and that causes them anxiety. (Physician)

For patients, one aspect of this type of burden was worry about their condition worsening and requiring intubation, with one participant voicing concern and anxiety which resonated across the patient groups:

That’s one of my biggest fears … I’m scared to death of it [intubation]. (Patient)

Many expressed worries about their COPD worsening and end-of-life treatment options and wanted their respiratory physicians to discuss these issues with them openly and honestly. Currently, such discussions were mainly held with social workers and other allied health staff but, according to patients, should also be proactively broached by the treating physician. The importance of having conversations about advanced care directives and formally documenting them were also highlighted by carers. One carer discussed a personal family experience:

I just know that when my dad was in ICU [Intensive Care Unit] following heart surgery and he didn’t come through. My mum was not listed as being allowed to speak on his behalf. I stood there in the ICU and said he has not signed a DNR [Do Not Resuscitate], you guys need to do everything you can. But there was nothing on paper. (Carer)

As a solution to minimise this type of burden, patients, carers and respiratory physicians all agreed that clear and empathetic communication about the condition, its prognosis, treatment plan, goals and outcomes were required. Patients wanted their GP or respiratory physician to initiate conversations about prognosis and the management of advanced symptoms, end-of-life care and resuscitation orders. Patients and carers both thought that it was important to be provided with information about their health and prognosis even if the news is not positive than affirmative action is taken in response.

If you are giving a nasty prognosis, follow up with would you like a referral to the social worker, the psychologist, the chaplain, someone who helps you process it?. (Patient)

Disconnect and Lack of Coordination of Care

COPD patients frequently discussed the difficulties they experienced when health-care services and providers were disconnected and offered little continuity and coordination of care. Patients ideally wanted consistent messaging, information, and guidance about how to manage their COPD and continuity in the health-care professionals they consulted. When asked what they wanted to be a discussion point in a clinical encounter, one patient responded:

Better communication obviously between specialists, doctors, overall. (Patient)

There were considerable discussions around the lack of coordination of care between respiratory physicians working at the hospital and family physicians. According to one patient, it was mostly the hospital-based specialist physicians not sufficiently communicating with their family physician rather than the other way around:

As far as the COPD part goes, no they’re in the dark. The hospital doesn’t forward that stuff back to them automatically. (Patient)

One participant voiced her frustration on this issue:

If they’ve got it on a computer, all they’ve got to do is put in an email address, and press send. How hard can that be?. (Patient)

Another participant echoed this frustration, adding that the e-health system should have addressed this issue, only if physicians in her words, “learnt how to use it”. Relocation of respiratory physicians or GPs (General Practitioners) was also a problem and contributed to potential disconnect between physicians and other health professionals. Despite not being happy with their care coordination, the patient groups did however acknowledge that physicians may not have the time to adequately communicate with the family physician:

I think the problem is, the specialists are so busy, they’re not going to have a great deal of time to communicate very much with the GPs. (Patient)

For carers, there was also a sense of disconnect in communication between the respiratory physician and the nurse, with carers’ expressing a desire for better communication and coordination between the two. In the respiratory physician group, although the importance of coordination between them and the family physician was discussed, this theme did not emerge in their top five priorities.

One solution for reducing the burden of disconnected care was having specialist referrals automated, which would overcome patients having to visit their GP for a new specialist referral. Further, if appointments and tests could be arranged to occur on the same day, it could save patients having to attend the hospital on multiple occasions:

I used to have an x-ray, blood test, scan, if necessary, all lined up, one after another, so I only had to make one visit to the hospital for one day. (Patient)

Medication Related Burden

Burdens related to medicine use were the fourth and third most important priority for patients and respiratory physicians, respectively (Tables 2 and 4). Although patients did acknowledge the burden of having to take multiple medications and experiencing side effects, most of the discussion on medications were around the correct use of medications and the need for regular medication reviews. Patients wanted their respiratory physicians to spend time discussing and reviewing their medications to ensure that they were being used correctly and still indicated:

Because I take that many tablets and puffers, that I’m sure it can’t be doing my health any good long term. (Patient)

The importance of communication and continuity around medication prescription between the GP and the respiratory physician was also discussed:

… when they give you different medications, I don’t know whether they actually look back on what they’ve already given you, or do they know what you’ve taken?. (Patient)

Respiratory physicians were also aware of the burden patients experienced because of medication use, with one physician pointing out his own personal experience:

To take medications every day is a burden. We all just write up prescriptions but from a personal point of view, I hate taking medicines every day and it’s something hard to do. (Physician)

Although medication-related burden did not emerge as a top five priority for carers, there were discussions in the group around the ways carers’ jobs could be made easier:

I guess every patient is different. They are on different treatment. They take different medications. So is there any like say they could give you a printout. (Carer)

Another carer added:

Maybe a folder that would at least help with the diet, with medications or allergy or things that reacts with other medications. (Carer)

Regular and routine review of medications was the main solution that was proposed by patients. GPs, respiratory physicians and pharmacists could all undertake a medication review. Again, there was acknowledgement that physicians may not have the time to adequately discuss and review medications during a short consultation. One participant suggested that community pharmacists could assist.

Patients and carers felt that there needed to be more responsibility taken by the person who is prescribing the medication to ensure all other medications are also necessary, check for interactions and communicate any changes in a timely manner to the patient’s GP. Carers wished to be provided with a summary of the patient’s medications, its indication, interactions and side-effects. From the perspective of respiratory physicians, solutions to minimize the burden of medications included tailoring prescriptions to a patient’s specific needs and context:

The right device for the patient, but also communicating it back to the referring GP as to why that particular device and combination of medications was chosen. (Physician)

Carers’ Needs

Issues associated with being a carer, such as their involvement in treatment decisions and the burdens caring for the care-recipient, were the highest priority for the carer group (Table 3). However, this theme did not emerge as a priority for physicians and emerged as a priority only during one of the three patient group sessions (not top five). Nevertheless, there was recognition in the patient and physician groups that carers should be involved in the care of the patient wherever possible. Regarding involvement in treatment, carers’ believed that the physicians should consider patients’ carers and other family members, and involve them in the care process:

I think it’s not just looking at the patient as the patient but realising the patient has people around them. It’s a holistic approach I suppose is required. (Carer)

One carer suggested that their involvement had increased treatment efficacy, especially when the patient was unable to fully participate in decision-making about treatments:

Because the doctor knows that he has memory issues and when doctors are asking him questions, his answers are not what doctors are expecting. So, my presence there is helpful to doctors. (Carer)

Although involvement of carers was discussed positively, carers did acknowledge potential privacy and confidentiality issues:

… sometimes the doctors are also very careful about the privacy issues. (Carer)

One carer, who was not invited into consultation by the care-recipient’s physician suggested the following, when asked what she preferred to have happened:

The doctor to have said to him, is your partner with you or your wife with you and if so invite her in because she needs to be across what I’m saying. (Carer)

The burden and struggle of being a carer was also discussed in the carer group. One participant, who felt lonely and isolated in her caring role, commented:

I wasn’t able to own up myself what I was going through or even tell anyone what I go through with my husband. (Carer)

Providing a space for carers could go to in the hospital to find solace, rest and re-energize (while the person they care for is hospitalized) was identified as a solution to reducing the burdens carers experience. The idea of a “chronic condition” support group was also favourably received by several members who had found attending the nominal group technique session cathartic. Carers, however, were not aware of any such support groups, nor did they know how they could find out if any existed.


This study is one of the first to concurrently focus on treatment burden priorities and potential solutions among COPD patients, carers and respiratory physicians. For example, for patients, the most important priorities were receiving more education and information during the clinical encounter, difficulties they experienced with accessing healthcare and worry about COPD treatment and prognosis. In contrast, respiratory physicians believed burdens associated with accessing healthcare should be the first priority for treatment burden discussions between the physician and patient/carer, followed by education and information, and then discussions about worry. Carers were aligned with the priority to discuss worry about COPD treatment and prognosis, and the need for education and information emerging as the second and third priority, respectively. In contrast to patient and physician groups, carers’ first priority was carers’ needs.

The results indicated that the education and information needs of patients may not currently be fully fulfilled in a clinical encounter. There is evidence from other studies to suggest that many COPD patients struggle with managing their condition because they lack basic understanding of their illness and its treatment.18,28 For example, Bauer et al, in their qualitative study, found that patients voiced frustration with COPD-related information and support received during clinical encounters, particularly at the time of diagnosis.18 The need for education and information has been identified as a priority in many other chronic conditions, and patients’ understanding of their illness(es) and treatments is an important determinant of engagement with health advice and treatment.29 Perhaps, the desire for better education and information reflects COPD patients’ need to feel in control of their condition and presents an opportunity to be heard in the context of all the worry they experience living with and treatment of COPD. We recommend that health professionals simplify treatments where possible, provide written and verbal explanations of treatment tasks to their patients, and make sure that patients have a basic understanding of their illness and its treatment.

Education and information emerged as the fourth most important priority for physicians. Although this may be construed as being less of an important priority for physicians than patients, the results must be interpreted in context. Only one session with physicians was conducted as opposed to three with patients and while this theme emerged as the most important priority for two of the patient groups, it was the fourth most important priority for the other. Either way, the need for education and information emerged as a top five priority for physicians and for patients signalling a common perception of its importance.

Furthermore, difficulties around access of healthcare have been described as a major source of burden for patients with COPD,16 and patients with chronic disease in general.13,30,31 Indeed, there are many documented examples of patient’s having to wait months or travel long distances to seek specialist treatment.12 The solution discussed by respiratory physicians regarding the hybrid model of care, specifically, the delivery of pulmonary rehabilitation programs for improving healthcare access, warrants further research attention. During the COVID-19 pandemic many patients were undertaking pulmonary rehabilitation online but future research is required to determine its effectiveness compared with the traditional model.

For the burden associated with worrying about COPD treatment and prognosis, there was mostly agreement across all participant groups. Physicians and carers ranked this as the second most important priority whereas the patients ranked it as the third most important priority for discussion in a clinical encounter, although this was ranked as the highest priority for one patient group (group 2). While the reasons for this could be complex, one possible explanation of this variation could be that two of the six patients in this group (group 2) were using continuous positive airway pressure treatment for an average of 7 hours each night, while this was 4.7 hours for group 1 and none for group 3. The burden associated with worrying about COPD treatment and prognosis is not surprising given COPD on its own is recognized as a “difficult” illness, with many people experiencing high symptom burden, difficulties performing everyday tasks, social isolation and making lifestyle changes.3,18 There is also evidence to suggest that patients struggle to follow health professionals’ treatment advice (eg, following diet advice and restrictions) and worry about their condition worsening.32 Clearly, treatment advice needs to be given in the context of specific circumstances and capacity of patients and carers to follow that advice.

Regarding disconnect and coordination of care, our results seem to confirm previous research that patients and carers find it difficult when there is a lack of teamwork and continuity of care between their health-care professionals.4,33 According to Haggerty et al’s34 seminal work on continuity of care, our results suggest that patients and carers preferred informational continuity, over management and relational continuity. That is, they wanted information on past events and personal circumstances around COPD and its treatment to be consistently used to inform current care and decisions. Haggerty et al34 suggests that information can be disease- or person-focused but it is equally important that it reflects knowledge of patients’ preferences, values, and context. However, in our study, the results indicated that patients and carers struggled with even the basic continuity around disease information and wanted their respiratory physicians to be aware of this.

Finally, although only one group was conducted with carers, our results confirm the widely reported frustration that unpaid carers experience. Research has frequently indicated that the burden a patient experiences is often inseparable from the carer’s burden.20,35 It is also important to remember that many carers have chronic health conditions themselves, which means that they are faced with the overwhelming work of providing care for somebody else while at the same time managing their own health condition(s). Despite providing a valuable role in society, our findings confirm that carers’ need may still not be sufficiently recognized and addressed by physicians and the broader health system. As discussed in the group, formal mechanisms of recognition, such as a carer card, could potentially minimize treatment burden and increase the quality of life of both the carer and the care-recipient. Other existing support strategies, such as accredited training, no interest loans for medical expenses, discount vouchers, etc. can also be more strongly advertised.

Limitations and Strengths

Although our findings offer a unique perspective into treatment burden of patients with COPD, they are based on a small group of participants. While we intended to recruit more participants from diverse backgrounds into each of the nominal group sessions, data collection was conducted during the COVID19 pandemic, and it was challenging to conduct group sessions with research participants in a health-care setting with changing regulations. The data reflect the opinions and experiences of a small group of mostly females, in one treatment centre and may therefore not be generalizable to other people and settings. Nevertheless, we believe that many of the raised issues are relevant to many patients with COPD, their carers and physicians, as they align with the findings in previous studies of patients with chronic diseases.

During the nominal group process, discussion among participants was limited, which may have inhibited the full expression and development of ideas. The decision to condense the priorities into umbrella themes, is a potential limitation of the nominal group technique. This may have also biased the results by potentially having different priorities contained under a particular theme. However, team discussions and consensus agreement during the development of the umbrella themes would minimize the risk of this bias.

The use of nominal group technique to elicit the priorities of participants is a key strength of our study. This data collection strategy made sure that the discussion was not dominated by one or two outspoken participants. Everyone’s voice was heard, thereby empowering, and motivating them to discuss their experiences and expectations of what they wanted discussed in a clinical encounter. Finally, the nominal group technique allowed us to compare the priorities between three different types of participants (patients, carers and physicians) with their unique views and priorities regarding treatment burden.


This study provides an insight into the preferences of treatment burden topics that patients, carers and physicians wish to discuss in a clinical encounter. Challenges around accessing healthcare, the need for better education and information, and the worry caused by COPD treatment and prognosis, emerged as top priorities. Carers’ needs were only identified as a priority by informal carers. Understanding and creating opportunities to discuss these issues in the clinical encounter is important to not only reduce treatment burden, but also improve health outcomes and quality of life for those living with and affected by COPD.


We would like to acknowledge Helen McEvoy with project management and Dr Bajee Krishna Sriram for assisting with recruitment. We would also like to thank all the participants for sharing their thoughts and priorities.


This study was funded by a grant from the Gold Coast Health Collaborative Research Grant Scheme (application ID RGS20190034). CCD had salary support (independent of the study) from the Australian National Health and Medical Research Council (NHMRC) (application ID APP1123733).


Adem Sav reports grants from Gold Coast Health Collaborative Research Grant Scheme, during the conduct of the study; and grants from the Gold Coast Health Collaborative Research Grant Scheme, outside the submitted work. Claudia C Dobler reports grants from Gold Coast Health and Australian National Health and Medical Research Council (NHMRC), during the conduct of the study. The authors report no other potential conflicts of interest in this work.


1. Dobler CC, Farah MH, Morrow AS. et al. Treatment of stable chronic obstructive pulmonary disease: protocol for a systematic review and evidence map. BMJ Open. 2019;9(5):e027935.

2. World Health Organization. Chronic obstructive pulmonary disease (COPD); 2021. Available from: Accessed January 14, 2022.

3. Buttery SC, Zysman M, Vikjord SAA, Hopkinson NS, Jenkins C, Vanfleteren L. Contemporary perspectives in COPD: patient burden, the role of gender and trajectories of multimorbidity. Respirology. 2021;26(5):419–441.

4. Sigurgeirsdottir J, Halldorsdottir S, Arnardottir RH, Gudmundsson G, Bjornsson EH. COPD patients’ experiences, self-reported needs, and needs-driven strategies to cope with self-management. Int J Chron Obstruct Pulmon Dis. 2019;14:1033–1043.

5. Lippiett KA, Richardson A, Myall M, Cummings A, May CR. Patients and informal caregivers’ experiences of burden of treatment in lung cancer and chronic obstructive pulmonary disease (COPD): a systematic review and synthesis of qualitative research. BMJ open. 2019;9(2):e020515.

6. Hakim MA, Garden FL, Jennings MD, Dobler CC. Performance of the LACE index to predict 30-day hospital readmissions in patients with chronic obstructive pulmonary disease. Clin Epidemiol. 2018;10:51–59.

7. Iheanacho I, Zhang S, King D, Rizzo M, Ismaila AS. Economic burden of Chronic Obstructive Pulmonary Disease (COPD): a systematic literature review. Int J Chron Obstruct Pulmon Dis. 2020;15:439–460.

8. Gu J, Yang C, Zhang K, Zhang Q. Mediating role of psychological capital in the relationship between social support and treatment burden among older patients with chronic obstructive pulmonary disease. Geriatr Nurs (Minneap). 2021;42(5):1172–1177.

9. Gatti V, Banfi P, Centanni S, et al. Enlightening chronic obstructive pulmonary disease through patients’ and caregivers’ narratives. Int J Chron Obstruct Pulmon Dis. 2018;13:3095–3105.

10. Buffel du Vaure C, Ravaud P, Baron G, Barnes C, Gilberg S, Boutron I. Potential workload in applying clinical practice guidelines for patients with chronic conditions and multimorbidity: a systematic analysis. BMJ Open. 2016;6(3):e010119.

11. Dobler CC, Harb N, Maguire CA, Armour CL, Coleman C, Murad MH. Treatment burden should be included in clinical practice guidelines. BMJ. 2018;363;k4065.

12. Sav A, Kendall E, McMillan SS, et al. ‘You say treatment, I say hard work’: treatment burden among people with chronic illness and their carers in Australia. Health Soc Care Community. 2013;21(6):665–674.

13. Sav A, King MA, Whitty JA, et al. Burden of treatment for chronic illness: a concept analysis and review of the literature. Health Expect. 2015;18(3):312–324.

14. Eton DT, Yost KJ, Lai J-S, et al. Development and validation of the Patient Experience with Treatment and Self-management (PETS): a patient-reported measure of treatment burden. Qual Life Res. 2017;26(2):489–503.

15. Sav A, Salehi A, Mair FS, McMillan SS. Measuring the burden of treatment for chronic disease: implications of a scoping review of the literature. BMC Med Res Methodol. 2017;17(1):140.

16. Harb N, Foster JM, Dobler CC. Patient-perceived treatment burden of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2017;12:1641.

17. Negewo NA, Gibson PG, Wark PA, Simpson JL, McDonald VM. Treatment burden, clinical outcomes, and comorbidities in COPD: an examination of the utility of medication regimen complexity index in COPD. Int J Chron Obstruct Pulmon Dis. 2017;12:2929.

18. Bauer WS, Schiffman RF. Factors influencing self-management of Chronic Obstructive Pulmonary Disease by community-dwelling adults. West J Nurs Res. 2020;42(6):423–430.

19. Bakthavatsalu B, Walshe C, Simpson J. A systematic review with thematic synthesis of the experience of hospitalization in people with advanced Chronic Obstructive Pulmonary Disease. COPD. 2021;18(5):576–584.

20. Denning J, Carter P, Galvin L, Pritchard L. How treatment burden affects the carer: the experiences of three individuals, a mother, a daughter and a husband. Breathe. 2021;17(1):200327.

21. Delbecq AL, Van de Ven AH, Gustafson DH. Group Techniques for Program Planning: A Guide to Nominal Group and Delphi Processes. Scott, Foresman; 1975.

22. Potter M, Gordon S, Hamer P. The nominal group technique: a useful consensus methodology in physiotherapy research. NZ J Physiother. 2004;32:126–130.

23. Drennan V, Walters K, Lenihan P, et al. Priorities in identifying unmet need in older people attending general practice: a nominal group technique study. Fam Pract. 2007;24(5):454–460.

24. Sanderson T, Hewlett S, Richards P, Morris M, Calnan M. Utilizing qualitative data from nominal groups: exploring the influences on treatment outcome prioritization with rheumatoid arthritis patients. J Health Psychol. 2012;17(1):132–142.

25. Ospina MB, Michas M, Deuchar L, et al. Development of a patient-centred, evidence-based and consensus-based discharge care bundle for patients with acute exacerbation of chronic obstructive pulmonary disease. BMJ Open Respir Res. 2018;5(1):e000265.

26. Sav A, McMillan SS, Kelly F, et al. The ideal healthcare: priorities of people with chronic conditions and their carers. BMC Health Serv Res. 2015;15(1):1–10.

27. McMillan SS, Kelly F, Sav A, et al. Using the nominal group technique: how to analyse across multiple groups. Health Serv Outcomes Res Methodol. 2014;14(3):92–108.

28. Kale MS, Federman AD, Krauskopf K, et al. The association of health literacy with illness and medication beliefs among patients with Chronic Obstructive Pulmonary Disease. PLoS One. 2015;10(4):e0123937.

29. Arat S, De Cock D, Moons P, Vandenberghe J, Westhovens R. Modifiable correlates of illness perceptions in adults with chronic somatic conditions: a systematic review. Res Nurs Health. 2018;41(2):173–184.

30. Morris JE, Roderick PJ, Harris S, et al. Treatment burden for patients with multimorbidity: cross-sectional study with exploration of a single-item measure. Br J Gen Pract. 2021;71(706):e381–e390.

31. Zucca A, Boyes A, Newling G, Hall A, Girgis A. Travelling all over the countryside: travel-related burden and financial difficulties reported by cancer patients in New South Wales and Victoria. Aust J Rural Health. 2011;19(6):298–305.

32. Russell S, Ogunbayo OJ, Newham JJ, et al. Qualitative systematic review of barriers and facilitators to self-management of chronic obstructive pulmonary disease: views of patients and healthcare professionals. NPJ Prim Care Respir Med. 2018;28(1):2.

33. Tavares N, Hunt KJ, Jarrett N, Wilkinson TM. The preferences of patients with chronic obstructive pulmonary disease are to discuss palliative care plans with familiar respiratory clinicians, but to delay conversations until their condition deteriorates: a study guided by interpretative phenomenological analysis. Palliat Med. 2020;34(10):1361–1373.

34. Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R. Continuity of care: a multidisciplinary review. BMJ. 2003;327(7425):1219–1221.

35. Hannan N, McMillan SS, Tiralongo E, Steel A. Treatment burden for pediatric eosinophilic esophagitis: a cross-sectional survey of carers. J Pediatr Psychol. 2020;46(1):100–111.

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Why is there a cost of living crisis?

So far, there has been much to celebrate in 2022, including plenty of sunshine and a lockdown-free winter, spring, and summer. However, ranking high up on the 2022 cons list is the 'cost of living crisis'. This refers to the fall in disposable income, caused by tax increases and the rising costs of typical goods and services (known as inflation) since late 2021.

What has triggered these changes? This all started with the COVID-19 pandemic lockdowns which froze economies around the world. It can take a while for economies to bounce back, and so as the world reopened and demand for goods and services returned to previous levels, crucial shortages - including oil, gas, and lorry drivers - drove prices up.

Since 2021, several other factors have made the situation worse. At the forefront is the war between Russia and Ukraine; fuel supplies and other essential industrial goods from these countries are either suffering shortages due to factory closures (from Ukraine) or have been intentionally cut off (from Russia).

It's worth noting that this is far from a simple issue with many factors at play. For example, mega-companies that dominate the oil industry have recently posted record profits1.

What is the impact on health and quality of life?

In the UK, the rising cost of living is already negatively affecting many people's health and quality of life.

In a YouGov survey carried out in April and May 20222:

  • 55% of Brits felt that it has negatively impacted their health.
  • 25% of this group had also had this confirmed by a medical professional.

Health inequalities between richer and poorer people are also apparent, with the latter experiencing a greater toll on their health. Sadly, the differences in health and healthcare access between different socio-economic groups is a long-standing issue, with the impact of these differences worsening due to the cost of living crisis.

It's also thought that health inequalities are costing the NHS in England £4.8 billion a year. According to one study3, people from the most deprived fifth of neighbourhoods have 72% more emergency hospital visits and 20% more planned visits than people living in the most affluent fifth of neighbourhoods.

"The surprise of the cost of living crisis is that people in above-average income groups are affected, too," adds Professor Sir Michael Marmot, director of the UCL Institute of Health Equity. "Food, heating, and transport appear to be having the greatest effect."

Cost of living - heating

Of the 55% Brits in the YouGov survey reporting poorer health, 84% blame the rising cost of heating2. This follows the price cap rise of gas in April 2022, implementing an unprecedented rise in household energy bills - the average UK bill increasing by a whopping 54%. The resulting energy crisis has pushed the number of homes living in fuel poverty to 6.5 million4.

The health risks

As autumn and winter approach, people who ration their heating to afford their bills are at risk of cold-related health problems. Elderly people are particularly vulnerable because they lose body heat faster5, and with over 7.8 million of them worried about heating their homes6, concerns are rising.

An older person with a body temperature below 35 degrees Celsius (°C) is at risk of health problems such as:

A cold house can also exacerbate less serious yet uncomfortable complaints, such as skin conditions like ulcers2.

Heating tips

  • Keep your home heated to at least 18°C and not below 16°C if you're elderly or have impaired mobility.
  • If you really need to reduce your heating bill, on milder days turn down your thermostat by one degree at a time, wait, and reassess if you need to again. This is better than dropping the temperature dramatically.
  • Check your boiler pressure isn't too low as this can cause your radiators to be less efficient.
  • Keep the area around your radiators clear.

Cost of living - food

Rising food prices are having the second biggest effect on our health after gas prices, according to 78% of Brits2. In fact, food prices are increasing at the fastest rate for 40 years.

Fresh and less processed foods have always been the more expensive food choice. Now recent grocery inflation is pushing these healthier options further out of reach for wide stretches of the public. Instead, many are turning to cheaper, less nutritious options such as microwave meals, or cutting back on food completely7.

Grocery inflation

The health risks

A diet with lower nutritional quality increases the risk of many health issues, such as:

Food tips

  • Nutritious yet affordable recipes can be found on anti-poverty campaigner Jack Monroe's website Cooking on a Bootstrap.
  • Food waste prevention apps like Olio allow you to pick up as well as share food that would otherwise have been chucked away for free.

Cost of living - transport

The cost of living crisis is also having an impact on our health in less direct ways. With oil driving up fuel prices, nearly all of us are feeling the pinch. Anecdotes reported by The Royal College of Physicians illustrate how this is affecting access to healthcare - with one patient not being able to afford travel to the hospital for lung cancer treatment2.

The risk of isolation for those unable to travel as much, as well as the stress many of us experience each time we fill up our vehicle tanks, are also likely to affect our mental health in a big way.

The health risks

Travel tips

  • Walk or cycle where you can - these also have other health benefits.
  • Check for bus discounts.
  • Invest in a railcard if you travel by train regularly.
  • Buy train tickets in advance where possible.
  • Shop around for better fuel prices.
  • Use apps like AppyParking to find free local parking, or Parkopedia for the cheapest nearby car parks.

Don't underestimate financial stress

As wages fail to keep up with the cost of these essential amenities - as well as many other factors such as housing costs, swelling interest rates, and council tax rises - financial health, stability, and quality of life are on a lot of people's minds.

In May 20229:

  • 77% of adults reported feeling either somewhat or very worried about the cost of living crisis.
  • 50% of those who were very worried felt these worries almost every day.

Health risks

Financial stress shouldn't be underestimated. In itself, stress can have a massive impact on our day-to-day lives and reduce our quality of life. There is also evidence that long-term, unmanaged stress can help to develop or worsen several mental and physical health conditions, including:

Stress management

Some helpful habits to ease stress include:

If stress and anxiety are dominating your life, these helplines can also offer support:

  • Mind UK: 0300 123 3393
  • Samaritans: 116 123
  • Anxiety UK: 03444 775 774

Will the cost of living go down?

"The cost-of-living crisis has barely begun so the fact that many people are already experiencing worsening health should sound alarm bells," says Dr Andrew Goddard, president of the Royal College of Physicians2.

Yet there is an end in sight, and it's important to remind ourselves of this fact. Experts are predicting that the cost of living will start to fall again around late 2023.

Further reading

  1. The Guardian, "The world is ablaze and the oil industry just posted record profits. It's us or them".
  2. Royal College of Physicians press release, "Over half of Brits say their health has worsened due to rising cost of living".
  3. University of York, "Researchers say inequality costs the NHS £4.8 billion a year".
  4. National Energy Action, "Energy crisis".
  5. National Institute on Ageing, "Cold weather safety for older adults".
  6. Age UK, "Number of older people worried about heating their homes".
  7. Sky news, "Cost of living ONS (Office for National Statistics) Survey".
  8. Age UK, "Loneliness, depression, and anxiety".
  9. ONS, "Worries about the rising costs of living, Great Britain: April to May 2022".

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A cough can be wet or dry. A dry cough is nonproductive and does not bring up fluid like mucus or phlegm. A wet, productive cough does bring up fluid.

This article will go over the common causes of a wet or dry cough, what it means for a cough to be productive or nonproductive, and the best treatments for each type of cough.

Ellen Lindner / Verywell

What Is a Productive Cough?

A productive cough brings up mucus or another fluid from the respiratory tract. It is also called a “chesty” or “wet” cough because you can hear a gurgling sound when you’re coughing.

A wet productive cough usually happens because something is irritating your respiratory tract, like an infection. Most wet coughs that are caused by cold or flu will go away after a few days. 

Possible causes of a wet cough include:

Your provider can do tests to figure out why you have a wet cough, including:

  • Chest X-ray
  • Sputum analysis (coughed-up mucus or phlegm is checked for infection or blood in a lab)
  • Blood tests (to look for signs of infection)
  • Pulmonary function tests (including spirometry and blood gases)

What Is a Nonproductive Cough?

A nonproductive cough does not bring up fluid. It’s also called a dry cough and is usually caused by irritation in the throat. Many people describe the feeling of a dry cough as a "tickling" or "scratchy" sensation.

While a cold is a common cause of a dry cough, a nonproductive cough can also be caused by swelling of the airways from conditions like asthma or bronchitis

A dry cough can also be caused by:

Can Medications Cause Dry Cough?

People who take medications for high blood pressure called ACE inhibitors may have a dry cough as a side effect of the drug.

If you have a dry cough, your provider may do tests to see if you have any of the following health conditions:

  • Asthma: You can find out if you have asthma by doing a test called spirometry. You breathe into a device that measures the force of your breath and the capacity of your lungs.
  • Gastroesophageal reflux disease (GERD): While GERD is associated with heartburn, 40% of people with the condition have a dry cough. GERD can be diagnosed with a procedure where a flexible scope is put down your esophagus to look in your stomach (endoscopy) and a pH acid test.
  • Sleep apnea: About 44% of people with sleep apnea have a cough. The sleep disorder can be diagnosed with an in-lab sleep study or a home test that measures blood gases, heart rate, and airflow/breathing patterns.
  • Vocal cord dysfunction: Breathing in an irritant or extreme exercise can cause narrowing of your vocal cords in the voice box (larynx). You might need to see an allergist to rule out allergic causes for your cough or have stress tests and imaging studies done to check for breathing abnormalities while you exercise.

Serious Causes of a Dry Cough

It’s less common but a dry cough that does not go away can also be a sign of more serious conditions like heart failure, a collapsed lung, or lung cancer.

Your provider may want you to have imaging tests, such as chest X-ray, computed tomography (CT), or magnetic resonance imaging (MRI) to rule out these more serious causes of a dry cough.

How to Treat Dry and Wet Coughs

The best treatment for a cough will depend on whether it's productive or nonproductive, as well as what is causing it.

For example, if you have a cold that's giving you a dry cough, taking a cough suppressant with dextromethorphan in it might help your symptoms.

Other treatments for a dry cough include:

If you have a wet productive cough from a cold, taking over-the-counter (OTC) medications like an expectorant can help. This type of medication can loosen and thin the mucus so that it's easier to cough up. 

Can You Use Cough Suppressants With a Wet Cough?

A cough suppressant can make a productive worse because it reduces the excretion of mucus. In some cases, using cough suppressants for a wet cough can turn a minor illness like a cold into a more serious one, like pneumonia.

Chronic productive coughs may need more aggressive treatment, depending on what’s causing the cough.

For example, infections may require antibiotic therapy, while chronic disorders like COPD and cystic fibrosis may require ongoing care with oxygen therapy, inhaled or oral medications, and pulmonary rehabilitation.

When to Call a Healthcare Provider

A cough from a cold typically lasts a week or two and can be treated at home. However, you should call your healthcare provider if:

  • Your cough is severe
  • Your cough lasts longer than three weeks
  • You cough up yellowish-green, pink, or bloody sputum
  • You have a fever of over 103 degrees F
  • You experience shortness of breath or a fast heartbeat
  • You had close contact with someone with COVID or pneumonia before your cough started

When to Seek Emergency Care

Call 911 or go to the ER if you are coughing a teaspoon of blood or more (hemoptysis).


A cough can be productive (wet) or nonproductive (dry). Wet and dry coughs can have different causes and need different treatments.

You can usually handle a cough from a cold at home, but you may need to see your provider and get treatment for coughs related to a chronic health condition or an infection.

However, if you are coughing so hard you're struggling to breathe or you're coughing up blood, don't wait. These symptoms can be signs of a serious lung problem that needs immediate medical care.

Frequently Asked Questions

  • Is it good when a cough becomes productive?

    Coughing helps bring up any fluid that's built up in your lungs. Clearing your airway is a good thing because it makes it easier for you to breathe and can help reduce your risk for complications and infections.

  • Is a productive/wet cough an infection?

    Wet coughs are a common symptom of infections but they can also occur if your respiratory tract is irritated for another reason. The mucus that makes the cough wet or productive is meant to protect your lungs. 

  • Is a COVID cough dry or wet?

    COVID-19 usually causes a dry cough. However, when people develop other respiratory complications (like pneumonia) they can have a wet cough with COVID.

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Incidence India is the second largest consumer and third largest producer of tobacco in the world. 28.6% of the Indian population uses tobacco products (42.4% men and 14.2% women), accounting for an estimated 267 million tobacco users in the country. Tobacco-related cancers constitute 27% of all cancers for both sexes combined. In India, lung cancer accounts for 5.9% of all cancers and 8.1% of all cancer-related deaths. The prevalence of smoking in patients with lung cancer is nearly 80%. There are 2.26 million active cases of lung cancer in India over the last 5 years.Also Read - Gynaecological Cancers And Fertility: Early Detection to Treatment, Know it All

Etiology /Cause / Risk factors for lung cancer include:

  • Smoking. Risk of lung cancer increases with the number of cigarettes smoked per day and the number of years you have smoked. Quitting at any age can significantly lower the risk of developing lung cancer.
  • Exposure to secondhand smoke. Is also a significant risk factor
  • Previous radiation therapy. If you’ve undergone radiation therapy to the chest for another type of cancer, (treated in the past with radiotherapy) then there is an increased risk of developing lung cancer.
  • Exposure to radon gas. Radon is produced by the natural breakdown of uranium in soil, rock and water that eventually becomes part of the air you breathe. Unsafe levels of radon can accumulate in any building, including homes.
  • Exposure to asbestos and other carcinogens. Workplace exposure to asbestos and other substances are known to cause cancer — such as arsenic, chromium and nickel.
  • Family history of lung cancer. People with a parent, sibling or child with lung cancer have an increased risk of the disease.

Signs and symptoms of lung cancer may include:

  • A new cough that doesn’t go away even with antibiotics and other symptomatic treatments.
  • Coughing up blood in sputum, even a small amount. This is seen in 20 to 60 per cent of patients with lung cancer.
  • Shortness of breath due to fluid build-up in the lungs
  • Chest pain due to involvement of ribs or lining of the lung cavity
  • Hoarseness of voice due to the involvement of the nerves.
  • Losing weight without trying (a sign of advanced disease with spread to distant organs)
  • Bone pain due to the spread of cancer to the bones
  • Headache due to metastases to the brain

Types of lung cancer :

There are 2 main types of lung cancer when studied under a microscope: Also Read - Heart Attack: 8 Early Signs To Catch

  1. Small cell lung cancer ( related to smoking) and
  2. Non-small cell lung cancer

A diagnosis chest x-ray should be advised for all suspected patients, but in India, the prevalence of benign and inflammatory diseases like tuberculosis and sarcoidosis is still high and they can present with much of the same symptoms and nodules in the lung on the chest X-ray. Also Read - Desi Ghee Side Effects: Stop Eating Ghee Right Away if You Have These Health Conditions

Low-dose computed tomography (LDCT) of the chest is an established strategy for the screening of lung cancer.

Flexible bronchoscopy and transthoracic sampling are the most often used techniques for the diagnosis of centrally located lung cancers while the peripheral one-third of lesions are accessed transthoracically.

Endobronchial ultrasound (EBUS) guided biopsy

Transthoracic biopsies are generally performed under CT image guidance. However, at present, less than 1% of hospitals in India have a dedicated setup for interventional radiology.

  • Treatment: Once the diagnosis is established it is mandatory to stage the disease so as to decide the course of treatment with PETCT, whether to go straight ahead for surgery or give neoadjuvant chemotherapy with or without radiotherapy followed by surgery. Surgery is a major undertaking This can be done via an open or conventional approach or a minimally invasive approach.
  • Prevention: The National Tobacco Control Program was launched by the Government of India from 2007 to 2008 with the aim to raise awareness of the deleterious effects of tobacco, regulate tobacco production and consumption, and enact and enforce the Cigarette and other Tobacco Products Act. This includes printing of pictorial warnings on tobacco products and the release of promotional videos for the same.

But what can you do to the prevention of lung cancer?

There’s no sure way to prevent lung cancer, but you can reduce your risk if you:

  • Don’t smoke. Don’t give in to the temptation. Don’t give in to peer pressure. Follow healthier ways of dealing with stress like meditation and yoga. Have a frank discussion with your children about not smoking, and confide in them about the dangers of smoking so that they know how to react to peer pressure.
  • Stop smoking. Stop smoking completely and permanently. Quitting reduces your risk of lung cancer, even if you’ve smoked for years. Many aids for stopping smoking are available that can help you quit. Options include nicotine replacement products, medications and support groups.
  • Avoid secondhand smoke. Counsel people, u live or work with to stop smoking. At the very least, ask them to smoke outside. Avoid areas where people smoke, such as bars and restaurants.
  • Avoid carcinogens at work. Take precautions to protect yourself from exposure to toxic chemicals at work. Wear the face mask, gloves and all protective equipment provided by your employer. Your risk of lung damage from workplace carcinogens increases if you smoke.
  • Eat a diet full of fruits and vegetables. Choose a healthy diet with a variety of fruits and vegetables. Food sources of vitamins and nutrients are best. Vitamins in the form of supplements have actually been proven to increase the risk of cancer
  • Exercise most days of the week. If you don’t exercise regularly, start out slowly. Try to exercise most days of the week.

(Inputs by Dr Mehul Bansali, Director,  Surgical Oncology, Jaslok Hospital) 

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There are many reasons why a dog might start coughing. It could be a sign of a minor infection, or it could be a symptom of something more serious. If your dog has been coughing for more than a day or two, it's important to take him to the vet to get checked out. In this article, we will discuss some of the most common causes of canine coughs.

Supplements for Dogs with Cough 

  1. Pupper Absorb 

  2. Penguin CBD Dog Oil

  3. NaturPet Lung Care Pet Supplement

  4. Fifth and Fido Coughly Homeopathic Medicine for Kennel Cough for Cats & Dogs

  5. Pet Wellbeing Lung GOLD Bacon Flavored Liquid Respiratory Supplement for Dogs

  6. Prana Pets Respiratory System Support Homeopathic Medicine for Asthma & Respiratory Infections for Cats & Dogs

  7. Earth Animal Cough, Wheeze & Sneeze Liquid Respiratory Supplement for Dogs

There are a few reasons why your dog may be coughing. It could be due to kennel cough, which is a highly contagious respiratory infection. Or, it could be an allergic reaction to something in the environment, such as pollen or mold. 

If your dog has been around other dogs who are coughing, it's important to have him seen by a vet as soon as possible. If you think your dog may be having an allergic reaction, try to identify the source of the allergens and remove it from his environment. This may require some trial and error, but it's important to do what you can to help your dog feel better. 

Coughing is a symptom of many different conditions, so it's important to have your dog seen by a vet to determine the cause. With proper treatment, most dogs will recover quickly and be back to their normal selves in no time.

How does a dog get kennel cough? 

Canine infectious tracheobronchitis, or “kennel cough” as it is commonly called, is a complex disease with many possible causes. The most common cause is Bordetella bronchiseptica, a bacteria that infects the upper respiratory tract of dogs. 

Other viruses and bacteria can also contribute to the development of kennel cough, including adenovirus, parainfluenza virus, and Bordetella pertussis. In some cases, mycoplasma or fungal organisms may also be involved.

Kennel cough is spread through direct contact with infected dogs, or by exposure to contaminated objects or air (such as in a kennel or grooming facility). It is important to note that dogs of all ages, breeds, and health status can be affected by kennel cough. 

If your dog has been coughing for more than a few days, or if the cough is severe, it's important to have him seen by a vet. Treatment will vary depending on the underlying cause of the cough, but may include antibiotics, anti-inflammatory drugs, or cough suppressants. 

In most cases, kennel cough is not a serious condition and will resolve on its own within a few weeks. However, it can be more severe in puppies or older dogs, so prompt treatment by a vet is important. 

If your dog has been diagnosed with kennel cough, there are a few things you can do to help him feel better. First, make sure he gets plenty of rest and limits his activity until he is feeling better. Second, provide him with a humidifier or steam vaporizer to help loosen the mucus in his airways and make coughing more productive. 

Finally, offer him small, frequent meals instead of large ones to avoid triggering a coughing fit. With proper care, most dogs will recover from kennel cough within a few weeks. However, if your dog's condition worsens or he develops other symptoms, it's important to have him seen by a vet as soon as possible. 

What are the symptoms of kennel cough? 

The most common symptom of kennel cough is a harsh, dry cough that sounds similar to a “honking” sound. In some cases, the cough may be accompanied by gagging or retching. Kennel cough is usually a mild condition and most dogs will continue to eat, drink, and play normally. 

However, in some cases the cough can be severe enough to cause vomiting or loss of appetite. If your dog is coughing excessively or has any other symptoms, it's important to have him seen by a vet as soon as possible. 

What are some signs that my dog coughing is from allergies? 

If your dog has been coughing for more than a few days, or if the cough is accompanied by other symptoms such as sneezing, runny nose, or watery eyes, it's likely that he is suffering from allergies. 

Allergies are a common cause of chronic cough in dogs and can be caused by anything from dust and pollen to food and environmental irritants. If your dog is allergic to something in his environment, the best course of action is to try to identify the source of the allergens and remove it from his environment. 

This may require some trial and error, but it's important to do what you can to help your dog feel comfortable. In some cases, your vet may also recommend allergy shots or other medications to help control your dog's allergies. 

If you think your dog may be suffering from allergies, it's important to have him seen by a vet so that he can get the proper diagnosis and treatment. 

What are some signs that my dog's coughing is due to heart disease? 

If your dog has been coughing for more than a few days, or if the cough is accompanied by other symptoms such as exercise intolerance, shortness of breath, or weight loss, it's possible that he may be suffering from heart disease. 

Coughing is often one of the first signs of heart disease in dogs, and can be caused by a number of different conditions. If your dog is showing signs of heart disease, it's important to have him seen by a vet as soon as possible so that he can get the proper diagnosis and treatment. 

Heart disease is a serious condition and early detection is critical to ensuring the best possible outcome for your dog. 

What is the most common reason why is your dog coughing? 

The most common reason for your dog coughing is allergies. Allergies can be caused by anything from dust and pollen to food and environmental irritants. 

If your dog is allergic to something in his environment, the best course of action is to try to identify the source of the allergens and remove it from his environment. This may require some trial and error, but it's important to do what you can to help your dog feel comfortable. 

In some cases, your vet may also recommend allergy shots or other medications to help control your dog's allergies. If you think your dog may be suffering from allergies, it's important to have him seen by a vet so that he can get the proper diagnosis and treatment. 

Can my dog just wake up one day and start coughing for no reason? 

Just like humans, dogs can develop a cough for a variety of reasons. Some causes are benign and resolve on their own, while others may require more serious medical treatment. If your dog is coughing, it's important to pay attention to other symptoms he or she is exhibiting and consult with your veterinarian to determine the cause.

However, your dog may need treatment if he or she is coughing up blood, has difficulty breathing, or seems to be in pain when coughing. These symptoms could indicate a more serious condition, such as pneumonia, heart disease, or lung cancer. If your dog is exhibiting any of these symptoms, it's important to seek veterinary care right away. 

In most cases, a cough is not cause for alarm. However, it's always best to consult with your veterinarian to be sure. They can help you determine the cause of your dog's cough and recommend the best course of treatment.

How to Choose the Best Supplement for Dog Coughing from Allergies

If your dog is suffering from allergies, there are a number of supplements that can help to ease his symptoms. One of the most popular supplements for dogs with allergies is fish oil, which is rich in omega-three fatty acids. 

Fish oil can help to reduce inflammation and itchiness associated with allergies, and can also help to improve your dog's overall health. Another popular supplement for dogs with allergies is probiotics, which can help to improve digestive health and boost the immune system. 

When it comes to choosing the best supplement for your dog after determining why is your dog coughing, you'll want to take into consideration the following factors:


Look for a supplement that contains all-natural ingredients that are known to be safe for dogs. 


Make sure to follow the recommended dosage on the supplement bottle. 

Side Effects

Some supplements may cause side effects in some dogs, so it's important to be aware of any potential risks before giving your dog a supplement. 


Compare prices to find a supplement that fits your budget. 


Choose a supplement that contains a high level of potency to ensure that your dog is getting the most benefit from it. 

Customer Reviews

Read customer reviews to get an idea of how well a particular supplement works. 

If you're unsure about which supplement is right for your dog, it's always best to consult with a vet. They can help you to choose the best supplement for your dog's individual needs and can also provide guidance on dosage and potential side effects. 

No matter what the reason is for why is your dog coughing, it's important to consult with a vet so that you can get the proper diagnosis and treatment. Coughing is often one of the first signs of illness in dogs, so it's important to be aware of any potential problems so that you can get your dog the help he needs. 

Image courtesy Pupper

Pupper's allergy soft chew is intended to alleviate symptoms and enhance allergic responses. The immune system is sensitized after being exposed to the allergen on numerous occasions, usually months to years apart. A reaction occurs when a person is exposed again to the same or similar allergen.

Normally, the dog's immune system protects him from infection and sickness, but with allergies, the immune reaction may actually be harmful to his health. Allergies can be compared to an unnecessary normal immunological response to a non-harmful external substance.

The most typical allergy symptom in dogs is itching of the skin, which may be either localized or widespread. The allergic symptoms might include wheezing, coughing, and/or sneezing in some situations. There could be a discharge from the eyes or nose in other situations. In certain instances, the allergic symptoms induce vomiting and diarrhea in the digestive system.

Image courtesy Penguin CBD 

Chicken-flavored CBD oil, which is prepared with the finest Oregon hemp, is for revitalizing your pet. A refined broad-spectrum extract is used in each batch.

CBD oil, which is especially designed for dogs, is one of the finest methods to provide your beloved pet with CBD it requires to live its fullest life. These CBD oils are guaranteed to be a hit with your dog thanks to their complete naturalness and carefully cultivated industrial-hemp source.

A 30-day supply of CBD oil with 500 mg or 1,000 mg of strong, effective full-spectrum CBD oil is contained in each container, which may be used to treat a range of diseases including arthritis and anxiety.

3.     NaturPet Lung Care Pet Supplement

Image courtesy NaturPet

NaturPet's Lung Care is an all-natural supplement that has been specifically designed to support your pet's respiratory health.

The main ingredients in this Lung Care supplement are eucalyptus leaf, licorice root, and marshmallow root. These ingredients have been chosen for their traditional use in supporting respiratory health.

The Eucalyptus leaf is known for its ability to help clear the sinuses and ease congestion. Licorice root is traditionally used as an expectorant to help relieve coughs. Marshmallow root soothes the throat and helps to reduce inflammation.

4.     Fifth and Fido Coughly Homeopathic Medicine for Kennel Cough for Cats & Dogs

Inage courtesy Fifth and Fido 

Fifth and Fido's Coughly is a homeopathic medicine that has been specifically designed to relieve the symptoms of kennel cough in cats and dogs.

The main ingredients in the Coughly supplement are bryonia, coccus cacti, and lobaria pulmonaria. These ingredients have been chosen for their traditional use in relieving the symptoms of kennel cough.

Bryonia is known for its ability to relieve dry, hacking coughs. Coccus cacti is traditionally used to relieve congestion and ease breathing. Lobaria pulmonaria is known for its ability to soothe the throat and reduce inflammation.

They have also included ingredients such as honey, propolis, and magnesium sulfate to further support your pet's respiratory health.

Honey is known for its ability to soothe the throat and reduce inflammation. Propolis is an antimicrobial agent that helps to keep the respiratory tract clear of infection. Magnesium sulfate is known for its ability to relax the muscles and ease coughing.

Coughly supplement is safe for cats and dogs of all ages and can be given to them on a daily basis as needed.

5.     Pet Wellbeing Lung GOLD Bacon Flavored Liquid Respiratory Supplement for Dogs

Image courtesy Pet Wellbeing

Pet Wellbeing Lung Gold Dog Supplement will help your beloved companion breathe more easily by reducing his or her need to pant. This liquid supplement is made to help your pet preserve a healthy immune system and improve breathing.

It's made up of only natural, organic components, including a unique combination of fresh reishi fruiting body, captis root, pleurisy root, and fresh marshmallow root! Use the medication as directed on your cat or dog to aid in good oxygenation.

Reishi is an age-old Chinese herbal remedy that has been used to treat a wide variety of respiratory ailments. Captis root is known for its ability to help clear the lungs and ease congestion. Pleurisy root is traditionally used as an expectorant to help relieve coughs. 

6.     Prana Pets Respiratory System Support Homeopathic Medicine

Image courtesy Prana Pets

Prana Pets' Respiratory System Support is a homeopathic medicine that has been specifically designed to relieve the symptoms of asthma and respiratory infections in cats and dogs.

The main ingredients in the Respiratory System Support supplement are bryonia, coccus cacti, lobaria pulmonaria, and hepar sulphuris calcareum. These ingredients have been chosen for their traditional use in relieving the symptoms of asthma and respiratory infections.

Bryonia is known for its ability to relieve dry, hacking coughs. Coccus cacti is traditionally used to relieve congestion and ease breathing. Lobaria pulmonaria is known for its ability to soothe the throat and reduce inflammation. Hepar sulphuris calcareum is known for its ability to relieve wheezing and difficulty breathing.

Respiratory System Support supplement is safe for cats and dogs of all ages and can be given to them on a daily basis as needed.

7.     Earth Animal Cough, Wheeze & Sneeze Liquid Respiratory Supplement for Dogs

Image courtesy Earth Animal 

Earth Animal's Cough, Wheeze & Sneeze Liquid Respiratory Supplement is a natural and effective way to relieve your dog's cough, wheeze, and sneeze.

The main ingredients in the Cough, Wheeze & Sneeze supplement are coccus cacti, lobaria pulmonaria, and hepar sulphuris calcareum. These ingredients have been chosen for their traditional use in relieving the symptoms of coughs, wheezes, and sneezes.

Coccus cacti is traditionally used to relieve congestion and ease breathing. Lobaria pulmonaria is known for its ability to soothe the throat and reduce inflammation. Hepar sulphuris calcareum is known for its ability to relieve wheezing and difficulty breathing.

They have also included ingredients such as honey, propolis, and magnesium sulfate to further support your pet's respiratory health. Honey is known for its ability to soothe the throat and reduce inflammation.

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Coughing is a natural reflex for clearing the throat and lungs of irritants. An occasional dry cough is rarely a cause for concern, but persistent coughing can indicate an underlying medical condition that may be more serious.

A dry or sometimes tickly cough is a cough that does not bring up any phlegm or mucus. Dry coughs may cause a tickling sensation and are often due to irritation in the throat.

Doctors often refer to dry coughs as non-productive coughs. In contrast, a wet, or productive, cough brings up phlegm that helps clear the airways of irritants.

Doctors also classify coughs as either acute or chronic. A cough is chronic if it lasts longer than 8 weeks, according to the American Lung Association.

In this article, we describe some of the possible causes of a dry cough and the treatment options. We also discuss diagnosis, general treatments, prevention tips, and when to see a doctor.

Symptoms of asthma can include wheezing and shortness of breath.

COVID-19 is a respiratory disease caused by the coronavirus SARS-CoV-2.

The most common symptoms are:

  • a fever
  • a dry cough
  • fatigue

People may also have:

  • body aches
  • nasal congestion, a runny nose, or both
  • a sore throat
  • diarrhea

In time, a person may develop chest pain and difficulty breathing. Without treatment, COVID-19 can be fatal for some people.

COVID-19 is one disease that results from infection with a coronavirus.

Learn more here about COVID-19 and other coronaviruses.


There is currently no cure for COVID-19, but paracetamol may help relieve symptoms. People should rest at home and keep away from other people as far as possible.

If a person experiences a medical emergency, such as breathing difficulties, they need emergency medical attention. Someone should call 911 and ask for advice. The person may need to spend time in the hospital.

Click here for live updates on the COVID-19 pandemic.

Asthma is a long-term lung condition that leads to inflammation and narrowing of the airways in the lungs. One of the most common symptoms of asthma is coughing, which is often worse at night or early in the morning when a person first wakes up.

The cough is often productive, meaning a person brings up phlegm. However, in a type of asthma called cough-variant asthma, the main symptom people experience is a dry cough.

Other symptoms of asthma can include:

  • wheezing
  • shortness of breath
  • chest tightness or pain


There is currently no cure for asthma, so treatment focusses on relieving symptoms and preventing future attacks.

Typically, doctors prescribe the following treatments for people with asthma:

  • a quick-relief inhaler, such as a short-acting beta-2-agonist, for treating symptoms when they flare-up
  • long-term medications, such as a low-dose corticosteroid inhaler, for reducing inflammation and preventing future attacks

Idiopathic pulmonary fibrosis (IPF) is a condition in which scar tissue develops inside a person’s lungs. As the scar tissue thickens, it makes breathing in air increasingly difficult. The term idiopathic means that doctors do not know exactly what causes the condition.

One of the most common symptoms of IPF is a persistent, dry cough. Other symptoms can include:

  • shortness of breath
  • loss of appetite and gradual weight loss
  • fatigue
  • clubbing, or widening and rounding of the tips of the fingers or toes, also affecting the shape of the nails


There is currently no cure for IPF, so the aim of treatment is to relieve a person’s symptoms and slow disease progression.

Treatment options for IPF include:

  • medications such as pirfenidone and nintedanib
  • oxygen therapy
  • pulmonary rehabilitation, which is a program of exercises, training, and support for people with long-term lung conditions
  • lung transplantation

Learn more here about lung scarring and idiopathic pulmonary fibrosis.

Gastroesophageal reflux disease (GERD) is a condition where acid leaks from the stomach back up into the esophagus, or food pipe.

According to a 2015 review, GERD causes a chronic, dry cough in up to 40% of people with the condition.

GERD typically also causes a number of gastrointestinal symptoms, which may include:

However, research suggests that up 75% of people with GERD-related cough may not experience these gastrointestinal symptoms. This can make it difficult for doctors to diagnose GERD in people with just a chronic, dry cough.


Many people can manage symptoms of GERD through lifestyle changes, such as:

  • eating multiple small meals each day instead of three large meals
  • limiting or avoiding foods that trigger or worsen symptoms, such as fatty or spicy foods
  • maintaining a healthful weight
  • quitting tobacco smoking
  • reducing or avoiding alcohol intake

Over-the-counter (OTC) and prescription medicines, such as antacids, H2-receptor blockers, and proton pump inhibitors, may also help relieve or prevent symptoms.

Postnasal drip is when mucus from the nose and sinuses drips down the back of the throat.

When the mucus drips into the throat, it can trigger a cough. Although this cough is often productive, it can sometimes also be dry.

Postnasal drip often occurs with a sinus infection or due to a nasal allergy, such as hay fever.

Other symptoms of postnasal drip may include:

  • runny nose
  • a feeling of something in the back of the throat
  • a sore throat
  • frequent swallowing


Treatment options for postnasal drip include decongestants, nasal sprays, and nasal saline irrigation.

Upper respiratory infections, such as common colds and the flu, can cause acute coughing. The cough often starts out productive but may become dry as a person recovers from the infections.

Other symptoms of upper respiratory infections may include:

  • a fever
  • muscle aches
  • runny nose
  • sore throat


A person can usually treat viral upper respiratory infections at home with plenty of rest, staying properly hydrated, and taking OTC medications to relieve aches and fever. A doctor may prescribe an antiviral medication for people with the flu.

A chronic, dry cough can sometimes be a symptom of lung cancer. However, other causes of dry cough are far more common.

Symptoms of lung cancer can include:

  • coughing up blood or phlegm that contains blood
  • chest pain that may get worse with breathing or coughing
  • weight loss
  • shortness of breath
  • fatigue
  • feeling weak


Treatment depends on the type and stage of the lung cancer. Early diagnosis and treatment can significantly improve a person’s outlook

Treatment options can include surgery, chemotherapy, and radiation therapy.

Other causes of a dry cough can include:

  • cigarette smoking
  • prolonged exposure to pollution, dust, and irritating chemicals
  • allergies
  • some medications, such as ACE-inhibitor drugs for high blood pressure

To diagnose the cause of a dry cough, a doctor will usually begin asking about a person’s symptoms and their medical history. They will then perform a physical examination.

A doctor may also need to order some tests to help with their diagnosis. These may include:

  • Imaging tests. An X-ray or CT scan creates an image of the inside of the chest that allows doctors to check for problems.
  • Spirometry. This involves breathing into a plastic device to check a person’s lung functioning. Doctors use spirometry to help diagnose conditions such as asthma or IPF.
  • Endoscopy. An endoscope is a long, thin tube with a camera and light on the end. With upper gastrointestinal endoscopy, doctors can insert the tube through a person’s mouth and down the throat to check for problems inside the esophagus, stomach, and beginning of the small intestine. For bronchoscopy, the tube is inserted through the mouth, but doctors look at the windpipe and airways.

Treating the underlying cause is usually the best way to reduce the severity and frequency of a dry cough. However, general treatments that may improve a person’s symptoms include:

  • Sucking on throat lozenges. Throat lozenges contain ingredients such as honey, menthol, and eucalyptus, which may ease irritation and reduce coughing.
  • Taking cough suppressants. OTC cough suppressants, which often contain dextromethorphan, may reduce a person’s cough reflex.
  • Elevating the bed. Sleeping with the upper body raised by 6–8 inches can help decrease symptoms of postnasal drip and GERD. A person can elevate the bed by placing blocks or wedges under the bedposts.
  • Taking a hot shower. The warm water and steam from the shower may ease throat dryness and irritation.

It is not always possible to prevent a dry cough. However, tips that can help include:

  • avoiding tobacco smoke
  • drinking plenty of water
  • using a humidifier to moisten the air
  • allergy-proofing the bedroom to reduce irritants

People with dry coughs that get worse, do not go away, or cause one to start producing blood or green mucus should see a doctor.

It is also advisable for a person to see a doctor if a dry cough occurs along with any of the following symptoms:

  • wheezing
  • a feeling of something being stuck in the throat
  • shortness of breath or difficulty breathing
  • trouble swallowing

A dry cough is one that does not produce phlegm or mucus. Dry coughs are often temporary and rarely a cause for concern. However, a chronic, dry cough may be a symptom of an underlying condition, such as asthma or GERD.

Treating the underlying cause is the best way of reducing the severity and frequency of chronic coughs, but OTC remedies may also help relieve symptoms.

People should see a doctor for dry coughs that do not get better or start bringing up blood.

Read the article in Spanish.

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Thick smoke caused by the Beetham dump covers the skyline in Port of Spain earlier this year. - AYANNA KINSALE
Thick smoke caused by the Beetham dump covers the skyline in Port of Spain earlier this year. - AYANNA KINSALE


Home to over 44 million people, the Caribbean is among the top travel destinations in the world. With its lush, inviting beaches, vast intricacies of flavourful food, rich, vibrant culture, and citizens, millions of people visit yearly.

Prior to the coronavirus pandemic, an estimated 58.8 million people visited the region in 2019. Despite boasting a paradise appeal, the region faces some of the most severe environmental and socio-economic issues, challenging the very survival of its countries and people.

The greenhouse gases released when burning fossil fuel contributes to air pollution and is one of the biggest drivers of climate change. National Geographic notes, “This creates a cycle where air pollution contributes to climate change and climate change creates higher temperatures in turn higher temperatures intensify some types of air pollution.” These conditions continue to influence the quality of the social and environmental factors that contribute to our health. Thus, citizens in the Caribbean face compounded issues challenging our health and well-being – the food and water we need to live, the security of our shelter, and even the air we breathe.

Four women from different fields relate their experience of living in the Caribbean and coping with the health implications of air pollution. Human activities, such as the burning of landfills and domestic waste, release toxic and harmful gases into the atmosphere which can enter our lungs and bloodstream and increase our risk of heart diseases, respiratory diseases, and lung cancer.

Drivers heading in to Port of Spain are forced to drive through thick smoke caused by the Beetham dump earlier this year. - AYANNA KINSALE

Paulette Palmer is a registered nurse and midwife who lives near a garbage landfill that on occasion ignites. “It just messes up the atmosphere and it’s not only for those that are close to it. The fumes can spread far and wide. And the irritation to your eyes and your respiratory system, especially for those people like me who have sinus problems, it’s not nice.” She recounts “years ago, one of my sisters used to live much closer to the Riverton side. She had to move because it was causing her sinus too, giving her dizzy spells and making her sick simply because of the fumes and her inhalation of it.”

For many, those sentiments are true and all too real. Abigail Jones is the founder of a Caribbean Diaspora Business – Nostalgic Islander living in Jamaica.

She said, “I live in an area where many of my neighbours burn their litter and household garbage so that instantly affects me.” As Jones ponders the gripping effects this has posed on her health, she continues to shed light on an even closer and personal ordeal.

“My grandmother and her neighbours are also affected by burning and smog because they live pretty close to the landfill. Whenever they burn, she gets all the smoke and it’s such a terrible smell. She has developed breathing problems because of this.”

According to a report from the World Health Organization (WHO), approximately seven million people from around the world die every year from pollution-related incidents, accounting for nearly 320,000 premature deaths in the region of the Americas. Consequently, air quality is a predominant problem influenced by the levels and location of outdoor air pollutants, fine particulate matter, and airborne allergens.

When we take action to improve the quality of the air, we make our environment cleaner, our health better, and reduce the impacts of the climate crisis
Courtesy the Caribbean Community Climate Change Centre, CCCCC -

UNICEF advocate, Priyanka Lalla, 15, said, “I’ve seen bushfires on the mountaintops and even close to my home. There’s a lot of smoke and ash that pollutes your entire equilibrium. You smell the smokiness and the compression of the air and it’s difficult to even breathe outside. I try to stay inside as much as I can during hot days to avoid heat stroke or to avoid breathing problems, especially with Saharan dust right now.”

Even natural phenomena such as volcanic eruptions contribute to air pollution when the plumes of ash and gas are emitted, resulting in a haze created by volcanic aerosols. Fine particulate matter resulting from the smoke from bushfires, black carbon or soot, and the ash plumes and sulphuric gases from volcanic eruptions, also contribute to poor air quality, causing severe health effects.

In 2021, the La Soufriere Volcano in St Vincent and the Grenadines erupted, resulting in the ashfall, and sulphur dioxide experienced in the neighbouring countries of Barbados, Saint Lucia, and Grenada.

“It was especially awful ’cause you couldn’t even go outside to that point. It was irritating to my eyes. And just breathing it in, I could feel it in my throat,” recalled Charlotte Tom from Trinidad and Tobago, a student currently in Barbados completing a master’s in environmental management who experienced the subsequent poor air quality from the eruption.

“I like to be outside; I like -fresh air. I like to pull my windows down. When something as simple as being outside is a threat to your health, it is kind of depressing. It takes a toll on you in more than one way.”

Air pollution is disproportionately felt by the most vulnerable and disadvantaged, including women, children, indigenous minorities, poor communities, migrants or displaced persons, the elderly, and those with underlying health conditions. An epidemiologist at the Epidemiology Unit of the Ministry of Health and Wellness in Belize, Antonio Hegar tells us that the long-term health consequences of exposure to poor air quality can cause respiratory diseases such as asthma, emphysema, chronic obstructive pulmonary disease (COPD) but also things that you wouldn’t normally associate with air pollution. “People are more at risk of developing strokes, blood clots, and heart attacks as the level of air pollution from fine particulate matter increases.”

Human activities, such as the burning of landfills and domestic waste, release toxic and harmful gases into the atmosphere which can enter our lungs and bloodstream and increase our risk of heart diseases, respira-
tory diseases, and lung cancer. - Courtesy the Caribbean Community Climate Change Centre, CCCCC

For many, like these four women, the reality that climate change and air pollution will continue to affect the quality of the air they breathe is sad. “There is not much that you can do because you can’t live in a vacuum,” said Palmer. In her dismay, Jones said, “It’s a bit scary thinking about what can go wrong next if it is that we don’t change anything. It almost feels like it’s still a taboo topic because many people who still don’t know what climate change is or even if they know, they don’t know that it directly affects them.”

Tom exclaimed feelings of exasperation when she questioned, “Who wants to live in a world where you have to limit your exposure to the air that you breathe? We island people are oftentimes neglected when it comes to the global setting. With an issue as serious and urgent as climate change, you would think there should be no alternatives, there should be no debates – it’s an existential crisis.”

“I wonder what it will be like for future generations if I’m feeling it already. That scares me,” said Lalla. “It doesn’t matter where you come from, who you are or what part of the world you live in; you are facing and feeling the effects and especially in Small Island Developing States.”

The good news is that when we take action to improve the quality of the air, we make our environment cleaner, our health better, and reduce the impacts of the climate crisis. Similarly, policies and interventions that reduce climate change and improve environmental conditions have the potential for huge health co-benefits.

Since 2020, much focus has been on actions for climate and health through the promotion of tools to measure the health co-benefits related to mitigation. The AirQ+ tool which quantifies the health burden and impact of air pollution includes a user-friendly mechanism to assess long-term and short-term exposure to ambient air pollution. The tool is being piloted in TT and Cuba and other countries, under the Strengthening Climate Resilient Health Systems in the Caribbean. The project is being funded by the European Union and implemented by PAHO/WHO, along with five sub-regional implementing partners including the CCCCC, UWI, CIMH, CARPHA, and the Caricom Secretariat, and Cariforum plays a key oversight role.

Chalsey Anthony is the communications assistant, Caribbean Community Climate Change Centre

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