I’m really worried about my three-year-old guinea pig as she keeps wheezing and it looks like she’s struggling to breathe. What could be wrong?

It sounds like your furry friend may have developed a breathing problem, which can become dangerous.

Your guinea pig will need to receive treatment quickly, so please contact your vet as an emergency.

You should also check she doesn’t have anything stuck in her throat or mouth if you can but be careful not to upset her doing this – if she gets distressed, leave it and get her straight to your vet.

Breathing problems in guinea pigs are commonly due to pneumonia or other infections, but they can also be caused by issues such as heart problems and stress.

Visit www.pdsa.org.uk/guineapighealth


My cat, Baxter, seems to be ignoring his food a lot. Why isn’t he eating?

It can be worrying when your puss stops eating, especially if they usually show a lot of interest around feeding time.

There are lots of possible causes for a reduced appetite in cats, including dental disease, stress, kidney disease or fever.

If Baxter hasn’t been interested in his food, or eating less than usual for a few days, then you should have him checked by your vet so they can examine him and investigate what might be the matter.

Sometimes cats may stop eating because of a change to their food or feeding location, but if nothing like this has changed at home, it’s best to pay a visit to your vet.


I recently rehomed some chickens but I’m not too sure what I should feed them

The right diet is really important for keeping your chickens happy and healthy.

You should always give them commercially produced feed appropriate for their life stage and whether they are laying eggs or not, which usually comes in dried pellets or crumbs.

This will give your feathered friends the right balance of nutrients they need.

Chickens like to graze, so they should have access to their food throughout the day but pick it up at night to keep rats away.

Keep in mind that hens can’t chew as they don’t have teeth!

So, it’s a good idea to give them grit or ground oyster shell with their feed, ideally a mixture of soluble and insoluble grit as this will help digest the food.

 

Picture: Pixabay/klimkin

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When we think of chest pain, we usually think about heart attacks.

According to the American Heart Association (AHA), a heart attack occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely, which can be fatal. Heart attack pain can last for hours if untreated.

A heart attack is the most serious symptom of coronary artery disease (CAD), the most common type of heart disease. CAD can produce a type of chest pain called angina.

Angina may feel like pressure or squeezing in your chest and typically happens when you are physically exerting yourself. The discomfort can also be felt in your:

  • Shoulders
  • Arms
  • Neck
  • Jaw
  • Abdomen
  • Back

Angina pain may even feel like heartburn, but it is short lived and typically doesn't last longer than 10 minutes.

If you're experiencing chest pain, it's important to get it checked out, ASAP. Don't hesitate to call 911, especially if it's a new symptom that you've never had before, the pain comes and goes, or the pain gets worse.

All chest pain should be checked out by a healthcare professional. They can determine if it's angina, heart attack pain, or something else.

Chest pain isn't always caused by a heart attach. Some causes can be mild, like heartburn, others can be dangerous, like pancreatitis.


You might be wondering how someone could mistake the symptoms of acid reflux for a heart attack, but there's a reason why it's called heartburn, after all.

Gastroesophageal reflux occurs when a person's stomach contents—including the gastric acids that help break down food—back up into the esophagus, the tube that connects the throat and stomach.

Stomach acid is highly acidic, hence, the burning sensation behind your breastbone; on the pH scale, it scores about a 1 according to the Environmental Protection Agency (EPA) falling somewhere between battery acid and vinegar.

Our stomachs are lined with protective membranes that shield it from the corrosive effects of acid, while our esophagus is not.

The occasional reflux is fairly common and probably nothing to worry about, but if you're experiencing it twice a week or more, you may have gastroesophageal reflux disease (GERD).

Left untreated over time, GERD can cause asthma, chest congestion, and a condition called Barrett's esophagus, which may increase your chances of developing a rare type of cancer, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).




It's possible for someone to mistake a strained chest muscle for something more serious, like a heart attack, said Christine Jellis, MD, PhD, a Cardiology Specialist at Cleveland Clinic.

"I had a patient who came in with chest pain, and he was worried he was having a heart attack," said Dr. Jellis. "After taking his history, I learned he had moved [to a new house] and hadn't lifted heavy furniture in years. But he did the right thing, coming in."

Healthcare providers don't expect people to be able to tell the difference between a heart attack and a pulled chest muscle, said Dr. Jellis, but a good way to check is that if you can press on the wall of the chest and it feels even more painful, it's more likely to be a musculoskeletal injury than a problem with your heart.




Costochondritis is an inflammation of the tissue (cartilage) connecting your ribs to your breastbone, according to MedlinePlus.

It's a common and benign (or non-threatening) cause of chest wall pain. But if it's new to you, it's a good idea to get it checked out by a medical professional anyway.

Although healthcare providers can't always pinpoint what triggered the condition, the causes can range from viral infections to chest injuries.

Typically, people feel a type of pressure on their chest wall and—similar to a strained muscle—a tenderness when they press on the area.

In this case, a healthcare provider will probably start by taking your medical history and doing a physical exam. "A physician is going to want to rule out cardiac and other serious issues first," said Dr. Jellis. "It'll most likely be a diagnosis by exclusion."

If you do have costochondritis, the pain typically goes away in a few days or weeks; taking over-the-counter painkillers can help.




The virus that causes chickenpox lingers in your body long after the spots have faded. In fact, the varicella-zoster virus can reactivate in adulthood (usually in people older than 50) as a disease called shingles.

The first symptoms include itching and burning skin. If the area over the chest is affected, someone might mistake this new pain for a heart attack or other cardiac issue, said Salman Arain, MD, an interventional cardiologist at Houston and the Memorial Hermann Heart & Vascular Institute-Texas Medical Center.

A few days later, however, the telltale rash can appear, followed by blisters.

If you think you have shingles, call a healthcare provider ASAP. Antiviral medications can lessen the pain and shorten the duration of the symptoms, but only if you take them within 72 hours of the rash appearing.

If it's too late to take antivirals, a healthcare provider can prescribe a prescription painkiller.




Pericarditis is a condition where there is inflammation in the layers of tissue that surround the heart (called the pericardium).

In 80%–85% of cases, pericarditis is caused by a viral infection, as reported in a 2022 review published in Current Cardiology Reports.

Other causes include bacterial infections, which are less common, and fungal infections, which are rare, according to MedlinePlus. Although there can be other causes as well.

Pain is present in most cases and is described as sharp or stabbing. The pain is located on the left side or front part of the chest, but it can also occur in the neck, shoulder, back, or abdomen.

It's more intense with lying down, breathing deeply, coughing, or swallowing, and it improves with sitting up and leaning forward, which is unique to this condition.

Although pericarditis is usually harmless, according to Dr. Arain, it can really impact your quality of life.

A healthcare provider may diagnose your condition after ordering a CT scan, EKG, or chest X-ray.

Chances are, however, your pericarditis will clear up in a few days or weeks simply through resting or taking over-the-counter pain medicine like ibuprofen, which also helps quell inflammation.




Just because a person's chest pain isn't related to a heart attack doesn't mean that it isn't dangerous. One example: acute pancreatitis—the sudden inflammation of the pancreas, which is located just behind the stomach, says NIDDK.

"Intense abdominal pain can radiate up to the chest," said Dr. Arain. "And the pain from pancreatitis is usually a deep-seated, intense pain."

Oftentimes, pancreatitis occurs when gallstones (hard, pebble-like pieces of material usually made of hardened cholesterol, according to NIDDK) trigger inflammation in the pancreas—something that's more likely to occur in women than men.

If you think you have pancreatitis, get medical attention right away; you'll probably have to stay in the hospital for a few days to get antibiotics, IV fluids, and pain medication.

A healthcare provider will also want to do blood work and order other tests, like a CT scan or abdominal ultrasound.




Chest pain can have a number of pulmonary (lung) causes. Because the lungs and heart are both located in the chest, it can be easy to confuse the origin of the pain.

Pleuritic chest pain occurs when the lining of your lungs (the pleura) becomes inflamed. This can cause "sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling," according to a 2017 article published in the American Family Physician.

While not related to a heart attack, this type of chest pain can also be serious and is another reason you'll want to get your symptoms checked out by a medical professional.

Pulmonary embolism is the most common serious cause of pleuritic chest pain and is life threatening.

Pulmonary embolism occurs when there is a blockage in a lung artery. This blockage can damage the lungs and cause low oxygen levels in your blood, which can damage other organs as well, according to MedlinePlus.

Pneumonia can also cause pleuritic chest pain. Pneumonia is an infection of the lungs and can range from mild to severe, depending on the cause, according to MedlinePlus. Chest pain from pneumonia will occur when you breathe or cough.

If you've had some type of injury or trauma to your chest, a broken or bruised rib can also cause chest pain. Breathing, coughing, and moving your upper body can be very painful if you've injured your rib.




Having a panic attack can certainly feel like a heart attack; people often believe they're dying when they are having one.

In addition to chest pain, symptoms can include a pounding heart, sweating, shaking, nausea, dizziness, and a feeling of going crazy. It's your body's fight-or-flight response kicking in, according to the American Psychological Association.

Panic attacks tend to crop up suddenly with no warning. People can experience them for a variety of reasons, including:

  • Having a family history of panic attacks
  • A history of childhood trauma
  • Dealing with major life changes and ongoing stress (such as a serious illness of a loved one)
  • Experiencing a traumatic event (such as a robbery or car accident)

If you think you've experienced a panic attack, it can be helpful to visit a healthcare provider. They can rule out any physical issues with your heart, which can help put you at ease.

A provider may also refer you to a mental health professional who can help you treat and manage your symptoms.



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What does "Pulmonary Fibrosis" mean?  
The word “pulmonary” means lung and the word “fibrosis” means scar tissue— similar to scars that form on the skin from an old injury or surgery. So, in its simplest sense, pulmonary fibrosis (PF) means scarring in the lungs.

Pulmonary fibrosis is a lung disease that occurs when lung tissue becomes damaged and scarred. This thickened, stiff tissue makes it more difficult for your lungs to work properly. As pulmonary fibrosis worsens, people can become progressively more short of breath.

The scarring associated with pulmonary fibrosis can be caused by a multitude of factors. But in most cases, doctors can't pinpoint what's causing the problem. When a cause can't be found, the condition is termed idiopathic pulmonary fibrosis.

The lung damage caused by pulmonary fibrosis can't be repaired, but medications and therapies can help ease symptoms and improve quality of life. For some patients, a lung transplant might be appropriate.

Symptoms of Pulmonary Fibrosis:  
The most common symptoms of pulmonary fibrosis are dry, persistent cough and shortness of breath. Symptoms may be mild or even absent early in the disease process. As the lungs develop more scar tissue, symptoms worsen. Shortness of breath initially occurs with exercise, but as the disease progresses patients may become breathless while taking part in everyday activities, such as showering, getting dressed, speaking on the phone, or even eating.

Due to a lack of oxygen in the blood, some people with pulmonary fibrosis may also have “clubbing” of the fingertips. Clubbing is a thickening of the flesh under the fingernails, causing the nails to curve downward. It is not specific to pulmonary fibrosis or idiopathic pulmonary fibrosis and occurs in other diseases of the lungs, heart, and liver, and can also be present at birth.

How Do Doctors Recognize and Diagnose Pulmonary Fibrosis? 
There are three consequences of pulmonary fibrosis. Doctors use these consequences to recognize that someone has PF:

1. Stiff Lungs. Scar tissue and inflammation make your lungs stiff. Stiff lungs are hard to stretch, so your breathing muscles have to work extra hard just to pull air in with each breath. Your brain senses this extra work, and it lets you know there’s a problem by triggering a feeling of breathlessness (or “shortness” of breath) while exerting yourself.

Also, stiff lungs hold less air (they shrink a bit). Doctors take advantage of this “shrinking” to diagnose and track the disease using breathing tests (called Pulmonary Function Tests) that measure how much air your lungs can hold. The more scar tissue your lungs have, the less air they will hold.

2. Low blood oxygen. Scar tissue blocks the movement of oxygen from the inside of your air sacs into your bloodstream. For many people living with pulmonary fibrosis, oxygen levels are only reduced a little bit while resting, but their oxygen levels drop quite a bit during activity. The brain can sense these low oxygen levels, triggering breathlessness.

Doctors will check your oxygen levels to see if they drop after walking, which could be a clue that PF might be present. Doctors also often prescribe oxygen to be used through a nasal cannula or a facemask during activity and sleep for those with PF. As pulmonary fibrosis progresses, oxygen may be needed 24 hours a day and flow rates may increase.

3. “Crackles" lung sounds. Your doctor may have told you that “crackles” were heard in your lungs. Crackles (also called “rales”) sound like Velcro being pulled apart.

They are heard in many lung diseases because any type of problem affecting the air sacs (such as PF, pneumonia, or a buildup of fluid in the lungs from heart failure) can cause crackles. Some people with pulmonary fibrosis don’t have crackles, but most do.

Can pulmonary fibrosis be reversed? 
Unfortunately, lung damage due to pulmonary fibrosis is permanent (not reversible). Getting diagnosed and starting treatment as early as possible may help your lungs work better, longer.

How is pulmonary fibrosis treated? 
Most pulmonary fibrosis treatments focus on easing symptoms and improving your quality of life.

Your provider may recommend one or more treatments: 
• Medication: Two medications — pirfenidone (Esbriet®) and nintedanib (OFEV®) —may slow down lung scarring. These medications can help preserve lung function.

• Oxygen therapy: Giving your body extra oxygen helps you breathe more easily. It may also increase your energy and strength.

• Pulmonary rehabilitation: Staying active in this special exercise program may improve how much (or how easily) you can do everyday tasks or activities.

• Lung transplant: A lung transplant replaces one or both diseased lungs with a healthy lung (or lungs) from a donor. It offers the potential to improve your health and quality of life. A lung transplant is major surgery, and not everyone is a candidate. Ask your provider if you may be eligible for a lung transplant.

Can pulmonary fibrosis be cured? 
No cure for pulmonary fibrosis exists today. But researchers around the world are working to change that.



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Patients with acute unstable chest wall injuries who were receiving mechanical ventilation experienced modest benefits with operative treatment, a randomized trial suggested.

In a modified intention-to-treat analysis involving 207 patients, those who underwent surgery to stabilize rib fractures had more ventilator-free days (VFDs) versus those who did not undergo surgery during the first 28 days after injury (22.7 vs 20.6 days), but this difference did not reach significance (mean difference 2.1 days, 95% CI -0.3 to 4.5, P=0.09), reported Niloofar Dehghan, MD, of the CORE Institute in Phoenix, Arizona, and colleagues.

However, a prespecified subgroup analysis of patients on mechanical ventilation at the time of randomization favored the operative group (mean difference 2.8 VFDs, 95% CI 0.1-5.5), they noted in JAMA Surgery.

"The potential advantage was primarily observed in the subgroup of patients at the time of randomization," Dehghan and team wrote. "We found no benefit to operative treatment in patients who were not ventilated."

Overall, lower mortality rates were seen in the operative group (0% vs 6%, P=0.01), while other secondary endpoints such as rates of complications (pneumonia, sepsis, tracheostomy) and length of hospital stay (median 16 vs 16.5 days) were similar.

Differences between the subgroups of patients ventilated and non-ventilated at the time of randomization were also similar for complications. A higher trend for mortality was seen in the subgroup who were ventilated at the time of randomization (P=0.06).

After highlighting the "methodological flaws" in the study in an accompanying editorial, Anthony G. Charles, MD, MPH, and colleagues of the University of North Carolina at Chapel Hill, concluded that "this trial demonstrates no role for routine surgical fixation of non-ventilated patients."

"However, it does not adjudicate the need for routine operative management of mechanically ventilated patients with unstable chest wall injuries," they noted. "A larger prospective randomized study with standardization of critical care management will be needed."

Unstable chest wall injuries, including flail chest, are often caused by blunt force trauma, which increases the risk for morbidity and mortality, Dehghan's group noted. Many complications can arise from these types of injuries, such as severe pulmonary restriction, chest wall instability, or even loss of lung volume, resulting in more patients requiring prolonged ventilation.

Nonoperative management strategies -- consisting of intubation, chest tube drainage, and intermittent positive-pressure ventilation, among others -- are the most common treatments for severe chest wall injuries, but these have not always led to the most optimal outcomes. While many prior studies have found improved outcomes with operative treatment for carefully selected patients, data are mixed on whether operative or nonoperative treatment is superior.

For this study, Dehghan and colleagues enrolled 207 patients ages 16 to 85 with acute unstable chest wall injuries and randomized them 1:1 to operative treatment with plate and screws (n=108) or nonoperative treatment (n=99) across 15 sites in the U.S. and Canada from October 2011 to October 2019. The nonoperative group received the standard of care, including pain management, chest tube drainage, chest physiotherapy/pulmonary toilet, or ventilation, if needed.

Baseline characteristics were similar between groups. Mean age was 53, and three-fourths were men. Most had injuries caused by motor vehicle collisions (30-37%), falls (17-26%), or motorcycle collisions (13-15%). Mean number of rib fractures was 10.

Common conditions included pneumothorax (89%), hemothorax (76%), and pulmonary contusion (54%). The most common types of plates used during surgery were pelvic reconstruction plates (53%) and pre-contoured locking rib plates (43%). Notably, 43% of patients received mechanical ventilation.

Six patients died while hospitalized, all in the nonoperative group. Four operative patients required repeat surgery.

Dehghan and team noted that their trial was "underpowered to detect statistical significance in outcomes that were potentially clinically significant" due to the small sample size. Variations in care may also have occurred across centers.

  • author['full_name']

    Zaina Hamza is a staff writer for MedPage Today, covering Gastroenterology and Infectious disease. She is based in Chicago.

Disclosures

This study was supported by the AO Foundation, Canadian Institutes of Health Research, and Physician Services.

Dehghan reported relationships with Acumed, AO International, Bioventus, Canadian Institutes of Health Research, ITS, Physician Services, Springer, Stryker, and Wolters Kluwer.

Co-authors reported relationships with Acumed, AO Foundation, AO International, Bioventus, Canadian Institutes of Health Research, DePuy Synthes, Elsevier, ITS, Medtronic, Orthopaedic Trauma Association, Physician Services, Stryker, Smith&Nephew, Springer, Synthes, Swemac, and Wolters Kluwer.

Charles and co-authors reported no conflicts of interest.

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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

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.

Mesothelioma

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

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

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.
  1. Charalampidis C, Youroukou A, Lazaridis G, et al. Pleura space anatomyJ Thorac Dis. 2015;7(Suppl 1):S27–S32. doi:10.3978/j.issn.2072-1439.2015.01.48

  2. Kass SM, Williams PM, Reamy BV. Pleurisy. Am Fam Physician. 2007;75(9):1357-64.

  3. Bintcliffe OJ, Lee GY, Rahman NM, Maskell NA. The management of benign non-infective pleural effusions. Eur Respir Rev. 2016;25(141):303-16. doi:10.1183/16000617.0026-2016

  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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Bag mask ventilation (BMV) is a method for providing a person with immediate ventilation in an emergency. BMV involves a medical professional manually pumping oxygen into a person’s lungs using a self-inflating bag to simulate breathing.

Certain health conditions and accidents can cause a person to have breathing difficulties. BMV uses bag valve masks, or Ambu bags, to supply a person with oxygen.

A bag valve mask is a handheld tool that a medical professional can use to pump oxygen into a person’s lungs.

This article details BMV, including how it works, step-by-step instructions, effectiveness, and possible risks.

The equipment used for BMV includes:

  • self-inflating bag
  • mask that covers a person’s nose and mouth
  • oxygen source
  • oxygen tubing
  • positive end-expiratory pressure (PEEP) valve, which helps maintain pressure in the lower airways during exhalation
  • tubes to hold the airways open

The self-inflating bag is attached to a valve and then to a soft face mask. The other end of the self-inflating bag is attached to a tank containing 100% oxygen.

A medical professional then places the face mask over a person’s nose and mouth, then manually squeezes the self-inflating bag. Squeezing the bag pushes oxygen into the person’s lungs, which replicates the action of breathing.

A medical professional can attach a PEEP valve to the bag valve mask to help maintain pressure inside the lungs. This can help prevent damage to the delicate sacs of air on the lungs, called alveoli.

A medical professional will perform the following steps:

  1. Stand behind the person and tilt their chin slightly upward to open their airway.
  2. Insert a tube into the person’s mouth to prevent the tongue from covering the airway. They may insert a tube into the nose if the throat is blocked.
  3. Place the mask over the person’s nose and mouth, and apply pressure to the mask with one hand to keep the seal tight.
  4. Before attaching the oxygen, squeeze the self-inflating bag, allowing air to flow into the person’s lungs. Empty the entire bag over 1⁠–2 seconds and then release it. Releasing the bag allows it to refill.
  5. Continue providing ventilation for 30 seconds before attaching the oxygen tank.
  6. Attach the oxygen, and supply the person with 15 liters of oxygen per minute.

If there are two medical professionals, one will hold the mask in place while the other squeezes the self-inflating bag.

The method is the same in adults and children. However, they will use smaller bag valve masks for children.

Medical professionals use BMV in emergencies to provide a rapid supply of oxygen. A person may need assistance breathing if they are experiencing:

Some people may also require BMV before certain scheduled surgeries.

Without an adequate amount of oxygen, a person can develop hypoxia. Hypoxia is a condition where a person does not have enough oxygen in their body tissues.

It can be mild or severe, causing symptoms such as:

Hypoxia can also lead to coma or death.

Research suggests that BMV can be a successful ventilation technique when used correctly.

A study from 2020 found that bag valve mask-only ventilation was associated with improved cardiac arrest episodes that occurred outside a hospital.

Additionally, research from 2019 found that critically ill people receiving BMV alongside tracheal intubation had higher oxygen saturation levels and lower rates of severely low oxygen levels.

Affecting factors

The success of BMV ventilation can depend on certain factors, such as:

  • the person’s airway
  • a tight seal on the face mask
  • proper ventilation technique
  • using a PEEP value when required

A medical professional must ensure that a person is in the correct position before beginning BMV. Certain factors can make BMV more difficult for a healthcare professional.

These factors include people who:

  • have obesity
  • are older adults
  • have no teeth
  • have beards
  • are snoring
  • are stiff

Certain complications can occur due to BMV. If the technique inflates the lungs too much, they can become damaged.

BMV can lead to air entering the stomach if used incorrectly or for long periods. This can cause a person’s stomach to swell or lead to vomiting.

Vomiting while being ventilated can be dangerous. If a person breathes in their vomit, it can lead to infections such as pneumonia or choking.

BMV is a technique used to ventilate a person in an emergency. It involves a healthcare professional manually pumping oxygen into a person’s lungs using a bag valve mask.

Certain factors can cause BMV to become more difficult, such as a person’s age. However, if done correctly, BMV can be a successful ventilation method.

BMV can cause certain complications if performed incorrectly. This includes lung damage and vomit aspiration.

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From a pathophysiological point of view, bronchiectasis disease is sustained by a vicious circle in which an alteration in mucociliary clearance is followed by chronic respiratory infections, chronic inflammation, and irreversible bronchial anatomical damage, which over time can lead to a progression and aggravation of the disease itself.

 What are the causes of bronchiectasis?

Bronchiectasis can have several causes, either congenital or acquired, such as primary or secondary immune deficits, previous pneumonias, alterations in ciliary motility, fungal infections (such as from Aspergillus) or from non-tuberculous mycobacteria, autoimmune and chronic inflammatory processes.

However, in 40-50% of cases the cause of the disease remains unknown despite extensive diagnostic investigations.

What are the symptoms of bronchiectasis?

The main symptoms/signs of bronchiectasis are coughing, daily expectoration, and recurrent respiratory infections (including pneumonia).

In addition to these symptoms, episodes of haemophthisis/haemoptysis (blood in the sputum), dyspnoea (shortness of breath), persistent fever, and daily significant asthenia may also be present.

Diagnosis

The gold standard for the diagnosis of bronchiectasis is a high-resolution chest CT scan and the pulmonologist is the referral specialist.

At the time of the diagnosis of bronchiectasis and depending on the severity of the clinical picture, a series of laboratory tests should be performed, including quantitative assessment of total IgG, IgA, IgM and IgE immunoglobulins, IgG and IgE specific for A. fumigatus, protein electrophoresis, complete respiratory function tests, a sputum culture test for bacteria, fungi and mycobacteria, a visit with a respiratory physiotherapist and a pulmonologist.

Then, every six months or annually, and always depending on the severity of the clinical picture, it is recommended to perform a sputum culture examination, and a re-evaluation with a respiratory physiotherapist and a pulmonologist.

In some patients it is also important to rule out certain genetic disorders (such as cystic fibrosis or primitive ciliary dyskinesia) as well as the coexistence of possible connective tissue diseases (such as rheumatoid arthritis).

Treatments

There are to date no European or American approved drugs to treat this disease.

The management of bronchiectasis is totally individualised on the basis of the clinical and biological characteristics expressed by each patient.

The most important treatment is respiratory physiotherapy, which uses a specific exercise programme to remove the mucus that tends to stagnate in bronchiectasis.

Other important tools at our disposal are antibiotics, immunomodulatory therapies, bronchodilator drugs (if bronchial obstruction is present) as well as treatments to manage the two most frequent complications of the disease: flare-ups and the presence of blood in the sputum.

The optimal management of bronchiectasis passes through a multidisciplinary approach in which the pulmonologist, flanked by the respiratory physiotherapist, can count on the collaboration of other professionals including the clinical microbiologist, the radiologist, the clinical immunologist/rheumatologist, the geneticist, the gastroenterologist and the otorhinolaryngologist.

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Humanitas



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While pain under the right breast is rarely a cause for concern, it can sometimes indicate an underlying condition. Some possible causes of this pain include injuries, infections, muscle strain, inflammation, and gastrointestinal issues.

A strain or injury are common causes of pain under the right breast, and the pain usually gets better on its own. However, it can also result from conditions affecting the underlying tissues and organs, or the pain may be extending from another area of the body, such as the stomach.

In this article, we explore some potential causes of pain under the right breast, along with their main symptoms and treatments. We also describe when to see a doctor.

Tired or exhausted man lying down after workout holding chest or abdomen in pain
An injury or muscle strain can cause pain under the right breast.

Injuries to the ribs or chest area are common and can be very painful. Depending on where the injury occurs, this pain may manifest under one or both of the breasts.

Possible causes of chest injuries include:

  • knocks or blows to the chest area
  • falls
  • severe coughing

Other symptoms of an injury can include swelling and bruising. More forceful injuries can also result in bruised or fractured ribs.

People recovering from surgery to the breasts or chest area may also experience pain or discomfort under one or both breasts.

Treatment

A person can usually treat minor chest injuries at home with rest and over-the-counter (OTC) medications, such as acetaminophen and ibuprofen.

Applying ice to the affected area for up to 20 minutes at a time may also help reduce pain and swelling.

See a doctor for pain that results from a serious injury, such as a car accident. People with severe or worsening pain should also speak to a doctor.

It is possible to strain or overstretch the chest muscles, which can result in soreness and pain. Depending on which muscles a person strains, this pain may occur under a single breast.

Chest muscle strains can result, for example, from throwing, heavy lifting, and using heavy tools or equipment.

Treatment

Muscle strains usually get better with rest. OTC pain relievers and applying ice to the affected area for up 20 minutes at a time may help reduce chest discomfort.

Hormonal fluctuations that occur during the menstrual cycle can cause the breasts to become swollen and tender.

This tenderness usually occurs in the week or so before a person’s period, and it can affect one or both breasts.

Treatment

Taking OTC pain relievers and drinking plenty of water can help reduce breast tenderness from menstrual hormonal changes. The symptoms usually resolve before a person’s period is over.

Costochondritis is an inflammation of the cartilage in the costochondral joint, which is the area where the ribs meet the sternum, also called the breastbone.

The main symptom of costochondritis is chest pain, which can occur in one or both sides of the chest. This pain can be dull or sharp and may get worse when taking a deep breath or coughing. There may also be tenderness around the breastbone.

Costochondritis does not usually cause severe symptoms, such as shortness of breath, fever, or dizziness.

Doctors do not fully understand what causes costochondritis, but it may result from one or more of these issues:

  • chest injuries
  • intense physical activity
  • strenuous coughing
  • illness, such as a chest infection near the costochondral joint

Treatment

Costochondritis often gets better on its own, but it may last several weeks.

Some ways to relieve inflammation and pain from costochondritis:

  • avoiding activities that stress or aggravate the chest area
  • applying heat packs to the affected area
  • taking nonsteroidal anti-inflammatory drugs — NSAIDs — such as naproxen or ibuprofen

For pain that gets worse or does not go away, a doctor may recommend steroid injections or physical therapy.

A person who experiences a gallbladder attack should seek treatment.
A person who experiences a gallbladder attack should seek treatment.

The gallbladder is a small organ on the right side of the body that stores bile from the liver. If bile contains too much cholesterol or bilirubin, or if a person’s gallbladder does not empty properly, gallstones can form.

Most gallstones pass without causing problems. However, gallstones that block the flow of bile in the bile ducts can cause pain and inflammation. The episodes of pain resulting from these blockages are called gallbladder attacks or biliary colic.

The pain from a gallbladder attack usually occurs in the upper right abdomen and can last for several hours.

Attacks that last for more than a few hours can lead to complications. For instance:

  • jaundice, which is yellowing of the skin and eyes
  • nausea and vomiting
  • fever

Treatment

Anyone who has had a gallbladder attack should see a doctor, even if symptoms get better, because more attacks may follow. People who experience complications should receive prompt medical attention.

If gallstones continue to cause problems, doctors usually recommend surgery to remove the gallbladder. The gallbladder is not an essential organ, and removal reduces the risk of it becoming infected and causing further complications.

For people who cannot undergo gallbladder removal, doctors may recommend some of the following nonsurgical treatments:

  • endoscopic retrograde cholangiopancreatography
  • oral dissolution therapy
  • shock wave lithotripsy

A hiatal hernia occurs when part of the stomach slides up through the hiatus, which is an opening in the diaphragm. The diaphragm is a large, thin sheet of muscle that separates the chest cavity from the abdomen.

Hiatal hernias do not always cause noticeable symptoms, but they can increase a person’s risk of gastroesophageal reflux disease (GERD). Some examples of symptoms:

  • chest pain
  • heartburn
  • problems swallowing
  • shortness of breath
  • nausea and vomiting

Treatment

Treatment is usually necessary if the hiatal hernia is causing problems. For people with symptoms of GERD, treatment options include:

  • lifestyle and dietary changes, such as maintaining a healthy weight and avoiding foods that make symptoms worse
  • medications that reduce stomach acid, such as antacids, H2 receptor blockers, and proton pump inhibitors

If these treatments are unsuccessful, a doctor may recommend surgery to correct the hernia.

Irritable bowel syndrome (IBS) causes gastrointestinal symptoms, such as abdominal pain and changes to a person’s bowel movements. These symptoms tend to vary in type and severity from person to person.

Some symptoms of IBS:

  • bloating and gas
  • constipation or diarrhea
  • a feeling of incomplete evacuation after having a bowel movement
  • stools containing a whitish mucus

IBS can sometimes also cause referred pain, including right-sided chest pain.

Treatment

Treatment for IBS typically includes some of the following lifestyle and dietary changes:

  • increasing fiber intake
  • exercising regularly
  • reducing and managing stress
  • getting enough sleep
  • following a specific diet, such as the low-FODMAP diet.

FODMAP is an acronym for oligo-, di-, monosaccharides, and polyols, which are groups of carbs that can cause digestive symptoms, including bloating, gas, and pain.

Doctors may also prescribe specific medications to reduce constipation, diarrhea, and abdominal pain.

Mature asian woman holding hand to chest due to heart attack or breathing pain.
Shortness of breath and chest tightness are potential symptoms of pleural disorders.

The pleurae make up a large, thin membrane that is folded over to form two layers. One layer wraps around the lungs, and the other lines the inside of the chest cavity. The space between these two layers is called the pleural space.

Inflammation of the pleura is called pleurisy, and it can cause the two layers to rub against each other. This friction can lead to sharp chest pain when coughing or breathing deeply.

In different pleural disorders, air, gas, fluid, or blood collects in the pleural space, which can also cause sharp chest pain.

Other symptoms of pleural disorders:

  • coughing
  • fever and chills
  • shortness of breath
  • fatigue
  • chest tightness
  • weight loss
  • a bluish tint to the skin

Treatment

Treatment for a pleural disorder depends on the underlying cause and the severity of a person’s symptoms.

For example, if a bacterial infection is causing the condition, a doctor may prescribe antibiotics. They may also recommend anti-inflammatory medications or pain relievers to help reduce a person’s discomfort.

Some people require a procedure to drain gas or fluids from the pleural space.

Pneumonia is infectious inflammation of the tiny air sacs in the lungs, which causes them to fill up with fluid. It can lead to a range of symptoms, including sharp chest pain that typically gets worse with deep breathing or coughing.

Other symptoms of pneumonia:

  • fever and chills
  • a persistent cough that produces green, yellow, or bloody mucus
  • a loss of appetite
  • fatigue and low energy levels
  • confusion
  • nausea
  • shortness of breath or other breathing difficulties

Early symptoms of pneumonia can be similar to a common cold or the flu and may come on suddenly or gradually worsen over a few days. Symptoms can vary from mild to severe.

The most common cause of pneumonia is a bacterial infection, but pneumonia can also result from viral or fungal infections.

Treatment

People with symptoms of pneumonia should see a doctor. Seek urgent medical attention if symptoms are severe.

Pneumonia can sometimes lead to life-threatening complications, and some people require hospitalization.

Treatment depends on the type of pneumonia and the severity of symptoms. Doctors may prescribe antibiotics for bacterial pneumonia or antiviral medications for viral pneumonia.

To treat mild pneumonia at home, a doctor may recommend the following:

  • getting plenty of rest
  • drinking lots of fluids
  • taking OTC pain relievers
  • avoiding tobacco smoke and other lung irritants
  • taking oral antibiotic or oral antiviral therapy, as prescribed

See a doctor if the pain under the right breast gets worse, does not go away, or is interfering with daily activities. Also, seek medical attention if the pain accompanies other concerning symptoms.

Some symptoms that require immediate medical attention:

  • severe, sharp, or sudden chest pain
  • chest pain that radiates to other parts of the body, such as the jaw, arms, or shoulders
  • a bluish tint to the lips or skin
  • difficulty breathing
  • coughing up blood
  • confusion, dizziness, or loss of consciousness

Pain under the right breast is rarely a cause for concern and often results from muscles strains or minor injuries.

However, it can indicate a more serious condition, such as an infection, chest inflammation, or a gastrointestinal issue.

If the pain gets worse, does not go away, or occurs with other concerning symptoms, see a doctor. Seek immediate medical attention for severe chest pain or pain that accompanies breathing difficulties.

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Viruses are responsible for about one-third of all pneumonias, according to Johns Hopkins Medicine.

Viral pneumonias tend to clear up in about one to three weeks, but they can increase your risk of bacterial pneumonia.

Viral pneumonia is usually less serious than bacterial pneumonia.

At first, the symptoms of viral pneumonia may be similar to symptoms often associated with the flu, except you may experience a dry cough that does not produce phlegm. You may also develop a fever and headache.

But within a couple of days, these symptoms typically get worse.

Adults with viral pneumonia can also expect to develop:

  • Sore throat
  • Loss of appetite
  • Muscle pain

The flu virus is a common cause of viral pneumonia in adults, which tends to be more serious in people with heart or lung disease, senior citizens, and pregnant women.

Not only can influenza cause pneumonia, it can also predispose people to bacterial pneumonia — yet another good reason to get the yearly flu shot.

Respiratory syncytial virus (RSV) pneumonia, another type of viral pneumonia, is usually a mild infection that clears up in about a week or two. It can be more severe and is more common in young children and older adults. In fact, RSV is the most common cause of pneumonia in children younger than 12 months, per the CDC.

In the last few years, SARS-CoV-2, the virus that causes COVID-19, has caused viral pneumonia. COVID pneumonia often affects both lungs, and it tends to spread across the lungs slowly, lasting longer and causing more damage than other types of pneumonia, according to the Cleveland Clinic.

If you have COVID pneumonia, you’ll likely be admitted to the hospital, and treatment may include certain antiviral medications, such as remdesivir, which targets the SARS-CoV-2 virus. Another antiviral is Paxlovid, though this is an outpatient medication, meant to be prescribed to patients not admitted to the hospital.

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Pulmonary edema occurs when fluid accumulates in the air sacs of the lungs, making it difficult to breathe. This interferes with gas exchange and can cause respiratory failure.

Pulmonary edema can be acute (occurring suddenly) or chronic (occurring more slowly over time). Acute pulmonary edema is a medical emergency and requires immediate medical attention.

One of the most common causes of pulmonary edema is congestive heart failure, in which the heart cannot keep up with the demands of the body.

Treatment of pulmonary edema usually focuses on improving respiratory function and addressing the source of the problem. It generally includes providing additional oxygen and medications to treat the underlying conditions.

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Pulmonary edema can be acute or chronic. Image credit: Adisorn Chiamchitr/Alamy Stock Photo

During normal breathing, the small air sacs in the lungs, known as alveoli, fill up with air. The lungs take in oxygen and expel carbon dioxide. Pulmonary edema occurs when fluid floods the alveoli.

This flooding causes two problems:

  1. The bloodstream cannot get enough oxygen.
  2. The body cannot expel carbon dioxide properly.

Common causes of pulmonary edema include:

  • pneumonia
  • sepsis (blood infection)
  • exposure to certain chemicals
  • organ failure that causes fluid accumulation, such as congestive heart failure, kidney failure, or liver cirrhosis
  • near-drowning
  • inflammation
  • trauma
  • reaction to certain medications
  • overdose of certain drugs, including opioids

Pulmonary edema also occurs as part of a condition called acute respiratory distress syndrome (ARDS), a severe inflammation of the lungs that leads to significant breathing difficulties. Direct injury to the lungs or inflammation in other parts of the body can cause this condition.

Other possible causes include:

  • brain injuries such as brain bleeding, stroke, head injury, brain surgery, tumor, or seizure
  • high altitude
  • blood transfusion

Cardiogenic pulmonary edema

Pulmonary edema that results from a direct problem with the heart is called cardiogenic pulmonary edema.

Congestive heart failure is a common cause of cardiogenic pulmonary edema. In this condition, the left ventricle is unable to pump out enough blood to meet the body’s needs.

This causes a buildup of pressure in other parts of the circulatory system, forcing fluid into the air sacs of the lungs and other parts of the body.

The following heart-related problems can also lead to pulmonary edema:

  • Fluid overload: This can result from kidney failure or intravenous fluid therapy.
  • Hypertensive emergency: This is a severe increase in blood pressure that places excessive strain on the heart.
  • Pericardial effusion with tamponade: This is a buildup of fluid around the sac that covers the heart, which can decrease the heart’s ability to pump.
  • Severe arrhythmia: This can be tachycardia (fast heartbeat) or bradycardia (slow heartbeat), both of which can result in poor heart function.
  • Severe heart attack: This can damage the muscle of the heart, making pumping difficult.
  • Abnormal heart valve: This can affect the flow of blood out of the heart.

Causes of pulmonary edema that are not due to poor heart function are called noncardiogenic and are often the result of ARDS.

Acute pulmonary edema causes significant breathing difficulties and can appear without warning. It is an emergency and requires immediate medical attention. Without proper treatment and support, it can be fatal.

In addition to breathing difficulties, the following symptoms can indicate acute pulmonary edema:

  • cough, often with a pink, frothy sputum
  • excessive sweating
  • anxiety and restlessness
  • feelings of suffocation
  • pale skin
  • wheezing
  • rapid or irregular heart rhythm (palpitations)
  • chest pain

If the pulmonary edema is chronic, symptoms are usually less severe until the body’s system can no longer compensate. Symptoms may include:

  • difficulty breathing when lying flat (orthopnea)
  • swelling (edema) of feet or legs
  • rapid weight gain due to the accumulation of excess fluid
  • paroxysmal nocturnal dyspnea, or episodes of severe sudden breathlessness at night
  • fatigue
  • increased breathlessness with physical activity

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Sometimes a chest X-ray can assist in the diagnosis of pulmonary edema. Image credit: Photographee.eu/Adobe Stock

A person will undergo a physical exam first. A doctor will use a stethoscope to listen to the lungs for crackles and rapid breathing and to the heart for abnormal rhythms.

The doctor will order blood tests to determine blood oxygen levels. They will often order additional blood tests to check the following:

  • electrolyte levels
  • kidney function
  • liver function
  • blood counts and blood markers of heart failure

An echocardiogram or an electrocardiogram (EKG) can help determine the condition of the heart.

The doctor may order a chest X-ray or a lung ultrasound to see whether there is any fluid in or around the lungs and to check the size of the heart. They may also order a CT scan.

Pulmonary edema happens when fluid collects inside the lungs, in the alveoli, making it hard to breathe. Pleural effusion also involves fluid in the lung area and is sometimes called “water on the lungs.”

However, in pleural effusion, fluid collects in the layers of the pleura that are outside the lungs.

Often, pleural effusion results from inflammation or a blockage due to a condition such as pneumonia, tuberculosis, or cancer. This is known as an exudative pleural effusion.

A transudative pleural effusion is another type that can also be due to excess fluid buildup in the body. This can result from heart failure, cirrhosis, or kidney failure.

Pulmonary edema can overlap with pneumonia, but it is a different condition. Pneumonia is an infection that often occurs as a complication of a respiratory infection such as the flu.

Though it can be difficult to distinguish between the two, a doctor will try to make a correct diagnosis and determine the best course of treatment based on a person’s detailed medical history, physical exam, and test results.

To raise a person’s blood oxygen levels, a healthcare professional will administer oxygen through either a face mask or nasal cannulas, which are tiny plastic tubes that a healthcare professional places in a person’s nose to provide oxygen.

Healthcare professionals may place a breathing tube in the trachea if a ventilator — a machine that helps a person breathe — is necessary.

If tests show that the pulmonary edema is the result of a problem in the circulatory system, healthcare professionals will administer intravenous medications to help reduce fluid volume and regulate blood pressure.

Diuretics are the most commonly used medication and can help reduce fluid buildup by increasing the production of urine.

Depending on the specific cause and a person’s symptoms, a healthcare professional may use any of the following other medications to treat pulmonary edema:

  • Vasodilators: These medications dilate the blood vessels to decrease pulmonary congestion.
  • Calcium channel blockers: These help reduce high blood pressure.
  • Inotropes: This type of medication can increase the force of heart muscle contractions so that the heart can pump blood throughout the body.
  • Morphine: This medication can help reduce anxiety and shortness of breath. However, because of its potential risks, healthcare professionals do not often recommend it.

People with an increased risk of developing pulmonary edema should follow a doctor’s advice to manage the condition.

If a person has congestive heart failure, following a healthy, balanced diet and maintaining a moderate body weight can help ease symptoms and reduce the risk of future episodes of pulmonary edema.

Regular exercise also improves heart health, as do other lifestyle habits, including:

  • Reducing salt intake: Excess salt can lead to water retention, which requires the heart to work harder.
  • Lowering cholesterol levels: High cholesterol can lead to fatty deposits in the arteries, which can increase the risk of heart attack and stroke in addition to pulmonary edema.
  • Smoking cessation: Tobacco increases the risk of a number of health conditions, including heart disease, lung disease, and circulatory problems.

It is possible to minimize altitude-induced pulmonary edema by making a gradual ascent, taking medications before traveling, and avoiding excess exertion while progressing to higher altitudes.

Pulmonary edema can be a result of several conditions, including congestive heart failure, pneumonia, and sepsis.

In addition to causing symptoms such as cough, wheezing, chest pain, and excessive sweating, pulmonary edema can result in severe breathing difficulties and may be fatal without proper treatment.

For this reason, if a person experiences any symptoms of pulmonary edema, it’s important to consult a doctor to determine the cause and the best course of treatment.

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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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Mucus in the lungs is common in certain health conditions and needs treatment. For example, if you have bronchiectasis or chronic obstructive pulmonary disease (COPD), clearing mucus from your lungs is an important part of managing your lung disease.

Having too much mucus in your lungs or phlegm build-up can block narrowed air passages and make it hard for you to breathe. Increased mucus in the lungs can also lead to infections, such as pneumonia.

There are ways to treat mucus in the lungs, including controlled coughing, medications, and chest physiotherapy.

This article will go over some causes of mucus in the lungs as well as ways that your provider might want you to clear mucus from your lungs as part of your treatment.

Verywell / Emily Roberts

Home Remedies and Lifestyle Changes for Mucus in Lungs

You can use at-home exercises to help prevent and decrease mucus buildup in your lungs. If you have lung disease these techniques should be used regularly to loosen and remove the excess mucus from your lungs.

Controlled Coughing for Mucus in Lungs

Controlled coughing engages the chest and stomach muscles to clear mucus in the lungs. Unlike a hacking cough that uses the chest muscles more than the diaphragm, controlled coughing focuses on stabilizing the core muscles to engage the diaphragm more effectively.

There are two common methods of controlled coughing: deep and huff.

How to use deep coughing to clear mucus in the lungs:

  1. Sit comfortably in a chair with your feet on the ground.
  2. Wrap your arms around your stomach, and take a deep breath in.
  3. Keeping your lips pursed, cough forcefully while pressing your arms firmly against your stomach muscles.

How to use huff coughing to clear mucus in the lungs:

  1. Take a deep, slow breath to fully expand your lungs.
  2. Tense your stomach muscles
  3. Exhale three times very quickly and make a "ha" sound with each breath.
  4. Repeat this step, keeping your core firm, until you feel the mucus in your lungs breaking up.
  5. Cough deeply to clear your lungs.

Deep Breathing for Mucus in Lungs

When you do deep breathing exercises, you slowly breathe in (inhale) and breathe out (exhale) to help your lungs expand. These breathing exercises are examples of pulmonary hygiene—treatments that use physical manipulation techniques to help you cough up sticky mucus and clear your lungs.

Your respiratory therapist can teach you deep breathing techniques that you can do at home on a regular schedule to help keep your lungs clear.

Over-the-Counter (OTC) Treatment for Lung Mucus

Several OTC medications can help clear excess mucus from your lungs, for example, Robitussin and Mucinex.

These medications are expectorants. They have an ingredient called guaifenesin in them that thins and loosens mucus in the lungs to make it easier to cough up. They can also block the production of the main protein in mucus (mucins).

Most expectorants can be bought at a pharmacy or grocery store, but some combination drugs that have expectorants and other ingredients in them require a healthcare provider's prescription.

Prescription Medications for Lung Mucus

Mucolytics, including N-acetylcysteine and carbocysteine, are only available by prescription.

These medications work differently than expectorants. Mucolytics break the chemical bonds in mucus to help make it easier to cough up.

Chest Physiotherapy for Mucus in Lungs

Chest physiotherapy (CPT) techniques can be done manually or with a mechanical device. A CPT routine can take anywhere from 20 minutes to an hour.

You can do some CPT techniques by yourself, but others require help from a partner, such as a therapist or a family member at home.

  • Manual CPT combines chest percussion and vibration to loosen the mucus in the lungs and make you cough. To do chest percussion, a therapist or loved one will clap on your chest or back to help loosen the thick mucus in your lungs so you can cough it up. Vibration is done by placing their flat hands on your chest wall and making a shaking motion.
  • Airway clearance devices are hand-held machines that use high-frequency vibration, low-frequency sound waves, and other technology to break up mucus in the lungs. They are easy to use by yourself. Some of the devices are worn like a vest, while others require you to breathe into them (like a flute).

While you are having chest physiotherapy, make sure you breathe in and out slowly and fully until the mucus in your lungs is loose enough to cough up. Your therapist will show you how to get into a position that uses gravity to help the mucus in your lungs drain.

Alternative Medicine for Lung Mucus

There are some natural remedies that may help reduce the mucus in your lungs. Keep in mind that even though they are "natural," complementary and alternative medicine (CAM) therapies can have side effects.

CAM therapies that may help clear mucus in the lungs include:

  • Warm fluids: Drinking warm (not hot) liquids can help loosen thickened mucus. Try tea, warm broth, or hot water with lemon.
  • Steam: You can use a device such as a cool-mist humidifier or steam vaporizer to breathe in warm air. You can also take a hot shower or breathe in vapors from a pot of simmering water. These methods introduce moist air into your air passages, which helps loosen the mucus in your lungs. However, do not inhale oils because they can cause an inflammatory or allergic lung reaction.
  • HoneyHoney may reduce inflammation and coughing. However, it is not clear whether honey specifically helps in coughing up mucus.
  • Chinese medicine: Chinese herbs and treatments have traditionally been used to reduce mucus in the lungs. While there are anecdotal reports that they are helpful, the scientific data is not clear about the benefits.
  • A few herbs—including mao huang (Herba ephedrae), tao ren (Semen persicae), and Huang qin (Radix scutellariae)—may ease the symptoms of respiratory disease.
  • Qigong, a practice of breathing exercises and movements, may also help.

Ask Your Provider About CAM for Lung Mucus

CAM therapies are not safe for everyone. If you take certain medications or have certain health conditions, you may not be able to use them.

If you want to try an herb, supplement, or natural remedy to help clear mucus in your lungs, talk to your provider. They will make sure that it would be safe for you to try these treatments.

Summary

Mucus in the lungs can be part of having certain health conditions and something that you'll need to learn how to manage.

Regularly clearing mucus from your lungs is part of living with bronchiectasis and COPD. Controlled coughing, deep breathing, over-the-counter and prescription medications, chest physiotherapy, and alternative therapies help by reducing, loosening, and coughing up the mucus to prevent lung infections.

It's important that you use mucus-reducing strategies on a regular basis, not just when your symptoms act up. If you have been diagnosed with pulmonary disease, talk to your healthcare provider or respiratory therapist about the best approaches for managing mucus in your lungs.

Frequently Asked Questions

  • How do you know if your lungs are filled with mucus?

    If you have mucus in your lungs, you might have a "wet" cough or be able to hear the fluid in your chest when you breathe. You may wheeze or find it harder to breathe if there is mucus build-up in your lungs.

  • How do I naturally get rid of mucus in the lungs?

    One way to get rid of mucus or phlegm naturally is by doing controlled huff coughing to clear your lungs.

    1. Sit up straight, slightly tilt your chin toward the ceiling, and open your mouth.
    2. Slowly take a deep breath in, filling your lungs about three-quarters full.
    3. Hold your breath for three seconds.
    4. Forcefully exhale in a slow, continuous manner.
    5. Repeat steps one to four at least two or three more times. Then, perform a single strong cough. This should remove mucus concentrated in the larger airways.

  • Is chest congestion common in COVID-19?

    About one-third of people with COVID-19 have chest congestion or pressure as a symptom. COVID often causes a dry (non-productive) cough but some people have a productive cough and cough up thick mucus.

  • What causes phlegm?

    The body makes phlegm and mucus to line the tissues and protect and moisturize them, as well as trap potential irritants and germs.

  • What medicine can be used to clear phlegm from the throat?

    Mucus thinners (mucolytics) are over-the-counter (OTC) medicines that help thin mucus or phlegm in the airways, making it easier to cough up. Two types of mucus thinners are Pulmozyme (dornase alfa) and hypertonic saline.

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.
  1. Poole P, Sathananthan K, Fortescue R. Mucolytic agents versus placebo for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Airways Group, ed. Cochrane Database of Systematic Reviews. 2019 May 20;5(5):CD001287. doi:10.1002/14651858.CD001287.pub6

  2. Aaron SD. Mucolytics for COPD: negotiating a slippery slope towards proof of efficacy. Eur Respir J. 2017;50(4). doi:10.1183/13993003.01465-2017

  3. Warnock L, Gates A. Chest physiotherapy compared to no chest physiotherapy for cystic fibrosis. Cochrane Database Syst Rev. 2015;(12):CD001401. doi:10.1002/14651858.CD001401.pub3

  4. Cohen HA, Hoshen M, Gur S, Bahir A, Laks Y, Blau H. Efficacy and tolerability of a polysaccharide-resin-honey based cough syrup as compared to carbocysteine syrup for children with colds: a randomized, single-blinded, multicenter studyWorld J Pediatr. 2017;13(1):27-33. doi:10.1007/s12519-016-0048-4

  5. Tong H, Liu Y, Zhu Y, Zhang B, Hu J. The therapeutic effects of qigong in patients with chronic obstructive pulmonary disease in the stable stage: a meta-analysis. BMC Complement Altern Med. 2019;19(1):239. doi:10.1186/s12906-019-2639-9

  6. American Lung Association. Understanding Mucus in Your Lungs.

  7. Centers for Respiratory Health. Clearing lung mucus in five easy steps with huff coughing.

  8. Cystic Fibrosis Foundation. Mucus thinners.

By Deborah Leader, RN

 Deborah Leader RN, PHN, is a registered nurse and medical writer who focuses on COPD.

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Post-Covid: Lifestyle Changes To Improve & Recover Lung Health Post-Covid

Post-covid: Quit smoking today to reduce further lung damage

Covid-19 took the world by storm since it emerged at the end of 2019. The coronavirus often attacks and causes harm to our respiratory system. Our lungs are an integral part of our respiratory system. Studies have shown, covid-19 might cause long-term harm to our lungs.

COVID-19 has the potential to result in lung problems such as pneumonia and, in the most severe cases, ARDS. Another potential COVID-19 consequence, sepsis, can injure the lungs and other organs permanently. More airway diseases like bronchitis that may be severe enough to require hospitalisation may also be brought on by more recent coronavirus strains.

Patients can take several actions to improve their risk of suffering from less severe lung damage. Regaining adequate lung capacity and function is a vital step in the healing process. Enhancing lung function also helps to remove mucus from the lungs, which makes breathing easier. In this article, we list lifestyle changes you can perform to improve your lung health post-covid.

Here are lifestyle choices that can help you recover from covid-19 and improve your lung health:

1. Exercise

Exercise the lung muscles to increase their capacity and function because it is one of the best ways to improve lung function. Similar to any physical activity, exercises that increase lung function concentrate on building and extending lung capacity. gradually increase the body's and the lungs' capacity. These workouts can enhance the way that our lungs expand. Respiratory issues can be managed and shortness of breath can be decreased with the use of pulmonary rehabilitation.

2. Eat well

Our general immune system is strengthened by eating foods high in antioxidants, which also benefits our lung function. Essential nutrients can be obtained via a nutritious diet, which also benefits the lungs. Fruits, vegetables, legumes, nuts, grains, juices, home-cooked meals, and foods high in vitamins and minerals should all be consumed. Water consumption needs to be increased during COVID-19 recovery in addition to important dietary adjustments because it is essential for improving our body's overall health.

3. Quit smoking

Smoking alters the lungs' and immune cells' functional and morphological characteristics. Smoking not only impairs the health and functionality of your lungs but also places additional stress on other crucial organs. Smoking after COVID-19 may lead to lung infections and long-term health issues. Speak to your doctor to navigate the best ways to quit tobacco.

4. Drink in moderation

Alcohol has a similar impact on our body's immune system as smoking does. Our immune system has tougher time-fighting infections as a result. It further affects the functioning and health of other organs such as our liver. Drinking occasionally may not cause the same amount of harm.

In conclusion, just simple lifestyle changes can go a long way in ensuring your lungs stay healthy and function to their best potential. You can improve your lung health and quickly recover from long COVID-19 symptoms by making these important lifestyle adjustments. Make sure to take good care of your lungs and overall body. You must also seek a doctor's help to help you navigate how you can care for yourself post-covid.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.

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We included two new trials in this update (540 participants), for a total of eight RCTs (974 participants). Four RCTs were conducted in the United States, two in Sweden, one in China, and one in the United Kingdom. The studies looked at five types of chest physiotherapy: conventional chest physiotherapy; osteopathic manipulative treatment (OMT, which includes paraspinal inhibition, rib raising, and myofascial release); active cycle of breathing techniques (which includes active breathing control, thoracic expansion exercises, and forced expiration techniques); positive expiratory pressure; and high-frequency chest wall oscillation.

We assessed four trials as at unclear risk of bias and four trials as at high risk of bias.

Conventional chest physiotherapy (versus no physiotherapy) may have little to no effect on improving mortality, but the certainty of evidence is very low (risk ratio (RR) 1.03, 95% confidence interval (CI) 0.15 to 7.13; 2 trials, 225 participants; I² = 0%). OMT (versus placebo) may have little to no effect on improving mortality, but the certainty of evidence is very low (RR 0.43, 95% CI 0.12 to 1.50; 3 trials, 327 participants; I² = 0%). Similarly, high-frequency chest wall oscillation (versus no physiotherapy) may also have little to no effect on improving mortality, but the certainty of evidence is very low (RR 0.75, 95% CI 0.17 to 3.29; 1 trial, 286 participants).

Conventional chest physiotherapy (versus no physiotherapy) may have little to no effect on improving cure rate, but the certainty of evidence is very low (RR 0.93, 95% CI 0.56 to 1.55; 2 trials, 225 participants; I² = 85%). Active cycle of breathing techniques (versus no physiotherapy) may have little to no effect on improving cure rate, but the certainty of evidence is very low (RR 0.60, 95% CI 0.29 to 1.23; 1 trial, 32 participants). OMT (versus placebo) may improve cure rate, but the certainty of evidence is very low (RR 1.59, 95% CI 1.01 to 2.51; 2 trials, 79 participants; I² = 0%).

OMT (versus placebo) may have little to no effect on mean duration of hospital stay, but the certainty of evidence is very low (mean difference (MD) −1.08 days, 95% CI −2.39 to 0.23; 3 trials, 333 participants; I² = 50%). Conventional chest physiotherapy (versus no physiotherapy, MD 0.7 days, 95% CI −1.39 to 2.79; 1 trial, 54 participants) and active cycle of breathing techniques (versus no physiotherapy, MD 1.4 days, 95% CI −0.69 to 3.49; 1 trial, 32 participants) may also have little to no effect on duration of hospital stay, but the certainty of evidence is very low. Positive expiratory pressure (versus no physiotherapy) may reduce the mean duration of hospital stay by 1.4 days, but the certainty of evidence is very low (MD −1.4 days, 95% CI −2.77 to −0.03; 1 trial, 98 participants).

Positive expiratory pressure (versus no physiotherapy) may reduce the duration of fever by 0.7 days, but the certainty of evidence is very low (MD −0.7 days, 95% CI −1.36 to −0.04; 1 trial, 98 participants). Conventional chest physiotherapy (versus no physiotherapy, MD 0.4 days, 95% CI −1.01 to 1.81; 1 trial, 54 participants) and OMT (versus placebo, MD 0.6 days, 95% CI −1.60 to 2.80; 1 trial, 21 participants) may have little to no effect on duration of fever, but the certainty of evidence is very low.

OMT (versus placebo) may have little to no effect on the mean duration of total antibiotic therapy, but the certainty of evidence is very low (MD −1.07 days, 95% CI −2.37 to 0.23; 3 trials, 333 participants; I² = 61%). Active cycle of breathing techniques (versus no physiotherapy) may have little to no effect on duration of total antibiotic therapy, but the certainty of evidence is very low (MD 0.2 days, 95% CI −4.39 to 4.69; 1 trial, 32 participants).

High-frequency chest wall oscillation plus fibrobronchoscope alveolar lavage (versus fibrobronchoscope alveolar lavage alone) may reduce the MD of intensive care unit (ICU) stay by 3.8 days (MD −3.8 days, 95% CI −5.00 to −2.60; 1 trial, 286 participants) and the MD of mechanical ventilation by three days (MD −3 days, 95% CI −3.68 to −2.32; 1 trial, 286 participants), but the certainty of evidence is very low.

One trial reported transient muscle tenderness emerging after OMT in two participants. In another trial, three serious adverse events led to early withdrawal after OMT. One trial reported no adverse events after positive expiratory pressure treatment.

Limitations of this review were the small sample size and unclear or high risk of bias of the included trials.

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Overview

Legionellosis varies in severity from a mild febrile illness to a serious and sometimes fatal form of pneumonia and is caused by exposure to the Legionella bacteria species found in contaminated water and potting mixes.

Cases of legionellosis are often categorized as being community, travel or hospital acquired based on the type of exposure.

Worldwide, waterborne Legionella pneumophila is the most common cause of cases including outbreaks. Legionella pneumophila and related species are commonly found in lakes, rivers, creeks, hot springs and other bodies of water. Other species including L. longbeachae can be found in potting mixes. 

The bacterium L. pneumophila was first identified in 1977 as the cause of an outbreak of severe pneumonia in a convention centre in the USA in 1976. It has since been associated with outbreaks linked to poorly maintained artificial water systems.

The infective dose is unknown but can be assumed to be low for susceptible people, as illnesses have occurred after short exposures and 3 or more kilometres from the source of outbreaks. The likelihood of illness depends on the concentrations of Legionella in the water source, the production and dissemination of aerosols, host factors such as age and pre-existing health conditions and the virulence of the particular strain of Legionella. Most infections do not cause illness.

The cause

The causative agents are Legionella bacteria from water or potting mix. The most common cause of illness is the freshwater species L. pneumophila, which is found in natural aquatic environments worldwide. However, artificial water systems which provide environments conducive to the growth and dissemination of Legionella represent the most likely sources of disease. 

The bacteria live and grow in water systems at temperatures of 20 to 50 degrees Celsius (optimal 35 degrees Celsius). Legionella can survive and grow as parasites within free-living protozoa and within biofilms which develop in water systems. They can cause infections by infecting human cells using a similar mechanism to that used to infect protozoa. 

Transmission

The most common form of transmission of Legionella is inhalation of contaminated aerosols from contaminated water. Sources of aerosols that have been linked with transmission of Legionella include air conditioning cooling towers, hot and cold water systems, humidifiers and whirlpool spas. Infection can also occur by aspiration of contaminated water or ice, particularly in susceptible hospital patients, and by exposure of babies during water births. To date, there has been no reported direct human-to-human transmission.

Extent of the disease

Legionnaires’ disease is believed to occur worldwide.

The identified incidence of Legionnaires’ disease varies widely according to the level of surveillance and reporting. Since many countries lack appropriate methods of diagnosing the infection or sufficient surveillance systems, the rate of occurrence is unknown. In Europe, Australia and the USA there are about 10–15 cases detected per million population per year.

Of the reported cases, 75–80% are over 50 years and 60–70% are male. Other risk factors for community-acquired and travel-associated legionellosis include smoking, a history of heavy drinking, pulmonary-related illness, immuno-suppression, and chronic respiratory or renal illnesses. 

Risk factors for hospital-acquired pneumonia are recent surgery, intubation (the process of placing a tube in the trachea), mechanical ventilation, aspiration, presence of nasogastric tubes, and the use of respiratory therapy equipment. The most susceptible hosts are immuno-compromised patients, including organ transplant recipients and cancer patients and those receiving corticosteroid treatment.

Delay in diagnosis and administration of appropriate antibiotic treatment, increasing age and presence of co-existing diseases are predictors of death from Legionnaires’ disease.

Symptoms

Legionellosis is a generic term describing the pneumonic and non-pneumonic forms of infection with Legionella

The non-pneumonic form (Pontiac disease) is an acute, self-limiting influenza-like illness usually lasting 2–5 days. The incubation period is from a few and up to 48 hours. The main symptoms are fever, chills, headache, malaise and muscle pain (myalgia). No deaths are associated with this type of infection.

Legionnaires’ disease, the pneumonic form, has an incubation period of 2 to 10 days (but up to 16 days has been recorded in some outbreaks). Initially, symptoms are fever, loss of appetite, headache, malaise and lethargy. Some patients may also have muscle pain, diarrhoea and confusion. There is also usually an initial mild cough, but as many as 50% of patients can present phlegm. Blood-streaked phlegm or hemoptysis occurs in about one-third of the patients. The severity of disease ranges from a mild cough to a rapidly fatal pneumonia. Death occurs through progressive pneumonia with respiratory failure and/or shock and multi-organ failure.

Untreated Legionnaires’ disease usually worsens during the first week. In common with other risk factors causing severe pneumonia, the most frequent complications of legionellosis are respiratory failure, shock and acute kidney and multi-organ failure. Recovery always requires antibiotic treatment, and is usually complete, after several weeks or months. In rare occasions, severe progressive pneumonia or ineffective treatment for pneumonia can result in brain sequelae.

The death rate as a result of Legionnaires’ disease depends on the severity of the disease, the appropriateness of initial anti-microbial treatment, the setting where Legionella was acquired, and host factors (for example, the disease is usually more serious in patients with immuno-suppression). The death rate may be as high as 40–80% in untreated immuno-suppressed patients and can be reduced to 5–30% through appropriate case management and depending on the severity of the clinical signs and symptoms. Overall the death rate is usually within the range of 5–10%. 

Response

Treatments exist, but there is no vaccine currently available for Legionnaires’ disease.

The nonpneumonic form of infection is self-limiting and does not require medical interventions, including antibiotic treatment. Patients with Legionnaires’ disease always require antibiotic treatment following diagnosis.

The public health threat posed by legionellosis can be addressed by implementing water safety plans by authorities responsible for building safety or water system safety. These plans must be specific to the building or water system and should result in the introduction and regular monitoring of control measures against identified risks including Legionella. Although it is not always possible to eradicate the source of infection, it is possible to reduce the risks substantially.

Prevention of Legionnaires’ disease depends on applying control measures to minimize the growth of Legionella and dissemination of aerosols. These measures include good maintenance of devices, including regular cleaning and disinfection and applying other physical (temperature) or chemical measures (biocide) to minimize growth. Some examples are: 

  • the regular maintenance, cleaning and disinfection of cooling towers together with frequent or continuous addition of biocides; 
  • installation of drift eliminators to reduce dissemination of aerosols from cooling towers; 
  • maintaining an adequate level of a biocide such as chlorine in a spa pool along with a complete drain and clean of the whole system at least weekly; 
  • keeping hot and cold water systems clean and either keeping the hot water above 50 °C (which requires water leaving the heating unit to be at or above 60 °C) and the cold below 25 °C and ideally below 20 °C or alternatively treating them with a suitable biocide to limit growth, particularly in hospitals and other health care settings, and aged-care facilities; and
  • reducing stagnation by flushing unused taps in buildings on a weekly basis. 

Applying such controls will greatly reduce the risk of Legionella contamination and prevent the occurrence of sporadic cases and outbreaks. Extra precautions may be required for water and ice provided to highly susceptible patients in hospitals including those at risk of aspiration (for example, ice machines can be a source of Legionella and should not be used by highly susceptible patients).

Control and prevention measures must be accompanied by proper vigilance on the part of general practitioners and community health services for the detection of cases. 

WHO makes available technical resources to support the management and control of legionellosis and advises Member States when specific queries are raised.

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Acute respiratory distress syndrome (ARDS) is a noncardiogenic pulmonary edema secondary to inflammation-related lung injury from a variety of causes. It is diagnosed clinically as it is characterized by acute onset bilateral pulmonary infiltrates associated with worsening dyspnea once cardiogenic pulmonary edema and alternate causes of acute hypoxic respiratory failure are ruled out. Pulmonary infiltrates in ARDS are caused by diffuse inflammatory lung injury from a variety of insults including sepsis, pneumonia, aspiration, toxin inhalation, blood transfusion reaction, pancreatitis, amniotic fluid embolism, and many other causes [1]. Amniotic fluid embolism (AFE) is a rare cause of ARDS in the immediate post-partum period and is one of the most severe complications of pregnancy. It is seen in about one out of 40,000 deliveries, and mortality ranges between 20% and 60% [2]. We present a patient who developed hypoxic respiratory failure six hours after delivery and required endotracheal intubation and mechanical ventilation within four hours of symptom onset. Narrowing down the differential diagnosis, atypical AFE remained the most likely explanation for her symptoms. The purpose of this case presentation is to share an unusual and rare case of ARDS secondary to atypical AFE where many of the clinical features of AFE were missing.

A 25-year-old gravida 3 para 2 Hispanic female with anemia of pregnancy and no other medical problems was admitted to the labor and delivery unit at 38 weeks gestation while she was in labor. She followed up with her obstetrician regularly throughout her pregnancy, and her pregnancy course had been uncomplicated. She did not have any history of complicated pregnancy or delivery in the past, no history of surgeries in the past, did not smoke cigarettes or drink alcohol, and did not use any illegal drugs. Her home medications included ferrous sulfate 325 mg daily and prenatal vitamins. The vital signs at presentation were pulse of 89 bpm, blood pressure of 130/85 mmHg, respiratory rate of 18/min, temperature of 98.6°F, and oxygen saturation of 97% on room air. The physical examination was normal, including normal respiratory and cardiovascular examination. The pelvic examination done by the obstetrician was normal for gestational age, and the fetal heart rate was also normal with moderate variability and no decelerations. Her only symptoms were related to her labor, and she denied any recent fever or any respiratory or cardiovascular symptoms. Laboratory workup showed white blood cell (WBC) count of 15.9/mcL (4-10.6/mcL) with 90% neutrophils and hemoglobin (Hb) of 8.8 mg/dL (12-16 mg/dL) with a low mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC) indicative of microcytic and hypochromic anemia, consistent with her previously diagnosed anemia of pregnancy. A healthy male infant was delivered vaginally within one hour of admission, without requiring any instrumentation or surgical procedure, a complete placenta was removed, and a second-degree laceration was successfully repaired. No postdelivery bleeding or any other complications were noted. The patient started complaining of dyspnea six hours after vaginal delivery and developed tachycardia and tachypnea. There was no chest pain, loss of consciousness, nausea, or vomiting, and she was not given any new medicines/food or blood transfusion before/during her symptoms started. Vital signs were as follows: pulse 142 bpm, blood pressure 140/78 mmHg, and temperature 97°F. CT pulmonary angiography (CTA) was performed to rule out pulmonary embolism (PE), which was negative for PE but showed dense bilateral opacities (Figure 1).

CT scan of the abdomen and pelvis with contrast only showed an enlarged uterus, and no other abnormalities were observed. Bedside transthoracic echocardiogram (TTE) showed left ventricular ejection fraction (EF) > 75%, without diastolic dysfunction or hemodynamically significant valvular abnormalities, and there were no vegetations. The patient was transferred to ICU as her oxygen saturation started dropping. She was started on oxygen, initially, a Venturi mask, which was later switched to a nonrebreather mask. However, hypoxia was not corrected, and tachypnea and tachycardia kept getting worse, ultimately requiring endotracheal intubation and mechanical ventilation within four hours of symptom onset. Arterial blood gases (ABGs) showed hypoxic respiratory failure, and the initial PaO2/FiO2 ratio was 95 (PaO2 38 mmHg while on Venturi mask with 40% oxygen saturation). The patient remained hemodynamically stable, no pressor support was required, and no cardiac arrhythmias were observed. Her physical examination at this point revealed bilateral crackles; however, the rest of the physical exam including the gynecological exam remained unremarkable, without any evidence of bleeding or infection. Repeat laboratory workup showed worsening leukocytosis with neutrophilic predominance and lymphopenia (Table 1). Blood and sputum cultures were sent, and broad-spectrum antibiotics including piperacillin-tazobactam 4-0.5 g every eight hours and linezolid 600 mg every 12 hours were started while awaiting culture results. The patient was on high ventilator support at this time and was transferred to a higher level of facility for extracorporeal membrane oxygenation (ECMO).

Laboratory workup 0 hours 10 hours 24 hours Reference range
White blood cells (WBC) 15.9 21.7 26.9 5.9-16.9/mcL
Absolute neutrophil count (ANC) 14.3 19.9 24.6 3.9-13.1/mcL
Absolute lymphocyte count 0.8 0.8 0.7 1-3.6/mcL
Hemoglobin (Hb) 8.8 7.4 7.7 9.5-15.0 g/dL
Platelets 156 207 209 146-429/mcL
Prothrombin time (PT)   10.4 10.3 9.6-12.9 seconds
International normalization ratio (INR)   1 0.99 0.8-1.09
Partial thromboplastin time (PTT)   24.5 55 22.6-35 seconds
Sodium   138 139 130-148 mmol/L
Potassium   3.5 3.6 3.3-5.1 mmol/L
Chloride   108 107 97-109 mmol/L
Bicarbonate   22 25 12-22 mmol/L
Creatinine   0.5 0.6 12-22 mmol/L
Blood urea nitrogen (BUN)   10 10 3-11 mg/dL
Calcium   7.1 7.8 8.2-9.7 mg/dL
Total bilirubin   0.35 0.29 0.1-1.1 mg/dL
Alkaline phosphatase (ALP)   180 168 38-229 units/L
Aspartate transaminase (AST)   32 39 4-32 units/L
Alanine aminotransferase (ALT)   15 18 2-25 units/L
Lactic acid     2.2 0.4-2.0 mmol/L

ARDS was first recognized in the 1960s and described as acute onset hypoxia, dyspnea, and loss of lung compliance after a variety of stimuli, which did not respond to usual respiratory therapy. It was later called adult respiratory distress syndrome due to its similarity to infant respiratory distress syndrome and was finally named ARDS [3]. Normal healthy lungs performed gas exchange as ventilation (V) matches perfusion (Q). At rest, the normal V/Q ratio is approximately equal to 1. This ratio is disturbed in many cardiorespiratory pathologies including ARDS. A normal alveolar-capillary unit consists of capillary endothelium, capillary basement membrane, interstitial space, alveolar epithelium, and alveolar basement membrane. On average, this barrier is only 0.5 µm thick, which allows excellent gas exchange, provided V matches Q. This barrier is disturbed in ARDS. ARDS results from one or more insults that cause diffuse lung injury. The injury results in pro-inflammatory cytokine release including interleukins (IL-1, IL-6, and IL-8) and tumor necrotic factor (TNF), which mediate damage and activation of the endothelium, resulting in increased permeability and release of fluid and proteins into the interstitium, leading to interstitial edema. This protein-rich edema also interferes with surfactant function, leading to an increase in lung compliance. The overall effect is V/Q mismatch leading to impaired gaseous exchange and a decrease in lung compliance causing stiff lungs [1,4]. There are more than 60 etiologies resulting in ARDS, and the list continues to get longer. The most common causes of ARDS include pneumonia, sepsis, and aspiration [5]. Our patient was diagnosed with ARDS using the Berlin definition. A list of differential diagnoses leading to ARDS in our patient with supporting and negating evidence is listed below (Table 2). 

Suspected differentials as a cause of ARDS in our patient Supporting evidence Negating evidence
Sepsis Sepsis is the most common cause of ARDS. The repair of a second-degree vaginal tear was recently performed. Fever, tachycardia, tachypnea, and leukocytosis were present. The patient meets the SIRS criteria for sepsis (temperature > 100, HR > 90, RR > 20, WBC > 12,000). Sudden onset of severe ARDS in a hemodynamically stable patient without definitive sepsis is unlikely secondary to sepsis. The symptoms started within six hours of vaginal tear repair, and the development of sepsis and causing ARDS is unlikely to happen within six hours only.
Infectious pneumonia Infectious pneumonia is a common cause of ARDS. Dyspnea, tachypnea, fever, and tachycardia were present when the symptoms started. Worsening leukocytosis was observed as the symptoms worsened. Dense bilateral pulmonary infiltrates were present, and pneumonia can have a similar appearance on imaging. No cough, dyspnea, or fever were present at the time of admission. The symptoms started within six hours of admission and quickly worsened, which is a short time for pneumonia to develop and get worse. Respiratory cultures and respiratory viral PCR panel including COVID-19 were negative, and no definitive respiratory infection was found.
Aspiration pneumonia Aspiration pneumonia is a common cause of ARDS. Sudden onset of symptoms may be seen with aspiration pneumonitis. The patient did not have any risk factors for aspiration. No nausea, vomiting, loss of consciousness, or any other aspiration events were observed before the symptoms started. Imaging showed diffuse bilateral pulmonary infiltrates rather than segmental or lobar infiltrates especially in dependent pulmonary segments.
Transfusion-related acute lung injury Sudden onset of symptoms No blood products were transfused before the symptoms started.
Amniotic fluid embolism The symptoms started after delivery. Rapid onset and worsening of symptoms are typical for amniotic fluid embolism. One-fourth of the cases of amniotic fluid embolism present with an atypical presentation, which may lack the other clinical features. No fever was present during labor. Amniotic fluid embolism is a rare cause of ARDS. The symptoms usually start within 30 minutes of delivery. No hemodynamic instability, cardiovascular collapse, seizures, or DIC were observed. 

Sepsis is the most common cause of ARDS, and it should be the first differential in consideration in patients with severe infection or new hypotension. Sepsis causes ARDS mainly secondary to systemic inflammation leading to increased pulmonary capillary endothelial permeability. Our patient had nonspecific symptoms related to sepsis, including fever, tachycardia, tachypnea, and leukocytosis, and she met the systemic inflammatory response syndrome (SIRS) criteria for sepsis (as shown in Table 2); however, most of these symptoms are nonspecific and can be seen in systemic inflammation from various etiologies. SIRS criteria are sensitive but lack specificity compared to qSOFA (Quick SOFA) criteria, and the patient met only one qSOFA criterion (RR > 22/min). Furthermore, she remained hemodynamically stable despite severe ARDS, and no definitive source of infection was found [6].

Infectious pneumonia is a common cause of ARDS outside the hospital and is mostly caused by COVID-19, Streptococcus pneumonia, Legionella pneumophila, and gram-negative bacilli. It is unlikely to be the cause of ARDS in our patient as infectious pneumonia presents with cough, dyspnea, and fever and is unlikely to cause sudden onset ARDS in a patient without any preceding respiratory symptoms [7,8]. Furthermore, laboratory workup including respiratory viral panel (includes COVID-19 PCR) and respiratory bacterial cultures was normal. Our patient was fully vaccinated against COVID-19.

Aspiration pneumonia is a recognized complication of general anesthesia, trauma, and ICU patients, especially with an altered level of consciousness. The gastric contents with acidic pH with or without particulate food are aspirated into the lungs, which leads to initial chemical pneumonitis and later may get infected and develop into bacterial pneumonia. Severity can range from mild pneumonitis to severe ARDS. Most events leading to aspiration are either unwitnessed or silent. Our patient did not have any risk factors for aspiration, and no aspiration events were observed. Aspiration can cause chemical pneumonitis initially, however, unlikely to cause a sudden onset of severe ARDS with dense bilateral infiltrates as initial presentation [9].

Transfusion-related acute lung injury (TRALI) is a clinical diagnosis and develops during or shortly after blood product transfusion is performed. ARDS should develop within six hours of blood product transfusion to meet the diagnostic criteria for TRALI. Our patient did not receive any blood transfusions before or during the symptoms started, making this diagnosis unlikely [10].

AFE remains one of the most dreadful complications of pregnancy. It is a rare condition, and the incidence varies in different parts of the world, usually between 1.9 and 6.1 cases per 100,000 deliveries [11]. It was initially reported in 1926, though it was described in the case series for the first time in 1941. The pathogenesis is not clear; however, it is believed to result from the entry of amniotic fluid into the maternal systemic circulation secondary to disruption of a barrier between the amniotic fluid and maternal circulation usually at the time of delivery. Entry of amniotic fluid into maternal circulation results in a severe inflammatory response that causes clinical manifestations of AFE. There is no mechanical obstruction of pulmonary vasculature from the amniotic fluid; however, elevated pulmonary pressures are still seen due to ARDS.

Elevated pulmonary pressures and the direct effect of the inflammatory mediators on the myocardium may lead to cardiac dysfunction, which may also contribute to pulmonary edema. Symptoms usually start during labor or 30 minutes after delivery; however, cases occurring during the first and second trimesters have been reported. Onset is abrupt most of the time, and the symptoms progress rapidly in a catastrophic manner. Clinical features include hypoxic respiratory failure secondary to ARDS, hemodynamic compromise usually from cardiac arrest (typically ventricular tachycardia or fibrillation), and bleeding secondary to disseminated intravascular coagulopathy (DIC). Laboratory workup may show findings suggestive of DIC (elevated D-dimer, low fibrinogen, and thrombocytopenia), leukocytosis, and anemia (secondary to hemorrhage). Chest imaging shows dense bilateral infiltrates. The diagnosis is clinical, and it is a diagnosis of exclusion as there is no confirmatory test available [1,12]. However, all clinical findings are not seen in every patient, and there are many atypical cases described in case reports. One-fourth of all patients present only with hypotension and acute respiratory failure. Rarely, DIC may be an initial presentation, or it may be absent [13]. Our patient may have atypical AFE as the patient was completely asymptomatic at the time of admission, and the symptoms rapidly developed and progressed after vaginal delivery to the point that she required intubation and later ECMO over less than 24 hours. Sepsis can be another possibility; however, AFE is more likely to cause a rapid onset of worsening ARDS after delivery in a patient without any evidence of sepsis or septic shock.

Other risk factors for ARDS include lung and hematopoietic stem cell transplant, drug overdose and idiosyncratic reaction, severe trauma including lung contusion and fat embolism, acute pancreatitis, near drowning, thoracic surgery, etc., none of which were observed or suspected in our patient.

ARDS is characterized by noncardiogenic pulmonary edema and is one of the most common diagnoses requiring ICU admission. It presents with acute onset hypoxic respiratory failure, associated with new bilateral pulmonary infiltrates. It is important to promptly diagnose and treat ARDS to reduce the associated high mortality. There are over 60 known causes of ARDS, and the list is getting longer with time. AFE is a very rare cause of ARDS, which is seen within six hours after delivery, and is usually associated with hemodynamic instability secondary to cardiac arrhythmias and bleeding secondary to DIC. Many atypical cases of AFE have been reported. Our patient did not have a clear cause of ARDS, and after ruling out the other diagnoses, the atypical AFE remained the most likely explanation for ARDS. The purpose of this case report is to highlight the importance of having atypical AFE among the differential diagnoses if ARDS develops in a pregnant woman especially after delivery, even if some of the clinical features of AFE are missing. 



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The name "Pickwickian syndrome" was coined after a fictional obese character named Joe in Charles Dickens's novel the “Pickwick Papers” [1]. There has been an inexorable rise in the number of cases of obesity worldwide in the past four to five years. India is undergoing a rapid epidemiological transition, from an underweight to an overweight/obese population. It can be attributed to the rapid lifestyle changes associated with high caloric intake and reduced physical activity, putting Indian people at a high risk of obesity. Obesity is associated with innumerable comorbidities including hypertension, diabetes mellitus, and cardiac complications [2]. Obesity hypoventilation syndrome (OHS), the prevalence of which has been shown to rise in direct proportion to the prevalence of obesity, is considered an important sequela of severe obesity. Patients with OHS experience a wide variety of difficulties ranging from congestive cardiac failure, metabolic syndrome, and obstructive sleep apnea (OSA). We report the case of a 62-year-old female who presented with severe dyspnea and, after polysomnography (PSG), was diagnosed with OHS and managed with non-invasive positive pressure ventilation (NIPPV) support.

A 62-year-old female presented to the ED with complaints of breathlessness for six months, which had been initially mild but progressed to severe dyspnea in the last 15 days prior to the admission. The patient also had complaints of a productive cough and intermittent low-grade fever with chills for 10 days. She had consulted at a local hospital for the same complaints and received symptomatic management with inhaled bronchodilators and oxygen support, but did not show any clinical improvement and was referred to our tertiary care center in Wardha, India for further management.

Clinical examination and routine investigations

On general examination, the patient was found to have severe obesity with a BMI of 42 Kg/m2. The vital parameters of the patient were as follows - pulse rate: 98 beats/minute, blood pressure: 150/90 mmHg, respiratory rate: 28 breaths/minute, and oxygen saturation: 84% on room air on pulse oximetry. She also had bilateral pitting edema present on the lower limbs and a raised jugular venous pressure (JVP). No other obvious abnormalities were found on the rest of the clinical examination. The clinical image of the patient on admission to the ICU is shown in Figure 1.

The patient underwent arterial blood gas (ABG) analysis, which revealed respiratory acidosis along with hypoxia and hypercapnia; other routine blood investigations showed no abnormalities apart from elevated blood d-dimer levels. The results of significant blood investigations are summarized in Table 1.

Arterial blood gas analysis (ABG) Patient values Normal range
Potential of hydrogen (pH) 7.26 7.35–7.45
Partial pressure of carbon dioxide (pCO2) 70 mmHg 35–45 mmHg
Partial pressure of oxygen (pO2) 58 mmHg 80–100 mmHg
D-dimer levels 980 ng/ml Less than 500 ng/ml

The patient was put on NIPPV support, but a repeat ABG analysis showed no improvements in her oxygenation status. She was intubated and put on mechanical ventilatory support in volume control (VC) mode. She was gradually weaned off mechanical ventilation and, following extubation after five days, was again put on NIPPV support. A detailed history of the patient did not reveal any major risk factors for chronic obstructive pulmonary disease (COPD). Further diagnostic imaging tests such as a chest X-ray and two-dimensional echocardiography (2D-echo) were done to rule out any comorbid cardiorespiratory conditions. The chest X-ray of the patient revealed bilateral mid-zone and lower-zone haziness, which may be seen in bilateral lower-lobe pneumonia or pleural effusion, as shown in Figure 2.

Ultrasonography (USG) of the thorax was done, which revealed no evidence of underlying pleural effusion. 2D-echo of the patient revealed a mildly dilated right atrium and right ventricle with a left ventricular ejection fraction (LVEF) of 55%. After the clinical stabilization of the patient, we conducted a PSG of the patient to investigate further causes of her respiratory failure, especially given her history of daytime sleepiness and excessive snoring. PSG revealed that the patient had an apnea-hypopnea index (AHI) of 58.2, which was classified as severe OSA as per a recent classification of OSA severity [3]. A summary of the PSG findings of the patient is given in Table 2.

Respiratory disturbance index including respiratory effort-related arousals (RERA) and total sleep time (TST)
  REM (episodes/hour) NREM (episodes/hour) TST (episodes/hour)
RDI 30 58.6 58.2
Apnea-hypopnea index (AHI) excluding central apneas
  REM (episodes/hour) NREM (episodes/hour) TST (episodes/hour)
AHI 30 58.6 58.2
Hypopnea summary
  Total events With drops in heart rate With drops in oxygen saturation
Total number 108 92 94
Max length (sec) 57.5 57 57.5
Central apnea summary
  Total events With drops in heart rate With drops in oxygen saturation
Total number 187 149 145
Max length (sec) 50 50 50
Apneas preceded by sighing 8 7 6

The hypnogram of the patient, showing multiple episodes of apnea and hypopnea and oxygen desaturation in various sleep stages, is shown in Figure 3.

After extensive investigations, we diagnosed the patient with OHS based on persistent daytime hypercapnia, OSA diagnosed on a PSG, and clinical findings of severe obesity. Overnight NIPPV support along with intermittent oxygen support during the daytime was continued. She was discharged after 15 days with stable vitals, with a prescription for overnight NIPPV support and a specialist consultation with a bariatric surgeon to consider possible weight-reduction interventions/surgeries.

After ruling out other pathologies that could lead to alveolar hypoventilation, OHS is characterized as the presence of obesity (BMI of 30 kg/m2), and daytime hypercapnia [arterial carbon dioxide tension (PaCo2) of more than 45 mmHg], with sleep-disordered breathing [2]. An upper airway obstruction, a deficiency in ventilatory drive, and obesity are the leading causes of OHS. Patients with OHS who are obese are forced to breathe at low functional residual capacity (FRC) with reduced diaphragm activity [3]. Indian patients have an OHS prevalence that is comparable to that of Caucasians, despite having a reduced BMI and spirometric findings [4]. All individuals with centrally distributed morbid obesity should get a thorough OHS evaluation. To confirm daytime hypercarbia and hypoxia, it is important to check for pulse oximetry data indicating awake hypoxemia and to conduct ABG analysis. To look into respiratory disorders related to sleep, a PSG should be carried out.

The patient in this report presented with severe hypoxia and hypercarbia needing mechanical intubation initially. This shows that obesity hypoventilation can present as acute illness or exacerbation where patients are more hypoxemic and more hypercapnic than usual. Proper management at such times becomes crucial. Therapeutic errors, especially at the time of hospitalization for respiratory or cardiovascular decompensation, should be avoided. Subjects with OHS may develop acute hypercapnia in response to the administration of excessive supplemental oxygen and excessive diuresis for peripheral edema using a loop diuretic such as furosemide exacerbates metabolic alkalosis, thereby leading to the worsening of daytime hypoventilation and hypoxemia [5]. Post-discharge management is essential for OHS patients. The most important component of managing OHS is weight loss [6]; yet, it is sometimes challenging to achieve and maintain weight loss with medical care. Bariatric surgery helps OHS patients lose weight more effectively and sustain it for longer periods of time. Recent research has revealed that using NIV to treat chronic respiratory failure is linked to weight loss and a reduction in sedentary time. In addition to NIV, a multimodal rehabilitation program can benefit OHS patients by enhancing weight loss and improving their ability to exercise [7].

OHS is not very frequently diagnosed in general practice and hence its prevalence is underestimated. A patient presenting with hypoxia and hypercarbia with central obesity should be carefully evaluated for OHS and a proper plan of management should be implemented to avoid any detrimental consequences. NIPPV should be instituted at the earliest along with effective weight reduction strategies to improve the prognosis of the patient. A PSG should also be done in such patients to rule out sleep-disordered breathing. Obesity is a health condition affecting almost all body systems, and this case report highlights its detrimental effects on respiratory and sleep physiology, which, in this case, led to hypercapnic respiratory failure.



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About a month after US Transportation Secretary Pete Buttigieg and his husband adopted their twins, the kids got a cold, which developed into a cough and then trouble breathing. What followed was a "terrifying" health scare, Buttigieg shared in a personal essay, describing the common yet often misdiagnosed sickness known as RSV.

Respiratory syncytial virus, more commonly referred to by the acronym RSV, is a respiratory virus that usually causes cold-like symptoms, according to the Centers for Disease Control and Prevention. Especially common in infants, almost all children get an RSV infection by their second birthday without too much cause for concern. But with more severe cases, RSV can cause infections such as bronchiolitis or pneumonia.

The twins, Penelope Rose and Joseph "Gus" August, were born prematurely and dealt with health issues during their first few weeks of life, putting them at higher risk for a severe case of RSV. The entire family were diagnosed with the virus: "For us it just meant a nasty cold, but for premature infants like them it was a serious threat," Buttigieg writes.

The twins were given oxygen and sent home a few days after receiving care. But Gus continued to struggle. "We started hearing words like 'serious' and then 'critical,' and soon the doctor was recommending we immediately transfer Gus to a full-scale children's hospital in Grand Rapids, about a hundred miles away, and place him on a ventilator," he continues. "Next thing we knew, the doctor had determined that the ventilator couldn't wait — Gus would need to be intubated now and then transferred." Fortunately, his condition improved enough to go home, and earlier this month, the twins celebrated their first birthday.

October is National RSV Awareness Month. Knowing what to look out for can save a life, so keep reading to learn more about how to prevent the virus and how to treat it.

What Is Respiratory Syncytial Virus?

It's a respiratory virus that usually causes cold-like symptoms. In high-risk babies — such as babies born prematurely, children under 2 born with heart or lung disease, infants with weakened immune systems, and children 8-10 weeks old — it can become a much more serious infection. Symptoms of RSV can include wheezing or difficulty breathing, decreased or no appetite, decreased fluid intake, sneezing and coughing, runny nose, and fever, according to the CDC. And severe cases of RSV can cause bronchiolitis or pneumonia.

How Is Respiratory Syncytial Virus Prevented?

Like with the common cold or COVID-19, washing your hands is an essential preventative measure, according to the Mayo Clinic. Avoiding exposure, keeping things clean by disinfecting surfaces, refraining from sharing glasses, and washing toys regularly are also listed as best practices. The Mayo Clinic also encourages parents not to smoke, as "babies who are exposed to tobacco smoke have a higher risk of getting RSV and potentially more-severe symptoms." If you do smoke, it's advised that you do it away from your baby — never in the house or car.

There's also a protective medication available, called palivizumab (Synagis). It's given in the form of a shot and designed for children under 2 who are at high risk of serious complications from RSV. Scientists are still working to develop a vaccine to protect against RSV.

If an infant has symptoms of a cold that aren't improving, take them to the doctor immediately.

How Is Respiratory Syncytial Virus Treated?

Most RSV infections go away on their own in less than two weeks, the CDC says. There's no current treatment plan to fight the infection, but for adults, you can relieve symptoms by drinking fluids to prevent dehydration and taking over-the-counter fever reducers and pain relievers. For children, talk to your healthcare provider first before giving them nonprescription cold medicines, and never give aspirin to children. In more severe cases when there is difficulty breathing, like with Buttigieg's twins, go to the hospital immediately. They may require additional oxygen or incubation.



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Human metapneumovirus (hMPV) is a viral illness that affects the upper respiratory tract. Several viruses can cause common cold symptoms, including hMPV. 

With hMPV, symptoms such as runny and stuffy nose are common. People may experience more serious effects in some cases, but most don't develop serious symptoms.

This article will take a closer look at the symptoms of human metapneumovirus, including frequent and rare symptoms and potential complications. It will also discuss when it might be time to seek medical help. 

Geber86 / Getty Images


Frequent Symptoms 

Most people who contract human metapneumovirus experience mild cold symptoms such as:

  • Runny nose
  • Congestion
  • Sore throat
  • Cough
  • Headache
  • Fever

Infants with human metapneumovirus may also experience weight loss.

Most people with mild symptoms will feel better within a few days and won’t require medical treatment. This virus most often circulates in winter and spring.

Rare Symptoms 

Some people with human metapneumovirus may develop shortness of breath. This is more likely in people with pre-existing respiratory conditions such as asthma (a chronic lung disease with constricted and inflamed airways). People with asthma may also experience flare-ups of their symptoms if they contract hMPV.

Other uncommon symptoms may include:

  • Trouble breathing
  • Wheezing (a high-pitched whistling sound when breathing)
  • Hoarse voice
  • Vomiting

Complications and Sub-Group Indications 

People are more likely to develop complications from a cold caused by human metapneumovirus if they are immunocompromised (have reduced immune system function).

However, hMPV is less likely to cause serious complications compared to other respiratory infections.

In some people, hMPV can develop into:

  • Pneumonia: Lung infection or inflammation of the airways and air sacs (alveoli)
  • Bronchitis: Inflammation of the bronchi, which are the larger air tubes in the lungs
  • Bronchiolitis: Inflammation of the smallest air tubes in the lungs (bronchioles)

What Is Bronchiolitis?

Bronchiolitis is inflammation of the smallest air passages in the lungs, the bronchioles. It is often caused by viral lung infections that primarily affect young children.

Symptoms may include:

  • Trouble breathing
  • Coughing
  • Fever
  • Fatigue
  • Intercostal retractions
  • Widening of nostrils while breathing
  • Fast breathing
  • Bluish tinge to the skin, which signals the need for emergency treatment

Children and Infants

According to the American Lung Association, between 5% to 16% of children who contract human metapneumovirus develop pneumonia, a serious lower respiratory tract complication. Infants are particularly susceptible to this kind of complication.

Infants under 1 year who develop serious complications may have a decreased appetite and display poor feeding. Additionally, children and infants with lung disease or who are born prematurely have a higher risk of developing complications.

One study found lower respiratory tract infection by hMPV was more common in infants and children whose birthing parent had asthma.

Symptoms of Pneumonia

Pneumonia is a potentially serious complication of hMPV that can cause:

  • Mucus-producing cough
  • Shortness of breath
  • Fever 
  • Sweating
  • Fast, shallow breathing
  • Chills
  • Pain in the chest coughing or breathing deeply
  • Nausea
  • Vomiting
  • Appetite loss 
  • Fatigue

Older Adults

People over age 75 are at greater risk of developing severe pneumonia from hMPV. Large outbreaks have been reported in nursing homes and skilled nursing facilities.

Symptoms of Bronchitis

Acute bronchitis (also called a chest cold) can cause symptoms such as:

  • Coughing, with mucus or without
  • Excessive fatigue
  • Body aches
  • Sore throat
  • Sore chest 
  • Headache 

Acute bronchitis develops because of an upper respiratory infection. Symptoms don't usually last longer than a few weeks.

Chronic bronchitis is characterized by long-term lung inflammation and is more serious. People with chronic bronchitis are at higher risk of developing complications due to respiratory infections like human metapneumovirus.

When to See a Healthcare Provider

Trouble breathing or shortness of breath are good indicators of when to seek medical attention. This may be a sign that the illness has developed into pneumonia or another lower respiratory tract infection.

Summary 

Human metapneumovirus (hMPV) is a virus that causes the symptoms of the common cold. It’s one of many viruses that causes similar upper respiratory symptoms. Common symptoms are coughing, runny nose, and congestion. Some people may also experience shortness of breath. 

People with weakened immune systems, such as older adults and infants, are more likely to develop complications from hMPV. But most people's symptoms go away in a few days without treatment.

A Word From Verywell 

For most people, a cold is self-limiting and doesn’t cause serious symptoms. If you have a stuffy nose, cough, and a mild fever, chances are some rest and fluids will help you cope with discomfort and eventually lead you on the road to recovery.

It’s important to remember, though, that symptoms of COVID-19 can resemble those of the common cold. If you have plans to attend a large gathering or interact with people who may have weakened immune systems, it’s a good idea to take a COVID-19 test to check for a positive result.

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.
  1. American College of Chest Physicians CHEST Foundation. Human metapneumovirus (hMPV).

  2. American Lung Association. Learn About human metapneumovirus (hMPV).

  3. Peña SA, Davis SS, Lu X, et al. Severe respiratory illness associated with human metapneumovirus in nursing home, New Mexico, USA. Emerg Infect Dis. 2019;25(2):383-384.  doi:10.3201/eid2502.181298

  4. Illinois Department of Public Health. Human metapneumovirus.

  5. Mount Sinai. Bronchiolitis.

  6. Libster R, Esteban I, Bianchi A, et al. Role for maternal asthma in severe human metapneumovirus lung disease susceptibility in children. J Infect Dis. 2021;223(12):2072-2079. doi:10.1093/infdis/jiaa019

  7. American Lung Association. Pneumonia symptoms and diagnosis

  8. Centers for Disease Control and Prevention (CDC). Chest cold (Acute bronchitis)

  9. American Lung Association. Chronic bronchitis.

  10. American Lung Association. Human metapneumovirus (hMPV) symptoms and diagnosis


By Steph Coelho

Steph Coelho is a freelance health writer, web producer, and editor based in Montreal. She specializes in covering general wellness and chronic illness.

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Nowadays physiotherapists are an integral part of a multidisciplinary team in most of the intensive care units (ICU) in Bangladesh. Doctors and hospital management realising the importance of physiotherapy management in ICU.

According to WCPT (World Confederation for Physical Therapy), Physiotherapy in ICU helps to reduce patient morbidity and mortality and prevent increased length of ICU and hospital stay. The focus of physiotherapy treatment in ICU is respiratory physiotherapy and physical rehabilitation.

Respiratory physiotherapy:

Every day our lungs produce fluid called sputum. Sputum traps the dirt particles that we breathe in and to clean the lungs this is normally coughed and cleared. Patients in ICU may require mechanical ventilation that helps for breathing but it stops patients from coughing and clearing the daily sputum load that causes sputum retention, chest infection or other complications.

Importance of respiratory physiotherapy in ICU:

* Reduce sputum retention, atelectasis and pneumonia

* Maintain lung volume

* Reduce airway resistance and work of breathing

* Optimise oxygenation and ventilation

* Improve respiratory muscle strength

* Improve ventilation/perfusion mismatch

* Minimise postoperative complications

* Decrease patient's dependency on the ventilator.

Physical rehabilitation:

Prolonged immobility or inactivity is a contributing factor of muscle weakness in ICU patients. According to The Chartered Society of Physiotherapy (CSP)-UK, patients who are mechanically ventilated for more than 7 days, 25% display significant muscle weakness, and approximately 90% of long-term ICU survivors will have ongoing muscle weakness. They can also experience joint stiffness, muscle tightness and reduce overall fitness. Physiotherapy rehabilitation programme plays an integral role in the treatment and prevention of these complications.

Importance of physical rehabilitation in ICU:

* Maintain joint range of movement

* Maintain muscle strength

* Help to improve cardio respiratory fitness

* Reduce venous stasis and risk of deep-vein thrombosis

* Maintain and improve exercise tolerance

* Maintain bone density

* Provide positive psychological benefits

* Aid to return to function and daily life

Physiotherapy in the ICU improves patient's physical wellbeing, facilitating weaning and promoting safe and early discharge from the intensive care unit. Early mobilisation results in decreased length of stay in ICU as well as overall hospital stay. ICU related complications such as deconditioning, muscle weakness, respiratory infections and contractures, can be prevented by early physiotherapy intervention.

 

The writer is a Clinical Physio-therapist at BRB Hospitals Ltd.

Email: [email protected]



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