Respiratory distress, also called acute respiratory distress syndrome (ARDS), is respiratory failure caused by rapid onset of widespread inflammation in the lungs

It can occur in patients who are critically ill or significantly injured.

Symptoms can include shortness of breath, rapid breathing, and bluish skin coloration.

Respiratory distress can be a serious, even fatal, condition.

Anyone who experiences these symptoms should seek emergency medical care immediately.

Diagnosing the cause of respiratory distress is not easy and requires clinical knowledge, a careful physical examination, and attention to detail.

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What is Respiratory Distress?

Respiratory distress, also called acute respiratory distress syndrome (ARDS), is respiratory failure caused by rapid onset of widespread inflammation in the lungs.

Patients with ARDS have severe shortness of breath and often are unable to breath without the support of a ventilator.

Symptoms can include shortness of breath (dyspnea), rapid breathing (tachypnea), and bluish skin coloration (cyanosis). Respiratory distress is a critical, often fatal condition, especially among the elderly and severely ill. If not properly treated, some extreme cases of respiratory distress can lead to a decreased quality of life.

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Respiratory distress can be primary or secondary:

  • Primary respiratory distress means the problem is in the lungs.
  • Secondary respiratory distress means the problem is somewhere else in the body and the lungs are compensating.

Possible primary respiratory distress problems include:

  • Anaphylaxis
  • Asthma
  • COPD
  • Pleural effusion
  • Pneumonia
  • Pneumothorax
  • Pulmonary edema

Possible secondary respiratory distress problems can include:

  • Diabetic ketoacidosis
  • Head trauma
  • Metabolic acidosis
  • Stroke
  • Sepsis
  • Toxicological overdose

Causes of Respiratory Distress and Treatment

Respiratory distress has a range of causes that can affect treatment, so EMTs must start by carefully considering the source of the condition.

For respiratory distress, the focus is usually on the lungs and auscultation (listening for sounds from the lungs, heart, and other organs).

An EMS provider’s assessment may include a physical exam, incident history, and vital signs before deciding the next step in treatment and transport of their patient.

The following are some of the most common types of respiratory distress and a brief overview of the appropriate treatment for each one.

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Airway Obstruction

There are many ways that a foreign object can lodge in an airway causing an obstruction.

For example, a stroke can damage swallowing reflexes, making the person more prone to choking.

Consumption of alcohol and some drugs can also suppress the gag reflex, which could also lead to choking.

Treatment: If the airway obstruction is mild and the patient is coughing forcefully, EMS providers may not interfere with the patient’s efforts to clear the obstruction.

If the patient has signs of severe airway obstruction, as indicated by a silent cough, cyanosis, or the inability to speak or breathe, you should intervene.

If in some cases a patient becomes unresponsive, you can perform a finger sweep to clear the airway obstruction, but only if you can see solid material blocking their airway.

Asthma

Asthma is a chronic, inflammatory disease of the airways.

Asthma attacks can be induced by many different causes including allergens, infections, exercise, and smoke.

Patients with asthma are very sensitive to things such as dust, pollen, drugs, air pollutants, and physical stimuli.

During an asthma attack, the muscles around the bronchioles tighten, the lining of the inside the bronchioles swells, and the inside of the bronchioles fills with thick mucus.

This severely restricts expiration of air from the lungs. Patients will often describe a history of asthma and have a prescription for a metered-dose inhaler.

TreatmentBasic Life Support treatment considerations include:

  • Calming the patient
  • Airway management
  • Oxygen therapy
  • Assisting with a prescribed inhaler

COPD

Chronic obstructive pulmonary disease (COPD) is a group of diseases that includes asthma, emphysema, and chronic bronchitis.

COPD causes a slow process of dilation and disruption of the airways and alveoli, and it includes several related irreversible conditions that limit the ability to exhale.

Symptoms of COPD include shortness of breath, fever, and increased sputum production.

The patient’s medical history can include conditions such as upper-respiratory infection, chronic bronchitis, emphysema, smoking, or working with hazardous substances such as chemicals, smoke, dust, or other substances.

Treatment. Common medications for COPD include:

  • Prednisone
  • Proventil
  • Ventolin
  • Atrovent
  • Azmacort

EMS treatment for a COPD patient with respiratory distress should include high flow oxygen.

Congestive Heart Failure

Congestive heart failure (CHF) results from too much fluid in the lungs, making it difficult to get air in.

This is in contrast to COPD patients, who typically experience difficulty getting the air out.

CHF occurs when the ventricles are weakened by a heart attack, underlying coronary artery disease, hypertension, or valve disease.

This impairs the heart’s ability to contract and empty during systole and blood backs up in the lungs and tissues of the body.

CHF is usually chronic with acute exacerbations.

During an acute episode, the patient will typically present sitting up, short of breath, diaphoretic, and pale, or cyanotic in color.

Breathing sounds can include rales or wheezes.

The medical history can include increased salt ingestion, respiratory infection, non-compliance with medications, angina, or symptoms of acute coronary syndrome.

Treatment. Common medications include:

  • ACE inhibitors
  • Furosemide (Lasix)
  • HCTZ (hydrochlorthiazide)
  • Beta-blockers
  • Angiotensin II receptor blockers
  • Digoxin (Lanoxin)

When treating patients who are suffering from congestive heart failure, seat the patient upright and administer high flow oxygen.

You may also consider positive pressure ventilation with a bag-valve-mask (BVM) if the patient is experiencing severe respiratory difficulty.

Inhalation Injuries

Inhalation injuries are caused by inhaling chemicals, smoke, or other substances.

Common symptoms include shortness of breath, coughing, hoarseness, chest pain due to bronchial irritation, and nausea.

Individuals with decreased respiratory reserve, including a history of COPD or CHF, are likely to experience an exacerbation of the disease.

Treatment: If a patient is in respiratory distress, treat immediately with high flow oxygen.

Assist breathing with a bag-valve-mask (BVM) if the respiratory effort is insufficient as indicated by a slow rate and poor air exchange.

Pneumonia

Symptoms of pneumonia include fever, chills, cough (often with yellowish sputum), shortness of breath, general discomfort, fatigue, loss of appetite and headache.

There can be chest pain associated with breathing (usually sharp and stabbing in nature) and worsened by coughing or deep inspirations.

Other signs that sometimes present are rales, clammy skin, upper abdominal pain, and blood-tinged sputum.

Treatment: Emergency care for pneumonia depends on the severity of the patient’s breathing difficulty but may include oxygen therapy.

Pneumothorax

A pneumothorax is the presence of air between the two layers of the pleura—which are the membranes lining the thorax and enveloping the lungs.

It is caused when an internal or external wound allows air to enter the space between these pleural tissues, which can cause the lungs to collapse.

A pneumothorax can occur spontaneously (e.g., a rupture caused by disease or localized weakness of the lung lining) or as a result of trauma (e.g., gunshot or stab wound).

People who have a prior history of pneumothorax or COPD may be more at higher risk of experience this medical condition.

In some rare instances, even forceful coughing can cause a pneumothorax.

A pneumothorax can cause sharp chest pain and shortness of breath.

The patient’s breathing will sound diminished and you may be able to feel air coming from under the patient’s skin.

Treatment:  EMS treatment of a pneumothorax includes high-flow oxygen. Be judicious with your use of positive-pressure ventilation. It can turn a spontaneous pneumothorax into a life-threatening tension pneumothorax.

Tension Pneumothorax

A tension pneumothorax is a progressively worsening pneumothorax that begins to impinge on the function of the lungs and the circulatory system.

It is caused when a lung injury acts like a one-way valve that allows free air to move into the pleural space but prevents the free exit of that air.

Pressure builds inside the pleural space and compresses the lungs and other organs.

Early signs of a tension pneumothorax include:

  • Increased dyspnea
  • Cyanosis
  • Signs of shock
  • Distended neck veins
  • Shift in PMI (Point of maximum intensity, where the heart is the loudest through auscultation)
  • Tracheal displacement
  • Tracheal deviation

Treatment: If the patient is hypotensive or showing signs of hypoperfusion, then EMS providers should initiate temporizing treatment for tension pneumothorax.

Open chest wounds should have a sealable dressing placed over them with a one-way air valve to prevent air build up.

This one-way valve can be created by applying an occlusive dressing and taping on three sides.

The EMS provider should perform needle decompression on the chest wall to release encased air.

Pulmonary Embolism

A pulmonary embolism (PE) can occur when a particle (such as a blood clot, fat embolus, amniotic fluid embolus, or air bubble) gets loose in the blood stream and travels to the lungs.

If the particle lodges in a major branch of the pulmonary artery, this can interrupt blood circulation to the lungs.

If blood cannot reach the alveoli, then it cannot be oxygenated.

This condition can be caused by immobility of the lower extremities, prolonged bed rest, or recent surgery.

Signs of PE are a sudden onset of shortness of breath, rapid breathing, chest pain worsened by breathing, and coughing up blood.

Treatment: Pulmonary embolism is a life-threatening condition and should be treated with high flow oxygen and rapid transport. Move the patient gently to avoid dislodging additional emboli (particles).

When to Call Emergency Number for Respiratory Distress

Breathing is something most of us do instinctively, day and night. We don’t even think about it.

So, if you experience shortness of breath or difficulty breathing it can be quite alarming.

If you experience shortness of breath that interferes with your daily routine or body functions, you should call Emergency Number or have someone drive you to the nearest Emergency Room immediately.

You should call Emergency Number immediately if you experience shortness of breath together with any of the following  symptoms:

  • Chest pain
  • Dizziness
  • Pain that spreads to your arms, neck, jaw or back
  • Sweating
  • Trouble breathing
  • How to Treat Respiratory Distress

If you experience shortness of breath, or shortness of breath together with any of the symptoms listed above, you need to call Emergency Number or get to an ER immediately.

Treatment of respiratory distress requires a doctor.

The first goal in treating respiratory distress will be to improve the oxygen levels in your blood.

Without sufficient oxygen, your organs can fail. Increasing your blood oxygen levels can be achieved through supplemental oxygen or a mechanical ventilator that pushes air into your lungs.

Careful management of any intravenous fluids will also be critical.

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People with respiratory distress are usually given medication to:

  • Prevent and treat infections
  • Relieve pain and discomfort
  • Prevent blood clots in the legs and lungs
  • Minimize gastric reflux
  • Sedate

USA: How Do EMTs & Paramedics Treat Respiratory Distress

For all clinical emergencies, the first step is rapid and systematic assessment of the patient.

For this assessment, in the USA most EMS providers will use the ABCDE approach.

The ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach is applicable in all clinical emergencies for immediate assessment and treatment.

It can be used in the street with or without any equipment.

It can also be used in a more advanced form where emergency medical services are available, including emergency rooms, hospitals or intensive care units.

Treatment Guidelines & Resources for Medical First Responders

Treatment guidelines for respiratory distress can be found on page 163 of the National Model EMS Clinical Guidelines by the National Association of State EMT Officials (NASEMSO).

These guidelines are maintained by NASEMSO to facilitate the creation of state and local EMS system clinical guidelines, protocols, and operating procedures.

These guidelines are either evidence-based or consensus-based and have been formatted for use by EMS professionals.

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The guidelines include a rapid assessment of the patient for symptoms of respiratory distress, which may include:

  • Shortness of breath
  • Abnormal respiratory rate or effort
  • Use of accessory muscles
  • Quality of air exchange, including depth and equality of breath sounds
  • Wheezing, rhonchi, rales, or stridor
  • Cough
  • Abnormal color (cyanosis or pallor)
  • Abnormal mental status
  • Evidence of hypoxemia
  • Signs of a difficult airway

Pre-hospital treatments and interventions might include:

  • Non-invasive ventilation techniques
  • Oropharyngeal airways (OPA) and nasopharyngeal airways (NPA)
  • Supraglottic airways (SGA) ort extraglottic devices (EGD)
  • Endotracheal intubation
  • Post-intubation management
  • Gastric decompression
  • Cricothyroidotomy
  • Transport to closest hospital for airway stabilization

EMS providers should reference the CDC Field Triage Guidelines for decisions regarding transport destination for injured patients.

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Seizures In The Neonate: An Emergency That Needs To Be Addressed

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Emergency Paediatrics / Neonatal Respiratory Distress Syndrome (NRDS): Causes, Risk Factors, Pathophysiology

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

Childbirth And Emergency: Postpartum Complications

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Supplemental Oxygen: Cylinders And Ventilation Supports In The USA

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Lung health

Lung diseases, excluding lung cancer, cause an estimated 235,000 deaths each year

New Delhi: Like other parts of the body, the lungs are an extremely important organ, which needs utmost care.

According to the National Heart, Blood and Lung Insititute, chronic lower respiratory diseases, including obstructive pulmonary disease (COPD) and asthma are the leading causes of death globally, every year.

Lung diseases, excluding lung cancer, cause an estimated 235,000 deaths each year.

Lungs age faster than other parts of the body since we breathe in toxic air, pollution, and dust, involve in smoking, and other things that deteriorate the organ. With time, the lungs lose their strength, which can make it more difficult to breathe.

But by adopting certain healthy habits, you can better maintain the health of your lungs, and keep them working optimally even into your senior years.

Your body relies on your respiratory system to supply the oxygen necessary for your organs to function. And if you struggle to breathe, your body may not get enough oxygen, and without enough oxygen, other critical organs may shut down.

Warning signs of respiratory distress

It is very important to learn to recognise the signs and symptoms of respiratory problems that may help you protect your life. If you notice any of these symptoms, you must contact your doctor immediately.

Breathlessness

Many people suffer from chronic breathlessness which means they are short of breath and the lungs are not able to get enough oxygen to breathe.

Even though it is normal to get breathless occasionally when you exert more than normal, sudden and regular shortness can be a sign of impending danger.

According to health experts, the lungs are involved in transporting oxygen to your tissues and removing carbon dioxide, and problems with either of these processes affect your breathing. Causes of breathlessness can be due to:

  • Asthma
  • Carbon monoxide poisoning
  • Excess fluid in the lungs
  • COPD
  • Covid-19
  • Lung collapse
  • Pulmonary embolism
  • Tuberculosis
  • Pulmonary fibrosis
  • Lung cancer
  • Croup
  • Anaphylaxis

Change in skin colour or Cyanosis

Health experts say that people who have less oxygen in their blood have a bluish colour to their skin. The condition is known as cyanosis, and it develops along with breathlessness and other symptoms. Cyanosis is caused due to lung problems and is a slow-progressing ailment, which needs immediate attention.

Causes of cyanosis in the lungs include:

  • High altitudes
  • Asthma
  • Respiratory tract infection
  • Blood clots in the arteries of the lungs
  • COPD
  • Pulmonary hypertension
  • Pneumonia

Hemoptysis

Hemoptysis is the coughing up of blood from the respiratory tract. Massive hemoptysis can cause the production of more than 600 ml of blood within 24 hours, and lead to lung collapse.

Doctors say in hemoptysis, the blood arises from this bronchial circulation when there is a trauma causing damage to pulmonary arteries because of a tumour caused by lung cancer. Hemoptysis is also caused by:

  • Severe pneumonia
  • Tuberculosis
  • Severe respiratory tract infection
  • Bronchitis

Wheezing

If you are constantly wheezing or breathing noisily, it could be an indication that your airways have become obstructed and there is a problem with the functioning of the lungs.

Doctors say it is important to report the first sign of experiencing wheezing. It is a result of inflammation and narrowing of the airway in any location from your throat to the lungs.

The most common causes of wheezing are:

Chest pain

If you suffer from lingering chest pain, you must contact your doctor immediately, as it can be due to:

  • A blood clot in the lung is known as a pulmonary embolism, where the artery can block blood flow to lung tissue.
  • Inflammation of the membrane covering the lungs, known as pleurisy in which chest pain, worsens when you inhale or cough.
  • A collapsed lung when air leaks into the space between the lung and the ribs.
  • High blood pressure in the lung arteries is known as pulmonary hypertension. This condition affects the arteries carrying blood to the lungs and can produce chest pain.

Disclaimer: Tips and suggestions mentioned in the article are for general information purposes only and should not be construed as professional medical advice. Always consult your doctor or a dietician before starting any fitness programme or making any changes to your diet.

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The 2023 report from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) — “Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease” (COPD)1 — details “an expanded range of therapies for COPD that now can be considered to improve mortality,” according to Gerard J. Criner, MD, FACP, FACCP, an author of the 2023 GOLD Report and director of the 2022 GOLD COPD Day conference, held in November, where the updated 5th version of the GOLD report was released and the scientific underpinnings of the updates were discussed.

The expanded range of COPD therapies discussed in the 2023 report includes “an expanded role of triple inhaled therapy in select patient populations, as well as noninvasive ventilation, which also may have a role in improving exacerbation in select patient groups with COPD,” said Dr Criner, who is Chair and Professor of Thoracic Medicine and Surgery at the Lewis Katz School of Medicine at Temple University in Philadelphia, which hosts the annual GOLD COPD Day conference.

The 2023 GOLD report contains numerous other important updates as well. Among these are a reconsideration of the definitions and taxonomy of COPD and symptomatic exacerbations; new material on chronic bronchitis; and an increased focus on genetic and environmental causal factors in COPD aside from tobacco smoking.

Definitions, Heterogeneity, and Exacerbations

An important change in the 2023 GOLD report involves “clarifications and suggestions on the definition of COPD,” said Dr Criner. Related to this, the updated report also has expanded the discussion of how an exacerbation is defined, he added. “We’ve integrated newer work on codifying the onset of an exacerbation and defining the severity of an exacerbation by using not only symptoms but also physiologic criteria in grading the exacerbation as mild, moderate, or severe. Now that’s more a hypothesis than something with data wrapped around it, but is meant to fuel thought into how we can do a better job of assessing exacerbations.”

The revised definition of COPD in the 2023 report “now describes symptoms clearly and underscores the heterogeneity of COPD,” said Fernando J. Martinez, MD, MS, another coauthor of the 2023 GOLD Report. “GOLD has now embraced the concept of both early COPD and pre-COPD, and this now is incorporated into the GOLD document,” explained Dr Martinez, who is also Chief of the Pulmonary and Critical Care Medicine Division at Weill Cornell Medicine in New York City.

“There’s a lot of interest right now regarding the heterogeneity of COPD,” added Dr Martinez. “Two very relevant articles recently advocated for highlighting that heterogeneity in the definition of COPD.2,3 Exactly what implication that’s going to have for patient management and therapeutics, no one yet knows. But that level of heterogeneity is now something that’s very clearly seen as an important component of COPD in general,” he stressed.

With regard to defining exacerbations and their severity, Dr Martinez added, “the science committee recommended adopting the ’Rome Proposal,4 which suggested that the definition of severity should evolve away from what therapies are used, and rather toward a series of objective parameters: how bad the symptoms are, whether there’s evidence of inflammation or an oxygen saturation problem, and so on. So that is a recommendation that was made for consideration only at this time, because it is not yet clear whether it has any therapeutic implications,” said Dr Martinez.

Assessment Schema and Pharmacotherapy

The evolution of GOLD’s approach to pharmacotherapeutic assessment for COPD — one of the topics “of greatest interest” at the 2022 COPD Day conference, according to Dr Martinez — is covered at length in the 2023 GOLD report.

Until the release of the 2023 report, it was recommended that clinicians determine a patient’s initial COPD pharmacologic regimen using the “ABCD Assessment Tool,” said Dr Criner, who described the tool as “a sort of ‘four squared’ algorithm…based on symptoms and exacerbation history.” First presented in the 2011 GOLD report and later refined in the 2017 GOLD report, the ABCD Assessment Tool was “based on the patient’s level of symptoms, future risk of exacerbations, the extent of airflow limitation, the spirometric abnormality, and the identification of comorbidities” and was “a major advance from the simple spirometric grading system” used previously, the 2018 GOLD report stated.5

Based on recent evidence, however, the 2023 GOLD report has further revised this tool, which is now called the “ABE Assessment Tool.”1 According to the 2023 report, this change recognizes the clinical relevance of exacerbations, independent of the level of symptoms, in making assessments. As Dr Martinez explains it, “This year we got rid of the ‘C’ [ie, less symptomatic, high-exacerbation-risk] and ‘D’ [ie, more symptomatic, high-risk] groups in the ABCD tool, and merged them into one ‘E’ group, representing exacerbation-prone patients. This was partly because the ‘C’ group was so uncommon in large population studies, and partly because the exacerbation component is such a crucial issue to address.”

The 2023 GOLD report also included significant changes in COPD pharmacotherapeutic strategy, said Dr Martinez. The first change is in line with the American Thoracic Society/European Respiratory Society (ATS/ERS) statement that combination bronchodilator therapy — a long-acting beta agonist (LABA) and a long-acting muscarinic antagonist (LAMA) together — is better than LABA or LAMA as monotherapy,6,7 he explained. “We now recommend dual bronchodilator therapy up front for symptomatic patients. There was advocacy for this for many years, and we finally made that change.”

“There is increasing awareness that dual bronchodilator therapy is initially indicated in people who are symptomatic or have exacerbations,” said Dr Criner. “This includes people who have COPD exacerbations and have peripheral blood eosinophilia.”

Yet more discussion on this topic seems inevitable; as Dr Martinez noted, “implementation of dual bronchodilator therapy and quantitative cutoff values for eosinophilia in treatment selection” were the subject of “spirited debates,” at the recent COPD Day Conference.

Another significant change in COPD pharmacotherapeutic strategy in the 2023 GOLD report is the recommendation to use inhaled triple therapy rather than inhaled corticosteroid (ICS)-plus-LABA for higher-risk patients who are more symptomatic and exacerbation prone. After much debate, the GOLD science committee concluded that for these patients, “triple therapy beats ICS/LABA in every category,” said Dr Martinez, who was involved with 2 or 3 major studies of these therapies. 8,9  As a result, said Dr Martinez, “ICS/LABA has been dropped from the therapeutic recommendations in GOLD. That is a major change. ICS/LABA remains one of those commonly used regimens globally. There are various generic formulations, and payers love it, because it’s cheap; but now it’s dropped off the GOLD therapeutic strategy. So it will be interesting to see how payers interpret that.”

To support this change, the 2023 report highlights “very convincing data that triple therapy, in a particular population of patients, can improve all-cause mortality.10,11 We included a tabular representation of all of the studies that have shown improvements in mortality, for pharmacotherapy and nonpharmacotherapy, and we recommend that be incorporated into therapeutic decision-making for individual patients,” Dr Martinez noted. “So the management recommendations for stable COPD have now changed to emphasize dual bronchodilators and triple therapy, and also with a strong emphasis on the eosinophil as a circulating biomarker that can be used to guide response.”

Chronic Bronchitis and Mucus Hypersecretion

The burden of mucus hypersecretion in patients with COPD is also covered in the 2023 report, said Dr Criner. In particular, chronic bronchitis is discussed at greater length, with a review of some of its pathobiology and epidemiology, as well as a discussion of new medical and interventional treatments.

“There is a lot of interest in particular symptoms such as cough and sputum production. But it’s only recently that the clinical implications of those symptoms have become evident,” said Dr Martinez. He added that “the effort to target a particular symptomatic expression of COPD, such as cough and sputum production, is now a very active area, with practical implications for patients. Interventional studies are ongoing; and oral pharmacotherapeutic approaches, including cystic fibrosis transmembrane conductance regulator (CFTR) potentiators,12 are under evaluation right now.”

Vascular Disease and Other Updates

The 2023 report also discusses pulmonary vascular diseases, both secondary pulmonary hypertension and pulmonary embolism. The latter has been the focus of more recent studies, including a large French study published in JAMA.13 As Dr Criner explained, “In that study, about 6% of patients who presented with an acute exacerbation of COPD were found to have a pulmonary embolism at the time of presentation.” This study “highlights the fact that some people with COPD exacerbations actually have COPD with exacerbation of symptoms that are due to another cause, such as pulmonary embolism, heart failure, or ischemic heart disease” — a topic of interest that was discussed during the conference, said Dr Criner. Accordingly, he noted, the importance of screening patients with COPD for comorbid conditions like pulmonary embolism and other diseases is reflected in the 2023 GOLD report.

Certain sections of the new report have some degree of updated information but were not exhaustively revised, said Dr Criner. “We discuss imaging more than previously, particularly the role of computed tomography (CT) scanning — both its current role and the role we think it will have in the future. We have also expanded and revised the discussion of surgical and interventional treatments for COPD. This includes indications for bullectomy or lung reduction surgery; bronchoscopic treatments for lung reduction, an evolving field both in and outside the US; and interventional treatments that are currently being studied for chronic bronchitis. There is also a more comprehensive discussion of the role, benefits, and complications of lung transplantation. Finally, we revised and updated chapters on comorbidities and on COVID-19.”

Interstitial Lung Abnormalities: A Future Topic

Interstitial lung abnormalities in patients with COPD was a topic of interest at the GOLD conference that was not exhaustively covered in the 2023 GOLD report, said Dr Criner. Interstitial lung abnormalities “have been reported in several epidemiologic studies, mainly imaging studies characterizing patients who have been exposed to smoke, and also studies of lung cancer screening data. These studies demonstrate that patients with COPD have some interstitial changes that could be related to smoke exposure, or occupational exposure, or smoking in people who also are predisposed to interstitial lung diseases,” said Dr Criner. This topic is likely to be a focus in the future, he added.

Disclosures:Dr Criner reports receiving grants from AstraZeneca, Boehringer Ingelheim, Broncus, Chiesi, Corvus, Genentech, Gilead, GlaxoSmithKline, Fisher-Paykel Healthcare, Lilly, NIH-NHLBI, Novartis, Olympus, PA-DOH, Pfizer, Pearl, PneumRx, Pulmonx, Regeneron, Roche and Spiration; consultant fees from Almirall, AstraZeneca, Broncus, BTG, CSA Medical, GlaxoSmithKline, EOLO, Intuitive, Ion, Mereo, Nuvaira, PneumRx, Pulmonx, Regeneron and Sanofi; and an equity interest in Free Flow Medical and Pleural Dynamics. Dr Martinez reports receiving fees for consulting and/or speaker roles with AstraZeneca, Boehringer Ingelheim, Chiesi, Sanofi/Regeneron, CSL, Behring, GlaxoSmithKline, Medtronic, Novartis, Polarean, Pulmatrix, Pulmonx, and Theravance/Viatris.

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Robert V. O’Toole, MD

A randomized clinical trial of more than 12,000 patients treated at medical centers in the US and Canada suggests aspirin was as effective as low-molecular-weight heparin for preventing life-threatening blood clots in patients hospitalized with fractures.

A noninferiority trial of adults who had a fracture of an extremity treated operatively or who had any pelvic or acetabular fracture, results of the study indicate use of aspirin was noninferior for preventing death and was associated with low incidences of deep-vein thrombosis and pulmonary embolism.

“Many patients with fractures will likely strongly prefer to take a daily aspirin over receiving injections after we found that both give them similar outcomes for prevention of the most serious outcomes from blood clots,” said lead investigator Robert V. O’Toole, MD, chief of Orthopaedics at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center (UMMC), in a statement from UMMC. “We expect our findings from this large-scale trial to have an important impact on clinical practice that may even alter the standard of care.”

Led by Toole, along with collaborators from UMMC and the Major Extremity Trauma Research Consortium, the Prevention of Clot in Orthopaedic Trauma (PREVENT CLOT) trial was designed pragmatic, multicenter, randomized, noninferiority trial that enrolled the aforementioned patient population and randomized them to low-molecular-weight heparin (enoxaparin) 30 mg twice daily or aspirin 81 mg twice daily during hospitalization. In total, the trial enrolled 12,211 patients from 21 trauma centers in the US and Canada between April 2017 and August 2021, with 6101 patients randomized to aspirin and 6110 randomized to low-molecular-weight heparin.

The study cohort had a mean age of 44.6±17.8 years, 0.7% had a history of venous thromboembolism, and 2.5% had a history of cancer. When examining thromboprophylaxis trends, investigators found the mean duration of in-hospital thromboprophylaxis was 8.8±10.6 days and the median duration of thromboprophylaxis prescribed at discharge was a 21-day supply. Per trial protocol, post-discharge thromboprophylaxis was conducted according to the protocols of each trauma center. The primary outcome of interest for the trial was all-cause mortality at 90 days. Secondary outcomes of interest included the incidence of nonfatal pulmonary embolism, deep vein thrombosis, and bleeding complications.

Upon analysis, a total of 47 (0.78%) deaths occurred among the aspirin group and 45 patients in the low-molecular-weight heparin group (difference, 0.05 percentage points [96.2% CI, -0.27 to 0.38]; P <.001 for a noninferiority margin 0.75 percentage points. Analysis of secondary outcomes indicated pulmonary embolism occurred in 90 patients (90-day probability, 1.49%) among the aspirin group and in 90 patients (90-day probability, 1.49%) among the low-molecular-weight heparin group (difference, 0.00 percentage points [95% CI, -0.43 to 0.43]). Further analysis indicated deep vein thrombosis occurred in 2.51% of patients among the aspirin group and 1.71% among the low-molecular-weight heparin group (difference, 0.80 percentage points [95% CI, 0.28 to 1.31]). Evaluation of bleeding complications and serious adverse indicated event rates were similar between the study arms.

“This relatively small difference was driven by clots lower in the leg, which are thought to be of less clinical significance and often do not require treatment,” said study investigator Deborah Stein, MD, MPH, professor of Surgery at UMSOM and director of Adult Critical Care Services at UMMC.

This study, “Aspirin or Low-Molecular-Weight Heparin for Thromboprophylaxis after a Fracture,” was published in the New England Journal of Medicine.

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Severe COVID-19 infection in ventilated patients with acute respiratory distress syndrome (ARDS) has been associated with invasive pulmonary aspergillus infections [1]. The structural damage of the lung architecture and the treatment of COVID-19 with steroids and immunosuppressants facilitate this co-infection. In general, those with host risk factors such as neutropenia, HIV, solid organ transplant, and chronic obstructive pulmonary disease (COPD) are more likely to develop Covid-19 Associated Pulmonary Aspergillus (CAPA) [2]. Despite the recent description of CAPA, it continues to be a difficult diagnosis with detrimental consequences in patient outcomes. The similarity in radiological signs between COVID-19 and Aspergillus is one reason for the difficulty in diagnosis [3]. The other reason is an inadequate respiratory sampling from the lower respiratory airway that would require bronchoscopy [4]. We describe three intensive care unit (ICU) cases to shed light on the early diagnosis and treatment of CAPA.

Case 1

A 61-year-old female with a past medical history of depression presented to our hospital with dyspnea, fatigue, fever, vomiting, and dizziness for the past few days. She had tested positive for COVID-19 ten days prior and had not been vaccinated for COVID-19. The patient required high-flow oxygen (FiO2 = 100%; 60 L) and non-invasive ventilation with Bilevel Positive Airway Pressure (BIPAP; IPAP = 18, EPAP = 14). Her initial thorax computed angiography showed predominantly ground-glass opacities in the apices with atelectasis in the bases. She was started on barcitinib (PO 4 mg q24), remdesivir (initial dose IV 200 mg; IV 100 mg q24 after that for a total of 5 days), and dexamethasone (IV 6 mg q24 for a total of 10 days). However, given her worsening oxygen requirements and poor improvement, barcitinib was discontinued, and she was given a dose of sarilumab (IV 400 mg once) the following day.

On day 10, the patient was started on broad-spectrum antibiotics, vancomycin, and piperacillin-tazobactam, due to an up-trending leukocytosis. The next day, her physical exam displayed a respiratory rate of 28 breaths/min, pulse = 102, and low oxygen saturation (SpO2 = 84%) on BIPAP (IPAP = 18 and EPAP = 16). Arterial blood gas on a fraction of inspired oxygen (FIO2) of 100% demonstrated pH 7.45, partial pressure of carbon dioxide (PCO2) of 54 mm Hg, and partial pressure of oxygen (PaO2) of 82 mm Hg (PaO2/FiO2 = 82) suggestive of severe acute respiratory distress syndrome (ARDS). Elective endotracheal intubation was performed with lung protective mechanical ventilation with ventilatory settings of tidal volume (TV) 4-6 ml/kg, respiratory rate (RR) = 30, Tidal Volume (Vt) = 350, positive expiratory end pressure (PEEP) = 12, FIO2 = 90% with the aim of PaO2 > 60 mm Hg and pH > 7.2 as per ARDSnet protocol. The patient was prone multiple times to assist with alveolar recruitment. Vancomycin was discontinued once the MRSA nares were negative three days later. The patient was treated with a 7-day course of piperacillin-tazobactam. On day 20, the patient's PaO2/FiO2 (P/F) ratio improved to 241.

On day+21, an increase in temperature to 38ºC was observed. She was pan-cultured and restarted on vancomycin and meropenem. Antibiotics were discontinued once blood culture and sputum cultures were negative. Despite a negative infectious work-up, she continued to have fevers (T = 38ºC to 38.4ºC) for two weeks. On day+29, the patient suffered a bradycardia episode leading to PEA arrest. She received one round of cardiopulmonary resuscitation (CPR) and epinephrine and achieved a return of spontaneous circulation (ROSC).

Given that the patient continued to have a low-grade fever, she was pan-cultured again on Day+30. Urine culture grew Enterococcus faecalis, so she was treated with a 7-day course of piperacillin-tazobactam. Despite antibiotic treatment, the patient continued to have a low-grade fever and increasing leukocytosis (16.8 x 10^3/uL). CT thorax with contrast showed diffuse ground-glass and consolidative opacities throughout the lungs with moderate right-sided pleural and small left-sided pleural effusion (Figure 1).

Sputum Culture eventually grew 4 colonies of Aspergillus fumigatus. The Department of Infectious Disease was consulted and recommended IV voriconazole (6 mg/kg q12) for 2 doses and then transitioned to IV voriconazole (4 mg/kg q12) after that for 12 weeks.

The patient made slow clinical and radiological progression in the following days. Her fevers had settled, and her ventilatory settings decreased. Steady-state voriconazole trough levels were observed (2.6 µg/mL). The patient could not tolerate a spontaneous breathing trial, given that she was intubated for 45 days. Per the family's wishes, the patient obtained a tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube. A CT thorax was obtained on day 56 and showed diffuse bilateral interstitial and alveolar infiltrates throughout with a 5 cm air-filled cyst in the anterior right upper lobe (Figure 2).

The patient was discharged to a long-term acute care hospital with continuing ventilatory support. She was transitioned to PO voriconazole (400 mg q12) to finish her 12-week antifungal course. Despite the completion of treatment, the patient continues to require ventilatory support and remains in a long-term facility.

Case 2

We describe the case of a 54-year-old woman who presented with fever, chills, cough and gradually worsening shortness of breath. A month prior, she initially tested positive for COVID-19 at an urgent care clinic, where she presented for cough, chills, and postnasal drip. Her medical history was significant for type II diabetes mellitus with diabetic neuropathy, bipolar disorder, hyperlipidemia, and chronic low back pain. She was not vaccinated against COVID-19 and denied any exposure to sick contacts.

Upon presentation to the emergency department, she was febrile to 39°C with a pulse of 88/min, respiratory rate of 22/min with increased work of breathing and bilateral rhonchi, and oxygen saturation of 88%, which improved to 91% on 5 L/min oxygen via nasal cannula. The rest of the physical examination was normal. A nasopharyngeal swab was positive for SARS-CoV-2 RNA (RT-PCR method). Chest X-ray showed extensive bilateral lower lobe infiltrates consistent with COVID-19 pneumonia (Figure 3).

She was admitted to general medicine service and was started on remdesivir (200 mg IV once followed by 100 mg daily for 5 days), dexamethasone 6 mg IV daily, and a one-time infusion of Tocilizumab (IV 8mg/kg ). On day 4 of admission, the patient started expectorating thick, yellow-colored sputum and desaturated to 80% on minimal movement. She required up to 10 L/min of oxygen via an oxy mask. CT angiography thorax showed extensive bilateral airspace disease with ground-glass opacities, and diffuse infiltrates suggestive of COVID-19 pneumonia. A dense left lower lobe consolidation was suggestive of superimposed bacterial pneumonia. There was no evidence of a pulmonary embolism. She was started on IV Cefepime (2g q8h) and vancomycin (1250mg q24h) and was transferred to the ICU for increased oxygen requirements. BiPAP was trialed without a good response, and a decision was made to electively intubate the patient on day 6 of admission. Just before intubation, her P/F ratio was 78; after intubation and appropriate sedation, it improved to 97. Her respiratory status gradually declined over the next few days, with P/F ratios as low as 66 on lung-protective ventilation per ARDSnet protocol, indicating severe ARDS. She developed a left-sided spontaneous pneumothorax, and a chest tube was placed to water seal.

The patient was evaluated by Extra-Corporeal Membrane Oxygenation (ECMO) service on day 10 of admission, and a decision was made to start Veno-venous (VV) ECMO. The cannulation procedure was complicated by post-procedural cardiac arrest due to hemorrhagic shock, and she was resuscitated with the return of spontaneous circulation after 8 minutes. Unfortunately, she developed a right-sided hemopneumothorax during bag-mask ventilation. A chest tube was inserted on the right side, and she was placed on lung rest ventilator settings while ECMO was being titrated to achieve adequate oxygenation. On Day 13 of admission, the patient started having low-grade fevers, and a chest X-ray showed near-total opacification of both lungs (Figure 4). Table 1 compares the patient's lab work from admission and Day13+.

  Day 0 Day 13+
White Blood Count (WBC) [/µL] 6.1 x 103 24 x 103
C-Reactive Protein (CRP) [mg/L] 81 57
Procalcitonin [ng/mL] 0.16 0.63

Repeated blood cultures showed no bacterial or fungal colonies; however, serum Aspergillus galactomannan antigen assay was positive with an index of 1.26. A diagnostic bronchoscopy was done at the bedside on day 16 of admission, which showed no mucus plugging, but endobronchial washings grew multiple colonies of Aspergillus fumigatus. On Day 18, the patient was started on Liposomal Amphotericin B (IV 5 mg/kg) per the Department of Infectious Diseases recommendations. Despite aggressive medical management in the ICU, the patient passed away on day 21 from multi-organ sepsis.

Case 3 

A 54-year-old man with a past medical history of chronic kidney disease stage 4, hypertension, and type 2 diabetes presented to our ICU with worsening dyspnea 11 days after he initially tested positive for COVID-19. Before the presentation, the patient was experiencing fever, chills, shortness of breath, fatigue, and poor oral intake. Upon arrival, the patient was hypothermic with a temperature of 31.4°C, tachypneic with RR of 30, bradycardic with heart rate (HR) between 40 to 60, and oxygen saturation as low as 83%. The patient was subsequently intubated to maintain his oxygen saturation. His ventilator settings were pressure control(PC)/assist control (RR = 16, PEEP = 10, PC = 16). CT angiography thorax did not show any sign of a pulmonary embolism. However, he had bilateral ground glass opacities consistent with COVID-19 infection. He was started on IV dexamethasone (6 mg once daily), remdesivir (initial dose IV 200 mg; IV 100 mg q24 after that), and one dose of IV 400 mg sarilumab. The patient required emergent dialysis for potassium of 7 with electrocardiogram changes showing sinus bradycardia with mildly prolonged PR interval. He was placed on continuous venovenous hemofiltration (CVVH) after that. His sputum culture the following day grew Enterobacter, and he was started on meropenem.

On day 3, the sputum culture grew mold. We questioned the likelihood of a fungal infection given his early hospital course and short duration of steroids. The Department of Infectious Disease agreed that the validity of the mold in the sputum was questionable and treatment should be withheld. The Department of Infectious disease also recommended deescalating meropenem to IV levofloxacin which was dosed according to the patient's renal function (IV 750 mg q48 hours). The sputum culture had speciated to Enterobacter homacaei. On day 6, the patient started to decompensate, requiring norepinephrine to maintain his mean arterial pressure (MAP) above 60. Since the mold had speciated to Aspergillus fumigates, the decision was made to start IV voriconazole (6 mg/kg q12 for 2 doses, then 4 mg/kg q12 after that) and repeat a sputum culture. Initially, the repeat sputum culture taken on day 6 did not grow Aspergillus. Given the improvement in the patient's respiratory status to minimal ventilatory settings (RR = 14, PEEP = 8, PC = 12), it was decided to discontinue the voriconazole. The following day (Day+7), his sputum culture grew one colony of Aspergillus fumigatus. The patient completed a ten-day course of IV levofloxacin for his Enterobacter pneumonia.

The patient continued to be periodically hypothermic with a temperature of 35ºC and required pressor support. An extubation was attempted on day 14. A few hours later, his oxygen saturation had declined to 62%, requiring re-intubation. The patient was in refractory shock requiring 5 pressors and an elevated lactic acid of 8 that was up-trending. The source was thought to be a septic shock. However, there was no clear source of infection. Chest x-ray showed worsening bilateral infiltrates (Figure 5).

It was unclear whether the patient had aspirated or whether this was the worsening of his pulmonary infection with Aspergillus. He was placed on broad-spectrum antibiotics with vancomycin, piperacillin-tazobactam, and IV voriconazole to cover for the Aspergillus. The family had decided to pursue comfort care measures for the patient, given his poor prognosis. The patient passed away shortly after extubation on day 15.

COVID-19-associated pulmonary Aspergillosis (CAPA) is a secondary Aspergillus mold infection characterized by invasive pulmonary Aspergillosis (IPA) that occurs in COVID-19 patients [5]. These cases highlight the clinical characteristics, diagnostic criteria, and treatment of hospitalized CAPA patients. IPA has been seen after severe viral-related pneumonia, especially in patients admitted to the ICU for respiratory failure [6,7]. IPA has been reported in up to 15% of COVID-19 patients [2], which was histologically diagnosed in a series of 45 consecutive COVID-19 laboratory-confirmed autopsies [8].

Severe COVID-19 pneumonia destroys the bronchial mucosa creating favorable conditions for fungal growth [8]. The virus allows for vascular and epithelial permeability, facilitating the invasion of Aspergillus species [9]. Severe COVID-19 is associated with dysregulation of the immune system and overexpression of pro-and anti-inflammatory cytokines contributing to a highly permissive inflammatory environment enhancing fungal growth [10]

Clinical features associated with pulmonary Aspergillosis in patients with COVID-19 vary considerably. In one case series containing 20 patients, pulmonary Aspergillosis had been diagnosed a median of 11 days after symptom onset of COVID-19 and 9 days after intensive care unit admission [11]. This correlates with the third case we presented. The patient was not treated for CAPA due to the assumption of colonization rather than an actual infection, given his short ICU duration and course of steroids. However, based on the number of days of symptoms on admission (11 days), he might have had an actual CAPA infection resulting in his multi-organ sepsis and demise. The risk factors that have widely been reported include underlying factors like structural lung damage caused by COPD, immunosuppressant drugs, widespread use of broad-spectrum antibiotics, and HIV/AIDS, which tend to increase the risk for CAPA [2]. In addition, dexamethasone renders critically ill patients more susceptible to CAPA. Tocilizumab and Sarilumab, IL-6 inhibitors used in the treatment of COVID-19, inhibit the development of protective T-helper cells (Th17 cells), leading to an inadequate immune response [12]

The most common method to diagnose Aspergillus is to recover the fungus on culture media with bronchoalveolar lavage (BAL) or tracheal aspirate. Serologic biomarker testing, such as the conventional galactomannan (GM) from BAL, tracheal aspirate, and serum specimens, is also used to diagnose Aspergillus infection. Other diagnostic tests that may prove helpful also include PCR and serum (1→3)-β-d-glucan (BDG); however, these techniques are relatively less sensitive [13]. It is challenging to interpret positive cultures obtained from the respiratory tract as an actual infection or colonization. Distinguishing invasive Aspergillosis and COVID-19 pneumonia can be difficult from a radiological perspective, given that they share many similarities. For example, the "halo sign" seen in invasive Aspergillosis could be mistaken for a pulmonary infarction in a severe COVID-19 infection due to vascular injury via microthrombi [14,15]. Mechanically ventilated COVID-19 patients without invasive Aspergillosis often have nodular infiltrates, complicating the identification of surrounding halos in the scans [3].

An actual CAPA infection is proven with histopathological or cultural microscopic detection of the fungi showing invasive growth into the tissues [5]. Bronchoscopy is one of the few ways to obtain enough respiratory material for culture or histology. However, only some patients can undergo a bronchoscopy making the diagnosis of proven CAPA difficult. Probable CAPA should be suspected if there is Aspergillus from the BAL, positive serum GM index ≥0.5, positive BAL GM index of ≥1.0, or the presence of a new nodule or cavitary lesion(s) on chest CT [16]. The combination of multiple and repetitive positive mycology tests with typical radiological and clinical criteria contributes to the diagnosis of CAPA. Bronchoscopy should be the diagnostic gold standard whenever CAPA is suspected, including tracheobronchial inspection and BAL sampling for culture and GM [4].

Azoles with activity against Aspergillus species like Voriconazole or Isavuconazole are the first-line treatment options for CAPA [1]. Liposomal amphotericin B can be considered an alternative agent [1,17]. The most used antifungal agent is voriconazole due to its low cost and easy availability, followed by Isavuconazole and liposomal amphotericin [17]. Voriconazole is hepatically metabolized, and patients should be monitored for possible drug interactions with cytochrome P450 family 2 subfamily C member 19 (CYP2C19) and CYP3A [17]. Therapeutic drug monitoring should be performed as increased levels may lead to hepatotoxicity and neurotoxicity. Isavuconazole is associated with less severe adverse events and exhibits fewer drug-drug interactions, but it is costly. Isavuconazole should be preferred in patients for whom liver toxicity is a concern [17]. At the same time, the role of liposomal amphotericin could be limited by acute kidney injury complicating severe COVID-19 [1].

COVID-19 predisposes the host to IPA as an independent host factor, as seen in the presented cases. IPA is recognized as an essential co-infection and cause of mortality in patients with severe COVID-19. The incidence will vary across ICUs. In settings where CAPA is known to occur commonly, screening for IPA in blood and true BAL samples (i.e., obtained via bronchoscopy) should be implemented, followed by preemptive treatment in those with mycological evidence of IPA. In other high-incidence settings, clinical antifungal prophylaxis trials should be considered among COVID-19 patients admitted to the ICU. The goal is to decrease the overall mortality of patients with CAPA using a multidisciplinary approach of infectious disease specialists, intensivists, pulmonologists, and clinical microbiologists.



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A tight chest can be a symptom of various underlying health conditions. It can be a feeling of tightness, pain, or discomfort in the chest area.

In some cases, it may even be accompanied by shortness of breath, sweating, and a rapid heartbeat. If you experience tightness in your chest, it's important to seek medical attention to determine the underlying cause and to receive appropriate treatment.

If you're suffering from a tight chest and need a remedy or are unsure whether you've got it or not, this article is for you:


Possible Causes of Tight Chest

Tightness in the chest doesn&#039;t just lead to discomfort and pain but could also be caused by a serious medical issue. (Image via Unsplash/Giulia Bertelli)
Tightness in the chest doesn't just lead to discomfort and pain but could also be caused by a serious medical issue. (Image via Unsplash/Giulia Bertelli)

Possible causes of tightness in the chest include:

1) Anxiety and stress

Anxiety and stress can cause muscles in the chest to tense up, leading to a feeling of tightness.

2) Asthma

Asthma is a lung condition that causes inflammation and narrowing of the airways, leading to difficulty breathing and chest tightness.

3) Pulmonary embolism

This is a serious condition in which a blood clot forms in the lungs, causing chest pain and tightness.

4) Gastroesophageal reflux disease (GERD)

GERD is a condition in which stomach acid flows back into the oesophagus, causing heartburn and chest tightness.

5) Costochondritis

This is an inflammation of the cartilage that connects the ribs to the breastbone, causing chest pain and tightness.

6) Heart attack

Chest tightness can be a symptom of a heart attack, a serious condition in which the blood flow to the heart is blocked.


How to Get Rid of Tight Chest

To get rid of a tight chest, it's important to first determine the underlying cause. If the cause is anxiety and stress, relaxation techniques such as deep breathing, yoga, and meditation can help alleviate symptoms. If the cause is asthma, an inhaler may be prescribed to help open up the airways.

If the cause is a blood clot, the treatment involves blood thinners and possibly surgery to remove the clot. If the cause is GERD, treatment may include antacids and lifestyle changes such as avoiding foods that trigger symptoms.

If the cause is costochondritis, anti-inflammatory medications and physical therapy may be prescribed to alleviate pain and tightness. In case of a heart attack, emergency medical treatment is necessary to restore blood flow to the heart and prevent further damage.

In addition to seeking medical treatment, there're a few steps you can take to alleviate your tight chest. These include:

  1. Practicing good posture: Poor posture can lead to tension in the chest muscles, so it's important to maintain good posture to help alleviate tightness.
  2. Stretching and strengthening exercises: Stretching and strengthening exercises can help alleviate muscle tension and improve flexibility.
  3. Avoiding triggers: If you know what triggers chest tightness, such as certain foods or activities, try to avoid them to help prevent the symptoms.
  4. Taking over-the-counter pain relievers: Acetaminophen or ibuprofen may help alleviate chest pain and tightness.
  5. Getting enough rest: Adequate sleep is important for both physical and mental health and can help alleviate symptoms of chest tightness.

It's important to note that a tight chest can be a symptom of a serious health condition, so it's important to seek medical attention if you experience chest tightness.

Your doctor will be able to determine the underlying cause and provide appropriate treatment. With proper treatment and lifestyle changes, you can alleviate chest tightness and improve your overall well-being.


Doing any kind of exercise, taking medication, stretching, yoga, etc. are great ways to relieve tightness in the chest. (Image via Unsplash/Norbert Buduczki)
Doing any kind of exercise, taking medication, stretching, yoga, etc. are great ways to relieve tightness in the chest. (Image via Unsplash/Norbert Buduczki)

In summary, a tight chest can be caused by various health conditions such as anxiety, asthma, pulmonary embolism, GERD, costochondritis, and heart attack.

It's important to seek medical attention to determine the underlying cause and receive appropriate treatment. In addition to seeking medical treatment, there're steps you can take to alleviate symptoms such as practicing good posture, stretching and strengthening exercises, avoiding triggers, taking over-the-counter pain relievers, and getting enough rest.

If you feel like your symptoms are worsening by the day, you must seek medical attention.

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The condition only proves fatal when blood clots reach the lungs, as the rest of the organs rely on them for oxygen.

Doctor Andrei Kindzelski, an NIH blood disease expert explained that before a person suffers pulmonary embolism, they may experience swelling, pain, warmth and redness of the leg.

How to avoid blood clots

Taking steps to reduce the chances of a blood clot forming in the veins can help people avoid potentially life-threatening health problems.

The most crucial step in avoiding pulmonary embolism is preventing blood clots in the deep veins of the legs.



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After a two-month hiatus, Al Roker is back on air. In November 2022, the popular TODAY anchor was hospitalized due to deep vein thrombosis, which is when blood clots form in deep veins, usually in the lower leg, thigh, or pelvis. In a recent interview with TODAY, Roker revealed that the blood clots had developed after he had COVID-19 in the fall. The blood clots had started in his leg, but later moved into his lungs. He was also dealing with internal bleeding.

As a result, Roker said he lost half his blood and had to have multiple surgeries after his medical team at NewYork-Presbyterian/Weill Cornell Medical Center discovered two bleeding ulcers.

“The risk of [blood clots] has increased after infection with COVID because [COVID] leads to an inflammatory response in the body and promotes blood clotting,” explains Dr. Shruti Chaturvedi, an associate professor of medicine at Johns Hopkins Hospital.

Here’s what you need to know about blood clots, symptoms and causes.

What is a blood clot?

A blood clot is a gel-like clump of blood, which can protect you against bleeding out from an injury.

“Blood clots are a problem when they form not in response as a defense mechanism to an injury, but they’re found for no good reason and obstruct the flow of blood,” explains Chaturvedi.

A blood clot can form either in the vein, as is the case with deep vein thrombosis, or in arteries, where it’s most commonly found in the heart and brain and can cause heart attacks and strokes.

What are common symptoms of blood clots?

The most common symptoms of blood clots are swelling and discomfort in the legs. More often than not, swelling and tightness will appear on one side of the body, or one leg, and progress to pain.

“Some people will also see that the leg is progressively getting slightly swollen and larger than the other side and in very extreme cases, the leg can actually change color and become kind of reddish or bluish,” says Chaturvedi.

When should I see a doctor?

You should call your doctor right away if you’re experiencing swelling, redness, or pain in your arms or legs. If you’re experiencing shortness of breath, chest pain, a sudden change in vision, sudden numbness or difficulty speaking, you should visit urgent care or go to an emergency room immediately.

Upon arrival, your doctor may administer a D-dimer test, which is a blood test to determine whether you have a blood clotting condition.

“This is a screening test,” explains Chaturvedi. “If the D-dimer test is negative, the chance of having a blood clot is very, very low. It’s essentially a good way to rule things out, but if it’s positive it tells you it might be a blood clot. It might be a whole number of things.”

In order to definitively find a blood clot, your doctor may recommend imaging, such as a Doppler ultrasound of the leg. To look for blood clots in the lung, or a pulmonary embolism, your doctor would order a CT scan with contrast.

How are blood clots treated?

If it’s a venous blood clot, which forms in a deep vein, it can be treated with anticoagulants or injectable blood thinners. Once patients are clinically stable—meaning they are breathing on their own, their blood pressure is normal, and there are no other danger signs—they may be treated with oral anticoagulants such as Eliquis or Xarelto. But the most common side effect, Chaturvedi warns, is an increased risk of bleeding.

“When someone’s starting on medications like this, your doctor is probably going to ask you questions that try to assess what your risk of bleeding is,” she says. “These questions may include: 'Have you ever noticed blood in your bowel movements or urine? Have you ever coughed up blood? Do you frequently have falls?' Because having a fall when you’re on a blood thinner can be very dangerous.”

Who is at risk for blood clots?

Age as well as certain medical conditions, such as cancer, can increase the risk of blood clots in individuals. Other conditions that may predispose someone to blood clots include autoimmune diseases or inflammatory diseases, as well as being pregnant or taking birth control containing estrogen.

What are common causes of blood clots?

Some factors and conditions that can lead to blood clots include heart arrhythmia, heart attack, heart failure, obesity, pregnancy, and prolonged sitting or bed rest, as well as smoking, stroke, and surgery.

“People who have a family history of clotting may have a much higher rate of blood clots than someone who doesn’t,” says Chaturvedi. “Also, if you’ve already had one blood clot, your risk of having a second one is higher. There are a lot of different kinds of risk factors here.”

This story was originally featured on Fortune.com

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After a two-month hiatus, Al Roker is back on air. In November 2022, the popular TODAY anchor was hospitalized due to deep vein thrombosis, which is when blood clots form in deep veins, usually in the lower leg, thigh, or pelvis. In a recent interview with TODAY, Roker revealed that the blood clots had developed after he had COVID-19 in the fall. The blood clots had started in his leg, but later moved into his lungs. He was also dealing with internal bleeding. 

As a result, Roker said he lost half his blood and had to have multiple surgeries after his medical team at NewYork-Presbyterian/Weill Cornell Medical Center discovered two bleeding ulcers.

“The risk of [blood clots] has increased after infection with COVID because [COVID] leads to an inflammatory response in the body and promotes blood clotting,” explains Dr. Shruti Chaturvedi, an associate professor of medicine at Johns Hopkins Hospital. 

Here’s what you need to know about blood clots, symptoms and causes.

What is a blood clot?

A blood clot is a gel-like clump of blood, which can protect you against bleeding out from an injury.

“Blood clots are a problem when they form not in response as a defense mechanism to an injury, but they’re found for no good reason and obstruct the flow of blood,” explains Chaturvedi.

A blood clot can form either in the vein, as is the case with deep vein thrombosis, or in arteries, where it’s most commonly found in the heart and brain and can cause heart attacks and strokes.

What are common symptoms of blood clots?

The most common symptoms of blood clots are swelling and discomfort in the legs. More often than not, swelling and tightness will appear on one side of the body, or one leg, and progress to pain.

“Some people will also see that the leg is progressively getting slightly swollen and larger than the other side and in very extreme cases, the leg can actually change color and become kind of reddish or bluish,” says Chaturvedi.

When should I see a doctor?

You should call your doctor right away if you’re experiencing swelling, redness, or pain in your arms or legs. If you’re experiencing shortness of breath, chest pain, a sudden change in vision, sudden numbness or difficulty speaking, you should visit urgent care or go to an emergency room immediately.

Upon arrival, your doctor may administer a D-dimer test, which is a blood test to determine whether you have a blood clotting condition. 

“This is a screening test,” explains Chaturvedi. “If the D-dimer test is negative, the chance of having a blood clot is very, very low. It’s essentially a good way to rule things out, but if it’s positive it tells you it might be a blood clot. It might be a whole number of things.”

In order to definitively find a blood clot, your doctor may recommend imaging, such as a Doppler ultrasound of the leg. To look for blood clots in the lung, or a pulmonary embolism, your doctor would order a CT scan with contrast.

How are blood clots treated?

If it’s a venous blood clot, which forms in a deep vein, it can be treated with anticoagulants or injectable blood thinners. Once patients are clinically stable—meaning they are breathing on their own, their blood pressure is normal, and there are no other danger signs—they may be treated with oral anticoagulants such as Eliquis or Xarelto. But the most common side effect, Chaturvedi warns, is an increased risk of bleeding.

“When someone’s starting on medications like this, your doctor is probably going to ask you questions that try to assess what your risk of bleeding is,” she says. “These questions may include: ‘Have you ever noticed blood in your bowel movements or urine? Have you ever coughed up blood? Do you frequently have falls?’ Because having a fall when you’re on a blood thinner can be very dangerous.”

Who is at risk for blood clots?

Age as well as certain medical conditions, such as cancer, can increase the risk of blood clots in individuals. Other conditions that may predispose someone to blood clots include autoimmune diseases or inflammatory diseases, as well as being pregnant or taking birth control containing estrogen.

What are common causes of blood clots?

Some factors and conditions that can lead to blood clots include heart arrhythmia, heart attack, heart failure, obesity, pregnancy, and prolonged sitting or bed rest, as well as smoking, stroke, and surgery.

“People who have a family history of clotting may have a much higher rate of blood clots than someone who doesn’t,” says Chaturvedi. “Also, if you’ve already had one blood clot, your risk of having a second one is higher. There are a lot of different kinds of risk factors here.”

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Al Roker is officially back at work after taking two months off to deal with serious health issues. Roker was hospitalized for blood clots (deep vein thrombosis) in November 2022, and is revealing details of his treatment at the NewYork-Presbyterian/Weill Cornell Medical Center. "I lost half my blood. They were trying to figure out where it was," he says. "He is a living, breathing miracle," says Roker's wife Deborah. "He really is, and I have to say — I'm not overstating it, I don't think — Al was a very, very, very sick man. And I think most people did not know that. He was a medical mystery for a couple of weeks. It was the most tumultuous, frightening journey we have ever been on."

Roker's medical team discovered he had two bleeding ulcers, and he ended up needing seven-hour surgery on his colon and duodenum (a part of the small intestine) as well as having his gallbladder removed. In true Roker fashion, he can joke about the situation now. "I went in for one operation, I got four free," Roker says. "I really do feel good. I'm sure I'm going to collapse like a stone after this is over because this is the first work I've done. It's been a journey."

Roker says he wasn't aware of the extent of his illness. "Thank God for Deborah," he says. "She basically shielded me from a lot of this. I had no idea how sick I was. I am a living example of ignorance is bliss. … I was able to put all my energy into just recuperating because I didn't know how bad off I was." It turns out his medical team were deeply concerned about the state of his health. "(We) were extraordinarily concerned about Al," says his gastroenterologist Dr. Felice H. Schnoll-Sussman. "Extraordinarily concerned. He had a life-threatening experience. I mean, there's just no doubt about that."

According to the CDC, 900,000 people are affected by DVT every year. Here are the warning signs of blood clots, according to experts. 

1

Leg Pain

unhappy senior man suffering from knee ache. Travel and tourism concept.health problem and people concept.

unhappy senior man suffering from knee ache. Travel and tourism concept.health problem and people concept.

Leg pain that doesn't go away could be a sign of a dangerous blood clot. "The area affected by the blood clot may become swollen and painful, and possibly turn red as the normal flow of blood is blocked," says Quratulain Syed, MD. You may also develop edema, which is the build-up of fluid in the skin tissues surrounding the clot. If the clot is somewhere other than your arm or leg, there may be no physical signs of DVT."

Dr. Syed says approximately one in 1,000 people develop DVT each year. "Older persons and people who are overweight are most susceptible. Other common risk factors include an injury or blow to the body, prolonged immobility including long air flights or car travels, and serious illnesses such as congestive heart failure, stroke, cancer, or inflammatory bowel disease. Women taking estrogen either in the form of birth control pills or post-menopausal therapy may be at increased risk. Some genetic blood clotting disorders can also lead to frequent blood clots. You should ask your doctor about your risk for DVT." 

2

Swelling

Mature woman doing thyroid self examination on light background, closeup

Mature woman doing thyroid self examination on light background, closeup

Leg swelling is a common symptom of DVT, doctors say. "About 70% of all patients develop swelling, which is the top warning sign of DVT," says vascular surgeon Obinna Nwobi, MD. "If your DVT is in your thigh or calf, you'll only have swelling in the affected leg. However, if the blood clot is in your pelvis, you can develop swelling in both legs."

"There are effective treatments for a blood clot in the leg, most notably blood thinners, which hinder clotting ability while they're being used," says Vikalp Jain, MD, vascular surgeon at Jersey Shore University Medical Center. "Seeking medical help early when you think that you may have a blood clot is always the right decision, even if it turns out to be nothing. It's better to be safe than sorry when pulmonary embolism could be a possibility."

3

Warm Skin

Stressed annoyed old senior woman using waving fan suffer from overheating, summer heat health hormone problem, no air conditioner at home sit on sofa feel exhaustion dehydration heatstroke concept

Stressed annoyed old senior woman using waving fan suffer from overheating, summer heat health hormone problem, no air conditioner at home sit on sofa feel exhaustion dehydration heatstroke concept

Unusually warm spots on the skin could be a sign of DVT. "Common symptoms are swelling of the leg, pain or tenderness in the leg, increased warmth in the area of the leg that is swollen or painful, and red or discolored skin in the area of the leg that is swollen or painful," says Antonios P. Gasparis, MD.

"Most people are unaware of deep venous thrombosis (DVT) and its possible consequences. DVT is a blood clot in a deep vein, usually in the legs. It is one of the leading causes of death in the United States. These blood clots can be dangerous if they break off and travel to the lungs. When this happens, it causes a serious, potentially life-threatening condition called pulmonary embolism."

4

Swollen Veins

Pregnant woman wearing compression stockings . Varicose veins prevention, Compression tights, relief for tired legs.

Pregnant woman wearing compression stockings . Varicose veins prevention, Compression tights, relief for tired legs.

Studies show varicose veins could be an early warning sign of blood clots. "The most common question from a varicose vein patient in the vein clinic is: 'Will varicose vein bring any health risk for me?'" says Dr. Shyueluen Chang, a phlebologist and dermatologist at Chang Gung Memorial Hospital in Taoyuan, Taiwan. 

Dr. Chang's research showed that in adults diagnosed with varicose veins, there was an "increased risk of deep vein thrombosis in both women and men, [yet] this association is stronger in men than in women. We believe that varicose veins are not merely a cosmetic or symptomatic concern… patients with varicose veins deserve careful monitoring and early evaluation."

5

Post-Thrombotic Syndrome

"A common complication of DVT is post-thrombotic syndrome," says Dr. Syed. "Up to 50% of people who have had DVT may develop this disorder, which causes long-lasting leg pain and swelling that worsens throughout the day. The skin surrounding the swollen area may thicken and become darker as well. If left untreated, post-thrombotic syndrome can lead to sores that do not heal, and chronic pain while walking. If you have post-thrombotic syndrome, your doctor may be able to prescribe elastic compression stockings and supervised exercise programs for improvement of the swelling."

So how is DVT treated? "The drugs used to treat a DVT are called anticoagulants or 'blood thinners'," says Dr Syed. "They help prevent new clots from forming and stop the growth of the clots you already have. Based on the extent of the DVT and other medical problems (including cancer or kidney problems), some people may need to stay in the hospital to receive a blood thinning medication by intravenous infusion or injections under the skin for the first few days. After that, they may switch to an oral medication such as warfarin (Coumadin). There are also newer oral medications such as rivaroxaban and apixaban that can be prescribed without the need for infusions or injections, as long as you do not have any major medical complications. Most DVTs are treated for 3-6 months. Some people who may be high risk for future DVTs may need to stay on blood thinning medication for the rest of their lives. Be sure to let all your healthcare providers know if you are taking a blood thinner."

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But if you have back pain that's triggered each time you take a breath, this may be a sign of something more serious like pneumonia or a blood clot.

Here are seven reasons you may have back pain while breathing and when you should see a doctor.

Strained muscles occur when your muscles are stretched too much, causing tears in the muscle fibers or tendons.

"There are small muscles between the ribs, front and back, that help expand and contract your chest as a normal part of breathing," says Dr. Kate Rowland, a family medicine doctor and professor at Rush University.

These muscles can get pulled or strained through activities like heavy lifting or prolonged coughing. When this happens, "the muscle strain can get re-aggravated with each breath you take," Rowland says.

Some other signs that you may have a strained muscle are:

  • Swelling
  • Bruising
  • Loss of strength in the muscle
  • Pain when twisting

To treat a strain, you'll need to rest your muscles for at least a day. If you have swelling, you can ice the area for 10 to 15 minutes every few hours.

Also, "people often say it feels better with an anti-inflammatory drug like ibuprofen or naproxen," Rowland says.

Pleurisy is a condition that occurs when the tissue between your lungs and your chest wall becomes inflamed.

When you take a breath, your lungs press the swollen tissue against your chest, which can trigger pain.

This pain often starts in your chest but can spread throughout your back, shoulders, and abdomen.

  • The influenza virus
  • Pneumonia
  • The Epstein-Barr virus
  • A staph infection
  • An injury
  • Lung cancer
  • A blood clot in the lungs
  • Cancer treatment like chemotherapy

If you think you have pleurisy, see your doctor as soon as possible so they can determine the underlying cause and plan your treatment.

Pneumonia is an infection in your lungs that's generally caused by bacteria or a virus like the flu.

A pneumonia infection irritates the lining of your lungs, which can trigger pleurisy and cause back pain when you breathe.

"The pain of pneumonia can be sharp or a dull ache, especially when taking a deep breath," says Dr. Megan Boysen Osborn, a professor of emergency medicine at the University of California, Irvine.

The pain also tends to get worse if you're coughing a lot, says Dr. Jessica Oswald, an emergency medicine and pain specialist.

If you think you may have pneumonia, see your doctor as soon as possible. If the infection is caused by bacteria, you'll need to take antibiotics, while a viral infection usually goes away on it's own.

Lung cancer is relatively rare, but it's much more common if you smoke — around 90 percent of lung cancer cases are linked to cigarette smoking.

"Most small and focal lung cancers are painless, but the lesions can erode into ribs, nerves and lining of the chest wall," Oswald says.

This erosion can cause sharp pain that gets worse with breathing or coughing.

The pain often appears in your chest, but if the lesions are on the back of the chest wall, you might have back pain as well, Oswald says.

  • Shortness of breath
  • A cough that won't go away
  • Coughing up blood
  • Weight loss
  • Hoarse voice

Your doctor can diagnose lung cancer by taking scans or samples of your tissue. Depending on how advanced the cancer is, your doctor may treat it with surgery, chemotherapy, radiation, or other cancer treatments.

A pulmonary embolism is a type of blood clot that occurs in one of the blood vessels of your lung.

A pulmonary embolism can cause chest or back pain, depending on where it appears in your lung.

"The pain can be felt anywhere in the back or chest, as high as the clavicles/neck and as low as the bottom of the rib cage," Osborn says.

You're at greater risk of developing a pulmonary embolism if you:

  • Take hormonal birth control pills
  • Have had a recent surgery
  • Have recently taken a long plane flight
  • Have a family history of blood clots
  • Smoke cigarettes

Your doctor can diagnose a pulmonary embolism by looking at scans of your chest. They can then decide how to treat you — some common treatments include blood-thinning medications, using a catheter to break up the clot, or surgery for severe cases.

The two main heart conditions that can cause back pain with breathing are pericarditis and myocarditis, says Osborn.

  • Myocarditis occurs when your heart muscle becomes inflamed, which reduces your heart's ability to pump blood. This can trigger back pain with breathing,

The are many possible causes of myocarditis, including:

  • Viral infections like COVID-19
  • Bacterial infections like staphylococcus or Lyme disease
  • Infections from parasites or fungi
  • Certain medications like cancer drugs and antibiotics
  • Inflammatory disorders like lupus or arthritis

  • Shortness of breath
  • Fatigue
  • Swelling in legs, feet, and ankles
  • Fast or irregular heartbeat
  • Flu-like symptoms
  • Pericarditis occurs when the pericardium, the thin tissue surrounding your heart, becomes irritated and inflamed.

Pericarditis causes some of the same symptoms as myocarditis as well as:

Pericarditis may also be caused by an infection or inflammatory disorder, as well as:

If you develop the symptoms of either condition, you should get medical help as soon as possible. Severe forms of myocarditis can damage your heart or may even be fatal.

Your doctor will determine what type of treatment you need, which may include corticosteroids, blood thinning medications, or various surgeries.

Broken or bruised ribs generally happen after you've had an injury or accident. "So usually people know when they have that kind of thing happen, and the pain starts right away," Rowland says.

"Broken ribs are usually very painful and hurt like crazy with every breath because the fracture moves a little with each one," Rowland says. If the break is on the back of your rib, you'll feel this pain in your back.

But even if you're in pain, "it is important for patients to take deep breaths to avoid getting pneumonia after a broken rib," Osborn says.

  • Swelling or tenderness around the ribs
  • Visible bruising on the skin
  • Feeling or hearing a crack in the rib

Broken or bruised ribs generally heal on their own, but you should still see your doctor to confirm that you have a break and make sure there aren't any complications like a punctured lung.

There are many different reasons you might feel back pain when you breathe. "Anything that causes irritation to the chest wall can cause pain while breathing; this could be a serious cause or a not serious cause," Osborn says.

It's important to see your doctor if you have any back pain that:

  • Doesn't go away
  • Happens after a fall, injury, or blow to the chest
  • "Comes with other symptoms, especially shortness of breath, chest pains, fevers, sweating, or fatigue/malaise that started at the same time," Rowland says.

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Telesolutions have been increasingly developing during past epidemics, e.g., for contact investigations and disease control6. In the time of the Ebola outbreak between the years 2014 and 2016, a mobile application helped to trace and monitor confirmed cases14, increasing the time to case registration, completeness, and security of the data. When SARS-CoV 1 was dealt with in Taiwan, online communication via a webcam increased the availability of medical consultations and reduced their costs15. Swiss teleservice notifications associated with fever were proven to reflect influenza activity16.

Lately, the pandemic situation forced outpatient care out of the doctor’s office. Italian authors, like Omboni17, complained of insufficient telemedicine implementation during the first striking COVID-19 wave and suggested it is a must in a modern healthcare system, especially in terms of chronically-ill patients during a lockdown. Nevertheless, more attention in the literature has been put on telehealth concerning home-isolated COVID-19 patients and controlling their disease18, especially after the unpredictable character of SARS-CoV 2-associated pneumonia presented itself throughout the world. The China health center19 has set up a network for COVID-19 alert and response with 126 network hospitals involved. Between January 28 and February 17 in 2020 63 teleconsulted patients had severe pneumonia alongside 591 were moderate cases. At that time, there were mobile devices used for collecting, evaluating, and reporting patient vital signs to the caring team in isolation wards. The authors outline that the bedside system allowed to limit the exposure to patients’ contagious secretions and the communication system was utilized to build and remotely train multidisciplinary health teams for a more comprehensive treatment. An utterly different telesurveillance solution for home-treated patients based on questionnaires in a mobile application has been developed by a French group20, with more than 65,000 users in Paris, and it consisted of Medical Responders and physicians reacting to changing subjective health status of ill individuals.

The effects of telemedicine implementation and its impact are well known in cardiology, with trials such as the TIM-HF221 which demonstrated that remote telemonitoring reduced days lost due to unplanned cardiovascular hospitalizations, as well as documented a decrease in all-cause mortality among patients managed in the study. In chronic obstructive pulmonary disease, our research group has previously shown that a decrease in saturation exceeding 4% can predict an exacerbation in the forthcoming 7 days22. With enough time and training, home spirometry starts to correlate with hospital spirometry among the idiopathic pulmonary fibrosis group23. Among the less obvious effects of telemedicine-enhanced home care, the worth-to-consider effects are both improved psychological well-being and individually tailored treatment decisions.

Much is known about the average recovery after COVID-19 pneumonia and persistent symptoms; however, the variety of research does not answer the question of which patients should be supervised with special attention. To our knowledge, no other group monitored patients at home for a longer period than we managed to do. This study aimed to stratify the usefulness of day-to-day saturation and heart rate measurements, as well as the subjective extent of dyspnea and cough, in post-COVID care among previously hospitalized survivors. Our findings suggest that a patient who provides at-rest saturation measurements lower than 94% will not significantly improve in pulmonary function tests—FVC and DLCO—after 2 to 3 months post-discharge. This equals continuous exercise intolerance.

Most of the existing research associated with COVID-19 and telehealth considers the acute infection stage, sometimes with a short sequence afterward. Motta et al. monitored saturation, heart rate, body temperature and peak expiratory flow of 12 patients during 30 consecutive days of acute home-treated individuals with mild to asymptomatic SARS CoV 2 infestations to evaluate a quick response system during the worsening symptoms24. The findings have shown a significant decrease in SpO2 and an increase in heart rate during the illness, while PEF values dropped below 80% of the normal range among 4 of the participants. The authors outlined that there was not enough data to guide the use of home pulse oximetry or validate it in disease progression.

O’Carroll et collaborates used remote oxygen saturation monitoring in COVID-19 cases to facilitate the discharge of non-oxygen-dependent patients and have their safe follow-up25. During the median time of 12 days of measurements, the telemonitoring allowed to detect 3/18 patients with desaturations because of worsening COVID-19 infiltrates and 1/18 worsening from hospital-acquired pneumonia developing after the hospital discharge. Telemedicine served its role—it allowed managing patients’ conditions in a more controlled manner; no one from this group (4/18) required non-invasive or invasive ventilation during readmission. Of note, the alerts that lead to medical attention were programmed to be generated after every measurement lower than 94% SpO2, consistent with our findings. The frequency of measurements was higher (mean 3.9 vs 5.7 per day) in the readmission group25; our own observations showed a higher cooperation rate among more seriously ill (non-improvers). Similar research from Grutters et al. proved the 5-day (± 3.8) shortening of hospital stay among the 33 participants group via the use of telehealth. It also allowed a safe follow-up with 3 readmissions and 1 pulmonary embolism diagnosis, along with the cost-effectiveness of a whole system. Most patients in these studies rate telemonitoring to be friendly and useful.

Research by Martínez-García et al. included two groups of patients in the surveillance26: 224 outpatients traced from the beginning of the disease and 89 inpatients after discharge. Every patient provided oxygen saturation and temperature 3 times a day. Proactively, the patient was reached at least once a day. Until the termination of the study after 30 days, 38 (16.90%) outpatients were referred to the Emergency Department, 18 were hospitalized (8.03%), and 2 were deceased. One patient from the inpatient group was re-hospitalized and one left the study. Importantly, neither deaths nor vital emergencies happened at home. The average time of monitoring was 11.64 (± 3.58) days, and 224 (73.68%) patients were discharged during the 30 days of the study.

Patients are reluctant to participate in telehealth research for various reasons explored e.g. by Sanders et al.27. Most anxiety comes from technical requirements—which are often misunderstood and exaggerated. There is a group of patients that consider telemedical surveillance with a high degree of dependency and ill health, which is unbearable to them. At the same time, others are glad to have their current healthcare providers and they are hesitant about the care methods they are unfamiliar with. Great telemonitoring adherence data comes from the paper by Lang et al.28. Among the analyzed group, some participants withdrew from the study during its course—referred to as the drop-outs. 41 patients gave reasons for dropping out after a period of sending data. They can be further categorized into groups: no perceived benefits for health; no need for telemonitoring; investing too much time in participation; insufficient user-friendliness; feeling a loss of privacy. The most mentioned reasons for dropping out were no perceived benefit (19/41; 46.3%) and the lack of telemonitoring needs (18/41; 43.9%). Cook29 also outline that the majority of users resigning from telehealth did not find the equipment useful once they had tried it, while Foster’s30 telehealth engagement study reported that as much as 40.1% (n = 2852) of decliners did not feel a need for additional health support, 27.2% (n = 1932) stated being too busy to use it and 15.3% (n = 1092) of decliners were not interested in the research. This data is greatly consistent with our findings, where non-adherence and omitting the daily measurements are correlated with functional improvement after COVID-19. We did not investigate participants’ motivation though, so we can only speculate that they did not feel the necessity to stay under strict surveillance.

Compared to the research cited above, our prospective study is unique because we prolonged the monitoring until a minimum of 2 weeks of SpO2 ≥ 95% with a mean observation time of 67 (range 45–114) days. The program allowed us to notice serious events in patients’ individual post-COVID history. It becomes crucial when you realize a striking study by Chopra et al.3 who depicted that from 1250 COVID-19 survivors in the US State of Michigan 84 patients (6.7% of hospital survivors and 10.4% of ICU-treated hospital survivors) died in the following 60 days, bringing the overall mortality rate for the cohort to 29.2% hospitalized and 63.5% of treated in ICUs. Data from Bellan et al. further confirm these results with 5% post-discharge 30-day mortality31. Furthermore, 189 convalescents (15.1%) became re-hospitalized in the same period. In our group, one of the patients returned to a hospital during the study because of Clostridioides difficile diarrhea as a post-hospitalization and post-antibiotic consequence. At the time of observation, the additional diagnoses were: one outpatient post-COVID pulmonary embolism; one hereditary thrombophilia (in another person); two asthma diagnoses; urinary bladder ulcers of possible viral etiology in one patient; myocarditis (two suspected and one of them confirmed in the MRI). There was also one underlying interstitial lung disease suspected but the final diagnosis of severe emphysema with overlapping post-COVID radiological changes has been determined. None of the participants died or had rapidly worsening respiratory parameters. Worthy of note, those hospitalized in pulmonary rehabilitation units reported notable subjective improvement. The efficacy of post-COVID pulmonary rehabilitation is undoubtedly beneficial in research papers32. Such a statement cannot be assigned to pharmacological interventions so far.

On the other hand, the heart rate measurements did not prove to be useful in our real-life telemonitoring study, probably because compensatory tachycardia was deeply modified by the use of medications like β-blockers and ivabradine. We were also disappointed with dyspnea and cough self-assessment scales that did not correspond with pulmonary improvement. Interestingly, it appears from existing studies that there is no significant difference in PFTs when comparing patients with persistent COVID-19-related symptoms and asymptomatic ones33.

The study could not consider confounding factors. The main limitation of our research is group heterogeneity; as explained in the methods section almost every patient hospitalized for COVID-19 pneumonia was allowed to join it. The severity of interstitial pneumonia among participants was not equal and men were the predominant sex. The starting point slightly differed between patients hospitalized in our unit and those from other centers, forming a possible bias. 6-min walk tests were performed with different supervisors and it probably had an impact on patients’ engagement in the test itself. The unique benefits come from a longer observation time and addressing the pulmonary function tests to pulse oximetry results; as far as we are concerned no other researchers found such a correlation. Every patient had technical training with access to technical and medical consultation whenever problems occurred; just to eliminate loss of data or potentially hazardous events.

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A pulmonary embolism (PE) can be life-threatening because a blockage in the lungs damages them and reduces the blood's ability to receive enough oxygen to support the rest of the body. With rapid treatment, most people affected by a pulmonary embolism can recover.

This article discusses breathing exercises and how to do them if you've recently had a pulmonary embolism.

DjelicS / Getty Images


About 1 in 1,000 people in the United States are diagnosed with a pulmonary embolism annually.

Breathing Exercises

Generally, the diaphragm can easily move oxygen and other gases in and out of the lungs. After a pulmonary embolism, the lungs might have more difficulty completing this task. If practiced regularly, breathing exercises can help make the lungs more efficient.

Two types of breathing exercises that may help include:

  • Pursed lip breathing is intended to reduce the number of breaths taken and to keep airways open a little longer. To practice this exercise, breathe in through the nose and breathe out about twice as long through pursed lips (as if you're using a straw).
  • Belly breathing or diaphragmatic breathing: Start by breathing in through the nose and paying attention to how your belly fills with air. Breathe out through the mouth at least two to three times longer than you inhale. While doing this exercise, keep your shoulders and neck relaxed.

Other Recovery Strategies

Although there is no standard guideline for post-pulmonary embolism rehabilitation, there are best practices to help with recovery. Speak with your healthcare provider about which of the following exercises can help assist you with your overall health outcome:

  • Exercise training can improve motor function and strengthen breathing muscles. Ensure that exercises help both upper extremity function (which helps decrease fatigue) and lower extremity function (which helps increase endurance and improves breathing function).
  • Health education should include preventing pulmonary embolism, understanding your treatment options, and learning healthy habits to improve lung and overall body function.
  • Psychological intervention: A life-threatening medical diagnosis can cause fear, anxiety, sadness, and post-traumatic stress, negatively affecting the healing process. Your healthcare providers should ensure you have resources to assist in regulating emotions, decreasing stress and anxiety, and modulating emotional reactions.
  • Nutritional supplementation: PE can adversely affect nutrition, so speaking with a dietician who can provide a treatment and a recovery-friendly nutrition plan can be helpful.

Monitoring Symptoms

Once a pulmonary embolism is diagnosed, the primary treatment is an anticoagulant; this medication is designed to stop the blood clot from growing and to give the body time to break the clot down naturally. It's typically used for three months or longer after a PE diagnosis. Since the use of anticoagulants requires some monitoring, expect follow-up appointments with your healthcare provider.

Any shortness of breath resulting from a PE typically resolves within a few weeks to months after the initial diagnosis. If shortness of breath remains six months after treatment, it is important to consult a healthcare provider. Further testing might be indicated to determine if the PE scarred the lung or the lung's blood vessels or if other treatments are needed.

Tips After a PE Diagnosis

Additional items your healthcare provider might encourage after a pulmonary embolism diagnosis include:

  • Compression socks help increase pressure in the veins of the legs to prevent blood from pooling and clotting. Increased pressure forces the blood to keep moving, making it harder for a blood clot to form and break off, becoming a pulmonary embolism.
  • Bleeding precautions: It's essential to be aware of anticoagulant interactions that may decrease their effectiveness. Examples of things to avoid while taking anticoagulants include alcohol, over-the-counter (OTC) medications (like aspirin), and certain foods.

Summary

A pulmonary embolism is a blood clot in the lungs that can block blood from being oxygenated to support the body's functions. Once a diagnosis is made and a treatment plan begins, it is helpful to learn breathing exercises to help the lungs regain optimal function.

There are also additional considerations for strength training, nutritional support, psychological care, and health education to assist with a successful recovery after a pulmonary embolism diagnosis.

A Word From Verywell

A life-threatening diagnosis of pulmonary embolism can be frightening and stressful. Understanding the disease condition is important, as is knowing how to regain optimal health and wellness. Collaborating with your healthcare provider is vital to ensure any additional activities or treatments are recommended and safe.

Frequently Asked Questions

  • How long will I be breathless after a pulmonary embolism?

    Feeling short of breath after a pulmonary embolism can often resolve quickly. In 3% to 4% of people affected by a pulmonary embolism, the damage can cause scarring, which can cause shortness of breath for weeks or months. If you're still experiencing shortness of breath six months post-treatment, you must talk to your healthcare provider to determine if additional testing is required.

  • What are the long-term effects of a pulmonary embolism?

    As with other lung conditions, people affected by a pulmonary embolism experience different degrees of respiratory symptoms and impaired motor functions for several weeks or months after the initial diagnosis.

    Current best practices to improve health after a pulmonary embolism include breathing exercises, exercise training, health education, nutrition improvement, and psychological intervention if depression or anxiety is present.

  • How much exercise should you do after a pulmonary embolism?

    Generally, exercise is safe until any pain or difficulty breathing is noted; if this happens, stop exercising immediately and contact your healthcare provider for further guidance. Before starting any exercise regimen, speak with your healthcare provider so they can ensure your lungs and motor function are stable enough.


By Pamela Assid, DNP, RN

Pamela Assid, DNP, RN, is a board-certified nursing specialist with over 25 years of expertise in emergency, pediatric, and leadership roles.

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When World Chronic Obstructive Pulmonary Disease (COPD) Day was observed recently, the focus of attention was on a subject that is becoming an extremely urgent hearth issue to chest physicians across the world and in Sri Lanka: namely, the long and short term damage of Chronic Obstructive Pulmonary disease to a person’s body. While this common chronic lung disease affects men and women the good news is that it is both preventable and treatable chronic lung disease.

Consultant Respiratory Physician, District General Hospital and District Chest Clinic, Trincomalee Dr. Upul Pathirana shares his expertise on this important health issue with the Sunday Observer on preventable risk factors causing it especially smoking and inhaling impure indoor and outdoor air emissions. Most importantly he also shares some simple rules to avoid these risks.

Excerpts

Q: When World COPD (Chronic Obstructive Pulmonary Disease) Day. ( Nov 16) was observed recently) I understand this year’s theme was “Lungs for Life.” Could you explain its significance to persons afflicted by this chronic lung condition.?

A. “Your Lungs for life, “is the theme for World COPD day 2022. Its message to all those who are not afflicted with COPD or already afflicted by the condition, is that keeping lungs healthy is a vital part of one’s future health and well being.

It is a process that starts from early childhood when the lungs are still developing, to the time one reaches adulthood. In order to create awareness of the important role of the lungs in our well being that the Global Initiative for Chronic Lung Disease ( GOLD) has selected this as a theme for this year’s COPD Day.

Q: With reference to what you just pointed out, COPD is a common respiratory disease across the world and keeping one’s lungs healthy plays an important role in one’s well being. Unfortunately many people still lack even basic knowledge of this condition-. Could you explain what exactly COPD is , and its adverse effects on our health?

A. COPD is a disease, which affects lungs making it hard to breathe. In patients with COPD, the airways (the branching tubes that carry breathing air within the lungs) are narrowed and can be clogged with secretions called mucus. The air sacs are also damaged. These combinations make patients feel short of breath and tired.

Q: Is Emphysema or chronic bronchitis the same thing? What is the difference?

A. Emphysema means damaged air sacs and air gets trapped inside the lungs making it harder to breathe in again. Breathlessness is the main symptom of emphysema. Constant and long-lasting irritation and swelling of the airways is the hallmark of chronic bronchitis. It is characterized by coughing and increased production of secretions called mucus. These are two different components of COPD.

Q: How is COPD caused?

A. Smoking is the most common cause of COPD globally. The noxious particles in smoking induce an inflammatory (immune reaction to injurious agents) cascade within the lungs. The damage incurred by smoking is permanent and causes COPD.

Q: Can symptoms of its onset be detected early?

A. The patient may not feel any symptom until the lung is damaged to a certain extent. As the severity of illness is getting worse, you may experience breathlessness, mainly when you are engaged in physical activities like walking. Your breathing might be noisy (“wheezing”) similar to that of bronchial asthma. Chronic cough with phlegm may cause further trouble.

The clinical course could further complicate with infective exacerbations and COPD patients are at risk of developing lung cancer and heart diseases.

Q: Main risk factors- what are they?

A. Smoking is the commonest causative factor for COPD although exposure to other toxic gases and fumes may induce COPD. Untreated long-standing bronchial asthma patients may behave like COPD. Indoors and outdoors air pollution are well-known risk factors to develop COPD and these can precipitate COPD flares as well. Alpha 1-antitrypsin deficiency is a rare genetic disorder associated with COPD.

Q: Is there a test/s to confirm the diagnosis?

A. Yes. Spirometry will help to establish the diagnosis. During this test, you will be advised to take a deep breath and then blow out as fast as you can into a tube. The tube is attached to a computerised system so that it can measure how much air you can blow out of your lungs and how fast you can blow. If the result is abnormal, the test is repeated in 15-20 minutes after an inhaled or nebulised medication. The second test aids to decide whether the abnormal results are reversible with medication and make alternative diagnosis like bronchial asthma.

Q: Do you offer tests other than spirometry?

A. Testing other than spirometry is individualized. Imaging your lungs with chest X-ray can show changes compatible with COPD although computed tomography (CT) of the chest is more accurate at detecting and characterizing emphysema. CT has other advantages like detection of early stage lung cancers for which COPD patients are at high risk.

Q: Can COPD be cured?

A. It cannot be cured and can get worse over time. However, there are treatment options to control symptoms and disability in COPD. There are therapeutic measures that prolong survival

Q: Will early diagnosis and treatment help?

A. It is important as removal of causative factors and can slow down the progression.

Q: What are the complications of persistent COPD? Is pneumonia one?

A. COPD is a progressive disease, and the trajectory may complicate with flares of disease, which could be non-infective or infective (pneumonia). Patients may end up with respiratory failure (a state of low oxygen in blood) and the pressure within the lung may go up (called pulmonary hypertension). Then, your right heart ultimately fails.

Q: Will regular exercise, nutritious diets help?

A. Eating healthy foods with a balanced meal improves your overall health. Patients with COPD can lose body weight and muscle mass because of disease itself (chronic inflammation) and lack of physical activity. The result is a lean patient with low body mass index (BMI), which is associated with poor outcome in these patients. Supervised regular exercise plan is an essential component in COPD management to reduce disability.

Q: Treatment options?

A. Your physician will stage the disease based on your clinical characteristics and spirometry results. The main forms of medicinal treatment are inhalers, which help to open and dilate the closed or narrowed airways. Thereby, the inhalers enhance your exercise capacity. Additionally, the doctor might prescribe pills and capsules as required, especially in flares of symptoms.

As the disease progresses, your lung fails to oxygenate the blood for the demand necessitating home oxygen therapy. On rare occasions, surgeons can help COPD patients with surgical interventions as decided by a multidisciplinary team led by a respiratory physician. Finally, replacing your disease lung with a donor lung (lung transplantation) is going to be the last option.

Q: You referred to flare-ups. What are they?

A. The disease is marked by the progressive nature of the disease over time. There may be rapid worsening of symptoms precipitated by an infection, exposure to toxic gases or fumes or related to any other stressful event. These are called acute exacerbations or flares. The other complications such as pneumothorax, heart attack, blood clot within the blood vessels inside your lungs (pulmonary embolism) or rhythm changes in your heart may mimic flares.

The flares could be mild or severe enough requiring hospitalized management to save your life. You should seek medical advice early in flares.

Q: Are there vaccinations to reduce risks?

A. Infections like influenza, pneumonia, Covid-19 can be very hard on your lungs and can cause COPD symptoms to flare up. Getting a vaccine against these bugs can lower the risk of flares. These include the pneumococcal vaccine at least once, the flu shot every year and the Covid -19 vaccine and boosters.

Q: Pulmonary rehabilitation for COPD is included in the Package of Interventions for Rehabilitation, currently under development as part of this WHO initiative. Can you elaborate on this?

A. COPD patients are chronically breathless, limiting their mobility and physical activities, which subsequently causes muscle wasting.

Therefore, you feel tired and weak despite well-controlled COPD with your medications. Targeted exercise sessions in a specialised institution supervised by a respiratory physician and physiotherapists enable patients to engage in activities at home to regain lost muscle power. This type of training programes are coupled with nutritional assessment and appropriate advice, and also psychological support. The whole programe is named as pulmonary rehabilitation, is happening in respiratory units in Sri Lanka with encouraging feedback from participants. .

Q: It has now been universally accepted that reducing exposure to tobacco smoke is one of the most important primary prevention of COPD. Do you agree?

A. Prevention or minimisation of tobacco exposure is the best measure in COPD control as it primarily prevents disease occurrence and mortality, thereby reducing the health care burden and impact on the economy. Quitting smoking is the first and most important step in COPD management.

It not only helps in COPD but also reduces the other complications associated with smoking, for example lung cancer, heart attack or stroke. No matter how much and how long you smoked, you must cease smoking for a healthier life.

Q: Any suggestions as to how a habitual smoker can quit smoking ?

A. Following are several options we have for those who have difficulty complying with this most important intervention in COPD. They include :

a) Nicotine replacement therapy

b) Motivation and counselling for cessation of smoking at all the stages including even if you have not thought of quitting To help make this a reality, WHO introduced the following MPOWER measures.

1) Monitoring tobacco consumption and the effectiveness of preventive measures

2) Protect people from tobacco smoke

3) Offer help to quit tobacco use

4) Warn about the dangers of tobacco

5) Enforce bans on tobacco advertising, promotion and sponsorship

6) Raise taxes on tobacco

These measures are intended to assist in the country-level implementation of effective interventions to reduce the demand for tobacco, contained in the WHO FCTC

Q: Your message to readers?

A. You buy diseases such as COPD, cancers, vascular diseases (heart attack, stroke) each time you smoke tobacco.

You spread these diseases to your loving relations, parents, children and friends, as passive smoking is also associated with tobacco related health issues.

My first, second and third message is quit smoking today, do not postpone it for tomorrow.

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At 37, Bethany Liefer, she had a pulmonary embolism, a serious health issue that is responsible for 50,000 to 200,000 deaths per year in the United States.
At 37, Bethany Liefer had a pulmonary embolism, a serious health issue that is responsible for 50,000 to 200,000 deaths per year in the United States. Photos courtesy of Bethany Liefer.

 

At age 37, Bethany Liefer was very much alive.

She excelled in the outdoors, running 15 miles a week and hiking up to 20 miles a week. She had climbed 16 of Colorado’s famed 14ers and reveled in the joy of reaching each summit.

Without warning, on a random day in June 2021, her heart stopped, and she wasn’t breathing.

As she lay lifeless on a gurney in the emergency room at UCHealth Memorial Hospital North, a team of doctors and nurses swarmed around her. Initially, they could not find a pulse.

A team of nurses and EMTs began doing chest compressions. Dr. Clinton Fouss, an emergency room physician, placed a tube down into her trachea and connected her to a machine that delivered oxygen, to help her breathe.

Fouss’ message to his team was crystal clear: Keep trying. Don’t give up. Keep going.

Bethany Liefer with her partner and three girls, ages 11, 8 and 6. Liefer, a pulmonary care nurse, nearly died after suffering a pulmonary embolism. She “coded” at UCHealth Memorial Hospital North and thanks her physician, Dr. Clinton Fouss, for not giving up on her.

For five to six minutes, the mother of three girls, now ages 11, 8 and 6, was “coding,’’ in hospital parlance, meaning her heart had stopped and she wasn’t breathing.

“I never saw the light …,’’ Liefer recalled months later. “Aren’t you supposed to go to the white light when you die? I don’t remember any real come to Jesus moment when I died.’’

Finally, her caregivers detected a faint pulse. Her heart started beating again and once stable enough to be loaded onto a helicopter for a short flight to Memorial Hospital Central, she was in the air. At Memorial Central, she went straight to the operating room, where a surgeon performed a six-hour open heart surgery.

From there, she spent the next nine days in a coma as a ventilator breathed for her in the intensive care unit.  Despite being unconscious, she felt her mother’s hand touch her face. She heard her soothing words.

“You are safe, and you’re going to be OK.’’

A seemingly normal Saturday morning in summer

A week before that fateful Saturday, June 19, 2021, Liefer had been climbing Mount Big Chief, elevation 11,224 feet. Liefer and her friends had reached the trailhead after 2.5 hours on a four-wheel drive road, southwest of Colorado Springs in Teller County. At the summit, it’s 360 degrees of splendor, with views of Pikes Peak, the Spanish Peaks in the distance, the Sangre de Cristo and Sawatch ranges.

Oddly, Liefer couldn’t make it to the top.

“I felt so bad, but I had never not summited a mountain, not including weather. But I have always been able to finish, I just thought I was being lazy, that I was not working hard enough,’’ she said. “And my friends were like, ‘this is not you.’’’

Bethany Liefer and her partner, at the top of a colorado peak. elevation climbing, birth control and a few other factors may have contributed to her pulmonary embolism in her 30s.
Bethany Liefer is thankful to be alive and grateful for her caregivers after she nearly died from a pulmonary embolism at 37. Here, she and her partner, revel in the Colorado mountains.

Feeling fatigued, Liefer went on with her life and a week later was doing yard work at her home in Monument. That morning she’d sent humorous texts to her friends.

“I was with my dog that morning, and I was really slow that morning, out of breath, just moving slowly,’’ she said. “And then I thought, maybe I’m just being lazy. Maybe I’m just not pushing it.’’

In time, she could barely breathe. She managed to call 911, and her daughter, then 10 years old, ran for their neighbor and called her grandfather. Her daughters were terrified to see their mother whisked away in an ambulance to Memorial North.

Her life had forever changed. She had a bilateral pulmonary embolism. Three out of four people who have a pulmonary embolism and require CPR die.

“So my heart, my pulmonary artery and my aortic artery, all of that was clotted and then that clot broke free and pushed into my lungs, and that’s when I had real respiratory distress,’’ Liefer said. “It’s a really, rapid decline, so I am so lucky.’’

Where the clot originated remains a mystery.

“Clots form in your legs or your abdomen, and so you have a little bit of warning, and it is painful to have a blood clot in your leg or in your abdomen because there are sensory neurons there. And they couldn’t ever find one, they scanned my legs and they scanned my abdomen, and they couldn’t find any source,’’ said Liefer, a pulmonary nurse at Children’s Hospital Colorado.

Bethany Liefer, who experience a pulmonary embolism at 37, enjoys the Colorado sunshine with her partner.
Bethany Liefer enjoys the Colorado sunshine with her partner. She loves to hike, but at 37, she was hospitalized for a pulmonary embolism that nearly took that all away.

Liefer’s hematologist told her that a combination of birth control medication, which has a small risk for blood clots, dehydration, being at altitude the week before and stress, could have “pushed me over the edge,’’ she said.

In retrospect, she wonders if the clots had been forming at least a week prior, when she couldn’t make it to the summit of Big Chief.

“We were 2.5 hours in on a four-wheel drive road, and I would have been dead. That’s what I always think. If it hadn’t happened when I was at my house with medical care at hand’s reach, I would have been dead,’’ she said.

Liefer has no memory of texting her friends that Saturday morning, the helicopter ride, the operating room. She only remembers the sound of her mother’s voice. When she awoke nine days later, it took a few days for her to gather herself.

What is pulmonary embolism?

Pulmonary embolism (PE) occurs when a blood clot goes to the lungs and blocks blood flow into one or both lungs. There are many causes for PE including any condition which causes a person’s blood to be prone to clot including the postoperative state, long periods of inactivity, birth control pills or cancer.  Pulmonary embolism is responsible for 50,000 to 200,000 deaths per year in the United States alone. Acute massive PE has a 25% mortality rate. Someone who requires CPR in the setting of massive PE (as Bethany did) will have a 75% chance of dying.

When recognized early and treated early, the outcomes are vastly different.  Memorial Hospital has an acute PE response team (PERT) to respond to this deadly disease and vastly improve the outcomes for our patients. The team is comprised of emergency department physicians, pulmonary critical care physicians, interventional radiologists and cardiac surgeons.

Because the treatment algorithm is complex and there are various ways to treat patients based on the severity of the PE, patients benefit from having the input and expertise of all team members in real time. This multidisciplinary effort assures timely diagnosis and treatment of this deadly disease.

Dr. Peter Walinsky, the chief of cardiac surgery at Memorial Hospital and the driving force in the creation of the PERT said: “Patients like Bethany are the reason we instituted the PERT at Memorial Hospital. She was in the highest risk category of PE and received the most aggressive treatment (open heart surgery). In centers without a PERT it is highly unlikely she would have survived.”

“I woke up, and I was really confused. I had big chest tubes, and I had a tracheotomy, and I had a G-tube (feeding tube), and I was just really confused and frightened. And they slowly filled me in, and I couldn’t see at the time, my vision was severely impaired.’’

When Liefer’s heart failed, blood did not reach the occipital part of her brain, which controls eyesight. Despite impaired vision, she was startled after emerging from her coma to see her father and her new boyfriend conversing in her hospital room.

“I was just divorced, and we had been dating three or four months, and I thought, ‘I’ll just take this really, really slow.’ And he just kind of bullied his way into the ICU, and he met my father for the first time at the foot of my hospital bed. He hugged my dad, who is a stodgy old German man, and I was like, ‘Woooooooo. Oh my God.’’

Dr. Fouss, her physician in the emergency room, also visited her twice while she was in the ICU. She said words cannot adequately express her gratitude for him.

“Thank you. Thank you. Thank you,’’ she says.

Recovery from a bilateral pulmonary embolism in your 30s

Fouss said Liefer’s recovery from the bilateral pulmonary embolism was the result of teamwork among many people.

“The common theme to any great outcome in medicine is the team effort put into the care of the patient,’’ Fouss said. “As the physician, I’m an extremely small cog in a very large wheel of people who take pride in what they do on a daily basis.

“From the ED (emergency department) tech, her nurse, advanced practice provider, CT tech to EMS transport and the helicopter pilot, none of what we do would be possible. Without ‘things’ happening the way they did that day, I don’t believe we would have had the outcome we had. I’m lucky to be surrounded by incredible people on a daily basis.’’

Liefer knows that in a life-and-death scenario, the actions of all team members matter. Years ago, she had been working in an emergency room in Texas when a physician stopped doing chest compressions on a patient. Liefer wasn’t ready yet to stop those compressions just yet, and the patient died. Fouss and the team kept them going for her, and it worked.

“I want to hug every person who did compressions – some nurse, probably an EMT,’’ she said.

She ended up spending more than 20 days in the hospital and then enrolled in outpatient cardiac rehabilitation, which lasted another 8 weeks and gave her the courage to resume her life.

“It’s mostly gratitude because it took the team in the ER, it took my surgeon who worked on me for 6 hours, and it took the ICU nurses. And I think of all of the things that could have gone wrong. …And the rehab people at Memorial Central and then I went to cardiac rehab, which is outpatient. There are probably no fewer than 250 people that touched my trajectory.’’

Returning to life, nursing and climbing after a pulmonary embolism at age 37

In the months since her hospitalization, Liefer has returned to work. She uses a giant computer monitor so she can see, and has a phone that talks to her when she receives a text message. She’s completed driver’s training aimed at helping people who have medical challenges and is driving again, though not at night or in inclement weather.

She says she is a more compassionate nurse who better understands fear in medical situations.

“Having been a patient and having felt out of control and frightened, I am a much more compassionate nurse, and I have a lot more patience for a little guy that comes in terrified of his flu shot. ‘You know kid, I get it.’’’

Her daughters are doing well, and together, they have run in a few 5K races. On the one-year anniversary of the event, June 19, 2022, Liefer and her boyfriend intended to summit Mt. Sneffels, a Colorado 14er near Ouray, Colorado. The weather held them back, so they headed up the mountain the next day with their dog, a husky.

Near the summit, there’s a “notch,’’ that requires people to climb up on all fours. A slip-up there, and a hiker could plunge 500 feet down the side of a rock-face mountain. The dog wanted nothing to do with traversing the notch, so Liefer’s boyfriend stayed with the dog, and she summited the 14er by herself. Triumph.

Later in the summer, they all took a backpacking trip – their first — into the wilderness. They carried two tents, a hammock, rations and water. They carried marshmallow fluff for s’mores since fire restrictions prevented the girls from roasting them over an open fire.

The three sisters stayed up most of the night, keeping the adults in the next tent over from getting any sleep.

At 2 a.m., Liefer heard her girls giggling and squealing. One of them shouted: “Tickle fight!’’

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Although there is certainly a benefit to breathing with two lungs, it is possible to live with just one. Surgery to remove one lung may be performed for lung cancer, trauma, or lung disease.

The lungs are responsible for bringing oxygen into the body and moving carbon dioxide out. Oxygen is needed for the body’s cells to produce energy. As a result of that energy-producing process, carbon dioxide is made, which can be toxic and needs to be removed from the body.

When you take a deep breath, the large muscle under the lungs, called the diaphragm, contracts to allow the lungs to expand and fill with air. The air travels into the lungs, down into the small air sacs called alveoli.

There are many small blood vessels, called capillaries, near the alveoli, which contain red blood cells that carry a protein called hemoglobin. Hemoglobin carries both carbon dioxide and oxygen.

Hemoglobin releases carbon dioxide in the alveoli (to be exhaled) and picks up oxygen to transport around the body. In the tissues, hemoglobin releases oxygen and picks up carbon dioxide to return to the lungs.

This article will review the need for surgical removal of a lung, called a pneumonectomy, as well as the risks, complications, and what happens during the surgery. 

What Is a Pneumonectomy?

A pneumonectomy is the surgical removal of one of the two lungs. During a pneumonectomy, a surgeon makes an incision on your side, through which the lung is removed. Lymph nodes near the lung may also be removed.

The body is generally able to function with just one lung. But in order to perform a pneumonectomy in the safest way possible, extensive testing must be done before surgery to ensure the remaining lung will be able to maintain oxygenation for the body.

Pulmonary function tests measure the volume of air the lungs can move and how well they diffuse oxygen into the blood. A ventilation perfusion scan (an X-ray using a tracer gas) may also be done. This scan can show how well each lung functions in terms of blood supply to the lungs and how much air they can breathe.

When Is a Pneumonectomy Necessary?

A pneumonectomy is most often performed to treat lung cancer. The most common type of lung cancer requiring a pneumonectomy is non-small cell lung cancer (NSCLC), but it may also be done for mesothelioma.

A pneumonectomy is usually only performed for primary lung cancer, which is cancer that starts in the lung. It is rarely an option when cancer has spread (metastasized) into the lung from a different primary site (such as the breast or prostate).

When lung cancer occurs in one of the major airways, called the main-stem bronchus, pneumonectomy may be the only way the cancer can be removed.

Trauma, such as a blunt force injury or something penetrating the lung, may require a pneumonectomy. There is a high risk of mortality when a pneumonectomy is needed for this reason.

Pneumonectomy may also be performed for inflammatory lung diseases such as pulmonary tuberculosis, fungal lung infection, and bronchiectasis (permanent widening of the airways due to inflammation or infection). There is a high risk of complications, so this procedure is usually reserved for those who can tolerate such an aggressive treatment.

Risks and Complications 

A pneumonectomy is an aggressive surgical procedure that carries a risk of serious complications, including:

  • Heart arrhythmias: After a pneumonectomy, the heart may experience an abnormal rhythm, most commonly atrial fibrillation. In this rhythm, the top part of the heart (atria) beats too quickly, causing a heartbeat that is too fast and irregular.
  • Pneumonia: A bacterial lung infection in the remaining lung is common after pneumonectomy. This is due to the risk of bacteria entering the lung while being hospitalized and undergoing multiple medical procedures.
  • Pulmonary embolism (PE): A pulmonary embolism is a blood clot that has lodged in the blood vessels in the lungs. This can be a potentially life-threatening complication after pneumonectomy.
  • Pulmonary edema: This is a condition in which fluid collects in the lungs, causing shortness of breath. It can be difficult for adequate gas exchange to happen, and this can lead to further complications.
  • Empyema: After the lung is removed, the space left behind can fill with fluid. It is possible that this fluid can become infected. This infection can cause a pus-filled area, called an empyema, to form.
  • Bronchopleural fistula (BPF): A bronchopleural fistula is a connecting opening that forms between the lining of the lung (pleura) and the airway. This can happen after pneumonectomy in the area called the stump, where the major airway has been closed off after the lung was removed.

What Happens During a Pneumonectomy?

A pneumonectomy can be done with one of two approaches; a thoracotomy, in which a large incision is made between two ribs to open the chest, or a VATS (video-assisted thoracic surgery), which is less invasive.

During a pneumonectomy, you will be given anesthesia, and the healthy lung is ventilated to assist with breathing. You are placed in the proper position for whichever type of surgical procedure will be used. Your chest is accessed through either one large incision or the smaller incisions used for VATS.

The lung is deflated and removed by the surgeon. The remaining airway will be closed off, forming a stump so that air doesn’t enter the newly formed cavity. Lymph nodes in the chest may also be removed during surgery to see if any cancer cells are present.

When removal is complete, the surgeon will close the wounds made in the chest wall muscles and skin, and a dressing will be applied. A chest tube may be left in place for a few days after surgery to help the cavity drain any fluid that builds up.

After surgery, the person is moved to the intensive care unit, where they will be monitored. 

Post-Op Recovery

In the immediate postoperative period, you may feel very tired and uncomfortable. Taking pain medications as needed can help with post-op pain. Drains and intravenous lines will be removed after a few days.

Pulmonary rehabilitation will likely be ordered as part of the long-term recovery from a pneumonectomy. During pulmonary rehabilitation, different breathing techniques are taught. Activity and exercise are increased gradually to be sure they are done safely. This can help you recover in a safer, more effective way after pneumonectomy.

Outlook

Your outlook after pneumonectomy can depend on any complications you experience following surgery and the recurrence of cancer.

Studies show that approximately 37% of people undergoing pneumonectomy will have postoperative complications. Those who have a left pneumonectomy often do better following surgery. The anatomical differences between the left and right lungs make a right pneumonectomy a higher risk for postoperative complications.

In a study of people with lung cancer who had pneumonectomy, those with NSCLC had a 52% three-year survival rate, and those with small cell lung cancer had a 38% three-year survival.

Summary 

A person can live with one lung. A pneumonectomy is the surgical removal of an entire lung, most often due to lung cancer. It is performed by a thoracic surgeon, who may do the surgery through one larger incision or several smaller incisions and the use of a camera.

After surgery, some complications can include infection, blood clots, and abnormal heart rhythms.  

A Word From Verywell

Taking good care of yourself is important when facing an upcoming surgery such as a pneumonectomy. Ask your surgeon about anything specific you need to do before surgery. Eating a healthy diet and getting regular exercise can help keep your body in the best shape possible for this major surgery. 

Frequently Asked Questions


  • Can a lung grow back?

    No, lungs cannot grow back once they are removed.


  • What organs can you live without?

    In addition to living with only one lung, it is possible to live without other organs in the body. Though not ideal, the body can still function without them, though some complications may occur. These other organs can include:

    • Spleen
    • Appendix
    • Gallbladder
    • One kidney
    • Stomach


  • What happens if one lung is damaged?

    If one lung is damaged, it is possible to live with only one functioning lung.

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. National Heart, Lung, and Blood Institute. What breathing does for the body.

  2. University of Rochester. Pneumonectomy.

  3. American Lung Association. Lung function tests.

  4. MedlinePlus. Pulmonary ventilation/perfusion scan.

  5. Yan S, Gritsiuta AI, Rosal GM del, Jones G, Rocco G, Jones DR. Pneumonectomy for lung cancer. Shanghai Chest. 2020;4(0). doi:10.21037/shc.2019.12.05

  6. Philips B., Turco L., Mirzaie M, Fernandez C. Trauma pneumonectomy: a narrative review. Int J Surg. 2017;46: 71-74. doi:10.1016/j.ijsu.2017.08.570

  7. Johns Hopkins Medicine. Pneumonectomy.

  8. Waguaf S, Boubia S, Idelhaj N, Fatene A, Ridai M. Video-assisted thoracoscopic pneumonectomy for destroyed lung. Asian Cardiovasc Thorac Ann. 2021 Feb;29(2):111-115. doi:10.1177/0218492320974516

  9. Campisi A, Bertolaccini L, Luo J, Stella F, Fang W. Management of medical complications after pneumonectomyShanghai Chest. 2020;4(0). doi:10.21037/shc.2019.10.10

  10. Haam S. Video-assisted thoracic surgery pneumonectomyJ Chest Surg. 2021;54(4):253-257. doi:10.5090/jcs.21.064

  11. National Heart, Lung, and Blood Institute. Pulmonary rehabilitation.

  12. Gu C, Wang R, Pan X, et al. Comprehensive study of prognostic risk factors of patients underwent pneumonectomyJ Cancer. 2017;8(11):2097-2103. doi:10.7150/jca.19454

  13. Mount Sinai. Splenectomy.

  14. Cedars Sinai. Appendicitis,

  15. MedlinePlus. Laparoscopic gallbladder removal.

  16. Price AM, Moody WE, Stoll VM, et al. Cardiovascular effects of unilateral nephrectomy in living kidney donors at 5 yearsHypertension. 2021;77(4):1273-1284. doi:10.1161/HYPERTENSIONAHA.120.15398

  17. Tan Z. Recent advances in the surgical treatment of advanced gastric cancer: a reviewMed Sci Monit. 2019;25:3537-3541. doi:10.12659/MSM.916475


By Julie Scott, MSN, ANP-BC, AOCNP

Julie is an Adult Nurse Practitioner with oncology certification and a healthcare freelance writer with an interest in educating patients and the healthcare community.

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KATY, Texas (KTRK) -- According to the Centers for Disease Control and Prevention, blood clots affect many people in the United States. About 100,000 people die of blood clots each year, and one in four people with pulmonary embolism, or P.E., can die without warning.

But Memorial Hermann Katy now has state-of-the-art technology to quickly treat patients with blood clots or P.E. and have them back home in no time.

One of those patients is a Harris County Sheriff's Office deputy who's now on a mission to share his story and raise awareness about deadly blood clots.

"I've been a deputy for 25 years with Harris County," Deputy Raymond Hubbard said.

Serving and protecting have always been a top priority for Hubbard. He admits he's a workaholic, and it's hard to slow down.

Recently, he was reminded that his health should come first.

"This was the scariest because I could not breathe," he recalled.

While playing with his 3-year-old daughter, he felt winded. He said it felt like a sledgehammer was hitting him in the chest.

"I had to stop, lean over on anything, and brace myself. It took minutes for me to catch my breath," he said.

His mom rushed him to Memorial Hermann Katy, and it all took a turn rather quickly.

"The doc comes back and says, 'Hey, you're not going to work today. We're going to prep you for ICU. And you're going to have surgery immediately,'" he said. "I say, 'What are you talking about?' He says, 'You (have) blood clots in both lungs. That's why you can't breathe."

This was the second time Hubbard had to deal with a blood clot, but this time it was different doctors who had to act fast to save his life.

"They put me down (and) got me ready for surgery," he said.

Before he knew it, he was up and breathing. His captain at the time was by his side, supporting him.

New technology is part of a procedure called mechanical thrombectomy. Memorial Hermann Katy doctors can now treat P.E. patients like Hubbard quickly by essentially suctioning out the blood clot and giving patients quick relief.

Hubbard is grateful for his doctors and all of the support he has received from his comrades. He's now making sure people are aware of how serious this can be.

"I think a lot more deputies need to get checked out. We're under a lot of stress out there. And it's not always that you are tired. You're not getting enough oxygen," he said.

For news updates, follow Mayra Moreno on Facebook, Twitter, and Instagram.

Copyright © 2022 KTRK-TV. All Rights Reserved.



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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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Dyspnea, commonly known as shortness of breath, is one of the common problems faced during pregnancy. Shortness of breath can also be considered as an early symptoms of pregnancy. Generally, dyspnea doesn’t cause any harm to the mother and the growing baby. But still, in some severe complicated conditions, it can lead to difficulty in breathing.

Reasons of breathlessness during pregnancy

An increase in levels of progesterone is the main cause of increase in shortness of breath during the first trimester of pregnancy, explains Dr. Anjali Chaudhary (PT), senior executive physiotherapist, Cloudnine Group of Hospitals, Noida.

it is basically due to increased capacity of lungs. The body adjusts itself to the new hormonal changes. However, other medical conditions such as asthma, anemia and pulmonary embolism, too can contribute to the same. Suitable precautions should be taken for the treatment of asthma and other underlying conditions.

shortness of breath
Keep a check on breathing patterns. Image courtesy: Shutterstock

As the size of the baby grows, other organs get compressed and start changing their position. At around 31st week to 34th week, the growing size of the belly exerts pressure on the diaphragm (the main muscle for breathing). This increase in the size restricts the lungs to expand fully and take in air.

Towards the end of pregnancy, the foetus head settles into the pelvis and eventually exerts less pressure on the diaphragm muscle. Therefore, the shortness of breath eases during the last few days of pregnancy.

How to handle the shortness of breath during pregnancy

You can try various breathing techniques and tips to manage and cope up with the situation of dyspnea or shortness of breath. By following these simple tips you can ease down the breathlessness.

1. Maintain a good posture:

Posture during pregnancy is important. Slouching while sitting will affect your lungs as lungs will not get enough space for expansion while breathing in. This may result in less oxygen intake. Sitting on a chair with your chest slightly bent forward can help relaxing the body and in creating extra space for breathing.

Standing with your back well-supported by a wall and body slightly leaned forward can also help relieve shortness of breath.

2. Sleep in a relaxed position

Dyspnea often leads to inability to sleep at night, leading to waking up several times and creating disturbance in sleep. To avoid this, sleep on the back with head elevated using extra pillows and knees bent with pillows below the feet. The right sleeping posture during pregnancy helps in keeping the airway relaxed and making breathing better.

sleeping posture during pregnancy
The right sleeping posture during pregnancy is important. Image courtesy: Shutterstock

3. Pursed lip breathing:

A very easy and a simple breathing technique that makes each breath deeper by helping release trapped air in the lungs, can help to manage shortness of breath during pregnancy.

Follow the simple steps to perform pursed lip breathing:
* Sit with shoulders relaxed.
* Slowly take in air through nose and keep the mouth closed while inhaling.
* Gently exhale or blow out air with pursed lips as if about to blow a candle.
* Practice for 5-10 minutes for about three to four times a day.

4. Diaphragmatic breathing:

Diaphragmatic breathing is basically deep breathing exercise which is also known as abdominal breathing or belly breathing.

To do diaphragmatic breathing or belly/abdominal breathing, follow these steps:

* Sit on a chair or simply lie down comfortably with knees bent and upper body relaxed.
* Place one hand on the chest and other below the rib cage (over the abdomen/belly) so that you can feel your diaphragm movement while breathing in and breathing out.
* Breathe in slowly and steadily so that the abdomen rises fully while doing so, making the hand to rise. Make sure the hand on the chest stays still.
* Then slowly exhale through pursed lips but make sure the abdomen lowers down while doing so and the hand on the chest remains still.
* Start practicing this exercise for 5-10 minutes for about three to four times a day. Gradually increase the number of times and even place a book over the abdomen to increase the efforts.

deep breathing
Deep breathing is good for lungs. Image courtesy: Shutterstock

5. Deep breathing with arm raise:

Deep breathing exercise with raised arms raises the diaphragm to open up the lungs. This helps to increase the capacity of the lungs and results in more oxygen uptake. It is similar to deep breathing, but along with breathing, hand movement is added.

* Stand and take a deep breath while raising arms slowly over your head. Exhale as you lower your arms. Repeat several times a days or whenever you feel breathlessness.
* Seeking Medical Help for Shortness of Breath during Pregnancy

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