Overview of Lung Disease

Non-exhaustive overview of lung disease

Physical therapy notes of Kim Byrd-Rider, not to be used for medical diagnoses

Objectives 

2.  Identify common respiratory conditions and disorders with evaluation methods utilizing epidemiology, signs and symptoms, and clinical presentations of each. Understand contraindications and precautions to treatment for all conditions covered. 

3.  Understand how dysfunctional muscle movement and lack of muscle tone contributes to these diseases. Understand physiotherapies role in improving cardiovascular and pulmonary diseases according to best practice, objective research data. 

II.  Restrictive: trouble breathing in. Decreased compliance of lung. Decrease O2. Increase Stiffness.  Must Increase pressure then normal to create same volume.  Lungs won’t expand.: stiffness of lungs, Stiffness of chest wall, weak muscles, damaged nerves. Increase vital capacity, decrease total lung capacity, normal or decrease of functional residual capacity FRC. 

When comparing the differences between obstructive and restrictive lung diseases,spirometry testing plays an important diagnostic role. Since each disease is characterized by a unique, physiologic pattern, careful interpretation of spirometry results helps doctors differentiate between the two conditions. Once the pattern is recognized, the right diagnosis should follow, but only after taking into consideration a patient's history, physical examination and additional diagnostic studies. 

The following guide takes you on a journey through each disorder, then provides a wealth of information about what's really important when rendering and interpreting a spirometry test: 

What Characterizes an Obstructive Lung Disease?  When a person has difficulty expelling all the air from her lungs, she's said to have an obstructive lung disease. An obstructive pattern exists when air moves out of the lungs at a slower rate than that of a healthy person. This occurs because inflammation and swelling (secondary to long-term, cumulative exposure to airway irritants) cause the airways to become narrow and blocked, making it difficult to completely rid the lungs of air. This leaves an abnormally high volume of air in the lungs after a full exhalation, which is referred to as "increased residual volume." In obstructive lung defects, increased residual volume leads to air getting trapped in, and hyperinflation of, the lungs — two changes in the lungs that may contribute to worsening symptoms. 

The following lung diseases are categorized as obstructive: 

• COPD (mainly a combination of emphysema andchronic bronchitis) 

• Chronic bronchitis 

• Asthma 

• Bronchiectasis 

• Bronchiolitis 

What Characterizes a Restrictive Lung Disease?Restrictive lung diseases are characterized by reduced total lung capacity (TLC). TLC represents the amount of air present in the lungs after taking the deepest breath possible. When a restrictive pattern is present, the lungs are "restricted" from fully expanding, making it difficult for a person to take a full breath. Measuring TLC is of critical importance to the diagnosis of restrictive lung disease because it confirms the presence of a true restriction, as well as quantifying the degree of that restriction. Restrictive lung diseases are categorized as extrinsic, intrinsic or neurological. 

Neurological Restrictive Lung Diseases 

Neuromuscular: Muscular dystrophy, Gillian Bar, Myasthenia Gravis, Polio, Lateral sclerosis, ALS (amyotrophic lateral sclerosis), head injury, tumor, narcotic overdose 

Extrinsic Restrictive Lung Diseases 

Extrinsic, as it applies to lung disease, refers to that which originates from outside the anatomical boundaries of the lungs. The following lists several examples of extrinsic restrictive lung disorders:  

Scoliosis, kyphosis, chest wall deformity, rib fractures, tumors 

Obesity: Obesity is defined as having an excessive amount of body fat. Obesity is more than just a cosmetic concern, though. It increases your risk of diseases and health problems such as heart disease, diabetes and high blood pressure. 

Being extremely obese means you are especially likely to have health problems related to your weight. 

The good news is that even modest weight loss can improve or prevent the health problems associated with obesity. You can usually lose weight through dietary changes, increased physical activity and behavior changes. In some cases, prescription medications or weight-loss surgery may be options. 

Weight loss is 20% exercise and 80% calorie intake. 

Pleurisy and pleural effusion: In some cases of pleurisy, excess fluid seeps into the pleural space, resulting in pleural effusion. 

Pleurisy is a condition in which the pleura — a membrane consisting of a layer of tissue that lines the inner side of the chest cavity and a layer of tissue that surrounds the lungs — becomes inflamed. Also called pleuritis, pleurisy causes sharp chest pain (pleuritic pain) that worsens during breathing. 

A variety of underlying conditions can cause pleurisy. Treatment of pleurisy involves pain control and treating the underlying condition. 

Symptoms 

The signs and symptoms of pleurisy might include: 

• Chest pain that worsens when you breathe, cough or sneeze 

• Shortness of breath — because you are trying to minimize breathing in and out 

• A cough — only in some cases 

• A fever — only in some cases 

Pain caused by pleurisy also might affect your shoulder or back. 

In some cases of pleurisy, fluid builds up in the small space between the two layers of tissue (pleural space). This is called pleural effusion. When there is a fair amount of fluid, pleuritic pain lessens or disappears because the two layers of pleura are no longer in contact. A large amount of fluid in the pleural space can create pressure, compressing your lung to the point that it partially or completely collapses. This makes breathing difficult and might cause you to cough. The extra fluid can also become infected. This is called an empyema. An empyema is often accompanied by fever. 

When to see a doctor 

Call your doctor right away if you experience unexplained, intense chest pain during breathing. 

You might have a problem with your lungs, heart or pleura or an underlying illness for which you need prompt medical care. 

Treatments and drugs 

Treatments used in pleurisy and pleural effusion focus primarily on the underlying cause. For example, if bacterial pneumonia is the cause, an antibiotic will control the infection. If the cause is viral, pleurisy will resolve on its own. 

The outcome of pleurisy treatment depends on the seriousness of the underlying disease. If the condition that caused pleurisy is diagnosed and treated early, a full recovery is typical. 

Lifestyle and home remedie 

The following steps might help relieve symptoms related to pleurisy: 

• Take medication. Take medication such as ibuprofen (Advil, Motrin IB, others) as needed to relieve pain and inflammation. 

• Get plenty of rest. Find the position that causes you the least discomfort and try to stay in it. Even when you start to feel better, be careful not to overdo it. 

Medications: corticosteroids (prednisone) Azathioprine (Imuran), cyclophosphamide, methotrexate (not many) 

Diagnosed: with chest xray or CT scan 

Physical Therapies job is to reduce fatigue, address deconditioning and keep the patient as mobile and independent as possible with exercise and modification strategies.  Rehab therapist need to create an exercise program at an appropriate level that increases and decreasing in intensity according to the patient’s presentation. 

Intrinsic Restrictive Lung Disorders 

Intrinsic, as it applies to lung disorders, refers to that which is inherent to the lungs themselves. Take a look at some common, intrinsic restrictive lung disorders: 

Atelectasis: Atelectasis (at-uh-LEK-tuh-sis) — a complete or partial collapse of a lung or lobe of a lung — develops when the tiny air sacs (alveoli) within the lung become deflated. It is one of the most common breathing (respiratory) complications after surgery. Atelectasis is also a possible complication of other respiratory problems, including cystic fibrosis, inhaled foreign objects, lung tumors, fluid in the lung, severe asthma and chest injuries. 

The amount of lung tissue involved in atelectasis is variable, depending on the cause. Signs and symptoms of atelectasis also vary. Atelectasis can be serious because it reduces the amount of oxygen available to your body. Treatment depends on the cause and severity of the collapse. 

Symptoms 

There may be no obvious signs or symptoms of atelectasis. If you do experience signs and symptoms, they may include: 

• Difficulty breathing (dyspnea) 

• Rapid, shallow breathing 

• Coughing 

• Low-grade fever 

When to see a doctor 

Significant atelectasis is likely to occur when you're already in a hospital. However, see your doctor right away if you have trouble breathing. Other conditions besides atelectasis can cause breathing difficulties and require an accurate diagnosis and prompt treatment. If your breathing becomes increasingly difficult, seek emergency care. 

Risk factors 

Factors that increase the risk of atelectasis include: 

• Premature birth, if the lungs aren't fully developed 

• Impaired swallowing function, particularly in older adults — aspirating secretions into the lungs is a major source of infections 

• Any condition that interferes with spontaneous coughing, yawning and sighing 

• Lung disease, such as asthma, bronchiectasis or cystic fibrosis 

• Confinement to bed, with infrequent change of position 

• Abdominal or chest surgery 

• Recent general anesthesia 

• Shallow breathing — a result of abdominal pain or rib fracture, for example 

• Respiratory muscle weakness, due to muscular dystrophy, spinal cord injury or another neuromuscular condition 

• Obesity — fat in the abdomen can elevate your diaphragm and hamper your ability to inhale fully 

• Age — being a young child between the ages of 1 and 3 

Complications 

The following complications may result from atelectasis: 

• Low blood oxygen (hypoxemia). Atelectasis hampers your lungs' ability to get oxygen to the alveoli. 

• Lung scarring. Some damage or scarring may remain after the lung is reinflated, resulting in bronchiectasis. 

• Pneumonia. You're at greater risk of developing pneumonia until the atelectasis has been cleared. The mucus in a collapsed lung is a breeding ground for bacterial infections. 

• Respiratory failure. A small area of atelectasis, especially in an adult, usually is treatable. But a large area, particularly in an infant or in someone with lung disease, can be life-threatening. 

Treatments and drugs 

Treatment of atelectasis depends on the cause. Atelectasis of a small area of your lung may subside without treatment. If there's an underlying condition, such as a tumor, treatment may involve removal or shrinkage of the tumor with surgery, chemotherapy or radiation. 

Chest physiotherapy 

Techniques that help people breathe deeply after surgery to re-expand collapsed lung tissue are very important. These techniques are best learned before surgery. They include: 

• Coughing. 

• Clapping (percussion) on your chest over the collapsed area to loosen mucus. You can also use mechanical mucus-clearance devices such as an air-pulse vibrator vest or a hand-held instrument. (There is evidence against this type of therapy) 

• Performing deep-breathing exercises (incentive spirometry). 

• Positioning your body so that your head is lower than your chest (called postural drainage). This allows mucus to drain better from the bottom of your lungs. (There is evidence against this type of therapy) 

Supplemental oxygen can help relieve shortness of breath. 

Medications 

In some cases, medications may be used. They include: 

• Inhaled bronchodilators (Foradil, Serevent, others), which open the bronchial tubes of the lungs, making breathing easier. 

• Acetylcysteine (Acetadote) may help thin mucus and make it easier to cough up. 

• Dornase Alfa (Pulmozyme) is used to clear mucus plugs in children with cystic fibrosis. Its role in treatment of atelectasis for people without cystic fibrosis is not fully defined. 

Surgical or other procedures 

Your doctor may suggest removal of airway obstructions, which may be done by suctioning mucus or by bronchoscopy. Bronchoscopy uses a flexible tube threaded down your throat to clear your airways. 

Use of continuous positive pressure may be helpful in some people with low oxygen levels (hypoxemia) after surgery. 

Pneumonia: Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus, causing cough with phlegm or pus, fever, chills and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia. 

Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants and young children, people older than age 65, and people with underlying health problems or weakened immune systems. 

Antibiotics and antiviral medications can treat many common forms of pneumonia. 

Symptoms 

The signs and symptoms of pneumonia vary from mild to severe, depending upon factors such as the type of germ causing the infection and your age and overall health. Mild signs and symptoms often are similar to those of a cold or flu, but they last longer. 

Signs and symptoms of pneumonia include: 

• Fever, sweating and shaking chills 

• Lower than normal body temperature in people older than age 65, and in people with poor overall health or weakened immune systems 

• Cough, which may produce thick, sticky fluid 

• Chest pain when you breathe deeply or cough 

• Shortness of breath 

• Fatigue and muscle aches 

• Nausea, vomiting or diarrhea 

• Headache 

Newborns and infants may not show any sign of the infection. Or they may vomit, have a fever and cough, appear restless or tired and without energy, or have difficulty breathing and eating. 

Older people who have pneumonia sometimes have sudden changes in mental awareness. 

When to see a doctor 

See your doctor if you have difficulty breathing, chest pain, persistent fever of 102 F (39 C) or higher or persistent cough, especially if you are coughing up pus. 

It's especially important to see a doctor if: 

• A child with signs and symptoms is younger than age 2 

• You are older than age 65 

• You have an underlying health condition or weakened immune system 

• You're having chemotherapy or taking medication that suppresses your immune system 

For some older adults and people with heart failure or lung ailments, pneumonia can quickly become a life-threatening condition. 

Risk factors 

Pneumonia can affect anyone. But the two age groups at highest risk are: 

• Infants and children younger than age 2 years, because their immune systems are still developing 

• People older than age 65 

Other risk factors include: 

• Certain chronic diseases, such as asthma, chronic obstructive pulmonary disease and heart disease 

• Weakened or suppressed immune system, due to factors such as HIV/AIDS, organ transplant, chemotherapy for cancer or long-term steroid use 

• Smoking, which damages your body's natural defenses against the bacteria and viruses that cause pneumonia 

• Being placed on a ventilator while hospitalized 

Complications 

Often, people who have pneumonia can be treated successfully with medication. But some people, especially those in high-risk groups, may experience complications, including: 

• Bacteria in the bloodstream (bacteremia). Bacteria that enter the bloodstream from your lungs can spread the infection to other organs, potentially causing organ failure. 

• Lung abscess. An abscess occurs if pus forms in a cavity in the lung. An abscess is usually treated with antibiotics. Sometimes, surgery or drainage with a long needle or tube placed into the abscess is needed to remove the pus. 

• Fluid accumulation around your lungs (pleural effusion).Pneumonia may cause fluid to build up in the thin space between layers of tissue that line the lungs and chest cavity (pleura). If the fluid becomes infected, you may need to have it drained through a chest tube or removed with surgery. 

• Difficulty breathing. If your pneumonia is severe or you have chronic underlying lung diseases, you may have trouble breathing in enough oxygen. You may need to be hospitalized and use a mechanical ventilator while your lung heals. 

Treatments and drugs 

Treatment for pneumonia involves curing the infection and preventing any complications. 

People who have community-acquired pneumonia usually can be treated at home with medication. Although your symptoms may ease in a few days or weeks, tiredness can persist for a month or more. 

Your doctor will likely recommend a follow-up chest X-ray to check that the infection is clearing. It may be safe to stop treatment even if your X-ray isn't completely normal. Only about half of chest X-rays in people with community-acquired pneumonia are normal after 28 days of treatment. 

Specific treatments depend on the type and severity of your pneumonia, and your age and overall health. The options include: 

• Antibiotics, to treat bacterial pneumonia. It may take time to identify the type of bacteria causing your pneumonia and to choose the best antibiotic to treat it. Symptoms often improve within three days, although improvement usually takes twice as long in smokers. If your symptoms don't improve, your doctor may recommend a different antibiotic. 

• Antiviral medications, to treat viral pneumonia. Symptoms generally improve in one to three weeks. 

• Fever reducers, such as aspirin or ibuprofen. 

• Cough medicine, to calm your cough so you can rest. Because coughing helps loosen and move fluid from your lungs, it's a good idea not to eliminate your cough completely. 

Hospitalization 

You may need to be hospitalized if: 

• You are older than age 65 

• You become confused about time, people or places 

• Your nausea and vomiting prevent you from keeping down oral antibiotics 

• Your blood pressure drops 

• Your breathing is rapid 

• You need breathing assistance 

• Your temperature is below normal 

If you need to be placed on a ventilator or your symptoms are severe, you may need to be admitted  to an intensive care unit. 

Children may be hospitalized if they: 

• Are younger than age 3 months 

• Are excessively sleepy 

• Have trouble breathing 

• Have low blood oxygen levels 

• Appear dehydrated 

• Have a lower than normal temperature 

Lifestyle and home remedies 

To help you recover more quickly and decrease your risk of complications: 

• Get plenty of rest. Even when you start to feel better, be careful not to overdo it. 

• Stay home from school or work until after your temperature returns to normal and you stop coughing up mucus. Because pneumonia can recur, it's better not to return to a full workload until you're sure you're well. Ask your doctor if you're not sure. 

• Drink plenty of fluids, especially water, to help loosen mucus in your lungs. 

• Take the entire course of any prescribed medications. If you stop medication too soon, your lungs may continue to harbor bacteria that can multiply and cause your pneumonia to recur. 

Prevention 

To help prevent pneumonia: 

• Get a seasonal flu shot. The influenza virus can be a direct cause of viral pneumonia. Bacterial pneumonia is also a common complication of the flu. A yearly flu shot provides significant protection. 

• Get a pneumonia vaccination. Doctors recommend a one-time vaccine against Streptococcus pneumoniae bacteria (pneumococcus) for everyone older than age 65, as well as for people of any age residing in nursing homes and long-term care facilities, and for smokers. The vaccine is especially recommended for anyone at high risk of pneumococcal pneumonia. Some doctors recommend a booster shot five years after the first dose. 

• Have your child vaccinated. Doctors recommend a different pneumonia vaccine for all children younger than age 2 and for children ages 2 to 5 years who are at particular risk of pneumococcal disease. Children who attend a group day care center should also get the vaccine. Doctors also recommend seasonal flu shots for children older than six months. 

• Practice good hygiene. To protect yourself against ordinary respiratory infections that sometimes lead to pneumonia, wash your hands regularly or use an alcohol-based hand sanitizer. 

• Don't smoke. Smoking damages your lungs' natural defenses against respiratory infections. 

• Stay rested and fit. Proper rest, a healthy diet and moderate exercise can help keep your immune system strong. 

• Set an example. Stay home when you're sick. When you're in public and have a cold, catch your coughs and sneezes in the inner crook of your elbow. 

Pulmonary edema: Pulmonary edema is a condition caused by excess fluid in the lungs. This fluid collects in the numerous air sacs in the lungs, making it difficult to breathe. 

In most cases, heart problems cause pulmonary edema. But fluid can accumulate for other reasons, including pneumonia, exposure to certain toxins and medications, and exercising or living at high elevations. 

Pulmonary edema that develops suddenly (acute) is a medical emergency requiring immediate care. Although pulmonary edema can sometimes prove fatal, the outlook improves when you receive prompt treatment for pulmonary edema along with treatment for the underlying problem. Treatment for pulmonary edema varies depending on the cause, but generally includes supplemental oxygen and medications. 

Symptoms 

Depending on the cause, pulmonary edema symptoms may appear suddenly or develop slowly. 

Sudden (acute) pulmonary edema symptoms 

• Extreme shortness of breath or difficulty breathing (dyspnea) that worsens when lying down 

• A feeling of suffocating or drowning 

• Wheezing or gasping for breath 

• Anxiety, restlessness or a sense of apprehension 

• A cough that produces frothy sputum that may be tinged with blood 

• Excessive sweating 

• Pale skin 

• Chest pain, if pulmonary edema is caused by heart disease 

• A rapid, irregular heartbeat (palpitations) 

If you develop any of these signs or symptoms, call 911 or emergency medical assistance right away. Pulmonary edema can be fatal if not treated. 

Long-term (chronic) pulmonary edema symptoms 

• Having more shortness of breath than normal when you're physically active. 

• Difficulty breathing with exertion, often when you're lying flat as opposed to sitting up. 

• Wheezing. 

• Awakening at night with a breathless feeling that may be relieved by sitting up. 

• Rapid weight gain when pulmonary edema develops as a result of congestive heart failure, a condition in which your heart pumps too little blood to meet your body's needs. The weight gain is from buildup of fluid in your body, especially in your legs. 

• Swelling in your legs and ankles. 

• Loss of appetite. 

• Fatigue. 

High-altitude pulmonary edema symptoms 

• Headache 

• Insomnia 

• Fluid retention 

• Cough 

• Shortness of breath 

When to see a doctor 

Pulmonary edema that comes on suddenly (acute) is life-threatening. Get emergency assistance if you have any of the following acute signs and symptoms: 

• Trouble breathing or a feeling of suffocating (dyspnea) 

• A bubbly, wheezing or gasping sound when you breathe 

• Pink, frothy sputum when you cough 

• Breathing difficulty along with profuse sweating 

• A blue or gray tone to your skin 

• A severe drop in blood pressure resulting in lightheadedness, dizziness, weakness or sweating 

• A sudden worsening of any of the symptoms associated with chronic pulmonary edema or high-altitude pulmonary edema 

Complications 

If pulmonary edema continues, it can raise pressure in the pulmonary artery and eventually the right ventricle begins to fail. The right ventricle has a much thinner wall of muscle than does the left side because it is under less pressure to pump blood into the lungs. The increased pressure backs up into the right atrium and then into various parts of your body, where it can cause: 

• Leg swelling (edema) 

• Abdominal swelling (ascites) 

• Buildup of fluid in the membranes that surround your lungs (pleural effusion) 

• Congestion and swelling of the liver 

When not treated, acute pulmonary edema can be fatal. In some instances it may be fatal even if you receive treatment. 

Treatments and drugs 

Giving oxygen is the first step in the treatment for pulmonary edema. You usually receive oxygen through a face mask or nasal cannula — a flexible plastic tube with two openings that deliver oxygen to each nostril. This should ease some of your symptoms. Sometimes it may be necessary to assist your breathing with a machine. 

Depending on your condition and the reason for your pulmonary edema, you may also receive one or more of the following medications: 

• Preload reducers. Preload reducing medications decrease the pressure caused by fluid going into your heart and lungs. Doctors commonly use nitroglycerin and diuretics, such as furosemide (Lasix), to treat pulmonary edema. Diuretics may make you urinate so much initially that you may temporarily need a urinary catheter while you're in the hospital. 

• Morphine (Astramorph). This narcotic may be used to relieve shortness of breath and anxiety. But some doctors believe that the risks of morphine may outweigh the benefits and are more apt to use other, more effective drugs. 

• Afterload reducers. These drugs dilate your blood vessels and take a pressure load off your heart's left ventricle. Some examples of afterload reducer medications include nitroprusside (Nitropress), enalapril (Vasotec) and captopril (Capoten). 

• Blood pressure medications. If you have high blood pressure when you develop pulmonary edema, you'll be given medications to control it. On the other hand, if your blood pressure is too low, you're likely to be given drugs to raise it. 

Treating high-altitude pulmonary edema (HAPE) 

If you're climbing or traveling at high altitudes and experience mild symptoms of HAPE, descending a few thousand feet (about 600 to 900 meters) as quickly as you can, within reason, should relieve your symptoms. Oxygen also is helpful. When symptoms are more severe, you'll likely need help in your descent. A helicopter rescue may be necessary for the most serious cases, because HAPE can be life-threatening. 

Some climbers take the prescription medication acetazolamide (Diamox) to help treat or prevent symptoms of HAPE. To prevent HAPE, acetazolamide is started as long as three days before ascent. Acetazolamide can occasionally have side effects — including tingling or burning in the hands and feet, confusion, diarrhea, nausea, loss of appetite, and hearing problems. 

Lifestyle and home remedies 

The following suggestions may speed your recovery from cardiac pulmonary edema and help prevent a recurrence: 

• Weigh yourself daily. Do so in the morning before breakfast and keep a record of your daily weight. Call your doctor if you've gained 2 to 3 pounds (about 1 to 1.4 kilograms) in a single day. 

• Follow your doctor's instructions regarding diet. Most people with cardiac pulmonary edema will need to follow a low-salt diet. Ask for a referral to a dietitian if you need help evaluating the salt content in foods. If you don't cook your own meals, have whoever does most of your cooking join you when you visit the dietitian. Most restaurant food is high in salt; learn about this if you eat out. Also aim to reach your ideal weight through diet and exercise. 

• If you have high blood pressure, take steps to control it.The best way to do this is to check your blood pressure with a home cuff at least once a day. Ask your doctor for guidelines regarding your optimal blood pressure. 

• Listen to medical advice. Follow your doctor's advice about controlling any underlying health problems, including advice about diet, weight and exercise. 

• Get plenty of sleep each night. Take a nap during the day if you feel tired. It may take as long as three to six months before the condition of your lungs returns to normal. If you snore or have other symptoms of possible obstructive sleep apnea, ask for a referral to a sleep center for evaluation. 

Prevention 

Pulmonary edema often isn't preventable, but these measures can help reduce your risk. 

Preventing cardiovascular disease 

Cardiovascular disease is the leading cause of pulmonary edema. You can reduce your risk of many kinds of heart problems by following these suggestions: 

• Control your blood pressure. High blood pressure (hypertension) can lead to serious conditions such as stroke, cardiovascular disease and kidney failure. Most adults should have their blood pressure checked at least once every two years. This is a noninvasive and painless procedure using an inflatable cuff that wraps around your upper arm. The test takes just a few minutes. 

A resting blood pressure reading below 120/80 millimeters of mercury (mm Hg) is considered normal. If your resting blood pressure is consistently 140/90 mm Hg or higher, you have high blood pressure. A reading in between these levels places you in the prehypertensive category. 

In many cases, you can lower your blood pressure or maintain a healthy level by getting regular exercise, reaching your ideal weight, eating a diet rich in fresh fruits, vegetables and low-fat dairy products, and limiting salt and alcohol. 

• Watch your blood cholesterol. Cholesterol is one of several types of fats essential to good health. But too much cholesterol can be too much of a good thing. Higher than normal cholesterol levels can cause fatty deposits to form in your arteries, impeding blood flow and increasing your risk of vascular disease. But lifestyle changes can often keep your cholesterol levels low. This includes limiting fats — especially saturated fats — eating more fiber, fish, and fresh fruits and vegetables, exercising regularly, stopping smoking, and drinking in moderation. 

• Don't smoke. If you smoke, the single most important thing you can do for your heart and lung health is to stop. Continuing to smoke increases your risk of a second heart attack or heart-related death and also increases your risk of lung cancer and other lung problems such as emphysema. What's more, you're at risk even if you don't smoke but live or work with someone who does. Exposure to secondhand smoke is a contributing factor to coronary artery disease. If you can't stop smoking by yourself, ask your doctor to prescribe a treatment plan to help you quit. 

• Eat a heart-healthy diet. Fish is one of the cornerstones of a heart-healthy diet — it contains omega-3 fatty acids, which help improve blood cholesterol levels and prevent blood clots. It's also important to eat plenty of fruits and vegetables, which contain antioxidants, vitamins and minerals that help prevent everyday wear and tear on your coronary arteries. Eat less fat, especially animal (saturated) and trans fats (hydrogenated oils). 

• Limit salt. It's especially important to use less salt (sodium) if you have heart disease or high blood pressure. In some people with severely damaged left ventricular function, excess salt — even in a single meal or a bag of chips — may be enough to trigger congestive heart failure. If you're having a hard time cutting back on salt, it may help to talk to a dietitian. He or she can help point out low-sodium foods as well as offer tips for making a low-salt diet interesting and good tasting. 

• Exercise regularly. Exercise is vital for a healthy heart. Regular aerobic exercise — about 30 minutes a day — helps you to control blood pressure and cholesterol levels, and maintain a healthy weight. If you're not used to exercise, start out slowly and build up gradually. Be sure to get your doctor's OK before starting an exercise program. 

• Maintain a healthy weight. Being even slightly overweight increases your risk of cardiovascular disease. On the other hand, even losing small amounts of weight can lower your blood pressure, cholesterol and reduce your risk of diabetes. 

• Consider taking baby aspirin. Talk to your doctor about the pros and cons of taking one baby aspirin (81 milligrams) a day. 

• Manage stress. To reduce your risk of heart problems, try to reduce your stress levels. Rethink workaholic habits and find healthy ways to minimize or deal with stressful events in your life. 

Preventing HAPE 

If you travel or climb at high altitudes, acclimate yourself slowly. Although recommendations vary, most experts advise ascending no more than 1,000 or 2,000 feet (300 to 600 meters) a day once you reach 8,000 feet (about 2,400 meters). In addition, it's important to drink plenty of water to stay hydrated. The higher you ascend the more rapidly you breathe, which means you lose larger amounts of water in the air you exhale from your lungs. 

Finally, although being physically fit won't necessarily prevent HAPE, people in good condition tend to be less stressed at high altitudes. However, just because you have hiked or skied at high altitude before doesn't protect you from HAPE. Taken 12 to 72 hours before you travel to a high altitude, the medication acetazolamide (Diamox) can help prevent HAPE. Consider continuing the medication for an additional few days if any signs of altitude sickness, especially headache or insomnia, occur. 

Interstitial lung disease: Interstitial (in-tur-STISH-ul) lung disease describes a large group of disorders, most of which cause progressive scarring of lung tissue. The scarring associated with interstitial lung disease eventually affects your ability to breathe and get enough oxygen into your bloodstream. 

Interstitial lung disease can be caused by long-term exposure to hazardous materials, such as asbestos. Some types of autoimmune diseases, such as rheumatoid arthritis, also can cause interstitial lung disease. In most cases, however, the causes remain unknown. 

Once lung scarring occurs, it's generally irreversible. Medications can slow the damage of interstitial lung disease, but many people never regain full use of their lungs. Lung transplants are an option for some people who have interstitial lung disease. 

The interstitial lung diseases are a group of disorders characterized by the abnormal accumulation of cells and/or noncellular material within the walls of the air sacs (alveoli) of the lungs. This process results in thickening and stiffness of the normally elastic tissues of the lung, and thus interferes with normal breathing, so that patients with interstitial lung diseases often breathe in a rapid and shallow manner. Many patients are short of breath on exertion, especially at higher altitudes, and some have a bothersome cough, which is usually dry. 

Although more than 100 conditions can cause scarring of the lungs, most are either rare or are obvious from a clinical history of previous events and exposures. Fortunately, most patients have one of the common diseases, each of which tends to have rather clear-cut features. 

Conditions and Symptoms Treated 

• Acute interstitial pneumonia (Hamman-Rich syndrome, idiopathic ARDS) 

• Alveolar proteinosis, pulmonary phospholipoproteinosis 

• Asbestosis 

• Berylliosis 

• Black lung disease 

• Coal worker's pneumoconiosis (black lung disease) 

• Connective-tissue disease-associated interstitial lung disease 

• Desquamative interstitial pneumonia (DIP) 

• Farmer's lung 

• Hamman-Rich syndrome 

• Hard-metal pneumoconiosis 

• Hypersensitivity pneumonitis (HSP) 

• Interstitial lung disease 

• Lupus lung, systemic lupus erythematosus 

• Lymphocytic interstitial pneumonia (LIP) 

• Mixed connective tissue disease 

• Nonspecific interstitial pneumonia (NSIP) 

• Pigeon breeder's disease 

• Pneumoconiosis 

• Polymyositis, dermatomyositis 

• Pulmonary alveolar microlithiasis 

• Pulmonary eosinophilic granuloma (EG), histiocytosis X (HX), or Langerhans cell granulomatosis 

• Pulmonary fibrosis, or idiopathic pulmonary fibrosis (IPF) 

________________ 

Pulmonary Fibrosis (scaring)-no percussion: Pulmonary fibrosis occurs when lung tissue becomes damaged and scarred. This thickened, stiff tissue makes it more difficult for your lungs to work properly. As pulmonary fibrosis worsens, you become progressively more short of breath. 

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

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

Symptoms 

Signs and symptoms of pulmonary fibrosis include: 

• Shortness of breath (dyspnea) 

• A dry cough 

• Fatigue 

• Unexplained weight loss 

• Aching muscles and joints 

The course of pulmonary fibrosis — and the severity of symptoms — can vary considerably from person to person. Some people become ill very quickly with severe disease. Others have more-moderate symptoms that worsen over months or years. 

Complications 

Complications of pulmonary fibrosis may include: 

• High blood pressure in your lungs (pulmonary hypertension). Unlike systemic high blood pressure, this condition affects only the arteries in your lungs. It begins when the smallest arteries and capillaries are compressed by scar tissue, causing increased resistance to blood flow in your lungs. This in turn raises pressure within the pulmonary arteries. Pulmonary hypertension is a serious illness that becomes progressively worse and may eventually prove fatal. 

• Right-sided heart failure (cor pulmonale). This serious condition occurs when your heart's lower right chamber (ventricle) has to pump harder than usual to move blood through partially blocked pulmonary arteries. 

• Respiratory failure. This is often the last stage of chronic lung disease. It occurs when blood-oxygen levels fall dangerously low. 

• Lung cancer. Long-standing pulmonary fibrosis also increases your risk of developing lung cancer. 

Risk factors 

Factors that make you more susceptible to pulmonary fibrosis include: 

• Age. Although pulmonary fibrosis has been diagnosed in children and infants, the disorder is much more likely to affect middle-aged and older adults. 

• Smoking. Far more smokers and former smokers develop pulmonary fibrosis than do people who have never smoked. 

• Your occupation. You have an increased risk of developing pulmonary fibrosis if you work in mining, farming or construction or if you're exposed to pollutants known to damage your lungs. 

• Cancer treatments. Having radiation treatments to your chest or using certain chemotherapy drugs makes you more susceptible to pulmonary fibrosis. 

• Genetic factors. Some types of pulmonary fibrosis appear to run in families, so a genetic component is suspected. 

Treatments and drugs 

The lung scarring that occurs in pulmonary fibrosis can't be reversed, and no current treatment has proved effective in stopping the ultimate progression of the disease. Some treatments, though, may improve symptoms temporarily or slow the disease's progress. Others help improve quality of life. 

Medications 

Many people diagnosed with pulmonary fibrosis are initially treated with a corticosteroid (prednisone), sometimes in combination with other drugs that suppress the immune system — such as methotrexate or cyclosporine. None of these combinations has proved very effective over the long run. Adding N-acetylcysteine, a derivative of a natural amino acid, to prednisone may slow the disease in some people. 

Oxygen therapy 

Using oxygen can't stop lung damage, but it can: 

• Make breathing and exercise easier 

• Prevent or lessen complications from low blood-oxygen levels 

• Reduce blood pressure in the right side of your heart 

• Improve your sleep and sense of well-being 

You're most likely to receive oxygen when you sleep or exercise, although some people may use it round-the-clock. 

Pulmonary rehabilitation 

The aim of pulmonary rehabilitation is not only to treat a disease or even improve daily functioning, but also to help people with pulmonary fibrosis live full, satisfying lives. To that end, pulmonary rehabilitation programs focus on: 

• Physical exercise, to improve your endurance 

• Breathing techniques that improve lung efficiency 

• Emotional support 

• Nutritional counseling 

Surgery 

Lung transplantation may be an option of last resort for younger people with severe pulmonary fibrosis who haven't benefited from other treatment options. 

_____________ 

• Respiratory bronchiolitis and respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) 

• Rheumatoid lung 

• Sarcoidosis 

__________________ 

Sarcoidosis-no percussion, asbestos, radiation, drugs: Sarcoidosis is the growth of tiny collections of inflammatory cells in different parts of your body — most commonly the lungs, lymph nodes, eyes and skin. 

Doctors believe sarcoidosis results from the body's immune system responding to an unknown substance, most likely something inhaled from the air. There is no cure for sarcoidosis, but most people do very well with modest treatment. Sarcoidosis often goes away on its own. Alternatively, signs and symptoms of sarcoidosis may last for years and sometimes lead to organ damage. 

Symptoms 

Signs and symptoms of sarcoidosis vary, depending on which organs are affected. Sarcoidosis sometimes develops gradually and produces symptoms that last for years. Other times, symptoms appear suddenly and then disappear just as quickly. Many people with sarcoidosis have no symptoms, so the disease may be discovered only when you have a chest X-ray for another reason. 

Generalized symptoms 

For many people, sarcoidosis begins with these signs and symptoms: 

• Fatigue 

• Fever 

• Swollen lymph nodes 

• Weight loss 

Lung symptoms 

Almost everyone who has sarcoidosis eventually experiences lung problems, which may include: 

• Persistent dry cough 

• Shortness of breath 

• Wheezing 

• Chest pain 

Skin symptoms 

As many as 25 percent of people who have sarcoidosis develop skin problems, which may include: 

• Rash. A rash of red or reddish-purple bumps, usually located on the shins or ankles, which may be warm and tender to the touch. 

• Lesions. Disfiguring skin sores may occur on your nose, cheeks and ears. 

• Color change. Areas of skin may get darker or lighter in color. 

• Nodules. Growths just under the skin may develop, particularly around scars or tattoos. 

Eye symptoms 

Sarcoidosis can affect the eyes without causing any symptoms, so it's important to have your eyes checked. When eye symptoms do occur, they may include: 

• Blurred vision 

• Eye pain 

• Severe redness 

• Sensitivity to light 

When to see a doctor 

Although sarcoidosis is not always serious, it can cause long-term damage to your organs. See your doctor if you experience signs and symptoms suggestive of sarcoidosis. 

Risk factors 

While anyone can develop sarcoidosis, factors that may increase your risk include: 

• Age and sex. Sarcoidosis often occurs between the ages of 20 and 40. Women are slightly more likely to develop the disease. 

• Race. African-Americans have a higher incidence of sarcoidosis than do white Americans. Also, sarcoidosis may be more severe and may be more likely to recur and cause lung problems in African-Americans. 

• Family history. If someone in your family has had sarcoidosis, you are more likely to develop the disease yourself. 

Complications 

For most people with sarcoidosis, the condition resolves on its own with no lasting consequences. But sarcoidosis can be long-lasting (chronic) in some people and lead to complications that may affect different parts of your body: 

• Lungs. Untreated pulmonary sarcoidosis can lead to irreversible damage to the tissue between the air sacs in your lungs, making it difficult to breathe. 

• Eyes. Inflammation can affect almost any part of your eye and can eventually cause blindness. Rarely, sarcoidosis also can cause cataracts and glaucoma. 

• Kidneys. Sarcoidosis can affect how your body handles calcium, which can lead to kidney failure. 

• Heart. Granulomas within your heart can interfere with the electrical signals that drive your heartbeat, causing abnormal heart rhythms and, in rare instances, death. 

• Nervous system. A small number of people with sarcoidosis develop problems related to the central nervous system when granulomas form in the brain and spinal cord. Inflammation in the facial nerves can cause facial paralysis. 

Treatments and drugs 

There's no cure for sarcoidosis. You may not need treatment if you don't have significant signs and symptoms of the condition. Sarcoidosis often goes away on its own. But you should be monitored closely with regular chest X-rays and exams of the eyes, skin and any other organ involved. 

Medications 

If organ function is threatened, you will likely be treated with a medication. 

• Corticosteroids. These powerful anti-inflammatory drugs are usually the first-line treatment for sarcoidosis. In some cases, corticosteroids can be applied directly to an affected area — via a cream to a skin lesion or with an inhaler to your lungs. 

• Anti-rejection medications. These medications reduce inflammation by suppressing your immune system. 

• Anti-malarial medications. These medications may be helpful for skin disease, nervous system involvement and elevated blood-calcium levels. 

• Tumor necrosis factor-alpha (TNF-alpha) inhibitors. These medications are most commonly used to treat the inflammation associated with rheumatoid arthritis. They can also be helpful in treating sarcoidosis that doesn't respond to other treatments. 

Surgery 

Organ transplant may be considered if sarcoidosis has severely damaged your lungs or liver. 

• Scleroderma lung 

• Silicosis 

• Smoker's bronchiolitis 

• Usual interstitial pneumonia (UIP) 

Occupational and environmental factors 

Long-term exposure to a number of toxins and pollutants can damage your lungs. These may include: 

• Silica dust 

• Asbestos fibers 

• Grain dust 

• Bird and animal droppings 

Radiation treatments 

Some people who receive radiation therapy for lung or breast cancer show signs of lung damage months or sometimes years after the initial treatment. The severity of the damage depends on: 

• How much of the lung was exposed to radiation 

• The total amount of radiation administered 

• Whether chemotherapy also was used 

• The presence of underlying lung disease 

Causes 

• Interstitial lung disease seems to occur when an injury to your lungs triggers an abnormal healing response. Ordinarily, your body generates just the right amount of tissue to repair damage. But in interstitial lung disease, the repair process goes awry and the tissue around the air sacs (alveoli) becomes scarred and thickened. This makes it more difficult for oxygen to pass into your bloodstream. 

• Interstitial lung disease can be triggered by many different things — including airborne toxins in the workplace, drugs and some types of medical treatments. In most cases, the causes are unknown. 

Medications 

Many drugs can damage your lungs, especially: 

• Chemotherapy drugs. Drugs designed to kill cancer cells, such as methotrexate (Trexall) and cyclophosphamide (Cytoxan), can also damage lung tissue. 

• Heart medications. Some drugs used to treat irregular heartbeats, such as amiodarone (Cordarone, Nexterone, Pacerone) or propranolol (Inderal, Inderide, Innopran), may harm lung tissue. 

• Some antibiotics. Nitrofurantoin (Macrobid, Macrodantin, others) and sulfasalazine (Azulfidine) can cause lung damage. 

Medical conditions 

Lung damage can also result from: 

• Systemic lupus erythematosus 

• Rheumatoid arthritis 

• Scleroderma 

Unknown causes 

The list of substances and conditions that can lead to interstitial lung disease is long. Even so, in most cases, the causes are never found. Disorders without a known cause are grouped together under the label idiopathic pulmonary fibrosis or idiopathic interstitial lung disease. 

Symptoms 

The primary signs and symptoms of interstitial lung disease are: 

• Shortness of breath, aggravated by exertion 

• Dry cough 

When to see a doctor 

By the time symptoms appear, irreversible lung damage has often already occurred. Nevertheless, it's important to see your doctor at the first sign of breathing problems. Many conditions other than interstitial lung disease can affect your lungs, and getting an early and accurate diagnosis is important for proper treatment. 

Risk factors 

Factors that may make you more susceptible to interstitial lung disease include: 

• Age. Interstitial lung disease is much more likely to affect adults, although infants and children sometimes develop the disorder. 

• Exposure to occupational and environmental toxins. If you work in mining, farming or construction or for any reason are exposed to pollutants known to damage your lungs, your risk of interstitial lung disease greatly increases. 

• Smoking. Some forms of interstitial lung disease are more likely to occur in people with a history of smoking, and active smoking may make the condition worse. 

• Radiation and chemotherapy. Having radiation treatments to your chest or using some chemotherapy drugs makes it more likely that you'll develop lung disease. 

• Oxygen. Continually inhaling very high levels of therapeutic oxygen for more than 48 hours can harm the lungs. 

Complications 

Interstitial lung disease can lead to a series of life-threatening complications, including: 

• High blood pressure in your lungs (pulmonary hypertension). Unlike systemic high blood pressure, this condition affects only the arteries in your lungs. It begins when scar tissue restricts the smallest blood vessels, limiting blood flow in your lungs. This in turn raises pressure within the pulmonary arteries. Pulmonary hypertension is a serious illness that becomes progressively worse. 

• Right-sided heart failure (cor pulmonale). This serious condition occurs when your heart's lower right chamber (right ventricle) — which is less muscular than the left — has to pump harder than usual to move blood through obstructed pulmonary arteries. Eventually the right ventricle fails from the extra strain. 

• Respiratory failure. In the end stage of chronic interstitial lung disease, respiratory failure occurs when severely low blood oxygen levels along with rising pressures in the pulmonary arteries and the right ventricle cause heart failure. 

Treatments and drugs 

The lung scarring that occurs in interstitial lung disease can't be reversed, and no current treatment has proved effective in stopping the ultimate progression of the disease. Some treatments, though, may improve symptoms temporarily or slow the disease's progress. Others help improve quality of life. 

Medications 

Many people diagnosed with interstitial lung diseases are initially treated with a corticosteroid (prednisone), sometimes in combination with other drugs that suppress the immune system — such as methotrexate or cyclosporine. None of these combinations has proved very effective over the long run. 

Oxygen therapy 

Using oxygen can't stop lung damage, but it can: 

• Make breathing and exercise easier 

• Prevent or lessen complications from low blood oxygen levels 

• Reduce blood pressure in the right side of your heart 

• Improve your sleep and sense of well-being 

You're most likely to receive oxygen when you sleep or exercise, although some people may use it round-the-clock. 

Pulmonary rehabilitation 

The aim of pulmonary rehabilitation is not only to improve daily functioning, but also to help people with intersitial lung disease live full, satisfying lives. To that end, pulmonary rehabilitation programs focus on: 

• Physical exercise, to improve your endurance 

• Breathing techniques that improve lung efficiency 

• Emotional support 

• Nutritional counseling 

Surgery 

Lung transplantation may be an option of last resort for younger people with severe interstitial lung disease who haven't benefited from other treatment options. 

Lifestyle and home remedies 

Being actively involved in your own treatment and staying as healthy as possible are essential to living with interstitial lung disease. For that reason, it's important to: 

• Stop smoking. If you have lung disease, the best thing you can do for yourself is to stop smoking. Talk to your doctor about options for quitting, including smoking cessation programs, which use a variety of proven techniques to help people quit. And because secondhand smoke can also be harmful to your lungs, don't allow other people to smoke around you. 

• Eat well. People with lung disease may lose weight both because it's uncomfortable to eat and because of the extra energy it takes to breathe. These people need a nutritionally rich diet that contains adequate calories. A dietitian can give you further guidelines for healthy eating. 

• Get vaccinated. Respiratory infections can worsen symptoms of intersitial lung disease. Make sure you receive the pneumonia vaccine and an annual flu shot. 

Acute respiratory distress syndrome: Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. More fluid in your lungs means less oxygen can reach your bloodstream. This deprives your organs of the oxygen they need to function. 

ARDS typically occurs in people who are already critically ill or who have significant injuries. Severe shortness of breath — the main symptom of ARDS — usually develops within a few hours to a few days after the original disease or trauma. 

Many people who develop ARDS don't survive. The risk of death increases with age and severity of illness. Of the people who do survive ARDS, some recover completely while others experience lasting damage to their lungs. 

Symptoms 

The signs and symptoms of ARDS can vary in intensity, depending on its cause and severity. They include: 

• Severe shortness of breath 

• Labored and unusually rapid breathing 

• Low blood pressure 

• Confusion and extreme tiredness 

When to see a doctor 

ARDS usually follows a major illness or injury, and most people who are affected are already hospitalized. 

Complications 

ARDS is extremely serious, but thanks to improved treatments, more people are surviving it. However, many survivors end up with potentially serious — and sometimes lasting — complications, including: 

• Pulmonary fibrosis. Scarring and thickening of the tissue between the air sacs can occur within a few weeks of the onset of ARDS. This stiffens your lungs, making it even more difficult for oxygen to flow from the air sacs into your bloodstream. 

• Collapsed lung (pneumothorax). In most ARDS cases, a breathing machine called a ventilator is used to increase oxygen in the body and force fluid out of the lungs. However, the pressure and air volume of the ventilator can force gas to go through a small hole in the very outside of a lung and cause that lung to collapse. 

• Blood clots. Lying still in the hospital while you're on a ventilator can increase your risk of developing blood clots, particularly in the deep veins in your legs. If a clot forms in your leg, a portion of it can break off and travel to one of your lungs (pulmonary embolism) — where it blocks blood flow. 

• Infections. Because the ventilator is attached directly to a tube inserted in your windpipe, this makes it much easier for germs to infect and further injure your lungs. 

• Abnormal lung function. Many people with ARDS recover most of their lung function within several months to two years, but others may have breathing problems for the rest of their lives. Even people who do well usually have shortness of breath and fatigue and may need supplemental oxygen at home for a few months. 

• Memory, cognitive and emotional problems. Sedatives and low levels of oxygen in the blood can lead to memory loss and cognitive problems after ARDS. In some cases, the effects may lessen over time, but in others, the damage may be permanent. Most ARDS survivors also report going through a period of depression, which is treatable. 

Risk factors 

Most people who develop ARDS are already hospitalized for another condition, and many are critically ill. You're especially at risk if you have a widespread infection in your bloodstream (sepsis). 

People who have a history of chronic alcoholism are at higher risk of developing ARDS. They're also more likely to die of ARDS. 

Treatments and drugs 

The first goal in treating ARDS is to improve the levels of oxygen in your blood. Without oxygen, your organs can't function properly. 

Oxygen 

To get more oxygen into your bloodstream, your doctor will likely use: 

• Supplemental oxygen. For milder symptoms or as a temporary measure, oxygen may be delivered through a mask that fits tightly over your nose and mouth. 

• Mechanical ventilation. Most people with ARDS will need the help of a machine to breathe. A mechanical ventilator pushes air into your lungs and forces some of the fluid out of the air sacs. 

Fluids 

Carefully managing the amount of intravenous fluids is crucial. Too much fluid can increase fluid buildup in the lungs. Too little fluid can put a strain on your heart and other organs, and lead to shock. 

Medication 

People with ARDS usually are given medication to: 

• Prevent and treat infections 

• Relieve pain and discomfort 

• Prevent clots in the legs and lungs 

• Minimize gastric reflux 

Lifestyle and home remedies 

If you're recovering from ARDS, the following suggestions can help protect your lungs: 

• Quit smoking. If you smoke, seek help to quit, and avoid secondhand smoke whenever possible. 

• Quit alcohol. Alcohol can relax the portion of your upper airway that keeps foreign material from entering your lungs. 

• Get vaccinated. The yearly flu (influenza) shot, as well as the pneumonia vaccine every five years, can reduce your risk of lung infections. 

Tuberculosis: Tuberculosis (TB) is a potentially serious infectious disease that mainly affects your lungs. The bacteria that cause tuberculosis are spread from one person to another through tiny droplets released into the air via coughs and sneezes. 

Once rare in developed countries, tuberculosis infections began increasing in 1985, partly because of the emergence of HIV, the virus that causes AIDS. HIV weakens a person's immune system so it can't fight the TB germs. In the United States, because of stronger control programs, tuberculosis began to decrease again in 1993, but remains a concern. 

Many strains of tuberculosis resist the drugs most used to treat the disease. People with active tuberculosis must take several types of medications for many months to eradicate the infection and prevent development of antibiotic resistance. 

Symptoms 

Although your body may harbor the bacteria that cause tuberculosis, your immune system usually can prevent you from becoming sick. For this reason, doctors make a distinction between: 

• Latent TB. In this condition, you have a TB infection, but the bacteria remain in your body in an inactive state and cause no symptoms. Latent TB, also called inactive TB or TB infection, isn't contagious. However, it can turn into active TB, so treatment is important for the person with latent TB and to help control the spread of TB in general. An estimated one-third of the world's population has latent TB. 

• Active TB. This condition makes you sick and can spread to others. It can occur in the first few weeks after infection with the TB bacteria, or it might occur years later. 

Signs and symptoms of active TB include: 

• Cough 

• Unintentional weight loss 

• Fatigue 

• Fever 

• Night sweats 

• Chills 

• Loss of appetite 

What organs are affected? 

Tuberculosis usually attacks your lungs. Signs and symptoms of TB of the lungs include: 

• Coughing that lasts three or more weeks 

• Coughing up blood or sputum 

• Chest pain, or pain with breathing or coughing 

Tuberculosis can also affect other parts of your body, including your kidneys, spine or brain. When TB occurs outside your lungs, signs and symptoms vary according to the organs involved. For example, tuberculosis of the spine may give you back pain, and tuberculosis in your kidneys might cause blood in your urine. 

When to see a doctor 

See your doctor if you have a fever, unexplained weight loss, drenching night sweats or a persistent cough. These are often signs of TB, but they can also result from other medical problems. Your doctor can perform tests to help determine the cause. 

Risk factors 

Anyone can get tuberculosis, but certain factors can increase your risk of the disease. These factors include: 

Weakened immune system 

A healthy immune system often successfully fights TB bacteria, but your body can't mount an effective defense if your resistance is low. A number of diseases and medications can weaken your immune system, including: 

• HIV/AIDS 

• Diabetes 

• End-stage kidney disease 

• Certain cancers 

• Cancer treatment, such as chemotherapy 

• Drugs to prevent rejection of transplanted organs 

• Some drugs used to treat rheumatoid arthritis, Crohn's disease and psoriasis 

• Malnutrition 

• Very young or advanced age 

International connections 

TB risk is higher for people who live in or travel to countries that have high rates of tuberculosis, such as: 

• Sub-Saharan Africa 

• India 

• China 

• Mexico 

• The islands of Southeast Asia and Micronesia 

• Parts of the former Soviet Union 

Poverty and substance abuse 

• Lack of medical care. If you are on a low or fixed income, live in a remote area, have recently immigrated to the United States, or are homeless, you may lack access to the medical care needed to diagnose and treat TB. 

• Substance abuse. Long-term drug or alcohol use weakens your immune system and makes you more vulnerable to tuberculosis. 

• Tobacco use. Using tobacco greatly increases the risk of getting TB and dying of it. 

Where you work or live 

• Health care work. Regular contact with people who are ill increases your chances of exposure to TB bacteria. Wearing a mask and frequent hand-washing greatly reduce your risk. 

• Living or working in a residential care facility. People who live or work in prisons, immigration centers or nursing homes are all at risk of tuberculosis. That's because the risk of the disease is higher anywhere there is overcrowding and poor ventilation. 

• Living in a refugee camp or shelter. Weakened by poor nutrition and ill health and living in crowded, unsanitary conditions, refugees are at especially high risk of tuberculosis infection. 

Complications 

Without treatment, tuberculosis can be fatal. Untreated active disease typically affects your lungs, but it can spread to other parts of the body through your bloodstream. Examples include: 

• Bones. Spinal pain and joint destruction may result from TB that infects your bones. In many cases, the ribs are affected. 

• Brain. Tuberculosis in your brain can cause meningitis, a sometimes fatal swelling of the membranes that cover your brain and spinal cord. 

• Liver or kidneys. Your liver and kidneys help filter waste and impurities from your bloodstream. These functions become impaired if the liver or kidneys are affected by tuberculosis. 

• Heart. Tuberculosis can infect the tissues that surround your heart, causing inflammation and fluid collections that may interfere with your heart's ability to pump effectively. This condition, called cardiac tamponade, can be fatal. 

Treatments and drugs 

Medications are the cornerstone of tuberculosis treatment. But treating TB takes much longer than treating other types of bacterial infections. With tuberculosis, you must take antibiotics for at least six to nine months. The exact drugs and length of treatment depend on your age, overall health, possible drug resistance, the form of TB (latent or active) and the infection's location in the body. 

A recent study suggests that a shorter term of treatment — three months instead of nine — with combined medication may be effective in keeping latent TB from becoming active TB. With the shorter course of treatment, people are more likely to take all their medication and the risk of side effects is lessened. More study is needed. 

Most common TB drugs 

If you have latent tuberculosis, you may need to take just one type of TB drug. Active tuberculosis, particularly if it's a drug-resistant strain, will require several drugs at once. The most common medications used to treat tuberculosis include: 

• Isoniazid 

• Rifampin (Rifadin, Rimactane) 

• Ethambutol (Myambutol) 

• Pyrazinamide 

There's some evidence that taking vitamin D during tuberculosis treatment enhances some of the effects of the drugs. More study is needed. 

Medication side effects 

Side effects of TB drugs aren't common but can be serious when they do occur. All tuberculosis medications can be highly toxic to your liver. When taking these medications, call your doctor immediately if you experience any of the following: 

• Nausea or vomiting 

• Loss of appetite 

• A yellow color to your skin (jaundice) 

• Dark urine 

• A fever that lasts three or more days and has no obvious cause 

Completing treatment is essential 

After a few weeks, you won't be contagious, and you may start to feel better. It might be tempting to stop taking your TB drugs. But it is crucial that you finish the full course of therapy and take the medications exactly as prescribed by your doctor. Stopping treatment too soon or skipping doses can allow the bacteria that are still alive to become resistant to those drugs, leading to TB that is much more dangerous and difficult to treat. 

To help people stick with their treatment, a program called directly observed therapy (DOT) is sometimes recommended. In this approach, a health care worker administers your medication so that you don't have to remember to take it on your own. 

Prevention 

If you test positive for latent TB infection, your doctor may advise you to take medications to reduce your risk of developing active tuberculosis. The only type of tuberculosis that is contagious is the active variety, when it affects the lungs. So if you can prevent your latent tuberculosis from becoming active, you won't transmit tuberculosis to anyone else. 

Protect your family and friends 

If you have active TB, keep your germs to yourself. It generally takes a few weeks of treatment with TB medications before you're not contagious anymore. Follow these tips to help keep your friends and family from getting sick: 

• Stay home. Don't go to work or school or sleep in a room with other people during the first few weeks of treatment for active tuberculosis. 

• Ventilate the room. Tuberculosis germs spread more easily in small closed spaces where air doesn't move. If it's not too cold outdoors, open the windows and use a fan to blow indoor air outside. 

• Cover your mouth. Use a tissue to cover your mouth anytime you laugh, sneeze or cough. Put the dirty tissue in a bag, seal it and throw it away. 

• Wear a mask. Wearing a surgical mask when you're around other people during the first three weeks of treatment may help lessen the risk of transmission. 

Finish your entire course of medication 

This is the most important step you can take to protect yourself and others from tuberculosis. When you stop treatment early or skip doses, TB bacteria have a chance to develop mutations that allow them to survive the most potent TB drugs. The resulting drug-resistant strains are much more deadly and difficult to treat. 

Vaccinations 

In countries where tuberculosis is more common, infants often are vaccinated with bacille Calmette-Guerin (BCG) vaccine because it can prevent severe tuberculosis in children. The BCG vaccine isn't recommended for general use in the United States because it isn't very effective in adults, and it causes a false-positive result on a TB skin test. Researchers are working on developing a more effective TB vaccine.