Pulmonary medicine focuses on diagnosis and treatment of conditions and diseases of the body’s respiratory system. The respiratory system, also called the ventilatory system, is comprised of organs that help you to breathe including the trachea, lungs, diaphragm and bronchi. A doctor who practices pulmonology is called a pulmonologist, whose main focus is analyzing diagnostic tests, researching symptoms, consulting with other medical professionals and administering appropriate treatments. They are skilled in helping patients with chronic conditions, such as COPD, as well as severe complications of respiratory failure. Pulmonologists may work in many different settings, including emergency care centers, general hospitals and private practice.
In order to better understand pulmonary disease, one must first be familiar with how the respiratory system operates. Blood is the body’s main way of delivering oxygen to the rest of the body. It is the respiratory system’s job to supply the oxygen that the blood uses. As a person breathes, they inhale oxygen and exhale carbon dioxide gases. This exchange of gases is the respiratory system’s way of getting oxygen to the blood. Breathing or respiration happens when oxygen enters through one’s nose or mouth and passes through the part of the body that produces sound and speech, called the larynx or voice box. It then passes through the rube that leads in to the chest cavity, called the trachea. Inside of the chest cavity the trachea splits in to two small tubes called bronchi. Each of these small tubes then divides again into bronchial tubes. The bronchial tubes lead directly into the lungs where they divide into thousands of smaller tubes called bronchioles. Bronchioles then connect to about 600 tiny spongy, air-filled sacs that are surrounded by capillaries. These tiny spongy sacs are called alveoli. The inhaled oxygen passes into the alveoli and then strains out through the capillaries into the blood in the arteries. Meanwhile, the waste-rich blood from the veins releases its carbon dioxide into the alveoli. The carbon dioxide then follows the same path backwards out of the lungs when a person exhales.
Within the chest cavity, there is a sheet of muscles that lie across the bottom of the chest cavity called the diaphragm. The diaphragm’s job is to help pump oxygen and carbon dioxide out of and into the lungs. When a person breathes, the diaphragm contracts to pull oxygen into the lungs and it relaxes to push carbon dioxide out. The airways (tubes) in the respiratory system including parts of the mouth and nose have small, sticky, mucous covered hairs called cilia that trap dust, germs and particles. When a person breathes these hairs act like little brooms, sweeping the germs, particles, dust and/or mucous up in to the nose or mouth where they are then swallowed, coughed or sneezed out of the body.
Some diseases of the respiratory system that are common among seniors include:
Chronic Obstructive Pulmonary Disease (COPD), also referred to as chronic bronchitis or emphysema, makes it more difficult for a person to breathe. When a person has chronic bronchitis, it involves a long-term cough with mucus. Emphysema, or smoker’s cough, involves the degeneration of the lungs over time, usually due to smoking. When a person suffers from COPD, they usually have a combination of the two. COPD is a long-term (chronic) illness. When a COPD flare up occurs, the tubes that carry air in and out of the lungs become partially blocked. If COPD is severe, shortness of breath and its other symptoms interfere with even the most daily living activities, such as doing light housework, taking a walk and sometimes even bathing and dressing. This disease kills more than 120,000 people each year in the U.S. and is the fourth leading cause of death among seniors. An estimated 12+ million people are diagnosed with COPD. It is also estimated that about another 12 million have the disease and don’t even know it. Risk factors for developing COPD are:
- exposure to certain gases or fumes
- exposure heavy amounts of second hand smoke
- use of cooking fires without proper ventilation
There is no cure for COPD but treatments are available. These may include the use of bronchodilator inhalers, light exercise, lifestyle changes (quitting smoking), anti-inflammatory medications, antibiotics, inhaled steroids, injected steroids, nebulizers, oxygen therapy and assisted breathing machines.
Lung cancer is cancer that forms in the tissues of the lung, especially in the cells that line the air passages. Of the two types of lung cancer — small cell and non-small cell lung cancer – the most common type is non-small cell. Occasionally, the cancer is made up of both types. This is called mixed small cell/large cell cancer. If the cancer starts somewhere else in the body and spreads to the lungs, it is referred to as metastasized lung cancer. Lung cancer is most common in older adults and affects both men and women. Those most at risk are those who:
- are cigarette smokers and/or those exposed to secondhand smoke
- have been exposed to asbestos
- have been exposed to cancer causing chemicals such as uranium, arsenic in the water, coal products, diesel exhaust and gasoline
- have a family history of lung cancer
- have been exposed to radon gas
- have had radiation therapy
- have been exposed to high levels of air pollution
Pneumonia is an infection that causes inflammation in the lungs that is usually caused by exposure to bacteria, viruses, parasites or fungi (See: INFECTIOUS DISEASE). Pneumonia is a particular concern if one is older than 65 or has a chronic illness or weak immune system. When there is inflammation in the lungs, it causes fluid to pour out of the infected part(s) of the lungs. Seniors are often not able to clear these secretions from the lungs which may end up going in to the bronchial tubes. If this area fills with mucous, pus and other liquids, it cannot function properly. As a result, blood flow to the infected portion of the lungs decreases. When blood flow decreases in the lungs, oxygen levels in the bloodstream can decline which can be a major cause of death for those aged 65 and older. Seniors may me more at risk for pneumonia due to other health conditions, their general frailties, weakened immune systems and previous surgeries. A person is more likely to get pneumonia after having a cold, bronchitis or the flu. After having these illnesses, it makes it harder for the lungs to fight infection so it is easier to get pneumonia. Additionally, having a chronic conditions such as heart disease, asthma, cancer or diabetes, also makes a person more likely to get pneumonia. Pneumonia can range in severity from mild to life threatening. A person can contract pneumonia in their daily life, such as at church or work. When this occurs, this is referred to as community-associated pneumonia. If someone who is in a hospital or nursing home gets pneumonia, it is considered healthcare-associated pneumonia. Healthcare-associated pneumonia may be more severe because the patient is already ill. Most pneumonia patients heal at home and it often clears up in about two to three weeks, although 15 to 20 percent of those with community-acquired pneumonia and 20 to 30 percent of people with nursing-home acquired pneumonia are treated in a hospital setting. Treatment for pneumonia usually includes the use of medications, antibiotics and antivirals. However, since there are now more antibiotic resistant strains of pneumonia, prevention is the most desirable approach.
Asthma is an inflammation of the airways that causes the airways to swell and narrow. When an asthma attack occurs, the muscles surrounding the airways become tight and the lining of the air passages swells. This reduces the amount of air that can pass by, leading to wheezing, shortness of breath, chest tightness and coughing. Many associate asthma more with children than among seniors. However, asthma in the elderly is not that rare but can be hard to diagnose as it mimics the symptoms of several other common age related diseases and conditions. For example, diseases such as chronic obstructive pulmonary disease (COPD) may be hard to distinguish from asthma because it is also caused by a blockage in the airways due to inflammation and has many of the same symptoms. In some patients, distinguishing the difference between late-onset asthma and other conditions such as COPD, especially in cigarette smokers, is difficult and may even be impossible. In asthma sensitive people, symptoms can be triggered by certain allergens such as pet dander, dust, changes in weather, chemicals in the air or food, exercise, mold, pollen, stress, tobacco smoke and respiratory infections. Some risk factors for asthma include:
- family history
- those with existing allergies
- airway hyperreactivity
- those with atopy or allergies that affect other parts of the body such as eczema (skin), allergic rhinitis (nose) and allergic conjunctivitis (eyes)
- environmental factors such as pollution, chemical fumes and weather
- cigarette smoking or exposure to cigarette smoke
Treatment for asthma may include medications, inhaled steroids, long-acting beta-agonist inhalers, short-acting bronchodilator inhalers and oral steroids. Severe asthma attacks may require a hospital stay, breathing assistance, oxygen and medications given through a vein (IV).
Bronchitis is an infectious respiratory disease in which there is an inflammation of the mucus membranes in the lungs’ bronchial tubes. Bronchitis is usually caused by infection with a virus (less commonly with a bacteria or fungus). Inflammation in the airways damages the cilia and prevents them from clearing the air passages causing them to become clogged with mucus. The lungs are then vulnerable to viral and bacterial infections which, over time, distort and permanently damage the lungs’ airways. When there is irreversible damage, people develop COPD. People who have bronchitis often have a cough that brings up mucus. Mucus is a slimy substance made by the lining of the bronchial tubes. Bronchitis also may cause wheezing (a whistling, squeaky type sound when a person breathes), a low fever, chest pain or discomfort and shortness of breath. There are two main types of bronchitis: acute (short term) and chronic (long term/ongoing). Acute bronchitis can last anywhere from one to three weeks. Chronic bronchitis can last for at least three months out of a year for at least two years in a row. Seniors are at higher risk for acute bronchitis than people in other age groups. People of all ages can develop chronic bronchitis, but it occurs more often in people who are aged 45 and older. Many adults who develop chronic bronchitis are smokers and women are more than twice as likely than men to be diagnosed with it. Other risk factors include:
- having an existing lung disease
- having an upper respiratory illness such as influenza (flu) or a cold caused by a virus such as coronavirus, adenovirus, or a rhinovirus (See: INFECTIOUS DISEASE)
- accidentally inhaling (aspirating) food or vomit
- exposure to someone with viral or bacterial bronchitis (See: INFECTIOUS DISEASE)
- exposure to dust, chemical fumes, and vapors in the environment
- exposure to people who smoke (secondhand or thirdhand smoke)
- a compromised immune system.
Treatment for bronchitis includes over the counter fever reducers, oral or intravenous (IV) antibiotics (for bacterial bronchitis), lifestyle changes, medications, oxygen therapy, nebulizer, bronchodilators and/or steroid inhalers.
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