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PULMONOLOGY
Pulmonary and lung diseases encompass a broad range of medical conditions affecting the respiratory system. These disorders can significantly impair lung function, ultimately affecting gas exchange, oxygenation, and overall health.
Chronic Obstructive Pulmonary Disease (COPD)
COPD is a progressive condition characterised by airflow limitation. It is often a result of prolonged exposure to irritants, such as tobacco smoke. Patients typically present with chronic bronchitis or emphysema, leading to symptoms of dyspnoea, chronic cough, and sputum production.
1How can you manage COPD during the COVID-19 pandemic?
COVID-19refers to the "coronavirus disease” that came about in 2019. SARS-CoV-2, a rapid-spreading virus, causes this disease. The virus first showed up in late 2019 and has since spread globally.
Patients with COVID-19 can have fever, cough, phlegm and other symptoms. When the condition becomes serious, it can cause pneumonia and problems with breathing. A few people with COPD are likely to experience severe symptoms if they become infected with COVID-19. If you develop COPD, you need to get the COVID-19 vaccine as soon as possible. Being vaccinated offers protection and will greatly lower your risk of getting very sick.
If you take medication for COPD, it's critical to remain taking them as usual. If you develop COVID-19 symptoms or think you might have come into contact with a family member, colleague or friend who had the virus, contact your doctor immediately.
2Why did you develop COPD?
Initially, COPD appears asymptomatic. As the condition worsens, it can make you:
- Appear out of breath, especially when you are physically active
- Wheezing (whistling sound as you breathe)
- Coughing and spitting phlegm (thick mucus)
- Lung infection, such as pneumonia
- Lung cancer
- Weakened heart
3Is there a specific test for COPD?
Yes, there is a test available. Your doctor can administer spirometry to check for COPD. During spirometry, you take in a lot of air and blow out by exhaling as fast and hard as possible into a tube. A machine that attaches to the tube measures the volume of air you can blow out of your lungs and how quickly you can exhale.
If the results of the spirometry are unusual, you will receive a type of medicine in an inhaler to monitor your breathing. Then within a few minutes, you will repeat the spirometry. This will help the doctor find out if the problem is a result of COPD or another lung disorder, such as asthma. Patients with asthma usually receive normal results after using an inhaler, whereas patients with COPD do not.
4Will you need additional testing?
Your doctor might order a few other tests as well. These can help rule out other issues besides COPD that might be causing your symptoms. They can also look for some of the problems that COPD can lead to. Tests you might get include:
- A blood test for a genetic condition called "antitrypsin deficiency" leads to COPD.
- An x-ray of the chest
- An electrocardiogram or ECG measures the heart’s electrical activity.
- A low-dose CT scan is an imaging test used to screen for lung cancer. (Imaging tests capture images of the inside of the body.) Your doctor might suggest screening for lung cancer, depending on your age and smoking history.
1How is COPD treated?
There are four primary forms of treatment for COPD:
• Medications – There are so many medicines to treat COPD. Most patients are given inhalers that help open up their airways or relieve swelling in the airways. Often patients require more than one inhaler at a time. You might need to take a steroid medicine in pill form when your condition causes a flare-up. This steroid medicine is not the type that athletes take to increase their muscle mass.
• Oxygen – If your condition worsens, you may require oxygen. Your doctor can test your blood oxygen to determine if you need this.
• Pulmonary rehabilitation – In pulmonary rehab, you can improve your symptoms in different ways. You can learn new exercises and ways to breathe that can help relieve your symptoms. Even if you choose not to complete a pulmonary rehab program, remaining active can help improve your breathing.
• Surgery and endobronchial valves – Rarely, patients with emphysema of severe COPD require surgery. Surgery involves the removal of the damaged lung portions. This surgery can relieve your symptoms, but it does not always work. Also, doctors can choose to insert small "endobronchial valves" in the affected airways. This can restore function to the healthier parts of the lungs to work better. The valves are inserted using a narrow tube that goes down your throat, commonly known as a "bronchoscope."
• Medications – There are so many medicines to treat COPD. Most patients are given inhalers that help open up their airways or relieve swelling in the airways. Often patients require more than one inhaler at a time. You might need to take a steroid medicine in pill form when your condition causes a flare-up. This steroid medicine is not the type that athletes take to increase their muscle mass.
• Oxygen – If your condition worsens, you may require oxygen. Your doctor can test your blood oxygen to determine if you need this.
• Pulmonary rehabilitation – In pulmonary rehab, you can improve your symptoms in different ways. You can learn new exercises and ways to breathe that can help relieve your symptoms. Even if you choose not to complete a pulmonary rehab program, remaining active can help improve your breathing.
• Surgery and endobronchial valves – Rarely, patients with emphysema of severe COPD require surgery. Surgery involves the removal of the damaged lung portions. This surgery can relieve your symptoms, but it does not always work. Also, doctors can choose to insert small "endobronchial valves" in the affected airways. This can restore function to the healthier parts of the lungs to work better. The valves are inserted using a narrow tube that goes down your throat, commonly known as a "bronchoscope."
ASTHMA
Asthma is characterised by reversible airflow obstruction due to hyperresponsiveness of the bronchial airways. Triggers may include allergens, exercise, or respiratory infections, leading to episodes of wheezing, shortness of breath, and chest tightness.
1How should you manage my asthma symptoms during the COVID-19 pandemic?
The 2019 global coronavirus has led to severe complications, particularly in patients with respiratory illnesses such as asthma and emphysema.COVID-19 worsens your asthma symptoms, making it critical to carry around your asthma pump in case of emergencies.
Attend regular follow-ups with your doctor to ensure you take the right steps to prevent flare-ups and the necessary precautions to avoid getting COVID-19. Also, getting vaccinated against the virus should remain a priority for you.
Attend regular follow-ups with your doctor to ensure you take the right steps to prevent flare-ups and the necessary precautions to avoid getting COVID-19. Also, getting vaccinated against the virus should remain a priority for you.
2Why did you develop asthma?
Being exposed to external irritants such as pollen, dust, certain types of food, and chemicals can cause your asthma to act up again. This is because your immune system mistakes these substances that we usually consider harmless as foreign invaders. In response, your body acts aggressively, and as a result, spurs a reaction.
3What are the symptoms of asthma?
• You experience breathing problems.
• Your chest becomes tight.
• You wheeze when you breathe out.
• Asthma symptoms such as coughing, wheezing and finding it hard to breathe keep you up at night.
• Cough or wheeze worsens when you have flu, pneumonia or coronavirus
• Your chest becomes tight.
• You wheeze when you breathe out.
• Asthma symptoms such as coughing, wheezing and finding it hard to breathe keep you up at night.
• Cough or wheeze worsens when you have flu, pneumonia or coronavirus
4Is there a test for asthma?
A physical exam can help rule out COPD and test for a respiratory infection. Lung function tests are standard tests for adults used to measure the amount and rate at which air flows as you breathe. These tests include spirometry and peak flow test.
Sometimes your doctor will find it imperative to carry out an allergy test that is either a blood test or skin test to detect potential allergens that could trigger your asthma symptoms.
Sometimes your doctor will find it imperative to carry out an allergy test that is either a blood test or skin test to detect potential allergens that could trigger your asthma symptoms.
5Are additional tests needed?
Your doctor can decide whether carrying out additional tests are necessary. For example, he may decide to conduct a chest x-ray, sputum test, a test to check for the exact number of white blood cells in your mucous and a Nitric oxide test.
6How to manage at home
There are some things you can do to prevent flare-ups. For example, avoid allergens that you know can trigger an attack and take the medication that the doctor prescribes. In addition, make sure your vaccinations against flu, pneumonia and COVID-19 are up to date.
7How is asthma treated?
• Inhaled corticosteroidsmust be taken as prescribed to relieve your symptoms.
• Immunotherapy (allergy shots) relieves an aggressive immune system response to allergens, triggering an asthma attack.
• Immunotherapy (allergy shots) relieves an aggressive immune system response to allergens, triggering an asthma attack.
PNEUMONIA
Pneumonia refers to an inflammatory condition of the lung, typically caused by infectious agents such as bacteria, viruses, or fungi. It results in the filling of the alveoli with fluid or pus, manifesting as cough, fever, and difficulty breathing.
1How should you manage pneumonia during the COVID-19 pandemic?
Viral pneumonia is quite common with the pandemic making it even worse forcing you to take precautions to avoid COVID pneumonia. You need to take the medication your doctor prescribes, or bacteria will fester and grow in your lungs, causing pneumonia to redevelop. It also helps to drink hot water to loosen phlegm and take the cough mixture your doctor advises you to take.
Taking the COVID-19 vaccine can help prevent life-threatening complications leading to your inability to breathe and the need to put you on a ventilator where there is a chance your condition may worsen due to you being exposed to more bacteria.
Taking the COVID-19 vaccine can help prevent life-threatening complications leading to your inability to breathe and the need to put you on a ventilator where there is a chance your condition may worsen due to you being exposed to more bacteria.
2Why did you develop pneumonia?
Certain organisms such as bacteria, fungi and viruses cause pneumonia. You can get pneumonia by breathing in the air with bacteria and viruses. Usually, your immune system is capable of preventing a lung infection, but sometimes these germs can overpower your body’s defence system and affect your health.
3What are the symptoms?
• Pain inside your chest that worsens when you take deep breaths or cough
• Phlegmy (wet) cough
• Tiredness
• Fever
• Sweating at night
• Diarrhoea and vomiting
• Trouble breathing
• Phlegmy (wet) cough
• Tiredness
• Fever
• Sweating at night
• Diarrhoea and vomiting
• Trouble breathing
4Is there a way to test for pneumonia?
Your doctor can conduct a simple blood test to determine whether you have an infection or carry out an x-ray of your chest to locate the infection. However, an x-ray cannot describe the bug causing your symptoms.
5Are additional tests necessary?
You may also need pulse oximetry that traces oxygen levels in your blood. This is because pneumonia affects the flow of oxygen throughout your bloodstream. You might also request your doctor to perform a sputum test. A sputum test involves removing a fluid sample from your lungs to find the cause of the infection.
6What you can do to manage the condition
Get treated as soon as possible to prevent further complications. By drinking lots of fluids, you can help loosen your phlegm and get rid of secretions. You also need to take medication your doctor prescribes to relieve symptoms.
7How do you treat pneumonia?
Types of treatment for pneumonia include:
• Prescribed antibiotics are given to treat pneumonia that occurs due to a bacterial infection. First, your doctor needs to locate and classify the bacteria causing your infection and then select an antibiotic to target the infection.
• Cough mixture eases your cough so that you do not need to take on further strain from excessive coughing. Over-the-counter cough medicines can be taken at their lowest dose, but your doctor will advise whether this is necessary.
• Pain/fever relief medications such as aspirin, Advil and acetaminophen alleviate discomfort while you are left to recover at home or in the hospital.
• Prescribed antibiotics are given to treat pneumonia that occurs due to a bacterial infection. First, your doctor needs to locate and classify the bacteria causing your infection and then select an antibiotic to target the infection.
• Cough mixture eases your cough so that you do not need to take on further strain from excessive coughing. Over-the-counter cough medicines can be taken at their lowest dose, but your doctor will advise whether this is necessary.
• Pain/fever relief medications such as aspirin, Advil and acetaminophen alleviate discomfort while you are left to recover at home or in the hospital.
8What are the symptoms of COVID-19?
These are the main symptoms of COVID-19 that may differ in each case:
• High fever
• Cough
• Cannot breathe
• Tiredness
• Uncontrollable shaking/chills
• Headache
• Scratchy throat
• Nasal congestion
• You lose your sense of smell/ taste
• Runny stomach
• Nausea
• High fever
• Cough
• Cannot breathe
• Tiredness
• Uncontrollable shaking/chills
• Headache
• Scratchy throat
• Nasal congestion
• You lose your sense of smell/ taste
• Runny stomach
• Nausea
9Is there a way to test for COVID-19?
You can test for COVID-19 at multiple drive-through testing stations in your area. The practitioners at these stations use a swab test kit on you. They insert a swab deep into your nose and retrieve a sample right at the back of your nose or throat.
10Will you need further testing?
You can also choose to take an antibody (serology) test that is done to check for antibodies (proteins) that develop in response to COVID-19. Our body releases these proteins, which remain present for six months or more after a COVID-19 infection or from a vaccine.
11What you can do to reduce the spread of COVID-19
If you suspect you are COVID positive, go and get tested so that you know this for sure. Then, isolate for at least fourteen days to prevent the infection from spreading to your family members and others.
12How do you treat COVID-19?
Scientists, researchers and medical practitioners are still learning about this virus because it is a fairly new strain. There are vaccines available for everyone, even five-year-old children. While these vaccines prevent you from getting severely ill, they cannot stop you from getting COVID-19.
You can treat your COVID symptoms by resting, drinking water, taking the medication your doctor prescribes and monitoring your fever and oxygen levels. Use a pulse oximeter, a small non-invasive medical device that traces the amount of oxygen in your blood.
You can treat your COVID symptoms by resting, drinking water, taking the medication your doctor prescribes and monitoring your fever and oxygen levels. Use a pulse oximeter, a small non-invasive medical device that traces the amount of oxygen in your blood.
Pulmonary Fibrosis and occupational related lung conditions
Pulmonary fibrosis involves progressive scarring of lung tissue, which restricts breathing capacity. Various aetiologies exist, including idiopathic forms, environmental exposures, and autoimmune conditions, leading to symptoms of progressive dyspnoea and a persistent dry cough.
Lung Cancer
Lung cancer represents a malignancy originating in the lungs, with primary forms including non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Symptoms may include unexplained weight loss, persistent cough, and chest pain.
1Is there a way to test your lung function?
A Pulmonary Function Test (PFT) is a test that demonstrates how well your lungs are functioning. Some PFTs measure your lung capacity, the rate at which air flows and gaseous exchange.
Types of PFTs are:
• Spirometry is a test that makes use of a device called a spirometer to check the level of air you inhale and exhale.
• A vital capacity test measures the air you exhale after taking a deep breath and inhaling as much air as possible.
• A peak expiratory flow rate is a test that assesses the speed at which you can expel air (the fastest rate).
• A minute volume test measures the amount of air you breathe out per minute.
There are many lung function tests that your doctor can advise you to take to assess your lung capacity and speed at which air flows. As you become older, your lung capacity decreases. Therefore, it is important to safeguard the health of your lungs and your overall health by eating a balanced diet and exercising regularly to breathe better.
Types of PFTs are:
• Spirometry is a test that makes use of a device called a spirometer to check the level of air you inhale and exhale.
• A vital capacity test measures the air you exhale after taking a deep breath and inhaling as much air as possible.
• A peak expiratory flow rate is a test that assesses the speed at which you can expel air (the fastest rate).
• A minute volume test measures the amount of air you breathe out per minute.
There are many lung function tests that your doctor can advise you to take to assess your lung capacity and speed at which air flows. As you become older, your lung capacity decreases. Therefore, it is important to safeguard the health of your lungs and your overall health by eating a balanced diet and exercising regularly to breathe better.
FAQ
1How do I know the results of my PPD skin test are positive for tuberculosis?
A welt that exceeds 5mm where your doctor injected the protein is a strong sign you have tested positive for tuberculosis. Anything between 5-15mm is a positive result.
2Can you get pneumonia while in the hospital?
Hospital-acquired pneumonia is more common than you think. For example, patients staying overnight in the hospital can develop pneumoniaas a result of a bacterial infection. Also, patients with kidney disease going to outpatient clinics for dialysis are at risk of acquiring pneumonia. In addition, being put on a breathing machine (ventilator) when suffering from COVID-19 can put you at great risk of developing pneumonia as well.
3Does SARS-CoV-2 have more than one strain?
According to a Chinese study, two strains of COVID-19 were initially detected. These two strains are called L and S. Strain S represents an older version, while strain L is linked to the recent outbreak.
Viruses also mutate all the time, which is why several variants (Alpha, Beta, Gamma, Delta, Omicron, Lambda and Mu) are on the rise. However, we are still unsure how many new variants are yet to arise.
Viruses also mutate all the time, which is why several variants (Alpha, Beta, Gamma, Delta, Omicron, Lambda and Mu) are on the rise. However, we are still unsure how many new variants are yet to arise.
"It all starts by caring enough to engage the patient in the decision-making. Many people argue that 'We don't have time for this in the consultation. I'd rather just tell people what I think is best for them, and then, they can decide whether they want it or not.' Well, that's not very caring. This might be efficient, but it does not reflect the best that we can offer.'"
Dr Victor Montori, on shared decision-making