Johns Hopkins Health Alerts - Lung Disorders

Got Asthma? Get a Flu Shot

Thu, 19 Nov 2009 06:00:00 CST

Outbreaks of the flu occur each winter and last for two to three months, leading to infection in 10 to 20% of the population. Influenza can worsen the symptoms experienced by people who have chronic obstructive pulmonary disease (COPD) or asthma. It can also make a person more prone to a bacterial infection that causes pneumonia, or the flu virus itself can cause pneumonia.

Despite this risk, many people with asthma aren't heeding the message from experts to protect themselves against flu-related complications by getting a flu shot. A report published by the U.S. Centers for Disease Control and Prevention in Morbidity and Mortality Weekly Report (Volume 57, page 653) found that during the 2005-2006 flu season, only 36% of people with asthma responding to a national health survey said they were vaccinated against the flu.

The flu vaccination rate was best among older adults with asthma: Those aged 50 to 64 years and 65 or older had the highest flu vaccination rate (49% and 76%, respectively). Flu vaccination is recommended for both age groups, whether or not a person has asthma, because the risk of flu death increases sharply among older adults.

Bottom line advice: Everyone with asthma should get a flu shot because they are at high risk for complications from the flu. Influenza is more serious in people with asthma and can often lead to pneumonia. If you're 50 or older, get your flu shot every year -- even if you don't have asthma. Although it's best to get your flu shot as soon as it becomes available in the fall, you may still benefit from being vaccinated as late as January, since influenza might not appear in some areas until February or March.

Is Fiber Good For Your Lungs? Stay Tuned

Thu, 17 Sep 2009 06:00:00 CDT

Q. I heard recently that eating more fiber is good for the lungs. Is that just marketing hype?

A. It may not be. A recent study of almost 12,000 middle-aged adults suggests that eating more fiber is associated with a slower rate of lung function decline. The study, reported in the American Journal of Epidemiology, found that those with the highest daily fiber intake (27 g per day) had better lung function and were less likely to have COPD than those who had the lowest fiber intake (9.5 g on average). Significant lung benefits were associated with consumption of fiber in cereal and, to a lesser degree, fruit, but not vegetables.

The benefits may be due to the fiber's antioxidant properties. Although most studies of nutrition and lungs have focused on antioxidant vitamins, this is the first major study to suggest that eating more fiber may protect your lungs.

There are many other reasons to increase your fiber intake. Fiber appears to reduce the risk of developing a variety of health conditions, such as heart disease, diabetes, diverticular disease, and constipation. The easiest way to boost your fiber intake is to eat bran cereal: One half cup of 100% bran ready-to-eat cereal can provide as much as 10 g of fiber. Add some fruit to increase your fiber count: One half cup of raspberries has 4.6 g and a medium banana has 3 g. If you are not used to eating fiber, increase your consumption gradually to reduce the risk of gastrointestinal side effects.

Getting Rid of Dust Mites

Thu, 27 Aug 2009 06:00:00 CDT

If you have asthma, it’s important to avoid asthma triggers whenever possible -- but sometimes it’s not so easy. A reader asks: I am meticulous about keeping my home dust free, but it doesn't seem to help my asthma. Am I doing something wrong?

A. Probably not, according to a recent review of studies of house dust-mite control measures for asthma reported in the Cochrane Database of Systematic Reviews. The review of 54 studies found no effect of chemical or physical methods aimed at reducing exposure to house dust-mite allergens. The total number of asthma patients who improved after some type of allergen treatment was very similar to the number in the control groups who did not try to mite proof their homes.

This finding is surprising, considering that environmental control of allergens, such as chemical treatments, mattress covers, vacuum cleaning, washing, or air filtration, is usually recommended for people with asthma. In fact, recent U.S. guidelines, which recommend a host of tips for limiting allergens in the home, include dust-mite control measures among their recommendations. But the review authors dismiss some of the studies used to formulate the guidelines as inadequate.

If you have asthma and find that it's improved since you have taken steps to mite proof your home, don't stop. But if these methods don't seem to help you, ask your doctor if there are other ways to improve your breathing, including changing your drug treatment.

True or False: Thunderstorms Trigger Asthma Attacks

Thu, 08 Oct 2009 06:00:00 CDT

For some asthma patients, the answer is “True.” Scientists in Atlanta report a surprising asthma trigger -- thunderstorms. They found that thunderstorms are associated with a 3% increase in emergency room visits for asthma.

The most likely explanations for the association are that pollen grains rupture in rainwater, releasing allergens, and that winds from thunderstorm downdrafts spread allergens, which may lead to an increased risk of asthma attacks.

The researchers used an emergency department (ED) visit database containing information on more than 10 million ED visits from 41 of 42 hospitals in Atlanta between 1993 and 2004. They looked at people who visited the ED for asthma and compared the zip codes in which they lived with rain and wind data for those areas. Of 215,832 asthma visits, 24,350 occurred on days following thunderstorms. Visits to the ED for asthma were highest when wind gusts were intermediate and high.

While a 3% increase in risk may seem modest, the researchers note, asthma is quite prevalent in Atlanta, and even a modest increase could have a significant public health impact. If you have asthma, pay attention to your breathing symptoms the next time there's a thunderstorm.

If you find that they trigger your asthma, you may want to stay inside during and after thunderstorms whenever possible.

Reported in THORAX (Volume 63, page 659).

COPD Flare-Up Advice

Thu, 06 Aug 2009 06:00:00 CDT

COPD complications can be serious. Johns Hopkins specialists provide bottom line advice to help you recognize a COPD problem before it turns dangerous.

If you have COPD, how do you know when you're not merely in discomfort, but in danger? Here are some danger signs that you shouldn’t ignore.

COPD flare-ups and infections. If you feel increasing shortness of breath, more mucus in your throat, and greater wheezing and coughing than usual, you may be experiencing a COPD flare-up -- something you need to share with your doctor. You should also call if the material you cough up changes color or if you have a fever lasting more than 24 hours. COPD flare-ups often result from a bronchial infection, which may be treatable with antibiotics, or from breathing fumes, dust, or pollution.

COPD and heart failure. Swelling of the legs, ankles, and feet is a warning that someone with COPD may have developed a type of heart failure called cor pulmonale, or right ventricular failure. Because COPD makes the heart work harder (particularly the right side, which pumps blood into the lungs), that side of the heart may enlarge. As the blood pressure in the lungs rises, the right ventricle contracts less efficiently. Cor pulmonale increases the risk that a blood clot will develop in a leg vein.

COPD and pneumothorax. A hole that develops in the lung, allowing air to escape into the space between the lung and the chest wall, pneumothorax causes the lung to collapse, leading to severe shortness of breath. People with COPD have an increased risk of pneumothorax, because changes in their lungs cause air to be emptied unevenly from the lungs. Symptoms of pneumothorax include: sudden shortness of breath; painful breathing; sharp chest pain, often on one side; chest tightness; dry, hacking cough; rapid heart rate.

COPD and too many red blood cells. Weakness, headaches, fatigue, and light-headedness may indicate the presence of an uncommon condition known as secondary polycythemia, which arises when there isn’t enough oxygen in the blood. Someone who develops polycythemia may have visual disturbances such as blind spots, distorted vision, and flashes of light. Gums and small cuts may bleed, and there may be a burning sensation in the hands and the feet.

Bottom line advice on COPD: If the problem is a flare-up of COPD, quick treatment can prevent serious breathing problems that might send you to the hospital. Call your doctor immediately if:

You have COPD and you have shortness of breath or wheezing that is rapidly worsening.

You have COPD and are coughing more deeply or more frequently, especially if you have an increase in mucus or a change in the color of the mucus you cough up.

You have COPD and cough up blood.

You have COPD and have increased swelling in your legs or abdomen.

You have COPD and have a fever over 100°F.

You have COPD and have severe chest pain.

You have COPD and develop flu-like symptoms.

You have COPD and feel that your medication is not working as well as usual.

All That Wheezes Is Not Asthma

Thu, 25 Jun 2009 06:00:00 CDT

Short of breath? Coughing? Chest pain? Johns Hopkins doctors explain why you should take your symptoms seriously.

Many lung disorders produce similar symptoms, but the severity and duration of these symptoms can vary considerably from disease to disease. The lung disorders can be acute (short and relatively severe) or chronic (persisting over a long time).

Chronic lung conditions may wax and wane in severity and can worsen quickly and markedly if another problem, such as a lung infection, occurs. Some people, however, have only mild symptoms or none at all. In these individuals, the lung disorder may be detected on a chest x-ray or by a test to check lung function.

Shortness of breath. Shortness of breath can dramatically compromise quality of life. The underlying cause of shortness of breath is usually a mechanical problem in the lungs or diaphragm (the large, dome-shaped muscle located at the base of the lungs). Examples of mechanical problems are airway obstruction (as occurs in asthma, COPD, and some lung cancers); increased stiffness of the lungs (as in interstitial lung disease, pneumonia, and heart failure); severe spine and rib cage abnormalities; and obesity.
If left untreated, shortness of breath can lead to fatigue and weakness that may profoundly limit activities. In turn, weakness related to being out of shape or musculoskeletal disease, such as severe curvature of the spine, may aggravate shortness of breath.

Coughing. Coughing up phlegm, infectious germs, and foreign substances is one of the ways in which the lungs protect themselves. Severe coughing, however, may signal lung disease. Obstructive diseases of the lungs (asthma and COPD) and lung cancer often cause a person to cough up phlegm, which, if yellow or green, may signal an infection. Coughing up blood is a critical sign, especially in a current or former cigarette smoker. It may suggest a potentially life-threatening disease, such as lung cancer or pulmonary embolism, although it can also be a sign of a less serious lung problem such as bronchitis.

Noisy breathing. Noisy breathing is an especially common sign of lung disease. Abnormal sounds range from a high-pitched crowing during inhalation to continuous musical sounds during exhalation (wheezing, which occurs with asthma and some other disorders). The maxim “all that wheezes is not asthma” underscores the fact that many health conditions, including diseases of the larynx, heart failure, pulmonary embolism, and COPD, can cause wheezing. Repetitive loud snoring during sleep, interrupted by periods of silence in which there's no air flow, is a major sign of sleep apnea.

Chest pain. Chest pain or other discomfort has numerous causes, and determining whether the cause is a heart, esophageal, or lung disease is often challenging. Pain on one side of the chest that worsens with deep breathing, coughing, or laughing suggests pleurisy, an inflammation of the pleura (the membrane around the surface of the lungs and the inner chest wall). Pleurisy may be caused by an infection, such as pneumonia; pulmonary embolism; cancer; or a systemic (affecting the entire body) inflammatory disease such as systemic lupus erythematosus. Alternatively, pain that worsens on inhalation may be due to a chest wall injury such as a broken rib.

Is Your Cough A Sign of Something Serious?

Thu, 04 Jun 2009 06:00:00 CDT

We all cough from time to time, but severe coughing may signal a respiratory disease. Any cough that lasts more than two months is defined as chronic and requires medical attention.

Coughing is a reflex that keeps the lungs and airways free from phlegm (excess mucus) and foreign objects (such as food) that might interfere with breathing. Occasional coughing is normal, as is the coughing associated with a cold (the most common acute medical problem that triggers a cough). Any cough that lasts more than two months, however, is defined as chronic and requires medical attention -- even if the cough occurs only in the morning, at night, or at certain times of the year.

Chronic cough is not a disease; rather, it is considered a symptom of another condition. A cough attributable to a cold, flu, or some other known cause that fails to get better within three weeks, or a persistent cough of unknown origin, is reason to see your doctor. Your cough may have qualities that, together with other symptoms, point towards an underlying cause that requires proper diagnosis and treatment.

A chronic cough associated with a normal chest x-ray most often results from one or more conditions that include postnasal drip, asthma, gastroesophageal reflux disease (GERD, in which stomach acid flows back into the esophagus), and chronic bronchitis. Blood pressure medications can also cause a dry, hacking cough in some people.

More serious, but less common, causes of chronic cough include: interstitial lung disease (a group of lung disorders that affect the supporting matrix of the lungs); bronchiectasis (persistent dilatation of the bronchi or bronchioles); and pneumonia. All of these conditions produce inflammation or scarring of the lungs. Lung cancer is usually suspected only when someone with a history of smoking has an abnormal chest x-ray.

Bottom-line advice: Self-care measures may help relieve a chronic cough but are not a substitute for medical evaluation. Try to increase the humidity in your home and drink plenty of fluids to thin phlegm and other secretions. However, do not treat a chronic cough with over-the-counter (OTC) cough medicine for more than two weeks unless directed by your doctor. These medications can suppress your cough but may not cure it. If your cough never entirely clears up or returns after you stop taking OTC medications, see your doctor.

Conserving Energy When You Have COPD

Thu, 14 May 2009 06:00:00 CDT

If you have chronic obstructive pulmonary disease (COPD), you know that going about your daily routine can be exhausting. Even though activities such as bathing, grooming, and dressing require a great deal of energy, careful planning can help you get through these tasks more quickly and with less effort. Here's some straight-talking advice from Johns Hopkins.

First, plan to bathe, groom, and dress at times when you're feeling most energetic. Second, gather all the supplies you will need before you start.

Bathing with COPD

Instead of standing in the shower, use a bath stool or take baths.

Because excess humidity can make it tougher to breathe with COPD, use warm water rather than hot, leave the bathroom door open, turn on exhaust fans, and open a window whenever possible.

If washing your hair in the shower, tub, or sink is difficult, ask someone else to do it for you.

Using a long-handled brush or sponge can eliminate reaching to wash your back and feet.

If you rely on oxygen for your COPD, you can still use it while in the tub or shower -- just drape the tube over the shower rod or side of the tub.

Dry off by wearing a long terry cloth robe and blotting rather than using a towel to rub yourself dry -- it takes less effort.

Grooming with COPD

Choose a simple hairstyle that doesn't require extensive blow drying or styling.

Conserve energy by sitting in front of a low mirror when shaving or applying makeup, rather than standing bent over the bathroom sink.

Avoid products that are aerosolized or heavily scented, which will irritate the lungs.

Perfumes and colognes may also make it more difficult for you to breathe with COPD, so avoid using these products.

Dressing with COPD

Keep your clothes in places that don't require you to bend or reach.

If you're most energetic in the evenings, plan ahead and lay out tomorrow's clothes the night before.

Avoid tight-fitting clothing that can make breathing difficult. For example, men can wear suspenders instead of belts, and women can wear camisoles or sports bras instead of regular bras.

Don't wear socks or stockings with elastic bands, since they can restrict circulation. (Support hosiery recommended by your doctor is the exception.)

Slip-on shoes mean you don't have to bend over to tie shoelaces. A long shoehorn can also make it easier to put shoes on.

To conserve energy with COPD, stay seated as long as possible while dressing, and dress your lower half first, as it is usually more difficult. Putting your underwear inside your pants and pulling both on together may be helpful as well.

The Benefits of Oxygen Therapy

Thu, 23 Apr 2009 06:00:00 CDT

If you use supplemental oxygen, you may be wondering if your body will become dependent on it. Dr. Peter Terry, Professor of Medicine in the Division of Pulmonary and Critical Care Medicine at Johns Hopkins, addesses this common concern.

Some people with chronic obstructive pulmonary disease (COPD) benefit not only from breath exercises, improved breathing techniques, and medications, but also from home oxygen therapy. Home oxygen therapy typically enhances sleep and mood, increases mental alertness and stamina, and allows people to carry out their daily activities more efficiently.

By reducing the blood pressure in the lungs and the workload of the right side of the heart, oxygen therapy may prevent the development of corpulmonale (heart disease that is caused by high blood pressure in the lungs).

Q. If I use my supplemental oxygen, will my body become dependent on it?

Dr. Terry: If you have been prescribed supplemental oxygen, it means that your body is deteriorating because you don't have adequate oxygen in your blood. Using supplemental oxygen will not cause a worsening of your COPD or make you dependent on oxygen in the way that the body might become dependent on an addictive drug. Taking supplemental oxygen will, however, help prevent a number of complications.

Studies show that people with COPD who have low levels of oxygen have more problems with short-term memory and concentration than those who have adequate oxygen levels. Low levels of oxygen can also increase blood pressure in the lungs, raising the risk of developing pulmonary hypertension.

Supplemental oxygen will also increase your stamina, which is important not only to your quality of life, but also to your health, because you won't lose muscle tone because of inactivity. If you need supplemental oxygen but don't use it, you may become short of breath very quickly -- for example, after only 20 steps. But by using supplemental oxygen, you may be able to walk five blocks without shortness of breath. Not only does that mean you can do more, but your muscle tone won't deteriorate because you'll be more active.

What You DON'T Know About Smoking and COPD

Thu, 12 Mar 2009 06:00:00 CST

According to a recent study, if you're a smoker, moderate to high levels of exercise may help slow the decline of your lung function and reduce your risk of developing chronic obstructive pulmonary disease or COPD. Here's what the research shows.

Findings from a large trial, called the Lung Health Study, showed that people with early-stage COPD who had no symptoms and who quit smoking after taking part in an intensive smoking cessation program were less likely to die of any cause (including lung cancer and heart disease) nearly 15 years after stopping than were those who had not given up smoking.

But what if you can't – or haven't yet -- quit smoking? A study reported in the American Journal of Respiratory and Critical Care Medicine (Volume 175, page 458) suggests that moderate exercise may reduce the risk on COPD in smokers.

Researchers assessed the physical activity, smoking history, and lung function of 6,790 people for 11 years. At the beginning of the study, they excluded people with COPD. Over the course of the study, 928 people developed COPD. However, smokers with moderate to high levels of physical activity (equal to walking about one mile or more per day) were 23% less likely to develop COPD than smokers who were less physically active.

The researchers speculate that exercise suppresses the production of inflammatory markers in the lungs caused by smoking, which reduces the development of COPD. People who had never smoked fared the best, with a slower lung function decline and reduced risk of developing COPD over the course of the study compared with current and former smokers.

Bottom Line: Of course the best way to reduce your risk of COPD is to quit smoking. But if you haven't achieved that milestone yet, make sure you're keeping physically active in the meantime to help protect your lungs.

Asthma and GERD

Thu, 19 Feb 2009 06:00:00 CST

Do you have asthma? If you do, there's a good chance you could also have gastroesophageal reflux disease or GERD. Johns Hopkins discusses the link between these two common lung conditions.

Up to 70% of people with asthma have gastroesophageal reflux disease (GERD), compared with 20–30% of the general population. These statistics suggest that if you have severe, chronic asthma, which does not respond well to treatment, you are particularly susceptible to GERD.

What is GERD? GERD is more than just heartburn, although that is the most common symptom. After you eat, a part of your digestive system called the lower esophageal sphincter normally stays closed as you digest food. But sometimes the sphincter relaxes, letting stomach acid flow back (reflux) into the esophagus. In addition to heartburn, other symptoms of GERD include:

Re-tasting your food after eating

Difficulty or pain when swallowing

Bad breath or sour taste

Inflamed gums

Excess saliva

Chronic sore throat and laryngitis

If your GERD is not treated, it can lead to long-term health problems such as inflammation of the esophagus from stomach acid, which can cause bleeding or ulcers. Scars from tissue damage can narrow the esophagus and make swallowing difficult. In addition, some people develop a condition called Barrett's esophagus, in which cells in the esophageal lining become an abnormal shape and color, which over time can lead to cancer.

The GERD-Asthma Connection -- Doctors are not sure exactly what the connection is between GERD and asthma, but there are several theories. If you have GERD, you may be breathing the digestive acid from the reflux into your lungs, where the acid irritates the lung’s lining and causes spasms in the bronchi, resulting in an asthma attack. It is also possible that when acid enters your esophagus, it dissolves the lining and exposes segments of a major nerve that affects the lungs. This triggers a nerve reflex that makes your airways narrow to prevent acid from entering them, thereby causing shortness of breath.

You may have both GERD and asthma if you have:

Increased asthma symptoms after you eat or exercise

Increased asthma symptoms when you lie down

Frequent coughing or hoarseness

Asthma that doesn’t respond to the standard asthma treatments

Although the connection between GERD and asthma is not well understood, doctors have found that treating your GERD symptoms often relieves your asthma symptoms as well.

How Lung Disorders Block the Airways

Thu, 27 Nov 2008 06:00:00 CST

In this Health Alert and accompanying illustration, Johns Hopkins explains how lung disorders block the airways and cause discomfort -- shortness of breath, coughing, noisy breathing, and chest pain.

The obstructive lung diseases -- asthma and chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema -- all interfere with normal breathing by narrowing the airways that deliver air to your lungs.

The airways begin in your nose and mouth. Inhaled air passes down the pharynx (throat), through the larynx (voice box), and into the trachea (windpipe), the body's largest airway. The trachea divides into two airways, the right and left mainstem bronchi, which bring air to the lungs. There the bronchi divide many times before ending in the smallest airways called bronchioles.

The lungs supply oxygen to the blood, which carries it throughout the body. Lungs also remove carbon dioxide (a waste product that accumulates in the blood). This process, called gas exchange, occurs in the alveoli, groups of tiny air sacs clustered at the end of each bronchiole.

In asthma, the bronchial lining swells and the lungs produce too much mucus, which can obstruct the airways. Also, the smooth muscle around the bronchi can constrict. In chronic bronchitis, the bronchial lining is inflamed and there is overproduction of mucus, but the smooth muscle around the bronchioles tightens only in some cases. In emphysema, the lungs lose some of their elasticity. The airways, which are normally held open by the elastic elements in the walls of the alveoli, collapse, obstructing airflow in and out of the lungs.

Got Asthma? Prevent Relapse With Corticosteroids

Thu, 29 Jan 2009 06:00:00 CST

Most asthma attacks require medication. Milder attacks are most common and usually begin with tightness in the chest and a cough. Breathing may be accompanied by wheezing as well as by restlessness and difficulty sleeping. Sometimes these mild attacks seem to improve for a while, only to be followed by the reappearance of persistent symptoms which require treatment in a hospital.

If you should suffer an asthma attack that lands you in the hospital, treatment with a corticosteroid may help. A study published in the Cochrane Database of Systematic Review (Issue 3, Article CD000195) reports that corticosteroids can prevent relapse after an asthma attack.

Up to 16% of people who undergo emergency treatment for an asthma attack have a relapse within two weeks. But the study finds that taking corticosteroids for a few days after being discharged from the hospital reduces the chances of a relapse and lessens the need for reliever inhalers.

Researchers reviewed six studies involving 374 people who were treated in the hospital for an asthma attack. They found that people who were given corticosteroids to relieve inflammation of the airways were 65% less likely to be hospitalized again, 62% less likely to need additional care in the week after discharge, and 53% less likely to have another asthma attack within three weeks than those who didn't take corticosteroids.

Patients receiving corticosteroids were also less likely to need a short-acting beta-agonist reliever inhaler. Both oral and intramuscular corticosteroids were found to be effective.

Bottom line advice: If you or a family member with asthma must be treated for an asthma attack in the emergency room, ask whether corticosteroids can help you avoid a relapse. If you don't already have an asthma action plan, talk with your doctor about developing one.

Help for Snorers

Thu, 08 Jan 2009 06:00:00 CST

If you have sleep apnea or another condition that causes snoring, you may want to talk with your doctor about the Thornton Adjustable Positioner II. It could help.

Loud snoring is the bane of many a marriage bed and is common in people with sleep apnea. But a new oral appliance designed to move the lower jaw forward can help snorers -- and their bed partner -- sleep and breathe a bit easier, according to a new study reported in the journal Otolaryngology – Head and Neck Surgery (Volume 136, page 827).

The researchers tested a two-piece device that snaps over the upper and lower teeth in 60 people who snored, some of whom had sleep apnea. They found that people who used the device, called the Thornton Adjustable Positioner II (TAP II), for three weeks snored less and more quietly than they had snored previously.

The device reduced both "palatal snoring" (the type that occurs when the muscles of the palate relax during sleep) and snoring caused when the tongue falls backwards into the airway. Wearing the device also reduced the snorers' number of oxygen desaturation events, in which oxygen levels were decreased by 4% or more from normal levels.

Sleep apnea can lower oxygen levels as a result of the many brief breathing pauses that occur during the night. If you know that you're a loud snorer or a loved one complains about your snoring, ask your doctor whether an oral appliance may help.

Talking About Flu Shots

Thu, 06 Nov 2008 06:00:00 CST

In this excerpt from our Health After 50 newsletter, Johns Hopkins doctors answer frequently-asked questions about flu shots. Bottom Line Recommendation: Get your flu shot!

It's flu season once again. October and November are the best months for vaccination, but a shot in December or even later can still be beneficial. Amidst the reminders and recommendations to get a flu shot, many people remain unsure about side effects, the availability of a nasal vaccine, and whether or not a flu vaccine is needed every year. Here are answers to some common flu questions.

Q. Can I get sick from the shot?

A. It is impossible for the flu shot to give you influenza. The vaccine is made up of parts of dead influenza virus, incapable of causing illness. It works by stimulating your body’s immune system to build a defense against antigens found on the virus. Some people experience a mild fever, fatigue, and muscle aches soon after receiving the flu vaccine. This is not the flu. These symptoms show that your body’s immune system is hard at work, producing antibodies to fight the virus. These side effects (which can occur after receiving any vaccine) can be managed with over-the-counter drugs such as ibuprofen, acetaminophen, or aspirin.

Q. Do I need a shot every year?

A. Yes. There are many different types of influenza virus. Types A and B cause infection in humans. Each type has many different subclasses with different antigens. Because the influenza virus constantly mutates slightly, these different subclasses change and new ones develop, making it harder for the body to continue to recognize and fight them. Every year, health officials predict the strains of virus most likely to cause widespread illness. These are the strains contained in the vaccine for that particular year and the strains you will build immunity to after receiving your shot.

Q. Does the flu shot always prevent the flu?
A. No, not always. The effectiveness of the vaccine depends in part on your general health. Illness can compromise effectiveness. In addition, people over 50 generally mount less of an immune response to the vaccine. Thus, if you're over 50 and receive a flu shot, you remain susceptible. But if you catch the flu after a flu shot, the vaccine will provide you with some protection. Usually, a vaccinated person will have a less severe illness. And the shot prevents prolonged illness, hospitalizations, complications such as pneumonia, and deaths associated with the flu.
The take-home message is: Get your flu shot!

Breathing Advice From Dr. Terry

Thu, 25 Sep 2008 06:00:00 CDT

If you have COPD, you may have to learn how to breathe all over again! Breathing exercises, such as pursed-lip breathing or diaphragmatic breathing techniques can help you control your breathing and improve the function of your respiratory muscles. In this health alert, Dr. Peter B. Terry answers the question, "I have chronic obstructive pulmonary disease (COPD). I notice that I become short of breath when I bend over. Why is that?"

Dr. Terry: When you have COPD, the elastic fibers in your lungs that hold open your breathing tubes are partially destroyed, so they are not kept open as readily as if you had all the elastic fibers in your lungs intact.

This means that your breathing tubes have a tendency to collapse when you're breathing quietly while at rest. To counteract this, your ribcage tends to become enlarged and your diaphragm, or main breathing muscle, moves down to enlarge your lungs and help your airways remain open. This stretches the few remaining elastic fibers that are available to keep your airways open.

When you bend over, you raise the pressure in your abdomen, and that pressure pushes up on the diaphragm, causing the lungs to be confined to a smaller space. Because of this, the airways tend to narrow, making it feel like you're breathing through a straw.

What to do … Whenever possible, try to avoid bending over. One easy way to do this is to get rid of shoes with laces, and buy slip-on shoes instead.

If you have to bend over, take a few deep breaths before you bend. Then as you're bending over, blow as much air out of your lungs as you can. Breathing extra breaths before bending over and then blowing out as you bend down does two things. It reduces the carbon dioxide in your blood, decreasing slightly your desire to breathe, and reduces the pressure buildup that is narrowing your airways.

Thick Waist? Trouble Breathing!

Thu, 16 Oct 2008 06:00:00 CDT

Is there any relationship between waist circumference and lung function? A recent report suggests there is.

If you're experiencing shortness of breath, your doctor may ask you to use a treadmill or stationary bicycle to evaluate your shortness of breath and determine whether it's caused by a lung problem, heart disease, or simply by being out of shape.

Now a report published in the American Journal of Clinical Nutrition (Volume 85, page 35) suggests that your waist size is a good predictor of how impaired your lung function is.

Previous studies showed that obesity -- not normal weight or overweight -- is associated with asthma and chronic obstructive pulmonary disease (COPD). But findings from this study hold true regardless of weight. The researchers studied 1,674 adults, measuring their height, weight, and lung function. They found that the greater a person's waist circumference, the worse his or her lung function was.

Although doctors commonly use body mass index (BMI) -- a measure of weight in relation to height -- as a predictor of a person's lung function, this study suggests that waist circumference is a better predictor. One reason is that some normal-weight people may have a high BMI simply because they have more muscle mass than fat mass.

Why is waist circumference related to lung impairment? The most likely reason, say the researchers, is that pressure in the abdomen pushes on the diaphragm. So if you find yourself getting a bit thick around the waist, consider that losing a few inches may result in better breathing.

Diet Do's and Don'ts For Patients With COPD

Thu, 24 Jul 2008 06:00:00 CDT

Recent studies confirm that diet affects your risk of developing chronic obstructive pulmonary disease (COPD), providing yet another reason to eat healthy foods!

Your diet may influence your risk of COPD, studies show. One study of data from more than 51,000 men finds that those who consumed a diet rich in fruit, vegetables, whole grains, and fish had a 50%lower risk of developing COPD than men who ate a diet rich in refined grains, cured and red meats, desserts, and french fries.

A separate study of data from more than 72,000 women found similar results. A third study suggests that frequently eating cured meat (bacon, sausage, luncheon meats, cured ham) lowers lung function and increases the odds of developing COPD.

Researchers examined data from more than 7,000 people and found that those who ate cured meats 14 times or more per month had almost twice the risk of COPD as people who didn’t. The most likely explanation: Cured meats are high in nitrates, which generate substances that may damage the lungs. There are many health reasons for indulging in healthier cuisine-- now you can add to the list a potentially reduced risk of COPD.

[COPD data was reported in the following journals: Thorax (Volume 62, page 785), American Journal of Clinical Nutrition (Volume 86, page 488), American Journal of Respiratory and Critical Care Medicine (Volume 175).

The Asthma-Cough Connection

Thu, 03 Jul 2008 06:00:00 CDT

Many people with asthma suffer from shortness of breath, wheezing, coughing, and tightness in the chest, but don't understand why these symptoms occur. In this Health Alert, Dr. Peter B. Terry, Professor of Medicine in the Division of Pulmonary and Critical Care Medicine at Johns Hopkins explains why asthma causes coughing.

Q. Why is my asthma making me cough?

A. Asthma can cause coughing in several ways. First, the airways of a person with asthma are more sensitive to any inhaled pollutants. Breathing in a pollutant can cause coughing. Also, breathing in cold, dry air can trigger a cough in some people with asthma. This happens most commonly when a person exercises.

Usually, you breathe in through your nose, which humidifies and warms the air before it gets to your airways. But when you exercise, you tend to breathe in through your mouth. That means if you’re exercising outdoors in the winter, you’re getting a blast of cold air directly into the airways, which can trigger a cough.

Gastroesophageal reflux disease (GERD) also can cause coughing in some people with asthma. Some studies suggest that more than half of people with asthma also have GERD. Doctors aren’t exactly sure what the connection is between GERD and asthma, but there are several theories. GERD may cause people to have a small amount of acid bathe their voice box, which can trigger spasms in the airways. It is also possible that the acid damages the lining, exposing segments of an underlying nerve and causing a reflex that makes your airways narrow.

Treatment Options for COPD

Thu, 14 Aug 2008 06:00:00 CDT

Living with COPD is difficult -- it can keep you from the simplest tasks, such as dressing, washing, or doing light housework. What can you do? In this Health Alert, Peter Terry, M.D., Professor of Medicine in the Division of Pulmonary and Critical Care Medicine at Johns Hopkins discusses COPD treatment options.

Chronic obstructive pulmonary disease (COPD), which causes an irreversible decline in lung function, is a common and serious condition. And not surprisingly, COPD is associated with other conditions, such as malnutrition, fatigue, weight loss, and depression. COPD is not curable, but there are ways to feel better and slow the progression of your disease.

Treating COPD with medication -- Beta2-agonist drugs (albuterol, levalbuterol, metaproterenol, pirbuterol, salmeterol, formoterol), anticholinergics (ipratropium, tiotropium), and inhaled corticosteroids make breathing easier. “Taking both an anticholinergic and a beta2-agonist to treat COPD is common,” says Peter Terry, M.D. “Advair, which combines the beta2-agonist salmeterol with an inhaled steroid in one medication, is popular.”

Oral rather than inhaled corticosteroids are another option for COPD, but one that is usually reserved for acute episodes; long-term use increases the risk of conditions such as osteoporosis, diabetes, cataracts, and high blood pressure. “However,” Dr. Terry adds, “some patients in the end stages of severe COPD may benefit from oral steroids in the last six months or so of life.”

Oxygen therapy for COPD -- For COPD patients who can’t get enough oxygen into their blood breathing on their own, oxygen therapy is necessary. It can increase energy, aid sleep, and improve mood. Some COPD patients need oxygen therapy only during exercise. If you need oxygen while sitting or during non-strenuous activities (resting oxygen), it’s probably best to keep the oxygen on all the time. If 24-hour use is not an option, people who use oxygen 15 hours a day while they’re awake do better than people who use it only while asleep. If mobility is a concern, ambulatory “liquid” oxygen is available in relatively light-weight, portable canisters.

Surgery for COPD-- Advanced COPD symptoms may warrant surgery. Lung volume reduction surgery removes diseased tissue and gives the lungs room to expand. This procedure seems to help prolong the lives of some people with emphysema that affects the upper lobes of the lung. In rare cases, a lung transplant may be an option; however, donor organs are very scarce and the operation carries the risk of rejection.

Pulmonary Rehabilitation Improves Life for Emphysema Patients

Thu, 12 Jun 2008 06:00:00 CDT

Good news for patients with emphysema. Results from the NETT trial show that pulmonary rehabilitation can significantly improve health-related quality of life for patients with emphysema.

Emphysema is a disorder characterized by destruction of lung tissue, including its elastic fibers. By reducing the elasticity of the lungs and destroying the walls of some of the air sacs, emphysema leads to the collapse of the airways, reducing airflow. More than three million Americans have emphysema, which is most common among men age 65 and older. Emphysema claims more than 15,000 lives each year; one of them was Johnny Carson.

Pulmonary rehabilitation is quite effective for patients with advanced emphysema and plays an important role in preparing and selecting patients for lung surgery, according to results of the National Emphysema Treatment Trial, or NETT.

NETT was the first multicenter clinical trial designed to determine the role, safety, and effectiveness of bilateral lung volume reduction surgery (LVRS) in the treatment of emphysema. The trial also aimed to develop criteria for identifying patients who are likely to benefit from the procedure. The researchers studied 1,218 patients with severe emphysema who underwent pulmonary rehabilitation before and after they received either LVRS or continued medical management.

Pulmonary rehabilitation is a comprehensive preventive healthcare program designed to help people cope physically, psychologically, and socially with chronic obstructive pulmonary disease.

Bottom line: The NETT investigators found that pulmonary rehabilitation produced significant improvements in exercise capacity, breathing problems, and health-related quality of life. But, they added, it is not widely used. If you have severe emphysema, ask your doctor where you can find pulmonary rehabilitation to help you manage your condition, whether or not you undergo LVRS. [Results of the NETT trial were reported in the journal Chest, Volume 128, page 3799.]

Researchers Identify Gene Linked to Lung Cancer -- Same Gene Can Influence Smoking Behavior

Thu, 01 May 2008 06:00:00 CDT

2008 JOHNS HOPKINS PRESS RELEASE

Why do some smokers get lung cancer, while other don't? Results from a new study may begin to answer this intriguing question.

Researchers at Johns Hopkins, as part of a large, multi-institutional study, have found one gene variant that is linked to an increased risk of lung cancer. The study was published in the April 3, 2008 issue of Nature Genetics.

The research team collected DNA from 1,154 smokers who have lung cancer and 1,137 smokers without lung cancer. Each DNA sample was analyzed at more than 300,000 points, looking for variations -- known as single nucleotide polymorphisms, or SNPs for short -- between those with lung cancer and those without. They then analyzed the top 10 SNPs in an additional 5,075 DNA samples from smokers with and without lung cancer.

Two of the 10 SNPs were consistently associated with lung cancer risk and both of them are located in chromosome 15 inside a region that contains genes for the nicotinic acetylcholine receptor alpha subunits 3 and 5, which already are suspected to play a role in lung cancer progression.

The research team then wondered if these genetic associations relate to nicotine dependence, and found that the same two SNPs also are weakly associated with smoking behavior.

"The power of genome-wide analysis is to look at many markers and many samples at once, which can reveal weak genetic associations in complex diseases like lung cancer.” says Kimberly Doheny, Ph.D., assistant director of the Center for Inherited Disease Research at the McKusick-Nathans Institute of Genetic Medicine at Johns Hopkins.

The research was funded by the National Institutes of Health, M.D. Anderson Cancer Center, Flight Attendants Medical Research Institute, Cancer Research UK, NCRN, HEAL, Sanofi-Aventis, and Allan J. Lerner Fund.

Authors on the paper are Christopher Amos, Xifeng Wu, Ivan Gorlov, Jian Gu, Qiong Dong, Qing Zhang, Xiangjun Gu, Wei Vivien Chen, Sanjay Shete, Gordon Mills and Margaret Spitz of U.T. M.D. Anderson Cancer Center, Houston, Texas; Peter Broderick, Jayaram Vijayakrishnan, Kate Sullivan, Athena Matakidou, Yufei Wang, and Richard Houlston of Institute of Cancer Research, UK; Timothy Eisen of Cambridge, UK; and Ya-Yu Tsai and Doheny of Hopkins.

The Truth About Smoking Cessation

Thu, 10 Apr 2008 06:00:00 CDT

Quitting smoking is hard, but not impossible. In this excerpt from our newsletter Health After 50, Johns Hopkins reviews your options.

Despite a steady decline in the number of smokers, tobacco continues to cause twice as many deaths per year as AIDS, alcohol abuse, motor vehicle collisions, illicit drug use, and suicides combined. Understandably, knowledge of the dangers of smoking or the benefits of quitting smoking is typically not enough to motivate people to quit. Nicotine is highly addictive, and the habitual act of smoking adds a further psychological obstacle to becoming cigarette free.

The large majority of would-be quitters don’t succeed on their first attempt. Research suggests that people who get help with quitting tend to be more successful. The American Heart Association recommends:

Smoking Cessation Strategy 1 -- Nicotine replacement therapy (NRT): The nicotine patch, inhaler, gum, or lozenges are available over-the-counter (OTC).

Smoking Cessation Strategy 2 -- Zyban (bupropion): A prescription antidepressant that replaces the “high” of nicotine by increasing the brain’s supply of dopamine.

Smoking Cessation Strategy 3 -- Chantix (varenicline): A prescription drug that blocks nicotine receptors in the brain.

Smoking Cessation Strategy 4 -- Smoking cessation counseling: Individual therapy and support groups.

One study published in Chest randomly assigned 209 smokers who were hospitalized for a heart attack to receive either three months of weekly hour-long smoking cessation counseling or “standard care,” which included a self-help brochure and a brief counseling session on quitting. Participants who received the intense smoking-cessation intervention were also encouraged to use NRT and bupropion.

Two years later, 33% of those in the intense smoking-cessation group had successfully quit, compared with 9%who got standard care. Those in the intense cessation group were also 44% less likely to be hospitalized and 77% less likely to die during the study.

Although many studies show that NRT products can help you quit smoking, you shouldn’t rule out going cold turkey -- quitting smoking all at once, rather than tapering your nicotine use. Cold turkey may be a cheaper, quicker, and more effective option, particularly for lighter smokers. A survey of over 6,000 California smokers, published in the Journal of the American Medical Association, found that moderate to heavy smokers (those who smoked 15 or more cigarettes per day) benefited the most from NRT. But NRT didn’t increase the chances of quitting for those who smoked less than 15 cigarettes per day.

The bottom line: No matter how you approach quitting, you will need a genuine desire to quit and a lot of willpower. The good news is that 20 minutes after quitting your heart rate will improve. After a few weeks, blood circulation improves, cilia -- the tiny hairlike fibers in the lungs that remove mucus -- grow back, and your risk of pancreatic and esophageal cancer drops. A year later, your risk of heart disease is cut in half, and if you stay smoke free for 10 years, the same can be said for your risk of lung cancer.

Why a Shorter Course of Antibiotics for Pneumonia Makes Sense

Thu, 20 Mar 2008 06:00:00 CST

A recent study shows that a short three-day course of antibiotics effectively treats pneumonia.

Pneumonia is an infection of the air sacs and surrounding lung tissue. Pneumonia is the sixth leading cause of death overall and the primary cause of death from infectious disease in the United States, claiming the lives of about 65,000 Americans each year. Most people who die of pneumonia are over the age of 65, and often they have had underlying disorders that increased their susceptibility to infection. Others at high risk for pneumonia include people with lung cancer or a suppressed immune system (for example, people with HIV or those who take immunosuppressive medications).

If you should come down with pneumonia, don’t be surprised if your doctor gives you very few antibiotic pills. A new study reported in the British Medical Journal (Volume 332, page 1355) finds that, for moderate to severe pneumonia caught outside the hospital, three days of antibiotics is as effective as eight days.

Because there has been no evidence that a shorter course of antibiotic treatment is effective, it has been accepted practice to continue treatment for days after pneumonia symptoms have improved. To test the question, the researchers studied 119 hospitalized adults with mild to moderately severe community-acquired pneumonia who had improved substantially after three days’ treatment with intravenous antibiotics. They were assigned at random to continue taking an antibiotic (oral amoxicillin) three times a day for five days or to take a placebo on the same schedule.

Now they know: The resolution of symptoms, x-ray results, and length of hospital stay were similar in the two groups. A shorter course of treatment would reduce antibiotic use, they pointed out, which would reduce antibiotic resistance among infectious microbes. Whenever you take an antibiotic, however, be sure that you finish all of the pills prescribed.

Rethinking Cough Medications for the Common Cold

Thu, 28 Feb 2008 06:00:00 CST

What should you take to soothe a bad cough? Experts from the American College of Chest Physicians have issued guidelines … and their advice may surprise you.

Here’s some counterintuitive news: The most effective medicines for a cough aren’t marketed as cough treatments. The American College of Chest Physicians (ACCP) has issued comprehensive guidelines for treating various types of cough, the number one reason people seek medical attention. The guidelines state that many of the key ingredients in cough and cold medications don’t effectively quiet coughs that are caused by the common cold.

They stress that most over-the-counter cough expectorants or suppressants, including cough syrups and cough drops, just don’t work. Instead, certain older allergy and pain medicines are more effective for treating coughs, even though they aren’t advertised as cough busters.

After reviewing studies done from 1980 to 2004 on cough and the common cold, an ACCP expert panel found that guaifenesin -- an expectorant found in such popular cough medicines as Robitussin and Mucinex -- is not effective in controlling cough caused by the common cold. Guaifenesin is supposed to thin mucus and make it easier to cough up phlegm.

Of the four studies, which compared guaifenesin with a placebo, two showed that the cough medicine was effective, but two showed it was not. The ACCP concluded that this was not enough evidence to say that the drug is effective for treating coughs due to colds.

Two other common cough treatments, dextromethorphan and codeine, also didn’t pass muster for treating coughs caused by colds. The experts found that the dose of dextromethorphan used in over-the-counter brands is ineffective. Even large doses of codeine didn’t work. Although neither drug is effective for coughs from the common cold, both drugs may help people with chronic bronchitis get short-term relief from coughing, the panel noted. It also found that the ever-popular zinc and echinacea were ineffective for coughs due to colds.

So What Does Work? The panel members didn’t merely knock popular cough remedies off their pedestal. They did find some over-the-counter products that can help to calm coughs -- but not the ones you’d expect.

Antihistamine/decongestant medications that contain brompheniramine and sustained-release pseudoephedrine can be effective, they found. These medications contain older antihistamines that can make you drowsy. However, newer non-sedating antihistamines don’t work for reducing cough, the panel concluded. Another treatment to try is the pain reliever naproxen (Aleve), which the panel said has been shown to decrease the severity and frequency of coughing.

COPD Support From Those Who Know Best

Thu, 17 Jan 2008 06:00:00 CST

People living with COPD face many challenges and it’s easy to feel overwhelmed, powerless, or alone. A COPD support group can help.

Finding an experienced physician to treat you or a loved one for lung disease is an important step. But however well trained, few doctors are likely to know what it really feels like to try to get through the day with chronic obstructive pulmonary disease (COPD) or lung cancer. The experts who can give that kind of advice are fellow COPD patients and their families. Support groups, both in person and online, are good sources for information about anything from how to find a caring physician to tips for traveling with supplemental oxygen.

People with COPD often say that one of the worst aspects of their illness is the feeling that they have lost control over their health. Having COPD can cause depression or anxiety, and it’s easy to withdraw from other people. By staying at home, COPD patients become more sedentary, which increases psychological distress. By joining a support group, participants gain a sense of control over their disease and enter a virtuous cycle: They get out of the house, meet other people, and become motivated to take action. Then they start to feel better -- psychologically and physically.

COPD support groups exist in many communities. The American Lung Association (www.lungusa.org) sponsors Better Breathers Clubs throughout the country, which may include adults with asthma. Also, many hospitals start support groups for people with chronic lung disease.

Often these groups are run by a respiratory therapist, who can educate group members and their families about ways to live well with COPD. Groups may invite medical professionals to share their expertise on topics including nutrition, exercise, breathing techniques, new treatments, stress and depression, and medical equipment. The education patients receive in these groups may help them to avoid preventable hospitalizations and emergency room visits.

COPD Guidelines

Thu, 27 Dec 2007 06:00:00 CST

A recent study shows that COPD patients often receive substandard hospital care. Our recommendation: COPD patients should keep a list of recommended tests and treatments with them in case they are hospitalized.

Chronic obstructive pulmonary disease (COPD) – which includes chronic bronchitis and emphysema -- is the fourth leading cause of death in the United States. Now a study published in the Annals of Internal Medicine (Volume 144, page 894) reports that two thirds of patients hospitalized for acute flare-ups of COPD do not receive ideal care.

The study of 70,000 patients found that only a third of patients hospitalized for a COPD flare-up get all of the tests, treatments, and interventions recommended in the COPD treatment guidelines from the American College of Physicians and the American College of Chest Physicians.

In the vast majority of cases, a COPD patient received at least one recommended test or treatment while in the hospital: 97% received bronchodilators, 95% had a chest X-ray, 91% received supplemental oxygen; and systemic steroids and antibiotics were given in 85% of cases. But only two thirds of COPD patients got everything they were supposed to get, according to the guidelines. Women and older people with COPD were most likely to have ideal care.

Meanwhile, nearly half of the study subjects (45%) received at least one treatment that is not recommended, such as a methylxanthine bronchodilator, a sputum test, acute spirometry, chest physiotherapy, or mucolytic drugs.

Bottom-line advice: Someone who has COPD (especially a younger man) might make note of the recommended tests and treatments, just in case.

New Research on Asthma

Thu, 15 Nov 2007 06:00:00 CST

Johns Hopkins Health Alerts | Lung Disorders | Older People with Asthma

In Asthma, at Least, Age Is an Advantage

Older people with asthma tend to fare better than younger asthma patients, even though they have worse lung function, a new study concludes. The three-year study, reported in the Annals of Allergy, Asthma and Immunology (Volume 96, page 406), included people with severe or difficult-to-treat asthma. Participants were under a doctor’s care for at least one year and used a lot of medication or health care resources.

The researchers compared 566 asthma patients who were 65 years of age or older with 2,912 patients who were ages 18 to 64. The older asthma group had significantly lower lung function, but they also had significantly fewer unscheduled office visits and emergency room visits, compared with younger patients. Older asthma subjects used more inhaled corticosteroids and reported having a better quality of life than did younger patients. Even though, compared with younger patients, older people said they didn’t communicate as well with their doctors, they reported fewer problems controlling their asthma.

Asthma Risk for Lean Women on Hormone Replacement Therapy

Hormone replacement therapy may increase women’s risk of asthma and wheezing, particularly if they are lean, suggests a recent study. Reporting in the journal Thorax (Volume 61, page 34 ), the researchers assessed 2,206 women between the ages of 46 and 54. Of these, 884 were going through menopause and 540 used hormone replacement therapy (HRT). Researchers grouped the women according to their body mass index (BMI), a calculation that uses a person’ height and weight to estimate body fat.

Analysis showed that hormone replacement therapy raised the risk of asthma by 57%, the risk of wheezing by 60%, and the risk of hay fever by 48%. In lean women, use of hormone therapy more than doubled the risk of asthma and wheezing.

Among women who did not use hormones, a larger BMI was associated with more asthma symptoms. The hormones and the excess weight may increase asthma risk in similar ways, the researchers speculated. Menopause itself, they added, was not significantly associated with asthma, wheezing, or hay fever.

Johns Hopkins Health Alerts | Lung Disorders | Older People with Asthma

The Risks of Long-Term Oral Steroid Use

Thu, 06 Dec 2007 06:00:00 CST

Johns Hopkins Health Alerts | Lung Disorders | Risks of Long-Term Oral Steroid Use

The higher the steroid dose, the more likely that side effects -- cataracts, osteoporosis, diabetes, high blood pressure, muscle weakness, hair loss -- may occur.

As a growing number of people with lung disease are living longer, more people are taking long-term oral steroids for asthma, chronic obstructive pulmonary disease (COPD), and other chronic lung conditions.

Long-term use of oral steroids can cause serious side effects, ranging from osteoporosis to cataracts to high blood pressure and diabetes. If you’re taking an oral steroid, it’s critical to talk with your doctor about how to minimize these steroid side effects.

Corticosteroids can prevent or reverse inflammation in the airways, making them less sensitive to triggers. If you have severe asthma and you have tried high doses of inhaled steroids without success, your doctor may recommend oral steroids. Some people take oral steroids because they have COPD that other medications can’t relieve.

If you take daily oral steroids for months or years, particularly in moderate to high doses, you are at increased risk for developing any of a variety of side effects: cataracts, osteoporosis, diabetes, high blood pressure, muscle weakness, easily bruised skin, hair loss, facial hair growth in women, weight gain, and puffy cheeks. Other possible side effects include hyperexcitability, insomnia, and (in a small number of patients) aggressive behavior or even psychosis.

Steps you can take to avoid osteoporosis and other side effects:

Ask your doctor about getting regular bone scans to detect osteoporosis.

Get about 1,500 mg of calcium daily through nutrition or supplements. Because vitamin D helps the body absorb calcium, it may help to take 800 international units (IU) daily of vitamin D.

If you are diagnosed with osteoporosis, your doctor will recommend medication.

If you take moderate to high doses of corticosteroids, have regular eye exams to check for glaucoma.

Ask your doctor whether you can reduce your oral steroid dose by adding other medications.

Have your blood pressure checked regularly.

Also have your blood sugar checked frequently. Use of high dose steroids has been associated with the development diabetes.

Johns Hopkins Health Alerts | Lung Disorders | Risks of Long-Term Oral Steroid Use

Viagra and Sleep Apnea

Thu, 13 Sep 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Lung Disorders | Viagra and Sleep Apnea

Johns Hopkins doctors advise men with a history of sleep apnea to consider the risks and benefits before taking Viagra.

Sleep apnea is a disorder characterized by repeated episodes of breathing cessation (apnea) during sleep. These episodes last from 10 seconds to nearly a minute, ending with a brief partial arousal. Episodes of sleep apnea can occur (and disrupt sleep) hundreds of times throughout one night. An estimated 18 million Americans have obstructive sleep apnea, yet 95% of them are undiagnosed and untreated. Sleep apnea is about twice as common among men as among women.

And now there’s news that Viagra (sildenafil) may worsen severe sleep apnea.

A report in the Archives Internal Medicine (Volume 166, page 1763 ) suggests that taking Viagra at bedtime may worsen severe obstructive sleep apnea. This may be disturbing news to many men, because erectile dysfunction is particularly common among those with sleep apnea. Viagra prolongs the action of nitric oxide, which promotes upper airway congestion, thereby contributing to sleep apnea. The researchers studied 14 men with severe sleep apnea, who spent a night in a sleep lab having their breath and blood oxygen monitored after they took a single 50- mg dose of Viagra or a placebo.

Just one dose of Viagra significantly increased the amount of sleep time with a lower blood oxygen saturation level; while asleep, men who took Viagra weren’t getting as much oxygen as those who took a placebo. They also had more breathing pauses per hour.

Bottom line advice on Viagra and sleep apnea: If you take Viagra and have sleep apnea, talk with your doctor about whether the pleasures you derive from taking the drug outweigh the risks of worsening your nighttime breathing problems.

Johns Hopkins Health Alerts | Lung Disorders | Viagra and Sleep Apnea

Recognizing COPD Complications

Wed, 22 Aug 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Lung Disorders | Recognizing COPD Complications

COPD complications can be serious. Johns Hopkins specialists provide bottom line advice to help you recognize a COPD problem before it turns dangerous.

If you have COPD, how do you know when you’re not merely in discomfort, but in danger? Here are some danger signs that you shouldn’t ignore:

COPD flare-ups and infections. If you feel increasing shortness of breath, more mucus in your throat, and greater wheezing and coughing than usual, you may be experiencing a COPD flare-up -- something you need to share with your doctor. You should also call if the material you cough up changes color or if you have a fever lasting more than 24 hours. COPD flare-ups often result from a bronchial infection, which may be treatable with antibiotics, or from breathing fumes, dust, or pollution.

COPD and heart failure. Swelling of the legs, ankles, and feet is a warning that someone with COPD may have developed a type of heart failure called cor pulmonale, or right ventricular failure. Because COPD makes the heart work harder (particularly the right side, which pumps blood into the lungs), that side of the heart may enlarge. As the blood pressure in the lungs rises, the right ventricle contracts less efficiently. Cor pulmonale increases the risk that a blood clot will develop in a leg vein.

COPD and pneumothorax. A hole that develops in the lung, allowing air to escape into the space between the lung and the chest wall, pneumothorax causes the lung to collapse, leading to severe shortness of breath. People with COPD have an increased risk of pneumothorax, because changes in their lungs cause air to be emptied unevenly from the lungs. Symptoms of pneumothorax include: sudden shortness of breath; painful breathing; sharp chest pain, often on one side; chest tightness; dry, hacking cough; rapid heart rate.

COPD and too many red blood cells. Weakness, headaches, fatigue, and light-headedness may indicate the presence of an uncommon condition known as secondary polycythemia, which arises when there isn’t enough oxygen in the blood. Someone who develops polycythemia may have visual disturbances such as blind spots, distorted vision, and flashes of light. Gums and small cuts may bleed, and there may be a burning sensation in the hands and the feet.

Bottom line advice on COPD: If the problem is a flare-up of COPD, quick treatment can prevent serious breathing problems that might send you to the hospital. Call your doctor immediately if:

You have COPD and you have shortness of breath or wheezing that is rapidly worsening.

You have COPD and are coughing more deeply or more frequently, especially if you have an increase in mucus or a change in the color of the mucus you cough up.

You have COPD and cough up blood.

You have COPD and have increased swelling in your legs or abdomen.

You have COPD and have a fever over 100°F.

You have COPD and have severe chest pain.

You have COPD and develop flu-like symptoms.

You have COPD and feel that your medication is not working as well as usual.

Johns Hopkins Health Alerts | Lung Disorders | Recognizing COPD Complications

Spirometry for COPD

Thu, 04 Oct 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Lung Disorders | Spirometry for COPD

Have you ever had a spirometry lung function test? New research shows that most patients are diagnosed with COPD based only on their symptoms.

Chronic obstructive pulmonary disease (COPD) is a term that encompasses chronic bronchitis and emphysema. The symptoms of COPD develop slowly over many several years and include wheezing, a chronic cough that produces phlegm, and progressive shortness of breath. COPD is the fourth leading cause of death in the United States.

In a recent study reported in the journal Chest (Volume 129, page 1509 ) researchers found that lung function tests are underused in the diagnosis of COPD. Only one third of patients recently diagnosed with COPD undergo the recommended lung function testing, according to a study of almost 200,000 patients.

The findings, based on data collection beginning in 1999, suggest that most patients involved were diagnosed with COPD based only on symptoms, even though national guidelines recommend spirometry lung function testing to diagnose and manage COPD. (Spirometry is the measurement of the volume of air forcefully exhaled by the lungs as a function of time.).

Researchers studied data from 197,878 patients, average age 67.5, with COPD. Most of the COPD patients (98.2%) were men. Only 66,744 (33.7%) underwent spirometry. Spirometry use for newly diagnosed COPD patients decreased with age and was 3.3 times higher for those visiting pulmonologists. Only 21.4% of patients who had acute flare-ups of COPD had spirometry. Current guidelines recommend spirometry four to six weeks after an exacerbation. Among patients undergoing anesthesia for surgery, spirometry rates were much higher: 85.5% had the test in the month before surgery.

Some study participants were treated before new guidelines about spirometry were published. Still, physicians may not order the test because they either don’t know about it or don’t believe it is effective. If you have been diagnosed with COPD but have never had spirometry, ask your doctor about it.

Johns Hopkins Health Alerts | Lung Disorders | Spirometry for COPD

Beware of VOCS

Thu, 02 Aug 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Lung Disorders | Lung Function and VOCS

A chemical in many air fresheners may reduce lung function in people with lung disease.

A new study finds that a chemical compound in many air fresheners, toilet bowl cleaners, and mothballs may harm the lungs. Researchers at the National Institute of Environmental Health Sciences found that exposure to a volatile organic compound (VOC) called 1,4 dichlorobenzene (1.4 DCB) may cause reductions in lung function.

VOCS are emitted as gases from thousands of products, including cigarettes, pesticides, paints and cleaning products. They are also released through automotive exhaust.

The researchers looked at the relationship between blood concentrations of 11 common VOCs and lung function measures in 953 adults. Of the VOCs analyzed, only the compound 1,4 DCB was associated with reduced lung function, and they saw this effect even after adjusting for smoking. The study found approximately a 4% decrease in lung function between the highest and lowest levels of exposure to 1,4 DCB.

The study did not test for long-term adverse effects, but they are possible. If you have a lung disorder, it is probably a good idea to read the labels on your air fresheners and cleaners, and discard them if you see this chemical among the ingredients. This study was reported in the journal Environmental Health Perspectives (Volume 114, page 1210).

Johns Hopkins Health Alerts | Lung Disorders | Lung Function and VOCS

8 Asthma Triggers to Avoid

Tue, 01 May 2007 15:04:21 CDT

Johns Hopkins Health Alerts | Lung Disorders | 8 Asthma Triggers to Avoid

May 1 is World Asthma Day – the perfect time to review allergens that may trigger your asthma symptoms and to discuss steps you can take to breathe easier. Here Dr. Peter B. Terry, professor of medicine in the division of Pulmonary Medicine at Johns Hopkins, offers advice that can help – even if you suffer from chronic, long-term asthma.

Even people whose asthma is well controlled with medication can experience symptoms if they are exposed to allergens—substances that can cause airway inflammation in susceptible people. Pollen, dust mites, animal dander, and mold are examples of allergens; they may trigger asthma in people allergic to these substances. Irritants, however, can worsen symptoms in all asthma sufferers. They include smoke, air pollution, strong odors, and cold air. It's not possible to completely eliminate allergens and irritants, but you can take the following steps to minimize your exposure to them.

Allergies, allergens, and asthma. If you have asthma and are allergic to pollen, dust mites, animal dander, or mold, exposure to these substances can cause asthma symptoms.

Pollen and asthma. Pollen, the microscopic male cells of flowering plants, travels through the air to fertilize other plants. People with pollen allergy—often referred to as hay fever—can experience sneezing, congestion, runny nose, and itchy nose, mouth, throat, eyes, and ears. The pollen season generally lasts from February or March through October. To reduce your exposure to pollen, keep your house and car windows closed and use air conditioning as needed. Don't hang sheets or clothing outside to dry, as pollen may collect on them and be brought inside the house. Avoid mowing lawns and being around freshly cut grass. In addition, limit your outside activities during the early morning (5 a.m. to 10 a.m.), when pollen levels are highest.

Dust mites and asthma. These microscopic creatures that live in house dust can cause a stuffy or runny nose, sneezing, itchy or watery eyes, coughing, or wheezing in people allergic to them. Dust mites thrive on warm, moist air, so keep the humidity in your home below 50%, using a dehumidifier or air conditioner if necessary. (You can use an instrument called a hygrometer, available at hardware stores, to measure the humidity level.)
Also, dust often with a damp cloth, have carpets and upholstered furniture vacuumed weekly (if you have asthma and need to vacuum, wear a mask that can filter out small particles—most drugstore masks do not help), and wash sheets and blankets once a week in hot water.

Allergists have long recommended encasing mattresses and pillows in plastic or allergen-impermeable covers. Although this practice has recently been called into question, people with asthma should continue to use such covers unless further studies confirm that they are not helpful.

Animal dander and asthma. Many people are allergic to a protein in the saliva, dander, or urine of animals with fur or feathers. Animal allergies can cause sneezing, wheezing, itchy or runny nose, or itchy or swollen eyes and throat.
The most effective way to reduce pet allergies is not to have a pet with fur or feathers. If you have a pet that you cannot keep outside or give away, minimize your contact with the animal. Do not allow the pet into your bedroom or other areas where you spend a lot of time. Keep all mattresses and cushions in plastic covers, and use hardwood, tile, or linoleum floors whenever possible (vacuuming doesn't remove pet dander from the lower levels of carpeting).

Ask your veterinarian if it is safe for your pet to be bathed weekly; this practice will reduce the amount of allergens released into the air by your pet but may also dry the animal's skin.

Mold and asthma. Mold spores can grow on wet surfaces in your home, and they thrive in moisture-rich environments. Symptoms of mold allergies are similar to those of hay fever and include sneezing, runny nose, red eyes, and skin rash. Mold also can cause wheezing in people with asthma. (Mold also can irritate the eyes, skin, nose, throat, and lungs of people without mold allergies.)
To lessen the chance that mold spores will grow, reduce the amount of moisture in your home. Use bathroom and kitchen fans when showering and cooking, respectively, fix any leaking pipes or faucets, keep humidity between 30% and 50%, and make sure the drainage system outside the house is working properly. Also, frequently clean areas where mold is likely to grow, such as bathrooms, kitchens, basements, shower curtains, and pans under refrigerators.

Irritants Can Cause Asthma Symptoms
Some substances in the air have the potential to cause breathing difficulties in everyone, but especially in people with asthma.

Smoke and asthma. Any form of tobacco smoke can exacerbate asthma. Ask others not to smoke around you, and don't allow anyone to smoke in your home, even with the windows open. If you are a smoker, talk to your doctor about ways to quit. In addition, avoid using wood-burning stoves, kerosene heaters, and fireplaces.

Air pollution and asthma. In the upper atmosphere, ozone (a type of oxygen) filters out some of the sun's ultraviolet rays. However, ozone can harm the lungs when it is in the air we breathe. Ground-level ozone is mostly a problem in large urban and suburban centers, where pollution levels from cars and industrial plants are high. Sunlight and heat play a role in ozone formation, so levels tend to be highest in the hotter months.
People with asthma or other chronic lung diseases may find that their symptoms worsen on days when ozone levels are high. If you have a lung disease and ozone levels are predicted to exceed 100 for the day, or an ozone alert is declared, you should avoid spending long periods of time outdoors and severely limit any outdoor physical exertion. If your local news does not provide ozone information, go to www.epa.gov/airnow for detailed information on ozone and other pollutants in your area. You can also visit www.weather.com and, under "Health," click on "Air Quality." Select your state to find the ozone levels for cities in your area.

Strong odors and asthma. Anything with a powerful scent can exacerbate your asthma. Limit your exposure to perfume, talcum powder, hair spray, and oil-based paints.

Cold air and asthma. Exposure of the lungs to very cold air can trigger the release of histamine, which can cause wheezing in people with asthma. Always inhale through your nose and cover your nose and mouth with a scarf on cold or windy days to warm the air before it enters your lungs.

Johns Hopkins Health Alerts | Lung Disorders | 8 Asthma Triggers to Avoid

Can Lung Cancer Screening Save Lives?

Sun, 01 Jul 2007 13:14:39 CDT

Johns Hopkins Health Alerts | Lung Disorders | Lung Cancer and CT Scans

Johns Hopkins experts weigh the risks and benefits of CT scans to detect lung cancer.

Lung cancer screening made headlines recently when The Early Lung Cancer Action Project (ELCAP) published new findings about spiral computed tomography (CT). This extremely sensitive imaging test detects lung cancer tumors under 1 cm in diameter. Traditional chest x-rays only detect lung cancer tumors 1-2 cm in size (stage I lung cancer tumors are defined as 3 cm or smaller). If lung cancer tumors are caught in the earliest stage, surgery can dramatically increase the odds of survival.

ELCAP examined spiral CT scans of 32,000 people at risk for lung cancer owing to a past or current smoking habit or exposure to secondhand smoke. Among participants, 484 people were diagnosed with lung cancer; 412 had stage I tumors. Researchers estimate that, after surgery, the stage I group had an 88% chance of living for 10 years.

Although these results sound like life-saving news, ELCAP was not a controlled study, meaning that spiral CT was not compared with other methods. Thus, researchers can’t say for certain that CT scans are better at diagnosing lung cancer and saving lives than chest x-rays or no screening at all -- an important consideration, since the scan is more expensive and exposes you to more radiation than traditional x-rays.

Most important, though, is the fact that spiral CT scans are so sensitive that they can detect abnormalities that may not be cancerous, such as scars or inflammation; the National Cancer Institute estimates that 25% to a whopping 60% of smokers have such lung abnormalities. In addition to causing needless worry, a false-positive result may lead to an unnecessary biopsy, which can be painful and put you at risk for infection or a collapsed lung.

The National Lung Screening Trial (NLST) will offer insight into these issues, including whether screening saves lives. Sponsored by the National Cancer Institute, NLST is comparing CT scans with chest x-rays among 50,000 current or former smokers. Final data won’t be available until 2009. In the meantime, spiral CT is an option for former smokers, but ask your doctor about your risk; it may be quite low depending on how long ago you quit. Therefore, the test’s drawbacks may outweigh any potential benefit.

This article comes from a recent issue of the Johns Hopkins Medical Letter: Health After 50. For more information about this acclaimed monthly newsletter, click here.

Johns Hopkins Health Alerts | Lung Disorders | Lung Cancer and CT Scans

Traveling Smart with Oxygen

Thu, 31 May 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Lung Disorders | Traveling Smart with Oxygen

Traveling by air? You’ll need to do some advance planning with your doctor and oxygen supplier.

Air travel offers special challenges for people who use supplemental oxygen. Here’s some helpful advice from the experts at Johns Hopkins … Call your doctor as soon as you know you’re going away. If you have COPD and don’t normally use supplemental oxygen, you may now need it if you’re traveling by air, as low oxygen levels in the airplane cabin may adversely affect your breathing. Your doctor will give you a pre-flight assessment, including measurement of your blood oxygen level and general lung function tests. Based on the assessment, your doctor may recommend the use of in-flight oxygen.

If you already are on supplemental oxygen, your doctor may recommend increasing the oxygen flow rate during the flight. If you do need in-flight oxygen, you will need a letter on your doctor’s letterhead with his or her name and contact information, information about your lung disorder, approval for air travel and verification of need for in-flight oxygen, and information about the oxygen flow rate in liters per minute and duration of use. Bring a copy for each flight you’ll be on. Also, ask your doctor for prescriptions for your medications, which you should carry onboard in case your luggage is lost or delayed. Your doctor may give you a supply of certain medications for emergencies, such as antibiotics to use if you develop a bacterial lung infection. These, too, should be in your carry-on bag, not in checked luggage.

Starting in August 2005 the Federal Aviation Administration (FAA) allows passengers who require medical oxygen to take certain portable oxygen concentrators on board. The allowable concentrators are made by AirSep Corporation and Inogen Inc. The FAA permits the devices to be used throughout the flight, including takeoff and landing. Passengers using concentrators during a flight are required to inform the pilot that they are doing so and provide a written statement signed by a licensed physician that verifies the passenger’s ability to use the device.

It’s important to note that the FAA regulation does not require individual airlines to let passengers use oxygen concentrators (it allows each airline to make its own policy). You should therefore make arrangements directly with the airline. Some airlines require at least 72 hours advance notice, particularly for international flights.

It’s a good idea to reconfirm your oxygen arrangements before your trip, to arrive at the airport early, and to ask these questions in advance of your trip:

What does the airline charge for supplying in-flight oxygen.

Does your medical insurance cover the costs of in-flight oxygen.

Can you bring your own empty oxygen equipment. Some airlines will allow you to bring empty personal oxygen equipment onboard or check it with your baggage.

Can you bring your own cannula or mask; if not, find out whether the airline will provide one or both of these.

Ask about seat requirements. Some airlines may require you to buy an additional seat if you will need more than a certain number of oxygen cylinders.

Make arrangements for oxygen at layover stops. Airlines do not make arrangements for oxygen on the ground, so you’ll need to ask your doctor and oxygen supplier to help you make arrangements. If at all possible, try to arrange for direct flights to avoid this problem. Call an oxygen supplier in your destination city ahead of time. Your oxygen supplier can help make sure you have a supply of oxygen waiting for you when you arrive.

For more Alerts and Special Reports, please visit the Lung Disorders Topic page.

Johns Hopkins Health Alerts | Lung Disorders | Traveling Smart with Oxygen

Interstitial Lung Disease

Thu, 21 Jun 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Lung Disorders | Interstitial Lung Disease

Symptoms of interstitial lung disease vary widely and may persist for months, even years.

Interstitial lung disease (ILD) refers to a group of more than 200 chronic disorders in which lung tissue is damaged, the walls of the air sacs become inflamed, and scarring (fibrosis) begins in the interstitium -- the tissue between the air sacs. Though many of the disorders are uncommon, taken together interstitial lung disease is a frequent cause of respiratory problems, accounting for 15% of all lung disorders evaluated by pulmonologists.

The lung scarring associated with interstitial lung disease leads to stiffness that makes breathing difficult and interferes with the transfer of oxygen in the lungs. The pace of lung deterioration varies greatly from person to person. Interstitial lung disease includes disorders such as pulmonary sarcoidosis, bronchiolitis obliterans organizing pneumonia, asbestosis, and silicosis.

Pulmonary sarcoidosis is an inflammatory disease in which granulomas -- small clusters of cells -- develop in the lungs and adjacent lymph nodes (small, round-shaped groups of immune defense cells that help prevent the spread of infection and protect the bloodstream from viral and bacterial invasion). Pulmonary sarcoidosis can increase lung stiffness, which reduces lung volumes. Bronchiolitis obliterans organizing pneumonia refers to inflammation with blockage of the bronchioles (the small airways in the lungs that branch from the large ones). Asbestosis and silicosis refer to damage caused by exposure to dust from asbestos and silica, respectively. Idiopathic pulmonary fibrosis is a condition of unknown (idiopathic) cause in which progressive scarring of the lungs markedly compromises day-to-day function.

Causes of interstitial lung disease -- A variety of factors can injure the air sacs and result in interstitial lung disease. Possible causes of interstitial lung disease include:

Certain prescription drugs (including chemotherapy drugs and cardiovascular medications)

Exposure to environmental toxins

Infectious agents (such as viruses, bacteria, or fungi)

Substances that trigger allergic or hypersensitivity reactions (such as certain proteins found in bird droppings) in susceptible persons

Connective tissue diseases, such as scleroderma, rheumatoid arthritis, and lupus, all of which can cause inflammation and scarring of organs, including the lungs

The spread of cancer to the lungs from other parts of the body. In many cases, the cause of lung injury is unknown.

For more Alerts and Special Reports, please visit the Lung Disorders Topic page.

Johns Hopkins Health Alerts | Lung Disorders | Interstitial Lung Disease

Your Lung Disorders Medical Team

Thu, 19 Apr 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Lung Disorders | Your Lung Disorders Medical Team

Johns Hopkins professor Dr. Peter B. Terry talks about the team of doctors who will treat you if you have a serious lung disorder, such as lung cancer.

If you have a serious lung disorder, you may see several specialists during the course of your treatment. "My patients often ask why they are seeing so many doctors,” says Peter B. Terry, M.D., author of the Johns Hopkins Lung Disorders White Paper. "A person with lung cancer, for example, may start with their internist, be referred to a pulmonologist, then to an oncologist, thoracic surgeon, radiologist, and pathologist. These specialists all have important and distinct roles in the individual’s care.”

The following is a quick guide to specialists whom you may encounter if you have a lung disorder.

Internist -- Internists often serve as primary care doctors, performing regular checkups and treating routine illnesses. If you have a lung disorder, your internist may refer you to a specialist such as a pulmonologist or allergist/immunologist for specialized care.

Pulmonologist -- These are specialists who are trained in diseases and conditions of the lungs and airways, such as pneumonia, asthma, emphysema, tuberculosis, or complicated chest infections.

Allergist|Immunologist -- These types of doctors specialize in the prevention, diagnosis, and treatment of disorders of the human immune system, including asthma; rhinitis (inflammation in the lining of the nose); eczema (skin inflammation); and adverse reactions to drugs, foods, and insect stings.

Medical Oncologist -- Oncologists specialize in the diagnosis and treatment of lung and all types of cancers and tumors. They can order and administer chemotherapy for treating malignant cancers and consult with surgeons and radiologists on other cancer treatments.

Thoracic Surgeon -- These doctors provide surgical care of the lungs, coronary arteries, esophagus, and chest wall. They can treat abnormalities of the trachea, the great vessels, and the heart valves, as well as diseases of the diaphragm.

Radiologist -- These specialists use techniques such as x-rays, ultrasound, magnetic resonance imaging (MRI), computerized tomography (CT) scan, nuclear medicine, and image-guided interventional procedures to visualize the body and its organs, aiding in the diagnosis and treatment of diseases.

Pathologist -- Pathology is a medical specialty focused on making a definitive diagnosis of various diseases, including cancer. Pathologists identify diseases by studying cells and tissues under a microscope and writing a report detailing the diagnosis, which helps the treating physician decide on a course of action.

For more Alerts and Special Reports, please visit the Lung Disorders Topic page.

Johns Hopkins Health Alerts | Lung Disorders | Your Lung Disorders Medical Team

The "Quiet" Symptoms of Lung Cancer

Thu, 08 Mar 2007 11:29:29 CST

Johns Hopkins Health Alerts | Lung Disorders | Symptoms of Lung Cancer

Lung cancer may not be such a silent disease after all, so it’s important to listen to your body and tell your doctor if you experience new symptoms

Although lung cancer is often thought to be a "silent disease," with no symptoms appearing until it’s too late for treatment, a new study finds that some lung cancer patients had symptoms for many months before they were diagnosed. This study of 22 men and women recently diagnosed with lung cancer found that patients recalled having new symptoms for many months, typically during the year before their lung cancer diagnosis, no matter what the stage of their disease when diagnosed.

Chest symptoms -- cough, breathing changes, and chest pain -- were common lung cancer symptoms, as were feelings of fatigue or lethargy, weight loss, and eating changes. Most symptoms were not interpreted as serious by patients at the time, and were therefore not acted on. The patients’ beliefs about health changes that could indicate lung cancer played a part in the delay in diagnosis.

Better insight into patients' perspectives on their experience before being diagnosed with lung cancer may help doctors to recognize patients with lung cancer earlier and more easily so that they can refer them for diagnosis and treatment as soon as possible. This lung cancer study was reported in the journal Thorax (Volume 60, page 314).

Peter B. Terry, M.D., professor of medicine at Johns Hopkins' Division of Pulmonary and Critical Care Medicine, cautions people to take their symptoms seriously.

So what should you look for? Symptoms specific to the growth and spread of lung cancer may include coughing up red or rust-colored phlegm, wheezing, and shortness of breath.

Sometimes an infection in the lung behind the tumor that is obstructing the airway produces a fever. Invasion of cancerous cells into the pleura or other nearby structures can produce pain in the chest, shoulders, or arms. If the lung cancer spreads to surrounding tissues, it can lead to enlarged lymph nodes in the chest or neck and impingement of various nerves, resulting in hoarseness. Due to narrowing of the esophagus, a person may have difficulty swallowing. There may be swelling of the neck and face from blockage of blood flow from these areas to the heart. In about 30% of patients, lung cancer also causes clubbing of the fingers (a thickening of the fingertips and increased curvature of the fingernails).

Johns Hopkins Health Alerts | Lung Disorders | Symptoms of Lung Cancer

Before You Take Antibiotics for Bronchitis, Consider This

Tue, 05 Dec 2006 06:00:00 CST

Johns Hopkins Health Alerts | Lung Disorders | Bronchitis and Antibiotics

Johns Hopkins professor Peter B. Terry, M.D. explains how overuse can lead to antibiotic resistance.

Many people who develop bronchitis go to their physician assuming they’ll receive antibiotics to clear up the bronchitis. But a recent study found that people with bronchitis or other uncomplicated lower respiratory tract infections who take antibiotics for their condition have little difference in relief of symptoms compared with patients who don’t take antibiotics.

The study, published in the Journal of the American Medical Association, included 807 patients with bronchitis or a similar uncomplicated lower respiratory tract infection. It did not include patients with chronic lung disease or suspected pneumonia. Participants were randomly assigned to receive either immediate antibiotics, no antibiotics, or delayed antibiotics if bronchitis symptoms had not gone away after 10 days.

Compared with immediate antibiotics, giving patients either no antibiotics or delayed antibiotics was associated with little difference in the duration or severity of bronchitis symptoms. On average, patients were ill with bronchitis for three weeks in total; taking antibiotics reduced moderately bad bronchitis symptoms an average of only one day. “It is difficult to justify widespread antibiotic prescribing for uncomplicated lower respiratory tract infection on this basis given the dangers of antibiotic resistance,” the researchers concluded.

The researchers also found that the approaches of not offering antibiotics or using delayed antibiotics were both acceptable to most bronchitis patients. “I hope that this study makes physicians think more carefully about prescribing antibiotics to patients with bronchitis and other uncomplicated lower respiratory infections,” says Peter B. Terry, M.D., author of the John Hopkins Lung Disorders White Paper and Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine.

Dr. Terry notes that a number of studies over the last several decades have clearly shown that about half of cases of acute bronchitis are caused by a virus. “Since antibiotics don’t work against viruses, then in these patients, taking an antibiotic won’t alter the natural course of their bronchitis.” But, Dr. Terry adds, some patients with bronchitis have bacteria growing in their airways and then become infected with a virus that encourages the bacteria to multiply, leading to pneumonia. “These bronchitis patients will respond to antibiotics,” Dr. Terry says. “The problem becomes how to know when a patient’s bronchitis is viral or not. That’s where a doctor’s judgment comes in.”

Absence of a fever and clear or light yellow phlegm usually suggests the bronchitis is viral, while fever, and dark yellow or green sputum that is thick and sticky is more suggestive of bacterial bronchitis infection. A doctor also needs to take into account the age and general health of the patient, according to Dr. Terry. “There are certain considerations a physician has to think about very carefully. If you’re young and healthy and get acute bronchitis, you are likely to have a strong enough immune system to fight it off. But if you have severe chronic obstructive pulmonary disease [an infection that further narrows already damaged airways and compromises lung function], physicians tend to be more conservative with these patients.”

Johns Hopkins Health Alerts | Lung Disorders | Bronchitis and Antibiotics

The Instant Benefits of Quitting Smoking

Thu, 25 Jan 2007 06:00:00 CST

Johns Hopkins Health Alerts | Lung Disorders | Instant Benefits of Quitting Smoking

Virtually the minute you quit smoking, your health begins to improve.

The negative effects of smoking are clear: One in every three people who starts smoking will die prematurely of a smoking-related illness, according to the American Lung Association. And one in every five deaths stems directly from tobacco exposure. But the good news is that it’s never too late to quit smoking. The benefits of smoking cessation begin within a few minutes of your last cigarette and continue for life, even for people with lung disease.

The Risks of Smoking

Although the link between smoking and lung cancer is well known, smoking is even more likely to cause a range of other illnesses. According to a survey published in Morbidity and Mortality Weekly Report, some 8.6 million Americans were living with a major smoking-related illness in 2000. The most common smoking-related illness was chronic bronchitis (35% of cases), emphysema (24%), heart attacks (19%), non-lung cancer (12%), strokes (8%), and lung cancer (1%).

The true number of people affected by smoking is probably much higher than the researchers stated because this study depended on people to report whether a doctor had ever told them they had a certain condition. People tend to underreport their own illnesses. In addition, the researchers did not look at non-debilitating conditions, such as impotence and sinusitis, that are often caused by cigarette smoking.

The Benefits of Quitting Smoking

Regardless of how long you’ve been smoking, your health begins to improve shortly after your last cigarette. And the longer you are cigarette free, the greater the benefits become. Look at the timeline below:

Time Since Last Cigarette -- 20 minutes: Elevated blood pressure levels begin to drop, and the temperature in your extremities begins to return to normal.

Time Since Last Cigarette -- 8 hours: You achieve normal blood levels of carbon monoxide.

Time Since Last Cigarette – 1 day: Your risk of a heart attack begins to decline.

Time Since Last Cigarette – 2 weeks–3 months: Circulation improves, and lung function increases, decreasing the risk of lung infections.

Time Since Last Cigarette -- 1–9 months: Shortness of breath, sinus congestion, coughing, and fatigue improve. A few months of smoking cessation improves lung function about 5% in patients with chronic obstructive pulmonary disease (COPD), and the risk of death from COPD declines.

Time Since Last Cigarette – 1 year: Your risk of having a heart attack is cut in half.

Time Since Last Cigarette – 5 years: The risk of cancer in the oral cavity and esophagus is already half that of continuing smokers, and the risk continues to decline with continued cessation.

Time Since Last Cigarette -- 5–15 years: The risk of a stroke becomes similar to that of a lifelong nonsmoker.

Time Since Last Cigarette -- 10 years: Your risk of developing lung cancer is 30–50% lower than it would be had you continued to smoke, and the risk continues to decline with continued abstinence. Also, you’ve significantly decreased your risk of developing cancer of the bladder, cervix, esophagus, kidney, mouth, pancreas, and throat.

Time Since Last Cigarette -- 10–15 years: Your odds of dying of any cause are the same as those of someone who never smoked.

Time Since Last Cigarette -- 15 years: Your risk of having a heart attack is the same as a lifelong nonsmoker.

Johns Hopkins Health Alerts | Lung Disorders | Instant Benefits of Quitting Smoking

Got Asthma? Beware of Drug Interactions

Thu, 15 Feb 2007 06:00:00 CST

Johns Hopkins Health Alerts | Lung Disorders | Asthma and Drug Interactions

Play it safe -- talk to your doctor about ALL the medications you’re taking.

Many adults with asthma may take a number of prescription and over the-counter medications to treat a variety of conditions. Some of these medications may trigger or worsen asthma symptoms. If you take any of the medications discussed below, it’s important to talk to your doctor about their possible negative effects on your asthma.

And remember: It’s not just prescription drugs that reduce the effectiveness of your asthma medications. You have to watch out for over-the-counter drugs, too.

Asthma and nonsteroidal anti-inflammatory drugs (NSAIDs). These over-the counter pain relievers include aspirin, ibuprofen (Motrin, Advil), and naproxen (Naprosyn, Aleve). NSAIDS can trigger severe and even fatal asthma attacks. A safer over-the-counter alternative is acetaminophen (Tylenol). Alternative prescription painkillers include propoxyphone (Darvon), and codeine.

Asthma and beta-blockers. These prescription medications are given in pill form to treat conditions such as high blood pressure, heart disease, or migraines. Beta-blockers also come in the form of eye drops for treating glaucoma. Both forms of beta-blockers can worsen asthma symptoms by interfering with the effectiveness of beta-agonist asthma drugs.

Asthma and ACE Inhibitors. These drugs are typically used to treat high blood pressure and heart disease. Lisinopril (Zestril) and enalapril (Vasotec) are examples. Although they usually don’t make asthma worse, some people who use these drugs develop a very troublesome cough, which can trigger increased wheezing. In addition, any cough can lead to reflux (acid coming up from the stomach into the esophagus), which, in turn, can cause more cough and worsen asthma.

Asthma and diuretics. Diuretics, used to treat high blood pressure and congestive heart failure, help the body to excrete urine. Some diuretics can cause a loss in potassium and are therefore referred to as non-potassium-sparing diuretics. These diuretics may interact with asthma medications such as steroids and beta 2 agonists, which also lead to potassium loss. The result is an additive, dangerous amount of potassium depletion. If left untreated, this depletion increases the risk for disturbances in heart rhythm that can occasionally lead to cardiac arrest.

Asthma and sleeping pills and tranquilizers. Sleeping pills, tranquilizers, and other sedative drugs make you breathe more slowly and less deeply, which can be dangerous if you have lung problems such as asthma.

Drug interactions are a two-way street. In addition to some drugs worsening your asthma, some asthma drugs can aggravate other health conditions. So it’s important that your doctor is aware of ALL the medications you are taking.

Johns Hopkins Health Alerts | Lung Disorders | Asthma and Drug Interactions

All That Wheezes Is Not Asthma

Thu, 04 Jan 2007 06:00:00 CST

Johns Hopkins Health Alerts | Lung Disorders | Symptoms of Chronic Lung Disease

Short of breath? Coughing? Johns Hopkins Doctors Explain Why You Should Take Your Symptoms Seriously.

Many lung disorders produce similar symptoms, but the severity and duration of these symptoms can vary considerably from disease to disease. The lung disorders can be acute (short and relatively severe) or chronic (persisting over a long time).

Chronic lung conditions may wax and wane in severity and can worsen quickly and markedly if another problem, such as a lung infection, occurs. Some people, however, have only mild symptoms or none at all. In these individuals, the lung disorder may be detected on a chest x-ray or by a test to check lung function.

Shortness of breath. Shortness of breath can dramatically compromise quality of life. The underlying cause of shortness of breath is usually a mechanical problem in the lungs or diaphragm (the large, dome-shaped muscle located at the base of the lungs). Examples of mechanical problems are airway obstruction (as occurs in asthma, COPD, and some lung cancers); increased stiffness of the lungs (as in interstitial lung disease, pneumonia, and heart failure); severe spine and rib cage abnormalities; and obesity. If left untreated, shortness of breath can lead to fatigue and weakness that may profoundly limit activities. In turn, weakness related to being out of shape or musculoskeletal disease, such as severe curvature of the spine, may aggravate shortness of breath.

Coughing. Coughing up phlegm, infectious germs, and foreign substances is one of the ways in which the lungs protect themselves. Severe coughing, however, may signal lung disease. Obstructive diseases of the lungs (asthma and COPD) and lung cancer often cause a person to cough up phlegm, which, if yellow or green, may signal an infection. Coughing up blood is a critical sign, especially in a current or former cigarette smoker. It may suggest a potentially life-threatening disease, such as lung cancer or pulmonary embolism, although it can also be a sign of a less serious lung problem such as bronchitis.

Noisy breathing. Noisy breathing is an especially common sign of lung disease. Abnormal sounds range from a high-pitched crowing during inhalation to continuous musical sounds during exhalation (wheezing, which occurs with asthma and some other disorders). The maxim “all that wheezes is not asthma” underscores the fact that many health conditions, including diseases of the larynx, heart failure, pulmonary embolism, and COPD, can cause wheezing. Repetitive loud snoring during sleep, interrupted by periods of silence in which there’s no air flow, is a major sign of sleep apnea.

Chest pain. Chest pain or other discomfort has numerous causes, and determining whether the cause is a heart, esophageal, or lung disease is often challenging. Pain on one side of the chest that worsens with deep breathing, coughing, or laughing suggests pleurisy, an inflammation of the pleura (the membrane around the surface of the lungs and the inner chest wall). Pleurisy may be caused by an infection, such as pneumonia; pulmonary embolism; cancer; or a systemic (affecting the entire body) inflammatory disease such as systemic lupus erythematosus. Alternatively, pain that worsens on inhalation may be due to a chest wall injury such as a broken rib.

Johns Hopkins Health Alerts | Lung Disorders | Symptoms of Chronic Lung Disease

Flu Shot Alert

Tue, 05 Sep 2006 14:05:12 CDT

Johns Hopkins Health Alerts | Lung Disorders | Flu Shot Alert

Can I get the flu from a flu shot? Read the answers to this and other questions about the flu.

It’s flu season once again. October and November are the best months for vaccination, but a shot in December or even later can still be beneficial. Amidst the reminders and recommendations to get a flu shot, many people remain unsure about side effects, the availability of a nasal vaccine, and whether or not a flu vaccine is needed every year. Here are answers to some common flu questions.

Q. Can I get sick from the shot?

A. It is impossible for the flu shot to give you influenza. The vaccine is made up of parts of dead influenza virus, incapable of causing illness. It works by stimulating your body’s immune system to build a defense against antigens found on the virus. Some people experience a mild fever, fatigue, and muscle aches soon after receiving the flu vaccine. This is not the flu. These symptoms show that your body’s immune system is hard at work, producing antibodies to fight the virus. These side effects (which can occur after receiving any vaccine) can be managed with over-the-counter drugs such as ibuprofen, acetaminophen, or aspirin.

Q. Do I need a shot every year?

A. Yes. There are many different types of influenza virus. Types A and B cause infection in humans. Each type has many different subclasses with different antigens. Because the influenza virus constantly mutates slightly, these different subclasses change and new ones develop, making it harder for the body to continue to recognize and fight them. Every year, health officials predict the strains of virus most likely to cause widespread illness. These are the strains contained in the vaccine for that particular year and the strains you will build immunity to after receiving your shot.

Q. Does the flu shot always prevent the flu?

A. No, not always. The effectiveness of the vaccine depends in part on your general health. Illness can compromise effectiveness. In addition, people over 50 generally mount less of an immune response to the vaccine. Thus, if you’re over 50 and receive a flu shot, you remain susceptible. But if you catch the flu after a flu shot, the vaccine will provide you with some protection. Usually, a vaccinated person will have a less severe illness. And the shot prevents prolonged illness, hospitalizations, complications such as pneumonia, and deaths associated with the flu. The take-home message is: Get your flu shot!

Q. Can I use a nasal vaccine instead of a shot?

A. Not if you’re 50 or older. The nasal vaccine is only approved for healthy people aged 5 to 49. The formulation, called FluMist, differs from the flu shot in that it contains alive, attenuated virus. This means that instead of being a killed vaccine that is absolutely incapable of causing the disease, FluMist contains a live form of the selected strain that has been weakened from its natural state. As you age and your immune system slows down, you may not be able to fight against the live virus.

Q. Will my insurance company pay for my flu shot?

A. Most insurance companies cover the cost of the vaccine. If you have Medicare Part B, there is no charge. Also, most communities have walk-in flu clinics where you can get a flu shot for around $10 to $30, regardless of insurance status.

Additional reminder: Protect Yourself From Pneumonia

Pneumonia shots get less publicity than flu shots, but everybody 65 and older, as well as people at risk for complications because of diabetes, heart disease, or other illnesses, should be vaccinated once every 5-10 years. According to a new study in the Journal of the American Medical Association, hospitalization rates for pneumonia among older Americans have greatly increased in the past 15 years. If you don’t know whether or when you’ve been immunized, be sure to ask your physician and get the shot if you need it..

Johns Hopkins Health Alerts | Lung Disorders | Flu Shot Alert

Asthma and Gastroesophageal Reflux Disease (GERD) -- What's The Connection?

Thu, 05 Oct 2006 06:00:00 CDT

Johns Hopkins Health Alerts | Lung Disorders | The Connection Between Asthma and GERD

Although the connection between GERD and asthma is not well understood, doctors have found that treating your GERD symptoms often relieves your asthma symptoms as well.

Up to 70% of people with asthma have gastroesophageal reflux disease (GERD), compared with 20–30% of the general population. These statistics suggest that if you have severe, chronic asthma, which does not respond well to treatment, you are particularly susceptible to GERD.

What is GERD?

GERD is more than just heartburn, although that is the most common symptom. After you eat, a part of your digestive system called the lower esophageal sphincter normally stays closed as you digest food. But sometimes the sphincter relaxes, letting stomach acid flow back (reflux) into the esophagus. In addition to heartburn, other symptoms of GERD include:

Re-tasting your food after eating

Difficulty or pain when swallowing

Bad breath or sour taste

Inflamed gums

Excess saliva

Chronic sore throat and laryngitis.

The GERD-Asthma Connection

Doctors are not sure exactly what the connection is between GERD and asthma, but there are several theories. If you have GERD, you may be breathing the digestive acid from the reflux into your lungs, where the acid irritates the lung's lining and causes spasms in the bronchi, resulting in an asthma attack. It is also possible that when acid enters your esophagus, it dissolves the lining and exposes segments of a major nerve that affects the lungs. This triggers a nerve reflex that makes your airways narrow to prevent acid from entering them, thereby causing shortness of breath.

You may have both GERD and asthma if you have:

Increased asthma symptoms after you eat or exercise

Increased asthma symptoms when you lie down

Frequent coughing or hoarseness

Asthma that doesn’t respond to the standard asthma treatments.

Johns Hopkins Health Alerts | Lung Disorders | The Connection Between Asthma and GERD

Recent Findings on Dangers of Sleep Apnea

Fri, 03 Nov 2006 06:00:00 CST

Johns Hopkins Health Alerts | Lung Disorders | Sleep Apnea and Sudden Death|Heart Attack

Men with Severe Sleep Apnea Have Higher Risk of Heart Problems

Men with untreated severe obstructive sleep apnea have a higher incidence of fatal and nonfatal heart problems compared to other men. But, according to a study in the journal Lancet, the risk of heart problems is reduced when sleep apnea is treated with continuous positive airway pressure (CPAP), the common therapy for the condition. The study included 264 healthy men, 377 men who snored but did not have sleep apnea, 403 with untreated mild to moderate sleep apnea, 235 with untreated severe sleep apnea, and 372 with sleep apnea who were treated with CPAP. Participants were followed up at least once a year for an average of 10 years.
The researchers found that men with untreated severe sleep apnea were almost three times as likely as healthy participants to suffer from a fatal heart attack or stroke, and more than three times as likely to have a non-fatal heart attack or stroke or to require heart surgery. Men with sleep apnea who were treated with CPAP had about one-third the risk of having a fatal heart problem compared to men with untreated severe sleep apnea.

Death From Sleep Apnea More Common During Sleep

People with obstructive sleep apnea have a significantly increased risk of sudden death from heart problems during sleep, reports The New England Journal of Medicine. This contrasts with the dip in sudden death from heart problems during sleep in people who do not have sleep apnea and in the general population.

Researchers reviewed the records of 112 sleep study participants who had subsequently died suddenly from cardiac causes. The researchers compared the rates of sudden death during various times of day from cardiac causes among people with sleep apnea with rates of sudden death among people without sleep apnea, rates in the general population, and expectations according to chance.

In more than half of those participants with sleep apnea, sudden death from cardiac causes occurred between 10 p.m. and 6 a.m. By contrast, the people without sleep apnea had a day-night pattern of sudden death from cardiac causes very similar to that in the general population, with a peak in sudden death from cardiac causes from 6 a.m. to noon. The risk of sudden death from cardiac causes during sleep hours was 40% higher overall in people with severe apnea, compared to people with mild-to-moderate sleep apnea.

Johns Hopkins Health Alerts | Lung Disorders | Sleep Apnea and Sudden Death|Heart Attack

There's No Such Thing as a "Safe" Cigarette: Debunking Smoking Myths

Fri, 04 Aug 2006 13:35:18 CDT

Johns Hopkins Health Alerts | Lung Disorders | Smoking and Lung Disease

Does switching to light cigarettes offer any protection? Cutting back on how much you smoke? Here’s the latest research.

While smoking tobacco damages the body in various ways—for example, it increases the risk of heart attack, stroke, bladder cancer, and even erectile dysfunction—the most direct effects -of smoking are on the lungs. Smoking increases the risk of nearly every lung disorder and causes most cases of lung cancer, which kills more than 150,000 Americans each year.

Despite these health risks, nearly a quarter of Americans still smoke. If you’re one of them, don’t get taken in by the following myths.

Myth #1: Smoking light cigarettes is better for your health than smoking regular cigarettes.

Fact: Smoking light cigarettes is no healthier than regular cigarettes. The milder taste and smoother feel of light, ultralight, or low-tar cigarettes often convince smokers that these products are less dangerous than regular cigarettes. But studies show that smokers of light and regular cigarettes are exposed to the same amounts of nicotine, tar, carbon monoxide, and other dangerous chemicals.

Even though light and low-tar cigarettes have lower levels of nicotine and other chemicals when tested with smoking machines, in real life, smokers compensate for the lower levels of these chemicals in several ways: They tend to smoke more cigarettes, take deeper or more frequent puffs, or cover the ventilation holes in filters to increase the amount of smoke they inhale.

Myth #2:Cutting down on smoking will improve health.

Fact: There is no safe level of smoking. Many smokers try to smoke fewer cigarettes per day to reduce the health risks associated with smoking, such as cardiovascular disease. But the results of a study published in Nicotine & Tobacco Research showed that two-pack-per-day smokers who cut their habit to one pack a day had similar amounts of dangerous chemicals in their urine, blood, and expired breath as they did before they cut back 24 weeks earlier.

Another study, published in the same journal, found that smokers who cut the number of cigarettes smoked per day by 50% improved on some measures of heart disease risk—such as high density lipoprotein (HDL, or “good”) cholesterol levels—after two years, but not on measures of lung health—like forced expiratory volume in one second (FEV1) and forced vital capacity (FVC).

Quitting Smoking

Because there is no way to continue smoking and significantly reduce the health risks of tobacco use, quitting smoking entirely is the only way to improve your health. While some smokers are able to quit smoking on their own, the chances of success are greatest when using a combination of smoking cessation counseling, nicotine replacement therapy, and bupropion (Zyban, a nicotine-free medication that can decrease your craving for cigarettes).

Johns Hopkins Health Alerts | Lung Disorders | Smoking and Lung Disease

People With Emphysema May Benefit From Surgery

Tue, 06 Jun 2006 13:38:46 CDT

Johns Hopkins Health Alerts | Lung Disorders | Lung Volume Reduction Surgery-Emphysema

For people with moderately severe emphysema, lung volume reduction surgery is considered the only surgical alternative to lung transplantation.

More than three million Americans have emphysema, and some of them—those who have emphysema that predominantly affects the upper lobes and low exercise capacity—may benefit from surgery called lung volume reduction surgery to remove diseased lung tissue. The procedure is believed to create more space in the chest cavity for the working lung tissue to expand.

For people with moderately severe emphysema, the procedure is considered the only surgical alternative to lung transplantation. However, volume reduction surgery is risky because lung function is already compromised and patients with emphysema are generally older and likely to be in poor health.

The first large study examining the risks and benefits of lung volume reduction surgery to treat emphysema showed patterns when researchers categorized patients based on the type and symptoms of their emphysema. Patients with predominantly upper-lobe emphysema and low exercise capacity before the surgery had the greatest benefit: Their mortality rate was cut in half compared with the medical therapy group, and their exercise capacity improved. Patients who had emphysema throughout their lungs but were still able to exercise benefited the least from surgery: They had twice the mortality rate of the medical therapy group and had little or no improvement in exercise capacity.

Although identifying these patient subgroups after the conclusion of the study is not statistically ideal, the findings are still considered valuable. Now doctors have a better way to know which of their patients with severe emphysema are most likely to benefit from lung volume reduction surgery.

In response to the study, Medicare now covers the procedure for appropriate candidates with emphysema.

Johns Hopkins Health Alerts | Lung Disorders | Lung Volume Reduction Surgery-Emphysema

Pneumonia -- Symptoms and Treatment Vary Depending on the Cause

Thu, 06 Jul 2006 13:34:42 CDT

Johns Hopkins Health Alerts | Lung Disorders | Viral and Bacterial Pneumonia

Pneumonia is the sixth leading cause of death in the United States.

Pneumonia, an infection of the air spaces and surrounding lung tissue, is the sixth leading cause of death and the primary cause of death from infectious disease in the United States. Hundreds of different microorganisms can infect the lungs, but most cases of pneumonia are caused by viruses or bacteria. Viral pneumonia, which accounts for about half of all cases, is most often a complication of influenza.

In bacterial pneumonia, the onset of symptoms is typically abrupt. Symptoms may include a cough that produces yellow phlegm, high fever, chills, sharp chest pain precipitated by breathing or coughing, and shortness of breath. Young pneumonia patients usually have increased breathing and heart rates and appear acutely ill. Many older adults have fewer pneumonia symptoms, often have no fever, and experience lethargy and confusion with or without lung-related symptoms.

The early symptoms of viral pneumonia may resemble those of infection with the influenza virus: a dry cough, fever, headache, muscle pain, and weakness. Twelve to 36 hours later, people with viral pneumonia often experience increased breathlessness, worsening cough with mucus, high fever, and, possibly, blueness of the lips. People with very serious viral pneumonia may have extreme difficulty breathing.

Antibiotics are the mainstay of treating bacterial pneumonia. Most people with viral pneumonia recover without treatment in one to three weeks. Antibiotics are not effective against viral pneumonia, but if there is any doubt as to the cause of the pneumonia, antibiotics are often prescribed.

When the cause is bacterial, early treatment produces the best outcomes. In one study, elderly pneumonia patients who got antibiotics within four hours of arriving at a hospital were less likely to die than those who had to wait longer.

Johns Hopkins Health Alerts | Lung Disorders | Viral and Bacterial Pneumonia

Living With COPD -- Breathing Training Brings Benefits

Mon, 17 Apr 2006 13:22:39 CDT

Johns Hopkins Health Alerts | Lung Disorders | Breathing Training for COPD Sufferers

Breath training helps to control breathing rate, decrease the amount of energy required for breathing, and improve the position and function of the respiratory muscles for people suffering from COPD.

Recent observations have underscored the benefits of pulmonary rehabilitation programs for people with COPD (chronic obstructive pulmonary disease). While maintaining general strength through regular aerobic exercise is beneficial, lung exercises to strengthen the muscles used for breathing are also important for people with COPD. Breath training helps to control breathing rate, decrease the amount of energy required for breathing, and improve the position and function of the respiratory muscles. A respiratory therapist can help people with COPD practice the following techniques:

Pursed-lip breathing for COPD. Inhale through your nose, and then exhale with your lips pursed in a whistling or kissing position. Each inhalation should take about two seconds and each exhalation should last about four to six seconds. It is not clear how pursed-lip breathing brings symptom relief for people with COPD, but it may work by keeping the airways open.

Diaphragmatic breathing for COPD. The diaphragm is the main muscle used for normal breathing. People with COPD, however, may also use the muscles in the rib cage, neck, and abdomen to breathe. This method is less efficient than using the diaphragm. To practice using the diaphragm, lie on your back, place your hand or a small book on your abdomen, and breathe. Your hand or the book should rise on inhalation and fall on exhalation. Practice for 20 minutes twice daily. Once you have mastered this skill while lying down, try to do it while sitting up.

Forward-bending posture for COPD. Breathing while bending slightly forward from the waist relieves symptoms for some people with severe COPD, possibly because the diaphragm has more room to expand.

Some research suggests that pulmonary rehabilitation may also increase survival for people with COPD, but this has not been proven.

Johns Hopkins Health Alerts | Lung Disorders | Breathing Training for COPD Sufferers

What To Do When A Cough Turns Chronic

Mon, 17 Apr 2006 21:30:09 CDT

Johns Hopkins Health Alerts | Lung Disorders | Chronic Cough Diagnosis

Any cough that lasts more than two months is defined as chronic and requires medical attention.

Coughing is a reflex that keeps the lungs and airways free from phlegm (excess mucus) and foreign objects (such as food) that might interfere with breathing. Occasional coughing is normal, as is the coughing associated with a cold (the most common acute medical problem that triggers a cough). Any cough that lasts more than 2 months, however, is defined as chronic and requires medical attention—even if the cough occurs only in the morning, at night, or at certain times of the year.

Chronic cough is not a disease; rather, it is considered a symptom of another condition. A cough attributable to a cold, flu, or some other known cause that fails to get better within 3 weeks, or a persistent cough of unknown origin, is reason to see your doctor. Your cough may have qualities that, together with other symptoms, point towards an underlying cause that requires proper diagnosis and treatment.

A chronic cough associated with a normal chest x-ray most often results from one or more conditions that include postnasal drip, asthma, GERD (gastroesophageal reflux disease), and chronic bronchitis. Blood pressure medications can also cause a dry, hacking cough in some people.

More serious (but less common) causes of chronic cough include interstitial lung disease, bronchiectasis (persistent dilatation of the bronchi or bronchioles), and pneumonia—all of which produce inflammation or scarring of the lungs. Lung cancer is usually suspected only when someone with a history of smoking has an abnormal chest x-ray.

Self-care measures may help relieve a chronic cough but are not a substitute for medical evaluation. Try to increase the humidity in your home and drink plenty of fluids to thin phlegm and other secretions. However, do not treat a chronic cough with over-the-counter (OTC) cough medicine for more than 2 weeks unless directed by your doctor. These medications can suppress your cough but may not cure it. If your cough never entirely clears up or returns after you stop taking OTC medications, see your doctor.

Johns Hopkins Health Alerts | Lung Disorders | Chronic Cough Diagnosis