pneumopathy

Interstitial lung disease is the name for a large group of diseases that inflame or scar the lungs. The inflammation and scarring make it hard to get enough oxygen. The scarring is called pulmonary fibrosis.

Breathing in dust or other particles in the air is responsible for some types of interstitial lung diseases. Specific types include:

• Black lung disease among coal miners, from inhaling coal dust
• Farmer's lung, from inhaling farm dust
• Asbestosis, from inhaling asbestos fibers
• Siderosis, from inhaling iron from mines or welding fumes
• Silicosis, from inhaling silica dust

Other causes include autoimmune diseases or occupational exposures to molds, gases, or fumes. Some types of interstitial lung disease have no known cause.

Treatment depends on the type of exposure and the stage of the disease. It may involve medicines, oxygen therapy, or a lung transplant in severe cases.

When you breathe, your lungs take in oxygen from the air and deliver it to the bloodstream. The cells in your body need oxygen to work and grow. During a normal day, you breathe nearly 25,000 times. People with lung disease have difficulty breathing. Millions of people in the U.S. have lung disease. If all types of lung disease are lumped together, it is the number three killer in the United States.

The term lung disease refers to many disorders affecting the lungs, such as asthma, COPD, infections like influenza, pneumonia and tuberculosis, lung cancer, and many other breathing problems. Some lung diseases can lead to respiratory failure.

Dept. of Health and Human Services Office on Women's Health

Pulmonary rehabilitation, also known as pulmonary rehab or PR, is a program for people who have chronic (ongoing) breathing problems. It can help improve your ability to function and quality of life. PR does not replace your medical treatment. Instead, you use them together.

PR is often an outpatient program that you do in a hospital or clinic. Some people have PR in their homes. You work with a team of health care providers to find ways to lessen your symptoms, increase your ability to exercise, and make it easier to do your daily activities.

Your health care provider may recommend pulmonary rehabilitation (PR) if you have a chronic lung disease or another condition that makes it hard for you to breathe and limits your activities. For example, PR may help you if you:

• Have COPD (chronic obstructive pulmonary disease). The two main types are emphysema and chronic bronchitis. In COPD, your airways (tubes that carry air in and out of your lungs) are partially blocked. This makes it hard to get air in and out.
• Have an interstitial lung disease such as sarcoidosis and pulmonary fibrosis. These diseases cause scarring of the lungs over time. This makes it hard to get enough oxygen.
• Have cystic fibrosis (CF). CF is an inherited disease that causes thick, sticky mucus to collect in the lungs and block the airways.
• Need lung surgery. You may have PR before and after lung surgery to help you prepare for and recover from the surgery.
• Have a muscle-wasting disorder that affects the muscles used for breathing. An example is muscular dystrophy.

PR works best if you start it before your disease is severe. However, even people who have advanced lung disease can benefit from PR.

When you first start pulmonary rehabilitation (PR), your team of health care providers will want to learn more about your health. You will have lung function, exercise, and possibly blood tests. Your team will go over your medical history and current treatments. They may check on your mental health and ask about your diet. Then they will work together to create a plan that is right for you. It may include:

• Exercise training. Your team will come up with an exercise plan to improve your endurance and muscle strength. You will likely have exercises for both your arms and legs. You might use a treadmill, stationary bike, or weights. You may need to start slowly and increase your exercise as you get stronger.
• Nutritional counseling. Being either overweight or underweight can affect your breathing. A nutritious eating plan can help you work towards a healthy weight.
• Education about your disease and how to manage it. This includes learning how to avoid situations that make your symptoms worse, how to avoid infections, and how/when to take your medicines.
• Techniques you can use to save your energy. Your team may teach you easier ways to do daily tasks. For example, you may learn ways to avoid reaching, lifting, or bending. Those movements make it harder to breathe, since they use up energy and make you tighten your abdominal muscles. You may also learn how to better deal with stress, since stress can also take up energy and affect your breathing.
• Breathing strategies. You will learn techniques to improve your breathing. These techniques may increase your oxygen levels, decrease how often you take breaths, and keep your airways open longer.
• Psychological counseling and/or group support. It can feel scary to have trouble breathing. If you have a chronic lung disease, you are more likely to have depression, anxiety, or other emotional problems. Many PR programs include counseling and/or support groups. If not, your PR team may be able to refer you to an organization that offers them.

NIH: National Heart, Lung, and Blood Institute

Asthma is a chronic (long-term) lung disease. It affects your airways, the tubes that carry air in and out of your lungs. When you have asthma, your airways can become inflamed and narrowed. This can cause wheezing, coughing, and tightness in your chest. When these symptoms get worse than usual, it is called an asthma attack or flare-up.

The exact cause of asthma is unknown. Genetics and your environment likely play a role in who gets asthma.

An asthma attack can happen when you are exposed to an asthma trigger. An asthma trigger is something that can set off or worsen your asthma symptoms. Different triggers can cause different types of asthma:

• Allergic asthma is caused by allergens. Allergens are substances that cause an allergic reaction. They can include
  • Dust mites
  • Mold
  • Pets
  • Pollen from grass, trees, and weeds
  • Waste from pests such as cockroaches and mice
• Nonallergic asthma is caused by triggers that are not allergens, such as
  • Breathing in cold air
  • Certain medicines
  • Household chemicals
  • Infections such as colds and the flu
  • Outdoor air pollution
  • Tobacco smoke
• Occupational asthma is caused by breathing in chemicals or industrial dusts at work
• Exercise-induced asthma happens during physical exercise, especially when the air is dry

Asthma triggers may be different for each person and can change over time.

Asthma affects people of all ages, but it often starts during childhood. Certain factors can raise your risk of having asthma:

• Being exposed to secondhand smoke when your mother is pregnant with you or when you are a small child
• Being exposed to certain substances at work, such as chemical irritants or industrial dusts
• Genetics and family history. You are more likely to have asthma if one of your parents has it, especially if it's your mother.
• Race or ethnicity. Black and African Americans and Puerto Ricans are at higher risk of asthma than people of other races or ethnicities.
• Having other diseases or conditions such as obesity and allergies
• Often having viral respiratory infections as a young child
• Sex. In children, asthma is more common in boys. In teens and adults, it is more common in women.

The symptoms of asthma include:

• Chest tightness
• Coughing, especially at night or early morning
• Shortness of breath
• Wheezing, which causes a whistling sound when you breathe out

These symptoms can range from mild to severe. You may have them every day or only once in a while.

When you are having an asthma attack, your symptoms get much worse. The attacks may come on gradually or suddenly. Sometimes they can be life-threatening. They are more common in people who have severe asthma. If you are having asthma attacks, you may need a change in your treatment.

Your health care provider may use many tools to diagnose asthma:

• Physical exam
• Medical history
• Lung function tests, including spirometry, to test how well your lungs work
• Tests to measure how your airways react to specific exposures. During this test, you inhale different concentrations of allergens or medicines that may tighten the muscles in your airways. Spirometry is done before and after the test.
• Peak expiratory flow (PEF) tests to measure how fast you can blow air out using maximum effort
• Fractional exhaled nitric oxide (FeNO) tests to measure levels of nitric oxide in your breath when you breathe out. High levels of nitric oxide may mean that your lungs are inflamed.
• Allergy skin or blood tests, if you have a history of allergies. These tests check which allergens cause a reaction from your immune system.

If you have asthma, you will work with your health care provider to create a treatment plan. The plan will include ways to manage your asthma symptoms and prevent asthma attacks. It will include:

• Strategies to avoid triggers. For example, if tobacco smoke is a trigger for you, you should not smoke or allow other people to smoke in your home or car.
• Short-term relief medicines, also called quick-relief medicines. They help prevent symptoms or relieve symptoms during an asthma attack. They include an inhaler to carry with you all the time. It may also include other types of medicines which work quickly to help open your airways.
• Control medicines. You take them every day to help prevent symptoms. They work by reducing airway inflammation and preventing narrowing of the airways.

If you have a severe attack and the short-term relief medicines do not work, you will need emergency care.

Your provider may adjust your treatment until asthma symptoms are controlled.

Sometimes asthma is severe and cannot be controlled with other treatments. If you are an adult with uncontrolled asthma, in some cases your provider might suggest bronchial thermoplasty. This is a procedure that uses heat to shrink the smooth muscle in the lungs. Shrinking the muscle reduces your airway's ability to tighten and allows you to breathe more easily. The procedure has some risks, so it's important to discuss them with your provider.

COPD (chronic obstructive pulmonary disease) is a group of lung diseases that make it hard to breathe and get worse over time.

Normally, the airways and air sacs in your lungs are elastic or stretchy. When you breathe in, the airways bring air to the air sacs. The air sacs fill up with air, like a small balloon. When you breathe out, the air sacs deflate, and the air goes out. If you have COPD, less air flows in and out of your airways because of one or more problems:

• The airways and air sacs in your lungs become less elastic
• The walls between many of the air sacs are destroyed
• The walls of the airways become thick and inflamed
• The airways make more mucus than usual and can become clogged

COPD includes two main types:

• Emphysema affects the air sacs in your lungs, as well as the walls between them. They become damaged and are less elastic.
• Chronic bronchitis, in which the lining of your airways is constantly irritated and inflamed. This causes the lining to swell and make mucus.

Most people with COPD have both emphysema and chronic bronchitis, but how severe each type is can be different from person to person.

The cause of COPD is usually long-term exposure to irritants that damage your lungs and airways. In the United States, cigarette smoke is the main cause. Pipe, cigar, and other types of tobacco smoke can also cause COPD, especially if you inhale them.

Exposure to other inhaled irritants can contribute to COPD. These include secondhand smoke, air pollution, and chemical fumes or dusts from the environment or workplace.

Rarely, a genetic condition called alpha-1 antitrypsin deficiency can play a role in causing COPD.

The risk factors for COPD include:

• Smoking. This is the main risk factor. Up to 75% of people who have COPD smoke or used to smoke.
• Long-term exposure to other lung irritants, such as secondhand smoke, air pollution, and chemical fumes and dusts from the environment or workplace
• Age. Most people who have COPD are at least 40 years old when their symptoms begin.
• Genetics. This includes alpha-1 antitrypsin deficiency, which is a genetic condition. Also, smokers who get COPD are more likely to get it if they have a family history of COPD.
• Asthma. People who have asthma have more risk of developing COPD than people who don't have asthma. But most people with asthma will not get COPD.

At first, you may have no symptoms or only mild symptoms. As the disease gets worse, your symptoms usually become more severe. They can include:

• Frequent coughing or a cough that produces a lot of mucus
• Wheezing
• A whistling or squeaky sound when you breathe
• Shortness of breath, especially with physical activity
• Tightness in your chest

Some people with COPD get frequent respiratory infections such as colds and the flu. In severe cases, COPD can cause weight loss, weakness in your lower muscles, and swelling in your ankles, feet, or legs.

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A family history
• Various tests, such as lung function tests, a chest x-ray or CT scan, and blood tests

Your doctor will diagnose COPD based on your signs and symptoms, your medical and family histories, and test results.

There is no cure for COPD. However, treatments can help with symptoms, slow the progress of the disease, and improve your ability to stay active. There are also treatments to prevent or treat complications of the disease. Treatments include:

• Lifestyle changes, such as
  • Quitting smoking if you are a smoker. This is the most important step you can take to treat COPD.
  • Avoiding secondhand smoke and places where you might breathe in other lung irritants
  • Ask your health care provider for an eating plan that will meet your nutritional needs. Also ask about how much physical activity you can do. Physical activity can strengthen the muscles that help you breathe and improve your overall wellness.
• Medicines, such as
  • Bronchodilators, which relax the muscles around your airways. This helps open your airways and makes breathing easier. Most bronchodilators are taken through an inhaler. In more severe cases, the inhaler may also contain steroids to reduce inflammation.
  • Vaccines for the flu and pneumococcal pneumonia, since people with COPD are at higher risk for serious problems from these diseases
  • Antibiotics if you get a bacterial lung infection
• Oxygen therapy, if you have severe COPD and low levels of oxygen in your blood. Oxygen therapy can help you breathe better. You may need extra oxygen all the time or only at certain times.
• Pulmonary rehabilitation, which is a program that helps improve the well-being of people who have chronic breathing problems. It may include
  • An exercise program
  • Disease management training
  • Nutritional counseling
  • Psychological counseling
• Surgery, usually as a last resort for people who have severe symptoms that have not gotten better with medicines:
  • For COPD that is mainly related to emphysema, there are surgeries that:
    • Remove damaged lung tissue
    • Remove large air spaces (bullae) that can form when air sacs are destroyed. The bullae can interfere with breathing.
  • For severe COPD, some people may need lung transplant

If you have COPD, it's important to know when and where to get help for your symptoms. You should get emergency care if you have severe symptoms, such as trouble catching your breath or talking. Call your health care provider if your symptoms are getting worse or if you have signs of an infection, such as a fever.

Since smoking causes most cases of COPD, the best way to prevent it is to not smoke. It's also important to try to avoid lung irritants such as secondhand smoke, air pollution, chemical fumes, and dusts.

NIH: National Heart, Lung, and Blood Institute

Pulmonary fibrosis is a condition in which the tissue deep in your lungs becomes scarred over time. This tissue gets thick and stiff. That makes it hard for you to catch your breath, and your blood may not get enough oxygen.

Causes of pulmonary fibrosis include environmental pollutants, some medicines, some connective tissue diseases, and interstitial lung disease. Interstitial lung disease is the name for a large group of diseases that inflame or scar the lungs. In most cases, the cause cannot be found. This is called idiopathic pulmonary fibrosis.

Symptoms include:

• Shortness of breath
• A dry, hacking cough that doesn't get better
• Fatigue
• Weight loss for no known reason
• Aching muscles and joints
• Clubbing, which is the widening and rounding of the tips of the fingers or toes

Your doctor may use your medical history, imaging tests, a biopsy, and lung function tests to diagnose pulmonary fibrosis. There is no cure. Treatments can help with symptoms and improve your quality of life. They include medicines, oxygen therapy, pulmonary rehabilitation, or a lung transplant.

NIH: National Heart, Lung, and Blood Institute

Alpha-1 antitrypsin deficiency (AAT deficiency, or AATD) is an inherited condition that raises your risk for lung and liver disease. If you have this condition, your body doesn't make enough alpha-1 antitrypsin (AAT).

AAT is made by your liver. It helps protect your lungs from inflammation and irritating substances you might breathe in, such as smoke. If your liver doesn't make enough AAT, your lungs may be more easily damaged from smoking, pollution, or dust from the environment. This can lead to a serious lung condition called chronic obstructive pulmonary disease (COPD). AAT deficiency may also cause a liver disease called cirrhosis. This is more common in children who have AAT deficiency.

AAT deficiency is a genetic disorder. That means it's caused by changes in your genes, which may also be called gene variants or mutations.

Your genes carry information that controls what you look like and how your body works. AAT deficiency is caused by changes in the SERPINA1 gene, which carries instructions for making the AAT protein. These gene changes are inherited from your parents, so AAT deficiency tends to run in families:

• If you have two mutated copies of the gene, it means you have a condition called AAT deficiency. People with this disorder have a higher risk of getting lung disease or liver damage before the age of 45.
• If you have one mutated copy of the gene, you are a carrier of AAT deficiency. In these cases, this means you are at slightly higher risk of developing lung disease, especially if you have other risk factors, such as being a smoker. You could still pass the mutated gene on to your children.

There are a few gene changes that cause AAT deficiency. These gene changes can:

• Decrease the amount of AAT protein your liver makes.
• Prevent your liver from making any AAT.
• Affect the shape of the AAT protein so that it can't move out of your liver to protect your lungs. Over time, AAT builds up in your liver and causes damage.

Some people who have AAT deficiency do not have any symptoms. For those who do, symptoms usually appear in people between 20 and 50 years old. These symptoms may include:

• Wheezing
• Shortness of breath, especially after exercise
• Chronic cough with phlegm (mucus)
• Repeated respiratory infections such as colds and the flu
• Chest pain
• Fatigue
• Faster-than-normal heartbeat when you stand up
• Vision problems
• Losing weight without trying

Some people who have AAT deficiency may have liver damage. Signs of liver damage include jaundice (a condition that causes your skin and eyes to turn yellow) and swelling in your legs.

Rarely, AAT deficiency can cause skin problems, such as painful lumps or patches.

Your health care provider may test you for AAT deficiency if you have:

• Symptoms of AAT deficiency
• A condition that could be related to AAT deficiency
• Relatives who have AAT deficiency
• Relatives who have a lung or liver disease that could be related to AAT deficiency

AAT deficiency in babies often affects the liver. Your baby may need AAT testing if he or she has signs of liver disease such as jaundice or abnormal liver enzyme tests.

A blood test can check the level of AAT protein in your blood. If the level is lower than normal, it is likely that you have AAT deficiency.

A genetic test is the most certain way to check for AAT deficiency and should be done to confirm the results of the blood test. There are two types of genetic tests:

• A genotype test looks for the more common types of gene changes that can cause AAT deficiency.
• A phenotype test checks for changes in the AAT protein that change how it would normally work.

If your lungs are affected, you may also have lung function tests to see how well your lungs are working.

There is no cure for AAT deficiency, but there are treatments to help with the symptoms and slow the lung damage it causes. Treatment options may include:

• Inhaled medicines to help you breathe better.
• Pulmonary rehabilitation.
• Oxygen therapy.
• Augmentation therapy, which is a lifelong treatment. It raises the levels of the AAT protein in your lungs, using ATT protein taken from the blood of donors. It helps slow down lung damage. It cannot prevent liver damage.
• Lung surgery or a lung transplant, if your lungs are severely damaged.
• Liver transplant, if your liver is severely damaged.

To help prevent or delay lung damage, it is important to quit smoking (if you smoke) and avoid secondhand smoke, dust, and air pollution. Ask your provider If you need to stop drinking alcohol.

Asbestos is the name of a group of minerals with long, thin fibers. It was once used widely as insulation. It also occurs in the environment. Asbestos fibers are so small you can't see them. If you disturb asbestos, the fibers can float in the air. This makes them easy to inhale, and some may become lodged in the lungs.

If you breathe in high levels of asbestos over a long period of time, the fibers can build up in the lungs. This causes scarring and inflammation, and can affect breathing. Eventually it can lead to diseases such as:

• Asbestosis, or scarring of the lungs that makes it hard to breathe
• Mesothelioma, a rare cancer that affects the lining of the lungs or abdomen
• Lung cancer

Lung diseases associated with asbestos usually develop over many years. People who become ill from asbestos are usually exposed on the job over long periods of time. Smoking cigarettes increases the risk.

Agency for Toxic Substances and Disease Registry

When you breathe in, the air travels down through your trachea (windpipe). It then goes through two tubes to your lungs. These tubes are your bronchi. Bronchial disorders can make it hard for you to breathe.

The most common problem with the bronchi is bronchitis, an inflammation of the tubes. It can be acute or chronic. Other problems include:

• Bronchiectasis - a condition in which damage to the airways causes them to widen and become flabby and scarred
• Exercise-induced bronchospasm - a breathing problem that happens when your airways shrink while you are exercising
• Bronchiolitis - an inflammation of the small airways that branch off from the bronchi
• Bronchopulmonary dysplasia - a chronic lung condition in infants, most often premature infants

The chest is the part of your body between your neck and your abdomen (belly). The medical term for your chest is thorax.

Your chest holds many important structures for breathing, digestion, blood circulation, and other important body functions. These structures include your:

• Ribs and breastbone
• Esophagus, the tube between your mouth and stomach
• Trachea, your windpipe
• Bronchi, the tubes that carry air from your windpipe to your lungs
• Lungs
• Pleura, a thin layer of tissue that covers the lungs and lines the inside wall of the chest space
• Heart and large blood vessels
• Thymus, a gland that's part of your immune system
• Nerves

Chest injuries and disorders are problems that affect any of the organs or structures located in your chest.

There are many types of chest injuries and disorders, for example:

• Broken ribs
• Esophagus disorders
• Swallowing disorders, also called dysphagia
• Tracheal disorders
• Bronchial disorders
• Lung diseases and collapsed lung
• Pleural disorders
• Heart diseases
• Mediastinal diseases, which are tumors, inflammation, and other problems with the structures in the mediastinum, which is the space between your lungs, breastbone, and spine
• Thoracic aortic aneurysm
• Thoracic outlet syndrome

Chest injuries may happen from the force of car accidents, falls, or sports injuries. Or the chest may be pierced by a bullet or sharp object. Because your chest holds so many important structures, certain chest injuries may be life-threatening.

Diagnosis of chest injuries or disorders depends on the type of symptoms you're having and whether you've had a chest injury. Injuries are usually obvious, but in most cases, you'll need tests to know how serious an injury is.

There are many types of tests for diagnosing different types of chest injuries and disorders, for example:

• Diagnostic imaging tests
• Heart tests
• Lung function tests
• Bronchoscopy
• Pleural fluid analysis
• Dysphagia tests
• Biopsy

Treatments will depend on the type of chest injury or disorder you have.