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Asthma

Asthma is a chronic inflammatory condition of the small airways in the lungs. During an asthma attack the airways become narrow, resulting in wheezing and difficulty breathing.

Asthma comes from a hereditary predisposition where chemicals or irritants in the air trigger the small airways in the lungs to tighten or constrict. An attack can be brought on by environmental irritants, cigarette smoke, pollution, or allergenic substances. Asthma can also be triggered in some people by exercise, exposure to cold air, and certain medications like aspirin or some heart medications.

The symptoms of an asthma attack include wheezing, coughing, shortness of breath, and a sensation of tightness in the chest.

Asthma is diagnosed in stages. First, a doctor will listen to your lungs with a stethoscope for changes in the pattern of the breath sounds, and for wheezing that are characteristic of asthma. The diagnosis is then confirmed by a test called spirometry. Spirometry measures the volume and speed of air when you breathe out or exhale. If you have symptoms of asthma, but have a normal spirometry test, a second test can be done to try and trigger the asthma. During this test, a chemical called metacholine is inhaled which causes the characteristic asthmatic breathing changes detected by spirometry.

If you have asthma you can prevent attacks by knowing and avoiding your triggers. These might include environmental irritants, cigarette smoke, allergenic substances, etc.

Asthma cannot be cured, but the symptoms can be controlled with medications.

For short acting relief medication like salbutamol (Ventolin) is taken through an inhaler.

For long term control inhaled corticosteroids are used daily. These two medications, Ventolin and corticosteroids, are frequently combined in the same inhaler.

 

Acute Bronchitis

Acute bronchitis, commonly called a “chest cold”, refers to an infection in the bronchi (large and medium sized airways) in the lungs. It generally lasts no more than 3 weeks, but because cigarettes make it harder to fight infections in the lungs, bronchitis can last much longer in smokers. Acute bronchitis is different from chronic bronchitis, a topic covered in the section on COPD.

Infection of the airways of the lungs is most frequently caused by a cold or flu virus, and occasionally by bacteria. The infection causes production of excessive mucous or phlegm. The most common symptom of acute bronchitis is coughing, often with phlegm. People with acute bronchitis can sometimes also have fever, laboured breathing, wheezing, and chest discomfort.

Acute bronchitis is diagnosed from the description of the symptoms including the cough, and particularly coughing up phlegm. Your doctor may also hear wheezing sounds when listening to your chest with a stethoscope. Sometimes an X-ray of the lungs is required to distinguish acute bronchitis from pneumonia.

Because acute bronchitis is most often caused by a cold virus, antibiotics are not required and should not be prescribed. The best treatment measures include rest, drinking plenty of fluids, and taking acetaminophen for fever or chest discomfort.

If you have persistent or worsening fever, worsening cough with increasing amounts of phlegm, profound fatigue, and significant chest pain you should see a healthcare provider. They can determine if the bronchitis is caused by a bacterial infection or if you also have pneumonia. In these cases you will be prescribed an antibiotic and an inhaled medication to help open your airways.

If significant symptoms persist beyond 3 weeks an inhaled steroid may be added.

A common misconception is that antibiotics are needed for acute bronchitis. As noted, most acute bronchitis is caused by a viral infection and antibiotics are ineffective. Remember that the cough can drag on and last for up to 3 weeks.

Chronic Obstructive Pulmonary Disease (COPD)

COPD is a chronic progressive lung condition characterized by reduced air flow into the lungs. It consists of 2 diseases, chronic bronchitis and emphysema.

Chronic bronchitis results from chronic inflammation and permanent narrowing of the bronchi, the tubes or air channels that deliver air down into the lungs. The symptoms of chronic bronchitis include a persistent cough, coughing up phlegm, and shortness of breath; all of which last for at least 3 months each year, over at least 2 years.

Emphysema results from the destruction of the tiny air sacs (called alveoli) deep within the lungs that allow the transfer of oxygen into the blood. When these air sacs are destroyed the blood does not carry enough oxygen and patients feel short of breath, even while at rest.

By far, the most common cause of COPD is smoking tobacco. A far less common cause is air pollution. There is also a rare genetic cause called alpha 1-antitrypsine deficiency.

COPD can sometimes be diagnosed simply based on a history of smoking; shortness of breath, while at rest or with minimal exertion; and with an X-ray. Occasionally a CAT-scan may be required. Your doctor may also order a test called spirometry, this measures how much air you can breathe in and out and how fast.

COPD is a lung disorder that gets progressively worse over time and cannot be cured. However, you can slow the rate of progression and help maintain your lungs if you stop smoking. Every drag on a cigarette worsens COPD. To help ease the symptoms of COPD, your doctor will likely prescribe “puffers”. These are inhaled medications that help open the breathing tubes (bronchi) and reduce inflammation. Pulmonary rehabilitation programs are helpful. If the amount of oxygen reaching your blood is too low you may require an oxygen tank and tubing to deliver oxygen through your nose. This allows you to breath a higher concentration of oxygen than is present in air. In late stage, severe COPD a lung transplant may be required.

To prevent COPD, don’t smoke tobacco. If you already smoke, quit. Other forms of smoking such as heavy marijuana use also increases your risk. Even exposure to second-hand smoke can cause COPD. Remember, tobacco and marijuana smoke contain poisonous chemicals that will directly damage lung tissue.

COPD is not rare, it is the 3rd leading cause of death in Canada. The most important thing to know about COPD is that its primary cause is smoking. If you are a smoker and have COPD, it is not too late to stop.

Pneumonia

Pneumonia is a serious infection of the lungs.

Pneumonia can be acquired in various settings. Information here will be limited to the most common form known as community acquired pneumonia.

Pneumonia can be caused by bacteria or respiratory viruses. Common bacteria that cause pneumonia are Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. Other “atypical bacteria” that cause pneumonia include Mycoplasma and Legionella. A number of respiratory viruses can also cause pneumonia, particularly the influenza virus (the flu), but also the parainfluenza virus, respiratory syncytial virus, and human metapneumovirus.

Certain individuals are at higher risk of developing pneumonia. They include the elderly, people who drink excessive alcohol, people suffering from chronic lung disease, and people with an impaired immune system.

Pneumonia can be a serious illness because the small air sacks in the lungs that deliver oxygen to the blood (alveoli) become filled with fluid. When the alveoli fill with fluid air cannot reach them and they cannot deliver oxygen to the blood. Because of this, people with pneumonia feel short of breath. Other symptoms of pneumonia include fever, sharp chest pains, and a cough, often with thick phlegm that sometimes can be tinged with blood.

Seeking urgent medical attention is recommended. The diagnosis of pneumonia is established by your doctor listening to your lungs with a stethoscope and by an X-ray. The X-ray will show the infected areas of one or both lungs.

By culturing your phlegm and a sample of blood in the laboratory, doctors can sometimes identify the infecting organism. This helps in choosing the appropriate antibiotic or determining if antibiotics are unnecessary, as in the case of pneumonia caused by a virus.

Vaccines exist for the Pneumococcus bacteria, the Haemophilus bacteria, and for the influenza virus; all of which can cause pneumonia. These vaccines are routinely provided to children and to adults at high risk of developing pneumonia.

Treatment of pneumonia involves an oral antibiotic prescribed by a doctor, acetaminophen for fever and pain, rest, and drinking plenty of fluids. Antibiotics are usually required for no more than 5 days. However, it can take 7-10 days, and sometimes up to 14, to feel completely better.

In case of severe symptoms or low levels of oxygen in the blood, hospitalization may be required for intravenous antibiotics. Pneumonias acquired while in the hospital or in other healthcare facilities may require more aggressive treatment

Sleep Apnea

Sleep apnea is a condition where an individual repeatedly stops breathing for short periods of time during sleep. This results in low oxygen levels in the blood, disrupted sleep, and day time drowsiness.

There 2 different forms of sleep apnea. The most common is obstructive sleep apnea (OSA). OSA is associated with snoring. During snoring tissue at the back of the throat can actually block the airway and prevent air from getting to the lungs. People with OSA may be unable to breath for several seconds to minutes, and then choke and gasp as the body struggles for air. This disrupts sleep and deprives the organs and tissues of oxygen. The second, and less common type of sleep apnea, is central sleep apnea (CSA). CSA occurs when there is an interruption in the nerve impulse to breath coming from the brain. In both types of sleep apnea individuals awaken, at least partially, throughout the night each time they stop breathing and the body is deprived of oxygen. This recurrent awakening results in non-restorative sleep, causing day time drowsiness and fatigue.

OSA is more common in younger and middle aged men, and is associated with obesity or with enlarged tonsils. CSA is generally experienced by elderly men with cardiac disorders or a brain tumor.

The most common presentation of OSA involves loud snoring interrupted by periods of silence when the airway is blocked and breathing stops. This can be observed by another person sleeping close by. The condition is diagnosed by a sleep lab study where the duration and number of breathing arrests per hour are measured, along with the drop in blood oxygen that occurs when the individual stops breathing.

Treatment for OSA involves losing weight, stopping smoking, reducing alcohol intake, and avoiding sedatives or muscle relaxants. Various oral appliances can be used to keep the upper airway open.  A more effective treatment of mild to moderate sleep apnea involves the use of a continuous positive airway pressure (CPAP) device. This device delivers air through a mask at pressures which keep the upper airway open and prevents it from collapsing and obstructing the delivery of air to the lungs. Finally, surgery is sometimes required to remove excessive tissue from the back of the throat.

Sleep apnea is a serious disorder which can result in fatigue, poor functioning, and low mood. If suspected it should be diagnosed through a sleep lab study, with specific treatment recommendations by a sleep specialist.

Sleep apnea is not serious problem.” In fact sleep apnea results in loss of daytime alertness and productivity, may lead to accidents, cardiac conditions, stroke, and can even result in death.

“All heavy snorers have sleep apnea.” Sleep apnea occurs only in those people who snore, and also regularly stop breathing while asleep.

“Only the elderly can have sleep apnea.” Although more common after age 40, you can have this condition at any age.

Smoking and smoking cessation

This information module refers to smoking tobacco in the form of cigarettes or pipes.

Inhalation of tobacco smoke directly damages the lungs, both the airways, and the lung tissue. Long-term smoking is the leading cause of chronic obstructive pulmonary diseases including chronic bronchitis and emphysema, as well as lung cancer. Damage to the airways also makes you more susceptible to respiratory infections. If you smoke you are more likely to get colds, the flu, and even pneumonia; your symptoms will be more severe, and they will most certainly last longer. Tobacco smoke contains over 5000 toxic chemicals. Absorption of these chemicals through the lungs into the blood stream allows these chemicals to reach all parts of your body, so they harm more than your lungs. Some of the chemicals damage the blood vessels, making it harder for them to deliver blood. Reduced blood delivery to the heart causes angina and heart attacks. Reduced blood flow to the brain causes dementia and stroke. Poor blood flow to the arms and legs can lead to chronic non-healing wounds. And insufficient blood delivery to the penis makes it difficult to get and maintain erections. Of the chemicals in tobacco smoke, at least 60 are known to cause cancer. As a result, smoking contributes to the development of many types of cancer, not just lung cancer. All of this makes smoking one of the leading causes of poor health, shortened life span, and death.

People become dependent on tobacco smoking because it is both chemically addictive and habit forming. One of the chemicals in tobacco smoke that is breathed in and absorbed into the blood stream is nicotine. Nicotine is then delivered through the blood to the brain. Brain cells have receptors that they use to detect signals from other brain cells. Nicotine can bind to these receptors causing two effects. First, nicotine can stimulate brain cells to release dopamine. Among other things, dopamine will make you feel good. Second, because nicotine occupies the brain cells’ receptors, the brain’s cells can’t detect other signals very well. In other words, it becomes hard of hearing. To compensate, the brain cells make more receptors so they can hear better in the presence of nicotine. If you stop smoking, nicotine is no longer present to occupy the receptors and now the cells have too many available receptors. Now it just feels like everyone is yelling at them. Nicotine withdrawal then means less dopamine and pleasure, and over stimulation of your brain cells. This making you feel jittery and irritable. Smoking is also habit forming. Most people smoke at regular times of the day, and with other activities like having a coffee or a drink. Doing these things then feel incomplete without a cigarette. Quitting smoking may mean breaking some long-term habits.

There are many ways to quit smoking: quitting abruptly or cold turkey, cutting back until you can stop, using the patch, or with medications such as Zyban or Champix.

When people quit smoking nicotine leaves their body, meaning their brain receives less dopamine and their brain cells become over stimulated. Symptoms of withdrawal include irritability, feeling anxious, difficulty sleeping, depression, difficulty focusing, and increased appetite. Symptoms can begin within hours of the last cigarette, peak in the first few days, and usually subside within a couple of weeks. Although the chemical addiction may pass, cravings may persist. Smoking is habit forming. If you have a cigarette every evening after dinner, then finishing dinner may cause a psychological craving for a cigarette.

Some people quit smoking cold turkey and bear through the withdrawal until it is over. Others slowly cut down the number of cigarettes they smoke until they are able to quit entirely. This is much like using the patch. The patch delivers nicotine through the skin to the blood stream. By using a series of patches that deliver less and less nicotine, the brain is able to readjust and people may find withdrawal less difficult. Medications like Zyban and Champix can reduce cravings and symptoms of withdrawal. These medications can be very effective, but they may have some side effects. They are only available by prescription, so talk to your doctor.

Because smoking is habit forming, quitting often requires more than dealing with withdrawal. You will likely have to develop some replacement habits. If you take a break at work by going outside for a smoke, go outside for a walk instead. If you have a cigarette every evening after dinner, replace it with a new after dinner ritual. Be creative! Many people find sharing their experience or problem solving together very helpful. In fact, attending smoking cessation programs provides the best outcomes when quitting smoking.

Please visit MyQuit or SmokersHelpline

Electronic cigarettes are devices that heat a mixture of water, propylene glycol, and nicotine to form a vapour and are being more frequently used to replace cigarette smoking. Some experts suggest that because the mixture does not contain most of the toxic chemicals in tobacco smoke, smoking e-cigarettes, also known as vaping, may be safer. There is truth to this. However, it is important to remember that nicotine in e-cigarettes is still highly addictive. We also do not know the long-term health effects of inhaling propylene glycol. Health Canada and the American Food and Drug Administration have questioned the safety of these products.

Smoking “light cigarettes” is usually no safer than smoking regular cigarettes as most people end up inhaling more deeply or smoking more. The same is true for just cutting down the number of cigarettes you smoke.

Long-term smokers may feel that the damage is already done, and therefore may choose not to quit. Since the damage from cigarettes is cumulative, stopping at any time does improve health outcomes.