Pulmonary & Respiratory Medicine

Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severity of the condition is variable. It is usually caused by infection with viruses or bacteria, and less commonly by other microorganisms. Identifying the responsible pathogen can be difficult.

A type of disease that affects the lungs and other parts of the respiratory system. Pulmonary diseases may be caused by infection, by smoking tobacco, or by breathing in secondhand tobacco smoke, radon, asbestos, or other forms of air pollution. Pulmonary diseases include asthma, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, pneumonia, and lung cancer. Also called lung disorder and respiratory disease.

Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, coughing, chest tightness, and shortness of breath. These may occur a few times a day or a few times per week. Depending on the person, asthma symptoms may become worse at night or with exercise. Asthma is thought to be caused by a combination of genetic and environmental factors. Environmental factors include exposure to air pollution and allergens.

Tuberculosis (TB) is an infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, in which case it is known as latent tuberculosis. Around 10% of latent infections progress to active disease which, if left untreated, kill about half of those affected. Typical symptoms of active TB are chronic cough with blood-containing mucus, fever, night sweats, and weight loss. It was historically referred to as consumption due to the weight loss associated with the disease. Infection of other organs can cause a wide range of symptoms.Tuberculosis is spread from one person to the next through the air when people who have active TB in their lungs cough, spit, speak, or sneeze.

Influenza, commonly known as "the flu", is an infectious disease caused by influenza viruses. Symptoms range from mild to severe and often include fever, runny nose, sore throat, muscle pain, headache, coughing, and fatigue. These symptoms begin from one to four days after exposure to the virus (typically two days) and last for about 2–8 days. Diarrhea and vomiting can occur, particularly in children. Influenza may progress to pneumonia, which can be caused by the virus or by a subsequent bacterial infection. Other complications of infection include acute respiratory distress syndrome, meningitis, encephalitis, and worsening of pre-existing health problems such as asthma and cardiovascular disease.

Lung cancer, also known as lung carcinoma (since about 98–99% of all lung cancers are carcinomas), is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung.[9] Lung carcinomas derive from transformed, malignant cells that originate as epithelial cells, or from tissues composed of epithelial cells. Other lung cancers, such as the rare sarcomas of the lung, are generated by the malignant transformation of connective tissues (i.e., nerve, fat, muscle, bone), which arise from mesenchymal cells. Lymphomas and melanomas (from lymphoid and melanocyte cell lineages) can also rarely result in lung cancer.

Cystic fibrosis (CF) is a rare genetic disorder that affects mostly the lungs, but also the pancreas, liver, kidneys, and intestine. Long-term issues include difficulty breathing and coughing up mucus because of frequent lung infections. Other signs and symptoms may include sinus infections, poor growth, fatty stool, clubbing of the fingers and toes, and infertility in most males. Different people may have different degrees of symptoms.

Pulmonary fibrosis is a condition in which the lungs become scarred over time. Symptoms include shortness of breath, a dry cough, feeling tired, weight loss, and nail clubbing. Complications may include pulmonary hypertension, respiratory failure, pneumothorax, and lung cancer. Causes include environmental pollution, certain medications, connective tissue diseases, infections, and interstitial lung diseases

Pulmonary hypertension (PH or PHTN) is a condition of increased blood pressure in the arteries of the lungs. Symptoms include shortness of breath, fainting, tiredness, chest pain, swelling of the legs, and a fast heartbeat. The condition may make it difficult to exercise. Onset is typically gradual. A patient is deemed to have pulmonary hypertension if the pulmonary mean arterial pressure is greater than 25mmHg at rest, or greater than 30mmHg during exercise

Surgery, radiation, chemotherapy, targeted therapy, immunotherapy, and combinations of these treatments are available for treating lung cancer. Scientists now have some encouraging findings for advanced-stage lung cancer,  but researchers continue to explore for novel therapy options for all stages of the disease.

A new coronavirus called SARS-CoV-2 appeared in 2019, sparking a pandemic over the world. Its condition, COVID-19, has the potential to cause mild to severe respiratory sickness as well as mortality. Fever, coughing, exhaustion, bodily aches, and a loss of taste or smell are just a few of the symptoms that can appear. In the face of this immediate health hazard, VA has put in place a prompt public health response to safeguard and care for Veterans and personnel.

Targeted research initiatives, community engagement with Veterans, screening at VA healthcare institutions, a phased immunization deployment, and policies to safeguard patients admitted to community living facilities are some of the measures the VA has done to reduce COVID-19 spread. Visit the COVID-19 topic page to read about the clinical studies, data analytics, and research collaborations that are being conducted by the VA to develop strategies to prevent and cure the new coronavirus.

Emphysema, or pulmonary emphysema, is a lower respiratory tract disease, characterized by air-filled spaces (pneumatosis) in the lungs, that can vary in size and may be very large. The spaces are caused by the breakdown of the walls of the alveoli, and they replace the spongy lung parenchyma. This reduces the total alveolar surface available for gas exchange leading to a reduction in oxygen supply for the blood.

Oxygen therapy, also known as supplemental oxygen, is the use of oxygen as medical treatment. Acute indications for therapy include hypoxemia (low blood oxygen levels), carbon monoxide toxicity and cluster headache. It may also be prophylactically given to maintain blood oxygen levels during the induction of anesthesia. Oxygen therapy is often useful in chronic hypoxemia caused by conditions such as severe COPD or cystic fibrosis. Oxygen can be delivered via nasal cannula or face mask, or via high pressure conditions such as in endotracheal intubation or hyperbaric chamber. It can also be given through bypassing the airway, such as in ECMO therapy.

Obstructive sleep apnea (OSA) is a situation in which breathing stops involuntarily for a short time at some point in sleep. Usually, air flows smoothly from the mouth and nose to the lungs at any time. In obstructive sleep apnea, normal airflow stops again and again throughout the night. Breathing stops because the airway in the throat is too narrow. Snoring is common in obstructive sleep apnea. Obstructive sleep apnea causes episodes of decreased oxygen delivery to the brain and other parts of the body. Good sleep is poor, which causes drowsiness during the sundial and lack of clarity in the morning. There are several forms of sleep apnea, but OSAS is the most common. Obstructive sleep apnea is much more common in older people and overweight people. Evidence shows that weight loss causes improve symptoms. Sleeping in your again can irritate obstructive sleep apnea. The prognosis for obstructive sleep apnea begins with complete records and physical examinations. Daytime sleepiness and snoring are important clues.

Pulmonary rehabilitation, also known as respiratory rehabilitation, is an important part of treating and maintaining the health of people with chronic respiratory conditions who persist in symptoms or continue to decline in function despite standard treatment. This is a broad therapeutic concept. The American Thoracic Society and the European Respiratory Society describe it as an evidence-based, interdisciplinary, and comprehensive intervention for patients with chronic respiratory conditions who have symptoms and regularly reduce daily activity. In general, pulmonary rehabilitation refers to the sequence of services that are provided to patients with respiratory disease and their families, usually with the aim of improving the patient's quality of life.

Pulmonary rehabilitation can be completed in a variety of settings, depending on the patient's wishes, and may or may not include pharmacological intervention. Pulmonary rehabilitation is usually tailored to the patient's personality to meet his or her desires. It is an extensive program that can benefit people with lung conditions such as chronic obstructive pulmonary disease (COPD), sarcoidosis, idiopathic pulmonary fibrosis (IPF), and cystic fibrosis, among others.  Although the technique is aimed at rehabilitating the victim himself, the family is also involved. The system usually does not start until a scientific examination of the victim has been performed by an authorized physician.

Interventional pulmonology is a subspecialty that uses advanced diagnostic and therapeutic procedures to care for patients with benign and malignant diseases of the lung, airways, and pleura. There has been a rapid proliferation of new pulmonary procedural technologies over the last decade. Common diagnostic applications include endobronchial ultrasound, guided bronchoscopy, and several pleural disease interventions. Endobronchial ultrasound is performed with a specially design flexible bronchoscope and allows safe and accurate sampling of intrathoracic structures through the airway wall under direct visualization. Guided bronchoscopy methods are granting significant improvement in the diagnostic yield of flexible bronchoscopy. Virtual bronchoscopy, radial probe endobronchial ultrasound and electromagnetic navigational bronchoscopy are examples of these methods.

Mechanical ventilation may be defined as a life-support system designed to replace or support normal ventilatory lung function. An individual may require mechanical aid for breathing to augment or replace spontaneous ventilatory efforts to achieve medical stability or to maintain life. This support may be short-term, in the form of rescue breathing or manual ventilation, or long-term, employing more advanced techniques of artificial respiration. The patient eligible for mechanical ventilation may require a tracheostomy tube or endotracheal tube for ventilatory support.