The Safety Net

Common Respiratory Conditions

 

Overview

The respiratory system is comprised of the structures we need for breathing. Breathing is the process by which oxygen in the air is brought into the lungs and into close contact with the blood, which absorbs it and carries it to all parts of the body. Waste matter (carbon dioxide) from the blood is carried out of the lungs when we breathe out. Some people develop conditions that negatively affect how this system works. The following sections provide information on a number of common respiratory conditions.

Asthma

Asthma is a condition in which the airways are narrowed due to sensitivity to inflammatory triggers. Triggers may include pollen, pet dander, tobacco smoke, and air pollution, as well as respiratory infections such as colds and flu. The severity and frequency of asthma episodes (attacks) can vary greatly; some people experience mild symptoms occasionally whereas others have significant distress on a regular basis.

Common symptoms of asthma include, but are not limited to, the following:

  • wheezing (a whistling or hissing sound when you breathe out);
  • shortness of breath;
  • tightness in the chest; and
  • a cough that lasts for more than a week.

For some people who have asthma, wheezing is not an apparent symptom. Coughing may be their primary symptom, especially at night or after exercising.

During an asthma attack, shortness of breath may become severe. The person may feel anxious and start sweating as they struggle for air. Body movements may come into play with the person leaning forward to use neck and chest muscles to help breathe. In a serious episode, the person would be unable to utter more than a few words at a time before stopping for a breath. If the person’s supply of oxygen becomes very limited, he or she can become drowsy and confused, and skin color can take on a bluish tinge. When this occurs, emergency treatment is necessary.

Evaluation, diagnosis, and treatment of asthma allow most people to lead normal lives. A variety of medications are available, including those that are administered via inhalers. Working with a physician to develop and implement an individualized asthma management plan can help to prevent episodes and handle those that do occur. These plans may include not only medication, but also strategies for avoiding or limiting exposure to known triggers.


Chronic Obstructive Pulmonary Disease (COPD)

COPD is the persistent obstruction of the airways caused by emphysema and/or chronic bronchitis. Emphysema results from a breakdown of the walls of the tiny lung air sacs (alveoli) which then causes over-inflation and a decrease in lung function. Chronic bronchitis is the inflammation, and eventually, the scarring of the lining of the bronchial tubes. These two conditions are frequently found together causing obstruction of airflow through the lungs. This comes on gradually over many years.

Between 80% and 90% of cases of COPD are caused by smoking. Other causes of COPD include frequent lung infections, exposure to certain industrial pollutants, and a metabolic deficiency related to digestive enzymes. The most important way to prevent COPD is to avoid smoking. Never starting to smoke in the first place, or quitting if you do smoke, is the most critical preventative measure related to COPD.

Available treatments for COPD include the following:

  • smoking cessation;
  • avoidance of environmental pollutants, including second hand smoke;
  • medications for bronchial dilation, inflammation, and bacterial infections;
  • long term oxygen therapy;
  • pulmonary rehabilitation programs, including exercises to strengthen muscles used in breathing; and
  • surgical procedures, including lung transplantation.

Physicians can assist people who have COPD to live more comfortably with this condition for many years. Short of lung transplants, however, currently there is no cure.

Pneumonia

Pneumonia is a serious infection or inflammation of one or both lungs. It is caused by viruses, bacteria, and occasionally, by parasites and other organisms. In pneumonia, the air sacs in the lung fill with fluid making it difficult for oxygen to reach the bloodstream. Pneumonia typically starts when a person inhales air particles that are infected. Pneumonia can also develop during or after an upper respiratory infection such as a cold or the flu. Complications from other viral illnesses such as measles or chicken pox may also result in pneumonia. Symptoms of viral pneumonia develop gradually and are frequently less obvious and severe than symptoms of bacterial pneumonia. It is not uncommon for viral pneumonia to go unnoticed due to the limited degree of symptoms.

People who have bacterial pneumonia have symptoms that usually come on suddenly. Common symptoms experienced by many people include:

  • cough, frequently productive with rusty, green, or blood-tinged discolored mucus (sputum) from the lungs;
  • fever, with chills;
  • rapid, often shallow, breathing and/or shortness of breath;
  • chest wall pain, often worse when coughing or inhaling;
  • rapid heart beat; and
  • fatigue or feeling of weakness

People who are at risk for serious complications of bacterial pneumonia can reduce their chances of infection by receiving the pneumococcal vaccine (Pneumovax). This vaccine can be administered at any time throughout the year. A one-time dose may be sufficient for people age 65 or older. Some people may require revaccination at 5-year intervals. Individuals' physicians can provide the person-by-person guidance regarding appropriateness and frequency of pneumococcal vaccination.

The pneumococcal vaccine provides protection against almost all types of bacteria that cause pneumococcal infections. It is not effective in preventing other types of pneumonia. As with flu vaccines, the pneumococcal vaccine cannot give you pneumonia because it does not contain live bacteria. The Centers for Disease Control and Prevention (CDC) recommends that a pneumococcal vaccine be administered to persons who:

  • are age 65 or older;
  • reside in a nursing home or other long-term care facility;
  • belong to certain Native-American populations;
  • are transplant recipients;
  • receive drugs that lower the body’s resistance to infection, such as certain cancer drugs and long-term steroids;
  • undergo radiation therapy;
  • have sickle cell disease;
  • have had their spleen removed;
  • have heart, liver, or lung disease (excluding asthma);
  • have alcoholism;
  • have diabetes;
  • have kidney failure requiring dialysis; and
  • have HIV or AIDS.

As with all types of preventative and ongoing health concerns, physicians are in the best position to offer advice and insight into the planning process for persons with respiratory risk factors.

Aspiration Pneumonia

Another type of pneumonia can develop when a person aspirates (inhales) food, vomit, or mucus into the lungs. This is referred to as Aspiration Pneumonia. Many individuals with developmental disabilities are considered at high risk for aspiration and aspiration pneumonia. It should be noted that pneumonia does not always develop as a result of aspiration. The risk of a person developing pneumonia increases when there are frequent episodes of aspiration, the aspirated matter is large, acidic (such as stomach contents), or infected (such as matter from periodontal disease).

Risk factors for aspiration pneumonia include, but are not limited to, the following:

  • history of recurrent pneumonia or other respiratory infections;
  • dysphagia (difficulties with swallowing)
  • GERD (gastro-esophageal reflux disease)
  • enteral (tube) feeding
  • scoliosis
  • spasticity
  • seizure activity
  • inability to feed oneself

All of these risk factors should be taken into consideration when planning with the consumer for their health needs.

Persons who have aspiration pneumonia may exhibit the following symptoms:

  • coughing
  • wheezing
  • intermittent fevers (typically low grade)
  • weight loss
  • dehydration
  • rumination

Individualized treatment for aspiration pneumonia may include hospitalization, use of antibiotic medications, and various other types of supportive care. Treatment interventions may include cessation of oral eating, modification of feeding techniques, airway protection, positioning, oxygen, and nebulizer treatments.

Influenza

Influenza, the flu, is caused by a virus that infects the respiratory system. It is spread when an infected person coughs, sneezes, and talks, sending the virus into the air where others can inhale it. People may also become infected by touching surfaces such as doorknobs or telephones where the virus is present, and then by touching their nose or mouth. The flu is highly contagious. To help prevent the spread of the virus, people should practice consistent hand washing and do their best to keep their hands away from their nose and mouth.

The CDC estimates that 10% to 20% of U.S. residents will get the flu each year. The CDC also estimates that 114,000 people will be hospitalized and 36,000 will die as a result of influenza. According to the National Center for Health Statistics, approximately 192 million days will be spent in bed due to people having with the flu. Most people recover from the flu within a week or two. Some people who become ill with the flu are at greater risk for developing pneumonia and other serious complications.

The CDC’s traditional recommendations on who should get a flu shot (and when) have included priorities for certain high risk groups. This means that people who are at greater risk from the flu and its potential complications should be the first people to get the vaccine. These include:

  • persons age 50 years or older;
  • young children age 6 months to 23 months;
  • persons who reside in long-term care facilities and have long-term illnesses;
  • adults and children (age 6 months or older) who have chronic heart or lung conditions (including asthma), chronic kidney disease, weakened immune systems, or metabolic diseases such as diabetes;
  • women who will be more than 3 months pregnant during the flu season; and
  • people working in health care or related settings to prevent infecting those in their care.

This year, however, the CDC is recommending that everyone (with the few exceptions noted below) receive a flu vaccine. It has been reported nationally that the virus expected to hit the U.S. this season is very potent. There is plenty of vaccine to go around and people are urged to take advantage of it.

The following people SHOULD NOT receive flu shots:

  • persons who have a severe allergy to eggs;
  • persons who have had a severe reaction to a flu shot in the past; and
  • persons who have developed Guillain-Barre' Syndrome during the 6-week period following a flu shot.

One myth about the flu is that the vaccine in flu shots causes the flu. This is not true. The flu vaccine used in the United States is made from inactivated (killed) flu viruses. This vaccine cannot cause the flu or flu illness. There is also a new form of the vaccine available that is administered in a nasal spray. People should contact their physician or health care professional regarding the most appropriate means of protection against the flu virus.

There are things that can alleviate flu symptoms. Resting and drinking plenty of fluids are both very helpful. Avoiding alcohol and tobacco is also recommended. Some over-the-counter medications may be used to lessen the symptoms, as long as your physician approves their use. Children and teenagers should avoid taking aspirin due to the possibility of developing the rare but serious illness called Reye Syndrome.

Resources

The following websites contain a wealth of information for anyone interested in conditions that impact respiratory health.


American Lung Association
www.lungusa.org

Centers for Disease Control and Prevention
www.cdc.gov

NIH/National Heart, Lung and Blood Institute Information Center
www.nhlbiinfo@rover.nhlbi.nih.gov

University of New Mexico Continuum of Care
www.unmcoc.org

 

Return To Article