Pulmonary

Occupational Lung Disease

Occupational lung diseases are a group of pulmonary disorders that are caused primarily by work related exposures to harmful substances, such as dusts or gases. Substances known to cause lung disease include:

  • Coal dust
  • Asbestos
  • Silicon (which is usually in the form of quartz)
  • Barium

Asbestosis

Asbestosis is caused by long-term, repeated exposure to asbestos, a natural fiber that is used for various industrial purposes, such as insulation and car brake linings. Fibers of asbestos in the air are inhaled and become lodged in the lungs. As a result, lung tissue is scarred and lungs are unable to contract and expand normally. Asbestosis also increases a persons chance of developing asbestos lung cancer and malignant mesothelioma, a rare form of cancer almost always caused by asbestos.

Symptoms of asbestosis typically do not develop until 20-30 years after initial exposure. The main symptom is shortness of breath that worsens over time.

There is currently no cureative treatment for asbestosis. Patients should end all contact with asbestos, although most people have been exposed in the past and often are retired altogether by the time they develop symptoms of the disease. Oxygen therapy is often used to relieve the shortness of breath and correct underlying hypoxia. Supportive treatment of symptoms includes:

  • Respiratory physiotherapy to remove secretions from the lungs by postural drainage
  • Chest percussion
  • Vibration
  • Nebulized medications

patients should take the annual influenza vaccination and be immunized against pneumococcal pneumonia. Quitting smoking is also highly recommended.

Chronic Beryllium Disease

Chronic beryllium disease (CBD) causes scarring of the lung tissue and occurs when a person inhales beryllium dust or fumes and has become sensitized to this material. Beryllium is a naturally occuring lightweight metal. It is used in various industries, such as electronics, aerospace, dental, aotomic energy and defense.

In the early stages, CBD may not cause any noticeable symptoms. However, over time, the following symptoms may develop:

  • Shortness of breath with physical activity
  • Dry cough that will not go away
  • Fatigue
  • Night sweats
  • Chest and joint pain
  • Loss of appetite

At this time, there is no cure for chronic beryllium disease. However, treatment is available that can help slow the progression of the disease, prevent further lung damage caused by scarring, improve oxygen levels in the bloodstream and manage symptoms.

Treatment depends on the severity of your disease and symptoms and may include the following:

Silicosis

Silicosis is a lung disease caused by the inhalation of crystalline silica dust. Silica is a common mineral found naturally in sand and rock, such as granite and sandstone. Silica scars lung and affects its ability to function normally. Inhalation of crystalline silica particles may also lead to other conditions, particularly tuberculosis. There is also a link between silicosis and lung cancer.

Silica exposure is common in mines and quarries and in a number of other occupations such as construction (especially sandblasting), foundry-work, ceramics and glass-making.

There are different types of silicosis depending on how quickly symptoms develop after exposure. The most common form is chronic silicosis, in which symptoms occur after ten years or more of overexposure. The most common symptoms are chronic dry cough and shortness of breath with physical activity.

Silicosis is an irreversible condition with no cure. Treatment options focus on alleviating symptoms and preventing complications. They include:

  • Stopping further exposure to silica
  • Avoiding other lung irritants, which includes quitting smoking
  • Cough suppressants
  • Antibiotics for bacterial lung infection
  • Bronchodilators to facilitate breathing
  • TB prophylaxis for those with positive tuberculin skin test or IGRA blood test
  • Prolonged anti-tuberculosis drug regimen for those with active TB
  • Chest physiotherapy to help the bronchial drainage of mucus
  • Oxygen administration to treat hypoxemia, if present
  • Lung transplantation to replace the damaged lung tissue is the most effective treatment, but is associated with severe risks of its own
  • For acute silicosis, Whole-lung lavage may alleviate symptoms, but does not decrease overall mortality

Nontuberculous Mycobacteria

Nontuberculous mycobacteria (NTM) is a group of bacteria, normally found in soil and water and some domestic and wild animals, that can cause severe lung disease. Although NTM naturally exists in the environment and doesn’t affect most people, some develop an NTM infection when they inhale the bacteria in the air or water mist, or when they drink water containing NTM.

Each year in North America, about two in every 100,000 people develop an NTM infection.

Some people who are susceptible to the infection have an unknown defect in their lung structure or immune system, lung damage from a pre-existing chronic obstructive pulmonary disease (COPD), such as emphysema and bronchiectasis, or an immune deficiency disorder, such as HIV or AIDS. Pulmonary disease caused by NTM is most often seen in post-menopausal women.

NTM does not cause tuberculosis (TB), and unlike TB, which is spread from person to person, NTM is not contagious.

Diagnosing NTM can be difficult because symptoms may be similar to other lung conditions.

Although nontuberculous mycobacteria can affect all organs of the body, the condition primarily affects the lungs. Symptoms typically progress slowly and may include:

  • Cough
  • Fever
  • Weight loss
  • Lack of appetite
  • Night sweats
  • Blood in the sputum
  • Loss of energy

Treatment for nontuberculous mycobacteria will depend on the specific bacteria causing your infection. Treatment may be difficult because NTM bacteria may be resistant to many common types of antibiotics. For some patients, the same drugs used to treat tuberculosis (TB) will be recommended.

To avoid becoming resistant to medications, you may need to take several types of antibiotics at the same time. These drugs may cause side effects. The length of treatment varies, depending on the severity of the disease.

Kleine-Levin Syndrome

Kleine-Levin syndrome is a rare disorder is characterized by recurring but reversible periods of excessive sleep (up to 20 hours per day).

Kleine-Levin syndrome primarily affects adolescent males (approximately 70 percent of those with Kleine-Levin syndrome are male).

Symptoms may be related to malfunction of the hypothalamus and thalamus, parts of the brain that govern appetite and sleep.

Symptoms occur as “episodes”, typically lasting a few days to a few weeks. Episode onset is often abrupt, and may be associated with flu-like symptoms. During episodes, the following may be observed:

  • Excessive food intake
  • Irritability
  • Childishness
  • Disorientation
  • Hallucinations
  • An abnormally uninhibited sex drive

Mood can be depressed as a consequence, but not a cause, of the disorder. Affected individuals are completely normal between episodes, although they may not be able to remember afterwards everything that happened during the episode. It may be weeks or more before symptoms reappear. Episodes eventually decrease in frequency and intensity over the course of eight to 12 years.

There is no definitive treatment for Kleine-Levin syndrome and watchful waiting at home, rather than pharmacotherapy, is most often advised. Stimulant pills, including amphetamines, methylphenidate, and modafinil, are used to treat sleepiness but may increase irritability and will not improve cognitive abnormalities. Because of similarities between Kleine-Levin syndrome and certain mood disorders, lithium and carbamazepine may be prescribed and, in some cases, have been shown to prevent further episodes. This disorder should be differentiated from cyclic re-occurrence of sleepiness during the premenstrual period in teen-aged girls, which may be controlled with birth control pills. It also should be differentiated from encephalopathy, recurrent depression, or psychosis.

Interstitial Lung Disease

Interstitial lung disease (ILD) refers to a group of lung diseases affecting the tissue and space around the air sacs of the lungs (the interstitium). It concerns alveolar epithelium, pulmonary capillary endothelium, basement membrane, perivascular and perilymphatic tissues.

Interstitial lung diseases include:

  • Hypersensitivity Pneumonitis
  • Idiopathic Pulmonary Fibrosis
  • Sarcoidosis

Hypersensitivity Pneumonitis

Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by repeated inhalation of certain fungal, bacterial, animal protein or reactive chemical particles, called antigens. While most people who breathe in these antigens don’t develop problems, in some people, the body’s immune reaction to these particles causes inflammation of the lung. In some cases, parts of the lungs may become scarred.

HP should not be confused with the more common types of allergies, which are caused by small amounts of proteins in the environment such as dust mites, cat dander, pollen and grass. Having seasonal or environmental allergies has nothing to do with having or developing HP.

It’s not known why a minority of people exposed to these antigens develop HP. Their genetics and environment may interact to make them more susceptible to the disease.

Hypersensitivity pneumonitis (HP) is subdivided into two forms: acute and chronic. Symptoms differ for each form.

  • The acute form of HP occurs after heavy, often short-term exposure to the antigen. Symptoms appear relatively suddenly and include fever, chills, fatigue, breathlessness, chest tightness and cough. If the person is removed from the antigen exposure, the symptoms usually resolve over 24 to 48 hours. Recovery is often complete.
  • The chronic form of HP is thought to occur due to longer term, low-level exposure to the antigen, and it often causes more subtle symptoms. Patients with chronic HP often describe chronic symptoms, such as shortness of breath or cough, that have gotten worse. Symptoms may worsen at work, at home or wherever the patient is being exposed to the antigen, but most often, patients with chronic HP haven’t had acute episodes.

The best treatment is to avoid the provoking allergen, as chronic exposure can cause permanent damage. Corticosteroids such as Prednisolone may help to control symptoms but may produce side-effects.

In addition to medications and removal of the antigen, pulmonary rehabilitation — a structured exercise and educational program designed for patients with chronic lung disease — is an important and effective treatment for patients with chronic HP.

Lung transplant may be an effective treatment option for some patients.

Idiopathic Pulmonary Fibrosis

Idiopathic pulmonary fibrosis, or IPF, is a condition that causes progressive scarring of the lungs. Fibrous scar tissue builds up in the lungs over time, affecting their ability to provide the body with enough oxygen.

IPF affects more than 100,000 people in North America, with 30,000 to 40,000 new cases diagnosed each year. Typically the disease is found in people between the ages of 50 and 70 and affects men more frequently than women. Most patients are former smokers. There are no proven risk factors for IPF, but a minority of patients does have a family history of lung scarring.

The cause of the condition is unknown.

Symptoms and signs of IPF often appear gradually and include:

  • Shortness of breath, particularly during or after physical activity
  • Chronic, dry hacking cough
  • Crackles in the lungs heard through a stethoscope
  • Rounding of the fingernails, a condition called clubbing

Symptoms of IPF may mimic those of other diseases that cause lung scarring, so diagnosing IPF often involves ruling out other conditions. Several visits with your doctor may be needed to finalize your diagnosis and treatment approach.

There is no cure for IPF and currently no satisfactory treatment exists. Medical studies suggest a potential role for several therapies, but further study is needed.

Pulmonary rehabilitation — a structured exercise and educational program designed for patients with chronic lung disease — is important for patients with IPF. Lung transplant may be an effective treatment option for some patients.

Sarcoidosis

Sarcoidosis is a disorder that causes inflamed tissue called nodules or granulomas to develop in the body’s organs, most often the lungs. It can also affect the skin, eyes, nose, muscles, heart, liver, spleen, bowel, kidney, testes, nerves, lymph nodes and brain. Nodules in the lungs can lead to narrowing of the airways and inflammation, also called fibrosis, of lung tissue.

Sarcoidosis affects people of all ages, races and gender, though it most commonly occurs in people between 20 to 40 years old. Children are rarely diagnosed with the disease. In very few cases, more than one family member is affected. African Americans are three to four times more likely to have sarcoidosis and may have a more severe form of the disease than people of European descent.

The exact cause of sarcoidosis is not known.

Symptoms of sarcoidosis may differ in each person and depends on the organs affected. Frequently, the condition causes mild symptoms and resolves on its own without treatment. In approximately half of all patients, sarcoidosis is detected on a routine chest X-ray before any symptoms develop.

The most common symptoms of sarcoidosis involving the lungs include:

  • Cough
  • Shortness of breath
  • Chest pain, which is usually a vague tightness of the chest, but can occasionally be severe and similar to the pain of a heart attack
  • Fatigue
  • Weakness
  • Fever
  • Weight loss

There is no specific treatment to cure the condition at this time. Fortunately, between 30 and 70% of patients do not require therapy because the nodules gradually resolve on their own and leave behind few, if any, signs of inflammation or other complications.

However, treatment is necessary in some cases. Medications are available that effectively suppress symptoms and help reduce lung inflammation, the impact of nodules and prevent the development of lung fibrosis. These include:

  • Corticosteroids
  • Methotrexate
  • Cyclophosphamide and Azathioprine
  • Antimalarial Medications (Hydroxychloroquine)
  • Colchicine

A number of other medications are currently being investigated for the treatment of sarcoidosis

Cystic Fibrosis

Cystic fibrosis (CF) is a chronic, progressive and frequently fatal genetic disease of the body’s mucus glands that often causes severe respiratory and digestive disorder. The disease causes the body to produce an abnormally thick, sticky mucus that obstructs the pancreas, preventing enzymes from reaching the intestines to digest food. The sweat glands and the reproductive system also are usually involved.

CF is caused by a mutation in the gene for the protein cystic fibrosis transmembrane conductance regulator (CFTR). In North America, cystic fibrosis affects about 30,000 children and adults. Caucasians of Northern European ancestry have the greatest chance of being carriers of the cystic fibrosis gene.

Cystic fibrosis has a variety of symptoms including:

  • Very salty-tasting skin
  • Persistent coughing, wheezing or pneumonia
  • Excessive appetite but poor weight gain
  • Bulky stools

The sweat test is the standard diagnostic test for cystic fibrosis. This simple and painless test measures the amount of salt in the sweat. A high salt level can indicate that a person has CF.

People who carry traits for these disorders may not have symptoms. However, if both parents are carriers of the same abnormal gene, the chance of having an affected child is 1 in 4, or 25 percent, for each pregnancy. A special blood test, called a carrier test, may be able to tell if you carry such a trait.

While there are no cures for cystic fibrosis there are several treatment methods. Disease management is aimed at maximizing organ function and consists of proactive treatment of airway infection, and encouragement of good nutrition and an active lifestyle. Current treatments only delay the decline in organ function at best. Targets for therapy are the lungs, gastrointestinal tract, the reproductive organs, and psychological support.

With improved treatments, the lifespan of individuals with cystic fibrosis has increased so that on average it now is about 30 years.

Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) refers to a group of lung conditions that interfere with normal breathing, including:

  • Bronchiectasis
  • Chronic bronchitis
  • Emphysema
  • Alpha 1 antitrypsin deficiency

These diseases cause a chronic, permanent and typically progressive obstruction of airflow in the lungs.

Bronchiectasis

Bronchiectasis is a type of chronic obstructive pulmonary disease (COPD) in which mucus accumulates and sticks in the airways of the lungs, called bronchi. As a result, the airways become infected and inflamed, eventually leading to enlarged and weak airways, which allows more mucus and bacteria to accumulate.

Bronchiectasis most often affects children, although people of all ages are diagnosed with the condition.

It can be caused by lung injury from other conditions, including cystic fibrosis, tuberculosis, pneumonia and immunodeficiency disorders, such as HIV and AIDS.

Symptoms of bronchiectasis vary for each person and in rare cases, a patient may not experience any symptoms at all. However, common symptoms may include:

  • Cough, which worsens when lying down
  • Shortness of breath
  • Abnormal chest sounds
  • Weakness
  • Weight loss
  • Fatigue
  • Discolored or foul smelling mucus, or mucus that contains blood

The goal of treatment for bronchiectasis is to treat any underlying conditions causing lung injury, help remove mucus from the lungs and prevent further complications.

Treatment may include:

  • Bronchodilator Medications
  • Steroids — Inhaled as an aerosol spray
  • Antibiotics
  • Mucus Thinners and Expectorants
  • Respiratory Therapy
  • Surgery — Lung volume reduction surgery, during which small wedges of damaged lung tissue are removed, may be recommended for some patients with severe cases of bronchiectasis.
  • Lung Transplant — In very severe cases, lung transplantation may be an option for some patients.

Chronic Bronchitis

Chronic bronchitis is a common type of chronic obstructive pulmonary disease (COPD) in which the air passages in the lungs — the bronchi — are repeatedly inflamed, leading to scarring of the bronchi walls. As a result, excessive amounts of sticky mucus are produced and fill the bronchial tubes, which become thickened, impeding normal airflow through the lungs.

Chronic bronchitis affects millions of North Americans each year. Cigarette smoking is the number one risk factor for developing chronic bronchitis. Over 90 percent of patients with chronic bronchitis have a smoking history, although only 15 percent of all cigarette smokers are ultimately diagnosed with some type of COPD, such as chronic bronchitis.

People with chronic bronchitis develop a persistent mucus-producing cough present most days of the month, or for three months of the year for two successive years. Other symptoms include frequent clearing of the throat and shortness of breath.

The goal of therapy for chronic bronchitis is to relieve symptoms, prevent complications and slow the progression of the disease. Quitting smoking is also essential for patients with chronic bronchitis, since continuing to use tobacco will only further damage the lungs.

Treatment may include:

  • Bronchodilator Medications
  • Steroids — Inhaled as an aerosol spray
  • Antibiotics
  • Vaccines — flu shot annually and pneumonia shot every five to seven years
  • Oxygen Therapy
  • Surgery — Lung volume reduction surgery, during which small wedges of damaged lung tissue are removed, may be recommended for some patients with chronic bronchitis.
  • Pulmonary Rehabilitation
    • Education
    • Nutrition counseling
    • Learning special breathing techniques
    • Help with quitting smoking
    • Starting an exercise regimen

Because people with chronic bronchitis are often physically limited, they may avoid any kind of physical activity. However, regular physical activity can actually improve a patient’s health and wellbeing.

Emphysema

When you breathe, air travels to your lungs through airways called bronchi. The bronchi divide into smaller airways, called bronchioles, which end in clusters of tiny air sacs, called alveoli. Emphysema affects the walls of the millions of tiny air sacs in the lungs, which become inflamed and loose elasticity, causing the bronchioles to collapse. As a result, air becomes trapped in the air sacks, which become overstretched and may rupture, greatly affecting a person’s ability to breathe normally.

Emphysema is the fourth leading cause of death in North America. The leading cause of emphysema is cigarette smoking. Other risks factors include:

  • Air pollution
  • Occupational exposure to dust and chemicals
  • Frequent lower respiratory infections
  • Second hand smoke

In rare cases, the genetic disorder — alpha-1 antitrypsin (AAT) deficiency — causes emphysema.

A person with emphysema will have shortness of breath — during physical activity and when the condition is more advanced, also during rest. Patients may eventually need supplemental oxygen and may have to rely on mechanical respiratory devices. Other symptoms of emphysema include chronic cough, frequent respiratory infections, reduced appetite, weight loss and fatigue.

The goal of therapy for emphysema is to provide relief of symptoms, prevent complications and slow the progression of the disease. Quitting smoking is also essential for patients with emphysema, since continuing to use tobacco will only further damage the lungs.

Treatments include:

  • Bronchodilator Medications
  • Steroids – Inhaled as an aerosol spray
  • Antibiotics
  • Vaccines – flu shot annually and pneumonia shot every five to seven years
  • Oxygen Therapy
  • Surgery or Lung Transplant
  • Protein Therapy – Patients with emphysema caused by an alpha-1 antitrypsin (AAT) deficiency may be given infusions of AAT to help slow the progression of lung damage.
  • Pulmonary Rehabilitation
    • Education
    • Nutrition counseling
    • Learning special breathing techniques
    • Help with quitting smoking
    • Starting an exercise regimen

Because people with emphysema are often physically limited, they may avoid any kind of physical activity. However, regular physical activity can actually improve a patient’s health and wellbeing.

Tuberous Sclerosis

Tuberous sclerosis (TSC) is a rare genetic disease that causes benign tumors to grow in the brain and on other vital organs such as the kidneys, heart, eyes, lungs, and skin. It commonly affects the central nervous system.

TSC may be present at birth, but signs of the disorder can be subtle and full symptoms may take some time to develop.

In addition to the benign tumors that frequently occur in TSC, other common symptoms include:

  • Seizures
  • Mental retardation
  • Behavior problems
  • Skin abnormalities

Three types of brain tumors are associated with TSC:

  • Cortical tubers – which generally form on the surface of the brain
  • Subependymal nodules – which form in the walls of the ventricles (the fluid-filled cavities of the brain)
  • Giant-cell astrocytomas – a type of tumor that can block the flow of fluids within the brain

The prognosis for individuals with TSC depends on the severity of symptoms. Individuals with mild symptoms generally do well and live long productive lives, while individuals with the more severe form may have serious disabilities. In rare cases, seizures, infections, or tumors in vital organs such as the kidneys and brain can lead to severe complications and even death. However, with appropriate medical care, most individuals with the disorder can look forward to normal life expectancy.

There is no cure for TSC, although treatment is available for a number of the symptoms. The generic drug everolimus is approved to treat benign tumors called subependymal giant cell astrocytomas (SEGA) in individuals with tuberous sclerosis who require treatment but are not candidates for surgery. Antiepileptic drugs may be used to control seizures and medications may be prescribed for behavior problems. Intervention programs, including special schooling and occupational therapy, may benefit individuals with special needs and developmental issues. Surgery, including dermabrasion and laser treatment, may be useful for treatment of skin lesions. Because TSC is a lifelong condition, individuals need to be regularly monitored by a doctor. Due to the many varied symptoms of TSC, care by a clinician experienced with the disorder is recommended.

Tuberculosis

Tuberculosis (TB) is a common and often deadly infectious disease caused by various strains of mycobacteria in humans. The slow-growing bacteria that cause TB grow best in areas of the body that have lots of blood and oxygen, which is why it is most often found in the lungs (called pulmonary TB). But TB can also spread to other parts of the body, which is called extrapulmonary TB.

Tuberculosis is either latent or active.

  • Latent TB means that you have the TB bacteria in your body, but your body’s immune system are keeping it from turning into active TB. This means that you don’t have any symptoms of TB right now and can’t spread the disease to others. If you have latent TB, it can become active TB.
  • Active TB means that the TB bacteria are growing and causing symptoms. If your lungs are infected with active TB, it is easy to spread the disease to others.

Pulmonary TB is contagious. It spreads when a person who has active TB breathes out air that has the TB bacteria in it and then another person breathes in the bacteria from the air. An infected person releases even more bacteria when he or she does things like cough or laugh.

If TB is only in other parts of the body (extrapulmonary TB), it does not spread easily to others.

Some people are more likely than others to get TB. This includes people who:

  • Have HIV or another illness that weakens their immune system.
  • Have close contact with someone who has active TB, such as living in the same house as someone who is infected with TB.
  • Care for a patient who has active TB, such as doctors or nurses.
  • Live or work in crowded places such as prisons, nursing homes, or homeless shelters, where other people may have active TB.
  • Have poor access to health care, such as homeless people and migrant farm workers.
  • Abuse drugs or alcohol.
  • Travel to or were born in places where untreated TB is common, such as Latin America, Africa, Asia, Eastern Europe, and Russia.

It is important for people who are at a high risk for getting TB to get tested once or twice every year.

Most of the time when people are first infected with TB, the disease is so mild that they don’t even know they have it. People with latent TB don’t have symptoms unless the disease becomes active.

Symptoms of active TB may include:

  • A cough that brings up thick, cloudy, and sometimes bloody mucus from the lungs (called sputum) for more than 2 weeks.
  • Tiredness and weight loss.
  • Night sweats and a fever.
  • A rapid heartbeat.
  • Swelling in the neck (when lymph nodes in the neck are infected).
  • Shortness of breath and chest pain (in rare cases).

Doctors usually find latent TB by doing a tuberculin skin test. During the skin test, a doctor or nurse will inject TB antigens under your skin. If you have TB bacteria in your body, within 2 days you will get a red bump where the needle went into your skin. The test can’t tell when you became infected with TB or if it can be spread to others.

To find pulmonary TB, doctors test a sample of mucus from the lungs (sputum) to see if there are TB bacteria in it. Doctors sometimes take a chest X-ray to help find pulmonary TB.

To find extrapulmonary TB, doctors can take a sample of tissue (biopsy) to test, do a CT scan, or an MRI.

Treatment is often a success, but it is a long process. It takes about 6 to 9 months to treat TB. Most of the time, doctors combine four antibiotics to treat active TB. It’s important to take the medicine for active TB for at least 6 months. Almost all people are cured following this treatment. If tests still show an active TB infection after 6 months, then treatment continues for another 2 or 3 months.

Most people with latent TB are treated with only one antibiotic that they take for 9 months. This reduces their risk for getting active TB.

TB can only be cured if you take all the doses of your medicine. A doctor or nurse may have to watch you take it to make sure that you never miss a dose and that you take it the proper way. You may have to go to the doctor’s office every day, or a nurse may come to your home or work. This is called direct observational treatment. It helps people follow all of the instructions and keep up with their treatment, which can be complex and take a long time. Cure rates for TB have greatly improved because of this type of treatment.

If active TB is not treated, it can damage your lungs or other organs and can be fatal.

Pneumonia

Pneumonia is an inflammatory condition of the lung. It is often characterized as inflammation of the the alveoli and abnormal alveolar filling with fluid. The alveoli are microscopic air filled sacs in the lungs responsible for exchanging carbon dioxide for oxygen.

You can get community-associated pneumonia in your daily life, such as at school or work. Healthcare-associated pneumonia is contracted when you are in a hospital or nursing home. This type of pneumonia may be more severe because you already are ill.

Germs called bacteria or viruses usually cause pneumonia. Pneumonia usually starts when you breathe the germs into your lungs. You may be more likely to get the disease after having a cold or the flu. These illnesses make it hard for your lungs to fight infection, so it is easier to get pneumonia. Other risk factors include:

  • Asthma
  • Heart disease
  • Cancer
  • Diabetes

Symptoms of pneumonia caused by bacteria usually come on quickly. They may include:

  • Cough. You will likely cough up mucus (sputum) from your lungs. Mucus may be rusty or green or tinged with blood.
  • Fever.
  • Fast breathing and feeling short of breath.
  • Shaking and “teeth-chattering” chills. You may have this only one time or many times.
  • Chest pain that often feels worse when you cough or breathe in.
  • Fast heartbeat.
  • Feeling very tired or feeling very weak.
  • Nausea and vomiting.
  • Diarrhea.

When you have mild symptoms, your doctor may call this “walking pneumonia.”

Older adults may have different, fewer, or milder symptoms. They may not have a fever, or they may have a cough but not bring up mucus. The main sign of pneumonia in older adults may be a change in how well they think. Confusion or delirium is common. Or, if they already have a lung disease, that disease may get worse.

Symptoms caused by viruses are the same as those caused by bacteria. But they may come on slowly and often are not as obvious or as bad.

If you are older than 65, you smoke, or you have a heart or lung problem, you may want to get a pneumococcal vaccine. It may not keep you from getting pneumonia. But if you do get pneumonia, you probably will not be as sick.

You can also lower your chances of getting pneumonia by staying away from people who have the flu, colds, measles, or chicken pox. You may get pneumonia after you have one of these illnesses. Wash your hands often. This helps prevent the spread of viruses and bacteria that may cause pneumonia.

For most people, pneumonia can be treated at home. It often clears up in 2 to 3 weeks. But older adults, babies, and people with other diseases can become very ill and they may need to be in the hospital.

Antibiotics are used to treat pneumonia is caused by bacteria. Pneumonia caused by a virus is treated only with home care, including:

  • Get plenty of rest and sleep
  • Drink lots of liquids
  • Do not smoke
  • If your cough keeps you awake at night, talk to your doctor about using cough medicine

Lung Cancer

Lung cancer is the growth of abnormal cells in one or both lungs. These cells can multiply rapidly and turn into tumors that interfere with the function of the lungs and, eventually, spread to other parts of the body.

Lung cancer is the second most common kind of cancer diagnosed in North America, and accounts for nearly a third of all cancer deaths. Most people who get lung cancer were cigarette smokers, but non-smokers get it too. Exposure to radon, asbestos, and secondhand smoke are also risk factors. In some cases, there is no known cause.

One of the challenging aspects of lung cancer is that it may be years before symptoms emerge. By the time it’s diagnosed, about half the patients have cancer that’s already spread outside the lungs.

Common signs and symptoms of lung cancer include:

  • A cough that doesn’t go away and gets worse over time
  • Constant chest pain
  • Coughing up blood
  • Shortness of breath, wheezing or hoarseness
  • Repeated problems with pneumonia or bronchitis
  • Swelling of the neck and face
  • Loss of appetite or weight loss
  • Fatigue

Cancers that begin in the lungs are divided into two major types — small cell lung cancer and non-small cell cancer. The two types are distinguished by how the cancer cells look under a microscope. Each type of lung cancer grows and spreads differently and calls for different treatment.

Non-small cell lung cancer is more common and generally grows more slowly. There are four main types of this cancer. They are named for the cells in which the cancer develops:

  • Squamous cell carcinoma
  • Adenocarcinoma
  • Bronchoalveolar carcinoma
  • Large cell carcinoma

Small cell lung cancer, sometimes called oat cell cancer, is less common. This type of lung cancer grows more quickly and is more likely to spread to other organs.

Treatment for lung cancer depends on the cancer’s specific cell type, how far it has spread, and the patient’s performance status. Common treatments include surgery, chemotherapy, and radiation therapy.