Interstitial (Nonidiopathic) Pulmonary Fibrosis: Practice Essentials, Pathophysiology, Etiology



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What Causes Shortness Of Breath (Dyspnea)?

Shortness of breath (dyspnea) can be uncomfortable, even stressful, if you've ever thought, "I can breathe, but I feel like I can't." The feeling that you're not getting enough air can come on suddenly whether you are active or sedentary. It's normal for strenuous exercise, temperature changes, and obesity to make breathing difficult.

Shortness of breath may also indicate a health condition if your breathing suddenly changes for no reason you can identify. More severe causes include pneumonia, asthma, and heart problems. Read on to learn why you may feel like you can't breathe when you are.

A blockage in the upper airway can narrow breathing passages, making it hard for air to travel naturally in and out of your body. This might cause shortness of breath as a result. The upper airway includes the larynx (voice box), pharynx (throat), and trachea (windpipe). Inflammation, which is an immune response to infection or injury, is a common cause of irritated lungs. Acute (short-term) inflammation is typically not dangerous. Chronic (long-term) inflammation may damage the airways and tissues in the lungs, making it harder to breathe. Causes of inflammation may include: Asthma Autoimmune disorders Environmental irritants, such as air pollution or cigarette smoke Lung cancer Lung infections Trauma to the chest wall or lungs Restrictive lung diseases are those that keep the lungs from expanding when you breathe in. These diseases reduce how much air you take in. Your breathing rate generally rises to send sufficient oxygen throughout your body. This may cause shortness of breath. Whether shortness of breath is hereditary is largely dependent on what's causing your symptoms. Some conditions are passed down between family members, while others, like infections, aren't. For example, alpha-1 antitrypsin (AAT) deficiency is an inherited gene disorder that might increase your risk of shortness of breath. Shortness of breath is one of the first signs of AAT deficiency. Other symptoms can include fatigue, recurrent respiratory infections, and wheezing. Many people with AAT deficiency also develop emphysema, a lung disease that damages the alveoli, or tiny air sacs, in the lungs. AAT deficiency runs in families. You're more likely to have the gene disorder if someone else in your family has it. You must have two mutated copies of the gene to have AAT deficiency. You're a carrier for the disease if you only have one mutated copy of the gene. However, your risk of certain lung diseases is higher than those with no mutated copies. The distribution of disease varies depending on the underlying cause. Shortness of breath commonly occurs in the following people: Age: Older adults are more likely to have shortness of breath than younger adults. Lung function generally decreases with age. Body mass index (BMI): People who have overweight or obesity more commonly experience shortness of breath than others. Excess adipose (fat) tissue may alter the immune response to airway inflammation and irritants, making these people likelier to have stronger respiratory symptoms than others. Sex: Females typically have narrower airways than males, increasing the risk of shortness of breath. Most shortness of breath is manageable with appropriate medication, breathing techniques, and exercise. However, if chest pain or pressure, fainting, or nausea accompanies it, treat it as a medical emergency. If you're experiencing shortness of breath, a healthcare provider can help identify the cause and treat it. Here are some of the most common factors that increase the risk of shortness of breath. Allergic Reactions Severe allergic reactions (anaphylaxis) sometimes develop in response to specific allergens. Shortness of breath will quickly escalate if the reaction causes your throat to swell and close off, blocking your air supply. Other symptoms of severe allergic reactions include: Diarrhea Itching Vomiting Wheezing The remedy is getting a shot of epinephrine (adrenaline) immediately. People who have severe allergies carry EpiPens, which quickly deliver epinephrine by injection. Immediately head to an emergency room or call 911 if you don't have an EpiPen or don't know whether you have an allergy but suddenly have a severe allergic reaction. Anemia Iron is essential to the body. This mineral helps produce red blood cells, which carry oxygen from the lungs throughout the body. Iron also supports physical growth and brain development. If you have anemia, your blood doesn't carry enough oxygen to the rest of your body. The most common cause of anemia is not having enough iron. Some evidence suggests that iron deficiency happens in about 4.5% to 18% of people in the United States. You may feel short of breath more frequently when climbing stairs or completing your usual workout. You might eventually start getting breathless when resting. Anemia can also cause symptoms like dizziness, fatigue, and irritability. Anxiety One of the classic symptoms of an anxiety attack is feeling like you can't breathe. The feeling of hyperventilating, feeling like you can't catch your breath, is very common with an acute anxiety attack. Feeling short of breath can then make you more anxious, creating a vicious cycle and sometimes leading to outright panic. Other anxiety symptoms include: Anxious thoughts or beliefs: These are hard to control, making you feel restless and tense and interfering with your daily life. They do not go away and can get worse over time. Changes in behavior: You may avoid everyday activities that you used to enjoy. Physical symptoms: This includes a pounding or rapid heartbeat, unexplained aches and pains, dizziness, and shortness of breath. You can manage anxiety with relaxation and deep breathing techniques. Avoid the things that trigger you. You might consider limiting caffeine and alcohol and avoiding cigarettes, which can heighten anxiety. Asthma Shortness of breath is one of the hallmark symptoms of asthma, caused by narrow airways. Other asthma symptoms include: Chest tightness Coughing Wheezing There are two main types of asthma: allergic and non-allergic. Each type has different causes and treatments. Allergic asthma is triggered by exposure to certain allergens, such as cigarette smoke, pollen, pet dander, dust mites, mold, and even weather elements. It's relatively easy to manage with medications. Non-allergic asthma is harder to treat than allergic asthma and tends to affect people who are middle-aged or have overweight. It's not clear if losing weight helps alleviate non-allergic asthma. Broken Ribs Broken ribs can cause shortness of breath and piercing pain. They can also puncture your lung and lead to a collapsed lung (pneumothorax). Fractured ribs also raise the risk of pneumonia, especially among older adults. There's no specific treatment for fractured ribs. A healthcare provider can care for a collapsed lung. Observation and oxygen therapy may be all that's needed if only a tiny portion of the lung has collapsed. A healthcare provider can insert a needle or tube into the chest, which can help if a significant portion of the lung is affected. Surgery may be necessary in some cases. Carbon Monoxide Poisoning Carbon monoxide is a severe hazard that can lurk very close to home. It's an odorless, tasteless, invisible gas produced by burning fuels in cars, trucks, fireplaces, furnaces, and grills. Carbon monoxide takes the place of oxygen in your red blood cells if you breathe it in—say, as it builds up in a small space with no ventilation, like a closed garage. This can lead to brain damage or even death. Carbon monoxide poisoning symptoms can include: Confusion Dizziness Minor headache Shortness of breath The best way to prevent carbon monoxide poisoning is to install a carbon monoxide detector in your home. These detectors look and act like smoke alarms, but they measure the concentration of carbon monoxide in the air. Also, check your heating system yearly, ensure good ventilation for all your appliances, and don't run your vehicle inside a closed garage. Choking Most people choking on a piece of food or anything else lodged in their throat know it immediately. It interrupts breathing and can kill you. Symptoms of choking include: Bluish skin color Inability to speak Loss of consciousness (unresponsiveness) if the blockage is not cleared Noisy breathing or high-pitched sounds while inhaling Shortness of breath Weak, ineffective coughing Coughing is a good thing and should be encouraged if you're choking. It means your body is trying to expel the object. Talking is also good since it means air is passing across your vocal cords. It doesn't mean you're out of the woods, though. You still need to clear the blockage.  The Heimlich maneuver is often effective. Someone stands behind the choking person and wraps their arms around the person's waist. They forcefully push into the choking person's abdomen, slightly above their belly button, until they spit out the object. You can even do the Heimlich maneuver on yourself by making a fist with one hand and then pushing it into your abdomen with the other hand. Chronic Obstructive Pulmonary Disease (COPD) Chronic obstructive pulmonary disease (COPD) involves constricted airways that cause shortness of breath. If you have COPD, you may be short of breath all the time, even sitting down. Shortness of breath more typically occurs every time you exercise. Other symptoms include wheezing, chest tightness, and a cough with mucus. Smoking is the most common risk factor for COPD. Healthcare providers urge people with the condition who still smoke to quit. The condition has no cure, but treatments vary depending on its severity. These include medications, oxygen therapy, surgery, or, in severe cases, a lung transplant. Heart Issues Shortness of breath with or without chest discomfort can signify a heart attack. A heart attack is a medical emergency. Call 911 if you suddenly experience any of the warning signs. Other heart attack symptoms include: Breaking out in a cold sweat, nausea, or lightheadedness Chest discomfort Pain in other areas of the upper body, such as one or both arms, the back, neck, jaw, or stomach Low Blood Pressure Low blood pressure (hypotension) can cause various symptoms, including shortness of breath. Other symptoms include: Blurry vision Confusion Dizziness or lightheadedness Fainting Feeling tired or weak Headache Heart palpitations, or feeling that your heart is skipping a beat, fluttering, or beating too hard or too fast Nausea Neck or back pain Low blood pressure can be caused by dehydration, infection, pregnancy, certain medications, and conditions. Prevent low blood pressure episodes by staying hydrated, eating enough salt, avoiding alcohol, and wearing compression socks. A healthcare provider can rule out any conditions or medications that may cause your symptoms. Lung Cancer Different lung conditions, including lung cancer, can cause shortness of breath at different stages in their development. Other symptoms may include: Chest pain Coughing that progressively worsens or doesn't dissipate Coughing up blood Fatigue Weight loss without a known reason Wheezing Lung cancer is often diagnosed in later stages when it's harder to treat. The disease generally doesn't cause symptoms in the early stages because it's localized. Lung cancer can block the airway when it grows larger. Myasthenia Gravis (MG) Myasthenia gravis (MG) causes chronic weakness of certain voluntary muscles, which are muscles you control. MG may affect your breathing muscles, resulting in shortness of breath. Other MG symptoms generally depend on what muscles are affected but generally include: Blurry or double vision Changes in facial expressions Difficulty swallowing Eyelid drooping Speech problems Weak eye muscles Weakness in the arms, hands, fingers, legs, and neck There's no cure for MG, but certain medications and lifestyle changes can strengthen your muscles. Anticholinesterase medicines, for example, improve nerve signals to your muscles. Lifestyle changes include getting plenty of rest, eating a nutrient-rich diet, and staying physically active. Obesity Pressure on the chest wall or pressure on the diaphragm from excess fat compresses the lungs. Inflammatory hormones secreted by excess body fat may also constrict the airways. Having overweight or obesity can aggravate symptoms of asthma. Excess weight can make breathing hard for anyone, regardless of whether they have asthma. Shortness of breath is a symptom of obesity hypoventilation syndrome (OHS). This condition causes inadequate breathing due to pressure on the chest. OHS lowers oxygen levels while raising carbon dioxide levels in the blood. If untreated, OHS can lead to heart problems and even death. Pleurisy Pleurisy is inflammation of the pleura, or the tissue that lines the chest and lungs. This inflammation may cause chest pain when you breathe or cough and shortness of breath. Other symptoms include coughing and rapid breathing. Treatment typically depends on the cause. Antibiotics can treat bacterial infections, whereas viral infections go away on their own. You may require a tube to be inserted in the chest or surgery to drain fluid build-up in the space outside the lungs. Pneumonia Pneumonia is an infection in your lungs. There are several types, including viral and bacterial. Pneumonia generally causes your airways to swell and the air sacs in your lungs to fill with mucus, leading to shortness of breath and fatigue. Other pneumonia symptoms include: Confusion, especially in older adults Cough, which may produce greenish, yellow, or even bloody mucus Fever, sweating, and shaking chills Loss of appetite, low energy, and fatigue Nausea and vomiting, especially in small children Rapid, shallow breathing Sharp or stabbing chest pain that gets worse when you breathe deeply or cough Bacterial pneumonia can come on suddenly or over a few days and may also bring a high fever. Viral pneumonia usually appears over a few days and can feel much like the flu. You can treat bacterial pneumonia with antibiotics. Antiviral medications may help with viral pneumonia. Vaccines against Streptococcus pneumoniae bacteria are recommended for young children, older adults, and people with certain conditions. Pulmonary Embolism A pulmonary embolism is a blood clot that has traveled from another body part (usually your legs) to your lungs. It causes sudden and severe shortness of breath, chest pain, and coughing up blood. Some people are genetically predisposed to pulmonary embolisms. Others may be at risk because they smoke, are overweight, have been injured, or have other conditions like cancer. People who take certain medications, like birth control pills, may also have an increased risk. Not moving for long periods can lead to a blood clot, which is why long plane trips can be dangerous for some people. You can help prevent pulmonary embolisms by regularly moving, especially on long trips. It's also important to drink plenty of fluids and wear compression socks if you're at risk. The condition is potentially fatal and needs to be treated right away. Healthcare providers usually treat pulmonary embolisms with blood thinners or surgery. Sarcoidosis Sarcoidosis causes immune cells to form small, red lumps (granulomas) in the body that swell. These lumps commonly develop in the lungs and lymph nodes in the chest, but they can occur in any organ. You may have shortness of breath if sarcoidosis affects the lungs. Other symptoms can include coughing, chest pain, and wheezing. There's no cure for sarcoidosis. A healthcare provider may prescribe medications that calm an overactive immune system and reduce inflammation. You may require oxygen therapy and surgery in some cases. Smoking Smokers' lungs become inflamed, inflaming the small airways and tissues. This can make the chest feel tight or cause wheezing or shortness of breath. After years of lung irritation, smokers may develop a chronic cough with mucus. The longer you smoke, the worse your shortness of breath and other symptoms will become. Smoking also increases the risk of COPD, lung cancer, and other conditions. Don't start if you don't smoke. Talk to a healthcare provider about quitting if you already do. They can help you develop a plan to quit. Reasons why you may feel shortness of breath can be as harmless as exercise or as severe as lung cancer. Don't ignore any sudden changes in your breathing. Let a healthcare provider know if you are experiencing shortness of breath. They can perform diagnostic tests on your body and help you understand and resolve the symptoms.

Lung Disease News

Apr. 10, 2024 — Findings show a newly created drug can prevent runaway inflammation while still allowing the immune system to handle the virus, even when given late into ...

Apr. 10, 2024 — One of the molecules responsible for triggering the inflammation that causes allergic respiratory diseases, such as asthma and allergic rhinitis, has just been discovered. This molecule, from the ...

Apr. 4, 2024 — Researchers have made a breakthrough into how two chronic respiratory diseases in childhood affect the immune system, paving the way for better ...

Mar. 26, 2024 — A new study suggest that using CXCL9 and CXCL10-producing dendritic cells alongside immunotherapy can be a promising strategy to overcome treatment resistance and improve clinical outcomes for ...

Mar. 25, 2024 — By evaluating sound vibrations produced by the airflow induced within the lungs and bronchial tree during normal breathing as well as those produced by the larynx during vocalizations, doctors can ...

Mar. 21, 2024 — New research finds a direct communication path between the lungs and the brain which may change the way we treat respiratory infections and chronic conditions. The lungs are using the same sensors ...

Mar. 15, 2024 — Researchers have discovered a potential way to predict which patients with severe COVID-19 are likely to recover well and which are likely to suffer 'long-haul' lung problems. That finding ...

Mar. 12, 2024 — Researchers may have discovered a mechanical explanation for instability observed in the lungs in cases of acute respiratory distress syndrome (ARDS), particularly in the aftermath of respiratory ...

Mar. 11, 2024 — Scientists trained a machine-learning algorithm to predict accurately brain metastasis using biopsy samples from early-stage non-small cell lung cancer patients. It was also highly accurate in ...

Mar. 6, 2024 — Study in mice reveals novel gasping reflex triggered by cells in the lungs when the airway is ...

Feb. 28, 2024 — Researchers built a new atlas of lung cells, uncovering new cellular pathways and precursors in the development of lung adenocarcinoma, the most common type of lung cancer. These findings open the ...

Feb. 15, 2024 — Biomedical engineers have developed a technique that uses inhalation of exosomes, or nanobubbles, to directly deliver IL-12 mRNA to the lungs of ...

Feb. 14, 2024 — Scientists have long thought of the fluid-filled sac around our lungs merely as a cushion from external damage. Turns out, it also houses potent virus-eating cells that rush into the lungs during flu ...

Feb. 12, 2024 — New research finds that premature lungs become stiffer than adult lungs under stress. This disrupts the function of transporters that are important for removing water from the lungs after ...

Feb. 8, 2024 — Lung tumors called adenocarcinomas sometimes respond to initially effective treatments by transforming into a much more aggressive small cell lung cancer (SCLC) that spreads rapidly and has few ...

Feb. 7, 2024 — Scientists discovered a novel self-perpetuating cancer mechanism in the lung microenvironment, wherein EGFR-driven lung adenocarcinoma cells exploit lung-resident macrophages -- remodeling them to ...

Feb. 7, 2024 — Bacteria in the mouth may play a role in survival from idiopathic pulmonary fibrosis (IPF), finds a new ...

Feb. 6, 2024 — An initial trial suggests that a new drug, originally developed for use with cancer patients, could improve the survival of patients with acute respiratory distress syndrome (ARDS). The patients in ...

Feb. 6, 2024 — Respiratory diseases like influenza and COVID-19 drive inflammatory responses that can cause long-term damage to the lungs and can be difficult to treat. Now, by using techniques that deliver mRNA ...

Jan. 14, 2024 — A new study shows how periodontitis, an oral disease, activates immune cells associated with aggravated progression of ...


Smoking And Chronic Obstructive Pulmonary Disease: How Does Smoking Trigger COPD And Management Tips

It is not a hidden fact that smoking can cause various health complications, such as damaging the lungs, triggering inflammation, and leading to the development of various diseases. One of the most common complications of smoking is the development of Chronic Obstructive Pulmonary Disease (COPD). It describes a group of lung conditions that cause difficulties in breathing due to airflow restrictions. We spoke to our expert Dr Uday Kiran G, Consultant - Pulmonary Medicine, Respiratory Sciences, Manipal Hospitals, Vijayawada, who explained how smoking triggers COPD and management tips.

COPD

According to a 2008 study, COPD is a lung condition that is difficult to reverse and is a leading cause of illness and death globally. While there is no cure for COPD, the only proven method to lower its incidence is to quit smoking.

COPD differs from asthma, as asthma occurs in attacks, while COPD is progressive. It manifests in two primary forms: chronic bronchitis and emphysema. 

  • Chronic bronchitis is when the lining of the bronchial tubes (which carry air to and from the lungs' air sacs or alveoli) is inflamed. The main characteristics of chronic bronchitis are daily coughing and constant mucus (sputum) production.
  • Emphysema destroys the alveoli at the end of the smallest air passages (bronchioles). This damage occurs due to constant exposure to cigarette smoke, other irritating gases, and particulate matter.
  • Symptoms of COPD

    COPD is chronic and progressive as it worsens over time and age. The typical symptoms of COPD as listed by Dr Kiran include:

    coughing

  • Chronic coughing
  • Wheezing
  • Excessive phlegm and mucous production
  • Shortness of breath
  • Lack of energy or malaise
  • Frequent respiratory infections due to lesser lung immunity
  • Causes of COPD

    asthma

    Here are factors that cause COPD as stated by Dr Kiran:

  • Long-term exposure to tobacco smoke and smoking
  • Air pollution 
  • Asthma
  • Weak lungs
  • Exposure to burning fuel fumes 
  • Genetics (alpha-1 deficiency)
  • Occupational exposure to dust and chemicals
  • Smoking and COPD

    "Multiple studies have firmly established a strong correlation between smoking and COPD. Individuals with a persistent smoking habit face an elevated risk of developing COPD. Moreover, for those already diagnosed with COPD, smoking can provoke and worsen symptoms," said Dr Kiran.

    When cigarettes burn, they create more than 7,000 chemicals, containing high concentrations of reactive oxidants. These components can induce inflammation in the lungs and airways which leads to damage, such as :

  • Narrowing of air passages
  • Swelling
  • Decreased lung immunity (resulting in heightened vulnerability to infections)
  • Hardening of the inner lung lining
  • Destruction of air sacs
  • "Even after cessation of smoking, the persistent inflammation continues as local inflammation remains active. Moreover, smoking damages the small cilia hairs in the airways responsible for keeping the lungs clean. Also, cigarettes may contain chemicals that allow the lungs' airways to open up, increasing the absorption of harmful substances and toxins", highlighted Dr Kiran.

    Simple Ways To Manage COPD
  • Despite the sustained inflammation, quitting the habit of smoking reduces the development and risks of COPD. The most effective preventive measure against COPD is to abstain from smoking altogether, and if you are a smoker, the optimal course of action is to quit.
  • While quitting smoking is tough, seeking behavioural interventions and counselling services, using alternate sources of nicotine, and talking to your loved ones can help you be accountable and help manage the withdrawal symptoms.
  • Another strategy is to steer clear of second-hand smoke emitted from burning tobacco products such as cigarettes, cigars, or pipes, and the exhalation of smoke by smokers.
  • [Disclaimer: This article contains information provided by an expert and is for informational purposes only. Hence, we advise you to consult your expert if you are dealing with any health issues to get the necessary treatment.]

    Disclaimer

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