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  Lung diseases

In the medical field, the branch of internal medicine that deals with lung problems is called pulmonology and the specialists that manage diseases of the lungs are known as pulmonologists. In some countries, this specialty is known as chest medicine or respiratory medicine.

Lung diseases Lung diseases
Lung diseases

Basically, the cornerstone of all medical practice including pulmonology is the medical history and the complete physical examination of the patient. These two aspects are very important to arrive in a primary diagnosis and rank several alternative diagnoses (differential diagnoses). The laboratory work up comes at the end to provide additional evidence and investigate further the condition of the patient to rule out other differential diagnoses and confirm the nature of the disease process.

Below are list of some more common lung diseases encountered in the field of respiratory medicine. Bronchial asthma is one of the most common lung disorders defined as a reversible airway disease. This is due to the fact that the events happening such as constriction, inflammation and excessive mucus formation in the inner lining of the airways upon exposure to any one or more of the known "triggers," are entirely reversed with bronchodilators. Some of the known triggers are exposure to stimulants present in the environment also called allergens (e.g. pollen, dust, fomites) while others are having asthma attacks due to exercise and even stress. The most common triggering factors in children are viruses such as those that cause the common cold or coryza. Clinical symptoms brought about by airway narrowing are wheezing, shortness of breath, chest tightness, and coughing. All of which are responsive to bronchodilators except for those with concomitant bacterial infection which necessitates antibiotic treatment. In between episodes though, most patients feel well. For those with severe persistent asthma, use of steroids will control and reduce the frequency of attacks. Avoidance of the known triggers are important to prevent asthmatic attacks.

Chronic obstructive pulmonary disease or COPD is a general term for a group of lung disorders which includes emphysema and chronic bronchitis. The common denominator of these two obstructive airways disease is its association with the single most preventable etiologic factor which is smoking. Chronic bronchitis is characterized more of inflammation of the airways hence, more sputum production initially before shortness of breath in the long run. It is a common disease of chronic smokers and local residents of highly polluted cities. Its acute form does not belong to COPD because it is mainly due to a predisposing factor which is a previous history of viral upper respiratory tract infection that goes down to the bronchi and usually has a short-term course. On the other hand, chronic bronchitis is clinically defined as a persistent productive coughing for at least three months in two consecutive years. Emphysema is another chronic lung disease that is often caused by exposure to toxic chemicals or prolonged exposure to cigarette smoke. The alveolar walls of these patients are damaged hence; trapping air within the air sacs. Patients with emphysema initially experience shortness of breath rather than productive coughing in contrast to chronic bronchitis. The endpoint of these COPD patients is a severe form of obstruction leading to a serious ventilation and perfusion ratio mismatch which may or may not be partially relieved with bronchodilators. Sometimes these patients need long term supplemental oxygen to improve survival rate.

Bronchiectasis is another chronic inflammatory condition of one or more medium-sized bronchi of the lungs with loss of elasticity of its walls therefore, leading to marked permanent dilatation. Infectious process is the major mechanism by which the disease progresses. If this lung disorder is left untreated, damage to the lung tissues and bronchial tubes will continue and eventually cause emphysema and severe breathing problems.

Cystic fibrosis (CF) is the most common lethal hereditary disease that affects not only the lungs but the entire body, causing progressive disability and early demise. Dyspnea is the most common symptom which results from frequent infection of the lung parenchyma. The infections are cured but not all of the time with antibiotics. Other symptoms due to the effects of cystic fibrosis in other parts of the body are the following: chronic sinusitis, impaired growth, diarrhea and infertility.

Lung cancer is the most lethal cancer worldwide with the highest fatality rate in both sexes, causing up to 3 million deaths every year. Bronchogenic carcinoma accounts for most of the lung cancer cases (about 90%). Due to the rising ratio of women smokers, lung cancer rate for women has been increasing in the last few years which previously under the predominance of male smokers. Presently, many women now die of lung cancer than any other cancer such as breast, colon, ovarian and endometrial cancers.

Pneumoconiosis is an occupationally related lung disease, also known as miner's lung. This is a lung condition caused by the inhalation of mineral dusts including asbestos, silica, and others. Asbestosis, silicosis, anthracosis are some of the diseases which are related to prolonged exposure to substances that when inhaled continuously, nodular fibrotic changes will form and eventually damages the lung tissues.

Pneumonia or pneumonitis is an infection of the lung parenchyma and the entire respiratory tree wherein the air sacs become inflamed and filled with exudative fluid. Pneumonia can result from any of the four major pathogens causing infection namely: bacteria, viruses, fungi, or parasites. Any chemical or physical injury may also cause pneumonia. Indirectly, pneumonia may also be due to another medical condition, such as lung cancer or alcohol abuse.

In the field of pulmonology, pneumothorax with atelectasis (collapsed lung) is a medical emergency. This is when air fills up the pleural cavity either in traumatic or spontaneous pneumothorax which compresses the lungs and hinders it expansion manifested by dyspnea. The lung re-expands once the air has been aspirated out of the pleural cavity.

Pulmonary hypertension (PH) is an elevation of blood pressure in the pulmonary artery. This can lead to a severe disease depending on its cause which can lead to a markedly decreased exercise tolerance and right-sided heart failure (cor pulmonale). It is vital to correct if there is any underlying cause first aside from addressing the problem of rising blood pressure in the lung vasculature.

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