Patients may have a cough, yellowish or green phlegm, and fever. A chest x-ray will show opacities in the lungs. Antibiotics are used to treat this common condition.
There is a spontaneous leakage of air into the pleural space. This may occur in patients with or without prior lung problems. Sudden chest pain and breathlessness are the usual symptoms. A chest x-ray is required for diagnosis. Immediate treatment involves using a needle or a chest tube to drain the air out.
- Parapneumonic Effusion and Empyema
In this condition, the cavity around the lung, known as the pleural cavity, is filled with infected fluid. Patients will experience fever, cough, chest pain and shortness of breath. This could be a complication of pneumonia. Initial treatment includes antibiotics and usually drainage of the fluid using either a needle or a chest tube after a confirmatory chest x-ray. Severe cases may require surgical intervention.
Tuberculosis may sometimes cause a primary infection of the pleural space. Patients may experience symptoms of cough, fever, breathlessness, chest discomfort with weight loss and loss of appetite. This condition is treated with anti-tuberculous medications for at least six months.
Cancers of the lungs or from other parts of the body may cause fluid to fill up the pleural cavity. In addition to the symptoms of the underlying cancer, patients may have chest discomfort and shortness of breath. Drainage of the fluid from the pleural cavity may be required as the first step. Other treatment approaches are available as well.
Tumours
This common cancer causes all kinds of symptoms, including cough, sometimes with bloody sputum, and breathlessness. In addition to chest x-rays and lung scans, sputum investigations, bronchoscopies or lung biopsies may be required. A multi-disciplinary approach involving the oncologist, radiotherapist, cardiothoracic surgeon, palliative medicine physician and pulmonologist is necessary. Symptomatic relief, surgery, chemotherapy and/or radiotherapy may be offered.
The pleural cavity may sometimes be affected by a relatively rare form of tumour known as a malignant mesothelioma. Patients will experience vague chest discomfort, and sometimes loss of weight, shortness of breath and a dry hacking cough. This usually occurs in patients with exposure to asbestos. Treatment varies depending on the stage of the disease.
There are several types of benign lung tumours. These usually do not cause symptoms and are often picked up incidentally.
Pulmonary Vasculature Disorders
The blood vessels supplying the lungs may sometimes be obstructed by blood clots. This typically occurs in patients with risk factors such as cancers, those who are bed-bound, and those after surgery. Symptoms include breathlessness, chest pain and occasionally lower limb swelling. Low blood pressure and low oxygen levels can occur in severe cases. Treatment usually involves anticoagulants (which are blood thinning medications) to reduce the progression of the clot.
In this condition, high blood pressure affects the blood vessels supplying the lungs, and this may be due to various reasons. Patients get breathless easily, and often have low levels of oxygen in the blood. Various treatment options are available depending on the root cause of the problem.
Sleep Disorders
The upper airways may sometimes be obstructed by various structures, including the tongue, during sleep. This may lead to disrupted sleep and lack of oxygen during sleep. Patients with this condition experience sleepiness during the day, and snoring during the night. Sleep studies are necessary to diagnose the condition. The use of a continuous positive airway pressure (CPAP) machine during the night to splint the airways open is usually effective.
Under normal circumstances, the brain plays an important role in regulating one's breathing. Due to various reasons, this regulation is sometimes disturbed during sleep, thus causing abnormalities in the breathing pattern. Central sleep apnoea often presents with symptoms similar to obstructive sleep apnoea, except that it is not due to an obstruction. The investigations and treatment are similar to obstructive sleep apnoea. A different mode of a machine is used for this condition.
Diffuse Parenchymal Lung Diseases (DPLD)
- Idiopathic Pulmonary Fibrosis
This disorder usually affects older people and involves scarring and degeneration of the lungs. Patients will experience progressive shortness of breath and dry cough. Chest x-rays and scans of the lungs typically show scarring. Treatment is focused on symptomatic relief, and supportive measures such as oxygen and antibiotics where necessary.
- Other Idiopathic Interstitial Pneumonias
There are several similar conditions in which the lungs are affected by degeneration, scarring and inflammation, often without a definite cause. Depending on the condition, various investigations and treatments may be required including lung scans, scopes of the lungs, biopsies and steroids.
- DPLD related to Collagen Vascular Disease
Collagen vascular diseases such as lupus and several other disorders may sometimes affect the lungs, causing various forms of interstitial pneumonia. Steroids and other drugs that target the immune system may or may not be required.
The lungs of people in some occupations may be damaged after many years of exposure to various dusts. Examples are sandblasting which causes silicosis (due to inhalation of silica), and cement piping and ship building which cause asbestosis (due to inhalation of asbestos fibres). Chest x-rays will show typical patterns of damage. Treatment is supportive with symptomatic relief.
Other Restrictive Lung Disorders
- Restrictive Lung Disorders
These disorders occur when the expansion of the lungs is restricted due to problems with the lungs, respiratory muscles or nerves, or chest wall.
Breathing involves the use of breathing muscles (including the diaphragm) which are controlled by various nerves. Any dysfunction of these muscles or nerves may disrupt breathing, leading to respiratory failure or recurrent chest infections. Treatment options vary depending on the underlying cause.
Severe structural deformities of the spine, ribs or sternum (a long flat bone in front of the body to which the collarbone and most of the ribs are attached) may cause breathing problems and lead to respiratory failure. Treatment may involve the supplementation of oxygen and the application of breathing masks.
Miscellaneous
This is defined as persistent cough for more than eight weeks. It may be due to a variety of reasons including the upper airway cough syndrome, asthma and gastro-oesophageal reflux. Several basic investigations may be required and treatment varies with the underlying cause.
The mediastinum is the area between the lungs and includes lymph nodes, various glands, the oesophagus (food pipe), nerves, blood vessels and the heart. Multiple disorders can affect these structures, including tumours. Treatment will depend on the exact diagnosis.
- Drugs and Inhalational Injuries
The ingestion of many drugs and the inhalation of many noxious gases may cause lung injury and lead to difficulty in breathing and low levels of oxygen in the blood. Treatment depends on the exact scenario, and sometimes involves the use of oxygen, antibiotics and/or steroids.
Critical Illnesses
This refers to a severe infection involving any part of the body and is one of the most common reasons for admission into the intensive care unit. It may lead to failure of several organs and is a common cause of death. Treatment is supportive with antibiotics and artificial life support.
- Acute Respiratory Distress Syndrome (ARDS)
The lungs are affected by severe inflammation and subsequently scarring, which leads to extremely low level of oxygen in the blood. This is a dangerous condition with a high risk of death. Treatment often involves the use of a breathing machine known as a ventilator.
Various disorders including severe infections may lead to the failure of several organs. These organs include the brain, heart and blood vessels, lungs, kidneys, liver, gut as well as the blood clotting system. Dedicated care in the intensive care unit or high dependency unit is critical to support these various organs.