About Your Condition

Asthma

Asthma is an inflammatory lung condition which is usually reversible and it is characterised by bronchospasm, cough, breathlessness and wheeze.

It is commonly presented in childhood but may develop at any age.  The condition may be hereditary or may have developed as a result of occupational or environmental factors. 

It is diagnosed following history taking, reversibility testing, peak flow monitoring and allergy testing.

Common triggers to the condition may include exposure to dust, animals and pollens etc.

It is treated with the use of inhaled bronchodilators and steroids and management follows a step-down approach to care illustrated by the NICE guidelines.

The condition may be irreversible in chronically undertreated or poorly compliant patients.

It may present itself either acutely or chronically and in its most severe form can be life threatening.

Chronic Obstructive Pulmonary Disorder (COPD)

COPD is an umbrella term consisting of emphysema, chronic bronchitis and chronic severe asthma.  It is a progressive disease that cannot be cured but can be slowed down by stopping smoking and undertaking pulmonary rehabilitation where appropriate.  However, it can be managed with treatment and support.  In COPD the airways are narrowed causing symptoms of breathlessness, persistent cough and frequent chest infections.

COPD is mainly caused by tobacco smoking with a small group being related to industrial exposures and an even smaller group having hereditary COPD, (alpha1 anti-trypsin deficiency)

It is normally diagnosed by taking a full history followed by lung function testing (spirometry) as well as CT scans of the lungs.

Treatment for COPD includes:-

Inhaler therapy
Steroids and antibiotics (for acute exacerbations)
In some cases smoking cessation
Pulmonary rehabilitation

The British Lung Foundation have developed a 10 point COPD patient passport.  Patients can follow the link and complete their own COPD passport to find out whether they are receiving the care they are entitled to.

Cluster Headaches

Cluster headaches are often described as Suicidal Headaches due to their severity.

Excruciating attacks of pain usually on one side of the head and often felt behind one eye.  

Cluster headaches are more painful than migraines, can start abruptly and last varying lengths of time. They are called cluster headaches due to their frequency which can be several times a day and can last for weeks. Periods of being free from pain can occur which can be months or even years before the attack return.

There are two types of cluster headache, 

Episodic- the clusters are separated by headache free periods of one month or more
Chronic- the clusters are separated by headache free period of less than one month or not at all.

The cause is not fully understood, but it is thought that an area in the brain, the hypothalamus, produces a lot more activity and in so doing releases various chemicals that possibly cause the blood vessels in the brain to dilate. No one knows why the hypothalamus acts in this way but it may be triggered by certain things:

Alcohol taken when the headache is occurring
Extreme changes in temperature ( after exercising in hot weather)
Or taking nitroglycerin (used to enlarge blood vessels often with angina patients)

Treatment includes the use of a drug called sumatriptan  or oxygen therapy. More often than not, they are used together.

Bronchectasis

Bronchiectasis is a chronic disease where irreversible dilatation of the airways occurs due to damage of the lining of the airways. 

Bronchiectasis can occur from early childhood through to older age.  This may be associated with other respiratory conditions such as COPD or it can be a condition that occurs independently.

The diagnosis will be made by taking a thorough history, a high resolution CT scan and possibly sputum sampling.

The main symptoms associate with bronchiectasis will usually be persistent cough with production of phlegm.  This often leads to frequent infections requiring treatment with antibiotics.

Due to it being a chronic condition it is a matter of managing the symptoms and trying to prevent infective exacerbations.  This is achieved by physiotherapy techniques such as postural drainage, devices to aid expectoration and when necessary treatment with antibiotics.

In some patients a long-term intravenous catheter maybe implanted so that regular cycles of antibiotics maybe given via this route.  In other patients nebulised antibiotics will be used.  In certain instances surgery maybe an option to remove certain areas of the lung.

Interstitial Lung Disease / Pulmonary Fibrosis

Interstitial lung disease is a progressive lung disease characterised by a decline in lung function.

It is diagnosed by lung function tests and may include a CT scan.

It is characterised by symptoms of increased breathlessness, cough and low oxygen levels at rest or with exercise. 

The treatment may include drugs, oxygen therapy and pulmonary rehabilitation.  Treatment of infections as and when they arise.

Pulmonary Hypertension

Pulmonary Hypertension occurs when the blood pressure within the blood vessels of the lung becomes raised. It is a very serious condition which can cause damage to the right side of the heart where the heart and lungs are connected. This can prevent oxygen getting to all areas of the body specifically the muscles.

Symptoms include:

Shortness of breath
Feeling faint or dizzy
Fatigue
A racing heartbeat
Swelling of the legs
Chest pain (angina)

The diagnosis can take some time due to the similarity of symptoms with other diseases. But if you are experiencing any of the listed symptoms then please visit your GP to discuss as pulmonary hypertension is a very serious condition.

The treatment will vary with the severity as well as the treatment of any underlying cause. Almost certainly you would be referred to a specialist centre that regularly deals with pulmonary hypertension as well as being under the care of your local hospital.

Lung Cancer

Cancer develops when some cells can not be controlled by your body and they start to alter, increase in number and size and then form a lump or tumour. When tumours are cancerous they are known as malignant and may grow quite rapidly and can spread to other areas of the body.

Cancer is termed primary or secondary (metastases). Primary tumours are those that start the process off in the affected organ in this case the lungs, but secondary tumours start off from another organ but spread into another organ.

There are several types of lung cancer but the two most prevalent are, Small cell lung cancer which accounts for about 15%  and Non Small cell lung cancer which accounts for about 85%.

Any one can go onto develop lung cancer but the large majority are related to smoking. The risks go up with the total number of cigarettes etc that you have smoked over time. If you stop smoking the risks lessen over time.

The symptoms of lung cancer can come on quite late in the disease so it may not be picked up until you have a scan or an X-Ray.

The symptoms include:

Persistent cough greater than three weeks
Feeling short of breath
Blood in your mucus
Pain
Weight loss

If you have any of these symptoms you should see your doctor.

If your doctor thinks you may have lung cancer you will be referred to a chest physician for further investigation.

Treatments can include:

Surgery
Chemotherapy
Radiotherapy
Palliative care

Lung Transplant Patients

A lung transplant is when an operation is required to remove a diseased lung and replace it with a healthy lung from a donor. This type of operation is not carried out that frequently within the UK due to lack of donors.

The operation is used to treat those with advanced lung disease who fail to respond to other treatments or if the life expectancy of the patient is thought to be less than two to three years without the operation.

Conditions that might fulfil these criteria are:

Cystic fibrosis
Pulmonary hypertension
Idiopathic pulmonary fibrosis
Chronic obstructive pulmonary disease

There are several types of lung transplant which include:

Single lung transplant
Double lung transplant
Heart and lung transplant

 Due to the lack of availability of donor lungs, these operations are only carried out if it is thought there will be a good outcome.

Those that currently smoke would not be considered for transplant and similarly those with lung cancer would not, due to the risk of the cancer re-occurring in the transplanted lung .

The lung transplant itself is quite lengthy procedure dependent on which operation is undertaken so can last between four and twelve hours.

There are obvious risks associated with this type of surgery as there are for any major surgery, but with transplants there is always the risk of rejection. All those having any type of transplant will have to take anti rejection drugs so rejection is less likely to happen but these drugs also have side effects, and can make you much more vulnerable to infection due to your immune system being reduced. 

The outlook for those having had transplants varies and the transplant can last from between 1 year and there have been reported case lasting twenty years.

More information can be found at  NHS Choices .