Dr. Jeffrey M. Dorf, M.D.

A pneumonia diagnosis is often suggested by patient symptoms, usually a productive cough,fever and chills. Examination of the chest with a stethoscope can lead to the diagnosis when certain abnormal sounds are localized to a specific area of the chest. Lastly a Chest X-ray may have an area that shows an infiltrate (due to a substance denser than air) when compared to the rest of the lung.

Smoke from the lighted end of a cigarette, pipe, or cigar, or tobacco burning in a hookah. This type of smoke has higher concentrations of cancer-causing agents (carcinogens) and is more toxic than mainstream smoke. It also has smaller particles than mainstream smoke. These smaller particles make their way into the lungs and the body’s cells more easily. Young children are most affected by SHS and least able to avoid it. Most of their exposure to SHS comes from adults (parents or others) smoking at home. Studies show that children whose parents smoke:

* Get sick more often
* Have more lung infections (like bronchitis and pneumonia)
* Are more likely to cough, wheeze, and have shortness of breath
* Get more ear infections

These are quotes from the American Cancer Website. If your daughter has whooping cough, it is caused by a bacteria called Bordetella Pertussis, but her exposure to second-hand smoke more than likely made her more susceptible

It is true that most upper respiratory infections are viral and will run their course. But sometimes when they do not get better a bacterial infection can be entertained. I would return to your provider, especially if you have not improved several days after the first visit or if you continue to get worse.

Four stages of lobar pneumonia have been described. In the first stage, which occurs within 24 hours of infection, the lung is characterized microscopically by vascular congestion and alveolar edema. Many bacteria and few neutrophils are present. The stage of red hepatization (2-3 d), so called because of its similarity to the consistency of liver, is characterized by the presence of many erythrocytes, neutrophils, desquamated epithelial cells, and fibrin within the alveoli. In the stage of gray hepatization (2-3 d), the lung is gray-brown to yellow because of fibrinopurulent exudate, disintegration of RBCs, and hemosiderin. The final stage of resolution is characterized by resorption and restoration of the pulmonary architecture. Fibrinous inflammation may lead to resolution or to organization and pleural adhesions.

It is hard to tell from your description. Shortness of breath has any number of reasons including endocrine etiologies. Start with your primary care physician who can listen to your symptoms, complete an examination and order appropriate testing. If the workup points in one direction, you can be referred appropriately to the correct specialist if needed.

As soon as you take your first puff. Do not wait until you have done irreversible damage to your lungs. There is no medical benefit from cigarette smoking, and it is no longer cool. So quitting sooner is better.

Clinically, the child may have a productive cough and fever and an abnormal examination with a stethoscope that might be consistent with pneumonia. Usually, a chest X-ray can confirm pneumonia.

Usually with diseases such as COPD or Asthma we like to apply a step wise approach to therapy. I usually start with one medication and if that is sufficient there is usually no benefit to adding a second medication. As the disease progresses or symptoms change adding a second medication may be warranted.

If your sister was hospitalized for pneumonia, she might have needed to go home with oxygen, which would be re-evaluated as an out-patient as she hopefully improves. The CPAP, if worn at night, is most often used for patients with obstructive sleep apnea. It is possible that while in the hospital it was noted that she had the signs and symptoms of sleep apnea and is now being treated. I suggest that her follow-up appointments include a pulmonologist to help sort through this.

Sorry to hear about your mother. Dyspnea in cancer patients is multi factorial. I would first make sure that there are no reversible etiologies such as underlying pulmonary disease or anemia. If they are present then treating those may help. If there are no reversible issues, then such things as tessalon perles taken regularly may be helpful. Also, having a fan available as the breeze is thought to cut down on the sensation of shortness of breath. As a last resort are the antianxiolytics such as ativan and lastly the opiods may cut down on the uncomfortable feeling. Good luck

A CT scan of the chest or computerized tomography is a radiological examination that allows one to see the chest and the inside contents much better than a regular chest X-ray can. The lungs and vessels can be seen in much more detail. It may or may not involve intravenous contrast to better highlight the chest structure. With all of the new scanners the whole test usually takes less than five minutes once you are on the table. Good luck!

In most cases, the fly will perish and he will be fine. Remnants of the fly (or other bugs) might be swept up and out of the lung and trachea, and then swallowed. Sometimes, the creature will lodge in the smaller passages of the lungs and become entombed there. This may happen without any further health repercussions, but not always. If the fly was contaminated with certain pathogenic agents, you could potentially suffer from infection. Would the fly lay eggs and perpetuate within you? Not likely, but this is a possibility. There are just a few kinds of flies, the larvae of which will infest living tissue. Some of these flies are quite large. The chances of inhaling one of these are tiny, but not zero. This cannot be seen on an X ray so that would not be helpful. I think the only time to seek medical help in a case such as this would be if there was a persistent cough or fever and chills.

I think to be able to control or stop the cough one needs to find out the etiology of the cough. A nocturnal cough can have several causes. Two of the foremost reasons are asthma or gastroesophageal reflux disease. I would discuss this with her pediatrician and hopefully with a good discussion with your daughter and possible a few tests you can get to the source of the cough.

Sometimes after you have been still for awhile, as in lying down, the bases or posterior of the lungs can be compressed and, as they open up with big breaths, they may feel like they are crackling. If your doc hears crackles and has you take a deep breath or cough, these benign sounds go away.

Congratulations on quitting smoking. Unfortunately, the lungs do not regenerate; once structural damage is done by smoking or other diseases, it is irreversible. However, the inflammatory response to cigarette smoking does improve within a few weeks after quitting smoking. That is why after you quit, you often produce more phlegm as the body is better able to help remove these secretions because they are functioning better. But quitting smoking will decrease your risk of developing lung cancer, too.

Asthma can change as people age. Sometimes asthma diagnosed in childhood goes away and returns later in life.

The question I have is, did you really have asthma or a process that mimicked asthma like symptoms. Any process that can precipitate bronchospasm (wheezing) such as reflux disease, post nasal drip from allergic rhinitis and even medications can cause a patient to wheeze and act like asthma. Even an upper respiratory tract infection with virus and simulate asthma. Best let your physician know if you have any of these other conditions.

I think everyone will be different, but from some of the comments people have made about their CF and hot humid weather, it is more difficult to breath. Don't forget that type of weather causes lots of perspiration and the loss of salt will need to be addressed with hydration and salt replacement. With the recent hurricane, not all of Puerto Rico is up and running, so there may still be areas without electricity. Make sure you check that where you are staying has all the basics you may need.

Once you have done damage to your lungs, unfortunately there is no going back. There is usually some immediate improvement from your baseline when you quit but after about six months the lung function will stabilize. The risk of lung cancer goes down and back to that of a non smoker within about 10 years from the currently available data.