Pulmonary Emphysema

Pulmonary emphysema is primarily the end-stage of lung diseases such as chronic bronchitis or COPD. Read more about symptoms, causes, and treatment.

Definition

Pulmonary emphysema is a serious, progressive, and incurable disease of the lungs. Medical professionals also refer to it as pulmonary emphysema. The colloquial language is particularly familiar with the disease terms lung flatulence or lung overinflation. With pulmonary emphysema, lung function continues to decrease. This creates progressive shortness of breath. The associated lack of oxygen not only severely restricts physical performance. There are also secondary reactions that place a heavy strain on the heart, among other things. A typical consequence of emphysema is, for example, the cor pulmonale, a common form of right heart failure.

Alpha-1 Antitrypsin Deficiency

In addition to the acquired form of emphysema, there is also a congenital variant. Alpha-1-antitrypsin deficiency is one of the rare diseases with 2.5 new cases per 10,000 inhabitants per year. In this disease, the congenital deficiency of the protein alpha-1-antitrypsin triggers chronic inflammatory processes in the lungs.

Frequency

According to experts, the frequency of emphysema is growing worryingly. Exact figures are not available because emphysema and COPD are not always properly recorded separately. But it is assumed that there are around a million cases in Germany. The vast majority of emphysema occurs in smokers over the age of 50.

Symptoms

A characteristic symptom of emphysema is increasing shortness of breath (dyspnoea). As a rule, the shortness of breath initially only occurs during physical exertion. As the disease progresses, there is difficulty breathing even when the body is at rest.

Advanced emphysema causes chronic oxygen deficiency, which can be recognized by the blue color of the lips and fingers (cyanosis). Another visible symptom of emphysema is a barrel-like enlargement of the upper body, the so-called barrel chest. Doctors speak of the barrel chest. The barrel breast is created because the lung tissue continues to inflate.

Causes

By far the most common cause of emphysema is chronic lung diseases such as chronic bronchitis. If the bronchial passages are permanently inflamed, narrowed, and cause shortness of breath, coughing, and increased sputum, this chronic bronchitis is one of the chronic obstructive pulmonary diseases that are described in more detail under COPD. Chronic bronchitis and COPD are also precursors of lung cancer. The most common cause of all these diseases smoking.

Pulmonary Emphysema

How Do The Symptoms Of Chronic Bronchitis Arise

In healthy people, the air you breathe reaches the alveoli via the bronchi. Gas exchange takes place in these alveoli. During the gas exchange, the elastic alveoli absorb the oxygen from the inhaled air and then release carbon dioxide from the blood with the exhaled air. That requires a certain elasticity. In the case of emphysema, this elasticity is gradually lost as a result of inflammatory processes. The alveoli become increasingly inelastic and are no longer able to completely release the exhaled air. As a result, less fresh inhaled air can be taken in. This causes the alveoli to expand and ultimately lose their function entirely. Sometimes the small alveoli transform into large emphysema bubbles.

The approximately 300 million alveoli of a healthy person have a surface area the size of a football field. With emphysema of the lungs, this area for gas exchange sometimes shrinks to the size of a towel.

Treatment

Pulmonary emphysema cannot be cured. Treatment can only relieve symptoms. The most important thing is to prevent the disease from progressing, or at least to slow it down. To do this, it is imperative to stop smoking.

Drug Therapy For Emphysema

The symptoms of not too advanced pulmonary emphysema can be alleviated by drug therapy. The aim of this therapy is to widen the bronchi (bronchodilation) and to stop the inflammatory processes in the lungs. So-called beta-2 sympathomimetics are often inhaled for this purpose. Active substances in this group are salbutamol, salmeterol, or reproterol. Anticholinergics like ipratropium or inhaled glucocorticoids like budesonide, beclometasone, or fluticasone have even stronger anti-inflammatory properties.

In the case of congenital alpha-1-antitrypsin deficiency, the protein can be given in the form of medication (infusions) and thus prevent the development of pulmonary emphysema. Unfortunately, the therapy is very costly and not as promising as one initially hoped it would be.

In the case of very advanced pulmonary emphysema, selected emphysema patients (younger than 60 years, high therapeutic motivation, no additional complications) only have a lung transplant as the last chance. The possibilities of artificial ventilation are very limited due to the characteristics of the disease.

Everything About A Cough

Talk about everything about a cough the possible causes and treatment, cough is less of a disease in its own right than a symptom of respiratory disease. It occurs, for example, when we have choked. However, coughing can also indicate serious medical conditions such as heart failure or reflux disease.

Definition

Who does not know the nights disturbed by a cold-related cough or the pain of a dry cough or dry cough? The bronchi are burning and you are short of breath. After a coughing fit, we sometimes feel like we have sprinted 100 meters. If the cough then loosens a little and produces sputum, this is often perceived as a relief.

Cough is not an independent disease in the medical sense, but a symptom. As a rule, a cough is triggered by illness. The most common are respiratory infections such as bronchitis, colds, or the flu. Allergies, asthma, or smoker’s cough are other common causes of coughs. Heart failure or drug side effects such as the ACE inhibitor cough are also causes of cough.

Symptoms

Doctors classify the symptom of cough into categories. First of all, a distinction is made according to the duration:

    • According to the medical definition, acute cough lasts up to 8 weeks.
    • Subacute cough is a classification that is sometimes used for coughs lasting between 3 and 8 weeks.
    • Chronic cough is the name given to a cough that lasts longer than 8 weeks.

In addition to this distinction based on duration, there is a division into productive and unproductive or dry cough:

    • Productive coughing is accompanied by increased secretion and expectoration.
    • Unproductive (dry cough) is also known as a dry cough. Mucus does not form with this form of cough. Therefore, unproductive cough is dry, so it remains without expectoration.

Everything About A Cough

Symptoms Of Productive Cough

A productive cough is characterized by the fact that the cough removes sputum from the airways or lungs. Often a productive cough begins with a dry cough. After usually 1 to 3 days, often accompanied by a sore throat, there is an increased production of mucus. This bronchial mucus is transported out of the airways or the lungs as sputum via the cough reflex.

Symptoms Of Unproductive Cough

An unproductive cough feels hard and painful, often burning. It does not produce sputum. Coughing fits that can last for minutes are also typical of dry coughs. Coughing attacks are said to occur more frequently at night and thus deprive the sick of sleep. Oftentimes, a dry cough is accompanied by allergy symptoms. Heartburn can also occur along with a dry cough.

More Symptoms Of Cough

The frequency and sound of coughing attacks are further characteristics that can sometimes even be used to determine the cause. Barking cough in small children, for example, suggests pseudo croup. An attack-like cough with a high repetition frequency like a staccato is typical of whooping cough (pertussis). A morning cough, often with copious expectoration, is particularly common among smokers.

Causes

The Cough Reflex

The cause of cough is the cough reflex. This is an innate protective mechanism of the body. The cough reflex has the task of protecting the respiratory tract from damaging influences and of removing secretions such as mucus and foreign bodies such as dust or swallowed items.

The cough reflex is triggered by receptors in the mucous membranes of the larynx, the trachea, and the larger bronchi. They react to mechanical stimuli such as those caused by secretions (mucus), foreign bodies (smoke, dust, swallowed things), or other stimuli (inflammation, gases). These stimuli reach a certain brain region, the medulla oblongata, via the vagus nerve (nervus vagus or 10th cranial nerve).

The medulla oblongata houses the respiratory center and is located in the brain stem. These nerve fibers are activated, which cause a sudden contraction of the diaphragm and the muscles of the abdominal wall and intercostal. In addition, the glottis is narrowed and extreme pressure builds up under the closed larynx.

When the lid of the larynx opens, exhalation occurs suddenly. With this impulse, foreign bodies or secretions are thrown out of the windpipe like an explosion. When coughing, enormous forces act on the larynx muscles. With strong coughing attacks, the air flows through the larynx at speeds up to the sound limit.

Causes Of Productive Cough

A productive cough is most often a symptom of a respiratory infection. These are, for example, the flu or cold, which in turn are accompanied by fever, runny nose, and a more or less pronounced feeling of illness. If the underlying disease is not healed properly or if there are constant new infections, the cough can become chronic; doctors speak of chronic bronchitis.

Causes Dry Cough

Dry cough is usually a reaction to a variety of harmful stimuli. These include smoke, dust, gases or chemical vapors. A very common typical example is the smoker’s cough.

Other causes of dry cough are severe respiratory diseases such as whooping cough, tuberculosis, or lung cancer (bronchial carcinoma) as well as pulmonary embolism or emphysema. Allergic asthma or other allergies can also trigger a dry cough.

Other Causes Of Cough

Medicines can also trigger a cough. For example, this is a common side effect of some drugs for high blood pressure, such as ACE inhibitors.

Irritation from stomach acid when stomach contents flow back into the esophagus (reflux disease) also leads to coughing. This is often accompanied by heartburn and acid regurgitation.

Examination

Diagnosing cough is easy based on the symptoms. To find out the exact cause, your doctor will first ask you in detail. This is followed by a physical examination, during which mainly the breathing sounds are listened to.

In the case of a productive cough, the color and texture of the sputum indicate the possible cause:

    • Clear whitish sputum: mostly caused by viral upper respiratory infections such as colds or flu
    • Yellowish or green sputum: indication of a possible additional bacterial infection in viral respiratory diseases
    • The bloody build-up is an indication of serious lung diseases such as pneumonia, pulmonary embolism, or lung cancer. In addition, the sputum is sometimes bloody if the blood vessels in the airways or the lungs have been damaged by swallowed objects or other injuries. Bloody sputum is usually a medical emergency and should be investigated immediately.
    • Brown or black sputum: especially common in smokers, often signs of advanced lung damage from chronic bronchitis or COPD.

At times, complex diagnostics may be necessary to find the cause of the cough. These more extensive examinations are usually carried out by specialists. As a rule, your family doctor will refer you to a pulmonologist (pulmonologist) for this purpose. For heart-related coughs, cardiologists are the specialists of choice. In the case of gastrointestinal diseases as the cause, the path leads to the gastroenterologist and in the case of allergies to the allergologist.

Treatment

Treatment for cough is based on the cause. If a cough is not triggered by a serious underlying disease, home remedies are usually well suited to relieve the excruciating urge to cough. If the cough does not improve within a few days, the first thing you should do is see a family doctor so that the cause of the cough can be found. Only then can meaningful treatment be initiated.

There are a number of medications your doctor can use to treat coughs. If necessary, he will treat infection or inflammation as the cause of the cough, for example with antibiotics. If ACE inhibitors are responsible for the cough, he will change the medication. In the event of a cough accompanied by heartburn and acid regurgitation, the doctor will order a gastroscopy and then treat the gastric acid reflux.

Do not take coughing lightly. This is especially true if the cough:

    • lasts longer than 2 weeks (for infants, toddlers, or children: longer than 3 days)
    • is accompanied by fever or severe malaise
    • occurs new and without a traceable harmless cause
    • with bloody, brown, or black obstruction
    • is accompanied by a high fever and/or extreme fatigue.

More information about treatment and self-help, as well as home remedies for coughs:

    • bronchitis
    • COPD
    • cough

Prevention

Coughing as a result of respiratory infections can hardly be prevented in a targeted manner. Basically, it is advisable to strengthen the immune system. A varied diet rich in vitamins and exercise in the fresh air strengthens the immune system and therefore helps prevent coughs. Smokers should give up smoking, especially if they have a smoker’s cough.

Pulmonary Edema

Pulmonary edema is usually accompanied by significant breathing problems and can easily lead to a life-threatening emergency. Read more about early warning signs, symptoms, causes and treatment, and what to do in an emergency. With pulmonary edema, fluid collects in the lungs. Doctors speak of pulmonary edema. Colloquially, pulmonary edema is also referred to as water in the lungs. Strictly speaking, these are liquid components of the blood that are pressed into the lung tissue from the finest blood vessels in the lungs, the lung capillaries. The function of the lungs is restricted by the free fluid.

In pulmonary edema, depending on the localization of the fluid, a distinction is made between two forms that can quickly merge without therapy:

    • Interstitial pulmonary edema: fluid accumulation in the connective tissue support structure or in the tissue between the cells, the interstitium
    • Intraalveolar pulmonary edema: accumulation of fluid within the finest alveoli.

Pulmonary congestion is a less pronounced preliminary stage of pulmonary edema. Especially in people with left heart failure and kidney failure, pulmonary congestion occurs as a chronic form of pulmonary edema.

Pulmonary edema usually causes clearly noticeable symptoms such as accelerated shallow breathing, rattling breath sounds, coughing, and shortness of breath. If left untreated, pulmonary edema can be life-threatening. If you have symptoms, you should seek medical help immediately. If the symptoms are severe, the emergency doctor should be called.

The most common causes of pulmonary edema are heart disease (cardiac pulmonary edema). Other causes include kidney disease (renal pulmonary edema), poisoning (toxic pulmonary edema), or a lack of oxygen at high altitudes (high altitude pulmonary edema). Sunstroke (cerebral pulmonary edema) can also lead to pulmonary edema under unfavorable circumstances. See the Causes section below for details.

With timely medical help, the life-threatening acute symptoms of pulmonary edema can in most cases be managed well with oxygen treatment and drug therapy. The long-term healing prospects depend primarily on whether the triggering circumstances can be eliminated.

Pulmonary Edema

Frequency

The exact frequency of pulmonary edema is not recorded. From medical practice, however, it can be said that it is a common complication of heart diseases, for example, especially heart failure. The prevalence (incidence) of heart failure is given in the literature to be up to 2 percent. The frequency increases sharply from the age of 60.

According to the German Heart Foundation, up to 3 million men and women in Germany are affected by heart failure. Around 450,000 people are hospitalized for cardiac insufficiency each year. Almost 10 percent do not survive.

Symptoms

The symptoms of pulmonary edema differ according to four degrees of severity.

Stage I: interstitial pulmonary edema

Doctors refer to stage I as interstitial pulmonary edema. Interstitial means that the fluid collects in the connective tissue of the lungs or between the cells of the lung tissue. At this stage, pulmonary edema is mainly noticeable as breathing difficulties. Most of the time, breathing is much faster and shallower. Typically, these symptoms of pulmonary edema subside when the person concerned is elevated or standing. Further symptoms of interstitial pulmonary edema are cough and a noticeable restlessness.

Stage II: Alveolar pulmonary edema

In stage II, the fluid from the lung tissue first penetrates into the alveoli. This is why doctors speak of alveolar pulmonary edema. Later, the fluid also collects in the small bronchi (bronchioles). Typical symptoms of this pulmonary edema stage are increasing shortness of breath and intensifying cough, which is sometimes accompanied by whitish-foamy sputum. Breathing sounds can be heard (so-called wheezing), the pulse is racing (tachycardia), the patients are pale and are afraid of suffocating. At the latest in stage of alveolar pulmonary edema, urgent medical help is required.

Stage III: Increased foaming

In the third stage, the breathing difficulties continue to worsen. More and more fluid collects in the bronchi. A visible symptom is increased foam formation, which is coughed up as whitish sputum. The breathing noises sound more and more rattling. A threatening lack of oxygen (hypoxemia) can occur. Signs of this are bluish discoloration of the lips and fingers (cyanosis).

Stage IV: Respiratory arrest (asphyxia)

Doctors refer to the life-threatening end-stage of pulmonary edema as asphyxia or respiratory failure. If those affected are not immediately supplied with oxygen, there is a risk of death from cardiac arrest.

Causes

Pulmonary edema can have very different causes. By far the most common cause is heart disease. In second place are kidney diseases. Other causes, such as lack of oxygen at high altitudes or other illnesses, are rare causes of pulmonary edema. More about the individual groups is below.

Cardiac Pulmonary Edema

Many people are unaware that the heart and lungs are closely connected by cardiopulmonary circulation. Very simply, the circuit looks like this: The oxygen-poor blood from the body reaches the lungs via the right ventricle. There it flows through the pulmonary capillaries along the alveoli. The blood releases carbon dioxide and absorbs vital oxygen. The freshly enriched blood then returns from the lungs to the heart and from the left ventricle back into the body.

The left ventricle is therefore responsible for the blood being pumped from the lungs into the body. If the left ventricle can no longer do this, the blood backs up into the pulmonary circulation. In addition, the right ventricle releases more and more blood into the lungs, as a result of which the pressure in the large and small blood vessels of the lungs continues to rise. Doctors speak of increasing hydrostatic pressure in the pulmonary veins and pulmonary capillaries. This pressure causes fluid from the blood to be forced through the walls of the blood vessels into the interstitial lung tissue, alveoli, and bronchioles.

Left heart failure (left heart failure) is the most common cause of cardiac pulmonary edema. In principle, however, pulmonary edema also occurs as a result of other severe cardiovascular diseases. These are above all:

Non-Cardiac Pulmonary Edema

If the cause of pulmonary edema is not in the heart, doctors speak of non-cardiac pulmonary edema. There are many possible triggers here.

    • Kidney weakness and pulmonary edema: The kidneys play a decisive role in regulating the fluid balance in the body. With kidney weakness, less fluid is usually excreted. This also promotes pulmonary edema. In addition, kidney diseases sometimes excrete more proteins that should remain in the blood. Because these proteins make a significant contribution to binding the fluid in the blood vessels. Without these proteins, fluid can more easily escape from the blood vessels into the tissue: edema develops. Acute kidney failure is a life-threatening emergency that requires the fastest possible therapy. Lung edema can also result from chronic kidney weakness.
    • Toxic pulmonary edema is caused by toxins or irritants. Typical for this form are, for example, the inhalation of irritant gases, nitric oxide, heroin, or gastric fluid.
    • Allergic pulmonary edema is based on a particularly severe form of an allergic reaction, anaphylactic shock.
    • The causes of high altitude pulmonary edema have not yet been clearly clarified. It sometimes arises in people who quickly ascend to great heights in the mountains. It occurs mainly at altitudes of more than 4,000 meters. About 7 percent of mountaineers are affected.
    • So-called cerebral or neurogenic pulmonary edema is very rare. These pulmonary edema arise, for example, as a result of severe brain injuries or brain infections (encephalitis). Epilepsy can also be associated with cerebral pulmonary edema. In addition, in particular rare cases, severe forms of sunstroke lead to pulmonary edema.

Examination

For doctors or paramedics, the suspected diagnosis of pulmonary edema usually arises from the obvious breathing symptoms. The eavesdropping examination with the stethoscope (auscultation) and imaging examinations create clarity. A simple X-ray examination is sufficient to detect the pulmonary edema itself. When looking for the cause of the pulmonary edema, very different diagnostic methods are used, depending on the initial suspicion. These include ultrasound examinations of the heart (echocardiography) and laboratory tests of blood and urine.

Treatment

The treatment of pulmonary edema is divided into immediate measures to alleviate breathing difficulties, drug therapy, and combating the triggering circumstances.

Immediate measures for pulmonary edema

Whether medical professionals, paramedics, or first aiders: If pulmonary edema is suspected, those affected should be positioned with the upper body upright. It is best for the patient to sit on a chair. Sitting or lying up has several positive effects:

    • The respiratory muscles can relax and thus better support breathing.
    • The pressure in the blood vessels in the lungs decreases because less blood normally gets to the chest when the legs are low.
    • A firm holds while sitting usually helps reduce the agitation and anxiety typical of pulmonary edema.

In the event of a respiratory arrest or pronounced lack of oxygen (recognizable by blue lips or fingers paired with a lack of breathing), cardiopulmonary massage and resuscitation by first aiders can save lives. Paramedics or doctors can compensate for a lack of oxygen by ventilating with oxygen through a nasogastric tube. If necessary, doctors give a sedative against feelings of fear and restlessness.

In the case of severe pulmonary edema obviously caused by cardiac disease, medication to relieve the heart, such as nitroglycerine, catecholamines to improve expectoration such as dobutamine, diuretic agents such as furosemide, and anxiety-relieving opiates such as morphine are usually administered intravenously in the ambulance. In the case of toxic or allergic pulmonary edema, in particular, anti-inflammatory drugs from the active ingredient group of glucocorticoids such as prednisolone and dexamethasone are injected.

Cause-specific treatment of pulmonary edema

Cause-specific treatment of pulmonary edema usually takes place after admission to the hospital. These include, for example, the treatment of cardiovascular diseases or kidney weakness.

Forecast

A general prognosis for pulmonary edema is not possible. Basically, the earlier professional treatment begins, the better the prospects. There are no official figures on the chances of survival. However, the statistics for cardiac insufficiency offer a clue. Of the approx. 450,000 heart failure patients treated in German hospitals each year, one in ten dies on average.

Prevention

Breathing difficulties of unknown cause should always be examined by a doctor as early as possible. In particular, people with cardiovascular diseases, high blood pressure, lung diseases or kidney diseases should strictly adhere to the treatment recommendations – and if the symptoms change, see a doctor immediately to prevent pulmonary edema.

Pulmonary Fibrosis

There are more than 200 forms of pulmonary fibrosis, many of which are rare diseases. More about the causes, symptoms, and treatment of this pathological stiffening of the lung tissue.

Synonyms: interstitial lung disease, pneumoconiosis, idiopathic interstitial pneumonia

Definition

Pulmonary fibrosis is not an independent disease, but rather a change in the lung tissue and the surrounding blood vessels, which is accompanied by an increasing loss of function of the lungs. This loss of function occurs because more and more lung tissue changes like connective tissue and the alveoli are, so to speak, suffocated. At the same time, the lungs lose their elasticity more and more to inflate when you breathe in. As a result, pulmonary fibrosis causes chronic shortness of breath with a lack of oxygen, which is ultimately fatal. The course of the disease can sometimes be slowed down. Lung fibrosis is not curable so far.

Frequency

There is no precise information on the frequency of pulmonary fibrosis in Germany. By far the most common form of the disease in this country is idiopathic pulmonary fibrosis. According to estimates by experts, the incidence rate for IPF is up to 10 cases per 100,000 population per year.

Many diseases related to pulmonary fibrosis are so rare that they are classified as rare diseases (orphan diseases).

Symptoms

Pulmonary fibrosis often goes unnoticed for many years because the lungs can compensate for the loss of functioning alveoli and bronchi for a long time. At the beginning of the symptomatic course, there are breathing difficulties, which are primarily noticeable during physical exertion. Later, symptoms such as shortness of breath and shortness of breath occur even at rest. As a rule, the symptoms continue to worsen. Coughing and accelerated shallow breathing are other signs of pulmonary fibrosis. The lack of oxygen usually severely restricts physical performance. Typical visible signs of advanced pulmonary fibrosis are blue lips and fingers. This cyanosis is a result of the lack of oxygen. This also applies to the so-called drumstick fingers (piston-shaped finger ends) and conspicuously curved fingernails (watch glass nails).

Pulmonary Fibrosis

Causes

There are more than 200 causes of pulmonary fibrosis or so-called fibrosing lung diseases. What all forms have in common is that the connective tissue between the alveoli and the surrounding pulmonary blood vessels and bronchi continues to multiply. Doctors refer to these tissues as the interstitium.

As a result of an inflammatory process, the interstitium becomes increasingly hard and scarred. This has two consequences: on the one hand, the alveoli areas it was suffocated, on the other hand, the lungs are less and less able to inflate when inhaling. This means that less oxygen reaches the lungs. And this reduced volume of oxygen can also be absorbed and released by the alveoli less and less.

How it relates to the inflammatory process has not yet been clearly clarified. Recent studies suggest that the inflammatory response begins on the surface of the alveoli.

In addition to inflammation, drugs can also promote pulmonary fibrosis. In particular, the active ingredients amiodarone, bleomycin, and busulfan are suspected of causing changes in the lungs of the connective tissue. Other causes of pulmonary fibrosis are inhalation of fibers such as asbestos and dust particles such as quartz dust, allergic reactions, and radiation therapy.

Treatment

Pulmonary fibrosis is incurable. Lung tissue that is lost once cannot be reactivated. Pulmonary fibrosis is fatal if left untreated. With a timely start of treatment, the course of the drug therapy can be slowed down. Above all, anti-inflammatory drugs based on cortisone are used. Other typical active ingredients in the treatment of pulmonary fibrosis are immunosuppressants such as azathioprine and cyclophosphamide.

Advanced pulmonary fibrosis often requires long-term oxygen therapy. The last option is a lung transplant.

Inflammation Of The Lungs (Pneumonia)

Inflammation of the lungs (pneumonia) is an infection of the lungs that is treated with antibiotics. Pneumonia causes more hospitalizations than heart attacks or strokes. Read more about the symptoms, causes and treatment of pneumonia here.

Definition

Pneumonia is an infection of the alveoli (alveoli, alveolar pneumonia) and / or the lung tissue in between (interstitium, interstitial pneumonia).

But what actually happens when the lungs become inflamed? In most cases, pneumonia is caused by bacteria or viruses, and rarely by fungi and parasites. The pathogens spread from the upper respiratory tract into the lungs, especially into the alveoli and the lung tissue in between. This invasion of the pathogen inflames certain areas of the lungs.

In addition, the body’s own immune system reacts: Certain immune cells (lymphocytes) produce proteins (cytokines) and fluid flows into the alveoli. The combination of inflamed cells and fluid entry into the vesicles, which are involved in gas exchange, means that less oxygen can be absorbed from the lungs into the blood. At the same time, less used carbon dioxide is released from the blood through the lungs and breath. Shortness of breath, paleness and other symptoms are the result.

Frequency

Pneumonia is a widespread disease, but its frequency is often underestimated by the public. It is true, however, that more people have to go to hospital with pneumonia than with heart attacks or strokes. Almost 280,000 (2014: 278,783) people in Germany are admitted to hospital with pneumonia every year, and there are even more in the case of influenza epidemics.

Most people with pneumonia are children under one year of age and adults over 65 years of age because their immune systems are not fully developed or are weakened with age. If the course is uncomplicated, pneumonia usually lasts two to three weeks, but it can lead to death if the immune system is severely weakened.

Pneumonia Deaths

The exact number of deaths from pneumonia in Germany is not known. The main problem: inaccurate information on death certificates. For example, old people often die of cardiac arrest. Then it is entered in the death certificate and counted as cardiac death in the statistics. You could just as easily list flu or pneumonia as the cause of death. Because this exemplary patient actually “only” had the flu. In the course of this, he acquired pneumonia and only went to the doctor when there was no other way. And in the hospital the already weakened heart stopped for good.

The Federal Statistical Office reports deaths from flu and pneumonia. These numbers vary a lot. In 2011 there were almost 12,000, in 2014 around 8,500. According to experts, the real number is likely to be at least twice as high. Some pulmonologists estimate up to 35,000 deaths.

A cough with a suddenly high fever of up to 40 degrees and a pronounced feeling of illness is one of the first symptoms of bacterial pneumonia (also called typical pneumonia). In addition, there are often fatigue, loss of appetite, chills, pain in the limbs and head as well as chest pain when breathing. Rapid, shallow breathing with occasional breathlessness is another symptom of pneumonia. If the lower lungs are affected, abdominal pain can be the only sign of the disease.

The lack of oxygen due to pneumonia can be recognized by blue lips and fingernails and a pale complexion. When there is a lack of oxygen, the body tries to compensate for this by increasing breathing and increasing the heartbeat. This can be recognized by accumulating breaths and an increased pulse. From about the 2nd day of pneumonia, a dry cough with little sputum develops, which can be rust-brown in color because it contains blood.

Inflammation Of The Lungs (Pneumonia)

Atypical Pneumonia

In addition to bacterial or typical pneumonia, there is atypical pneumonia. This form is less common and is usually caused by viruses (or rare bacteria such as mycoplasma, legionella, or chlamydia). Atypical pneumonia is usually much milder than typical pneumonia. It does not begin acutely, but rather insidiously. The symptoms only appear after a few days. Often headache and body aches, coupled with fatigue, are the only symptoms. High fever and chills rarely occur. The cough also differs from the typical form. It is often described as excruciating and dry. Sputum is produced very rarely.

Causes

It is often pathogens such as bacteria or viruses that cause pneumonia, less often fungi or parasites. The pathogens penetrate the protective mechanisms of the lungs because the immune system of the person affected is weakened or because the pathogens are very aggressive. The infection usually takes place via droplet infection, for example when speaking, coughing or sneezing. The pneumonia can also be the result of the flu or bronchitis.

Overview Of Causes

    • Infection with bacteria (Pneumococci, Haemophilus, Legionella, Mycoplasma, Pseudomonas)
    • Infection with viruses (such as flu viruses), fungi (often Candida and Aspergillus species), and parasites (such as toxoplasma)
    • Effects of chemical irritants, dust particles and toxic gases (e.g. gasoline or flour)
    • allergic diseases such as asthma
    • Inhaled foreign objects such as bites of food or stomach acid
    • Circulatory disorder in individual sections of the lung, for example in the case of heart failure or pulmonary embolism
    • Tumors or foreign bodies that block a trunk of air (bronchus).

These factors promote pneumonia:

    • Weak immune systems as in children under three years of age or adults over 60 years of age
    • Conditions such as heart failure, asthma, chronic bronchitis, diabetes, liver and kidney diseases, leukemia
    • Organ transplants, spleen removal, HIV infection
    • Flu, bronchitis
    • Smoke
    • Alcohol addiction
    • severe neurological diseases
    • immune suppressive therapies such as B. Immunosuppressants (corticosteroids), chemotherapy, radiation therapy
    • artificial respiration
    • Bedridden, hospitalization, operations

Examination

The characteristic noises when listening to the chest give the doctor an initial clue to the diagnosis of pneumonia. If in doubt, the lungs are x-rayed to determine the extent and location of the inflamed areas of the lung tissue. Finally, a blood test can determine the type and extent of the inflammation. In bacterial pneumonia, for example, the number of white blood cells is significantly increased (leukocytosis). An examination of the sputum serves to identify the pathogen and the inflammatory cells involved.

Bronchoscopy

In rare cases of pneumonia without expectoration, tissue must be removed when the bronchi are rinsed (bronchoalveolar lavage) in order to determine the causative agent of the pneumonia. Because determination is important for choosing the right medication. For bronchoscopy, a bronchoscope (a tube-shaped or tubular device) is inserted through the mouth. Depending on the type of procedure, the patient is given a local or general anesthetic.

Treatment

The medical treatment of bacterial pneumonia is comparatively easy. As a rule, so-called broad spectrum antibiotics are used right from the start. In the vast majority of cases, they turn out to be very effective. Such broad spectrum antibiotics are, for example, aminopenicillins or cephalosporins, possibly in combination with macrolides (another group of antibiotics).

If the symptoms of pneumonia do not improve within 2 to 3 days with broad spectrum antibiotics, the causative agent of the disease is determined more precisely. And then prescribed an antibiotic that specifically switches off this pathogen.

Acetylcysteine ​​and ambroxol are particularly suitable for dissolving the mucus. Pronounced dry coughs are dampened with pentoxyverine or codeine, for example.

Therapy Of Atypical Pneumonia

The treatment of atypical pneumonia is much more difficult. It starts with the search for the right medication. Depending on the pathogen, special antibiotics against non-typical bacteria (such as ciprofloxacin, doxycycline, erythromycin or levofloxacin), antifungal agents (such as caspofungin or fluconazole) or anti-virus agents (such as acyclovir or ganciclovir) are given. In the case of pneumonia caused by inhaled foreign bodies, inhaled secretions must first be sucked off or the foreign body removed.

Inpatient Treatment

Whether bacterial causes or others: In the case of pneumonia, hospitalization is often necessary. This applies, for example, to complicated processes or when large parts of the lungs are affected. For example, it is not uncommon for pneumonia drugs to be infused directly into the bloodstream. That alone requires stationary monitoring. Artificial ventilation is another reason why pneumonia often requires hospital treatment.

Self-Help With Pneumonia

If your family doctor or pediatrician agrees, you can cure pneumonia at home. You should take care of the weakened body and keep strict bed rest. It is helpful if you drink a lot to help dissolve the inflammatory secretions in the lungs. In addition, you compensate for the fluid loss caused by fever and sweating.

Many patients find inhalations (with table salt) or steam baths with anise, camphor, menthol, eucalyptus, thyme and chamomile helpful. In any case, you should make sure that the air in the hospital room is not too dry. Here, scented bowls with the essential oils mentioned can also bring moisture into the room air.

Medicinal plants for coughs and colds help relieve the annoying symptoms. The guidebook “Many herbs are grown against colds” offers further suggestions for gentle help.

No Fragrance Oils In Young Children

Caution: Aromatic oils, herbs and herbal bath additives can sometimes be dangerous for babies and toddlers. Agents containing menthol, for example, irritate the child’s airways and can even cause life-threatening larynx cramps.

Course of Disease

Pneumonia heals in an otherwise healthy person in about two to three weeks if treated. The fever usually subsides after 7 to 9 days. With typical pneumonia, patients feel significantly sicker than with the atypical form.

With or after pneumonia, secondary diseases can occur. These are, for example, pleurisy or pleurisy. Sometimes capsules of lung tissue form in the lungs in which pus collects (lung abscesses). Changes in the lung tissue (pulmonary fibrosis) become noticeable as severe breath-dependent pain.

However, the consequences of pneumonia need not be limited to the lungs. If bacterial pathogens causing pneumonia spread through the blood in the body, they can cause meningitis, otitis media, heart inflammation (endocarditis) or pericarditis. Even brain abscesses are possible.

Special Forms Of Pneumonia

    • Nosocomial pneumonia: Infection occurs in hospitals, especially in intensive care units, often through germs that could develop resistance to antibiotics.
    • Fungal pneumonia: Severely immunocompromised people are affected, such as those suffering from AIDS and leukemia or people who take drugs that suppress the body’s immune system (immunosuppressants, corticosteroids).
    • Pneumocystis carinii pneumonia (PCP): This pneumonia is caused by a hose fungus. There is a highly acute and a creeping form. Early diagnosis can save lives. In HIV-positive patients, the so-called Pneumocystis carinii is a typical causative agent of pneumonia. In this form, both lungs are usually affected, often with a very severe course.
    • Aspiration pneumonia: Foreign bodies can get into the lungs in different situations and cause infections there. Patients with impaired consciousness (therefore never give them anything to drink) or people with reflux – i.e. acidic belching of stomach acid – have an increased risk.
    • Chronic pneumonia: Pneumonia can become chronic. This particularly affects patients with a weakened immune system and existing changes in the lungs such as COPD, bronchitis, chronic bronchitis or other lung diseases. Alcoholics and patients with diabetes are also prone to chronic disease.

Prevention And Vaccination

The best protection against pneumonia is vaccination against influenza and vaccination against pneumococci, one of the widespread pathogens causing pneumonia.

Why Does The Flu Shot Protect Against Pneumonia?

The real flu, influenza, is not the harmless common cold that many people confuse this infection with. In particular for small children, the elderly, people with chronic illnesses and weakened immune defenses, the flu is a life-threatening illness. Because the flu viruses often severely weaken the body and the immune system. Then bacteria and other pathogens causing pneumonia have an easy job – and often conjure up very complicated infections.

Vaccination Against Pneumococci

The pneumococcal vaccination protects against one of the common pathogens causing pneumonia. This vaccination can save the lives of old and sick people in particular. The risk of dying as a result of pneumonia drops by more than 90 percent after the pneumococcal vaccination.

Vaccination Recommendations

The Standing Vaccination Commission (STIKO) recommends the pneumococcal vaccination for all children (from the 2nd month of life) as well as for adults over 60 years. The recommendation also applies to patients with cardiovascular diseases, asthma, chronic bronchitis, diabetes, liver and kidney diseases as well as people with organ transplants, people without or with a functionally impaired spleen, people infected with HIV or leukemia patients.

Vaccines

Various vaccines are available for the pneumococcal vaccination. So-called conjugate vaccines are usually used in infants and young children. This conjugated vaccine contains antigens bound to a protein – mostly from fragments of the bacterial shell of the respective pathogen. The 10-valent pneumococcal conjugate vaccine (PCV10) protects against 10 pneumococcal subsets (1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F and 23F). PCV13 is also effective against serogroups 3, 6A, and 19A. An adult polysaccharide vaccine protects against 23 types of pneumococci.

Vaccination Schedule

  • Infants: Since 2015, the STIKO has generally only recommended 3 instead of the previously usual 4 vaccination appointments: 1st vaccination at 2 months, 2nd vaccination 2 months later and the 3rd vaccination 6 months later at the earliest. According to the latest STIKO recommendation from August 2020, the STIKO recommends an additional vaccine dose for premature babies at the age of 3 months, i.e. a total of 4 vaccine doses. The basic immunization should ideally be completed before the age of 2 (U7).
  • Adults aged 60 and over who are not or not fully vaccinated should be immunized once with the 23-valent polysaccharide vaccine.

Contraindications / Vaccination Bans

  • Hypersensitivity to active substances or other components
  • The pneumococcal vaccination should be postponed in the event of severe illnesses requiring treatment. Other vaccinations can be given at the same time as the PCV vaccination.

Side Effects

In the vast majority of cases, there are no side effects of the pneumococcal vaccination. However, among other things, redness and swelling at the puncture site and allergic reactions in the form of hives are possible. Fever, tiredness or gastrointestinal complaints are also typical vaccination reactions, which usually go away by themselves after 2 to 3 days. If not, or if symptoms are severe, please contact your doctor.

Infants and young children rarely develop febrile seizures after vaccinations, which usually go away quickly.

Treatment Methods For Lung Cancer

Cancer therapies serve the purpose of curing the patient of the disease (“curative” = healing therapy) or to stop the further growth and spread of the tumor as long as possible, to relieve discomfort, and to prolong the lifetime (“palliative” = alleviative) Therapy). An indispensable component of oncological care is the so-called “supportive therapy” (supportive therapy). It treats and prevents complications of cancer and survival-related but often aggressive cancer therapies.

How is lung cancer operated?

If the tumor has not exceeded a certain size and has not yet formed distant metastases, surgery is sought with the aim of completely removing the tumor tissue and the lymph nodes affected by tumor cells. The operation plays an important role especially in non-small cell lung cancer – as small cell lung cancer is often diagnosed at a later stage, then other treatments are in the foreground.

The surgical procedure is preceded by extensive research. In particular, it must be ensured that after the removal of part of the lung, the remaining lung sections are able to sufficiently take over the respiratory function. Condition for the operation is a good general condition of the patient; Severe comorbidities often rule out surgery. Furthermore, removal of the tumor should not pose a risk to neighboring vital organs such as large blood vessels or the esophagus. If the expected burdens and restrictions are too great, a different therapy strategy must be chosen.

During surgery, the tumor-bearing lung section and the adjacent lymph nodes are removed. The most common procedure is the removal of a lung lobe (lobectomy). With very large tumors the removal of an entire lung wing may be necessary (pneumectomy). In many cases, however, it is possible to avoid the removal of the entire lung through special, organ-preserving surgical techniques.

Possible side effects:

As a result of the operation, the available breathing area of ​​the patient is reduced. However, if the lung function before surgery is sufficient, it will not be a major problem for the patient, and he will usually be able to compensate well for the loss of lung tissue. Special breathing exercises in rehabilitation also help to improve lung performance after tumor therapy. The first exercises can already be learned in the clinic under the guidance of a physiotherapist and later be continued at home. For smokers, however, should stop smoking immediately before the operation to improve their lung function.

What happens during irradiation?

Radiation therapy is the only therapy for non-small cell lung cancer in stages I and II when surgery is not possible and for selected patients in stage III. Otherwise, it is usually combined with chemotherapy in patients with stage III and small cell lung cancer. If cancer has secondary tumors, called metastases, in other organs such as the brain or the bones, they may also be irradiated.

The high-energy ionizing radiation, which is directed from the outside to the tumor, destroys the cancer cells. The total radiation dose is divided into several single doses, which are administered about five times a week. In the so-called hypofractionated radiation, which can be used in lung cancer, is even twice a day at intervals of several hours, but then irradiated with lower single doses.

In addition to conventional radiotherapy, the so-called stereotactic radiotherapy is also used. Here, the disease is in a few sessions, sometimes in only one, irradiated with a high dose of radiation. This is possible because the beams are directed to the target area from different directions after computer-controlled irradiation planning. There, all the rays meet at one point and add up to the total dose, which is thus maximum at the site of the disease, while the surrounding healthy tissue is largely spared. For this reason, stereotactic radiotherapy is particularly well suited for small tumors and tumors in delicate environments, such as brain metastases.

Possible Side Effects

Side effects of radiotherapy may be hoarseness and difficulty swallowing. The skin is also sensitive to the treatment. In combination with chemotherapy in particular, mucous membrane inflammation and fungal infections can occur in the oral cavity. A late consequence is pneumonitis, an inflammation of the irradiated lung tissue. Overall, the severity of side effects depends on the type and intensity of the radiation used.

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How does chemotherapy work?

Chemotherapy uses cell-growth-inhibiting drugs known as cytostatics. They act primarily against fast-growing cells and thus especially against cancer cells. For the treatment of lung cancer several chemotherapeutic drugs are available, which are selected according to individual requirements.

Which medicines are used depends on various factors, including the stage of the disease, the general condition, and concomitant diseases. Usually, two or three substances are combined, with cisplatin or carboplatin as the basic drug in most cases. Commonly used cytostatic drugs in non-small cell lung carcinoma include cisplatin, carboplatin, vinorelbine, docetaxel, gemcitabine, paclitaxel, pemetrexed and etoposide, small cell lung carcinoma cisplatin, carboplatin, bendamustine, cyclophosphamide, doxorubicin, etoposide, irinotecan, paclitaxel, topotecan and vinca alkaloids such as vincristine.

Possible side effects:

Chemotherapy affects all rapidly dividing lines. These include not only the malignant cancer cells but also healthy cells such as the mucous membrane cells of the digestive tract and the hair root cells. The most common side effects of chemotherapy include nausea, diarrhea, mouth sores, and hair loss. Red blood and white blood cells may also be reduced during chemotherapy, leading to anemia and increased susceptibility to infection. In addition, the various cytotoxic drugs can each cause specific side effects. A good education, as well as preventive and accompanying (supportive) medications, can avoid or at least alleviate many side effects. As a rule, they stop when the chemotherapy is over.

Which targeted medical therapies are used?

Novel therapeutic approaches, termed “targeted therapy,” are designed to target cancer cells exclusively or preferentially. The active ingredients are directed, for example, against factors that promote tumor growth, they prevent the blood supply to the tumor, repair defects in the genome or eliminate their consequences or prevent the signal transmission between tumor cells, so that cell division and growth signals are absent. Targeted therapies are currently used exclusively in advanced (metastatic) non-small cell lung cancer, because good efficacy has not yet been demonstrated in small cell lung cancer. Since intensive research is being carried out in this field, it can be expected that more targeted substances will be approved for the treatment of lung cancer in the near future.

The tyrosine kinase inhibitor of epidermal growth factor (EGFR tyrosine kinase inhibitor)

Activating genetic alterations in the epidermal growth factor receptor (EGFR) cause tyrosine kinases, located in the cell interior of the receptor, to activate a signaling chain that promotes the division of the cancer cells and their multiplication. The EGFR tyrosine kinase inhibitors can stop this. The tiny molecules penetrate the cells through the cell wall and occupy the internal part of the EGF receptor. This breaks the signal chain for cell division and slows down the proliferation of cancer cells.

Currently, three EGFR tyrosine kinase inhibitors are approved for the treatment of lung cancer: erlotinib, gefitinib, and afatinib. These medicines are available in tablet form. The therapy can therefore be performed by the patients at home, which for many means a gain in quality of life. EGFR tyrosine kinase inhibits the progression of the disease and alleviates symptoms.

Possible side effects:

Although tyrosine kinase inhibitors are well tolerated compared to chemotherapy, they are not side effects. A common side effect is the appearance of an acne-like rash on the face and upper body, also called Rash. It can be a sign that the medication works well. Other typical side effects include diarrhea, concomitant weight loss, and prolonged fatigue. Preventive concomitant therapy for rash and diarrhea is recommended.

Drugs for resistance to EGFR tyrosine kinase inhibitors

Tumors can become resistant to the therapy with an EGFR tyrosine kinase inhibitor, ie resistant. In the majority of cases, it is the so-called gatekeeper mutation T790M. It causes the tyrosine kinase inhibitors of the first (gefitinib, erlotinib) and second-generation (afatinib) to be displaced from binding to the tyrosine kinase and unable to inhibit the growth factor. A novel EGFR tyrosine kinase inhibitor that selectively acts even when a T790M mutation is present is osimertinib. It is given in tablet form.

Possible side effects:

The most common side effects with osimertinib therapy are diarrhea, exanthematic rash, nausea, loss of appetite, and constipation. These side effects are significantly less pronounced than with the first and second-generation drugs (gefitinib, erlotinib, afatinib).

EGFR antibody

Although cancer cells on their surface form the “normal” (wild-type) EGF receptor, as is sometimes the case with squamous cell carcinomas of non-small cell lung cancer, cell division is increasingly initiated and tumor growth promoted. In this case, a combination of the chemotherapeutic agents cisplatin/gemcitabine and the anti-EGFR antibody necitumumab may be worthwhile. If this therapy starts and is well tolerated, maintenance therapy with necitumumab is possible. The side effects of Necitumumab are similar to those of the EGFR tyrosine kinase inhibitors but more pronounced in their severity than in the first and second generation of active agents.

Tyrosine kinase inhibitors of ALK and ROS1 kinases

Tyrosine kinase inhibitors of this group of drugs are directed against proteins in the cell that stimulate cell growth. The binding of the active ingredients to the proteins blocks certain signaling pathways and restricts uncontrolled cell growth in the tumor. For example, the ALK tyrosine kinase inhibitor crizotinib is approved for the first and second treatment (after chemotherapy) of patients with ALK translocation. Second-generation ALK tyrosine kinase inhibitors are alectinib and ceritinib. They have an even more specific effect on ALK kinase. Other effective ALK inhibitors currently being tested in studies are Brigatinib and Lorlatinib.

Rarer than ALK translocations are activating ROS1 translocations. The affected patients can be treated with the tyrosine kinase inhibitor crizotinib in the first therapy. A newer ROS1 inhibitor is lorlatinib.

Possible side effects:

ALK and ROS1 kinase inhibitors can also cause side effects, with each drug having its own specific side-effect profile. Often liver dysfunction, diarrhea, nausea, vomiting, abdominal pain, and prolonged fatigue, but also visual disturbances and taste changes may occur.

Angiogenesis Inhibitors

Angiogenesis means the formation of blood vessels. These blood vessels are needed by the tumor to supply themselves with oxygen and nutrients. Ultimately, angiogenesis thus supports tumor growth and the spread of the tumor in the body.

Angiogenesis inhibitors hinder the blood supply to tumors by blocking the vascular cell growth factor VEGF (Vascular Endothelial Growth Factor). Studies have shown that cancer cells grow less and that given chemotherapies work better. Such angiogenesis inhibitors are bevacizumab, ramucirumab, and nintedanib. Bevacizumab may be used in patients with metastatic (stage IV) non-small cell non-epithelial lung carcinoma in combination with platinum-based chemotherapy for initial treatment. Ramucirumab (regardless of tumor type) and nintedanib (adenocarcinoma only) are used in patients undergoing second-line therapy in combination with docetaxel chemotherapy if relapses have occurred.

Possible side effects:

Patients with bevacizumab have an increased risk of bleeding and therefore good monitoring is essential. Often, high blood pressure occurs. Other typical but less common side effects include blood vessel obstruction (embolism), increased urinary protein excretion, and wound healing disorders. Common side effects of ramucirumab in combination with docetaxel are a lack of white blood cells with and without fever (neutropenia and febrile neutropenia), persistent fatigue and hypertension, and the side effects described with bevacizumab. The side effects of nintedanib are similar, with side effects such as EGFR tyrosine kinase inhibitors.

Other targeted agents

One to two percent of all non-small cell lung carcinomas has BRAF mutations, about half of which are V600E alterations. The BRAF gene produces a protein (B-Raf), which is involved in the normal growth and survival of cells as an important component of the so-called mitogen-activated protein kinase (MAPK) pathway. Changes in the gene can cause this signaling pathway to becoming overly active, leading to uncontrolled cell growth and cancer. So-called BRAF inhibitors can stop this. However, experience has shown that tumors develop rapid resistance to BRAF inhibitors. However, inhibiting the so-called MEK kinases 1 and 2 in the MAP kinase pathway simultaneously with BRAF inhibition effectively prevents the development of resistance. Preliminary study results indicate that good response rates and disease control rates are achieved in multiple-chemotherapy patients with the progressive disease by combining the BRAF inhibitor dabrafenib with the MEK inhibitor trametinib.

Nearly one-third of all patients who do not have a KRAS, ALK, ROS, or EGFR mutation in the tumor have RET mutations. In this case, therapy with cabozantinib can be beneficial. Around two percent of all adenocarcinomas of non-small cell lung cancer show changes in the HER2 receptor. Affected patients often respond well to HER2 inhibitors such as trastuzumab or afatinib. For MET amplification and/or MET mutations, MET tyrosine kinase inhibitors such as capmatinib may be used.

Activate the immune system: immunotherapies

Activating one’s own immune system in such a way that it recognizes the tumor as “ill/foreign” and fights it is the goal of immunotherapy. Cancer cells can escape the natural immune defense, such as by losing their tumor-specific antigens, by which they would recognize the immune system as sick, by mutations, inhibit the activity of immune cells or manipulate so-called immune checkpoints. The latter regulates the intensity and quality of the activity of so-called T cells of the immune system. In lung cancer, the PD-1 checkpoint plays an important role. The PD1 receptor is typically produced on T cells of the immune system, the associated “ligand” PD-L1 of dendritic cells of the immune system, but also of cancer cells. When PD-L1 binds to its PD-1 receptor on the T cells, they are inactivated. If the tumor cells now release more PD-L1 themselves, they can escape the clutches of the immune system because they “paralyze” the T-cells. If the immune checkpoint PD-1 or PD-L1 is blocked by so-called PD-1 inhibitors such as pembrolizumab or nivolumab or PD-L1 inhibitors such as atezolizumab, its damaging effect on the immune cells is eliminated – these become active and fight the tumor cells.

Pembrolizumab may be used as the sole treatment for chemotherapy in patients with metastatic stage IV non-small cell lung cancer with> 50% PD-L1 expression and no EGFR and ALK alterations of tumor cells. In second-line therapy, when metastatic non-small cell lung cancer continues to grow or return despite therapy, immunotherapy with nivolumab, pembrolizumab (> 1% PD-LD1 expression) may be initiated.

Possible side effects:

In addition to fatigue, loss of appetite, and general weakness, the PD-1, and PD-L1 blocker therapy can be associated with side effects related to the immune system, such as disorders of thyroid function, pneumonia, hepatitis, and renal dysfunction. Also, side effects on the skin are possible, for example, rash, itching, and vitiligo (white spot disease). In addition, diarrhea can occur as a result of colitis.

Treatment of bone metastases

Lung tumors tend to form secondary tumors in the bones. These can cause significant pain and increase the risk of fractures. Single bone metastases can be removed by surgery or stereotactic radiotherapy. In addition, the administration of substances that inhibit bone loss, so-called bisphosphonates, reduces the risk of complications, alleviating pain. Another group of drugs used to treat bone metastases are so-called targeted therapies. In Germany, the antibody denosumab from this group is approved. It binds itself in the body specifically to a protein called RANKL, which normally activates bone-degrading cells. When denosumab blocks RANKL, bone-degrading cell activity diminishes, bone mass is retained and fractures become less common.

Supportive

The medical care of cancer patients is not only the antitumoral therapy, the cure, or cancer as long as possible to push back – an integral part is also the so-called supportive therapy. Irrespective of the stage of the tumor, it ensures that cancer patients do not suffer too much from the complications of cancer and as well as possible tolerate the survival-related but often aggressive tumor therapies. The catalog of measures for possible supportive therapies is long; Prevention and treatment of nausea and vomiting are also included, such as the treatment of anemia and missing white blood cells (neutropenia), the prevention of infections, the prevention, and treatment of oral mucosal inflammation and the prevention and treatment of skin manifestations.

Palliative Therapy

When lung cancer is too advanced, therapy is no longer focused on healing, but on relieving tumor-related symptoms and maintaining the quality of life for patients and their relatives. This includes not only the prevention and treatment of pain and other physical ailments but also assistance and therapy in psychosocial stress situations and problems that may be associated with cancer. In the case of physical symptoms, respiratory distress and pain are most prominent for lung cancer patients with advanced disease. They can be well-alleviated in many cases with the medicines and methods available today. Even if certain standards play a role in this, the therapy is always individually tailored to the patient’s situation.

Lung Cancer Centers

The treatment of lung cancer is complex and requires the cooperation of specialists of different disciplines. In addition, research into new therapies is in constant flux. In order to be able to guarantee optimal treatment for lung cancer patients based on the latest scientific findings and treatment guidelines, so-called lung cancer centers are being certified by the German Cancer Society. For certification, the facilities must meet strict standards, e.g. a minimum number of qualified specialists and a minimum number of lung cancer patients treated there each year. Only then can the centers gain sufficient experience with the disease and constantly expand it. The treatment in the lung cancer center is interdisciplinary by pulmonary specialists, thoracic surgeons, radiation therapists, oncologists, pathologists, and radiologists. They participate in regular tumor conferences, where individual treatment plans are developed for each patient. The treatment team is supplemented by psycho-oncologists, social workers, pastoral workers, and physiotherapists.

 

Source:

Esche B., Geiseler J. & Karg O. (ed.): Pulmonology. Textbook for Respiratory Therapists. German Society for Pulmonology and Respiratory Medicine e.V. Berlin 2016

Griesinger F & Heukamp L. What’s hot in lung cancer. TumorDiagn u Ther 2016;37:1–7

Improve Lung Function With Nutrition

If you want to do something good for your lungs, you should regularly eat plenty of apples and tomatoes. These two foods seem to have a particularly positive effect on lung health. They inhibit the natural aging process of the lungs and allow the lungs of former smokers to recover much faster. In addition to apples and tomatoes, other foods have been found to help the lungs in the past. There are also foods that should not be eaten for the sake of the lungs.

High fiber foods protect the lungs

The type of diet enormously influences the state of health of the individual organs. This is evident in the organs of the digestive system. After all, they come into direct contact with food. In the lungs, however, one can hardly imagine that these organs could be happy about fiber, for example. But that’s exactly the case:

People who eat high-fiber foods are more likely to have healthy lung function than low-fiber people, as we’ve already reported here: fiber protects the lungs, and you’ll also find a list of the best fiber suppliers.

Foods with beta-cryptoxanthin reduce lung cancer risk

And it’s not just fiber that’s good for the lungs. Even foods containing the so-called beta-cryptoxanthin seem to have an extremely positive effect on the lungs, as a study from November 2016 had shown. The substance is found in all red and orange vegetables and fruits and reduces the risk of lung cancer. Details and the corresponding food can be found here: Plant substance reduces lung cancer risk

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Apples, tomatoes, and bananas promote the repair of the lungs

Apples, tomatoes, and other antioxidant-rich foods also help to keep the lungs healthy, and even make sure that damaged lungs can recover faster – as reported by the Johns Hopkins University Bloomberg School of Public Health in December 2017 at the European Respiratory Journal announced.

In their study, scientists looked at the nutrition and lung function of more than 650 adults – once in 2002 and then ten years later in 2012. Participants came from Germany, Norway, and the United Kingdom.

The more tomatoes, the better the lung functions

Anyone who had once smoked could slow down the natural aging process of his lungs if he followed a diet rich in vegetables and fruits. Especially tomatoes, bananas, and apples proved to be helpful in the investigation. These foods appear to contain special substances that also contributed to a faster recovery of the tobacco-damaged lungs after smoking cessation.

But also for people who had never smoked, a healthier lung function could be observed, if they had eaten the said food regularly. Yes, the more tomatoes the participants had on the diet, the better.

And because the condition of the lungs is closely correlated with the risk of death – be it through chronic lung disease, heart disease, lung cancer or other diseases – the increased consumption of tomatoes is certainly a very good idea. Read also: Drink for lung cleansing.

Only fresh fruits and vegetables work

However, it is not enough to eat a tomato or an apple now and then. You should consume more than two tomatoes per day or more than three servings of fresh fruits per day to achieve the mentioned benefits (1 serving = 80 g). Also processed tomato products, eg. B. tomato sauce from the glass or fruit from the can did not have a corresponding effect. Only fresh fruits and vegetables had a positive impact on lung health.

Nutrition advice for lung patients and risk groups recommended

Study author Dr. Vanessa Garcia-Larsen said the results showed the need for nutritional recommendations, especially for high-risk groups. People with weakened lungs or first signs of certain lung diseases, such as COPD (chronic obstructive pulmonary disease), should therefore be given appropriate nutritional advice.

More often eat foods that help with repair of the lungs

Already at the age of about thirty the lung functions begin to weaken – depending on the general condition of the person. If you eat many fruits and vegetables, you can slow down the age-related worsening of lung function and better repair lung damage such as smoking.

“Nutrition, as we now know, is an important way to combat increasingly common COPD diseases,” concludes Garcia-Larsen.

Further information on the positive effects of a healthy diet on lung health can be found here: Healthy diet protects against smoker’s cough. Important is here u. a. that sugar and white flour products as well as foods with a high glycemic load (= foods that cause high blood sugar levels) should be avoided.

Symptoms and Diagnosis of Stage 4 Lung Cancer

To assist physicians in deciding what type of treatment is more appropriate for lung cancer, there is a recognized numerical staging system that creates benchmarks. At Stage I, the cancer is small and localized in a specific area of ​​the lung. During phases 2 and 3, the cancer grows and spreads to the surrounding tissue and possibly the lymph nodes.

Stage 4 lung cancer is when the cancer has spread, or metastised, from the lungs to other parts of the body. Typically, the cancer spreads to the liver, bones, brain or adrenal glands. This is commonly known as secondary or advanced cancer. About 40% of lung cancer patients are diagnosed at stage 4, mainly because the symptoms of lung cancer could include symptoms of other diseases. In Stage 4, the cancer is not curable, but it can be treated. These are some of the symptoms that may help your doctor to diagnose stage 4 lung cancer.

Breathing problems

Lung cancer patients often present with shortness of breath, wheezing and hoarseness. It is often a persistent cough, and the patient can cough up blood. Sometimes, a chronic cough that the patient may suddenly change for some time may be natural. Because these symptoms may also affect other conditions, they are not sufficient to suggest a diagnosis of lung cancer. However, if a smoker presents with these symptoms, a diagnosis of stage 4 lung cancer is likely to be considered by the doctor.

Pain

Patients may experience pain in various areas of the upper body, including the back, chest, arms, ribs and hips. Deep breathing often intensifies the pain that can be felt in the tissues or bones depending on the spread of the cancer. It can also be pain when swallowing. Some people suffer from frequent headaches, which is an indication that the cancer could be affecting the brain.

Weight Loss

With stage 4 lung cancer, there is often a sudden, unexplained weight loss that is often accompanied by loss of appetite and a general feeling of weakness and fatigue. If this weight loss is significant and you do not have a diet, it should be investigated.

“Clubbing”

The nails on the fingers and toes can bulge, and the ends of the fingers change shape. This symptom usually develops in the latter stages of lung cancer, so it is a good indicator of diagnosis.

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Diagnosis

The diagnostic process for stage 4 lung cancer is usually some form of imaging, such as computed tomography (CAT) or magnetic resonance imaging (MRI). These scans give a detailed picture of the spread of the cancer as X-rays, allowing the doctor to determine the cancerous stage. A radionuclide scan can detect if the cancer has spread to other organs, while a bone scan will show if the bones are affected.

The doctor may also conduct tests to determine if the cancer has spread to the lymph nodes. This involves removing a tissue sample for testing under general anesthesia. This process is called medias or mediastinotomy, depending on whether the tissue is absorbed by the neck or the chest.

While all these symptoms refer to other conditions, if you experience one or more of them for two weeks or more, you should consult your doctor. Lung cancer is particularly dangerous because it metastises to other parts of the body relatively quickly, making it one of the most life-threatening cancers there is. As with most conditions, the earlier the diagnosis, the more likely that the treatment will succeed. During treatment for stage 4 lung cancer, the condition will not heal, it can prolong life and improve quality of life, so it is important to seek medical advice as soon as possible.

What are The Symptoms Of Lungs Cancer, Treatment & Prognosis

Lung cancer is a malignant neoplasm in the respiratory system (lungs and bronchi). In addition to breast cancer, colon cancer and prostate cancer, it is one of the most common cancers worldwide. Unfortunately, the number of illnesses continues to increase, especially among women.

Short version:

    • Smoking causes 85% of lung cancers.
    • Lung cancer is caused by a change in the genetic material due to chronic damage.
    • Lung carcinomas can be divided into two groups.
    • Because symptoms are unrecognized or misinterpreted, lung cancer is often discovered by accident during examinations.
    • The treatment of a lung tumor depends on the type of cancer.

In Austria, around 2,500 men and almost 1,200 women suffer from bronchial carcinoma each year. Thus lung cancer is second only to prostate cancer in males and third in women after breast and colon cancer. Most cases are detected between the 55th and the 65th year of life. However, patients can be significantly younger.

The main risk factor for the development of lung cancer is cigarette smoking: Around 85% of all cases can be attributed to tobacco consumption. Hereditary predispositions or contact with other harmful substances (such as arsenic, radon or asbestos), on the other hand, play a subordinate role. 3-5% of the diseases are caused by passive smoking.

From surgery to Targeted Therapy: Depending on the type and stage, lung cancer is treated differently.

Anyone smoking a pack of cigarettes every day for over 20 years increases their lung cancer risk 30 to 40 times. By contrast, a familial accumulation only leads to a doubling or tripling of the risk.

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How does lung cancer develop?

In the cells of the mucous membranes of the bronchi and in the alveoli, there is a change in the genetic material due to prolonged chronic damage (for example, chronic inflammation from cigarette smoke). After a long time, this change means that the normal control mechanisms for the growth and death of cells are no longer effective and a malignant tumor develops. At an early stage of development, this process can sometimes be reversed, such as when the damaging effects are stopped.

Basically, two groups of lung cancer are differentiated:

    1. Non-small cell lung carcinoma

The non-small cell type accounts for around three quarters of cancers of the lung. It is roughly subdivided into:

    • squamous cell carcinoma
    • the adenocarcinoma
    • the large cell carcinoma
    1. Small cell lung carcinoma

Small cell lung cancer (about 20% of the disease) spreads rapidly through the bloodstream and lymphatics, but is better for chemotherapy.

This distinction is important from a medical point of view, because the therapy is targeted accordingly.

Which symptoms occur?

In those cases of lung cancer that are discovered at an early stage, these are generally incidental findings: pulmonary x-raying is actually done for quite different reasons, e.g. in case of release for surgical procedures or severe infections suggesting pneumonia.

The most significant problem is that the disease remains asymptomatic for a long time. Often, the typical symptoms, such as coughing, shortness of breath, fatigue or back pain, misinterpreted or ignored. Since the majority of sufferers are smokers with chronic bronchitis and often have cardiovascular problems, the symptoms are attributed to them.

A doctor’s visit is therefore often delayed for a long time. Only the appearance of blood in the sputum or severe weight loss are alarming. More than two-thirds of all cases of lung cancer are therefore diagnosed at a local or systemic (i.e., distant metastasis) stage.

Unfortunately, previous large-scale studies on the possibility of early diagnosis have not shown sufficiently satisfactory results to be meaningful to broad sections of the population. A so-called spiral computed tomography (spiral CT) with low radiation dose is therefore recommended as a preventive check only certain risk groups: chronic smokers over 50 years, especially if at the same time a chronic obstructive pulmonary disease (COPD) is present; in addition, in the case of lung cancer in the family or a workplace that is burdened by inhaled carcinogens (carcinogenic substances). However, the last two factors only seem relevant if the person smokes himself at the same time.

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How does the doctor make a diagnosis?

If lung cancer is suspected, the patient is referred to a specialized department where a complete examination is made as soon as possible. Among other things, the stage of the disease, the type of tumor and the spread in the body is examined.

For this purpose, different examination methods such as computed tomography, ultrasound, biopsy or a PET scan are performed.

Which treatment methods are available?

The choice of treatment for lung cancer depends largely on the type of cancer and the stage of the cancer.

Treatment options range from surgery to radiation and chemotherapy, to molecular biology therapy.

What is the prognosis for lung cancer?

In contrast to other types of cancer, in the case of bronchial carcinoma, there are no meaningful early detection measures or long-term successful treatment methods. Lung cancer is the only cancer in which the rate of new disease is nearly identical to that of deaths.

Taking all the cases together, current treatment methods achieve a 5-year survival rate of only 15%. However, when early-stage non-small cell lung cancer is detected, around 75 out of every 100 people treated surgically are still alive five years later.

At the same time, lung cancer is virtually the only cancer that has a prevalent and avoidable risk factor. Prevention through smoking cessation is therefore at the forefront.

Especially in the case of lung cancer, it must be emphasized how important it is to participate in the clinical trials offered, as it provides access to new drugs that are not yet on the market, and one can expect further improvements. Moreover, it is only possible to further advance the progress in the treatment of this problematic disease.

As regards therapy, great progress has been made in all areas in recent years. It has become much better in terms of effectiveness and tolerability. This leads to an improvement in quality of life, lifespan and a reduction in side effects.

What can i do on my own?

If you are a smoker, stop as soon as possible!

There are studies showing that certain drugs used to treat lung cancer are less effective when smoked during treatment. The effect of radiation therapy is also disturbed, and surgery increases the rate of complications.

In addition, it is known that patients who have undergone successful surgery have a higher risk of developing another lung cancer if they continue to consume nicotine than those who have quit smoking.

In addition, of course, all health care measures are also useful in the case of this disease: such as vitamin and fiber rich diet with restriction of sugar and fat content and sufficient exercise in the fresh air.

Different Types Of Lung Cancer

Lung cancer is a malignant tissue proliferation in the lungs, mainly from the mucous membranes of the bronchi. The medical term bronchial carcinoma hides numerous tumors with different cell types and therefore different forms of therapy and prognosis.

In the case of bronchial carcinoma, a distinction is made between small cell and non-small cell tumors

Non-Small Cell Lung Cancer (NSCLC) includes squamous cell carcinoma, which accounts for half of all lung cancers. The tumor cells do not grow as fast as e.g. in small cell bronchial carcinoma. It can usually be operated on well because it is predominantly located centrally in the lungs and more distinct than small cell lung cancer. Also, the cancer cells grow less quickly, but also do not respond so well to chemo or radiation therapy.

Adenocarcinoma also belongs to the group of non-small cell lung carcinomas. It has some special status, as it occurs mainly in non-smoking middle-aged women. Otherwise, it can be said that about every tenth cell-type lung cancer is an adenocarcinoma.

The third representative of this group is the rarely occurring large-cell bronchial carcinoma, which accounts for five to ten percent of all malignant lung tumors. All three tumor types grow more slowly compared to small cell bronchial carcinoma and do not form metastases (secondary tumors) as quickly.

Small Cell Lung Cancer (SCLC) is also referred to as oat cell cancer because the tumor cells are very similar to oat grains. This type of lung cancer is extremely fast and invasive and early causes metastases in the lymph nodes, liver, kidneys, brain, and skeletal system (predominantly spine). As a form of treatment, chemotherapy or radiation therapy is available here, under which the tumor size can greatly reduce or reduce due to the cell specificity. Surgery is performed if the cancer is found only in one lung and near lymph nodes. However, as this type of cancer does not usually occur in just one area, surgery as a single treatment is not useful. Often there are also recurrences.

Small cell bronchial carcinomas also have as a special feature the formation of a paraneoplastic syndrome, i. The tumor cells produce hormone-like substances that can lead to a variety of endocrinological symptoms. Since 80% of all patients already have metastasis at the time of the first diagnosis, this tumor has the worst prognosis.

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Special shapes :

    • Pancoast tumor

The tumor sits at a certain point in the lung tip and has just through this situation a typical symptom. The most common symptoms here are unilateral shoulder pain radiating to the arm, ribs, neck, and back. This symptomatology is due to the ingrowth of the tumor into surrounding nerve tracts. Often a Horner syndrome also occurs. Horner’s syndrome is the combination of drooping eyelid, narrowing of the pupil, withdrawal of the eyeball, and reversed perspiration on one side. As a therapy, a combined chemo and radiation therapy followed by surgery is recommended if the condition of the patient allows it and there are no metastases in adjacent lymph nodes or other organs.

    • Pleural Mesothelioma

This rather rare malignant tumor starts from the pleura, which covers the lungs. Although it can greatly affect the function of the lungs and lead to severe breathing difficulties, it does not formally belong to the group of different types of lung cancer. Causes of pleural mesothelioma are mostly asbestos contacts. Asbestos is the most important risk factor for this type of cancer. Since 1977, pleural mesothelioma has been recognized as an occupational disease in recent occupational asbestos exposure. It grows quite slowly compared to other tumors. Decades may pass between the inhalation of asbestos-containing dusts and the manifestation of pleural mesothelioma.

In the end, however, it destroys and displaces other organs such as the lungs, heart, and diaphragm and forms metastases. It also comes very often to a pleural effusion. This is an accumulation of often purulent, often bloody fluid in the chest. In the treatment of pleural mesothelioma, the affected tissues are removed and replaced if necessary by artificial sculptures. Accompanying radiation and/or chemotherapy can be used.