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This
Resource Page is designed to provide a simple overview of some of
the medical problems we commonly encounter. The disease summary briefly
defines selected respiratory and sleep problems. To learn about the
procedures we perform and those we frequently request, review the
procedure section. For further exploration of any of the disease,
conditions, symptoms and procedures discussed, visit the various websites
of interest listed at the end of this page.
RESPIRATORY PROBLEMS
ASTHMA: Asthma is difficult to define. The most commonly
accepted definition of asthma is a chronic inflammatory disorder of
the airways in which many inflammatory pathways play a role. This
inflammation causes recurrent episodes of wheezing, breathlessness,
chest tightness, and cough, particularly at night or early in the
morning. It is often associated with dramatic changes in breathing.
BRONCHIECTASIS: Bronchiectasis is usually a form of chronic
obstructive pulmonary disease that has specific findings in the airways.
Inflammation, dilation, and herniation of the airways into the lung
parenchyma (saccular changes) are characteristic findings of bronchiectasis.
Bronchiectasis usually is confirmed by radiograph changes seen on
chest computed tomographic scans (CT).
CANCER
OF THE LUNG: Cancer is an uncontrolled growth of cells. Malignant
cells are the cells that are growing out of control. Cancer of the
lung occurs when cells within the lung become malignant. Lung cancer
can cause a wide variety of symptoms, but if discovered early, there
may be no symptoms at all. Smokers and ex-smokers are at much higher
risk for lung cancer.
CHRONIC BRONCHITIS: Chronic bronchitis is defined by the
presence of a cough that occurs for at least three months out of the
year over two successive years and is productive of mucus.
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD): Chronic obstructive
pulmonary disease is characterized by expiratory obstruction to breathing
and is not reversible with medications. The obstruction is a result
of both small airways problems and lung tissue destruction. The contribution
of each process to COPD varies from person to person. COPD can be
accompanied by partially reversible airway obstruction. Patients with
chronic obstructive pulmonary disease have varying components of asthma,
emphysema, and chronic bronchitis.
COMMUNITY ACQUIRED PNEUMONIA: Community acquired
pneumonia is infectious pneumonia that occurs in an individual who
is not a hospital patient and results from agents found in the general
population. Hospital acquired pneumonias are caused by infectious
agents frequently found in the hospital but not usually found in the
general population The most common causes of community-acquired pneumonia
in Arizona are Mycoplasma pneumonia, bacterial pneumonia such as Streptococcus
pneumoniae, and Valley Fever.
EMPHYSEMA: Emphysema is a process that refers to
the abnormal permanent enlargement of alveoli (the small air sacs
where oxygen and carbon dioxide are exchanged in the lungs). This
enlargement of the alveoli occurs because of the rupture of the alveoli
walls.
INFECTIOUS PNEUMONIA: Pneumonia is inflammation of the lung
tissue. It is found by physical and chest x-ray examination. Pneumonia
often results from infection and is caused by viruses, bacteria, and
fungus. Pneumonia can also be non-infectious in origin. One example
of non-infectious pneumonia is aspiration pneumonia. Aspiration pneumonia
is the result of stomach contents, stomach acid, or partially digested
food being regurgitated into the airway and then into the lung tissue
causing inflammation.
INTERSTITIAL PULMONARY FIBROSIS:
Interstitial pulmonary fibrosis is a process of unknown cause that
affects the walls of the lungs between the alveolar sacs and along
smaller airways. The changes that occur are an increased presence
of inflammatory cells and scar tissue which can be seen on chest
x-rays. These changes progress in a variable rate in each individual.
Usual symptoms are breathlessness and cough.
PLEURAL EFFUSIONS: Fluid can accumulate in the
chest. Most often it occurs between the lung and the chest wall
in a space that is called the pleural space. Normally there is a
very small amount of fluid in that space. However, certain diseases
and medical problems can cause increased fluid to develop in the
space. The fluid may cause symptoms and can be found on a chest
x-ray.
PULMONARY ARTERY HYPERTENSION: Pulmonary artery
hypertension is high blood pressure in the pulmonary arterial system.
The pulmonary arterial system extends from the right side of the
heart into the lung tissue where the pulmonary veins then collect
the blood that goes back to the left side of the heart. Normally
the pressure in the pulmonary arteries is very low compared to systemic
blood pressure. Pulmonary artery blood pressure is usually approximately
20 mmHg while systemic arterial blood pressure is usually 110 mmHg.
When the pulmonary artery blood pressure is elevated for long periods,
strain can occur to the right side of the heart causing symptoms
and right-sided heart failure.
PULMONARY EDEMA: Pulmonary edema is a condition that results
when the small air sacks (alveoli) are filled with fluid. Most frequently
the fluid accumulates to there because of heart failure. The heart
is not able to pump the blood from the lungs and the result is the
excess fluid accumulation in the lung tissue.
PULMONARY
EMBOLISM: Pulmonary embolism is an abnormal blood clot
that floats through the venous system, through the right side of
the heart and then lodges in the pulmonary arteries within the lung.
Normally there are no identifiable clots in the human venous system.
When there are clots in the general venous system, they can break
off and flow through the veins through the heart and be lodged in
a pulmonary artery vessel in the lung. These vessels, when occluded,
can cause symptoms of chest pain, shortness of breath, coughing
up blood, and even result in rapid death.
SARCOIDOSIS:
Sarcoidosis is a condition that most often affects the lungs and
lymph nodes in the chest but can involve many of the body’s
organs. Lung damage occurs when a certain type of inflammation (granulomatous)
develops, progresses and persists. A cause for the granulomatous
inflammation of sarcoid has not been found.
VALLEY
FEVER: Valley Fever is the common name for an infection
caused by a fungus named coccidioidomycosis. The most common form
of this infection is a pneumonia that results from the inhalation
of fungus spores. The coccidioidomycosis organism grows in the desert
areas of the Southwest.
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SLEEP PROBLEMS
CENTRAL SLEEP APNEA: Central Sleep Apnea is apnea that
occurs as the result of failure of the chest to make efforts to
breathe. Sleep is repeatedly interrupted.
EXCESSIVE DAYTIME SLEEPINESS: Excessive daytime
sleepiness is a symptom produced by many sleep disorders. Difficulty
with the quantity of sleep, quality of sleep, duration of sleep,
habits affecting sleep, medications taken and brain diseases can
all result in excessive daytime sleepiness.
INSOMNIA: Insomnia is defined as an inadequate
amount of sleep due to difficulties getting to sleep or staying
asleep resulting in problems with daytime activities.
MOVEMENT DISORDERS: Abnormal movements during sleep result
in poor quality sleep for both individuals and their bed partners.
Such movement can be frightening or alarming, and have the potential
to cause injury to the individual or the bed partner. Movement disorders
include Periodic Limb Movement Disorder, Parasominas, and REM Behavior
Disorder.
OBSTRUCTIVE SLEEP APNEA: Obstructive Sleep Apnea
is apnea that occurs as the result of obstruction in the upper airway
during sleep. The chest makes respiratory efforts, but air movement
is obstructed by the collapse of the throat. Sleep is repeatedly
interrupted. Obstructive sleep apnea is the most common type of
apnea and affects five to ten percent of the population.
RESTLESS LEGS SYNDROME: A condition of the legs
characterized by uncomfortable feelings such as disagreeable crawling
or creeping sensations that are relieved by movement. Restless legs
problems cause difficultly with going to sleep.
SLEEP APNEA: Sleep apnea is a breathing problem
that occurs during sleep. When asleep, the patient’s breath
stops intermittently. The two major types of apnea are obstructive
and central. Sleep apnea has two major effects. First, it disturbs
the quality of sleep producing sleep related symptoms. Secondly,
when present for many years it causes many serious cardiovascular
diseases.
SLEEP PHASE SYNDROME (ADVANCED AND DELAYED): Sleeping
well but sleeping at a time of the day that is not desired, is a
sleep phase problem. When an individual’s sleep time is later
than they desire, a delayed sleep phase syndrome is present (i.e.
sleeping between 3AM and 11AM when the desired time is 10PM to 6AM).
When the sleep time is earlier than the desired time an advanced
sleep phase syndrome is present.
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PROCEDURES:
BRONCHOALVEOLAR
LAVAGE: The collection of fluid and cells from the distal
airways and alveoli of the lung. Lavage is performed during a bronchoscopy
procedure by irrigating a small portion of lung with sterile saline
solution.
BRONCHOSCOPY: The examination of the interior of the tracheobronchial
tree by means of a lighted tube. There are both flexible (fiberoptic)
and rigid tubes (bronchoscopes) used for this purpose.
COMPUTED
TOMOGRAPHIC SCANS: A radiographic study that results in
highly detailed images of a portion of the body. The image is a
picture of a thin slice of body tissue (i.e. chest) that is produced
by a moving x-ray camera. The x-rays are collected by the detectors
and then digitized, stored and reconstructed by computers to create
the image.
FIBEROPTIC BRONCHOSCOPY: A bronchoscopy performed
using a flexible tube containing fiberoptic bundles to transmit
light and visual images. Fiberoptic bronchoscopes are very small
and are usually inserted through the nose. Several types of procedures
can be done through the bronchoscope including bronchial wall biopsies,
lung biopsies and bronchoalveolar lavage.
MULTIPLE SLEEP LATENCY (MSLT) and MAINTAINANCE OF WALKFULLNESS
(MWT): Sleep tests performed during the waking hours. These
test measure many of the physiologic variables measured during polysomnography.
The test is conducted as a series of measurements spaced at fixed
times during the day.
OXIMETRY: Oximetry is a measure of the oxygen saturation
of the blood. A sensor called an oximeter is place on a finger.
The oximeter measures the transfer of light through the finger and
converts the results to the oxygen saturation reading. The oximeter
is widely used in medicine and the sensor can be used for a few
minutes, a whole night or continuously.
POLYSOMNOGRAPHY: A continuous recording of physiologic
variables during sleep which include brain waves (electroencephalogram
or EEG), muscle tones (electromyogram or EMG), eye movements (electro-oculogram
or EOG), respirations, heart rhythm, electrocardiogram (ECG or EKG),
oxygen saturation and airflow at the nose and mouth.
POSITIVE PRESSURE POLYSOMNOGRAPHY: A polysomnogram
performed while an individual is breathing through a positive pressure
device such as constant positive airway pressure (CPAP) or bi-level
airway pressure.
PULMONARY FUNCTION STUDIES: Pulmonary function
studies are tests of the breathing capacity and lung function. They
include measurements of airflow in and out of the lungs, the effect
of medication on the airflow, the size of the lungs and how well
gases are able to pass into (diffuse) the blood. The test requires
the individual to make varying breathing efforts while the air is
collected so that the measurements can be made.
TRANSBRONCHIAL LUNG BIOPSY: The removal of small
portions of lung tissue for examination under a microscope. It is
performed by passing a very small instrument with cup like pinchers
on the end through a bronchoscope, through the airway and into the
lung.
TRANSTHORACIC NEEDLE BIOSPSY: The removal of small
portions of a lung abnormality (usually identified by a radiograph)
with a needle for examination under a microscope. It is performed
by passing a special needle through the chest wall into the abnormality
while its location is verified by a radiograph such as fluoroscopy
or computed tomography.
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WEBSITES OF
INTEREST:
Respiratory Sites
American Lung Association
www.lungusa.org
(Look under tab Diseases
A to Z)
Lung Cancer
www.lungcancer.org
National Heart, Lung and Blood Institute
www.nhlbi.nih.gov/health/dci/Browse/Lung.html
NIH Lung Cancer Home page
www.cancer.gov/cancertopics/types/lung
Sleep Sites
American Academy of Sleep Medicine
www.aasmnet.org
(Patient information –
Look under Patients and Public heading)
American Insomnia Association
www.americaninsomniaassociation.org
American Sleep Apnea Association
www.sleepapnea.org
Narcolepsy Network
www.narcolepsynetwork.org
Sleep Education provided by the American Academy of Sleep Medicine
www.sleepeducation.com
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