American Medical Association Family Medical Guide - American Medical Association [393]
Symptoms
Breathing in toxic substances can cause the following symptoms in the lungs: fluid buildup, bleeding, inflammation, scarring (fibrosis), and a dry cough or a cough that produces phlegm. The phlegm of coal miners is often black. An affected person may have breathlessness that goes away after a few hours or difficulty breathing that becomes progressively worse. Molecules from inhaled fumes can enter the bloodstream and cause other symptoms, such as fever with chills or a headache.
WARNING!
Respiratory Failure
If you have symptoms of respiratory failure or congestive heart failure (such as swelling of the ankles and legs, bluish skin color, sweating, wheezing, or severe difficulty breathing), get to a hospital emergency department as soon as possible. Treatment includes helping you breathe with the aid of a ventilator, supplemental oxygen, and medication.
Diagnosis
If you are continuously exposed to hazardous substances (or think you may have been) and have symptoms, your doctor will recommend that you have diagnostic tests such as a chest X-ray and lung function tests (see page 647) to see if, and how severely, your lungs are affected.
Treatment
If you have an occupational lung disease, change jobs if possible. If you can’t change jobs, try to avoid the toxic material or fumes. Avoid unventilated areas. Wear a canister face mask while working. If you smoke, stop (see page 29). Smoking increases your risk of developing other lung disorders.
Idiopathic Pulmonary Fibrosis
Idiopathic pulmonary fibrosis, also called interstitial pulmonary fibrosis or fibrosing alveolitis, is an inflammatory disorder that results in thickening and scarring of the fibrous tissue of the lungs. Over time, this scarring can accumulate to such an extent that the lungs can no longer provide sufficient oxygen to the body. The disorder affects men and women in equal numbers and is usually diagnosed between ages 40 and 70. Although the cause is unknown, some doctors think that it may result from an autoimmune response (in which the immune system mistakenly attacks its own tissues), a lung infection (usually a viral infection), taking certain medications, or undergoing radiation therapy (see page 23) for breast cancer. In some cases, heredity seems to be a factor. Idiopathic pulmonary fibrosis may lead to other conditions, such as respiratory failure (see previous page) or congestive heart failure (see page 570).
Symptoms
The symptoms of idiopathic pulmonary fibrosis include a dry cough and shortness of breath, especially during exertion. Enlargement or clubbing of the fingertips develops in most people. As the disease progresses, you may have symptoms of respiratory failure or congestive heart failure such as swelling of the ankles and legs, bluish skin color, or wheezing and breathlessness.
Diagnosis
To diagnose idiopathic pulmonary fibrosis and to help determine the type you have, your doctor may recommend diagnostic imaging tests such as a chest X-ray or a CT scan (see page 112). He or she also may recommend a blood test to determine the level of oxygen in your blood. The only sure way to diagnose idiopathic pulmonary fibrosis is by examining tissue or phlegm samples from the lungs, usually obtained in a procedure called bronchoscopy (see page 661) or through an endoscope inserted into the pleural cavity through a skin incision.
Treatment
There is no effective treatment for 90 percent of the cases of idiopathic pulmonary fibrosis. In the remaining 10 percent of cases, a doctor may prescribe the corticosteroid prednisone to reduce inflammation or the immune-suppressing drug cyclophosphamide to reduce the abnormal activity of the immune system. Some people with the disorder may also need supplemental oxygen to boost oxygen levels in their blood, reduce breathlessness, and enable them to become more active. Your doctor may recommend a lung transplant (see page 658) if you are a good candidate for a transplant.
Lung Cancer
Lung cancer is the uncontrolled