Clinical infromation A-Z

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 COPD stands for chronic obstructive pulmonary disease and is synonymous with the term emphysema. It is the result of excessive smoking which causes limitation of airflow through damaged airways and poor exchange of oxygen due to destruction of alveolar (lung) tissue. Symptoms of COPD include breathlessness, cough, mucus expectoration, chest discomfort, weight loss, frequent infections and lack of energy. COPD is categorised into mild, moderate and severe. In the latter, limitation of both oxygen intake and carbon dioxide expiration may produce life-threatening respiratory failure. The mainstay of COPD treatment is smoking avoidance, improvement of airway function using the right combination of inhaled bronchodilators, mucus-loosening drugs and steroid tablets as well as antibiotics when an infective exacerbation occurs. Pulmonary rehabilitation may be a beneficial form of therapy for many.

Coughs may be acute, subacute or chronic. A common symptom, it may result from an upper or lower respiratory infection, occur following exposure to an irritant or indicate the presence of a more established condition such as asthma, COPD, chronic lung inflammation or scarring, postnasal drip or even gastro-oesophageal reflux disease (occasionally without heartburn). A cough persisting for more several weeks in the absence of infective symptoms warrants investigation.

The lung is susceptible to a range of infections caused by viruses, bacteria and other transmissible agents. Depending on the individual’s systemic (general) and lung-based (local) immunity, both common and unusual agents may cause concern. Viral infections often clear up without requiring treatment but may be complicated by secondary bacterial infections. On the other hand, bacterial infections may produce abnormalities on a chest radiograph which give rise to the term pneumonia. Public health hazards including tuberculosis, new forms of flu and other ‘emerging’ viral infections continue to pose diagnostic and treatment challenges.

Interstitial lung diseases (ILD) affect the lung structures that enable oxygen exchange to take place. ILD may be inflammatory or fibrotic, i.e. cause scar tissue to accumulate. Often, one leads to the other. Some important forms of ILD do not have an identifiable cause (idiopathic) but many others may develop following specific exposure (e.g. medical drug, industrial hazard or environmental protein), occur in association with an underlying disease (e.g. rheumatoid arthritis or sarcoidosis) or form part of a rare syndrome. ILD may also be an unwanted effect of important medical procedures such as chemotherapy and radiotherapy. Often, early and appropriate treatment may retard progression to lung fibrosis (scarring). In many cases however, ILD are misdiagnosed or missed entirely because of their propensity to develop insidiously over time.

Lung cancer is one of the commonest cancers in the world, with almost 40,000 cases diagnosed in the UK each year. The vast majority of cases occur in current or ex-heavy smokers, particularly in those over 60. Early detection is associated with better survival. Non-small cell lung cancer (NSCLC) is the commonest form and includes several different subtypes. Small cell lung cancer (SCLC) is less common but more aggressive. Effective management takes into account the cancer cell type, its stage (size and extent of spread) and its likely response to treatment, the last often depending on molecular testing. A complete cure is possible for many early stage lung cancers; for others, treatment with drugs, radiotherapy, radiofrequency ablation or robotic radiosurgery may offer realistic life-prolonging treatment. Holistic lung cancer care must always include a multidisciplinary team comprising Respiratory physicians, Radiologists, Oncologists, Thoracic surgeons, Pain management specialists, specialist nurses, pharmacists and allied professionals.

Pleural effusion is the accumulation of fluid in the pleural space. This space lies adjacent to the outer surface of both lungs and is lined by two layers of pleural lining, namely the parietal (outer) and visceral (inner) membranes. Diseases or abnormalities affecting the pleural linings may give rise to a pleural effusion including infections such as pneumonia or tuberculosis, lung cancer, inflammatory conditions such as rheumatoid arthritis or injury to the ribs. It is vitally important to distinguish benign from cancerous causes of an unexplained effusion. Pain due to a pleural abnormality is known as pleurisy. The investigation of pleural effusion may include a CT scan, ultrasound scan, pleural fluid aspiration, pleural biopsy or a surgical procedure to both visualise as well as to take samples of the pleura (VATS).

The surgical procedure is a keyhole operation (known as VATS, or Video-Assisted Thoracopic Surgery) and can be used to diagnose and treat the underlying pleural disease.

A pneumothorax or collapsed lung is air that is trapped next to the lung in the chest cavity. Most cases occur ‘out of the blue’ in healthy young people. Some develop as a complication from a chest injury or a lung disease. The common symptom is a sudden sharp chest pain followed by pains when you breathe in. You may become breathless. In most cases, the pneumothorax clears without needing treatment. The trapped air of a large pneumothorax may need to be removed if it causes breathing difficulty through removing the air (aspiration) or in some cases a chest drain. A keyhole operation is needed in some cases.

Pulmonary embolism (PE), the formation of blood clot/s in the lungs, may be associated with mild symptoms or less frequently, develop into a life-threatening condition. It may arise remotely, often starting as deep venous thrombosis (DVT) of the lower limbs before moving into the lung circulation. Approximately one in 10 to 15 people with DVT will develop PE. A number of tests can be done to enhance the diagnosis of PE, including a special contrast-enhanced CT scan. Prompt treatment with a blood thinning agent will prevent clot enlargement. Occasionally, a clot-busting drug (thrombolytic agent) may be administered if the clots are exerting a potentially dangerous effect on the circulatory system.

Sleep disorders and sleep disordered breathing is an umbrella term that includes obstructive sleep apnoea (OSA) and central hypoventilation syndrome. Certain risk factors are recognised for sleep disorders including being male, having a large body habitus, having a large collar size or unusual neck anatomy and taking sedative medications. Rare disorders of the central nervous system are also known to cause under-breathing (hypoventilation) particularly during sleep. A special sleep study can be done to identify sleep disordered breathing as well as assess its severity. A number of effective treatment options are available for this condition; non-treatment may lead to restrictions being placed on vehicular driving and other work-related activities.