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95-537: These schemes exist to compensate UK coal miners and their families in relation to respiratory disease and Vibration white finger (VWF). These are the biggest personal injury schemes in British legal history and possibly the world. The claims are processed for the government by Capita (formerly IRISC who were acquired by Aon Corporation who sold the IRISC part of their operation to Capita in 2004). Claims are processed using

190-562: A pneumothorax of pneumomediastinum also possible. Persistent Pulmonary Hypertension of the Newborn (PPHN) is a syndrome that occurs from an abnormal transition to extra-uterine life. It is marked by an elevated pulmonary vascular resistance and vasoconstriction causing a right-to-left shunt of the blood through the foramen ovale or ductus arteriosus . There are three main causes of PPHN are parenchymal diseases such as meconium aspiration syndrome, idiopathic, and hypoplastic vasculature like in

285-776: A decline in the FEV1 . There is evidence of it causing some respiratory problems and its use in combination may have a cumulative toxic effect suggesting it as a risk factor for spontaneous pneumothorax, bullous emphysema , COPD and lung cancer. A noted difference between marijuana use and tobacco was that respiratory problems were resolved with stopping usage unlike the continued decline with stopping tobacco smoking. Respiratory symptoms reported with marijuana use included chronic cough, increased sputum production and wheezing but not shortness of breath. Also these symptoms were typically reported ten years ahead of their affecting tobacco smokers. Another study found that chronic marijuana smokers even with

380-527: A degree of airway hyperresponsiveness to irritants similar to those found in asthma. Low oxygen levels and eventually, high carbon dioxide levels in the blood , can occur from poor gas exchange due to decreased ventilation from airway obstruction, hyperinflation and a reduced desire to breathe. During exacerbations, airway inflammation is also increased, resulting in increased hyperinflation, reduced expiratory airflow and worsening of gas transfer. This can lead to low blood oxygen levels which if present for

475-726: A diaphragmatic hernia. It will eventually resolve in most infants. This is the only syndrome that inhaled nitric oxide is approved for by the FDA. Transient Tachypnea of the Newborn is caused by the retention of alveolar fluid in the lungs. It commonly occurs in infants who are delivered via caesarean section without the onset of labor because absorption of amniotic fluid in the lungs has not yet commenced. Other risk factors are male sex, macrosomia , multiple gestations, and maternal asthma. It usually presents with tachypnea and increased work of breathing. On an x-ray diffuse infiltrates, interlobar fissures, and sometimes pleural effusions can be seen. It

570-462: A difficulty noted of determining the best treatment. The only genotype is the alpha-1 antitrypsin deficiency (AATD) genetic subtype and this has a specific treatment. The cause of the development of COPD is the exposure to harmful particles or gases, including tobacco smoke , that irritate the lung causing inflammation that interacts with a number of host factors. Such exposure needs to be significant or long-term. The greatest risk factor for

665-508: A genetic susceptibility, factors associated with poverty , aging and physical inactivity. Asthma and tuberculosis are also recognized as risk factors, as the comorbidity of COPD is reported to be 12 times higher in patients with asthma after adjusting for smoking history. In Europe airway hyperresponsiveness is rated as the second most important risk factor after smoking. A host factor of an airway branching variation , arising during development has been described. The respiratory tree

760-496: A government sponsored website [1] the current version of this was built and is operated by Web Technology Group . Prior to 2003 it was operated by Integrated Solutions Consultants Ltd of Hemel Hempstead who used to have the domain www.isc.co.uk though this has now been resold. For the BCRDL scheme calculators to calculate the portion of quantum attributable to the miner's exposure to coal dust and their pension loss can be downloaded from

855-634: A greater exposure. These fuels are used as the main source of energy in 80% of homes in India , China and sub-Saharan Africa . Intense and prolonged exposure to workplace dusts , chemicals and fumes increases the risk of COPD in smokers, nonsmokers and never-smokers. Substances implicated in occupational exposure and listed in the UK, include organic and inorganic dusts such as cadmium , silica , dust from grains and flour and fumes from cadmium and welding that promote respiratory symptoms. Workplace exposure

950-458: A high inflammatory cell recruitment ( neutrophil ) and/or destructive cycle of infection , (e.g. mediated by Pseudomonas aeruginosa ). Some of the most common are asthma , chronic obstructive pulmonary disease , and acute respiratory distress syndrome . Most chronic respiratory dieseases are not curable; however, various forms of treatment that help dilate major air passages and improve shortness of breath can help control symptoms and increase

1045-628: A high rate of morbidity and mortality and this rate is amplified when comorbid with COPD. Tuberculosis is a risk factor for the development of COPD, and is also a potential comorbidity. Most people with COPD die from comorbidities and not from respiratory problems. Anxiety and depression are often complications of COPD. Other complications include reduced quality of life and increased disability, cor pulmonale , frequent chest infections including pneumonia , secondary polycythemia , respiratory failure , pneumothorax , lung cancer, and cachexia (muscle wasting). Along with these complications, there

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1140-451: A history of exposure to risk factors for the disease. Spirometry is then used to confirm the diagnosis. Spirometry measures the amount of airflow obstruction present and is generally carried out after the use of a bronchodilator , a medication to open up the airways. Two main components are measured to make the diagnosis, the forced expiratory volume in one second (FEV1), which is the greatest volume of air that can be breathed out in

1235-417: A hoarse voice. Croup (Laryngotracheobronchitis) is a viral infection of the vocal cords typically lasting five to six days. The main symptom is a barking cough and low-grade fever . On an X-ray, croup can be recognized by the "steeple sign", which is a narrowing of the trachea . It most commonly occurs in winter months in children between the ages of 3 months and 5 years. A severe form caused by bacteria

1330-549: A lung abscess, a round cavity in the lung caused by the infection, or may spread to the pleural cavity . Poor oral care may be a contributing factor to lower respiratory disease, as bacteria from gum disease may travel through airways and into the lungs. Primary ciliary dyskinesia is a genetic disorder causing the cilia to not move in a coordinated manner. This causes chronic respiratory infections, cough, and nasal congestion. This can lead to bronchiectasis, which can cause life-threatening breathing issues. Malignant tumors of

1425-528: A marked decrease in the number of cold and flu infections during this time. Smoke from wildfires is proving an increasing risk in many parts of the world and government agencies have published protective advice on their websites. In the US the EPA advises that the use of dust masks do not give protection from the fine particles in wildfires and instead advise the use of well-fitting particulate masks . This same advice

1520-589: A modified MRC scale that if used, needs to include other tests since it is simply a test of breathlessness experienced. Scores on CAT range from 0–40 with the higher the score, the more severe the disease. Spirometry may help to determine the severity of airflow limitation. This is typically based on the FEV1 expressed as a percentage of the predicted "normal" for the person's age, gender, height and weight. Guidelines published in 2011 by American and European medical societies recommend partly basing treatment recommendations on

1615-509: A possibility of certain inhaled corticosteroids for COPD providing a protective role against COVID-19. Differentiating COVID-19 symptoms from an exacerbation is difficult; mild prodromal symptoms may delay its recognition and where they include loss of taste or smell COVID-19 is to be suspected. Many definitions of COPD in the past included chronic bronchitis and emphysema but these have never been included in GOLD report definitions. Emphysema

1710-428: A prolonged period, can result in narrowing of the arteries in the lungs, while emphysema leads to the breakdown of capillaries in the lungs. Both of these conditions may result in pulmonary heart disease also classically known as cor pulmonale . The diagnosis of COPD should be considered in anyone over the age of 35 to 40 who has shortness of breath , a chronic cough, sputum production, or frequent winter colds and

1805-489: A significant and chronic inflammatory response to inhaled irritants which ultimately leads to bronchial and alveolar remodelling in the lung known as small airways disease . Thus, airway remodelling with narrowing of peripheral airway and emphysema are responsible for the alteration of lung function. Mucociliary clearance is particularly altered with a dysregulation of cilia and mucus production. Small airway disease sometimes called chronic bronchiolitis , appears to be

1900-442: A slow deterioration with the need for increased ventilatory support. Chest x-ray is the standard for diagnosis where it is seen as linear or cystic translucencies extending to the edges of the lungs. Bronchiolitis is the swelling and buildup of mucus in the bronchioles. It is usually caused by respiratory syncytial virus (RSV), which is spread when an infant touches the nose or throat fluids of someone infected. The virus infects

1995-414: A small number of studies. Infections can affect any part of the respiratory system. They are traditionally divided into upper respiratory tract infections and lower respiratory tract infections. The upper airway is defined as all the structures connecting the glottis to the mouth and nose. The most common upper respiratory tract infection is the common cold . However, infections of specific organs of

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2090-570: A system known as ICMS (IRISC Claims Management System) which is as custom application written in FoxPro). This system integrates with the BCRDL (British Coal Respiratory Disease Litigation) Pension Loss Calculator that was developed by Workflow Consulting Limited under joint instruction from the British Government and the CSG (Claimant Solicitors Group). Claimant solicitors can also track their cases using

2185-548: A tribunal accused of taking cuts from compensation pay-outs. Jim Beresford , 58, and Douglas Smith, 51, from Beresfords Solicitors in Doncaster, denied 11 allegations of misconduct at the hearing in London. Jim Beresford was notably the highest paid solicitor in the UK for the year of 2006 as a consequence of Coalclaims work. Respiratory disease Respiratory diseases , or lung diseases , are pathological conditions affecting

2280-499: Is alpha-1 antitrypsin deficiency (AATD) and this is the only genotype (genetic subtype) with a specific treatment. This risk is particularly high if someone deficient in alpha-1 antitrypsin (AAT) also smokes. It is responsible for about 1–5% of cases and the condition is present in about three to four in 10,000 people. Mutations in MMP1 gene that encodes for interstitial collagenase are associated with COPD. The COPDGene study

2375-465: Is asthma-COPD overlap , which is a condition sharing clinical features of both asthma and COPD. Spirometry measures are inadequate for defining phenotypes and chest X-ray, CT and MRI scans have been mostly employed. Most cases of COPD are diagnosed at a late stage and the use of imaging methods would allow earlier detection and treatment. The identification and recognition of different phenotypes can guide appropriate treatment approaches. For example,

2470-469: Is tobacco smoking with an increased rate of developing COPD shown in smokers and ex-smokers. Of those who smoke, about 20% will get COPD, increasing to less than 50% in heavy smokers. In the United States and United Kingdom, of those with COPD, 80–95% are either current or previous smokers. Several studies indicate that women are more susceptible than men to the harmful effects of tobacco smoke. For

2565-601: Is tobacco smoking , and common causes of bronchiectasis include severe infections and cystic fibrosis . The definitive cause of asthma is not yet known. Restrictive lung diseases are a category of respiratory disease characterized by a loss of lung compliance , causing incomplete lung expansion and increased lung stiffness, such as in infants with respiratory distress syndrome. Restrictive lung diseases can be divided into two categories: those caused by intrinsic factors and those caused by extrinsic factors. Restrictive lung diseases yielding from intrinsic factors occur within

2660-421: Is a chronic cough, which may or may not be productive of mucus as phlegm . Phlegm coughed up as sputum can be intermittent and may be swallowed or spat out depending on social or cultural factors and is therefore not always easy to evaluate. However, an accompanying productive cough is only seen in up to 30% of cases. Sometimes limited airflow may develop in the absence of a cough. Symptoms are usually worse in

2755-412: Is a condition that occurs after birth usually from mechanical ventilation and oxygen use. It happens almost exclusively in pre-mature infants and is characterized by the alveoli, and lung vasculature becoming inflamed and damaged. Complications from BPD can follow a patient into adulthood. As a child they may experience learning disabilities, pulmonary hypertension, and hearing problems. As an adult, there

2850-422: Is a diagnosis of exclusion because of its similarity to other diseases and frequently CPAP is used to help push the lung fluid into the pulmonary vasculature. Pulmonary interstitial emphysema is the condition of air escaping overdistended alveoli into the pulmonary interstitium. It is a rare disease that occurs most often in premature infants, even though it is possible to appear in adults. It often presents as

2945-494: Is a filter for harmful substances and any variant has the potential to disrupt this. A variation has been found to be associated with the development of chronic bronchitis and another with the development of emphysema. A branch variant in the central airway is specifically associated with an increased susceptibility for the later development of COPD. A genetic association for the variants has been sometimes found with FGF10 . Alcohol abuse can lead to alcoholic lung disease and

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3040-565: Is a particularly severe form of this condition where the air in the pleural cavity cannot escape, so the pneumothorax keeps getting bigger until it compresses the heart and blood vessels, leading to a life-threatening situation. Pulmonary vascular diseases are conditions that affect the pulmonary circulation . Examples are: Pulmonary diseases also impact newborns and the disorders are often unique from those that affect adults. Infant respiratory distress syndrome most commonly occurs in less than six hours after birth in about 1% of all births in

3135-422: Is a sudden worsening of signs and symptoms that lasts for several days. The key symptom is increased breathlessness, other more pronounced symptoms are of excessive mucus, increased cough and wheeze. A commonly found sign is air trapping giving a difficulty in complete exhalation . The usual cause of an exacerbation is a viral infection , most often the common cold . The common cold is usually associated with

3230-511: Is an air pollutant associated with an increased risk of hospitalization due to the exacerbations caused. Long-term exposure is indicated as an increased rate of mortality in COPD. Studies have shown that people who live in large cities have a higher rate of COPD compared to people who live in rural areas. Areas with poor outdoor air quality, including that from exhaust gas , generally have higher rates of COPD. Urban air pollution significantly effects

3325-578: Is an associated risk of developing pulmonary hypertension . The estimated prevalence of pulmonary hypertension complicating COPD was reported at 39% in a meta-analysis. Of the people with COPD listed for lung transplantation, 82% were documented as having pulmonary hypertension via right heart catheterization, noting a mean pulmonary arterial pressure greater than 20mm Hg. Despite pulmonary hypertension being relatively rare in people with COPD, mild elevations of pulmonary arterial pressure can lead to worse outcomes, including risk of death. Cognitive impairment

3420-410: Is an important risk factor for COPD. It is advised that everybody with COPD be screened for A1AD. Metabolic syndrome has been seen to affect up to fifty percent of those with COPD and significantly affects the outcomes. When comorbid with COPD there is more systemic inflammation. It is not known if it co-exists with COPD or develops as a consequence of the pathology. Metabolic syndrome on its own has

3515-581: Is an increased likelihood for asthma and exercise intolerance. Meconium Aspiration Syndrome occurs in full term or post-term infants who aspirate meconium . Risk factors include a diabetic mother, fetal hypoxia, precipitous delivery, and maternal high blood pressure. Its diagnosis is based on meconium stained amniotic fluid at delivery and staining on the skin, nails, and umbilical cord. Aspiration can cause airway obstruction, air-trapping, pneumonia, lung inflammation, and inactivated surfactant. It presents as patchy atelectasis and hyperinflation on an x-ray with

3610-503: Is an ongoing longitudinal study into the epidemiology of COPD, identifying phenotypes and looking for their likely association with susceptible genes. Genome wide analyses in concert with the International COPD Genetics Consortium has identified more than 80 genome regions associated with COPD and further studies in these regions has been called for. Whole genome sequencing is an ongoing collaboration (2019) with

3705-414: Is associated with low-grade systemic inflammation. The most common cause of COPD is tobacco smoking . Other risk factors include indoor and outdoor air pollution including dust , exposure to occupational irritants such as dust from grains , cadmium dust or fumes , and genetics , such as alpha-1 antitrypsin deficiency . In developing countries , common sources of household air pollution are

3800-502: Is believed to be the cause in 10–20% of cases and in the United States, it is believed to be related to around 30% of cases among never smokers and probably represents a greater risk in countries without sufficient regulations. The negative effects of dust exposure and cigarette smoke exposure appear to be cumulative. Genetics play a role in the development of COPD. It is more common among relatives of those with COPD who smoke than unrelated smokers. The most well known genetic risk factor

3895-418: Is called bacterial tracheitis. Tonsillitis is swelling of the tonsils by a bacterial or viral infection. This inflammation can lead to airway obstruction. From tonsillitis can come a peritonsillar abscess which is the most common upper airway infection and occurs primarily in young adults. It causes swelling in one of the tonsils, pushing the uvula to the unaffected side. Diagnosis is usually made based on

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3990-428: Is common in those with COPD as it is for other lung conditions that affect airflow. Cognitive impairment is associated with the declining ability to cope with the basic activities of daily living . It is unclear if those with COPD are at greater risk of contracting COVID-19 , though if infected they are at risk of hospitalization and developing severe COVID-19. However, there are laboratory and clinical studies showing

4085-442: Is defined as enlarged airspaces ( alveoli ) whose walls break down resulting in permanent damage to the lung tissue and is just one of the structural abnormalities that can limit airflow. The condition can exist without airflow limitation but commonly it does. Chronic bronchitis is defined as a productive cough that is present for at least three months each year for two years but does not always result in airflow limitation although

4180-520: Is it caused by insufficient surfactant production and immature lung and vascular development. The lack of surfactant makes the lungs atelectatic causing a ventilation to perfusion mismatch, lowered compliance, and increased air resistance. This causes hypoxia and respiratory acidosis which can lead to pulmonary hypertension . It has a ground glass appearance on an x-ray. Symptoms can include tachypnea, nasal flaring, paradoxical chest movement, grunting, and subcostal retractions. Bronchopulmonary Dysplasia

4275-409: Is more complex, with a diverse group of disorders of differing risk factors and clinical courses that has resulted in a number of subtypes or phenotypes of COPD being accepted and proposed. The two classic emphysematous and chronic bronchitic phenotypes are fundamentally different conditions with unique underlying mechanisms. Another subtype of COPD, categorized by some as a separate clinical entity,

4370-450: Is not sufficient for the diagnosis of COPD. Screening using spirometry in those without symptoms has uncertain effect and is generally not recommended; however, it is recommended for those without symptoms but with a known risk factor. A number of methods can be used to assess the affects and severity of COPD. The MRC breathlessness scale or the COPD assessment test (CAT) are simple questionnaires that may be used. GOLD refers to

4465-528: Is offered in Canada and Australia to the effects of their forest fires. The number of exacerbations is not seen to relate to any stage of the disease; those with two or more a year are classed as frequent exacerbators and these lead to a worsening in the disease progression. Frailty in ageing increases exacerbations and hospitalization. Acute exacerbations in COPD are often unexplained and thought to have many causes other than infections. A study has emphasized

4560-507: Is seen to be an independent risk factor for COPD. Mucociliary clearance is disrupted by chronic exposure to alcohol; macrophage activity is diminished and an inflammatory response promoted. The damage leads to a susceptibility for infection, including COVID-19 , more so when combined with smoking; smoking induces the upregulation of the expression of ACE2 , a receptor for the SARS-CoV-2 virus. The primary risk factor for COPD globally

4655-399: Is started, resulting in an increase in the total volume of air in the lungs at any given time, a process called air trapping which is closely followed by hyperinflation . Hyperinflation from exercise is linked to shortness of breath in COPD, as breathing in is less comfortable when the lungs are already partly filled. Hyperinflation may also worsen during an exacerbation. There may also be

4750-425: Is the frequent exacerbator. The frequent exacerbator has two or more exacerbations a year, has a poor prognosis and is described as a moderately stable phenotype. A pulmonary vascular COPD phenotype has been described due to cardiovascular dysfunction. A molecular phenotype of CFTR dysfunction is shared with cystic fibrosis . A combined phenotype of chronic bronchitis and bronchiectasis has been described with

4845-410: Is the second most commonly smoked substance, but evidence linking its use to COPD is very limited. Limited evidence shows that marijuana does not accelerate lung function decline. A low use of marijuana gives a bronchodilatory effect rather than the bronchoconstrictive effect from tobacco use, but it is often smoked in combination with tobacco or on its own by tobacco smokers. Higher use however has shown

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4940-618: The BCRDL maintained by Workflow Consulting Limited . Miners who worked at british coal also known as the National Coal Board can use the help for miners scheme and claim for industrial compensation using the Industrial disease benefit scheme or use the Help for Miners Compensation As of November 2008, two solicitors who won personal injury claims for thousands of miners have appeared before

5035-566: The National Heart, Lung and Blood Institute (NHLBI) to identify rare genetic determinants. COPD is a progressive lung disease in which chronic, incompletely reversible poor airflow (airflow limitation) and an inability to breathe out fully ( air trapping ) exist. The poor airflow is the result of small airways disease and emphysema (the breakdown of lung tissue ). The relative contributions of these two factors vary between people. Air trapping precedes lung hyperinflation. COPD develops as

5130-515: The PDE4 inhibitor roflumilast is targeted at the chronic-bronchitic phenotype. Two inflammatory phenotypes show a phenotype stability: the neutrophilic inflammatory phenotype and the eosinophilic inflammatory phenotype. Mepolizumab , a monoclonal antibody , has been shown to have benefit in treating the eosinophilic inflammatory type rather than the use of oral corticosteroids, but further studies have been called for. Another recognized phenotype

5225-422: The connective tissue of the lungs by proteases (particularly elastase ) that are insufficiently inhibited by protease inhibitors . The destruction of the connective tissue of the lungs leads to emphysema, which then contributes to the poor airflow and finally, poor absorption and release of respiratory gases. General muscle wasting that often occurs in COPD may be partly due to inflammatory mediators released by

5320-516: The lung tissue . Chronic bronchitis is defined as a productive cough that is present for at least three months each year for two years. Both of these conditions can exist without airflow limitation when they are not classed as COPD. Emphysema is just one of the structural abnormalities that can limit airflow and can exist without airflow limitation in a significant number of people. Chronic bronchitis does not always result in airflow limitation. However, in young adults with chronic bronchitis who smoke,

5415-439: The FEV1. The GOLD guidelines group people into four categories based on symptoms assessment, degree of airflow limitation and history of exacerbations. Weight loss, muscle loss and fatigue are seen in severe and very severe cases. Use of screening questionnaires, such as COPD diagnostic questionnaire (CDQ), alone or in combination with hand-held flow meters is appropriate for screening of COPD in primary care. A chest X-ray

5510-436: The UK, approximately 1 in 7 individuals are affected by some form of chronic lung disease, most commonly chronic obstructive pulmonary disease , which includes asthma , chronic bronchitis and emphysema . Respiratory diseases (including lung cancer) are responsible for over 10% of hospitalizations and over 16% of deaths in Canada. In 2011, respiratory disease with ventilator support accounted for 93.3% of ICU utilization in

5605-483: The United States in 2010 the economic cost was put at US$ 32.1 billion and projected to rise to US$ 49 billion in 2020. In the United Kingdom this cost is estimated at £3.8 billion annually. A cardinal symptom of COPD is the chronic and progressive shortness of breath which is most characteristic of the condition. Shortness of breath (breathlessness) is often the most distressing symptom responsible for

5700-446: The United States. Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease ( COPD ) is a type of progressive lung disease characterized by chronic respiratory symptoms and airflow limitation. GOLD 2024 defined COPD as a heterogeneous lung condition characterized by chronic respiratory symptoms ( dyspnea or shortness of breath , cough , sputum production and/or exacerbations) due to abnormalities of

5795-401: The United States. The main risk factor is prematurity with the likelihood of it occurring going up to 71% in infants under 750g. Other risk factors include infant of a diabetic mother (IDM), method of delivery, fetal asphyxia, genetics, prolonged rupture of membranes (PROM), maternal toxemia, chorioamnionitis , and male sex. The widely accepted pathophysiology of respiratory distress syndrome

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5890-405: The additional use of tobacco developed similar respiratory problems, but did not seem to develop airflow limitation and COPD. Exposure to particulates can bring about the development of COPD, or its exacerbations. Those with COPD are more susceptible to the harmful effects of particulate exposure that can cause acute exacerbations brought about by infections. Black carbon also known as soot ,

5985-501: The airways ( bronchitis , bronchiolitis ) and/or alveoli ( emphysema ) that cause persistent, often progressive, airflow obstruction. The main symptoms of COPD include shortness of breath and a cough , which may or may not produce mucus . COPD progressively worsens , with everyday activities such as walking or dressing becoming difficult. While COPD is incurable, it is preventable and treatable. The two most common types of COPD are emphysema and chronic bronchitis and have been

6080-561: The amount of air that is able to enter alveoli because of constriction of the bronchial tree, due to inflammation. Obstructive lung diseases are often identified because of symptoms and diagnosed with pulmonary function tests such as spirometry . Many obstructive lung diseases are managed by avoiding triggers (such as dust mites or smoking ), with symptom control such as bronchodilators , and with suppression of inflammation (such as through corticosteroids ) in severe cases. One common cause of COPD including emphysema , and chronic bronchitis,

6175-760: The associated anxiety and level of disability experienced. Symptoms of wheezing and chest tightness associated with breathlessness can be variable over the course of a day or between days and are not always present. Chest tightness often follows exertion. Many people with more advanced COPD breathe through pursed lips , which can improve shortness of breath. Shortness of breath is often responsible for reduced physical activity and low levels of physical activity are associated with worse outcomes. In severe and very severe cases there may be constant tiredness , weight loss, muscle loss and anorexia . People with COPD often have increased breathlessness and frequent colds before seeking treatment. The most often first symptom of COPD

6270-461: The cells causing ciliary dysfunction and death. The debris, edema, and inflammation eventually leads to the symptoms. It is the most common reason for admission of children under the age of one year. It can present widely from a mild respiratory infection to respiratory failure. Since there is no medication to treat the disease, it is only managed supportively with fluids and oxygen. Respiratory diseases may be investigated by performing one or more of

6365-449: The developing lung and its maturation, and contributes a potential risk factor for the later development of COPD. The overall effect in relation to smoking is believed to be small. Poorly ventilated fires used for cooking and heating, are often fueled by coal or biomass such as wood and dry dung , leading to indoor air pollution and are one of the most common causes of COPD in developing countries . Women are affected more as they have

6460-503: The development of COPD is tobacco smoke. However, less than 50 percent of heavy smokers develop COPD, so other factors need to be considered, including exposure to indoor and outdoor pollutants, allergens, occupational exposure, and host factors. One of the known causes of COPD is the exposure to construction dust . The three main types of construction dust are silica dust , non-silica dust (e.g., dust from gypsum, cement, limestone, marble and dolomite) and wood dust . Host factors include

6555-424: The elderly. The National Institute for Health and Care Excellence criteria additionally require a FEV1 less than 80% of predicted. People with COPD also exhibit a decrease in diffusing capacity of the lung for carbon monoxide due to decreased surface area in the alveoli, as well as damage to the capillary bed. Testing the peak expiratory flow (the maximum speed of expiration), commonly used in asthma diagnosis,

6650-451: The first second of a breath and the forced vital capacity (FVC), which is the greatest volume of air that can be breathed out in a single large breath. Normally, 75–80% of the FVC comes out in the first second and a FEV1/FVC ratio less than 70% in someone with symptoms of COPD defines a person as having the disease. Based on these measurements, spirometry would lead to over-diagnosis of COPD in

6745-457: The following tests: Respiratory disease is a common and significant cause of illness and death around the world. In the US, approximately one billion common colds occur each year. A study found that in 2010, there were approximately 6.8 million emergency department visits for respiratory disorders in the U.S. for patients under the age of 18. In 2012, respiratory conditions were the most frequent reasons for hospital stays among children. In

6840-460: The global population). It typically occurs in males and females over the age of 35–40. In 2019 it caused 3.2 million deaths, 80% occurring in lower and middle income countries, up from 2.4 million deaths in 1990. In 2021, it was the fourth biggest cause of death, responsible for approximately 5% of total deaths. The number of deaths is projected to increase further because of continued exposure to risk factors and an aging population. In

6935-414: The lung, treatment can occasionally be curative but only in certain, rare circumstances. Benign tumors are relatively rare causes of respiratory disease. Examples of benign tumors are: Pleural cavity diseases include pleural mesothelioma which are mentioned above. A collection of fluid in the pleural cavity is known as a pleural effusion . This may be due to fluid shifting from the bloodstream into

7030-407: The lungs into the blood. Narrowing of the airways occurs due to inflammation and subsequent scarring within them. This contributes to the inability to breathe out fully. The greatest reduction in air flow occurs when breathing out, as the pressure in the chest is compressing the airways at this time. This can result in more air from the previous breath remaining within the lungs when the next breath

7125-401: The lungs themselves, such as tissue death due to inflammation or toxins. Conversely, restrictive lung diseases caused by extrinsic factors result from conditions originating from outside the lungs such as neuromuscular dysfunction and irregular chest wall movements. Chronic respiratory diseases are long-term diseases of the airways and other structures of the lung. They are characterized by

7220-401: The lungs, it is common for cancer metastases to occur within the lung. Breast cancer may invade directly through local spread, and through lymph node metastases. After metastasis to the liver , colon cancer frequently metastasizes to the lung. Prostate cancer , germ cell cancer and renal cell carcinoma may also metastasize to the lung. Treatment of respiratory system cancer depends on

7315-495: The morning. A chronic productive cough is the result of mucus hypersecretion and when it persists for more than three months each year for at least two years, it is defined as chronic bronchitis . Chronic bronchitis can occur before the restricted airflow diagnostic of COPD. Some people with COPD attribute the symptoms to the consequences of smoking. In severe COPD, vigorous coughing may lead to rib fractures or to a brief loss of consciousness . An acute exacerbation

7410-567: The organ or tissue involved, by the type and pattern of associated signs and symptoms, or by the cause of the disease. The study of respiratory disease is known as pulmonology . A physician who specializes in respiratory disease is known as a pulmonologist, a chest medicine specialist, a respiratory medicine specialist, a respirologist or a thoracic medicine specialist. Asthma , chronic bronchitis , bronchiectasis and chronic obstructive pulmonary disease (COPD) are all obstructive lung diseases characterised by airway obstruction . This limits

7505-654: The organs and tissues that make gas exchange difficult in air-breathing animals. They include conditions of the respiratory tract including the trachea , bronchi , bronchioles , alveoli , pleurae , pleural cavity , the nerves and muscles of respiration . Respiratory diseases range from mild and self-limiting, such as the common cold , influenza , and pharyngitis to life-threatening diseases such as bacterial pneumonia , pulmonary embolism , tuberculosis , acute asthma , lung cancer , and severe acute respiratory syndromes , such as COVID-19 . Respiratory diseases can be classified in many different ways, including by

7600-441: The pleural cavity due to conditions such as congestive heart failure and cirrhosis. It may also be due to inflammation of the pleura itself as can occur with infection, pulmonary embolus , tuberculosis, mesothelioma and other conditions. A pneumothorax is a hole in the pleura covering the lung allowing air in the lung to escape into the pleural cavity. The affected lung "collapses" like a deflated balloon. A tension pneumothorax

7695-559: The possibility of a pulmonary embolism as sometimes being responsible in these cases. Signs can include pleuritic chest pain and heart failure without signs of infection. Such emboli could respond to anticoagulants . COPD often occurs along with a number of other conditions ( comorbidities ) due in part to shared risk factors. Common comorbidities include cardiovascular disease , skeletal muscle dysfunction, metabolic syndrome , osteoporosis , depression , anxiety , asthma and lung cancer . Alpha-1 antitrypsin deficiency (A1AD)

7790-588: The precursor for the development of emphysema. The inflammatory cells involved include neutrophils and macrophages , two types of white blood cells. Those who smoke additionally have cytotoxic T cell involvement and some people with COPD have eosinophil involvement similar to that in asthma. Part of this cell response is brought on by inflammatory mediators such as chemotactic factors . Other processes involved with lung damage include oxidative stress produced by high concentrations of free radicals in tobacco smoke and released by inflammatory cells and breakdown of

7885-402: The presence or not of collateral ventilation , evident in emphysema and lacking in chronic bronchitis. This terminology was no longer accepted as useful, as most people with COPD have a combination of both emphysema and airway disease. These are now recognized as the two major phenotypes of COPD — emphysematous phenotype and chronic bronchitic phenotype. It has since been recognized that COPD

7980-666: The presentation and examination. Symptoms generally include fever, sore throat, trouble swallowing, and sounding like they have a "hot potato" in their mouth. The most common lower respiratory tract infection is pneumonia , an infection of the lungs which is usually caused by bacteria, particularly Streptococcus pneumoniae in Western countries. Worldwide, tuberculosis is an important cause of pneumonia. Other pathogens such as viruses and fungi can cause pneumonia, for example severe acute respiratory syndrome , COVID-19 and pneumocystis pneumonia . Pneumonia may develop complications such as

8075-406: The quality of life. Telerehabilitation for chronic respiratory disease The latest evidence suggests that primary pulmonary rehabilitation and maintenance rehabilitation delivered through telerehabilitation for people with chronic respiratory disease reaches outcomes similar to centre-based rehabilitation. While there are no safety issues identified, the findings are based on evidence limited by

8170-482: The release of excessive proteases in lungs, which then degrades elastin , the major component of alveoli. Smoke also impairs the action of cilia , inhibiting mucociliary clearance that clears the bronchi of mucus, cellular debris and unwanted fluid. Other types of tobacco smoke, such as from cigar, pipe , water-pipe and hookah use, also confer a risk. Water-pipe or hookah smoke appears to be as harmful or even more harmful than smoking cigarettes. Marijuana

8265-428: The respiratory system, particularly primary carcinomas of the lung , are a major health problem responsible for 15% of all cancer diagnoses and 30% of all cancer deaths. The majority of respiratory system cancers are attributable to smoking tobacco . The major histological types of respiratory system cancer are: In addition, since many cancers spread via the bloodstream and the entire cardiac output passes through

8360-435: The risk of developing COPD is great. These older definitions grouped the two types as type A and type B . Type A were emphysema types known as pink puffers due to their pink complexion, fast breathing rate and pursed lips. Type B were chronic bronchitic types referred to as blue bloaters due to low oxygen levels causing a bluish color to the skin and lips and swollen ankles. These differences were suggested to be due to

8455-429: The risk of developing COPD is high. Many definitions of COPD in the past included emphysema and chronic bronchitis, but these have never been included in GOLD report definitions. Emphysema and chronic bronchitis remain the predominant phenotypes of COPD but there is often overlap between them and a number of other phenotypes have also been described. COPD and asthma may coexist and converge in some individuals. COPD

8550-431: The same amount of cigarette smoking, women have a higher risk of COPD than men. In non-smokers, exposure to second-hand smoke (passive smoking) is the cause of 1.2 million deaths from the more than 8 million deaths worldwide each year due to tobacco smoke . Women who smoke during pregnancy , and during the early life of the child is a risk factor for the later development of COPD in their child. Inhaled smoke triggers

8645-427: The two classic COPD phenotypes . However, this basic dogma has been challenged as varying degrees of co-existing emphysema, chronic bronchitis, and potentially significant vascular diseases have all been acknowledged in those with COPD, giving rise to the classification of other phenotypes or subtypes. Emphysema is defined as enlarged airspaces ( alveoli ) whose walls have broken down resulting in permanent damage to

8740-407: The type of cancer. Surgical removal of part of a lung ( lobectomy , segmentectomy , or wedge resection ) or of an entire lung pneumonectomy ), along with chemotherapy and radiotherapy , are all used. The chance of surviving lung cancer depends on the cancer stage at the time the cancer is diagnosed, and to some extent on the histology , and is only about 14–17% overall. In the case of metastases to

8835-548: The upper respiratory tract such as sinusitis , tonsillitis , otitis media , pharyngitis and laryngitis are also considered upper respiratory tract infections. Epiglottitis is a bacterial infection of the larynx which causes life-threatening swelling of the epiglottis with a mortality rate of 7% in adults and 1% in children. Haemophilus influenzae is still the primary cause even with vaccinations. Also Streptococcus pyogenes can cause epiglottitis. Symptoms include drooling, stridor, difficulty breathing and swallowing, and

8930-896: The use of coal and biomass such as wood and dry dung as fuel for cooking and heating . The diagnosis is based on poor airflow as measured by spirometry . Most cases of COPD can be prevented by reducing exposure to risk factors such as smoking and indoor and outdoor pollutants. While treatment can slow worsening, there is no conclusive evidence that any medications can change the long-term decline in lung function. COPD treatments include smoking cessation , vaccinations , pulmonary rehabilitation , inhaled bronchodilators and corticosteroids . Some people may benefit from long-term oxygen therapy , lung volume reduction and lung transplantation . In those who have periods of acute worsening , increased use of medications, antibiotics , corticosteroids and hospitalization may be needed. As of 2015, COPD affected about 174.5 million people (2.4% of

9025-608: The winter months but can occur at any time. Other respiratory infections may be bacterial or in combination sometimes secondary to a viral infection. The most common bacterial infection is caused by Haemophilus influenzae . Other risks include exposure to tobacco smoke (active and passive ) and environmental pollutants  – both indoor and outdoor. During the COVID-19 pandemic , hospital admissions for COPD exacerbations sharply decreased which may be attributable to reduction of emissions and cleaner air. There has also been

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