Everything You Need To Know About Lung Disease Diagnosis
The lungs are one of five vital organs in the human body along with the brain, heart, kidneys, and liver. Every breath you take helps to produce and distribute nutrients in the bloodstream that provide you with energy, heal your wounds, and maintain every other organ throughout the body. And while most people understand the basics of maintaining healthy lungs i.e., getting enough exercise, eating healthy foods, and not smoking, many people aren’t aware of how specific lung diseases differ from one another and how they’re diagnosed by medical professionals.
There are many lung diseases, but each one affects a different part of the respiratory process. For example, one condition may affect your physical ability to take in air while another could affect your lung’s ability to absorb oxygen from that air. While the symptoms you experience may be similar in these two situations, the way they’re diagnosed and treated could be very different.
If you’re diagnosed with a lung disease, it’s important that you’re educated about its unique characteristics because, while your doctor will provide you with medication and information regarding your disease, your body’s ability to heal will inevitably depend on the lifestyle changes you make.
In the following sections, we’re going to break down each category of lung disease to help you demystify them and eliminate any confusion you may have. Then, we’ll take a look at how exactly respiratory diseases are diagnosed by doctors. Keep in mind that if you have any questions or concerns about your respiratory health, don’t hesitate to discuss them with your pulmonologist or in one of the many online forums designed to support those suffering with respiratory disease.
The Importance of Respiratory Health
Despite lung disease being one of the leading causes of death worldwide, many people are unaware of the role their lungs play in their overall health. While asthma and lung cancer are household names in the health world, they are far from the only conditions you should be aware of or concerned about.
Unfortunately, as we age, most things become more difficult and that includes breathing and maintaining healthy lungs. If you’ve smoked in the past or lived in a polluted area, you’re going to be at a much higher risk for a variety of different respiratory conditions so the best way to stay healthy is to get started as soon as possible with protecting your lungs.
Generally, raising awareness is a great way to stress the importance of lung health and prevent many diseases before they take hold. Simply discussing the topic with a friend and striking up a conversation on a blog, online forum, or among your friend group will get people talking and cause them to be more conscious about their lung health.
How The Lungs Work
The lungs are one piece of the respiratory system and are responsible for bringing oxygen into the body and removing carbon dioxide. The respiratory process begins when the diaphragm (the muscle between the lungs and the abdomen) contracts, expanding the lungs and causing air to flow down the windpipe to the trachea where it is divided into the bronchial tubes and into the lungs.
As air enters the lungs it’s divided into smaller air passages called bronchioles. At the ends of these bronchioles are alveoli, tiny air sacs with blood vessels and capillaries on them. The walls of the alveoli absorb oxygen where it passes into the blood. Simultaneously, carbon dioxide is released from the blood and sent out of the body when you exhale.
Your red blood cells need oxygen to complete a process called metabolism. This is where nutrients taken from the food you eat are broken down using oxygen to create usable energy for your body. The heart then pumps this blood throughout the body reaching every organ in the body.
Your respiratory system has a number of “defense mechanisms” that it uses to prevent irritants and harmful substances from entering the lungs and bloodstream. Tiny hairs in the nose called cilia help to prevent larger particles from entering your lungs. Additionally, mucus in the bronchial tubes and trachea help prevent viruses and bacteria from reaching the lungs. However, if these impurities do reach the lungs, they can sometimes be brought up through mucus.
The Different Types of Respiratory Disease
The majority of lung disease in the United States are the result of smoking, infections, and genetics. They can be classified into six different categories. Each category impacts a different part of the lungs. Because each of these categories can overlap in terms of symptoms, causes, and risk factors, it’s often difficult to diagnose them without the appropriate diagnostic tests and a thorough examination of symptoms. Read on to learn more about each category of respiratory disease.
Diseases Affecting the Airways
The airways are all parts of the respiratory system that transport air from one point to another. It starts at the nose and mouth, passes through the pharynx and larynx, and into the trachea. After reaching the trachea, it passes into the left and right bronchi and then the three lobes in each lung.
Asthma is one of the most common respiratory diseases affecting the airways. It’s characterized by persistent inflammation and spasms that result in shortness of breath and wheezing. During an asthma attack, muscles near the airways contract and they become swollen causing the bronchial tubes to narrow. 1 in 13 people have moderate to severe asthma according to the Centers for Disease Control (CDC).
Asthma is classified into two different categories: allergic asthma (extrinsic) or non-allergic asthma (intrinsic). Allergic asthma is caused by external factors or irritants that come from outside the body such as pollution, cigarette smoke, pollen, exhaust, or airborne chemicals. Non-allergic asthma is the result of internal triggers such as bacterial and viral inflammations of the airways. Emotional or physical stress can also induce an asthma attack.
Chronic Obstructive Pulmonary Disease (COPD)
COPD is one of the leading causes of death in the United States. It’s an umbrella term that includes emphysema (damage to the alveoli) and chronic bronchitis (damage to the bronchial tubes). 90 percent of instances of COPD are the result of smoking.
COPD isn't a disease that takes hold overnight; it develops gradually over years like many lung conditions. As a result, many people don't realize they have COPD until their symptoms get bad enough for them to see a doctor. Like an asthma attack, a COPD exacerbation is a sudden onset of symptoms. These symptoms include:
- Breathlessness - especially during physical activity
- Chronic cough that tends to get worse over time
- Wheezing or other breathing sounds
- Coughing up mucus (phlegm)
- Symptoms that get worse with sickness such as a cold or the flu
Also known as a chest cold, acute bronchitis is the temporary inflammation of the bronchi. This is usually accompanied by a fever, shortness of breath, wheezing, and excess mucus production. While acute bronchitis is not usually a huge health concern, combined with other more serious respiratory conditions, it can cause an exacerbation that could be fatal. This is why it's so important to avoid getting sick if you have any type of lung disease.
Cystic fibrosis differs from the above conditions in that it’s genetic. Someone with with cystic fibrosis will have difficulty clearing mucus from the airways because the disease causes it to become sticky and thick. These people typically have frequent lung infections and a chronic cough and it's often detected in childhood so it can be treated early on.
Cystic fibrosis alters a protein in the body called the cystic fibrosis transmembrane (CFTR). This protein manages the flow of salt and water in and out of cells in the body. Because the balance of salt and water is altered, mucus becomes thicker which can affect a number of systems throughout the body, especially the respiratory, digestive, reproductive systems, and sweat glands.
Diseases Affecting the Air Sacs (Alveoli)
There are millions of alveoli in the lungs. Each balloon-shaped air sac is only one cell thick and are the “endpoint” of the respiratory system where oxygen enters the bloodstream. There are a number of disorders affecting the alveoli that can result in inflammation, overdistention, or surfactant which prevents the alveoli from deflating entirely between breaths.
A pulmonary edema occurs when the alveoli begin to fill with fluid preventing the exchange of oxygen and carbon dioxide. This disease can often occur as a result of congestive heart failure and can be deadly.
In situations where pulmonary edemas are not caused by the heart, this is called noncardiogenic pulmonary edema. This results when the capillaries in the lungs become leaky or more permeable. This may happen as a result of high-altitude pulmonary edema (HAPE), acute respiratory distress syndrome (ARDS), a viral infection or more.
In order to prevent pulmonary edemas, you should focus on your cardiovascular health. Eat a heart-healthy diet low in salt, sugar, and solid fats, exercise regularly, and never smoke. Pulmonary edemas can be fatal so it's important that you visit a cardiologist and pulmonologist regular to monitor your heart and lung health.
This condition results when the alveoli become inflamed and infected, usually filling with pus and making it difficult to breathe. While pneumonia can range from mild to life-threatening, it's more dangerous for people with a weakened immune system or people with other health problems.
Pneumonia can be acquired from a number of sources including hospitals, long-term care facilities, or other healthcare facilities. In order to prevent pneumonia, you should get vaccinated, practice good hygiene, and keep your immune system strong by eating right and not smoking.
Tuberculosis is a contagious disease resulting from a bacteria called mycobacterium tuberculosis. This disease begins in the lungs but bacteria is known to travel to other parts of the body like the spine, brain, and kidney. People who have active tuberculosis may experience symptoms like shortness of breath, fatigue, and coughing up blood-tinged phlegm. To some, tuberculosis is known as the "disease of poverty" because it is far more common in developing countries that are often overcrowded.
While lung cancer can occur in any part of the lungs, it occurs more frequently in or around the alveoli. Lung cancer is the most common form of cancer but it's also the most preventable with up to 90 percent of all cases being caused by smoking. While there are more than 20 different types of lung cancer, the two most common are small cell and non-small cell lung cancer.
Acute Respiratory Distress Syndrome (ARDS)
ARDS occurs when the alveoli in the lungs begin to fill with blood from surrounding blood vessels. Because ARDS leads to low blood oxygen levels and breathing failure, it can often be a fatal disease and while two thirds of ARDS patients survive, some may never fully recover from their symptoms.
Diseases Affecting the Interstitium
Between the alveoli in the lungs, there is a thin lining containing blood vessels that are responsible for the exchange of oxygen and carbon dioxide between the blood and the air sacs. This delicate layer is called the interstitium.
Diseases that affect the interstitium are classified under the umbrella term “interstitial lung disease” (ILD) and include things like autoimmune disease, sarcoidosis, and idiopathic pulmonary fibrosis. Other diseases that can affect the interstitium include pulmonary edema and pneumonia.
Diseases Affecting Blood Vessels
It’s important to remember that what affects one part of the body often has an effect on another party of the body — this is often the case with diseases affecting blood vessels. When the right side of the heart receives deoxygenated blood, it goes to the lungs through the pulmonary arteries. These arteries may become damaged by disease as well.
Idiopathic pulmonary arterial hypertension (high blood pressure in the lungs) can result in chest pain and shortness of breath. The primary concern with pulmonary hypertension is heart failure as it puts a strain on the right ventricle of the heart.
High blood pressure usually results when capillaries and pulmonary arterioles are damaged, clogged, or narrowed in some way. When this happens, the right side of your heart will have a harder time pumping blood through the lungs. Eventually, the patient will experience heart failure.
Pulmonary Embolism (PE)
Also known as a blood clot, a PE may be pumped into the lungs resulting in low blood oxygen levels and difficulty breathing. It can also result in damage to the lungs or other organs within the body and can even be fatal. Common signs of a pulmonary embolism are a chronic cough, chest pain, and shortness of breath. Treatment options for PE include blood thinners, compression clothing, and physical activity.
Diseases Affecting the Pleura
The pleura is the outer lining of the lungs made up of the parietal pleura and the visceral pleura. The pleura as a whole assists the lungs as you inhale and exhale by producing a fluid that lubricates them and allows them to move easily.
Heart failure or pneumonia can sometimes result in what’s called a pleural effusion. This is when an excess amount of fluid builds up in the space between the chest wall and the lung. Draining the fluid can help the patient regain their breathing.
The two types of pleural effusion are exudative and transudative. Exudative pleural effusions are the result of an excess of white blood cells that have reached the pleural fluid. Cancer, infection, and inflammation are usually the cause of this type of pleural effusion. On the other hand, transudative effusion is usually caused by kidney disease, liver disease, and cardiac failure. It's usually pale and yellow in color.
Pneumothorax, also known as a collapsed lung, results when air leaks into the area between the lung and the chest wall (pleural cavity). There are a number of things that can cause pneumothorax like chest injury, lung disease, or lung procedures. Depending on how severe the event was, pneumothorax can fix it self or it may require medical attention. To treat it, doctors insert a needle or tube between the ribs and remove excess air.
This is a rare type of cancer that’s typically caused by exposure to asbestos, a fibrous mineral often used in the building and construction industry. Years of exposure can significantly damage the lungs and can be life threatening. In order to prevent mesothelioma, it's a good idea to have the air quality in your home tested regularly.
This cancer attacks mesothelial cells found in the abdominal cavity and membranes lining the chest. This forms a tissue called mesothelium which lubricates organs and prevents them from becoming damaged as they move up against one another. Peritoneal mesothelioma occurs in the abdomen while pleural mesothelioma occurs in the chest cavity.
Diseases Affecting the Chest Wall
In order to take in as much air as possible, your lungs, diaphragm, and chest wall need to be as flexible as possible. When any one of these is obstructed it can result in difficulty breathing and other respiratory disorders.
Obesity Hypoventilation Syndrome
Obesity is common and can have numerous adverse effects on the body. Extra weight on the abdomen and chest, however, can lead to serious breathing problems, especially if other respiratory diseases are involved. In most cases, respiratory patients will undergo some form of exercise in order to prevent fat from building up in the chest.
Myasthenia gravis and amyotrophic lateral sclerosis are two neuromuscular disorders that may affect the lungs. These conditions affect the nerves that control the muscles in your chest wall resulting in difficulty breathing. This can’t be cured but it can be managed and treated.
Diagnostic Tests for Lung Conditions
Because so many lung conditions have overlapping symptoms, it can be difficult to diagnose them. According to WebMD, between 25 and 50 percent of people in the United States visit a doctor with a concern about shortness of breath every year. Lung diseases are by no means uncommon, but they can range in severity from mild to life-threatening.
While your doctor will likely ask you about the symptoms you’ve been having, he/she will likely have to perform some type of test to accurately diagnose your condition. A physical examination is usually where they will start along with studying your medical history. If these bring up any concerns, your doctor will have a better idea of what test to perform.
If your doctor believes you are exhibiting signs of COPD, asthma, or pulmonary fibrosis, he may perform a spirometry test. These tests can also be used if you already have a lung disease in order to see how well your treatment is working.
During a spirometry test you will exhale into a tube that’s attached to a spirometry device. This will result in two measurements: forced vital capacity (FVC), the amount of air you can exhale, and forced expiratory volume (FEV), the amount you can exhale in one second.
A chest X-ray can reveal a number of things about your pulmonary health. Because they produce images of your heart, lungs, blood vessels, and airways, your doctor will be able to see how your lungs are functioning with the rest of the body. Your doctor will be able to identify cancer, emphysema, pneumonia, collapsed lungs, and heart issues that could be affecting your lungs.
Blood Gas Tests
This is a type of blood test used to determine your blood oxygen levels. Blood gas tests or blood gas analysis will provide your doctor with crucial information about the function of your lungs and can be used to diagnose a wide range of respiratory diseases. It will measure your oxygen saturation level, partial pressure of oxygen and carbon dioxide, bicarbonate, and arterial blood pH. If you already have a lung disease, pulse oximetry is a quick and noninvasive way to check your blood oxygen levels. Your doctor may recommend this, especially if you are using supplemental oxygen like an oxygen tank or oxygen concentrator.
Chest CT Scan
A CT Scan is a more advanced form of X-ray allowing your doctor to see more detailed images of the chest and its internal organs. A CT scan can be used to reveal tumors and evaluate heart and lung diseases. The main benefit of a CT scan over a traditional X-ray is that it’s much easier to see subtle details in the internal organs which could be crucial for accurately diagnosing a lung diseases like pneumonia, tuberculosis, interstitial diseases, and detect inflammation of the pleura covering the lungs.
Bronchoscopy With Biopsy
A bronchoscopy is a procedure where a thin tube with a camera on the end is inserted through the nose or mouth in order to view the airways and the lungs. The biopsy part involves taking a small amount of tissue for testing which is not always necessary depending on what your doctor is testing for. Bronchoscopies are typically used to look for blockages in the airways, diagnose shortness of breath or a chronic cough, or to follow up on a CT scan that revealed a lung infection.
Electrocardiography is a noninvasive test that can help your doctor determine if blood flow to the heart is being impaired. During this procedure, several electrodes will be attached to your chest and monitor your heart rhythm which is displayed on a screen. This type of test can be used to diagnose lung disorders that affect the blood vessels and heart.
How To Maintain Healthy Lungs
Respiration is one of the most important processes that your body performs and your lungs are at the center of it. Fortunately, you don’t have to leave your lung health up to chance. According to the Centers for Disease Control and Prevention, 39 percent of chronic lower respiratory diseases cases (the fourth leading cause of death in the U.S.) are preventable. What this means is that making healthy lifestyle choices will significantly decrease your chance of being diagnosed with a lung disease.
What’s more, many of the lifestyle changes you can make are very simple and will have far reaching effects beyond just your respiratory health. Heart health is very closely linked to lung health, so chances are, if you’re taking good care of your heart, you’re also helping your lungs. Let’s take a look at some simple things you can do to improve your health.
Avoid Airborne Pollutants
The scary thing about airborne pollutants is that we’re surrounded by them constantly, sometimes without us even knowing.