What it takes for a cough to expel mucus from the airway

Cough is one of the most common symptoms for seeking medical care (1, 2). If cough is going to cause that much trouble, it better be worth it, and the clinical evidence is that indeed it is. Patients with impaired cough due to neuromuscular disease or postoperative sedation suffer high rates of atelectasis and pneumonia due to the failure to clear secretions from the airways, and there is evidence that a heightened cough reflex improves health (3, 4). Chief among airway secretions is mucus, and, in PNAS, Button et al. (5) analyze the biophysical requirements for a cough to separate adherent mucus from an airway wall. Before diving into the details, it is worth reviewing what is known about the biochemistry of mucus and the forces generated by a cough.

Mucus is an important defense against perturbations from the outside world at wet epithelial surfaces throughout the body, including the eyes, airways, gastrointestinal tract, and genitourinary tract. Its importance is revealed when the mucus barrier malfunctions in disorders such as dry eyes or inflammatory bowel disease. Mucus is a remarkable and protean substance, with properties on the border between a viscous fluid and a soft elastic solid. Its properties primarily reflect the interactions of mucin glycoproteins (∼0.5% of mass) with water (∼98%) and salts (∼1%). Globular proteins are also present in normal mucus (∼0.5% of mass) but do not have a major impact on the physical properties of mucus unless they and DNA are present in abnormal amounts during pathologic processes (3). Mucins are very large highly glycosylated molecules, accounting for their avid interactions with water. Secreted mucins polymerize into chains and networks that confer on mucus its semisolid consistency. However, the physical properties of mucus are highly dependent on mucin concentration, with dilute mucus acting like a fluid, and concentrated mucus like a solid (6). Furthermore, dilute mucus is an excellent lubricant, whereas concentrated mucus is adhesive (7⇓⇓–10).

In the lungs, a layer of mucus is continuously propelled from peripheral to central airways by the beating of cilia on epithelial cells that are interspersed among secretory cells in a mosaic pattern (Fig. 1, Lower Right). Inhaled particles and pathogens land on the mucus layer and are moved by cilia up the trachea, through the vocal cords, and then swallowed and cleared by the gastrointestinal tract (Fig. 1, Upper Right). Topologically, the lung is a blind sac, so without the clearance of particles and pathogens by a mobile mucus layer, these materials would accumulate. In contrast, the gastrointestinal tract is an open tube through which particles and pathogens pass readily. The mucus layer is generated by the secretion of mucins from surface epithelial cells (Fig. 1, Lower Right) and submucosal glands (not illustrated). Ciliary beating is the primary mechanism for clearance of mucus, with cough being a backup mechanism when mucus accumulates in the airways or adheres to airway walls (3, 11).

Fig. 1.

The pulmonary mucus clearance system. Mucins are synthesized by secretory cells in the airway surface epithelium (Lower Right) and in submucosal glands (not shown). Secreted mucins rise through the periciliary layer and combine with water and salts to form an overlying layer of mucus that is propelled from peripheral to central airways by the beating of cilia. Normally, cilia propel a thin layer of mucus up the trachea and through the larynx at the posterior commissure (Upper Right), which is covered by mucociliary epithelium (unlike the vocal cords, which are covered by squamous epithelium), and then into the pharynx where it mixes with saliva from the mouth and is swallowed into the esophagus (Left). During a cough, central airways narrow (Middle Right), and globs of mucus are propelled forcefully by a column of air moving at high velocity directly into the pharynx where they are either swallowed or expectorated, while some small fragments of mucus break off to travel as droplets with the expired air (20). Image courtesy of The University of Texas MD Anderson Cancer Center.

Cough has been studied extensively, so its mechanism and the forces it generates are well known (12). A cough begins with a rapid inspiration to fill the lungs with air, followed by closure of the glottis, contraction of the expiratory muscles of the chest and abdomen to generate a high intrathoracic pressure, and the sudden opening of the glottis to forcefully expel air from the mouth. During coughing, intrathoracic pressure can reach 200 cmH₂O, which both provides the motive force for airflow (up to 8 L/s) and narrows the central airways by compression (Fig. 1, Middle Right) to maximize velocity (up to 28,000 cm/s or 626 mi/h). This expels secretions from the airways and into the throat (pharynx) (Fig. 1, Left), where they can be either swallowed or expectorated. What has been almost entirely unknown until now is how the shear force generated by cough interacts with adherent mucus in the airways.

To address this issue, Button et al. (5) first developed a conceptual model whereby adherent mucus could be separated from the airway wall either by cohesive or adhesive failure. Cohesive failure involves fracture of the adherent mucus by physically breaking mucins and other polymers within the mucus, whereas adhesive failure involves separating the adherent mucus from the glycocalyx of the underlying cell surfaces (see figure 1 of ref. 5). Next, they set up a peel-testing device to measure the force required to peel an adherent mucus layer off a layer of airway epithelial cells to test their model. This system was also used to assess the roles of mucin concentration and pH in determining the strength of mucus cohesion and adhesion, finding that the effects of mucin concentration dominated over pH within physiologic ranges of these two parameters. Last, they assessed the effects of therapeutic modalities such as mucus hydration with saline solution, mucin polymer lysis with a reducing agent to break disulfide bonds, and decreasing cohesion and adhesion with a surfactant. Each of these modalities provided benefit when used alone, and the combination of hydration and mucin lysis was particularly effective.

The mobile mucus layer is an essential defense of mammalian lungs, as shown by the death of mice from infection, inflammation, and obstruction when the major secreted airway mucin, Muc5b, is deleted (13). The importance of this defense to human health is highlighted by the fact that an overexpressing allele of MUC5B has been so strongly selected that it is present in 20% of whites (14), similar to the allele frequency of sickle hemoglobin in areas of hyperendemic malaria. Also similar to sickle hemoglobin, protection comes at a price because the MUC5B-overexpressing allele is the major risk factor for idiopathic pulmonary fibrosis late in life, probably as a result of epithelial progenitor depletion caused by the proteostasis stress of producing high levels of this large and complex molecule (14, 15).

Far more common than the problems that MUC5B hyperexpression causes in pulmonary fibrosis are the central roles that mucus dysfunction plays in obstructive diseases of the airways such as asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF). In asthma, mucus dysfunction is mostly due to hyperproduction of the other secreted airway mucin, MUC5AC, together with the abnormal presence of plasma proteins, both resulting from inflammation as part of aberrant pathogen defenses (16). In CF, mucus dysfunction is due to insufficient chloride and bicarbonate transport into the airway lumen to allow adequate mucin hydration and expansion (17). In COPD, mucus dysfunction is due to a combination of the mechanisms operating in asthma and CF, as well as to ciliary dysfunction, all induced by cigarette smoke (3). In these disorders, mucus both accumulates in large central airways and plugs small peripheral airways. Accumulated mucus in central airways is cleared relatively effectively by cough because, at that level, airflow is high and mucus is not as concentrated as in peripheral airway plugs. However, in small airways, airflow during coughing tapers off peripherally, and concentrated mucus becomes impacted. A radiographic imaging study in subjects with asthma has shown that peripheral airway mucus plugs persist for years (18). Airways of intermediate size and distance from the trachea are where work like that of Button et al. (5) is likely to have the biggest impact. The careful definition of forces involved in clearing mucus adherent to airway walls by cough, combined with analysis of the interactions of new mucus therapies with these forces, will allow us to derive the benefits of the complex biological defense mechanism that is mucus clearance, while minimizing the adverse effects of mucus dysfunction (19).

Acknowledgments

I thank David M. Aten, MA, CMI, for the artwork. This research is supported by the NIH National Heart Lung and Blood Institute Grant R01 HL129795, the NIH National Institute of Allergy and Infectious Diseases Grant R21 AI137319, and the Cystic Fibrosis Foundation Grant DICKEY18G0.

Footnotes

• Author contributions: B.F.D. wrote the paper.

• The author declares no conflict of interest.

• See companion article on page 12501.

COPD: Clearing Your Lungs | Michigan Medicine

Introduction

COPD (chronic obstructive pulmonary disease) is a long-term illness that makes it hard to breathe. When you have COPD, air does not flow easily into and out of your lungs. You may be short of breath, cough a lot, and have a lot of mucus in your lungs. Learning to clear your lungs may help you save energy and oxygen and may also help prevent lung infections.

There are three things you can do to clear your lungs:

• Controlled coughing. This type of coughing comes from deep in your lungs. It loosens mucus and moves it though your airways.
• Postural drainage. You lie down in different positions to help drain mucus from your lungs.
• Chest percussion. You lightly tap your chest and back. The tapping loosens the mucus in your lungs.

How do you do controlled coughing, postural drainage, and chest percussion?

Controlled coughing

Coughing is how your body tries to get rid of mucus. But the kind of coughing you cannot control makes things worse. It causes your airways to close. It also traps the mucus in your lungs.

Controlled coughing comes from deep in your lungs. It loosens mucus and moves it though your airways. It is best to do it after you use your inhaler or other medicine. Follow these steps for controlled coughing:

• Sit on the edge of a chair, and keep both feet on the floor.
• Lean forward a little, and relax.
• Breathe in slowly through your nose, and fold your arms over your belly.
• As you exhale, lean forward. Push your arms against your belly.
• Cough 2 or 3 times as you exhale with your mouth slightly open. Make the coughs short and sharp. Push on your belly with your arms as you cough. The first cough brings the mucus through the lung airways. The next coughs bring it up and out.
• Inhale again, but do it slowly and gently through your nose. Do not take quick or deep breaths through your mouth. It can block the mucus coming out of the lungs. It also can cause uncontrolled coughing.
• Rest, and repeat if you need to.

Postural drainage

Postural drainage means lying down in different positions to help drain mucus from your lungs.

Hold each position for 5 minutes. Do it about 30 minutes after you use your inhaler. Make sure you have an empty stomach. If you need to cough, sit up and do controlled coughing.

Follow these steps for postural drainage:

• Lie down on a bed or the floor. Use pillows to help you with different positions.

• To drain the front of your lungs

  • Lie on your back. Make sure that your chest is lower than your hips. Put two pillows under your hips. Use a small pillow under your head. Keep your arms at your sides.
  • Then follow these instructions for breathing: With one hand on your belly and the other on your chest, breathe in. Push your belly out as far as possible. You should be able to feel the hand on your belly move out, while the hand on your chest should not move. When you breathe out, you should be able to feel the hand on your belly move in. This is called belly breathing or diaphragmatic (say “die-uh-fruhg-MAT-ik”) breathing. You will use it in the other drainage positions too.

• To drain the sides of your lungs

  • Do this step as you lie on one side. Then turn over, and do it on the other side.
  • Place two or three pillows under your hips. Use a small pillow under your head. Make sure your chest is lower than your hips. Use belly breathing. After 5 or 10 minutes, switch sides.

• To drain the back of your lungs

  • Lie on your stomach.
  • Place two or three pillows under your hips. Use a small pillow under your head.
  • Place your arms by your head.
  • Use belly breathing.

Chest percussion

Chest percussion means that you lightly tap your chest and back. The tapping loosens the mucus in your lungs.

Follow these steps to do chest percussion:

• Cup your hand, and lightly tap your chest and back.
• Ask your doctor where the best spots are to tap. Avoid your spine and breastbone.
• It may be easier to have someone do the tapping for you.

Credits

Current as of:
October 26, 2020

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD – Internal Medicine
Adam Husney MD – Family Medicine
Hasmeena Kathuria MD – Pulmonology, Critical Care Medicine, Sleep Medicine

Current as of: October 26, 2020

Author:
Healthwise Staff

Medical Review:E. Gregory Thompson MD – Internal Medicine & Adam Husney MD – Family Medicine & Hasmeena Kathuria MD – Pulmonology, Critical Care Medicine, Sleep Medicine

Cystic Fibrosis: Helping Your Child Cough Up Mucus

Introduction

Cystic fibrosis causes mucus to become thick and sticky, which can clog the lungs and cause serious problems. You can help your child maintain lung function and avoid complications from mucus buildup and blockage by performing an airway clearance technique (ACT). Postural drainage and chest percussion (PD & P) is one of several airway clearance techniques that help clear mucus from your child’s lungs.

• To help keep the lungs clear, it is important to do an airway clearance technique (such as postural drainage and chest percussion) every day. PD & P works well when used regularly.
• These techniques are one part of a larger treatment plan for cystic fibrosis.
• You may not notice an improvement in your child’s lung function right away. But stopping these treatments will cause decreased lung function after about 3 weeks in children who have mild to moderate lung problems.^{footnote 1}

It is important for your child to visit his or her doctor regularly and make any needed changes in treatment.

How do I do postural drainage?

There are several postural drainage positions. The different positions help drain mucus from different sections of the lungs. All people who have cystic fibrosis should do all the positions except babies, who should not be placed in the head-down position (“tipping”). Tipping a baby can cause reflux, which is when the contents of the stomach enter the esophagus.

Talk to your doctor or your respiratory therapist before starting PD & P. He or she can show you how the treatment is done and tell you how often and how long the treatment should be. Most doctors recommend that PD & P be done at least once a day.

PD & P is a time-consuming process. It usually takes 20 to 30 minutes. In general, a baby or small child who has no symptoms of congestion may require less treatment time than an older child who sounds congested and is coughing a lot.

At first, PD & P can seem complicated. But with help and practice, the treatment becomes easier, especially when you notice the benefits to your child. It is important to do these exercises exactly as instructed.

• Before you start, gather the materials you need, such as tissues, pillows, a thin cloth, or towels. If you have a baby or small child, you may sit in a chair with the child in your lap. If your child is older, he or she may be in bed using pillows for the different positions. You may need to experiment to find the best place to do the treatment so that both you and your child are comfortable.
• Position your child. Your doctor or therapist will recommend certain positions to use.
• Clap your child’s back or chest with your cupped hand quickly and rhythmically. This loosens the mucus, allowing it to drain. Do not clap directly on the skin—cover the area with thin clothing or a cloth. Bend your hand at the wrist and form a cup. When you clap, you should hear a hollow “popping” sound. If you hear a slapping sound, your hand is not cupped enough. You may safely clap over the ribs, but do not clap below the lower ribs or over the spine or female breasts. Follow this procedure for each position.
• How much force to use while clapping, and how long you clap, depends on the child. Consider the following:
  • Younger and smaller children require less force and time than older and larger children or teens.
  • Watch the child for signs of pain and discomfort. If you notice this, you may be using too much force.
  • Is your child congested but mucus isn’t coming up? If so, you may need to use more force.
• After clapping, apply vibrations. At the end of each position, you can vibrate the chest area to help loosen and move mucus. Have your child take a big breath and blow it out forcefully. As the child is blowing out, place your hand over the chest area and apply a little bit of pressure. Then quickly contract and relax your arm and shoulder muscles to produce vibrations throughout the chest area. To get the most out of this technique, ask your doctor or respiratory therapist to teach you how to do it properly. When your child is old enough, having his or her cooperation will make it easier to do this technique.
• After vibrations, have your child huff and cough. A huff is a forced exhalation that moves mucus higher and makes it possible to cough up more mucus. Huffing is best learned through demonstration, so ask your doctor or respiratory therapist to show you and your child how to do it. Huffing involves taking a deep breath and then breathing out forcefully, saying “huff.” Your child will do this 2 or 3 times before he or she coughs. If huffing is done well, you can actually hear the mucus moving upwards. Your child will spit out the mucus that comes up.

References

Citations

1. Egan M (2011). Cystic fibrosis. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 1481–1497. Philadelphia: Saunders.

Credits

Current as of:
May 27, 2020

Author: Healthwise Staff
Medical Review:
John Pope MD – Pediatrics
Kathleen Romito MD – Family Medicine
Catherine O’Malley RRT – Respiratory Therapy

Current as of: May 27, 2020

Egan M (2011). Cystic fibrosis. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 1481-1497. Philadelphia: Saunders.

Causes, Symptoms, Diagnosis & Treatment

Overview

Cystic fibrosis (CF) causes sticky, thick mucus to build up in your organs.

What is cystic fibrosis (CF)?

Cystic fibrosis (CF) is a genetic (inherited) disease that causes sticky, thick mucus to build up in organs, including your lungs and pancreas.

If you don’t have CF, the mucus that lines organs and body cavities, such as your lungs and nose, is slippery and watery. If you do have CF, thick mucus clogs the airways and makes it difficult to breathe.

Mucus also blocks the ducts in the pancreas, causing problems with digesting food. Babies and children who have CF might not be able to absorb enough nutrients from food. CF, which is chronic (long-lasting) and progressive (getting worse over time), also affects your liver, sinus, intestines and sex organs.

There’s also a form of disease called “atypical cystic fibrosis. ” It’s different from classic CF because it’s a milder form and may only affect one organ. The other “atypical” thing about it is that it usually comes on much later in life. “Typical” or classic CF generally shows up in the first few years of a child’s life.

How common is cystic fibrosis (CF)?

Among white children in the U.S., the rate of CF cases is 1 in 2,500 to 3,500 newborns. CF affects about 1 in 17,000 Black newborns and 1 in 31,000 newborns of Asian descent.

Symptoms and Causes

What causes cystic fibrosis (CF)?

Cystic fibrosis is genetic. People who have CF inherit two faulty genes, one from each parent. CF is said to be recessive because you need to have two gene variants to have the condition itself. (An older name for gene variant is gene mutation.)

Your parents don’t have to have cystic fibrosis for you to have CF. In fact, many families don’t have a family history of CF. If your family doesn’t have a history of cystic fibrosis, the person with the gene variant is called the carrier. About 1 in 31 people in the U.S. is a carrier who is free of CF symptoms.

What are the symptoms of cystic fibrosis (CF)?

Classic cystic fibrosis

Children who have classic CF have the following symptoms:

• Failure to thrive (inability to gain weight despite having a good appetite and taking in enough calories).
• Loose or oily stools.
• Trouble breathing.
• Recurrent wheezing.
• Frequent lung infections (recurrent pneumonia or bronchitis).
• Recurrent sinus infections.
• A nagging cough.
• Slow growth.

Atypical cystic fibrosis

People with atypical cystic fibrosis may be adults by the time they’re diagnosed with atypical CF. Respiratory signs and symptoms may include:

Other signs and symptoms of atypical CF may include:

Diagnosis and Tests

How is cystic fibrosis (CF) diagnosed?

In most cases, CF is diagnosed during childhood. Doctors diagnose CF with a thorough evaluation and by using different tests. These include:

• Newborn screening: Your healthcare provider takes a few drops of blood from a heel prick, usually while your newborn is in the hospital, and places the drops on a special card called a Guthrie card. The screening looks for a list of conditions, including CF. Every U.S. state requires the testing of newborns at birth and a few weeks later.
• Sweat test: The sweat test measures the amount of chloride in the body’s sweat, which is higher in people who have CF. In the test, your healthcare provider spreads a chemical called pilocarpine on your skin, then applies a small amount of electric stimulation to encourage the sweat glands to produce sweat. Your provider then collects the sweat in a plastic coil or on a piece of filter paper or gauze. People of any age can have a sweat test. It’s not painful and does not use a needle. This is the most conclusive test for CF.
• Genetic tests: Blood samples are tested for the genes that cause CF.
• Chest X-rays: Your healthcare provider will order X-rays of the chest are used to support or confirm CF, but a chest X-ray isn’t the only test needed to confirm a diagnosis. Other tests must be done.
• Sinus X-rays: As with chest X-rays, sinus X-rays can confirm CF in people who show certain symptoms. Other forms of testing are used along with sinus X-rays.
• Lung function tests: The most common lung function test uses a device called a spirometer. You breathe in completely, then push the inhaled breath into the mouthpiece of the spirometer.
• Sputum culture: Your healthcare provider takes a sample of your sputum (spit) and tests it for bacteria. Certain bacteria, such as Pseudomonas, are most commonly found in people who have CF.
• Nasal potential difference (NPD): This test uses a voltmeter and electrodes placed in two places in your nose and one place outside of your nose to measure the electricity generated by the transfer of ions in solution across the nasal tissue. The test uses three different types of solutions.
• Intestinal current measurement (ICM): You’ll have to have a biopsy of rectal tissue for this test. The tissue is made to secrete chloride, which is then measured.

In people who have atypical cystic fibrosis, the sweat test may be normal in terms of the levels of chloride. Some people with atypical CF may have been born before testing became routine. Your provider may order NPD and ICM tests when the diagnosis is questionable.

Management and Treatment

How is cystic fibrosis (CF) treated?

You’ll probably have a healthcare team that includes a specialist in cystic fibrosis and many other types of caregivers. There is no cure for cystic fibrosis, but your team will help you manage the disease. The major focus of management is keeping your airways clear. Your provider will also prescribe medicine when needed.

Keeping airways clear

You can help to keep your airways clear if you have cystic fibrosis in a number of ways:

• You can learn special ways of coughing and breathing.
• You can use devices that fit into your mouth or therapy vests that rely on vibrations to loosen mucus.
• You can learn something called chest physical therapy, also known as postural drainage and percussion to loosen mucus. With this method, you move into certain positions so that your lungs can drain. Another person claps their hand on your chest and/or your back to help loosen the mucus. You might combine this with coughing.

Medications for cystic fibrosis

Your provider may prescribe these medicines, which won’t cure CF, but which will help you in certain situations. They include:

• Antibiotics to treat lung infections or prevent them.
• Inhaled bronchodilators to make breathing easier by opening and relaxing your airways.
• Inhaled medicine to make mucus thinner and easier to get rid of.
• Anti-inflammatory drugs, including steroids and non-steroidal anti-inflammatories.
• Medications to treat the cause of cystic fibrosis in people with certain gene variants.
• Pancreatic enzymes to aid in digestion.
• Stool softeners to help with constipation.

Surgeries for cystic fibrosis

You may need surgery for cystic fibrosis or one of its complications. These might include:

• Surgery on your nose or sinuses.
• Bowel surgery to remove blockages.
• Transplant surgery, including a double lung transplant or a liver transplant.

Why is a high-calorie, high-fat diet needed for people with cystic fibrosis (CF)?

People with cystic fibrosis have nutritional needs that aren’t the same as the needs of people without CF. People with CF may need 1.5 to 2 times the number of calories as people without CF. You need the extra calories if you have CF because you use more energy than other people to breathe, fight lung infections and maintain your strength.

You also need more calories and fat because cystic fibrosis stops the digestive enzymes made by your pancreas from working completely. This means nutrients and fats from foods aren’t fully absorbed by your intestines.

Although the enzyme capsules that are taken before all meals and snacks helps digest fats, proteins and starches, a certain amount of nutrients and fats don’t get absorbed. If your body doesn’t absorb enough fats, then fat-soluble vitamins aren’t being fully absorbed either, and these vitamins are needed to protect the lungs.

It’s also important to stress that people with cystic fibrosis should keep a higher than normal weight starting in early childhood. Researchers have shown that young people with CF who maintain a higher weight grow faster and taller up to puberty and again grow taller when they hit their growth spurt at puberty.

Young people with CF who started life at a lower weight did not grow as many inches, started puberty at a later age and never got that same puberty growth spurt. Reaching your full genetic potential — getting as tall as possible with lungs as large as possible — is another reason why higher-than-normal weight in young people with CF is so important.

Another common misbelief is that salt (sodium) is unhealthy for all people. This isn’t true for children and adults with CF. People with CF lose a lot of salt in their sweat. Although there’s not a set standard, healthcare providers generally tell people with CF to eat salty foods. This is true especially during hot, humid weather and exercise. If you have CF, you can probably add salt to meals and snacks as desired. Ask your provider or a registered dietician about the amount of salt you need each day.

What are the complications of cystic fibrosis (CF)?

The complications of CF include the following:

• Adults who have CF can have problems with breathing, digestion and their reproductive organs.
• The thick mucus present in people who have CF can hold bacteria, which can lead to more infections.
• People who have CF have a higher risk of developing diabetes or the bone-thinning conditions like osteopenia and osteoporosis.
• Men who have CF are not able to father children without the aid of alternative reproductive technology. Women who have CF can have a decrease in fertility (the ability to have children) and complications in pregnancy.

Prevention

How can I prevent cystic fibrosis?

You can’t prevent cystic fibrosis because it’s an inherited condition. If you or your partner have any kind of family history, you may want to speak to a genetic counselor before you decide to have children.

Outlook / Prognosis

What is the prognosis (outlook) for people who have cystic fibrosis (CF)?

There is no cure for CF and it cannot be prevented. However, new treatment methods help children who have CF live well into adulthood and have a better quality of life.

Therapies are most helpful when CF is diagnosed early, which is why newborn screening is so important. These therapies include treating infections, trying to prevent weight loss and seeing a CF specialist frequently. The addition of cystic fibrosis transmembrane conductor regulator (CFTR) modulator therapy at a young age seems to be very beneficial and may improve long-term health.

According to information from the Cystic Fibrosis Foundation Patient Registry, more than half of people born with CF between 2015 and 2019 are expected to live to age 46 or longer.

People with atypical cystic fibrosis tend to have longer life expectancies than those with classic CF.

Living With

How do I take care of myself if I have cystic fibrosis?

An adult with cystic fibrosis has different needs than a child with CF. If you’re a parent of a child with CF or if you’re an adult with CF, you can do a lot to promote a healthy life. This includes developing and following recommendations from a treatment plan developed with your healthcare team.

Follow suggestions from your providers about eating enough, eating well and exercising wisely. Ask your provider if pulmonary rehabilitation would be a good idea for you.

Take care to prevent infections by distancing yourself from people who are ill. Practice good hand washing techniques. Get the vaccines that your providers say are needed.

Follow any recommended schedule of appointments with your provider and other members of your healthcare team. If you need help with social or emotional issues, reach out to your team and examine your options.

Decide if you’d like to be part of a clinical trial. Ask your provider to point you in the right direction to be a participant.

Frequently Asked Questions

Is cystic fibrosis contagious?

No. Cystic fibrosis isn’t contagious. It’s a genetic disorder, not an infection. You can’t catch it from anyone and you can’t give it to anyone. If you have it, though, you need to be careful if you’re exposed to infections.

Can you get cystic fibrosis at any age?

Most cases of cystic fibrosis are found during the first few years of life. However, it’s possible to become an adult and then be diagnosed as having CF.

Is cystic fibrosis a terminal illness?

In the past, cystic fibrosis was considered to be a fatal illness. People who had it died in childhood. This is no longer true. Today, most children who have CF grow up to be adults with CF.

A note from Cleveland Clinic

If you have cystic fibrosis or your child has CF, you know that this genetic disorder requires lifelong management. As with many illnesses, being diagnosed early and getting treatment early usually results in the best outcomes. Work with your healthcare team, or your child’s healthcare team, to find ways to stay healthy. You may have access to more resources than you realize. Research is ongoing and scientists are working toward even better outcomes.

Basics of Lung Care | Cystic Fibrosis Foundation

Breathing problems (also called respiratory or pulmonary problems) affect the lungs and the airways and are the most serious problems associated with CF. The severity of respiratory problems differs for each person. For most people with CF, lung disease affects how well they do and how long they live. Many treatments are available to keep the lungs as healthy as possible.

The Lungs

The right lung has three lobes — upper, middle, and lower. The left lung has two lobes — upper and lower. The lobes branch off into smaller segments. Airway clearance techniques (ACTs) help clear the mucus from these segments. Each segment has airways (bronchi), air sacs (alveoli), and blood vessels (arteries, veins, and capillaries). Oxygen and carbon dioxide are exchanged between the blood and air in the air sacs.

The Respiratory System

The respiratory system has two main parts:

• Upper respiratory tract: the nose and sinuses 
  The upper respiratory tract filters out particles such as dust and germs in the air we breathe. It also warms and moistens that air.
• Lower respiratory tract: the airways and lungs 
  The lower respiratory tract starts at the trachea (the main windpipe), just below the vocal cords, and keeps branching until it gets to the air sacs.

The air sacs are where oxygen (O2) enters into the blood (“in with the good air”) and the carbon dioxide (CO2) comes out (“out with the bad air”). The tubes that go from the windpipe to the air sacs are called the “airways.”

The airways have cells with “house cleaning” tools called cilia (small hair-like structures). They move together to push the dust, germs, and mucus out of the lungs where it can be coughed out. The cilia are normally bathed in a thin layer of fluid that is kept at just the right volume and has a mixture of chemicals (like sodium and chloride) and special chemicals that help fight infections.

CF and the CFTR Protein 

Cystic fibrosis is caused by abnormalities in a protein called CFTR (cystic fibrosis transmembrane conductance regulator). When working properly, the CFTR protein moves to the surface of cells in the lungs — and in the pancreas and other organs — where it helps move chloride, water, and other small molecules out of the cells and onto the surface.

But in people with CF, this protein doesn’t get to the cell surface, or it doesn’t function properly if it does reach the cell surface. The right amounts of chloride, water, and other molecules do not move into the airways. This results in the buildup of thick, sticky mucus. The mucus becomes so thick that the cilia cannot easily move the mucus to the throat. So, instead of the cilia cleaning the airways, the mucus clogs the airways. When mucus blocks an airway, it is called a mucus plug.

The following video shows what it looks like when the CFTR protein functions normally in the lungs — hair-like cilia can move mucus and germs out of the airways — and what happens when the protein doesn’t work.

Mucus plugs keep air from getting into or out of some alveoli (air sacs). Oxygen cannot get into the blood and carbon dioxide cannot get out. The thick, sticky mucus in the small airways:

• Gets in the way of air getting into and out of alveoli
• Makes it hard to remove particles and germs from the airways

If not cleared from the lungs, mucus plugs can lead to lung infections and lung damage. Lung infections cause serious problems for people with CF because:

Infections cause inflammation, which can damage the cilia and airways, making them even less able to clear mucus, particles and germs from the lungs.
Infections often cause more mucus to be made. This can lead to more mucus plugs and worse infections.
This infection-inflammation cycle causes lung damage. Mucus plugs airways, allowing germs to grow and cause infection. When the body’s defense system — white blood cells — attack the germs, the lungs become inflamed. This inflammation spurs the creation of more mucus, which then blocks the airways and allows more germs to grow. As you can see, it’s a vicious cycle.

See how the lungs work normally and how cystic fibrosis can affect the lungs over time.

How Your CF Care Team Can Help You Protect Your Lungs 

Monitoring and minimizing the buildup of germs, like bacteria in your lungs, is one of the main ways your CF care team can help you protect your lungs.

Starting at age 5 or older, your CF care team will ask you to take a type of breathing test, known as a pulmonary function test (PFT), during one of your quarterly visits. You will also be asked about your breathing, coughing, and the amount of sputum (mucus or phlegm from the lungs) you are producing.

Your care team will ask for a sample of your sputum which is tested to see what kinds of bacteria are growing in your lungs and determine which antibiotics might fight the bacteria. This is called a “sputum culture.”

Your PFT results will probably look like a sea of numbers and maybe a line graph. Your care center team will review your PFT results with you to help you understand what they mean. One component of your PFT report is the forced expiratory volume (FEV1), which is the amount of air you can blow out in the first second of a forceful exhalation. Your care team will work with you on ways to keep your FEV1 as high as possible.

Clearing the airways to reduce lung infections and improve lung function with airway clearance techniques is a big part of keeping your FEV1 numbers high.

Sputum Culture: MedlinePlus Medical Test

What is a sputum culture?

A sputum culture is a test that checks for bacteria or another type of organism that may be causing an infection in your lungs or the airways leading to the lungs. Sputum, also known as phlegm, is a thick type of mucus made in your lungs. If you have an infection or chronic illness affecting the lungs or airways, it can make you cough up sputum.

Sputum is not the same as spit or saliva. Sputum contains cells from the immune system that help fight the bacteria, fungi, or other foreign substances in your lungs or airways. The thickness of sputum helps trap the foreign material. This allows cilia (tiny hairs) in the airways to push it through the mouth and be coughed out.

Sputum can be one of several different colors. The colors can help identify the type of infection you may have or if a chronic illness has become worse:

• Clear. This usually means no disease is present, but large amounts of clear sputum may be a sign of lung disease.
• White or gray. This may also be normal, but increased amounts may mean lung disease.
• Dark yellow or green. This often means a bacterial infection, such as pneumonia. Yellowish-green sputum is also common in people with cystic fibrosis. Cystic fibrosis is an inherited disease that causes mucus to build up in the lungs and other organs.
• Brown. This often shows up in people who smoke. It is also a common sign of black lung disease. Black lung disease is a serious condition that can happen if you have long-term exposure to coal dust.
• Pink. This may be a sign of pulmonary edema, a condition in which excess fluid builds up in the lungs. Pulmonary edema is common in people with congestive heart failure.
• Red. This may be an early sign of lung cancer. It may also be a sign of a pulmonary embolism, a life-threatening condition in which a blood clot from a leg or other part of the body breaks loose and travels to the lungs. If you are coughing up red or bloody sputum, call 911 or seek immediate medical attention.

Other names: respiratory culture, bacterial sputum culture, routine sputum culture

Chronic Bronchitis | Johns Hopkins Medicine

What is chronic bronchitis?

Bronchitis is inflammation of the breathing tubes. These are the airways called
bronchi. This inflammation causes too much mucus production and other changes. There are
different types of bronchitis. But the most common are acute and chronic.

Chronic bronchitis is long-term inflammation of the bronchi. It is common among
smokers. People with chronic bronchitis tend to get lung infections more easily. They
also have episodes of acute bronchitis, when symptoms are worse.

To be classified as chronic bronchitis:

• You must have a cough and mucus most days for at least 3 months a year, for 2 years in a row.
• Other causes of symptoms, such as tuberculosis or other lung diseases, must be ruled out.

People with chronic bronchitis have chronic obstructive pulmonary disease (COPD). This
is a large group of lung diseases that includes chronic bronchitis. These diseases can
block air flow in the lungs and cause breathing problems. The 2 most common conditions
of COPD are chronic bronchitis and emphysema.

What causes chronic bronchitis?

Chronic bronchitis is not caused by a virus or bacteria. Most experts agree that the
main cause of chronic bronchitis is cigarette smoking. Air pollution and your work
environment may also play a role. This is especially true if you also smoke.

Bronchitis symptoms often happen with other lung diseases, such as:

• Asthma
• Pulmonary emphysema
• Scarring of the lungs (pulmonary fibrosis)
• Sinusitis
• Tuberculosis
• Upper respiratory infections

What are the symptoms of chronic bronchitis?

Below are the most common symptoms of chronic bronchitis. But each person may have slightly different symptoms.

Symptoms may include:

• Cough, often called smoker’s cough
• Coughing up mucus (expectoration)
• Wheezing
• Chest discomfort

People with chronic bronchitis often have a cough and make mucus for many years before
they have shortness of breath.

Chronic bronchitis may cause:

• Disability
• Frequent and severe infections that affect your airways
• Narrowing and plugging of your breathing tubes (bronchi)
• Trouble breathing

Other symptoms may include:

• Bluish fingernails, lips, and skin because of lower oxygen levels
• Wheezing and crackling sounds with breathing
• Swollen
  feet
• Heart failure

The
symptoms of chronic bronchitis may look like other lung conditions or health problems.
See your healthcare provider for a diagnosis.

How is chronic bronchitis diagnosed?

Your
healthcare provider will take a complete health history and do a physical exam. He or
she may order the following tests:

Pulmonary function tests

These tests help to measure the lungs’ ability to move air in and out of your lungs.
The tests are often done with special machines that you breathe into. They may
include:

Spirometry. This test uses a spirometer device to see how well your lungs
are working. It is one of the simplest, most common pulmonary function tests. It may
be used for any or all of these reasons:

• To find out how well your lungs take in, hold, and move air
• To keep watch on a lung disease
• To see how well treatment is working
• To find out how serious your lung disease is
• To
  find out if your lung disease is restrictive or obstructive. Restrictive means
  less air will get into your lungs. Obstructive means less air will get out of your
  lungs.

Peak
flow monitor. This test measures the fastest speed you can blow air out of
your lungs. Inflammation and mucus in the large airways in the lungs narrow the
airways. This slows the speed of air leaving the lungs. It can be measured with a
peak flow monitor. This measurement is very important in telling how well your
disease is being controlled.

Arterial blood gas

This blood test is used to check the amount of oxygen and carbon dioxide in your blood. It also measures the acidity of your blood.

Pulse oximetry

An oximeter is a small machine that measures the amount of oxygen in your blood. To get this measurement, a small sensor is taped or clipped onto a finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless, and the red light does not get hot.

Chest X-ray

This test makes pictures of your internal tissues, bones, and organs, including the lungs.

CT scan

This imaging test uses a combination of X-rays and computer technology to make
images of the body. A CT scan shows detailed images of any part of the body,
including the bones, muscles, fat, and organs. CT scans are more detailed than
general X-rays.

How is chronic bronchitis treated?

Treatment for chronic bronchitis is aimed at treating the causes and symptoms. It may
include:

• Quitting smoking
• Staying
  away from secondhand smoke and other lung irritants
• Taking
  medicines by mouth (oral) to open airways and help clear away mucus
• Taking inhaled medicines, such as bronchodilators and steroids
• Getting oxygen from portable containers
• Having lung reduction surgery to take out damaged areas of the lung
• Getting a lung transplant, in rare cases
• Humidifying the air
• Pulmonary rehab to help you learn how to live with your breathing problems and stay active

Key points about chronic bronchitis

• Bronchitis is inflammation of the breathing tubes (bronchi). There are several types of bronchitis, but the most common are acute and chronic.
• Chronic bronchitis is often part of chronic obstructive pulmonary disease (COPD). This is a group of lung diseases that cause airflow blockage and breathing problems.
• The most important cause of chronic bronchitis is cigarette smoking. Air pollution and your work environment may also play a role.
• This
  condition causes a cough that’s often called smoker’s cough. It also causes you to
  cough up mucus, wheeze, and have chest discomfort. These may get worse over time and
  lead to severe breathing problems.
• Tests that help measure how well your lungs are working are used to diagnose chronic bronchitis. Blood, breathing, and imaging tests may also be used to see how severe the problem is and watch it over time.
• The
  goal of treatment is to live more comfortably by controlling symptoms. A key part of
  treatment is to quit smoking.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your healthcare provider if you have questions.

90,000 🧬 How to get rid of a cough and when to run to the doctor

Coughing can be troublesome at any time of the year. Together with the general practitioner, we understand the possible causes and consider treatment options.

The airways of our body are covered with a thin layer of cilia cells. They constantly move and remove all mucus and dirt from the lungs and bronchi to the outside. But if the amount of irritants or mucus is too large, as well as when a foreign body gets in, the second defense mechanism comes to the rescue – a cough.

Andrey Besedin, MD, PhD, internist, family doctor, GMS Clinic.

The cough is a protective reflex in our airways. It is needed to shake off all that is superfluous that gets there. A cough effectively relieves the body of almost any irritant that may enter the respiratory tract.

Why does a cough appear

A cough can start from any object or substance that gets into the respiratory tract: food fragments, perfume or aerosol fumes.Sometimes it is caused by allergies and sometimes by stress.

Most often, a cough is triggered by viruses or bacteria and their waste products. In this case, the cough is called infectious, and its manifestations will differ depending on the pathogen:

Manifestations of an infectious cough:

• Coronavirus infection. The cough is most often dry, debilitating, besides this, there are other symptoms: shortness of breath, weakness, fever, headache.
• Pneumonia. Symptoms depend on the type of infection, but often the illness begins with a cough that builds up and turns into a persistent, moist cough. The amount of sputum increases, chest pain, fever, and weakness may appear. There is a general deterioration in the condition.
• Bronchitis. The cough is moist, relieves after coughing. With deep breathing, sounds are sometimes heard in the chest – they are caused by the fact that phlegm accumulates in the bronchi.
• Whooping cough.The cough in this disease is debilitating, paroxysmal, prolonged, it interferes with sleep. It is difficult to find a position to alleviate the condition. Intercostal muscles hurt from constant coughing, hemorrhage in the eye may occur. Over time, the frequency of attacks decreases, but this condition sometimes continues for several months.

A cough can be a sign of not only an infectious disease, but also other conditions and illnesses.

More often than others, there are:

• Allergies and asthma.In most cases, coughing fits occur after contact with an irritant in the air.
• Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by a chronic restriction of airflow in the airways. The main symptoms of COPD are coughing up phlegm and shortness of breath.
• Heartburn or gastroesophageal reflux disease (GERD). Moving acidic stomach contents up the esophagus irritates the throat and vocal cords, leading to coughing and sore throat.
• Nervous disorder. In a stressful situation, especially in children, a nervous cough is possible as a variant of a nervous disorder like a tic.
• Foreign body or tumor.
• Smoking.
• Tuberculosis.

How to understand the cause of cough

To understand the cause of a cough, you need to answer a few questions:

• When does the cough occur? At night in a dream, after exercise or after eating?
• Have you had contact with ARVI patients in the last few days?
• Are there any gastrointestinal diseases or symptoms of stomach upset?
• Is there sputum, what does it look like?
• Did you get a cough during birch flowering or after contact with other allergens?
• Does the cough have other symptoms? Is there a fever, chills, weakness, is there any weight loss?
• Have you been under severe stress recently?
• Is the office or apartment well ventilated, is there a humidifier?
• How long does the cough last? Is it decreasing or increasing?

If you make a characterization of the cough, it will be approximately clear where to look for the cause and how urgently you need to see a doctor.Any type of cough that lasts more than a few days, interferes with sleep, is accompanied by a high fever, or produces a pronounced colored discharge – this is a reason to see a doctor. It is especially necessary to go to the appointment quickly if, due to coughing, it is difficult to inhale and exhale when there is not enough breath.

How to get rid of a cough

You need to go to the doctor and not self-medicate, but this is not always possible to do right away. If you can’t get an appointment right away, there are ways to relieve the condition using proven methods.

Clean air

If you fantasize, the best option is to live on the shores of the warm Mediterranean Sea, not stress, eat well and tasty and not get sick. But this is not always possible, so you need to take care of breathing hygiene. The first and most important thing is to moisturize the mucous membranes. We forget to humidify the air where we are constantly. Offices often have a central air filtration system that is not efficient enough. In this case, walks in the woods or in the park help.

Dry dusty air irritates the mucous membranes and increases coughing. Therefore, at home, you can put a humidifier or put a damp towel on the battery, in addition, it is worthwhile to arrange wet cleaning more often and do not forget to open the windows for ventilation.

Natural remedies

Evidence-based medicine treats herbal infusions with caution. Herbs can cause allergies, and the concentration of the beneficial substance in them is unknown, it is difficult to measure it for normal dosage of the medicine.

Lollipops

The easiest way to moisturize mucous membranes is to use any lozenges. It is not necessary to buy medical products from the pharmacy, you can take any delicious ones in the store. This stimulates the flow of saliva and slightly moisturizes the oropharynx.

Drinking plenty of water

It moisturizes mucous membranes and liquefies phlegm, making it easier for the body to get rid of it. If there is not enough fluid in the body, then the sputum thickens, coughs up worse, can become a breeding ground for bacteria and cause complications.

Saline solution

Salt solution should be instilled into the nose when coughing, which appeared due to irritation of the back of the pharynx with discharge from the nose. You can buy saline at the pharmacy or make it at home: dissolve a quarter teaspoon of baking soda and half a teaspoon of salt in a glass of water (250 ml).

Inhalation with saline

They well moisturize the respiratory tract and help remove phlegm, but in recent decades, world medicine has increasingly warned against inhalation without a preliminary examination by a doctor.

Medicines

There are many medicines available to treat coughs that are available over the counter at the pharmacy. But they can only be taken after consulting a doctor. With ordinary ARVI, moisturizing the mucous membranes and drinking plenty of fluids work no worse than drugs, and buying inappropriate drugs can worsen the condition.

For example, if you take antitussives to get rid of an annoying cough, phlegm can accumulate in the bronchi and cause bacterial complications.

The doctor can prescribe medications if he sees the need for it. Most often these are:

• Antitussives. They are indicated for dry, debilitating coughs when the cough interferes with sleep, such as whooping cough.
• Expectorants. They are prescribed for sputum that does not cough up on its own. Children under the age of four should not take these medications without a doctor’s approval.
• Nasal drops. If the cause of the cough is a runny nose and mucus flowing into the oropharynx, then they can help.But drops from the common cold cannot be used for more than 3-5 days because of the danger of addiction.
• Medicinal inhalations. In this case, bronchodilator or hormonal drugs are added to the saline solution to reduce inflammation and relieve spasm.
• Attacks of respiratory failure (bronchial obstruction) in children are relieved by inhalation drugs, but this is discussed at a face-to-face appointment with the parents. There is no need to build a first aid kit based on articles from the Internet. After all, there is no the same course of even an ordinary rhinitis, and it is not always possible to understand how to reduce bronchial obstruction in a particular patient right away, even at the reception.

How to recognize a chronic cough

If the cough lasts more than three weeks, you need to be wary. Only a doctor can help determine the cause of the cough, its type and choose the right treatment.

The diagnosis of “Chronic cough” is made based on the results of a discussion with a doctor, it is impossible to independently determine this. Sometimes it happens that a person comes to an appointment and says that he has a chronic cough. It turns out that for the first three weeks he was recovering from an acute respiratory viral infection, then for two weeks there was an exacerbation of GERD (gastroesophageal reflux disease), which provoked a cough.And another whole month fell in early spring and the spraying of some birch or alder. In this case, we are not talking about a chronic cough. And it happens that a patient has chronic obstructive pulmonary disease, and he coughs precisely because of it.

What to do if cough interferes

First of all, you need to sit down or stand up and try to inhale through your nose. If inhalation and exhalation through the nose is successful, then everything is fine so far. If you can’t take a breath, then you need to wake up someone close to you, try to scream or say something.If it works, it means that breathing is preserved – already not bad. If you can’t scream and breathe, then you need to urgently call an ambulance.

If a cough gets in the way at night so that it is impossible to sleep, you need to find out if an ambulance and hospitalization is required.

While the ambulance is on the way, you need to:

• open the window for fresh cool air;
• turn on hot water in the bathroom and breathe over the steam;
• calm down.

How heart disease and cough are related

If the heart ceases to cope with its work and slowly pumps out blood, then the pressure rises in the lungs, fluid accumulates, and this causes a reflex coughing. This condition is characterized by bouts of dry cough. In severe cases, blood-streaked sputum may appear. That is, a cough is associated with the formation of heart failure, excessive pressure occurs in the pulmonary circulation.Fortunately, this is not common.

How to treat a cough during pregnancy

In pregnant women, coughing may be associated with increased pressure on the lungs or heartburn later in life, but there may be more serious causes.

Any cough in pregnant women, even a minor one, is a reason to look to the doctor. There can be many reasons for coughing, and pregnancy is a period of increased attention to health.

Features of cough in children

You should not buy coughing and expectorant drugs for children on your own, they can worsen the condition and cause complications.

In most cases, young children have an irregular cough that occurs against the background of swelling of the nose. If the child does not have a high fever and shortness of breath, then most likely the cause of the cough is nasopharyngeal drip. In this case, mucus runs down the back of the nose and irritates the vocal cords. But at home it is impossible to determine exactly.

Cough is not a disease, but one of the signs that something is wrong in the body. Most often, the cough goes away on its own and without consequences, but each situation is individual, and it is important to consult a doctor in time in search of reasons.Especially if there are other warning symptoms besides coughing.

symptoms of pneumonia, how to treat and can it go away by itself, causes and diagnosis, types of pneumonia, community-acquired and viral

This material was updated on 09/01/2021

Daniil Davydov

medical journalist

Author’s profile

Pneumonia, or pneumonia, is considered one of the most dangerous diseases on Earth.

According to WHO, it accounts for 15% of deaths of all children under five years of age.Pneumonia is also dangerous for adults. All sick people are at risk to face serious complications and even die, but especially people over 65 and patients with chronic diseases such as diseases of the cardiovascular system and diabetes mellitus.

To make it easier to figure out how to act correctly in case of suspected pneumonia, let’s first look at how the lungs work.

See your doctor

Our articles are written with a passion for evidence-based medicine. We refer to reputable sources and go for comments from reputable doctors.But remember: the responsibility for your health lies with you and your doctor. We do not write prescriptions, we make recommendations. It is up to you to rely on our point of view or not.

How the lungs work

Lungs are paired organs that live in the chest, which we need for breathing. During inhalation, oxygen-rich air does not immediately enter the lungs. First, it enters the nasal cavity lined with mucous epithelium. The epithelium moisturizes and warms the air to body temperature, and also secretes mucus, which traps most of the dust and microbes.

What the Respiratory System Consists of – Lumen Learning

Pneumonia in Adults – Uptodate

The warmed and purified air then passes through a series of “pipelines”: first through the pharynx and then through the trachea, which branches into two passages called the bronchi. The bronchi are also lined with mucus-secreting epithelium. The epithelium is covered with small cilia, which help mucus, with dust and microbes stuck in it, up the throat and into the mouth, where it can be spit out or swallowed.

In the lungs, the bronchi begin to branch into smaller tubes – bronchioles, the smallest of which is only half a millimeter in diameter. The smallest bronchioles end in air sacs-alveoli, they are entwined with small blood vessels-capillaries. The alveoli are the final stop for the air we breathed in. It is in them that what happens for which everything was started: the blood is saturated with oxygen and parted with carbon dioxide.

Alveoli are composed of cells that secrete mucus into the lumen of the alveoli, which facilitates their expansion during inhalation.In the same place, in the lung tissue, there are immune macrophage cells: they patrol the alveoli and devour viruses and microbes that have slipped through the mucus barrier.

The air path begins in the nose and ends in the alveoli of the lungs, where gas exchange takes place. Source: American Lung Association

Thus, the lungs have three effective defense systems against microbes – mucus, cilia, and macrophage eaters. But sometimes the protection fails, and pathogens enter the lungs, which the macrophages cannot cope with.In this situation, a lung infection can develop, which can lead to pneumonia.

As we already know, the highest risk group includes people who, due to age or other reasons, have problems with immune defense: infants and young children, adults aged 65 years and older, patients with serious illnesses.

TEXTBOOK

How to beat burnout

A course for those who work hard and get tired. The price is open – you set it yourself

Start learning

What is pneumonia

Pneumonia – inflammation of one or both lungs, which is provoked by pathogenic bacteria, viruses or, much less often, pathogenic fungi.As a rule, pathogens are transmitted from sick to healthy by sneezing and coughing, or if a healthy person touches an object that has been infected with pathogens.

What is pneumonia – American Lung Association

Is pneumonia contagious – NHS

When infectious agents enter the lungs, the body triggers a universal immune response designed to protect against any infectious agent. Here’s what’s going on:

1. The body temperature rises above +38 ° C – it is difficult for viruses and bacteria to multiply in such heat.
2. Many immune cells move to the inflammation zone, that is, to the alveoli affected by microbes: they help macrophages attack pathogens, but at the same time cause an inflammatory reaction. When immune cells die, they remain in the lungs and turn into pus, which gives sputum a green or yellow tint.
3. In response to inflammation, more mucus is secreted in the alveoli – this increases the chance that germs will become trapped in it and not spread to other parts of the lungs.

The universal immune response protects the lungs from pathogens.But it also causes the symptoms of the disease: fever, cough, in which green mucus “flies out” from the lungs, and difficulty breathing due to the fact that excess phlegm in the alveoli interferes with normal gas exchange.

Pneumonia or pneumonia?

Lung inflammation is a popular diagnosis for pneumonia. Both can be an independent disease or symptom, for example, heart failure. To avoid confusion, we have only used the medical term pneumonia.

Causes of pneumonia

The most common cause of pneumonia is bacteria or viruses. The most “popular” bacterial pathogen of pneumonia is pneumococcus. It lives in the nasopharynx and spreads when you cough, so even perfectly healthy people can catch it as easily as a cold. Respiratory syncytial virus is the most common cause of viral pneumonia in children.

But sometimes bacterial pneumonia begins with a viral illness – a cold, flu or coronavirus disease.In some people, viruses weaken the body so much that it temporarily loses its immune defenses. Disease-causing bacteria, which under normal circumstances immunity does not leave the slightest chance, gladly settle in defenseless lungs and cause pneumonia.

Bacterial and viral pneumonias are slightly different from each other. For example, bacterial pneumonia usually lasts longer than viral pneumonia and its symptoms are more severe. The rest of the pneumonia caused by different pathogens is very similar.

Types of pneumonia

There are three most popular classifications of pneumonia. They help to describe the disease in more detail, clarify the diagnosis and make other important decisions. For example, to figure out whether it is time to hospitalize a patient or you can leave him sick at home, and choose a recovery method that will be optimal for this particular person.

Classification of Pneumonia – Training Course for Medical Students and Nurses PDF, 307 KB

Classification by site of infection. This is the most popular classification in which pneumonia is divided into two large types: community-acquired and nosocomial. Knowing where the person got infected, the doctor can guess which microbes caused the pneumonia. This classification facilitates diagnosis and simplifies the selection of an appropriate treatment.

Pneumonia classification – Informed Health Online

Community-acquired pneumonia is usually caused by:

• respiratory viruses, eg influenza A and B viruses;
• rhinoviruses, adenoviruses and coronaviruses, such as the causative agent of the coronavirus disease SARS-CoV-2;
• typical bacteria – pneumococcus, group A streptococcus, Haemophilus influenzae and Staphylococcus aureus;
• Atypical bacteria that only react to antibiotics specially selected for them, such as Legionella, Mycoplasma and Chlamydia.

Fungal infection – Medscape

Hospital pneumonia – Medscape

Sometimes a fungal infection provokes community-acquired pneumonia. But it is much more difficult for a fungus to enter the lungs than viruses and bacteria. So either immunocompromised patients, such as those infected with HIV and not taking antiretroviral therapy, or people who are in constant contact with pathogenic fungi, such as farmers, suffer from fungal infection.

Why do patients get nosocomial infections – Osmosis

Nosocomial pneumonia is a disease that infects patients hospitalized for a completely different reason.For pneumonia to be considered nosocomial, the patient must become infected at least two days after being admitted to the hospital.

Drowning pneumonia – International Journal of Environmental Research and Public Health

It is believed that hospital patients are more vulnerable because their immune systems are already weakened by the “underlying” disease. They also stay in hospital walls for a long time, that is, they are in contact with nosocomial pathogens longer, and they are often placed with catheters and subjected to other invasive procedures, due to which drug-resistant bacteria can get into the body.

Some experts distinguish pneumonia in a separate group associated with the provision of medical care. These are ventilation pneumonia, which develops two to three days after tracheal intubation, and pneumonia, which develops in regular hospital guests: chronic patients, patients undergoing dialysis and chemotherapy, residents of nursing homes.

Classification by anatomical position. Pneumonia can be:

1. lobar – that is, to hit all the right or all the left lung;
2. interstitial – that is, infect the tissues surrounding the respiratory tract;
3. bronchopneumonia – that is, to affect not the entire lung, but its individual structures: bronchi, bronchioles or alveoli.

Classification by pathogen. This classification is consistent with the causes of pneumonia: the disease can be associated with bacteria, viruses, fungi and mycoplasmas.

There are several more clarifying classifications that are used primarily in our country.

Classification by the mechanism of development of pneumonia. Pneumonia can be:

1. primary. The disease arose in a person who had not been ill with anything before;
2. secondary.In this situation, pneumonia is a complication of some other disease. For example, cystic fibrosis, bronchial asthma, or coronary heart disease;
3. aspiration. The disease has developed due to the fact that foreign particles have entered the bronchi – for example, crumbs or vomit;
4. post-traumatic or postoperative. The pneumonia is caused by injury or surgery;
5. associated with blood vessel infarction. The disease arose because a blood clot blocked a vessel supplying blood to the lungs.

Aspiration pneumonia – Medscape

Classification by the nature of the flow. Pneumonia can be acute – when the disease occurred suddenly, but the person recovered quickly enough, and chronic, if the person is sick for a long time, that is, for months or years.

Classification by severity. From the point of view of the patient, pneumonia can be:

1. mild (latent, asymptomatic) – temperature up to +37 ° C, the person feels normal, no breathing problems, can be treated at home;
2. moderate severity – temperature up to +38 ° C, the person is unwell, as with a severe cold, there are no breathing problems.Can usually be treated at home;
3. severe – the body temperature is more than +38 ° C, the person feels very bad, it is difficult for him to breathe. The person needs urgent hospitalization.

Pneumonia symptoms

Symptoms of community-acquired pneumonia of various origins are usually similar.

Most people complain of fever – when the temperature rises above + 38 ° C. But it must be borne in mind that people over 65 can get pneumonia without fever.

Fever helps doctors distinguish bacterial pneumonia from acute viral bronchitis, which does not require antibiotic treatment. With bronchitis, patients cough for 10-20 days in a row, sometimes spitting out clear, yellow or green mucus. But there is often no fever.

Acute bronchitis in adults – Uptodate

Other common symptoms of pneumonia are heart palpitations and breathing, shortness of breath, chest pain when breathing, cough that spits out clear, yellow or green phlegm, nausea, vomiting and diarrhea.Some people have chills and confusion.

If you or your loved ones have a high fever and symptoms that resemble a cold for three or four days, it is better not to come to the clinic on your own: in case of fever, it is safer to stay in bed. Call a doctor at home. This can be done free of charge under the compulsory medical insurance policy, and for money – by calling a private clinic.

Due to the coronavirus disease epidemic, doctors from many private clinics do not visit patients with cold-like symptoms.And patients who plan to visit the clinic on their own may be asked to first take a PCR smear for COVID-19 or make an appointment only after prior consultation by phone or online.

The cost of calling a doctor at home in Moscow – free of charge or from 4000 R.

Most pneumonia patients can recover at home. As a rule, only patients with pneumonia are hospitalized who:

1. are especially seriously ill – with impaired consciousness, blood pressure below 90 to 60 mm Hg.Art. and tachypnea, that is, with rapid shallow breathing over 30 breaths per minute;
2. risk serious complications, such as sepsis, that is, blood poisoning, or lung abscess, in which a cavity filled with pus forms in place of living lung tissue. At risk are patients with chronic diseases and people over 65 years of age.

Diagnosis of pneumonia

In our country, doctors diagnose pneumonia if two conditions are met:

1. X-ray of the patient shows lesions in the lung tissue.
2. The patient has any two of these symptoms: fever with a temperature above +38 ° C; coughing up phlegm; wheezing is heard in the lungs; in the general blood test, the level of leukocytes is higher than 10 × 10 ⁹ / l; in the general analysis of blood more than 10% of stab leukocytes.

Community-acquired pneumonia in adults – clinical guidelines of the Ministry of Health, 2019 PDF, 2.16 MB

This means that to confirm the diagnosis, you need to do the following:

1. Get a medical examination.The doctor should measure the temperature and listen to breathing with a stethoscope.
2. Make an anterior frontal and lateral chest x-ray. If it is not known which lung is affected by the inflammation, the picture is taken in the right lateral projection. You need to ask your doctor about what kind of image is required.
3. To hand over a general blood test.

How much does the diagnostics cost. You can take an X-ray and take a blood test for free under the compulsory medical insurance policy or in a private clinic for money.

The cost of an X-ray of the chest in two projections in Moscow – from 370 R.

The cost of a general (clinical) blood test along with taking a biomaterial in Moscow – from 475 R.

In addition, the compilers of Russian clinical guidelines advise measuring saturation – blood oxygen saturation – for all patients with suspected pneumonia. Saturation is measured with a pulse oximeter. Most likely, the doctor will do this on the first visit. But if the person is not planning to be hospitalized, it is worth asking the doctor whether it makes sense to buy your own device in order to monitor the state of health on your own.

Microbiological tests of blood or sputum are prescribed only for hospitalized patients – this helps to choose an antibiotic more accurately. Microbiological tests are not recommended for patients left to recover at home. The result will still not affect the tactics of treatment and will not increase the likelihood of recovery.

How to treat pneumonia

The main goal of treating community-acquired pneumonia is to get rid of the infection and prevent complications.

When a doctor diagnoses pneumonia, he often does not know what caused it – viruses or bacteria. But he can assess the severity of the symptoms and knows where and how a person got infected. This allows you to select a treatment aimed at combating the most likely pathogens.

Review of Community-Acquired Pneumonia in Adults – Uptodate

As a rule, patients with community-acquired pneumonia without serious illness who are younger than 65 years of age and recovering at home are prescribed antibiotics to treat pneumococcus and other popular pathogens.This is usually amoxicillin and must be taken three times a day.

Sometimes doctors add another antibiotic. For example, from the class of macrolides – azithromycin or doxycycline. For most patients, it is sufficient to take antibiotics for five days, but for some people the fever and other symptoms of the disease do not go away during this time. In such a situation, the doctor may prolong the course of antibiotics.

The cost of amoxicillin – from 111 R, azithromycin – from 150 R, doxycycline – from 297 R.

Patients with chronic heart, lung, kidney or liver diseases, diabetes mellitus, alcohol dependence or immunosuppression, smokers and patients who have taken antibiotics within the past three months need a different set of antibiotics – for example, amoxicillin with clavulanic acid. The price of this drug starts from 96 R.

At the same time, there are people with an allergy to amoxicillin and individual contraindications, among them patients who take medications that are incompatible with some of the “basic” antibiotics.Therefore, doctors still have to adapt standard therapy for a specific patient.

For some patients whose lungs have thick, viscous mucus, which is difficult to get rid of along with a cough, the doctor may prescribe a mucolytic, a drug that thinns phlegm. For example, a drug with acetylcysteine ​​or a drug based on bromhexine.

The cost of the drug with acetylcysteine ​​- from 132 R, with bromhexine – from 223 R.

Rinsing the nose with saline. Helps to ease breathing and get rid of snot. You can make a saline solution yourself or buy it – the price starts from 50 R.

Antipyretic drug based on paracetamol or ibuprofen. It will help people whose temperature has exceeded +39.4 ° C and those who do not tolerate fever. Price starts from 25.5 R.

How to Treat Fever – Mayo Clinic

Combined preparation with paracetamol, phenylephrine and feniramine. This drug is three in one: it works as an antipyretic, vasoconstrictor and decongestant. People who choose it do not need vasoconstrictor drops and antipyretic drugs. Price starts from 178 R.

How combination drugs work – National Center for Health Research

Hospitalized patients with community-acquired pneumonia are also prescribed antibiotics. Combination therapy is usually used: both beta-lactam and an antibiotic from the macrolide class are prescribed.If the patient is allergic to one of these drugs, the antibiotic fluoroquinolone is prescribed.

In addition to antibiotics, patients recovering in hospital and those who develop very severe inflammation may be prescribed a hormonal drug such as the glucocorticoid hormone prednisone.

This treatment helps the majority of hospitalized patients. However, some people get sick or develop complications. Such patients are transferred to intensive care, continue to be treated with antibiotics and provided with artificial ventilation of the lungs using a ventilator, which delivers the oxygen mixture directly to the lungs.Usually, a patient on mechanical ventilation is injected into a medical coma so that he does not feel discomfort and pain, but is fed through a catheter.

What remedies are useless for pneumonia

It is useless to take antiviral drugs like rimantadine, immunomodulators like kagocel, vitamin C supplements and homeopathic remedies. Rimantadine is a flu medicine that has already expired. Immunomodulators and high doses of vitamin C have little evidence of effectiveness, and homeopathy basically doesn’t work.

Cough preparations based on butamirate for pneumonia should not be used either. A cough is a defense reaction that helps to flush mucus from the body in which bacteria and viral particles are trapped. So it’s safer and healthier to endure it.

Supplements with probiotics and prebiotics. Dietary supplements with beneficial intestinal bacteria from the Lactobacillus and Bifidobacterium groups are often advised to be taken together with antibiotics to replenish the loss of beneficial intestinal microbes.However, there is no consensus on the benefits of this practice.

Some experts believe that taking probiotic and prebiotic supplements is most likely useless because the bacteria from the supplements do not take root in the intestines.

On the other hand, members of the World Gastroenterology Organization claim there is evidence that probiotics are useful in preventing antibiotic-associated diarrhea. And researchers from the Cochrane community found that antibiotic-associated probiotics were less likely to develop antibiotic-associated diarrhea caused by Clostridia by an average of 60%.

The situation is complicated by the fact that the additives differ markedly both in the species composition of beneficial bacteria and in their concentration. Therefore, it makes sense to discuss the choice of probiotic with your doctor.

Prevention of pneumonia

Get the flu and pneumococcal vaccine. Every year all citizens of Russia are vaccinated against influenza – it is free of charge under the compulsory medical insurance policy.

How not to get pneumonia – American Lung Association

There are two vaccines against pneumococcus in our country: Prevenar 13, which protects against 13 strains, and Pneumovax 23, which protects against 23 strains.Under the compulsory medical insurance policy, only children at 2, 4.5 and 12 months, recruits and people over 65 from the risk group are vaccinated.

This vaccine was only introduced to children in 2014, so most adults have no protection. Those who have not been vaccinated against pneumococcus should think about getting vaccinated in a private clinic for money. The cost of vaccination against pneumococcus in a private clinic in Moscow with examination by a doctor – 4700 R.

National calendar of preventive vaccinations

“Prevenar 13” – the official reference book of the Ministry of Health of the GRLS

“Pnevmovax 23” – the official reference of the Ministry of Health of the GRLS

Wash your hands. Especially after the street, toilet and before eating. Otherwise, there is a chance to swallow a virus or bacterium, which can provoke illness.

Take care of yourself if you catch a cold. Give yourself time to rest – there is less chance that a bacterial infection will be added to the viral infection and pneumonia will develop.

Try to quit smoking. Tobacco smoke damages the lungs, so smokers have a higher risk of pneumonia. People who continue to smoke are in one of the high-risk groups for whom the pneumococcal vaccine is recommended.

How much does it cost to treat pneumonia

Designation

Price in Moscow

House call

Free or from 4000 R

General blood test along with taking biomaterial

From 475 R

Saline solution, vasoconstrictor drops, antipyretic or combination drug

From 400 R

X-ray of the chest in two projections

From 370 R

Azithromycin or doxycycline

From 150 R or from 297 R

Amoxicillin

From 111 R

90,000 Pneumonia – MyPathologyReport.ca

What is pneumonia?

Pneumonia is an infection of the lungs caused by: viruses, bacteria or fungi. Most cases of pneumonia begin when infectious particles, inhaled through the nose and mouth, travel through the airways to the lungs. Pneumonia can affect one or both lungs at the same time. The disease can affect only part of the affected lung or the whole.

Lungs

When you breathe, air enters your body through your mouth and nose and into your lungs through the respiratory tract.Inside the lungs, oxygen enters the bloodstream and carbon dioxide is excreted from the body.

The largest airway is called the trachea. Once in the chest, the trachea splits into two branches called the bronchi. The airways are hollow tubes lined with cells with fine microscopic hair-like structures on the surface called cilia. Cilia help prevent infections by removing inhaled particles before they reach your lungs. The airways also contain glands that produce thick mucus that traps particles in the air.

You have two lungs, one on the right side of your chest and one on the left. The lungs are divided into parts called lobes. The right lung consists of three lobes – upper, middle and lower. The left lung is slightly smaller in size and has two lobes – an upper and a lower one. When the bronchi enter the lungs, they split into smaller and smaller airways known as bronchioles, eventually ending in air-filled spaces called alveoli.

Alveoli are extremely small, cup-shaped, air-filled spaces lined with flat cells called pneumocytes.There are two types of pneumocytes. Type 1 pneumocytes are small and flat. Type 2 pneumocytes are thicker and cube-shaped. The alveoli are surrounded by a thin network of blood vessels called capillaries that carry blood to and from the lungs.

What are the symptoms of pneumonia?

The most common symptoms of pneumonia include cough, fever, chills, mucus and shortness of breath. Other less common symptoms include confusion, chest pain, blue lips and nails, and loss of appetite.Pneumonia, like other infections, is worse in older people and people with weakened immune systems.

Types of pneumonia

There are many types of pneumonia, but most are caused by bacteria or viruses. Less common types are caused by a fungus.

Bacterial pneumonia

This type of pneumonia begins when bacteria enter the lungs and alveoli, usually from the nose or mouth. Bacteria can also enter the lungs from other parts of the body through the blood.Bacteria in the alveoli will grow in the air until they are detected by the body’s immune system, which tries to remove the bacteria from the body. To aid in this process, small capillaries surrounding the alveoli open up, increasing blood flow to the lungs. This allows more inflammatory cells, including neutrophils, to reach the lungs. Pathologists describe this process as acute inflammation. The green or yellow phlegm produced when a person with pneumonia coughs is made up of millions of neutrophils and remnants of damaged tissue and dead bacteria.This is a sign that there is active inflammation in the lungs.

Although neutrophils are essential to kill and remove bacteria in the lungs, they can also damage the pneumocytes that line the alveoli. The combination of damaged pneumocytes with additional blood flow can cause fluid to fill the air spaces. This process is called edema. Because the fluid prevents air from entering the alveoli, a person with pneumonia may have difficulty breathing. When X-rays or computed tomography (CT) scans are done, areas of the lung with infection and swelling are described as “consolidated.”

Once your immune system is under control, specialized immune cells called macrophages will move around to clear out dead bacteria and damaged tissue. At the same time, the edematous fluid organizes in the air spaces and becomes more solid. These areas of the lung will appear gray or white on x-rays or CT scans.

Bacterial pneumonia can be divided into croupous and bronchopneumonia. With croupous pneumonia, the bacteria have spread and spread to most of the lobe of one lung.In bronchopneumonia, bacteria spread through small air spaces, affecting parts of more than one lobe of the lung. Because of this, areas of the lung affected by bronchopneumonia are usually located near the airways.

Types of bacteria that commonly cause pneumonia include:

• Streptococcus
• Staphylococcus
• Klebsiella
• Pseudomonas
• Legionella
• Mycoplasma

Viral pneumonia

This type of pneumonia begins when viral particles enter the body, usually through the nose or mouth.The virus enters the lungs, where it infects pneumocytes or other cells in the alveoli and airways.

Viruses use specialized proteins found on their surface to attach to other proteins on the surface of lung cells. For example, SARS-CoV-2, the virus that causes Covid-19, uses a protein on its surface to attach to the angiotensin-converting enzyme 2 (ACE2) protein on lung cells. After the virus attaches to the cell, it enters the cell, where it uses the cell’s machinery to create new copies of the virus.

Pneumocytes infected with the virus can damage and die. The body responds to this injury by replacing thin Type 1 Pneumocytes with thicker, stronger Type 2 Pneumocytes. Damaged pneumocytes also emit signals that tell specialized immune cells that fight viruses called lymphocytes to travel to the lungs. As with bacterial pneumonia, fluid fills the air spaces, making it difficult for someone with pneumonia to breathe.

Pathologists use the term hyaline membranes to describe thick pink bands of tissue on the inner surface of the alveoli.These hyaline membranes are often found in combination with type 2 pneumocytes and fluid filling the air spaces and alveolar walls. People with pneumonia find it difficult to breathe because the thickened alveolar walls make it difficult for the lungs to exchange oxygen with the blood. Changes associated with viral pneumonia will also appear grayer or whiter on x-rays or CT scans because the alveoli have less air than normal in these areas.

Types of viruses that commonly cause pneumonia include:

• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
• Influenza
• parainfluenza
• measles
• respiratory syncytial virus
• Cytomegalovirus
• adenovirus
• Herpes simplex virus
• Varicella-zoster virus

How do pathologists diagnose pneumonia?

A pathologist can diagnose pneumonia by examining a sample of lung tissue under a microscope.A procedure that removes only a small sample of tissue is called a biopsy. The amount of tissue sent for microscopic examination will depend on the type of biopsy performed.

Common types of biopsies include:

• Transbronchial biopsy : A small sample of tissue is removed using forceps, which are inserted through the bronchial wall into the lung.
• Cryobiopsy : A larger tissue sample is obtained by freezing a small area of ​​the lung with a probe and removing the frozen tissue from the body.
• Endobronchial Biopsy : Several small tissue samples are removed with forceps to obtain tissue from the inside of the airway or airway wall.
• Wedge biopsy : A large piece of lung is removed by the surgeon in the operating room.

Most of the changes associated with pneumonia can be seen when tissue is stained with a combination of dyes called hematoxylin and eosin (OH). However, to determine the type of pneumonia, your pathologist may prescribe specific stains such as Gram stains, GMS and PAS stains.Another type of test called immunohistochemistry can be ordered looking for specific types of viruses. However, the exact cause can only be determined after the tissue sample is sent to the microbiological laboratory, where there are special instruments to detect viruses, bacteria and fungi.

Other useful resources

Centers for Disease Control and Prevention

World Health Organization

Radiopedia – Pneumonia

Katerina Baranova MD and Matthew J.Cecchini, MD, FRCPC (updated 3 Aug 2021)

90,000 Mucus in the throat, causes and treatment of mucus in the throat, why phlegm is constantly accumulating

Accumulation of mucus in the pharynx is an unpleasant but curable condition. The main thing is to accurately determine the cause of this symptom, and eliminate it. That is, a condition in which mucus collects in the pharynx is not an independent diagnosis, but one of the manifestations of the underlying disease. Phlegm in the throat can accumulate not only due to inflammatory processes in the nasopharynx.There are other reasons not related to ENT organs. Which? Read on in our new article.

The accumulation of mucus in the throat is a very unpleasant condition, especially in those cases when it accumulates constantly, and the person does not leave the feeling that something is in the throat.

In medicine, there is even a special term that is used when mucus constantly flows down the throat from the nasal cavity – postnasal syndrome. In fact, this is the same runny nose, but vice versa.

When mucous nasal discharge does not go outside, but inside, it irritates the walls of the pharynx and causes a person to have an irresistible desire to often cough up and swallow phlegm.This state, of course, cannot be called pleasant. To get rid of it, you first need to determine why mucus accumulates in the throat, in which of the body systems there was a failure and to carry out competent treatment of the disease. Unfortunately, you won’t be able to do it yourself. I need the help of a qualified otorhinolaryngologist.

So why does mucus build up in the throat? The causes and treatment of this condition is the topic of our new article.

Why mucus is formed

The production of mucous masses by the nasopharynx is a natural phenomenon.They have a moisturizing and protective function. Mucous masses trap foreign particles, pollen, bacteria that enter with the air and prevent them from going down into the trachea and lungs. As soon as these foreign agents enter the mucous membranes, the amount of secretion produced increases, a person has a desire to clear his nose or cough up. When the stimulus is removed from the body, secretion production returns to its previous level.

Normally, a person does not notice the formation of mucous masses – they are swallowed along with saliva.

The accumulation of mucus in the throat becomes noticeable when it is produced continuously and thickens. The patient directly feels how the mucous masses flow along the back wall of the pharynx and accumulate in it. In the daytime, the accumulation of phlegm is not so disturbing – it is swallowed and does not greatly irritate the cough receptors. But it is worth taking a horizontal position, for example, at night during sleep, the mucous masses cannot freely pass inward and stagnate in the pharynx. This causes violent coughing fits, which can even provoke vomiting.

When a person comes to the otorhinolaryngologist and says: “I constantly swallow mucus in my throat,” the first thing the ENT doctor will find out why mucus is accumulating in the throat.

Only after establishing the true cause of the mucus in the throat, it will be possible to prescribe the correct treatment.

Causes of postnasal syndrome

The causes of persistently accumulating mucus in the pharynx can be infectious and non-infectious in nature. These include:

• Inflammatory diseases of the nasopharynx and larynx (sinusitis, pharyngitis, laryngitis).The increased production of mucous secretions during this period is associated with the body’s attempt to clear the airways from bacteria and viruses, thereby speeding up recovery. The fact that mucus is released abundantly in this case, on the contrary, is a variant of the norm. Such mucous masses do not interfere, but help get rid of pathogens.
• Chronic diseases of the upper respiratory tract. These diseases cause inflammation in the nasopharynx, as a result of which a permanent source of infection is formed here.
• Diseases of the lower respiratory tract (bronchitis, pneumonia, tuberculosis).
• Allergic reactions to external stimuli. Allergies can be accompanied by an abundant accumulation of phlegm, which interferes and you want to constantly swallow it.
• Disorders in the gastrointestinal tract, in which the contents of the stomach are thrown back into the esophagus and further into the pharynx (gastroesophageal reflux disease, gastritis, ulcer).
• Features of the structure of the nasal cavity (deviated nasal septum, enlarged turbinates).
• Adenoids.
• Improper diet – eating too fatty or spicy foods irritates the digestive tract and can provoke increased secretion.
• Bad habits. Smoking and alcohol abuse leads to burns of the pharyngeal mucosa. The body tries to get rid of the harmful effects of harmful substances by intensively producing mucous masses.
• The ingress of foreign objects into the nasal cavity is a common reason for the accumulation of mucous masses in the pharynx in children, since babies during the game can shove beads, small parts of toys, etc. into the nasal passages.p.
• Poor environmental situation in the place of residence – polluted air and dust. In this way, the body tries to get rid of harmful particles trapped in the air.

The sooner the cause of this condition is determined, the sooner an effective throat treatment will be prescribed and carried out.

Symptoms

When the mucous masses are constantly “standing” in the throat, the patient wants to swallow them. Such actions (if the secret is too thick) can cause vomiting and nausea.This condition usually proceeds in parallel with other characteristic signs that patients complain about when they see an ENT doctor:

• tickling in the larynx;
• sensation of a lump in the throat, which cannot be removed;
• Constant desire to cough up, although coughing does not bring relief; coughing fits are especially bad at night;
• discomfort when swallowing food;
• Bad breath caused by pathogens that multiply in the throat;
• enlarged lymph nodes;
• loud snoring.

To understand how to treat a throat, you need to consult an ENT doctor to determine the cause of postnasal syndrome.

How to treat mucus in the throat

The otorhinolaryngologist is engaged in determining the cause of the accumulation of mucous masses. Sometimes you have to additionally contact related specialists: allergist, gastroenterologist, etc. After establishing the cause of the unpleasant condition, the patient will be assigned an effective treatment regimen aimed not only at getting rid of sputum, but also at treating the underlying disease.

After all, the drainage of mucous masses through the nasopharynx is just a symptom that was provoked by the main diagnosis. If the disease is treated with high quality, the problem of accumulating mucus will go away.

The ENT doctor will definitely recommend to the patient to adjust the amount of fluid consumed: it is necessary to drink more warm fluid to thin the mucus (of course, if the patient does not have kidney problems). Also, the patient is prescribed expectorant drugs and drugs to dilute sputum (mucolytics) in order to speed up its discharge.

Further treatment tactics depend on the nature of the underlying disease. If sputum is formed due to an infectious disease, the doctor prescribes antibacterial or antiviral therapy (the drug, its dosage and course of administration are also determined by the otorhinolaryngologist).

If the cause is an allergy, antihistamines are prescribed. Further treatment is carried out by an allergist.

When diagnosing problems with the gastrointestinal tract, it is necessary to undergo treatment with a gastroenterologist.

Local therapy also includes the use of antiseptic sprays (for example, “Miramistin”), taking immunostimulants (“Imudon”, “Lizobakt”). Physiotherapy procedures in the ENT clinic will perfectly complement the main treatment and speed up the healing process.

If the problem of accumulation of mucous masses bothers you, do not delay the treatment and come to the ENT Clinic of Doctor Zaitsev, because this is the profile of our clinic.

To make an appointment for a consultation, please call: +7 (495) 642-45-25 and +7 (926) 384-40-04.

We will be glad to help you!

Always yours, Doctor Zaitsev.

About the author: ENT doctor of the highest category, candidate med. sciences.

90,000 Sputum – causes, diseases, diagnosis, prevention and treatment – Likar24

Sputum is mucus that is produced in the lungs and respiratory tract. It is important to prevent germs from entering the respiratory tract and lungs. Usually it is transparent and thin, completely invisible. However, when an infection occurs, the mucus can thicken and change color.Therefore, depending on the disease, mucus of different colors can form:

Clear sputum: Clear sputum is usually normal, although it may increase in certain lung conditions.

White or gray sputum: White or gray sputum is also normal, but may increase with some lung conditions or precede other color changes associated with other conditions.

Dark yellow / green sputum: A type of white blood cell known as neutrophils is green in color.These types of white blood cells are attracted to the site of bacterial infections, and therefore bacterial infections of the lower respiratory tract, such as pneumonia, can cause green phlegm to develop.

Brown sputum: Brown sputum appears through the presence of tar, sometimes occurs in people who smoke. The phlegm may also be brown or black due to the presence of old blood in the lungs.

Pink sputum: pink, especially frothy pink sputum can arise from pulmonary edema, a condition in which fluid and small amounts of blood drain from the capillaries into the alveoli of the lungs.Pulmonary edema is often a complication of congestive heart failure. Pink or bloody sputum is usually caused by tuberculosis.

Bloody sputum: Coughing up blood is the first sign of lung cancer. Bloody sputum can occur with pulmonary embolism, a condition in which a blood clot in the leg breaks off and travels to the lungs.

Sputum can be of different textures, ranging from watery to thick:

Thin and watery mucus is usually normal and indicates a healthy respiratory tract.During an infection, immune cells, germs and debris build up in the phlegm, making it thicker and more sticky. Foamy phlegm is mucus that contains bubbles. Whitish-gray and frothy mucus can be a sign of chronic obstructive pulmonary disease. Pink and frothy sputum may indicate severe left-sided heart failure.

Green or yellow sputum

This is usually a sign that the body is fighting an infection. The color comes from leukocytes.The change occurs with the severity and duration of the possible illness.

Green or yellow sputum usually caused by:

• Bronchitis: Usually begins with a dry cough and over time, green or yellow phlegm forms with clear or white phlegm.
• Pneumonia: This is usually a complication of another respiratory illness. Symptoms depend on the type of pneumonia. Cough, fever, chills, and shortness of breath are common symptoms in all types of pneumonia.
• Sinusitis: Also known as sinus infection.This virus can cause another virus, allergy, or bacteria.
• Cystic fibrosis: a chronic disease of the lungs where mucus builds up.

Brown sputum

Brown often means old blood. This color is usually called:

• Bacterial pneumonia.
• Bacterial bronchitis: the risk of developing chronic bronchitis increases if you smoke or frequently inhale vapors and other irritants.
• Cystic fibrosis.
• Pneumoconiosis: Inhalation of various dusts such as coal, asbestos and silicosis can cause this incurable lung disease.
• Pulmonary abscess: This is a cavity filled with pus inside the lungs. It is usually surrounded by infected and inflamed tissue.

White sputum

White sputum usually caused by:

• Viral bronchitis;
• GERD: This chronic condition affects the digestive system.
• COPD: This condition causes the airways to narrow and the lungs to excess mucus.
• Congestive heart failure: This occurs when the heart does not pump enough blood to other parts of the body. Fluid builds up in various areas, resulting in swelling. Fluid builds up in the lungs and can lead to increased white phlegm.

Black sputum

Black sputum is also called melanoptism. The appearance of black phlegm may mean that a large amount of something black, like coal dust, has been inhaled.It could also mean that there is a fungal infection. Black sputum usually caused by:

• Smoking: Smoking cigarettes or other drugs may produce phlegm.
• Pneumoconiosis.
• Fungal Infection: A black yeast called Exophiala dermatitidis causes this infection. They are more likely to affect people with cystic fibrosis.

Clear sputum

Clear sputum usually caused by:

• Allergic rhinitis: Also called nasal allergy or sometimes hay fever.
• Viral bronchitis: In some cases, it may be found that the sputum progresses to a yellow or green color.
• Viral pneumonia.

Bloody sputum

Red or pink sputum usually caused by:

• Pneumonia: This lung infection can cause red phlegm as it progresses, and may be accompanied by chills, fever, and chest pain.
• Tuberculosis: The main symptoms are cough for more than three weeks, coughing up blood and red sputum, fever and night sweats.
• Congestive heart failure In addition to pink or red sputum, you may feel short of breath.
• Pulmonary embolism: This condition is life threatening and can also cause shortness of breath and chest pain.
• Lung cancer: This condition causes many respiratory symptoms: coughing up red phlegm or even blood.

Your doctor may do a variety of tests to determine the cause, including x-rays and sputum analysis. Sputum can be analyzed in a laboratory to determine its content and to identify infection or cancer.Tests may include:

Sputum culture: A sputum culture is done by placing a sputum sample in a growing medium (agar dish) and looking for growth. This can be done to identify the specific type of bacteria causing pneumonia.

Tuberculosis Sputum: A sputum sample can be obtained to look for tuberculosis.

Sputum Cytology: In sputum cytology, a sputum sample is examined under a microscope. This can be done to look for signs of tuberculosis or signs of cancer cells.At one time it was believed that sputum cytology can detect lung cancer, but this is not an effective screening tool.

Some conditions that lead to increased sputum:

• chronic bronchitis;
• bronchiectasis;

90,019 pulmonary edema;

• congestive heart failure;
• pulmonary embolism;
• tuberculosis;
• obstructive pulmonary disease;
• allergy;
• cystic fibrosis,
• pneumoconiosis;
• fungal infection.

Sputum production is part of the respiratory system. However, it is a health hazard if it begins to interfere with normal daily life. It is worth contacting your family doctor so that he can establish the correct diagnosis and begin treatment. It is important to realize that doctors cannot diagnose a specific disease based on the color of the sputum. Additional tests are needed.

The following methods of preventing lung diseases can be used:

Smoking cessation

Smoking damages the lungs and increases the risk for several diseases.This is because when materials are burned, harmful substances are released into the lungs (toxins and carcinogens). If you do smoke, it’s never too late to quit. In addition, stay away from extraneous smoke, residual tobacco fumes, adjacent walls and furniture, which together with indoor contaminants form damaging compounds. Clean carpets. Paint the walls with low VOC paints.

Daily hygiene

Wash your hands thoroughly with soap and water several times a day to prevent germs from entering the body.

Protection

To help stop the spread of germs, cover your mouth and nose with a cloth or gauze bandage when you cough or sneeze. Stay out of the crowds during peak cold and flu season, get some rest, eat well, and keep your stress levels in check.

House cleaning

Air fresheners, mold, pet dander and building materials are potential problems. Turn on the fan when cooking and avoid using aerosol products such as hair spray.Change your air filter. Poor ventilation, closed work areas and increased heat are also culprits. Avoid breathing toxic fumes from chemicals, solvents and paints. Wear protective masks when handling chemicals and report hazardous working conditions.

Regular examination

Consult a doctor if there is shortness of breath, pain when breathing, dizziness, persistent cough, wheezing, cough during exertion, pain in the respiratory tract.Do fluorography regularly (maximum once a year).

Physical activity

Exercise 30 minutes of sports or physical activity daily to relieve lung strain and improve oxygen transport and metabolic efficiency. People with lung conditions such as asthma and COPD need to pay special attention to air pollution levels.

Concept of asthma

Asthma is a long-term (chronic) lung disease.It affects the airways (bronchi). This happens when a trigger firing causes swelling and narrowing of the airways. The muscles around your airways begin to tighten. When your airways begin to narrow, air cannot enter and exit your lungs properly. Mucus also builds up in the airways. This makes it even more difficult for air to enter the lungs.

Experts are not entirely sure what causes asthma. It can be caused by a combination of hereditary and environmental factors.People with asthma may not have symptoms until they are exposed to an allergen or trigger.

Healthy lungs

The lungs contain an extensive system of airways made of elastic tissue. Each breathing tube is surrounded by muscle bands. The airways get smaller as they go deeper into the lungs. Their smallest sections end in the accumulation of tiny, spherical alveolar sacs (alveoli). Accumulations of alveolar sacs are surrounded by blood vessels.When you breathe (inhale), air enters the lungs. It travels through the airways until it reaches the alveolar sacs. When you exhale, air passes through the airways and out of the lungs. Mucus is produced in the airways, which traps particles that enter the lungs when inhaled. Usually mucus is secreted from the lungs by tiny hairs (cilia) that line the airways. After that, the mucus is swallowed or coughed up.

Lung function

The air you breathe contains oxygen.When air reaches the alveolar sacs, oxygen is transferred to the blood vessels surrounding the sacs. The blood then carries oxygen to all cells in the body. When you exhale, carbon dioxide is removed in a similar manner from the blood in the air sacs and leaves your body.

If you have asthma

The airways in asthma become more sensitive than usual. This means that they react to the influence of certain triggers (provoking factors).Triggers can include pollen, dust, or smoke. Triggers cause inflammation. It makes the airways swell and narrow. This is a long-term (chronic) problem. Your airways are not always narrowed enough for you to notice breathing problems.

Chronic inflammation symptoms include:

• cough (chronic),

• chest tightness,

• shortness of breath,

• wheezing (wheezing sound, especially when you exhale),

• Lack of energy or feeling tired.

In some people, over time, chronic mild inflammation can lead to long-term (permanent) scarring of the airways and loss of lung function.

Asthma attacks

When the sensitive airways are irritated by the trigger, the muscles around the airways tense. The mucous membrane of the airways also swells. The thick, sticky mucus becomes larger and partially clogs the airways. All this makes breathing difficult.

Symptoms of seizures may include:

• Cough, especially at night. You may not sleep due to coughing.

• Rapid fatigue or shortness of breath.

• Wheezing.

• Feeling of tightness in the chest.

• Frequent breathing at rest.

Seizures can be life-threatening if left untreated. With a strong attack, muscles tighten, swelling and mucus production increases.It is very difficult to breathe. Your body cannot get enough oxygen and cannot remove carbon dioxide. The exhaust gas is captured by the alveoli. Gas exchange does not occur. The body does not receive enough oxygen. In the absence of oxygen, damage to body tissues begins, primarily brain tissue. Prolonged lack of oxygen can lead to brain damage or death.

Call 911 (or have someone call for you) if you have any of the following symptoms and do not go away after taking the rapid symptom relief medication:

• Difficulty breathing,

• a feeling of shortness of breath that interferes with speaking or walking,

• lips or fingers turn blue,

• a feeling of dizziness, as if you are about to pass out,

• peak flow less than 50% of your reading if you are using a meter flow.

How to keep asthma under control

Asthma is a long-term illness. Therefore, in order to control it, it is important to work with your healthcare provider. If you have asthma, you can prevent attacks. Write an asthma action plan with your healthcare provider. It can help control asthma and symptoms. An asthma action plan will also tell your family or friends what to do if an asthma attack or worsening condition occurs.

Take your medicines as directed.Also learn about your asthma triggers. By knowing what triggers your asthma attack in the first place, you can prevent future breathing problems.

If you smoke, quit.

90,000 What they are treating us with: ACC. Fights phlegm and paracetamol

Another review compares the effects of two drugs, acetylcysteine ​​and carbocysteine, against acute respiratory tract infections in children. The authors reviewed 34 scientific papers devoted to the safety of drugs, and six scientific papers, where the effectiveness of the drug was investigated.Overall, acetylcysteine ​​appears to be safe for children over two years of age. The effectiveness of the drugs was limited – by the seventh day of treatment, the cough was clearly reduced, but it was not entirely clear what role natural recovery plays in this. Not the most convincing were the data on the use of acetylcysteine ​​in bronchiectasis (expansion of the area of ​​the bronchi when they are damaged).

However, there are many clinical trials proving the benefits of acetylcysteine ​​in chronic bronchitis (but not bronchitis with complications).But inhalation with acetylcysteine ​​for bronchitis did not help. In pulmonary obstruction, acetylcysteine ​​promotes sputum separation and prevents further complications, as shown in numerous systematic reviews of randomized, double-blind comparative trials.

Indicator.Ru recommends: use in the complex treatment of respiratory diseases

The effectiveness of acetylcysteine ​​- the active substance of the ACC drug – against dry cough has been confirmed by evidence-based medicine.Also, acetylcysteine ​​is included in the list of essential drugs from the point of view of the World Health Organization as a specific antidote (antidote), which is used in case of an overdose of paracetamol. At the same time, the ACC will most likely not help from cystic fibrosis, although it was included in the federal recommendations for combating the symptoms of this disease. This is also the case with lung injuries.

It should be understood that despite its effectiveness against cough, ACC by itself is far from always enough to cope with the infection – the cause of the disease.Therefore, in the case of pneumonia, for example, you will need antibiotics, and to combat other symptoms – pain, weakness, fever – antipyretic and pain relievers can be useful. If you also have a stuffy nose, you may need medication for the common cold.

It is possible to choose the right combination of drugs and decide whether an antibiotic is needed only by making the correct diagnosis. Sometimes a laboratory test is needed for this (for example, to find some specific bacteria), so it is better to visit a doctor.