When you breathe, your lungs take in oxygen from the air and deliver it to the bloodstream. The cells in your body need oxygen to work and grow. During a normal day, you breathe nearly 25,000 times. People with lung disease have difficulty breathing. Millions of people in the U.S. have lung disease. If all types of lung disease are lumped together, it is the number three killer in the United States.

The term lung disease refers to many disorders affecting the lungs, such as asthma, COPD, infections like influenza, pneumonia and tuberculosis, lung cancer, and many other breathing problems. Some lung diseases can lead to respiratory failure.

What is asthma?

Asthma is a chronic (long-term) lung disease. It affects your airways, the tubes that carry air in and out of your lungs. When you have asthma, your airways can become inflamed and narrowed. This can cause wheezing, coughing, and tightness in your chest. When these symptoms get worse than usual, it is called an asthma attack or flare-up.

What causes asthma?

The exact cause of asthma is unknown. Genetics and your environment likely play a role in who gets asthma.

An asthma attack can happen when you are exposed to an asthma trigger. An asthma trigger is something that can set off or worsen your asthma symptoms. Different triggers can cause different types of asthma:

• Allergic asthma is caused by allergens. Allergens are substances that cause an allergic reaction. They can include
  • Dust mites
  • Mold
  • Pets
  • Pollen from grass, trees, and weeds
  • Waste from pests such as cockroaches and mice
• Nonallergic asthma is caused by triggers that are not allergens, such as
  • Breathing in cold air
  • Certain medicines
  • Household chemicals
  • Infections such as colds and the flu
  • Outdoor air pollution
  • Tobacco smoke
• Occupational asthma is caused by breathing in chemicals or industrial dusts at work
• Exercise-induced asthma happens during physical exercise, especially when the air is dry

Asthma triggers may be different for each person and can change over time.

Who is at risk for asthma?

Asthma affects people of all ages, but it often starts during childhood. Certain factors can raise your risk of having asthma:

• Being exposed to secondhand smoke when your mother is pregnant with you or when you are a small child
• Being exposed to certain substances at work, such as chemical irritants or industrial dusts
• Genetics and family history. You are more likely to have asthma if one of your parents has it, especially if it's your mother.
• Race or ethnicity. Black and African Americans and Puerto Ricans are at higher risk of asthma than people of other races or ethnicities.
• Having other medical conditions such as allergies and obesity
• Often having viral respiratory infections as a young child
• Sex. In children, asthma is more common in boys. In teens and adults, it is more common in women.

What are the symptoms of asthma?

The symptoms of asthma include

• Chest tightness
• Coughing, especially at night or early morning
• Shortness of breath
• Wheezing, which causes a whistling sound when you breathe out

These symptoms can range from mild to severe. You may have them every day or only once in a while.

When you are having an asthma attack, your symptoms get much worse. The attacks may come on gradually or suddenly. Sometimes they can be life-threatening. They are more common in people who have severe asthma. If you are having asthma attacks, you may need a change in your treatment.

How is asthma diagnosed?

Your health care provider may use many tools to diagnose asthma:

• Physical exam
• Medical history
• Lung function tests, including spirometry, to test how well your lungs work
• Tests to measure how your airways react to specific exposures. During this test, you inhale different concentrations of allergens or medicines that may tighten the muscles in your airways. Spirometry is done before and after the test.
• Peak expiratory flow (PEF) tests to measure how fast you can blow air out using maximum effort
• Fractional exhaled nitric oxide (FeNO) tests to measure levels of nitric oxide in your breath when you breathe out. High levels of nitric oxide may mean that your lungs are inflamed.
• Allergy skin or blood tests, if you have a history of allergies. These tests check which allergens cause a reaction from your immune system.

What are the treatments for asthma?

If you have asthma, you will work with your health care provider to create a treatment plan. The plan will include ways to manage your asthma symptoms and prevent asthma attacks. It will include

• Strategies to avoid triggers. For example, if tobacco smoke is a trigger for you, you should not smoke or allow other people to smoke in your home or car.
• Short-term relief medicines, also called quick-relief medicines. They help prevent symptoms or relieve symptoms during an asthma attack. They include an inhaler to carry with you all the time. It may also include other types of medicines which work quickly to help open your airways.
• Control medicines. You take them every day to help prevent symptoms. They work by reducing airway inflammation and preventing narrowing of the airways.

If you have a severe attack and the short-term relief medicines do not work, you will need emergency care.

Your provider may adjust your treatment until asthma symptoms are controlled.

Sometimes asthma is severe and cannot be controlled with other treatments. If you are an adult with uncontrolled asthma, in some cases your provider might suggest bronchial thermoplasty. This is a procedure that uses heat to shrink the smooth muscle in the lungs. Shrinking the muscle reduces your airway's ability to tighten and allows you to breathe more easily. The procedure has some risks, so it's important to discuss them with your provider.

When you're short of breath, it's hard or uncomfortable for you to take in the oxygen your body needs. You may feel as if you're not getting enough air. Sometimes you can have mild breathing problems because of a stuffy nose or intense exercise. But shortness of breath can also be a sign of a serious disease.

Many conditions can make you feel short of breath:

• Lung conditions such as asthma, emphysema, or pneumonia
• Problems with your trachea or bronchi, which are part of your airway system
• Heart disease can make you feel breathless if your heart cannot pump enough blood to supply oxygen to your body
• Anxiety and panic attacks
• Allergies

If you often have trouble breathing, it is important to find out the cause.

When you breathe in, the air travels down through your trachea (windpipe). It then goes through two tubes to your lungs. These tubes are your bronchi. Bronchial disorders can make it hard for you to breathe.

The most common problem with the bronchi is bronchitis, an inflammation of the tubes. It can be acute or chronic. Other problems include:

• Bronchiectasis - a condition in which damage to the airways causes them to widen and become flabby and scarred
• Exercise-induced bronchospasm - a breathing problem that happens when your airways shrink while you are exercising
• Bronchiolitis - an inflammation of the small airways that branch off from the bronchi
• Bronchopulmonary dysplasia - a chronic lung condition in infants, most often premature infants

What is COPD?

Chronic obstructive pulmonary disease, or COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems. It includes emphysema and chronic bronchitis.

What are the symptoms of COPD?

Symptoms of COPD include:

• Frequent coughing or wheezing.
• Excess phlegm, mucus, or sputum production.
• Shortness of breath.
• Trouble taking a deep breath.

Who has COPD?

Chronic lower respiratory disease, primarily COPD, was the third leading cause of death in the United States in 2014. Almost 15.7 million Americans (6.4%) reported that they have been diagnosed with COPD. More than 50% of adults with low pulmonary function were not aware that they had COPD, so the actual number may be higher. The following groups were more likely to report COPD in 2013.

• Women.
• People aged 65 to 74 years and ≥75 years.
• American Indians/Alaska Natives and multiracial non-Hispanics.
• People who were unemployed, retired, or unable to work.
• People with less than a high school education.
• People who were divorced, widowed, or separated.
• Current or former smokers.
• People with a history of asthma.

What causes COPD?

In the United States, tobacco smoke is a key factor in the development and progression of COPD. Exposure to air pollutants in the home and workplace, genetic factors, and respiratory infections also play a role. In the developing world, indoor air quality is thought to play a larger role than it does in the United States. People should try to avoid inhaling tobacco smoke, home and workplace air pollutants, and respiratory infections to prevent developing COPD. Early detection of COPD may change its course and progress.

What are the complications or effects of COPD?

Compared to adults without COPD, those with this disease are more likely to:

• Have activity limitations like difficulty walking or climbing stairs.
• Be unable to work.
• Need special equipment like portable oxygen tanks.
• Not engage in social activities like eating out, going to places of worship, going to group events, or getting together with friends or neighbors.
• Have increased confusion or memory loss.
• Have more emergency room visits or overnight hospital stays.
• Have other chronic diseases like arthritis, congestive heart failure, diabetes, coronary heart disease, stroke, or asthma.
• Have depression or other mental or emotional conditions.
• Report a fair or poor health status.

How is COPD diagnosed?

A simple test, called spirometry, can be used to measure pulmonary—or lung—function and detect COPD in anyone with breathing problems.

How is COPD treated?

Treatment of COPD requires a careful and thorough evaluation by a physician. COPD treatment can alleviate symptoms, decrease the frequency and severity of exacerbations, and increase exercise tolerance. Treatment options that your physician may consider include:

• Quit smoking. For people who smoke, the most important part of treatment is smoking cessation.
• Avoid tobacco smoke and other air pollutants at home and at work.
• Ask your doctor about pulmonary rehabilitation, which is a personalized treatment program that teaches COPD management strategies to improve quality of life. Programs may include plans that teach people how to breathe better and conserve their energy, as well as provide advice on food and exercise.
• Take medication. Symptoms such as coughing or wheezing can be treated with medication.
• Avoid lung infections. Lung infections can cause serious problems in people with COPD. Certain vaccines, such as flu and pneumococcal vaccines, are especially important for people with COPD. Respiratory infections should be treated with antibiotics, if appropriate.
• Use supplemental oxygen. Some people may need to use a portable oxygen tank if their blood oxygen levels are low.

A collapsed lung happens when air enters the pleural space, the area between the lung and the chest wall. If it is a total collapse, it is called pneumothorax. If only part of the lung is affected, it is called atelectasis.

Causes of a collapsed lung include

• Lung diseases such as pneumonia or lung cancer
• Being on a breathing machine
• Surgery on the chest or abdomen
• A blocked airway

If only a small area of the lung is affected, you may not have symptoms. If a large area is affected, you may feel short of breath and have a rapid heart rate.

A chest x-ray can tell if you have it. Treatment depends on the underlying cause.

Interstitial lung disease is the name for a large group of diseases that inflame or scar the lungs. The inflammation and scarring make it hard to get enough oxygen. The scarring is called pulmonary fibrosis.

Breathing in dust or other particles in the air is responsible for some types of interstitial lung diseases. Specific types include

• Black lung disease among coal miners, from inhaling coal dust
• Farmer's lung, from inhaling farm dust
• Asbestosis, from inhaling asbestos fibers
• Siderosis, from inhaling iron from mines or welding fumes
• Silicosis, from inhaling silica dust

Other causes include autoimmune diseases or occupational exposures to molds, gases, or fumes. Some types of interstitial lung disease have no known cause.

Treatment depends on the type of exposure and the stage of the disease. It may involve medicines, oxygen therapy, or a lung transplant in severe cases.

What is lung cancer?

Lung cancer is cancer that forms in tissues of the lung, usually in the cells that line the air passages. It is the leading cause of cancer death in both men and women.

There are two main types: small cell lung cancer and non-small cell lung cancer. These two types grow differently and are treated differently. Non-small cell lung cancer is the more common type.

Who is at risk for lung cancer?

Lung cancer can affect anyone, but there are certain factors that raise your risk of getting it:

• Smoking. This is the most important risk factor for lung cancer. Tobacco smoking causes about 9 out of 10 cases of lung cancer in men and about 8 out of 10 cases of lung cancer in women. The earlier in life you start smoking, the longer you smoke, and the more cigarettes you smoke per day, the greater your risk of lung cancer. The risk is also greater if you smoke a lot and drink alcohol every day or take beta carotene supplements. If you have quit smoking, your risk will be lower than if you had kept smoking. But you will still have a higher risk than people who never smoked.
• Secondhand smoke, which is the combination of smoke that comes from a cigarette and smoke breathed out by a smoker. When you inhale it, you are exposed to the same cancer-causing agents as smokers, although in smaller amounts.
• Family history of lung cancer
• Being exposed to asbestos, arsenic, chromium, beryllium, nickel, soot, or tar in the workplace
• Being exposed to radiation, such as from
  • Radiation therapy to the breast or chest
  • Radon in the home or workplace
  • Certain imaging tests such as CT scans
• HIV infection
• Air pollution

What are the symptoms of lung cancer?

Sometimes lung cancer does not cause any signs or symptoms. It may be found during a chest x-ray done for another condition.

If you do have symptoms, they may include

• Chest pain or discomfort
• A cough that doesn't go away or gets worse over time
• Trouble breathing
• Wheezing
• Blood in sputum (mucus coughed up from the lungs)
• Hoarseness
• Loss of appetite
• Weight loss for no known reason
• Fatigue
• Trouble swallowing
• Swelling in the face and/or veins in the neck

How is lung cancer diagnosed?

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A family history
• A physical exam
• Imaging tests, such as a chest x-ray or chest CT scan
• Lab tests, including tests of your blood and sputum
• A biopsy of the lung

If you do have lung cancer, your provider will do other tests to find out how far it has spread through the lungs, lymph nodes, and the rest of the body. This is called staging. Knowing the type and stage of lung cancer you have helps your provider decide what kind of treatment you need.

What are the treatments for lung cancer?

For most patients with lung cancer, current treatments do not cure the cancer.

Your treatment will depend on which type of lung cancer you have, how far it has spread, your overall health, and other factors. You may get more than one type of treatment.

The treatments for small cell lung cancer include

• Surgery
• Chemotherapy
• Radiation therapy
• Immunotherapy
• Laser therapy, which uses a laser beam to kill cancer cells
• Endoscopic stent placement. An endoscope is a thin, tube-like instrument used to look at tissues inside the body. It may be used to put in a device called a stent. The stent helps to open an airway that has been blocked by abnormal tissue.

The treatments for non-small cell lung cancer include

• Surgery
• Radiation therapy
• Chemotherapy
• Targeted therapy, which uses drugs or other substances that attack specific cancer cells with less harm to normal cells
• Immunotherapy
• Laser therapy
• Photodynamic therapy (PDT), which uses a medicine and a certain type of laser light to kill cancer cells
• Cryosurgery, which uses an instrument to freeze and destroy abnormal tissue
• Electrocautery, a treatment that uses a probe or needle heated by an electric current to destroy abnormal tissue

Can lung cancer be prevented?

Avoiding the risk factors may help to prevent lung cancer:

• Quitting smoking. If you don't smoke, don't start.
• Lower your exposure to hazardous substances at work
• Lower your exposure to radon. Radon tests can show whether your home has high levels of radon. You can buy a test kit yourself or hire a professional to do the test.

Your pleura is a large, thin sheet of tissue that wraps around the outside of your lungs and lines the inside of your chest cavity. Between the layers of the pleura is a very thin space. Normally it's filled with a small amount of fluid. The fluid helps the two layers of the pleura glide smoothly past each other as your lungs breathe air in and out.

Disorders of the pleura include

• Pleurisy - inflammation of the pleura that causes sharp pain with breathing
• Pleural effusion - excess fluid in the pleural space
• Pneumothorax - buildup of air or gas in the pleural space
• Hemothorax - buildup of blood in the pleural space

Many different conditions can cause pleural problems. Viral infection is the most common cause of pleurisy. The most common cause of pleural effusion is congestive heart failure. Lung diseases, like COPD, tuberculosis, and acute lung injury, cause pneumothorax. Injury to the chest is the most common cause of hemothorax. Treatment focuses on removing fluid, air, or blood from the pleural space, relieving symptoms, and treating the underlying condition.

What is a pulmonary embolism (PE)?

A pulmonary embolism (PE) is a sudden blockage in a lung artery. It usually happens when a blood clot breaks loose and travels through the bloodstream to the lungs. PE is a serious condition that can cause:

• Permanent damage to the lungs
• Low oxygen levels in your blood
• Damage to other organs in your body from not getting enough oxygen

PE can be life-threatening, especially if a clot is large, or if there are many clots.

What causes a pulmonary embolism (PE)?

The cause is usually a blood clot in the leg called a deep vein thrombosis that breaks loose and travels through the bloodstream to the lungs.

Who is at risk for a pulmonary embolism (PE)?

Anyone can get a pulmonary embolism (PE), but certain things can raise your risk of PE:

• Having surgery, especially joint replacement surgery
• Certain medical conditions, including
  • Cancers
  • Heart diseases
  • Lung diseases
  • A broken hip or leg bone or other trauma
• Hormone-based medicines, such as birth control pills or hormone replacement therapy
• Pregnancy and childbirth. The risk is highest for about six weeks after childbirth.
• Not moving for long periods, such as being on bed rest, having a cast, or taking a long plane flight
• Age. Your risk increases as you get older, especially after age 40.
• Family history and genetics. Certain genetic changes that can increase your risk of blood clots and PE.
• Obesity

What are the symptoms of a pulmonary embolism (PE)?

Half the people who have pulmonary embolism have no symptoms. If you do have symptoms, they can include shortness of breath, chest pain or coughing up blood. Symptoms of a blood clot include warmth, swelling, pain, tenderness and redness of the leg.

How is a pulmonary embolism (PE) diagnosed?

It can be difficult to diagnose PE. To make a diagnosis, your health care provider will:

• Take your medical history, including asking about your symptoms and risk factors for PE
• Do a physical exam
• Run some tests, including various imaging tests and possibly some blood tests

What are the treatments for a pulmonary embolism (PE)?

If you have PE, you need medical treatment right away. The goal of treatment is to break up clots and help keep other clots from forming. Treatment options include medicines and procedures.

Medicines:

• Anticoagulants, or blood thinners, keep blood clots from getting larger and stop new clots from forming. You might get them as an injection, a pill, or through an I.V. (intravenous). They can cause bleeding, especially if you are taking other medicines that also thin your blood, such as aspirin.
• Thrombolytics are medicines to dissolve blood clots. You may get them if you have large clots that cause severe symptoms or other serious complications. Thrombolytics can cause sudden bleeding, so they are used if your PE is serious and may be life-threatening.

Procedures:

• Catheter-assisted thrombus removal uses a flexible tube to reach a blood clot in your lung. Your health care provider can insert a tool in the tube to break up the clot or to deliver medicine through the tube. Usually you will get medicine to put you to sleep for this procedure.
• A vena cava filter may be used in some people who cannot take blood thinners. Your health care provider inserts a filter inside a large vein called the vena cava. The filter catches blood clots before they travel to the lungs, which prevents pulmonary embolism. But the filter does not stop new blood clots from forming.

Can pulmonary embolism (PE) be prevented?

Preventing new blood clots can prevent PE. Prevention may include:

• Continuing to take blood thinners. It's also important to get regular checkups with your provider, to make sure that the dosage of your medicines is working to prevent blood clots but not causing bleeding.
• Heart-healthy lifestyle changes, such as heart-healthy eating, exercise, and, if you smoke, quitting smoking
• Using compression stockings to prevent deep vein thrombosis (DVT)
• Moving your legs when sitting for long periods of time (such as on long trips)
• Moving around as soon as possible after surgery or being confined to a bed

Pulmonary fibrosis is a condition in which the tissue deep in your lungs becomes scarred over time. This tissue gets thick and stiff. That makes it hard for you to catch your breath, and your blood may not get enough oxygen.

Causes of pulmonary fibrosis include environmental pollutants, some medicines, some connective tissue diseases, and interstitial lung disease. Interstitial lung disease is the name for a large group of diseases that inflame or scar the lungs. In most cases, the cause cannot be found. This is called idiopathic pulmonary fibrosis.

Symptoms include

• Shortness of breath
• A dry, hacking cough that doesn't get better
• Fatigue
• Weight loss for no known reason
• Aching muscles and joints
• Clubbing, which is the widening and rounding of the tips of the fingers or toes

Your doctor may use your medical history, imaging tests, a biopsy, and lung function tests to diagnose pulmonary fibrosis. There is no cure. Treatments can help with symptoms and improve your quality of life. They include medicines, oxygen therapy, pulmonary rehabilitation, or a lung transplant.

Idiopathic pulmonary fibrosis (IPF) is a serious chronic (long term) disease that affects the tissue surrounding the air sacs, or alveoli, in your lungs. This condition develops when that lung tissue becomes thick and stiff for unknown reasons. Over time, these changes can cause permanent scarring in the lungs, called fibrosis, that makes it progressively more difficult to breathe.

Your risk for IPF is higher if you smoke or have a family history of IPF, and the risk increases with age. The most common symptoms of IPF are shortness of breath and cough. Some people may not have symptoms at first, but symptoms can develop and get worse as the disease progresses.

The way that IPF progresses varies from person to person, and scarring may happen slowly or quickly. In some people, the disease stays the same for years. In other people, the condition quickly gets worse. Many people with IPF also experience what are known as acute exacerbations, where symptoms suddenly become much more serious. Other complications of IPF include pulmonary hypertension and respiratory failure, which happen when the lungs cannot deliver enough oxygen into the bloodstream without support. This prevents the brain and other organs from getting the oxygen they need.

There is currently no cure for IPF. However, certain treatments may slow the progression of IPF and help your lungs work better. This may extend the lifespan and improve the quality of life of people who have the disease.

Idiopathic pulmonary fibrosis has an estimated prevalence of 13 to 20 per 100,000 people worldwide. About 100,000 people are affected in the United States, and 30,000 to 40,000 new cases are diagnosed each year.

Familial pulmonary fibrosis is less common than the sporadic form of the disease. Only a small percentage of cases of idiopathic pulmonary fibrosis appear to run in families.

What You Need to Know

In 2016, approximately 730,000 people worked as dental personnel (i.e., dental assistants, dental technicians, dental hygienists, and dentists). This is according to the United States Department of Labor, Bureau of Labor Statistics.

A study was conducted of 10 dentists and one dental technician treated for idiopathic pulmonary fibrosis (IPF) at a Virginia specialty clinic during 2000–2017. IPF is an ongoing, worsening lung disease of unknown cause and associated with a poor outcome. This is the first known cluster of IPF involving dental personnel. None of the employees worked in the same dental clinic. The number of dentists treated for IPF was 29 times higher than the number of dentists expected to be treated.

No clear cause for IPF was identified. It is possible work-related exposures in dental clinics or dental laboratories contributed. Dental personnel can be exposed to a variety of breathing hazards, including:

• Bacteria
• Viruses
• Chemicals
• Dust
• Radiation
• Other hazards

The cluster of IPF cases reinforces the need to better understand breathing exposures that occur while working in dental clinics and laboratories and the use of appropriate personal protective equipment.

Symptoms, Diagnosis, Treatment, and Prognosis

• Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive lung disease without a known cause. Typical symptoms include difficulty breathing that slowly worsens and dry cough.
• A careful health history and physical exam are required before diagnosing IPF. Additional tests are necessary to make the diagnosis. These tests might include:
  • Lung function tests (e.g., spirometry)
  • Chest x-ray
  • CT scan of the chest
  • Surgical lung biopsy
  • Additional diagnostic tests to exclude other lung diseases
• Limited treatment options are available for IPF. Supportive treatment options include oxygen and pulmonary rehabilitation. Two drugs, nintedanib and pirfenidone, have recently been approved for the treatment of IPF. Patients with worsening lung health can be treated with lung transplantation.
• Unfortunately, the prognosis for those diagnosed with IPF is poor. The average survival time from diagnosis is only 3 to 5 years. However, the rate of disease progression cannot be predicted for individual patients.

Dental personnel who have persistent or worsening cough or shortness of breath should see their doctor.

Epidemiology and Risk Factors

• Idiopathic pulmonary fibrosis (IPF) is most often diagnosed in people aged 50-60 years. More men than women are diagnosed with IPF. The number of cases increase with age. IPF is rarely seen in people aged less than 50 years.
• In the United States, an estimated 10 to 60 people per 100,000 are living with IPF. The number of people over 65 years living with IPF is much greater. One study estimated that 494 people over the age of 65 years per 100,000 are living with IPF.
• Risk factors
  • Cigarette smoking
  • Environmental exposures (e.g., metal dusts, wood dust, farming, raising birds)
  • Working in certain industries (e.g., production of wood buildings and mobile home, metal mining)
  • Gastroesophageal reflux disease (GERD)
  • Genetic factors

Pulmonary hypertension (PH) is high blood pressure in the arteries to your lungs. It is a serious condition. If you have it, the blood vessels that carry blood from your heart to your lungs become hard and narrow. Your heart has to work harder to pump the blood through. Over time, your heart weakens and cannot do its job and you can develop heart failure.

Symptoms of PH include

• Shortness of breath during routine activity, such as climbing two flights of stairs
• Tiredness
• Chest pain
• A racing heartbeat
• Pain on the upper right side of the abdomen
• Decreased appetite

As PH worsens, you may find it hard to do any physical activities.

There are two main kinds of PH. One runs in families or appears for no known reason. The other kind is related to another condition, usually heart or lung disease.

There is no cure for PH. Treatments can control symptoms. They involve treating the heart or lung disease, medicines, oxygen, and sometimes lung transplantation.

Pulmonary hypertension is a condition that affects the blood vessels in the lungs. It develops when the blood pressure in your lungs is higher than normal. About 1% of people globally have pulmonary hypertension.

Pulmonary hypertension makes the heart work harder than normal to pump blood into the lungs. This can damage the heart and cause symptoms such as shortness of breath, chest pain, and lightheadedness.

Pulmonary hypertension can develop on its own or be caused by another disease or condition. There are five different groups of pulmonary hypertension:

• Group 1: Pulmonary arterial hypertension (PAH)
• Group 2: Pulmonary hypertension due to left-sided heart disease
• Group 3: Pulmonary hypertension due to lung disease and/or hypoxia
• Group 4: Pulmonary hypertension due to pulmonary artery obstructions, including chronic thromboembolic pulmonary hypertension (CTEPH)
• Group 5: Pulmonary hypertension with unknown and/or multiple causes

Over 50% of pulmonary arterial hypertension cases worldwide have no known cause. In the United States, the most common type of pulmonary hypertension is caused by left-sided heart disease, such as left heart failure. Several other medical conditions and environmental factors can raise your likelihood of developing pulmonary hypertension. Your healthcare provider will consider your symptoms and health history before conducting tests to diagnose pulmonary hypertension.

Treatments for pulmonary hypertension will depend on the cause of the condition. Many times, there is no cure for pulmonary hypertension, but your provider can work with you to manage the symptoms. This may include medicine or healthy lifestyle changes.

To understand pulmonary hypertension, it is helpful to understand the job of the heart and lungs, and the flow of blood.

As your heart beats, it sends blood throughout the body. The tissues of the body need oxygen from the blood to function properly. After the tissues use oxygen from the blood, they send oxygen-poor blood to the right side of the heart. Then, the heart pumps oxygen-poor blood through the pulmonary arteries to the lungs so the lungs can add oxygen to the blood. The force (pressure) of the blood against the walls of the pulmonary arteries is called the pulmonary pressure.

When this pressure gets too high, the pulmonary arteries become narrow or blocked. This makes the blood not flow as well, so the heart has to work harder to maintain blood flow into the lungs. Over time, this can cause damage to the heart and lungs.

What is pulmonary hypertension?

Pulmonary hypertension happens when the pressure in the blood vessels leading from the heart to the lungs is too high.

With pulmonary hypertension, the blood vessels to the lungs develop an increased amount of muscle in the wall of the blood vessels. The heart pumps blood from the right ventricle to the lungs to get oxygen. Because the blood does not have to travel very far, the pressure in this side of the heart and in the artery taking blood from the right ventricle to the lungs is normally low—usually much lower than systolic or diastolic blood pressure.

When the pressure in this artery gets too high, the arteries in the lungs can narrow and then the blood does not flow as well as it should, resulting in less oxygen in the blood.

What causes pulmonary hypertension?

Some common underlying causes of pulmonary hypertension include high blood pressure in the lungs’ arteries due to some types of congenital heart disease, connective tissue disease, coronary artery disease, high blood pressure, liver disease (cirrhosis), blood clots to the lungs, and chronic lung diseases like emphysema. Genetics also play a role.

Pulmonary hypertension can happen in association with many other diseases, such as lung disease and heart disease. Heart failure is common in pulmonary hypertension.

What are the risk factors for pulmonary hypertension?

• Pulmonary hypertension happens at all ages, including children, and its incidence increases with age.
• Pulmonary hypertension is more common among women, non-Hispanic black people, and people age 75 or older.

What are the signs and symptoms of pulmonary hypertension?

The symptoms of pulmonary hypertension during the initial stage of the disease are common to many other medical conditions (e.g., difficulty breathing, fatigue). This often results in a delayed diagnosis until more severe symptoms arise, such as dizziness, chest pain, ankle swelling, or feeling the heart race or pound (palpitations).

How is pulmonary hypertension treated?

There is no cure for pulmonary hypertension. However, there are many different types of treatments, including

• Inhaled medicine
• Medicine given through the veins under the skin
• Medicine to reduce swelling in the feet (diuretics)
• Oxygen therapy

How can I prevent pulmonary hypertension?

While not all pulmonary hypertension can be prevented, you can take steps to prevent it by making healthy lifestyle changes and managing high blood pressure, coronary heart disease, chronic liver disease, and chronic lung disease from tobacco use.

What is respiratory syncytial virus (RSV)?

Respiratory syncytial virus, or RSV, is a common respiratory virus. It usually causes mild, cold-like symptoms. But it can cause serious lung infections, especially in infants, older adults, and people with serious medical problems.

How is respiratory syncytial virus (RSV) spread?

RSV spreads from person to person through:

• The air by coughing and sneezing
• Direct contact, such as kissing the face of a child who has RSV
• Touching an object or surface with the virus on it, then touching your mouth, nose, or eyes before washing your hands

People who have an RSV infection are usually contagious for 3 to 8 days. But sometimes infants and people with weakened immune systems can continue to spread the virus for as long as 4 weeks.

Who is at risk for respiratory syncytial virus (RSV) infections?

RSV can affect people of all ages. But it is very common in small children; nearly all children become infected with RSV by age 2. In the United States, RSV infections usually occur during RSV season, which is usually fall through spring.

Certain people are at higher risk of having a severe RSV infection:

• Infants
• Older adults, especially those ages 65 and older
• People with chronic medical conditions such as heart or lung disease
• People with weakened immune systems

What are the symptoms of respiratory syncytial virus (RSV) infections?

The symptoms of RSV infection usually start about 4 to 6 days after infection. They include:

• Runny nose
• Decrease in appetite
• Cough
• Sneezing
• Fever
• Wheezing

These symptoms usually appear in stages instead of all at once. In very young infants, the only symptoms may be irritability, decreased activity, and trouble breathing.

RSV can also cause more severe infections, especially in people at high risk. These infections include bronchiolitis, an inflammation of the small airways in the lung, and pneumonia, an infection of the lungs.

How are respiratory syncytial virus (RSV) infections diagnosed?

Your health care provider may use many tools to make a diagnosis:

• A medical history, including asking about symptoms.
• A physical exam.
• A lab test of nasal fluid or another respiratory specimen to check for RSV. This is usually done for people with severe infection.
• Tests to check for complications in people with severe infection. The tests may include a chest x-ray and blood and urine tests.

What are the treatments for respiratory syncytial virus (RSV) infections?

There is no specific treatment for RSV infection. Most infections go away on their own in a week or two. Over-the-counter pain relievers can help with the fever and pain. However, do not give aspirin to children. And do not give cough medicine to children under four. It is also important to get enough fluids to prevent dehydration.

Some people with severe infection may need to be hospitalized. There, they might get oxygen, a breathing tube, or a ventilator.

Can respiratory syncytial virus (RSV) infections be prevented?

There are some vaccines to protect against RVS illness. Two of them are for people ages 60 and older. If you are in this age group, talk to your provider about whether an RSV vaccine would be right for you.

There is also a vaccine is for pregnant people. It is given between 32 and 36 weeks of pregnancy. It helps protect their newborn babies from RSV illness for the first 6 months of life.

There are two medicines to help prevent severe RSV illness in babies and young children. These medicines may help prevent severe RSV illness, but they can't cure or treat children who already have RSV. And they cannot prevent an RSV infection. Both medicines are given by injections (shots).

One medicine is given to infants who are younger than 8 months during their first RSV season. This includes infants who are born during RSV season. This medicine may also be given to some children between the ages of 8 and 19 months who are at high risk for severe RSV illness. For example, they might be at high risk because they:

• Were born prematurely
• Have congenital heart disease
• Have chronic lung disease
• Have a weakened immune system

The other medicine is given monthly during RSV season. It is for children under 24 months of age who are at high risk for severe RSV illness.

There are also some steps you can take to lower your risk of getting or spreading an RSV infection, including:

• Washing your hands often with soap and water for at least 20 seconds
• Avoiding touching your face, nose, or mouth with unwashed hands
• Avoiding close contact, such as kissing, shaking hands, and sharing cups and eating utensils, with others if you are sick or they are sick
• Cleaning and disinfecting surfaces that you frequently touch
• Covering coughs and sneezes with a tissue. Then throw away the tissue and wash your hands
• Staying home when sick

What is respiratory failure?

Respiratory failure is a condition in which your blood doesn't have enough oxygen or has too much carbon dioxide. Sometimes you can have both problems.

When you breathe, your lungs take in oxygen. The oxygen passes into your blood, which carries it to your organs. Your organs, such as your heart and brain, need this oxygen-rich blood to work well.

Another part of breathing is removing the carbon dioxide from the blood and breathing it out. Having too much carbon dioxide in your blood can harm your organs.

What causes respiratory failure?

Conditions that affect your breathing can cause respiratory failure. These conditions may affect the muscles, nerves, bones, or tissues that support breathing. Or they may affect the lungs directly. These conditions include:

• Diseases that affect the lungs, such as COPD (chronic obstructive pulmonary disease), cystic fibrosis, pneumonia, pulmonary embolism, and COVID-19
• Conditions that affect the nerves and muscles that control breathing, such as amyotrophic lateral sclerosis (ALS), muscular dystrophy, spinal cord injuries, and stroke
• Problems with the spine, such as scoliosis (a curve in the spine). They can affect the bones and muscles used for breathing.
• Damage to the tissues and ribs around the lungs. An injury to the chest can cause this damage.
• Drug or alcohol overdose
• Inhalation injuries, such as from inhaling smoke (from fires) or harmful fumes

What are the symptoms of respiratory failure?

The symptoms of respiratory failure depend on the cause and the levels of oxygen and carbon dioxide in your blood.

A low oxygen level in the blood can cause shortness of breath and air hunger (the feeling that you can't breathe in enough air). Your skin, lips, and fingernails may also have a bluish color. A high carbon dioxide level can cause rapid breathing and confusion.

Some people who have respiratory failure may become very sleepy or lose consciousness. They also may have arrhythmia (irregular heartbeat). You may have these symptoms if your brain and heart are not getting enough oxygen.

How is respiratory failure diagnosed?

Your health care provider will diagnose respiratory failure based on:

• Your medical history
• A physical exam, which often includes
  • Listening to your lungs to check for abnormal sounds
  • Listening to your heart to check for arrhythmia
  • Looking for a bluish color on your skin, lips, and fingernails
• Diagnostic tests, such as
  • Pulse oximetry, a small sensor that uses a light to measure how much oxygen is in your blood. The sensor goes on the end of your finger or on your ear.
  • Arterial blood gas test, a test that measures the oxygen and carbon dioxide levels in your blood. The blood sample is taken from an artery, usually in your wrist.

Once you are diagnosed with respiratory failure, your provider will look for what is causing it. Tests for this often include a chest x-ray. If your provider thinks you may have arrhythmia because of the respiratory failure, you may have an EKG (electrocardiogram). This is simple, painless test that detects and records your heart's electrical activity.

What are the treatments for respiratory failure?

Treatment for respiratory failure depends on:

• Whether it is acute (short-term) or chronic (ongoing)
• How severe it is
• What is causing it

Acute respiratory failure can be a medical emergency. You may need treatment in intensive care unit at a hospital. Chronic respiratory failure can often be treated at home. But if your chronic respiratory failure is severe, you might need treatment in a long-term care center.

One of the main goals of treatment is to get oxygen to your lungs and other organs and remove carbon dioxide from your body. Another goal is to treat the cause of the condition. Treatments may include:

• Oxygen therapy, through a nasal cannula (two small plastic tubes that go in your nostrils) or through a mask that fits over your nose and mouth
• Tracheostomy, a surgically-made hole that goes through the front of your neck and into your windpipe. A breathing tube, also called a tracheostomy, or trach tube, is placed in the hole to help you breathe.
• Ventilator, a breathing machine that blows air into your lungs. It also carries carbon dioxide out of your lungs.
• Other breathing treatments, such as noninvasive positive pressure ventilation (NPPV), which uses mild air pressure to keep your airways open while you sleep. Another treatment is a special bed that rocks back and forth, to help you breathe in and out.
• Fluids, often through an intravenous (IV), to improve blood flow throughout your body. They also provide nutrition.
• Medicines for discomfort
• Treatments for the cause of the respiratory failure. These treatments may include medicines and procedures.

If you have respiratory failure, see your health care provider for ongoing medical care. Your provider may suggest pulmonary rehabilitation.

If your respiratory failure is chronic, make sure that you know when and where to get help for your symptoms. You need emergency care if you have severe symptoms, such as trouble catching your breath or talking. You should call your provider if you notice that your symptoms are worsening or if you have new signs and symptoms.

Living with respiratory failure may cause fear, anxiety, depression, and stress. Talk therapy, medicines, and support groups can help you feel better.