PLEUROPULMONARY & BRONCHIAL INFECTIONS

WHAT IS BRONCHITIS? 


Bronchitis is an inflammation of the lining of your bronchial tubes, which carry air to and from your lungs. People who have bronchitis often cough up thickened mucus, which can be discolored. Bronchitis may be either acute or chronic.

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Often developing from a cold or other respiratory infection, acute bronchitis is very common. Chronic bronchitis, a more serious condition, is a constant irritation or inflammation of the lining of the bronchial tubes, often due to smoking.


Acute bronchitis, also called a chest cold, usually improves within a week to 10 days without lasting effects, although the cough may linger for weeks.

 

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However, if you have repeated bouts of bronchitis, you may have chronic bronchitis, which requires medical attention. Chronic bronchitis is one of the conditions included in chronic obstructive pulmonary disease (COPD).

PNEUMONIA VS. BRONCHITIS

 
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In terms of symptoms, these two diseases may seem very similar. Both cause cough, fever, fatigue, and a heavy feeling in your chest. Bronchitis can sometimes progress to pneumonia.


Despite similarities, the conditions are different. First, bronchitis involves the bronchial tubes, while pneumonia affects the alveoli or the air sacs in the lungs. Second, pneumonia symptoms are usually much worse. In addition, pneumonia can be life-threatening, especially in older people and other vulnerable groups.


If your symptoms do not get better in a week or so, it is best to contact your doctor.

WHAT CAUSES BRONCHITIS?

 

ACUTE BRONCHITIS


Brought on by a viral infection, though it may also be caused by a bacterial infection. 
The most common viral infections causing acute bronchitis are influenza virus- Influenza A and B viruses are most closely associated with winter outbreaks of acute bronchitis in both children and adults because of the high incidence of infection and efficiency of influenza virus to infect and damage bronchiolar cells. 


Rhinovirus, coronaviruses, respiratory syncytial virus, metapneumovirus, and adenovirus are all etiologic agents of acute bronchitis.  
Mycoplasma pneumoniae, C. pneumoniae, and Bordetella pertussis are the bacteria most associated with acute bronchitis, however, fewer than 10% of acute bronchitis cases are caused by these bacteria.  

CHRONIC BRONCHITIS

 
Usually, but not always, caused by smoking tobacco. It can also be caused by exposure to secondhand cigarette smoke, air pollution, dust, or toxic gases. Your risk can be increased by a family history of bronchitis, having asthma and allergies, and having gastroesophageal reflux disease (GERD).

SYMPTOMS

 
  • A cough that is frequent and produces mucus.

  • A lack of energy.

  • A wheezing sound when breathing (may or may not be present).

  • A fever (may or may not be present).

  • Shortness of breath.

TRANSMISSION

 

Acute bronchitis can be contagious because it is usually caused by infection with a virus or bacteria. Chronic bronchitis is not likely to be contagious because it is a condition usually caused by long-term irritation of the airways. 

 

HOW LONG ARE YOU CONTAGIOUS WITH ACUTE BRONCHITIS? 

 

If you have begun taking antibiotics for bronchitis, you usually stop being contagious 24 hours after starting the medication. If you have a viral form of bronchitis, antibiotics will not work. You will be contagious for at least a few days and possibly for as long as a week. 

 

HOW IS BRONCHITIS DIAGNOSED?

 
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  • Our specialists will do a physical examination and take a medical history. They may ask if you have had a cold recently, how long your cough has lasted, and if you produce mucus when you cough.  

  • Chest X-ray. If you have a fever or had one recently, this can help rule out or confirm pneumonia. 

  • Sputum culture. If your symptoms are severe, your doctor might get a sample of the mucus you cough up (sputum). 

  • Spirometry. This is a test of your lung function. It measures how much air your lungs can hold and how quickly you can blow it all out. The test will help our specialists find out whether you have asthma or another breathing problem, along with your bronchitis. 

TREATMENT

 

The treatment for bronchitis depends on what type you have. If you have acute bronchitis, you might not need any treatment. Or you might use over-the-counter drugs that break up mucus or that treat fever or pain. If you have a bacterial infection, your doctor might prescribe antibiotics. 

If you have chronic bronchitis, treatment will be different. Chronic bronchitis, considered to be chronic obstructive pulmonary disease (COPD), is not curable. Symptoms can be treated using a variety of methods, including drugs, oxygen therapy, pulmonary rehabilitation, surgery, or a combination of these. Your healthcare provider might prescribe a mucus clearing device, also called an airway clearance device, to help you bring up mucus easily. 

 

What medications are used to treat chronic bronchitis/COPD? 

Drug classes that may be used to treat chronic bronchitis/COPD include: 

  • Antibiotics to treat worsening coughs, breathlessness, and mucus production caused by infections. 

  • Anti-inflammatory drugs, such as corticosteroids (also called steroids), reduce swelling and mucus output. Steroids can have many different types of side effects, including swelling in feet and hands, mood changes, increased appetite and weight gain, trouble sleeping, and more serious ones such as diabetes, higher risk of infections, osteoporosis, and cataracts.  

  • Bronchodilators to keep muscles around the airways relaxed so that airways stay open. There are long-acting and short-acting bronchodilators. Short-acting products are often called rescue drugs because they act quickly but wear off in a couple of hours. 

  • Combination drugs that contain a mix of steroids and long- or short-acting bronchodilators 


PREVENTION

 

To reduce your risk of bronchitis, follow these tips: 

  • Avoid cigarette smoke. Cigarette smoke increases your risk of chronic bronchitis. 

  • Get vaccinated. Many cases of acute bronchitis result from influenza, a virus. Getting a yearly flu vaccine can help protect you from getting the flu. You may also want to consider vaccination that protects against some types of pneumonia. 

  • Wash your hands. To reduce your risk of catching a viral infection, wash your hands frequently and get in the habit of using alcohol-based hand sanitizers. 

  • Wear a surgical mask. Stay away from or try to reduce your time around things that irritate your airway (nose, throat, and lungs). Irritants can include dust, mold, pet dander, air pollution, smoke, and cleaners. If you have COPD, you might consider wearing a face mask at work if you're exposed to dust or fumes, and when you are going to be among crowds, such as while traveling. 

 
 

COCCIDIOIDOMYCOSIS

(VALLEY FEVER)

 

OVERVIEW

 

Coccidioidomycosis, also known as Valley fever, is caused by the fungus Coccidioides. This fungus is typically found in the soil of hot, dry regions where weather conditions and soil composition promote its growth. 

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The fungi's spores can be stirred into the air by anything that disrupts the soil, such as farming, construction, and wind. It is endemic to parts of Mexico, Central and South America, and the southwestern United States, particularly Arizona and California. There are two fungi species of Coccidioides that cause human disease: Coccidioides immitis is typically found in California while Coccidioides posadasii is found outside of California, especially in Arizona. 

People can get Valley fever by breathing in the microscopic fungal spores from the air, although most people who breathe in the spores don’t get sick. 

Usually, people who get sick with Valley fever will get better on their own within weeks to months, but some people will need antifungal medication. 


If your symptoms last for more than a week, contact our office.
 

Valley fever can progress into meningitis and it is fatal if it is not treated urgently.

SYMPTOMS 

 
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Valley fever is the initial form of coccidioidomycosis infection. This initial, acute illness can develop into a more serious disease, including chronic and disseminated coccidioidomycosis. 


Acute coccidioidomycosis (valley fever)
 

The initial or acute, form of coccidioidomycosis is often mild, with few or no symptoms. Signs and symptoms occur one to three weeks after exposure. They tend to be similar to flu symptoms. Symptoms can range from minor to severe, including: 

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  • Fever

  • Cough

  • Tiredness

  • Shortness of breath

  • Headache

  • Chills

  • Night sweats

  • Joint aches and muscle soreness

  • Red, spotty rash, mainly on lower legs but sometimes on the chest, arms and back

If you do not become ill or have symptoms from valley fever, you may only find out you have been infected later. You may find out when you have a positive skin or blood test or when small areas of residual infection in the lungs (nodules) show up on a routine chest X-ray. The nodules typically do not cause problems, but they can look like cancer on X-rays. 

If you develop symptoms, especially severe ones, the course of the disease is highly variable. It can take months to fully recover. Fatigue and joint aches can last even longer. The disease's severity depends on several factors, including your overall health and the number of fungus spores you inhale. 


Chronic coccidioidomycosis

 

If the initial coccidioidomycosis infection does not completely resolve, it may progress to a chronic form of pneumonia. This complication is most common in people with weakened immune systems. 

Signs and symptoms include: 

  • Low-grade fever 

  • Weight loss 

  • Cough 

  • Chest pain 

  • Blood-tinged sputum (matter discharged during coughing) 

  • Nodules in the lungs 

 

Disseminated coccidioidomycosis

 

The most serious form of the disease, disseminated coccidioidomycosis, is uncommon. It occurs when the infection spreads (disseminates) beyond the lungs to other parts of the body. Most often these parts include the skin, bones, liver, brain, heart, and the membranes that protect the brain and spinal cord (meninges). 

Signs and symptoms of the disseminated disease depend on the body parts affected and may include: 

  • Nodules, ulcers, and skin lesions are more serious than the rash that sometimes occurs with other forms of the disease. 

  • Painful lesions in the skull, spine, or other bones 

  • Painful, swollen joints, especially in the knees or ankles 

  • Meningitis — an infection of the membranes and fluid surrounding the brain and spinal cord. 

 

In extremely rare cases, the fungal spores can enter the skin through a cut, wound, or splinter and cause a skin infection. 


HOW LONG DO SYMPTOMS LAST?

 

The symptoms of Valley fever usually last for a few weeks to a few months.  However, some patients have symptoms that last longer than this, especially if the infection becomes severe. 

Certain groups of people are at higher risk for becoming severely ill. It is difficult to prevent exposure to Coccidioides in areas where it is common in the environment, but people who are at higher risk for severe Valley fever should try to avoid breathing in large amounts of dust if they are in these areas.

RISK AND PREVENTION

 

WHO GETS VALLEY FEVER?

Anyone who lives in or travels to the southwestern United States (Arizona, California, Nevada, New Mexico, Texas, or Utah), or parts of Mexico or Central or South America can get Valley fever. Valley fever can affect people of any age, but it is most common in adults aged 60 and older. Certain groups of people may be at higher risk for developing the severe forms of Valley fever, such as: 

  • People who have weakened immune systems, for example, people who: 

  • Have HIV/AIDS 

  • Have had an organ transplant. 

  • Are taking medications such as corticosteroids or TNF-inhibitors. 

  • Pregnant women 

  • People who have diabetes  

  • People who are Black or Filipino 


IS VALLEY FEVER CONTAGIOUS?

 

No. The fungus that causes valley fever, Coccidioides, cannot spread from the lungs between people or between people and animals. However, in extremely rare instances, a wound infection with Coccidioides can spread Valley fever to someone else, or the infection can be spread through an organ transplant with an infected organ.  

TRAVELING TO AN ENDEMIC AREA 

SHOULD I WORRY ABOUT VALLEY FEVER IF I’M TRAVELING TO AN AREA WHERE THE FUNGUS IS COMMON?  

Valley Fever is common in the Southwestern United States and Northern Mexico. Every year, 150,000 people in the U.S. are infected, and Arizona is home to two-thirds of them.

Estimated areas with coccidioidomycosis (Valley fever)

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These maps show the current estimate of where the fungus that causes coccidioidomycosis (Valley fever) live in the environment in the United States and the world. The fungus is not distributed evenly in the shaded areas, might not be present everywhere in the shaded areas, and can also be outside the shaded areas. Darker shading shows areas where Coccidioides are more likely to live. Diagonal shading shows the potential range of Coccidioides. 


The risk of getting Valley fever is low when traveling to an area where Coccidioides lives in the environment, such as the southwestern United States, Mexico, or Central or South America. Your risk for infection could increase if you will be in a very dusty setting, but even then, the risk is still low. If you have questions about your risk of getting Valley fever while traveling, please call our office.  

I’VE HAD IT BEFORE, COULD I GET IT AGAIN? 

 

Usually not. If you have already had Valley fever; your immune system will most likely protect you from getting it again. Some people can have the infection come back again (a relapse) after getting better the first time, but this is very rare. 


CAN MY PETS GET VALLEY FEVER?

Yes. Pets, particularly dogs, can get Valley fever, but it is not contagious between animals and people. Valley fever in dogs is similar to Valley fever in humans.  Like humans, many dogs that are exposed to Coccidioides never get sick. Dogs that do develop symptoms often have symptoms that include coughing, lack of energy, and weight loss. If you are concerned about your pet’s risk of getting Valley fever or if you think that your pet has Valley fever, please talk to a veterinarian. 

HOW CAN I PREVENT VALLEY FEVER? 

 

It is very difficult to avoid breathing in the fungus Coccidioides in areas where it is common in the environment. People who live in these areas can try to avoid spending time in dusty places as much as possible. People who are at risk for severe Valley fever (such as people who have weakened immune systems, pregnant women, people who have diabetes, or people who are Black or Filipino) may be able to lower their chances of developing the infection by trying to avoid breathing in the fungal spores. 

The following are some common-sense methods that may be helpful to avoid getting Valley fever. It is important to know that although these steps are recommended, they have not been proven to prevent Valley fever. 

  • Try to avoid areas with a lot of dust like construction or excavation sites. If you cannot avoid these areas, wear an N95 respirator (a type of face mask) while you are there. 

  • Stay inside during dust storms and close your windows. 

  • Avoid activities that involve close contact to dirt or dust, including yard work, gardening, and digging. 

  • Use air filtration measures indoors. 

  • Clean skin injuries well with soap and water to reduce the chances of developing a skin infection, especially if the wound was exposed to dirt or dust. 

  • Take preventive antifungal medication if your healthcare provider says you need it. 

 

IS THERE A VACCINE FOR VALLEY FEVER? 

No. Currently, there is no vaccine to prevent Valley fever, but scientists have been trying to make one since the 1960s. Because people who have had valley fever are usually protected from getting it again, a vaccine could make the body’s immune system think that it already had valley fever, which would likely prevent a person from being able to get the infection. 

Scientists have tried several different ways to make a Valley fever vaccine. When one version of the vaccine was tested on humans in the 1980s, it did not provide good protection, and it also caused people to develop side effects such as swelling at the injection site.  Since then, scientists have been looking at ways to make a vaccine with different ingredients that will provide better protection against Valley fever and will not cause side effects. Studies of these new vaccines are ongoing, so it is possible that a vaccine to prevent Valley fever could become available in the future.  

DIAGNOSIS AND TESTING

 
 
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HOW IS VALLEY FEVER DIAGNOSED? 

The incredible board-certified specialists at Apex, rely on your medical and travel history, symptoms, physical examinations, and laboratory tests to diagnose Valley fever. The most common way that our specialists test for Valley fever is by taking a blood sample and sending it to the laboratory to look for Coccidioides antibodies or antigens. 

In addition, our specialists may do imaging tests such as chest x-rays or CT scans of your lungs to look for Valley fever pneumonia. They may also perform a tissue biopsy, in which a small sample of tissue is taken from the body and examined under a microscope. Laboratories may also see if Coccidioides will grow from body fluids or tissues (this is called a culture). 

WHERE CAN I GET TESTED FOR VALLEY FEVER? 

Contact our office, we can order a test for Valley fever.

HOW LONG WILL IT TAKE TO GET MY RESULTS? 

It depends on the type of test. Results from a blood test will usually be available in a few days. If our specialists send a sample to a laboratory to be cultured, the results could take a few days to a couple of weeks. 

SKIN TESTING

A skin test can detect whether you have developed an immune response to the fungus Coccidioides, the cause of Valley fever. This test became available again in the United States in 2014 for the first time since the late 1990s. Your healthcare provider might do this test if you have a history of Valley fever. 

The test involves getting a small injection on the inside of your forearm, similar to a skin test for tuberculosis. If the test is positive, a bump will appear at the injection site. A healthcare provider must examine the injection site two days (48 hours) after the test was given to measure the size of the bump. 

A positive test result means that you have an immune response to Coccidioides because of a past or current Coccidioides infection. Some people with a positive test result have been sick with Valley fever, which can cause a flu-like illness and other symptoms, but many people with a positive test have not had symptoms from the infection. A positive skin test generally means that you are immune to Coccidioides and will not get Valley fever in the future. 

A negative skin test can mean that you have not been exposed to Coccidioides and have not had Valley fever. However, some people may not react to the skin test even though they have had a Coccidioides infection. This is called a false-negative result. False-negative results occur more commonly in people who: 

  • Have had a Coccidioides infection that is recent or severe. 

  • Have a condition or illness that interferes with the skin test results. 

  • Are taking a medication that interferes with the skin test results. 

For more information about skin testing for Valley fever, please contact our office. 


TREATMENT FOR VALLEY FEVER

For many people, the symptoms of Valley fever will go away within a few months without any treatment. Our specialists choose to prescribe antifungal medication for some people to try to reduce the severity of symptoms or prevent the infection from getting worse. Antifungal medication is typically given to people who are at higher risk for developing severe valley fever.  The treatment is usually 3 to 6 months of antifungal medication. People who have severe lung infections or infections that have spread to other parts of the body always need antifungal treatment and may need to stay in the hospital. For these types of infections, the course of treatment is usually longer than 6 months. Valley fever that develops into meningitis is fatal if it is not treated, so lifelong antifungal treatment is necessary for those cases. 

 

STATISTICS

Number of reported Valley fever cases

 
 
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INFLUENZA A vs. INFLUENZA B

 

In a typical year, flu season occurs from fall to early spring — and with it comes sniffling, sneezing, coughing, fatigue, and all the familiar trappings of the flu. 

Influenza viruses that infect humans can be classified into three main groups: A, B, and C. Type A influenza infection can be serious and cause widespread outbreaks and disease. 

Common symptoms of type A infection can be confused with other conditions. While in some milder cases the flu can resolve on its own without significant symptoms, severe cases of type A influenza can be life-threatening. 

Common symptoms of type A infection can be confused with other conditions. While in some milder cases the flu can resolve on its own without significant symptoms, severe cases of type A influenza can be life-threatening.

 

INFLUENZA A SYMPTOMS 

 

Unlike a common cold, the flu typically occurs with a sudden onset of symptoms.

 

Common signs of an influenza infection include: 

  • Coughing 

  • Runny or stuffy nose 

  • Sneezing 

  • Sore throat  

  • Fever  

  • Headache 

  • Fatigue  

  • Chills  

  • Body aches and pains 

Sometimes, influenza A symptoms may resolve on their own. However, if symptoms persist for more than a week without improvement, schedule a visit with our office. 

People who are at high risk for flu complications, such as those who are 65 years old and up or who have weakened immune systems, should seek immediate medical treatment. In rare cases, the flu can be deadly. 

Left untreated, the flu can cause: 

  • Ear infection, diarrhea, nausea, vomiting, dizziness, abdominal pain, chest pain, asthma attack, pneumonia, bronchitis, cardiac issues.  

 

INFLUENZA A vs. INFLUENZA B 

 

Types A and B influenza are the more common forms of this infection, routinely causing seasonal outbreaks. Type C influenza usually only causes mild respiratory infections. 

Type B influenza can be just as severe as type A influenza but is less common throughout the flu season compared to type A. 

Humans are the natural host for type B infection. Type B viruses mutate much slower than type A infections and are categorized by strains, but not subtypes. The B virus strains take longer for their genetic makeup to change than influenza A. This drastically reduces the risk of a widespread pandemic due to type B influenza. 

Type A influenza can be dangerous and is known to cause outbreaks and increase your risk of disease. Unlike a type B infection, type A viruses are categorized by subtypes and strains. Influenza A mutates faster than influenza B, but both viruses are always changing, creating new strains from one flu season to the next. Past flu vaccinations will not prevent infection from a new strain. 

Wild birds are the natural hosts for a type A virus, also called avian flu and bird flu. This infection can also spread to other animals and humans. This, combined with the ability of type A influenza to mutate faster than type B, can cause pandemics. 

TREATMENT 

 

In some cases, influenza A symptoms can clear on their own with ample rest and fluid intake. In other cases, your doctor may prescribe antiviral medication to fight the infection.

These medications, known as neuraminidase inhibitors, reduce the ability of the influenza virus to spread from cell to cell, slowing down the infection process.

Though effective, these medications can cause side effects such as nausea and vomiting. If you begin to experience any of these symptoms or if your condition worsens, stop using the prescription and visit your doctor immediately.

Over-the-counter medication therapy can also ease flu symptoms. Be sure to stay hydrated to loosen mucus in your chest and strengthen your immune system.

 

HOW LONG WILL I BE CONTAGIOUS?

 

If you have the flu, you’re contagious from at least a day before you begin to experience symptoms up to five days after your symptoms begin.

In more severe cases, you could be contagious for even longer after you begin experiencing symptoms. This number can fluctuate if your immune system is weak or undeveloped, specifically in cases of children or older adults.

 

PREVENTION

The best and most efficient way to avoid the flu and prevent spreading it is to get annual flu vaccinations. Each flu shot protects against three to four different influenza viruses within that years’ flu season. Flu vaccination is especially important this season because the flu and coronavirus disease 2019 (COVID-19) cause similar symptoms. Flu vaccination could reduce symptoms that might be confused with those caused by COVID-19. Preventing the flu and reducing the severity of flu illness and hospitalizations could also lessen the number of people needing to stay in the hospital. 

 
 
 
 
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The flu vaccine is available in the following forms:

  • injectable shot

  • high-dose injectable shot (for those over age 65)

  • intradermal shot

  • nasal spray - In recent years, there was concern that the nasal spray vaccine wasn't effective enough against certain types of flu. However, the nasal spray vaccine is expected to be effective in the 2020-2021 season. The nasal spray still isn't recommended for some groups, such as pregnant women, children between 2 and 4 years old with asthma or wheezing, and people who have compromised immune systems.

 

If you have an egg allergy, you can still get a flu vaccine.

 

The more people that get vaccinated against the flu, the less the flu can spread. It also helps with herd immunity, helping to protect those who can’t get the vaccine for medical reasons.

Additional ways to prevent spreading this disease include:

  • washing your hands regularly

  • avoiding large crowds, specifically during a flu outbreak

  • covering your mouth and nose when you cough or sneeze.

  • staying home if you develop a fever and for at least 24 hours after it goes away.

 

OUTLOOK

 

Type A influenza is a contagious viral infection that can cause life-threatening complications if left untreated. While some cases of this infection can improve without prescribed medication, a visit to your doctor is recommended.  

Do NOT self-diagnose your condition. The flu can resemble the common cold but may trigger worsening symptoms. If you think you have contracted influenza, please call our office to discuss treatment.