Chest and Respiratory Problems

Asthma and Reducing Triggers in Your Home

There are many things in every home that can cause an asthma attack or make asthma worse. These are called triggers. If your asthma attacks are triggered by an allergic reaction, avoid your triggers as much as possible.

Below is a list of common triggers. Make changes based on child’s specific allergies or triggers for asthma attacks.

Tobacco smoke

  • If you smoke, ask your child’s doctor for ways to help you quit. Ask other family members to stop smoking also.
  • If you have to smoke, wear a specific coat or “duster” when outside to smoke. Remove when entering the home.
  • Do not allow smoking in your home, car or around your child.
  • Be sure no one smokes at your child’s day care center.

House dust mites

Many people are allergic to dust mites. Dust mites are tiny bugs that you cannot see. They live in cloth and carpet. Follow the guidelines below to help reduce the number of dust mites your child may encounter in your home.

  • Put your child’s mattress, pillow, and box springs in plastic or vinyl covers that close with a zipper.
  • Remove stuffed animals or toys from your child’s bed.
  • Wash all blankets and bedding once a week in hot water; wipe off once a week then change bedding.
  • Mattress box springs should be covered with plastic, airtight cover.
  • Wipe off furniture and items near your child’s bed once a week with a damp cloth.
  • Do not dust or vacuum while your child is in the room.
  • Remove carpeting if possible, especially from your child’s sleeping area and play area.

Exercise, sports, work and play

  • Your child should be able to be active without symptoms.
  • Ask the doctor about giving your child medicine before exercise to prevent symptoms.
  • Have your child warm up for 5-10 minutes before exercise.
  • Have your child avoid hard work or play outside when pollution or pollen levels are high.

Indoor and outdoor pollens and molds

  • Use half-strength bleach or mold-killing solution to clean bathrooms, kitchens and basements.
  • Ensure shower curtains, refrigerator doors, bathtub and window corners are free of mildew/mold growth.
  • Use air conditioning and keep windows closed, if possible.
  • Use a dehumidifier, if available. Empty the pan daily.
  • Do not use vaporizers.
  • Avoid houseplants. If you have them, change the soil frequently.
  • Do not mow grass or rake the leaves around your child.
  • Repair leaky faucets and pipes or other water leaks.
  • Monitor the pollen count and have your child stay indoors mid-day when the pollen count is high.

Pets

  • Remove the pet from the child’s room at all times.
  • Take asthma medications if you can not avoid visits to family and friends with pets.
  • Wash your pet every week.
  • Choose a pet without fur or feathers.

Cockroaches

  • Keep counters and floors free of food crumbs and keep food and trash in closed containers.
  • Avoid clutter such as piles of papers where cockroaches can hide.
  • Do not use pesticide sprays, foggers or bombs.
  • Use bug spray when your child is out of the house and completely air out the house before they return.
  • Use roach traps in areas that children cannot reach.

Strong odors and sprays

  • Avoid burning wood, incense and scented candles.
  • Avoid strong odors such as perfume, hairspray, paints and cleaning products.

Other triggers

  • Food allergies – Avoid foods your child does not tolerate.
  • Colds/The flu – Have your child get a flu shot each fall.
  • Cold air – Have your child cover his/her nose and mouth with a scarf on cold or windy days.
  • Emotional/Stress – Stressful situations which lead to changes in breathing can make asthma worse
  • Other medicines – Tell your child’s doctor about all the medicines your child takes.

Vocal Cord Paralysis

Vocal cord paralysis is a voice disorder that occurs when one or both of the vocal cords (or vocal folds) do not open or close properly.

The vocal cords are two elastic bands of muscle tissue located in the larynx (voice box) directly above the trachea (windpipe). The vocal cords produce voice when air held in the lungs is released and passed through the closed vocal cords, causing them to vibrate. When a person is not speaking, the vocal cords remain apart to allow the person to breathe.

Vocal cord paralysis may be caused by:

  • Head trauma
  • A neurologic insult such as a stroke
  • A neck injury
  • Lung or thyroid cancer
  • A tumor pressing on a nerve
  • A viral infection

In older people, vocal cord paralysis is a common problem affecting voice production. People with certain neurologic conditions, such as multiple sclerosis or Parkinson’s disease, or people who have had a stroke may experience vocal cord paralysis. In many cases, however, the cause is unknown.

Vocal cord paralysis is a common disorder, and symptoms can range from mild to life threatening. Someone who has vocal cord paralysis often has difficulty swallowing and coughing because food or liquids slip into the trachea and lungs. This happens because the paralyzed cord or cords remain open, leaving the airway passage and the lungs unprotected.

People who have vocal cord paralysis experience abnormal voice changes, changes in voice quality, and discomfort from vocal straining. For example, if only one vocal cord is damaged, the voice is usually hoarse or breathy. Changes in voice quality, such as loss of volume or pitch, may also be noticeable. Damage to both vocal cords, although rare, usually causes people to have difficulty breathing because the air passage to the trachea is blocked.

There are several methods for treating vocal cord paralysis, among them surgery and voice therapy. In some cases, the voice returns without treatment during the first year after damage. For that reason, doctors often delay corrective surgery for at least a year to be sure the voice does not recover spontaneously. During this time, the suggested treatment is usually voice therapy, which may involve exercises to strengthen the vocal cords or improve breath control during speech. Sometimes, a speech-language pathologist must teach patients to talk in different ways. For instance, the therapist might suggest that the patient speak more slowly or consciously open the mouth wider when speaking.

Surgery involves adding bulk to the paralyzed vocal cord or changing its position. The added bulk reduces the space between the vocal cords so the nonparalyzed cord can make closer contact with the paralyzed cord and thus improve the voice.

Treating people who have two paralyzed vocal cords may involve performing a surgical procedure called a tracheotomy to help breathing. In a tracheotomy, an incision is made in the front of the patient’s neck and a breathing tube (tracheotomy tube) is inserted through a hole, called a stoma, into the trachea. Rather than breathing through the nose and mouth, the patient now breathes through the tube. Following surgery, the patient may need therapy with a speech-language pathologist to learn how to care for the breathing tube properly and how to reuse the voice.

Vascular Rings

A vascular ring is a type of congenital lesion where abnormally located blood vessels may cause compression or obstruction of the esophagus or airway. These arteries may be those carrying blood to the body, to the lungs, or both. They are most easily segregated into three main groups:

  • Vascular rings
  • The innominate compression syndrome
  • Pulmonary arterial slings

Vascular rings include a number of anatomic variations of abnormal development of the aortic arch complex resulting in the formation of a ring encircling both the trachea and esophagus.

The aorta originally develops as a series of arches with bilateral symmetry. By the end of the second month of fetal development, parts of the arch complex have regressed leaving the “typical” anatomy of a left aortic arch with three arch branches (innominate, left common carotid, and left subclavian) and a left-sided ductus arteriosus from the proximal left pulmonary artery to the aorta in the general vicinity of the left subclavian artery origin. Virtually all vascular rings can be explained by abnormal regression or persistence of different components of the bilateral aortic arch complex.

The two most common anatomic variants of true vascular rings, occurring in nearly equal frequency, are persistent double aortic arch and right aortic arch with anomalous origin of the left subclavian artery. In the latter, the left-sided ligamentum arteriosum completes the vascular ring as it passes from the left pulmonary artery to the left subclavian artery as it travels abnormally behind the esophagus.

The symptoms seen with vascular rings can be quite varied. Many patients are asymptomatic or have very mild symptoms. They may occasionally be noted in the newborn, but more often are recognized later. Vascular rings diagnosed in patients less than six months of age are often associated with symptoms of airway obstruction, such as stridor (noisy breathing). Worsening of breathing difficulties with feeding or during upper respiratory infections may be seen.

Children with double aortic arch anomalies tend to present earlier than those with right aortic arch variants. Swallowing problems are uncommon in the first months of life while children are on a liquid diet. Choking or swallowing difficulties are more common in older children as the predominant symptoms. Occasionally, a vascular ring is discovered incidentally during evaluation of a seemingly unrelated problem.

Physical examination may help characterize the “noisy breathing” and help differentiate it from other more common problems such as asthma. With a vascular ring, the noisy breathing may be heard both during inspiration and expiration, while in asthma, the noise is mainly at the end of expiration.

Occasionally, physical examination will detect an abnormally weak pulse in an arm or the legs due to narrowing in a part of the anomalous blood vessels. Listening to the chest for murmurs is often included to assess the need for more thorough evaluation for associated cardiac anomalies (which are uncommon).

A chest X-ray is often performed as a part of the initial evaluation, and if the aortic arch appears to be right-sided, a vascular ring should be suspected. The identification of the side of the aortic arch on the plain chest x-ray, though, may be difficult in some children, particularly infants.

Patients with swallowing difficulties should undergo a barium swallow as part of the initial evaluation. This will typically demonstrate abnormal compression of the middle part of the esophagus, characteristic for a vascular ring. A barium study demonstrating classic features of a vascular ring, coupled with a chest x-ray showing a right-sided aortic arch is generally all that is necessary to proceed with operation.

When breathing symptoms predominate, bronchoscopy may be performed which will often demonstrate extrinsic, sometime pulsatile compression of the trachea.

An operation to divide the vascular ring is indicated in all symptomatic cases. Given the low risk associated with surgical division of a vascular ring, it is difficult to recommend continued observation, particularly in younger patients.

The goal of surgical intervention for vascular rings is to convert a restrictive, closed ring into one that is open realizing that there may still be an abnormal course of some of the blood vessels. With the ring open in at least one direction, symptoms related to esophageal and tracheal compression will be relieved.

In most cases the operation is performed using an incision on the left side of the chest, entering between the ribs. In the case of double aortic arch, the left side of the ring (which is usually the smaller side) is divided where it is compressing the esophagus.

With a right aortic arch and anomalous left subclavian artery, the ligamentum arteriosum (a ligament that was a blood vessel during fetal life) is divided between the descending aorta and the pulmonary artery. Hospitalization after surgery is rarely more than a day or two.

Complete relief of symptoms may be noted immediately following the operation, although persistence of some findings is not uncommon. In infants, there may be some degree of tracheomalacia (floppiness of the trachea) associated with the vascular anomaly and persistence of some stridor, particularly during times of great activity or during upper respiratory infections.

Depending on the specific anatomy, division of the ring may still leave either the subclavian artery or a segment of the aorta itself in an abnormal position behind the esophagus. Improvement of swallowing symptoms in such cases may be seen only gradually.

Tuberculosis

Tuberculosis (TB) is a common and often deadly infectious disease caused by various strains of mycobacteria in humans. The slow-growing bacteria that cause TB grow best in areas of the body that have lots of blood and oxygen, which is why it is most often found in the lungs (called pulmonary TB). But TB can also spread to other parts of the body, which is called extrapulmonary TB.

Tuberculosis is either latent or active.

  • Latent TB means that you have the TB bacteria in your body, but your body’s immune system are keeping it from turning into active TB. This means that you don’t have any symptoms of TB right now and can’t spread the disease to others. If you have latent TB, it can become active TB.
  • Active TB means that the TB bacteria are growing and causing symptoms. If your lungs are infected with active TB, it is easy to spread the disease to others.

Pulmonary TB is contagious. It spreads when a person who has active TB breathes out air that has the TB bacteria in it and then another person breathes in the bacteria from the air. An infected person releases even more bacteria when he or she does things like cough or laugh.

If TB is only in other parts of the body (extrapulmonary TB), it does not spread easily to others.

Some people are more likely than others to get TB. This includes people who:

  • Have HIV or another illness that weakens their immune system.
  • Have close contact with someone who has active TB, such as living in the same house as someone who is infected with TB.
  • Care for a patient who has active TB, such as doctors or nurses.
  • Live or work in crowded places such as prisons, nursing homes, or homeless shelters, where other people may have active TB.
  • Have poor access to health care, such as homeless people and migrant farm workers.
  • Abuse drugs or alcohol.
  • Travel to or were born in places where untreated TB is common, such as Latin America, Africa, Asia, Eastern Europe, and Russia.

It is important for people who are at a high risk for getting TB to get tested once or twice every year.

Most of the time when people are first infected with TB, the disease is so mild that they don’t even know they have it. People with latent TB don’t have symptoms unless the disease becomes active.

Symptoms of active TB may include:

  • A cough that brings up thick, cloudy, and sometimes bloody mucus from the lungs (called sputum) for more than 2 weeks.
  • Tiredness and weight loss.
  • Night sweats and a fever.
  • A rapid heartbeat.
  • Swelling in the neck (when lymph nodes in the neck are infected).
  • Shortness of breath and chest pain (in rare cases).

Doctors usually find latent TB by doing a tuberculin skin test. During the skin test, a doctor or nurse will inject TB antigens under your skin. If you have TB bacteria in your body, within 2 days you will get a red bump where the needle went into your skin. The test can’t tell when you became infected with TB or if it can be spread to others.

To find pulmonary TB, doctors test a sample of mucus from the lungs (sputum) to see if there are TB bacteria in it. Doctors sometimes take a chest X-ray to help find pulmonary TB.

To find extrapulmonary TB, doctors can take a sample of tissue (biopsy) to test, do a CT scan, or an MRI.

Treatment is often a success, but it is a long process. It takes about 6 to 9 months to treat TB. Most of the time, doctors combine four antibiotics to treat active TB. It’s important to take the medicine for active TB for at least 6 months. Almost all people are cured following this treatment. If tests still show an active TB infection after 6 months, then treatment continues for another 2 or 3 months.

Most people with latent TB are treated with only one antibiotic that they take for 9 months. This reduces their risk for getting active TB.

TB can only be cured if you take all the doses of your medicine. A doctor or nurse may have to watch you take it to make sure that you never miss a dose and that you take it the proper way. You may have to go to the doctor’s office every day, or a nurse may come to your home or work. This is called direct observational treatment. It helps people follow all of the instructions and keep up with their treatment, which can be complex and take a long time. Cure rates for TB have greatly improved because of this type of treatment.

If active TB is not treated, it can damage your lungs or other organs and can be fatal.

Tonsillitis

Tonsillitis is an infection or inflammation of the tonsils.

The tonsils are balls of lymphatic tissue on both sides of the throat, above and behind the tongue. They are part of the immune system, which helps the body fight infection.

Most often, tonsillitis is caused by a virus. Less often, it is caused by the same bacteria that cause strep throat. In rare cases, a fungus or a parasite can cause it.

Tonsillitis is spread through the air in droplets when an infected person breathes, coughs, or sneezes. You may then become infected after breathing in these droplets or getting them on your skin or on objects that come in contact with your mouth, nose, or eyes.

The main symptom of tonsillitis is a sore throat. The throat and tonsils usually look red and swollen. The tonsils may have spots on them or pus that covers them completely or in patches. Fever is also common.

If you feel like you have a cold, with symptoms such as runny and stuffy nose, sneezing, and coughing, a virus is most likely the cause. If you have a sore throat plus a sudden and severe fever and swollen lymph nodes, but you do not have symptoms of a cold, the infection is more likely caused by bacteria. This means you need to see a doctor and probably need a strep test.

Your doctor may do a rapid strep test along with a throat culture when diagnosing you. These will show whether the tonsillitis is caused by streptococcus bacteria. Your doctor may also ask about past throat infections. If you get tonsillitis often, it may affect the choice of treatment.

Tonsillitis often goes away on its own after 4 to 10 days if it is caused by a virus. Treatment focuses on helping you feel better. You may be able to ease throat pain by:

  • Gargling with salt water
  • Drinking warm tea
  • Taking over-the-counter pain medicine
  • Using other home treatments

If your tonsillitis is caused by strep, you need treatment with antibiotics. Antibiotics can help prevent rare but serious problems caused by strep and can control the spread of infection.

Doctors only advise surgery to remove tonsils (tonsillectomy) when there are serious problems with the tonsils. These include infections that happen again and again, or long-lasting infections that do not get better after treatment and get in the way of daily activities.

Spasmodic Dysphonia

Spasmodic dysphonia is a neurological disorder affecting the voice muscles in the larynx, or voice box. When we speak, air from the lungs is pushed between two elastic structures—called vocal folds or vocal cords—with sufficient pressure to cause them to vibrate, producing voice. In spasmodic dysphonia, the muscles inside the vocal folds experience sudden involuntary movements—called spasms—which interfere with the ability of the folds to vibrate and produce voice.

Spasmodic dysphonia can affect anyone. It is a rare disorder, occurring in roughly one to four people per 100,000 people. The first signs of spasmodic dysphonia are found most often in people between 30 and 50 years of age. It affects women more than men. In some cases, spasmodic dysphonia may run in families.

The cause of spasmodic dysphonia is unknown. In rare cases, psychogenic forms (originating in a person’s mind) of spasmodic dysphonia do exist. However, in most instances, the muscle spasms are caused by abnormal functioning in an area of the brain called the basal ganglia.

Symptoms of spasmodic dysphonia generally develop gradually and with no obvious explanation. Although the risk factors for spasmodic dysphonia have not been identified, the voice symptoms can begin following an upper respiratory infection, injury to the larynx, voice overuse, or stress.

Spasmodic dysphonia causes voice breaks and can give the voice a tight, strained quality. People with spasmodic dysphonia may have occasional breaks in their voice that occur once every few sentences. Usually, however, the disorder is more severe and spasms may occur on every other word, making a person’s speech very difficult for others to understand. At first, symptoms may be mild and occur only occasionally, but they may worsen and become more frequent over time. Spasmodic dysphonia is a chronic condition that continues throughout a person’s life.

The types of spasmodic dysphonia are:

  • Adductor spasmodic dysphonia is the most common form of spasmodic dysphonia. It is characterized by spasms that cause the vocal folds to slam together and stiffen. These spasms make it difficult for the vocal folds to vibrate and produce sounds. Words are often cut off or are difficult to start because of muscle spasms. Therefore, speech may be choppy. The voice of someone with adductor spasmodic dysphonia is commonly described as strained or strangled and full of effort. The spasms are usually absent—and the voice sounds normal—while laughing, crying, or shouting. Stress often makes the muscle spasms more severe.
  • Abductor spasmodic dysphonia is characterized by spasms that cause the vocal folds to open. The vocal folds cannot vibrate when they are open too far. The open position also allows air to escape from the lungs during speech. As a result, the voice often sounds weak and breathy. As with adductor spasmodic dysphonia, the spasms are often absent during activities such as laughing, crying, or shouting.
  • Mixed spasmodic dysphonia, a combination of the above two types, is very rare. Because both the muscles that open and the muscles that close the vocal folds are not working properly, it has features of both adductor and abductor spasmodic dysphonia.

Spasmodic dysphonia may co-occur with other dystonias that cause involuntary and repetitious movement of such muscles as the eyes; face, body, arms, and legs; jaws, lips, and tongue; or neck.

There is currently no cure for spasmodic dysphonia; therefore, treatment can only help reduce its symptoms. The most common treatment for spasmodic dysphonia is the injection of very small amounts of botulinum toxin directly into the affected muscles of the larynx. The toxin weakens muscles by blocking the nerve impulse to the muscle. Botulinum toxin injections generally improve the voice for a period of three to four months, after which the voice symptoms gradually return. Reinjections are necessary to maintain a good speaking voice.

Behavioral therapy (voice therapy) is another form of treatment that may work to reduce symptoms in mild cases. Other people may benefit from psychological counseling to help them accept and live with their voice problem.

In some cases, augmentative and alternative devices can help people with spasmodic dysphonia to communicate more easily. For example, some devices can help amplify a person’s voice in person or over the phone. Special software can be added to a computer or handheld device such as a personal digital assistant (PDA) or cell phone to translate text into synthetic speech.

When more conventional measures have failed, surgery on the larynx may be performed. Long-term benefits and effects of this procedure are unknown.