Pulmonology focuses on diagnosing and treating lung and airway conditions such as asthma, COPD, and pneumonia, as well as overall respiratory health.

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The Language of the Lungs: Symptoms

Symptoms of lung disease are the body’s urgent distress signals, indicating that the vital process of gas exchange is compromised. While some symptoms, like cough, are nonspecific, the pattern, duration, severity, and associated features can provide critical diagnostic clues. At Liv Hospital, we emphasize a detailed symptom history as the first and most crucial step in unraveling the underlying pathology. Ignoring or minimizing these signs often leads to delayed diagnosis and the progression of irreversible damage.

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Dyspnea: The Cardinal Symptom

Shortness of breath, or dyspnea, is the most common, distressing, and life-limiting symptom of lung disease.

  • Acute Dyspnea: Sudden onset suggests acute, potentially life-threatening events like pulmonary embolism, pneumothorax, acute heart failure, or a severe asthma attack.
  • Chronic Dyspnea: Progressive breathlessness that worsens insidiously over months or years is typical of COPD, interstitial lung disease, or pulmonary hypertension. Patients often unconsciously limit their activity to avoid this sensation.
  • Exertional Dyspnea: Breathlessness triggered by physical activity is an early, sensitive sign of limited lung reserve. As the disease progresses, it occurs with minimal effort (like dressing) or even at rest.

Orthopnea: Difficulty breathing when lying flat, often indicating heart failure, diaphragm weakness, or severe obesity hypoventilation syndrome.

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Cough: Productive vs. Non-Productive

    • Chronic Cough: Defined as a cough lasting >8 weeks. In smokers, it strongly suggests chronic bronchitis. In non-smokers, it may indicate asthma (cough-variant), GERD, or upper airway cough syndrome (post-nasal drip).
    • Productive Cough: Bringing up sputum (phlegm). The color, volume, and consistency matter greatly:
    • Purulent (Yellow/Green): Suggests active infection (pneumonia, acute bronchitis) or neutrophil presence (bronchiectasis).
    • Mucoid (Clear/White): Typical of asthma or viral infections.
    • Putrid (Foul-smelling): Strongly indicates anaerobic infection, such as a lung abscess.
    • Tenacious (Sticky): Hard to clear, classically seen in cystic fibrosis or severe asthma.
    Dry Cough: Typical of interstitial lung disease (fibrosis), viral post-infectious cough, or a side effect of ACE inhibitors used for blood pressure

Hemoptysis: A Red Flag

  • Pleuritic Pain: Sharp, stabbing pain that worsens with deep breathing or coughing. It indicates inflammation of the pleura (the lining of the lung), which is commonly seen with pneumonia, pulmonary embolism, or pneumothorax.
  • Chest Tightness: A sensation of band-like constriction or heaviness, classic for asthma or COPD bronchospasm.

Dull Ache: Can be associated with large tumors, mediastinal masses, or chronic pleural effusions.

Systemic and Other Signs

  • Wheezing: High-pitched musical sound during exhalation, indicating narrowed airways (asthma, COPD).
  • Stridor: Harsh, vibrating sound during inhalation, indicating upper airway obstruction (medical emergency).
  • Cyanosis: Blue discoloration of lips or fingernails due to critically low oxygen saturation (hypoxemia).
  • Clubbing: Bulbous enlargement of the fingertips and loss of the nail angle, associated with lung cancer, idiopathic pulmonary fibrosis, and bronchiectasis (but notably not typical of COPD).

Fatigue and Weight Loss: Chronic hypoxia and the massively increased work of breathing burn calories and cause systemic inflammation, leading to muscle wasting (cachexia) and profound exhaustion.

Environmental and Lifestyle Risk Factors

Tobacco Smoke: The Primary Architect

Cigarette smoking is the single most significant preventable risk factor for lung disease globally.

  • Direct Damage: Smoke contains thousands of toxic chemicals that paralyze cilia, increase mucus production, induce oxidative stress, and destroy alveolar walls.
  • Diseases: It is the primary cause of COPD (80-90% of cases) and lung cancer (85% of cases). It also exacerbates asthma and increases susceptibility to respiratory infections.
  • Secondhand Smoke: Passive exposure causes the same diseases in non-smokers, particularly affecting children (asthma, middle ear infections) and spouses of smokers (lung cancer).

Vaping/E-cigarettes: Emerging evidence links vaping to acute lung injury (EVALI) and chronic inflammation (bronchiolitis), though long-term data are still evolving.

Occupational Hazards

Workplace exposures account for a significant fraction of lung diseases, often with long latency periods.

  • Dusts: Silica (miners, sandblasters, construction), coal dust (miners – black lung), asbestos (insulation, shipyards – mesothelioma/asbestosis), and cotton dust (textile workers – byssinosis).
  • Chemicals: Fumes from welding, painting, cleaning, or chemical processing can cause occupational asthma or acute chemical pneumonitis.

Pneumoconiosis: These are specific fibrotic lung diseases caused by the inhalation and deposition of inorganic dusts in the lung tissue.

Environmental Pollutants

    • Outdoor Air Pollution: Fine particulate matter (PM2.5), ozone, and nitrogen oxides from vehicle exhaust and industry irritate the lungs, trigger asthma/COPD exacerbations, and stunt lung growth in children living near busy roadways.
    Indoor Air Pollution: Biomass fuel smoke (wood, dung, coal) used for cooking and heating in poorly ventilated homes is a leading cause of COPD globally, especially in women in developing nations. Radon gas accumulation in basements is a silent, leading cause of lung cancer in non-smokers. Molds, pet dander, and dust mites are potent triggers of allergies.

Genetic and Host Factors

    • Alpha-1 Antitrypsin Deficiency (AATD)

      A genetic condition where the body produces insufficient or defective Alpha-1 Antitrypsin protein, which usually protects the lungs from destructive enzymes released by immune cells. This leads to early-onset emphysema, often in the 30s or 40s, and is severely exacerbated by smoking.

Cystic Fibrosis (CF)

    • An inherited disorder affecting the CFTR gene, causing thick, sticky mucus to clog the airways. This leads to chronic bacterial infections, progressive bronchiectasis, and eventual respiratory failure.

Genetic Susceptibility

      • Asthma: Highly heritable; a family history of atopy (eczema, allergic rhinitis, asthma) is a strong predictor.
      • Lung Cancer: Genetics influence metabolic susceptibility to carcinogens and DNA repair; family history increases risk independent of smoking status.

      Pulmonary Fibrosis: Familial forms exist, often linked to genes maintaining telomere length or surfactant proteins.

Age and Development

Prematurity: Babies born prematurely often have underdeveloped lungs (bronchopulmonary dysplasia), leading to lifelong reduced lung function and a higher risk of COPD.

        • Childhood Infections: Severe viral (RSV, Adenovirus) or bacterial pneumonias in early childhood can permanently damage developing airways, predisposing to COPD in adulthood (the “Barker hypothesis”).

Immune System Status

  • Immunodeficiency: HIV/AIDS, chemotherapy, or post-transplant immunosuppression drastically increases risk for opportunistic infections (Pneumocystis, fungal pneumonias, TB).
  • Autoimmunity: Systemic diseases such as Rheumatoid Arthritis, Scleroderma, or Lupus often affect the lungs, leading to interstitial lung disease, pleural effusions, or pulmonary vascular disease.

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Assoc. Prof. MD. Engin Aynacı Assoc. Prof. MD. Engin Aynacı Pulmonology Overview and Definition
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FREQUENTLY ASKED QUESTIONS

Why does my cough get worse at night?

CT scans use X-rays to create detailed cross-sectional images and are excellent for visualizing kidney stones, detecting tumors, and evaluating traumatic injuries. They are fast and widely available. MRI uses strong magnetic fields and radio waves to produce detailed images of soft tissues, making it superior for staging prostate cancer, evaluating bladder wall invasion, and assessing pelvic floor disorders without ionizing radiation.

Contrast dye, usually iodine-based, is injected into a vein to highlight the blood vessels and urinary tract organs. As the kidneys filter the dye from the blood, it opacifies the urine. This allows the radiologist to see the internal structure of the kidneys, the ureters, and the bladder clearly, revealing blockages, tumors, or structural abnormalities that would be invisible on a non-contrast scan.

Multiparametric MRI is an advanced imaging technique that combines standard anatomical sequences with functional sequences like Diffusion-Weighted Imaging and Dynamic Contrast-Enhanced imaging. This provides a comprehensive assessment of the prostate, allowing doctors to distinguish between benign conditions like BPH and significant prostate cancer, and to guide targeted biopsies.

CT scans do involve exposure to ionizing radiation, which carries a small theoretical risk of cellular damage over time. However, modern CT scanners use dose-modulation technology to minimize this exposure to the lowest level necessary for a diagnostic image. The benefit of an accurate and timely diagnosis for serious urological conditions typically far outweighs the minimal risk of radiation.

Many modern orthopedic implants are MRI-safe, although they may cause some image distortion. However, older pacemakers, defibrillators, and certain metal clips may be unsafe in the strong magnetic field. It is critical to inform the imaging team of any metallic implants so they can verify their safety compatibility or recommend an alternative test like a CT scan.

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